About
India’s healthcare system is a mixed system involving public and private providers and is organised broadly into primary, secondary and tertiary levels of care. Primary healthcare acts as the first point of contact, secondary care provides specialist and hospital-based services, while tertiary care deals with advanced and highly specialised treatment. Despite improvements in maternal health, immunisation and institutional deliveries, the sector continues to face regional disparities, shortage of health personnel, high out-of-pocket expenditure and an increasing burden of non-communicable diseases.
Primary Healthcare (Current Situation)
Primary healthcare is the first level of contact between people and the health system. It covers preventive, promotive and basic curative services, including immunisation, maternal and child healthcare, treatment of common illnesses and screening for non-communicable diseases. The NFHS-5 provides useful evidence on these outcomes, although it is a household survey and does not directly assess the quality or capacity of PHCs.
· Maternal Healthcare: NFHS-5 recorded substantial improvement in institutional deliveries, with 88.6% of births taking place in health institutions, compared with 78.9% in NFHS-4.
· Child Immunisation: According to NITI Aayog’s SDG India framework, 93.23% of children aged 9–11 months were fully immunised in the latest reported period, showing progress in preventive healthcare.
· Malnutrition: NFHS-5 found that 35.5% of children below five years were stunted, 19.3% were wasted and 32.1% were underweight. Although all three indicators improved over NFHS-4, the nutritional burden remains substantial.
· Anaemia: Anaemia continues to be a major public-health concern, particularly among women and children. NFHS-5 reported anaemia among 57.0% of women aged 15–49 years and 67.1% of children aged 6–59 months.
· Maternal Mortality: India’s maternal mortality ratio has improved considerably; NITI Aayog reports an MMR of 97 per 1,00,000 live births for the latest period used in its SDG framework.
Infrastructure and Access
· Ayushman Arogya Mandirs: The government has been expanding comprehensive primary healthcare through the transformation of Sub-Health Centres and PHCs into Ayushman Arogya Mandirs, providing services beyond the traditional focus on maternal and child health.
· Service Expansion: The primary-care package now includes screening and management of hypertension, diabetes, common cancers, mental-health conditions, oral and eye problems, elderly and palliative care, along with reproductive and child healthcare.
Secondary Healthcare (Current Situation)
Secondary healthcare generally refers to specialist consultation, district and sub-district hospitals, Community Health Centres and other referral facilities. NFHS-5 does not directly measure the capacity of these facilities; therefore, its indicators such as institutional delivery and Caesarean-section rates provide only an indirect picture of hospital-based care.
· Hospital-Based Delivery: The NFHS-5 institutional delivery rate of 88.6% indicates that a large majority of women now access institutional care for childbirth. However, interstate differences remain substantial.
· Caesarean Deliveries: NFHS-5 recorded Caesarean deliveries for 21.5% of births nationally. The rate was substantially higher in private facilities than in public facilities, pointing to differences in the pattern of utilisation between the two sectors.
· Private Sector Dependence: NITI Aayog’s analysis of NSS data found that nearly 58% of hospitalised cases were treated in the private sector. The average expenditure on hospitalisation in the private sector was around ₹34,552, compared with about ₹6,050 in the public sector.
· Infrastructure: Current IPHS data lists around 31,053 Primary Health Centres, 6,064 Community Health Centres, 1,275 Sub-District Hospitals and 767 District Hospitals in the assessed public-health system. However, only 57,468 assessed facilities scored 80% or above, the threshold used for IPHS compliance.
· Regional Disparity: The availability and quality of secondary healthcare vary considerably across States and between urban and rural areas, creating unequal access to specialist services and referral care.
Major Challenges Faced by the Healthcare Sector
High Out-of-Pocket Expenditure
· Financial burden remains one of the major weaknesses of India’s healthcare system. According to the National Health Accounts 2021–22, households’ out-of-pocket expenditure was ₹3.56 lakh crore, accounting for 39.4% of total health expenditure. Government health expenditure stood at 1.84% of GDP.
o A major part of household expenditure is associated with medicines, diagnostics and outpatient treatment, which are not always adequately covered by insurance.
Shortage and Unequal Distribution of Health Workforce
· India continues to face shortages and uneven distribution of doctors, nurses, specialists and other health professionals, particularly in rural, tribal and remote areas.
o NITI Aayog has highlighted health workforce availability and regional disparities as continuing challenges for the sector.
Malnutrition and Anaemia
· The NFHS-5 figures show that despite improvement, malnutrition remains widespread, with 35.5% of under-five children stunted and 32.1% underweight. Anaemia among women and children also remains a serious concern.
o This reflects the close relationship between healthcare and wider determinants such as nutrition, sanitation, education, poverty and women’s status.
Growing Burden of Non-Communicable Diseases
· India is experiencing a rising burden of diabetes, hypertension, cardiovascular diseases, cancer and mental-health disorders.
o This is putting additional pressure on a healthcare system that historically focused more heavily on maternal-child health and communicable diseases.
Regional and Rural–Urban Disparities
· Healthcare infrastructure, specialists, diagnostics and quality of services are not evenly distributed.
o Remote tribal and hilly areas often face additional problems of distance, transport, connectivity and shortage of medical personnel.
Quality of Healthcare
· The availability of a health facility does not necessarily guarantee quality care.
o IPHS assessments show that a significant number of facilities do not yet meet the prescribed standards for infrastructure, equipment and human resources.
Fragmented Healthcare Delivery
· The coexistence of multiple public programmes, State schemes, private providers and insurance mechanisms can result in fragmentation, duplication and weak referral linkages.
o NITI Aayog’s assessment of the National Health Mission also highlighted problems in some States relating to coordination between NHM structures and regular health directorates.
Government Efforts
National Health Mission (NHM)
o NHM seeks to provide accessible, affordable, accountable and effective healthcare, with particular attention to vulnerable populations.
o It supports States through financial assistance, infrastructure development, human-resource augmentation, ASHA workers, maternal and child health programmes and disease-control initiatives.
Ayushman Bharat
o Ayushman Bharat follows a continuum-of-care approach, combining comprehensive primary healthcare through Ayushman Arogya Mandirs with financial protection for hospitalisation under PM-JAY.
o It seeks to address healthcare needs across primary, secondary and tertiary levels rather than treating them as separate systems.
Ayushman Bharat – PM-JAY
· PM-JAY provides financial protection against major hospitalisation expenses for eligible beneficiaries.
· It supports cashless and paperless hospitalisation at empanelled public and private hospitals and is designed to reduce catastrophic health expenditure.
o NITI Aayog has noted the role of PM-JAY in reducing out-of-pocket expenditure and expanding access to hospital-based care.
Ayushman Arogya Mandirs
o They aim to make primary healthcare comprehensive, accessible and closer to communities.
o Services include maternal and child healthcare, communicable diseases, NCD screening, mental health, elderly care, oral and eye care and basic emergency services.
Pradhan Mantri Ayushman Bharat Health Infrastructure Mission
o PM-ABHIM aims to strengthen India’s health infrastructure and preparedness for future pandemics and health emergencies.
o It focuses on critical-care blocks, public-health laboratories, surveillance systems and strengthening health infrastructure at different levels.
Ayushman Bharat Digital Mission (ABDM)
o ABDM seeks to create a digital health ecosystem that makes health information more accessible and interoperable.
o It promotes digital health IDs, interoperable health records, healthcare registries and digital connectivity between patients and healthcare providers.
Pradhan Mantri Bhartiya Janaushadhi Pariyojana
o The scheme seeks to make quality generic medicines available at affordable prices.
o Jan Aushadhi Kendras provide medicines at substantially lower prices, helping reduce the burden of medicine expenditure, which is a major component of household health spending.
Way Forward
Strengthen Primary Healthcare
· The healthcare system should move from a hospital-centric model towards strong comprehensive primary healthcare.
o NITI Aayog has recommended shifting primary healthcare from selective interventions towards assured comprehensive care, while strengthening infrastructure and human resources in underserved regions.
o Ayushman Arogya Mandirs should be strengthened with adequate doctors, nurses, medicines, diagnostics and referral linkages.
Increase Public Health Investment
· India needs greater and more efficient public investment in healthcare to reduce dependence on private expenditure.
o The National Health Accounts 2021–22 show government health expenditure at 1.84% of GDP, while household OOPE remained at 39.4% of total health expenditure, indicating the need for further financial protection.
Move Towards Outcome-Based Health Financing
· NITI Aayog’s assessment of NHM recommends moving from input-based budgeting towards performance-based budgeting, where expenditure is linked to measurable health outcomes.
o States should therefore be evaluated on indicators such as maternal mortality, infant mortality, disease control, waiting time, treatment outcomes and patient satisfaction, rather than expenditure alone.
Strengthen Human Resources
o Medical colleges, nursing institutions and allied-health training should be expanded in underserved areas.
o Rural service incentives, telemedicine and appropriate task-sharing can help address the urban-rural distribution gap.
Reduce Regional Inequality
o Healthcare planning should adopt a targeted approach for tribal, hilly, aspirational and geographically remote districts rather than following a uniform model for all States.
o Mobile medical units, telemedicine, community health workers and stronger referral networks can improve access in difficult terrains.
Strengthen Public–Private Coordination
· The private sector provides a large share of India’s healthcare services, particularly hospitalisation.
o The government should strengthen quality regulation, standard treatment protocols, transparent pricing and strategic purchasing while using private capacity where public infrastructure is insufficient.
Use Technology as an Enabler
· ABDM, telemedicine, AI-based diagnostics and digital health records can improve continuity of care, referrals and access to specialists.
o However, digital health should complement—not replace—physical healthcare infrastructure, particularly in areas affected by the digital divide.
Conclusion
India has made visible progress in institutional deliveries, immunisation, maternal mortality and nutritional indicators, but the health system still faces the twin challenge of unfinished basic-health needs and a growing burden of NCDs. The priority should therefore be to build a system in which strong primary healthcare prevents avoidable illness, secondary care provides timely specialist treatment and tertiary care remains accessible without pushing families into financial distress.
FAQs
1. What are the three major levels of healthcare in India?
Ans: India’s healthcare system is broadly organised into primary, secondary and tertiary healthcare, covering basic and preventive care, specialist treatment and advanced medical services respectively.
2. What does NFHS-5 indicate about the health status of children in India?
Ans: NFHS-5 reported that 35.5% of children under five were stunted, 19.3% were wasted and 32.1% were underweight, showing that malnutrition remains a major public-health challenge.
3. What is the major financial challenge faced by India’s healthcare system?
Ans: High out-of-pocket expenditure (OOPE) remains a major concern. According to the National Health Accounts 2021–22, household OOPE accounted for 39.4% of total health expenditure, creating a significant financial burden on families.
4. What are the major government initiatives to improve healthcare in India?
Ans: Major initiatives include Ayushman Bharat, PM-JAY, Ayushman Arogya Mandirs, National Health Mission, PM-ABHIM, Ayushman Bharat Digital Mission and PM Bhartiya Janaushadhi Pariyojana.
5. What measures are needed to strengthen India’s healthcare system?
Ans: India needs to strengthen comprehensive primary healthcare, increase public investment, improve health workforce availability, reduce regional disparities and shift towards outcome-based healthcare, as emphasised in various NITI Aayog assessments.
