MAINS Current Affairs includes Progressing Towards Universal Health Coverage & Partners for Multilateralism (P4M)

Health/Governance

1. Progressing Towards Universal Health Coverage

Context: Eight years after the launch of Ayushman Bharat, India continues to move towards the goal of ensuring that every citizen has access to quality and affordable healthcare.

• The programme seeks to strengthen healthcare access across the continuum, from primary healthcare to specialised hospital-based treatment.

About

• The Government launched the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) in 2018.
• Aim: To advance the objective of Universal Health Coverage (UHC) in India.
• It is a public health assurance scheme primarily providing financial protection for secondary and tertiary healthcare.
• It is among the world’s largest publicly funded healthcare initiatives.
• Around 33% of India’s population, representing more than 48.51 crore people, already possess Ayushman cards.

What is Universal Health Coverage?

• Universal Health Coverage (UHC) means ensuring that everyone can access the complete range of necessary, quality health services without being pushed into financial hardship.

Key Components of UHC

• Access to Care: Every individual should be able to obtain essential healthcare services whenever required.
• Quality Healthcare: Services must be effective, safe, appropriate and of adequate quality.
• Financial Protection: People should not experience financial hardship because of healthcare expenditure.
• UHC is based on the principle that health is a universal human right, recognised through international commitments and the Alma-Ata Declaration of 1978, which emphasised comprehensive primary healthcare.

Need for Universal Health Coverage in India

• High Out-of-Pocket Expenditure: A substantial portion of healthcare costs is paid directly by households, which can push economically vulnerable families into financial stress.
• Unequal Access to Healthcare: Rural, tribal and geographically remote regions frequently face shortages of doctors, specialists, diagnostic services and well-equipped hospitals, resulting in regional disparities.
• Large Disease Burden: India simultaneously faces communicable diseases and non-communicable diseases, creating the need for accessible preventive, primary and specialised healthcare.
• Strengthening Preventive and Primary Healthcare: UHC can move the healthcare system beyond costly hospital-centric treatment towards prevention, early diagnosis and primary-level care, thereby reducing pressure on tertiary hospitals.
• Demographic and Epidemiological Transition: Population ageing and the growing incidence of chronic diseases require healthcare systems that can provide long-term, affordable and sustainable care.

Constitutional Basis for UHC

• The Directive Principles of State Policy (DPSPs) contained in Part IV of the Constitution provide an important constitutional foundation for promoting public health.
• Article 39(e): Directs the State to protect the health and strength of workers.
• Article 42: Provides for just and humane conditions of work and maternity relief.
• Article 47: Places a duty upon the State to raise nutrition levels and the standard of living and to improve public health.
• Article 243G: Provides scope for strengthening public health through the functions assigned to Panchayats, while municipalities also have responsibilities relating to public health within the constitutional framework.

Challenges in Adopting UHC in India

• Resource Constraints: Limited public spending on healthcare constrains the capacity to provide comprehensive and high-quality health services across the country.
• Infrastructure Gaps: Several regions, particularly rural and remote areas, continue to lack adequate hospitals, clinics, laboratories and other healthcare infrastructure.
• Healthcare Workforce Shortages: Insufficient availability of doctors, specialists and other trained healthcare personnel—especially in rural areas—creates disparities in both access and quality.
• Fragmented Health System: The coexistence of public and private healthcare providers can result in differences in service quality, affordability and accessibility.
• Centre–State Coordination: Health is a State subject, while major financing mechanisms and flagship health programmes are driven substantially at the national level. This can contribute to variations in implementation and outcomes across States.

Conclusion

• AB-PMJAY expands access to affordable and quality secondary and tertiary healthcare for eligible beneficiaries, while Ayushman Aarogya Mandirs extend comprehensive primary healthcare services closer to communities.
• ABHA (Ayushman Bharat Health Account) provides individuals with a unique digital health identity and facilitates access to their health records across participating healthcare facilities.
• PM-ABHIM strengthens health-system capacity and preparedness by supporting health centres, laboratories and critical-care infrastructure from the grassroots to the district level.
• Together, these initiatives contribute to a continuum of healthcare, connecting primary care, digital health services, hospital-based treatment and resilient health infrastructure—key elements in India’s progression towards Universal Health Coverage.

International Relations

2. Partners for Multilateralism (P4M)

Context: The Partners for Multilateralism (P4M) initiative was launched on the sidelines of the 81st UN General Assembly.

• Australia, Barbados, Brazil, Canada, the European Union, India and Kenya were the initial co-sponsors of the initiative.

What is Partners for Multilateralism (P4M)?

• Partners for Multilateralism (P4M) is designed as an open and flexible platform that brings together countries from different regions and political systems that support:
  • International law;
  • Multilateral cooperation;
  • Peace; and
  • Inclusive and sustainable prosperity.
• The initiative is based on the recognition that contemporary global challenges cannot be effectively managed by individual countries acting independently.
• Issues such as armed conflicts, climate change, pandemics, artificial intelligence, economic insecurity and disruptions in global supply chains require collective international responses.
• Unlike a formal military or political alliance, P4M is intended to function as a network for dialogue, coalition-building and practical cooperation.
• Its membership remains open to participation by additional countries.

Reasons for Formation of P4M

1. Fragmentation of the International Order

• The post-World War II multilateral system is facing increasing pressure from:
  • Geopolitical rivalries;
  • Unilateral actions;
  • Protectionist policies;
  • Armed conflicts;
  • Sanctions; and
  • Erosion of respect for international norms.
• Existing institutions established largely during the post-1945 period do not fully correspond to the contemporary distribution of economic, demographic and political power.

2. Demand for Greater Representation

• Developing countries increasingly seek a greater role in global decision-making institutions such as:
  • UN Security Council;
  • IMF;
  • World Bank; and
  • The global trading system.

3. Transnational Nature of Global Challenges

• Challenges including climate change, global health emergencies, AI governance, cyber risks, financial instability and supply-chain disruptions cross national boundaries.
• This creates the need for stronger multilateral mechanisms capable of delivering global public goods and coordinated international responses.

Objectives of P4M

1. Reform of Multilateral Institutions

• P4M seeks to make international institutions more representative, effective and accountable.
• The declaration supports initiatives such as UN80, aimed at reforming and strengthening the United Nations system.

2. Upholding International Law

• Members reaffirm fundamental principles of international relations, including:
  • Sovereign equality of states;
  • Territorial integrity;
  • Peaceful settlement of disputes; and
  • Prohibition of the threat or use of force.

3. Strengthening Economic Cooperation

• P4M promotes:
  • More resilient and diversified global supply chains;
  • Reform of the multilateral trading system; and
  • Improvements in the international financial architecture.

4. Cooperation on Emerging Technologies

• Artificial Intelligence and digital transformation are identified as areas where greater international coordination is required.
• The platform seeks to encourage cooperation on emerging technological challenges and opportunities.

5. Promoting Sustainable Development

• P4M connects multilateral cooperation with broader global development objectives, including:
  • Paris Agreement;
  • Sustainable Development Goals (SDGs);
  • Global health;
  • Climate action; and
  • Poverty reduction.

India’s Role and Relevance

1. Advancing Reformed Multilateralism

• India has consistently advocated reformed and more representative multilateral institutions, particularly greater representation for developing countries in global decision-making.
• P4M complements India’s engagement with platforms such as:
  • G20;
  • BRICS;
  • G4; and
  • Non-Aligned Movement (NAM).

2. Greater Voice for the Global South

• India can utilise P4M to highlight concerns of developing countries relating to:
  • Development finance;
  • Food security;
  • Energy security;
  • Access to technology;
  • Climate justice; and
  • Reform of international institutions.

3. Strategic Autonomy

• P4M provides India with an additional diplomatic platform for cooperation without requiring alignment with any single major-power bloc.
• This is consistent with India’s broader approach of maintaining flexibility in its external partnerships while engaging with multiple international groupings.

What are the Challenges?

1. Divergent National Interests

• Participating countries have different:
  • Economic structures;
  • Strategic priorities;
  • Foreign-policy interests; and
  • Relationships with major powers.
• These differences could make consensus-building difficult.

2. Risk of Forum Proliferation

• The global governance landscape already contains numerous institutions, coalitions and dialogue platforms.
• P4M could face difficulties in establishing a clearly differentiated role amid this overlapping institutional architecture.

3. Limited Enforcement Capacity

• P4M is not a treaty-based security alliance.
• It does not possess independent enforcement mechanisms, limiting its ability to compel members to implement collective decisions.

Way Ahead

• P4M should remain open, inclusive and strategically broad-based, allowing participation from countries representing different regions and political systems.
• Developing countries should receive a stronger voice within the multilateral reform agenda.
• Their concerns relating to development, financing, technology access, food and energy security and climate-related challenges should be meaningfully incorporated.
• The initiative should focus on practical cooperation and coalition-building rather than creating another purely declaratory forum.

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