Abstract

India’s Vision for 2047 aims to transform the nation into a developed country, with healthcare being pivotal for this progress. Achieving universal health coverage and modernising healthcare infrastructure are essential for fostering a healthy productive population, which in turn drives economic growth and reduces poverty. Central to this vision is the concept of health and nutrition security, ensuring inclusive protection against health threats across diverse strata of populations. The proposed National Public Health & Nutrition Security Index (NPHNSI) will be a strategic tool to monitor the progress, evaluate its performance and enhance India's readiness for public health equity and emergencies like COVID-19. By integrating key indicators, such as healthcare infrastructure, workforce availability, and emergency preparedness, the NPHNSI will facilitate targeted improvements and investments. This approach supports the broader goal of Viksit Bharat 2047 by creating a robust health system that aligns with sustainable development goals and strengthens India's global standing. The NPHNSI will also address challenges in health protection, bridge gaps in coverage, and enhance the healthcare workforce, ultimately contributing to a developed and equitable healthcare system by 2047.

Background 

The healthcare industry in India, valued at $372 billion, is a major employer with around 7.5 million workers (Government of India, 2023). The COVID-19 pandemic exposed gaps such as insufficient testing, weak surveillance, and inadequate care (Kumar, 2020). Low government health expenditure has led to high out-of-pocket costs, particularly through private providers. In rural Rajasthan, Madhya Pradesh, and urban Delhi, healthcare expenses consume a significant portion of household budgets—7.7 per cent in rural and 5.7 per cent in urban areas, often exceeding 10 per cent of total expenditure. According to the Global Health Security Index 2021, India’s healthcare system faces significant challenges, including inadequate capacity in health clinics, hospitals, and community care centres, with an average score of 46.1 out of 100. The country lacks comprehensive plans for distributing medical countermeasures like vaccines during emergencies (Johns Hopkins Center for Health Security, 2023). By 2050, India's population is projected to rise by 18 per cent to 1.7 billion, intensifying pressure on the healthcare system. 

India's vision for 2047 is centred on transforming the nation into a developed country by its 100th year of independence, with the healthcare sector playing a pivotal role. Ensuring universal health coverage and modern healthcare infrastructure is critical for achieving a healthy and productive population, essential for driving economic growth and reducing poverty and inequality (Watkins et al., 2017). Quality healthcare improves the quality of life, promotes social stability, and fosters technological advancements (Kane, 2001, Custodio et al., 2009). Additionally, the healthcare sector aligns with sustainable development goals and enhances India’s global standing. There is an urgent need to make healthcare systems streamlined across all the parameters. By investing in healthcare infrastructure, services, and innovations, India can create a robust system that supports its broader developmental aspirations.

This paper advocates the mainstreaming of the term ‘health and nutrition security’. Being a fluid concept, it may be presented as an inclusive approach that seeks to ensure that all populations, regardless of geographic, economic, or social conditions, have protection against health threats. This concept is particularly pertinent to India due to its vast and diverse population, significant disparities in healthcare access, and susceptibility to various health emergencies. Health Security aims for inclusive health protection, promoting health equity and addressing a broad range of health threats, including infectious diseases, non-communicable diseases, and the social determinants of health (Saraswathy, 2021; Brown et al., 2022). 

India’s Vision for 2047 and health and nutrition security are two sides of the same coin. Achieving health security for all will give a strong impetus to the vision of a Viksit Bharat and a Viksit Bharat will sustain health security for all, indefinitely. To realise this vision, the development and implementation of a National Public Health & Nutrition Security Index (NPHNSI) is a strategic and practical approach. It will serve as a comprehensive tool to evaluate and monitor the country’s readiness and capacity to manage public health emergencies and ensure health equity across diverse populations. 

By systematically assessing and enhancing the country’s health and nutrition security framework, the NPHNSI helps ensure better preparedness, monitor the progress and evaluate response to health emergencies. This not only protects the health and well-being of the population but also aligns with the broader vision of Viksit Bharat 2047. Implementing NPHNSI-driven policies and programs can create a robust health system that supports India's developmental aspirations, fostering a prosperous and equitable nation. The National Public Health & Nutrition Security Index (NPHNSI) will play a crucial role in evaluating the scope and impact of these reforms. The NPHNSI will offer a comprehensive framework to assess and monitor the health system's performance, resilience, and equity, guiding future reforms. Since, implementation of health is a subject under states consideration as the constitution, NPHNSI will also measure governance structures, policy implementation, and leadership in healthcare across states and provide insights into how effectively reforms suggested at Centre are being carried out.

The NPHNSI will not just evaluate workforce availability, distribution, and competency, ensuring schemes like Ayushman Bharat but also monitor health information systems, medical products, technologies, and healthcare financing for sufficiency and efficiency. This approach will identify areas needing attention, supporting continuous improvement toward health equity and Vision 2047 goals. By integrating these dimensions, the NPHNSI will provide a clear picture of health system performance and reform effectiveness. Guided by NPHNSI insights, effective planning and risk management will balance outcomes and prevent social issues, ensuring reforms are equitable and aligned with India's development goals.

Literature Review for National Public Health & Nutrition Security Index (NPHNSI) Development

The reviewed documents highlight the importance of a multidimensional approach to developing the NPHNSI. Key aspects include governance, health system capacity, workforce, information systems, and financing. The combination of qualitative and quantitative measures provides a comprehensive assessment framework (See Table 1). Additionally, insights from the global health security index GHSI evaluation stress the need for robust and context-specific indicators to predict and respond to health threats effectively (Ravi et al., 2020). 

Table 1: Indicators used for Various Studies for Performance Measurement Health System and Security

Framework for the National Public Health & Nutrition Security Index (NPHNSI)

The National Public Health & Nutrition Security Index (NPHNSI) is proposed as a strategic initiative to enhance public health security in India, aligning with the "Pathway to Viksit Bharat 2047" vision. This comprehensive index will evaluate the country's public health system through a blend of quantitative and qualitative analyses, focusing on key health dimensions such as nutrition, physical and mental health, and public health infrastructure. The NPHNSI framework will also integrate key insights from recent global food security reports such as UNICEF’s State of Food Security and Nutrition Report. Tackling global hunger and food insecurity, along with understanding the effects of urbanisation on agrifood systems, is crucial. Utilising technological advancements and adopting comprehensive governance strategies across various sectors will significantly improve the framework's impact.

Benefits of NPHNSI

The NPHNSI aims to enhance emergency preparedness, identify risks, and improve response systems, supporting citizen well-being and aligning with India's 2047 vision. It will establish standardised criteria for uniformity across regions and enhance coordination among healthcare agencies and government bodies.

The National Public Health & Nutrition Security Index (NPHNSI) will offer several benefits:

● Enhanced Emergency Preparedness: It will address a wide range of health emergencies, including infectious disease outbreaks, natural disasters, and environmental hazards.

● Risk Identification: It will highlight areas at increased risk due to diverse geographical and climatic conditions, and high population density.

● Effective Response Systems: It will improve disease surveillance and robust response systems, crucial in light of recent events like the COVID-19 pandemic.

● Citizen Well-being: It will ensure a strong healthcare system, essential for the well-being of citizens.

● Support for National Vision: It will support the foundation for economic growth, innovation, quality education, smart city development, environmental sustainability, governance reforms, and cultural preservation as part of the 2047 vision.

● Targeted Interventions: It will identify gaps in public health infrastructure and emergency response capabilities, enabling targeted improvements.

● Standardisation and Comparability: It will establish standardised criteria and indicators to ensure uniformity and comparability across different regions, enhancing overall preparedness.

● Improved Coordination: It will enhance coordination among healthcare agencies and government bodies, strengthening public health infrastructure and emergency response systems.

Approach to NPHNSI

The NPHNSI will involve meticulous data collection, index calculation, real-time monitoring, and capacity building. National surveys and data from organisations like WHO and UNICEF will ensure accuracy. A real-time monitoring dashboard will track progress and inform policy recommendations. Training programs for healthcare workers and strengthening infrastructure will build capacity and resilience.

The NPHNSI represents a strategic approach to enhancing public health security in India. By integrating quantitative and qualitative analyses with global insights, and focusing on capacity building and real-time monitoring, the NPHNSI will play a crucial role in achieving a healthier, more secure future for India.

Quantitative Analysis

The NPHNSI will measure critical health indicators, including child malnutrition (stunting, wasting, and underweight), infant and young child feeding practices (exclusive breastfeeding and introduction of solid foods), maternal nutrition (anaemia and low birthweight), micronutrient supplementation (vitamin A and iodized salt), and WASH (improved drinking water and sanitation). These metrics will provide a robust foundation for assessing and improving public health security.

Qualitative Analysis

Qualitative analysis will involve stakeholder consultations, case studies, and policy analysis. Engaging public health experts, government officials, and community leaders will validate the selected indicators. In-depth case studies will highlight contextual factors affecting health security, while policy reviews will assess the effectiveness of existing health programs.

Possible indicators for NPHNSI to Begin with 

Definition of indicators for NPHNSI is a continuous process as different levels of progress achieved in different states. To begin the process, the Table 2 outlines key indicators for the National Public Health & Nutrition Security Index, focusing on healthcare infrastructure, preparedness, and public health responsiveness at initial stages. These indicators provide a framework for measuring critical aspects of health security at present. These indicators are not exhaustive and will be continuously updated throughout the index's development to address emerging needs and evolving circumstances.

Table 2: Suggested Indicators for NPHNSI first Phase

Implementation Challenges and Needed Reforms 

Implementing a National Public Health & Nutrition Security Index in India requires a comprehensive approach that addresses various structural, policy, and operational aspects. By implementing following reforms, India can establish a robust National Public Health & Nutrition Security Index that accurately reflects the health and nutrition status of its population and guides effective policy interventions:

1. Policy and Legislative Reforms

• National Policy Framework: Presently health policy does not include does conjoined with national agriculture, nutrition and education policy. There is a need to develop a cohesive national policy that outlines the goals, objectives, and mechanisms for public health and nutrition security.

• Legislative Support: As per the constitution of India public health service delivery is the responsibility of State Government but on the other hand family planning, medical education and food safety and nutrition are the prerogative of centre government.  Therefore, there is need to enact legislation to support the establishment and operation of the index, ensuring it has a robust legal foundation.

2. Institutional Reforms

• Central Coordinating Body: A central coordinating body (preferably third party) is needed to oversee the implementation, monitoring, and evaluation of the index.

• Inter-Ministerial Coordination: Strengthen coordination between ministries such as Health, Women and Child Development, Agriculture, and Education for integrated efforts.

3. Data Collection and Management

• Unified Data System: Developing a unified data collection system that integrates health and nutrition data from various sources.

• Standardized Metrics: Defining and standardizing the metrics and indicators used to measure health and nutrition security.

4. Capacity Building

• Training Programs: Implementing training programs for healthcare workers, nutritionists, and data analysts to effectively collect and interpret data.

• Public Awareness: Conducting awareness campaigns to educate the public about the importance of health and nutrition security.

5. Technological Integration

• Digital Platforms: Developing and deploying digital platforms for real-time data collection, monitoring, and analysis.

• Geospatial Mapping: Utilizing geospatial technologies to map and monitor health and nutrition status across different regions.

6. Funding and Resource Allocation

• Budget Allocation: Ensuring adequate funding for the establishment and maintenance of the index.

• Public-Private Partnerships: Encouraging partnerships with private entities, NGOs, and international organisations for resource mobilisation.

7. Monitoring and Evaluation

• Regular Assessments: Conducting regular assessments and audits of the data and methodologies used.

• Feedback Mechanisms: Implementing feedback mechanisms to incorporate inputs from stakeholders and improve the index over time.

8. Equity and Inclusion

• Targeted Interventions: Designing targeted interventions for vulnerable and marginalised communities to ensure equitable health and nutrition security.

• Inclusive Policies: Ensuring that policies and programs are inclusive and address the needs of all demographics, including women, children, and the elderly.

9. Community Engagement & Awards

• Grassroots Involvement: Engaging local communities and grassroots organizations in data collection, validation and awareness campaigns.

• Empowerment Programs: Empowering communities through education and capacity-building initiatives.

• Rewards and Documentation of Best Practices: Reward best performer to motivate and document the lessons learnt in the form of best practices. These documents needs to be shared and tested for up-scaling.  

10. Research and Innovation

• Research Initiatives: Promoting research in public health and nutrition sector to develop innovative solutions based on data collected.

• Innovation Hubs: Establishing innovation hubs to foster the development of new technologies and methodologies.

Conclusion

In envisioning Viksit Bharat by 2047, the integration of a National Public Health & Nutrition Security Index (NPHNSI) represents a transformative step towards realising a developed and equitable India. By systematically assessing and enhancing healthcare infrastructure, workforce capacity, and emergency preparedness, the NPHNSI not only addresses current health security gaps but also aligns seamlessly with the broader developmental aspirations of the nation. To future-proof India’s healthcare, we must embrace innovative solutions alongside traditional approaches. Leveraging artificial intelligence for predictive analytics, fostering public-private partnerships for rapid infrastructure scaling, and implementing blockchain technology for transparent health data management can revolutionise how we address both preventive and curative care. Moreover, integrating telemedicine and digital health tools can bridge the urban-rural divide, ensuring equitable access to quality healthcare services. Ultimately, a robust and forward-thinking NPHNSI, combined with strategic innovations and unwavering commitment to health equity, will pave the way for a healthier, more resilient India. This alignment of health security with national development goals is not just a vision but a practical pathway to achieving Viksit Bharat by 2047.

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