Recently, the Standing Committee on Health and Family Welfare submitted its report to the Parliament on the National Commission for Human Resource for Health Bill, 2011. The objective of the Bill is to “ensure adequate availability of human resources in the health sector in all states”. It seeks to set up the National Commission for Human Resources for Health (NCHRH), National Board for Health Education (NBHE), and the National Evaluation and Assessment Council (NEAC) in order to determine and regulate standards of health education in the country. It separates regulation of the education sector from that of professions such as law, medicine and nursing, and establishes professional councils at the national and state levels to regulate the professions.
See here for PRS Bill Summary.
The Standing Committee recommended that this Bill be withdrawn and a revised Bill be introduced in Parliament after consulting stakeholders. It felt that concerns of the professional councils such as the Medical Council of India and the Dental Council of India were not adequately addressed. Also, it noted that the powers and functions of the NCHRH and the National Commission on Higher Education and Research (to be established under the Higher Education and Research Bill, 2011 to regulate the higher education sector in the country) were overlapping in many areas. Finally, it also expressed concern over the acute shortage of qualified health workers in the country as well as variations among states and rural and urban areas. As per the 2001 Census, the estimated density of all health workers (qualified and unqualified) is about 20% less than the World Health Organisation’s norm of 2.5 health workers per 1000 population.
See here for PRS Standing Committee Summary.
Shortfall of health workers in rural areas
Public health care in rural areas is provided through a multi-tier network. At the lowest level, there are sub health-centres for every population of 5,000 in the plains and 3,000 in hilly areas. The next level consists of Primary Health Centres (PHCs) for every population of 30,000 in the plains and 20,000 in the hills. Generally, each PHC caters to a cluster of Gram Panchayats. PHCs are required to have one medical officer and 14 other staff, including one Auxiliary Nurse Midwife (ANM). There are Community Health Centres (CHCs) for every population of 1,20,000 in the plains and 80,000 in hilly areas. These sub health centres, PHCs and CHCs are linked to district hospitals. As on March 2011, there are 14,8124 sub health centres, 23,887 PHCs and 4809 CHCs in the country.[i]
Sub-Health Centres and Primary Health Centres
- § Among the states, Chhattisgarh has the highest vacancy of doctors at 71%, followed byWest Bengal(44%),Maharashtra(37%), and Uttar Pradesh (36%). On the other hand, Rajasthan (0.4%), Andhra Pradesh (3%) and Kerala (7%) have the lowest vacancies in PHCs.
- § Nine states do not have any doctor vacancies at all at the PHC level. These states includeBihar, Jharkhand andPunjab.
- § Ten states have vacancy in case of ANMs. These are: Manipur, Uttar Pradesh, Chhattisgarh,Gujarat,Goa, Himachal Pradesh, Tamil Nadu, Haryana, Kerala and Andhra Pradesh.
- § The overall vacancy for ANMs in the country is 5% while for doctors it is 24%.
Table 1: State-wise comparison of vacancy in PHCs
Doctors at PHCs
ANM at PHCs and Sub-Centres
|State||Sanctioned post||Vacancy||% of vacancy||Sanctioned post||Vacancy||% of vacancy|
|Andaman & Nicobar Isld||40||12||30||214||0||0|
|Dadra & Nagar Haveli||6||0||NA||40||0||0|
|Daman & Diu||3||0||NA||26||0||0|
|Jammu & Kashmir||750||0||NA||2282||0||0|
|Sources: National Rural Health Mission (available here), PRS.Note: The data for all states is as of March 2011 except for some states where data is as of 2010. For doctors, these states are Bihar, UP, Mizoram and Delhi. For ANMs, these states are Odisha and Uttar Pradesh.|
- § A CHC is required to be manned by four medical specialists (surgeon, physician, gynaecologist and paediatrician) and 21 paramedical and other staff.
- § As of March 2011, overall there is a 39% vacancy of medical specialists in CHCs. Out of the sanctioned posts, 56% of surgeons, 47% of gynaecologists, 59% of physicians and 49% of paediatricians were vacant.
- States such as Chhattisgarh, Manipur and Haryana have a high rate of vacancies at the CHC level.
Table 2: Vacancies in CHCs of medical specialists
% of vacancy
|Andaman & NicobarIsland||100||100||100||100|
|Dadra & Nagar Haveli||0||0||0||0|
|Daman & Diu||0||100||0||100|
|Jammu & Kashmir||34||34||53||63|
|Sources: National Rural Health Mission (available here), PRS.|