Lok Sabha Question No. 2854 (UNSTARRED), answered on 2018-08-03
Subject: Government Hospitals in Tribal Dominated Areas
Ministry: HEALTH AND FAMILY WELFARE
Asked by: JITENDRA CHAUDHURY, BHEEMRAO BASWANTHRAO PATIL, HARIOM SINGH RATHORE

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

LOK SABHA UNSTARRED QUESTION NO. 2854 TO BE ANSWERED ON  3 RD AUGUST, 2018

## GOVERNMENT HOSPITALS IN TRIBAL DOMINATED AREAS

## 2854. SHRI JITENDRA CHAUDHURY: SHRI BHEEMRAO B. PATIL: SHRI HARIOM SINGH RATHORE :

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

- (a) the total number of Government hospitals in the tribal dominated areas as on date country, State/UT - wise;
- (b)  whether  the  Government  has  undertaken  any  survey  regarding  the  health  needs  of  tr people in tribal dominated areas across the country considering the fact that the tribal confined to particular habitation which are generally far from cit ies/town/villages;
- (c) if so, the details thereof and if not, the reasons therefor;
- (d) whether the Government proposes to set up hospitals and healthcare centres equipped wi infrastructural facilities in the tribal dominated and far - flung  areas with a view to mitigat the sufferings of the tribal people; and
- (e) if so, the details thereof, State/ UT - wise and if not, the reasons therefor?

## ANSWER THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE (SHRI ASHWINI KUMAR CHOUBEY)

- (a): The  state  wise  number  of    Sub  Health  Centres,  Primary  Health  Centres  (PHCs)  & Community Health Centres (CHCs) in Tribal areas as per Rural Health Statistics Bulletin, is at Annexure - I.
- (b) &  (c) : As  per  information  received  from  Indian  Counc il  of  Medical  Research  (ICMR) surveillance for different diseases in the tribal areas, especially in Madhya Pradesh, Ch and Odisha are being routinely conducted for different diseases prevalent in tribes by th -National Institute for Researc h in Tribal Health. Brief description of surveillance activitie different d iseases by the Institute is at Annexure - II. In addition, surveys like National Family Health  Survey  (NFHS),  and  District  Level  Household  Survey  (DLHS),  conducted  by  the Ministry give estimates inter - alia for tribal health indicators.

Contd…….

(d)& (e) : 'Public Health & Hospitals' being a state subject ,the primary responsibility to set up  hospitals  and  healthcare  centres quipped  with  all  infrastructural  facilities  in  all  ar including tribal dominated and far -flung areas is that of respective State Government s.U nder the National Health Mission (NHM), financial and technical support is provided to States/UTs to strengthen their health caresystems including for setting up/upgrading public health faciliti augmenting health human resource on contractual basis for provision of equitable, affo healthcare  to  all  its  citizens  particularly  the  poor  and  vulnerab le  population  including  tribal population based on requirements posed by the States in their Programme Implementation Pl Under  NHM,  all  tribal  majority  districts  whose  composite  health  index  is  below  the average have been identified as High Prior ity Districts (HPDs) and these districts are to receiv more resources per capita under the NHM as compared to the rest of the districts in th These districts also receive focused attention and supportive supervision. Norms infrastructure, Huma n resource, ASHAs, MMUs etc. under NHM are relaxed for tribal and hilly areas.

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## Rural Health Statistics Bulletin, 2017

## NUMBER OF SUB CENTRES, PHCs & CHCs IN TRIBAL AREAS

| S.No.   | State/ UT          | Sub Centres   | PHCs   | CHCs   |
|---------|--------------------|---------------|--------|--------|
| 1       | Andhra Pradesh     | 804           | 155    | 19     |
| 2       | Arunachal Pradesh# | 312           | 143    | 63     |
| 3       | Assam              | 1283          | 283    | 31     |
| 4       | Bihar^^            | 23            | 6      | 0      |
| 5       | Chhattisgarh       | 2804          | 392    | 80     |
| 6       | Goa                | 66            | 8      | 1      |
| 7       | Gujarat            | 2775          | 406    | 92     |
| 8       | Haryana *          | 0             | 0      | 0      |
| 9       | Himachal Pradesh   | 104           | 43     | 8      |
| 10      | Jammu & Kashmir    | 307           | 48     | 11     |
| 11      | Jharkhand          | 2465          | 165    | 104    |
| 12      | Karnataka          | 321           | 64     | 7      |
| 13      | Kerala             | 831           | 137    | 12     |
| 14      | Madhya Pradesh     | 2952          | 332    | 104    |
| 15      | Maharashtra        | 2057          | 315    | 67     |
| 16      | Manipur            | 226           | 45     | 7      |
| 17      | Meghalaya #        | 436           | 109    | 27     |
| 18      | Mizoram            | 370           | 57     | 9      |
| 19      | # Nagaland #       | 396           | 126    | 21     |
| 20      | Odisha             | 2689          | 425    | 132    |
| 21      | Punjab *           | 0             | 0      | 0      |
| 22      | Rajasthan          | 1658          | 209    | 65     |
| 23      | Sikkim             | 48            | 12     | 0      |
| 24      | Tamil Nadu         | 564           | 65     | 20     |
| 25      | Telangana          | 698           | 93     | 23     |
| 26      | Tripura            | 512           | 47     | 8      |
| 27      | Uttarakhand        | 187           | 24     | 9      |
| 28      | Uttar Pradesh      | NA            | NA     | NA     |
| 29      | West Bengal        | 3206          | 300    | 104    |
| 30      | A&N Island         | 41            | 4      | 1      |
| 31      | Chandigarh *       | 0             | 0      | 0      |
| 32      | D&N Haveli #       | 46            | 7      | 0      |
| 33      | Daman & Diu        | 5             | 0      | 0      |
| 34      | Delhi *            | 0             | 0      | 0      |
| 35      | Lakshadweep# (2)   | 14            | 4      | 3      |
| 36      | Puducherry *       | 0             | 0      | 0      |
|         | All India/Total    | 28200         | 4024   | 1028   |

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.

*: State / UT has no separate Tribal Area / Population;

#:States are predominantly tribal areas

2 The population is less than the norm (CHC) of 80,000.

^^ Data for year 2010 used

NA -Data not available

## Annexure - II

## A  brief  description  of  surveillance  activities  in  different  diseases  by  ICMR - National Institute for Research in Tribal Health

- Study  conducted  during  2015 - 2017  in  different  clusters  of  Madhya  Pradesh  and  Chhattisgarh revealed 72 TB cases in Madhya Pradesh out of 14409 population screened, and 21 TB cases were detected out of the total 5882 suspected individual screened in Chhattisgarh.
- A cross - sectional  survey  of  primary  and  secondary  care  facilities  including  the  provide patients in Mandla district, Madhya Pradesh consisting of 129 patients surveyed revealed the that:
- Majority of the patients were between 46 - 60 years of age.
- Nearly 57% of hypertension and 79% for diabetes patients took regular treatment in previous month.
- Overall, 9%  of  the  patients  had  their  blood  pressure  under  control,  and  25%  of diabetes patients had glycemic control.
- A cross - sectional  causes  of  death  survey  in  Mandla  District  of  Madhya  Pradesh  using  ver autopsy in 2017 revealed 579 deaths in 2016 among adults (more than fifteen years of age).
- Overall, non - communicable diseases accounted for more than half of the deaths (63%) followed by other causes (22%) and infectious diseases (15%). Age - standardized cause -specific  death  rate  (CSDR)  was  highest  for  non - c mmunicable  diseases,  among  both males and females.
- About  29%  of  the  deceased  died  due  to  circulatory  system  disorder  followed respiratory system diseases (12%) and neoplasm (8%). Infectious and parasitic dise accounted for 14% of deaths; tubercul osis was the major cause of death in infectious and parasitic diseases category (8%).
- Intervention Programme for the management of Scabies -Baiga Tribe of  Dindori district of Madhya Pradesh '
- A total of 202 villages of Dindori district were surveyed covering a total population of 93,669 individuals.
- Among all the studied individuals, 1052 were identified to be positive for scabies. individuals were then randomly allocated to two groups i.e. Group A (n=389) who we treated with Ivermectin and G B Lotion and Group B (n=663) treated with GBH Lotion alone.
- Results showed that completion/cured rate in the two groups was 34.4% (A) and 11.8 (B) on day 3; 95.6% and 81.1% on  day 5 and 98.8% and 99.5% on day 7, respectively.
- The cumulative cure rates in Group A showed statistically significant reduction in th scabies beginning day 3.
- Mapping of hemoglobinopathies in undivided Madhya Pradesh.
- Surveillance for hemoglobinopathies is a regular activity of ICMR -NIRTH in tribal areas of Madhya Pradesh, Chh attisgarh and Odisha.
- Similar surveillance has now been initiated in the Lahul and Spiti district of H Pradesh in Himalayan tribes.
- Recently, a large scale screening for sickle cell anaemia in 22 tribal districts of Madhya Pradesh is initiated by ICMR - NIRTH  to  provide  all  technical  support  and  training  for health professional involved in the program in collaboration with government of Mad Pradesh.
- Considering malaria is known to be in high prevalence among tribes, regular surveillance on malaria for prevalence of different types of malaria parasites, drug - resis ant parasites, different species of mosquito vectors and insecticide -resistant mosquitoes are conducted in different tribal ar eas of Madhya Pradesh, Chhattisgarh, and Odisha.
- Efficacy of different antimalarials as well as different diagnostic kits are also regularly in field.
- At a malaria clinic established at the Government Medical College & Maharani Hospit Jagdal pur (a tribal district), Chhattisgarh by the ICMR - NIRTH, a total of 15769 patients were screened for malaria in the last year. among these 685 patients were found po for malaria with P. falciparum (87.4%) as major infection, with 111 severe malaria a nd 64 cerebral malaria.
- At a malaria clinic located in Biswanathpur Community Health Centre (CHC), Kalahand district (a tribal district), Odisha a total of 4515 febrile patients were screened parasite last year. Out of total 4515 patients scre ened, a total of 354 (7.8%) patients were found  to  be  positive  for  malaria  parasite P.  falciparum .  Malaria  positivity  rate  varied from June 2017 (26.8%)) to December 2018 (2.6%) .

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