Lok Sabha Question No. 2354 (UNSTARRED), answered on 2018-03-09
Subject: Treatment of Doctors in Rural Areas
Ministry: HEALTH AND FAMILY WELFARE
Asked by: (ADV.) JOICE GEORGE

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

LOK SABHA UNSTARRED QUESTION NO. 2354 TO BE ANSWERED ON 9 TH MARCH, 2018

## TREATMENT OF DOCTORS IN RURAL AREAS

## 2354. ADV. JOICE GEORGE:

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

- (a) whether as per health survey report private doctors are the most important single s treatment in both rural and urban areas;
- (b) if so, the details thereof, State/UTwise;
- (c) whether the number of people reporting sick is more in urban India compared to rural a so, the details thereof;
- (d) whether the Government has noted that a much higher portion of people have no intere taking any treatment for various a ilments, if so, the details thereof; and
- (e) the steps taken by the Government to improve healthcare facilities in the country?

## ANSWER THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE (SHRI ASHWINI KUMAR CHOUBEY)

(a)& b): Yes. According to NSS Report No. 574: Health in India based on National Sample Survey  71 st round  (January  2014 -June  2014)  conducted  by  National  Sample  Survey Office(NSSO), more than 70% (72 percent in the rural areas and 79 percent in the urban spells of ailment were treated in the private sector (consisting of private doctors, nursin private hospitals, charitable institutions).

State/UT  wise  percent  distribution  of  spells  of  ailment  treated  over  levels  of given at  Annexure -I .

- (c): Yes, according to above NSS Report, 89 persons per 1000 persons in rural areas and persons per 1000 persons in urban areas reported any ailment during last 15 days precedi date of survey.

The details are given at Annexure - II.

Contd………

( d): Above NSS reports also reveals that around 4.1% Male and 4.0% Female in rural are and 2.8% Male and 2.5% Female in urban people did not take/ receive any treatment for var ailments.

The details  are given at  Annexure -III .

(e):  P ublic  healt h  and  hospitals  are  state  subject,  however,  under  National  Health  Miss (NHM), support is provided to the States/UTs to strengthen their health care system based requirements  proposed  by  them  under  Programme  Implementation  Plans.  NHM  envisages achievement of universal access to equitable, affordable & quality healthcare services accountable  and  responsive  to  people's  needs.  The  main  programmatic  components  include Health System Strengthening in rural and urban areas, Reproductive, Maternal , New- born, Child and  Adolescent  Health  (RMNCH+A)  interventions  and  control  of  Communicable  and  Non -Communicable Diseases. The recent initiatives taken include the following:

- Launching of Pradhan Mantri National Dialysis Services Programme.
- Launching of Mother's Absolute Affection (MAA) Programme.
- Launching of   Pradhan Mantri Surakshit Matritva Abhiyan.
- Introduction  of  Rubella  vaccine - it  has  been  introduced  in  Universal  Immunization Programme  as  Measles - Rubella  combination  vaccine  to  provide  protectio n  against congenital birth defects caused by Rubella infection.
- Free Drugs Service Initiative.
- Free Diagnostics Service Initiative.
- Launching of 'Mission Parivar Vikas' in high focus districts having higher total fertility rate (TFR) in the country.
- Launch of Kayakalp -an initiative for Award to Public Health Facilities.
- Expansion of basket of choices, to include new contraceptives like contraceptive, Centchroman and Progestogen Only Pills (POP).

Inject

- Launching  of  a  universal  population  based  screening  programme  for  early  detecti management and control of common non - communicable diseases such as hypertension, diabetes, and cancers (breast, cervix and oral).
- Swachh  Swasth  Sarvatra  (SSS),  a  joint  initi ative  of  the  Ministry  of  Health  &  Family Welfare  (MoHFW)  and  the  Ministry  of  Drinking  Water  and  Sanitation  (MoDWS)  to leverage the achievements of the two Ministries for convergence of the interventio maximise the health gains.

Further, In General Bu dget 2018 - 19, Government has announced two major initiatives in health sector, as part of Ayushman Bharat programme. These are Health and Wellness Centre provide comprehensive health care, including for non - communicable diseases and maternal and childhealth services and NationalHealth Protection Scheme to cover over 10 crore poor and vulnerable families (approximately 50 crore beneficiaries) providing coverage upto 5 lakh per family per year for secondary and tertiary care hospitalization.

……………………

Annexure I Percentage distribution of spells of ailment treated on medical advice over levels of care in each State/UT

| State/UT          | Rural               | Rural            | Rural          | Rural             | Rural   | U rban              | U rban           | U rban         | U rban            | U rban   |
|-------------------|---------------------|------------------|----------------|-------------------|---------|---------------------|------------------|----------------|-------------------|----------|
| State/UT          | HSC/PHC and others* | Public hospitals | Private doctor | Private hospitals | A ll    | HSC/PHC and others* | Public hospitals | Private doctor | Private hospitals | A ll     |
| (1)               | (2)                 | (4)              | (5)            | (6)               | (7)     | (9)                 | (10)             | (11)           | (12)              | (13)     |
| Andhra Pradesh    | 5.8                 | 9.8              | 29.1           | 55.4              | 100     | 2.6                 | 9.7              | 27.2           | 60.5              | 100      |
| Arunachal Pradesh | 71.4                | 28               | 0.5            | 0.1               | 100     | 6.6                 | 87.2             | 1.4            | 4.8               | 100      |
| Assam             | 53.8                | 30.4             | 15.1           | 0.6               | 100     | 19.8                | 24.5             | 44.3           | 11.5              | 100      |
| Bihar             | 6.2                 | 7.8              | 75.9           | 10.2              | 100     | 1.6                 | 10.7             | 80.7           | 7                 | 100      |
| Chhattisgarh      | 22.4                | 8.1              | 60.3           | 9.2               | 100     | 8.3                 | 7.4              | 66.6           | 17.7              | 100      |
| Delhi             | 0                   | 22.3             | 74             | 3.7               | 100     | 9.2                 | 10.9             | 71.6           | 8.3               | 100      |
| Goa               | 1.2                 | 19.5             | 62.4           | 17                | 100     | 4.3                 | 26.3             | 54             | 15.3              | 100      |
| Gujarat           | 13.2                | 10.5             | 48.1           | 28.2              | 100     | 4.4                 | 10.6             | 58.3           | 26.8              | 100      |
| Haryana           | 5                   | 5.6              | 59.6           | 29.8              | 100     | 0.3                 | 8.1              | 70.9           | 20.6              | 100      |
| Himachal Pradesh  | 5.3                 | 38               | 40             | 16.7              | 100     | 4.1                 | 75.3             | 13.9           | 6.8               | 100      |
| Jammu & Kashmir   | 4.8                 | 43.6             | 50.2           | 1.4               | 100     | 2.4                 | 38.6             | 58.1           | 1                 | 100      |
| Jharkhand         | 10.3                | 21.8             | 60.7           | 7.2               | 100     | 0.3                 | 14.4             | 64.5           | 20.9              | 100      |
| Karnataka         | 6.3                 | 19.7             | 47.8           | 26.2              | 100     | 3                   | 11.4             | 42.6           | 42.9              | 100      |
| Kerala            | 15.3                | 21               | 33.8           | 30                | 100     | 5.5                 | 25.6             | 37.5           | 31.4              | 100      |
| Madhya Pradesh    | 6.9                 | 22.5             | 58.9           | 11.7              | 100     | 4.9                 | 19               | 59.6           | 16.4              | 100      |
| Maharashtra       | 10.4                | 9.8              | 60.3           | 19.5              | 100     | 3.5                 | 11               | 64.8           | 20.7              | 100      |
| Manipur           | 17.5                | 32.6             | 32.7           | 17.3              | 100     | 0                   | 66               | 34             | 0                 | 100      |
| Meghalaya         | 78.3                | 5.5              | 15.9           | 0.3               | 100     | 0.8                 | 13               | 68.5           | 17.7              | 100      |
| Mizoram           | 83.5                | 3.2              | 12.1           | 1.2               | 100     | 19.4                | 24.2             | 49.7           | 6.7               | 100      |
| Nagaland          | 45.4                | 37.7             | 16             | 0.9               | 100     | 22                  | 33.3             | 29.4           | 15.4              | 100      |
| Odisha            | 49.7                | 25.8             | 23.6           | 1                 | 100     | 21.7                | 32.7             | 38.3           | 7.3               | 100      |
| Punjab            | 5.7                 | 11.1             | 55             | 28.2              | 100     | 2.8                 | 19.8             | 59.7           | 17.7              | 100      |
| Rajasthan         | 19.2                | 24.7             | 44.3           | 11.8              | 100     | 3.2                 | 25.8             | 50.3           | 20.6              | 100      |
| Sikkim            | 87.6                | 8.4              | 0.5            | 3.5               | 100     | 0                   | 45               | 38.2           | 16.8              | 100      |

## Percentage distribution of spells of ailment treated on medical advice over levels of care in each State/UT

|                             | Rural               | Rural            | Rural          | Rural             | Rural   | U rban              | U rban           | U rban         | U rban            | U rban   |
|-----------------------------|---------------------|------------------|----------------|-------------------|---------|---------------------|------------------|----------------|-------------------|----------|
| State/UT                    | HSC/PHC and others* | Public hospitals | Private doctor | Private hospitals | A ll    | HSC/PHC and others* | Public hospitals | Private doctor | Private hospitals | A ll     |
| (1)                         | (2)                 | (4)              | (5)            | (6)               | (7)     | (9)                 | (10)             | (11)           | (12)              | (13)     |
| Tamil Nadu                  | 11.4                | 30.9             | 18.8           | 38.9              | 100     | 3.6                 | 25               | 26.6           | 44.8              | 100      |
| Telangana                   | 8                   | 10.6             | 41.9           | 39.5              | 100     | 1.2                 | 7.5              | 29.2           | 62.1              | 100      |
| Tripura                     | 31.7                | 31.8             | 34.1           | 2.5               | 100     | 13.5                | 27.7             | 50.4           | 8.3               | 100      |
| Uttar Pradesh               | 5                   | 9.5              | 75.5           | 10.1              | 100     | 3.9                 | 12.2             | 71.4           | 12.6              | 100      |
| Uttarakhand                 | 12.9                | 44.5             | 22.1           | 20.5              | 100     | 0.4                 | 25.3             | 62.1           | 12.3              | 100      |
| West Bengal                 | 7.1                 | 15.5             | 74.6           | 2.9               | 100     | 2.9                 | 11.9             | 82             | 3.2               | 100      |
| A ndaman & N icobar Islands | 64.6                | 10.5             | 24.5           | 0.5               | 100     | 21.2                | 49.7             | 14.5           | 14.6              | 100      |
| Chandigarh                  | 7.6                 | 27.2             | 63.9           | 1.2               | 100     | 9.2                 | 31.5             | 58.3           | 1                 | 100      |
| Dadra & Nagar Haveli        | 33.5                | 9.8              | 10.6           | 46.2              | 100     | 13.9                | 46.7             | 14.5           | 24.9              | 100      |
| Daman & Diu                 | 23.4                | 2.4              | 10             | 64.2              | 100     | 1.6                 | 1.3              | 40.6           | 56.4              | 100      |
| Lakshadweep                 | 47.7                | 36.3             | 0              | 16                | 100     | 1.2                 | 70.1             | 3.8            | 24.9              | 100      |
| Puducherry                  | 0.2                 | 18.1             | 65.6           | 16.2              | 100     | 0.3                 | 48.6             | 4.6            | 46.5              | 100      |
| all                         | 11.5                | 16.8             | 50.7           | 21                | 100     | 3.9                 | 17.3             | 50             | 28.8              | 100      |

* includes ANM (Auxiliary Nurse Midwive ) / ASHA (Accredited Social Health Activist) /AWW (Anganwadi worker) /dispensary/ CHC (Community Health Centre) / MMU ( Mobile Medical Unit ) HSC :Health Sub -Centre; PHC :Primary Health Centre .

## Annexure II

## Number (per 1000) of persons reported ailment during last 15 days

| Sector   | A ilment       | Male   | Female   | A ll   |
|----------|----------------|--------|----------|--------|
| (1)      | (2)            | (3)    | (4)      | (5)    |
| Rural    | short duration | 44     | 54       | 49     |
| Rural    | chronic        | 36     | 45       | 40     |
| Rural    | any            | 80     | 99       | 89     |
| Urban    | short duration | 45     | 56       | 51     |
| Urban    | chronic        | 56     | 79       | 67     |
| Urban    | any            | 101    | 135      | 118    |

Note: Ailments for long - duration (30 days or more) are referred as chronic ailments with a 15 day reference period, rest are short - duration ailments.

## Annexure I II

## Percentage of spells of ailment for which no treatment was received

| State/UT                    | ural   | ural   | U rban   | U rban   |
|-----------------------------|--------|--------|----------|----------|
| State/UT                    | M ale  | Female | M ale    | Female   |
| Andhra Pradesh              | 1.1    | 4      | 0.1      | 1.3      |
| Arunachal Pradesh           | 4.8    | 3.8    | 0        | 35.1     |
| Assam                       | 0.6    | 1.4    | 0        | 0        |
| Bihar                       | 2.3    | 3.5    | 0.3      | 0.6      |
| Chhattisgarh                | 0.1    | 7      | 0.1      | 0.1      |
| Delhi                       | 0      | 0      | 0        | 0.2      |
| Goa                         | 0      | 1.9    | 6.2      | 0        |
| Gujarat                     | 19.7   | 21.5   | 11.1     | 11.3     |
| Haryana                     | 2.9    | 0.3    | 0.7      | 3.4      |
| HimachalPradesh             | 0.6    | 4.3    | 0.8      | 0.7      |
| Jammu & Kashmir             | 0      | 0      | 0        | 0        |
| Jharkhand                   | 2.4    | 17.5   | 5.8      | 1.4      |
| Karnataka                   | 1.9    | 0.3    | 4.2      | 2        |
| Kerala                      | 4      | 2.1    | 6.6      | 2.9      |
| Madhya Pradesh              | 3.9    | 5.7    | 0.3      | 1.6      |
| Maharashtra                 | 5.4    | 5      | 0.6      | 1.3      |
| Manipur                     | 0      | 0      | 0        | 0        |
| Meghalaya                   | 1.2    | 12.2   | 0        | 0.2      |
| Mizoram                     | 0      | 0      | 0        | 0        |
| Nagaland                    | 0      | 0.8    | 0        | 0        |
| Odisha                      | 1.3    | 2.6    | 2.2      | 0.4      |
| Punjab                      | 0      | 0      | 0        | 0        |
| Rajasthan                   | 1.7    | 1.7    | 7.6      | 0.5      |
| Sikkim                      | 0      | 0      | 0        | 0        |
| Tamil Nadu                  | 5.1    | 2.3    | 1.5      | 2.3      |
| Telangana                   | 0.7    | 0      | 0        | 0        |
| Tripura                     | 0      | 0.5    | 0        | 0        |
| Uttar Pradesh               | 5.2    | 1.7    | 1.1      | 1.6      |
| Uttarakhand                 | 1.8    | 1.8    | 0        | 0        |
| West Bengal                 | 5.1    | 6.5    | 1.7      | 4.2      |
| A ndaman & N icobar Islands | 4.7    | 5.8    | 14.8     | 1.7      |
| Chandigarh                  | 0.5    | 0.3    | 0        | 0        |
| Dadra & NagarHaveli         | 10.3   | 17.3   | 0        | 0.3      |
| Daman & Diu                 | 0      | 0      | 0        | 0        |
| Lakshadweep                 | 0      | 0      | 6.6      | 16.4     |
| Puducherry                  | 0      | 0      | 0        | 0        |
| all                         | 4.1    | 4      | 2.8      | 2.5      |