Kaushiki Sanyal

kaushiki@prsindia.org
January 25, 2012

PRS Legislative Research Centre for Policy Research Dharma Marg Chanakyapuri New Delhi 110021
Tel: (011) 2611 5273-76, Fax: 2687 2746
www.prsindia.org
Policy Guide
Delivery of Healthcare
Public health and hospitals fall within the purview of the State List in the Constitution. Therefore, state
governments regulate the delivery of healthcare. The central government frames national policies and
provides financial support for some schemes.
Urban areas have a two-tier system with Urban Health Centres for every 100,000 population, followed
by a general hospital. In rural areas, healthcare is provided through a multi-tier network (see Table 1).
Table 1: Norms for public health institutions in rural areas
Tiers Population and staff norms Services Status as of 2009
Sub-Health Centre
Level
(GramPanchayat
level)
1 Sub-Centre for a population of 5,000 in the plains and 3,000 in
hilly areas.
Staffed with Auxiliary Nurse Midwife and a male health worker.
Perform tasks related to maternal and
child health, nutrition, immunisation,
diarrhoea control etc. Provided with
basic drugs for minor ailments.
1,45,894 Sub
Centres
Primary Health
Centres (PHCs)
(Cluster of Gram
Panchayats)
1 PHC for a population of 30,000 in the plains and 20,000 in the
hilly areas.
Staffed with one Medical Officer and 14 other workers. Acts as
a referral unit for 6 sub-centres and has 4-6 beds for patients.
Provides a package of essential public
health programmes.
23,391 PHCs
Community
Health Centres
(CHCs)
(Block level)
1 CHC for a population of 1,20,000 in the plains and 80,000 in
hilly areas.
Staffed with 4 Medical Specialists and 21 paramedical and other
staff. Has 30 in-door beds and serves as a referral centre for 4
PHCs.
Provides facilities for emergency
obstetrics care and specialist
consultations.
4,501 CHCs
District and Sub-
District Hospitals
(District level)
1 hospital for each district, which is linked to sub-district
hospitals, CHCs, PHCs and Sub-Centres.
Staff norms vary based on the size of the hospitals i.e. the
number of beds. District hospitals generally have 75 to 500
beds. Sub-District hospitals have 31 to 50 beds.
Services include OPD, indoor and
emergency services. Provides
consultation services with specialists.
District hospitals provide secondary
level referral services for institutions
below district level.
615 district
hospitals for 609
districts.
Sources: Annual Report 2010-2011, Ministry of Health and Family Welfare; Indian Public Health Standards for 201-300 Bedded District Hospitals:
Guidelines, J anuary 2007, MoHFW.
Key government schemes
National Rural Health Mission (NRHM)
NRHM is a flagship programme launched in April 2005 to provide comprehensive healthcare in rural areas.
The programme focuses on 18 states. Each village with a population of 1,000 in these states are to have an
Accredited Social Health Activist. NRHM proposes to (a) strengthen existing infrastructure; (b) prepare
district health plans; (c) guide sanitation and hygiene projects; (d) strengthen disease control programmes;
(e) foster public-private partnerships in healthcare; and (f) implement new finance mechanisms.
The components of NRHM include: (i) Reproductive and Child Health Programme (RCH); and (ii) J anani
Suraksha Yojana (J SY). RCH focuses on reducing infant and maternal deaths. J SY provides cash to
women who are below the poverty line to deliver up to 3 babies in hospitals. The goal is to reduce maternal
and neo-natal mortality. So far, about 3.2 crore women have been covered.
Rashtriya Swasthya Bima Yojana (RSBY)
RSBY was launched by the Ministry of Labour to provide health insurance coverage for BPL families.


Delivery of Healthcare PRS Legislative Research
January 25, 2012 - 2 -

Beneficiaries are entitled to up to Rs 30,000 if their illness requires hospitalization. RSBY extends to five
members of a family, who need to pay Rs 30 as registration fee while the central and state governments pay
the premium to the insurer. As on October 2011, about 2.5 crore families were issued smart cards.
Key health indicators
Indias key health indicators vary widely across states. For example, Keralas Infant Mortality Rate is
much lower than Madhya Pradesh, Uttar Pradesh and Assam. Except for Delhi, J &K and four north-eastern
states, the government expenditure per person on health is lower than what individuals spend for their
health treatment.
Table 2: Comparison of states on key health indicators
States Life Expectancy at birth
(in years)
Maternal Mortality
Rate (MMR)
Infant Mortality
Rate (IMR)
Underweight children
(Under-5years) (in %)
Per capita health expenditure
(in Rs)
M F Public Private
All-India 62.6 64.2 212 47 42.5 242 959
Andhra Pradesh 62.9 65.5 134 46 32.5 191 870
Arunachal Pradesh NA NA NA 31 32.5 841 613
Assam 58.6 59.3 390 58 36.4 162 612
Bihar 62.2 60.4 261 48 55.9 93 420
Chhattisgarh 58.5 62 269 51 47.1 146 626
Delhi 70.6 73.8 NA 30 26.1 560 170
Goa NA NA NA 10 25 861 1437
Gujarat 62.9 65.2 148 44 44.6 198 755
Haryana 65.9 66.3 153 48 39.6 203 875
Himachal Pradesh 66.5 67.3 NA 40 36.5 630 881
Jammu and Kashmir 63 64.5 NA 43 25.6 512 489
Jharkhand NA NA NA 42 NA 155 345
Karnataka 63.6 67.1 178 38 37.6 233 597
Kerala 71.4 76.3 81 13 22.9 287 2663
Madhya Pradesh 58.1 57.9 269 62 60 145 644
Maharashtra 66 68.4 104 28 37 204 1008
Manipur NA NA NA 14 22.1 294 379
Meghalaya NA NA NA 55 48.8 430 464
Mizoram NA NA NA 37 19.9 867 266
Nagaland NA NA NA 23 25.2 639 180
Odisha 59.5 59.6 258 61 40.7 183 719
Punjab 68.4 70.4 172 34 24.9 247 1112
Rajasthan 61.5 62.3 318 55 39.9 186 575
Sikkim NA NA NA 30 19.7 1082 425
Tamil Nadu 65 67.4 97 24 29.8 223 1033
Tripura NA NA NA 27 39.6 328 1158
Uttar Pradesh 60.3 59.5 359 61 42.4 128 846
Uttarakhand 62 66 359 38 38 280 538
West Bengal 64.1 65.8 145 31 38.7 173 1086
Sources: National Family Health Survey - 3 (2005-06) IIPS; Family Welfare Statistics in India 2011, Ministry of Health and Family Welfare; National
Health Accounts 2004-05, MoHFW; SRS Bulletin, Registrar General of India, Dec 2011 and J une 2011.
Note: IMR: Deaths within one year of being born per 1000 live births; MMR: Deaths per 100,000 live birth; NA: Not Available
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