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India’s healthcare system has long struggled with a stark urban–rural divide. Metropolitan cities host multi-specialty hospitals and advanced diagnostics, while rural India, home to nearly 65% of the population, continues to grapple with inadequate infrastructure, limited medical professionals, and fragile preventive care systems.
Rural India has just 0.9 hospital beds per 10,000 people compared to 2.7 in urban areas. Despite an expanding network of Primary Health Centres (PHCs) and Community Health Centres (CHCs), according to a Health ministry report nearly 80% of specialist posts and 58% of radiographer positions in CHCs remain vacant
The imbalance is reflected in outcomes: in 2021, rural India’s infant mortality rate stood at 30 per 1,000 live births compared to 18 in urban areas. Maternal mortality, malnutrition, and anaemia remain disproportionately higher in villages, often tied to delays in accessing timely care. Further, rural patients are forced to travel long distances, adding to India’s already high out-of-pocket health expenditure, which accounts for nearly 40% of total health spending.
Expanding Rural Healthcare Infrastructure
Policy momentum in recent years has attempted to correct this imbalance. Ayushman Arogya Mandirs (AAMs) have expanded rapidly, from just over 17,000 in 2018–19 to nearly 1.8 lakh by August 2025, delivering maternal health services, NCD screening, and palliative care. These centres have facilitated over 55 crore hypertension screenings and 48 crore diabetes screenings, embedding preventive health in rural ecosystems.
Complementing physical infrastructure, the expansion of broadband under BharatNet is enabling teleconsultations, digital health records, and remote training. States such as Uttar Pradesh and Andhra Pradesh have pioneered e-PHCs, e-CHCs, telemedicine, teleradiology, and even e-ICUs, demonstrating how digital infrastructure can bring specialist care closer to underserved regions.
Building a Digital Health Ecosystem
Ayushman Bharat Digital Mission (ABDM), launched in 2021, is emerging as a backbone for India’s connected health vision. With 80 crore Ayushman Bharat Health Accounts (ABHA) and 69 crore linked health records, ABDM provides portability of medical histories across providers and geographies.Digital platforms are also transforming service delivery. e-Sanjeevani has crossed 37 crore teleconsultations, making specialist access more democratic. U-WIN, digitizing the Universal Immunization Program, has enabled over 41 crore vaccine doses with 10 crore registered beneficiaries. Combined with the success of CoWIN during the pandemic, these platforms illustrate India’s ability to deploy population-scale digital public goods.
Together, they are reshaping how care is accessed and reducing travel costs, ensuring continuity of care, and bringing urban-level access to rural households.
Harnessing Artificial Intelligence for Healthcare
India is also moving toward AI-enabled precision healthcare. Centres of Excellence at AIIMS Delhi, PGIMER Chandigarh, and AIIMS Rishikesh are developing AI-driven diagnostics and treatment models. The Clinical Decision Support System (CDSS) integrated into e-Sanjeevani has powered 12 million AI-based consultations, while AI-enabled surveillance tools have generated over 4,500 disease outbreak alerts since 2022.
Practical applications are already visible. AI-based cough analysis has improved TB detection rates by up to 16%. Startups are delivering AI solutions in radiology, diabetic retinopathy, and chest X-ray interpretation. Through the Digital Health Incentive Scheme (DHIS), the government is encouraging wider adoption of ABDM-compliant AI tools across hospitals and innovators, ensuring affordability and scaling.
Challenges
Despite progress, significant roadblocks remain. Infrastructure gaps remain stark, with critical shortages of beds, ICUs, and diagnostics, adding 30 lakh beds over 15 years will require heavy investment. Human resources are skewed, with vacancies in specialists and nurses despite expanded colleges. Rural digital literacy lags behind, limiting uptake of ABDM and telemedicine. Out-of-pocket costs remain high, undermining equity. Weak ambulance networks, patchy broadband, and unreliable power continue to hinder last-mile delivery of healthcare.
The Road Ahead
Bridging India’s rural–urban health divide requires more than incremental measures. It calls for a coordinated 10–15 year strategy combining infrastructure expansion, workforce strengthening, digital acceleration, and AI-enabled healthcare.
- Infrastructure expansion: Scale up AAMs, Health & Wellness Centres, and public-private partnerships in Tier-2 and Tier-3 cities.
- Workforce strengthening: Expand postgraduate medical seats, strengthen rural deployment, and leverage nurse practitioners to fill gaps. The government has committed to opening 157 new nursing colleges.
- Digital acceleration: Universalize BharatNet access and scale platforms like e-Sanjeevani, U-WIN, and tele-diagnostics.
- AI integration: Invest in Centres of Excellence, support startups, and embed AI tools into public health programs
The opportunity lies in convergence. Rural health infrastructure must be complemented by digital literacy among frontline workers, geo-tagged ambulances for last-mile access, and rural health innovation labs to co-create solutions with academic institutions and startups. If executed with consistency and collaboration, India can create a connected health ecosystem where geography no longer dictates the quality of care.
The article is written by Satyam Shivam Sundaram, Partner, EY India.
(DISCLAIMER: The views expressed are solely of the author and ETHealthworld.com does not necessarily subscribe to it. ETHealthworld.com shall not be responsible for any damage caused to any person/organisation directly or indirectly)
