Healthcare Architecture in India: Strategic Design Principles to Address the Urban-Rural Divide

In a nation as diverse as India, the healthcare landscape presents wicked problems and plentiful opportunities. The country’s hospital infrastructure has been increasingly strained in the areas of accessibility, quality, and equity, especially with a snowballing population growth. While urban development expands amidst these constraints, architects have been able to position innovative design solutions as mediators, also sealing the gap between urban and rural healthcare quality and accessibility in India.

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Arti Gugnani of Vijay Gupta Architects sheds light on the current state of healthcare in India, “There is a marked disparity in the quality and accessibility of healthcare services between urban and rural areas”. A critical look at the population distribution reveals that the majority of Indians still live in rural areas. Despite this fact, 75% of healthcare infrastructure is concentrated in urban areas, leaving rural regions underserved.

This trend further exacerbates the rural-to-urban migration, as families travel or relocate in pursuit of better healthcare facilities. This urban-rural divide also faces a significant shortage of healthcare professionals and historically low government expenditure on healthcare. As a result, the burden on existing facilities continues to grow, making equitable access to quality healthcare an increasingly elusive goal for many Indians.

To alleviate the burden on urban centers, a key strategy lies in establishing and upgradation of primary healthcare centers, sub-centers, and community health centers in rural regions. Adequate infrastructure is crucial for providing critical healthcare services and timely interventions, also reducing the load on urban healthcare facilities.

Another aspect in narrowing the urban-rural divide is addressing rural infrastructure challenges beyond healthcare. By enhancing opportunities in rural areas, India can mitigate the migration patterns that currently shift pressure toward urban hospitals. For instance, developing rural areas through improved education, employment opportunities, and access to essential services can help retain populations in these regions.

Combined with policy and infrastructure establishment, Gugnani believes that architectural design can have a noticeable impact in addressing the healthcare facility crisis. She emphasizes the importance of biophilic design principles in healthcare settings, noting that “the healing powers of nature allow many illnesses to be addressed without the help of medicines, simply by paying attention to the surrounding environment, air, food, rest, physical activity, and state of mind.” Studies show that simply viewing nature can speed up recovery and reduce the need for painkillers. Healing gardens’ can also be deployed to promote independence, social interaction, and physical activity.

This approach is already taking root in India, with projects like the Mother and Child Block at AIIMS, New Delhi, incorporating natural elements to create healing environments. Gugnani explains, “By integrating these elements—such as ample natural light, ventilation, and greenery—these designs foster a connection between patients and nature. This approach not only reduces stress and pain but also enhances overall physical, mental, and emotional well-being.”

Other projects, such as the Tata Medical Centre in Kolkata and the Symbiosis University Hospital and Research Centre in Pune, make visible the power of patient-centric design. The Ashirwad Hospital in Varanasi, designed by Vijay Gupta Architects, is an example of how revitalizing existing facilities with a focus on patient well-being can create a positive, welcoming environment that enhances both physical recovery and mental well-being. As India increases its efforts to foster health and well-being, momentum for healthy building practices is starting to soar. Since 2020, the uptake of WELL certification has seen a fourfold increase. This promising growth allows for a structured framework to implement patient-centric and health-promoting design principles.

When it comes to addressing healthcare accessibility in remote rural areas, Gugnani advocates for a design ethos that respects local climate, culture, and needs. She suggests prioritizing sensitive design that respects the climate, culture, and local needs, while also integrating efficient spatial programming and zoning. This aids in the fostering of physical and emotional well-being, allowing rural healthcare facilities to be transformed into inclusive spaces. This approach involves thoughtful considerations such as building orientation to maximize natural light and ventilation, limiting air conditioning to critical clinical spaces, and incorporating cultural elements like verandas and balconies. 

Additionally, the importance of integrating local art and indigenous vegetation is not to be overlooked. Creating welcoming environments encourages regular health checkups, thereby promoting disease prevention. It is important to design around the patient experience to create a convenient and accessible healthcare infrastructure, meeting the people where they are.

International examples, such as Partners In Health and Muso Health, provide case studies on community-based healthcare models. These can be scaled up to improve infrastructure and long-term care in underserved areas, strengthening healthcare infrastructure at the grassroots level. Community-based approaches can help healthcare providers build trust, enhance access, and deliver culturally appropriate care to those who are often marginalized. Involving collaborations with local organizations, community leaders, and healthcare providers addresses the nuanced needs and challenges of specific populations.

India has great potential in grassroots initiatives that can successfully scale up. Recent government efforts to provide piped water, toilets with sewer connections, and solid waste management systems have greatly impacted the healthcare sector. Safe drinking water and sanitation are strong determinants of health, which would directly contribute to a 70-80% reduction in the burden of communicable diseases.

Gugnani advocates for a strategic design approach that uses several elements: data analytics, patient-centric environments, user-friendly medical devices, streamlined processes, and interdisciplinary thinking. She believes that strategic design can help healthcare providers improve patient satisfaction ratings, increase volume growth, and position the provider positively for the future of patient-centered healthcare.

India’s healthcare challenges demand an innovative approach to design. The path forward involves an intentional approach to patient-centric and culturally sensitive environments that address the needs of urban and rural populations in an equitable manner.

This article is part of an ArchDaily series titled India: Building for Billions, where we discuss the effects of population rise, urbanization, and economic growth on India’s built environment. Through the series, we explore local and international innovations responding to India’s urban growth. We also talk to the architects, builders, and community, seeking to underline their personal experiences. As always, at ArchDaily, we highly appreciate the input of our readers. If you think we should feature a certain project, please submit your suggestions.