The Political Pathway to Health System Improvements in India

Executive Summary

The Indian healthcare sector has made significant progress in the last few decades. The under-5 child mortality rate dropped from 126 in 1990 to 34 in 2019, life expectancy rose from 58 years in 1990 to 69.4 years in 2018, and polio, guinea worm disease, maternal, and neonatal tetanus were successfully eradicated from the country.

Lack of access, availability, affordability, and quality care have resulted in sub optimal health outcomes for India, well below many of its peer countries

Despite the progress, healthcare delivery in India remains largely focused on periodic treatment, with inadequate attention to preventive and primary care. With a predominantly family health and infectious disease focus, India’s health system is not well geared to deal with the increasing burden of noncommunicable diseases. Lack of access, availability, affordability, and quality care have resulted in sub optimal health outcomes for India, well below many of its peer countries, and a significant financial burden of health expenditure at the individual and household level.

In this paper, we analyse the political determinants of improved health outcomes, making a case for political attention to healthcare, through increased investments, healthcare reforms and improved capacity to deliver curative and public health. We build on both theoretical frameworks and global and sub national experience, to develop hypotheses for greater political priority to health in India.

The paper is divided into four sections. The first provides a brief summary of the key challenges in the health sector. The second locates these in the political economy of healthcare. The third offers a framework and hypotheses for political priority to health in India. The fourth and final section summarises global and sub national experience, as the rationale for the framework and hypotheses for India.