India’s public health system has witnessed several transformative initiatives in the past decade—from affordable medicines through Janaushadhi Kendras to neighbourhood-based Mohalla Clinics pioneered by the Aam Aadmi Party (AAP) in Delhi. States too have experimented with their own people-friendly health schemes: Tamil Nadu’s erstwhile Amma Clinics, Rajasthan’s Nirogi Rajasthan campaign, and Maharashtra’s Aapla Dawakhana. These initiatives share one common principle: Healthcare must be brought closer to people and at prices that do not push families into poverty.
Yet, amidst these reforms, one critical gap persists—the lack of affordable radiology and pathology diagnostic services. In a country where out-of-pocket health expenditure still accounts for nearly 46% of all healthcare spending, as per the World Health Organisation (WHO) in 2022, diagnostic tests like X-rays, ultrasounds, blood investigations, and CT or MRI scans remain prohibitively expensive. It is here that an intervention is urgently needed: Public diagnostic laboratories, set up in every neighbourhood and made available for free or at nominal prices. A fitting name for such a network could be ‘Swasthya LABhar Kendras’ (Health Benefit Centres). Such an initiative would not just improve medical outcomes but also reshape healthcare accessibility, affordability, and employment opportunities.
Diagnostics: The missing pillar in affordable healthcare
Both medicines and consultations rely on a vital third element—timely diagnosis. Unfortunately, the reality in India is that a simple blood test or X-ray can cost a day’s wages for a daily-wage worker. More advanced scans like MRI or CT are simply out of reach for most, even among middle-income families. This leads to delayed diagnosis, worsening of diseases, overcrowding at tertiary hospitals, and ultimately higher costs of treatment.
By establishing the proposed Swasthya LABhar Kendras (SLKs) in neighbourhoods—whether urban colonies, rural blocks, or semi-urban wards—the government can ensure that diagnostic testing is no longer a privilege but a public health right. These centres can be integrated with digital health records, linked to Ayushman Bharat, and operated with standardised protocols to maintain quality and transparency.
Accessibility, affordability, and trust
Rural areas often lack both doctors and testing facilities, forcing patients to travel to district hospitals. Urban poor populations, despite proximity to private labs, are deterred by high costs. SLKs can directly address these barriers by placing diagnostic services within walking distance of every citizen.
Affordability is the key. If medicines can be sold at 50% to 90% less than the private price through Janaushadhi outlets, why can’t blood tests or scans also be offered at reduced rates? Bulk procurement of reagents, public-private partnerships for equipment, and leveraging government medical colleges for manpower can make this financially sustainable. Nominal user fees can be levied for those above a certain income, while economically weaker sections receive services free of cost.
Finally, trust is vital. Public diagnostic labs can be made transparent by publishing standard price lists, ensuring National Accreditation Board for Testing and Calibration Laboratories (NABL) certification, and providing results digitally to reduce malpractice or overcharging. Citizens should feel confident that their tests are accurate, affordable, and free of exploitation.
Creating jobs and building capacity
A network of public diagnostic laboratories would not just benefit patients—it would also create thousands of jobs for medical graduates, technicians, and allied health professionals. SLKs could provide the many medical lab technologists and radiographers, who struggle to find stable employment, with structured roles, decent pay, and opportunities for continuous training. Additionally, partnerships with medical colleges could allow graduate students in radiology and pathology to rotate through these centres, thereby strengthening service delivery while giving students hands-on experience.
By generating employment and skill-building opportunities, these labs would align with the government’s twin goals of Swasth Bharat and Rozgar Bharat. In the long run, this initiative would reduce the pressure on tertiary hospitals, prevent catastrophic health expenditures, and contribute to India’s demographic dividend by keeping its working-age population healthier for longer.
A pilot in Goa, a model for India
Goa, with its manageable population size, could serve as the ideal pilot state for this initiative. A network of neighbourhood SLKs could be rolled out across the state, linked to PHCs and district hospitals but embedded within communities. If successful, this model could be scaled nationwide and create a comprehensive public health ecosystem of consultations, diagnostics, and medicines. By doing so, we would not only save lives but also affirm the principle that healthcare is not a privilege but a right.
(Sainandan Iyer is Assistant Professor of Political Science at DCT’s Dhempe College of Arts & Science, Miramar-Panaji)
