Lok Sabha Question No. 393 (STARRED), answered on 2019-07-19
Subject: Health Infrastructure in Tribal Areas
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Achyutananda Samanta

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

## LOK SABHA STARRED QUESTION NO. 393 TO BE ANSWERED ON THE 19 TH JULY , 2019 HEALTH INFRASTRUCTUR E IN TRIBAL AREAS

## *393. SHRI ACHYUTANANDA SAMANTA:

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

- (a)  whether  the  Government  proposes  to  launch  any  specific  schemes  towar development of health infrastructure in tribal areas and if so, the details t
- (b) whether the Governmen t is aware that Kandhamal district of Odisha which i covered with dense forests and hilly terrain is deprived of any advanced m facility;
- (c) if so, the details of the funds sanctioned and utilized for development facilities in this regi on dur ng the last five years; and
- (d) whether there is any proposal to build a super - speciality hospital and medical college in Kandhamal region, if so, the details thereof and time frame fixed same?

## ANSWER THE MINISTER OF HEALTH AND FAMILY WELFARE (DR. HARSH VARDHAN)

- (a) to ( d):  A statement is laid on the Table of the House

## STATEMENT REFERRED TO IN REPLY TO LOK SABHA STARRED QUESTION NO. 393* FOR 19 TH JULY , 2019

(a)Public health and hospitals being a State subject, the primary respons ofdevelopment of health infrastructure in tribal areas lies with the State However,  u nder  National  Health  Mission,  financial  and  technical  support provided to States/U Ts for strengthening the public healthcare system including development of health infrastructure in tribal areas based on the priori need  and  context  projected  by  the  States/UTs  in  their  annual  Program Implementation Plans.

For schemes/parameters available for development of health infrastructure , preferential treatment and relaxed norms exist for tribal which are as under: -

- i. The  population  norms  for  setting  up PublicHealth  Facilities  in  tribal areas are relaxed. Against the population norms of 5000, 30000, and 1, 20,000 for setting up of Sub Centre, PHC and CHC respectively, in tr and  desert  areas  its  3000,  20,000  and  80,  0000 ,  respectively .    A  new norm of 'time to care' has also been adopted for setting up sub health Centres in tribal areas ,which can be set up within 30 minutes of walk from habitation .
- ii. A ll  tribal  districts  whose  composite  health  index  is  below  the average have been identified as H igh Priority Districts (HPDs) and State Governments/UTs are advi sed to allocate 1.3 times more resources per capita as compared to the rest of the districts in the State . These districts also have enhanced monitoring ,focussed supportive supervision, and are encouraged  to  adopt  innovative  approaches  to  address  their  pe culiar health challenges.
- iii. Approved  norms  for Mobile  Medical  Unit (MMU)  is  one  MMU  per district with a normative population of 10 lakh, with a cap of five per district.  This can be further relaxed for hilly and tribal are the  populations  are widely  dispersed  and  the  geographical  terrain  is difficult.
- iv. States have been provided with the flexibility of relaxing the norm o ASHA per 1000 population to one ASHA per habitation in Tribal/hill and difficult areas .
- v. Tribal  Sub - Plan  (TSP)  is  a  d edicated  source  of  funds  for  tribal development across the country. Ministry of health allocates 8.6% of total Scheme budget under different schemes towards TSP as per norm fixed by Ministry of Finance.  A statement showing allocation of fu

under T ribal Sub - Plan in respect of various schemes/programmes, for the last three years, is attached as per Annexures I to III.

S

- vi. Ministry of Tribal Affairs through its schemes 'Special Central Assistance  to  Tribal  Sub -Scheme  (SCA  to  TSS)'  and  Grants  under Article 275(1) of the Constitution, provides funds to the Governments  as  an  additive  towards  development  of  various  sector including  health,  based  on  their  proposal  after  approval  of  Pr Appraisal Committee in the Ministry.
- vii. Since North - eastern States have a higher percentage of tribal populat (>25%),  North - Eastern  Council  has  been  established  to  improve  the healthcare infrastructure in these states to ensure greater availab accessibility to good quality public health services.

(b)& (c) Kandhamal district has been identified as one of the Aspirational d for giving focused attention for develop ment. As per Rural Health Statistics, 2018, as  on  31.03.2018,  there  are  172  Sub - centres,  40  Primary  Health  Centres,  14 Community  Health  Centres  and  1  each  of  Sub - District Hospital  and  District Hospital functioning in Kandhamal district.

As intimated by the State Government, the details of the funds sanction and utilized for development of health infrastructure (civil works) under NHM in this district during the last five years from 2014 - 15 to 2018 - 9 are as under:

| Sl No   | Financial Year   |   Approved Budget (In Lakhs.) |   Expenditure (In Lakhs.) |
|---------|------------------|-------------------------------|---------------------------|
| 1       | 2014- 15         |                        309.05 |                    425.56 |
| 2       | 2015- 16         |                        215.6  |                    429.61 |
| 3       | 2016- 17         |                        892.26 |                    400.78 |
| 4       | 2017- 18         |                        268.53 |                     66.59 |
| 5       | 2018- 19         |                        570.26 |                    564.11 |
| Total   | Total            |                       2255.7  |                   1886.65 |

The  State  has  further  intimated  that  due  attention  has  been  given provisioning  of  advance  medical  facilities  in  all  districts  including  Kan Various steps are being taken for establishment of different critical health like  Cancer  Chemot herapy,  Free  Dialysis,  Free  diagnostic  including  high - end pathology  test,  digitalisation  &  reporting  of  X - Ray,  MCH  wings,  Digital Dispensaries etc. at Kandhamal district. Funds to the tune of Rs. 16179.97 have  been  allocated  under  NHM  and  State  budge t from  2014 - 15  to  2018 - 19 towards

improvement of healthcare facilities in the district.  The year - wise  details are as under: -

Rs. in lakhs

| Years    | Release under NHM   | Release under State Budget   | Total     |
|----------|---------------------|------------------------------|-----------|
| 2014- 15 | 1,760.68            | 171.94                       | 1,932.62  |
| 2015- 16 | 2,100.56            | 210.54                       | 2,311.10  |
| 2016- 17 | 3,589.51            | 875.88                       | 4,465.39  |
| 2017- 18 | 2,067.88            | 392.19                       | 2,460.07  |
| 2018- 19 | 3,738.26            | 1,272.52                     | 5,010.78  |
| Total    | 13,256.88           | 2,923.08                     | 16,179.97 |

(d)There is no such proposal for establishment of any Super speciality Hospital and Medical College in Kandhamal.  However, the State Government is alway free  to  propose  advanced  medical  facilities  for  the  district  under  any schemes of Government of India.

## Annexure-I

## DEPARTMENT OF OF HEALTH AND FAMILY WELFARE

## STATEMENT SHOWING SCHEMES FOR DEVELOPMENT OF SCHEDULED TRIBES 2016-17

(Rs. in Crores)

| Sl. No.   | Details of the Schemes                                                                                                                                      | ST Allocation (BE) 2016-17   | ST Allocation (RE) 2016-17   |
|-----------|-------------------------------------------------------------------------------------------------------------------------------------------------------------|------------------------------|------------------------------|
| A         | National Rural Health Mission                                                                                                                               |                              |                              |
| 1         | RCH Flexible Pool including Routine Immunization Programme, Pulse Polio Immunization Programme, National Iodine Deficiency Disorders Control Programme etc. | 702.67                       | 795.57                       |
| 2         | Health System Strengthening under NRHM                                                                                                                      | 625.49                       | 667.05                       |
| 3         | Flexible Pool for Communicable Diseases                                                                                                                     | 138.36                       | 159.70                       |
| 4         | Flexible Pool for Non-Communicable Diseases, Injury and Trauma                                                                                              | 62.16                        | 62.16                        |
| 5         | Infrastructure Maintenance                                                                                                                                  | 596.54                       | 550.11                       |
| 6         | Forward Linkages                                                                                                                                            |                              |                              |
| 7         | Strengthening of State Drug Regulatory System                                                                                                               |                              |                              |
| 8         | Other Health Schemes (PILOT)                                                                                                                                |                              |                              |
| 9         | Human Resources for Health                                                                                                                                  |                              |                              |
| 10        | Prime Minister's Development Plan for Jammu and Kashmir                                                                                                     |                              | 35.50                        |
| 11        | Strengthening of National Programme Management of the NHM                                                                                                   |                              |                              |

|    | Total - National Rural Health Mission                                                                                  | 2125.22   | 2270.09   |
|----|------------------------------------------------------------------------------------------------------------------------|-----------|-----------|
| B  | National Urban Health Mission                                                                                          | 109.18    | 25.15     |
| C  | National Health Protection Scheme                                                                                      | 212.50    | 59.35     |
| D  | Tertiary Care Programme                                                                                                |           |           |
| 1  | National Mental Health Programme                                                                                       | 4.12      | 4.12      |
| 2  | Capacity Building for Trauma Centres                                                                                   | 22.16     | 22.16     |
| 3  | National Programme for prevention and control of Cancer, Diabetes, Cardio-vascular Disease and Stroke                  | 30.58     | 31.56     |
| 4  | National Programme for Health Care for the Elderly                                                                     | 2.50      | 2.50      |
| 5  | National Programme for Control of Blindness                                                                            |           |           |
| 6  | Tobacco Control Programme &Drug De-addiction Programme                                                                 |           |           |
| 7  | Telemedicine                                                                                                           |           |           |
|    | Total - Tertiary Care Programme                                                                                        | 59.36     | 60.34     |
| E  | Human Resources for Health and Medical Education                                                                       |           |           |
| 1  | Upgradation/Strengthening of Nursing Services (ANM/GNM).                                                               |           |           |
| 2  | Strengthening/upgradation of Pharmacy School/Colleges.                                                                 |           |           |
| 3  | District Hospitals-Upgradation of State Govt. Medical Colleges (PG Seats)                                              |           |           |
| 4  | Strengthening Government Medical College (UG Seats) and Central Government Health Institutions                         | 12.94     | 12.94     |
| 5  | Establishing New Medical Colleges (Upgrading District Hospitals)                                                       | 52.99     | 144.32    |
| 6  | Setting up State Institutions of Para-Medical Sciences in States and Setting up of Colleges of Para-Medical Education. |           |           |
|    | Total - Human Resources for Health and Medical Education                                                               | 65.93     | 157.26    |
|    | Grand Total                                                                                                            | 2572.19   | 2572.19   |

## Annexure-II

## DEPARTMENT OF OF HEALTH AND FAMILY WELFARE

## STATEMENT SHOWING SCHEMES FOR DEVELOPMENT OF SCHEDULED TRIBES 2017-18

(Rs. in Crores)

| Sl. No.   | Details of the Schemes                                                                                                                                      | ST Allocation (BE) 2017- 18   | ST Allocation (RE) 2017-18   |
|-----------|-------------------------------------------------------------------------------------------------------------------------------------------------------------|-------------------------------|------------------------------|
| A         | National Rural Health Mission                                                                                                                               |                               |                              |
| 1         | RCH Flexible Pool including Routine Immunization Programme, Pulse Polio Immunization Programme, National Iodine Deficiency Disorders Control Programme etc. | 483.22                        | 551.86                       |
| 2         | Health System Strengthening under NRHM                                                                                                                      | 932.16                        | 932.16                       |
| 3         | Flexible Pool for Communicable Diseases                                                                                                                     | 179.56                        | 158.04                       |
| 4         | Flexible Pool for Non-Communicable Diseases, Injury and Trauma                                                                                              | 110.66                        | 112.66                       |
| 5         | Infrastructure Maintenance                                                                                                                                  | 589.51                        | 589.51                       |
| 6         | Forward Linkages                                                                                                                                            |                               |                              |
| 7         | Strengthening of State Drug Regulatory System                                                                                                               |                               |                              |
| 8         | Other Health Schemes (PILOT)                                                                                                                                |                               |                              |
| 9         | Prime Minister's Development Plan for Jammu and Kashmir                                                                                                     | 37.17                         | 37.17                        |
| 10        | Strengthening of National Programme Management of the NHM                                                                                                   |                               |                              |
|           | Total - National Rural Health Mission                                                                                                                       | 2332.28                       | 2381.40                      |
| B         | National Urban Health Mission                                                                                                                               | 24.15                         | 20.40                        |

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| C   | National Health Protection Scheme                                                                                      | 107.40   | 63.16   |
|-----|------------------------------------------------------------------------------------------------------------------------|----------|---------|
| D   | Tertiary Care Programme                                                                                                |          |         |
| 1   | National Mental Health Programme                                                                                       | 4.12     | 4.12    |
| 2   | Capacity Building for Trauma Centres                                                                                   | 20.42    | 13.55   |
| 3   | National Programme for prevention and control of Cancer, Diabetes, Cardio-vascular Disease and Stroke                  | 27.92    | 31.72   |
| 4   | National Programme for Health Care for the Elderly                                                                     | 6.12     | 5.06    |
| 5   | National Programme for Control of Blindness                                                                            |          |         |
| 6   | Tobacco Control Programme &Drug De-addiction Programme                                                                 |          |         |
| 7   | Telemedicine                                                                                                           |          |         |
|     | Total - Tertiary Care Programme                                                                                        | 58.58    | 54.45   |
| E   | Human Resources for Health and Medical Education                                                                       |          |         |
| 1   | Upgradation/Strengthening of Nursing Services (ANM/GNM).                                                               |          |         |
| 2   | Strengthening/upgradation of Pharmacy School/Colleges.                                                                 |          |         |
| 3   | District Hospitals-Upgradation of State Govt. Medical Colleges (PG Seats)                                              |          |         |
| 4   | Strengthening Government Medical College (UG Seats) and Central Government Health Institutions                         | 51.55    | 51.55   |
| 5   | Establishing New Medical Colleges (Upgrading District Hospitals)                                                       | 398.90   | 401.90  |
| 6   | Setting up State Institutions of Para-Medical Sciences in States and Setting up of Colleges of Para-Medical Education. |          |         |
|     | Total - Human Resources for Health and Medical Education                                                               | 450.45   | 453.45  |
|     | Grand Total                                                                                                            | 2972.86  | 2972.86 |

## Annexure-III

## DEPARTMENT OF OF HEALTH AND FAMILY WELFARE

## STATEMENT SHOWING SCHEMES FOR DEVELOPMENT OF SCHEDULED TRIBES 2018-19

(Rs. in Crores)

| Sl. No.   | Details of the Schemes                                                                                                                                      | ST Allocation (BE) 2018- 19   | SC Allocation (RE) 2018-19   |
|-----------|-------------------------------------------------------------------------------------------------------------------------------------------------------------|-------------------------------|------------------------------|
| A         | National Rural Health Mission                                                                                                                               |                               |                              |
| 1         | RCH Flexible Pool including Routine Immunization Programme, Pulse Polio Immunization Programme, National Iodine Deficiency Disorders Control Programme etc. | 547.88                        | 776.20                       |
| 2         | Health System Strengthening under NRHM                                                                                                                      | 1161.13                       | 1125.31                      |
| 3         | Flexible Pool for Communicable Diseases                                                                                                                     | 217.89                        | 204.14                       |
| 4         | Flexible Pool for Non-Communicable Diseases, Injury and Trauma                                                                                              | 107.75                        | 51.02                        |
| 5         | Infrastructure Maintenance                                                                                                                                  | 622.15                        | 718.69                       |
| 6         | Forward Linkages                                                                                                                                            |                               |                              |
| 7         | Strengthening of State Drug Regulatory System                                                                                                               | 22.24                         | 22.24                        |
| 8         | Other Health Schemes (PILOT)                                                                                                                                |                               |                              |
| 9         | Prime Minister's Development Plan for Jammu and Kashmir                                                                                                     | 32.59                         | 32.59                        |
| 10        | Strengthening of National Programme Management of theNHM                                                                                                    |                               |                              |
|           | Total - National Rural Health Mission                                                                                                                       | 2711.63                       | 2930.19                      |
| B         | National Urban Health Mission                                                                                                                               | 26.06                         | 26.33                        |
| C         | National Health Protection Scheme                                                                                                                           | 205.00                        | 25.80                        |

| D   | Tertiary Care Programme                                                                                                |         |         |
|-----|------------------------------------------------------------------------------------------------------------------------|---------|---------|
| 1   | National Mental Health Programme                                                                                       | 4.00    |         |
| 2   | Capacity Building for Trauma Centres                                                                                   | 14.43   |         |
| 3   | National Programme for prevention and control of Cancer, Diabetes, Cardio-vascular Disease and Stroke                  | 30.03   | 14.95   |
| 4   | National Programme for Health Care for the Elderly                                                                     | 6.12    |         |
| 5   | National Programme for Control of Blindness                                                                            |         |         |
| 6   | Tobacco Control Programme &Drug De-addiction Programme                                                                 |         |         |
| 7   | Telemedicine                                                                                                           |         |         |
|     | Total - Tertiary Care Programme                                                                                        | 54.58   | 14.95   |
| E   | Human Resources for Health and Medical Education                                                                       |         |         |
| 1   | Upgradation/Strengthening of Nursing Services (ANM/GNM).                                                               |         |         |
| 2   | Strengthening/upgradation of Pharmacy School/Colleges.                                                                 |         |         |
| 3   | District Hospitals-Upgradation of State Govt. Medical Colleges (PG Seats)                                              |         |         |
| 4   | Strengthening Government Medical College (UG Seats) and Central Government Health Institutions                         | 85.76   | 85.76   |
| 5   | Establishing New Medical Colleges (Upgrading District Hospitals)                                                       | 299.29  | 299.29  |
| 6   | Setting up State Institutions of Para-Medical Sciences in States and Setting up of Colleges of Para-Medical Education. |         |         |
|     | Total - Human Resources for Health and Medical Education                                                               | 385.05  | 385.05  |
|     | Grand Total                                                                                                            | 3382.32 | 3382.32 |