Rural Health Care System in India

Rural Health Care System the structure and current scenario The health care infrastructure in rural areas has been developed as a three tier system (see Chart 1) and is based on the following population norms: Table 1. Population orms Centre Sub-Centre Primary Health Centre Community Health Centre Plain Area 5000 30,000 1,20,000 Hilly/Tribal/Difficult Area 3000 20,000 80,000

1.2. The Sub-Centre is the most peripheral and first contact point between the primary health care system and the community. Each Sub-Centre is required to be manned by at least one Auxiliary Nurse Midwife (ANM) / Female Health Worker and one Male Health Worker (for details of staffing pattern, see Box 1 and for recommended staffing structure under Indian Public Health Standards (IPHS) see Annexure I). Under NRHM, there is a provision for one additional second ANM on contract basis. One Lady Health Visitor (LHV) is umber of Sub Centres existing as on March 2010 increased from 146026 in 2005 to 147069 in 2010. entrusted with the task of supervision There is significant increase in the number of Sub of six Sub-Centres. Sub-Centres are Centres in the States of Chhattisgarh, Haryana, assigned tasks relating to Jammu & Kashmir, Maharashtra, Orissa, Punjab, interpersonal communication in Rajasthan, Tamil adu, Tripura and Uttarakhand. order to bring about behavioral change and provide services in relation to maternal and child health, family welfare, nutrition, immunization, diarrhoea control and control of communicable diseases programmes. The Sub-Centres are provided with basic drugs for minor ailments needed for taking care of essential health needs of men, women and children. The Ministry of Health & Family Welfare is providing 100% Central assistance to all the Sub-Centres in the country since April 2002 in the form of salary of ANMs and LHVs, rent at the rate of Rs. 3000/- per annum and contingency at the rate of Rs. 3200/- per annum, in addition to drugs and equipment kits. The salary of the Male Worker is borne by the State Governments (Also see para 2.4 for NRHM additionalities). Under the Swap Scheme, the Government of India has taken over an additional 39,554 Sub Centres from State Governments / Union Territories since April, 2002 in lieu of 5,434 Rural Family Welfare Centres transferred to the State Governments / Union Territories. There are 1,47,069 Sub Centres functioning in the country as on March 2010.

As on March, 2010, there are 147069 Sub Centres, 23673 Primary Health Centres (PHCs) and 4535 Community Health Centres (CHCs) functioning in the country

Sub-Centres (SCs)

Primary Health Centres (PHCs) PHC is the first contact point between village community and the Medical Officer. The PHCs were envisaged to provide an integrated curative and preventive At the national level, there is an increase of 437 PHCs in health care to the rural population with 2010 as compared to that existed in 2005. Significant increase is also observed in the number of PHCs in the emphasis on preventive and promotive States of Bihar, Chhattisgarh, Haryana, Jammu & aspects of health care. The PHCs are Kashmir, Karnataka, Maharashtra, agaland, established and maintained by the Uttarakhand, Uttar Pradesh 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. It has 4 - 6 beds for patients. The activities of PHC involve curative, preventive, promotive and Family Welfare Services. (Also see para 2.4 for NRHM additionalities). There are 23,673 PHCs functioning as on March 2010 in the country. Community Health Centres (CHCs) 1.4. CHCs are being established and maintained by the State Government under MNP/BMS programme. As per minimum norms, a CHC is required to be manned by four medical specialists i.e. Surgeon, At the national level there is an increase of 1189 CHCs Physician, Gynecologist and in 2010 as compared to that existed in 2005. Significant Pediatrician supported by 21 increase is observed in the number of CHCs in the States paramedical and other staff. It has 30 of Arunachal Pradesh, Chhattisgarh, Gujarat, Haryana, in-door beds with one OT, X-ray, Himachal Pradesh, Jammu & Kashmir, Jharkhand, Labour Room and Laboratory Karnataka, Kerala, Madhya Pradesh, Punjab, Rajasthan, facilities. It serves as a referral centre Tamil adu, Uttarakhand, Uttar Pradesh and West for 4 PHCs and also provides facilities Bengal for obstetric care and specialist consultations (Also see para 2.4 for NRHM additionalities). As on March, 2009, there are 4,535 CHCs functioning in the country. 1.5. The details of the norms for each level of rural health infrastructure and current status against these norms are given in Box 2. First Referral Units (FRUs) 1.6. An existing facility (district hospital, sub-divisional hospital, community health centre etc.) can be declared a fully operational First Referral Unit (FRU) only if it is equipped to provide round-the-clock services for Emergency Obstetric and New Born Care, in addition to all emergencies that any hospital is required to provide. It should be noted that there are three critical determinants of a facility being declared as a FRU: i) Emergency Obstetric Care including surgical interventions like Caesarean Sections; ii) New-born Care; and iii) Blood Storage Facility on a 24-hour basis. 1.3.

Chart 1.

RURAL HEALTH CARE SYSTEM I I DIA

Community Health Centre (CHC) A 30 beded Hospital/Referal Unit for 4 PHCs with Specialised services

Primary Health Centre (PHC) A Referal Unit for 6 Sub Centres 4-6 beded manned with a Medical Officer Incharge and 14 subordinate paramedical staff

Sub Centre Most peripheral contact point between Primary Health Care System & Community manned with one HW(F)/A M & one HW(M)

2. Strengthening of Rural Health Infrastructure Under ational Rural Health Mission 2.1. The National Rural Health Mission (2005-12) seeks to provide effective healthcare to rural population throughout the country with special focus on 18 states, which have weak public health indicators and/or weak infrastructure. These 18 States are Arunachal Pradesh, Assam, Bihar, Chhattisgarh, Himachal Pradesh, Jharkhand, Jammu & Kashmir, Manipur, Mizoram, Meghalaya, Madhya Pradesh, Nagaland, Orissa, Rajasthan, Sikkim, Tripura, Uttarakhand and Uttar Pradesh. The Mission is an articulation of the commitment of the Government to raise public spending on Health from 0.9% of GDP to 2-3% of GDP. 2.2. NRHM aims to undertake architectural correction of the health system to enable it to effectively handle increased allocations as promised under the National Common Minimum Programme and promote policies that strengthen public health management and service delivery in the country. It has as its key components provision of a female health activist in each village; a village health plan prepared through a local team headed by the Health & Sanitation Committee of the Panchayat; strengthening of the rural hospital for effective curative care and made measurable and accountable to the community through Indian Public Health Standards (IPHS); integration of vertical Health & Family Welfare Programmes, optimal utilization of funds & infrastructure, and strengthening delivery of primary healthcare. It seeks to revitalize local health traditions and mainstream AYUSH into the public health system. It further aims at effective integration of health concerns with determinants of health like sanitation & hygiene, nutrition, and safe drinking water through a 3

District Plan for Health. It seeks decentralization of programmes for district management of health and to address the inter-State and inter-district disparities, especially among the 18 high focus States, including unmet needs for public health infrastructure. It also seeks to improve access of rural people, especially poor women and children, to equitable, affordable, accountable and effective primary healthcare. Box 1. STAFFI G PATTER
A. 1. 2. 3. 4. STAFF FOR SUB - CENTRE: Number of Posts

Health Worker (Female)/ANM .................................................................................................... 1 Additional Second ANM (on contract)..................................................................................1 Health Worker (Male) ................................................................................................................. 1 Voluntary Worker (Paid @ Rs.100/- p.m. as honorarium) ......................................................... 1 Total: .............................................................................................................................. 3 STAFF FOR NEW PRIMARY HEALTH CENTRE Medical Officer............................................................................................................................ 1 Pharmacist.................................................................................................................................. 1 Nurse Mid-wife (Staff Nurse) ....................................... 1 + 2 additional Staff Nurses on contract Health Worker (Female)/ANM .................................................................................................... 1 Health Educator .......................................................................................................................... 1 Health Assistant (Male) .............................................................................................................. 1 Health Assistant (Female)/LHV .................................................................................................. 1 Upper Division Clerk ................................................................................................................... 1 Lower Division Clerk ................................................................................................................... 1 Laboratory Technician ................................................................................................................ 1 Driver (Subject to availability of Vehicle) .................................................................................... 1 Class IV ...................................................................................................................................... 4 Total: ............................................................................................................................ 15 STAFF FOR COMMUNITY HEALTH CENTRE: Medical Officer #......................................................................................................................... 4 Nurse Mid Wife(staff Nurse) ..................................................................................................... 7 Dresser ....................................................................................................................................... 1 Pharmacist/Compounder ............................................................................................................ 1 Laboratory Technician ................................................................................................................ 1 Radiographer .............................................................................................................................. 1 Ward Boys .................................................................................................................................. 2 Dhobi .......................................................................................................................................... 1 Sweepers .................................................................................................................................... 3 Mali ............................................................................................................................................. 1 Chowkidar .................................................................................................................................. 1 Aya ............................................................................................................................................. 1 Peon ........................................................................................................................................... 1 Total: ............................................................................................................................ 25

B. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12.

C. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13.

:Either qualified or specially trained to work as Surgeon, Obstetrician, Physician and Pediatrician. One of the existing Medical Officers similarly should be either qualified or specially trained in Public Health).

Note: The above is the minimum norm for staffing pattern. However, additional staff has been prescribed under IPHS as given in Annexure I of this Chapter.

Box 2.
RURAL HEALTH I FRASTRUCTURE - ORMS A D LEVEL OF ACHIEVEME TS (ALL I DIA)
Indicator S.No. 1 Rural National Norms General Tribal/Hilly/Desert Present Average Coverage

Population (2001) covered by a: Sub Centre Primary Health Centre (PHC) Community Health Centre (CHC)

5000 30000
120000

3000 20000 80000 6 4

5049 31364 163725 6 5

2 3 4

Number of Sub Centres per PHC Number of PHCs per CHC Rural Population (2001) covered by a: HW (F) (at Sub Centres and PHCs) HW (M) (At Sub Centres) Ratio of HA (M) at PHCs to HW (M) at Sub Centres Ratio of HA (F) at PHCs to HW (F) at Sub Centres and PHCs Average Rural Area (Sq. Km) covered by a: Sub Centre PHC CHC Average Radial Distance (Kms) covered by a: Sub Centre PHC CHC Average umber of Villages covered by a: Sub Centre PHC CHC

5000 5000 1:6

3000 3000

3878 14069 1:3

1:6

1:11

----

21.20 131.72 687.61

----

2.60 6.47 14.79

----

4 27 141

2.3. Following are the core and supplementary strategies of NRHM: 2.3.1. Core Strategies: Train and enhance capacity of Panchayati Raj Institutions (PRIs) to own, control and manage public health services. Promote access to improved healthcare at household level through the female health activist (ASHA). Health Plan for each village through Village Health Committee of the Panchayat. Strengthening sub-centre through an untied fund to enable local planning and action and more Multi Purpose Workers (MPWs). Strengthening existing PHCs and CHCs, and provision of 30-50 bedded CHC per lakh population for improved curative care to a normative standard (Indian Public Health Standards defining personnel, equipment and management standards). Preparation and Implementation of an inter-sectoral District Health Plan prepared by the District Health Mission, including drinking water, sanitation & hygiene and nutrition. Integrating vertical Health and Family Welfare programmes at National, State, District, and Block levels. Technical Support to National, State and District Health Missions, for Public Health Management. Strengthening capacities for data collection, assessment and review for evidence based planning, monitoring and supervision. Formulation of transparent policies for deployment and career development of Human Resources for health. Developing capacities for preventive health care at all levels for promoting healthy life styles, reduction in consumption of tobacco and alcohol etc. Promoting non-profit sector particularly in under served areas. 2.3.2 Supplementary Strategies: Regulation of Private Sector including the informal rural practitioners to ensure availability of quality service to citizens at reasonable cost. Promotion of Public Private Partnerships for achieving public health goals. Mainstreaming AYUSH revitalizing local health traditions. Reorienting medical education to support rural health issues including regulation of Medical care and Medical Ethics.

2.4. 2.4.1

RHM Plan of Action relating to Infrastructure and Manpower Strengthening Component (A): Accredited Social Health Activists Every village/large habitat will have a female Accredited Social Health Activist (ASHA) - chosen by and accountable to the panchayat- to act as the interface between the community and the public health system. States to choose State specific models. ASHA would act as a bridge between the ANM and the village and be accountable to the Panchayat. She will be an honorary volunteer, receiving performance-based compensation for promoting universal immunization, referral and escort services for RCH, construction of household toilets, and other healthcare delivery programmes. She will be trained on a pedagogy of public health developed and mentored through a Standing Mentoring Group at National level incorporating best practices and implemented through active involvement of community health resource organizations. She will facilitate preparation and implementation of the Village Health Plan along with Anganwadi worker, ANM, functionaries of other Departments, and Self Help Group members, under the leadership of the Village Health Committee of the Panchayat. She will be promoted all over the country, with special emphasis on the 18 high focus States. The Government of India will bear the cost of training, incentives and medical kits. The remaining components will be funded under Financial Envelope given to the States under the programme. She will be given a Drug Kit containing generic AYUSH and allopathic formulations for common ailments. The drug kit would be replenished from time to time. Induction training of ASHA to be of 23 days in all, spread over 12 months. On the job training would continue throughout the year. Prototype training material to be developed at National level subject to State level modifications. Cascade model of training proposed through Training of Trainers including contract plus distance learning model Training would require partnership with NGOs/ICDS Training Centres and State Health Institutes.

2.4.2

Component (B): Strengthening Sub-Centres (SC) Each sub-centre will have an Untied Fund for local action @ Rs. 10,000 per annum. This Fund will be deposited in a joint Bank Account of the ANM & Sarpanch and operated by the ANM, in consultation with the Village Health Committee. 7

Supply of essential drugs, both allopathic and AYUSH, to the Sub-centres. In case of additional Outlays, Multipurpose Workers (Male)/ Additional ANMs wherever needed, sanction of new Sub-centres as per 2001 population norm, and upgrading existing Sub-centres, including buildings for Sub-centres functioning in rented premises will be considered. 2.4.3 Component (C): Strengthening Primary Health Centres (PHCs) Mission aims at strengthening PHCs for quality preventive, promotive, curative, supervisory and outreach services, through: Adequate and regular supply of essential quality drugs and equipment (including Supply of Auto Disabled Syringes for immunisation) to PHCs Provision of 24 hour service in at least 50% PHCs by addressing shortage of doctors, especially in high focus States, through mainstreaming AYUSH manpower. Observance of Standard treatment guidelines & protocols. In case of additional Outlays, intensification of ongoing communicable disease control programmes, new programmes for control of non-communicable diseases, upgradation of 100% PHCs for 24 hours referral service, and provision of 2nd doctor at PHC level (1 male, 1 female) would be undertaken on the basis of felt need. Component (D): Strengthening Community Health Centres (CHCs) for First Referral Care A key strategy of the Mission is: Operationalising existing Community Health Centres (30-50 beds) as 24 hour First Referral Units, including posting of anaesthetists. Codification of new Indian Public Health Standards" setting norms for infrastructure, staff, equipment, management etc. for CHCs. Promotion of Stakeholder Committees (Rogi Kalyan Samitis) for hospital management. Developing standards of services and costs in hospital care. Develop, display and ensure compliance to Citizen's Charter at CHC/PHC level. In case of additional Outlays, creation of new Community Health Centres (30-50 beds) to meet the population norm as per Census 2001, and bearing their recurring costs for the Mission period could be considered. 3. Rural Health Infrastructure - a statistical overview

2.4.4

The Centres Functioning 3.1. The Primary Health Care Infrastructure has been developed as a three tier system with Sub Centre, Primary Health Centre (PHC) and Community Health Centre (CHC) being the three pillars of Primary Health Care System. Progress of Sub Centres, which is the most peripheral contact point between the Primary Health Care System and the community, is a prerequisite for the overall progress of the entire system. A look at the number of Sub Centres 8

functioning over the years reveal that at the end of the Sixth Plan (1981-85) there were 84,376 Sub Centres, which increased to 1,30,165 at the end of Seventh Plan (1985-90) and to 1,45,272 at the end of Tenth Plan (2002-2007). As on March, 2010, 1,47,069 Sub Centres are functioning in the country.

160000 140000 120000

Graph 1A. Progress of Primary Health Care System

130165 84376 136258 137311 145272 147069

umber

100000 80000 60000 40000 20000 0 Sixth Plan (1981-85) Seventh Plan (1985-90) Eighth Plan (1992-97) inth Plan (1997-2002) Tenth Plan (2002-2007) Eleventh Plan (Upto March, 2010)
Sub Centres

Five Year Plan / Year

Graph 1B. Progress of Primary Health Care System

25000 20000 22149 18671 15000 10000 5000 0 Sixth Plan (1981-85) Seventh Plan (1985-90) Eighth Plan (1992-97) inth Plan (1997-2002) Tenth Plan (2002-2007) Eleventh Plan (Upto March, 2010) 9115
Primary Health Centres

22875

22370

23673

umber

Five Year Plan / Year

Graph 1C. Progress of Primary Health Care System

5000 4500 4000 3500 3000 2500 2000 1500 1000 500 0 4535 4045 3054

umber

2633 1910

Community Health Centres

761 Sixth Plan (1981-85) Seventh Plan Eighth Plan (1985-90) (1992-97) inth Plan (1997-2002) Tenth Plan Eleventh Plan (2002-2007) (Upto March, 2010)

Five Year Plan / Year

Similar progress can be seen in the number of PHCs which was 9115 at the end of sixth plan (1981-85) and almost doubled to 18671 at the end of Seventh Plan (1985-90). Number of PHCs rose to 22370 at the end of Tenth Plan (2002-2007). As on March, 2010, there are 9

23673 PHCs functioning in the country. A number of PHCs have been upgraded to the level of CHCs in many States. In accordance with the progress in the number of Sub Centres and PHCs, the number of CHCs have also increased from 761 at the end of Sixth Plan (1981-85) to 1910 at the end of Seventh Plan (1985-90) and 4045 at the end of Tenth Plan (2002-2007). As on March, 2010, 4535 CHCs are functioning in the country. 3.2. Statement 1 presents the number of Sub Centres, PHCs and CHCs existing in 2010 as compared to those reported existing in 2005. As may be seen from the Statement 1, at the national level there is an increase of 1043 Sub Centres, 437 PHCs and 1189 CHCs in 2010 as compared to those existing in 2005. This implies an increase of about 35% in number of CHCs, about 1.8% in number of PHCs and about 0.7% in number of Sub Centres in 2010 as compared to 2005. There is significant increase in the number of Sub Centres in the States of Chhattisgarh, Haryana, Jammu & Kashmir, Maharashtra, Orissa, Punjab, Rajasthan, Tamil Nadu, Tripura and Uttarakhand. Significant increase is also observed in the number of PHCs in the States of Bihar, Chhattisgarh, Haryana, Jammu & Kashmir, Karnataka, Maharashtra, Nagaland, Uttarakhand, Uttar Pradesh and also in the number of CHCs in the States of Arunachal Pradesh, Chhattisgarh, Gujarat, Haryana, Himachal Pradesh, Jammu & Kashmir, Jharkhand, Karnataka, Kerala, Madhya Pradesh, Punjab, Rajasthan, Tamil Nadu, Uttarakhand, Uttar Pradesh and West Bengal. The average population covered by a Sub Centre, PHC and CHC was 5049, 31364 and 163725, respectively. The State-wise variations in the average population covered by a Sub Centre, PHC and CHC are represented in the Map 1 to 3 below, respectively

10

11

ote: It may be noted that the all India analysis presented below for infrastructure and manpower is based on the data received from various States / UTs. The States / UTs which do not have relevant data for a particular item / category, are excluded while calculating percentages for facilities functioning in Government buildings, manpower vacancies and shortfall etc. Building Status 3.3. As on March, 2010, 57.8% of Sub Centres, 88.6% of PHCs and 93.4% of CHCs are located in the Government buildings. The rest are located either in rented building or rent free Panchayat/ Voluntary Society buildings

Graph 2 A. Percentage Distribution of Sub Centres by Building Postion

10.3 Government Buildings 57.8 32.0 Rent-free Rented

Graph 2 B. Percentage Distribution of PHCs by Building Postion

6.6 4.8 Government Buildings Rented Rent-free 88.6

Graph 2 C. Percentage Distribution of CHCs by Building Postion

6.6

Government Buildings Other Rented or Rent-free 93.4

3.4. Statement 2, Statement 3 and Statement 4 give the comparative picture of the status of buildings for Sub Centres, PHCs Percentage of Sub Centres functioning in the and CHCs, respectively, in 2010 as Government buildings has increased from 50% in 2005 compared to that in 2005. As may be to 57.8% in 2010 seen, percentage of Sub Centres Percentage of PHCs functioning in Government functioning in the Government buildings has increased significantly from 78% in 2005 buildings has increased from 50% in to 88.6% in 2010 2005 to 57.8% in 2010 mainly due to The % of CHCs in Govt. buildings has increased from substantial increase in the 90% in 2005 to 93.4% in 2010. government buildings in the States 12

of Chhattisgarh, Goa, Haryana, Karnataka, Madhya Pradesh, Maharashtra, Manipur, Meghalaya, Mizoram, Orissa, Punjab, Rajasthan, Sikkim, Tripura, Uttarakhand, Uttar Pradesh and West Bengal 3.5. Similarly, percentage of PHCs functioning in Government buildings has also increased significantly from 78% in 2005 to 88.6% in 2010. This is mainly due to increase in the Government buildings in the States of Assam, Chhattisgarh, Gujarat, Haryana, Himachal Pradesh, Karnataka, Madhya Pradesh, Maharashtra, Nagaland and Uttar Pradesh. 3.6. Number of CHCs functioning in Government buildings have increased appreciably in 2010 as compared to 2005. The % of CHCs in Govt. buildings has increased from 90% in 2005 to 93.4% in 2010. Manpower 3.7. The availability of manpower is one of the important prerequisite for the efficient functioning of the Rural Health Infrastructure. As on March, 2010 the overall shortfall (which excludes the existing surplus in some of the states) in the posts of HW(F) / As on March, 2010 the overall shortfall in the posts of ANM was 8.8% of the total HW(F) / A M was 8.8% of the total requirement, mainly requirement as per the norm of one due to shortfall in States namely, Bihar, Chhattisgarh, HW(F) / ANM per Sub Centre and Gujarat, Himachal Pradesh, Jammu & Kashmir, Kerala, PHC. The overall shortfall is mainly Orissa, Tripura and Uttar Pradesh. For allopathic Doctors at PHCs, there was a shortfall of due to shortfall in States namely, 10.3% of the total requirement for existing infrastructure Bihar, Chhattisgarh, Gujarat, Himachal as compared to manpower in position. Pradesh, Jammu & Kashmir, Kerala, Orissa, Tripura and Uttar Pradesh. The State-wise variation in shortfall of ANMs is depicted in the Map 4 below.

13

Similarly, in case of HW(M), there was a shortfall of 64.1% of the requirement. In case of Health Assistant (Female)/LHV, the shortfall was 31.9% and that of Health Assistant (Male) was 44%. For allopathic Doctors at PHC, there was a shortfall of 10.3% of the total requirement. This is again mainly due to significant shortfall in Doctors at PHCs in the States of Bihar, Chhattisgarh, Gujarat, Himachal Pradesh, Madhya Pradesh, Orissa, Punjab, Uttarakhand and Uttar Pradesh. Even out of the sanctioned posts, a significant percentage of posts are vacant at all the levels. For instance, 6.3% of the sanctioned posts of HW(Female)/ ANM were vacant as compared to 34% of the sanctioned posts of Male Health Worker.
Graph 3. Percentage Shortfall and Vacancy
70.0 60.0 50.0 40.0 30.0 20.0 10.0 0.0 HW(F)/ANM HW(M) LHV/Health Assistants(F) Health Assistant(M) Doctors at PHC 8.8 6.3 10.3 34.0 31.9 24.3 44.0 30.4 20.7 64.1

Percentage Shortfall Percentage Vacant

At PHCs, 24.3% of the sanctioned posts of Female Health Assistant/ LHV, 30.4% of Male Health Assistant and 20.7% of the sanctioned posts of doctors were vacant. The State-wise variation in the shortfall of Doctors at PHCs is presented in the Map 5 below

14

3.8. At the Sub Centre level the extent of existing manpower can be assessed from the fact that 4.2% of the Sub Centres were without a Female Health Worker / ANM, 51.8% Sub Centres were without a Male Health Worker and 2% Sub Centres were without both Female Health Worker / ANM as well as Male Health Worker.
Graph 4. Percentage of Sub Centres functioning without A Ms or/and HW(M)
51.8

60.0
Percentage

50.0 40.0 30.0 20.0 10.0 0.0

4.2 Without HW (F)/ A M Without HW(M)

2.0 Without Both

3.9. PHC is the first contact point between village community and the Medical Officer. Manpower in PHC include a Medical Officer supported by paramedical and other staff. As on March, 2010, 3.3% of the PHCs were without a doctor, 36.3% were without a Lab technician and 17.5% were

without a Pharmacist.

3.10. The Community Health Centres facilities of Surgeons, Obstetricians & Gynaecologists, Physicians and Paediatricians. The current position of specialists manpower at CHCs reveal that as on March, 2010, out of the sanctioned posts, 49.7% of Surgeons, 36.6% of Obstetricians & Gynaecologists, 49.6% of Physicians

provide specialized medical care in the form of

The Specialist doctors at CHCs have increased from 3550 in 2005 to 6781 in 2010. However, as compared to requirement for existing infrastructure, there was a shortfall of 62.8% of Surgeons, 55.2% of Obstetricians & Gynaecologists, 72% of Physicians and 69.5% of Paediatricians. Overall, there was a shortfall of 62.6% specialists at the CHCs

and 51.9% of Paediatricians were vacant. Overall about 42% Graph 5. Percentage of PHCs without Doctor, Lab Tech., Pharmacist of the sanctioned posts of 40.0 36.3 specialists at CHCs were 35.0 vacant. Moreover, as compared 30.0 25.0 to requirement for existing 17.5 20.0 infrastructure, there was a 15.0 shortfall of 62.8% of Surgeons, 10.0 3.3 55.2% of Obstetricians & 5.0 Gynaecologists, 72% of 0.0 Physicians and 69.5% of Without Doctor Without Lab Technician Without Pharmacist Paediatricians. Overall, there was a shortfall of 62.6% specialists at the CHCs as compared to the requirement for existing CHCs. The shortfall in Specialists is significantly high in most of the States. The State-wise variations in the shortfall of Specialists is presented in Map 6 below. However, alongwith the specialists, about 9971 General Duty Medical Officers (GDMOs) are also available at CHCs as on March, 2010.
Percentage of PHCs

15

Graph 6. Percentage Shortfall and Vacancy of Specialits at CHCs

Percentage Shortfall
80.0 70.0 60.0 49.7 50.0 40.0 30.0 20.0 10.0 0.0 Sugeons O&G Physicians Paediatricians Total 36.6 62.8 55.2 49.6 51.9 42.3 71.7 69.5

Percentage Vacant
62.6

3.11. When we compare the manpower position of major categories in 2010 with that in 2005, as presented in Statement 5 to Statement 11, it is observed that there are significant improvement in terms of the numbers in all the categories. For instance, the number of ANMs at Sub Centres and PHCs (Statement 5) have increased from 133194 in 2005 to 191457 in 2010 which amounts to an increase of about 43.7%. Similarly, the Doctors at PHCs (Statement 6) have increased from 20308 in 2005 to 25870 in 2010, which is about 27% increase. Moreover, the Specialist doctors at CHCs (Statement 7) have increased from 3550 in 2005 to 6781 in 2010, which implies an appreciable 91% increase in 5 years of NRHM.

16

3.12. Looking at the State-wise picture, it may be observed that the increase in ANMs is attributed mainly to significant increase in the States of Andhra Pradesh, Assam, Goa, Haryana, Jammu & Kashmir, Karnataka, Madhya Pradesh, Maharashtra, Manipur, Mizoram, Nagaland, Orissa, Punjab, Rajasthan, Uttarakhand, Uttar Pradesh and West Bengal. Similarly, there is significant increase in the number of Doctors at PHCs in the States namely Andhra Pradesh, Jammu & Kashmir, Karnataka, Kerala, Manipur, Mizoram, Nagaland, Punjab and Rajasthan. In case of specialists, appreciable increase is noticed in the States of Andhra Pradesh, Chhattisgarh, Goa, Jammu & Kashmir, Karnataka, Kerala, Madhya Pradesh, Punjab and West Bengal. Significant increase in the number of paramedical staff is also observed when compared with the position of 2005. For instance, the number of Radiographers at CHCs (Statement 8) have increase from 1337 in 2005 to 1817 in 2010. Number of Pharmacists at PHCs and CHCs (Statement 9) have increased from 17708 in 2005 to 21688 in 2010. Similarly, the number of Laboratory Technicians at PHCs and CHCs (Statement 10) have increased from 12284 in 2005 to 15094 in 2010 and number of Nurses at PHCs and CHCs (Statement 11) have increased from 28930 in 2005 to 58450 in 2010.

17

Statement 1.
UMBER OF SUB-CE TRES, PHCs & CHCs FU CTIO I G
2005 2010

S. o. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35

State/UT Andhra Pradesh Arunachal Pradesh Assam Bihar Chhattisgarh Goa Gujarat Haryana Himachal Pradesh Jammu & Kashmir1 Jharkhand Karnataka Kerala2 Madhya Pradesh Maharashtra Manipur Meghalaya Mizoram Nagaland Orissa Punjab3 Rajasthan Sikkim Tamil Nadu Tripura Uttarakhand Uttar Pradesh West Bengal4 Andaman & Nicobar Islands Chandigarh Dadra & Nagar Haveli5 Daman & Diu Delhi Lakshadweep Puducherry All India

Sub Centre 12522 379 5109 10337 3818 172 7274 2433 2068 1879 4462 8143 5094 8874 10453 420 401 366 394 5927 2858 10512 147 8682 539 1576 20521 10356 107 13 38 21 41 14 76 146026

PHCs 1570 85 610 1648 517 19 1070 408 439 334 561 1681 911 1192 1780 72 101 57 87 1282 484 1713 24 1380 73 225 3660 1173 20 0 6 3 8 4 39 23236

CHCs 164 31 100 101 116 5 272 72 66 70 47 254 106 229 382 16 24 9 21 231 116 326 4 35 10 44 386 95 4 1 1 1 0 3 4 3346

Sub Centre 12522 286 4604 9696 4776 172 7274 2484 2071 1907 3958 8143 4575 8869 10580 420 405 370 396 6688 2950 11487 147 8706 627 1765 20521 10356 114 16 50 26 41 14 53 147069

PHCs 1570 97 856 1863 716 19 1096 441 449 375 330 2193 813 1155 1816 73 109 57 126 1279 446 1504 24 1283 79 239 3692 909 19 0 6 3 8 4 24 23673

CHCs 167 48 108 70 143 5 290 107 73 77 188 325 233 333 365 16 29 9 21 231 129 368 0 256 11 55 515 348 4 2 1 2 0 3 3 4535

Note:
1 2

8 CHCs upgraded to the level of District Hospital during 2009-10

Because of the implementation of standardization of health institutions some of the PHCs were changed to CHC and vice versa Some of the CHCs with more facilities and patient attendance have been changed to Taluk Hospitals.
3 4 5

State Govt notified rural hospitals and other institutions functioning in the state as PHCs.

PHCs upgraded to CHCs 12 new Sub Centres opened

18

Statement 2.
BUILDI G POSITIO FOR SUB CE TRES 2005
Sub Centres functioning in Total umber of Sub Centers functioning Rent Free Panchayat / Vol. Society Building Total umber of Sub Centers functioning

2010
Sub Centres functioning in Rent Free Panchayat / Vol. Society Building Buildings under constructio n

S. o. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35

Govt. Building

Rented Building

Govt. Building

Rented Building

State/UT
Andhra Pradesh Arunachal Pradesh Assam Bihar Chhattisgarh Goa Gujarat Haryana Himachal Pradesh Jammu & Kashmir Jharkhand Karnataka Kerala Madhya Pradesh Maharashtra Manipur Meghalaya Mizoram Nagaland Orissa# Punjab Rajasthan Sikkim Tamil Nadu Tripura Uttarakhand Uttar Pradesh West Bengal A& N Islands Chandigarh D & N Haveli Daman & Diu Delhi Lakshadweep Puducherry All India

12522 379 5109 10337 3818 172 7274 2433 2068 1879 4462 8143 5094 8874 10453 420 401 366 394 5927 2858 10512 147 8682 539 1576 20521 10356 107 13 38 21 41 14 76 146026

4221 NA 2637 NA 1458 40 5554 1499 1262 NA NA 4460 2986 3996 6527 216 391 366 NA 2542 1443 8211 108 6510 278 562 6494 1923 107 8 38 20 NA 8 36 63901

8301 NA 2472 NA 0 132 0 0 14 NA NA 2893 1098 4878 1098 131 10 0 NA 3385 0 0 31 2172 202 1014 14027 8433 0 0 0 1 NA 6 40 50338

0 NA 0 NA 2360 0 1720 934 792 NA NA 790 1010 0 2828 73 0 0 NA 0 1415 2301 8 0 59 0 0 0 0 5 0 0 NA 0 0 14295

12522 286 4604 9696 4776 172 7274 2484 2071 1907 3958 8143 4575 8869 10580 420 405 370 396 6688 2950 11487 147 8706 627 1765 20521 10356 114 16 50 26 41 14 53 147069

4221 286 2152 4848 2019 46 5212 1502 1274 582 1809 4493 2128 7254 7717 316 397 370 333 2730 1828 10245 139 6510 321 909 10403 4684 114 5 38 20 8 8 36 84957

8301 0 2084 4848 33 126 0 0 14 1263 1314 2585 981 1035 974 104 8 0 0 3958 0 652 8 1860 171 849 10118 5656 0 0 12 4 11 6 17 46992

0 0 368 0 2724 0 2062 982 783 62 835 1065 1466 580 1889 0 0 0 63 0 1122 590 0 336 135 7 0 16 0 11 0 2 22 0 0 15120

691 2 2250 0 591 4 852 286 189 0 392 152 62 667 625 104 15 0 50 242 0 115 2 0 95 0 1545 477 0 0 0 0 0 0 4 9412

For calculating the overall percentages the States/UTs for which building position is not available, may be excluded # Data for 2009 repeated

19

Statement 3.
BUILDI G POSITIO FOR PRIMARY HEALTH CE TRES

2005
PHCs functioning in Total umber of PHCs functioning Rent Free Panchayat / Vol. Society Building Total umber of PHCs functioning

2010
PHCs functioning in Rent Free Panchayat / Vol. Society Building Buildings under construction

S. o. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35

Govt. Building

Rented Building

Govt. Building

Rented Building

State/UT Andhra Pradesh Arunachal Pradesh Assam Bihar Chhattisgarh Goa Gujarat Haryana Himachal Pradesh Jammu & Kashmir Jharkhand Karnataka Kerala Madhya Pradesh Maharashtra Manipur Meghalaya Mizoram Nagaland Orissa# Punjab Rajasthan Sikkim Tamil Nadu Tripura Uttarakhand Uttar Pradesh West Bengal A& N Islands Chandigarh D & N Haveli Daman & Diu Delhi Lakshadweep Puducherry All India

1570 85 610 1648 517 19 1070 408 439 334 561 1681 911 1192 1780 72 101 57 87 1282 484 1713 24 1380 73 225 3660 1173 20 0 6 3 8 4 39 23236

1281 NA 610 NA 326 18 663 288 312 NA NA 1439 837 746 1417 NA 101 57 87 1282 409 1446 24 1340 73 182 1835 1173 20 0 6 3 8 4 36 16023

289 NA 0 NA 0 1 0 0 46 NA NA 92 34 446 7 NA 0 0 0 0 0 0 0 40 0 43 1825 0 0 0 0 0 0 0 3 2826

0 NA 0 NA 191 0 407 120 81 NA NA 150 40 0 356 NA 0 0 0 0 75 267 0 0 0 0 0 0 0 0 0 0 0 0 0 1687

1570 97 856 1863 716 19 1096 441 449 375 330 2193 813 1155 1816 73 109 57 126 1279 446 1504 24 1283 79 239 3692 909 19 0 6 3 8 4 24 23673

1281 97 856 NA 355 19 1035 309 347 287 185 2154 794 999 1557 73 109 57 115 1248 402 1425 24 1267 79 179 3091 909 19 0 6 3 8 4 24 19317

289 0 0 NA 110 0 0 0 39 86 58 0 12 135 15 0 0 0 0 0 0 35 0 7 0 60 601 0 0 0 0 0 0 0 0 1447

0 0 0 NA 251 0 61 132 63 2 87 39 7 21 244 0 0 0 11 31 44 44 0 9 0 0 0 0 0 0 0 0 0 0 0 1046

52 0 150 NA 126 0 13 79 102 60 86 40 0 99 113 20 0 0 13 36 0 117 0 126 3 0 44 0 0 0 0 1 3 0 0 1283

otes: For calculating the overall percentages the States/UTs for which building position is not available, may be excluded

20

Statement 4.
BUILDI G POSITIO FOR COMMU ITY HEALTH CE TRES 2005 2010
CHCs functioning in Total umber of CHCs functioning Rent Free Panchayat / Vol. Society Building Total umber of CHCs functioning CHCs functioning in Rent Free Panchayat / Vol. Society Building

S. o.

State/UT

Govt. Building

Rented Building

Govt. Building

Rented Building

Buildings under construction

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35

Andhra Pradesh Arunachal Pradesh Assam Bihar Chhattisgarh Goa Gujarat Haryana Himachal Pradesh Jammu & Kashmir Jharkhand Karnataka Kerala Madhya Pradesh Maharashtra1 Manipur Meghalaya Mizoram Nagaland Orissa Punjab Rajasthan Sikkim Tamil Nadu Tripura Uttarakhand Uttar Pradesh West Bengal A& N Islands Chandigarh D & N Haveli Daman & Diu Delhi Lakshadweep Puducherry All India

164 31 100 101 116 5 272 72 66 70 47 254 106 229 382 16 24 9 21 231 116 326 4 35 10 44 386 95 4 1 1 1 0 3 4 3346

164 NA 100 NA 116 5 225 72 65 NA NA 207 105 229 290 NA 24 9 21 231 115 256 4 35 10 44 386 95 4 1 1 1 0 3 4 2822

0 NA 0 NA 0 0 0 0 0 NA NA 0 0 0 5 NA 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5

0 NA 0 NA 0 0 47 0 1 NA NA 47 1 0 87 NA 0 0 0 0 1 70 0 0 0 0 0 0 0 0 0 0 0 0 0 254

167 48 108 70 143 5 290 107 73 77 188 325 233 333 365 16 29 9 21 231 129 368 0 256 11 55 515 348 4 2 1 2 0 3 3 4535

167 48 108 70 110 5 245 106 73 76 188 299 233 215 309 16 29 9 21 231 116 362 0 256 11 55 515 348 4 2 1 2 0 3 3 4236

0 0 0 0 8 0 0 0 0 1 0 0 0 117 56 0 0 0 0 0 0 3 0 0 0 0 0 0 0 0 0 0 0 0 0 299

0 0 0 0 25 0 45 1 0 0 0 26 0 1 0 0 0 0 0 13 3 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 60 0 22 0 35 19 0 0 144 53 0 41 28 0 0 0 3 0 0 12 0 50 0 0 17 0 0 0 0 0 0 0 0 484

otes: For calculating the overall percentages the States/UTs for which building position is not available, may be excluded 1 Break-up of rented, rent-free buildings etc. not available

21

Statement 5.
HEALTH WORKER [FEMALE] / A M AT SUB CE TRES & PHCs

2005
Health Worker [Female]/A M

2010
Health Worker [Female]/A M Shortfall Required1 Sanctioned In Position Vacant Shortfall

S. o. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35

State/UT Andhra Pradesh Arunachal Pradesh Assam Bihar# Chhattisgarh Goa Gujarat Haryana Himachal Pradesh Jammu & Kashmir Jharkhand Karnataka Kerala Madhya Pradesh Maharashtra## Manipur Meghalaya Mizoram Nagaland Orissa Punjab Rajasthan Sikkim Tamil Nadu Tripura Uttarakhand Uttar Pradesh West Bengal A& N Islands Chandigarh D & N Haveli Daman & Diu Delhi Lakshadweep Puducherry All India2

Required1

Sanction ed

In Position

Vacant

[R] 14092 464 5719 11985 4335 191 8344 2841 2507 2213 5023 9824 6005 10066 12233 492 502 423 481 7209 3342 12225 171 10062 612 1801 24181 11529 127 13 44 24 49 18 115 169262

[S] 14077 454 5719 NA 4335 196 7274 2841 2210 1964 NA 8756 5675 10027 11032 463 667 366 342 7121 2704 11425 267 10366 525 1660 18577 10356 127 13 38 24 60 22 115 139798

[P] 13740 454 5719 NA 3667 179 6508 2818 1790 1588 NA 8544 5565 9345 10699 463 608 345 342 6768 2602 11425 260 10112 561 1486 18146 9070 127 13 38 24 51 22 115 133194

[S-P] 337 0 0 NA 668 17 766 23 420 376 NA 212 110 682 333 0 59 21 0 353 102 0 7 254 * 174 431 1286 0 0 0 0 9 0 0 6640

[R-P] 352 10 0 NA 668 12 1836 23 717 625 NA 1280 440 721 1534 29 * 78 139 441 740 800 * * 51 315 6035 2459 0 0 6 0 * * 0 19311

[R] 14092 383 5460 11559 5492 191 8370 2925 2520 2282 4288 10336 5388 10024 12396 493 514 427 522 7967 3396 12991 171 9989 706 2004 24213 11265 133 16 56 29 49 18 77 170742

[S] 10568 NA NA 10557 5492 185 7248 5142 2213 2282 NA 15450 4236 10135 14408 1058 667 388 342 7442 4003 14182 219 10179 NA 2077 22540 10356 214 16 40 26 43 14 72 161794

[P] 22140 395 9144 9127 2986 237 6431 4507 1710 2064 6443 15081 4173 13282 17512 948 775 619 822 7322 4009 16086 260 10067 406 2192 19209 12966 214 30 79 40 43 14 124 191457

[S-P] * NA NA 1430 2506 * 817 635 503 218 NA 369 63 * * 110 * * * 120 * * * 112 NA * 3331 * 0 * * * 0 0 * 10214

[R-P] * * * 2432 2506 * 1939 * 810 218 * * 1215 * * * * * * 645 * * * * 300 * 5004 * * * * * 6 4 * 15079

otes: # Data for 2009 repeated ## Sanctioned data for 2009 used 1 One per each existing Sub Centre and Primary Health Centre 2 Total given in the Table are not strictly comparable as figures for some of the States were not available in 2005. For calculating the overall percentages of vacancy and shortfall, the States/UTs for which manpower position is not available, may be excluded. *: Surplus. All India figures for Vacancy and Shortfall are the totals of State-wise Vacancy and Shortfall ignoring surplus in some States / UTs

22

Statement 6.
DOCTORS AT PRIMARY HEALTH CE TRES
3

2005
Doctors at PHCs

2010
Doctors at PHCs Vacant Shortfall Required1 Sanctione d In Position Vacant Shortfall

S. o. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35

State/UT Andhra Pradesh Arunachal Pradesh Assam Bihar# Chhattisgarh Goa Gujarat Haryana Himachal Pradesh Jammu & Kashmir Jharkhand Karnataka Kerala Madhya Pradesh Maharashtra## Manipur Meghalaya Mizoram## Nagaland Orissa Punjab Rajasthan Sikkim Tamil Nadu Tripura Uttarakhand Uttar Pradesh West Bengal A& N Islands Chandigarh D & N Haveli Daman & Diu Delhi Lakshadweep## Puducherry All India2

Required1

Sanctione d

In Position

[R] 1570 85 610 1648 517 19 1070 408 439 334 561 1681 911 1192 1780 72 101 57 87 1282 484 1713 24 1380 73 225 3660 1173 20 0 6 3 8 4 39 23236

[S] 2497 78 NA NA 1034 56 1070 862 354 668 NA 2237 1345 1278 3157 95 127 57 53 1353 646 1517 48 3806 161 272 NA 1560 36 0 6 5 31 4 63 24476

[P] 2137 78 NA NA 628 53 848 862 467 643 NA 2041 949 839 3158 67 123 35 53 1353 373 1506 48 2257 152 182 NA 1319 36 0 6 5 23 4 63 20308

[S-P] 360 0 NA NA 406 3 222 0 * 25 NA 196 396 439 * 28 4 22 0 0 273 11 0 1549 9 90 NA 241 0 0 0 0 8 0 0 4282

[R-P] * 7 NA NA * * 222 * * * NA * * 353 * 5 * 22 34 * 111 207 * * * 43 NA * * 0 0 * * 0 * 1004

[R] 1570 97 856 1863 716 19 1096 441 449 375 330 2193 813 1155 1816 73 109 57 126 1279 446 1504 24 1283 79 239 3692 909 19 0 6 3 8 4 24 23673

[S] 2497 NA NA 2078 1432 47 1096 651 582 750 NA 3528 1204 1155 1800 219 127 57 33 1396 477 1659 48 2569 NA 299 4509 1302 52 0 6 3 22 4 37 29639

[P] 2214 92 1301 1565 577 44 837 513 438 786 404 3198 1122 541 2065 85 117 51 102 1074 410 1763 45 2268 104 234 2861 932 52 0 6 5 21 6 37 25870

[S-P] 283 NA NA 513 855 3 259 138 144 * NA 330 82 614 * 134 10 6 * 322 67 * 3 301 NA 65 1648 370 0 0 0 * 1 * 0 6148

[R-P] * 5 * 298 139 * 259 * 11 * * * * 614 * * * 6 24 205 36 * * * * 5 831 * * 0 0 * * * * 2433

ote: # Data for 2009 repeated ## Sanctioned data for 2009 used 1 One per each Primary Health Centre 2 Total given in the Table are not strictly comparable as figures for some of the States were not available in 2005. For calculating the overall percentages of vacancy and shortfall, the States/UTs for which manpower position is not available, may be excluded 3 Allopathic Doctors *: Surplus. All India figures for Vacancy and Shortfall are the totals of State-wise Vacancy and Shortfall ignoring surplus in some States / UTs

23

Statement 7.
TOTAL SPECIALISTS AT CHCs 2005
[Surgeons, OB&GY, Physicians & Paediatricians]

2010
[Surgeons, OB&GY, Physicians & Paediatricians] In Position

S. o. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35

State/UT Andhra Pradesh Arunachal Pradesh Assam Bihar# Chhattisgarh Goa Gujarat Haryana Himachal Pradesh Jammu & Kashmir Jharkhand3 Karnataka Kerala3 Madhya Pradesh Maharashtra## Manipur Meghalaya# Mizoram## Nagaland Orissa Punjab Rajasthan Sikkim Tamil Nadu4 Tripura Uttarakhand Uttar Pradesh West Bengal A& N Islands Chandigarh D & N Haveli Daman & Diu Delhi Lakshadweep Puducherry All India2

Required1

Sanctioned

In Position

Vacant

Shortfa ll

Required1

Sanctioned

Vacant

Shortfall

[R] 656 124 400 404 464 20 1088 288 264 280 188 1016 424 916 1528 64 96 36 84 924 464 1304 16 140 40 176 1544 380 16 4 4 4 0 12 16 13384

[S] 406 4 NA NA 464 14 321 288 NA 276 NA 843 424 253 1987 40 1 0 0 496 393 811 16 48 2 163 NA 310 12 4 2 0 0 0 4 7582

[P] 224 0 NA NA 18 7 92 49 NA 142 NA 691 82 49 1099 19 1 0 0 NA 226 581 4 48 2 71 NA 133 0 4 2 0 0 0 6 3550

[S-P] 182 4 NA NA 446 7 229 239 NA 134 NA 152 342 204 888 21 0 0 0 NA 167 230 12 0 0 92 NA 177 12 0 0 0 0 0 * 3538

[R-P] 432 124 NA NA 446 13 996 239 NA 138 NA 325 342 867 429 45 95 36 84 NA 238 723 12 92 38 105 NA 247 16 0 2 4 0 12 10 6110

[R] 668 192 432 280 572 20 1160 428 292 308 752 1300 932 1332 1460 64 116 36 84 924 516 1472 0 1024 44 220 2060 1392 16 8 4 8 0 12 12 18140

[S] 668 NA NA 280 572 14 346 372 NA 315 NA 1300 640 502 314 64 3 0 NA 812 448 931 0 0 NA 210 1460 542 16 11 0 2 0 0 3 9825

[P] 480 1 209 104 46 13 79 70 3 165 84 726 774 245 954 1 4 4 34 469 300 492 0 0 0 78 1256 175 0 10 0 0 0 0 5 6781

[S-P] 188 NA NA 176 526 1 267 302 NA 150 NA 574 * 257 * 63 * * NA 343 148 439 0 0 NA 132 204 367 16 1 0 2 0 0 * 4156

[R-P] 188 191 223 176 526 7 1081 358 289 143 668 574 158 1087 506 63 112 32 50 455 216 980 0 1024 44 142 804 1217 16 * 4 8 0 12 7 11361

otes: # Data for 2009 repeated ## Sanctioned data for 2009 used 1 Four per each Community Health Centre 2 Total given in the Table are not strictly comparable as figures for some of the States were not available in 2005. For calculating the overall percentages of vacancy and shortfall, the States/UTs for which manpower position is not available, may be excluded. 3 Breakup of Specialist not available for 2010 4 For 2010, Specialists attending CHCs on hiring basis *: Surplus. All India figures for Vacancy and Shortfall are the totals of State-wise Vacancy and Shortfall ignoring surplus in some States / UTs

24

Statement 8.
RADIOGRAPHERS at CHCs 2005
Radiographer

2010
Radiographer In Sanctione Positio Vacan d n t

S. o. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35
otes:

State/UT Andhra Pradesh Arunachal Pradesh Assam Bihar # Chhattisgarh Goa Gujarat Haryana Himachal Pradesh Jammu & Kashmir Jharkhand Karnataka Kerala Madhya Pradesh Maharashtra ## Manipur Meghalaya Mizoram## Nagaland Orissa Punjab Rajasthan Sikkim Tamil Nadu Tripura Uttarakhand Uttar Pradesh West Bengal A& N Islands Chandigarh D & N Haveli Daman & Diu Delhi Lakshadweep## Puducherry All India2

Required1

Sanctioned

In Position

Vacan t

Shortfa ll

Required
1

Shortfall

[R] 164 31 100 101 116 5 272 72 66 70 47 254 106 229 382 16 24 9 21 231 116 326 4 35 10 44 386 95 4 1 1 1 0 3 4 3346

[S] 161 22 NA NA 116 7 271 118 66 61 NA 51 17 NA 180 5 28 NA 11 26 80 269 8 28 4 40 NA 86 4 1 1 1 0 3 4 1669

[P] 140 22 NA NA 95 7 113 106 54 61 NA 30 16 NA 159 5 26 NA 11 8 57 269 5 28 4 30 NA 77 4 1 1 1 0 3 4 1337

[S-P] 21 0 NA NA 21 0 158 12 12 0 NA 21 1 NA 21 0 2 NA 0 18 23 0 3 0 0 10 NA 9 0 0 0 0 0 0 0 332

[R-P] 24 9 NA NA 21 * 159 * 12 9 NA 224 90 NA 223 11 * NA 10 223 59 57 * 7 6 14 NA 18 0 0 0 0 0 0 0 1176

[R] 167 48 108 70 143 5 290 107 73 77 188 325 233 333 365 16 29 9 21 231 129 368 0 256 11 55 515 348 4 2 1 2 0 3 3 4535

[S] 167 NA NA 89 143 8 273 91 71 77 NA 51 13 193 407 16 21 9 11 48 112 192 0 207 NA 55 269 366 4 5 0 3 0 3 3 2907

[P] 65 9 61 15 60 7 122 73 45 70 23 30 10 138 121 12 22 9 1 33 107 258 0 98 7 13 163 226 4 3 1 3 0 5 3 1817

[S-P] 102 NA NA 74 83 1 151 18 26 7 NA 21 3 55 286 4 * 0 10 15 5 * 0 109 NA 42 106 140 0 2 * 0 0 * 0 1260

[R-P] 102 39 47 55 83 * 168 34 28 7 165 295 223 195 244 4 7 0 20 198 22 110 0 158 4 42 352 122 0 * 0 * 0 * 0 2724

# Data for 2009 repeated ## Sanctioned data for 2009 used 1 One per each Community Health Centre 2 Total given in the Table are not strictly comparable as figures for some of the States were not available in 2005. For calculating the overall percentages of vacancy and shortfall, the States/UTs for which manpower position is not available, may be excluded *: Surplus. All India figures for Vacancy and Shortfall are the totals of State-wise Vacancy and Shortfall ignoring surplus in some States / UTs

25

Statement 9.
PHARMACISTS at PHCs & CHCs 2005
S. o.

2010
Pharmacist In Sanctioned Position

State/UT Andhra Pradesh# Arunachal Pradesh Assam Bihar # Chhattisgarh Goa Gujarat Haryana Himachal Pradesh Jammu & Kashmir Jharkhand Karnataka Kerala Madhya Pradesh Maharashtra## Manipur Meghalaya Mizoram## Nagaland Orissa Punjab Rajasthan Sikkim Tamil Nadu Tripura Uttarakhand Uttar Pradesh West Bengal A& N Islands Chandigarh D & N Haveli Daman & Diu Delhi Lakshadweep## Puducherry All India2

Required1

Pharmacist In Sanctioned Position

Vacant

Shortfall

Required1

Vacant

Shortfall

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35
otes:

[R] 1734 116 710 1749 633 24 1342 480 505 404 608 1935 1017 1421 2162 88 125 66 108 1513 600 2039 28 1415 83 269 4046 1268 24 1 7 4 8 7 43 26582

[S] 1704 31 NA NA 749 28 1413 480 505 456 NA 1935 1038 1419 2256 111 145 69 85 2040 854 2375 28 1440 47 293 NA 1438 28 6 8 4 13 11 63 21072

[P] 1637 31 NA NA 467 27 807 464 375 456 NA 1880 858 216 2055 88 121 35 85 1984 811 2355 3 1252 63 281 NA 1231 28 6 8 4 11 11 58 17708

[S-P] 67 0 NA NA 282 1 606 16 130 0 NA 55 180 1203 201 23 24 34 0 56 43 20 25 188 * 12 NA 207 0 0 0 0 2 0 5 3380

[R-P] 97 85 NA NA 166 * 535 16 130 * NA 55 159 1205 107 0 4 31 23 * * * 25 163 20 * NA 37 * * * 0 * * * 2858

[R] 1737 145 964 1933 859 24 1386 548 522 452 518 2518 1046 1488 2181 89 138 66 147 1510 575 1872 24 1539 90 294 4207 1257 23 2 7 5 8 7 27 28208

[S] 1686 NA NA 989 1002 26 1394 502 614 606 501 2518 1035 642 2367 105 149 69 35 1720 844 362 24 1640 NA 331 2585 1527 27 16 6 5 8 11 30 23376

[P] 1614 56 1255 439 370 26 904 410 344 643 344 2054 1014 331 1921 128 142 54 112 1567 1067 587 24 1159 120 267 3527 1103 27 15 8 4 7 16 29 21688

[S-P] 72 NA NA 550 632 0 490 92 270 * 157 464 21 311 446 * 7 15 * 153 * * 0 481 NA 64 * 424 0 1 * 1 1 * 1 4653

[R-P] 123 89 * 1494 489 * 482 138 178 * 174 464 32 1157 260 * * 12 35 * * 1285 0 380 * 27 680 154 * * * 1 1 * * 7655

# Data for 2009 repeated ## Sanctioned data for 2009 used 1 One per each Primary Health Centre and Community Health Centre 2 Total given in the Table are not strictly comparable as figures for some of the States were not available in 2005. For calculating the overall percentages of vacancy and shortfall, the States/UTs for which manpower position is not available, may be excluded *: Surplus. All India figures for Vacancy and Shortfall are the totals of State-wise Vacancy and Shortfall ignoring surplus in some States / UTs

26

Statement 10.
LABORATORY TECH ICIA S at PHCs & CHCs 2005
S. o.
Lab Technician In Positio Sanctioned n Vacant

2010
Lab Technician

State/UT Andhra Pradesh Arunachal Pradesh Assam Bihar # Chhattisgarh Goa Gujarat Haryana Himachal Pradesh Jammu & Kashmir Jharkhand Karnataka Kerala Madhya Pradesh Maharashtra## Manipur Meghalaya Mizoram## Nagaland Orissa Punjab Rajasthan Sikkim Tamil Nadu Tripura Uttarakhand Uttar Pradesh West Bengal A& N Islands Chandigarh D & N Haveli Daman & Diu Delhi Lakshadweep## Puducherry All India2

Required1

Shortfall

Required1

Sanctioned

In Position

Vacant

Shortfall

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35

[R] 1734 116 710 1749 633 24 1342 480 505 404 608 1935 1017 1421 2162 88 125 66 108 1513 600 2039 28 1415 83 269 4046 1268 24 1 7 4 8 7 43 26582

[S] 1691 18 NA NA 633 26 1357 391 505 395 NA 1650 368 454 1845 38 137 69 45 344 747 2153 36 1024 55 90 NA 427 24 2 7 4 8 8 20 14571

[P] 1437 18 NA NA 348 25 870 231 462 395 NA 1451 358 386 1709 30 134 31 45 311 600 2065 32 861 43 32 NA 341 24 2 7 4 5 7 20 12284

[S-P] 254 0 NA NA 285 1 487 160 43 0 NA 199 10 68 136 8 3 38 0 33 147 88 4 163 12 58 NA 86 0 0 0 0 3 1 0 2287

[R-P] 297 98 NA NA 285 * 472 249 43 9 NA 484 659 1035 453 58 * 35 63 1202 0 * * 554 40 237 NA 927 0 * 0 0 3 0 23 7226

[R] 1737 145 964 1933 859 24 1386 548 522 452 518 2518 1046 1488 2181 89 138 66 147 1510 575 1872 24 1539 90 294 4207 1257 23 2 7 5 8 7 27 28208

[S] 1591 NA NA 683 859 25 1386 446 387 529 446 1694 238 535 1816 105 146 40 13 476 648 1818 24 1316 NA 89 1116 1365 23 8 6 4 8 8 10 17858

[P] 1363 88 1213 135 280 25 975 344 194 457 417 1344 268 384 1170 146 134 82 104 388 476 2635 27 870 66 87 995 334 23 9 9 4 6 13 29 15094

[S-P] 228 NA NA 548 579 0 411 102 193 72 29 350 * 151 646 * 12 * * 88 172 * * 446 NA 2 121 1031 0 * * 0 2 * * 5183

[R-P] 374 57 * 1798 579 * 411 204 328 * 101 1174 778 1104 1011 * 4 * 43 1122 99 * * 669 24 207 3212 923 0 * * 1 2 * * 14225

otes # Data for 2009 repeated ## Sanctioned data for 2009 used 1 One per each Primary Health Centre and Community Health Centre 2 Total given in the Table are not strictly comparable as figures for some of the States were not available in 2005. For calculating the overall percentages of vacancy and shortfall, the States/UTs for which manpower position is not available, may be excluded

27

Statement 11.
ursing Staff at PHCs & CHCs 2005
S. o.

2010
Required1 Sanctioned In Position Vacant Shortfall

State/UT
Andhra Pradesh Arunachal Pradesh Assam Bihar## Chhattisgarh Goa Gujarat Haryana Himachal Pradesh Jammu & Kashmir Jharkhand Karnataka Kerala Madhya Pradesh Maharashtra ## Manipur Meghalaya Mizoram Nagaland Orissa Punjab Rajasthan Sikkim Tamil Nadu Tripura Uttarakhand Uttar Pradesh West Bengal A& N Islands Chandigarh D & N Haveli Daman & Diu Delhi Lakshadweep## Puducherry All India2

Required1

Sanctioned

In Position

Vacant

Shortfall

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35
otes:
1

[R] 2718 302 1310 2355 1329 54 2974 912 901 824 890 3459 1653 2795 4454 184 269 120 234 2899 1296 3995 52 1625 143 533 6362 1838 48 7 13 10 8 25 67 46658

[S] 2309 105 NA NA 601 129 2769 1530 1540 244 NA 3229 2811 908 2766 83 355 270 520 657 697 9891 45 167 125 145 NA 1901 108 13 12 12 10 13 96 34061

[P] 2053 105 NA NA 540 119 1453 1160 1259 68 NA 3100 2578 902 2575 62 263 122 520 637 640 8425 45 167 274 129 NA 1479 108 13 10 12 4 13 95 28930

[S-P] 256 0 NA NA 61 10 1316 370 281 176 NA 129 233 6 191 21 92 148 0 20 57 1466 0 0 * 16 NA 422 0 0 2 0 6 0 1 5280

[R-P] 665 197 NA NA 789 * 1521 * * 756 NA 359 * 1893 1879 122 6 * * 2262 656 * 7 1458 * 404 NA 359 * * 3 * 4 12 * 13352

[R] 2739 433 1612 2353 1717 54 3126 1190 960 914 1646 4468 2444 3486 4371 185 312 120 273 2896 1349 4080 24 3075 156 624 7297 3345 47 14 13 17 8 25 45 55418

[S] 4882 NA NA 1662 344 118 4058 2478 546 991 NA 3463 2811 2879 7526 234 441 NA 520 729 1715 5628 NA 5379 NA 240 4548 5264 115 47 8 14 10 34 121 56805

[P] 4056 293 2755 1425 330 116 2705 2003 379 783 578 4309 3383 1831 6150 373 413 241 302 649 1806 11621 16 4287 247 343 2627 4026 115 49 42 11 7 47 132 58450

[S-P] 826 NA NA 237 14 2 1353 475 167 208 NA * * 1048 1376 * 28 NA 218 80 * * NA 1092 NA * 1921 1238 0 * * 3 3 * * 10289

[R-P] * 140 * 928 1387 * 421 * 581 131 1068 159 * 1655 * * * * * 2247 * * 8 * * 281 4670 * * * * 6 1 * * 13683

*:

A: ot Available. One per Primary Health Centre and 7 per Community Health Centre Surplus. 2 Total given in the Table are not strictly comparable as figures for some of the States were not available in 2005. For calculating the overall percentages of vacancy and shortfall, the States/UTs for which manpower position is not available, may be excluded # Data for 2009 repeated ## Sanctioned data for 2009 used

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Annexure I. Manpower Recommended Under Indian Public Health Standards (IPHS)

Sub Centre
S. o. 1. .2. Personnel Health Worker (Female) Health Worker (Male) Existing 1 1 Recommended 2 1 (funded and appointed by State Government) 1 (optional)

3.

Voluntary worker to keep the Sub Centre clean and assisting ANM. She is paid by the ANM from her contingency fund @ Rs. 100 per month

1 (optional)

Primary Health Centres

S. o. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. Medical Officer AYUSH practitioner Account Manager Pharmacist Nurse - Midwife (Staff Nurse) Health Worker (Female) Health Educator Health Assistant male and female Clerks Laboratory Technician Driver Class IV Personnel Existing pattern 1 NIL NIL 1 1 1 1 2 2 1 1 4 Recommended 3 (At least 1 female) 1 (AYUSH or any ISM system prevalent locally) 1 2 5 1 1 2 2 2 Optional; vehicles may be out-sourced 4

29

Annexure I. Manpower Recommended Under Indian Public Health Standards (IPHS) (Contd..) Community Health Centre
S. o. A. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. B. S. o. 1. a. b. c. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. Personnel Clinical Manpower Block Health Officer General Surgeon Physician Obstetrician / Gynaecologist Paediatrics Anaesthetist Public Health Manager Eye Surgeon Dental Surgeon General Duty Medical Officer Specialist of AYUSH General Duty Medical Officer of AYUSH Support Manpower Personnel Staff Nurse Public Health Nurse ANM Pharmacist / compounder Pharmacist - AYUSH Lab. Technician Radiographer Ophthalmic Assistant Dresser Ward boys / nursing orderly Sweepers Chowkidar Dhobi Mali Aya Peon OPD Attendant Registration Clerk Statistical Assistant / Data entry operator Accountant / Admin. Assistant OT Technician IPHS orm 19 1 1 3 1 3 2 1 2 5 5 5 1 1 5 2 1 2 2 1 1 IPHS orm 1 1 1 1 1 1 1 1 6 1 1

30