Lok Sabha Question No. 1763 (UNSTARRED), answered on 2016-11-25
Subject: Improving Health Indicators in India
Ministry: HEALTH AND FAMILY WELFARE
Asked by: RANGASWAMY DHRUVANARAYANA

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

## LOK SABHA UNSTARRED QUESTION NO. 1763 TO BE ANSWERED ON 25 TH NOVEMBER, 2016

## IMPROVING HEALTH IND ICATORS IN INDIA

## 1763. SHRI R. DHRUVA NARAYANA:

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

- (a)  whether  the  Government  is  aware that  despite  economic  growth  there  has  been no improvement in the health indicators of the country as much as in the past decade;
- (b) whether the Government is aware that self - harm deaths have increased over the years, if so, the details thereof along with the measures undertaken by the Government to deal with the same; and
- (c) the details of centrally sponsored schemes to improve the health i ndicators 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): The country has demonstrated reduction in key health indicators such as Infant Mortality Rate, Maternal Mortality  Ratio  (MMR), Under  5 Mortality Rate.  Further, the annual aver pace  of  decline  in  MMR  (for  the  period  1990  to  2013)  was  much  faster  in  India  (4.5%) compared to global rate (2.6 %).

Additionally, mortality due to various diseases has reduced too. For instance, the Burden of Disease (2015) reports a decrease in mortality (between the years 2005 and 201 account of lower respiratory infections (by 22.6%), diarrhoeal dise ases (by 31.7%), tuberculosis (by  30.7%),  neonatal  preterm  birth  (by  39.5%),  neonatal  encephalopathy  (by  31%)  and  r injuries (by 2.7%).

- (b): As per the Global Burden of Disease report for India, the deaths due to self - harm for the period 2005 to 2015 h ave 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  Healt Mission (NUHM). While NRHM was launched in April 2005, launch of NUHM was approved by the Cabinet on 1 st May 2013. NHM envisages achievement of universal access to equitable, 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, Reproductive - Maternal - Neonatal - Child and Adolescent Health (RMNCH+A) interventions  and  control  of  Communicable  and  Non - Commu icable  Diseases.  Under  NHM, support  is  provided  to  the  States/UTs  to  strengthen  the ir  health  care  system  based  on  the requirements posed by them under Programme Implementation Plans. Funds allocated,  releas and expenditure incurred State/UT wise are given  at Annexure 1.

To meet the shortfall of human resource in health, the governme nt is implementing a Centrally  Sponsored  Scheme  for  'establishment  of  new  medical  colleges  by  upgrading district/referral hospitals' with fund sharing between the Central Government and States in the ratio of 90:10 for North Eastern /special category state s and 60:40 for other states. This scheme was approved in January, 2014. Criteria for identification of Districts under the sche i)District  Hospitals/referral  hospital  with  bed  strength  of  200  or  more  ii)District hospitals of the districts where there is no medical college iii) Preference to underserved are Funds released to the State Governments for the approved districts under the scheme are atAnnexure- 2.

Upgradationof  existing  State  Government/Central  Government  medical  colleges  to increase 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 State Special category States and 60:40 for other States with the upper ceiling cost pegged at crore per seat. 22 Medical Colleges have been approved under the scheme to increase UG se Funds released under 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 cr new PG seats. The funding pattern between Centre and States is in the ratio of 60:40. A t 72 Government Medical colleges are covered under the scheme for increasing PG seats. Fun released under the scheme are at Annexure- 4.

Rashtriya  Swasthya  Bi ma  Yojana  (RSBY),  a  centrally  sponsored  health  insurance scheme is being implemented by this Ministry which covers BPL families (a unit of five) other  categories  namely  Building  &  Other  Construction  Workers,  licensed  Railway  porte Street  Vendors,  MG NREGA  workers  (who  have  worked  for  more  than  fifteen  days  during preceding  financial  year),  Beedi  workers,  Domestic  workers,  Sanitation  Workers,  Mi Workers, Rickshaw pullers, Rag pickers and Auto/Taxi drivers, who are enrolled under RSB They are entitl ed for health insurance coverage of Rs.30,000/ -cashless  per annum per family. Under RSBY there is no state/UT - wise  allocation of funds. Central Government releases its share of premium to State Governments on the receipt of their proposals. The State/UT - wise details of the funds released to State Governments during last three years are at Annexur - 5.

National Health Mission Statement showing States/UTs wise Allocation, Release and Expenditure during 2013 - 14 to 2015- 16 (Rs in crore)

| Sl. No.   | States                    | 2013- 14    | 2013- 14   | 2013- 14     | 2014- 15    | 2014- 15   | 2014- 15     | 2015- 16    | 2015- 16   | 2015- 16     |
|-----------|---------------------------|-------------|------------|--------------|-------------|------------|--------------|-------------|------------|--------------|
| 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 | 23.83       | 29.06      | 29.12        | 28.22       | 23.36      | 24.33        | 28.21       | 37.30      | 11.47        |
| 2         | Andhra Pradesh            | 1184.24     | 878.73     | 1044.81      | 707.15      | 519.73     | 902.91       | 616.23      | 643.52     | 1090.17      |
| 3         | Arunachal Pradesh         | 86.31       | 78.60      | 92.03        | 185.65      | 139.41     | 69.50        | 160.01      | 162.65     | 146.27       |
| 4         | Assam                     | 1214.83     | 1077.81    | 956.89       | 1095.38     | 877.13     | 915.88       | 941.29      | 971.35     | 1186.01      |
| 5         | Bihar                     | 1487.65     | 1110.32    | 1480.68      | 1292.13     | 1148.32    | 1427.40      | 1108.61     | 1159.49    | 1621.67      |
| 6         | Chandigarh                | 18.53       | 11.46      | 14.42        | 19.40       | 12.15      | 15.26        | 14.24       | 23.89      | 20.98        |
| 7         | Chattisgarh               | 500.72      | 355.98     | 805.50       | 555.66      | 500.41     | 716.04       | 479.38      | 412.26     | 758.28       |
| 8         | Dadra & Nagar Haveli      | 8.73        | 9.23       | 9.83         | 13.99       | 8.40       | 8.56         | 11.37       | 14.37      | 15.54        |
| 9         | Daman & Diu               | 6.48        | 6.50       | 8.40         | 9.69        | 6.91       | 7.67         | 9.11        | 10.53      | 15.69        |
| 10        | Delhi                     | 211.46      | 129.78     | 132.59       | 192.59      | 154.04     | 222.64       | 142.81      | 163.80     | 137.29       |
| 11        | Goa                       | 27.12       | 19.35      | 30.58        | 27.63       | 26.03      | 29.50        | 19.41       | 16.77      | 24.92        |
| 12        | Gujarat                   | 833.94      | 833.72     | 977.48       | 858.47      | 832.86     | 873.66       | 677.65      | 693.78     | 1272.42      |
| 13        | Haryana                   | 313.57      | 315.94     | 423.79       | 317.42      | 273.60     | 438.18       | 249.33      | 291.96     | 493.23       |
| 14        | Himachal Pradesh          | 225.95      | 205.29     | 158.60       | 232.00      | 185.84     | 306.92       | 197.92      | 246.49     | 281.26       |
| 15        | Jammu & Kashmir           | 433.87      | 395.10     | 391.10       | 435.17      | 335.51     | 393.29       | 368.00      | 367.90     | 420.94       |
| 16        | Jharkhand                 | 582.97      | 396.38     | 521.49       | 563.92      | 359.62     | 372.01       | 493.37      | 411.50     | 590.18       |
| 17        | Karnataka                 | 814.17      | 611.11     | 812.56       | 834.09      | 697.24     | 858.18       | 706.09      | 740.45     | 1141.61      |
| 18        | Kerala                    | 424.15      | 360.98     | 673.07       | 373.58      | 521.99     | 509.83       | 305.87      | 304.14     | 632.88       |
| 19        | Lakshadweep               | 3.61        | 3.20       | 2.28         | 5.89        | 5.08       | 1.36         | 4.28        | 5.69       | 2.72         |
| 20        | Madhya Pradesh            | 1141.03     | 865.94     | 1583.60      | 1250.17     | 1162.50    | 1738.02      | 1085.37     | 1132.19    | 2046.60      |
| 21        | Maharashtra               | 1520.71     | 1218.51    | 1806.86      | 1536.58     | 1431.76    | 1834.40      | 1282.31     | 1085.92    | 1734.44      |
| 22        | Manipur                   | 127.75      | 88.93      | 74.57        | 144.97      | 128.81     | 86.91        | 118.53      | 112.16     | 105.51       |
| 23        | Meghalaya                 | 139.24      | 125.51     | 71.53        | 160.21      | 104.13     | 70.72        | 131.00      | 102.22     | 133.55       |
| 24        | Mizoram                   | 86.20       | 77.43      | 91.89        | 116.53      | 103.28     | 93.29        | 97.87       | 94.68      | 172.38       |
| 25        | Nagaland                  | 114.42      | 99.73      | 90.40        | 131.26      | 114.92     | 63.04        | 108.75      | 104.85     | 81.05        |
| 26        | O disha                   | 678.99      | 604.20     | 901.65       | 730.09      | 667.16     | 944.10       | 624.71      | 652.62     | 1205.77      |
| 27        | Puducherry                | 21.29       | 18.10      | 25.43        | 25.46       | 22.56      | 23.35        | 17.77       | 18.61      | 21.77        |
| 28        | Punjab                    | 362.38      | 333.47     | 437.57       | 351.89      | 379.35     | 460.59       | 284.75      | 295.23     | 649.49       |
| 29        | Rajasthan                 | 1091.20     | 922.93     | 1457.06      | 1238.11     | 1115.96    | 1722.69      | 1069.38     | 1287.84    | 1799.11      |
| 30        | Sikkim                    | 42.32       | 45.91      | 44.82        | 51.42       | 51.60      | 41.36        | 45.86       | 41.01      | 50.71        |
| 31        | Tamil Nadu                | 1020.75     | 906.24     | 1430.28      | 968.18      | 952.75     | 2248.06      | 794.38      | 1093.22    | 1633.37      |
| 32        | Tripura                   | 165.43      | 140.15     | 101.93       | 161.75      | 123.11     | 130.15       | 139.08      | 136.29     | 118.77       |
| 33        | Uttar Pradesh             | 3584.98     | 3024.60    | 2924.38      | 2650.25     | 2431.06    | 3671.26      | 2299.49     | 2862.83    | 4451.78      |
| 34        | Uttarakhand               | 310.55      | 245.25     | 255.28       | 308.10      | 270.55     | 324.42       | 256.60      | 276.41     | 335.95       |
| 35        | West Bengal               | 1179.64     | 948.51     | 1271.71      | 1053.27     | 1058.62    | 1196.78      | 883.49      | 959.51     | 1487.62      |
| 36        | Telangana                 | 0.00        | 0.00       | 0.00         | 506.45      | 378.72     | 334.68       | 440.58      | 436.63     | 505.55       |

Funds  released  under  the  Centrally  Sponsored  Scheme  for  Establishment  of  New  Medica Colleges attached with existing District/Referral ho spitals during last three years

(Rs. in crore)

|   S. No. | States/UT                   |   2014- 15 |   2015- 16 |   2016- 17 till date |
|----------|-----------------------------|------------|------------|----------------------|
|        1 | Andaman and Nicobar Islands |       0    |      28    |                   20 |
|        2 | Arunachal Pradesh           |       0    |      42.5  |                   10 |
|        3 | Assam                       |       0    |      30    |                   19 |
|        4 | Bihar                       |       0    |       8    |                   34 |
|        5 | Chhattisgarh                |      14    |      39.02 |                   83 |
|        6 | Himachal Pradesh            |      12.53 |      67.98 |                  114 |
|        7 | Jharkhand                   |       0    |       0    |                   48 |
|        8 | Jammu & Kashmir             |       0    |       0    |                   48 |
|        9 | Madhya Pradesh              |      14    |      24    |                   81 |
|       10 | Maharashtra                 |       6    |       7    |                   55 |
|       11 | Mizoram                     |       0    |      30    |                   10 |
|       12 | Nagaland                    |       0    |      36.5  |                   10 |
|       13 | Odisha                      |      35    |      85    |                   50 |
|       14 | Rajasthan                   |      41    |      89.2  |                   88 |
|       15 | Uttar Pradesh               |       0    |      16    |                   78 |
|       16 | Uttarakhand                 |       6    |       8    |                   18 |
|       17 | West Bengal                 |       0    |      20    |                   79 |

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      |   2014- 15 |   2015- 16 |   2016- 17 till |
|----------|----------------|------------|------------|-----------------|
|        1 | Andhra Pradesh |          0 |        6   |           10.2  |
|        2 | Gujarat        |          0 |        4.5 |           11.56 |
|        3 | Madhya Pradesh |          0 |       12   |           27.48 |
|        4 | Odisha         |          0 |        5   |           12    |
|        5 | Punjab         |          0 |        4   |            6.8  |
|        6 | Rajasthan      |          0 |        7   |           15.4  |
|        7 | Tamil Nadu     |          0 |        9.5 |           23.16 |
|        8 | Uttarakhand    |          0 |        2   |            3.4  |

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         |   2013- 14 |   2014- 15 | 2016- 17 Till date   |
|----------|------------------|------------|------------|----------------------|
|        1 | Assam            |       0    |          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    |          0 |                      |
|       11 | Kerala           |       0    |          0 |                      |
|       12 | Madhya Pradesh   |       0    |          5 | 1.94                 |
|       13 | Maharashtra      |       0    |          0 |                      |
|       14 | Odisha           |       0    |          0 | 3.06                 |
|       11 | Punjab           |      30.92 |          0 |                      |
|       16 | Rajasthan        |       0    |          0 |                      |
|       17 | Telangana        |       0    |          0 | 2                    |
|       18 | Tripura          |       0    |          0 |                      |
|       19 | Uttarakhand      |       0    |          5 |                      |
|       20 | Uttar Pradesh    |       0    |          0 |                      |
|       21 | West Bengal      |       0    |          0 |                      |

Note: There was no release in 2015 - 16

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

|   Sr. No. | Name of State /UT   | 2013- 14   | 2014- 15   | 2015- 16   |
|-----------|---------------------|------------|------------|------------|
|         1 | Arunachal Pradesh   | -          | -          | -          |
|         2 | Assam               | 35.68      | 1.06       | 23.24      |
|         3 | Bihar               | 152.71     | 34.07      | -          |
|         4 | Chandigarh          | 0.00       | -          | -          |
|         5 | Chhattisgarh        | 48.34      | 58.81      | 88.77      |
|         6 | Delhi               | -          | -          | -          |
|         7 | Goa                 | -          | -          | -          |
|         8 | Gujarat             | 60.59      | 18.47      | 74.24      |
|         9 | Haryana             | 13.01      | 5.38       | 4.67       |
|        10 | Himachal Pradesh    | 9.03       | 3.75       | 13.90      |
|        11 | Jammu & Kashmir     | 0.53       | -          | -          |
|        12 | Jharkhand           | 51.25      | 5.51       | -          |
|        13 | Karnataka           | 31.59      | -          | 94.99      |
|        14 | Kerala              | 115.49     | 110.43     | 112.37     |
|        15 | Madhya Pradesh      | 2.82       | 8.21       | 1.00       |
|        16 | Maharashtra         | 13.88      | -          | -          |
|        17 | Manipur             | 2.52       | 1.73       | 1.17       |
|        18 | Meghalaya           | 1.79       | 1.25       | 4.10       |
|        19 | Mizoram             | 4.31       | 10.35      | 9.43       |
|        20 | Nagaland            | 2.07       | 4.66       | -          |
|        21 | Odisha              | 70.51      | 93.64      | 59.55      |
|        22 | Puducherry          | -          | -          | 0.17       |
|        23 | Punjab              | 5.58       | 2.59       | 2.80       |
|        24 | Rajasthan           | 10.72      | 32.10      | 53.57      |
|        25 | Tamil Nadu          | -          | -          | -          |
|        26 | Tripura             | 18.70      | 14.29      | 15.64      |
|        27 | Uttar Pradesh       | 72.56      | 36.47      | 11.91      |
|        28 | Uttarakhand         | 1.78       | -          | 10.20      |
|        29 | West Bengal         | 160.45     | 101.65     | 93.38      |