Lok Sabha Question No. 251 (STARRED), answered on 2016-12-02
Subject: National Health Policy
Ministry: HEALTH AND FAMILY WELFARE
Asked by: DODDAALAHALLI KEMPEGOWDA SURESH, C. MAHENDRAN

## GOVERNMENT OF INDIA MINISTRY OF HEALTH AND FAMILY WELFARE DEPARTMENT OF HEALTH AND FAMILY WELFARE

## LOK SABHA STARRED QUESTION NO. 251 TO BE ANSWERED ON THE 2 ND DECEMBER , 2016 NATIONAL HEALTH POLI CY

## *251. SHRI D.K. SURESH: SHRI C. MAHENDRAN:

Will  the  Minister  of HEALTH  AND  FAMILY  WELFARE be pleased to state:

- (a) whether healthcare is a major concern in the rural areas of the countr the details thereof and the reasons therefor;
- (b)  the  details  of  healthcare  infrastructure  avail able  including  manpower  and affordability of healthcare facilities for the rural people, State/UT - wise;
- (c) the details of the steps taken to address the problems of rural health and micro levels and to improve the healthcare sector in rura l areas of the country;
- (d) whether the financial outlay for health related activities have decreas the details thereof; and
- (e) whether the Government proposes to revise National Health Policy and long term perspective plan to add ress prevailing inequalities in rural health and if so, the details thereof?

## ANSWER

## THE MINISTER OF HEALTH AND FAMILY WELFARE (SHRI JAGAT PRAKASH NADDA)

(a) to ( e):  A statement is laid on the Table of the House

## STATEMENT REFERRED TO IN REPLY TO LOK SABHA STARRED QUESTION NO. 251* FOR 2 ND DECEMBER , 2016

(a) The  health  care  indicators  of  rural  areas  in  terms  of  Infant  Morta (IMR),  Total  Fertility  Rate  (TFR),  Under  5  Mortality  Rate  (U5MR) availability  of beds  etc.  are  considerably  poor  as  compared  to  urban  a Hence, addressing health care needs of rural areas is a key priority.

(b) As  per  Rural  Health  Statistics  (RHS),  2014 - 15,  the  details  of  Sub - Centres (SCs), Primary Health Centres (PHCs), Community H ealth Centres (CHCs), Sub -District Hospitals (SDH) and District Hospitals (DHs) functioning in the state - wise are given at annexure - I and II.  The details about number of allopa doctors at PHCs, pharmacists, laboratory technicians and nursing staff available at PHCs and CHCs are given at annexure III to VI.

According to NSSO Health and Morbidity Survey data analysis, in 2014 a 23.66% rural households faced catastrophic healthcare expenditures in Ind

(c) NRHM was launched in 2005 essentiall y to improve health care in rural area Some  key  steps  taken  to  improve  health  care  services  in  rural  areas annexure - VII.

(d) There is no decrease in budgetary support during any succeeding year NHM.  Further, the centre - state funding pattern has been revised from 75:25 60:40  w.e.f.  Financial  Year  2015 - 16,  which  has  also  led  to  increase  in  t resources for health activi ties under NHM.

(e) The  draft  National  Health  Policy,  2015  has  been  formulated  to  rev existing  NHP,  2002.    One  of  the  key  principles  of  the  principles  of National Health Policy, 2015 is reducing inequality, which implies min disparity on account of gender, poverty, caste, disability, other forms exclusion and geographical barriers.

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Annexure-I

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Note:

* Data for 2013-14 repeated

1 State informed that PHCs include 79 other hospitals which are equivalent to PHCs

Annexure - II

| NUMBER OF SUB DIVISIONAL HOSPITAL& DISTRICT HOSPITAL FUNCTIONING   | NUMBER OF SUB DIVISIONAL HOSPITAL& DISTRICT HOSPITAL FUNCTIONING   | NUMBER OF SUB DIVISIONAL HOSPITAL& DISTRICT HOSPITAL FUNCTIONING   | NUMBER OF SUB DIVISIONAL HOSPITAL& DISTRICT HOSPITAL FUNCTIONING   | NUMBER OF SUB DIVISIONAL HOSPITAL& DISTRICT HOSPITAL FUNCTIONING   |
|--------------------------------------------------------------------|--------------------------------------------------------------------|--------------------------------------------------------------------|--------------------------------------------------------------------|--------------------------------------------------------------------|
|                                                                    |                                                                    |                                                                    | As on 31st March 2015                                              | As on 31st March 2015                                              |
| S. No.                                                             | State/UT                                                           | Sub Divisional                                                     |                                                                    | District Hospital                                                  |
|                                                                    |                                                                    | Hospital (SDH)                                                     |                                                                    | (DH)                                                               |
| 1                                                                  | Andhra Pradesh                                                     | 31                                                                 |                                                                    | 8                                                                  |
| 2                                                                  | Arunachal Pradesh                                                  | 0                                                                  |                                                                    | 14                                                                 |
| 3                                                                  | Assam                                                              | 13                                                                 |                                                                    | 25                                                                 |
| 4                                                                  | Bihar                                                              | 45                                                                 |                                                                    | 36                                                                 |
| 5                                                                  | Chhattisgarh                                                       | 10                                                                 |                                                                    | 27                                                                 |
| 6                                                                  | Goa                                                                | 1                                                                  |                                                                    | 2                                                                  |
| 7                                                                  | Gujarat                                                            | 31                                                                 |                                                                    | 21                                                                 |
| 8                                                                  | Haryana                                                            | 20                                                                 |                                                                    | 20                                                                 |
| 9                                                                  | Himachal Pradesh                                                   | 48                                                                 |                                                                    | 12                                                                 |
| 10                                                                 | Jammu & Kashmir                                                    | NA                                                                 |                                                                    | 23                                                                 |
| 11                                                                 | Jharkhand                                                          | 10                                                                 |                                                                    | 24                                                                 |
| 12                                                                 | Karnataka                                                          | 146                                                                |                                                                    | 32                                                                 |
| 13                                                                 | Kerala                                                             | 79                                                                 |                                                                    | 16                                                                 |
| 14                                                                 | Madhya Pradesh                                                     | 66                                                                 |                                                                    | 51                                                                 |
| 15                                                                 | Maharashtra                                                        | 86                                                                 |                                                                    | 23                                                                 |

|   16 | Manipur*                  |   1 |   7 |
|------|---------------------------|-----|-----|
|   17 | Meghalaya                 |   1 |  12 |
|   18 | Mizoram                   |   2 |   8 |
|   19 | Nagaland                  |   0 |  11 |
|   20 | Odisha                    |  27 |  32 |
|   21 | Punjab                    |  41 |  22 |
|   22 | Rajasthan                 |  19 |  34 |
|   23 | Sikkim                    |   0 |   4 |
|   24 | Tamil Nadu                | 240 |  31 |
|   25 | Telangana                 |  31 |   7 |
|   26 | Tripura                   |  11 |   6 |
|   27 | Uttarakhand               |  17 |  19 |
|   28 | Uttar Pradesh             |   0 | 160 |
|   29 | West Bengal               |  37 |  22 |
|   30 | Andaman & Nicobar Islands |   0 |   3 |
|   31 | Chandigarh*               |   0 |   1 |
|   32 | Dadra & Nagar Haveli      |   0 |   1 |
|   33 | Daman & Diu               |   0 |   2 |
|   34 | Delhi                     |   7 |  41 |
|   35 | Lakshadweep               |   2 |   1 |

| 36   | Puducherry   |    0 |   5 |
|------|--------------|------|-----|
|      | All India    | 1022 | 763 |

* In U.T, Chandigarh the concept of MMU has been changed to Alternative Medical Units.

* Data for 2013-14 repeated

## VACANCY POSITION OF ALLOPATHIC DOCTORS AT PHCs

| S. No.   | State/UT          | Sanctioned   | In Position   | Vacant   |
|----------|-------------------|--------------|---------------|----------|
|          |                   | [S]          | [P]           | [S-P]    |
| 1        | Andhra Pradesh    | 2270         | 1412          | 858      |
| 2        | Arunachal Pradesh | NA           | 102           | NA       |
| 3        | Assam             | NA           | 1355          | NA       |
| 4        | Bihar###          | 2078         | 2521          | *        |
| 5        | Chhattisgarh      | 752          | 368           | 384      |
| 6        | Goa               | 48           | 56            | *        |
| 7        | Gujarat#          | 1504         | 889           | 615      |
| 8        | Haryana           | 635          | 489           | 146      |
| 9        | Himachal Pradesh  | 636          | 571           | 65       |
| 10       | Jammu &Kashmir    | 1352         | 834           | 518      |
| 11       | Jharkhand         | 327          | 372           | *        |
| 12       | Karnataka         | 2353         | 2196          | 157      |
| 13       | Kerala            | 1120         | 1169          | *        |
| 14       | Madhya Pradesh    | 1658         | 999           | 659      |
| 15       | Maharashtra       | 3009         | 2937          | 72       |
| 16       | Manipur^          | 238          | 199           | 39       |
| 17       | Meghalaya         | 128          | 114           | 14       |
| 18       | Mizoram##         | 152          | 49            | 103      |
| 19       | Nagaland          | 108          | 133           | *        |
| 20       | Odisha 3          | 1312         | 1008          | 304      |
| 21       | Punjab            | 490          | 441           | 49       |
| 22       | Rajasthan         | 2807         | 2412          | 395      |

| 23   | Sikkim        |    NA |    29 | NA   |
|------|---------------|-------|-------|------|
| 24   | Tamil Nadu    |  2744 |  2375 | 369  |
| 25   | Telangana     |  1318 |  1024 | 294  |
| 26   | Tripura       |   158 |   158 | 0    |
| 27   | Uttarakhand** |   325 |   160 | 165  |
| 28   | Uttar Pradesh |  4509 |  2209 | 2300 |
| 29   | West Bengal   |  2600 |   723 | 1877 |
| 30   | A& N Islands  |    42 |    36 | 6    |
| 31   | Chandigarh    |     0 |     0 | 0    |
| 32   | D &NHaveli    |     6 |     8 | *    |
| 33   | Daman &Diu    |     3 |     5 | *    |
| 34   | Delhi         |    21 |    21 | 0    |
| 35   | Lakshadweep   |     9 |     9 | 0    |
| 36   | Puducherry    |    38 |    38 | 0    |
|      | All India 2   | 34750 | 27421 | 9389 |

Source: Rural Health Statistics (RHS) 2014-15

Note: ###Inposition data for 2013-14 & Sanctioned data for 2011 used ^Data for 2013-14 repeated

# Data  for 2013 repeated ## Sanctioned data for 2011 used

- 1 One per Primary Health Centre
- 2 Total given in the Table are not strictly comparable as figures for some of the States were not available in 2005. For calculating the overall percentages of vacancy and shortfall, the States/UTs for which manpower position is not available, may be excluded
- *: Surplus. All India figures for Vacancy and Shortfall are the totals of State-wise Vacancy and Shortfall ignoring surplus in some States / UTs

## VACANCY POSITION OF PHARMACISTS AT PHCs & CHCs

| S. No.   | State/UT          | Sanctioned   | In Position   | Vacant   |
|----------|-------------------|--------------|---------------|----------|
|          |                   | [S]          | [P]           | [S-P]    |
| 1        | Andhra Pradesh    | 1279         | 951           | 328      |
| 2        | Arunachal Pradesh | NA           | 97            | NA       |
| 3        | Assam##           | 1284         | 1347          | *        |
| 4        | Bihar+            | 989          | 250           | 739      |
| 5        | Chhattisgarh      | 1081         | 844           | 237      |
| 6        | Goa               | 17           | 16            | 1        |
| 7        | Gujarat#          | 1550         | 879           | 671      |
| 8        | Haryana           | 568          | 508           | 60       |
| 9        | Himachal Pradesh  | 594          | 456           | 138      |
| 10       | Jammu &Kashmir    | 1057         | 872           | 185      |
| 11       | Jharkhand         | 515          | 305           | 210      |
| 12       | Karnataka         | 2668         | 2521          | 147      |
| 13       | Kerala            | 1036         | 1102          | *        |
| 14       | Madhya Pradesh    | 1443         | 1023          | 420      |
| 15       | Maharashtra       | 2355         | 2100          | 255      |
| 16       | Manipur^          | 145          | 146           | *        |
| 17       | Meghalaya         | 135          | 135           | 0        |
| 18       | Mizoram           | NA           | 46            | NA       |
| 19       | Nagaland          | 135          | 101           | 34       |
| 20       | Odisha            | 1819         | 1499          | 320      |

## Annexure-IV

| 21   | Punjab        | 841   |   806 | 35   |
|------|---------------|-------|-------|------|
| 22   | Rajasthan     | 1282  |   667 | 615  |
| 23   | Sikkim        | NA    |    14 | NA   |
| 24   | Tamil Nadu    | 1799  |  1526 | 273  |
| 25   | Telangana     | 928   |   691 | 237  |
| 26   | Tripura       | 102   |   131 | *    |
| 27   | Uttarakhand   | 312   |   100 | 212  |
| 28   | Uttar Pradesh | 2952  |  2883 | 69   |
| 29   | West Bengal   | 1229  |   966 | 263  |
| 30   | A& N Islands  | 62    |    60 | 2    |
| 31   | Chandigarh^^  | 16    |    17 | *    |
| 32   | D &NHaveli    | 7     |     9 | *    |
| 33   | Daman &Diu    | 5     |     5 | 0    |
| 34   | Delhi         | 6     |     6 | 0    |
| 35   | Lakshadweep   | 15    |    15 | 0    |
| 36   | Puducherry    | 42    |    37 | 5    |
|      | All India 2   | 28268 | 23131 | 5456 |

Source: Rural Health Statistics (RHS) 2014-15

## Notes:

+ Sanctioned data  for 2010 repeated
- # Data  for 2013 repeated
- ^^Sanctioned data for 2013-14 used
- 1 One per each Primary Health Centre and Community Health Centre
- 2 Total given in the Table are not strictly comparable as figures for some of the States were not available in 2005. For calculating the overall percentages of vacancy and shortfall, the States/UTs for which manpower position is not available, may be excluded
- *: Surplus. All India figures for Vacancy and Shortfall are the totals of State-wise Vacancy and Shortfall ignoring surplus in some States / UTs

## VACANCY POSITION OF LABORATORY TECHNICIAN AT PHCs & CHCs

| S. No.   | State/UT          | Sanctioned   | In Position   | Vacant   |
|----------|-------------------|--------------|---------------|----------|
|          |                   | [S]          | [P]           | [S-P]    |
| 1        | Andhra Pradesh    | 1053         | 776           | 277      |
| 2        | Arunachal Pradesh | NA           | 74            | NA       |
| 3        | Assam##           | 860          | 1225          | *        |
| 4        | Bihar+            | 683          | 611           | 72       |
| 5        | Chhattisgarh      | 1069         | 657           | 412      |
| 6        | Goa               | 15           | 14            | 1        |
| 7        | Gujarat#          | 1556         | 1401          | 155      |
| 8        | Haryana           | 517          | 437           | 80       |
| 9        | Himachal Pradesh  | 352          | 157           | 195      |
| 10       | Jammu &Kashmir    | 930          | 763           | 167      |
| 11       | Jharkhand         | 515          | 301           | 214      |
| 12       | Karnataka         | 1790         | 1294          | 496      |
| 13       | Kerala            | 324          | 365           | *        |
| 14       | Madhya Pradesh    | 1043         | 892           | 151      |
| 15       | Maharashtra       | 1474         | 1387          | 87       |
| 16       | Manipur^          | 102          | 96            | 6        |
| 17       | Meghalaya         | 118          | 125           | *        |
| 18       | Mizoram           | NA           | 61            | NA       |
| 19       | Nagaland          | 72           | 72            | 0        |
| 20       | Odisha^           | 476          | 378           | 98       |
| 21       | Punjab            | 578          | 482           | 96       |
| 22       | Rajasthan         | 3425         | 1930          | 1495     |

| 23   | Sikkim        |    NA |    31 | NA   |
|------|---------------|-------|-------|------|
| 24   | Tamil Nadu    |  2142 |  1314 | 828  |
| 25   | Telangana     |   765 |   566 | 199  |
| 26   | Tripura       |    50 |    67 | *    |
| 27   | Uttarakhand   |   127 |   157 | *    |
| 28   | Uttar Pradesh |  1331 |   963 | 368  |
| 29   | West Bengal   |  1185 |   448 | 737  |
| 30   | A& N Islands  |    29 |    27 | 2    |
| 31   | Chandigarh^^  |     8 |    19 | *    |
| 32   | D &NHaveli    |     7 |     9 | *    |
| 33   | Daman &Diu    |     4 |     4 | 0    |
| 34   | Delhi         |     5 |     2 | 3    |
| 35   | Lakshadweep   |    11 |    11 | 0    |
| 36   | Puducherry    |    10 |    38 | *    |
|      | All India 2   | 22626 | 17154 | 6139 |

Source: Rural Health Statistics (RHS) 2014-15

## Notes

+ Sanctioned data  for 2011 repeated

# Data  for 2013 repeated

- ^Data for 2013-14 repeated

1 One per each Primary Health Centre and Community Health Centre

2 Total given in the Table are not strictly comparable as figures for some of the States were not available in 2005. For calculating the overall percentages of vacancy and shortfall, the States/UTs for which manpower position is not available, may be excluded

| VACANCY POSITION OF NURSING STAFF AT PHCs &CHCs   | VACANCY POSITION OF NURSING STAFF AT PHCs &CHCs   | VACANCY POSITION OF NURSING STAFF AT PHCs &CHCs   | VACANCY POSITION OF NURSING STAFF AT PHCs &CHCs   | VACANCY POSITION OF NURSING STAFF AT PHCs &CHCs   |
|---------------------------------------------------|---------------------------------------------------|---------------------------------------------------|---------------------------------------------------|---------------------------------------------------|
| S. No.                                            | State/UT                                          | Sanctioned                                        | In Position                                       | Vacant                                            |
|                                                   |                                                   | [S]                                               | [P]                                               | [S-P]                                             |
| 1                                                 | Andhra Pradesh                                    | 2300                                              | 2006                                              | 294                                               |
| 2                                                 | Arunachal Pradesh                                 | NA                                                | 319                                               | NA                                                |
| 3                                                 | Assam##                                           | 2798                                              | 3056                                              | *                                                 |
| 4                                                 | Bihar#                                            | 1662                                              | 1736                                              | *                                                 |
| 5                                                 | Chhattisgarh                                      | 2495                                              | 1511                                              | 984                                               |
| 6                                                 | Goa                                               | 80                                                | 86                                                | *                                                 |
| 7                                                 | Gujarat+                                          | 4058                                              | 2705                                              | 1353                                              |
| 8                                                 | Haryana                                           | 1783                                              | 1685                                              | 98                                                |
| 9                                                 | Himachal Pradesh                                  | 819                                               | 635                                               | 184                                               |
| 10                                                | Jammu &Kashmir                                    | 1616                                              | 1184                                              | 432                                               |
| 11                                                | Jharkhand                                         | 703                                               | 1230                                              | *                                                 |
| 12                                                | Karnataka                                         | 3457                                              | 3176                                              | 281                                               |
| 13                                                | Kerala                                            | 3610                                              | 3969                                              | *                                                 |
| 14                                                | Madhya Pradesh                                    | 4189                                              | 3629                                              | 560                                               |
| 15                                                | Maharashtra                                       | 3218                                              | 2535                                              | 683                                               |
| 16                                                | Manipur^                                          | 484                                               | 433                                               | 51                                                |
| 17                                                | Meghalaya                                         | 413                                               | 413                                               | 0                                                 |
| 18                                                | Mizoram                                           | NA                                                | 224                                               | NA                                                |
| 19                                                | Nagaland                                          | 117                                               | 378                                               | *                                                 |
| 20                                                | Odisha^                                           | 903                                               | 1260                                              | *                                                 |
| 21                                                | Punjab                                            | 2189                                              | 1907                                              | 282                                               |
| 22                                                | Rajasthan                                         | 13435                                             | 9250                                              | 4185                                              |

| 23   | Sikkim        |    NA |    41 | NA    |
|------|---------------|-------|-------|-------|
| 24   | Tamil Nadu    |  8177 |  7349 | 828   |
| 25   | Telangana     |  1666 |  1453 | 213   |
| 26   | Tripura       |   421 |   421 | 0     |
| 27   | Uttarakhand   |   275 |   456 | *     |
| 28   | Uttar Pradesh |  4497 |  4412 | 85    |
| 29   | West Bengal   |  8285 |  7047 | 1238  |
| 30   | A& N Islands  |   191 |   185 | 6     |
| 31   | Chandigarh^^  |    47 |    99 | *     |
| 32   | D &NHaveli    |     8 |    37 | *     |
| 33   | Daman &Diu    |    14 |    14 | 0     |
| 34   | Delhi         |     5 |     7 | *     |
| 35   | Lakshadweep   |    52 |    52 | 0     |
| 36   | Puducherry    |   131 |   139 | *     |
|      | All India 2   | 74098 | 65039 | 11757 |

## Source: Rural Health Statistics (RHS) 2014-15

Notes:

NA: Not Available. 1 One per Primary Health Centre and 7 per Community Health Centre *: Surplus. 2 Total given in the Table are not strictly comparable as figures for some of the States were not available in 2005. For calculating the overall percentages of vacancy and shortfall, the States/UTs for which manpower position is not available, may be excluded + Data  for 2013 repeated # Data  for 2011 repeated

## Measures taken to strengthen Health Care Services in the rural areas under NRHM/ NHM

1. More  resources  through  increased  state  share  have  been  made  available  for NRHM/NHM.    Incentive  pool  to  encourage  states  to  undertake  health  sector reform has been introduced.
2. Reproductive, Maternal, Newborn, Child and Adolescent Health Services (RMNCH + A)  :  The  following  programmes  are  under    implementation  for  improving  health care:-
3.  Janani Suraksha Yojana,
4.  Janani Shishu Suraksha Karyakram (JSSK)
5.  Rashtriya Bal Swasthya Karyakram (RBSK)
6.  Rashtriya Kishore Swasthya Karyaqkram (RKSK)
7.  Facility Based Newborn care including Special Newborn Care Units (SNCUs)
8.  Newborn Care Stabilisation Units (NBSUs)
9.  Maternal & Child health wings
10.  Routine Immunisation and Pulse Polio Immunisation etc
3. Support  under  NHM  is  provided  for  provision  of  ANMs,  ASHAs  and  lady  health visitors  at  peripheral  public  health  facilities  like  sub-centres  and  primary  health centes to strengthen outreach services in rural areas.
4. Communicable  Disease  Control  Programmes -includes  national  programmes namely Revised National Tuberculosis Control Programme, National Vector Borne Disease Control Programme  to  control  malaria,  dengue,  filariasis, kala-azar, National  Leprosy  Eradication  Programme,  and  Integrated  Disease  Surveillance Project.
5. NonCommunicable  Diseases  Control  Programme interventions  upto  District Hospital  level -including  National  Programme  for  Prevention  and  Control  of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS), National
14. Programme for Control of Blindness (NPCB), National Mental Health Programme (NMHP),  National  Programme  for  Health  Care  of  the  Elderly  (NPHCE),  National Tobacco Control Programme (NTCP) and National Oral Health Programme (NOHP).
6. Infrastructure strengthening upgradation - The framework for NHM provides for setting up new facilities based on time to care.  It allows funding support to states for setting up of Sub Health Centres in selected districts of hilly states and desert areas.
7. 100/50/30  bedded  Maternal  and  Child  Health  (MCH)  Wings  are  sanctioned  in Public Health facilities  with  high  bed  occupancy to cater to the hugely increased demand for services.
8. Mobile  Medical  Units  (MMUs) - 1148  MMUs  operationalised  in  348  districts  for delivery of health care to difficult areas.
9. National Ambulance Service (NAS):-
19. Support under the NHM provided for 23,226 NAS Vehicles [ 8165 (108-Type); 8638 (102/104-Type) and 6,423 vehicles (Janani Express, MamataVahan etc)]
20. 10.Mainstreaming of AYUSH
21. 17,449 AYUSH facilities co-located at PHCs, CHCs and Districts Hospitals.
22. 27830 AYUSH doctors and 4,450 AYUSH paramedics co-located at various health facilities.
11. Human Resource: - Support is also provided to States/UTs by giving hard area allowance to health human resources for serving in rural and remote areas and for their residential quarters so that they find it attractive to serve in public health facilities in such areas. Further, in order to encourage doctors to work in remote and difficult areas, the Medical Council  of  India,  with  the  previous  approval  of  Central  Government,  has  amended  the

Post Graduate Medical Education Regulations, 2000 to provide:

- (i) 50%  reservation  in  Post  Graduate  Diploma Courses  for  Medical  Officers  in  the Government service, who have served for at least three years in remote and difficult areas; and
- (ii) Incentive at the rate of 10% the marks obtained for each year in service in remote or difficult areas as upto the maximum of 30% of the marks obtained in the entrance test for admissions in Post Graduate Medical Courses.