India’s Public Health Policy: Why Primary Healthcare Must Prevail Over Wellness and Digitalisation

24 Jun 2026

GS II: Issues related to Health

Context: India’s health policy is moving away from people’s immediate health-care needs, as access to affordable curative care remains weak despite initiatives on wellness centres and digital health records.

About Public Health Policy

Population Health: Public health policy plays a central role in improving the overall health status of the population and helping India utilise its demographic dividend effectively.
Universal Health Coverage: Universal Health Coverage (UHC) seeks to ensure that every individual gets required health services without facing financial hardship.
Evidence-Based Policy: Health policies must be guided by evidence, measurable outcomes and people’s actual needs rather than by populist or politically attractive schemes.
Access to Care: Access to health care is deteriorating due to rising private-sector costs and poor quality in several public-sector facilities.
People’s Felt Needs: Public health policy must prioritise affordable curative care because it remains the most immediate health requirement for most people.

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Ayushman Bharat Health and Wellness Centres

Policy Initiative: Ayushman Bharat Health and Wellness Centres were introduced in 2018 to strengthen grassroots health infrastructure.
Institutional Renaming: Existing health sub-centres, Primary Health Centres (PHCs) and Community Health Centres (CHCs) were given the common prefix of “Health and Wellness Centre”.
Mandate Ambiguity: The common naming has created confusion regarding the actual roles and responsibilities of different levels of grassroots health institutions.
District Health System: Sub-centres, PHCs and CHCs have distinct mandates within the district health system, and their identities evolved according to their institutional roles.
Wellness Shift: The wellness-centre approach has shifted attention from population health outcomes to individual well-being.

Concerns with Wellness-Based Approach

Subjective Concept: Well-being is difficult to define and measure because it is highly individualistic and subjective.
Measurement Problem: There are no universally accepted measures of well-being at the population level, making policy evaluation difficult.
Individual Responsibility: The wellness narrative places excessive responsibility on individuals by assuming that they can independently modify health-related choices.
Structural Neglect: This approach underestimates the role of poverty, sanitation, nutrition, drinking water, environment, housing and access to health services in shaping health outcomes.
Weak Public Health Fit: Public health requires measurable and population-based indicators, while wellness often remains centred on individual behaviour and lifestyle.

Health Promotion versus Wellness

Health Promotion: Health promotion is more suitable for public health because it recognises the social, economic and environmental conditions that influence people’s ability to adopt healthy behaviours.
Population-Based Approach: Health promotion focuses on collective conditions that shape health outcomes instead of placing responsibility only on individual choices.
Measurable Outcomes: Health promotion allows better measurement through indicators such as service coverage, disease burden, morbidity, mortality and access to essential services.
Holistic Health: Wellness expanded the meaning of health beyond biological disease to include mental, social, spiritual and environmental dimensions.
Policy Limitation: Excessive dependence on wellness weakens the ability of health systems to identify and address concrete deficiencies in access, quality and service delivery.

Individualisation of Health

Changing Narrative: Public health policy is increasingly shifting from population health status to individual well-being.
Unmet Needs: Earlier health assessment focused on unmet needs in preventive, promotive, curative and rehabilitative care.
Basic Services: Public health must address basic needs such as drinking water, nutrition, chronic disease management, emergency care and maternal and child health services.
Health Coaches: The wellness narrative has encouraged the rise of health coaches and social media messages promoting individual well-being.
Policy Dilution: The focus on individual well-being can dilute the core public health agenda by shifting attention away from institutional care and population health needs.

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Ayushman Bharat Digital Health Mission

Digital Repository: The Ayushman Bharat Digital Health Mission (ABDHM) aims to create a digital repository of health information for every individual.
ABHA Card: The ABHA card provides a unique health ID for maintaining individual health records digitally.
Health Registries: The mission also seeks to maintain registries of health facilities, health-care professionals and health insurance-related information.
Information Portal: Digital health records and infrastructure databases cannot by themselves resolve the problem of inadequate access to health care.
Budget Concern: The allocation of around ₹300 crore annually to ABDHM becomes questionable without clear measurable outcomes linked to improved health-care access.

Limitations of Digital Health Mission

Data-Centric Design: ABDHM focuses mainly on generating information about individuals, facilities and health-care professionals.
Care Provisioning Gap: Digital records cannot guarantee treatment when health-care infrastructure remains inadequate and unaffordable.
Existing Data: India already has several reports and datasets on health infrastructure, access and service gaps.
Institutional Mechanism: Health-care delivery requires strong institutions, trained staff, medicines, diagnostics, referral systems and financial protection.
Siloed Functioning: Patients, health facilities and health-care professionals continue to operate largely in silos despite digital mapping.

Factors Behind Inadequate Access to Health Care

Private Sector Cost: Health care in the private sector remains unaffordable for a large section of the population.
Public Sector Quality: Many public-sector facilities suffer from poor quality, weak infrastructure and inadequate service delivery.
Infrastructure Deficit: Digital health IDs cannot compensate for the shortage of functional hospitals, doctors, nurses, diagnostics and medicines.
Affordability Crisis: High out-of-pocket expenditure continues to prevent poor and vulnerable households from accessing timely health care.
Curative Care Need: Affordable curative care remains the most immediate and visible health need for people before they can meaningfully engage with preventive and promotive interventions.

Governance Challenges

Weak Public Institutions: Public health-care institutions under India’s three-tier health system continue to weaken in many regions.
Policy Mismatch: Current initiatives focus more on wellness branding and digital information than on strengthening service delivery.
Implementation Deficit: Renaming institutions or creating digital records does not automatically improve actual access to doctors, medicines and treatment.
Outcome Gap: Policies built around subjective well-being and data generation are difficult to assess without measurable improvements in health outcomes.
Provider-Centric Priorities: Public health policies may become tools for advancing the priorities of policymakers and health-care providers instead of addressing people’s actual concerns.

Way Forward

Strengthen Public Facilities: India must strengthen sub-centres, PHCs and CHCs with adequate staff, infrastructure, medicines, diagnostics and referral capacity.
Prioritise Curative Care: Affordable and quality curative care must be treated as a central public health priority because it reflects people’s immediate needs.
Improve Health Financing: Higher public spending on health is required to reduce out-of-pocket expenditure and improve access to government health facilities.
Measure Health Outcomes: Public health policy should rely on measurable indicators such as access, affordability, quality, morbidity, mortality and service coverage.
Integrate Digital Health: Digital health systems should be linked with service delivery, referral networks, treatment access, insurance support and institutional accountability.
Address Social Determinants: Health policy must address nutrition, sanitation, drinking water, environment, housing and income-related barriers to health.
Strengthen Health Promotion: Preventive and promotive care should be built on population-level health promotion rather than narrow individual wellness messaging.
Independent Evaluation: Health initiatives should be regularly assessed through independent audits, outcome-based monitoring and public accountability mechanisms.

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Conclusion

India’s health policy must reconnect with people’s real needs by prioritising affordable curative care, stronger public institutions and measurable health outcomes instead of relying excessively on wellness narratives and digital data generation.