Category: Health

Mental Health at Workplaces: Transforming the Narrative

A caring and empathetic organisational culture that respects and values the dignity of employees is critical to foster a sense of belonging and well-being.

The recent comment of Larsen & Toubro Chairman, SN Subrahmanyan promoting 90-hour work weeks and working Sundays, has stoked the ire of many, while drawing attention to the vexed issue of mental health in workplaces.

In a post-covid world, as mental health increasingly becomes a part of our daily parlance, public discourse is now turning its gaze to the role of workplaces in shaping our mental health and well-being. 

In 2022, a survey by Deloitte revealed that of its 3,995 white collar respondents, approximately 80% reported experiencing one or more symptoms of mental health problems, while around 47% considered workplace-stress as the biggest factor impacting their mental health. 

The survey results are indicative of the stressors that employees often grapple with in workplaces, such as long working hours, oppressive organisational cultures, unsupportive leadership, denial of accommodations for employees with specific needs, and often, an unreasonable fixation on productivity and performance targets. 

Inadequate regulatory safeguards to ensure the well-being of informal workers

However, the crisis takes on a graver dimension in a country like India, where over 90% of the workforce belongs to the informal sector which lacks adequate regulatory safeguards to ensure the well-being of informal workers. 

In 2022, the National Crime Records Bureau reported that the highest number of suicide deaths (26.4%) were amongst daily wage earners as compared to all other professions – many of whom are likely to be migrants from oppressed caste communities who travelled to urban cities in search of livelihoods away from their families and support systems. 

Some of them probably put in 90-hour work weeks (or more) and without the guarantee of adequate social security and welfare benefits from their employers. Such disabling work environments are not only a cause for distress, physical health problems or mental health conditions, but reproduce existing caste-based inequalities.

Despite being a multidimensional problem, the discourse on workplace mental health oscillates between two narratives. At worst, employers don’t recognise mental health as a legitimate concern or deny institutional responsibility by shifting the onus to individuals (or their ‘lack’ of resilience to manage pressure). 

At best, there’s an overemphasis on individual focused, band-aid type solutions such as mental health apps, self-care tools, yoga workshops, stress management or therapy/counselling – an approach which misses the woods for the trees as such interventions might help in the short term, but don’t address the underlying systemic problems for workplace stress. 

Also Read: Algorithms of Exclusion: Why Start-Ups Are Not Solving Our Mental Health Crisis

Emerging scientific evidence has expanded our understanding of mental health, moving beyond solely biomedical approaches which focus on expert-driven individualistic treatments, to recognising the role of interpersonal, institutional and socio-economic factors that shape an individual’s mental health. 

What this means is that mental health is complex and there are multiple systemic factors in an individual’s life which can create a ripple effect both within and beyond their workplaces. For instance, an underpaid factory worker’s distress due to unsafe working conditions or an abusive employer may not only lead to mental health conditions but could also affect their household’s financial stability leading to further distress. 

Conversely, a woman experiencing domestic violence in her marital home may find it difficult to complete her work deliverables due to the distress and consequently may receive negative feedback or pressure to deliver from her boss who refuses to acknowledge her situation. 

Need for a holistic strategy

In this context, a shift is required to address organisational and systemic factors both within the formal and informal sector. Workplaces should be understood as complex systems comprising multiple parts such as leadership, organisational culture, institutional policies, interpersonal relationships, welfare benefits, labour regulations and inclusion – all of which individually and cumulatively impact employee mental health and well-being.  This requires a holistic strategy that addresses all these moving parts simultaneously. 

This is reflected in India’s National Suicide Prevention Strategy (2022) which mandates the integration of mental wellness programs and facilities in all workplaces, protecting the welfare of informal workers and improving access to employment opportunities by vulnerable populations. To achieve this, the Ministry of Labour & Employment has been tasked with the responsibility to formulate and implement guidelines for promoting wellness at the workplace and ensuring that minimum wage is uniformly and strictly adopted across all states.

One of the first steps organisations should take is to understand employee narratives on how existing policies and work cultures impact their mental health and well-being. This could lead to changes such as more flexible work arrangements and balancing requirements of productivity by creating conditions and incentives which motivate employees to realise their potential, rather than overwhelm them with unreasonable expectations. 

A caring and empathetic organisational culture that respects and values the dignity of employees is critical to foster a sense of belonging and well-being. Leadership across the organisation including managers need to be trained to not only promote mental health conversations but also practice care in professional interactions and regular communication with employees, especially while having difficult conversations, providing feedback or setting expectations. 

There is a body of scientific evidence on training first responders such as peer groups to identify and provide informal mental health support to employees showing early signs of distress such as fatigue, absenteeism (absence from office), presenteeism (present at work but not contributing), not engaging with peers, to name a few. 

Ensuring inclusion of employees belonging to diverse and marginalised groups

Also known as peer support, this evidence-based approach draws on the lived experience of persons with similar lived experiences to provide employees with a safe space to open up about their experiences and receive emotional support without the fear of any consequences. Some of these approaches can help organisations mitigate the risk of long-term mental health problems among employees while also nurturing a sense of community and belonging. 

An under emphasised factor which is critical for shaping mental health are institutional mechanisms to ensure inclusion of employees belonging to diverse and marginalised groups. Diversity and inclusion (popularly known as DEI) initiatives tend to be tokenistic without addressing the structural problems which lead to discrimination, cultural biases and exclusion, thus disproportionately impacting employees from vulnerable groups.

For instance, we know that workplaces today are overwhelmingly overrepresented (in key leadership positions across the organisation) by savarna and dominant castes which shapes how organisational policies impact employees from Dalit, Bahujan & Adivasi communities. 

Also Read: Silent Sufferers: The Critical Role of Parenting, Community and Awareness for Mental Health Wellbeing

To address this, equity audits can identify and analyse demographics to provide insights on employee and leadership demographics at all levels of the organisations, specifically senior leadership and managerial positions to ensure equitable representation of employees from other communities and probe any overt or covert discrimination in the workplace.

This can be done both internally and through an external consultant; preferably external, as internal audits can sometimes be mired with preconceived ideas and biases that might influence the findings. 

There are other systemic problems with how organisations don’t accommodate for the specific needs or challenges of employees who identify with gender and sexual minorities, disabilities or other vulnerabilities. For instance, some employees may require reasonable accommodations such as flexible working arrangements, disability-assisting infrastructure and tools, crèches for working mothers, or other forms of support to overcome challenges in the workplace.

Most importantly, organisations have to institute impartial institutional mechanisms for fair and timely redressal of grievances related to discrimination, harassment, abuse, etc. perpetrated by any employee in the organisation. 

Lastly, employers, including large organisations from the formal sector which closely engage with informal workers directly or through vendors, have to prescribe practices to ensure all workers are treated fairly. This may also include providing basic health benefits, social security and safe working conditions as per India’s labour regulations. 

Perhaps, one may begin this in our personal contexts by ensuring basic leave, allowances and healthcare support for informal employees such as domestic workers providing their services in our homes.

This article was authored based on insights from a panel discussion titled “Policies of Care: Mental Health and the Workplace” organised by Asia Society India in collaboration with the Centre for Mental Health Law & Policy, Indian Law Society which can be found here.

Arjun Kapoor is Senior Research Fellow, Centre for Mental Health Law & Policy, Indian Law Society. 

Soumitra Pathare is Director, Centre for Mental Health Law & Policy, Indian law Society.

Tuberculosis Patients in Rural India Are Also Fighting ​​Mental Illnesses

Stigma and lack of awareness keep many from disclosing their problems to local medical practitioners or ASHA workers.

Patiala: On January 25, Ram Chand sat on a chair outside his house in the narrow lane of Patial’s Gian Colony, basking in the winter sun. The 65-year-old, wearing a red beanie and his face covered with a mask, had spent months in a small room by himself after being diagnosed with tuberculosis.

Though it has been almost a month since he has tested negative for the disease, the nebuliser still lies in a dark corner of his room and medicines are loosely arranged on a small shelf. 

The government claims that treatment for tuberculosis is free in the country. But Chand, who used to work as a daily labourer earning a meagre says he has to spend almost Rs 20,000 to purchase additional medicines from private shops.

Fixed-dose combination or FDC medicines – a single dosage form that contains two or more active ingredients – are available for free at government hospitals. Ram Chand received free TB medication from a government hospital for nine months.

But Ram did not avail himself of the Jan Aushadhi scheme. He also wanted to avoid the long queues and limited facilities at government hospitals, and thus made multiple visits to private psychiatrists for therapy. Each session cost him Rs 1,500, along with an additional Rs 1,000 for medicines.

Ram was first diagnosed with TB three years ago. He took medication as advised by doctors for months and the disease went away. But a year ago he was re-diagnosed and underwent treatment at a TB hospital in Patiala for 10 days. 

When he returned home , his family gave him a separate room, even though there were only three rooms for his family of 14. Ram has three sons and three daughters in law, and six children.

Ram sits on a chair, basking in the sunlight after recovering from TB, as recommended by his doctor. Photo: Suhail Bhat/The Wire.

He was given separate plates and glasses for his meals. While these were precautions he could understand, he only felt more lonely as a result.

For nine months, he took medicines given to him by the hospital.

For those months, he was unable to work, making him feel like a burden on his family. His financial condition worsened significantly during this time, pushing him into depression. 

The worst came when his wife, who was ill, passed away three months ago. “I couldn’t be with her during her final days…We would talk to each other through this small window,” Chand said.

“I feel guilty that I couldn’t sit beside my wife, hold her hand and tell her that I am there. I felt so helpless. I would cry in loneliness,” he said. “It only deepened my depression.”

Pulmonary tuberculosis (PTB) is a bacterial infection that primarily affects the lungs. Patients should be treated in hospitals for six months to prevent the spread of the disease to others. “Many patients stop taking their medication once symptoms disappear, usually after 4-5 weeks, but the full course of at least six months is essential for recovery,” says Dr Parmod Singla from Singla Chest TB and Asthma Clinic in Bathinda, Punjab.

“In my 25 years of experience, I have observed that men are often the first to be affected as they are more exposed to external environments,” he explains. “Most of my patients come from below the poverty line, and they are the most vulnerable to this disease.”

Ram Chand sits on a single Charpai

Ram Chand sits on a charpai in his small room, where he has spent nine months alone during his TB treatment. Photo: Suhail Bhat/The Wire.

Support

TB affects over 10 million people worldwide annually and claims 1.5 million lives each year. Studies estimate that between 40% and 70% of TB patients experience clinical anxiety or depression during treatment; many patients lose their jobs, struggle to support their families, and withdraw from their communities out of fear of rejection. 

The lack of psychological support in TB care often leads to poor treatment adherence, worsening health outcomes.

Studies also reveal that 60% of patients do not reveal their diagnosis to friends and neighbours. Also, stigma is more common among middle class and female patients. This feeling of discrimination hampers personal, sexual, social and professional aspects of a patient’s life.

Dr. Sakshi Gupta, a psychiatrist with 12 years of experience and the founder of The Healing Clinic in Patiala, has received several TB patients referred by family members or physicians. “However, there is a lack of awareness among patients, leading to severe consequences like increased risks of substance abuse, and in some cases, suicidal thoughts.”

She says that TB is often viewed as a purely physical ailment, but its psychological toll can be devastating. “Stigma, social isolation, and discrimination make the recovery process even more difficult, especially for women who are frequently blamed as the source of the disease. In extreme cases, they face rejection from their own families and even divorce.”

Aarti shows her X-ray, taken at the Government TB hospital in Patiala. She is scared to get closer to her kids to
prevent spreading the disease. Photo: Suhail Bhat/The Wire.

Women

In many cases, patients with TB have no choice but to continue working due to their financial situations. 

Aarti, 26, from Patiala was diagnosed with TB in November last year. It started with a dry cough. The mother of three children thought it was a viral infection. 

For two weeks she took a cough syrup and other medicines but there was no improvement. With help from a local ASHA worker, she visited a hospital where she was diagnosed with TB.  

She was told that all her treatment costs would be covered by the government and that she has to isolate herself from the rest of the family. “Who would feed my children?” she asked herself. 

Aarti has been living with her in-laws since she got married at 16. Her husband passed away in 2021. She does agricultural labour work in the fields to support her in-laws and children, earning around Rs 250 per day. Despite her illness, she had to work to ensure her family had something eat. 

Also read: India Is Going to Miss the TB Elimination Deadline Set by the Modi Government

“I wish I could rest, but there’s no one to help,”she said. She has been on medication for three months and is often too weak to work.

There are other worries too. “I used to breastfeed my younger child, but now I worry about spreading the virus to him,” Aarti said.

“My children don’t understand. They still want the same care and closeness from me. There’s no one to look after them. I feel like I’m carrying a heavy burden. Every time I cough, I worry I might spread it to my kids,” she added.

Aarti struggled with anxiety and eventually fell into depression but did not know where to turn for help. She felt uncomfortable discussing her mental health with anyone.  

Although ASHA workers play a crucial role in supporting TB patients by providing regular follow-ups, ensuring medication adherence, and offering basic healthcare guidance, Aarti said she would feel “strange talking about her mental health with them.”

As per the latest study in India, the overall prevalence of common mental disorders (CMDs), encompassing depressive and anxiety disorders, was 5.1% in the 2016 National Mental Health Survey, with a treatment gap of 80.4%. The treatment gap refers to the percentage of people – with mental health disorders in this case – who need treatment but do not receive it. In India, this gap is 80.4%, meaning most individuals struggling with mental health issues lack access to proper care due to stigma, limited mental health professionals, and high costs.

Persons with mental health issues face many challenges while reaching out to mental health services. These challenges are compounded among people from marginalised populations or hard-to-reach areas, leading to inconsistent usage of these services.

Dr. Gupta stressed on the importance of training ASHA workers in this regard as they are the first point of contact for patients including those suffering from TB. Door-to-door support would improve things, she added.

There’s a significant gap in mental health services, particularly in rural areas, she said, adding that many patients and their families don’t understand the mental health challenges associated with TB. “This disconnect creates a barrier between them and the government’s healthcare initiatives,” Gupta, who has worked extensively in rural communities, added.

Gupta emphasised that TB patients from marginalised communities require immediate mental health support, yet very few mental health professionals operate in rural areas. “In cities, we at least have the option of therapy and counselling services. But in villages, even acknowledging mental health as a real concern is a challenge,” she added.

The disease affects the young, too.

Seventeen-year-old Archana’s life was drastically changed by both TB and its mental health toll.

“I never thought something like this would happen to me,” said Archana. “I was just a regular student, living my life. Suddenly, everything changed.”

Archana, a class 12 student at Government Girls School in Patiala, had been struggling with a persistent cough for a month. She initially took cough medicines, but when nothing worked, her family decided to take her to the TB hospital for tests. After a day, her uncle went to pick up the reports and found out that she was TB positive.

“I didn’t go to school for a few months, and my studies were impacted. Now I’m trying to catch up on the lessons I missed. I didn’t visit any relatives, and I didn’t tell my school friends about what I was going through,” said Archana.

This report was supported by The National TB and Mental Health Media Fellowship by Survivors Against TB. This is one of three reports on the topic.

After Stampede, Cops Roam New Delhi Railway Station, Trains to Kumbh Popular as Ever

Outside the LNJP hospital are security forces and the Delhi Police who have been barring camerapersons from going inside. Inside, doctors and administrators are quiet.

New Delhi: Despite the gruesomeness of the stampede that took place at the New Delhi Railway Station on February 15, the station is still being frequented by people who wish to board a train to Prayagraj, where the Maha Kumbh Mela is taking place.

Victims of the stampede at the New Delhi Railway Station were rushed into the Lok Nayak Jai Prakash hospital late on February 15. “They brought in two people in the night at around 10-11 pm. One had a crushed nose bleeding profusely and the other was badly bruised,” assisting staff at the hospital told The Wire. The man’s voice is hushed. 

Outside the hospital are security forces and the Delhi Police who have been barring camerapersons from going inside. Inside, doctors and administrators are quiet.

Dr. Satyajeet was the Chief Medical Officer (CMO) at LNJP who accepted that the victims were brought in an injured condition but refused to share any further details about their current status.

LNJP hospital. Photo: Tarushi Aswani.

LNJP Hospital. Photo: Tarushi Aswani.

Mere metres away from the sight of the stampede, LNJP had attracted a lot of media professionals who were waiting for an official statement from the hospital. Outside the hospital, this reporter saw men who claimed that they were waiting to offer assistance to those admitted due to the stampede. Two of them said they were from the Bajrang Dal and added that the Bharatiya Janata Party was facilitating them in getting assistance for those in need. “We are here for them as they were on their way to a great Hindu pilgrimage. Their injuries are unfortunate,” said one of them, Dev Kumar.

Another Bajrang Dal member present there said that this unfortunate stampede was “a conspiracy against those travelling to attend the Maha Kumbh pilgrimage and must be investigated like a crime”. A little later, on the insistence of Dev Kumar, he retracted this line of thinking and requested anonymity.

Outside LNJP, the daughter of an injured pilgrim alleged that the hospital was not taking her father’s injuries into account. Speaking to several reporters present at the scene, the woman said that her father was being refused treatment despite having been injured at NDLS.

The daughter of an injured pilgrim alleges that the LNJP officials did not take her father's injuries into account.

The daughter of an injured pilgrim alleges that the LNJP officials did not take her father’s injuries into account. Photo: Tarushi Aswani/The Wire.

Many who were injured in the stampede were also taken to other hospitals such as Ram Manohar Lohiya Hospital and Lady Hardinge Medical College. 

Kilometres away from NDLS, at the Lady Hardinge Medical College, staff told The Wire that two of the victims were declared dead on arrival. As of 4 pm, February 16, both the dead bodies were in the hospital’s mortuary.

Police presence is mounting at all three hospitals treating the injured. This stampede that killed at least 18 people when the crowd in the station had gone out of control also poses multiple questions at the government at the Centre and now even in Delhi about crowd management, mismanagement and preventing future stampedes.

At the site of the stampede, crowds persisted. A Delhi Police official who was posted at the site told this reporter that at least 400 Delhi Police and Railway Police Force personnel were posted there after the stampede. Several officers were also repeatedly patrolling the platforms and shooing away people sitting on the platform.

Police at the NDLS.

Police at the NDLS. Photo: Tarushi Aswani/The Wire

At NDLS, after the stampede, the Ministry of Railways had set up a first aid desk for the injured and victims. The medical staff at the desk however claimed that the injuries were such that the desk saw no victims asking for help – they were rushed to the hospitals straightaway. Kishan Pal, a medical officer at the desk said that victims from the stampede did not get a chance to arrive at the desk. “Crowds should be managed better. I have served at the Prayagraj Railway Station as well, and know that these mishaps are beyond first aid. But the government is setting up such desks everywhere to aid pilgrims,” he said.

The help desk at the NDLS.

The help desk at the NDLS. Photo: Tarushi Aswani/The Wire

Outside NDLS, a swarm of porters await work. One of them who claims to have witnessed the stampede said, “It doesn’t only have to be travellers who can get crushed in the stampede. It could be relatives who come to drop them off at the station, it could be us. We could have died. There was simply no arrangement do deal with such heavy crowds,” he said.

“The rush is such that people are hopping onto trains that go to Prayagraj like they hop onto local buses. People with just a single backpack are hopping onto Kumbh trains,” another porter told The Wire.

Despite the stampedes, several pilgrims were still seen buying train tickets and heading to platforms with trains to Prayagraj from NDLS. Travellers at the railway station pointed out that it is as if no stampede ever took place.

US Firm Takes Down Private Network Profiling Indian Activists Opposing Pesticides, GMO After Reports

The company confirmed the removal of over 500 profiles on the network after a legal review of European data privacy rules, and threats of litigation, following a media investigation.

Mumbai/London/Athens: A US-based reputation management firm involved in monitoring activities of those critical of pesticides and genetically modified (GM) crops on a private social network has ceased its profiling operations following an investigation led by investigative newsroom Lighthouse Reports, and shared with The Wire and other international media partners.

The Missouri-based firm v-Fluence Interactive, headed by a former Monsanto executive, Jay Byrne, confirmed in an official statement on December 9, 2024, that the company has removed its Bonus Eventus portal that served as a “stakeholder wiki” hosting profiles of over 500 individuals globally. The private network included profiles of prominent Indian environmentalist Vandana Shiva, ecologist Debal Deb, organisations like Pesticide Action Network (PAN) India and other scientists and academics.

Among other findings, the investigation revealed that v-Fluence had received funding from the now-reduced US Agency for International Development (USAID) for Bonus Eventus via the International Food Policy Research Institute. The sub-contracts were aimed at countering criticism of “modern agriculture approaches” in Asia and Africa, according to public records obtained by Lighthouse Reports.

The investigation also highlighted that v-Fluence and Byrne are co-defendants in a lawsuit against global pesticide giant Syngenta, for suppressing information on the dangers of paraquat herbicide, alleged to have caused Parkinson’s disease among farmers in the US. Byrne had denied the allegations of the lawsuit, saying they were based on claims which were “manufactured and false”.

In India too, Syngenta came under scrutiny in 2017 after the Yavatmal pesticide poisoning scandal in Maharashtra that claimed the lives of at least 20 farmers. Farmers had alleged that Syngenta had failed to provide sufficient information regarding the risks of its pesticide ‘Polo’. Syngenta, however, maintained that there’s no evidence proving that its product caused the tragedy.

Narasimha Reddy Donthi, an independent policy analyst and consultant with PAN India, who has also worked closely with farmers in Yavatmal for securing compensation from Syngenta, says that the removal of the profiles is a “positive outcome”.

“However, they have to tell why they did that and for whom. Furthermore, we need to know how US funds got involved in such an enterprise. We need a deterrence – a official promise,” Donthi adds.

Legal concerns, lost clients and threats of litigation 

v-Fluence said in its official statement in December last year that the removal of profiles comes after an “independent legal review” of obligations under the European data privacy rules. They also informed that the firm will “continue to offer stakeholder research with updated guidelines to avoid future misinterpretations of our work product”.

In an emailed statement, Byrne confirmed that the profiles had been removed, but said that they had been taken down prior to the legal review in light of litigation and threats of litigation.

According to reporting from David Zaruk, a Bonus Eventus member who was a recipient of Byrne’s emails, v-Fluence had to lay off around 40 staff after industry clients cancelled their contracts.

The investigation, published in September last year, revealed that v-Fluence’s Bonus Eventus was accessible to over 1,000 members, including many executives associated with global agrochemical companies, lobbyists and government members. 

The eight Indians who had access to the Bonus Eventus portal include Raghavan Sampathkumar, the executive director of the Federation of Seed Industry of India (FSII); and Anand Ranganathan, consulting editor of the Indian right-wing magazine Swarajya, and a former staff research scientist at the International Centre for Genetic Engineering and Biotechnology (ICGEB).

Notably, the FSII is involved in a project with the Ministry of Agriculture and Farmers Welfare for deploying technologies to agro-ecological zones allotted for cotton production. The ICGEB also works with the Union Ministry of Science and Technology, for supporting biotech research and development. However, Ranganathan informed Lighthouse Reports and The Wire that he was unaware of the network and denied association with v-Fluence.

‘What about the harm already done?’

A number of profiles on the Bonus Eventus portal contained personal information such as phone number, email and residential address, details of people’s personal website, and income among other details of the individuals. Indian activists profiled on the network expressed concerns about potential misuse of data by those having access to such data.

In a written statement last year, Byrne had informed that the private, community-edited wiki platform includes only “publicly available and referenced information”, asserting that, “Any contact or other information which may appear on the wiki is from public records and is used publicly by the source as part of their business or advocacy.” 

However, technology lawyer and policy adviser Pranesh Prakash, who had reviewed excerpts from some of the profiles, found that personal data was indeed being processed, and because much of the collected personal data was not made available by the person who was profiled, India’s Digital Personal Data Protection Act (DPDPA) applied to it. 

Prakash informed that the exception for “research purposes” under DPDPA does not apply if the data is being used to make any decision specific to any of the activists whose personal data has been collected.

Ecologist and seed conservator Debal Deb, who was profiled by v-Fluence, says that the company closing down the network is an “important development”, however, he also raised apprehensions about the harm already done.

“The issue is that no one knows what and how much harm these corporate agents have already perpetrated to the lives and careers of the scientists and environmental activists. A public announcement of dismantling a website does not absolve the decades-long crime of appropriation of citizens’ personal data, nor atone for the intangible damages to the individuals,” says Deb.

Compassion in Short Supply: The Unsettling Truth About Indian Healthcare

While qualities like humility, empathy, and rationality may come naturally to some, they must be taught as vital skills in medical education.

Trigger warning: Mentions of discrimination and mistreatment against vulnerable populations including birthing women.

In one of India’s top hospitals, a breathless, half-conscious man in his 50s is wheeled into the emergency room. He wears a neck collar from a tree fall a few days earlier. The senior resident, recognising him, mutters, “This guy is a pain, he’s been here before,” setting a tone of irritation. The junior resident picks up on it. Together, they threaten him – if he doesn’t speak clearly, he’ll be put on a ventilator, as if it’s a punishment. The patient, confused and distressed, cannot even process the threat.

Nearby, a homeless patient in a confused state is pinned down roughly to the hospital trolley by a health worker for not cooperating. 

Elsewhere, in a different private hospital a poor woman with an infected wound is turned away for failing to pay an upfront deposit – despite having traveled a long way and spent much of her savings on transport. She had been one of the construction workers who had helped build this very hospital a few years back.

As a medical doctor, I have spent time in various healthcare setups – in different wards, out-patient departments, emergency rooms and intensive care units. These were in several types of hospitals such as private, NGO, trust, public sector including some premier hospitals. 

Also read: Constitution@75: From Govt to Opposition, Everyone is United in the Assault on Scientific Temper

Regardless of whether those healthcare institutions are premier or where they are located geographically, violence against those seeking care occurs everyday – a function of a clearly skewed power dynamic brought about by the egos of individuals, teams and systems.

When speaking out is not allowed

When patients and their relatives walk into a hospital or clinic, they are rarely pushy from the start. Anxiety about illness is natural – I’ve seen hands folded in resignation, faith placed blindly in the doctor, who, skilled or not, is seen as second only to God.

Relatives, out of concern, may question or request immediate interventions. Their worries are often valid as they are emotionally invested in the patient’s wellbeing. Yet health professionals tone-police them, expecting submissiveness. Many doctors fail to communicate clearly, dismissing it as a waste of time, assuming patients won’t understand. This then blocks shared decision making. Some health professionals even mock the perceived ignorance of patients – among themselves in doctor’s rooms or, at times, even to the patient’s face.

Often this demeaning behaviour is because of the difference in class, caste, gender, religion and appearance. 

To be fair, even influential patients face irritation or disdain, but their privilege shields them from the worst of it. At most, healthcare providers may grumble privately. In contrast, the underprivileged bear the full weight of the system’s frustrations.

What does violence against patients look like in India?

Violence isn’t just physical assault or foul language – it takes many insidious forms that have been normalised in our healthcare system. These are the forms that I have witnessed in my years of work in various places.

This includes forcing patients in severe pain to stand due to a lack of chairs in the OPD, hurriedly addressing complaints in groups of ten or more, asking questions to them turn by turn, handing out token prescriptions, ordering tests and medications that may be unavailable, unaffordable, or irrational, yelling at patients for arriving late or not taking medications regularly despite them having valid reasons for the same and so on.

There are also violations of personal space, such as examining body parts roughly or repeatedly without consent and failing to close curtains when patients must undress for a procedure etc. Many health professionals neglect basic courtesies like explaining procedures that they are about to do to the patient or even thanking patients.

Patient comfort is often disregarded during health interventions – leaving ultrasound or ECG gel that they applied on the patient unwiped after the procedure is over, making patients starve longer than necessary before surgery, providing inadequate pain relief during painful procedures, or using unnecessary tight abrasive knots as restraints for almost all patients who may get fidgety.

Health professionals may also engage in outright unethical practices – writing fake lab values without performing those significant tests, avoiding hooking up monitors to escape beeping sounds, ignoring alarms, using futile artificial life support on dying patients, neglecting to check for bedsores as standard practice etc.

Display of lack of empathy and or counseling skills are for eg. referring a grieving or homesick patient to a psychiatrist instead of offering basic human connection. 

Abuse of birthing women

Mothers often face additional forms of violence.

Labour rooms in India have become the “birthplace of violence against patients,” with outdated and harmful practices normalised as routine care – repeated, unnecessary per vaginal examinations, unwarranted episiotomies (cutting of vaginal wall to prevent natural tearing and facilitate birth), and unnecessary application of fundal pressure (pressing a pregnant woman’s abdomen from the top to help push the baby out) to hasten delivery. This systemic mistreatment is now recognised as obstetric violence.

“Violence during labour rather scares the woman and in fact can cause contractions to stop,” says a person who runs a center for respectful maternity care in rural Jharkhand.

Over-medicalisation of birth – breaking the water bag, inducing labour with drugs to increase turnover – raises the risk of fetal hypoxia and emergency C-sections. Treating normal childbirth as a condition needing aggressive intervention is the norm. The failure to obtain consent for per vaginal exams and other procedures has even led to the term “institutional betrayal.”

Violations extend beyond labour: forced copper T insertions (a contraceptive device), denial of tubal ligation or abortion due to personal beliefs, and failing to refer patients to appropriate care undermine reproductive justice. Some women, despite easy access to both public and private hospitals, choose to deliver at facilities where they feel respected and cared for.

Why does violence happen?

The stark difference in how patients are treated is deeply tied to class and social status, further complicated by gender, religion, tribal identity, disability, and sexuality. Across all these situations, patients are forced into deference to the healthcare professional, unable to advocate for themselves.The scenario reflects a deeply ingrained hierarchy in the health system, where those ‘lowered’ in the ladder are often denied respect and dignity.

One justification for differential treatment in public healthcare is the belief that poorer patients are freeloaders undeserving of care – an argument rooted in ignorance of taxation. In reality, India’s tax structure ensures that the poor contribute significantly more than the wealthy to public sector funding. Seeking care in government hospitals is not receiving charity; it is accessing services they have already paid into.

Another justification is overburdened healthcare workers – immense workload, limited staff and burnout. Poor management is one of the key factors, and administrators must strengthen infrastructure, optimise patient load management, and address staffing shortages.

Thirdly, the medical education system itself is designed in a way to perpetrate violence. The current focus of medical education in MCQ solving to get from NEET UG to PG to SS, poises them to be increasingly violent towards patients in a two pronged way – one, being inadequate in clinical skills and hence unable to address patient concerns in a skillful manner and two being inadequate in communication and soft skills and hence treating patients with disrespect.

Medical curriculum design also leaves no space for students to learn about the ground realities of oppressive societal structures like caste, class and gender. This lack of sensitisation forms a crucial reason why they tend to not challenge their biases and perpetrate the same.

Further, the hierarchical nature of medical education and workplaces ensure that junior health professionals are working in intolerable conditions – with no time to eat, sleep or study. Without adequate time to care for themselves, many are headed towards burnout. A lot of them even lack basic labour protections such as a guaranteed stipend, paid maternity leave, protected medical leaves etc. There is an important need to dismantle this aspect of the system because the brunt of this is unjustly thrust on the patients who are seeking healthcare. 

Furthermore, the government’s failure to ensure affordable, quality care, proper nutrition, clean water, and fair wages can be seen as systemic acts of violence against patients, undermining their well-being. The current design towards privatization in healthcare is also going to work towards distancing doctors from the realities of poor and marginalised patients, and likely increase chances of violence.

The system is broken on various levels, but this does not justify the violence meted out to the vulnerable patients seeking healthcare in any way. While it is important to understand the nuances of the problem, our narrative must always remain focussed on accountability and reform.

The focus on violence against doctors and health professionals

Despite violence against patients being extremely common, what mostly gets news coverage is the violence against healthcare professionals by patients. There is no doubt that a hospital or clinic environment is an intense and dynamic space, where tensions may run high.

However, health worker’s safety is inseparably linked to patient safety. Negative patient experience and lack of patient safety are strongly related to workplace violence. Of the few studies done on patient’s opinion about care and violence, one in Turkey, reveals that level of satisfaction of care and knowledge of one’s condition are inversely proportional to workplace violence. 

Centres that are doing it right

While there’s much work to be done, there is hope. Some organisations are offering workshops to sensitise medical students to all aspects of wellbeing beyond what is taught in tertiary care and urban centric medical schools.

Students attending Rural Health Sensitisation workshops in Rajasthan or the Tribal Health Initiative in Tamil Nadu and State Medical Officers who underwent family medicine training in a rural health care organisation in Chhattisgarh are often struck by the compassionate communication of the staff. These busy centers, despite handling complex cases, prioritize respect and empathy—something many students find lacking in their own training.

Ravi, a surgeon and administrator at the Tribal Health Initiative, a centre that has young medical residents flocking from across the country for this learning, emphasises that institution and mentorship significantly impact a doctor’s approach. “If a team leader, often a doctor, behaves with compassion, it’s hard for support staff not to follow suit.”

Towards solutions

If healing is the purpose of being a doctor, then studies show that soft skills like kindness, warmth, and active listening play a crucial role in better outcomes and lower readmission rates. In some countries, compassionate care is even a mandatory requirement for healthcare providers. However, in India, compassion is often expected from nurses and lower-paid female caregivers but not from doctors.

Ken Schwartz, an American attorney, founded the Schwartz Center for Compassionate Healthcare in 1995 during his battle with lung cancer. He emphasised that medicine is more than tests and treatments – it was empathy from health workers that restored his hope and dignity through illness. His center now trains healthcare professionals in several countries such as the US, UK, Canada, Australia etc. It hosts Schwartz Rounds, forums that explore the emotional and social aspects of patient care for medical students and junior healthcare professionals

While qualities like humility, empathy, and rationality may come naturally to some, they must be taught as vital skills in medical education. These should receive equal focus as pharmacology, mnemonics, and other technical aspects. Institutions could introduce Schwartz Rounds or mentor intense rural sensitisation workshops like those done at Sittilingi, Bokaro, Udaipur and Gudalur for all health professionals, health bureaucrats and seniors included. As done in these workshops, there must also be intense education about the history and ground realities of oppressive social structures. 

Also read: Less Than a Third of People Suffering from Diabetes Get Treatment in India, World’s Diabetes Capital

There has been progress with the inclusion of the AETCOM (Attitude, Ethics, and Communication) module in undergraduate curricula since 2019, though its impact can be diluted by negative role modeling by medical teachers. These skills must be embodied by senior professionals in their day-to-day patient care practice.

Moreover, not all patients have the same access to resources like unions, redressal systems, or the judiciary, and addressing these gaps is crucial. 

Ensuring reasonable working hours, patient load management, adequate staffing, and worker protections for health service providers will help maintain their mental capacity to care for patients. A system that fosters violence toward its own workers cannot provide compassionate care to patients.

In conclusion, both patients and health workers are human, experiencing pain in similar ways. When we choose to drop the one way vision glasses to see the lower part of the iceberg, the magnitude and varieties of pain inflicted onto vulnerable patients is huge. There is a need to visibilise these invisible realities via dialogue and research which will help in addressing the same. 

The gap can only be bridged if we start looking at all people as one and incorporate respect and kindness as a routine. Dr M.R. Rajagopal, founder of Pallium India, says the grateful eyes and tearful thank-yous from patients are the most invaluable rewards of compassionate care.

Author’s disclaimer: Most of my kin are likely to disagree with what I have to say. They may even not consider me in the league. I write to learn and for those who care to pause.

Acknowledgements: The author would like to acknowledge the support of Parth Sharma, Public Health Physician and founder of Nivarana, Rema Nagarajan, Journalist TOI and M.R. Rajagopal, Palliative care physician and founder of Pallium India.

This article first appeared on Nivarana, a platform that focuses on India’s health issues. Read the original piece here.

The Cost of Mismanaging the Kumbh: In Bihar, Stampede Survivors Say They Cannot Sleep

‘There was complete chaos. No policeman for security. No one to show the way.’

Maner (Patna): Ever since the Maha Kumbh started at Prayagraj in Uttar Pradesh on January 13, Rinku Devi would see on her phone and read in the newspapers that the administrative arrangements for the punya snan (holy dip) of devotees at the Triveni Sangam, where Ganga, Yamuna and the mythical Saraswati meet, were very good.

This gave her and other women of her village courage.

The 35-year-old lives at the Jeevrakhan Tola village of Maner situated on the bank of the river Sone in rural Patna of Bihar.

She set out for Prayagraj on January 27 at around 11 am. More than a dozen women including her mother-in-law, Siya Devi, accompanied her. All were aged between 35 and 65 years. Most belonged to the Yadav caste. 

They took a train from Danapur junction about 20 kilometres away from their village. The train took them to Prayagraj railway station where they got a bus which dropped them near a bridge. From there they walked several kilometres. 

When they finally reached a place the ghat on the intervening night of January 28 and 29, Rinku Devi understood that talk of good arrangements were untrue. “There was nothing like that there. There was complete chaos. No policeman for security. No one to show the way,” Rinku Devi said.

Rinku Devi. Photo: Umesh Kumar Ray

The women held hands and started moving towards the ghat. “We wanted to take a dip as early as possible. At around 11 pm on January 28, an announcement was made on the mic that common devotees should take a dip between 12 pm and 2 pm, because after that, those from the Akhara will take a dip and at that time, common pilgrims will not be allowed to go to the ghat,” she told The Wire.

They reached a spot closer to the ghat at around 1 am on January 29, when a huge crowd of people started coming towards them. These were people who had already taken a dip. Behind them was a huge crowd who were going to take a dip. “Both crowds collided. It turned into a stampede,” she says.

Rinku Devi and her mother-in-law Siya Devi were pushed by both crowds and fell on the ground. Many people fell on them. Others just ran. Some fell on them. “There must have been 8-9 people on us,” Rinku said. She felt that she would die and she screamed for help. “The locals pulled me out. People were trampling the dead bodies and running away,” she said.

Rinku had lost Siya Devi and the others. Convinced that her mother-in-law was among the pile of bodies, Rinku pleaded with local youth to help look for her.

One Abhishek Singh ultimately recovered Siya Devi’s body and took it to the ambulance, which took her to the makeshift Kendriya Chikitsalaya at Sector 2 in Prayagraj. 

Siya Devi is among 11 persons from Bihar who have been reported dead in the stampede at the Kumbh mela. Photo: Umesh Kumar Ray

Rinku Devi claimed that the police were initially not allowing her to sit in the ambulance and kept asking her to collect the body from the police station. “But we forcibly boarded the ambulance with the body,” she said. Siya Devi was declared dead in hospital. Her body reached her village in an ambulance on January 30.

Siya Devi is among 11 persons from Bihar who have so far been reported dead in the Maha Kumbh Mela stampede. The Adityanath government has owned up to only 30 deaths, reports have suggested the count could be as many as 70, and Rinku swears that she saw hundreds dead. 

“My own mother-in-law’s body was pulled out from under a pile of eight bodies,” she said.

Siya and Rinku Devi’s house. Photo: Umesh Kumar Ray.

The Wire spoke to at least half a dozen of devotees who witnessed the stampede that day. Many blamed the fact that there were no separate barricades for the exit of devotees who had already taken a dip and the entry of devotees who wanted to go into the water.

Abhishek Singh, who pulled Siya out of the pile of dead bodies, told The Wire over phone, “Barricades ended 59 metres before the ghats. So everything was open. When it was announced that the Mauni Amavasya is starting now, the huge crowd thronged to the ghat and on the other side there were crowds of devotees who had already taken a dip and wanted to return.” 

The women who witnessed and suffered the heart-rending stampede still shudder at the memory of that day. Many who were caught in the stampede are undergoing treatment as they have suffered severe internal injuries.

Almost all the women The Wire talked to said that they did not get any help from administration, even though their clothes had been torn and their money, lost.

Seventy-two-year-old Janaki Devi, of the same village in Bihar, believes that a miracle saved her at the stampede. She, too, is undergoing treatment – four injections a day. She has been advised to get a chest x-ray done. For three or four days after returning, Janaki could not utter a single word out of shock.

Janaki Devi. Photo: Umesh Kumar Ray

“I had thought that I was getting old and may die anytime so I should take a holy dip. I had also heard that after 140 years such an auspicious occasion has coincided with the Kumbh. I had no idea that all this would happen,” she said, while sitting on a cot in front of her house in the afternoon. “Now I have decided not to go to Kumbh again. I will die of of the pain I sustained that day,” she added.

Janaki and her woman relatives have been on at least half a dozen pilgrimages, including Kumbh Mela 12 years ago. “That time there was no such chaos. We took the holy dip smoothly,” she said.

Janaki said that on the day of the Mauni Amavasya, an announcement was made to proceed slowly – which they followed. “But, people returning from the other side after taking the dip collided with us. People started running and crushing each other,” she said.

Janaki Devi fell in the stampede and became unconscious. She doesn’t know what happened after that. When she regained consciousness after two hours, she found a blanket on her body. A young man and six or seven women were surrounding her. “I lost my saree in the stampede. So they had wrapped me in a blanket,” she said. 

The man who rescued her turned out to be from the Kaimur district of Bihar. He had gone to the Kumbh with his family. He sheltered Janaki at his house for two days and then called her family members after Janaki was able to provide their numbers to him.

“I think he must have been my son in my previous life. If I am alive today, it is due to him. I pray to God that he never faces a single crisis,” Janaki said, adding that she did not get any help from the Kumbh administration.

Seventy-year-old Bhagwaniya Devi, a resident of a neighbouring village, had a harrowing experience. In the stampede some people snatched her bag from her and punched her on the chest.

Bhagwaniya Devi. Photo: Umesh Kumar Ray

“Once the stampede started, I was helpless and pleaded with people to save me. Two people came and punched me twice on the chest, snatched my bag and ran away. The bag contained clothes, money and utensils. I fainted due to the punch,” she said.

When she regained consciousness, she was in a safe place and some women, who had come to take a dip in the Kumbh, were taking care of her. “The woman who was taking care of me told me that one of the police personnel who reached the spot thought I was dead and told the other police personnel to put me away in a vehicle. The woman shouted at the police and said that I had stirred,” she said. 

After regaining consciousness, Bhagwaniya did not know where to go. No administration official was there to help her. “Government didn’t help in any way. I began walking alone. I was crying. Some people helped me and took me to my village,” she said. She shows a red shawl which a woman gave her as she had lost her clothes in the crush.

Bhagwaniya’s chest still hurts and she is undergoing treatment. “I will never go to Kumbh again,” she said.

Forty-year-old Savita Devi, a woman of the same village who was also part of the group of women is similarly in shock and cannot sleep at night. 

Savita Devi, one of the survivors of Kumbh stampede. Photo: Umesh Kumar Ray

“I had felt that I will not survive. I did due to god’s grace,” she told The Wire. 

She remembered that she was walking behind a man and when the mayhem happened, she caught hold of that man’s bag and followed him for at least two or three kilometres. “I reached the bridge and took the bus to the railway station,” she said.  

“I have never seen such horrific sights in my life. When I recall that incident, I shake,” she said.

“I can’t sleep at night. Whenever I sleep, the sound of people crying, asking for help echoes in my ear and I wake up.”

Rajinder Rai who lost his wife Siya Devi in Kumbh stampede. Photo: Umesh Kumar Ray.

The death of 61-year-old Siya Devi – mentioned at the beginning of this report – has shaken her husband, 65-year-old Rajinder Rai, to the core. He said that if administration had been in action, such an incident would not have happened.

“It is being said that crores of rupees have been spent on Kumbh. We ask where all this money was spent that a stampede broke out so easily and people died?” he asked.

According to the Uttar Pradesh government, a total of Rs 7,500 crores was spent on the Maha Kumbh Mela.

“I am most troubled by her departure because I was dependent on her. I have four sons, all are married and living separately. She would cook for me and also take care of the cattle in the house. I don’t know how I will survive,” he said.

He expressed anger at the statement of controversial religious preacher Dhirendra Shashri who said that those who died at the Kumbh will attain moksha – deliverance.

“A crowd will crush a person and she will get moksha? My wife was killed,” Rajinder said.

Janaki and Rinku both said that the preacher had reduced the death of people to a joke.

“They had gone to have a holy dip and not to die this way. How can anyone say this?” Rinku asked.

An Era of Darkness: How No Data Helps BJP’s Politics

The absence of data is not about academics and researchers losing out. It is actively helping the ruling party carry on with its politics without any roadblocks and preventing basic questions being asked of it.

The government took almost a day to come up with estimates of the dead in the Kumbh stampedes. It did its best to not give out details, until being forced to say “30 died”. Subsequent reports put the numbers of the dead at 79, at least. Official figures are gung-ho on bathers attending the grand event, they are said to be in crores and hyped daily, as markers of the success of the government of Uttar Pradesh and the Centre. But there are no details on the number of people crushed. What is worse is that the government’s reluctance to part with numbers of the dead, does not surprise anyone.

Experts have spoken of a pervasive culture of less knowledge and information having become the norm in this past decade. The now-disbanded Planning Commission, for example, was the repository of reliable data sets and evidence. Contrast this with the pattern currently of only “good stories” with “inconvenient data…actively delegitimised”.

In a post-truth world, as opposed to facts, the effectiveness of your politics is weighed by ‘vibes’.

This is not because facts don’t matter but because they have great power to influence the shape of politics and claims. Suppressing data, ensuring that they are not publicised when they emerge, are important to cloud the air with baseless assertions.

In at least four arenas, the absence of data is helping run a particular kind of politics.

Population ‘explosion’ bogey will explode if facts are available

The first proposition of India being the most populous nation is itself not established by an Indian agency, as the postponed Census 2021 is yet to be conducted and there is no word about when it will be held.

So 140 crore or 1.4 billion is yet to be stated as an established fact by India. The PM raised a bogey of “population explosion”, from the Red Fort in 2019, followed by the Union finance minister in the budget speech last year, when Nirmala Sitharaman said, “a high-powered committee for an extensive consideration of the challenges arising from fast population growth and demographic changes” would be set up. But the Total Fertility Rate or TFR is set to go below 2.1. The TFR of 2.1 is the basic rate required to stabilise current population levels. As the last two National Family and Health Surveys (NFHS) have indicated, India is rushing into worryingly low territory as far as population goes and far from an “explosion” it needs to prepare for a large ageing cohort.

More so, the fall in the TFR is levelling off across communities and this trend has been at play since 2001. The steepest fall in fertility is indicated across Muslim communities in India and the figures out so far have made clear that fertility has very little to do with religion. But if facts like these emerge and authoritatively so through a Census, then where would hateful propaganda like asking Hindu families to “have three children” and sustaining falsehoods about rapidly increasing Muslim numbers go? Feeding a fear of the Muslim demographic being out of control is an essential part of Hindutva politics.

Tall claims on ration but feeding fewer numbers?

The BJP-led government has made much of its ration scheme. It has projected its responsibilities to provide food following an Act passed by parliament in 2013 falsely, as the personal munificence of PM Modi. But the basis of the total numbers being fed is the 14-year-old, 2011 Census. The Additional Solicitor General Aishwarya Bhati, told the Supreme Court in December 2024, that the NFSA had 81.35 crore eligible beneficiaries.

But this could be a serious under-estimation. Lawyers arguing for the Right to Food campaign say that there could be as many as 10 crore eligible (i.e. hungry) Indians being left out. Activists cited COVID-19 as a tipping point that may have left many unable to meet their daily needs as losing out. The government list not having been updated due to no Census has real world consequences. The Global Hunger Index 2024 testifies to the Indian situation as worrisome and worse-off from before.

In the 2024 Global Hunger Index, India ranked 105th out of the 127 countries with sufficient data to calculate 2024 GHI scores. It has a score of 27.3 in the 2024 Global Hunger Index, India has a level of hunger that is classified as “serious”. India, as it has done consistently with data and facts that are inconvenient to its political rhetoric, has dissed the Global Hunger Index data, calling it “a ploy to derail Viksit Bharat.”

No poverty numbers since 2012

Poverty numbers, after 2011-12 remain a mystery.

The absence of fresh data, not estimations relying on inflation to confuse the picture, allows politics misrepresenting claims to gain ground.

At the start of 2024, the NITI Aayog projected that “India is all set to reach single-digit poverty levels during 2024.” A few months on, the NITI Aayog CEO, B.V.R. Subrahmanyam said the poverty levels “could be closer to 5% or less”. He also asserted that rural deprivation “has almost disappeared” going by levels of consumption expenditure. But instead of undertaking a proper revised study, either taking the Tendulkar Committee’s recommendations as the basis, the method termed the Rangarajan method or guidelines proposed by the Arjun Sengupta Committee, the “5% poor” claim was made simply by adjusting the last 2011–12 poverty line for inflation using the Consumer Price Index and applying it to the Household Consumption Expenditure Survey data from 2022–23. In addition, there are many questionable assumptions about ‘welfare schemes’ working for the poor which render these numbers incomparable. A study by C.A. Sethu, L.T. Abhinav Surya and C.A. Ruthu, using the Rangarajan Method (which accounts for nutritional needs being met, not just expenditure) and the same 2022-2023 Household Consumption data, concluded that 26.4% of Indians are below the poverty line. This makes it a difference of more than 21 percentage points from government’s claims.

A comparable survey, a Census, or even releasing the numbers for the Socio-Economic Caste Census of 2011, which are available with the government but hidden, would help get closer to the true picture. Conversely, not getting proper evaluations done, helps the politics of the ruling party.

India is after all boasting about heading towards becoming the “fourth largest” economy in the world. It is bad enough that it is one with the lowest median income (approximately $ 2480 per annum) amongst large economies. That would only get underlined if the extent of deprivation and poverty is actually surveyed, updated and owned up to.

Masking COVID-19 deaths

It was exactly five years last month since COVID-19 was declared a Public Health Emergency of International Concern by the WHO. India declared its own ‘lockdown’ minus any preparation or information in March, five years ago.

A reluctance to face up to the deaths in India during COVID may well be among the reasons for the missing Census of 2021. The WHO estimates suggest a ten-fold discrepancy between the number of Covid dead in India and the ones recorded. India has denied any underestimation and says only about 4,81,000 have died, but WHO puts the number of the dead in India at 4.7 million, the highest in the world. A systematic headcount, the Census, one that India had not missed till 2011, since 1872, whether facing wars, disease or the partition of the country would establish how many have died, and fix the number of ‘excess deaths’. But in the absence of the Census, the BJP government can spin a tragic failure to even acknowledge the deaths on its head and claim Covid handling as a success story.

No national census for 14 years, a first in 150 years and a pattern by the government to debunk unflattering estimates put out by global agencies has resulted in the lack of crucial information on the most populous nation in the world. This is not just a detail that should only concern a geek. No data means even affected people are unclear about the whole picture. A pliant media then further gaslights citizens into seeing their own precarity as being one of their own making and not part of a general trend in the country.

The absence of data is not about academics and researchers losing out. It is actively helping the ruling party carry on with its politics without any roadblocks and preventing basic questions being asked of it.

Winston Smith in George Orwell’s 1984 says, “Freedom is the freedom to say that two plus two make four.” But that freedom is premised on the knowledge of 2 and 2. If basic and critical data points are missing from the discourse, and instead, the citizen finds herself in a position of transparency inverted, where she is expected to share her data with the state, but the state being under no obligation to transparently and honestly share information with her, Winston would be unable to even find the 2 and 2, let alone add it up and arrive at 4.

This piece was first published on The India Cable – a premium newsletter from The Wire & Galileo Ideas – and has been updated and republished here. To subscribe to The India Cable, click here.

Everything You Need To Know About the NFHS

Researchers have used NFHS data to highlight the persistent socio-economic disparities in maternal and child health outcomes.

The National Family Health Survey (NFHS) is one of the world’s largest household surveys, and was launched in 1992. It is widely used to track data on demographic and health indicators across Indian states and districts. In this piece, we explain the history of the NFHS including the changes in its scope and structure, its methodology, its uses, and some debates about the data quality of the NFHS.

The evolution of the NFHS

The NFHS is part of a global cohort of surveys run by the United States Agency for International Development (USAID) under its Demographic and Health Survey (DHS) program. The DHS surveys began in 1984, replacing two earlier survey cohorts: the World Fertility Surveys (1973-1984) and the Contraceptive Prevalence Surveys (1977-1985), run by USAID across the globe. These surveys were designed primarily to monitor population trends in developing countries.

The first DHS survey in India, christened as NFHS, took place in 1992-93 (NFHS-1). The focus was on generating national and state-level data on fertility, family size preferences, knowledge and practice of family planning, and related topics. It was designed to explore the demographic and socioeconomic determinants of fertility, family planning, and maternal and child health outcomes. The database was intended to assist policymakers and researchers in assessing and evaluating family welfare programmes and strategies.

The survey was conducted under the Indian Ministry of Health and Family Welfare (MoHFW). The International Institute for Population Sciences (IIPS), Mumbai – an autonomous research institute of the MoHFWworking primarily on demography and population health – was designated as the nodal agency for conducting the survey, and state level population research centres were roped in as regional partners to collect the survey data.

NFHS-2, conducted in 1998-99, canvassed information on some of the same topics covered in the first round. Additionally, it included questions relating to the quality of health and family welfare services provided by the government, reproductive health problems, the autonomy of women, and domestic violence.

A men’s questionnaire was added for the first time in NFHS-3 (2005-06), covering issues such as family planning choices and health.

In NFHS-4 (2015-16), the sample-size was expanded to provide district-level estimates for key demographic and health parameters. Surveyors used tablets rather than printed questionnaires to collect data in this round, and that speeded up the publication process.

NFHS-5 (2019-21) introduced questions on death registration and disability for the first time.

The NFHS-6 was conducted in 2023-24, but the data is yet to be released. Details relating to the questions asked in this round are available publicly. Questions on disability and biomarker data on anaemia, waist-hip ratio, and waist circumference have been dropped from this round. For the first time since NFHS started, the survey was run solely by IIPS, without any assistance or involvement of USAID.

How the surveys are conducted

Selecting the sample

The NFHS aims to provide representative demographic and health estimates at the national, state, and district levels. Towards that end, it divides each district and state into sub-parts or strata and selects sample villages or urban blocks from them at random.

Once the sampling units (villages/urban blocks) or sub-units are identified, survey field staff are assigned to these units to collect data on housing structures, household type (residential/non-residential) and basic household details (such as household head’s name) from all households in that unit. From the list of all households, 22 households are randomly chosen for the survey in a manner that each household has an equal chance of being selected.

This is called a multi-stage stratified sampling strategy, similar to that used by other national surveys.

Conducting the survey

The field staff visit each sampled household and conduct interviews with household heads, eligible women, and men. Each interview team includes three women (who interview female members), one man (who interviews male members), two health investigators (who collect biomedical data such as blood pressure readings and blood samples), and one field supervisor (who conducts on-the-spot data quality checks).

The field staff use mini-notebook computers loaded with a Computer Assisted Personal Interviewing (CAPI) application. They ask questions in a pre-assigned sequence and enter the answers directly in the tablet. This approach, introduced in NFHS-4, replaced the earlier method, where field staff used to note down answers on printed forms. The use of CAPI eliminates the need for separate data entry, reduces manual errors, and incorporates real-time data consistency checks. It also enables the daily transmission of data to the central office, facilitating timely feedback on data quality issues.

NFHS-1 covered over 88,000 households and 89,000 women. The NFHS sample-size was increased considerably from the 4th round onward to ensure representative district-level estimates for maternal, child health, and household characteristics. NFHS-5 covered over 600,000 households, 700,000 eligible women (15-49 years), and 100,000 eligible men (15-54 years). Estimates for men’s health outcomes and their family planning choices are computed at the state level only, and require a smaller sample size.

The questionnaire

The NFHS employs four questionnaires: Household, women’s, men’s, and biomarker.

The household questionnaire, answered by the household head, includes questions on socio-economic characteristics (such as religion and caste) of the members of the household, as well as on access to household amenities (such as source of drinking water and toilet facilities) and assets (such as TV or refrigerator). The data collected on household members from this questionnaire is used to identify men aged 15-54 and women aged 15-49, who are eligible for individual interviews.

The women’s questionnaire focuses on reproductive health, fertility choices and related topics. Women aged 15-49 are asked about the number of children they have had (alive and deceased), experiences of miscarriages, abortions, or stillbirths, knowledge and use of contraceptives, and sexual behaviour (number of partners, age at first intercourse etc.). Women are interviewed in privacy or in a separate space to ensure they feel comfortable and can provide honest responses. If privacy cannot be fully ensured, efforts are made to minimise the presence of others, especially men.

The men’s questionnaire asks men aged 15-54 about their use of contraceptives, involvement in partner’s antenatal and delivery care, and preferences regarding having children.

The biomarker questionnaire is used to record anthropometric measurements such as those relating to height and weight as well as bio-medical data such as haemoglobin levels.

The many uses of the NFHS

India has several demographic and health databases, including the Civil Registration System (CRS), the Sample Registration System (SRS), the Health Management Information System (HMIS), and the decennial census. Among these, CRS and HMIS are incomplete in terms of coverage; census and SRS do not provide individual-level records. NFHS is unique as it not only provides individual records on a regular basis but also provides a wealth of information on health correlates (socio-economic status, healthcare access, and risk factors). This enables researchers to analyse trends, patterns, determinants, and drivers of changes in health outcomes effectively.

Early research using NFHS data centred around fertility dynamics and family planning. However, as fertility levels declined across the country, and public health initiatives such as the National Rural Health Mission (NRHM) gained momentum, the focus shifted to maternal and child health. Researchers have used NFHS data to highlight the persistent socio-economic disparities in maternal and child health outcomes. Poor and socially marginalised households tend to have poor access to health services, and children born in these households tend to fall ill more often, analyses of NFHS data suggest.

Researchers have also used NFHS data to point to the role of institutional deliveries, improved antenatal care coverage, and the adoption of early breastfeeding practices in improving survival odds of newborns in the country. They have also pointed to important non-biological parameters that determine maternal health outcomes such as educational attainment, women’s empowerment and male involvement in healthcare decisions.

Research using NFHS data has pointed to the growing prevalence of obesity, diabetes, and hypertension among rural and socio-economically marginalised communities. These conditions are considered as serious risk factors for cardiovascular diseases, and were earlier viewed as a predominantly urban and ‘lifestyle’ phenomenon.

With the expansion of NFHS’ sample-size in the fourth round and the availability of district-level estimates, the database has been used widely to identify regions where welfare programmes need to be targeted as well as to study the impact of those interventions over time. NFHS is also used to track progress on Sustainable Development Goal (SDG) indicators. NFHS also provides the indicators used to compute India’s Multidimensional Poverty Index (MPI).

Key debates on NFHS data

Over the years, there have been questions raised and debates over some data in the NFHS, which we discuss in brief here.

Sample size

The six-fold expansion in sample-size in NFHS-4 (to generate district-level estimates) led the National Statistical Commission to express concerns about data quality and comparability with past rounds. The NFHS-4 report acknowledged this issue, stating that “the NFHS-4 figures and those of earlier NFHS rounds may not be strictly comparable due to differences in sample size”.

Sex ratio

The NFHS-5 reported a sex ratio of 1,020 females per 1,000 males, which was interpreted as women outnumbering men in India. However, this is not consistent with either the Registrar General of India’s (RGI) population projection (the benchmark for population estimates in the absence of census data) or with National Sample Survey (NSS) data. Hence, NFHS data on sex ratios and gender gaps need to be treated with caution.

Unexplained fluctuations in data over time

NFHS data on immunisation has shown inconsistencies, with unexplained fluctuations in full immunisation coverage across states and rounds, as well as an increasing trend in “zero-dose children” (children aged 12-23 months who have not received their first dose of the diphtheria-tetanus-pertussis (DTP) vaccine) in states with relatively better-performing healthcare systems such as Kerala and Tamil Nadu. These trends, unsupported by changes in healthcare delivery, funding, or policy, suggest that data quality issues may be driving these results. Hence immunisation-related findings from the NFHS dataset need to be interpreted with caution.

Similarly, the data on age at death of adults in the NFHS has shown notable inconsistencies, including substantial digit preferences (a bias towards ages ending in 0 or 5), reflecting inaccuracies in reporting. Further, the data indicated significant underreporting of female deaths.

Measurement of anaemia

The NFHS-5 reported a high prevalence of anemia among children and women (with anemia levels higher than in NFHS-4).

The NFHS uses capillary blood samples collected via finger pricks. These are considered practical for field conditions but are likely to produce higher and less reliable estimates than venous samples. The Comprehensive National Nutrition Survey (CNNS) 2016-18 – which used venous blood samples – reported significantly lower anemia among children compared to NFHS.

In March 2024, the WHO released new guidelines recommending the use of venous blood samples and automated hematology analysers in laboratory settings to estimate anemia prevalence. It also revised the hemoglobin thresholds below which a person or child is labeled anemic, lowering the thresholds for children in the 6-23 month age group.

Following the controversy, anaemia measurements have been left out of NFHS-6, and will now be part of the Diet and Biomarkers Survey in India (DABS-I) currently being conducted by the Indian Council of Medical Research (ICMR).

Time taken for the interview

Some researchers have argued that private firms involved in data collection are completing interviews faster than earlier, compromising data quality. However, shorter interview durations in recent rounds may not necessarily indicate compromised data quality. The length of the interview depends on the number of children born in the last five years (repeating sections for each child), and the time needed to ensure privacy protocols for sensitive modules such as domestic violence. Any assessment of variations in interview lengths needs to take these factors into account.

The shift from manual pen-and-paper interviews (PAPI) to automated computer-assisted personal interviews (CAPI) may also have contributed to lower interview times.

Nandlal Mishra, Pramit Bhattacharya (2025), ‘Understanding India’s National Family Health Survey.’ Published on Data for India. Retrieved from https://www.dataforindia.com/nfhs-explainer/ [Online Resource].

Data Story: The Unseen Costs of Underfunding Education and Healthcare

No nation has ever achieved sustained prosperity without first ensuring that its people are healthy, skilled, and empowered.

 This article is from a two-part series analysing the budget numbers and their sectoral allocations for FY 25-26.

Beyond mainstream news headlines, a closer look at the budgetary numbers offers critical insights. India’s defence budget has more than doubled in the last decade alone, surpassing Rs 6.8 lakh crore in the recently announced budget. 

Yet, despite this staggering figure, the armed forces remain far from satisfied. Purchased weapons arrive late, critical modernisation projects have dragged on for years, and nearly a quarter of the budget is swallowed by pensions. Even with record-high spending, the military still lacks the firepower it desperately seeks.

All this comes at a cost of critical sectors like education and healthcare which continues to be sidelined. 

Schools across the country remain underfunded, with many lacking even basic infrastructure. The crisis is so severe that the suicide rate among students has now surpassed that of farmers, a grim reflection of the pressure and neglect in the education sector. Healthcare paints an equally dire picture where India is short by a staggering 2.4 million hospital beds, leaving millions without access to proper medical treatment.

While India races to strengthen its borders, it seems to be overlooking its most valuable asset which is its people. 

India’s education crisis: A system in need of urgent reform

Education has long been touted as the foundation of India’s future, yet budgetary allocations and systemic inefficiencies tell a different story. Public expenditure on education remains around 2.9% of GDP (2024), far below the 6% target recommended by the Kothari commission​. While funding has increased since 2015-16, the sector continues to grapple with severe infrastructure and manpower shortages​

One of the most pressing concerns is the acute shortage of qualified teachers. Over 1.2 million teachers vacancies exist nationwide, leading to overcrowded classrooms with student-teacher ratios exceeding 50:1 in many government schools​. Worse, nearly 40% of government-appointed teachers lack proper qualifications, severely impacting learning outcomes​. In rural areas, these issues are compounded by poor infrastructure, outdated curricula, and the digital divide which seriously hampers quality of education for millions.

Also read: Despite the ‘Investing in People’ Rhetoric, Budget 2025 Does Little for the Social Sector

The cracks in the system manifest in tragic ways. India has one of the highest youth suicide rates in the world, with one student taking their own life every 42 minutes in 2020​. The numbers paint a grim picture – 11,396 student suicides were recorded that year, most attributed to academic pressure, parental expectations, and anxiety. Yet, mental health support in schools remains largely absent.

While government with the recent budget did try to boost initiatives such as Atal Tinkering Labs and digital connectivity programmes, these attempt to modernise education and their impact is limited when the fundamental issue of lack of investment, inadequate teacher training, and mental health neglect continues to remain unaddressed​.

The disparity in budget allocation does make one thing clear, how education simply isn’t a priority for this government. Year after year, defence spending sees steady increase, while education remains on the back burner. The graph below reflects this stark reality:

Education and defence spending in budget 2025-26

Source: Budget 2025-26

Additionally, when we examine India’s defence budget closely, we see how it has witnessed a staggering 152% increase over the past decade, rising from Rs 2.46 lakh crore in 2015-16​ to Rs 6.8 lakh crore in 2025-26​. This sharp escalation reflects India’s evolving security concerns, modernisation efforts, and the financial strain of a massive standing army.

A closer breakdown of the numbers, however, highlights the structural challenges within this surge. In 2020-21, out of Rs 3.37 lakh crore allocated for defence, nearly Rs 1.34 lakh crore (29%) was earmarked for pensions​. This means that a significant chunk of the budget is not directly contributing to modernisation, procurement, or infrastructure. 

Healthcare hasn’t been left too unaffected from this trend. When looked at first glance, India’s healthcare budget appears to be improving and although it’s partially true the allocation has increased from Rs 33,152 crore in 2015-16​ to Rs 95,957 crore in 2025-26​, showing a more than 100% jump but dig deeper, and the picture is far less reassuring.

Despite this increase, India’s hospital bed availability remains critically low, with just 1.4 beds per 1,000 people, far below the WHO recommendation of 3.5 per 1,000. Worse, government hospitals have an even more alarming ratio – only 0.79 beds per 1,000, meaning the country is short by 2.4 million beds. The doctor-to-patient ratio stands at 1:1,511, again failing to meet the WHO-recommended 1:1,000​.

The rural-urban divide further exposes the cracks in the system; 70% of Indians live in rural areas, yet only 40% of hospital beds are available to them​. Nurse-to-patient ratios stand at 1:670, a glaring shortfall from the recommended 1:300. Public hospitals are overwhelmed, underfunded, and stretched beyond their limits, while private hospitals, though better equipped, remain out of reach for millions due to high costs.

The graph bellow tells us a troubling story, not only is the healthcare sector underfunded, but the government doesn’t even fully utilise what it allocates. As seen in the graph, actual expenditure often falls short of budget estimates, highlighting deep structural gaps within the system. Whether due to bureaucratic inefficiencies, delays in project execution, or lack of long-term planning, the unspent funds reflect a widening disconnect between policy and implementation. Allocating money on paper means little if it fails to translate into real improvements. This consistent underutilisation raises a serious question. 

Source : CDPP

Perhaps the most devastating statistic is this: 62.6% of India’s total healthcare expenditure is paid out-of-pocket by individuals, making it one of the highest in the world. Medical bills are a leading cause of poverty in India, yet the government has done little to reduce this burden​.

While the defence budget enjoys a steady rise, with Rs 1.80 lakh crore allocated for capital outlay alone in 2025-26, healthcare remains chronically underfunded. Modernisation in the military is deemed necessary, but what about the modernisation of hospitals? Where is the urgency in building new medical infrastructure?

The key to a stronger and prosperous India

If we truly want to escape the traps that loom over our future, from the middle-income trap to the risk of premature deindustrialisation or even from jobless growth to what economist Arvind Subramanian calls the danger of becoming a “stalling economy” we must recognise that national power isn’t just measured in defence budgets and GDP figures. It is measured in the capabilities of its people.

Also read: Health Budget: How Closer Scrutiny of Major Announcements Reveals Half-Baked Truths

With a young population, we have a fleeting window to reap the benefits of a demographic dividend, but without robust investments in education and healthcare, that advantage could easily turn into a demographic disaster. A McKinsey report warns that India risks “growing old before it grows rich,” as inadequate human capital investments could stall economic progress before the country fully develops. 

No nation has ever achieved sustained prosperity without first ensuring that its people are healthy, skilled, and empowered. We can continue funnelling resources into military expansion while neglecting the very foundation that sustains national strength, or we can recognise that a truly secure India is one where every child has access to quality education, where no family fears medical bankruptcy, and where human potential, not just military power, defines our progress. 

Anania Singhal also contributed to this article’s research. 

Deepanshu Mohan is a Professor of Economics, Dean, IDEAS, and Director, Centre for New Economics Studies. He is a Visiting Professor at London School of Economics and an Academic Visiting Fellow to AMES, University of Oxford.

Ankur Singh is a Research Assistant with Centre for New Economics Studies (CNES) and a team member of its InfoSphere initiative.

Health Budget: How Closer Scrutiny of Major Announcements Reveals Half-Baked Truths

For instance, while the Economic Survey prepared by Nirmala Sitharaman’s ministry cautions about declining standards in medical education, she, in her budget, announced an increase in the seats without addressing the core issue in this area. 

New Delhi: Finance minister Nirmala Sitharaman’s 2025-26 budget speech gave more attention to health announcements than the previous year. 

One such announcement was exempting 36 medicines from customs duty. These are medicines that are consumed by patients suffering from rare diseases. The customs duty – a tax levied on import and export – on these medicines was 10%.

This appears to be a proposal to alleviate the problems of patients.

But Purva Mital, who suffers from Spinal Muscular Atrophy (SMA), a rare disease, says that those who believe in the ‘progressiveness’ of this announcement are delusional. 

The SMA causes muscle weakness in arms, legs, face, chest, throat, and tongue. This severely impacts all day-to-day activities. Risdipalm is a drug that can help patients like her. She says the annual expenditure of purchasing this drug is about Rs 72 lakh.

“How do you think a 10% discount, if at all companies decide to pass the relief on to the consumers, is going to make a difference in our lives?” she told The Wire on February 1, 2025. 

According to one estimate, 70-96 million people are suffering from various rare diseases in India and their annual expenditure on drugs runs into several lakhs.

Mital, 32, is a government employee based in Delhi who also suffers from SMA. When asked if this discount would in any small way give her better access to the drug, she replied, “I have never purchased this drug in the first place because neither my family nor I could ever afford to spend Rs 72 lakh per year.” Her condition will worsen in absence of consumption of this drug.

“This drug is not manufactured in India,” said K.M. Gopakumar who is associated with the non-profit Third World Network (TWN) which advocates for making the prices of drugs affordable.

“If the intent in the budget was to make the lives of these patients easier, then this spirit has to find a match in policy making, to encourage local production of this drug. Without this, today’s announcement [the budget speech of February 1] is just tokenism with little effect,” he added.

While presenting the budget for the last year, the finance minister had exempted four drugs for cancer patients from the GST. These were trastuzumab, deruxtecan, osimertinib and durvalumab.

“We have no evidence, yet, to conclude if this move made the lives of cancer patients easier to a significant extent,” Gopakumar said. 

The other major announcement in the finance minister’s speech was adding 10,000 more undergraduate and postgraduate medical education seats. 

“In the next year, 10,000 additional seats will be added in medical colleges and hospitals, towards the goal of adding 75,000 seats in the next 5 years,” she said. The minister also said the Narendra-Modi government had added 1 lakh MBBS and post-graduate seats in the last 10 years.

This announcement does not seem to be addressing the concern that the Economic Survey 2024-25, released a day before the Budget, raised. It essentially cast doubts over the quality of the medical education being imparted with the number of seats rapidly increasing. 

The Survey said despite several measures of the National Medical Commission, the “issues like shortage of faculty, ghost faculty, low patient load in hospitals continue to affect the quality of training.” Low patient loads deprive budding doctors of an opportunity to treat patients coming with different kinds of diseases to gain better understanding.

The Survey also pointed out the exorbitant fee in private colleges for MBBS courses which range from Rs 60 lakh to Rs 1 crore. As many as 48% of all the medical seats are in the private sector.

So while the Economic Survey prepared by Sitharaman’s ministry cautions about declining standards in medical education, she, in her budget, announced an increase in the seats without addressing the core issue in this area. 

The Economic Survey 2024-25, just like its previous edition, gave substantial space to mental health. Various aspects of it were discussed in detail in four pages of the Survey tabled this year. Therefore, one expected that the trend of decreasing the allocation to mental health, which happened in the last Budget, would be reversed this year.

But for FY 2025-26, too, the money earmarked to at least two programmes for mental health went down. One of them is the National Tele Mental Health Programme – a 24×7 tele-mental health counselling service. Its outlay for FY 25-26 decreased 16% compared to the financial previous year.

Similarly, National Institute of Mental Health and Neuro-Sciences (NIMHANS) saw a 4.5% decrease. It is a premier institute catering to patients of mental illnesses.

Health spending

The health ministry comprises two departments – department of family and health welfare, and the department of health research. The former executes all health policies of the country while the latter is exclusively dedicated to health research.

The outlay to the department of health and family welfare for FY 2025-26 is Rs 95,957.87 crore. The budget estimates (BE) for FY 2024-25 was Rs 87,656.90 crore. When adjusted for inflation of 6.5%, the overall allocation for the department of health and family welfare increased by 3%.

Even though the allocation for this department has gone up in nominal numbers in the last several years, when adjusted for inflation, there used to be a decline in the real numbers. The budget earmarked for FY 2025-26 has reversed the trend of at least the last three years, when real numbers also increased – and not just the nominal numbers.

Notes: All the calculations comparing budget estimates for FY 2025-26 and FY 2024-25 have been adjusted for 6.5% inflation. In other words, the inflation rate has been added to the BEs for FY 2024-25 to arrive at the real numbers and compare them with the allocations of FY 2025-26.

The table titled ‘health budget at a glance’ gives details how these calculations were arrived at. 

The budget allocated to Pradhan Mantri Jan Arogya Yojana (PMJAY-Ayushman Bharat) went up by 20%. This outlay for this scheme has been consistently increased in the last several years despite not-so-adequate utilisation of the budget. But one of the additional reasons, which could be responsible for this hike this year, could be expansion of the ambit of this scheme that was announced in the second half of the last year.

Initially, the scheme provided an insurance cover of Rs 5 lakh every year per family to meet hospitalisation needs. This scheme has now been expanded for ASHA workers and ANMs, and 4.5 crore senior citizens, over and above the family cover. The scheme covers only in-patient admissions.

Just like Ayushman Bharat scheme, Pradhan Mantri Ayushman Bharat Health Infrastructure Mission (PM-ABHIM) is a flagship programme of the Narendra Modi government. Both are centrally sponsored schemes – 60% of the funding comes from the Union government and rest from the state governments. As for north-eastern states, the ratio is 90:10.

As much as 20% more money was allocated to PM-ABHIM for FY 2025-26 as compared to the previous fiscal year. PM-ABHIM focuses on developing capacities of health systems and institutions at primary, secondary and tertiary levels to prepare health systems in responding effectively to the current and future pandemics or disasters. 

This increase for the scheme came despite two parliamentary committee reports which revealed  that the state governments have failed to fully utilise the quantum of money given by the Union government.  

One separate component of this scheme is PM-ABHIM (health). It focuses on health services while PM-ABHIM is the broader initiative. The former’s allocation has been decreased for FY 2025-26 by 5.4%.

The allocation to theNational Health Mission (NHM) went down by 3%. This umbrella programme plays the most crucial role in addressing the needs of rural healthcare. Maternal and child health programmes form the bulk of the NHM. The other areas are: non-communicable (lifestyle) diseases programme, communicable diseases programme, health systems strengthening and infrastructure maintenance. 

Indranil Mukopadhyay, a health economist and a professor at O.P. Jindal University, said this development  was worrisome. “In the last few years we saw new and more programmes added to the NHM. For example, the health and wellness centres were also added to the NHM,” he said. 

“While new components are being added, a decline in the budget for the NHM is also happening,” he added.

In so far as new AIIMS-like institutions are concerned, 5% more allocation was done for ‘Establishment Expenditure of New AIIMS’ scheme this fiscal year. This captures the capital expenditure of the scheme.

One component of Pardhan Mantri Swasthya Suraksha Yojana (PMSSY) also includes the spending on new AIIMS-like institutions to capture their revenue expenditure. The capital expenditure includes the spending on assets while the revenue expenditure includes the costs incurred on day-to-day activities.

Only six AIIMS-like institutions at Bhopal, Bhubaneswar, Jodhpur, Patna, Raipur and Rishikesh are fully functional. All of them were approved by the Atal Bihari Vajpayee government.

Besides OPD services, the institutions located at Rae Bareli, Kalyani, Mangalagiri, Bibinagar, Bilaspur, Bathinda and Deoghar offer in-patient admission services. Their counterparts at Gorakhpur and Nagpur started IPD services in January this year. The ones at Rajkot, Guwahati, Bilaspur (Himachal Pradesh) and Vijaypur offer only OPD services, the budget documents and the websites of these institutions reveal.

The other ones at Madurai, Darbhanga, Awantipura and Rewari are under various stages of construction and yet to begin any service.

The second component of PMSSY is the upgradation of various projects of existing government colleges in various stages. The overall allocation to PMSSY has been reduced by 6% for the next financial year.

The budget designated for AIIMS-Delhi and PGI-Chandigarh went up by 8% and 2.4%, respectively. The BE 2025-26 for National AIDS and Sexually Transmissible Diseases Control Programme has been increased by 5.6%. 

Indian Council of Medical Research (ICMR) comes under the department of health research. The premier research institute of India was allocated 17.7% more funds in BE 2025-26 as compared to the previous year’s estimated expenditure.

This article was updated at 11:04 pm to reflect the correct status of eight AIIMS-like institutions.