Lok Sabha Question No. 2005 (UNSTARRED), answered on 2019-11-29
Subject: Health Centres/District Hospitals in Rural Areas
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Ramapati Ram Tripathi

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

LOK SABHA UNSTARRED QUESTION NO. 2005 TO BE ANSWERED ON 29 TH NOVEMBER, 2019

## HEALTH CENTRES/DISTR ICT HOSPITALS IN RURAL AREAS

## 2005. DR. RAMAPATI RAM TRIPATHI:

Will the Minister of HEALTH AND FAMILY WELFARE

be pleased to state:

- (a) the process/criteria fixed by the Government to set up health centres/district hospitals in rural areas of the country,
- (b) the number of health centres/ district hospital s needed to cater to the requirement of rural population, State/UTwise;
- (c) whether the country has dearth of health centres/district hospitals, if so, the details thereof and the reasons therefor and the reformative steps taken by the Government,State/UT - wise; and
- (d) the steps taken/being taken by the Government to provide quality medical facilities at an affordable cost in the country, if so, the details thereof?

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

(SHRI ASHWINI KUMAR CHOUBEY)

- (a): Population norm is the criterion for setting up of health centres based on whi health care infrastructure in rural areas has been developed as a three tier system below:-

| Centre                                                   | Population Norms                | Population Norms                                 |
|----------------------------------------------------------|---------------------------------|--------------------------------------------------|
| Sub Centre Primary Health Centre Community Health Centre | Plain Area 5000 30,000 1,20,000 | Hilly/ Tribal/ Difficult Area 3000 20,000 80,000 |

However, as the population density in the country is not uniform, it shall also upon the case load of the facility and distance of the village/habitations which comprise the Sub- centre.A  subdivision  hospital  caters  to  about  5 - 6  lakhs  people .  As  regards  district hospital, every district is expected to have one.

(b) to (d) The number of Sub - Centres,  PHCs  and  CHCs  nee ded State/UT - wise  as  well  as those in position are as per Annexure.  The information regarding district hospital maintained centrally.

There is some shortfall in health centres vis - à- vis requirement, which is also reflected in  Annexure -I.    One  of  the  reasons  for  deficient  health  infrastructure  is  his underfunding in health sector.

Public  health  and  hospitals  being  a  State  subject,  the  primary  responsibili providingquality  medical  facilities  at  an  affordable  cost  lies  with  respective  St Governments.To address the healthcare challenges, particularly in rural areas, the Na Rural  Health  Mission  (NRHM)  was  launched  in  2005  to  supplement  the  efforts  of  th State/UT governments to provide accessible, affordable and quality healthcare to all who  access  public  health  facilities. After  National  Urban  Health  Mission  (NUHM)  was introduced in 2013, the Mission was known as National Health Mission (NHM), merging both the components.  Under NHM, technical and financial support is provided to States for strengthening their healthcare system in the form of Record of Proceeding(RoPs) on the proposals submitted by the States in their Program Implementation P lans (PIPs).

This  support  under  NHM  includes provision  of  a  host  of  free services such  as maternal  health,  child  health,  adolescent  health,  family  planning,  universal  immunis programme, and for major diseases such as Tuberculosis, HIV/ AIDS, vector borne diseases like Malaria, Dengue and Kala Azar, Leprosy etc.

Other  major  initiatives  include  Janani  Shishu  Suraksha  Karyakram  (JSSK)  (under which  free  drugs,  free  diagnostics,  free  blood  and  diet,  free  transport  from  ho institution,  between  faci lities  in  case  of  a  referral  and  drop  back  home  is  provided) Rashtriya  Bal  Swasthya  Karyakram  (RBSK)  (which  provides  newborn  and  child  health screening and early interventions services free of cost for birth defects, diseases, de and development al delays to improve the quality of survival), implementation of Free Dru and Free Diagnostics Service Initiatives, PM National Dialysis Programme and implementation of National Quality Assurance Framework.

Mobile Medical Units (MMUs) & Telemedicine ar e also being implemented with NHM support to improve healthcare access particularly in rural areas.

As  part  of  Ayushman  Bharat,  the  Government  is  supporting  the  States  fo strengthening Sub Centres and Primary Health Centres as Health and Wellness Centres (AB HWCs)  for  provision  of  comprehensive  primary  health  care  that  includes  preventive health  promotion at  the  community  level  with  continuum  of  care  approach.  Further, Ayushman  Bharat,  Pradhan  Mantri  Jan  Arogya  Yojana (AB - PMJAY)  provides  health coverage up to Rs. 5.00 lakh per family per year to around 10.74 crore poor and vuln families as per Socio Economic Caste Census (SECC).

|       | ANNEXURE               | ANNEXURE                  | ANNEXURE                  | ANNEXURE    | ANNEXURE    | ANNEXURE    | ANNEXURE    | ANNEXURE   | ANNEXURE   | ANNEXURE   | ANNEXURE   | ANNEXURE          | ANNEXURE          | ANNEXURE          | ANNEXURE          |
|-------|------------------------|---------------------------|---------------------------|-------------|-------------|-------------|-------------|------------|------------|------------|------------|-------------------|-------------------|-------------------|-------------------|
|       | State/ UT              | IN POSITION& Total        | SHORTFALL Tribal          | Sub Centres | Sub Centres | Sub Centres | Sub Centres | PHCs       | PHCs       | PHCs       | PHCs       | March, 2018) CHCs | March, 2018) CHCs | March, 2018) CHCs | March, 2018) CHCs |
| S.No. | State/ UT              | Population in Rural Areas | Population in Rural Areas | R           | P           | S           | % Shorfall  | R          | P          | S          | % Shorfall | R                 | P                 | S                 | % Shorfall        |
| 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        | 4644        | 1206        | 21          | 954        | 946        | 8          | 1          | 238               | 172               | 66                | 28                |
| 4     | Bihar                  | 92341436                  | 1270851                   | 18637       | 9949        | 8688        | 47          | 3099       | 1899       | 1200       | 39         | 774               | 150               | 624               | 81                |
| 5     | Chhattisgarh           | 19607961                  | 7231082                   | 4885        | 5200        | *           | *           | 774        | 793        | *          | *          | 193               | 169               | 24                | 12                |
| 6     | Goa                    | 551731                    | 87639                     | 122         | 214         | *           | *           | 19         | 25         | *          | *          | 4                 | 4                 | 0                 | 0                 |
| 7     | Gujarat                | 34694609                  | 8021848                   | 8008        | 9153        | *           | *           | 1290       | 1474       | *          | *          | 322               | 363               | *                 | *                 |
| 8     | Haryana                | 16509359                  | 0                         | 3301        | 2589        | 712         | 22          | 550        | 368        | 182        | 33         | 137               | 113               | 24                | 18                |
| 9     | Himachal Pradesh       | 6176050                   | 374392                    | 1285        | 2084        | *           | *           | 212        | 576        | *          | *          | 53                | 91                | *                 | *                 |
| 10    | Jammu& Kashmir         | 9108060                   | 1406833                   | 2009        | 2967        | *           | *           | 327        | 637        | *          | *          | 81                | 84                | *                 | *                 |
| 11    | Jharkhand              | 25055073                  | 7868150                   | 6060        | 3848        | 2212        | 37          | 966        | 298        | 668        | 69         | 241               | 171               | 70                | 29                |
| 12    | Karnataka              | 37469335                  | 3429791                   | 7951        | 9443        | *           | *           | 1306       | 2359       | *          | *          | 326               | 206               | 120               | 37                |
| 13    | Kerala                 | 17471135                  | 433092                    | 3551        | 5380        | *           | *           | 589        | 849        | *          | *          | 147               | 227               | *                 | *                 |
| 14    | Madhya Pradesh         | 52557404                  | 14276874                  | 12415       | 11192       | 1223        | 10          | 1989       | 1171       | 818        | 41         | 497               | 309               | 188               | 38                |
| 15    | Maharashtra            | 61556074                  | 9006077                   | 13512       | 10638       | 2874        | 21          | 2201       | 1823       | 378        | 17         | 550               | 361               | 189               | 34                |
| 16    | Manipur                | 2021640                   | 791126                    | 509         | 429         | 80          | 16          | 80         | 91         | *          | *          | 20                | 23                | *                 | *                 |
| 17    | Meghalaya              | 2371439                   | 2136891                   | 759         | 443         | 316         | 42          | 114        | 108        | 6          | 5          | 28                | 28                | 0                 | 0                 |
| 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       | 1288       | 27         | 2          | 328               | 377               | *                 | *                 |
| 21    | Punjab                 | 17344192                  | 0                         | 3468        | 2950        | 518         | 15          | 578        | 432        | 146        | 25         | 144               | 151               | *                 | *                 |
| 22    | Rajasthan              | 51500352                  | 8693123                   | 11459       | 14405       | *           | *           | 1861       | 2078       | *          | *          | 465               | 588               | *                 | *                 |
| 23    | Sikkim                 | 456999                    | 167146                    | 113         | 147         | *           | *           | 18         | 24         | *          | *          | 4                 | 2                 | 2                 | 50                |
| 24    | Tamil Nadu             | 37229590                  | 660280                    | 7533        | 8712        | *           | *           | 1251       | 1421       | *          | *          | 312               | 385               | *                 | *                 |
| 25    | Telangana              | 21585313                  | 2939027                   | 4708        | 4744        | *           | *           | 768        | 643        | 125        | 16         | 192               | 91                | 101               | 53                |
| 26    | Tripura                | 2712464                   | 1117566                   | 691         | 1020        | *           | *           | 109        | 108        | 1          | 1          | 27                | 22                | 5                 | 19                |
| 27    | Uttarakhand            | 7036954                   | 264819                    | 1442        | 1847        | *           | *           | 238        | 257        | *          | *          | 59                | 67                | *                 | *                 |
| 28    | Uttar Pradesh          | 155317278                 | 1031076                   | 31200       | 20521       | 10679       | 34          | 5194       | 3621       | 1573       | 30         | 1298              | 822               | 476               | 37                |
| 29    | West Bengal            | 62183113                  | 4855115                   | 13083       | 10357       | 2726        | 21          | 2153       | 913        | 1240       | 58         | 538               | 348               | 190               | 35                |
| 30    | A &NIslands            | 237093                    | 26715                     | 50          | 123         | *           | *           | 8          | 22         | *          | *          | 2                 | 4                 | *                 | *                 |
| 31    | Chandigarh             | 28991                     | 0                         | 5           | 17          | *           | *           | 0          | 0          | 0          | 0          | 0                 | 0                 | 0                 | 0                 |
| 32    | D &NHaveli             | 183114                    | 150944                    | 56          | 71          | *           | *           | 8          | 9          | *          | *          | 2                 | 2                 | 0                 | 0                 |
| 33    | Daman &Diu             | 60396                     | 7617                      | 13          | 26          | *           | *           | 2          | 4          | *          | *          | 0                 | 2                 | *                 | *                 |
|       |                        |                           |                           |             |             |             |             |            |            |            |            |                   |                   | 3                 | 100               |
| 34    | Delhi                  | 419042 14141              | 0                         | 83          | 12          | 71          | 86 *        | 13         | 5          | 8 *        | 62 *       | 3 0               | 0 3               | *                 | *                 |
| 35 36 | Lakshadweep Puducherry | 395200                    | 13463 0                   | 4           | 14          | *           | 32          | 0 13       | 4 24       | *          | *          | 3                 | 3                 | 0                 | 0                 |
|       | All India/ Total       | 833748852                 | 93819162                  | 79 179240   | 54 158417   | 25 32900    | 18          | 29337      | 25743      | 6430       | 22         | 7322              | 5624              | 2188              | 30                |

Notes: The requirement is calculated using the prescribed norms on the basis of rural population from Census, 2011.  All India shortfall is derived by adding state-wise figures of shortfall ignoring the existing surplus in some of the states.

R: Required; P: In Position; S: Shortfall;     *: Surplus