Keynote Address Issues in Public Health in India - Keynote address by Keshav Desiraju, Former Secretary of Health and Family Welfare to the ...
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Journal of Public Health | Vol. 43, Supp 2, pp. ii3–ii9
Keynote Address
Issues in Public Health in India - Keynote address by Keshav
Desiraju, Former Secretary of Health and Family Welfare to
the Government of India
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ABSTRACT
The state of public health in India can be studied in terms of disease burden, health human resources and health care financing. There are many
regional variations within these broad areas, and many complexities. Communicable and non-communicable diseases remain major challenges,
as do maternal and infant mortality. At every level, trained human resources are scarce. Government budgetary resources are inadequate and
the current discussion in India on universal health care appears to be biased towards privately provided care. At the same time, there have been
remarkable achievements, often diminished by the size of India’s population. Public health is about social justice and the task before India today
is to demonstrate the political will, the administrative ability and the democratic vision to achieve universal health care. Can this come about?
Introduction to make a difference.1 Several of the failures identified by
In calling this talk ‘Issues in Public Health in India’, my Prof. Pai relate to India. These include India’s failure to invest
intention is, quite simply, only to identify the issues which in health, India’s premature declaration in 2005 of leprosy
have a bearing on the health and welfare of a very large elimination and India’s failure to address child malnutrition
population. There are many complications and regional varia- and stunting. There are also situations where India is not alone
tions, whether in disease burden, health infrastructure, health but where there is still a recognized shortcoming such as the
human resources or styles of governance. There are many failure to deliver on the Alma Ata Declaration, the failure
implications for the establishment of better health systems of the global Malaria Eradication Programme, the failure to
arising from India’s federal structure where the primary, con- achieve the Millenium Development Goal [MDG] 5 goal on
stitutional, responsibility for health care is that of the states maternal deaths, failure to address the NCD epidemic, the
even if a not insignificant share of public spending on health weakening of the campaigning to end AIDS by end-2030 and
care is by the central government. the failure to address global mental health.
Clearly, these issues will need to be addressed in a sensible This sorry list gives a very good outline of the ‘range’
and inter-connected manner if efficient health systems are to of India’s public health issues. One very striking feature is
be built. the continued prevalence of communicable disease along
This talk comes at the end of a conference on mental illness with the rapid increase in the spread of non-communicable
and mental health, but while there are critical issues at the disease in a country where maternal and infant mortality are
heart of a mental health policy or programme, it is essential still unacceptably high. India is forever in a state of transi-
that those issues are understood within the context of the tion. Several developed countries have reduced maternal and
health of a people, the public health context. And I would like infant mortality and have also brought communicable disease
to spend a little time on this. There can be no mental health under control. This allows them the resources and the space
without public health. to address the threat to non-communicable disease. India
A good place to start is to look at what has gone wrong. In does not have this luxury. If we have successfully eliminated
a recent piece entitled ‘Archives of failures in global health’, small pox and polio, we still are fighting malaria, tuberculosis,
Professor Madhukar Pai of the McGill University looks not leprosy, AIDS and a string of what are rather sadly called
at the dramatic successes with which we are all familiar but ‘neglected tropical diseases’.
at failures, areas where the global health community and None of this is actually new. The Alma-Ata Conference
individual governments have been either unable or unwilling on primary Health Care of September 1978 urged that
© The Author(s) 2021. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com ii3ii4 JOURNAL OF PUBLIC HEALTH
‘Governments have a responsibility for the health of non-communicable diseases such as hyper tension and
their people which can be fulfilled only by the provision diabetes were the result of inappropriate diet in high income
of adequate health and social measures’. Alma Ata also countries. We now know more realistically that diabetes
recognized the importance of promotive, preventive, curative and hyper tension as also cancers and mental illnesses have
and rehabilitative services, of nutrition and safe drinking comparatively little to do with incomes and much more to do
water, of public health education, of access to drugs, with the now clearly identified risk factors of tobacco use,
immunization, family planning, maternal and child health. uncontrolled use of alcohol, lack of exercise and poor diet.
Most importantly, the Alma Ata Declaration recognized India, which moved the global mental health resolution in
the need for health human resources both at the local and the World Health Assembly 2012 which led to the action plan
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referral level, for ‘health workers, including physicians, nurses, adopted at the World Health Assembly 2013, has consistently
midwives, auxiliaries and community workers as applicable, called for a ‘greater recognition of the fact that mental illness
as well as traditional practitioners as needed, suitably trained be regarded as one of the major non-communicable diseases’,
socially and technically to work as a health team and to calling for medication, treatment and long-term management.
respond to the expressed health needs of the community’. Approximately 5% of India’s population is believed to have
common mental disorder with a further 1.5% with severe
mental disorder. This translates into about 80 million persons,
Disease burden a staggering number on any reckoning.6
While all non-communicable ailments need continuous
Communicable disease
and regular treatment, the stigma surrounding mental illness
Public health policy and practice in India has traditionally been
makes it the more difficult for appropriate measures to be
driven by ‘communicable disease’. There have been significant
taken. India’s Mental Health Policy of 2014 and the National
achievements in the past and also very recently in the case of
Mental Health Care Act of 2017 lay down very salutary
polio, where it has been over 7 years without an incidence of
principles which place the interest of persons with illness
wild polio virus. India’s polio campaign was a combination
at the fore, and not necessarily the interest of families and
of financial resources, superior technology and dedicated
guardians, and of treating psychiatrists. It is a legislation that
manpower. There have not been comparable results in routine
recognizes the rights of persons with illness to appropriate
immunization where the all India average is 62%.2
treatment, a major move forward in a country where the right
‘Malaria and other vector borne diseases’ such as dengue
to healthcare is not easily understood.
still pose a major public health challenge. A reduction has been
Other diseases, whether communicable or non-communic-
seen in the number of cases; about 9.5 million malaria cases
able, may affect smaller number of persons but still add to the
in 2017, but 1.25 billion Indians—94% of the population—
burden of disease and require appropriate responses. These
are still at risk of malaria. The government has set 2030 as the
include rheumatic heart disease, leprosy, thalassemia, sickle
target year for eliminating malaria.3
cell anaemia, congenital disorders and accidental deaths.
Despite reduction in mortality of ‘tuberculosis’ by 42 per
100 000 persons in 1990 to 23 per 100 000, India still con-
tributes 25% of the global burden, with an estimated 2.8 Maternal and infant mortality
million new cases in 2018.4 The Global TB Report of 2018
Numbers do not tell us everything but we must still know
reported an incidence of 28 million persons, about a quarter
what they are. Despite magnificent efforts, largely driven by
of the world’s cases.5 Of these 28 million, about 1.47 million
Government, maternal mortality, nation-wide, is still at 142
are afflicted with Drug Resistant TB, a situation which has
deaths per 100 000 births. We were not successful in achieving
arisen almost entirely because of unregulated treatment of
the MDG target of 109 by 2015. The Sustainable Develop-
tuberculosis by private providers. If India is to achieve elim-
ment Goals (SDGs) now require us, by 2030, to reduce the
ination of tuberculosis by 2025, a much publicized objective,
global maternal mortality ratio to less than 70 per 100 000 live
much more will need to be done.
births. Some states have indeed achieved this; Kerala at 61,
Maharashtra at 68 and Tamil Nadu at 79 have shown what is
Non-communicable disease possible but we must also recognize Rajasthan at 244, Uttar
We also recognize the major threat of ‘non-communicable’ Pradesh at 285 and Assam at 300.
disease. ‘Diabetes, cardio-vascular disease and cancers Infant mortality, nation-wide, is still 39 deaths per 1000 live
contribute significantly to the disease burden’. For many births. SDG 3.2 requires us to reduce neonatal mortality to at
years India, with the rest of the world, believed that least as low as 12 per 1000 live births and under-5 mortalityISSUES IN PUBLIC HEALTH IN INDIA KEYNOTE ii5
to at least as low as 25 per 1000 live births. We were not states, more particularly Uttar Pradesh, Bihar, Jharkhand,
successful in achieving the MDG of not more than 41 deaths Madhya Pradesh and Rajasthan have not yet reached this level.
per 1000 live births in the under-5 age group. The actual More positively, in the 70 odd years since independence
estimate in 2015 was nearer 48 deaths per 1000 live births. life expectancy has increased significantly, from 26 at inde-
Here, again there is wide variation among states with Kerala pendence, to 70.3 years for women and 66.9 years for men.
at 12, Tamil Nadu at 23 and Delhi at 26 at one end of the There is a real danger in a country of India’s size and as
range, already having achieved the SDG, and Odisha at 66, divided in access to resources that we concentrate only on the
Madhya Pradesh at 69 and Assam at 73 at the other. diseases of the urban population, of the relatively better off
These numbers indicate the scale of the challenge. What sections of the society, of persons who have access to health
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they conceal are the details. True, more women and infants are care facilities and of persons who are in a position to pay for
surviving the trauma of childbirth; however, not much else is health care. It is possible that the diseases of those persons
changing in their lives. Women continue to be underweight, who are unable to access health care fall outside the area of
anaemic, married too early, are becoming mothers too early interest of health policy makers.
and are giving birth to underweight babies at some risk of
wasting and stunting. The Lancet has recently called atten-
tion to the fact that ‘Malnutrition was the predominant risk Health care financing
factor for death in children younger than 5 years of age in Prof. Pai’s list of failures also, significantly, highlights India’s
every state of India in 2017, accounting for 68·2% of the failure to invest in health care. Most discussions of this
total under-5 deaths’.7 The additional details are grim. ‘The subject tend to highlight the fact that, as against the Alma Ata
prevalence of low birth weight in India in 2017 was 21·4%, objective of 3% GDP to health care, India has never gone
child stunting 39·3%, child wasting 15·7%, child underweight beyond 1.1%. There are several important riders to this.
32·7%, anaemia in children 59·7%, anaemia in women 15–49 Expenditure as a percentage of GDP is by both the centre
years of age 54·4%, exclusive breastfeeding 53·3% and child and the state, though traditionally, it is the central government
overweight 11·5%’. With 28 million babies born every year, that has made substantial contributions towards this. This
the actual numbers are staggering. And even more recently, expenditure also includes the cost of maintaining the hos-
the 2019 Global Hunger Index places India at a rank of 102 pitals and salaries of nurses within the government system,
of 117 countries assessed. expenditures largely borne by the states many of whom do
not find it easy to generate significant resources of their own.
We must also look at how the public expenditures are
Population divided across infrastructure, human resources, hospital care,
Any study of disease burden in India must, obviously, recog- public health, medical education and medical research. Each
nize population size. The relationship between health policy of these would require a formidable level of investment and
and population policy in India has been contentious. For the tendency has been for both the government of India
too long, population policy has been seen as a question of and the states to look for the low hanging fruit such as
population control and it is only relatively recently that more construction of hospital buildings or the purchase of expen-
voices are heard, primarily from civil society, calling for a sive equipment rather than the more time consuming effort
population policy that addresses the questions of women’s involved in investing in the education of nurses and public
health, nutritional status, the ability of women within families health workers or clinical and health research.
and communities to take decisions relating to themselves, Most issues in health care financing are well-known but
women’s literacy and education, awareness among both men I would like to speak a little about India’s current policy as
and women of the options for family planning available to reflected in the scheme known as the Ayushman Bharat Prad-
them and the recognition that higher standards of primary han Mantri Jan Arogya Yojana, or Prime Minister’s Health
care impact significantly on the health of women and children. India Programme. There has been a widely publicized, social
It is also necessary to recognize that whatever efforts are media driven campaign promoting this Programme but it is
made by India today howsoever heroic and howsoever well- necessary not to be diverted by the glitz of the campaign and
funded, the impact will not really be felt for the next 15 or to look at actual and projected achievements.
20 years. India’s population today stands approximately at The PMJAY has two components. The first is an insurance-
1.3 billion. In population growth as well as in communicable based hospital care scheme. Persons enrolled under the
disease, there is significant variation across the states many of PMJAY are entitled to seek treatment at empanelled gov-
whom have achieved replacement fertility rate of 2.1. Other ernment and private hospitals the payment for which, up toii6 JOURNAL OF PUBLIC HEALTH
a maximum of Rs. 500 000, for any one of 1350 packages, at there are about 24 000 PHCs and over 1 56 000 Sub Centres,
prior negotiated rates, is to be made to the treating facility by this is not a large number. It is also not clear whether a sim-
the insurance company. This is the way many health insurance ple conversion of existing centres into the newly christened
schemes work including the Rashtriya Swasthya Bima Yojana Wellness Centres would be able to successfully address the
which India launched in 2008 and has now, for all practical problems of inadequate human resources, limited availability
purposes, abandoned. The latest figures are that 4.46 million of drugs and disposables and general poor maintenance. The
persons have received cashless treatment in over 18 000 eco-system in which the Wellness Centres are to function
hospitals, and while figures are frequently released of the remains the same and it is not clear that renaming them has
numbers of claims settled with hospitals, information is not effectively solved anything.11
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necessarily forthcoming on improved health outcomes, if any. There is also the more fundamental question of who
There are several difficulties in the entire structure. Where should pay for healthcare. Having an insurance-based system
it is government’s intention to negotiate lowest possible rates still requires substantial amounts of government funds to be
for prescribed treatment, it is the endeavour of private hospi- paid out as insurance premium on population cover. There is
tals to increase these as much as they can, and while it is pos- no sign in any of the annual budgets since the scheme was
sible that negotiated rates have been announced, it is perfectly launched of increased funding of the order that is required to
clear that private hospitals will render only as much treatment make it work. Even the Chief Executive of the PMJAY, in a
as they believe they can do so do within the negotiated rate. much publicized interview, admitted that he hoped India’s
Another very serious problem with PMJAY is that it only investment in health care would reach 2.55 of the GDP
supports cases of hospital admission ignoring the fact that a by 2025, of which only a small amount would come to the
substantial number of cases could conveniently be dealt with PMJAY.12 If government has not budgeted for the insurance
in the outpatient wards. Indeed, in these cases, hospitalization claims which will be received in increasing volume, if it has
probably brings on a range of unrelated additional costs not not budgeted for the up-gradation of the Wellness Centres, it
covered by the insurance payment. There is, of course, also is not very clear that the scheme can continue to function. It
the issue of useless hospitalization and useless surgeries being is also not clear why if the government has the resources, or
undertake only in return for the insurance claims.8 plans to have the resources, to pay the insurance companies,
All of this leads to the suspicion that the scheme has been why these funds could not be used to strengthen existing
designed primarily to make use of unused capacity in private systems, and to better equip them to function or to ensure
hospitals. Interestingly, a recent article authored by the two the reliable presence at all times of trained health human
senior most civil servants in the health establishment relates resources in public sector facilities.
with some pride that more than half the hospitals empanelled
under the scheme are private, and that private hospitals have
witnessed a 20% increase in footfall.9 Health human resources
I have said that there are two parts to the PMJAY pro- The availability of well-trained and suitably motivated human
gramme. The second is the establishment of Health & Well- resources remains one of the most challenging issues in public
ness Centres. This really appears to be a programme for health in India. The requirement is huge, whether of doctors
up-gradation and strengthening of existing sub-centres and with a first degree, super specialists or doctors with post-
primary health centres; 12 services have been identified which graduate qualifications, nurses, allied health professionals and
the Wellness Centres are expected to provide, unlike the public health workers. Each of these categories is a crisis
limited range of services currently provided, or expected to situation in itself.
be provided, in Sub Centres or PHCs. In an ideal situation, As per the most recent information, the Medical Council
this would have been addressed first on the understanding that of India, of which more anon, has approved, for the award
the bulk of people’s health concerns would be taken care of of MBBS, the first degree, 80 312 seats every year of which
within at the level of primary care with only more complicated 42 222 or slightly over 50% are in government colleges, the
cases being referred to a secondary or tertiary level, either in remainder being in private colleges. Everything to do with
the government or in the private sector, where hospitalization the establishment of medical colleges, and the conduct of
would be more or less essential and the cost would be covered the Medical Council of India, needs careful examination. The
by insurance. Council itself has recently been abolished with an interim
Comparatively, little information is available on how suc- body holding charge till the National Medical Commission
cessfully the Wellness Centres have been established. A figure takes office. Relevant legislation, the National Medical Com-
of ‘more than 20 000’ is cited in official reports.10 Given that mission Act of 2019, has been approved by Parliament. It isISSUES IN PUBLIC HEALTH IN INDIA KEYNOTE ii7
much too early to say how this reform will play out. ‘Whether introduction of a Community Health Worker, the liveliness
this leaner avatar of the MCI in the form of the NMC will stemming from the fact that there is no clear idea of who this
be transparent, impartial, free of corruption and improve person will be, and how well trained and with what specific
efficiency remains to be seen’.13 responsibility.
Clearly, a very large number of medical graduates are being
produced every year. It is unclear how many of them are
actually available for public service. It is also the case that there Public health
is a very wide variation in the quality of these graduates. Those In identifying three big areas where both policy and
leaving government medical colleges are generally regarded programme attention is required, disease burden, financial
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to have been better trained. While there are outstanding resources and human resources, I have still followed what
institutions of medical education in the private sector such might be called a hospital driven approach to healthcare. How
as the Christian Medical College in Vellore, many of them do differently do we need to think if we look at a public health
not have the same reputation. They survive on the strength policy for India?
of high fee structures, a feature that does not appear to be India’s leading public health specialist, also one of India’s
deterrent given the very high status given to doctors in India. leading cardiologists, Dr K. Srinath Reddy has recently called
The fact is, however, that a student graduating from a private attention to the six key elements of a health system identified
college, howsoever well or badly trained, is not going to be by the WHO.14 These are healthcare infrastructure, health
available for public service if she is to repay the debt that she work force, availability of drugs and technologies, the level
has incurred in acquiring a medical education. and use of health financing, health information systems and
Issues of medical curriculum and syllabus were not given overall governance of health services. Dr Reddy makes the
adequate attention by the Medical Council of India prior important point that these six elements do not include the role
to its unlamented demise, and the same is true of nursing of the community in driving demand for adequate healthcare.
education. As per the most recent information available on the It is still common in India for public health to be under-
Nursing Council of India which for some peculiar reason has stood as basically concerned with hygiene and sanitation, with
not been abolished along with the Medical Council of India controlling the spread of communicable disease. ‘It could
and appears to continue outside the newly created National however be more usefully understood as the establishment of
Medical Commission, there are 1630 colleges for the training a viable and functioning primary healthcare system serving
of midwives, 2960 colleges for the training of staff nurses the community which takes into its fold all matters relat-
and 1703 colleges for the training of graduate nurses. The ing to health and welfare of the public including preventive
overwhelming majority of these are privately owned and run, measures, appropriate nutrition and well-functioning drinking
of indeterminate quality. Not enough positions have been cre- water and sanitation systems, for all members of the public
ated by the state governments for nurses, many of whom look and particularly for women and children, and over their life
for employment opportunities abroad. The nursing council course’.
also has regulatory control over the training of midwives, This is a description that I have created but it covers all the
another shamefully neglected area. relevant issues: the prevention of communicable disease, the
On the positive side, we must note that there is legislation treatment of non-communicable diseases over the life course,
currently pending, The Allied and Healthcare Professions Bill, the need for government investment, the need for qualified
2018, which aims to define and regulate the conduct and persons at all levels and the role of the community. I may add
training of allied health professionals, defined as an associate, that all of this said in one form or the other in India’s National
technician or technologist trained to support the diagnosis Health Policy issued in 2017. The policy actually says more,
and treatment of any illness, disease, injury or impairment. including an emphasis on traditional systems of medicine,
The Bill further lists 15 categories of professionals, with 53 and as in the case of much of India’s legislation, is more a
specific professions, with the possibility of including new statement of aspiration than of commitment.
professions as they emerge in the course of time. India is All this is easier said than done. It is not necessarily
strong in the drafting of legislation and we must wait and see only a question of resources. Nothing can be done without
how effective the proposed national and state councils will be resources, but resources without the necessary motivation,
in laying down and maintaining high standards of training and political will and executive ability will also not deliver
professional practice. satisfactory health outcomes.
The National Medical Commission to which have referred I should also call attention to remarkable civil society inter-
earlier has livened the debate considerably by proposing the ventions which in their motivation and work on the groundii8 JOURNAL OF PUBLIC HEALTH
reflect the best elements of what I have defined as a public Conclusion
health policy. I think here of Dr Yogesh Jain and his colleagues
Public health is about social justice. The SDGs recognize
at the Jan Swasthya Sahyog, in Chhattisgarh, at the heart of
this, and in their different areas, they target inequality. But
India. The JSS runs a hospital which provides a very high
it is also true that even where substantial progress has been
quality of care to a large and vulnerable population. I am
made towards achieving the SDGs, gaps between countries
grateful to Dr Jain for always calling my attention to what
and between communities within countries continue to rise
he describes as the diseases of the very poor. I think also of
enormously.16
Dr Vandana Gopikumar and her colleagues at The Banyan in
The distinguished psychiatrist and public health practi-
Chennai, an organization that has worked for 25 years now
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tioner Vikram Patel has urged, ‘Inequality corrodes the fabric
with homeless women with mental illness. In India, to be
of a society that is crucial for all people to feel they belong to it
female, poor and sick is to be very vulnerable indeed and it
and have a stake in a shared future. Social scientists refer to this
is in the work of The Banyan that one sees a combination
connectedness as social capital. It acts as an invisible glue that
of professional excellence and compassionate imagination. I
binds us all together, both rich and poor, through good times
must also mention two institutions for children with disability,
and bad. It is this communion of hearts and minds which pro-
the Latika Roy Foundation in Dehradun run by the remark-
motes individual, and ultimately, societal well-being. In short,
able Jo Chopra and Vidyasagar in Chennai set up by Poonam
inequality destroys the soul of nations, of societies, of com-
Natarajan. I must also mention my friend Dr M.R. Rajagopal
munities and, ultimately, of every individual’s well-being’.17
of Pallium India in Thiruvananthapuram, an organization
And when governments aim at making quality health care
devoted to establishing palliative care services.
accessible and affordable, when they strive, in the words of
These institutions and many more that I have not men-
Alma Ata, for ‘the provision of adequate health and social
tioned are marked in many ways but most importantly by the
measures’, they work towards removing inequalities. That is
human and ethical quality of the individuals behind them.
the core of good governance. These noble thoughts have
And while this gives these institutions their distinction, it also
been reiterated in the UN General Assembly’s High Level
makes us ask the question of what one may expect from
Resolution of 23 September 2019.
institutions which are not guided by a hugely charismatic
Everything lies with national governments, and in the con-
figure. Government does not believe in charisma. Yet, it is
text of today’s address, India’s government and its ability to
government’s responsibility to establish fund and manage
show leadership and ownership in establishing effective health
healthcare institutions. The best examples we have in India
governance, to promote access to safe, effective, quality and
are in the non-profit sector. Where and how are we going to
affordable essential medicines and vaccines, to invest ade-
bring about a union?
quate sustainable resources, to invest in the education, recruit-
India’s experience in tackling the AIDS epidemic stands as a
ment and retention of a fit-for-purpose and responsive public
lesson in how appropriate health policy and programmes can
health workforce and to address the social, environmental and
be framed in response to medical evidence, and how com-
economic determinants of health and health inequity. These
munity involvement can significantly impact on the efficacy
are monumental challenges and of great importance to all
of health investments. My distinguished friend Sujatha Rao in
who care for the future of India.
her book ‘Do We Care?’ makes the point that India showed the
capacity to respond to a situation which require not only clin-
ical intervention but also changes in the societal attitudes.15 Supplement Funding
For possibly, the first time issues of sexuality and sexual ori-
Oxford-India Sustainable Centre, Somerville College, Univer-
entation were brought into the public discourse, with a recog-
sity of Oxford.
nition of the fact that behavioural change needed to drive
India’s response to controlling the epidemic. India’s national
AIDS control programmes will always be remembered for References
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situation. 10 October 2019.ISSUES IN PUBLIC HEALTH IN INDIA KEYNOTE ii9
5 India TB Report. Annual Status Report. Ministry of Health & Family 12 The Times of India, 26 July 2019.
Welfare, 2018. 13 Dash S, Nagral S. The National Medical Commission: A Renaming or
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Soumitra Pathare and Laura Wood, 2015. Blackswan Pvt. Ltd., 2019.
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states of India: the Global Burden of Disease Study 1990-2017. Lancet, 19
16 Bill & Melinda Gates Foundation. 2019 Gatekeepers Report.
September 2019.
17 Patel V. The Indian Express, 28 January 2017.
8 Rukmini S. Cracks in our Healthcare System, The Mint, 23 September 2019.
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9 Sudan P, Bhushan I. In one year, PM-JAY has created a framework for Keshav Desiraju
comprehensive universal healthcare. The Indian Express, 23 September
2019.
Former Secretary of Health and Family Welfare to the
Government of India Somerville College, Oxford.
10 Sudan P, Bhushan I, op cit
Keynote talk – Mental Health in India – Bridging the Gap
11 Unpacking Ayushman Bharat and other Recent Health Policy
initiatives: Parts I and II, T. Sundararaman, https://medium.com/fro
Conference - Issues in Public Health in India Somerville
m-prof-sundararamans-desk/unpacking-ayushman-bharat-and-othe College, Oxford, 31 October 2019.
r-recent-health-policy-initiatives-part-ii-545b93f17f32. https://doi.org/10.1093/pubmed/fdab305You can also read
