Next Steps for an Efficient U.S.-India Healthcare Dialogue

India’s public health initiatives such as eSanjeevani, a tele-consultation service, and the expansion of Ayushman Bharat, India’s social health insurance mission, demonstrate recent efforts that the country has taken to provide equitable access to healthcare. Despite these programs, India still faces significant health challenges. India’s infant mortality and maternal mortality rates rank amongst the highest within G20 countries, and just recently, the country counted 27 percent of the world’s drug-resistant tuberculosis. Bilateral international collaboration can help address public health challenges for India and strengthen global health systems through mobilization of financial support for healthcare infrastructure.

U.S.-India cooperation on healthcare has made progress, and has the potential to go even further through the inclusion of Indian state governments as well as global foundations and key NGO partners. This can be done in the following ways.

1. Engaging Indian states further.

Under India’s largely decentralized system, state governments are the apex public health funders (2019-2020 government health expenditures totaled ₹ 2,71,544 crores—of this, state governments spent 64.2 percent, and the union government spent 35.8 percent). State governments also implement most healthcare services and, given the unique challenges faced by each state, are often better positioned than the central government to offer solutions.

At the federal level, bilateral health cooperation between the two countries has been discussed at the U.S.-India Healthcare Dialogue. Additionally, during the Covid-19 pandemic, both countries executed emergency response efforts across the Indo-Pacific—including with vaccine development, and sharing of best practices. However, states in India have unique challenges and do not benefit from a “one size fits all” strategy. For instance, Rajasthan has some of the highest rates of pulmonary tuberculosis, whereas highly urbanized states such as Tamil Nadu are looking to target non-communicable diseases like diabetes. Therefore, going beyond Washington-New Delhi cooperation, and creating state level partnerships will better suit addressing existing challenges. 

The next healthcare dialogue would benefit from sub-dialogues that include priority state governments’ health departments, NGO partners, and foundations. Going past the Track 1 dialogue format will create a conducive environment for more Memorandum of Understanding (MoU) signings between states and NGOs for building on future trainings, activities, and consultancies alongside state government health departments, akin to those being signed by ministries. Such a platform where the United States Agency for International Development (USAID), U.S. Department of Health and Human Services (HHS), and the Centers for Disease Control (CDC) can have discussions with state governments, could give these agencies a direct channel of communication on what exactly these states’ needs are. This will be crucial as states are a driving force for reducing maternal mortality rates and infant mortality rates, integrating telehealth and digital health platforms for broader accessibility, among other initiatives.

State-level engagement will strengthen subnational diplomacy, thereby furthering the U.S. Department of State’s mission to build these local channels of engagement. The U.S. government signs MoUs and facilitates national to subnational dialogues with India, so more dialogue can further expand the scope and potential for tackling Indian states’ unique challenges.

2. Leveraging NGO networks and encouraging investment from global foundations from US and India.

Civil society collaboration between the two countries will contribute to more investment from global foundations that could directly address state government priorities. Foundations that participate in the health dialogue will gain insights on state priorities, and will be able to better coordinate funding. Government agencies are often limited in their scope to facilitate projects due to earmarked funding; therefore, the benefit to formally including NGOs and foundations is that their scope of work can address Indian state priorities beyond those currently covered by the U.S. government’s mandate. Global foundations and funding bodies, when tapped in to the local level, have been able to create quality interventions and implement them alongside government priorities.

NGOs can localize their approaches and solutions for state governments’ priorities. Therefore, an all-inclusive health dialogue will allow state governments to leverage NGO expertise which, combined with seats for global foundations, will create an impactful channel of communication to help state governments build interventions around Sustainable Development Goal 3 for healthcare. Providing such a channel of communication between state government officials, NGOs, and funding agencies or foundations could be a trigger point in facilitating more U.S.-India healthcare collaboration and providing effective development interventions on the ground.

The United States and India will have a health dialogue to discuss new challenges, synergies, and consensus outside of the G20. As the two countries look to complement their efforts and build on the success they have had at the bilateral level, going past the Track 1 format and giving an additional platform to foundations, NGOs, and Indian states will result in greater cross-collaboration and successfully yield effective and informed interventions to support India’s healthcare system.

Yatin Jain is a program coordinator and research assistant for the Chair in U.S.-India Policy Studies at the Center for Strategic and International Studies (CSIS), Washington, DC, where he supports programs related to the chair’s Indian states work and engaging U.S. and Indian stakeholders in health and energy.


Yatin Jain
Program Manager and Research Associate, Chair in U.S.-India Policy Studies