Healthcare Vision Under Viksit Bharat 2047
Key milestones and initiatives to drive India's health sector forward
The Government of India announced the theme of "One Earth, One Health" during the G-20 summit, with the goal of "Wellness and Welfare for everyone - physical, mental, and social well-being." With this vision in mind, and based on my 35 years of experience dealing with health departments in the Governments of Delhi, Goa, Daman Diu, and Lakshadweep, I pen the following 15 ideas to help facilitate Health for All by 2047.
India has 788 districts, but only 706 medical colleges exist in about 500 districts. This indicates that around 300 districts lack medical colleges, highlighting a concentration in metro cities. The COVID-19 pandemic taught us the importance of having hospitals with adequate infrastructure near the population for survival. Therefore, it is imperative to cover all 788 districts with a medical college, both public and private, to ensure decentralised medical education and a 500-bedded hospital within 50-100 km of residents' district headquarters. This would ensure good secondary and tertiary healthcare for all.
India has 2.55 lakh gram panchayats and 3,600 urban local bodies. Our healthcare structure comprises primary health centers (about 25,000 in rural areas and 6,000 in urban areas), community health centers (about 5,500 in rural areas and 600 in urban areas), and district hospitals. While the healthcare sector employs 7.5 million people, the doctor-to-patient ratio is abnormally low at 1:1500. The number of allopathic doctors registered with the national and state medical councils is about 1.3 million. There is a 10 per cent deficit of qualified doctors in primary health centres and an 80 per cent deficit of specialists in community health centres. District hospitals are no better.
MBBS seats have reached 1.1 lakh today, and postgraduate seats 65,000, but these are not enough to cater to a developed India with health for all. Enhancing MBBS seats in all public medical colleges, along with PG and super-speciality seats like DM, alone can bring us closer to achieving a reasonable doctor-patient ratio and medical care availability in the far-flung corners of this large country. The NEET exam controversy must be addressed by creating a system like the CAT exam, where IIMs by rotation are responsible for the entire examination proceedings. This can be replicated by some of the reputed 23 AIIMS now operational.
There are 26,400 dispensaries across the country to serve the semi-urban and urban populations. It is important to assess their geographical spread to ensure that no densely populated area is left out. Appropriate infrastructure, healthcare facilities, and adequate nursing and paramedical staff must be provided in these locations to ensure Health for All becomes a reality.
India has only 1,936 nursing colleges, and 40 per cent of the districts are uncovered so far. There is a marked shortfall of qualified nurses in rural India. My suggestion is that a nursing college should be allowed to complement each medical college in every district, as approved by the Nursing Council of India. Both the Central and State governments need to be proactive in creating nursing colleges where the demand exists. Creating an excess of nursing colleges is also desirable as it provides a great opportunity for exporting such services, which are in large demand abroad.
A concerted, planned, and data-based approach is required to ensure that basic medical device infrastructure is available in all our primary health centres, community health centres, dispensaries, and district hospitals. This would enable all required testing to be done locally, rather than sending patients elsewhere. India has started producing most of the basic medical devices, making this feasible. District hospitals and medical colleges need to be equipped with the latest equipment required for all major diseases to ensure self-sufficient healthcare coverage throughout India.
In Digital India, we still lack a system for collecting data on medicine shortages in each medical centre and ensuring their quick and complete replenishment. Irregularities in medicine purchase and distribution are common, causing acute inconvenience to the public. A fully automated medicine procurement and dissemination process is the need of the hour. The Pharmacy Council of India must address the availability of fake medicines quickly through appropriate checks and balances, regular inspections, strict quality testing of drugs, and severe penal action.
There is an extensive shortage of medical technicians of all kinds in health centres across the country. Exact figures for the demand-supply gap are not available. However, the Healthcare Sector Skill Council, promoted by the CII and the National Skill Development Corporation, needs significant upgradation to ensure skill-wise data gaps are identified and institutions are located or created to provide skill development in the allied healthcare sector to fulfil the needs of a developed India.
Top-class super-specialty hospitals, both public and private, exist in India but demand far exceeds supply. Enhancing the availability of super specialists is essential to staff existing hospitals and new ones being created to meet the country's requirements. Similarly, new technologies like robotic surgery, stem cell research and applications, ease of organ transplantation including 3D printing of organs, and longevity solutions through new and developing technologies are areas where India should not lag. New inventions include wearables for checking febrile symptoms, machine learning for medical image analysis, smartphone apps for digital contact tracing, online search engines for accurate information, teleconferencing and telemedicine facilities in remote areas, chatbots for personalised information, and nanotechnology for efficient sensing and imaging. Additionally, the Internet of Medical Things to create interconnected communication for biomedical devices, facilitating virtual interaction between physicians and patients, is desirable. Big data analytics to improve decision-making, and mobile health labs with facilities for rapid diagnosis, better patient monitoring, and spatial tracking are equally vital.
Regulating private medical colleges for the quality of instruction and intake methods requires a complete overhaul by the Medical Council of India and the Ministry of Higher Education, in consultation with the Ministry of Health. The NEET exam scandal has revealed admissions of candidates with substandard results in private colleges. Hence, mandatory grading by NAAC, NBA, and NIRF has become imperative. Regular inspections to ensure faculty with the right qualifications and labs with appropriate facilities are available in these medical colleges cannot be overemphasized.
Indian students going abroad for study involves an annual forex outflow of nearly USD17 billion, with a significant portion accounted for by medical students seeking admissions wherever available. Since NEP allows foreign universities to set up facilities in India, a planned approach to get the best medical education in India under this dispensation is the need of the hour. Visits abroad should be only for the latest technologies and scientific discoveries, rather than for basic graduate and postgraduate studies.
For all non-allopathic branches of medicine, which have been traditional cures in India, the AYUSH Ministry needs to create evidence-based medication that has scientific reliability through thorough research and vigorous clinical trials. This will ensure the public is not duped. The AYUSH Ministry needs to substantially upgrade itself to create an integrated model that can advance a preventive and curative healthcare strategy, holistically contributing to community health. International Day of Yoga is celebrated on June 21 since 2015 when the UNGA adopted it. The 5.6 lakh AYUSH doctors in India spread across all states must receive due recognition.
With rising tensions on several accounts, even youngsters face mental health issues, evident from the queues of Gen Z and Gen X outside psychiatrists' rooms. The Health Ministry needs to comprehensively review the demand for good mental healthcare and create facilities for the same up to the district hospitals. Holistic lifestyles with healthy food and adequate exercise must be stressed by the ministry in all its public awareness programs. NGOs must be encouraged to take the lead in providing volunteers and mental health specialists.
This is a serious issue as lifespans are increasing, and senior citizens/pensioners are not getting the desired attention in hospitals already packed with patients. Recently, attempts to create exclusive geriatric care facilities are appreciable and need to be multiplied to take care of all those who have superannuated and are more susceptible to all kinds of risks of germs, diseases, and infections.
India's medical tourism estimate is USD 7.6 billion today, with the potential to double by 2030. In 2023, 6.3 lakh foreigners came for medical treatment, accounting for about 7 per cent of total international tourists. India has emerged as a global leader in medical tourism, especially for advanced treatment seekers. The Health Ministry, in consultation with the Tourism Ministry and our embassies abroad, needs to study the total demand for medical tourism and allow the private sector to create specific facilities for such care, ensuring that domestic patients do not suffer. Apollo Hospital is doing an excellent job in this regard, as are many others. An appropriate strategy needs to be implemented in the next few years, given the Government's extension of the e-medical visa facility to citizens of 156 countries.
Several innovative startups are making significant strides in the health sector, greatly contributing to advancements and improved healthcare access. The PM Mahila Kisan Drone Kendra exemplifies women-led development by equipping nearly 15,000 women with drones for distributing medicines in remote areas, accompanied by comprehensive training. Qure.ai has advanced AI and data analytics for the early detection of tuberculosis (TB) and other lung diseases. SEARCH has notably reduced infant mortality by focusing on improved nutrition and hygiene for children. Vidhi aids in the legal drafting of acts and regulations, supporting nearly 400 government projects. SaveLIFE Foundation (SLF) has launched the Zero Fatality Corridor on the Mumbai-Pune route, cutting road fatalities by about 60 per cent, with plans to extend this model to the 100 most dangerous highways in India. The Piramal Foundation enhances healthcare services in Rajasthan and strengthens last-mile delivery in 125 aspirational districts. Tata Trusts supports the National Nutrition Mission, addressing nutritional needs across India, while the Azim Premji Foundation rehabilitates mentally ill homeless individuals. These startups and organisations are driving technological innovation and addressing critical healthcare needs, significantly advancing India’s goal of achieving Health for All
Maternal mortality rates have decreased by 50 per cent, while the infant mortality rate has fallen from 39 per thousand births to 25. Neo-natal mortality has also seen significant reductions. The Manodarpan initiative has been instrumental in providing psycho-social support to students, teachers, and families for mental health challenges following COVID-19.The pandemic has led to a substantial increase in the number of testing laboratories, now totaling 3,400 in India. However, whether these labs are sufficient to meet the testing needs of 1.4 billion people remains a concern.
Launched in 2013, the National Health Mission (NHM) includes the National Rural Health Mission (NRHM) and the National Urban Health Mission (NUHM), aiming to enhance maternal, neonatal, and child healthcare through improved data collection and immunisation programs. Since its inception in 2018, Ayushman Bharat has been providing financial protection and health coverage by establishing 1.17 lakh Ayushman Bharat Health and Wellness Centres. These centres offer free diagnostic services, medicines, and teleconsultation for a range of health issues. The Pradhan Mantri Jan Arogya Yojana (PMJAY) provides health insurance coverage up to Rs. 5 lakhs per family per year for secondary and tertiary care hospitalization, targeting 100 million economically weaker section (EWS) families or 500 million beneficiaries. To date, 260 million Ayushman cards have been issued, to achieve full coverage.
Health insurance penetration has reached approximately 40 per cent, yet considerable work is required to meet the standards of a developed nation. This sector contributes 33 per cent to India's total insurance market.The 10,000 Jan Aushadhi Kendras are making medicines more affordable, intending to expand to 25,000 Kendras. However, a broader vision is needed to enhance both the quality and quantity of medicines supplied.
The Ayushman Bharat Digital Mission (ABDM) supports the creation of Ayushman Bharat Health Accounts (ABHA), health IDs, a unified health interface, a healthcare professionals registry, and a healthcare facility registry. So far, 45 crore ABHA IDs have been created, 2.2 lakh health facilities registered, and 2.3 lakh healthcare professionals are involved in ABDM.
The Ministry of Tourism has established the National Medical & Tourism Board to promote medical tourism in India. Foreign direct investment (FDI) in the health sector is significant, with USD 23 billion in the drugs and pharmaceutical sector, USD 10 billion in hospitals and diagnostic centres, and USD 3.3 billion in medical and surgical appliances.
The Indian Council of Medical Research (ICMR) has issued standard treatment guidelines for 51 common illnesses across 11 specialities to aid doctors in diagnosis and treatment. The National Pharmaceutical Pricing Authority (NPPA) has set retail prices for 84 drug formulations to ensure affordability. MedTech Mantra has been launched as a platform to support research, development, and innovation in the med-tech sector, fostering a $50 billion industry to advance India’s health goals.
The Poshan Abhiyan aims to equip all Anganwadi centres with smartphones and essential devices, such as infantometers, stadiometers, and weighing scales for mothers and infants.
Mission Parivar Vikas focuses on intensifying family planning services in 145 high-fertility districts across seven of the most populous states.The PM Dialysis Program provides free dialysis services for EWS through public-private partnerships (PPP), with 1 lakh patients having benefited. Further efforts are needed to increase the number of dialysis units and machines to meet growing demand.
The National Institute for Global Health and Science Security is developing a bio-risk assessment and management guide to enhance biosafety and security. Public institutions are being strengthened to combat zoonotic infections and antimicrobial resistance. Additionally, a neuron model is being developed to address global bio-threats in public health emergencies.
The pace, extent, and coverage of these steps must expand significantly to achieve a healthy and vibrant India. The government must continue its commendable work but should also consider out-of-the-box solutions to make life easier and healthier for the common citizen.
The author is MBA IIMA, IAS Retd.
