India’S Health Governance: Ministry of Health and Family Welfare — Structure and Functions

Public health governance in India operates through a complex federal framework where health is primarily a State subject under the Seventh Schedule of the Constitution. The central government plays a central policy-making, coordinating, and funding role through the Union Ministry of Health and Family Welfare (MoHFW). Established following independence in 1947, the ministry acts as the nodal central agency for national health policies, disease control programs, medical education standards, and family planning initiatives across all States and Union Territories.

Historical Evolution and Constitutional Framework

Constitutional Allocation

• State List (Entry 6): Public health, sanitation, hospitals, and dispensaries fall directly under the jurisdiction of State governments.
• Concurrent List (Entry 20, 23, 26): Economic and social planning, population control and family planning, and medical education fall under joint central and state authority.
• Union List (Entry 28, 66): Port quarantine, mental quarantine, and co-ordination and determination of standards in institutions for higher education or research fall under the Central government.

Institutional Evolution

• 1947: Formed as the Ministry of Health following independence.
• 1966: Creation of a separate Department of Family Planning to handle national population policies.
• 1977: Renamed as the Ministry of Health and Family Welfare.
• 2007: Creation of the Department of Health Research under the ministry through an amendment to the Allocation of Business Rules.
• 2014: The Department of AYUSH, previously under MoHFW, was detached and elevated into an independent Ministry of AYUSH.

Organizational Structure of MoHFW

The Ministry functions under two main departments, headed by administrative secretaries from the civil services, supported by technical advisory bodies and national institutions.

Department of Health and Family Welfare

• Primary Role: Oversees national public health policy, prevention of communicable and non-communicable diseases, medical education, maternal and child healthcare, and national health schemes.
• Directorate General of Health Services (DGHS): Functions as the technical attached wing to the department. It provides expert advice on medical matters, manages central government healthcare facilities, and executes statutory technical mandates.

Department of Health Research

• Primary Role: Coordinates medical research, evaluates health technologies, and translates scientific innovations into public health solutions.
• Apex Research Body: The Indian Council of Medical Research functions as an autonomous body under this department, leading biomedical research and pandemic outbreak investigations.

Key Attached, Subordinate, and Statutory Bodies

Key National Health Programs and Initiatives

Ayushman Bharat Initiative

• Health and Wellness Centres: Delivers Comprehensive Primary Health Care, free essential drugs, and diagnostic tests at the community level.
• Pradhan Mantri Jan Arogya Yojana: Offers cashless health cover up to 5 lakh rupees per family per year for secondary and tertiary hospitalization to vulnerable households.

National Health Mission

• Components: Merges the National Rural Health Mission (launched 2005) and National Urban Health Mission (launched 2013).
• Focus Areas: Reproductive, Maternal, Newborn, Child and Adolescent Health, vector-borne disease control, non-communicable disease interventions, and healthcare infrastructure building.

Immunization and Disease Elimination Programs

• Mission Indradhanush: Targets full immunization coverage against vaccine-preventable diseases among children and pregnant women.
• National Tuberculosis Elimination Programme: Aims to eliminate TB through early diagnosis, active case finding, treatment, and financial support under Nikshay Poshan Yojana.
• National AIDS Control Programme: Managed under the National AIDS Control Organisation to reduce new infections and expand anti-retroviral treatment.

Policy Frameworks and Guiding Directives

National Health Policy 2017

• Expenditure Target: Advocates raising public health spending to 2.5% of Gross Domestic Product.
• Primary Care Focus: Reallocates two-thirds or more of public health resources to primary healthcare services.
• Digital Integration: Directs the creation of an integrated digital health infrastructure across primary, secondary, and tertiary care tiers.

Ayushman Bharat Digital Mission

• Creates Ayushman Bharat Health Accounts, digital registries for doctors and facilities, and personal health records for nationwide health data interoperability.

Core Facts for Revision

• Constitutional Entry: Public health and sanitation fall under Entry 6 of the State List (List II) of the Seventh Schedule.
• Department Count: MoHFW consists of two departments: Department of Health and Family Welfare, and Department of Health Research.
• DHR Creation: Created in September 2007 to promote biomedical research and health technology assessment.
• NMC Mandate: The National Medical Commission replaced the Medical Council of India under the NMC Act 2019 to oversee medical education.
• CDSCO Oversight: Headed by the Drugs Controller General of India under DGHS for drug approvals and clinical trial sanctions.
• FSSAI Status: Established under the Food Safety and Standards Act 2006 as an autonomous statutory body under MoHFW.
• National Health Authority: Replaced the National Health Agency in 2019 to function as an attached agency for PM-JAY and ABDM implementation.
• Ministry Headquarters: Located at Nirman Bhawan / Kartavya Bhawan premises in New Delhi.