Lok Sabha Question No. 3756 (UNSTARRED), answered on 2017-03-24
Subject: Healthcare Infrastructure
Ministry: HEALTH AND FAMILY WELFARE
Asked by: PONGULETI SRINIVASA REDDY

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

LOK SABHA UNSTARRED QUEST ION NO. 3756 TO BE ANSWERED ON 24 TH MARCH, 2017

## HEALTHCARE INFRASTRU CTURE

## 3756. SHRI PONGULETI SRINIVASA REDDY:

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

- (a) whether India's elemental healthcare infrastructure needs to be strengthened in view of the shortage of specialist doctors in the Community Health Centres across the country;
- (b)  i f  so,  the  details  thereof  and  the  corrective  measures  taken/proposed  to  be  taken regard;
- (c) whether private hospitals continue to be more lucrative for doctors and recruiting s is not an easy task for the States, even though the Govern ment is offering additional incentives to specialists, not many are coming forward to serve in rural areas;
- (d) if so, the details thereof and reasons therefor for such situation; and
- (e) the steps being taken to attract the specialist doctors in these centres?

## ANSWER THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE (SHRI FAGGAN SINGH KULASTE)

(a) to (e):As per Rural Health Statistics (RHS) 2016, there is shortage of specialist doctors in Community Health Centres (CHCs). State/UT - wise specialist doctors and shortfall thereof is at Annexure.

Public health being a State subject, the primary responsibility to ensure availab specialist doctors in public health fac ilities lies with the State Governments. However, under the National Health Mission (NHM), financial and technical support is provided to States/U strengthen their healthcare systems including support for insourcing or engagement of sp doctorson  contractual  basis,  based  on  the  requirements  posed  by  the  States/UTs  in Programme Implementation Plans (PIPs) within their overall resource envelope.

Support is also provided to States/UTs for hard area allowance to specialist doct servin g in rural and remote areas and for their residential quarters so that they find it serve in public health facilities in such areas.

Contd………

The Government has taken various steps to increase availability of doctors specialists in the country and also to encourage them to serve in rural and remote are These steps include:

(i) The ratio of teachers to students has been revised from 1:1 to 1:2 for all disciplines  and  1:1  to  1:3  in  subjects  of  Anaesthesiology,  Forensic  Medic e, Radiotherapy,  Medical  Oncology,  Surgical  Oncology  and  Psychiatry  in  all  medica colleges  across  the  country.  Further,  teacher:  student  ratio  in  public Government Medical Colleges for Professor has been increased from 1:2 to 1:3 in clinical su bjects and for Associate Prof. from 1:1 to 1:2 if the Associate Prof. is head. This would result in increase in number of specialists in the country.

(ii) DNB qualification has been recognized for appointment as faculty to take ca shortage of f aculty.

(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 require for land, faculty, staff, bed/bed strength and other infrastructure.

(vi) Strengthening/upgradation of State Government Medical Colleges for starting PG courses/Increase o f PG seats.

(vii) Establishment of New Medical Colleges by upgrading district/referral hosp preferably in underserved districts of the country.

(viii)  Strengthening/  upgradation  of  existing  State  Government/Central  Governme Medical Colleges to incre ase MBBS seats.

(ix) Strengthening of districts hospitals to run DNB/CPS courses.

Further, in order to encourage doctors to work in remote and difficult area Medical  Council  of  India,  with  the  previous  approval  of  Central  Government,  h amended the Post Graduate Medical Education Regulations, 2000 to provide:

(i) 50% reservation in Post Graduate Diploma Courses for Medical Officers in th Government service, who have served for at least three years in remote and diff areas; and

(ii) In centive  at  the  rate  of  10%  the  marks  obtained  for  each  year  in  servic remote or difficult areas as upto the maximum of 30% of the marks obtained in entrance test for admissions in Post Graduate Medical Courses.

Various reasons attributed for shortage of specialists in public health facilitie particularly in rural areas include overall shortage of specialists in the countr of professional isolation among specialists, and unwillingness on their part to rural areas.

.........

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## Annexure

| 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                                               |
|-----------------------------|-----------------------------|-------------------------------------------------------------------------|-------------------------------------------------------------------------|-------------------------------------------------------------------------|-------------------------------------------------------------------------|-------------------------------------------------------------------------|
| S. No.                      | State/UT                    | [Surgeons, OB&GY, Physicians & Paediatricians] (As on 31st March, 2016) | [Surgeons, OB&GY, Physicians & Paediatricians] (As on 31st March, 2016) | [Surgeons, OB&GY, Physicians & Paediatricians] (As on 31st March, 2016) | [Surgeons, OB&GY, Physicians & Paediatricians] (As on 31st March, 2016) | [Surgeons, OB&GY, Physicians & Paediatricians] (As on 31st March, 2016) |
| S. No.                      | State/UT                    | Required 1                                                              | Sanctioned                                                              | In Position                                                             | Vacant                                                                  | Shortfall                                                               |
|                             | State/UT                    | [R]                                                                     | [S]                                                                     | [P]                                                                     | [S- P]                                                                  | [R- P]                                                                  |
| 1                           | Andhra Pradesh              | 772                                                                     | 384                                                                     | 159                                                                     | 225                                                                     | 613                                                                     |
| 2                           | 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                                                                    |
| 8                           | Haryana                     | 440                                                                     | 153                                                                     | 30                                                                      | 123                                                                     | 410                                                                     |
| 9                           | Himachal Pradesh            | 316                                                                     | NA                                                                      | 7                                                                       | NA                                                                      | 309                                                                     |
| 10                          | Jammu & Kashmir             | 336                                                                     | 344                                                                     | 190                                                                     | 154                                                                     | 146                                                                     |
| 11                          | Jharkhand                   | 752                                                                     | 131                                                                     | 122                                                                     | 9                                                                       | 630                                                                     |
| 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                          | Punjab                      | 600                                                                     | 578                                                                     | 196                                                                     | 382                                                                     | 404                                                                     |
| 22                          | Rajasthan                   | 2284                                                                    | 1654                                                                    | 497                                                                     | 1157                                                                    | 1787                                                                    |
| 23                          | Sikkim                      | 8                                                                       | NA                                                                      | 0                                                                       | NA                                                                      | 8                                                                       |
| 24                          | Tamil Nadu                  | 1540                                                                    | NA                                                                      | 76                                                                      | NA                                                                      | 1464                                                                    |
| 25                          | Telangana                   | 456                                                                     | 284                                                                     | 147                                                                     | 137                                                                     | 309                                                                     |
| 26                          | Tripura                     | 80                                                                      | 0                                                                       | 1                                                                       | *                                                                       | 79                                                                      |
| 27                          | Uttarakhand                 | 236                                                                     | 200                                                                     | 41                                                                      | 159                                                                     | 195                                                                     |
| 28                          | Uttar Pradesh               | 3092                                                                    | 2099                                                                    | 484                                                                     | 1615                                                                    | 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                          | Daman & Diu                 | 8                                                                       | 2                                                                       | 0                                                                       | 2                                                                       | 8                                                                       |
| 34                          | Delhi                       | 0                                                                       | 0                                                                       | 0                                                                       | 0                                                                       | 0                                                                       |
| 35                          | Lakshadweep                 | 12                                                                      |                                                                         |                                                                         |                                                                         | 12                                                                      |
| 36                          | Puducherry                  | 12                                                                      | 0 5                                                                     | 0                                                                       | 0                                                                       | 7                                                                       |
|                             | All India 2 / Total         | 22040                                                                   | 11262                                                                   | 5 4192                                                                  | 0 7359                                                                  | 17854                                                                   |

Notes:

**Sanctioned data for 2013 -14 used ##Sanctioned data for 2015 used ### 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 -wiseVacancy and Shortfall ignoring surplus in some States / UTs