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Hunger / HDI | Public Health
Public Health

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What's Inside

The key findings of the report titled Rural Health Statistics 2020-21 (released in May 2022), which has been prepared by the Ministry of Health and Family Welfare, are as follows (please click here to access):

• As on 31st March, 2021, there were 1,56,101 and 1,718 Sub Centres (SCs), 25,140 and 5,439 Primary Health Centres (PHCs), and 5,481 and 470 Community Health Centres (CHCs), respectively, which were functioning in rural and urban areas of the country.

• The average rural population covered by a Sub Centre was 5,734 as on 1st July, 2021, whereas the norm is that one Sub Centre should be serving a population of size in the range 300-5,000.

• The average population in tribal/ hilly/ desert areas covered by a Sub Centre was 3,839 as on 1st July, 2021, whereas the norm is that one Sub Centre should be serving a population of size up to 3,000 in such areas.

• A Sub Centre is the most peripheral and first contact point between the primary health care system and the community. Sub Centres are assigned tasks relating to interpersonal communication in order to bring about behavioral change and provide services in relation to maternal and child health, family welfare, nutrition, immunisation, diarrhoea control and control of communicable diseases programmes. Each Sub Centre is required to be manned by at least one auxiliary nurse midwife (ANM) / female health worker and one male health worker. Under the National Rural Health Mission (NRHM), there is a provision for one additional second ANM on contract basis. One lady health visitor (LHV) is entrusted with the task of supervision of six Sub Centres. The Government of India bears the salary of ANM and LHV while the salary of the Male Health Worker is borne by the state governments.

• The average rural population covered by a Primary Health Centre (PHC) was 35,602 as on 1st July, 2021, whereas the norm is that one PHC should be serving a population of size in the range 20,000-30,000.

• The average population in tribal/ hilly/ desert areas covered by a PHC was 25,507 as on 1st July, 2021, whereas the norm is that one PHC should be serving a population of size up to 20,000 in such areas.

• PHC is the first contact point between the village community and the medical officer. The PHCs were envisaged to provide an integrated curative and preventive health care to the rural population with emphasis on preventive and promotive aspects of health care. The PHCs are established and maintained by the state governments under the Minimum Needs Programme (MNP)/ Basic Minimum Services (BMS) Programme. As per minimum requirement, a PHC is to be manned by a medical officer supported by 14 paramedical and other staff. Under NRHM, there is a provision for two additional staff nurses at PHCs on contract basis. It acts as a referral unit for 6 Sub Centres and has 4-6 beds for patients. The activities of PHC involve curative, preventive, promotive and family welfare services.

• The average rural population covered by a Community Health Centre (CHC) was 1,63,298 as on 1st July, 2021, whereas the norm is that one CHC should be serving a population of size in the range 80,000-1,20,000.

• The average population in tribal/ hilly/ desert areas covered by a CHC was 1,03,756 as on 1st July, 2021, whereas the norm is that one CHC should be serving a population of size up to 80,000 in such areas.

• CHCs are being established and maintained by the state government under Minimum Needs Program (MNP)/Basic Minimum Services (BMS) programme. As per minimum norms, a CHC is required to be manned by four medical specialists i.e. surgeon, physician, gynecologist and pediatrician supported by 21 paramedical and other staff. It has 30 indoor beds with one OT, X-ray, labour room and laboratory facilities. It serves as a referral centre for 4 PHCs and also provides facilities for obstetric care and specialist consultations.

Rural Health Care System in India

• Out of the sanctioned posts, a significant percentage of posts were vacant at all the levels. Nearly 21.1 percent of the sanctioned posts of Health Worker (Female)/ Auxiliary Nurse Midwife-ANM (at SCs and PHCs) were vacant as compared to 41.9 percent vacancies of Health Worker (Male) in 2021 at SCs. At PHCs, 64.2 percent of the sanctioned posts of Health Assistant (Male and Female) and 21.8 percent of the sanctioned posts of Doctors were vacant in 2021.

• The availability of manpower is one of the important prerequisites for the efficient functioning of the Rural Health services. As on 31st March, 2021, the overall shortfall (which excludes the existing surplus in some of the states) in the posts of Health Worker (Female) / ANM was 2.9 percent of the total requirement as per the norm of one HW(F)/ ANM per Sub Centre and PHC. The overall shortfall was mainly due to shortfall in states of Uttar Pradesh (1,871), Himachal Pradesh (1,253), Gujarat (616), Odisha (397), Tripura (380), and Uttarakhand (252). Similarly, in case of Health Worker (Male), there was a shortfall of 66.1 percent of the requirement. There was a vacancy of 21.1 percent for HW (Female)/ ANM (at SCs and PHCs) as compared to the sanctioned posts. There was a vacancy of 41.9 percent for Health Worker (Male) as compared to the sanctioned posts in 2021 at SCs. At PHCs, 64.2 percent of the sanctioned posts of Health Assistant (Male and Female) and 21.8 percent of the sanctioned posts of Doctors were vacant in 2021.

• PHC is the first contact point between the village community and the Medical Officer. Manpower in PHC includes a Medical Officer supported by paramedical and other staff. In the case of PHC, for Health Assistant (male + female), the shortfall was 72.2 percent. For allopathic doctors at PHC, there was a shortfall of 4.3 percent of the total requirement at the national level. This happened due to a significant shortfall of doctors at PHCs in the states of Odisha (362), Karnataka (340), and Chhattisgarh (271).

• The Community Health Centres provide specialised medical care of Surgeons, Obstetricians & Gynecologists, Physicians and Pediatricians. The position of specialists manpower at CHCs as on 31st March, 2021 shows that out of the sanctioned posts, 72.3 percent of Surgeons, 64.2 percent of Obstetricians & Gynecologists, 69.2 percent of physicians, and 67.1 percent of pediatricians were vacant. Overall 68 percent of the sanctioned posts of specialists at CHCs were vacant in rural areas. Moreover, as compared to requirements for existing infrastructure, there was a shortfall of 83.2 percent of Surgeons, 74.2 percent of Obstetricians & Gynecologists, 82.2 percent of Physicians, and 80.6 percent of Pediatricians. Overall, there was a shortfall of 79.9 percent of specialists at the CHCs as compared to the requirement for existing CHCs. The shortfall of specialists was significantly high in most of the states. However, in addition to the specialists, about 17,012 General Duty Medical Officers (GDMOs) Allopathic and 514 AYUSH Specialists along with 2,955 GDMO AYUSH were also available at CHCs as on 31st March, 2021. In addition to this, there were 805 Anaesthetists and 289 Eye Surgeons available at CHCs as on 31st March, 2021.

• Comparison of the manpower position of major categories in 2021 with that in 2020 shows an overall increase in the number of ANMs at SCs & PHCs and Doctors at PHCs during the period. However, there was a marginal decrease in the number of Specialists at CHCs. There was an increase of ANMs at SCs & PHCs from 2,12,593 in 2020 to 2,14,820 in 2021 and Doctors at PHCs from 28,516 in 2020 to 31,716 in 2021.

• Considering the status of paramedical staff, there was an increase of Lab Technicians from 19,903 in 2020 to 22,723 in 2021 at PHCs and CHCs. There was an increase in the number of pharmacists from 25,792 in 2020 to 28,537 in 2021. A significant increase was also observed for nursing staff under PHC & CHCs from 71,847 in 2020 to 79,044 in 2021. The number of radiographers decreased from 2,434 in 2020 to 2,418 in 2021.

• A total of 1,224 Sub Divisional/ Sub District Hospitals were functioning as on 31st March, 2021 throughout the country. In these hospitals, 15,274 doctors were available. In addition to these doctors, nearly 42,073 paramedical staffs were also available at those hospitals as on 31st March, 2021. The number of doctors in Sub Divisional/ Sub District Hospitals increased from 13,399 in 2020 to 15,274 in 2021. The number of paramedical staff in Sub Divisional/ Sub District Hospitals also went up from 29,937 in 2020 to 42,073 in 2021.

• In addition to the above, 764 District Hospitals (DHs) were also functioning as on 31st March, 2021 throughout the country. There were 26,929 doctors available in the DHs. In addition to the doctors, roughly 90,435 paramedical staff were also available at District Hospitals as on 31st March, 2021. The number of doctors in District Hospitals went up from 22,827 in 2020 to 26,929 in 2021. The number of paramedical staff in District Hospitals increased from 80,920 in 2020 to 90,435 in 2021.
 

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