Critically examine India's progress toward the National Health Policy 2017 target of 2.5–3% of GDP on public health spending.

Q. Critically examine India's progress toward the National Health Policy 2017 target of 2.5–3% of GDP on public health spending. (15 marks, 250-350 words)

The National Health Policy (NHP) 2017 committed India to raising public health expenditure progressively to 2.5% of GDP by 2025 [1], a benchmark the Economic Survey 2020-21 reiterated as the threshold for cutting out-of-pocket expenditure (OOPE) from 65% to 35% of total health spend [2]. Progress has been real but falls short of the target.

Achievements

• Sustained rise in outlay: Government Health Expenditure (GHE) grew from 1.13% of GDP (2014-15) to 1.84% (2021-22); per-capita GHE tripled from ₹1,108 to ₹3,169 [3].
• Public share crowding out private: GHE now funds 48% of Total Health Expenditure, up from 28.6% in FY14 [3][4], with a 37% jump in 2020-21 to 2021-22 reflecting pandemic-era prioritisation [3].
• Equity dividend: OOPE fell from 64.2% of THE in FY14 to 48.2% in FY19 [4], validating the policy's causal logic.
• Federal depth: States finance the larger share (58.2% of GHE against the Union's 41.8%), showing spending is not centrally concentrated [3].

Shortfalls and constraints

• Target missed: at 1.84%, India is barely past two-thirds of the 2.5% floor with the 2025 deadline lapsed; health is only about 6.12% of general government expenditure [3].
• Base effect: the 2021-22 spike was COVID-driven and may not be structural.
• Persistent burden: OOPE near half of THE still pushes households into catastrophic expenditure.
• Shrinking external cushion: OECD projects a 9–17% fall in global ODA in 2025 with health funding down up to 60% from its 2022 peak [5], removing any donor substitute for domestic effort.

India's trajectory is directionally right but pace-deficient. The way forward lies in twinning "spending more" with "spending better" — states raising health's budget share, strengthening public financial management to curb leakages, and channelling funds into primary care through Ayushman Bharat. Meeting the NHP benchmark is essential to realising Article 21's right to health and SDG-3's universal health coverage pledge.

(~330 words)

Sources: 1. National Health Policy, 2017 — PIB, Ministry of Health & Family Welfare — NHP 2017 commitment to raise public health expenditure to 2.5% of GDP by 2025 2. Economic Survey recommends increase in public health spending from 1% to 2.5-3% of GDP — PIB — Economic Survey 2020-21 target and OOPE reduction from 65% to 35% 3. National Health Account (NHA) Estimates 2020-21 and 2021-22 — PIB/MoHFW — GHE 1.84% of GDP, 48% of THE, per-capita ₹3,169, 6.12% of government expenditure, 37% growth, Centre–State split 4. Share of Government Health Expenditure in Total Health Expenditure increases from 28.6% in FY14 to 40.6% in FY19 — PIB — rise in public share; OOPE decline from 64.2% to 48.2% of THE 5. Cuts in Official Development Assistance, OECD Policy Brief, June 2025 — 9–17% projected ODA fall in 2025; health funding down up to 60% from 2022 peak