Government-Led Health Initiatives: Steering India Towards Better Health

India is home to over 1.4 billion people, and delivering quality healthcare to every corner of this vast, diverse nation is no small task. From malnourished children in remote tribal areas to elderly citizens in urban slums, the healthcare needs are staggering. Recognising this, the Indian government has, over decades, rolled out a series of health policies, missions, and schemes – each targeting specific gaps in the system. Together, these initiatives form a layered, ambitious effort to move India towards universal health coverage. Understanding these programs is essential not just for policy students but for anyone seeking to grasp how rights-based healthcare actually takes shape on the ground.

The policy foundation: national health policies over the years 🔗

India’s health governance has been guided by successive National Health Policies (NHPs). The first was introduced in 1983, followed by the National Health Policy of 2002, which laid the groundwork for prioritising public health expenditure, addressing communicable diseases, and expanding healthcare infrastructure across rural India. The 2002 policy was significant because it acknowledged the severe shortage of trained health personnel and inadequate infrastructure, especially in states with weak public health indicators.

After a 15-year gap, the National Health Policy 2017 marked a paradigm shift. It represented a major revision after 15 years, moving from a curative approach to a preventive and promotive healthcare model, and aiming to achieve universal health coverage for all Indians. The 2017 policy recognised that the healthcare landscape had changed dramatically – the growing burden of non-communicable diseases, a rising private sector, and increased healthcare costs shaped the direction of the new policy.

Key goals of the National Health Policy 2017 🔗

The policy envisions attaining the highest possible level of health and well-being for all citizens at all ages, through a preventive and promotive healthcare orientation across all developmental policies, and universal access to good-quality health services without financial hardship. Among its specific targets: the policy aimed to reduce the maternal mortality rate to 100 per lakh live births by 2020 and the infant mortality rate to 28 by 2019, and to increase life expectancy at birth from 67.5 years to 70 years by 2025.

The policy also pushed for raising public health expenditure to 2.5% of GDP. While public health spending did increase from 0.9% of GDP to 1.6% between 2015-16 and 2021-22, it has yet to meet this target – a key challenge that remains. Beyond financing, the 2017 policy gave special emphasis to digital health, the Make in India initiative for drugs and medical devices, and the integration of AYUSH systems into mainstream healthcare delivery.

National Rural Health Mission: healthcare goes to the village 🔗

While national policies set the direction, missions translate them into action. The National Rural Health Mission (NRHM), launched on 12 April 2005 by Prime Minister Manmohan Singh, was a transformative step in bringing healthcare to underserved rural populations. The mission was designed to provide accessible, affordable, and quality healthcare to the rural population, especially vulnerable groups, with special focus on the Empowered Action Group (EAG) states, North-Eastern states, Jammu & Kashmir, and Himachal Pradesh.

What set NRHM apart from earlier programmes was its emphasis on communitisation, flexible financing, improved management through capacity building, monitoring against standards, and innovations in human resource management. In practical terms, this meant communities were no longer passive recipients of healthcare – they became active stakeholders.

ASHA workers: the backbone of rural health 🔗

One of NRHM’s most celebrated innovations was the creation of Accredited Social Health Activists (ASHAs) – trained community health volunteers who serve as the bridge between rural households and the public health system. More than 10 lakh ASHAs and ASHA facilitators are currently engaged under the National Health Mission. Their role in promoting institutional deliveries, antenatal care, and immunisation has been particularly impactful.

One of the notable successes attributed to NRHM is a significant increase in institutional deliveries – the number of beneficiaries under the Janani Suraksha Yojana rose from 7 lakhs in 2005-06 to over 86 lakhs by 2008-09. The Janani Suraksha Yojana (JSY) provides cash incentives to below-poverty-line pregnant women who choose to deliver in health facilities, directly combating maternal and neonatal mortality.

From NRHM to National Health Mission 🔗

In 2013, the Union Cabinet approved the expansion of NRHM into an overarching National Health Mission (NHM), which subsumed both the National Rural Health Mission and the newly launched National Urban Health Mission (NUHM). Over 15 years of implementation, the NHM has enabled the achievement of the Millennium Development Goals for health, with India recording much higher rates of decline in maternal mortality ratio and infant and under-five mortality rates compared to global averages. Today, the NHM also oversees free drug and diagnostics initiatives, mobile medical units, and tele-consultation services for remote populations.

Integrated Child Development Services: investing in the earliest years 🔗

India’s approach to health cannot be complete without addressing child nutrition and early development. The Integrated Child Development Services (ICDS) scheme, launched on 2 October 1975, is one of the world’s largest community-based programmes for early childhood care. The programme provides holistic early childhood services to children under six, pregnant women, and lactating mothers, with a special focus on reaching rural, tribal, and economically disadvantaged communities.

The scheme operates primarily through Anganwadi Centres (AWCs) – community-level hubs where a package of six core services is delivered: supplementary nutrition, pre-school education, health check-ups, immunisation, referral services, and nutrition and health education. These objectives aim to improve the nutritional and health status of children aged 0-6 years, lay the foundation for their psychological, physical, and social development, reduce mortality, morbidity, malnutrition and school dropouts, and enhance the capability of mothers to look after their children’s health and nutritional needs.

Scale and impact of ICDS 🔗

Studies confirm that on the whole the programme has performed well – the nutritional status of ICDS children, their immunisation coverage, and vitamin A and iron and folic acid coverage have improved significantly compared to non-ICDS children. However, challenges in consistent implementation across states remain. Despite widespread coverage, the quality and quantity of services are not uniform everywhere, and persistent issues like child malnutrition and anaemia require continued attention.

Under the broader umbrella of ICDS, newer programmes have been added over the years. Mission Poshan 2.0, launched in 2021, integrates the Poshan Abhiyaan (National Nutrition Mission) and the Supplementary Nutrition Programme to sharpen the focus on reducing stunting, wasting, and under-nutrition in children, adolescent girls, pregnant women, and lactating mothers.

Pradhan Mantri Swasthya Suraksha Yojana: closing the specialist care gap 🔗

Even as primary and community healthcare expanded, a stark reality persisted: quality tertiary care remained concentrated in a few urban centres. The Pradhan Mantri Swasthya Suraksha Yojana (PMSSY) was designed to address this directly. Announced in 2003, the scheme’s twin objectives were to correct regional imbalances in the availability of affordable and reliable tertiary healthcare, and to augment facilities for quality medical education across the country.

The scheme operates through two main components. First, it involves setting up new AIIMS-like institutions across states that have historically lacked premier medical facilities. Each new AIIMS is envisioned to have state-of-the-art modular operation theatres, diagnostic facilities, a minimum of 750 beds, 15-20 speciality departments, 100 MBBS seats, and 60 B.Sc. Nursing seats, with a strong focus on postgraduate education and research. A total of 22 new AIIMS have been announced under the scheme so far.

The second component involves the upgradation of existing government medical colleges into super-speciality centres. Around 75 government medical colleges have received funding to convert them into centres of high-quality healthcare – a majority of these upgradations have been completed across states. The union government bears the bulk of the cost, contributing approximately Rs. 820 crore per new AIIMS.

Why PMSSY matters 🔗

At the time PMSSY was conceived, nearly 700 million Indians had no access to specialist care, and around 80% of specialists were concentrated in urban areas. By establishing institutions of national importance in underserved regions, PMSSY aims to make the standard of care available at AIIMS Delhi accessible to people in states like Bihar, Odisha, Rajasthan, and the North-East. It is, in effect, a structural redistribution of medical excellence.

Disease-specific and population-specific programmes 🔗

Beyond the flagship missions, the Indian government runs a wide array of targeted health programmes. These cover communicable diseases such as tuberculosis (Nikshay Pradhan Mantri TB Mukt Bharat Abhiyan), malaria, leprosy, and vector-borne diseases, as well as non-communicable diseases like cancer and heart conditions. The Rashtriya Bal Swasthya Karyakram (RBSK) screens all children aged 0-18 years for birth defects, diseases, deficiencies, and developmental delays. The National Programme for Health Care of the Elderly (NPHCE) provides specialised outpatient and inpatient services for senior citizens at various levels of the health delivery system.

Population-specific efforts include the Pradhan Mantri Jan Arogya Yojana (PM-JAY) under the Ayushman Bharat scheme, which provides health insurance coverage of up to ₹5 lakh per family per year for secondary and tertiary hospitalisation – currently one of the largest government-funded health assurance programmes in the world. Complementing this are Health and Wellness Centres, which transform existing sub-centres and Primary Health Centres into comprehensive care hubs capable of handling a wide range of primary health needs closer to where people live.

The bigger picture: a multifaceted approach 🔗

What stands out across all these initiatives is that the Indian government has moved away from isolated, vertical programmes and towards an integrated, multi-level approach. From the community-level Anganwadi worker monitoring a child’s growth, to the ASHA facilitating a safe institutional delivery, to a patient in a newly built AIIMS receiving tertiary cancer care – each layer connects to the next. The National Health Policy 2017 explicitly recognises that healthcare requires cross-sectoral action, linking it to sanitation, nutrition, education, and economic security.

Challenges remain substantial – uneven implementation across states, out-of-pocket expenditure still being high for many households, and persistent gaps in health workforce availability. But the policy architecture built over the past two decades gives India both a legal and institutional framework to keep pushing towards the goal of health as a right, not a privilege.

What do you think? Given that implementation quality varies significantly across Indian states, what reforms in local governance and health infrastructure could ensure that schemes like NRHM and ICDS deliver uniformly effective results? And with public health spending still below the 2.5% of GDP target set by the National Health Policy 2017, how should India prioritise its health financing – through insurance-based models, direct public provisioning, or a combination of both?

References

1. https://www.pib.gov.in/newsite/Printrelease.aspx?relid=159376
2. https://nhsrcindia.org/sites/default/files/2021-07/National%20Health%20Policy%202017%20(English)%20.pdf
3. https://nhm.gov.in/index1.php?lang=1&level=1&lid=49&sublinkid=969
4. https://en.wikipedia.org/wiki/National_Health_Mission
5. https://pmc.ncbi.nlm.nih.gov/articles/PMC4925843/
6. https://pmssy.mohfw.gov.in/index1.php?lang=1&level=1&sublinkid=81&lid=127