Lok Sabha Question No. 537 (UNSTARRED), answered on 2018-07-20
Subject: Health Sub Centres
Ministry: HEALTH AND FAMILY WELFARE
Asked by: REKHA ARUN VERMA, BHAVANA GAWALI (PATIL), ASHOK MAHADEORAO NETE

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

LOK SABHA UNSTARRED QUESTION NO. 537 TO BE ANSWERED ON  20 TH JULY, 2018

## HEALTH SUB CENTRES

## SHRIMATI BHAVANA PUNDALIKRAO GAWALI PATIL:

## 537. SHRIMATI REKHA VERMA: SHRI ASHOK MAHADEORAO NETE:

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

- (a) whether present Health Centres are sufficient to cater to the public health system in country;
- (b) if so, the details thereof along with the norms fixed and number of sub - centres functioning in the country at presents, State - wise, Union - Territory -wise;
- (c) whether there is any job chart for health attendant (woman), ANM and ASHA workers of a sub- centre;
- (d) if so, the details thereof;
- (e) whether the Government proposes to increase the honorarium of ASHA workers so that the may be financially secured; and
- (f) if so, the details thereof?

## ANSWER

## THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FA MILY WELFARE

(ASHWINI KUMAR CHOUBEY)

- (a) & (b):   The health care infrastructure in rural areas has been developed as a three tier system and is based on the following population norms :

| Centre                  | Population Norms   | Population Norms       |
|-------------------------|--------------------|------------------------|
|                         | Plain Area         | Hilly/tribal/Difficult |
| Sub Centre              | 5000               | 3000                   |
| Primary Health Centre   | 30000              | 20000                  |
| Community Health Centre | 120000             | 80000                  |

As per Rural Health Statistics 2017, there is shortfalls in availability of differe health facilities such as sub centres, primary health centres and community health centres in the country. The States/UT wise details are given at Annexure - I.

(c) & (d): Roles and responsibilities/job charts have been prepared for service provide the sub centre including ANM.  The IPHS guidelines for sub centres (Revised 2012) lays down the roles and responsibilities of ANMs, which are available a http://www.nhm.gov.in/nhm/nrhm/guidelines/indian - public - health - sta ndards.html .  In  addition, prototype job charts and weekly work plans have also been provided in the Ministry of H and Family Welfare 'Guidebook for enhancing performance of Multi - purpose worker (Female) 2014' which is available at 'http://nhsrcindia.o rg/category - detail/policy -andguidelines/ODY=' ASHA is a community level voluntary health worker, who is trained and supported to play of healthcare support roles in her community. The roles and responsibilities of ASHA as ASHA Guidelines re leased by the GIO are at Annexure - II.

(e)& (f): ASHAs are envisaged as Voluntary Health activists who receive only task/activ based incentives. The incentives to ASHAs finalized at the national level are regularly by  the  Government  fro m  time  to  time.  In  2013,  ASHA  incentives  were  enhanced  for  many activities and new incentives for routine and recurring activities were introduced to en ASHAs  get  at  least  Rs  1000/ - per  month.  Thereafter,  the  Mission  Steering  Group  of  NHM approvedincentives for ASHAs at the rate of Rs.100 for notification if the suspect ref diagnosed to be TB patient by MO/Lab, in 2014.  Rs 100/ - per round during Indoor Residual Spray i.e. Rs 200 in total for two rounds Indoor Residual Spray, in 2015 and R s. 150/case for escorting or facilitating beneficiary to the health facility for the Post Abortion IUCD i 2017.  Under  the  Framework  for  Implementation  of  NHM,  States  have  also  been  given  the flexibility to design ASHA incentives.

………………

Table 11

<!-- image -->

| SHORTFALL IN HEALTH INFRASTRUCTURE AS PER 2011 POPULATION IN INDIA (As on 31st   | SHORTFALL IN HEALTH INFRASTRUCTURE AS PER 2011 POPULATION IN INDIA (As on 31st   | SHORTFALL IN HEALTH INFRASTRUCTURE AS PER 2011 POPULATION IN INDIA (As on 31st   | SHORTFALL IN HEALTH INFRASTRUCTURE AS PER 2011 POPULATION IN INDIA (As on 31st   | SHORTFALL IN HEALTH INFRASTRUCTURE AS PER 2011 POPULATION IN INDIA (As on 31st   | SHORTFALL IN HEALTH INFRASTRUCTURE AS PER 2011 POPULATION IN INDIA (As on 31st   | SHORTFALL IN HEALTH INFRASTRUCTURE AS PER 2011 POPULATION IN INDIA (As on 31st   | SHORTFALL IN HEALTH INFRASTRUCTURE AS PER 2011 POPULATION IN INDIA (As on 31st   | SHORTFALL IN HEALTH INFRASTRUCTURE AS PER 2011 POPULATION IN INDIA (As on 31st   | SHORTFALL IN HEALTH INFRASTRUCTURE AS PER 2011 POPULATION IN INDIA (As on 31st   | SHORTFALL IN HEALTH INFRASTRUCTURE AS PER 2011 POPULATION IN INDIA (As on 31st   | SHORTFALL IN HEALTH INFRASTRUCTURE AS PER 2011 POPULATION IN INDIA (As on 31st   | SHORTFALL IN HEALTH INFRASTRUCTURE AS PER 2011 POPULATION IN INDIA (As on 31st   | SHORTFALL IN HEALTH INFRASTRUCTURE AS PER 2011 POPULATION IN INDIA (As on 31st   | SHORTFALL IN HEALTH INFRASTRUCTURE AS PER 2011 POPULATION IN INDIA (As on 31st   | SHORTFALL IN HEALTH INFRASTRUCTURE AS PER 2011 POPULATION IN INDIA (As on 31st   |
|----------------------------------------------------------------------------------|----------------------------------------------------------------------------------|----------------------------------------------------------------------------------|----------------------------------------------------------------------------------|----------------------------------------------------------------------------------|----------------------------------------------------------------------------------|----------------------------------------------------------------------------------|----------------------------------------------------------------------------------|----------------------------------------------------------------------------------|----------------------------------------------------------------------------------|----------------------------------------------------------------------------------|----------------------------------------------------------------------------------|----------------------------------------------------------------------------------|----------------------------------------------------------------------------------|----------------------------------------------------------------------------------|----------------------------------------------------------------------------------|
| S.No.State/                                                                      | UT                                                                               |                                                                                  | Tribal                                                                           | Sub Centres                                                                      | Sub Centres                                                                      | Sub Centres                                                                      | Sub Centres                                                                      | PHCs                                                                             | PHCs                                                                             | PHCs                                                                             | PHCs                                                                             | CHCs                                                                             | CHCs                                                                             | CHCs                                                                             | CHCs                                                                             |
| S.No.State/                                                                      | UT                                                                               | Total Population in Rural Areas                                                  | Population in Rural R Areas                                                      | P                                                                                | S                                                                                | l                                                                                | % R Shortfal                                                                     | P                                                                                | S                                                                                | l                                                                                | % R Shortfal                                                                     | P                                                                                | S                                                                                | l                                                                                | % Shortfal                                                                       |
| 1                                                                                | Andhra Pradesh                                                                   | 34776389                                                                         | 2293102                                                                          | 7261                                                                             | 7458                                                                             | *                                                                                | *                                                                                | 1197                                                                             | 1147                                                                             | 50                                                                               | 4                                                                                | 299                                                                              | 193                                                                              | 106                                                                              | 35                                                                               |
| 2                                                                                | Arunachal Pradesh                                                                | 1066358                                                                          | 789846                                                                           | 318                                                                              | 312                                                                              | 6                                                                                | 2                                                                                | 48                                                                               | 143                                                                              | *                                                                                | *                                                                                | 12                                                                               | 63                                                                               | *                                                                                | *                                                                                |
| 3                                                                                | Assam                                                                            | 26807034                                                                         | 3665405                                                                          | 5850                                                                             | 4621                                                                             | 1229                                                                             | 21                                                                               | 954                                                                              | 1014                                                                             | *                                                                                | *                                                                                | 238                                                                              | 158                                                                              | 80                                                                               | 34                                                                               |
| 4                                                                                | Bihar                                                                            | 92341436                                                                         | 1270851                                                                          | 18637                                                                            | 9949                                                                             | 8688                                                                             | 47                                                                               | 3099                                                                             | 1899                                                                             | 1200                                                                             | 39                                                                               | 774                                                                              | 150                                                                              | 624                                                                              | 81                                                                               |
| 5                                                                                | Chhattisgarh                                                                     | 19607961                                                                         | 7231082                                                                          | 4885                                                                             | 5186                                                                             | *                                                                                | *                                                                                | 774                                                                              | 785                                                                              | *                                                                                | *                                                                                | 193                                                                              | 169                                                                              | 24                                                                               | 12                                                                               |
| 6                                                                                | Goa                                                                              | 551731                                                                           | 87639                                                                            | 122                                                                              | 214                                                                              | *                                                                                | *                                                                                | 19                                                                               | 24                                                                               | *                                                                                | *                                                                                | 4                                                                                | 4                                                                                | 0                                                                                | 0                                                                                |
| 7                                                                                | Gujarat                                                                          | 34694609                                                                         | 8021848                                                                          | 8008                                                                             | 9082                                                                             | *                                                                                | *                                                                                | 1290                                                                             | 1392                                                                             | *                                                                                | *                                                                                | 322                                                                              | 363                                                                              | *                                                                                | *                                                                                |
| 8                                                                                | Haryana                                                                          | 16509359                                                                         | 0                                                                                | 3301                                                                             | 2589                                                                             | 712                                                                              | 22                                                                               | 550                                                                              | 366                                                                              | 184                                                                              | 33                                                                               | 137                                                                              | 112                                                                              | 25                                                                               | 18                                                                               |
| 9                                                                                | Himachal Pradesh                                                                 | 6176050                                                                          | 374392                                                                           | 1285                                                                             | 2083                                                                             | *                                                                                | *                                                                                | 212                                                                              | 538                                                                              | *                                                                                | *                                                                                | 53                                                                               | 89                                                                               | *                                                                                | *                                                                                |
| 10                                                                               | Jammu & Kashmir                                                                  | 9108060                                                                          | 1406833                                                                          | 2009                                                                             | 2967                                                                             | *                                                                                | *                                                                                | 327                                                                              | 637                                                                              | *                                                                                | *                                                                                | 81                                                                               | 84                                                                               | *                                                                                | *                                                                                |
| 11                                                                               | Jharkhand                                                                        | 25055073                                                                         | 7868150                                                                          | 6060                                                                             | 3848                                                                             | 2212                                                                             | 37                                                                               | 966                                                                              | 297                                                                              | 669                                                                              | 69                                                                               | 241                                                                              | 188                                                                              | 53                                                                               | 22                                                                               |
| 12                                                                               | Karnataka                                                                        | 37469335                                                                         | 3429791                                                                          | 7951                                                                             | 9381                                                                             | *                                                                                | *                                                                                | 1306                                                                             | 2359                                                                             | *                                                                                | *                                                                                | 326                                                                              | 206                                                                              | 120                                                                              | 37                                                                               |
| 13                                                                               | Kerala                                                                           | 17471135                                                                         | 433092                                                                           | 3551                                                                             | 5380                                                                             | *                                                                                | *                                                                                | 589                                                                              | 849                                                                              | *                                                                                | *                                                                                | 147                                                                              | 232                                                                              | *                                                                                | *                                                                                |
| 14                                                                               | Madhya Pradesh                                                                   | 52557404                                                                         | 14276874                                                                         | 12415                                                                            | 9192                                                                             | 3223                                                                             | 26                                                                               | 1989                                                                             | 1171                                                                             | 818                                                                              | 41                                                                               | 497                                                                              | 309                                                                              | 188                                                                              | 38                                                                               |
| 15                                                                               | Maharashtra                                                                      | 61556074                                                                         | 9006077                                                                          | 13512                                                                            | 10580                                                                            | 2932                                                                             | 22                                                                               | 2201                                                                             | 1814                                                                             | 387                                                                              | 18                                                                               | 550                                                                              | 360                                                                              | 190                                                                              | 35                                                                               |

## A nnexure-I

| 16   | Manipur          |   2021640 |   791126 | 509   |          421 | 88    | 17   |    80 |    85 | *    | *   |   20 |   17 | 3    | 15   |
|------|------------------|-----------|----------|-------|--------------|-------|------|-------|-------|------|-----|------|------|------|------|
| 17   | Meghalaya        |   2371439 |  2136891 | 759   |          436 | 323   | 43   |   114 |   109 | 5    | 4   |   28 |   27 | 1    | 4    |
| 18   | Mizoram          |    525435 |   507467 | 172   |          370 | *     | *    |    25 |    57 | *    | *   |    6 |    9 | *    | *    |
| 19   | Nagaland         |   1407536 |  1306838 | 455   |          396 | 59    | 13   |    68 |   126 | *    | *   |   17 |   21 | *    | *    |
| 20   | Odisha           |  34970562 |  8994967 | 8193  |         6688 | 1505  | 18   |  1315 |  1280 | 35   | 3   |  328 |  370 | *    | *    |
| 21   | Punjab           |  17344192 |        0 | 3468  |         2950 | 518   | 15   |   578 |   432 | 146  | 25  |  144 |  151 | *    | *    |
| 22   | Rajasthan        |  51500352 |  8693123 | 11459 |        14406 | *     | *    |  1861 |  2079 | *    | *   |  465 |  579 | *    | *    |
| 23   | Sikkim           |    456999 |   167146 | 113   |          147 | *     | *    |    18 |    24 | *    | *   |    4 |    2 | 2    | 50   |
| 24   | Tamil Nadu       |  37229590 |   660280 | 7533  |         8712 | *     | *    |  1251 |  1362 | *    | *   |  312 |  385 | *    | *    |
| 25   | Telangana        |  21585313 |  2939027 | 4708  |         4797 | *     | *    |   768 |   689 | 79   | 10  |  192 |  114 | 78   | 41   |
| 26   | Tripura          |   2712464 |  1117566 | 691   |          987 | *     | *    |   109 |    93 | 16   | 15  |   27 |   21 | 6    | 22   |
| 27   | Uttarakhand      |   7036954 |   264819 | 1442  |         1847 | *     | *    |   238 |   257 | *    | *   |   59 |   60 | *    | *    |
| 28   | Uttar Pradesh    | 155317278 |  1031076 | 31200 |        20521 | 10679 | 34   |  5194 |  3621 | 1573 | 30  | 1298 |  822 | 476  | 37   |
| 29   | West Bengal      |  62183113 |  4855115 | 13083 |        10369 | 2714  | 21   |  2153 |   914 | 1239 | 58  |  538 |  349 | 189  | 35   |
| 30   | A & N Islands    |    237093 |    26715 | 50    |          123 | *     | *    |     8 |    22 | *    | *   |    2 |    4 | *    | *    |
| 31   | Chandigarh       |     28991 |        0 | 5     |           17 | *     | *    |     0 |     3 | *    | *   |    0 |    2 | *    | *    |
| 32   | D & N Haveli     |    183114 |   150944 | 56    |           71 | - 15  | - 27 |     8 |     9 | *    | *   |    2 |    2 | 0    | 0    |
| 33   | Daman & Diu      |     60396 |     7617 | 13    |           26 | *     | *    |     2 |     4 | *    | *   |    0 |    2 | *    | *    |
| 34   | Delhi            |    419042 |        0 | 83    |           10 | 73    | 88   |    13 |     5 | 8    | 62  |    3 |    0 | 3    | 100  |
| 35   | Lakshadweep      |     14141 |    13463 | 4     |           14 | *     | *    |     0 |     4 | *    | *   |    0 |    3 | *    | *    |
| 36   | Puducherry       |    395200 |        0 | 79    |           81 | *     | *    |    13 |    40 | *    | *   |    3 |    4 | *    | *    |
|      | All India/ Total | 833748852 | 93819162 |       | 179240156231 | 34946 | 19   | 29337 | 25650 | 6409 | 22  | 7322 | 5624 | 2168 | 30   |

Notes: The requirement is calculated using the prescribed norms on the basis of rural population from Censu 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

## Roles and Responsibilities of an ASHA

The  roles  and  responsibilities  of  an  ASHA  include  the  functions  of  a  healthcare facilitator,  a  service  provider  and  a  health  activist.  Broadly  her  functions  involve  providing preventive,  promotive  and  basic  curative  care  in  a  role  complementary  to  other  health functionaries; educating and mobilizing communities particularly those belonging to marginalized  communities,  for  adopting  behaviours  related  to  better  health  and  create awareness on social determinants, enhancing better utilization of health services; participation in health campaigns and enabling people to claim health entitlements.

Her roles and responsibilities would be as follows:

- ASHA will take steps to create awareness and provide information to the community on determinants of health such as nutrition, basic sanitation and hygienic practices, healthy living and working conditions, information on existing health services and the need for timely use of health services.
- She will counsel women and families on birth preparedness, importance of safe delivery, breastfeeding and complementary feeding, immunization, contraception and prevention of common  infections  including Reproductive  Tract Infection/Sexually Transmitted Infection (RTIs/STIs) and care of the young child.
- ASHA will mobilize the community and facilitate people's access to health and health related  services  available  at  the  village/sub-centre/primary  health  centres,  such  as Immunization, Ante Natal Check-up (ANC), Post Natal Check-up (PNC), ICDS, sanitation and other services being provided by the government.
- She will work with the Village Health, Sanitation and Nutrition Committee to develop a comprehensive village health plan, and promote convergent action by the committee on social determinants of health. In support with VHSNC, ASHAs will assist and mobilize the community for action against gender based violence.
- She  will  arrange  escort/accompany  pregnant  women  &  children  requiring  treatment/ admission to the nearest preidentified health facility i.e. Primary Health Centre/Community Health Centre/First Referral Unit (PHC/CHC/FRU).
- ASHA will provide community level curative care for minor ailments such as diarrhoea, fevers, care for the normal and sick newborn, childhood illnesses and first aid. She will be  a  provider  of  Directly  Observed  Treatment  Short-course  (DOTS)  under  Revised National  Tuberculosis  Control  Programme.  She  will  also  act  as  a  depot  holder  for essential  health  products  appropriate  to  local  community  needs.  A  Drug  Kit  will  be provided to each ASHA. Contents of the kit will be based on the recommendations of the expert/technical advisory group set up by the Government of India. These will be updated from time to time, States can add to the list as appropriate.
- The ASHA's role as a care provider can be enhanced based on state needs. States can explore the  possibility  of  graded  training  to  the  ASHA  to  provide  palliative  care,

## Annexure -II

- screening for non- communicable diseases, childhood disability, mental health, geriatric care and others.
- The ASHA will provide information on about the births and deaths in her village and any unusual health problems/disease outbreaks in the community to the SubCentres/Primary  Health  Centre.  She  will  promote  construction  of  household  toilets under Total Sanitation Campaign.

The ASHA will fulfill her role through five activities:

1. Home Visits: For up to two hours every day, for at least four or five days a week, the ASHA  should  visit  the  families  living  in  her  allotted  area,  with  first  priority  being accorded to marginalized families. Home visits are intended for health promotion and preventive  care.  They  are  important  not  only  for  the  services  that  ASHA  provides  for reproductive,  maternal,  newborn  and  child  health  interventions,  but  also  for  noncommunicable diseases, disability, and mental health. The ASHA should prioritize homes where  there  is  a  pregnant  woman,  newborn,  child  below  two  years  of  age,  or  a malnourished child. Home visits to these households should take place at least once in a month. Where there is a new born in the house, a series of six visits or more becomes essential.
3. Visits to the health facility: This usually involves accompanying a pregnant woman, sick child,  or  some  member  of  the  community  needing  facility  based  care.  The  ASHA  is expected to attend the monthly review meeting held at the PHC.
2. Attending  the  Village  Health  and  Nutrition  Day  (VHND):  The  ASHA  should  promote attendance  at  the  monthly  Village  Health  and  Nutrition  Day  by  those  who  need Aganwadi or Auxiliary Nurse Midwife (ANM) services and help with counselling, health education and access to services.
4. Holding village level meeting: As a member or member secretary of the Village Health, Sanitation and Nutrition Committee (VHSNC), the ASHA is expected to help convene the monthly meeting of the VHSNC and provide leadership and guidance to its functioning. These meetings are supplemented with additional habitation level meetings if necessary, for providing health education to the community.
5. Maintain records: Maintaining records which help her in organizing her work and help her to plan better for the health of the people.