Strengthening Public Health Systems in India

Syllabus: GS2/Issue Related Health

Context

• Global cuts in Development Assistance for Health (DAH), rising public debt, and concerns over under-utilisation of health budgets have renewed focus on improving the efficiency and governance of public health systems, particularly in India and other developing countries.

About Public Health Systems in India

• India’s public health system is built on a three-tier healthcare structure i.e. Sub-Centres/Health & Wellness Centres (HWCs), Primary Health Centres (PHCs), Community Health Centres (CHCs), district hospitals, and tertiary institutions.
• It is guided by the National Health Policy (2017) and implemented primarily through the National Health Mission (NHM).
• Key features include:
  • National Health Mission (NHM): Strengthens basic health care, maternity and child health, disease control and health infrastructure.
  • Ayushman Bharat Scheme:
    • Health and Wellness Centres (AB-HWCs): Provide integrated primary health care.
    • PM-JAY: Offers health insurance cover of ₹5 lakh per household for secondary and tertiary treatment.
  • Digital Health Initiatives: The Ayushman Bharat Digital Mission (ABDM) seeks to develop a digital health ecosystem.
  • WHO India Partnership: Strengthens health system by improving governance, workforce development, surveillance and Universal Health Coverage (UHC).

Concerns & Issues in Public Health Systems

• Lack of Funding for Public Health: The percentage of public health expenditure in GDP still remains around 2%, below the aim of 2.5% set in the National Health Policy.
  • Although the difference in terms of GDP share is reducing, per capita public health expenditure in LMICs remains much lower than in high-income nations.
• Declining External Health Assistance: Major cuts to falling external health aid Development Assistance for Health (DAH), which peaked under COVID-19, are falling dramatically.
  • Major contributors including the United States, United Kingdom, France and Germany have cut foreign health support, impacting health projects around the world.
• Poor Budget Utilisation: The health budgets in many LMICs are implemented only to the extent of 85–90% which is less than sectors like education. In India:
  • Much of the allocations under the Health Infrastructure Mission was unspent.
  • 26% of funds allocated to communicable and non-communicable disease programmes under NHM were utilised in 2024-25.
• Skewed Spending Pattern: Higher spending on secondary and tertiary curative care.
  • Preventive and basic healthcare still receive comparatively lower financing.
  • Immunisation, sanitation, surveillance and health promotion as preventive health measures have continued to be under-prioritised.
• Governance Challenges: Weak public financial management; delays in fund release; procurement inefficiencies; capacity gaps at State and district levels; corruption and administrative inefficiencies reduce the effectiveness of public expenditure.
• Emerging Health Challenges: Rising burden of Non-Communicable Diseases (NCDs); ageing population; climate-sensitive diseases; and pandemic preparedness requirements.

Related Efforts & Initiatives

• National Health Mission (NHM) for strengthening primary healthcare.
• Ayushman Bharat (AB-PMJAY & Health and Wellness Centres).
• Ayushman Bharat Digital Mission (ABDM).
• The PM Ayushman Bharat Health Infrastructure Mission (PM-ABHIM) intends to increase disease surveillance, critical care, laboratories and public health infrastructure.
• Medical colleges and health workforce expansion.
• International Support:
  • WHO India promotes health system strengthening through Universal Health Coverage (UHC), health workforce development, health funding reforms, disease surveillance and emergency preparedness.
  • Sustainable Development Goal (SDG) 3 is one of the 17 SDGs established by the United Nations General Assembly in 2015.

Prioritizing Better Public Health Spending

• Better Budget Utilisation: Timely release of funds, better monitoring of expenditure, accountability of implementing agencies, and better coordination between Union and State governments.
• Prioritise spending on High-Impact Interventions: Greater focus should be given to preventive healthcare, immunisation, nutrition, sanitation and hygiene, disease surveillance, health promotion and early screening for NCDs.
  • Public resources should be directed to public goods in areas where market failures exist, such as epidemic control and vaccination, with the private sector offering complementary cheap curative services.
• Enhance Governance and Efficiency: Improve public financial management; boost transparency in procurement; digitise the tracking of funds; give district-level health administrations more authority; include frontline health providers in planning and budgeting; and develop flexible budgeting mechanisms for emergencies.

Way Forward: Strengthening Measures

• Increase public health spending to 2.5% of GDP as per the National Health Policy.
• Promote primary and preventative health care rather than excessive curative expenditure.
• Enhance credibility of the budget, utilisation and results-based financing.
• Strengthen Health and Wellness Centres as the cornerstone of Universal Health Coverage.
• Invest in monitoring, laboratories, digital health and disaster planning to build resilient health systems.
• Strengthen State and local governance and capabilities to promote cooperative federalism.
• Support resource allocation based on evidence of illness burden and health outcomes indicators.
• Grow public-private partnerships while guaranteeing equity and affordability.

Conclusion

• The immediate priority is to spend existing resources more efficiently while increasing health expenditure remains essential.
• Better budget execution, strategic planning of resource allocation towards preventative care, and better governance can yield large health gains even in a tight budgetary context.
• Long-term sustained investment and institutional reforms would be key to achieving Universal Health Coverage (UHC) and creating a sustainable, equitable and inclusive public health system in India.

Source: TH