Urgent measures to address the Health Crisis in India

 Based on the discussion above, the following steps are urgent and necessary: Act on the Social Determinants of Health: This would include promotion of food security by universalisation and expansion of the Public Distribution System. It would also include providing safe drinking water, sanitation facilities, full employment to all, education for all and decent and adequate housing. Address the Gender dimensions of Health: Guarantee comprehensive, accessible, quality health services for all women for all their health needs which includes but is not limited to maternal care. Abolish all coercive laws, policies and practices that violate the reproductive, sexual and democratic rights of women, including coercive family planning measures. Immediately reverse Caste Based Discrimination: Take immediate and effective steps to entirely reverse all forms of caste based discrimination, which is one of the most important social determinants of ill health. Immediate ban on manual scavenging should be implemented. Enact a Right to Health Act which assures universal access to good quality and comprehensive health care for all for the entire range of primary, secondary and tertiary services, and that makes denial or non-availabilityfor reasons of access, affordability or quality a justiciable offence. Increase Public Expenditure on Health to 3.6% of GDP annually (Rs 3000/- per capita at current rates) with the central government’s contribution being at least 1% of GDP (Rs 1000/- per capita). All public health expenditure to be tax financed. Progressively increase public health expenditure of the government to at least 5% of GDP. Ensure quality and assured availability of health care: Quality of care to be ensured in all health facilities. Public health facilities to be entirely free of user fees and the entire range of services to be provided directly by government run facilities and not through Public Private Partnerships (PPPs). Stop both Active and Passive Privatization of health care services: Necessary measures to stop active privatization in the form of transfer of public resources or assets to the private sector. Measures to stop passive privatization (where private facilities fill the gap left by inadequate public facilities) by increasing investment in public health facilities. Training of Health workforce: Increase public investment in education and training of the entire range of health personnel. Ensure that government run colleges to train a range of health workers, nurses and doctors are located in areas where they are needed most.

Well Governed, Adequate Public Health Workforce: Create adequate posts for the entire range of health personnel in the public health system. Regularize contractual employees and provide ASHAs, ANMs and all levels of public health system staff with adequate skills, salaries, and decent working conditions. Secure access to quality assured essential medicines and diagnostic services in all public health facilities, free of charge.

Reverse Exploitation by private hospitals practitioners: The national Clinical Establishment Act should have provisions for: observance of patient's rights in all clinical establishments; regulation of the rates of various services; and elimination of kickbacks for prescriptions, diagnostics and referrals. Absorb, over a period, existing publicly funded health insurance schemes (RSBY and different state health insurance schemes) into an expanded public health system publicly financed through general taxation. Ensure access to essential and safe Drugs & Devices: Costbased price-control of all medicines need to be re-established. Measures are also necessary to ensure banning of all irrational medicines and irrational combinations.

Access to medicines

Access to essential medicines is an integral, and often crucial, component of health care. The World Medicine Report of the World Health Organization finds that India is the country with the largest number of people (649 million) without access to essential medicines. Given that India today is one of the largest producers of drugs (by volume) in the world and exports medicines to over 200 countries, this is clearly an unacceptable situation. In an ideal situation all medicines that are researched and marketed should enhance therapeutic goals and should be available to all those who require these medicines. Unfortunately the actual situation in the medicines market is much more complex. There are several issues that need to be addressed in order to ensure access to all medicines that people need. The drug industry is rapidly transforming with increasing mergers and takeovers by multinational corporations. The government’s new policy of allowing 100% FDI in the drug industry has become an instrument to acquire Indian companies. Without investing anything for manufacturing or establishing any plants the MNCs are capturing the existing Indian drug companies. While this may be in line with the Government’s ‘make in India policy’ (where the only consideration is that companies shift production to India irrespective of ownewrship of the companies involved), it is starting to choke the domestic industry built and nurtured over decades. Medicine costs are the major component of out of pocket expenses that we talked of earlier. Changes in the Drug Price Control order in 2012 have converted the price control of medicines into a cruel joke. Essential drug prices are now fixed on the basis of their price in the market, which is inflated, rather than on actual production costs. Many studies have shown that market prices of drugs are often 10 or even a 100 times that of the production cost
Patients in India are also affected by a huge market, promoted by unethical marketing practices of drug companies, by the marketing of irrational and harmful medicines. Doctors are bribed by companies to prescribe such medicines. Following adverse comments by the Parliamentary Committee on Health the government, in early 2016, issued notifications banning over 300 irrational medicines. The medicines of many large companies, including top selling products of multinational corporations were affected. The major reason why people in India cannot access medicines is that they are forced to buy them from the market. Even public facilities often do not stock all essential medicines and ask patients to buy them. A few state governments have started free medicines schemes to supply all essential medicines free of cost to patients attending public facilities. The schemes are running successfully in a few states, notably Tamilnadu and Rajasthan. However, most states are yet to effectively implement such schemes. Neither has the central government lived up to an earlier promise to support such schemes in all states

Low public spending and Private Sector

Low public spending and consequently high burden of out of pocket expenses Public Spending on health in India is among the lowest in the world - when compared in terms of share of GDP and per capita spending. There were only few countries in the world which spent lesser proportion of GDP on health in 2014 (WHO 2016). Governments in neighbouring countries like Sri Lanka, China, and Nepal could mobilise more resources towards health than what is done in India. Per capita public investment on health in India, is almost at the same level with the average of the low income countries (LICs) and much lower than the average for low middle income countries (LMICs). Countries like Brazil, Thailand, and South Africa which have recently attempted to universalise have stepped up public spending on health to 3-5 % of GDP over the period of a decade or so, while it languishes at around 1% of GDP in India. Box II: Health care Financing Public spending on health as a percentage of GDP is among the lowest in the world (1.1%)
 India is among the most privatized health systems -- out of 100 rupees spend on health more than 70 comes from people’s out-of-pocket expenses (OOPs). Every year some 55 million people are pushed below poverty line - this is more than the population of 177 countries in the world Expenses on medicine alone lead to impoverishment of some 34 million people. During 2004 (latest data available), nearly 30 percent in rural India and 20 percent in urban India who were ill but did not seek care because of financial barrier. Socio-economically deprived groups tend to suffer greater impoverishment due to OOP spending on health care. In the absence of adequate public spending households are forced to buy healthcare services from the market – either in private facilities or through expenses they incur even in public facilities. What people pay directly while accessing care is called ‘Out of Pocket’(OoP) expense. In India the share of OoP in total healthcare spending is around 73% - which is one of the highest in the world. Thus in India, out of every 100 rupee spent on healthcare, the government spends only 27 rupees. Such a subsystem where access to care depends on ability to pay leads to inequality in access, untreated ailments and preventable deaths; and pushes people towards poverty and indebtedness. Numerous studies indicate that the poor in India are often required to borrow and sell off household assets to finance their health-care needs. The burden on OoP is largely on account of outpatient expenses but recently we also see a steep rise in hospitalisation expenses that are borne by patients. Recent National Health Accounts estimates show that the share of OoP has increased to 72.9% of total health expenditure, and public spending .
Growing private sector and expansion of public funded insurance Over the years, as economic policies have slashed expenditure on public services like health and education, dependence on private
sector for healthcare has progressively grown. Dependence of people on private facilities for short duration treatment was higher compared to public services, even in the mid 1980s. By the mid 1990s more than 80% of short duration illnesses were being treated in the private sector. The public sector used to be the main source of care requiring hospitalisation in the mid 1980s. By the mid 1990s there was a reversal in the situation and the private sector became the main source of treatment for hospitalized cases as well. In the next decade or so the spread of private sector got reflected in even greater utilization of private facilities for hospitalisation. By 2004-05 almost 60 per cent of total in-patient care (hospital care) was covered by the private sector
In the past decade a new trend has emerged, led by changes in the government’s overall economic policies and priorities. The involvement of the private sector in providing services while using public funds is being promoted under the guise of improving efficiency in the delivery of health services. This can be seen in the outsourcing of health facilities in states such as Arunachal Pradesh and Karnataka; and outsourcing of various critical services in public hospitals like diagnostics in Bihar and West Bengal. Insurance schemes like the Rashtriya Swasthya Bima Yojana and Arogyasri are another mechanism to pump public funds into the private sector. However, the dreadful implications of this strategy on the public health system, quality of services and access of the poor to health care services is slowly becoming apparent.
Experiences of outsourcing, like of diagnostics in Bihar, has shown that it has led to decreased access to services and even denial of services for the poor, increased out of pocket expenditure and decline in the quality of services. Despite its rapid growth and large size, the private medical sector in India suffers from a wide range of serious problems. It is widely acknowledged that these arise due to its commercial interest to maximize profits, along with an almost complete lack of effective regulation. This has led to a huge urban-rural divide, massive wastage, exploitation due to excessive/irrational medications, and frequent exploitation of patients by overcharging and unnecessary interventions, major variations in quality and overall substandard care, and violation of patients’ rights. This is compounded by the exploitation by the drug industry through manufacturing and sale of irrational medicines and irrational drug combinations, promotion of costly brands, and overpricing. In addition, during the last 20 years there has been proliferation of private medical colleges. Thus overall, barring some centres of excellence, private medical care in India is substandard and unnecessarily costly. There has been a complete failure of regulatory agencies like the Central Drug Standards Control Organisation (CDSCO) and the Medical Council of India, accompanied by a complete lack of self-regulation by professional bodies like the Indian Medical Association (IMA). Despite these known problems related to the private sector, public money is now being pumped into the sector in the name of providing financial protection to the people. There has been an increase in the number of publicly-financed insurance schemes floated by central and state governments, with the stated aim of protecting the poor and the informal sector workers from catastrophic expenditures on health. The Yeshasvini Health Insurance Scheme in Karnataka in 2003 and the Rajiv Aarogyasri Scheme in Andhra Pradesh in 2007 are the precursors to the Rashtriya Swasthya Bima Yojana (RSBY) launched by the Ministry of Labour, in 2007 as a Central scheme. The schemes (state and central)claimed to cover an estimated 302 million people in 2010 -- roughly one-fourth of the population (as we shall see later these claims are inflated). However, in terms of the benefit package available through these insurance schemes, only limited secondary and tertiary level hospitalisation cover is provided (with the exception of the much older  Employees’ State Insurance Scheme (ESIS) and Central Government Health Services (CGHS))

Though these insurance schemes continue to remain popular among policy makers and politicians, evidences suggest that impact on financial protection has been minimal if not detrimental. As per the latest National Sample Survey Organisation Survey on Health and Morbidity (2014) only 13% population is covered under various government funded insurance schemes. Coverage among the poorest sections, in both rural (10.6%) and urban areas (8.6%) is even lowerleaving out huge sections of intended beneficiaries. But what happens to those who are covered and access hospitalisation services? In contrast to what is promised, free care is very rare - only 3 out of 100 hospitalisation cases with coverage receive free care. The actual benefits to those who do of facilities under these schemes is not very high. Data suggest that on an average those who are not covered under any insurance scheme spend around Rs.14,400 for one hospitalization episode compared to the government funded insurance schemes where average cost is Rs.10,900 -- a far cry from the promise that these schemes would provide free care. Thus the poor go to private hospitals, in the hope of free care and end up paying for care that of dubious quality and which may not even be necessary
Government funded insurance schemes cover only a select set of in-patient procedures and surgeries while households spend twothird health expenditure on outpatient care and particularly on medicines. In most states more private than public hospitals have been empanelled for providing services under such insurance schemes. These private facilities are concentrated mainly in cities, with very few in rural, tribal and remote areas. Beneficiaries thus are concentrated in the easier to reach villages and left out in the hard to reach villages or hamlets. Further, these insurance schemes focus on specific treatment procedures rather than on treatment of all illnesses, and therefore conditions treatable at primary level end up being hospitalised (for example, for uncomplicated anemia or diabetes) or transferred to secondary/tertiary levels. This also results in public funds being shifted from primary level care to secondary and tertiary level care, or to private providers. Patients also receive care of bad quality through the insurance schemes. Many unnecessary procedures like hysterectomies (removal of uterus) had been performed by the private sector hospitals in order to benefit from the insurance money; thousands of such instances have been documented in Bihar, Chhattisgarh and Andhra Pradesh. There is no real choice for the beneficiaries in terms of which hospital they can go to; as it is the hospitals that dictate what conditions and which patients they wanted to treat. Thus, while private hospitals ‘cherry pick’ the most profitable conditions/procedures to treat, public hospitals end up treating the more complicated and difficult cases. In rural areas, especially remote places, public facilities are the only ones available. The nest result of public funded insurance is that public money is being transferred to private facilities, thus further depleting the already meager resources available to strengthen public facilities. There is also a continuous demand from the private sector to increase the reimbursement they receive for providing care as part of the insurance schemes. Reports from Chhattisgarh and Andhra Pradesh have shown that RSBY and Arogyashri schemes were facing financial problems as demands from private providers for higher reimbursements had increased and some hospitals had even stopped providing services.
Clearly, commercial and profit motives guide healthcare provision, leading to unnecessary procedures, wastage of resources and no improvement in health outcomes. Their goal clearly is to profit from ill-health. Only a strong public sector can function as an effective check on the vast unregulated private sector, where it is forced to compete for quality of services with the public sector.

Health in India--1

Health in India: 

The story of deep neglect Extreme inequality in access to health care services and the poor living conditions of a majority of the people are responsible for the poor conditions of health in India. While people who can pay are able to receive world class treatment facilities, for most people in India a major illness in the family plunges the family into extreme poverty and destitution. Not only are healthcare facilities out of reach for most people, routine public health measures to protect our people are denied to a majority. India continues to figure among the bottom in global estimates regarding deaths among infants and young children and among pregnant women. India lags behind most countries, including many much poorer than us, even in providing routine immunization to children. India is also currently experiencing a ‘multiple burden of disease’. Several preventable infectious diseases are growing unchecked, nutritionlinked health problems (gross under-nutrition coexisting with a rising trend of obesity) continue to affect millions, while chronic health conditions are rising substantially. Every family in India dreads a medical emergency. When a family member falls ill, we pay from our pocket – often by selling our assets or by borrowing. Thus the poor are either denied care because they cannot bear the expenses or the family gets pushed to further poverty and destitution. As families cope with health shocks the vicious cycle of poverty and ill-health continues. Poor health services in the country  are a tale of deep apathy of successive governments towards the suffering of a majority of the poor and the vulnerable. Those in power have contributed to the systematic neglect of the public health system on one hand and to an aggressive expansion of unaffordable, often unnecessary, unethical and low quality private health services on the other. In this booklet we highlight some of the key issues pertaining to health of millions of Indians and raise some of the key demands for improvement of access to quality health care. Poor Conditions of Health One-fifth of world’s children who die before their fifth birthday are born in India, while the highest number of mothers who die while giving birth are from India. We perform poorly in comparison to most countries in the world, including most developing countries. Even in our region, only two countries lag behind India. See Box 1 to understand how we continue to be one of the worst performing countries in the world as regards healthcare and health outcomes. A survey of 179 countries across the world shows that India is among the least safe countries to be a mother (Save the Children, 2015). High undernourishment prevalent among women in the reproductive age group, coupled with low coverage of care during pregnancy (ante natal care – ANC) make women vulnerable at the time of delivery and lead to complications. Millions of children die every year from preventable diseases because they are not immunized and from hunger and malnutrition. Over one-third of our children do not get enough food, a rate that is comparable or worse than some of the poorest countries in Africa. Children die routinely from common diseases like diarrhea and pneumonia because of lack of access to safe drinking water, lack of sanitary facilities and absence of free public facilities for treatment.

Surveys show that only 68.7 % of women have received three antenatal check-ups, only 26.3% of pregnant women have consumed more than 100 iron and folic tablets and only 61% of children (12 -23 months) have been fully immunized. India ranks 119thof 169 countries in Human Development Index(HDI)

India ranks 140th of 179 countries as the best place to be a mother (State of World’s Mother 2015) India is placed at 67thof 84 countries in Global Hunger Index (GHI) More than a fifth of under five deaths per year, take place in India – the highest anywhere in the world; a majority of these deaths are preventable More than 100 million children under five are undernourished, and 8.5 million suffer from severe acute malnutrition. Only half of children under five receive routine immunisation (National Family Health Survey III) Only about half (52%) of deliveries are safe: (National Rural Health Mission) Only one-third of children having diarrhoea receive ORS (State of the World’s Children, UNICEF, 2011) Pneumonia: 69% taken to hospital and only 13% receive antibiotics (SoWC, 2011) Only half of the pregnant women receive 3 or more check ups before delivery Box 1: Where do we stand in protecting our people’s health? Table 1: A cross country comparison of key health outcomes and outputs

As we can see from Table 1, India fares poorly in comparison to even developing countries, including our immediate neighbours Sri Lanka and Bangladesh. The state of public health is clearly depicted by the fact that we are not able to protect a large number of children from vaccine preventable illnesses. Childhood vaccination is regarded as one of the most cost effective interventions to prevent child deaths. A third of the un-immunized children across the world are in India. Large inequalities in immunization coverage persist in India, across and within states and according to wealth, caste, religion, location etc. Children from the richest wealth group are 2.5 times more likely to be immunized than their poorest counterparts. It is distressing to note that states which had performed well earlier (as per data available in 2005-06) have slipped back over the last ten years, including Tamil Nadu, Haryana, Uttarakhand and Maharashtra (Fig 1). Most significant is the decline in TN. From being among leading states in terms of full immunisation coverage, the state has experienced a dramatic 11.2 percentage point decline. The major reason for stagnation or decline in overall immunisation coverage is decline in coverage in urban areas. Most noteworthy is the decline in Haryana (from 82.2 to 57%), Maharashtra (68 to 55.8), Tamil Nadu (83.7 to 73.3) and Uttarakhand (67.2 to 56.5).

 Health of Women and Girls Discrimination faced women and girls have a lasting and tragic impact on their health status. Data from National Family Health Survey (NFHS) shows that child deaths rates for girls are 61 per cent higher than those for boys after the first month, all the way up through age four. Among 15-19 year olds in the country, complications during pregnancy are the leading cause of death. As many as two out of three adolescent girls living in India’s backward districts have experienced sexual violence. Maternal death rates continue to be very high (at 190/ 100,00 live births, one of the highest rates in the world). Maternal deaths are highest amongst young women, while girls continue to be married off before the legal age of marriage. Too many girls become pregnant before tyhey are old enough and before their bodies are ready for pregnancy. This combined with malnutrition and anemias ensure that young women, many still in their teens, die during pregnancy. Women also continue to die around child birth because health facilities in many parts of the country are not equipped to provide emergency care to them when complications arise, the quality of care during pregnancy available is inadequate, and safe abortion services in the public sector are inaccessible for the majority of women. Quality contraceptive services as are not provided according to what women need. Instead women are targeted for hysterectomies to achieve family planning camps. Horrendous accounts surface periodically of how women are herded into unhygienic and under staffed hysterectomy camps.

The burden of communicable, non-communicable diseases and mental distress is also seen more in women. Sexually transmitted diseases amongst women remain undiagnosed, and when diagnosed can have drastic social consequences for them. Heart attack and stroke are more lethal for women, and depression twice as common. Women over the age of 60 years have greater disability and suffer more from ill health than men of the same age-group, due to delays in or lack of healthseeking, mismatched care provision (as women are under-represented in health care delivery systems and in research, particularly related to chronic diseases).Gender-based violence is extremely high, with as many as 40.3% of women reporting at least one instance of physical abuse. There seems to be an epidemic of sexual violence against women in recent years. Mental and physical consequences of violence against women need to be addressed by the health sector

Neglect of public health system In most countries where people have near universal access to health care, it has been achieved through a well-functioning public health system. Here we may note that while a well functioning system to provide universal access to care is a necessary condition for good health outcomes, it is not sufficient on its own. Good health is a result of better nutrition, safe drinking water and sanitation, universal access to education, gainful employment and equitable and inclusive development, better working and living conditions, control over addictions as well as environmental pollution and an end to various forms of discrimination. Reduction in poverty itself contributes immensely to improved health outcomes. A strong, comprehensive public health system is the most efficient way to provide appropriate health care. It creates a separation between health care needs and people’s ability to pay for healthcare. It also allows much stricter control of health care costs, serves as an effective check on unregulated growth of the private sector and helps prevent unethical practices in the private  sector. However, in India the public health system has experienced continuous neglect, systematic underinvestment, provisioning of a select set of services and a ‘targeted’ approach. The introduction of National Rural Health Mission had introduced some efforts to strengthen public systems for a limited set of services;however recent trends show that there is a reversal already taking place due to cuts in budgets. India’s poor investment in health care translates into a failure to create the necessary health infrastructure, or to build a health workforce, or to ensure availability of necessary equipment, diagnostic facilities and medicines. We are just not adding enough beds in public hospitals or enough doctors and nurses to make public services effective. After the introduction of some public health measures under the NHRM, some improvements did take place. Services of close to 23,000 doctors, 35,000 nurses and 70,000 ANMs and 10,000 management staff were added under the NRHM. However as compared to the government’s own Public Health Standards, this is less than one-third of the total number of public health workforce that is required. Further the terms of engagement of these staff were extremely adverse -- almost all of the additional staff under NHRM is contractual, with remuneration packages often less than half of the regular staff that does the same work, and with no security of tenure. There continue to be substantial shortfalls in the number of SubCentres (SC), Primary Health Centres (PHCs) and Community Health Centres (CHCs) across states. Nationally, there are only 0.16 facilities for every 10,000 persons, and there are approximately 5.5 government beds for every 10,000 persons. Outpatient visits have nearly doubled from 55 per 1,000 persons in 1995-96 to 100.7 per 1,000 in 2014, with more marked increases in urban as compared to rural areas. Inpatient episodes increased nearly three-fold in the same period, from 15 per  1,000 persons in 1995-96 to 44 per 1,000 in 2014. Yet the number of beds in the public sector, per 10,000 population has remained stagnant since the 1980s. For SCs, nearly 21 states had shortfalls ranging from 4.4% in Jammu and Kashmir to 50.6% in Delhi. Uttar Pradesh (33.9%), Jharkhand (34.5%), Meghalaya (46.6%) and Bihar (47.7%) also have high shortfalls in the number of SCs. For PHCs, the states of Uttar Pradesh, Delhi, Bihar, Madhya Pradesh, West Bengal and Jharkhand had shortfalls ranging from 28.6-69.8%. For CHCs, states with shortfalls above 30% included Madhya Pradesh, Maharashtra, West Bengal, Andhra Pradesh, Karnataka, Sikkim, Assam, Tripura, Uttar Pradesh, Bihar and Delhi. Nationally, the shortfall was: SCs, 20.1%; PHCs, 24.1%; and CHCs, 37.9% (GoI, 2011). More than three quarter of Sub-centres (76.4%) do not have any water supply. Piped water is not available in a majority of PHCs (63.3%) and CHCs (54.6%). Almost a third of PHCs (32.5%) do not have a functional labour room for conducting deliveries. Seven out of every ten CHCs (70.9%) do not have regular power supply (Concurrent evaluation, NRHM, 2011). One of the most important reasons for underutilization of primary health care facilities is the lack of the full range of required primary care services. Most sub-centers and PHCs provide little beyond immunization services, some ante-natal care and at best care for normal delivery. Most treatment of chronic illness like hypertension and diabetes is referred away and so is the treatment for most infectious disease except some of those on the national programmes. This would accounts for less than 20% of all health care needs. Along with expansion of infrastructure and filling up vacancies of human resources, quality of care delivered at public health facilities need immediate attention.

World Health Day 2018

World Health Day 2018

World Health Day messages

Universal health coverage is about ensuring all people can get quality health services, where and when they need them, without suffering financial hardship.
No one should have to choose between good health and other life necessities.
UHC is key to people’s and nations’ health and well-being.
UHC is feasible. Some countries have made great progress. Their challenge is to maintain coverage to meet people’s expectations.
All countries will approach UHC in different ways: there is no one size fits all. But every country can do something to advance UHC.
Making health services truly universal requires a shift from designing health systems around diseases and institutions towards health services designed around and for people.
Everyone can play a part in the path to UHC, by taking part in a UHC conversation.
Too many people are currently missing out on health coverage

“Universal” in UHC means “for all”, without discrimination, leaving no one behind. Everyone everywhere has a right to benefit from health services they need without falling into poverty when using them.

Here are some facts and figures about the state of UHC today:

At least half of the world’s people is currently unable to obtain essential health services.
Almost 100 million people are being pushed into extreme poverty, forced to survive on just $1.90 or less a day, because they have to pay for health services out of their own pockets.
Over 800 million people (almost 12 percent of the world’s population) spend at least 10 percent of their household budgets on health expenses for themselves, a sick child or other family member. They incur so-called “catastrophic expenditures”.
Incurring catastrophic expenses for health care is a global problem. In richer countries in Europe, Latin America and parts of Asia, which have achieved high levels of access to health services, increasing numbers of people are spending at least 10 percent of their household budgets on out-of-pocket health expenses.
What UHC is

UHC means that all people and communities receive the health services they need without suffering financial hardship.
UHC enables everyone to access the services that address the most important causes of disease and death and ensures that the quality of those services is good enough to improve the health of the people who receive them.
What UHC is not

UHC does not mean free coverage for all possible health interventions, regardless of the cost, as no country can provide all services free of charge on a sustainable basis.
UHC is not only about ensuring a minimum package of health services, but also about ensuring a progressive expansion of coverage of health services and financial protection as more resources become available.
UHC is not only about medical treatment for individuals, but also includes services for whole populations such as public health campaigns – for example adding fluoride to water or controlling the breeding grounds of mosquitoes that carry viruses that can cause disease.
UHC is not just about health care and financing the health system of a country. It encompasses all components of the health system: systems and healthcare providers that deliver health services to people, health facilities and communications networks, health technologies, information systems, quality assurance mechanisms and governance and legislation.