Intended for healthcare professionals

Feature Elections 2014

Expert views: what the next Indian government should do for health and healthcare

BMJ 2014; 348 doi: (Published 03 April 2014) Cite this as: BMJ 2014;348:g2479

Re: Expert views: what the next Indian government should do for health and healthcare

India is now at a critical point- Shri Narendra Modi really has the ability and potential to transform the country and restore its rightful place as a beacon in the world. Development, good governance and robust management, the three essential ingredients, are finally coming together under his leadership, and I welcome the dawn of this new era. A focus on economic development, rooting out corruption and accountability is a win: win formula for both: the political party and the public. Of course, it will be a while before we see the results but the next few months will tell whether we are on the right road. To me, being on the right road means addressing the root causes of a failed nation and especially the health of Indian people.

Some of the worst health indices in the world, vast inequalities, unaffordable health care, poor education and training of health care professionals and corruption at almost all levels, with a few exceptions, have become the norm and are a blot on the country. Successive governments have failed to tackle the problem, and the major reasons for this are the conceptual separation between economic development and health and reliance on ‘trickle down economics’. The belief that health is a consumptive sector (needing endless resources) is fallacious- health is a productive sector; healthier people work, pay taxes, improve economy and boost development. And the last few decades have confirmed the failure of trickle-down economics- poor have become poorer and access to healthcare is further impoverishing them with millions of Indian falling below poverty line due to illness and lack of affordable and safe care. Health truly is wealth, and it is time to start taking it seriously.

Despite massive growth of the health sector recently, largely in the for-profit private sector and in high tech, acute services although I recognise the investment in public facilities including creating the new AIIMS in various parts of the country, there has been a failure to address the four key challenges facing the Indian health system. To create healthier people and ensure safe and affordable health care requires:
- Better governance including clinical governance to root out corruption, challenge poor clinical practices and raise standards
- More and better academic capacity through using modern educational programmes and promoting research
- Investment in primary care, and out of hospital care in the community and
- Most importantly a robust public health policy and systems for delivering the public health programmes

Although there are pockets of excellence in each of these domains, there has been a serious lack of a comprehensive and joined up health policy and which is then systematically programme managed. The new Government has the unique opportunity, and indeed a responsibility, to pull all this together and create a healthier and wealthier India.

It is also not a one sided affair, there are some very committed people and organisations, who if properly mandated can be mobilised to deliver this transformation and shed the image of India as the ‘Sick Nation of Asia’. I have had the privilege of meeting and working with such individuals and organisations and am sure that they will rise to the challenges, given the chance - this is a once in a life time opportunity to make a real difference for the country.

Rajan Madhok, Chairman, British Association of Physicians of Indian Origin (BAPIO), UK


Further details of my work in India are available at

An earlier version of this letter is available on

Competing interests: No competing interests

29 May 2014
Rajan Madhok
Public Health Doctor
Independent practice
34 Stafford Road, Manchester, M309ED