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The Justice Srikrishna Committee, which is looking into the feasibility of a separate Telangana State, is expected to submit its report by tomorrow. It might be useful at this point in time to revisit the recommendations of the 1953 States Reorganization Commission (SRC) – the Commission that had first examined the Telangana issue in detail. However, it must be kept in mind that some of those arguments and recommendations may not be applicable today. Background Before independence, Telangana was a part of the Nizam's Hyderabad State and Andhra a part of the erstwhile Madras Province of British India. In 1953, owing to agitation by leaders like Potti Sreeramulu, Telugu-speaking areas were carved out of the Madras Province. This lead to the formation of Andhra Pradesh, the first State formed on the basis of language. Immediately afterward, in 1953, the States Reorganization Commission (SRC) was appointed. SRC was not in favour of an immediate merger of Telangana with Andhra and proposed that a separate State be constituted with a provision for unification after the 1961/ 62 general elections, if a resolution could be passed in the Telangana assembly by 2/3rd majority. However, a 'Gentlemen's agreement' was subsequently signed between the leaders of the two regions and this lead to a merger. The agreement provided for some safeguards for Telangana - for instance, a 'Regional Council' for all round development of Telangana. Thus, a unified Andhra Pradesh was created in 1956. In the years that followed, Telangana continued to see on-and-off protests; major instances of unrest were recorded in 1969 and in the 2000s. The SRC 1953 report The full SRC report can be accessed here. Summarized below are its main arguments and recommendations related to Telangana. Arguments in favour of 'Vishalandhra'
Arguments in favour of a separate Telangana State
SRC recommendations The Commission agreed that there were significant advantages in the formation of 'Vishalandhra'. However, it noted that while opinion in Andhra was overwhelmingly in favour of a larger unit, public opinion in Telangana had still to crystallize. Even though Andhra leaders were willing to provide guarantees ensuring development focus on Telangana, the SRC felt that any guarantee, short of Central Government supervision, could not be effective. In addition, it noted that Andhra, being a relatively new State, was still in the midst of developing policies related to issues like land reform. Thus, a hurried merger could likely create administrative difficulties both for both units. The SRC thus recommended the creation of a separate Telangana State with provision for unification after the 1961/62 general elections.
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 |
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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).