India has built the healthcare network. Now it must build the last mile 

The Indian healthcare story in the last decade has been one of phenomenal growth. The nation has expanded its healthcare capacities considerably, improved its primary and preventive care systems, enhanced the level of financial coverage, improved diagnostic facilities, and has entered into the world of digital health which can connect patients with the providers and medical record systems across borders. But, despite these developments, there is still the problem of the serious discrepancy between the health care available and the health care accessible. So the challenge now is not just to provide more health facilities, but to make the existing facilities easier to access and use. 

What’s the real meaning of the last mile? 

For a family living in a remote village, a health centre may exist on paper but still be difficult to reach because of distance, transport, work commitments or the absence of someone who can accompany an elderly patient. A teleconsultation may connect a patient to a specialist, but the patient may still need a diagnostic test, medicines or a physical examination. A government scheme may provide financial protection, but a family may not know where to go, which facility is empanelled or how to complete the process. Healthcare access is therefore not a single point. It is a chain. If even one link is weak, the patient journey can break. India has already built many of those links. The next step is to connect them better. 

The measure of last-mile healthcare should therefore shift from people reached to care successfully completed. 

Community health workers can become the missing navigation layer 

India already has one of its strongest last-mile assets in its community health workforce. ASHA workers and other frontline workers have demonstrated that healthcare becomes more effective when there is a trusted person between the system and the household. During the pandemic and in chronic disease programmes, community workers helped maintain treatment and follow-up for patients who could not routinely travel to facilities. WHO has documented examples in India where ASHA workers supported doorstep delivery of medicines and helped achieve continuity of hypertension care despite transport constraints. 

This model can be expanded 

The frontline worker of the future should not be viewed only as someone responsible for awareness or mobilisation. With appropriate training and digital support, that worker can become a health navigator: helping families understand available services, scheduling appointments, tracking referrals, reminding patients about follow-ups and identifying when a condition requires escalation. Technology can make this role considerably more effective without replacing the human relationship that makes it work. 

Digital health must meet people where connectivity and confidence meet 

India has shown that digital health can work at remarkable scale. eSanjeevani has brought specialist consultations closer to underserved communities, while the Ayushman Bharat Digital Mission is building a more connected and portable health ecosystem. The next step is to make these systems easier to use for people who may not be digitally confident. 

Digital healthcare should therefore be built around assisted access. Community health workers, local health centres, pharmacies and outreach clinics can help patients create digital health identities, access records, book teleconsultations and navigate referrals. The goal is simple: technology should remove a journey, not create another one. 

Diagnostics and medicines are as important as doctors 

Healthcare access is not only about having doctors and hospitals nearby. A patient’s care can still be disrupted if essential diagnostics are unavailable, medicines are out of stock or reports do not move with the patient between facilities. The last-mile agenda must therefore strengthen diagnostics, medicines and logistics alongside clinical care. Mobile diagnostic services, decentralised sample collection, hub-and-spoke laboratories and reliable medicine supplies can reduce repeated travel and treatment delays. The guiding question should be simple, “What can be taken to the patient, rather than what must the patient travel to find?” 

Referral systems need to close the loop 

A referral should not end with a patient being handed a piece of paper. A stronger system would track the entire journey, with every referral linked to a destination, timeline and follow-up. Digital tools can help monitor whether patients reach the next facility, while community health workers can support those who need help completing the journey. The goal should be a coordinated patient pathway, with public institutions, private providers, civil society and technology platforms connecting their strengths rather than working in isolation. 

The next frontier is continuity, especially for chronic disease 

India’s growing burden of hypertension, diabetes, cardiovascular disease and cancer requires care that continues beyond a single consultation or health camp. For many patients, especially in remote communities, the journey involves screening, diagnosis, medication, monitoring and periodic specialist care over years. A practical answer is a hybrid care model that combines community-level screening and follow-up, primary care closer to home, teleconsultation for specialist advice and physical referral when needed. India does not need a specialist in every village. It needs a system that ensures every village can reliably reach the right specialist when required. 

Last-mile healthcare should also be designed around dignity 

Accessibility is not only about geography. An elderly person may struggle with multiple counters and long queues. A person with disability may need physical accessibility. A woman may require a female health worker or greater privacy. 

A migrant worker may need services that remain accessible outside the home state. Someone with limited literacy may need information in a local language and through channels beyond written instructions. These are not peripheral considerations. They determine whether a healthcare service is actually used. The next phase of healthcare design must therefore ask a more human question and that is “Can a person navigate the system without needing privilege, familiarity or a personal network?” 

Measure the distance between the patient and the outcome 

India’s next healthcare priority should be to measure not just infrastructure created, but care actually completed from referrals and diagnostics to continuous medicines and follow-up. Hospitals, specialists and digital platforms remain essential, but so are community health workers, mobile clinics and local diagnostics that connect patients to them. The next breakthrough will not simply be another facility or technology; it will be ensuring that every patient can reach the right care, at the right time, wherever they live.