Lok Sabha Question No. 1708 (UNSTARRED), answered on 2022-12-16
Subject: Modernizing Healthcare Facilities
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Sisir Kumar Adhikari

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

LOK SABHA UNSTARRED ADMITTED QUESTION NO. 1708 TO BE ANSWERED ON 16 th  DECEMBER, 2022

## MODERNIZING HEALTHCARE FACILITIES

## 1708. SHRI SISIR KUMAR ADHIKARI:

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

- (a) whether the Government is aware that in spite of high budget estimates the actual health expenditure of the Government to GDP is consistently below 1.4 per cent during the last five consecutive years;
- (b) if so, the details thereof;
- (c) whether the Government has issued/proposed to issue guidelines to States to modernize the hospitals with modern equipment and facilities and if so, the details thereof; and
- (d) whether the Government intends to provide free medical treatment to all its citizen and if so, the time by which it is likely to be implemented?

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

- (a) &  (b):    As  per  the  National  Health  Accounts  (NHA)  Estimates,  Government  health expenditure as percentage of Gross Domestic Product in India during the latest five years, for which data is available is as:

| Year    |   Government Health Expenditure as percentage (%) of GDP |
|---------|----------------------------------------------------------|
| 2014-15 |                                                     1.13 |
| 2015-16 |                                                     1.18 |
| 2016-17 |                                                     1.2  |
| 2017-18 |                                                     1.35 |
| 2018-19 |                                                     1.28 |

Source:  National Health Accounts Estimates for India

(c)  &  (d):    Government  is  providing  technical  and  financial  support  to  state  government through various schemes to improve health Infrastructure and to provide accessible, affordable & quality  health  care  to  citizens.  Government  has  initiated  various  schemes/programmes  to supplement the efforts of the State/UT governments and to provide quality healthcare across the  country.  Details  of  financial  assistance  provided  during  the  last  three  years  to  the States/UTs for the activity of hospital strengthening and new constructions/renovation / setting up is as per Annexure.

The  Government  has  launched  four  mission  mode  projects,  namely  PM-Ayushman Bharat  Health  Infrastructure  Mission  (PM-ABHIM),  Ayushman  Bharat  Health  &  Wellness Centres  (ABHWCs),  Pradhan  Mantri  Jan  Arogya  Yojana  (PMJAY)  and  Ayushman  Bharat Digital  Mission  (ABDM).  Other  notable  initiatives  which  have  contributed  to  this  increase  in health  expenditure  include  schemes  viz.,  National  Health  Mission  (NHM),  setting  up  of  new AIIMS  and  upgrading  of  Government  medical  colleges  under  the  Pradhan  Mantri  Swasthya Suraksha Yojna (PMSSY), support to State/UTs for setting up of new medical colleges as well as for increasing UG and PG medical seats , provision of free drugs and free diagnostic facilities at Primary Health Centres (PHC)/ Community Health Centres (CHC) and district hospital level, substantial  increase  in  availability  of  government  ambulances  etc.  The  Fifteenth  Finance Commission  has  also  recommended  health  grants  aggregating  to  Rs.  70,051  crore  to  local governments for addressing the gaps in primary health infrastructure in rural and urban areas.

Under NHM, the flagship programme of the government, many steps have been taken towards  supporting  the  State  Governments  in  providing  accessible  &  affordable  healthcare  to people.  Financial  and  technical  support  are  provided  to  States/UTs  to  provide  accessible, affordable  and  quality  healthcare,  especially  to  the  poor  and  vulnerable  sections  of  the population, in both urban and rural areas. The NHM provides support for improvement in health infrastructure,  availability  of  adequate  human  resources  to  man  health  facilities,  to  improve availability and accessibility to quality health care especially for the underserved and marginalized  groups  in  rural  areas.  Major  initiatives  for  which  States  are  supported  include Janani  Shishu  Suraksha  Karyakram  (JSSK),  Rashtriya  Bal  Swasthya  Karyakram  (RBSK), Rashtriya Kishor Swasthya Karyakram (RKSK), implementation of NHM Free Drugs and Free Diagnostics  Service  Initiatives,  PM  National  Dialysis  Programme  and  implementation  of National Quality Assurance Framework.

Under  the  PM-ABHIM,  focus  is  on  developing  capacities  of  health  system  and institutions across the continuum of care at all levels viz. primary, secondary and tertiary and on preparing  health  systems  in  responding  effectively  to  the  current  and  future  pandemics  and disasters. PM-ABHIM is a Centrally Sponsored Scheme with some Central Sector Components with an outlay of Rs. 64,180 crore.

Under  Ayushman  Bharat  Health  &  Wellness  Centres  (AB-HWCs),  a  comprehensive need-based healthcare services covering maternal and child health services and noncommunicable diseases, including free essential drugs, diagnostic services and tele consultation services are provided to all citizens of the country.  The HWCs are strengthening existing Sub Health Centres (SHCs) and Primary Health Centres (PHCs). A total number of 1,31,150 HWCs have already been operationalized.

The Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) - a centrally sponsored scheme provides health coverage upto Rs. 5 lakh per family per year for secondary and  tertiary  care  hospitalization  to  over  10.74  crore  poor  and  vulnerable  families  (approx.  50 crore beneficiaries). Approx 20.96 Crore Ayushman  cards have been verified and approximately  4.18  crore  hospital  admission  amounting  to  Rs.  48,934  Crores  have  been authorized through a network of approximately 26,267 empanelled public and private health care providers.

Ayushman  Bharat  Digital  Mission  (ABDM)  has  been  announced  on  27 th September, 2021  with  the  aim  to  develop  the  backbone  necessary  to  support  the  integrated  digital  health infrastructure  of  the  country.  It  will  bridge  the  existing  gap  amongst  different  stakeholders  of Healthcare ecosystem through digital highways. A total 27,46,56,356 Ayushman Bharat Health Account (ABHA) have already been created till 29.11.2022. Under ABDM more than 1.72 lakh Health Facilities and   1,03,886 Healthcare Professionals are registered.

For providing affordable and accessible Mental Healthcare facilities, the Government is implementing National Mental Health Programme (NMHP) in the country. The District Mental Health Programme (DMHP) component of the NMHP has been sanctioned for implementation in 704 districts for which support is provided to States/UTs through the NHM. Facilities made available  under  DMHP  at  the  Community  Health  Centre  and  Primary  Health  Centre  levels, include outpatient services, assessment, counselling/ psycho-social interventions, continuing care and  support  to  persons  with  severe  mental  disorders,  drugs,  outreach  services,  ambulance services etc.

Tele  Mental  Health  Assistance  and  Networking  Across  States  (Tele-MANAS)  was launched  on  10.10.2022  with  the  aim  to  provide  free  tele-mental  health  services  all  over  the country  round  the  clock,  particularly  to  under-served  areas  and  people  remotely  located.  The programme includes a network of 23 tele-mental health centres of excellence, with NIMHANS as  the  nodal  centre  and  International  Institute  of  Information  Technology-Bangalore  (IIITB) providing technology support.

The treatment in Government Hospitals is either free or highly subsidized for the poor and needy.  Besides,  quality  generic  medicines  are  made  available  at  affordable  prices  to  all  under Pradhan  Mantri  Bhartiya  Janaushadhi  Pariyojana  (PMBJP)  in  collaboration  with  the  State Governments. Affordable Medicines and Reliable Implants for Treatment (AMRIT) Pharmacy stores have been set up in some hospitals/institutions.

,*****

## Statement  Showing  the  State/UT  wise  Approvals  under  Hospital  Strengthening  and  New Constructions/ Renovation and Setting up from the F.Y. 2019-20 to 2021-22

(Rs. in lakhs)

|   S.No. | State/UT                 |   2019-20 | 2020-21   | 2021-22   |
|---------|--------------------------|-----------|-----------|-----------|
|       1 | Andaman &Nicobar Islands |    340    | 135.00    | 159.00    |
|       2 | Andhra Pradesh           |  43234    | 14399.00  | 2583.25   |
|       3 | Arunachal Pradesh        |   2549.94 | 2828.89   | 5674.45   |
|       4 | Assam                    |  18009.3  | 33641.14  | 23425.82  |
|       5 | Bihar                    |  52755.2  | 36745.92  | 37842.57  |
|       6 | Chhattisgarh             |  12983.5  | 14686.45  | 15047.86  |
|       7 | Dadra &Nagar Haveli      |      1.92 |           |           |
|       8 | Daman &Diu               |      5.76 | 5.76      | 2.88      |
|       9 | Delhi                    |   1012.12 | 381.96    | 681.80    |
|      10 | Goa                      |     36.32 | 119.60    | 125.95    |
|      11 | Gujarat                  |   3901.65 | 2185.12   | 878.22    |
|      12 | Haryana                  |   7603.28 | 17020.75  | 12804.52  |
|      13 | Himachal Pradesh         |   5521    | 8731.00   | 3547.39   |
|      14 | Jammu &Kashmir           |   6805.35 | 4505.65   | 3433.33   |
|      15 | Jharkhand                |  11349.1  | 10591.96  | 2494.78   |
|      16 | Karnataka                |  25128.3  | 19381.04  | 15324.05  |
|      17 | Kerala                   |  14310.1  | 11316.81  | 5897.00   |
|      18 | Ladakh                   |      0    | 3240.67   | 3125.00   |
|      19 | Madhya Pradesh           |  30611.2  | 53937.59  | 25482.92  |
|      20 | Maharashtra              |  79683.4  | 49479.00  | 55881.84  |
|      21 | Manipur                  |   1779.33 | 2633.15   | 2999.42   |
|      22 | Meghalaya                |    954.68 | 1444.80   | 1656.32   |
|      23 | Mizoram                  |    449.17 | 570.03    | 35.40     |
|      24 | Nagaland                 |   1100.19 | 3943.01   | 1074.84   |
|      25 | Odisha                   |  43027.6  | 21229.04  | 32846.14  |
|      26 | Puducherry               |     58    | 14.88     | 26.16     |
|      27 | Punjab                   |   7121    | 9096.00   | 5201.90   |
|      28 | Rajasthan                |  53999.2  | 96888.58  | 85616.83  |
|      29 | Sikkim                   |    693.17 | 388.52    | 391.84    |
|      30 | Tamil Nadu               |  27386.9  | 36251.27  | 26196.13  |
|      31 | Telangana                |  31612.3  | 15012.86  | 7640.83   |
|      32 | Tripura                  |   5051.69 | 4549.00   | 4998.54   |
|      33 | Uttar Pradesh            |  45650.9  | 147304.31 | 124665.62 |
|      34 | Uttarakhand              |   7082.25 | 10574.88  | 13588.14  |
|      35 | West Bengal              |  16703    | 18282.20  | 7984.58   |

## Note:

1. The  above  data  comprises  of  Hospital  Strengtheining  -  Up-  Gradation  of  CHCs,  PHCs,  Dist.  Hospitals,  Rent  and Contingencies  and  New  Constructions/  Renovation  and  Setting  up  -  CHCs,  PHCs,  SHCs/Sub  Centres,  Setting  up Infrastructure  wing  for  Civil  works,  Govt.  Dispensaries/  others  renovations  and  Construction of  BHO,  BemOC  and CemOC centres, Major civil works for operationalization of FRU, Major civil works for operationalization of 24 hour services  at  PHCs,  Infrastructure  of  Training  Institutions,  SDH,  DH,  Civil  work  of  DEIC  (RBSK),  Infrastructure strengthening under NUHM, etc.
2. The above data is as per the available Financial Management Reports submitted by the States/UTs.