BENGALURU: As Karnataka’s new Health and Family Welfare Minister UT Khader takes charge of the department, he is welcomed by a plethora of issues plaguing the health sector: persistent shortage of workers, medicine, gaps in primary healthcare services, growing dependence on private healthcare and rising maternal mortality rate.
At the heart of the concerns is the condition of the state’s primary healthcare system. Public health activists argue that government facilities are increasingly unable to provide patients with all the services they require. Medicines are often unavailable, diagnostic tests are referred outside and overburdened facilities struggle to meet demand.
Dr Swathi SB, member, Saarvajanika Arogya Andolana - Karnataka (SAAK), said studies conducted by public health groups have found that patients frequently leave government facilities with prescriptions for medicines and tests that must be done privately.
“When people have to spend money outside even after visiting a government hospital, they begin to lose trust in the public system. Many eventually turn to private healthcare because they feel they are paying anyway,” she said. One of the most pressing concerns, according to public health experts and workers, is the weakening of healthcare services at the taluk level.
First referral units the weakest link
Akhila Vasan of Karnataka Janaarogya Chaluvali says that taluk hospitals, which are expected to function as First Referral Units (FRUs) for emergency and specialist care, remain one of the weakest links in the state’s healthcare chain. “These facilities are supposed to handle critical emergencies and specialist services. But many continue to face shortage of specialists and essential services,” she said.
The consequences are visible across Karnataka. Many patients bypass local health centres and taluk hospitals, travelling directly to district hospitals or major tertiary-care institutions in Bengaluru in search of better care. As a result, government institutions such as Victoria Hospital and Vani Vilas Hospital are seeing a sharp rise in patient footfall, placing immense pressure on already stretched facilities. This overload often leads to longer waiting times for patients and increased strain on healthcare workers, though a significant share of these cases could have been effectively treated at primary or secondary levels of the healthcare system.
Experts argue that these shortcomings are compounded by a severe shortage of personnel. Health department data for 2024-25 shows that 1,194 Community Health Officer (CHO) posts of 6,780 sanctioned posts remain vacant, while 2,949 Primary Health Care Officer (PHCO) posts are vacant, affecting service delivery across the state’s primary healthcare network.
Dr Akshay Dinesh, co-founder of Action for Equity, said Karnataka’s healthcare challenges are rooted in long-standing systemic gaps rather than isolated administrative issues. He pointed to shortage of CHOs, ASHAs, nurses and other frontline staff across primary health centres and sub-centres, citing RTI responses and Comptroller and Auditor General (CAG) reports as evidence of uneven vacancy levels across districts.
“There is a chronic problem of facilities not having adequate staff, and people no longer rely on these centres for care,” he said, adding that this has pushed patients towards private providers over time. Dinesh said that repeated policy announcements on recruitment and reforms often remain unimplemented on the ground, and argued that without consistent staffing, transparent data systems and accountability in primary care delivery, improvements in Karnataka’s public healthcare system will remain limited.
Health experts pointed out that vacancies in Primary Health Centres and Community Health Centres often result in delayed treatment, reduced outreach activities and increased workload for existing staff. In rural areas, where public facilities serve as the first point of contact for healthcare, these gaps can have significant consequences.
Maternal mortality
Concerns about the effectiveness of Karnataka’s healthcare system are also reflected in maternal health indicators. According to the Sample Registration System (SRS) Special Bulletin on Maternal Mortality in India, 2022-24, Karnataka recorded a Maternal Mortality Ratio (MMR) of 73 deaths per 1,00,000 live births, the highest among southern states. The figure is considerably higher than Telangana (48), Andhra Pradesh (39), Tamil Nadu (25) and Kerala (24).
Experts say these figures point to deeper systemic challenges that extend beyond maternity care alone. While institutional deliveries and maternal health programmes have expanded over the years, issues such as anaemia among women, inadequate nutrition, delayed detection of high-risk pregnancies, shortages of healthcare personnel and gaps in primary healthcare services continue to affect outcomes.
Akhila Vasan said that nearly half of pregnant women in Karnataka are anaemic, making it one of the most significant underlying factors contributing to pregnancy-related complications and maternal deaths.
She argued that maternal mortality cannot be viewed in isolation from broader public health concerns, including malnutrition, regional disparities and weaknesses in primary healthcare services. Experts stressed that timely antenatal screening, nutritional interventions and regular monitoring are essential to reduce these risks.
According to public health specialists, many maternal deaths are linked to delays in identifying complications and accessing appropriate treatment, underscoring the need to strengthen primary healthcare infrastructure and ensure adequate staffing at government facilities.
Frontline workers, particularly ASHAs, play a critical role in addressing these gaps by tracking pregnancies, promoting institutional deliveries, ensuring immunisation and connecting women with healthcare services. However, concerns remain about their workload and the support available to them.
Better wages
Rama TC, vice-president of the Karnataka Rajya Samyukta ASHA Karyakarteyara Sangha (AIUTUC), said ASHA workers continue to shoulder a wide range of responsibilities, including maternal healthcare, immunisation drives, disease surveillance and community outreach, despite receiving inadequate compensation.
She said ASHA workers are frequently assigned additional duties without corresponding increases in honorariums or support. Strengthening the public healthcare system, she argued, must include better wages, timely payments and improved working conditions for frontline workers, who form the backbone of healthcare delivery at the village level.
Alongside concerns about public healthcare delivery, activists and researchers have raised alarm over the increasing role of private healthcare providers in the state. Prasanna Saligram, a public health researcher, said Karnataka’s healthcare system has witnessed a gradual shift towards privatisation over several decades, driven partly by inadequate public investment and growing policy reliance on private providers.
“Healthcare has always had a significant private presence in India. What we are seeing now is governments actively promoting private healthcare and insurance-based models instead of strengthening public healthcare systems,” he said.
According to Saligram, underinvestment in public healthcare has created a situation where patients increasingly rely on private providers not out of preference but necessity. “When government hospitals lack medicines, diagnostics or adequate staff, people are pushed towards private healthcare. It is often desperation rather than choice that drives patients to private hospitals,” he said.
Saligram also pointed to growing corporatisation of healthcare, arguing that large hospital chains are increasingly dominating the sector. He warned that weak regulation has allowed problems such as overcharging, unnecessary procedures and lack of accountability to persist.
Karibasappa M, State Executive Committee Member of SAAK, Davanagere, criticised the expansion of Public-Private Partnership (PPP) models in healthcare. He said health rights groups had earlier organised protests against proposed PPP initiatives in Davanagere district and continue to oppose the outsourcing of healthcare services.
“Patients in government facilities, including Women and Child Hospitals and urban health centres, are frequently asked to purchase medicines and obtain tests outside. This is especially difficult for daily wage workers, domestic workers and other people in the unorganised sector,” Karibasappa said.
He added that health activists have been demanding legislation guaranteeing free medicines, diagnostics and treatment in government hospitals, and have called for greater investment in government-run medical colleges and healthcare infrastructure. “We believe healthcare is the responsibility of the government. Medicines, tests and treatment should be provided free of cost, and healthcare workers paid adequately and on time,” he said.
As the new Health Minister begins his tenure, public health experts say the priorities are clear: Fill vacancies across the system, strengthen PHCs and government hospitals, ensure free medicines and diagnostics, improve maternal healthcare outcomes, support ASHA workers, regulate private healthcare providers and rebuild public confidence in the state’s health system. This, they argue, will be critical if Karnataka is to move closer to delivering equitable and affordable healthcare for all.
