ANSWER
THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND
FAMILY WELFARE
(DR. BHARATI PRAVIN PAWAR)
(a) & (b): In order 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 all over the country, including ensuring availability of doctors and other human resources. Currently, NRHM is a sub-mission of National Health Mission (NHM).
Public Health and Hospitals being a State Subject, all the administrative and personnel matters, including support for outsourcing or engagement of doctors, para-medical staff and technicians on contractual basis, lies with the respective State/UT Governments. However, under National Health Mission (NHM), Government of India provides financial and technical support to States/UTs to strengthen their healthcare systems including support for recruitment of doctors, para-medical staff and technicians on contractual basis, based on the requirements posed by them in their Programme Implementation Plans (PIPs) within their overall resource envelope. Hence the primary responsibility to ensure availability of doctors of various streams of medicines in rural area, lies with the respective State/UT Governments.
The following steps have also been taken to increase the availability of doctors in rural, remote and difficult areas of the country:
(i) 50% of the seats in Post Graduate Diploma Courses are reserved for Medical Officers in the Government service, who have served for at least three years in remote and/or rural areas. After acquiring the PG Diploma, the Medical Officers shall serve for two more years in remote and/or difficult and/or rural areas.
(ii) Incentive at the rate of 10% of the marks obtained for each year in service in remote and/or difficult or rural areas as upto the maximum of 30% of the marks obtained in the entrance test for admissions in Post Graduate Medical Courses.
Under NHM, support is also 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. Support for 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. The States are also 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, empanelling private medical facilities to provide requisite Specialists and other methods of engaging specialists 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) under the National Health Mission.
The Mainstreaming of AYUSH is one of the core strategies in National Rural Health Mission (NRHM), one of the component of National Health Mission (NHM) which seeks to provide accessible, affordable and quality health care to the rural population. Under National Health Mission (NHM), engagement of Ayurveda Yoga & Naturopathy, Unani, Siddha and Homoeopathy (AYUSH) doctors/ paramedics is being supported, provided they are co-located with existing District Hospitals (DHs), Community Health Centres (CHCs) and Primary Health Centres (PHCs) with priority given to remote PHCs and CHCs.
As on March, 2021, over 27792 AYUSH doctors are supported at 15,340 functional co-located facilities at various healthcare under NHM and the details are placed at Annexure-I & Annexure-II, respectively.
(c) The Government of India routinely collects facility level disease surveillance information across levels of care i.e. Sub Health Centre (SHC), Primary Health Centre (PHC), Community Health Center (CHC) and higher levels in both rural and urban areas through Integrated Disease Surveillance Program (IDSP). Additionally, under NHM, disease control programs are routinely collecting disease specific information and facility level data.
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