3

Revamping India's Health Infrastructure

at the Grassroots Level: Policies and
Strategiesfor Primary Healthcare
Sangita Dhal and Ishika Chauhan

Introduction
Che healthcare services of a country are a testimony to its
T:
progress and human development indicators. Access to
healthcare services is an essential part of the state's mandate to
assure a life of dignity for its citizens. India, since Independence,
has lagged far behind in terms of public health, with a high rate
of mortality and poor healthcare facilities for the underprivileged
and deprived sections of society. Only big cities and towns in
semi-urban regions have had a semblance of reasonable medical
facilities, which remained exclusively for the upper-income
categories of people who could afford to avail themselves of such
services. These facilities remained inaccessible to the poor, who
either could not travel from far-flung areas to cities and towns or
simply remained unaware of any such facilities. As a result, rural
health has remained a cause of concern for the state without
adequate redressal or reforms. Health, considered to be a vital
sector of the economy and society, constitutes the most important
area of focus for any nation that aims to achieve credible goals
of human development. While government spending is mostly
targeted towards the development and improvement of public
sector healthcare services, it is the private-sector organisations
that dominate the sphere. The government allocated 86,200.65
Crores to the health sector for the financial year 2022-23, a
16% increase over the previous year. The aim was to strengthen
50 Swastha Bharat and India's
National Health
India's public healthcare systems, whose failures were
Policy
exposed during the COVID-19 pandemic' (PTI, 2022), accurately
Th
chapter largely focuses on assessing the state of India's publ:
healthcare systems, especially in a post-COVID world.
authors try to analyse policies that have shaped the health
The
landscape of the country to ill in the gap in qualitative research
on the agenda. Additionally, it seeks to outline ways to
a robust primary healthcare infrastructure at the grassroots for develop
the benefit of the comnon man.

Contextual Setting
The earliest evidence of healthcare in India can be traced
back to Vedic India when Ayurveda was the only medical science
in existence. As cited by Rudrappa et al. (2018), the country's
progress in healthcare development and research saw a major
setback during the British Raj. Independent India adopted a
comprehensive public healthcare system outlined by the Bhore
Committee Report 1946, the Kartar Singh Committee Report
1973, the National Rural Health Mission (NRHM) 2005, the
National Health Policy (NHP) 2017 and Ayushmann Bharat
2019. These are some of the few milestones that have provided
a multilayered decentralised healthcare mechanism fulilling
the demands of the average citizen in the new millennium for
proactive healthcare systems that help in carly diagnosis and
reducing the burden on city hospitals (Rao, 2022, Aug 13). The
three-tiered healthcare mechanism sought to provide accessible
and affordable quality healthcare facilities across India. Since
health falls under the State List, the state governments are
primary stakeholders in providing healthcare services. Therefore,
even though the Central Government takes responsibility
for issues such as family welfare and prevention and control
of major diseases, it is the state governments who manage
local hospitals, public health, primary healthcare centres and
sanitation² (Rudrappa, Agarkhed & Vaidya, 2018).

1. Financial Express.
2. Indian Express.
3. Springer eBooks.
 Health Infrastructure
RevampingIndia's 51

Ever since independence, the focus on priority sectors

such as industry, agriculture and infrastructure building in the
country has relegated social sectors, like health and education,
to the background.
Despite many decades since independence, India is still
struggling to meet its targets of literacy and primary healthcare.
Despite a steady decline in the mortality rates, the policy
planners in the 1950s and 1960s were hoping to contain
population growth and take the country towards a path of
economic development based on the five-year plan
model. However, the experience of governance deficit in the
health sector in India has been the single most important factor
for the deplorable condition of our health sector.
Notably, in the 1990s, under the impact of globalisation,
sectoral reforms were introduced through new economic policies
wherein health and education began to be prioritised by the
government. The emphasis on the binary approach to either
industrial or agricultural development for overall economic
growth was replaced by a more holistic approach that included
social sectors as well. This multidimensional approach laid
emphasis on human resource development. Development of
all sectors needed to be simultaneously pursued in order to
avoid sectoral imbalance. Interlinkages and balancing between
different sectors of the economy had to be established because
the human development index was linked to economic growth,
productivity and development.
The Indian state witnessed the first NHP in 1983, decades
after its independence. It aimed to provide access to primary
healthcare toall citizens by 2000. Later, in 2005, the government
launched a National Rural Health Mission (Rudrappa et al.,
2018). Thereafter, the nation saw a rapid boost in the allopathic
medical practice. While Ayurveda is still prevalent in rural and
semi-urban areas, the healthcare landscape is largely dominated
by allopathic practices. It has been observed that, over the years,
the spread of traditional Indian medical knowledge, in the form
of Ayurveda, Yoga and other practices, has been on the rise. In
2014, the Government of India launched the AYUSH (Ayurveda,
 Swastha Bharat and India's National Heath
52
Policy
Yoga and Naturopathy, Unani, Siddha and
Homoeopathy)
programme with the idea of preserving and spreading awareness
about our cultural roots that have great potential to achiee
healthcare equity.
The pandemic exposed humankind to the worst heall
crisis in decades. It painted the true picture of the strength of
healthcare systems around the globe and lett millions grieving
and helpless for two years. hile being inadequate in terms of
providing healthcare services, the healthcare institutions were
also ill-prepared to control the spread of infection and enforce
guidelines at workplaces and publicplaces. Health faclities i
period
most parts of India were overburdened throughout the
of the lockdowns, experiencing shortages in beds, medicines
and even doctors. Despite such issues, in terms of mortality
countries worldwide
rate, India has performed better than most
(Bhatnagar et al., 2020).
National Health Mission, 2013
launched in 2013,
The National Health Mission (NHM),
community-owned,
aimed to establish a fully functional, inter-sectoral
decentralised health delivery system with
simultaneous action on a
convergence at all levels, to ensure
as water, sanitation,
wide range of determinants of health such
education, nutrition, social and gender equality".
Undoubtedly, NHM has proved crucial in improving Indias
thatremains to be
public healthcare scenario, but there's a lot increasedthe
government
done. Notably, under the NHM, the sub-centres
number of delivery points, establishing 8% more
Healthcare Centres (PHS.
since 2005 and 7% more Primary also increased by
The number of community healthcare centres were created
S9%, while an additional 121 district hospitals healh
India's public
in the last decade and a half. However, signinea
expenditure still remains around 1.6%, which is a (9.4%)
low when compared to the USA (8.5%), Germany report bythe
and China (3.2%)6 (Jadhay, 2021). Further, a
4. Journal of Family Medicine and Primary Care.
5. Ministry of Health and Family Welfare.
6. Business Line.
 Infrastructure
Revamping India's Health 53

Centre for Policy Research shows that health infrastructure was

overburdened even before the COVID-19 pandemic exposed
the inherent loopholes in the system. Data doctor
shows that there
and 1.666
were 9,702 people per government allopathic
people per government hospital bed in India.? These numbers
reveal the limited capacity of the state to manage such an
unprecedented health crisis and highlight the existing need
to allocate more funds to the healthcare sector. So, there is a
need for a better policy framework and execution of a more
inclusive governmental approach with requisite funding in this
crucial sector, which is abysmally low. Furthermore, the regional
inequalities in the availability of healthcare facilities across the
states and the income disparities amongst the various economic
classes made quality health services inaccessible for a large
number of people (Dhal, 2021).
Primary Healthcare Services in India: A Review
Globalisation has unleashed such forces through the spread
of global capitalism that today, people across continents are being
exposed to various types of existential crises and challenges. Be
it global warming or the spread of deadly diseases, the threat to
public health has increased manifold in the present-day world.
The rapid spread of the COVID-19 pandemic throughout the
world was a wake-up call for every nation to revamp their
health infrastructures and put in place a robust health policy
to face future challenges. To accomplish this, a paradigm shift
in focus and approach, alongside reasonable investment in the
health sector, is extremely necessary. It is a challenging task
to cater to the needs of millions of people who are unable to
access quality healthcare services. Modern healthcare facilities,
life-saving drugs and state-of-the-art diagnostic systems need to
be put in place for public use, which requires massive investment
that the government alone is incapable of bearing. Hence a
new policy framework involving public-private partnership is
the way forward.

7. Centre for Policy Research.

8. Journal of Humanities and Social Sciences.
 Swastha Bharat and India's National
54 Health Policy
Number of Sub-Centres (SCs)
165000
160713

$
160000 156231 157819
153655
155000

148366
150000

145000

140000 2016-17 2018-19

2011-12
2014-15 2020-21
Functional Sub-Centres (SCs) in India froos
Fiqure 3.1: Number of 2011-12 to 2020-21.
Source: https://main.mohfw.gov.in/documents/reports

Figure 3.1 shows an increasing trend in the number of

functional sub-centres (SCs) in India from 2011-12 to 2018-19
However, a decline in the number of SCs has been seen aftrer
that. According to the Ministry of Health and Family Welfare
report (2021), the decrease in the number of centres can be
attributed to the availability of better healthcare infrastructure
in the semi-urban areas adjacent to these rural primary health
centres (Ministry of Health and Family Welfare, 2021).° Avalid
assumption to justify this decline can also be that the COVID-19
pandemic largely affected the functioning of these sub-centres
due to low attendance of para-medical staff and other challenges
such as lack of adequate supplies of medicine, oxygen, etc.
Inversely,in the urban areas, where the corona pandemic
had spread rapidly and affected more people as compared o
the rural spaces, the health infrastructure developed rapdly
in both public and private sectors. The government took up
this task on a priority basis to not only ramp up the exsting
urban healthcare facilities but also create additional health
9. Ministry of Health and Family Welfare.
 Health Infrastructure 55
RevampingIndia's
cooperative
infrastructure. Public health is an area that requires
federalism with the centre andisthe state both sharing significant
responsibility. Furthermore, it imperativeto explorethe model
public-private partnerships as an effective policy intervention
of government to facilitate the smooth implementation of
by the grassroots level. The public sector
public health policies at the
on providing accessible primary
currently focuses extensively sector emphasises the delivery of
healthcare, while the private requirements largely located
secondary and tertiary healthcare
in urban centres.
can be achieved
New India's primary healthcare system
wellness centres to provide
by revitalising 1,50,000 health everyday healthcare
affordable primary healthcare and address
by the Ayushman Bharat
needs of the common man as envisioned observed that there was
Programme". In Figure 3.2, it can be
PHC centres from 24,049
asteady increase in the number of in 2020-21.
30,579 PHCs
in 2011-12 to a steep increase of

Number of Primary Healthcare Centres (PHCs)

32000
30579
30045

30000

28000

26000
25650
25308

24049
24000
2011-12 2014-15 2016-17 2018-19 2020-21

Figure 3.2: Number of Functional Primary Healthcare Centres

(PHCs) in India from 2011-12 to 2020-21.
Source: https://main.mohfw.gov.in/documents/reports

10. pib.gov.in.
56 Swastha Bharat andIndia's National Health
To prepare states to manage health
Policy
a robust public healthcare system for early emergencies requires
prevention. There is a need to bridge the ru
by addressing the issue of migration and
detection and
rural-urban divide
health centres at the village level. In terms devel
of theopitotal
ng primary
of number
Community Health Centres (CHCs), Figure 3.3 showS
consistent increase till 2019-20. Institutional
reeforms
investments in India's health infrastructure should and
be given
priority for revitalising the PHCs.
Number of Community Healthcare Centres (CHCs)
6500

6000 5951

5685
5624 5649

5396
5500

5000 4833

4500
2011-12 2014-15 2016-17 2018-19 2019-20 2020-21

Figure 3.3: Number of Functional Community Healthcare

Centres (CHCs) in India from 2011-12 to 2020-21.
Source: https://main. mohfw.gov.in/documents/reports
In the post-COVID world, the individual, society and state
need to work in tandem with better synergy and coordination
to effectively counter any such challenge in the future. Public
health management and action, through integration into a
sectoral and multi-stakeholder approach, needs to be targeted
at communities, individuals and grassroots organisations. Ihe
nations whom we aspire to emulate or compete with, have
achieved their health and wellness outcomes based on the
foundation of a strong public health system.
 Infrastructure
Revamping India's Health 57

Health Policy Analysis

India's efforts to achieve equitable access to healthcare can
1983 when the first NHP was initiated. Since
be traced back to India has launched multipleinitiatives to
then, the Government of
maximise health coverage and improve the quality of healthcare
services across the nation. The three health policies launched in
1983. 2002 and 2017 serve as milestone documents and continue
to shape India's public health structure. In addition to those,
policies such as Pradhan Mantri Surakshit Matritva Abhiyan
(PMSMA), various National Insurance Schemes, National
Mental Health Policy, etc., strengthen the foundation of public
health infrastructure in India. The following section focuses on
assessing India's healthcare policies in order to understand their
strong points and loopholes from acritical lens. Further, it aims
to highlight areas that need the most attention.
National Health Policy 2017
India has a universal healthcare system that has been adopted
by the constituent states and union territories. The National
Health Policy 2017 aimed at achieving a reasonably healthy
standard of life for the general population of the country. To
achieve this objective, a comprehensive approach was adopted,
which included improvements in individual healthcare, public
health, sanitation, clean drinking water, access to food and
knowledge of hygiene and feeding practices. Keeping in mind
the rapid changes in the healthcare sector and the urgent need
to meet the current challenges, NHP 2017 gave priority to
investment in health, financing of healthcare services, prevention
of new communicable diseases (such as swine flu), development
of human resources, encouraging medical pluralism, building
the knowledge base required for better health, etc. The policy
further highlights the urgent need to improve the performance
of the health systems with a focus on reducing maternal
mortality rate, controlling infectious diseases, tackling the
growing burden of non-communicable diseases and bringing
down medical expenses.
The NHP of 2017 focuses on multiple changes that make
It contextually different from the NHP of 2002. These include
58 Swastha Bharat and Indiaa's National
addressing issues of non-communicable diseases and
Health Policy
infectious diseases, the rise of independent and
robust other
healthcare institutions andchaotic expenditure caused by private
costs! (Kaur & Rathi, 2019). The policy seeks to healtheth
abysmal landscape of healthcare delivery in the improve
2025. Some goals mentioned in NHP 2017 are: country by
1. Increase Life Expectancy at birth from 67.5 to 70 years
by 2025.
2. Reduce infant mortality rate to 28 by 2019.
3. Increase utilisation of public health facilities by Soo
from current levels by 2025.
4. Meet 90% of family planning needs at the national and
sub-national levels by 2025.
5. Access to safe water and sanitation: Swachh Bharat
Mission.
6. Increase governmental health expenditure, as
percentage of GDP, from the existing 1.15% to 2.5%
by 2025.
7. Increase state sector health spending and establjsh
primary and secondary healthcare facilities in high.
priority districts by 2025.
8. Ensure district-level electronic database of information
on health system components.
9. Strengthen the health surveillance system and establish
registries for diseases of public health importance.
10. Establish federated integrated health information
architecture, Health Information Exchanges and
National Health Information Networks by 2025.!
Despite the visionary activities outlined in the document,
there are multiple areas of concern that pose a challenge to the
effective implementation of the policy. Firstly, the policy only acts
as a guiding document that is non-binding on the government.
oensure proper accountability and transparency, it is of utmost
significance that adequate tools and mechanisms are deployed
11. Journal of Health Managenent.
12. Ministry of Health and Family Welfare.
 Infrastructure
Revamping India's Health 59

check on the government and monitor the success

to keep a
of the policy. Secondly, the policy lacks requisite stakeholder
involvement and fails to take into account intersectional
problemssuch as nutrition, sanitation, education and so on. The
challenges of poor governance and low budgetary allocation are
evident, especially in the health sector, and must be addressed
at the bureaucratic level. The policy has further laid down
ambitious goals, ignoring the current state of the healthcare
system, including the lack of state capabilities, infrastructural
issues and various other challenges. Lastly, half adecade after
rhe launch of NHP 2017, the country is yet to experience the
'assurance' promised in the policy. Especially in a post-pandemic
world, it is even more relevant to say that India has been pushed
Five-Years back in time in terms of achieving its healthcare
objectives as laid down in the policy.
Challenges to Public Healthcare in India
In India, healthcare facilities are largely faced with
challenges of affordability, accessibility and awareness. The
poor healthcare facilities, or the lack of minimum health services
in some cases, have deprived the rural people of facilities that
they rightly deserve as citizens of the country. The differential
rate of mortality, skewed heavily against the rural population, is
a testimony to the subpar health services being provided in such
places. The best doctors and healthcare professionals choose
cities and towns to render their services and earn good money
rather than serving in poorly managed government hospitals
located in far-flung areas that are financially much less lucrative.
In this context, the biggest challenge before the government is
to provide the best healthcare services at affordable prices to
the rural people. The rural healthcare sector needs a complete
overhaul through public-private partnerships, infusion of
government funds, private sector investment and use of state
of-the-art technology.
During the COVID-19 pandemic the entire public healthcare
system was overburdened by the sudden outbreak. The health
intrastructure, trained manpower and other logistic support fell
Short, and the government's lack of preparedness in handling
60 Swastha Bharat and India's National
Health Policy
such a crisis was clearly evident. So, there is a need for a
better policy framework and execution of a
more inclusive
governmental approach, with requisite funding in this ccial
healthcare sector, which is abysmally low. Furthermore. th
regional inequalities in the availability of healthcare facilities
across the states and the income disparities amongst the varioue
economic classes made quality health services inaccessible for a
large number of people! (Singh, 2021).
Provision of quality healthcare services till the last milejis
an extremely challenging task given the demography of India's
large population and geographical and cultural obstacles.
of the biggest challenges faced by the health sector in India is
that over 20% of India's population lives below the poverty
line (Sharma, 2019). Several million people still live in rural
parts of the country that are often cut off from urban healthcare
centres and deprived of proper health services. Additionally,
though India is rapidly undergoing urbanisation, a large
proportion of its population occupies urban slums that are
often breeding grounds for several diseases and are particularly
backward in the management of WaSH (Water, Sanitation and
Hygiene).
Recent statistics by the Ministry of Health and Family
Welfare highlight that as of 31 March 2021, there are 1,56,101
and 1,718 Sub-Centres (SCs), 25,140 and 5,439 Primary Health
Centres (PHCS), and 5,481 and 470Community Health Centres
(CHCS), which are functioning in rural and urban areas of the
Country, respectively. For an ever-increasing population like
India, the infrastructure has still proven to be inadequate, whicn
and

underlines the need for improved management of resources

human capital in the health sector.
Pandve et al., in 2014, noted that India's public healthcare
local
system is fairly rigid, which limits it from accommnodating
realities and needs. Further, there is a severe lack of resources
the
ut
health
many states, which adds to the poor performance of
13. Social Action.
14. The Financial Express.
15. Ministry of Health and amily Welfare, 2021.
 Infrastructure 61
Revamping India's Health
sector. Indian public healthcare system has been restrictive to
understanding the reasons why people choose private healthcare
government care. Some major drawbacks of public
over free
include absenteeism, low patient satisfaction,
health mechanisms and a lack of
poor referral systems, inadequate infrastructure (2018)
sufficient personnell (Pandve & Pandve, 2014). Kasthuri of five
form
has categorically presented these challenges in the affordability
A's: awareness, accessibility, absence of resources, deliberated
and accountability."Each of these issues needs to be
achieving India's
as they create multiple hurdles on the way to
health service delivery goals.
1. Lack of awareness
There is a substantial lack of awareness amongst
with
citizens, especially women, about their bodies
reference to reproductive knowledge, sex education and
maternal care. Contrary to popular assumptions, this
is not just the case in rural India, where there would
presumably be a lack of information. Despite exposure
to health information, Indians living in urban set-ups
struggle with keeping themselves healthy. People are
bound to lose years of their lives due to diseases and
injuries. While this is limited to physical health, there
is also a grave ignorance about mental health in the
countryl8 (Bahri, 2015). A recent study (2019) by
Cosmos Institute of Medical Health and Behavioural
Sciences (CIMHBS) and the World Federation of Mental
Health (WEMH), conducted across 175 districts of
seven states in North India, shows that almost half of
the respondents were unaware of mental health issues
and did not have access to mental health assistance.
2. Lack of accessibility
It is the underlying cause of a failing healthcare
mechanism, as publicservices, more often than not, fail
to reach the patient in time and vice-versa. Even beyond
16. International Journal of Health System and Disaster Management.
17. Indian Journal of Community Medicine.
18. Business Standard India.
19. Financial Express.
62 Swastha Bharat and India's
National
Health Policy
the problems of physical distance in
the challenge stretches to the quality ofaccessi
heal
accessible. Thissiincludes problems such as
tb
hili
cartye,
unavailability
of medicines, lack of advanced machinery, lack of
trained medical professionals and so on.
3. Absenteeism
It is a persistent threat to healthcare
security in most
parts of India. As Muralidharan et al.
their study, data from 2003 shows that(2011),
out ofcite in
1400 public healthcare centres across 19 maior stat
of India, nearly 40% of doctors were absent from
work20 (Muralidharan et al., 2011). These
rates ranged from 30% in Madhya Pradesh to a absenteeism
high
of 67% in Bihar. Furthe, looking at more recent data
as stated by a study conducted by Dinesh Sharma
(2015), "as of 2015, more than 8% of 25,300 primary
healthcare centres in the country were without a
doctor, 38% were without a laboratory technician.
and 22% had no pharmacist. Nearly 50% of posts
for female health assistants and 61% for male health
assistants remain vacant. In community health centres.
the shortfall is huge-surgeons (83%), obstetricians
and gynaecologists (76%), physicians (83%), and
paediatricians (82%)."21 The gap further widens when
one looks at these statistics from the lens of a country
only recovering from the terror of the pandemic.
4. Affordability
Another crucial challenge that adds tothe government's
woes is making healthcare affordable. Most Indian
people have to pay from their pockets to access
healthcare services as they are not insured. Public
healthcare policies do not cover some major expenses,
including medical tests, medicines, etc.2 The COVID-19
pandemic has been critical in exposing the shortcomings
20. Harvard University.
21. The Lancet.
22. Times of India Blog.
 Infrastructure
Revamping India's Health 63

of the same and has highlighted the gaps that affect the
health sector of the country.
5. Accountability
Accountability is an essential feature of any public
service. Accountability in healthcare services circles
back to the idea of understanding grassroot realities
and inadequacies to improve the quality of services.
Attached to accountability is the concept of feedback
and grievance redressal. The government needs to
put in place well-functioning grievance redressal
mechanisms to foster a culture of accountability.
Moreover, the elinmination of corruption when it comes
to accessing medical facilities is another facet of feeding
accountability in the system.
There is a need to actively survey and take account of the
ground reality of the rosy image of government healthcare
services to overcome the said challenges. Moreover, India needs
to introduce structural changes in the existing system to harness
the potential of the public health sector overall.
The Way Forward
The public health sector needs radical reforms through
the public-private partnership model and exploring alternative
policy strategies to improve the functioning and quality of the
public health sector and ensure accountability. The need of the
moment is to find innovative ways to improve the delivery of
health services. For instance, the government will benefit from
Successful partnerships with NGOs and private actors and can
take inspiration from the Bangladesh model, which today has
better child mortality factors than India because of successful
partnerships between government, NGOs and private actors.
A healthy India needs a sound healthcare infrastructure not
only in urban areas but also in distant corners of the rural
countryside, where the majority of the Indian population lives.
Poor healthcare facilities. or the lack of minimum health services
In some cases, have deprived rural people from availing of
modern healthcare services for themselves, which they rightfully
deserve as citizens of the country.
 Swastha Bharat and India's
64
National Health
The rural healthcare sector needs a complete
Poicy
through public-private partnerships, infusion
funds, private sector investment and the use of
of
ovegovernment
rhauling
technology. Apart from these fundamental changes in
and approach to rural healthcare, the issue of
state-of-the-art
polandicy
regulation should also be revised. E-govern governance
E-governance in the rural
health sector
is a much-needed solution to address the challenges
of inaccessibility, and lack of connectiVity and creating heal:
awareness amongst the rural people.
Digitisation has seeped into all aspects of human life
including healthcare, and has the power to transform the
paradigm of Indian healthcare. Technological advancements
have paved the way for healthcare delivery to move beyond
traditional ways of service to reach the patient's doorstep
and revolutionise healthcare processes forever. The inclusion
of ICT in healthcare provisions will enable citizens to acces
healthcare services effectively from their homes. The Ministry
of Health and Family Welfare states that the benefits of e-health
can be best understood in the form of the 10 E's: effciency,
enhancing quality, evidence-based, empowerment of consumers
and patients, encouragement, education, enabling, extending,
ethics, and equity.2 Thus, governments should take proactive
measures to integrate science and technology into health systems
in an effective manner to provide early health alerts.
COVID software applications like Aarogya Setu and the
Co Win vaccine registration platform (Figure 3.4) were launched
for the benefit of the citizens to fight against the coronavius
and boost the country's digital health infrastructure. CoWm
played a critical role in the vaccination drive and ensured a
smooth vaccine registration process for millions of Indians.
The ubiquitous rural telecentres known as the 'common service
centres' [2.7 lakh] were used as vaccine registration centres,
which increased the COVID-19 vaccination coverageSyStems
n ru in
areas. To further improve the current healthcare and
India, it is crucial to focus on management, administration
of health
governance. They form the root causes of the faailure
23. www.nhp.gov.in.
 Infrastructure
RevampingIndia's Health
65

servicedeliveries across the nation. It has been a trend that states

with better capacity and stronger bureaucratic management
successful in implementing and meeting the promised
have been
outcomes under all policies
and schemes.

Ce-WIN

1 49 549 702 29 158

12,725

97.568 13411
9,055
12,562

2,19,61,73,610 13,658 1,10,82,17,871

420232 R44

Figure 3.4: Managing Covid-19 through Artificial Intelligence

Technology
Source: https://dashboard.cowin.gov.in/, Retrieved on October 20th, 2022

To sum up, healthcare policymaking should lay emphasis on

addressing the foundational questions of access and affordability
of healthcare services, including the cost of medicine and
diagnostics. The process must involve readdressing and
redefining the goals of existing policies andreinventing them
through structural and institutional reforms. Moreover, a shift
inperspective is essential to look at healthcare as intersectional
and not in isolation. An ambitious yet effective idea can be to
learn from the best practices of other Indian states, such as
lamil Nadu, that have been performing relatively better in the
provision of healthcare. Lastly, in order to achieve the ideals of
atma nirbharta (self-reliance), India must increase investment in
the Primary Health Centres with a skilled health workforce that
Can play a meaningful role in prevention and early detection
protect people. In the post-COVID world, the individual,
the society and the state need to work in tandem through an
grated and multi-stakeholder approach and robust healthcare
 Swastha Bharat and India's National
66 Health Palicy
information systems with better synergy and coordination
to effectively counter any health emergency challenges in the
future. In the post-COVID world, the individual, the and
and the state need to work in tandem with better synergy society
coordination to effectively counter any such challenges in the
future. This will lay the foundation tor astrong public hest
system, delivering a comprehensive and quality healthcare
affordable costs
service to every section of society at
Bibliography
Government Reports
National Health Misin
Centre for Policy Research. (2022-23). Retrieve
Budget Briefs. 14(6). Government of India.
September 22, 2022, from https:/lcprindia.org/wp-conten
uploads/2022/06/National-Health-Mission_2022-23.Ddf
Financial Express. (2019, Oct. 11). A New Survey Highlights
Health in the
Acute Lack of Awareness about Mental
Country. Financial Express. Retrieved, September 19, 2022,
from https:/www.financialexpress.com/opinion/new-survey
highlights-acute-lack-of-awareness-about-mental-health-in-the
country/1 732339/
(2013). National Health
Ministry of Health and Family Welfare.
Mission. Government of India. Retrieved from https://main.
mohfw.gov.in/sites/defaul/fles/56987532145632566578. pdf.
(2017). National Health
Ministry of Health and Family Welfare.
Policy 2017. Government of India. Retrieved from https:l
www.nhp.gov.in/nhpfiles/national_health_policy_2017.pdf.
(2014). National Mental
Ministry of Health and Family Welfare.
India. Retrieved from htp:/
Health Policy. Government of
nhm.gov.in/images/pdf/National_Health_Mental_Policypdf.
Health and Family Welfare. (2020). Rural Health
Ministry of Government of India. Retrieved trom
Statistics 2019-20.
https://main.mohfw.gov. in/sites/default/Ales/RHS%202019.
20_2.pdf. Rural Hean
Health and Family Welfare. (2021). Retrieved from
Ministry of of India.
Statistics 2020-21. Government
https://main.mohfw.gov.in/newshighlights-90.
 Infrastructure 67
Revamping India's Health
Information Bureau. (2022, Jan. 4) Ministry of Health
Press Welfare: Initiatives and Achievements-202 1.
& Family
Governmentof India. Retrieved from https://pib.gov.in/
PressRelescDetailm.aspx?PRID=1787361.

PTL. (2022b, February 11). Union Budget 2022: Health sector

wellbeing
allocation up 16o, new programme for mental
announced. Financial Express. Retrieved from https://www.
financialexpress.com/budget/union-budget-%202022-health
sector-allocation-up-16-new-programme-for-mental-wellbeing
announced/2422913/
Ministry of
Singh, A. (2017, Aug. 4). Government of India Family
Healthand Family Welfare Department of Health and
Welfare Lok Sabha Unstarred Question No. 3320. Lok Sabha.
Retrieved from https://sansad.in/getFile/loksabhaquestions/
annex/12/AU3320.pdf?source=pqalspib.gov.in.
India
Thakur, R.K. & Thakur, R.K. (2022, Sep. 2). Suicides inIndian
on rise, most dying by hanging: NCRB. The New
Express. Retrieved from https://www.newindianexpress.com/
nation/2022/Sep/02/suicides-in-india-on-rise-most-dying-by
hanging-ncrb-2493982.html.
Books and Authors
Adani, S. (2022, June 14). Creating Quality and Affordable
Healthcare for Every Indian. Times of India Blog. https://
timesofindia.indiatimes.com/blogs/voices/creating-quality-and
affordable-healthcare-for-every-indian/.
Bahri, C. (2015, Sep. 30). How Ignorance Cuts India's Healthy Life
by Half. Business Standard India, September 30, 2015. https:
www.business-standard.com/article/specials/how-ignorance
cuts- india-s-healthy-life-by-half-115093000416_1.html.
Dhal, S. (2021). Managing Covid-19 Pandemic through
E-Governance: Evaluating the Performance of State and Its
Health Sector in India. Journal of Humanities and Social
Sciences, Scottish Church College (University of Calcutta).
116-34.
Garg, S. et al. (2020, Dec. 1), Strengthening Public Healthcare
Systems in India; Learning Lesons in COVID-19 Pandemic.
Journal of Family Medicine and Primary Care 9(12): 5853.
https:/doi.org/10.4103/jfmpc.jfmpc_1187_20.
68 Swastha Bharat and India's National Health Policy

Gopal, K.M. (2019). "Strategies for Ensuring Quality Healthcare

in India: Experiences from the Field." Indian Journal
of Community Medicine: Official Publication of Indian
Association of Preventive Social Medicine, 44(1). pp. 1-3.
https://doi.org/10.4103/ijcm.IJCM_65_19.
Gupta, S. & Sagar. R. (2021, Oct. 25). National Mental Health
Policy, India (2014): Where Have We Reached? Indian Journal
of Psychological Medicine. 025371762110483. https:/ldoi.
org/10.1177/0253 717621 1048335.
Jadhav, R. (2022, Sep. 22). Has the National Health
Mission Been Effective Enough? @businessline. https:ll
www.thehindubusinessline.com/data--stories/data-focus/
has-the-national-health-mission-been-effective- enough/
article35533043.ece. Retrieved September 22, 2022.
Kasthuri, A. (2018). Challenges to Healthcare in India--the Five As.
Indian Journal of Community Medicine: Oficial Publication
of Indian Association of Preventive o Social Medicine 43(3):
141-43. https:/doi.org/10.4103/ijcm.IJCM_194_18.
Kaur, H. & Rathi, S. (2020). National Health Policies in Practice: An
Explorative Analysis for India. Journal of Health Management,
21(3). http:ldx.doi.org/10.1177/0972063419868554.
Muralidharan, K., Chaudhury, N., Hammer, J., Kremer, M. X
Halsey, F (2011). Is There a Doctor in the House? Medical
Worker Absence in India. Scholars at Harvard. https:
scholar.harvard.edu/fles/kremer/fles/is there a_doctor_ in_the
house_-_12_april_2011.pdí.
Nundy, M., Sharma, S. Anjaney, Jain, M. & Kotwal, A. National
(2021,:
Public-Private Partnerships in Healthcare under the
Health Mission in India: A Review, National Health Syste
.org/sites/defauld
Resource Centre(NHSRC). https://nhsrcindia.
files/2022-09/PPP%20BOOK%2027.05.2022_0.pdt.
Healthcare
Pandve, H.T., &Pandve, T.K. (2014, March 20). Primary.
International
System in India: Evolution and Challenges. 1(3).
Journal of Health System and Disaster Management,
https://doi.org/10.4103/2347-9019.129126. Heart
the
Rao, S. (2022, Aug. 13). Why Family Needs to Be at hrtps:/
of India's Health System. The Indian Express.
 Infrastructure
Revamping India's Health 69

indianexpress.com/articlelopinion/columns/whyfamily-needs
to-be-at-the-heart-of-indias-health-system-80871 37/.
Rudrappa, S., Agarkhed, D.V. & Vaidya, S.S. (2018, Oct. 26).
Healthcare Systems: India. Quality Spine Care. pp. 211-24.
https://doi.org/10.10077978-3-319- 97990-8 13.
Sharma, D.C. (2015). India Still Struggles with Rural Doctor
Shortages. The Lancet, 386 (10011). pp. 2381-82. https:l
doi.org/10.1016/s0140-6736(15)01231-3.
Sharma, S. (2019, Sep. 21). Around 22% Indians Live below
Poverty Line; Chhattisgarh, Jharkhand Fare Worst. The
Financial Express. https://www.financialexpress.com/economy/
around-22-indians-live-below-poverty-line- chattisgarh
jharkhand-fare-worst/1 71 3365/.
Singh, N. (2022). Navigating the Challenges of Covid-19: Civil
Society Reactions and State's Responses in India. Reprint,
Social Action.