Despite the implementation of National Rural Health Mission since 2005 to provide quality healthcare to population in rural India, there are some formidable challenges confronting public hospitals. These challenges are associated with the social, economic, cultural and political scenarios of the country. It is unfortunate that, sometimes even basic healthcare becomes unaffordable to many common people due to the policies framed by governing bodies.

Deficient infrastructure, insufficient manpower, high patient load, vague quality of services and cost burden are the major challenges currently confronting public hospitals in India.

Most of the public hospitals in India are devoid of basic infrastructure, which also includes amenities like water, electricity, beds, medical and paramedical manpower. On the other hand, improper distribution of available infrastructure leads to undermining of merely available resources. Unavailability of any of the resources like water, electricity would render the functioning of existing facilities worthless. Under National Health Mission (NHM), government has provided financial assistance to states to build or upgrade the existing facilities at healthcare centers. Up to 33% of these funds can be spent by high focus states whereas other states can spend up to 25%.

Deficit of human resources in health sector occurs majorly at two levels: regions – between rural and urban areas and sectors – between the public and private sectors. Healthcare professionals have put themselves beyond the reach of the rural population due to their unwillingness to serve in rural, tribal and hilly areas. On the other hand, healthcare personnel seems to be more inclined towards for-profit privately owned hospitals in the urban areas. According to a study, the deficiency of manpower in rural healthcare is as high as more than 90% in states like Chhattisgarh, Jharkhand, and Rajasthan, while being at nearly 86% in Uttarakhand, and Odisha. According to WHO, India stands 52^nd among the 57 countries facing human resources deficit.

Lack of infrastructure and manpower are rendered even more serious by growing population of patients. Inevitable rapid urbanization caused expansion of slums that engender various infectious diseases. Improper planning of cities, lack of proper sanitation, social exclusion, lack of outreach and economic backwardness are some of the factors that heighten the incidence of diseases among these populations. Apart from this, poorly functioning subcenters, PHCs, and CHCs in rural areas make those populations opt for hospitals in towns and cities thereby limiting the infrastructure at these hospitals.

For more than two decades now, there has been a remarkable deterioration in the quality of services rendered by the public hospitals. Owing to neoliberal policies, there is a growing dominance of private healthcare. Another interesting trend in this direction is outsourcing of many services in public hospitals such as security, housekeeping, catering services, diagnostic and curative facilities on public-private partnership mode.

 As stated by the last “National Health Accounts” for India published in 2004-05: “Among all the sources, households contributed a significant portion at 71.13% of total health expenditure for availing health care services from different health care institutions. This covers expenditure on inpatient, outpatient care, family planning, and immunization, and so forth”. The average hospitalization cost in India rose at a double digit pace over the past decade. Majority of Indian population do not avail any form of employee provided or state funded insurance, resulting in out-of pocket health expenditure.

These challenges can possibly be overcome by adequately investing in most fundamental needs such as nutritious food, water, sanitation, education and healthcare as a matter of right to all individuals, free from profit motives.

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