Lok Sabha Question No. 5050 (UNSTARRED), answered on 2022-04-01
Subject: National Rural Health Mission
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Bhavana Gawali (Patil), Sudarshan Bhagat, Bhagirath Chaudhary, Omprakash Bhupalsinh alias Pawan Rajenimbalkar

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

## LOK SABHA UNSTARRED QUESTION NO. 5050 TO BE ANSWERED ON THE 01 ST APRIL, 2022

## NATIONAL RURAL HEALTH MISSION

5050:  SHRIMATI BHAVANA PUNDALIKRAOGAWALI:

SHRI SUDARSHAN BHAGAT:

SHRI BHAGIRATH CHOUDHARY:

SHRI OMPRAKASH BHUPALSINH alias

PAWAN RAJENIMBALKAR:

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

- (a) whether NRHM seeks to provide equitable, affordable, and quality health care to the  rural population, especially the vulnerable groups and if so, the details thereof along with medical facilities being made available in rural areas of the country, State/UT-wise;
- (b) the  extent  to  which  National  Rural  Health  Mission(NRHM)  and  National  Urban  Health Mission  (NUHM)have  achieved  their  objectives  in  the  country,  State/UT-wise  including Rajasthan, Maharashtra and Jharkhand;
- (c) the  details  of  technical  and  financial  support  extended  to  States/UTs  for  strengthening healthcare system in the country under NRHM and NUHM during last five years, State/UTwise including number of pending and proposed Multi Super Speciality Hospitals there under;
- (d) the  necessary  steps  taken/being  taken  including  allocation  of  additional  funds  by  the Government for proper implementation of NRHM and NUHM in the country, State/UT-wise; and
- (e) the  other  specific  steps  taken/being  taken  for  strengthening  healthcare  systems  to  cater  to future healthcare needs in the country?

## ANSWER

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

(a)  to  (e)  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.  NHM  encompasses  its  two  Sub-Missions,  the  National  Rural  Health  Mission (NRHM) and the National Urban Health Mission (NUHM). The main programmatic components include Health System Strengthening in rural and urban areas, Reproductive-Maternal- Neonatal-

Child  and  Adolescent  Health  (RMNCH+A)  and  Communicable  and  Non-Communicable Diseases.

Public  Health  &  Hospital  is  a  State  subject,  the  responsibility  of  strengthening  public healthcare  system,  especially  to  rural  &  vulnerable  population,  including  strengthening  of existing  health/  medical  facilities  lies  with  the  respective  State/  UT  Governments.  Under National Health Mission (NHM), Ministry of Health & Family Welfare, Government of India provides  financial  and  technical  support  to  States/UTs  including  support  for  health/  medical facilities, upto District Hospital level, 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.

Government of India extends supports to states to expedite the process of creating health infrastructure as per Indian Public Health Standards. These standards include norms for services, infrastructure, human resource, diagnostics, equipment, medicines etc.

Under Ayushman Bharat, the existing  Sub-health  Centres  (SHCs)  and  Primary  Health Centres (PHCs)  are being transformed into 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. Another essential component of Ayushman Bharat Health & Wellness Centres (AB-HWCs) is the roll out of tele-consultation services through 'eSanjeevani'. This platform provides telemedicine services for the communities through a hub and spoke model which connects ABHWCs  (spokes)  to  District  Hospitals/Medical  colleges  (Hubs)  for  specialist  consultation services.  Teleconsultation  services  are  aimed  at  improving  access  of  specialist  services  to  the communities, especially in the rural areas.

Statements  showing  physical  achievements  and  progress  under  NHM  (NRHM  and NUHM)  as  per  NHM-MIS  report  (as  on  30.09.2021),  State/UT-wise  including  Rajasthan, Maharashtra and Jharkhand, are placed at Annexure-I .

Statement showing State/UT wise details of Central releases under NRHM and NUHM during the last five financial years i.e. F.Y. 2016-17 and 2020-21 are placed at Annexure-II.

Further, following steps have been taken for strengthening healthcare systems to cater to future healthcare needs:

-  'Emergency  Response  and  Health  Systems  Preparedness  Package-I  (ECRP-I)', for  Rs.  15,000  Crore,  including  Central  Component,  was  approved  by  Cabinet  to extend  support  to  all  States/UTs,  by  providing  required  technical  and  financial assistance with a 100% grant from centre for strengthening of their healthcare system including management of the COVID-19 Public Health Challenge from time to time. Support  has  been  given  to  States/UTs  under  this  package  for  the  containment  and management  of  the  pandemic,  including  for  augmentation  of  infrastructure,  oxygen supported  beds,  isolation  beds,  ICUs  &  Human  Resources,  supply  of  drugs,  etc. MOHFW  has  also  provided  in-kind  support  to  the  States/UTs,  by  procuring  and

distributing oxygen cylinders, Trunat COVID  Test Cartridges, X-pert  COVID cartridges, N 95 masks, PPE kits, Remdesivir and ventilators

-  'Emergency Response and Health Systems Preparedness Package - II (ECRP-II)' for  Rs.  23,123  Crore,  including  Central  Component,  was  approved  by  Cabinet  to extend  support  to  the  States/UTs  for  establishing  District  Paediatric  Units  (including Oxygen Supported  beds  and  ICU  beds)  in  all  the  Districts  of  the  Country.  Besides, support is also provided to increase the availability of ICU beds in Government health facilities. Maintaining buffer stock of essential medicines required for effective COVID management, in addition to provision for required drugs and diagnostics, is also being supported. Support is also available for establishing field hospitals (100 bedded or 50 bedded units), wherever required.
-  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  recommendations  of 15 th Finance  Commission  (FC-XV) w.r.t  Health  Grants through Local Governments announced in Union Budget 2021-22, addresses the gaps in Primary Healthcare facilities.
-  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 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.

## Annexure-I

## Statement showing State/UT-wise physical achievement & progress under National Health Mission (as on September, 2021)

|        |                           | InRural and Urban areas             | InRural and Urban areas    | InRural and Urban areas   | InRural and Urban areas                    | InRural and Urban areas        | In Rural areas                    | In Rural areas                        | In Rural areas                                                 |
|--------|---------------------------|-------------------------------------|----------------------------|---------------------------|--------------------------------------------|--------------------------------|-----------------------------------|---------------------------------------|----------------------------------------------------------------|
| Sl.no. | State                     | Health Human Resources Augmentation | Mobile Medical Units (MMU) | Ambulances (Operational)  | Accredited Social Health Activists (ASHAs) | Setting up Rogi Kalyan Samitis | No. of PHCs working on 24X7 basis | Functional FRUs (First Referral Unit) | Village Health Sanitation and Nutrition Committees constituted |
| 1      | Bihar                     | 14392                               | 0                          | 1202                      | 92792                                      | 1918                           | 496                               | 66                                    | 8406                                                           |
| 2      | Chhattisgarh              | 7498                                | 30                         | 625                       | 71983                                      | 1013                           | 254                               | 37                                    | 19180                                                          |
| 3      | Himachal Pradesh          | 1101                                | 12                         | 329                       | 32390                                      | 777                            | 81                                | 19                                    | 7831                                                           |
| 4      | Jammu &Kashmir            | 8074                                | 10                         | 493                       | 12623                                      | 741                            | 190                               | 51                                    | 6494                                                           |
| 5      | Jharkhand                 | 8008                                | 92                         | 2140                      | 42670                                      | 582                            | 114                               | 50                                    | 30012                                                          |
| 6      | Madhya Pradesh            | 14978                               | 0                          | 1460                      | 82021                                      | 1673                           | 771                               | 148                                   | 49567                                                          |
| 7      | Orissa                    | 6465                                | 9                          | 1131                      | 47733                                      | 1796                           | 125                               | 77                                    | 46064                                                          |
| 8      | Rajasthan                 | 10573                               | 299                        | 1335                      | 67730                                      | 3143                           | 990                               | 88                                    | 43440                                                          |
| 9      | Uttar Pradesh             | 32331                               | 170                        | 4720                      | 164523                                     | 1760                           | 439                               | 334                                   | 72880                                                          |
| 10     | Uttarakhand               | 3533                                | 16                         | 388                       | 13111                                      | 324                            | 87                                | 50                                    | 15296                                                          |
| 11     | Arunachal Pradesh         | 1911                                | 16                         | 240                       | 4082                                       | 228                            | 64                                | 13                                    | 3772                                                           |
| 12     | Assam                     | 19104                               | 130                        | 1035                      | 32546                                      | 1244                           | 314                               | 72                                    | 28149                                                          |
| 13     | Manipur                   | 1525                                | 9                          | 43                        | 4009                                       | 132                            | 66                                | 7                                     | 3878                                                           |
| 14     | Meghalaya                 | 1659                                | 4                          | 50                        | 6866                                       | 172                            | 65                                | 9                                     | 6310                                                           |
| 15     | Mizoram                   | 1244                                | 9                          | 65                        | 1170                                       | 86                             | 41                                | 15                                    | 830                                                            |
| 16     | Nagaland                  | 893                                 | 11                         | 80                        | 1992                                       | 170                            | 33                                | 14                                    | 1346                                                           |
| 17     | Sikkim                    | 360                                 | 0                          | 9                         | 658                                        | 30                             | 24                                | 3                                     | 641                                                            |
| 18     | Tripura                   | 680                                 | 0                          | 50                        | 8044                                       | 158                            | 85                                | 11                                    | 1178                                                           |
| 19     | Andhra Pradesh            | 7163                                | 67                         | 628                       | 42209                                      | 1382                           | 1144                              | 239                                   | 12940                                                          |
| 20     | Goa                       | 535                                 | 0                          | 55                        | 0                                          | 37                             | 13                                | 2                                     | 247                                                            |
| 21     | Gujarat                   | 11810                               | 74                         | 636                       | 49917                                      | 2217                           | 311                               | 130                                   | 17672                                                          |
| 22     | Haryana                   | 9166                                | 12                         | 501                       | 20125                                      | 655                            | 244                               | 27                                    | 6049                                                           |
| 23     | Karnataka                 | 14758                               | 70                         | 909                       | 47053                                      | 2938                           | 956                               | 172                                   | 26087                                                          |
| 24     | Kerala                    | 5456                                | 31                         | 315                       | 30476                                      | 1320                           | 171                               | 87                                    | 19692                                                          |
| 25     | Maharashtra               | 22937                               | 70                         | 3611                      | 69106                                      | 3553                           | 1720                              | 159                                   | 39770                                                          |
| 26     | Punjab                    | 4573                                | 33                         | 242                       | 22262                                      | 679                            | 211                               | 185                                   | 12982                                                          |
| 27     | Tamil Nadu                | 30916                               | 425                        | 1153                      | 5360                                       | 2580                           | 1316                              | 576                                   | 15015                                                          |
| 28     | Telangana                 | 11249                               | 0                          | 624                       | 32575                                      | 1075                           | 314                               | 156                                   | 10426                                                          |
| 29     | West Bengal               | 18472                               | 49                         | 3465                      | 63609                                      | 1209                           | 234                               | 154                                   | 48472                                                          |
| 30     | A&N Island                | 330                                 | 0                          | 1                         | 422                                        | 33                             | 20                                | 1                                     | 275                                                            |
| 31     | Chandigarh                | 401                                 | 0                          | 6                         | 18                                         | 32                             | 0                                 | 4                                     | 0                                                              |
| 32     | D&N Haveli and Daman &Diu | 452                                 | 3                          | 11                        | 6725                                       | 12                             | 9                                 | 8                                     | 89                                                             |
| 33     | Delhi                     | 1629                                | 2                          | 229                       |                                            | 33                             | 1                                 | 32                                    | 0                                                              |
|        |                           |                                     |                            |                           | 0                                          |                                |                                   |                                       |                                                                |
| 34     | Ladakh                    | 634                                 | 1                          | 18                        | 593                                        | 41                             | 12                                | 5                                     | 247                                                            |
| 35 36  | Lakshadweep Puducherry    | 232 413                             | 0 4                        | 0 11                      | 110 220                                    | 9 48                           | 4 23                              | 6 4                                   | 9 100                                                          |
|        | All India                 | 275455                              | 1658                       | 27810                     | 1077723                                    | 33800                          | 10942                             | 3011                                  | 555346                                                         |

Source: - NHM-MIS report as on September, 2021.

## Annexure-II

State/UT wise Central Release under National Rural Health Mission (NRHM) and National Urban Health Mission (NUHM) from F.Y. 2016-17 to 2020-21 Rs. in crore

| Sl. No.   | States                    | 2016-17        | 2016-17    | 2017-18        | 2017-18    | 2018-19        | 2018-19    | 2019-20        | 2019-20     | 2020-21        | 2020-21     |
|-----------|---------------------------|----------------|------------|----------------|------------|----------------|------------|----------------|-------------|----------------|-------------|
| Sl. No.   | States                    | NRHM           | NUHM       | NRHM           | NUHM       | NRHM           | NUHM       | NRHM           | NUHM        | NRHM           | NUHM        |
| 1         | Andaman &Nicobar Islands  | 44.90          | 0.00       | 33.94          | 0.00       | 17.71          | 0.34       | 34.43          | 0.49        | 36.37          | 0.54        |
| 2         | Andhra Pradesh            | 585.58         | 43.97      | 832.96         | 42.10      | 1012.32        | 68.97      | 1054.08        | 56.99       | 1037.21        | 60.60       |
| 3         | Arunachal Pradesh         | 159.50         | 1.10       | 258.83         | 2.86       | 216.11         | 0.81       | 185.25         | 0.70        | 241.64         | 1.40        |
| 4         | Assam                     | 1033.63        | 12.46      | 1374.95        | 17.71      | 1360.11        | 21.40      | 1721.69        | 27.55       | 1782.37        | 25.11       |
| 5         | Bihar                     | 1040.59        | 0.00       | 1557.40        | 0.00       | 1398.63        | 11.15      | 1486.65        | 24.03       | 1803.05        | 11.58       |
| 6         | Chandigarh                | 19.98          | 1.49       | 15.53          | 4.82       | 20.42          | 6.64       | 19.38          | 3.39        | 18.01          | 4.20        |
| 7         | Chhattisgarh              | 568.42         | 18.55      | 812.44         | 13.32      | 853.29         | 21.81      | 792.83         | 23.24       | 958.43         | 20.98       |
| 8         | Dadra &Nagar Haveli       | 16.99          | 0.13       | 18.25          | 0.89       | 23.14          | 0.32       | 25.14          | 0.19        |                |             |
| 9         | Daman &Diu                | 11.35          | 0.18       | 10.67          | 0.00       | 11.66          | 0.10       | 16.68          | 0.11        | 35.81          | 0.58        |
| 10        | Delhi                     | 195.88         | 46.10      | 204.35         | 64.04      | 128.54         | 25.69      | 108.63         | 30.11       | 97.20          | 28.53       |
| 11        | Goa                       | 25.64          | 0.49       | 25.68          | 0.39       | 33.38          | 0.58       | 35.12          | 0.35        | 33.83          | 0.98        |
| 12        | Gujarat                   | 820.35         | 43.31      | 1104.79        | 117.04     | 997.91         | 40.78      | 1057.35        | 53.45       | 961.08         | 44.58       |
| 13        | Haryana                   | 314.30         | 21.25      | 337.16         | 47.09      | 519.00         | 19.83      | 540.04         | 27.67       | 508.50         | 23.00       |
| 14        | Himachal Pradesh          | 212.13         | 0.36       | 370.60         | 0.29       | 344.89         | 0.54       | 504.23         | 0.61        | 440.83         | 1.11        |
| 15        | Jammu &Kashmir            | 362.42         | 0.00       | 545.65         | 4.77       | 547.05         | 9.41       | 692.49         | 9.71        | 656.39         | 11.07       |
| 16        | Jharkhand                 | 454.64         | 0.00       | 735.99         | 0.00       | 614.44         | 1.79       | 815.72         | 14.91       | 596.02         | 6.78        |
| 17        | Karnataka                 | 689.29         | 24.80      | 1263.51        | 81.99      | 1196.02        | 58.80      | 1120.14        | 53.63       | 1178.89        | 53.30       |
| 18        | Kerala                    | 434.68         | 17.68      | 572.41         | 14.11      | 865.56         | 22.34      | 814.36         | 21.78       | 766.56         | 21.66       |
| 19        | Lakshadweep               | 3.83           | 0.00       | 5.54           | 0.00       | 6.58           | 0.00       | 6.16           | 0.00        | 7.11           | 0.00        |
| 20        | Madhya Pradesh            | 1490.75        | 0.00       | 1696.56        | 0.00       | 1656.06        | 12.03      | 1684.59        | 44.14       | 2311.39        | 65.75       |
| 21        | Maharashtra               | 1181.52        | 71.03      | 1650.92        | 56.68      | 1433.52        | 132.46     | 1579.12        | 145.87      | 1686.67        | 146.92      |
| 22        | Manipur                   | 77.13          | 1.94       | 161.65         | 1.40       | 145.19         | 1.90       | 181.61         | 4.04        | 188.93         | 0.56        |
| 23        | Meghalaya                 | 158.45         | 2.68       | 185.17         | 3.85       | 140.47         | 4.59       | 135.80         | 5.37        | 199.42         | 3.21        |
| 24        | Mizoram                   | 76.33          | 4.55       | 122.58         | 4.37       | 113.91         | 4.45       | 122.06         | 5.18        | 139.05         | 4.68        |
| 25        | Nagaland                  | 91.47          | 4.45       | 132.94         | 1.92       | 127.76         | 4.35       | 119.41         | 3.82        | 184.26         | 3.95        |
| 26        | Odisha                    | 711.07         | 17.51      | 1176.64        | 39.58      | 727.26         | 16.31      | 1453.04        | 22.10       | 1597.69        | 19.94       |
| 27 28     | Puducherry Punjab         | 41.16 271.36   | 0.19 21.19 | 32.91 468.52   | 2.64 15.22 | 34.43 550.69   | 3.73 19.82 | 29.18 691.23   | 2.38 20.79  | 23.68 544.60   | 1.87 23.54  |
| 29        | Rajasthan                 | 1218.03        | 16.15      |                |            |                | 30.24      |                | 31.49       | 1964.29        | 36.29       |
|           |                           |                |            | 1615.29        | 0.00       | 1636.76        |            | 1750.34        |             | 69.03          | 1.10        |
| 30        | Sikkim                    | 40.78          | 0.94       | 54.72          | 0.68       | 44.17          | 1.05       | 52.84          | 0.71        |                |             |
|           | Tamil Nadu                |                |            | 1278.53        |            | 1388.01        |            |                |             |                | 85.39       |
| 31        |                           | 749.14         | 39.54      |                | 15.44      |                | 91.70      | 1349.28        | 74.94       | 1437.32        |             |
| 32        | Tripura                   | 121.27         | 4.49       | 155.89         | 3.10       | 178.32         | 8.20       | 233.56         | 5.91        | 223.18         | 2.73        |
| 33 34     | Uttar Pradesh Uttarakhand | 3269.48 259.04 | 45.27 6.49 | 3913.26 351.35 | 54.20 3.50 | 3802.01 291.12 | 84.69 6.06 | 4634.96 341.15 | 114.09 7.68 | 3672.27 575.98 | 100.68 7.27 |
| 35        | West Bengal               | 806.98         | 0.00       | 1250.35        | 55.02      | 1029.52        | 86.57      | 1677.47        | 71.85       | 1812.63        | 82.38       |
| 36        | Telangana                 | 375.00         | 23.08      | 468.34         | 0.00       | 661.72         | 51.71      | 924.03         | 40.31       | 624.55         | 47.33       |
| 37        | Ladakh                    | 0.00           | 0.00       | 0.00           | 0.00       | 0.00           | 0.00       | 0.00           | 0.00        | 91.62          | 0.27        |

Note:

1. National Health Mission (NHM) comprises of two sub Missions viz. National Rural Health Mission (NRHM) and National Urban Health Mission (NUHM).

2. The above releases relate to Central Govt. Grants & do not include State share contribution.

3. After the Reorganisation of the State of Jammu and Kashmir (J&K) into the Union Territory of J&K and Union Territory of Ladakh, NHM funds to the UT of Ladakh were disbursed for the first time during 2020-21.