A STATE-LEVEL SITUATIONAL ANALYSIS OF AVAILABILITY AND DISTRIBUTION OF PUBLIC HEALTH SERVICES IN RURAL INDIA

Volume 9, Issue 3(7), March 2020 I nt er nat io nal Jo ur nal o f M ul t idis cipl inar y E ducat io nal R es ear ch Published by Sucharitha Publications D.No: 8-42-18/3, F-2,1st Floor, M.K. Residency Tamil Street , Chinna Waltair Visakhapatnam – 530 017 Andhra Pradesh – India Email: victorphilosophy@ gmail.com Website: www.ijmer.in I NT ERNAT I ONAL JOURNAL OF M ULT I DI SCI PLI NARY E DUCAT I ONAL R ESEARCH ISSN:2277- 7881; IMPAC T FA C TO R :6.514(2020); IC V ALUE:5.16; ISI V ALUE:2.286 Peer Reviewed and UGC Approved: VO LUME:9, ISSUE:3(7), M A RC H:2020 A STATE-LEVEL SITUATIONAL ANALYSIS OF AVAILABILITY AND DISTRIBUTION OF PUBLIC HEALTH SERVICES IN RURAL INDIA Dr.L.Ganesan, Professor, Department of Economics, Bharathidasan University, Tiruchirappalli R.Senthamizh Veena, RGNF Research Scholar, Department of Economics, Bharathidasan University, Tiruchirappalli Abstract India as a nation is committed to the attainment of ‘Health for All’ by 2020 AD through the universal provision of comprehensive primary health care services (Planning Commission, 2002). In order to materialize this goal of rendering health services to all, availability of adequate number of health centres with required facilities and health personnel with suitable skills are fundamental. Further, their appropriate deployment at different levels of health care set-up is also crucial for the attainment of this ‘Health for All’ vision. Thereby this study sees through the level of availability/non-availability and inequality of public health infrastructure and health personnel in rural areas of all the states of India. This study is entirely based on secondary data sourced from Rural Health Statistics, National Health Profile and other reports of Ministry of Health and Family Welfare among others. This is a descriptive study and the researchers have used statistical tools like average and percentage to analyse the availability and distribution of rural health services in all the states of the country. The study finds that there is large amount of non availability and uneven distribution of rural health centres and health personnel in rural areas of the Indian states and this problem will be a central challenge in meeting our health goals. Therefore the researchers call for sustainable and evidence based health infrastructure and health personnel plans to address the imbalance in rural health services. Key Words: Health for All; Health Infrastructure; Health Personnel; Rural Health Introduction: “India lives in her seven hundred thousand villages”, is a famous quote of Mahatma Gandhi. Even after seventy years of independence, true to his words, almost seventy percent of India’s population live in rural areas of the country. This human resource forms a vital component of the country’s growth and development. Thereby the health of rural population has a crucial role to pave way for the inclusive and sustainable development of the country. This necessitates the need for the existence of strong and efficient public healthcare system in rural India. But lack of quality infrastructure, dearth of qualified medical personnel, and non-access to basic medicines and medical facilities characterize the rural health system in our country (Singh and Badaya 2014). Still many people in rural areas have to travel long distance to get health services due to lack of availability and accessibility of quality health services (Iyengar and Dholakia 2012). People in rural areas suffer from many health issues and rural health sector in India confronts many issues more than any other social sector. Though a lot of policies and programs are being run by the Government for rural health, the success and effectiveness of these programs is questionable due to gaps in the implementation. www.ijmer.in 104 I NT ERNAT I ONAL JOURNAL OF M ULT I DI SCI PLI NARY E DUCAT I ONAL R ESEARCH ISSN:2277- 7881; IMPAC T FA C TO R :6.514(2020); IC V ALUE:5.16; ISI V ALUE:2.286 Peer Reviewed and UGC Approved: VO LUME:9, ISSUE:3(7), M A RC H:2020 Many studies (Singh and Badaya 2014) (Iyengar and Dholakia 2012) (Saha UC and Saha KB 2010) have highlighted these problems that prevail in rural health sector in India. In this context, this paper attempts to examine the availability/non-availability and inequality in distribution of rural health services across the states of India in aim of fulfilling any gap in pointing out the issues in rural health and providing solutions for the same. Need for the Study: Foundation of our rural health services was laid by Bhore committee about 60 years ago when acute infections dominated the health scenario. In view of the changing health scenario, it is time to review the structure of rural health services and shape the Government policies to cater to the needs of rural population (Ananthakrishnan N, 2007). The challenge for any healthcare system is to ensure the equitable distribution of health Services – both geographically and in the different areas of health care (Martinez and Martineau, 2002). In India, for example, urban areas command 73 per cent of the public hospital beds, even when 69 per cent of India’s population resides in rural areas. In 2016, only 11.14 per cent of all allopathic doctors registered with the Central or State Medical Councils worked in Government service and barely 3.3 per cent of all allopathic doctors worked in public health facilities in rural areas (National Health Profile 2017). Considering the picture of grim facts there is a dire need of new practices and procedures to ensure that quality and timely health-care reaches the deprived corners of the Indian villages. This necessitates the need for the study of availability and distribution of health services in rural areas of the Indian states. Objectives: The objectives of the study are:  To examine the availability and shortfall i.e., non-availability of rural health services in terms of health infrastructure and health personnel in Indian states  To make an inter-state comparison of level of non-availability of rural health services among the states of India  To suggest suitable solutions to overcome the issues in rural health infrastructure in the country Methodology: In this paper, the researchers have attempted to study the present scenario of rural health services by analysing the availability and shortfall of rural health infrastructure and health personnel in all the states of the country. This study is entirely based on secondary data sourced from the Government publications like Rural Health Statistics, National Health Profile and other reports of Ministry of Health and Family Welfare among others. The researchers have used statistical tools like average and percentage to analyse the availability and inequality in distribution of rural health services in all the states of the country. Rural Population in Indian States: In order to provide a complete picture of availability of health services and their distribution among the states this study focuses on all the 29 states of the country (Census 2011). The rural population profile of the states is given in the Table 1. www.ijmer.in 105 I NT ERNAT I ONAL JOURNAL OF M ULT I DI SCI PLI NARY E DUCAT I ONAL R ESEARCH ISSN:2277- 7881; IMPAC T FA C TO R :6.514(2020); IC V ALUE:5.16; ISI V ALUE:2.286 Peer Reviewed and UGC Approved: VO LUME:9, ISSUE:3(7), M A RC H:2020 Table 1: State-Wise Rural Population in India States Rural Population % of Rural to Total Populatio n States Rural Populati on % of Rural to Total Populati on 34776389 70.4 Manipur 2021640 70.8 Andhra Pradesh Arunachal Pradesh Assam 1066358 77.1 Meghalaya 2371439 79.9 26807034 85.9 Mizoram 525435 47.9 Bihar 92341436 88.7 Nagaland 71.1 Chhattisgarh 19607961 76.8 Odisha 551731 37.8 Punjab Gujarat 34694609 57.4 Rajasthan Haryana Himachal Pradesh Jammu Kashmir Jharkhand 16509359 65.1 6176050 90 Sikkim Tamil Nadu 9108060 72.6 Telangana 25055073 76 Karnataka 37469335 61.3 Kerala 17471135 52.3 Madhya Pradesh 52557404 72.4 Tripura Uttarakha nd Uttar Pradesh West Bengal 1407536 3497056 2 1734419 2 5150035 2 456999 3722959 0 2158531 3 2712464 Maharashtra 61556074 54.8 Goa India 7036954 1553172 78 6218311 3 8337488 52 83.3 62.5 75.1 74.8 51.6 61.3 73.8 69.8 77.7 68.1 68.9 Source: Population Census of India 2011, Office of the Registrar General & Census Commissioner, India. www.ijmer.in 106 I NT ERNAT I ONAL JOURNAL OF M ULT I DI SCI PLI NARY E DUCAT I ONAL R ESEARCH ISSN:2277- 7881; IMPAC T FA C TO R :6.514(2020); IC V ALUE:5.16; ISI V ALUE:2.286 Peer Reviewed and UGC Approved: VO LUME:9, ISSUE:3(7), M A RC H:2020 The Table 1 and Figure 1, shows the state-wise rural population in India and also how much percentage of the state’s population live in rural areas of the respective states. From the Table 1 and Figure 1 it can be clearly seen that, except states like Goa (37.8 per cent), Mizoram (47.9 per cent), Tamil Nadu (51.6 per cent), Kerala (52.3 per cent), Maharashtra (54.8 per cent) and Gujarat (57.4 per cent) in all other states more than 60 per cent of the respective state’s population live in rural areas. Especially in states like Himachal Pradesh (90 per cent), Bihar (88.7 per cent), Assam (85.9 per cent) and Odisha (83.3 per cent) more than 80 per cent of the state’s population live in rural areas. Overall, out of total population in the country 69 per cent i.e., more than 800 million people live in rural areas of the country. Among the states Uttar Pradesh has the largest rural population and in this state alone more than 150 million people live in rural areas, which is more than the population of many countries of the world. Availability and Non-Availability of Rural Health Infrastructure in Indian States: To protect and promote general health, the public health infrastructure must be strong. Health Infrastructure is an important indicator to understand the healthcare delivery provisions and mechanisms in a country. According to the government's Indian Public Health Standard (IPHS) norms, we're supposed to have one Sub-Centre for every 5,000 people (3,000 in hilly areas), one Primary Health Centre for every 30,000 people (20,000 in hilly areas) and one Community Health Centre for every 120,000 people (80,000 in hilly areas). In this connection, Table 2 shows the availability and shortages i.e., non-availability of health infrastructure in the Indian states. Table 2: State-Wise Availability and Non-Availability of Public Health Infrastructure Sub Centres State R P PHC S R CHC P S Andhra Pradesh 7261 7458 * 1197 1147 50 (4) Arunachal Pradesh 318 312 6 (2) 48 143 * www.ijmer.in R P S 299 193 106 (35) 12 63 * 107 I NT ERNAT I ONAL JOURNAL OF M ULT I DI SCI PLI NARY E DUCAT I ONAL R ESEARCH ISSN:2277- 7881; IMPAC T FA C TO R :6.514(2020); IC V ALUE:5.16; ISI V ALUE:2.286 Peer Reviewed and UGC Approved: VO LUME:9, ISSUE:3(7), M A RC H:2020 Assam 5850 4644 1206 (21) 954 946 * 238 172 66 (28) Bihar 18637 9949 8688 (47) 3099 1899 1200 (39) 774 150 624 (81) Chhattisgarh 4885 5200 * 774 793 * 193 169 Goa 122 214 * 19 25 * 4 4 24 (12) 0 Gujarat 8008 9153 * 1290 1474 * 322 363 * Haryana 3301 2589 712 (22) 550 368 182 (33) 137 113 24 (18) Himachal Pradesh Jammu & Kashmir 1285 2009 2084 2967 212 327 576 637 53 81 91 84 Jharkhand 6060 3848 966 298 241 171 Karnataka 7951 9443 * 1306 2359 * 326 206 120 (37) Kerala 3551 5380 * 589 849 * 147 227 * Madhya Pradesh 12415 11192 1223 (10) 1989 1171 818 (41) 497 309 188 (38) Maharashtra 13512 10638 2874 (21) 2201 1823 378 (17) 550 361 189 (34) Manipur 509 429 80 (16) 80 91 * 20 23 * Meghalaya 759 443 316 (42) 114 108 6 (5) 28 28 0 (0) Mizoram 172 370 * 25 57 * 6 9 * Nagaland 455 396 59 (13) 68 126 * 17 21 * Odisha 8193 6688 1505 (18) 1315 1288 27 (2) 328 377 * Punjab 3468 2950 518 (15) 578 432 146 (25) 144 151 * Rajasthan 11459 14405 * 1861 2078 * 465 588 * Sikkim 113 147 * 18 24 * 4 2 Tamil Nadu 7533 8712 * 1251 1421 385 4708 4744 * 768 643 192 91 Tripura 691 1020 * 109 27 22 * 10679 (34) 2726 (21) 32900 (18) * 125 (16) 1 (1) * 1573 (30) 1240 (58) 6430 (22) 312 Telangana Uttarakhand 1442 1847 Uttar Pradesh 31200 20521 West Bengal 13083 10357 All India/ Total 179240 158417 * * 2212 (37) 108 238 257 5194 3621 2153 913 29337 25743 * * 668 (69) 59 67 1298 822 538 348 7322 5624 * * 70 (29) 2 (50) * 101 (53) 5 (19) * 476 (37) 190 (35) 2188 (30) Source: Rural Health Statistics 2018, GoI Note: ‘*’- Surplus; R-Required, P-In Position, S-Shortfall i.e., (S=R-P) Figures shown in parentheses are the percentage shortfall of health centres to the required health centres; www.ijmer.in 108 I NT ERNAT I ONAL JOURNAL OF M ULT I DI SCI PLI NARY E DUCAT I ONAL R ESEARCH ISSN:2277- 7881; IMPAC T FA C TO R :6.514(2020); IC V ALUE:5.16; ISI V ALUE:2.286 Peer Reviewed and UGC Approved: VO LUME:9, ISSUE:3(7), M A RC H:2020 All India figures for Shortfall is the total of State-wise Shortfall ignoring surplus in some States In Table 2, the “Required (R)” column shows the required number of health centres in accordance to the population of the respective states and the “In Position (P)” column shows the number of health centres available in the states. The “Shortfall (S)” column shows the difference between the number of required and in position health centres and also the percentage shortfall of health centres to the required health centres in the states. It also reveals that there is surplus availability of health centres in some states which is expressed by the ‘*’ symbol. Especially in states like Gujarat, Himachal Pradesh, Jammu & Kashmir, Kerala, Mizoram, Rajasthan, Tamil Nadu and Uttarakhand there are surplus number of all three health centres i.e., Sub-Centre, PHC and CHC available in relation to the required numbers in those states. Then in states like Bihar, Haryana, Jharkhand, Madhya Pradesh, Maharashtra, Meghalaya, Uttar Pradesh and West Bengal there is shortfall of all three health centres in relation to the required number of SC, PHC and CHC in those states. Other states show mixed performance of both surplus and shortfall in either of Sub-Centres, PHCs or CHCs. Among all states the highest number of shortage is found in Uttar Pradesh with shortfall of 10,679 SubCentres, 1573 PHCs and 476 CHCs followed by Bihar with 8688 Sub-Centres, 1200 PHCs and 624 CHCs shortage. On the other hand, Rajasthan has the most surplus number of health centres with 2946 SCs, 217 PHCs and 123 CHCs in excess followed by Kerala with 1829 SCs, 260 PHCs and 80 CHCs more than the required number in those states. Source: Based on Table 2 The Figure 2 shows the percentage shortfall of health centres to required health centres in Indian states. This will help to know the level of shortage of SC, PHC and CHC in each state and through this, the inequality in availability of health centres can be identified. The highest shortfall of Sub-Centre is found in Bihar with 47 per cent www.ijmer.in 109 I NT ERNAT I ONAL JOURNAL OF M ULT I DI SCI PLI NARY E DUCAT I ONAL R ESEARCH ISSN:2277- 7881; IMPAC T FA C TO R :6.514(2020); IC V ALUE:5.16; ISI V ALUE:2.286 Peer Reviewed and UGC Approved: VO LUME:9, ISSUE:3(7), M A RC H:2020 followed by Meghalaya with 42 per cent shortfall. Then the shortfall of PHC is highest in Jharkhand with 69 per cent followed by West Bengal with 58 per cent shortage of PHC. The CHC is found to be most deficient in the state of Bihar with whopping 81 per cent shortfall followed by Sikkim with 50 per cent of shortfall of CHCs in relation to the requirement. Overall it can be seen that when people of some states are favoured with the benefits from surplus number of health centres, people belonging to other states suffers from the lack of availability of even the minimum number of required health centres to provide the primary healthcare services. This shows the inequality in the availability of health services among the states of the country. Availability and Non-Availability of Rural Health Personnel in India: Another very important facet that constitutes the healthcare system besides infrastructural facilities is the availability of adequate and competent personnel for proper functioning of the health system. Health personnel have been described as the heart of a health system in any country. Human resources for health are defined as “the stock of all individuals engaged in the promotion, protection or improvement of population health” (WHO, 2006). The current availability of health personnel in the country is shown in the Table 3. Table 3: Availability and Non-Availability of ANMs, Doctors and Specialists at Rural Health Services State Andhra Pradesh Arunachal Pradesh ANM at Sub Center & PHC R P S 8605 13698 * R 1147 Doctors at PHC P S 2045 * 455 481 * 143 125 18 (12.58) Assam 5635 10230 * 1014 1376 * Bihar 11848 23390 * 1899 1786 Chhattisgarh 5971 6799 * 785 359 Goa 238 273 * 24 56 * 2287 (21) 1392 1321 153 (10.99) 113 (5.95) 434 (55.28) Gujarat 10474 8340 Haryana 2955 4374 * 366 491 * 2621 1846 814 (31) 538 622 * 3604 4582 * 637 694 * 4145 6632 * 297 340 * 4646 (39) 2359 2136 223 (9.45) 849 1169 * Himachal Pradesh Jammu & Kashmir Jharkhand Karnataka 11740 7156 Kerala 6229 7950 * 1171 1112 59 (5.03) Madhya Pradesh 10363 12353 10 (1) Maharashtra 12394 14605 * 1814 2929 * Manipur 506 923 * 85 194 * www.ijmer.in Total Specialists at CHC P S 388 772 384 (50.25) 248 252 4 (98.41) 530 632 158 (83.86) 518 600 82 (86.33) 619 676 57 (91.56) 6 16 10 (37.5) 1334 1452 118 (91.87) 435 448 17 (97.09) 352 356 4 (98.87) 80 336 256 (23.80) 592 752 92 (78.72.) 326 824 498 (39.56) 868 928 40 (93.53) 988 1236 248 (79.93) 959 1440 485 (66.59) 68 3 65 R 110 I NT ERNAT I ONAL JOURNAL OF M ULT I DI SCI PLI NARY E DUCAT I ONAL R ESEARCH ISSN:2277- 7881; IMPAC T FA C TO R :6.514(2020); IC V ALUE:5.16; ISI V ALUE:2.286 Peer Reviewed and UGC Approved: VO LUME:9, ISSUE:3(7), M A RC H:2020 Meghalaya 545 1080 * 109 130 Mizoram 427 629 * 57 59 * 108 9 * 36 0 84 8 1480 253 8 (6.34) 371 (28.98) Nagaland 522 913 * 126 118 Odisha 7968 8108 * 1280 917 Punjab 3382 4525 * 432 480 * 604 105 Rajasthan 16485 18257 * 2079 2396 * 2316 565 Sikkim 171 227 * 24 24 0 8 0 Tamil Nadu 10074 7854 2279 (22) 1362 2780 * 1540 210 Telangana 5486 7679 * 689 1066 * 456 112 93 119 * 84 2 240 211 3288 192 Tripura Uttarakhand Uttar Pradesh West Bengal All India/ Total 1080 601 2104 1760 24142 25751 11283 181881 527 (48) 344 (16) 16 (6.22) 2277 (62.88) 257 241 * 3621 1344 17583 * 914 1016 * 1396 125 219326 10907 (6) 25650 27567 3673 (14.31) 22496 4074 (96) 103 (95.37) 36 (100) 76 (90.47) 1255 (84.79) 499 (82.61) 1787 (77.15) 8 (100) 1330 (86.36) 252 (55.26) 82 (97.61) 211 (88) 3096 (94.16) 1267 (90.75) 18422 (81.89) Source: Rural Health Statistics 2018, GoI Note: R-Required, P-In Position, S-Shortfall i.e., (S=R-P), ‘*’-Surplus Total Specialists at CHC includes Surgeons, Obstetrician & Gynaecologists, Physicians and Paediatricians; Figures shown in parenthesis is the percentage shortfall of health personnel to the required personnel All India figures for Shortfall is the total of State-wise Shortfall ignoring surplus in some States The above Table 3 shows the Required, In Position and Shortfall of ANM at Sub-Centres and PHCs, Doctors at PHCs and Specialists at CHCs in the Indian states. Among them, 22 states have surplus of ANMs and 18 states have surplus of Doctors at PHCs but all the states suffer from the shortage of specialists at CHCs. The shortfall of ANMs is found to be highest in Karnataka with 4646 ANMs, followed by Gujarat with 2287 ANMs shortage. It is important to note that these two states consist of surplus number of Sub-Centres and PHCs but they have registered shortfall in manpower. In respect to number of doctors in PHCs and Total Specialists in CHCs, Uttar Pradesh has the highest shortfall of massive 2277 doctors and 3096 specialists. It is important to note that the Uttar Pradesh state has registered the highest shortfall in health centres as well (Table 2), which shows the destitute condition of health services in the state. www.ijmer.in 111 I NT ERNAT I ONAL JOURNAL OF M ULT I DI SCI PLI NARY E DUCAT I ONAL R ESEARCH ISSN:2277- 7881; IMPAC T FA C TO R :6.514(2020); IC V ALUE:5.16; ISI V ALUE:2.286 Peer Reviewed and UGC Approved: VO LUME:9, ISSUE:3(7), M A RC H:2020 From the Table 3 and Figure 3, it can be seen that, while some states show surplus of health personnel, other states show an acute shortage of health personnel; especially the massive shortfall of specialists in all the states can be clearly seen. In states like Mizoram and Sikkim there is 100 per cent shortfall in specialists i.e., there are no specialists at all in those state’s CHCs. It is interesting to note that there is surplus number of CHCs at Mizoram but it does not have any specialists to render health services. Overall from Figure 3, it can be clearly seen that this scarcity in staff numbers is massively compounded by the inequitable distribution of human resources both within the health centres set-up (i.e., between SC, PHC and CHC) and also among the states. Findings and Discussions: The aim of this study was to assess the level of health infrastructure and health personnel availability and identify the inequalities in distribution of health services availability among states of India. The majority of the selected variables studied above show the sad state of affairs in the rural healthcare services in India. Based on the data from above Tables (Table 2, Table 3), the major findings have been summarized as follows:  Overall, among all states Kerala and Rajasthan has registered better performance in rural health services by showing surplus of availability in five out of six parameters studied in this paper. www.ijmer.in 112 I NT ERNAT I ONAL JOURNAL OF M ULT I DI SCI PLI NARY E DUCAT I ONAL R ESEARCH ISSN:2277- 7881; IMPAC T FA C TO R :6.514(2020); IC V ALUE:5.16; ISI V ALUE:2.286 Peer Reviewed and UGC Approved: VO LUME:9, ISSUE:3(7), M A RC H:2020  On the other hand, Uttar Pradesh is found to be the state with most inferior performance in availability of health infrastructure and personnel. Out of six parameters studied it has shown shortfall in five parameters and those shortages were the highest among all Indian states. Therefore addressing the health services issues should become an urgent, social and political priority in the state.  Further, states like Gujarat, Himachal Pradesh, Tamil Nadu and Uttarakhand have surplus of all three health centres but they show high shortage of health personnel. This leads to less efficiency in delivery of health services at those health centres.  Insufficient infrastructure and manpower at the SCs and the PHCs make the population to reach out to the specialists at the CHCs, thus increasing the burden of work on the CHCs. But approaching CHCs also ends to be futile because there are no care providers at the CHCs. From the given Table 3 it can be seen that the CHCs in rural India have a shortfall of nearly 82 per cent of specialists, thereby aggravating the problem. Thus the rural community is stuck between inadequate and understaffed SCs and PHCs and the CHCs where health manpower is missing. It is a classic case of ‘poor designing’ of our health manpower planning.  Manpower planning involves assessment of current and future demand and supply and analysing the gap and formulating short and long term strategies for ensuring availability of sustainable levels of staff. Therefore, the primary aim of manpower planning is to make available the “right kind of personnel, in the right number, with appropriate skills, of the right place, at the right time, for doing the right job” (Mehta 2014). Problems like procedural delays in appointment of faculty, low pay scale structure, lack of supportive system for career development, non-transparent transfer and posting policy and lack of transparency in career progression are the major issues that need policy attention. Moreover, it is a common complaint of people that government health centres suffer from non-availability of medical staff due to absenteeism and lack of regularity in time. Therefore strict actions must be taken against irregular health personnel.  These findings suggest that mere increase in production capacity is unlikely to resolve the issues related to health personnel availability or distribution in Government rural health centres. It requires a comprehensive review of existing recruitment rules in order to cater to the current and future needs of health personnel. Thereby, development of standard policies regarding recruitment, training, career development plan, transfers and performance appraisal are the need of the day. Conclusion: As India seeks to achieve universal health coverage by 2020, the realization of this goal remains challenged by the current lack of availability and inequitable distribution of health infrastructure and appropriately trained and qualified health personnel. Considering the picture of grim facts there is a dire need to address imbalances in the rural sector to ensure that quality and timely healthcare reaches the deprived corners of the Indian villages catering to the needs of the rural population. Therefore the rural health care in India needs to be examined carefully and it immediately calls for effective steps to provide required health services successfully. www.ijmer.in 113 I NT ERNAT I ONAL JOURNAL OF M ULT I DI SCI PLI NARY E DUCAT I ONAL R ESEARCH ISSN:2277- 7881; IMPAC T FA C TO R :6.514(2020); IC V ALUE:5.16; ISI V ALUE:2.286 Peer Reviewed and UGC Approved: VO LUME:9, ISSUE:3(7), M A RC H:2020 References: Ananthakrishnan, N. (2007). Acute shortage of teachers in medical colleges: Existing problems and possible solutions. National Medical Journal of India, 20(1), 25. Central Bureau of Health Intelligence Directorate General of Health Services (2017). National Health Profile 2017, MoHFW, GoI Hazarika, I. (2013). 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A trend in women's health in India-what has been achieved and what can be done, Rural Remote Health, vol. 10 no. 2 Singh, S., & Badaya, S. (2014). Health care in rural India: A lack between need and feed, South Asian journal of cancer, 3(2), 143. WHO (2006). Working together for health, The world health report 2006, World Health Organization, Geneva, Available at: http://www.who.int/whr/2006/en/index.html Website: www.indiannursingcouncil.org/Statistics.asp www.ijmer.in 114