The George Institute For Global Health
United Kingdom

Key regional disparities notwithstanding India shows improvement in Healthcare access and quality index

A new paper published in the Lancet recently used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in 7 countries, from 1990 to 2016.

The study found that HAQ index has improved in India from 24.7 in 1990 to 41.2 in 2016. However, striking subnational disparities still exist within the country with particularly large gaps between locations with the highest and lowest scores. The country saw a 30·8-point disparity, from 64·8 (59·6–68·8) in Goa to 34·0 (30·3–38·1) in Assam.

Globally, healthcare access and quality, as measured by the HAQ Index, improved from 37.6 in 1990 to 54.4 in 2016, on a scale of 0 to 100. Among countries in the same GBD region as India (South Asia), 2016 HAQ Index scores ranged from 37.6 in Pakistan to 47.6 in Bangladesh. From 2000 to 2016, the global pace of progress accelerated for the HAQ Index, improving by an average of 1.6% per year. From 1990 to 2000, the world saw overall healthcare access and quality improve by an average of 1.2% per year.

For India, HAQ Index performance improved at an average rate of 2.4% per year from 2000 to 2016. Between 1990 and 2000, India recorded, on average, a 1.3% per year gain in healthcare access and quality.

Performance on the HAQ Index showed strong linkages to overall development, with high and high-middle SDI countries generally having higher scores and faster gains for non-communicable diseases. Nonetheless, countries across the development spectrum including India saw substantial gains in some key health service areas from 2000 to 2016, most notably vaccine-preventable diseases. Overall, national performance on the HAQ Index was positively associated with higher levels of total health spending per capita, as well as health systems inputs, but these relationships were quite heterogeneous, particularly among low-to-middle SDI countries.

Despite substantial gains since 2000, many low-SDI and middle-SDI countries face considerable challenges unless heightened policy action and investments focus on advancing access to and quality of health care across key health services, especially non-communicable diseases.

A key component of achieving universal health coverage is ensuring that everyone has access to quality health care. Measuring healthcare access and quality is crucial to track progress and guide decisions and strategies for future improvement.

The study argues that stagnating or minimal improvements experienced by several low-middle to high-middle SDI countries could reflect the complexities of re-orienting both primary and secondary health-care services beyond the more limited foci of the Millennium Development Goals. Alongside initiatives to strengthen public health programmes, the pursuit of universal health coverage hinges upon improving both access and quality worldwide, and thus requires adopting a more comprehensive view—and subsequent provision—of quality health care for all populations.