Lok Sabha Question No. 2281 (UNSTARRED), answered on 2021-12-10
Subject: Shortage of Doctors and Medical Equipments in Health Centres
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Uday Pratap Singh

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

## LOKSABHA UNSTARRED QUESTION NO. 2281

## TO BE ANSWERED ON THE 10 th  DECEMBER, 2021

## SHORTAGE OF DOCTORS AND MEDICAL EQUIPMENTS IN HEALTH CENTRES

## 2281.  SHRI UDAY PRATAP SINGH:

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

- (a) the scheme of the Government to address the shortage of doctors and medical appliances/equipments  in  Government  health  centres  operational  across  the country, particularly in the rural areas;
- (b) whether  the  Government  has  earmarked  such  areas  in  the  State  of  Madhya Pradesh where there is acute shortage of doctors and medical facilities;
- (c) if so, the details thereof; and
- (d) if not, the reasons therefor?

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

(a) to (d) Public  Health  and  Hospitals  is  a  State  Subject,  hence  all  the  matters related  to  health  system  strengthening,  including  rural  areas,  lies  with  the  respective State/UT Governments. However under National Health Mission, Ministry of Health & Family Welfare provides financial and technical support to States/UTs including Madhya Pradesh  to  strengthen  their  healthcare  systems  including  support  for  recruitment  of doctors  and  medical  appliances/  equipments,  based  on  the  requirements  posed  by them  in  their  Programme  Implementation  Plans  (PIPs)  within  their  overall  resource envelope.

Under NHM, following types of incentives and honorarium are provided to staff for ensuring service delivery in rural and remote areas of the country:

-  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.
-  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.
-  Incentives like special incentives for doctors, incentive for ANM for ensuring timely ANC checkup and recording, incentives for conducting Adolescent Reproductive and Sexual Health activities.
-  States  are  also  allowed  to  offer  negotiable  salary  to  attract  specialist  including flexibility in strategies such as 'You Quote We Pay'.
-  Non-Monetary incentives such as preferential admission in post graduate courses for  staff  serving  in  difficult  areas  and  improving  accommodation  arrangement  in rural areas have also been introduced under NHM.
-  Multi-skilling  of  doctors  is  supported  under  NHM  to  overcome  the  shortage  of specialists. Skill upgradation of existing HR is another major strategy under NRHM for achieving improvement in health outcomes.

Further,  Government of India has taken various steps to strengthen the health care system.

Under  Ayushman  Bharat,  the  existing  Sub-health  Centres  (SHCs)  and  Primary Health  Centres  (PHCs)  are  being  transformed  into  AB-HWCs  to  deliver  twelve packages  of  Comprehensive  Primary  Health  Care  (CPHC)  that  includes  preventive, promotive,  curative,  palliative  and  rehabilitative  services  which  is  universal,  free  and close to the community.

Another  essential  component  of  Ayushman  Bharat  Health  & Wellness  Centres (AB-HWCs)  is  the  roll  out  of  tele-consultation  services  through  'eSanjeevani'.  This platform provides telemedicine services for the communities through a hub and spoke model which connects AB-HWCs (spokes) to District Hospitals/Medical colleges (Hubs) for  specialist  consultation  services.  Teleconsultation  services  are  aimed  at  improving access of specialist services to the communities, especially in the rural areas.

Further, PM Ayushman Bharat Health Infrastructure Mission (PM-ABHIM) with an outlay  of  Rs.  64,180  crores  till  2025-26  envisages  increased  investments  in  public health and other health reforms to provide better access to health infrastructure in rural areas by:

- o Strengthening of Health and Wellness Centres in villages and cities for early detection of diseases.
- o Addition of new critical care-related beds at district level hospitals.
- o Support for Block Public Health Units (BPHU) in 11 high focus States
- o Integrated district public health laboratories in all districts

As public health and hospital is a State Subject, the data for earmarking of areas of acute shortage of doctors and medical facilities is not done centrally.  However, the status of shortage of doctors and medical facilities as per Rural Health Statistics, 201920,  for  the  State  of  Madhya  Pradesh  are  placed  at Annexure-I and Annexure-II , respectively.

## Annexure-I

## The status of shortage of doctors as per the Rural Health Statistics (2019-20) for the State of Madhya Pradesh

| Doctors At District Hospital and Sub District/ Sub Divisional Hospital   | District Hospital   | District Hospital   | Sub District/ Sub Divisional Hospital   | Sub District/ Sub Divisional Hospital   |
|--------------------------------------------------------------------------|---------------------|---------------------|-----------------------------------------|-----------------------------------------|
| Doctors At District Hospital and Sub District/ Sub Divisional Hospital   | Sanctioned          | In Position         | Sanctioned                              | In Position                             |
|                                                                          | 1134                | 1186                | 470                                     | 395                                     |

| HR Type                                                                   | (As on 31st March, 2020)   | (As on 31st March, 2020)   | (As on 31st March, 2020)   | (As on 31st March, 2020)   | (As on 31st March, 2020)   |
|---------------------------------------------------------------------------|----------------------------|----------------------------|----------------------------|----------------------------|----------------------------|
| HR Type                                                                   | Required 1                 | Sanctioned                 | In Position                | Vacant                     | Shortfall                  |
| HR Type                                                                   | [R]                        | [S]                        | [P]                        | [S-P]                      | [R-P]                      |
| Doctors+ At Primary Health Centres in Rural Areas                         | 1199                       | 1525                       | 1065                       | 460                        | 134                        |
| AYUSH Specialist at Community Health Centres in Rural Areas               | 309                        | 309                        | 0                          | 309                        | 309                        |
| Surgeons at CHCs in Rural Areas                                           | 309                        | 324                        | 7                          | 317                        | 302                        |
| Obstetricians & Gynaecologists at CHCs in Rural Areas                     | 309                        | 324                        | 21                         | 303                        | 288                        |
| Physicians at CHCs in Rural Areas                                         | 309                        | 324                        | 7                          | 317                        | 302                        |
| Paediatricians at CHCs in Rural Areas                                     | 309                        | 60                         | 11                         | 49                         | 298                        |
| Total Specialists at CHCs in Rural Areas                                  | 1236                       | 1032                       | 46                         | 986                        | 1190                       |
| Anaesthetists at CHCs in Rural Areas                                      | NA                         | 60                         | 5                          | 55                         | NA                         |
| Eye Surgeons at CHCs in Rural Areas                                       | NA                         | 0                          | 0                          | 0                          | NA                         |
| General Duty Medical Officers (GDMOs) - Ayush at CHCs in Rural Areas      | NA                         | 309                        | 89                         | 220                        | NA                         |
| General Duty Medical Officers (GDMOs) - Allopathic at CHCs in Rural Areas | 618                        | 713                        | 609                        | 104                        | 9                          |
| Radiographers at CHCs in Rural Areas                                      | 309                        | 309                        | 183                        | 126                        | 126                        |

Annexure-II The  status  of  shortage  of  medical  facilities  as  per  the  Rural  Health  Statistics

(2019-20) for the State of Madhya Pradesh

|               | Shortfall In Health Facilities   | Shortfall In Health Facilities   | Shortfall In Health Facilities   | Shortfall In Health Facilities   |
|---------------|----------------------------------|----------------------------------|----------------------------------|----------------------------------|
| Facility Type | Required                         | In Position                      | Shortfall                        | %Shortfall                       |
| Sub Centres   | 14106                            | 10226                            | 3880                             | 28                               |
| PHCs          | 2260                             | 1199                             | 1061                             | 47                               |
| CHCs          | 565                              | 309                              | 256                              | 45                               |