Lok Sabha Question No. 1969 (UNSTARRED), answered on 2021-07-30
Subject: Availability of doctors in rural areas
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Jadon Chandra Sen, Jyotsna Charandas Mahant

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

## LOK SABHA UNSTARRED QUESTION NO.1969 TO BE ANSWERED ON THE 30 TH JULY, 2021

## 'AVAILABILITY OF DOCTORS IN RURAL AREAS'

1969:

DR. CHANDRA SEN JADON: SHRIMATI JYOTSNA CHARANDAS MAHANT:

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

- (a) whether  the  Government  is  contemplating  to  make  availability  of  doctors  of  all three  streams  of  medicines  to  look  after  the  health  of  rural  population and  if  so,  the details thereof;
- (b) whether  the  Government  proposes  to  make  such  an  arrangement  in  every State/UT and if so, the details thereof; and
- (c) whether the Government has conducted any survey to assess the diseases most prevalent in rural areas and if so, the details thereof and names of these diseases?

## ANSWER THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE (DR. BHARATI PRAVIN PAWAR)

(a) & (b): In order to address the healthcare challenges, particularly in rural areas, the National Rural Health Mission (NRHM) was launched in 2005 to supplement the efforts of the State/UT governments to provide accessible, affordable and quality healthcare to all  those  who  access  public  health  facilities  all  over  the  country,  including  ensuring availability of doctors and other human resources. Currently, NRHM is a sub-mission of National Health Mission (NHM).

Public Health and Hospitals being a State Subject, all the administrative and personnel matters, including support for outsourcing or engagement of doctors, para-medical staff and technicians on contractual  basis,  lies  with  the  respective  State/UT  Governments. However, under National Health Mission (NHM), Government of India provides financial and  technical  support  to  States/UTs  to  strengthen  their  healthcare  systems  including support  for  recruitment  of  doctors,  para-medical  staff  and  technicians on  contractual basis, based on the requirements posed by them in their Programme Implementation Plans (PIPs) within their overall resource envelope. Hence the primary responsibility to ensure availability of doctors of various streams of medicines in rural area, lies with the respective State/UT Governments.

The following steps have also been taken to increase the availability of doctors in rural, remote and difficult areas of the country:

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

(ii) Incentive at the rate of 10% of the marks obtained for each year in service in remote and/or difficult or rural areas as upto the maximum of 30% of the marks obtained in the entrance test for admissions in Post Graduate Medical Courses.

Under NHM, support is also provided to States/UTs for hard area allowance to specialist doctors for serving in rural and remote areas and for their residential quarters so that they  find  it  attractive  to  serve  in  public  health  facilities  in  such  areas. Support  for honorarium to Gynecologists/ Emergency Obstetric Care (EmoC) trained, Pediatricians & Anesthetist/ Life Saving Anaesthesia Skills (LSAS) trained doctors is also provided to increase availability of specialists for conducting Cesarean Sections in rural & remote area. The States are also encouraged to adopt flexible norms for engaging specialists at public  health  facilities.  These  include  various  mechanisms  for  'contacting  in'  and 'contracting out' of specialist services, empanelling private medical facilities to provide requisite Specialists and other methods of engaging specialists outside the government system for service delivery at public facilities and the mechanism to include requests for these  in  the  state  Program  Implementation  Plans  (PIP)  under  the  National  Health Mission.

The  Mainstreaming  of  AYUSH  is  one  of  the  core  strategies  in  National  Rural  Health Mission (NRHM), one of the component of National Health Mission (NHM) which seeks to provide accessible, affordable and quality health care to the rural population. Under National Health Mission (NHM), engagement of Ayurveda Yoga & Naturopathy, Unani,

Siddha and Homoeopathy (AYUSH) doctors/ paramedics is being supported, provided they  are  co-located  with  existing  District  Hospitals  (DHs),  Community  Health  Centres (CHCs)  and  Primary  Health  Centres  (PHCs)  with  priority  given  to  remote  PHCs  and CHCs.

As on March, 2021, over 27792 AYUSH doctors are supported at 15,340 functional colocated  facilities at  various  healthcare under  NHM and  the  details  are  placed  at Annexure-I & Annexure-II, respectively.

(c) The  Government  of  India  routinely  collects  facility  level  disease  surveillance information across levels of care i.e. Sub Health Centre (SHC), Primary Health Centre (PHC), Community Health Center (CHC) and higher levels in both rural and urban areas through  Integrated  Disease  Surveillance  Program  (IDSP).  Additionally,  under  NHM, disease  control  programs  are  routinely  collecting  disease  specific  information  and facility level data.

| Details of State/UT-wise AYUSH Doctors under NHM   | Details of State/UT-wise AYUSH Doctors under NHM   | Details of State/UT-wise AYUSH Doctors under NHM   |
|----------------------------------------------------|----------------------------------------------------|----------------------------------------------------|
| Sr. No.                                            | State/UT                                           | AYUSH Doctors                                      |
| 1                                                  | Bihar                                              | 2783                                               |
| 2                                                  | Chhattisgarh                                       | 557                                                |
| 3                                                  | Himachal Pradesh                                   | 243                                                |
| 4                                                  | Jammu & Kashmir                                    | 872                                                |
| 5                                                  | Jharkhand                                          | 559                                                |
| 6                                                  | Madhya Pradesh                                     | 1422                                               |
| 7                                                  | Orissa                                             | 2151                                               |
| 8                                                  | Rajasthan                                          | 1647                                               |
| 9                                                  | Uttar Pradesh                                      | 4097                                               |
| 10                                                 | Uttarakhand                                        | 366                                                |
| 11                                                 | Arunachal Pradesh                                  | 116                                                |
| 12                                                 | Assam                                              | 710                                                |
| 13                                                 | Manipur                                            | 177                                                |
| 14                                                 | Meghalaya                                          | 234                                                |
| 15                                                 | Mizoram                                            | 60                                                 |
| 16                                                 | Nagaland                                           | 51                                                 |
| 17                                                 | Sikkim                                             | 10                                                 |
| 18                                                 | Tripura                                            | 154                                                |
| 19                                                 | Andhra Pradesh                                     | 130                                                |
| 20                                                 | Goa                                                | 78                                                 |
| 21                                                 | Gujarat                                            | 2392                                               |
| 22                                                 | Haryana                                            | 616                                                |
| 23                                                 | Karnataka                                          | 1493                                               |
| 24                                                 | Kerala                                             | 742                                                |
| 25                                                 | Maharashtra                                        | 2344                                               |
| 26                                                 | Punjab                                             | 596                                                |
| 27                                                 | Tamil Nadu                                         | 418                                                |
| 28                                                 | Telangana                                          | 584                                                |
| 29                                                 | West Bengal                                        | 1987                                               |
| 30                                                 | A&N Island                                         | 33                                                 |
| 31                                                 | Chandigarh                                         | 29                                                 |
| 32                                                 | D&N Haveli/ Daman & Diu                            | 20                                                 |
| 33                                                 | Delhi                                              | 0                                                  |
| 34                                                 | Ladakh                                             | 19                                                 |
| 35                                                 | Lakshadweep                                        | 12                                                 |
| 36                                                 | Puducherry                                         | 90                                                 |
| All India Source: NHM-MIS                          | report as on March 2021                            | 27792                                              |

## Annexure-I

Annexure-II Details of State/UT wise AYUSH co-located Facilities at various healthcare under NHM

| Sr. No.        | State/UT                | DH             |   CHC |   Other than CHC or above district level |   PHC |   Other health facilities above SC but below block level |   Total |
|----------------|-------------------------|----------------|-------|------------------------------------------|-------|----------------------------------------------------------|---------|
| 1              | Bihar                   | 36             |     0 |                                        0 |     0 |                                                     1348 |    1384 |
| 2              | Chhattisgarh            | 18             |    98 |                                        0 |   454 |                                                        0 |     570 |
| 3              | Himachal Pradesh        | 1              |    32 |                                        0 |   101 |                                                        0 |     134 |
| 4              | Jammu & Kashmir         | 20             |    13 |                                        0 |   375 |                                                      571 |     979 |
| 5              | Jharkhand               | 24             |    48 |                                        0 |    97 |                                                      267 |     436 |
| 6              | Madhya Pradesh          | 36             |    88 |                                        0 |   305 |                                                        0 |     429 |
| 7              | Orissa                  | 3              |   314 |                                        0 |  1162 |                                                        0 |    1479 |
| 8              | Rajasthan               | 1              |   164 |                                        1 |   837 |                                                        0 |    1003 |
| 9              | Uttar Pradesh           | 102            |   666 |                                        0 |   627 |                                                      105 |    1500 |
| 10             | Uttarakhand             | 13             |    53 |                                        7 |    44 |                                                        0 |     117 |
| 11             | Arunachal Pradesh       | 0              |     0 |                                        0 |     0 |                                                        0 |       0 |
| 12             | Assam                   | 0              |     0 |                                        0 |     0 |                                                        0 |       0 |
| 13             | Manipur                 | 7              |    17 |                                        1 |    78 |                                                        0 |     103 |
| 14             | Meghalaya               | 11             |    23 |                                        0 |    55 |                                                        0 |      89 |
| 15             | Mizoram                 | 9              |     9 |                                        1 |     9 |                                                        0 |      28 |
| 16             | Nagaland                | 9              |    20 |                                        0 |     9 |                                                        0 |      38 |
| 17             | Sikkim                  | 4              |     1 |                                        0 |     4 |                                                        0 |       9 |
| 18             | Tripura                 | 3              |    21 |                                       11 |    84 |                                                        0 |     119 |
| 19             | Andhra Pradesh          | 9              |   105 |                                        0 |   273 |                                                        0 |     387 |
| 20             | Goa                     | 2              |     6 |                                        2 |    24 |                                                        1 |      35 |
| 21             | Gujarat                 | 0              |     0 |                                        0 |   886 |                                                        0 |     886 |
| 22             | Haryana                 | 21             |    97 |                                        0 |   109 |                                                        5 |     232 |
| 23             | Karnataka               | 14             |    70 |                                       96 |   395 |                                                        0 |     575 |
| 24             | Kerala                  | 0              |     0 |                                        0 |     0 |                                                        0 |       0 |
| 25             | Maharashtra             | 23             |   238 |                                        0 |    20 |                                                        0 |     281 |
| 26             | Punjab                  | 20             |    62 |                                       23 |   134 |                                                        0 |     239 |
| 27             | Tamil Nadu              | 31             |   385 |                                      232 |   537 |                                                        0 |    1185 |
| 28             | Telangana               | 8              |    46 |                                       42 |   479 |                                                      137 |     712 |
| 29             | West Bengal             | 16             |   213 |                                       39 |   222 |                                                     1561 |    2051 |
| 30             | A&N Island              | 3              |     4 |                                        0 |    20 |                                                        0 |      27 |
| 31             | Chandigarh              | 1              |     2 |                                        1 |     0 |                                                       26 |      30 |
| 32             | D&N Haveli/ Daman & Diu | 2              |     4 |                                        1 |    11 |                                                        1 |      19 |
| 33             | Delhi                   | 43             |     0 |                                        0 |   131 |                                                        0 |     174 |
| 34             | Ladakh                  | 2              |     0 |                                        0 |    32 |                                                        0 |      34 |
| 35             | Lakshadweep             | 1              |     3 |                                        0 |     4 |                                                        1 |       9 |
| Source:        | Puducherry as on        | 497 March 2021 |  2806 |                                      457 |    39 |                                                        0 |      47 |
| 36 All NHM-MIS | India report            | 4              |     4 |                                        0 |  7557 |                                                     4023 |   15340 |