Planning, Budgeting and Analysis of Public Health care Systems

by
Sameer Agrawal (173190008)
Hitesha Nemade (173194002)
Abhijit Tomar (13D100031)

Under the guidance of

Prof. Ashutosh Mahajan

Inter Disciplinary Programme

in
Industrial Engineering and Operations Research
Indian Institute of Technology Bombay
5th May, 2018
Contents

1 Health care Industry in India 5

1.0.1 Sub-centers (SC) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
1.0.2 Primary Health center . . . . . . . . . . . . . . . . . . . . . . . . . . 6
1.0.3 Community Health center . . . . . . . . . . . . . . . . . . . . . . . . 6
1.0.4 First referral unit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

2 Planning and Budget allocation to Healthcare Sector 8

3 Data Collection 9

4 Statistical analysis of different parameters related to health care 11

5 OR Model for Tertiary health care system 19

2
List of Figures

1.1 Indian Public Health System [1] . . . . . . . . . . . . . . . . . . . . . . . . . 7

2.1 Summary of Budgeting Process [5] . . . . . . . . . . . . . . . . . . . . . . . 8

5.1 Optimal Locations in 2016 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

5.2 Optimal Locations in 2021 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
5.3 Number of SCs in 2016 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
5.4 Number of SCs in 2021 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
5.5 Number of PHCs in 2016 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
5.6 Number of PHCs in 2021 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
5.7 Number of DHs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
5.8 Number of DHs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

3
Abstract
India’s health care system policies were designed years ago. In due course of time, there
has been several disparities that have emerged which can be attributed to different lifestyles,
cultures, weather, demography, etc. Structure and Evolution of health care system in India
is studied.
Data available on government websites is exploited and few statistical analysis is conducted
to develop some interesting inferences. An attempt is also made to develop some OR model
to allocate health care sector budget, specifically related to tertiary health care system, under
certain assumptions.

4
Chapter 1

Health care Industry in India

Health system and policies determine how the health care services are determined and uti-
lized. Current Health policies and systems have evolved from the “Bhore Committee Re-
port”, 1946 (for more details, refer to [2], as well as the influence of the Alma Ata Declaration
of Health for All by the Year 2000. Although the first national population program was an-
nounced in 1951, the first National Health Policy of India (NHP) got formulated only in
1983 with its main objective of providing primary health care to all by 2000. [1]
Indian health care system is based on the recommendation of three-tiered health-care sys-
tem. In three-tier health-care system, the primary level refers to the primary health care
which included care for mother and child which included family planning, immunization,
treatment of common diseases or injuries, providing essential facilities, health education,
prevention of locally endemic diseases, etc. Secondary level refers to second level of health
care in which patients from primary health care are referred to specialists in higher hospitals
for treatment. In Tertiary Health care (third level of health system), specialized consultative
care is provided usually on referral from primary and secondary medical care which includes
Specialized Intensive Care Units, advanced diagnostic support services and specialized med-
ical personnel. [3]
Three-tier health care system was implemented to ensure everybody receives access to pri-
mary care independent of their individual socioeconomic conditions. However, lack of ca-
pacity of public health systems to provide access to quality care resulted in a simultaneous
evolution of the private health-care systems with a constant and gradual expansion of pri-
vate health-care services. Private health-care systems concentrated in Urban India and on
secondary and tertiary health-care services.[1]
India has mixed health-care which includes public and private health-care service providers.
India’s health system was designed several years ago, when expectations from health-care
systems were quite different. In due course of time, there has been several disparities that
have emerged which can be attributed to different lifestyles, cultures, weather, demography,
etc. The old approach to national health policies and programme is increasingly inappropri-
ate. The content of national health policy needs to be more specific, pertaining to specific
states and regions, considering the disparities eg. fertility rate, HIV epidemic etc.

5
Public Health care System in India
Public health care system is designed as three tier system based on population norms. Com-
ponents of three tier systems are as follows:

1.0.1 Sub-centers (SC)

A sub-center is first contact point between Primary Health center (PHC) and the commu-
nity. It is established in plain area (with population of 5000) and in hilly/difficult to reach
area (with population of 3000).
Staffing requirements include atleast one auxiliary nurse midwife (ANM)/female health
worker and one male health worker. For more details, refer to recommended staffing struc-
ture under the Indian Public Health Standards(IPHS)[6]
Ministry of health and family welfare is providing 100% support to all SC’s in country in
the form of salaries, rent, etc along with drugs and equipments. [1]

1.0.2 Primary Health center

A primary health center (PHC) is the first contact point between the village community
and medical officer. It is established and maintained by State Government under Minimum
Needs Program (MNP), in plain area (with population of 30,000) and in hilly/difficult to
reach area (with population of 20,000).
Staffing requirements (minimum) includes a medical officer, supported by 14 paramedical
and other staff.
PHCs acts as a referral unit for 5-6 SCs and has 4-5 beds for inpatients.[1]

1.0.3 Community Health center

Community health centers (CHCs) serves as a referral unit for PHCs within the block and is
established and maintained by State Government under Minimum Needs Program (MNP),
in plain area (with population of 120,000) and in hilly/difficult to reach area (with popula-
tion of 80,000).
Staffing requirements (minimum) includes four medical specialists(surgeon, physician, gyne-
cologist/obstetrician and pediatrician) supported by 32 paramedical and other staff. CHCs
acts as a referral center for PHCs within block and has 30 beds with an Operation theater,
X-ray, labor room and laboratory facilities.[1]

1.0.4 First referral unit

Any existing facility, may it be a district hospital, sub-divisional hospital or CHC can be
declared as a fully operational first referral unit (FRU) only if it can provide 24*7 services
for emergency obstetric and newborn care. Any facility qualifies for FRU only if it meets
below three critical determinants:

1. Emergency obstetric care including surgical interventions such as caesarean facilities

6
 2. Care for small and sick newborns

3. Blood storage facility on 24hr basis

Currently there are 722 district hospitals, 4833 CHCs, 24 049 PHCs and 148 366 SCs in
the country.[1]
Below figure summarizes Indian Public Health Standard (IPHS) norms, which decides the
distribution of health-care infrastructure as well the resources needed at each level of care.

Figure 1.1: Indian Public Health System [1]

7
Chapter 2

Planning and Budget allocation to

Healthcare Sector

To ensure efficient resource allocation in the country, a sound understanding of underlying

principles of budget and political dynamics is essential for effective health policy-making,
planning, costing and budgeting. Both the process; Health policy-making, costing, planning
and budgeting should be interlinked for setting health sector priorities in overall strategic
plans and policies.
Budget is the government’s forecast of revenue and planned expenditure. A health budget
refers to the allocation of national funds to health sector. Health budget is more than allo-
cation of funds, it reflects government’s objective and commitment towards implementation
of health policies and strategies.
Budgeting process can be summarized as shown in below figure.

Figure 2.1: Summary of Budgeting Process [5]

Initial budgeting process starts with preparation or formulation of budget proposals,

which includes negotiation phase between MoH and MoF and ends up with parliamentary
review and approval. In a year, three cycles potentially are taking place at simultaneously:
implementation of the current budget (all around the year); budget preparation for the next
year; and review or audit of the previous year.
During the budgeting process, Ministry of Finance(MoF) requests for the plan of health
sectoral priorities and an associated price tag. Good understanding of the budget process and
better collaboration between Ministry of Health (MoH) and other health sector stakeholders,
increases the probability of the final budget allocation to cater the planned health sector
needs.[5]
For more detailed information on ”Budgeting for health”, refer to [5]

8
Chapter 3

Data Collection

Data for performing statistical analysis and OR analysis was collected from different au-
thorized government websites such as censusindia.gov.in, indiastat.com, pbplanning.gov.in,
niti.gov.in, mohfw.gov.in, etc. Data that we collected include:

Data Source Used in

Latitude & Longitude Using python program - OR Model
lat lon.py
Total Population & its fur- census.gov.in OR Model and Statistical analysis
ther bifurcation
Data related to diseases indiastat.com OR Model and Statistical analysis
Data for growth rate ’Size, Growth Rate and OR Model and Statistical analysis
Distribution Of popula-
tion’ report of Census
India(census.gov.in)
Total Public health Rev- mohfw.gov.in OR Model and Statistical analysis
enue and capital; Total
Public health expenditure
Per capita income pbplanning.gov.in Statistical analysis
Total literacy rate niti.gov.in Statistical analysis
Sex Ratio census2011.co.in Statistical analysis
Average Temperature of currentresults.com Statistical analysis
States

• Population district wise (belonging to which state) distribution, male-female popula-

tion of rural-urban areas (district wise) are collected and arranged in proper excel sheet
format after having some hands on excel programming.

• Cases and deaths numbers for the respective states for various diseases like AIDS,
Cancer, Gonococcal Infection, Hepatitis, Diabetes, etc. are collected for the year 2011
and 2016.
For this type of data collection, we made data scrapping code to automate the process
of going to different web-pages of the same website like a human navigator and saving

9
 it under a different file name in our systems.Basically it was done for data collection
for different diseases.Code is named ’dataScrapper.py’ and attached with the report.

• Latitudes and longitudes of each district are listed in the excel sheet by automating
the collection and and its saving in the given excel file. The code has been made in
Python 3.6. (lat lon.py)

• Total revenue and capital for Medical and Public Health data for each state is collected
from ’HEALTH SECTOR FINANCING BY CENTRE AND STATEs/UTs IN INDIA’
by Ministry of Home and Family Welfare. Average exponential yearly Growth Rate of
the respective state (1991-2001 and 2001-11) has been collected from ’SIZE, GROWTH
RATE AND DISTRIBUTION OF POPULATION’ report of Census India.

• ’Per Capita income at current prices’ data of different states is collected, to define the
notion of ’Richer states’.

• Average Maximum and Minimum temperature data is noted. The average of both high
and low temperatures is taken to define the notion of ’Hotter States’

10
Chapter 4

Statistical analysis of different

parameters related to health care

Hypothesis testing was conducted on different claims and relevant inferences were drawn
from the data available, using R software.

Hypothesis Testing - Claims and Inferences

We have used Pearson’s product-moment correlation test in R software, assuming 95% con-
fidence interval.
Indicators:

• p-value > 0.05, accept null hypothesis

• Value of r indicates amount of co-relation with +1 as strong positive co-relation, -1 as

strong negative co-relation and 0 as zero co-relation.

1. Claim: There is no correlation between deaths due to AIDS and sex ratio of a state.
H0: No or very slight correlation between deaths due to AIDS and sex ratio of a state
H1: Deaths due to AIDS and sex ratio of a state are corelated
Analysis:

• t = 1.3954
• df = 34
• p-value = 0.1719
• 95% confidence interval: -0.1037287 0.5214059
• Sample Estimates: cor = 0.2327384

Inference: As p value is (> 0.05), there is no enough evidence to support alternative

¯
Hypothesis. Therefore, Incidence of AIDS and sex ratio have very slight co-relation
(r=0.2327)

11
2. Claim: There is no correlation between deaths due to Diabetes and sex ratio of a
state.
H0: No or very slight correlation between deaths due to Diabetes and sex ration of a
state
H1: Deaths due to diabetes and sex ratio of state are co-related
Analysis:

• t = 1.2401
• df = 34
• p-value = 0.2234
• 95% confidence interval: -0.129359 0.502230
• Sample Estimates: cor = 0.2080173

Inference: As p-value is (> 0.05), there is no enough evidence to support alternative

Hypothesis. Therefore, Incidence of Diabetes and sex ratio have very slight co-relation
(r=0.2080)

3. Claim: Incidence of Cancer has no correlation with literacy rate of a state

H0: No or very slight correlation between incidence of cancer and literacy rate of state
H1: Incidence of cancer is co-related with literacy rate of state
Analysis:

• t = -2.839
• df = 34
• p-value = 0.007583
• 95% confidence interval: -0.6699450 0.1275725
• Sample Estimates: cor = -0.4377607

Inference: As p-value is (> 0.05), there is no enough evidence to support null Hy-
pothesis. Incidence of cancer and literacy rate are negatively co-relation (r = -0.4377)

4. Claim: Incidence of AIDS has no correlation with literacy rate of a state

H0: No or very slight correlation between incidence of AIDS and literacy rate of state
H1: Incidence of AIDS is co-related with literacy rate of state
Analysis:

• t = -1.3334
• df = 34
• p-value = 0.1913
• 95% confidence interval: -0.5138259 0.1139604
• Sample Estimates: cor = -0.2229

12
 Inference: As p-value (> 0.05), there is no enough evidence to support alternative
Hypothesis. Therefore, Incidence of AIDS and literacy rate have some negative co-
relation (r = -0.2229).

5. Claim: Ratio of cases:deaths for Cancer is not related to public healthcare spending
H0: No or very slight correlation between deaths of cancer and public healthcare
spending
H1: Deaths for cancer is co-related with public healthcare spending
Analysis:

• t = 0.038158
• df = 34
• p-value = 0.9697
• 95% confidence interval: -0.3226856 0.3343608
• Sample Estimates: cor = 0.0065

Inference: As p-value (> 0.05), there is no enough evidence to support alternative

Hypothesis. Therefore, there is no-correlation between public health care spending and
deaths due cancer (r=0.0065).

6. Claim: Cases:Death ratio is similar from 2011 to 2016 for AIDS

H0: No or very slight correlation between deaths of AIDS in 2011 and 2016
H1: Death ratio of 2011 and 2016 are co-related for AIDS
Analysis:

• t = -8.823
• df = 35.068
• p-value = 1.985e-10
• 95% confidence interval: -5.355960 -3.352372
• Sample Estimates: mean of x = 0.1156879; mean of y = 4.4698544

Inference: As p-value is (> 0.05), there is no enough evidence to support null Hy-
pothesis. Therefore, there is an increasing co-relation in deaths due to AIDs in year
2011 and year 2016.

7. Claim:Amount of public spending on healthcare has no effect on incidence of AIDS

H0: No or very slight co-relation between amount of public spending on healthcare
and incidence of AIDS
H1: Amount of public spending on health care and incidence of AIDS are co-related
Analysis:

• t = 6.4409
• df = 34
• p-value = 2.318e-7

13
 • 95% confidence interval: 0.5457094 0.8603324
• Sample Estimates: cor = 0.7413349
Inference: As p-value is (> 0.05), there is no enough evidence to support null Hy-
pothesis. Therefore, there is a strong positive co-relation in amount of public spending
on health care and incidence of AIDS (r = 0.7413349)
8. Claim: Cancer incidence in states has no relation to sex ratio
H0: No or very slight co-relation between incidence of cancer and sex ratio
H1: Incidence of cancer in states and sex ratio are co-related
Analysis:
• t = 0.67205
• df = 34
• p-value = 0.5061
• 95% confidence interval: -0.2224038 0.4269725
• Sample Estimates: cor = 0.114498
Inference: As p-value is (> 0.05), there is no enough evidence to support alternative
Hypothesis. Therefore, there is very slight co-relation in incidence of cancer and sex
ratio (r = 0.114498)
9. Claim: Gonococcal infection / Malaria incidence in states is not related to population
growth rate
H0: No corelation between Gonococcal infection / Malaria incidence in states and
population growth rate
H1: Gonococcal infection/Malaria incidence in states and population growth rate are
co-related
Analysis:
• t = -0.75666
• df = 34
• p-value = 0.4545
• 95% confidence interval: -0.4386758 0.2086715
• Sample Estimates: cor = -0.1286864
Inference: As p-value is (> 0.05), there is no enough evidence to support alternative
Hypothesis. Therefore, there is very slight negative co-relation in incidence of cancer
and sex ratio (r = -0.1286)
10. Claim: Number of deaths due to Hepatitis is similar over the years
H0: No or very slight corelation between number of deaths due to Hepatitis over the
years
H1: Number of deaths due to Hepatitis over the years are co-related
Analysis:

14
 • t = 1.0088
• df = 64.564
• p-value = 0.3168
• 95% confidence interval: -5.089954 15.478843
• Sample Estimates: mean of x = 14.388889; mean of y = 9.19444

Inference: As p-value is (> 0.05), there is no enough evidence to support alternative

Hypothesis. Therefore, number of deaths due to Hepatitis are slightly decreasing over
the years. (mean values are 14.38 and 9.19)

11. Claim: Incidence of AIDS is not related to population growth

H0: No or very slight co-relation between incidence of AIDS and population growth
H1: Incidence of AIDS and population growth are co-related
Analysis:

• t = -1.0083
• df = 34
• p-value = 0.2841
• 95% confidence interval: -0.4829001 0.1543685
• Sample Estimates: cor = -0.1834

Inference: As p=value is (> 0.05), there is no enough evidence to support alternative

Hypothesis. Therefore, there is very slight negative co-relation between incidence of
AIDS and population growth (r=-0.1834).

12. Claim: Incidence of Diabetes is not related to per capita income of the state
H0: No or very slight corelation between incidence of diabetes and per capita income
of the state
H1: Incidence of Diabetes and per capita income of the state are co-related
Analysis:

• t = -0.21336
• df = 34
• p-value = 0.8323
• 95% confidence interval: -0.3607686 0.2955190
• Sample Estimates: cor = -0.03656

Inference: As p-value is (> 0.05), there is no enough evidence to support alternative

Hypothesis. Therefore, there is slight negative co-relation between incidence of diabetes
and per capita income of the state (r = -0.03656).

15
13. Claim: Incidence of Cancer is not related to per capita income of the state
H0: No or very slight corelation between incidence of cancer and per capita income of
the state
H1: Incidence of Cancer and per capita income of the state are co-related
Analysis:

• t = -2.127
• df = 34
• p-value = 0.04075
• 95% confidence interval: -0.6033057 -0.0159552
• Sample Estimates: cor = -0.3426

Inference:As p-value os (> 0.05), there is no enough evidence to support null Hy-
pothesis. Therefore, there is negative co-relation between incidence of cancer and per
capita income of the state (r = -0.3426).

14. Claim: Healthcare spending in a state is not correlated with literacy rate of the state
H0: No or very slight co-relation between Healthcare spending and literacy rate of the
state
H1: Health care spending and literacy rate are co-related
Analysis:

• t = -1.6514
• df = 34
• p-value = 0.1079
• 95% confidence interval: -0.55164243 0.06155484
• Sample Estimates: cor = -0.2724915

Inference: As p-value is (> 0.05), there is no enough evidence to support alternative

Hypothesis. Therefore, there is slight negative co-relation between health care spending
and literacy rate of the state (r = -0.2724).

15. Claim:Urban population in a state is not related to literacy rate

H0: No or very slight corelation between Urban population and literacy rate of the
state
H1: Urban population and literacy rate of the state are co-related

textbfAnalysis:

• t = -0.099655
• df = 34
• p-value = 0.9212
• 95% confidence interval: -0.3436945 0.3132058

16
 • Sample Estimates: cor = -0.017088

Inference: As p-value is (> 0.05), there is no enough evidence to support alternative

Hypothesis. Therefore, there is almost no co-relation between urban population and
literacy rate of the state (r = -0.017088).

16. Claim: Females are more in states with large Urban population
H0: No or very slight corelation between number of females in state and large urban
population
H1: Females and Large urban population are co-related
Analysis:

• t = 27.929
• df = 34
• p-value ¡ 2.2e-16
• 95% confidence interval: 0.9586667 0.9892766
• Sample Estimates: cor = 0.9788937

Inference: As p-value is (> 0.05), there is no enough evidence to support null Hy-
pothesis. Therefore, there is strictly positive co-relation between number of females in
state and large urban population (r = 0.9788937).

17. Claim: Average Annual temperature of a state has no relation to population growth
rate
H0: No or very slight co-relation between average annual temperature of state and
population of the state
H1: Average annual temperature and population of the state are co-related
Analysis:

• t = -0.14433
• df = 34
• p-value = 0.8861
• 95% confidence interval: -0.3504312 0.3062814
• Sample Estimates: cor = -0.024744

Inference: As p-value is (> 0.05), there is no enough evidence to support alterna-

tive Hypothesis. Therefore, there is almost no co-relation between average annual
temperature of state and population of the state (r = -0.024744).

18. Claim: Rural population in a state is not related to literacy rate

H0: No or very slight co-relation between Rural population and literacy rate of the
state
H1: Co-relation between rural population and literacy rate of the state are co-related
Analysis:

17
 • t = -3.2544
• df = 34
• p-value = 0.002572
• 95% confidence interval: -0.7032876 -0.1891006
• Sample Estimates: cor = -0.4873586

Inference: As p-value is (> 0.05), there is no enough evidence to support null Hypoth-
esis. Therefore, there is negative co-relation between Rural population and literacy rate
of the state (r = -0.48735).

19. Claim: Avg annual state temperature has no relation to per capita income of the state
H0: No or very slight co-relation between Avg annual state temperature and per capita
income of the state
H1: Average annual state temperature and per capita income of the state are co-related
Analysis:

• t = 0.90288
• df = 34
• p-value = 0.3729
• 95% confidence interval: -0.184807 0.458505
• Sample Estimates: cor = 0.1530194

Inference: As p-value is (> 0.05), there is no enough evidence to support alternative

Hypothesis. Therefore, there is slight positive co-relation between Avg annual state
temperature and per capita income of the state (r = 0.1530194).

20. Claim: The population growth rate states has no correlation with literacy rate
H0: No or very slight co-relation between population growth rate and literacy rate of
the state
H1: Population growth rate and literacy rate of the state are co-related
Analysis:

• t = -1.0346
• df = 34
• p-value = 0.3082
• 95% confidence interval:-0.4759241 0.1631979
• Sample Estimates: cor = -0.1747049

Inference: As p-value is (> 0.05), there is no enough evidence to support alternative

Hypothesis. Therefore, there is some negative co-relation between population growth
rate and literacy rate of the state (r = -0.1747049 ).

18
Chapter 5

OR Model for Tertiary health care

system

Data used for developing OR model for the pan India locations of Specialized Care centers
(Regional Cancer Care center,RCC) and Tertiary Care Centers (TCC) are as follows:

• Total population and its further bifurcation into males & females, and further into
rural & urban district wise, collected from ”censusindia.gov.in”

• Latitude and longitude of each district, using a ”python program” (lat lon.py)

• Data related to diseases, from ”indiastat.com”

• Data of total number of SCs, PHCs and DHs in India ”data.gov.in”

• Budget allocated to state government is calculated from ”mohfw.gov.in”

• Budget allocated to union government is calculated from GDP. 1.6% of GDP is al-
located to health care sector. Out of the total budget alloted to health care sector,
0.6% is spend on building infrastructure required for health care (0.6% is taken from
authentic report)

• Current inflation rate (2016 year) is considered as 0.042

Program is ”sameer project.py” made in Python 3.6 Objective:

• To maximize population coverage through RCC and TCC

• We have forecasted number of Cases/Death from Cancer/other diseases treated in RCC

and TCC

• Plot facility location (RCC and TCC) on map of India using district coordinates

• Answer questions like

– How do we prepare for increase in Cancer case by 2021?

19
 – Where and what type of facilities should be located?

• Optimize number location of RCC and TCC facilities constrained on budget

Assumptions and Constraints:

• SCs are established and maintained by Union Government

• PHC and District Hospitals are established and maintained by State Government

• RCC is jointly handled by Central and State Government

• TCC are established and maintained only by Union Government

• If a TCC is covering a particular region, then RCC should not be placed near

Optimization Model
Let,

• u i = binary variable indicating whether ith district is covered by RCC, {0,1}

• v i = binary variable indicating whether ith district is covered by TC‘C, {0,1}

• x1 = binary variable indicating district having RCC facility,{0,1}

• x2 = binary variable indicating district having TCC facility,{0,1}

• y = Integer variable giving sum of number of RCCs in a state

• z = Integer variable giving sum of number of TCCs in a state

Objective function:
sum over i (u i + v i)*population[0, i], where i = ith district

Results and Output:

Based on the current and forecasted values of number of cases/deaths from cancer/other
dieases, we have:

• Forecasted optimal location of RCCs and TCCs are plotted on pan India map

• Current and forecasted number of SCs, PHCs and DHs

Plots are shown below:

The red dots represent location of RCCs and the blue dots represent location of TCCs

20
 Figure 5.1: Optimal Locations in 2016

Figure 5.2: Optimal Locations in 2021

Table 5.1: For 2016, Data for Number of SCs, PHCs and DHs

No of DHs No of PHCs No of SCs States

8.0 495.0 2292.0 Jammu and Kashmir
4.0 270.0 1547.0 Himachal Pradesh
18.0 1106.0 4353.0 Punjab
0.0 42.0 7.0 Chandigarh
6.0 400.0 1768.0 Uttarakhand
17.0 1013.0 4158.0 Haryana
11.0 673.0 103.0 Delhi
46.0 2752.0 12985.0 Rajasthan
132.0 7913.0 38470.0 Uttar Pradesh
70.0 4193.0 23326.0 Bihar
0.0 22.0 112.0 Sikkim
Continued on next page

21
 Table 5.1 – Continued from previous page
No of DHs No of PHCs No of SCs States
0.0 49.0 263.0 Arunachal Pradesh
1.0 73.0 345.0 Nagaland
1.0 111.0 505.0 Manipur
0.0 41.0 129.0 Mizoram
2.0 146.0 681.0 Tripura
2.0 117.0 597.0 Meghalaya
20.0 1246.0 6740.0 Assam
61.0 3668.0 15640.0 West Bengal
22.0 1322.0 6315.0 Jharkhand
28.0 1674.0 8785.0 Odisha
15.0 933.0 4533.0 Chhattisgarh
48.0 2911.0 13239.0 Madhya Pradesh
40.0 2427.0 8738.0 Gujarat
0.0 9.0 15.0 Daman and Diu
0.0 14.0 46.0 Dadra and Nagar Haveli
73.0 4421.0 15441.0 Maharashtra
23.0 1413.0 5431.0 Telangana
33.0 1979.0 8733.0 Andhra Pradesh
39.0 2367.0 9057.0 Karnataka
0.0 57.0 137.0 Goa
0.0 2.0 3.0 Lakshadweep
22.0 1333.0 4372.0 Kerala
48.0 2890.0 9362.0 Tamil Nadu
1.0 61.0 125.0 Puducherry
0.0 14.0 58.0 Andaman and Nicobar Islands

Table 5.2: For 2021, Data for Number of SCs, PHCs and DHs

No of DHs No of PHCs No of SCs States

No. of DHs No. of PHCs No. of SCs States
8.0 502.0 2314.0 Jammu and Kashmir
4.0 273.0 1558.0 Himachal Pradesh
18.0 1116.0 4382.0 Punjab
0.0 42.0 7.0 Chandigarh
6.0 403.0 1785.0 Uttarakhand
17.0 1023.0 4193.0 Haryana
11.0 680.0 103.0 Delhi
46.0 2781.0 13115.0 Rajasthan
133.0 7983.0 38828.0 Uttar Pradesh
70.0 4239.0 23592.0 Bihar
Continued on next page

22
 Table 5.2 – Continued from previous page
No of DHs No of PHCs No of SCs States
0.0 22.0 113.0 Sikkim
0.0 50.0 264.0 Arunachal Pradesh
1.0 73.0 345.0 Nagaland
1.0 112.0 509.0 Manipur
0.0 41.0 130.0 Mizoram
2.0 147.0 685.0 Tripura
2.0 118.0 604.0 Meghalaya
21.0 1251.0 6795.0 Assam
61.0 3686.0 15741.0 West Bengal
22.0 1332.0 6381.0 Jharkhand
28.0 1688.0 8843.0 Odisha
15.0 940.0 4580.0 Chhattisgarh
49.0 2934.0 13361.0 Madhya Pradesh
41.0 2447.0 8816.0 Gujarat
0.0 9.0 15.0 Daman and Diu
0.0 14.0 47.0 Dadra and Nagar Haveli
74.0 4449.0 15555.0 Maharashtra
23.0 1425.0 5473.0 Telangana
33.0 1989.0 8780.0 Andhra Pradesh
40.0 2387.0 9123.0 Karnataka
0.0 57.0 138.0 Goa
0.0 2.0 3.0 Lakshadweep
22.0 1335.0 4381.0 Kerala
48.0 2912.0 9429.0 Tamil Nadu
1.0 62.0 127.0 Puducherry
0.0 14.0 58.0 Andaman and Nicobar Islands

23
Figure 5.3: Number of SCs in 2016

Figure 5.4: Number of SCs in 2021

24
Figure 5.5: Number of PHCs in 2016

Figure 5.6: Number of PHCs in 2021

25
Figure 5.7: Number of DHs

Figure 5.8: Number of DHs

26
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