India’s healthcare paradox: would the domestic doctor shortage result in failure of journey towards universal health coverage?

Authors

  • Ridhima Malhotra CMS Research House, New Delhi, India

DOI:

https://doi.org/10.18203/2394-6040.ijcmph20261449

Keywords:

Health workforce, Vacancies, Primary health centres, Universal health coverage, Sustainable development goal, Ayushman Bharat

Abstract

Doctor vacancies in rural India, particularly in Primary and Community Health Centres (PHCs & CHCs), represent a critical challenge to the healthcare system and threaten progress toward the Sustainable Development Goals (SDGs), especially SDG 3 (Good Health and Well-being) and SDG 8 (Decent Work and Economic Growth). These centres form the backbone of rural healthcare, serving nearly 64 percent of India’s population. However, persistent shortages of medical personnel undermine access to quality care in rural areas. As per 2023, rural CHCs face a shortfall of over 17,551 specialists, including 4,499 physicians. These gaps limit comprehensive service delivery, particularly in emergency care, maternal health, and the management of non-communicable diseases. Contributing factors include underfunding, inadequate infrastructure, poor working conditions, and difficult recruiting and retaining of doctors. This study examines how doctor shortages in rural centres threaten India’s progress toward Universal Health Coverage (UHC) and related SDG targets. Using recent workforce data and policy analysis, it explores the scale of vacancies, their impact on healthcare delivery and workforce conditions, and broader economic and equity implications. Inadequate staffing undermines UHC, increases morbidity and mortality among vulnerable populations, and exacerbates rural–urban health disparities, directly impeding SDG 3. From an SDG 8 perspective, these shortages reflect unstable employment and missed decent work opportunities in public health sector, constraining economic productivity. Addressing these vacancies through comprehensive workforce reforms, improved working conditions, and sustained incentives along with proper implementation is essential for strengthening rural healthcare, advancing health equity, and supporting India’s broader health and development goals.

References

World Health Organization. Universal Health Coverage (UHC), SDG Target 3.8. 2026. Available at: https://www.who.int/data/gho/data/major-themes/universal-health-coverage-major. Accessed on 9 February 2026.

Gera R, Narwal R, Jain M, Taneja G, Gupta S. Sustainable Development Goals: Leveraging the Global Agenda for Driving Health Policy Reforms and Achieving Universal Health Coverage in India. Indian J Community Med. 2018;43(4):255-9. DOI: https://doi.org/10.4103/ijcm.IJCM_41_18

Ghosh K. Why we don’t get doctors for rural medical service in India? Natl Med J India. 2018;31(1):44-6. DOI: https://doi.org/10.4103/0970-258X.243416

National Health Mission. Health System Strengthening Infrastructure. Available at: https://nhm.gov.in/index1.php?lang=1&level=2&sublinkid=1220&lid=190. Accessed on 9 February 2026.

World Bank Group. India Overview. Available at: https://www.worldbank.org/en/country/india. Accessed on 9 February 2026.

Purohit B, Martineau T. Issues and challenges in recruitment for government doctors in Gujarat, India. Hum Resour Health. 2016;14:43. DOI: https://doi.org/10.1186/s12960-016-0140-9

UNICEF. Sustainable Development Goals. Goal 3: Good Health and Well-Being. Available at: https://data.unicef.org/sdgs/goal-3-good-health-wellbeing/. Accessed on 9 February 2026.

International Labour Organization. Concept Note: Sustainable Development Goal 8: Promote sustained, inclusive and sustainable economic growth, full and productive employment and decent work for all. Available at: https://sdgs.un.org/sites/default/files/2024-12/EGM%20concept%20note%20-SDG8%20-%202025.pdf. Accessed on 10 February 2026.

Singh A. Shortage and inequalities in the distribution of specialists across community health centres in Uttar Pradesh, 2002–2012. BMC Health Serv Res. 2019;19:331. DOI: https://doi.org/10.1186/s12913-019-4134-x

Chatterjee S, Singh A, Kar SK. Service bonds in rural health care in India – Challenges and the way forward. Lancet Reg Health Southeast Asia. 2022;6:100060. DOI: https://doi.org/10.1016/j.lansea.2022.100060

Noya F, Carr S, Freeman K, Thompson S, Clifford R, Playford D. Strategies to Facilitate Improved Recruitment, Development, and Retention of the Rural and Remote Medical Workforce: A Scoping Review. Int J Health Policy Manag. 2022;11(10):2022-37. DOI: https://doi.org/10.34172/ijhpm.2021.160

Right to Health Resources Conversations on Health Policy. Specialist Skills for Community Health Centres - Breaking through the brick wall. Conversation between Dr Yogesh Jain (YJ) and Prof T Sundararaman (TS). Available at: https://rthresources.in/conversations-on-health-policy/specialist-skills-for-community-health-centresbreaking-through-the-brick-wall/. Accessed on 10 February 2026.

Ugargol AP, Mukherji A, Tiwari R. In search of a fix to the primary health care chasm in India: can institutionalizing a public health cadre and inducting family physicians be the answer? Lancet Reg Health Southeast Asia. 2023;13:100197. DOI: https://doi.org/10.1016/j.lansea.2023.100197

Sharma K, Subbiah N, Pancholi A. From vision to reality: Dissecting Ayushman Bharat’s role in Indian healthcare. Int J Sci Res Arch. 2024;12:2124–34. DOI: https://doi.org/10.30574/ijsra.2024.12.2.1479

Rao GP, Parvathi G. Evolution of primary health care centres concept in India – A study. Int J Curr Res Technol. 2024;12:e70-e80.

Ministry of Health and Family Welfare, Government of India. Indian Public Health Standards: Health and Wellness Centre 2022 Volume III. Available at: https://nhm.gov.in/images/pdf/guidelines/iphs/iphs-revised-guidlines-2022/03_PHC_IPHS_Guidelines-2022.pdf. Accessed on 10 February 2026.

Ministry of Health and Family Welfare, Government of India. Ayushman Arogya Mandir. Available at: https://aam.mohfw.gov.in/home/aboutus. Accessed on 10 February 2026.

FICCI. Discussion Paper on Advancing Primary Healthcare in India – Through Ayushman Arogya Mandir. November 2024. Available at: https://ficci.in/public/storage/SPDocument/24036/HD9O0qUCmCCOuPZM6O7h2gClhMxbcDa8YmVMWwaH.pdf. Accessed on 10 February 2026.

Ministry of Health and Family Welfare, Government of India. State and District Wise Status of Operational Ayushman Arogya Mandir. Available at: https://aam.mohfw.gov.in/. Accessed on 10 February 2026.

The Hindu. In Tamil Nadu, primary health centres have now been transformed into Ayushman Bharat Health and Wellness Centres. Available at: https://www.thehindu.com/news/national/tamil-nadu/in-tamil-nadu-primary-health-centres-have-now-been-transformed-into-ayushman-bharat-health-and-wellness-centres/article30962994.ece. Accessed on 10 February 2026.

Ministry of Health and Family Welfare Statistics Division, Government of India. Rural Health Statistics 2021-22. Available at: https://ruralindiaonline.org/en/library/resource/rural-health-statistics-2021-22/. Accessed on 10 February 2026.

The Print. Primary health centres see over 50% increase in doctors but shortfall of 80% specialists at CHCs. Available at: https://theprint.in/health/primary-health-centres-see-over-50-increase-in-doctors-but-shortfall-of-80-specialists-at-chcs/1310905/. Accessed on 10 February 2026.

Ministry of Health & Family Welfare, Government of India. Reform, Perform, Transform: Governance Reforms in Medical Education (2014-2023). Available at: https://static.pib.gov.in/WriteReadData/specificdocs/documents/2023/apr/doc2023424185601.pdf. Accessed on 10 February 2026.

Medicine Careers 360. Total MBBS Seats in India 2026: Government & Private MBBS seats. Available at: https://medicine.careers360.com/articles/total-mbbs-seats-in-india. Accessed on 10 February 2026.

Swain S, Preetha GS, Kumar S, Aggarwal D, Kumar R, Kumar S. Human Resources for Health in India: Need to go Beyond Numbers. Indian J Community Med. 2020;45(3):266-9. DOI: https://doi.org/10.4103/ijcm.IJCM_247_19

Regional College of Management. Medical College Fees in India 2025 – A Complete Guide. Available at: https://rcm.ac.in/medical-college-fees-in-india-2025-a-complete-guide/. Accessed on 24 February 2026.

Ministry of Health and Family Welfare, Government of India. Press Release: Enhancement Of Healthcare Workforce. Available at: https://www.pib.gov.in/PressReleasePage.aspx?PRID=1809812. Accessed on 10 February 2026.

JMN Medical College. Patient-to-doctor Ratio: A Real Challenge in Maintaining Quality Healthcare. Available at: https://jmnmedicalcollege.org.in/patient-to-doctor-ratio-a-real-challenge-in-maintaining-quality-healthcare/. Accessed on 10 February 2026.

World Health Organization South-East Asia. India: Primary Health Care. Available at: https://www.who.int/india/health-topics/primary-health-care. Accessed on 10 February 2026.

Murthy S, Rao K, Ramani S, Chokshi M, Khandpur N, Hazarika I. What do doctors want? Incentives to increase rural recruitment and retention in India. BMC Proc. 2012;6(Suppl 5):P5. DOI: https://doi.org/10.1186/1753-6561-6-S1-P5

Rao KD, Ryan M, Shroff Z, Vujicic M, Ramani S, Berman P. Rural Clinician Scarcity and Job Preferences of Doctors and Nurses in India: A Discrete Choice Experiment. PLoS ONE. 2013;8(12):e82984. DOI: https://doi.org/10.1371/journal.pone.0082984

India Development Review. Do Indian PHCs really have too many doctors? Available at: https://idronline.org/article/health/do-indian-phcs-really-have-too-many-doctors/. Accessed on 10 February 2026.

Rao KD, Ramani S, Murthy S, Hazarika I, Khandpur N, Chokshi M, et al. Health worker attitudes toward rural service in India: results from qualitative research. Health, Nutrition and Population Discussion Paper. Washington (DC): The World Bank; 2010. Available at: https://openknowledge.worldbank.org/server/api/core/bitstreams/2322db1f-e88e-541c-b455-1443a42a60c6/content. Accessed on 10 February 2026.

The Print. Rural India has an 80% shortfall of specialists doctors. MP, Gujarat, Tamil Nadu worst off. Available at: https://theprint.in/health/rural-india-has-an-80-shortfall-of-specialist-doctors-mp-gujarat-tamil-nadu-worst-off/2259874/. Accessed on 10 February 2026.

India Spend. India’s Villages Don’t Have Enough Health Workers. But Here Is How Modicare’s Wellness Drive Can Still Succeed. Available at: https://www.indiaspend.com/indias-villages-dont-have-enough-health-workers-but-here-is-how-modicares-wellness-drive-can-still-succeed. Accessed on 10 February 2026.

Muralidharan K, Chaudhury N, Hammer J, Kremer M, Rogers FH. Is There a Doctor in the House? Medical Worker Absence in India. Global Resource Center; 2011. Available at: https://www.hrhresourcecenter.org/node/3964.html. Accessed on 10 February 2026.

World Health Organization. Fact Sheet: Primary Health Care. Available at: https://www.who.int/news-room/fact-sheets/detail/primary-health-care. Accessed on 10 February 2026.

Srivastava AK, Gupt RK, Bhargava R, Singh RR, Songara D. Utilisation of rural primary health centers for outpatient services - a study based on Rajasthan, India. BMC Health Serv Res. 2023;23:387. DOI: https://doi.org/10.1186/s12913-022-08934-y

Tripathi N, Parhad P, Garg S, Biswal SS, Ramasamy S, Panda A, et al. Performance of health and wellness centre in providing primary care services in Chhattisgarh, India. BMC Prim Care. 2024;25:360. DOI: https://doi.org/10.1186/s12875-024-02603-1

Ministry of Health and Family Welfare Statistics Division, Government of India. Health Dynamics of India (Infrastructure & Human Resources) 2022-23. Available at: https://www.mohfw.gov.in/?q=en/reports-23. Accessed on 10 February 2026.

Feroz A. Primary Health Care: Programmatic Engine for Universal Health Coverage and Sustainable Development Goals. Open Access Text. 2021. Available at: https://www.oatext.com/primary-health-care-programmatic-engine-for-universal-health-coverage-and-sustainable-development-goals.php. Accessed on 10 February 2026.

Lahariya C. Health & Wellness Centers to Strengthen Primary Health Care in India: Concept, Progress and Ways Forward. Indian J Pediatr. 2020;87:916-29. DOI: https://doi.org/10.1007/s12098-020-03359-z

Ministry of Health and Family Welfare, Government of India. Press Information Bureau: Measures taken to encourage doctors to practice in villages. Available at: https://www.pib.gov.in/Pressreleaseshare.aspx?PRID=1813649. Accessed on 10 February 2026.

The Brookings Institution. India: The Crisis in Rural Health Care. Available at: https://www.brookings.edu/articles/india-the-crisis-in-rural-health-care/. Accessed on 10 February 2026.

Rao KD, Shroff Z, Ramani S, Khandpur N, Murthy S, Hazarika I, et al. How to attract Health workers to rural areas? Findings from a discrete choice experiment from India. Health, Nutrition and Population Discussion Paper. Washington (DC): The World Bank; 2012. Available at: https://openknowledge.worldbank.org/server/api/core/bitstreams/9d1e73c7-40a0-59ef-8c8e-a9cea2127c00/content. Accessed on 10 February 2026.

Rural Health Information Hub. Recruitment and Retention for Rural Health Facilities. Available at: https://www.ruralhealthinfo.org/topics/rural-health-recruitment-retention. Accessed on 10 February 2026.

Gupte SS, Sachdeva A, Kabra A, Singh BP, Krishna A, Pathni AP, et al. Private provider practices and incentives for hypertension management in rural and peri-urban Telangana, India– a qualitative study. BMC Health Serv Res. 2024;24:1206. DOI: https://doi.org/10.1186/s12913-024-11560-5

Goel S, Angeli F, Bhatnagar N, Singla N, Grover M, Maarse H. Retaining health workforce in rural and underserved areas of India: What works and what doesn't? A critical interpretative synthesis. Natl Med J India. 2016;29(4):212-8.

Global Health Now. Helping Doctors reach rural India. Available at: https://globalhealthnow.org/2021-02/helping-doctors-reach-rural-india. Accessed on 10 February 2026.

Ballard Brief. Healthcare access in Rural Communities in India. Available at: https://ballardbrief.byu.edu/issue-briefs/healthcare-access-in-rural-communities-in-india. Accessed on 10 February 2026.

Mohammadiaghdam N, Doshmangir L, Babaie J, Khabiri R, Ponnet K. Determining factors in the retention of physicians in rural and underdeveloped areas: a systematic review. BMC Fam Pract. 2020;21:216. DOI: https://doi.org/10.1186/s12875-020-01279-7

Naidu AA. Telemedicine: Bridging the Gap in Providing Primary Care to Rural Area Patients Across India. Telehealth and Medicine Today. 2024;9(2). DOI: https://doi.org/10.30953/thmt.v9.518

FICCI. Discussion Paper on Advancing Primary Health in India - through Ayushman Arogya Mandir. Nov 2024. Available at: https://ficci.in/public/storage/SPDocument/24036/HD9O0qUCmCCOuPZM6O7h2gClhMxbcDa8YmVMWwaH.pdf. Accessed on 10 February 2026.

Jayaraman A, Fernandez A. Role of civil society in health care: Mechanisms for realizing universal health coverage in vulnerable communities of India. Front Public Health. 2023;11:1091533. DOI: https://doi.org/10.3389/fpubh.2023.1091533

Downloads

Published

2026-04-30

How to Cite

Malhotra, R. (2026). India’s healthcare paradox: would the domestic doctor shortage result in failure of journey towards universal health coverage?. International Journal Of Community Medicine And Public Health, 13(5), 2550–2561. https://doi.org/10.18203/2394-6040.ijcmph20261449

Issue

Section

Review Articles