India, home to nearly 146 crore people, stands at a critical juncture in public health. Even as health infrastructure expanded in the post-pandemic years, the country faces a complex mix of non-communicable diseases, resurgent infections, climate-linked risks, pharmaceutical quality concerns, and, above all, chronic underfunding. Together, these challenges raise a fundamental question: can India realistically achieve “health for all” without a decisive shift in health financing and policy priorities?
Why health funding has come under strain
A significant external shock to India’s health financing emerged in early 2025, when the United States, under President Donald Trump, withdrew from the . This move triggered a broader rollback of U.S.-supported health and development assistance. India, which had benefited from programmes such as PEPFAR and funding through , was directly affected.
Several ongoing interventions in HIV/AIDS, population services, and maternal and child health suddenly faced funding gaps. Although USAID committed about $97 million for seven projects, this was only a small share of the nearly $750 million allocated across all collaborations. The immediate burden of bridging this deficit fell on Union and State governments, stretching domestic resources that were already under pressure.
Budgetary allocation and the persistent policy gap
Public spending on health in India has remained below 2% of GDP for decades. In the 2025–26 fiscal year, ₹99,859 crore was allocated to health—an 11% increase over the previous year. Yet this figure still does not meet the National Health Policy target of 2.5% of GDP.
The shortfall is not merely technical. Rising disease burdens, demographic pressures, and increasing costs of care mean that incremental increases are insufficient. Without sustained movement towards the policy benchmark, universal access to quality health care is likely to remain uneven and fragile.
Infectious diseases and environmental stressors
Inadequate funding has direct implications for India’s ability to manage infectious disease resurgence. Weak surveillance systems, uneven diagnostic capacity, and gaps in treatment continuity undermine efforts to reduce mortality and morbidity.
At the same time, environmental health risks are intensifying. Severe air pollution, particularly during winter in northern cities, has sharply reduced quality of life. Children, older adults, and individuals with pre-existing respiratory conditions bear a disproportionate burden. Experiences from cities such as Beijing suggest that determined, well-funded policy interventions can reverse deterioration, but delay will only deepen health costs.
Why tuberculosis elimination remains elusive
India had advanced the global tuberculosis elimination target and committed to achieving it by 2025. Despite notable progress—especially in diagnostics and improved drug regimens—the goal now appears unattainable within the timeline.
Indigenous molecular tests like TrueNat have improved early detection and identification of drug resistance. However, the growing burden of multidrug-resistant and extensively drug-resistant TB remains a serious concern. Detection rates vary widely across States, reflecting disparities in funding, infrastructure, and human resources.
Antimicrobial resistance as a looming public health threat
Antimicrobial resistance (AMR) has emerged as one of India’s most urgent health challenges. According to the WHO’s GLASS report, one in three bacterial infections in India involves resistant organisms, compared to one in six globally. High resistance levels are seen in serious infections caused by E. coli, Klebsiella pneumoniae, and Staphylococcus aureus, particularly in intensive care units.
Several systemic factors drive this trend:
- Easy over-the-counter access to antibiotics
- Self-medication and incomplete treatment courses
- Environmental contamination from pharmaceutical manufacturing and hospital waste
- Uneven enforcement of drug regulations
Kerala stands out as the only State where sustained stewardship has reduced AMR levels in the community, underscoring the role of coordinated policy and investment.
Pharmaceutical quality and regulatory credibility
Concerns over drug quality came sharply into focus after the deaths of 25 children in Madhya Pradesh linked to contaminated cough syrup containing diethylene glycol. Similar incidents abroad, including child deaths in The Gambia involving India-manufactured syrups, have raised uncomfortable questions about regulatory oversight.
For a country aspiring to be the “pharmacy of the world,” recurring quality failures erode both domestic trust and international credibility. Strengthening regulatory capacity, improving quality control mechanisms, and enforcing accountability are now central to India’s health and industrial ambitions.
What to note for Prelims?
- National Health Policy target: 2.5% of GDP for health spending
- Impact of reduced external health funding from WHO-linked programmes
- TrueNat as an indigenous molecular diagnostic tool for TB
- GLASS as the WHO’s antimicrobial resistance surveillance system
What to note for Mains?
- Linkages between health financing, system resilience, and outcomes
- Implications of declining external aid for India’s public health priorities
- Structural challenges in TB elimination and AMR containment
- Need for regulatory reforms to ensure pharmaceutical quality and patient safety
