LegislationShortage of doctors may hit rural healthcare deliveryKaushiki- November 26, 2012Recently, the Standing Committee on Health and Family Welfare submitted itsreportto the Parliament on theNational 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. Seeherefor 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 The Standing Committee recommended that this Bill be withdrawn and a revised Bill be introduced in Parliament after consulting stakeholders.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. Seeherefor PRS Standing Committee Summary.Shortfall of health workers in rural areasPublic 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 PHCsDoctors at PHCsANM at PHCs and Sub-CentresStateSanctioned postVacancy% of vacancySanctioned postVacancy% of vacancyChhattisgarh1482105871639496415West Bengal18078014410,356NA0Maharashtra361813263721,12200Uttar Pradesh450916483625,190272611Mizoram57203538800Madhya Pradesh12384243411,90400Gujarat112334531724881711Andaman & Nicobar Isld40123021400Odisha72520028744200Tamil Nadu23266222799101361Himachal Pradesh58213122221352824Uttarakhand2996522207700Manipur240482098432333Haryana6511211954203867Sikkim4891921900Meghalaya127231866700Delhi223144300Goa46511260208Karnataka23102211011,18000Kerala12048274232591Andhra Pradesh242476324,523287612Rajasthan147860.414,34800Arunachal PradeshNANANANANA0AssamNANANANANA0Bihar20780NANANA0Chandigarh00NA1700Dadra & Nagar Haveli60NA4000Daman & Diu30NA2600Jammu & Kashmir7500NA228200Jharkhand3300NA428800Lakshadweep40NANANA0NagalandNANANANANA0Puducherry370NA7200Punjab4870NA404400TripuraNANANANANA0India30,0517,246241,77,1038,8355Sources: National Rural Health Mission (availablehere), 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 specialistsSurgeonsGynaecologistsPhysiciansPaediatriciansState% of vacancyAndaman & NicobarIsland100100100100Andhra Pradesh740453Arunachal PradeshNANANANAAssamNANANANABihar41446038Chandigarh504050100Chhattisgarh85859084Dadra & Nagar Haveli0000Daman & Diu01000100Delhi0000Goa20206766Gujarat7773091Haryana71809485Himachal PradeshNANANANAJammu & Kashmir34345363Jharkhand4508161Karnataka33NANANAKeralaNANANANALakshadweep001000Madhya Pradesh78697658Maharashtra210340Manipur100949487Meghalaya50NA10050MizoramNANANANANagalandNANANANAOdisha44456241Puducherry00100NAPunjab16364048Rajasthan57%464924SikkimNANANANATamil Nadu0000TripuraNANANANAUttar PradeshNANANANAUttarakhand69637440West Bengal057078India56475949Sources: National Rural Health Mission (availablehere), PRS.[i].  “Rural Healthcare System in India”, National Rural Health Mission (availablehere).ParliamentFirst no-confidence motion of the 17th Lok Sabha discussed todayNiranjana Menon- August 8, 2023Discussion on the first no-confidence motion of the 17thLok Sabha began today.  No-confidence motions and confidence motions are trust votes, used to test or demonstrate the support of Lok Sabha for the government in power.  Article 75(3) of the Constitution states that the government is collectively responsible to Lok Sabha.  This means that the government must always enjoy the support of a majority of the members of Lok Sabha.  Trust votes are used to examine this support.  The government resigns if a majority of members support a no-confidence motion, or reject a confidence motion.So far, 28 no-confidence motions (including the one being discussed today) and 11 confidence motions have beendiscussed.  Over the years, the number of such motions has reduced.  The mid-1960s and mid-1970s saw more no-confidence motions, whereas the 1990s saw more confidence motions.Figure1: Trust votes in ParliamentNote: *Term shorter than 5 years; **6-year term.Source: Statistical Handbook 2021, Ministry of Parliamentary Affairs; PRS.The no-confidence motion being discussed today wasmovedon July 26, 2023.  A motion of no-confidence is moved with the support of at least 50 members.   The Speaker has the discretion to allot time for discussion of the motion.  TheRules of Procedurestate that the motion must be discussed within 10 days of being introduced.  This year, the no-confidence motion wasdiscussed13 calendar days after introduction.  Since the introduction of the no-confidence motion on July 26, 12 Bills have been introduced and 18 Bills have been passed by Lok Sabha.  In the past, on four occasions, the discussion on no-confidence motions began seven days after their introduction.  On these occasions, Bills and other important issues were debated before the discussion on the no-confidence motion began.Figure2: Members rise in support of the motion of no-confidence in Lok SabhaSource: Sansad TV, Lok Sabha, July 26, 2023; PRS.Figure3: Number of days from introduction to discussion on no-confidence motionsNote: Number of days implies calendar days.Source: Statistical Handbook 2021, Ministry of Parliamentary Affairs; PRS.On average, no-confidence motions (excluding the one being discussed today) have been discussed for 13 hours over three days.  Discussions have lasted longer than 20 hours on four instances, most recently in 2003.  Today’s no-confidence motion was allotted 12 hours discussion time by theBusiness Advisory Committee.Following the discussion, the motion is put to vote.  26 out of 27 no-confidence motions (excluding the one being discussed today) have been voted upon and rejected.  This means that no government has ever had to resign following a vote of no-confidence.   On one occasion, in 1979, the discussion on a no-confidence motion against the Morarji Desai government remained inconclusive.  He resigned before the motion was put to vote.  50% of all no-confidence motions (14 out of 28) were discussed between 1965 and 1975.  Of these, 12 were against governments headed by Indira Gandhi.Figure4: Duration of discussion on no-confidence motionsNote: This graph excludes the no confidence motion moved on July 26, 2023.Source: Statistical Handbook 2021, Ministry of Parliamentary Affairs; PRS.In comparison, confidence motions have a more varied history.  The first motion, brought in 1979 to demonstrate confidence in Charan Singh’s government, was not discussed at all.  The Prime Minister resigned before the discussion could take place.  Since then, 11 confidence motions have been discussed in Lok Sabha, with nine occurring in the 1990s.  During this period, several coalition governments were formed, and Prime Ministers sought to prove their majority throughconfidence motions.   These motions have been discussed, on average, for 12 hours over two days.Figure5: Duration of discussion of confidence motionsSource: Statistical Handbook 2021, Ministry of Parliamentary Affairs; PRS.Of the 11 confidence motions discussed in Lok Sabha, seven were accepted.  On three instances, governments had to resign as they could not prove that they had the support of the majority.  On one instance in 1996, the motion was not put to vote.  Following an eleven-hour discussion on this confidence motion, Prime Minister Atal Bihari Vajpayee announced his intention to resign on the floor of the House.  He resigned 16 days into his term.Vajpayee became Prime Minister again in 1999, and faced another confidence motion.   This time, it was put to vote.   The motion was defeated by a margin of one vote.  This has been the closest result on a trust vote in the history of Lok Sabha.  The next closest result was when a motion of no-confidence against P V Narasimha Rao’s government was defeated by 14 votes in 1993.  In most cases, results have been in favour of the government by a large margin.«12345678910»
LegislationShortage of doctors may hit rural healthcare deliveryKaushiki- November 26, 2012