Lok Sabha Question No. 2294 (UNSTARRED), answered on 2017-07-28
Subject: Healthcare Services in the North-Eastern Region
Ministry: HEALTH AND FAMILY WELFARE
Asked by: NINONG ERING, PREM DAS RAI

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

## LOK SABHA UNSTARRED QUESTION NO. 2294 TO BE ANSWERED ON 28 TH JULY, 2017

## HEALTHCARE SERVICES IN THE NORTH - EASTERN REGION

## 2294. SHRI NINONG ERING: SHRI PREM DAS RAI:

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

(a) whether the Government has assessed the availability of health professionals and quality of healthcare service facilities in hilly and in the North -Eastern region of t he country particularly in Arunachal Pradesh and if so, the details along with the outcome thereof;

(b) the estimated number of doctors, medical colleges, hospitals and hospital beds available in the North - Eastern States specially in Arunachal Pradesh, State/ UT - wise;

(c) the steps taken/proposed to be taken by the Government to improve access to affordable and quality healthcare services in the hilly and North - Eastern region specially in Arunachal Pradesh alongwith the funds earmarked, allocated and utilized during each of the last three years and the current year, State - wise;

(d) the details of the incentives being provided for setting up of hospitals and medic l colleges in the North - Eastern region specially in Arunachal Pradesh;

(e) whether the Go vernment has supported/proposes to support any projects aimed at creation of health informatics, healthcare knowledge system and other e - Health solutions in the region and if so, the details thereof, State - wise; and

(f) fund spent in the last three years and the current year to improve access to the healthcare facility in such regions?

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

(SHRI FAGGAN SINGH KULASTE)

(a): Status of availability of health professionals in hilly and in t he North - Eastern region of the  country  including  Arunachal  Pradesh,  as  per  Rural  Health  Statistics  (RHS)  2016, Annex - I .

Further, assessment of quality of healthcare service facilities in hilly and in t -Eastern  region  of  the  country  including Arunachal  Pradesh  is  carried  out  through  various external  surveys  such  as,  National  Family  Health  Survey  (NFHS), District  Level  Household Survey (DLHS) andSample Registration System (SRS) etc. Further, Common Review Missions (CRMs) also undertake review of the quality of healthcare service facilities, in hilly and North - Eastern  region  of  the  country  including  Arunachal  Pradesh.  D etails  of  different evaluations  are vailable in public domain as under:

NFHS - 4:http://nrhm - mis.nic.in/SitePages/NFHS.aspx

DLHS 4: https://nrhm - mis.nic.in/SitePages/DLHS - 4.aspx

SRS:http://www.censusindia.gov.in/2011 - Common/Sample\_Registration\_System.html

CRM reports: http://nhm.gov.in/monitoring/common - review - miss ion.html

(b): Status of number of Government allopathic doctors, number of medical colleges -public & private, number of government hospitals and number of beds available in the North - Eastern States including Arunachal Pradesh, State - wise is at Annex - II .

(c): Public health and hospitals being a State subject, the primary responsibility to healthcare services to its people lies with the respective State/UT Governments. However, the National Health Mission (NHM), financial and technical su pport is provided to States/UTs to strengthen their healthcare systems including support for engagement or in - sourcing of health professionals  on  contractual  basis,  provision  of  free  drugs,  diagnostics,  ambulances, Medical  Units  etc.,  based  on  the  r equirements  posed  by  the  States/UTs  in  their  Programme Implementation Plans (PIPs) within their overall resource envelope.

Besides NHM, the Scheme for Forward Linkages to NRHM complement & supplement the  initiatives  under  NHM  by  improving  the  Tertiary,  Secondary  level    and  other  he infrastructure in North - Eastern region.

Funds allocated and utilized during each of the last three years and the current healthcare services in t he hilly and North - Eastern  region  including  Arunachal  Pradesh,  State -wise, is at Annex - III.

(d) & (e): Under  the  scheme  for  'Establishment  of  new  Medical  Colleges  attached  with existing District /referral hospitals', following States/Districts have been i dentified -Arunachal Pradesh  (Naharlagun),  Assam  (Diphu,  Dhubri,  Nagaon,  North  Lakhimpur),  Meghalaya  (West Garo Hills, Tura), Mizoram (Falkawn), Nagaland (Naga Hospital). Further, under NHM suppor is also provided to States/UTs, including the North - Easte rn region, including Arunachal Pradesh, for setting up of public health facilities like hospitals and projects aimed at creati informatics, healthcare knowledge system and other e -Health solutions.

Ministry  has  taken  following  measures  to adopt  IT  Solutions  in  existing  health infrastructure in meeting the challenges of healthcare delivery especially to rural and areas to ensure continuum of care:

- Computerization & Hospital Management Information System (HMIS): Computerization of D istrict / Sub - district hospitals & Community Health Centers (CHC) and implementation of Hospital Management Information System (HMIS) for creation of Electronic Health Record in a phased manner.  This is to strengthen online patient - centric interface, targ eted impact of better  delivery  of  services  to  patients  and  improvement  in  efficiency  of  process hospitals. So far, financial support has been provided to State of Meghalaya & Tripura.
- Online Registration System (ORS): Online Registration System (ORS) is implemented in various  hospitals  in  States/UTs  and  Central  Govt.  Hospital/Institutes  to  provide registration,  online  appointment  services  to  citizens'  alongwith  and  online  viewing  of medical examination report on ORS portal by citizens. This app lication has already been implemented in 7 Hospital in N - E region.
- National Telemedicine Network: Under National Telemedicine Network scheme, PHC/CHCs & District/ Sub District hospitals are being interlinked with the tertiary care facility, M edical Colleges and super specialty hospitals for providing Tele - Consultation &  Tele - Follow - up  services  with  specialists  with  the  purpose  of  reaching  out  to  rura remote areas.  So far, financial support has been provided to Assam & Tripura.
- Ministry i s also  establishing National Medical College Network (NMCN) scheme under which 50 Government medical colleges are being networked in the first phase riding o National  Knowledge  Network  (NKN)  with  the  purpose  of  e - Education  and  e - Healthcare delivery inc luding following six (6) medical colleges of  North Eastern Region:
- i.NEIGRIHMS, Shillong( Regional Resource Centre, NE Region)
- ii.Guwahati Medical College, Guwahati, Assam
- iii. Assam Medical College, Dibrugarh, Assam
- iv.Regional Institute of Medical Sciences Imphal, Manipur
- v. Agartala Government Medical College, Agartala, Tripura
- vi.Christian Institute of Nursing Science & Research, Dimapur, Nagaland.
- (f): Under NHM, funds allocated and utilized during each of the last three years and current year, for heal thcare services in the hilly and North - Eastern region including Arunachal Pradesh, State - wise, is at Annex - III.

## Notes:

## Sanctioned data for 2015 used

## Annex-I

| DOCTORS + AT PRIMARY HEALTH CENTRES   | DOCTORS + AT PRIMARY HEALTH CENTRES   | DOCTORS + AT PRIMARY HEALTH CENTRES   | DOCTORS + AT PRIMARY HEALTH CENTRES   | DOCTORS + AT PRIMARY HEALTH CENTRES   | DOCTORS + AT PRIMARY HEALTH CENTRES   | DOCTORS + AT PRIMARY HEALTH CENTRES   |
|---------------------------------------|---------------------------------------|---------------------------------------|---------------------------------------|---------------------------------------|---------------------------------------|---------------------------------------|
|                                       |                                       | (As on 31st March, 2016)              | (As on 31st March, 2016)              | (As on 31st March, 2016)              | (As on 31st March, 2016)              | (As on 31st March, 2016)              |
|                                       |                                       | Required 1                            | Sanctioned                            | In Position                           | Vacant                                | Shortfall                             |
| S. No.                                | State/UT                              | [R]                                   | [S]                                   | [P]                                   | [S-P]                                 | [R-P]                                 |
| 1                                     | Arunachal Pradesh                     | 143                                   | NA                                    | 122                                   | NA                                    | 21                                    |
| 2                                     | Assam                                 | 1014                                  | NA                                    | 932                                   | NA                                    | 82                                    |
| 3                                     | Himachal Pradesh                      | 518                                   | 636                                   | 424                                   | 212                                   | 94                                    |
| 4                                     | Jammu& Kashmir                        | 637                                   | 1347                                  | 761                                   | 586                                   | *                                     |
| 5                                     | Manipur                               | 85                                    | 238                                   | 194                                   | 44                                    | *                                     |
| 6                                     | Meghalaya##                           | 109                                   | 128                                   | 105                                   | 23                                    | 4                                     |
| 7                                     | Mizoram ^                             | 57                                    | 152                                   | 71                                    | 81                                    | *                                     |
| 8                                     | Nagaland                              | 126                                   | 108                                   | 120                                   | *                                     | 6                                     |
| 9                                     | Sikkim                                | 24                                    | NA                                    | 26                                    | NA                                    | *                                     |
| 10                                    | Tripura ##                            | 94                                    | 158                                   | 147                                   | 11                                    | *                                     |
| 11                                    | Uttarakhand                           | 257                                   | 386                                   | 215                                   | 171                                   | 42                                    |
|                                       | Total 2                               | 3064                                  | 3153                                  | 3117                                  | 1128                                  | 249                                   |

^ 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

## General Duty Medical Officers (GDMOs) - Allopathic at CHCs

|        |                   | (As on 31st March, 2016)   | (As on 31st March, 2016)   |
|--------|-------------------|----------------------------|----------------------------|
|        |                   | Sanctioned                 | In Position                |
| S. No. | State/UT          | [S]                        | [P]                        |
| 1      | Arunachal Pradesh | NA                         | 128                        |
| 2      | Assam             | NA                         | 350                        |
| 3      | Himachal Pradesh  | 234                        | 220                        |
| 4      | Jammu& Kashmir    | 751                        | 604                        |
| 5      | Manipur           | 97                         | 93                         |
| 6      | Meghalaya##       | 91                         | 64                         |
| 7      | Mizoram           | NA                         | 13                         |
| 8      | Nagaland          | 42                         | 51                         |
| 9      | Sikkim            | NA                         | 3                          |
| 10     | Tripura###        | 64                         | 58                         |
| 11     | Uttarakhand       | 57                         | 47                         |
|        | Total 2           | 1336                       | 1631                       |

Notes:

## Data for 2015 used

### Sanctioned data for 2015 used

NA: Not Available

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] | Total Specialists [Surgeons, OB&GY, Physicians &Paediatricians] | Total Specialists [Surgeons, OB&GY, Physicians &Paediatricians] | Total Specialists [Surgeons, OB&GY, Physicians &Paediatricians] | Total Specialists [Surgeons, OB&GY, Physicians &Paediatricians] | Total Specialists [Surgeons, OB&GY, Physicians &Paediatricians] | Total Specialists [Surgeons, OB&GY, Physicians &Paediatricians] |
| S. No.                                                          |                                                                 | (As on                                                          | (As on                                                          | (As on                                                          | (As on                                                          | (As on                                                          |
| S. No.                                                          |                                                                 | Required 1                                                      | Sanctioned                                                      | In Position                                                     | Vacant                                                          | Shortfall                                                       |
| S. No.                                                          | State/UT                                                        | [R]                                                             | [S]                                                             | [P]                                                             | [S-P]                                                           | [R-P]                                                           |
| 1                                                               | Arunachal Pradesh                                               | 252                                                             | NA                                                              | 4                                                               | NA                                                              | 248                                                             |
| 2                                                               | Assam                                                           | 604                                                             | NA                                                              | 131                                                             | NA                                                              | 473                                                             |
| 3                                                               | Himachal Pradesh                                                | 316                                                             | NA                                                              | 7                                                               | NA                                                              | 309                                                             |
| 4                                                               | Jammu& Kashmir                                                  | 336                                                             | 344                                                             | 190                                                             | 154                                                             | 146                                                             |
| 5                                                               | Manipur                                                         | 68                                                              | 4                                                               | 3                                                               | 1                                                               | 65                                                              |
| 6                                                               | Meghalaya##                                                     | 108                                                             | 3                                                               | 12                                                              | *                                                               | 96                                                              |
| 7                                                               | Mizoram###                                                      | 36                                                              | 0                                                               | 0                                                               | 0                                                               | 36                                                              |
| 8                                                               | Nagaland                                                        | 84                                                              | NA                                                              | 8                                                               | NA                                                              | 76                                                              |
| 9                                                               | Sikkim                                                          | 8                                                               | NA                                                              | 0                                                               | NA                                                              | 8                                                               |
| 10                                                              | Tripura                                                         | 80                                                              | 0                                                               | 1                                                               | *                                                               | 79                                                              |
| 11                                                              | Uttarakhand                                                     | 236                                                             | 200                                                             | 41                                                              | 159                                                             | 195                                                             |
|                                                                 | Total 2                                                         | 2128                                                            | 551                                                             | 397                                                             | 314                                                             | 1731                                                            |

### Data for 2015 repeated

NA: Not Available.

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

## Notes

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| NURSING STAFF at PHCs &CHCs   | NURSING STAFF at PHCs &CHCs   | NURSING STAFF at PHCs &CHCs   | NURSING STAFF at PHCs &CHCs   | NURSING STAFF at PHCs &CHCs   | NURSING STAFF at PHCs &CHCs   | NURSING STAFF at PHCs &CHCs   |
|-------------------------------|-------------------------------|-------------------------------|-------------------------------|-------------------------------|-------------------------------|-------------------------------|
|                               |                               | (As on 31st March, 2016)      | (As on 31st March, 2016)      | (As on 31st March, 2016)      | (As on 31st March, 2016)      | (As on 31st March, 2016)      |
|                               |                               | Required 1                    | Sanctioned                    | In Position                   | Vacant                        | Shortfall 1                   |
| S. No.                        | State/UT                      | [R1]                          | [S]                           | [P]                           | [S-P]                         | [R1-P]                        |
| 1                             | Arunachal Pradesh             | 584                           | NA                            | 489                           | NA                            | 95                            |
| 2                             | Assam#                        | 2071                          | 2798                          | 2552                          | 246                           | *                             |
| 3                             | Himachal Pradesh              | 1071                          | 837                           | 666                           | 171                           | 405                           |
| 4                             | Jammu& Kashmir                | 1225                          | 1410                          | 1391                          | 19                            | *                             |
| 5                             | Manipur                       | 204                           | 484                           | 397                           | 87                            | *                             |
| 6                             | Meghalaya**                   | 298                           | 413                           | 582                           | *                             | *                             |
| 7                             | Mizoram                       | 120                           | NA                            | 219                           | NA                            | *                             |
| 8                             | Nagaland                      | 273                           | 175                           | 334                           | *                             | *                             |
| 9                             | Sikkim                        | 38                            | NA                            | 44                            | NA                            | *                             |
| 10                            | Tripura **                    | 234                           | 421                           | 540                           | *                             | *                             |
| 11                            | Uttarakhand                   | 670                           | 307                           | 349                           | *                             | 321                           |
|                               | Total                         | 6788                          | 6845                          | 7563                          | 523                           | 821                           |

# Data  for 2013 used

**Sanctioned data for 2015 used

- 1 One per Primary Health Centre and seven 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.

NA: Not Available.

Notes:

## Statement showing Estimated Number of Doctors, Medical Colleges, Hospitals and Hospital beds in all the NE States including Arunachal Pradesh

|   S.No | States            |   No. of Govt. Allopathic Doctors | Number of Medical colleges   |   Number of Govt. Hospitals |   Number of Beds |
|--------|-------------------|-----------------------------------|------------------------------|-----------------------------|------------------|
|      1 | Arunachal Pradesh |                               418 | -                            |                         212 |             2313 |
|      2 | Assam             |                              4522 | 6                            |                        1215 |            16862 |
|      3 | Manipur           |                              1099 | 2                            |                          30 |             1427 |
|      4 | Meghalaya         |                               659 | 1                            |                          40 |             3097 |
|      5 | Mizoram           |                               239 | -                            |                          34 |             1628 |
|      6 | Nagaland          |                               437 | -                            |                          36 |             1880 |
|      7 | Sikkim            |                               254 | 1                            |                          33 |             1560 |
|      8 | Tripura           |                              1021 | 2                            |                         140 |             4806 |

Source: National Health Profile 2017((www.cbhidghs.nic.in).

## Statement showing Allocation, Central Release and Utilization for the F.Y. 2014-15 to 2017-18

Annex-III

Rs. In lakh

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| S.No.           | State              | 2014-15         | 2014-15         | 2014-15         | 2015-16         | 2015-16         | 2015-16         | 2016-17         | 2016-17         | 2016-17         | 2017-18         | 2017-18         | 2017-18         |
|-----------------|--------------------|-----------------|-----------------|-----------------|-----------------|-----------------|-----------------|-----------------|-----------------|-----------------|-----------------|-----------------|-----------------|
| S.No.           | State              | Allocation      | Release         | Utilization     | Allocation      | Release         | Utilization     | Allocation      | Release         | Utilization     | Allocation      | Release         | Utilization     |
| A. Hilly States | A. Hilly States    | A. Hilly States | A. Hilly States | A. Hilly States | A. Hilly States | A. Hilly States | A. Hilly States | A. Hilly States | A. Hilly States | A. Hilly States | A. Hilly States | A. Hilly States | A. Hilly States |
| 1               | Himachal Pradesh   | 232.00          | 185.84          | 306.92          | 249.58          | 246.49          | 281.26          | 213.63          | 209.30          | 316.27          | 309.14          | 201.52          | 0.00            |
| 2               | Jammu & Kashmir    | 433.50          | 335.51          | 393.29          | 365.90          | 367.90          | 420.94          | 400.12          | 350.26          | 414.43          | 492.18          | 308.73          | 0.00            |
| 3               | Uttarakhand        | 328.63          | 270.55          | 324.42          | 296.80          | 276.41          | 335.95          | 271.88          | 259.53          | 346.01          | 354.30          | 66.91           | 0.00            |
|                 | Sub Total          | 994.13          | 791.90          | 1024.63         | 912.28          | 890.80          | 1038.15         | 885.64          | 819.09          | 1076.70         | 1155.61         | 577.15          | 0.00            |
| B. NE States    | B. NE States       | B. NE States    | B. NE States    | B. NE States    | B. NE States    | B. NE States    | B. NE States    | B. NE States    | B. NE States    | B. NE States    | B. NE States    | B. NE States    | B. NE States    |
| 4               | Arunachal Pradesh* | 185.28          | 139.41          | 69.50           | 160.01          | 162.65          | 146.27          | 166.20          | 157.57          | 161.81          | 184.88          | 3.35            | 0.00            |
| 5               | Assam              | 1,114.50        | 877.13          | 915.88          | 973.90          | 971.35          | 1186.01         | 985.73          | 1022.33         | 1331.77         | 1056.25         | 32.31           | 0.00            |
| 6               | Manipur#           | 144.97          | 128.81          | 86.91           | 115.16          | 112.16          | 105.51          | 117.10          | 75.22           | 77.54           | 130.45          | 5.06            | 0.00            |
| 7               | Meghalaya          | 136.83          | 104.13          | 70.72           | 107.62          | 102.22          | 133.55          | 165.94          | 158.74          | 145.68          | 140.32          | 0.00            | 0.00            |

| 8   | Mizoram     | 116.53   |   103.28 |   93.29 |   97.50 |   94.68 |   172.38 |   98.99 |   80.10 |   90.45 |   101.79 |   7.20 |   0.00 |
|-----|-------------|----------|----------|---------|---------|---------|----------|---------|---------|---------|----------|--------|--------|
| 9   | Nagaland    | 135.26   |   114.92 |   63.04 |  108.75 |  104.85 |    81.05 |  106.96 |   94.16 |   94.13 |   113.67 |   5.97 |      0 |
| 10  | Sikkim@     | 51.09    |    51.6  |   41.36 |   43.54 |   41.01 |    50.71 |   46.62 |   39.62 |   50.57 |    48.33 |   0    |      0 |
| 11  | Tripura     | 164.24   |   123.11 |  130.15 |  139.07 |  136.29 |   118.77 |  145.53 |  122.51 |  141.27 |   149    |   5.68 |      0 |
|     | Sub Total   | 2,048.71 |  1642.4  | 1470.84 | 1745.55 | 1725.22 |  1994.25 | 1833.06 | 1750.26 | 2093.22 |  1924.7  |  59.56 |      0 |
|     | Grand Total | 3,042.84 |  2434.29 | 2495.48 | 2657.83 | 2616.01 |  3032.39 | 2718.7  | 2569.35 | 3169.92 |  3080.31 | 636.71 |      0 |

Note:

1. Allocation is as per original outlay/B.E. after revising the allocation under Infrastructure Maintenance to the extent of releases made.
2. For the F.Y. 2016-17, the allocation under Health System Strengthening under NRHM is revised to the extent of additional allocation made available for Revised Estimate.
3. Release for the F.Y. 2017-18 is updated upto 30.06.2017 and is provisional. The above releases relate to Central Govt. Grants & do not include State share contribution.
4. During the F.Y. 2015-16, release in r/o Arunachal Pradesh is more than allocation on account of incentives earned.
5. Expenditure includes expenditure against central Release, State release & unspent balances at the beginning of the year. The above figures are as per FMR reported by State/Uts hence provisional.
6. Expenditure is collected on quarterly basis & due after the expiry of 1 month from the quarter end. Therefore, for the F.Y. 2017-18 is not yet due, hence not furnished.

*Rs 59.3 Cr. & Rs 14.04 Cr was released in 2015

- # Rs5.78 Cr. was released in 2014
- @Rs 13.5 Cr. was released in 2016

- 16 & 2016 - 17 respectively for Forward Schemes also. - 15 for Forward Linkages Schemes also. - 17 for Forward Linkages Schemes also.