By Manisha Dhulipala
India’s healthcare system has always been a complex mix, with its burden, progress, challenges underscored by enduring issues of disparity and inequality.
According to a press release by the Ministry of Health & Family Welfare (MOHFW) 2021, historically tracking down the progress, India successfully eradicated diseases such as polio, measles, kala azar, and tuberculosis. Yet, the prevalence of malaria, dengue, typhoid, etc. continues to pose a challenge. Adding to this are new emerging threats such as COVID-19, swine flu, along with the ever-old menace, cancer. Climate change further adds to the burden of diseases exposing us to many unknown diseases. As the country navigates this maze, critical questions on accessibility, affordability, and equity will be pivotal in shaping the course of the future.
Current health indicators
An overview of the wins that we have had is also the decrease in infant mortality, maternal mortality as well as increase in the life expectancy. According to NFHS-5 data, the life expectancy at birth has increased to 67.74 years as of 2022, up from 47.7 years in 1970. The MOHFW data shows reduction in maternal mortality, with the Maternal Mortality Ration (MMR) declining from 130 per 100,000 live births in 2016 to 97 per 100,000 live births in 2022. With the various government initiatives and the movement towards better medical interventions, some of these indicators are slowly but steadily improving. However, disparities still persist between the urban-rural, across states and strata, highlighting the uneven development. The rural areas face the brunt with under resourced healthcare infrastructure posing a daunting task for policymakers to make drastic changes.
Health infrastructure
It is an established fact that infrastructure forms the foundation to an efficient healthcare system and in India, the public health infrastructure is a 3-layer system—Primary Health Centres (PHCs), Secondary Health Centres (SHCs), District Hospitals, along with specialised institutions within the public as well as private sector. The private sector accounts for a significant portion of providing healthcare services, and even though it plays a crucial role, it often raises concerns about equity and cost.
A middle road taken by the government to overcome this was formalising the Public Private Partnership (PPP) models during the 1990s, even though they existed way before in time in different forms of interactions and modes of collaboration as a means of mobilising resources. However, as the concept was fairly new at that time and with very few private players in the market, there was a lack of conceptual clarity in defining PPPs.
According to the NHSRC report on “Public-Private Partnerships in Health Care under the National Health Mission in India: A Review” (2022), PPPs gained momentum when the government opened up to the multilateral, bilateral, international NGOs, pharmaceutical companies, and other American foundations. The idea behind this was to bridge the gap of accessibility and cost by bringing in together their strengths and weaknesses respectively. Despite efforts to strengthen this institution, challenges like accessibility, affordability, and quality of care remain, as India’s population is largely dependent on the public health system.
As per the Ministry of Health & Family Welfare’s Health Dynamics of India report 2022−23, the country has a total of 1,69,615 Sub-Centres (SCs), 31,882 Primary Health Centres (PHCs), 6,359 Community Health Centres (CHCs), 1,340 Sub-Divisional/District Hospitals (SDHs), 714 District Hospitals (DHs), and 362 Medical Colleges (MCs) serving both rural and urban areas.
Supporting the infrastructure is more than 5 lakh health workers including doctors, specialists, medical officers, nursing staff and paramedical staff across all the health centers. Additionally, the medical colleges and training institutions are constantly increasing their numbers. However, researchers and practitioners still believe the ground reality is far different than what’s on paper, with a dearth of personnel, let alone skilled ones, and the rural areas facing the direct impact of the large gap.
Emerging technologies
India’s health policy, outlined in the National Health Policy 2017, has clear guidelines; “universal access with quality healthcare without financial hardship, emphasising preventive and promotive healthcare.” The government of India initiated new programmes in 2018 keeping up with the emerging technologies. The intention was to provide easy access to citizens and ensure data management for building future programmes. Some of the initiatives are:
- Ayushman Bharat Digital Mission (ABDM): Creating a national digital health system including features like unique health IDs, known as Ayushman Bharat Health Account (ABHA).
- Health Facility Registry: Digital health database for both public and private health facilities across the country.
- Healthcare Professionals Registry: A comprehensive, centralised database of registered and verified healthcare practitioners.
- National Digital Health Mission (NDHM): Focused on creating a comprehensive digital health system including electronic health records and telemedicine services.
Along with this, the government also initiated many digital health apps that played a very crucial role especially during the COVID-19 pandemic. A few prominent ones are (i) CoWIN, (ii) Aarogya Setu, and (iii)e-Sanjeevani.
However, even with so much data being generated and recorded through these initiatives, aimed at transforming India’s healthcare landscape by leveraging technology to make it more inclusive and efficient, some of the major implementation challenges faced were adaptability, technological barriers, lack of digital awareness/digital literacy, capacity building, privacy, and data handling.
While digital health initiatives promise accessibility, they also create exclusions. Technical concerns also persist, including hesitation from healthcare institutions, data security, management, and analysis. Awareness of schemes like health insurance remains a major challenge, and private hospitals often resist these schemes due to payment issues.
A long haul
India’s healthcare system is at a crossroads, with so many new and evolving central government driven programmes, initiatives and schemes. In a country as diverse as India, health remains a “state subject” which means that the state alone acts as a provider, facilitator, and regulator of the public health system.
This causes a rift between the centre and the state in terms of financial disparities with states facing challenges in meeting their expenditure responsibilities due to limited financial powers and reliance on intergovernmental transfers. Another issue is the resource allocation of funds to the health sector which is dependent on overall resource availability, competing priorities, and the capacity of the system. The key challenge is that of coordination and collaboration between the centre and the state, crucial for effective healthcare delivery.
With continued investment in infrastructure, technology, and policy reforms, India shows promise and the potential to achieve equitable and high-quality healthcare. However, there is a need to focus on preventive care while addressing social determinants of health and fostering innovation. Transparency and accountability in the healthcare system is prime to bring about equity and remove any disparity in the society.
(The Centre for Development Policy and Practice held a conference in Hyderabad on March 28, 2025, titled “Development Policy and Practice Conference, March 2025.” This article is based on the panel discussion on “India’s Healthcare: Access and Equity.”)
Manisha Dhulipala is a Senior Research Fellow at CDPP. She holds a double masters degree in Environmental Sciences and Sustainable Development. Her areas of research interest are public health, environment & sustainable development, education, and gender.
| 
