Lok Sabha Question No. 839 (UNSTARRED), answered on 2021-07-23
Subject: Health Projects with Foreign Aid
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Ramapati Ram Tripathi

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

LOK SABHA U NSTARRED QUESTION NO. 839 TO BE ANSWERED ON 23 RD JULY, 2021

## HEALTH PROJECTS WITH FOREIGN AID

## 839. DR. RAMAPATI RA M TRIPATHI:

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

(a)  the  details  of  upgradation/modernization  work being  carried  out  in  health  related projects/schemes including hospitals operated with the support/financial aid from international institutions/agencies like World Bank, World Health Organization (WHO), State/UT/ agency wise;

(b) the present status of each such project along with the progress achieved thereunder during each of last three years and the current year;

(c) whether any per iodic evaluation has been done regarding the progress of all such projects and if so, the details of the outcome thereof; and

(d) the steps taken/being taken by the Government to improve the quality of healthcare services in the country?

## ANSWER

## THE MINISTE R OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE (DR . BHARATI PRAVIN PAW AR )

(a) & (b): As as per information received from WHO, they have not provided any financial Government  of  India  for  upgradation /modernization  work  in  health  related  projects/schemes including  hospitals.  WHO  provides  technical  assistance  to  Government    of  India  in  pri public  health  programme  like  routine  immunization  ,TB  elimination  ,  Non  communicabl diseases  ,  Neglected  trop ical  diseases  ,  environmental  health  ,health  systems,  reproducti maternal, child health and public health emergency ,preparedness and response .The tech support includes monitoring epidemiological trends and activities for elimination of di capacities building of health workers in above areas ,developing technical guidance ;sup surveillance  ,quality  assurance  of  laboratories,  strengthen  in fection  prevention  and  control; support response to Covi d- 19 and vaccination campaign.

In addition, Projects supported by World Bank, Japan International Cooperation Age (JICA)  and  United  National  Development  Programme  (UNDP),  the  details  are  attached  a Annexure (A), (B) and (C).

(c): For Projects assisted by World Bank and JICA, Trip artite portfolio review meetings, project review meeting, state review meetings are held by DEA to review the project progress ti time

(d):  Health  is  a  state  subject,  the  primary  responsibility  for  strengthening  public system and provision of quality healthcare services at the public healthcare facilities, in upgradation / modernization of public healthcare facilities, lies with respectiv Governments.

To  address  the  healthcare  challenges,  particularly  in  rural  areas,  the  Nat ional  Rural Health  Mission  (NRHM)  was  launched  in  2005  to  supplement  the  efforts  of  the  State/U governments  to  provide  accessible,  affordable  and  quality  healthcare  to  all  those  who public health facilities. Currently, NRHM is a sub - mission of Nati onal Health Mission (NHM).

NHM support is provided to States/ UTs for setting up of new facilities as per norm upgradation of existing facilities for bridging the infrastructure gaps based on the re posed by them in the State PIP.

NHM support is also provided for provision of a range of free services related to ma health, child health, adolescent health, family planning, universal immunisation programm for major diseases such as Tuberculosis, vector borne diseases like Malaria, Den gue nd Kala Azar, Leprosy etc.

Other  major  initiatives  supported  under  NHM  include  Janani  Shishu  Suraksha Karyakram (JSSK) (under which free drugs, free diagnostics, free blood and diet, free tra from  home  to  institution,  between  facilities  in  case of  a  referral  and  drop  back  home  is provided),  Rashtriya  Bal  Swasthya  Karyakram  (RBSK)  (which  provides  newborn  and  child health  screening  and  early  interventions  services  free  of  cost  for  birth  defects, deficiencies and developmental delays to i mprove the quality of survival), implementation of Free  Drugs  and  Free  Diagnostics  Service  Initiatives,  PM  National  Dialysis  Programme  a implementation  of  National  Quality  Assurance  Framework  in  all  public  health  facili including in rural areas.

Mob ile Medical Units (MMUs) & Telemedicine are also being implemented to improve access to healthcare particularly in rural areas.

As  part  of  Ayushman  Bharat,  the  States  are  supported  for  establishment  of  1.5 Health  and  Wellness  Centres  across  the  countr y  by  December,  2022  for  provision  of comprehensive  primary  care  that  includes  preventive  healthcare  and  health  promotion  at community  level  with  continuum  of  care  approach.  Besides  expanding  and  strengthening  t existing Reproductive and Child Health (RMNCHA+N) services and Communicable Diseases services,  the  functional  AB - HWCs  provide  services  related  to  Non - Communicable  Diseases (NCDs) (screening and management for NCDs such as Hypertension, Diabetes and 3 common cancers of Oral, Breast and Cervix) a nd incrementally adding other primary healthcare services for  mental  health,  ENT,  Ophthalmology,  oral  health,  geriatric  and  palliative  health  c trauma care etc.

So  far,  approvals  for  above  1,50,115  Ayushman  Bharat - Health  &  Wellness  Centres (HWCs) have been accorded. Out of those, as reported by the States/UTs on the HWC Portal, 77,406 Health & Wellness Centres have been operationalized till 20th July, 2021

Further Ayushman Bharat, Pradhan Mantri Jan Arogya Yojana (AB - PMJAY) provides health coverage up to Rs 5 Lakh per family per year to around 10.74 crore poor and vulnera families as per Socio Economic Caste Census (SECC).

National Quality Assurance Programme (NQAP) under National Health Mission (NHM) have  subsumed  all  the  six  subgroups  of  qualit y  healthcare  services,  such  as  patient  centered, equitable,  accessible,  effective,  safe  and  efficient.    NQAS  (National  Quality  Ass Standards),  one  of  the  key  components  under  the  ambit  of  NAQP,  meets  the  national  a international benchmarks like the Insurance Regulatory and Development Authority (IRDA) and International Society for Quality in Healthcare (ISQUA) respectively.

NQAS for PHC level (24x7), UPHC & Health & Wellness Centre have been shared with the  States  to  strengthen  provision  of  quali ty  healthcare  at  the  Primary  Healthcare  Centers  by maximizing  efficiency,  effectiveness,  productivity  of  available  resources,  such  as procedures  for  drug  administration  and  Standard  Treatment  Guidelines  (STGs),  defined established procedures fo r  maintaining, updating of patients' clinical records and their storage, established system for assuring and improving quality of clinical & support services by and external quality control mechanism, Infection prevention protocols etc.

## World Bank Assisted Projects:

## Annexure-A

|   S. No. | Status   | Project Name                                                               | Board Approval   | Closing Date   |   IBRD Loan |   IDA Loan |   Total Loan |   Disburs e-ment |   Disburse- ment (%) |
|----------|----------|----------------------------------------------------------------------------|------------------|----------------|-------------|------------|--------------|------------------|----------------------|
|        1 | Active   | Mizoram Health Systems Strengthening Project                               | 31-Mar- 21       | 30-Dec- 26     |          32 |          0 |           32 |             0    |                 0    |
|        2 | Active   | India COVID- 19 Emergency Response and Health Systems Preparedness Project | 02-Apr- 20       | 31-Dec- 24     |        1000 |          0 |         1000 |           705.38 |                70.54 |
|        3 | Active   | Andhra Pradesh Health Systems Strengthening Project                        | 15-May- 19       | 30-Sep- 24     |         328 |          0 |          328 |            68.27 |                20.81 |
|        4 | Active   | Program Towards Elimination of Tuberculosis                                | 29-Mar- 19       | 30-Jun- 24     |         400 |          0 |          400 |           163.21 |                40.8  |
|        5 | Active   | Tamil Nadu Health System Reform Program                                    | 19-Mar- 19       | 31- May-24     |         287 |          0 |          287 |            57.74 |                20.12 |
|        6 | Active   | Uttarakhand Health Systems Development Project                             | 26-Jan- 17       | 30-Sep- 23     |           0 |        100 |          100 |            17.47 |                24.95 |
|        7 | Active   | Nagaland Health Project                                                    | 19-Dec- 16       | 31-Mar- 23     |           0 |         48 |           48 |            20.83 |                47.39 |
|        8 | Close d  | National AIDS Control Support Project                                      | 01-May- 13       | 30-Jun- 20     |           0 |        255 |          255 |           237.12 |                92.9  |
|        9 | Close d  | Uttar Pradesh Health Systems Strengthening Project                         | 20-Dec- 11       | 30-Sep- 19     |           0 |        152 |          152 |           129.32 |                85    |

## JICA Assisted Projects:

|   S. No. | Project Name                                                                   |   Loan amount (in JPY billion) | Date of LA Signing   | Date of LA Closing                                            |   Cumulative Disbursement Status as on 30.06.2021 (in billion JPY) | Percentage Disbursement   |
|----------|--------------------------------------------------------------------------------|--------------------------------|----------------------|---------------------------------------------------------------|--------------------------------------------------------------------|---------------------------|
|        1 | Tamil Nadu Urban Health Care Project                                           |                         25.537 | 31.03.2016           | 28.07.2024                                                    |                                                              1.045 | 4.09%                     |
|        2 | COVID-19 Crisis Response Emergency Support Loan                                |                         50     | 31.08.2020           | to be effectuate shortly (awaiting GoI's approval from MoHFW) |                                                              0     | 0.00%                     |
|        3 | Project for the Setting- up of All India Institute of Medical Sciences Madurai |                         22.788 | 26.03.2021           | to be effectuate shortly                                      |                                                              0     | 0.00%                     |

## Annexure-B

## UNDP Assisted Projects:

| Part of question   | eVIN                                                                                                                                                                                                                                                                                                  | CO-WIN                                                                                                                                                                                                                                                                                                                                            | Oxygen Generation Plants                                                                                                                                                                                                                                                                                                                                                                               |
|--------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| (a)                | A Government of India initiative led by Ministry of Health and Family Welfare, with Health System Strengthening (HSS) grant (USD 40 million) from Gavi. UNDP has provided technical support in implementing the Electronic Vaccine Intelligence Network (eVIN) in all the 36 states and UTs of India. | A Government of India initiative led by Ministry of Health and Family Welfare, with COVAX TA grant (USD 4.65 million) from Gavi, UNDP has provided technical support in developing and implementing the CO-WIN platform, a COVID vaccine beneficiary tracking system, across all states and UTs of India, to support the COVID vaccination drive. | Under the leadership of Ministry of Health and Family Welfare, GOI, and grant from Japan's Supplementary Budget (JSB) and UNDP (USD 1.6 million), UNDP is supporting to set-up Oxygen Generation plants across 11 identified hospital sites, to surge the capacity of Oxygen Supply in North-eastern states for effective management of patients during the COVID pandemic and in post pandemic stage. |
| (b)                | 2018 eVIN became functional in 16,004 cold chain points of 443 districts, across 20 states and UTs.                                                                                                                                                                                                   | 2020- 21 Established framework, design and processes for CO-WIN in coordination with various ministries and stakeholders. Supported MoHFW in development of CoWIN and its operational guidelines. Mapped                                                                                                                                          | 2020- 21 Identified 11 hospital sites in consultation with Ministry of Health and Family Welfare and state health departments across Arunachal Pradesh, Nagaland, Meghalaya and Tripura. Completed site inspection, designing, readiness including pipe-laying and other civil work. Procured, tested, and supplied                                                                                    |
|                    | 2019 eVIN became functional in 20,273 cold chain                                                                                                                                                                                                                                                      | health facilities and health officials & workers and conducted training                                                                                                                                                                                                                                                                           |                                                                                                                                                                                                                                                                                                                                                                                                        |

## Annexure-C

|      | points of 521 districts across 21 states and UTs.                                                 | on CO-WIN software. Trained over one million officials and health workers on using                                                                                                                                                                                                                                                                                                                                                                                                     | materials. Commissione d 10 of the 11 Oxygen Generation plants and trained staff.   |
|------|---------------------------------------------------------------------------------------------------|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-------------------------------------------------------------------------------------|
| 2020 | eVIN became functional in all 28,522 cold chain points of 732 districts across 36 states and UTs. | CO-WIN. Established a dedicated CO- WIN 24X7 Helpline and a digital grievance handling portal, integrated with the Ministry of Health's COVID Helpline number 1075. 28 million health and frontline workers were enrolled in CoWIN for vaccination. Nearly 172 thousand vaccination centres are carrying out transactions on CoWIN across India. CoWIN has registered transactions for 330 million doses administered to the beneficiaries (inclusive of both first and second doses). |                                                                                     |