Ayushman Arogya Mandir and India's progress toward Universal Health Coverage: A narrative review

Ayushman Arogya Mandir (AAM) represents a watershed moment in the history of public health, marking a transformative step toward achieving Universal Health Coverage (UHC) in India. This manuscript provides a narrative review and secondary analysis of its impact, implementation challenges, and future potential. A narrative review was conducted in line with the Scale for the Assessment of Narrative Review Articles guidelines to enhance methodological transparency. A structured search was performed across PubMed, Scopus, and Google Scholar, complemented with official Government of India reports and policy documents. The search covered literature from January 2014 to November 2024 to capture developments before and after the launch of AAM in 2018. Search terms included combinations of "Ayushman Arogya Mandir," "Health and Wellness Centres," "Comprehensive Primary Health Care," "Universal Health Coverage India," "Ayushman Bharat," and "National Health Mission." A two-step screening process was followed: (i) titles and abstracts were screened to remove clearly irrelevant items, and (ii) full texts of potentially relevant articles and reports were assessed for inclusion. Peer-reviewed articles, government reports, and publicly available datasets relevant to India's UHC reforms were included, while commentaries without evidence, opinion pieces, were excluded. The analysis explores the initiative's alignment with global UHC principles and its role in enhancing equitable health access across diverse population segments, particularly marginalized communities. Significant paradigm shifts implemented after operationalization of AAM coupled with related health reforms have contributed to progress toward UHC by progressing its UHC Service Coverage Index from 57 in 2015 to 63 in 2021 (World Health Organization) and reduce the out of pocket expenditure from 60.6% in 2014-15 to 39.4% in 2021-22 (National Health Accounts estimates for India 2021-22). Though significant progress has been achieved, there persist challenges such as workforce shortages, infrastructural issues, and supply chain issues which require focused policy interventions. Despite the persisting challenges, AAM demonstrates significant promise as a scalable model for strengthening affordable, accessible, and quality primary healthcare, thereby contributing to India's progress toward UHC and offering lessons for other low- and middle-income countries.