Lok Sabha Question No. 1666 (UNSTARRED), answered on 2022-02-11
Subject: Health Schemes in Tribal Areas
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Gajendra Singh Patel

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

## LOK SABHA UNSTARRED QUESTION NO 1666 TO BE ANSWERED ON 11 th  FEBRUARY, 2022

## HEALTH SCHEMES IN TRIBAL AREAS

## †1666. SHRI GAJENDRA SINGH PATEL:

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

- (a) the  details  of  the  schemes  of  the  Ministry  under  consideration  for  implementation  in tribal dominated areas of Madhya Pradesh including Khargone-Barwani parliamentary constituency;
- (b) if so, the details thereof, district-wise;
- (c) whether any special scheme is proposed for implementation in tribal dominated areas to improve healthcare facilities there; and
- (d) the district-wise details of health related schemes in Madhya Pradesh?

## ANSWER THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE (DR. BHARATI PRAVIN PAWAR)

(a) to (d):

'Public  Health  and  Hospital'  is  a  State  subject,  the  primary  responsibility  of  ensuring availability of healthcare facilities including access to healthcare facilities in tribal dominated areas  lies  with  the  respective  State  Governments  including  Madhya  Pradesh.  However, Ministry of Health and Family Welfare, Government of India provides technical and financial support to the States/UTs to strengthen the public healthcare facilities through NHM.

The  National  Health  Mission  (NHM)  is  a  Centrally  Sponsored  Scheme  which  envisages achievement of universal access to equitable, affordable & quality health care services that are accountable and responsive to people's needs. NHM encompasses its two Sub-Missions, the  National  Rural  Health  Mission  (NRHM)  and  the  National  Urban  Health  Mission (NUHM). The main programmatic components include Health System Strengthening in rural and urban areas, Reproductive-MaternalNeonatal-Child and Adolescent Health (RMNCH+A), and Communicable and Non-Communicable Diseases.

The NHM focuses on universal approach and hence all the Health and Family Welfare Schemes run under the umbrella of NHM  is applicable and available in the KhargoneBarwani  parliamentary  constituency  as  well  as  all  the  districts  of  Madhya Pradesh.

Under the  National  Health  Mission  (NHM),  financial  and  technical  support  is  provided  to States/UTs  to  strengthen  their  health  care  systems  including  setting-up/upgrading  public health facilities and augmenting health human resource on contractual basis for provision of equitable,  affordable  healthcare  to  all  its  citizens  particularly  the  poor  and  vulnerable population in the tribal areas based on requirements posed by the States in their Programme Implementation Plans (PIPs) within their resource envelope.

Various relaxations that are supported under NHM for better healthcare for beneficiaries in tribal areas are as follows;

-  Ayushman  Bharat-  Health  and  Wellness  Centres  (HWCs)  are  established  by transforming the Sub-Health Centres (SHCs) and Primary Health Centres (PHCs), as part of the Ayushman Bharat - the flagship programme of Government of India, to deliver  twelve  packages  of  Comprehensive  Primary  Health  Care  (CPHC)  that includes preventive, promotive, curative, palliative and rehabilitative services which is  universal,  free  and  close  to  the  community.  In  the  current  financial  year,  over 90109 HWCs have been operationalized till 06 th February, 2022. Of these, 15041 are in 177 tribal districts.
-  The population norms for setting up Health Facilities in vulnerable areas are relaxed. Against the population norms of 5,000, 30,000 and 1,20,000 for setting up of SHC, PHC  and  CHC,  the  norm  is  3,000,  20,000  and  80,000  respectively  in  vulnerable areas such as remote, tribal, desert and hard to reach areas.
-  Under NHM, States/UTs have been given flexibility to deploy Mobile Medical Units (MMUs) to provide a range of health  care  services  for  the  population  particularly living  in  remote,  in-accessible,  un-served  and  under-served  areas,  as  per  the  needs identified by the respective States/UTs.
-  To  minimize  the  Out  of  Pocket  Expenditure  incurred  on  health  services,  National Free  Drugs  Service  Initiative  and  National  Free  Diagnostic  Service  Initiative  have been  rolled  out.  The  medicines  are  provided  adequately  to  all  health  facilities, including the health facilities in vulnerable areas, as per the essential medicines lists for respective levels of facilities. Special focus is given to ensure that there are no interruptions in availability of medicines in health facilities in vulnerable areas.
-  The  ASHA  programme  guidelines  provide  for  recruitment  of  ASHA  at  habitation level, in hilly, tribal and difficult areas. Consequently, ASHAs have been put in place at  habitation  level  (well  below the  national  norm  of  one  ASHA  at  a  population  of about 1000).
-  Government of India is supporting states in implementation of National Ambulances Services under NHM for free transportation of sick patients to the health facilities. States are free to place these ambulances at a lower population norm or as per time to care approach so that these ambulances are easily accessible by all.
-  Further, all tribal majority districts whose composite health index is below the State 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 State. These districts receive higher per capita funding, have enhanced monitoring  and  focussed  supportive  supervision  and  are  encouraged  to  adopt innovative approaches to address their peculiar health challenges.
-  States  are  encouraged  to  adopt  flexible  norms  for  engaging  specialists  for  public health facilities by various mechanisms like 'contracting in' and 'contracting out' of specialist  services  under  National  Health  Mission.    NHM  provides  for  following types of incentives and honorarium to staff for ensuring service delivery in rural and remote areas in the country:
-  Honorarium  to  Gynecologists/Emergency  Obstetric  Care  (EmoC)  trained, Pediatricians&Anesthetist/  Life  Saving  Anaesthesia  Skills  (LSAS)  trained doctors for conducting C Sections.
-  Hard Area allowances and special packages are provided to attract  health HR, especially medical officers and specialists, to remote and difficult areas.
-  Incentives  like  special  incentives  for  doctors,  incentive  for  ANM  for ensuring  timely  ANC  checkup  and  recording,  incentives  for  conducting Adolescent Reproductive and Sexual Health (ARSH) activities etc.
-  States have  also been  allowed  to  offer negotiable salaries to attract Specialists including flexibility in strategies such as ''You quote, we pay".
-  In addition, non-Monetary incentives such as preferential admission in post graduate courses for staff serving in difficult areas and improving accommodation arrangement in rural areas have also been introduced under NHM.

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