India’s healthcare system is marked by issues of multiple dimensions, requiring urgent attention and reform. Unsettling trends are seen in public health expenditure by the latest statistics, thus threatening the trajectory of universal health coverage and Sustainable Development Goals. Major problems like health crises due to climate change, the growing problem of antimicrobial resistance, mental health challenges, and an increase in NCD will have created a “double burden” for the healthcare system. The structural issues of fragmented governance, low funding in the health sector, deficits of health manpower, and gaps between rural and urban infrastructure complicate these health risks and thus pose great challenges to delivering effective healthcare.
| GS Paper | GS Paper II |
| Topics for UPSC Prelims | Government health spending, Sustainable Development Goals, Extreme weather events, Vector-borne diseases, antimicrobial resistance, Central Drug Regulator, National Mental Health Survey, zoonotic diseases, H3N2 influenza, Clinical Establishments Act of 2010, Ayushman Bharat Digital Mission, Active Pharmaceutical Ingredient. |
| Topics for UPSC Mains | Impact of Custom Duty on technological advancements in India, Analysis of Custom Duty policies and their influence on India’s technology and science innovation efforts |
This editorial is based on “SDG goals at risk in nations such as India due to declining health spending: Data,” published in The Hindu on 13/10/2024.It draws insights from a recent World Bank study, examining health spending trends across low and middle-income countries.
Any UPSC aspirant will find that the health challenges in India are all in line with the syllabi for “Health,” “Governance,” and “Sustainable Development.” This analysis will give the reader a detailed understanding of current health issues, policy gaps, and reforms to bolster one’s knowledge for General Studies and essay topics on public health and governance.
India spends less in healthcare and is beset by rising concerns of antimicrobial resistance, climate change-related illnesses, and mental health emergencies. This forms one of the most important interconnected topics from GP I to GS II on Health and Education and now GS III on Environment and Biodiversity, always appearing in the exam pertaining to issues of governance, public health, and sustainable development.
Many health issues face the country of India, from impacts of climate change to resistance to antimicrobials, mental health issues, and a rise in noncommunicable diseases. All these factors call for a “double burden,” straining the healthcare system and placing the need for comprehensive reforms well into view.
India has seen a lot of increasing instances of heatstroke, respiratory diseases, and vector-borne diseases attributed to changing temperatures and extreme weather. Flooding contaminates sources of water, and diseases like cholera and typhoid are spread. There is evidence of 191 billion labor hours lost due to heat exposure in 2022; this is a call for climate-focused health interventions.
The high rate of usage of antibiotics has led to the growth of antimicrobial resistance because most private sector antibiotic formulations are not approved by Central Drug Regulator. Resistant infections challenge healthcare systems such as E.coli and Klebsiella pneumoniae in hospital ICUs. Bringing about regulation and awareness can sort out the AMR challenge.
The pandemic has merely exacerbated India’s mental health crisis- limited infrastructure combined with stigma has meant that precious few have ever received any form of care. Data from the WHO indicates a 25% increase in anxiety and depression worldwide, while India has just 0.75 psychiatrists per 100,000 people, underlining the need for mental health infrastructure.
Such chronic diseases are diabetes, heart conditions, and cancer, and lifestyle and dietary changes continue to dominate. The NCD burden on India is adding to the infectious diseases burden and is stretching the country’s healthcare resources. Such conditions of a sedentary lifestyle and unhealthy dietary change add to these health issues and therefore there needs to be a greater focus on the prevention of NCD and chronic care.
India is facing the challenge of both infectious and non-infectious diseases. On the one hand, common infections like tuberculosis, malaria, and newly emerging H3N2 influenza call for continued vigilance while, on the other hand, long-term care models are needed for lifestyle diseases. This has over-stressed healthcare facilities, especially in rural and low-income areas.
Weak Indian healthcare system: There are governance fractures, inadequate funding, and disparities in infrastructure, whereas workforce shortages combined with a failure to implement preventive healthcare makes the Indian healthcare system weak. All these factor into the quality of care and put constraints on accessibility within urban and rural regions.
Fragmented governance complicates the health delivery system in India, wherein health policies vary from state to state. To standardize health care, the Clinical Establishments Act of 2010 has been instituted. Nonetheless, its enactment is inconsistent across states, which may lead to variability in quality and availability of health care. Effective healthcare reform requires uniform governance and regulation to succeed in an effort that spans the entire country.
Public health spending in India is as low as 1.9% of GDP, which poses the lowest figure in the world and circumscribes health care access. Due to out-of-pocket spends being too high, healthcare remains inaccessible to many, causing high economic pressure on households. Increasing health investment becomes critical to improve accessibility and reduce the economic burden on households.
Another reason why disparities between healthcare infrastructure in cities and rural areas exacerbate the problem of access is that few sub-centers and community health centers are of public health standards. Hospitals and hospital beds, as revealed from data obtained from Niti Aayog, have an unevenly skewed distribution at present, where the rural regions have to suffer primarily on account of the equipment missing from the facilities most of the time.
India is badly deficient in the health sector, especially in rural centers. Even though there was an expansion of medical education, brain drain and low incentives have turned out to be a disincentive for professionals serving in the rural posting, thereby leaving some gaps in service delivery. Rural health centres are short of more than 80 percent required surgeons and pediatricians, stressing health care delivery.
Although Indian health care systems offer preventive healthcare to a large extent, they still focus on curative services. The absence of education and measures on public health leads to the tremendous load of disease burden with escalated treatment costs and inflicting resource strains. An approach through prevention is going to curb long-term expenditures and strains on the healthcare systems..
Healthcare reforms may take the form of digital health integration, improved primary care services, public-private partnerships, adequate financing, and an appropriate balanced medical workforce distribution. Such measures have long-term implications for improving health care access, quality, and sustainability.
This includes initiatives such as the Ayushman Bharat Digital Mission, which provides connected healthcare data across systems with potential improvement in coordination and disease outbreak surveillance. Telemedicine combined with stronger data privacy measures standardized electronic health records can further smoothen services for better access to health and better care, especially in rural areas.
There is an urgent need to upgrade HWCs into preventive healthcare centres where individuals can receive diagnostic services along with telemedicine facilities. Early detection of diseases will be possible due to the benefits created by such centers, and educating the community will also be feasible. An efficient referral system from HWCs to hospitals can be achieved in an integrated way to ensure coordinated care.
Public-private partnerships (PPP) can expand access to healthcare and set quality standards. For private sectors to collaborate with the government in filling gaps in service, frameworks can be developed considering metrics of performance and quality. Independent monitoring and capacity-building programs can help build accountability and drive improvement service delivery nationwide.
Increasing public health spending to 2.5% of GDP, complemented by increased coverage under the Ayushman Bharat scheme, will relieve patients of financial burdens and smoothen claim processes. Wider insurance cover shall ensure more citizens benefit from good health care and out-of-pocket expenditure is reduced and health equity increased.
Service delivery of healthcare can be balanced by the gap between only through the skill development program and incentivized rural postings of medical doctors. Programs like Chhattisgarh’s Mitanin model can frame appropriate community health engagement to balance the urban-rural divide so that, to some extent, local healthcare needs can be fulfilled.
Increasing local production of essential medicines through API parks and promoting the Jan Aushadhi program would reduce dependency on imports. Quality control of generic medicines, judiciously marketed at affordable domestic manufacturing costs, would enhance drug access and affordability and ensure drug security.
| Political Factors: India’s healthcare system struggles with fragmented governance and inconsistent standards. Policies like the Clinical Establishments Act aim to unify healthcare, but state-by-state variation hinders equal quality. Limited healthcare spending at 1.9% of GDP restricts access and quality, underscoring the need for stronger political commitment to reforms.Economic Factors: Low government healthcare spending creates heavy reliance on out-of-pocket expenses, straining families financially, particularly in rural areas. Public-private partnerships (PPP) offer a solution, with private sector investment supporting public healthcare. Clear regulations on quality and affordability are essential to ensure PPPs benefit healthcare access and service quality nationwide.Social Factors: India’s rising non-communicable diseases, driven by lifestyle changes, strain healthcare resources. These chronic diseases demand focused management and preventive care. Additionally, mental health services remain limited due to social stigma, with restricted access to necessary care. Addressing these health burdens requires awareness programs and expanded mental health infrastructure.Technological Factors: Digital health solutions, like the Ayushman Bharat Digital Mission, can improve healthcare coordination and disease tracking, especially in underserved regions. Telemedicine expansion increases rural healthcare access, while domestic production of essential drugs and medical devices through API parks can enhance drug security, affordability, and reduce dependency on imports.Environmental Factors: Climate change exacerbates India’s healthcare challenges, with rising temperatures and floods leading to more cases of heatstroke, respiratory issues, and waterborne diseases. Adaptation in healthcare infrastructure is essential to manage these climate impacts, as extreme weather increasingly affects public health, requiring responsive healthcare systems to handle these threats.Legal Factors: A unified regulatory framework can standardize healthcare quality across India, enabling consistent enforcement of healthcare standards. Establishing a national regulatory authority can improve service transparency and equity. Enhanced regulation for drug approvals and monitoring antibiotic use is vital to combat antimicrobial resistance and ensure drug safety and quality. |
In this journey of India’s health care, much complexity stands necessitating immediate reforms. On preventive care, infrastructure strengthening, and public-private partnership, a resilient healthcare structure can be erected in the country. For UPSC aspirants, therefore, it will project how the strategic policies would respond to India’s crucial health needs and work toward universal coverage and Sustainable Development Goals.
| UPSC Civil Services Examination, Previous Year Questions (PYQs) Mains Q. Discuss the challenges and implications of emerging health issues such as antimicrobial resistance, vector-borne diseases, and zoonotic infections for India’s healthcare system. (UPSC Mains 2022, GS Paper III) Q. India’s healthcare spending as a percentage of GDP has been declining in recent years. Analyze the potential impacts of reduced government health expenditure on achieving Sustainable Development Goals (SDGs) related to health and well-being. Suggest policy interventions that could mitigate these impacts. |
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