Health systems in the Global South are facing unprecedented vulnerabilities such as pandemics, climate change related shifts in disease burden, and systemic inequities and inequalities. In World Health Statistics Report 2025, the World Health Organization (WHO) indicates that India had some notable success in the context of infectious disease such as malaria and improving maternal/child health but continues to be challenged in plant of non-communicable disease management, disease financing, air pollution, and access to health equity.
Furthermore, as seen throughout the COVID-19 pandemic, many lower-income and marginalized communities were minimally or not impacted in terms of the access to care because of the redirection of existing resources towards pandemic response and the shutting down or cancelling of non-urgent and specialized services. The existing health inequities were worsened and produced collateral damage or adverse effects on vulnerable groups representing the poor, the elderly, women being vulnerable to violence, migrants and informal workers in the Global South. Therefore, we need to revolutionize health systems; we need to transform health systems into adaptive and anticipatory. This would involve strengthening any existing evaluations systems and innovation to assist wider communities.
Strategic governance requires continuous improvement, and evaluation can be a strong performance driver for governance. Countries like India are raising the bar on evaluation and making it into a sophisticated tool to respond to emerging socio-economic uncertainty. By converting data to actionable intelligence, governments can prevent a crisis, determine its escalation and provide equitable and just allocation of resources. Thus, embedding evaluations in the public health governance ethos is essential for strengthening community health and well-being.
Evaluation as a Governance Instrument, Not Just a Tool
Evaluation’s role is closely tied to measuring success of programs. It is a top down, bottom up, inside out model that builds accountability and supports deep, lasting change from the bottom up, linking systemic change to the communities and people most at risk. In the National Rural Health Mission (NRLM), evaluation highlighted shocking revelations: disparate data systems, inequitable gendered access to health services, and only 34% of health facilities met the minimum public health standards of the facilities surveyed. These findings were not just abstract numbers; they resulted in actual policy reform and created pressure on leaders to invest money in rural infrastructure and implement gender equity legislation. Likewise, the 2024 assessment of Health and Wellness Centers unearthed limitations to managing chronic diseases with only 21% coverage in rural areas. The experience trained an entire generation of pharmacists to think about preventive care and patient education as opposed to just dispensing medications. These kinds of examples show evaluation’s dual role to reflect and learn from the past and to build a stronger future.
India’s Evaluation Challenges
Systemic barriers hinder progress. Institutional capacity gaps, fractured data ecosystems, and political hesitancy to act on evidence plague many health systems. In terms of socio-cultural barriers, India’s NRHM evaluation specifically notes that caste and gender-based social hierarchies continue to stifle healthcare access in rural areas. These social barriers affect the utilization of healthcare services, with marginalized communities—especially women and lower-caste groups—facing significant obstacles in accessing care. At the technical front, an evaluation report by NITI Aayog highlight issues such as duplication and redundancy in data systems, limited capabilities of frontline staff in data collection and reporting, and the need for better training and support for using health information effectively. The report also asserts that there are persistent weaknesses in governance and technical capacity at central, state, and district levels, affecting effective planning, implementation, and accountability
Disruption and Opportunity: Tech-Enabled and Community-Rooted Innovation
There have been many tech-enabled innovations in Indian public health systems. A Study confirms the feasibility and high accuracy, up to 98% of machine learning models for predicting vaccine defaulters and acceptability in immunization programs, using demographic and health records data. These models have been piloted in Indian settings, including Uttar Pradesh, and demonstrate the potential for targeted outreach and improved immunization rates. Furthermore, according to the World Economic Forum, AI is accelerating drug discovery, improving the speed and precision of research, and is projected to drive 30% of all new drug discoveries globally by 2025. Indian pharmaceutical companies are using AI to address diseases with high national burdens, such as tuberculosis and diabetes. In fact, digital public infrastructure (DPI) like the Ayushman Digital Bharat Mission is digitizing substantial patient records, enabling predictive health modeling and seamless data exchange across providers.
Conclusion: Toward an Evaluative State
The Global South and India doesn’t need to copy-paste models from the Global North. It’s time to chart our own path—to build evidence systems rooted in our lived realities, while learning from the world where it makes sense. India’s story reflects this shift. From the NRHM’s community-led audits to the way CoWIN was adapted for tribal communities, we’re seeing how evaluation can evolve into something much bigger: a public good.
When data is made open, easy to understand, and truly local, it does more than inform. It holds power to account, bridges gaps, and builds trust. That’s the north star: an evaluation ecosystem that doesn’t just serve the majority but truly includes everyone.
