The Indian government often cites the World Health Organization (WHO)’s “benchmark” of one doctor for every 1,000 people. However, this is not a standard officially prescribed by the WHO.
Parliament Question and Answer records show that until at least 2010, the government maintained that the WHO had not prescribed any specific standard for the doctor-population ratio. But answers from 2015 and as recently as 2024 show otherwise. Replies in both these years cite the 1:1,000 ratio.
In both replies, the government used this benchmark to compare doctor availability in India. Since relying solely on registered allopathic doctors pushed the doctor–population ratio above the 1:1,000 benchmark, the government opted to include AYUSH practitioners as well, lowering the final ratio. Notably, while calculating the ratio for allopathic doctors, the government used only 80% of them, as only this proportion can be considered “available”. However, when it came to AYUSH doctors, they did not apply the availability factor.
The below chart shows these doctor-population ratio calculations sourced from various Lok Sabha and Rajya Sabha replies.
Setting these discrepancies aside, the ratio itself is questionable. The WHO, in a written response to The Hindu, clarified that it “does not provide recommendations for health worker population ratios at country level”. The agency does not make such recommendations because ratios should be determined based on a country’s health labour market dynamics and individual needs, it said.
Many experts have confirmed this. “There has never been any norm by the WHO for the doctor-population ratio,” said public health expert Dr. Chandrakant Lahariya, a former staff member of the WHO. The number, he explained, was initially referenced as a WHO-recommended norm in some academic papers without attribution to any source within the WHO. Subsequently, it was cross-cited without verification and used by Parliament in its responses too.
Dr. Kiran Kumbhar, a public health expert and a historian of medicine and healthcare in India, said that there is “absolutely no indication anywhere in the WHO’s documents about this recommendation”. According to Dr. Kumbhar’s article in The India Forum, the earliest official reference to the 1:1,000 figure appears in the Medical Council of India’s ‘Vision 2015’ report, released in 2011. The document stated, based on expert consultations, that the targeted doctor population ratio would be 1:1,000 and projected that India could reach this by 2031.
While the WHO did not refer to the 1:1,000 ratio in its response, the global body stated that there are some global benchmarks used to monitor global health worker needs, such as the Sustainable Development Goals (SDG) composite index threshold, which is the most recent one. “It consists of the estimated number of skilled health workers needed to reach the minimum proportion of achievement of high coverage, defined as 80% or above for 12 selected health indicators linked to the SDGs,” the WHO explained. The latest figure for that benchmark is 4.45 doctors, nurses, and midwives per 1,000 population, it said.
Health systems researcher Siddhesh Zadey, co-founder of the Association for Socially Applicable Research India, explained the origins of this composite figure. “First, in 2006, they said the minimum number should be 2.25 per 1,000 and then revised it to 4.45 later,” he said. Mr. Zadey explained that many misrepresented the composite figure, assuming that within it, a specific portion would be doctors and the rest nurses and midwives. “However, the WHO was clear that the combined group had to be 2.25; they never stated that within that, there is a specific distribution,” he said.
Mr. Zadey argued that separate figures for doctors are often cited to justify the need for more medical colleges. “In the last 10 years, we have seen that this number has become political. It is being weaponised by the AYUSH side of health workforce, which is pitching that the target can be reached if they are included,” he said.
Dr. Lahariya argued that while composite figures are useful in assessing the overall performance, these have limited relevance because there is inequitable distribution. “Within a country, there can be States that have achieved varying ratios per thousand population,” he said.
The WHO response stated that the latest estimates for the composite and individual figures can be accessed from the National Health Workforce Accounts Data Portal. The below chart plots the estimated number of doctors per 1,000 population. With 0.7 doctors per 1,000 people, India ranked 118 out of 181 countries.
The below chart plots the estimated number of doctors, nurses and midwives per 1,000 population (the composite figure) using the latest data for countries where they are available. With a composite figure of 3.06 per 1,000 people — behind the 4.45 mark cited by the WHO — India ranked 122 of the 181 countries.
Dr. Kumbhar argued that India has always had a sufficient number of doctors; very few public health experts had ever claimed there was a paucity. It is only recently, after the 1:1,000 ratio came into the picture, that questions are being raised.
The real crisis is not the average number, Mr. Zadey said. “We know that we have a huge rural-urban disparity. In rural areas, we are nowhere close to the ideal composite threshold.”
The data was sourced from the National Health Workforce Accounts Data Portal and Lok Sabha and Rajya Sabha replies.
devyanshi.b@thehindu.co.in
Published – November 26, 2025 07:00 am IST
