Lok Sabha Question No. 379 (STARRED), answered on 2019-12-13
Subject: Healthcare Facilities in Scheduled  Districts
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Jual Oram

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

## LOK SABHA STARRED QUESTION NO. 379 TO BE ANSWERED ON THE 13 TH DECEMBER , 2019 HEALTHCARE FACILITIE S IN SCHEDULED DISTR ICTS

## *379. SHRI JUAL ORAM:

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

- (a)  whether  the  Government  is  aware  of  the  poor  healthcare  facilities scheduled districts of the country;
- (b) if so, whether the Government proposes to sponsor any Central schem for the people of the scheduled areas of the country;
- (c) if so, the details thereof along with the time by which it will be imp and
- (d)  if  not,  the  alternative  steps  proposed  to  be  taken  by  the  Governme providing proper healthcare facilities to the people residing in such areas?

## ANSWER THE MINISTER OF HEALTH AND FAMILY WELFARE (DR. HARSH VARDHAN)

- (a) to ( d):  A statement is laid on the Table of the House

## STATEMENT REFERRED TO IN REPLY TO LOK SABHA STARRED QUESTION NO. 379* FOR 13 TH DECEMBER , 2019

(a)    Public  Health  and  Hospitals  is  a  state  subject. The status  of  healthcare facilities  in  scheduled  districts  of  the  ten  states  under  Schedule  V Constitution varies from state to state. The tribal population are scatter in large areas which are remote, difficult and hard to reach areas and t refo create challenges in accessibility to and availability of health facilit and services.

Surveys  like National  Family  Health  Survey  (NFHS)  and  District  Level Household Survey (DLHS), conducted by the Ministry give estimates inter - alia fortribal health indicators. Analysis of National Family Health Survey (NFHS) 3 (2005 - 06) and NFHS 4 (2015 - 16) data shows that health outcome indicators of tribal population have improved at faster rate than all India Indicato is due to focused inter ventions in tribal areas.

- IMR  for  tribal  areas  improved  by  17.7  points  where  as  for  India  i improved by 16.3 points.
- Under five Mortality in Tribal areas is improved by 38.5 points where a India is improved by 24.6 points.
- Prevalence of Anaemia in tribal women and children have reduced by 8.7 points  and  13.7  points  respectively  as  compare  to  corresponding  nati reduction figures for women 2.3 points and 11.1 points respectively.

Further,  as  per  Rural  Health  Statistics  (2018),  the  increas e  in  health facilities in Tribal areas is higher as compared to All India average 2005 and 2018, which is as below:

|                              | All India   | All India   | Tribal Areas   | Tribal Areas   |
|------------------------------|-------------|-------------|----------------|----------------|
| Type of Facility             | RHS 2005    | RHS 2018    | RHS 2005       | RHS 2018       |
| CHCs                         | 3222        | 5624        | 643            | 1017           |
| PHCs                         | 23109       | 25743       | 2809           | 3971           |
| SCs                          | 142655      | 158417      | 16748          | 28091          |
| Total                        | 168986      | 189784      | 20200          | 33079          |
| Increase in Total facilities | 12.30%      | 12.30%      | 63.75%         | 63.75%         |

(b)to  (d)  Public  Health  and  Hospitals  being  a  State  Subject,  the  pri responsibility of ensuring healthcare facilities all over the country including Scheduled Districts is that of respective State Governments. Moreover, u National  Health  Mission  (NHM),  support  is  provided  to  the  States  /UTs strengthen their health care systems based on the proposals received fro States so as to p rovide universal  access to  equitable,  affordable  and  quali health care services all over the country including in Scheduled Districts Support  is  also  provided  for provision  of  a  host  of  free services related  to maternal  health,  child  health,  adolescent health,  family  planning,  universal immunisation programme, and for major diseases such as Tuberculosis, HIV AIDS, vector borne diseases like Malaria, Dengue and Kala Azar, Leprosy et Other major initiatives supported include Janani Shishu Suraksha Karyakram (JSSK)  (under  which  free  drugs,  free  diagnostics,  free  blood  and  diet, transport from home to institution, between facilities in case of a refe drop  back  home  is  provided),  Rashtriya  Bal  Swasthya  Karyakram  (RBSK) (which provides newb orn and child health screening and early intervention services free of cost for birth defects, diseases, deficiencies and devel delays to improve the quality of survival), implementation of Free Drugs Free  Diagnostics  Service  Initiatives,  etc. Mobile  Medical  Units  (MMUs)  & National Emergency Transport are also being implemented with NHM support to improve healthcare access particularly in rural areas.

- In addition to the above, under NHM, tribal areas enjoy relaxed norms as u
- i. Norms for health facilities - The population norms for setting up Health Facilities  in  tribal  areas  are  relaxed.  Against  the  population  no 5000, 30000, and 1,20,000 for setting up of Sub Centre, PHC and CHC respectively, in tribal areas its 3000, 20,0 00 and 80, 0000.
- ii. States have been provided with the flexibility of relaxing the norm o ASHA per 1000 population to one ASHA per habitation in Tribal/hill and difficult areas.
- iii. While  other  States  can  have  Mobile  Medical  Units  per  10  lakh populations subject to capping of 5 MMUs per district, for tribal and h states this could be relaxed as per need. The norms for MMU have be revised with one additional MMU where existing MMU is exceeding 60 patients per day in plain areas and 30 patients per day in tribal/hilly areas.
- iv. In addition, all tribal majority districts whose composite health index i the State average have been identified as High Priority Districts (HPDs). districts  are  to  receive  higher  per  capita  funding,  enhanced  monitorin g  and focussed supportive supervision, and encouraged to adopt innovativ approaches to address their peculiar health challenges.
- ****