J. Multidiscip. Res. Healthcare

Rural Healthcare Infrastructural Disparities in India: a Critical Analysis of Availability and Accessibility

Mohd Taqi, Swati Bidhuri, Susmita Sarkar, Wani Suhail Ahmad, Padma Wangchok

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Rural, Healthcare, Disparity, Availability, Accessibility.

PUBLISHER The Author(s) 2017. This article is published with open access at www.chitkara.edu.in/ Publications

Health and well being of human resource plays an important role in the economic as well as social development of the country. To ensure better health of the people an adequate healthcare infrastructure is of primary importance. Inadequate infrastructure generally leads to poor quality of health services which is positively dangerous to health and welfare of the community at large. About 68% of India’s population still lives in rural areas, yet healthcare infrastructures in these areas are in pathetic condition. There are very few government health centers and even those are devoid of most of the medical facilities and personnel’s. Although the National Rural Health Mission (NRHM), launched in 2005 has made significant progress in the healthcare infrastructure (mainly in physical infrastructure) in rural areas and has impacted the lives of rural masses to some extent but it has simultaneously failed to bring desired results because of lack of implementation. So the accessibility and availability of health facilities as well as delivery of quality services in the rural areas deserve considerable attention from planners, researchers and healthcare workers. In this context, the present paper critically examines and evaluates the disparities in availability as well as accessibility of health infrastructure in rural areas of India.


The health and well being of the people of a country largely depends on well developed, accessible and effective healthcare infrastructure. Also healthcare infrastructure is an important indicator for analyzing the healthcare policy and welfare mechanism in the country. India is 2nd most populous country in the world, and it also has largest rural population in the world. Although India has achieved robust economic growth in the last few decades and has become one of the world’s fastest and most dynamic big economies, it has performed poorly in terms of health sector development. Today health sector in India particularly in rural areas is in a debilitating condition with lack of proper physical infrastructure, manpower and necessary drugs.

Recognizing the importance of health and well being of the people in development and also the importance of healthcare infrastructure in improving health, the Government of India launched the National Rural Health Mission (NRHM) in 2005 to strengthen the rural healthcare infrastructure in the country. The NRHM aims to provide an efficient and effective healthcare to the underserved rural areas in the country with special focus on the availability, accessibility, equitable and affordable health care services.

Although India has achieved considerable progress in health infrastructure under NRHM launched in 2005, the progress has been quite uneven across regions with large-scale interstate disparities in terms of availability and accessibility of healthcare services. The major issues in the rural healthcare are

  • Inadequate health infrastructure.
  • Lack of proper healthcare facilities and skilled human resource in the existing health centres.
  • Inefficiency and in accessibility of healthcare infrastructure in terms of population coverage.
  • Lack of connectivity in the healthcare centres at different levels. Thus in context of the issues given above, the paper seeks to analyze the present scenario of disparities in the availability and accessibility of healthcare infrastructure in rural areas.
Page(s) 125–149
URL http://dspace.chitkara.edu.in/jspui/bitstream/123456789/672/1/32011_JMRH_Taqi.pdf
ISSN Print : 2393-8536, Online : 2393-8544
DOI http://doi.org/10.15415/jmrh.2017.32011

Healthcare infrastructure, be it physical or human resources forms a critical part of health service delivery in a whole healthcare system. Efficient and effective delivery of healthcare services depends on the availability and accessibility of health infrastructure for the people. Unfortunately health care system in rural India has remained inefficient and sub optimal even after decades of planned development. The country is lagging in terms of both availability and accessibility of healthcare infrastructure at all levels as revealed by the above discussion. Thus the major findings from the study can be summed under following sub headings.

6.1 Availability of physical infrastructure and human resources.

As far as availability of physical infrastructure is concerned only seven states viz. Jammu and Kashmir, Himachal Pradesh, Uttarakhand, Rajasthan, Goa and Kerala had surplus of SCs, PHCs and CHCs. But at the national level India still have 20%, 22% and 32% shortfall in SCs, PHCs and CHCs respectively in rural areas. On the other hand the situation of human resource availability is not much different as India have 32% and 81% shortfall at SCs and CHCs. About 10% of the available PHCs in India are still functioning without a single doctor, added to that there is 36% shortfall in the paramedical staff at PHCs and CHCs with 13 states having shortfall above national average.

6.2 Rural healthcare accessibility.

Considering the accessibility of healthcare, the situation is not much better as most of the states in northern, central, and eastern India particularly Bihar and Uttar Pradesh are serving population much more than the average population as per specified population norms at all levels. Coming to the ratio of doctors to the population states like West Bengal, Uttar Pradesh, Jharkhand, Chhattisgarh, Madhya Pradesh etc. have a very poor ratio of population to doctors (i.e. above 1:50000), however most of the south, north, and north eastern states of India have an optimum ratio (i.e. below 1:30000). As far as ratio of specialists to population are concerned not a single state in the country has an optimum ratio. In some states like Bihar, Arunachal Pradesh, Himachal Pradesh, Meghalaya and Tripura the ratio is as high as above 1:800000 with Bihar being the highest I.e. 1:1400000. On the other hand states like Goa, Jammu and Kashmir, Karnataka, Maharashtra, Odisha etc has an optimum ratio of specialist to the population.

Accessibility to health centres through proper all weather road connectivity is as important as the availability of proper infrastructure. Unfortunately considering the facts, 22 out of 29 states in India still have SCs without proper road connectivity, on an average there are about 10 percent SCs without proper road connectivity. In terms of PHCs, 20 out of 29 states lack proper road connectivity. Nationally, 8 percent of PHCs in India does not have proper road connectivity.

Considering the above grim facts it can be finally concluded that healthcare infrastructure in India be it physical or human is inadequate and inefficient to cater the needs of rural population. Rural healthcare in India has always remained sub-optimal and has not reached to the level of satisfaction. However encouraging fact is that rural healthcare system in India has made terrific progress in the recent past. But the discouraging fact it that the progress has remained confined only to some states of the country (mostly south Indian states).

Such a grim situation of rural healthcare infrastructure may be attributed to many underlying factors, which includes inadequate budgetary provisions, administrative mismanagement, shortage of human resource, infrastructural inefficiency and the complacency unwillingness of the government among all. Further, there is no transparency and accountability in the functioning of these health institutions which keeps them at their lowest.

6.3 Suggestions

So the rural healthcare system in India needs a comprehensive overhaul in order to make it adequate and efficient so that rural people can take maximum benefit from it. Following feasible suggestion could be made in this direction.

  • Provide adequate budgetary provisions to health sector in order to overcome the shortfall of health centre’s at various levels, because the present budget allocations for health sector is not sufficient to fulfill the needs of rural masses. However national health policy 2017 aims to increase the public expenditure to 2.5% of GDP from current 1.4% which would hopefully improve the present situation.
  • Strengthen the regulatory mechanism and healthcare at any level should make to strictly follow the Indian Public Health Standards (IPHS) to ensure quality management and effective, economical and accountable healthcare delivery system.
  • Immediate need is to appoint the suitable Personnel where it is lacking.
  • Provide adequate facilities in the existing health centre.

Limitations of the Study

  • The study is completely based on secondary data because it is impossible to collect primary data for such a large scale study.
  • The analysis in present study is mostly quantitative and descriptive in nature. No specific statistical tools have been used.
  • Data was not available on some of the other important parameters to assess the availability and accessibility of healthcare.
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