Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Oct 9;89(1):69.
doi: 10.5334/aogh.4120. eCollection 2023.

The Barriers to Universal Health Coverage in India and the Strategies to Address Them: A Key Informant Study

Anuska Kalita  1 , Noah Carton-Rossen  1 , Linju Joseph  2   3 , Deepshikha Chhetri  4   5 , Vikram Patel  1   6
Affiliations

The Barriers to Universal Health Coverage in India and the Strategies to Address Them: A Key Informant Study

Anuska Kalita et al. Ann Glob Health. .

Abstract

Background: India has adopted several policies toward improving access to healthcare and has been an enthusiastic signatory to several global health policies to achieve Universal Health Coverage (UHC). However, despite these policy commitments, there has been limited success in realizing these goals. The COVID-19 pandemic has highlighted the urgent need for health system re-design and amplified the calls for such reforms.

Objectives: We seek to understand the views of a diverse group of policy actors in India to address the following research questions: what are the (i) conceptualizations of UHC, (ii) main barriers to realizing UHC, and (iii) policy strategies to address these barriers.

Data and methods: We collected data through in-depth interviews with 38 policy actors from diverse backgrounds and analyzed using the Framework Method to develop themes both inductively and deductively using the Control Knob Framework of health systems.

Findings: There was congruence in the conceptualization of UHC by policy actors. Quality of care, equity, financial risk protection, and a comprehensive set of services were the most commonly cited features. The lack of a comprehensive systems approach to health policies, inadequate and inefficient health financing mechanisms, and fragmentation between public and private sectors were identified as the main barriers to UHC. Contrasting views about specific strategies, health financing, provider payments, organization of the delivery system, and regulation emerged as the key policy interventions to address these barriers.

Discussion and conclusion: This is the first systematic examination of a diverse set of policy actors' problem analyses and suggestions to advance UHC goals in India. The study underscores the need to recognize the complex and interlinked nature of health system reforms and initiate a departure from path-dependent vertical interventions to bring about transformative change.

Keywords: India; health policy; health system; universal health coverage.

PubMed Disclaimer

Conflict of interest statement

The authors have no competing interests to declare.

Figures

Characteristics of the sample: Respondents by their gender
Figure 1
Characteristics of the sample: Respondents by their gender.
Characteristics of the sample: Respondents by their primary professional affiliations
Figure 2
Characteristics of the sample: Respondents by their primary professional affiliations.
See this image and copyright information in PMC

References

    1. IIPS. National Family Health Survey-5. International Institute for Population Sciences; 2020. https://rchiips.org/nfhs/.
    1. IIPS. National Family Health Survey-1. International Institute for Population Sciences; 1992. https://rchiips.org/nfhs/.
    1. Global Health Observatory. UHC Service Coverage Index. World Health Organization. https://www.who.int/data/gho.
    1. Lozano R, Fullman N, Mumford JE, et al. Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020; 396(10258): 1250–1284. DOI: 10.1016/S0140-6736(20)30750-9 - DOI - PMC - PubMed
    1. Kruk ME, Gage AD, Arsenault C, et al. High-quality health systems in the Sustainable Development Goals era: time for a revolution. Lancet Glob Health. 2018; 6: e1196–e1252. DOI: 10.1016/S2214-109X(18)30386-3 - DOI - PMC - PubMed

Publication types