India's three health revolutions: from scarcity to access to excess

We fought poverty and then revolutionized inclusion but NFHS findings urge us to battle diseases that accompany prosperity

- RAJESH SHUKLA

The most important lesson of the latest National Family Health Survey (NFHS) is that development does not eliminate challenges; it transforms them.

About 20 years ago, India’s public health challenge was one of exclusion. Not enough women had bank accounts. Not enough households had health insurance. There were too many undernourished women. Much of the population was beyond the reach of maternal health services. Many of those deficits are now receding. But a new challenge of obesity, diabetes and other lifestyle diseases is sweeping through village and city alike.

Recently released NFHS data for 2023-24 suggests that India has experienced one developmental transition and is in the midst of another. The first revolution has been towards financial inclusion. In 2005-06, less than 5% of Indian households had some form of health insurance coverage. By 2015-16, the figure was up to 29%. It was 60% in 2023-24. Historically, rural India has been the most vulnerable to catastrophic health expenses, but now has 62% coverage, slightly more than urban India’s 56%.

It’s one of the fastest expansions of financial risk protection ever seen in a large developing country. Programmes like Ayushman Bharat, along with state insurance schemes, have turned healthcare from a purely private household burden into a partially socialized risk. India is still far from the levels of universal health coverage achieved by countries such as Thailand or South Korea, but the direction of change is clear.

Women’s empowerment has been the second revolution. The proportion of women who manage their own bank accounts rose from 53% in 2015-16 to 89% in 2023-24. The increase was more dramatic in rural India: from 49% to 89%. Nationally, women’s ownership of mobile phones increased from 46% to 64% and use of hygienic menstrual protection increased from 58% to 77%.