Mapping political commitments: Analysing health priorities in Indian election manifestos.

Introduction: Political manifestos are crucial for communicating party visions and policy priorities during elections. In the health context, manifestos provide a lens to examine political commitment to addressing structural challenges in India. Despite India's position as the largest democracy and the fourth-largest economy, the healthcare system is inequitably distributed, disproportionately affecting vulnerable populations. This study aims to evaluate how national political parties prioritise health in their manifestos for the 18th Lok Sabha elections, identifying patterns, gaps, and areas of focus. Methodology: Manifestos from four national parties-Indian National Congress (INC), Bhartiya Janata Party (BJP), Communist Party of India-Marxist (CPI-M) and National People's Party (NPP)-were analyzed using content and conceptual analysis. Health-related statements were categorized into five themes: nature, area, focus, prevention levels, and management. Statements not aligned with predefined categories were grouped under new areas or focuses. Each category's emphasis was quantitatively assessed by counting and summing relevant terms. Inter-coder reliability was ensured through independent coding and discussion. Results: The analysis identified one hundred and four health-related statements. INC emphasized Universal Health Coverage and workforce protection, while the BJP highlighted its achievements and program expansion. The CPI-M adopted a rights-based approach, focusing on equity and private-sector regulation. NPP presented a generalized vision, but lacked actionable strategies. Health infrastructure and traditional medicine featured across manifestos, yet governance, finance, and systemic reforms were largely neglected. Parties selectively addressed population-specific issues, with limited attention to tertiary care or research and development. Discussion: Manifestos reflected the ideological leanings but revealed a low prioritization of systemic health reforms and governance. Short-term, delivery-based solutions dominate over long-term investments. Political and electoral calculations influence the framing of health policies, perpetuating inequities, and systemic inefficiencies. Conclusion: India's political manifestos recognize health as important but fail to address systemic challenges. Greater political will and citizen engagement, is essential to elevate health as a governance priority, fostering universal health coverage and equity.