Mapping Inter-State Disparities in India’s Rural Health Human Resources: An Ecosystem-Level Analysis

In a large federal-type health system governance like India, where health is decentralized but nationally guided, an integrated study aimed at inter-state variation in rural health human resources provides a critical window into structural inequalities in public health service delivery patterns. This study examines the structural patterns of public-sector rural health human resource (RHHR) distribution across Indian states and Union Territories, focusing on key categories of RHHR deployed at different levels of rural health care. Using secondary data on RHHR and applying correspondence analysis (CA), the study explores the association between state-centric categories of RHHR. The results of CA reveal a statistically significant and non-random association, highlighting distinct inequalities in RHHR composition and distribution. The first four dimensions of the correspondence analysis explain 77.3% of the total inertia, suggesting that these dimensions summarize the primary associations and contrasts in the RHHR data. The findings indicate that administratively developed states exhibit diversified and hospital-centric RHHR ecosystems, while smaller states rely on limited and substitutive health cadres. Such imbalances reflect deeper social and structural inequalities that influence access to public healthcare services. By empirically mapping these disparities, the study contributes to broader discussions on social equity, public service delivery and health system governance. The paper underscores the need for the development of context-sensitive and state-specific RHHR policies to address persistent public health inequities in India. The present paper further tries to establish an alignment of the CA dimensions with the specific and relevant Sustainable Development Goals of the UNDP.