Lok Sabha Question No. 1097 (UNSTARRED), answered on 2021-12-03
Subject: Healthcare in Tribal/Naxalite Areas
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Nama Nageswara Rao

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

## LOK SABHA UNSTARRED QUESTION NO. 1097 TO BE ANSWERED ON THE 03 rd  DECEMBER, 2021

## HEALTHCARE IN TRIBAL/NAXALITE AREAS

## 1097. SHRI NAMA NAGESWARA RAO:

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

- a) whether the Government is aware of the fact that healthcare facilities in the tribal, backward,  naxalite  affected  areas  are  unavailable/totally  neglected  and  the  people living in these areas are vulnerable to various diseases;
- b) if so, the details thereof;
- c) whether  the  Government  proposes  to  launch  any  comprehensive  plan  to  provide adequate healthcare facilities in all such areas;
- d) if so, the details thereof; and
- e) if not, the reasons therefor?

## ANSWER

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

(a) to (e)

'Public  Health  and  Hospital'  is  a  State  subject,  the  primary  responsibility  of  ensuring availability  of  healthcare  facilities  including  access  to  healthcare  in  tribal  areas  lies  with respective State/UT Governments.

Under  the  National  Health  Mission  (NHM),  government  of  India  provides  financial  and technical  support  to  States/UTs  to  strengthen  their  health  care  systems  including  settingup/upgrading public health  facilities  and  augmenting  health  human  resource  on  contractual basis for provision of equitable, affordable healthcare to all its citizens particularly the poor and  vulnerable  population  in  the  tribal,  backward  &naxalite  affected  areas  based  on requirements posed by the States in their Programme Implementation Plans (PIPs).

Various interventions that are supported under NHM for better healthcare for beneficiaries in vulnerable areas including tribal, backward, naxalite affected areas are as follows;

-  Health and Wellness Centres (HWCs) are established by transforming the SHCs and PHCs, as part of the Ayushman Bharat - the flagship programme of Government of India, to improve the health care delivery.   In the current financial  year, over 80466 HWCs have been operationalized till 28th November, 2021. Of this 13636 AB-HWCs are operational in 177 tribal districts (as on 28 November 2021).
-  The population norms for setting up Health Facilities in vulnerable areas are relaxed. Against  the  population  norms  of  5,000,  30,000,  and  1,20,000  for  setting  up  of  Sub Centre,  PHC  and  CHC,  the  norm  is  3,000,  20,000  and  80,000  respectively  in vulnerable areas such as remote, tribal, desert, hard to reach areas.
-  Under NHM, States/UTs have been given flexibility to deploy Mobile Medical Units (MMUs) to  provide  a  range  of  health  care  services  for  the  populations  particularly living  in  remote,  inaccessible,  un-served  and  underserved  areas,  as  per  the  needs identified by the respective States/UTs.
-  To minimize the Out of Pocket Expenditure incurred on health services, National Free Drugs  and  Diagnostic  Service  Initiative  has  been  rolled  out.  The  medicines  are provided adequately to all health facilities, including the health facilities in vulnerable areas,  as  per  the  essential  medicines  lists  for  respective  levels  of  facilities.  Special focus is given to ensure that there are no interruptions in availability of medicines in health facilities in vulnerable areas.
-  The ASHA programme guidelines provide for recruitment of ASHA at habitation level, in  hilly,  tribal  and  difficult  areas).  Consequently,  ASHAs,  have  been  put  in  place  at habitation level (well below the national norm of one ASHA at a population of about 1000).
-  Government of India is supporting states in implementation of National Ambulances Services  under  NHM  for  free  transportation  of  sick  patients  to  the  health  facilities. States are free to place these ambulances at a lower population norm or as per time to care approach so that these ambulances are easily accessible by all.
-  Further,  all  tribal  majority  districts  whose  composite  health  index  is  below  the  State average  have  been  identified  as  High  Priority  Districts  (HPDs)  and  these  districts receive  more  resources  per  capita  under  the  NHM  as  compared  to  the  rest  of  the districts in the State. These districts receive higher per capita funding, have enhanced monitoring and focussed supportive supervision and are encouraged to adopt innovative approaches to address their peculiar health challenges.
-  States are encouraged to adopt flexible norms for engaging specialists for public health facilities by various mechanisms like 'contracting in' and 'contracting out' of specialist services under National Health Mission.NHM  provides  for  following types of incentives  and  honorarium  to  staff  for  ensuring  service  delivery  in  rural  and  remote areas in the country:
-  Honorarium to Gynecologists/ Emergency Obstetric Care (EmoC) trained, Pediatricians&Anesthetist/ Life Saving Anaesthesia Skills (LSAS) trained doctors for conducting C Sections.
-  Hard  area  allowances  and  special  packages  are  provided  to  attract  health  HR, especially medical officers and specialists, to remote and difficult areas.
-  Incentives like special incentives for doctors, incentive for ANM for ensuring timely ANC checkup and recording, incentives for conducting Adolescent Reproductive and Sexual Health (ARSH) activities etc
-  States  have  also  been  allowed  to  offer  negotiable  salaries  to  attract  Specialists including flexibility in strategies such as ''You quote, we pay".

In addition, non-Monetary incentives such as preferential admission in post graduate courses for staff serving in difficult areas and improving accommodation arrangement in rural areas have also been introduced under NHM.