Lok Sabha Question No. 2181 (UNSTARRED), answered on 2022-07-29
Subject: Healthcare in Tribal Areas
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Vivek Narayan Shejwalkar, Sukhbir Singh Jaunapuria, Ramesh Chandra Majhi

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

## LOK SABHA UNSTARRED QUESTION NO. 2181 TO BE ANSWERED ON 29 th   JULY, 2022

## HEALTHCARE IN TRIBAL AREAS

## 2181. SHRI VIVEK NARAYAN SHEJWALKAR: SHRI SUKHBIR SINGH JAUNAPURIA: SHRI. RAMESH CHANDRA MAJHI:

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

- (a) whether the Government has conducted any survey/study relating to health status of the tribal people and the healthcare facilities in tribal regions of the country;
- (b) if so, the details thereof along with necessary steps taken/being taken in this regard;
- (c) the details of schemes being rolled out for improving healthcare facilities in tribal areas of the country, State/UT-wise including district-wise in Odisha; and
- (d) the number of Public Health Centers and Sub-Centers functioning in the tribal areas in the  country  and  the  quantum  of  funds  allocated  and  utilized  for  development  of  such center during each of the last three years and the current year, State/UT-wise including Rajasthan?

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

(a):  There  are  various  Government/Non-Government  institutional  mechanisms  and  survey agencies which generate data on tribal healthcare on a periodic basis. Rural Health Statistics (RHS) provides details of infrastructure and human resource in tribal areas. National Family Health Survey (NFHS) provides details on major health indicators about maternal and child health among Scheduled Tribes. Census of India provides population and household details including Tribal areas.  National Sample Survey provides household surveys on various socioeconomic subjects.

The Expert Committee on Tribal Health titled, 'Tribal Health in India: Bridging the Gap and a Roadmap for the Future' came in 2018 which gives details on the status of tribal health. The Report  of  the  Committee  pieces  together  the  health  status  of  the  tribal  populations,  did  a detailed analysis of the health situation in tribal areas, maps out the disease burden, discusses the challenges in areas of infrastructure, facilities, Human resource, financing, participation in planning etc.,  and  makes  recommendations  for  improving  health  outcomes  for  tribal populations.  The  main  recommendations  of  the  Committee  include  -  strengthen  access  to comprehensive  primary  healthcare  by  establishing  health  and  wellness  centres,  provide insurance for access to secondary and tertiary care; enhance human resource via community health  officers/mid-level  healthcare  providers,  enhancing  capacities/roles  of  ASHA,  task sharing  and  shifting  etc.;  community  mobilisation  and  IEC;  use  of  technology  to  increase access  to  health  services;  strengthening  school  health  program;  integration  of  tribal  health practitioner in primary care; increased financing for tribal health, for instance through Tribal Sub Plan (TSP).

(b)  &  (c):  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  all  the States/UTs  including  Odisha.  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  supports  under  NHM  for  better  healthcare  for  beneficiaries  in  tribal  areas  are  as follows;

-  Ayushman BharatHealth 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.
-  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 ASHA programme guidelines provide for recruitment of ASHA at habitation level in hilly,  tribal  and  difficult  areas.  (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.

(d): The number of Primary Health Centers and Sub- Centers functioning in the tribal areas in the country as per RHS 2020-21 is attached in Annexure-I .  The State/UT-wise details relating  to  Scheduled  Tribal  Sub  Plan  (STSP)  Central  Releases  under  National  Health Mission (NHM) from F.Y. 2019-20 to 2022-23 is given at Annexure-II .

Annexure-I Number of Primary Health Centers and Sub- Centers functioning in the tribal areas (as

## per RHS 2020-21)

|   States/UTs | States/UTs                         | PHCs   | Sub-Centres   |
|--------------|------------------------------------|--------|---------------|
|            1 | Andhra Pradesh                     | 159    | 822           |
|            2 | Arunachal Pradesh #                | 127    | 347           |
|            3 | Assam                              | 188    | 833           |
|            4 | Bihar *                            | NApp   | NApp          |
|            5 | Chhattisgarh                       | 420    | 2944          |
|            6 | Goa *                              | NApp   | NApp          |
|            7 | Gujarat                            | 439    | 2871          |
|            8 | Haryana *                          | NApp   | NApp          |
|            9 | Himachal Pradesh                   | 45     | 106           |
|           10 | Jharkhand                          | 159    | 2465          |
|           11 | Karnataka                          | 31     | 195           |
|           12 | Kerala                             | 40     | 285           |
|           13 | Madhya Pradesh                     | 375    | 3247          |
|           14 | Maharashtra                        | 317    | 2054          |
|           15 | Manipur                            | 48     | 240           |
|           16 | Meghalaya #                        | 145    | 451           |
|           17 | Mizoram #                          | 68     | 377           |
|           18 | Nagaland #                         | 138    | 445           |
|           19 | Odisha                             | 444    | 2701          |
|           20 | Punjab *                           | NApp   | NApp          |
|           21 | Rajasthan                          | 202    | 1539          |
|           22 | Sikkim                             | 12     | 48            |
|           23 | Tamil Nadu                         | 96     | 545           |
|           24 | Telangana                          | 202    | 1489          |
|           25 | Tripura                            | 46     | 439           |
|           26 | Uttarakhand                        | 7      | 145           |
|           27 | Uttar Pradesh *                    | NApp   | NApp          |
|           28 | West Bengal                        | 146    | 1188          |
|           29 | A&NIslands                         | 4      | 41            |
|           30 | Chandigarh *                       | NApp   | NApp          |
|           31 | Dadra &Nagar Haveli and Daman &Diu | 6      | 49            |
|           32 | Delhi *                            | NApp   | NApp          |
|           33 | Jammu &Kashmir                     | 66     | 189           |
|           34 | Ladakh #                           | 32     | 289           |
|           35 | Lakshadweep #                      | 4      | 7             |
|           36 | Puducherry *                       | NApp   | NApp          |

Notes:

N App - Not applicable

#:States are predominently tribal areas

*: State / UT has no separate Tribal Area / Population

## Annexure-II

## Statement showing state-wise Central Releases under ST Component under NHM for the F.Ys. 2019-20 to 2022-23

Rs. in crore

|   S. No. | Name of the State/UT     | 2019-20   | 2020-21   | 2021-22   | 2022-23   |
|----------|--------------------------|-----------|-----------|-----------|-----------|
|        1 | Andaman &Nicobar Islands | *         | *         | *         | *         |
|        2 | Andhra Pradesh           | 90.92     | 98.14     | 95.09     | 45.63     |
|        3 | Arunachal Pradesh        | 62.54     | 94.81     | 68.97     | 0.03      |
|        4 | Assam                    | 228.97    | 171.46    | 247.37    | 46.24     |
|        5 | Bihar                    | 27.16     | 142.89    | 32.12     | 2.47      |
|        6 | Chandigarh               | *         | *         | *         | *         |
|        7 | Chattisgarh              | 225.19    | 268.82    | 254.85    | 120.28    |
|        8 | Dadra &Nagar Haveli      | *         | *         | *         | *         |
|        9 | Daman &Diu               | *         |           |           |           |
|       10 | Delhi                    | -         | -         | -         | -         |
|       11 | Goa                      | 14.02     | 3.73      | 2.15      | 0.92      |
|       12 | Gujarat                  | 208.20    | 163.50    | 197.94    | 4.63      |
|       13 | Haryana                  | -         | -         | -         | -         |
|       14 | Himachal Pradesh         | 124.52    | 58.31     | 74.11     | 6.26      |
|       15 | Jammu &Kashmir           | 68.57     | 23.81     | 14.04     | 7.16      |
|       16 | Jharkhand                | 274.21    | 146.53    | 166.10    | 7.67      |
|       17 | Karnataka                | 98.06     | 145.30    | 89.72     | 0.90      |
|       18 | Kerala                   | 27.80     | 18.72     | 24.32     | 3.93      |
|       19 | Lakshadweep              | *         | *         | *         | *         |
|       20 | Madhya Pradesh           | 394.50    | 457.39    | 462.25    | 107.34    |
|       21 | Maharashtra              | 254.09    | 165.04    | 349.85    | 51.74     |
|       22 | Manipur                  | 38.05     | 30.84     | 25.20     | 0.50      |
|       23 | Meghalaya                | 83.31     | 71.29     | 145.05    | 1.19      |
|       24 | Mizoram                  | 83.97     | 48.08     | 51.72     | 0.40      |

|   25 | Nagaland      | 85.36   | 49.85   | 50.73   | 0.38   |
|------|---------------|---------|---------|---------|--------|
|   26 | Odisha        | 285.42  | 410.63  | 338.50  | 124.56 |
|   27 | Puducherry    | -       | -       | -       | -      |
|   28 | Punjab        | -       | -       | -       | -      |
|   29 | Rajasthan     | 209.12  | 300.17  | 266.31  | 50.04  |
|   30 | Sikkim        | 9.79    | 15.23   | 9.75    | 0.04   |
|   31 | Tamil Nadu    | 31.31   | 36.39   | 27.38   | 2.30   |
|   32 | Tripura       | 55.76   | 55.14   | 52.00   | 16.05  |
|   33 | Uttar Pradesh | 177.88  | 176.85  | 63.18   | 1.41   |
|   34 | Uttarakhand   | 10.89   | 31.72   | 19.51   | 0.14   |
|   35 | West Bengal   | 143.35  | 225.44  | 103.66  | 24.64  |
|   36 | Telangana     | 180.98  | 66.90   | 70.52   | 11.32  |
|   37 | Ladakh        | *       | *       | *       | *      |

Note: The above releases relate to Central Govt. Grants & do not include State share contribution. It is updated upto 04.07.2022 .

Note * : In the UTs without legislature,  funds are placed under NHM from 2211 Budget head.