India is prioritising access to affordable, high-quality healthcare services through recent government policies, reflecting a strong commitment to healthcare accessibility
This essay is part of the series titled: World Health Day 2024: My Health, My Right
India, with its population exceeding 1.4 billion, grapples with a range of health issues spanning from infectious diseases to non-communicable diseases (NCDs), worsened by socio-economic disparities and limited healthcare infrastructure. The country's diverse demographics offer both opportunities and challenges for public health interventions. Factors such as urbanisation, industrialisation, and evolving lifestyles have contributed to a dual-disease burden. Communicable diseases like tuberculosis and malaria persist alongside the increasing prevalence of lifestyle-related conditions such as diabetes and cardiovascular diseases. Moreover, maternal and child health remain pressing concerns, marked by challenges such as malnutrition and insufficient access to healthcare services, especially in rural areas.
The country's diverse demographics offer both opportunities and challenges for public health interventions.
As per World Health Statistics 2023, India's average life expectancy stands at 70.8 years. The National Family Health Survey-5 data indicates that India's Infant Mortality Rate (IMR) was 35 per 1,000 births between 2019 and 2021, only 5.5-percent decrease compared to figures from 2015-16. The persistently high IMR underscores underlying social determinants such as malnutrition, with 35.5 percent of children under five experiencing stunting and 19 percent facing wasting—low-weight-for-height. India's Global Hunger Index ranking deteriorated from 94th in 2020 (among 116 countries) to 111 in 2023 (among 125 countries). The National Cancer Registry Programme has estimated cancer incidence of 100.4 per 100,000 in India for 2022, with projection of 12.5-percent increase by 2025.
On the other hand, diabetes prevalence in India averages at 16.1 percent, higher in men at 16.8 percent and for women at 15.4 percent. In India, one in four adults suffers from hypertension, while obesity affects 44 and 41 percent of males and females respectively. Despite notable shifts in India's top 10 causes of death in the decade leading up to 2019, Non-Communicable Diseases (NCDs) remained a significant contributor. To increase awareness about the risks associated with NCDs, the Ministry of Health and Family Welfare has rolled out the ‘National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases, and Stroke’ and established screening units in primary health centres nationwide. Additionally, India has been an early adopter of the World Health Organization's (WHO) Global Action Plan for Preventing and Controlling Non-communicable Diseases 2013-2020, aiming for a 25 percent reduction in NCDs by 2025.
India's total healthcare expenditure has increased steadily in recent years, reflecting the growing emphasis on healthcare infrastructure, services, and access. According to data from the National Health Accounts 2019-20, India's total healthcare expenditure in the country’s GDP, increased from 1.13 to 1.35 from 2014-15 to 2019-20 respectively as also the government health expenditure share has gone up to 41.4 from 20 percent. The out-of-pocket expenditure has gone down to 47.1 (2019-20) from 62.6 percent (2014-15). The social security expenditure on health has gone up from 5.7 in 2014-15 to 9.4 percent in 2019-20.
The healthcare sector has witnessed significant progress since its inception following the recommendations of the Bhore Committee in 1946.
It is crucial for India to ensure that its population has access to high-quality healthcare services at reasonable costs. The healthcare sector has witnessed significant progress since its inception following the recommendations of the Bhore Committee in 1946. The committee's recommendations established the foundational framework for health planning, subsequently influencing the design of various programs and policies in India.
The Sixth Five Year Plan (1980-85) was shaped by the global initiative “Health for All by 2000 AD.” In 1983, India introduced its inaugural National Health Policy (NHP), with the primary objective of attaining universal healthcare that is both affordable and tailored to the requirements of the populace. In 2002, the finalised NHP document was published, aiming to achieve commendable health standards for the Indian population. It emphasised decentralisation, equity, improved accessibility to healthcare services, and the availability of affordable private healthcare. The National Health Policy 2017 builds upon the advancements made since the previous NHP (2002). It aims to achieve the highest attainable level of health and well-being for all individuals across all age groups by enhancing accessibility, elevating quality, and reducing the expenses associated with healthcare delivery. Moreover, the policy acknowledges the critical significance of the Sustainable Development Goals (SDGs).
The Government of India launched the National Health Mission (NHM) in 2013, integrating both the previously established National Rural Health Mission (NRHM) in 2005 and the newly formed National Urban Health Mission (NUHM) in 2013 into its framework. They are key initiatives aimed at improving healthcare access and quality in rural and urban areas, through strengthening healthcare infrastructure, training healthcare workers, and promoting community participation in health governance. NUHM specifically targets the urban poor and marginalised populations, addressing their unique health needs. The Ministry of Health & Family Welfare introduced the Reproductive, Maternal, Newborn, Child, Adolescent Health and Nutrition (RMNCAH+N) initiative in 2013 to drive essential interventions aimed at decreasing maternal and child morbidity and mortality.
NUHM specifically targets the urban poor and marginalised populations, addressing their unique health needs.
Recognising the close link between sanitation and health outcomes, the Swachh Bharat Mission (SBM) launched in 2014 endeavoured to achieve universal sanitation coverage and eliminate open defecation. Improved sanitation facilities not only prevent infectious diseases but also contribute to overall well-being, particularly among women and children. SBM emphasises behaviour change communication and community mobilisation to foster a culture of cleanliness. In December 2014, Mission Indradhanush (MI) was launched as a response to the issue of low childhood immunization coverage. This mission specifically targeted unvaccinated and partially vaccinated children who had been missed during routine immunisation efforts, with a particular emphasis on reaching those in remote and underserved areas. In 2017, the Intensified Mission Indradhanush was launched and to date 5.46 crore children and 1.32 crore pregnant women have been vaccinated.
Ayushman Bharat Yojana (National Health Protection Mission) 2018 is one of the most ambitious healthcare initiatives globally, aiming to provide financial protection to over 500 million vulnerable individuals through two flagship programmes: Health and Wellness Centers (HWCs) and the Pradhan Mantri Jan Arogya Yojana (PMJAY). HWCs focus on comprehensive primary healthcare services, while PMJAY provides health insurance coverage of up to 5 lakh rupees per family per year, targeting the poorest households.
The POSHAN Abhiyaan, initiated in 2018, aims to combat stunting, undernutrition, aneamia, and low birth weight through a comprehensive approach involving multiple sectors.
Malnutrition remains a significant public health issue in India, especially among women and children. The POSHAN Abhiyaan, initiated in 2018, aims to combat stunting, undernutrition, aneamia, and low birth weight through a comprehensive approach involving multiple sectors. This program is dedicated to promoting optimal feeding practices for infants and young children, improving access to nutritious food, and bolstering healthcare and nutrition services at the grassroot level.
These policies and initiatives underscore India's dedication to enhancing public health by addressing a wide array of health challenges including insufficient funding, uneven allocation of resources, weak governance of health systems and poor access to healthcare services across various demographics. Achieving universal health coverage and tackling the underlying causes of poor health outcomes demand ongoing political commitment, increased investments in healthcare infrastructure and personnel, and enhanced collaboration among government entities, civil society, and private stakeholders.
Shoba Suri is a Senior Fellow at the Observer Research Foundation
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Dr. Shoba Suri is a Senior Fellow with ORFs Health Initiative. Shoba is a nutritionist with experience in community and clinical research. She has worked on nutrition, ...
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