India’s success in meeting the SDGs ensure the success of the global community, making an “India Model” the blueprint for large parts of the world to emulate
This piece is part of the series, India@75: Aspirations, Ambitions, and Approaches
Some estimates suggest that India already has the world’s highest population, with 31 percent living in urban areas as of 2011. Despite being the sixth-largest and fastest-growing economy in the world, with a GDP of US$3.25 trillion, India ranks low in the human development index. Some analysts have argued that if India fails to meet its Sustainable Development Goals (SDGs), the global SDGs will fail. On the other hand, India’s success will ensure the success of the global community, making an “India Model” the blueprint for large parts of the world to emulate. This rings true the most in the healthcare sector in India, where globally recognised factors that limit quality healthcare access to the population have been scaled to the extreme and brought to focus during the ongoing pandemic. Starting from a very low baseline, the way India scaled up its testing and vaccination infrastructure very quickly to overcome the daunting challenges brought about by COVID-19 has been remarkable. By making the COWIN software open-source, which coordinated the country’s vaccine deployment effort, India has announced that along with the vaccines, it is also willing to actively share its experience in quickly distributing the vaccines with other nations.
Starting from a very low baseline, the way India scaled up its testing and vaccination infrastructure very quickly to overcome the daunting challenges brought about by COVID-19 has been remarkable.
Indeed, COVID-19 has cast doubt on whether the world can achieve the SDGs in time. The pandemic has overwhelmed the health systems globally, impacting both lives and livelihoods. The progress on the SDGs has been hindered severely by the outbreak, which is causing massive devastation in low- and lower-middle-income countries. Many have called it the worst human and economic crisis in human history. The COVID-19 pandemic has led to a disruption of essential health and nutritional services across the country, particularly the urban areas, putting the vulnerable population at a higher risk of malnutrition, food insecurity and disease exposure.
India’s urbanisation is driven by migration across regions as well as the gradual transformation of rural areas into urban over time. It is estimated that by 2047, close to 65 percent of all Indians will be living in urban areas, emphasising the need to provide an urban way of life for at least 800 million Indians in the near- to mid-term. Given the chronic underfunding of the Indian health system, this poses additional challenges for decision-makers, e.g., reaching out to the marginalised and vulnerable communities in urban and rural areas and ensuring equitable health outcomes. There is a need to ramp up the urban health system. Further, it must be ensured that channelling resources to urban areas does not result in the limited resources meant for rural areas being spread too thin across the country.
India’s urbanisation is driven by migration across regions as well as the gradual transformation of rural areas into urban over time.
Health is a state subject under India’s federal system, and historically, centrally-driven efforts towards regulation have not fared well. The High-Level Group on Health constituted under the Fifteenth Finance Commission recently recommended shifting healthcare under “Concurrent Subjects.” Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) has already empanelled more than 10,000 private hospitals and is trying to use the new “poor patient market” as an incentive for these hospitals to regulate better.
In many states in India, considerable proportions of the population across the socio-economic spectrum are unhealthy, according to the Latest National Family Health Survey. Anaemia in reproductive age women has worsened, with even relatively prosperous states like Punjab and Gujarat showing a higher prevalence. States with better nutrition are the worst affected by lifestyle diseases, which poses a great challenge and forces the health systems to spread their scarce resources even thinner. This issue has come to the fore during the COVID-19 pandemic. According to the World Heart Federation, non-communicable diseases (NCDs), particularly chronic obstructive pulmonary disease, heart disease, hypertension and diabetes are major risk factors for developing severe symptoms of COVID-19.
Inadequate infrastructure and human resources are significant challenges faced by Indian healthcare, as made evident during the pandemic. A 2017 study estimates the need for 2.07 million doctors by 2030 for equitable healthcare. The Indian government is aggressively trying to expand medical college seats, both in the public and private sectors, aiming to overcome personnel bottlenecks. The number of undergraduate medical seats has seen a jump of 48 percent, from 54,348 in 2014–15 to 80,312 in 2019–20. There has also been a 47 percent rise in public-sector medical colleges during 2014–19, compared to a 33 percent increase in the total number of medical colleges in the past five years, from 404 in 2014–15 to 539 in 2019. Currently, India is deploying telehealth to tide over the disruption caused by the pandemic.
The Indian government is aggressively trying to expand medical college seats, both in the public and private sectors, aiming to overcome personnel bottlenecks.
However, the infrastructure gaps are proving to be insurmountable at current levels of spending. According to the latest data presented in the Rural Health Statistics 2019-20, the shortfall of Primary Health Centres in Jharkhand and West Bengal stand at 73 percent and 58 percent, respectively. The shortfall of CHCs (community health centres) in Bihar is as much as 94 percent. The severe shortfall of primary and secondary infrastructure in rural areas causes strain on the tertiary hospitals in urban areas and overwhelm the facilities.
Infrastructure and urban planning are linked to rural infrastructure, since the supply bottleneck in rural areas forces excess demand to spill over to urban areas and render any planning meaningless. Projecting a requirement of INR 5.38 lakh crore over the next five years for providing primary healthcare to the Fifteenth Finance Commission, the Ministry of Health hopes to manage the spiralling demand for tertiary care by dealing with health problems early on and by strengthening the comprehensive primary healthcare access and outreach.
The current formation in power (NDA), over the last seven years, has been able to consolidate the gains from the previous coalition in power (UPA) within the health sector and has built on and broad-based them, as in the cases of the AB-PMJAY, Ayushman Bharat Digital Mission (ABDM), Ayushman Bharat Health and Wellness Centres, and Pradhan Mantri Bhartiya Janaushadhi Pariyojana (PMBJP). Moreover, the NDA has been silently working on converting the Social Determinants of Health (SDH) framework into practice, with flagship interventions in key areas such as nutrition (National Nutrition Mission), drinking water (Water Mission), indoor air pollution (Ujjwala Yojna), sanitation (Swachh Bharat), road access (Gram Sadak Yojana), and gender (Bet Bachao Beti Padhao). These initiatives have contributed greatly to India’s multisector response to the pandemic and will certainly provide templates for other health systems to accept, adapt and build on.
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Oommen C. Kurian is Senior Fellow and Head of Health Initiative at ORF. He studies Indias health sector reforms within the broad context of the ...
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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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