Is the ‘health for all’ campaign on track?: Explained

India's aspiration for 'Health for All' is a cornerstone of its developmental agenda, reflecting a commitment to social justice and human capital formation. However, the journey is fraught with systemic challenges that demand urgent attention and robust policy interventions. The background context reveals a healthcare system historically characterized by low public expenditure, a significant rural-urban divide, and an over-reliance on out-of-pocket expenses for healthcare services. Since independence, health policies have evolved, from the Bhore Committee Report (1946) advocating for comprehensive primary healthcare, to the National Health Policy 2017 (NHP 2017) which set an ambitious goal of increasing public health spending to 2.5% of GDP by 2025. Despite these policy pronouncements, actual expenditure has consistently hovered around a meager 1.2-1.5% of GDP, placing India among the lowest spenders globally.

The core challenges highlighted include inadequate funding, a growing resistance to antibiotics (Antimicrobial Resistance or AMR), and the struggle to meet ambitious targets for tuberculosis (TB) elimination. Low public spending directly impacts infrastructure, human resources, and access to affordable care, particularly for marginalized communities. This financial constraint exacerbates health disparities and pushes millions into poverty due to catastrophic health expenditures. The NHP 2017 aimed to shift the focus towards preventive and promotive health, emphasizing primary healthcare and universal access to free drugs, diagnostics, and emergency services. However, the gap between policy intent and implementation remains substantial.

Antimicrobial Resistance (AMR) is another formidable threat, described by the WHO as one of the top 10 global public health threats facing humanity. In India, the widespread and often unregulated use of antibiotics in human health, animal husbandry, and agriculture has accelerated AMR. This means common infections are becoming harder to treat, leading to prolonged illness, higher healthcare costs, and increased mortality. Recognizing this, India launched its National Action Plan on AMR (NAP-AMR) in 2017, a multi-sectoral strategy involving various ministries to combat this menace through surveillance, infection prevention, antibiotic stewardship, and research. Key stakeholders in this fight include the Ministry of Health and Family Welfare, the pharmaceutical industry, healthcare professionals, agricultural sector, and even citizens who need to be educated on responsible antibiotic use.

India's ambitious target to eliminate Tuberculosis (TB) by 2025, five years ahead of the global Sustainable Development Goal (SDG) target of 2030, faces significant hurdles. Despite initiatives like the Revised National Tuberculosis Control Programme (RNTCP), renamed as National Tuberculosis Elimination Programme (NTEP), challenges persist in early diagnosis, treatment adherence, managing drug-resistant TB, and addressing social determinants like nutrition and housing. The COVID-19 pandemic further disrupted TB services, potentially reversing years of progress. The pharmaceutical industry's role in ensuring quality control of drugs is critical here. The Central Drugs Standard Control Organisation (CDSCO) is the primary regulatory body responsible for ensuring the quality, safety, and efficacy of drugs and medical devices. Lapses in quality control not only undermine treatment effectiveness but also erode public trust in the healthcare system.

The significance of these issues for India is profound. A healthy population is a productive population. Poor health outcomes directly impact human capital, reduce economic productivity, and perpetuate intergenerational poverty. Achieving 'Health for All' aligns with Sustainable Development Goal 3 (Good Health and Well-being) and is crucial for India's demographic dividend to translate into economic growth. Politically, failure to deliver on health promises can lead to public discontent. Socially, it deepens inequities, as the poor and vulnerable disproportionately bear the burden of disease and inadequate healthcare. Constitutionally, the state's responsibility to ensure public health is enshrined in the Directive Principles of State Policy, particularly Article 47, which mandates the State to raise the level of nutrition and the standard of living of its people and the improvement of public health as among its primary duties.

Looking ahead, future implications demand a multi-pronged approach. Increased public investment in health, as envisioned by NHP 2017, is non-negotiable. This must be accompanied by strengthening primary healthcare, leveraging technology for better diagnostics and data management, and fostering public-private partnerships. Addressing AMR requires strict regulatory oversight, promoting R&D for new drugs, and widespread public awareness campaigns. For TB elimination, an intensified focus on active case finding, nutritional support for patients, and community engagement is essential. The pharmaceutical industry must uphold the highest standards of quality and ethical practices, with CDSCO ensuring stringent enforcement. India's ability to achieve 'Health for All' will not only define its social progress but also determine its trajectory as a global economic power.