Life expectancy is improving steadily but India needs rapid gains in health. Communicable diseases, maternal, perinatal and nutritional deficiencies continue to be important causes of deaths; non-communicable diseases and injuries are also taking a substantial toll of human lives. A basic health care package based on a core set of cost-effective health interventions can address existing disease burden. Its implementation requires increased investment and enhanced health care delivery capacity. Large diversity in India calls for local adaptation of the basic health care package and its delivery mechanism. To encourage accountability, access should be monitored at district level by an independent agency.