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INDIA - Himachal Pradesh

India’s goal of achieving UHC by 2030 is ambitious for such a populous and varied country, but it has the technical expertise and other strengths to achieve it.

So far, the country’s UHC service coverage is 61% – approximately double the coverage of two decades ago (31%). But there are significant differences between states and widespread challenges to further progress, including funding, efficiency and staffing issues.

Health financing remains one of the biggest obstacles. Despite the scale and growth of the country’s economy, India spends just 2.96% of its GDP on health, substantially below the average for low-income countries (4.99%) and sub-Saharan Africa (4.92%). As a result, the country’s out-of-pocket-expenditure on health is one of the highest in the world. According to one study, over 63 million people are pushed into poverty every year due to health care costs.

To address this problem, the Government of India introduced the Pradhan Mantri – Jan Arogya Yojana (PM-JAY) insurance scheme in 2018, as part of the Ayushman Bharat initiative. This includes establishing 150,000 Health and Wellness Centres across the country and annual inpatient cover of 500,000 rupees (USD 7,210) per family for 107 million families (more than 500 million people) for most of the secondary and tertiary care conditions. This makes the scheme the largest fully Government-funded health insurance programme in the world.

 

 

UHC Indicators

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UHC service coverage index: 61%

Physicians per 1,000 population: 0.7

Catastrophic expenditure: 17.3%

L4UHC Support

Start Date

2023

Type of Support

  • L4UHC Modules
  • Collective Action Initiatives
  • National coach
  • National Health Mission Kerala
  • State Health Agency Kerala
  • National Health Authority
  • National Health Authority Telangana
  • State Health Agency Jammu Kashmir
  • Employee’s State Insurance Corporation

  • German Development Cooperation

  • World Bank

  • US Agency for International Development

  • World Health Organization

  • Amit Paliwal (GIZ)

Ongoing Collective Action Initiatives

The programme has brought together a variety of key stakeholders for advancing UHC from three states (Himachal Pradesh, Kerala and Punjab), the union territory of Jammu & Kashmir, and the National Health Authority (NHA). Each of the five teams is currently assessing which Collective Action Initiatives to focus on. 

The completed CAIs are listed below:

Completed Collective Action Initiatives

Objectives

Reduce the number of inactive HIMCARE membership cards by 50% in four districts (Bilasurp, Solan, Sirmaur and Shimla), from 159,000 to 80,000, by 1 April 2024.

Results

  • Coalition issued 30,600 insurance cards, reducing the number of inactive HIMCARE membership cards from 159,000 to 128,400, representing a 20% achievement of their goal. The coalition is struggling to focus on project given the HIMCARE system has collapsed financially, and the repercussions are distracting leadership from the CAI.

Timeline

November 2023
National module in Goa
Module
November 2023
August 2023
Sensing journey reflection
Virtual Workshop
August 2023
April 2023
National module in Goa
Module
April 2023