Bridging India’s HRH Gaps: From Shortages to Systemic Reform

Approximately 6 in 10 people worldwide still lack access to essential healthcare services, including immunization, safe pregnancy and childbirth practices, prevention and treatment of infectious diseases, and management of chronic or noncommunicable conditions. These delays in care result in poorer health outcomes, death and disability. In most resource-constrained settings, the shortage of skilled health workers remains one of the key reasons for the gaps in healthcare delivery.

In India too, the gap in human resources for health is a persistent concern. It is vital to have adequately staffed public healthcare facilities that offer free services, reducing dependence on high-cost private care and lowering out of pocket expenditures. However, only 30% of out‑patient visits and 42% of in‑patient hospitalizations, excluding childbirth, are handled at government hospitals. The chronic shortfall in HRH continues to adversely affect our healthcare ecosystem.

What causes this disparity?

Even though India has significantly increased the production of HRH in recent years, it has not resulted in availability in public facilities. Urban areas remain better staffed while, in rural areas, many sanctioned posts remain unfulfilled. This maldistribution is not accidental and, in turn, feeds a larger disparity of rural healthcare access. This urban-rural HRH divide persists because rural postings mean weaker living conditions, poor incentives, and fragile governance systems, making them less attractive than urban roles. Thus, the problem is not the shortage of trained workforce but that it fails to be effectively deployed and retained within the public health system.

On the other hand, the private sector employs a majority of India’s healthcare workforce, but it is highly fragmented, unevenly distributed, and weakly regulated, leading to gaps in both quality and availability. The private health sector grapples with skill-mix imbalances, low retention, attrition and the presence of underqualified or inactive professionals, especially outside large urban hospitals. In effect, its own HRH constraints combined with an urban skew and high costs often deepen inequities in access to care, rather than alleviating them.

How can these Inequities be bridged?

Through the Centrally Sponsored Scheme, India has taken substantial measures to strengthen early talent pipelines by opening new medical colleges, increasing UG and PG seats in these colleges while also relaxing the norms for nursing colleges. Now, the gap is not production but equitable deployment and retention. For these inequities to be bridged, the solutions cannot be one-size-fits-all. Instead, they must be tailored to the unique demands of each healthcare segment while still addressing shared systemic gaps. Some key measures that can help address these issues more effectively include:

• Structured internship and hands-on training opportunities for continued learning, wherein high-volume hospitals function as learning and training hubs for fresh graduates and as capacity-building centres for HRH, providing on-site training and helping minimise the skill gap.
• Expanding proactive, time-bound recruitment through local hiring and community-linked training, as providers are more likely to serve where they are trained. Campus placements, mission-mode hiring, and simplified recruitment processes can ensure trained workers are not concentrated in select settings, thereby reducing public-private and rural-urban HRH gaps.
• Improving retention through incentives and support, including special allowances, especially in underserved settings, along with housing, safety, and clear career progression pathways.
• Redesigning roles and team-based care, enabling task-shifting to nurses and mid-level providers to reduce overburdening of doctors, improve efficiency and expand access outside of specialized settings.
• Investing in continuous learning and supportive work cultures, with mentoring, digital training, and better facility infrastructure to make service in Tier 2, Tier 3 cities and rural areas professionally viable.

In essence, while healthcare continues to evolve rapidly, human capital strategies must evolve even faster. Bridging the skill gap will require not only structural changes but also a shift in mindset, towards agility, cross-disciplinary collaboration, and continuous adaptation. The real test now is not creation of a new talent pool, but deployment and retention of adequately trained HRH, ensuring that skills translate into service delivery. The deeper question is: can India turn its trained talent into a workforce that reaches those who need it the most?

*This blog draws insights from the discussion on ‘The Skill Gap: Unpacking Human Capital Challenges in new- age Healthcare’ during ISB’s Healthcare Catalyst 2026.

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