BharatNotes Why this chapter matters for UPSC: Health governance is a major GS2 topic — the structure of India's public health system (primary/secondary/tertiary), the debate over public vs private healthcare, National Health Policy 2017, Ayushman Bharat, and health as a fundamental right under Article 21 are all directly tested in Prelims and Mains.
PART 1 — Quick Reference Tables
India's Public Health Structure (Three-Tier System)
| Level | Facility | Covers | Services |
|---|---|---|---|
| Primary | Sub-centre (SC), Primary Health Centre (PHC), Community Health Centre (CHC) | Village/block/taluk level | Preventive, promotive, basic curative; maternal and child health; immunisation; family planning |
| Secondary | District Hospital, Sub-district Hospital | District level | Specialist care (surgery, medicine, gynaecology); referral from PHC |
| Tertiary | AIIMS, PGIMER, JIPMER, State Medical Colleges + Hospitals | Regional/national | Superspecialty care; teaching and research; referral from secondary |
Key Health Norms (Indian Public Health Standards)
| Facility | Population Served |
|---|---|
| Sub-centre | 3,000–5,000 (plains); 1,000–3,000 (hilly/tribal) |
| PHC (Primary Health Centre) | 20,000–30,000 (plains); 12,000–20,000 (hilly) |
| CHC (Community Health Centre) | 80,000–1,20,000; minimum 30 beds; 4 specialist doctors |
| District Hospital | District population |
PART 2 — Detailed Notes
Public vs Private Healthcare
Public healthcare (government):
- Funded by taxpayers; theoretically free or subsidised for all
- Goal: Universal access regardless of ability to pay
- In India: Government hospitals, PHCs, CHCs, AIIMS, ESI hospitals, etc.
- Problems: Underfunding, understaffing, poor infrastructure, medicines often unavailable, long queues
Private healthcare:
- Profit-driven; patient pays
- Often better equipped and staffed (in cities)
- Problems: Expensive (catastrophic for the poor), unregulated quality, diagnostic tests often over-prescribed, concentrated in urban areas
India's healthcare situation:
- Public expenditure on health: ~2.2% of GDP (2023-24 budget estimate) — BELOW the 2.5% target set in National Health Policy 2017 and the 5% recommended by WHO for developing countries
- Out-of-pocket expenditure (OOPE): ~39–40% of total health expenditure (2025 estimate) — one of the highest in the world; major cause of household impoverishment
- Medical poverty trap: Every year, ~3–5 crore Indians are pushed below the poverty line due to healthcare costs (catastrophic health expenditure)
The case for government healthcare:
- Health is a public good with positive externalities (vaccinating one person benefits others; treating TB prevents spread)
- Markets cannot provide equity in healthcare — poor cannot pay for life-saving treatment
- Article 21 of the Constitution: Right to Life includes right to health (Supreme Court interpretation: Paschim Banga Khet Mazdoor Samity vs State of West Bengal, 1996 — state must provide primary healthcare as a component of right to life)
India's Health Schemes and Policy
UPSC GS2 — Health Schemes:
Ayushman Bharat: India's flagship universal health coverage initiative — two components:
1. PM-JAY (Pradhan Mantri Jan Arogya Yojana):
- Health insurance: Rs 5 lakh per family per year for hospitalisation
- Covers ~12 crore poorest families (~55 crore individuals) — bottom 40% by SECC (Socio-Economic Caste Census)
- Cashless treatment at empanelled public AND private hospitals
- Launched: September 23, 2018
- World's largest government-funded health insurance scheme
- Coverage gap: Outpatient care, medicines, diagnostics NOT covered — only hospitalisation
2. HWCs (Health and Wellness Centres):
- Transform 1.5 lakh sub-centres and PHCs into Ayushman Bharat Health and Wellness Centres
- Provide comprehensive primary health care including: screening for NCDs (hypertension, diabetes, cancer), mental health, palliative care, ophthalmology
- Target: All 1.5 lakh centres by 2024 — substantially achieved
- Run by Community Health Officers (CHOs) / nurses
National Health Policy 2017:
- Target public health expenditure: 2.5% of GDP (not yet achieved)
- Universal health coverage as goal
- Emphasis on preventive and promotive care
- Integration of AYUSH (Ayurveda, Yoga, Unani, Siddha, Homeopathy) into mainstream healthcare
ASHA (Accredited Social Health Activist):
- Key frontline health worker; one ASHA per village (~10 lakh ASHAs nationwide)
- Coordinates health services at community level: immunisation, maternal care, TB DOTS, nutrition
- Performance-based incentive; now getting minimum honorarium
- ASHA workers central to India's COVID-19 vaccination campaign success
National Health Mission (NHM):
- Umbrella mission since 2013 (merged NRHM + NUHM)
- NRHM (2005): Focus on rural health; improved immunisation (Mission Indradhanush), maternal health, malaria, TB
- Reproductive and Child Health (RCH): Janani Suraksha Yojana (JSY) — cash incentive for institutional delivery; dramatically increased hospital births; India's MMR fell from 254 (2004–06) to 88 per lakh live births (SRS 2020–22; ORGI, released 2023)
Health as a Right
Is there a fundamental right to health in India?
Article 21 (Right to Life): Supreme Court has interpreted "life" broadly — includes right to live with dignity, right to health, right to livelihood. Key cases:
- Consumer Education and Research Centre vs Union of India (1995): Right to health is a fundamental right under Article 21
- Vincent Panikurlangara vs Union of India (1987): State has a duty to maintain public health
Directive Principles (DPSP) — Part IV:
- Article 39(e): Health and strength of workers
- Article 41: State shall make effective provision for securing right to public assistance in case of sickness and disablement
- Article 42: Just and humane conditions of work, maternity relief
- Article 47: Raise the level of nutrition and standard of living; improve public health — specifically mentions prohibition of intoxicating drinks and drugs injurious to health
DPSPs are NOT directly enforceable (unlike Fundamental Rights) but guide government policy and courts interpret FRs in light of DPSPs.
International commitment:
- India has ratified the International Covenant on Economic, Social and Cultural Rights (ICESCR) which includes the right to the highest attainable standard of health (Article 12)
- Sustainable Development Goal 3 (SDG 3): Good Health and Well-Being — includes universal health coverage (UHC) target
[Additional] 2a. Ayushman Bharat PM-JAY — Senior Citizens 70+ Expansion and Latest Data
The chapter covers PM-JAY as launched in 2018 but misses the September 2024 Cabinet approval extending PM-JAY to all senior citizens aged 70+, the Ayushman Vay Vandana Card, and the latest enrollment and hospitalization data — all of which are directly tested in current-affairs-linked UPSC GS2 questions.
Key Terms — PM-JAY Expansion:
| Term | Meaning |
|---|---|
| Ayushman Vay Vandana Card | New Ayushman Bharat card for senior citizens aged 70 years and above; Cabinet approved September 11, 2024; launched October 29, 2024; coverage = Rs 5 lakh per year regardless of income; covers all 70+ seniors — not means-tested |
| PM-JAY 2025-26 allocation | Rs 9,406 crore — a ~29% increase over the previous year; total MoHFW allocation ~Rs 1 lakh crore |
| Gig workers extension | Budget 2025-26 announced extension of PM-JAY to ~1 crore gig workers registered on e-Shram portal |
| Empanelled hospitals | 32,320 hospitals under PM-JAY (as of October 2025), including 13,173 private hospitals |
[Additional] Ayushman Bharat PM-JAY — 2024 Expansion and Updated Data (GS2 — Health Governance):
PM-JAY — September 2024 expansion to all senior citizens:
| Parameter | Detail |
|---|---|
| Cabinet approval date | September 11, 2024 |
| Launch date | October 29, 2024 |
| New card | Ayushman Vay Vandana Card |
| Who is covered | All senior citizens aged 70+ — irrespective of income or socio-economic status |
| Coverage amount | Rs 5 lakh per year (cashless, secondary + tertiary hospitalization, ~2,000 procedures) |
| Additional top-up | Seniors from existing PM-JAY families get an additional dedicated Rs 5 lakh exclusively for themselves (family's existing Rs 5 lakh pool is NOT reduced) |
| Estimated beneficiaries | ~6 crore senior citizens from ~4.5 crore families |
| Pre-existing conditions | No waiting period for pre-existing conditions |
PM-JAY enrollment and utilization data (latest):
| Parameter | Data | As of |
|---|---|---|
| Eligible base | ~12 crore families (~55 crore beneficiaries) + 6 crore seniors 70+ | Cumulative |
| Ayushman Vay Vandana Cards issued | 96.7 lakh cards | December 2025 |
| Vay Vandana hospitalisations | 1.03 million admissions; Rs 2,154 crore expenditure | December 2025 |
| Total Ayushman cards (all categories) | 36.9 crore | March 2025 |
| Cumulative hospitalisations (all PM-JAY) | 8.39 crore hospital admissions; Rs 1.16 lakh crore treatment cost | December 2024 |
| Empanelled hospitals | 32,320 (including 13,173 private) | October 2025 |
Timeline of PM-JAY expansions:
| Date | Expansion |
|---|---|
| September 23, 2018 | Original PM-JAY launch — 12 crore families, bottom 40% by SECC |
| March 2024 | Added ~37 lakh ASHA/Anganwadi Workers and Helpers + their families |
| September 11, 2024 | Cabinet approved extension to all 70+ seniors (~6 crore) |
| October 29, 2024 | Ayushman Vay Vandana Card launched |
| Budget 2025-26 | ~1 crore gig workers (e-Shram registered) to be added |
Budget 2025-26 — health allocations:
- PM-JAY: Rs 9,406 crore (~29% increase)
- PM-ABHIM (Ayushman Bharat Health Infrastructure Mission): Rs 4,200 crore (~40% increase)
- Saksham Anganwadi + Poshan 2.0: Rs 21,200 crore
- 5 new skill centres to train 3 lakh healthcare professionals annually
UPSC synthesis: PM-JAY = GS2 Health. Key exam facts: PM-JAY original launch = September 23, 2018; coverage = Rs 5 lakh/family/year; ~12 crore families / ~55 crore individuals (bottom 40%); Vay Vandana Card = all 70+ seniors = Rs 5 lakh/year = Cabinet approval September 11, 2024 = launch October 29, 2024 = ~6 crore seniors covered; total Ayushman cards = 36.9 crore (March 2025); cumulative hospitalisations = 8.39 crore (December 2024). Prelims trap: Vay Vandana is NOT a separate scheme — it is a card/sub-component of AB PM-JAY for 70+ seniors; existing PM-JAY families' Rs 5 lakh pool is NOT diluted — seniors get an additional dedicated Rs 5 lakh; PM-JAY coverage is per family (NOT per person — the Rs 5 lakh is shared among family members, except Vay Vandana which gives seniors their own dedicated pool); gig workers extension is from Budget 2025-26 (e-Shram registered — ~1 crore).
[Additional] 2b. India's Key Health Indicators — TB Elimination, NCD Burden, IMR/U5MR, Mission Indradhanush
The chapter mentions ASHA workers and MMR but lacks the full picture of India's current health indicator status — TB burden (India = 25% of global cases), NCD burden (~63–65% of deaths), IMR/U5MR (latest SRS 2023 data), and Mission Indradhanush — all of which are directly tested in UPSC GS2.
Key Terms — India Health Indicators:
| Term | Meaning |
|---|---|
| IMR | Infant Mortality Rate — deaths of children under 1 year per 1,000 live births; India SRS 2023 = 25 (Rural 28; Urban 18) |
| U5MR | Under-5 Mortality Rate — deaths of children under 5 per 1,000 live births; India SRS 2023 = 29 |
| NMR | Neonatal Mortality Rate — deaths within 28 days of birth per 1,000 live births; India SRS 2023 = 17 |
| MMR | Maternal Mortality Ratio — maternal deaths per 1,00,000 live births; India SRS 2020-22 = 88 (SDG target <70 by 2030) |
| TB incidence | New TB cases per 1 lakh population per year; India 2024 = 187 per lakh (down from 237 in 2015) |
| Mission Indradhanush | GoI immunization catch-up programme launched December 25, 2014; targets children 0–5 and pregnant women who missed routine immunization; IMI 5.0 = latest phase |
| NCDs | Non-Communicable Diseases — cardiovascular diseases, diabetes, cancer, COPD; now cause ~63–65% of all deaths in India |
[Additional] India's Key Health Indicators — TB, NCDs, IMR/U5MR, Immunization (GS2 — Social Justice / Health):
India's mortality indicators (SRS 2023, released 2025):
| Indicator | India (SRS 2023) | Rural | Urban | Lowest State | Highest |
|---|---|---|---|---|---|
| IMR | 25 per 1,000 LB | 28 | 18 | Kerala (5) | MP/CG/UP (~37) |
| U5MR | 29 per 1,000 LB | 33 | 20 | — | — |
| NMR | 17 per 1,000 LB | — | — | — | — |
| MMR (SRS 2020-22) | 88 per 1,00,000 LB | — | — | Kerala | Assam |
India's progress: IMR declined 71% from 1990 to 2023 (global: 58%); U5MR declined 78% from 1990 to 2023 (global: 61%).
Mission Indradhanush — key facts:
| Parameter | Detail |
|---|---|
| Launched | December 25, 2014 |
| Target | Children 0–5 years + pregnant women who missed routine immunization |
| Latest phase | IMI 5.0 — first phase to cover ALL districts; extended to children up to 5 years (earlier: up to 2 years); U-WIN digital platform for real-time tracking |
| Full immunization coverage (FIC) | NFHS-4 (2015-16): 62% → NFHS-5 (2019-21): 76.4% (12-23 months age group) |
| Cumulative achievement | 701 districts covered; 4.46 crore children + 1.12 crore pregnant women vaccinated |
India's TB burden — WHO Global TB Report 2025:
| Parameter | Data |
|---|---|
| India's TB incidence (2024) | 187 per lakh population (down from 237 in 2015) |
| Decline 2015–2024 | 21% — nearly double the global decline rate of 12% |
| India's global share | 25% of all global TB cases — highest in the world |
| Absolute cases (2024) | 27.1 lakh |
| TB deaths (2024) | Over 3 lakh (mortality rate: 21 per lakh, down from 28 in 2015) |
| Treatment coverage (2024) | 92% (up from 53% in 2015) |
| Treatment success rate | 90% (global average: 88%) |
| India's elimination target | 2025 (vs. global target 2030) — defined as <1 case per million population |
| Target achievement status | Significantly off-track — needed 50% incidence reduction by 2025; achieved only 21% |
TB Mukt Bharat Abhiyan (launched December 2024): Screened over 19 crore vulnerable individuals; detected 24.5 lakh TB patients including 8.61 lakh asymptomatic cases.
NCD burden in India:
| Parameter | Data |
|---|---|
| NCDs as % of all deaths | ~63–65% (up from 37.9% in 1990) |
| Leading NCD cause | Cardiovascular diseases (CVD) — ~27% of all deaths |
| Four major NCDs (CVD + respiratory + cancer + diabetes) | ~82% of all NCD deaths |
| NCDs as % of DALYs | 55.4% of total Disability-Adjusted Life Years |
| Premature NCD mortality | ~25–26% of NCD deaths in the 30–70 age group |
| Economic impact | India projected to lose USD 4.58 trillion by 2030 due to NCDs + mental health |
UPSC synthesis: India health indicators = GS2 Health + Social Justice. Key exam facts: IMR (SRS 2023) = 25; U5MR = 29; NMR = 17; MMR (SRS 2020-22) = 88 (SDG target <70 by 2030); Mission Indradhanush = launched December 25, 2014 = FIC went from 62% (NFHS-4) to 76.4% (NFHS-5); TB incidence = 187 per lakh (2024) = decline of 21% from 2015 (= double global 12% rate) = India = 25% of global cases = 27.1 lakh cases 2024 = India's target 2025 (global = 2030) = off-track; NCDs = ~63–65% of all deaths = leading cause = cardiovascular diseases (~27% of all deaths). Prelims trap: MMR = 88 (SRS 2020-22, NOT 2021 data — SRS 2020-22 is the official figure); SDG target for MMR = <70 by 2030 (NOT <100); India's TB target = 2025 (NOT 2030 — that's the global target; India committed to elimination 5 years ahead); TB incidence = 187 per lakh (NOT 237 — 237 was 2015 baseline; current = 187); India's share of global TB = 25% (NOT 30% — the 30% figure appears in older data; latest WHO 2025 data = 25%); leading NCD = cardiovascular disease (NOT diabetes, NOT cancer — CVD is the single largest NCD killer accounting for ~27% of all deaths); IMR state with lowest = Kerala (5) — routinely asked.
Exam Strategy
Prelims traps:
- PM-JAY = Rs 5 lakh per family per year (launched 2018) — NOT Rs 2 lakh, NOT per person
- PM-JAY covers ~55 crore individuals (12 crore families) — world's largest government health insurance
- India's public health expenditure = ~2.2% GDP (target is 2.5%; actual is below target)
- Article 47 = nutrition and public health (DPSP) — often confused with Article 21 (fundamental right)
- Right to health = Article 21 (via judicial interpretation) — NOT a separate article
- ASHAs = 10 lakh frontline workers; performance-based; Village-level
- MMR (Maternal Mortality Ratio) India = 88 per lakh live births (SRS 2020–22; ORGI, 2023) — significant improvement from 254 in 2004–06 and 97 in 2018–20; SDG target <70 by 2030
Practice Questions
Prelims:
"Ayushman Bharat — PM-JAY" provides health insurance coverage of how much per family per year?
(a) Rs 1 lakh
(b) Rs 2 lakh
(c) Rs 5 lakh
(d) Rs 10 lakhUnder India's three-tier public health system, which facility is expected to provide specialist care and serves a population of 80,000–1,20,000?
(a) Sub-centre
(b) Primary Health Centre (PHC)
(c) Community Health Centre (CHC)
(d) District HospitalThe "right to health" in India is derived primarily from which constitutional provision through judicial interpretation?
(a) Article 14 (Right to Equality)
(b) Article 21 (Right to Life)
(c) Article 39 (DPSP)
(d) Article 47 (DPSP on public health)
