Evolution of National Health Policies in India

Health policy is the quiet architecture behind every clinic, ASHA worker, vaccination drive, and insurance card in the country. It decides who gets care, who pays for it, and what counts as a national priority. For a country as vast and unequal as India, this architecture has been built brick by brick over nearly eight decades, starting from a colonial-era committee report to the most recent push toward universal health coverage. Understanding how it evolved helps explain both the strengths of the current system and the gaps that still trouble it.

What is a health policy? 🔗

A health policy is a formal statement of intent. It lays out what a government plans to do about the health of its people, which problems it will prioritise, how resources will be allocated, and which institutions will deliver care. The World Health Organization describes health policy as the decisions, plans, and actions undertaken to achieve specific healthcare goals within a society. It is essentially a roadmap that translates broad ideals like “health for all” into concrete programmes, budgets, and laws.

The WHO’s global agenda has long shaped how countries think about their own policies. The 1948 WHO Constitution declared health a fundamental human right, and the 1978 Alma-Ata Declaration positioned primary healthcare as the route to “Health for All”. More recently, the push for Universal Health Coverage (UHC) has become the dominant frame. UHC means that all people can use the promotive, preventive, curative, rehabilitative, and palliative services they need, of sufficient quality, without facing financial hardship in the process.

Every country adapts this global agenda to its own demographic, epidemiological, and economic realities. A national health policy is therefore both a borrowed vocabulary and a local strategy.

The colonial inheritance and the Bhore Committee 🔗

Before independence, healthcare in India was patchy, urban-biased, and largely meant for European populations and the army. The British colonial administration set up the Health Survey and Development Committee in 1943 under the chairmanship of Sir Joseph William Bhore, a senior Indian civil servant. The committee was tasked with two things: surveying the existing health conditions in British India and recommending a path forward.

The report submitted in 1946, popularly known as the Bhore Committee Report, was a landmark document. It painted a bleak picture of mortality, life expectancy, and infrastructure, and proposed a national health service that would provide universal coverage to the entire population, free at the point of delivery, through a state-run salaried health service. This was a radical vision for its time.

Key recommendations of the Bhore Committee 🔗

The committee laid the conceptual foundation that still shapes public health in India today. Its core recommendations included a three-tier health system (primary, secondary, and tertiary care), integration of preventive and curative services at every administrative level, a focus on rural healthcare, and the training of “social physicians” who combined clinical and public health skills.

The proposed structure of primary health centres and sub-centres, refined over decades, became the backbone of rural healthcare. Many of the rural health units, community health centres, and district hospitals operating today can trace their lineage directly to the Bhore Committee’s blueprint. Even the language of “comprehensive primary healthcare” used in current policy documents echoes Bhore.

Post-independence committees that refined the vision 🔗

While the Bhore Committee gave the country its blueprint, implementing it in a newly independent, resource-strapped nation was a different matter. Successive committees were appointed to review progress and recalibrate strategy.

The Mudaliar Committee (1962) 🔗

Officially called the Health Survey and Planning Committee, this body was set up in 1959 under Dr. A. Lakshmanaswami Mudaliar, then Vice-Chancellor of Madras University. Its mandate was to assess how far the Bhore Committee’s recommendations had been implemented and what should come next.

The committee found that primary health centres were spread too thinly and that the quality of services was poor. It recommended strengthening existing primary health centres before opening new ones, capping the population served by each PHC at 40,000, and integrating curative, preventive, and promotive services at the PHC level. It also proposed an All India Health Service modelled on the Indian Administrative Service, to ensure professional leadership for the sector.

The Chadah and Mukerji committees 🔗

The Chadah Committee (1963), chaired by the Director General of Health Services, focused specifically on integrating malaria surveillance into general health services through basic health workers. The Mukerji Committees of 1965 and 1966 took up the question of separating family planning from malaria work, recognising that vertical programmes were straining the general health system.

The Kartar Singh Committee (1973) 🔗

This committee recommended the introduction of the multipurpose worker scheme, where a single field-level worker would handle several health functions instead of being tied to one disease programme. The idea was to reduce duplication and provide more holistic care at the village level.

The Srivastava Committee (1975) 🔗

The Srivastava Committee, formally the Group on Medical Education and Support Manpower, made arguably the most influential recommendation of this era: that primary healthcare should be provided within the community itself, by people drawn from and trained in the community. This idea fed directly into the Rural Health Scheme of 1977 and laid the conceptual ground for community health workers, the precursors to today’s ASHA workers. The committee’s recommendations also anticipated the international consensus that would crystallise at Alma-Ata a year later.

From committees to formal policy 🔗

Despite this rich tradition of committees, India did not have a formal, codified national health policy until 1983, thirty-six years after independence. The 1978 Alma-Ata Declaration on Primary Health Care and the global “Health for All by 2000” agenda provided the final push.

National Health Policy 1983 🔗

The first National Health Policy (NHP) placed primary healthcare at the centre of the national health system. It aimed at a phased, time-bound programme to set up a well-dispersed network of comprehensive primary healthcare services, linked with health education and community participation. The policy emphasised the role of voluntary “health volunteers” with basic skills, control of communicable diseases, maternal and child health, immunisation, family planning, and a health management information system.

NHP 1983 was ambitious but inherited a thinly funded public health system. Public health spending remained around 1 per cent of GDP for decades, leading to chronic under-resourcing.

National Health Policy 2002 🔗

By the early 2000s, the health landscape had shifted. Communicable diseases like tuberculosis, malaria, and HIV/AIDS remained significant burdens, while non-communicable diseases were rising. The private sector had expanded rapidly. NHP 2002 aimed at an acceptable standard of good health for the general population, decentralisation of public health delivery, equitable access across regions, and the rational use of drugs. It also formally acknowledged the role of traditional medicine and the private sector.

National Health Policy 2017 🔗

The third and current policy reflects the global shift toward universal health coverage. NHP 2017 articulates the goal of attaining the highest possible level of health and well-being for all, with a focus on preventive and promotive healthcare and universal access to quality services without financial hardship. It commits to raising public health expenditure to 2.5 per cent of GDP, strengthening primary care through Health and Wellness Centres, and addressing the rural-urban divide.

The Ayushman Bharat programme, which combines Health and Wellness Centres with the Pradhan Mantri Jan Arogya Yojana (PM-JAY) for hospital-based care, is the most visible operational arm of NHP 2017.

Impact of the early policy framework 🔗

The committees of the mid-twentieth century did far more than produce reports. They built a vocabulary, a structure, and a set of assumptions that still guide Indian health policy.

The Bhore Committee gave the country its three-tier health system. The Mudaliar Committee reinforced the importance of strengthening, not just expanding, primary care. The Srivastava Committee planted the seed of community-based workers, which has since flowered into one of the largest community health worker networks in the world. The 1983 policy made primary healthcare a formal national commitment, and the 2002 and 2017 policies broadened the lens to include equity, financial protection, and universal coverage.

Many gaps remain. Public spending on health is still below the targets set in policy documents, out-of-pocket expenditure pushes millions into poverty each year, and rural-urban and inter-state disparities persist. But the conceptual scaffolding laid down by Bhore, Mudaliar, Srivastava, and their successors is what allows current reforms to be possible at all. The arc of Indian health policy shows how a colonial-era report became the seed of a national project, refined and re-refined through decades of committees, declarations, and political moments.

What do you think? Looking at how India’s health policy has evolved from the Bhore Committee to NHP 2017, which gap do you feel deserves the most urgent attention in the next policy revision: financial protection, rural healthcare infrastructure, or the quality of primary care? And how much of a country’s health depends on its policies versus how those policies are actually implemented on the ground?

References

1. https://www.who.int/health-topics/universal-health-coverage
2. https://www.emro.who.int/health-topics/uhc/
3. https://pmc.ncbi.nlm.nih.gov/articles/PMC11414765/
4. https://csep.org/working-paper/evolution-of-the-healthcare-policy-framework-in-india/
5. https://nihfw.ac.in/cms/committee–and-commission.php
6. https://www.who.int/india/health-topics/national-health-policy
7. https://pmc.ncbi.nlm.nih.gov/articles/PMC7122919/
8. https://main.mohfw.gov.in/sites/default/files/9147562941489753121.pdf
9. https://ippr.in/index.php/ippr/article/view/335