India at 100: Charting the future of Indian health care

For India’s journey ahead, we recommend interventions in four critical areas of public health: Health infrastructure, medical workforce, research and development (R&D), and medical tourism.

India’s journey as an independent nation has been long and marked by many successes that have established it as a global leader. As India celebrates 75 years of Independence, we did what one is tempted to do at this age: Look back over the years to remember its achievements.

India has been critical in producing affordable vaccines. Today, 65% of children globally receive at least one vaccine manufactured in India. (File Photo)

The story of India at 75 begins with the slogan Jai Jawan Jai Kisan (hail the soldier, hail the farmer). It was the 1960s; the country was grappling with a serious food shortage and wars with China and Pakistan further strained the economic fabric. Pushed to the wall, India came back with a resounding response, the Green Revolution, which catapulted the nation into self-sufficiency in food production. Then came the 1970s and 80s, which refined our slogan to Jai Jawan, Jai Kisan, Jai Vigyaan (hail science). India sent its first indigenously designed satellite, Aryabhatta, into space in 1975. In April 1984, the nation left a permanent mark in space as Rakesh Sharma became the first Indian in outer space, famously describing his view of the country as “Sare Jahan se achha” (better than the entire world). As we moved into the 1990s and 2000s, liberalisation unleashed a new phase of growth in the country, red tape was reduced, private enterprise, particularly in information technology boomed, and India soon emerged as an economic powerhouse.

While this story is well known to many of us, there is one aspect often neglected — India’s remarkable achievements in health care. Today, we attempt to correct this.

Let’s start in the 1990s, when HIV/AIDS was spreading through nations. Big pharma priced the drugs at $10,000 per patient per year, making them inaccessible for the vast majority. At this critical juncture, India stepped in to produce low-cost, generic versions of the drugs. By 2001, India was providing medication at $1 per day to patients.

India has also been critical in producing affordable vaccines. Today, 65% of children globally receive at least one vaccine manufactured in India. Steps taken by the government to reduce dependence on China for active pharmaceutical ingredients during the pandemic have further strengthened India’s position as the world’s pharmacy. This expertise in pharmaceutical production came to the fore in 2020, when the country not only produced its own indigenous vaccine, Covaxin, but also supplied nearly 60 million doses of Covid-19 vaccines to 70 countries as of March 2021.

In 2014, the government launched Mission Indradhanush to bridge gaps in coverage. Today, India’s immunisation programme is one of the world’s biggest public health interventions and has helped bring down infant mortality rates from 126 per 1,000 live births in 1990 to 32 per 1,000 live births in 2020, and maternal mortality rates from 398 per 100,000 in 1997-98 to 99 per 100,000 in 2020.

2014 was also a significant year when the country was officially declared polio-free. India’s policymakers, government officials, and scientists worked for decades, engaging 2.4 million volunteers and 150,000 vaccine administration supervisors to inoculate people. India’s initiatives in polio elimination are today applied in other polio-endemic countries.

India has much to be proud of as it turns 75. However, the road doesn’t end here. How should India’s health sector be at 100?

For India’s journey ahead, we recommend interventions in four critical areas of public health: Health infrastructure, medical workforce, research and development (R&D), and medical tourism.

In recent years, India has made tremendous progress in expanding its health infrastructure, setting up 18 new All India Institutes of Medical Sciences (AIIMS), over 157 new medical colleges, and 8,600 Jan Aushadhi Kendras. However, there remains scope for improvement.

First, the availability of hospital beds per person remains at 1 per 1,000, against the desired 2 per 1,000. Diagnostics and treatment facilities need further expansion to achieve universal access to health care. The recently launched Pradhan Mantri Ayushman Bharat Health Infrastructure Mission (PM-ABHIM) scheme is a much-needed intervention that will prove critical in strengthening public health infrastructure.

Second, between 2014 and 2022, India registered a 75% increase in undergraduate seats for medical students and 93% in postgraduate seats. However, the doctor-to-population ratio stands at 0.74:1,000 people against the World Health Organization (WHO) recommended 1:1,000. The nurse-to-population availability stands at 1.96:1,000 people, against the WHO recommended 3:1,000. In the coming decades, there is a need for the expansion of government medical colleges that can ensure access to affordable education.

Third, the next 25 years will be critical for breakthrough technologies and innovations in areas such as gene therapy, stem cells, and artificial intelligence. Enhanced investments in R&D will continue to provide diagnostic and treatment facilities to people at a low cost. This will cement our leadership in affordable and quality health care innovations.

Fourth, the PM’s recent articulation of “Heal in India, Heal by India” highlights the potential of health tourism in the country. Medical tourism has expanded from a few private hospitals to an industrial complex, treating two million patients a year, generating $4 billion in annual forex. However, realising the vision of India as the global hub for medical tourism requires the standardisation of medical hospitality and travel services and expanding telemedicine services.

Going forward, India’s health sector must continue to retain its principles of Sewa (service) and Vasudhaiva Kutumbakam (the world is one family), ensuring that scientific breakthroughs and innovations provide affordable and accessible health care. Focusing on these critical areas will ensure that India emerges as the powerhouse of health care delivery, marking our 100th year with the slogan: Jai Jawaan, Jai Kisan, Jai Vigyaan, Jai Anusandhan (hail research).

Prof (Dr) Balram Bhargava is chief, Cardio-Thoracic Sciences Centre, AIIMS. Rajesh Bhushan is secretary, Health and Family Welfare and Health Research

The views expressed are personal