Page 218 - India Insurance Report 2023- BIMTECH

206 India Insurance Report - Series II

The VI( sixth) declaration of Alma–Ata states that “Primary health care is essential health care based on
practical, scientifically sound and socially acceptable methods and technology made universally accessible to
individuals and families in the community through their full participation and at a cost that the community
and country can afford to maintain at every stage of their development in the spirit of self-reliance and self-
determination (World Health Organisation, 1978) It forms an integral part of the country’s health system,
the central function and main focus, and the community’s overall social and economic development. It is the
first level of contact of individuals, the family and the community with the national health system, bringing
health care as close as possible to where people live and work. It constitutes the first element of a continuing
health care process.” We find community participation in the spirit of self-reliance and self-determination is
the driver of the primary healthcare movement. Community participation has to be the real enabler if a
country wants to move towards universal coverage with preventive and promotive healthcare orientation.
The healthcare delivery structure has to be built around and with community participation. PHC-reliant
health system entails an overarching approach to the organization and operation of health systems that makes
the right of the highest attainable level of health its main goal while maximizing equity and solidarity. Such a
system is guided by the principles of responsiveness to people’s health needs, quality orientation, government
accountability, social justice, sustainability, participation, and intersectionality (Montenegro and Etienne,
2007). The need for vibrant Primary care is felt more as the availability of good medical care tends to vary
inversely with the needs of the population served. This inverse care law operates more completely where
medical care is most exposed to market forces and less where such exposure is reduced (Hart,1971).

The need for a PHC is further accentuated by the fact that COVID alone accounted for 1014 years
of totally lost life and eight median years of life with disability per 100,000 person-years, as per Singhet
al.(2022). Therefore, the total Disability-Adjusted Life Years (DALYs) has been 1022 years per 100,000
person years in 2020. The absolute Disability-Adjusted Life Years (DALYs) exceeded 14 million in 2020
in India due to COVID-19. In India, a total of four hundred sixty-eight million DALYs in 2019 show the
intensity of the disease burden (Singh et al., 2022).

5. The Need for Two-Tier Healthcare

The public and private health sectors complement each other’s work worldwide. There is, however,
considerable variation in collaboration between the two from country to country. The concern worldwide
is that there should be equality of care. All citizens can access healthcare without any discrimination. In
India, it is a fundamental right, as explained above, and the government is committed to providing healthcare
to all its citizens. Healthcare access in Canada is primarily based on need and not the ability to pay. Canada’s
single-payer model suffers from “mediocrity’’. Most Canadians want a two-tier system to flourish. Historically,
the fight between Single-Payer and Multi-Payer Financing systems dates back to 1960 when the province of
Saskatchewan implemented universal medical coverage on a single-payer design. In a single-payer system,
the government finances health care. But often, the health care services are delivered by private healthcare
providers - different from the state-owned and -operated healthcare providers (Tuohy et al.,2009).

The National Health Service (NHS) by the British government is also based on a single-payer design
but is different from the Canadian model. In NHS, the government arranged people’s health care expenses
through publicly owned hospitals.