Healthcare for All

K. Srinath Reddy is a renowned cardiologist and epidemiologist and the founder and past president of the Public Health Foundation of India (PHFI).Girija Vaidyanathan is a retired Indian Administrative Service (IAS) officer (1981 batch) with extensive experience in public health, nutrition, and environmental governance.Amarjeet Sinha is a distinguished IAS officer from the 1983 Bihar Cadre with a profound commitment to transforming lives and livelihoods of marginalised communities.

‘These volumes fill a unique niche in the continuum between academic research and advocacy. They go beyond merely identifying challenges in various aspects of human development, particularly health, nutrition, and education, and instead explore potential solutions through critical reviews of what works. This makes the collection immensely valuable to both academicians and practitioners, rendering these volumes essential reading for anyone interested in public policy.’ Sonalde Desai, Professor, National Council of Applied Economic Research and University of Maryland, USA.‘Human development cannot be viewed segmentally through a reductionist lens, since the various elements are closely integrated and impact each other. Health is inseparable from nutrition, and both are influenced by education, environment and economic development. In each of these, equity is the litmus test of development serving its social purpose. These six volumes knit these varied skeins into a unified tapestry of human development. While detailing the key components of each of the main themes, the composite collection connects them to create a coherent design for accelerated and equitable people centric human development in India.’K. Srinath Reddy, Founder (Past) President, Public Health Foundation of India‘These volumes compile the results of many micro studies in the areas of health, nutrition, education and rural livelihood development. These are critical areas where India needs to improve performance to achieve the objective of Viksit Bharat. Larger funding is unavoidable but even more important is to ensure efficiency of spending and it is here that these micro studies will provide evidence-based guidance in what works and in what circumstances. The solutions will not be the same across all states and this must be built into the design of each programme at the state level. The collection is an invaluable contribution in this very important area.’Montek Singh Ahluwalia, Ex–Deputy Chairman, Planning Commission of India‘This book is a comprehensive introduction to the perspectives, problems and challenges that define India’s quest for universal health coverage. Every paper in this collection reiterates a simple, yet essential message - that for Healthcare for All to become a reality, it has to be based on strengthened public services, delivered with public as active participants, characterised by what the book calls, its publicness. This message is evidenced and reiterated across the different chapters that draw lessons from the experience of the last two decades in India and elsewhere. The book also has chapters that provide how human resource challenges are managed, capacities are built and how social and commercial determinants of health are addressed. Addressing the challenges needs finances, innovation, and technology but above all, it needs a community connect.’T. Sundararaman, Ex–Executive Director, National Health System Resource Centre, India‘Healthcare for All is a comprehensive volume on health and public policy in India. It contains well-researched papers; some of them carry clear messages that strengthening the public health system is vital to achieving the goals of "Viksit Bharat". It raises vital questions of public policy choice – should India grow by GDP numbers, or should it grow by investing in human capital? Should GDP size be the end of public policy or should it be a means to achieving the well-being of the people? With this larger question on public policy choices, this volume goes on to argue that universal health care, is vital to: (a) “converting demography into a dividend”, (b) “promoting human capital” with a view to raising productivity, and finally (c) enabling the “lives of dignity” to the people.Ashok Pankaj, Professor, Council for Social Development, India

• List of Figures viii List of Tables x List of Contributors xii Preface to Volume xxiii Preface xxv Acknowledgements xxvii 1 Making Healthcare for All a Reality: Addressing Key Challenges 1 K. Srinath Reddy, Girija Vaidyanathan, and Amarjeet Sinha PART I Overview – Perspectives on Public Health 17 2 Envisioning a Healthy India: Learning from the Past and Looking to the Future 19 K. Srinath Reddy 3 Key Gaps in Healthcare for All – Why Public Systems Matter 26 Amarjeet Sinha 4 Global Insights on Comprehensive Primary Healthcare 52 Sandhya Venkateswaranvi Contents 5 Turning the Politics of Knowledge Upside Down: Community-Centred Public Policy for Sustainable Universal Healthcare Systems 86 Ritu Priya 6 Towards Realising the Goal of Universal Health Coverage 117 A.K. Shiva Kumar PART II Learning from the States 137 7 Building Ayushman Bharat – Health and Wellness Centres – Early Lessons with Comprehensive Primary Health Care in Tamil Nadu – 2015–2022 139 V.R. Muraleedharan, Girija Vaidyanathan, and Rajesh M. 8 Learning from the Past: Kerala’s Preparedness for Future Pandemics 160 Rajeev Sadanandan 9 Bringing ‘the Public into Public Health’: Learnings from India’s Community Action for Health Programme, National Health Mission 173 Poonam Muttreja 10 Making Government-Funded Health Insurance an Effective Strategy for Universal Health Coverage 200 Sanjay Kaul and Nikita Pandey 11 Improving Health and Well-Being of Migrants in India 220 Pavitra Mohan, Ashmita Gulechha, and Divya Varma PART III Human Resources for Health 245 12 Reflections from Two Decades of ASHA Programme Implementation 247 Garima Gupta 13 Building Capacity in Public Health Systems: Experience of the National Health Systems Resource Centre and the Mitanin Programme 276 T. Sundararaman 14 Strengthening the Health Workforce in India: Challenges and Priorities for Achieving Universal Healthcare 295 Sanjay Zodpey and Anup Karan PART IV Sectoral Policy Challenges in Healthcare for All 327 15 Healthcare for All: Challenges in Urban Areas 329 Mahaveer Golechha and Dileep Mavalankar 16 Addressing Commercial Determinants of Health to Promote Health for All 356 Monika Arora, Shalini Bassi, and Ankur Sharan 17 Evolving Landscape of India’s Pharmaceutical Sector 383 Preeti Kumar, Aashna Mehta, and Senthil Ganesh 18 Moving beyond Corporatisation: Advancing Publicness in Healthcare Systems 408 Abhay Shukla 19 Air Pollution: Public Health Impacts and Policy Measures 430 Bhargav Krishna and Nazneen 20 The Future of Mental Health Care in India: Policy Innovations with a Community Focus 449 Satish Suhas and Pratima Murthy Index 482