Lok Sabha Question No. 3198 (UNSTARRED), answered on 2019-12-06
Subject: Roadmap to improve Health System
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Adala Prabhakara Reddy, Rakesh Singh

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

## LOK SABHA UNSTARRED QUESTION NO. 3198 TO BE ANSWERED ON 6 TH DECEMBER, 2019

## ROADMAP TO IMPROVE H EALTH SYSTEM

## 3198. SHRI ADALA PRABHAKARA REDDY: SHRI RAKESH SINGH:

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

- (a) whether the Government has taken note of the fact that there is a shortage of hospital and doctors in the country and half of the population of the country is not cover ed  under  any public healthcare scheme, if so, the details thereof and the reasons therefor;
- (b) whether the NITI Aayog has prepared a report 'Health System for a New India: Building Blocks - Potential Pathways to Reform', to build a health system in the medium to long - term forthose belonging to middle class, if so, the details thereof;

(c) whether the middle class has to p y f r this healthcare delivery system and if so, the details thereof; and

(d) the details of the roadmap outlined to improve the co untry's health system along with the timeframe set to achieve the same?

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

## (SHRI ASHWINI KUMAR CHOUBEY)

(a): Public  Health  and  Hospitals  being  a  State  subject,  the  primary  responsibil ity  of provision of public healthcare and strengthening it to address the shortage of hospit doctors  lies  with  the  respective  State/  UT  Government.  However,  under  National  Heal Mission (NHM), technical and financial support is provided to States/U Ts for strengthening their  healthcare  systems  on  the  basis  of  proposals  received  from  States/  UTs  in Programme Implementation Plans (PIPs).

Also,  Shortage  of  doctors  in  public  health  facilities  varies  from  State  to depending  upon  their  policies  and  context.  However,  As  per  the  Rural  Health  Statis (RHS)  2017- 18,  the  state - wise  details  of  shortfall  of  public  healthcare  facilities  viz, Sub Health  Centres  (SHCs),  Primary  Health  Centres  (PHCs)  &  Community  Health  Centres (CHCs), availability of Sub District Hospitals & District Hospitals and vacancy positi doctors at PHCs and CHCs are at Annexure -Ito Annexure -III.

As per information p rovided by Medical Council of India (MCI), there are a total 11,59,309 allopathic doctors registered with the Medical Council of India as on 31 st March, 2019.  Assuming  80%  availability,  it  is  estimated  that  around  9.27  lakh  doctors  may actually  availabl e  for  active  service.  It  gives  a  doctor - population  ratio  of  1:1456  as  per current population estimate of 1.35 billion, which is lower than the WHO norm of 1:10

Besides, there are 7.88 lakh Ayurveda, Unani and Homeopathy (AUH) doctors in the country. As suming 80% availability, it is estimated that around 6.30 lakh Ayurveda, Una and  Homeopathy  (AUH)  doctors  may  be  actually  available  for  service  and  considered together with allopathic doctors, it gives a doctor population ratio of 1:867.

(b): NITI Aayog has released the report on 'Health Systems for a New India: Building BlocksPotential  Pathways  to  Reforms'. The report consolidates global findings on key health system themes of financing and provisioning with a focus on risk pooling, str purchas ing, and health service provisioning and digital health. With insights to transf Indian health system in the 21st Century, the report presents a preliminary menu of st choices  available  before  India  to  reform  its  healthcare  system.  The  detail ed  report  is available in public domain at https://niti.gov.in/node/916 .

- (c): Under NHM, financial support is provided to Public healthcare facilities in pri and secondary health sector in the States/ UTs to provide majority of services free of all those visiting the facilities including middle class. Further, Ayushman B harat, Pradhan Mantri Jan Arogya Yojana (AB - PMJAY) scheme provides health coverage up to Rs. 5.00 lakh per family per year to around 10.74 crore poor and vulnerable families as per Economic Caste Census (SECC).

(d): National  Health  Policy,  2017  outl ines  the  priorities  and  targets  along  with  time frames to achieve it in healthcare systems. The detailed NHP, 2017 is available in domain at https://www.nhp.gov.in//NHP files/national\_health\_policy\_2017.pdf .

## Annexure-I

|       |                   | SHORTFALL IN HEALTH FACILITIES AS   | SHORTFALL IN HEALTH FACILITIES AS   | SHORTFALL IN HEALTH FACILITIES AS   | SHORTFALL IN HEALTH FACILITIES AS   | PER 2011 POPULATION IN INDIA (As on 31st March, 2018)   | PER 2011 POPULATION IN INDIA (As on 31st March, 2018)   | PER 2011 POPULATION IN INDIA (As on 31st March, 2018)   | PER 2011 POPULATION IN INDIA (As on 31st March, 2018)   | PER 2011 POPULATION IN INDIA (As on 31st March, 2018)   | PER 2011 POPULATION IN INDIA (As on 31st March, 2018)   | PER 2011 POPULATION IN INDIA (As on 31st March, 2018)   | PER 2011 POPULATION IN INDIA (As on 31st March, 2018)   |
|-------|-------------------|-------------------------------------|-------------------------------------|-------------------------------------|-------------------------------------|---------------------------------------------------------|---------------------------------------------------------|---------------------------------------------------------|---------------------------------------------------------|---------------------------------------------------------|---------------------------------------------------------|---------------------------------------------------------|---------------------------------------------------------|
| S.No. | State/ UT         | Sub Centres                         | Sub Centres                         | Sub Centres                         | Sub Centres                         | PHCs                                                    | PHCs                                                    | PHCs                                                    | PHCs                                                    | CHCs                                                    | CHCs                                                    | CHCs                                                    | CHCs                                                    |
| S.No. | State/ UT         | R                                   | P                                   | S                                   | % Shorfall                          | R                                                       | P                                                       | S                                                       | % Shorfall                                              | R                                                       | P                                                       | S                                                       | % Shorfall                                              |
| 1     | Andhra Pradesh    | 7261                                | 7458                                | *                                   | *                                   | 1197                                                    | 1147                                                    | 50                                                      | 4                                                       | 299                                                     | 193                                                     | 106                                                     | 35                                                      |
| 2     | Arunachal Pradesh | 318                                 | 312                                 | 6                                   | 2                                   | 48                                                      | 143                                                     | *                                                       | *                                                       | 12                                                      | 63                                                      | *                                                       | *                                                       |
| 3     | Assam             | 5850                                | 4644                                | 1206                                | 21                                  | 954                                                     | 946                                                     | 8                                                       | 1                                                       | 238                                                     | 172                                                     | 66                                                      | 28                                                      |
| 4     | Bihar             | 18637                               | 9949                                | 8688                                | 47                                  | 3099                                                    | 1899                                                    | 1200                                                    | 39                                                      | 774                                                     | 150                                                     | 624                                                     | 81                                                      |
| 5     | Chhattisgarh      | 4885                                | 5200                                | *                                   | *                                   | 774                                                     | 793                                                     | *                                                       | *                                                       | 193                                                     | 169                                                     | 24                                                      | 12                                                      |
| 6     | Goa               | 122                                 | 214                                 | *                                   | *                                   | 19                                                      | 25                                                      | *                                                       | *                                                       | 4                                                       | 4                                                       | 0                                                       | 0                                                       |
| 7     | Gujarat           | 8008                                | 9153                                | *                                   | *                                   | 1290                                                    | 1474                                                    | *                                                       | *                                                       | 322                                                     | 363                                                     | *                                                       | *                                                       |
| 8     | Haryana           | 3301                                | 2589                                | 712                                 | 22                                  | 550                                                     | 368                                                     | 182                                                     | 33                                                      | 137                                                     | 113                                                     | 24                                                      | 18                                                      |
| 9     | Himachal Pradesh  | 1285                                | 2084                                | *                                   | *                                   | 212                                                     | 576                                                     | *                                                       | *                                                       | 53                                                      | 91                                                      | *                                                       | *                                                       |
| 10    | Jammu & Kashmir   | 2009                                | 2967                                | *                                   | *                                   | 327                                                     | 637                                                     | *                                                       | *                                                       | 81                                                      | 84                                                      | *                                                       | *                                                       |
| 11    | Jharkhand         | 6060                                | 3848                                | 2212                                | 37                                  | 966                                                     | 298                                                     | 668                                                     | 69                                                      | 241                                                     | 171                                                     | 70                                                      | 29                                                      |
| 12    | Karnataka         | 7951                                | 9443                                | *                                   | *                                   | 1306                                                    | 2359                                                    | *                                                       | *                                                       | 326                                                     | 206                                                     | 120                                                     | 37                                                      |
| 13    | Kerala            | 3551                                | 5380                                | *                                   | *                                   | 589                                                     | 849                                                     | *                                                       | *                                                       | 147                                                     | 227                                                     | *                                                       | *                                                       |
| 14    | Madhya Pradesh    | 12415                               | 11192                               | 1223                                | 10                                  | 1989                                                    | 1171                                                    | 818                                                     | 41                                                      | 497                                                     | 309                                                     | 188                                                     | 38                                                      |
| 15    | Maharashtra       | 13512                               | 10638                               | 2874                                | 21                                  | 2201                                                    | 1823                                                    | 378                                                     | 17                                                      | 550                                                     | 361                                                     | 189                                                     | 34                                                      |
| 16    | Manipur           | 509                                 | 429                                 | 80                                  | 16                                  | 80                                                      | 91                                                      | *                                                       | *                                                       | 20                                                      | 23                                                      | *                                                       | *                                                       |
| 17    | Meghalaya         | 759                                 | 443                                 | 316                                 | 42                                  | 114                                                     | 108                                                     | 6                                                       | 5                                                       | 28                                                      | 28                                                      | 0                                                       | 0                                                       |
| 18    | Mizoram           | 172                                 | 370                                 | *                                   | *                                   | 25                                                      | 57                                                      | *                                                       | *                                                       | 6                                                       | 9                                                       | *                                                       | *                                                       |
| 19    | Nagaland          | 455                                 | 396                                 | 59                                  | 13                                  | 68                                                      | 126                                                     | *                                                       | *                                                       | 17                                                      | 21                                                      | *                                                       | *                                                       |
| 20    | Odisha            | 8193                                | 6688                                | 1505                                | 18                                  | 1315                                                    | 1288                                                    | 27                                                      | 2                                                       | 328                                                     | 377                                                     | *                                                       | *                                                       |
| 21    | Punjab            | 3468                                | 2950                                | 518                                 | 15                                  | 578                                                     | 432                                                     | 146                                                     | 25                                                      | 144                                                     | 151                                                     | *                                                       | *                                                       |
| 22    | Rajasthan         | 11459                               | 14405                               | *                                   | *                                   | 1861                                                    | 2078                                                    | *                                                       | *                                                       | 465                                                     | 588                                                     | *                                                       | *                                                       |
| 23    | Sikkim            | 113                                 | 147                                 | *                                   | *                                   | 18                                                      | 24                                                      | *                                                       | *                                                       | 4                                                       | 2                                                       | 2                                                       | 50                                                      |
| 24    | Tamil Nadu        | 7533                                | 8712                                | *                                   | *                                   | 1251                                                    | 1421                                                    | *                                                       | *                                                       | 312                                                     | 385                                                     | *                                                       | *                                                       |
| 25    | Telangana         | 4708                                | 4744                                | *                                   | *                                   | 768                                                     | 643                                                     | 125                                                     | 16                                                      | 192                                                     | 91                                                      | 101                                                     | 53                                                      |
| 26    | Tripura           | 691                                 | 1020                                | *                                   | *                                   | 109                                                     | 108                                                     | 1                                                       | 1                                                       | 27                                                      | 22                                                      | 5                                                       | 19                                                      |
| 27    | Uttarakhand       | 1442                                | 1847                                | *                                   | *                                   | 238                                                     | 257                                                     | *                                                       | *                                                       | 59                                                      | 67                                                      | *                                                       | *                                                       |

| 28   | Uttar Pradesh    |   31200 |   20521 | 10679   | 34   |   5194 |   3621 | 1573   | 30   |   1298 |   822 | 476   | 37   |
|------|------------------|---------|---------|---------|------|--------|--------|--------|------|--------|-------|-------|------|
| 29   | West Bengal      |   13083 |   10357 | 2726    | 21   |   2153 |    913 | 1240   | 58   |    538 |   348 | 190   | 35   |
| 30   | A & N Islands    |      50 |     123 | *       | *    |      8 |     22 | *      | *    |      2 |     4 | *     | *    |
| 31   | Chandigarh       |       5 |      17 | *       | *    |      0 |      0 | 0      | 0    |      0 |     0 | 0     | 0    |
| 32   | D & N Haveli     |      56 |      71 | *       | *    |      8 |      9 | *      | *    |      2 |     2 | 0     | 0    |
| 33   | Daman & Diu      |      13 |      26 | *       | *    |      2 |      4 | *      | *    |      0 |     2 | *     | *    |
| 34   | Delhi            |      83 |      12 | 71      | 86   |     13 |      5 | 8      | 62   |      3 |     0 | 3     | 100  |
| 35   | Lakshadweep      |       4 |      14 | *       | *    |      0 |      4 | *      | *    |      0 |     3 | *     | *    |
| 36   | Puducherry       |      79 |      54 | 25      | 32   |     13 |     24 | *      | *    |      3 |     3 | 0     | 0    |
|      | All India/ Total |  179240 |  158417 | 32900   | 18   |  29337 |  25743 | 6430   | 22   |   7322 |  5624 | 2188  | 30   |

Notes: The requirement is calculated using the prescribed norms on the basis of rural population from Census, 2011 a shortfall is derived by adding state - wise figures of shortfall ignoring the existing surplus in some of the states.

R: Required; P: In Position; S: Shortfall;     *: Surplus

## Annexure - II

| NUMBER OF SUB DIVISIONAL HOSPITAL & DISTRICT HOSPITAL FUNCTIONING   | NUMBER OF SUB DIVISIONAL HOSPITAL & DISTRICT HOSPITAL FUNCTIONING   | NUMBER OF SUB DIVISIONAL HOSPITAL & DISTRICT HOSPITAL FUNCTIONING   | NUMBER OF SUB DIVISIONAL HOSPITAL & DISTRICT HOSPITAL FUNCTIONING   |
|---------------------------------------------------------------------|---------------------------------------------------------------------|---------------------------------------------------------------------|---------------------------------------------------------------------|
| S.                                                                  | State/UT                                                            | As on 31st March 2018                                               | As on 31st March 2018                                               |
| No.                                                                 |                                                                     | Sub Divisional Hospital                                             | District Hospital (DH)                                              |
| 1                                                                   | Andhra Pradesh                                                      | (SDH) 31                                                            | 8                                                                   |
| 2                                                                   | Arunachal                                                           | NA                                                                  | 18                                                                  |
| 3                                                                   | Pradesh Assam                                                       | 14                                                                  | 25                                                                  |
| 4                                                                   | Bihar                                                               | 55                                                                  | 36                                                                  |
| 5                                                                   | Chhattisgarh                                                        | 19                                                                  | 26                                                                  |
| 6                                                                   | Goa                                                                 | 2                                                                   | 2                                                                   |
| 7                                                                   | Gujarat                                                             | 37                                                                  | 22                                                                  |
| 8                                                                   | Haryana                                                             | 21                                                                  | 22                                                                  |
| 9                                                                   | Himachal Pradesh                                                    | 71                                                                  | 12                                                                  |
| 10                                                                  | Jammu &                                                             | NA                                                                  | 22                                                                  |
| 11                                                                  | Kashmir Jharkhand                                                   | 13                                                                  | 23                                                                  |
| 12                                                                  | Karnataka                                                           | 146                                                                 | 15                                                                  |
| 13                                                                  | Kerala                                                              | 81                                                                  | 18                                                                  |
| 14                                                                  | Madhya Pradesh                                                      | 66                                                                  | 51                                                                  |
| 15                                                                  | Maharashtra                                                         | 89                                                                  | 23                                                                  |
| 16                                                                  | Manipur                                                             | 1                                                                   | 8                                                                   |
| 17                                                                  | Meghalaya                                                           | 1                                                                   | 12                                                                  |
| 18                                                                  | Mizoram                                                             | 2                                                                   | 9                                                                   |
| 19                                                                  | Nagaland                                                            | NA                                                                  | 11                                                                  |
| 20                                                                  | Odisha                                                              | 33                                                                  | 32                                                                  |
| 21                                                                  | Punjab                                                              | 41                                                                  | 22                                                                  |
| 22                                                                  | Rajasthan                                                           | 19                                                                  | 27                                                                  |
| 23                                                                  | Sikkim                                                              | NA                                                                  | 4                                                                   |
| 24                                                                  | Tamil Nadu                                                          | 278                                                                 | 31                                                                  |
| 25                                                                  | Telangana                                                           | 31                                                                  | 6                                                                   |
| 26                                                                  | Tripura                                                             | 12                                                                  | 7                                                                   |
| 27                                                                  | Uttarakhand                                                         | 18                                                                  | 18                                                                  |
| 28                                                                  | Uttar Pradesh                                                       | NA                                                                  | 171                                                                 |
| 29                                                                  | West Bengal                                                         | 36                                                                  | 23                                                                  |
| 30                                                                  | A & N Islands                                                       | NA                                                                  | 3                                                                   |
| 31                                                                  | Chandigarh                                                          | 1                                                                   | 1                                                                   |
| 32                                                                  | Dadra & Nagar                                                       | 1                                                                   | 1                                                                   |
| 33                                                                  | Haveli Daman & Diu                                                  | NA                                                                  | 2                                                                   |
| 34                                                                  | Delhi                                                               | 9                                                                   | 47                                                                  |
| 35                                                                  | Lakshadweep                                                         | 2                                                                   | 1                                                                   |
| 36                                                                  | Puducherry                                                          | NA                                                                  | 5                                                                   |
|                                                                     | All India/ Total                                                    | 1130                                                                | 764                                                                 |

Note:

NA Not Applicable

| VACANCY POSITION AT A GLANCE (Number of posts vacant against sanctioned)   | VACANCY POSITION AT A GLANCE (Number of posts vacant against sanctioned)   | VACANCY POSITION AT A GLANCE (Number of posts vacant against sanctioned)   | VACANCY POSITION AT A GLANCE (Number of posts vacant against sanctioned)   |
|----------------------------------------------------------------------------|----------------------------------------------------------------------------|----------------------------------------------------------------------------|----------------------------------------------------------------------------|
| S. No                                                                      | State/UT                                                                   | Medical Officer [PHC]                                                      | Specialists [CHC]                                                          |
| 1                                                                          | Andhra Pradesh                                                             | 222                                                                        | 149                                                                        |
| 2                                                                          | Arunachal Pradesh                                                          | NA                                                                         | NA                                                                         |
| 3                                                                          | Assam                                                                      | NA                                                                         | NA                                                                         |
| 4                                                                          | Bihar                                                                      | 292                                                                        | NA                                                                         |
| 5                                                                          | Chhattisgarh                                                               | 434                                                                        | 595                                                                        |
| 6                                                                          | Goa                                                                        | *                                                                          | *                                                                          |
| 7                                                                          | Gujarat                                                                    | 544                                                                        | 1059                                                                       |
| 8                                                                          | Haryana                                                                    | 60                                                                         | 42                                                                         |
| 9                                                                          | Himachal Pradesh                                                           | 14                                                                         | NA                                                                         |
| 10                                                                         | Jammu & Kashmir                                                            | 653                                                                        | 88                                                                         |
| 11                                                                         | Jharkhand                                                                  | 216                                                                        | 592                                                                        |
| 12                                                                         | Karnataka                                                                  | 223                                                                        | 326                                                                        |
| 13                                                                         | Kerala                                                                     | *                                                                          | *                                                                          |
| 14                                                                         | Madhya Pradesh                                                             | 659                                                                        | 988                                                                        |
| 15                                                                         | Maharashtra                                                                | 80                                                                         | 338                                                                        |
| 16                                                                         | Manipur                                                                    | 44                                                                         | 1                                                                          |
| 17                                                                         | Meghalaya                                                                  | *                                                                          | *                                                                          |
| 18                                                                         | Mizoram                                                                    | 93                                                                         | 33                                                                         |
| 19                                                                         | Nagaland                                                                   | *                                                                          | NA                                                                         |
| 20                                                                         | Odisha                                                                     | 409                                                                        | 1276                                                                       |
| 21                                                                         | Punjab                                                                     | 113                                                                        | 488                                                                        |
| 22                                                                         | Rajasthan                                                                  | 355                                                                        | 1166                                                                       |
| 23                                                                         | Sikkim                                                                     | NA                                                                         | NA                                                                         |
| 24                                                                         | Tamil Nadu                                                                 | 356                                                                        | NA                                                                         |
| 25                                                                         | Telangana                                                                  | 188                                                                        | 208                                                                        |
| 26                                                                         | Tripura                                                                    | *                                                                          | *                                                                          |
| 27                                                                         | Uttarakhand                                                                | 184                                                                        | 239                                                                        |
| 28                                                                         | Uttar Pradesh                                                              | 3165                                                                       | 1907                                                                       |
| 29                                                                         | West Bengal                                                                | 252                                                                        | 544                                                                        |
| 30                                                                         | A& N Islands                                                               | 8                                                                          | 9                                                                          |
| 31                                                                         | Chandigarh                                                                 | 0                                                                          | 0                                                                          |
| 32                                                                         | D & N Haveli                                                               | 7                                                                          | 0                                                                          |
| 33                                                                         | Daman & Diu                                                                | 1                                                                          | 3                                                                          |
| 34                                                                         | Delhi                                                                      | *                                                                          | 0                                                                          |
| 35                                                                         | Lakshadweep                                                                | 0                                                                          | 0                                                                          |
| 36                                                                         | Puducherry                                                                 | *                                                                          | *                                                                          |
| All India/Total                                                            |                                                                            | 8572                                                                       | 10051                                                                      |

Note: * Surplus

Annexure - III