Is the ‘health for all’ campaign on track?”

The Hindu

Core Theme and Context

The article interrogates India’s claim of progressing towards universal health coverage, questioning whether policy intent has translated into adequate funding, effective regulation, and improved outcomes. It situates public health within a triple crisis framework: rising disease burden, weak state capacity, and market-driven distortions in healthcare delivery.

Rather than celebrating schemes, the piece asks a fundamental governance question: is India structurally prepared to deliver health for all, or merely rhetorically committed?

Key Arguments Presented

1. Disease Burden Is Outpacing State Capacity

The author highlights India’s epidemiological double burden—communicable diseases such as tuberculosis alongside non-communicable diseases, climate-linked illnesses, and emerging antimicrobial resistance.

The central argument is that health outcomes are deteriorating faster than policy responses, making universal healthcare increasingly difficult to achieve without systemic reform.

2. Chronic Underfunding as the Core Bottleneck

A major thrust of the article is the persistent inadequacy of public health spending. Despite policy targets, actual allocations remain low relative to GDP and insufficient to support infrastructure, workforce expansion, diagnostics, and drug supply chains.

The author argues that health budgets reflect political symbolism rather than fiscal prioritisation, leaving states to manage crises with limited resources.

3. Missed Tuberculosis Elimination Goals

India’s failure to meet its self-imposed tuberculosis elimination targets is used as a case study of policy overreach. While diagnostics have improved, drug resistance, treatment adherence issues, and health-system gaps continue to undermine outcomes.

The argument is that technological fixes without systemic strengthening cannot deliver public health transformation.

4. Antimicrobial Resistance as a Governance Failure

The article treats antimicrobial resistance not merely as a medical issue but as a regulatory and enforcement failure. Over-the-counter antibiotic access, poor hospital infection control, and weak surveillance systems have allowed resistance to spread unchecked.

The author implicitly links this to India’s broader regulatory culture, where rules exist but compliance is uneven.

5. Pharmaceutical Quality and Regulatory Lapses

Citing instances of contaminated and substandard medicines, the article raises serious concerns about drug regulation and manufacturing oversight. The argument is that weak enforcement, fragmented regulation, and export-oriented complacency have endangered both domestic and global trust.

Public health, the author suggests, cannot coexist with lax quality control.

Author’s Stance

The author adopts a skeptical but reformist stance:

• Accepts that policy intent exists
• Rejects the idea that intent equals impact
• Frames health as a governance and accountability issue rather than a welfare slogan

The tone is critical without being ideological, focusing on structural deficits rather than political blame alone.

Implicit Biases and Editorial Leanings

1. State-Centric Problem Diagnosis

The article places primary responsibility on government systems, offering limited examination of:

• Federal coordination challenges
• Public–private health partnerships
• Community-level behavioural factors

2. Regulatory Pessimism

There is an implicit assumption that Indian regulatory institutions are inherently weak, with less attention to recent incremental improvements or capacity-building efforts.

3. Outcome-Driven Evaluation

The piece privileges measurable outcomes over long-term institutional reform, which may understate the time lag inherent in health-sector transformation.

Pros and Cons of the Argument

Pros

• Clearly identifies funding as the foundational constraint
• Integrates disease control, regulation, and pharmaceutical quality into a unified narrative
• Avoids scheme-centric analysis, focusing instead on system performance
• Raises antimicrobial resistance as a national security-level concern

Cons

• Limited discussion on primary healthcare and preventive strategies
• Underplays the role of social determinants such as nutrition, sanitation, and education
• Offers fewer concrete pathways for reform beyond increased funding and enforcement

Policy Implications

1. Health Financing Reform

The article implies the need for:

• Sustained increase in public health expenditure
• Better centre–state fiscal coordination
• Outcome-linked budgeting rather than headline allocations

2. Regulatory Capacity Building

Strengthening drug regulation, hospital protocols, and antibiotic stewardship emerges as a policy imperative, not merely a technical fix.

3. Reframing Health as Development Infrastructure

Health is positioned as foundational to productivity, demographic dividend realisation, and social stability, demanding cross-sectoral governance.

Real-World Impact

• Continued underfunding risks recurrent public-health emergencies
• Poor drug quality undermines trust in domestic healthcare systems
• Antimicrobial resistance threatens future treatment viability
• Missed disease-control targets erode policy credibility

For citizens, the impact is felt through out-of-pocket expenditure, preventable mortality, and uneven access to care.

UPSC GS Paper Alignment

GS Paper II – Governance and Social Justice

• Public health policy
• Federal challenges in healthcare delivery
• Regulatory institutions

GS Paper III – Human Development

• Health as human capital
• Disease burden and productivity
• Pharmaceutical regulation

GS Paper IV – Ethics in Governance

• Accountability in public health
• Ethical responsibility of the pharmaceutical industry
• State duty to protect life and dignity

Balanced Conclusion and Future Perspective

The article persuasively argues that “health for all” remains an aspiration rather than an achievement. While policy frameworks exist, they are undermined by chronic underinvestment, regulatory weakness, and uneven implementation.

Going forward, progress will depend on:

• Treating health expenditure as investment, not welfare
• Strengthening institutions rather than announcing targets
• Aligning pharmaceutical growth with ethical regulation

Ultimately, the success of the health-for-all campaign will be judged not by schemes launched, but by lives saved, diseases prevented, and trust restored in public health systems.