**Executive Summary**
This document is a response to an unstarred question in Lok Sabha regarding incentives for specialist doctors in rural and remote areas. It outlines the incentives provided by the Ministry of Health and Family Welfare under the National Health Mission (NHM) to address the shortage of specialists. The response details financial and non-financial incentives, training programs, and infrastructure improvements. The question was to be answered on December 12, 2025.
**Key Points / Main Content**
* **Primary Responsibility:** Strengthening public healthcare, including filling vacancies, lies with State/UT Governments.
* **Ministry of Health and Family Welfare Support:** Provides technical and financial assistance to States/UTs based on Programme Implementation Plans (PIPs) under NHM. Approvals are granted through Record of Proceedings (RoPs).
* **Human Resources (HR) Management:** States/UTs should create regular posts according to Indian Public Health Standards (IPHS) and use NHM posts to fill critical gaps.
* **Incentives and Honorarium under NHM:**
* Hard area allowance for specialist doctors in rural/remote areas.
* Honorarium for Emergency Obstetric Care (EmOC)/Life Saving Anaesthesia Skills (LSAS) trained doctors conducting Cesarean Sections.
* Incentives for doctors and Auxiliary Nurse Midwives (ANMs) for timely Antenatal Checkups (ANC).
* Negotiable salaries to attract specialists ("You Quote We Pay").
* Non-monetary incentives like preferential admission to post-graduate courses and improved accommodation.
* Support for multi-skilling of doctors.
* **Performance-Based Incentives for Emergency Obstetrics Care/Cesarean Sections:**
* Performance-based incentives (as decided by the State) for LSAS or CEmONC trained doctors providing spinal anaesthesia or Cesarean section.
* EmOC team at District Hospital/FRUs: Rs. 3,000 per C-section beyond 10 per month (limited to 20% of total deliveries).
* EmOC team at Sub-District CHC/FRUs: Rs. 3,000 per C-section beyond 5 per month.
* **Residential Accommodation:** Government recognizes providing accommodation to attract and retain medical professionals in rural areas.
* **Short-Term Training Programs:** Provisions for short-term training for Medical Officers to address the shortage of specialists. These include:
* 10-day training in Basic Emergency Obstetrics and Newborn Care (BEmONC).
* Six-month training in Comprehensive Emergency Obstetrics and Newborn Care (CEmONC) and Life Saving Anaesthesia Skills (LSAS).
* **Additional Initiatives:** Government is also implementing PM-Ayushman Bharat Health Infrastructure Mission (PM-ABHIM), 15th Finance Commission (FC-XV) Health Sector Grants, Pradhan Mantri Swasthya Suraksha Yojna (PMSSY) and Establishment of new Medical Colleges attached with existing district/referral hospitals.
**Impact Analysis**
**Stakeholder: State/UT Governments**
* **Impact:** Primarily responsible for strengthening public healthcare, filling vacancies, and ensuring HR availability. Need to create regular posts as per IPHS and utilize NHM posts effectively.
* **Action Required:** Prepare Programme Implementation Plans (PIPs) for seeking financial and technical support. Ensure availability of HR by creating adequate number of regular posts as per the Indian Public Health Standards (IPHS).
**Stakeholder: Specialist Doctors and Medical Professionals**
* **Impact:** Can benefit from various incentives and allowances for serving in rural and remote areas, including hard area allowance, honorariums, and preferential admission to post-graduate courses.
* **Action Required:** Be aware of the available incentives and opportunities for professional development and skill upgrades under NHM.
**Stakeholder: Patients in Rural and Remote Areas**
* **Impact:** Improved access to specialist medical care through increased availability of doctors and better healthcare infrastructure.
* **Action Required:** None explicitly mentioned in the document.
Key Entities Referenced
Ministry of Health and Family Welfare: The central ministry responsible for providing technical and financial support for strengthening the public healthcare system.
National Health Mission (NHM): A scheme providing incentives and programs to encourage medical professionals to work in rural and difficult areas and address the shortage of specialists.
States/UTs: Subnational entities responsible for strengthening public healthcare and ensuring availability of human resources in healthcare facilities.
Programme Implementation Plans (PIPs): Proposals submitted by States/UTs under the National Health Mission to strengthen the public healthcare system in rural areas.
Indian Public Health Standards (IPHS): Standards used to ensure the availability of adequate number of regular posts in healthcare facilities.
GOVERNMENTOFINDIA
MINISTRYOFHEALTH AND FAMILYWELFARE
DEPARTMENTOFHEALTH AND FAMILYWELFARE
LOK SABHA
UNSTARREDQUESTION NO. 2152
TO BE ANSWERED ON12.12.2025
INCENTIVES FORSPECIALISTDOCTORSIN RURALAND REMOTE AREAS
2152. SHRINAVEENJINDAL:
Will the Ministerof HEALTH AND FAMILYWELFAREbe pleasedtostate:
(a) the details of the incentives provided to specialist doctors for serving in rural and remote
areasinthe country, includingthe detailsof the hardarea allowance;
(b) whether the Government provides additional honorarium for specialists conducting
emergency obstetric care and Caesarean sections in rural areas, if so, the number of doctors
benefitingfrom thisscheme;
(c) the details of non-monetary incentives introduced under the National Health Mission
(NHM) toencourage medicalprofessionals to workin rural anddifficultareas;
(d) the steps taken under NHM to address the shortage of specialists through multi-skilling
programmesfor doctorsacross the country; and
(e) the measures taken by the Government to improve healthcare infrastructure in rural areas
tosupport andretainmedical professionals?
ANSWER
THE MINISTER OFSTATE IN THE MINISTRYOFHEALTH AND
FAMILYWELFARE
(SHRIPRATAPRAO JADHAV)
(a)to(e): The primary responsibility of strengthening public healthcare system,
including filling up of the vacancies in healthcare facilities lies with the respective State/UT
Governments. The Ministry of Health and Family Welfare provides technical and financial
support to the States/UTs to strengthen the public healthcare system in rural areas based on
the proposals receivedinthe form of ProgrammeImplementationPlans(PIPs)underNational
Health Mission. Government of India provides approval for the proposal in the form of
Record of Proceedings (RoPs) as per norms & available resources. States/ UTs are to ensure
availability of HR by creating adequate number of regular posts as per the Indian Public
Health Standards (IPHS) in the long run and use NHM posts in the short to medium term to
fill critical gaps. The NHM supplementsthe regularhuman resources by fillingupthe gapsin
human resources in secondary andprimary care facilities (District Hospital and below) as per
IPHS.Under NHM, following types of incentives and honorarium are provided for
encouraging doctors and other health care staff to practice in rural and remote areas of the
countrytoaddress the shortage of staff:
Hard area allowance to specialist doctors for serving in rural and remote areas and
for their residential quarters so that they find it attractive to serve in public health
facilitiesinsuch areas.
Honorarium to Gynecologists/ Emergency Obstetric Care (EmOC) trained,
Pediatricians & Anesthetist/ Life Saving Anaesthesia Skills (LSAS) trained doctors
is also provided to increase availability of specialists for conducting Cesarean
Sectionsinrural & remote area.
Incentives like special incentives for doctors, incentive for Auxiliary Nurse and
Midwife (ANM) for ensuring timely Antenatal Checkup (ANC) checkup and
recording, incentives for conducting Adolescent Reproductive and Sexual Health
activities.
States are also allowed to offer negotiable salary to attract specialist including
flexibilityinstrategies such as“YouQuote We Pay”.
Non-Monetary incentivessuch aspreferentialadmission inpost graduate courses for
staff serving in difficult areas and improving accommodation arrangement in rural
areashave also beenintroduced underNHM.
Multi-skilling of doctors is supported under NHM to overcome the shortage of
specialists. Skill upgradation of existing HR is another major strategy under NRHM
for achievingimprovement inhealthoutcomes.
The provisions for performance-based incentives for conducting Emergency Obstetrics Care
andCaesarean Sections are asunder:
i. As per the operational guidelines of Life Saving Anaesthesia Skills (LSAS) and
Comprehensive Emergency Obstetrics and Newborn Care (CEmONC), there is a
provision for awarding performance-based incentives (as decided by the State) for
every emergency obstetric case wherein LSAS or CEmONC trained doctors provide
services such asspinal anaesthesia or Caesarean section, respectively.
ii. As per the guidelines of RMNCH+A: Illustrative Performance-Based Incentive for
High PriorityDistricts (HPDs), the following provisions are available:
•EmOC team at District Hospital/FRUs isentitledtoreceive Rs.3,000per C-section
beyond 10 C-sections per month (limited to a maximum of 20% C-sections of total
deliveries).
• EmOC team at Sub-District CHC/FRUs is entitled to receive Rs. 3,000 per C-
section beyond5C-sections permonth.
The Government of India,inconsultation with the State/UTgovernments, hasrecognised that
providing residential accommodation is one of the key measures to attract, retain, and
motivate medical professionals to serve in rural and difficult areas. Accordingly, the Ministry
of Health & Family Welfare (MoHFW) has approved several staff quarters across variousStates/UTs. The details of such approvals for the last three years and the current financial
year are available and can be accessed through the following link to the RoPs on the
Ministry’swebsite:
https://nhm.gov.in/index4.php?lang=1&level=0&linkid=59&lid=72
Under the National Health Mission, provisions have been made for short-term training
programmes for Medical Officers to address the shortage of specialists across the country.
The initiativesinclude:
i. 10-day training programme in Basic Emergency Obstetrics and Newborn Care
(BEmONC); and
ii. Six-month training programme in Comprehensive Emergency Obstetrics and
Newborn Care (CEmONC) andLife SavingAnaesthesia Skills(LSAS).
In addition to the National Health Mission, Government of India is implementing PM-
Ayushman Bharat Health Infrastructure Mission (PM-ABHIM), 15th Finance Commission
(FC-XV) Health Sector Grants, Pradhan Mantri Swasthya Suraksha Yojna (PMSSY) and
Establishment of new Medical Colleges attached with existing district/referral hospitals in
States/UTs to improve the healthcare infrastructure and service delivery in backward and
under-servedregions.
****