Lok Sabha Question No. 3007 (UNSTARRED), answered on 2021-08-06
Subject: Strengthening of Rural Healthcare Services
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Vishnu Dutt Sharma, Rajendra Dhedya  Gavit, Jugal Kishore Sharma, Geeta Kora, Dileshwar Kamait

(a) to (d):

'Public Health and Hospitals' being a State subject, the primary responsibility of strengthening public healthcare system, including for provision of quality healthcare and advanced treatment and diagnostic facilities, lies with the respective State Governments.  However, the Ministry of Health  and  Family  Welfare  provides  technical  and  financial  support  is  provided  to  the States/UTs to strengthen the public healthcare delivery at public healthcare facilities.

Under  the  National  Health  Mission  (NHM),  financial  and  technical  support  is  provided  to States/UTs to strengthen their health care systems including setting-up/upgrading public health facilities and augmenting health human resource on contractual basis for provision of equitable,

## GOVERNMENT OF INDIA MINISTRY OF HEALTH AND FAMILY WELFARE

## DEPARTMENT OF HEALTH AND FAMILY WELFARE

## LOK SABHA UNSTARRED QUESTION NO. 3007 TO BE ANSWERED ON THE 06 th  AUGUST, 2021

## STRENGTHENING OF RURAL HEALTHCARE SERVICES

## 3007.   SHRI VISHNU DATT SHARMA:

SHRI RAJENDRA DHEDYA GAVIT:

SHRI JUGAL KISHORE SHARMA:

SHRIMATI GEETA KORA:

SHRI DILESHWAR KAMAIT:

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

- a) whether the Government proposes to formulate any long term perspective plan to address the existing disparities in rural health sector in the country and if so, the details thereof;
- b) the details of the programmes/schemes being implemented or proposed by the Government to bridge the gap between rural and urban areas with regard to availing quality healthcare facilities, modern treatment methods and diagnostic facilities ;
- c) whether the Government has made any study comparing the affordability of healthcare facilities in  rural  and  urban  areas  of  the  country  along  with  the  other  factors  like  ease  of access/ availability of healthcare facilities/infrastructure and manpower; and
- d) if so, the details thereof along with the steps taken to resolve the rural health problems at all levels and to improve the healthcare sector in the rural areas of the country?

## ANSWER

## THE MINISTER OF STATE IN THE MINISTRY OF HEALTH & FAMILY WELFARE

## (DR. BHARATI PRAVIN PAWAR)

affordable and quality healthcare with modern treatment methods and diagnostic facilities in the public healthcare facilities of the Country including rural areas based on requirements posed by the States in their Programme Implementation Plans (PIPs).

NHM support is also provided for provision of a range 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),  implementation  of  Free  Drugs  and Free Diagnostics Service Initiatives, PM National Dialysis Programme and implementation of National Quality Assurance Framework in all public health facilities including in rural areas.

Mobile  Medical  Units  (MMUs)  &  Tele-consultation  services  are  also  being  implemented  to improve access to healthcare particularly in rural areas.

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.  Further  Ayushman  Bharat,  Pradhan Mantri  Jan  Arogya  Yojana  (AB-PMJAY)  provides  health  coverage  up  to  Rs  5  Lakh  per family per year to around 10.74 crore poor and vulnerable families as per Socio Economic Caste Census (SECC).

Financial support is also provided to States for providing hard area allowance, performance-based incentives, providing accommodation and transport facilities in rural and remote areas including tribal areas, sponsoring training programmes, etc to engaged human resources to address the issue of shortage of doctors and specialists in the public health facilities.

In  the  15  years  of  implementation,  the  NHM  has  enabled  achievement  of  the  Millennium Development Goals (MDGs) for health. It has also led to significant improvements in maternal, new-born, and child health indicators, particularly for maternal mortality ratio, infant and under five  mortality  rates,  wherein  the  rates  of  decline  in  India  are  much  higher  than  the  global averages and these declines have accelerated during the period of implementation of NHM.

Report  of  NITI  Aayog  (March  2021),  collated  the  three  Studies  done  on  the  aspects  of Governance, Human Resources, Financing and Health outcomes(details given in Annexure) and the key findings of the Report are as follows:

-  There  has  been  significant  improvement  in  the  infrastructure  facilities  during  NHM period  with  an  increase  in  number  of  beds  in  the  government  hospitals  as  well  in  the community health centers (CHCs) from 0.44 in 2005 to 0.7 in 2019 per 1000 population. The focus on infrastructure  improvement  resulted  in  construction  of  more  than  46,000 health  facilities,  with  a  significant  increase  in  the  total  number  of  first  referral  units (FRUs) (940 in 2005 to 3057 in 2019).
-  The  number  of  doctors,  nurses  in  PHCs  and  CHCs  also  increased  during  the  NHM periods.  An  additional  200,000  healthcare  providers  (from  auxiliary  nurse-midwives (ANMs)  to  specialists'  doctors)  and  850,000  village  level  ASHA  in  rural  areas  were recruited during the NHM period.
-  There  is  strong  evidence  to  show  that  increased  infrastructure  and  increased  human resources  has  had  a  positive  effect  on  improving  the  availability,  affordability  and accessibility of maternal and child services, leading to improved antenatal and postnatal care and improved maternal and child outcomes.
-  Maternal  and  child  indicators  such  as  the  IMR,  NMR  and  MMR  have  shown  a marked improvement in the NHM period. There has been a remarkable decline in under five  mortality rate (U5MR) from 78 to 37 per thousand live births from 2005 to 2019. The infant mortality rate (IMR) declined from 58 per 1000 live births to 32 per 1000 live births during 2013-18. the neonatal mortality reduced from 38 per thousand live births to 22  per  thousand  live  births,  with  a  percentage  decline  of  42.1%  from  2005  to  2019. Maternal mortality ratio (MMR) declined by 52%, from 257 per lakh live births in 200406 to 122 per lakh live births, in 2015-17.
-  Improvements in maternal and child indicators can be attributed to better implementation of  facility  based  newborn  care  including  sick  newborn  care  units  (SNCUs),  evidenced from systematic review.
-  Various  studies  showed  that  Janani  Suraksha  Yojana  (JSY)  strategy  had  a  strong evidence in promoting institutional delivery and reducing perinatal mortality. JSSK had a role in providing free diagnostics by improving the affordability.
-  There is  strong  evidence  that  shows  that  child  health  strategies  such  as  Facility  Based Newborn Care (FBNC), Home Based Post Natal Care (HBPNC), Integrated Management of Neonatal and Childhood Illness (IMNCI) and immunization improved the availability, affordability  and  accessibility  of  child  health  services  especially  for  the  rural  and  poor community.
-  There  has  been  steady  decline  in  out-of-pocket  expenditure  for  under  five  child hospitalization, institutional deliveries and catastrophic hospitalizations as per consecutive rounds of NSS surveys. Multiple schemes launched by the government like free  transport,  free  diagnostics,  free  dialysis,  and  free  drug  /  Jan  AushadhiKendras  are initiatives that have contributed to reducing OOPE.

## Details of the three studies in NITI Aayog report of March 2021

1. The study on Governance and Human Resource issues under NHM, was conducted by IIPH-Gandhinagar  (Principal  Investigator:  Dr.DileepMavalankar)  with  help  from  two senior faculty members of IIM Ahmedabad.
2. The Study on NHM Financing was conducted by National Institute of Public Finance and Policy (Principal Investigator: Dr MitaChoudhary).
3. Impact  of  NHM  on  Health  Outcomes,  the  study  on  this  aspect  was  conducted  by Department of Community Medicine & School of Public Health Postgraduate Institute of Medical  Education  and  Research  (PGIMER)  Chandigarh  (Principal  Investigator:  Dr. Rajesh Kumar).