Lok Sabha Question No. 3270 (UNSTARRED), answered on 2022-08-05
Subject: Healthcare in Rural Areas
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Ramdas Chandrabhanji Tadas

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

## LOK SABHA UNSTARRED QUESTION NO. 3270 TO BE ANSWERED ON THE 5 TH  AUGUST, 2022

## HEALTHCARE IN RURAL AREAS

## 3270. SHRI RAMDAS C. TADAS :

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

(a) whether the healthcare delivery system introduced in rural areas has achieved the desired goals during the implementation of the National Rural Health Mission (NRHM);

(b) if so, the details thereof;

(c) the details of expenditure incurred on rural healthcare delivery system during the last three years and the current year, State/UT-wise; and

(d) the number of people provided health insurance cover so far in rural areas of the country?

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

(a) and (b) National Health Mission (NHM) 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-Maternal-  Neonatal-Child  and  Adolescent Health (RMNCH+A) and Communicable and Non-Communicable Diseases.

The responsibility of strengthening public healthcare delivery system, especially to rural areas lies with the respective State/ UT Governments. Under National Health Mission (NHM), Ministry of Health  &  Family  Welfare,  Government  of  India  provides  financial  and  technical  support  to States/UTs including support for health/ medical facilities, upto District Hospital level, based on the proposals  submitted  by  States/UTs  in  their  Program  Implementation  Plans  (PIPs).  Government  of India  provides  approval  for  the  proposals  in  the  form  of  Record  of  Proceedings  (RoPs)  as  per available resources.

The  outcome  of  the  implementation  of  healthcare  delivery  system  under  NHM  to  provide universal access to good quality healthcare services to the people is given below:

-  As per the estimates of National Health Accounts, there has been a decline of 30% in Out-ofPocket Expenditure (OOPE) from 69.4% in 2004-05 to 48.8% in 2017-18.
-  Maternal  Mortality  Rate  (MMR)  has  declined  from  130/lakh  live  births  in  2014-16  to 103/lakh live births in 2017-19.
-  Infant Mortality Rate (IMR) has declined from 47 in 2010 to 30 in 2019.
-  Under 5 Mortality Rate (U5MR) has declined from 52 in 2012 to 35 in 2019.
-  Total Fertility Rate (TFR) has declined from 2.3 in 2014 to 2.1 in 2019.
-  The incidence of Tuberculosis per 1,00,000 population has reduced from 234 in 2012 to 193 in 2019. The mortality due to TB per 1,00,000 population has also reduced from 42 in 2012 to 33 in 2019.
-  The 12 th Five Year Plan target of reducing prevalence of Leprosy to <1/10,000 population in all  districts  by  March,  2017  has  been  achieved  nationally.  The  prevalence  rate  of  Leprosy reduced to less than 1/10,000 population in 662 Districts in 2021.
-  For  Malaria,  Annual  Parasitic  Index  (API)  was  sustained  at  levels  of  less  than  1  and  has declined from 0.89 in 2014 to 0.13 in 2020. In the year 2020, malaria cases and deaths have declined by 46.28 % and 18.18 % respectively as compared to 2019
-  The percentage of Kala-Azar(KA)  endemic blocks, achieving the elimination target  of  <  1 KA case per 10,000 population has increased from 74.2% in 2014 to 97.5% in 2020-21.
-  The National target of sustaining case fatality rate (CFR) to less than 1 percent for Dengue was achieved. The case fatality rate on account of Dengue in 2020 was 0.01%.
-  Under  the  National  Programme  for  Control  of  Blindness  &  Visual  Impairment  (NPCBVI) activities  such  as  cataract  surgeries,  cornea  transplantation  are  done.  The  prevalence  of blindness (visual acuity <3/60) has reduced to 0.36% in 2019 from 0.68% in 2010.
-  There is a 17.3% relative reduction in prevalence of tobacco use from 34.6% to 28.6% from 2009-10 to 2016-17 through sustained public awareness campaigns, enforcement of tobacco control  laws  and  tobacco  dependence  treatment  service  under  National  Tobacco  Control Programme.
-  There has been a significant increase in the number of Healthcare facilities at the Primary and Secondary care level after the introduction of National Health Mission in 2005 as shown in the table below:

| Public Health Facility                     | 2005     | 2021          |
|--------------------------------------------|----------|---------------|
| Sub-Health Centre (SHC)                    | 1,42,655 | 1,57,819 (11% |
| Primary Health Centre (PHC)                | 23,109   | 30,579 (32% ) |
| Community Health Centre (CHC)              | 3,222    | 5,951 (85% )  |
| Sub Divisional/Sub District Hospital (SDH) | NA       | 1224          |
| District Hospital (DH)                     | NA       | 764           |

-  Additionally, Sub Health Centres and Primary Health Centres are transformed as Ayushman Bharat  Health  and  Wellness  Centres  (AB-HWCs)  with  an  aim  to  provide  Comprehensive Primary Health Care (CPHC). As reported by the States/UTs on the AB-HWC Portal, as on 30th  June,  2022,  total  1,20,112  AB-HWCs  have  been  operationalized  against  the  target  of 1,50,000 AB-HWCs by December, 2022.
-  Technical  and  financial  support  is  provided  for  National  Ambulance  Service  (NAS)  to States/UTs  with  28,010  Ambulances  operational  under  Dial  108/102  including  5,057  Other Patient Transport Vehicles.
-  Under Free Drugs Service Initiative (FDSI), 30 States/UTs have drugs procurement, quality system  and  distribution  streamlined  through  IT-enabled  Drugs  Distribution  Management System. 33 States/UTs have facility-wise Essential Medicines List (EML).
-  Similarly,  under  Free  Diagnostics  Services  Initiative  (FDI),  support  is  provided  to  States  / UTs for provision of medical equipment to enables access and use of high-quality diagnostic services. FDI laboratory services have been implemented in 33 States/UTs.

(c) State/UT  wise  information  regarding  Central  Releases  under  NRHM  from  FY  2019-20  to 2021-22 is given at Annexure-I .  Further, under NHM, pools have been merged from FY 2022-23 onwards, hence State/UT wise information regarding Central Releases under NHM for the FY 202223 is given at Annexure-II.

(d)      Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) provides health assurance of up to Rs. 5.00 Lakh per family per year for secondary and tertiary healthcare hospitalization, for 10.74 crores poor and vulnerable families, identified as per Socio-economic Caste Census (SECC) 2011.  Many  of  the  33  State  and  Union  Territories  (UTs)  implementing  AB-PMJAY  have  further expanded the beneficiary base under the scheme to approximately 14.75 Crore families, using nonSECC data sources (including National Food Security Act, State specific datasets).  The rural-urban categorization of beneficiary families is not available in many of the non-SECC databases, hence, the number of rural beneficiary families covered under AB-PMJAY is also not available.

## Annexure -I

Statement showing State/UT Central wise releases under NRHM for FY 2019-20 to 2021-22 (Rs. In crore)

|   Sl. No. | States                   |   2019-20 | 2020-21   | 2021-22   |
|-----------|--------------------------|-----------|-----------|-----------|
|         1 | Andaman &Nicobar Islands |     34.43 | 36.37     | 43.10     |
|         2 | Andhra Pradesh           |   1054.08 | 1037.21   | 1161.02   |
|         3 | Arunachal Pradesh        |    185.25 | 241.64    | 187.86    |
|         4 | Assam                    |   1721.69 | 1782.37   | 1941.52   |
|         5 | Bihar                    |   1486.65 | 1803.05   | 1735.34   |
|         6 | Chandigarh               |     19.38 | 18.01     | 15.69     |
|         7 | Chhattisgarh             |    792.83 | 958.43    | 957.01    |
|         8 | Dadra &Nagar Haveli      |     25.14 | 35.81     | 38.07     |
|         9 | Daman &Diu               |     16.68 |           |           |
|        10 | Delhi                    |    108.63 | 97.20     | 113.02    |
|        11 | Goa                      |     35.12 | 33.83     | 25.63     |
|        12 | Gujarat                  |   1057.35 | 961.08    | 1061.53   |
|        13 | Haryana                  |    540.04 | 508.50    | 553.43    |
|        14 | Himachal Pradesh         |    504.23 | 440.83    | 553.74    |
|        15 | Jammu &Kashmir           |    692.49 | 656.39    | 455.69    |
|        16 | Jharkhand                |    815.72 | 596.02    | 635.26    |
|        17 | Karnataka                |   1120.14 | 1178.89   | 1240.57   |
|        18 | Kerala                   |    814.36 | 766.56    | 757.55    |
|        19 | Lakshadweep              |      6.16 | 7.11      | 8.41      |
|        20 | Madhya Pradesh           |   1684.59 | 2311.39   | 2283.96   |
|        21 | Maharashtra              |   1579.12 | 1686.67   | 1743.40   |
|        22 | Manipur                  |    181.61 | 188.93    | 94.58     |
|        23 | Meghalaya                |    135.8  | 199.42    | 280.86    |
|        24 | Mizoram                  |    122.06 | 139.05    | 92.55     |
|        25 | Nagaland                 |    119.41 | 184.26    | 125.06    |
|        26 | Orissa                   |   1453.04 | 1597.69   | 1242.57   |
|        27 | Puducherry               |     29.18 | 23.68     | 19.85     |
|        28 | Punjab                   |    691.23 | 544.60    | 340.23    |
|        29 | Rajasthan                |   1750.34 | 1964.29   | 1903.49   |
|        30 | Sikkim                   |     52.84 | 69.03     | 51.62     |
|        31 | Tamil Nadu               |   1349.28 | 1437.32   | 1555.80   |
|        32 | Tripura                  |    233.56 | 223.18    | 214.32    |
|        33 | Uttar Pradesh            |   4634.96 | 3672.27   | 3217.87   |
|        34 | Uttarakhand              |    341.15 | 575.98    | 549.33    |
|        35 | West Bengal              |   1677.47 | 1812.63   | 1569.59   |
|        36 | Telangana                |    924.03 | 624.55    | 717.36    |

Note:  The above releases relate to Central Govt. Grants & do not include State share contribution.

## Annexure -II

## Statement showing State/UT wise Central release under NHM for the FY 2022-23

(Rs. In crore)

|   Sl. No. | States                             |   Central Releases |
|-----------|------------------------------------|--------------------|
|         1 | Andaman &Nicobar Islands           |              17.15 |
|         2 | Andhra Pradesh                     |             650.66 |
|         3 | Arunachal Pradesh                  |               0.05 |
|         4 | Assam                              |             371.84 |
|         5 | Bihar                              |             231.64 |
|         6 | Chandigarh                         |              14.01 |
|         7 | Chhattisgarh                       |             376.8  |
|         8 | Dadra &Nagar Haveli and Daman &Diu |               7.7  |
|         9 | Delhi                              |              16.76 |
|        10 | Goa                                |               9.04 |
|        11 | Gujarat                            |              35.95 |
|        12 | Haryana                            |             125.18 |
|        13 | Himachal Pradesh                   |             109.91 |
|        14 | Jammu &Kashmir                     |              66.93 |
|        15 | Jharkhand                          |              31.84 |
|        16 | Karnataka                          |              16.44 |
|        17 | Kerala                             |             287.35 |
|        18 | Lakshadweep                        |               2.69 |
|        19 | Madhya Pradesh                     |             385.31 |
|        20 | Maharashtra                        |             548.85 |
|        21 | Manipur                            |               1.7  |
|        22 | Meghalaya                          |               1.38 |
|        23 | Mizoram                            |               0.47 |
|        24 | Nagaland                           |               0.52 |
|        25 | Odisha                             |             544.75 |
|        26 | Puducherry                         |               0.41 |
|        27 | Punjab                             |             148.63 |
|        28 | Rajasthan                          |             381.86 |
|        29 | Sikkim                             |               0.16 |
|        30 | Tamil Nadu                         |             199.98 |
|        31 | Tripura                            |              50.62 |
|        32 | Uttar Pradesh                      |            1170.63 |
|        33 | Uttarakhand                        |               4.83 |
|        34 | West Bengal                        |             416.09 |
|        35 | Telangana                          |             159.67 |
|        36 | Ladakh                             |               3.67 |

Note:

1. The above releases relate to Central Govt. Grants & do not include State share contribution. It is updated upto 04.07.2022
2. Releases  to  State  is  linked  with  submission  of  utilization  certificate  and  progress  of  expenditure,  Audited Statement of previous year by States/Uts.