Lok Sabha Question No. 4335 (UNSTARRED), answered on 2019-12-13
Subject: National Rural Health Mission
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Ajay Nishad

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

## LOK SABHA UNSTARRED QUESTION NO. 4335 TO BE ANSWERED ON 13 TH DECEMBER, 2019

## NATIONAL RURAL HEALT H MISSION

## †4335. SHRI AJAY NISHAD:

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

(a) the present status of implementation of National Rural Health Mission in the country;

(b) whether the Government is aware of the non - availability of essential medicines, diagnostic tests and als medicalequipments remaining out of order in many Government hospitals of the country;

(c) if so, the details thereof and the corrective measures taken in this regard;

(d) whether the Government has reviewed the progress and implementation of medical facilities/schemes/programmes under the National Rural Health Mission recently in various States; and

(e)  if  so,  the  outcome  thereof  and  the corrective  measures  taken  by  the Government  to  remove  the shortcomings?

## ANSWER

## THE MINISTER OF STATE IN THE MINIST RY OF HEALTH AND FAMILY WELFARE

## (SHRI ASHWINI KUMAR CHOUBEY)

(a) The National Rural Health Mission (NRHM) is a sub - mission under the overarching National Healt Mission,  (NHM)  along  with  National  Urban  Health  Mission  (NUHM)  as  the  other  sub - mission.  It  is implemented in all the States/UTs in the country .

Statements  showing  physical  achievements  and  outcomes  under  NHM  are  given  at  Annexure -I  and  II respectively.

(b) & (c) 'Public Health and Hospitals' being a State subject, the primary responsibility of  en suring availability of essential medicines, diagnostic tests and medical equipments in public heal with  the  respective  State  Governments.  To  ensure  availability  of  essential  drugs,  diagnos Equipment  and  reduce  the  Out  of  Pock et  Expenditure  (OOPE)  of  the  patients  visiting  the  public facilities,  Government  has  rolled  out  the  Free  Drugs  Service  Initiative  (FDSI),  Free  Diagn Initiative and Bio - Medical Equipment Management and Maintenance Programme (BMMP) under NHM.

Under  NHM,  technical  and  financial  support  is  provided  to  States  /  UTs  for  provision  of  f medicines,  free  essential  diagnostics  and  medical  equipment  in  public  health  facilities requirements posted by them in their Programme Implementation Plans (PIPs) within their overall reso envelope. This support also includes, support for strengthening/setting up robust systems o quality  assurance  mechanism,  warehousing,  prescription  audit,  grievance  redressal,  disse ation  of Standard Treatment Guidelines, and IT backed supply chain management systems like Drugs and Distribution Management Systems (DVDMS).

A ll States/ UTs have reported that they have notified this policy to provide free essential m public health  facilities. The  Ministry  has  also  provided  illustrative  list  of  essential  medicines  tha provided at Sub Centres, Primary Health Centres, Community Health Centres and District Hospita

DVDMS is a web-based Supply Chain Management System that deals in purchase, supply, distributio inventory management of various drugs, sutures, surgical and consumable items. It has an in - built provision of monitoring and checking the availability of medicine at all facilities at district and st ate level. DVDMS links  various  Regional/  District  Drug  Warehouses  (DWH),  District  Hospitals  (DH),  their  sub Community Health Centres (CHC) and Primary Health Centres (PHC). Moreover, it has the function distribution of drugs to patient s, thus enabling tracking of consumption till last mile.

Under Free Diagnostics Service Initiative, a Guidance Note has been shared with States/ UT, wh an expanded list of essential diagnostics tests specific to various levels of care that incl ude 14 tests at Sub Centre level, 63 tests at PHC level, 97 tests at CHC level, 111 tests at SDH level and 134 te The tests encompass hematology, serology, bio - chemistry, clinical pathology, microbiology, radiology cardiology.

Compreh ensive guidelines of BMMP have been linked with uptime of equipment (95% in District H 90% in Community Health Centres and 80% in Primary Health Centres). The technical manual for implementation in In - house and PPP mode is released in August 2 019, which provides details on planning monitoring, SOPs for Inventory management, protocols & training components for effective pla execution of BMMP. 30 States/ UTs have reported implementation of BMMP.

In addition to this Ayushman Bharat proga mme, 1.5 lakh Sub Health Centres and Primary Health Centr across the country are being transformed into Health and Wellness Centres (AB - HWC) by December 2022 for provision of comprehensive primary care that includes preventive healthcare and health pr tion at the community level with continuum of care approach.

All these Ayushman Bharat -Health & Wellness Centres (AB - HWCs) have the provision of free essentia medicines and   diagnostics to the visiting patients.

(d) & (e) The working  of  National  Health  Mission  (NHM)  has  been  regularly  assessed,  int - alia, through external surveys such as, National Family Health Survey (NFHS) and Sample Registrati (SRS). Further, Common Review Missions (CRMs) also undertake a review o f NHM annually. The details of various reports of CRM are available in public domain https://nhm.gov.in/index1.php?lang=1&level=1&sublinkid=795&lid=195

Further, under N ational Health Mission (NHM), the performance of various health programmes is regularly  assessed,  through  regular  review  meetings,  video  conferences  &  field  visits  of  s promoting performance by setting up benchmarks for service delive ry & rewarding achievements etc.

At village level, Village Health Sanitation & Nutrition Committee (VHSNC) is constituted whi under  the  ambit  of  the  Panchayati  Raj  Institution  (PRI)  and  acts  as  a  sub - Committee or  a  Standing Committee  of  the  Gra m  Panchyat,  to  enable  communities  to  take  collective  action  for  the  atta better health status in the village. A similar mechanism in urban areas is the Mahila Arogya Untied funds are provided to the VHSNC and MAS on an annual basis t o undertake their functions.

Similarly, at health facility level, Rogi Kalyan Samitis (RKSs) are envisaged to act as a fo the functioning and service provisioning, increase participation and enhance accountability, better fac ilities to the patients at the level of Primary Health Centres and above.

( As on June 2019)*

| S.N   | State/UT          |   Health Human Resources Augmentation |   Functional FRUs (First Referral Units) |   Mobile Medical Units (MMUs) |   Ambulances (Operational) |   Accredited Social Health Activists (ASHAs) |   No of PHCs working on 24X7 basis |   Setting up RogiKalyanSa mitis |   Village Health Sanitation and Nutrition Committees constituted |
|-------|-------------------|---------------------------------------|------------------------------------------|-------------------------------|----------------------------|----------------------------------------------|------------------------------------|---------------------------------|------------------------------------------------------------------|
| 1     | Bihar             |                                 13570 |                                       68 |                             6 |                       1102 |                                        88791 |                                496 |                            2003 |                                                             8406 |
| 2     | Chhattisgarh      |                                  6021 |                                       37 |                            30 |                        590 |                                        69515 |                                247 |                             999 |                                                            19180 |
| 3     | Himachal Pradesh  |                                   819 |                                       16 |                             3 |                        323 |                                        32376 |                                 81 |                             667 |                                                             7790 |
| 4     | Jammu & Kashmir   |                                  7463 |                                       55 |                            11 |                        331 |                                        12355 |                                204 |                             795 |                                                             6741 |
| 5     | Jharkhand         |                                  8001 |                                       63 |                            92 |                       2120 |                                        41312 |                                114 |                             582 |                                                            30012 |
| 6     | Madhya Pradesh    |                                 10671 |                                      148 |                           150 |                       1358 |                                        77018 |                                754 |                            1617 |                                                            49567 |
| 7     | Odisha            |                                  9228 |                                       64 |                             8 |                       1004 |                                        46566 |                                117 |                            1795 |                                                            46060 |
| 8     | Rajasthan         |                                  8787 |                                       82 |                           214 |                       1353 |                                        63972 |                                982 |                            3008 |                                                            43440 |
| 9     | Uttar Pradesh     |                                 32687 |                                      334 |                           134 |                       4008 |                                       162959 |                                439 |                            1710 |                                                            69580 |
| 10    | Uttarakhand       |                                  2070 |                                       50 |                             5 |                        234 |                                        12212 |                                 87 |                             330 |                                                            15296 |
| 11    | Arunachal Pradesh |                                  1531 |                                       13 |                            16 |                        149 |                                         3880 |                                 64 |                             228 |                                                             3772 |
| 12    | Assam             |                                 15386 |                                       73 |                           130 |                        938 |                                        32256 |                                314 |                            1221 |                                                            27673 |
| 13    | Manipur           |                                  1528 |                                        7 |                             9 |                         43 |                                         4090 |                                 66 |                             126 |                                                             3878 |
| 14    | Meghalaya         |                                  1693 |                                        8 |                             4 |                         43 |                                         6697 |                                 61 |                             150 |                                                             6249 |
| 15    | Mizoram           |                                  1073 |                                        9 |                             9 |                         60 |                                         1170 |                                 41 |                              85 |                                                              830 |
| 16    | Nagaland          |                                   936 |                                       16 |                            11 |                         82 |                                         1992 |                                 33 |                             167 |                                                             1346 |
| 17    | Sikkim            |                                   299 |                                        3 |                             4 |                          9 |                                          656 |                                 24 |                              30 |                                                              641 |
| 18    | Tripura           |                                   497 |                                       11 |                             0 |                          0 |                                         8044 |                                 84 |                             153 |                                                             1038 |
| 19    | Andhra Pradesh    |                                  9524 |                                      240 |                            52 |                        439 |                                        42346 |                                596 |                            1385 |                                                            12940 |
| 20    | Goa               |                                   428 |                                        2 |                             0 |                         51 |                                            0 |                                 13 |                              36 |                                                              247 |
| 21    | Gujarat           |                                 11871 |                                      132 |                            74 |                        587 |                                        45092 |                                314 |                            2200 |                                                            17644 |
| 22    | Haryana           |                                  8500 |                                       36 |                            12 |                        363 |                                        20025 |                                251 |                             640 |                                                             6049 |
| 23    | Karnataka         |                                 12085 |                                      164 |                            70 |                        911 |                                        43458 |                               1006 |                            2930 |                                                            26087 |
| 24    | Kerala            |                                  4638 |                                       87 |                            29 |                         43 |                                        30042 |                                171 |                            1296 |                                                            19692 |
| 25    | Maharashtra       |                                 20645 |                                      219 |                            50 |                       3611 |                                        70285 |                                704 |                            3535 |                                                            39788 |
| 26    | Punjab            |                                  5351 |                                      205 |                            33 |                        242 |                                        21436 |                                211 |                             670 |                                                            12956 |
| 27    | Tamil Nadu        |                                 23543 |                                      569 |                           415 |                        936 |                                         3905 |                               1315 |                            2586 |                                                            15015 |
| 28    | Telangana         |                                 13260 |                                      156 |                             0 |                        632 |                                        32575 |                                314 |                            1074 |                                                            10426 |
| 29    | West Bengal       |                                 15600 |                                      143 |                            49 |                       3616 |                                        61471 |                                234 |                            1223 |                                                            46862 |
| 30    | A & N Islands     |                                   328 |                                        1 |                             0 |                          1 |                                          422 |                                 20 |                              29 |                                                              275 |
| 31    | Chandigarh        |                                   479 |                                        4 |                             0 |                         15 |                                           32 |                                  0 |                               5 |                                                                0 |
| 32    | D & N Haveli      |                                   310 |                                        2 |                             1 |                          0 |                                          539 |                                  7 |                               6 |                                                               61 |
| 33    | Daman & Diu       |                                   122 |                                        2 |                             0 |                         11 |                                          124 |                                  2 |                               6 |                                                               28 |
| 34    | Delhi             |                                  1670 |                                       32 |                             2 |                        234 |                                         5781 |                                  0 |                              34 |                                                                0 |
| 35    | Lakshadweep       |                                   220 |                                        2 |                             0 |                          0 |                                          110 |                                  4 |                               9 |                                                                9 |
| 36    | Puducherry        |                                   467 |                                        4 |                             4 |                         11 |                                          206 |                                 23 |                              48 |                                                              100 |
| TOTAL | TOTAL             |                                251301 |                                     3057 |                          1627 |                      25450 |                                      1043710 |                               9393 |                           33378 |                                                           549678 |

The outcomes achieved under the NHM are:

- Decline in the Maternal Mortality Ratio (MMR) to 122 during 2015-17 from 130during 2014-16;
- Decline in the Infant Mortality Rate (IMR) to 33 in 2017 as compared to 42 in 2012.
- Decline in the Under 5 Mortality Rate (U5MR) to 37 in 2017 from 52 in 2012.
- Decline in the Total Fertility Rate (TFR) to 2.2 in 2017.

(State/UT  wise  details  of  CBR,  CDR,  MMR,  IMR,  U5MR  and  TFR  is enclosed)

Further various diseases-related health indicators have also shown improvement, such as:

- Annual Parasite Incidence (API) of Malaria Cases has declined to 0.02 in 2019 from 1.10 in 2011.
- The  incidence  of  Tuberculosis  (TB)  per  1  lakh  population  has  been reduced to 204 in 2017, from 234 in 2012.
- The target of prevalence of leprosy <1/one lakh population has been achieved nationally.
- At  the  end  of  November  2019,  92% Kala-azar  endemic  blocks  have achieved  the  elimination  target  of  <1  Kala  Aazar  case  per  10,000 population at block level.
- The prevalence of tobacco use has reduced by six percentage points from 34.6% (2009-10) to 28.6% (2016-17) as per Global Adult Tobacco Survey (GATS-2)]

## Statement showing State/UTs wise Details of IMR, U5MR and TFR

|         |                   | SRS 2017         | SRS 2017         | SRS 2017              | SRS 2017                  | SRS 2017               | SRS 2017             |
|---------|-------------------|------------------|------------------|-----------------------|---------------------------|------------------------|----------------------|
| Sl. No. | States            | Crude Birth Rate | Crude Death Rate | Infant Mortality Rate | Neo -natal Mortality Rate | Under 5 Mortality Rate | Total Fertility Rate |
|         | ALL INDIA         | 20.2             | 6.3              | 33                    | 23                        | 37                     | 2.2                  |
| 1       | Andhra Pradesh    | 16.2             | 7.2              | 32                    | 23                        | 35                     | 1.6                  |
| 2       | Assam             | 21.2             | 6.5              | 44                    | 22                        | 48                     | 2.3                  |
| 3       | Bihar             | 26. 4            | 5.8              | 35                    | 28                        | 41                     | 3.2                  |
| 4       | Chhattisgarh      | 22. 7            | 7.5              | 38                    | 26                        | 47                     | 2.4                  |
| 5       | Gujarat           | 19.9             | 6.2              | 30                    | 21                        | 33                     | 2.2                  |
| 6       | Haryana           | 20.5             | 5.8              | 30                    | 21                        | 35                     | 2.2                  |
| 7       | Jharkhand         | 22.7             | 5.5              | 29                    | 20                        | 34                     | 2.5                  |
| 8       | Karnataka         | 17.4             | 6.5              | 25                    | 18                        | 28                     | 1.7                  |
| 9       | Kerala            | 14.2             | 6.8              | 10                    | 5                         | 12                     | 1.7                  |
| 10      | Madhya Pradesh    | 24.8             | 6.8              | 47                    | 33                        | 55                     | 2.7                  |
| 11      | Maharashtra       | 15.7             | 5.7              | 19                    | 13                        | 21                     | 1.7                  |
| 12      | Odisha            | 18.3             | 7.4              | 41                    | 32                        | 47                     | 1.9                  |
| 13      | Punjab            | 14.9             | 7.0              | 21                    | 13                        | 24                     | 1.6                  |
| 14      | Rajasthan         | 24.1             | 6.0              | 38                    | 27                        | 43                     | 2.6                  |
| 15      | Tamil Nadu        | 14.9             | 6.7              | 16                    | 11                        | 19                     | 1.6                  |
| 16      | Telangana         | 17.2             | 6.6              | 29                    | 20                        | 32                     | 1.7                  |
| 17      | Uttar Pradesh     | 25.9             | 6.7              | 41                    | 30                        | 46                     | 3.0                  |
| 18      | West Bengal       | 15.2             | 5.8              | 24                    | 17                        | 26                     | 1.6                  |
| 19      | Arunachal Pradesh | 18.3             | 6.1              | 42                    | ..                        | ..                     | ..                   |
| 20      | Delhi             | 15.2             | 3.7              | 16                    | 14                        | 21                     | 1.5                  |
| 21      | Goa               | 12.5             | 6.2              | 9                     | ..                        | ..                     | ..                   |
| 22      | Himachal Pradesh  | 15.8             | 6. 6             | 22                    | 14                        | 25                     | 1.6                  |
| 23      | Jammu & Kashmir   | 15.4             | 4.8              | 23                    | 17                        | 24                     | 1.6                  |
| 24      | Manipur           | 14.6             | 5.3              | 12                    | ..                        | ..                     | ..                   |
| 25      | Meghalaya         | 22.8             | 6.1              | 39                    | ..                        | ..                     | ..                   |
| 26      | Mizoram           | 15.0             | 4.0              | 15                    | ..                        | ..                     | ..                   |
| 27      | Nagaland          | 13.5             | 3.6              | 7                     | ..                        | ..                     | ..                   |
| 28      | Sikkim            | 16.4             | 4.5              | 12                    | ..                        | ..                     | ..                   |
| 29      | Tripura           | 13.0             | 5.2              | 29                    | ..                        | ..                     | ..                   |
| 30      | Uttarakhand       | 17.3             | 6.7              | 32                    | 24                        | 35                     | 1.9                  |
| 31      | A&N Islands       | 11.4             | 5.1              | 14                    | ..                        | ..                     | ..                   |
| 32      | Chandigarh        | 13.5             | 4.5              | 14                    | ..                        | ..                     | ..                   |
| 33      | D&N Haveli        | 23.6             | 4.4              | 13                    | ..                        | ..                     | ..                   |

.. Not available, Source: SRS 2017, RGI

MATERNAL MORTALITY RATIO (per 1,00,000 live births)

| India/States   |   2015-17 * |
|----------------|-------------|
| India          |         122 |
| Andhra Pradesh |          74 |
| Assam          |         229 |
| Bihar          |         165 |
| Jharkhand      |          76 |
| Gujarat        |          87 |
| Haryana        |          98 |
| Karnataka      |          97 |
| Kerala         |          42 |
| Madhya Pradesh |         188 |
| Chhattisgarh   |         141 |
| Maharashtra    |          55 |
| Odisha         |         168 |
| Punjab         |         122 |
| Rajasthan      |         186 |
| Tamil Nadu     |          63 |
| Telangana      |          76 |
| Uttar Pradesh  |         216 |
| Uttarakhand    |          89 |
| West Bengal    |          94 |

Source : * latest available SRS (2015-17)