Shortage of doctors may hit rural healthcare delivery

Kaushiki - November 26, 2012

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 The Standing Committee recommended that this Bill be withdrawn and a revised Bill be introduced in Parliament after consulting stakeholders.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.

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

Legislation

The Personal Data Protection Bill, 2019: How it differs from the draft Bill

Anurag Vaishnav - December 27, 2019

The Personal Data Protection Bill, 2019 was recently introduced in Parliament. The Bill has been referred to a Joint Parliamentary Committee for detailed examination, and the Committee is expected to submit its report by the last week of Budget Session, 2020. The Bill seeks to provide for the protection of personal data of individuals (known as data principals), and creates a framework for processing such personal data by other entities (known as data fiduciaries). It provides the data principal with certain rights with respect to their data, such as seeking correction, completion or transfer of their data to other fiduciaries. Similarly, it sets out certain obligations, and other transparency and accountability measures to be undertaken by the data fiduciary, such as instituting grievance redressal mechanisms to address complaints of individuals. Processing of personal data is exempted from the provisions of the Bill in certain cases, such as security of state, public order, or for prevention, investigation, or prosecution of any offence. The Bill also establishes a Data Protection Authority to ensure compliance with the provisions of the Bill and provide for further regulations.

As per the Statement of Objects and Reasons of the 2019 Bill, the provisions of the Bill are based on the recommendations of the report of the Expert Committee (Chair: Justice B. N. Srikrishna) which examined issues related to protection of personal data and proposed a Draft Personal Data Protection Bill, 2018.

In a previous blog, we provided a brief background to the 2019 Bill, explained why a Bill was brought for personal data protection and what are some of the key provisions of the Bill. In this blog, we look at how the 2019 Bill differs from the 2018 Draft Bill.

Table 1: Comparison of the provisions of the 2018 Draft Bill with the 2019 Bill

Provision	Draft Personal Data Protection Bill, 2018	Personal Data Protection Bill, 2019
Definition of personal data	Personal data pertains to characteristics, traits or attributes of identity, which can be used to identify an individual.	The Bill retains the definition and adds that such characteristics or traits will also include any inference drawn from such data for the purpose of profiling.
Sensitive personal data	Sensitive personal data includes personal data related to health, sex life, sexual orientation, financial data, passwords, among others. The Data Protection Authority can categorise any other personal data as sensitive personal data.	The Bill removes passwords from the category of sensitive personal data. The power to further categorise personal data as sensitive personal data will lie with the central government (in consultation with Data Protection Authority and the sector regulator concerned).
Rights of individual (data principal)	The data principal has certain rights with respect to their data such as obtaining confirmation on whether their data has been processed, seeking correction, transfer, or restriction on continuing disclosure of their data.	The Bill provides the right to erasure of personal data which is no longer necessary for the purpose for which it was processed, as an additional right for the data principal.
Non-consensual processing of personal data	Personal data may be processed without obtaining the consent of the individual on certain grounds. These include: (i) any function of Parliament or state legislature, (ii) if required by the State for providing benefits to the individual, and (iii) for reasonable purposes specified by the Authority, such as fraud detection, debt recovery, and whistle blowing.	The Bill removes the provision on any function of Parliament or state legislature as a ground for non-consensual processing of personal data. The Bill adds ‘operation of search engines’ as a reasonable purpose for which non-consensual processing of personal data may be allowed by the Authority.
Social media intermediaries	The draft Bill did not contain this term.	The Bill defines a social media intermediary as an intermediary which enables online interaction between users and allows for sharing of information. All social media intermediaries which are classified as significant data fiduciaries (fiduciaries with users above a notified threshold whose actions can impact electoral democracy or public order) must provide a voluntary user verification mechanism for all users in India.
Exemptions for the government for processing of personal data	The State is exempted from the provisions of the Bill while processing personal data in the interest of national security. However, such processing must be permitted by a law and must be proportionate to the interests being achieved. Further, such processing must be done in a fair and reasonable manner.	The government can exempt any of its agencies from any or all provisions of the Act, for processing of personal data in certain cases. These include: (i) in interest of security of state, public order, sovereignty and integrity of India and friendly relations with foreign states, and (ii) for preventing incitement to commission of any cognisable offence relating to the above matters.
Exemptions for manual processing by small entities	Transparency and accountability measures and certain other obligations will not apply to small entities. These are fiduciaries which: (i) have annual turnover below Rs 20 lakh (or such lower amount as prescribed), and (ii) did not process data of more than 100 individuals in any one day in the last year.	The Bill retains the exemption for small entities. However, it does away with the prescribed limits and allows the Authority to classify fiduciaries as small entities based on the annual turnover of fiduciary and the volume of data processed by such fiduciary.
Transfer of personal data outside country	One serving copy of all personal data should be stored in India.	The Bill removes the provision for mandatory storage of all personal data in the country. It provides that sensitive personal data must continue to be stored in India. Such data can be transferred outside India if explicitly consented by the individual, and subject to certain additional conditions.
Composition of Data Protection Authority of India	The chairperson and members of the Authority will be appointed by the central government on the recommendations of a selection committee. The selection committee will be comprised of: (i) Chief Justice of India or a Judge of Supreme Court as the chairperson, (ii) Cabinet Secretary, and (iii) an expert in field of data protection, information technology and related subjects.	The Bill provides that the selection committee will be comprised of: (i) Cabinet Secretary as the chairperson, (ii) Secretary, Department of Legal Affairs, and (iii) Secretary, Ministry of Electronics and Information Technology.
Offences and penalties	Under the Bill, offences such as: (i) obtaining, disclosing, transferring, or selling personal data in contravention of the Act, and (ii) re-identification and processing of de-identified personal data (data from which identifiers have been removed) without consent, are punishable with imprisonment.	Under the Bill, re-identification and processing of de-identified personal without consent is the only offence punishable with imprisonment.
Non-personal and anonymised personal data	No provision of the Bill would apply to non-personal data used by government for formulation of policies for digital economy, growth or security.	The Bill retains the provision and further provides that the government can direct data fiduciaries to provide it any: (i) non-personal data and (ii) anonymised personal data (where it is not possible to identify data principal) for better targeting of services and formulation of evidence-based policy.

Sources: The Draft Personal Data Protection Bill, 2018; The Personal Data Protection Bill, 2019; PRS.

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Shortage of doctors may hit rural healthcare delivery

The Personal Data Protection Bill, 2019: How it differs from the draft Bill

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