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National Health Policy

The National Health Policy was endorsed by the Parliament of India in 1983 and updated in 2002, and then again updated in 2017. The recent four main updates in 2017 mention the need to focus on the growing burden of non-communicable diseases, the emergence of the robust healthcare industry, growing incidences of unsustainable expenditure due to health care costs, and rising economic growth enabling enhanced fiscal capacity. Furthermore, in the long-term, the policy aims to set up India's goal to reform its current system to achieve universal health care.

In practice however, the private healthcare sector is responsible for the majority of healthcare in India, and a lot of healthcare expenses are paid directly out of pocket by patients and their families, rather than through health insurance due to incomplete coverage.

Government health policy has thus far largely encouraged private-sector expansion in conjunction with well designed but limited public health programmes.

Rural areas

Rural areas in India have a shortage of medical professionals. 74% of doctors are in urban areas that serve the other 28% of the population, leaving many with unmet medical needs. This is a major issue for rural access to healthcare. The lack of human resources causes citizens to resort to fraudulent or ignorant providers. Doctors tend not to work in rural areas due to insufficient housing, healthcare, education for children, drinking water, electricity, roads and transportation. Additionally, there exists a shortage of infrastructure for health services in rural areas. In fact, urban public hospitals have twice as many beds as rural hospitals, which are lacking in supplies. Studies have indicated that the mortality risks before the age of five are greater for children living in certain rural areas compared to urban communities. Due to these geographic barriers, limited healthcare infrastructure, and a shortage of healthcare professions, rural areas face unique challenges. Scholars believe that if healthcare providers are able to understand these cultural nuances, they may be able to provide culturally-sensitive services specifically tailored to the needs and preferences of these communities. Children face a myriad of health risks in relation to the healthcare challenges those in rural areas encounter. Across three different measuring points from 1992 through 2006, more developed states in India had a lower proportion of households with an underweight boy or girl than less developed states, which tend to contain more rural communities. Full immunization coverage also varies between rural and urban India, with 39% completely immunized in rural communities and 58% in urban areas across India. Vaccine illiteracy remains a significant obstacle in the path towards greater immunization coverage, often due to misinformation, unreliable healthcare, a lack of awareness among parents, and other social factors. Inequalities in healthcare can result from factors such as socioeconomic status and caste, with caste serving as a social determinant of healthcare in India. One study showed more health disparities arise when comparing urban versus rural homes rather than between castes; using three rounds of the National Family Health Surveys, researchers calculated the Multidimensional Poverty Index, which is aimed at further elucidating the indicators and social determinants of health. Between urban and rural households, the headcount ratio difference was found to be 20-30% in 2005-2006, while between scheduled castes/scheduled tribes and other households the difference was only 10-15%. Other critical social determinants of health in India include sanitation/hygiene, environmental pollution, nutrition, and more. Across all states, less than 50% (and in some less than 25%) of urban homes had unimproved sanitation, compared to over 50% (and in some over 75%) of rural homes, according to the 2007-2009 District Level Household Survey. Sanitation and hygiene are directly linked to disease and overall rural health outcomes.

Similar with many other countries, often those in rural India rely on informal providers to deliver necessary medical care. Utilizing modern and traditional medical practices, such as allopathic medicines and herbal remedies, informal providers have varying degrees of skills and education, but usually no formal medical qualifications. Yet, they far outnumber the quantity of medical providers in India; a study from Madhya Pradesh found there to be 24,807 qualified medical doctors, compared to 89,090 informal providers. They are also the most common first call for those in rural areas requiring medical services. Due to the lack of accessible healthcare in rural India, informal providers respond to much of the resulting unmet medical needs, proving them integral to rural health infrastructure.

Government-led

The Twelfth Plan

The government of India has a Twelfth Plan to expand the National Rural Health Mission to the entire country, known as the National Health Mission. Community based health insurance can assist in providing services to areas with disadvantaged populations. Additionally, it can help to emphasize the responsibility of the local government in making resources available. Furthermore, according to the Indian Journal of Community Medicine (IJOCM) the government should reform health insurance as well as its reach in India. The journal states that universal healthcare should slowly yet steadily be expanded to the entire population. Healthcare should be mandatory and no money should be exchanged at appointments. Finally, both private and public sectors should be involved to ensure all marginalized areas are reached. According to the IJOCM, this will increase access for the poor.

See Twelfth Five Year Plan (India).

National Rural Health Mission

To counteract the issue of a lack of professionals in rural areas, the government of India wants to create a 'cadre' of rural doctors through governmental organizations. The National Rural Health Mission (NRHM) was launched in April 2005 by the Government of India. The NRHM has outreach strategies for disadvantaged societies in isolated areas. The goal of the NRHM is to provide effective healthcare to rural people with a focus on 18 states with poor public health indicators and/or weak infrastructure. NRHM has 18,000 ambulances and a workforce of 900,000 community health volunteers and 178,000 paid staff. The mission proposes creating a course for medical students that is centered around rural healthcare. Furthermore, NRHM wants to create a compulsory rural service for younger doctors in the hopes that they will remain in rural areas. However, the NRHM has failings. For example, even with the mission, most construction of health related infrastructure occurs in urban cities. Many scholars call for a new approach that is local and specialized to each state's rural areas. Other regional programs such as the Rajiv Aarogyasri Community Health Insurance Scheme in Andhra Pradesh, India have also been implemented by state governments to assist rural populations in healthcare accessibility, but the success of these programs (without other supplemental interventions at the health system level) has been limited. Furthermore, a key goal of the NRHM was to bolster maternal and child health via infrastructural support and incentives, a long-time obstacle in India. The program led to an increase in the number of institutional births, yet labor shortages meant patients received poorer care, trading one challenge for another. Statistically, the infant mortality rate was 58 per 1000 live births in 2005, compared to 34 per 1000 in 2016. While this is a considerable reduction, India also accounted for 17% of global annual child deaths, which must be addressed going forward. Since the program's inception, maternal and child health have significantly improved in the country, yet it remains a pressing health priority.

South India

Informal providers provide key health care services throughout rural India, including South India, due to a lack of access to qualified professionals and medical resources. Specifically, in Guntur, Andhra Pradesh, India, these informal healthcare providers generally practice in the form of services in the homes of patients and prescribing allopathic drugs. A 2014 study by Meenakshi Gautham et al., published in the journal Health Policy and Planning, found that in Guntur, about 71% of patients received injections from informal healthcare providers as a part of illness management strategies. The study also examined the educational background of the informal healthcare providers and found that of those surveyed, 43% had completed 11 or more years of schooling, while 10% had graduated from college.

In general, the perceived quality of healthcare also has implications on patient adherence to treatment. A 2015 study conducted by Nandakumar Mekoth and Vidya Dalvi, published in Hospital Topics examined different aspects that contribute to a patient's perception of quality of healthcare in Karnataka, India, and how these factors influenced adherence to treatment. The study incorporated aspects related to quality of healthcare including interactive quality of physicians, base-level expectation about primary health care facilities in the area, and non-medical physical facilities (including drinking water and restroom facilities). In terms of adherence to treatment, two sub-factors were investigated, persistence of treatment and treatment-supporting adherence (changes in health behaviors that supplement the overall treatment plan). The findings indicated that the different quality of healthcare factors surveyed all had a direct influence on both sub-factors of adherence to treatment. Furthermore, the base-level expectation component in quality of healthcare perception, presented the most significant influence on overall adherence to treatment, with the interactive quality of physicians having the least influence on adherence to treatment, of three aspects investigated in this study.