India’s public health infrastructure remains woefully lacking, with little having changed in the 73 years since Independence. India’s GDP spending on building healthcare is very little. Though the country’s expenditure on healthcare has shot up substantially in the past few years, it is still very low in comparison to other nations. Public expenditure on healthcare as a percentage of GDP for 2017-18 was a mere 1.28 percent. Total healthcare spending in the country, including the private sector, rose to 3.6 percent of GDP in 2016, but even this is very low compared with other countries. The average for OECD countries in 2018 was 8.8 percent of GDP, while healthcare expenditure in developed countries like the US was 16.9 percent; for China, it was 5 percent, for both Germany and France it was 11.2 percent, and for Japan, it was 10.9 percent.[1]

The current COVID-19 pandemic has made it clear that building health infrastructure is the need of the hour. It has put the spotlight on the severe gaps in our healthcare system because of which the lives of hundreds and thousands were negatively impacted. Another factor to note is the unequal distribution of facilities. The national capital Delhi particularly has the highest number of hospitals in comparison to its population and size. There are 9 SDH and 47 DH functioning in Delhi[2]. Only three states, Madhya Pradesh (MP), Uttar Pradesh (UP), and Odisha, have a higher number of functioning District Hospitals than Delhi. The health facilities in Delhi are also better, as it is the nation’s capital. It is apparent that importance was given to building healthcare facilities in Delhi, much more than in the other areas. It is a common sight to see people from neighboring states coming to Delhi to get treatment. This unequal distribution of resources has been only increasing.

The number of SCs in rural areas are functioning without HW(F) and HW(M). In Rajasthan, 63.8% of SCs do not have female health workers. In the northeast region, Mizoram and Sikkim, have HW(F) in all SCs, whereas Arunachal Pradesh has the highest percentage of SCs functioning without both and the percentage stands at 23.7%. Digital infrastructure is not properly developed in few states located in the hilly regions. It is noteworthy that Manipur, Odisha, and Telangana have a very well developed digital infrastructure.

This paper aims to analyse the Rural Health Statistics of 2018-19 highlighting current rural health infrastructure and how it varies from state to state. The paper also focuses on the gaps that exist in the digital infrastructure. To begin with, the pre-existent system will be discussed, and then the changes that Ayushman Bharat brought in will be stressed on.

[1] Samrat Sharma, ‘India spending more on healthcare now, but yet not as much as others; here’s how much US, China spend’, Financial Express, 8 April 2020,

[2] Table 7, Section 4, Rural Health Statistics

Date: 28 September 2020
Author: Meghna
Reviewer: Ritu Srivastava

Focus Area: Health
What We Do: Research & Advocacy
Resource Type: Research Analysis