The Department-related Parliamentary Standing Committee on Health & Family Welfare headed by Prof. Ram Gopal Yadav, M.P., Rajya Sabha has presented the following Reports pertaining to the Ministry of Health and Family Welfare to both the Houses of Parliament today i.e. the 7^th August, 2026:–

1. 175^th  Report on the subject “A Study Of Vector-Borne Diseases In North-East India”;
2. 176^th Report on the subject “Affordability and Accessibility of Healthcare Facilities in Public and Private Sector”; and
3. 177^th Report on the subject “Prevalence of Chronic Kidney Disease in India-prevention, Diagnosis, Treatment and Management”.

2.   The 175^th Report was presented to Rajya Sabha and laid on the Table of Lok Sabha on 07^th August, 2026. The Committee has made a total of 29 recommendations in the report inter-alia includes a series of recommendations aimed at strengthening disease surveillance, improving public health infrastructure, enhancing research and innovation, promoting the One Health approach, and ensuring effective prevention, control, and eventual elimination of vector-borne diseases in the country, particularly in the North-Eastern Region.

3.       The 176^th Report was presented to Rajya Sabha and laid on the Table of Lok Sabha on 07^th August, 2026. The Committee made a total of 368 recommendations in the report. Key recommendations include immediate formulation of a mechanism to standardize and cap the costs of essential treatments, diagnostics, and routine procedures across all private hospitals, to establish Jan Aushadhi Kendras within the premises of all District Hospitals, CHCs, and large private hospitals empanelled under government schemes, introduction of a well-designed, voluntary and contributory insurance model through a collaborative effort between the Government and the private sector, comprehensively review the GST framework applicable to the healthcare sector. The Committee further recommended for the establishment of an additional, independently administered AIIMS facility or a fully equipped satellite center in the northern outskirts of Delhi to strategically decentralize the tertiary healthcare burden and ensure equitable, timely medical access for the broader region.

 4.      The 177^th Report was presented to Rajya Sabha and laid on the Table of Lok Sabha on 07^th August, 2026. The Committee made a total of 66 recommendations in the report.  Key recommendations include a dedicated National Chronic Kidney Disease (CKD) Programme on the lines of the successful HIV/AIDS programme, along with the establishment of a National CKD Registry for systematic disease surveillance and management, institutionalising screening of high-risk individuals, including mandatory biannual kidney assessment for all persons aged 20 years and above, nationwide CKD awareness campaigns, community-based preventive interventions in collaboration with the Ministry of Ayush and strengthened research on Chronic Kidney Disease of Unknown Etiology (CKDu). The Committee has also recommended expansion of dialysis and kidney transplantation services, promotion of home-based Peritoneal Dialysis, adoption of digital health technologies, mandatory health insurance coverage for CKD patients, reduction of regional disparities in access to specialised kidney care and extension of post-transplant care for CKD patients under AB-PMJAY from the existing 15 days to one year.

5.       The detailed recommendations/observations- at a glance has been incorporated below on all three reports.

6.       The 175^th, 176^th & 177^th Reports were considered and adopted by the Committee on the 6^th August, 2026.

8.       The Reports are also available at https://sansad.in/rs/committees/14?departmentally-related-standing-committees

 

RECOMMENDATIONS/OBSRVATIONS OF THE COMMITTEE–AT A GLANCE (175^TH REPORT)

Vector-borne diseases in India: Definition, Distribution & Management

 

1.         The Committee takes into account that India faces persistent Vector Borne Disease (VBD) burdens, with Dengue reporting hundreds of deaths in recent years, along with Malaria, Chikungunya and other VBDs outbreaks influenced by various factors. The Committee understands that VBDs have varied determinants which include environmental, socio-economic and infrastructural factors. Therefore, to control and manage the advances of VBDs, an integrated approach combining chemical, biological, and environmental controls are needed. The Committee believes that while Government has taken many major measures in containing the VBDs, there is always scope for innovation and improvement in the area.  The measures taken by the Government to eliminate breeding sites, regular community clean-up drives, usage of chemical vector control like adulticides via fogging, etc., seems to have been exerting limited effect. But the biological control measures like the promotion of natural predators like larvivorous fish and sterile insect techniques are potent and promise long-term success. The Committee feels that all these efforts would gain more benefits if a common and coordinated task approach, involving various Ministries/Organizations concerned, is adopted and adhered to. Such coordinated policy/programme should also take into consideration the different levels of incidents across affected states/districts. Scattered policies and its implementation would only lead to resurgence of VBDs, therefore, leading to escalation of economic and health costs. Accordingly, the Committee recommends that the Government should strengthen the existing framework/ roadmap for controlling and managing VBDs with a clear-cut timeline for phasing out and for complete elimination of each the vector-borne diseases from the country.

(Para 2.20)

2.         While the Committee acknowledges the efforts of National Vector Borne Disease Control (NVBDC) through Integrated Vector Management (IVM) in India, the concept developed by WHO, as early as in the 1980s, it feels that the Government should revamp the IVM in India.  The Committee, in this connection, recommends that the Government must re-orient IVM in India more effective and productive manner by encompassing aspects like interdisciplinary research networks; regularly reviewing and updation of existing guidelines/policies; innovative capacity building programs; scaled up infrastructure; digital platforms for sharing best practices; usage of authentic social media as awareness campaign forum, promoting community participation, focusing more on high-risk groups, like children, pregnant women, outdoor workers and travelers to endemic areas, etc.

(Para 2.21)

3.         Regarding the vaccinations for counter and management of VBDs, the Committee understands that internationally, vaccination is available for Yellow Fever, Japanese Encephalitis, Tick-Borne Encephalitis (TBE), Chikungunya, Dengue, and Malaria. Whereas in India, vaccination is available only for Japanese Encephalitis which is free of cost under the Universal Immunization Programme. To address the gaps, the Committee strongly recommends that India should pursue international collaborations with WHO and other leading organizations and benefit from the global expertise for vaccine development. Further, the Government should also facilitate the efforts to speed up the indigenous vaccine development for Dengue and Chikungunya through the establishment of clinical trial networks and also expand immunization coverage of JE. The Committee also recommends that the Ministry should further explore the newer ideas like mRNA and viral vector technologies for rapid development of vaccines, micro needles, nasal sprays to enhance vaccine uptake and efficacy, cold-chain vaccine outreach for vulnerable and unreachable regions, etc., for strengthening immunization of VBDs.

(Para 2.22)

4.         The Committee has also been made aware of lack of defined protocols to treat complicated stages of VBDs like 3^rd and 4^th stage of Dengue, Dengue Hemorrhagic Fever and Dengue Shock Syndrome. The Committee also recognizes the need for effective research for future preparedness in anticipation of the emergence of new VBDs. In this regard, the Committee recommends that the Ministry should prioritize the development of disease-wise Standard Treatment Protocols, especially for complicated stages of VBDs. The Committee further recommends that research may be undertaken under the guidance of ICMR to identify new diseases transmitted by vectors and related complications as part of future preparedness.

(Para 2.23)

Trends of VBDs in North–East India

5.         The Committee feels that the NER States and also the entire country should maintain data specifically reflecting the incidence/rate of vector-borne diseases among tribal, rural and urban population, which would help framing effective and sustainable localized public health policy in the areas. India’s VBD epidemiology is highly diverse due to differences in vectors, ecology, socio-economic conditions and healthcare access, etc. In India’s diverse landscape, aggregate statistics may not present the ground realities and will lead to “one-size-fits-all” approaches. Specific data would help in drafting tailor-made control and management strategies, efficient resource allocation and prioritization. This should act as support material for prioritizing research subjects, capacity building and policy refinement. The data would also support proper allocation of funds and helps integrate VBD control with broader programs like Ayushman Bharat Health and Primary Health Centres/Wellness Centres in rural areas, urban health missions, One Health approaches in tribal-forest regions. Accordingly, the Committee recommends for the maintenance and sharing of specific data at national and state levels on VBD spread in tribal, rural and urban areas.

(Para 3.8)

Major determinants surging VBDs outbreaks in NER

6.         The Committee understands that NER’s unique geo-climatic, ecological, and socio-cultural setting create exceptionally high receptivity and perennial transmission in many areas, explaining the disproportionate historical burden of VBDs. The Committee finds that the key determinants for the spread of VBDs in the region include environmental and climatic conditions like hot-humid conditions, abundant water bodies, deforestation, shifting cultivation and unplanned urbanization. Vector Bionomics and ecological shifts like multiple efficient Anopheles species, multi-insecticide resistant, high biting rates, pigs/birds as amplifiers also accounts for as determinants. Further, there are Socio-economic, demographic, and access determinants like diverse indigenous/tribal populations, cross-border and internal migration facilitating parasite/vector movement, limited healthcare access, asymptomatic reservoirs, etc. Behavioural and occupational factors include outdoor livelihoods, proximity to breeding sites and poor waste management. Health system and programmatic factors include funding and human resource gaps, vaccination coverage gaps or diagnostic challenges, fragmented surveillance. Taking these factors into consideration, the Committee feels that the Government should implement a region-specific, integrated, multi-sectoral VBDs strategy for assured control and management of VBDs in the NER.  Such approach should be adhered to and implemented while keeping into consideration the eco-epidemiological understanding of local determinants, prioritize universal coverage of proven tools like long-lasting insecticidal nets/LLINs and artemisinin-based combination therapies (ACTs), strengthened surveillance by including detection of asymptomatic and GIS hotspot mapping.

(Para 4.5)

7.         The Committee, accordingly, recommends for regular community engagement customized to tribal sensitivities, enhanced cross-border and inter-state coordination, dedicated funding along with inter disciplinary research collaborations and stronger coordination between the National Vector Borne Disease Control, State Governments , Medical institutions, ICMR, and Department of Health Research (DHR) for effective implementation of adopted strategy. Improved public awareness programmes about VBDs, their transmission, and preventive measures as well as education campaigns should target high-risk populations, focusing on behavioural changes to reduce vector exposure are vital. The Committee believes that a general national template is insufficient due to NER heterogeneity, hence, recommends for a region-specific, integrated, multi-sectoral VBDs strategy for effective and result oriented control and management of VBDs in the NER of India.

(Para 4.6)

Measures adopted by Central/State Governments in NER to control vector-borne diseases

8.         The Committee understands that insecticide resistance is one of the major challenges related to vector management. Insecticide resistance against vector mosquito species is regularly monitored by National Vector Borne Disease Control and accordingly technical guidelines are issued to the States for change in the usage of insecticide. Following various studies undertaken by ICMR that reported resistance of DDT in Malaria vectors, DDT has been phased out, and Synthetic Pyrethroids & Malathion are used. The Committee believes that rotation of Indoor Residual Spraying (IRS) insecticides, introduction of next-generation Long Lasting Insecticidal Nets (LLINs) (PBO/dual-active), routine insecticide susceptibility testing, and adoption of Integrated Vector Management (IVM) combining multiple interventions, including environmental management and larval control could be more effective measures that can be adopted to deal with insecticide resistance. Hence, the Committee strongly recommends that the said measures/strategies be made part of the IVM guidelines and promoted vigorously among the NER population through varied platforms.

(Para 5.3)

9.         The Committee, while acknowledging the free diagnosis and treatment services for VBDs provided under National Health Mission, feels the necessity for in depth considering of the diversity and extent of the country’s population, especially in NER.  The Committee has come across the fact that the there is still considerable gap in the distribution of laboratory and diagnostic infrastructure in the NER. In the opinion of the Committee, limited laboratory capacity and processing time delays confirmation of VBDs cases. Accordingly, the Committee recommends for the creation/expansion of adequate Viral Research and Diagnostic Laboratories (VRDL) network in NE states. Regarding diagnostic tests, the Committee wants the Ministry to explore the possibility of multiplex diagnostic platforms and point-of-care diagnostic tests, for use in low-resource regions, that can be rapid, affordable and detect multiple VBDs, simultaneously.

(Para 5.6)

10.       Shortage in manpower, supply management, and timely disease surveillance are the challenges faced in the remote areas of NER related to VBDs. The Committee desires that the disease surveillance system should be strengthened through real time, technology-driven monitoring to ensure early detection and timely response to infectious disease. It has also been brought to the notice of the Committee that many sanctioned posts under National Vector Borne Disease Control (NVBDC) and State health departments remain vacant or filled by non-specialists. The shortage of skilled and trained human resources in NVBDC and State health departments prove to be a major operational gap in implementing VBD control programmes as absence of skilled entomologists affects entomological surveillance, insecticide resistance monitoring, and data-driven decision-making, which in turn, limits evidence-based vector control and delays response actions. Accordingly, the Committee recommends for fast-track recruitment and deployment of qualified entomologists in all NCVBDC districts and regular certificate driven capacity building programmes to be held through premium institutes for stakeholders. The need for the establishment of a North Eastern Regional Entomology Training Hub for capacity building and technical certification has also been brought to the notice of the Committee, accordingly, the Committee recommends that the Ministry should actively look into the feasibility of the settling up of such a training hub in the NER.

(Para 5.7)

11.       The Committee acknowledges that agricultural practices such as paddy cultivation and pig rearing create conditions conducive to malaria and JE transmission. Most of the time people engaged in such agricultural practices/ animal rearing overlook the hygiene protocols related to water logging, disposal of pig manure, etc. This is due to lack of awareness which reflects in their behavioural pattern. The Ministry has submitted that the National Vector Borne Disease Control provides technical guidance and advisories regularly, especially during pre- and post-monsoon seasons, to be followed in such agricultural practices/ animal rearing. Nevertheless, the Committee recommends that the Ministry should enhance the promotion of animal and human surveillance, pig rearing regulation and zoning as per international One Health best practices. The Committee, moreover, recommends the Ministry to conduct regular community awareness campaigns under the guidance of Village Health Committees, thereby targeting school and workplaces to bring forth sustained behavioural changes.

(Para 5.9)

12.       Keeping in view multi-dimensional socio-economic challenges such as different tribes and their beliefs/interactions, water sourcing practices, etc., the Committee believes that concerted efforts should be made to have door to door surveillance and awareness campaigns to boost the confidence of tribes in the popular national health system and universal immunization programmes.  Such efforts should be made with the help of Accredited Social Health Activist (ASHA) and Community Health Officers. According to the Committee, such approach and strategy for social causes will bear fruit only through sustained efforts.  The Committee, therefore, recommends that to encourage the commitment of the foot workers the Ministry should review and revise the incentives of ASHA workers and Community Health Officers periodically as a motivating measure to support the efforts undertaken by them. In this regard, the Committee notes that in the tribal, hilly and desert areas the national norm for deployment of ASHA workers (1 ASHA per 1,000 populations) is relaxed to one ASHA per habitation. The Committee desires that the Ministry should strictly follow this deployment norm in the NE Region. The Committee also strongly recommends the Government for targeted vector control measures, like fever detection camps, school-based awareness, citizen reporting systems in high-risk areas such as tribal and forest settlements, tea gardens, industrial zones.

(Para 5.12)

13.       On cross-border transmission of VBDs, the Committee is of the firm view that the NER’s topography along with cross-border movement across international boundaries and dispersed settlements accentuates VBDs importation. The Committee recommends for cross border vector disease coordination mechanism to establish a regional coordination platform with neighbouring countries (Bangladesh, Bhutan and Myammar) for surveillance and information sharing. Harmonise outbreak reporting and vector-control strategies in border districts. There is need to strengthen preparedness against cross-border transmission of vector-borne diseases. To address this issue, the Committee recommends the use of remote-sensing technology for mapping larval habitats and inaccessible zones along with mobile surveillance with the calibrated help of drones under Namo Drone Didi Scheme which provides Self-Help Groups (SHGs) of women with heavily subsidized agricultural drones. The Committee also recommends the Ministry to take adequate lessons from global malaria elimination frameworks such as the Greater Mekong Subregion initiative, enhance cross-border district-to-district data sharing and collaborative surveillance along the Myanmar and Bangladesh borders to address the prevalence of VBDs. Further, the Committee recommends the Ministry to undertake joint measures to engage with healthcare agencies of neighbouring countries to explore the possibility of joint action under a partnership group against VBDs prevalence in NER.

(Para 5.13)

14.       The Committee observes that though robust Integrated Vector Management (IVM) remains the cornerstone for VBDs, the IVM of VBDs should be all inclusive covering different zones/states and different levels of incidents, with special impetus to NER. According to the Committee, peri-urban expansion, unplanned construction, accumulation of waste, inaccessibility of health facilities in remote areas, lack of awareness, etc., are the causative factors for the surge of VBDs in NER. In regard, the Committee recommends that the Integrated Vector Management (IVM) in NER should be specially curated and due impetus be given to aspects like climate-informed planning along with infrastructure modifications like improved drainage, strict enforcement of municipal bye-laws related to construction-site and waste management by local bodies, launch of year-round multi-media awareness programs through ASHA workers, schools and digital platforms, especially in local languages, etc.

(Para 5.15)

15.       The Committee, furthermore, recommends for adequate deployment of mobile health units and setting up of pre-monsoon seasonal camps for remote/tribal villages with periodic evaluation, usage of citizen science apps for reporting breeding sites and tracking vector density, regular refresher courses for health workers/ field and laboratory staff, strengthening of district laboratories, institutionalization of a cadre-based entomology system and rapid response teams be made part of the IVM in NER. The Committee wants the Ministry to develop an exclusive portal, covering day to day activities in NER with real time data related to VBDs management, reporting of incidence, etc, accessible to all concerned including citizens.

(Para 5.16)

16.       The Committee have come across that the North East Special Infrastructure Development Scheme (NESIDS) primarily support and accelerate infrastructure and socio-economic developments in the NER. The Committee feels that NESIDS should focus on developmental projects related to health as well as projects that would help to bridge infrastructure gaps in VBD hotspots. Extending NESIDS scope in control and management of VBDs in NER would address the infrastructure gaps like improvement in diagnostics facilities and climate-resilient water management, etc. Accordingly, the Committee recommends the creation of a dedicated VBD window under NESIDS catering to allocate funds for integrated development and infrastructure like vector-proof housing and diagnostics facilities in high-burden areas of NER. It is of the considered opinion of the Committee that as long as the crippling grip of VBDs on the NER is not effectively and decisively addressed, the holistic economic and infrastructural development of the region is not possible.

(Para 5.19)

17.       Taking into account the submission of various States in the NER the Committee infers that the persistence VBDs in the region is rooted in a mix of general factors including environmental, socio-economic and infrastructural. Apart from this, certain studies indicate State wise causative factors like malaria hotspots linked to elevation and land-use in Assam and Arunachal Pradesh, climate change - like an increase in both maximum and minimum temperatures in hilly areas of Manipur, jhum cultivators in Mizoram, language barriers from multiple dialects in States like Nagaland and Tripura, population movement in Sikkim, etc, also adds to the problem. Accordingly, the Committee feels that considering the unique topography, climatic conditions, and socio-demographic characteristics of the NER and State specifications, region-specific action plans with micro level sub-plans need to be formulated to strengthen vector-borne disease control and elimination efforts.

(Para 5.44)

18.       Keeping in view the State specific requirements, the Committee recommends that the Ministry should ensure that the Regional Review Meetings (RRM) of the State’s National Vector Borne Disease Control Programme are conducted every three months to monitor progress on aspects like surveillance, monitoring, and evaluation of VBDs as well as the smooth functioning of intersectoral coordination with departments such as Veterinary, Fisheries, and Municipal bodies to control the surge of VBDs in NER, especially, during the times when the spread of these diseases is at its peak. Further, the RRM should tangibly assess the progress made during the previous quarter in comparison to the benchmarks set and accordingly, review and reset the targets for the next quarter. Responsibilities to achieve the targets should also be clearly defined so as to measure achievements and lapses, objectively and to make course correction.

(Para 5.45)

19.       The Committee also urges the Ministry to confirm the usage of Daily Treatment Tracking Forms are used by Multi-Purpose Health Worker (MPWs) and ASHAs to ensure treatment compliance. Moreover, the Committee recommends that the data collected through Daily Treatment Tracking Forms needs to be digitised for ease of access and analysis for research purpose. For certifying complete treatment, the Committee wants the Ministry to strengthen the Public-Private Partnership (PPP) approach as well by supplying anti-malarial drugs to private hospitals and laboratories while tracking all diagnosed malaria patients.

(Para 5.46)

 

20.       The Committee understands that on the entomology front, the Ministry could not conduct a comprehensive vector resistance study between 2019 and 2024 due to insufficient mosquito specimens, as susceptibility tests on Anopheles philippinensis in 2023 showed 100% mortality to both DDT and Malathion. In this regard, the Committee opines that the Ministry should not postpone such studies due to reasons like insufficient mosquito specimens and should consider techniques like archived specimen genetic screening by utilizing samples already stored in laboratories or repositories from the past, pool-sequencing, etc., to undertake such studies. Further, the Committee would also want the Ministry to explore the feasibility of controlled rearing of the vectors for specimen purpose as per established WHO protocols. Accordingly, the Committee recommends that the Ministry should adopt new techniques and measures to conduct vector resistance study which would help in future preparedness against VBDs.

(Para 5.47)

21.       Further, the Committee understands from domain experts that certain State specific steps/management that can be further adopted at micro and macro levels to contain/mitigate vector-borne diseases like universal LLIN coverage in Mizoram and Tripura, strengthened cross-border screening and surveillance along the Myanmar and Bangladesh borders, development of  city-specific action plans for Guwahati, Agartala, Kohima and Aizawl involving weekly container surveillance, construction-site compliance enforcement and use of long-lasting larvicides in high-risk wards, wide JE vaccination coverage in Assam and spill-over districts, ensuring pig-sty distancing of at least 500 meters from human dwellings wherever feasible and managing night-roost bird habitats near habitation, to complete pending MDA/IDA rounds, correct coverage gaps, and conduct of pre-TAS/TAS for Lymphatic Filariasis as per eligibility in endemic districts of Assam, etc. Accordingly, the Committee strongly recommends that the Ministry must act upon these measures as suggested by domain experts for addressing the challenges of VBDs in NER.

(Para 5.48)

Research done on Vector-borne diseases in India and in the International arena

22.       The Committee assumes that the purpose of the Zoonotic Vector Borne Diseases Research & Training Centre (ZVBDC) is to bring together expertise in public health, clinical medicine, veterinary sciences, laboratory methods, and social sciences to improve understanding and support integrated research of key Zoonotic and Vector-Borne Diseases in NER. Considering the relevance of the purpose of such an institution, the Committee strongly recommends that the Government should continue its financial aid to the Institution either through collaborative grants or extension of its parent grant and even consider augmenting the functioning of the Centre though enhanced monetary support. The Committee views that the Ministry must conduct yearly review/audit on the effective utilization of the grants so made before further extension of grant provision. The Committee is of the firm opinion that budget constraints should not limit innovation and scientific research and development, and hence private sector involvement in funding of such projects needs to be explored. The Committee recommends that the Ministry should look into PPP investment on Research and Development, on high priority. Apart from the financial aspect, the Committee recommends that ZVBDC should concentrate in genomic surveillance of vectors and pathogens as emerging insecticide resistance and new strains requires real-time data on vector genetics and virus evolution. Further the Committee recommends the development of a National One Health platform for VBDs connected through various central institutions like ICMR, ICAR, etc., and State machinery like ZVBDC, Veterinary Departments, etc. This would enable the sharing of data and other real-time information relating to vector control measures being undertaken at different locations by multitude of agencies.

(Para 6.8)

23.       The Committee, during its examination on the subject observes that data collection and surveillance is a one of the major challenges in the control and management of VBDs in NER. The Committee appreciates the work done by the Government through the launch of Integrated Health Information Platform (IHIP) which enables real-time case-based surveillance, mapping of vector indices, and weekly analytics on “fever plus vector density” trends. The Committee, in this regard, recommends an exclusive portal, covering day to day activities in NER or to publish a North-East Vector Surveillance Bulletin, based on real time data related to VBDs management, before and after each monsoon season to facilitate evidence-based planning in NER.  The Committee feels that Government should upgrade the diagnostic panels & electronic reporting through IHIP. Ineffective feedback mechanism is another factor that impedes regular reporting, leading to undetected hotspots. Accordingly, the Committee recommends user-friendly mobile apps and helplines to be communicated in vernacular languages with acknowledgment and follow-up protocols, ensuing two-way communication systems with SMS updates and documentation of each resolution, etc.

(Para 6.10)

24.       The Committee, strongly view that the data interpretation is equally important as its collection, therefore, health workers should get regular training in data interpretation for timely resource allocation and outbreak response. Along with human resources, artificial intelligence can also be used for big data analytics, climate & epidemiological trends and predict outbreak patterns. The Committee, hence, recommends the Ministry to resort to AI-powered early warning systems integrated with IHIP for hotspot prediction and similar activities. Use of Machine Learning for vector image recognition via citizen apps, etc can also be considered. The data so collected/analysed should be the backbone of the findings of research institution and these findings should in turn give shape to future health policies.  Research-to-Policy Integration should be the aim of the Government in dealing with health hazards of the country. Further, the Government can also look into the possibility of creating a national VBD research mission, encourage CSR contributions and international collaborations for projects under the mission to set in place a sustainable ecosystem in this sphere.

(Para 6.11)

Global perspective/response towards the management of vector-borne diseases

25.       The Committee observes that World Health Organization’s (WHO) Global Vector Control Response (GVCR 2017–2030) provides a new strategy to strengthen vector control worldwide through increased capacity, improved surveillance, better coordination and integrated action across sectors and diseases, surveillance and early detection, etc. The Committee understands that India’s vector-borne disease control strategies are largely aligned with the WHO Global Vector Control Response. Accordingly, much emphasis needs to be given by the Government on Integrated Vector Management (IVM), usage of next-generation Tools, Zoonotic Disease Management, Cross-Border Coordination, Community-Led Urban Sanitation Models, Antimicrobial Resistance (AMR) Surveillance, etc. till the achievement of objective conceived. The Government, therefore, needs to strive to adopt the good global practices into India’s framework, so that that full-scale implementation of such measures in the North-Eastern States are commensurate to meet challenges due to terrain, international borders, tribal populations and climatic variability.  The Committee, therefore, recommends the Ministry to take a cue from WHO strategy to review and evaluate India’s current VBDs guidelines and policies and to implement the same to tackle VBDs in NER and in the country as a whole.

(Para 7.7)

26.       The Committee feel that 2030 elimination goals of Malaria require accountability and course correction. The target of the Government should be to achieve zero indigenous cases by 2027 and sustain malaria-free status by 2030 through phased, district-level elimination. Hence, the Committee recommends a sustained and community-involved approach with annual audited reports, adaptation to local vector behaviour and resistance patterns and tie up funding to performance matrices. The Committee strongly believes that in order to eradicate any VBDs, a multi-faceted approach is far more effective than any single method. Political commitment, adequate funding, addressing climate change/urbanization impacts and adaptive strategies based on local epidemiology are critical for success in both India and globally for the elimination of VBDs.

(Para 7.8)

Experts’ Opinions/suggestions on VBDs

27.       The Committee intends to identify ways to combat Vector-Borne Diseases (VBDs) through widespread environmental control, modified measures, proper management and adequate community mobilization in the NER.  The Committee takes into account different aspects ofVBDs that are specific to NER States, like the socio-economic challenges faced, coordination mechanism, measures adopted for community sensitization and training involved, data sharing on prevalence, spread, vaccination, treatment methods, etc. Effectiveness of Intensified Malaria Elimination Project-3 (IMEP-3), implementation of WHO guidelines for Vector-Borne Diseases in India, outcome of various research done by ICMR-NIMR on VBDs, role and participation of local bodies/ stakeholders at State level like municipality, corporations, etc. along with the best practices in effective implementation of vector control measures undertaken so far in the country were bought before the Committee as part of the examination. The Committee had examined all these aspects and have given its recommendations after weighing the suggestions of the domain experts as well. Further, the Committee recommends the Ministry to look into the additional suggestions put forward by the domain experts before the Committee to tackle the VBDs in NER and implement them appropriately. Some of such suggestions are - universal testing preceding the therapy with artemisinin-based combination therapy (ACT) for P. falciparum, chloroquine for susceptible P. vivax and primaquine to prevent relapses, deployment of the recently approved QDenga vaccine in high-transmission settings, setting up a Regional Entomology Training Hub, institutional capacity building in vector management and treatment, effective platforms for inter-sectoral coordination, One Health approach to deal with VBDs, climate-based risk modelling and digital reporting systems to enable timely outbreak response and effective disease control, emulating facets from models like Odisha’s DAMAN and Chhattisgarh’s Malaria Mukt Bastar Abhiyaan and extensive use of drones for mapping, delivery of supplies/services to overcoming topographical challenges.

(Para 8.11)

28.       Deployment of the QDenga vaccine in high-transmission settings         

            The Committee has been given to understand that the first preventive vaccine for dengue has been given official approval by CDSCO and DCGI for 04 to 60 years age of persons to be administered two dosages in the interval of three months as QDenga is effective for all the four serotypes of dengue. Since the vaccine Qdenga will be available on commercial basis in the market in the mid of year 2027, the Committee, therefore, recommends for incorporation of Qdenga vaccine in universal immunization programme with accelerated impetus.

(Para 8.12)

29.       Climate-Based Vector Disease Early Warning System

            The Committee recommends the Government to integrate IMD weather forecasts, satellite/GIS mapping and vector surveillance to predict disease hotspots and to issue district-level early warning alerts before outbreaks occur. The Committee further stresses strategic course of action to enable proactive vector control and better resource deployment.          

(Para 8.13)

 

RECOMMENDATION/OBSERVATIONS OF THE COMMITTEE –AT A GLANCE (176^th REPORT)

OVERVIEW OF INDIAN HEALTHCARE SYSTEM

1.         The Committee is of the view that while the current 51% allocation to primary healthcare establishes a vital preventive foundation, the disproportionately low spending on secondary (28%) and tertiary (11%) care drives citizens toward expensive private facilities, resulting in catastrophic out-of-pocket expenditure (OOPE). The Committee, therefore, recommends a systematic expansion of public sector capital investment in Community Health Centres (CHCs), District Hospitals, and state-run medical colleges. The Committee understands that the focus of such expansion should be on upgrading regional secondary-care facilities to provide dependable, round-the-clock emergency, obstetric, and pediatric care, thereby reducing the referral burden on overstretched apex institutions. The Committee recommends for strengthening of the CHC infrastructure and facilities so that post-graduate doctors can work there in suitable conditions. Facilities like proper accommodation and salary incentives be extended to enable such doctors to work at CHC level.

(Para 1.3.4)

2.         The Committee observes that government expenditure on governance and supervision currently stands at 8%, double the combined expenditure (both government and private) of 4%. While an extensive administrative apparatus is necessary, the Committee believes that such high overhead costs signal systemic inefficiencies and operational duplication. The Committee, therefore, recommends an immediate administrative rationalization program utilizing digital health infrastructure, such as the Ayushman Bharat Digital Mission. By automating routine oversight and streamlining scheme delivery, the government can safely redirect these administrative funds directly into the procurement of medical equipment, diagnostics, and specialist human resources and all vacancy position at CHC level be filled up on utmost priority basis.

(Para 1.3.5)

3.         The Committee is of the view that, given the significant role of the private sector in delivering specialized treatments, a balanced regulatory framework is imperative to protect patients from financial vulnerability. The Committee, therefore, recommends enforcing standardized, subsidized pricing models and expanding public insurance coverage for high-end tertiary procedures within public-private partnership (PPP) frameworks. The Committee believes that implementing digital referral systems, outcome-based monitoring, and robust public-private partnership (PPP) frameworks will bridge the equity gap in advanced curative care, improving transparency and accessibility while strictly regulating costs for rationalising out-of-pocket expenditure.

(Para 1.3.6)

4.         The Committee observes that while the private sector accommodates over 60% of inpatient and 70% of outpatient care, it remains highly heterogeneous, with a vast network of small clinics, nursing homes, and diagnostic centres operating without regulations. The Committee is of the view that the unbridled growth of clinics, nursing homes and diagnostic centres and uneven implementation of the Clinical Establishments (Registration and Regulation) Act, 2010, across states creates glaring disparities in both the quality and cost of care in private sector, leaving patients vulnerable to arbitrary pricing and substandard practices. The Committee, therefore, recommends that the Ministry actively coordinate with State Governments to mandate the uniform adoption and strict enforcement of the Clinical Establishments Act nationwide. Furthermore, the Committee believes that relying solely on voluntary NABH accreditation is insufficient; hence, a mandatory quality-assurance and price-transparency framework must be implemented across the country for all private clinical establishments to ensure standardized treatment protocols and protect patients from monetarily exploitation. Further, the NABH system be made user friendly and transparat for the small health establishment as NABH compliance in itself adds to the total cost for these health care providers in small towns.

(Para 1.3.11)

5.         The Committee notes the robust financial performance of corporate hospital chains, marked by a high Average Revenue per Occupied Bed (ARPOB) driven heavily by high-value treatments and an expanding medical tourism market. The Committee believes that while India’s emergence as a premier, cost-effective global medical destination is commendable, the advanced medical infrastructure, often bolstered by government incentives such as 100% FDI, must simultaneously serve the domestic population equitably. Conversely, the Committee is of the view that India’s significantly low private health insurance penetration, which remains well below the global average, forces domestic patients to bear debilitating out-of-pocket expenses for such services.The Committee, therefore, recommends the formulation of a structured cross-subsidization policy. Under the said framework, large corporate hospitals benefiting from government concessions should be required to utilize a portion of revenues generated from international and high-net-worth patients to provide cross-subsidized advanced tertiary care for economically weaker domestic patients as is the case inseveral countries. Additionally, these institutions must be mandated to allocate a defined quota of beds for empanelment under national health insurance schemes at standardized, regulated package rates.

(Para 1.3.12)

6.         The Committee is of the view that the current private healthcare landscape is disproportionately concentrated in urban tertiary markets, leaving a significant void in tier-2, tier-3, and rural areas despite a growing demand for specialized care in rural, semi-urban, hilly and tribal areas. The Committee believes that market forces alone will not bridge this geographical divide, and that advanced technologies, such as robotic surgery, AI-diagnostics, and telemedicine, currently remain confined to metropolitan corporate chains. The Committee notes with concern that smaller hospitals in these regions severely lack access to modern infrastructure, advanced medical equipment, and emerging technologies. The Committee believes that such small rural facilities are critical to decentralized healthcare delivery but require urgent systemic support to balance quality with affordability.The Committee, therefore, recommends that the government restructure its healthcare incentive frameworks, making tax benefits, land subsidies, and FDI facilitations strictly conditional upon private sector investment in underserved geographical regions. By heavily incentivizing Public-Private Partnerships (PPPs) in non-urban areas, the government can ensure that the infrastructure, technological advancements, and high quality of care characteristic of the corporate private sector are made accessible and affordable to the broader rural and peri-urban population.

(Para 1.3.13)

7.         The Committee, further, recommends that the government restructure its healthcare incentive frameworks to explicitly protect and upgrade smaller healthcare providers. Alongside incentivizing corporate Public-Private Partnerships (PPPs) to expand into non-urban areas, the government must launch targeted financial assistance, technology-upgrade grants, and subsidized equipment procurement programs specifically for small and medium-sized rural and semi-urban hospitals. Leveling such technological playing field will ensure that high-quality, modern care is not exclusively confined to corporate urban centers but is made accessible and affordable throughout the rural, semi-urban, hilly and tribal landscape.

(Para 1.3.14)

COMPARATIVE ANALYSIS: STRENGTHS AND WEAKNESSES OF PUBLIC AND PRIVATE HEALTHCARE SECTORS

8.         The latest National Statistical Office survey (80^th round of the National Sample Survey January-December 2025) highlights India’s deepening healthcare affordability crisis. The Committee notes with deep concern that treatment in private hospitals is often five to ten times costlier than in government facilities, with childbirth and serious illnesses like cancer, heart disease, and kidney failure reflecting the sharpest divides. The average cost of inpatient treatment for an illness in India is about Rs 37,858, while out-of-pocket expenditure is about Rs 34,064. The average cost of hospitalization is Rs. 6,631 in government hospitals compared to Rs. 50,508 in private hospitals. The gap widens further for serious illnesses such as cancer, heart disease and kidney failure.

(Para 1.4.6)

9.         The Committee would like to highlight that, as per the 80^th round of the National Sample Survey January-December 2025 conducted by National Statistics Office on Household Social Consumption: Health, state-wise data shows that healthcare costs are not uniform across India, but vary significantly. Treatment costs are higher in the south and in some more developed states. In Telangana, the total cost of hospitalisation reaches about Rs 55,000, while in Tamil Nadu it is around Rs 52,000. In Kerala and Karnataka, the cost ranges between Rs 40,000 and Rs 45,000. Expenditure is also high in states such as West Bengal and Maharashtra, where total spending is recorded at or above Rs 40,000. In Uttar Pradesh and Haryana, the level also reaches about Rs 45,000. By contrast, spending in the north-east and some less developed states is relatively low. In Odisha, it is around Rs 22,000, while in Mizoram and Meghalaya it is about Rs 25,000. In areas such as Ladakh, spending is recorded at only about Rs 8,000. However, lower spending does not necessarily mean better conditions. It may also point to limited access to healthcare, lower use of services, or people being restricted to cheaper options. The state-wise data also shows that where government health services are stronger, public spending on treatment remains lower. But where the private sector has expanded, spending rises rapidly.For example, in southern Indian states, the role of private hospitals is greater and spending is also higher. In contrast, in the north-eastern states, there is greater reliance on government services, resulting in relatively lower expenditure.

(Para 1.4.8)

10.       The Committee is of the view that while the public healthcare system remains the crucial backbone for rural and low-income populations, with severe infrastructure deficiencies, workforce shortages, and extreme overcrowding that, in fact, erodes public trust and driving patients toward unaffordable private care. The Committee, however, notes with concern that excessive patient loads in government hospitals directly compromise consultation times and service efficiency. The Committee, nevertheless,believes that improving the perceived and actual quality of public healthcare is the most sustainable method to reduce the national burden of out-of-pocket expenditure (OOPE). The Committee, therefore, recommends for an accelerated capacity-building initiative focused on expanding bed capacity and recruiting specialized medical personnel in public facilities, particularly in high-demand metropolitan centers. Furthermore, the Ministry must strictly enforce Indian Public Health Standards (IPHS) to ensure that the availability of essential medicines, diagnostics, and modern amenities in government hospitals matches the responsiveness and patient satisfaction levels currently available exclusively to the private sector.

(Para 1.4.17)

11.       The Committee observes with concern the widening cost disparity between public and private healthcare, where the recent 80^thNSO survey (2025) reveals private hospitalization averages Rs. 50,508 (as compared to Rs. 6,631 in public facilities. Such huge disparity has triggered a deepening affordability crisis. The Committee believes that the rampant commercialization of private healthcare, characterized by grievances of excessive billing, unnecessary diagnostics, and soaring costs for routine procedures like childbirth (average out-of-pocket medical expenditure of Rs. 37,630 in private as compared to Rs. 2,299 in public), is directly pushing vulnerable households into catastrophic debt and distress causing asset sales. The Committee, therefore, recommends for the existing regulatory framework for immediate formulation of a mechanism to standardize and cap the costs of essential treatments, diagnostics, and routine procedures across all private hospitals. Additionally, the government must mandate absolute price transparency prior to admission and establish a unified, fast-track grievance redressal ombudsman specifically designed to audit excessive billing and resolve insurance claim disputes in the private sector.

(Para 1.4.18)

12.       The Committee is of the firm view that geographical inequities severely distort healthcare accessibility, with private tertiary care concentrated in urban centers and southern states, driving hospitalization costs above Rs. 50,000, while regions like the Northeast suffer from limited access to advanced care altogether. Although OOPE has declined to 43.4% (as per NHA Estimates 2022-23), the Committee, however, believes that current insurance coverage remains insufficient, as it largely ignores outpatient costs (which are five times higher in private settings) and indirect expenses like transportation and wage loss. The Committee, therefore, recommends a targeted geographical reallocation of health infrastructure funds to establish advanced public tertiary centers in underserved rural areas and northeastern regions, reducing regional reliance on the private sector. Simultaneously, the government must broaden the scope of existing national health insurance schemes to include comprehensive coverage for outpatient treatments and diagnostics, thereby shielding marginalized communities, the elderly, and women from the catastrophic financial impoverishment caused by private healthcare expenses.

(Para 1.4.19)

ROLE OF MAJOR GOVERNMENT SCHEMES IN HEALTHCARE DELIVERY AND FINANCIAL PROTECTION

13.       The Committee is of the view that while the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY) provides critical financial protection to over 500 million vulnerable citizens, its success heavily depends on the availability of robust medical infrastructure. Currently, a significant portion of PMJAY funds is absorbed by the private sector due to enduring deficiencies in public tertiary care. The Committee believes that to build long-term systemic resilience and reduce dependency on private facilities, the public sector's absorptive capacity must be drastically improved to enable public sector hospitals as tertiary care providers. The Committee, therefore, recommends the aggressive, fast-tracked execution of the Pradhan Mantri Ayushman Bharat Health Infrastructure Mission (PM-ABHIM). The government must urgently prioritize the establishment of critical care hospital blocks and integrated public health laboratories at the district level. By synergizing PM-ABHIM’s infrastructure upgrades with PMJAY’s financial coverage, the government can ensure that public hospitals capture a larger share of insured patients, thereby retaining public funds within the public healthcare ecosystem and guaranteeing high-quality, cashless tertiary care.

(Para 1.5.12)

14.       The Committee also acknowledges the severe burden of compliance faced by private providers. Rising operational costs for medical supplies, medications, and state-of-the-art equipment, combined with rational government price caps under schemes like Ayushman Bharat and CGHS, continuously squeeze profit margins and threaten financial sustainability. The Committee believes that forcing an unviable financial model upon hospitals ultimately compromises patient care. The Committee, therefore, recommends that while the Ministry must aggressively mandate the uniform adoption of the Clinical Establishments Act and enforce a tiered quality-assurance framework, it must simultaneously institute a dynamic, consultative pricing mechanism. Package rates under government schemes must be periodically rationalized to reflect realistic, rising operational costs, ensuring that private facilities can maintain high-quality care without facing systemic revenue instability.

(Para 1.5.13)

 

15.       The Committee observes that digital initiatives, particularly the Ayushman Bharat Digital Mission (ABDM) and teleconsultation platforms like eSanjeevani and SeHAT, are transformative in bridging the geographical healthcare divide. However, the Committee is of the view that voluntary or fragmented adoption of these digital tools limits their potential to reduce diagnostic duplications and streamline patient referrals. The Committee believes that a seamless digital continuum is necessary to lower the financial and travel burdens on rural populations seeking specialist care. The Committee, therefore, recommends making ABDM compliance mandatory for all public healthcare facilities and private hospitals empanelled under PMJAY. Furthermore, the capacity of Ayushman Bharat Health and Wellness Centres (AB-HWCs) must be systematically augmented with uninterrupted high-speed digital connectivity to ensure that every rural citizen has seamless, reliable access to doctor-to-patient teleconsultations, effectively reducing the referral burden on higher-level urban hospitals.

(Para 1.5.14)

16.       The Committee notes with deep concern that despite free treatment entitlements, outpatient expenditures and the cost of medicines continue to drive significant out-of-pocket expenditure (OOPE) for households. The Committee is, therefore, of the considered view that while schemes like the Pradhan Mantri Bhartiya Janaushadhi Pariyojana (PMBJP) have successfully provided affordable generic medicines, their physical footprint remains inadequate compared to the overall population's need. The Committee believes that mitigating such specific limitation is the most direct way to protect the patients of economically weaker sections from financial distress. The Committee, therefore, recommends the Government to establish Jan Aushadhi Kendras within the premises of all District Hospitals, CHCs, and large private hospitals empanelled under government schemes to ensure accessibility and availability of medicines at affordable costs. Concurrently, the Ministry must implement rigorous, technology-enabled audits through the National Health Mission (NHM) to ensure zero out-of-pocket expenditure for pregnant women and neonates under JSSK, explicitly penalizing medical centres that fail to provide complete free entitlements for drugs, diagnostics, and transport.

(Para 1.5.15)

DEFINITION AND INDICATORS OF AFFORDABILITY AND ACCESSIBILITY

17.       The Committee is of the view that affordability and accessibility are intrinsically interlinked.Affordable healthcare holds limited value if facilities remain unavailable or inaccessible, just as accessible infrastructure fails equitability tests if it imposes catastrophic financial burdens on households.The Committee, therefore, recommends that the Government heavily synchronize the expansion of financial protection frameworks, such as the Pradhan Mantri Jan Arogya Yojana (PM-JAY), with targeted infrastructural investments under the PM Ayushman Bharat Health Infrastructure Mission (PM-ABHIM). Immediate financial allocations must be directed toward eliminating Out-of-Pocket Expenditure (OOPE) by guaranteeing the uninterrupted supply of free essential medicines, diagnostic services, and emergency transport across all operational Ayushman Arogya Mandirs.

(Para 2.1.6)

18.       The Committee believes that the mere physical availability of healthcare centers does not equate to genuine accessibility if such facilities suffer from inadequate staffing, a deficit of specialists, or substandard equipment.The Committee, therefore, recommends the Ministry of Health and Family Welfare to embark upon the web-based Indian Public Health Standards (IPHS) Dashboard i.e.,from a passive self-assessment mechanism into an active, real-time remediation tool. Statutory, time-bound interventions must be mandated to rectify any identified infrastructure and human resource gaps, specifically optimizing doctor-population ratios and hospital bed density, ensuring absolute compliance with both the IPHS and National Quality Assurance Standards (NQAS).

(Para 2.1.7)

19.       The Committee is of the view that digital health innovations, particularly telemedicine platforms and the Ayushman Bharat Digital Mission (ABDM), act as crucial equalizers for populations facing severe geographical barriers/gaps.The Committee, therefore, recommends the rapid acceleration of digital health interoperability across the public and private sectors. This expansion must be aggressively supported by upgraded broadband connectivity and digital infrastructure at all rural healthcare facilities to maximize the functional reach of platforms like eSanjeevani. This will ensure seamless continuity of care and immediate access to specialized consultations, effectively bypassing the traditional barrier of physical travel time.

(Para 2.1.8)

OUT-OF-POCKET EXPENDITURE AND FINANCIAL PROTECTION

20.       The Committee is of the view that despite the recent reduction in Out-of-Pocket Expenditure (OOPE) over the past decade, the current Government Health Expenditure (GHE) of 1.43 per cent of GDP remains inadequate to ensure universal financial protection. The Committee believes that persisting below the 2.5 per cent of GDP target envisaged in the National Health Policy, 2017, severely hinders the mitigation of catastrophic health expenditures and medical impoverishment. The Committee, therefore, recommends that the Government should exponentially scale up its budgetary allocations to health, establishing a binding, time-bound roadmap to achieve the 2.5 per cent GDP threshold. This augmented funding must be strategically channeled into strengthening public healthcare infrastructure to progressively reduce the populace's disproportionate reliance on costly private healthcare financing.

(Para 2.2.9)

21.       The Committee believes that the heavy reliance on the private sector, which currently delivers nearly 60 per cent of hospitalisations and 70 per cent of outpatient services, creates an environment where unregulated costs for diagnostics, consumables, medicines, and intensive care persistently push vulnerable households into indebtedness. The Committee further notes that outpatient treatment, being predominantly composed of consultation and medicine costs, remains the segment least protected by existing insurance architecture, which is overwhelmingly weighted towards hospitalization. Consequently, the Committee is of the view that existing health insurance schemes inadequately address the immense financial burden of outpatient treatment, particularly the recurring cost of medicines. The Committee, therefore, recommends that the Government institute stringent regulatory mechanisms to standardize and cap pricing across private healthcare facilities, including retail pharmacies. Concurrently, it is imperative that the scope of existing public health insurance frameworks, such as PM-JAY, be broadened to comprehensively encompass outpatient consultations, diagnostic evaluations, medicine costs, and post-hospitalization care.

(Para 2.2.10)

22.       The Committee is of the view that a stark paradox exists wherein India, globally recognized as the 'pharmacy of the world' for its robust generic pharmaceutical industry, still leaves its citizens to bear massive financial burdens for medicines. The Committee notes with concern that Total Pharmaceutical Expenditure constitutes nearly 30 per cent of Current Health Expenditure, with pharmacies alone accounting for over 21 per cent of CHE by provider, making medicines the single largest identifiable component of the nation's healthcare spending. The Committee is of the view that since such pharmaceutical expenditure is disproportionately financed directly by households rather than through insurance or government schemes, thereby constituting one of the foremost structural drivers of India's persistently high OOPE. The Committee believes such compulsion of patient is a major driver of impoverishment, particularly for households managing chronic illnesses. The Committee, therefore, recommends the Government to aggressively expand and strictly monitor initiatives ensuring the uninterrupted provision of free essential medicines across all tiers of public health facilities. Additionally, the Government must consider to enforce more rigorous price controls on life-saving drugs and over-the-counter medicines in the open market to shield consumers from exploitative pricing, and must actively work to bring pharmaceutical expenditure within the ambit of prepaid and insured health financing rather than leaving it as a direct household cost.

(Para 2.2.11)

23.       The Committee finds that the prolonged, recurring nature of treatments for non-communicable diseases (NCDs) consistently drives low-income families into catastrophic health expenditure, effectively neutralizing broader systemic gains in financial protection. The Committee believes that such chronic care is inherently medicine-intensive, requiring sustained and often lifelong pharmaceutical therapy, and that this recurring medicine expenditure, being largely excluded from episodic hospitalization-based insurance coverage, is a principal reason why OOPE remains elevated among NCD-afflicted households, given their limited inclusion under existing public financing and insurance mechanisms, translates directly into household out-of-pocket payments. The Committee, therefore, recommends the formulation of specialized financial support frameworks and enhanced insurance sub-limits explicitly targeted at chronic care management, with specific provision for recurring pharmaceutical costs. These safety nets must guarantee lifelong, heavily subsidized access to required diagnostics, therapeutics, essential medicines, and medical consultations for patients suffering from long-term ailments.

(Para 2.2.12)

24.       The Committee is of the view that the apparent progress in Government Health Expenditure (GHE), which peaked at 1.84 per cent of GDP in 2021-22, was an anomaly driven by one-off COVID relief and vaccination spending. Relying on this pandemic-year figure created a misleading impression of advancement toward the 2.5 per cent target, a distortion only corrected when the delayed 2022-23 estimates revealed a sharp reversion to 1.43 per cent, perilously close to the pre-pandemic baseline. The Committee believes that the statutory target envisaged under the National Health Policy 2017 must be insulated from emergency fiscal cycles. The Committee, therefore, recommends that the Ministry of Health and Family Welfare, in consultation with the Ministry of Finance, chalk out financial outlook depicting a year-wise, costed glide path, moving beyond a mere aspirational target, detailing how GHE will move forward from the current levels, i.e., 1.43 per cent, to 2.5 per cent of GDP by a revised goal but with binding timeline. This glide path must be secured by ring-fenced, multi-year budgetary commitments rather than single-year allocations that are vulnerable to cutbacks, with progress strictly reported to Parliament on an annual basis.

(Para 2.2.13)

25.       The Committee is of the view that the prioritization of healthcare within the broader fiscal framework has regressed alarmingly post-pandemic. The data explicitly reveals that Government Health Expenditure (GHE) as a percentage of General Government Expenditure (GGE) plummeted from a peak of 6.12 per cent in 2021-22 to just 4.89 per cent in 2022-23, pulling back to a level even lower than the pre-pandemic baseline of 5.02 per cent in 2019-20. The Committee believes that treating health allocations as expendable once a public health emergency subsides fundamentally undermines the structural integrity and resilience of the healthcare system.The Committee, therefore, recommends that the Government should establish and adhere to a statutory minimum threshold for health allocations as a fixed proportion of total government spending. Such budgetary provision and allocation will guarantee that healthcare retains a permanently prioritized status in the national and state budgets, explicitly safeguarding public health investments from being crowded out or deprioritized in favor of other sectors during non-pandemic years.

(Para 2.2.14)

26.       The Committee is of the view that the financial protection gains witnessed during the pandemic were fundamentally non-structural. The reduction of Out-of-Pocket Expenditure (OOPE) to 39.4 per cent of Total Health Expenditure (THE) in 2021-22 was highly dependent on emergency-level public spending crowding out private costs; consequently, OOPE rebounded to 43.4 per cent in 2022-23 as government spending receded. The Household health expenditure, as a percent of THE, followed the same reversing pattern from 44.10 in 2021-22 to 49.10 in 2022-23. The Committee believes that genuine affordability requires shielding citizens from these fluctuating cycles exposing to volatile out-of-pocket costs, particularly in the unorganized private sector. The Committee, therefore, recommends the aggressive scaling up and deepening of insurance / pooled health financing mechanisms. This includes expanding PM-JAY coverage, strengthening state health assurance schemes, and improving primary and secondary care availability in public facilities to prevent patients from being pushed into the costly private sector. Furthermore, the Committee recommends the provision of a statutory target of enhancing Government Expenditure and capping on prices of medical drugs, diagnostics and devices to ensure reductions in OOPE as a percentage of THE, bringing OOPE below 30 per cent, tied to a specific target year.

(Para 2.2.15)

27.       The Committee takes into account that Capital Health Expenditure is the sole metric demonstrating sustained, consistent improvement, rising steadily from 9.5 per cent to 13.0 per cent of THE, reflecting investment in hospitals, equipment, research and development, and medical education/training. The robust investments in medical education, physical infrastructure, and research and development are the bedrock of long-term healthcare accessibility. The Committee, however, believes that even at 13 per cent, capital allocation as percentage of the still remains critically insufficient relative to the infrastructure deficits in public healthcare (rural hospitals, diagnostic capacity, tertiary care, medical education seats). The Committee, therefore, recommends that the Government aggressively enhance the capital expenditure outlay within the health budget. This augmented funding must be strictly ring-fenced for the rapid infrastructure expansion, procurement of advanced medical equipment, and the scaling up of training capacity for healthcare personnel, thereby shielding infrastructure development from fluctuations in current expenditure priorities and ensuring that long-term accessibility is not compromised.

(Para 2.2.16)

28.       The Committee believes that effective policy formulation is fundamentally compromised by delayed and insufficiently disaggregated data, as evidenced by the delayed release of the 2022-23 NHA estimates in May 2026 and the continued reliance on 2013-14 survey extrapolations for enterprise expenditures. The Committee is of the view that such time lags create misleading fiscal impressions regarding the true state of healthcare affordability. Furthermore, the Committee finds that the current methodology (National Health Accounting & Practice) fails to adequately capture private-sector, dental, and rehabilitative care spending. The Committee, therefore, recommends that the Ministry of Health and Family Welfare immediately invest in advanced digital systems and Artificial Intelligence-enabled data collection systems to automate healthcare data collection. Such technological overhauling must ensure that NHA estimates are published by the final quarter of the subsequent financial year. Furthermore, comprehensive, updated surveys must be commissioned to accurately capture expenditures in the private sector, dental care, rehabilitative care, and by autonomous bodies.

(Para 2.2.18)

 

 

INSURANCE PENETRATION AND FINANCIAL PROTECTION

29.       Low public expenditure on health has constrained the capacity and quality of healthcare services in the public sector, resulting in nearly two-thirds of healthcare utilisation taking place in the costlier private sector. Consequently, households remain vulnerable to catastrophic health expenditure and impoverishment due to medical expenses. The Committee therefore emphasizes that pre-payment and risk-pooling mechanisms through health insurance are indispensable instruments for protecting households against health shocks and reducing out-of-pocket expenditure.

(Para 2.2.25)

30.       The Committee is of the view that the "missing middle", constituting over 40 crore individuals or 30% of the population, presents a unique challenge, as they possess the financial capacity to pay nominal premiums but remain excluded by both fully subsidized government schemes and prohibitively expensive private products. The Committee believes that relying solely on existing frameworks will not suffice for this demographic, which predominantly comprises informal sector and self-employed workers. The Committee, therefore, recommends the introduction of a well-designed, voluntary, and contributory insurance model through a collaborative effort between the Government and the private sector. Specifically, the Committee recommends developing a modified, highly standardized product building upon the Aarogya Sanjeevani plan, structurally priced between Rs. 4,000 to Rs. 6,000 per family annually. To ensure widespread uptake, this product must strictly minimize waiting periods for disease coverage and explicitly include out-patient (OPD) benefits.

(Para 2.2.26)

31.       The Committee also observes that private health insurance penetration remains concentrated among urban and higher-income groups, with limited coverage in rural areas and among informal-sector workers. Concerns were also expressed regarding rising insurance premiums, exclusions and waiting periods, co-payments, claim rejections and the limited coverage of outpatient care, diagnostics and chronic disease management. The Committee further noted that delays in claim settlements and inefficiencies in the functioning of Third-Party Administrators (TPAs) adversely affect public confidence in health insurance mechanisms. The Committee is concerned to note that insurance claims charges very steeply for the same procedure between various hospitals.  The Committee strongly recommends for a transparent, well regulated health insurance sector where claim settlements date is integrated onto a common  portal with open access.  This will ensure transparency in the settlement of insurance claims.

(Para 2.2.27)

32.       The Committee is of the considered view that, while India has made significant progress in expanding health insurance coverage and reducing out-of-pocket expenditure through initiatives such as AB-PMJAY, increased public investment and affordable medicines programmes, however, substantial gaps in financial protection persist. The continued burden of expenditure on medicines, diagnostics and outpatient care, inadequate insurance penetration among informal-sector workers and the "missing middle", and concerns relating to claim management and private healthcare costs underscore the need for sustained policy interventions. Achieving Universal Health Coverage would require enhanced public health expenditure, stronger primary healthcare systems, expansion of financial protection beyond hospitalisation, affordable insurance products for uncovered populations, wider availability of free medicines and diagnostics, greater adoption of generic medicines and a robust digital health insurance ecosystem to effectively protect households from catastrophic health expenditure and impoverishment.

(Para 2.2.35)

33.       The Committee observes that employer-sponsored insurance currently proves significantly more effective in reducing out-of-pocket expenditure (OOPE) than government-funded schemes. The Committee believes this effectiveness stems directly from broader coverage limits that include routine OPD visits, fewer hidden costs for diagnostics and specific medicines, and seamless access to high-quality provider networks. The Committee is of the view that to prevent catastrophic and impoverishing health expenditures, government-funded schemes must emulate these structural advantages. The Committee, therefore, recommends an evidence-based expansion of Health Benefit Packages (HBP) under public Insurance schemes to formally encompass comprehensive OPD services, psychiatric disorders, chronic non-communicable disease (NCD) management, and rehabilitation, thereby preventing the systemic diversion of patients to costlier private care avenues.

(Para 2.2.36)

34.       The Committee emphasizes that the current private insurance market is heavily skewed toward high-income groups, with unacceptably low penetration in rural and informal sectors, and a rigid focus on inpatient care. Furthermore, widespread inefficiencies, such as slow claim settlements and selective denial of services, severely undermine public trust. The Committee believes that arbitrary pricing and claim manipulation by insurers or empanelled hospitals must be met with stringent regulatory penalties. The Committee, therefore, recommends the mandatory integration of all stakeholders-insurers, TPAs, and healthcare providers-into the National Health Claims Exchange (NHCX) to guarantee real-time, transparent claims processing. Furthermore, the Committee recommends that the National Anti-Fraud Unit (NAFU) continuously leverage AI-driven triggers to heavily penalize deliberate delays and ensure that all private insurance products align with the broader vision of Universal Health Coverage.

(Para 2.2.37)

35.       The Committee is of the view that the foundation of affordable healthcare relies on fully functional public infrastructure and the strict regulation of pharmaceutical costs. The Committee believes that the exorbitant OOPE driven by branded medicines, pharmacy malpractices, and irrational antibiotic use requires aggressive, sustained intervention. The Committee, therefore, recommends the immediate execution of a national audit utilizing the Drugs and Vaccines Distribution & Management System (DVDMS) to assess the availability of National List of Essential Medicines (NLEM) drugs and the user costs of diagnostics at all central institutes. Concurrently, the Committee recommends that State Health Agencies utilize the Indian Public Health Standards (IPHS) 2022 web-based dashboard to ensure 100% of healthcare facilities comply with essential service delivery benchmarks, while strictly monitoring the mandate for generic prescribing across all clinical establishments.  The Committee recommends that the Governemnt should make provision for upgrading and strengthening infrastructure to meet IPHS standards, maintenance, ensure availability of medicines at these centres, strengthen the diagnostic servies wherever required through PPP mode also, promote universal annual health check-ups, strengthen the AYUSH based arms, ARogya Mandirs.

(Para 2.2.38)

36.       The Committee is of the view that while there is a pressing need to equip Health and Wellness Centres (HWCs), Community Health Centres (CHCs), and district hospitals in tribal and rural areas with advance affordable medical equipment.  Relying on refurbished diagnostic systems is highly unrealistic to long-term healthcare outcomes. The Committee recommends that the Ministry significantly expand financial and structural incentives under the "Make in India" initiative to guarantee the uninterrupted supply of safe, novel, and affordable indigenous medical technology to all tier-2 and tier-3 public health facilities all across the country.

(Para 2.2.39)

37.       The Committee is of the view that the persistent financial burden on patients is severely exacerbated by retail pharmacy malpractices, wherein pharmacies exploit high Maximum Retail Price (MRP) margins, misuse GST refunds through fraudulent billing, and offer arbitrary discounts outside of prescription mandates. Furthermore, the Committee believes that the unregulated, over-the-counter sale of antibiotics driven by these profit motives accelerates the critical threat of Antimicrobial Resistance (AMR). The Committee, therefore, recommends the deployment of strict, multi-sectoral audits targeting retail pharmacy supply chains to cap unjustified trade margins and penalize fake billing practices. Concurrently, the Committee recommends that the Central Drugs Standard Control Organisation (CDSCO) comprehensively enforce the "Red Line" campaign and existing FSSAI and ICMR guidelines to categorically prohibit the sale of antibiotics without a valid prescription, ensuring the rational use of medicines across the country.

(Para 2.2.40)

38.       The Committee is of the view that the escalating threat of Antimicrobial Resistance (AMR) cannot be contained solely through clinical prescription guidelines, as the rampant misuse of antibiotics in veterinary and agricultural sectors heavily contaminates the human food chain. The Committee, therefore, recommends the rigorous, coordinated enforcement of Food Safety and Standards Authority of India (FSSAI) notifications that prohibit the use of 19 specified antibiotics across all stages of meat, poultry, and seafood processing. Furthermore, the Committee recommends strict national audits to ensure total compliance with Rule 97 of the Drugs and Cosmetics Rules, 1945, which mandates explicit labeling of withdrawal periods for drugs administered to food-producing animals. In addition to regulating pharmaceutical contents, the Committee believes that the physical integrity of medicines is equally vital. The Committee, therefore, recommends that the Central Drugs Standard Control Organisation (CDSCO) strictly enforce statutory standards for primary packaging, specifically promoting and regulating the use of glass bottle containers to ensure the chemical stability and safety of dispensed drugs.

(Para 2.2.41)

39.       The Committee is of the view that the reported 33% gap in AB-PMJAY fund utilization highlights systemic bottlenecks that restrict the scheme's potential to deliver Universal Health Coverage. Furthermore, the Committee believes that constrained public health expenditure inevitably diverts approximately two-thirds of individuals to seek treatment in the private sector. The Committee, therefore, recommends the Government to grant greater budget flexibility to State Health Agencies, enabling them to adapt benefit packages to localized epidemiological needs and accelerate fund deployment. Concurrently, the Committee recommends the strategic induction of at least 4 lakh private hospital beds into the AB-PMJAY network. This must be achieved by streamlining paperless empanelment, reducing the administrative compliance burden for smaller hospitals, and ensuring predictable, monthly payment cycles, all while strictly upholding the minimum infrastructure and staffing benchmarks mandated by the Clinical Establishments Act, 2010.

(Para 2.2.42)

40.       The Committee observes that while the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) has significantly enhanced financial protection and access to healthcare services, several operational and implementation challenges continue to affect its efficient functioning. The Committee recommends that the Ministry of Health and Family Welfare and the National Health Authority (NHA) undertake a comprehensive review of the Scheme's package architecture and IT platform to address all the issues. The Committee specifically recommends provision for simultaneous application of multiple packages in emergency and multi-speciality cases, introduction of appropriate package codes for critically ill ICU patients requiring surgical intervention, bilateral procedures and patients with concurrent medical and surgical conditions. The Committee also recommends that annual utilization limits for high-cost investigations such as MRI and CT scans be displayed transparently on the portal and that the pending implementation of the 2022 package revisions across all States and Union Territories be expedited to ensure uniformity in reimbursement and service delivery.

(Para 2.2.43)

41.       The Committee highlights the need for strengthening the AB-PMJAY portal by enhancing file attachment capacity for complex cases, establishing a robust query management system with real-time tracking and detailed reasons for claim rejections, and designating nodal officers for addressing inter-State and out-of-State beneficiary-related issues. Considering the increasing burden of outstanding payments and delays in claim settlements, the Committee urges the Government to institute a time-bound mechanism for claim processing and reimbursement to safeguard the financial sustainability of empanelled hospitals. The Committee believes that greater transparency through real-time display of package eligibility, utilization limits, claim status and query resolution would significantly improve administrative efficiency, reduce disputes and further strengthen the effective implementation and inclusiveness of the Scheme.

(Para 2.2.44)

42.       The Committee believes that while the Employees' State Insurance Corporation (ESIC) remains a cornerstone of India's social security framework, the rapid proliferation of the gig economy and informal labor necessitates an immediate, comprehensive modernization. The Committee is of the view that systemic inefficiencies, specifically unviable private hospital package rates, delayed financial settlements, and cumbersome referral processes, severely restrict beneficiary access to critical tertiary healthcare. To rectify these structural deficits and transition toward a technology-driven, patient-centric ecosystem, the Committee, therefore, recommends the immediate execution of strategic administrative and digital reforms to restore stakeholder trust and reduce out-of-pocket expenditures.

(Para 2.2.45)

43.       The Committee, further, recommends the phased inclusion of unorganized and platform workers via national databases like e-Shram, supported by flexible contribution structures. Furthermore, the Committee is of the view that the Corporation must implement an end-to-end digital architecture for automated, time-bound claim processing, establish interoperable electronic health records with AI-driven fraud detection, and mandate market-aligned treatment package rates to incentivize premier private healthcare providers. Through enhanced administrative autonomy, robust multilingual grievance redressal, and total transparency in performance metrics, these interventions will decisively align the Corporation with India's universal health coverage objectives.

(Para 2.2.46)

GEOGRAPHICAL DISTRIBUTION OF FACILITIES AND REGIONAL DISPARITIES

44.       The Committee is of the view that the Government should first and foremost define the criteria of functional arm of Ayushman Bharat i.e Arogya Mandir.  The Government needs to come out with technical specification in terms of infrastructure, HR, availability of supplies and the level of services etc. to ensure uniform understanding and implementation across State services.  Need is to ensure implementation of all 12 service packages and strengthen under served services viz. Mental Health, Senior, palliative, dental and ophthtalmic care in all Arogya Mandirs.  The Government should fill up critical vacancies, introduce incentives and career path, especially for CHOs and strengthen competency base training.  There is further need to enhance community engagement by expanding localized IEC comapigns and strengthn participation of Panchaats, Jan Arogya Samiti (JAS), Mahila Arogya Samiti (MAS) and frontline workers to improve service uptake.  The Committee further recommends the Government to ensure availability of reliable ABDM compliant IT infrasturctuve and use of Ayushman Bharat Health Account (ABHA) and Electonic Health Record (HER) for continuum of care and referrals. Moreover, there is need to Digitize Community-base Assessment Checklist (CBAC), integrate with ABHA and NCD portals, and build frontling worker capacity for effective screening and follow-up and integrate Ayush services.

(Para 2.3.9)

DIGITAL HEALTHCARE INITIATIVE

45. The Committee observes that, notwithstanding the considerable expansion of healthcare infrastructure and digital health services, regional disparities in healthcare accessibility continue to persist across the country. The concentration of specialist services and advanced healthcare facilities in urban areas, coupled with shortages of healthcare personnel and infrastructure in rural and remote regions, continues to constrain equitable access to healthcare. The Committee strongly recommends for posting of post graduate specialists like surgeons, Gynaecologist, Paediatricians, Orthopedicion at CHC levels. The Committee is of the considered view that sustained investment in public healthcare infrastructure, geographically balanced distribution of health facilities and human resources, strengthening of referral and emergency transport systems, expansion of digital health services, incentivizing private sector participation in underserved regions, and targeted interventions for underserved regions are essential for ensuring equitable access to quality healthcare across the country.

(Para 2.3.15)

46.       The Committee is of the view that while the Pradhan Mantri Ayushman Bharat Health Infrastructure Mission (PM-ABHIM), with its outlay of ₹64,180 Crores, has initiated crucial structural corrections, the profound urban-rural asymmetry in healthcare infrastructure requires expedited intervention. The operationalization of 1.80 lakh Ayushman Arogya Mandirs, alongside the targeted establishment of 3,382 Block Public Health Units (BPHUs), 730 District Integrated Public Health Labs (IPHLs), and 602 Critical Care Hospital Blocks (CCBs), provides a robust foundation. Furthermore, the Committee notes the significant expansion under the Pradhan Mantri Swasthya Suraksha Yojana (PMSSY), including the establishment of 22 new AIIMS and the upgrading of 75 Government Medical Colleges.The Committee believes that the corresponding surge in medical colleges and the exponential increase in undergraduate and postgraduate seats must be strategically harnessed to correct regional human resource deficits by improving health care access by posting trained past graduate doctors at CHC level. The Committee, therefore, recommends that the Government implement a geographically responsive deployment policy, linking the increased output of medical professionals directly to mandatory service periods in deficit States, tribal regions, and aspirational districts. Furthermore, infrastructural gaps in the targeted 17,788 building-less Sub-Centres must be prioritized for immediate construction to ensure physical accessibility. The Committee recommends for enchanced facilities for these medical professionals in these areas.

(Para 2.3.16)

47.       The Committee is of the view that the Ayushman Bharat Digital Mission (ABDM) has fundamentally transformed the accessibility landscape, evidenced by the creation of over 82.84 crore ABHA IDs, the registration of 4.33 lakh health facilities on the Health Facility Registry (HFR), and the linking of 77 crore health records. The monumental success of eSanjeevani, which has delivered over 425 million consultations through a Hub-and-Spoke model across 1.36 lakh Ayushman Arogya Mandirs, proves that digital interventions can effectively bridge geographical divides. The rollout of the U-WIN portal for immunization and the transition of AarogyaSetu into a comprehensive National Health App further solidify this ecosystem.The Committee believes that maintaining the momentum of digital adoption requires continuous incentivization and advanced technological integration. The Committee, therefore, recommends that the Digital Health Incentive Scheme (DHIS) be significantly expanded to function as a robust "cashback" and financial reward mechanism for doctors and hospitals, thereby lowering adoption costs and encouraging the generation of Electronic Health Records (EHR). Additionally, the Committee recommends accelerating the deployment of Artificial Intelligence, leveraging the Clinical Decision Support System (CDSS) and partnerships with institutions like IIT Kanpur and the Wadhwani Institute, to enable early screening, smart diagnostics, and ambient listening tools for seamless prescription generation in both urban and remote settings.

(Para 2.3.17)

48.       The Committee is of the view that the concentration of advanced healthcare facilities in urban areas paradoxically leaves urban slum and vulnerable populations exposed to prohibitive out-of-pocket expenditures and corporate healthcare monopolies. The interventions under the National Urban Health Mission (NUHM) are critical to addressing such disparity. The operationalization of 7,998 Urban Sub-Health Centres (USHCs), 5,401 Urban Primary Health Centres (U-PHCs), 1,373 Polyclinics, and 240 Urban Community Health Centres (U-CHCs) demonstrates a vital commitment to community-embedded urban healthcare.The Committee believes that to truly ensure affordability for migratory and slum populations, the public urban health infrastructure must be aggressively scaled to outpace the reliance on private providers for primary and secondary care. The Committee, therefore, recommends the rapid scaling of 100-bedded U-CHCs in all metropolitan cities, coupled with specialized funding under the National Health Mission (NHM) to manage overcrowding in urban public hospitals. Simultaneous policy frameworks must be introduced to provide low-interest loans and tax incentives to private sector entities willing to establish tertiary care and diagnostic facilities exclusively in Tier-2 and Tier-3 cities, thereby redirecting private investment away from saturated metropolitan hubs to deficit regions.

(Para 2.3.18)

49.       The Committee expresses concern to find that regional disparities are acutely exposed during health emergencies, infectious disease outbreaks, and disasters. The establishment of Metropolitan Public Health Surveillance Units (MSUs) and the expansion of the Integrated Health Information Platform (IHIP) across all 36 States and UTs, achieving over 70% reporting, are commendable milestones in real-time disease surveillance. The deployment of BHISHM (Bharat Health Initiative for Sahyog, Hita, and Maitri) cubes and the establishment of 15 Health Emergency Operation Centres (HEOCs) significantly bolster rapid response capabilities.The Committee believes that proactive biosecurity and epidemic preparedness must be a localized reality rather than a centralized luxury. The Committee, therefore, recommends the expedited completion and operationalization of the five Regional Centres for Disease Control and the National Centre for Disease Control (NCDC) upgrades, particularly the specialized divisions for Antimicrobial Resistance (AMR), One Health, and Climate Change. The Government must ensure that the surveillance networks established at Points of Entry (PoE) and regional laboratories are fully integrated with the ABDM infrastructure to provide immediate, predictive data modeling for localized health interventions.

(Para 2.3.19)

50.       The Committee is of the view that the burden of healthcare costs disproportionately impacts vulnerable demographic segments. The data explicitly highlights that poorer households, older adults, and individuals with lower education levels incur significantly higher Out-of-Pocket Expenditure (OOPE). Furthermore, women face pronounced barriers to access and suffer from lower insurance claim settlement rates, which fundamentally contradicts the vision of Universal Health Coverage. This inequity is compounded by stark regional variations in treatment costs—where hospitalization expenses in southern states like Tamil Nadu and Telangana (~₹50,000–₹55,000) are more than double those in Odisha (~₹22,000).The Committee believes that the digital health infrastructure must evolve beyond data interoperability to become a proactive instrument for financial protection and ethical healthcare delivery. The Committee, therefore, recommends the immediate implementation of an AI-enabled National Digital Health Ecosystem, supported by a dedicated AI-enabled National Health Fund. Such framework must institutionalize AI-driven financial surveillance tools to monitor billing anomalies, audit exorbitant out-of-pocket costs, standardize tertiary care pricing across the private sector, and ensure swift, equitable claim settlements for marginalized groups.

(Para 2.3.20)

51.       The Committee, further, recommends the Government to expand the assisted and offline modes of ABHA ID creation in low-connectivity regions, capitalizing on the momentum that women currently constitute 49.15% of ABHA holders. This must be coupled with targeted capacity-building programs, localized community outreach, and the expansion of multilingual support via the 14477 toll-free helpline to foster digital literacy. To further build trust and ensure patient-centric care, the Committee believes that adopting specific technological safeguards, such as leveraging AI and subscription models in ultrasound diagnostics to eradicate sex-determination fears, must be prioritized. These targeted interventions will ensure that technological advancements in healthcare directly safeguard the financial and social security of the most vulnerable citizens.

(Para 2.3.21)

 

 

AVAILABILITY OF HUMAN RESOURCES: PERSISTENT CHALLENGES

52.       The Committee, having examined stakeholder submissions and the Ministry's progress on capacity building through the SASHAKT portal, strongly recommends that the Ministry of Health and Family Welfare formulate a comprehensive strategy to strengthen health human resources in rural and tribal regions by expediting recruitment processes, establishing uniform pay scales for specialist doctors, and ensuring the prompt, uninterrupted payment of remuneration to ASHA and NHM personnel. To immediately alleviate critical shortages in under-resourced areas, the Committee is of the view that the Ministry must institutionalize flexible hiring mechanisms, such as part-time engagements for super-specialists and consultant appointments at taluka and sub-district hospitals, while simultaneously expanding the role of allied health and paramedical professionals. Furthermore, the Committee recommends further scaling the SASHAKT digital ecosystem to continuously track, upgrade, and standardize training modules for all frontline and medical cadres across expanded healthcare service packages.

(Para 2.4.9)

53.       The Committee is of the view that despite commendable efforts to expand medical education capacity, evidenced by the 151% increase in MBBS seats, the 163% increase in PG seats, the establishment of 818 medical colleges, and the induction of over 5.23 lakh personnel under the National Health Mission, the severe shortfall of specialists at Community Health Centres fundamentally compromise equitable healthcare access. The physical infrastructure of Primary Health Centres and premier institutes alike is rendered ineffective without a stable, adequately distributed workforce. While the induction of nearly 25,000 AYUSH doctors and the formalization of 57 allied professions under the National Commission for Allied and Healthcare Professions (NCAHP) Act, 2021 are positive steps, they must be matched with aggressive retention strategies and safe working environments. The Committee, therefore, recommends that the Government immediately mandate all States to establish dedicated Health Recruitment Boards to drastically fast-track the filling up of vacant posts in strict accordance with IPHS 2022 norms. To counter rural attrition and correct inter-State disparities, it is imperative to regularize contract doctors, expand the "You Quote, We Pay" scheme, implement uniform pay scales for specialists. Furthermore, the mandatory District Residency Programme (DRP) must be rigorously monitored to guarantee a sustained specialist presence at the secondary level, particularly within aspirational and tribal districts.

(Para 2.4.10)

54.       The Committee further believes that the quality of healthcare delivery is intrinsically linked to the physical safety, mental well-being, and continuous capacity building of medical professionals and frontline health workers. Persistent issues such as unregulated duty hours, inadequate service conditions, and acute mental health challenges among resident doctors demand urgent statutory intervention. Therefore, the Committee recommends the strict, time-bound execution of the short-, mid-, and long-term action plans formulated by the National Task Force, pursuant to the Hon'ble Supreme Court's directives. The Government must strictly enforce fixed duty hours and structured well-being programs for all resident doctors and nursing staff. The Committee recommends for suitable augmentation of the salary and allowances of resident doctors. Finally, the Committee appreciates the March 2025 increase in ASHA fixed incentives to ₹3,500 and recognition awards up to ₹50,000, but recommends that systemic delays in remuneration to ASHA and NHM workers be eliminated through seamless and timely disbursement mechanisms. Public hospitals must also be mandated to appoint dedicated biomedical engineers and physiotherapists to bolster comprehensive care.

(Para 2.4.11)

INFRASTRUCTURE DEVELOPMENT AND ESSENTIAL SERVICES

55.       The Committee is of the view that addressing the critical deficit of 0.79 public sector beds per 1,000 population and persistent regional disparities requires a targeted, systematic overhaul of public health infrastructure. To effectively utilize the budgetary allocation and bridge the gap toward the World Health Organization norm, the Committee, therefore, recommends establishing a dedicated Healthcare Capital Expenditure (CAPEX) Fund to restore rural public facilities, specifically prioritizing Primary Health Centres and Health and Wellness Centres based on local demographic needs and disease burdens. Furthermore, the Committee believes it is imperative to accelerate the deployment of 15^th and 16^th Finance Commissions health grants for rehabilitating dilapidated sub-district infrastructure, ensure the immediate rollout of the proposed 200 Day Care Cancer Centres across district hospitals, and mandate that public medical institutions establish dedicated vascular and endovascular surgery departments to combat complex, emerging disease burdens. The Committee further recommends that the Government should implement in letter and spirit the budget announcements (2026-27) pertaining to the Health Sector, including Health and Family Welfare, Health Research and Ayush intended to ensure the accessibility and affordability of health care facilities.

(Para 2.4.18)

56.       The Committee believes that to supplement public expenditure and alleviate the severe overburdening of tertiary public hospitals, public capital must be synergized with private capabilities without heavy upfront capital demands. The Committee, therefore, recommends formulating a comprehensive incentive framework, comprising targeted tax holidays, soft loans, subsidized land, and concessional electricity tariffs, explicitly designed to attract private investment for multi-specialty facilities in Tier-2, Tier-3, and rural zones. Concurrently, the Committee is of the view that the Ministry must adopt Operational Expenditure (OPEX)-based Public-Private Partnership (PPP) models, facilitate the regulated deployment of high-quality pre-owned equipment in smaller cities, and establish urban PPP clinics tailored to middle-income populations. Furthermore, the Committee considers it essential that Corporate Social Responsibility (CSR) guidelines be immediately amended to mandate the prioritization of corporate contributions toward healthcare infrastructure in underserved rural and Tier-2/3 towns.

(Para 2.4.19)

57.       The Committee is of the view that access to advanced medical technology remains heavily concentrated in urban corporate centers, and immediate structural interventions must be taken to decentralize these essential services. The Committee, therefore, recommends deploying mobile diagnostic units equipped with portable X-ray, ultrasound with liver scan facility to assess fatty liverand other diseases like pancreatitis etc., ECG machinery portable ventilators for life saving directly to rural and remote populations, while simultaneously leveraging Public-Private Partnerships to scale high-quality diagnostic services across all public healthcare facilities. To ensure seamless operational execution and timely medical interventions, the Committee believes the Ministry should mandate the expansion of the hub-and-spoke telehealth model across all districts. Additionally, the Committee recommends forging a strategic partnership with the Department of Posts to utilize its extensive rural logistics network for the rapid and secure transportation of diagnostic samples and essential medicines.

(Para 2.4.20)

58.       Beyond immediate infrastructure and diagnostic coverage, the Committee believes that long-term healthcare resilience requires systemic policy innovation and rigorous accountability. The Committee, therefore, recommends increasing strategic investments in research and development to promote the indigenous manufacturing of medical devices and specialized hardware, thereby neutralizing import dependencies and significantly lowering overall patient treatment costs. Finally, to ensure transparent resource distribution and actively eliminate geographic inequities across the country, the Committee is of the view that the Government must develop a standardized Health Facility Access Index to systematically measure spatial, temporal, and financial accessibility, ensuring that all future policy interventions are strictly equitable and data-driven.

(Para 2.4.21)

ACCESSIBILITY FOR VULNERABLE AND DISADVANTAGED GROUPS

59.       The Committee is of the view that socially and geographically marginalized segments, specifically Scheduled Castes (SC), Scheduled Tribes (ST), Particularly Vulnerable Tribal Groups (PVTGs), and migrant laborers, encounter persistent structural barriers that severely compromise their right to timely healthcare. The Government's decision to relax population norms for setting up public health facilities in tribal and hilly areas (establishing a Sub-Health Centre for every 3,000 population, a PHC for every 20,000, and a CHC for every 80,000) and the deployment of 30,593 Ayushman Arogya Mandirs (AAMs) across 178 tribal-majority districts are highly progressive policy recalibrations. The Committee believes that the immense capital outlays under the ₹79,156 crore DhartiAabaJanjatiya Gram Utkarsh Abhiyan and the ₹24,104 crore PM JANMAN Mission serving PVTGs have the potential to fundamentally transform tribal health equity, but must be translated into immediate, resilient last-mile delivery mechanisms to counter high out-of-pocket expenditure and localized health crises. The Committee, therefore, recommends that the Ministry of Health and Family Welfare must expedite the deployment and rigorous tracking of the envisioned 1,694 Mobile Medical Units (MMUs) under these schemes to systematically cover villages situated beyond 5 km in hilly terrains and 10 km in plain regions.

(Para 2.4.26)

60.       The Committee recommends that the Government must establish dedicated public Centres of Excellence within high-burden tribal belts to anchor the screening, counselling, and therapeutic targets of the 7 crore population mandated under the Sickle Cell Anaemia Elimination Mission. Furthermore, to safeguard the health of floating labor populations, the Ministry must also cross-link the U-Win platform's portable digital vaccination record system with inter-State labor registries to guarantee that children of migrant families receive uninterrupted, contiguous immunization coverage regardless of relocation. Also, PM-JAY’s expansion to 12 crore families, ASHA workers, and all senior citizens aged 70 and above must be backed by aggressive grassroots awareness campaigns.

(Para 2.4.27)

61.       The Committee recommends extending the coverage under the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) to all children below five years of age and all senior citizens aged 60 years and above, irrespective of their socio-economic status or geographical location. The Committee considers this universalization a pivotal step toward advancing Universal Health Coverage (UHC) and mitigating the disproportionate financial burden associated with childhood and geriatric illnesses. To operationalize this effectively, the Committee further recommends that the Ministry ensure adequate financial provisioning, establish seamless enrolment mechanisms, and build robust synergy with existing child and elderly health programs to guarantee equitable, timely, and affordable healthcare services to every eligible beneficiary.

(Para 2.4.28)

QUALITY ASSURANCE AND REGULATORY OVERSIGHT

62.       The Committee is of the view that while the scaling of 1.8 lakh Ayushman Arogya Mandirs (AAMs) and the delivery of over 425 million consultations via the eSanjeevani platform through 18,000 hubs have significantly transformed primary healthcare and contributed to reducing Out-of-Pocket Expenditure (OOPE) from 64.2% to 43.4%, a persistent and troubling gap remains between policy formulation and ground-level execution. Reports of recurrent shortages of mandated essential medicines (172 drugs) and diagnostic capabilities (63 tests) at sub-centres and rural primary health facilities continue to force vulnerable populations to seek expensive private care, thereby diluting the impact of the National Health Mission’s free initiatives. The Committee believes that structural institutionalization and supply-chain resilience are paramount. The Committee, therefore, recommends that the Government immediately strengthen the hub-and-spoke tele-health network by integrating the extensive logistics network of the Department of Post to ensure the uninterrupted, real-time supply of medicines and diagnostic reagents to remote spokes. The Ministry must expand the fleet of Mobile Medical Units (MMUs) beyond the current ceiling of five units per district in high-demand areas, equipping them with portable X-ray, ultrasound, and ECG machines for comprehensive rural coverage. Furthermore, the Committee recommends the development and implementation of a standardized Health Facility Access Index to continuously audit and map physical, operational, and structural barriers at public facilities, thereby ensuring absolute accountability, compliance with National Quality Assurance Standards (NQAS), and zero stock-outs of mandated essential medicines and diagnostic reagents at the grassroots level.

(Para 2.4.36)

63.       The Committee is of the considered view that socio-economic vulnerabilities uniquely distort health outcomes for low-income households, women, the elderly, and persons with disabilities. Although women constitute 49 per cent of Pradhan Mantri Jan Arogya Yojana (PM-JAY) card users, and targeted schemes like the Janani Shishu Suraksha Karyakram (JSSK) and LaQshya have significantly compressed maternal healthcare delivery liabilities, delayed health-seeking behaviors and rising out-of-pocket spending on chronic non-communicable diseases (NCDs) remain critical concerns. The Committee believes that the expansion of universal PM-JAY coverage to all citizens aged 70 years and above, marked by the issuance of over 86 lakh cards providing a ₹5 lakh cover, demands structured physical and clinical institutionalization to avoid becoming a mere financial mechanism. The Committee, therefore, recommends that the Government scale up decentralized palliative and geriatric care infrastructure across all operational AAMs to manage the long-term chronic needs of the aging demographic. The Ministry must mandate the time-bound establishment of a Physical Medicine and Rehabilitation (PMR) Centre in every district of the country to ensure specialized, dignified care for persons with disabilities. To bridge the gap between policy intent and ground-level execution, the Committee further recommends that compliance with the NQAS and Indian Public Health Standards (IPHS) regarding physical access features, such as ramps and disabled-friendly toilets, be subjected to mandatory annual independent audits. Finally, the Government must launch a hyper-localized, multi-lingual Information-Education-Communication (IEC) campaign to raise community awareness regarding decentralized entitlements, including the National Dialysis Programme and free community-level NCD screenings.

(Para 2.4.37)

64.       The Committee is of the view that the lack of transparency in the pricing of healthcare services, escalating rates of Caesarean-section deliveries, and excessive diagnostic testing within private hospitals continue to drive high out-of-pocket expenditure and severely exploit economically vulnerable patients. While the Ministry's implementation of the National Medical Commission (NMC) guidelines to regulate fees for 50% of seats in private medical institutions and deemed universities is a commendable step toward affordable medical education, the actual costs of clinical treatments and procedures in the private sector remain inadequately monitored. The Committee believes that absolute transparency and stringent accountability must be enforced to protect patients from commercialized exploitation. The Committee, therefore, recommends that the Government formulate and execute a comprehensive, legally binding regulatory framework to standardize rates for common medical procedures and diagnostic tests across all private healthcare providers. The Ministry must introduce mandatory compliance audits for private clinical establishments to monitor deviations from standard medical practices, such as unwarranted surgical interventions, and strictly audit private hospitals offering DNB and residency training to prevent exorbitant fee extraction. Concurrently, the government must enforce the mandatory availability and prescription of generic medicines in private hospitals.

(Para 2.4.38)

65.       The Committee believes that the current institutional framework in the public sector unnecessarily burdens highly trained medical specialists with routine administrative and logistical operations, resulting in long patient wait-times and diminished quality of clinical care. The Committee believes that bridging the gap between macroeconomic outlays and ground-level healthcare delivery requires a structural separation of clinical and administrative workflows. The Committee, therefore, recommends that the Government advise and assist States in establishing a dedicated, specialized cadre of Hospital Administrators across all public secondary and tertiary institutions, effectively liberating doctors to focus exclusively on patient care.

(Para 2.4.39)

66.       The Committee is of the view that to systematically dismantle regional imbalances in super-specialty treatment, the Ministry must implement a multi-tiered strategy that includes clustering groups of 5-6 medical colleges to share specialist resources and upgrading existing state medical institutions to function at par with AIIMS Delhi. Finally, the National Medical Register (NMR) portal, launched in August 2024, must be cross-leveraged alongside the enrolment portals of the NCAHP to maintain real-time, transparent oversight of the country's medical and allied health workforce credentials and transfers, ensuring that statutory standards are uniformly maintained across both the public and private sectors. The government must ensure the time-bound, rigorous execution of the Union Budget 2025-26 mandate to operationalize 200 additional Day Care Cancer Centres this year, maintaining strict oversight to guarantee that every single district hospital nationwide is equipped with fully functional oncology day-care facilities within the designated three-year horizon.

(Para 2.4.40)

67.       The Committee is of the view that the recent Cabinet approval adding over 10,000 new medical and PG seats (scaling to 75,000 over five years) is a right step toward correcting the doctor-population ratio. Innovations like the mandatory Family Adoption Programme, the District Residency Programme (DRP), and Competency-Based Medical Education reflect a forward-looking academic vision. The Committee believes that while primary care is expanding, super-specialty care remains geographically concentrated, necessitating further decentralization. The Committee, therefore, recommends that alongside the 22 approved AIIMS, the Government must identify geographic clusters to develop existing state medical colleges at par with premier institutes. Furthermore, academic curriculum must be urgently modernized. Undergraduate and postgraduate curricula should be immediately updated to include strengthened, mandatory modules on respiratory medicine, and dedicated departments for endovascular/vascular surgery must be established. Finally, the Committee recommends increased R&D funding aimed at indigenizing specialized medical devices and vascular hardware to reduce import dependencies.  The Committee is, however, concerned to note that the rapid expansion of PG medical seats without adequate clinical exposure and proper training is severely diluting the quality of health care standards.  The Committee recommends that the expansion of under graduate and post graduate seats should be done only after ensuring quality education, adequate training and clinical exposure.

(Para 2.4.41)

68.       The Committee is of the considered view that strengthening public healthcare infrastructure, improving financial protection mechanisms, ensuring availability of affordable medicines and diagnostics, enhancing regulatory oversight of private healthcare services, expanding human resource capacity, and ensuring targeted interventions for vulnerable groups are essential for achieving affordable, accessible and equitable healthcare for all citizens.

(Para 2.4.42)

DEVELOPMENT OF INNOVATIVE AND COST-EFFECTIVE TREATMENT PROCEDURES AND TECHNOLOGIES

69.       The Committee appreciates the highly promising outcomes of the MedTech Mitra platform, which has already mentored over 400 innovators, and the establishment of Centres of Excellence (CoEs) across seven IITs, yielding 43 indigenous medical technologies and 16 start-ups. The Committee believes that achieving self-reliance in medical technology is the most sustainable pathway to significantly lower the cost of critical treatments, such as the drastically reduced prices already achieved for paediatric formulations like isotretinoin and PREVALL. The Committee, therefore, recommends a substantial expansion of the CoE scheme to other premier engineering and medical institutes across the country to follow the suit with intention to lower the cost of treatment. The Committee also recommends that the Government should establish a dedicated procurement quota within national health programs for indigenously developed, validated technologies to guarantee market access for start-ups and MSMEs navigating the "valleys of death” with a hope to cross over.

(Para 3.2.5)

70.       The submission of DHR highlights the pivotal role of the Health Technology Assessment in India (HTAIn) in providing rigorous, evidence-based recommendations on the cost-effectiveness and safety of health interventions. Given the imperative to optimize government spending and reduce the out-of-pocket burden on citizens, the Committee is of the view that systematic evaluations must become the bedrock of all public healthcare expenditure. The Committee, therefore, recommends that HTAIn clearance be made a mandatory prerequisite for the inclusion of any new diagnostic tool, medical device, vaccine, or therapeutic procedure into the procurement lists of the National Health Mission and the Pradhan Mantri Jan Arogya Yojana (PMJAY). The Committee, further, recommends the establishment of state-level HTA nodes to ensure that cost-effectiveness thresholds are tailored to regional health priorities and economic realities to expand the length and breadth of health schemes of the programmes to the last miles.

(Para 3.2.6)

71.       The proposed Medical Innovations Development Acceleration Council (MIDAC) represents a critical intervention for de-risking biomedical research in areas that lack lucrative commercial incentives but possess immense public health importance. Furthermore, the Model Rural Health Research Units (MRHRUs) and Tribal Health Research Network are essential for ensuring that innovations reach the most vulnerable populations especially rural, hilly and tribal region. The Committee believes that an equitable healthcare system cannot rely solely on market-driven research but must touch the poor population through welfare measures. The Committee, therefore, recommends the immediate operationalization and robust capitalization of MIDAC to foster public-private partnerships specifically targeting neglected tropical diseases and regional outbreaks. The Committee believes linking MRHRUs directly with the MedTech Mitra ecosystem, ensuring that new point-of-care diagnostics (such as the AI-enabled handheld X-ray devices and CRISPR-CAS kits) are field-tested and deployed directly in underserved rural and tribal corridors.

(Para 3.2.7)

72.       The introduction of the Patent Mitra initiative in March 2025 is a commendable step, having already facilitated 24 patent applications and the successful transfer of one technology to the industry. However, to translate laboratory success into widespread accessibility, the bridge between patenting and commercial-scale manufacturing must be strengthened and expanded. The Committee is of the view that a robust intellectual property framework is only effective if it culminates in the rapid commercialization and deployment of affordable health solutions for all & irrespective of gender. The Committee, therefore, recommends creating a fast-track technology transfer mechanism within Patent Mitra that actively matches patent-holders with public sector undertakings (PSUs) and established private manufacturers. The Committee also recommends providing targeted financial subsidies or tax incentives to private sector entities that successfully license and mass-produce technologies protected under the Patent Mitra and CoE frameworks and intended to ensure accessibility and affordability of healthcare facilities.

(Para 3.2.8)

EFFECTIVE PREVENTIVE HEALTHCARE STRATEGIES FOR REDUCING HEALTHCARE COSTS

73.       The Committee takes note of preventive healthcare strategies of DHR for reducing healthcare cost. The DHR clearly demonstrated that preventive interventions, such as rapid diagnostic tests for Sickle Cell Disease, universal neonatal hearing screening (Sohum), and tele-screening for diabetic retinopathy, have saved the exchequer thousands of crores while preventing irreversible disease progression. The Committee is of the view that shifting the healthcare paradigm from curative treatments to proactive, early detection is the most effective strategy to manage India’s disease burden. The Committee, therefore, recommends the immediate integration and nationwide rollout of ICMR-validated syndromic diagnostic algorithms and point-of-care screening tools across all Ayushman Arogya Mandirs and Primary Health Centres (PHCs). The Committee is of the view that dedicated budgetary allocations be made for state governments to deploy decentralized screening models, similar to the successful Hepatitis B & C screening in Tamil Nadu and ECG deployments in Gujarat, to intercept chronic diseases at their onset.

(Para 3.3.9)

74.       The rational interpretation of DHR data reveals that targeted cost-effectiveness analyses, such as the Costing of Health Services in India (CHSI) and the optimization of Breast Cancer therapy (Trastuzumab) from a 1-year to a 6-month regimen, have vastly improved reimbursement efficiency and saved hundreds of crores annually. The Committee believes that standardizing treatment regimens based on synthesized, indigenous evidence (through platforms like SARANSH) is essential to prevent over-medicalization and ensure the financial sustainability of public health insurance. The Committee, therefore, recommends that the National Health Authority (NHA) strictly utilize DHR’s CHSI data and evidence-based clinical guidelines to continuously recalibrate and revise the costings of all health benefit packages under AB-PMJAY. The Committee, further, recommends making adherence to these cost-effective, standardized clinical protocols mandatory for all private hospitals empanelled under government insurance schemes to curb inflated out-of-pocket expenditures for patients.

(Para 3.3.10)

DEVELOPMENT OF AN INCLUSIVE AND EQUITABLE HEALTHCARE SYSTEM THROUGH HEALTH RESEARCH

75.       The Committee considers that the current network of 118 Multi-Disciplinary Research Units (MRUs) and 36 Model Rural Health Research Units (MRHRUs) is not sufficient for adequate development of an inclusive and equitable healthcare system. While successful pilot projects like the DISHA surveillance system and the TAEI-SMART stroke management app have proven effective, the Committee is of the view that a footprint of just 36 MRHRUs is geographically inadequate to represent the diverse epidemiological profile of rural India. The Committee believes that rural populations must be actively included in clinical trials to ensure that medical research is genuinely equitable. The Committee, therefore, recommends a time-bound expansion plan to establish at least one MRU in every government medical college and one MRHRU in every district across the country. The Committee also recommends that these units be explicitly mandated to operate integrated environmental and disease surveillance systems (like DDESS) to track emerging outbreaks at the grassroots level and to conduct large-scale, multi-centric clinical trials directly within rural communities.

(Para 3.4.5)

 

HEALTH LITERACY FOR INFORMED HEALTHCARE DECISIONS

76.       The Committee observes that the DHR has initiated crucial steps to translate scientific research into accessible knowledge through state sensitization workshops and digital tools like the DARPAN dashboard. However, the Committee believes that scientific advancements and clinical evidence fail to achieve their full impact if the research remain confined to academic circles and are not systematically transferred to frontline health workers and the general public. The Committee, therefore, recommends the establishment of dedicated "Evidence Translation Cells" within State Health Departments to systematically convert ICMR research findings and HTAIn evaluations into vernacular, highly accessible guidelines for ASHA and Anganwadi workers. The Committee believes in scaling up regional digital literacy programs to ensure that district-level public health functionaries are fully trained to utilize evidence synthesis tools and data dashboards for real-time, programmatic decision-making.

(Para 3.5.2)

USE OF AI, DRONES AND IT IN DISEASE SURVEILLANCE AND HEALTHCARE DELIVERY

 

77.       The Committee takes into account the successful pilots under the i-DRONE initiative, ranging from vaccine distribution in hilly terrains of Nagaland and Himachal Pradesh to ultra-critical intraoperative biopsy transport in Karnataka, blood delivery in Delhi-NCR, and corneal transport in Haryana, demonstrate that drone technology can overcome severe geographical and logistical barriers. The Committee, however, views that transitioning from isolated pilot projects to a operationalized, nation-wide medical drone delivery system is paramount for achieving universal health accessibility. The Committee believes that reducing turnaround times for pathological testing and ischemic windows for organ transplants directly translates into lives saved. The Committee, therefore, recommends that the Department of Health Research collaborate with the Ministry of Civil Aviation to establish designated "Green Medical Air Corridors" connecting peripheral health centers to district and tertiary care hospitals across all hilly, island, and hard-to-reach regions. The Committee is of the view that the formal integration of drone-based logistics into the Universal Immunization Program (UIP), the National TB Elimination Program (NTEP), and the National Organ and Tissue Transplant Organization (NOTTO) to ensure the uninterrupted, rapid transport of vaccines, diagnostic samples, blood products, and tissue grafts.

(Para 3.8.5)

78.       The Committee is assured that the creation of the ICMR-IISc Centre for Medical Image Datasets (MIDAS) and the release of ethical guidelines for AI in healthcare mark significant steps forward. The Committee believes that AI-powered point-of-care tools can democratize specialized diagnostic expertise in resource-constrained rural public health facilities. The Committee, however, observes that a lack of standardized, indigenous reference data often stifles private and academic medtech innovation in India. The Committee, therefore, recommends expanding the MIDAS initiative beyond oral cancer and dural lesions to include thematic reference datasets for high-burden conditions such as diabetic retinopathy, maternal-fetal anomalies, and chest radiographs. The Committee, further, recommends that AI-enabled be progressively procured and deployed at all Ayushman Arogya Mandirs to empower mid-level health providers with immediate, high-accuracy diagnostic capabilities.

(Para 3.8.6)

79.       The Committee notes that ICMR has initiated AI-based predictive analytics for disease burden estimation and early warning systems for outbreaks such as Dengue, Malaria, and COVID-19 through the newly established ICMR-National Institute of Research in Digital Health and Data Sciences. The Committee is of the view that proactive, data-driven epidemic forecasting is far more cost-effective than reactive outbreak management, which severely strains healthcare infrastructure and public finances. The Committee, therefore, recommends establishing real-time linkages between ICMR’s AI early-warning predictive models and state public health management cadres to enable automated alerts for vector-borne and infectious disease surges. The Committee believes that dedicated funding for investigator-initiated AI/ML projects focusing on non-communicable disease (NCD) risk projection, enabling targeted lifestyle and clinical interventions long before acute hospitalization is required.

(Para 3.8.7)

80.       The Committee appreciates the critical breakthroughs in cost reduction, such as providing pediatric formulations like PREVALL for childhood leukemia at one-tenth of international costs, alongside diagnostic solutions for occupational diseases like silicosis. The Committee believes that no family should face catastrophic health expenditure or impoverishment due to specialized childhood cancers or occupational hazards that afflict vulnerable labor populations. The Committee is of the view that public sector production and procurement must be leveraged to drive market prices down across all rare and high-cost conditions. The Committee, therefore, recommends that formulations like PREVALL and pediatric isotretinoin be included in the National Essential Medicines List (NEML) and guaranteed through centralized public procurement schemes to ensure zero-cost availability across all government pediatric oncology centers. The Committee also recommends launching targeted, mandatory screening drives using DHR-validated low-cost diagnostics for occupational diseases like silicosis in high-risk industrial, mining, and construction corridors across India.

(Para 3.8.8)

OPTIMAL USE OF RESOURCES TO STRENGTHEN HEALTH SERVICES FOR UNDERSERVED POPULATIONS

81.       The Committee is pleased to observe that the National Health Research Priorities (NHRP) focus on antimicrobial resistance (AMR), One Health, tuberculosis, vector-borne diseases, cancer and non-communicable diseases, with emphasis on high-burden and underserved regions. In this regard, the Committee recommends that under the Pradhan Mantri Ayushman Bharat Health Infrastructure Mission (PM-ABHIM), DHR-ICMR must continue for strengthening pandemic preparedness by upgrading Virus Research and Diagnostic Laboratories (VRDLs) to improve early pathogen detection, outbreak investigations and disease control.

(Para 3.9.3)

82.       The Committee takes note of significant establishment of five BSL-3 facilities (in Kota, Rishikesh, Raipur, Rajkot, and Bibinagar), the deployment of mobile BSL-3 units, and the setting up of the National Institute of One Health (NIOH) at Nagpur alongside four regional National Institutes of Virology (NIVs). The Committee views that decentralized regional biosecurity infrastructure is essential to detect pathogen clusters early and prevent localized outbreaks from escalating into national crises. The Committee believes that cross-sectoral threats at the human-animal-environmental interface require a unified governance structure. The Committee, therefore, recommends the time-bound operationalization and full staffing of the four regional NIV hubs (Jammu, Jabalpur, Dibrugarh, and Bengaluru) and the National Institute of One Health (NIOH) at Nagpur. The Committee, visualizes that expanding the deployment of Mobile BSL-3 diagnostic units to cover every geographically isolated, eco-sensitive, and international border zone would definitely ensure rapid on-site outbreak investigation and ensure immediate necessary medical interventions for needy patients.

(Para 3.9.5)

RESEARCH & DEVELOPMENT PROJECTS ENHANCING HEALTHCARE AFFORDABILITY AND ACCESSIBILITY

83.       The Committee applaudes that the R&D initiatives of DHR have significantly improved healthcare affordability and accessibility through the development of indigenous diagnostics, medical technologies and affordable treatments. Key innovations include AI-enabled TB screening devices, CRISPR-based diagnostic kits, rapid tests for infectious diseases, automated cervical cancer screening, brain injury assessment tools, and low-cost paediatric cancer therapies. DHR has also strengthened national programmes such as the India Hypertension Control Initiative (IHMI) and Anaemia Mukt Bharat, while Health Technology Assessment in India (HTAIn) has supported evidence-based adoption of cost-effective interventions under Ayushman Bharat and other public health programmes.

(Para 3.10.1)

BARRIERS TO HEALTH INNOVATION AND STRATEGIES TO OVERCOME

 

84.       The Committee commends that DHR has adopted an integrated strategy comprising risk mitigation support through the First-in-the-World Challenge and MedTech Mitra; Health Technology Assessment (HTA) for large-scale adoption of cost-effective interventions; Centres of Excellence at IITs and other academic institutions to accelerate affordable MedTech innovation; implementation of the National Health Research Priorities (NHRP) focusing on tuberculosis, antimicrobial resistance (AMR), cancer and non-communicable diseases; and promotion of the One Health approach to strengthen collaborative research across human, animal and environmental health sectors.

(Para 3.11.3)

85.       The Committee highlights that the I-RISE portal, launched by ICMR in November 2024, has facilitated over 1,700 bookings for high-end research infrastructure, directly lowering compliance and validation hurdles for early-stage innovators. Furthermore, DHR proposes establishing a national network of Biobanks and Validation Centres under MIDAC a section 8 Company. The Committee believes that capital-intensive biomedical instruments in public institutions must be treated as national assets rather than isolated institutional property. The Committee is of the view that lack of access to biological samples and standardized testing facilities remains a major barrier for Indian MSMEs. The Committee, therefore, recommends making it mandatory for all central health institutions, AIIMS, and state medical colleges receiving government grants to list their advanced research equipment on the I-RISE portal for shared access. The Committee, further, recommends the immediate rollout of the proposed national network of accredited Biobanks and Validation Centres under MIDAC to provide start-ups with seamless access to high-quality clinical samples and testing facilities.

(Para 3.11.4)

86.       The Committee emphasizes DHR’s efforts to tackle NCDs through the scale-up of the India Hypertension Control Initiative (IHMI) and nutritional advocacy by ICMR-NIN regarding High in Fat, Sugar, and Salt (HFSS) food labelling. The Committee, however, is of the view that curb-side clinical treatment alone cannot halt the growing burden of metabolic disorders, hypertension, and cardiovascular diseases. The Committee believes that strong, preventive public policy interventions are necessary to foster healthier population-level choices and minimize long-term chronic healthcare costs. The Committee, therefore, recommends that the Government expedite mandatory, standardized front-of-pack HFSS food labelling regulations, incorporating the scientific thresholds established by the ICMR-National Institute of Nutrition (NIN). The Committee also recommends expanding the India Hypertension Control Initiative (IHMI) framework into a universal protocol across every primary healthcare center in the country, ensuring protocol-based management and unbroken supply chains for essential anti-hypertensive drugs.

(Para 3.11.5)

87.       The Committee understands that developing breakthrough biomedical technology involves high capital requirements, complex regulatory compliance, and significant market risk, often leading to limited private sector participation. Schemes like the "First in the World Challenge" and translational grant frameworks are designed to mitigate these financial "valleys of death." The Committee believes that relying exclusively on imported cutting-edge technologies exposes national health security to supply chain vulnerabilities and prohibitive pricing. The Committee is of the view that state-backed risk-sharing mechanisms are necessary to build indigenous global technology leaders. The Committee, therefore, recommends the creation of a dedicated, high-value 'National Biomedical Breakthrough Innovation Fund' under DHR to expand programs like the 'First in the World Challenge' for high-risk, high-reward translational research. The Committee believes establishing tax-incentivized co-developmental frameworks and matching-grant schemes to encourage private medtech and pharmaceutical enterprises to co-fund public R&D projects from prototype to market launch.

(Para 3.11.6)

STRENGTHENING INDIA'S GLOBAL MEDTECH ECOSYSTEM AND PRODUCT DEVELOPMENT

 

88.       The Committee understands highlights the limitations of the current market-based drug pricing mechanism administered by the National Pharmaceutical Pricing Authority (NPPA) under DPCO 2013, particularly regarding innovative biologics, biosimilars, and high-cost therapies. The Committee is of the view that pricing based on average retailer margins fails to deliver fair, sustainable pricing for novel interventions. The Committee believes that pricing governance must strike a balance between the cost-based model and a value-based model to ensure both affordability and industry sustainability. The Committee, in this regard, recommends that Health Technology Assessment (HTAIn) outputs on clinical efficacy, social value, and cost-effectiveness be formally integrated into NPPA’s price-fixation guidelines for all high-cost biologics, orphan drugs, and biosimilars. The Committee, further, recommends that DHR collaborate with the NPPA to establish legal and economic policy frameworks for Value-Based Pricing and Managed Entry Agreements (MEAs), while strengthening capacity to utilize TRIPS flexibilities for critical, life-saving therapies.

(Para 3.22.2)

89.       The DHR-ICMR Viksit Bharat Strategic Plan (2025–2029) sets ambitious targets to transition India into a high-value global innovation hub by advancing frontier research in synthetic organs, gene therapy platforms, and therapeutic vaccines. To support this, stage-wise funding mechanisms—such as the "First in the World Challenge" (offering ₹1 crore for PoC, ₹4 crore for prototype, and ₹10 crore for rollout)—have been structured. The Committee believes that India’s long-term health security depends on shifting from low-cost generic manufacturing to pioneering transformative, cutting-edge therapies. The Committee, therefore, recommends dedicated annual budgetary outlays under the 2025–2029 Strategic Plan specifically earmarked for high-risk, frontier biomedical research in gene therapy and synthetic biology. The Committee also recommends for establishing specialized 'Frontier Health Accelerators' across leading research institutions to facilitate the seamless transition of projects through DHR’s three-tiered funding framework from concept to nationwide market deployment.

(Para 3.22.3)

90.       The Committee notes that in order to elevate the domestic MedTech sector within the global value chain, ICMR has operationalized a Phase-I First-in-Human trial network, the 79-centre INTENT network for Phase II/III trials, and the mPRAGATI Metal Additive Manufacturing facility at IIT Delhi. Furthermore, the Department of Expenditure has granted in-principle approval for establishing MIDAC. The Committee is of the view that a lack of affordable prototyping tools and delayed clinical validations remain the primary bottlenecks for domestic MedTech enterprises. The Committee, therefore, recommends replicating the mPRAGATI rapid-prototyping and additive manufacturing model across all major technical and medical hubs to give start-ups and MSMEs affordable access to advanced engineering tools. The Committee believes that establishing an expedited validation track within the 79-centre INTENT network under MIDAC would allow domestic manufacturers to conduct regulation-compliant preclinical and clinical evaluations within fixed, fast-tracked timelines.

(Para 3.22.4)

 

91.       The Committee understands stresses that Universal Health Coverage (UHC) requires balancing the five dimensions of access: Affordability, Availability, Accessibility, Accommodation, and Acceptability. DHR has initiated R&D into assistive tech for the differently-abled, voice-based applications for low-literacy users, and scientifically validated AYUSH formulations (such as Punarnavadi Mandura for anemia). The Committee believes that equity cannot be achieved without customizing health delivery to the socio-cultural, physical, and literacy constraints of marginalized populations. The Committee, therefore, recommends that DHR launch a targeted grant scheme for digital and assistive innovations, prioritizing voice-assisted diagnostic tools for low-literacy populations and AI-based triaging systems for primary health settings. The Committee is of the view to expand clinical trials under the AYUSH-ICMR Advanced Centres to evaluate, standardize, and scale cost-effective traditional formulations into mainstream national health programs to reduce out-of-pocket therapeutic expenditures.

(Para 3.22.5)

MINISTRY OF AYUSH

 

92.       The Committee notes the proactive consultations held by the Ministry of Ayush with the Insurance Regulatory and Development Authority of India (IRDAI) and the subsequent advisory mandating 100 per cent reimbursement for cashless Ayush treatments. However, the Committee is of the view that true affordability for the most vulnerable sections of society can only be achieved if holistic healthcare is firmly integrated into robust public welfare schemes. The Committee believes that the ongoing consultations with the National Health Authority (NHA) must be concluded without further delay. The Committee, therefore, recommends that the Government immediately formalize the inclusion of comprehensive Ayush treatment packages under the Ayushman Bharat–Pradhan Mantri Jan Arogya Yojana (AB-PMJAY). Furthermore, a strict monitoring mechanism must be established to ensure that private insurers comply seamlessly with the IRDAI directives, thereby minimizing administrative bottlenecks and reducing out-of-pocket expenditure (OOPE) for the public.

(Para 3.23.8)

93.       The Committee acknowledges the ongoing efforts to expand access to Ayush healthcare through the empanelment of private institutions under the Central Government Health Scheme (CGHS). However, the Committee is of the view that restricting the empanelment of Ayush Day Care Centres to the Delhi-NCR region on a pilot basis creates geographic disparities in healthcare access for beneficiaries. The Committee, therefore, recommends that the Ministry swiftly approve and implement the proposal currently under consideration to expand the empanelment of private Ayurveda, Yoga & Naturopathy, Unani, and Siddha Day Care Centres, as well as IPD hospitals, across all CGHS-covered cities nationwide. This expansion must be closely tied to National Accreditation Board for Hospitals & Healthcare Providers (NABH) accreditation to guarantee high standards of service delivery and equitable access to holistic healthcare across the country.

(Para 3.23.9)

94.       The Committee observes with concern the Ministry's submission that no statutory price control mechanism currently exists for Ayush drugs in the open market. While acknowledging the price-vetting methodology applied to the central public sector undertaking (IMPCL), the Committee believes that leaving private sector Ayush pharmaceuticals unregulated exposes patients to arbitrary pricing, directly contravening the National Ayush Mission’s objective of cost-effective healthcare. The Committee, therefore, recommends that the Ministry of Ayush, in coordination with the Ministry of Finance and relevant pharmaceutical pricing authorities, formulate and implement a comprehensive statutory price control framework. This mechanism should cap the maximum retail prices of essential and widely prescribed Ayush medicines, ensuring they remain affordable for the general populace while curbing overall out-of-pocket expenditure.

(Para 3.23.10)

95.       The Committee acknowledges the pivotal role of the National Ayush Mission (NAM) in establishing a holistic wellness model via Ayushman Arogya Mandir- Ayush [AAM (Ayush)] to promote preventive healthcare and reduce the overall disease burden. However, the Committee is of the view that the dependency on State Annual Action Plans (SAAPs) for grant-in-aid can often lead to procedural delays, hampering the timely deployment of human resources and the strengthening of critical healthcare infrastructure. The Committee believes that robust preventive and promotive healthcare at the grassroots level is the most effective strategy to sustainably lower out-of-pocket expenditure. The Committee, therefore, recommends that the Ministry establish a strict, time-bound framework for the evaluation and approval of SAAPs. Furthermore, a dedicated monitoring mechanism must be instituted to ensure prompt fund disbursement and execution by the State and Union Territory Governments, thereby accelerating the nationwide delivery of cost-effective and equitable Ayush services.

(Para 3.23.11)

96.       The Committee notes with appreciation the outreach initiatives undertaken by the National Institute of Homoeopathy (NIH), notably the free healthcare camps organized in collaboration with Hindustan Copper Limited and the medical relief provided to over 2,000 patients during the Gangasagar Mela. The Committee is of the view that such public-private collaborations and targeted interventions during mass gatherings are highly effective in extending affordable Ayush healthcare directly to the masses. The Committee believes that this proactive outreach model should not remain an isolated effort but must be systematically replicated across all disciplines. The Committee, therefore, recommends that the Ministry formulate a structured policy mandating all National Institutes and autonomous bodies under its purview to actively partner with Central Public Sector Enterprises (CPSEs) and private stakeholders. By systematically leveraging Corporate Social Responsibility (CSR) funds, these institutes can permanently scale up the deployment of free healthcare camps and mobile clinics in remote and underserved regions, significantly enhancing grassroots accessibility.

(Para 3.23.12)

97.       The Committee notes the decision taken during the Review Meeting chaired by the Hon'ble Prime Minister on 27 February 2025 to leverage Pradhan Mantri Bhartiya Janaushadhi Kendras for the promotion of Ayush medicines through appropriate co-branding. However, the Committee is of the view that merely "exploring further action" is an inadequate response to an executive directive aimed at reducing out-of-pocket healthcare costs. The Committee believes that utilizing the established nationwide retail network of Jan Aushadhi Kendras will exponentially increase the accessibility and affordability of essential, quality-tested Ayush pharmaceuticals. The Committee, therefore, recommends that the Ministry of Ayush rapidly finalize and execute this co-branding initiative in a strict, time-bound manner, ensuring that high-quality, standardized Ayush medicines are made available across all Jan Aushadhi Kendras without further administrative delay.

(Para 3.23.19)

98.       The Committee appreciates the diverse outreach strategies adopted by the National Institutes and Research Councils, such as the co-location of Unani and Siddha OPDs in major allopathic hospitals by CCRUM and CCRS, the adoption of rural villages by NEIAH, and the establishment of satellite clinics by ITRA. Concurrently, the Committee notes that the broader mainstreaming of Ayush through co-location at Primary Health Centres (PHCs), Community Health Centres (CHCs), and District Hospitals (DHs) is currently contingent upon the manpower support and demand projected by States and Union Territories in their respective Programme Implementation Plans (PIPs) and State Annual Action Plans (SAAPs). The Committee is of the view that relying entirely on the proactive requests of individual States leads to severe regional disparities in healthcare accessibility, and that highly cost-effective integrative models should not be restricted to specific autonomous institutes but must be universally adopted as standard operating procedure.

(Para 3.23.20)

99.       The Committee believes that out-of-pocket expenditure can be most effectively minimized when patients have simultaneous, unhindered access to both conventional and holistic Ayush treatments under a single roof, directly within their communities. The Committee, therefore, recommends that the Ministry of Ayush, in strict coordination with the Ministry of Health and Family Welfare, formulate a mandatory baseline policy requiring a minimum percentage of all newly sanctioned and existing PHCs, CHCs, and DHs to feature operational, co-located Ayush facilities. The Central Government should aggressively leverage the National Ayush Mission (NAM) to actively incentivize States to meet these integration targets rather than passively awaiting proposals. Furthermore, the Ministry must institutionalize the satellite clinic model across all its institutes to systematically cover underserved areas, tribal regions, and vulnerable populations nationwide.

(Para 3.23.21)

 

100.     The Committee takes positive note of the integration of digital health platforms, such as eSanjeevani, A-HMIS, and AYUSH NEXT- by institutions like CCRS and NEIAH to facilitate tele-consultations, e-prescriptions, and patient registration. The Committee is of the view that digital interventions are paramount in bridging the geographical divide, particularly for patients who face logistical and financial barriers to physical healthcare access. The Committee believes that expanding these tele-medicine services across all Ayush disciplines will drastically reduce the indirect costs of healthcare, such as travel expenses and wage loss. The Committee, therefore, recommends that the Ministry establish a centralized mandate to integrate eSanjeevani and comprehensive Hospital Management Information Systems (HMIS) across all Ayush dispensaries, peripheral institutes, and clinical units across the country to guarantee continuous remote access to affordable care.

(Para 3.23.22)

101.     The Committee commends the National Institute of Homoeopathy (NIH) for providing highly subsidized and comprehensive healthcare- including a nominal ₹5 registration fee that covers medicines, and notes its planned expansion from a 100-bedded to a 250-bedded facility. Conversely, the Committee observes that developing institutions like the National Institute of Sowa-Rigpa (NISR) operate with a significantly smaller 10-bedded teaching hospital. The Committee is of the view that robust inpatient infrastructure is critical for the holistic management of complex, chronic, and non-communicable diseases. The Committee believes that the highly affordable fee structure and expanding inpatient capacity modeled by NIH must serve as the benchmark across the Ayush sector to ensure structural parity. The Committee, therefore, recommends that the Ministry urgently allocate targeted funding to upgrade the bed capacity and diagnostic infrastructure of smaller institutes like NISR. Simultaneously, the Ministry must ensure that a universally subsidized tariff structure, covering registration, diagnostics, and essential medicines, is implemented across all National Institutes to genuinely benefit economically disadvantaged populations.

(Para 3.23.23)

102.     The Committee acknowledges the ongoing capacity-building efforts under the Ayurgyan Scheme and the specific training programmes conducted by the All India Institute of Ayurveda (AIIA) and the North Eastern Institute of Ayurveda and Homoeopathy (NEIAH). However, the Committee is of the view that the current scale of training—benefiting approximately 5,000 personnel and a limited number of nursing and technical staff—is vastly insufficient to meet the nationwide demand for accessible Ayush healthcare. The Committee believes that a critical shortage of trained allied professionals, such as Panchakarma technicians and Ayush-specialized nurses, directly hampers the delivery of affordable, holistic care at the grassroots level. The Committee, therefore, recommends that the Ministry mandate all National Institutes and teaching hospitals under its purview to introduce formalized diploma and certificate courses for allied Ayush healthcare workers, emulating the NEIAH model. Furthermore, funding under the Ayurgyan Scheme must be substantially augmented to support a decentralized, nationwide training network.

(Para 3.23.33)

103.     The Committee appreciates the formulation of specialized Ayush Public Health Programmes under the National Ayush Mission (NAM), such as SUPRAJA, VAYO MITRA, KARUNYA, and the deployment of Ayush Mobile Medical Units, directed at underserved, tribal, and remote areas. The Committee is of the view that these preventive and promotive interventions are vital for managing non-communicable diseases and reducing the long-term disease burden among the most vulnerable demographic segments. The Committee believes that the uninterrupted delivery of these specific outreach programmes is essential for ensuring national health equity. The Committee, therefore, recommends that the Ministry establish a dedicated, ring-fenced budget allocation within NAM explicitly for these targeted public health programmes and mobile medical units. Strict monitoring must be enforced to ensure that funds intended for rural and tribal healthcare outreach are not diverted, thereby guaranteeing sustained accessibility to affordable Ayush care for marginalized populations.

(Para 3.23.34)

104.     The Committee appreciates the constitution of a dedicated committee by the Drug Policy Section (DPS) to revise the "Guidelines for Insurance Coverage of Ayush Treatments and Settlement of Claims on the Basis of Benchmark Rates of Various Therapies/Interventions (2016)". The Committee is of the view that outdated benchmark rates and non-standardized therapy pricing lead to arbitrary claim settlements, forcing patients to pay out-of-pocket top-ups or face claim rejections by insurance providers. The Committee believes that transparent, actuarially sound, and updated tariff schedules are essential to ensure that private and public health insurance policies deliver genuine financial protection to policyholders seeking Ayush treatments. The Committee, therefore, recommends that the Ministry of Ayush expedite the finalization and rollout of the revised guidelines in a strict, time-bound manner. This revision must establish uniform, standardized benchmark rates across all recognized Ayush therapies and mandate their adoption by insurance underwriters to prevent out-of-pocket cost escalation during claim settlements.

(Para 3.23.41)

105.     The Committee observes from the submissions of the research councils (CCRAS, CCRUM, and CCRS) that the high cost of Ayush care is heavily driven by raw material price volatility, seasonal supply shortages, and complex formulation processes. While noting initiatives such as the Siddha Medicinal Plants Garden at Mettur Dam and the promotion of MSMEs, the Committee is of the view that an unorganized raw material supply chain severely inflates input costs, which are ultimately passed on to the consumer. The Committee believes that stabilizing raw material pricing through structured, local supply chains and decentralized processing is a critical prerequisite for lowering the retail price of finished Ayush medicines. The Committee, therefore, recommends that the Ministry formulate a national strategy to establish regional herbal cultivation clusters in coordination with State Forest and Agriculture Departments. Furthermore, the Ministry must scale up support for decentralized, Good Manufacturing Practice (GMP)-certified small and medium enterprise (MSME) pharmacy units, guaranteeing a steady supply of affordable, high-quality raw materials and finished formulations.

(Para 3.23.42)

106.     The Committee highlights the collaborative research initiatives undertaken by CCRAS, CCRUM, and CCRS, including drug standardization using modern analytical techniques like High-Performance Liquid Chromatography (HPLC), Centralized Instrumentation Research Facilities (CIRF), and the creation of Ayush–ICMR Advanced Centres for Integrative Health Research (AI-ACIHR) across various AIIMS facilities. The Committee is of the view that a lack of standardized quality controls and limited pharmacoeconomic data often result in prolonged treatment protocols and unnecessary resource expenditure. The Committee believes that establishing concrete clinical evidence and quantifying Quality-Adjusted Life Years (QALYs) will demonstrate the true cost-effectiveness of Ayush interventions and prevent wastage in healthcare delivery. The Committee, therefore, recommends that the Ministry mandate systematic pharmacoeconomic studies for all widely prescribed classical and proprietary Ayush formulations. Additionally, the Ministry should expand the Ayush-ICMR AI-ACIHR network to all major tertiary medical colleges across the country to standardize treatment protocols, eliminate ineffective drug variations, and drive down long-term treatment costs through evidence-based integrative medicine.

(Para 3.23.43)

107.     The Committee expresses concern over the constraints on affordability and accessibility arising from limited awareness and understanding of Ayush among healthcare service providers. While the Drug Policy Section (DPS) is currently developing Standard Treatment Guidelines (STGs) and standardized documentation for insurance claims, the Committee is of the view that the lack of institutionalized clinical protocols has historically led to skepticism among allopathic practitioners and private health insurers, resulting in arbitrary claim rejections or delayed treatments. The Committee believes that establishing evidence-based, universally recognized clinical benchmarks is essential to build provider trust, standardize care delivery, and ensure predictable reimbursement. The Committee, therefore, recommends that the Ministry of Ayush must accelerate the notification of comprehensive STGs across all recognized Ayush streams. Furthermore, the Ministry must make these guidelines mandatory for all empanelled public and private healthcare institutions and integrate them into cross-disciplinary CME modules to bridge the knowledge deficit among service providers and insurance underwriters.

(Para 3.23.48)

108.     The Committee takes positive note of the Ministry’s initiatives to position India as a global destination for traditional medicine, including the introduction of a dedicated Ayush Visa, the launch of the Advantage Healthcare India Portal, and the establishment of international MoUs and Ayush Information Cells worldwide. The Committee is of the view that while Medical Value Travel (MVT) brings significant foreign exchange and international recognition, the economic benefits of this growing sector must be strategically harnessed to bolster domestic healthcare equity. The Committee believes that high-margin international wellness and medical tourism can serve as a vital financial engine to support underfunded public health infrastructure. The Committee, therefore, recommends that the Ministry, in coordination with the Ministry of Health and Family Welfare, formulate a framework that requires accredited private and public MVT-empaneled Ayush hospitals to contribute a designated percentage of their revenue from foreign patients into an 'Ayush Public Healthcare Equity Fund'. This fund should be exclusively utilized to subsidize complex Ayush treatments, diagnostics, and essential medicines for economically disadvantaged domestic patients.

(Para 3.23.49)

109.     The Committee observes the progress made in facilitating international and national quality benchmarks, such as the ISO Technical Committee (ISO/TC 249/SC 2) and the publication of IS/ISO 21426:2018 regarding medical spa service requirements. However, the Committee is of the view that without strict regulatory enforcement, the private wellness and Ayush sector remains susceptible to unstandardized service quality, varying safety protocols, and commercial exploitation. The Committee believes that adherence to accredited quality standards is directly linked to patient safety and fair pricing. The Committee, therefore, recommends that the Ministry of Ayush, in collaboration with the Bureau of Indian Standards (BIS) and the Quality Council of India (QCI), institute a mandatory accreditation framework based on ISO/BIS standards for all commercial Ayush wellness centres and clinical spas operating in the country. To ensure affordability and prevent predatory pricing in the private sector, this accreditation must be strictly linked to public price disclosures and transparent tariff structures for all offered therapies.

(Para 3.23.50)

STRENGTHENING AYUSH SERVICES

110.     The Committee is of the view that true holistic healthcare necessitates seamless patient access to both traditional and modern medical systems under a single roof to facilitate cross-referrals and integrated management. The Committee, therefore, recommends the strict enforcement of a policy mandating the compulsory co-location of Ayurveda and other AYUSH dispensaries or hospitals alongside all government Allopathic centers, Primary Health Centres (PHCs), Community Health Centres (CHCs), and District Hospitals. The Committee believes that geographical equity in traditional healthcare delivery is paramount. The Committee, therefore, recommends the formulation and immediate execution of a definitive policy that ensures the establishment of population-based Ayurveda and AYUSH facilities uniformly across the country.

(Para 3.23.55)

111.     While acknowledging the collaborative efforts between AYUSH research councils (CCRAS, CCRUM, CCRH, CCRS) and premier institutes like AIIMS, ICMR, and IITs, the Committee observes that the evidence base research and development must be pro-actively expanded to ensure treatment of diseases under Ayush System. The Committee believes that rigorous empirical validation is crucial for the mainstream and global acceptance of traditional practices of treatment under Ayush System. The Committee, therefore, recommends the allocation of dedicated, ring-fenced funding to accelerate the scientific validation of AYUSH interventions through robust academic and industry partnerships. The Committee is of the view that multiple branches of healthcare (Allopathy, Ayurveda, Yoga, Homeopathy, etc.) must be integrated with a strict research mindset to understand the emerging trends of diseases due to climate change and global ecological disaster and disorder. The establishment of Ayush-ICMR Advanced Centres for Integrative Health Research (AI-ACIHR) must be scaled to all major tertiary care centers, prioritizing joint clinical trials for non-communicable diseases (NCDs), cancer care, and geriatric health.

(Para 3.23.56)

112.     The Committee acknowledges the progress made in establishing an AYUSH vertical within the Central Drugs Standard Control Organization (CDSCO) and the initiation of Standard Treatment Guidelines (STGs). The Committee, therefore, recommends the expedited finalization and nationwide enforcement of comprehensive STGs for all major disease classifications across all AYUSH disciplines to ensure safe, evidence-based, and standardized integrative care. The Committee believes that domestic and international trust hinges upon uncompromising quality control. The Committee, therefore, recommends the continuous and speedy promotion and enforcement of WHO-CoPP (Certificate of Pharmaceutical Product) and Quality Council of India (QCI) certifications for all AYUSH pharmaceutical products.

(Para 3.23.57)

113.     The Committee considers that the successful implementation of an integrative medical model relies entirely on a well-trained, multi-skilled, and unbiased healthcare workforce. The Committee, therefore, recommends the immediate development and deployment of competency-based, evidence-oriented training programs specifically designed to safely integrate AYUSH services into mainstream standard treatment workflows. The Committee believes that fostering mutual respect and practical synergy between allopathic and traditional practitioners is vital to reducing systemic bias. The Committee, therefore, recommends the immediate introduction of integrated curriculum modules, exchange fellowships, and cross-system Continuous Medical Education (CME) sessions across both Allopathic and AYUSH educational institutions so as to complement each other and capable of reducing rural-urban gaps in accessibility  of medical facilities at the grass root level, especially rural, hilly and tribal regions.

(Para 3.23.58)

SWOT ANALYSIS OF THE NATIONAL HEALTH MISSION (NHM)

 

114.     The Committee finds that NHM has substantially strengthened India's public health infrastructure and expanded access to essential health services over the past two decades. However, addressing remaining gaps in quality, equity, urban healthcare, human resources and system resilience through sustained investment, integrated

planning and digital health will be essential for achieving the SDGs, Universal Health Coverage and equitable healthcare in the country.

(Para 3.24.3)

115.     The Committee considers that while the transformation of primary care infrastructure under Ayushman Bharat is commendable, the failure to address fundamental human resource deficits, financial bottlenecks, and data fragmentation severely undermines the Mission's capacity to deliver equitable healthcare and combat the rising non-communicable disease (NCD) burden. The Committee believes that achieving Universal Health Coverage (UHC) and the Sustainable Development Goals (SDGs) requires moving beyond incremental operational tweaks toward a synchronized strategy that integrates human resource parity, financial streamlining, and unified digital governance.

(Para 3.24.4)

116.     The Committee, therefore, recommends that the Ministry of Health and Family Welfare, in close coordination with the Ministry of Ayush and State Governments, undertake a comprehensive overhaul of the NHM implementation framework through the following structured measures:

 

1. Human Resource Rationalization and Staff Security: Formulate a uniform national policy to address the acute disparities between contractual and permanent healthcare staff, establish hard-duty hardship allowances and career progression pathways to attract and retain doctors, specialists, and paramedics in rural and remote regions, and systematically scale up digital training modules for frontline health workers (ASHAs and ANMs).
2. Fiscal Streamlining and Absorptive Capacity: Institute a real-time, Direct Benefit Transfer (DBT)-linked fund disbursement tracking mechanism to eliminate administrative delays in releasing Central grants to States. Furthermore, the Ministry must provide specialized technical and administrative handholding to smaller, Union Territory, and North-Eastern States to enhance their fiscal absorptive capacity and ensure unhindered resource utilization.
3. Data Convergence and Continuity of Care: Rationalize and merge overlapping data reporting software into a single, unified architecture integrated with the Ayushman Bharat Digital Mission (ABDM). This platform must establish seamless digital referral pathways linking Ayushman Arogya Mandirs with Community Health Centres, District Hospitals, and AB-PMJAY tertiary care networks to guarantee end-to-end, lifelong continuity of care for every citizen.

(Para 3.24.5)

AIIMS- NEW DELHI

117.     The Committee believes that technology-enabled healthcare solutions offer an unprecedented opportunity to bridge geographic divides, mitigate specialist shortages, and reduce patient congestion at apex tertiary care centers. The Committee is of the view that proven, cost-effective digital innovations developed by Institutes of National Importance (INIs) should not remain isolated successes but must be scaled nationally. The Committee, therefore, recommends the immediate establishment of a dedicated national programme to document, standardize, and replicate best administrative and clinical practices from AIIMS New Delhi across all state Government Medical Colleges (GMCs) and district hospitals. This must include structured mentorship, digital patient navigation systems, public dashboards, dynamic queue management, and integrated appointment modules.

(Para 3.25.9)

118.     The Committee recommends scaling up validated AI platforms, specifically: (i) MadhuNetrAI for frontline screening and early detection of diabetic retinopathy in resource-constrained primary settings; (ii) UPPCHAR for AI-assisted health education, supportive care, and treatment adherence in advanced oncology; (iii) AI-assisted Chest X-ray Triage to prioritize high-volume diagnostic imaging within 5–10 minutes while preserving final validation by certified radiologists; and (iv) "Never Alone" digital mental health frameworks (WhatsApp-integrated) for round-the-clock screening and facilitated expert consultation. The Committee further recommends accelerating the full integration of e-prescriptions, clinical decision support systems (CDSS), and remote patient monitoring under the Ayushman Bharat Digital Mission (ABDM).

(Para 3.25.10)

119.     The Committee believes that the current unorganized patient flow severely strains tertiary institutions like AIIMS, leading to extreme congestion, prolonged waiting times, and indirect financial hardship for rural families traveling long distances. Furthermore, both public and private sectors must be viewed as complementary components of the health ecosystem. The Committee, therefore, recommends the implementation of a mandatory, technology-enabled referral framework linking Ayushman Aarogya Mandirs (AAM), district hospitals, and tertiary/private institutions. Standardized electronic referral protocols and real-time feedback loops must ensure that tertiary care facilities entertain primary and secondary-level conditions only through structured, verifiable referrals, thereby reducing overcrowding.

(Para 3.25.11)

120.     The Committee is of the view that private sector capacity, currently urban-centric and variably regulated, must be strategically leveraged to serve public health goals. The Committee recommends formulating robust PPP frameworks in high-capillary service areas, including advanced diagnostics, emergency ambulance networks, telemedicine, and medical education. To prevent commercial exploitation, all PPP initiatives must operate under strict price ceilings, defined Service Level Agreements (SLAs), and independent quality audits to ensure equitable access for vulnerable populations.

(Para 3.25.12)

121.     The Committee believes that financial protection cannot be achieved through insurance coverage alone; it requires stringent cost containment, elimination of defensive or predatory medical practices, and strict adherence to evidence-based medicine across both sectors. The Committee, therefore, recommends that the Ministry mandate standardized baseline pricing and mandatory public disclosure of tariffs for common medical procedures, diagnostic panels, and surgical implants. Private hospitals must strictly adhere to national Standard Treatment Guidelines (STGs) to eliminate unwarranted investigations, unnecessary hospitalizations, and polypharmacy. The Committee also recommends the statutory enforcement of Essential Diagnostics Lists (EDL), Antimicrobial Stewardship Programmes, and mandatory generic drug prescribing across all public and empanelled private facilities. Jan Aushadhi Kendras and AMRIT Pharmacies must be co-located within all secondary and tertiary hospital premises with guaranteed stock availability.

(Para 3.25.13)

122.     The Committee is of the view that public hospitals must increase throughput by monitoring and publicly disclosing Key Performance Indicators (KPIs), such as Average Length of Stay (ALOS), Bed Occupancy Rates, Healthcare-Associated Infection Rates, and waiting times, alongside dynamic resource allocation and automated supply chain management. Enforcement of stringent audit mechanisms to curb over-investigation and excessive billing practices.

(Para 3.25.14)

123.     The Committee believes that India's changing demographic profile necessitates an immediate pivot toward elder care, alongside a fundamental shift from volume-based care to patient-centric, value-based healthcare where patients are active, informed participants in their care journey. The Committee, therefore, recommends integrating dedicated geriatric medicine, palliative care, rehabilitation, and home-based care networks into primary (Ayushman Aarogya Mandirs) and secondary (District Hospital) care tiers. Specialized workforce training in geriatric nursing and allied health care must be fast-tracked to manage the rising burden of non-communicable diseases (NCDs) and age-related ailments. The Committee also recommends institutionalizing multi-lingual patient navigation desks and establishing formal Patient Advocacy Groups / Patient Representative Organizations. These platforms must actively educate patients not only on disease management but also on available government financial assistance schemes (such as AB-PMJAY and illness assistance funds) to eliminate catastrophic out-of-pocket expenditure.

(Para 3.25.15)

124.     The Committee is of the view that health system financing should progressively transition toward value-based outcomes measured by standardized patient safety metrics and National Quality Assurance Standards (NQAS/NABH). Furthermore, robust, real-time digital grievance redressal mechanisms must be made mandatory across all empanelled institutions.

(Para 3.25.16)

125.     The Committee believes that physical infrastructure alone cannot deliver care without an adequately trained, equitably distributed, and motivated health workforce. The severe shortage and stark urban-rural maldistribution of specialists, nurses, and allied health professionals at district and peripheral facilities remain fundamental barriers to healthcare access. The Committee, therefore, recommends that the Ministry, in consultation with State Governments and the National Medical Commission (NMC), formulate a dedicated cadre structure and transparent incentive framework—including financial bonuses, preferential postgraduate seats, and accelerated promotion pathways—for medical specialists serving in remote and rural district hospitals.

(Para 3.25.17)

126.     The Committee is of the view that postgraduate medical seats (MD/MS/DNB) and clinical training programs must be rapidly expanded at all district-level hospitals. Furthermore, statutory recognition and continuous professional development for nurses, paramedics, and allied health professionals must be institutionalized to support task-shifting and multi-skilled healthcare delivery. The Committee recommends establishing a dynamic, transparent National Health Workforce Registry under ABDM to track real-time staffing levels and prevent chronic vacancy gaps in underserved regions.

(Para 3.25.18)

127.     The Committee believes that delay in emergency response and lack of real-time critical care coordination are major contributors to avoidable mortality and catastrophic out-of-pocket expenditure during medical crises. The Committee, therefore, recommends the creation of a unified, technology-enabled Emergency Care Network linking basic/advanced life support ambulances, district emergency departments, trauma centers, and tertiary hospitals through a single national access line and GIS-based tracking.

(Para 3.25.19)

128.     The Committee considers that public and empanelled private institutions must mandatorily publish live updates regarding ICU beds, ventilator availability, and emergency department occupancy on centralized public dashboards, preventing chaotic hospital-hopping by distress-ridden families. The Committee recommends the implementation of universal emergency triage guidelines and tele-ICU linkages, enabling district doctors to stabilize critically ill patients under expert consultation from apex institutions like AIIMS prior to or during transport.

(Para 3.25.20)

129.     The Committee believes that long-term affordability cannot be sustained without a firm fiscal commitment from the Union Government, alongside an aggressive pivot toward early detection and prevention of non-communicable diseases (NCDs). The Committee, therefore, recommends that the Ministry lay down a statutory, year-on-year roadmap to progressively scale public health expenditure to 2.5–3% of GDP within a defined timeframe, as envisaged under the National Health Policy.

(Para 3.25.21)

130.     The Committee is of the view that public health procurement should shift toward "strategic purchasing," leveraging the market size of Ayushman Bharat (AB-PMJAY) to drive down cost tariffs, enforce strict clinical quality norms, and expand coverage to currently vulnerable populations exposed to catastrophic health spending. The Committee recommends expanding population-based screening, routine adult vaccination, lifestyle interventions, and early NCD diagnostics across all Ayushman Aarogya Mandirs (AAM), thereby reducing the high long-term financial burden of advanced secondary and tertiary illness.

(Para 3.25.22)

 

VIEWS OF THE SELECT HOSPITALS

STAR DENTAL

131.     The Committee is of the view that oral and dental healthcare has not been accorded adequate priority within the national healthcare framework, resulting in a significant gap in both affordability and accessibility. Submissions received by the Committee indicate a stark absence of dental coverage in both public and private health insurance schemes, as well as a lack of collaborative initiatives between private dental organizations and public healthcare institutions. While organized private dental networks have successfully expanded into Tier-II cities and established transparent, software-integrated standardized billing practices, their complete absence in rural areas leaves a vast segment of the population underserved.

(Para 3.26.2)

132.     The Committee believes that optimal public health outcomes cannot be realized until dental care is formally recognized and promoted on par with mainstream medical care. The existence of standardized treatment rates and transparent patient record-keeping within the private sector demonstrates that dental healthcare costs can be systematically structured, regulated, and monitored for insurance integration. The Committee, therefore, recommends that the Government take immediate, concrete policy measures to mainstream dental healthcare and explicitly incorporate comprehensive dental treatments into government-sponsored health insurance schemes. Additionally, the Government must proactively facilitate public-private partnerships to incentivize private dental healthcare providers to expand their clinical and operational footprint into rural regions, thereby ensuring that equitable, transparent, and affordable dental care becomes accessible to all citizens across the country.

(Para 3.26.3)

JAWAHARLAL NEHRU MEDICAL COLLEGE

133.     The Committee is of the view that the severe delays in claim settlements under government health schemes fundamentally undermine the accessibility of healthcare for vulnerable beneficiaries. While the acceptable turnaround time for claims processing under frameworks like Karnataka's Suvarna Arogya Suraksha Trust (SAST) is stipulated to be between 15 to 21 days, the actual average lead time of 6 to 8 months reported by institutions such as Jawaharlal Nehru Medical College is unacceptable. This systemic bottleneck, starkly contrasting the 25 to 30 days taken by private insurers, severely cripples the working capital of empanelled providers. When coupled with frequent bill rejections due to ambiguously defined "insufficient post-operative investigations," these delays actively discourage private sector participation and threaten the operational stability of participating medical colleges.

(Para 3.27.2)

134.     The Committee believes that the structural rigidity of the current reimbursement matrix actively penalizes critical care providers and restricts patient access. The prevailing disparity, wherein government package rates remain an average of 30% lower than private insurance equivalents, challenges the sustainability of quality care delivery. More critically, the absence of separate ICU packages for critical patients requiring surgical interventions, alongside the illogical prohibition of bilateral surgical procedures under PMJAY, forces suboptimal clinical pathways, creating unnecessary financial burdens and requiring repeated hospitalizations for patients. The Committee, therefore, recommends that the Ministry of Health and Family Welfare, in strict coordination with the National Health Authority (NHA) and respective State Health Agencies (SHAs), immediately execute the following systemic interventions:

1. Enforcement of Settlement SLAs: Institute a rigid, technology-driven 30-day maximum turnaround time for all government scheme claim settlements, mandating the automatic payment of penal interest to healthcare providers for any delays beyond this operational window.
2. Rationalization of Benefit Packages: Undertake a comprehensive and immediate revision of the Health Benefit Packages (HBP) to introduce standalone, unbundled ICU packages for post-surgical critical care, while systematically aligning overarching package rates with the realistic operational costs of tertiary care.
3. Authorization of Bilateral Procedures: Allow the bilateral diseases treatment and simultaneous surgical procedures under PMJAY, permitting concurrent clinical interventions in a single operative setting to reduce patient trauma, mitigate risk, and lower the cumulative cost of care.
4. Standardization of Clinical Audits: Formulate and publish an exhaustive, standardized, and specialty-specific checklist of required post-operative investigations to eliminate arbitrary claim rejections by state schemes like SAST and streamline the adjudication process.

(Para 3.27.3)

 

GOVERNMENT–PRIVATE COLLABORATION AND AREAS FOR JOINT ACTION

135.     The Committee is of the view that the capital-intensive nature of establishing specialized oncology facilities, requiring investments of around ₹1,000 crore for a 500-bed hospital with a four-year gestation period, creates severe entry barriers and drives up operational treatment costs. The extreme scarcity and high acquisition cost of institutional land in Tier-I and Tier-II cities (ranging from ₹50 crore to ₹250 crore for five acres in the NCR region), coupled with the absence of priority-sector lending, forces healthcare providers into high-cost commercial financing or private equity, ultimately escalating financial burdens on patients. Furthermore, while healthcare services are currently GST-exempt, this status prevents tertiary hospitals from claiming Input Tax Credit (ITC) on heavy capital outlays for specialized construction, consumables, and advanced medical equipment (which attract an 18% GST burden and high import duties, making equipment nearly 35% costlier in India). The Committee, therefore, recommends that the Government undertake the following structural interventions:

1. Priority Sector Financing and Concessional Land Allotment: Grant priority-sector lending status to healthcare infrastructure, particularly standalone, non-profit, and tertiary oncology centers, to enable access to low-cost institutional finance. State Governments must be mandated to allocate institutional land at concessional rates for public-interest healthcare projects in urban and semi-urban hubs.
2. Zero-Rating Healthcare under GST: Reclassify healthcare services from 'GST Exempt' to 'Zero-Rated GST (0%)' framework, enabling hospitals to claim Input Tax Credit on medical equipment, consumables, and specialized infrastructure, thereby directly lowering overall operational costs.
3. Customs Rationalization and Domestic Manufacturing: Rationalize import duties on non-indigenously manufactured high-end radiation and diagnostic equipment, while simultaneously providing targeted incentives under the 'Make in India' initiative to build indigenous manufacturing capabilities for advanced medical technology.

(Para 3.28.8)

136.     The Committee expresses grave concern over the fact that nearly 70% to 80% of cancer treatment expenditure in India is met through out-of-pocket payments, with average treatment costs reaching ₹7.5 lakh per patient. The empanelment of premier specialized cancer hospitals under public health schemes like Ayushman Bharat (PM-JAY), CGHS, ECHS, and ESIC remains severely constrained because prevailing reimbursement package rates, often up to 70% lower than market costs, are fixed on marginal costing principles without accounting for capital investment, medical inflation, or operational sustainability. Moreover, despite price regulation under the Drug Price Control Order (DPCO), retail margins on anti-cancer drugs remain exorbitantly high (50–60%), with manufacturers frequently circumventing price caps by introducing alternate strengths or formulations. Crucially, Patient Assistance Programmes (PAPs) currently exclude beneficiaries covered under public health insurance, while unstandardized diagnostic pricing (PET-CT, MRI, genetic testing) further inflates costs. The Committee, therefore, recommends that the Ministry of Health and Family Welfare, in coordination with the National Health Authority (NHA) and the National Pharmaceutical Pricing Authority (NPPA), execute the following measures:

1. Dynamic Package Rate Revision: Conduct a comprehensive, inflation-indexed revision of empanelment package rates under PM-JAY and government health schemes. Reimbursement structures must factor in capital depreciation, specialty infrastructure, and modern oncology protocols to ensure financial viability and encourage widespread private sector empanelment.
2. Enforcement of Trade Margin Rationalization (TMR) and DPCO Expansion: Expand the National List of Essential Medicines (NLEM) and DPCO coverage to include all alternate strengths, formulations, supportive therapies (such as anti-emetics and anti-infectives), and antifungal medicines. Strict Trade Margin Rationalization must be enforced across all anti-cancer molecules to eliminate artificial retail markups.
3. Ceiling Prices for Diagnostics and Universal PAP Access: Establish national ceiling prices for high-volume diagnostic procedures, including PET-CT, MRI, and genetic profiling, while encouraging shared diagnostic infrastructure among healthcare facilities. Additionally, issue clear guidelines enabling patients covered under public health schemes to access manufacturer-funded Patient Assistance Programmes (PAPs) without disqualification.

(Para 3.28.9)

137.     The Committee believes that mitigating the cancer burden requires a shift from isolated tertiary care to an integrated framework emphasizing Public-Private Partnerships (PPP), community screening, and early intervention. Past PPP models have often faltered due to misaligned incentives; however, a structured revenue-sharing model, where the Government provides land and primary support while specialized private or non-profit institutes manage operations, mobile diagnostics, and technical training, presents a highly sustainable path for expanding tertiary care into underserved regions. The Committee, therefore, recommends that the Government execute the following joint action directives:

 

1. Standardized Revenue-Sharing PPP Framework: Formulate a national policy framework for Public-Private Partnerships in oncology, under which the Government provides land and basic infrastructure while private entities manage hospital operations. A portion of the generated revenue should be directed to subsidize public health insurance and finance ongoing infrastructure expansion.
2. Integration of Cancer Screening in PM-JAY: Formally include comprehensive cancer screening (oral, cervical, and breast) within the preventive health packages of Ayushman Bharat.
3. Grassroots Screening and Immunization Collaboration: Institutionalize collaborative drives between state health departments and specialized oncology institutes to utilize ASHA and Anganwadi networks for community outreach. Establish regular diagnostic camps at Primary Health Centres (PHCs) and Community Health Centres (CHCs) using mobile diagnostic units, launch joint capacity-building programs for public healthcare personnel, and execute a national campaign for HPV vaccination among girls aged 9-26 years.

(Para 3.28.10)

INSTITUTIONALIZING PUBLIC-PRIVATE PARTNERSHIPS (PPP) AND CSR FOR DIAGNOSTIC AND SPECIALIZED SERVICES

138.     The Committee notes that high Out-Of-Pocket Expenditure (OOPE) is largely driven by the exorbitant costs of diagnostic tests and specialized treatments. The Committee is of the view that the strategic Public-Private Partnership (PPP) models implemented by Punjab, providing high-end radio-diagnostic (MRI/CT) and laboratory services at steeply discounted Central Government Health Scheme (CGHS) rates, and Goa’s collaboration for free dialysis services, are highly effective mechanisms for cost reduction. Furthermore, the Committee acknowledges the suggestion from the Municipal Corporation of Delhi (MCD) that the capital cost of expensive medical equipment can be supplemented by external funding. The Committee, therefore, recommends that the Union Government develop a standardized PPP framework to assist all States in outsourcing high-cost diagnostic and dialysis services at capped rates. Additionally, the Ministry should formulate guidelines to systematically channel Corporate Social Responsibility (CSR) funds toward procuring capital-intensive medical infrastructure for public hospitals.

(Para 3.32.2)

 

OVERCOMING GEOGRAPHICAL BARRIERS IN REMOTE REGIONS AND SCALING TELEMEDICINE

139.     The Committee recognizes the severe accessibility challenges in remote, rural, and hilly terrains, as highlighted by the State of Manipur, where infrastructural deficits and a distinct shortage of specialist doctors disproportionately affect vulnerable populations. Concurrently, while telemedicine platforms like e-Sanjeevani offer a viable solution, their utilization often diminishes without sustained public awareness, as observed by the MCD. The Committee believes that physical infrastructure development in challenging terrains must be aggressively supplemented by digital outreach. The Committee, therefore, recommends the creation of a dedicated infrastructure fund to establish specialized hubs in geographically challenging districts. Furthermore, the Committee recommends that the Government launch intensive Information, Education, and Communication (IEC) campaigns to publicize telemedicine services, mandating the integration of district-level specialist hubs with primary rural clinics to minimize unnecessary out-of-pocket travel expenses for patients.

(Para 3.32.4)

DENSIFYING PRIMARY CARE NETWORKS AND DECENTRALIZING HEALTH GOVERNANCE

140.     The Committee observes that robust primary healthcare is the cornerstone of disease prevention and early management. The proactive approach of Andhra Pradesh, establishing Village Health Clinics for every 2,500–3,000 population, surpassing standard Indian Public Health Standards (IPHS) norms, and Kerala’s transformation of Primary Health Centres into extended-hour Family Health Centres managed through decentralized local self-governments, constitute exemplary models of grassroots healthcare delivery. The Committee is of the view that increasing the density of primary care facilities drastically reduces the burden on tertiary hospitals. The Committee, therefore, recommends that financial incentives must be provided to States that successfully densify their primary care networks and empower local self-governments to allocate dedicated plan funds for grassroots health monitoring.

(Para 3.32.6)

ASSURING FINANCIAL PROTECTION FOR CRITICAL CARE AND HIGH-COST LIFE-SAVING INTERVENTIONS

141.     The Committee notes with grave concern that life-threatening emergencies, such as strokes and myocardial infarctions (STEMI), often lead to catastrophic financial ruin for affected families. The Committee commends the State of Goa for its STEMI project and Stroke Programme, which utilize a hub-and-spoke model to ensure treatment within the "golden hour" and provide highly expensive clot-busting drugs (such as Tenecteplase) entirely free of cost. Similarly, Puducherry’s strategy of signing MoUs with specialized private institutions for pediatric cardiac and cancer care effectively bridges public sector gaps. The Committee believes that no citizen should be denied life-saving critical care due to financial constraints. The Committee, therefore, recommends the establishment of a national corpus to subsidize high-cost, life-saving emergency drugs (such as newer thrombolytics) across all public district hospitals. Furthermore, the Government should encourage States to enter into strategic Memorandums of Understanding (MoUs) with specialized private and non-profit institutions to provide free or highly subsidized tertiary care for critical ailments like cancer and pediatric anomalies.

(Para 3.32.8)

STREAMLINING PROCUREMENT FRAMEWORKS AND AUGMENTING THE HEALTHCARE WORKFORCE

142.     The Committee acknowledges the severe administrative and logistical bottlenecks impeding healthcare delivery, particularly the shortage of appropriately skilled professionals (radiologists, anesthesiologists) and critical delays in procuring essential medicines and surgical items, as underscored by the MCD. The Committee is of the view that a lack of agile procurement systems and inadequate upskilling budgets severely hamstring public healthcare infrastructure. The Committee, therefore, recommends that the Government immediately address the procurement delays on digital marketplaces by instituting mandatory, fast-tracked Rate Contract Agreements (RCAs) for life-saving medicines and surgical consumables. Additionally, the Committee recommends a targeted increase in budgetary allocations explicitly earmarked for the recruitment, upskilling, and reskilling of specialized medical and paramedical personnel.

(Para 3.32.10)

INTEGRATING EMERGING TECHNOLOGIES AND ARTIFICIAL INTELLIGENCE FOR PROACTIVE SCREENING

143.     The Committee observes that leveraging technology is essential for achieving Universal Health Coverage (UHC). Initiatives such as Goa's AI-based interpretation of digital chest X-rays for early lung cancer detection, Kerala’s deployment of digital pathology and robotic surgery, and Assam’s proactive digital screening and national identity validation mechanisms to ensure scheme saturation, demonstrate the transformative potential of modern technology in public health. The Committee believes that artificial intelligence and centralized digital health records are critical for the early detection of non-communicable diseases (NCDs) and the prevention of scheme exclusion. The Committee, therefore, recommends that the Ministry launch a centralized initiative to deploy AI-driven diagnostic tools for cancer and NCD screening across all secondary and tertiary public health facilities. Concurrently, States should be technically supported to conduct proactive, door-to-door digital verification drives to ensure 100% saturation and inclusion of eligible beneficiaries under national health protection schemes.

(Para 3.32.12)

FOSTERING FINANCIAL AUTONOMY OF PUBLIC HOSPITALS THROUGH SCHEME CLAIM REINVESTMENT

144.     The Committee observes that public healthcare institutions often grapple with perennial budgetary constraints that impede the routine maintenance and upgradation of infrastructure. The Committee is of the view that the innovative strategy adopted by the State of Assam, whereby public hospitals retain and utilize the claims reimbursed under national health protection schemes (such as AB-PMJAY) for their own infrastructure development, is a highly pragmatic and replicable model. This mechanism effectively reduces institutional dependency on State grants and transforms public hospitals into self-sustaining entities capable of continuously upgrading their services. The Committee, therefore, recommends that the Ministry of Health and Family Welfare issue standard operating procedures to enable and encourage public hospitals across all States to reinvest a substantial portion of the funds generated through insurance claims directly into local hospital infrastructure, medical equipment procurement, and patient welfare initiatives.

(Para 3.32.14)

ENACTING DEDICATED FRAMEWORKS FOR GERIATRIC CARE AND RING-FENCING LOCAL FUNDS

145.    The Committee notes with appreciation the pioneering initiatives undertaken by the State of Kerala, notably the establishment of a statutory Senior Citizens Commission, the deployment of AI-based surveillance for bedridden patients, and the mandate for local governments to allocate 5% of their plan funds specifically for elderly care. Furthermore, the Committee acknowledges the suggestion made by the Municipal Corporation of Delhi (MCD) to consider elevating health to the status of a Fundamental Right. The Committee believes that as the demographic profile of the nation evolves, the healthcare system must proactively cater to the complex and specialized needs of an aging population. The Committee, therefore, recommends that the Union Government formulate a comprehensive national policy specifically targeting geriatric and palliative care. Furthermore, the Ministry must incentivize States to mandate their local self-governments to ring-fence a fixed percentage of their budgetary allocations exclusively for elderly care, home-based palliative support, and the provision of free medicines for senior citizens.

(Para 3.32.16)

 

OPTIMIZING TERTIARY BED CAPACITY THROUGH 'STEP-DOWN' CARE PROTOCOLS

146.    The Committee acknowledges the severe strain on tertiary and super-specialty hospitals, where a significant number of acute-care beds remain occupied by patients who have stabilized but require prolonged, lower-intensity recovery care. The Committee is of the view that the strategy proposed by the MCD, to establish formalized collaborations wherein stabilized post-operative patients are seamlessly transferred from specialized hospitals to smaller, peripheral health centres, is vital for optimizing the availability of tertiary beds for new, critical patients. The Committee, therefore, recommends that the Government establish a formal 'Step-Down Care' referral framework. Such a framework should facilitate the smooth transition of stabilized patients from apex tertiary institutions back to secondary or district hospitals, backed by integrated electronic health records and a robust ambulance network. This will ensure that highly specialized healthcare infrastructure is utilized optimally and primarily for critical and complex interventions.

(Para 3.32.17)

147.  The Committee observes that while flagship health insurance schemes have significantly widened coverage, practical and financial challenges persist that threaten their long-term efficacy. The Committee takes serious note of the concerns raised by the State of Assam regarding the inadequacy of the central premium of ₹1,052 per family under AB-PMJAY, which has remained stagnant despite rising treatment costs and expanded health benefit packages. Concurrently, the Committee appreciates Assam’s robust anti-fraud mechanism, which utilizes District Medical Officers and third-party auditors for rigorous clinical and infrastructure audits. The Committee believes that financial viability and strict vigilance are twin pillars for the success of universal health coverage. The Committee, therefore, recommends that the Union Government urgently undertake a comprehensive actuarial review to upwardly revise the central premium under national health protection schemes, aligning it with current medical inflation. Simultaneously, the Ministry must mandate all States to institute rigorous, multi-tier clinical and beneficiary audits to eliminate malpractices and ensure that scheme benefits exclusively reach the rightful beneficiaries.

(Para 3.32.20)

 

GOVERNMENT POLICIES ON HEALTHCARE AFFORDABILITY AND ACCESSIBILITY

148.     The Committee envisages that comprehensive health assurance is instrumental to reduce OOPE and to make healthcare affordable to all. Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) has fundamentally altered the healthcare financing landscape by covering over 11 crore hospital admissions and empanelling 38,038 public and private hospitals. The Committee believes that the substantial benefits realized through AB-PMJAY, which has authorized treatments worth ₹1.57 lakh crore, must be structurally insulated from medical inflation and unchecked technological cost escalations. The Committee, therefore, recommends that the government institute a statutory mechanism to periodically revise package rates under all government insurance schemes, factoring in regional economic variations to ensure continued and active participation of private sector hospitals without compromising the quality of care. Furthermore, the Committee is of the view that unwarranted variations in private healthcare costs create unpredictable out-of-pocket burdens that undermine financial protection. The Committee, therefore, recommends mandating transparent, standardized treatment packages across all healthcare providers to ensure cost predictability, reduce catastrophic health expenditure, and safeguard patient trust.

(Para 4.1.3)

149.     The Committee observes that the middle-income demographic, often excluded from publicly funded schemes, requires robust, accessible safety nets to prevent sudden impoverishment due to medical emergencies. The Committee, therefore, recommends the accelerated expansion of standardized, low-cost health insurance products, akin to Aarogya Sanjeevani, featuring simplified policy terms and wider demographic coverage. Concurrently, the Committee believes that the strict enforcement of the recently introduced IRDAI regulatory reforms, specifically the removal of upper age limits for purchasing policies and the reduction of waiting periods for pre-existing diseases to three years, is critical to enhancing patient inclusion and customer satisfaction. The Committee, therefore, recommends for the optimal utilization of the National Health Exchange platform to ensure expeditious, transparent cashless claim settlements and strict adherence to these modernized insurance mandates across all providers.

(Para 4.1.4)

150.     The Committee acknowledges the savings of over ₹45,000 crore generated by the 19,200 Jan Aushadhi Kendras and ₹8,400 crore by AMRIT pharmacies. The Committee believes that affordable generics and implants are the cornerstone of equitable healthcare. The Committee, therefore, recommends establishing Jan Aushadhi Kendras in all remaining block-level public health facilities and encouraging private tertiary hospitals to host AMRIT pharmacies to extend discounted implants and surgical consumables to a wider patient base.

(Para 4.1.5)

151.     The Committee notes that the Pradhan Mantri National Dialysis Programme (PMNDP) has already generated ₹10,102 crore in patient savings.The Committee is of the view that end-stage renal disease remains a significant financial drain. The Committee, therefore, recommends exploring public-private partnerships to expand free or highly subsidized haemodialysis centers beyond District Hospitals to sub-district levels.

(Para 4.1.6)

152.     The Committee believes that to sustain and expand the massive decentralized infrastructure of 19,200 Jan Aushadhi Kendras and over 1,816 PMNDP dialysis centres, state governments must proportionally elevate their fiscal commitments alongside the central government. The Committee, therefore, recommends that the Union Government actively incentivize States to enhance their respective health allocations to a minimum of 8% of their aggregate state expenditure.

(Para 4.1.7)

153.     The Committee, furthermore, is of the view that holistic wellness must be integrated seamlessly into the nation's primary financial protection frameworks to offer citizens a comprehensive continuum of care. The Committee, therefore, recommends the formal inclusion of Ayush treatment packages within the ambit of AB-PMJAY to provide beneficiaries with regulated, traditional therapeutic options while maintaining zero out-of-pocket expenditure.

(Para 4.1.8)

154.     The Committee appreciates that the operationalization of over 1.86 lakh Ayushman Arogya Mandirs (AAMs) and the proactive screening of over 41 crore citizens for non-communicable diseases constitute a monumental and necessary shift toward preventive and promotive healthcare at the grassroots level. Furthermore, the Committee believes that the targeted investments under the Pradhan Mantri Ayushman Bharat Health Infrastructure Mission (PM-ABHIM) to establish Integrated Public Health Laboratories and Critical Care Hospital Blocks are paramount for fortifying decentralized pandemic preparedness. The Committee, however, recommends strict administrative monitoring to ensure the timely completion of all pending infrastructural projects under PM-ABHIM. Since without skilled manpower, the infrastructure and equipments keep lying idle and instead become a burden over the exchequer, the Committee further recommends alongside a mandate to continuously upskill frontline healthcare workers at AAMs, thereby ensuring standardized, high-quality primary care delivery from the village to the district level.

(Para 4.1.10)

155.     The Committee takes into account that the exceptional penetration of digital health initiatives, evidenced by the creation of over 93 crore ABHA accounts, 104 crore digital health records, and the execution of 45 crore eSanjeevani teleconsultations, has fundamentally dismantled geographical barriers to specialized healthcare. The Committee believes that sustaining this trajectory of improved continuity of care requires comprehensive participation across the entire healthcare spectrum. The Committee, therefore, recommends that the Government must formulate statutory guidelines to mandate the integration of all private healthcare providers into the Ayushman Bharat Digital Mission (ABDM) ecosystem, while simultaneously expanding regional Tele-MANAS and eSanjeevani hubs to guarantee that specialized psychiatric and medical consultations are uninterruptedly accessible in the most remote areas. The Committee further believes that the teleconsultation interface should by user-friendly and easy to use with smooth functioning. Also to harvest the optimal potential of digital initiatives, the Government should strengthen the internet network in rural and remote areas on a mission mode with proper digital training to ASHA workers and healthcare volunteers, along with basic digital literacy to population.

(Para 4.1.11)

156.     The Committee believes that the unprecedented expansion in medical education infrastructure over the last decade, marked by the growth of medical colleges to over 820 and a near-tripling of undergraduate and postgraduate medical seats, addresses a critical historical deficit in human resources. The Committee, however, is of the view that generating educational capacity must be matched with strategic deployment to effectively reduce regional disparities in tertiary care as envisioned by the Pradhan Mantri Swasthya Suraksha Yojana (PMSSY). The Committee, therefore, recommends the urgent formulation of a targeted national deployment strategy that integrates robust rural service incentives, enhanced infrastructural support for newly established nursing colleges, and preferential professional development pathways to ensure the equitable distribution of skilled medical, nursing, and Ayush practitioners across underserved districts.

(Para 4.1.12)

157.     The Committee is of the view that the unprecedented quantitative expansion of medical infrastructure, evidenced by the growth of medical colleges from 387 to over 820, the increase of AIIMS institutions to 23, and the planned addition of 75,000 medical seats and 157 nursing colleges, must be strictly commensurate with the highest standards of clinical excellence. The Committee believes that merely augmenting physical infrastructure and seat capacity without stringent, continuous evaluation risks diluting the operational proficiency of the national healthcare framework. The Committee, therefore, recommends that the central regulatory councils institute a mandatory, independent annual audit framework to evaluate faculty adequacy, clinical exposure, and infrastructure viability across all newly established or upgraded medical and nursing institutions to ensure uncompromised educational and healthcare delivery standards.

(Para 4.1.13)

158.     The Committee understands that while the empanelment of 38,038 public and private hospitals under AB-PMJAY represents a monumental stride in providing secondary and tertiary care, maintaining uniform quality across this vast network requires intense regulatory scrutiny. The Committee is of the view that periodic legislative and financial oversight is essential not only to prevent fund leakage but also to ensure that the private sector adheres strictly to evidence-based clinical guidelines rather than profit-driven diagnostic redundancies. The Committee, therefore, recommends the formulation of a centralized, data-driven clinical audit authority tasked with periodically reviewing the treatment protocols, patient outcomes, and financial claims of all public and private facilities empanelled under central health assurance schemes.

(Para 4.1.14)

159.     The Committee has come across the heavy reliance on tertiary hospitals for continuous treatments, trauma response, and mental healthcare compromises accessibility and affordability for rural and district-level populations. The Committee believes that the recent policy mandates to decentralize specialized care, specifically the approval of 297 Day Care Cancer Centres (DCCCs) for FY 2025–26 and the 50% capacity expansion of 24×7 Emergency and Trauma Care Centres in district hospitals, constitute a vital structural correction. Furthermore, expanding advanced psychiatric infrastructure through the proposed establishment of NIMHANS-2 in North India and the upgradation of the National Mental Health Institutes in Ranchi and Tezpur into Regional Apex Institutions addresses a critical geographic deficit in mental healthcare.The Committee, therefore, recommends that the Government institute a stringent, centrally monitored timeline for the operationalization of the approved DCCCs and trauma care expansions to guarantee a seamless continuum of care without administrative delays. Furthermore, the Committee recommends proactive inter-ministerial coordination to expedite land acquisition and foundational deployment for NIMHANS-2 and the regional apex institutions, ensuring these centers are systematically integrated with district-level community screening and digital counseling networks to maximize early intervention.

(Para 4.1.16)

160.     The Committee is of the view that the physical infrastructure for specialized care cannot function optimally without a proportionally scaled and highly skilled technical workforce. The Committee believes that the Union Budget announcement to create one lakh allied health professionals through a five-year national roadmap is critical to addressing systemic gaps in diagnostics, peri-operative care, and post-treatment rehabilitation. To effectively navigate demographic and epidemiological transitions, evolving disease patterns, and the broad vision of Viksit Bharat @2047, the scope of these disciplines must transcend the initial Ten Priority Areas.The Committee, therefore, recommends the immediate execution of the five-year national roadmap with an expanded curriculum framework that formally incorporates advanced disciplines, including Critical Care, Respiratory & Cardiac Care, Molecular Diagnostics, Nuclear Medicine, Health Informatics, Geriatric Care, Rehabilitation & Palliative Care, Nutrition Science, and Public Health Laboratory Sciences. The Committee further recommends establishing robust accreditation protocols to ensure these expanded disciplines align strictly with Indian Public Health Standards (IPHS), thereby directly enhancing the operational functionality and quality of both public and private healthcare facilities.

(Para 4.1.17)

161.     The Committee feels that while public healthcare infrastructure is expanding at an unprecedented rate, a significant proportion of the populace remains reliant on the private sector for advanced diagnostic and tertiary care. The Committee believes that true affordability cannot be achieved if private healthcare costs remain fragmented and largely unregulated outside of the government insurance ecosystems. The Committee, therefore, recommends the accelerated, nationwide adoption and stringent enforcement of the Clinical Establishments (Registration and Regulation) Act. Furthermore, the Committee recommends the formulation of a binding national charter of Standard Treatment Guidelines (STGs) to prevent unethical practices, unwarranted diagnostic testing, and arbitrary pricing in private medical facilities, thereby shielding citizens from medical impoverishment.

(Para 4.1.18)

162.     The Committee considers that the ambitious targets set by flagship initiatives, including the rollout of Day Care Cancer Centres, the PM-ABHIM infrastructure projects, and the addition of 75,000 medical seats, are heavily contingent upon sustained and optimally utilized capital outlays. The Committee believes that the mere allocation of central funds is insufficient if systemic administrative bottlenecks at the state level lead to the underutilization of budgetary estimates and subsequent delays in project execution. The Committee, therefore, recommends the institution of a dedicated, multi-tier financial oversight mechanism to rigorously audit quarterly fund utilization by State health departments. This mechanism must strictly link future tranches of central health grants to the verified, on-ground infrastructural progress of the preceding allocations.

(Para 4.1.19)

163.     The Committee notes with satisfaction that the Out-of-Pocket Expenditure (OOPE) has witnessed a precipitous decline to 43.40% of Total Health Expenditure (THE), heavily correlated with the Government Health Expenditure (GHE) increasing its share to 43.70%. The Committee is of the view that the ongoing expansion of essential diagnostics and the massive scale-up of Jan Aushadhi Kendras to 19,200 units have fundamentally transformed affordability for the common citizen. However, acknowledging the critical need for optimal fund utilization across health departments, the Committee believes that sustaining these positive outcomes, including the notable reductions in the Maternal Mortality Ratio and Infant Mortality Rate, requires insulating these financial gains from future inflationary pressures.The Committee, therefore, recommends the formulation of a statutory, multi-year financial outlay roadmap to systematically peg the per capita Government Health Expenditure (currently standing at ₹2,786) to medical inflation and evolving demographic health requirements. Furthermore, the Committee recommends the institution of stringent financial tracking and utilization audits for the expanded medicine procurement networks.

(Para 4.1.21)

164.     The Committee recognizes the unprecedented and aggressive augmentation of the nation's medical education framework, highlighted by the exponential growth of medical colleges from 387 to 818 and the near-tripling of both Undergraduate (128,875) and Postgraduate (82,059) medical seats. The Committee believes that this capacity building, alongside the operationalization of 23 AIIMS institutions, is indispensable for bridging historical deficits, as evidenced by the corresponding surge in registered allopathic doctors to 13.88 lakh and nurses to 42.94 lakh.However, the Committee is of the view that such exponential quantitative growth must be strictly matched with high operational proficiency, adequate faculty deployment, and uncompromising statutory compliance. The Committee, therefore, recommends that the designated national medical and nursing regulatory commissions execute mandatory, bi-annual statutory audits of all newly approved and upgraded medical colleges to meticulously evaluate infrastructural compliance and faculty adequacy. Additionally, the Committee recommends the creation of a specialized deployment policy to strategically integrate this augmented workforce into rural and underserved tier-3 districts, ensuring that the enhanced bed capacity of 8.40 lakh translates directly into accessible, high-quality patient care.

(Para 4.1.22)

165.     The Committee views that while flagship schemes like AB-PMJAY comprehensively protect the economically vulnerable bottom 50% of the population, a substantial segment, comprising approximately 30% of the demographic, often referred to as the "missing middle", remains devoid of structured financial health protection. The Committee believes that addressing this systemic gap is paramount for achieving true Universal Health Coverage.The Committee, therefore, recommends the urgent design and collaborative rollout of low-cost, comprehensive voluntary health insurance products specifically tailored for this demographic. Furthermore, the Committee recommends that the Government utilize robust digital exchange platforms to drive consumer awareness, enforce the regulatory standardization of these new insurance products, and facilitate operational efficiency across both public and private insurers.

(Para 4.1.23)

166.     The Committee takes note of the fact that the private sector manages a dominant share of hospitalized cases across the country, yet its geographic distribution remains disproportionately skewed towards metropolitan centers. The Committee is of the view that highly decentralized regulatory standards, where a vast majority of compliance mandates vary drastically by state, create significant administrative bottlenecks that deter private healthcare investment in Tier-2 and Tier-3 cities.The Committee, therefore, recommends a systemic overhaul of the existing regulatory framework to institute a "Single Window Clearance" mechanism for hospital registrations, blood bank licensing, and medical device manufacturing. The Committee believes that standardizing Clinical Establishment regulations nationally is crucial to improving the ease of doing business, thereby encouraging the expansion of affordable private care into underserved geographies.

(Para 4.1.24)

ROLE OF REGULATORY BODIES

167.     The Committee opines that the National Health Authority (NHA) has successfully driven healthcare equity through the world’s largest public health assurance scheme, generating an estimated ₹1.91 lakh crore in out-of-pocket expenditure (OOPE) savings and authorizing 12.59 crore hospital admissions as of mid-2026. To sustain this momentum and eliminate persistent geographic inequities, a more aggressive approach to hospital network expansion is required.The Committee believes that while the empanelment of 37,413 hospitals (including 17,265 private institutions) has vastly improved tertiary care utilization, significant access gaps remain in underserved and rural districts. The Committee, therefore, recommends that the NHA actively collaborate with state health authorities to prioritize the empanelment of private healthcare facilities in aspirational and remote districts. Furthermore, the Committee is of the view that underutilized healthcare infrastructure managed by various central ministries and Public Sector Undertakings (PSUs) represents an immediate opportunity to scale capacity. The Committee, therefore, also recommends that the NHA institute a fast-track compliance framework to seamlessly empanel all eligible PSU and federal ministry hospitals into the AB-PMJAY network.

(Para 4.2.19)

168.     The Committee further acknowledges the rapid rollout of 1.27 crore Ayushman Vay Vandana cards for senior citizens aged 70 and above, and believes that the NHA must proactively expand specialized health benefit packages (HBPs) to include comprehensive geriatric and palliative care protocols, thereby ensuring that the unique epidemiological needs of the elderly demographic above the age of 60 years are fully met without out-of-pocket vulnerabilities.

(Para 4.2.20)

169.     The Committee appreciates view that the establishment of the Ayushman Bharat Digital Mission (ABDM) has laid down a robust foundation for a modern digital public infrastructure, as demonstrated by the creation of 93.98 crore ABHA accounts and the linking of 105.27 crore health records by July 2026,however, the true potential of an interoperable health ecosystem can only be realized through universal adoption across both public and private sectors.The Committee believes that the low-cost digital tools developed by the NHA, such as e-Sushrut@Clinic and the AIIMS-validated Clinical Decision Support System (CDSS), are vital instruments to digitize smaller clinics and primary facilities without placing an administrative burden on clinicians. The Committee, therefore, recommends that the NHA mandate a phased, nationwide integration of all private diagnostic centers and hospitals into the National Health Claims Exchange (NHCX) and Unified Health Interface (UHI) gateways. The Committee is assured that such approval would further standardize digital health claims, accelerate cashless settlements, and reduce information asymmetry for patients booking consultations or locating generic medicines.

(Para 4.2.21)

170.     Furthermore, the Committee is of the considered view that the revamped Aarogya Setu 2.0 app must be utilized as the central, citizen-facing node for longitudinal health records. The Committee, therefore, recommends intensive localized awareness campaigns to ensure citizens actively utilize consent-based data sharing, thereby avoiding the repetitive costs and logistical challenges associated with lost physical diagnostic reports.

(Para 4.2.22)

171.     The Committee understands that primary healthcare units serve as the critical gatekeeper of the national healthcare framework, and their optimal performance directly mitigates the overcrowding of tertiary facilities. While the deployment of over 1.86 lakh Ayushman Arogya Mandirs (AAMs) has registered an impressive 540 crore patient visits, standardizing the quality of care across all regions remains an unfulfilled mandate.The Committee believes that primary care must transcend basic consultations to deliver the full spectrum of the 12 Comprehensive Primary Health Care (CPHC) service packages, with a particular focus on underserved domains like mental health, eye care, and oral hygiene. The Committee, therefore, recommends that the government establish rigid, uniform criteria for an "IPHS-Compliant Functional AAM," explicitly binding central fund disbursements to the verified availability of human resources, essential drugs, and functional diagnostic tools.

(Para 4.2.23)

172.     To achieve a seamless continuum of care, the Committee envisages that localized screening data must be structurally linked to advanced treatment platforms. The Committee, therefore, recommends that the NHA completely digitize the Community-Based Assessment Checklist (CBAC) used by frontline workers, integrating it directly with ABHA IDs and the National Non-Communicable Diseases (NCD) portal to establish automated, digital referral pathways from village sub-centers directly to empanelled secondary and tertiary hospitals.

(Para 4.2.24)

173.     The Committee is of the view that specialized oncological, trauma, and psychiatric care must be aggressively decentralized to shield rural citizens from catastrophic travel and treatment costs. The budget mandates for FY 2025–26 and 2026–27, including the approval of 297 Day Care Cancer Centres (DCCCs), a 50% capacity expansion of Emergency Care in district hospitals, and the establishment of NIMHANS-2, represent vital policy interventions that require rapid execution.The Committee believes that specialized physical infrastructure cannot function in a vacuum without a parallel, highly specialized workforce. The Committee, therefore, recommends that the government implement the Union Budget announcement for the creation of one lakh allied health professionals through a strict, time-bound 5-year national roadmap.

(Para 4.2.25)

174.     The Committee is of the further view that to align with evolving disease patterns and the overarching vision of Viksit Bharat @2047, the training curriculum must expand beyond basic health roles. The Committee, in this regard, recommends the formal inclusion of advanced technical disciplines, specifically Critical Care, Respiratory & Cardiac Care, Molecular Diagnostics, Nuclear Medicine, Health Informatics, and Public Health Laboratory Sciences, into this national roadmap. This diversification will ensure that both newly constructed Critical Care Hospital Blocks under PM-ABHIM and private tertiary centers are permanently equipped with a world-class, IPHS-compliant workforce.

(Para 4.2.26)

175.     The Committee understands that the long-term financial sustainability and affordability of the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) are intrinsically linked to robust regulatory oversight and the absolute prevention of resource leakage. The Committee notes that the National Health Authority (NHA) processes massive volumes of daily claims and has proactively deployed Artificial Intelligence (AI) and Machine Learning (ML) models, including an Auto-Adjudication Engine (AAE), to detect anomalous clinical scenarios, document forgery, and deepfake medical records.The Committee believes that minimizing fraud, waste, and misabuse is paramount to ensuring that finite public funds are strictly utilized for genuine beneficiaries rather than unscrupulous entities. The Committee, therefore, recommends that the NHA aggressively scale up its AI-driven National Anti-Fraud Unit (NAFU) algorithms to proactively flag irregular treatment patterns, inflated billing, and manipulated radiological images across all empanelled public and private hospitals.

(Para 4.2.27)

176.     Furthermore, the Committee is conscious of the fact that technological deterrence must be matched with strict administrative action. The Committee, therefore, recommends instituting stringent, real-time punitive protocols, including immediate de-empanelment and heavy fiscal penalties, for clinical establishments engaged in fraudulent practices. Concurrently, the Committee recommends that these advanced auto-adjudication mechanisms be optimized to significantly reduce claim settlement turnaround times for compliant healthcare providers, thereby maintaining a high degree of trust and incentivizing wider private sector participation in the scheme.

(Para 4.2.28)

NATIONAL PHARMACEUTICAL PRICING AUTHORITY (NPPA)

177.     The Committee is of the view that the "trade margin rationalisation" (TMR) pilot projects executed by the National Pharmaceutical Pricing Authority (NPPA) have proven effective in enhancing healthcare affordability. Capping trade margins at 30% for 42 non-scheduled anti-cancer medicines and at 70% on the price to distributor (PTD) for critical medical devices (including oxygen concentrators, pulse oximeters, and glucometers) has yielded cumulative annual savings exceeding ₹1,984 crore for consumers. The Committee, however, believes that expanding this framework is vital to combat predatory markups, given that the collective average markup for common dosage forms currently stands at approximately 43%.The Committee, therefore, recommends that the Government should establish a permanent statutory framework for trade margin rationalisation under the Drugs (Prices Control) Order (DPCO), 2013, extending price caps to a broader spectrum of high-cost, non-scheduled chronic disease formulations. However, the Committee notes the legitimate operational concerns raised by micro, small, and medium enterprises (MSMEs) that heavily rely on traditional trading channels for market access. The Committee, therefore, recommends that the finalized TMR framework may incorporate a graded markup structure that shields low-cost MSME manufacturers from institutional displacement while consistently protecting the end consumer.

(Para 4.2.35)

178.     The Committee is of the view that the mandate of the NPPA extends beyond capping expenditure to ensuring the continuous, unhindered market availability of life-saving therapeutics. The Committee notes that the historic implementation of DPCO, 2013 has driven down Indian medicine costs to among the lowest globally, generating annual savings of ₹26,055 crore. The Committee, however, believes that extreme pricing pressures must not lead to commercial unviability, which inadvertently forces critical formulations off the market and compels patients to resort to high-cost alternatives.The Committee notes that the NPPA has periodically exercised its emergency powers under Paragraph 19 of DPCO, 2013, most recently in June 2026 via S.O. 3004(E) & 3005(E), to grant one-time 50% upward revisions on essential ceiling prices to preserve supply lines. The Committee, in this regard, recommends that the Government formalize a fast-tracked, data-driven institutional mechanism within the NPPA to monitor raw material costs (such as Active Pharmaceutical Ingredients) allowing for the proactive, temporary invocation of Paragraph 19 before market scarcities manifest. Concurrently, the Committee recommends that the strict enforcement of guidelines governing the discontinuation of scheduled formulations be coupled with strategic production directives under Paragraph 3 to prevent artificial or structural drug shortages.

(Para 4.2.36)

179.     The Committee is of the view that the formulation-based, market-data average pricing approach under DPCO, 2013 ensures fairness and objectivity, yet its success ultimately relies on absolute implementation compliance at the retail level. While the NPPA has established a clear ceiling price for 935 formulations and fixed 3,845 retail prices for new drugs as of July 2026, information asymmetry remains an operational challenge for the average citizen.The Committee believes that digital public infrastructure is the most potent weapon to bridge this gap. The Committee, therefore, recommends that the Government must mandate the real-time synchronization of the Integrated Pharmaceutical Database Management System (IPDMS 2.0) with state drug control portals to enforce the 10% annual price-increase cap on non-scheduled drugs. Furthermore, the Committee recommends that the Pharma Sahi Daam mobile application be proactively promoted through nationwide public health networks. The Committee, moreover, views that strict compliance audits must be instituted to enforce the statutory mandate requiring retailers to conspicuously display official manufacturer price lists, ensuring that the financial benefits of NPPA price regulations are transparently and fully passed on to patients at the point of purchase.

(Para 4.2.37)

180.     The Committee is of the view that the definition of healthcare accessibility has evolved significantly, making advanced medical devices and complex combination formulations fundamental to modern tertiary treatment. The historical inclusion of coronary stents, knee implants, condoms, and intra-uterine devices within the National List of Essential Medicines (NLEM) has directly protected millions from catastrophic medical debt, with coronary stent price caps alone generating an unprecedented ₹13,353 crore in annual consumer savings.The Committee believes that as technology advances, the scope of the NLEM must dynamically expand to match emerging epidemiological realities. The Committee, therefore, recommends that the Standing National Committee on Medicines (SNCM) systematically evaluate and incorporate high-volume diagnostic and therapeutic medical devices, such as advanced pacemakers, ophthalmic lenses, and implantable pumps, into the scheduled list of the DPCO. Additionally, noting that the NPPA has successfully regulated 3,845 "new drugs" (including 1,380 anti-diabetic and 677 cardiovascular formulations) to control cost variations in altered dosages and combinations, the Committee, in this direction, recommends that the scrutiny of fixed-dose combinations (FDCs) be intensified to prevent manufacturers from bypassing ceiling price regulations through minor structural changes to scheduled drugs.

(Para 4.2.38)

181.     The Committee is of the considered view that while pro-active price regulation is paramount for patient protection, the regulatory framework must concurrently stimulate domestic pharmaceutical research and the development of advanced therapeutic delivery systems. The Committee notes that under Paragraph 32 of the Drugs (Prices Control) Order, 2013, the National Pharmaceutical Pricing Authority (NPPA) has successfully incentivized innovation by granting critical price control exemptions to 14 newly patented or indigenously researched products.The Committee believes that such strategic exemption serves as a vital catalyst for the Indian pharmaceutical sector to transition from generic manufacturing to pioneering advanced drug discovery. The Committee, therefore, recommends that the Government should establish a dedicated, fast-track evaluation cell within the NPPA and the Department of Pharmaceuticals to objectively assess and expedite these Paragraph 32 exemptions, explicitly prioritizing breakthrough treatments in oncology, rare diseases, and antimicrobial resistance.

(Para 4.2.39)

182.     The Committee, however, is of the view that this commercial incentive must not inadvertently foster prolonged monopolies that lock out vulnerable patient demographics. The Committee, therefore, recommends the enforcement of a strict, automated statutory transition protocol. This mechanism must ensure that immediately upon the expiration of the mandated five-year exemption window, these innovative formulations are seamlessly brought under standard DPCO retail price caps without administrative delay, thereby guaranteeing that the benefits of scientific advancement ultimately translate into affordable, mass-market access.

(Para 4.2.40)

INSURANCE REGULATORY AND DEVELOPMENT AUTHORITY OF INDIA (IRDAI)

183.     The Committee is of the view that while the National Sample Survey (NSS) 80th Round (2025) indicates notable progress with 46% of the population covered under at least one health insurance or financing scheme, expanding coverage alone cannot guarantee affordability if private sector healthcare costs remain uncontained. The Committee notes with concern that households continue to face massive financial strain when accessing private healthcare, where the average out-of-pocket expenditure (OOPE) per hospitalization episode stands at ₹34,064, substantially higher than the protective, low-cost environment of public hospitals. This problem is severely compounded by an annual medical inflation rate of 10-13% that significantly outpaces general inflation, driven by a lack of standardized treatment protocols and exploitative differential billing practices, such as room rent-linked pricing for clinical procedures. The Committee believes that collaborative regulatory intervention between the Insurance Regulatory and Development Authority of India (IRDAI) and healthcare providers is imperative to stabilize the ecosystem. The Committee, therefore, recommends that the Government, utilizing the multi-stakeholder Working Groups constituted by IRDAI and the Confederation of Indian Industry (CII), formalize a statutory framework to implement standardized treatment guidelines and cap arbitrary price variations. Specifically, the Committee recommends the elimination of room rent-linked inflation models for standard procedures across all private hospitals to protect citizens from catastrophic out-of-pocket expenses.

(Para 4.2.46)

184.     The Committee is of the view that the health insurance ecosystem has become an indispensable pillar of financial protection, as demonstrated by the settlement of 3.26 crore health insurance claims amounting to ₹94,248 crore during FY 2024–25. However, the Committee notes that the financial sustainability of this risk-pooling framework is heavily undermined by integrity risks, including provider-induced demand, fraudulent or fictitious billing, and ineligible beneficiaries, which systematically drive up claim costs and insurance premiums. The Committee believes that robust, unified digital infrastructure is the most effective mechanism to introduce absolute transparency and efficiency into claims management. The Committee, therefore, recommends that the Government mandate the universal onboarding and participation of all private hospitals and healthcare providers onto the National Health Claims Exchange (NHCX) platform developed by the National Health Authority (NHA). Concurrently, the Committee recommends that IRDAI expedite the full deployment of the Public Insurance Registry (PIR) as a foundational Digital Public Infrastructure to facilitate secure, consent-based information sharing, minimize late-stage claim settlement disputes, and eliminate systemic leakages.

(Para 4.2.47)

185.     The Committee is of the view that making health insurance accessible to an aging population undergoing an epidemiological transition requires the absolute removal of systemic entry barriers that have historically penalized vulnerable demographics, particularly senior citizens of 60 years of age and above individuals with chronic non-communicable diseases (NCDs). The Committee commends the landmark consumer-centric reforms introduced by IRDAI, including the removal of maximum entry age caps, the reduction of pre-existing disease (PED) waiting periods from four years down to three years, the reduction of the moratorium limit to five years, and the mandate for universal AYUSH coverage. The Committee believes that these progressive guidelines must be backed by strict regulatory penalties to prevent insurance companies from creating artificial compliance bottlenecks or hidden exclusions. The Committee, therefore, recommends that IRDAI institute a rigorous compliance audit framework to ensure absolute adherence to the mandated three-hour turnaround time for cashless discharge approvals to eliminate hospital exit delays. Furthermore, the Committee recommends that the Sub-Committee of the Insurance Advisory Committee be directed to design affordable, micro-insurance model products specifically calibrated for late-entrants and low-income households to solidify universal health coverage.

(Para 4.2.48)

186.     The Committee is of the view that the traditional health insurance model, which primarily covers secondary and tertiary hospitalization, is fundamentally misaligned with India's ongoing epidemiological transition. The Committee notes from the provided data that the rising prevalence of non-communicable diseases (NCDs), such as diabetes, hypertension, and cardiovascular diseases, necessitates continuous, lifelong medical management rather than episodic hospitalization. The Committee observes that the average out-of-pocket expenditure (OOPE) for outpatient care currently stands at ₹861 per treatment episode. The Committee believes that relying exclusively on hospitalization-centric insurance products leaves policyholders vulnerable to the compounding, long-term financial burden of routine chronic care.The Committee, therefore, recommends that the Insurance Regulatory and Development Authority of India (IRDAI) mandate the integration of comprehensive Outpatient Department (OPD) coverage into standard health insurance frameworks. Furthermore, the Committee recommends that insurers design specialized products that explicitly subsidize the recurring costs of lifelong diagnostics, pharmacy bills, and specialist consultations for NCDs, thereby, securing financial protection across the entire continuum of care.

(Para 4.2.49)

187.     The Committee is of the view that the financial burden of childbirth within the private healthcare sector remains disproportionately high, directly undermining the broader objective of healthcare affordability. The Committee notes that the average expenditure for childbirth across all hospitals is ₹14,775, which is substantially higher than the corresponding out-of-pocket expenditure in public health facilities. The Committee believes that maternity care is a fundamental healthcare requirement and must not be a source of structural financial distress for households.The Committee, therefore, recommends that IRDAI introduce regulatory guidelines compelling insurers to offer standardized maternity benefits as a core, accessible component of base health insurance products, rather than categorizing them as heavily restricted or premium add-on riders. Concurrently, the Committee recommends that the multi-stakeholder Working Groups explicitly prioritize the standardization of maternity and childbirth treatment protocols across empanelled private hospitals, ensuring that institutional delivery costs are stringently regulated and transparently priced.Recognizing the need for coordinated reforms, IRDAI, in collaboration with CII, has constituted multi-stakeholder Working Groups to examine healthcare costs, treatment standardization, fraud mitigation, common empanelment, NHCX adoption, transparency and consumer protection. In parallel, IRDAI is developing the Public Insurance Registry (PIR) as a Digital Public Infrastructure to enable secure, consent-based sharing of insurance information, simplify policy servicing and improve transparency and efficiency. The Committee strongly recommends for transparency in claim settlements through a Public Insurance Registry so that inflated claims are reduced by corporate hospitals and there is a check on such malpractices.

(Para 4.2.50)

INTERPRETING NATIONAL HEALTH ACCOUNTS ESTIMATES FOR INDIA 2022-23 ON “HEALTH INSURANCE EXPENDITURES”

188.     Health Insurance constitutes health-financing schemes financed by contributions/ premiums collected from individuals or Governments and pooled to actively purchase services from healthcare providers either by the Government (health department or government-governed Corporation/Trust/Society) and/or insurance company. The Committee observed from the National Health Accounts Estimates for India 2022-23 that expenditures of the following five types of health financing schemes are considered health insurance expenditures: (i) Social health Insurance (Central Government Health Scheme, Employees’ State Insurance Scheme, and Ex- Servicemen Contributory Health Scheme); (ii) Government Financed Health Insurance Schemes (of both Union and State Governments); (iii) Employer-based insurance - other than enterprise schemes (Private Group Health Insurance); (iv) Other primary coverage schemes (Private Individual Health Insurance); and (v) Community-based health insurance.

(Para 4.2.51)

189.     The Committee has thoroughly analyzed the data derived from the National Health Accounts Estimates regarding Health Insurance Expenditure (2022-23). The Committee is of the view that the overwhelming dominance of private health insurance expenditure, standing at ₹81,012 crores and substantially dwarfing both Social Health Insurance (₹32,090 crores) and Government-Financed Insurance, exposes a massive segment of the population to unregulated medical inflation and exorbitant out-of-pocket costs due to exclusionary policies. The Committee, therefore, recommends that the regulatory authorities institute a stringent pricing and coverage framework to standardize all private health insurance policies nationwide. The Committee believes that private insurance providers must be statutorily mandated to align their reimbursement structures and package caps with government-approved clinical protocols. By legally curbing arbitrary premium escalations and mandating the inclusion of comprehensive outpatient department (OPD) care, the catastrophic financial burden on the middle-class demographic can be sustainably contained.

(Para 4.2.52)

190.     The Committee believes that the extraordinarily negligible expenditure of merely ₹10 crores in Community-Based Health Insurance represents a severe underutilization of grassroots financial risk protection, particularly for the vast informal sector that remains largely ineligible for employer-based private insurance or specific central schemes. The Committee, therefore, recommends that the government aggressively catalyze the expansion of community-level cooperative insurance models. The Committee is of the view that the Ministry of Health should introduce a formal "matching grant" framework to systematically inject public capital into these local community pools. This structural subsidization will empower rural and marginalized collectives to collectively pool risks and negotiate affordable, localized healthcare rates with regional medical facilities.

(Para 4.2.53)

CENTRAL DRUGS STANDARD CONTROL ORGANISATION (CDSCO)

191.     The Committee is of the view that ensuring the availability of high-quality, safe, and effective medical devices across both public and private health institutions is paramount to building public trust and avoiding substandard clinical outcomes. The Committee notes that under the risk-based classification framework of the Medical Devices Rules (MDR), 2017, the Central Drugs Standard Control Organisation (CDSCO) has successfully licensed 3,480 manufacturing units for Class A & B devices, 1,100 manufacturing units for Class C & D devices, and approved 12,866 import license applications as of July 1, 2026. Furthermore, to secure the supply chain, the Committee notes that CDSCO issued a circular on November 25, 2025, mandating that all procurement agencies, hospitals, and health institutions must require a valid CDSCO or State Licensing Authority (SLA) license for the procurement of medical devices. The Committee believes that structural accountability must be institutionalized through technology without human interface to ensure that uncertified or non-compliant equipment does not penetrate the healthcare delivery network.The Committee, therefore, recommends that the Ministry of Health and Family Welfare should impress upon the concerned State Government to stringently monitor the compliance of the November 25, 2025 Procurement Mandate across all public and private entities to verify that only legally licensed, globally compliant technologies reach patients. The Committee, furthermore, recommends the Government to encourage the State Governments to fully utilize the powers delegated under the MDR, 2017 to establish and notify additional Medical Device Testing Laboratories (MDTLs), expanding beyond the currently registered 84 MDTLs and 18 Notified Bodies. The Committee is of the firm view that expanding this public testing infrastructure and deploying the pool of 258 notified Medical Device Officers (MDOs) will drive robust domestic quality assurance, ultimately making safe medical technologies accessible to all socioeconomic strata.  The Committee recommends for greater autonomy to State Licensing Authorities forlicensing of  medical devices as per quality approved by  notified laboratorieswhich are approved  by the QCI.

(Para 4.2.57)

192.     The Committee is of the further view that the heavy financial dependency on high-cost, imported medical technologies significantly inflates out-of-pocket expenditures for patients across India. The Committee notes that the "MedTech Mitra" program, a collaborative ecosystem co-launched by NITI Aayog, ICMR, and CDSCO, has emerged as a vital mechanism for domestic indigenization, having received 856 applications, conducted 53 Technical Advisory Committee (TAC) meetings, and provided structured lifecycle handholding to 798 innovators. This end-to-end facilitation spans crucial operational areas, including regulatory strategy guidance for 611 innovators, test license facilitation for 74 innovators, and the establishment of 21 proofs of concept. The Committee believes that systematically addressing technical, clinical, manufacturing, and market-entry barriers via indigenous innovation is the most sustainable approach to introducing cost-effective alternatives into the market. The Committee, therefore, recommends that the Government to significantly scale up the budgetary and institutional capacity of the MedTech Mitra platform to accelerate the commercialization of domestic technologies. The Committee is of the considered view that CDSCO must streamline its processes to fast-track test license facilitation, funding support for pre-clinical/clinical trials, and final manufacturing licenses for innovators transitioning through designated platform. The Committee understands that by fostering a highly competitive domestic manufacturing ecosystem, the resulting market competition will naturally reduce medical device acquisition costs for both public and private hospital networks.

(Para 4.2.58)

193.     The Committee has been given to understand that protracted regulatory timelines, administrative redundancies, and high compliance burdens inadvertently inflate the final market cost of medical devices, thereby hurting healthcare accessibility. The Committee takes into account that CDSCO has instituted progressive digital transformation measures under the MDR, 2017 policy measures, including the automated allocation of applications to reviewers, the auto-generation of regulatory certificates, and centralized online modules for compliance management. The Committee recommends the policy reforms aimed at reducing manufacturing license timelines, specifically cutting Class B approval timelines from 140 days to 115 days, and Class C & D timelines from 105 days to 90 days. The Committee believes that maximizing efficiency through digital framework is fundamental to improving the ease of doing business without diluting safety parameters.The Committee, therefore, recommends that the Government formally notify and implement the shortened manufacturing license timelines (115 days for Class B; 90 days for Class C & D) to eliminate operational delays. The Committee further recommends that CDSCO expand its centralized online portal to integrate automated post-approval changes (PACs) and finalize clear, distinct regulatory pathways for digital health and artificial intelligence-based medical software. The Committee is of the view that lowering these entry barriers will incentivize greater private sector investment in manufacturing, optimize supply chain timelines, and translate administrative savings into reduced treatment costs for patients.  The Committee strongly believes that undertaken policy reforms and action plan would definitely promote indigenization and import substitution, thereby promoting accessibility and affordability of healthcare facilities. The Committee hopes that Medical Device Rules, 2017 would further strengthen India’s healthcare sytem by ensuring safer high quality medical devices, of course, promoting greater affordability and wider access to healthcare services. The need of the hour is to provide quality care at an affordable cost to the cross-section of the society.

(Para 4.2.59)

194.     The Committee is of the view that pharmaceutical expenditures continue to constitute a massive proportion of out-of-pocket health spending for the general public, forcing an unsustainable reliance on expensive, branded, or patented foreign pharmaceuticals. The Committee observes that CDSCO holds the definitive statutory mandate under the Drugs and Cosmetics Act, 1940 to prescribe drug standards and regulate the safety, efficacy, and quality of imported and domestically produced medical products. The Committee believes that the strategic deployment of regulatory fast-tracks for generic variants represents the most direct public health mechanism to democratize access to critical therapies. The Committee, therefore, recommends that CDSCO drastically speed up its clinical trial evaluation and licensing framework specifically tailored for generic medications. The Committee recommends that the regulatory machinery focus on rapidly approving high-quality, low-cost bio-equivalents to flood the public and private markets, effectively disrupting monopolies held by expensive foreign brands. The Committee believes that coordinating closely with State Drug Control Authorities for uniform enforcement will ensure that these affordable, generic alternatives maintain impeccable therapeutic equivalence, protecting both patient pocketbooks and clinical safety standards.

(Para 4.2.60)

195.     The Committee visualizes that since India scales its domestic medical device ecosystem, there is urgent need for maintaining long-term regulatory agility and market trust that requires the continuous strengthening of administrative human capital and the decentralization of oversight mechanisms. The Committee notes that critical institutional steps have already been taken, such as the delegation of Post-Approval Change (PAC) and Risk-classification decisions to Deputy Drugs Controllers (DDCs) to accelerate regulatory throughput. Furthermore, the regulatory framework has sought to build technical capacity through the recruitment of additional manpower, targeted training programs for inspectors, and active collaboration with international regulatory bodies to achieve alignment with global best practices. The Committee believes that ensuring uniform enforcement of the Medical Devices Rules (MDR), 2017 across all jurisdictions is vital for preventing regulatory fragmentation and maintaining high safety standards. The Committee, therefore, recommends the Ministry of Health and Family Welfare should establish a permanent, mandatory training and capacity-building framework for the expanded pool of 258 Medical Device Officers (MDOs) and State inspectors, focusing heavily on advanced risk-based classifications and Quality Management System (QMS) audit techniques in coordination with the 18 registered Notified Bodies. Concurrently, the Committee recommends that the Medical Device Technical Advisory Group (MDTAG) be mandated to hold fixed, quarterly statutory assemblies to drive continuous policy reforms, systematically evaluate international regulatory updates, and formalize global harmonization pathways. The Committee is of the view that these proactive governance measures are essential to eliminating localized regulatory delays, reducing compliance errors for domestic enterprises, and solidifying India’s position as a highly credible, globally compliant manufacturing hub for affordable medical technologies.

(Para 4.2.61)

196.     The Committee is of the considered view that genuine indigenous manufacturing, rather than the mere assembly of imported components, is vital to securing healthcare self-reliance and reducing lifecycle costs. The Committee notes reports indicating the potential misuse of the 'Make in India' clause by entities that simply assemble imported components, particularly from China, to secure government contracts. The Committee believes that relying exclusively on current self-certification requirements and statutory documentation is insufficient for verifying the origin of high-value medical technologies. The Committee, therefore, recommends the implementation of a rigorous, mandatory verification mechanism for companies participating in Government procurement. This comprehensive framework must require a minimum of 40% local value addition, enforce component-level traceability, and mandate the submission of digital Bills of Materials (BoM). Furthermore, the Committee recommends that such mechanism include periodic third-party audits, strict country-of-origin disclosures for critical components, and independent verification of local content to ensure complete supply chain integrity and foster true domestic technology development.

(Para 4.2.62)

197.     The Committee is of the view that centralized, shared infrastructure models, which provide design, precision manufacturing, testing, validation, and clinical research facilities under one roof, significantly reduce capital investment requirements for individual companies and accelerate product development timelines. The Committee notes that the original 270-acre campus of the Visakhapatnam MedTech Park (AMTZ) is entirely allotted and fully utilized, necessitating immediate expansion to meet the growing demands of the industry and advance the strategic goal of contributing 25–30% of India's medical device market. The Committee, therefore, recommends the expedited acquisition and allocation of an additional 300–350 acres of contiguous land adjoining the existing AMTZ campus to support facility expansions and accommodate new investments. The Government should also replicate the success of Visakhapatnam MedTech Park in other such parks in Odisha, Jharkhand, West Bengal, Bihar and Uttar Pradesh for medical devices and increase the number of MedTech Parks in different regions of the country viz. Odisha, Jharkhand, West Bengal, Bihar and Uttar Pradesh to promote local manufacturing and to provide world-class facilities to Medical Device industry in India by replicating AMTZ model. To further catalyze the growth and global competitiveness of the domestic medical device sector, the Committee recommends the formal introduction of an "Innovation Passport" mechanism designed to provide faster regulatory approvals and seamless access to global markets. Additionally, the Committee believes that the Government must deploy targeted financial and operational incentives, specifically including stamp duty and registration fee exemptions, capital and research subsidies, and duty exemptions on critical components.

(Para 4.2.63)

198.     The Committee, in nutshell, desires that the government must continue to strengthen the regulatory eco-system through simplified compliance procedures, expansion of notified testing laboratories and regulatory personnel, including institutions such as MedTech Mitra.  The Committee believes that continuous policy measures including simplified licensing for low-risk devices enhanced testing infrastructure and procurement of only licensed devices by hospitals and Government agencies would further instill regulatory compliance and market confidence.  The Committee is of the considered view that when implemented on ground level it would definitely promote domestic manufacturing increase competition reduced regulatory burden and improved availability of safe, quality assured and affordable medical devices across both public and private healthcare sectors, thereby ensuring India’s position as an global MedTech hub and leader.

(Para 4.2.64)

199. The Committee is of the view that the technical rigour and specialised expertise required for evaluating increasingly complex drug formulations and biologics cannot be sustained through the existing generalist administrative structure of the Central Drugs Standard Control Organisation (CDSCO). The Committee notes that persistent vacancies in the cadre of Drugs Controllers have continued to constrain the organisation's day-to-day regulatory throughput. The Committee believes that a dedicated technical workforce, distinct from general administrative staff, is essential to keep pace with global scientific and regulatory developments. The Committee, therefore, recommends that the Government expeditiously create a Specialist Core Cadre and a Scientific Review Cadre within CDSCO to institutionalise domain-specific technical evaluation capacity. The Committee, in concise, recommends that all existing vacancies of Drugs Controllers be filled on a time-bound basis, so that vacancy in CDSCO vis-à-vis sanctioned regulatory strength is not allowed to remain a bottleneck to approval timelines.

(Para 4.2.65)

200. The Committee has been given to understand that the sequential nature of laboratory testing and clinical trial processes has been a significant contributor to delays in bringing new drugs to market, thereby indirectly raising costs and restricting timely access to therapies. The Committee believes that regulatory speed can be substantially improved without compromising scientific scrutiny by re-engineering the processes to run concurrently rather than in sequence. The Committee, therefore, recommends that CDSCO introduce parallel processing of laboratory testing and clinical trial evaluation, supported by a Single-Window Clearance System, to eliminate redundant procedural handoffs and reduce the cumulative time taken for testing and trial approvals. The Committee also recommends the Government to substantially expand the authorised testing ecosystem by empanelling additional public and private laboratories, covering both drugs and all categories of medical devices, that meet accreditation and competency benchmarks prescribed by Quality Council of India &CDSCO, besides existing CDSCO-affiliated laboratories must be upgraded in a phased manner under defined annual plans to keep testing infrastructure aligned with rising demand and evolving product complexity.  The Committee strongly recommends for decentralization of A&B medical devices to State Level Authority (SLA) so that respective State Government can be empowered to create a positive regulatory mechanism and also to increase competition amongst various State Governments to attract Global companies to set up manufacturing base in their States helping the entire country in turn.  As both Health and Industry are State subject, it would be appropriate for the State Government to regulate A&B medical devices to notified laboratories.

(Para 4.2.66)

 201. The Committee is of the view that regulatory approval alone is insufficient to guarantee drug quality unless it is matched by robust oversight of the distribution chain through which medicines reach patients. The Committee believes that gaps in traceability create vulnerabilities for the entry of substandard or spurious drugs into the supply chain. The Committee, therefore, recommends that the Government enforce end-to-end traceability of pharmaceutical products and mandate strict compliance with Good Distribution Practices (GDP) across manufacturers, distributors, and retailers. The Committee further recommends the creation of a unified Digital Drug Regulatory System (DDRS) that seamlessly connects Central and State drug regulators on a common technology platform, with an inbuilt Risk Management System to enable real-time monitoring, early identification of quality risks, and coordinated enforcement action. The Committee is of the view that these measures, taken together, will yield a strengthened, transparent, and technology-enabled drug regulatory framework marked by faster approvals, enhanced quality assurance, expanded testing capacity, and improved safety of drugs for the public.

(Para 4.2.67)

QUALITY COUNCIL OF INDIA (QCI)

202.     The Committee is of the view that while the quality ecosystem in India has grown significantly, hospital and laboratory accreditation remains largely voluntary and driven by market pull. To uniformly strengthen the safety, reliability, and quality of healthcare services, a standardized baseline must be established across both public and private sectors. However, this transition must not result in regulatory choking or administrative delays. The Committee, therefore, recommends that the Ministry of Health and Family Welfare, in coordination with QCI, formulate a phased roadmap to transition to mandatory entry-level quality certification. To prevent operational bottlenecks, such transition must be powered by QCI’s newly announced Single, Paperless, Modular One-stop Accreditation Platform to replace legacy multi-portal systems, alongside the Quality Setu ticket-based system for time-bound grievance redressal. This transition should prioritize clinical establishments sequentially, so that benchmarks are progressively elevated to full NABH and NABL standards. To support this massive scaling, the Committee recommends expanding the national assessor pool by lowering entry barriers to bring in young experts, thereby, ensuring robust last-mile reach and drastically reducing turnaround times.

(Para 4.2.72)

203.     The Committee believes that the stark urban-rural divide in healthcare infrastructure can be effectively bridged by leveraging low-cost certification structures. However, rigid compliance norms and capital strain have historically prevented smaller, semi-urban facilities from entering the formal quality ecosystem. The Committee, therefore, recommends that the government continuously expand the NABH "Entry-Level Certification" programs, specifically targeting smaller facilities in tier-2, tier-3, and rural areas by operationalizing QCI's relaxed accreditation norms that allow hospitals with even 20% occupancy to apply. To accelerate adoption without placing capital strain on smaller entities, the enforcement framework must shift from blanket bans to graded penalties coupled with guidance and course correction. Furthermore, direct and hands-on lifecycle support must be provided through NABH’s MITRA programme, utilizing trained and officially empanelled mentors to actively guide small-town hospitals. This must be supplemented by the Gunvatta Pathshala initiative to provide role-based skilling for doctors, nurses, and technicians in patient safety, while utilizing AI-assisted desktop surveillance and desk-based monitoring for consistently performing hospitals to minimize the friction of physical inspections.

(Para 4.2.73)

204.     The Committee is of the view that institutionalizing efficiency and eliminating waste are critical parameters for optimizing public expenditure and making tertiary care accessible to the masses. The partnership between QCI and the National Health Authority (NHA) to fast-track empanelment for certified hospitals under Ayushman Bharat (PM-JAY) is an excellent mechanism, but it requires deeper structural optimization to transition from an inspection-heavy model to a trust-based ecosystem. The Committee, therefore, recommends that such digital health certification framework be deeply integrated into all central and state government insurance schemes, deliberately pivoting from rigorous inspection to a high-trust, low-friction environment characterized by reduced paperwork and shorter processing timelines. State governments should mandate that any private or public medical institution seeking public empanelment must possess a verified QCI quality certification. By utilizing technology-driven systems to accelerate processes, such integration would maximize the fiscal efficiency of public health budgetary allocations and fast-track cashless care delivery for vulnerable populations.

(Para 4.2.74)

205.     The Committee believes that diagnostic accuracy is the bedrock of affordable healthcare, as spurious or incorrect laboratory results lead to repetitive testing, misdiagnoses, and compounding medical costs. While scaling up legitimate laboratories, the state must simultaneously empower consumers and eliminate the administrative lag that keeps quality labs outside the accredited network. The Committee, therefore, recommends strict regulatory clampdowns on unaccredited, self-declared commercial testing labs. To rapidly expand the network of verified labs, QCI’s NABL reforms must be fully deployed, including the introduction of a model scope for medical testing laboratories to ensure nationwide uniformity, a 48-hour self-declaration window for approving authorized signatories, and 48-hour scope extensions for similar testing methods to eliminate long waiting periods. Additional fees for product-based accreditation must be eliminated where test parameters are already covered. To ensure the technical sustainability of laboratory ecosystem, the government must support the technical skilling initiatives aimed at training 5,000 laboratory personnel in 2026. Furthermore, to protect citizens from fraudulent, substandard clinics, the government must systematically scale up the newly unveiled "Q Mark – Desh ka Haq" reform. This QR-coded Mark of Quality must be prominently integrated into public health portals and physically mandated at the entrance of every clinical laboratory, ensuring full public disclosure, eliminating fake certificates, and allowing ordinary citizens to instantly verify a facility's authentic certification status.

(Para 4.2.75)

NATIONAL MEDICAL COMMISSION (NMC)

206.     The Committee believes that keeping medical education affordable is absolutely critical to preventing the commercialization of healthcare delivery. Under the current regulatory structure managed by the Medical Assessment and Rating Board (MARB), the evaluation of new institutions relies on strict compliance documentation, including an Essentiality Certificate from the respective State or Union Territory valid for three years, a Consent of Affiliation from a recognized university, and definitive proof of a corpus fund and financial solvency certified by a Chartered Accountant.The Committee, therefore, recommends that the Ministry of Health and Family Welfare stringently enforce the NMC guidelines regarding the regulation of fees and all other charges for 50% of the seats in private medical colleges and deemed universities.The Committee further recommends that these mandatory baseline financial tracking mechanisms must be leveraged to audit institutional cost structures, ensuring that hidden capitation fees do not circumvent the mandate for socio-economic inclusivity in medical education training.

(Para 4.2.80)

207.     The Committee is of the view that expanding national training capacities must be paired with operational relaxations that allow quick scaling without compromising educational integrity. The transition from legacy MSR 1999 guidelines to the modern Minimum Standard Requirements (MSR) 2023 regulations represents a significant systemic reform. For instance, a 100-seat undergraduate institution now requires 420 beds and 85 faculty members compared to the historic requirement of 500 beds, while a 250-seat institution has seen its bed requirement optimized from 1,100 to 900 beds, balanced against an elevated mandatory bed occupancy rate of 80% to maintain rigorous clinical exposure. The aggregate capacity across the country now boasts approximately 80,000 postgraduate seats inclusive of AIIMS, Institutes of National Importance (INIs), and NBEMS tracks. The Committee, therefore, recommends that the MARB fully execute its multi-pronged strategic reforms for enhancing the quality and clinical exposure of the post graduate students by ensuring that the clinical requirement is not reduced.

(Para 4.2.81)

208.     The Committee further recommends that government medical institutions be permitted to initiate postgraduate courses concurrently with their undergraduate launch only after ensuring adequate cinical exposure, while private medical colleges should be cleared to introduce PG specialties from their third operational year using streamlined resource models requiring as few as two faculty members—specifically one Professor and one Associate or Assistant Professor as per specialty subject to proven clinical exposue and real hands on training. Most significantly, the Committee strongly recommends NMC to ensure cheaper cost medical education and proficiency pursuit to enhance inclusivity and expanding opportunity for candidature of weaker section of society. The Committee also recommends tapping non-traditional public clinical resources, such as specialized Railways and Mines hospitals, to rapidly expand regional specialty training footprints in underserved zones viz. hilly and tribal regions. To ensure quality, the Committee recommends for an Exit examination for both graduate and post-graduate students. 

(Para 4.2.82)

209.     The Committee believes that legacy five-year periodic recognition inspections created systemic vulnerabilities and structural inefficiencies in medical education monitoring. Under the Maintenance of Standards of Medical Education Regulations (MSMER) 2023 and the Graduate Medical Education Regulations (GMER), the NMC has executed a sweeping digital transformation toward a continuous monitoring model based on annual self-declarations submitted via a centralized portal. Routine seat renewals and institutional approvals are now managed through standardized virtual inspections to mitigate subjective biases and eliminate assessor exploitation, while physical assessments for new applicants require real-time final assessment reports to be jointly signed and instantly uploaded via an IT-enabled module.

(Para 4.2.83)

210.     The Committee, therefore, recommends the absolute consolidation of the centralized, Aadhaar-enabled biometric attendance system (AEBAS), which tracks over 4 lakh enrolled faculty, students, interns, and tutors across the nation. The Committee stands for ensuring universal compliance with the face-authentication upgrades introduced via the geo-fenced National Informatics Centre (NIC) mobile application to systematically eradicate "ghost faculty" and capture absolute employment logs. The Committee, in this regard,  furtherfor recommends scaling the pilot Hospital Management Information System (HMIS) API integration module to bind all clinical material assessments directly to unique patient ABHA IDs. Such digital mapping, combined with live classroom and hospital area CCTV surveillance streamed through shared Network Video Recorder (NVR) links, will permanently prevent the manipulation of clinical workloads or the utilization of fake patients during institutional evaluations.

(Para 4.2.84)

211.     The Committee understands that the structural architecture of the NMC—specifically the functional coordination between the Under-Graduate Medical Education Board (UGMEB), the Post-Graduate Medical Education Board (PGMEB), and the Ethics and Medical Registration Board (EMRB)—must remain anchored to public health priorities. The Committee, in this connection, recommends that the UGMEB continuously refine the Competency-Based Medical Education (CBME) curriculum to emphasize primary and preventative clinical competencies. The Committee strongly believes that the strict enforcement of the Village and Family Adoption Programmes within undergraduate training will ensurethe future medical cohorts tuned with structurally and culturally oriented to address the unique healthcare accessibility barriers faced by rural communities.

(Para 4.2.85)

212.     The Committee is of the firms opinion that pharmaceutical expenditures represent the largest component of catastrophic out-of-pocket spending for patients in India. Shifting clinical practice from expensive branded medicines to unbranded generic equivalents is one of the most effective ways to lower healthcare costs for the public. The Committee, therefore, recommends that the Ethics and Medical Registration Board (EMRB) rigidly enforce the professional conduct codes that mandate all registered medical practitioners to prescribe affordable generic molecules rather than high-cost brand names. The Committee strongly desires that the government must integrate the National Medical Register with public procurement data and establish automated grievance mechanisms through State Medical Councils to track, review, and audit prescribing patterns across both public and private hospital ecosystems.

(Para 4.2.86)

NATIONAL TESTING AGENCY (NTA)

213.     The Committee is of the view that the National Testing Agency (NTA) operates as a critical, upstream regulatory anchor in India’s healthcare ecosystem. While it does not directly control medical tariffs or drug pricing, its entry-level oversight of human capital directly shapes the quality, equity, and long-term delivery costs of national healthcare. The administrative challenges observed in 2024 and May 2026 examination cycle highlight those vulnerabilities in paper-based logistics threaten the sanctity of merit-based selection. If compromised, the system risks tilting admissions back toward arbitrary commercialization, thereby inflating the downstream cost of medical professionals and hurting public trust. The Committee, therefore, recommends that the Ministry of Education and the Ministry of Health and Family Welfare jointly expedite the implementation of the High-Level Committee of Experts (HLCE) roadmap. The government must prioritize a phased, conditional transition of the National Eligibility-cum-Entrance Test (NEET-UG) from a Pen-and-Paper Test (PPT) to Computer-Based Testing (CBT) to completely eliminate vulnerable physical print-and-transport supply chains. The Committee further recommends that during the transitional phase, the NTA must institutionalize the proposed Computer-assisted Secure PPT (CPPT) model—utilizing encrypted, candidate-randomized papers printed locally within secure rooms—alongside robust, multi-layered biometric authentication and live AI-enabled CCTV analytics to guarantee a zero-error, tamper-proof testing environment.

(Para 4.2.90)

214.     The Committee believes that achieving true equity in healthcare delivery requires a socio-economically and geographically diverse medical workforce. Aspirants from rural, remote, and economically weaker backgrounds are statistically more inclined to serve underrepresented provincial regions later in their medical careers. By providing a single, standardized gateway into heavily subsidized government institutions, the NTA has successfully curbed exploitative "donation seats" and diminished the out-of-pocket financial burden of writing dozens of separate institutional exams. However, physical and economic barriers to testing centers still restrict lower-income candidates. The Committee, therefore, recommends that the NTA, in close coordination with State Governments, drastically scale up the creation of secure, government-owned testing centers by retrofitting Kendriya Vidyalayas, Navodaya Vidyalayas, and state universities. To eliminate the logistical and financial strain on rural candidates, the Committee recommends the deployment of specialized mobile testing units in underserved districts. This infrastructure expansion must be supported by a highly rationalized fee structure and priority-based center allocations for female, differently-abled, and economically vulnerable students to ensure no qualified candidate is excluded from the medical education pipeline due to geographic or financial distress.

(Para 4.2.91)

215.     The Committee is of the considered view that alternative medicine (AYUSH) and nursing practitioners serve as the absolute first line of clinical defense across rural and semi-urban India. Standardizing entry-level quality for these streams is vital to preventing misdiagnoses and subsequent medical complications that drive up catastrophic out-of-pocket healthcare expenditures for vulnerable populations. The NTA's mandate to make NEET-UG the uniform entrance test for BAMS, BHMS, BUMS, and nursing courses is a major regulatory step toward uniformizing human capital quality across all medical disciplines.

(Para 4.2.92)

216.     The Committee recommends that the National Medical Commission (NMC) and the National Commission for Indian System of Medicine closely align with the NTA to continually refine the technical and psychometric vetting of entrance examinations. Such collaboration should introduce hybrid Classical Test Theory and Item Response Theory (CTT-IRT) models to evaluate candidates on both fundamental aptitude and practical reasoning. The Committee recommends the Ministry of Education to roll out its comprehensive Guidelines for Regulation of Coaching Centres. By actively reducing student dependency on hyper-commercialized test-preparation institutes, the government will level the playing field for candidates who rely solely on public school curricula, ensuring that primary healthcare across rural India is managed by highly competent, merit-selected professionals.

(Para 4.2.93)

217.     The Committee understands that the persistent vacancies and inequitable distribution of healthcare personnel, particularly in remote and underserved regions, fundamentally undermine the efficacy of primary healthcare delivery. The Committee believes that overcoming such systemic retention barriers requires states to abandon rigid, centralized human resource models in favor of innovative, localized, and incentive-driven workforce strategies.The Committee, therefore, recommends that state governments immediately transition to decentralized recruitment frameworks, empowering district and local authorities to hire personnel based on localized clinical needs. The successful digitalized, district-level recruitment of Community Health Officers (CHOs) executed in Karnataka must be adopted as a structural benchmark to streamline timelines and reduce rural vacancies.The Committeestrongly appeals the Government for the implementation of robust, incentive-linked rural postings to attract and retain health professionals in difficult-to-reach areas. The Committee desires that structural incentives must comprehensively encompass financial hardship allowances alongside essential non-financial benefits such as housing, accelerated career progression, and preferential opportunities for higher medical education.

(Para 4.2.94)

218.     The Committee firmly opines that optimizing the existing workforce is critical; thus, the Committee stands for the rapid formalization of task-shifting protocols. Appropriately trained nurses, mid-level healthcare providers, and community health workers must be clinically and functionally enabled to deliver targeted public health services under defined supervisory guidelines.The Committee, therefore, recommends for the establishment of specialized, dedicated public health management cadres at the State level to systematically strengthen disease surveillance, emergency preparedness, health promotion, and evidence-based fiscal planning.The Committee,in this regard, recommends for fostering institutional partnerships between established medical colleges and grassroots primary healthcare facilities. Such collaborations are essential to provide regular specialist mentoring, tele-mentoring, continuing medical education, and structural capacity building for all frontline healthcare workers.

(Para 4.2.95)

219.     The Committee visualizes that expanding the national pool of available medical doctors requires a decisive dismantling of legacy regulatory bottlenecks that artificially constrain the growth and operational efficiency of medical education. The Committee believes that transitioning from a restrictive compliance framework to a rationalized, resource-optimized model is imperative to accelerate the production of medical professionals and maximize the utility of existing clinical infrastructure.The Committee, in this connection, recommends the complete elimination of the requirement for obtaining an Essentiality Certificate from the State government to establish a new medical college, thereby removing a significant bureaucratic hurdle to institutional entry. The Committee further recommends for removing the administrative requirement for the annual renewal of the letter of permission from the Medical Assessment and Rating Board (MARB) thereby adoption of user regulatory mechanism. The Committee is of the view that regulatory oversight should instead be maintained through a robust mechanism of mandatory annual online disclosures.

(Para 4.2.96)

220.     The Committee recommends permitting the strategic sharing of institutional infrastructure across multiple colleges within the same university or across different universities, formalized through mutual agreements and Memorandums of Understanding (MoUs), to prevent the redundant duplication of capital assets.

(Para 4.2.97)

221.     The Committee is of the opinion that qualified visiting faculty be explicitly counted toward the fulfillment of minimum institutional faculty requirements, subject to their strict adherence to the stipulated thresholds for minimum class delivery.The Committee, therefore, recommends reducing the mandatory minimum duration requirement for hospital leases or formal MoU arrangements from 30 years to 25 years to significantly lower long-term real estate and capital barriers for new medical institutions.

(Para 4.2.98)

RATIONALIZATION OF TREATMENT COST

222.     The Committee is of the view that the Government should formulate comprehensive regulatory guidelines, in consultation with hospital management and relevant medical stakeholders, to standardize and rationalize overall treatment and procedural charges across the country. Furthermore, the Committee believes that such a framework must rigorously uphold the welfare motive of the public sector while concurrently encouraging and incentivizing private sector hospitals to play a complementary, ethical role, thereby ensuring holistic affordability and accessibility of healthcare facilities to the low- and middle-class population. The constitutional provision of the welfare nature of the State and socialistic pattern of society cherished in the Directive Principle of State Policy under Part IV of the Constitution of India entrust the Government of the day to make the healthcare accessible and affordable for the people of the country in compliance with the direction of the Supreme Court of India under Article-21 of the Indian Constitution interpreting thereon inherent provision of Fundamental Right to Health. On the other hand, today’s economy is the democratic and competitive driven liberal economy where market forces fixes/determines the rates. The need of the hour is to strike a balance between the constitutional provision and the prevailing market economy in order to ensure quality, cost-effectiveness, accessibility and affordability of healthcare. In this regard, the Committee, thoroughly, understands that the rate of the art and innate skill of medical professionals can not be precisely capped but can be humanly rationalized in the interest of the lower and middle class people.

(Para 5.1.1)

 

DRUGS (PRICES CONTROL) ORDER, 2013

223.     As regards the issue of trade margin, the Committee has come across that the average mark up for common dosage forms of non-scheduled drugs, namely, tablets, capsules, sachet, gums and strips, is around 43% for distributors, stockists, wholesalers and retailers collectively. Such instances  indicates that incidence of high trade margins is generally not the norm,  however, the Committee desires that Government must look into the matter  of high trade margin in the noticeable cases.  In this regard, the Committee recommends that the Government should initiate consultation with stakeholders for making suitable policy and regulatory provision for trade margin rationalisation. During the consultation process, there is need to pay attention to the legitimate concerns raised, especially by low-cost micro, small and medium enterprises (MSME) manufacturers who rely mainly on the trading channel for market development to ensure that their low-cost drugs reach consumers.

(Para 5.3.2)

224.     The Committee is pleased to observe that the existing pricing and policy framework has resulted in the prices of both non- scheduled and scheduled drugs in India being generally the lowest across categories and across both manufacturing and non-manufacturing countries. However, the Committee believes that the aim behind formulating essential medicine list must ensure that these medicines are available in adequate amounts, in appropriate dosage with assured quality. This is so because essential medicines are those medicines that satisfy the priority health care needs of any population, based on efficacy, safety, quality and includes total cost of the treatment. The NLEM must be basically a list of medicines that are safe, efficacious and collectively address a majority of the public health concerns of India and are cost-effective.

(Para 5.3.3)

NATIONAL PHARMACEUTICAL PRICING AUTHORITY (NPPA)

225.     The Committee is of the view that price control mechanisms on formulations alone are insufficient to guarantee universal healthcare accessibility across all demographics. As recognized by the foundational principles of the National Pharmaceuticals Pricing Policy (NPPP), 2012, regulatory control over drug prices represents only a single element within a much broader strategy required for affordable healthcare. The Committee believes that alternative infrastructure for delivering low-cost therapies must be aggressively expanded to shield the vulnerable populace from exorbitant out-of-pocket expenditures. The Committee, therefore, recommends that the Government should exponentially scale up the well-spread, low-cost Jan-Aushadhi pharmacy chain programme, prioritizing penetration into unserved rural and semi-urban districts. The Committee is of the view that the Government must also seamlessly integrate these pharmacy chains with direct Government healthcare and state insurance programmes, ensuring that affordable generic medicines serve as the frontline choice for public health delivery. The Committee recommends for a quality check mechanism to remove apprehensions regarding quality of medicines delivered through Jan Aushadi Kendras.

(Para 5.4.6)

226.     The Committee is of the view that the statutory provision under Paragraph 16 of the DPCO, 2013, which allows for the annual revision of ceiling prices for scheduled formulations based on the Wholesale Price Index (WPI), is a necessary mechanism to account for macroeconomic inflation. However, the Committee believes that since the WPI-based increase explicitly represents the maximum permissible hike and is not a mandatory increment, there is a risk of manufacturers routinely and uniformly availing the highest allowable price increase regardless of their actual, localized production costs. The Committee, therefore, recommends that the National Pharmaceutical Pricing Authority (NPPA) should institute an evidence-based monitoring and audit framework to scrutinize the justification of these WPI-linked price hikes by pharmaceutical companies. The Committee is of the view that such heightened regulatory vigilance will prevent routine, arbitrary price inflations of scheduled medicines and ensure that the foundational objective of the DPCO, delivering required medicines at reasonable and fair prices, remains strictly uncompromised.

(Para 5.4.7)

SANKARA NETHRALAYA

227.     The Committee appreciates that, as a not-for-profit institution, Sankara Nethralaya follows a transparent and standardized pricing policy for all treatments and services. The hospital does not adopt a variable tariff structure and ensures uniformity in treatment costs across patient categories. It has established well-defined package rates for common surgical procedures, covering surgeon's fees, consumables, investigations and post-operative care, thereby eliminating ambiguity and enabling patients to plan their medical expenses in advance. Unlike many private hospitals, the institution does not practice differential pricing based on demand, timing or urgency, ensuring fairness and equity in service delivery. Prior to surgery, patients are informed of the applicable package rates along with a detailed break-up of charges, while any exclusions, such as post-discharge medications, extended hospital stay or special investigations, are clearly communicated in advance. The Committee observes that consultation charges, day-care services and surgical package rates are displayed at the hospital reception and are made available to patients upon request, thereby promoting transparency and safeguarding patients' rights. The hospital management, in a written submission to the Committee, emphasized that the hospital does not levy exorbitant charges for diagnostic or treatment services and that all costs are standardized, transparent and aligned with its objective of making quality eye care accessible irrespective of a patient's financial status. The Committee understands that other centers for excellence like the Sankara Nethralaya in eye treatment be treated as a gold standard on the parameters of quality, affordability and public trust and the other hospitals in both the private and public sector should follow suit.

(Para 5.5.2)

228.     The Committee is of the view that the prevailing practice of variable, demand-based, or urgency-based pricing in many private hospitals severely compromises healthcare affordability and leads to financial distress for patients. The Committee believes that absolute transparency is the first step toward effective cost rationalizing. The Committee, therefore, recommends that the Government should strictly mandate all private and public healthcare institutions to formulate and publicly display fixed, unified package rates for all standard surgical and medical procedures. Such mandatory packages must comprehensively include surgeon fees, diagnostic investigations, consumables, and standard post-operative care. The Committee believes that such measures would lead to self-regulating and rationalization of treatment cost by the hospital. The Committee further believes that by measure of legally eliminating hidden charges and differential pricing, would act as a de-facto capping of treatment cost and would also ensure that patients can precisely plan their medical expenses without fear of arbitrary billing inflation.

(Para 5.5.8)

229.     The Committee believes that the long-term sustainability of affordable healthcare delivery, particularly by private and not-for-profit hospitals, is heavily reliant on the efficiency of government health assurance schemes like Ayushman Bharat. The Committee is of the view that chronic administrative delays and inconsistencies in claim settlements actively discourages private institutions from dedicating beds to economically weaker sections. The Committee, therefore, recommends the immediate overhaul and automation of the reimbursement architecture. The government must institute a strict, statutory timeframe for the processing and clearing of hospital dues under all state and central health schemes. The Committee firmly believes that the process of making Ayushman Bharat cards and process of settlement of claims by the hospitals needs to be simplified for better interest of needy patients as well as operational proficiency of the treating hospital. Furthermore, a provision for penal interest on delayed payments must be introduced to ensure mutual trust, accountability, and the uninterrupted participation of private providers in subsidized healthcare initiatives.

(Para 5.5.9)

230.     The Committee visualizes that genuine accessibility requires taking specialized, high-quality healthcare directly to rural and underserved populations, thereby eliminating the catastrophic indirect costs associated with travel, accommodation, and wage loss. The Committee believes that decentralized care models, such as Mobile Eye Surgical Units (MESU), have proven highly effective in bridging the urban-rural healthcare divide. The Committee, therefore, recommends that the government must provide targeted policy recognition, logistical assistance, and capital subsidies to both public and private institutions that deploy fully equipped mobile surgical and diagnostic units. These mobile units must be formally integrated into national rural health programs, ensuring that standardized treatment reaches the most marginalized demographics without compromising on clinical safety or quality.

(Para 5.5.10)

231.     The Committee considers that redundant and repetitive compliance requirements impose an unnecessary administrative and financial burden on healthcare providers, particularly not-for-profit organizations operating on cross-subsidy models. The Committee is of the opinion that reducing such operational friction is essential to lower the overarching cost of healthcare delivery. The Committee, therefore, recommends the urgent deployment of a centralized, single-window digital portal for all statutory compliance and reporting required from hospitals, effectively eliminating repetitive physical documentation. Additionally, the Committee believes that the most effective method to rationalize long-term healthcare costs is through early screening, diagnosis, detection and treatment, if required. The Committee strongly believes in prevention is always better than cure. The Committee is of the opinion that non-communicable diseases can easily be controlled through preventive health care. The Committee, furthermore, recommends that the government drastically increase financial allocations for preventive screening initiatives, such as school health programs, community outreach camps and cardiac screening which significantly mitigate the future economic burden of advanced and complex diseases on both the state and the citizen. Moreover, awareness program amongst the school/college going children and community awareness as well needs to be emphasized in the policy action.

(Para 5.5.11)

VIEWS OF THE PRIVATE HEALTHCARE SECTOR ON THE COST OF TREATMENT

232.     The Committee has been given to understand that the current taxation structure inadvertently inflates the overall cost of medical treatment. While healthcare services are exempt from GST, private healthcare providers are unable to claim Input Tax Credit (ITC) on the GST paid for procured goods, medical consumables, and auxiliary services. This unclaimable tax becomes an embedded operational cost that is ultimately passed on to the patient. The Committee, therefore, recommends that the Ministry of Finance should comprehensively review the GST framework applicable to the healthcare sector. The government should evaluate the feasibility of "zero-rating" critical healthcare services or introducing a specialized refund/rebate mechanism that allows healthcare providers to claim ITC. The Committee believes that neutralizing this embedded tax burden will instantly reduce the operational overheads of private hospitals, providing immediate fiscal space to lower the capped costs of patient treatments.

(Para 5.6.3)

233.     The Committee believes that the exorbitant capital required to procure sophisticated medical technology, a significant proportion of which must be imported, acts as a primary driver of high diagnostic and surgical costs. The Committee, therefore, recommends the formulation of a rationalized tariff structure to significantly reduce or eliminate customs duties, cesses, and allied levies on advanced, life-saving medical equipment and their critical components. To ensure this financial relief translates into affordable care, the Committee is of the view that tax exemptions on such equipment must be strictly contingent upon the importing healthcare facilities committing to standardized, capped pricing for the diagnostic tests and procedures utilizing that specific machinery.

(Para 5.6.4)

234.     The Committee understands that the prohibitive commercial cost of real estate acquisition severely restricts the expansion of affordable healthcare infrastructure, forcing private institutions to recover land investments through higher treatment tariffs. The Committee, therefore, recommends that the Ministry of Health and Family Welfare coordinate with State Governments to draft a unified national policy for the concessional or preferential allotment of land for the establishment of new healthcare facilities. The Committee believes that such preferential land grants to private investors in healthcare must be legally bound to entrust sense and responsibility of robust social obligations for providing treatment to the needy patient at the concessional/subsidized rates. Hospitals benefiting from subsidized land must be mandated to dedicate a fixed percentage of their beds capacity upto 20% of the total beds capacity of the hospital for  outpatient services, especially to economically weaker sections at strictly capped and Government-approved rates.

(Para 5.6.5)

235.     The Committee has been given to understand that unilateral rate-setting for Government-sponsored health schemes generally skip the accounting for the practical realities of infrastructure investments, specialized manpower, and technology adoption required by the private sector. While empirical data collection is vital, the Committee believes that the interpretation of such data requires practical industry context. The Committee, therefore, recommends the establishment of a permanent, statutory Consultative Pricing Board comprising representatives from both the National Health Authority and major private healthcare consortiums tasked with jointly developing the scientific, evidence-based costing models used to determine package rates. By ensuring that compensation under health schemes accurately reflects the true cost of delivering quality care. The Committee firmly believes that the Government can ensure the financial sustainability of these programs and prevent private hospitals from compensating for scheme losses by inflating the treatment costs of general-category patients.

(Para 5.6.6)

JAWAHARLAL NEHRU MEDICAL COLLEGE (JNMC)

236.     The Committee is of the view that the rigid imposition of predefined package durations disproportionately penalizes healthcare institutions handling complex, acute cases. Treatments involving high-cost specialties, such as Neurosurgery, Cardiovascular and Thoracic Surgery (CVTS), Orthopaedics, and critical care, frequently necessitate prolonged Intensive Care Unit (ICU) stays that exceed standard package parameters. The Committee believes that forcing hospitals to absorb these outlier costs acts as a severe deterrent to the admission of critically ill scheme beneficiaries. The Committee, therefore, recommends the immediate unbundling of prolonged critical care from standard surgical packages. Clear clinical parameters must be defined to categorize "outlier events." For hospital stays extending beyond the prescribed package duration due to medical necessity, hospitals must be permitted to transition to an open, itemized billing system subject to a predefined daily ceiling, ensuring fair compensation while maintaining a cap on overall expenditure.

(Para 5.7.11)

237.     The Committee believes that functional limitations and rigid procedural algorithms within the Ayushman Bharat–PMJAY IT portal and analogous state portals actively generate avoidable claim rejections and administrative delays, which ultimately drive up the operational cost of healthcare delivery. The Committee, therefore, recommends a comprehensive technological overhaul of all national and state health Insurance IT portals. The upgraded infrastructure must provide real-time visibility of annual utilization limits for high-cost diagnostic investigations (such as MRI and CT scans) at the family level to enable accurate treatment planning. Furthermore, the Committee recommends the immediate expansion of digital storage capacities on these portals to allow for the seamless uploading of voluminous medical records associated with prolonged ICU stays. A transparent, bidirectional tracking mechanism must also be instituted, compelling health authorities to provide detailed justifications for claim rejections and affording hospitals a fair appellate window beyond the current restrictive 15-day limit.

(Para 5.7.12)

238.     The Committee is of the view that the mandatory, hierarchical routing of critical patients through primary and district-level hospitals before such patients can access tertiary care introduces fatal delays, exacerbates the patient's clinical condition, and ultimately inflates the cost of treatment upon admission. The Committee, therefore, recommends the immediate deployment of a real-time, digital referral system that connects all tiers of healthcare facilities. Clear clinical triage protocols must be established to allow lower-level medical officers to bypass intermediary district hospitals and generate direct referrals to empanelled tertiary care institutions for complex, life-threatening conditions. The Committee believes that streamlining this pathway will significantly shorten overall hospital stays, minimize the need for redundant diagnostic testing across multiple facilities, and drastically lower the cumulative cost of care.

(Para 5.7.13)

239.     The Committee considers that achieving true affordability in specialized treatments, particularly in orthopaedics and cardiology, is impossible as long as the sector remains highly dependent on imported implants and medical devices. Furthermore, treating hospitals as commercial industries for the purpose of licensing and utility tariffs unnecessarily escalates their baseline operating costs. The Committee, therefore, recommends that the Government should pro-actively expand the Production Linked Incentive (PLI) Scheme to strictly target the domestic manufacturing of high-cost surgical implants, stents, and specialized critical care consumables. Simultaneously, the Committee is of the view that state governments must be directed to comprehensively review and rationalize the institutional licensing costs imposed on healthcare facilities. The Committee recommends reclassifying hospitals under an essential service category rather than an industrial category for the purpose of statutory licenses, utility tariffs, and operational fees, thereby facilitating a direct reduction in the overhead costs passed on to patients.

(Para 5.7.14)

240.     The Committee is of the view that the existing disparity between the package rates offered under the Ayushman Bharat–PMJAY and various State-run health insurance schemes, such as the Ayushman Bharat Arogya Karnataka (AB-ArK), creates a fragmented healthcare financing ecosystem. The Committee notes the submissions of tertiary care providers highlighting that current PMJAY rates for several high-cost specialties are inadequate, which actively disincentivizes private sector participation and limits beneficiary access to complex procedures. The Committee believes that a standardized, evidence-based approach is urgently required to determine fair institutional compensation. The Committee, therefore, recommends that the Government may constitute an independent, multi-disciplinary ‘Health Technology Assessment and Costing Board’ tasked with the scientific rationalization and periodic revision of standard package rates across all national and state health insurance schemes. This Board must ensure that package rates are dynamically indexed to actual regional procurement costs, inflation, and standardized clinical protocols, thereby harmonizing central and state tariffs while safeguarding equitable remuneration for healthcare providers.

(Para 5.7.15)

241.     The Committee is of the view that information asymmetry regarding scheme eligibility, utilization limits, and complex documentation requirements often leads to severe operational friction and avoidable disputes between beneficiaries and hospital administrations. The Committee believes that dedicated institutional facilitation, as demonstrated by the successful deployment of Public Relations Officers (PROs) and counselors at JNMC, can dramatically improve scheme uptake and protect vulnerable patients from exploitation. Furthermore, the Committee is of the view that a robust, accessible grievance redressal infrastructure is vital for public trust. The Committee, therefore, recommends that the Government mandate the establishment of dedicated ‘Patient Navigation and Grievance Redressal Cells’ across all tertiary care hospitals empanelled under national health schemes. These cells must be fully staffed with trained counselors and equipped with multi-modal communication platforms—including digital tracking, WhatsApp interfaces, and physical complaint boxes—to proactively educate beneficiaries, assist with seamless documentation, and ensure the time-bound, transparent resolution of patient grievances.

(Para 5.7.16)

RIMS HOSPITAL, IMPHAL

242.     The Committee is of the view that establishing transparent institutional procurement mechanisms is foundational to reducing the baseline cost of medical treatments. Taking note of the highly successful integration of the Government e-Marketplace (GeM) alongside the deployment of AMRIT and Jan Aushadhi centres at public institutions like RIMS, the Committee believes that such models significantly curtail exorbitant out-of-pocket expenditures on pharmaceuticals and consumables. The Committee, therefore, recommends that the Government should mandate the establishment of AMRIT and Jan Aushadhi pharmacies within the premises of all AB-PMJAY empanelled hospitals, both in the public and private sectors. Furthermore, the Committee recommends that the Government formulate regulatory guidelines requiring private empanelled hospitals to adopt centralized, transparent tender-based procurement systems to strictly cap the internal mark-ups levied on life-saving consumables and medical devices at a mutually agreed-upon ceiling, such as the 20 percent margin observed in proactive institutions.

(Para 5.8.7)

243.     The Committee understands that the foundational objective of entirely free public healthcare is severely undermined when patients are compelled to procure surgical consumables and diagnostics from private vendors out-of-pocket due to institutional stockouts. The Committee observes with concern that even in public institutions offering ostensibly free major surgical procedures, patients frequently bear substantial financial burdens for critical items, such as oncology consumables or specialized dialysis tubing. The Committee believes that comprehensive healthcare accessibility dictates that no patient seeking treatment in a government tertiary facility should face catastrophic secondary costs for essential surgical supplies. The Committee, therefore, recommends that the Government augment the budgetary allocations specifically earmarked for the continuous, uninterrupted stocking of high-value consumables and surgical implants in public hospitals. The Committee further recommends the implementation of an automated 'Zero-Stockout Policy' supported by digital inventory management systems that trigger expedited government procurement long before critical supply thresholds are breached.

(Para 5.8.8)

CONTAINING THE COST OF RARE DISEASE AND CANCER CARE

244.     The Committee is of the considered view that while the public display of standard package rates is necessary, the management of complex, multi-stage diseases like cancer requires highly individualized treatment plans, making total cost anticipation difficult for the average citizen. The Committee believes that patients must be insulated from financial unpredictability and mid-treatment billing shocks. The Committee, therefore, recommends that the government institute a statutory mandate requiring all tertiary care hospitals to provide a comprehensive, legally binding upfront cost estimate to the patient prior to the initiation of any complex or prolonged medical intervention. Furthermore, hospitals must be mandated to deploy dedicated 'Financial Navigators', specialized counselors who guide patients and their families through these estimates, available philanthropic support, and health assurance limits, thereby enabling fully informed financial planning.

(Para 5.9.7)

245.     The Committee is of the considered opinion that some private hospitals levy or charge large amounts for hospital stays especially in metropolitan cities. Having analysed the break up of the hospital billing structure the Committee believes that rationalizing of room charges needs to be done on an emergent basis.The Committee understands that hospital room charges are not uniform and vary across geographic regions and even among hospitals within the same area due to differences in infrastructure, service levels and operating costs. The Committee hence  recommends that the room charges for a hospital should not exceed the average room tariffs prevailing in three star hotels in the peripheral area or vicinity of the hospital. The Committee recommends for making this benchmark mandatory for all private hospitals in large metropolitan cities. The resident doctor cost, Nursing cost, disposable costs of consumables, meal charges, laundry charges can be added to the basic room tariff so that the entire cost is rationalized.

(Para 5.9.8)

246.     The Committee firmly believes that the current ecosystem often limits financial capping to acute interventions or surgical procedures, leaving patients highly vulnerable to unregulated out-of-pocket expenses during extended follow-ups, rehabilitation, or end-of-life care. The Committee is of the view that true affordability must encompass the entire lifecycle of disease management. The Committee, therefore, recommends the formulation and regulatory enforcement of 'Continuum of Care' packages. These advanced packages must comprehensively bundle preventive screening, diagnostic, curative, and palliative services under a single, capped financial umbrella, ensuring that economically disadvantaged patients are not forced to abandon care during the critical palliative or supportive phases.

(Para 5.9.9)

247.     The Committee is of the view that novel, highly efficacious treatment modalities, such as immunotherapy, genomic therapies, and targeted therapies, remain prohibitively expensive. Integrating these directly into standard capped packages currently risks overwhelming the financial sustainability of health assurance schemes. The Committee believes that the fragmented mobilization of Corporate Social Responsibility (CSR) and philanthropic funds by individual hospitals, while commendable, is insufficient for achieving national scale. The Committee, therefore, recommends the establishment of a highly regulated, centralized National/State Healthcare Corpus Fund. This fund must systematically aggregate CSR contributions, philanthropic donations, and charitable grants from across the corporate sector. These pooled resources must be strictly earmarked to subsidize or entirely fund advanced, high-cost therapeutics for eligible patients, thereby bypassing standard commercial pricing barriers without burdening the hospital's operational budget.

(Para 5.9.10)

248.     The Committee knows that the intense psychological and emotional toll of catastrophic illnesses frequently leads to severe depression, loss of livelihood, and ultimately, treatment abandonment. Such abandonment not only jeopardizes patient survival but also results in a massive wastage of medical resources and financial investments already expended. The Committee is of the view that mental health and psychosocial support are not auxiliary luxuries, but clinical necessities that directly improve treatment adherence and optimize outcomes. The Committee, therefore, recommends that structured psychological counseling, emotional support services, and patient support groups be formally integrated as mandatory, zero-cost components within all approved treatment protocols and capped financial packages for severe, chronic, and terminal diseases across both the public and private sectors.

(Para 5.9.11)

MEDICAL DEVICES BE BROUGHT UNDER PRICE CONTROL

249.     The Committee is of the view that the structural reliance on imports for 70 to 80 percent of medical device components, such as medical-grade electronics, sensors, semiconductors, and precision-engineered parts, severely constrains India's global competitiveness and structurally inflates the baseline cost of healthcare. The Committee believes that conventional financing mechanisms remain fundamentally inadequate to support the high capital intensity, long gestation periods, and technology risks inherent in medical device component manufacturing. The Committee, therefore, recommends that the Government immediately operationalize the proposed National Medical Device Component Financing Framework (NMDCFF) under the National Medical Devices Policy, 2023. This framework must deploy a lifecycle-based financing approach, utilizing targeted instruments such as long-term concessional loans, credit guarantee schemes, and R&D grants, to transition the domestic industry from mere assembly operations to high-value, indigenous manufacturing of critical inputs.

(Para 5.11.7)

250.     The Committee dwells upon the view that while capital and technological support are vital for capacity building, creating a predictable and assured domestic market is equally essential to ensure the commercial viability of indigenous medical device component manufacturers. The Committee believes that without guaranteed demand, domestic manufacturers will struggle to achieve economies of scale against established global supply chains. The Committee, therefore, recommends that the Government should pro-actively implement the 'Market Development & Demand Assurance' pillar of the NMDCFF by instituting strict preferential public procurement policies. Procurement platforms and agencies under the Ministry of Health and Family Welfare, prominently including GeM, PMJAY, CGHS, and ESIC, must be mandated to enforce stringent domestic value-addition criteria and offer long-term procurement commitments to domestic manufacturers, thereby structurally incentivizing self-reliance.

(Para 5.11.8)

251.     The Committee opines that the successful execution of the NMDCFF necessitates seamless synergy across multiple administrative, scientific, and financial domains, rather than allowing ministries to function in isolated bureaucratic silos. The Committee believes that addressing complex challenges, ranging from pilot manufacturing and technology transfer to global market expansion, requires a unified and dynamic institutional architecture. The Committee, therefore, recommends the formal establishment of a coordinated, multi-agency apex mechanism spearheaded by the Department of Pharmaceuticals. This body must systematically integrate financial institutions like SIDBI and NABFID for risk-sharing, scientific bodies like DBT, DST, and ICMR for research and innovation, and the Ministry of Commerce & Industry for export promotion, ensuring a holistic, end-to-end ecosystem that permanently secures India's medical device supply chain.

(Para 5.11.9)

252.     The Committee is of the view that the historical reliance on ad-hoc or purely reactive decision-making for rationalising medical device prices is inadequate for a complex, modern healthcare system. The Committee, therefore, recommends the formal institutionalization of a multi-criteria, evidence-based prioritization framework, structured similarly to the 100-point Medical Device Price Regulation Score (MDPRS). The government must establish a statutory mandate to evaluate all unregulated medical devices across critical dimensions, prominently including disease burden, annual procedure volume, and out-of-pocket burden. The Committee believes that deploying this transparent, reproducible methodology will enable regulatory authorities to systematically identify and prioritize devices that urgently warrant intervention, thereby shielding regulatory actions from industry opacity and arbitrary policymaking.

(Para 5.11.10)

253.     The Committee believes that medical devices categorized under the highest public health urgency, specifically those scoring more than 80 on the MDPRS framework, represent the most significant financial risk to vulnerable patient populations. The Committee, therefore, recommends immediate and absolute statutory price capping for all medical devices classified as 'Priority I'. This categorization must trigger automatic regulatory intervention to fix the maximum retail price, similar to the successful interventions previously applied to coronary stents and knee implants. The Committee is of the view that targeting high-volume, high-disease-burden devices will instantly alleviate the most severe instances of catastrophic health expenditure borne by the low and middle-income demographic.

(Para 5.11.11)

254.     The Committee is of the view that excessive and unregulated trade margins, often occurring between the manufacturer or importer and the final point of care, are primary drivers of the massive price variations observed across different healthcare providers. The Committee, therefore, recommends that for devices falling into the 'Priority II' bracket (MDPRS 60–79), or those demonstrating high import dependency, the government must impose strict trade margin rationalization. Rather than a flat price cap, the regulatory authority must cap the maximum permissible percentage markup from the first point of sale (price to distributor) to the maximum retail price (MRP). The Committee believes this targeted approach will eradicate exploitative profiteering in the supply chain while maintaining market viability for a diverse range of specialized clinical tools.

(Para 5.11.12)

255.     The Committee believes that while cost rationalization is a primary objective, price regulation must not inadvertently stifle medical innovation, restrict the availability of cutting-edge therapies, or compromise clinical outcomes. The Committee, therefore, recommends that the regulatory framework structurally integrate Health Technology Assessments (HTA) and robust clinical evidence before finalizing the degree of price regulation for any specific device. A dedicated expert committee must evaluate the clinical superiority and availability of therapeutic alternatives for devices under review. The Committee believes that ensuring regulatory decisions, if, remain rigorously evidence-informed, would balance the dual imperatives of accessibility & affordability of treatment at rationalized cost on the one hand and the maintenance of world-class clinical standards within both the public and private healthcare sectors, on the other hand.

(Para 5.11.13)

256.     The Committee opines that the success of a medical device park can take place only when it has got its own World Class testing laborarities which are notified and certified for quality benchmark by the Quality Council of India. These laboratories need to be empowered to check all kinds of medical devices ranging from Category A, B, C and D. The Committee strongly recommends that the licensing mechanism also needs to be decentralized to various State Governments for even category A & B Medical Devices. This will inculcate a healthy competition within States to attract medical device manufactures from all across the Globe creating huge employment and saving on precious foreign exchange besides making the country Atam Nirbhar in the field of Medical Devices in the shortest possible timeframe.

(Para 5.11.14)

257.     The Committee further recommends that Government should chalk-out Inter-Governmental Action Plan by selecting consumable end products under National Health Mission (NHM) and thereby transforming demand into an engine growth to invite global investment. The Committee feels that there is need to target the products under National Health Mission (NHM) and in tandum with the Ministry concerned should manufacture the product in the country itself to make the product and medical devices affordable that would be beneficial to the needy patients.

(Para 5.11.15)

258.     The Committee realizes India has huge growth potential in manufacturing of medical devices. Well-coordinated inter-ministerial and inter-governmental (central and state) strategies aimed at offering manufacturers competitive advantage in manufacturing in India will result in importers finding it more profitable to manufacture in India than to import it. The Committee believes that logistical support in shared manufacturing facilities like Medtech parks would significantly reduce capital expenditure of manufacturers and thus giving a boost to manufacturing in India. The Mediparks should have NABL (National Accreditation Board for Testing and Calibration Laboratories) approved medical device testing laboratories to reduce time required in manufacturing a product.

(Para 5.11.16)

259.     The Committee further recommends that some of the Mediparks should focus on manufacturing medical device components and thus make the country self reliant on spare parts with provision for extending necessary services. This can further strengthen into India emerging as hotspot for medical devices spare parts and hub for medical devices repairing and service centres for other countries. Thus Medical Devices industry would have added advantage of huge employment generation capacity.

(Para 5.11.17)

260.     The Committee is of the considered view that in order to encourage indigenous manufacturing, the Government should provide incentives or encourage preferential purchase for domestically manufactured products in Government procurement. In this regard, the Department should ensure that in all public procurement, the preference must be given to Indian manufactured medical devices having domestic content of at least 50%.

(Para 5.11.18)

 GRIEVANCES REDERESAL MECHANISM

261.     The Committee was apprised of incidents wherein NABH has on frivolous ground denied accreditation on the basis of false complaints resulting in harassment of small medical establishments. The Committee, therefore, feels the need for a suitable Grievance Redressal Mechanism to be institutionalized by Quality Control of India for all accreditation bodies like NABH/NABL so that they did not become another tool for corruption, high handedness and blatant harassment thus thereby increasing the cost of healthcare.

(Para 5.11.19)

262.     In nutshell, the Committee desires that Government should make provision for sufficient number of Testing Labs to evaluate the quality of the product; ensuring availability of raw-material components by promoting indigenous production at reasonable cost; formulating and impementing component-based financing schemes for encouraging indigenous production of medical devices under PPP model to promote components start-ups in the country. The Committee desires that the Government should encourage through various incentives to the Start-ups for manufacturing medical devices like Implantable Cardioverter Defibrillators (ICDs), heart valve, cardiac cath labs, pacemakers and PET scan at the reasonable cost. The Committee underscores the pivotal role of regulatory bodies in reducing the gap between the landing cost and MRP because some of these implants are not covered under the Ayushman Bharat Scheme, thereby enhancing OOPE for the patients. The Committee also recommends for Single Window System to promote MeDTech park like AMTZ in Vishakhapatnam in other parts of the country.

(Para 5.11.20)

263.     The Committee expresses serious concern over the huge difference between the landing costs of the medical devices or drugs and the MRP, despite the fact India is considered to be the pharmacy of the world. The Committee strongly believes that such gap needs to be reduced to the extent that the quality medical devices and the drugs are made available at the affordable cost to the needy patients. For example, the landing cost of Tenecteplase, a life-saving medicine for heart attack given in golden hour, is Rs. 18,000 but MRP is Rs. 50,000 and the billing cost is at MRP. The Committee appreciates the decision of the Government for capping the price of the cardiac stent to Rs. 25,000 to Rs. 30,000 in 2017 which earlier used to be around Rs. 1,90,000. The Committee, therefore, recommends that the gap should not be more than 20% between landing price and MRP for medical devices and drugs for ensuring quality drugs and medical devices at the affordable cost. The Committee also recommends for rationalizing the cost of peripheral stents and drug-eluting ballons. Since medical devics are used directly in patient care, the Committee, therefore, recommends that manufacturers must operateunder strict Quality Management Systems such as ISO 13485 and FDA 21 CFR Part 820. The Committee further recommends that while rationalizing the price of high end medical consumables, the Government must ensure stringent quality control and uninterrupted market availability. Of course, the Government should design dynamic rationalizing mechanism for specialized consumables that balances aggressive consumer affordability with necessary manufacturing margin and prevent artificial market shortages and black marketing.  

(Para 5.11.21)

264.     The Committee has been given to understand that the cost of clear aligners ranges between Rs. 1.5 to 5 lakhs, therefore, the regulatory body should consider the standardization of cost of clear aligners and dental materials. The Committee is of the view that, along side affordability, availability of the drug is also critical, and pharma companies should not neglect availability of any medicine on account of less profit margin linked with that drug. The Committee comes to know that lithium is a very important drug to control bipolar disorder and its availability at the affordable cost should be ensured throughout the year.

(Para 5.11.22)

265.     The Committee also recommends the Government to establish a a dedicated medical devices subsidy fund to complement existing manufacturing support schemes.  The fund should partially offset the research, development and scaling cost of advanced medical equipment, enabling public hospitals to procure domestically produced devices at lower cast while systematically reduing dependence on import alternatives.

(Para 5.11.23)

TATA MEMORIAL CENTRE

266.     The Committee believes that the stark disparity in healthcare costs between public and private institutions severely compromises patient welfare. Without a unified framework, out-of-pocket expenditure remains unsustainably high for low- and middle-income demographics. The Committee, therefore, recommends the urgent formulation of a standardized, evidence-based treatment protocol mandate across all secondary and tertiary care hospitals. The Ministry of Health and Family Welfare must establish a national statutory body to determine and implement a rigid cap on essential procedures and diagnostics. To ensure compliance, the government must mandate all healthcare facilities to publish a unified, transparent 'Schedule of Charges' on their respective platforms, mirroring the TMC model, to prevent arbitrary pricing and unwarranted clinical investigations.

(Para 5.12.9)

267.     The Committee is of the view that private sector hospitals must be incentivized and structurally guided to play a complementary role to public welfare initiatives. The current purely commercial approach of many private entities restricts affordability & accessibility for economically disadvantaged patients. The Committee, therefore, recommends the introduction of a cross-subsidy model across major private and trust-run hospitals. The cross subsidy model has been successfully implemented across many South Asian Countries. Policies should be framed to mandate that a fixed percentage of revenue generated from standard or premium paying categories is legally earmarked to subsidize care for economically weaker sections. The government should offer tax incentives or capital subsidies to private hospitals that successfully demonstrate the earmarking of at least 20 percent of their bed capacity for highly subsidized or free treatment.

(Para 5.12.10)

268.     The Committee believes that the unregulated pricing of pharmaceuticals, medical consumables, and equipment significantly inflates the overall cost of treatment. The Committee, therefore, recommends the establishment of a centralized digital procurement grid for all critical care medicines and high-end medical equipment. Private and public hospitals must be directed to utilize transparent tendering mechanisms to negotiate prices substantially lower than prevailing market rates. It should be made legally binding for practitioners across both sectors to prioritize the prescription and dispensation of high-quality generic medicines wherever clinically appropriate, thereby instantly driving down out-of-pocket expenditures for patients.

(Para 5.12.11)

269.     The Committee is of the view that complex billing procedures and the deliberate obfuscation of health insurance benefits actively deter patients from seeking timely secondary or tertiary care. The Committee, therefore, recommends that all secondary and tertiary healthcare facilities install a fully integrated Hospital Information System linked directly to their approved Schedule of Charges to automatically generate non-manipulable bills. Every private hospital above a specified bed capacity must be mandated to establish a dedicated claims management cell to facilitate cashless treatment under government schemes such as Ayushman Bharat–Pradhan Mantri Jan Arogya Yojana (AB-PMJAY). Strict penal provisions should be introduced for hospitals that deny admission to patients eligible under these central or state-sponsored health assurance initiatives.

(Para 5.12.12)

CASE STUDY: TMC MODEL OF CANCER TREATMENT AT AFFORDABLE COST

270.     Pooled procurement for high value and high cost medicines: Tata Memorial Centre (TMC) piloted pooled procurement to improve negotiability of high-value oncology and supportive care medicines. A total of 40 drugs were included in this pilot. The pooled demand for the drugs from 23 centres was equivalent to 15.6 billion Indian rupees (197 million United States dollars (US$)) based on maximum retail prices. The process included technical and financial evaluation followed by contracts between individual centres and the selected vendors. Savings of 13.2 billion Indian Rupees (US$ 166.7million) were made compared to the maximum retail prices. The savings ranged from 23% to 99% (median: 82%) and were more with generics than innovator and newly patented medicines. This process has made it possible to improve access to effective but expensive medicines by making them affordable for majority of patients and reducing the stockout at smaller centres in geographically remote areas.

(Para 5.13.4)

271.     The Committee believes that the establishment of unified, national disease-specific networks is pivotal in minimizing geographical and socioeconomic healthcare inequities. The Committee, therefore, recommends that the government replicate the National Cancer Grid (NCG) model to establish similar national grids for other high-burden non-communicable diseases, such as cardiovascular diseases and diabetes. The Committee is of the view that resource-stratified treatment guidelines developed by these expert grids must be explicitly linked with the reimbursement structures of the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY). Such integration will mandate the adoption of comprehensive Health Benefit Packages  (HBP) across both public and private sectors, ensuring uniform, value-based care while curbing the economic burden on patients presenting with advanced disease stages.

(Para 5.13.13)

272.     The Committee is of the view that the fragmented procurement of pharmaceuticals significantly inflates the operational costs of healthcare delivery, which is invariably passed on to the patient. The Committee believes that the monumental savings, achieving a median cost reduction of 82%, demonstrated by the pooled procurement pilot for high-value oncology medicines must serve as a foundational blueprint for national policy. The Committee, therefore, recommends the immediate institutionalization of a centralized, pooled procurement mechanism for all high-cost, life-saving, and supportive care medicines across all public healthcare institutions and empanelled private hospitals. This aggregated demand framework will maximize negotiating leverage against pharmaceutical vendors, thereby drastically reducing maximum retail prices and eliminating vital drug stockouts in geographically remote centers. The Committee, in turn, recommends that savings out of pooled procurement must be passed on to patients, to reduce out of pocket expenditure and utilized as source of cross-subsidy.

(Para 5.13.14)

273.     The Committee believes that the indirect costs of healthcare, including travel, boarding, and loss of livelihood for patients seeking tertiary care in metropolitan centers, severely exacerbate catastrophic health expenditures. The Committee, therefore, recommends the aggressive expansion and decentralization of specialized healthcare through the mandatory implementation of Virtual Disease Boards and comprehensive teleconsultation facilities in all district-level hospitals. The Committee is of the view that digitally linking smaller, remote medical centers with apex tertiary institutions will facilitate expert multidisciplinary treatment planning and External Quality Assurance Schemes (EQAS) for diagnostics. This will ensure that complex clinical decisions are made accurately without necessitating the physical displacement of the patient.

(Para 5.13.15)

274.     The Committee is of the view that seamless continuity of care and absolute financial transparency are fundamental right of the patient and critical components of an affordable healthcare ecosystem. The Supreme Court interprets Right to Health as a fundamental right under Article 21 of Indian Constitution i.e. Right to Life and in Part IV under Directive Principles of State Policy, thereby, Key constitutional pillars include Article 21, Article 47, outlining the duty of the State to improve public health, raise nutritional levels, and enhance the standard of living and Article 39(e), that directs the State to protect the health and strength of workers of Indian Constitution. The Committee, therefore, strongly believes that it is the constitutional responsibility of the Government to keep the citizens of the Country healthy by providing adequate healthcare facilities at the affordable cost. The Committee desires that the private sector hospital should voluntarily play the pivotal role of complementing the efforts of the public sector hospital in that direction.

(Para 5.13.16)

275.     Moreover, the Committee believes that restricting a patient's access to their own medical records hinders their ability to seek localized care or second opinions, thereby locking them into potentially unaffordable care continuums. The Committee, therefore, recommends the accelerated, nationwide adoption of interoperable, specialty-specific Electronic Medical Records (EMRs) that grant patients secure, remote ownership of their clinical data via web portals. Furthermore, it must be made mandatory for all secondary and tertiary care hospitals to deploy real-time digital billing infrastructure. Systems utilizing smart cards and automated SMS alerts must be implemented to keep patients continuously apprised of generated bills and available fund balances, thereby eradicating opaque billing practices.

(Para 5.13.17)

276.     The Committee is of the view that arbitrary or static rate setting for health benefit packages compromises provider participation and obscures the true operational expenditure of medical care. While standardizing benefit packages is critical, ensuring those packages reflect reality is paramount. The Committee, therefore, recommends the immediate deployment of a standardized National Cost Accounting System. The government must mandate this framework to collect empirical, real-world costing data from either all empanelled centers or a rigorously selected, representative cross-section of hospitals nationwide. The Committee believes that clinical guidelines must be meticulously mapped across every step of the patient pathway to ensure that health benefit packages are explicitly tied to actual, data-backed costs rather than estimates.

(Para 5.13.19)

277.     Furthermore, the Committee firmly opines that rate setting must become dynamic. The pricing structures must incorporate predefined, empirical adjustments for variables such as the severity of the patient's condition, the geographical location of the facility, and the institutional tier of the hospital. The Committee believes that instituting this level of structural transparency will guarantee fair and adequate compensation to healthcare providers, thereby significantly increasing their voluntary uptake of national health schemes. Concurrently, it will empower policymakers to accurately identify systemic cost inefficiencies, isolate primary cost drivers, and conduct precise budget impact assessments prior to the integration of new medical technologies.

(Para 5.13.20)

278.     The Committee is of the view that the development and deployment of Health Benefit Packages (HBPs) must transition from ad-hoc rollouts to a highly structured, well-documented standard operating procedure. While the packages exist, ensuring they reach the most vulnerable demographics requires rigorous oversight. The Committee believes that a robust monitoring and evaluation framework must be integrated into the national health infrastructure to continuously audit scheme efficacy and equity. The Committee, therefore, recommends the mandatory implementation of unified clinical procedure coding across all digital health and billing platforms. To ensure accountability without compromising patient privacy, the government must mandate all empanelled healthcare facilities to securely share predefined Key Performance Indicators (KPIs) with a central monitoring agency, thereby tracking the actual ground-level impact of these schemes.

(Para 5.13.22)

279.     The Committee expresses serious concern regarding recent national and international reports questioning the quality standards of certain pharmaceuticals. Furthermore, the Committee is of the view that while aggressive price controls have undeniably expanded access for the masses, pushing manufacturing costs below viable thresholds risks systemic compromises in drug quality and industry sustainability. The Committee believes that an immediate and comprehensive review of the national drug approval and quality control regulatory framework is highly desirable to restore absolute confidence in medical supplies. The Committee, therefore, recommends the institutionalization of a formal, mutual dialogue mechanism between the Ministry of Health and the pharmaceutical industry. This forum must aim to establish rational price ceilings that balance mass affordability with uncompromising quality assurance and manufacturing viability. The Committee recommends leveraging this collaborative platform to negotiate national-level pricing for novel, highly effective therapeutics. Bringing advanced medications into the National List of Essential Medicines (NLEM) at negotiated rates will strategically drive high-quality procurement across the entire country.

(Para 5.13.23)

HUB AND SPOKE MODEL OF CANCER CARE

280.     The Committee recapitulates its observation as made in its 139^th Report on Cancer Care Plan & Management: Prevention, Diagnosis, Research & Affordability of Cancer Treatment. The Hub and Spoke Model is an efficient distribution model of providing comprehensive cancer care by creation of hubs and spokes in all the States of the country. The Committee notes that TMC has worked in close contact with the State Governments to create hubs and spokes in States. The Committee believes that such collaborations will enable in further strengthening the cancer care infrastructure along with knowledge, skill and resource sharing. The Committee appreciates the work done by TMC and DAE and advocates the need for establishing government funded hub and spoke model of cancer care across States. The Committee further believes that ensuring adequate human resource in Cancer centers under the hub and spoke model is also crucial for complete operationalization of the Centers. The Committee reiterates its recommendation that the Ministry of Health and Family Welfare must work in close collaboration with the Department of Atomic Energy to decide a timeline for implementing the hub and spoke model in each State. The Committee urges upon the Government to ensure that the existing SCI/TCCCs are upgraded to hubs and spokes depending on their existing infrastructure and capabilities.

(Para 5.14.2)

CROSS-SUBSIDY MODEL TO MITIGATE RISING COST OF PRIVATE HEALTHCARE

281.     The Committee was apprised of the rising cost of private healthcare and the submissions before the Committee attributed much of the rising cost of private treatment to escalating infrastructure cost. Further world-class technology is concentrated in cosmopolitan cities and requires enormous capital outlay to install and maintain. Compounding this, super-specialist doctors command high compensation, adding further to hospital overheads. Because most private investment is profit-driven, patient care and outcomes are often treated as a secondary concern rather than the primary objective. With only around 14 percent of the population holding private insurance, the majority of patients are exposed to significant out-of-pocket spending. This is worsened by overbilling practices, where professional fees are inflated through the addition of procedural costs, and by the ever-present risk of complications, which can push a family into deep financial crisis and erode trust in the healthcare system even when the original treatment was appropriate.

(Para 6.2.2)

282.     The Committee, to address the issue of overbilling, recommends strengthening ethical oversight through hospital-level ethics committees, which review professional fees and hold doctors accountable, with real consequences such as reprimand for non-compliance. The Committee also calls for a dedicated regulatory body to oversee public-private partnerships and verify that services genuinely reach the needy rather than remaining a formality. The Committee suggests cross-subsidy models, in which higher-paying private patients effectively help fund treatment for poorer patients, and encourages large industries to channel CSR funding directly toward covering treatment costs for indigent patients through formal partnerships with hospitals.

(Para 6.2.3)

283.     The Committee observes that although the government has reserved a percentage of beds in private hospitals for free treatment of BPL cardholders and beneficiaries of schemes like Ayushman Bharat and PMJAY, many private hospitals simply opt out of these obligations, leaving the mandate poorly enforced in practice. A related problem is that the BPL eligibility criteria themselves are outdated and have not been revised in some time, which excludes many people who are genuinely poor, including a broader "upper-middle income poverty" group that faces very similar financial strain but has no formal recognition or protection. There is currently no strong regulatory body dedicated to ensuring that private hospitals meet these public-service obligations.

(Para 6.2.4)

284.     The Committee recommends raising the mandatory bed-reservation quota for BPL, EWS, and PMJAY patients in private hospitals from the current ten percent to twenty percent, with strict and uniform enforcement across all private hospitals nationwide. Alongside this, the BPL eligibility criteria should be revised to reflect current economic realities and extended to cover the broader population living just above the poverty line who face comparable hardship. The Committee also suggests that hospitals should have an internal formal financial safety net for families facing unexpected cost escalation due to complications. The cost should be cross-subsidized towards the needy patients.

(Para 6.2.5)

Ensuring Healthcare Accessibility to Rural Population

285.     The Committee finds that access remains a major issue for India's rural population, who often must travel long distances to reach a hospital, since high-quality treatment facilities are largely concentrated in cities and are absent from small towns and district centres. This problem is worsened by inefficiencies in Primary and Community Health Centres, where doctors do not always serve their full contracted duration or follow service guidelines. Most rural and daily-wage patients also cannot afford to lose a day of work to seek treatment, yet OPD timings rarely accommodate this reality. The difficulty is magnified further in hilly, desert, and forest terrain, where simply reaching the nearest hospital is a challenge in itself. The Committee has been informed that the incidental cost of accessing care, including travel, food, and lost wages, comes to roughly five hundred rupees per visit, a sum many rural poor households simply cannot absorb.

(Para 6.2.6)

286.     The Committee calls for, to improved access in rural areas, investment in cheap and reliable transport so patients can reach the nearest hospital without sacrificing a day's income, building on the improvements already seen in emergency ambulance coverage for maternal and child health. The Committee also recommends stricter enforcement of PHC and CHC staffing requirements, ensuring doctors complete their full contracted duration and follow service guidelines, supported by biometric attendance tracking. To reinforce accountability, the Committee suggests surprise visits by senior bureaucrats and local elected representatives such as MLAs and MPs to verify that facilities are functioning as intended, which would also help rebuild public trust in local governance. Extending OPD hours into the evening is particularly valuable, allowing daily-wage earners and migrant workers to seek treatment without losing income, a model the Committee has seen apprised of that it works well through NGO-run OPDs that run from six in the evening past midnight, offering free consultation and medicines. Finally, hilly, desert, and forest regions should be prioritized for targeted infrastructure investment given how disproportionately access challenges affect them.

(Para 6.2.7)

287.     The Committee was apprised of that liver transplantation costs anywhere between twenty-five and fifty lakh rupees across Indian hospitals, putting it out of reach for all but high-earning professionals and business owners. Organ donation rates are also markedly uneven across the country, with the South donating more than the North, and the West performing somewhat better than the North. The Committee further notes that some private centres charge very large sums for organ transplantation, which runs counter to the spirit of organ donation as a public service rather than a profit opportunity for hospitals.  The Committee recommends for detailed study of the rural health care model being provided under AB-PMJAY.

(Para 6.2.8)

288.     The Committee finds the Maharashtra's approach as a model worth replicating nationally, in which senior private-sector surgeons are attached to municipal hospitals and oversee government-employed medical teams during complex operations, effectively extending high-end surgical expertise to public-sector patients. More broadly, the Committee suggests that public-private partnership should be treated as the long-term backbone of healthcare infrastructure development, rather than allowing the two systems to continue developing in isolation from one another.

(Para 6.2.9)

289.     The Committee, on the cost of transplantation specifically, recommends rationalizing the price of liver transplants performed in government-sector hospitals at four to five lakh rupees, a benchmark already achieved at IKDRC in Ahmedabad and Stanley Medical College in Chennai, as brought to the knowledge of the Committee, which would bring the procedure within reach of India's working middle class. The Committee also would highlight the example of Pravara Institute of Medical Sciences, Loni, Ahmednagar, Maharashtra wherein affordable and accesable health care in rural setting is being provided to a significant population on a very large scale including a affordable organ transplant program.  The same model can be extended to provide accessible and affordable healthcare in rural parts of the country. The Committee also recommends for scaling of AIIMS-standard organ transplant programs to more States. To address the low organ donation rates in North India, the Committee suggests adapting successful state frameworks, noting that Tamil Nadu's donation laws have already been shared with a NITI Aayog panel member for possible national replication. The Committee stresses that organ donation should remain strictly public-service oriented, with regulatory safeguards to prevent private hospitals from treating it as a profit centre.

(Para 6.2.10)

290.     The Committee observes that the rising medical education costs are pushing many families toward education loans that take years to repay, and this financial burden shapes how newly qualified doctors approach their careers once they begin practising. At the same time, while new medical colleges are being established across many districts, staffing them with qualified faculty remains genuinely a challenge. Compounding this, the requirement that graduating doctors serve some time in rural, hilly, or tribal areas is sometimes circumvented by paying a fine, which undermines the very purpose the policy was meant to serve.

(Para 6.2.11)

291.     The Committee recommends, to ease the financial burden on medical students, rationalizing medical education fees, particularly in private institutions, so that graduates are not forced into years of loan repayment that shapes their later career choices. The Committee also calls for strict enforcement of the mandatory rural, tribal, and hilly service requirement for graduating doctors, without allowing a fine-based opt-out, so that the underlying intent of the policy is actually met. Beyond this, the Committee visualize real potential in the Indian medical diaspora and proposes that a streamlined registration pathway, building on the state medical council registrations which many NRI doctors already retain, would allow doctors of Indian origin nearing or post retirement to serve in district medical colleges. This would bring world-class exposure and language-matched care to patients closer to home, while broadening the learning opportunities available to local doctors and students.

(Para 6.2.12)

292.     The Committee was apprised that age-related and lifestyle conditions, including diabetes, hypertension, high cholesterol, and obesity, are increasingly common and, left unaddressed, driving major complications along with significant financial strain on the whole family. The Committee was informed that even in the developed countries like the United Kingdom, despite treatment being free at the point of delivery, the system there is described as being in a difficult state, with long waitlists and patient mistrust. The Committee observes that funding alone does not guarantee accessible or trusted care.

(Para 6.2.13)

293.     The Committee places strong emphasis on prevention, public health education on salt, sugar, and lifestyle-driven disease that has the potential to change patient behavior measurably. The Committee advocates promoting Yoga as a low-cost preventive practice, building on the platform created by International Yoga Day, positioned as a complement to clinical care rather than a replacement for it. More broadly, the Committee encourages replicating low-barrier community OPD models, offering free consultation and medicines during evening hours and delivered with an emphasis on dignity and self-worth, as a scalable way to reach street vendors, rickshaw pullers, and other daily-wage populations who are otherwise underserved.

(Para 6.2.14)

294.     The Committee acknowledges that structural deficits must be rectified to support equitable healthcare delivery. The Committee recommends bridging existing gaps in Sub-Health Centres (SHCs), Primary Health Centres (PHCs), and Community Health Centres (CHCs) in strict accordance with IPHS 2022 norms. The Committee also recommends developing a phased roadmap to upgrade Ayush facilities in alignment with Ayush IPHS 2024 norms.

(Para 6.2.15)

295.     The Committee believes that strengthening procurement and supply chain management systems is critical to ensuring the uninterrupted availability of essential medicines and diagnostics across all healthcare levels. The Committee is of the view that Public-Private Partnerships should be promoted to expand diagnostic capacities, improve biomedical waste management, and enhance access to specialized services where the public sector is constrained.

(Para 6.2.16)

296.     The Committee believes that addressing child and adolescent health is foundational to long-term human capital gains. The Committee recommends significantly improving the screening quality and coverage of disease conditions by strengthening RBSK (Rashtriya Bal Swasthya Karyakram) teams. The Committee also recommends incorporating specific provisions for positive mental health and addressing mental ailments within the school ecosystem. The Committee is of the view that schools must promote yoga, meditation, physical activity, and comprehensive health and nutrition education through both curricular and extracurricular avenues, alongside ensuring the mandatory provision of first aid.

(Para 6.2.17)

297.     The Committee notes that NQAS lacks statutory backing and NQAS certification is "voluntary and does not derive from a separate statutory enactment," even though 100% coverage of public facilities is the stated goal. The Committee recommends considering a phased move toward statutory or executive-order backing for NQAS, at minimum, making certification a binding precondition for PMJAY empanelment and NHM fund disbursement, rather than relying solely on incentive-linkage through NHA. The Committee further observes that human resource capacity forms a critical pillar of the quality governance framework and recommends deployment of more than 2350 National and over 10,500 State Trained Assessors across the diverse geographical settings facilitating harmonized implementation of standards and promoting peer learning and exchange of best practices.

(Para 6.2.18)

298.     The Committee notes that there is fragmented multi-agency architecture with NQAS sits under MoHFW while NABH/NABL sit under QCI, which reports to DPIIT, a different ministry altogether. The Committee acknowledges this creates "potential for duplication of assessments, documentation requirements and administrative effort" for facilities pursuing multiple accreditations. The Committee recommends establishing a formal inter-ministerial coordination mechanism (MoHFW–DPIIT/QCI) to build a standards crosswalk or equivalence mapping between NQAS, NABH and NABL, so facilities aren't re-assessed against near-identical criteria. A shared digital evidence repository (leveraging the existing SaQsham platform) could let assessment documentation be reused across systems.

(Para 6.2.19)

299.     The Committee observes that teaching/research/high-volume service delivery not reflected in standards. The current frameworks may not fully reflect the broader responsibilities and operational realities of Government Medical Colleges and public sector hospitals, including teaching, research, national health programmes, and high-volume service delivery. The Committee recommends developing a supplementary NQAS module specifically for teaching/tertiary hospitals that captures academic and research functions, and coordinate this with National Medical Commission (NMC) recognition criteria so medical colleges aren't juggling contradictory or duplicative accreditation demands.

(Para 6.2.20)

300.     The Committee finds that there is no data on disproportionate burden for small/rural/remote facilities. No consolidated national assessment has been carried out regarding differential burden, sustainability, or benefits across categories of healthcare institutions, despite acknowledging that small, rural, remote and underserved facilities likely face proportionately higher costs than large corporate hospitals. The Committee recommends commissioning of a study on structured national assessment comparing compliance cost, time-to-certification, and assessor availability across facility size/location/ownership. The findings should be used to design tiered timelines, additional mentoring support, or higher NHM incentive weighting for ADP/ABP and underserved facilities, rather than treating all facilities under one compliance bar.

(Para 6.2.21)

301.     The Committee is of the view that, with NQAS running 2,350 + national and 10,500 + state assessors, rapid scale-up raises a natural question of scoring consistency even though there are standardised toolkits and objective scoring. The Committee recommends institutionalizing periodic inter-assessor calibration exercises and refresher cycles alongside the existing fortnightly learning series, and publish inter-rater reliability metrics as part of SaQsham's data analytics.

(Para 6.2.22)

302.     The Committee believes that SaQsham's analytics capability should be used to publish a public, facility-level dashboard tracking certification status, time taken, and geographic/tier-wise disparities, turning the "digital ecosystem" already built into an accountability tool, not just a workflow system.

(Para 6.2.23)

 

INVESTMENT IN PREVENTIVE HEALTHCARE

303.     The Committee observes that healthcare spending is predominantly directed toward treating advanced diseases rather than preventing illness, driving higher long-term costs. Tertiary care institutions face severe overcrowding by patients whose conditions could be effectively managed at primary or secondary facilities, which limits access for those requiring advanced specialist interventions. A significant proportion of patients bypass primary care to seek specialist consultation for manageable conditions. The Committee, therefore, recommends increasing investment in preventive healthcare, health promotion, and screening programmes to alleviate the burden on higher-tier hospitals. The Committee believes that tertiary care institutions must operate as true referral centres, evaluating non-emergency patients strictly upon referral while maintaining immediate access for emergencies. The Committee is of the view that Family Medicine training must be expanded, effectively establishing family physicians as the first point of contact within the healthcare system.

(Para 6.2.24)

STRUCTURED DISTRICT RESIDENCY CLINICAL POSTING

304.     The Committee observes that Community Health Centres (CHCs) and Sub-District Hospitals remain underutilized as teaching facilities, restricting students' exposure to district-level healthcare. Current faculty norms and training capacities are likely insufficient to address the rising demand for super-specialists in chronic care, oncology, and critical care. Discrepancies between government and private medical colleges regarding bed and faculty requirements inflate the cost of postgraduate programmes without enhancing educational quality. There are localized shortages of specialist faculty alongside underutilized expertise in other institutions. The Committee recommends that all medical colleges affiliate with designated CHCs and Sub-District Hospitals to facilitate structured district residency and clinical postings for students and interns.

(Para 6.2.25)

305.     The Committee believes that super-specialty (DM/MCh) training should be expanded by reintroducing appropriate flexibility in faculty norms. The Committee, therefore, recommends that DM/MCh faculty and their clinical beds be recognized as eligible teaching resources for undergraduate and postgraduate education to optimize resources and increase specialist manpower. The Committee is of the view that uniform competency-based standards for postgraduate education must be implemented across all institutions, focusing on clinical exposure and case mix rather than institutional ownership. The Committee recommends developing a national framework for faculty sharing to utilize expertise through visiting appointments and tele-education.

(Para 6.2.26)

CLINICAL AUDIT TO PROMOTE COST-EFFECTIVE CARE

306.     The Committee notes that corporate hospital charges lack transparency and vary widely for procedures and investigations. Out-of-pocket expenditure is heavily driven by the costs of medicines, implants, and diagnostics. Current healthcare financing mechanisms primarily reward service volume rather than clinical outcomes. Variations in clinical practice lead to unnecessary investigations and escalated costs. The Committee, therefore, recommends introducing standardized cost-accounting and transparent pricing to ensure charges align with audited costs and reasonable operating margins. The Committee believes centralized procurement must be strengthened, generic prescribing encouraged, and the prices of essential medicines and implants strictly regulated. The Committee is of the view that hospital reimbursement and incentives must be tied to quality indicators, patient safety, and efficiency rather than procedure volume. The Committee recommends implementing evidence-based national treatment protocols alongside regular clinical audits to promote cost-effective care.

(Para 6.2.27)

DIGITAL HEALTH RECORDS

307.     The Committee is of the view that fragmented health records and duplicated diagnostic investigations reduce systemic efficiency and increase costs. Advanced diagnostic and therapeutic equipment is highly expensive and often underutilized, yet inaccessible in many districts. Substantial private sector healthcare infrastructure remains underutilized for achieving national public health objectives. Numerous procedures requiring hospital admission could be safely executed as day-care surgeries. The Committee recommends establishing interoperable electronic health records, telemedicine services, and AI-supported clinical decision systems. The Committee believes that validated AI-assisted screening programmes must be scaled up to facilitate the early diagnosis of common diseases. The Committee, therefore, recommends the creation of regional shared-resource networks, allowing government and accredited private hospitals to schedule access to high-cost equipment such as PET-CT, MRI, and molecular diagnostics. The Committee is of the view that a structured framework must be established to require or incentivize accredited private hospitals to contribute to national health programmes, including disease surveillance and immunization. The Committee recommends expanding day-care surgery services through the deployment of standardized clinical protocols and appropriate reimbursement mechanisms.

(Para 6.2.28)

 

308.     The Committee is of the view that the current commercial market for Electronic Medical Records (EMR) and Hospital Information Systems (HIS) restricts access to vital digital infrastructure due to prohibitively expensive licensing walls. The Committee, therefore, recommends that the Ministry of Health and Family Welfare, alongside MeitY, commission a dedicated fund to subsidize top-tier software enterprises in building an enterprise-grade, open-source digital healthcare platform. The Committee believes this platform must natively bridge the gap between all stakeholders and incorporate direct IoT integration with bedside equipment. Once finalized, the software must be released globally under an open-source license, entirely free of cost, to democratize access to modern digital workflows. The Committee, therefore, strongly recommends for an open source extremely affordable AI solution to interpret X-rays, specially portable X-rays so that interpretation can be done at the Community Health Centers (CHCs) or Primary Health Care Centers (PHCCs) level.  The Committee strongly recommends, therefore, rationalizing/capping the cost of AI used to interprete  such x-rays at CHCs and PHCCs.

(Para 6.2.29)

STRATEGIC ACTION PLAN OF HEALTH SAVINGS ACCOUNT (HSA)

309.     The Committee observes that over 85% of the Indian workforce operates within the informal sector, entirely lacking institutional social security or structured healthcare coverage. While the government spends approximately 1.5% of its GDP on public healthcare, however the Committee has expressed that public financing alone cannot fully absorb the catastrophic out-of-pocket health expenditures (OOPE) faced by millions of families. Formalizing these employment relationships under standard corporate health covers is an administrative bottleneck in the short term. The Committee, therefore, recommends that the Government must deploy the economic tool of Health Savings Accounts (HSAs), modeled after successful global precedent and frameworks and Singapore pioneered HSAs approach via the Medisave system in 1984, followed by China (covering over 300 million workers) and the United States with over $50 billion managed in consumer HSAs. 

(Para 6.2.30)

310.     The Committee, in this regard, finds that the Reserve Bank of India (RBI) has cleared the regulatory pathway for zero-balance HSAs (analogous to the Jan Dhan architecture), with the Bank of Baroda launching India's first dedicated HSA product on December 18, 2025. The Committee, therefore, recommends that Government to undertake Strategic action plan by mandating account creation, encouraging volunteery contribution and disintermediation of insurance. The Central Government should mandate that all temporary, gig, and informal sector workers be signed up for a zero-balance HSA. The administrative responsibility of on-boarding should rest on the immediate employer or contracting platform. To bypass employer resistance against mandatory payroll taxes for temporary labor, contributions should initially be voluntary. Employers should be systemically nudged to contribute a modest 100 to 200 per month per worker. Funds accumulated within these HSAs must be legally ring-fenced, usable only for health-related expenses and direct premiums for micro-health insurance policies. By linking insurers directly to HSA holders, the Government must intend to eliminate intermediaries and brokers who traditionally skim 30% to 40% off premium distributions, drastically lowering insurance costs for the poor.

(Para 6.2.31)

TRANSIT TO GLOBAL MEDICAL DEVICE MANUFACTURING HUB

311.     Indian healthcare delivery is deeply reliant on imported medical technology. Many government tertiary center or private hospital, and the critical diagnostic and life-support infrastructure is almost exclusively manufactured by foreign conglomerates that creates a severe national security liability and ties the cost of domestic clinical procedures to foreign exchange volatility (USD/EUR). According to the Association of Indian Medical Device Industry (AiMeD), India currently imports nearly 70-80% of its medical devices, exposing the system to external supply shocks and high capital expenditure requirements. The Committee, therefore, views that the Government must transit from an import-dependent market to a global manufacturing hub for medical devices. There is an urgent need to replicate the phased manufacturing and technology-transfer models successfully utilized by the domestic automotive sector and China's industrial frameworks.

(Para 6.2.32)

312.     The government should grant a complete 0-5 year corporate tax exemption to global medical equipment manufacturers that establish full-scale manufacturing facilities within India with the rider of mandating component localization. The policy must explicitly disincentivize simple "screwdriver assembly" plants. Tax concessions must be systematically tied to progressive localization schedules, requiring components, sensors, and software architecture to be developed natively. The Committee understands that Collaborating with global giants will train cadre of Indian biomedical engineers and technicians and over time, these individuals will drive native enterprise, replicating the trajectory where domestic automotive firms evolved to successfully compete with global market leaders.

(Para 6.2.33)

ENSURING AVAILABILITY OF CLINICAL SPECIALTIES IN TIER-II & TIER-III CITIES AND RURAL AREAS

313.     The Committee is of the view that to resolve the acute shortage of clinical specialists in Tier-2, Tier-3, and rural regions, the National Medical Commission (NMC) must shift away from rigid, legacy pedagogical structures and optimize the available medical talent pool. Tens of thousands of MBBS graduates spend their most productive clinical years isolated in libraries, rote-learning multiple-choice questions (MCQs) to crack the hyper- competitive NEET-PG exam. Concurrently, patients in smaller towns reject basic MBBS practitioners, demanding specialists doctors. Distribution from Tier-I cities to Tier-II and Tier-III has to be increased by balancing regional distribution through affirmative action and incentives.

(Para 6.2.34)

314.     The Committee observes that Cardiovascular disease (CVD) remains India's leading cause of premature mortality. Super-specialists holding a DM in Cardiology require up to 14 years of rigorous training and rarely settle outside Tier-1 cities. The Committee has come across that eighteen years ago, the Indira Gandhi National Open University (IGNOU) launched the Diploma in Community Cardiology, a two-year structural program for MBBS doctors executed in partnership with India's premier cardiac institutes. It successfully trained over 2,500 non-interventional cardiologists who managed early heart attack interventions and conducted pediatric cardiac screenings across rural and semi-urban communities. Although, the NMC recently recognized the validity of those initial 2,500 practitioners, the training pipeline remains frozen due to legacy pushback from the erstwhile Medical Council of India (MCI). The Committee, therefore, desires the NMC for considering to re-institutionalize the Diploma in Community Cardiology to position non- interventional cardiac care specialists directly at the sub-district level.

(Para 6.2.35)

ENSURING AVAILABILITY OF POINT-OF-CARE ULTRASOUND (POCUS)

315.     The Committee observes that the Pre-Conception and Pre-Natal Diagnostic Techniques (PNDT) Act, while vital for preventing female foeticide, has created an operational crisis. The law strictly penalizes any practitioner outside of a registered radiologist or gynecologist who operates an ultrasound machine, however, now–a-days, point-of-care ultrasound (POCUS) is a critical diagnostic tool- effectively the modern stethoscope-essential for triaging trauma, cardiac events, and acute abdominal crises.  The Committee recommends for easing out the regulating mechanism for point of care devices. The Lancet Commission on Global Surgery states that low- and middle- income countries face an immense surgical deficit. India performs roughly 25 million surgeries annually against an estimated true demand of 70 million, driven significantly by a lack of localized diagnostic access. India has fewer than 12,000 registered radiologists. A significant portion focus primarily on reporting teleradiology CT and MRI scans remotely, as a standard physical ultrasound requires roughly 20 minutes of localized, direct physical engagement, reducing throughput.  The Committee recommends for preventing screening on a mission mode to diagnose early liver diseases , in view of the fact that the country is facing an epidemic of fatty liver disease. Liver scanning fibroscan machines can be installed at CHC level wherein the medical professional can be trained to interpret the findings. 

(Para 6.2.36)

316.     The Committee, therefore, recommends that Government must operationalize the Supreme Court direction given from 14 years ago, which permitted MBBS doctors with a six-month structured training certification to perform and interpret general ultrasound scans. To eliminate the risk of illegal fetal sex determination, the Indian government, via the Indian Council of Medical Research (ICMR), should collaborate with medical imaging manufacturers to mandate a dual-firmware market split i.e. technological safeguard. The Committee recommends for introduction of a six month course for MBBS doctors in radiology so that they can interpret scans at the CHC level.

(Para 6.2.37)

 317.    The Committee believes that public resource allocation must pivot toward early detection to systematically mitigate premature mortality from cardiovascular diseases and oncological malignancies. The Committee, therefore, recommends provisioning an affordable annual diagnostic package for every citizen over the age of 40. This bundle must include standardized haematological profiles, an Electrocardiogram (ECG), a basic Echocardiogram, and Low-Dose Computed Tomography (LDCT) scans of the chest and abdomen to facilitate curative, low-cost interventions.

(Para 6.2.38)

NURSING CAPACITY BUILDING

318.     The Committee is of the view that the clinical proficiency deficit among entry-level nurses stems from standalone institutions lacking clinical exposure. The Committee, therefore, recommends that the Indian Nursing Council and State licensing boards legally bind nursing education to active clinical environments. The Committee believes no entity should be granted a license to operate a nursing college unless they own and operate a functional, baseline 100-bed general hospital. The Committee, therefore, recommends implementing a bedside learning framework. This will simultaneously improve immediate hospital nursing capacity and allow institutions to reduce tuition fees, making education more accessible while producing highly skilled graduates. The Committee recommends for creation of a ecosystem wherein Nursing Graduates can migrate for providing manpower for resource deficit countries.

(Para 6.2.39)

319.     To address the chronic shortfall of primary care physicians in rural and semi-urban areas, the Committee is of the view that India must adopt an advanced practice nursing framework. The Committee, therefore, recommends the introduction of a certified Nurse Practitioner (NP) framework. Experienced nurses undergoing this certification must be granted limited independent prescription rights for a strictly defined formulary of 47 essential primary care medications. Stationing these certified NPs at the Health and Wellness Centre (HWC) level will instantly bridge the primary care deficit.

(Para 6.2.40)

GST WAIVER A HEALTH INSURANCE PREMIUM

320.     The Committee believes that the current fiscal logic—which taxes group health insurance at 18% while exempting individual retail policies—creates an unintended penalty for vulnerable workforces, such as gig workers and informal collectives. The Committee, therefore, recommends a full GST waiver on low-cost group health insurance premiums up to a specific designated cap per life covered. This adjustment will actively encourage platforms and cooperatives to secure essential safety nets for millions of low-income workers.

(Para 6.2.41)

STRENGTHENING HEALTHCARE DELIVERY THROUGH INTEGRATED MEDICAL EDUCATION AND RATIONALISATION OF REGULATORY NORMS

321.     The Committee is of the view that affordable healthcare is intrinsically linked to the availability of an adequate, competent and well-trained healthcare workforce. It believes that optimal utilisation of existing teaching infrastructure, clinical resources and specialist expertise is essential for strengthening medical education and improving healthcare delivery. The regulatory framework governing medical education should, therefore, facilitate integration, efficient utilisation of resources and uniform standards while maintaining the quality of medical education.

(Para 6.3.1)

322.     The Committee notes that varying statutory requirements for Government and Private Medical Colleges do not further the objective of maintaining uniform standards in medical education. Regulatory norms relating to faculty strength, bed strength, infrastructure and academic resources should be guided by educational requirements and patient care needs rather than the ownership of the institution. The Committee, therefore, recommends harmonisation of statutory standards applicable to Government and Private Medical Colleges.

(Para 6.3.2)

323.     The Committee further notes that changing disease patterns, increasing disease complexity and advances in medical science require greater integration between Specialty and Super-specialty services. The Committee recommends greater integration of Specialty and Super-specialty Departments in undergraduate and postgraduate medical education through appropriate academic and clinical exposure, wherever feasible. Such integration would optimise the utilisation of existing academic and clinical resources and strengthen multidisciplinary clinical training.

(Para 6.3.3)

324.     The Committee further recommends that faculty and beds in relevant Super-specialty Departments may be considered towards the teacher-student ratio and bed strength requirements of the corresponding broad specialty, in accordance with the norms prescribed by the National Medical Commission. This would facilitate better utilisation of existing infrastructure and specialist expertise while strengthening medical education and promoting the expansion of Super-specialty education and healthcare services.

(Para 6.3.4)

325.     The Committee is of the view that the requirement for separate faculty and bed strength for each Super-specialty programme may constrain the expansion of Super-specialty education and services. Rationalisation of these regulatory norms through recognition of shared academic and clinical resources would encourage greater utilisation of existing infrastructure, expand training capacity, improve access to specialised healthcare services and strengthen the specialist healthcare workforce.

(Para 6.3.5)

326.     The Committee believes that these measures would promote efficient utilisation of available resources, strengthen medical education, facilitate expansion of specialised healthcare services and improve access to quality healthcare. This would contribute towards achieving the objective of affordable, equitable and quality healthcare.

(Para 6.3.6)

327.     The Committee, therefore, recommends that the National Medical Commission undertake a comprehensive review of the existing regulatory framework relating to faculty and bed norms with a view to promoting integrated medical education, facilitating optimal utilisation of institutional resources, encouraging expansion of Super-specialty education and strengthening the healthcare delivery system without compromising the quality of medical education.

(Para 6.3.7)

CGHS FACILITIES FOR SENIOR CITIZENS

328.     The Committee is of the considered opinion that CGHS beneficiaries form a significant component of health beneficiaries seeking affordable and accessible health care in their post retirement phase. Logistical and administrative difficulties make it difficult for them to access referral from CGHS wellness centers for their treatment requirements. The Committee notes that beneficiaries above the age of 70 years can directly approach empanelled hospitals without going through the referral process for all consultations as well as procedures.  Seeking treatment under the existing system  in itself is time consuming with long queues and at times arbitrary and the beneficiaries can access the health care without referral only in case of emergencies. The Committee recommends that the 70 year age bar be reduced to 60 years so that all retired beneficiaries can approach empanelled hospital for their health care requirements without going through a time consuming cumbersome process for all purposes.  This would reduce unnecessary paper work besides providing ease of living for retired personnel.

(Para 6.4.1)

CLIMATE CHANGE AND HEALTH

329.     The Committee understands that India ranks among the countries most exposed on nearly every indicator the Lancet Countdown tracks having one of the largest absolute air pollution mortality burdens of any country, alongside China; it is warming in a way that is measurably increasing heatwave frequency and duration; and it is losing tree cover (about 2.33 million hectares between 2001 and 2023) that would otherwise buffer both heat and air pollution exposure. The Global Burden of Disease (GBD) 2019 study — carried out for India in partnership with UNEP at the invitation of the Ministry of Environment, Forest and Climate Change — found that air pollution accounted for 17.8% of all deaths in the country that year, split between ambient particulate matter and household air pollution.

(Para 6.5.2)

330.     UNEP further submitted that Heatwave frequency and severity are set to keep rising through mid-century even under moderate emissions pathways, and climate-sensitive infectious diseases such as dengue are projected to expand geographically into currently low-risk states and shift seasonally, lengthening transmission windows in most parts of the country. Consequently, affordability and access are also affected. Out-of-pocket costs for treating heat illness, respiratory disease and vector-borne infection fall disproportionately on lower-income and informal-sector households who lack heat-safe workplaces or health insurance, and rural or hilly districts often face longer travel times to facilities equipped for climate-sensitive emergencies. Health financing planning has not yet systematically absorbed these climate-attributable costs, which the Lancet Countdown work suggests already run into tens of billions of dollars a year for India when premature mortality and lost productivity are counted.

(Para 6.5.3)

VECTOR-BORNE AND WATER-BORNE DISEASE

331.     Dengue cases reported to the National Centre for Vector-Borne Disease Control rose from about 28,000 in 2010 to roughly 289,000 in 2023, a roughly ten-fold increase  and modelling studies project further increases in transmission-suitable months as temperatures and monsoon patterns shift, with new transmission risk emerging in areas such as the upper Himalayas, parts of the Thar Desert, and north-eastern states that previously saw little dengue activity. Similar climate sensitivity applies to malaria, chikungunya, and water-borne diseases linked to flooding and water stress, though the strength of projected effects varies by region and emissions pathway.

(Para 6.5.4)

NON-COMMUNICABLE DISEASE AND MENTAL HEALTH

332.     Heat and air pollution both aggravate cardiovascular, respiratory and renal disease, and a growing evidence base links extreme heat and humidity to worsening mental health outcomes and, in some studies, increased interpersonal violence. Vulnerable groups — outdoor labourers, slum residents, the elderly, pregnant women, and people with pre-existing NCDs — carry a disproportionate share of this burden, which compounds existing health equity gaps.

(Para 6.5.5)

POLICY AND INSTITUTIONAL

333.     The Committee is of the view that the Government should undertake concrete to broaden targeted health strategies and outreach to the full range of climate-vulnerable groups, including children, pregnant women and urban poor populations, alongside the elderly and outdoor workers already prioritised and explicitly address climate-linked nutrition and food-security risks (undernutrition and micronutrient deficiencies arising from disrupted agricultural productivity) and the psychological distress associated with heat, disasters and displacement. Moreover, the Committee observes that the Government should formulate minimum-standard Heat Action Plans for all districts (not only cities) with defined triggers, cooling-centre and hospital-surge protocols, and independent evaluation, building on the Ahmedabad model. There is also a need to rormalise occupational heat-safety norms (work-rest cycles, shaded rest areas, hydration access) for outdoor and informal-sector workers, who bear a disproportionate share of heat-related morbidity.  Besides that the Government must expand green healthcare guidelines into a comprehensive resilience framework: the existing guidelines focus more on climate change mitigation (reducing the health sector's own carbon footprint) than on adaptation, and should be broadened to also cover facility-level heat and flood preparedness, continuity of care during climate shocks, and workforce protection.

(Para 6.5.6)

ASSURING QUALITY HEALTHCARE AT GRASS-ROOT LEVEL

334.     The Committee is of the view that uniform clinical practices are vital for equitable and safe patient care across all healthcare institutions. The Committee, therefore, recommends the strict enforcement of mandatory Standard Treatment Guidelines (STGs) across both public and private sectors. Treatment protocols and diagnostic criteria must be standardized and aligned with universally accepted evidence-based benchmarks, such as those prescribed by the World Health Organization (WHO) or the National Health Service (UK).

(Para 6.6.4)

335.     The Committee is of the view that while recognizing the role of the National Council for Clinical Establishment (NCCE), grassroots monitoring and active oversight require immediate fortification. The Committee believes that localized administration is critical for timely interventions. The Committee, therefore, recommends the formalization of dedicated District-level Medical Committees to conduct periodic reviews, resolve local grievances, and coordinate directly with the Director General of Health Services (DGHS) and state officials. Strict annual audits of all healthcare services must be institutionalized. District Regulatory Authorities (DRAs) must be fully empowered to inspect, audit, and penalize non-compliance. The Committee strongly recommends that the National Council for Clinical Establishment State Councils and District Regulatory Authorities must remain alert and at work all the time to implement the provision of the Clinical Establishment Act, 2010 to ensure compliance with prescribed Standard Treatment Protocol (STP) at ground level.

(Para 6.6.5)

336.     The Committee feels that although self-assessments via the IPHS dashboard and the widespread adoption of the Kayakalp initiative demonstrate progress, continuous infrastructural enhancement remains paramount. The Committee believes that preventive health is intrinsically linked to facility hygiene. Strict maintenance protocols for sanitation, specifically concerning wastewater management and environmental controls, must be rigidly enforced to prevent disease transmission emerging due to climate change and ecological disorders. Continuous capital and operational investments must be directed toward addressing basic infrastructure gaps to ensure 100% compliance with NQAS and IPHS benchmarks.

(Para 6.6.6)

337.     The Committee recommends the progressive expansion of NABH and NABL accreditations across the broader healthcare ecosystem. The Committee is of the view that transparency drives institutional excellence. Therefore, public performance ratings for healthcare facilities must be published periodically to ensure direct accountability to the public. Building upon the National Health Policy 2017, all governmental policies must be continuously revisited refined and reformed to prioritize the patient experience. Healthcare delivery must remain demonstrably gender-sensitive, inherently safe, and strictly confidential at all points of care.

(Para 6.6.7)

INSTITUTIONALIZING COMMUNITY LEVEL HEALTHCARE FACILITIES AND MONITORING SYSTEM

338.     The Committee is of the view that centralized planning sometimes fails to capture the nuanced realities of diverse demographic clusters. Facilities must be expanded based on empirical, grassroots data rather than uniform assumptions. The Committee, therefore, recommends that local panchayats, working in tandem with VHSNCs in rural areas and MAS in urban slums, be mandated to conduct comprehensive need-based analyses before any new healthcare facility is approved or existing infrastructure is expanded. The Committee believes that untied funds managed by these local bodies must be strictly appropriated and monitored to ensure that expenditures are directed toward locally identified priorities, bridging the gap between healthcare providers and the community.

(Para 6.7.4)

339.     While recognizing the establishment of 35,870 Rogi Kalyan Samitis (RKS) and over 5.65 lakh VHSNCs, the Committee notes that mere constitution does not guarantee effective oversight. The Committee believes that transparent accountability is the cornerstone of public trust. The Committee, therefore, recommends the formal institutionalization of Community-Based Monitoring systems across all public health facilities. Regular and mandatory Social Audits of all health programs must be conducted through RKS and JAS. The findings of these audits must be integrated into the performance reviews of the respective health facilities.

(Para 6.7.5)

340.     The Committee acknowledges the monumental role of the 10.33 lakh ASHAs as the foundation of primary healthcare and public health mobilization. However, operational guidelines issued in the years 2013 and 2014 require modernization and revision. The Committee, therefore, recommends that the Ministry immediately revise and update the ASHA operational guidelines for both rural and urban contexts to reflect current epidemiological realities and emerging public health challenges due to climate change and global ecological and environmental disorder. ASHAs must be systematically capacitated through continuous training programs and capacity building to better educate and mobilize marginalized communities, focusing sharply on the social determinants of health and improving the utilization metrics of Ayushman Arogya Mandirs.

(Para 6.7.6)

341.     The Committee is of the strongly view that sustainable health outcomes cannot be achieved by state machinery alone thereby requiring a paradigm shift in societal behavior. The Committee believes that public health must be universally recognized as a 'Personal, Familial, Community, and State Joint Responsibility.' The Committee, therefore, recommends the deployment of state-level, culturally calibrated Awareness Campaigns designed specifically to encourage proactive health-seeking behavior and reinforce absolute trust in government health services.

(Para 6.7.7)

TRANSFORMING EMERGENCY HEALTHCARE

342.     The Committee is of the view that rapid, optimized medical transport is the bedrock of effective emergency intervention and disaster management. The Committee, therefore, recommends the immediate creation and deployment of highly optimized ground and air ambulance systems, ensuring equitable distribution across difficult terrains, rural settings, and high-density urban regions. To eliminate transit-to-treatment delays, the Committee recommends the strict formulation and enforcement of standardized ambulance-to-hospital handover protocols. The Committee believes that immediate public access to emergency transport must be drastically simplified. The Committee, therefore, recommends the widespread promotion and continuous provision of a unified, highly responsive centralized and operational helpline number.

(Para 6.8.5)

343.     The Committee believes that casualty and emergency medical services must be expertly staffed and financially sound at the time of crisis. The Committee, therefore, recommends that dedicated Emergency Medicine (EM) departments, staffed exclusively by specifically trained physicians, be made mandatory across all district hospitals, medical colleges, and public tertiary centers. Furthermore, greater institutional recognition must be afforded to these crucial departments. The Committee is of the view that financial constraints must never delay life-saving interventions. The Committee, therefore, recommends that emergency care be provided entirely free of cost at the point of care in both public and private hospitals. Such mandate must be supported by automated, prompt reimbursement mechanisms executed through government schemes.

(Para 6.8.6)

344.     Recognizing the absolute necessity of sustained respiratory support, both during

emergencies and post-discharge, the Committee is of the view that targeted infrastructural and policy enhancements are required. The Committee, therefore, recommends that the Government immediately establish district-level oxygen concentrator banks embedded within the existing public health infrastructure. The Committee believes that chronic respiratory care must be financially protected. The Committee, therefore, recommends bringing Long-Term Oxygen Therapy (LTOT) comprehensively under existing insurance schemes. Furthermore, mandatory follow-up and reassessment protocols for LTOT patients must be instituted to guarantee patient safety, clinical efficacy, and systemic cost-effectiveness.

(Para 6.8.7)

345.     The Committee acknowledges the vital safety nets established by the Cashless Treatment of Road Accident Victims Scheme, 2025, and the ongoing infrastructure projects under the PM-Ayushman Bharat Health Infrastructure Mission (PM-ABHIM). The Committee is of the view that robust hospital preparedness is non-negotiable. The Committee, therefore, recommends that the construction and operationalization of the approved 50-100 bedded Critical Care Blocks (CCBs) be expedited to guarantee readiness for pandemics, mass casualty events, and natural disasters.

(Para 6.8.8)

NEED OF STRONG ACCREDITATION ECOSYSTEM

346.     The Committee understands that NABH brings the principles from ISQua, which is a globally competitive accreditation body, and works with hospitals, clinics and Ayush facilities in implementing quality management system. The Committee takes note that QCI undertakes Gunvattha Yatra and conduct Gunvattha Mitra and inculcates capacity-building and skill development through gunvattha pathshala. Moreover, QCI promotes ease of doing business through Gunvattha Manthan and encouraged hospitals to adopt an attitude towards maintaining health quality at an affordable cost. The Committee desires that QCI should promote hospitals to acquire ISO 15189 in tier I, II and III cities which is the golden standard and globally recognized for diagnostic labs. The Committee believes that the Gunvattha Chakra activities and Gunvattha Yatras would definitely promote QCI to ensure global quality standard at affordable costs.

(Para 6.9.1)

QUALITY OF GENERIC MEDICINE AND CONTROL OVER SPURIOUS MEDICINE

347.     The Committee has come across about the quality and efficacy of generic medicine, therefore, CDSCO needs to take concrete steps to ensure the quality and efficacy of generic medicine which are made available at Jan Ausdhi Kendra.  Moreover, the Committee wishes to point out that sometimes there is concern over the availability of spurious and fake drugs in the market having detrimental impact on the health of the common man, therefore, the Committee feels that there is urgent need to control the quality of a generic medicine and making the public aware that the quality of generic medicine at cheaper rate is equally effective to the branded medicine available at the market at the comparatively at the higher rate. Need is to win the public trust. The Committee strongly recommends for complet ban on spurious medicine.

(Para 6.10.1)

 REVERSE BRAIN DRAIN

348.     The Committee has come across that a large number of Indian doctors who have migrated abroad and constitute our diaspora possess the latest skills and are ready to come back to nurture our manpower besides providing advanced health care.  The number of such doctors who have although retired but are skilled senior doctors and living abroad, however, are willing to serve the nation provided those doctors are allowed to come and work in different parts of the country. The Committee, therefore, desires that such doctors may be given opportunity to register on the portal formed for the purpose and express their willingness in writing to serve the nation during the certain months of the year in different parts of the country, preferably in their home state, the benefits of their professional experience and expertise can be suitably utilized to ward off severe diseases in under served area/region of the country.  Besides that the resident doctors in different hospitals will get additional benefits of gaining their experience in general public interest. Therefore, the Committee recommends the Government to undertake necessary steps in this direction.  

(Para 6.11.1)

HEALTH EXPENDITURE AND GDP ALLOCATION

349.     The Committee notes with deep concern the low budget allocation for the health sector, comprising the Department of Health & Family Welfare, the Department of Health Research, and the Ministry of Ayush, which has hovered between 0.28% and 0.33% of GDP over the past five years. Although GHE has increased from 1.35% of GDP in 2017–18 to 1.43% in 2022–23, the Committee is of the view that this financial trajectory is severely inadequate and falls significantly short of the National Health Policy (NHP) 2017 goal of raising Government Health Expenditure to 2.5% of GDP by 2025. Because the 2025-26 financial year has concluded without achieving this milestone, The Committee believes that healthcare must urgently be prioritized as a foundational pillar for socio-economic development, demanding aggressive and sustained investment in public health infrastructure, preventive care, and equitable service delivery. The Committee, therefore, reiterates its recommendation in 172^nd Report that a strategic revision of the NHP target, mandating a rapid escalation of government health expenditure to 5% of GDP over the next five years to ensure robust and comprehensive healthcare expansion.

(Para 6.12.1)

HEALTHCARE PRICING AND REGULATORY INTEGRATION

350.     The Committee notes with serious concern that CAG in its Report of 2023 states inter-alia that the National Health Authority (NHA) formulated tertiary procedure rates by simply replicating existing central schemes and state averages rather than conducting localized, scientific clinical cost assessments. As highlighted by performance audits on the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (PMJAY), systemic gaps in hospital empanelment remain a challenge, exacerbated by pricing procedures far below actual operational costs, which has driven premier private hospitals to refuse empanelment. Furthermore, the Committee believes that IRDAI’s failure to enforce a strict policy against dual pricing, whereby private hospitals arbitrarily inflate charges for insured patients, and its inability to mandate the integrated National Health Claims Exchange (NHCX) IT interface by the June 2026 deadline represent severe regulatory lapses. The Committee, therefore, recommends the following immediate interventions:

1. Scientific Costing Revision: The NHA must immediately undertake comprehensive, localized scientific studies to revise and rationalize health benefit package rates. These metrics must accurately reflect current clinical operational costs to ensure the active empanelment and participation of premier private healthcare providers.
2. Mandatory NHCX Integration: IRDAI must issue stringent regulatory directives mandating the immediate technical integration of the NHCX interface with corporate hospital billing desks, imposing penalties for further delays beyond the June 2026 target.
3. Elimination of Dual Pricing: IRDAI must formulate and enforce a robust, standardized policy framework that explicitly prohibits the unethical practice of dual pricing, ensuring equitable and transparent billing practices for all patients regardless of their insurance status.

(Para 6.13.1)

RURAL HEALTHCARE DEPLOYMENT AND PM-JAY EXPANSION

351.     The Committee observes with grave concern the critical 70-80% shortfall of specialist physicians in rural Community Health Centres (CHCs). The Committee is of the view that despite a 133% increase in postgraduate medical seats over the last decade, the absence of effective deployment strategies has completely failed to bridge this rural healthcare disparity. The Committee is of the view that India does not face an absolute shortage of medical professionals; rather, the core crisis lies in deeply skewed distribution, with practitioners heavily concentrated in urban centers while rural areas remain severely underserved. To capitalize on this augmented educational capacity and establish a self-sustaining pipeline of medical professionals in underserved areas, the Committee believes that while augmenting postgraduate seats has expanded educational capacity, bridging this rural healthcare disparity requires robust retention and incentive frameworks rather than mere seat expansion. To systematically encourage and stimulate medical graduates to serve in rural government hospitals and Taluka facilities, the Committee recommends instituting a mandatory one-year rural service policy. Furthermore, to make this retention strategy effective, the Committee recommends awarding weighted incentive marks (such as an additional 10 to 20 marks) in the NEET-PG examinations for doctors who complete extended rural service, alongside the implementation of targeted rural reservation quotas. However, the Committee is of the considered view that deploying young doctors to rural PHCs and CHCs must be matched by immediate infrastructural upgrades. The Committee, therefore, urges the Ministry to ensure that adequate residential quarters, modern facilities, and secure infrastructure are provided on-site to make rural postings viable and sustainable.

(Para 6.14.1)

352.     The Committee believes that stringent retention and deployment policies are urgently required. Furthermore, recognizing that Out-of-Pocket Expenditure (OOPE) is primarily driven by outpatient (OPD) care and medicines, the current PM-JAY framework, which exclusively covers inpatient hospitalization, remains fundamentally inadequate. The Committee, therefore, recommends that the Ministry expanding PM-JAY to comprehensively cover OPD treatments and essential medical supplies.

(Para 6.14.2)

 

353.     The Committee is of the view that the current Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) coverage limit of Rs. 5 lakhs per family is fundamentally inadequate, particularly given the recent inclusion of six crore senior citizens over the age of 70 who present high rates of comorbidities. Furthermore, the Committee believes that the omission of 600 high-end, complex medical procedures from the current framework actively misleads beneficiaries and inflicts unsustainable out-of-pocket expenditures on vulnerable families. The Committee, therefore, recommends an urgent collaborative intervention by the Department of Health and Family Welfare, the Department of Finance, and NITI Aayog to mandate the immediate coding of these 600 excluded procedures and enhance the annual AB-PMJAY financial package to Rs. 10 lakhs per family.

(Para 6.14.3)

CASHLESS HEALTH SCHEMES, INCLUSIVE INSURANCE, AND HOSPITAL EMPANELMENT

354.     The Committee is of the view that the systemic and prolonged delays in clearing financial dues under major cashless health schemes, such as PM-JAY, are actively driving private hospitals to suspend services, thereby exacerbating the severe shortage of empanelled facilities and leaving patients stranded during medical emergencies. Furthermore, the Committee believes that the widespread exclusion of Persons with Disabilities, characterized by an alarming 53% arbitrary rejection rate that leaves approximately 16 crore vulnerable citizens without coverage, and the blatant failure of insurance providers to comply with the mental health parity mandated by Section 21(4) of the Mental Healthcare Act, 2017, represent a profound regulatory failure in delivering equitable healthcare. The Committee, therefore, recommends the immediate enforcement of a strict, time-bound financial settlement mechanism to clear all pending hospital arrears and stabilize the cashless healthcare ecosystem, which is essential for rapidly expanding the network of empanelled hospitals. Concurrently, the Committee strongly urges the regulatory authorities to issue stringent directives penalizing insurance companies that arbitrarily deny coverage to Persons with Disabilities or fail to provide comprehensive, equal-basis coverage for mental health conditions and outpatient (OPD) treatments.

(Para 6.15.1)

UPGRADING PUBLIC HEALTH INFRASTRUCTURE AND EXPANDING AIIMS

355.     The Committee is of the view that the technology-driven best practices successfully demonstrated by AIIMS, such as AI-based diagnostics, digital grievance redressal, patient navigation, and advanced hospital management, must be rapidly standardized across the public healthcare system. The Committee believes that launching a 'National Hospital Programme' will effectively replicate these successful models across all Government medical colleges and major district hospitals, significantly elevating the quality and efficiency of patient care nationwide. Furthermore, the Committee notes with concern the glaring regional disparities in tertiary healthcare access. Despite the sanctioning of 23 AIIMS across the country, critical regions remain unrepresented, notably Mumbai, the nation's economic capital, and the State of Karnataka, particularly the high-need Aspirational District of Raichur in the Karnataka region. The Committee, therefore, recommends that the Government expedite the approvals and establishment of new AIIMS facilities in these geographically and demographically critical areas, while simultaneously executing the National Hospital Programme to ensure equitable, technology-enabled healthcare delivery across all states.

(Para 6.16.1)

EMERGENCY NEONATAL AND PAEDIATRIC REFERRALS

356.     The Committee is of the view that the severe deficiency of specialized neonatal and paediatric care facilities within district hospitals poses a grave risk to public health, particularly for newborns and infants. The Committee believes that the current administrative protocol, which mandates acquiring a formal consent letter from a district hospital before a critical patient can be transferred to an empanelled facility, is deeply flawed and life-threatening. Such bureaucratic hurdles cause inexcusable delays during the critical 'golden hour' of medical emergencies, inflicting profound and unnecessary suffering on vulnerable patients and their families. The Committee, therefore, recommends the immediate abolition of the prior-consent requirement for all emergency neonatal and paediatric referrals to ensure seamless and rapid medical intervention, alongside a targeted infrastructural drive to establish self-sufficient paediatric care units directly within all district hospitals.

(Para 6.17.1)

SENIOR CITIZEN INSURANCE, EMERGENCY CARE, AND TERTIARY INFRASTRUCTURE EXPANSION

357.     The Committee is of the view that current healthcare delivery and insurance frameworks inadequately protect senior citizens and critically delay emergency medical interventions due to procedural financial barriers. The Committee believes that achieving equitable healthcare access requires both decentralized medical infrastructure and seamless, automated financial mechanisms. The Committee, therefore, recommends a multi-pronged intervention: first, the Insurance Regulatory and Development Authority of India (IRDAI) must mandate affordable insurance policies for citizens over 60 and deploy a dispute-free digital claim verification system; second, NITI Aayog and the Ministry of Health and Family Welfare must jointly establish autonomous tertiary healthcare centers in Tier-II and Tier-III cities, sustained by a cross-subsidization model where private ward revenues fund care for economically weaker sections; and third, a specific operational carve-out under PM-JAY must be instituted to guarantee immediate financial clearing for life-threatening emergencies, strictly enforcing a 'treatment first, payment later' protocol.

(Para 6.18.1)

358.     The Committee is of the view that expanding advanced tertiary healthcare beyond metropolitan areas to Tier-II and Tier-III cities is critical for equitable medical access. The Committee believes this can be effectively achieved by incentivizing private sector participation through targeted tax holidays, coupled with a mandatory obligation for these private facilities to provide cashless treatment to all Ayushman Bharat beneficiaries and uninsured patients at standardized CGHS rates. The Committee, therefore, recommends that the Ministry formulate a strategic public-private partnership framework to establish subsidized tertiary care centers in smaller cities, ensuring that commercial incentives are directly aligned with universal healthcare affordability and public welfare.

(Para 6.18.2)

359.     The Government should take steps to expand access to affordable bone marrow transplantation (BMT), which is presently largely available in private hospitals at a high cost of approximately ₹25–30 lakh per patient. All AIIMS should be equipped with dedicated BMT units, and, considering the large number of medical colleges in the country, one nodal BMT centre may be established for every five medical colleges to ensure wider geographical access. The facilities may be integrated with the existing framework of the National Organ and Tissue Transplant Organisation (NOTTO) and strengthened for the treatment of children suffering from Sickle Cell Disease and Thalassemia. Further, the Government may consider expanding empanelment of BMT centres under relevant public health schemes to reduce the financial burden on patients and ensure equitable access to this life-saving treatment.

(Para 6.18.3)

MARKET REGULATION

360.     The Committee is of the view that efficiently managed, high-quality public healthcare institutions play a critical role not only in delivering accessible patient care but also in acting as definitive market regulators that organically drive down exorbitant private sector medical costs. The Committee believes that the current centralized model of healthcare delivery must be decentralized to reduce patient travel burdens, and that government facilities must urgently adopt a "corporate culture" characterized by operational efficiency, accountability, and robust public relations frameworks. The Committee, therefore, recommends the strategic establishment of autonomous, efficiently managed public sector multispeciality hospitals in every revenue division across the States to ensure equitable access, minimize travel time to capital cities, and actively regulate regional healthcare pricing through superior public service delivery.

(Para 6.19.1)

REGULATING FOREIGN DIRECT INVESTMENT IN PRIVATE HEALTHCARE

361.     The Committee observes with serious concern the accelerating trend of substantial Foreign Direct Investment (FDI), often exceeding 51%, in the operational management of private hospital chains. The Committee is of the view that this unchecked influx of foreign capital is facilitating the monopolistic acquisition of cost-effective, mid-sized hospitals by large corporate entities. The Committee believes that this aggressive corporatization is fundamentally transforming healthcare from a public service sector into a purely capitalistic enterprise, artificially inflating the cost of medical procedures and triggering a cascading effect of price hikes across the entire healthcare ecosystem. While acknowledging that foreign capital is highly beneficial and should be actively encouraged in the manufacturing sector, specifically for medical devices, consumables, and specialized medicines for rare diseases, its unrestricted application in direct hospital operations is proving detrimental to affordable patient care. The Committee, therefore, recommends that the Government strictly review and rationalize Foreign Direct Investment limits concerning the operational management and acquisition of existing healthcare facilities to protect affordable mid-sized hospitals from predatory corporate buyouts. Concurrently, the Government must introduce a targeted regulatory framework that explicitly redirects and incentivizes such foreign investments toward the domestic manufacturing of medical technologies and pharmaceuticals.

(Para 6.20.1)

DECONGESTING AIIMS DELHI

362.     The Committee observes with deep concern the delays in operationalizing the memorandum of understanding signed in March 2024 between AIIMS New Delhi and the Central Armed Police Forces (CAPF) for the establishment of a specialized 970-bed facility at Maidan Garhi. The Committee recommends that the Ministry of Health and Family Welfare (MoHFW) expedite administrative clearances to ensure this state-of-the-art facility becomes fully operational without further delay. Furthermore, to alleviate the massive patient congestion and severe strain on the main AIIMS New Delhi campus, the Committee strongly supports utilizing available land resources in the National Capital Region. Specifically, the Committee recommends that MoHFW, in coordination with the Ministry of Housing and Urban Affairs (MoHUA) and the Delhi Development Authority (DDA), immediately evaluate and submit a formal proposal to reserve a portion of the 400-acre vacant NTPC land near Badarpur Border, Sarita Vihar, for the establishment of a major new AIIMS branch. Given its direct connectivity to major highways, this strategic location will significantly improve healthcare access for the populations of South Delhi, Faridabad, Noida, and the wider NCR.

(Para 6.21.1)

363.     The Committee is of the view that the existing infrastructure at AIIMS, New Delhi, is severely overburdened by a combination of a massive local population, an alarming rise in lifestyle diseases among younger demographics, and a relentless influx of patients from neighboring States. While acknowledging the relief provided by southern satellite institutions, the Committee believes that the northern periphery of the National Capital Region, including North Delhi, parts of northern Haryana, and western Uttar Pradesh, continues to suffer from a critical deficit in accessible tertiary healthcare, which perpetuates severe patient congestion and extreme stress on medical professionals at the main campus. The Committee, therefore, reiterates its recommendation in 172^nd Report that the Government urgently evaluate and execute the establishment of an additional, independently administered AIIMS facility or a fully equipped satellite center in the northern outskirts of Delhi, to strategically decentralize the tertiary healthcare burden and ensure equitable, timely medical access for the broader region.

(Para 6.21.2)

STRENGTHENING HUMAN RESOURCES IN MEDICAL COLLEGES AND DISTRICT HOSPITALS

364.     The Government should undertake a comprehensive review of the availability and deployment of healthcare professionals, particularly non-clinical faculty in medical colleges and anaesthetists in district hospitals. Despite the substantial expansion of medical colleges, many institutions continue to face acute shortages of non-clinical teaching faculty, adversely affecting the quality of medical education. Similarly, several district hospitals serving populations of over 10 lakh reportedly have only one anaesthetist, making it difficult to ensure uninterrupted surgical services, particularly during leave or absence. The Government should, therefore, assess manpower requirements and ensure adequate, rational and equitable deployment of doctors and specialists through NHM and other appropriate mechanisms. At the same time, given the reported availability of doctors in certain States, efforts should focus on better distribution, appropriate remuneration and employment opportunities, rather than merely increasing the overall number of doctors.

(Para 6.22.1)

 

STRENGTHENING AWARENESS AND OUTREACH OF GOVERNMENT HEALTH SCHEMES

365. The Government should undertake a comprehensive and sustained awareness campaign to ensure that rural and underserved populations are adequately informed about various Government health schemes, programmes and available healthcare services. Despite the launch of numerous initiatives, lack of awareness often prevents eligible beneficiaries from accessing their entitled benefits. Radio, television, local media and other appropriate communication channels, including community-level outreach, may be effectively utilised to disseminate information in local languages. The Government should also establish mechanisms to assess whether the intended beneficiaries are actually availing the benefits of these schemes, so that gaps in awareness, access and implementation can be identified and addressed.

(Para 6.23.1)

366.     The Committee further recommends that the Government should establish Patient Navigation and Facilitation Desk in every Distrct Hopital and Medical College to assist patients with referral, disgnostics, AB-PMJAY benefits, medicine availability and grienvances redressal. There is further need to improve healthcare accessibility, especially for the elderly, women and economically weaker sections. 

(Para 6.24.1)

NATIONAL HEALTHCARE AFFORDABILITY DASHBOARD

367.     The Committee understands that there is need to create  a district-wise digital dashboard on healthcare affordability and accessibility to track treatment costs, waiting times, specialist vacancies, diagnostics, medicine availability and redressal of patient grievances and to promote transparency, accountability and evidence-based policy interventions. 

(Para 6.25.1)

OUTCOME-BASED HASPITAL ACCREDITATION

368.     The Committee feels that there is to complement infrastructure-based accreditation with outcome-based quality indicators. The need of the hour is to assess hospitals on patient safety, treatment outcomes, infection rates, waiting time, patient satisfaction and grievance resolution, besides, encourage quality improvement based on health outcomes rather then infrastructure alone.

(Para 6.26.1)

 

RECOMMENDATIONS/OBSRVATIONS OF THE COMMITTEE–AT A GLANCE

(177^TH REPORT)

 

Overview and Burden Of  Chronic Kidney Disease

 1.        The Committee observes with concern that Chronic Kidney Disease (CKD) has emerged as one of the fastest-growing non-communicable diseases in the country, with a steadily increasing prevalence and a substantial proportion of patients being diagnosed only at advanced stages. The Committee further notes that although CKD constitutes a major public health challenge, the disease has not yet received commensurate policy attention in proportion to its growing burden and long-term socioeconomic impact. The Committee is of the considered view that addressing CKD requires a comprehensive and coordinated national response involving prevention, early detection, treatment, research and long-term patient care. The Committee, therefore, recommends that the Ministry of Health and Family Welfare accord higher priority to CKD within the national health agenda and formulate a comprehensive national strategy with clearly defined objectives, measurable outcomes and coordinated implementation across all levels of healthcare.

(Para 1.4.4)

Major Epidemiological Studies on CKD in India

2.         The Committee observes that Chronic Kidney Disease (CKD) is a progressive multisystem disease associated with several serious complications with cardiovascular disease being the leading cause of mortality among CKD patients. The Committee is of the view that delayed diagnosis and inadequate management often accelerate disease progression, resulting in increased morbidity, mortality and the need for dialysis or kidney transplantation. The Committee, therefore, believes that timely detection and comprehensive management are essential to improve clinical outcomes and reduce the overall burden of CKD. Accordingly, the Committee recommends strengthening early screening, timely diagnosis and integrated management of CKD to prevent disease progression, reduce complications and improve patient survival and quality of life.

(Para 1.5.2)

Environmental and Occupational Determinants of CKD

3.         The Committee recommends that the Ministry accord priority to focused research, strengthened surveillance and targeted preventive interventions to address CKD risk factors, particularly among agricultural and economically vulnerable populations.

(Para 1.8.2)

CKD in Children

4.         The Committee underscores that while diabetes mellitus and hypertension continue to be the leading causes of Chronic Kidney Disease in India, increasing evidence points towards the growing burden of Chronic Kidney Disease of Unknown Etiology (CKDu), particularly among agricultural workers and populations exposed to environmental and occupational hazards. The Committee further observes that chronic heat stress, recurrent dehydration, exposure to pesticides, contaminated drinking water and heavy metals have emerged as important areas requiring scientific investigation. The Committee is of the considered opinion that greater understanding of these determinants is essential for designing effective preventive interventions. The Committee, therefore, recommends that the Ministry of Health and Family Welfare, in collaboration with the Indian Council of Medical Research, Department of Health Research and other concerned Ministries and scientific institutions, undertake comprehensive multidisciplinary research on CKDu and other environmental and occupational determinants of CKD, strengthen surveillance in identified endemic regions and develop evidence-based preventive strategies for vulnerable populations.

(Para 1.9.2)

Regional Disparities in  Kidney Healthcare:

5.         The Committee observes from the evidence furnished by the Ministry and the programme implementation data placed before it that considerable disparities continue to exist in the availability and accessibility of kidney healthcare services across different States and Union Territories. The Committee was informed that rural populations, economically weaker sections, tribal communities and residents of remote and geographically difficult areas continue to face limited access to nephrologists, diagnostic facilities, dialysis centres and transplantation services. The Committee finds that variations in healthcare infrastructure, specialist availability and programme implementation have contributed to inequitable access to kidney care, often resulting in delayed diagnosis, interrupted treatment and poorer health outcomes. The Committee is, therefore, of the considered view that reducing regional disparities and ensuring equitable access to quality kidney healthcare should remain a central objective of the Ministry's strategy for prevention and management of Chronic Kidney Disease.

(Para 1.10.1)

 Economic and Social Burden

6.         The Committee expresses concern to observe that affordability and accessibility continue to remain major barriers to equitable kidney healthcare across the country, particularly in rural and underserved regions where specialized nephrology services remain limited. The Committee is of the considered view that financial hardship should not become a barrier to accessing life-saving kidney care. The Committee, therefore, recommends that the Ministry of Health and Family Welfare strengthen financial protection mechanisms for CKD patients, expand access to affordable renal care services, including dialysis in underserved regions, enhance insurance coverage for kidney disease and periodically assess regional disparities in kidney healthcare to ensure equitable distribution of specialized services across the country.

(Para 1.11.4)

Consequences of Late Diagnosis

7.         The Committee observes with concern that delayed diagnosis continues to be one of the principal factors contributing to poor clinical outcomes, increased mortality, higher treatment costs and greater dependence on dialysis and kidney transplantation. The Committee believes that the asymptomatic nature of CKD during its early stages, coupled with inadequate public awareness, delayed health-seeking behavior and limited identification of high-risk individuals, results in a substantial proportion of patients presenting only after irreversible kidney damage has occurred. The Committee is of the considered view that reducing delays in diagnosis is essential for improving long-term patient outcomes and reducing the overall burden of CKD. The Committee, therefore, recommends that the Ministry of Health and Family Welfare strengthen mechanisms for early identification and timely referral of individuals at high risk of CKD through the primary healthcare system, while enhancing awareness among healthcare providers and the general public regarding the importance of early evaluation of kidney disease. The Committee further recommends that appropriate protocols for risk-based assessment and referral be implemented across all levels of healthcare to facilitate timely intervention and delay disease progression.

(Para 1.12.2)

CKD and Climate Change: An Emerging Public Health Concern

8.         The Committee observes that climate change and environmental degradation have emerged as important determinants influencing the burden of Chronic Kidney Disease, particularly CKDu, among vulnerable occupational groups. The Committee is of the considered view that the health impacts of climate change on kidney disease require greater policy attention, scientific research and coordinated action across sectors. The Committee, therefore, recommends that the Ministry of Health and Family Welfare, in collaboration with the Ministries of Environment, Forest and Climate Change, Labour and Employment, Agriculture and Farmers' Welfare, and Jal Shakti, develop a coordinated national framework to address the environmental and climate-related determinants of Chronic Kidney Disease. The Committee further recommends that climate-resilient kidney health strategies, including surveillance of vulnerable populations, promotion of occupational heat mitigation measures, access to safe drinking water, and region-specific research on CKDu, be integrated into national policies and programmes for the prevention and control of Chronic Kidney Disease.

(Para 1.13.2)

Need for Early Detection and Preventive Healthcare

9.         The Committee observes that a substantial proportion of CKD cases remain undiagnosed until advanced stages due to low public awareness regarding kidney health, inadequate understanding of risk factors and delayed health-seeking behaviour. The Committee is of the considered opinion that sustained public awareness and preventive health promotion constitute the most effective long-term strategy for reducing the burden of CKD. The Committee, therefore, recommends that the Ministry accord greater emphasis to kidney health promotion through sustained Information, Education and Communication (IEC) campaigns, community outreach programmes and integration of kidney health messages within existing non-communicable disease awareness initiatives. The Committee further recommends that special emphasis be placed on educating high-risk populations regarding healthy lifestyle practices, early symptoms, risk factors and the importance of timely medical consultation.

(Para 1.14.2)

PREVENTION STRATEGIES

Prevention of Chronic Kidney Disease: An Overview:

10.       The Committee acknowledges that the Ministry has recognised prevention of chronic kidney disease as an integral component of the National Programme for Prevention and Control of Non-Communicable Diseases and has initiated several measures aimed at promoting healthy lifestyles and reducing major risk factors. Prevention should not be viewed only as a medical intervention but also as a public health strategy involving behavioural change, lifestyle modification, nutrition, environmental protection and community participation. The Committee observes that the growing burden of Chronic Kidney Disease (CKD) has significant economic implications for patients, families and the public health system. The Committee is concerned that while substantial resources are being devoted to dialysis and other renal replacement therapies, preventive nephrology has not received commensurate policy and financial attention despite its potential to reduce disease progression and long-term healthcare costs. Strengthening preventive nephrology would reduce long-term healthcare expenditure, improve quality of life and lessen the growing burden on dialysis services. The Committee is of the considered view that sustained investment in prevention, early detection and risk factor management would not only improve health outcomes but also substantially reduce the future demand for costly tertiary care services. The Committee, therefore, recommends that the Ministry of Health and Family Welfare accord higher priority to preventive nephrology in health planning and resource allocation, undertake periodic evaluation of the cost-effectiveness of preventive interventions and incorporate measurable kidney health indicators within the national monitoring framework for non-communicable diseases to facilitate evidence-based planning and performance assessment. The Committee endorses the views that comprehensive prevention strategy must therefore address lifestyle, environmental, occupational and systemic factors while leveraging existing health infrastructure at the community level.

(Para 2.1.5)

 

Primordial and Primary Prevention: Reducing Risk Factors Before Disease Onset

11.       The Committee acknowledges the efforts of the Ministry in conducting over 6.43 crore Health and Wellness Sessions through approximately 1.8 lakh Ayushman Arogya Mandirs to promote healthy lifestyles and create awareness on non-communicable diseases. However, the Committee is constrained to observe that the burden of chronic kidney disease (CKD) continues to rise, indicating that preventive efforts require further strengthening beyond facility-based wellness sessions. The Committee is of the considered view that the effectiveness of these sessions is inherently dependent upon attendance at Ayushman Arogya Mandirs and, therefore, may not adequately reach a large section of the at-risk population. Considering the largely asymptomatic nature of CKD in its early stages, the Committee recommends that the Ministry adopt a proactive, community-based approach by taking kidney health awareness beyond health facilities through sustained door-to-door campaigns, village and ward-level outreach programmes, and targeted IEC activities involving ASHAs, ANMs and other frontline health workers. The Committee believes that such measures would improve community participation, enhance awareness of CKD risk factors and symptoms, and facilitate early detection and timely intervention.

(Para 2.2.5)

 

12.       The Committee is of the considered view that, given India's large population and the substantial burden on the healthcare system, prevention is a far more effective and sustainable approach than treatment in addressing Chronic Kidney Disease. Accordingly, the Committee recommends that the Ministry of Health and Family Welfare accord priority to preventive and community-based interventions by institutionalising healthy hydration practices and heat stress awareness through Self-Help Groups, schools, workplaces, and local community organisations. The Committee further recommends that such preventive messages be integrated into existing flagship programmes such as Swachh Bharat Mission and Poshan Abhiyaan to maximise outreach, promote sustained behavioural change and reduce the incidence of CKD, particularly in vulnerable rural and agricultural communities.

(Para 2.2.6)

13.       The Committee observes that effective prevention of CKD is intrinsically linked to sustained behavioural change through the adoption of healthy lifestyles and effective management of modifiable risk factors. However, the Committee is constrained to observe that kidney health has not received adequate prominence in existing public health awareness campaigns. The Committee, therefore, strongly recommends that the Ministry of Health and Family Welfare must formulate and implement a dedicated National Chronic Kidney Disease Awareness Programme with sustained nationwide outreach through print, electronic, digital and social media on the lines of successful public health awareness campaigns such as those for Tuberculosis (TB) and HIV/AIDS. The Committee further recommends strengthening community engagement by organising awareness campaigns and health education programmes in schools, workplaces and communities. The Committee also recommends promoting healthy dietary practices, including reduced salt intake, regular physical activity, avoidance of tobacco and alcohol, adequate hydration, and periodic screening of high-risk individuals in its awareness campaigns. The Committee therefore, strongly recommends the Ministry of Ayush to actively complement these efforts by promoting evidence-based healthy lifestyle practices and preventive healthcare through its existing wellness programmes in coordination with the Ministry of Health and Family Welfare.

(Para 2.2.9)

Awareness of Chronic Kidney Disease (CKD):

14.       The Committee observes that an effective awareness strategy for the prevention of Chronic Kidney Disease (CKD) must extend beyond healthcare facilities and place greater emphasis on primary prevention through health education and awareness from an early age. The Committee is of the view that younger populations is more prone and behaviourally sensitive to unhealthy dietary habits, sedentary lifestyles, obesity, tobacco and alcohol consumption, and poor awareness regarding kidney health. The Committee observes that kidney health literacy in the country continues to remain largely ppatient oriented which is inadequate for achieving meaningful prevention at the population level. The Committee believes that preventing CKD requires a paradigm shift from a predominantly patient-centric approach to a whole-of-society approach by strengthening kidney health literacy among school children, the general public, healthcare providers and communities. Accordingly, the Committee recommends that the Ministry of Health and Family Welfare, in coordination with the Ministry of Education, incorporate basic concepts of kidney health, healthy dietary practices, adequate hydration, physical activity, prevention of non-communicable diseases and the importance of protecting kidney function into school health education programmes and appropriate school curricula. The Committee further recommends that sustained nationwide awareness campaigns be undertaken through Ayushman Arogya Mandirs, educational institutions, workplaces, mass media and digital platforms to improve kidney health literacy among the general population and foster lifelong healthy behavioural practices for the prevention of CKD.

(Para 2.3.3)

15.       The Committee finds that the growing burden of Chronic Kidney Disease (CKD) in the country is closely associated with the increasing prevalence of metabolic risk factors such as diabetes, hypertension, obesity and cardiovascular diseases, which are, in turn, driven by changing dietary patterns, increasing consumption of ultra-processed and packaged foods high in salt, sugar and saturated fats, sedentary lifestyles and inadequate public awareness regarding healthy living. The Committee appreciates that the Ministry of Health and Family Welfare has undertaken several initiatives under the National Programme for Prevention and Control of Non-Communicable Diseases (NP-NCD), Poshan Abhiyaan and other health promotion programmes, the Committee is of the considered view that substantially greater emphasis is required on primordial prevention aimed at preventing the emergence of these risk factors before they progress to chronic disease. The Committee, therefore, recommends that the Ministry of Health and Family Welfare, in coordination with the Food Safety and Standards Authority of India (FSSAI) and other concerned stakeholders, examine appropriate measures for strengthening consumer awareness regarding the nutritional quality of packaged food products through suitable front-of-pack food labelling, colour coding and other evidence-based regulatory interventions that enable informed dietary choices. The Committee further recommends that the Ministry launch a targeted, high-impact national mass media campaign on the dangers of excessive dietary sodium and hidden salts. Furthermore, the Ministry should institutionalize community-based lifestyle modification programs specifically leveraging Ayush wellness systems and daily physical activity modules across schools, workplaces, and local Ayushman Arogya Mandirs to curb metabolic risk factors at the population level.

(Para 2.3.4)

16.       The Committee observes with concern that indiscriminate and unsupervised use of non-steroidal anti-inflammatory drugs (NSAIDs) and other nephrotoxic medications continues to contribute to preventable kidney injury in the country. The Committee further finds that limited public awareness regarding the potential adverse effects of prolonged self-medication and inadequate regulation of inappropriate drug use remain important public health concerns, particularly in rural and underserved areas. The Committee is of the considered view that prevention of drug-induced kidney disease requires a combination of public awareness, rational prescribing practices and effective regulatory oversight. The Committee, therefore, recommends that the Ministry of Health and Family Welfare, in consultation with the Central Drugs Standard Control Organisation (CDSCO), review existing regulatory and awareness measures relating to over-the-counter availability and irrational use of nephrotoxic medicines. The Committee further recommends that appropriate public education campaigns be undertaken to sensitise citizens regarding the risks associated with indiscriminate use of painkillers and other potentially nephrotoxic medications. The Government should also undertake effective measures to regulate the indiscriminate use of antibiotics as the same exert lethal impact on kidney health, therefore, the Committee desires that a robust, science driven and evidence based policy is essential to address such growing threat.

(Para 2.3.5)

17.       The Committee appreciates the Ministry's efforts in organising large-scale health camps and community outreach programmes under various initiatives such as the Swasth Nari, Sashakt Parivar Abhiyaan, Poshan Maah, Ayushman Shivir and the National NCD Campaign, as well as the regular conduct of wellness and screening activities through the Ayushman Arogya Mandir network. Such initiatives have significantly expanded access to screening for major non-communicable diseases and have contributed to improving public awareness regarding preventive healthcare. The Committee, however, observes that such campaigns have primarily focused on common NCDs such as diabetes, hypertension and cancer, while kidney health and Chronic Kidney Disease (CKD), despite being closely linked with these conditions and have not received commensurate attention within community-based outreach activities. The Committee is therefore, of the considered view that such large-scale public health platforms utilise the ideal opportunity for integrating kidney health promotion, early risk identification and public education, particularly among high-risk populations. The Committee, therefore, recommends that the Ministry of Health and Family Welfare institutionalise kidney health promotion as an integral component of all major national health outreach campaigns and community screening initiatives. The Committee further recommends that standardised kidney health education, risk assessment, counselling on preventive lifestyle measures and referral pathways for high-risk individuals be incorporated into health camps conducted under the National Programme for Prevention and Control of Non-Communicable Diseases (NP-NCD) and through Ayushman Arogya Mandirs. The Committee strongly desires that dedicated awareness and screening activities be organised on occasions such as World Kidney Day and other national public health campaigns to enhance early detection, improve community awareness and reduce the long-term burden of CKD in the country.

(Para 2.3.7)

Role of Ayush Systems in Primary Prevention

18.       The Committee finds that the Ministry has adopted an integrative approach wherein Ayush interventions are intended to complement modern medicine through health promotion, lifestyle counselling, stress management and preventive care. The Committee desires that Ayush institutions must undertake health promotion activities through non-communicable disease outpatient clinics, health camps, school health programmes and community outreach initiatives aimed at early identification and management of diabetes and hypertension, thereby contributing indirectly to the prevention of kidney diseases and slowing disease progression among high-risk individuals.

(Para 2.4.3)

19.       The Committee observes that Chronic Kidney Disease (CKD) is largely driven by lifestyle-related risk factors such as diabetes, hypertension, obesity and unhealthy dietary practices which necessitate sustained behavioural change and adoption of healthy lifestyles. The Committee further observes that India's traditional systems of medicine have a wide community reach and place considerable emphasis on preventive healthcare through balanced nutrition, physical activity, yoga, stress management and healthy living. The Committee is of the considered view that while modern medicine remains the cornerstone for the diagnosis and clinical management of CKD, the preventive principles of Ayush can complement ongoing public health efforts particularly in promoting healthy lifestyles, creating awareness and preventing lifestyle disorders that predispose individuals to CKD. The Committee, therefore, strongly recommends that the Ministry of Health & Family Welfare in coordination with the Ministry of Ayush develop an integrated preventive framework for CKD that leverages the strengths of both systems focussing on health promotion, yoga-based wellness interventions, dietary counselling, public awareness, behavioural change communication and early risk-factor management through Ayushman Arogya Mandirs and other community-based platforms. The Ministry of Ayush should work aggressively for preventive healthcare by undertaking health promotion activities through OPD clinics, organising health camps, school health initiatives and community reach initiatives aimed at kidney health awareness. The Committee is of the view that an evidence-based integrative approach would strengthen preventive healthcare, support early identification of at-risk individuals and contribute to reducing the long-term burden of CKD.

(Para 2.4.6)

 Secondary Prevention: Early Detection and Risk Factor Control

20.       The Committee commends that the Ministry has initiated population-based screening for non-communicable diseases under NP-NCD and strengthened comprehensive primary healthcare through Ayushman Arogya Mandirs. The Committee notes the evidence placed before it that CKD continues to be detected predominantly in advanced stages because kidney health assessment is not yet uniformly integrated into routine management of diabetes, hypertension and other high-risk conditions. The Committee endorses the view of experts and strongly advocates for systematic risk-based screening to facilitate early identification, monitoring and policy planning. The Committee is of the considered view that strengthening secondary prevention represents one of the most effective interventions for reducing progression to End Stage Kidney Disease and lowering the future demand for dialysis and transplantation. The Committee, therefore, recommends that the Ministry of Health and Family Welfare integrate targeted risk-based kidney health assessment into all NP-NCD services by ensuring periodic evaluation of individuals with diabetes mellitus, hypertension, cardiovascular disease, obesity, family history of kidney disease and other recognised risk factors.

(Para 2.5.4)

Tertiary Prevention

21.       The Committee observes that Chronic Kidney Disease (CKD) is a complex, progressive and multisystem disorder that is frequently accompanied by diabetes, hypertension, cardiovascular disease, anaemia, mineral and bone disorders, nutritional deficiencies and psychosocial challenges. The Committee is of the considered view that effective tertiary prevention cannot be achieved through nephrology care alone but requires a coordinated, multidisciplinary approach involving physicians, nephrologists, diabetologists, cardiologists, dieticians, clinical pharmacists, nurses, physiotherapists, mental health professionals and social workers. However, multidisciplinary CKD care services remain limited and are largely confined to tertiary care institutions with inadequate coordination and continuity of care across different levels of the healthcare system.The Committee, therefore, recommends that the Ministry institutionalise multidisciplinary CKD management as an integral component of tertiary prevention by adoption of integrated care pathways, shared electronic patient records, structured follow-up mechanisms, patient education programmes and regular multidisciplinary case reviews to ensure continuity of care and improve long-term clinical outcomes while delaying progression to End-Stage Kidney Disease (ESKD).

(Para 2.6.2)

 

Environmental and Occupational Prevention

22.       The Committee observes with concern the emerging evidence indicating that environmental and occupational factors are emerging contributors to the occurrence of Chronic Kidney Disease of Unknown Etiology (CKDu) in certain parts of the country. Taking into account the approx. 16% prevalence of CKDu, the Committee is of the firm view that the increasing burden of CKDu among agricultural workers and other outdoor labourers necessitates a precautionary and proactive public health response. The Committee observes that existing preventive efforts remain fragmented across multiple sectors and there is no comprehensive framework for surveillance, risk assessment and coordinated intervention in vulnerable districts. The Committee appreciates the research initiatives undertaken by the Department of Health Research and the Indian Council of Medical Research to generate evidence on the environmental and occupational determinants of CKDu. The Committee, however, believes that preventive public health action should proceed alongside scientific research and should not be deferred until complete causal certainty is established. The Committee, therefore, recommends that the Ministry of Health and Family Welfare in coordination with the Ministries of Labour and Employment, Agriculture and Farmers' Welfare, Jal Shakti, Environment, Forest and Climate Change and the concerned State Governments formulate a National Framework for Prevention and Surveillance of CKDu with district-specific implementation strategies for identified high-risk areas. The framework should provide for systematic surveillance of CKDu hotspots; periodic occupational health screening of vulnerable workers; access to safe drinking water and adequate hydration facilities at workplaces; implementation of heat mitigation measures in occupations including regular hydration breaks in prolonged outdoor work; strengthening of environmental monitoring wherever warranted; regulation and safe handling of agrochemicals in accordance with existing laws and guidelines; and continued multidisciplinary research to generate robust evidence for future policy interventions. The Committee, in this regard, recommends the establishment of an inter-ministerial coordination mechanism to periodically review implementation and facilitate convergence of health, occupational safety, environmental and climate adaptation measures in CKDu-prone regions.

(Para 2.7.2)

SCREENING AND DIAGNOSIS

23.       The Committee also believes that early detection of Chronic Kidney Disease (CKD) is fundamental to effective management, as the disease often remains asymptomatic until significant kidney function (up to 60-70%) is lost. The Committee is of the considered view that Screening and diagnosis form the critical bridge between prevention and treatment. In India, where the pooled prevalence of CKD is estimated at approximately 13.24% with substantial regional variation, a robust, accessible and cost-effective screening system is essential to reduce progression to End-Stage Kidney Disease (ESKD), lower treatment costs and improve patient outcomes. The Committee, keeping in view that the growing burden of diabetes, hypertension and other non-communicable diseases continues to drive the increasing prevalence of kidney disease across the country, is of the view that a precautionary approach or strategic course of action is needed to address it and accordingly, recomnmends for regular screening for high risk groups particularly individuals with diabetes and hypertension through Non Communicable programmes.

(Para 3.1.4)

Screening for Chronic Kidney Disease

Rationale for Screening

24.       The Committee strongly believes that early detection through systematic screening is not only clinically beneficial but also economically advantageous for the Indian healthcare system. The cost of screening high-risk individuals and initiating timely treatment is significantly lower than the expenditure incurred in managing advanced Chronic Kidney Disease (CKD), which often necessitates dialysis, kidney transplantation and the treatment of multiple complications. Screening, therefore, represents one of the most cost-effective public health interventions for reducing the overall burden of CKD. The Committee recommends that the Government encourage regular medical consultation and adherence to evidence-based clinical guidance for periodic monitoring and effective control of blood pressure and blood glucose levels and also emphasizes the need for timely lifestyle modifications and the early initiation of evidence-based pharmacological therapy wherever clinically advised, to preserve kidney function and reduce the risk of progression to End-Stage Kidney Disease (ESKD). The Committee is of the considered view that investing in prevention and early intervention is far more cost-effective than treating advanced kidney disease, which imposes a substantial financial burden on the healthcare system while being associated with prolonged patient suffering, diminished quality of life, and increased mortality.

(Para 3.3.2)

Screening Tests

25.       The Committee notes that serum creatinine continues to be the most widely prescribed laboratory test for assessing kidney function across the country. However, the Committee is constrained to observe that reliance on serum creatinine values alone is inadequate for the early detection of Chronic Kidney Disease (CKD), as serum creatinine often remains within the normal range until nearly half of the kidney function has already been lost. Moreover, interpretation of raw creatinine values without adjustment for age and sex may lead to under-recognition of early CKD, particularly at the primary care level. The Committee also acknowledges the unanimous opinion of experts that kidney function assessment in high-risk individuals should include automatic estimation of the Estimated Glomerular Filtration Rate (eGFR), preferably using the CKD-EPI equation, along with urine albumin estimation rather than relying solely on serum creatinine. In view of the foregoing, the Committee recommends that the Ministry of Health and Family Welfare mandate automatic estimation and reporting of the Estimated Glomerular Filtration Rate (eGFR), preferably using the CKD-EPI equation, along with every serum creatinine test conducted in public and private diagnostic laboratories, without requiring a separate test request or additional cost to the patient. The Committee further recommends that appropriate laboratory standards and quality assurance protocols be revised to ensure uniform implementation of this requirement across the country. The Committee believes that mandatory eGFR reporting will facilitate early detection of Chronic Kidney Disease, enable timely clinical intervention and referral, and significantly strengthen the national strategy for CKD prevention and control.

(Para 3.4.3)

Target Population for Risk-Based Screening

26.       The Committee observes that Chronic Kidney Disease (CKD) remains largely asymptomatic during its early stages and is therefore frequently diagnosed only after significant and irreversible loss of kidney function has occurred. The Committee notes with serious concern the indiscriminate use of pain killers by the young generation who are inclined towards sedentary life style and associated risks. Instances of undiagnosed hyper tension have increased amongst the younger generation leading to silent onset of kidney disease which is now assuming epidemic proportion. Although CKD screening has been integrated under the National Programme for Prevention and Control of Non-Communicable Diseases (NP-NCD), the present approach is largely based on opportunistic screening of individuals attending Ayushman Arogya Mandirs and other health facilities. The Committee is concerned that such occasional approach intervention does not ensure periodic screening of all high-risk individuals and largely depends on patient attendance for check up resulting in delayed diagnosis and missed opportunities for early intervention. The Committee, therefore, recommends that the Ministry institutionalise regular Annual CKD screening of all high-risk individuals under the NP-NCD to enable early diagnosis and delay disease progression. The screening should include assessment of kidney function using eGFR and urine albumin/protein testing, along with appropriate referral and follow-up. The Committee further recommends maintaining longitudinal digital records of screened individuals to monitor disease progression, support continuity of care, strengthen programme monitoring, and generate reliable evidence for future policy formulation and resource planning.

(Para 3.5.2)

27.       The Committee understands that principal high-risk groups requiring periodic screening include individuals with diabetes mellitus and hypertension, which together account for the majority of CKD cases in the country. Such individuals should undergo regular kidney function assessment, preferably on an annual basis, to facilitate early detection and timely intervention. Other priority groups include adults above 60 years of age; individuals with a family history of kidney disease; persons with obesity or tobacco use; and individuals with a history of acute kidney injury (AKI), recurrent urinary tract infections, recurrent kidney stones or prolonged exposure to nephrotoxic medications, including non-steroidal anti-inflammatory drugs (NSAIDs). The Committee takes into account the immediate increasing significance of screening among occupational and agrarian populations residing in regions affected by Chronic Kidney Disease of Unknown Etiology (CKDu), particularly in parts of Andhra Pradesh, Odisha and Karnataka. Evidence suggests that prolonged exposure to heat stress, recurrent dehydration and agrochemicals that may contribute to kidney damage in these populations. The Committee, therefore, that targeted screening in such endemic regions is therefore essential for early identification of affected individuals and for generating epidemiological evidence to better understand the disease burden and its determinants for early detection and necessary medical intervention.

(Para 3.5.3)

Existing Screening Framework in India

28.       The Committee acknowledges that the Ministry has integrated Chronic Kidney Disease screening within the National Programme for Prevention and Control of Non-Communicable Diseases (NP-NCD) and has leveraged the extensive network of Ayushman Arogya Mandirs (AAMs) to undertake large-scale population-based screening population-based screening of major non-communicable diseases. The Committee, however, expresses concern that implementation of kidney health assessment remains inconsistent across States owing to variations in infrastructure, availability of trained manpower, diagnostic facilities and referral mechanisms. The Committee observes that the existing screening framework needs to be streamlined to provide a strong foundation for early detection of Chronic Kidney Disease among vulnerable groups. Keeping into account, the absence of standardized protocols, uneven implementation across States and inadequate integration of kidney health assessment in routine management of diabetes and hypertension continue to limit its effectiveness, the Committee, therefore, recommends that the Ministry of Health and Family Welfare should develop and implement a uniform national screening protocol for Chronic Kidney Disease under the NP-NCD. The Committee further recommends that all primary health facilities including Ayushman Arogya Mandirs, must adopt mandatory standardized screening pathways for individuals with high-risk factors, supported by clearly defined referral mechanisms, standard operating procedures and periodic monitoring of programme outcomes.

(Para 3.6.3)

29.       The Committee believes that the effectiveness of screening for Chronic Kidney Disease (CKD) under the National Programme for Prevention and Control of Non-Communicable Diseases undertaken through Ayushman Arogya Mandirs is inherently dependent upon individuals voluntarily visiting these facilities. Given that CKD remains largely asymptomatic during its early stages and public awareness regarding kidney health continues to be low, a significant proportion of at-risk individuals do not seek screening until the disease has progressed to advanced stages. Consequently, valuable opportunities for early diagnosis and timely intervention are often missed. The Committee is therefore of the opinion that community-based outreach should complement facility-based screening. In this regard, frontline workers like Accredited Social Health Activists (ASHAs), by virtue of their regular household visits and close engagement with the community, should play a pivotal role in identifying individuals at risk of CKD. The Committee, therefore, recommends that the Ministry examine the feasibility of training ASHA workers to undertake preliminary urine dipstick testing for proteinuria among high-risk individuals during home visits or village health activities. Individuals exhibiting adverse findings may thereafter be referred to the nearest Ayushman Arogya Mandir or higher health facility for confirmatory investigations, including serum creatinine estimation, urine albumin assessment and eGFR evaluation. Such a decentralised screening approach system would substantially improve early case detection, enhance coverage among vulnerable populations, reduce delays in diagnosis and ultimately lessen the burden of advanced CKD requiring expensive renal replacement therapy.

(Para 3.6.4)

Diagnostic Modalities for Chronic Kidney Disease

30.                   The Committee takes note of the various diagnostic techniques currently available, as well as the emerging biomarkers and technologies for the diagnosis of Chronic Kidney Disease (CKD). The Committee observes that no single diagnostic modality is effective enough for the accurate detection and assessment of CKD and that each investigation has a distinct and complementary role depending on the clinical presentation, stage of disease and underlying cause. The Committee is of the considered view that the diagnosis of CKD should be based on a comprehensive clinical assessment incorporating kidney function tests, urine examination, imaging studies and, where clinically indicated, histopathological evaluation. The Committee further believes that strengthening diagnostic infrastructure, ensuring quality-assured laboratory services, promoting standardised reporting practices and facilitating equitable access to advanced diagnostic technologies are essential for improving early diagnosis, guiding appropriate treatment and enhancing long-term patient outcomes.

(Para 3.10.2)

 

31.       The Committee notes that while these emerging biomarkers viz Cystatin-C, NGAL, KIM-1, IL-18, Microglobin etc. offer significant potential for earlier and more precise diagnosis, current costs, infrastructure requirements and limited availability may restrict their immediate applicability for large-scale population screening. The Committee, however, recommends that the initial use of emerging biomarkers may therefore be prioritised for pilot projects, tertiary care settings and CKDu research programmes and upon success of pilot projects, may later be implemented at macro level.

(Para 3.10.3)

Staging of Chronic Kidney Disease

32.   The Committee understands that combined assessment of kidney function and albuminuria provides a comprehensive estimate of disease severity and the risk of disease progression. It also serves as the basis for determining the frequency of monitoring, the intensity of therapeutic intervention, management of associated complications and the need for referral to specialised nephrology services. The Committee, therefore, recommends the Ministry for adoption of a standardised staging system which further facilitates uniform clinical decision-making and comparability of patient data across healthcare institutions. The Committee observes that uniform adoption of the KDIGO staging framework across all levels of the healthcare system would promote consistency in diagnosis, facilitate standardised clinical management and enable meaningful aggregation of CKD data for surveillance, programme monitoring and health policy planning.

(Para 3.11.2)

Referral for Specialist Care

33.       The Committee expresses concern that referral pathways between primary, secondary and tertiary healthcare facilities remain inadequately developed in several parts of the country. Limited availability of nephrologists, particularly in rural, tribal and geographically remote regions, often delays specialist consultation and continuity of care. Strengthening referral mechanisms and improving access to specialist services are therefore critical for ensuring timely diagnosis and appropriate management of CKD. The Committee, therefore, recommends the Ministry to plan necessary institutional arrangements for early referral & comprehensive disease management leading to timely preparation for kidney replacement therapy where required and improved long-term clinical outcomes.

(Para 3.13.3)

Research and Innovation in Early Diagnosis

34.       The Committee is pleased to note that several Indian institutions are undertaking research to improve early diagnosis of CKD through development of novel biomarkers and advanced diagnostic tools. The Committee appreciates that the Centre for Advanced Research on Kidney Disease at SGPGIMS, Lucknow has developed patented urinary exosome microRNA biomarkers for early detection of CKD and diabetic nephropathy. The Committee understands that research must continue on genomic testing, kidney genetics services and artificial intelligence-based prediction models integrating retinal imaging and clinical parameters. The Committee believes that such technologies hold promise for improving risk stratification and early detection, particularly among high-risk populations.

(Para 3.15.1)

Integration with Digital Health Infrastructure

35.       The Committee acknowledges that the Ayushman Bharat Digital Mission offers significant opportunities for strengthening screening, diagnosis and long-term management of Chronic Kidney Disease through digital health records, electronic referrals and improved continuity of care. The Committee also notes that experts have highlighted the importance of leveraging digital technologies for disease surveillance, patient tracking and clinical decision support. The Committee is of the considered view that digital health interventions should complement existing healthcare services and contribute to more efficient implementation of risk-based screening and referral mechanisms, particularly in rural and underserved areas. The Committee, therefore, recommends that the Ministry of Health and Family Welfare to leverage the Ayushman Bharat Digital Mission to develop an integrated digital framework for Chronic Kidney Disease, including electronic referral pathways, longitudinal patient records, monitoring of high-risk individuals and linkage with a proposed National CKD Registry. The Committee further recommends that suitable digital decision-support tools be developed for primary healthcare providers to facilitate timely identification and referral of suspected CKD cases while ensuring appropriate safeguards for data privacy and security.

(Para 3.16.4)

 

TREATMENT MODALITIES

 

Pharmacological Management of CKD and Associated Complications

36.       The Committee observes that effective management of CKD extends beyond clinical treatment and is heavily dependent upon sustained patient education, dietary counselling and long-term adherence to prescribed medications and lifestyle modifications. However, the Committee expresses concern that patient education and counselling services remain inadequate across the healthcare system owing to the shortage of trained renal dietitians, limited counselling time during routine nephrology consultations and the absence of standardized, patient-friendly educational resources particularly for individuals with low health literacy especially in rural areas. The Committee, therefore views that unless these systemic gaps are addressed, patients are likely to experience poor treatment adherence, avoidable disease progression and increased healthcare costs. The Committee, in this regard, recommends that the Ministry of Health and Family Welfare must strengthen patient education and counselling services by developing standardized multilingual and low-literacy educational resources, establishing structured counselling protocols across all levels of healthcare facilities. The Committee also recommends for capacity building of Medical Officers, nurses and Community Health Officers to ensure professional proficiency at Ayushman Arogya Mandirs in CKD counselling and patient education, along with appropriate training and effective utilisation of ASHA workers for periodic household follow-up, counselling, reinforcement of dietary and medication adherence, and timely referral of CKD patients wherever necessary.

(Para 4.4.6)

 Delivery of Dialysis Services

37.       The Committee notes from the deposition of the Secretary, Ministry of Health and Family Welfare, that while the utilisation of haemodialysis services under the Pradhan Mantri National Dialysis Programme (PMNDP) has increased substantially, with annual dialysis sessions rising from about 25 lakh to 70 lakh over the last five years, the uptake of Peritoneal Dialysis (PD) remains limited despite its availability in selected States. The Committee observes that the continued reliance on facility-based haemodialysis, despite the advantages of home-based Peritoneal Dialysis in reducing travel burden, out-of-pocket expenditure and improving patients' quality of life, reflects gaps in awareness, trained manpower, availability of PD consumables, institutional support, and patient counselling, where haemodialysis continues to be presented as the default treatment option. The Committee is of the view that Peritoneal Dialysis is particularly suited to India's vast rural and remote population and should be promoted as the preferred first-line renal replacement therapy for clinically suitable patients. The Committee, therefore, recommends that the Ministry formulate and implement a comprehensive strategy to promote Peritoneal Dialysis under PMNDP through structured pre-dialysis patient counselling at the point of CKD diagnosis, strengthening healthcare provider capacity, ensuring uninterrupted availability of PD consumables, providing necessary financial and logistical support for home-based dialysis, and prescribing measurable national targets for increasing the proportion of patients on Peritoneal Dialysis, thereby reducing dependence on facility-based haemodialysis and improving access to affordable, patient-centric renal care.

(Para 4.6.3)

Conservative (Non-Dialytic) Kidney Management and Integration of Palliative Care

 

38.       The Committee appreciates the Ministry's efforts in expanding access to dialysis and kidney transplantation through the Pradhan Mantri National Dialysis Programme (PMNDP). However, it observes that Conservative Kidney Management (CKM) is an active and patient-centred treatment pathway and should not be regarded as the withdrawal or withholding of medical care. The Committee further observes that CKM has not received commensurate policy attention despite being a clinically recognised treatment option for elderly patients, those with multiple comorbidities and others who are unsuitable for or choose not to undergo renal replacement therapy. The absence of structured CKM pathways and integrated palliative care services may lead to unnecessary interventions, increased financial burden and compromised quality of life for such patients. The Committee, therefore, recommends that the Ministry of Health and Family Welfare should develop and institutionalise a structured framework for Conservative Kidney Management by incorporating standard treatment protocols, shared decision-making guidelines, symptom management and palliative care services under the National Programme for Prevention and Control of Non-Communicable Diseases (NP-NCD) while ensuring adequate training of healthcare providers and counselling support for patients and their families.

(Para 4.7.2)

 Status of Transplantation in India

39.       The Committee appreciates the initiatives undertaken by the government under the National Organ Transplant Programme (NOTP) to promote deceased organ donation through public awareness campaigns, stakeholder engagement, online pledging and financial assistance for the honourable cremation of deceased donors. However, it observes that India's deceased organ donation rate continues to remain significantly lower than global benchmarks due to persistent social misconceptions, inadequate public awareness, limited organ retrieval infrastructure and procedural bottlenecks. The Committee is of the view that increasing deceased organ donation is critical to bridging the widening gap between the demand and availability of organs for transplantation. The Committee, therefore, recommends that the Ministry of Health and Family Welfare must intensify nationwide behaviour change and awareness campaigns to remove misconceptions, strengthen hospital-based organ retrieval and transplant coordination infrastructure, simplify procedural processes and establish a robust performance monitoring mechanism for States to substantially enhance deceased organ donation across the country.

(Para 4.9.2)

Post-Transplant Care

40.           The Committee finds from the submissions of experts that lifelong immunosuppressive therapy is indispensable for preventing graft rejection and ensuring the long-term success of kidney transplantation. The Committee observes that the recurring cost of post-transplant medicines places a considerable financial burden on patients who have already incurred substantial expenditure on dialysis and transplantation. The Committee is of the view that uninterrupted access to immunosuppressive medicines is essential for treatment adherence and graft survival and that their high cost should not become a barrier to continued care. The Committee views that inadequate post-transplant care and interruption of immunosuppressive therapy may result in graft failure, leading patients back to kidney failure pool of patients requiring dialysis or repeat transplantation, thereby imposing an even greater clinical and financial burden on both patients and the healthcare system. The Committee, therefore, recommends that the Ministry of Health and Family Welfare examine the feasibility of ensuring the availability of essential immunosuppressive medicines to kidney transplant recipients free of cost through transplant centres and Government hospitals so as to ensure uninterrupted treatment and improve long-term transplant outcomes.

(Para 4.10.2)

Technology and Innovation in Treatment Delivery

 

41.       The Committee appreciates the Ministry's efforts in operationalising the PMNDP Portal integrated with the Ayushman Bharat Health Account (ABHA) for registration, portability and tracking of dialysis patients across the country. The Committee, however, observes that digital tracking presently commences largely at the stage of dialysis, whereas continuity of care requires longitudinal monitoring from the point of identification of high-risk individuals and diagnosis of CKD at Ayushman Arogya Mandirs and other primary healthcare facilities. The Committee is of the view that technology should enable seamless patient management across the entire continuum of CKD care. The Committee, therefore, recommends that the Ministry of Health and Family Welfare expand the existing PMNDP digital platform into a comprehensive CKD patient management system by integrating ABHA-linked longitudinal tracking of high-risk individuals and CKD patients from the primary healthcare level, supported by Clinical Decision Support Systems and a National Tele-Nephrology Network through the eSanjeevani platform to ensure timely referrals, specialist consultations, treatment continuity and post-transplant follow-up across all levels of healthcare.

(Para 4.11.4)

4.11.5  The Committee is concerned with the increasing incidents of renal failure in rural India. It has been observed that Zonal Transplant Committees’ have been informed in major metropolitan centres and town that decides the eligibility criteria and parameters for deciding patient of organs for transplant. This puts the rural population at a disadvantage as they are placed in long wait listed queues wherein waiting patients do not get requisite organ as a result their survival rate is very low.  The Committee, in order to, provide equal opportunity to get organs at the need of the hour for transplantation, recommends for development of transparent SOP so that the patient get decided on actual need basis. 

 (Para 4.11.5)

GOVERNMENT POLICY LANDSCAPE, INITIATIVES AND KEY PROGRAMMES

 

43.       The Committee finds that the National Programme for Prevention and Control of Non-Communicable Diseases (NP-NCD) has integrated CKD within its framework and encompasses targeted screening of high-risk individuals with diabetes, hypertension and other risk factors. The Committee, however, observes that CKD screening at the primary healthcare level continues to rely largely on opportunity and referral-based diagnosis. In many cases, individuals identified with diabetes or hypertension at Ayushman Arogya Mandirs are referred to higher facilities for serum creatinine estimation and eGFR assessment, resulting in loss to follow-up and delayed diagnosis. Considering the silent progression of CKD, the Committee is of the view that dependence on secondary-level referral weakens early detection and misses a significant proportion of high-risk individuals before irreversible kidney damage occurs. The Committee, therefore, strongly recommends that the Ministry of Health and Family Welfare must progressively integrate serum creatinine testing with automatic eGFR reporting into the routine screening protocol for all high-risk individuals attending Ayushman Arogya Mandirs and other primary healthcare facilities.

(Para 5.4.5)

From Treatment to Prevention: Reordering National Priorities

44.       The Committee observes that although the National Programme for Prevention and Control of Non-Communicable Diseases (NP-NCD) envisages the prevention and early detection of CKD, the focus on kidney health awareness at the primary healthcare level continues to remain highly inadequate. The Committee is of the view that public awareness regarding basic kidney health remains limited, as insufficient emphasis has been placed on sustained kidney health awareness, lifestyle modification, risk-factor counselling and community-based preventive interventions. There is an urgent need to reorient national priorities towards prevention, early detection and slowing disease progression in order to reduce the future demand for kidney replacement therapy. The Committee believes that unless preventive efforts at the primary healthcare level are substantially strengthened, the growing burden of CKD will continue to place increasing pressure on dialysis and transplantation services, thereby undermining the long-term sustainability of the healthcare system. The Committee further believes that Ayushman Arogya Mandirs should assume a much greater role in promoting kidney health awareness, encouraging lifestyle modification, providing risk-factor counselling and facilitating the early identification of CKD among high-risk individuals at the community level. The Committee, therefore, strongly recommends that the Ministry reorient the implementation of NP-NCD towards a prevention-first approach by substantially strengthening the role of Ayushman Arogya Mandirs in promoting kidney health awareness and behaviour change communication. The Committee further recommends that structured kidney health education, lifestyle modification counselling, risk-factor management and community awareness programmes be institutionalised as integral components of primary healthcare. The Ministry should also strengthen the capacity of Medical Officers, Community Health Officers, ASHA workers and other frontline health workers through regular training on CKD prevention, risk communication and early behavioural interventions, and develop culturally appropriate Information, Education and Communication (IEC) material in regional languages.

(Para 5.5.2)

Pradhan Mantri National Dialysis Programme (PMNDP)

45.       The Committee acknowledges the expansion of the Prime Minister's National Dialysis Programme, however, several operational challenges continue to affect the delivery and quality of dialysis services. The Committee expresses the concerns over shortage of trained dialysis technicians and nurses, inadequate supervision and maintenance of dialysis equipment, deficiencies in vascular access monitoring and delays in the availability of consumables and release of funds to service providers. The Committee views that merely augmenting dialysis infrastructure without ensuring adequate skilled manpower, quality assurance, timely maintenance and uninterrupted supply of consumables may compromise the quality, continuity and accessibility of dialysis services. The Committee, therefore, recommends that the Ministry undertake a comprehensive assessment of operational capacity under PMNDP, covering not only the availability of haemodialysis machines but also trained human resources, machine utilisation, maintenance protocols, adequacy of consumables and timeliness of fund release. The Committee further recommends that uniform quality standards and periodic clinical audits be instituted across all PMNDP centres and that vacancies of dialysis technicians and nurses be filled up on priority so as to ensure safe, uninterrupted and quality dialysis services.

(Para 5.6.5)

46.       The Committee takes into account that the Programme has provided 375.88 lakh haemodialysis sessions to 29.46 lakh patients, which translates to an average of approximately 12.8 dialysis sessions per patient. The Committee notes that patients with End-Stage Kidney Disease ordinarily require maintenance haemodialysis two to three times a week, amounting to approximately 8-12 sessions every month. While the Committee recognises that the figures furnished by the Ministry represent cumulative programme data and do not necessarily reflect the treatment history of individual patients, the Committee is nevertheless of the view that the reported indicators are insufficient to assess whether beneficiaries are receiving adequate and uninterrupted dialysis over the duration clinically required. The Committee observes that reporting only cumulative patients and cumulative sessions may overstate programme reach while providing limited insight into treatment continuity, patient retention, adequacy of dialysis, or long-term outcomes. The Committee, therefore, recommends the Ministry to supplement the existing reporting framework with patient-centric outcome indicators including the average number of dialysis sessions per active patient per month, the number of patients receiving the recommended frequency of dialysis, treatment adherence, drop-out rates, transplantation rates, mortality and reasons for discontinuation of treatment to enable a more meaningful assessment of the effectiveness and quality of dialysis services under the Programme.

(Para 5.6.6)

Continuous Ambulatory Peritoneal Dialysis (CAPD)

47.       The Committee observes that the inclusion of CAPD under PMNDP supported through dedicated financial assistance under NHM has the potential to improve equity in access to dialysis services, particularly for patients in remote areas, elderly persons, and those for whom regular travel to haemodialysiscentres is difficult. The Committee, however, finds that the utilisation of CAPD remains limited with the Ministry reporting only 1,637 beneficiaries across 12 States (approx. 1.1 % of active PMNDP beneficiaries) indicating significant scope for further expansion of this home-based dialysis modality. The Committee, therefore, strongly recommends that the Ministry should expand the coverage of Continuous Ambulatory Peritoneal Dialysis (CAPD), particularly in rural and remote areas, by ensuring uninterrupted availability of consumables, strengthening the Medical College hub-and-spoke model, enhancing patient counseling for informed modality selection and building the capacity of Peritoneal Dialysis nurses and healthcare personnel to improve the quality and uptake of home-based dialysis services.

(Para 5.7.3)

ONE NATION- ONE DIALYSIS INITIATIVE VIS-A-VIS PMNDP PORTAL

48.       The Committee appreciates the operationalisation of the the 'One Nation – One Dialysis' initiative under PMNDP Portal which has enabled nationwide portability of dialysis services through ABHA integration, digital patient records, OTP-based authentication, and real-time scheduling of dialysis sessions. The Committee is of the view that the Portal has the potential to significantly improve continuity of care for patients who migrate for employment, education or medical treatment. However, considering that only 39,983 patient transfers have been facilitated since its launch in May 2022, the Committee believes that the portability feature remains underutilised. The Committee, therefore, recommends that the Ministry undertake wider awareness and capacity-building initiatives among healthcare providers and beneficiaries to promote utilisation of the portability facility. The Ministry should also ensure real-time integration of all PMNDP centres with the PMNDP Portal and the Ayushman Bharat Digital Mission (ABDM), strengthen interoperability with other national health platforms, and develop a comprehensive patient management system capable of tracking treatment continuity, dialysis adequacy, patient outcomes and inter-State referrals.

(Para 5.8.2)

Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (AB-PMJAY)

49.       The Committee observes that the long-term nature of chronic kidney disease often entails treatment costs that extend beyond the existing Health Benefit Packages under AB-PMJAY. The Department-related Parliamentary Standing Committee on Health and Family Welfare, in its 172nd Report had observed that the existing ₹ 5 lakh health insurance cover per family under AB-PMJAY may be inadequate for high-cost medical treatments and has recommended enhancement of limit of health insurance coverage to ₹ 10 lakh per family per year. The Committee is, therefore, of the view that the Health Benefit Packages relating to chronic kidney disease under AB-PMJAY require periodic review to ensure that they adequately reflect prevailing treatment costs, advances in clinical practice and the long-term nature of CKD management. The Committee therefore, recommends that the Ministry of Health and Family Welfare, in consultation with National Health Authority,  nephrology experts and other stakeholders undertake a comprehensive review of the CKD-specific Health Benefit Packages under AB-PMJAY, including package rates, treatment protocols and the scope of covered services so as to ensure that eligible beneficiaries receive timely, comprehensive and uninterrupted treatment across the continuum of dialysis, kidney transplantation and post-transplant care to ensure that the scheme remains responsive to evolving clinical standards and treatment costs.

(Para 5.9.3)

 

50.       The Committee takes into consideration the Health Benefit Package Guidelines under Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) and observes that post-hospitalisation care under the kidney transplantation package is presently admissible for a period of only 15 days. The Committee , therefore, is of the strong view that kidney transplantation is not a one-time surgical intervention but requires intensive post-transplant management, particularly during the first year which carries the highest risk of graft rejection and infections. The Committee considers that limiting post-transplant coverage to 15 days does not adequately correspond to the clinical requirements of kidney transplant recipients. The Committee, therefore, recommends that the Ministry of Health and Family Welfare in consultation with the National Health Authority and nephrology experts review the existing Health Benefit Package for kidney transplantation under AB-PMJAY and extend the admissible period of post-transplant care from the present 15 days to one year. The revised package should provide financial support for follow-up consultations, essential diagnostic investigations, immunosuppressive medicines and the management of transplant-related complications during the first year after transplantation so as to improve treatment adherence, reduce graft rejection and maximise long-term transplant outcomes.

(Para 5.9.4)

National Organ Transplant Programme (NOTP)

51.       The Committee appreciates the initiatives taken by the government under the National Organ Transplant Programme to strengthen the institutional framework for organ transplantation. The Committee, however, observes from the expert evidence that equitable access to kidney transplantation remains a challenge due to the limited availability of living donors, uneven development of deceased organ donation programmes across States, particularly in northern and eastern India, and the inability of many economically weaker patients to afford transplantation and post-transplant care. The Committee is of the view that these factors continue to create significant regional and socio-economic disparities in access to kidney transplantation. The Committee, therefore, recommends that the Ministry adopt a targeted strategy to reduce regional disparities in kidney transplantation by strengthening deceased organ donation programmes in underperforming States, expanding transplant facilities in underserved regions, and ensuring that economically weaker patients receive adequate support for transplantation and post-transplant care.

(Para 5.10.5)

 

HEALTH SYSTEMS: GAPS AND CHALLENGES

 

 Need for National Kidney Registry

52.       The Committee is of the considered view that the lack of reliable national data has far-reaching implications for public health planning. In the absence of robust epidemiological evidence, healthcare infrastructure, dialysis capacity, nephrology workforce, financial allocations and procurement of essential medicines are planned on estimates rather than actual disease burden, resulting in inefficient resource allocation and widening regional disparities in renal care. The absence of a national registry also impedes identification of high-risk populations, evaluation of screening and treatment programmes, assessment of patient outcomes, monitoring of government interventions and evidence generation for clinical research, health technology assessment and informed policymaking. The Committee, therefore, strongly recommends the Ministry of Health & Family Welfare to establish a comprehensive National Renal Registry integrated with the Ayushman Bharat Digital Mission& PMNDP portal to provide real-time, standardised and longitudinal data across all stages of CKD strengthening disease surveillance and improved monitoring of treatment outcomes leading to evidence-based policymaking and align India's renal care ecosystem with international best practices.

(Para 6.2.3)

Acute shortage of nephrologists and trained dialysis workforce

53.       The Committee takes into account that the nephrologist non availability at District hospitals reflects a serious disconnect between infrastructure creation and the availability of specialised human resources compromising the quality, safety and continuity of CKD care, delays clinical decision-making, limits the management of complications and reduces the effectiveness of dialysis services, particularly in rural and underserved regions. The Committee, therefore, recommends that the Ministry of Health and Family Welfare, in coordination with the State Governments, undertake a time-bound exercise to fill all vacant sanctioned posts of nephrologists, urologists and dialysis technicians at District Hospitals, with priority accorded to States reporting nil or severely inadequate availability of such specialists especially in Bihar, Rajasthan, Odisha, Assam, Chattisgarh etc. The Ministry should also mandate and support the phased establishment of dedicated Nephrology Departments in all Government Medical Colleges and substantially expand DM Nephrology seats and allied training capacity to geographically balanced adequacy to address the acute shortage of nephrologists and trained specialist manpower in all States to ensure equitable access of needy patients to specialist kidney care across the country, especially at District hospitals.

(Para 6.3.5)

 

Persistent Out-of-Pocket Expenditure Despite Financial Protection Schemes

54.       The Committee finds that despite the implementation of PMNDP and AB-PMJAY, the financial burden of Chronic Kidney Disease continues to remain substantial due to the lifelong nature of treatment, recurring dialysis costs, expenditure on medicines, diagnostics, travel, nutritional requirements and loss of livelihood. The recent 4% increase in Out-of-Pocket Expenditure (OOPE) from 39.4 per cent in 2021-22 to 43.4 per cent in 2022-23 further indicates that existing financial protection mechanisms have not adequately insulated households from catastrophic health expenditure. The Committee is of the view that merely expanding access to renal replacement therapies is insufficient unless the overall economic burden borne by CKD patients and their families is comprehensively addressed. The Committee, therefore, recommends the Ministry to undertake a comprehensive national costing study of CKD vis-a-vis financial protection available to Chronic Kidney Disease patients under existing government schemes to access the actual out-of-pocket expenditure incurred by CKD patients across different stages of the disease, identify expenditure not covered under existing schemes and recommend measures to reduce catastrophic health expenditure. The Ministry should also develop a long-term strategy to progressively reduce out-of-pocket expenditure for CKD care by strengthening public financing, expanding the scope of financial assistance beyond dialysis procedures especially to post transplant care where necessary and ensuring equitable access to affordable kidney care particularly for rural and economically vulnerable populations, both in public and private sector hospitals.

(Para 6.4.4)

 

Need for expanding Insurance Coverage

55.       The Committee appreciates the financial protection being provided under PMNDP and Ayushman Bharat–PM-JAY or state specific insurance schemes which has significantly reduced the burden and improved access to dialysis and kidney transplantation for patients with advanced CKD. The Committee, however, believes that for addressing the CKD effectively, there is a need for financial protection for CKD patients beyond end-stage interventions which remains inadequately covered under existing framework. The Committee, therefore, strongly recommends that the Ministry explore the feasibility of implementing mandatory health insurance coverage for each individual, partially funded by each the government and the individual to address the entire continuum of CKD care especially screening of high-risk individuals, periodic diagnostic investigations, outpatient consultations, essential medicines, management of CKD-related complications and pre-dialysis care. The Committee believes that comprehensive mandatory financial coverage for each individual across all stages of the disease would promote early diagnosis, improve treatment adherence, reduce out-of-pocket expenditure, prevent catastrophic health spending and delay progression to kidney failure, thereby reducing the long-term burden on both patients and the public healthcare system.

(Para 6.5.3  )

 Inequities in Access and Outcomes

56.       The Committee is of the considered view that regional and gender inequities reflect persistent systemic gaps in the equitable distribution of specialised kidney care services and undermine the objective of universal health coverage. Unless barriers relating to geography, affordability, gender and social vulnerability are addressed through targeted policy interventions, the benefits of ongoing investments in CKD infrastructure and financial protection schemes are unlikely to reach rural, tribal and geographically isolated populations who infact remain in the greater and immediate need of CKD treatment and care. The Committee, therefore, recommends that the Ministry of Health and Family Welfare, in coordination with State Governments, prepare a targeted strategy to reduce disparities in CKD care by strengthening specialist and diagnostic services in rura and underserved districts, improving referral and transport support for rural and tribal populations, expanding community-based screening and awareness programmes, ensuring financial support for indirect treatment costs and adopting gender-responsive measures to promote equitable access to diagnosis, dialysis and kidney transplantation.

(Para 6.6.4)

Widening Gap Between Kidney Transplant Demand and Capacity

57.       The Committee is of the considered opinion that demand supply mismatch of kidney requires a two-pronged strategy -- substantially strengthening deceased organ donation rates through sustained public awareness and expanding transplantation infrastructure and specialist capacity in under-served States, particularly in the North-Eastern and hilly regions. The Committee, therefore, recommends the Ministry of Health and Family Welfare to set time-bound targets for expanding the network of organ retrieval centres and kidney transplant facilities to at least three Government medical colleges in every large State & one govt. medical college in small state or UTs and strengthen financial and technical support by extending to States for transplant infrastructure and transplant coordinators and intensify public awareness campaigns for deceased organ donation, particularly in States presently reporting negligible deceased-donor transplant activity.

(Para 6.7.2)

 

58.       The Committee is of the considered view that the significant gender disparity observed in living organ donation and kidney transplantation warrants careful examination to ensure that access to transplantation is guided solely by clinical need and not influenced by socio-economic or gender-related barriers. The Committee, therefore, recommends that the Ministry of Health and Family Welfare, through the National Organ and Tissue Transplant Organization (NOTTO), undertake a comprehensive study to identify the factors contributing to the disproportionate representation of women as living organ donors and men as transplant recipients. Based on the findings, the Ministry should formulate appropriate policy interventions, strengthen counselling and informed consent processes, enhance gender-disaggregated data collection and monitoring, and ensure equitable access to kidney transplantation and organ donation services across all sections of society.

(Para 6.7.4)

 

 

Health Literacy, Awareness and Delayed Diagnosis

59.       The Committee observes that the complexity of CKD management involving dietary restrictions, long-term medication and regular monitoring presents considerable challenges for patients with limited health literacy. The Committee is of the considered view that inadequate public awareness, poor understanding of disease progression and limited access to counselling and supportive care contribute significantly to delayed diagnosis, poor treatment adherence and avoidable progression to End-Stage Kidney Disease. The Committee further observes that the absence of sustained patient education and psychosocial support may lead to discontinuation of treatment, missed follow-up visits and poor compliance with prescribed dietary and medication regimens, particularly among economically vulnerable patients. Further, these challenges also place a disproportionate emotional, social and financial burden on caregivers, especially in low-income and rural households, thereby widening existing inequities in CKD outcomes. The Committee, therefore, strongly recommends that the Ministry of Health and Family Welfare scale up gender and region-sensitive awareness campaigns on CKD with particular focus on rural areas and Tier-II and Tier-III towns; develop and disseminate culturally appropriate dietary and treatment-adherence counselling material in regional languages and strengthen the capacity of frontline health workers including ASHA workers to provide sustained community-level counselling and support to CKD patients and their caregivers.

(Para 6.8.3)

 Unregulated Medication Use and Quality Assurance Gaps

60.       The Committee is concerned that inadequate public awareness regarding the nephrotoxic effects of certain commonly used medicines, coupled with the absence of a robust framework for promoting their rational use, continues to expose individuals to avoidable kidney damage. The Committee recommends that the Ministry in coordination with the concerned regulatory authorities should strengthen public awareness on the risks associated with the unsupervised and prolonged use of medicines known to adversely affect kidney function, particularly over-the-counter analgesics. The Committee further recommends promoting rational use of medicines through appropriate patient counselling and strengthening pharmacovigilance and prescription practices, especially for individuals with diabetes, hypertension and other high-risk conditions requiring long-term medication.

(Para 6.9.2)

Research and Evidentiary Gaps

61.       The Committee finds that India's response to CKD is constrained not only by gaps in healthcare delivery but also by deficiencies in the country's research and evidence-generation ecosystem. Significant knowledge gaps regarding the causes of CKDu, limited translation of indigenous scientific innovations into clinical practice, inadequate multicentric and collaborative research and insufficient scientific validation of complementary therapies collectively impede the formulation of evidence-based policies and effective interventions for CKD prevention and management. The Committee, therefore, recommends that the Department of Health Research and the Indian Council of Medical Research formulate a coordinated national research agenda to reconcile the variance in estimates of CKD of unknown aetiology, fast-track large-scale validation of indigenous diagnostic biomarkers, and actively pursue international research collaboration. The Committee further recommends that the Ministry of Ayush in collaboration with ICMR and DHR, design and undertake rigorous, adequately powered clinical studies to scientifically evaluate the role of Yoga and other Ayush modalities in CKD management, while expanding the geographic footprint of Yoga Therapy Centres and Preventive Health Care Units across the country.

(Para 6.10.5)

Need for Pediatric Kidney Care - A distinct CKD priority

62.       The Committee understands that paediatric Chronic Kidney Disease (CKD) is predominantly congenital, hereditary or developmental in origin with clinical manifestations often appearing as early as two to three years of age. Unlike adult CKD, paediatric CKD requires continuous medical care from infancy through adulthood, with many patients likely to undergo multiple kidney transplants during their lifetime due to the limited functional lifespan of transplanted kidneys. The Committee, therefore, views paediatric CKD as a lifelong healthcare commitment requiring sustained institutional support. The Committee is of the view that children with CKD require dedicated paediatric nephrology centres equipped with age-appropriate dialysis facilities, paediatric transplant expertise and multidisciplinary support. The Committee believes that paediatric CKD should be addressed as a distinct healthcare priority rather than being subsumed within adult CKD programmes. The Committee therefore, recommends the Ministry of Health & Family Welfare to recognise paediatric CKD as a separate component under the national CKD framework and formulate a National Paediatric Kidney Wellness and Equity Programme encompassing early diagnosis, comprehensive care and a structured transition to adult nephrology services. The Committee further recommends that dedicated paediatric CKD clinics be progressively established in tertiary care institutions across the country to ensure equitable access to specialised care for affected children.

(Para 6.11.4)

 Low Priority, Communication Gaps and Provider Challenges

63.       The Committee observes that inadequate communication and counseling often contribute to poor treatment adherence, delayed decision-making and sub-optimal management of Chronic Kidney Disease (CKD). Experience suggests patients frequently face difficulty in understanding disease progression, dietary restrictions and treatment options, particularly during the transition from conservative management to dialysis or transplantation. The Committee further observes that counseling on symptom management, quality-of-life issues and end-of-life care for patients with limited treatment options remains inadequate. The Committee is of the view that strengthening communication, counseling and patient engagement is essential for improving treatment outcomes and ensuring patient-centered care. The Committee therefore, recommends that the Ministry accord greater emphasis to health literacy, shared decision-making and structured long-term counseling to promote sustained adherence to medicines, dietary modifications and lifestyle changes.

(Para 6.12.3)

National CKD Performance Dashboard

64.       The Committee recommends the Government to develop a district-wise CKD Performance Dashboard to monitor screening coverage, early diagnosis, dialysis outcomes, transplant waiting lists and specialist vacancies.  The Committee understands that use of real time data would be beneficial in identifying regional gaps and improve accountability.  Evidence based planning and resource allocation is required to achieve the objective of maintaining healthy kidney.

(Para 6.13.1)

Workplace Kidney Health Programme

65.       The Committee desires the Government to launch a Kidney Health Programme for higher risk occupations such as agricultural workers, construction workers and factory laborers. The Committee also recommends to generate the public awareness for periodic screening, provide hydration facilities, shaded rest areas and occupational health education and awareness against CKD associated with heat stress, dehydration and environmental exposure. 

(Para 6.14.1)

National Policy for Healthy Kidney

66.       The Committee understands that the CKD posses huge challenge, therefore, there is need to generate public awareness and formulate policy for its control early identification diagnostic test and treatment and long term kidney care by strengthening integrated management. Keeping in view the importance of Ayush system in preventing CKD, the Committee recommends All India Ayurved Institutes to undertake in depth research.  The Committee desires that there should be facilities for free dialysis in Ayushman Arogya Mandirs.

(Para 6.15.1)

 

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RKK

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