Overview

India's healthcare journey toward Universal Health Coverage (UHC) represents one of the world's largest health protection schemes, combining insurance coverage, primary care democratization, digital health infrastructure, and targeted disease interventions. The National Statistical Office 2025 survey confirms increased public healthcare utilization, lower out-of-pocket expenditure, and improved access—driven primarily by Ayushman Bharat and the National Health Mission.

Key Achievements in Healthcare

Universal Health Coverage & Insurance

  • AB-PMJAY Launch: Operational since 2018 under National Health Policy 2017
  • Coverage: Free health insurance up to Rs 5 lakh/family/year for 12 crore socio-economically deprived families
  • Scale: Over 44.14 crore Ayushman Cards created, funding 12.03 crore hospitalizations
  • Senior Citizen Coverage: Ayushman Bharat Vay Vandana (October 2024) extended coverage to all citizens above 70 years
  • 1.20 crore seniors enrolled by June 2026
  • Treatments worth Rs 3,000 crore availed

Democratizing Primary Care

  • Ayushman Arogya Mandirs (AAMs): Over 1.86 lakh facilities upgraded to provide 12 free comprehensive services
  • Includes Sub-Centres, PHCs, and AYUSH centres
  • 540 crore cumulative footfall recorded
  • Case Study: Lalmati sub-centre (Assam) achieved zero maternal and child mortality from preventable causes since 2024

Pandemic Preparedness & Infrastructure

  • PM-ABHIM: Building resilient infrastructure including:
  • 744 integrated public health labs
  • 631 critical care hospital blocks
  • COVID-19 Response:
  • World's largest vaccination drive: 220+ crore doses
  • ICU beds scaled from 2,168 to 1.45 lakh
  • Vaccine Maitri: 300 million doses to 100 countries

Maternal, Child Health & Disease Elimination

SchemeAchievement
Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA)7.47 crore pregnant women examined
Mission Indradhanush5.46 crore previously unimmunized children vaccinated
Zero-dose children (April 2026)Reduced to just 0.06%
Pradhan Mantri TB Mukt Bharat Abhiyaan20 crore people screened
Malaria mortality reduction78% drop
Mother-to-child HIV transmission74.5% reduction since 2010

Managing Non-Communicable Diseases (NCDs)

  • Mass Screenings at AAMs:
  • Hypertension: 41.5 crore screened
  • Diabetes: 41.3 crore screened
  • Oral, breast, cervical cancers: 60+ crore combined screenings
  • Pradhan Mantri National Dialysis Programme (PMNDP): 4 crore free hemodialysis sessions
  • Cancer Care: Facilities approved at all 22 new AIIMS
  • Lifestyle Interventions: Eat Right India, Fit India Movement
  • International Recognition: 2025 Bloomberg Philanthropies Award for reducing tobacco use by 17.3%

Digital Health & Last-Mile Delivery

  • ABDM & ABHA: 20.49 crore unique Ayushman Bharat Health Accounts created
  • U-WIN Platform: Digitally tracks vaccinations for 11.87 crore children and 3.96 crore pregnant women
  • Telemedicine: eSanjeevani delivered 47+ crore teleconsultations
  • Tele-MANAS: Mental health support across 53 cells in 20 languages
  • i-DRONE (ICMR): Delivered 22,000 medicines across 7,700 km of difficult terrain
  • AI Diagnostics:
  • Clinical Decision Support Systems (CDSS)
  • Cough Against TB tool (detecting 12-16% additional hidden cases)
  • MadhuNetrAI for diabetic retinopathy screening

Affordable Medicines & Workforce

  • Jan Aushadhi Kendras: 18,000+ centers offering 50-90% cheaper generic drugs
  • AMRIT Pharmacies: Saved patients ₹8,400 crore
  • Free Diagnostics Initiative: Covers up to 57 tests at district hospitals
  • Workforce Expansion:
  • Medical colleges doubled
  • 157 new nursing colleges established
  • AYUSH integration across 13,093 facilities
  • Dedicated AYUSH Visa introduced (July 2023)

Challenges in Healthcare

Fiscal Deficits

  • Unfulfilled Target: National Health Policy 2017 target of 2.5% GDP public health spending by 2025 remains unmet
  • Declining Union Spending:
  • Dropped from 0.37% of GDP (2020-21) to 0.29% (2025-26)
  • Reduced Central Share: Union's share for Centrally Sponsored Schemes dropped from 75.9% (2014-15) to 43% (2024-25)

Low Per-Capita Investment

India's per-capita public health spending comparison:

  • Bhutan: 2.5 times more
  • Sri Lanka: 3 times more
  • BRICS nations: 14-15 times more
  • Thailand/Malaysia: 10 times more

Institutional Fragmentation

  • Siloed Operations: Health determinants (sanitation, nutrition, clean water, air pollution) handled by disparate ministries
  • Constitutional Constraint: "Public health and sanitation; hospitals and dispensaries" under Entry 6 of State List (Seventh Schedule)
  • Hampers uniform national standards
  • Creates regional disparities

Out-of-Pocket Expenditure

NITI Aayog study revealed:

  • 65% of PMJAY beneficiaries still incurred out-of-pocket expenditure
  • Only 35% enjoyed completely cashless hospitalization
  • Major gaps in regulatory oversight and empanelment compliance

Other Critical Challenges

  • Absence of Statutory Backing: No centralized Right to Health Act
  • NCD Explosion: NCDs account for 60% of all deaths
  • Geographical Barriers: Remote areas face supply and specialist access challenges
  • Mental Health Stigma: Psychiatric care concentrated in urban centers
  • Diagnostic Gaps: Traditional methods miss complex diseases in primary care

Recommended Measures

  1. Fiscal Correction: Legally backed roadmap to achieve 2.5-3% GDP public health expenditure
  2. AI-Powered Diagnostics: Expand MadhuNetrAI and Cough Against TB across all rural AAMs
  3. Drone Logistics: Institutionalize i-DRONE network nationwide for blood samples, vaccines, medicines
  4. Jan Andolan Approach: Replicate Nik-shay Mitras and Eat Right India success for NCD prevention
  5. AYUSH Integration: Accelerate AYUSH Grid rollout, promote medical tourism via AYUSH Visa
  6. Digital Portability: Ensure 100% adoption of 14-digit ABHA ID and U-WIN platform
  7. Right to Health Framework: Enact comprehensive Right to Health Act as justiciable right

Constitutional and Policy Framework

  • National Health Policy 2017: Sets vision for health assurance
  • Article 47 (Directive Principles): State's duty to raise nutrition and living standard
  • Entry 6, State List: Public health and sanitation under state jurisdiction
  • SDG 3: Good Health and Well-being
  • Viksit Bharat @ 2047: Vision for healthier, more productive population

Significance for UPSC Preparation

This topic covers multiple dimensions:

  • Government schemes and their implementation
  • Federalism challenges in healthcare
  • Digital health infrastructure
  • Public health economics
  • International comparisons
  • Social justice and welfare governance