India ranks low on both the Human Development Index and the Global Hunger Index. According to the Global Hunger Index (GHI) 2025, released by Concern Worldwide and Welthungerhilfe, India ranks 102 out of 123 countries, with a score of 25.8, categorised as a “serious” level of hunger. The index is based on child malnutrition, undernourishment, and under 5 mortality. Alarmingly, India ranks below several of its neighbours—Pakistan (94th), Bangladesh (88th), and Sri Lanka (66th).

While there has been some improvement in Maternal Mortality Rate (MMR) and Infant Mortality Rate (IMR), India still lags far behind other BRICS countries. According to data from the National Health Mission, Government of India, India’s IMR stands at 25–28 deaths per 1,000 live births (2020–2023) and the MMR at 88 per 100,000 live births (2020–22). In comparison, Brazil’s IMR is 10.42 and MMR 49.9; Cuba’s IMR 3.94 and MMR 35–40; Russia’s IMR 4.54 and MMR 9; China’s IMR 7.93 and MMR 11.04; while South Africa records an IMR of 22.69 and MMR 118.
(Source: National Health Mission, Government of India)

These figures underline the urgent need for concrete and comprehensive public health interventions to ensure the healthy growth of India’s population.

The Planning Commission of India had constituted a High Level Expert Group (HLEG) on Universal Health Coverage (UHC) in October 2010, chaired by Dr. K. Srinath Reddy, with the mandate to develop a framework for accessible, affordable, and universal healthcare, with financial protection as its core objective. The HLEG gave several recommendations for Universal Health Coverage (UHC).

Public investment in health remains grossly inadequate. In the previous Union Budget, the government allocated Rs.95,958 crore to health—which is less than 2% of the total budget. This translates into a per capita public health expenditure of approximately Rs.696/- per year, which is extremely low by international standards.

Countries that spend less than India on government (public) health expenditure include Somalia, South Sudan, Chad, the Central African Republic, Afghanistan, Yemen, Haiti, Nigeria, Pakistan, and Bangladesh.

These are largely fragile, conflict-affected, or extremely poor nations—yet India is projected as the world’s third-largest economy and repeatedly projected as a “Vishva Guru”.

The government frequently projects Ayushman Bharat as the world’s largest health insurance scheme. However, a closer examination reveals serious limitations. The scheme covers only about 80 crore people and is restricted almost entirely to inpatient (hospitalisation) care. It excludes outpatient care (OPD), medicines, and diagnostic tests taken without hospital admission—despite the fact that nearly 70% of illnesses are treated in OPD settings.

Additionally, the scheme excludes large sections of the population, including those who own two- three- or four-wheelers, mechanised farming equipment, or fishing boats; those holding Kisan Credit Cards with limits above Rs.50,000; government employees; workers in government-managed non-agricultural enterprises; individuals earning more than Rs.10,000 per month; households owning refrigerators or landlines; those living in pucca houses; and families owning five acres or more of agricultural land. These exclusions undermine the very principle of universality.

In contrast, Universal Health Care (UHC) is not an insurance scheme. It is a publicly funded health system that guarantees healthcare for everyone, not just selected beneficiaries. UHC ensures free or affordable OPD services, access to essential medicines, preventive and primary care, mental health services, and minimal out-of-pocket expenditure. Importantly, several countries poorer than India have successfully implemented such systems.

Because of low public Health expenditure the out-of-pocket expenditure remains at about 45%, among the highest in the world. Under Ayushman Bharat, private hospitals dominate service provision, while public hospitals remain underfunded, understaffed, and overstretched.

The HLEG clearly warned that insurance-based models divert public funds to private hospitals while weakening the public health system. Hospital-centred care without a strong primary healthcare foundation increases costs, delays diagnosis, and pushes families into debt.

Universal Health Care entails access to promotive, preventive, curative, and rehabilitative services at all levels; inclusive coverage for all sections of society; and health protection through action on social determinants of health. These services must be affordable to ensure that people do not suffer financial hardship in the pursuit of good health.

The HLEG emphasised that social determinants—such as nutrition, sanitation, education, housing, and environmental conditions—have a profound influence on health outcomes and access to care. Therefore, the foundation of UHC lies in universal entitlement to comprehensive health security and an overarching obligation of the State to ensure adequate food and nutrition, safe drinking water, sanitation, education, health information, and other prerequisites of health.

According to the HLEG the UHC is built on the principles of universality, equity, non-exclusion, non-discrimination, comprehensive and quality care, financial protection, patients’ rights, accountability, transparency, community participation, and a strengthened public health system.

In practical terms, UHC requires simultaneous attention to nutrition and food security, water and sanitation, social inclusion across gender, caste, religion, and tribal communities, decent housing, a clean environment, employment security, occupational safety, and disaster preparedness.

Financing such a system will require increasing public health expenditure from the current to at least 5% of GDP, a level consistent with both government estimates and the requirements outlined in the National Health Policy.

Healthcare must and preventive care as core health services. Only such a commitment can ensure health equity, social justice, and genuine national development. (IPA Service)