India has one of the most well-planned healthcare policies. It was detailed in addressing the multi-
layered issues of a developing nation that has wide disparities in wealth distribution, geographic and
climatic variations and illnesses that are both infectious and non-infectious in aetiology.
It is in this backdrop that healthcare policies were planned. India represents a unique case with
various governments having built a healthcare service delivery eco-system that had to address
various needs. At one end of the spectrum India has islands of excellence and, at the other, quality
and affordable care are still out of reach of many. Enabling access to good and affordable health care
has been at the heart of all policy drafts..
Affordability has been addressed in the National Health Protection Scheme (NHPS) for over 10 crore
poor and vulnerable families announced in the 2018 Union Budget. This is one of the biggest
`thinking’ and plan chiselled by Prime Minister Narendra Modi for a skilled India. It is undoubtedly
the world’s largest government-funded healthcare programme. NHPS will be part of an umbrella
Ayushman Bharat scheme, along with a preventive healthcare component worth Rs 1,200 crore.
The NHPS has been rightly described as the mother of all insurance schemes in the country with sum
assured estimated to touch a whopping Rs 50 lakh crore!
Affordability addressed, India has to further strengthen its healthcare delivery, especially the last
mile issue. For this, India had designed a unique three-tier healthcare delivery – Primary Healthcare
Centres, tertiary care and super speciality hospitals. Basic healthcare services, including preventive
healthcare, were to be addressed at the PHCs. Only cases that could not be addressed and resolved
were to be referred to district hospitals. Complicated cases would go to super speciality hospital.
Into this ecosystem came private players who opened both multi-speciality hospitals and
But somewhere down the line, the PHCs system broke down, sending patients to already crowded
district hospitals. Since district hospitals could not handle the volume, patients were rather forced to
go to private sector hospitals or super speciality centres.
Time has now come to strengthen the PHCs. A beginning has been made with the government move
to reactivate and re-invent the PHCs as preventive healthcare units. When the over 1.5 lakh such
rural centres are recalibrated as wellness centres to bring healthcare system closer to the homes of
people, the first step at the bottom of the pyramid would have been addressed.
These centres will provide comprehensive health care, including for non-communicable diseases and
maternal and child health services. These centres will also provide free essential drugs and
diagnostic services, according to the new healthcare policy addressed in the Union Budget last year.
This will not only reduce the crowd at the district hospitals, it will also give the district units more
elbow space to operate and expand. And government’s move to open outlets to dispense drugs at
affordable prices is a good move that needs to spread out to rural heartlands too through the PHCs.
Into this operative space, the government has planned for better public-private partnership. What
needs flagging here is that the economic contribution and potential of healthcare for the country is
staggering. Healthcare is the fifth largest employer in the country. Every bed added has the potential
to create five direct jobs, and at least as many indirect jobs.
Healthcare policies not doubt have ensured that while strengthening the PHCs, private investments
in healthcare and research too has received a boost. The Proton Cancer Centre in Chennai is an
example, not to speak of a string of super speciality hospitals that are of world standard.
With infrastructure in place, there is a pressing need to double the number of doctors, triple the
number of nurses and quadruple the number of paramedics.
The future looks bright and the momentum is sure to gain speed with a government that has
healthcare for the people at its heart. India’s public expenditure on health was 1.02% of Gross
Domestic Product as of 2015-16, while the corresponding figure for the world was 10.02%. That
speaks of the huge gap. But there is no doubt that the government’s commitment to healthcare has
been unswerving; what needs underlining is that it cannot do all the work alone.
So what has to be done? To reiterate, strengthen the PHCs further and reboot the PPP model.
Lessons from both developed and emerging worlds tell us that a strong regulatory framework, public
financing and private delivery results in sustainable healthcare models.
It is time policies are reframed to further bring about a robust synthesis of private sector expertise
and efficiency with public outreach infrastructure availability. That will make Bharat truly