Bridging Access and Equity in India’s Healthcare

• 12 Mar 2026

This editorial is based on “Building a safety net to protect people’s health” which was published in The Hindustan Times  on 06/03/2026. This editorial provides a multidimensional analysis of India’s evolving healthcare landscape. It proposes a roadmap for structural reforms to ensure that the vision of universal health coverage becomes a ground reality for every citizen by 2047.

For Prelims: PM-JAY , ABDM , eSanjeevani,PM-ABHIM, U-WIN Portal,Jan Aushadhi Kendras, National Health Account. 

For Mains:Developments in healthcare access in India, Key issues in achieving universal healthcare in India, measures needed to achieve universal healthcare access. 

India’s healthcare landscape is undergoing a transformation from limited reach to broad-based accessibility and affordability. Despite progress, high out-of-pocket expenditure constituting nearly 39% of total health spending, continues to challenge equitable access to treatment. Initiatives such as Ayushman Bharat Pradhan Mantri Jan Arogya Yojana and Pradhan Mantri Bhartiya Janaushadhi Pariyojana are expanding financial protection and affordable medicine availability for millions. Together, these efforts signal India’s shift toward universal, affordable and people-centric healthcare under the Viksit Bharat vision. 

How is India Strengthening Access and Equity in its Healthcare System?  

• Interoperable Digital Health Identities: The Ayushman Bharat Digital Mission (ABDM) has structurally transformed patient record management by transitioning from fragmented physical files to a cohesive, interoperable digital ecosystem.  
  • Such digital portability drastically reduces diagnostic repetition and enhances continuity of care for migrant and rural populations.  
    • As of August 2025, the Ayushman Bharat Digital Mission (ABDM) has achieved a major milestone with creation of over 79.91 crore Ayushman Bharat Health Accounts (ABHAs) across the country. 
• Universal Health Insurance (PM-JAY Expansion): The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) serves as the world's largest publicly funded health insurance scheme, shielding vulnerable demographics from catastrophic out-of-pocket medical expenditures.  
  • By ensuring paperless and cashless hospitalization for secondary and tertiary care, the initiative effectively democratizes access to expensive life-saving treatments.  
    • Recent policy expansions have systematically widened the beneficiary net, making universal health coverage a more tangible reality across all socioeconomic divides.  
    • The scheme covers 6 crore senior citizens of age 70 years and above belonging to 4.5 crore families irrespective of their socio-economic status. 
  • Cumulatively, by early 2026, over 43 crore Ayushman cards have been issued. Also, 5.77 crore hospital admissions amounting to Rs. 1.15 lakh crore have been authorized for private hospitals, under the scheme. 
• Developing National Telemedicine Network: To bridge the severe doctor-patient ratio disparity in remote regions, India has aggressively scaled its national telemedicine service, eSanjeevani, making specialist consultations accessible via smartphones. 
  • Operating on a hub-and-spoke model, this digital intervention connects peripheral health centers with specialized medical professionals in urban tertiary hubs.  
    • This reduces the logistical and financial burden of medical travel while providing timely medical interventions to underserved communities.  
  • Demonstrating massive digital health equity, the eSanjeevani platform crossed an unprecedented milestone of over 43 crore teleconsultations by late 2025.  
• Affordable Pharmaceuticals (Jan Aushadhi Kendras): The Pradhan Mantri Bhartiya Janaushadhi Pariyojana (PMBJP) actively combats pharmaceutical inflation by providing high-quality generic medicines at significantly reduced costs.  
  • By eliminating exorbitant corporate branding and marketing markups, these state-backed dispensaries make chronic disease management financially sustainable for low-income households.  
  • As of March 2026, the network has expanded to over 18,000 functional Jan Aushadhi Kendras across all Indian districts, supplying medicines at 50% to 80% lower prices.  
    • The government is currently utilizing a franchise-based model to aggressively pursue its target of establishing 25,000 Kendras by March 2027. 
• Primary Healthcare Upgradation: India is fundamentally decentralizing primary healthcare by upgrading existing sub-health centers and primary health centers into comprehensive Ayushman Arogya Mandirs (AAMs).  
  • These centers shift the systemic focus from reactive illness treatment to proactive wellness, maternal care, and non-communicable disease (NCD) screening.  
  • Equipped with modern IT systems, essential diagnostics, and additional human resources, they serve as the crucial first point of medical contact for rural citizens.  
  • Under the PM-ABHIM framework, the government has committed ₹64,180 crore between 2021 and 2026 to fortify these grassroots health facilities.  
    • Further, the Union Budget 2026-27 has provided an ₹4,770 crore to PM-ABHIM to continue this momentum, focusing on specialized labs and critical care blocks 
• Medical Education and Workforce Expansion: Addressing the chronic scarcity of qualified healthcare professionals, the government has executed a massive infrastructural push to establish new medical colleges and tertiary institutions.  
  • By systematically relaxing establishment norms and integrating district hospitals with medical colleges, the country is rapidly increasing its domestic output of doctors and nursing staff.  
  • This localization of medical education inherently improves the geographic distribution of specialized healthcare providers across historically underserved states.  
  • The past decade has witnessed a dramatic surge, with the total number of medical colleges jumping from 387 to over 800. 
    • Furthermore, the operationalization of over 20 new All India Institutes of Medical Sciences (AIIMS) has successfully decentralized elite tertiary care away from metropolitan centers. 
• AI-Driven Health-Tech Innovations: The integration of Artificial Intelligence into public health surveillance and diagnostic frameworks is drastically reducing diagnostic turnaround times and improving clinical accuracy.  
  • The National Health Authority (NHA) and ICMR spearheaded the Federated Intelligence Hackathon to develop AI-based Digital Public Goods tailored for public health.  
    • Concurrently, the nationwide deployment of the Clinical Decision Support System (CDSS) within the eSanjeevani platform is actively assisting doctors in making evidence-based diagnostic decisions. 
  • Also, India is now pioneering the SAHI (Strategy for AI in Healthcare) and BODH platforms to use data for proactive rather than reactive health interventions. 
• Digital Immunization Registries (U-WIN Portal): Replicating the monumental success of the CoWIN platform, India has transitioned its routine immunization program into a fully digitized ecosystem through the U-WIN portal.  
  • This digital registry meticulously tracks every pregnant woman and newborn, ensuring timely administration of critical vaccines and sending automated reminders to reduce dropout rates.  
  • Such real-time data visibility allows health administrators to micro-plan vaccine supply chains and identify geographical gaps in immunization coverage.  
  • As of February 2026, The U-WIN system digitizes the records for over 3.7 crore pregnant women and 11.12 crore infants annually across India.  
    • By replacing manual registers, it issues verifiable digital vaccination certificates and completely eliminates the risk of lost immunization histories for migrant families. 
• Maternal and Child Nutritional Health: Recognizing that equitable healthcare begins with systemic malnutrition eradication, India has converged multiple maternal and child health initiatives under the umbrella of Poshan Abhiyan.  
  • By integrating Anganwadi services with cash transfer schemes like the PM Matru Vandana Yojana, the state incentivizes institutional deliveries and ensures proper maternal nutrition.  
    • This multidimensional life-cycle approach significantly mitigates neonatal mortality, stunting, and maternal anemia in economically deprived regions.  
  • Under PM Matru Vandana Yojana, as of July 2025, more than 4.05 crore beneficiaries have been paid the maternity benefit (at least one instalment), through direct benefit transfer in their bank/post office accounts. 
  • Integrated with the digital Poshan Tracker application, the government now actively monitors the daily nutritional status of over 10 crore beneficiaries nationwide. 
• Public-Private Partnerships and Drone Logistics: To overcome severe infrastructural deficits in tier-2 and tier-3 cities, the government is aggressively leveraging Public-Private Partnerships (PPP) and advanced logistical technologies like medical drones.  
  • Viability Gap Funding (VGF) incentivizes private healthcare conglomerates to build multi-specialty hospitals in under-penetrated rural areas, effectively expanding the PM-JAY provider network.  
  • Meanwhile, drone-based medical deliveries bypass difficult geographical terrains, ensuring rapid supply of vaccines, blood, and emergency medications to remote outposts.  
    • Through ICMR’s i-Drone initiative, drone logistics are now routinely utilized in states like Himachal Pradesh to deliver essential medical supplies in a fraction of the traditional transit time.  
  • Additionally, over 15,733 private hospitals are currently empaneled under the PM-JAY scheme, highlighting the successful integration of private capital in public healthcare delivery. 

What are the Key Persisting Issues Preventing Universal Healthcare Access in India?  

• High Out-of-Pocket Expenditure (OOPE) Burden: Despite the massive expansion of public insurance schemes, crippling out-of-pocket expenditure remains a formidable barrier to true universal healthcare access in India. 
  • Consequently, millions are repeatedly pushed into medical poverty traps because existing insurance frameworks disproportionately prioritize tertiary inpatient care over everyday outpatient expenses.  
  • Recent national health accounts indicate that OOPE still constitutes approximately 39% of total health expenditures, severely burdening lower-income demographics.  
• Severe Urban-Rural Infrastructure Maldistribution: The stark geographical maldistribution of healthcare infrastructure creates an entrenched structural inequality that systematically disenfranchises India's rural majority.  
  • While metropolitan centers boast world-class corporate hospitals and advanced diagnostic hubs, peripheral regions suffer from chronically dilapidated primary and secondary care facilities.  
    • This severe infrastructural asymmetry forces rural patients to undertake arduous, costly physical migrations to urban centers for even basic life-saving medical interventions.  
  • Current distribution metrics highlight that nearly 70-75% of India's comprehensive healthcare infrastructure is concentrated in urban areas that serve only 30% of the total population. 
• Acute Deficit of Specialized Human Resources: A chronic scarcity of specialized medical professionals at the grassroots level fundamentally cripples the operational clinical efficacy of rural public health facilities.  
  • The systemic inability to incentivize surgeons, gynecologists, and pediatricians to serve in remote geographies drastically diminishes the quality of localized secondary care available to marginalized communities.  
  • This persistent talent vacuum forces high-risk patients to bypass unequipped local centers entirely, overwhelming tertiary city hospitals and fatally delaying critical clinical interventions.  
  • The Rural Health Statistics 2023 report shows that there is a shortfall of more than 80% of the required surgeons and paediatricians in the 6,064 Community Health Centres across the country. 
• Persisting Digital Divide in Health-Tech: While digital health missions are rapidly modernizing data registries, a formidable digital divide fundamentally restricts equitable public access to these highly praised technological advancements.  
  • For instance, the National Statistics Office (NSO) Comprehensive Modular Survey 2025 shows a persistent digital gender divide, with 51.6% of rural women lacking personal mobile phone ownership.  
    • Rapid health-tech innovations inadvertently create a new tier of technological exclusion, disproportionately benefiting urban digital natives while leaving digitally marginalized populations further behind.  
• Chronically Low Macroeconomic Health Financing: The systemic underfunding of the public health sector at the macroeconomic level severely constrains the state's capacity to absorb the soaring structural costs of universal healthcare.  
  • Insufficient budgetary allocations aggressively limit the upgrading of primary care networks, stall the procurement of modern diagnostics, and strictly prevent the hiring of adequate medical personnel.  
  • According to Reserve Bank of India data, the Union government's health expenditure declined from 0.37% of GDP in 2020-21 to 0.29% in 2025-26. 
    • This chronic fiscal conservatism directly translates into weakened public health resilience, ultimately forcing desperate citizens to rely on expensive, unregulated private healthcare providers.  
• Weak Regulatory Oversight and Quality of Care: The profound absence of robust regulatory enforcement regarding clinical protocols and quality standardization severely jeopardizes patient safety, particularly across the deeply unorganized private sector. 
  • Widespread clinical malpractices, the highly irrational prescription of powerful antibiotics, and a fundamental lack of standard treatment guidelines lead to substandard care and the systemic exploitation of vulnerable patients.  
  • A report by World Health Organization (WHO) shows that 1 in every 6 bacterial infections globally was resistant to antibiotics, with India being one of the biggest contributors to this alarming pattern of antimicrobial resistance (AMR). 
  • This led to an estimated 297,000 deaths directly linked to AMR in India in 2019, with the "silent pandemic" projected to worsen if stewardship is not enforced. 
• Supply Chain Fragility and Essential Drug Stockouts: Severe operational inefficiencies and fragmented logistics within the public health supply chain persistently cause critical stockouts of essential diagnostic reagents and vital life-saving medicines.  
  • Bureaucratic bottlenecks in centralized procurement processes and highly inadequate last-mile cold chain management constantly disrupt the continuous availability of critical therapeutics at rural state dispensaries.  
    • This systemic supply chain fragility literally forces patients to purchase essential baseline drugs from high-priced private pharmacies, actively undermining the financial protection promised by public health schemes.  
  • For instance, the central government flagged concerns that some state-level hospitals hold less than 40% of required essential stocks, prompting a national "alarm bell" for procurement reform. 
• The Escalating Burden of Non-Communicable Diseases: India is currently grappling with a massive epidemiological transition where the exponential surge in chronic non-communicable diseases (NCDs) is systematically overwhelming the foundational primary healthcare infrastructure.  
  • Because the existing rural health architecture was historically designed for acute infectious disease management and maternal care, it remains fundamentally under-equipped for complex, longitudinal NCD treatment.  
  • Recent ICMR epidemiological data from 2025 demonstrates that NCDs now account for a staggering 63- 66% of all national mortalities, heavily driven by cardiovascular conditions and late-stage oncology.  
    • Specifically, according to the Indian Council of Medical Research-India Diabetes survey, 11.4% of adults have diabetes and 15.3% are pre-diabetic. 
• Structural Marginalization of Tribal Populations: Deep-rooted social determinants and severe geographical isolation systematically prevent India's indigenous and tribal populations from accessing equitable primary and secondary healthcare services.  
  • Formidable linguistic barriers, cultural disconnects with modern allopathic medical practitioners, and the sheer physical inaccessibility of forested or hilly terrains create profound blind spots in state public health outreach. 
  • For instance, according to the NFHS-5 (2019–21), the Under-Five Mortality Rate (U5MR) among the Scheduled Tribe (ST) population was 50 deaths per 1,000 live births, significantly higher than the national average of 41.9, highlighting persistent disparities in healthcare access and outcomes for tribal communities. 
• Over-reliance on the Profit-Driven Private Sector: The historical, systemic deterioration of public health facilities has inadvertently fostered an immense national over-reliance on a highly fragmented, aggressively profit-driven private healthcare sector.  
  • Because the private sector predominantly operates on a fee-for-service model without strict national price capping, it intrinsically prioritizes financial maximization over equitable patient welfare.  
  • This structural over-dependence relentlessly forces desperate citizens to engage in massive distress financing and severe asset liquidation just to procure emergency care that the state fundamentally fails to provide.  
  • For instance, according to a study by the World Health Organization, nearly 70% of outpatient care and about 60% of inpatient treatments in India are delivered by the private sector.  
    • This heavy reliance highlights the limited capacity and accessibility of the public healthcare system, especially for affordable care.

What Measures Are Needed to Improve Healthcare Access and Equity in India? 

• Institutionalizing Sovereign Health Financing: To secure sustainable macroeconomic health financing, India must institutionalize dedicated sovereign health bonds and ring-fenced public health cesses to guarantee predictable fiscal space for systemic modernization.  
  • This targeted fiscal decentralization empowers state governments to scale public health spending independently of volatile central budgetary allocations, ensuring uninterrupted capital flow toward rural primary care upgrades. 
• Deploying Deep-Tech Clinical Decision Support: Integrating interoperable, deep-tech clinical decision support systems within grassroots health facilities can structurally mitigate the chronic deficit of rural medical specialists.  
  • Deploying federated machine learning algorithms across the digital public infrastructure enables frontline workers to standardize diagnostic accuracy, ensuring predictive and precision medicine reaches the last mile without requiring immediate physical specialist presence. 
• Establishing an Autonomous Regulatory Authority: Achieving true equity necessitates the establishment of an independent, decentralized national regulatory authority equipped with statutory powers to ruthlessly enforce standardized clinical protocols across the fragmented private sector.  
  • By legally capping exorbitant out-of-pocket outpatient pricing and aggressively auditing facility quality, this governance framework curtails clinical exploitation and ensures standardized patient safety irrespective of geographic location. 
• Restructuring Medical Education and Retention: To rectify the severe maldistribution of healthcare personnel, medical education policies must pivot toward mandating staggered rural service bonds for specialized postgraduate medical degrees.  
  • Coupling these structural mandates with performance-linked financial incentives and localized hardship allowances for difficult terrains will systematically attract and retain critical human capital within historically marginalized districts. 
• Automating Decentralized Supply Chains: Overhauling the fragile public health logistics network requires the implementation of blockchain-enabled, end-to-end supply chain visibility to eradicate systemic inefficiencies and pilferage.  
  • Shifting toward predictive, automated decentralized procurement models ensures the continuous availability of critical therapeutics and fortifies cold-chain resilience, effectively eliminating life-threatening essential drug stockouts at rural dispensaries. 
• Converging Primary Care with Social Welfare: Decentralizing the architectural focus from reactive tertiary treatments to proactive primary prevention requires transforming existing sub-centers into holistic, community-integrated wellness hubs.  
  • By converging robust non-communicable disease screening protocols with localized nutritional security interventions, this multidimensional social welfare approach fundamentally curtails the systemic escalation of chronic lifestyle morbidities before they require hospitalization. 
• Redesigning Outpatient-Centric Insurance: Publicly funded health insurance architectures must be aggressively restructured to comprehensively absorb the financial burden of routine outpatient consultations, diagnostics, and pharmaceutical purchases.  
  • Shifting the insurance paradigm away from exclusively covering catastrophic inpatient procedures directly nullifies the primary driver of everyday out-of-pocket expenditures, actively shielding vulnerable demographics from sudden medical poverty traps. 
• Incentivizing Viability Gap Funding (VGF) Models: Expanding infrastructural capacity in deeply underserved tier-3 and tier-4 geographies demands strategically calibrated, outcome-based public-private partnerships.  
  • Utilizing specialized viability gap funding structures incentivizes corporate healthcare conglomerates to establish advanced multi-specialty facilities in rural hinterlands, effectively democratizing access to high-quality tertiary care while mitigating state infrastructural deficits. 
• Devolving Health Administrative Autonomy: Institutionalizing community-led healthcare governance by devolving substantial financial and administrative autonomy to democratically elected Panchayati Raj institutions ensures hyper-localized accountability.  
  • This decentralized administrative empowerment allows marginalized communities to tailor localized public health interventions, fostering culturally sensitive care delivery and directly addressing the structural exclusion of indigenous and tribal populations. 
• Institutionalizing 'One Health' Surveillance: Fortifying long-term national health security necessitates the structural implementation of a unified "One Health" epidemiological surveillance architecture that seamlessly integrates environmental, veterinary, and human health data matrices.  
  • This multidimensional, predictive framework allows public health administrators to preemptively identify zoonotic spillover events and localized outbreaks, enabling proactive containment strategies rather than reactive crisis management. 

Conclusion:

Achieving universal healthcare in India requires transitioning from a fragmented, reactive system to a digitally integrated, preventive model that prioritizes the "last mile." While initiatives like PM-JAY and ABDM have laid a robust foundation, success hinges on reducing out-of-pocket burdens and rectifying the stark urban-rural infrastructural divide. Ultimately, a "One Health" approach, backed by sustained macroeconomic funding, is essential to realize the vision of a resilient and equitable Viksit Bharat. 

Drishti Mains Question

The shift from 'Sick-care' to 'Wellness-care' is central to India's healthcare transformation. Evaluate the role of Ayushman Arogya Mandirs in decentralizing primary healthcare and managing the rising NCD burden.

FAQs

Q. What is the primary goal of the ABHA ID?
To create an interoperable digital health identity for seamless access to longitudinal medical records across providers. 

Q. How does PM-JAY protect senior citizens?
The Ayushman Vay Vandana card provides cashless hospitalization cover for all citizens aged 70 and above, regardless of income. 

Q. What is the 'Hub and Spoke' model in eSanjeevani?
It connects peripheral Health Wellness Centers (Spokes) to specialized doctors in large tertiary hospitals (Hubs) via teleconsultation. 

Q. Why is 'Out-of-Pocket Expenditure' (OOPE) a major concern?
It forces families to pay for healthcare from savings, often leading to debt or poverty due to lack of outpatient coverage. 

Q. What is the function of the U-WIN portal?
It is a permanent digital registry for the Universal Immunization Programme, tracking vaccinations for every pregnant woman and child. 

UPSC Civil Services Examination, Previous Year Questions (PYQs)

Prelims 

Q. Which of the following are the objectives of ‘National Nutrition Mission’? (2017)

1. To create awareness relating to malnutrition among pregnant women and lactating mothers.   
2. To reduce the incidence of anaemia among young children, adolescent girls and women.   
3. To promote the consumption of millets, coarse cereals and unpolished rice.   
4. To promote the consumption of poultry eggs.   

Select the correct answer using the code given below:   

(a) 1 and 2 only

(b) 1, 2 and 3 only

(c) 1, 2 and 4 only

(d) 3 and 4 only

Ans: (a)

---

Mains

Q. “Besides being a moral imperative of a Welfare State, primary health structure is a necessary precondition for sustainable development.” Analyse. (2021)