Working Paper 7: State-Level Health Systems Assessments in India Based on Publicly Available Data

India has engaged in several healthcare reforms at the national and state levels since the 2000s and has experienced significant improvements in many health outcomes of its people. Yet, the nation continues to face challenges in its health system that impedes the progress toward universal health coverage where all people have access to good quality health services they need without financial hardship. Some of these problems were exacerbated during the COVID-19 pandemic and highlighted the urgent need to improve the health system.

Designing effective solutions to improve a health system requires a robust understanding of the performance of the system, which can be obtained through an empirical examination of the system. The most important component of carrying out such an exercise is accurate and up-to-date information on the various aspects of the system. This report presents a review of the data that are available to conduct a health system assessment in the country. Having identified the pros and cons of the current data landscape, this report also provides three recommendations on how to expand data availability and enhance the breadth as well as the depth of a health system assessment. The first option proposes a way to conduct an assessment without new data collection, while the second and third options suggest data collection efforts of increasing resource intensities to address the existing data gaps.

Given that healthcare in India falls under the administration of states, health system assessments are best conducted at the state level. A state-level assessment is also appropriate considering the diversity among states in terms of geographic, social, political, and economic factors. Therefore, the intended audience for this report is state-level policymakers, analysts, and donor institutions engaged in providing technical assistance to state governments for health systems reforms.