Health care is commonly seen as a state subject in India, but in India’s federal structure, roles and responsibilities are spread across the three levels of governance. Functional responsibilities across the Union, states and local bodies are outlined in the Seventh Schedule of the Indian Constitution. Major responsibilities of creating, maintaining and managing health institutions rest with the states (State List). Union and states jointly provide public health services and take care of medical education (Concurrent List). The Union’s role on aspects such as family planning, health policymaking and research has been through Concurrent List. As per 73rd and 74th Constitutional Amendments local bodies are supposed to play critical roles in provision of preventive and public health services.