Reimagining Health Access for a Viksit Bharat

• 11 Dec 2025

This editorial is based on “Road map for universal health coverage in India” which was published in The Hindustan Times on 10/12/2025. The article brings into picture India’s push toward UHC by 2030 amid rising pressures from ageing populations, rapid urbanization, and climate change. It highlights the need for stronger care linkages, multi-sectoral coordination, and a Right to Health law to shift from Universal Health Coverage to Universal Health Assurance.

For Prelims: Universal Health Coverage(UHC) Day,  Pradhan Mantri Jan Arogya Yojana (PM-JAY), Ayushman Arogya Mandirs (AAMs), Ayushman Bharat Digital Mission, Ni-Kshay Mitras, PM Ayushman Bharat Health Infrastructure Mission, Non-Communicable Diseases, Economic Survey 2024-25.  

For Mains: India’s Progress Towards Achieving Universal Health Coverage, Critical Roadblocks that Impede India’s Journey to Universal Health Coverage

India will observe Universal Health Coverage(UHC) Day on December 12, marking a critical juncture in its journey toward UHC by 2030 and Viksit Bharat by 2047. The nation's health system must become agile, adaptive, and anticipatory to deliver equitable healthcare while addressing emerging challenges from demographic shifts, rapid urbanization, and climate change. With 193 million Indians expected to be over 65 by 2030 and 40% living in urban areas, the healthcare infrastructure faces unprecedented pressure. The path forward demands bridging gaps between primary, secondary, and tertiary care. Success ultimately requires multi-sectoral collaboration backed by strong legislation, to transform the vision of Universal Health Coverage into Universal Health Assurance.

How has India Progressed Towards Achieving Universal Health Coverage? 

• Financial Democratization via PM-JAY: The Pradhan Mantri Jan Arogya Yojana (PM-JAY) has effectively decoupled healthcare quality from financial status, functioning as a critical safety net against catastrophic health expenditure (CHE).  
  • By expanding coverage to senior citizens (70+) regardless of income in late 2024, it has transitioned from a pro-poor scheme to a broader social security entitlement, ensuring equitable access to secondary and tertiary care. 
  • As of July 2025, over 41 crore Ayushman Cards have been created and more than 9.84 crore hospital admissions worth over Rs. 1.40 lakh crore have been authorized under the scheme.  
• Primary Care Transformation (Ayushman Arogya Mandirs and Tele-MANAS): India has shifted its health paradigm from "illness to wellness" by upgrading Sub-Centres into Ayushman Arogya Mandirs (AAMs).  
  • These centers bridge the rural-urban divide by providing Comprehensive Primary Health Care (CPHC), moving beyond maternal care to include screening for non-communicable diseases (NCDs) like cancer and diabetes closer to community doorsteps.  
  • By October 2025, India operationalized 1.80 lakh AAMs, surpassing targets. These centers have conducted over 38.79 crore screenings for hypertension, acting as the first line of defense. 
    • As of November 2025, 36 States/ UTs have set up 53 Tele-MANAS Cells. Also, Tele-MANAS services are available in 20 languages based on the language opted by the States.  
• Digital Health Backbone (ABDM): The Ayushman Bharat Digital Mission (ABDM) is revolutionizing the ecosystem by creating a Unified Health Interface (UHI), making patient records interoperable and portable.  
  • This "Digital Public Infrastructure" approach eliminates fragmented data, enabling longitudinal health history tracking and facilitating seamless telemedicine access for remote populations.  
  • As of August 2025, 79.91 crore ABHA IDs (health accounts) have been created. eSanjeevani has facilitated over 43 crore teleconsultations, expanding digital health access nationwide through the integration of ABHA and ABDM, serving as the world's largest government-owned telemedicine network. 
• Pharmaceutical Affordability (PMBJP): The Pradhan Mantri Bhartiya Janaushadhi Pariyojana (PMBJP) has aggressively tackled the high cost of medicines, which constitutes the bulk of out-of-pocket expenditure.  
  • By scaling up the network of dedicated outlets, the government has standardized the availability of high-quality generic drugs at prices significantly lower than branded equivalents, ensuring treatment adherence. 
  • As of June 2025, over 16,000 Janaushadhi Kendras are functional across all districts.  
    • Also, Jan Aushadi outlets have saved about Rs 38000 crore for the citizens over the last 11 years.  
• Aggressive Disease Elimination (TB Mukt Bharat): Adopting a "mission mode" approach, India has demonstrated global leadership in disease elimination, particularly with the National TB Elimination Program.  
  • By leveraging AI-assisted diagnostics and community engagement (Ni-Kshay Mitras), India is reducing incidence rates faster than the global average, addressing the social determinants of health through nutritional support.  
  • India’s TB incidence dropped by 21% (2015-2024), double the global decline rate. Treatment coverage increases to 92%, placing India ahead of other high-burden countries.  
• Supply-Side Augmentation (Medical Education): To correct the historical doctor-population skew, the government has implemented structural reforms in medical education, including the establishment of new AIIMS and deregulation of college setups.  
  • This ensures a sustainable pipeline of healthcare professionals (doctors and nurses) to meet the WHO recommended ratios in the coming decade.  
  • Number of MBBS seats increased by 118% from 51,000 before 2014 to more than 1.12 lakh recently.  
    • Additionally, 157 new nursing colleges were recently approved to strengthen the allied healthcare workforce in underserved districts. 
• Health Infrastructure Resilience (PM-ABHIM): Post-pandemic, the PM Ayushman Bharat Health Infrastructure Mission (PM-ABHIM) focuses on building long-term resilience against future outbreaks.  
  • By establishing Critical Care Blocks (CCBs) and Integrated Public Health Labs at the district level, the state is decentralizing critical care, ensuring that robust testing and treatment facilities are available without traveling to metros. 
  • With an outlay of ₹64,180 crore, the mission is setting up 730 Integrated Public Health Labs in all districts.  

What Critical Roadblocks Impede India’s Journey to Universal Health Coverage? 

• The "Urban Vacuum" & Workforce Skew: While India has technically achieved a WHO-compliant doctor-population ratio of 1:811, this aggregate number masks a "national inequity" where medical professionals are hyper-concentrated in urban metros, creating an "urban vacuum" that sucks talent away from the hinterland.  
  • This structural imbalance leaves rural Community Health Centers (CHCs) critically understaffed, functioning merely as referral points rather than treatment centers.  
  • As of 2025, while Goa enjoys a doctor density of 1:335, Bihar lags severely. Recent Rural Health Statistics indicate an 80% shortfall of specialists (surgeons, pediatricians) in rural CHCs, forcing patients to travel 50-100km for basic secondary care. 
• The "Missing Middle" & Outpatient Burden: Current insurance models like PM-JAY focus heavily on secondary/tertiary hospitalization, largely ignoring outpatient (OPD) care which constitutes the bulk of daily medical expenses.  
  • This leaves the "missing middle", the economically vulnerable class just above the poverty line who don't qualify for PM-JAY but cannot afford private insurance, exposed to poverty-inducing spending on diagnostics and medicines. 
  • As per the Economic Survey 2024-25, India’s OOPE stands at 39.4%, with outpatient care, diagnostics, and medicines emerging as the primary contributors. 
    • Roughly 55-60 million Indians are pushed into poverty annually due to these uncovered medical costs. 
• Dual Disease Burden: India is fighting a war on two fronts: it has not yet fully conquered infectious diseases (TB, Malaria) while simultaneously facing an explosion of "lifestyle" Non-Communicable Diseases (NCDs) like diabetes and cancer.  
  • This "epidemiological transition" requires a health system capable of managing acute infections and expensive, lifelong chronic care, straining resources originally built only for the former.  
  • NCDs now account for 63% of all deaths in India. They are also expected to cost India $3.55 trillion in lost economic output between 2012 and 2030.  
    • In 2024, India was dubbed the "Cancer Capital of the World," with incident cases rising faster than the global average. 
  • Also, Antimicrobial resistance (AMR) has become a major health issue, with around 6 lakh lives lost in India each year due to resistant infections. 
• Stagnant Public Spending & Fiscal Federalism: Despite repeated policy commitments (National Health Policy 2017), India’s public health expenditure has failed to break the 2.5% of GDP ceiling, hovering stubbornly lower.  
  • This chronic underfunding forces states, who bear the primary constitutional responsibility for health, to rely on "mission-mode" central grants (like NHM) rather than building permanent, autonomous state health capacities. 
  • In 2023-24, public health spending stood at roughly 1.9% of GDP. Consequently, India has just 1.3 hospital beds per 1,000 population. 
• The "Digital Divide" in Digital Healthcare: The Ayushman Bharat Digital Mission (ABDM) aims to create a seamless digital backbone, but it faces a hard "analog reality" where digital illiteracy and infrastructure gaps in rural India create an exclusionary wall. 
  • Without universal smartphone access and connectivity, "app-based" healthcare solutions risk becoming a privilege for the urban elite rather than a tool for rural equity.  
  • While more than 79.91 crore ABHA IDs exist, active usage remains low in Tier-3 towns due to frequent server down-times and lack of digital readiness at PHC levels. 
• Unregulated Private Sector Dominance: The private sector provides nearly 70% of healthcare services in India but operates in a regulatory "Wild West" with weak enforcement of the Clinical Establishments Act.  
  • This leads to rampant price variation, irrational treatments, and "supply-induced demand" (unnecessary surgeries/tests), which the government struggles to control without a unified payer monopoly.  
  • The World Health Organization (WHO) recommends that the percentage of cesarean deliveries should not exceed 10% to 15% in any nation. However, in the private sector in India, these numbers stand at 43.1% (2016) and 49.7% (2021), meaning that nearly one in two deliveries in the private sector is a C-section. 
• Governance & Implementation Fragmentation: Health is a state subject, but policy is often centrally designed, leading to "implementation fragmentation" where schemes like PM-JAY face resistance or modification by states (e.g., West Bengal).  
  • This lack of a "One Nation, One Health System" approach results in non-portable benefits and disjointed surveillance systems that fail to talk to each other during outbreaks.  
  • Several states still run their own parallel health schemes with different software, preventing full portability of PM-JAY benefits for migrant workers.  

What Measures can India Adopt to Achieve Universal Health Coverage?  

• Mandatory "Gatekeeper" Referral Mechanism: India must institutionalize a strict "Graduated Referral System" where primary care centers (Ayushman Arogya Mandirs) act as the mandatory entry point for non-emergency care.  
  • This filters out minor ailments at the local level, preventing the choking of tertiary hospitals with secondary cases and optimizing specialist resource allocation.  
  • By enforcing this triage, the state ensures that high-cost hospital infrastructure is reserved for critical care, significantly improving system efficiency and reducing waiting times. 
• Strategic Purchasing & Value-Based Care: The government must shift from being a passive payer to an active "Strategic Purchaser" of health services from the private sector.  
  • Instead of fee-for-service models that encourage unnecessary tests, the state should adopt "capitation-based" or "bundled payment" models that reward providers for patient recovery outcomes rather than the volume of procedures. 
  • This aligns private sector incentives with public health goals, capping cost escalation while leveraging private infrastructure for public coverage. 
• Task Shifting to Mid-Level Health Providers (MLHPs): To bypass the chronic shortage of MBBS doctors, the system must aggressively implement "Task Shifting" by legally empowering Community Health Officers (CHOs) and nurse practitioners to prescribe basic medicines and manage routine chronic diseases.  
  • Creating a dedicated cadre of "Rural Medical Practitioners" with bridge courses allows for the decentralization of clinical care to the sub-centre level. 
  • This ensures that essential health services reach the "last mile" without being held hostage by the reluctance of specialists to serve in rural hinterlands. 
• "Health in All Policies" (HiAP) Framework: UHC must move beyond the Health Ministry by adopting a "Health in All Policies" legislative framework that mandates Health Impact Assessments (HIA) for large-scale projects in transport, urban planning, and agriculture.  
  • This inter-sectoral convergence addresses the "Social Determinants of Health", such as air quality, road safety, and nutrition, at the source.  
  • By treating health as an ecological outcome of development, the state reduces the downstream clinical burden on hospitals. 
• Urban Health Mission 2.0 (Poly-Clinics): A dedicated focus is needed on the "invisible urban poor" through a revitalized National Urban Health Mission that establishes evening-shift "Mohalla Clinics" or Polyclinics tailored to the working hours of daily wage earners.  
  • Unlike the rural tiered structure, urban health requires high-density, easily accessible outpatient units that integrate sanitation and vector control. This closes the coverage gap for slum populations who currently rely on quacks due to the overcrowding of major government hospitals. 
• "Continuum of Care" Integration: The digital health mission must evolve from simple record-keeping to a "Predictive Phygital Ecosystem" that uses AI to flag high-risk patients for proactive home visits by frontline workers (ASHAs).  
  • By integrating wearable technology data with the public health stack, the system can transition from "episodic curative care" to "continuous preventive monitoring."  
  • This digital tether allows for real-time surveillance and remote specialist interventions, breaking the geographical barriers of healthcare access. 
• Towards One Health Approach & Community Oversight: India must adopt a One Health framework that integrates human, animal, and environmental health to prevent zoonotic outbreaks and antimicrobial resistance.  
  • This should be complemented by social audits through Jan Arogya Samitis and Rogi Kalyan Samitis, enabling local communities to monitor hospital performance, service delivery, and resource utilization.  
  • By combining ecological health monitoring with grassroots accountability, the system ensures preventive care, improves trust in public health institutions, and strengthens Universal Health Coverage at the community level.

Conclusion:

India stands at a defining moment where the promise of Universal Health Coverage must evolve into Universal Health Assurance—guaranteeing not just access, but continuity, quality, and financial protection. The path ahead demands bold reforms: strengthening primary care, bridging rural–urban gaps, regulating the private sector, and institutionalizing a rights-based approach through robust legislation. If backed by sustained political will and multi-sectoral collaboration, India can transform its healthcare ecosystem into one that is equitable, resilient, and future-ready—laying the foundation for a truly healthy and Viksit Bharat by 2047.

Drishti Mains Question:

India’s march toward Universal Health Coverage (UHC) is marked by ambitious reforms but constrained by structural inequities. Discuss the key achievements and the major systemic barriers, and critically evaluate what policy interventions are needed to transition from UHC to Universal Health Assurance in India.

FAQs:

Q. What is Universal Health Coverage (UHC) and why is India focusing on it?
UHC means ensuring that every individual receives essential health services—preventive, promotive, curative, and rehabilitative—without financial hardship. India is prioritizing UHC to build a healthier population, reduce poverty from medical costs, and achieve the goals of Viksit Bharat 2047. 

Q. How has India progressed toward universal healthcare in recent years?
India has expanded financial protection through PM-JAY, strengthened primary care via Ayushman Arogya Mandirs, scaled digital health under ABDM, expanded affordable medicines through PMBJP, and enhanced disease elimination efforts and health infrastructure. 

Q. What are the biggest roadblocks preventing India from achieving UHC?
Key challenges include rural–urban workforce imbalance, high out-of-pocket expenditure due to limited OPD coverage, the dual burden of NCDs and infectious diseases, low public health spending, digital divide issues, and weak regulation of the private healthcare sector. 

Q. Why is bridging primary, secondary, and tertiary care essential for UHC?
Because most health issues can be resolved at the primary level, strengthening it reduces overcrowding of tertiary hospitals, improves efficiency, ensures early diagnosis, and lowers costs. A strong referral system is critical for effective resource use and equitable access. 

Q. What policy changes can help India move from UHC to Universal Health Assurance?
Key reforms include implementing a mandatory referral system, adopting value-based purchasing, empowering mid-level providers, strengthening urban health ecosystems, expanding digital health with equity, and enacting a Right to Health law for universal entitlements.

 

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)