Lok Sabha Question No. 137 (STARRED), answered on 2023-02-10
Subject: National Health Mission
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Guman Singh Damor, Dhal Singh Bisen

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

## LOK SABHA STARRED QUESTION NO. 137 TO BE ANSWERED ON THE 10 TH  FEBRUARY, 2023

## NATIONAL HEALTH MISSION

## †*137. SHRI GUMAN SINGH DAMOR: DR. DHAL SINGH BISEN:

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

(a)  the  works  undertaken,  programmes  being  run  and  targets  set  under  the  National Health Mission (NHM) along with the details of components/works for which funds are provided/released thereunder during the last five years, State/UT-wise and districtwise in Madhya Pradesh;

(b) the details of funds allocated/utilized under NHM, State/UT-wise along with the per capita  average  amount  being  spent  on  healthcare  services  annually  in  the  country including the tribal dominated areas;

(c) whether the Government proposes to allocate more funds under NHM and if so, the details thereof, State/UT-wise;

(d)  the  details  of  the  proposals  received  from  States/UTs  under  NHM  and  the  action taken thereon during the last five years, State/UT-wise including Madhya Pradesh and Rajasthan;

(e)  whether  the  Government  proposes  to  open  Medical  Colleges  in  tribal  dominated Jhabua  and  Alirajpur  districts  on  priority  basis  as  various  communicable  and  noncommunicable diseases including Sickle Cell Anaemia, Silicosis, Fluorosis are prevalent  and  there  is  lack  of  adequate  health  facilities  and  if  so,  the  details  thereof along  with  the  time  by  which  such  medical  colleges  will  be  opened  and  if  not,  the reasons therefor; and

(f)  the  concrete  steps  taken  by  the  Government  to  streamline  the  implementation  of NHM in urban and rural areas of the country including Maharashtra?

## ANSWER

## THE MINISTER OF HEALTH AND FAMILY WELFARE (DR MANSUKH MANDAVIYA)

(a) to (  f) A Statement is laid on the Table of the House.

## STATEMENT REFERRED TO IN REPLY TO LOK SABHA STARRED QUESTION NO. 137 FOR 10 TH  FEBRUARY, 2023

- (a)  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. Some major programme under NHM are as follows:
-  Ayushman Bharat - Health & Wellness Centres (AB-HWCs) :  More than 1.56 lakh Sub- Health Centres (SHC), Primary Health Centres (PHC) and Urban Primary Health Centres (UPHC) have been transformed into Ayushman Bharat- Health and Wellness  Centres  (AB-HWCs)  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.
-  National  Free  Drugs  Initiative :  States/UTs  are  supported  to  provide  essential drugs based on the level  of  public  health  facilities  free  of  cost  to  all  who  access these facilities.
-  Free  Diagnostics  Initiatives.  (FDI) :  Under  the  initiative,  support  provided  to States/UTs to provide a set of essential diagnostics in States/UTs at various levels of care, free of cost.
-  National  Ambulance  Services  (NAS) :  Under  the  NHM,  technical  and  financial support  is  provided  for  emergency  medical  services  in  States/UTs  through  a functional  National  Ambulance  Service  (NAS)  network  linked  with  a  centralized toll-free number 108/102.
-  Mobile Medical Units (MMU) are  supported  to  facilitate  access  to  public  health care at the doorstep particularly to people living in remote, difficult, under-served and unreached areas to provide primary care services.
-  Surakshit Matritva Aashwasan (SUMAN) provides assured, dignified, respectful and quality healthcare at no cost and zero tolerance for denial of services for every woman and newborn visiting public health facilities to end all preventable maternal and newborn deaths.
-  Janani Suraksha Yojana (JSY) , a demand promotion and conditional cash transfer scheme for promoting institutional delivery.
-  Under Janani  Shishu  Suraksha  Karyakram  (JSSK), every  pregnant  woman  is entitled  to  free  delivery,  including  caesarean  section,  in  public  health  institutions along with the provision of free transport, diagnostics, medicines, other consumables & diet
-  Pradhan  Mantri  Surakshit  Matritva  Abhiyan  (PMSMA) provides  pregnant women  a  fixed  day,  free  of  cost  assured  and  quality  antenatal  check  up  by  a Specialist/Medical Officer on the 9th day of every month.
-  LaQshya  i mproves  the  quality  of  care  in  labour  room  and  maternity  operation theatres to ensure that  pregnant women receive respectful and quality care during delivery and immediate post-partum.
-  Monthly Village Health, Sanitation and Nutrition Day (VHSND) is an outreach activity  at  Anganwadi  centers  for  provision  of  maternal  and  child  care  including nutrition in convergence with the ICDS.
-  Reproductive  and  child  health  (RCH)  portal is  a  name-based  web-enabled tracking  system  for  pregnant  women  and  new  born  so  as  to  ensure  seamless provision  of  regular  and  complete  services  to  them  including  antenatal  care, institutional delivery and post-natal care.
-  Delivery  Points -  Over  25,000  'Delivery  Points'  across  the  country  have  been strengthened  in  terms  of  infrastructure,  equipment,  and  trained  manpower  for provision of comprehensive RMNCAH+N services
-  Setting  up  of  Maternal  and  Child  Health  (MCH)  Wings at  high  caseload facilities to improve the quality of care provided to mothers and children.
-  Functionalization  of  First  Referral  Units  (FRUs) by  ensuring  manpower,  blood storage units, referral linkages to improve the access to quality of care for pregnant women.
-  Further,  initiatives  such  as Mission  Parivar  Vikas,  Adolescent  Friendly  Health Clinics (AFHCs), Weekly Iron Folic Acid Supplementation (WIFS), Menstrual Hygiene Scheme, Facility Based Newborn Care (FBNC), Home Based Newborn Care Program,  Social Awareness  and  Actions to Neutralize  Pneumonia Successfully (SAANS), Home Based Care for Young Child (HBYC), Rashtriya Bal  Swasthya  Karyakram  (RBSK),  Early  Childhood  Development  (ECD), Comprehensive Abortion Care (CAC), Anemia Mukt Bharat (AMB) strategy, Nutrition Rehabilitation Centre (NRC) program are supported to increase access to  quality  healthcare  services.  Support  is  also  provided  to  strengthen  Universal Immunization programme.

Details of targets set under the National Health Mission are attached at Annexure-I.

(b) & (c) The details of State/UT-wise Central Release and utilisation under National Health Mission (NHM) for 2021-22 in the country is attached at Annexure-II. As per the latest available National Health Accounts Estimates (NHA 2018-19), the per capita government expenditure on health is Rs. 1,815. The funds are allocated to States/UTs in the  form  of  RoP  on  the  basis  of  Resource  Envelope  of  State/UT  based  on  Budget/ Revised Estimate.

(d) The details of State/UT proposals under NHM and action taken thereon during the last  five  years  including  Madhya  Pradesh  and  Rajasthan  are  available  as  Programme Implementation Plans (PIPs) on the National Health Mission website:

https://nhm.gov.in/index1.php?lang=1&level=1&sublinkid=1377&lid=744

(e) 157  Medical  colleges  have  been  approved  in  three  phases  including  14  medical colleges  in  the  State  of  Madhya  Pradesh,  of  which  06  Medical  Colleges  have  been approved  in  tribal  districts  of  the  State,  namely,  Mandla,  Shahdol,  Chhindwara, Singrauli, Ratlam & Khandwa (East Nimar). The list of Medical Colleges approved in tribal  districts  under  the  Scheme  is  at Annexure-III.  In NHM,  under  National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS), 707 District NCD Clinics, 193 District Cardiac Care Units, 268 Day Care Centres and 5,541 Community Health Centre NCD Clinics have been set up across  country.  For  Sickle  cell  Screening  in  tribal  areas,  NHM  supports  the  states  in screening of affected population by approving the proposals in annual PIP. The GoI is also supporting the states to establish the Sub Health Centres, Primary Health Centres in tribal areas as per the prescribed norm of 3,000 and 20,000 population respectively.

(f) MoHFW has issued guidelines to States/UTs for strengthening the implementation of National Health Mission in country. Few important to mention are National Health Policy 2017, to provide overall vision towards Health, Indian Public Health Standards 2022 for prescribing Standard of service from health facilities, Public Health Management Cadre guidelines to prescribe the various cadre of Health Professional in States/UTs.  MoHFW  provides  technical  and  financial  assistance  to  states  on  various health challenges in country.

****

## The major milestones to be achieved under NHM till 31.03.2026 are as follows:

|   Sl. No. | Major Milestones                                                                                                                                                                                                     | Timeframe for completion / target date   |
|-----------|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|------------------------------------------|
|         1 | Reduction of MMRfrom 113/100000 to 87/100000                                                                                                                                                                         | 31 .03.2026                              |
|         2 | Reduce U5 MRfrom 30/1000 to 23/1000; IMR from 28/ 1000 to 22/1000 , NMRfrom 20/1000 to 16/1000                                                                                                                       | 31 .03.2026                              |
|         3 | Sustain TFR-2.0 (Source: NFHS-S) at national level and achieve replacement level TFR at sub-national level                                                                                                           | 31.03.2026                               |
|         4 | Sustain Antenatal care coverage (ANC) above 90% and pregnant women receiving skilled birth attendant (SBA) during deliveries (institutional + home) above 90%                                                        | 31.03.2026                               |
|         5 | Achieve and Sustain 90% Full immunization coverage of all children by one year of age                                                                                                                                | 31.03.2026                               |
|         6 | All districts (730) in the country to have following facilities by 2026: Diagnosis and management of viral hepatitis Free dialysis services in all district hospitals NCD clinics in all district hospitals and CHCs | 31.03.2026                               |
|         7 | 40% increase in no. of dialysis sessions in public health facilities over a period of 5 years by 2026                                                                                                                | 31.03.2026                               |
|         8 | 6500 no. of UPHCs to be made operational as Health and Wellness Centers (UPHCS- HWCs)                                                                                                                                | 31.03.2026                               |
|         9 | Tuberculosis : 90% of the districts will achieve 90% of annual targets for TB case notification by 2025                                                                                                              | 31.03.2026                               |
|        10 | Perform at least 365 Lakh Cataract surgeries by 2025- 26                                                                                                                                                             | 31.03.2026                               |
|        11 | Malaria: No. of districts with API< 1/1000 population - 710                                                                                                                                                          | 31.03.2026                               |
|        12 | Leprosy: Achieve prevalence rate of less than 1 case/10,000 population in all districts                                                                                                                              | 31.03.2026                               |
|        13 | Achieve the operationalization of 1.5 lakh Ayushman Bharat- Health and Wellness Centres (AB-HWCs) Baseline: 80,348 functional HWCs as on 26.11.21                                                                    | 31.03.2026                               |
|        14 | NPCDCS Persons screened for high blood pressure and high blood sugar- 50 crore Patients under treatment for diabetes and hypertension - 2.2 crore                                                                    | 31.03.2026                               |
|        15 | Reduce OOPE by 15%                                                                                                                                                                                                   | 31.03.2026                               |

State/UT wise Central Release and Utilisation under National Health Mission (NHM) in 2021-22 (Rs. In Crore)

|   Sl. No. | State/UT                 | 2021-22 (Release)   | 2021-22 (Utilisation)   |
|-----------|--------------------------|---------------------|-------------------------|
|         1 | Andaman& Nicobar Islands | 43.68               | 31.20                   |
|         2 | Andhra Pradesh           | 1199.37             | 2448.67                 |
|         3 | Arunachal Pradesh        | 188.53              | 248.51                  |
|         4 | Assam                    | 1955.93             | 2194.36                 |
|         5 | Bihar                    | 1748.76             | 1905.35                 |
|         6 | Chandigarh               | 17.47               | 26.86                   |
|         7 | Chhattisgarh             | 969.61              | 1833.45                 |
|         8 | Dadra &Nagar Haveli      | 38.59               | 45.02                   |
|         9 | Daman &Diu               |                     |                         |
|        10 | Delhi                    | 127.37              | 237.79                  |
|        11 | Goa                      | 26.01               | 60.56                   |
|        12 | Gujarat                  | 1094.48             | 1835.81                 |
|        13 | Haryana                  | 577.07              | 879.91                  |
|        14 | Himachal Pradesh         | 555.09              | 525.09                  |
|        15 | Jammu &Kashmir           | 459.1               | 779.61                  |
|        16 | Jharkhand                | 640.18              | 1176.55                 |
|        17 | Karnataka                | 1274.71             | 2200.92                 |
|        18 | Kerala                   | 771.47              | 1230.96                 |
|        19 | Lakshadweep              | 8.41                | 7.26                    |
|        20 | Madhya Pradesh           | 2295.66             | 3714.92                 |
|        21 | Maharashtra              | 1769.67             | 4227.31                 |
|        22 | Manipur                  | 95.59               | 154.09                  |
|        23 | Meghalaya                | 282.46              | 227.08                  |
|        24 | Mizoram                  | 93.82               | 153.16                  |
|        25 | Nagaland                 | 126.66              | 192.16                  |
|        26 | Odisha                   | 1263.07             | 2587.72                 |
|        27 | Puducherry               | 21.33               | 46.36                   |
|        28 | Punjab                   | 349.21              | 918.96                  |
|        29 | Rajasthan                | 1924.95             | 3230.01                 |
|        30 | Sikkim                   | 51.86               | 46.06                   |
|        31 | Tamil Nadu               | 1631.91             | 3039.39                 |
|        32 | Tripura                  | 217.95              | 237.24                  |
|        33 | Uttar Pradesh            | 3235.46             | 6210.20                 |
|        34 | Uttarakhand              | 553.47              | 606.07                  |
|        35 | West Bengal              | 1654.26             | 2229.46                 |
|        36 | Telangana                | 725.67              | 1556.65                 |
|        37 | Ladakh                   | 44.79               | 62.81                   |

## Note:

1. The above releases relate to Central Govt. Grants & do not include State share contribution.
2. National Health Mission (NHM) comprises of two sub Missions viz. National Rural Health Mission (NRHM) and National Urban Health Mission (NUHM).
3. Expenditure includes expenditure against Central Release, State Release & unspent balances at the beginning of the year. Expenditure is as per available Financial Management Reports submitted by the States/UTs.

## Details of Medical Colleges approved in Tribal districts under the Centrally Sponsored Scheme for 'Establishment of new Medical Colleges attached with existing District/Referral Hospitals'

|   S.No. | State             | Districts               |
|---------|-------------------|-------------------------|
|       1 | Arunachal Pradesh | Papum Pare              |
|       2 | Assam             | Kokrajhar               |
|       3 | Bihar             | Jamui                   |
|       4 | Chhattisgarh      | Surguja                 |
|       5 | Chhattisgarh      | Kanker                  |
|       6 | Chhattisgarh      | Korba                   |
|       7 | Chhattisgarh      | Mahasamund              |
|       8 | Chhattisgarh      | Rajnandgaon             |
|       9 | Gujarat           | Narmada                 |
|      10 | Gujarat           | Navsari                 |
|      11 | Gujarat           | Panchmahal              |
|      12 | Himachal Pradesh  | Chamba                  |
|      13 | Jammu & Kashmir   | Leh (Ladakh)            |
|      14 | Jammu & Kashmir   | Rajouri                 |
|      15 | Jharkhand         | Pashchimi- Singhbhum    |
|      16 | Jharkhand         | Dumka                   |
|      17 | Jharkhand         | Palamu                  |
|      18 | Jharkhand         | Hazaribagh              |
|      19 | Madhya Pradesh    | Mandla                  |
|      20 | Madhya Pradesh    | Shahdol                 |
|      21 | Madhya Pradesh    | Chhindwara              |
|      22 | Madhya Pradesh    | Singrauli               |
|      23 | Madhya Pradesh    | Ratlam                  |
|      24 | Madhya Pradesh    | Khandwa (East Nimar)    |
|      25 | Maharashtra       | Nandurbar               |
|      26 | Manipur           | Churachandpur           |
|      27 | Meghalaya         | West Garo Hills         |
|      28 | Mizoram           | Aizwal                  |
|      29 | Nagaland          | Mon                     |
|      30 | Nagaland          | Kohima                  |
|      31 | Odisha            | Mayurbhanj              |
|      32 | Odisha            | Koraput                 |
|      33 | Odisha            | Kalahandi               |
|      34 | Rajasthan         | Banswara                |
|      35 | Rajasthan         | Dungarpur               |
|      36 | Rajasthan         | Sirohi                  |
|      37 | Rajasthan         | Dausa                   |
|      38 | Sikkim            | East District (Gangtok) |