ANSWER
THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND
FAMILY WELFARE
(SHRI ASHWINI KUMAR CHOUBEY)
(a): Public health being a State subject, the primary responsibility to ensure availability of health human resources in public health facilities lies with the State Governments. However, as per Rural Health Statistics, 2016-17(as on 31st March, 2017) brought out by the Ministry of Health and Family Welfare based on the information provided by the States/UTs, there were 4156 specialist doctors available (in position) against the requirement of 22496 in the Community Health Centres (CHCs) across the country. There was a shortfall of 81.6% specialist doctors in the Community Health Centres (CHCs). State/UT wise details are annexed.
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(b): The government has supported reviews and studies to explore the reasons for the shortage of service providers in the public health system. These include –
1. Why Some Doctors Serve in Rural Areas: A Qualitative Assessment from Chhattisgarh State (NHSRC, PHFI and SHRC Chhattisgarh; 2009).
2. A review of existing regulatory mechanism to address the shortage of doctors in rural, remote and underserved area: A study across five States in India (NHSRC; 2015).
To address this issue, the Ministry of Health and Family Welfare issued letter providing guidance to States on flexible norms for engaging specialists. These include various mechanisms for having contractual services to engage specialists from 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) for their financial support.
(c): The government has taken several measures to improve the availability of specialists at public facilities. These include:
1. Measures to increase the production of specialist doctors, such as (i) the number of seats for post-graduate doctors at government medical colleges is being increased; (ii) States have been encouraged to initiate Diplomate of the National Board (DNB) and the College of Physicians and Surgeons (CPS) courses to increase the production of specialists and (iii) Government initiatives for up-skilling of MBBS doctors to provide Life Saving Anaesthetic Skills (LSAS) and Emergency Obstetric Care (EmOC) have been put in place.
2. The Ministry of Health and Family Welfare has issued letter providing guidance to states on flexible norms for engaging specialists, as indicated above.
3. The National Health Mission (NHM) provides financial flexibility for the States to offer negotiable and competitive salaries in the recruitment of specialists.
4. Various financial and non-financial incentives are provided in States under NHM to encourage specialists to join and remain within the public health system. These include innovations such as walk-in interviews to reduce delays in engaging specialists; providing them an extra hardship allowance for serving in remote, rural and under-served areas; accommodation arrangements or a housing allowance; facilitating jobs for spouses and children’s education; insurance facilities, e.g. medical cover and support for continuing medical education, attendance at conferences and workshops. Some examples of these measures include Karnataka’s “Our post, your quote” initiative where specialists can negotiate and bid for salaries against specialist vacant posts and the Chhattisgarh Rural Medical Corps (CRMC) – where the state has offered an attractive package of financial and non-financial incentives to significantly improve the availability of specialists at facilities situated in Left Wing Extremist affected areas.
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(d) to (f): There was 7.96 doctors per 10,000 populations according to a WHO report published in 2014. (The Health workforce in India, WHO; 2014).
Further, a study ‘Aggregate availability of doctors in India: 2014 – 2030’ conducted by the Foundation for Organizational Research and Education (FORE) and published in the Indian Journal of Public Health (2017) has estimated that there were 4.8 practicing doctors available per 10000 people in India in 2014. This was based on the Medical Council of India’s historical data (1960-2015).
However, as per the information provided by Medical Council of India, there was a total 10,41,395 allopathic doctors registered with the State Medical Councils / Medical Council of India as on 30th September, 2017. Assuming 80% availability, it is estimated that around 8.33 lakh doctors may be available for active service, which gives doctor-population ratio 1:1597 whereas WHO prescribes a doctor population ratio of 1:1000.
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