Lok Sabha Question No. 390 (UNSTARRED), answered on 2017-02-03
Subject: Doctor-Patient Ratio
Ministry: HEALTH AND FAMILY WELFARE
Asked by: RAVINDRA KUMAR RAY, HARI MANJHI, JANARDAN SINGH SIGRIWAL, ANTO  ANTONY, DEVENDRA (ALIAS) BHOLE SINGH SINGH, BHAIRON PRASAD MISHRA, KAMAL NATH, RAJESH KUMAR DIWAKAR, VISHNU DAYAL RAM, ASHOK MAHADEORAO NETE, JYOTI DHURVE, BANSHILAL MAHTO, KAMLA DEVI PATLE, MD. BADARIDDOZA KHAN, DEVJI MANSINGRAM PATEL, SUBHASH PATEL, SUNIL KUMAR SINGH, RABINDRA KUMAR JENA, BHARATI DHIRUBHAI SHIYAL

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

## LOK SABHA UNSTARRED QUESTION NO. 390 TO BE ANSWERED ON 03 RD FEBRUARY , 201 7

## DOCTOR - PATIENT RATIO

## 390. DR. RAVINDRA KUMAR RAY:

SHRI HARI MANJHI:

SHRI JANARDAN SINGH SIGRIWAL:

SHRI ANTO ANTONY:

SHRI DEVENDRA SINGH BHOLE:

SHRI BHAIRON PRASAD MISHRA:

SHRI KAMAL NATH:

SHRI RAJESH KUMAR DIWAKER:

SHRI VISHNU DAYAL RAM:

SHRI ASHOK MAHADEORAO NETE:

SHRIMATI JYOTI DHURVE:

DR. BANSHILAL MAHATO:

SHRIMATI KAMLA DEVI PAATLE:

SHRI MD. BADARUDDOZA KHAN:

SHRI DEVJI M. PATEL:

SHRI SUBHASH PATEL:

SHRI SUNIL KUMAR SINGH:

SHRI RABINDRA KUMAR JENA:

DR. BHARATIBEN D. SHYAL:

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

- (a) the details of requirement and availability of doctors in the country particularly in rural, remote and hilly areas in the country, State/UT -wise along with the existing doctor - patient/people ratio;
- (b) whether there is a shortage of doctors and other health professionals in rural and remote areas of the  country  and  if  so,  the de ails  thereof  and  corrective  measures taken/  being  taken  by  the Government for speeding up the recruitment process in this regard;
- (c) whether the Government proposes to make it mand atory for the doctors to ender service in rural areas and if so, the details thereof and if not, the reasons therefor;
- (d) whether the Government proposes to start new medical courses including restarting the earlier practiced Integrated System of Medicines and Surgery which includes the ayurveda and allopathy to address the acute shortage of doctors in the country, and if so, the details thereof along with the time by which the decision is likely to be taken in this regard, if not, the reasons ther efor; and

(e) the other measures taken/being taken by the Government to improve the doctor pa ient/ people ratio in the country?

## ANSWER THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE

## (SHRI FAGGAN SINGH KULASTE)

- (a) : As  per  Rural  Health  Statistics  (RHS)  2015 - 16,  State/UT  wise  details  of  requirement  and availability of doctors, specialists at Primary Health Centers (PHCs) and Community Healt (CHCs) are at Annexure. As per information provided by Medical Counc il of India, there are a total 9, 88, 922 allopathic doctors registered with the State Medical Council/Medical Council of In 30 th June, 2016 . Assuming 80% availability, is estimated that around 7.91 lakh doctors may be actually  available for  act ive  service.  It  gives  a  d octor - population  ratio  of  1:1668  as  per  current population estimate of 1.32 billion.
- (b) : Health being a State subject, the primary responsibility to ensure availability of and other health professionals in public health facilities lies with the State Governments. However, under National Health Mission (NHM), technical and financial support is being provided to State strengthening their health care system.
- (c) : The issue of compulsory rural posting has been left to the wisdom of the State Governments who are the principal employer of doctors. However, to encourage doctors working in remote and difficult areas, the MCI with the previous approval of Central Government, has amended Graduate Me dical Education Regulations, 2000 to provide : -
- I. 50% of the seats in Post Graduate Diploma Courses shall be reserved for Medical Off the  Government  service,  who  have  served  for  at  least  three  years  in  remote  and areas. After acquiring the PG Diploma, the Medical Officers shall serve for two more years remote and/or difficult areas; and
- II. Incentive  at  the  rate  of  10%  of  the  marks  obtained  for  each  year  in  service  in difficult areas as upto the maximum of 30% of the marks obtaine d in the entrance test for admissions in Post Graduate Medical Courses.

Further, under NHM, financial incentive is also provided to MBBS as well as PG doct serving in the rural areas. These incentives are over and above the salaries of the doctor concerned.

- (d): Section  15  of  Indian  Medical  Council  Act,  1956  prohibits  persons  other  than  a practitioner  enrolled  on  a  State  Medical  Register  to  practice  medicine  in  any  Stat Similar provisions are also available in the Indian Medicine Centra l Council Act, 1970 which does not allow practitioners of modern medicine to practice Indian System of Medicine.
- (e): The Government has taken various steps to increase the number of doctors. These include -
- (i) The  ratio  of  teachers  to  students  has  been  revised  from  1:1  to  1:2  for  al disciplines and 1:1 to 1:3 in subjects of Anaesthesiology, Forensic Me Radiotherapy,  Medical  Oncology,  Surgical  Oncology  and  Psychiatry.  Further,  tea student  ratio n  public  funded  Government  Medical  Colleges  for  Professor  has  be increased from 1:2 to 1:3 in all clinical subjects and for Asso. Prof. from 1:1 Asso. Prof. is a unit head. This would result in increase in number of PG se countr y.
- (ii) DNB  qualification  has  been  recognized  for  appointment  as  faculty  to  take  c shortage of faculty.
- (iii) Enhancement of maximum intake capacity at MBBS level from 150 to 250.
- (iv) Enhancement of age limit for appointment/ extension/ re -employment  against posts of teachers/dean/principal/ director in medical colleges from 65 - 70 years.
- (v) relaxation in the norms of setting up of Medical College in terms of requirement faculty, staff, bed/bed strength and other infrastructure.
- (vi) Strengthening/upgradat ion of State Government Medical Colleges for starting new P courses/Increase of PG seats.
- (vii) Establishment of New Medical Colleges by upgrading district/referral preferably in underserved districts of the country.

hos

- (viii)Strengthening/  upgradation  of existing  State  Government/Central  Government  Medical Colleges to increase MBBS seats.

Table 21.

## ANNEXURE

|        |                            | DOCTORS + AT PRIMARY HEALTH CENTRES (As on 31st March, 2016)   | DOCTORS + AT PRIMARY HEALTH CENTRES (As on 31st March, 2016)   | DOCTORS + AT PRIMARY HEALTH CENTRES (As on 31st March, 2016)   | DOCTORS + AT PRIMARY HEALTH CENTRES (As on 31st March, 2016)   | DOCTORS + AT PRIMARY HEALTH CENTRES (As on 31st March, 2016)   |
|--------|----------------------------|----------------------------------------------------------------|----------------------------------------------------------------|----------------------------------------------------------------|----------------------------------------------------------------|----------------------------------------------------------------|
| S. No. | State/UT                   | Required 1                                                     | Sanctioned                                                     | In Position                                                    | Vacant                                                         | Shortfall                                                      |
| 1      | Andhra Pradesh             | [R] 1075                                                       | [S] 2270                                                       | [P] 1412                                                       | [S-P] 858                                                      | [R-P] *                                                        |
| 2      | Arunachal Pradesh          | 143                                                            | NA                                                             | 122                                                            | NA                                                             | 21                                                             |
| 3      | A ssam                     | 1014                                                           | NA                                                             | 932                                                            | NA                                                             | 82                                                             |
| 4      | B ihar**                   | 1802                                                           | 2078                                                           | 1786                                                           | 292                                                            | 16                                                             |
| 5      | Chhattisgarh               | 790                                                            | 777                                                            | 344                                                            | 433                                                            | 446                                                            |
| 6      | Goa                        | 22                                                             | 48                                                             | 56                                                             | *                                                              | *                                                              |
| 7      | Gujarat                    | 1314                                                           | 1697                                                           | 1105                                                           | 592                                                            | 209                                                            |
| 8      | H aryana                   | 474                                                            | 635                                                            | 489                                                            | 146                                                            | *                                                              |
| 9      | Himachal Pradesh           | 518                                                            | 636                                                            | 424                                                            | 212                                                            | 94                                                             |
| 10     | Jammu & Kashmir            | 637                                                            | 1347                                                           | 761                                                            | 586                                                            | *                                                              |
| 11     | Jharkhand                  | 327                                                            | 327                                                            | 271                                                            | 56                                                             | 56                                                             |
| 12     | Karnataka                  | 2353                                                           | 2353                                                           | 2133                                                           | 220                                                            | 220                                                            |
| 13     | Kerala                     |                                                                |                                                                |                                                                | *                                                              | *                                                              |
|        |                            | 824                                                            | 1120                                                           | 1169                                                           |                                                                |                                                                |
| 14 15  | Madhya Pradesh Maharashtra | 1171 1811                                                      | 1771 3009                                                      | 946 2927                                                       | 825 82                                                         | 225 *                                                          |
| 16     | Manipur                    | 85                                                             |                                                                | 194                                                            | 44                                                             | *                                                              |
|        | Meghalaya##                | 109                                                            | 238                                                            | 105                                                            | 23                                                             | 4                                                              |
| 17 18  | Mizoram ^                  | 57                                                             | 128 152                                                        | 71                                                             | 81                                                             | *                                                              |
| 19     | Nagaland                   | 126                                                            | 108                                                            | 120                                                            | *                                                              | 6                                                              |
| 20     | Odisha                     | 1305                                                           | 1312                                                           | 959                                                            | 353                                                            | 346                                                            |
| 21     | Punjab                     | 427                                                            | 518                                                            | 494                                                            | 24                                                             | *                                                              |
| 22     | Rajasthan                  | 2080                                                           | 2807                                                           | 2422                                                           | 385                                                            | *                                                              |
| 23     | Sikkim                     | 24                                                             | NA                                                             | 26                                                             | NA                                                             | *                                                              |
| 24     | Tamil Nadu                 | 1368                                                           | 2927                                                           | 2751                                                           | 176                                                            | *                                                              |
| 25     | Telangana                  | 668                                                            | 1318                                                           | 1024                                                           | 294                                                            | *                                                              |
|        | Tripura                    | 94                                                             | 158                                                            | 147                                                            | 11                                                             | *                                                              |
| 26     | ##                         |                                                                |                                                                |                                                                |                                                                |                                                                |
| 27     | Uttarakhand                | 257                                                            | 386                                                            | 215                                                            | 171                                                            | 42                                                             |
| 28     | Uttar Pradesh              | 3497                                                           | 4509                                                           | 2209                                                           | 2300                                                           | 1288                                                           |
| 29     | West Bengal                | 909                                                            | 1324                                                           | 721                                                            | 603                                                            | 188                                                            |
| 30     | A& N Islands               | 22                                                             | 42                                                             | 36                                                             | 6                                                              | *                                                              |
| 31     | Chandigarh##               | 3                                                              | 0                                                              | 2                                                              | *                                                              | 1                                                              |
| 32     | D & N Haveli               | 11                                                             | 6                                                              | 11                                                             | *                                                              | 0                                                              |
| 33     | Daman & Diu                | 4                                                              | 3                                                              | 7                                                              | *                                                              | *                                                              |
| 34     | Delhi                      | 5                                                              | 21                                                             | 20                                                             | 1                                                              | *                                                              |
| 35     | Lakshadweep                | 4                                                              | 5                                                              | 7                                                              | *                                                              | *                                                              |
| 36     | Puducherry                 | 24                                                             | 38                                                             | 46                                                             | *                                                              | *                                                              |
|        | All India 2 / Total        | 25354                                                          | 34068                                                          | 26464                                                          | 8774                                                           | 3244                                                           |

Notes:

## Sanctioned data for 2015 used

** Sanctioned data for 2011 used

^ Sanctioned data for 2013 -14 used

NA: Not Available.

+: Allopathic Doctors

All India figures for Vacancy and Shortfall are the totals of State - wise Vacancy and Shortfall ignoring surplus in some States / UTs *: Surplus.

1 One per Primary Health Centre

2 For calculating the overall percentages of vacancy, the States/UTs for which manpower position is not available, are excluded

| TOTAL SPECIALISTS AT CHCs   | TOTAL SPECIALISTS AT CHCs                                                                 | TOTAL SPECIALISTS AT CHCs                                                                 | TOTAL SPECIALISTS AT CHCs                                                                 | TOTAL SPECIALISTS AT CHCs                                                                 | TOTAL SPECIALISTS AT CHCs                                                                 | TOTAL SPECIALISTS AT CHCs                                                                 |
|-----------------------------|-------------------------------------------------------------------------------------------|-------------------------------------------------------------------------------------------|-------------------------------------------------------------------------------------------|-------------------------------------------------------------------------------------------|-------------------------------------------------------------------------------------------|-------------------------------------------------------------------------------------------|
|                             | Total Specialists [Surgeons, OB&GY, Physicians & Paediatricians] (As on 31st March, 2016) | Total Specialists [Surgeons, OB&GY, Physicians & Paediatricians] (As on 31st March, 2016) | Total Specialists [Surgeons, OB&GY, Physicians & Paediatricians] (As on 31st March, 2016) | Total Specialists [Surgeons, OB&GY, Physicians & Paediatricians] (As on 31st March, 2016) | Total Specialists [Surgeons, OB&GY, Physicians & Paediatricians] (As on 31st March, 2016) | Total Specialists [Surgeons, OB&GY, Physicians & Paediatricians] (As on 31st March, 2016) |
| S. No.                      | State/UT                                                                                  | Required 1                                                                                | Sanctioned                                                                                | In Position                                                                               | Vacant                                                                                    | Shortfall                                                                                 |
| 1                           | Pradesh                                                                                   | [R]                                                                                       | [S]                                                                                       | [P]                                                                                       | [S-P]                                                                                     | [R-P] 613                                                                                 |
| 2                           | Andhra                                                                                    | 772                                                                                       | 384                                                                                       | 159                                                                                       | 225                                                                                       |                                                                                           |
|                             | Arunachal Pradesh                                                                         | 252                                                                                       | NA                                                                                        | 4                                                                                         | NA                                                                                        | 248                                                                                       |
| 3                           | Assam                                                                                     | 604                                                                                       | NA                                                                                        | 131                                                                                       | NA                                                                                        | 473                                                                                       |
| 4                           | Bihar                                                                                     | 592                                                                                       | NA                                                                                        | 40                                                                                        | NA                                                                                        | 552                                                                                       |
| 5                           | Chhattisgarh                                                                              | 620                                                                                       | 620                                                                                       | 61                                                                                        | 559                                                                                       | 559                                                                                       |
| 6                           | Goa                                                                                       | 16                                                                                        | 5                                                                                         | 5                                                                                         | 0                                                                                         | 11                                                                                        |
| 7                           | Gujarat                                                                                   | 1288                                                                                      | 186                                                                                       | 148                                                                                       | 38                                                                                        | 1140 410                                                                                  |
| 8                           | Haryana                                                                                   | 440                                                                                       | 153                                                                                       | 30                                                                                        | 123                                                                                       |                                                                                           |
| 9                           | Himachal Pradesh                                                                          | 316                                                                                       | NA                                                                                        | 7                                                                                         | NA                                                                                        | 309                                                                                       |
| 10 11                       | Jammu & Kashmir Jharkhand                                                                 | 336 752                                                                                   | 344                                                                                       | 190                                                                                       | 154 9                                                                                     | 146 630                                                                                   |
|                             |                                                                                           |                                                                                           | 131                                                                                       | 122                                                                                       |                                                                                           |                                                                                           |
| 12                          | Karnataka                                                                                 | 824                                                                                       | 824                                                                                       | 498                                                                                       | 326                                                                                       | 326                                                                                       |
| 13                          | Kerala                                                                                    | 900                                                                                       | 30                                                                                        | 40                                                                                        | *                                                                                         | 860                                                                                       |
| 14                          | Madhya Pradesh                                                                            | 1336                                                                                      | 1336                                                                                      | 289                                                                                       | 1047                                                                                      | 1047                                                                                      |
| 15                          | Maharashtra                                                                               | 1440                                                                                      | 823                                                                                       | 505                                                                                       | 318                                                                                       | 935                                                                                       |
| 16                          | Manipur                                                                                   | 68                                                                                        | 4                                                                                         | 3                                                                                         | 1                                                                                         | 65                                                                                        |
| 17                          | Meghalaya##                                                                               | 108                                                                                       | 3                                                                                         | 12                                                                                        | *                                                                                         | 96                                                                                        |
| 18                          | Mizoram###                                                                                | 36                                                                                        | 0                                                                                         | 0                                                                                         | 0                                                                                         | 36                                                                                        |
| 19                          | Nagaland                                                                                  | 84                                                                                        | NA                                                                                        | 8                                                                                         | NA                                                                                        | 76                                                                                        |
| 20                          | Odisha                                                                                    | 1508                                                                                      | 908                                                                                       | 354                                                                                       | 554                                                                                       | 1154                                                                                      |
| 21 22                       | Punjab Rajasthan                                                                          | 600 2284                                                                                  | 578 1654                                                                                  | 196 497                                                                                   | 382 1157                                                                                  | 404 1787                                                                                  |
| 23                          | Sikkim                                                                                    | 8                                                                                         | NA                                                                                        | 0                                                                                         | NA                                                                                        | 8                                                                                         |
| 24                          | Tamil Nadu                                                                                | 1540                                                                                      | NA                                                                                        | 76                                                                                        | NA                                                                                        | 1464                                                                                      |
| 25                          | Telangana                                                                                 | 456                                                                                       | 284                                                                                       | 147                                                                                       | 137                                                                                       | 309                                                                                       |
| 26                          |                                                                                           |                                                                                           |                                                                                           |                                                                                           |                                                                                           | 79                                                                                        |
|                             | Tripura                                                                                   | 80                                                                                        | 0                                                                                         | 1                                                                                         | *                                                                                         |                                                                                           |
| 27 28                       | Uttarakhand Uttar Pradesh                                                                 | 236 3092                                                                                  | 200 2099                                                                                  | 41 484                                                                                    | 159 1615                                                                                  | 195 2608                                                                                  |
| 29                          | West Bengal                                                                               | 1396                                                                                      | 669                                                                                       | 125                                                                                       | 544                                                                                       | 1271                                                                                      |
| 30                          | A& N Islands                                                                              | 16                                                                                        | 9                                                                                         | 0                                                                                         | 9                                                                                         | 16                                                                                        |
| 31                          | Chandigarh**                                                                              | 8                                                                                         | 11                                                                                        | 14                                                                                        | *                                                                                         | *                                                                                         |
| 32                          | D & N Haveli                                                                              | 0                                                                                         | 0                                                                                         | 0                                                                                         | 0                                                                                         | 0                                                                                         |
| 33                          | Diu                                                                                       | 8                                                                                         | 2                                                                                         | 0                                                                                         | 2                                                                                         |                                                                                           |
| 34                          | Daman &                                                                                   |                                                                                           |                                                                                           |                                                                                           |                                                                                           | 8                                                                                         |
|                             | Delhi                                                                                     | 0                                                                                         | 0                                                                                         | 0                                                                                         | 0                                                                                         | 0                                                                                         |
| 35                          | Lakshadweep                                                                               | 12                                                                                        | 0                                                                                         | 0                                                                                         | 0                                                                                         | 12                                                                                        |
| 36                          | Puducherry                                                                                | 12                                                                                        | 5                                                                                         | 5                                                                                         | 0                                                                                         | 7                                                                                         |
|                             | All India 2 / Total                                                                       | 22040                                                                                     | 11262                                                                                     | 4192                                                                                      | 7359                                                                                      | 17854                                                                                     |

Notes:

**Sanctioned data for 2013 - 14 used

##Sanctioned data for 2015 used

### Data for 2015 repeated

NA: Not Available.

1Four per Community Health Centre

All India figures for Vacancy and Shortfall are the totals of State -wise Vacancy and Shortfall ignoring surplus in some States / UTs

*:  Surplus.

2For calculating the overall percentages of vacancy and shortfall, the States/UTs for which manpower position is not available , are excluded

Table 28 A

| General Duty Medical Officers (GDMOs) -Allopathic at CHCs   | General Duty Medical Officers (GDMOs) -Allopathic at CHCs   | General Duty Medical Officers (GDMOs) -Allopathic at CHCs   | General Duty Medical Officers (GDMOs) -Allopathic at CHCs   |
|-------------------------------------------------------------|-------------------------------------------------------------|-------------------------------------------------------------|-------------------------------------------------------------|
| S. No.                                                      | State/UT                                                    | Sanctioned                                                  | (As on 31st March, In Position [P]                          |
| 1                                                           | Andhra Pradesh                                              | [S] 312                                                     | 272                                                         |
| 2                                                           | Arunachal Pradesh                                           | NA                                                          | 128                                                         |
| 3                                                           | Assam                                                       | NA                                                          | 350                                                         |
| 4                                                           | Bihar                                                       | NA                                                          | 735                                                         |
| 5                                                           | Chhattisgarh                                                | 321                                                         | 393                                                         |
| 6                                                           | Goa                                                         | 12                                                          | 10                                                          |
| 7                                                           | Gujarat                                                     | 1049                                                        | 812                                                         |
| 8                                                           | Haryana                                                     | 410                                                         | 265                                                         |
| 9                                                           | Himachal Pradesh                                            | 234                                                         | 220                                                         |
| 10                                                          | Jammu & Kashmir                                             | 751                                                         | 604                                                         |
| 11                                                          | Jharkhand                                                   | 564                                                         | 594                                                         |
| 12                                                          | Karnataka                                                   | 255                                                         | 218                                                         |
| 13                                                          | Kerala                                                      | 781                                                         | 1019                                                        |
| 14                                                          | Madhya Pradesh                                              | 1854                                                        | 904                                                         |
| 15                                                          | Maharashtra                                                 | 512                                                         | 486                                                         |
| 16                                                          | Manipur                                                     | 97                                                          | 93                                                          |
| 17                                                          | Meghalaya##                                                 | 91                                                          | 64                                                          |
| 18                                                          | Mizoram                                                     | NA                                                          | 13                                                          |
| 19                                                          | Nagaland                                                    | 42                                                          | 51                                                          |
| 20                                                          | Odisha                                                      | 449                                                         | 722                                                         |
| 21                                                          | Punjab                                                      | 206                                                         | 398                                                         |
| 22                                                          | Rajasthan                                                   | 1442                                                        | 1045                                                        |
| 23                                                          | Sikkim                                                      | NA                                                          | 3                                                           |
| 24                                                          | Tamil Nadu                                                  | 2100                                                        | 1787                                                        |
| 25                                                          | Telangana                                                   | 226                                                         | 197                                                         |
| 26                                                          | Tripura###                                                  | 64                                                          | 58                                                          |
| 27                                                          | Uttarakhand                                                 | 57                                                          | 47                                                          |
| 28                                                          | Uttar Pradesh                                               | 778                                                         | 778                                                         |
| 29                                                          | West Bengal                                                 | 790                                                         | 876                                                         |
| 30                                                          | A& N Islands                                                | 13                                                          | 13                                                          |
| 31                                                          | Chandigarh^                                                 | 6                                                           | 18                                                          |
| 32                                                          | D & N Haveli                                                | 0                                                           | 0                                                           |
| 33                                                          | Daman & Diu                                                 | 4                                                           | 4                                                           |
| 34                                                          | Delhi                                                       | 0                                                           | 0                                                           |
| 35                                                          | Lakshadweep                                                 | 12                                                          | 12                                                          |
| 36                                                          | Puducherry                                                  | 18                                                          | 18                                                          |
|                                                             | All India/Total 2                                           | 13450                                                       | 13207                                                       |

Notes:

## Data for 2015 used

### Sanctioned data for 2015 used

^ Sanctioned data for 2013 - 14 used

NA: Not Available

2 For calculating the overall percentages of vacancy, the States/UTs for which manpower position is not available, are excluded