The Challenges Confronting Public Hospitals in India, Their Origins, and Possible Solutions

Table 1

Comparison between “ten-year plan,” the “three-million plan” and the presently available health infrastructure.

	“Ten-year plan” (targets to be met at the end of ten years)			“Three-million plan”			Present available infrastructure
	Population norm	Medical officers	Hospital	Population norm	Medical officers	Hospital	Population per facility	Medical officers	Hospital bed norms^##
Primary unit	40,000	2	15 beds	20,000 population	6	75 beds	34 and 641.3**	1.2	4 beds
Secondary unit	5,00,000	17	200 beds	6,00,000 population	140	650 beds	1, 72, and 375**	3.3	30
District headquarters/bigger secondary units	7,50,000	—	500 beds* (1.03/1000)	30,00,000; population	268	2,500 beds (5.67/1000)	17, 45, and 152 approximately^#	—	100 to 500 beds (0.9/1000)

Note: the “three-million plan” laid down the required health infrastructure to provide for the health needs of an average district in India having a population of three million. This was to be implemented over a period of three to four decades. Anticipating resource constraints, both in terms of manpower and money to make such an infrastructure available in a short time, the committee recommended a shorter “ten-year plan” to be implemented first.
Source: details of the “ten-year plan” and “three-million plan” have been obtained from chapters III and IV of the Government of India [1]: “Report of the Health Development and Survey Committee (Bhore Committee), Vol. II,” Government of India Press. *In the “ten-year plan,” the Bhore committee did not recommend setting up of a district level tertiary health set-up. Instead, 4 of the 200-bed secondary units in the districts were to be elevated to the level of 500-bed secondary units.
**Figures obtained from Table  11 of the “Rural Health Bulletin, 2012,” Ministry of Health and Family Welfare, Government of India [2].
^#Figure has been obtained by dividing the total population of the country in 2011 by the number of district hospitals.
^##Obtained from Rural Health Bulletin, 2012, Ministry of Health and Family Welfare [2].
Figures in parenthesis are the beds per thousand population set to be achieved in the “ten-year plan” and “three-million plan” and the ratio at present in India.