THE MINISTER OF STATE IN THE MINISTRY OF HEALTH
AND FAMILY WELFARE
(DR. BHARATI PRAVIN PAWAR)
(a): Rural Health Statistics (RHS) is an annual publication, based on Health care administrative data reported by States/UTs. As per RHS 2019-20, the number of Primary Health Centres (PHCs) in place in the country is 30,813 and number of Community Health Centres (CHCs) in the country, is 5649. The State-wise number of PHCs and CHCs functioning in rural & urban areas is at Annexure-I.
(b): Key Deliverables are identified for each of the programme, intervention and important activities at the time of finalization of the Program Implementation Plans (PIPs) under National Health Mission. Progress on the key deliverables is captured through the Health Management Information System (HMIS) and through quarterly financial and physical progress reports. Regular review meetings are held with states for monitoring of progress on the key deliverables for the year, besides regular monitoring visits from National Program Management Unit and Ministry officials.
Several other mechanisms such as, the Annual Common Review Missions (CRM) which comprise of teams of government officials from different Ministries, NITI Aayog, public health experts and representatives of civil society and development partners; data from the external surveys such as Sample Registration Survey (SRS) and National Family Health Survey (NFHS) also provide information for course correction in implementation strategies. In addition, mechanisms of third-party monitoring of infrastructure related works is also envisaged, including geo-tagging of assets created under NHM.
At the District Level, the DISHA Committees, under the Chairmanship of Member of Parliament, monitor the progress of implementation of NHM. RogiKalyanSamitis (RKS) are set up at Public Health Facilities from Primary Health Centre (PHC) upwards, as an accountability measure to ensure high quality patient care. Village Health, Sanitation and Nutrition Committee (VHSNC) constituted with representation of the Panchayati Raj Institutions and MahilaArogyaSamitis for rural and urban areas, to facilitate an active role for communities in action for addressing social and environmental determinants of health.
(c) to (f) : Public health and hospitals is a State subject, the primary responsibility to ensure availability of human healthcare professionals- doctors including female doctors and paramedical staff and to check unauthorized absence of doctors and staff in the public health facilities lies with the respective State/UT Governments. Under the National Health Mission (NHM), financial and technical support is provided to States/UTs to strengthen their health care systems including augmenting health human resource on contractual basis including support for in-sourcing or engagement of doctors, specialist doctors and other health professionals for provision of equitable, affordable healthcare based on requirements posed by the States in their Programme Implementation Plans (PIPs) and within their overall resource envelope.
Shortage of health professionals including female doctors and other paramedical staff in public health facilities varies from State to State depending upon their policies and context. States/UTs are advised to put in place transparent policies of posting and transfer, and ensure rational deployment of doctors. As the posts required for health facilities are filled up by respective State/UT Governments, they are impressed upon from time to time to fill up the vacant posts. States formulate scheme for reservation / quota in medical admission for women candidates as per their admission policy and gives reservations in their recruitment policy to maintain the parity.
However, Government has taken various steps to optimize the number of doctors and specialists in the country - such as increasing the number of seats in UG/PG level at various medical educational institutes/medical colleges across the country, an increase of more than 70 % in last 7 years; encouraging doctors to work in remote and difficult areas; encouraging States to adopt flexible norms for engaging specialists for public health facilities by various mechanisms like ‘contracting in’ and ‘contracting out’ of specialist services under National Health Mission.
NHM provides for following types of incentives and honorarium to staff for ensuring service delivery in rural and remote areas in the country
? Honorarium to Gynecologists/ Emergency Obstetric Care (EmoC) trained, Pediatricians&Anesthetist/ Life Saving Anaesthesia Skills (LSAS) trained doctors for conducting C Sections.
? Incentives for staff for serving in rural and remote areas: Hard area allowances and special packages are provided to attract health HR, especially medical officers and specialists, to remote and difficult areas.
? Other incentives for service delivery: Incentives like special incentives for doctors, incentive for ANM for ensuring timely ANC checkup and recording, incentives for conducting Adolescent Reproductive and Sexual Health (ARSH) activities etc
? States have also been allowed to offer negotiable salaries to attract Specialists including flexibility in strategies such as ''''You quote, we pay".
In addition, 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. Government of India has requested the States to formulate HR policies so that availability of health HR is improved. Formulation of State HRH policy is an agreed support under NHM.
States/UTs have been urged to fill-up the vacancies in sanctioned positions. As per Rural Health Statistics (RHS) – 2019-20, the State/UT wise status of availability of doctors and shortfall thereof in public health facilities both rural and urban areas is given at Annexure II.
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