Lok Sabha Question No. 3326 (UNSTARRED), answered on 2021-12-17
Subject: AIIMS in Tribal Areas
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Durga Das Uikey

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

## LOK SABHA UNSTARRED QUESTION NO. 3326

## TO BE ANSWERED ON 17 th  DECEMBER 2021

## AIIMS IN TRIBAL AREAS

## 3326. SHRI DURGA DAS (D.D.) UIKEY:

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

- (a) whether  the  Government  proposes  to  set  up  All  India  Institute  of  Medical  Sciences (AIIMS) colleges at district level in tribal dominated districts;
- (b) if  so,  the  details  thereof,  district  wise  and  State/UT-wise  particularly  Betul,  Madhya Pradesh; and
- (c) the details of steps being taken by his Ministry to ensure access of healthcare facilities to every citizen including tribal people?

## ANSWER

## THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE

## (DR. BHARATI PRAVIN PAWAR)

(a) & (b) New AIIMS are set up under Pradhan Mantri Swasthya Suraksha Yojana (PMSSY) for which  land  is  provided  by  the  concerned  State/UTs.  The  site  for  AIIMS  is  selected  by Government of India from out of the sites offered by the State Government. As far as Madhya Pradesh is concerned, an AIIMS at Bhopal has already been set up and is functional.

(c) 'Public Health and Hospital' is a State subject, hence, the primary responsibility of ensuring access  to  healthcare  facilities  to  every  citizen  including  tribal  people  lies  with  respective State/UT Governments.

Under  the  National  Health  Mission  (NHM),  Government  of  India  provides  financial  and technical  support  to  States/UTs  to  strengthen  their  health  care  systems  including  settingup/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).

Various interventions  that  are  supported  under  NHM  for  better  healthcare  for  beneficiaries  in vulnerable areas including tribal areas are as follows:

 Health and Wellness Centres (HWCs) are established by transforming the SHCs and PHCs, as part of the Ayushman Bharat - the flagship programme of Government of India, to improve the  health  care  delivery.   In  the  current  financial  year,  over  80466  HWCs  have  been operationalized  till  28th  November,  2021.  Of  this  13636  AB-HWCs  are  operational  in  177 tribal districts (as on 28 November 2021).

-  The  population  norms  for  setting  up  Health  Facilities  in  vulnerable  areas  are  relaxed. Against the general population norms of 5,000 for sub-centre, 30,000 for PHC , and 1,20,000 for CHC, the norm is  3,000  for  sub-centre,  20,000  for  PHC  and  80,000for  CHC  in  vulnerable areas such as remote, tribal, desert, 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 populations particularly living in remote,  inaccessible,  un-served  and  underserved  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  and  Diagnostic  Service  Initiative  has  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.

Due  to  above  interventions  under  NHM,  there  has  been  73%  increase  in  Health  Facilities available in Tribal areas as compared to 10% increase in all India

| Type of Facility   | All India   | All India   | All India   | Tribal Areas   | Tribal Areas   | Tribal Areas   |
|--------------------|-------------|-------------|-------------|----------------|----------------|----------------|
|                    | RHS 2005    | RHS 2020    | % Increase  | RHS 2005       | RHS 2020       | % Increase     |
| SHCs               | 1,42,655    | 1,55,404    | 9%          | 16,748         | 29,745         | 78%            |
| PHCs               | 23,109      | 24,918      | 8%          | 2,809          | 4,203          | 50%            |
| CHCs               | 3,222       | 5,183       | 61%         | 643            | 1035           | 61%            |
| Total              | 1,68,986    | 1,85,505    | 10%         | 20,200         | 34,983         | 73%            |

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