Healthcare Accessibility and Social Inequality in Rural India: A Geographical Analysis

Healthcare accessibility in rural India is shaped not only by the physical presence of medical facilities but also by distance, human-resource availability, affordability, social position and the quality of care that can actually be obtained. This paper examines the geographical relationship between healthcare accessibility and social inequality in rural India through a secondary-data-based analytical approach. It draws principally on the National Family Health Survey-5 (2019–21), Health Dynamics of India: Infrastructure and Human Resources 2022–23, National Health Accounts 2022–23, and peer-reviewed research on spatial accessibility, healthcare markets and social inequity. The analysis combines the concepts of spatial accessibility, healthcare fit and patient-centred access to examine how territorial disadvantage interacts with poverty, caste and tribal marginalisation, gender and uneven health-system capacity. The findings show substantial deficits in rural Sub-Centres, Primary Health Centres and Community Health Centres relative to population norms, together with an especially serious shortage of specialist personnel. Rural–urban gaps remain visible in antenatal and institutional maternity care, while local evidence demonstrates that the costs of distance fall disproportionately on poorer populations. At the same time, expanded public financing has reduced the long-term share of household out-of-pocket spending, although financial protection remains incomplete. The paper argues that numerical expansion of facilities alone cannot achieve healthcare equity. Rural health planning needs to integrate travel distance, functional staffing, service quality, social deprivation and household capacity to reach and use care. A geographical equity approach is therefore essential for progressing towards effective universal health coverage in India.