Lok Sabha Question No. 1256 (UNSTARRED), answered on 2018-02-09
Subject: Availability of Specialist Doctors in CHCs
Ministry: HEALTH AND FAMILY WELFARE
Asked by: VINAYAK BHAURAO RAUT, SHRIKANT EKNATH SHINDE, PRITAM GOPINATH MUNDE, DHARMENDRA YADAV, Shrirang Appa Barne

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

## LOK SABHA UNSTARRED QUESTION NO. 1256 TO BE ANSWERED ON 9 TH FEBRUARY, 2018

## AVAILABILITY OF SPEC IALIST DOCTORS IN CHCS

## 1256. SHRI VINAYAK BHAURAO RAUT:

DR. SHRIKANT EKNATH SHINDE:

DR. PRITAM GOPINATH MUNDE:

SHRI DHARMENDRA YADAV:

SHRI SHRIRANG APPA BARNE:

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

- (a)  whether  India's elemental healthcare infrastructure seems to be in critical co ndition with a meager 19 per cent availability of specialist doctors in the Commu i y Health Centres (CHCs) across the country and if so, the details thereof;
- (b) whether the Government has made any study to find out the causes for this sh tfall and if so, the details thereof and the action taken by the Government in this regard;
- (c) whether the Government has issued any irections to the States to solve this issue and if so, State - wise details thereof and the action taken by the Government in this rega rd;
- (d) whether according to the Ministry and World Health Organisation (WHO) India has only seven doctors per 10000 people;
- (e) if so, whether a research had found that only 4.8 practising doctors was actually available per 10000 people in India in 2014 ;and
- (f) if so, the reaction of the Governm nt thereto along with the current status thereof?

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

- (a): Public health being a State subject, the primary responsibility to ensure availability of health human resources in public health facilities lies with the State Governments. However, Rural Health Statistics, 2016 - 17(as on 31 st March, 2017) brought out by the Ministry of Health and  Family  Welfare  b ased  on  the  information  provided  by  the  States/UTs,  there  were  4156 specialist  doctors  available  (in  position)  against  the  requirement  of  22496  in  the  Com Health Centres (CHCs) across the country. There was a shortfall of 81.6% specialist doct the Community Health Centres (CHCs). State/UT wise details are annexed.

Contd…….

- (b): The government has supported reviews and studies to explore the reasons for the shorta service providers in the public health system. These include -
- 1.Why Some Doctors Serve in Rural Areas: A Qualitative Assessment from Chhattisgarh State (NHSRC, PHFI and SHRC Chhattisgarh; 2009).
2. A review of existing regulatory mechanism to address the shortage of doctors in remote and underserved area: A stud y across five States in India (NHSRC; 2015).

To address this issue, the Ministry of Health and Family Welfare issued letter pro guidance to States on flexible norms for engaging specialists. These include various mech for having  contractual s ervices to engage specialists from outside the government system fo service delivery at public facilities and the mechanism to include requests for these in Program Implementation Plans (PIP) for their financial support.

- (c):  The  government  has taken  several  measures  to  improve  the  availability  of  specialists public facilities. These include:
1. Measures to increase the production of specialist doctors, such as (i) the number for post - graduate doctors at government medical colleges is b eing increased; (ii) States have been  encouraged  to  initiate  Diplomate  of  the  National  Board  (DNB)  and  the  College Physicians  and  Surgeons  (CPS)  courses  to  increase  the  production  of  specialists  and Government initiatives for up - skilling of MBBS d octors to provide Life Saving Anaesthetic Skills (LSAS) and Emergency Obstetric Care (EmOC) have been put in place.
2. The Ministry of Health and Family Welfare has issued letter providing guidance to s on flexible norms for engaging specialists, as ind icated above.
3. The National Health Mission (NHM) provides financial flexibility for the States to negotiable and competitive salaries in the recruitment of specialists.
4. Various  financial  and  non - financial  incentives  are  provided  in  States  under  NHM  to encourage  specialists  to  join  and  remain  within  the  public  health  system.  These  i innovations such as walk - in  interviews  to  reduce  delays  in  engaging  specialists;  prov iding them  an  extra  hardship  allowance  for  serving  in  remote,  rural  and  under - served  areas; accommodation  arrangements  or  a  housing  allowance;  facilitating  jobs  for  spouses children's  education;  insurance  facilities,  e.g.  medical  cover  and  support  for continuing medical  education,  attendance  at  conferences  and  workshops.  Some  examples  of  thes measures  include  Karnataka's  'Our  post,  your  quote'  initiative  where  specialists  can negotiate  and  bid  for  salaries  against  specialist  vacant  posts  and  the  Chhatt isgarh  Rural Medical Corps (CRMC) -where the state has offered an attractive package of financial non- financial  incentives  to  significantly  improve  the  availability  of  specialists  at situated in Left Wing Extremist affected areas.

Contd……

(d) to (f): There was 7.96 doctors per 10,000 populations according to a WHO report publishe in 2014. (The Health workforce in India, WHO; 2014).

Further, a study 'Aggregate availability of doctors in India: 2014 - 2030' conducted by the Foundation for Organizational Research and Education (FORE) and published in the Ind Journal of Public Health (2017) has estimated that there were 4.8 practicing doctors available per 10000 people in India in 2014. This was based on the Medical Council of India's historical data (1960- 2015).

However, as per the information provided by Medical Council of India, there was a 10,41,395 allopathic doctors regist ered with the State Medical Councils / Medical Council of India as on 30 th September, 2017. Assuming 80% availability, it is estimated that around 8. lakh  doctors  may  be  available  for  active  service,  which  gives  doctor - population  ratio  1:1597 whereas WHO prescribes a doctor population ratio of 1:1000.

………………

Annexure States/UTs -wise Specialists Doctors at Community Health Centres

| S. No.   |                                | (As on 31st March, 2017)   | (As on 31st March, 2017)   | (As on 31st March, 2017)   | (As on 31st March, 2017)   |
|----------|--------------------------------|----------------------------|----------------------------|----------------------------|----------------------------|
| S. No.   | State/UT                       | Required 1                 | Sanctioned                 | In Position                | Shortfall                  |
| 1        | Andhra Pradesh                 | 772                        | 533                        | 348                        | 424                        |
| 2        | Arunachal Pradesh              | 252                        | NA                         | 4                          | 248                        |
| 3        | Assam                          | 632                        | NA                         | 139                        | 493                        |
| 4        | Bihar                          | 600                        | NA                         | 82                         | 518                        |
| 5        | Chhattisgarh                   | 676                        | 620                        | 59                         | 617                        |
| 6        | Goa                            | 16                         | 5                          | 4                          | 12                         |
| 7        | Gujarat                        | 1452                       | 611                        | 92                         | 1360                       |
| 8        | Haryana                        | 448                        | 74                         | 16                         | 432                        |
| 9        | Himachal Pradesh               | 356                        | NA                         | 12                         | 344                        |
| 10       | Jammu & Kashmir                | 336                        | 344                        | 191                        | 145                        |
| 11       | Jharkhand                      | 752                        | 424                        | 75                         | 677                        |
| 12       | Karnataka                      | 824                        | 824                        | 498                        | 326                        |
| 13       | Kerala                         | 928                        | 30                         | 40                         | 888                        |
| 14       | Madhya Pradesh                 | 1236                       | 1236                       | 180                        | 1056                       |
| 15       | Maharashtra                    | 1440                       | 823                        | 508                        | 932                        |
| 16       | Manipur                        | 68                         | 4                          | 3                          | 65                         |
| 17       | Meghalaya                      | 108                        | 3                          | 13                         | 95                         |
| 18       | Mizoram                        | 36                         | 33                         | 0                          | 36                         |
| 19       | Nagaland                       | 84                         | NA                         | 8                          | 76                         |
| 20       | Odisha                         | 1480                       | 884                        | 318                        | 1162                       |
| 21       | Punjab                         | 604                        | 593                        | 203                        | 401                        |
| 22       | Rajasthan                      | 2316                       | 1593                       | 497                        | 1819                       |
| 23       | Sikkim                         | 8                          | NA                         | 1                          | 7                          |
| 24       | Tamil Nadu                     | 1540                       | NA                         | 78                         | 1462                       |
| 25       | Telangana                      | 456                        | 284                        | 125                        | 331                        |
| 26       | Tripura                        | 84                         | 0                          | 0                          | 84                         |
| 27       | Uttarakhand                    | 240                        | 200                        | 41                         | 199                        |
| 28       | Uttar Pradesh                  | 3288                       | 2099                       | 484                        | 2804                       |
| 29       | West Bengal                    | 1396                       | 669                        | 117                        | 1279                       |
| 30       | A& N Islands                   | 16                         | 9                          | 0                          | 16                         |
| 31       | Chandigarh                     | 8                          | 9                          | 15                         | *                          |
| 32       | D & N Haveli                   | 8                          | 0                          | 0                          | 8                          |
| 33       | Daman & Diu                    | 8                          | 2                          | 0                          | 8                          |
| 34       | Delhi                          | 0                          | 0                          | 0                          | 0                          |
| 35       | Lakshadweep                    | 12                         | 0                          | 0                          | 12                         |
| 36       | Puducherry All India 2 / Total | 16 22496                   | 4 11910                    | 5 4156                     | 11 18347                   |

Notes:

NA: Not Available. *: Surplus 1 Four ( Surgeon , O bstetrician & G ynaecologist, Physician & Paediatrician ) per Community Health Centre ;All India figures for  Shortfall are the totals of State - wise Shortfall ignoring surplus in some States / UTs ; 2 For calculating the overall percentages of shortfall, the States/UTs for which manpower positi is not available, are excluded .