Prerequisites

Before starting with health promotion, the Prerequisites of UHC are as under.

• Develop a health product for health. Health products provide both OPD (Outpatient Disease) and IPD (Inpatient Disease) in terms of primary, secondary, tertiary health care, rehabilitation, and palliative care procedures, treatments, or services equally to all. Every human being has an equal right to enjoy good health without financial hardship.

• The development of new and concrete reforms in the already developed health system is required on a priority basis. Health system means service providers both public and private sector from grass root level like Basic/Rural Health Unit (BHU/RHU) to State Level like Secondary, Tertiary level hospitals, rehabilitation, and palliative care centers,  i.e. its building, accessibility, equipment, 24/7 availability of doctors, paramedic staff and pharmacy. It is suggested that Public sector service providers should be organized/reorganized as autonomous bodies under the shelter of the Government. The Health system is like a distribution channel for the product to launch timely and adequately in the market.
• Accessibility of this health system from grass root level to the state level should be the focus of the Government because poor people do not afford transportation costs to bring patients to the hospital located in far-flung areas. They require at least functional primary healthcare at their doorsteps.
• Assure strict implementation of set standards and procedures in the health system of the public and private sector by the Government to maintain equality in performance. Lack of standards at the grass-root level to state-level service providers dis-hurt the country’s citizens. In turn, they will not give up their traditional way of treatment.
• Eradicate VIP and VVIP culture, especially in developing countries, as every human being has equal rights to live and enjoy good health in society. Therefore, the Government must ensure equality of health service provision from the grassroots level to state-level without discrimination of religion, race, gender, profession, and political party.
• Develop standard KPI (Key Performance Indicator) of measurement as per WHO guidelines for M&E of the health system.
• Cross Monitoring and Evaluation (M&E) of the health system by top-level Higher Commission of experts for transparency, true implementation of set standards and procedures, timely evaluation to assess the achievements of targets, and onward submission of periodically published reports to the higher management of health system as well as Cabinet of the Government. The Constitution of this top-level higher commission of experts may include internal and external resources members.
• Development of the M & E Department across the country for the health system and its reward and punishment must be based on the published reports of the Higher Commission constituted above.

• Development of a standard price catalog or Rate List of each procedure, treatment, or service, for public and private sector service providers including rehabilitation and palliative care centers under UHC, based on strategic purchasing using general practice in terms of diseases ICD. Codes (International Classified Disease Codes).

Sample Format of price catalog or Rate List

• Digital developments and artificial intelligence can support and are a part of UHC. In-house digital development by applying Role-Based Access Control (RBAC) for all operational processes, a health complaint portal, and a management information system (MIS) for stakeholders is a compulsory component or central pillar of UHC.
• Role-Based Access Control (RBAC)

• Create various roles at the database level such as Admin, Supervisor, Service Provider, and Complaint.
• Grant privileges or permission set to each role such as System Privileges, and Object Privileges.
• Assign responsibilities of function relevant to menu navigation to each role.
• Create Users and grant relevant roles to each user.
• It should be deployed centrally as a three-tier model (Database Server -> Web Server -> Client) at a Government-owned Data Center.
• It should be accessed online 24/7 basis across the country.
• Disaster Recovery (DR) should be developed in another location outside of the Data Center i.e. in another secured area of the country.
• Real-time backup should be placed in one of the county’s Foreign Embassies.
• It should be the property of the Government.
• The recommended database is the Oracle database which is a paid version. The other option is the PostgreSQL database which is freeware for such a massive project in terms of the enormous volume of data manipulation.
• A complaint cell must be developed to resolve all complaints well in time for the complainant’s satisfaction.
• Further detailed operation processes may be developed according to the country's standards and prevailing practices.

• The budgetary structure of UHC for developing or bringing reforms in an already developed health system and its operation is as under:
• Development Budget
• The Government may arrange funds from internal resources like taxes and national and international Donors for the development of new or bringing concrete reforms to the already developed health system in the country.
• Operational Budget
• Arrangement of Health Insurance by the Government.
• To ensure each family or member of the family or a combination of both of the total population.
• The claim will be routed to the relevant insurance company wherever the patient will get treatment from any hospital across the country.
• The whole country, including remote and no-go areas, should be geographically divided into different small and large segments/zones.
• The insurance companies should apply for one or many zones to which they qualify according to their financial resources, infrastructure, and human resources. Do not award the whole country to one insurance company to avoid monopolistic and insolvency problems.
• Uniform average premium rate per thousand will be the best option for insurance companies according to the hard and soft areas of the country.
• Develop an adequate national policy for an adult to an adult live donor of liver, kidney, eyes transplants.
• The insurance premium will be paid to insurance companies from UHC Fund, which will be funded regularly by
• Community contributions like the minor amount of entry fee, card processing fee.
• Contribution from Service Providers, Pharmaceutical and Surgical Industries, Medical Laboratories. The contribution from private sector service providers and pharmaceutical and surgical industries and Medical Laboratories is strategic purchasing.
• All types of employees’ medical allowances and medical expenditures of public and private sector organizations may be routed towards the UHC Fund instead of paying employees.
• Merging of Employees Social Security Institution with UHC Fund.
• National and international Donors’ contribution.
• Government contribution from taxes.
• Payment of claims from Insurance Companies to UHC Fund as well as private sector Service Providers accordingly as per the above standard rate list of treatments, procedures, or services.
• Payment of Profit Commission from Insurance Companies to UHC Fund.
• Assume that both parties i.e. Insurance Company and the Client, agree that after every three years, the insurance company will calculate and pay 85% of his profit to the Client after deducting three years' claims and 5% administration charges.

• Any message relating to promotion, prevention, treatment, rehabilitation, and palliative care at a massive level i.e. across the country, may not be possible without media, the internet, and NGOs. Therefore, the following steps are also part of the pre-requisites of UHC.
• Preparation of a subsidized standard rate list for all social, electronic, or print media agencies and NGOs especially media campaigns for UHC so that it may not become a burden on UHC Fund.

• The registration of all media agencies, public or private, and NGOs should abide by the law to prefer health campaigns over commercial ads/work.
• All types of media campaigns should be prepared periodically. Religious preaching is scheduled daily or weekly under the direct supervision of communication experts and their remuneration must be linked with its effectiveness.
• A media team for UHC should comprise IT and communication experts to develop media campaigns, select appropriate- media for specific communities, on-air it through media agencies at an appropriate time, and monitor and evaluate campaigns so that their rewards and punishment may be evaluated on its effectiveness.
• They are approaching notables of the community through NGOs by conducting seminars, conferences, and training sessions. NGOs have a strong network up to the grass-root level of the community and in remote areas of the country. Their remuneration must be based on the campaign's effectiveness and rates must be applied according to the above subsidized standard rate list.

• Rehabilitation of people with chronic diseases, drug addiction, roll back or disability is important for UHC. It is an essential responsibility of the Government to develop or restructure and re-equip the rehabilitation centers across the country from grass root level to the state level and ensure their operations. It is an essential part of the health system.

• Sustainability is one of the essential prerequisites of the UHC scheme because so many above-hectic efforts/works may be rolled back after the change of Government in developing and developed countries.  The new Government may have its agenda and priorities or may politicize it to reduce the vote bank of the previous political party. It is the prime responsibility of the Government that initiates UHC in the country to protect it under Constitutional Law. No Government or authority may roll back the scheme under any country’s circumstances. It cannot advertise for the name, flag, health, or agenda as a human welfare development and get created to increase vote bank or any other political objectives. The existing Government must carry it out only based on humanitarian background, considering equal rights of human beings irrelevant to specific political party members to develop the country's health. Side by side, UHC Fund must become a part of the National Annual Budget of the country as per Government share and assured other parties’ contribution under law. The entitlement of UHC for the beneficiaries may be linked with tax payments, or Utility Bills Payments. In this way, the Government may document the country’s economy and strengthen the tax and utility collection regime.

All the above prerequisites are the homework for adopting this massive project for a country. Upon completing this homework, a country may enter into the implementation phase of UHC that will enable it to achieve the maximum goals of a healthy socio-economic system.

More detail

1. Home
2. Overview
3. Prerequisites
4. Health Promotion
5. Disease Prevention
6. Treatment, Rehabilitation, and Palliative Care