Healthcare transformation in 11 years of Modi Sarkar: From scarcity and disarray to digitalised, streamlined development
The story of Indian healthcare before 2014 was one of crisis on almost every front: funding was patchy, inefficiencies accumulated, and treatment often felt like a long, arduous journey that few rural residents had even started. The scale of the crisis was staggering, with government spending teetering between 0.9% and 1.2% of GDP, a figure so low that by 2007, the World Bank ranked India 184th out of 191 countries. Private out-of-pocket payments covered nearly four-fifths of total health costs, a burden so heavy that families routinely borrowed money, sold off small parcels of land, or chose silence over treatment. A 2004-05 survey found that 28% of rural patients turned back at the clinic door because they could not afford the fee, and the annual tally of households sliding into poverty due to medical bills was estimated at fifty to sixty million.
Picture the countryside, where the disparity was stark. Roughly three-quarters of qualified doctors clustered in cities, leaving villages to scramble for care in makeshift clinics and poorly lit pharmacies. There were only 12 trained providers for every 10,000 people, about half of what the WHO deems acceptable, and in many districts, unlicensed quacks handled seventy-five per cent of primary visits.
The bricks-and-mortar side of public health was almost as wobbly. Data from the mid-2010s suggested that barely two-thirds of Primary Health Centres were open on a typical workday, and one-third of Community Health Centres lacked the mandated staff, including doctors and nurses. Even when a PHC was staffed, essential supplies such as vaccines, glucose strips, or clean syringes disappeared with alarming regularity; as a result, nurses often prescribed medicines that patients could not obtain from the local shop.
Why did previous Central governments shy away from healthcare?
India’s healthcare crisis before 2014 wasn’t just the result of poor infrastructure or lack of funding. It stemmed from a more profound, systemic neglect that ran through the core of the policy and governance structure. The most significant structural flaw was that healthcare was treated as a “state subject” under the Constitution, which meant the central government often shied away from direct responsibility. This led to uneven priorities, policy paralysis, and wide interstate disparities in both spending and service delivery. The Centre had the funds and constitutional responsibility for national programmes, but the execution rested with overburdened and often corrupt state governments. Coordination between them was poor, and political will was usually missing.
The system existed on pen and paper, and the files were stored in dusty cabinets that nobody opened until necessary. There were no digital rails to hold things together—central dashboards, statewide insurance logs, a central disease ledger, or even a simple immunisation tracker. Public hospitals maintain individual logbooks located by the reception desk, so moving a chart from one ward to the next is akin to playing snail-paced charade. Primary clinics, district hospitals, and specialist wards often fail to communicate effectively, resulting in patients having to recount the same story repeatedly.
In the big cities, the waiting rooms were crowded, but the price tags were steep. Corporate chains have refined their marketing so thoroughly that many people assume top-tier care is what healthcare entails. Out in the villages, oxygen tanks and CT scans were the stuff of science fiction, so most people stopped at the nearest chemist and gambled on whatever remedy sounded least silly. Quacks on scooters, BHMS grads or full-blown improvisers in faded white coats often fill the gap.
Everything about the safety net was woven for people who already had a cushion, leaving the rest to juggle symptoms and unpaid bills. Speed, scale, and fairness lined up on paper, but consistently fell short in real life. For millions, the choice boiled down to empty pockets today or empty bellies tomorrow, and neither option felt like a victory. Ultimately, India’s pre-2014 healthcare system failed because it lacked vision, urgency, accountability, and national ownership. Without a coherent and centralised strategy, it was a system doomed to collapse under its contradictions.
What changed after 2014, when Modi came to power?
The period following 2014 marked a significant and permanent shift in India’s healthcare policy. Instead of piecemeal welfare schemes, India established a coherent, integrated system with sustained, long-term ambitions that encompassed out-of-hospital and community healthcare, clinical care, and public health. Healthcare was no longer treated as a fringe issue; instead, it was returned to its rightful place as a cornerstone of national development, economic security, and social equity. The restructuring of India’s healthcare system was not simply a matter of constructing hospitals or dispensing drugs; it was a systematic change that brought with it a new vision for health. This new vision focused on preventive care, technological advancements, and equitable access to healthcare, and it was implemented nationwide.
Ayushman Bharat: From slogan to systemic shift
In 2018, the Indian government launched Ayushman Bharat, comprising two landmark initiatives that have transformed the healthcare landscape in India. PM-JAY (Pradhan Mantri Jan Arogya Yojana) and Health and Wellness Centres (HWCs). PM-JAY became the world’s most extensive government-funded health insurance system, covering up to ₹5 lakh annually and over 50 crore Indians, primarily poor and vulnerable populations. It provided coverage for secondary and tertiary care and established a chain of thousands of hospitals, both public and private, that were empanelled into this system. For the rural family who had previously avoided hospitals due to prohibitive costs, PM-JAY became the affordable safety net.
At the same time, Health and Wellness Centres (HWCs) were addressing the stale, old base of India’s healthcare, primary care. HWCs provided a free source of treatments for day-to-day diseases, diagnostics, medications, maternal and child care, and referral networks. By 2025, over 1.7 lakh HWCs were operationalised, many in tribal and rural areas that were previously hard to reach, creating access to primary care at a minimum decent and mostly professional level at the first point of contact.
Digitally Disruptive: Ayushman Bharat Digital Mission (ABDM)
The bar on a turn of transformation was set higher with the launch of ABDM in 2021, which was a digitally enabled infrastructure for health services. Citizens can now locate their own Health IDs, which will allow them to securely manage and share their health records across multiple platforms and with various stakeholders, thereby reducing the risk of lost prescriptions and accidental disconnection. Hospitals, clinics, lab reports, and pharmacies were all critical components of a national healthcare network that enabled teleconsultations, AI-based diagnostics, and facilitated referrals. For the first time, continuity of care was a reality, even for patients in difficult-to-reach or remote districts. The connection of the ABDM platform also helped to plug significant leakages in the system and reduced possibilities for corruption that emerged through erroneous funding arrangements and fake claims.
Today, the Ayushman Bharat Digital Mission links more than 55 crore health records and has onboarded over 6.4 lakh verified health professionals on a single platform.
Expanding Capacity: Budget Boost & Institutional Expansion
Beyond the expansion supported by a massive budgetary increase, specifically a jump from ₹37,000 crore in 2013–14 to ₹89,000 crore in 2023–24. There was also a significant increase in the number of new medical colleges to help alleviate the shortage of medical doctors, especially in the poorest states. Several new AIIMS were established in states such as Bihar, Chhattisgarh, and Assam, providing tertiary care access to populations that had previously been neglected due to their geographic location.
Through their budgetary decisions and various Production-Linked Incentive (PLI) schemes aimed at promoting the indigenous manufacturing of devices, APIs, and health tech equipment, the Indian government has demonstrated a serious interest in strengthening India’s medical manufacturing ecosystem.
Telemedicine & Mental Health
India’s adoption of telemedicine was significantly accelerated, especially during the COVID-19 pandemic. The eSanjeevani platform has facilitated over 10 crore (100 million) consultations during this period, in collaboration with urban doctors engaged by rural patients via video consultations. Whereas traditional medical delivery systems have left the area of mental health unattended, the government launched an effort to address mental health with Tele-MANAS, a 24/7 telephone helpline for anyone managing the impacts of anxiety, depression, and stress, particularly during COVID-19. Publicly funded special initiatives extended telemedicine services to areas including women’s health, adolescent health, and geriatric health, each signalling a more comprehensive approach to health.
COVID-19 Response: Digital Precision and Scale
India’s response to COVID-19 was remarkable when compared to many countries, characterised by incredible speed, scalability, and data-driven decision-making. India’s CoWIN digital platform was the essential backbone of the world’s most extensive vaccination programme: CoWIN tracked more than 2.2 billion doses in real-time and registered over 111 crore users. ICU beds across states, oxygen plants across states, and isolation centres were quickly scaled up, and remote consultations were made speedy and convenient through eSanjeevani to reduce the burden on hospitals that were overwhelmed. Digital tracking of the pandemic facilitated the containment of outbreaks. Overall, India’s process involved considerable coordination, yet also demonstrated that India can excel under pressure.
For its leadership role, India not only kept its people safe from disease, but it also protected the world from COVID-19. As a demonstration of ‘Vaccine Maitri,’ India directed more than 130 million doses of vaccines to over 100 countries around the world.
News