Lok Sabha Question No. 2961 (UNSTARRED), answered on 2018-12-28
Subject: NHM and NRHM
Ministry: HEALTH AND FAMILY WELFARE
Asked by: HEENA VIJAYKUMAR GAVIT, LALLU SINGH, SUPRIYA SADANAND SULE, ARVIND GANPAT SAWANT, AJAY NISHAD, DHANANJAY BHIMRAO MAHADIK, ABHIJIT MUKHERJEE, P.R. SUNDARAM, JAYAKUMAR JAYAVARDHAN, VIJAYSINH MOHITE PATIL

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

## LOK SABHA UNSTARRED QUESTION NO. 2961 TO BE ANSWERED ON 28 TH DECEMBER, 2018

## NHM AND NRHM

## 2961. DR. HEENA VIJAYKUMAR GAVIT:

SHRI LALLU SINGH:

SHRIMATI SUPRIYA SULE:

SHRI ARVIND SAWANT:

SHRI AJAY NISHAD:

SHRI DHANANJAY MAHADIK:

SHRI ABHIJIT MUKHERJEE:

SHRI P.R. SUNDARAM:

DR. J. JAYAVARDHAN:

SHRI MOHITE PATIL VIJAYSINH SHANKARRAO:

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

- (a)the details along with salient features and objectives of the National Rural Health Mission (NRHM)/NationalHealth Mission (NHM);
- (b) whether the Government has achieved the objectives and targets under NRHM, if so, the details thereof and if not the reas ons therefor;
- (c) whether the Government has made any assessment of progress in providing public health infrastructure after launching the NRHM/NHM and if so, the details thereof, State/UT - wise;
- (d)  whether  the  Government  has received  any  complaints  abou t  the implementation  of NRHM/NHM in various parts of the country;
- (e) if so, the details thereof and the corrective measures taken by the Government to check fraudulent  activities in  the  procurement  and  distribution  of drugs  under  NRHM/NHM  by State/UTagencies; and
- (f)  the  steps  taken  by  the  Government for  making  available  better  health  services in  the Government hospitals of rural areas?

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

## (SHRI ASHWINI KUMAR CHOUBEY)

- (a): The National Health Mission (NHM) encompasses its two Sub - Missions, the National Rural  Health  Mission  (NRHM)  and  the  National  Urban  Health  Mission  (NUHM).  NHM envisages  achievement  of  universal  access  to  equitable,  affordable  &  quality  healt services  tha t  are  accountable  and  responsive  to  people's  needs.  Under  NHM,  support  to States/UTs is provided for five key programmatic components:
- Health  Systems  Strengthening  including  infrastructure,  human  resource,  drugs equipment, ambulances, MMUs, ASHAs etc
- Reproductive, Maternal, Newborn, Child and Adolescent Health ( RMNCH + A)
- Communicable Disease sControl Programmes
- Non - Communicable Diseases Control Programme interventions upto District Hospital level
- Infrastructure Maintenance -to support sa lary of ANMs and LHVs etc .

The objectives of NHM are summarized as under:

- Reduction in child and maternal mortality
- Prevention and control of communicable and non - communicable diseases, including locally endemic diseases.
- Access to integrated comprehensive primary health care.
- Population stabilisation, gender and demographic balance.
- Revitalize local health traditions & mainstream AYUSH.
- Universal access to public services for food and nutrition, sanitation and hygie nd universal access to public health care services with emphasis on services addre women's and children's health and universal immunization.
- Promotion of healthy life styles.

(b): The  country  has  successfully  achieved  the  Millenium  Development  Goals of reduction  in  MMR  and  combating  HIV/AIDS,  Malaria  and  other  diseases  and  has  nearly achieved the MDG of reduction in under -five mortality (decline from 126 in 1990 to 43 in 2015, as against the target of 42 under MDGs). The key targets and achievements of NHM framework for Implementation (2012 - 17) are given at Annexure -I.

(c): Public health being a State subject, assessment of public health infrastructure by States. Through the State Programme Implementation Plans (PIPs), NHM has supported new  constructions  and  renovation/upgradation  of  public  health  infrastructure  as  giv Annexure-II

(d)& (e): Public  health  being  a  State  subject,  the  implementation  of  National  Hea Mission  (NHM)  is  done  by  the  States/UTs.  Therefore,  when  such complaints  regarding implementation  of  NHM/NRHM  are  received,  same  are  forwarded  to  respective  State Governments for examination and appropriate action.

To facilitate transparency in purchase of medicines and prevent stock outs/wasta medicines  in the  States,  under  NHM,  technical  and  financial  support  is  provided  to States/UTs  for  setup  of  IT  backed  Drug  Distribution  System,  Grievance  Redress mechanism and prescription audit, based on proposals received from the States/UTs in Programme Implementation Plans (PIPs) within their resource envelope.

(f): To  achieve  Universal  Healthcare  &  bring  down  Out - Of  Pocket  Private  (OOPE) expenditure the Central Government is supporting States/ UTs under NHM for provision o host of free services such as maternal health, child health, adolescent health, family planni universal  immunisation  programme,  and  for  major  diseases  such  as  Tuberculosis,  HI AIDS, vector borne diseases such as Malaria, Dengue and Kala Azar, Leprosy etc. Oth major  initiativ es  for  which  states  are  being  supported  include  Janani  Shishu  Suraks Karyakram (JSSK), Rashtriya Bal SwasthyaKaryakram (RBSK), Rashtriya Kishor Swasthya Karyakram  (RKSK),  implementation  of  NHM  Free  Drugs  and  Free  Diagnostics  Service Initiatives,  PM  Natio nal  Dialysis  Programme  and  implementation  of  National  Quality Assurance Framework.

Services

As  part  of  Ayushman  Bharat,  the  Government  is  supporting  the  States  fo strengthening Sub Centres and Primary Health Centres as Health and Wellness Centres provision of comprehensive primary care that includes preventive and health promotion at community level with continuum of care approach.

## Annexure -I

Statement showing key targets and achievement as per NHM Framework for

## Implementation

| S.no. Targets (2012 - 17)                                                | Achievements                                                                                                                                                                                      |
|--------------------------------------------------------------------------|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| 1 Reduce IMR to 25/1000 live                                             | births IMR has reduced to 34 in 2016 (SRS). Infant Mortality Rate (IMR) in India fell 61% during 1990 - 2016 in comparison to decline of 52% during same period.                                  |
| 2 Reduce MMR to 100/1,00,000 births                                      | live India has achieved the Development Goals (MDG) of Mortality Ratio (MMR) - 139 per lakh births by 2015                                                                                        |
| 3 Reduce TFR to 2.1                                                      | TFR has reduced to 2.3 in 2016 (SRS). TFR in India fell by 43% during 1990 - 2016 in comparison to global decline of 27% same period.24 States has achieved replacement level TFR of 2.1 or less. |
| 4 Reduce annual prevalence mortality from Tuberculosis                   | and by half Incidence reduced from 300 / lakh in 204/ lakh in 2017 Mortality reduced from 76/ lakh in 31/ lakh in 2017 Data Source: WHO Global TB report 2017                                     |
| 5 Reduce prevalence rate of Leprosy to <1/10000 population in districts. | all Prevalence rate of Leprosy reduced than 1/10000 population in 571 31 st March 2018.                                                                                                           |
| 6 Annual Malaria Incidence to <1/1000                                    | be Annual Malaria Incidence is 0.17 in                                                                                                                                                            |
| 7 Less than 1 per cent prevalence in all districts                       | microfilaria Out of 256 LF endemic districts, 99 have reported Mf rate less than 1% reports of 2018.                                                                                              |
| 8 case per 10000 population blocks                                       | in all Out of 633 endemic blocks 48 have elimination till 2018.                                                                                                                                   |

Millennium

Maternal the

Annexure-II Health Infrastructure under NHM

| Facility   | New Construction   | New Construction   | Renovation/Upgradation   | Renovation/Upgradation   |
|------------|--------------------|--------------------|--------------------------|--------------------------|
| Facility   | Sanctioned         | Completed          | Sanctioned               | Completed                |
| SC         | 26953              | 20610              | 15751                    | 14385                    |
| PHC        | 2518               | 2037               | 11983                    | 11117                    |
| CHC        | 555                | 346                | 6162                     | 5264                     |
| SDH        | 166                | 123                | 1048                     | 938                      |
| DH         | 139                | 97                 | 2726                     | 2195                     |
| Total      | 30331              | 23213              | 37670                    | 33899                    |

Source: NHM-MIS report as on June 2018