Building India's Low-Carbon Healthcare System: A Comprehensive Review of National Policies, Operational Frameworks,...

Background: Climate change poses a profound threat to public health globally and in India, but ironically healthcare activities themselves contribute significantly to greenhouse gas emissions. The healthcare sector produces about 4-5% of global carbon emissions. India's healthcare system is estimated to be the world's seventh-largest carbon emitter in absolute terms. To align with climate goals and protect health, India has begun instituting policies to foster a low-carbon, climate-resilient healthcare system. Objective: To comprehensively review India's national policies, operational frameworks, and strategies aimed at reducing healthcare-related carbon emissions (decarbonization) while strengthening health system sustainability. Methods: We conducted a narrative review of policy documents and PubMed-indexed literature from 2018 to 2025 focusing on climate change mitigation in the Indian health sector. Findings: India has mainstreamed health into national climate planning with the release of the National Action Plan on Climate Change and Human Health (2018) and the launch of the National Programme on Climate Change and Human Health (2019). These set targets for climate-health surveillance and low-carbon, climate-resilient medical health facilities. Climate action and sustainability are being included in accreditation standards. Early benefits include: greater energy reliability and lower cost energy services for healthcare centers with solar energy and higher health facility performance during extreme weather events. However, implementation remains nascent. Gaps remain in data, funding, and capacity to scale low-carbon practices across India's sprawling health system. Conclusions: India has made initial strides in aligning its health sector with climate mitigation imperatives through policies and guidelines for sustainable, low-carbon healthcare. Strengthening governance, financing, and technical support will be critical to fully implement decarbonization strategies. A low-carbon healthcare system in India can not only reduce emissions but also improve public health, resilience, and healthcare quality, setting an example for sustainable healthcare development in low- and middle-income countries.