The Universal Health Coverage (UHC) pilot project launched in three rural blocks in Tamil Nadu in early 2017 has brought out significant increase in access to primary care at health sub-centres (HSCs), according to a survey report by the IIT Madras.
 
After implementation of the UHC pilot, participation of rural population in the HSCs has scaled up and dependence on private hospitals has fallen drastically. Besides, it reduced the out-of-pocket expenditure of the patient, as also the cost of care incurred by the government, says the survey.
 
The pilot project was launched in three blocks in three districts, such as Shoolagiri block of the health unit district (HUD) of Krishnagiri, Viralimalai block of Pudukkottai HUD and Veppur block Perambalur HUD. The state has total 39 health unit districts.
 
A close to one-year survey was carried out by the Centre for Technology and Policy of the Department of Humanities and Social Sciences, Indian Institute of Technology Madras (IIT Madras). The survey study was titled, 'Universal Health Coverage-Pilot in Tamil Nadu-- has it delivered what was expected?' The report of the survey was submitted to the government last month.
 
According to the report, presently, the HSCs account for 18% of all out-patients (OP) in Shoolagiri block, 15% of all OPs in Viralimalai block and 23.1% in Veppur block. Before launching the UHC pilot, these three blocks accounted for less than 1% of all OPs. In the month of December 2017, the OP attendance in all the 75 HSCs in the three blocks steadily increased and each sub-centre served 10 out-patients per day in Shoolagiri block, 13 outpatients per day in Viralimalai block and 10 outpatients in Veppur. All these centres were having less than 3 outpatients per day in July 2017, but in December each block under UHC-pilot catered to more than 7,000 patients.
 
Further, it shows that there is significant fall in the share of private hospitals for OP care. Attendance in private institutions has reduced from 51% to 21% in Shoolagiri block, from 48% to 24.2% in Viralimalai block and from 41% to 24% in Veppur block. The out-of-pocket expenditure for those seeking care from any public facility has also decreased drastically.
 
The state health ministry launched the union government’s ambitious project as pilot in three blocks with an objective to boost community participation in rural health services and improve the health outcomes and wellness of all the people in the country. The scheme envisages that by strengthening sub-centers, access to primary care can be increased and thereby to build a public health system which will lead to measurable improvements in health outcomes.

 “Health sub-centres, which are the closest delivery points to the community, have logically become the building blocks of the UHC in the state. These tail end facilities have been the weakest link in the entire edifice of public healthcare delivery system, and therefore, from equity perspective, it is logical to first strengthen these facilities providing basic primary care services. The steps taken by the government by launching the scheme showed definite signs of progress”, said a person of the survey team.