HSTP Reorienting Public Health for Equity and Sustainability

The Forum for Health Systems Design and Transformation, widely known as the Health Systems Transformation Platform (HSTP), operates as a not-for-profit organization registered under Section 8 of the Indian Companies Act, 2013 and incubated by Tata Trusts. It works to strengthen India’s public health systems through rigorous, evidence-driven research and on-ground implementation. HSTP partners closely with state and national governments to diagnose systemic challenges, co-create context-specific solutions, and translate insights into actionable policies and practices that advance equity and improve health outcomes. Simultaneously, it builds national capacity in health policy and systems research, catalyses multi-stakeholder collaboration, and produces knowledge assets that enable scalable and resilient health systems across the country.

In an exclusive interaction with The Interview World, Dr. Pratheeba John, Chief Program Officer at HSTP, offers a detailed account of the organization’s work. She explains how HSTP ensures its research remains locally relevant and operationally feasible for diverse state contexts. Further, she highlights innovative financing approaches that promote sustainability and equity, details HSTP’s engagement with community stakeholders and frontline health workers to anchor interventions in lived realities, and outlines the organization’s strategic priorities as it prepares to navigate emerging health system challenges.

The following are the key takeaways from this insightful conversation.

Q: Could you elaborate on HSTP’s overarching mission and how your strategies contribute to strengthening public health systems in India?

A: The Health Systems Transformation Platform (HSTP) is a mission-driven health policy and systems organisation working to strengthen India’s public health system so that it delivers equitable, people-centred, and resilient care. Its focus is on populations that remain underserved due to geography, structural disadvantage, or persistent inequities. HSTP’s central mission is to support governments, particularly at the state level, to shift from fragmented, programme-led service delivery towards integrated, adequately financed, and accountable health systems. Such systems are essential to addressing India’s changing demographic and epidemiological profile, including the rising burden of non-communicable diseases (NCDs) and multimorbidity.

HSTP is grounded in the conviction that sustainable and scalable health gains arise through systemic reform that governments own and institutionalise, rather than through parallel or externally driven service delivery. Accordingly, HSTP operates as a long-term technical partner to Union and State governments, embedding robust evidence, institutional capacity, and fiscal realism into policy formulation and implementation. Formal partnerships, established through Memoranda of Understanding with states including Odisha, Meghalaya, Karnataka, and Madhya Pradesh, and complemented by collaborations in several others, enable close alignment with government priorities. This model ensures that HSTP’s support strengthens routine public health systems instead of functioning as time-bound projects.

HSTP advances health system strengthening through a systems-wide, equity-first approach that recognises the interdependence of governance, financing, workforce, service delivery, medicines, data, and accountability. Evidence-informed planning and policy reform anchor this work. HSTP generates rigorous, policy-relevant evidence across key domains, including health financing, human resources for health, primary healthcare, NCDs, urban health, emergency care, health insurance, and One Health and Climate Change. Its research, published in peer-reviewed journals and reflected in globally recognised efforts such as The Lancet Commissions, informs decisions on resource allocation, service design, and priority-setting. Importantly, HSTP translates evidence into costed plans, policy briefs, implementation frameworks, and decision-support tools that directly shape state health plans, Universal Health Coverage roadmaps, NCD strategies, and health workforce reforms.

Q: How do you ensure that HSTP’s research and recommendations are context-specific and actionable for different state governments?

A: HSTP delivers context-specific, implementable research by working directly with state governments and by rigorously anchoring its analysis in each state’s administrative, fiscal, and implementation realities. Recognizing India’s pronounced diversity in disease burden, geography, fiscal space, and governance structures, HSTP steers away from uniform policy prescriptions. Instead, it applies a state-embedded, systems-oriented approach that aligns evidence generation with government priorities, institutional capacity, and operational constraints.

Before recommending reforms, HSTP conducts deep contextual diagnostics. Its teams carry out comprehensive assessments of state health systems, systematically examining epidemiological patterns, multi-year budget trajectories, fund flows and public financial management practices, workforce and cadre structures, supply chains, service delivery platforms, and digital infrastructure. These diagnostics ensure that recommendations respond to real bottlenecks rather than theoretical gaps.

Equally important, HSTP places co-creation and iteration at the centre of its engagement model. Teams routinely deliberate research findings and draft recommendations with state officials through workshops, consultations, review meetings, and working groups. This continuous feedback loop tests assumptions, sharpens proposals, and builds government ownership. As a result, HSTP’s work has translated into tangible reforms, including performance-based financing in Meghalaya, primary care workforce competency building in Odisha, emergency care strengthening in Chhattisgarh and Madhya Pradesh, and urban health planning in cities such as Mysuru and Bhopal.

Q: Health financing and planning are core to HSTP’s work. How do you approach innovative financing models that ensure sustainability and equity?

A: Health financing and planning are central to HSTP’s work because we treat financing not as a narrow exercise in resource mobilisation, but as a decisive lever for equity, accountability, and system-wide performance. Accordingly, our approach to innovative financing rests on three principles. First, reforms must remain fiscally sustainable within public systems. Second, they must expand equitable access and financial protection. Third, they must align with state-level implementation realities. Innovation, therefore, must strengthen government systems from within and deliver measurable gains for populations that are underserved or vulnerable to financial hardship.

Equally, HSTP prioritizes improving the effectiveness and use of existing public resources rather than depending solely on additional allocations. We advance decentralised, results-oriented, performance-linked financing models that sharpen accountability while preserving equity. For example, our support for the design and rollout of Internal Performance Agreements in Meghalaya demonstrates how states can link existing budgets to service readiness, quality, and continuity-of-care indicators within the public system.

Finally, HSTP embeds rigorous costing and long-term planning into all financing reforms. We work with states to estimate the true resource requirements for comprehensive primary care and essential secondary services, including specialist care at district hospitals. Through costed implementation plans and investment cases, we help governments align financing decisions with clearly defined service packages and outcomes.

Q: How does HSTP engage with community stakeholders and frontline health workers to ensure that interventions are grounded in lived realities?

A: HSTP systematically embeds frontline and community perspectives at the problem-diagnosis stage through rigorous formative research. Across state engagements, it integrates quantitative system analysis with qualitative methods, including facility visits and structured consultations with ASHAs, ANMs, Community Health Officers, staff nurses, pharmacists, laboratory technicians, medical officers, and programme managers. These interactions surface operational constraints that top-down planning often misses. Specifically, they reveal workload pressures, role ambiguity, supply chain gaps, referral bottlenecks, digital reporting burdens, and weaknesses in patient follow-up.

Building on these insights, HSTP engages frontline workers and community stakeholders as active co-designers of solutions. Providers and facility managers directly shape the tools, protocols, and workflows they will implement. Consequently, competency-based training modules, performance indicators under Internal Performance Agreements, and care pathways for NCD screening and follow-up through platforms such as the National NCD Portal are iteratively refined based on frontline feedback.

Finally, HSTP treats community engagement as essential to improving access, trust, and continuity of care. Across urban and primary healthcare settings, it partners with communities, civil society organizations, and local governments to identify priority health and social challenges. The SAMAGRA initiative in Mysuru illustrates this approach, where participatory consultations with vulnerable communities inform integrated responses to health needs, access barriers, and social determinants.

Q: Looking ahead to the next five years, what are HSTP’s biggest strategic priorities and how do you plan to navigate emerging health system challenges?

A: HSTP will pursue five strategic priorities to strengthen state health systems over the coming period. First, it will reorient health systems to address chronic and complex care needs. Although India’s public health system remains structured around episodic, acute care, the burden of non-communicable diseases, multimorbidity, mental health conditions, and population ageing continues to rise. In response, HSTP will support states to redesign primary and secondary care models that ensure continuity of care across the life course.

Second, HSTP will advance sustainable, equity-centred health financing reforms. As fiscal pressures grow, the focus will move beyond budget expansion toward more strategic use of existing public resources. Accordingly, HSTP will strengthen results-oriented and performance-linked financing, improve public financial management for health, align budgets with clearly defined service packages, and embed medium- and long-term costing into planning processes. Throughout, equity will remain central, with reforms explicitly targeting reductions in out-of-pocket expenditure, stronger financial risk protection, and improved access for populations facing the greatest barriers.

Third, HSTP will reinforce state capacity for implementation and governance. Recognizing that effective policy hinges on institutional capability, it will invest in technical assistance to strengthen health systems and capacity building of health workforce across the building blocks at state and district levels.

Fourth, HSTP will anchor its health systems strengthening efforts in evidence-driven research, using policy-relevant, real-world insights to bridge the gap between policy intent and implementation. By integrating data, digital systems, and decision-making, HSTP will ensure that information drives timely action rather than serving compliance alone.

Finally, HSTP will support states build resilience to shocks and emerging risks, such as COVID-19 pandemic, by strengthening emergency and trauma care systems, referral networks, and health workforce surge capacity while embedding preparedness for climate-related risks, zoonotic diseases, antimicrobial resistance, and future pandemics into routine health system planning.