Health Equity in India: Strategies to Bridge the Gap in Healthcare Access Across Urban and Rural Areas

By- Colonel Hemraj Singh Parmar, Co-Founder, AyushPay

In the recently concluded budgetary session, the government allocated Rs 99,858.56 crore for the country’s healthcare system, a 9.78% increase from Rs 90,958.63 crore in FY25. The government also allocated Rs 2,445 crore for PLI for the pharmaceutical industry. Of the Rs 99,858.56 crore allocation, Rs 95,957.87 crore was earmarked for the Department of Health and Family Welfare, and Rs 3,900.69 crore to the Department of Health Research.
The government of India (GoI) wishes to bring the budgetary allocation to 2.5% of the country’s GDP from the current abysmal allocation of 1.9%. The global average is 8-10%, and that of the USA alone is more than 20% of their $31 trillion GDP – this is more than the entire GDP of India (~$ 4 trillion).

About 30% of the Indian population is uninsured, and out-of-pocket expense is still around 40%.

Sustainable Development Goals (SDGs) of the United Nations

SDGs make a bold commitment to end the epidemics of AIDS, tuberculosis, malaria, and other communicable diseases by 2030. The aim is to achieve universal health coverage and provide access to safe and affordable medicines and vaccines for all.

SDG 3, focused on "Good Health and Well-being," includes targets such as reducing maternal mortality, ending preventable deaths under five years old, combating communicable diseases such as HIV/AIDS and malaria, promoting mental health, and achieving universal health coverage, with indicators such as maternal mortality rates, under-five mortality rates, new HIV infection rates, and access to essential healthcare services across the population.

India is currently sitting on a significant dual disease burden: the simultaneous presence of a high prevalence of both communicable diseases (such as tuberculosis and malaria) and non-communicable diseases (such as diabetes, hypertension, cancer, and COPD) within the population.

Urban-Rural Healthcare Divide: Understanding the Disparities

Despite substantial GoI and private sector expenditures, healthcare equity remains a primary concern. Our healthcare capacity and infrastructure are more biased towards the urban areas. While there is an acute shortage of beds nationwide, our overall occupancy remains less than 60%. Most of the bed shortage and clinical excellence gaps are felt in the last mile. PHC/ CHC / wellness centers have still been unable to mitigate the care divide.

Today, we have more than 70,000 hospitals across India, of which approximately 50% of hospitals and 30% of beds are situated in rural India, which accounts for two-thirds of our population.

Approximately 58% of our beds are in public-sector hospitals, and the rest are in private-sector hospitals. This inequity becomes stark when we add the lack of superspecialty and quaternary care.

Ergo, hospital accessibility remains a significant challenge.

Our primary healthcare system is broken. Government-run primary health centers (PHCs) and community health centers (CHCs) are not adequately staffed or equipped, and they lack essential medicines. Establishing wellness clinics has partly mitigated the problem, but a lot more needs to be done.

Not many people are insured by private insurance or covered under the Ayushman Bharat Health Mission (ABHM). The sum insured is often inadequate and doesn’t cover the treatment of major life-threatening diseases. Financial barriers and lack of funding further compound good healthcare delivery.

Our poor health literacy and awareness are other major challenges.

Strategies to Bridge the Healthcare Divide

Strengthening Primary Healthcare

PHCs and CHCs need to be strengthened for better reach and broader coverage. Preventive health is key to the prevention of chronic diseases. We need better budget allocations for the same. We need better availability of basic diagnostic facilities and essential medicines for primary care facilities.

Expanding Telemedicine Services

We need to increase access to the eSanjeevani scheme and add super specialty consultations to the delivery stack. Affordable mobile services could help reach inaccessible areas, and emerging cutting-edge healthcare technologies could prove to be game changers.

Ensuring Better Healthcare Workforce Distribution

GoI could consider mandating rural services for healthcare workers. Doctors, nurses, and allied healthcare staff should be adequately incentivized for this. Auxiliary Nurse Midwives (ANMs) and community health workers should be increased and trained for PHCs/CHCs.

Strengthening Public-Private Partnership (PPP) Delivery Models

Refined PPP models are the way forward. Satellite/ outreach clinics linked to urban hospitals could help bring super specialty care delivery to the last mile. Private diagnostic chains should be onboarded to support PHCs/ CHCs. Companies with CSR funds should be incentivized to invest in rural healthcare.

Improving Health Insurance Coverage

As of September 2023, about 14.1% of the rural population in India was covered by health insurance. Better coverage through ABHM and private insurance can overcome financial barriers. Rural insurance needs a major boost, as the absence of it can lead to avoidable bankruptcies in more expensive treatments.

Improving Social Determinants of Healthcare

In 2024, India's infant mortality rate (IMR) was 25.8 deaths per 1,000 live births, whereas maternal mortality ratio (MMR) decreased to 97 deaths per 100,000 live births during the 2018-2020 period, down from 130 in 2014-2016. Access to maternal and infant health, proper sanitation, good nutrition, and clean drinking water can improve health. Better health education and preventive care assume importance.

Leveraging Advanced Technologies & AI

Telemedicine, remote care technologies, drone use for sample collection and medicine delivery, mobile diagnostics with apps, e-diagnostics, e-pharmacy, and blockchain could be employed at scale with affordable rates to reach a larger population for more efficient and equitable health delivery.

Conclusion

The rural economy will contribute significantly to our national vision and meet the ends of SDG and economic growth. A healthier India with 1.4 billion people, a country with a vision for a $5 trillion economy size by 2025, and a ‘Viksit Bharat’ with a $30 trillion economy size by 2047 needs to bridge the urban-rural healthcare divide on a war footing to provide affordable, accessible and high-quality healthcare delivery to the last mile. Healthcare and economic development are interlinked and need equal focus for us to be counted in the comity of nations as a healthy and vibrant nation-state on the path to global prominence.

[Disclaimer: This is an authored article, DHN is not liable for the claims made in the same.]