When the plug gets pulled: India’s healthcare sovereignty is at stake

Not long ago, the world watched Nayara Energy, one of India’s largest oil refiners, wake up to find its Microsoft services suspended overnight. Outlook, Teams, cloud data: gone. Not because Nayara had failed to pay, it had. Not because it had violated Indian law, it had not. Microsoft acted under compliance pressure linked to EU sanctions due to Nayara’s Russian ownership connections, and the company had to approach the Delhi High Court before services were restored.

On a personal note, I experienced a smaller but telling version of this reality when my WhatsApp account was restricted for 24 hours while sending non-commercial invitations for an intellectual gathering linked to a foundation launch. Pause and reflect: a fully compliant Indian enterprise loses access to its own data, and an individual could not send a simple invite, because these platforms are not answerable to India, but to external jurisdictions. This is not an isolated incident; it is a preview. If this can happen to an oil refinery, what happens when the same logic applies to hospitals?

From data to healthcare sovereignty

What happens when foreign capital controls India’s healthcare and compliance instructions originate outside India? This scenario is no longer hypothetical, it is being quietly assembled. Over the past five years, $15.5 billion has flowed into India’s healthcare sector from global private equity and sovereign funds, shifting ownership from doctor-led institutions to financially-controlled systems. The dominant investors: Temasek, Blackstone, TPG, and KKR are accountable to global capital markets and geopolitical environments. Hospitals alone have attracted 68% of healthcare private equity investments, with $4.96 billion flowing in between 2022 and 2024, accounting for 40% of total deal value.

India now represents 26% of all Asia-Pacific healthcare buyouts in 2024, and in FY23, hospitals accounted for 50% of healthcare FDI at $1.5 billion, up sharply from 24% in FY21. While we celebrate this as growth, we must ask: is this strength, or a silent surrender of sovereignty? If geopolitical tensions escalate tomorrow, what stops foreign-owned hospital chains from receiving compliance directives, restructuring services, or restricting access? Nayara had contracts, payments, and legal standing, and still lost access overnight. A patient in an ICU has none of these safeguards and cannot approach a court in time. The stark reality is that India has no sovereign health security framework, no FDI scrutiny for critical healthcare infrastructure, and no public system strong enough to absorb such shocks. This was never the intent.

National Health Policy, 2017

I vetted and finalised the National Health Policy 2017, I recall the clear commitment: public hospitals were to be part of a tax-financed single-payer system, delivering cost-efficient, pre-paid care, with a lovng-term vision of fully equipped public sector hospitals meeting secondary and tertiary needs. This was a sovereign promise. We are now in 2026, and that promise is yet to be fulfilled. Instead, we are witnessing the outsourcing of our most critical function to private equity and calling it progress. Yet, there is a solution.

The AIIMS Model Report, presented at the International Patients’ Union annual conference, offers a replicable, scalable framework for public healthcare excellence anchored in sovereign ownership. AIIMS institutions are perfect- though they are underfunded and overloaded, above all, they are ours, no foreign fund can sanction them, no external board can shut them down, and no geopolitical directive can disrupt their services. Replicating the private and public ward mixed model with a cross-subsidisation model is a national security imperative. This is not an argument against private investment; it has brought efficiency and scale. But there is a critical distinction between private participation and foreign-controlled ownership of essential infrastructure, and India has dangerously blurred that line.

What is required

Healthcare is not just an industry; it is a strategic national asset. Three urgent actions are required: establish a health security review mechanism to monitor foreign ownership and trigger national security oversight beyond defined thresholds; increase public health expenditure to 2.5% of GDP in the Union Budget 2026–27 as a strategic priority; and launch a National Public Hospital Expansion Mission based on the AIIMS model, ensuring at least one government-owned centre of excellence in every district within five years.

India built its space programme, nuclear capability, and digital public infrastructure because it understood that sovereignty cannot be outsourced. The Nayara episode proved that even fully compliant entities can lose access when geopolitics intervenes. Healthcare is far more critical than cloud services. The question is not whether healthcare will be used as leverage, it is whether India will be prepared when it happens. The time to build that preparedness is now, before the plug is pulled-because when it is, there will be no negotiation, only collapse.

(Dr. Rajendra Pratap Gupta is the architect of the Viksit Bharat and former advisor to the Union Health Minister. He leads an India-based global healthcare think tank – Health Parliament. X/rajendragupta)