Healthcare in India

Healthcare in India represents a vast and evolving system characterised by a mix of public and private providers, traditional and modern medicine, and uneven access across regions. The system has undergone significant transformation since independence, driven by demographic changes, technological advances, and government reforms aimed at achieving universal health coverage (UHC). Despite notable progress in life expectancy, maternal health, and disease control, challenges such as inadequate infrastructure, workforce shortages, and disparities between rural and urban areas continue to shape India’s healthcare landscape.

Historical Background and Evolution

The origins of organised healthcare in India can be traced to the colonial period, when the British established hospitals primarily to serve military and administrative personnel. Public health initiatives during this era focused on controlling epidemics such as plague, cholera, and malaria. Following independence in 1947, the Indian government adopted a welfare-oriented approach, integrating health into the broader framework of nation-building.
The Bhore Committee Report (1946) laid the foundation for a comprehensive public health system, recommending free, state-funded healthcare for all citizens. Over subsequent decades, India developed a three-tier structure of healthcare delivery—primary, secondary, and tertiary care—supported by national health programmes targeting infectious diseases, maternal and child health, and family welfare.
The 1980s and 1990s marked a shift towards liberalisation and privatisation, which encouraged private investment in hospitals and diagnostics. This era also saw the rise of medical tourism and the expansion of corporate hospital chains. In recent years, government initiatives such as the National Rural Health Mission (NRHM), National Urban Health Mission (NUHM), and the flagship Ayushman Bharat Programme have sought to make healthcare more inclusive and affordable.

Structure of the Healthcare System

India’s healthcare system functions through a dual model comprising the public sector (managed by central and state governments) and the private sector, which includes hospitals, clinics, and diagnostic centres.

• Public Sector: Operates through a three-tier network—
  • Primary Health Centres (PHCs) and Sub-Centres at the rural level.
  • Community Health Centres (CHCs) and District Hospitals providing secondary care.
  • Medical Colleges and Specialised Hospitals delivering tertiary care.These are largely financed by the government and offer free or low-cost services.
• Private Sector: The private sector accounts for nearly 70% of outpatient care and 60% of inpatient care in India. It ranges from small clinics to large corporate hospitals and plays a significant role in urban areas. However, the cost of private healthcare often remains beyond the reach of low-income groups, leading to high out-of-pocket expenditure (OOPE).

Major Government Health Initiatives

Several flagship programmes have been launched to address healthcare access and quality:

• Ayushman Bharat (2018): Encompasses two key components:
  • Health and Wellness Centres (HWCs) offering comprehensive primary care.
  • Pradhan Mantri Jan Arogya Yojana (PM-JAY) providing health insurance cover of ₹5 lakh per family per year for secondary and tertiary care.It aims to cover over 500 million beneficiaries, making it one of the world’s largest government-funded health schemes.
• National Health Mission (NHM): Includes the NRHM and NUHM, focusing on maternal and child health, disease prevention, and strengthening rural and urban health infrastructure.
• Universal Immunisation Programme (UIP): Provides free vaccination against preventable diseases such as polio, measles, hepatitis B, and tuberculosis.
• National AIDS Control Programme (NACP) and National Tuberculosis Elimination Programme (NTEP) represent ongoing public health efforts against major communicable diseases.

Public Health Challenges

Despite progress, several systemic challenges persist:

1. Inequitable Access: Rural areas, home to nearly 65% of India’s population, often lack adequate medical facilities and trained personnel. Urban regions, conversely, face overcrowding in hospitals and rising costs.
2. Shortage of Healthcare Professionals: India faces an estimated deficit of doctors, nurses, and paramedics, particularly in rural zones.
3. High Out-of-Pocket Expenditure: Over 55% of total health expenditure is borne by individuals, pushing many households into poverty.
4. Disease Burden Transition: The country faces a dual burden—communicable diseases such as malaria and tuberculosis alongside rising non-communicable diseases (NCDs) like diabetes, cardiovascular diseases, and cancer.
5. Infrastructure Gaps: Many PHCs lack basic amenities such as electricity, water supply, and diagnostic facilities.

Role of Traditional Medicine (AYUSH)

India’s healthcare ecosystem is unique for integrating traditional systems under the AYUSH framework—Ayurveda, Yoga, Unani, Siddha, and Homoeopathy. The Ministry of AYUSH, established in 2014, promotes research, education, and practice in these disciplines. Ayurvedic hospitals, yoga therapy centres, and Unani dispensaries operate alongside allopathic facilities, offering holistic and preventive health solutions.
AYUSH’s inclusion in mainstream healthcare aligns with India’s emphasis on integrative medicine, combining traditional wisdom with modern science to enhance wellness and disease prevention.

Technological Advancement and Digital Health

The past decade has witnessed rapid adoption of digital health technologies. Initiatives such as the National Digital Health Mission (NDHM) aim to create an integrated digital ecosystem, enabling electronic health records (EHRs) and telemedicine services. Platforms like eSanjeevani, India’s national teleconsultation service, have connected millions of patients—especially in remote areas—to qualified doctors.
Private healthcare providers are increasingly investing in artificial intelligence (AI), robotic surgery, and data analytics to improve diagnostics and patient outcomes. The pandemic accelerated this digital transformation, demonstrating the importance of virtual healthcare delivery.

Public-Private Partnerships and Insurance

Public-Private Partnerships (PPPs) have emerged as a strategy to enhance efficiency and resource sharing. Under various state-level schemes, private hospitals provide services to beneficiaries of government insurance programmes. India’s growing health insurance market—both public and private—has expanded significantly, with companies offering coverage for hospitalisation, critical illness, and preventive care.
The Insurance Regulatory and Development Authority of India (IRDAI) oversees this sector, ensuring transparency and consumer protection. Despite expansion, insurance penetration remains low, with many citizens still lacking financial protection against health emergencies.

Environmental and Preventive Health Concerns

Environmental issues such as air pollution, unsafe water, and poor sanitation contribute significantly to India’s disease burden. Government campaigns like Swachh Bharat Abhiyan (Clean India Mission) and Jal Jeevan Mission aim to improve hygiene and access to safe drinking water. Preventive healthcare has gained prominence through awareness drives, screenings, and lifestyle interventions addressing obesity, tobacco use, and mental health.

Future Prospects

The future of healthcare in India rests on expanding accessibility, affordability, and quality through innovation and policy reforms. The government envisions achieving universal health coverage by 2030, in line with the United Nations Sustainable Development Goals (SDGs). Strengthening primary healthcare, enhancing human resources, and investing in public health research will be critical to this goal.