India became the world’s most populous nation 75 years after Independence. As it looks ahead to the centenary of freedom in 2047, the country aspires to be recognised as a global leader, driven by the productive potential of its large and relatively young population. Achieving this vision places a major responsibility on India’s health system: to keep its people healthy, productive and resilient as the population ages, while supporting equitable and environmentally sustainable development.
In a federal structure where the Centre designs health policy and states deliver health services, India’s health system must be unified in its objectives and aligned in execution. To meet this mandate, public financing for health must increase substantially. At least 2.5 per cent of GDP should be allocated to health—an oft-repeated policy promise that remains unfulfilled. Higher investment from both central and state governments would strengthen infrastructure across primary, secondary and tertiary care, expand and upskill the health workforce, ensure reliable access to medicines and diagnostics, and promote research and innovation to address both persistent and emerging health challenges.
India’s health system must be both anticipatory and adaptive. It should recognise shifting determinants of health to forecast future disease trends, while also responding swiftly to unforeseen crises. The Covid-19 pandemic and the growing threat of climate change highlight this dual need. Even as new risks emerge, the country continues to face a complex disease burden—ranging from infectious diseases like tuberculosis and persistent undernutrition, to a rapid rise in non-communicable diseases, mental health conditions and overweight-obesity.
India’s commitment to primary care–led universal health coverage (UHC) by 2030 requires strong rural and urban primary health services. These must deliver comprehensive, continuous care close to communities, supported by point-of-care diagnostics and linked to higher-level facilities through telehealth and emergency transport. District hospitals and medical colleges need upgrading to provide advanced care while serving as training hubs for doctors, nurses and allied health professionals.
Addressing workforce shortages is critical. Maldistribution across states and urban–rural divides continues to widen inequities. Expanding and upskilling frontline workers such as ASHAs and Auxiliary Nurse Midwives—supported by technology—can help meet primary care needs. Training larger numbers of health professionals will not only strengthen India’s system but also allow the country to contribute to the global health workforce, which is increasingly strained by ageing populations. India’s traditional systems of medicine should also be promoted and integrated where appropriate.
UHC rests on two pillars: financial protection and service availability. Reducing out-of-pocket spending, catastrophic health costs and healthcare-induced impoverishment is essential—but financial coverage is meaningful only if quality care is actually accessible and affordable. India must therefore address gaps in both service delivery and financial protection.
Affordable service coverage will require a responsive public sector, a responsible private sector and a supportive voluntary sector. Financial protection should be driven primarily by public provisioning and tax-funded government health insurance, with employer-based and private insurance playing a supplementary role.
Health outcomes are shaped far beyond hospitals and clinics. India’s health system must catalyse policies across sectors such as education, income security, nutrition-sensitive agriculture, environment, gender equity, urban planning and transport. Alongside improving health and nutrition literacy, public policy must curb the aggressive marketing of tobacco, ultra-processed foods, sugar-sweetened beverages and alcohol.
India’s population is extraordinarily diverse—geographically, climatically, ethnically and culturally. Studying the country’s wide range of gene–environment interactions, epigenetic changes and microbiome patterns can significantly enrich global scientific understanding of physical and mental health. Its pluralistic health systems offer complementary approaches to complex health challenges, while frugal innovation and technological ingenuity position India to model new pathways for global health.
Building a health system that truly cares—through adequate financing, strong primary care, universal coverage and multi-sectoral action—is not just a national imperative, but a cornerstone of India’s global leadership aspirations.
