As India prepares for the Union Budget 2026, the nation's healthcare sector stands at a pivotal crossroads. While aspirations for a healthier population are ambitious, fiscal commitments frequently fail to match these objectives. This critical moment demands a fundamental reevaluation: should India's health system focus solely on treating illnesses, or should it evolve into a comprehensive framework that safeguards lives, supports livelihoods, and promotes holistic well-being?
The Imperative for Increased Public Health Investment
The most pressing expectation from the upcoming Budget is a clear and credible commitment to boosting public investment in health. India remains significantly distant from the long-standing target of allocating 2.5% of GDP to healthcare. This Budget must make substantial strides to close that gap, ensuring that financial resources align with the nation's health ambitions.
Reversing the Decline in Primary Healthcare Spending
A concerning trend has emerged in India's public health expenditure: the proportion dedicated to primary healthcare has been declining, while spending on tertiary care has risen. This imbalance must be urgently reversed. Strong primary healthcare serves as the cornerstone of an efficient and equitable health system. By diagnosing and managing health issues at an early stage, the burden on tertiary hospitals can be significantly reduced, lowering overall healthcare costs and out-of-pocket expenses for citizens.
Currently, India's healthcare model remains heavily skewed toward hospital-based treatment. The nation has barely begun to address essential areas such as preventive care, palliative care, rehabilitation, geriatric care, and long-term support for individuals with disabilities. Budgetary allocations must extend beyond physical infrastructure to prioritize human resources. This includes not only increasing the number of doctors and specialists in rural areas but also providing in-service training and mentoring for the entire primary healthcare team.
Strengthening the Primary Healthcare Workforce
The national network of well-staffed and stocked health and wellness centers, known as Ayushman Arogya Mandirs, has enabled the delivery of comprehensive primary healthcare. However, what is needed is a dedicated team that feels accountable for the health of the population it serves—approximately 30,000 people per primary health center. This team should include nurses, auxiliary nurse midwives (ANMs), accredited social health activists (ASHAs), community health officers (CHOs), and male health workers, all working cohesively to improve community health outcomes.
Leveraging Technology and Data for Health System Efficiency
India has made notable progress in developing a digital health ecosystem, including the implementation of ABHA numbers under the Ayushman Bharat Digital Mission, as well as facility and physician registries. Despite these advancements, health data remains fragmented across multiple silos. Frontline health workers often juggle dozens of physical registers alongside a growing array of mobile applications, leading to inefficiencies.
These systems must be integrated in meaningful ways to enable data-driven decision-making. For instance, district-level health dashboards could empower collectors and health officials to identify local disease burdens, analyze leading causes of death, and allocate resources based on regional priorities. Health data should not merely be collected; it must be actively utilized to inform policy and practice.
Building Climate Resilience into Health Planning
Another critical expectation from the Budget is a stronger emphasis on climate resilience in health planning. India is already experiencing more frequent heatwaves, floods, and extreme weather events, trends that are expected to intensify. The health system must be prepared to respond effectively without being pushed to the brink, as witnessed during the COVID-19 pandemic when healthcare workers faced severe exhaustion and burnout.
The Budget should allocate resources for physical infrastructure upgrades and manpower enhancements in climate disaster-prone areas. This proactive approach will ensure that the health system remains robust and resilient in the face of future crises.
Strengthening Regulatory Frameworks and Research
To maintain India's status as the 'pharmacy of the world,' a science-based, independent, and agile regulatory framework is essential. Weak regulatory systems erode public trust and damage India's global reputation as a reliable producer of medicines and vaccines. Agencies such as the Central Drugs Standard Control Organisation (CDSCO) and the Food Safety and Standards Authority of India (FSSAI) must be strengthened by incorporating more scientific expertise and granting them greater autonomy.
Regulators must be technically qualified, of high calibre, and empowered to act independently and decisively. The prolonged delay in implementing front-of-pack labelling due to industry pressure underscores the urgent need for stronger and more independent regulatory bodies in the country.
Fostering a Learning Health System
While government funding for health research through institutions like the Department of Health Research (DHR) and the Indian Council of Medical Research (ICMR) has shown an upward trend, states must also invest in their own departments of health research. This will help transform health systems into 'Learning Health Systems,' where policies and programs are regularly evaluated and refined based on evidence.
Capacity for research in medical colleges needs to be enhanced, enabling them to collaborate with local policymakers to address contextual health issues. Additionally, the private sector must step up its contributions. India has one of the lowest levels of private sector Research & Development (R&D) investment globally. Large, profitable companies should reinvest funds into R&D to drive homegrown innovation and advance the nation's healthcare landscape.
In summary, the Union Budget 2026 presents a crucial opportunity to reorient India's health system toward primary healthcare, strengthen regulatory frameworks, and build resilience against future challenges. By prioritizing these areas, India can move closer to achieving its goal of a healthier, more equitable society.
