Lok Sabha Question No. 3342 (UNSTARRED), answered on 2019-07-12
Subject: Health Indicators in Tribal Areas
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Sanjay Jaiswal

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

## LOK SABHA UNSTARRED QUESTION NO. 3342 TO BE ANSWERED ON 12 TH JULY, 2019 HEALTH INDICATORS IN TRIBAL AREAS

## 3342. DR. SANJAY JAISWAL:

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

- (a) whether the Government has taken note of the relatively weak health indicators among the tribal communities in the country; and
- (b) if so, the details thereof along with the steps being taken by the Gove rnment to address the issue?

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

- (a) & (b)An Expert Committee on Tribal Health was constituted jointly by the Ministry Health & Family Welfare and the Ministry of Tribal Affairs which submitted its report to the Ministry. The Report is available in public domain at https:// nhm.gov.in/New\_Updates\_2018/NHM\_Components/Health\_System\_Stregthening/tribal \_health/Tribal - Health - Report.pdf .The status of Tribal Health has been summarized in the report as under:

'Tribal people have the poorest health status and they carry a triple burden of disease. Moreover,  despite  the  high  reliance  of  the  tribal  people  on  the  public  health  care  s Scheduled Areas, it continues to be characterized by low output, low quali ty and low outcome delivery system, often targeting wrong priorities.

An important reason behind this is the near complete absence of community participa in  the  planning,  design  and  implementation  of  health  services.  Therefore,  restructuri stren gthening of the public health care system, in accordance with the needs and aspirat the tribal communities, and with their full participation, should be the highest prior Ministries of Health and Family Welfare, both at the Centre and in the states'.

Public Health & Hospitals' being a State subject, the primary responsibility of provision of healthcare to all including tribal population is that of respective State Government.

However, under the National Health Mission (NHM), financial an d technical support is provided to States/UTs to strengthen their health care systems including for setting up/u public health facilities, augmenting health human resource on contractual basis for prov equitable, affordable healthcare to al l its citizens particularly the poor and vulnerable populat including  tribal  population  based  on  requirements  posed  by  the  States  in  their  Prog Implementation Plans (PIPs).

Under  NHM,  tribal  areas  already  enjoy  relaxed  norms  for  setting  up  public health facilities including 'time to care' norm for setting up sub health Centres in tribal areas within 30 minutes of walk from habitation and relaxed norm for Mobile Medical Units for tribal a extra one MMU if it exceeds 30 patients per day against 60 patients per day in plain areas for bringing healthcare delivery to the doorsteps of the population.

Further,  all  tribal  majority  districts  whose  composite  health  index  is  below  th average have been identified as High Priority Districts (HPDs) and these districts receive more resources per capita under the NHM as compared to the rest of the districts in the Stat districts receive higher  per capita funding, have enhanced monitoring and focused supp supervision and are encouraged to adopt innovative approaches to address their peculiar health challenges.

The  Allocation  of  funds  under  Scheduled  Tribal  Sub - Plan  in  respect  of  major  health schemes/ programme during 2016 - 7 to 2018 - 19 are at Annexure -I to Annexure -III.

As per Rural Health Statistics the change in health facilities in Tribal areas versus A between 2005 and 2018 is given as below:

| Facilities   |   All India |   All India |   Tribal Areas |   Tribal Areas |
|--------------|-------------|-------------|----------------|----------------|
|              |     2005    |     2018    |        2005    |        2018    |
| CHCs         |     3346    |     5624    |         643    |        1017    |
| PHCs         |    23236    |    25743    |        2809    |        3971    |
| SCs          |   146026    |   158417    |       16748    |       28091    |
| Total        |   172608    |   189784    |       20200    |       33079    |
| % increase   |        9.95 |        9.95 |          63.75 |          63.75 |

## Allocation of funds under Scheduled Tribal Sub - Plan in respect of major health schemes/programme during 2016 - 17  (Rs in Crores)

| No.   | Name of Scheme                                                                              | STC             |
|-------|---------------------------------------------------------------------------------------------|-----------------|
| A.    | National Mental Health Programme (NMHP)                                                     | 4.12            |
| B.    | Trauma Centres                                                                              | 22.16           |
| C.    | National Programme for Prevention and Control of Cardiovascular Disease and Stroke (NPCDCS) | Diabetes, 30.58 |
| D.    | National Programme for Health Care for the Elderly                                          | (NPHCE) 2.50    |
| E.    | Human Resources for Health                                                                  | 65.93           |
| F.    | NRHM -RCH Flexi Pool                                                                        | 1328.16         |
| G.    | National Urban Health Mission - Flexi Pool                                                  | 109.18          |
| H.    | Flexible Pool for Communicable Diseases                                                     | 138.36          |
| I.    | Flexible Pool for Non - Communicable Diseases, Injury Trauma                                | & 62.16         |
| J.    | Infrastructure Maintenance                                                                  | 596.54          |
| K.    | Rashtriya Swasthya SuraksPha Yojana                                                         | 212.50          |
|       | TOTAL                                                                                       | 2572.19         |

Source :

-Annual Report 2016 - 17 MoH&FW

## Annexure - II

## Allocation of funds under Scheduled Tribal Sub - Plan in respect of major health schemes/ program during 2017 - 18  (Rs in Crores)

| Sl. No.   | Name of Scheme                                                                                                                                    | TSP               |
|-----------|---------------------------------------------------------------------------------------------------------------------------------------------------|-------------------|
| A         | National Rural Health Mission                                                                                                                     |                   |
| 1         | RCH Flexible Pool including Routine Immunization Programme, Pulse Polio on Programme, National Iodine Deficiency Disorders Control Pr gramme etc. | Immunizati 483.22 |
| 2         | Health Systems Strengthening under NRHM                                                                                                           | 932.16            |
| 3         | Flexible Pool for Communicable Diseases                                                                                                           | 179.56            |
| 4         | Flexible Pool for Non - Communicable Diseases, Injury and Trauma                                                                                  | 110.66            |
| 5         | Infrastructure Maintenance                                                                                                                        | 589.51            |
| 6         | Prime Minister's Development Plan for Jammu and Kashmir                                                                                           | 37.17             |
|           | Total National Rural Health Mission                                                                                                               | 2332.28           |
| B         | National Urban Health Mission                                                                                                                     | 24.15             |
| C         | National Health Protection Scheme                                                                                                                 | 107.40            |
| D         | Tertiary Care Programme                                                                                                                           |                   |
| 1         | National Mental Health Programme                                                                                                                  | 4.12              |
| 2         | Capacity Building for Trauma Centres                                                                                                              | 20.42             |
| 3         | National Programme for Prevention and Control of Cancer, Diabetes, Cardio - Vascular D isease and Stroke                                          | 27.92             |
| 4         | National Programme for Health Care for Elderly                                                                                                    | 6.12              |
|           | Total -Tertiary Care Programme                                                                                                                    | 58.58             |
| E         | Human Resources for Health and Medical Education                                                                                                  |                   |
| 1         | Strengthening Government Medical Colleges(UG Seats) and Central Govt Health ons                                                                   | 51.55             |
| 2         | Establishing New Medical Colleges (Upgrading District Hospitals)                                                                                  | 398.90            |
|           | Total - Human Resources for Health and Medical Education                                                                                          | 450.45            |
|           | Grand Total                                                                                                                                       | 2972.86           |

Source : -Annual Report 2017 - 18 MoH&FW

## Annexure - III

## Allocation of funds under Scheduled Tribal Sub - Plan in respect of major health schemes/programme during 2018 - 19  (Rs in Crores)

(Rs. in Crores)

| Sl. No.   | Details of the Schemes                                                                                                                                       | ST Allocation 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. | 776.20                   |
| 2         | Health System Strengthening under NRHM                                                                                                                       | 1073.54                  |
| 3         | Flexible Pool for Communicable Diseases                                                                                                                      | 204.14                   |
| 4         | Flexible Pool for Non - Communicable Diseases, Injury and Trauma                                                                                             | 51.02                    |
| 5         | Infrastructure Maintenance                                                                                                                                   | 718.69                   |
| 6         | Forward Linkages                                                                                                                                             | 0.00                     |
| 7         | Strengthening of State Drug Regulatory System                                                                                                                | 22.24                    |
| 8         | Other Health Schemes (PILOT)                                                                                                                                 | 0.00                     |
| 9         | Prime Minister's Development Plan for Jammu and Kashmir                                                                                                      | 32.59                    |
| 10        | Strengthening of National Programme Management of the NHM                                                                                                    | 0.00                     |
| 11        | ASHA Benefits Packages                                                                                                                                       | 51.77                    |
|           | Total-National Rural Health Mission                                                                                                                          | 2930.19                  |
| B         | National Urban Health Mission                                                                                                                                | 26.33                    |
| C         | Tertiary Care Programme                                                                                                                                      |                          |
| 1         | National Mental Health Programme                                                                                                                             |                          |
| 2         | Capacity Building for Trauma Centres                                                                                                                         |                          |
| 3         | National Programme for prevention and control of Cancer, Cardio - vascular Disease and Stroke                                                                | Diabetes, 14.95          |
| 4         | National Programme for Health Care for the Elderly                                                                                                           |                          |
| 5         | National Programme for Control of Blindness                                                                                                                  |                          |
| 6         | Tobacco Control Programme & Drug De-addiction Programme                                                                                                      |                          |
| 7         | Telemedicine                                                                                                                                                 |                          |
|           | Total-Tertiary Care Programme                                                                                                                                | 14.95                    |
| D         | 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 Seats)                                                    | (PG           |
|-----|----------------------------------------------------------------------------------------------------------------------------|---------------|
| 4   | Strengthening Government Medical College (UG Seats) and Government Health Institutions                                     | Central 85.76 |
| 5   | Establishing New Medical Colleges (Upgrading District Hospitals)                                                           | 299.29        |
| 6   | Setting up State Institutions of Para - Medic l Sciences in States and Setting up of Colleges of Para - Medical Education. | 0.00          |
|     | Total-Human Resources for Health and Medical Education                                                                     | 385.05        |
|     | Total-NationalHealth Mission                                                                                               | 3356.52       |
| E   | Rashtriya Swasthya Bima Yojna (RSBY)                                                                                       |               |
| 1   | Support from Gross Budgetary                                                                                               | 25.80         |
| 2   | Support from National Investment                                                                                           | 0.00          |
|     | Total Rashtriya Swasthya Bima Yojna (RSBY)                                                                                 | 25.80         |
|     | Grand Total                                                                                                                | 3382.32       |

Source- Budget Division MoH& FW