Public Health Policies in India

The effectiveness of Ayushman Bharat Health and Wellness Centres (HWCs) and the Ayushman Bharat Digital Mission (ABDM) has once again brought attention to the broader question of whether India's public health policies are successfully advancing the goal of Universal Health Coverage (UHC). While several reforms have expanded healthcare access, persistent challenges relating to infrastructure, affordability, and service quality continue to hinder the realization of equitable healthcare for all.

About Public Health in India

India's public health system seeks to provide universal access to preventive, promotive, curative, and rehabilitative healthcare services through national programmes, state initiatives, and local healthcare institutions. The system plays a vital role in addressing India's double burden of communicable and non-communicable diseases, alongside significant regional and social disparities in health outcomes.

Public health policies influence the overall health status of citizens by ensuring the delivery of essential services, ranging from immunisation and maternal healthcare to disease prevention and treatment. This assumes particular importance in a country like India, which aims to harness its demographic dividend through a healthy and productive population.

Linkage with Universal Health Coverage (UHC)

The principle of Universal Health Coverage (UHC) ensures that every individual receives quality healthcare services without suffering financial hardship. The concept is embedded in Sustainable Development Goal (SDG) 3: Good Health and Well-being.

India's commitment to UHC is reflected through several major policy initiatives. The National Health Policy (NHP), 2017 envisages raising public health expenditure to 2.5% of GDP, while the Ayushman Bharat Programme (2018) represents a landmark attempt to expand healthcare access and financial protection. The establishment of Health and Wellness Centres (HWCs) further seeks to strengthen primary healthcare delivery across the country.

Despite these efforts, significant barriers remain. Out-of-Pocket Expenditure (OOPE) continues to be high, public healthcare infrastructure remains inadequate in many regions, and concerns persist regarding the quality and accessibility of health services. Nevertheless, according to the National Health Accounts, OOPE has declined from approximately 62.6% of total health expenditure in 2014–15 to around 43.89% in 2023, indicating gradual progress.

Major Public Health Policies in India

National Health Policy (NHP), 2017

The National Health Policy, 2017 places Universal Health Coverage at the centre of India's healthcare strategy. It emphasizes the importance of preventive and promotive healthcare, while advocating the strengthening of Primary Healthcare Institutions as the foundation of the public health system.

The policy also aims to increase public investment in healthcare, improve service quality, and reduce the financial burden on households.

Ayushman Bharat Programme (2018)

The Ayushman Bharat Programme consists of two major pillars designed to strengthen healthcare access and affordability.

Health and Wellness Centres (HWCs)

The programme seeks to transform Sub-Centres (SCs), Primary Health Centres (PHCs), and Community Health Centres (CHCs) into comprehensive Health and Wellness Centres. These centres provide a broader range of services, including maternal and child healthcare, screening and treatment for Non-Communicable Diseases (NCDs), mental healthcare services, palliative care, and geriatric care.

The objective is to shift the focus from disease treatment alone towards comprehensive primary healthcare.

Pradhan Mantri Jan Arogya Yojana (PM-JAY)

The Pradhan Mantri Jan Arogya Yojana (PM-JAY) provides health insurance coverage of ₹5 lakh per family per year for secondary and tertiary healthcare needs. It primarily targets economically vulnerable populations and seeks to reduce catastrophic health expenditures among poor households.

Ayushman Bharat Digital Mission (ABDM)

Launched in 2021, the Ayushman Bharat Digital Mission (ABDM) aims to establish an integrated digital healthcare ecosystem across the country.

The mission includes the creation of Ayushman Bharat Health Account (ABHA) IDs, the development of registries for healthcare professionals and healthcare facilities, and the establishment of Electronic Health Records (EHRs) to ensure continuity and portability of care.

The broader vision is supported by the National Digital Health Ecosystem (NDHE), which promotes interoperability among digital health platforms and facilitates seamless healthcare delivery.

Concerns and Issues Associated with Public Health Policies

Shift from Population Health to Individual Wellness

The growing emphasis on the concept of Health and Wellness has, in some respects, shifted policy attention away from broader population health strategies towards individual well-being. While wellness is important, it remains difficult to measure because of its subjective nature.

Unlike indicators such as immunization coverage, Infant Mortality Rate (IMR), or Maternal Mortality Ratio (MMR), well-being lacks universally accepted population-level metrics, creating ambiguity in policy evaluation.

Individualization of Health Responsibility

The wellness approach increasingly places responsibility for health outcomes on individual behaviour and lifestyle choices. However, such an approach risks ignoring crucial social determinants of health, including poverty, malnutrition, poor sanitation, inadequate housing, and limited access to clean water.

Health outcomes are shaped not only by personal choices but also by broader economic and social conditions.

Weaknesses in Primary Healthcare Infrastructure

Despite policy initiatives, many Sub-Centres, PHCs, and CHCs continue to suffer from shortages of doctors, specialists, diagnostic facilities, and healthcare workers. Infrastructure gaps remain particularly severe in rural, tribal, and remote regions, limiting effective healthcare delivery.

The absence of adequate human resources and medical equipment reduces the capacity of primary healthcare institutions to serve as the first line of defence against diseases.

Digitalisation Without Corresponding Service Delivery

The Ayushman Bharat Digital Mission focuses heavily on creating digital health records and information systems. However, digitalisation alone cannot guarantee healthcare access.

Electronic records cannot substitute for the availability of hospitals, medicines, healthcare personnel, laboratories, and diagnostic services. Without strengthening physical healthcare infrastructure, the utility of digital platforms remains limited.

Persistently High Out-of-Pocket Expenditure

Although OOPE has declined over the years, private healthcare services remain unaffordable for many households. Expenditure on medicines and diagnostic tests continues to account for a substantial share of healthcare spending, often pushing families into poverty due to catastrophic medical expenses.

This remains a major obstacle in achieving genuine Universal Health Coverage.

Lack of Evidence-Based Policymaking

Critics argue that certain health initiatives place excessive emphasis on technological innovation and administrative reforms without adequately addressing basic healthcare needs, especially curative services and primary healthcare delivery.

Public health policies must be grounded in evidence relating to disease burden, mortality indicators, healthcare accessibility, and service quality rather than solely focusing on technological advancements.

Way Forward: Strengthening Public Health Policies

Strengthening the Three-Tier Healthcare Infrastructure

India must enhance infrastructure, diagnostics, and human resource availability across Sub-Centres, Primary Health Centres, and Community Health Centres while ensuring effective coordination among these institutions.

A strong primary healthcare system remains the foundation of successful Universal Health Coverage.

Increasing Public Health Expenditure

The target of raising healthcare expenditure to 2.5% of GDP, as envisioned in the National Health Policy, 2017, must be achieved through sustained public investment, particularly in primary healthcare services.

Greater public spending can reduce dependence on expensive private healthcare and lower Out-of-Pocket Expenditure.

Promoting Evidence-Based Policymaking

Healthcare policies should be guided by measurable indicators such as IMR, MMR, disease prevalence, healthcare access, and service quality. Evidence-driven policymaking enhances effectiveness and ensures that interventions address actual public health needs.

Balancing Digital Health with Physical Healthcare Delivery

The implementation of ABDM should complement rather than replace investments in healthcare infrastructure. Digital health systems must be integrated with strong institutional arrangements that guarantee the availability of healthcare services on the ground.

Addressing Social Determinants of Health

Public health policies must work in convergence with programmes related to nutrition, sanitation, drinking water, education, and social protection, recognising that health outcomes are deeply connected to broader socioeconomic conditions.

Enhancing Community Participation

Local governments, ASHA workers, and community organisations should play a greater role in healthcare planning, monitoring, and service delivery. Community engagement strengthens accountability and improves responsiveness to local health needs.

Conclusion

India's journey towards Universal Health Coverage extends far beyond digitalisation and individual wellness initiatives. The success of public health policies ultimately depends on ensuring equitable access to affordable, high-quality healthcare services, strengthening primary healthcare institutions, and addressing the social determinants of health.

A balanced approach that combines robust infrastructure, increased public investment, evidence-based policymaking, digital innovation, and community participation offers the most sustainable pathway towards achieving comprehensive and inclusive healthcare for all citizens.