Lok Sabha Question No. 65 (STARRED), answered on 2024-07-26
Subject: Inadequate Medical Infrastructure
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Shri Magunta Sreenivasulu Reddy

## GOVERNMENT OFINDIA MINISTRY OF HEALTH AND FAMILY WELFARE DEPARTMENTOFHEALTH AND FAMILYWELFARE

## LOKSABHA STARRED QUESTION NO. 65 TO BE ANSWERED ON THE 26 TH JULY, 2024

## INADEQUATE MEDICALINFRASTRUCTURE

## *65 SHRI MAGUNTA SREENIVASULU REDDY:

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

- (a) whether there is shortage of hospitals, particularly in rural areas with many existing healthcare facilities lacking basic equipment and resources outside cities;
- (b) if so, the measures taken/proposed to be taken to improve the accessibility of healthcare in rural areas;
- (c) the details of hospital beds per 1000 population and the percentage of these beds in rural areas, State-wise;
- (d) whether the Government has taken note of the new notice issued by National Medical Commission regarding limiting the number of medical seats in the States; and
- (e) if so, the details of steps taken/proposed to be taken in this regard?

## ANSWER THE MINISTER OF HEALTH AND FAMILY WELFARE

## (SHRI JAGAT PRAKASH NADDA)

- (a) to (e) A Statement is laid on the Table of the House.

## STATEMENT REFERRED TO IN REPLY TO LOK SABHA STARRED QUESTION NO. 65 FOR 26 TH JULY, 2024

(a) & (b) The healthcare system of the country involves a three-tier system with Sub Health Centre (Rural), Primary Health Centre (Urban and Rural) and Community Health Centre (Urban and Rural) as the three pillars of Primary Health Care System in India.

The details of State/UT-wise number of Sub-Centres, Primary Health Centres (PHCs), Community Health Centres (CHCs), Sub-Divisional Hospital, District Hospital & Medical Colleges functioning in rural & urban areas is at Annexure-I & II .

The Government has increased number of medical colleges and subsequently increased MBBS seats. There is an increase of 88% in medical colleges from 387 before 2014 to 731 as of now. Further, there is an increase of 118% in MBBS seats from 51,348 before 2014 to 1,12,112 as of now, there is also an increase of 133% in PG seats from 31,185 before 2014 to 72,627 as of now.

As per Rural Health Statistics (RHS), 2021-22, there is a 3.6 % increase in the number of Sub-Health Centres (SHCs), 21% increase in the number of Primary Health Centres (PHCs) and 7.8 % increase in number of Community Health Centres (CHCs) as compared to RHS, 2016-17.

To provide quality comprehensive primary healthcare that is accessible, affordable and equitable, the Government has launched Ayushman Bharat Mission with four pillars, namely PM-Ayushman Bharat Health Infrastructure Mission (PM-ABHIM), Ayushman Arogya Mandir erstwhile Ayushman Bharat Health & Wellness Centres (AB-HWCs), Pradhan Mantri Jan Arogya Yojana (PMJAY) and Ayushman Bharat Digital Mission (ABDM).

Through Ayushman Arogya Mandir, comprehensive primary healthcare is provided by strengthening Sub Health Centres (SHCs) and Primary Health Centres (PHCs). These Ayushman Arogya Mandir (AAM) provide preventive, promotive, rehabilitative and curative care for an expanded range of services encompassing reproductive and child healthcare services, Communicable diseases, Non-communicable diseases and other health issues.

PM-ABHIM was launched to develop the capacities of primary, secondary, and tertiary healthcare systems, strengthen existing national institutions and create new institutions to cater to detection and cure of new and emerging diseases. PM-ABHIM is a Centrally Sponsored Scheme with some Central Sector Components. The scheme has an outlay of Rs. 64,180 crore till year 2025-26.

Ayushman Bharat Pradhan Mantri -Jan Arogya Yojana (AB PM-JAY) provides health cover of Rs. 5 lakhs per family per year for secondary and tertiary care hospitalization to approximately 55 Cr beneficiaries corresponding to 12.34 Crore families constituting the bottom 40% of India's population.

The Ayushman Bharat Digital Mission (ABDM) aims to develop the backbone necessary to support the integrated digital health infrastructure of the country. It will bridge the existing gap amongst different stakeholders of Healthcare ecosystem through digital highways.

The Government of India has taken several steps to provide healthcare facilities in rural areas which inter-alia includes Free Drugs and Free Diagnostics initiative to provide essential drugs and diagnostics free of cost in public health facilities.

Under NHM, the States are supported for augmenting the referral network in the country by Advanced Life Support (ALS), Basic Life Support (BLS) and Patient Transport Vehicle (PTV) ambulance system in both rural and urban areas. Support is also provided for Mobile Medical Units (MMUs) under NHM to improve healthcare affordability. MMUs conduct outreach activities to offer range of services in remote, difficult and hard to reach areas.

The recommendations of 15th Finance Commission (FC-XV) with respect to Health Grants through Local Governments with a total outlay of Rs 70,051 crore, addresses the gaps in Primary Healthcare facilities throughout the country.

In order to address the shortage of human resources (HR), following types of incentives and honorarium are provided for encouraging doctors and paramedics to practice in rural and remote areas of the country under NHM:

-  Hard area allowance to specialist doctors for serving in rural and remote areas and for their residential quarters.
-  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.
-  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 NHM for achieving improvement in health outcomes.

For fulfilling objective of providing exposure of District Health System to the Post Graduate (PG) students and to involve them in health care services at the District Hospital, the District Residency Programme (DRP) was mandated, under which, there is provision for compulsory three months posting cum training of PG medical students at District Hospitals as a part of the course curriculum.

(c) As per National Health Profile, 2022, State/UT-wise Number of Government Hospitals and Beds in Rural & Urban Areas in India are at Annexure-III .

(d) & (e) The ' Guidelines for Under Graduate Courses under Establishment of New Medical Institutions, Starting of New Medical Courses, Increase of Seats for Existing Courses & Assessment and Rating Regulations, 2023 ' issued by the National Medical Commission (NMC) on 16th August, 2023 have provision of the ratio of 100 MBBS seats for 10 lakh population in the State/UT. However, with a view to re-examine the said provision, NMC, vide Public Notice dated 15th November, 2023, has declared that ' OBJECTIVE ' clause under Chapter-1 of these Guidelines, which includes this provision, has been put on hold upto academic year 2025-26.

## Annexure-I

## NUMBER OFSUB-CENTRES, PHCs, CHCs FUNCTIONING IN RURAL& URBAN AREAS

|        |                   | (As on 31st March 2022)   | (As on 31st March 2022)   | (As on 31st March 2022)   | (As on 31st March 2022)   | (As on 31st March 2022)   | (As on 31st March 2022)   |
|--------|-------------------|---------------------------|---------------------------|---------------------------|---------------------------|---------------------------|---------------------------|
| S. No. | State/UT          | Sub Centers               | Sub Centers               | PHCs                      | PHCs                      | CHCs                      | CHCs                      |
|        |                   | Rural                     | Urban                     | Rural                     | Urban                     | Rural                     | Urban                     |
| 1      | Andhra Pradesh    | 11073                     | 407                       | 1142                      | 547                       | 139                       | 42                        |
| 2      | Arunachal Pradesh | 355                       | 12                        | 126                       | 5                         | 57                        | 0                         |
| 3      | Assam             | 4667                      | 34                        | 920                       | 90                        | 172                       | 29                        |
| 4      | Bihar             | 9375                      | 1024                      | 1492                      | 268                       | 269                       | 32                        |
| 5      | Chhattisgarh      | 5124                      | 370                       | 770                       | 52                        | 167                       | 3                         |
| 6      | Goa               | 219                       | 0                         | 24                        | 4                         | 6                         | 0                         |
| 7      | Gujarat           | 9132                      | 0                         | 1474                      | 330                       | 344                       | 17                        |
| 8      | Haryana           | 2653                      | 0                         | 394                       | 103                       | 129                       | 2                         |
| 9      | Himachal Pradesh  | 2114                      | 1                         | 553                       | 17                        | 93                        | 4                         |
| 10     | Jharkhand         | 3848                      | 0                         | 291                       | 70                        | 171                       | 7                         |
| 11     | Karnataka         | 8757                      | 515                       | 2138                      | 383                       | 182                       | 30                        |
| 12     | Kerala            | 4933                      | 479                       | 780                       | 164                       | 211                       | 19                        |
| 13     | Madhya Pradesh    | 10287                     | 0                         | 1266                      | 306                       | 332                       | 24                        |
| 14     | Maharashtra       | 10673                     | 0                         | 1853                      | 686                       | 256                       | 142                       |
| 15     | Manipur           | 393                       | 23                        | 74                        | 21                        | 8                         | 9                         |

| 16   | Meghalaya                          |    459 |    0 |   122 |   25 |   28 |   0 |
|------|------------------------------------|--------|------|-------|------|------|-----|
| 17   | Mizoram                            |    300 |   73 |    57 |    9 |    9 |   0 |
| 18   | Nagaland                           |    434 |   18 |   129 |    7 |   23 |   0 |
| 19   | Odisha                             |   6688 |    0 |  1288 |  105 |  377 |   7 |
| 20   | Punjab                             |   2951 |    0 |   422 |  100 |  150 |  10 |
| 21   | Rajasthan                          |  13523 |   66 |  2133 |  276 |  616 |  69 |
| 22   | Sikkim                             |    147 |    6 |    24 |    2 |    2 |   0 |
| 23   | Tamil Nadu                         |   8713 |    0 |  1422 |  464 |  385 |  15 |
| 24   | Telangana                          |   4229 |  681 |   578 |  256 |   28 |  54 |
| 25   | Tripura                            |    956 |   44 |   108 |    9 |   21 |   2 |
| 26   | Uttarakhand                        |   1785 |   66 |   531 |   76 |   52 |  28 |
| 27   | Uttar Pradesh                      |  20781 |    0 |  2919 |  594 |  829 |  12 |
| 28   | West Bengal                        |  10357 |    0 |   915 |  456 |  348 |   0 |
| 29   | Andaman & Nicobar Islands          |    124 |    0 |    22 |    5 |    4 |   0 |
| 30   | Chandigarh                         |      0 |    0 |     0 |   43 |    0 |   2 |
| 31   | Dadra& Nagar Haveli and Daman &Diu |     94 |    3 |    12 |    2 |    3 |   1 |
| 32   | Delhi                              |     12 |    2 |     5 |  545 |    0 |   0 |
| 33   | Jammu& Kashmir                     |   2429 |   42 |   891 |   82 |   56 |  23 |
| 34   | Ladakh                             |    288 |    0 |    32 |    1 |    7 |   0 |
| 35   | Lakshadweep                        |      9 |    0 |     4 |    0 |    3 |   0 |
| 36   | Puducherry                         |     53 |   28 |    24 |   15 |    3 |   1 |
|      | All India                          | 157935 | 3894 | 24935 | 6118 | 5480 | 584 |

Note: Chandigarh has no Rural area Delhi has no CHCs

Source: RHS-2021-22

## Annexure-II

| NUMBER OFSUB DIVISIONALHOSPITAL, DISTRICT HOSPITAL& MEDICALCOLLEGES FUNCTIONING   | NUMBER OFSUB DIVISIONALHOSPITAL, DISTRICT HOSPITAL& MEDICALCOLLEGES FUNCTIONING   | NUMBER OFSUB DIVISIONALHOSPITAL, DISTRICT HOSPITAL& MEDICALCOLLEGES FUNCTIONING   | NUMBER OFSUB DIVISIONALHOSPITAL, DISTRICT HOSPITAL& MEDICALCOLLEGES FUNCTIONING   | NUMBER OFSUB DIVISIONALHOSPITAL, DISTRICT HOSPITAL& MEDICALCOLLEGES FUNCTIONING   |
|-----------------------------------------------------------------------------------|-----------------------------------------------------------------------------------|-----------------------------------------------------------------------------------|-----------------------------------------------------------------------------------|-----------------------------------------------------------------------------------|
| S. No.                                                                            | State/UT                                                                          | (As on 31st March 2022)                                                           | (As on 31st March 2022)                                                           | (As on 31st March 2022)                                                           |
| S. No.                                                                            | State/UT                                                                          | Sub Divisional Hospital (SDH)                                                     | District Hospital (DH)                                                            | Government Medical Colleges                                                       |
| 1                                                                                 | Andhra Pradesh                                                                    | 51                                                                                | 17                                                                                | 13                                                                                |
| 2                                                                                 | Arunachal Pradesh                                                                 | 0                                                                                 | 19                                                                                | 1                                                                                 |
| 3                                                                                 | Assam                                                                             | 14                                                                                | 25                                                                                | 9                                                                                 |
| 4                                                                                 | Bihar                                                                             | 45                                                                                | 36                                                                                | 12                                                                                |
| 5                                                                                 | Chhattisgarh                                                                      | 12                                                                                | 27                                                                                | 8                                                                                 |
| 6                                                                                 | Goa                                                                               | 2                                                                                 | 2                                                                                 | 1                                                                                 |
| 7                                                                                 | Gujarat                                                                           | 54                                                                                | 20                                                                                | 18                                                                                |
| 8                                                                                 | Haryana                                                                           | 24                                                                                | 22                                                                                | 5                                                                                 |
| 9                                                                                 | Himachal Pradesh                                                                  | 84                                                                                | 9                                                                                 | 7                                                                                 |
| 10                                                                                | Jharkhand                                                                         | 13                                                                                | 21                                                                                | 7                                                                                 |
| 11                                                                                | Karnataka                                                                         | 147                                                                               | 16                                                                                | 21                                                                                |
| 12                                                                                | Kerala                                                                            | 87                                                                                | 48                                                                                | 10                                                                                |
| 13                                                                                | Madhya Pradesh                                                                    | 119                                                                               | 52                                                                                | 14                                                                                |
| 14                                                                                | Maharashtra                                                                       | 93                                                                                | 23                                                                                | 29                                                                                |
| 15                                                                                | Manipur                                                                           | 1                                                                                 | 7                                                                                 | 2                                                                                 |
| 16                                                                                | Meghalaya                                                                         | 2                                                                                 | 11                                                                                | 1                                                                                 |
| 17                                                                                | Mizoram                                                                           | 2                                                                                 | 12                                                                                | 1                                                                                 |

| 18   | Nagaland                           |    0 |   12 |   0 |
|------|------------------------------------|------|------|-----|
| 19   | Odisha                             |   33 |   32 |   9 |
| 20   | Punjab                             |   41 |   23 |   5 |
| 21   | Rajasthan                          |   22 |   30 |  17 |
| 22   | Sikkim                             |    1 |    4 |   0 |
| 23   | Tamil Nadu                         |  282 |   20 |  38 |
| 24   | Telangana                          |   41 |    5 |  11 |
| 25   | Tripura                            |   12 |    7 |   1 |
| 26   | Uttarakhand                        |   19 |   13 |   5 |
| 27   | Uttar Pradesh                      |    0 |  169 |  35 |
| 28   | West Bengal                        |   60 |   18 |  20 |
| 29   | Andaman & Nicobar Islands          |    0 |    2 |   1 |
| 30   | Chandigarh                         |    1 |    1 |   1 |
| 31   | Dadra &Nagar Haveli and Daman &Diu |    1 |    2 |   1 |
| 32   | Delhi                              |   10 |   40 |   8 |
| 33   | Jammu &Kashmir                     |    0 |   15 |   9 |
| 34   | Ladakh                             |    0 |    2 |   0 |
| 35   | Lakshadweep                        |    2 |    1 |   0 |
| 36   | Puducherry                         |    0 |    4 |   2 |
|      | All India/ Total                   | 1275 |  767 | 322 |

Source: RHS-2021-22 & National Medical Commission

Annexure-III

## State/UT wise Number of Government Hospitals and Beds in Rural & Urban Areas In India

| Sl. No.   | State/UT/Divi sion   | Rural Hospitals (Govt.)   | Rural Hospitals (Govt.)   | Urban Hospitals (Govt.)   | Urban Hospitals (Govt.)   | Total Hospitals (Govt.)   | Total Hospitals (Govt.)   |
|-----------|----------------------|---------------------------|---------------------------|---------------------------|---------------------------|---------------------------|---------------------------|
| Sl. No.   | State/UT/Divi sion   | No.                       | Beds                      | No.                       | Beds                      | No.                       | Beds                      |
| 1         | Andhra Pradesh       | 1291                      | 11941                     | 153                       | 24778                     | 1444                      | 36719                     |
| 2         | Arunachal Pradesh    | 208                       | 2136                      | 10                        | 268                       | 218                       | 2404                      |
| 3         | Assam                | 1178                      | 20620                     | 61                        | 7419                      | 1239                      | 28039                     |
| 4         | Bihar                | 1946                      | 11747                     | 186                       | 17592                     | 2132                      | 29339                     |
| 5         | Chhattisgarh         | 198                       | 9200                      | 49                        | 410                       | 247                       | 9610                      |
| 6         | Goa                  | 18                        | 1485                      | 25                        | 1601                      | 43                        | 3086                      |
| 7         | Gujarat              | 1825                      | 19917                     | 420                       | 9485                      | 2245                      | 29402                     |
| 8         | Haryana              | 498                       | 7928                      | 92                        | 6130                      | 590                       | 14058                     |
| 9         | Himachal Pradesh     | 726                       | 7232                      | 99                        | 7922                      | 825                       | 15154                     |
| 10        | Jammu& Kashmir       | 1435                      | 5707                      | 342                       | 3525                      | 1777                      | 9232                      |
| 11        | Jharkhand            | 4516                      | 10804                     | 73                        | 4589                      | 4589                      | 15393                     |
| 12        | Karnataka            | 4036                      | 9692                      | 21761                     | 135563                    | 25797                     | 145255                    |
| 13        | Kerala               | 1075                      | 16123                     | 209                       | 21974                     | 1284                      | 38097                     |
| 14        | Madhya Pradesh       | 330                       | 9900                      | 135                       | 21206                     | 465                       | 31106                     |

| 15    | Maharashtra   | 365   | 10950   | 149   | 22078   |   514 |   33028 |
|-------|---------------|-------|---------|-------|---------|-------|---------|
| 16    | Manipur       | 7     | 657     | 6     | 2050    |    13 |    2707 |
| 17    | Meghalaya     | 142   | 2040    | 15    | 2517    |   157 |    4557 |
| 18    | Mizoram       | 72    | 930     | 71    | 985     |   143 |    1915 |
| 19    | Nagaland      | 164   | 1286    | 13    | 1175    |   177 |    2461 |
| 20    | Odisha        | 1655  | 6339    | 197   | 12180   |  1852 |   18519 |
| 21    | Punjab        | 507   | 5963    | 151   | 12662   |   658 |   18625 |
| 22    | Rajasthan     | 2170  | 13020   | 867   | 45302   |  3036 |   58322 |
| 23    | Sikkim        | 24    | 260     | 9     | 2000    |    33 |    2260 |
| 24    | Tamil Nadu    | 1863  | 26463   | 582   | 26288   |  2445 |   52751 |
| 25    | Telangana     | 791   | 23784   | 235   | 470     |  1026 |   24254 |
| 26    | Tripura       | 104   | 1390    | 53    | 3558    |   157 |    4948 |
| 27    | Uttar Pradesh | 4545  | 42698   | 358   | 31742   |  4903 |   74440 |
| 28    | Uttarakhand   | 538   | 2152    | 120   | 6700    |   658 |    8852 |
| 29    | West Bengal   | 1304  | 26260   | 290   | 69752   |  1594 |   96012 |
| 30    | A&N Island    | 27    | 825     | 3     | 589     |    30 |    1414 |
| 31    | Chandigarh    | NA    | NA      | 50    | 4035    |    50 |    4035 |
| 32    | D&N Haveli    | 10    | 273     | 1     | 316     |    11 |     589 |
| 33    | Daman &Diu    | 0     | 0       | 4     | 320     |     4 |     320 |
| 34    | Delhi         | NA    | NA      | 121   | 28760   |   121 |   28760 |
| 35    | Lakshadweep   | 10    | 250     | NIL   | NIL     |    10 |     250 |
| 36    | Puducherry    | 84    | 338     | 49    | 2955    |   133 |    3293 |
| Total | Total         | 33662 | 310310  | 26959 | 538896  | 60620 |  849206 |

Source : National Health Profile 2022