Critical Evaluation of Indian Public Health Standards (IPHS) Human Resource Norms: Systemic Deficiencies in 24×7 Primary and Community Health Centres – A Longitudinal WISN Analysis

Abstract The Indian Public Health Standards (IPHS) were developed to standardize service delivery across India’s vast public health network (1). Despite revisions in 2012 and 2022 to support the National Health Mission (NHM) and Ayushman Bharat programs (2,3), significant human-resource challenges persist—particularly in 24×7 facilities. The current IPHS staffing norm of a single medical officer and three nurses per Primary Health Centre (PHC) remains unrealistic once leave, holidays, and childcare absences are factored in (4,5). This longitudinal study used the Workload Indicators of Staffing Need (WISN) methodology (6,7) to assess staffing adequacy across 108 facilities in Ajmer District, Rajasthan, from 2021–2024. Data from HMIS , PCTS , and e-Aushadhi were triangulated with facility records (Fig 1). Outpatient visits rose 10% (5.69M–6.26M), inpatient admissions by 50% (219,140–329,681), while antenatal registrations declined 31% and live births 21%. Neonatal deaths fell to 44 district-wide (0.1%), maternal deaths dropped by 47%, and low-birth-weight cases declined 31%. Yet, full immunization coverage decreased by 15% (Table 4). Vacancy rates averaged 9–17% for doctors, 39–47% for nurses, and 42% for paramedical staff. WISN ratios—0.42 for doctors, 0.45 for nurses, 0.12 for pharmacists, and 0.31 for laboratory technicians—signified severe understaffing (Fig 2) (8). Ajmer’s dispersed geography—villages 10–20 km apart with small populations—further amplifies workload disparities. While Rajasthan’s NHM 2025 plan to recruit 13,252 new posts shows promise (9), WISN findings suggest a need for 50–100% more sanctioned positions, plus a 20–30% buffer for leave and geographic constraints. India’s path toward Universal Health Coverage requires IPHS norms grounded in real workload evidence rather than static population ratios (10,11).