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Hunger / HDI | Public Health
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What's Inside

Please click here to access the Standard Operating Procedure (SOP) on COVID-19 Containment and Management in Peri-urban, Rural and Tribal areas dated 16th May, 2021. The SOP was issued by the Ministry of Health and Family Welfare.

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The key findings of the report titled Rural Health Statistics 2019-20 (released in April 2021), which has been prepared by the Ministry of Health and Family Welfare, are as follows (please click here to access):

• As on 31st March, 2020, there were 1,55,404 and 2,517 Sub Centres (SCs), 24,918 and 5,895 Primary Health Centres (PHCs) and 5,183 and 466 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 5,729 as on 1st July, 2020, 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 3,381 as on 1st July, 2020, 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 35,730 as on 1st July, 2020, whereas the norm is that one Primary Health Centre 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 23,930 as on 1st July, 2020, 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 was 1,71,779 as on 1st July, 2020, whereas the norm is that one Community Health Centre 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 97,178 as on 1st July, 2020, 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 14.1 percent of the sanctioned posts of Health Worker (Female)/ ANM (at SCs +PHCs) were vacant as compared to 37 percent vacancies of Health Worker (Male) in 2020. At PHCs, 37.6 percent of the sanctioned posts of Health Assistant (Male + Female) and 24.1 percent of the sanctioned posts of Doctors were vacant in 2020.

• The availability of manpower is one of the important prerequisites for the efficient functioning of the Rural Health services. As on 31st March, 2020, the overall shortfall (which excludes the existing surplus in some of the states) in the posts of Health Worker (Female) / ANM was 2 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 the shortfall in states of Gujarat (1073), Himachal Pradesh (992), Rajasthan (657), Tripura (389) and Kerala (277). Similarly, in case of Health Worker (Male), there was a shortfall of 65.5 percent of the requirement.

• 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 71.9 percent. For allopathic doctors at PHC, there was a shortfall of 6.8 percent of the total requirement at all India level. This shortfall happened due to a significant shortfall of doctors at PHCs in the states of Odisha (461), Chhattisgarh (404), Rajasthan (249), Madhya Pradesh (134), Uttar Pradesh (121) and Karnataka (105).

• The Community Health Centres provide specialised medical care of Surgeons, Obstetricians & Gynecologists, Physicians and Pediatricians. The latest available position of specialists manpower at CHCs as on 31st March, 2020 shows that out of the sanctioned posts, 68.4 percent of Surgeons, 56.1 percent of Obstetricians & Gynecologists, 66.8 percent of physicians and 63.1 percent of pediatricians were vacant. Overall 63.3 percent of the sanctioned posts of specialists at CHCs were vacant. Moreover, as compared to requirements for existing infrastructure, there was a shortfall of 78.9 percent of Surgeons, 69.7 percent of Obstetricians & Gynecologists, 78.2 percent of Physicians and 78.2 percent of Pediatricians. Overall, there was a shortfall of 76.1 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 15,342 General Duty Medical Officers (GDMOs) Allopathic and 702 AYUSH Specialists along with 2,720 GDMO AYUSH were also available at CHCs as on 31st March, 2020. In addition to this, there were 890 Anaesthetists and 301 Eye Surgeons available at CHCs as on 31st March, 2020.

• Comparison of the manpower position of major categories in 2020 with that in 2019 shows an overall decrease in the number of ANMs at SCs & PHCs and Doctors at PHCs during the period. However, there was an increase in the number of Specialists at CHCs. The number of Specialists at CHCs had increased from 3,881 in 2019 to 4,857 in 2020, which was an increase of 27.7 percent.

• Considering the status of paramedical staff, there was an increase of Lab Technicians from 18,715 in 2019 to 19,903 in 2020 at PHCs and CHCs. There was a marginal decrease in the number of pharmacists from 26,204 in 2019 to 25,792 in 2020. A significant decrease was also observed in nursing staff under PHC & CHCs from 80,976 in 2019 to 71,847 in 2020. The number of radiographers had increased marginally from 2,419 in 2019 to 2,434 in 2020.

• A total of 1,193 Sub Divisional/ Sub District Hospitals were functioning as on 31st March, 2020 throughout the country. In these hospitals, 13,399 doctors were available. In addition to these doctors, about 29,937 paramedical staff were also available at those hospitals as on 31st March, 2020. The number of doctors in Sub Divisional/ Sub District Hospitals had reduced from 13,750 in 2019 to 13,399 in 2020. The number of paramedical staff in Sub Divisional/ Sub District Hospitals fell from 36,909 in 2019 to 29,937 in 2020.

• In addition to above, 810 District Hospitals (DHs) were also functioning as on 31st March, 2020 throughout the country. There were 22,827 doctors available in the DHs. In addition to the doctors, about 80,920 paramedical staff were also available at District Hospitals as on 31st March, 2020. The number of doctors in District Hospitals went down from 24,676 in 2019 to 22,827 in 2020. The number of paramedical staff in District Hospitals fell from 85,194 in 2019 to 80,920 in 2020.

• As per the Health & Wellness Centre (HWC) portal data, there were a total of 38,595 HWCs functional in India as on 31st March 2020. In total, 18,610 SCs had been converted into HWC-SCs. Also at the level of PHC, a total of 19,985 PHCs had been converted into HWC-PHCs. Out of 19,985 HWC-PHCs, 16,635 PHCs had been converted into HWCs in rural areas and 3,350 in urban areas.

 
 

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