Lok Sabha Question No. 1050 (UNSTARRED), answered on 2021-12-03
Subject: National Rural Health Mission
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Rajan Baburao  Vichare

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

## LOKSABHA UNSTARRED QUESTION NO. 1050 TO BE ANSWERED ON THE 3 RD  DECEMBER, 2021

## 'NATIONAL RURAL HEALTH MISSION'

## 1050:  SHRI RAJAN VICHARE:

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

- a) whether  the  rural  population  do  not  have  access  to  adequate  medical  facilities  till  date  in most of the rural areas in the country including Maharashtra;
- b) the extent to which National Rural Health Mission (NRHM) has achieved its objectives;
- c) whether the Government proposes to set up super specialty healthcare centres in rural areas; and
- d) if so, the details thereof along with number of such centres set up during the last three years?

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

a) to (d) Public Health and Hospitals is a State Subject, the responsibility of strengthening public healthcare  system  in  rural  areas  including  setting  up  of  new  hospitals,  up  gradation  and strengthening of existing health/ medical facilities lies with the respective State/  UT Governments  including  Maharashtra.  Under  National  Health  Mission  (NHM),  technical  and financial  support  is  provided  to  States/UTs  for  strengthening  their  healthcare  systems,  upto District Hospital level, based on the proposals submitted by them in their Program Implementation Plans (PIPs), subject to availability of resources.  The  NHM  envisages achievement of universal access to equitable, affordable & quality health care services that are accountable and responsive to people's needs.

NHM is successfully achieving the following objective to provide universal  access to good quality healthcare services to the people including rural and urban areas:

## A. Improvements in Core Health Outcomes:

- 1) Reduction  in  Out-of-Pocket  Expenditure  (OOPE):  The  OOPE  has  decreased  from 58.7% in 2016-17 to 48.8% in 2017-18.
- 2) Maternal Mortality Rate (MMR) has declined from 130/lakh live births in 2014-16 to 113/lakh live births in 2016-2018.
- 3) Infant Mortality Rate (IMR), declined from 47 in 2010 to 30 in the year 2019.
- 4) Under 5 Mortality Rate (U5MR), declined from 52 in 2012 to 36 in 2018.
- 5) Total Fertility Rate (TFR) declined from 2.2 in 2015-16 to 2.0 in the year 2019-21.
- 6) The incidence of Tuberculosis per 1,00,000 population reduced from 234 in 2012 to 193 in 2019. The mortality due to TB per 1,00,000 population also reduced from 42 in 2012 to 33 in 2019.
- 7) The number of districts that achieved the target of leprosy elimination increased from 543 districts in 2011-2012 to 554 by March 2017 and to 571 districts by March 2018. The  prevalence  rate  of  Leprosy  reduced  to  less  than  1/10000  population  in  610 Districts in 2020.
- 8) For Malaria, Annual Parasitic Index (API) was sustained at levels of less than 1 and declined  from  0.89  in  2014  to  0.32  in  2018,  and  0.25,  in  2019.  Malaria  cases  and deaths declined from 21.27% and 20% respectively in 2019 from 2018.
- 9) By  the  end  of  December  2019,  94%  Kala-azar  endemic  blocks  have  achieved  the elimination target of <1 KA case per 10,000 population at block level.
- 10) The National target for sustaining Dengue related case fatality rate to less than 1% was met. Dengue related case fatality rate in 2014 was 0.3% and reduced to 0.1% in 2019.
- 11) The prevalence of blindness (visual acuity <3/60) has reduced to 0.36% in 2019) from 0.68% in 2010.
- 12) There is a 17.3% relative reduction in prevalence of tobacco use from 34.6% to 28.6% from 2009-10 to 2016-17.

## B. Increased Access to Health Services:

1. As a result of the health systems strengthening efforts of NHM, the proportion of those seeking care from public health facilities, increased from 28.3% to 32.5% in rural areas and  21.2%  to  26.2%  in  urban  areas  between  2014  to  2017.;  and  utilization  of  public health  facilities  for  institutional  deliveries  increased  from  56%  to  69.2%  in  rural  areas and from 42% to 48.3% in urban areas.

## 2. Growth in Public Health Facilities :

NHM adopts a health system approach and targets to build a network for public health facilities  with  Health  &  Wellness  Centres  at  the  grassroot  level  and  District  Hospitals, with robust referral linkage, to offer Comprehensive primary and secondary care services to citizens. The growth in the number of facilities at various levels since 2005 is given in Table 1 -

| S. No.                                             | Type of facility                                       | Status 2005   | Status 2020                 |
|----------------------------------------------------|--------------------------------------------------------|---------------|-----------------------------|
| Facilities as per classification in 2005           | Facilities as per classification in 2005               |               |                             |
| 1.                                                 | Sub Health Centres                                     | 146026        | 157921                      |
| 2.                                                 | Primary Health Centres                                 | 23236         | 30813                       |
| 3.                                                 | Community Health Centres                               | 3346          | 5649                        |
| 4.                                                 | District Hospitals                                     | 635           | 810                         |
| Facilities conceptualised and implemented underNHM | Facilities conceptualised and implemented underNHM     |               |                             |
| 5.                                                 | Ayushman Bharat Health & Wellness Centres              | -             | 80,466 28 nd November 2021) |
| 6.                                                 | Urban PHCs                                             | -             | 5,895                       |
| 7.                                                 | MCHWings                                               | -             | 650                         |
| 8.                                                 | Obstetric ICUs/HDUs                                    | -             | 278                         |
| 9.                                                 | Sick New-born Care Units (SNCU) / Neonatal ICUs (NICU) | -             | 894                         |
| 10.                                                | New-Born Stabilization Units                           | -             | 2,571                       |

|     | (NBSU)                                            |    |                                           |
|-----|---------------------------------------------------|----|-------------------------------------------|
| 11. | New Born Care Corners (NBCC)                      | -  | 20,337                                    |
| 12. | Paediatric ICUs (PICU)                            | -  | 42                                        |
| 13. | Nutritional Rehabilitation Centres (NRC)          | -  | 1072                                      |
| 14. | NCD Clinics                                       | -  | Dt NCD Clinics: 638 CHC NCD clinics: 4464 |
| 15. | Molecular Diagnostic facilities for TB            | -  | 3,470                                     |
| 16. | Geriatric wards in District Hospitals             | -  | 578                                       |
| 17. | Geriatric services in District Hospitals and CHCs | -  | DHs: 578 CHCs: 2,704                      |
| 18. | National Ambulance Service (ALS\BLS ambulances    | -  | 20,990                                    |
| 19. | Adolescent Friendly Health Clinics (AFHCs)        | -  | 7,980                                     |
| 20. | Treatment Centres for Viral Hepatitis             | -  | 792                                       |
| 21. | PMNDP Dialysis Centres                            | -  | 862                                       |
|     | Dental Care Units                                 | -  | 1,759                                     |

It  may  be  seen  from  the  above  that  implementation  of  NHM  has  not  only contributed to increase in the institutional capacities for service delivery but also has led to development of capacities for targeted interventions of the various National Programmes under the NHM.

3. Equitable  development :  There  was  also  a  sustained  focus  on  the  health  of  tribal populations,  those  in  Left  Wing  Extremism  areas,  and  the  urban  poor.  A  more  recent effort at ensuring equity in access and use, is the Aspirational district initiative, in which 115 districts across 28 states, with weak social and human development indicators have

been identified for allocation of additional resources and capacity enhancement to catch up with more progressive districts.

4. National Ambulance Services :  Under National Health Mission (NHM), Govt. of India (GOI)  provides  technical  and  financial  support  for  emergency  medical  services  in States/UTs through a functional National Ambulance Service (NAS) network linked with centralized toll-free number 108/102.
5. Human Resource Augmentation : Health care service delivery requires sufficient skilled human resources. There has been an enormous shortage of human resources in the public health care sector in the country. NHM has attempted to fill the gaps in human resources by  providing  additional  health  human  resources  to  the  States.  NHM  also  supports  colocation of AYUSH services in health facilities such as PHCs, CHCs and DHs.
6. Health Sector Reforms: The NHM enabled the design and implementation of reforms specifically related to Governance , Procurement and Technology.
7. Addressing  high  Out-of-Pocket  Expenditure  (OOPE) :  Recognising  the  need  for reducing the current high levels OOPE, and that, almost 70% of the OOPE is on account of drugs and diagnostics, the Free Drugs and Free Diagnostics Services Initiatives have been implemented under the NHM.