India’s Path to Health Leadership

• 24 Jan 2025

This editorial is based on “The health leadership opportunity for India” which was published in Hindustan Times on 23/01/2025.  The article brings into focus the need for new global health leadership following the US withdrawal from the WHO. India, with its growing contributions in health innovation, is well-positioned to lead in fostering equitable and sustainable global health practices.

For Prelims: US withdrawal from the WHO, Digital health, Mission Indradhanush, National Digital Health Mission, Economic Survey, Rajasthan’s Right to Health Act, Health and Education Cess,  Maternal mortality rate, Global Innovation Index 2023, Global Health Security Index , Vaccine Maitri initiative, Gavi, The Vaccine Alliance, National Clean Air Programme.  

For Mains: Key Achievements of India in the Healthcare and Healthcare Governance, Major Challenges Holding Back India's Leadership in Global Health Governance.

The US withdrawal from the WHO underlines the need for global health leadership, as its departure disrupts funding and expertise crucial to WHO's functioning. While the WHO faces criticism for bureaucracy, political influences, and declining efficiency, its role in addressing global health challenges remains critical. India's relatively small but impactful contributions, particularly in traditional medicine and digital health, highlight its growing potential in global health governance. With reforms in global health institutions on the horizon, India can leverage its expertise and innovative health solutions to emerge as a leader. This moment presents India with an opportunity to champion equitable and sustainable global health practices.

What are the Key Achievements of India in the Healthcare and Healthcare Governance?

• Democratization of Healthcare:: Ayushman Bharat, launched in 2018, has revolutionized access to healthcare by covering over 36 crore beneficiaries (as of 2024), ensuring free hospitalization for poor families.  
  • It bridges the urban-rural gap in secondary and tertiary healthcare.  
  • The Ayushman Bharat program has led to a remarkable 21% reduction in out-of-pocket healthcare expenditures and an 8% decrease in the incidence of emergency loans taken for health-related expenses 
• Unparalleled Vaccine Coverage and Disease Elimination: India's immunization efforts have eliminated polio and neonatal tetanus while tackling diseases like measles and hepatitis.  
  • India effectively mastered its Covid-19 vaccination campaign. As of January 2023, nearly 97% of eligible beneficiaries have received at least one dose of the Covid-19 vaccine, and approximately 90% have received both doses. 
  • Mission Indradhanush has boosted full immunization from 62% in NFHS-4 (2015-16) to 76.4% in NFHS-5 (2019-21). 
• Strengthening Rural Healthcare Infrastructure: India has operationalized 1.72 lakh Ayushman Arogya Mandir under Ayushman Bharat as of 31st March 2024, providing primary healthcare services, maternal health, and Non-communicable disease screenings.  
  • These centers cater to over crores of people annually, improving health outcomes in underserved rural areas.  
• Health Digitization through the National Digital Health Mission (NDHM): NDHM, launched in 2020, is a game-changer in health governance, enabling electronic health records and telemedicine services.  
  • Under this, the QR-code-based OPD registration service allows patients to share demographic details digitally, reducing wait times from 30-40 minutes to just 5-10 minutes.  
    • By November 2024, 17,481 facilities across 35 states/UTs had generated 6.64 crore tokens, saving 3.3 crore person-hours, enhancing accessibility and efficiency in healthcare delivery. 
• Focus on Traditional Medicine through AYUSH Integration: India is leading globally in traditional medicine with initiatives like the WHO Global Centre for Traditional Medicine in Gujarat (2022).  
  • The AYUSH sector grew by 17% annually, contributing $18 billion to the economy(2021), while programs promoting yoga and Ayurveda improved preventive care and wellness awareness among citizens. 
• Innovative Health Financing for Equity: India has improved health governance by increasing health expenditure. India's public expenditure on healthcare touched 2.1 % of GDP in FY23 and 2.2% in FY22, against 1.6% in FY21, as per the Economic Survey 2022-23.  
  • The Health and Education Cess ensures sustainable funding for welfare programs.  
• Health Governance through Decentralized Efforts: Localized governance models like Kerala’s participatory health programs and Rajasthan’s Right to Health Act (2022) emphasize accountability and citizen-centric healthcare. 
  • These frameworks have empowered states to innovate, improving health indicators such as maternal mortality, where India achieved a maternal mortality rate of 97 per lakh live birth by 2020, marking a 25% reduction since 2014-16 levels.

What are the Major Challenges Holding Back India's Leadership in Global Health Governance?  

• Insufficient Health Expenditure: India’s public health expenditure, though improved, lags behind the WHO recommendation of 5%.  
  • This underfunding impacts infrastructure, manpower, and research capabilities necessary to lead globally.  
  • Also, despite improvements through Ayushman Bharat, a recent CAG report revealed that in 6 states/UTs, ineligible households were registered as PMJAY beneficiaries and received benefits under the scheme.  
    • This undermines India's international image as a responsible healthcare provider. 
• Weak R&D in Healthcare Innovations: Despite strides in vaccine production, India's healthcare R&D ecosystem is underdeveloped, limiting its capacity for global leadership in cutting-edge medical research.  
  • For instance, India ranks 40th in the Global Innovation Index 2023, reflecting limited investment in medical technologies.  
  • India's R&D funding stands at 0.64% of GDP, with state budgets contributing only 0.1% of GSDP, hindering breakthroughs in emerging diseases. 
• Lack of Comprehensive Regulatory Frameworks: India’s health regulatory framework is fragmented, leading to inefficiencies in drug approval and public health emergencies. 
  • Issues like the cough syrup controversy in 2023, linked to substandard exports, highlighted gaps in drug quality assurance.  
    • For instance, the World Health Organization linked Indian-made cough syrups to the acute kidney failure and deaths of 66 children in the West African country, The Gambia. 
  • Also, India is becoming a hotspot for Antimicrobial resistance, it is among the countries overusing "Watch" group antibiotics, with over 75% of infections for many antibiotic-bacterium combinations caused by resistant bacteria.  
• Disparities in Health Infrastructure: Regional imbalances in healthcare facilities undermine India’s ability to address health crises equitably.  
  • While southern states like Kerala have advanced health indicators, northern states like Uttar Pradesh still grapple with high infant mortality.  
  • India faces significant geographic disparities in health outcomes, with life expectancy ranging from 56 years in Madhya Pradesh to 74 years in Kerala. 
    • Also, disparities in health spending per capita worsen inequality and reduce India’s credibility as a health leader. 
• Challenges in Pandemic Preparedness: While India managed Covid-19 effectively, gaps in pandemic preparedness persist due to fragmented surveillance systems and poor coordination. 
  • For instance, India ranked 66th in the Global Health Security Index (2021), reflecting weaknesses in biosecurity and zoonotic disease monitoring.  
  • Insufficient real-time data integration across states limits India’s capacity to respond to global outbreaks like H3N2 in 2023. 
• Dual Burden of Communicable and Non-Communicable Diseases (NCDs): India faces a dual burden of communicable and non-communicable diseases. 
  • The proportion of deaths due to Non-Communicable Diseases (NCDs) in India have increased from 37.9% in 1990 to 61.8% in 2016. 
  • Poor lifestyle choices and limited preventive care hinder India’s global health leadership in combating these challenges.  
    • The Economic Survey 2023-24 highlights that obesity is significantly higher in urban India than rural areas, with 29.8% of men and 33.2% of women affected, compared to 19.3% and 19.7% in rural India (NFHS-5). 
• Dependence on Generic Drug Manufacturing: While India is the "pharmacy of the world," its focus on generic drug manufacturing limits innovation in novel medicines.  
  • At present a major component of Indian exports are low value generic drugs while a large proportion of the demand for patented drugs is met through imports.  
  • This is because the Indian Pharmaceutical sector still has much ground to cover in high value production and instil global pharma R&D. 
• Global Health Diplomacy Gaps: India’s global health outreach lacks consistency, often overshadowed by China's Health Silk Road (HSR).  
  • Though, under the Vaccine Maitri initiative, India has supplied over 235 million total supplies of Covid-19 vaccines to 98 countries of the world, but its limited participation in global health alliances like Gavi, The Vaccine Alliance reduces its leadership role.  
    • This contrasts with the EU and China, which contribute more robustly to global health initiatives. 
• Environmental and Climate Health Challenges: India’s worsening air and water quality undermines its global credibility in addressing environmental determinants of health.  
  • India is home to 14 of the world's 20 most polluted cities. Air pollution in India resulted in 1.67 million deaths in 2019—the largest pollution-related death toll in any country in the world 
  • India’s ineffective implementation of the National Clean Air Programme (NCAP) raises concerns about its commitment to global environmental health goals. 
• Brain Drain of Health Professionals: The migration of skilled doctors and nurses to developed nations limits India’s ability to establish global health leadership.  
  • India has been a major exporter of healthcare workers to developed nations particularly to the Gulf Cooperation Council (GCC) countries, Europe and other English-speaking countries.  

How India Can Emerge as a Global Health Leader?  

• Strengthening Research and Development (R&D) in Health Innovation: India must invest in R&D to develop cutting-edge medical technologies, indigenous vaccines, and affordable drugs.  
  • With initiatives like the Production Linked Incentive (PLI) scheme for pharmaceuticals, India can boost manufacturing of complex generics and biosimilars.  
  • By enhancing collaboration between the private sector, ICMR, and academia, the country can position itself as a hub for innovation. 
    • Develop regional biotech clusters (e.g., Bengaluru, Hyderabad) as global hubs for health R&D, supported by incubation centers. 
  • Also,  establish a dedicated fund to finance research in precision medicine, biotechnology, and vaccine development. 
• Leverage Digital Health to Improve Accessibility: Expanding the scope of the National Digital Health Mission (NDHM) to provide services to neighboring nations in the Global South and promoting telemedicine services. 
  • India should actively promote health-tech start-ups and platforms for international collaboration in data-sharing and AI-based diagnostics.  
    • Provide seed funding for startups working on wearable health devices and health management apps. 
  • Deploy AI-driven diagnostic tools for early detection of diseases in rural and underserved areas. 
• Integrating AYUSH with Modern Medicine: India can promote its traditional medicine systems globally by integrating AYUSH with allopathic healthcare, focusing on evidence-based practices.  
  • Establishing more research centers like the WHO Global Centre for Traditional Medicine (Gujarat, 2022) in partnership with global organizations will enhance credibility.  
  • Increase funding for clinical trials and research to scientifically validate AYUSH practices. 
  • Promote yoga and Ayurveda through embassies and Indian cultural centers worldwide. 
• Expanding the Reach of Affordable Vaccines and Medicines: India should further expand its leadership in vaccine manufacturing by leveraging its vaccine diplomacy initiatives like the "Vaccine Maitri" program.  
  • Scaling up initiatives under the Gavi Alliance can ensure global availability of affordable vaccines.  
  • Collaborate with African countries to build vaccine production capacity under “Vaccine Maitri 2.0.” 
  • Ease regulatory approvals for Indian generics in international markets through bilateral agreements. 
• Improving Health Infrastructure through Global Collaboration: India must invest in health infrastructure under schemes like the PM-Ayushman Bharat Health Infrastructure Mission (PM-ABHIM) while creating avenues for international partnerships in hospital management, diagnostics, and equipment manufacturing.  
  • Set up vaccine manufacturing hubs in Tier-2 cities to boost production and accessibility. 
  • Encourage foreign investments in tertiary hospitals and medical device manufacturing under “Make in India.” 
• Tackling Antimicrobial Resistance (AMR) through Global Leadership: India, a hotspot for Antimicrobial resistance due to overuse of antibiotics, should lead the fight by strengthening surveillance mechanisms and promoting the National Action Plan on AMR.  
  • Encouraging responsible antibiotic use in domestic policies and collaborating with WHO and G20 nations can help address this global health crisis.  
    • Push for global implementation of WHO's AMR containment policies, led by India. 
  • India reported nearly 60% resistance in common bacterial infections (ICMR, 2023), making it critical to prioritize AMR in global health strategies. 
• Expanding the Scope of Ayushman Bharat for Global Health Diplomacy: India can showcase Ayushman Bharat as a model for achieving Universal Health Coverage (UHC) in low- and middle-income countries.  
  • By assisting developing nations in replicating the program, India can demonstrate its leadership in global health governance.  
• Addressing Climate Change and Health: India should lead initiatives linking climate action to public health, such as promoting resilient healthcare infrastructure in disaster-prone regions.  
  • By leveraging the National Adaptation Fund for Climate Change (NAFCC) and integrating health impact assessments into climate policies, India can drive global action.  
  • India can also focus on building energy-efficient hospitals with solar power and sustainable waste management. 
• Focusing on Women’s and Children’s Health for Global Impact: India must champion programs targeting maternal and child health through platforms like Poshan Abhiyaan and Mission Shakti.  
  • Expanding these programs globally, especially in South Asia and Africa, can reduce maternal and infant mortality worldwide.  
  • India's success in reducing MMR to 97 per lakh live births and increased institutional delivery rates positions it as a model for addressing gendered health disparities. 
• Combining Swachh Bharat and Health Initiatives: Linking the Swachh Bharat Mission (SBM) with health programs can improve hygiene-related health outcomes, such as reducing diarrheal diseases globally.  
  • About 95% of villages in India have declared themselves “open defecation free plus” till now, India can scale this initiative internationally to address public health challenges in sanitation-deficient regions. 
• Improving Global Supply Chain Resilience for Health Products: India should enhance global health supply chain resilience by strengthening the pharmaceutical and API (Active Pharmaceutical Ingredients) sectors. 
  • Investments in schemes like the PLI for APIs and bulk drugs, combined with trade partnerships in Africa and Latin America, can establish India as a reliable supplier. 
  • India can also leverage trade pacts to expand the export of affordable generics and medical devices worldwide. 

Conclusion:  

India’s potential to emerge as a global health leader lies in leveraging its achievements in vaccine diplomacy, digital health, and traditional medicine while addressing critical gaps in health expenditure, infrastructure, and R&D. By tackling challenges like antimicrobial resistance and climate-linked health risks, India can set an example for sustainable and inclusive global health governance. With strategic reforms and investments, India can transform global health systems and promote equality worldwide. 

Drishti Mains Question:

Discuss key factors contributing to India's rise as a global leader in healthcare governance, and discuss the challenges and opportunities that lie ahead in strengthening its role on the world stage.

UPSC Civil Services Examination Previous Year Question (PYQ) 

Prelims

Q. Which of the following are the objectives of ‘National Nutrition Mission’? (2017)

1. To create awareness relating to malnutrition among pregnant women and lactating mothers. 
2. To reduce the incidence of anaemia among young children, adolescent girls and women. 
3. To promote the consumption of millets, coarse cereals and unpolished rice. 
4. To promote the consumption of poultry eggs. 

Select the correct answer using the code given below: 

(a) 1 and 2 only 

(b) 1, 2 and 3 only 

(c) 1, 2 and 4 only 

(d) 3 and 4 only 

Ans: (a)

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Mains 

Q. “Besides being a moral imperative of a Welfare State, primary health structure is a necessary precondition for sustainable development.” Analyse. (2021)

Q.  Appropriate local community-level healthcare intervention is a prerequisite to achieve ‘Health for All’ in India. Explain. (2018)