Evolution of the health care policy framework in India

This paper traces the history of the evolution of India’s health care policy framework, focusing on its major objectives, challenges faced, and outcomes emerged. Though the groundwork for the healthcare framework was laid down by the Bhore Committee’s well-thought-out report in 1946, the country’s attention was focused on controlling and eradicating several communicable diseases in the first three decades post-independence. It was only in 1983 that the country framed the first National Health Policy (NHP) with the goal of improving healthcare services. The NHP-1983 was replaced by NHP-2002, which, in turn, was replaced by NHP-2017. Several other policy initiatives were also concurrently undertaken, which, among others, included Pradhan Mantri Swasthya Suraksha Yojana (PMSSY), National Rural Health Mission (NHRM) (which was subsumed under National Health Mission in 2015), Rashtriya Swasthya Bima Yojana (RSBY), Pradhan Mantri Jan Arogya Yojana (PM-JAY), and Pradhan Mantri Ayushman Bharat Health Infrastructure Mission (PM-ABHIM). The key themes prevalent across most of these policies and specific initiatives included: (i) increasing public health spending and reducing out-of-pocket or catastrophic health spending; (ii) addressing rural-urban inequalities in healthcare; (iii) developing primary health care; and (iv) achieving universal health coverage.

Undoubtedly, the country has made a good progress in health care facilities post-Independence, with a significant improvement in various health indicators over the years, such as life expectancy at birth, child and maternal mortality rate, creating a large pool of medical and para-medical personnel, among others. However, despite these improvements, health has remained a low priority, with public health spending at about 1% of the Gross Domestic Product (GDP), much lower than many of its peers with similar tax-GDP ratios. Consequently, the out-of-pocket expenditures in India are among the highest in the world, pushing about 55 million people into poverty every year due to catastrophic health spending. The rural-urban divide in health care services remains wide, with the relative neglect of primary health care. The goal of universal health care has eluded so far, constrained primarily by inadequate public health spending. Research at a global level and experiences of many other countries suggest that achieving the goal of Universal Health Coverage (UHC) will require public health spending to rise to 5% of GDP. Therefore, both the central and state governments need to commit to raising public health spending to 5% of GDP in a time-bound manner.

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This article is authored by Janak Raj, senior fellow, Aashi Gupta, research associate and Shauryavir Dalal, former research assistant, CSEP, New Delhi.