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| From the Window of a Public Health Professional: Health at the Crossroads in a Shifting Global Order | | | Dr Manorama Bakshi
As 2025 draws to a close, viewed from the window of a public health professional, the year offers a clear reminder that health leadership is not merely about systems, policies, or technologies. It is about trust, continuity, and the courage to make long-term choices amid uncertainty.
The past year tested health systems worldwide. Economic volatility, geopolitical realignments, climate stress, and workforce pressures converged to expose long-standing vulnerabilities. India was not immune. Yet beyond the dominant crisis narratives, India’s health trajectory in 2025 tells a quieter and more consequential story, one of steady progress shaped by public investment, institutional memory, and the everyday work of frontline systems.
Global Headwinds and a Contracting Donor Landscape
The global health financing environment is undergoing a recalibration. Recent restrictions and reassessments of overseas spending by the United States, alongside changing USAID priorities, reflect a broader shift towards shrinking and increasingly conditional donor support. For India, which has progressively reduced dependence on external aid, this brings both reassurance and new responsibilities.
This resilience was tested in 2025 as global health financing tightened, with the United States pausing and terminating large parts of its USAID-supported programmes. For India, this translated into stop-work instructions for some implementers and visible disruptions in select community-facing services. It was a reminder that even mature systems can feel the shock of global decisions, and that domestic capacity and continuity matter more than ever.
While major national programmes are now largely domestically financed, donor support historically played a catalytic role in enabling innovation, piloting community-based models, and strengthening last-mile delivery in areas such as HIV, tuberculosis, reproductive health, and nutrition. As this space contracts, the challenge is no longer one of replacement, but of prioritisation, ensuring that public financing protects hard-won equity gains and sustains preventive interventions that rarely make headlines but shape outcomes.
Public Health Gains That Matter
From a public health lens, India’s milestones in 2025 deserve attention precisely because they were achieved in a period of global turbulence. India’s certification as trachoma-free by the World Health Organization is not merely symbolic. It reflects decades of investment in sanitation, surveillance, and community participation. Similarly, sustained declines in malaria burden underscore a basic public health truth. Disease elimination is not a campaign, but a long game that demands consistency across political cycles.
Together, these gains reinforce a simple lesson. Resilient health systems are built before crises, not during them.
Digital Health and System Capacity
The continued expansion of the Ayushman Bharat Digital Mission marks an important step towards continuity of care and population-level prevention. Interoperable digital health records can reduce fragmentation, improve referrals, and support better planning. Their real value, however, will depend on governance, data protection, and how well they are integrated with frontline service delivery.
At the same time, investments in human capital, including the addition of over 10,000 medical seats and the establishment of advanced research platforms such as the AI Centre of Excellence for Healthcare at IISc Bengaluru, signal long-term intent. Yet numbers and infrastructure alone are not enough. They must be matched by attention to faculty strength, rural deployment, and quality assurance, or existing disparities will only deepen.
The Unfinished Burden: Air Pollution and Environmental Determinants
Any reflection on health in 2025 would be incomplete without acknowledging the persistent burden of air pollution and environmental risks, now among India’s leading contributors to illness and premature death. Despite policy intent through programmes such as the National Clean Air Programme, urban and peri-urban populations continue to face high exposure to particulate matter, with the heaviest impact on children, older adults, and those with chronic disease.
From a public health perspective, this points to a critical gap. Health outcomes cannot improve sustainably without stronger convergence between environmental policy, urban planning, and health systems. Addressing air pollution is no longer only an environmental concern. It sits at the heart of India’s prevention agenda and universal health coverage ambitions.
Regulation, Ethics, and Knowledge Flow
Recent policy decisions restricting certain categories of medical representatives from hospital access highlight a familiar dilemma, how to curb unethical practices without constraining legitimate scientific exchange. In a therapeutic landscape moving rapidly, from long-acting HIV treatments to new cancer therapies, clinicians need timely and credible information.
Over-regulation risks widening knowledge gaps, particularly in public facilities and smaller cities. A more balanced path would strengthen transparent engagement, disclosure norms, and institution-led continuing medical education, rather than relying on outright exclusion.
Innovation Without Access Is Inequity
Scientific progress in 2025 has been substantial. Long-acting antiretroviral therapies promise better adherence and dignity for people living with HIV. Advances in oncology are steadily turning some cancers into manageable conditions. Yet innovation alone does not guarantee impact.
The real test lies in whether these advances find their way into public programmes through timely price negotiations, pooled procurement, and inclusion under schemes such as Ayushman Bharat. Without this, innovation risks reinforcing inequity instead of reducing it.
Ayushman Bharat: Coverage, Quality, and Continuity
Ayushman Bharat remains central to India’s universal health coverage ambition. It has expanded financial protection for inpatient care and strengthened primary healthcare through Health and Wellness Centres. At the same time, concerns around quality of care, delayed reimbursements, and uneven state capacity persist.
Coverage without quality risks becoming a numerical milestone rather than a health outcome. Moreover, outpatient care, diagnostics, and chronic disease management, where most household spending occurs, remain insufficiently addressed.
Public–Private Trust: An Unfinished Compact
Equally important is the evolving relationship between policymakers and the private healthcare sector. Despite regular consultations, a trust deficit remains. Industry often experiences policy as unpredictable, while the state remains wary of commercial motivations.
Universal healthcare will remain out of reach without structured, transparent, and accountable public–private collaboration, moving beyond episodic dialogue to institutional platforms that allow co-design of policy, responsible data sharing, and alignment of incentives with public health goals.
Looking Ahead to 2026
From the vantage point of public health practice, the defining lesson of 2025 is that prevention, data, workforce development, and equity must move together, not in silos. Leadership in health calls for patience when outcomes take time, fidelity to evidence when narratives grow noisy, and a people-centred approach when systems are stretched.
As India steps into 2026 amid global uncertainty and diminishing external buffers, the task is to convert momentum into measurable, inclusive, and sustainable health impact. The choices made now will decide whether India merely expands coverage, or succeeds in delivering equitable, high-quality healthcare for all.
Dr. Manorama Bakshi is Director & Head of Healthcare & Advocacy at Consocia Advisory, Founder & Director of the Triloki Raj Foundation, and a Senior Visiting Fellow at IMPRI |
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