The Forgotten Right: Why India Must Fight for Universal Healthcare

India’s healthcare system should serve every citizen equally and not just those who can pay.

The death of Tanisha Bhise, a young mother, at the Deenanath Mangeshkar Hospital in Pune earlier this month prompted angry op-eds about medical negligence, fiery debates about the regulation of private hospitals and the usual deluge of hashtags demanding accountability. Yet the most urgent question, which is the collapse of government-provided healthcare and the need for universal, free medical services has barely been whispered.

India’s Constitution promises healthcare as a right. But in practice, successive governments have abdicated much of this responsibility, leaving the private sector and charitable institutions to fill the breach. Today, 80 percent of healthcare services are delivered by private or charitable providers. Only 20 percent are provided by the state. In a country of 1.4 billion people, such a balance is dangerous. The burden of public health cannot be offloaded onto entities designed neither to serve the poorest nor to guarantee equitable access.

If India is serious about improving healthcare outcomes and preventing future tragedies, it must confront the systemic collapse of its public health infrastructure.

Start with maternal care. In many government hospitals, women who suffer postpartum haemorrhage find that even basic medicines like carbocistin used to stop bleeding, are unavailable. Despite years of maternal deaths and warnings from public-health experts, successive health ministers have failed to ensure the supply of such life-saving drugs. The shortage of trained specialists is even more glaring. Ideally, a government hospital providing maternal care should have at least four specialists: a gynaecologist, an anaesthesiologist, a radiologist and a paediatrician. Most district hospitals and sub-district health centres fall woefully short of these minimum standards.

The result is a grim and predictable chain of events. Women are shuttled from one government facility to another as complications arise, wasting the critical ‘golden hours’ when medical intervention could save both mother and child. By the time they reach a private hospital or a better-equipped medical college, it is often too late.

India’s infant care system fares no better. Neonatal intensive care units and paediatricians are rare in government hospitals. Even medical colleges, which generally offer higher standards of care, are plagued by overwhelming patient loads, manpower shortages and bed unavailability. The mass deaths at government hospitals in Nanded and Thane in recent months - 24 dead in 24 hours at one, 18 dead in 24 hours at the other - should have triggered urgent reforms. Instead, they have been quietly forgotten.

The key question is not why patients choose private hospitals but why the government has made them the only viable option for so many. Public outrage about private hospital fees and standards, though understandable, misses the point. In a well-functioning system, private hospitals should serve as a supplement to, not a substitute for, state healthcare.

If India wishes to move towards universal healthcare, it must start with maternal and child health, and then expand the model to cover broader services. Equity, and not merely access, must be at the heart of the system. Today, healthcare quality is stratified by income: the ultra-rich, the middle class and the poor receive vastly different levels of care. Universal healthcare, properly executed, would guarantee the same quality of care for all citizens.

Achieving this will require radical changes to both policy and spending priorities. At present, 60 percent of healthcare spending in Maharashtra comes directly out of patients’ pockets. The goal must be to reduce this to zero. Yet the 2024-25 state budget allocated just Rs. 3,827 crore to public health, a paltry 4 percent of total spending. Even this modest sum was not targeted based on epidemiological priorities. Manpower shortages, medicine procurement failures and crumbling infrastructure have persisted for decades without serious attempts at resolution.

Solutions exist. Tamil Nadu’s medicine procurement model has been studied repeatedly, yet remains unimplemented elsewhere. Recruitment of BAMS doctors and BSc nursing graduates as community health officers has expanded access, but delays in salary payments and a lack of basic equipment render many of them ineffective. Cases of corruption in medicine procurement continue to surface, further eroding trust in government health services.

Ultimately, the state cannot confine itself to regulating private hospitals while neglecting its own obligations. It must invest in building a robust, high-quality public healthcare system that matches the private sector. COVID-19 brutally exposed the cost of India’s public health collapse. Families were ruined financially. Deaths surged not only because of the virus, but because of a system unprepared to deal with the scale of the crisis.

The lessons of the pandemic seem already forgotten. Despite widespread calls for reform, there has been little serious movement towards establishing a system of free, universal healthcare. Globally, 40% of countries provide some form of universal healthcare. Britain’s National Health Service (NHS) has survived for over 80 years. Cuba, Thailand, Canada and Japan have all developed models that ensure healthcare is treated as a public good, not a market commodity. India need not copy these systems wholesale but must choose a path and commit to it with seriousness and urgency.

Healthcare and education are primary responsibilities of the state. Yet because they yield scant electoral dividends, they are routinely neglected. If past history is any guide, then the inquiries ordered and reforms suggested in wake of Tanisha Bhise’s death will soon be forgotten. The Lentin Commission’s recommendations after hospital deaths in 1988 still gather dust.

Universal healthcare is not charity. It is not largesse. It is not even policy. It is justice. And it is long overdue.