Health diplomacy has been an enduring pillar of India's relations with small island neighbours. Examine with reference to the Maldives.

Health diplomacy means using medical expertise, training and infrastructure to build trust between countries. With the Maldives, India's version of it began as expertise sent through WHO in the 1970s and has become direct assistance under India's own name. It has stayed a steady pillar of the relationship, but it now needs to deepen.

Evolution: from multilateral to bilateral

• 1976 WHO mission: Dr S. Kameswaran of Madras Medical College became the first ENT expert to visit Malé. He surveyed ENT diseases, held clinics, trained health staff and helped set up ENT units [1].
• Infrastructure: the Government of India paid for a ₹52 crore renovation of Indira Gandhi Memorial Hospital (IGMH), completed in 2017 [2].
• Emergency response: India has run MEDVACs (medical evacuations) and search-and-rescue since 2019, and Indian specialists have served at the MNDF's Senahiya Hospital [2].

Why health has stayed a pillar

• Geography: WHO names the "geographical remoteness" of islands and the long ocean distances as the core problem for emergency care [3].
• Hub-and-spoke system: IGMH is the only public-sector tertiary hospital, and six regional hospitals depend on it for referrals [4]. Support to IGMH therefore reaches the whole country.
• Strategic return: health aid earns visible goodwill under Neighbourhood First and SAGAR, and supports India's role as first responder in the Indian Ocean.

Limitations

• Primary care neglected: WHO says the lack of investment in primary health care (PHC) has directly raised tertiary costs and crowding [5]. Aid centred on Malé leaves the atolls underserved.
• Short-lived visits: expert visits end, but trained local staff stay. The 1976 mission put training first for this reason [1].
• Politicisation: aid that carries India's name can get pulled into Maldivian domestic politics.
• More partners: the Maldives now writes its EMS guidelines with WHO and ADB [3], so India is one partner among several.

Way forward

• Move from building projects to building capacity: train and keep Maldivian doctors, and extend telemedicine to the atolls.
• Co-fund PHC at the island level, in line with plans the Maldives itself owns.
• Partner as equals. The Maldives' world-first triple elimination of mother-to-child transmission in 2025 shows its own strength [4][6].

From one ENT expert in 1976 to hospital upgrades and air evacuations, health has been a constant in India–Maldives ties. If India shifts the focus to primary care and local staff that the Maldives owns, this pillar will stay non-political and lasting. That would advance SDG-3 and India's credibility as a dependable neighbour.