Fixing structural deficits in India’s health system
On March 11, 2026, the Minister of State for Health, Anupriya Patel, informed Parliament that 43 new medical colleges have been established and 11,682 MBBS seats along with 8,967 postgraduate seats have been approved for the 2025-26 academic year.
Will this address India’s problem of non-availability of doctors in the public health system? Of the 8,967 new postgraduate doctors, how many will actually have the inclination to serve in aspirational districts or underserved areas? Of the 43 newly sanctioned medical colleges, only eight are under State governments, eight are in the Employees’ State Insurance (ESI) sector, and 27 are in the private sector. Private medical colleges, after charging high capitation fees, have no obligation to post their trainees in government service, nor can they be compelled to do so. There is also no clearly defined policy or stipulations to ensure that public health institutions benefit maximally by filling existing vacancies in specialist cadre posts.
Merely investing in capital expenditure and infrastructure alone will not yield the desired improvement in health services in hilly, tribal, and other remote underserved areas. Eleven out of 18 All India Institutes of Medical Sciences report around 40% vacancies in their teaching and research faculty positions. Without adequate research and teaching capacity, how can we effectively train specialists?
Glaring vacancy rate
According to The Health Dynamics of India 2022-23 report, the vacancy rate in 5,491 rural Community Health Centres (CHC) across 757 districts in India is 79.9%, with only 4,413 specialists available against a requirement of 21,964. Since 2014, the shortfall of specialists in CHCs has remained at around 17,500, despite the creation of additional postgraduate medical seats — 72,627 across 731 medical colleges.
Newly graduated specialists are often unwilling to work in remote and underserved areas due to inadequate facilities, including lack of equipment, decent staff quarters, schools for their children, and adequate peer medical support. If specialists were available at CHCs, patients from rural and tribal areas would not need to travel long distances to district headquarters hospitals or medical colleges.
A CHC serves as a first referral unit for a population of about 1.6 lakh to 2 lakh and is expected to have 30 beds with five specialists — physician, surgeon, obstetrician, paediatrician, and anaesthetist. However, the majority of CHCs remain crippled due to a persistent shortage of specialists, a problem that has continued for many years.
Yet, States continue to construct more CHCs to utilise available central government funds, even though many of them function effectively as primary health centres. There are 5,491 CHCs across 785 districts — about seven CHCs per district — which is not a feasible model. With only 4,413 specialists available at present, just 882 CHCs can be fully operationalised, effectively leaving only one functional CHC per district in addition to the district hospital for specialised care.
Flawed budgetary focus
The central health Budget is largely focused on infrastructure, without matching allocations for drugs, diagnostics, ambulance services, emergency care, or salaries for temporary staff. If the goal is to improve people’s health, it must prioritise operational outcomes rather than merely investing capital in building construction, leaving the rest to be managed by State budgets.
How do we manage better with what we have in hand? We need to put the brakes on overly enthusiastic declarations of new CHCs, which often serve populist political mileage rather than functional need.
Classify all PHCs and CHCs into normal, difficult, and most difficult areas based on defined criteria, as was done in Chhattisgarh under the Rural Medical Corps Scheme. The most difficult areas are those with persistently high staff vacancies over long periods. Introduce special incentives such as additional compensatory financial allowances, priority for postgraduate seats, staff quarters, and quality schooling facilities for children, among others.
Additional steps to take
Hereafter, all government-sponsored postgraduate seat allocations must be linked to existing vacancies in CHCs or district hospitals. Candidates willing to fill a specialist vacancy in a CHC should be allotted a seat in the corresponding speciality, with the assurance that upon completion of training, they will be posted there immediately.
Conversely, aspirant doctors must provide an undertaking to serve in the designated government facility first. Priority may be given to those who commit to a 10-year service bond in difficult-area CHCs, along with additional incentives under the National Health Mission. We must strictly follow an “all or none” principle in posting specialists — either all five specialists are placed in a CHC or none at all —avoiding piecemeal deployment or the dilution of services by spreading specialists too thinly.
Urgent construction of staff quarters and renovation of operation theatres, labour rooms, intensive care units, and 24-hour emergency units must be undertaken in such CHCs, which may number two or three per district. Similar undertakings and post graduate training can be awarded to nurses willing to serve in remote needy areas.
When adequate specialists are posted as a team at the sub-district or town level, the image of government hospitals improves in the public eye. The workload is better distributed, and optimal sharing reduces stress on doctors on duty. Interpersonal communication with patients also improves. This, in turn, enhances patient satisfaction and reduces conflicts between the public and doctors and other health staff.
We can no longer afford to see nearly 70,000 specialists graduating from 731 medical colleges without adequately filling the vacant posts in the public health system, which remains the only source of care for the poor and marginalised.
Dr. K.R. Antony is a public health system and policy development adviser
Published – May 07, 2026 12:08 am IST
