Lok Sabha Question No. 549 (UNSTARRED), answered on 2022-12-09
Subject: Healthcare Facilities in Remote and Tribal Areas
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Achyutananda Samanta

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

## LOK SABHA UNSTARRED QUESTION NO. 549 TO BE ANSWERED ON THE 9 th  DECEMBER, 2022

## HEALTHCARE FACILITES IN REMOTE AND TRIBAL AREAS

## 549: SHRI ACHYUTANANDA SAMANTA:

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

- (a) whether  the  Government  has  taken/proposes  to  take  measures  to create quality healthcare infrastructure in remote locations and interior parts of the country particularly in Odisha;
- (b) if so, the details thereof; and
- (c) the  concrete  steps  taken/proposed  to  be  taken  by  the  Government  to  provide  quality health  and  wellness  services  to  the  people  residing  in  remote,  tribal  dominated  and interior locations of the country including Odisha?

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

(a) to (c): Under National Health Mission (NHM), Ministry of Health & Family Welfare, Government of India provides financial and technical support to States/UTs including settingup/upgrading  public  health  facilities  and  augmenting  health  human  resources  on  contractual especially to rural & vulnerable population, including strengthening of existing health/ medical facilities  in  remote  and  interior  parts  of  the  country  lies  with  the  respective  State/  UT Governments  health  care  facilities  in  tribal  area,  based  on  the  proposals  submitted  by States/UTs  in  their  Program  Implementation  Plans  (PIPs).  Government  of  India  provides approval  for  the  proposals  in  the  form  of  Record  of  Proceedings  (RoPs)  as  per  available resources.  The  details  of  PIPs  and  RoPs  for  the  State  of  Odisha  is  available  at  website  of National  Health  Mission  i.e.  https://nhm.gov.in  at  the  Uniform  Resource  Locator  (URL)  as under:

https://nhm.gov.in/index4.php?lang=1&level=0&linkid=45&lid=58

Further, following steps have been taken for strengthening healthcare systems to cater to future healthcare needs including remote, tribal dominated and interior parts of the country:

-  PM  Ayushman  Bharat  Health  Infrastructure  Mission  (PM-ABHIM) with  an outlay  of  Rs.  64,180  crores  till  2025-26  envisages  increased  investments  in  public health and other health reforms to provide better access to health in rural areas by i) Strengthening of Health and Wellness Centres in villages and cities for early detection of diseases; ii) Addition of new critical care-related beds at district level hospitals; iii) Support  for  Block  Public  Health  Units  (BPHU)  in  11  high  focus  States;  and  iv) Integrated district public health laboratories in all districts. The amount of 251 Cr is approved for FY 2021-22 & 2022-23 each for implementation of PM-ABHIM in the State of Odisha. Under PM-ABHIM support has been provided for establishment of 604 Sub Health Centers (SHCs), 35 Block Public Health Units (BPHUs), 9 Integrated Public Health Labs (IPHLs), 9 Critical Care Blocks (CCBs) in the FY 2021-22 and 2022-23 to the State of Odisha.
-  The Fifteenth Finance Commission (FC-XV) has recommended grants through local governments  for  specific  components  of  the  health  sector  to  the  tune  of  Rs  70,051 crores and the same have been accepted by the Union Government. These grants for health through Local Governments will be spread over the five-year period from FY 2021-22 to FY 2025-26 and will facilitate strengthening of health system at the grassroot  level.  For  the  State  of  Odisha,  the  Commission  has  recommended  Rs  2454  Cr over the five-year period from FY 2021-22 to FY 2025-26.
-  The Pradhan  Mantri  Swasthya  Suraksha  Yojana  (PMSSY) aims  at  correcting regional imbalances in the availability of affordable tertiary healthcare services and to augment facilities for quality medical education in the country. The Scheme has two components, namely, (i) Setting up of All India Institute of Medical Sciences (AIIMS); and (ii) Upgradation of existing Government Medical Colleges/ Institutions (GMCIs). So far setting up of 22  new  AIIMS  ( Establishment  of  One  new  AIIMS, Bhubaneswar  in  Odisha) and  75  projects  of  upgradation  of  GMCIs  have  been approved  under  the  Scheme  in  various  phases.  The  setting  up  of  AIIMS  contains Medical College, Nursing College, Hospital, Trauma Centre, Emergency, Blood Bank, ICU,  Diagnostic  &  Pathology,  Research  etc.  Upgradation  of  GMCIs  under  PMSSY broadly involves construction of Super Speciality Block (SSB) and/ or Trauma Centre/

or  other  facilities  and/  or  procurement  of  medical  equipment.  The  details  of  GMCIs approve under PMSSY for Odisha is as under:

|   Sl.No. | Name of the GMCIs                | Approved Infrastructure                              |
|----------|----------------------------------|------------------------------------------------------|
|        1 | MKCG Medical Collages, Berhampur | Super Specialty Block                                |
|        2 | VSS Medical Collage, Burla       | Super Specialty Block                                |
|        3 | GMCCuttack                       | State Government has request for change in location. |

-  Under  the  Centrally  Sponsored  Scheme  (CSS)  ,  'Establishment  of  new  medical colleges attached with existing district/referral hospitals', establishment of 157 medical colleges  has  been  sanctioned  out  of  which  38  medical  colleges  are  in  tribal  areas (Annexure 1) and 40 in Aspirational Districts (Annexure 2).
-  Under NHM, following types of incentives and honorarium are provided for encouraging doctors to practise in rural and remote areas of the country:
-  Hard area allowance to specialist doctors for serving in rural and remote areas and for their residential quarters so that they find it attractive to serve in public health facilities in such areas.
-  Honorarium  to  Gynecologists/  Emergency  Obstetric  Care  (EmoC)  trained, Pediatricians  &  Anesthetist/  Life  Saving  Anaesthesia  Skills  (LSAS)  trained doctors  is  also  provided  to  increase  availability  of  specialists  for  conducting Cesarean Sections in rural & remote area.
-  Incentives  like  special  incentives  for  doctors,  incentive  for  ANM  for  ensuring timely  ANC  checkup  and  recording,  incentives  for  conducting  Adolescent Reproductive and Sexual Health activities.
-  States  are  also  allowed  to  offer  negotiable  salary  to  attract  specialist  including flexibility in strategies such as 'You Quote We Pay'.
-  Non-Monetary incentives such as preferential admission in post graduate courses for staff serving in difficult areas and improving accommodation arrangement in rural areas have also been introduced under NHM.
-  Multi-skilling of doctors is supported under NHM to overcome the shortage of specialists.  Skill  upgradation  of  existing  HR  is  another  major  strategy  under NRHM for achieving improvement in health outcomes.
-  As per Section (51) of the NMC Act, 2019, the regulations of National Medical Commission of India provide for incentive of marks at the rate of upto 10% for each year service in rural/ remote/ difficult areas of the State and maximum upto 30% in NEET (PG) for admission to PG medical courses. Further, 50% medical diploma  seats  are  reserved  for  the  in-service  medical  doctors  of  the  State Government who have served in remote and/ or difficult areas.

****

## LIST OF MEDICAL COLLEGES APPROVED IN TRIBAL DISTRICTS

|   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        |

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

|   S.No | Name of the State   | Name of the Districts                                                   |
|--------|---------------------|-------------------------------------------------------------------------|
|      1 | Andhra Pradesh      | Paderu (Vishakhapatnam)                                                 |
|      2 | Assam               | Dhubri                                                                  |
|      3 | Bihar               | Purnia, Sitamarhi, Jamui                                                |
|      4 | Chhattisgarh        | Rajnandgaon, Korba, Mahasamund, Kanker                                  |
|      5 | Gujarat             | Narmada                                                                 |
|      6 | Himachal Pradesh    | Chamba                                                                  |
|      7 | Jammu &Kashmir      | Baramulla, Handwara (Distt. Kupwara)                                    |
|      8 | Jharkhand           | Dumka, Hazaribagh, Palamu (Daltonganj), Chaibasa (Singhbhum)            |
|      9 | Karnataka           | Yadgiri                                                                 |
|     10 | Madhya Pradesh      | Khandwa, Vidisha, Rajgarh, Singrauli                                    |
|     11 | Maharashtra         | Nandurbar                                                               |
|     12 | Odisha              | Bolangir, Koraput, Kalahandi                                            |
|     13 | Rajasthan           | Dholpur, Baran, Jaisalmer, Karauli, Sirohi                              |
|     14 | Uttarakhand         | Haridwar, Rudrapur, (Distt. Uddham Singh Nagar)                         |
|     15 | Uttar Pradesh       | Bahraich, Fatehpur, Siddharthnagar (Domariyaganj), Chandauli, Sonbhadra |
|     16 | Tamil Nadu          | Ramanathapuram, Virudhunagar                                            |