From policy to practice: An analysis of health system strengthening and universal health coverage in India

• Author Details:   
• Manoj Kumar Kar ^*
• Sipra Ram

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India’s healthcare system continues to face significant challenges, particularly in rural regions, due to deep-rooted disparities in manpower, infrastructure, and access to services. These imbalances are most visible in the unequal distribution of resources between states and across urban and rural populations. Although Primary Health Centres (PHCs), envisioned under the "Health for All" framework of the Alma-Ata Declaration, are central to healthcare delivery, their effectiveness is constrained by insufficient staffing, inadequate infrastructure, and systemic inefficiencies, undermining the ability to provide comprehensive and equitable health care.

Traditionally, evaluations of India’s health system have focused primarily on outcome indicators such as infant mortality and life expectancy. However, this approach often overlooks key elements such as health systems performance, delivery efficiency, and equity, all of which are essential for understanding disparities. The World Health Organization’s broader framework emphasizes the need for responsive healthcare and equitable financial allocation to achieve improved health outcomes.

This paper critically explores the shift from policy design to practical implementation in India’s pursuit of ‘Universal Health Coverage (UHC)’. It argues that achieving UHC by 2030 requires renewed focus on revitalizing primary healthcare, strengthening human resource development, and addressing financial inequities. A comprehensive, performance-based evaluation framework that integrates both outcome measures and delivery efficiency is essential to bridge the gap between policy intentions and actual implementation. The paper concludes by offering targeted policy recommendations to strengthen the health system’s resilience, efficiency, and equity. Furthermore, it advocates for the recognition of healthcare as a fundamental right, supported by assured funding and a rights-based policy environment, which is crucial for realizing UHC.