CHAPTER 1
Introduction
Since Independence, India has struggled to provide its people with universal health coverage. Whether defined in terms of financial protection or access to and effective use of health care, the majority of Indians remain irregularly and incompletely covered. Addressing the coverage gap is a huge challenge in light of the traditionally low public spending on health (currently about 1 percent of GDP), the high levels of informal or unorganized labor (93 percent of the labor force) (NCEUS 2007), a large but dispersed rural population (72 percent rural) (MOHA 2001), high levels of poverty (27.5 percent) (Planning Commission 2007),1 unregulated service delivery, and low quality of service providers serving the poor (Das et al. 2011; Shiva Kumar et al. 2011; Reddy 2011; Berman et al. 2010; Human Rights Watch 2009; Rani, Bonu, and Harvey 2007; Planning Commission 2005; MOHFW 2005; Das and Hammer 2004, 2006). Despite this ominous picture, opportunities to reverse the trend have recently come to the fore. As specified in the National Health Policy (MOHFW 2002) and the current coalition government’s framework for governance (“common minimum program�) (Government of India 2004), the government is committed to raising public health spending to between 2 and 3 percent of GDP. Increasing public spending on 1