Half of India's states do not have a district hospital in each district

Delhi and Kerala have 3 district hospitals per district; Uttar Pradesh has two. Telangana has one hospital for five districts

The Covid-19 pandemic exposed the frailties in India’s health system. The country had a woeful shortage of doctors, nurses and beds. Even in the metros, the medical infrastructure could not keep pace with the rising caseload.

While the new Indian Public Health Standard guidelines announced last week aim to plug the infrastructure gaps, an analysis by Business Standard shows that states lag far behind. Data from Rural Health Statistics shows that half the states in the country do not have a district hospital in each district—one of the parameters of the new guidelines is one district hospital per district.

Of the 36 states/UTs for which data is available, 18 did not have a district hospital in each of their districts, 11 just about met the criteria, whereas seven had more than one district hospital per district.

Delhi and Kerala had, on average, 3.4 district hospitals per district, whereas Uttar Pradesh had 2.2 hospitals per district. The 75 districts in the states had 168 district hospitals.

Among the worst performers were Telangana, with only five district hospitals for 33 districts, Tamil Nadu had 20 district hospitals for 38 districts, and Gujarat had a similar number for 33 districts.

A report released by Niti Aayog in 2021 assessing the district hospitals had found gaps in service delivery across most district hospitals.

The IPHS-2012 guidelines had envisaged 22 beds per lakh population, but only 217 of the over 700 district hospitals satisfied these criteria. About 89 hospitals could cater to all 14 services laid down in the IPHS guidelines; the average was 11 services. On the other hand, average bed occupancy was 57 per cent, against the laid down benchmark of 80 per cent.

Further analysis shows that 14 of the 35 states/UTs for which data was available had fewer hospitals in 2020-21 than in 2014-15. Gujarat had 13 fewer district hospitals in 2020-21 compared to 2014-15. The number of district hospitals in Tamil Nadu and Maharashtra had reduced by 12 and 10 during this period. In contrast, Uttar Pradesh added 93 district hospitals, Kerala added 33, and Delhi added 26.