The Central Government, in the Union Budget for FY 2026-27 allocated ₹1,06,530.42 crore to the health sector—a modest 10% increase over the previous year. While many experts have welcomed the higher budgetary allocations, concerns persist over its skewed concentration toward secondary and tertiary care, alongside industry expansion and medical tourism, while primary health care received dismal attention. This imbalance is critical because the lack of emphasis on primary health care (PHC) can significantly impede India’s fight against antimicrobial resistance (AMR).
AMR occurs when micro-organisms evolve to survive and even multiply despite medicines designed to kill them, making treatments increasingly ineffective. Although resistance mechanisms are considered a natural process, their rapid acceleration today is driven primarily by the misuse and overuse of antibiotics. Often described as a silent pandemic, AMR emerged as a global health concern, responsible for over a million deaths worldwide annually and is projected to claim up to 10 million lives a year by 2050 if urgent action is not taken.
India is among the worst-affected countries, with an estimated 300,000 deaths each year linked to drug-resistant infections since 1990. In November, last year, India updated its National Action Plan on AMR for the five-year period between 2025-2029, building on the earlier 2017 framework. Although the revised strategy recognised One Health approach integrating human, animal, and environmental health, and calls for stronger surveillance, antimicrobial stewardship, research and innovation, yet challenges persists like most laboratory and diagnostic systems, antimicrobial stewardship personnel located in few urban locations, while rural and semi-urban coverage remains patchy where nearly two-thirds of India’s population depend heavily on the primary health care system.
The World Health Assembly resolution and United Nations General Assembly’s political declaration in 2024 highlights the importance of investing in sustainable, PHC-oriented health systems as the backbone of public health preparedness against the emerging health threats like AMR. In India, Primary health care regulated through a combination of central-state frameworks and executed through subcentres and primary health centres—serves as the first point of contact between communities and formal health systems and covers a wide spectrum of services from universal health coverage, health promotion and disease prevention to treatment and rehabilitation.
Report indicates that almost 80-90% of antibiotics are frequently prescribed at the primary care level, making it a crucial frontline in the fight against AMR. Evidence from India’s primary care facilities consistently revealed widespread irrational antibiotics prescribing practices, with overuse remaining alarmingly high. The World Health Organization’s AWare (Access, Watch, Reserve) classification provides a standardised framework for evaluating rational use of antibiotics—promoting antimicrobial stewardship, however adherence to these guidelines remains low. Pooled estimates suggest that more than 65% of patient consultations resulting in antibiotic prescribing—far above the global benchmarks. Strikingly, antibiotics are often prescribed for conditions such as respiratory infections and fever, many of which are viral and do not necessitate antibiotics—patterns that are widely reported in Indian primary health care settings.
These trends are often shaped less by individual behaviour and clinical decision-making but more by structural constraints and persistent weakness embedded within the primary care system. Many primary care facilities have faced doctor shortages, leaving clinicians to manage heavy patient loads with limited consultation time compounded by diagnostic uncertainty and inadequate laboratory testing facilities. Weak supervision and monitoring of antibiotic use, limited awareness among staff and poor regulatory oversight further reinforce irrationality. As a result, antibiotics are frequently used through a ‘just-in-case’ prescribing approach, where clinicians often prescribe antibiotics empirically as a precautionary and as an easy and quick remedy. Over time, antibiotics become substitutes for proper diagnostic testing, leading to the acceleration of resistance and the normalisation of unnecessary use.
Moreover, the persistent issues in primary care facilities shape community-level trust and health care seeking behaviour, as long waiting hours at the facilities, frequent doctor absenteeism, and delays in treatment often push patients to seek care from informal health workers or rely on over-the-counter antibiotics, encouraging self-medication and unregulated antibiotic use in rural settings. India is already one of the largest consumers of antibiotics globally, with consumption nearly doubling over the past decade — a trend that highlights the pressing need to reorient attention toward primary health care.
India’s fight against AMR cannot succeed without addressing the problem at its source. Strengthening diagnostic infrastructure, building laboratory networks, deploying rapid diagnostic tools, and improving health information systems for effective monitoring and reporting are key steps to reduce unnecessary antibiotic use. Identifying dedicated stewardship teams at PHCs, allocating funds for periodical training to hospital staff, focusing on staff management, creating context-specific antimicrobial prophylaxis, enforcing prescription-compliance mechanisms and implementing regulatory frameworks against irrational antibiotics dispensing must become central to strengthening primary health care responses to AMR.
At the same time empowering frontline health care workers like ASHA and ANM workers through targeted AMR training and capacity building programs is crucial to raise awareness about the rational use of antibiotics among community levels. Community-based programmes like antibiotic-smart villages should be properly incentivised and piloted with dedicated Centre–State coordination.
Although Government programmes like AB-HWC have been put in place to upgrade the primary care facilities— available data reveal persistent funding bottlenecks, with uneven state-level spending and delays in fund utilisation.
If India’s primary health care system continues to remain underprioritised—leaving it understaffed, under-equipped and inadequately supervised, with limited capacities to respond to emerging health challenges—it risks undermining the country’s fight against AMR. Combating antimicrobial resistance is a race against time and requires a conducive, well-coordination across all stakeholders, and a decisive reset that strengthens response at the primary level. Ultimately, India’s battle against AMR will be decided in its primary health centres and communities where antibiotics are prescribed, consumed — and too often overused or misused every day.
This article is authored by Mahesh Ganguly, teaching assistant and research fellow, IIT Bombay.
