Health Status in India: Challenges and Opportunities

Executive Summary:

India has experienced considerable progress in health, in outcomes as also infrastructure. However, the task of addressing the health of India’s citizens remains an unfinished task.
This paper outlines some of the key challenges currently experienced in improving health outcomes in India, and opportunities to address them. This acknowledges the progress that has been made, but identifies what needs further attention. The paper takes a holistic view of health delivery in all its aspects; those in the purview of institutions dedicated to addressing health as well as aspects that go beyond the health sector, to broader structural issues that impact the effectiveness of health delivery. The paper is based on secondary analysis, and is a summary consolidation of various diagnostics and analytical work undertaken, and does not include any recommendations. This will serve as the base on which deeper insights—in terms of further questions, additional diagnostics, and suggested pathways—will be developed.
The paper is divided into three broad sections. The first outlines the health status in terms of India’s health outcomes, with a disaggregation across states, geography and identity, and comparison with other countries. The second outlines the architecture of the system that finances and delivers health. The third summarises the key challenges in the health system, across both public and private. It covers promotive, preventive and curative aspects, and begins with a discussion on public health (focused on health promotive and disease prevention) and primary healthcare (which includes elements of both public health and curative health). This is followed by a focus on curative healthcare in terms of the challenges in financing and provisioning. Beyond the specifics of health financing and provision, there are three additional overarching aspects that have a bearing on the financing and delivery of health services and consequently health outcomes. Of these, we discuss the governance of health, especially in terms of the capacity and accountability within the system and with respect to India’s federal structure. The last element focuses on the political economy of health which drives the priority to the health sector, the expenditure and the extent and nature of reforms.