Status of Public Healthcare Infrastructure and Workforce in Rural India
India's rural healthcare system is in dire need of better infrastructure and more workforce.
22 August 2022 by Ashish Khandalikar
The National Rural Health Mission (NRHM) was launched in the year 2005 to strengthen the rural public health system in India. The Union Health Ministry claims that it has since met many hopes and expectations. However, the recent Rural Health Statistics (RHS)1 report tells a different story.
The structure of the public healthcare system in rural India consists of sub centres (SCs), primary health centres (PHCs) and community health centres (CHCs). As of March 2021, only a small percentage of these function as per Indian Public Health Standards (IPHS)2. Out of the 5,183 CHCs in the country, only 439 or 5.6 per cent follow IPHS guidelines. Similarly, out of the 24,918 PHCs, only 3,278 or 10.5 per cent and out of the 155,404 SCs, only 5,363 or 2.8 per cent follow the guidelines. IPHS guidelines were released by the Union Health Ministry in 2007, two years after NRHM to ensure the quality of healthcare in rural India. To know more about the centres and the IPHS guidelines please refer to the footnotes.
Statewise Distribution and Status of Healthcare Centers in Rural India
Apart from IPHS, the RHS report also provides information on the status of infrastructure facilities available at these centres. Each type of centre is supposed to have certain facilities. For example, the SCs, which are located in some of the remotest parts of the country, are expected to just have regular water and electricity supply; each SC is expected to have a male and a female health worker. PHCs, the first contact points between patients and a doctor, are expected to have operation theatres (OTs), referral transport and function 24x7 amongst other facilities. The CHCs, which are the largest amongst the three, are expected to have facilities like X-Ray machines, a functional laboratories and at least 30 beds amongst other facilities.
The following Chart 2A shows the number of centres that are required in each state, the number of centres that are present and the number of centres that have a certain infrastructure facility. Please use the dropdown menu on the top to select the type of centre and the type of facility to access the full list of facilities that should be present at each level. The list for facilities would change based on the type of centre selected. For example, the current view shows that Uttar Pradesh has the maximum number of SCs in India as of 2021 and out of 20,788 of them 19,088 (91.9 per cent) centres have regular water supply. Still, the state has a shortage of 14,695 centres.
Doctors and Nurses In Position across States
Workforce forms a crucial part of the infrastructure of any organisation and this is even truer in the case of healthcare. Chart 2B shows the number of doctors and nurses in position across states in rural India. Please use the dropdown menu on the top to select the type of centre and the manpower type to further filter the chart as needed. The current view shows that as of 2021, Uttar Pradesh had 60.77 per cent of doctors and nurses that its rural parts needed. Please hover on the bars to get an exact count of the ‘in position’ and ‘shortage’ values.
State Profile for Health Infrastructure and Workforce
In order to better understand one of the States in detail, Chart 3 shows three things -
- complete list of infrastructure facilities that should be present at each of the levels,
- the no. of SCs, PHCs, CHCs that are Required, Present, the no. of Centres that have a certain facility,
- the no. of Doctors and Nurses that are Required and In Position at those levels.
The Chart currently shows the data for the State of Uttar Pradesh as of 2021. Please use the dropdown menu on the top to change the State or the Year.
Changes over the Years
Since the launch of NRHM in 2005, the number of healthcare centres as well as the facilities at them has improved considerably. Likewise, the number of doctors and nurses too has increased. However, it is important to know whether these numbers have been able to keep up with the increasing requirements. The following two charts (4A and 4B) show the infrastructure and manpower changes from 2017 till 2021. Chart 4A currently shows the number of SCs, PHCs and CHCs that are required, present and the ones that are functioning as per IPHS in Uttar Pradesh. It can be seen that over the years, the number of SCs has increased slightly but has not been able to keep up with the increasing requirement. As for the SCs functioning as per IPHS, none of the centres qualify. (For 2021, “Functioning as per IPHS” field was removed from the data, hence the chart is left blank). Please use the dropdown menu on the top to change the state or any other facility (like with regular water supply, with X-Ray machine, etc). Please note that since the ‘facility’ dropdown is an exhaustive list of facilities, not all the facilities would be available at all the levels. For example, since SCs are the smallest units they are not supposed to have OTs or X-Ray machines. Similarly, since CHCs are the largest units, data for the number of them having facilities like regular water/ electricity supply is not recorded as all of them already have it.
Chart 4B shows the change in manpower (doctors and nurses) from 2017 to 2021 in a similar design. An additional filter for ‘manpower subtype’ has been added to filter the doctors based on the allopathy and AYUSH specialities.
All citizens in India can avail free outpatient and inpatient care at these centres. However, since a considerable number of them are neither fully staffed nor do they have the required facilities, over the years this has led to an over-dependence on private healthcare services, even if it means, patients have to pay for it themselves. For a developing nation with annual per capita income at ₹ 91,481 ($1145.50)3 these out-of-pocket healthcare payments are slowly contributing towards a financial catastrophe, especially for low and middle income households4. Recent National Family Health Survey (NFHS -5)5 highlights this issue as well. According to the survey, as high as half (50 per cent) of the households in India do not generally seek healthcare from the public sector.
To sum it up, there is a dire need to update the infrastructure facilities and increase the manpower at these centres to ensure that the 64.6 per cent7 of the Indian population that lives in rural areas has access to quality healthcare while not having to pay dearly for it.
The healthcare infrastructure in rural areas has been developed as a three-tier system. Sub centres (SCs) at the lowest level, primary health centres (PHCs) in the middle and community health centres (CHCs) at the very top.
Sub centres, as mentioned above are the most peripheral and first contact points between the healthcare system and the community. There are no doctors here but they are manned by female and male health workers who are assigned tasks relating to interpersonal communication in order to bring about behavioural change and provide services in different programmes like maternal and child health, family welfare, nutrition and immunisation.
Primary health centres are the first contact points between village community and the medical officers. The PHCs provide an integrated curative and preventive healthcare to the rural population with emphasis on preventive and promotive aspects. They also act as a referral unit for six sub centres and have 4-6 beds for patients.
Community health centres are much larger facilities and manned by four medical specialists i.e., surgeon, physician, obstetrician/ gynaecologist and paediatrician who are supported by paramedical and other staff. A CHC has 30 in-door beds with one OT, X-ray, labour room and laboratory facilities. It serves as a referral centre for four PHCs and also provides facilities for obstetric care and specialist consultations6.
Ministry of Health and Family Welfare:
National Health Mission: http://nhm.gov.in/index1.php
Business Standard News article: shorturl.at/dpuvY
Trends in catastrophic health expenditure in India: 1993 to 2014. Link: http://dx.doi.org/10.2471/BLT.17.191759
The National Family Health Survey (NFHS) is a large-scale, multi-round survey conducted in a representative sample of households throughout India. For more information please visit:
For more information on the structure of the healthcare facilities please visit: https://hmis.nhp.gov.in/#!/
The Global Economy: shorturl.at/BCMOW