There have been many articles, research papers and writeup on this topic available on the web. As part of a research project, I managed to gather some data points for understanding the State of HealthCare in India. Thorough this post, would like to share my findings and provide some references for a better understanding on this subject.Economically, India has been consistently growing at over 8% GDP every year for the last 3 years and if the Economists prediction goes right, we will continue to grow the same way for the next few years.

HealthCare is one of the key parameters in which a country’s Development and stature are measured. To begin this discussion, let us first understand the structure of HealthCare in the Indian Context.

Primary Health Care is essential health care; based on practical, scientifically sound, and socially acceptable method and technology; universally accessible to all in the community through their full participation; at an affordable cost; and geared toward self-reliance and self-determination (WHO & UNICEF, 1978).
The World Health Organization (WHO) has identified five key elements to achieving this objective:
  • Reducing exclusion and social disparities in health (universal coverage reforms)
  • Organizing health services around people’s needs and expectations (service delivery reforms)
  • Integrating health into all sectors (public policy reforms)
  • Pursuing collaborative models of policy dialogue (leadership reforms); and
  • Increasing stakeholder participation.

Primary HealthCare in India

In 1947, the year of India’s independence, average life expectancy was 29 years and today, in just 63 years, it has reached 65 years. According to estimates, it will reach 74 Years by 2025. There are many reasons for this impressive progress in life expectancy in India and one of the key reasons is the maturity of the Primary Health Care facilities and services in India.

PHC was conceptualized in 1946, three decades before the Alma Ata declaration, with the recommendations of the Bhore committee, that laid emphasis on social orientation of medical practice and high level of public participation. The government followed it up with setting the Community Development Plan in the 1st 5 year plan (1951-55) and Health Survey and Planning Committee in the 2nd 5 year plan.

Primary HealthCare as a key initiative has been an Objective only in the 9th 5 Year Plan (1997-2002).

  • Department of Women and Child Welfare (DoWCW) is responsible for the overall implementation of HealthCare schemes in India.
  • The Central Government is responsible for providing funds for HealthCare infrastructure across the country.
  • The State Government is responsible for allocation of funds to respective regions and building up the personnel and HealthCare facilities across the state.
  • At times of emergency, the Central Government is responsible for collecting and distributing Medicine’s and required support to the state/region.
  • The Government provides a three-tier (Primary, Tertiary and Secondary) support structure for addressing the HealthCare needs across the country.
Structure of Indian Public HealthCare System
The Indian HealthCare system is a three-tire structure which focus’s on delivering care at the individual level. This structure is designed according to the population norms.

Population

Urban

Hilly/Tribal/Rural

Sub Center

5000

3000

Primary Health Center

30,000

20,000

Community Health Center

1,20,000

80,000

Sub Center
The Sub Center is the closest to the common man and becomes the first point of contact in the three tire system.
  • Each Sub Center is managed by an Auxiliary Nurse Midwife (ANM) and one Male Health Worker.
  • One Female Health Assistant and One Male Health Assistant manage 6 Sub Centers.
As of 2008,
  • There are 1,58,792 Sub Centers.
  • 53,390 ANM’s
  • 1,46,036 Male Health Workers
  • 23,458 Female Health Workers
  • 23,458 Male Health Workers.
Primary HealthCare Center (PHC)

Primary HealthCare Center’s form the second tire in the system (Secondary Care) and each PHC is a hub for 6 Sub-Center’s. A PHC typically has a 4-6 beds for addressing immediate and basic Health Care necessities.

Community Health Center (CHC)

CHC forms the third tier in the system.

  • A CHC has 1 Surgeon, 1 Physician, 1 Gynecologist and 1 Pediatrician along with 21 Paramedical Staff.
  • CHC is a 30 bed facility.
  • 1 CHC for 4 PHC’s.

Now, let us look at the core data of HealthCare Infrastructure in India.

Personnel Availability

Required In Position Shortfall
CHC 6491 4276 2337
PHC 26022 23458 4477
Sub-Center 158792 146036 20486
Doctors at PHC 23458 24380 3537
Multipurpose Worker (Female) at PHC & SC 169494 153537 21066
Nurse MidWife 53390 44940 18017
Only ANM 19385 21313 1841
Health Assistant (Female) 23458 17599 6481
Health Assistant (Male) 23458 17972 8827
Health Worker (Male) 146036 60247 79322
Laboratory Technician 27734 12885 14135
Obstetricians and Gynecologists (PHC) 4042 1029 2576
Obstetricians and Gynecologists (Other Location) 219 143 115
Peadiatrician (PHC) 4042 791 2814
Peadiatrician (Other Location) 219 73 146
Pharmacists 27734 20964 7017
Physicians (PHC) 4042 1043 2562
Physicians (Other Location) 219 81 138
Radiographers 4276 1695 2280
Surgeons 234 81 142
All Specialists at PHCs 17104 4279 11033
Total 739849 556822 209349

Infrastructure – (District Hospitals, Ayurvedic Dispensaries & Hospitals, Family Welfare Center and Referral Hospitals)

State District Hospitals Ayurvedic Dispensaries Ayuevedic Hospitals City Family Welface Center Referral Hospitals
Andhra Pradesh 16 557 9 0
Assam 22 380 1 0
Arunachal Pradesh 14 2 1 0
Bihar 25 311 11 12 70
Chhattisgarh 16 634 8 0
Goa 2 77 1 0
Gujarat 23 493 48 106 409
Haryana 21 472 8 0
Himachal Pradesh 12 1109 25 0
Jammu & Kashmir 14 273 2 0
Jharkhand 24 122 1 0
Karnataka 27 589 122 2 57
Kerala 14 740 124 0
Madhya Pradesh 50 1427 34 0
Maharastra 23 469 55 0
Manipur 7 0 0 4 8
Meghalaya 5 12 1 0
Mizoram 8 0 0 0
Nagaland 11 85 0 0
Orissa 32 624 8 0
Punjab 20 507 15 0
Rajasthan 33 3539 100 0
Sikkim 4 1 1 0
Tamil Nadu 27 35 7 104 100
Tripura 2 55 1 0
Uttar Pradesh 71 340 1771 0
Uttaranchal 18 467 7 0
West Bengal 16 295 4 0
Andaman & Nicobar 3 5 1 0
Chandigarh 1 6 1 0
Dadra and Nagar Haveli 1 3 0 0 1
Daman and Diu 2 1 0 0
Lakshadweep 1 2 0 0
New Delhi 9 148 10 0
Pondicherry 4 16 1 0
Total 578 13796 2378 228 645

Infrastructure – Homeopathic Dispensary & Hospitals, Medical Colleges, Unani Dispensaries/Hospitals

State Homeopathic Dispensary Homeopathic Hospitals Medical Colleage Rural Dispensaries Unani Dispensaries Unani Hospitals
Andhra Pradesh 286 6 32 196 6
Assam 75 3 3 1 -
Arunachal Pradesh 44 2 - -
Bihar 179 11 8 366 144 4
Chhattisgarh 52 3 3 6 1
Goa 59 1 1 - -
Gujarat 216 14 13 8347 - -
Haryana 20 1 3 19 1
Himachal Pradesh 14 1 2 3 -
Jammu & Kashmir 0 0 4 235 2
Jharkhand 54 2 3 30 -
Karnataka 42 20 36 176 51 13
Kerala 580 33 18 1 -
Madhya Pradesh 146 22 8 50 2
Maharastra 0 45 39 25 5
Manipur 9 1 1 42 - -
Meghalaya 10 7 - -
Mizoram 1 0 - -
Nagaland 115 1 - -
Orissa 603 6 4 9 -
Punjab 107 5 7 35 -
Rajasthan 178 9 8 102 3
Sikkim 1 0 1 - -
Tamil Nadu 46 9 25 1421 21 1
Tripura 93 1 2 - -
Uttar Pradesh 1482 8 16 49 210
Uttaranchal 60 1 3 3 2
West Bengal 1220 12 9 3 1
Andaman & Nicobar 15 1 - 1
Chandigarh 5 1 1 - -
Dadra and Nagar Haveli 1 0 3 - -
Daman and Diu 0 0 - -
Lakshadweep 1 0 - -
New Delhi 98 2 5 25 2
Pondicherry 7 0 8 - -
Total 5819 228 263 10355 1008 254

State wise Population to Infrastructure availability

State Population Sub Center PHC CHC Doctor
Andaman & Nicobar Islands* 356,265 3,125 18,751 89,066 4,880
Andhra Pradesh 75,727,541 6,048 48,234 453,458 34,204
Arunachal Pradesh 1,091,117 1,843 9,406 24,798 12,542
Assam 26,638,407 5,801 31,562 258,625 65,290
Bihar 82,878,796 9,356 50,505 1,183,983 52,958
Chandigarh* 900,914 64,351 450,457
Chhatisgarh 20,795,956 4,386 28,843 152,911 24,125
Dadra & Nagar Haveli* 220,451 5,801 36,742 220,451 36,742
Daman & Diu* 158,059 7,185 52,686 158,059 26,343
Delhi* 13,782,976 336,170 1,722,872 599,260
Goa 1,343,998 7,814 70,737 268,800 30,545
Gujarat 50,596,992 6,956 47,155 185,337 49,654
Haryana 21,082,989 8,665 50,198 245,151 60,237
Himachal Pradesh 6,077,248 2,934 13,535 83,250 14,932
Jammu & Kashmir 10,069,917 5,281 26,853 118,470 22,328
Jharkhand 26,909,428 6,799 81,544 138,708 81,544
Karnataka 52,733,958 6,476 24,025 163,263 18,562
Kerala 31,838,619 6,250 35,026 297,557 18,383
Lakshadweep* 60,595 4,328 15,149 20,198 10,099
Madhya Pradesh 60,385,118 6,836 52,554 223,649 57,951
Maharashtra 96,752,247 9,146 53,278 237,721 81,236
Manipur 2,388,634 5,687 33,175 149,290 20,771
Meghalaya 2,306,069 5,751 22,389 88,695 21,755
Mizoram 891,058 2,435 15,633 99,006 17,136
Nagaland 1,988,636 5,009 23,124 94,697 25,173
Orissa 36,706,920 5,488 28,700 158,904 27,130
Pondicherry* 973,829 12,647 24,970 243,457 14,321
Punjab 24,289,296 8,499 50,184 192,772 120,842
Rajasthan 56,473,122 5,257 37,574 161,814 36,623
Sikkim 540,493 3,677 22,521 135,123 12,869
Tamil Nadu 62,110,839 7,134 51,120 301,509 27,483
Tripura 3,191,168 5,512 41,989 290,106 12,514
Uttar Pradesh 166,052,859 8,092 45,001 322,433 82,985
Uttaranchal 8,479,562 4,804 35,479 154,174 9,792
West Bengal 80,221,171 7,746 86,819 229,860 99,038
Total 1,027,015,247 7,033 2,988,332 7,595,753 1,830,246

I will append more information as I get to learn more.

Most of the data was taken from Ministry of Family and Child Welfare (http://www.mohfw.nic.in) and also from search, papers and other websites. I ensured that I do not violate any copyright information.

9 Comments

  1. Hi Hari,

    Thanks you for this information. This is a thorough analysis of the resource availability in India. Hopefully more people like you can carry out this kind of work and drive for a change. This lies in conjunction with curative and palliative medicine, however I believe with the increasing incidences of cases moving towards Non-communicable diseases [NCDs] or chronic diseases like diabetes, heart diseases, obesity among other NCDs, our government needs to pay more attention in adapting a preventive care approach to arrest the further spread of such NCDs by developing a public health model in India. The Ottawa Charter (1986) by the WHO outlines how public health can be approached.

  2. Thanks Rajiv. Yes, what you say is correct. This is the first part of my blog. Working on few suggestions and ideas around how we can improve this and also bring to light many organizations which are working towards addressing them.

  3. Thanks Arun

  4. Hello Hari,

    Thanks for such informatics article. This is a good analysis of the resource availability in India. It is good to found that Maharashtra is good at some places but their are still something we have to achieve to make good state.

  5. Thank you Mr. Vijay

  6. Please contribute with us to get change in Healthcare industry
    give your ideas, share views ….

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  7. Very useful compilation. However in the manpower table some corrections are essential. PHC is not supposed to have specialists like Obstetrician or Physisian.

  8. Hello Prakash. I do agree with you. But this is the information I have compiled from MoH & FW notes and web site. Looking at the numbers (which are very small when compared to the population and needs) I am assuming that they are more required in areas where Secondary/Tertiary Care is geographically far.

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