Healthcare and the provision of health services have been unimaginably altered for the better since 1947

Healthcare in India has come a long way over the past 75 years. Core health indicators then and now tell us the journey India has made thus far. India marks a momentous year as it completes 75 years as an independent nation and looks ahead with vigour, vitality, and hope over the next two and half decades. The foundations laid over the past seven decades across multiple pillars that form a nation-state – economic, social and cultural – give a reason for optimism that India will be among the leading nations of the world as we mark a centenary as an independent nation. Healthcare and the provision of health services have been unimaginably altered for the better since 1947. India now has a health system that one should be proud of, flaws and all, considering the country was a basket case on the health front in 1947.

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Evolution of India’s Healthcare

It is important to take a step back and see the evolution of Indian healthcare since our independence. In 1947, health services were provided through myriad modes of delivery. From large public hospitals to institutes run through charity or religious endowments were the norm. Along with these were larger institutions where private practitioners and smaller nursing homes delivered care of varying quality. India did not adopt a universal health coverage system like the UK’s National Health Service given the economic fragility of our state which could not afford to pay for such a system. Instead, much like the other aspects of infrastructure and institutional development borne out of the Five-Year Plan system, large institutes like the All India Institute of Medical Sciences and others found favour. Along with this, the writers of our constitution, in their wisdom, transferred the delivery of health services to the states, probably with the intent of enabling states with adequate constitutional mandates to design services to the local needs of the population. Much of the health system that developed in the intervening decades bears the call-signs of these two approaches – large infrastructure development and provision of health programs by the state, with cooperative federalism ensuring the delivery of large national programs.

Addressing the issues

These initial paradigms delivered results on multiple fronts – from improving access to eradicating diseases and measurable improvements in health indicators like maternal and infant mortality. However, an equal number of issues remained unaddressed. Financial provision for healthcare, creation of advanced health infrastructure, last mile delivery of care and formalization of health administration to drive efficiencies. The past three decades have witnessed these issues being addressed first under the broad economic liberalization regime witnessed in the nineties to the introduction of payor mechanisms to improve access to healthcare and more recently the introduction of technology.

Economic Liberalization for Health

The economic liberalization regime brought in private health institutions to augment existing state-run health facilities. Considering the focus of private enterprises on driving operational efficiencies, formalizing health management and hospital operations made sense. In state-run hospitals and institutes, the hierarchical management approach whereby the seniormost clinician becomes the institute’s head continues to hold sway. However, the need for formal managerial training in operations, human resource management, organizational theory and financial management was felt across public and privately run institutions. This has been a welcome change that aligns with the maturing of the health sector over the past three decades. It has helped in driving a scientific approach toward management and ushering in efficiencies. While this shift has faced flak, given the constraints on resources, the formal managerial-ization of health management has ensured that hospitals become financially viable and operationally sustainable.

Operations Management and Technology

The advent of hospital operations management has also helped create world-class teaching institutions that offer courses that cover these subjects. The aim of these courses is to strengthen and build managerial capabilities across all sectors of the health sector. While this profound change in managing hospitals and health systems is underway, the use of technologies such as Artificial Intelligence and Machine Leaning in healthcare, data security, and confidentiality have thrown up new challenges and opportunities.

The Way Forward

The one abiding lesson from the seven decades of Indian health care’s evolution has been our ability to foresee challenges and adapt. One is confident that the aforementioned challenges and those more perennial in nature – access to quality and affordable health care for every citizen – will be faced and managed effectively in the years ahead and beyond.