All through 2024, we have been doing extensive field-based research for the study titled “Forty Years’ Development Saga of Dhampur: Growth Dynamics and Regional Transformation Potential of an Indian Small Town.” This small town has gone through major transformations in several spheres over the four decades. One such area of change is abundant provision of medical services.

At the time of earlier study, Pushpa Pathak had observed that there were just a few doctors’ clinics. Even in the recent past, there were only 3 or 4 well known doctors practicing in Dhampur such as: Dr. Bagchi, Dr. Parikh, Dr. Lalin Khan and one Homeopathic doctor popularly known as Dr. Chawanni as he charged only 4 Annas for a consultation.

Currently, Dhampur is a small town of about 1 lakh population located in district Bijnor, Uttar Pradesh. Public health infrastructure in Dhampur includes a Primary Health Centre (PHC), Community Health Centre (CHC) and a 100 bed hospital that is not fully functional, However, these government centres provide limited medical services. At present 200-300 patients visit the Outpatient department (OPD) and 1-2 patients visit Inpatient Department (IPD) in CHC every day, but it has only one doctor and four beds, which is far lower than the norms for CHC. According to the Indian Public Health Standards (IPHS) Guidelines, a CHC should have 30 beds and 7 doctors specialising in Medicine, Obstetrics and Gynaecology, Surgery, Paediatrics, Dental Care and AYUSH. 

The first striking feature pertaining to medical services is the surprisingly large number of private hospitals and clinics for a small town like Dhampur. Another striking fact is that most of the medical facilities are located along both sides of the Kalagarh Road, an east-west state highway in the Northern part of the town. The total number of private hospitals and clinics in Dhampur is around fifty, including Dental Care, of which 37 are located on the Kalagarh Road alone and rest of them are located in other parts of the town. In addition, there are 2 Homeopathic clinics and 16 diagnostic centres located in various parts of the town. 

All the private hospitals together in Dhampur have around 500 beds and 40 to 45 doctors catering to a very large number of patients. For example, 50 OPD and 5 to 7 IPD patients visit Damyanti Devi Nursing Home every day. It has 25 beds and 3 doctors. Durga City Hospital has 50 beds and 3 doctors and gets 20 to 25 OPD and 2 to 3 IPD patients daily. Clearly the ratio of doctors and beds to the number of patients in private hospitals is far better than in the government CHC. 

These facts obviously made us ask: Why are there so many private hospitals and clinics in Dhampur? Why are most of them clustered along a single road one after the other? Following are some of the explanations for these two questions: 

First, India has a large healthcare infrastructure dominated by the private sector, which is very common all over India. This is basically because most public health sector entities have limited facilities which are often of lower quality.

Second, there has been a tremendous surge in private hospitals due to the massive increase in the number of medical colleges and graduates. According to Dr. Kamaal Ahmad, there were only 9 medical colleges in Uttar Pradesh and around 1,000 doctors in 1981. Now there are about ten times more medical colleges and nearly 15,000 doctors.

Third, many of the doctors in Dhampur have rural roots. But, most of the doctors are educated in urban areas and are used to urban lifestyles. Hence, they prefer to practice in towns and cities.

Fourth, Dhampur is well connected with the national and state highways. The neighbouring 3 towns and 500-600 villages are completely dependent on Dhampur for most of the services including healthcare facilities. According to Dr. Aditya Agarwal, Nagina town, where he practiced earlier, is less accessible with weaker connectivity, less developed and has lower footfall in comparison to Dhampur.

Fifth, although most of the doctors have a business mindset, they are also involved in social service such as: campaigns to promote health, provide free consultation, medicine and 1/4th price of the required test for those who cannot afford it, as is done by both Dr. Ahmad and Dr. Agarwal. 

Sixth, Kalagarh Road acts as a central axis that ensures maximum visibility and easy accessibility for patients. Moreover, the clustering of private hospitals on Kalagarh Road suggests that in a competitive market, similar service providers tend to cluster in the same location to maximize access to customers and reduce risk as explained by the Hotelling Location Model (Harold Hotelling, 1929).

To sum up, a large number of private hospitals have come up in Dhampur clearly in response to the demand from the town and nearby villages. But the way they are established on Kalagarh Road, shows that competition might be shaping the choice of location of healthcare facilities.