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 The Standing Committee recommended that this Bill be withdrawn and a revised Bill be introduced in Parliament after consulting stakeholders.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
Chhattisgarh	1482	1058	71	6394	964	15
West Bengal	1807	801	44	10,356	NA	0
Maharashtra	3618	1326	37	21,122	0	0
Uttar Pradesh	4509	1648	36	25,190	2726	11
Mizoram	57	20	35	388	0	0
Madhya Pradesh	1238	424	34	11,904	0	0
Gujarat	1123	345	31	7248	817	11
Andaman & Nicobar Isld	40	12	30	214	0	0
Odisha	725	200	28	7442	0	0
Tamil Nadu	2326	622	27	9910	136	1
Himachal Pradesh	582	131	22	2213	528	24
Uttarakhand	299	65	22	2077	0	0
Manipur	240	48	20	984	323	33
Haryana	651	121	19	5420	386	7
Sikkim	48	9	19	219	0	0
Meghalaya	127	23	18	667	0	0
Delhi	22	3	14	43	0	0
Goa	46	5	11	260	20	8
Karnataka	2310	221	10	11,180	0	0
Kerala	1204	82	7	4232	59	1
Andhra Pradesh	2424	76	3	24,523	2876	12
Rajasthan	1478	6	0.4	14,348	0	0
Arunachal Pradesh	NA	NA	NA	NA	NA	0
Assam	NA	NA	NA	NA	NA	0
Bihar	2078	0	NA	NA	NA	0
Chandigarh	0	0	NA	17	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
Jharkhand	330	0	NA	4288	0	0
Lakshadweep	4	0	NA	NA	NA	0
Nagaland	NA	NA	NA	NA	NA	0
Puducherry	37	0	NA	72	0	0
Punjab	487	0	NA	4044	0	0
Tripura	NA	NA	NA	NA	NA	0
India	30,051	7,246	24	1,77,103	8,835	5
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.

 

Community Health Centres

• § 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

	Surgeons	Gynaecologists	Physicians	Paediatricians
State	% of vacancy
Andaman & NicobarIsland	100	100	100	100
Andhra Pradesh	74	0	45	3
Arunachal Pradesh	NA	NA	NA	NA
Assam	NA	NA	NA	NA
Bihar	41	44	60	38
Chandigarh	50	40	50	100
Chhattisgarh	85	85	90	84
Dadra & Nagar Haveli	0	0	0	0
Daman & Diu	0	100	0	100
Delhi	0	0	0	0
Goa	20	20	67	66
Gujarat	77	73	0	91
Haryana	71	80	94	85
Himachal Pradesh	NA	NA	NA	NA
Jammu & Kashmir	34	34	53	63
Jharkhand	45	0	81	61
Karnataka	33	NA	NA	NA
Kerala	NA	NA	NA	NA
Lakshadweep	0	0	100	0
Madhya Pradesh	78	69	76	58
Maharashtra	21	0	34	0
Manipur	100	94	94	87
Meghalaya	50	NA	100	50
Mizoram	NA	NA	NA	NA
Nagaland	NA	NA	NA	NA
Odisha	44	45	62	41
Puducherry	0	0	100	NA
Punjab	16	36	40	48
Rajasthan	57%	46	49	24
Sikkim	NA	NA	NA	NA
Tamil Nadu	0	0	0	0
Tripura	NA	NA	NA	NA
Uttar Pradesh	NA	NA	NA	NA
Uttarakhand	69	63	74	40
West Bengal	0	57	0	78
India	56	47	59	49
Sources: National Rural Health Mission (available here), PRS.

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[i].  “Rural Healthcare System in India”, National Rural Health Mission (available here).