India’s health care system has evolved rapidly over the past two decades. Advances in pharmaceuticals, hospitals, medical technology, and digital health have transformed the way people access and experience care. From life-saving therapies to cutting-edge equipment and expanded insurance coverage, healthcare has become more sophisticated and more available than ever before.
Yet for millions of people, the first and most critical step in the health journey, accurate and timely diagnosis still remains out of reach. Diagnosis shapes clinical decisions, guides treatment, prevents misuse of medicines, and enables stronger disease surveillance. Without it, even the best doctors, hospitals, and therapies cannot achieve their full impact.
This gap is not about what has not been done; it is about what more can be achieved if diagnostics is given the same priority as treatment. Making diagnostics accessible, affordable, and reliable across all levels of care is not simply a technical fix, it is a public health imperative that directly determines how healthy, productive, and resilient India can be.
Globally, it is estimated that around 70% of medical decisions are informed by diagnostic tests (WHO, 2019). In India, however, diagnostics still account for less than 10% of the health care sector, despite being central to every treatment pathway. The market is projected to grow rapidly reaching ₹1,275 billion by 2028 across more than 300,000 laboratories (Frost & Sullivan, 2023) but regulation and quality control remain inconsistent.
In recent years, there have been efforts to expand access to diagnostics, but progress has been uneven. A shortage of trained personnel, fragmented compliance frameworks, and limited public health infrastructure mean that quality and access remain inconsistent. As a result, patients—especially in underserved areas often go undiagnosed, are misdiagnosed, or rely on unaccredited facilities.
This imbalance has real-world consequences. At the community level, patients may be forced into empirical treatment or drop out of care entirely. At the population level, public health priorities such as tuberculosis or emerging outbreaks remain vulnerable. If India is to achieve universal health coverage and a healthy, productive population, diagnostics must move from the margins to the mainstream of care.
There are encouraging signs of change. Initiatives such as the National Essential Diagnostics List (NEDL), developed by ICMR, are helping to reduce out-of-pocket spending and ensure the availability of essential tests across care levels. The Free Diagnostics Service Initiative (FDSI) under the National Health Mission is extending free diagnostic services to patients in public facilities.
New infrastructure is also emerging. Integrated Public Health Laboratories (IPHLs) are being set up at district and sub-district levels to improve surveillance and integrate diagnostics across human, veterinary, and environmental health. Viral Research and Diagnostic Laboratories (VRDLs) have expanded from just two in 2016 to more than 100 today, significantly strengthening outbreak response.
Public–private partnerships (PPPs) are also helping expand reach in underserved areas, while AI-driven innovations are beginning to transform the speed and accuracy of diagnosis. These developments point to a growing recognition of diagnostics’ critical role, even if coverage remains uneven.
For India to build a stronger, more equitable health care system, diagnostics must move from being an afterthought to becoming a central part of how care is planned and delivered. This requires a mindset shift — one that recognises diagnosis not just as a test result, but as the starting point of every health journey. Lessons from other health systems underline this point clearly. Geneva, home to the World Health Organization (WHO) and the Foundation for Innovative New Diagnostics (FIND), has shown how prioritising diagnostics for diseases such as TB, HIV, malaria, and Covid-19 can dramatically improve public health outcomes. The same approach — adapted to India’s realities — can significantly change how care is delivered and accessed.
For India, this shift should rest on three key principles:
- Diagnostics-first primary care: Ensure that essential tests are available at every level of the healthcare system so that treatment decisions are guided by accurate information rather than assumptions.
- Quality and consistency: Strengthen national accreditation standards so that test results are reliable and comparable across both public and private laboratories.
- Innovation-driven access: Develop regional diagnostic hubs, mobile laboratories, and AI-enabled solutions to extend quality testing into rural and underserved communities.
Building local capability is just as important. Encouraging indigenous manufacturing of diagnostic equipment and consumables, investing in R&D, and creating a trained workforce will make services more affordable and self-reliant. And because the scale of the challenge is significant, public–private partnerships will remain vital to expanding infrastructure and bringing diagnostics closer to where people live and seek care.
India’s health care system has made impressive strides, but its true potential will only be realised when diagnostics receives the attention it deserves. By making diagnosis the foundation of care, India can ensure that every patient’s journey begins on the right path. This is not only a clinical priority but also a public health necessity, central to building a healthier, more resilient, and more productive nation.
This article is authored by Surendran Chemmenkotil, managing director, Metropolis Healthcare Ltd.