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 The Standing Committee recommended that this Bill be withdrawn and a revised Bill be introduced in Parliament after consulting stakeholders.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

  • § 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 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

  • § 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 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).  

As of April 22, 2020, Sikkim does not have any confirmed cases of COVID-19.  As of April 21, 2020, 87 samples have been sent for testing from Sikkim.  Of these, 80 have tested negative for COVID-19, and the results of seven samples are awaited.  The state has announced several policy decisions to prevent the spread of the virus and provide relief for those affected by it.  In this blog post, we summarise some of the key measures taken by the Sikkim state government in this regard as of April 22, 2020.  

Response before national lockdown

On March 16, the state government responded to the growing number of suspected cases in India by notifying certain directions to be applicable till April 15, 2020.  These included: (i) banning the entry of all domestic and foreign tourists in to the state, (ii) closing all educational institutes and anganwadis, (iii) prohibiting the use of recreational facilities such as, casinos, gym, and cinemas, (iii) closing three out of five check posts (border opening) for all visitors in to the state and opening the other two only for medical and police teams, and (iv) banning private industries from getting migrant workers from outside the state and avoiding large concentration of workers at one place.

On March 19, assembly of more than five people was prohibited in the state until April 15, 2020.  The government ordered the suspension of all non-essential work on March 19.  The supply of all essential commodities such as food grains, vegetables, sanitisers and masks was allowed.  Further, the formation of a sub-divisional task force to detect suspected cases was ordered.  

On March 22, the government regulated intra-state movement of private vehicles, two-wheelers and taxis on an odd-even basis (allowing plying of vehicles on alternate days as per the number plate) until April 15, 2020.  The government also reduced the budget session of the state to two days on March 23. 

On March 25, the central government announced on a 21-day country-wide lockdown till April 14.  During the lockdown the state government took various steps for physical containment, health, financial and welfare measures.  These are detailed below.

Measures taken during lockdown

Movement Restrictions

Certain movement restrictions were put across the state.   These include:

  • Movement of vehicles: Inter-state movement of vehicles was restricted to vehicles transporting essential goods.  These vehicles need to have a permanent pass for such movement.  On April 5, intra-state movement of vehicles was restricted to government officials, transportation of essential commodities, banks and PSUs, and media and cable networks.   Their passes are valid only from 8am to 5pm.
     
  • Validity of passes:  The state government noted that a large number of vehicle passes were issued due to various reasons.  On April 14, the government ordered that all passes issued by District Magistrates, and other Departmental Authorities (except those issued by the police, health department and forest and environment department) will be invalid from April 14.  New passes will be issued only by Magistrates and Block Development Officers.  
     
  • Securing borders:  In view of the COVID-19 pandemic and to check unauthorised cross-border infiltration from China, Nepal, and Bhutan, the state government secured all porous borders along the Rangpo river and other vulnerable areas.

Essential Goods and Services

On April 5, the state government issued an order requiring establishments such as shops, hotels, private offices, and commercial establishments to remain closed until April 15.  Establishments which were permitted to remain functional include law enforcement agencies, health services, electricity and water services, petrol pumps, and media.  Shops for PDS, groceries, vegetables, milk and, medicines were only allowed remain open from 9 am to 4 pm.

  • Valid prescription and label required:  On March 25, the state prohibited the sale of hand sanitisers without drug manufacturing licence label.  It also prohibited sale of N95 masks to general public without valid prescription. 
     
  • Transit camps:  On April 17, the state government notified that transit camps (temporary accommodation) will be set up for drivers and helpers of vehicles carrying essential goods.

Health Measures

On March 31, the Sikkim government identified and set up dedicated isolation wards and treatment centres in the STNM hospital, Sochakgang as a precautionary measure.  The government also issued directions for citizens to avoid getting infected by coronavirus.  These included social distancing, and maintaining proper hygiene.  

On April 18, the state government made it mandatory for all the public, students, teachers, and government employees, to install the Aarogya Setu application.  The government of India launched a mobile app called ‘Aarogya Setu’ to enable people to assess the risk of catching COVID-19 on April 2, 2020.   The app uses Bluetooth and Global Positioning System (GPS) based device location for contact tracing in order to prevent the spread of COVID-19. 

Welfare Measures

  • Economic relief package:  On March 27, an economic relief package was announced by the state government.   This included free ration in specific quantities (other than the PDS entitlement) to needy families in rural and urban areas, daily wagers, migrant labourers, casual workers, and stranded people.  Further, the government announced an additional incentive wage of Rs 300/day for tea workers at Temi-tea estate. 
     
  • Food distribution:  On April 16, the government announced that Asha workers will be given Rs 5,000 as honorarium for work done during COVID-19.  Further, it ordered the food and civil supply department to compile a list of all the left out beneficiaries for distribution of food relief packages.
     
  • Relief to stranded patients:  On April 16, the government announced that a financial relief of Rs 30,000 will be provided to each patient undergoing treatment and stranded outside Sikkim from the Chief Minister's relief fund.
     
  • Relief for casual workers:  On March 30, the Sikkim government issued directions to all contractors/ employers to pay migrant and casual labourers on the due date without any deductions due to the lockdown.  The state government also provided grants worth Rs 2,000 to the 7,836 registered building and other construction workers in the state.
     
  • Relief for stranded students:  On March 29, the state announced that it will provide Rs 5,000 to each state student stranded outside Sikkim during the nationwide lockdown.

Certain relaxations after 20th April 

On April 14, the nation-wide lockdown was further extended till May 3, 2020.  On April 15, the Ministry of Home Affairs issued guidelines outlining select activities which will be permitted from April 20 onwards.  These activities include health services, agriculture related activities, certain financial sector activities, operation of Anganwadis, MNREGA works, and cargo movement.  Further, subject to certain conditions, commercial and private establishments, industrial establishments, government offices, and construction activities will also be permitted.  The Sikkim government took the following steps in the same line.

  • On April 19, the state government gave directions to all government and PSU offices to work with up to one-third of their actual staff strength from April 20 onwards. 
     
  • On April 19, the state government gave directions and standard operating procedures to be followed at manufacturing establishments, work spaces and public places post April 20.  These include: (i) no overlapping shifts, (ii) staggered lunch breaks, (iii) training on good hygiene practices, (iv) compulsory wearing of face cover, and (v) sanitising workplaces between shifts. 

For more information on the spread of COVID-19 and the central and state government response to the pandemic, please see here.