Lok Sabha Question No. 5672 (UNSTARRED), answered on 2017-04-07
Subject: Global Burden of Disease Report
Ministry: HEALTH AND FAMILY WELFARE
Asked by: KIRIT PREMJIBHAI SOLANKI

## GOVERNMENT OF INDIA MINISTRY OF HEALTH AND FAMILY WELFARE DEPARTMENT OF HEALTH AND FAMILY WELFARE

LOK SABHA UNSTARRED QUESTION NO. 5672 TO BE ANSWERED ON 7 th APRIL, 2017

## GLOBAL BURDEN OF DIS EASE REPORT

## 5672. DR. KIRIT P. SOLANKI:

Will the Minister of HEALTH AND FAMILY WELFARE be pleased to state:

- (a) whether the Government is aware of the latest Global Burden of Disease Report (2015) which shows that despite economic growth, health indicators in the country haven't improved as muc h as inthe past decade, if so, the details thereof and the reaction of the Government thereto including action taken to tackle this menacing issue;
- (b) whether self - harm deaths have increased over the years and if so, the details thereof along with the m easures undertaken by the Government to deal with the same; and
- (c) the details of Centrally Sponsored Schemes to improve the health indicators and status along with State/UT - wise budget allotment and utilisation during the last thr e years?

## ANSWER THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE (SHRI FAGGAN SINGH KULASTE)

- (a): Global  Burden  Disease  report  (2015)  has  compared  results  in  current  study  with  2 observations  and  India  has  shown  improvement  across  multiple  indicator s.  For  instance,  the  life expectancy has improved (for males as well as females) and mortality for under 5 age gro reduced too. Additionally, mortality due to various diseases has reduced. For instance, the (between the years 2005 and 2015) is reduced for lower respiratory infections (by 22.6%), diarrho diseases  (by  31.7%),  tuberculosis  (by  30.7%),  neonatal  preterm  birth  (by  39.5%),  ne encephalopathy (by 31%) and road injuries (by 2.7%). However, there is an increase in the bu f ischemic heart disease and diabetes.

The Ministry of Health and Family Welfare is aware of the increase in burden of the -communicable diseases and has launched a screening and control programme for five common no -communicable  diseases,  namely  Hyper tension,  Diabetes,  and  Cancers  of  oral  cavity,  breast  an cervix.

- (b): As per the Global Burden of Disease report for India, the deaths due to self - harm for the period 2005 to 2015 have declined by 3.9%.
- (c):  The  Centrally  Sponsored  Scheme  (CSS)  National Health  Mission  (NHM),  has  two  sub -missions, viz. the National Rural Health Mission (NRHM) and the National Urban Health Missi (NUHM).  While  NRHM  was  launched  in  April  2005,  NUHM  was  launched  in  2013.  NHM envisages achievement of universal access to equi table, affordable & quality healthcare services that are accountable and responsive to people's needs. The main programmatic

components  include  Health  System  strengthening  in  rural  and  urban  areas,  Reproducti -Maternal - Neonatal - Child  and  Adolescent  Hea lth  (RMNCH+A)  interventions  and  control  of Communicable  and  Non - Communicable  Diseases.  Under  NHM,  support  is  provided  to  the States/UTs to strengthen their health care system based on the requirements posed by them Programme  Implementation  Plans.  Fun ds  allocated,  released  and  expenditure  incurred  State/UT wise are given at Annexure 1.

To  meet  the  shortfall  of  human  resource  in  health,  the  government  is  implementin Centrally Sponsored Scheme for 'Establishment of new Medical Colleges attached with existing district/referral  hospitals'  with  fund  sharing  between  the  Central  Government  a nd  States  in  the ratio of 90:10 for North Eastern /special category states and 60:40 for other states. Th was  approved  in  January,  2014.  58  districts  in  20  States/UTs  have  been  identified  unde Scheme to establish new Medical Colleges attache d with existing district/referral hospitals. Out o these, 53 have been approved till date. Funds released to the State Governments for the a districts under the scheme are given at Annexure-2.

Upgradation of existing State Government/Central Government medical colleges to increas MBBS seats in the country: -This scheme was approved in January, 2014. The funding pattern is 90:10 by Central and State Governments respectively for North Eastern States and Sp ecial category States and 60:40 for other States with the upper ceiling cost pegged at Rs.1.20 crore per Medical Colleges have been approved under the scheme to increase UG seats. Funds released un this scheme are at Annexure- 3.

Strengthening and upgradation of State Government Medical colleges for starting new PG disciplines and increasing PG seats : - The  scheme  was  launched  in  the  XI  Plan  period  with  the objective to strengthen and upgrade State/Central Government Medical Colleges to create n ew PG seats.  The  funding  pattern  between  Centre  and  States  is  in  the  ratio  of  60:40.  A  tota Government Medical colleges in 21 States/UTs are covered under the scheme for increasing seats. Funds released under the scheme are at Annexure- 4.

Rashtr iya Swasthya Bima Yojana (RSBY), a Centrally S ponsoredHealth I nsurance scheme is being implemented by this Ministry which covers BPL families (a unit of five) and other categories namely Building & Other Construction Workers, licensed Railway por Str eet Vendors, MGNREGA workers (who have worked for more than fifteen days during preceding  financial  year),  Beedi  workers,  Domestic  workers,  Sanitation  Workers, Workers,  Rickshaw  pullers,  Rag  pickers  and  Auto/Taxi  drivers,  who  are  enrolled  u RSBY. They are entitled for health insurance coverage of Rs.30,000/ - cashless  per annum per family. The Senior Citizens Health Insurance Scheme (SCHIS) as top up over existi RSBY scheme has been implemented from 01.04.2016 for senior citizens aged 60 years a d above. SCHIS provides enhanced coverage of Rs. 30,000 per senior citizen in the f eligible  for  coverage  under  RSBY . Under  RSBY  there  is  no State/UT - wise  allocation  of funds.  Central  Government  releases  its  share  of  premium  to  State  Governments  on e receipt  of  their  proposals.  The  State/UT -wise  details  of  the  funds  released  to  State Governments during last three years are at A nnexure - 5.

## National Health Mission

## Statement showing States/UTs wise Allocation, Release and Expenditure during 2014- 15 to 201 6- 17 (Rs in crore)

| Sl. No.                           | States                            | 2014- 15    | 2014- 15   | 2014- 15     | 2015- 16    | 2015- 16   | 2015- 16     | 2016- 17    | 2016- 17   | 2016- 17     |
|-----------------------------------|-----------------------------------|-------------|------------|--------------|-------------|------------|--------------|-------------|------------|--------------|
| Sl. No.                           | States                            | Allocati on | Releas e   | Expend iture | Allocat ion | Releas e   | Expend iture | Allocat ion | Releas e   | Expend iture |
| 1                                 | Andaman & Nicobar Islands         | 28.22       | 23.36      | 24.33        | 28.21       | 37.30      | 11.47        | 47.51       | 26.50      | 14.92        |
| 2                                 | Andhra Pradesh                    | 707.15      | 519.73     | 902.91       | 616.23      | 643.52     | 1090.17      | 596.79      | 556.96     | 779.40       |
| 3                                 | Arunachal Pradesh                 | 185.65      | 139.41     | 69.50        | 160.01      | 162.65     | 146.27       | 162.62      | 106.47     | 57.73        |
| 4                                 | Assam                             | 1095.38     | 877.13     | 915.88       | 941.29      | 971.35     | 1186.01      | 937.39      | 801.73     | 794.34       |
| 5                                 | Bihar                             | 1292.13     | 1148.32    | 1427.40      | 1108.61     | 1159.49    | 1621.67      | 1129.08     | 939.01     | 620.23       |
| 6                                 | Chandigarh                        | 19.40       | 12.15      | 15.26        | 14.24       | 23.89      | 20.98        | 22.30       | 18.86      | 14.46        |
| 7                                 | Chattisgarh                       | 555.66      | 500.41     | 716.04       | 479.38      | 412.26     | 758.28       | 478.19      | 548.49     | 648.01       |
| 8                                 | Dadra & Nagar Haveli              | 13.99       | 8.40       | 8.56         | 11.37       | 14.37      | 15.54        | 18.85       | 16.88      | 10.18        |
| 9                                 | Daman & Diu                       | 9.69        | 6.91       | 7.67         | 9.11        | 10.53      | 15.69        | 15.08       | 9.36       | 5.57         |
| 10                                | Delhi                             | 192.59      | 154.04     | 222.64       | 142.81      | 163.80     | 137.29       | 207.01      | 176.85     | 99.69        |
| 11                                | Goa                               | 27.63       | 26.03      | 29.50        | 19.41       | 16.77      | 24.92        | 19.74       | 18.42      | 21.99        |
| 12                                | Gujarat                           | 858.47      | 832.86     | 873.66       | 677.65      | 693.78     | 1272.42      | 676.51      | 842.22     | 743.89       |
| 13                                | Haryana                           | 317.42      | 273.60     | 438.18       | 249.33      | 291.96     | 493.23       | 242.46      | 306.44     | 274.02       |
| 14                                | Himachal Pradesh                  | 232.00      | 185.84     | 306.92       | 197.92      | 246.49     | 281.26       | 209.03      | 205.34     | 235.81       |
| 15                                | Jammu & Kashmir                   | 435.17      | 335.51     | 393.29       | 368.00      | 367.90     | 420.94       | 391.14      | 336.00     | 245.00       |
| 16                                | Jharkhand                         | 563.92      | 359.62     | 372.01       | 493.37      | 411.50     | 590.18       | 487.41      | 284.04     | 333.01       |
| 17                                | Karnataka                         | 834.09      | 697.24     | 858.18       | 706.09      | 740.45     | 1141.61      | 702.94      | 685.71     | 817.49       |
| 18                                | Kerala                            | 373.58      | 521.99     | 509.83       | 305.87      | 304.14     | 632.88       | 303.32      | 417.76     | 447.65       |
| 19                                | Lakshadweep                       | 5.89        | 5.08       | 1.36         | 4.28        | 5.69       | 2.72         | 6.73        | 3.12       | 2.88         |
| 20                                | Madhya Pradesh                    | 1250.17     | 1162.50    | 1738.02      | 1085.37     | 1132.19    | 2046.60      | 1105.63     | 1432.78    | 1254.68      |
| 21                                | Maharashtra                       | 1536.58     | 1431.76    | 1834.40      | 1282.31     | 1085.92    | 1734.44      | 1246.56     | 1097.15    | 1161.04      |
| 22                                | Manipur                           | 144.97      | 128.81     | 86.91        | 118.53      | 112.16     | 105.51       | 119.41      | 47.97      | 58.39        |
| 23                                | Meghalaya                         | 160.21      | 104.13     | 70.72        | 131.00      | 102.22     | 133.55       | 128.47      | 74.44      | 97.68        |
| 24                                | Mizoram                           | 116.53      | 103.28     | 93.29        | 97.87       | 94.68      | 172.38       | 94.65       | 77.36      | 52.46        |
| 25                                | Nagaland                          | 131.26      | 114.92     | 63.04        | 108.75      | 104.85     | 81.05        | 105.80      | 75.02      | 80.60        |
| 26                                | O disha                           | 730.09      | 667.16     | 944.10       | 624.71      | 652.62     | 1205.77      | 709.01      | 614.24     | 722.68       |
| 27                                | Puducherry                        | 25.46       | 22.56      | 23.35        | 17.77       | 18.61      | 21.77        | 37.52       | 30.58      | 21.32        |
| 28                                | Punjab                            | 351.89      | 379.35     | 460.59       | 284.75      | 295.23     | 649.49       | 280.89      | 279.75     | 417.79       |
| 29                                | Rajasthan                         | 1238.11     | 1115.96    | 1722.69      | 1069.38     | 1287.84    | 1799.11      | 1101.93     | 1217.36    | 1036.78      |
| 30                                | Sikkim                            | 51.42       | 51.60      | 41.36        | 45.86       | 41.01      | 50.71        | 46.16       | 32.29      | 26.34        |
| 31                                | Tamil Nadu                        | 968.18      | 952.75     | 2248.06      | 794.38      | 1093.22    | 1633.37      | 779.18      | 747.35     | 1303.29      |
| 32                                | Tripura                           | 161.75      | 123.11     | 130.15       | 139.08      | 136.29     | 118.77       | 137.71      | 82.75      | 93.01        |
| 33                                | Uttar Pradesh                     | 2650.25     | 2431.06    | 3671.26      | 2299.49     | 2862.83    | 4451.78      | 2292.55     | 3069.87    | 2666.11      |
| 34                                | Uttarakhand                       | 308.10      | 270.55     | 324.42       | 256.60      | 276.41     | 335.95       | 266.59      | 249.31     | 191.82       |
| 35                                | West Bengal                       | 1053.27     | 1058.62    | 1196.78      | 883.49      | 959.51     | 1487.62      | 856.54      | 734.44     | 1028.25      |
| 36                                | Telangana                         | 506.45      | 378.72     | 334.68       | 440.58      | 436.63     | 505.55       | 434.01      | 304.32     | 349.32       |
| Others including arrears under IM | Others including arrears under IM | 1211.51     | 35.83      | -            | 1100.00     | 92.82      | -            | 1761.20     | -          | -            |

1. Allocation is as per Original outlay/Budget Estimat s
2. Expenditure includes expenditure against central Release, state release & unspent balances at the beginning d it is  updated  as  per  FMR  submitted  by  the  States/UTs.    3. Release  for  the  F.Y.  2016 - 17  is  updated  upto 02.03.2017  and  is provisional. 4.The above releases relate to Central Govt. Grants & do not include State share contribution an under Immunization.   5. The arrears under IM cannot be anticipated earlier hence not allocated State -wise, however the release to States including arrear payments.

## Annexure - 1

Funds released under the Centrally Sponsored Scheme for establishment of new Medical Colleges attached with existing district/referral hospitals during last three years (Rs. in crore)

|   S. No. | States/UT                   |   2014- 15 |   2015- 16 |   2016- 17 |
|----------|-----------------------------|------------|------------|------------|
|        1 | Andaman and Nicobar Islands |       0    |      28    |      40    |
|        2 | Arunachal Pradesh           |       0    |      42.5  |      10    |
|        3 | Assam                       |       0    |      30    |     143.97 |
|        4 | Bihar                       |       0    |       8    |      44    |
|        5 | Chhattisgarh                |      14    |      39.02 |      83    |
|        6 | Himachal Pradesh            |      12.53 |      67.98 |     123    |
|        7 | Haryana                     |       0    |       0    |      14.05 |
|        8 | Jharkhand                   |       0    |       0    |      78    |
|        9 | Jammu & Kashmir             |       0    |       0    |     108    |
|       10 | Madhya Pradesh              |      14    |      24    |     111    |
|       11 | Maharashtra                 |       6    |       7    |      55    |
|       12 | Mizoram                     |       0    |      30    |      21.02 |
|       13 | Nagaland                    |       0    |      36.5  |      14.53 |
|       14 | Odisha                      |      35    |      85    |      50    |
|       15 | Rajasthan                   |      41    |      89.2  |     103    |
|       16 | Uttar Pradesh               |       0    |      16    |     154.1  |
|       17 | Uttarakhand                 |       6    |       8    |      37.02 |
|       18 | West Bengal                 |       0    |      20    |     104    |

Funds  released  under  the  Centrally  Sponsored  Scheme  for  ' Up - gradation  of  existing  State Government/Central  Government  medical  colleges  to  increase  MBBS  seats  in  the  Country ' during the last three years

(Rs. in crore)

|   S. No. | States/UT      |   2015- 16 |   2016- 17 |
|----------|----------------|------------|------------|
|        1 | Andhra Pradesh |        6   |      15.51 |
|        2 | Gujarat        |        4.5 |      15.6  |
|        3 | Madhya Pradesh |       12   |      38.33 |
|        4 | Odisha         |        5   |      16.56 |
|        5 | Punjab         |        4   |      10.34 |
|        6 | Rajasthan      |        7   |      21.73 |
|        7 | Tamil Nadu     |        9.5 |      31.76 |
|        8 | Uttarakhand    |        2   |       5.17 |

Note: There was no release in 2014- 15

Funds Released under the scheme for 'Strengthening and up -gradation of State Government Medical Colleges for starting new PG disciplines and increasing PG seats' during the last three years ( Rs.in crore)

|   S. No. | State/UT         |   2014- 15 |   2016- 17 |
|----------|------------------|------------|------------|
|        1 | Assam            |          0 |       3    |
|        2 | Andhra Pradesh   |          0 |       0    |
|        3 | Bihar            |          0 |       0    |
|        4 | Chandigarh       |          0 |       0    |
|        5 | Chhattisgarh     |          0 |       0    |
|        6 | Goa              |          0 |       0    |
|        7 | Gujarat          |          0 |       0    |
|        8 | Himachal Pradesh |          0 |       0    |
|        9 | Jammu & Kashmir  |          0 |       0    |
|       10 | Jharkhand        |          0 |       3    |
|       11 | Kerala           |          0 |       0    |
|       12 | Madhya Pradesh   |          5 |       1.94 |
|       13 | Maharashtra      |          0 |       0    |
|       14 | Odisha           |          0 |       4.06 |
|       11 | Punjab           |          0 |       0    |
|       16 | Rajasthan        |          0 |       0    |
|       17 | Telangana        |          0 |       2    |
|       18 | Tripura          |          0 |       6    |
|       19 | Uttarakhand      |          5 |       0    |
|       20 | Uttar Pradesh    |          0 |       0    |
|       21 | West Bengal      |          0 |       0    |

Note: There was no release in 2015 - 16

## Annexure - 5

Central share of Premium released to State Governments under RSBY during last three years (Amount in Crore)

|   Sr. No. | Name of State    | 2014- 15   | 2015- 16   | 2016- 17   |
|-----------|------------------|------------|------------|------------|
|         1 | Assam            | 1.06       | 23.24      | 54.72      |
|         2 | Bihar            | 34.07      | -          | -          |
|         3 | Chhattisgarh     | 58.81      | 88.77      | 114.09     |
|         4 | Gujarat          | 18.47      | 74.24      | 22.34      |
|         5 | Haryana          | 5.38       | 4.67       | 0.60       |
|         6 | Himachal Pradesh | 3.75       | 13.90      | 12.30      |
|         7 | Jharkhand        | 5.51       | -          | -          |
|         8 | Karnataka        | -          | 94.99      | 45.89      |
|         9 | Kerala           | 110.43     | 112.37     | 73.29      |
|        10 | Madhya Pradesh   | 8.21       | 1.00       | -          |
|        11 | Manipur          | 1.73       | 1.17       | 2.20       |
|        12 | Meghalaya        | 1.25       | 4.10       | 4.10       |
|        13 | Mizoram          | 10.35      | 9.43       | 14.13      |
|        14 | Nagaland         | 4.66       | -          | -          |
|        15 | Odisha           | 93.64      | 59.55      | 31.70      |
|        16 | Puducherry       | -          | 0.17       | -          |
|        17 | Punjab           | 2.59       | 2.80       | -          |
|        18 | Rajasthan        | 32.10      | 53.57      | -          |
|        19 | Tripura          | 14.29      | 15.64      | 10.83      |
|        20 | Uttar Pradesh    | 36.47      | 11.91      | -          |
|        21 | Uttarakhand      | -          | 10.20      | -          |
|        22 | West Bengal      | 101.65     | 93.38      | 50.47      |