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Amid pandemic tragedy, an opportunity for change?

Alvin Powell

Harvard Staff Writer

Mittal Institute/Lancet commission to study universal care in India

With almost 11 million cases and more than 150,000 deaths, India is among the nations hardest-hit by the coronavirus pandemic. The Asian giant has also taken an economic hit, its gross domestic product expected to shrink 8 percent this year.

The figures have starkly highlighted the connection between a nation’s physical and economic health, and the Harvard chairs of a new panel seeking to overhaul and improve health care in India say today’s difficult times create a moment of opportunity because people who often tune each other out are now listening.

“For the first time the connection between health and economic outcomes has become transparent,” said Tarun Khanna , director of Harvard’s Lakshmi Mittal and Family South Asia Institute and one of four co-chairs of a new Lancet Citizens’ Commission to study how to bring universal health care to India. “The morality of universal health care has always been a driver of this urgency, but that’s not the new thing here. Rather, for the first time in 30 years GDP is expected to fall in response to a health crisis.”

The 21-member commission is a joint effort between The Lancet medical journal and Mittal Institute. The panel is chaired by Khanna; Vikram Patel , the Pershing Square Professor of Global Health at Harvard Medical School ; Professor Gagandeep Kang, vaccine researcher at Christian Medical College in Vellore, India; and Kiran Mazumdar-Shaw, executive chairperson of Indian biotech company Biocon Ltd and one of India’s top businesspeople. S.V. Subramanian , professor of population health and geography at the Harvard T.H. Chan School of Public Health , is a member of the commission.

The group’s charge is to report by August 2022 how India can achieve universal health care within a decade. The Mittal Institute is encouraging participation by the Harvard community and sponsoring an online panel discussion on Monday to introduce the effort.

Patel and Khanna said the commission has a challenging road ahead, one that has proven too difficult for an array of efforts studying the same question in the decades since India became independent in 1947.

Most of the nation’s 1.4 billion residents (a population second only to China) view the current publicly-funded system as so bad that even the poorest Indians would rather pay out-of-pocket for care in a network of private providers, itself sometimes seen as uncaring and untrustworthy. The end result is that more than 60 percent of Indian health care is paid for out-of-pocket, and a sudden illness can mean financial ruin for millions. Only the wealthy can afford regular, high-quality care.

Sandeep Praharsha (India Fellow) discussing preventive measures for malaria in Kerpai village in Thumul Rampur block of Kalahandi district in Odisha Swasthya Swaraj.

“Today, India’s health care system is routinely ranked as one of the worst in the world,” Patel said. “A few get expensive, world-class care, while a large part of the population doesn’t even get basic quality care.”

Where the current commission differs from prior efforts is that it is based on a consultative effort to seek input from an array of stakeholders, including representatives of the private health care sector, providers of traditional medicine, physicians, community health workers, and citizens from diverse communities across the country.

“It genuinely is a cross-section of society,” said Khanna, HBS’ Jorge Paulo Lemann Professor. “That makes consultation more complex, but the potential for achievement is large.”

The eventual report will focus on the “architecture” of a new system, according to an article by the initiative’s co-chairs and commissioners in The Lancet in December. It will include ways to provide preventive care for physical and mental health, offer financial protection for all health care costs, not just hospitalization, and ensure access to the same quality of care for all.

“We aspire for a health care system in which most people do not pay out-of-pocket for most health care needs,” Patel said. “The last thing a sick person needs is to have their care calibrated by how much they can afford to pay or to be impoverished by their medical bills.”

Resources are always a key issue in consideration of universal health care and India — whose proportion of GDP spent on health care is low compared with other middle-income countries — will likely have to spend more, Khanna said. But he also said that significant low-cost steps probably could be taken early in the process.

“I think we can improve outcomes with existing resources being better managed,” Khanna said. “We can get some victories in the next two to three years through optimization of existing structures.”

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Improving Health in India

As the world’s second-most-populous country and one of its fastest-growing economies, India faces both unique challenges and unprecedented opportunities in the sphere of public health.

For more than a decade, India has experienced record-breaking economic growth that has been accompanied by significant reductions in poverty. According to the World Bank, infant mortality in India fell from 66 to 38 per 1,000 live births from 2000 to 2015. Life expectancy at birth has increased from 63 to 68 years, and the maternal mortality ratio has fallen from 374 to 174 per 100,000 live births over the same period.

India also has dynamic pharmaceutical and biotechnology industries; world-class scientists, including a burgeoning clinical trials industry; and leading hospitals that attract foreign patients and treat its better-off citizens.

Yet Indian government and public health officials agree that the country also faces persistent and daunting public health challenges, particularly for the poor. These include child undernutrition and low birth weights that often lead to premature death or lifelong health problems; high rates of neonatal and maternal mortality; growth in noncommunicable diseases such as obesity, diabetes, and tobacco use, leading to cancer and other diseases; and high rates of road traffic accidents that result in injuries and deaths.

As the Indian government strives to provide comprehensive health coverage for all, the country’s rapidly developing health system remains an area of concern. There are disparities in health and health care systems between poorer and richer states and underfunded health care systems that in many cases are inefficiently run and underregulated. New government-financed health insurance programs are increasing coverage, but insurance remains limited.

Public and private health systems are placing huge demands on the country’s capacity to train exceptional health leaders and professionals. Rising to meet these challenges, the people of India have an opportunity to have a major influence on their own future health and on the future of public health and medical efforts globally.

Supporting Development of India’s Health Workforce

The Harvard T.H. Chan School of Public Health is collaborating with partners across India to address those challenges. Together, the School and its partners are introducing educational innovations to India to expand skills training, degree programs, and leadership development at new schools and institutes of public health. We seek to leverage the School’s resources to help strengthen public health training and build capacity across the health sector in India.

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Indian Health Sector: Opportunities and Challenges

Published: 10th Apr, 2021

In Budget 2021 health sector is focused on by Government, which was severely hit by the unprecedented pandemic. The focus has been laid on healthcare and infrastructure with an eye on achieving the vision of Atmanirbhar Bharat.

  • The unprecedented COVID-19 pandemic has completely changed the situation no one could ever imagine. Almost all aspects of society have witnessed disruptions.
  • However, every challenge comes with various opportunities, so does this pandemic.
  • It has opened a wide window of opportunities to restructure and reform the Indian health industry which has been in a bad state of repair.
  • Underscoring the significant importance of health and wellbeing for the growth and development of the country, the Budget allocation for the same was increased to ?2,23,846 crore in 2021-22 as against this year's ?94,452 crores, according to an official release.
  • This manifests into an increase of 137%.

Assessing Indian Healthcare Industry

  • In India, the Health care sector is one of the largest sectors in terms of both revenue and employment.
  • Public health care hospitals comprise secondary and tertiary care institutions in urban areas while primary basic facilities are focused in rural areas.
  • Private health care sectors provide secondary, tertiary, and quaternary services in metro cities.

Healthcare Industry in India

essay on health sector in india

What are the issues and concerns of the Sector?

India’s health care sector has achieved some positive achievements on the health indicators but suffers some serious shortcomings in care delivery.

  • Inadequate reach: The inadequate reach of basic healthcare services, shortage of medical personnel, quality assurance, the inadequate outlay for health, and most importantly insufficient impetus to research.
  • Inadequate Fund: The inadequate fund allocation by the administrations is one of the grave concerns.
  • Optimal Insurance: The concept of health insurance is still not clear in India and the market is still virgin.
  • No focus on Preventive Care : In India, there is a very low emphasis on preventive care, which can be proved very effective in solving a lot of problems for the patient in terms of misery or financial losses.
  • Less emphasis on Medical Research: In India, there is no much impetus is being given to R&D and cutting-edge technology-led new initiatives. Such technologies could be useful in an unprecedented situation like Covid-19.
  • Issue of Policymaking: For providing effective and efficient healthcare services policymaking is certainly an important aspect. In India, the problem is fundamental of supply than demand, where policymaking can be effective.
  • Shortage of Medical Workforce: In India, there is a shortage of doctors, nurses, and other staff in the health sector. As per a report laid down by a minister in Parliament, there is a shortage of 600,000 doctors in India.
  • Inadequate outlay for health: As per National Health Policy 2002, India contributes only 0.9 percent of its GDP to the Health care sector.
  • Lack of structure: Private hospitals are expensive and public hospitals are either not enough for the Indian Population or lack the basic facilities.

Opportunities in Health Care Sector

  • Indian health care sector is expected to increase to Rs. 8.6 trillion (US$ 133.44 billion) by 2022. It is almost three times which is what it’s now in present.
  • Data Analytics: With the arrival of the National Digital Health Mission (NDHM), the digital Health ID will come which will store the data of patients. It would help in effective policymaking and private players can get an edge in introducing the new technologies in the market.
  • Employment opportunity: As we know Indian health care sector lacks a workforce, there is a space for thousands of employees.
  • Start-ups: With the help of Government and private players an environment of start-ups and entrepreneurship can be created in this field.
  • Medical Tourism: India is already one of the favorite medical Tourism Destinations in the world and in the upcoming years this sector can be harnessed efficiently.

What measures are required in the sector?

  • Improving infrastructure: There is a need of improvising the infrastructure of public hospitals which have a lot of burden due to the high population in India.
  • Focus on private hospitals: Private hospitals must be encouraged by the government because their contribution is important. Private sector also needs to participate because the challenges are significant and these cannot be resolved only by the government alone.
  • Efficiency enhancement: More medical personnel must be recruited to enhance the capabilities and efficiency of the sector.
  • Technology utilisation: Technologies must be used to connect the dots in the health system. Medical devices in hospitals/ clinics, mobile care applications, wearables, and sensors are some forms of technology that should be added in this sector.
  • Awareness: People should be made aware of early detection and preventive care. It would help them in saving pocket expenditure also.

The year 2021 could be the year when India consolidates and expands on its social determinants of health (SDH) approach. India now needs to sustain its current interest in strategic health policy as a key pillar of the economy.

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The Transformation of The Indian Healthcare System

Ankit kumar.

1 Respiratory Medicine, King George's Medical University, Lucknow, IND

The Indian healthcare system is a diverse and complex network of public and private sectors that provide a wide range of medical services to India's 1.4 billion inhabitants. Despite undergoing significant changes over the years, the system continues to face multiple challenges. These challenges include inadequate infrastructure, a shortage of healthcare professionals, urban-rural disparities, limited health insurance coverage, insufficient public healthcare funding, and a fragmented healthcare system. India is grappling with a growing burden of non-communicable diseases, which poses a significant challenge to its healthcare system.

The Indian government has initiated multiple programs to improve the healthcare system. The National Health Mission improves the availability of medical equipment and supplies. This also promotes community participation and engagement in healthcare decision-making and service delivery. The Ayushman Bharat scheme is a health insurance program that provides coverage of up to INR 5 lakhs per family per year for secondary and tertiary care hospitalization.

The Indian healthcare system is also witnessing multiple healthcare innovations, ranging from low-cost medical devices to innovative healthcare delivery models. The country's healthcare regulatory system is evolving to ensure patient safety, promote high-quality care, and control costs.

Furthermore, India has emerged as a leading destination for medical tourism due to the relatively low cost of medical procedures, the availability of skilled doctors, and advanced technology. Factors such as cost-effective treatment, advanced technology, a wide range of specialities, alternative medicine, English language proficiency, and ease of travel have contributed to India's growing medical tourism industry.

The Indian healthcare system has made significant progress in recent years. The positive transformation of the Indian healthcare system involves a range of changes and initiatives. Despite challenges, the continued investment in healthcare and innovation provides reasons to be optimistic about the future of healthcare in India.

The structure and organization of healthcare systems vary widely across different countries and regions. Some countries have a predominantly public healthcare system, where the government is responsible for providing healthcare services to the population. Other countries have a predominantly private healthcare system where healthcare services are provided by private hospitals. A well-functioning healthcare system provides high-quality healthcare services to the people, and it should be accessible, affordable, and sustainable over the long term [ 1 ].

The Indian healthcare system is a complex and diverse network made up of the public and private sectors, which offer a range of medical services and infrastructure to the 1.4 billion people living in India. It has undergone significant transformations over the years but still faces several challenges. The public sector includes primary, secondary, and tertiary care facilities managed by the central and state governments. Primary healthcare services are the individual's first point of contact and are provided through primary health centers, community health centers, and sub-centers. Secondary care focuses on acute and specialist services provided by district hospitals. Tertiary care refers to advanced medical services, including specialty and super-specialty services provided by medical colleges. The private sector consists of individual practitioners, nursing homes, clinics, and corporate hospitals [ 2 ].

The Indian healthcare system faces several challenges that impact its ability to deliver quality healthcare services to its large and diverse population [ 3 ]. Some of the key challenges are:

Inadequate infrastructure

India has a shortage of healthcare facilities, especially in rural areas, where the majority of the population resides. Many primary health centers and sub-centers lack essential infrastructure, medical equipment, and resources, making it difficult to provide even basic healthcare services to the population. The insufficient number of healthcare facilities, poorly maintained facilities, inadequate medical equipment and resources, and limited access to advanced healthcare services exacerbate the existing challenges in providing quality healthcare services to the population [ 3 ].

Shortage of healthcare professionals 

India has a significant shortage of healthcare professionals, including doctors, nurses, and paramedical staff. This is a critical challenge facing the Indian healthcare system, affecting the quality and accessibility of healthcare services across the country. The scarcity of trained medical staff has consequences like inadequate patient care. This is particularly evident in rural areas, where the majority of the population resides but has limited access to trained medical professionals. The limited capacity of medical and nursing schools to train healthcare professionals is a contributing factor to the shortage of skilled staff.

Urban-rural disparities

There is a marked disparity in the quality and accessibility of healthcare services between urban and rural areas. Urban areas tend to have better infrastructure, access to skilled professionals, and availability of specialized care, while rural areas often struggle with inadequate facilities and limited human resources.

Financial constraints and health insurance

The high out-of-pocket expenses for healthcare services can be a major burden for many Indians. Health insurance in India is not as widespread as in some other countries. This can lead to delayed or avoided treatments, causing further complications and health issues.

Insufficient public healthcare funding

The Indian government's expenditure on healthcare has historically been low compared to other countries, which contributes to the inadequacy of public healthcare facilities and the high reliance on private healthcare services, which may not be affordable for all citizens.

Fragmented healthcare system and inequity in access to care

The Indian healthcare system is characterized by a complex mix of public and private providers with varying degrees of quality and regulation. Socioeconomic disparities and regional differences in access to healthcare services result in unequal healthcare outcomes for different population groups, with poorer communities and those living in remote areas often facing greater challenges in accessing quality healthcare.

Growing burden of non-communicable and communicable diseases

Non-communicable diseases, such as diabetes, cardiovascular diseases, and cancer, have been on the rise in India, putting additional strain on the healthcare system. Despite progress in recent years, India still faces challenges in controlling communicable diseases like tuberculosis, malaria, and HIV/AIDS, which continue to pose significant public health risks.

The positive transformation of the Indian healthcare system is a multifaceted and ongoing process that involves many different changes and initiatives. The statistical data shows that the average life expectancy at birth in India has increased by approximately three years in the last ten years. The government has been working to improve the healthcare system through various initiatives to strengthen primary, secondary, and tertiary healthcare services. The Indian government spent two percent of India's gross domestic product (GDP) on healthcare in financial year 2022 and is forecast to reach over 2.5% of the GDP by 2025. In the financial year 2022, the government of India allocated approximately 860 billion Indian rupees to the Ministry of Health and Family Welfare in the Union Budget. The health tech sector in India secured private equity and venture capital investments worth nearly 1,740 million U.S. dollars in 2021. India's healthcare sector was worth about 280 billion U.S. dollars in 2020, and it was estimated to reach up to 372 billion dollars by 2022. The country's healthcare market had become one of the largest sectors in terms of revenue and employment, and the industry was growing rapidly [ 2 ].

Indians spend approximately 20 percent of their health spending as an out-of-pocket expenditure. In 2019, Indians spent around 55 percent of their total health spending as an out-of-pocket expenditure. This was at 74 percent in 2001, showing a gradual decrease in the share of healthcare expenses that people pay directly to the providers [ 2 ].

Some of the key elements of this positive transformation of India's healthcare system are the National Health Mission, Ayushman Bharat, and medical tourism.

The National Health Mission (NHM) was launched in 2013 and comprises the National Rural Health Mission (NRHM) and the National Urban Health Mission (NUHM). The NHM aims to strengthen primary healthcare infrastructure and services by upgrading existing facilities, building new ones, and improving the availability of medical equipment and supplies. This initiative also seeks to enhance human resources for health by training and recruiting more doctors, nurses, and paramedical staff, especially in rural areas. The NHM also aims to improve maternal, neonatal, and child health by expanding access to essential services such as antenatal care, skilled birth attendance, and immunization programs. Finally, it targets communicable and non-communicable diseases through targeted interventions and public health campaigns. The National Health Mission was allocated a budget of over 290 billion Indian rupees for the financial year 2024 [ 2 ].

Ayushman Bharat is another flagship healthcare initiative launched in 2018. This scheme provides financial protection and health coverage to India's vulnerable populations through Health and Wellness Centers (HWCs) and the Pradhan Mantri Jan Arogya Yojana (PMJAY). As of December 2022, there were about 117 thousand Ayushman Bharath Health and Wellness Centers (AB-HWCs) across India. AB-HWCs provide free essential medicine, diagnostic services, and teleconsultation. The HWCs aim to provide comprehensive primary healthcare services to rural and urban populations, including preventive, promotive, and curative care. The HWCs focus on maternal and child health, non-communicable diseases, communicable diseases, and palliative care while providing essential drugs and diagnostic services. The PMJAY is a health insurance scheme that provides coverage of up to INR 5 lakhs per family per year for secondary and tertiary care hospitalization. This initiative targets approximately 100 million economically disadvantaged families, covering around 500 million beneficiaries, and covers a range of medical procedures and treatments at empanelled hospitals. PMJAY aims to reduce out-of-pocket expenses and improve access to quality healthcare for India's poorest and most vulnerable populations. Over 217 thousand public health facilities were reported in India as of the financial year 2022. Over 1.4 billion services were performed by outpatient departments across India, a significant increase from the previous year's value of over 1.1 billion [ 2 ].

Digital healthcare

The shift towards digital healthcare in India is transforming the way healthcare services are delivered, particularly in remote areas. Telemedicine, digital health records, and mobile health apps are all being used to improve healthcare service quality and efficiency [ 4 ].

Non-communicable disease prevention and management

India is facing a growing burden of non-communicable diseases, but there are efforts underway to prevent and manage these diseases. This includes initiatives to promote healthy lifestyles, increase awareness of disease prevention, and provide specialized care and treatment for those with chronic conditions.

The penetration of health insurance across India stood at around 35 percent as of the financial year 2018. This was a slight increase compared to the previous year, when penetration levels were about 33 percent. In the financial year 2021, nearly 514 million people across India were covered under health insurance schemes, and the value of premiums for the government-sponsored health insurance schemes across India aggregated to around 43 billion Indian rupees [ 2 ].

Healthcare innovation and regulation

There are many examples of healthcare innovation happening in India, from low-cost medical devices to innovative healthcare delivery models. These innovations have the potential to improve healthcare outcomes and reduce costs in the long term. India's healthcare regulatory system is evolving to ensure patient safety, promote high-quality care, and control costs. The government is taking steps to streamline the regulatory system and ensure that healthcare providers adhere to high standards of care [ 5 ].

The private healthcare sector in India plays a vital role in achieving universal health coverage, as recognized by the government. India offers healthcare services at comparatively low costs, attracting international patients seeking quality treatment at affordable prices. The private healthcare sector has made significant advancements in infrastructure, technology, specialized services, and healthcare access. Private healthcare providers have invested in modern hospitals, clinics, and diagnostic centers equipped with advanced medical technology. They have embraced digital innovations such as electronic medical records, telemedicine, health apps, and remote monitoring systems to improve patient care. Increased health insurance coverage has facilitated access to private healthcare services, with insurance companies collaborating with private hospitals and clinics. The government has encouraged public-private partnerships to enhance healthcare access and infrastructure, particularly in underserved areas. Collaborative efforts between the public and private sectors, along with targeted interventions, can help bridge gaps and create a more inclusive healthcare system.

Medical tourism

India has become a popular destination and thrived due to the availability of advanced treatments at relatively lower costs, the availability of skilled doctors and advanced technology in private hospitals contributing to foreign exchange earnings, and a positive reputation. India has emerged as a popular destination for medical tourism in recent years, attracting patients from around the world. The factors contributing to India's growing medical tourism industry include cost-effective treatment, skilled medical professionals, advanced technology, a wide range of specialties, alternative medicine, English language proficiency, and ease of travel.

Despite the challenges, the Indian healthcare system has made significant positive progress in recent years, particularly in terms of expanding access to healthcare services and improving health outcomes. These government initiatives, programs, and policies address the various challenges faced by the Indian healthcare system and improve access to quality healthcare services for all citizens. The positive transformation of India's healthcare system is ongoing and involves a range of changes and initiatives. While there are still significant challenges to overcome, such as healthcare access disparities and the burden of disease, the continued investment in healthcare and innovation in the sector are reasons to be optimistic about the future of healthcare in India. However, sustained efforts and investments are required to ensure that the benefits of these initiatives reach the intended beneficiaries and lead to lasting improvements in health outcomes.

The authors have declared that no competing interests exist.

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Essay on Health Care In India

Students are often asked to write an essay on Health Care In India in their schools and colleges. And if you’re also looking for the same, we have created 100-word, 250-word, and 500-word essays on the topic.

Let’s take a look…

100 Words Essay on Health Care In India

Introduction to health care in india.

The health care system in India is a mix of public and private providers. Public health care is free or low-cost, but it’s often crowded and has limited resources. Private health care offers more services, but it’s more expensive. This system is trying to meet the needs of over 1.3 billion people.

Challenges in Indian Health Care

One big challenge is that health care is not evenly spread across India. Urban areas have more doctors and hospitals than rural areas. Many people in rural areas must travel long distances for medical care. This can delay treatment and make health problems worse.

Government’s Role in Health Care

The Indian government is working to improve health care. It has launched programs to provide free health services and insurance. These programs aim to make health care more accessible and affordable. Yet, there is still a lot of work to do to ensure everyone has access to quality health care.

Private Sector’s Influence

The private sector plays a big role in health care in India. Many people prefer private hospitals because they offer better facilities and services. But these hospitals are often too expensive for the poor. This creates a gap in health care access between the rich and the poor.

Future of Health Care in India

The future of health care in India looks promising. With advancements in technology, more services can be provided remotely. This could help reach people in rural areas. Also, the government’s continued efforts to improve public health care will hopefully reduce health disparities.

250 Words Essay on Health Care In India

Understanding health care.

Health care means looking after the health of people. It involves doctors, nurses, and other health workers. They help us when we are sick. They also help us stay healthy.

Health Care in India

In India, health care is a big challenge. There are not enough hospitals and doctors for all the people. This is more of a problem in villages than in cities.

The Government’s Role

The government of India is trying to improve health care. They have started programs like Ayushman Bharat. This program gives poor people money to pay for health care. The government is also building more hospitals.

Private Health Care

In India, there are also private hospitals and clinics. They often have better facilities than government hospitals. But they are also more expensive. Not everyone can afford them.

Challenges and Future

There are still many challenges to health care in India. There are not enough doctors. Many people cannot afford good health care. But the government is working to make things better. We hope that in the future, everyone in India will have access to good health care.

This is a simple explanation of health care in India. Remember, health care means keeping people healthy and treating them when they are sick. It is an important part of every country. In India, there are many challenges, but also many efforts to improve health care.

500 Words Essay on Health Care In India

Introduction.

Health care is a basic need for every human being. In India, the health care system is a mix of public and private providers. It includes a range of services from basic check-ups to complex surgeries. Let’s discuss more about health care in India.

Public Health Care

The government in India offers health care services through public hospitals and clinics. These are usually free or at a very low cost. This helps people who cannot afford expensive treatments. The government also runs special programs for mother and child health, disease control, and immunization.

In addition to public health care, there are many private hospitals and clinics in India. They often have more modern equipment and shorter waiting times. But, their services can be costly. So, they are mostly used by people who can afford them.

Challenges in Health Care

India faces several challenges in health care. One big problem is the shortage of doctors and nurses, especially in rural areas. Many people have to travel long distances to reach a hospital.

Another challenge is the high cost of treatments in private hospitals. Not everyone can afford them. Also, there is a lack of awareness about health and hygiene in many parts of India. This leads to the spread of diseases.

Steps Towards Improvement

The government is taking steps to improve health care in India. It has started the Ayushman Bharat scheme. This provides free health insurance to poor families. It covers the cost of treatments in both public and private hospitals.

The government is also increasing the number of medical colleges. This will produce more doctors and nurses. Efforts are being made to spread awareness about health and hygiene too.

Health care in India has come a long way. But, there is still a lot of work to be done. Everyone should have access to good health care services. It is a basic right. The government, private sector, and society must work together to achieve this goal.

In the end, we can say that health care is very important. It helps us stay healthy and live a good life. We should all do our part to improve health care in India. We can start by taking care of our own health and helping others do the same.

That’s it! I hope the essay helped you.

If you’re looking for more, here are essays on other interesting topics:

  • Essay on Health And Hygiene
  • Essay on Health And Nutrition
  • Essay on Health And Medicine

Apart from these, you can look at all the essays by clicking here .

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Indian Health Sector Problems – Can the National Health Policy 2017 Make a Change?

Last updated on March 11, 2024 by ClearIAS Team

The health sector in India faces numerous problems. With the new national health policy, the government aims to achieve better and more inclusive health standards for all. But can the National Health Policy 2017 really make a change? This article is an analysis of the problems of the health sector, solutions, and new initiatives.

Table of Contents

A background study of the Indian health scenario

National Health Policy 2017

Indian Health Sector Data: Budget Spending and Insurance Levels

  • The public expenditure on the health sector remains a dismal show of only around 1.4% of the GDP.
  • The investment in health research has been low with a modest rate of 1% of the total public health expenditure.
  • Insurance coverage remains low as per the latest NSSO reports over 80% of India’s population remains uncovered by any health insurance scheme.
  • Under the centre-run Rashtriya Swyasthya Bima Abhiyan , only 13% of the rural and 12% of the urban population had access to insurance coverage.
  • There has been a stark rise in out-of-pocket expenditure (6.9% in rural areas and 5.5% in urban areas – OOP in proportion to monthly expenditure). This led to an increasing number of households facing catastrophic expenditures due to health costs.

Indian Health Sector Data: IMR, MMR, Hunger, Non-Communicable diseases, and Mental Diseases

  • India missed by close margins in achieving the millennium development goals of maternal mortality (India – 167, MDG – 139) and under 5 child mortality rate (India 49, MDG – 42). The rate of decrements in stillbirths and neonatal death cases has been slow.
  • Nutrition status has been dismal and is one of the causes of child mortality and morbidity. As per the global hunger index  (by IFPRI), India ranks 78th among 118 developing countries (with 15% of our population being undernourished; about 15% under-5 children who are ‘wasted’ while the share of children who are `stunted’ is a staggering 39% and the under-5 mortality rate is 4.8% in India.)
  • While communicable diseases contribute 28% of the entire disease burden, non-communicable diseases (60%) show ample rise, and injuries at (12%) now constitute the bulk of the country’s disease burden.
  • India ironically has to cater to two extreme healthcare situations. They are (1) one arising out of exclusions (out of poverty or lack of proper healthcare facilities) (2) while the other is lifestyle diseases like diabetes and cardiac-related problems.
  • There has been a steady rise in mental illnesses in the country. According to a recent publication, one in every four women and 10% of men suffer from depression in India.
  • At the same time, progress has been marked in the field of communicable diseases as such. Polio has been eradicated, leprosy has been curtailed and HIV – AIDS cases have met the MDG target of being reduced by half in number.

Indian Health Sector Data:  Personnel Status

  • Health workforce density in India remains low .
  • India’s ratio of 7 doctors and 1.5 nurses per 1,000 people is dramatically lower than the WHO average of 2.5 doctors and nurses per 1,000 people .
  • The majority of the health workforce is concentrated in urban areas.
  • Furthermore, there is an acute shortage of paramedical and administrative professionals too.

Note: Taking cognizance of the prevailing situations, the Government of India has been aiming to improve the health system via various policies and initiatives. The latest National Health Policy, 2017 highlights the future aims and agendas of the government which can be summarised as follows:

What do we aim for in our current National Health policy?

The national health policy 2017.

The main objectives of the National Health Policy 2017 are as follows:

  • To achieve Universal Health Coverage by assuring the availability of free, comprehensive primary health care services, ensuring improved access and affordability, of quality secondary and tertiary care, and achieving a significant reduction in out-of-pocket expenditure due to health care costs.
  • To make a predictable, efficient, patient-centric, affordable, and effective health care system.
  • Bringing in healthy and vital private sector contributions.
  • By increasing public investment (raise it to 5% of the GDP ).
  • To coordinate various non-health departments to improve the environment for health (by linking areas like – Swatch Bharath, balanced diet, reduced stress at the workplace, Yatri Suraksha, etc.).
  • Incorporating health education as part of the curriculum, promoting hygiene and safe health practices within the school environs by acting as a site of primary health care, and promoting healthy practices via AYUSH and Yoga at workplaces and schools.
  • Organizing public health care delivery.
  • To enhance National health programs .
  • Utilizing the potential of AYUSH and mainstreaming it.
  • Improving women’s health and addressing gender violence. Initiatives like Janani Suraksha Yojana, new norms of addressing domestic violence, family planning programs,s, etc. can go a long way.
  • Enhancing tertiary care services – via specialized consultative and intensive care facilities, tertiary services via advanced medical colleges, and health institutes.
  • providing better health education
  • incentivizing doctors for rural services
  • enhancing nursing and other paramedical services
  • developing and encouraging ASHA volunteers.
  • Collaborating with non-governmental organizations and the private sector too –
  • Train, and encourage skill development programs
  • Utilise and direct Corporate social responsibility into health investments
  • Encourage personnel training in mental health care and disaster management etc.
  • Establishing a strong regulatory framework to include regulation of clinical establishments, professional and technical education, food safety, medical technologies, medical products, clinical trials, research, and implementation of other health-related laws.
  • Involving and providing more role to local self-governments, bringing in decentralization and enhancing the accountability of government institutions to ensure effective efficient delivery of services.

Out of these the key and specific objectives remain to

Strengthen health system

  • Increase Life Expectancy at birth from 67.5 to 70 by 2025.
  • Establish regular tracking of the Disability Adjusted Life Years (DALY) Index as a measure of the burden of disease and its trends by major categories by 2022.
  • Reduction of TFR to 2.1 at national and sub-national levels by 2025.
  • Reduce under Five Mortality to 23 by 2025 and MMR from current levels to 100 by 2020.
  • Reduce infant mortality rate to 28 by 2019.
  • Reduce neonatal mortality to 16 and stillbirth rate to “single digit” by 2025.
  • Achieve the global target of 2020 which is also termed as the target of 90:90:90 , for HIV/AIDS i. e,- 90% of all people living with HIV know their HIV status, – 90% of all people diagnosed with HIV infection receive sustained antiretroviral therapy and 90% of all people receiving antiretroviral therapy will have viral suppression.
  • Achieve and maintain the elimination status of Leprosy by 2018 , Kala-Azar by 2017, and Lymphatic Filariasis in endemic pockets by 2017.
  • To achieve and maintain a cure rate of >85% in new sputum-positive patients for TB and reduce the incidence of new cases, to reach elimination status by 2025.
  • To reduce the prevalence of blindness to 0.25/ 1000 by 2025 and disease burden by one-third from current levels.
  • To reduce premature mortality from cardiovascular diseases, cancer, diabetes, or chronic respiratory diseases by 25% by 2025.

Also read: Healthcare Sector in India

Improve health system performance 

  • Increase utilization of public health facilities by 50% from current levels by 2025.
  • More than 90% of the newborns are fully immunized by one year of age by 2025
  • The relative reduction in the prevalence of current tobacco use by 15% by 2020 and 30% by 2025.
  • Reduction of 40% in the prevalence of stunting of under-five children by 2025.
  • Access to safe water and sanitation to all by 2020 (Swachh Bharat Mission).
  • Reduction of occupational injury by half from current levels of 334 per lakh agricultural workers by 2020.

Enhance health status and program impact

  • Increase health expenditure by the Government as a percentage of GDP from the existing 1.15% to 2.5 % by 2025.
  • Ensure availability of paramedics and doctors as per the Indian Public Health Standard (IPHS) norm in high-priority districts by 2020.
  • Establish primary and secondary care facilities as per norms in high-priority districts (population as well as time to reach norms) by 2025.
  • Ensure district-level electronic database of information on health system components by 2020.
  • Strengthen the health surveillance system and establish registries for diseases of public health importance by 2020.

Also read: Global Tobacco Epidemic

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Major national programs in this sector

The following highlights of recent initiatives in this field showcase our renewed effort to achieve global standards.

Health Policy 2017

National Health Mission

  • This mission is targeting universal health care, to achieve IMR, MMR, TFR targets, family welfare, infrastructure maintenance, etc.
  • The major components of the program are:
  • RMNCH+A services – which stands for reproductive, maternal, newborn, child, and adolescent health care. Programs like Janani Suraksha Yojana, the program for adolescents like addressing the problem of anemia among adolescent girls and boys, etc.
  • Communicable Diseases : The National Health Policy 2017 recognizes the interrelationship between communicable disease control programs and public health system strengthening . Different programs like the National Aids Control Program, National Leprosy Eradication Program, Revised Tuberculosis Control Program, and National Vector Borne Disease Control Program.
  • Non-Communicable Diseases : The National Health Policy 2017 recognizes the need to halt and reverse the growing incidence of chronic diseases. Different programs through the involvement of AYUSH are taking forth to address these situations, for instance , Mission Madhumeha through Ayurveda is an example of efforts to address the issue of diabetes among people.
  • Health system improvement at rural and urban levels.
  • Universal Immunisation Programme – to provide life-saving vaccines to all children across the country free of cost to protect them against Tuberculosis, Diphtheria, Pertussis, Tetanus, Polio, Hepatitis B, Pneumonia and Meningitis, Measles, Rubella, Japanese Encephalitis (JE) and Rotavirus diarrhea. via Mission Indra Dhanush
  • Mental Health : via new mental health policy.

Also read: Palliative Care in India

Other global initiatives in health involving India

International Vaccine Institute (IVI)

International Vaccine Institute (IVI)

  • India has taken full membership of the International Vaccine Institute.
  • Initially a UNDP initiative, IVI began formal operations as an independent international organization, in Seoul, South Korea.
  • It is devoted to developing and introducing new and improved vaccines to protect people, especially children, against deadly infectious diseases.
  • The Institute has a unique mandate to work exclusively on vaccine development and introduction specifically for people in developing countries, with a focus on neglected diseases affecting these regions
  • India has to contribute $50,000 annually to the institute.

The Global Promotion of the Traditional System of Medicines

  • Ministry of AYUSH, the Government of India, and the World Health Organization (WHO) have signed a historic Project Collaboration Agreement (PCA) for the same.
  • PCA is titled ‘Co-operation on promoting the quality, safety, and effectiveness of service provision in traditional and complementary medicine between WHO and AYUSH, India, 2016-2020’.
  • It will help build and strengthen national capacities.

The Network to Improve Quality of Care for Mothers, Newborns, and Children

  • India is among nine countries that will be part of a global health network focused on improving the quality of care for new mothers and babies and strengthening national efforts to end preventable deaths of pregnant women and newborns by 2030.
  • The nine countries are India, Bangladesh, A Cote d’Ivoire, Ethiopia, Ghana, Malawi, Nigeria, Tanzania, and Uganda.
  • The new ‘Network for Improving Quality of Care for Maternal, Newborn and Child Health’ is supported by the World Health Organisation (WHO), UN International Children’s Fund (Unicef) and other partners.

India and SDG Goal 3 Commitment 

  • India’s National Health Mission is making striding efforts in ensuring the goal of good health and well-being of the sustainable development goal.
  • We have strengthened the implementation of the WHO framework convention on tobacco control
  • To enhance the research and development of medicines for communicable and non-communicable diseases, provide access to essential medicines and vaccines in accordance with the Doha Declaration on TRIPS agreement and public health regarding flexibility to protect public health.
  • We are aiming to increase our spending in this field and also strengthen institutions to target the achievement of the goal.

Also read: Anti-Microbial Resistance (AMR) and the Red Line Campaign

  • Health plays a vital role in ensuring the rights of people and in facilitating social justice. A healthy and strong India can reap the best from the future world.
  • Developments in the health sector enhance the human resource and also open avenues for revenue and employment generation.

Also read: Digital Health: Latest developments

Article by: Honey Mathew.

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Reader Interactions

essay on health sector in india

June 23, 2017 at 7:12 am

This to notify that according to the above article under National Health Policy 2017 it is stated that the rise of public investment in health care would be of 5%. If you scroll two sections down in the ENHANCE HEALTH STATUS AND PROGRAMME IMPACT it is again mentioned that government spending will increase from 1.5% to 2.5% by 2025. This is slightly confusing and is not helping me understand which one to follow. Please help and its a request to clarify the above doubt.

essay on health sector in india

July 10, 2017 at 11:52 pm

Good effort sir..thank you very much..

essay on health sector in india

May 10, 2018 at 3:47 am

I think doctor nurse to patient ratio need correction….. please read the sentence

essay on health sector in india

October 19, 2018 at 3:05 pm

Spreading awareness about non-communicable diseases like hypertension, diabetes. For all kind of disease treatments please visit online portal meddco.com which introduced affordable healthcare service packages

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  • Systematic Review
  • Open access
  • Published: 21 May 2024

Human resource shortage in India’s health sector: a scoping review of the current landscape

  • Vini Mehta 1 ,
  • Puneeta Ajmera 2 ,
  • Sheetal Kalra 3 ,
  • Mohammad Miraj 4 ,
  • Ruchika Gallani 5 ,
  • Riyaz Ahamed Shaik 6 ,
  • Hashem Abu Serhan 7 &
  • Ranjit Sah 1 , 8  

BMC Public Health volume  24 , Article number:  1368 ( 2024 ) Cite this article

342 Accesses

Metrics details

For healthcare delivery to be optimally effective, health systems must possess adequate levels and we must ensure a fair distribution of human resources aimed at healthcare facilities. We conducted a scoping review to map the current state of human resources for health (HRH) in India and the reasons behind its shortage.

A systematic search was conducted in various electronic databases, from the earliest available date till February 2024. We applied a uniform analytical framework to all the primary research reports and adopted the “descriptive-analytical” method from the narrative paradigm. Inductive thematic analysis was conducted to arrange the retrieved data into categories based on related themes after creating a chart of HRH problems.

A total of 9675 articles were retrieved for this review. 88 full texts were included for the final data analysis. The shortage was addressed in 30.6% studies ( n  = 27) whereas 69.3% of studies ( n  = 61) addressed reasons for the shortage. The thematic analysis of data regarding reasons for the shortage yielded five kinds of HRH-related problems such as inadequate HRH production, job dissatisfaction, brain drain, regulatory issues, and lack of training, monitoring, and evaluation that were causing a scarcity of HRH in India.

There has been a persistent shortage and inequitable distribution of human resources in India with the rural expert cadres experiencing the most severe shortage. The health department needs to establish a productive recruitment system if long-term solutions are to be achieved. It is important to address the slow and sporadic nature of the recruitment system and the issue of job insecurity among medical officers, which in turn affects their other employment benefits, such as salary, pension, and recognition for the years of service.

Peer Review reports

Universal healthcare is recognized as a basic human right by the World Health Organization (WHO). Human resources for health (HRH) are an essential component of effective and high-quality healthcare systems, which are responsible for the maintenance and promotion of good health. In order for health care delivery to be as effective as possible, health systems must have adequate levels and fair distribution of human resources for health [ 1 , 2 ]. HRH are defined as “the stock of all individuals engaged in the promotion, protection or improvement of population health”. This includes both public and private sectors and different domains of health systems, such as personal curative and preventive care, non-personal public health interventions, disease prevention, health promotion services, research, management, and support services (WHO, 2007) [ 1 ]. The HRH is eventually required to carry out policies, conduct processes, prescribe medication, and offer care to the populace. Therefore, it should come as no surprise that nations with low physician densities are thought to do poorly in terms of life expectancy and maternal and child mortality [ 3 , 4 ]. India is one of the 57 nations with a clear shortage of HRH [ 1 , 6 ]. WHO recommends 44.5 doctors, nurses, and midwives per 10,000 inhabitants, whereas the national density was found to be 20.6 [ 7 ]. The current health worker density is noteworthy since it represents a significant improvement from the anticipated 13.6 per 10,000 in 2005 [ 8 ]. However, the distribution of HRH throughout the states is uneven [ 9 , 10 ]. There are notable variances between urban and rural locations in HRH, with urban areas having a doctor density that is four times higher than rural ones. Availability, distribution, and quality of HRH are crucial for achieving universal health coverage (UHC) in lower-to-middle-income countries (LMICs) such as India. There have been multiple studies measuring the HRH shortage. There are also quantitative and qualitative studies looking at the reasons for the shortage. Here, we attempt to provide the most comprehensive scoping review of the estimates of the HRH shortage in India and a critical discussion of the reasons/factors underlying this shortage. To our knowledge, this would be the first review on the matter.

From a policy perspective, it is critical to comprehend how a country with a surplus of human resources structures its shortfall. Despite India’s obvious public health problems, the topic has received little attention from researchers. The academic literature on HRH in India from inception to January 2023 was reviewed here, along with the current state of affairs, trends, and the nature of the shortage. Therefore, this scoping review aims to map the current state of HRH in India and the reasons behind its shortage.

This scoping review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis: Extension for Scoping Reviews (PRISMA-SCR) [ 11 ]. A scoping review was most appropriate due to the broad nature of this subject and the range of study designs included. Furthermore, it was necessary to conduct a wide search encompassing studies that examined WHO-Sustainable Development Goals (SDGs) benchmarks, Indian Public Health Standards (IPHS) guidelines, and India-SDG benchmarks. On 2-11-2022 the completed protocol was prospectively registered with the Open Science Framework ( https://doi.org/10.17605/OSF.IO/6S4QB ).

Search strategy

An exhaustive literature search was conducted to identify the shortage and reasons for shortages of HRH in India. Online electronic databases such as PubMed-Medline, Embase, Scopus, Cochrane Library, Web of Science (WoS), the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and EBSCO (Global Health) were searched from the earliest available date till February 2024. Additional sources like Google Scholar, WHO library database (WHOLIS), Public Health Foundation of India Knowledge Repository (PHFI), INDMED, conference proceedings, and cross-references were explored. Non-English language publications were translated into the English language using Google Translate [ 12 ]. Contact with authors was done for any unpublished studies. A detailed search strategy is given in Table  1 for PubMed-Medline and tailored to each database when necessary [Supplementary Table 1 ].

Eligibility criteria

We sought to define and characterize the state of shortage of HRH in India. In order to be included in the review, included studies needed to focus on metrics for shortage measurements such as density estimates, raw/absolute numbers, shortfall, and vacancies. We included studies that analyzed records from national, sub-national (state), district, administrative block, and center-level based on the comprehensive comprehensive list of cadres mentioned in the National Classification of Occupations (NCO) by the Government of India (GoI) [ 13 ], and the International Standard Classification of Occupations (ISCO-08) [ 14 ] by the International Labour Office was selected. Public, private, and public-private partnerships (PPPs), and social/non-governmental/trust were taken into consideration, making the list of cadres comprehensive. In the Indian healthcare industry, health workers are broadly classified as medical health professionals, including paramedical people and non-medical workers. The latter includes numerous categories of non-medical workers. They are classified as healthcare workers. They are classified as healthcare workers since they work in healthcare facilities.

Screening and selection

We imported all search results into Zotero 5.0 and reimported all titles and abstracts into the Excel screening workbook. Two researchers independently screened (VM and RG), first by the title and abstract to verify the agreement between the reviewers on the inclusion and exclusion criteria. Case reports, letters, and narrative/historical reviews were not included in the search. The eligibility criteria were refined until a good agreement was reached. Papers without abstracts but with titles suggesting that they were related to the objectives of this review were also selected to screen the full text for eligibility. After selection, full‑text papers were read in detail by two reviewers (PA and SK). Those papers that fulfilled all of the selection criteria were processed for data extraction. Two reviewers (VM and RG) hand-searched the reference lists of all selected studies for additional relevant articles. The level of agreement between the two reviewers, calculated by Cohen’s kappa (k), was 0.92 for titles and abstracts and 0.90 for full texts. Disagreements between the two reviewers were resolved by discussion. If a disagreement persisted, the judgment of a third reviewer (MM) was considered decisive.

Also, studies examining HRH (absolute numbers/shortage/vacancy/shortfall) at national levels in urban and rural locations in India were considered for comparing the density of HRH. We carefully examined the papers to get information on HRH enumeration, openings, and deficits. For uniformity and comparison with WHO criteria, the available data was adjusted as necessary. For instance, all HRH densities are recalculated and given as 10,000 HRH workers.

Data extraction and analysis

Two authors (VM and PA) independently extracted data using specially designed data extraction forms, utilizing Microsoft Excel software. Inter-rater reliability between the two authors was 0.8 for data extraction and analysis. The following informational data fields were used: author/year of publication, location, study design, sample size, study setting, study design, data collection tool, cadre shortages, career stages, employment status, reasons for the shortage, results, and conclusion of the studies. We applied descriptive analysis for objective one and thematic analysis approach for second objective. Since articles might belong to numerous categories, the total number of articles belonging to one category may be smaller than the total number of articles belonging to all other categories. In the text and the supplemental materials, figures depict the distributions of papers by publication year, journal, and therapeutic/practice area. Inductive thematic analysis, as defined by Braun and Clarke [ 15 ], was used to arrange the retrieved data into categories based on related themes. A thorough literature review was conducted and the following steps were undertaken to create a chart of HRH-related challenges in India:

Extensive literature search: For a thorough grasp of the major themes and topics that have surfaced, a comprehensive literature review was conducted.

Developing initial codes: Data was initially coded by determining the meaningful text units related to HRH shortages in India. The key descriptive and interpretative concepts and ideas contained in the data were captured by these codes.

Identify themes: After the initial codes were identified, connections and patterns among them were explored by the reviewers. Similar codes were grouped to generate five themes that reflected the underlying meanings and concepts in the data by utilizing an iterative and inductive method. Any disagreement was resolved by discussion between the authors.

Refine themes: The five themes were refined further in terms of wording and language and finally agreed upon by all the authors ensuring that all of them are coherent and accurately reflect the underlying meanings and ideas within the data.

The available data was modified for uniformity and comparison with WHO-SDG’s benchmarks, Indian Public Health Standards (IPHS) guidelines, and India-SDG benchmarks.

Methodological quality appraisal

In line with guidelines for conducting a scoping review, no formal assessment of the methodological quality of the included articles was performed.

Search and selection results

A total of 9,580 articles were retrieved for this review, including 9483 from the databases and 97 from the additional sources. After removing duplicates, 3,155 articles remained for screening the titles. 154 articles were chosen for screening the abstracts, yielding 100 articles eligible for full-text screening. 88 full texts10,16–102 were included for the final data analysis (PRISMA flow diagram in Fig.  1 ). Study characteristics [ 10 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 ] are described in detail in Supplementary Table 2 . The first research question was addressed in 30.6% of studies ( n  = 27) whereas 69.3% of studies ( n  = 61) addressed the second research question. In Fig.  2 , the publication years are displayed. The first article was published in 1978. 11.3% of articles ( n  = 10) were published before 2010 while 85.2% were published from 2011 to 2020. Highest number of papers ( n  = 10) were published in 2012 and 2017.

figure 1

Flowchart summarizing the article selection process ( n – number of studies)

Articles were categorized into state level (HRH issues of only one state), national level (HRH issues of more than one state/multicentric), and international level (HRH issues of more than one country including India) for ease of understanding. 50% of studies ( n  = 44) were conducted at the state level focussing on the HRH of a single state. 36.3% of studies were multicentric ( n  = 32) and were conducted at the national level including more than one state of India while 13.6% ( n  = 12) were international level studies conducted in more than one country including India 67.7% of studies were based on primary data while 26.8% studies were based on secondary data obtained from different sources. In 5.3% of studies both primary as well as secondary data was used to collect data.

figure 2

Number of studies according to publication years

48.2% of studies were cross-sectional surveys. A questionnaire ( n  = 44, 89%) was used in the majority of the surveys for data collection. Qualitative methods such as interviews were also used in surveys, albeit less frequently ( n  = 16, 17.3%). One study used focus group discussion while in three studies, both interviews as well as focus group discussions were conducted. A mixed method study design (both qualitative and quantitative) was used in 6.4% of studies. In two qualitative studies, the Fujifilm Quick-Snap disposable camera was used to take photographs and conduct thematic analysis.

Studies enumerating more than one cadre were categorized as all HRH ( n  = 33, 37.5%) in the present study. 35.2% ( n  = 31) studies were conducted on doctors, 17% ( n  = 15) on nurses, 5.6% ( n  = 5) on dentists and 4.5% ( n  = 4) on pharmacists (Fig.  3 ).

figure 3

Distribution of studies according to HRH

Eight cross-sectional national-level studies reporting the HRH data in India are presented in this scoping review. The HRH concentrations are compiled in Fig.  3 . Comparable figures have been derived from the data since the WHO views the doctor, nurse, and midwife cadres as vital HRH. The key data sources for the studies were considered to be estimates from the Census, the National Sample Survey Organisation (NSSO), professional registration bodies, Population data and health-professional statistics, the National Health Profile, and the Indian Ministry of Statistics and Programme Implementation’s 2011 Report on Health and Family Welfare. Results depict an increase in the density of all HRH and doctors from 19.46 to 6.07 in 2012 to 29.1 and 11.3 in 2019 respectively (Fig.  4 ).

figure 4

National Level HRH densities. NSSO = National Sample Survey Organization; MCI = Medical Council of India; INC = Indian Nursing Council; IMSPI = Indian Ministry of Statistics and Programme Implementation; WBO = World Bank Open Data; NHP = National Health Profile 2017; ABCE project surveys: Access, Bottlenecks, Costs, and Equity (ABCE) project surveys

Thematic analysis

The thematic analysis of data regarding the second research question yielded five kinds of HRH-related problems that are causing a scarcity of HRH in India. The outcomes of each study are described in Supplementary Tables 3 and codes identified under each theme is shown in Supplementary Table 4 [ 10 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 ]. A summary of these themes is provided in Table  2 below:

A detailed description of all the themes are given below:

Theme 1: Inadequate HRH Production and recruitment

“Inadequate HRH production” emerged out to be the first theme in the present review. Eight studies reported this theme as one of the reasons for the HRH shortage in India. With nearly 1.3 billion citizens, India is the second-most populated nation in the world. This puts a tremendous amount of strain on the healthcare system, which needs a sizable number of healthcare staff to meet the population’s healthcare needs [ 80 , 88 ]. Also, India suffers from serious health disparities, with a large divide between urban and rural areas as well as across various states [ 65 , 66 , 88 ]. Healthcare professionals are in insufficient supply in many rural areas and several states, and their distribution is not equitable for instance, in urban Madhya Pradesh (MP), there are 120 doctors per 100,000 people, whereas in rural MP, there are only 12 doctors per 100,000 people [ 22 ]. With an aging population, India is going through a demographic transformation as well [ 65 , 66 , 74 , 75 , 81 ]. The demand for healthcare services will rise as a result, especially for geriatric care, which calls for a qualified staff [ 81 , 88 ]. With a large number of people coming from other nations for medical treatment, India has become a well-liked location for medical tourism. The need for healthcare personnel has expanded as a result, especially in specialized professions. However, there is a limited number of postgraduate (PG) seats in medical courses which makes it challenging to maintain supply as per the demand [ 88 ]. Moreover, there is a lack of a centralized HRH database which hinders effective planning and HRH deployment in certain locations [ 88 ].

Theme 2: Job dissatisfaction

Thirty-nine studies reported that job dissatisfaction is a major contributor to India’s shortage of Human Resources for Health (HRH). In India, a large number of healthcare professionals operate in subpar facilities with insufficient equipment. Burnout, stress, and work unhappiness may result from this [ 10 , 16 , 24 , 26 , 39 ]. Further, healthcare professionals are frequently underpaid, especially in the public sector. Many Indian healthcare employees believe that there are few opportunities for professional growth, which might cause them to feel unmotivated and dissatisfied with their jobs [ 63 , 71 , 75 ]. Therefore, in order to address the lack of HRH in India, it is imperative to address the issue of work unhappiness among healthcare professionals.

Theme 3: Brain Drain

Ten studies reported that for emerging nations like India, where the loss of trained individuals can have a large influence on economic growth and development, brain drain can be a serious issue [ 17 , 31 , 37 , 48 , 68 , 70 , 80 , 85 , 90 , 97 ]. The term “brain drain” describes the emigration of highly educated and competent people from one nation to another [ 31 , 37 ]. The desire for better employment possibilities is one of the primary causes of brain drain. Many highly qualified individuals leave their home nation in quest of better-paying work and living conditions [ 68 , 70 ]. Another factor in brain drain is a lack of employment prospects in a particular field or business. Skilled workers may search for chances abroad if they are unable to obtain employment in their field at home.

In some situations, the pursuit of educational possibilities can result in brain emigration. Professionals with advanced degrees may travel abroad to complete their studies or receive training in an area that is not offered or accessible in their native country [ 68 , 70 , 80 , 85 , 90 , 97 ].

Theme 4: Regulatory concerns

“Regulatory concerns” emerged to be another important theme. Thirty-three studies reported that to ensure an adequate supply of HRH, regulatory concerns must be resolved. A lack of qualified healthcare personnel is caused by inadequate staffing and training regulations. The health department’s protracted delivery of wage benefits and service regularisation, unequal opportunities with regard to job stability, no wage benefits, and non-acknowledgment of prior work experience, extremely complex and dispersed recruitment rules, a slow and erratic recruitment process are the key regulatory issues indicated by majority of studies [ 36 , 42 , 43 , 45 , 47 , 49 , 50 , 67 , 69 ].

Theme 5: lack of training, monitoring and evaluation

Six studies stated that in the absence of proper training healthcare professionals might not be able to pick up the skills and information required to do their professions well. This may result in a lack of qualified healthcare professionals who can deliver high-quality care. Further, without efficient monitoring and evaluation methods, it may be challenging to pinpoint the areas in which healthcare staff need more assistance or training [ 34 , 35 , 40 , 52 , 60 , 83 ]. The expertise and abilities of healthcare professionals may not match the population’s demands as a result, which could contribute to the shortage of HRH.

Theme 6: Regulatory issues

15 studies Workforce expansions are not at pace with population growth and changing dynamics of regional disease burden. Incredibly complex, non-transparent and dispersed recruitment rules, slow and extremely erratic recruitment process, health department’s protracted delivery of wage benefits and service regularisation, unequal opportunities with regard to job stability, no wage benefits, and non-acknowledgement of prior work experience are key regulatory issues. Regular vacancy planning is not done at the district level. The district health societies hire only contractual staff at the district level. Current central civil service rules, recruitment methods, appraisal systems, reward and punishment, and so on are insufficient to address human resource management issues.

This scoping review is aimed at offering a thorough comparative evaluation of research conducted on the scarcity of human resources for the health sector in India, and an analysis of the deficit distribution throughout cadres. Numerous aspects of HRH in India, as well as current and upcoming issues that must be resolved to enhance the availability of health personnel, both nationally and at the state level, have been highlighted. A total of 88 studies that reported HRH densities and reasons for HRH shortages indicated variations in their data sources like sample surveys, censuses, and registries. Thirty-three national level studies examining the HRH data in India were identified. Findings reveal that the number of doctors, nurses, and midwives in India is only one-quarter of the World Health Organization guideline of 2.3/1000 people, indicating a severe general deficit of health professionals. The workforce has an inefficient skill mix because there are at least as many doctors as nurses. Just one-third of the work force are women. Most workers reside in cities and are employed by the private sector [ 37 ].

Studies by Singh et al. and Rao et al. also report overall low numbers of qualified health workers, a high presence of unqualified health workers, particularly in rural areas, and significant differences in qualified health worker distribution between urban and rural areas [ 52 , 69 ]. A framework has been developed to identify the reasons for the underlying shortage, in the form of six themes along with proposed strategies and actions that can assist governments, policy makers and health agencies in planning, creating, and executing efficient strategies for achieving a sustainable health workforce and UHC. It is clear that there are shortages of health workers in some regions of India and in some speciality fields, but it is challenging to assess the scope and type of such shortages due to a dearth of research and health statistics. There is a glaring lack of clarity on whether a connection exists between these shortages and global migration. Although there is no specific policy agenda to control health worker migration in general, policy responses to migration of health workers are typically integrated into wider processes aimed at managing the health workforce. India’s decision-makers have divergent opinions on whether it is necessary or desirable to restrict immigration [ 78 ].

India’s health care systems and services are still developing, therefore facing issues like lack of skilled workers, absenteeism, inadequate infrastructure, and care quality [ 66 , 80 , 99 ]. One important determinant of the availability of health workforce is the density of the health personnel, relative to the population. Poorer health and service utilisation results are found in states with lower health worker densities [ 32 ]. The findings also revealed that public hospital employees were more satisfied with their recruitment and selection process, less committed to their organisation, and had lower levels of occupational stress than private hospital employees [ 41 , 49 ]. Enhancing working conditions, providing the bare necessities in terms of supplies and equipment, providing possibilities for professional growth, and strengthening supervision may prove to be equally significant in boosting employee retention in a desperate human resources situation. Furthermore, there is an unequivocal need to improve the quality of the output in terms of an explicitly stated and standardized competency framework tailored to the Indian context.

Forty-seven studies focussing on the HRH of a single state were conducted at the state level. Studies conducted in Gujarat reported that incredibly complex, non-transparent and dispersed recruitment rules, slow and extremely erratic recruitment process, the health department’s protracted delivery of wage benefits and service regularisation, unequal opportunities with regard to job stability, no wage benefits, and non-acknowledgement of prior work experience are the key factors influencing the HRH in most of the states. As opposed to extrinsic motivation, intrinsic motivation is more crucial. In order to meet the demands of service providers in terms of motivation, state health departments must address the motivation of health service providers by designing a set of strategies. State health departments, lawmakers, and reformers need to create management strategies that address both intrinsic and extrinsic motivational factors [ 77 , 89 ].

Similarly, the study conducted in Mumbai reported that the high rate of burnout syndrome among resident doctors in public sector hospitals had a negative impact on the physical and mental health of medical professionals and lowered their motivation and productivity at work [ 81 ]. Migration of Indian HRH to nations with higher incomes emerged as another significant factor that impacts HRH retention in India. A study conducted at the international level, including India, indicated that it is difficult for India to retain skilled medical personnel due to the movement of Indian HRH to nations with higher incomes, which affects government efforts to make healthcare more accessible throughout the nation [ 17 ]. Low pay and unfavourable working conditions, particularly in the private sector, are the main drivers of Indian HRH leaving India for other countries [ 21 , 75 , 78 , 85 ].

Another significant concern identified by a majority of the research is a lack of HRH databases [ 23 , 28 , 49 , 82 , 90 ]. There is a backlog of shortages because actual HR requirements are not assessed as a result of the lack of routinely updated HR planning. Although having a big workforce, the state health department lacks a specialised HR department to offer assistance with a variety of HR responsibilities. Ad hoc workers who put in long hours do not receive the same perks as regular workers. The existing sanctioning standards require an evidence-based update. Workload-based HRH deployment in different regions will guarantee sufficient availability and equitable distribution, which are required to raise the general standard of healthcare.

Inequitable distribution of HRH, lack of training, limited and poor supervision turned out to be another important factor that influence HRH in India. The most apparent doctor distributional gaps have a significant impact on health outcomes. Lack of or unequal distribution of the medical workforce may also result in inefficient utilisation of physical facilities and equipment, making the infrastructure and equipment investments useless. Zurn et al. also reported that inequitable distribution of healthcare manpower is an important challenge for health policymakers [ 103 ].

Health planners and managers must pinpoint crucial aspects, including training opportunities, which can be methodically handled at the management and policy level in order to solve this issue. Quantification, understanding, and accessibility of crucial elements can surely aid in the development of efficient administrative and human resource policies. The population is growing, and the dynamics of the regional illness burden are changing, yet workforce expansion is not keeping up. The health department’s lengthy delivery of wage benefits and service regularisation, unequal opportunities with regard to job stability, no wage benefits, and non-accountability of prior work experience are important regulatory issues. Further regulatory concerns include excessively complex, unclear, and dispersed hiring standards, a sluggish and inconsistent hiring procedure, and extremely slow and erratic recruitment rules [ 29 , 45 , 55 , 56 , 66 ]. Public-private partnerships (PPPs) are frequently employed to take advantage of the resources, skills, and knowledge of the private sector around the world [ 7 ]. In order to complement the public sector, the partnership may look into the resources and experience of the commercial sector. The findings of the present scoping review could assist decision-makers in deciding the future road map to accomplish the sustainable development goals. The study has a number of strengths. Firstly, it adds to the little body of knowledge on the shortage of HRH and the disparities in the publicly financed healthcare system in India. Secondly, the current study not only assessed the shortage of human resources for health (HRH) in India but also identified the key reasons for the shortage.

There are a few limitations as well. WHO’s methodology for determining HRH density requirement thresholds for doctors, nurses and midwives and dentists were the only considerations, thus leaving out other paramedical staff due to non-availability of data in most of the studies. The HRH system in India is divided into public and private sectors and, while the private sector lacks a formal hierarchy of structure, the public health system follows a three-tier model, with primary, secondary, and tertiary levels. In our review we witnessed a lack of literature depicting the shortages of public and private HRH. This is because we followed a scoping review approach and considered reasons for shortages published in the literature which may not be comprehensive. Another limitation is that, due to heterogeneity in the included studies, public and private sector and urban and rural comparisons couldn’t be estimated. Although we have tried to cover all the major databases, we might have missed out some of the important papers due to the non-responsiveness of authors in sharing the complete data. Furthermore, our scoping analysis did not explicitly analyse data from sources such as Rural Health Statistics, National Health Workforce Accounts, and the Periodic Labour Force Survey, which can give critical information on HRH. As a result, the assessment may not fully capture the detailed insights from these main data sources. Further research could benefit from a more direct examination of these primary data sources to gather a greater range of information about the health workforce.

The present scoping review has a few recommendations. Firstly, a comprehensive national database covering HRH cadres in public and private sectors could accurately track the state of HRH in India and make necessary policy changes to improve it. The current skill mix is dominated by doctors and consists of fewer nurses. At the national level, there needs to be a focus on both retaining nurses in the workforce and significantly boosting nursing supply. More focus will be required on the unique role of task shifting and its effects on patient care and well-being. Reduce the current human resource shortfalls in public sector organisations, especially at the primary levels, by making recruiting processes more effective through walk-in interviews or contractual/flexible norms of involvement. To strengthen the HRH in India, we require a comprehensive strategy that covers finance, infrastructure, working conditions, gender and social inequities.

This scoping review reveals that there has been a persistent shortage and inequitable distribution of human resources in India over the years, with the rural expert cadres experiencing the most shortage. The critical challenges in India’s Human Resources for Health (HRH), highlight inadequate HRH production and recruitment, job dissatisfaction, brain drain, regulatory issues, and training deficits as key factors contributing to the HRH shortage. To address these multifaceted challenges, the health department must establish a productive recruitment system to achieve long-term solutions Having clear guidelines for managing human resources and being transparent in how these are put into practice would enhance governance and foster trust among healthcare professionals, thus motivating them to work in the public sector. Therefore, the optimal management of these challenges has the power to promote retention by boosting motivation and preventing voluntary turnover.

Data availability

All data are included in the manuscript. Remaining data can be provided on reasonable request by corresponding author.

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Department of Dental Research Cell, Dr. D. Y. Patil Dental College and Hospital, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, 411018, India

Vini Mehta & Ranjit Sah

Department of Public Health, School of Allied Health Sciences, Delhi Pharmaceutical Sciences and Research University, New Delhi, India

Puneeta Ajmera

School of Physiotherapy, Delhi Pharmaceutical Sciences and Research University, New Delhi, India

Sheetal Kalra

Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, AlMajmaah, Saudi Arabia

Mohammad Miraj

STAT SENSE, Gujarat, 382421, India

Ruchika Gallani

Department of Family and Community Medicine, College of Medicine, Majmaah University, Al Majmaah, Saudi Arabia

Riyaz Ahamed Shaik

Department of Ophthalmology, Hamad Medical Corporation, Doha, Qatar

Hashem Abu Serhan

SR Sanjeevani Hospital, Kalyanpur, Siraha, Nepal

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VM, PA and SK write the original manuscript and MM, RG, RAS, HAS and RS edit the manuscript. All authors approve for the final manuscript.

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Mehta, V., Ajmera, P., Kalra, S. et al. Human resource shortage in India’s health sector: a scoping review of the current landscape. BMC Public Health 24 , 1368 (2024). https://doi.org/10.1186/s12889-024-18850-x

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Received : 29 December 2023

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DOI : https://doi.org/10.1186/s12889-024-18850-x

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  • Human resources for health
  • Health workforce
  • South East Asia

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Context –  The problems in India’s health sector.

What are the issues with healthcare sector in India?

  • Low government spending –  Public expenditure on health accounts for only 1.13% of the total health expenditure which is abysmally low when compared to WHO recommendation of 5%.
  • High out of pocket expenditure – Out of pocket expenses account for 62% of the expenditure. This led to an increasing number of households facing catastrophic expenditures due to health costs.
  • 85% of the population cannot afford high cost, corporate private health care.
  • Insurance- 76% of Indians does not have health insurance. Government contribution to insurance is just 32%. Low insurance penetration forces people to spend out of pocket.
  • The behaviour of a private corporate hospital is skewed in favour of profitability.
  • Malpractices in the healthcare sector  – Selling substandard and counterfeit medicines, unnecessary hospital admissions and exploitation.
  • Weak government policy – only 1.27 crore people have taken advantage of the Ayushman Bharat scheme out of 12 crore card holders.
  • Dark reality of private hospitals – The insurance backup incentivizes hospitals to expand the bill but the patients do not get attended to in their best interests.
  • Low health workforce density –  India’s public system has a shortage of nurses. The ratio of 0.6 nurses per doctor while the World Health Organization specification is three nurses per doctor.
  • 80:20 Rule  – Only 20% of people can afford modern health care, 40% cannot afford it at all and the other 40%, the non-poor, pay with difficulty.
  • Nearly 7 crore of the non-poor slide into poverty on a year-to-year basis.
  • Under-qualified doctors – Due to this, 80% of people routinely reach Registered Medical Practitioners who are not trained to treat patients.

What needs to be done to improve healthcare sector?

  • Increase the number of doctors – Ramp up the number of doctors with counterpart obligation to serve in rural areas.
  • The Licentiate Medical Practitioner [LMP]  – The scheme involves a three-and-a-half year course that leads to a bachelor’s degree in medicine and surgery. Doctors trained under this scheme will work in rural areas.
  • Empower graduates of BSc (Nursing) to be nursing practitioners.
  • Focusing of primary care – India needs to shifts focus from secondary and tertiary sectors to primary care. PHCs should be made attractive to doctors by providing incentives and making rural service mandatory for medical students.
  • States should be incentivized to carry out the appointments of health workers and doctors.

Way forward-

  • PHCs should be well-staffed and well-provisioned through a reasonable fee which will cover at least part of the cost.
  • Focus should be shifted to preventive healthcare from curative healthcare.
  • Policymakers need to focus on the larger picture with steps being taken to reclaim the space under public care.

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Human resource shortage in India's health sector: a scoping review of the current landscape

Affiliations.

  • 1 Department of Dental Research Cell, Dr. D. Y. Patil Dental College and Hospital, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, 411018, India. [email protected].
  • 2 Department of Public Health, School of Allied Health Sciences, Delhi Pharmaceutical Sciences and Research University, New Delhi, India.
  • 3 School of Physiotherapy, Delhi Pharmaceutical Sciences and Research University, New Delhi, India.
  • 4 Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, AlMajmaah, Saudi Arabia.
  • 5 STAT SENSE, Gujarat, 382421, India.
  • 6 Department of Family and Community Medicine, College of Medicine, Majmaah University, Al Majmaah, Saudi Arabia.
  • 7 Department of Ophthalmology, Hamad Medical Corporation, Doha, Qatar. [email protected].
  • 8 Department of Dental Research Cell, Dr. D. Y. Patil Dental College and Hospital, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, 411018, India. [email protected].
  • 9 SR Sanjeevani Hospital, Kalyanpur, Siraha, Nepal. [email protected].
  • PMID: 38773422
  • PMCID: PMC11110446
  • DOI: 10.1186/s12889-024-18850-x

Background: For healthcare delivery to be optimally effective, health systems must possess adequate levels and we must ensure a fair distribution of human resources aimed at healthcare facilities. We conducted a scoping review to map the current state of human resources for health (HRH) in India and the reasons behind its shortage.

Methods: A systematic search was conducted in various electronic databases, from the earliest available date till February 2024. We applied a uniform analytical framework to all the primary research reports and adopted the "descriptive-analytical" method from the narrative paradigm. Inductive thematic analysis was conducted to arrange the retrieved data into categories based on related themes after creating a chart of HRH problems.

Results: A total of 9675 articles were retrieved for this review. 88 full texts were included for the final data analysis. The shortage was addressed in 30.6% studies (n = 27) whereas 69.3% of studies (n = 61) addressed reasons for the shortage. The thematic analysis of data regarding reasons for the shortage yielded five kinds of HRH-related problems such as inadequate HRH production, job dissatisfaction, brain drain, regulatory issues, and lack of training, monitoring, and evaluation that were causing a scarcity of HRH in India.

Conclusion: There has been a persistent shortage and inequitable distribution of human resources in India with the rural expert cadres experiencing the most severe shortage. The health department needs to establish a productive recruitment system if long-term solutions are to be achieved. It is important to address the slow and sporadic nature of the recruitment system and the issue of job insecurity among medical officers, which in turn affects their other employment benefits, such as salary, pension, and recognition for the years of service.

Keywords: Health workforce; Human resources for health; India; Shortage; South East Asia.

© 2024. The Author(s).

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  • Size of healthcare market in India FY 2023-2028, by sector

The healthcare delivery (hospitals) sector was valued the highest among the different Indian healthcare sectors in the financial year 2023. The diagnostics sector followed with a market size of 55 billion U.S. dollars. The healthcare market overall was valued at over 200 billion dollars for the same year.

Size of healthcare market in India for financial year 2023, with projections for 2028, by sector (in billion U.S. dollars)

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  • Market size of genomics testing India FY 2018-2027
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  • Revenue of Dr Lal PathLabs FY 2019-2023
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  • Gross revenue of Apollo Diagnostics FY 2020-2023

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  • Premium Statistic Size of diagnostics market in India FY 2017-2028
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