Public healthcare is not in the pink; it is deteriorating. In fact, it has been on a serious "decline' during the last two to three decades. This fact was highlighted by a report of the high-level group on services sector by the Planning Commission, which was released on Wednesday. The report stressed "shortage' of human resources as a major distressing factor. The report said according to the number of doctors registered (in 2006), a doctor-to-population ratio stands at 60:1,00,000, much below than that of Australia (249.1), UK (1,665.5) and US (548.9). "If the targeted doctor-population norm is taken as 1:1000, there is a requirement of 6,00,000 doctors, one million nurses, 2,00,000 dental surgeons and a large number of paramedical staff, including radiographers, X-ray technicians, physiotherapists, laboratory technicians, dental hygienists, orthopaedists and opticians. Compared to the requirement of 21,88,890 in 2007, only 11,56,372 nurses were available,' finds the report. "The situation in availability of specialist manpower in community health centres is particularly bad as against the sanctioned posts, about 59.4 per cent surgeons, 45 per cent obstetricians and gynaecologists, 61 per cent physicians and 53 per cent paeditricians were not in position (in March 2006),' notes the report. On people opting for private hospitals, the report says, "Despite higher costs in the private sector, this shift shows the people's growing lack of trust in the public health care system. Critical shortage of health personnel, inadequate incentives, poor working conditions, lack of transparency in posting doctors in rural areas, absenteeism, long wait, inconvenient clinic hours, poor outreach, time of service, insensitivity to local needs, inadequate planning, management and monitoring of service/facilities appear to be the main reasons for low utilisation.' Maintaining that essential therapeutic drugs are not supplied in most public health institutions, the report underlines a "serious' regulatory gap in the country as there are no mandatory standards prescribed and enforced for the hospitals, nursing homes and clinics. "The standards of hospitals should cover all aspects ranging from building and fire safety to availability of potable water and from basic laboratory services to employment of health professionals,' says the report. The commission has proposed to raise the public health expenditure level from 1 per cent of GDP at the end of the 10th Five Year Plan to 2 per cent of the GDP at the end of the 11th Five Year Plan. The report hopes that over five lakh accredited social health activists will be provided, one for every 1,000 population, and 30,000 primary health centres will be staffed with three staff nurses to provide round-the-clock services by 2010. "An essential component of strengthening primary health facilities will be a system to guarantee essential drugs,' the report adds.