In India today, the promise of universal health coverage often feels like a horizon that keeps moving further away the closer we get to it.
The country has made remarkable strides in terms of public health spending with the government allocating 1.94% of the total budget to healthcare in 2025. Initiatives like Ayushman Bharat have given millions access to insurance coverage that was unthinkable a decade ago. Mobile technology and telemedicine have reshaped how services reach remote areas. Yet for vast swaths of India’s rural poor and urban informal settlements, healthcare remains something closer to a lottery than a right.
Healthcare pushing Indians into poverty
More than 65% of Indians live in rural areas, where the nearest doctor could be miles away and where reaching a hospital often involves impossible costs in travel and time. Even in cities, the sprawling slums, teeming with life but invisible to planners, are glaring reminders that formal healthcare systems have not kept pace with economic growth. Every year, an estimated 17% of households in India still face catastrophic health expenditures, pushing them deeper into poverty.
Against this backdrop, the healthcare work Smile Foundation does reveals a more grounded story of progress—a quiet, persistent effort to shift health from being an aspiration to being a daily, lived reality.
Take Shashikala, a pregnant woman living on the edge of Bengaluru. Without the Smile on Wheels mobile healthcare unit that visited her settlement, her prenatal care would have been sporadic at best. Instead, consistent check-ups and medication brought her a healthy pregnancy, offering a glimpse of what community-centered healthcare could look like at scale. Smile Foundation runs 105 such mobile healthcare units across 16 states, bringing basic outpatient care, medicines, and diagnostic services directly to those who might otherwise be invisible to formal health systems.
Having more than one touchpoint
But access is not just about putting clinics on wheels. It’s about permanence and trust—values that Smile Foundation weaves into its model through static health clinics in some of India’s remotest regions. In a village in Tamil Nadu, the Smile-run clinic stands as one of the few reliable touchpoints for patients managing chronic diseases like hypertension and diabetes. Beyond primary care, these centers offer physiotherapy, family counseling, and even mental health support—services that are often left out of conventional rural health planning.
Telemedicine, too, has been embraced, not as a futuristic luxury but as a pragmatic bridge between rural patients and urban specialists. Smile Foundation’s mobile telemedicine units, linking patients to doctors in Bengaluru, Chennai, and Hyderabad, provided over 85,000 specialized consultations last year alone. For a hypertensive farmer or a pregnant teenager in a village three bus rides away from the nearest city, such access can mean the difference between life and death.
Community health camps remain another critical lever. More than a hundred were organized over the past year, responding to seasonal outbreaks and local health crises. In areas where government outreach is sporadic, these camps are not just supplementary but essential.
Yet beyond the immediate relief of treatment, our real investment lies in the fabric of local health systems. Working with public health facilities, it has helped equip district hospitals and urban primary health centers with essentials like ECG machines, baby warmers, operating lights, and biomedical waste management systems. Such seemingly technical interventions carry enormous weight: without them, even the best-trained doctors are helpless.
The importance of training
Importantly, we recognize that healthcare delivery is as much about people as it is about infrastructure. Over the last year, it trained more than 1,000 frontline workers—ASHAs, ANMs, and VHSNC members—on everything from first aid and family planning to non-communicable disease management. These women, often unpaid or underpaid, are the real scaffolding of India’s rural health ecosystem. Strengthening their capacity is not charity; it is strategy.
There are specialized interventions too, often overlooked by mainstream public health narratives. More than 48,000 people accessed free dental care through Smile Foundation’s Mobile Dental Units operating in Delhi NCR and Agra. Meanwhile, over 71,000 transport workers—drivers, loaders, mechanics—received physiotherapy, checkups, and counseling through Transport Aarogyam Kendras in places like Unnao, Ranchi, and Ludhiana. These are not marginal acts. They are recognitions that health is holistic, and that occupational health cannot be the poor cousin of general medicine.
And then there is the work that is harder to quantify but perhaps most transformational: driving behavior change. Through information, education, and communication (IEC) activities, we reached over 350,000 people with messages about immunization, nutrition, hygiene, lifestyle diseases, management of vector borne diseases like malaria, filariasis, diarrhea, and typhoid, tobacco use and substance abuse, diabetes and hypertension, care seeking for blindness, first aid, and common geriatric ailments.. Changing habits and perceptions takes decades, not months. Yet without this slow, community-driven work, even the best services can remain underutilized.
Always bottom up or something similar to it
If there is a lesson for others from our approach, it is this: health systems cannot be built from the top down alone. Real health equity grows from the last mile upward.
The government’s macro-level efforts are necessary, but insufficient on their own. To meet the SDG target of Universal Health Coverage by 2030, India needs models that understand the complexities of local geographies, cultures, and economies. It needs partnerships that amplify government programmes rather than replicate them inefficiently. It needs, in short, a bottom-up movement that prizes proximity, trust, and adaptability over scale for scale’s sake.
Stories like that of Mannu Mahato, a centenarian stage actor who now receives regular geriatric care thanks to our healthcare efforts in Bihar, capture this larger truth. Health is not just about clinical outcomes. It is about dignity, independence, and the ability to live life fully at every age.
As India moves through the next crucial years of its development trajectory, it must ask itself whether health is truly seen as a public good or merely as a private burden mitigated by market solutions.
If it chooses the former, it must invest not just in hospitals and insurance schemes, but in grassroots models of compassion and proximity. Models that move toward people, not away from them. Models that treat health not as a service, but as a shared promise.
