Health for All in India: Funding Gaps and Systemic Challenges

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• India’s progress towards the “Health for All” goal has come under scrutiny amid funding constraints, rising disease burdens, antimicrobial resistance and recent pharmaceutical quality failures. 

India’s Health Landscape: The Emerging Context

• With a population of nearly 146 crore, India’s public health system faces complex and overlapping challenges. 
• The disease profile has shifted significantly over the last decade, marked by a sharp rise in non-communicable diseases (NCDs) such as diabetes, cardiovascular disorders and cancers, alongside the continued presence of infectious diseases like tuberculosis and emerging viral outbreaks. 
• Climate change has further intensified health risks through heat stress, air pollution and extreme weather events, increasing morbidity and healthcare demand.
• At the same time, India’s expanding pharmaceutical industry and growing role as a global medicine supplier have raised concerns over drug quality regulation, underscoring the need for stronger governance frameworks to protect public health.

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Public Health Financing and Budgetary Constraints

• One of the most persistent bottlenecks in achieving Health for All is under-investment in healthcare. 
• India’s public health expenditure has consistently remained below 2% of GDP, despite the National Health Policy setting a target of 2.5% of GDP. 
• For 2025-26, the Union health allocation stood at Rs. 99,859 crore, representing an increase over the previous year but still insufficient to meet population-level needs.
• The funding stress has been exacerbated by external factors, including the withdrawal of certain international funding streams that previously supported programmes in HIV/AIDS, maternal health and population services. 
• As a result, both Union and State governments have had to absorb additional fiscal pressure, often leading to uneven capacity across regions.

Infrastructure Gaps and Environmental Health Concerns

• Although post-pandemic investments improved diagnostic capacity and hospital bed availability, infrastructure gaps persist, particularly in rural and peri-urban areas. 
• The demand–supply mismatch is further worsened by severe air pollution, especially in northern India during the winter months. 
• Poor air quality has reduced life expectancy, increased respiratory illnesses, and disproportionately affected children, elderly citizens and those with pre-existing conditions.
• Without sustained environmental health interventions and long-term urban air quality management, these health stressors risk overwhelming already stretched public health systems.

Tuberculosis Control and Antimicrobial Resistance

• India’s decision to advance its tuberculosis elimination target to 2025 has not yielded the desired outcomes. 
• While diagnostic capacity has improved through indigenous molecular tools such as TrueNat, challenges persist due to inconsistent detection rates and the growing burden of multidrug-resistant and extensively drug-resistant TB.
• A related and more systemic threat is antimicrobial resistance (AMR). Global surveillance data indicate that resistance levels in India are significantly higher than global averages, particularly for serious bacterial infections treated in hospital settings. 
• Factors such as over-the-counter antibiotic access, self-medication, incomplete treatment courses, pharmaceutical waste contamination and weak regulatory enforcement continue to fuel AMR. 
• Although policy frameworks exist, effective implementation remains uneven across States.

Pharmaceutical Quality and Regulatory Oversight

• Recent incidents involving contaminated medicines have exposed serious regulatory lapses within India’s pharmaceutical quality control ecosystem. 
• The deaths of children due to toxic cough syrup consumption in Madhya Pradesh highlighted failures in manufacturing oversight, testing and enforcement. 
• Such episodes not only undermine domestic health outcomes but also weaken India’s credibility as a global supplier of affordable medicines.
• Ensuring rigorous quality standards, strengthening drug regulators and enforcing accountability are essential for safeguarding public trust and advancing India’s ambition of being the “pharmacy of the world”.

Source: TH