Lok Sabha Question No. 2939 (UNSTARRED), answered on 2018-12-28
Subject: Shortage of Medical Professionals
Ministry: HEALTH AND FAMILY WELFARE
Asked by: KULAMANI SAMAL, POONAMBEN HEMATBHAI MAADAM

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

## LOK SABHA UNSTARRED QUESTION NO. 2939 TO BE ANSWERED ON 28 TH DECEMBER, 2018

## SHORTAGE OF MEDICAL PROFESSIONALS

## 2939. DR. KULAMANI SAMAL: SHRIMATI POONAMBEN MAADAM:

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

(a) whether there is huge gap in the doctor - patient ratio in the country, if so, the details of corrective measures taken by the Government to address the issue;

(b) t he details of necessary measures taken to fill up vacancies of doctors/para medics in Hospitals/PHC/CHC/dispensaries in the country;

(c) whether the Government has a plan of action to improve/support public healthcare system to bring down out - ofpocketprivate expenditure of the common man;

(d) whether the Government is considering to seek assistance of retired Government/private medical professionals/ para medics to meet the above shortage, if so, the details thereof; and

(e) the details of funds allo cated, disbursed and utilized for rural healthcare services during the last three years, State/ UT - wise?

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

(a): As per information provided by Medical Council of India (MCI), there are a total 11,15,835 allopathic doctors registered with the State Medical Councils/Medical Counc India as on 30 th June, 2018. Assuming 80% availability, it is estimated that around 8.93 l doctors  may  be  actually  avail able  for  active  service.  It  gives  a  doctor - population  ratio  of 1:1511 as per current population estimate of 1.35 billion, which is lower than the WHO of 1:1000. Besides, there are 7.63 lakh Ayurveda, Unani and Homeopathy (AUH) doctors i the  country. Assuming  80%  availability,  it  is  estimated  that  around  6.10  lakh  Ayurved Unani and Homeopathy (AUH) doctors may be actually available for service and considere together with allopathic doctors, it gives a doctor population ratio of 1:898.

The  Government  has  taken  various  steps  to  increase  availability  of  doctors  in country which include:

- I. The ratio of teachers to students has been revised from 1:1 to 1:2 for all M disciplines  and  1:1  to  1:3  in  subjects  of  Anaesthesiology,  Forensic  Medic Radiotherapy,  Medical  Oncology,  Surgical  Oncology  and  Psychiatry.  Further, teacher: student ratio in public funded Government Medical Colleges for Profes has been increased from 1:2 to 1:3 in all clinical subjects and for Asso. Prof. to 1:2 if the A sso. Prof. is a unit head. The same has also been extended to the pri medical colleges with certain conditions. This would result in increase in numb PG seats in the country.
- II. DNB  qualification  has  been  recognized  for  appointment  as  faculty  to  tak e  care  of shortage of faculty.
- III. Enhancement of maximum intake capacity at MBBS level from 150 to 250.
- IV. Relaxation in the norms of setting up of Medical College in terms of requiremen faculty, staff, bed strength and other infrastructure.
- V. Requirementof land for establishment of medical college in metropolitan cities notified under Article 243P(c) of the Constitution of India has been dispensed wi
- VI. Strengthening/upgradation  of  State  Government  Medical  Colleges  for  starting  ne PG courses/Increase of PG seats.
- VII. Establishment  of  New  Medical  Colleges  by  upgrading  district/referral  hospit preferably in underserved districts of the country.
- VIII. Strengthening/ upgradation of existing State Government/Central Medical Colleges to increase MBB S seats.

Government

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

(b) : Public health and hospitals being a State subject, the primary responsibility t l up vacancies  of  doctors  /  para  medics  in  public  health  facilities  lies  with  the Governments. However, under the National Health Mission (NHM), financial and technica support is provided to States/UTs to strengthen their healthcare systems inclu ding upport for engagement  of  doctors  on  contractual  basis,  based  on  the  requirements  posed  by States/UTs  in  their  Programme  Implementation  Plans  (PIPs)  within  their  overall  reso envelope.

(c) : Rashtriya  Swasthya  Bima  Yojana  (RSBY),  a  centrally sponsored  scheme,  is implemented  by  Ministry  of  Health  &  Family  Welfare  w.e.f.  01.04.2015.  This  scheme provides  health  insurance  coverage  to  Below  Poverty  Line  (BPL)  families  and  11  ot categories  of  Unorganized  Workers(UOWs)  namely  MGNREGA  Workers,  Cons truction Workers, Domestic workers, Sanitation Workers, Mine Workers, licensed Railway Porters Street Vendors, Beedi Workers, Ricks haw Pullers, Rag Pickers and Aut o/ T axi drivers. Each family enrolled in the scheme is entitled to hospitalization benefits of upto Rs. 30,000 per annum  in  Government  as  well  as  empanelled  private  hospitals.  One  of  the  objectives RSBY is to reduce out - of - pocket expenditure.

Senior  Citizen  Health  Insurance  Scheme ( SCHIS ) as  top  up  over  existing  RSBY scheme has been implemented from 01.04.2016 for senior citizens aged 60 years and abo SCHIS provides enhanced coverage of Rs. 30,000 per senior citizen in the family enro under RSBY. The State wise list of funds release d to State Governments for implementation of RSBY during the last three years is at Annexure -I.

Further,  Pradhan  Mantri  Jan  Arogya  Yojana  (PMJAY),  has  been  launched  on 23.09.2018 which provides benefit coverage of upto Rs. 5 lakh per annum per family f or secondary and tertiary care hospitalization to over 10 crore poor and vulnerable families .This scheme covers poor and vulnerable families based on deprivation and occupational crite per  Socio  Economic  Caste  Census  (SECC)  data.  PMJAY  provides  cash less  and  paperless access to services for the beneficiary at the point of service in any empanelled hospi India.

With the launch of PMJAY, RSBY and SCHIS schemes stand subsumed in it in the States where the PMJAY is being implemented. The details of State / UT wise release funds under PMJAY are at Annexure II.

(d): As  mentioned  at  (b)  above,  the  matter  comes  un der  the  purview  of  the  State Governments.

(e): The Details of funds released to the State / UTs under National Rural Health Mis (NRHM) for the last three years are at Annexure -III.

## ANNEXURE -I

| Sr. No.   | Name of State    | 2015- 16   |   2016- 17 |   2017- 18 |
|-----------|------------------|------------|------------|------------|
| 1         | Assam            | 23.24      |      54.72 |       0    |
| 2         | Bihar            | -          |       0    |       0    |
| 3         | Chhattisgarh     | 88.77      |     114.09 |     171.38 |
| 4         | Gujarat          | 74.24      |      22.34 |      15.07 |
| 5         | Haryana          | 4.67       |       0.6  |       0    |
| 6         | Himachal Pradesh | 13.90      |      12.3  |       6.15 |
| 7         | Jharkhand        | -          |       0    |       0    |
| 8         | Karnataka        | 94.99      |      45.89 |       7.39 |
| 9         | Kerala           | 112.37     |      73.29 |      77.53 |
| 10        | Madhya Pradesh   | 1.00       |       0    |       0    |
| 11        | Manipur          | 1.17       |       2.2  |       0    |
| 12        | Meghalaya        | 4.10       |       4.1  |       0    |
| 13        | Mizoram          | 9.43       |      14.13 |      12.96 |
| 14        | Nagaland         | -          |       0    |       4.87 |
| 15        | Odisha           | 59.55      |      31.7  |      55.75 |
| 16        | Puducherry       | 0.17       |       0    |       0    |
| 17        | Punjab           | 2.80       |       0    |       0    |
| 18        | Rajasthan        | 53.57      |       0    |       0    |
| 19        | Tripura          | 15.64      |      10.83 |       0.04 |
| 20        | Uttar Pradesh    | 11.91      |       0    |       0    |
| 21        | Uttarakhand      | 10.20      |       0    |       9.15 |
| 22        | West Bengal      | 93.38      |      50.47 |      95.01 |
|           | Grand Total      | 675.10     |     436.66 |     455.3  |

ANNEXURE -II

(In

| Sr. No.   | Name of State/UT        |   Amount released to States/UTs Crore) (As on 10.12.2018) |
|-----------|-------------------------|-----------------------------------------------------------|
| 1         | Chhattisgarh            |                                                    114.44 |
| 2         | Uttar Pradesh           |                                                     32.71 |
| 3         | Himachal Pradesh        |                                                   7018    |
| 4         | Manipur                 |                                                      7.18 |
| 5         | Tripura                 |                                                     12.81 |
| 6         | Mizoram                 |                                                      5.05 |
| 7         | Bihar                   |                                                    188.27 |
| 8         | Jharkhand               |                                                     48.48 |
| 9         | Gujarat                 |                                                     77.5  |
| 10        | West Bengal             |                                                    193.35 |
| 11        | Haryana                 |                                                     26.81 |
| 12        | Madhya Pradesh          |                                                     27.57 |
| 13        | Dadra & Nagar Haveli    |                                                      0.94 |
| 14        | Daman & Diu             |                                                      0.29 |
| 15        | Tamil Nadu              |                                                     11.66 |
| 16        | Sikkim                  |                                                      1.03 |
| 17        | Maharashtra             |                                                     12.55 |
| 18        | Nagaland                |                                                      4.72 |
| 19        | Assam                   |                                                     21.08 |
| 20        | Jammu and Kashmir       |                                                     20.64 |
| 21        | Arunachal Pradesh       |                                                      2.31 |
| 22        | Lakshadweep             |                                                      0    |
| 23        | Chandigarh              |                                                      0.18 |
| 24        | Puducherry              |                                                      0.16 |
| 25        | Goa                     |                                                      0.64 |
| 26        | Andaman Nicobar Islands |                                                      0.05 |
| 27        | Uttarakhand             |                                                      0.12 |
| Total     | Total                   |                                                    817.73 |

## ANNEXURE -III

StatementShowing State - wise Allocation, Release and Expenditure under NRHM for the F.Y. 2015 -16 to 2017 - 18

Rs. in crore

| Sl. No.   | Name of the States/UTs   | 2015-16   | 2015-16   | 2016-17   | 2016-17   | 2017-18   | 2017-18   |
|-----------|--------------------------|-----------|-----------|-----------|-----------|-----------|-----------|
| Sl. No.   | Name of the States/UTs   | Release   | Exp       | Release   | Exp       | Release   | Exp       |
| 1         | Andaman & Nicobar        | 37.55     | 25.83     | 44.90     | 28.51     | 33.94     | 32.48     |
| 2         | Andhra Pradesh           | 615.90    | 1,072.78  | 585.58    | 1,223.42  | 832.96    | 1,438.78  |
| 3         | Arunachal Pradesh        | 163.80    | 146.57    | 159.50    | 163.54    | 258.83    | 163.04    |
| 4         | Assam                    | 997.59    | 1,200.73  | 1,033.63  | 1,322.02  | 1,374.95  | 1,458.14  |
| 5         | Bihar                    | 1,253.53  | 1,726.92  | 1,040.59  | 1,610.81  | 1,557.40  | 1,808.01  |
| 6         | Chandigarh               | 17.53     | 16.62     | 19.98     | 19.00     | 15.53     | 25.47     |
| 7         | Chattisgarh              | 409.32    | 750.03    | 568.42    | 967.47    | 812.44    | 1,144.16  |
| 8         | Dadra & Nagar Haveli     | 14.24     | 15.31     | 16.99     | 16.87     | 18.25     | 19.39     |
| 9         | Daman & Diu              | 10.55     | 10.14     | 11.35     | 10.22     | 10.67     | 10.54     |
| 10        | Delhi                    | 122.53    | 105.00    | 195.88    | 121.12    | 204.35    | 204.34    |
| 11        | Goa                      | 17.30     | 24.62     | 25.64     | 36.41     | 25.68     | 42.00     |
| 12        | Gujarat                  | 665.41    | 1,198.44  | 820.35    | 1,295.88  | 1,104.79  | 1,491.18  |
| 13        | Haryana                  | 294.18    | 482.76    | 314.30    | 506.75    | 337.16    | 602.93    |
| 14        | Himachal Pradesh         | 248.33    | 283.67    | 212.13    | 345.52    | 370.60    | 376.86    |
| 15        | Jammu & Kashmir          | 364.12    | 419.05    | 362.42    | 404.34    | 545.65    | 514.04    |
| 16        | Jharkhand                | 410.92    | 597.12    | 454.64    | 629.58    | 735.99    | 744.53    |
| 17        | Karnataka                | 772.15    | 1,145.49  | 689.29    | 1,192.38  | 1,263.51  | 1,913.09  |
| 18        | Kerala                   | 288.69    | 618.65    | 434.68    | 709.25    | 572.41    | 899.94    |
| 19        | Lakshadweep              | 5.72      | 2.75      | 3.83      | 4.33      | 5.54      | 6.20      |
| 20        | Madhya Pradesh           | 1,092.97  | 2,036.16  | 1,490.75  | 2,035.74  | 1,696.56  | 2,282.87  |
| 21        | Maharashtra              | 1,142.64  | 1,729.61  | 1,181.52  | 1,722.74  | 1,650.92  | 2,081.85  |
| 22        | Manipur                  | 115.19    | 107.19    | 77.13     | 80.70     | 161.65    | 109.96    |
| 23        | Meghalaya                | 107.50    | 134.64    | 158.45    | 148.92    | 185.17    | 163.58    |
| 24        | Mizoram                  | 91.06     | 92.90     | 76.33     | 98.54     | 122.58    | 108.40    |
| 25        | Nagaland                 | 102.30    | 80.88     | 91.47     | 92.46     | 132.94    | 91.40     |
| 26        | Orissa                   | 645.18    | 1,179.59  | 711.07    | 1,232.88  | 1,176.64  | 1,441.63  |
| 27        | Puducherry               | 17.54     | 20.32     | 41.16     | 35.48     | 32.91     | 35.57     |
| 28        | Punjab                   | 289.08    | 606.04    | 271.36    | 639.42    | 468.52    | 605.95    |
| 29        | Rajasthan                | 1,280.78  | 1,769.92  | 1,218.03  | 1,636.74  | 1,615.29  | 1,807.21  |
| 30        | Sikkim                   | 41.54     | 50.68     | 40.78     | 50.15     | 54.72     | 42.89     |
| 31        | Tamil Nadu               | 998.32    | 1,496.93  | 749.14    | 1,729.71  | 1,278.53  | 2,143.28  |
| 32        | Tripura                  | 136.94    | 120.57    | 121.27    | 141.91    | 155.89    | 200.56    |
| 33        | Uttar Pradesh            | 2,892.77  | 4,417.65  | 3,269.48  | 4,968.91  | 3,913.26  | 6,387.94  |
| 34        | Uttarakhand              | 277.66    | 332.21    | 259.04    | 342.07    | 351.35    | 443.51    |
| 35        | West Bengal              | 1,000.58  | 1,552.93  | 806.98    | 1,805.20  | 1,250.35  | 2,183.84  |
| 36        | Telangana                | 399.08    | 509.64    | 375.00    | 635.83    | 468.34    | 917.43    |
|           | Sub Total                | 17,340.50 | 26,080.34 | 17,933.06 | 28,004.80 | 24,796.26 | 33,943.01 |

Note:

1. The above releases relate to Central Govt. Grants & do not include State share contribution.
2. Expenditure includes expenditure against Central Release, State release & unspent balances at the beginning of the year.