In a crucial domain like the public healthcare system the Indian State should play a vital role to contain the adverse impact of…

The marketisation of healthcare has driven severe urban-rural asymmetries and corporatised tertiary care, resulting in catastrophic out-of-pocket expenditure (OOPE) that accounts for nearly half of India's total health spending. To counter these market distortions and ensure equitable access, the State must aggressively expand public healthcare at the grassroots level.

Human Resource Reforms at Primary Level Strengthen Sub-Centres and Primary Health Centres (PHCs) by regularising National Health Mission (NHM) contractual staff and providing hardship allowances and academic quotas to incentivise rural postings. Formalise task-shifting protocols to empower ASHAs and ANMs with diagnostic tools and community-level management of non-communicable diseases.

Decentralised Drug and Diagnostic Supply Adopt the Tamil Nadu Medical Services Corporation (TNMSC) model of centralised, automated procurement with decentralised distribution to eliminate stock-outs. Expand Jan Aushadhi Kendras to the Gram Panchayat level to provide zero-cost generic medicines and point-of-care diagnostics.

Technology-Enabled Last-Mile Access Scale digital infrastructure through e-Sanjeevani telemedicine hubs at Ayushman Arogya Mandirs, linking rural patients directly with specialists. Mainstream drone delivery of critical drugs, antivenoms, and vaccines in remote tribal terrains, scaling up ICMR’s pilot projects in Manipur and Arunachal Pradesh.

Inter-Sectoral Convergence Integrate clinical outreach with preventive determinants like clean drinking water, sanitation (Swachh Bharat), and nutrition (POSHAN Abhiyaan). Models like Delhi's Mohalla Clinics and Rajasthan’s upgraded Arogya Mandirs showcase how urban-rural decentralised clinics can deliver comprehensive primary care.

Community Accountability and Governance Democratise local health administration by revitalising Rogi Kalyan Samitis, institutionalising mandatory social audits under the NHM, and establishing block-level citizen grievance redressal mechanisms.

A coordinated governance framework linking Central financing, State administrative capacity, and Panchayati Raj Institutions is essential to transform healthcare from a market commodity into a guaranteed fundamental right under Article 21.