World Health Day 2026 invites us to stand with science. For India, that standing must be structural, built into the architecture of how the health system is organised across sectors and levels of care
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This essay is part of the series: World Health Day 2026: Standing with Science in an Age of Shared Risk
World Health Day 2026 arrives with the theme, “Together for Health. Stand with Science”, whose emphasis on One Health makes it particularly resonant for countries navigating complex, interconnected health challenges. One Health is the recognition that human health, animal health, and environmental health are not parallel domains but deeply interdependent systems: what happens in one reverberates through the others. The science underpinning this recognition is now substantial, and it carries direct implications for how health systems must be organised.
For India, the World Health Day theme offers a timely opportunity to reflect on how the country has responded to this evidence and where further strengthening is needed. This response can be understood along two structural axes. The first is horizontal integration: the coordination of action across sectors, ministries, and disciplines that One Health demands. The second is vertical integration: the functional coherence of the health system across its primary, secondary, and tertiary levels. India has made notable progress on both; the scientific case for deepening that progress is equally clear.
One Health is an integrated, unifying approach that aims to sustainably balance and optimise the health of people, animals, and ecosystems. It is a conceptual framework formulated in response to evidence that siloed sectoral thinking is scientifically untenable. The evidence is threefold.
The launch of the National Action Plan on Antimicrobial Resistance 2.0 in November 2025, developed in alignment with the WHO Global Action Plan on AMR, represents the most explicit expression of this cross-sectoral scientific logic.
First, the zoonotic burden: an estimated 60 percent of all known human infectious diseases are zoonotic in origin, and approximately 75 percent of emerging infectious diseases have crossed from animal reservoirs. COVID-19, Nipah virus, and H5N1 avian influenza are contemporary expressions of a well-documented epidemiological pattern: the boundaries between human and animal health are ecologically permeable.
Second, the climatic dimension: rising temperatures, shifting precipitation patterns, and habitat disruption are expanding the geographical range of vector-borne diseases like dengue, malaria, and chikungunya, and altering the seasonal dynamics of disease transmission in ways that no single sector can address in isolation.
Third, antimicrobial resistance (AMR): the overuse and misuse of antimicrobials across human medicine, veterinary practice, and agriculture have accelerated the emergence of resistant pathogens, whose containment requires coordinated action across domains. The scientific case, in short, is that human health cannot be protected without simultaneously attending to the health of animals and the integrity of ecosystems.
India’s response to this evidence has been substantive in the form of horizontal integration: the coordination of action across sectors, ministries, and disciplines. The launch of the National Action Plan on Antimicrobial Resistance 2.0 in November 2025, developed in alignment with the WHO Global Action Plan on AMR, represents the most explicit expression of this cross-sectoral scientific logic. The plan coordinates action across the Ministries of Health and Family Welfare, Agriculture and Farmers’ Welfare, Fisheries, Animal Husbandry and Dairying, and Environment, Forest and Climate Change. This configuration mirrors the One Health framework in its institutional architecture. Its implementation creates a productive site for shared surveillance and stewardship programmes across sectors.
The National One Health Mission, established to coordinate zoonotic disease surveillance and response across human and animal health systems, reflects a similar recognition that early warning requires integrated data, and that integrated data requires institutional coordination. At the scientific and technical level, this coordination is increasingly embodied in the working relationships between institutions like the Indian Council of Medical Research (ICMR), the National Centre for Disease Control (NCDC), and the National Institute of Virology (NIV), which have progressively deepened their collaboration across disease surveillance, outbreak investigation, and pathogen characterisation. The integration of animal health data from the Department of Animal Husbandry and Dairying into shared surveillance frameworks and the involvement of environmental agencies in vector monitoring further signal the maturing of this architecture into operational practice.
The National One Health Mission, established to coordinate zoonotic disease surveillance and response across human and animal health systems, reflects a similar recognition that early warning requires integrated data, and that integrated data requires institutional coordination.
India’s G20 Presidency in 2023 provided a further impetus for horizontal integration at the multilateral level. The Health Track outcomes on pandemic preparedness, AMR, and digital health continue to shape international discussions, and the Science20 and Health20 engagement groups that India hosted created platforms for scientific communities to shape policy discourse at the highest levels. Further, India’s position as a co-founding member of the Coalition for Epidemic Preparedness Innovations (CEPI), its sustained engagement with WHO norm-setting processes, and the global recognition of its vaccine manufacturing capacity have together positioned it as a consequential partner in science-led international health collaboration, one whose domestic reform agenda and multilateral commitments are increasingly mutually reinforcing. This is what horizontal integration means in practice: an institutional architecture through which scientific evidence crosses sectoral boundaries and is translated into coordinated action. These are meaningful foundations. The opportunity for further strengthening lies in deepening the operational dimensions of this coordination.
If horizontal integration concerns how India coordinates across sectors, vertical integration concerns how the health system functions across its own levels, from the sub-centres and primary health centres at the base, through the community health centres and district hospitals at the secondary level, to the medical colleges and specialised facilities at the tertiary level. Here, too, the scientific evidence is clear.
India’s out-of-pocket expenditure (OOPE) on health stands at approximately 39 percent of total health expenditure. A share of this burden can be attributed to the cumulative cost of a fragmented system: multiple consultations before a diagnosis is reached, repeated investigations because records do not move across levels of care, and avoidable hospitalisations when conditions that could have been managed at the primary level present late at tertiary facilities. The phenomenon of facility bypassing — patients presenting directly at secondary or tertiary facilities for conditions well within the clinical scope of primary care — is well documented in the Indian literature. The result is underutilisation at the primary level and congestion at the tertiary level. This fragmentation has particular implications in a One Health context, which requires a primary care system that is closely linked upward to higher facilities through effective referral pathways and outward to surveillance networks that inform and expand its diagnostic scope.
India’s response to this evidence is expressed in the architecture of the Ayushman Bharat programme, whose components address distinct nodes of the vertical continuum and, taken together, constitute a coherent framework for system-wide integration.
India’s response to this evidence is expressed in the architecture of the Ayushman Bharat programme, whose components address distinct nodes of the vertical continuum and, taken together, constitute a coherent framework for system-wide integration. The Ayushman Arogya Mandirs (formerly Health and Wellness Centres) represent the primary care anchor of this architecture. Operationalised through a defined package of service areas spanning promotive, preventive, curative, rehabilitative, and palliative care, they are designed to function as the first and most sustained point of contact between individuals and the health system. Critically, they are also designed as referral nodes: the point from which patients with needs beyond primary care capacity are directed to higher facilities. This referral function is central to the vertical integration logic.
The Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) finances the secondary and tertiary end of the continuum across public as well as private facilities. The scheme’s design logic is curative, but its full value is realised only when patients arrive at empanelled facilities through a functioning referral pathway anchored in primary care. The Pradhan Mantri Ayushman Bharat Health Infrastructure Mission (PM-ABHIM) addresses the capacity layer that makes the referral logic viable. By strengthening primary and secondary care infrastructure, expanding disease surveillance and diagnostic capabilities, and building research capacity for emerging and re-emerging diseases, PM-ABHIM enables a more responsive and resilient health system. In doing so, it ensures that referral pathways are operational and anchored in facilities that are equipped to receive, diagnose, and treat patients.
At its core, the ABDM addresses a fundamental source of fragmentation: the absence of clinical continuity. By making patient histories accessible across levels of care, it reduces duplication, improves diagnostic accuracy and efficiency, and supports more appropriate, cost-effective care.
The connective tissue binding these pillars is the Ayushman Bharat Digital Mission (ABDM), operationalised through key building blocks such as Ayushman Bharat Health Account (ABHA), the Health Facility Registry (HFR), the Health Professional Registry (HPR), the Unified Health Interface (UHI), and the National Claims Exchange (NCX). Together, these components establish an interoperable and integrated digital health architecture that enables the seamless, longitudinal flow of patient information across providers and levels of care, ensuring continuity, coordination, and efficiency within the health system. At its core, the ABDM addresses a fundamental source of fragmentation: the absence of clinical continuity. By making patient histories accessible across levels of care, it reduces duplication, improves diagnostic accuracy and efficiency, and supports more appropriate, cost-effective care. Beyond immediate efficiency gains, ABDM also establishes the foundations for a more integrated and intelligence-driven health system. Its interoperability logic also aligns with the One Health agenda: the same architecture can, over time, link human health data with animal and environmental surveillance, enabling a shared epidemiological framework.
The foundational architecture is in place; the opportunity now lies in strengthening and deepening these connective nodes to ensure that integration translates into system-level gains.
The World Health Day theme, “Together for Health. Stand with Science,” is framed as a call for scientific solidarity; it can also be understood as a design imperative for health systems. The evidence is unambiguous: health risks do not respect sectoral boundaries, with spillovers from animal reservoirs to human populations and from environmental degradation to clinical outcomes. It likewise underscores that fragmented systems impose significant costs — clinical, financial, and temporal — on patients navigating care pathways independently and in silos. India’s policy response reflects an emerging alignment with this evidence, advancing both horizontal integration across sectors and vertical integration across levels of care. The institutional and programmatic foundations for a more coherent system are now in place. The next phase lies in consolidating and operationalising these gains by strengthening linkages, ensuring functional continuity, and embedding integration in routine practice, so that system design translates into sustained improvements in efficiency, equity, and health outcomes.
Maulik Chokshi is the Global Director, Health System Research and Policy, at ACCESS Health International.
Oshia Garg is a Research Associate, Health System Research and Policy, at ACCESS Health International.
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Maulik Chokshi is the Global Director, Health System Research and Policy, at ACCESS Health International. ...
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Oshia Garg is a health policy and systems researcher with over three years of experience in applied research at the intersection of health systems design, ...
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