Lok Sabha Question No. 773 (UNSTARRED), answered on 2021-02-05
Subject: National Rural Health Mission (NRHM)
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Vijay Kumar

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

LOK SABHA UNSTARRED QUESTION NO. 773 TO BE ANSWERED ON 5 TH FEBRUARY, 2021

## NATIONAL RURAL HEALT H MISSION (NRHM)

## 773. SHRI VIJAY KUMA R:

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

- (a) salient features of National Rural Health Mission (NRHM)
- (b) the details of targets set and achieved during each of the last five years under NRHM year wise and State/UT - wise;
- (c) whet her the said Mission has been successful in centralizing various vertical health schemes and decentralization of healthcare facilities at village level; and
- (d) if so, the details thereof?

## ANSWER

## THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE (SHRI ASHWINI KUMAR CHOUBEY)

- (a)& (b):  National  Rural  Health  Mission  (NRHM)  is  a  sub - Mission  under  the  overarching National Health Mission (NHM), along with National Urban Health Mission (NUHM) as the other sub - Mission. Technical and financial support is provided to States/UTs under Natio nal Health Mission in rural and urban areas for strengthening of their healthcare systems ba the proposals submitted by them in their Programme Implementation Plans (PIPs) subject availability of resources. The targets under the National Health Mi ssion are aligned with the targets of National Health Policy (NHP) 2017 and Sustainable Development Goals (SDG) - 3. However, no State specific targets are set. A s tat ment showing targets set at the national level under National Health Mission and status of current achievements thereon is annexed.
- (c)& (d) : Yes, the integration of vertical health programmes at all levels has been one of t strategies of the National Rural Health Mission (NRHM)/National Health Mission (NHM). Th integration of vertic al health programs under one umbrella of NHM has given the States/UTs flexibility to plan, implement State specific action plans and utilize available funds a felt needs and priorities within the broad national parameters.

Under  Ayushman  Bharat ,  AB  initiative  Health  &  Wellness  Centres  (AB - HWCs),  an integrative and expanded range of health services is being provided at the primary lev -

HWCs has helped to move from a selective approach of healthcare to deliver comprehensi range of services spanning preventive, promotive, curative, rehabilitative and palliative care

Further,  various  institutional  mechanisms  under  the  Mission  such  as  District  H Society, Rogi Kalyan Samitis, Village Health Sanitation and Nutrition Committees, etc. important instruments for bringing effective integration and decentralization of programmes/schemes at all levels including at village level.

and Skilled

85.2 to 90% and

96.5%

97.3%

97%

67.3% (* The

## Annexure

| Sl. No                                 | Name of the Output/Outcome             | Committed Target of the Indicator in EFC note of 17-20                                  | Progress/ Status of Indicator year wise                                                             | Progress/ Status of Indicator year wise                                                             | Progress/ Status of Indicator year wise   | Progress/ Status of Indicator year wise   | Remarks                                                                      |
|----------------------------------------|----------------------------------------|-----------------------------------------------------------------------------------------|-----------------------------------------------------------------------------------------------------|-----------------------------------------------------------------------------------------------------|-------------------------------------------|-------------------------------------------|------------------------------------------------------------------------------|
| Sl. No                                 | Name of the Output/Outcome             | Committed Target of the Indicator in EFC note of 17-20                                  | 2017-18                                                                                             | 2018-19                                                                                             | 2019-20                                   | 2020-21                                   | Remarks                                                                      |
| A. Reproductive and Child Health (RCH) | A. Reproductive and Child Health (RCH) | A. Reproductive and Child Health (RCH)                                                  | A. Reproductive and Child Health (RCH)                                                              | A. Reproductive and Child Health (RCH)                                                              | A. Reproductive and Child Health (RCH)    | A. Reproductive and Child Health (RCH)    | A. Reproductive and Child Health (RCH)                                       |
| 1.                                     | Reduction of Maternal Mortality Ratio  | From 167/100000 to 100/ 100000                                                          | 122 (SRS 2015- 17)                                                                                  | 113 (SRS 2016- 18)                                                                                  |                                           |                                           | Latest MMRdata is as per SRS 2016-18                                         |
| 2.                                     | U5MR IMR NMR                           | U5MR- from 45/1000 to 32/1000 IMR- from 37/1000 to 26/1000 NMR- from 26/1000 to 20/1000 | U5MR: 37/1000 live births in 2017 IMR: 33/1000 live births in 2017 NMR: 23/1000 live births in 2017 | U5MR: 36/1000 live births in 2018 IMR: 32/1000 live births in 2018 NMR: 23/1000 live births in 2018 |                                           |                                           | Latest data of Child Mortality is available for the year 2018 as per SRS-RGI |
| 3.                                     | Total Fertility Rate(TFR)              | Reduce and sustain TFR from 2.3 to 2.1 at National and Sub- National level.             | 2.2 (SRS 2017)                                                                                      | 2.2 (SRS 2018)                                                                                      |                                           |                                           | Latest TFR data is as per SRS 2018                                           |
| 4.                                     | Modern Contraceptive Prevalence Rate   | By 0.5% annually from the current level of 52.1 (Track 20 Estimate) and 47.1 (DLHS-3)   | 47.8 (NFHS-4)                                                                                       |                                                                                                     |                                           |                                           |                                                                              |
| 5.                                     | Antenatal Care Coverage (ANC)          | Increase Antenatal Care Coverage from                                                   | ANC Coverage:                                                                                       | ANC Coverage:                                                                                       | ANC Coverage:                             | ANC Coverage:                             |                                                                              |

| Sl. No   | Name of the Output/Outcome                               | Committed Target of the Indicator in EFC note of 17-20                         | Progress/ Status of Indicator year wise                  | Progress/ Status of Indicator year wise                  | Progress/ Status of Indicator year wise                  | Progress/ Status of Indicator year wise                  | Remarks                                                                                                                                                                         |
|----------|----------------------------------------------------------|--------------------------------------------------------------------------------|----------------------------------------------------------|----------------------------------------------------------|----------------------------------------------------------|----------------------------------------------------------|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
|          |                                                          |                                                                                | 2017-18                                                  | 2018-19                                                  | 2019-20                                                  | 2020-21                                                  |                                                                                                                                                                                 |
| 6.       | Attendance at Birth (SBA)                                | Skilled Attendance (SBA) at Birth from 81.01 to 90%.                           | SBA: 93.7% Source: HMIS                                  | SBA: 94.6% Source: HMIS                                  | SBA: 95.5% Source: HMIS                                  | drop possibly due to COVID) SBA: 95.9% Source: HMIS      |                                                                                                                                                                                 |
|          | Full Immunization of all newborns                        | Increase Full Immunization of all newborns by one year of age from 87.5 to 90% | 86.71 (HMIS)                                             | 87.01 (HMIS)                                             | 92.83 (HMIS)                                             | 76.71 (HMIS April- October 2020)                         |                                                                                                                                                                                 |
| B. 7.    | National Vector Borne Disease Control Programme (NVBDCP) | National Vector Borne Disease Control Programme (NVBDCP)                       | National Vector Borne Disease Control Programme (NVBDCP) | National Vector Borne Disease Control Programme (NVBDCP) | National Vector Borne Disease Control Programme (NVBDCP) | National Vector Borne Disease Control Programme (NVBDCP) | National Vector Borne Disease Control Programme (NVBDCP)                                                                                                                        |
|          | Leprosy                                                  | 118 districts to achieve elimination (<1/ 10000)                               | 133                                                      | 120                                                      | 107                                                      | Data not available                                       | Increase in no. of districts endemic for Leprosy in 2017-18 and 2018- 19 is due to detection of higher number of leprosy cases through intensified active case search campaigns |
|          | Kala Azar (case less than 1/10000 at block level         | 54 (No. of endemic districts yet to achieve)                                   | 54                                                       | 14                                                       | 8                                                        | 5                                                        | Situation till Nov 2020.                                                                                                                                                        |
|          | Lymphatic Filariasis                                     | 256 districts to achieve elimination (mf<1%)                                   | 89 districts achieved                                    | 95 districts achieved                                    | 98 districts achieved                                    | 98 districts achieved                                    | Non- endemic districts are being re-mapped in                                                                                                                                   |

endemic states.

| Sl. No   | Name of the Output/Outcome                                                                                                                    | Committed Target of the Indicator in EFC note of 17-20                  | Progress/ Status of Indicator year wise                  | Progress/ Status of Indicator year wise                  | Progress/ Status of Indicator year wise                  | Progress/ Status of Indicator year wise                  | Remarks                                                                                                                                                                  |
|----------|-----------------------------------------------------------------------------------------------------------------------------------------------|-------------------------------------------------------------------------|----------------------------------------------------------|----------------------------------------------------------|----------------------------------------------------------|----------------------------------------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Sl. No   | Name of the Output/Outcome                                                                                                                    | Committed Target of the Indicator in EFC note of 17-20                  | 2017-18                                                  | 2018-19                                                  | 2019-20                                                  | 2020-21                                                  | Remarks                                                                                                                                                                  |
|          | Malaria API                                                                                                                                   | Presently API< 1                                                        | 0.64                                                     |                                                          | 0.25                                                     |                                                          | Since October 2020, the endemic districts for the ELF are 272 instead of the earlier figure of 257. Hence the denominator of the indicator has increased. Indicators are |
|          |                                                                                                                                               |                                                                         | 9.58                                                     |                                                          | 9.95                                                     |                                                          |                                                                                                                                                                          |
|          |                                                                                                                                               |                                                                         |                                                          | 0.32 9.31                                                |                                                          | - -                                                      |                                                                                                                                                                          |
| 8.       | ABER Reduce/ sustain case fatality rate for dengue                                                                                            | Presently ABER> 10 Case fatality rate for dengue at <1% (by 2018 &2019) | <1%                                                      | <1%                                                      | <1%                                                      | -                                                        | calculated annually                                                                                                                                                      |
|          | Set up one sentinel site Hospital (SSH) in each district                                                                                      | No. of SSH in 2018 and 2019 is 15 and 10 respectively                   | 609                                                      | 646                                                      | 680                                                      | 695*                                                     | *Till date                                                                                                                                                               |
| C. 9.    | National Tuberculosis Elimination Programme (NTEP) 81.4%                                                                                      | National Tuberculosis Elimination Programme (NTEP) 81.4%                | National Tuberculosis Elimination Programme (NTEP) 81.4% | National Tuberculosis Elimination Programme (NTEP) 81.4% | National Tuberculosis Elimination Programme (NTEP) 81.4% | National Tuberculosis Elimination Programme (NTEP) 81.4% | National Tuberculosis Elimination Programme (NTEP) 81.4%                                                                                                                 |
|          | Achieve and maintain a treatment success rate of90% amongst notified drug sensitive TB cases by 2020 (treatment successes rate among notified | 90%                                                                     |                                                          | 82.64%                                                   | 80.78%                                                   | 80.66% (Upto Jan- June 2020)                             |                                                                                                                                                                          |

drug sensitive TB

| Sl. No   | Name of the Output/Outcome                                                                                     | Committed Target of the Indicator in EFC note of 17-20                                                         | Progress/ Status of Indicator year wise                                                                                                                                                                         | Progress/ Status of Indicator year wise                                                                                                                                                                         | Progress/ Status of Indicator year wise                                                                                                                                                                         | Progress/ Status of Indicator year wise                                                                                                                                                                         | Remarks                                                                                                                                                                                                                                        |
|----------|----------------------------------------------------------------------------------------------------------------|----------------------------------------------------------------------------------------------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
|          |                                                                                                                |                                                                                                                | 2017-18                                                                                                                                                                                                         | 2018-19                                                                                                                                                                                                         | 2019-20                                                                                                                                                                                                         | 2020-21                                                                                                                                                                                                         |                                                                                                                                                                                                                                                |
|          | patients is 76% as per Annual Report 2016).                                                                    |                                                                                                                |                                                                                                                                                                                                                 |                                                                                                                                                                                                                 |                                                                                                                                                                                                                 |                                                                                                                                                                                                                 |                                                                                                                                                                                                                                                |
| D.       | National Programme for Control of Blindness (NPCB)                                                             | National Programme for Control of Blindness (NPCB)                                                             | National Programme for Control of Blindness (NPCB)                                                                                                                                                              | National Programme for Control of Blindness (NPCB)                                                                                                                                                              | National Programme for Control of Blindness (NPCB)                                                                                                                                                              | National Programme for Control of Blindness (NPCB)                                                                                                                                                              | National Programme for Control of Blindness (NPCB)                                                                                                                                                                                             |
| 10.      | Blindness                                                                                                      | Reduce the prevalence of blindness to 0.3% and disease burden by one fourth of 1.1% (2007).                    | The National Blindness Survey done from 2015-2019 indicates that prevalence of blindness has reduced to 0.36%. Achieved. Disease burden has been reduced by 67%.                                                | The National Blindness Survey done from 2015-2019 indicates that prevalence of blindness has reduced to 0.36%. Achieved. Disease burden has been reduced by 67%.                                                | The National Blindness Survey done from 2015-2019 indicates that prevalence of blindness has reduced to 0.36%. Achieved. Disease burden has been reduced by 67%.                                                | The National Blindness Survey done from 2015-2019 indicates that prevalence of blindness has reduced to 0.36%. Achieved. Disease burden has been reduced by 67%.                                                |                                                                                                                                                                                                                                                |
| E.       | National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) | National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) | National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS)                                                                                                  | National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS)                                                                                                  | National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS)                                                                                                  | National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS)                                                                                                  | National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS)                                                                                                                                 |
| 11.      | No. of persons screened for High BP and                                                                        | 10% increase from the previous year                                                                            |                                                                                                                                                                                                                 |                                                                                                                                                                                                                 |                                                                                                                                                                                                                 |                                                                                                                                                                                                                 | Data is taken from 6 of NPCDCS opportunistic screening                                                                                                                                                                                         |
| 11.      | High Blood sugar                                                                                               | 10% increase from the previous year                                                                            | 4,65,75,176                                                                                                                                                                                                     | 6,79,62,186                                                                                                                                                                                                     | 6,60,95,757                                                                                                                                                                                                     | 1,83,82,045 (till Sep 2020)                                                                                                                                                                                     | Data is taken from 6 of NPCDCS opportunistic screening                                                                                                                                                                                         |
| F.       | National Tobacco Control Programme (NTCP)                                                                      | National Tobacco Control Programme (NTCP)                                                                      | National Tobacco Control Programme (NTCP)                                                                                                                                                                       | National Tobacco Control Programme (NTCP)                                                                                                                                                                       | National Tobacco Control Programme (NTCP)                                                                                                                                                                       | National Tobacco Control Programme (NTCP)                                                                                                                                                                       | National Tobacco Control Programme (NTCP)                                                                                                                                                                                                      |
| 12.      | Reduce prevalence of current tobacco use                                                                       | Reduce by15% vis- vis current level of 28.6% as per Global Adult Tobacco Survey (GATS-2) of 2016-17            | Prevalence of tobacco use is measured through GATS. In the scheme period no GATS has been undertaken, therefore progress against the target is not available and will be assessed when next GATS is undertaken. | Prevalence of tobacco use is measured through GATS. In the scheme period no GATS has been undertaken, therefore progress against the target is not available and will be assessed when next GATS is undertaken. | Prevalence of tobacco use is measured through GATS. In the scheme period no GATS has been undertaken, therefore progress against the target is not available and will be assessed when next GATS is undertaken. | Prevalence of tobacco use is measured through GATS. In the scheme period no GATS has been undertaken, therefore progress against the target is not available and will be assessed when next GATS is undertaken. | However as per the 4 th round of Global Youth Tobacco Survey (GYTS-4), conducted among the 13-15-year age group students, there has been relative reduction of 41.78% over a period of 10 years, vis-à-vis GYTS-3 conducted in 2009(i.e., from |

14.6% to 8.5%).

| Sl. No   | Name of the Output/Outcome                                | Committed Target of the Indicator in EFC note of 17-20                         | Progress/ Status of Indicator year wise                                                                                                                                                               | Progress/ Status of Indicator year wise                                                                                                                                                               | Progress/ Status of Indicator year wise                                                                                                                                                               | Progress/ Status of Indicator year wise                   | Remarks                                                                                                                                                                                                                                    |
|----------|-----------------------------------------------------------|--------------------------------------------------------------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-----------------------------------------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
|          |                                                           |                                                                                | 2017-18                                                                                                                                                                                               | 2018-19                                                                                                                                                                                               | 2019-20                                                                                                                                                                                               | 2020-21                                                   |                                                                                                                                                                                                                                            |
|          |                                                           |                                                                                |                                                                                                                                                                                                       |                                                                                                                                                                                                       |                                                                                                                                                                                                       |                                                           | This estimates to 4.2% reduction every year. Using this reduction as proxy reduction among 15 years and above, it is estimated, there is decrease in 16.8% of tobacco use prevalence, which is nearly the same as target of 15% reduction. |
| G.       | Utilization of Public Health Facilities (PHFs)            | Utilization of Public Health Facilities (PHFs)                                 | Utilization of Public Health Facilities (PHFs)                                                                                                                                                        | Utilization of Public Health Facilities (PHFs)                                                                                                                                                        | Utilization of Public Health Facilities (PHFs)                                                                                                                                                        | Utilization of Public Health Facilities (PHFs)            | Utilization of Public Health Facilities (PHFs)                                                                                                                                                                                             |
| 13.      | Utilization of Public Health Facilities                   | Increase utilization by 22.5% from the then levels of25% for OPD, 38% for IPD. | Outpatient Treatment: Proportion of OPD services from Govt. facilities increased by 32%(from 25%to 33%). Achieved. Inpatient Treatment: Proportion of IPD Services from Govt. facilities increased by | Outpatient Treatment: Proportion of OPD services from Govt. facilities increased by 32%(from 25%to 33%). Achieved. Inpatient Treatment: Proportion of IPD Services from Govt. facilities increased by | Outpatient Treatment: Proportion of OPD services from Govt. facilities increased by 32%(from 25%to 33%). Achieved. Inpatient Treatment: Proportion of IPD Services from Govt. facilities increased by |                                                           | Source: 75 th Round of National Sample Survey, 2017-18.                                                                                                                                                                                    |
| H.       | 21.05% (from 38% to 46%) Out of Pocket Expenditure (OOPE) | 21.05% (from 38% to 46%) Out of Pocket Expenditure (OOPE)                      | 21.05% (from 38% to 46%) Out of Pocket Expenditure (OOPE)                                                                                                                                             | 21.05% (from 38% to 46%) Out of Pocket Expenditure (OOPE)                                                                                                                                             | 21.05% (from 38% to 46%) Out of Pocket Expenditure (OOPE)                                                                                                                                             | 21.05% (from 38% to 46%) Out of Pocket Expenditure (OOPE) | 21.05% (from 38% to 46%) Out of Pocket Expenditure (OOPE)                                                                                                                                                                                  |
| 14.      | Out of Pocket Expenditure (OOPE)                          | Reduce OOPE on health by15% from 64.2% (NHA 2014- 15)                          | 8.56% reduction to 58.7% (NHA2016- 17)                                                                                                                                                                |                                                                                                                                                                                                       |                                                                                                                                                                                                       |                                                           | The latest estimate of OOPE as a share of total health expenditure (THE) is available for                                                                                                                                                  |

2016-17