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A Universal Health Coverage (UHC) pilot project in three rural blocks of Tamil Nadu has significantly improved access to primary care at the sub-centre level, according to a study conducted by IIT-Madras.
It also revealed that the UHC pilot brought about a dramatic fall in the overall dependence on private providers, particularly those seeking care from private hospitals. It also brought about a substantial fall in the out-of-pocket expenditure among those seeking OP care from both public and private providers, according to a statement.
The study, titled Universal Health Coverage-Pilot in Tamil Nadu: Has it delivered what was expected? , was taken up by the Centre for Technology and Policy, Department of Humanities and Social Sciences, IIT-M, and the findings have been submitted to the Department of Health and Family Welfare, Government of Tamil Nadu.
The UHC pilot was launched in early 2017 in the blocks of Shoolagiri (Krishnagiri), Viralimalai (Pudukkottai) and Veppur (Perambalur).
Health sub-centres
Strengthening the primary health care service was the first step in the design and rolling out of UHC pilot. As a result, health sub-centres (HSCs), which are the closest delivery points to the community have logically become the building blocks of the UHC in Tamil Nadu.
After the implementation of the UHC pilot, HSCs now account for 17.8 per cent of all OP (out-patient) cases in Shoolagiri, 14.8 per cent in Viralimalai, and 23.1 per cent in Veppur. HSCs accounted for less than one per cent of all OP cases prior to the pilot.
The share of private hospitals for OP care has dropped significantly from during the pre-UHC pilot period (2015-16) — to 21 per cent from 51 per cent in Shoolagiri; to 24.2 per cent from 47.8 per cent in Viralimalai; and to 23.9 per cent from 40.9 per cent in Veppur.
“This is perhaps the first time that we have a robust survey on both household health-seeking behaviour and facility-based utilisation before and after intervention in public health,” said VR Muraleedharan, Department of Humanities and Social Sciences, IIT-M.
“Evidently, it makes sense to scale up this UHC pilot, as it is cost-effective, and makes the public primary health care delivery system more efficient. The amount saved could well be spent on further strengthening public healthcare delivery system,” pointed out the report.
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