Critical analysis of Health Care Delivery System of India

The healthcare delivery system in India is a complex and multi-layered structure, characterized by both significant achievements and persistent challenges.

Here’s a critical analysis of its strengths and weaknesses:

Strengths of the Indian Healthcare Delivery System

1. Wide Network of Infrastructure

• India has an extensive three-tier healthcare system:

  • Primary: Sub-centres and Primary Health Centres (PHCs)

  • Secondary: Community Health Centres (CHCs) and District Hospitals

  • Tertiary: Specialized hospitals and medical institutions

• This structure is designed to provide a continuum of care from rural to urban settings.

2. Flagship Programs

• Programs like Ayushman Bharat, National Health Mission (NHM), and Universal Immunization Program (UIP) have significantly improved health access and outcomes.

• Digital platforms like eSanjeevani (telemedicine) and Ni-kshay (TB tracking) have modernized health service delivery.

3. Growing Private Sector

• The private healthcare sector fills critical gaps in infrastructure and innovation, accounting for nearly 70% of outpatient and 60% of inpatient care.

• Advanced diagnostics, super-specialty services, and medical tourism are led by this sector.

4. Human Resources in Health

• India produces the highest number of medical graduates annually.

• Increased focus on Allied Health Professionals and Community Health Officers (CHOs) at Health and Wellness Centres (HWCs) helps bridge rural access gaps.

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Weaknesses and Challenges

1. Urban-Rural Divide

• Around 70% of the population lives in rural areas, but 80% of doctors are concentrated in urban zones.

• Rural areas face shortages in infrastructure, staff, and essential drugs.

2. Out-of-Pocket Expenditure

• Despite insurance schemes, over 55% of total health expenditure is out-of-pocket, pushing many into poverty due to catastrophic health costs.

3. Public vs Private Imbalance

• The public sector is underfunded (public health spending is only ~2.1% of GDP), overburdened, and often of poor quality.

• The private sector, while efficient, is largely unregulated—leading to concerns about affordability, ethics, and quality control.

4. Fragmented Services

• Lack of coordination among various health programs and between levels of care often results in duplication or service gaps.

• Disease-specific vertical programs (like TB, malaria) sometimes neglect broader primary care and social determinants of health.

5. Human Resource Issues

• Shortages of skilled professionals, especially in rural areas.

• Burnout, absenteeism, and poor working conditions affect service quality.

6. Inequities in Access

• Marginalized groups (tribal communities, urban slum dwellers, women) face higher barriers to accessing timely and quality care.

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Opportunities for Improvement

• Strengthen primary healthcare through full-scale implementation of Ayushman Bharat HWCs.

• Increase public spending on health to at least 2.5% of GDP as recommended by the National Health Policy.

• Enhance digital health infrastructure through platforms like Ayushman Bharat Digital Mission (ABDM).

• Public-private partnerships (PPPs) for infrastructure, diagnostics, and capacity-building.

• Community-based health models to increase participation and trust.

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Conclusion

India’s healthcare system has made notable progress in recent years, particularly in digital health, insurance coverage, and disease control programs. However, to achieve Universal Health Coverage (UHC) and meet SDG health goals, India must address systemic issues—especially financing, human resources, quality of care, and rural access.

India has recently introduced and expanded several health programs to enhance public healthcare services:​

1. Expansion of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY): In September 2024, the Union Cabinet approved the inclusion of all senior citizens aged 70 and above, regardless of income, under AB PM-JAY. This expansion aims to provide free health insurance coverage up to ₹5 lakh per family, benefiting approximately 6 crore senior citizens across 4.5 crore families.

2. National Health Mission (NHM) Achievements: As of March 2024, significant progress under the NHM includes the certification of 7,998 public health facilities, with over 4,200 receiving national certification. Additionally, the number of operational Ayushman Arogya Mandir (AAM) centers has increased to 1,72,148, with 1,34,650 centers offering 12 key healthcare services.

3. Cervical Cancer Elimination Initiative: In April 2025, India launched a major campaign to eliminate cervical cancer by training tens of thousands of doctors to promote the HPV vaccine. This initiative addresses the fact that India accounts for one in five cervical cancer cases globally, with most caused by the human papillomavirus (HPV). Efforts include community outreach in local languages and integrating vaccination awareness into regular gynecological visits. ​

4. Increased Healthcare Budget Allocation: The healthcare budget for the fiscal year 2024-25 was increased to ₹90,958 crore, a 2% rise from the previous year. This budget prioritizes infrastructure improvements, strengthens existing programs, and combines maternal and child health initiatives under the National Health Mission. ​

These initiatives reflect India’s commitment to enhancing healthcare accessibility and quality for its citizens.