Lok Sabha Question No. 4899 (UNSTARRED), answered on 2016-12-16
Subject: Lack of Health Facilities
Ministry: HEALTH AND FAMILY WELFARE
Asked by: NANABHAU FALGUNRAO PATOLE

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

LOK SABHA UNSTARRED QUESTION NO. 4899 TO BE ANSWERED ON 16 TH DECEMBER,

## LACK OF HEALTH FACIL ITIES

## 4899. SHRI NANA PATOLE:

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

- (a) whether the Government is aware about the lack of health facilities in the country i Delhi and NCR, if so, the reasons therefor;
- (b)  whether  the  Government  is  also  aware  that  AIIMS,  Delhi  is  not  func tioning  as  referral hospital and that good medical facilities are not available to patients across the countr the details thereof;
- (c) whether the Government have prepared any scheme for better medical facilities in the suggestions/ recommendations made by a Parliamentary Committee; and
- (d) if so, the details of the schemes prepared and the time limit of their implementation?

## ANSWER THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE

## (SHRI FAGGAN SINGH KULASTE)

- (a):     As per Rural Health Statistics (RHS), there is a shortage of public health faci State/ UT wise details given at Annexure - I . The details are not maintained in respect of NCR. One of the key reasons for lack of health facilities is lack of public investment in healthcare. Public health being a State subject, the primary responsibility to ensure availability o public health facilities lies with the State Governments. Nonetheless, under NHM, financi technical  support  is  pro vided  to  States/UTs  to  strengthen  their  healthcare  systems  includi setting  up  of/upgradation  of  public  health  facilities,  based  on  the  requirements  posed States/UTs in their Programme Implementation Plans (PIPs).
- (b):        The  patients,  who  come  to AIIMS  and  require  hospitalization  for  diagnostic  and/or therapeutic purpose, are admitted either from the OPD's (including specialty clinics) or through the casualty/emergency. In the casualty/emergency life saving situations, all efforts are admit the  seriously  ill  patient  in  the  hospital  as  far  as  `practically'  possible.  In  case  of  non -availability  of  bed  in  the  emergency,  the  emergency  patients  are  first  evaluated  and appropriate  treatment  as  may  be  required  to  stabilize  them  clinically  and after  adequate stabilization, they are sent to other Government hospitals for admission and further manag The AIIMS hospital entertains not only referral patients but also direct cases coming to on their own. To improve access to affordable hi gh quality tertiary medical care facilities, 6 more AIIMS have been set up and 12 more have been approved.

Contd……..

(c)  &  (d) : Government  does  seriously  consider  the  recommendations  of  Parliamentary Committees for improving medical facilities. Under the flagship programme of National He Mission (NHM), financial and technical support is provided to the States/UTs to strengthe their health care system to provide accessible, affordable and quality health care.

Various  measures  have  been  taken  under  the  National  Health  Mission  to  act  on  t recommendations of Parliamentary Standing Committees e.g. as regards recommendation to ta credible  action  towards  reducing  IMR  and  MMR  to  targeted  levels,  key  measures  taken are provided  at Annexure - II .    As  regards  adopting  innovative  strategies  to  control  populat growth, different steps taken are given at Annexure - III .

## Annexure - I

| SHORTFALL IN HEALTH INFRASTRUCTURE   | SHORTFALL IN HEALTH INFRASTRUCTURE   | SHORTFALL IN HEALTH INFRASTRUCTURE   | SHORTFALL IN HEALTH INFRASTRUCTURE   | SHORTFALL IN HEALTH INFRASTRUCTURE   | SHORTFALL IN HEALTH INFRASTRUCTURE   | SHORTFALL IN HEALTH INFRASTRUCTURE   | SHORTFALL IN HEALTH INFRASTRUCTURE   | SHORTFALL IN HEALTH INFRASTRUCTURE   | SHORTFALL IN HEALTH INFRASTRUCTURE   | SHORTFALL IN HEALTH INFRASTRUCTURE   | SHORTFALL IN HEALTH INFRASTRUCTURE   | SHORTFALL IN HEALTH INFRASTRUCTURE   | SHORTFALL IN HEALTH INFRASTRUCTURE   | SHORTFALL IN HEALTH INFRASTRUCTURE   | SHORTFALL IN HEALTH INFRASTRUCTURE   |
|--------------------------------------|--------------------------------------|--------------------------------------|--------------------------------------|--------------------------------------|--------------------------------------|--------------------------------------|--------------------------------------|--------------------------------------|--------------------------------------|--------------------------------------|--------------------------------------|--------------------------------------|--------------------------------------|--------------------------------------|--------------------------------------|
| S.No.                                | State/ UT                            | Total Population in Rural Areas      | Tribal Population in Rural Areas     | (As Sub Centres                      | (As Sub Centres                      | (As Sub Centres                      | (As Sub Centres                      | PHCs                                 | PHCs                                 | PHCs                                 | PHCs                                 | CHCs                                 | CHCs                                 | CHCs                                 | CHCs                                 |
| S.No.                                | State/ UT                            | Total Population in Rural Areas      | Tribal Population in Rural Areas     | R                                    | P                                    | S                                    | % Shorfall                           | R                                    | P                                    | S                                    | % Shorfall                           | R                                    | P                                    | S                                    | % Shorfall                           |
| 1                                    | Andhra Pradesh                       | 34776389                             | 2293102                              | 7261                                 | 7659                                 | *                                    | *                                    | 1197                                 | 1069                                 | 128                                  | 11                                   | 299                                  | 179                                  | 120                                  | 40                                   |
| 2                                    | Arunachal Pradesh                    | 1066358                              | 789846                               | 318                                  | 286                                  | 32                                   | 10                                   | 48                                   | 117                                  | *                                    | *                                    | 12                                   | 52                                   | *                                    | *                                    |
| 3                                    | Assam                                | 26807034                             | 3665405                              | 5850                                 | 4621                                 | 1229                                 | 21                                   | 954                                  | 1014                                 | *                                    | *                                    | 238                                  | 151                                  | 87                                   | 37                                   |
| 4                                    | Bihar                                | 92341436                             | 1270851                              | 18637                                | 9729                                 | 8908                                 | 48                                   | 3099                                 | 1883                                 | 1216                                 | 39                                   | 774                                  | 70                                   | 704                                  | 91                                   |
| 5                                    | Chhattisgarh                         | 19607961                             | 7231082                              | 4885                                 | 5186                                 | *                                    | *                                    | 774                                  | 792                                  | *                                    | *                                    | 193                                  | 155                                  | 38                                   | 20                                   |
| 6                                    | Goa                                  | 551731                               | 87639                                | 122                                  | 209                                  | *                                    | *                                    | 19                                   | 21                                   | *                                    | *                                    | 4                                    | 4                                    | 0                                    | 0                                    |
| 7                                    | Gujarat                              | 34694609                             | 8021848                              | 8008                                 | 8063                                 | *                                    | *                                    | 1290                                 | 1247                                 | 43                                   | 3                                    | 322                                  | 320                                  | 2                                    | 1                                    |
| 8                                    | Haryana                              | 16509359                             | 0                                    | 3301                                 | 2569                                 | 732                                  | 22                                   | 550                                  | 461                                  | 89                                   | 16                                   | 137                                  | 109                                  | 28                                   | 20                                   |
| 9                                    | Himachal Pradesh                     | 6176050                              | 374392                               | 1285                                 | 2065                                 | *                                    | *                                    | 212                                  | 500                                  | *                                    | *                                    | 53                                   | 78                                   | *                                    | *                                    |
| 10                                   | Jammu & Kashmir                      | 9108060                              | 1406833                              | 2009                                 | 2265                                 | *                                    | *                                    | 327                                  | 637                                  | *                                    | *                                    | 81                                   | 84                                   | *                                    | *                                    |
| 11                                   | Jharkhand                            | 25055073                             | 7868150                              | 6060                                 | 3957                                 | 2103                                 | 35                                   | 966                                  | 327                                  | 639                                  | 66                                   | 241                                  | 188                                  | 53                                   | 22                                   |
| 12                                   | Karnataka                            | 37469335                             | 3429791                              | 7951                                 | 9264                                 | *                                    | *                                    | 1306                                 | 2353                                 | *                                    | *                                    | 326                                  | 206                                  | 120                                  | 37                                   |
| 13                                   | Kerala                               | 17471135                             | 433092                               | 3551                                 | 4575                                 | *                                    | *                                    | 589                                  | 827                                  | *                                    | *                                    | 147                                  | 222                                  | *                                    | *                                    |
| 14                                   | Madhya Pradesh                       | 52557404                             | 14276874                             | 12415                                | 9192                                 | 3223                                 | 26                                   | 1989                                 | 1171                                 | 818                                  | 41                                   | 497                                  | 334                                  | 163                                  | 33                                   |
| 15                                   | Maharashtra                          | 61556074                             | 9006077                              | 13512                                | 10580                                | 2932                                 | 22                                   | 2201                                 | 1811                                 | 390                                  | 18                                   | 550                                  | 360                                  | 190                                  | 35                                   |
| 16                                   | Manipur#                             | 2021640                              | 791126                               | 509                                  | 421                                  | 88                                   | 17                                   | 80                                   | 85                                   | *                                    | *                                    | 20                                   | 17                                   | 3                                    | 15                                   |
| 17                                   | Meghalaya                            | 2371439                              | 2136891                              | 759                                  | 428                                  | 331                                  | 44                                   | 114                                  | 110                                  | 4                                    | 4                                    | 28                                   | 27                                   | 1                                    | 4                                    |
| 18                                   | Mizoram                              | 525435                               | 507467                               | 172                                  | 370                                  | *                                    | *                                    | 25                                   | 57                                   | *                                    | *                                    | 6                                    | 9                                    | *                                    | *                                    |
| 19                                   | Nagaland                             | 1407536                              | 1306838                              | 455                                  | 396                                  | 59                                   | 13                                   | 68                                   | 128                                  | *                                    | *                                    | 17                                   | 21                                   | *                                    | *                                    |
| 20                                   | Odisha                               | 34970562                             | 8994967                              | 8193                                 | 6688                                 | 1505                                 | 18                                   | 1315                                 | 1305                                 | 10                                   | 1                                    | 328                                  | 377                                  | *                                    | *                                    |
| 21                                   | Punjab                               | 17344192                             | 0                                    | 3468                                 | 2951                                 | 517                                  | 15                                   | 578                                  | 427                                  | 151                                  | 26                                   | 144                                  | 150                                  | *                                    | *                                    |
| 22                                   | Rajasthan                            | 51500352                             | 8693123                              | 11459                                | 14407                                | *                                    | *                                    | 1861                                 | 2083                                 | *                                    | *                                    | 465                                  | 568                                  | *                                    | *                                    |
| 23                                   | Sikkim                               | 456999                               | 167146                               | 113                                  | 147                                  | *                                    | *                                    | 18                                   | 24                                   | *                                    | *                                    | 4                                    | 2                                    | 2                                    | 50                                   |
| 24                                   | Tamil Nadu                           | 37229590                             | 660280                               | 7533                                 | 8706                                 | *                                    | *                                    | 1251                                 | 1372                                 | *                                    | *                                    | 312                                  | 385                                  | *                                    | *                                    |
| 25                                   | Telangana                            | 21585313                             | 2939027                              | 4708                                 | 4863                                 | *                                    | *                                    | 768                                  | 668                                  | 100                                  | 13                                   | 192                                  | 114                                  | 78                                   | 41                                   |
| 26                                   | Tripura                              | 2712464                              | 1117566                              | 691                                  | 1017                                 | *                                    | *                                    | 109                                  | 91                                   | 18                                   | 17                                   | 27                                   | 20                                   | 7                                    | 26                                   |
| 27                                   | Uttarakhand                          | 7036954                              | 264819                               | 1442                                 | 1848 20521                           | * 10679                              | *                                    | 238                                  | 257 3497                             | *                                    | *                                    | 59 1298                              | 59 773                               | 0 525                                | 0                                    |
| 28                                   | Uttar Pradesh                        | 155317278                            | 1031076                              | 31200                                |                                      |                                      | 34                                   | 5194                                 |                                      | 1697                                 | 33                                   |                                      |                                      |                                      | 40                                   |
| 29                                   | West Bengal                          | 62183113                             | 4855115                              | 13083                                | 10357                                | 2726                                 | 21                                   | 2153                                 | 909                                  | 1244                                 | 58                                   | 538                                  | 347                                  | 191                                  | 36                                   |
| 30                                   | Andaman & Nicobar Islands            | 237093                               | 26715                                | 50                                   | 122                                  | *                                    | *                                    | 8                                    | 22                                   | *                                    | *                                    | 2                                    | 4                                    | *                                    | *                                    |
| 31                                   | Chandigarh                           | 28991                                | 0                                    | 5                                    | 16                                   | *                                    | *                                    | 0                                    | 0                                    | 0                                    | 0                                    | 0                                    | 2                                    | *                                    | *                                    |
| 32                                   | Dadra & Nagar Haveli                 | 183114                               | 150944                               | 56                                   | 56                                   | 0                                    | 0                                    | 8                                    | 7                                    | 1                                    | 13                                   | 2                                    | 1                                    | 1                                    | 50                                   |

| 33   | Daman & Diu   |     60396 |     7617 |     13 |     26 | *     | *   |     2 |     3 | *    | *   |    0 |    2 | *    | *   |
|------|---------------|-----------|----------|--------|--------|-------|-----|-------|-------|------|-----|------|------|------|-----|
| 34   | Delhi         |    419042 |        0 |     83 |     27 | 56    | 67  |    13 |     5 | 8    | 62  |    3 |    0 | 3    | 100 |
| 35   | Lakshadweep   |     14141 |    13463 |      4 |     14 | *     | *   |     0 |     4 | *    | *   |    0 |    3 | *    | *   |
| 36   | Puducherry    |    395200 |        0 |     79 |     54 | 25    | 32  |    13 |    24 | *    | *   |    3 |    3 | 0    | 0   |
|      | India         | 833748852 | 93819162 | 179240 | 153655 | 35145 | 20  | 29337 | 25308 | 6556 | 22  | 7322 | 5396 | 2316 | 32  |

Notes: The requirement is calculated using the prescribed norms on the basis of rural population from Census, 2011.  All India shortfall is derived by adding state - wise figures of shortfall ignoring the existing surplus in some of the states.

R: Required; P: In Position; S: Shortfall;     *: Surplus

# Data for 2013 - 14 repeated

## Key measures taken for reducing Infant Mortality Rate (IMR) and Maternal Mortality Ratio (MMR)

……..

The Government of India is implementing the following interventions under the National Health Mission (NHM) all across the country to reduce IMR and MMR:

i. The  Pradhan  Mantri  Surakshit  Matritva  Abhiyan  (PMSMA)  has  been  introduced  to ensure quality Antenatal care to over 3 crore pregnant women in the country in their 2nd or 3rd trimesters  of  pregnancy.  Under  the  campaign,  a  minimum  package  of  antenatal  care  servi (including investigations) would be provided to the beneficiaries on the 9th day of every Private health care providers also being engaged on a voluntary basis.

ii. Strengthening of delivery points for providing comprehensive and quality Reproduct Maternal,  Newborn,  Child  and  Adolescent  Health  (RMNCH+A)  Services,  ensuring  essential newborn  care  at  all  delivery  points,  establishment  of  Spe cial  Newborn  Care  Units  (SNCU), Newborn Stabilization Units (NBSU) and Kangaroo Mother Care (KMC) units for care of sic and small babies.

iii.            Mothers  Absolute  Affection  (MAA)  programme  launched  on  5th  August  2016  f improving breastfeeding practic es (Initial Breastfeeding within one hour, Exclusive Breastfeedi up to six months and complementary Breastfeeding up to two years) through mass media a capacity building of health care providers in health facilities as well as in communities.

iv. Ironand  folic  acid  (IFA)  supplementation  for  the  prevention  of  anaemia  among  t vulnerable age groups, annual deworming on National Deworming Day (NDD), home visit by ASHAs to promote exclusive breast feeding and promote use of ORS and Zinc for management ofdiarrhoea in children.

- v. For  ensuring  fast  tracking  of  operationalization  of  FRUs,  detailed  guidance appropriate planning, placing/ in sourcing of HR, operationalization of Blood Storage/ Bank, Infrastructure upgradation etc. has been provide d.
- vi. Maternal Death Review (MDR) is being implemented across the country both at facilit and in the community. The purpose is to take corrective action at appropriate levels and the quality of obstetric care.

vii. Operationalization  of  Safe  A bortion  Services  and  Reproductive  Tract  Infections  and Sexually Transmitted Infections (RTI/STI) at health facilities with a focus on 'Delivery Points'.

viii. To further accelerate the pace of decline in MMR and improving quality of ante - natal care,  new  g uidelines  have  been  prepared  and  disseminated  to  the  states  for  screening diagnosis  &  management  of  gestational  diabetes  mellitus,  hypothyroidism  during  pregnan training of General Surgeons for performing Caesarean Section, Calcium supplementation d uring pregnancy and lactation, de - worming during pregnancy, Maternal Near Miss Review, screening for  syphilis  during  pregnancy,  standardization  of  Labor  rooms    at  Delivery  points,  t manual  for  facilitators  and  training  manual  for  participants  for  th e  Daksh  Skills  Lab  for RMNCH+A services  and Dakshata guidelines for strengthening intra - partum care.

ix. Guidance  note  on  use  of  uterotonics during  labor,  Guidance  note  on  prevention  and management  of  postpartum  hemorrhage  and  Guidance  note  on  Birth  Companion  have  been released to the States which will further improve quality in service delivery during in and post - partum care.

## An nexure- III

## Strategies and new interventions adopted to achieve population stabilization

…………..

- i. Compensation scheme for sterilization acceptors - unde  the scheme MoHFW provides compensation for loss of wages to the beneficiary on account of undergoing sterilisation. The scheme  has  been  recently  enhanced  for  11  high  focus  states  (8  EAG+  Assam+  Gujarat+ Haryana).
- ii. Accreditation of more private/ NGO facilities to increase the provider base for planning services under PPP.
- iii. Improving contrace ptives supply management up to peripheral facilities.
- iv. A rational human resource development plan is in place for provision of IUCD, Mini and NSV to empower the facilities (DH, CHC, PHC, SHC) with at least one provider each f each of the services a nd Sub Centres with ANMs trained in IUD insertion
- v. Demand generation activities in the form of display of posters, billboards and othe and video materials in the various facilities.
- vi. The packaging for Condoms, OCPs and ECPs has now been improve d and redesigned so as to influence the demand for these commodities.
- vii. The current basket of choice has been expanded to include the new contraceptives Injectable contraceptive DMPA, Centchroman and Progrsterone Only Pills (POP).
- viii. To  increase the  demand  for  family  planning,  new  Family  Planning,  media  campaign (with Shri Amitabh Bachchan as a brand ambassador) has also been launched.
- ix. Promotion of IUCDs as a short & long term spacing method -Introduction of Cu IUCD -375 (5 years effectivity) under the Family Planning Programme.
- x. Emphasis on Postpartum Family Planning (PPFP) services with introduction of PPIUCD and promotion of minilap as the main mode of providing sterilization in the form of post - partum sterilization to capitalize on the h uge cases coming in for institutional delivery under JSY.
- xi. Appointment of dedicated RMNCH+A counsellors at high case load facilities.