India, Aug. 25 -- Assured health care is indeed vital for human development of individuals and economic development of nations. It must span a wide range of services - from health promotion and disease prevention to prompt detection of health disorders and early implementation of effective interventions to reduce risk and restore health. It must extend to rehabilitation services and palliative care where needed. Focus must be both on extending life expectancy (lifespan) and enabling people to live in good health till the end of a full and fulfilled life (health span). This will enable all individuals to be productive to their full potential, while ensuring a prosperous nation. Health of each Indian, across the entire life course, will be the engine that will propel our journey to Viksit Bharat by 2047. But, as RSS chief Mohan Bhagwat recently pointed out, these services are not assuredly available to all persons in India. Speaking at the inauguration of Arogya Kendra and Cancer Care Centre in Indore, Bhagwat said, "Healthcare and education are among the most important things for a person, and both are beyond the reach of the common man in the present times." Barriers of availability, access, cost and quality deter many persons from seeking needed healthcare (foregone care) or land them in poverty due to unaffordable "out of pocket" expenditure on chronic outpatient care or unforeseen catastrophic expenditure on hospitalised care. The Ayushman Bharat programme is working towards strengthening primary care through a network of health and wellness centres. It also offers financial protection for hospitalised care through the Pradhan Mantri Jan Arogya Yojana (PMJAY). However, the programme faces challenges of health system capacity, capability and governance in several parts of the country. India's federal structure and constitutional assignment of separate roles to the Union and state governments call for coherence in the design and delivery of health care. India's health services are also heavily dependent on the private sector. In a mixed health system that has grown not by design but by default, the heterogenous private sector extends from individual practitioners and family-run nursing homes to single specialty tertiary care centres and multi-speciality corporate hospitals. The voluntary sector exists in scattered patches of charitable hospitals. Some of them are advanced centres operating in a cross-subsidisation mode to make rich patients partly pay for poor patients. However, the weakly regulated private sector often imposes costs that are unaffordable for the common man. It is also limited in presence in rural areas and small towns of many states. To overcome the barriers to universal health coverage (UHC), we need to stimulate the public sector to be more responsive (by enhancing capacity and efficiency), the private sector to be more responsible (by avoiding excessive charges and unnecessary procedures) and the voluntary sector to be more resourceful (by building models of people-partnered public health and community-connected clinical care). The strengths of all three sectors must be drawn upon to create partnerships for public purpose. In each of these, a strong public sector must set goals, identify deliverables, define standards and ensure accountability by each of the partners. Access barriers must be overcome by expanding primary health care infrastructure to reach close to home in both rural and urban locations, providing road connectivity and emergency transport services and utilising robust digital health architecture for efficient tele-health services. Investment in a multi-layered, multi-skilled health workforce is needed, to generate the needed numbers across diverse categories and create teams that are customised for public health and clinical care services, while ensuring fair distribution across all districts and urban-rural settings. Technology enabled non-physician healthcare providers can provide much of primary care and reduce referral load for secondary and tertiary care centres. Pluralistic medical care and healing systems must be promoted, with appropriate delineation of roles and adequate resource allocation to allopathic and traditional systems of medicine. This endeavour requires greater funding for health in both state and Union budgets. Government spending on health must progressively rise to 3% of GDP, while keeping out of pocket health expenditure below 20% of all health care related expenditure. The package of essential health services covered by UHC's benefit package should be progressively expanded as more resources accrue over time and revised whenever demographic and epidemiological transitions bring forth fresh priorities for health care. Gaps in insurance coverage under PMJAY must be bridged. Equity has to remain at the heart of the design and delivery of health services. While horizontal equity provides a common set of services to all, vertical equity must ensure allocation of greater resources or provision of additional services to population groups who have experienced health inequities in the past. Early benefits can be provided through pooled public procurement of essential medicines and vaccines at state level followed by free distribution in public health care facilities. Essential diagnostic services too have to be provided free of cost in such facilities. The private health care sector can also use pooled consortia purchases to lower costs for patients. Jan Aushadhi stores should provide inexpensive options for direct patient purchase. Disconnects that exist between primary care (National Health Mission) and PMJAY (National Health Authority) must be removed to create models of integrated care. Other disconnects (between public and private systems, allopathic and traditional systems) must also be negotiated to create an effective, equitable, empathetic, and economically viable health system....