Lok Sabha Question No. 2213 (UNSTARRED), answered on 2020-09-23
Subject: Upgradation/Modernisation of Hospitals
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Vinayak Bhaurao Raut, Veena Devi, N.K. Premachandran, Nishikant  Dubey, Chandeshwar Prasad

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

## LOK SABHA UNSTARRED QUE STION NO. 2213 TO BE ANSWERED ON 23 RD SEPTEMBER, 2020

## UPGRADATION/MODERNIS ATION OF HOSPITALS

## 2213. SHRI VINAYAK RAUT:

SHRIMATI

VEENA DEVI:

SHRI N.K. PREMACHAND RAN:

DR. NISHIKANT DUBEY:

SHRI CHANDESHWAR PRA SAD:

Will the Minister of HEALTH AND FAMILYWELFARE be pleased to state:

- (a) the norms set for the basic infrastructure of p ivate and Government hospitals in the country including Bihar, Jharkhand and Maharashtra;
- (b)  whether  the  Government  has  assessed  the  major deficiencies/challenges  confronting  the PublicHealthcare  Centres  and  Government  hospitals  in  the country  and  if  so,  the  outcome thereof;
- (c)  whether  the  Governme t  proposes  to  improve the  infrastructure  in  Hospitals/Public Healthcare Centres and root out other deficiencies in order to provide quality healthcare services and if so, the details thereof indicating the hospitals upgraded/modernized during the last fou r years alongwith the funds provided and utilized therefor, State, district and hospitalwise;
- (d)  whether  the  Government  proposes  to  deploy sufficient  manpower  in  healthcare  facilities across the country and if so, the details of steps taken/proposes to be taken thereon;
- (e) the concrete action taken by the Government to resolve the unmanageable patient load in public hospitals including for expansion of hospitals infrastructure; and
- (f)  the  details  of  the  action  taken  for  ensuring adequate  supply  of  medici nes  in  public hospitals/ healthcare facilities?

## ANSWER

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

- (a) Central Government has laid down Indian Public Health Standards (IPHS) as norms for public health facilities for the country including the States of Bihar, Jharkhand and Mahara . IPHS are a set of uniform standards envisaged to improve the quality of healthcare deli the  country  and  have  been  used  as  the  reference  point  for  public  healthcare infrastructu planning  and  up -gradation  in  the  States  and  UTs.  These  standards  have  been  developed  fo

Sub-centres, Primary Health Centres (PHCs), Community Health Centres (CHCs), Sub - District and District Hospitals.

Further, the Central government al so enacted Clinical Establishments (Registration and Regulation)  Act,  2010 to  provide  for  registration  and  regulation  of  all  clinical  establish (both  public  and  private)  in  the  country  with  a  view  to  prescribe  the  minimum  standar facilities and s ervices provided by them. States have the flexibility to adopt it under clause Article 252 of the Constitution. Among others, the States of Bihar and Jharkhand have ad the Act. The State of Maharashtra enacted Bombay Nursing Home Registrations Act, 1949 to provide for registration and inspection of nursing homes in the state.

(b)    Shortage of infrastructure and manpower are the major issues faced by healthcare s the  Country.  ' Public  Health  &  Hospital '  being  a  State  subject,  the  primar y  responsibility  to provide adequate medical facilities in public health care centres across the country lie respective  State  Government.  However,  under  the  NHM,  technical  and  financial  support provided to States for strengthening of their hea lthcare systems based on the proposals submitted by them through their Programme Implementation Plans (PIPs).

(c)   In order to provide quality healthcare services, Indian Public Health Standards h laid  down  which,  inter - alia,  provide  norms  for  se rvices,  infrastructure,  human  resource, diagnostics, equipment, medicines, etc. As per these standards, the services that different leve of  facilities  are  expected  to  provide  are  grouped  under  two  categories  i.e.  'Minimum Assured Services or Essential Se rvices' and 'Desirable Services'. Essential Services should be available at  the  facility  which  includes  promotive,  preventive,  curative,  referral  services  an national health programmes. The services which are indicated as 'Desirable' are for the p urpose that States should aspire to achieve for the particular level of the facility. The overal IPHS  is  to  provide  healthcare  that  is  quality  oriented  and  sensitive  to  the  needs community. State -wise details of State Programme Impleme ntation Plans (SPIP) approvals are given in Annexure.

(d)  &  (e)      Under  the  National  Health  Mission  (NHM),  financial  and  technical  suppor provided to States to strengthen their healthcare systems including support for outsou engagement of medi cal officers, specialist doctors and other staff on contractual basis, b the requirements posed by the States in their Programme Implementation Plans (PIPs). To e the States engage and retain Specialist doctors in rural and remote area, support is also provided for hard - area allowance, performance - based incentives, providing accommodation / residential quarters,  transport  facilities  and  sponsoring  of  training  programmes,  etc.  The  States encouraged to adopt flexible norms for engaging sp ecialists at public health facilities. Remedial steps  to  increase  the  number  of  doctors  and  specialists  in  the  country  include mechanisms  for  ' contracting - in '  and  ' contracting - out '  of  specialist  services,  empanelment  of private  medical  facilities  t o  provide  requisite  Specialists  and  other  methods  of  engaging specialists outside the government system for service delivery at public facilities. S also  been  allowed  to  offer  negotiable  salaries  to  attract  Specialists  including  fle st rategies,  such  as, 'You  quote,  We  pay ".  Also,  States  are  advised  to  put  in  place  transparen policies of posting and transfer, and ensure rational deployment of doctors.

Further, under Ayushman Bharat -Health  &  Wellness  Centres  (AB - HWCs),  1.5  lakh Sub Health Centres and Primary Health Centres are to be transformed into Health and Well Centres (AB - HWCs) across the country for provision of Comprehensive Primary Health Care (CPHC) that includes preventive healthcare and health promotion at the community l vel with continuum of care approach. By providing CPHC services near to the community, these AB -HWCs are to act a gate keeper and decrease the load of patients in Secondary and Tertiary

(f)      'Public  Health and Hospitals' being State subject, the primary responsibility of ensuring sufficient  supply  of  essential  medicines  in  public  health  facilities  is  that  of  respe Governments.

their

Prog including

To ensure availability of essential drugs and di agnostics and reduce the 'Out of Pocket Expenditure'  of  the  patients  visiting  the  public  healthcare  facilities,  Central  Government  has rolled  out  Free  Drugs  Service  Initiative  (FDSI)  under  the  National  Health  Mission  (N Under FDSI, financial support is provided to States for provision of free essential medicines public healthcare facilities based on their requirements proposed in Implementation Plans (PIPs) within their overall resource envelope, strengthening  /  sett ing - up  robust  systems  of  procurement,  quality  assurance  mechanism, warehousing,  prescription  audit,  grievance  redressal,  dissemination  of  Standard  Trea Guidelines,  and  IT  backed  supply  chain  management  systems  like  Drugs  and  Vaccines Distribution Mana gement Systems (DVDMS), etc.

All  States  have  reported  that  they  have  notified  this  policy  to  provide  free  e medicines in the public healthcare facilities.

## ANNEXURE

## Details of SPIP Approvals and Expenditure for the activity "Hospital Strengthening and New Constructions" under NHM for the FY 2016 - 17 to 2019 -20

Rs. In Lakhs

| S.No.                | Name of the State UT   | 2016-17        | 2016-17     | 2017-18        | 2017-18     | 2018-19        | 2018-19     | 2019-20        | 2019-20     |
|----------------------|------------------------|----------------|-------------|----------------|-------------|----------------|-------------|----------------|-------------|
|                      |                        | SPIP Approvals | Expenditure | SPIP Approvals | Expenditure | SPIP Approvals | Expenditure | SPIP Approvals | Expenditure |
| A. High Focus States |                        |                |             |                |             |                |             |                |             |
| 1                    | Bihar                  | 12445.29       | 4502.04     | 19,568.63      | 594.92      | 48,262.46      | 4,899.63    | 52,065.00      | 49,548.31   |
| 2                    | Chattisgarh            | 3971.20        | 12279.05    | 12,488.91      | 10,446.11   | 17,331.84      | 8,883.84    | 12,888.53      | 12,248.67   |
| 3                    | Himachal Pradesh       | 3879.11        | 3931.17     | 5,363.32       | 3,279.32    | 4,850.91       | 5,814.97    | 5,521.00       | 1,759.30    |
| 4                    | Jammu & Kashmir        | 2705.67        | 3812.83     | 1,787.58       | 1,342.24    | 3,339.64       | 3,875.45    | 6,694.80       | 2,608.06    |
| 5                    | Jharkhand              | 4982.49        | 172.84      | 1,758.38       | 462.39      | 6,588.40       | 2,682.63    | 11,228.01      | 3,361.45    |
| 6                    | Madhya Pradesh         | 20511.94       | 17637.58    | 22,974.68      | 15,024.05   | 29,241.08      | 13,076.21   | 29,949.82      | 21,788.56   |
| 7                    | Orissa                 | 30429.09       | 22311.13    | 26,768.21      | 14,978.25   | 26,259.56      | 21,919.95   | 40,032.09      | 41,903.45   |
| 8                    | Rajasthan              | 32484.61       | 25292.05    | 27,896.81      | 26,688.58   | 24,690.87      | 27,089.26   | 53,445.75      | 27,344.14   |
| 9                    | Uttar Pradesh          | 30996.44       | 56907.11    | 29,354.43      | 61,052.80   | 120,496.60     | 34,528.34   | 43,896.82      | 33,131.33   |
| 10                   | Uttarakhand            | 1826.23        | 322.35      | 1,113.05       | 1,867.63    | 2,741.93       | 3,405.96    | 7,064.25       | 7,262.03    |
|                      | Sub Total              | 144,232.06     | 147,168.15  | 149,074.00     | 135,736.29  | 283,803.29     | 126,176.24  | 262,786.07     | 200,955.30  |
| B. NE States         |                        |                |             |                |             |                |             |                |             |
| 11                   | Arunachal Pradesh      | 3119.17        | 3912.76     | 1,714.58       | 1,804.77    | 3,587.42       | 1,891.51    | 2,549.94       | 1,555.67    |
| 12                   | Assam                  | 13599.60       | 11630.55    | 14,949.75      | 9,648.51    | 9,263.29       | 7,302.67    | 17,892.22      | 12,222.96   |
| 13                   | Manipur                | 1708.56        | 389.18      | 6.16           | 345.60      | 1,061.70       | 2,028.09    | 1,744.57       | 615.02      |
| 14                   | Meghalaya              | 650.55         | 2102.91     | 949.40         | 2,064.07    | 610.30         | 265.24      | 895.50         | 468.87      |
| 15                   | Mizoram                | 92.75          | 98.05       | 116.00         | 15.48       | 199.90         | 176.77      | 414.00         | 202.46      |
| 16                   | Nagaland               | 208.09         | 469.77      | 719.24         | 222.80      | 2,229.48       | 1,296.69    | 1,087.31       | 603.80      |
| 17                   | Sikkim                 | 185.64         | 382.72      | 352.08         | 266.53      | 412.27         | 846.44      | 692.81         | 408.64      |
| 18                   | Tripura                | 1010.00        | 1176.35     | 5,101.50       | 3,107.49    | 3,455.28       | 2,631.40    | 5,050.54       | 1,642.06    |
|                      | Sub Total              | 20,574.36      | 20,162.28   | 23,908.71      | 17,475.24   | 20,819.64      | 16,438.80   | 30,326.89      | 17,719.46   |

| C. Non-High Focus States   |                           |            |            |            |            |            |            |            |            |
|----------------------------|---------------------------|------------|------------|------------|------------|------------|------------|------------|------------|
| 19                         | Andhra Pradesh            | 1243.09    | 6502.96    | 1,918.55   | 2,547.46   | 7,680.76   | 6,281.62   | 43,234.00  | 9,016.00   |
| 20                         | Goa                       | 6.65       | 2.30       | 113.80     | 33.70      | 122.70     | 45.49      | 34.92      | 30.64      |
| 21                         | Gujarat                   | 322.48     | 13157.92   | 1,191.25   | 1,470.26   | 1,444.05   | 2,532.25   | 3,388.00   | 1,633.52   |
| 22                         | Haryana                   | 237.23     | 608.96     | 346.41     | 92.74      | 6,129.73   | 2,192.26   | 7,381.01   | 299.91     |
| 23                         | Karnataka                 | 12594.56   | 4455.73    | 21,461.64  | 21,271.81  | 26,997.24  | 21,431.10  | 24,610.02  | 17,002.85  |
| 24                         | Kerala                    | 3554.14    | 3895.10    | 1,872.64   | 1,448.59   | 12,562.06  | 1,467.46   | 13,743.61  | 2,999.87   |
| 25                         | Maharashtra               | 12999.40   | 10079.25   | 13,585.59  | 13,628.96  | 29,932.97  | 17,007.05  | 78,537.33  | 37,973.10  |
| 26                         | Punjab                    | 4000.00    | 7273.48    | 4,100.00   | 3,022.69   | 10,070.00  | 3,461.16   | 6,950.00   | 3,520.88   |
| 27                         | Tamil Nadu                | 16043.45   | 23505.02   | 10,522.05  | 10,425.09  | 16,844.94  | 19,146.43  | 27,158.48  | 36,643.35  |
| 28                         | Telangana                 | 1675.78    | 3639.57    | 17,460.79  | 3,024.12   | 5,988.31   | 6,096.09   | 31,449.78  | 1,735.69   |
| 29                         | West Bengal               | 2274.47    | 15304.42   | 5,008.45   | 11,980.64  | 13,918.61  | 7,771.82   | 16,269.00  | 4,559.16   |
|                            | Sub Total                 | 54,951.25  | 88,424.70  | 77,581.17  | 68,946.05  | 131,691.37 | 87,432.74  | 252,756.15 | 115,414.98 |
| D. Small States/UTs        |                           |            |            |            |            |            |            |            |            |
| 30                         | Andaman & Nicobar Islands | 183.60     | 64.80      | 236.32     | 19.98      | 78.00      | 8.00       | 340.00     | 47.05      |
| 31                         | Chandigarh                | 0.00       | 0.00       | 16.00      | -          | -          | -          | -          | -          |
| 32                         | Dadra & Nagar Haveli      | 7.98       | 0.00       | -          | -          | -          | -          | -          | -          |
| 33                         | Daman & Diu               | 4.56       | 0.44       | 4.80       | 0.70       | 4.80       | 1.24       | 5.76       | 0.90       |
| 34                         | Delhi                     | 3518.00    | 305.88     | 134.00     | 5,213.47   | 208.00     | -          | 590.00     | -          |
| 35                         | Lakshadweep               | 3.84       | 0.00       | 6.84       | -          | 3.24       | -          | -          | -          |
| 36                         | Puducherry                | 0.00       | 7.13       | 20.50      | -          | 66.00      | 30.35      | 49.00      | 51.32      |
|                            | Sub Total                 | 3,717.98   | 378.26     | 418.46     | 5,234.15   | 360.04     | 39.59      | 984.76     | 99.27      |
|                            | Grand Total               | 223,475.65 | 256,133.39 | 250,982.34 | 227,391.74 | 436,674.34 | 230,087.36 | 546,853.88 | 334,189.01 |

## Note:

1. SPIP stands for State Program Implementation Plan.

2. Expenditure includes  expenditure against central Release, State release & unspent balances at the beginning of  the year.

3. The above figures are as per reported by the State/UTs.