Lok Sabha Question No. 751 (UNSTARRED), answered on 2018-12-14
Subject: Posting of Doctors in Rural Areas
Ministry: HEALTH AND FAMILY WELFARE
Asked by: K. ASHOK KUMAR

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

## LOK SABHA UNSTARRED QUESTION NO. 751 TO BE ANSWERED ON  14 TH DECEMBER, 2018

## POSTING OF DOCTORS I N RURAL AREAS

## 751. SHRI K. ASHOK KUMAR:

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

- (a) whether rural health statistics report shows a crippling shortage of specialists in Health Centres (CHCs), if so, the necessary steps taken in this regard;
- (b) whether th e Government has taken note of the fact that doctors are reluctant to take postings, if so, the details thereof; and
- (c) the number of specialists doctors posted in CHCs under National Rural Health Mission its launch?

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

- (a) : As per Rural Health Statistics (RHS) 2018, there is shortage of specialist in Comm Health Centres (CHCs). State/UT - wise specialist doctors and sho rtfall thereof is at Annexure -I .

Public health and hospitals being a State subject, the primary responsibility to ensure a of specialist doctors in public health facilities lies with the State/UT Governments. under  the  Nat ional  Health  Mission  (NHM),  financial  and  technical  support  is  provided States/UTs to strengthen their healthcare systems including support for insourci engagement of specialist doctors on contractual basis, based on the requirements posed States/UTs  in  their  Programme  Implementation  Plans  (PIPs)  within  their  overall  reso envelope.

The Government has taken various steps to increase number of doctors and Specialist the country. These steps include:

- (i) The ratio of teachers to stude nts has been revised from 1:1 to 1:2 for all MD/MS disciplines and  1:1  to  1:3  in  subjects  of  Anaesthesiology,  Forensic  Medicine,  Radiotherapy,  Med Oncology, Surgical Oncology and Psychiatry in all medical colleges across the country. Fu teacher: student  ratio  in  public  funded  Government  Medical  Colleges  for  Professor  has  be increased from 1:2 to 1:3 in all clinical subjects and for Associate Prof. from 1:1 to Associate  Prof.  is  a  unit  head.  This  would  result  in  increase  in  number  of  s pecialists  in  the country.

Contd…….

(ii) Diplomate of National Board (DNB) qualification has been recognized for appointment as faculty to take care of shortage of faculty.

(iii)  Enhancement  of  age  limit  for  appointment/  extension/  re - employment against  posts  of teachers/dean/principal/ director in medical colleges from 65 - 70 years.

(iv) relaxation in the norms of setting up of Medical College in terms of requirement f faculty, staff, bed/bed strength and other infrastructure.

(v)  Strength ening/upgradation  of  State  Government  Medical  Colleges  for  starting  new  PG courses/Increase of PG seats.

(vi) Establishment of New Medical Colleges by upgrading district/referral hospitals prefe underserved districts of the country.

(viii) Strengt hening of districts hospitals to run DNB/CPS courses.

(b) : Shortage of specialist doctors varies from State to State depending upon their polic context.

However, as stated above, public health and hospitals being a State subject, the p responsibility to ensure availability of specialist doctors in public health facilities State/UT Governments.

Support  is  provided  to  States/UTs  for  hard  area  allowance  to  specialist  doctor serving in rural and remote areas and for th eir residential quarters so that they find it attractiv serve in public health facilities in such areas.

Also, in order to encourage doctors to work in remote and difficult areas, the M Council  of  India,  with  the  previous  approval  of  Central  Gov ernment,  has  amended  the  Post Graduate Medical Education Regulations, 2000 to provide:

(i) 50% of the seats in Post Graduate Diploma Courses shall be reserved for Medical Offi in the Government service, who have served for at least three years in remote and difficult areas. After acquiring the PG Diploma, the Medical Officers shall serve for two more years in r and/or difficult areas; and

(ii) Incentive at the rate of 10% the marks obtained for each year in service in rem difficul t  areas  as  upto  the  maximum  of  30%  of  the  marks  obtained  in  the  entrance  test admissions in Post Graduate Medical Courses.

(c) : State/UT wise details of specialist doctors under NRHM, posted at CHCs on contract basis is at Annexure -II.

NA: Not Available.

1 Four per Community Health Centre as per IPHS norms

All India figures for Vacancy and Shortfall are the totals of State

*: Surplus.

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

- wise

## Annexure-I

| TOTAL SPECIALISTS AT CHCs Total Specialists [Surgeons, OB&GY, Physicians & Paediatricians]   | TOTAL SPECIALISTS AT CHCs Total Specialists [Surgeons, OB&GY, Physicians & Paediatricians]   | TOTAL SPECIALISTS AT CHCs Total Specialists [Surgeons, OB&GY, Physicians & Paediatricians]   | TOTAL SPECIALISTS AT CHCs Total Specialists [Surgeons, OB&GY, Physicians & Paediatricians]   | TOTAL SPECIALISTS AT CHCs Total Specialists [Surgeons, OB&GY, Physicians & Paediatricians]   | TOTAL SPECIALISTS AT CHCs Total Specialists [Surgeons, OB&GY, Physicians & Paediatricians]   | TOTAL SPECIALISTS AT CHCs Total Specialists [Surgeons, OB&GY, Physicians & Paediatricians]   |
|----------------------------------------------------------------------------------------------|----------------------------------------------------------------------------------------------|----------------------------------------------------------------------------------------------|----------------------------------------------------------------------------------------------|----------------------------------------------------------------------------------------------|----------------------------------------------------------------------------------------------|----------------------------------------------------------------------------------------------|
| S. No.                                                                                       | State/UT                                                                                     | Required 1                                                                                   | (As on Sanctioned                                                                            | 31st March, 2018) In Position                                                                | Vacant                                                                                       | Shortfall                                                                                    |
| 1                                                                                            | Andhra Pradesh                                                                               | [R] 772                                                                                      | [S] 533                                                                                      | [P] 384                                                                                      | [S-P] 149                                                                                    | [R-P] 388                                                                                    |
| 2                                                                                            | Arunachal Pradesh                                                                            | 252                                                                                          | NA                                                                                           | 4                                                                                            | NA                                                                                           | 248                                                                                          |
| 3                                                                                            | Assam                                                                                        | 688                                                                                          | NA                                                                                           | 158                                                                                          | NA                                                                                           | 530                                                                                          |
| 4                                                                                            | Bihar                                                                                        | 600                                                                                          | NA                                                                                           | 82                                                                                           | NA                                                                                           | 518                                                                                          |
| 5                                                                                            | Chhattisgarh                                                                                 | 676                                                                                          | 652                                                                                          | 57                                                                                           | 595                                                                                          | 619                                                                                          |
| 6                                                                                            | Goa                                                                                          | 16                                                                                           | 5                                                                                            | 10                                                                                           | *                                                                                            | 6                                                                                            |
| 7                                                                                            | Gujarat                                                                                      | 1452                                                                                         | 1177                                                                                         | 118                                                                                          | 1059                                                                                         | 1334                                                                                         |
| 8                                                                                            | Haryana                                                                                      | 452                                                                                          | 59                                                                                           | 17                                                                                           | 42                                                                                           | 435                                                                                          |
| 9                                                                                            | Himachal Pradesh                                                                             | 364                                                                                          | NA                                                                                           | 4                                                                                            | NA                                                                                           | 360                                                                                          |
| 10                                                                                           | Jammu & Kashmir                                                                              | 336                                                                                          | 344                                                                                          | 256                                                                                          | 88                                                                                           | 80                                                                                           |
| 11                                                                                           | Jharkhand                                                                                    | 684                                                                                          | 684                                                                                          | 92                                                                                           | 592                                                                                          | 592                                                                                          |
| 12                                                                                           | Karnataka                                                                                    | 824                                                                                          | 824                                                                                          | 498                                                                                          | 326                                                                                          | 326                                                                                          |
| 13                                                                                           | Kerala                                                                                       | 908                                                                                          | 30                                                                                           | 40                                                                                           | *                                                                                            | 868                                                                                          |
| 14                                                                                           | Madhya Pradesh                                                                               | 1236                                                                                         | 1236                                                                                         | 248                                                                                          | 988                                                                                          | 988                                                                                          |
| 15                                                                                           | Maharashtra                                                                                  | 1444                                                                                         | 823                                                                                          | 485                                                                                          | 338                                                                                          | 959                                                                                          |
| 16                                                                                           | Manipur                                                                                      | 92                                                                                           | 4                                                                                            | 3                                                                                            | 1                                                                                            | 89                                                                                           |
| 17                                                                                           | Meghalaya                                                                                    | 112                                                                                          | 3                                                                                            | 9                                                                                            | *                                                                                            | 103                                                                                          |
| 18                                                                                           | Mizoram                                                                                      | 36                                                                                           | 33                                                                                           | 0                                                                                            | 33                                                                                           | 36                                                                                           |
| 19                                                                                           | Nagaland                                                                                     | 84                                                                                           | NA                                                                                           | 8                                                                                            | NA                                                                                           | 76                                                                                           |
| 20                                                                                           | Odisha                                                                                       | 1508                                                                                         | 1529                                                                                         | 253                                                                                          | 1276                                                                                         | 1255                                                                                         |
| 21                                                                                           | Punjab                                                                                       | 604                                                                                          | 593                                                                                          | 105                                                                                          | 488                                                                                          | 499                                                                                          |
| 22                                                                                           | Rajasthan                                                                                    | 2352                                                                                         | 1731                                                                                         | 565                                                                                          | 1166                                                                                         | 1787                                                                                         |
| 23                                                                                           | Sikkim                                                                                       | 8                                                                                            | NA                                                                                           | 0                                                                                            | NA                                                                                           | 8                                                                                            |
| 24                                                                                           | Tamil Nadu                                                                                   | 1540                                                                                         | NA                                                                                           | 210                                                                                          | NA                                                                                           | 1330                                                                                         |
| 25                                                                                           | Telangana                                                                                    | 364                                                                                          | 320                                                                                          | 112                                                                                          | 208                                                                                          | 252                                                                                          |
| 26                                                                                           | Tripura                                                                                      | 88                                                                                           | 0                                                                                            | 2                                                                                            | *                                                                                            | 86                                                                                           |
| 27                                                                                           | Uttarakhand                                                                                  | 268                                                                                          | 268                                                                                          | 29                                                                                           | 239                                                                                          | 239                                                                                          |
| 28                                                                                           | Uttar Pradesh                                                                                | 3288                                                                                         | 2099                                                                                         | 192                                                                                          | 1907                                                                                         | 3096                                                                                         |
| 29                                                                                           | West Bengal                                                                                  | 1392                                                                                         | 669                                                                                          | 125                                                                                          | 544                                                                                          | 1267                                                                                         |
| 30                                                                                           | A& N Islands                                                                                 | 16                                                                                           | 9                                                                                            | 0                                                                                            | 9                                                                                            | 16                                                                                           |
| 31                                                                                           | Chandigarh                                                                                   | 0                                                                                            | 0                                                                                            | 0                                                                                            | 0                                                                                            | 0                                                                                            |
| 32                                                                                           | D & N Haveli                                                                                 | 8                                                                                            | 0                                                                                            | 0                                                                                            | 0                                                                                            | 8                                                                                            |
| 33                                                                                           |                                                                                              | 8                                                                                            | 6                                                                                            |                                                                                              | 0                                                                                            |                                                                                              |
|                                                                                              | Daman & Diu                                                                                  |                                                                                              |                                                                                              | 3                                                                                            | 3                                                                                            | 5                                                                                            |
| 34 35                                                                                        | Delhi Lakshadweep                                                                            | 0 12                                                                                         | 0 0                                                                                          | 0 0                                                                                          | 0                                                                                            | 0 12                                                                                         |

Notes:

Vacancy and Shortfall ignoring surplus in some States / UTs

Source: NHM-MIS report as on June 2018

Annexure-II

| Specialists (Contractual- In -position) at CHC level under NRHM   | Specialists (Contractual- In -position) at CHC level under NRHM   | Specialists (Contractual- In -position) at CHC level under NRHM   |
|-------------------------------------------------------------------|-------------------------------------------------------------------|-------------------------------------------------------------------|
| Sl. No.                                                           | States/UTs                                                        | Specialists at CHC level                                          |
| 1                                                                 | Bihar                                                             | 52                                                                |
| 2                                                                 | Chhattisgarh                                                      | 4                                                                 |
| 3                                                                 | Himachal Pradesh                                                  | 0                                                                 |
| 4                                                                 | Jammu & Kashmir                                                   | 22                                                                |
| 5                                                                 | Jharkhand                                                         | 25                                                                |
| 6                                                                 | Madhya Pradesh                                                    | 34                                                                |
| 7                                                                 | Odisha                                                            | 0                                                                 |
| 8                                                                 | Rajasthan                                                         | 11                                                                |
| 9                                                                 | Uttar Pradesh                                                     | 134                                                               |
| 10                                                                | Uttarakhand                                                       | 0                                                                 |
| 11                                                                | Arunachal Pradesh                                                 | 1                                                                 |
| 12                                                                | Assam                                                             | 90                                                                |
| 13                                                                | Manipur                                                           | 0                                                                 |
| 14                                                                | Meghalaya                                                         | 1                                                                 |
| 15                                                                | Mizoram                                                           | 0                                                                 |
| 16                                                                | Nagaland                                                          | 3                                                                 |
| 17                                                                | Sikkim                                                            | 0                                                                 |
| 18                                                                | Tripura                                                           | 0                                                                 |
| 19                                                                | Andhra Pradesh                                                    | 13                                                                |
| 20                                                                | Goa                                                               | 2                                                                 |
| 21                                                                | Gujarat                                                           | 35                                                                |
| 22                                                                | Haryana                                                           | 32                                                                |
| 23                                                                | Karnataka                                                         | 9                                                                 |
| 24                                                                | Kerala                                                            | 2                                                                 |
| 25                                                                | Maharashtra                                                       | 331                                                               |
| 26                                                                | Punjab                                                            | 73                                                                |
| 27                                                                | Tamil Nadu                                                        | 0                                                                 |
| 28                                                                | Telangana                                                         | 35                                                                |
| 29                                                                | West Bengal                                                       | 4                                                                 |
| 30                                                                | A & N Islands                                                     | 1                                                                 |
| 31                                                                | Chandigarh                                                        | 0                                                                 |
| 32                                                                | D & N Haveli                                                      | 4                                                                 |
| 33                                                                | Daman & Diu                                                       | 6                                                                 |
| 34                                                                | Delhi                                                             | 1                                                                 |
| 35                                                                | Lakshadweep                                                       | 0                                                                 |
| 36                                                                | Puducherry                                                        | 4                                                                 |
|                                                                   | Total                                                             | 929                                                               |