Recently, the Standing Committee on Health and Family Welfare submitted its report to the Parliament on the National 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. See here for 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 The Standing Committee recommended that this Bill be withdrawn and a revised Bill be introduced in Parliament after consulting stakeholders.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. See here for PRS Standing Committee Summary. Shortfall of health workers in rural areas Public 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
Table 1: State-wise comparison of vacancy in PHCs
|
Doctors at PHCs |
ANM at PHCs and Sub-Centres |
|||||
| State | Sanctioned post | Vacancy | % of vacancy | Sanctioned post | Vacancy | % of vacancy |
| Chhattisgarh | 1482 | 1058 | 71 | 6394 | 964 | 15 |
| West Bengal | 1807 | 801 | 44 | 10,356 | NA | 0 |
| Maharashtra | 3618 | 1326 | 37 | 21,122 | 0 | 0 |
| Uttar Pradesh | 4509 | 1648 | 36 | 25,190 | 2726 | 11 |
| Mizoram | 57 | 20 | 35 | 388 | 0 | 0 |
| Madhya Pradesh | 1238 | 424 | 34 | 11,904 | 0 | 0 |
| Gujarat | 1123 | 345 | 31 | 7248 | 817 | 11 |
| Andaman & Nicobar Isld | 40 | 12 | 30 | 214 | 0 | 0 |
| Odisha | 725 | 200 | 28 | 7442 | 0 | 0 |
| Tamil Nadu | 2326 | 622 | 27 | 9910 | 136 | 1 |
| Himachal Pradesh | 582 | 131 | 22 | 2213 | 528 | 24 |
| Uttarakhand | 299 | 65 | 22 | 2077 | 0 | 0 |
| Manipur | 240 | 48 | 20 | 984 | 323 | 33 |
| Haryana | 651 | 121 | 19 | 5420 | 386 | 7 |
| Sikkim | 48 | 9 | 19 | 219 | 0 | 0 |
| Meghalaya | 127 | 23 | 18 | 667 | 0 | 0 |
| Delhi | 22 | 3 | 14 | 43 | 0 | 0 |
| Goa | 46 | 5 | 11 | 260 | 20 | 8 |
| Karnataka | 2310 | 221 | 10 | 11,180 | 0 | 0 |
| Kerala | 1204 | 82 | 7 | 4232 | 59 | 1 |
| Andhra Pradesh | 2424 | 76 | 3 | 24,523 | 2876 | 12 |
| Rajasthan | 1478 | 6 | 0.4 | 14,348 | 0 | 0 |
| Arunachal Pradesh | NA | NA | NA | NA | NA | 0 |
| Assam | NA | NA | NA | NA | NA | 0 |
| Bihar | 2078 | 0 | NA | NA | NA | 0 |
| Chandigarh | 0 | 0 | NA | 17 | 0 | 0 |
| Dadra & Nagar Haveli | 6 | 0 | NA | 40 | 0 | 0 |
| Daman & Diu | 3 | 0 | NA | 26 | 0 | 0 |
| Jammu & Kashmir | 750 | 0 | NA | 2282 | 0 | 0 |
| Jharkhand | 330 | 0 | NA | 4288 | 0 | 0 |
| Lakshadweep | 4 | 0 | NA | NA | NA | 0 |
| Nagaland | NA | NA | NA | NA | NA | 0 |
| Puducherry | 37 | 0 | NA | 72 | 0 | 0 |
| Punjab | 487 | 0 | NA | 4044 | 0 | 0 |
| Tripura | NA | NA | NA | NA | NA | 0 |
| India | 30,051 | 7,246 | 24 | 1,77,103 | 8,835 | 5 |
| Sources: National Rural Health Mission (available here), 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
Table 2: Vacancies in CHCs of medical specialists
| Surgeons | Gynaecologists | Physicians | Paediatricians | |
| State |
% of vacancy |
|||
| Andaman & NicobarIsland | 100 | 100 | 100 | 100 |
| Andhra Pradesh | 74 | 0 | 45 | 3 |
| Arunachal Pradesh | NA | NA | NA | NA |
| Assam | NA | NA | NA | NA |
| Bihar | 41 | 44 | 60 | 38 |
| Chandigarh | 50 | 40 | 50 | 100 |
| Chhattisgarh | 85 | 85 | 90 | 84 |
| Dadra & Nagar Haveli | 0 | 0 | 0 | 0 |
| Daman & Diu | 0 | 100 | 0 | 100 |
| Delhi | 0 | 0 | 0 | 0 |
| Goa | 20 | 20 | 67 | 66 |
| Gujarat | 77 | 73 | 0 | 91 |
| Haryana | 71 | 80 | 94 | 85 |
| Himachal Pradesh | NA | NA | NA | NA |
| Jammu & Kashmir | 34 | 34 | 53 | 63 |
| Jharkhand | 45 | 0 | 81 | 61 |
| Karnataka | 33 | NA | NA | NA |
| Kerala | NA | NA | NA | NA |
| Lakshadweep | 0 | 0 | 100 | 0 |
| Madhya Pradesh | 78 | 69 | 76 | 58 |
| Maharashtra | 21 | 0 | 34 | 0 |
| Manipur | 100 | 94 | 94 | 87 |
| Meghalaya | 50 | NA | 100 | 50 |
| Mizoram | NA | NA | NA | NA |
| Nagaland | NA | NA | NA | NA |
| Odisha | 44 | 45 | 62 | 41 |
| Puducherry | 0 | 0 | 100 | NA |
| Punjab | 16 | 36 | 40 | 48 |
| Rajasthan | 57% | 46 | 49 | 24 |
| Sikkim | NA | NA | NA | NA |
| Tamil Nadu | 0 | 0 | 0 | 0 |
| Tripura | NA | NA | NA | NA |
| Uttar Pradesh | NA | NA | NA | NA |
| Uttarakhand | 69 | 63 | 74 | 40 |
| West Bengal | 0 | 57 | 0 | 78 |
| India | 56 | 47 | 59 | 49 |
| Sources: National Rural Health Mission (available here), PRS. | ||||
[i]. “Rural Healthcare System in India”, National Rural Health Mission (available here).
According to news reports, the Supreme Court stayed a Calcutta High Court judgement on the Singur Land Rehabilitation and Development Act, 2011 [Singur Act] on August 24, 2012. The apex court also issued a notice to Tata Motors seeking its response within four weeks, on the West Bengal government's petition challenging the High Court order. In 2008, the Left Front government acquired land in Singur under the Land Acquisition Act, 1894, for Tata Motors to build a Nano car factory. In its first year of coming to power in West Bengal, the Trinamool Congress (TMC) led government notified the Singur Act through which it sought to reclaim this land to return a portion of it to farmers. On June 22, 2012, a Division bench of the Calcutta High Court struck down the Singur Act terming it unconstitutional and void. In its judgment, the Court found some sections of the Singur Act to be in conflict with the central Land Acquisition Act, 1894. As land acquisition is a Concurrent List subject under the Constitution, both Parliament and state legislatures have the power to make laws on it. However, if provisions in the state law conflict with provisions in the central law, then the state law cannot prevail unless it receives Presidential assent. The Calcutta High Court held the Singur Act to be unconstitutional because: (a) it was in conflict with the central Land Acquisition Act, 1894, and (b) Presidential assent was not obtained for the Act to prevail in West Bengal. The central Act mentions that for the government to acquire land, it has to demonstrate: (1) that land is being acquired for a public purpose,[i] and (2) that the government will provide compensation to persons from whom land is being acquired. Provisions in the Singur Act that relate to public purpose and compensation were found to be in conflict with the corresponding provisions in the central Act. The Court was of the opinion that transfer of land to the farmers does not constitute ‘public purpose’ as defined in the central Act. As argued by the Tata Motors’ counsel, return of land to unwilling owners is a ‘private purpose’ or in ‘particular interest of individuals’ rather than in the ‘general interest of the community’. Second, clauses pertaining to compensation to Tata Motors for their investment in the Nano project were found to be vague. The Singur Act only provides for the refund of the amount paid by Tata Motors and the vendors to the state government for leasing the land. It does not provide for the payment of any other amount of money for acquiring the Tata Motors’ land nor the principles for the determination of such an amount. The High Court ordered that these provisions tantamount to ‘no compensation’ and struck down the related provisions. The matter will come up for consideration in the Supreme Court next on October 15, 2012.
[i] According to Section 3 of the Land Acquisition Act, 1894, acquisition of land for ‘public purpose’ includes, among others: provision or planned development of village sites; provision of land for town or rural planning; the provision of land for planned development of land from public funds in pursuance of a scheme or policy of the Government; and the provision of land for a corporation owned or controlled by the State.
