Bridging India’s medical divide

In the architectural blueprint of India’s Universal Health Coverage (UHC), there lies a silent, structural fault line: the rural-urban medical divide. While metropolitan centres boast robotic surgeries and medical tourism, rural India lacks even a basic antipyretic for a common fever. To bridge this chasm, India must move beyond battles over medical “mixopathy” and embrace clinical pragmatism. Empowering India’s eight lakh AYUSH doctors to prescribe a carefully curated list of 47 essential allopathic drugs is not merely about “integration”; it is about decolonising healthcare delivery.

At the heart of this argument is a policy proposition. The ‘47-drug framework’ outlined here is offered as a practical, tightly regulated solution to India’s rural primary-care deficit. The principal objection to such reform is patient safety. But this proposal is neither reckless nor expansive. It does not argue for unrestricted allopathic practice by AYUSH doctors. Instead, it advances a clearly defined “restricted clinical privilege”, centred on a vetted list of 47 essential medicines. This proposed safety shield includes basic, life-saving drugs such as antipyretics to prevent febrile seizures. Under the framework, every prescription would be governed by strict Standard Treatment Guidelines (STGs) and backed by a mandatory six-month online bridge course in pharmacology. The online format allows for scalability, standardisation and verifiable certification, while enabling doctors to remain at their rural postings. The intent is not to dilute medical standards but to formally design a primary-care tier that protects rural citizens from the far more dangerous alternative they currently face—unregulated, uncertified quackery.  

India is a global outlier in this regard. It is perhaps the only country where even a limited set of essential, life-saving drugs remains the exclusive preserve of the MBBS cadre. Critics often cite Western models to oppose pluralistic practice, but global experience points the other way.

In the United Kingdom, nurses and pharmacists function as “independent prescribers” after specific training. In the United States, nurse practitioners—often with fewer years of formal clinical training than Indian BAMS or BHMS doctors—form the backbone of rural primary care.

Against this backdrop, denying a five-and-a-half-year institutionally trained AYUSH doctor the right to prescribe paracetamol, while trusting far less-trained paramedics elsewhere, exposes a systemic irony that rural India can no longer afford.

The most compelling case for reform lies in its economic impact. India’s healthcare system is trapped in a vicious poverty-health cycle. Nearly 70%
of healthcare spending is
out-of-pocket, much of it incurred by rural families forced to travel long distances for minor ailments.

First, legalising limited prescribing rights for AYUSH doctors helps eliminate the hidden “quack tax”. In the absence of authorised prescribers, villagers turn to informal practitioners. Bringing AYUSH doctors into the formal system integrates them with the National Digital Health Mission.

Second, timely first-line treatment prevents minor illnesses from escalating into emergencies that drain a family’s life savings.

Critics frequently invoke “mixopathy” as a rhetorical shield against reform. The legal window for this change already exists—it requires administrative clarity and resolve. Under the Drugs and Cosmetics Act, specifically Rule 2(ee), the definition of a Registered Medical Practitioner (RMP) can be explicitly expanded to include institutionally qualified AYUSH doctors as authorised prescribers for primary care.

The Supreme Court’s ruling in the Mukhtiar Chand case (1998) upheld the State’s power to notify practitioners of modern medicine. What is being proposed is a restricted, regulated clinical privilege.

Interactions with medical undergraduates across the country reveal a sobering consensus. Few join medical colleges aspiring to become general practitioners. The dominant ambition is specialisation and super-specialisation. As a result, rural primary care is treated as a temporary inconvenience before their postgraduate exams. This “specialist trap” leaves primary health centres with infrastructure without stable prescribers.

Ultimately, the health of a nation cannot be measured by the sophistication of its urban hospitals alone but by the accessibility of a single life-saving pill in its most remote hamlet. The 47-drug framework has the potential to bridge India’s rural-urban health divide.

(The writer is a doctor, an ex-bureaucrat and Karnataka BJP state secretary)

Disclaimer: The views expressed above are the author's own. They do not necessarily reflect the views of DH.