Health Sector — Programmes and Challenges

2.1 Health Infrastructure

India's Health Indicators (2024):

• Life Expectancy at Birth: 70.1 years (M: 68.6, F: 71.7) — up from 50 years at independence
• Maternal Mortality Ratio (MMR): 97 per 1 lakh live births (SRS 2018-20) — target <70 by 2030
• Infant Mortality Rate (IMR): 27 per 1,000 live births (SRS 2022) — target <12 by 2030
• Under-5 Mortality Rate: 32 per 1,000 (NFHS-5 2019-21)
• Total Fertility Rate: 2.0 — at replacement level nationally (NFHS-5)
• Physician Density: 0.73 per 1,000 population (below WHO recommended 1 per 1,000)

Government Spending on Health:

• India spends ~2.2% of GDP on health (public + private combined government expenditure)
• Public health spending: ~1.35% of GDP — below WHO recommended 5%
• Out-of-pocket (OOP) expenditure: ~47% of total health spending — a major driver of impoverishment

2.2 National Health Mission (NHM)

Background: The National Rural Health Mission (NRHM) was launched in 2005. In 2013, NUHM (National Urban Health Mission) was added; together they formed NHM (National Health Mission).

Key NHM Components:

1. Reproductive, Maternal, Neonatal, Child, and Adolescent Health (RMNCH+A): Institutional deliveries, antenatal care, immunisation
2. Disease Control Programmes: National TB Elimination Mission (NIKSHAY), National Vector Borne Disease Control Programme, National Leprosy Eradication Programme
3. Human Resources for Health: ASHA (Accredited Social Health Activists) — 10.4 lakh ASHAs serving as community health workers
4. Infrastructure: Upgradation of Sub-Health Centres (SHCs), Primary Health Centres (PHCs), Community Health Centres (CHCs); B-HRH (Bridge course Health Workforce)

ASHA Workers are the backbone of NHM — 10.4 lakh female community health workers in rural areas (1 per 1,000 population or 1 per village). They are trained to promote health behaviours, accompany women for institutional delivery, conduct immunisation, and distribute ORS. Workers receive performance-linked incentives plus a fixed salary of Rs 2,000/month.

2.3 Ayushman Bharat Programme (2018)

Ayushman Bharat has two interrelated components:

Component 1 — Ayushman Arogya Mandirs (AAMs, formerly Health and Wellness Centres):

• Converting 1.5 lakh Sub-Health Centres and PHCs into AAMs (extended to 2024)
• Provide comprehensive primary health care — 12 health services including mental health, geriatrics, palliative care, dental, AYUSH, yoga
• As of 2024: Over 1.75 lakh AAMs functional

Component 2 — PM Jan Arogya Yojana (PM-JAY):

• Coverage: 55 crore individuals (10.74 crore families from bottom 40% by SECC database)
• Benefit: Rs 5 lakh per family per year for hospitalisation (over 1,900 medical procedures/packages)
• Universality: Cashless and paperless treatment at empanelled hospitals; portability across India
• Scale: Largest government-funded health insurance scheme globally
• Progress (2024): Over 6.5 crore hospital admissions; over 31,000 empanelled hospitals (public + private); Rs 1 lakh crore cumulative claims paid
• Expansion 2024: AB-PMJAY extended to all citizens above 70 years of age — 4.5 crore+ additional beneficiaries

Budget 2025-26 for AB-PMJAY: Rs 9,406 crore

2.4 Other Key Health Schemes

Scheme	Focus	Key Achievement
Mission Indradhanush	Universal Immunisation Programme expansion	12 vaccines; 4.5 crore children immunised in Mission Indradhanush 4.0 (2022)
National TB Elimination Mission (NTEP)	TB-free India by 2025 (now 2030)	25.5 lakh cases notified (2023); Ni-kshay Poshan Yojana (nutritional support Rs 500/month)
Pradhan Mantri Swasthya Suraksha Yojana	AIIMS + super-specialty hospitals in underserved states	22 new AIIMS; 75 government medical colleges upgraded
National Mental Health Programme (NMHP)	Mental health care in district hospitals	750+ district mental health programmes
e-Sanjeevani	Teleconsultation via National Telemedicine Service	310 million teleconsultations by 2025

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