Instead, it focused on primary care, socio-economic factors influencing health and community participation (National Health Policy 1983). However, as the document was more of a vision statement than an action plan, few tangible goals or practical applications were undertaken. Although the number of health care facilities has increased, their utilization has been low due to lack of staff, resources and monitoring. When the World Bank and others began emphasizing cost-effectiveness and vertical interventions in the 1990s, the country moved away from the goal of universal coverage. This decline in access to public health care, coupled with a dramatic increase in the number of private facilities available only to the wealthy, has increased disparities in access to care (Shukla and Duggal 2006). In response, the country created a new national health policy in 2002, containing ambitious goals, such as increasing the use of public facilities to 75% of total health care utilization (National Health Policy 2002). However, again, the policy contained no explicit strategy to achieve these goals, leading to further decline of the public health system and exponential growth of the private sector. Subsequently, several new programs were implemented to try to meet the needs of vulnerable populations, such as the National Rural Health Mission in 2005 and the National Elderly Health Program in 2011, but these programs did not had a great impact in reducing disparities and improving the overall health of the population. In 2015, the government began drafting a new version of the National Health Policy that aims to address these issues by providing universal health care, but this new version has not yet become law (Lahariya and Menabde