ANSWER
THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND
FAMILY WELFARE
(SHRI ASHWINI KUMAR CHOUBEY)
(a): As per RHS 2018, there are shortages in the availability of human resource of various categories in public health facilities. The details of availability of human resources vis-à-vis requirements in public health facilities, State/UT-wise is given at Annexure-I to VI.
The Government has taken various steps to train more health professionals and depute them in rural areas, these efforts include:
(i) 50% reservation in Post Graduate Diploma Courses for Medical Officers in the Government service who have served for at least three years in remote and difficult areas.
(ii) Incentive at the rate of 10% of the marks obtained for each year in service in remote or difficult areas up to the maximum of 30% of the marks obtained in the entrance test for admissions in Post Graduate Medical Courses.
(iii) Support is 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.
(iv) The States are 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, methods of engaging specialists outside the government system for service delivery at public facilities (lucrative flexible salary: “You quote We pay”).
(v)Further steps taken to attract Health Professionals to rural areas include;
• Higher remuneration for staff posted in rural areas compared to those posted in urban areas.
• Provision for paying performance-based team incentives to staff after achieving over and above defined threshold of performance.
• Providing proper working conditions in terms of availability of team, equipment and supplies to practice specialty.
(b): Shortage of Doctors in public health sector varies from State to State depending upon their policies and context. Public Health and hospitals being a state subject, the shortfall is to be managed at the State level. Government both at central and state level regularly monitor the status.
The main reasons for shortfall in infrastructure and human resource are historical underfunding in rural health infrastructure and unwillingness of health professional to serve in rural areas.
(c): As per information provided by Medical Council of India (MCI), there are a total 11,46,044 allopathic doctors registered with the State Medical Councils/Medical Council of India as on 31.12.2018. Assuming 80% availability, it is estimated that around 9.17 lakh doctors may be actually available for active service. It gives a doctor-population ratio of 1:1472 as per current population estimate of 1.35 billion, which is lower than the WHO norm of 1:1000. Besides, there are 7.63 lakh Ayurveda, Unani and Homeopathy (AUH) doctors in the country. Assuming 80% availability, it is estimated that around 6.10 lakh Ayurveda, Unani and Homeopathy (AUH) doctors may be actually available for service and considered together with allopathic doctors, it gives a doctor-population ratio of 1:884. The MBBS intake capacity in the country is around 75,000 seats per annum.
(d): The key health indicators such as Infant Mortality Rate (IMR), Under 5 Mortality Rate (U5MR), Total Fertility Rate (TFR), proportion of institutional deliveries etc. are poor in rural areas as compared to urban areas due to gaps in availability of health human resources & health infrastructure in rural areas as compared to urban areas.
(e): Public Health & hospitals being a State subject, the primary responsibility to provide healthcare to its citizens lies with the State Governments. 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. Currently, NRHM is a sub-mission of National Health Mission.
This support under NHM includes provision of a host of free services such as maternal health, child health, adolescent health, family planning, universal immunisation programme, and for major diseases such as Tuberculosis, HIV/ AIDS, vector borne diseases like Malaria, Dengue and Kala Azar, Leprosy etc.
Other major initiatives include Janani Shishu Suraksha Karyakram (JSSK) (under which free drugs, free diagnostics, free blood and diet, free transport from home to institution, between facilities in case of a referral and drop back home is provided), Rashtriya Bal Swasthya Karyakram (RBSK) (which provides newborn and child health screening and early interventions services free of cost for birth defects, diseases, deficiencies and developmental delays to improve the quality of survival), implementation of Free Drugs and Free Diagnostics Service Initiatives, PM National Dialysis Programme and implementation of National Quality Assurance Framework.
Mobile Medical Units (MMUs) & Telemedicine are also being implemented with NHM support to improve healthcare access particularly in rural areas.
As part of Ayushman Bharat, the Government is supporting the States for strengthening Sub Centres and Primary Health Centres as Health and Wellness Centres (AB-HWCs) for provision of comprehensive primary health care that includes preventive and health promotion at the community level with continuum of care approach. Further, Ayushman Bharat, Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) provides health coverage up to Rs. 5.00 lakh per family per year to around 10.74 crore poor and vulnerable families as per Socio Economic Caste Census (SECC).
To improve availability of doctors & specialists in underserved areas, the Government is upgrading District Hospitals to Medical Colleges in 82 districts which do not have any Medical College thereby providing at least one Medical College for every three contiguous Parliamentary Constituencies.
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