Challenges the Indian Healthcare faces.
Prof. Vikram Patel et al. (2015), suggest that the Indian healthcare faces seven challenges;
The first one being that India has a weak primary health care sector; As cited by Patel et al., (2015), expansion of public health sector has been inequitable, for example, where one government hospital bed exists for every 614 people in Goa, only one exists for 8789 in Bihar (Central Bureau of Health Intelligence, 2015). The other concern Patel et al., (2015) talk about is the uneven and poor quality of care offered by the public healthcare facilities; In 2011, 60% of district hospitals had no intensive care, a quarter of them lacked basic sanitation and drainage (Planning Commission of India, 2011). As cited by Patel et al., (2015), a study conducted by Powell-Jackson et al., (2013), regarding service availability, training, staff, drugs, equipment and basic infrastructure in the primary healthcare facilities found most fell short of the minimum standards; Nearly 50% of the beds may not have been functional (Planning Commission of India, 2011).
The second challenge is the unequally skilled human resources; As cited by Sharma (2015), Vikram Patel, professor of international mental health at the London School of Hygiene & Tropical Medicine, UK is of the opinion that “Working in the public health sector is often a demoralising experience for doctors because their professional lives are blighted by lack of professional development opportunities, accountability, and access to even basic medical resources necessary to perform an effective role”. As cited by Patel et al., (2015), estimates suggests that other than doctors and nurses, about 6.4 million allied health professionals are needed to meet Indian healthcare requirements (Narayan, Kar and Gupta, 2012); though there had been more than 0.5 million so-called AYUSH practitioners in 2014, [Planning commission of India, Twelfth Five Year Plan (2012–2017)], nearly 90% of the population sought care with the allopathic system in both urban and rural areas (National Sample Survey Office 2015).
Indian healthcare does not have a national policy for human resources for health. Healthcare Professional’s Central Council Bill, 2015, was drafted to regulate more than 15 allied and health-care categories; Recently the government has proposed a central healthcare bill to regulate over 50 allied healthcare categories (The Economic Times, 2017).
The third challenge is the large unregulated private sector; In the private sector, large corporate-funded hospitals have been established by business houses which focus on specialised services, though most of the private hospitals are relatively small establishments such as nursing homes; As cited by Patel et al., 2015, apart from a few exceptions, the quality of care in the organised private sector also remains doubtful [(Das, J, Holla, Das, Mahajan,, Tabak, and Chan, 2012) (Rao,2012)]; Patel et al., (2015) suggest, because there is lack of regulatory climate and absence of proper standards or mechanisms to monitor ethics or quality, it is steadily eroding trust in both the public and private health-care systems.
The fourth challenge is the low public spending on health; Both the central and state governments contribute to the Public health expenditure, due to which the economically weaker states become more susceptible to low public health investments; As cited by Patel et al., (2015), the real state expenditure on health, which is after taking inflation into account, has increased by 7% per year (Mukhopadhyay, 2015). The central government’s share in expenditure on public health has remained less than 30% since the year 2010 and has reduced progressively, even if marginally (Patel et al., 2017).
The fifth challenge is fragmented health information system; As cited by Patel et al., 2015, despite the many data collection agencies, several gaps exist. Firstly, the systems for collecting data have many weaknesses; Second, there is hardly any coordination between the agencies managing health information; Third, data gathering is incomplete due to the non-inclusion of the private sector which is the major health care provider in India; Fourth, although data collection on some indicators is duplicated, vast gaps exist on others; Fifth, use of data is limited by an inadequate focus on outputs and outcomes while decisions are made for fund allocation and there is shortage of skilled managers who could analyse and use data for decision making (Patel et al., 2015). To address some of these deficiencies, the National Rural Health Mission has established an integrated nation-wide health management information system portal that facilitates the flow of health information.
The sixth challenge Patel et al., 2015 suggested is the irrational use and spiralling costs of drugs and technology, India spends only a little more than 0.1 % of GDP on publicly funded drugs; close to two-thirds of the total out-of-pocket expenditure was incurred on drugs (Selveraj et al, 2014).
The seventh being weak governance and accountability, Patel et al., (2015) suggest that the single most important hurdle to health governance is the inadequate convergence between various departments within the Ministry of Health and Family Welfare that deal with health services, medical education, health education, family welfare, and a multitude of vertically implemented national programmes, and other ministries related to health, like those dealing with sanitation and water; Number of new laws have been introduced in the last five years to strengthen the healthcare governance but many are yet to be implemented.
Different challenges require different types of leadership; The pressures faced by Indian health care system and the health care professionals can be considered as technical as well as adaptive both of which call for different leaderships. The 2017 National Health policy sounds promising with its Universal Health Coverage (UHC), though what seems to be missing is ‘health as a fundamental right’. The policy has identified the loopholes regarding the present healthcare situation, 70% of the healthcare needs are being met by the private sectors and affordability is an issue for many.
The policy proposes to increase the public health expenditure to 2.5% of the GDP and its focus has shifted towards preventive and promotive healthcare. The policy talks about buying services from the private hospitals and involvement of other stakeholders; It is important to proceed with caution having seen how the Public Private Partnership (PPP) have not done well in other parts of the world, especially in our country due to too much chaos and complexity and there needs to be transparency in the system. It would be a great move to focus on improving and upgrading the existing public health facilities making healthcare accessible and affordable to all within the public sector.
The National Healthcare bill, 2017 has set good visions and changed its strategies, quite different from the previous healthcare bills in the country. The bill sounds idealistic, but achieving these goals will be an extremely challenging task, given the demography, over population, politics, economics, social, technological aspects to consider. Effective leadership roles, public awareness, reaching out to the rural areas, and involving many leaders in informal roles will help meeting some targets if not all.
Dr Pallavi Hoskote
Government redrafts Bill for regulating allied healthcare services, 2017, Available at
National Health Policy, 2017 Available at
Patel V, et al., (2015), Assuring health coverage for all in India, The Lancet, Available at
Sharma C, (2015), India still rural doctor shortages, Available at