Lok Sabha Question No. 4314 (UNSTARRED), answered on 2019-12-13
Subject: Health Indicators and Healthcare Status of Tribal People
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Sukhbir Singh Jaunapuria

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

## LOK SABHA UNSTARRED QUESTION NO. 4314 TO BE ANSWERED ON 13 TH DECEMBER, 2019

## HEALTH INDICATORS AN D HEALTHCARE STATUS OF TRIBAL PEO PLE

## 4314. SHRI SUKHBIR SINGH JAUNAPURIA:

Will the Minister of HEALTH AND FAMILY WELFARE

be pleased to state:

- (a) whether the Government has conducted any survey to assess the health indicators and healthcare status of tribal people throughout the country;
- (b) if so, the details thereof; and
- (c)  the  number  of  Public  Health Centres  (PHCs)  and  sub - centres functioning  in  the  tribal areas and the funds allocated and utilised, State/UT - wiseparticularly in Rajasthan during the last three years and the current year?

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

- (a)& (b): No specific survey has been conducted by the Ministry for getting tribal health indicators. However surveys like National Family Health Survey (NFHS), and District Level Household Survey (DLHS), conducted by the Ministry give estimates inter -alia for tribal health indicators.
- Analysis of Nati onal Family Health Survey (NFHS) 3 (2005 - 06)and NFHS 4 (2015 - 16) data shows that health outcome indicators of tribal population have improved at fast rate than all India Indicators which is due to focused interventions in tribal areas.
- IMR for tribal areas improved by 17.7 points where as for India it is improved by 16.3 points.
- Under five Mortality in Tribal areas is improved by 38.5 points where as for Indi improved by 24.6 points.
- Prevalence of A naemia in tribal women and children have reduced by 8.7 points and 13.7 points respectively as compare to correspon dingnational reduction figures for women 2.3 points and 11.1 points respectively.

Further , in order to have all the Institutes / Centers working in the field of tri health on a single platform ,Indian Council of Medical Research ( ICMR )  has establis hed Tribal Health Research Forum (THRF), which iscommitted to prioritize research addressing specific health needs of the tribal population. Under this THRF, there a Institutes / Centers and major Divisions of ICMR under leadership of National Instit ute of Research In Tribal Health (NIRTH), Jabalpur. 10 Tribal Health Research Units (THRUs) are also functioning, with an overall mandate to improve tribal health through diagnosis and develop strategies for management in their sub - population with emphasis on various infectious diseases as well as non -communicable diseases, apart from hemoglobinopathies, nutrition and maternal and child health etc. Key Contributions National Health Research Programmes / Policies by ICMR are at Annexure -I.

- (c) : As per R ural Health Statistics 2018, state wise details of Publi c Health Centres (PHCs) and sub health centres functioning in the tribal areas is at Annexure -II.

State - wise details of Central release and expenditure under National Health Mission (NHM for last three years and current year is at Annexure -III.

## Annexure - I Key Contributions to the National Health Research Programmes / Policies by

## ICMR

- Established  facilities  for  newborn  screening  for  SCD,  prenatal  diagnosis  of  β -thalassemia  syndrome,  sickle  cell  d isorders  and  micro  mapping  of  G6PD deficiency, in Madhya Pradesh, Assam and the Andaman and Nicobar Islands. Established  Sickle  Cell  diagnostic  Clinics  in  5  tribal  districts  of  MP  an remote tribal district Baster in CG. The same is underway in 22 tri bal districts.
- Conducted regional training workshops / training of Master Trainers on diagno of  SCD  and  management- Inducted  in  19  States.  More  than  1.5  crore  tribal school children screened.
- Developed  evidence - based  malaria  intervention  model  (Dindor i)  f control  of forest  and  tribal  malaria.  The  model  up - scaled  to  make  a  model  in  malaria elimination through PPP mode in Mandla district of MP through MEDP project. Prepared 'Tribal Malaria Action Plan' as a part of NHM -Contributed to policy formulati on  for  Malaria - in - Pregnancy.  Evaluated  bivalent  malaria  rapid  kits (RDTs)  inducted  into  National  programme.  Monitoring  therapeutic  efficacy  i malaria endemic tribal regions of the country to support National programme.
- A sharp decrease in Malaria incidenc e has been shown in Car Nicobar since the Tsunami  (API  decreased  from  105  in  2005  to  <1  in  2013).  Further,  repeate surveys conducted in Car Nicobar showed a declining prevalence of pulmonary tuberculosis, which is attributed to the better socio - economic s tatus and housing brought about the post - tsunami reconstruction and rehabilitation initiatives. Als implemented a programme for elimination of lymphatic filariasis from its o focus in India viz. the Nancowry of islands. The programme has almost achiev ed its objective of bringing down the mf rate <1%.
- Among Saharias (a PVTG in India), several studies identified and reported v high TB prevalence (upto 3000 / 1,00,000). Intervention study among this tr demonstrated decline in TB prevalence and an in tensified TB control program (Research cum Intervention study) has been launched.
- Developed  universally  accepted  Nutritional  supplementation  and  safe  drinki water based intervention model for fluorosis prevention & control developed included in the National Program.
- Sickle cell anaemia is among over 1 lakh tribal population of Rajasthan has studied and a prevalence of about 10% recorded.
- Kathodi - Katkari  tribe  in  Karnataka  has  been  successfully  assessed  for  heal status of and the report / reco mmendations have been submitted to Dept of Tribal Welfare and Govt .of Karnataka, Mysuru for mitigating the ailments among the tribes.
- Regular  health  and  nutritional  surveys  have  been  carried  out  among  th accessible  indigenous  tribes  of  Andaman  and  Nicob ar  (Onges,  Andamanese, Shompens, Jarawas).
- A  project  to  eliminate  tuberculosis  from  Nicobarese  of  Car  Nicobar  an subperiodic filariasis from Nicobarese of Nancowry group of Islands are ongoi
- Various studies have been recently initiated and are current ly being undertaken, which has a direct relevance for health of tribal communities as below :
- o New  born  screening  for  sickle  cell  anaemia  has  been  initiated  in  tri populations of 6

States.

- o Understanding  tribal  culture,  lifestyle,  animal  husbandry activities  and cause  of  death  in  five  tribes  of  India  through  establishment  of  tr habitats.
- o Study on prevalence and severity of hemoglobin disorders (Hemoglobinopathies  and  G6PD  Deficiency)  and  the  measures  of  multi -morbidity  and  morbidity  burden  of  s elected  hemoglobinopathies  among tribal populations of Tamil Nadu.
- o Project to eliminate malaria from Car Nicobar.
- o Surveillance of long term sequelae of chronic heptatis B infection and reduction from Car Nicobar.
- o Double  fortified  salt  (DEC  +  Iodine) as  a  supplementary  measure  to  the ongoing  MDA  for  eliminating  a  persistent  foci  of  diurnally  sub  period Wuchereria bancrofti in nancowry group of islands.
- o Comprehensive  Health  Assessment  including  a  study  of  reproductive  tract infections among women of Lahaul & Spiti, Himachal Pradesh.
- o Lifestyle  intervention  program  on  health  seeking  behavior,  malnutrition malaria  prevention  in  Ashram  school  children  of  Dindori  district  in  Madh Pradesh.
- o Socio - economic  development  among  tribes  of  India:  Analysis  of 2001 & 2011 censuses.
- o Revitalizing  ethnomedicine  among  Baiga  of  Madhya  Pradesh - an  exploratory research.

Number of Sub Centres(SCs) & Primary Health centre (PHCs) in Tribal areas. ( Source: RHS-2018)

|    |                    | Tribal Population in   | Sub Centres   | PHCs   |
|----|--------------------|------------------------|---------------|--------|
|    |                    | Rural Areas            | P             | P      |
| 1  | Andhra Pradesh     | 2293102                | 804           | 153    |
| 2  | Arunachal Pradesh# | 789846                 | 312           | 143    |
| 3  | Assam              | 3665405                | 768           | 176    |
| 4  | Bihar              | 1270851                | NA            | NA     |
| 5  | Chhattisgarh       | 7231082                | 2811          | 396    |
| 6  | Goa                | 87639                  | 66            | 8      |
| 7  | Gujarat            | 8021848                | 2775          | 421    |
| 8  | Haryana *          | 0                      | 0             | 0      |
| 9  | HimachalPradesh    | 374392                 | 104           | 47     |
| 10 | Jammu & Kashmir    | 1406833                | 307           | 48     |
| 11 | Jharkhand          | 7868150                | 2465          | 165    |
| 12 | Karnataka          | 3429791                | 321           | 64     |
| 13 | Kerala             | 433092                 | 831           | 137    |
| 14 | Madhya Pradesh     | 14276874               | 3545          | 332    |
| 15 | Maharashtra        | 9006077                | 2057          | 315    |
| 16 | Manipur            | 791126                 | 234           | 53     |
| 17 | Meghalaya #        | 2136891                | 443           | 108    |
| 18 | Mizoram #          | 507467                 | 370           | 57     |
| 19 | Nagaland #         | 1306838                | 396           | 126    |
| 20 | Odisha             | 8994967                | 2701          | 427    |
| 21 | Punjab *           | 0                      | 0             | 0      |
| 22 | Rajasthan          | 8693123                | 1659          | 210    |
| 23 | Sikkim             | 167146                 | 48            | 12     |
| 24 | Tamil Nadu         | 660280                 | 432           | 105    |
| 25 | Telangana          | 2939027                | 698           | 93     |
| 26 | Tripura            | 1117566                | 484           | 48     |
| 27 | Uttarakhand        | 264819                 | 148           | 12     |
| 28 | Uttar Pradesh      | 1031076                | NA            | NA     |
| 29 | West Bengal        | 4855115                | 3206          | 300    |
| 30 | A&N Island         | 26715                  | 41            | 4      |
| 31 | Chandigarh *       | 0                      | 0             | 0      |
| 32 | D&N Haveli #       | 150944                 | 46            | 7      |
| 33 | Daman & Diu        | 7617                   | 5             | 0      |
| 34 | Delhi *            | 0                      | 0             | 0      |
| 35 | Lakshadweep# (2)   | 13463                  | 14            | 4      |
| 36 | Puducherry *       | 0                      | 0             | 0      |
|    | All India/Total    | 93819162               | 28091         | 3971   |

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

P: In Position;     **: Surplus,       *: State / UT has no separate Tribal Area / Population;

#:States are predominently tribal areas

2 The population is less than the norm (CHC) of 80,000.

NA -Data not available

## Annexure - III

## Statement Showing Statewise Central Release and Expenditure under National Health Mission (NHM) from the FY 2016-17 to 2019-20

| Sl. No.   | States                    | 2016-17         | 2016-17     | 2017-18         | 2017-18     | 2018-19         | 2018-19      | 2019-20         | 2019-20      |
|-----------|---------------------------|-----------------|-------------|-----------------|-------------|-----------------|--------------|-----------------|--------------|
|           |                           | Central Release | Expenditure | Central Release | Expenditure | Central Release | Expenditur e | Central Release | Expenditur e |
| 1         | Andaman & Nicobar Islands | 44.90           | 28.92       | 33.94           | 32.84       | 18.05           | 33.80        | 23.92           | 11.32        |
| 2         | Andhra Pradesh            | 629.55          | 1287.04     | 875.06          | 1,555.50    | 1081.29         | 1658.07      | 767.32          | 702.55       |
| 3         | Arunachal Pradesh         | 160.60          | 165.42      | 261.70          | 165.75      | 216.92          | 168.74       | 10.08           | 42.95        |
| 4         | Assam                     | 1046.09         | 1337.40     | 1,392.66        | 1,476.86    | 1381.51         | 1571.54      | 873.34          | 677.10       |
| 5         | Bihar                     | 1040.59         | 1619.20     | 1,557.40        | 1,820.14    | 1409.78         | 1788.82      | 837.40          | 759.77       |
| 6         | Chandigarh                | 21.47           | 24.57       | 20.35           | 31.64       | 27.06           | 29.21        | 15.49           | 8.35         |
| 7         | Chattisgarh               | 586.97          | 999.33      | 825.76          | 1,180.27    | 875.10          | 1138.90      | 474.29          | 429.32       |
| 8         | Dadra & Nagar Haveli      | 17.12           | 17.36       | 19.14           | 19.76       | 23.46           | 23.52        | 8.98            | 7.52         |
| 9         | Daman & Diu               | 11.53           | 10.24       | 10.67           | 10.63       | 11.76           | 14.30        | 2.88            | 3.63         |
| 10        | Delhi                     | 241.98          | 155.15      | 268.39          | 251.37      | 154.23          | 156.47       | 26.38           | 77.91        |

Rs. in crore

|   11 | Goa              |   26.13 |   37.38 | 26.07    | 43.28    |   33.96 |   46.23 |   15.23 |   26.42 |
|------|------------------|---------|---------|----------|----------|---------|---------|---------|---------|
|   12 | Gujarat          |  863.66 | 1395.67 | 1,221.83 | 1,593.16 | 1038.69 | 1793.63 |  870.34 |  721    |
|   13 | Haryana          |  335.55 |  535.09 | 384.25   | 637.75   |  538.83 |  705.96 |  442.16 |  312.69 |
|   14 | Himachal Pradesh |  212.49 |  346.58 | 370.89   | 377.08   |  345.43 |  441.38 |  210.41 |  143.57 |
|   15 | Jammu & Kashmir  |  362.42 |  419.55 | 550.42   | 521.86   |  556.46 |  573.12 |  500.87 |  165.63 |
|   16 | Jharkhand        |  454.64 |  633.54 | 735.99   | 753.03   |  616.23 | 1016.8  |  404.43 |  479.97 |
|   17 | Karnataka        |  714.09 | 1291.49 | 1,345.50 | 2,016.65 | 1254.82 | 1942.61 |  606.53 |  610.79 |
|   18 | Kerala           |  452.36 |  744.98 | 586.52   | 936.35   |  887.9  |  870.15 |  641.18 |  551.3  |
|   19 | Lakshadweep      |    3.83 |    4.33 | 5.54     | 6.20     |    6.58 |    5.85 |    4.4  |    2.01 |
|   20 | Madhya Pradesh   | 1490.75 | 2066.38 | 1,696.56 | 2,313.93 | 1668.09 | 2531.87 | 1191.61 | 1167.98 |
|   21 | Maharashtra      | 1252.55 | 1804.67 | 1,707.60 | 2,192.88 | 1565.98 | 2714.86 | 1102.26 | 1217.97 |
|   22 | Manipur          |   79.07 |   81.4  | 163.05   | 110.51   |  147.09 |  146.46 |   90.74 |   65.39 |
|   23 | Meghalaya        |  161.13 |  152.85 | 189.02   | 169.14   |  145.06 |  159.81 |   85.66 |   52.52 |
|   24 | Mizoram          |   80.88 |   99.55 | 126.95   | 112.35   |  118.36 |  125.46 |   58.82 |   37.95 |
|   25 | Nagaland         |   95.92 |   95.17 | 134.86   | 95.55    |  132.11 |  133.73 |    9.24 |   44.54 |
|   26 | Orissa           |  728.58 | 1299.27 | 1,216.22 | 1,514.45 |  743.57 | 1673.91 |  910.53 |  855.36 |
|   27 | Puducherry       |   41.35 |   38.41 | 35.55    | 38.83    |   38.16 |   45.95 |    6.56 |   14.24 |

| 28        | Punjab        |   292.55 |   695.31 | 483.74    | 639.53    |   570.51 |   739.07 |   406.51 |   343.13 |
|-----------|---------------|----------|----------|-----------|-----------|----------|----------|----------|----------|
| 29        | Rajasthan     |  1234.18 |  1734.34 | 1,615.29  | 1,885.55  |  1667    |  2309.53 |  1165.9  |   930.78 |
| 30        | Sikkim        |    41.72 |    50.62 | 55.40     | 43.48     |    45.22 |    59.38 |    17.12 |     7.84 |
| 31        | Tamil Nadu    |   788.68 |  1852.9  | 1,293.97  | 2,285.56  |  1479.71 |  2533.41 |   982.97 |  1015.97 |
| 32        | Tripura       |   125.76 |   143.14 | 158.99    | 202.79    |   186.52 |   199.86 |   111.1  |    69.85 |
| 33        | Uttar Pradesh |  3314.75 |  5120.68 | 3,967.46  | 6,569.01  |  3886.7  |  6871.79 |  2471.07 |  3336.13 |
| 34        | Uttarakhand   |   265.53 |   350.67 | 354.85    | 448.22    |   297.18 |   491.87 |   225.42 |   211.06 |
| 35        | West Bengal   |   806.98 |  1914.71 | 1,305.37  | 2,341.05  |  1116.09 |  2236.34 |  1371.91 |   814.6  |
| 36        | Telangana     |   398.08 |   700.76 | 468.34    | 977.76    |   713.43 |  1078.7  |   712.15 |   387.84 |
| Sub Total | Sub Total     | 18424.4  | 29254.1  | 25,465.28 | 35,370.74 | 24998.8  | 38031.1  | 17655.2  | 16307    |

Note: 1. Release  for the F.Y. 2019-20 is updated upto 31.10.2019 and is provisional. 2. The above releases relate to Central Govt. Grants & do not include State share contribution. 3. Expenditure includes expenditure against Central Release, State release & unspent balances at the beginning of  the year. Expenditure for the F.Y. 2019-20 (upto

- 30.09.2019 as per FMR) are provisional.