Why in news ?
- India’s “Health for All” agenda faces serious stress points in 2024–25—funding gaps after U.S. withdrawal from WHO programmes, widening AMR (antimicrobial resistance) burden, missed targets on TB elimination, and repeated pharma quality failures linked to contaminated cough syrups.
- With a population of 146 crore, rising NCDs, climate-linked illnesses, resurgent infections, and weak regulatory enforcement make universal health coverage a difficult—but urgent—goal.
Relevance
- GS-II (Issues relating to Health, Welfare Schemes, Regulation)
- UHC gaps, AMR crisis, TB elimination shortfalls, pharma-quality regulation
- GS-III (Economy – Budgeting & Public Expenditure, Health Economics)
- Low health spending, fiscal prioritisation, donor-funding shocks
India’s health challenges — facts & evidence
- AMR burden (WHO-GLASS 2025)
- 1 in 3 Indians with bacterial infections carry drug-resistant organisms (vs 1 in 6 globally).
- High resistance in E. coli, Klebsiella pneumoniae, Staphylococcus aureus — especially in ICUs.
- Drivers: OTC antibiotic sales, self-medication, incomplete courses, environmental contamination, livestock misuse, weak regulation.
- Kerala is the only State showing decline in AMR due to stewardship + surveillance + prescription control.
- Resurgent infectious diseases
- Rising incidence of TB, dengue, influenza-like illnesses, and climate-linked vector diseases.
- Multidrug-resistant (MDR/XDR) TB growing despite diagnostics expansion.
- Non-communicable diseases
- Cardiovascular diseases, diabetes, cancers, mental-health disorders continue to drive >60% of mortality (IHME estimates).
- Air-quality & climate risks
- Severe urban air pollution → respiratory & cardiovascular morbidity, productivity loss; weak multi-sectoral mitigation.
Funding deficit — what changed and why it matters ?
- External funding shock (2025)
- U.S. exit from WHO → funding cuts to PEPFAR, USAID health initiatives affecting HIV/AIDS, population services, maternal-child health in India.
- Govt reported $97 million committed across 7 projects, but broader programme pipelines faced uncertainty → States had to backfill gaps.
- Budgetary constraints
- Union health outlay ₹99,859 crore (2025-26) — ~11% rise, but still < 2% of GDP (target in National Health Policy = 2.5% of GDP).
- Persistent under-investment → infrastructure shortages, skewed urban concentration of care, weak primary health systems.
Why AMR is a cause for worry (public-health and economic risk)
- Leads to higher mortality, longer hospital stays, ICU overload, and expensive last-line drugs.
- Threatens success of surgery, cancer therapy, maternal care, and TB control.
- Environmental AMR pathways (pharmaceutical effluents, hospital wastewater, poultry/aquaculture) remain poorly regulated.
- National Action Plan on AMR (Phase-II) needs uniform State-level stewardship, lab networks, prescription audits, antibiotic procurement controls.
Why India missed the TB elimination goal?
- Structural gaps
- High household transmission, under-nutrition, overcrowding, delayed diagnosis in remote areas.
- Private-sector under-notification, irregular treatment adherence, socio-economic vulnerabilities.
- Programmatic progress (but insufficient)
- Wider deployment of TrueNat molecular tests, faster detection + drug-resistance mapping.
- Newer regimens introduced, but MDR/XDR TB burden rising, requiring longer, costlier, toxic therapies.
- Lesson: Diagnostics alone cannot offset deficits in nutrition support, contact tracing, adherence monitoring, social protection, urban housing & migration health policies.
Pharma-quality failures — why they are alarming ?
- Recent tragedies
- 25 child deaths in Madhya Pradesh due to cough syrup containing diethylene glycol (DEG).
- Earlier incidents (e.g., 70 child deaths in The Gambia) linked to Indian-made syrups exposed systemic lapses.
- Systemic weaknesses
- Fragmented State-level licensing, uneven lab capacity, inadequate batch testing & traceability, limited post-marketing surveillance.
- Global reputation risk to India’s “pharmacy of the world” ambition; threatens exports and domestic patient safety.
- Regulatory priorities
- Centralised risk-based inspections, mandatory GMP 2.0, stronger API & excipient quality chains, product recall systems, and criminal liability for falsified drugs.
Is ‘Health for All’ on track? — Balanced assessment
- Strengths
- Expanded diagnostics & beds post-COVID, digital health initiatives, insurance coverage growth, supply-side reforms in select States.
- Gaps
- Low public spending, workforce shortages at PHCs/CHCs, uneven State capacity, weak surveillance, AMR surge, quality-control lapses, climate-health inattention.
- Bottom line
- Without higher public investment + regulation + primary-care centric reforms, the campaign risks stagnation.
What India needs to do ?— policy way forward
- Financing
- Raise public health outlay to ≥2.5% of GDP; prioritise primary care, district hospitals, epidemiology, labs; ring-fence funds for AMR & TB.
- AMR control
- Nationwide stewardship programmes, prescription audits, ban OTC antibiotic sales, regulate industrial effluents, expand GLASS-aligned labs.
- TB strategy
- Intensify nutritional support, contact tracing, community DOT, migrant coverage, private-sector integration, shorter MDR regimens where evidence permits.
- Pharma quality
- Nationalised quality grid, lot-level testing, bar-code traceability, recall & whistle-blower mechanisms, capacity building of State regulators.
- Climate & air-quality health actions
- Health-sector engagement in clean-air missions, heat-action plans, surveillance for climate-sensitive diseases.
