The first wave of reforms was introduced as part of structural adjustments in India, in the 1990s. This was based on the World Bank promoted model of limited state intervention in the health sector. The role of the state was defined as investing in public health management, focussed only on those health services characterised as non-excludable and non-rivalrous, where markets are considered to fail in efficient resource allocation. The consequence of these reforms was privatisation, soaring costs of health care with exclusion of large sections of the population from any healthcare services.
In India, the National Rural Health Mission was introduced as an effort to strengthen public health systems and address the failures of the first reform wave.