Lok Sabha Question No. 3036 (UNSTARRED), answered on 2021-08-06
Subject: Strengthening of Primary Healthcare Services
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Rahul Kaswan, Sunil Kumar Pintu

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

## LOK SABHA UNSTARRED QUESTION NO. 3036 TO BE ANSWERED ON THE 06 th  AUGUST, 2021

## STRENGTHENING OF PRIMARY HEALTHCARE SERVICES

## 3036. SHRI RAHUL KASWAN: SHRI SUNIL KUMAR PINTU:

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

- a) whether the Government proposes to take any steps to strengthen the Primary Healthcare Services network in the country and if so, the details thereof;
- b) whether the Government plans to implement the Universal Health Insurance scheme;
- c) if so, the details thereof and the date from which it is likely to be implemented; and
- d) the steps taken by the Government to address the problem of exorbitant expenses being paid at the time of admission in hospitals particularly in metro cities?

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

(a) to (d):

'Public Health and Hospitals' being a State subject, the primary responsibility of strengthening public  healthcare  system,  including  for  strengthening  the  provision  of  primary  healthcare services in public healthcare system and regulation of hospitals including those in metro cities, lies  with  the  respective  State  Governments.    However,  the  Ministry  of  Health  and  Family

Welfare  provides  technical  and  financial  support  to  the  States/UTs  to  strengthen  the  public healthcare delivery at public healthcare facilities.

Support  under  National  Health  Mission  (NHM)  is  provided  to  States/  UTs  to  supplement  the efforts  of  the  State/UT  governments,  for  setting  up  of  new  facilities  as  per  norms  and upgradation of existing facilities for bridging the infrastructure and human resource gaps, based on the requirements posted by them in their Programme Implementation Plans (PIPs) and within their  overall  resource  envelope.Under  NHM,  States  are  supported  for  several  interventions towards strengthening the primary healthcare services in the country and the same is given in the Annexure.

Ayushman  Bharat,  a  flagship  scheme  of  Government  of  India,  is  an  attempt  to  move  from sectoral  and  segmented  approach  of  health  service  delivery  to  a  comprehensive  need-based health  care  service.  This  scheme  aims  to  undertake  path  breaking  interventions  to  holistically address  the  healthcare  system  (covering  prevention,  promotion  and  ambulatory  care)  at  the primary, secondary and tertiary level. Ayushman Bharat adopts a continuum of care approach, comprising of two inter-related components, which are -

- (i) Health and Wellness Centres (HWCs)
- (ii) Pradhan Mantri Jan Arogya Yojana (PM-JAY)

As part of Ayushman Bharat, the Government is supporting the States for transformation of Sub Health Centres and Primary Health Centres into 1.5 lakh Health and Wellness Centres across the country by December, 2022 for provision of Comprehensive Primary Health Care (CPHC) that includes preventive healthcare and health promotion at the community level with continuum of care approach. Under this programme, CPHC services of an expanded range of services, that are universal and free to users, with a focus on wellness, are provided, closer to the community. As on 4 th August 2021, 77,673 HWCs are operational across the country. Delhi is not implementing the  scheme.  As  reported  by  the  States/UTs  in  the  HWC  Portal,  cumulatively,  these  HWCs reported a total  of  56.86  Cr  footfalls  and  a  cumulative  32.99  Cr  Screenings  for  common  Non Communicable Diseases (NCDs). A total of 76.39 lakh wellness Sessions have been reported from these functional HWCs.

Ayushman Bharat Pradhan Mantri Jan Arogya  Yojana  (PM-JAY), aims at  providing  a  health cover of Rs. 5 lakhs per family per year for secondary and tertiary care hospitalization to over 10.74  Crores  poor  and  vulnerable  families  (approximately  50  crore  beneficiaries)as  per  Socio Economic  Caste  Census  (SECC)  and  at  reducing  out-of-pocket  expenditure  on  healthcare services. 33 States and UTs are currently implementing the scheme except West Bengal, Odisha and  Delhi.  The  implementing  States/UTs  have  expanded  the  beneficiary  base  to  cover  13.44 Crore families.  As on date, more than 1.98 Cr. hospital admissions worth Rs.24,683 Cr have been authorized under the scheme.

## Annexure

Support to the States/UTs under NHM is provided for provision of a host of free services related to  maternal  health,  child  health,  adolescent  health,  family  planning,  universal  immunisation programme,  and  for  major  diseases  such  as  Tuberculosis,  vector  borne  diseases  like  Malaria, Dengue and 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 transport 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,  diseases,  deficiencies  and  developmental delays to improve the quality of survival) in all public health facilities including in rural areas.

Janani Suraksha Yojana (JSY) ,  a  safe  motherhood intervention with the objective to reduce maternal  and  neonatal  mortality  by  promoting  institutional  delivery  among  pregnant  women expecially  with  weak  socio-economic  status,  i.e.  women  from  SC/ST/BPL  households  and presently, under implementation in all States/UTs with a special focus on Low Performing States and  provides  Cash  incentives  for  women  with  the  special  focus  for  BPL/SC/ST  women  for institutional  delivery  (in  government/  private  accredited  health  facilities)  and  for  BPL  women who prefer for home delivery.

Mobile Medical Units (MMUs) & Telemedicine are also being implemented with NHM support to improve healthcare access particularly in rural areas.

To ensure availability of essential drugs and reduce the Out of Pocket Expenditure (OOPE) of the  patients  visiting  the  public  health  facilities,  Government  has  rolled  out  the  Free  Drugs Service Initiative (FDSI) under National Health Mission (NHM).  Under this, financial support is provided to States / UTs for provision of free essential medicines in public health facilities based on the requirements posted by them in their Programme Implementation Plans (PIPs) and within their overall resource envelope.

Further,  Ministry  has  recommended  facility  wise  Essential  Medicines  List  (EML)  to  be  made available at the public healthcare facilities. The number of drugs under EML at various levels of Public Healthcare facilities is as below:-

- i. Sub Health Centre Health & wellness centre (SHC-HWCs)- 105
- ii. Primary Health Centre Health & wellness centre (PHC-HWCs)- 172
- iii. Community Health Centres (CHCs)- 455
- iv. District Hospital (DHs)- 544

However, States have the flexibility to add more medicines and Essential Drugs List (EDL) of States vary from State to State.

The Free Diagnostics Service Initiative, launched in 2015, enables access and use of high-quality diagnostic  services,  including  Hub  and  Spoke  Model  and  Public  Private  Partnerships.  The number of diagnostic tests in public healthcare facilities has been increased and the number of tests at different public healthcare facilities, for which, support is provided to the States under Free Diagnostic Services Initiative is as follows: 134 tests at DHs, 111 tests at the SDHs, 97 at CHCs, 63 tests at PHC level AB-HWCs and 14 tests at SHC level AB-HWCs; Tele-radiology and CT scan services are also provided free of cost.

The PM-National Dialysis Program was launched to support dialysis services at district hospitals to provide hemodialysis, with free services for BPL patients. Recently guidelines for Peritoneal Dialysis have been launched.

States are supported under NHM to provide the assistance for emergency transport of patients through National Ambulance Services (NAS) and also transport assistance under JSSK. States are also supported to provide dietary support to people visiting public healthcare facilities.