India’s flagship medical institutions—the All-India Institute of Medical Sciences (AIIMS), New Delhi, and the Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh—are pillars of India’s healthcare system and symbols of national pride. Yet beneath their shining reputations lies an uncomfortable reality: overstretched infrastructure, chronic staff shortages, and governance bottlenecks that now threaten their very excellence.

What began as centres of excellence for tertiary care and research are today struggling under the weight of their own success. Designed for specialized referrals, these hospitals have become de facto primary and secondary care providers for millions seeking affordable, quality treatment.

1. The Human Resource Crisis: The Hidden Fracture

Persistent understaffing remains the Achilles’ heel of India’s premier public hospitals. Thousands of sanctioned posts for doctors, nurses, and support staff remain vacant, overburdening existing teams, eroding morale, and compromising patient safety.

At AIIMS Delhi, nearly 462 of 1,306 faculty positions are unfilled. At PGIMER Chandigarh, about 1,874 non-faculty posts lie vacant—nearly a quarter of the total sanctioned strength. Across the newer AIIMS campuses, vacancy rates are as high as 60%, especially for nurses and paramedical staff.

Prolonged recruitment cycles, administrative delays, and the lure of private-sector opportunities have triggered a steady exodus of talent. While the Union Health Ministry has launched drives and contractual hiring, retention and motivation remain unresolved.

“India’s leading hospitals cannot sustain excellence on exhausted human capital. Closing the staffing gap is no longer an administrative issue—it is a national health imperative.”

2. Overcrowding: When Excellence Meets Excess

AIIMS Delhi handles over 15,000 OPD patients daily, while PGIMER sees nearly 10,000, far beyond designed capacities. Patients travel from distant states, often bypassing local facilities due to weak referral systems and limited specialist care.

The consequence is predictable:

Long queues and delays, with appointments booked months in advance.

ICUs operating at 1:10 nurse-patient ratios (against the ideal 1:2).

Resident doctors doubling as clerks or attendants, leaving little room for learning or rest.

This relentless overload dilutes postgraduate education and weakens the research output that once defined these institutions.

3. Infrastructure Fatigue: Cracks Beneath the Surface

Aging infrastructure and delayed maintenance have led to what administrators call “infrastructure fatigue.” Elevators, HVAC systems, and imaging units often break down under continuous use.

At PGIMER, 13% of critical equipment is non-functional at any given time. A CAG audit recently found maintenance spending at less than 5% of actual needs. Equipment failures and power disruptions in ICUs and operation theatres compromise both safety and efficiency.

While government allocations—₹2,400 crore for PGIMER and similar support for AIIMS—signal intent, reactive repairs must give way to preventive maintenance and data-driven asset management.

4. Funding Gaps: Big Budgets, Small Impact

Despite incremental budget increases, public health spending remains just 1.3–1.5% of GDP, far below the global average of 5–6%.

In 2025–26, health received ₹99,858 crore, with 20% directed to AIIMS campuses. Yet underutilization persists—only 81% of last year’s outlay was spent. Salaries consume over 90% of budgets, leaving little for modernization, maintenance, or research.

Experts argue that unless at least 10% of institutional budgets are ring-fenced for maintenance and innovation, India’s apex institutions will continue to face periodic crises.

5. Digital Fragility: The Cyber Threat Within

The 2022 ransomware attack on AIIMS Delhi exposed the digital fragility of even the nation’s best hospitals. Operations were paralyzed for days, compromising millions of patient records.

At PGIMER, outdated Hospital Information Systems (HIS) continue to limit data integration and digital efficiency. Less than 5% of health budgets are allocated to cybersecurity—a critical vulnerability as digital health expands under the Ayushman Bharat Digital Mission (ABDM).

A “zero-trust” security model and dedicated cyber training for healthcare workers are urgently needed to prevent another AIIMS-like digital paralysis.

6. Governance and Corruption: Weak Links in a Strong Chain

Procurement irregularities, administrative inertia, and misuse of welfare funds have marred governance across several AIIMS campuses and at PGIMER.

From inflated glove purchases and rigged tenders to fraudulent PMJAY claims, such lapses erode morale and public trust. Despite e-governance efforts, systemic transparency and accountability remain weak.

Third-party audits, real-time fund tracking, and performance-linked leadership reforms could restore integrity to these institutions.

7. Infection Control, AMR, and Patient Safety

Overcrowding and staff shortages have led to rising hospital-acquired infections and antimicrobial resistance (AMR).

Recent audits show 30% non-compliance in hand hygiene at PGIMER and MRSA outbreaks at AIIMS Delhi. Nearly 70% of inpatients receive antibiotics—double the WHO recommendation—driving drug resistance.

Patient safety is a paramount priority for hospitals in India. Building a strong safety culture, ensuring robust surveillance, and advancing antimicrobial stewardship are vital to safer care with leading institutes like AIIMS and PGI continuing to set benchmarks of excellence.

8. Ayushman Bharat: Expanding Access, Intensifying Pressure

The Ayushman Bharat–PMJAY scheme has expanded access for millions—offering up to ₹5 lakh annual coverage per family—but also amplified the load on apex hospitals.

At AIIMS Delhi and PGIMER, PMJAY admissions have grown 20–30% annually, stretching infrastructure and delaying reimbursements. Fraudulent claims and administrative overload have added new challenges.

While the scheme democratizes healthcare, without strong primary and district-level systems, it risks turning tertiary centres into overburdened safety nets.

The Way Forward: Restoring Balance

India’s premier institutions—AIIMS and PGIMER—represent the pinnacle of medical education and care. But excellence cannot survive on exhausted manpower, decaying infrastructure, and weak governance.

Reforms must be systemic and sustained:Fill sanctioned posts and rationalize recruitment.

Decentralize care through strong referral systems.

Reserve 10% of budgets for maintenance, modernization, and cybersecurity.

Implement transparent, data-driven governance.

Strengthen infection control and patient safety frameworks.

“Excellence in healthcare is not defined by technology or buildings alone, but by the systems and people that sustain them.”

Unless urgent reforms are enacted, India’s most respected hospitals risk collapsing under the weight of their own success—turning symbols of national pride into symptoms of systemic neglect.

( The writer is the former President, AIIMS, Bathinda, Dean (R), Medical Superintendent & Professor, PGIMER, Chandigarh. )