Driving Health Reforms

India’s significant strides towards universal health coverage, with a firm commitment to improving the quality of life for all citizens is rooted in the National Health Policy 2017. It seeks to ensure that everyone has access to high-quality healthcare without financial hardship to elevate the overall well-being of every Indian, ‘leaving no one behind’.

The government's healthcare strategy is focused on providing equitable, affordable, and comprehensive primary healthcare at no cost through robust interventions designed to boost demand while simultaneously strengthening the healthcare system to meet this demand with high quality healthcare.

Raising Standards Across the Board
A critical component of this transformation is the Indian Public Health Standards (IPHS), revised in 2022 to align with government reforms under the flagship Ayushman Bharat initiative. These standards set minimum benchmarks for infrastructure, service delivery, and patient amenities at all healthcare facilities. Leveraging digital tools for self-assessment through an open-source app and a web-based IPHS dashboard these benchmarks are more accessible and actionable and enable facilities to identify areas for improvement and guide administrators in targeted interventions.

The revised IPHS ensure creation of a more reliable, resilient and efficient healthcare system. By leveraging technology for self-assessment, IPHS app and dashboard will help facilities to continuously improve and align with national benchmarks, ensuring better patient outcomes.

Quality Care: The Cornerstone of Health Reforms
Ensuring quality in healthcare is paramount, as it directly impacts patient outcomes and overall well-being. the National Quality Assurance Standards (NQAS) of the Ministry of Health and Family Welfare (MoHFW) aim to improve healthcare services across the board. NQAS certification ensures that healthcare facilities (HCFs) meet high standards in service provision, patient safety, clinical care, and support services. NQAS certification is a recognition to HCFs for their excellence in service delivery, which increases public trust and utilization. The continuous improvement required for maintaining NQAS certification ensures that HCFs consistently strive for better performance and patient care.

Ayushman Arogya Mandir: Saving cost while raising standards
The Ayushman Arogya Mandir (AAM) initiative under the National Health Mission (NHM) is a significant step towards enhancing access to quality comprehensive primary healthcare (CPHC). These centers focus on citizen priorities, providing comprehensive care that is both accessible and reliable.
A new cadre of Community Health Officers (CHO) is transforming CPHC at the AAM-Sub Health Centre (SHC) level. With more than 1.18 lakh CHOs now in place, the government has strengthened significant recent reforms to ensure availability of essential healthcare services to all with assured linkages and without financial hardship.

The essential list of drugs and diagnostics at the primary and secondary care level has been expanded to meet changing health needs. Now, individuals may not have to travel far for these services, thereby reducing both direct and indirect costs associated with seeking healthcare. This localized approach to healthcare delivery is crucial in ensuring that the benefits of these reforms reach every corner of the country. Additionally, these facilities are linked with the block public health labs and integrated district public health labs.

The government aims NQAS certification of 100 per cent of these HCFs by December 2026, leveraging virtual assessments to speed up the process and reduce costs. The financial implications of this virtual assessment approach are noteworthy. With a normative budget of Rs. 0.96 lakh for physical assessment of each AAM-SHC, the total budget for 1.58 lakh SHC-AAM would be 15.16 billion INR. However, if done virtually, this cost would reduce 16 times to just 0.94 billion INR, with a per AAM-SHC cost of Rs. 6,000.00, with a resultant massive saving of billions over next 2.5 years as all AAMs will get NQAS certified by December 2026. This ambitious plan demonstrates the government’s dedication to efficient spending and maximizing the impact of every rupee invested in health while leveraging technology.

Towards Universal Health Coverage
The government's increased investment in health is yielding tangible benefits. Government Health Expenditure as a share of Total Health Expenditure (THE) rose from 28.6% in 2013-14 to 48 per cent in 2021-22, with further increase anticipated as per policies. This shift has significantly reduced the Out-of-Pocket Expenditure for citizens, which dropped from 64.2 per cent to 39.4 per cent between 2013-14 and 2020-21. These figures highlight the government’s success in making healthcare more affordable and accessible to the general population.

With IPHS 2022 and NQAS at the forefront of health system strengthening, India is on track to achieve its universal healthcare goals. These efforts are grounded in the principle of ‘Antyodaya’—uplifting the most marginalized.  India's healthcare reforms represent a transformative journey towards a future where every citizen can enjoy the highest attainable standard of health. By focusing on quality, accessibility, and affordability, the government is paving the way for a healthier and more equitable society. These comprehensive efforts, marked by strategic investments and innovative approaches, underscore the nation's commitment to ensuring health and well-being for all.

Co-Author: Doctor Neha Dumka

Maj Gen (Prof) Atul Kotwal, SM, VSM

Guest Author Maj Gen Atul Kotwal is a public health professional with more than 39 years of experience and is currently heading National Health Systems Resource Centre (NHSRC), the premier think tank of MoHFW, as its Executive Director. Doctor Neha Dumka, a public health professional and is currently heading the Knowledge Management Division as Lead Cons, NHSRC.