Two days after the Union Budget was presented, I found myself not in a seminar room or policy discussion, but inside Ward 2 of the Sherbagh Maternity Hospital in Anantnag, Jammu and Kashmir.
A close family member had been admitted for emergency inpatient care and monitoring. What I witnessed there, however, extended far beyond one household’s distress. On a single hospital bed, two patients lay facing each other, not separated by partitions or privacy, but by exhaustion and institutional constraint. Each patient required at least one attendant, meaning that around a single bed, four individuals occupied an already limited space. In a maternity settingwhere infection risk, privacy, and continuous monitoring are critical,such crowding transforms care spaces into zones of heightened vulnerability rather than safety.
This was not an exceptional situation.
It was routine.
And it raised an unavoidable question: what does a ₹1 lakh crore health budget actually look like on the ground?

The Budgetary Promise

In the Union Budget 2026–27, approximately ₹1.05 lakh crorewas allocated to the Ministry of Health and Family Welfare. The figure has been widely cited as evidence of growing commitment to public health.
Yet perspective matters.
Despite crossing the ₹1 lakh crore mark:
Health spending constitutes only about 2% of total Union Budget expenditure
As a share of GDP, public health spending remains below 1%
This falls far short of the National Health Policy target of 2.5% of GDP
In effect, while the headline number sounds impressive, India continues to underinvest in public health relative to its population size, disease burden, and regional vulnerabilities.
Globally, the bar is higher. The World Health Organization has repeatedly shown that countries with resilient and equitable health systems spend around 5% of GDP or more on public health.
Among developed economies, Germany spends roughly 11–12% of its GDP on health, while the United Kingdom allocates close to 10%, largely through publicly financed systems that prioritise universal access and inpatient capacity.
What is more telling is the contrast with developing economies. Brazil spends about 9% of GDP on health, supported by a constitutionally guaranteed public health system, while Thailand, often cited as a model for universal health coverage in the Global South, spends around 4–5% of GDP, with a strong emphasis on public hospitals and primary care.
Against this backdrop, India’s public health spending—still below 1% of GDP—reflects not merely underinvestment, but a persistent structural gap between policy ambition and lived reality.
The consequences of this underinvestment are not abstract. They are visible—in beds, wards, and waiting rooms.

Where the Money Goes

A substantial portion of health allocations flows toward:
Insurance-based schemes
Tertiary and specialised care
Medical education and research
Programme-driven interventions
These investments matter. But what remains persistently underfunded is the everyday infrastructure of care:
Adequate hospital beds
Sufficient ward space
Nurse-to-patient ratios
Basic inpatient dignity
The result is a familiar landscape across public hospitals: overcrowded wards, overstretched staff, and clinical spaces stretched far beyond their intended capacity.
The Bed-to-Population Reality
One of the clearest indicators of health system capacity is the hospital bed-to-population ratio.
India averages roughly 1.3 beds per 1,000 people, including both public and private facilitieswell below the World Health Organization’s benchmark of 3 beds per 1,000. In the public sector alone, availability often falls below 0.8 beds per 1,000, particularly in poorer and geographically challenging regions.
To reach even a modest global standard, India would need over 2.4 million additional hospital beds.
This shortfall becomes especially acute in women’s and maternal healthcare, where treatment cannot be shifted to outpatient settings. Pregnancy, delivery, and neonatal care demand continuous monitoring, dedicated inpatient space, and immediate emergency response.
When these are absent, overcrowding is not just inconvenient, it is dangerous.
Hospitals as Regional Lifelines
Sherbagh Maternity Hospitalformally the Maternity & Child Care Hospital (MCCH), Government Medical College, Anantnagis not merely a local facility. Established in 1956, it serves the entirety of South Kashmir, including Anantnag, Kulgam, Shopian, and adjoining areas of the Pir Panjal range.
For patients from far-flung villages, reaching this hospital often involves long travel under difficult terrain and harsh weather. During winter months, when roads become unreliable or blocked, options shrink dramatically. For many families, Sherbagh is not a choiceit is the only reachable point of care.
This makes overcrowding not a management anomaly, but a structural outcome of insufficient regional health capacity.
An Essential Institution Under Visible Strain
MCCH offers an extensive range of services:
24×7 obstetric, neonatal, and paediatric care
Special Newborn Care Units and High Dependency Units
Thousands of deliveries annually
Emergency surgical and diagnostic services
Its medical staff operate under intense pressure, often compensating for infrastructural limits through professional commitment and experience.
Yet a contradiction remains.
Despite covering a vast population and functioning as a regional emergency hub, the hospital’s physical scale and bed strength do not reflect its mandate. With just over 100 beds, including 96 obstetric beds, the facility manages tens of thousands of inpatient admissions each year.
The result is a normalization of scarcity: shared beds, crowded wards, and emergency care delivered under constrained conditions.
In maternity care, this is not a marginal concern. It directly shapes outcomes.
What a Hospital Ward Reveals
The sight of two patients sharing a single bed is not merely about comfort. It reflects:
Severe bed shortages
Chronic understaffing
Inadequate planning for emergency maternal care
In spaces where maternal and neonatal outcomes can change within minutes, overcrowding becomes a clinical risk rather than a logistical inconvenience.
The Illusion of Adequacy
India’s health budget challenge is not only about allocation size, but about scale relative to need.
When public health spending remains low:
Hospitals become sites of congestion rather than care
Emergencies turn into negotiations over space
Patient dignity becomes an unintended casualty
The irony is difficult to ignore. Maternal health is repeatedly identified as a policy priority, yet maternity wards remain among the most congested spaces in public hospitals.
From Policy Documents to Hospital Corridors
Health budgets are debated in official forums and evaluated in spreadsheets. But their real audit happens elsewherein hospital corridors, crowded wards, and emergency rooms operating at full stretch.
What I observed was not the failure of medical professionals. It was the predictable outcome of long-term structural underinvestment.
A system cannot deliver dignity if it is designed only to deliver numbers.
Rethinking Health Investment
If India is serious about health reform, priorities must shift:
From insurance coverage to care capacity
From flagship programmes to frontline infrastructure
From headline allocations to sustained, region-sensitive investment
Public hospitals do not need louder announcements. They need more beds, more staff, and more spaceespecially in regions where alternatives are few and distances are vast.
The Real Measure of a Health Budget
A health budget should not be judged by how impressive it sounds in budget speeches, but by what it prevents in practice.
If ₹1 lakh crore still allows:
Two patients on one bed
Emergency wards operating beyond capacity
Hospitals serving vast regions without adequate infrastructure
Then the issue is not inefficiencyit is insufficient and uneven investment.
Until health budgets translate into dignity at the bedside, they will remain numbers on paperdetached from the realities they are meant to address.In health, the distance between policy intent and patient experience is measured not in crores, but in beds.

Email:-------------------sameersofi.ecscholar@kashmiruniversity.net