Why this chapter matters for UPSC: Health governance is a major GS2 topic — the structure of India's public health system (primary/secondary/tertiary), the debate over public vs private healthcare, National Health Policy 2017, Ayushman Bharat, and health as a fundamental right under Article 21 are all directly tested in Prelims and Mains.

PART 1 — Quick Reference Tables

India's Public Health Structure (Three-Tier System)

Level Facility Covers Services
Primary Sub-centre (SC), Primary Health Centre (PHC), Community Health Centre (CHC) Village/block/taluk level Preventive, promotive, basic curative; maternal and child health; immunisation; family planning
Secondary District Hospital, Sub-district Hospital District level Specialist care (surgery, medicine, gynaecology); referral from PHC
Tertiary AIIMS, PGIMER, JIPMER, State Medical Colleges + Hospitals Regional/national Superspecialty care; teaching and research; referral from secondary

Key Health Norms (Indian Public Health Standards)

Facility Population Served
Sub-centre 3,000–5,000 (plains); 1,000–3,000 (hilly/tribal)
PHC (Primary Health Centre) 20,000–30,000 (plains); 12,000–20,000 (hilly)
CHC (Community Health Centre) 80,000–1,20,000; minimum 30 beds; 4 specialist doctors
District Hospital District population

PART 2 — Detailed Notes

Public vs Private Healthcare

Key Term

Public healthcare (government):

  • Funded by taxpayers; theoretically free or subsidised for all
  • Goal: Universal access regardless of ability to pay
  • In India: Government hospitals, PHCs, CHCs, AIIMS, ESI hospitals, etc.
  • Problems: Underfunding, understaffing, poor infrastructure, medicines often unavailable, long queues

Private healthcare:

  • Profit-driven; patient pays
  • Often better equipped and staffed (in cities)
  • Problems: Expensive (catastrophic for the poor), unregulated quality, diagnostic tests often over-prescribed, concentrated in urban areas

India's healthcare situation:

  • Public expenditure on health: ~2.2% of GDP (2023-24 budget estimate) — BELOW the 2.5% target set in National Health Policy 2017 and the 5% recommended by WHO for developing countries
  • Out-of-pocket expenditure (OOPE): ~39–40% of total health expenditure (2025 estimate) — one of the highest in the world; major cause of household impoverishment
  • Medical poverty trap: Every year, ~3–5 crore Indians are pushed below the poverty line due to healthcare costs (catastrophic health expenditure)

The case for government healthcare:

  • Health is a public good with positive externalities (vaccinating one person benefits others; treating TB prevents spread)
  • Markets cannot provide equity in healthcare — poor cannot pay for life-saving treatment
  • Article 21 of the Constitution: Right to Life includes right to health (Supreme Court interpretation: Paschim Banga Khet Mazdoor Samity vs State of West Bengal, 1996 — state must provide primary healthcare as a component of right to life)

India's Health Schemes and Policy

UPSC Connect

UPSC GS2 — Health Schemes:

Ayushman Bharat: India's flagship universal health coverage initiative — two components:

1. PM-JAY (Pradhan Mantri Jan Arogya Yojana):

  • Health insurance: Rs 5 lakh per family per year for hospitalisation
  • Covers ~12 crore poorest families (~55 crore individuals) — bottom 40% by SECC (Socio-Economic Caste Census)
  • Cashless treatment at empanelled public AND private hospitals
  • Launched: September 23, 2018
  • World's largest government-funded health insurance scheme
  • Coverage gap: Outpatient care, medicines, diagnostics NOT covered — only hospitalisation

2. HWCs (Health and Wellness Centres):

  • Transform 1.5 lakh sub-centres and PHCs into Ayushman Bharat Health and Wellness Centres
  • Provide comprehensive primary health care including: screening for NCDs (hypertension, diabetes, cancer), mental health, palliative care, ophthalmology
  • Target: All 1.5 lakh centres by 2024 — substantially achieved
  • Run by Community Health Officers (CHOs) / nurses

National Health Policy 2017:

  • Target public health expenditure: 2.5% of GDP (not yet achieved)
  • Universal health coverage as goal
  • Emphasis on preventive and promotive care
  • Integration of AYUSH (Ayurveda, Yoga, Unani, Siddha, Homeopathy) into mainstream healthcare

ASHA (Accredited Social Health Activist):

  • Key frontline health worker; one ASHA per village (~10 lakh ASHAs nationwide)
  • Coordinates health services at community level: immunisation, maternal care, TB DOTS, nutrition
  • Performance-based incentive; now getting minimum honorarium
  • ASHA workers central to India's COVID-19 vaccination campaign success

National Health Mission (NHM):

  • Umbrella mission since 2013 (merged NRHM + NUHM)
  • NRHM (2005): Focus on rural health; improved immunisation (Mission Indradhanush), maternal health, malaria, TB
  • Reproductive and Child Health (RCH): Janani Suraksha Yojana (JSY) — cash incentive for institutional delivery; dramatically increased hospital births; India's MMR fell from 254 (2004–06) to 97 per lakh live births (2018–20 SRS)

Health as a Right

Explainer

Is there a fundamental right to health in India?

Article 21 (Right to Life): Supreme Court has interpreted "life" broadly — includes right to live with dignity, right to health, right to livelihood. Key cases:

  • Consumer Education and Research Centre vs Union of India (1995): Right to health is a fundamental right under Article 21
  • Vincent Panikurlangara vs Union of India (1987): State has a duty to maintain public health

Directive Principles (DPSP) — Part IV:

  • Article 39(e): Health and strength of workers
  • Article 41: State shall make effective provision for securing right to public assistance in case of sickness and disablement
  • Article 42: Just and humane conditions of work, maternity relief
  • Article 47: Raise the level of nutrition and standard of living; improve public health — specifically mentions prohibition of intoxicating drinks and drugs injurious to health

DPSPs are NOT directly enforceable (unlike Fundamental Rights) but guide government policy and courts interpret FRs in light of DPSPs.

International commitment:

  • India has ratified the International Covenant on Economic, Social and Cultural Rights (ICESCR) which includes the right to the highest attainable standard of health (Article 12)
  • Sustainable Development Goal 3 (SDG 3): Good Health and Well-Being — includes universal health coverage (UHC) target

Exam Strategy

Prelims traps:

  • PM-JAY = Rs 5 lakh per family per year (launched 2018) — NOT Rs 2 lakh, NOT per person
  • PM-JAY covers ~55 crore individuals (12 crore families) — world's largest government health insurance
  • India's public health expenditure = ~2.2% GDP (target is 2.5%; actual is below target)
  • Article 47 = nutrition and public health (DPSP) — often confused with Article 21 (fundamental right)
  • Right to health = Article 21 (via judicial interpretation) — NOT a separate article
  • ASHAs = 10 lakh frontline workers; performance-based; Village-level
  • MMR (Maternal Mortality Ratio) India = 97 per lakh live births (2018–20) — significant improvement from 254 in 2004–06; still above target of <70

Previous Year Questions

Prelims:

  1. "Ayushman Bharat — PM-JAY" provides health insurance coverage of how much per family per year?
    (a) Rs 1 lakh
    (b) Rs 2 lakh
    (c) Rs 5 lakh
    (d) Rs 10 lakh

  2. Under India's three-tier public health system, which facility is expected to provide specialist care and serves a population of 80,000–1,20,000?
    (a) Sub-centre
    (b) Primary Health Centre (PHC)
    (c) Community Health Centre (CHC)
    (d) District Hospital

  3. The "right to health" in India is derived primarily from which constitutional provision through judicial interpretation?
    (a) Article 14 (Right to Equality)
    (b) Article 21 (Right to Life)
    (c) Article 39 (DPSP)
    (d) Article 47 (DPSP on public health)