India sets new ICU standards; specifies levels, bed strength, specialist qualifications

The directorate general of health services (DGHS), operating under the health and family welfare ministry, has categorized ICUs into three levels. The standards start at Level 1 units that are intended for basic stabilization with a minimum of six beds and one ventilator, to Level 3 units equipped for advanced multi-organ failure support with bedside portable CT and mobile digital radiography.

The norms set round-the-clock physician coverage, nurse-to-patient ratios and require Level 2 and Level 3 doctors to hold a Doctorate of Medicine or a Doctorate of the National Board in intensive care. The public sector operates 37,834 ICU beds across medical colleges and district hospitals, including 26 specialized critical care blocks in hilly and northeastern regions, according to government data presented in Parliament in July 2025.

Queries sent to the health ministry spokesperson on Thursday remained unanswered till press time. Queries sent to Apollo, Max, Fortis, Manipal, and Medanta hospitals did not elicit any response.

Level 2 ICUs should have at least eight beds, a central oxygen supply, invasive ventilation for at least half the beds and access to renal replacement therapy.

While clinicians have mostly welcomed the move as long overdue, particularly for smaller facilities that had operated in a grey area, health experts say the challenge lies in training and deploying enough trained healthcare personnel.

“By acknowledging MD doctors with significant ICU experience and diploma holders with over ten years in the field, the criteria effectively balance the need for new academic standards with the practical reality of our current workforce,” said Dr. Dhiren Gupta, pediatric co-director at the Division of Intensive Care, Sir Ganga Ram Hospital.

These doctors should be postgraduates in fields such as anaesthesia, medicine, or paediatrics. The goal is to move toward a ‘closed ICU’ model, where an ‘intensivist-led ICU’ oversees all clinical governance.

The plan also sets rules for hospital design. ICUs should ‘preferably be in proximity to the emergency department and operation theatres’. Each bed must have a ‘multiparameter monitor’. For Level 3 cases, the guidelines recommend ‘advanced imaging techniques such as mobile digital radiography and bedside portable CT’.

"The levels of intensive care units need to be there because you cannot be building high-tech ICUs everywhere, but basic resuscitation services and stabilization of the patient need to happen at every level,” said Dr Sowmya Swaminathan, former WHO Scientist at the World Health Organisation (WHO).

She said that peripheral health facilities currently lack ICUs entirely, meaning patients often deteriorate beyond saving by the time they reach district hospitals. Citing the covid pandemic, she said the lack of basic oxygen support at primary health centres left patients critically ill upon arrival at higher facilities. While she stressed the urgency of immediate care at every level, Dr Swaminathan cautioned that building infrastructure alone will not suffice; it will be important to train and mentor enough doctors and nurses to run these ICUs, particularly in remote regions.