Healing the system: Public-health gaps demand stronger governance

The Delhi government’s 2026-27 Budget, of about ₹1.03 trillion, presented this week, allocated ₹13,034 crore to the health sector, which was  an increase of about 1 per cent over this financial year’s allocation. While the government plans to focus on completing the construction of hospitals, expanding Ayushman Arogya Mandirs, and setting up integrated public-health laboratories, the recently released audit report by the Comptroller and Auditor General for the years between 2016-17 and 2021-22 highlighted considerable gaps in Delhi’s public health care. Among the gaps, the report refers to an over 21 per cent staff shortage, essential drugs not available, overcrowded hospitals, and unspent funds. With the availability of hospital beds at just 0.7 per 1,000 people, long waiting periods for patients needing a surgery, and delayed infrastructure projects, this points to deep governance and capacity issues. 

However, Delhi is no exception. At all-India level, these problems reflect a wider structural problem in public health care. India’s public spending on health remains around 1.8 per cent of gross domestic product, which is significantly lower than the National Health Policy target of 2.5 per cent. Out-of-pocket expenditure by households is still about 39 per cent of health expenditure, with medicines accounting for a large share of medical expenses, making health care unaffordable for many families. Gaps are visible across primary infrastructure, with many facilities serving populations far above prescribed norms, leading to overcrowding and poor quality of care. India also has only 1.4 hospital beds per 1,000 people, far below the global average of 2.9. Human-resource shortages remain a critical constraint. India has about one doctor per 1,263 people, below the World Health Organization norm of 1:1,000. Specialist shortages are particularly severe in rural areas, where about 70 per cent of specialist posts in community health centres are vacant. 

The Union Budget for 2026-27 allocated about ₹1.06 trillion to the Ministry of Health and Family Welfare, a 10 per cent increase over the previous year. A large share continues to go to the National Health Mission, followed by funding for autonomous institutions such as the All India Institute of Medical Sciences and medical colleges. Allocation to the PM Ayushman Bharat Health Infrastructure Mission has increased. However, several schemes have seen under-utilisation of funds, reflecting administrative and implementation bottlenecks. The broader lesson is that India’s health challenge is not only about spending more but also about spending better. Weak fund utilisation, delayed infrastructure projects, staff vacancies, and drug procurement failures are governance issues that require administrative attention. 

Strengthening decentralised primary health care, especially health and wellness centres and urban primary health centres, is critical to reducing pressure on large hospitals. India has nearly 180,000 Ayushman Arogya Mandirs, but these centres must be equipped with staff and medicines. Better Centre-state coordination is essential. Ultimately, India’s economic growth and demographic advantage depend on the health of its workforce. The audit findings in Delhi, therefore, can be seen as a warning about systemic weaknesses in public health care governance across India. There is a need to build a more efficient, accountable, and accessible public health system.