Lok Sabha Question No. 628 (UNSTARRED), answered on 2016-11-18
Subject: National Rural Health Mission
Ministry: HEALTH AND FAMILY WELFARE
Asked by: MALLIKARJUN  KHARGE, ARVIND GANPAT SAWANT, KRUPAL BALAJI TUMANE, PARBHUBHAI NAGARBHAI VASAVA

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

## LOK SABHA UNSTARRED QUESTION NO. 628 TO BE ANSWERED ON 18 TH NOVEMBER, 2016

## NATIONAL RURAL HEALT H MISSION

## 628. SHRI MALLIKARJUN KHARGE:

SHRI ARVIND SAWANT:

SHRI KRUPAL BALAJI TUMANE:

SHRI PARBHUBHAI NAGARBHAI VASAVA:

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

- (a) whether the Government considers National Rural Health Mission (NRHM) as successful in fulfilling  its  mandate for healthcare  requirements  of  rural  India  during eleven  years  of  its existence from the year 2005 to 2016 and if so, the shortcomings of the said Mission along with the manner Government proposes to improve it;
- (b) the number of rural centres set up sinc e year 2005 vis - a- vis the targets under NRHM and the amount spent under NRHM since the year 2010, year - wise,State - wise  along with the current status of the NRHM, in terms of outcome targets, State and year - wise;
- (c) whether the Government is aware of 70 - 80  per  cent  shortage  of  doctors even after eleven years of NRHM implementation and the details of the pending health projects along with the funds allocated under the NRHM in the country and if so, the details thereof; and
- (d) whether the Government proposes to constitute a review Committee on NRHM and if so, the details thereof?

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

## (SHRI FAGGAN SINGH KULASTE)

- (a): The National Rural Health Mission (NRHM) was laun ched in the year 2005 to provide accessible, affordable and quality health care to the rural population, especially the sections.

The NRHM has been successful in accelerating the decline of Maternal Mortality Rat (MMR), Under 5 Mortality Rat e (U5MR), Infant Mortality Rate (IMR) and Total Fertility Rate (TFR). It has also achieved many of the disease control targets.

The key goals of NRHM and achievements made during XI and XII plan (coterminous with the NRHM/NHM targets) are at Annexure -I.

The corrective measures taken/being taken by the Government to achieve the targets as under:

- More  resources  through  increased  State  share  have  been  made  available  fo NRHM/NHM.
- Based on the continuous learning from the implementation of NRHM, strategies suc as RMNCH+A - continuum of care approach, High Priority Districts, strengthenin Facility Based Newborn C are, HomeBased Newborn Care etc. have been adopted.
- Better outreach s ervices, new drug regimen and focussed attention to disease hot spo has been adopted to eliminate/eradicate diseases such as kala - azar, leprosy, filaria etc.
- Incentive  pool  to  encourage  State  to  undertake  health  sector  reforms  has  b introduced.

## (b): State - wise d etails of public health facilities set up since year 2005 is at Annexure -II.

Amount spent under NRHM/NHM during 2010 - 11 to 2015 - 16, year -wise, State - wiseis at Annexure -III.

Current  status  of  achievement  of  outcomes  (MMR,  U5MR  &  TFR) State  wise  is  at Annexure-IV.

(c): As per Rural Health Statistics (RHS), there is a shortage of doctors in various health  facilities.  However, public  health  being  a  State  subject,  the  primary  responsibility ensure  availability  of  doctors  in  pub lic  health  facilities  lies  with  the  State  Governments Nonetheless,  under  NHM,  financial  and  technical  support  is  provided  to  States/UTs strengthen their healthcare systems including support for engagement of doctors on contr basis, based on the r equirements posed by the States/UTs in their Programme Implementation Plans (PIPs).

Support is also provided to States/UTs by giving hard area allowance to health hu resources for serving in rural and remote areas and for their residential quarters o that they find it attractive to serve in public health facilities in such areas.

Further, in order to encourage doctors to work in remote and difficult areas, the Council  of  India,  with  the  previous  approval  of  Central  Government,  has  amended the  Post Graduate Medical Education Regulations, 2000 to provide:

- (i) 50%  reservation  in  Post  Graduate  Diploma  Courses  for  Medical  Officers  in  th Government service, who have served for at least three years in remote and diff areas; and
- (ii) Incentive at the rate of 10% the marks obtained for each year in service in remote difficult areas as upto the maximum of 30% of the marks obtained in the entrance test for admissions in Post Graduate Medical Courses.

Process  of  approvals  against  the  proposals  is a  regular  ongoing  activity.  Approvals under NHM in 2016 - 17 for all States have been issued.

(d): The  working  of  NRHM/NHM  is  regularly  monitored/  reviewed,  inter - alia,  through external  surveys  such  as,  National  Family  Health  Survey  (NFHS),  District  Level Household Survey (DLHS), Annual Health Survey (AHS) and Sample Registration System (SRS). NFHS - 4 Survey is presently going on. Institute of Economic Growth (IEG) conducted an evaluatio NRHM  on  behalf  of  the  Planning  Commission.  Further,  Common  Review Missions  (CRMs) also undertake a review of NRHM/NHM annually.

## Achievements up to XIth  Plan

| Physical Outcomes : Targets &Achievements underNRHM   | Physical Outcomes : Targets &Achievements underNRHM                | Physical Outcomes : Targets &Achievements underNRHM                                      |
|-------------------------------------------------------|--------------------------------------------------------------------|------------------------------------------------------------------------------------------|
| S.No.                                                 | Targets (2005-12)                                                  | Achievements (up to 2012)                                                                |
| 1                                                     | IMR reduced to 30/1000 live births                                 | IMR reduced from 58 in 2005 (SRS) to 42 in 2012 (SRS).                                   |
| 2                                                     | Maternal Mortality to reduce to 100/100,000 live births            | MMR has reduced from 254 in 2004-06 (SRS) to 178 in 2010-12 (SRS).                       |
| 3                                                     | TFR reduced to 2.1                                                 | TFR has reduced from 2.9 in 2005 (SRS) to 2.4 in 2012 (SRS).                             |
| 4                                                     | Malaria Mortality reduction to 60%                                 | 70% Malaria mortality reduction- (Reduced from 1707 in 2006 to 519 in 2012).             |
| 5                                                     | Kala Azar Mortality reduction to 100%                              | 88% Kala Azar mortality reduction- (Reduced from 187 in 2006 to 22 in 2012).             |
| 6                                                     | Filaria / Microfilaria Reduction Rate to 80%                       | 66% reduction- Filaria/ Microfilaria (Rate reduced from 0.98% in 2006 to 0.33% in 2012). |
| 7                                                     | Dengue Mortality reduction by 50%                                  | 8% reduction- Dengue Mortality has reduced from 184 in 2006 to 169 in 2011.              |
| 8                                                     | Cataract operations- increasing to 46 lakhs per year               | Cataract operations of more than 63.49 lakhs per year have been reported in 2012.        |
| 9                                                     | Leprosy Prevalence Rate reduction to less than 1 per 10,000        | Leprosy Prevalence Rate reduced from 1.8 per 10,000 in 2005 to 0.68 per 10,000 in 2012.  |
| 10                                                    | Tuberculosis Control - over 70% case detection & 85% cure rate     | Tuberculosis is having 71% case detection and 88% Cure rate.                             |
| 11                                                    | Engaging 4 lakhs female Accredited Social Health Activists (ASHAs) | More than 8.6 lakhs female Accredited Social Health Activists (ASHAs) engaged as on 2012 |

## Annexure-I

## Targets of XIIth Plan:

| Targets (2012-17)                                                                                       | Achievements                                                                              |
|---------------------------------------------------------------------------------------------------------|-------------------------------------------------------------------------------------------|
| Reduce IMR to 25/1000 live births                                                                       | IMR reduced from 42 in 2012 (SRS) to 39 in 2015 (SRS).                                    |
| ReduceMMR to 1/1000 live births                                                                         | MMR has reduced to 167 in 2011-13 (SRS).                                                  |
| Reduce TFR to 2.1                                                                                       | TFR has reduced to 2.3 in 2014 (SRS).                                                     |
| Reduce annual incidence and mortality from Tuberculosis by half                                         | Annual total case notification of 107 lakh cases and 88% Cure rate up to March 2016.      |
| Reduce prevalence of Leprosy to <1/10000 population and incidence to zero in all districts Leprosy than | Prevalence Rate reduced to less 0.68 per 10,000 in March 2016.                            |
| Annual Malaria Incidence to be <1/1000                                                                  | Annual Malaria Incidence is 0.12 in March 2016.                                           |
| Less than 1 per cent microfilaria prevalence in all districts                                           | Out of 255 districts, 222 districts have been reported microfilaria rate to less than 1%. |
| Kala-Azar Elimination by 2015, <1 case per 10000 population in all blocks                               | Number of reported deaths due to Kala- Azar reduced from 187 (2006) to 3 (2015).          |

## Annexure-II

| S. No.   | State/UTs            | Public Health facilities in   |   2005 Public Hea lth facilities set upto March 2016 | up New health set up   |
|----------|----------------------|-------------------------------|------------------------------------------------------|------------------------|
| 1        | Andhra Pradesh       | 14173                         |                                                 8946 | -                      |
| 2        | Arunachal Pradesh    | 485                           |                                                  469 | -                      |
| 3        | Assam                | 5819                          |                                                 5824 | 5                      |
| 4        | Bihar                | 12086                         |                                                11763 | -                      |
| 5        | Chhattisgarh         | 4450                          |                                                 6170 | 1720                   |
| 6        | Goa                  | 196                           |                                                  237 | 41                     |
| 7        | Gujarat              | 8615                          |                                                 9682 | 1067                   |
| 8        | Haryana              | 2913                          |                                                 3179 | 266                    |
| 9        | Himachal Pradesh     | 2571                          |                                                 2703 | 132                    |
| 10       | Jammu & Kashmir      | 2283                          |                                                 3009 | 726                    |
| 11       | Jharkhand            | 5070                          |                                                 4506 | -                      |
| 12       | Karnataka            | 10075                         |                                                12001 | 1926                   |
| 13       | Kerala               | 6142                          |                                                 5719 | -                      |
| 14       | Madhya Pradesh       | 10256                         |                                                10814 | 558                    |
| 15       | Maharashtra          | 11889                         |                                                12860 | 971                    |
| 16       | Manipur              | 508                           |                                                  531 | 23                     |
| 17       | Meghalaya            | 519                           |                                                  578 | 59                     |
| 18       | Mizoram              | 420                           |                                                  446 | 26                     |
| 19       | Nagaland             | 502                           |                                                  556 | 54                     |
| 20       | Odisha               | 7440                          |                                                 8429 | 989                    |
| 21       | Punjab               | 3453                          |                                                 3591 | 138                    |
| 22       | Rajasthan            | 11899                         |                                                17111 | 5212                   |
| 23       | Sikkim               | 175                           |                                                  177 | 2                      |
| 24       | Tamil Nadu           | 10097                         |                                                10734 | 637                    |
| 25       | Telangana            | -                             |                                                 5683 | 5683                   |
| 26       | Tripura              | 621                           |                                                 1145 | 524                    |
| 27       | Uttarakhand          | 1790                          |                                                 2200 | 410                    |
| 28       | Uttar Pradesh        | 22511                         |                                                24951 | 2440                   |
| 29       | West Bengal          | 11624                         |                                                11672 | 48                     |
| 30       | A & N Islands        | 131                           |                                                  151 | 20                     |
| 31       | Chandigarh           | 14                            |                                                   19 | 5                      |
| 32       | Dadra & Nagar Haveli | 45                            |                                                   65 | 20                     |
| 33       | Daman & Diu          | 25                            |                                                   33 | 8                      |
| 34       | Delhi                | 50                            |                                                   80 | 30                     |
| 35       | Lakshadweep          | 21                            |                                                   24 | 3                      |
| 36       | Puducherry           | 118                           |                                                   86 | -                      |
|          | All India            | 168986                        |                                               186144 | 23743                  |

## Annexure-III

## State/UTs wise Utilization under NRHM/NHM from the F.Y. 2010-11 to 2015-16

| Sl. No.   | States                    | 2010-11 Utilization   | 2011-12 Utilization   |   2012-13 Utilization |   2013-14 Utilization |   2014-15 Utilization | 2015-16           |
|-----------|---------------------------|-----------------------|-----------------------|-----------------------|-----------------------|-----------------------|-------------------|
| 1         | Andaman & Nicobar Islands | 17.66                 | 21.30                 |                 27.52 |                 29.12 |                 24.33 | Utilization 11.47 |
| 2         | Andhra Pradesh            | 693.92                | 709.05                |               1066.65 |               1044.81 |                902.91 | 1090.17           |
| 3         | Arunachal Pradesh         | 78.64                 | 90.70                 |                 73.68 |                 92.03 |                 69.5  | 146.27            |
| 4         | Assam                     | 1093.37               | 1035.14               |               1253.73 |                956.89 |                915.88 | 1186.01           |
| 5         | Bihar                     | 1454.98               | 1147.74               |               1333.54 |               1480.68 |               1427.4  | 1621.67           |
| 6         | Chandigarh                | 9.25                  | 10.75                 |                 12.65 |                 14.42 |                 15.26 | 20.98             |
| 7         | Chattisgarh               | 308.60                | 482.58                |                512.34 |                805.5  |                716.04 | 758.28            |
| 8         | Dadra & Nagar Haveli      | 5.76                  | 6.49                  |                  7.43 |                  9.83 |                  8.56 | 15.54             |
| 9         | Daman & Diu               | 3.96                  | 5.21                  |                  6.85 |                  8.4  |                  7.67 | 15.69             |
| 10        | Delhi                     | 90.13                 | 92.27                 |                109.3  |                132.59 |                222.64 | 137.29            |
| 11        | Goa                       | 18.37                 | 27.49                 |                 29.63 |                 30.58 |                 29.5  | 24.92             |
| 12        | Gujarat                   | 722.26                | 766.41                |                821.11 |                977.48 |                873.66 | 1272.42           |
| 13        | Haryana                   | 287.78                | 289.21                |                369.63 |                423.79 |                438.18 | 493.23            |
| 14        | Himachal Pradesh          | 164.74                | 149.75                |                276.69 |                158.6  |                306.92 | 281.26            |
| 15        | Jammu & Kashmir           | 210.76                | 249.39                |                293.78 |                391.1  |                393.29 | 420.94            |
| 16        | Jharkhand                 | 381.09                | 419.41                |                423.93 |                521.49 |                372.01 | 590.18            |
| 17        | Karnataka                 | 700.62                | 767.55                |                807.1  |                812.56 |                858.18 | 1141.61           |
| 18        | Kerala                    | 385.95                | 428.16                |                628.24 |                673.07 |                509.83 | 632.88            |
| 19        | Lakshadweep               | 3.44                  | 4.10                  |                  4.44 |                  2.28 |                  1.36 | 2.72              |
| 20        | Madhya Pradesh            | 996.80                | 968.86                |               1223.5  |               1583.6  |               1738.02 | 2046.60           |
| 21        | Maharashtra               | 1271.63               | 1483.17               |               1840.14 |               1806.86 |               1834.4  | 1734.44           |
| 22        | Manipur                   | 68.21                 | 65.88                 |                 68.48 |                 74.57 |                 86.91 | 105.51            |
| 23        | Meghalaya                 | 91.99                 | 107.72                |                104.75 |                 71.53 |                 70.72 | 133.55            |
| 24        | Mizoram                   | 77.33                 | 76.92                 |                 87.69 |                 91.89 |                 93.29 | 172.38            |
| 25        | Nagaland                  | 81.84                 | 111.81                |                105.35 |                 90.4  |                 63.04 | 81.05             |
| 26        | Orissa                    | 664.37                | 727.75                |                780.73 |                901.65 |                944.1  | 1205.77           |
| 27        | Puducherry                | 17.36                 | 20.59                 |                 20.53 |                 25.43 |                 23.35 | 21.77             |
| 28        | Punjab                    | 339.34                | 382.71                |                423.47 |                437.57 |                460.59 | 649.49            |
| 29        | Rajasthan                 | 1172.06               | 1051.53               |               1181.47 |               1457.06 |               1722.69 | 1799.11           |
| 30        | Sikkim                    | 33.45                 | 31.95                 |                 37.3  |                 44.82 |                 41.36 | 50.71             |
| 31        | Tamil Nadu                | 825.22                | 917.15                |                900.73 |               1430.28 |               2248.06 | 1633.37           |
| 32        | Tripura                   | 105.43                | 109.15                |                118.96 |                101.93 |                130.15 | 118.77            |
| 33        | Uttar Pradesh             | 2693.30               | 2011.11               |               3263.04 |               2924.38 |               3671.26 | 4451.78           |
| 34        | Uttarakhand               | 206.31                | 212.90                |                246.97 |                255.28 |                324.42 | 335.95            |
| 35        | West Bengal               | 836.69                | 901.71                |               1104.09 |               1271.71 |               1196.78 | 1487.62           |
| 36        | Telangana                 |                       |                       |                  0    |                  0    |                334.68 | 505.55            |
| Total     | Total                     | 16112.63              | 15883.63              |              19565.4  |              21134.2  |              23076.9  | 26396.94          |

## Note:

2. The above figures does not include Kind Grants under Immunization.

Rs. in crore

1. Above mentioned Utilization figures are as reported by States/UTs and includes expenditure against Central Release, State share & Unspent balances of previous years.

## Maternal Mortality Ratio(MMR) (2011- 13)

| India & Major States         |   MMR |
|------------------------------|-------|
| INDIA                        |   167 |
| Assam                        |   300 |
| Bihar / Jharkhand            |   208 |
| Madhya Pradesh / Chhatisgarh |   221 |
| Orissa                       |   222 |
| Rajasthan                    |   244 |
| Uttar Pradesh / Uttarakhand  |   285 |
| Andhra Pradesh               |    92 |
| Karnataka                    |   133 |
| Kerala                       |    61 |
| Tamil Nadu                   |    79 |
| Gujarat                      |   112 |
| Haryana                      |   127 |
| Maharashtra                  |    68 |
| Punjab                       |   141 |
| West Bengal                  |   113 |
| Other States                 |   126 |

Sourse: SRS 2014

## Under-Five Mortality Rates (U5MR), 2014

| States/UTs       |   U5MR |
|------------------|--------|
| India            |     45 |
| Andhra Pradesh   |     40 |
| Assam            |     66 |
| Bihar            |     53 |
| Chhattisgarh     |     49 |
| Delhi            |     21 |
| Gujarat          |     41 |
| Haryana          |     40 |
| Himachal Pradesh |     36 |
| Jammu & Kashmir  |     35 |
| Jharkhand        |     44 |
| Karnataka        |     31 |
| Kerala           |     13 |
| Madhya Pradesh   |     65 |
| Maharashtra      |     23 |
| Odisha           |     60 |
| Punjab           |     27 |
| Rajasthan        |     51 |
| Tamil Nadu       |     21 |
| Telangana        |     37 |
| Uttar Pradesh    |     57 |
| Uttarakhand      |     36 |
| West Bengal      |     30 |

Sourse: SRS 2014

## Total Fertility Rate (TFR), 2014

| States/UTs       | TFR     |
|------------------|---------|
| India            | 2.3     |
| Andhra Pradesh   | 2.3 1.8 |
| Assam            | 2.3     |
| Bihar            | 3.2     |
| Chhattisgarh     | 2.6     |
| Delhi            | 1.7     |
| Gujarat          | 2.3     |
| Haryana          | 2.3     |
| Himachal Pradesh | 1.7     |
| Jammu & Kashmir  | 1.7     |
| Jharkhand        | 2.8     |
| Karnataka        | 1.8     |
| Kerala           | 1.9     |
| Madhya Pradesh   | 2.8     |
| Maharashtra      | 1.8     |
| Odisha           | 2.1     |
| Punjab           | 1.7     |
| Rajasthan        | 2.8     |
| Tamil Nadu       | 1.7     |
| Telangana        | 1.8     |
| Uttar Pradesh    | 3.2     |
| Uttarakhand      | 2.0     |
| West Bengal      | 1.6     |