Did India’s largest healthcare infrastructure scheme miss a golden opportunity to electrify healthcare sustainably?
By Nashwa Naushad
In 2021, India launched the Pradhan Mantri Ayushman Bharat Health Infrastructure Mission (PM-ABHIM), the country’s largest healthcare infrastructure programme. Slated to run until 2025–26, it promised to enhance India’s public healthcare through infrastructure improvements. But as the scheme enters its final years, one question remains: did India miss a golden opportunity to integrate electricity into the very design of its landmark health infrastructure policy? When close to 24 per cent of primary health centers remained unelectrified around the time of the policy adoption, a small tweak in its design — explicitly linking funding to reliable and sustainable power — could have left a lasting mark on the resilience of India’s healthcare system.
Why electricity is central to healthcare
Electricity plays a critical role in advancing healthcare and improving health outcomes. Buildings are just the shell of the health system — what makes them functional is the ability to power medical equipment, refrigeration for vaccines, lighting for safe delivery rooms and life-saving ventilators. Moreover, renewable energy solutions like solar-powered systems, help reduce emissions and the impact of climate change, and promote environmentally friendly practices in the health sector.
While India has made tremendous progress in household electrification — which reached 96 per cent in 2020, only 76 per cent of health facilities were electrified around the same time. Additionally, there is work to be done to improve the quality and reliability of electricity. Frequent power cuts, voltage fluctuations, and inadequate back-up systems mean that health facilities remain vulnerable.
Policies and standards already exist in India to guide electrification of healthcare facilities. The Indian Public Health Standards (IPHS) set minimum electricity requirements for operating rooms, labour rooms, blood banks and vaccine storage. They allow flexibility for regional priorities and encourage the use of solar power where feasible. The government has also published guidelines for powering healthcare facilities using solar energy. Some states like Assam have identified the correlation between energy and health outcomes and have an action plan to operationalize the policy. Under the National Health Mission (NHM), existing health facilities have been electrified all across the country.
Building back after COVID
COVID-19 exposed deep gaps in India’s public health infrastructure — not enough hospital beds, a shortage of diagnostic labs, limited critical care capacity and weak disease surveillance. PM-ABHIM was conceived as a direct response to these gaps, with the aim of making India’s healthcare system more resilient and better prepared for future pandemics and disasters.
Structured as a Centrally Sponsored Scheme (CSS) — where the central government provides a share of funds and states contribute the rest — PM-ABHIM was allocated nearly ₹65,000 crore (USD 7.5 billion) in total from the centre and states over six years. This would go into building wellness centres, health blocks, critical care facilities and diagnostic labs, in both rural and urban areas. About a quarter of the total funding was reserved for 10 to 11 high-priority states including Assam, Jharkhand and Bihar to address geographic disadvantages and improve healthcare in underserved areas.
Despite its high ambitions and good intent, the scheme has faced criticism. Only half the budget has actually been allocated up to date. Moreover, the scheme is focused heavily on capital expenditure (CAPEX) — constructing buildings and facilities — without adequate provisions for operations and maintenance (O&M). After 2026, states will have to bear the recurring costs for running this new infrastructure.
A less discussed but equally significant gap is electricity, an essential component to support infrastructure.
A missed opportunity
PM-ABHIM unfortunately fails to link up with India’s existing standards and policies, thereby creating parallel silos rather than synergies. If electrification, especially through renewable energy solutions, had been added in its operational guidelines, states would have been compelled to include it in their plans and budgets. Instead, electricity provision is only mentioned as a requirement for critical care blocks.
Nashwa Naushad is a participant of the 41st cohort of the Graduate Certificate in Public Policy programme at the Takshashila Institution. This blog was originally published on her Medium, Views are personal and do not represent Takshashila’s policy recommendations.
