Lok Sabha Question No. 926 (UNSTARRED), answered on 2021-12-03
Subject: Healthcare in Rural Areas
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Dharambir Singh

## GOVERNMENT OF INDIA MINISTRY OF HEALTH AND FAMILY WELFARE

## DEPARTMENT OF HEALTH AND FAMILY WELFARE

## LOKSABHA UNSTARRED QUESTION NO. 926 TO BE ANSWERED ON THE 3 RD  DECEMBER, 2021

## HEALTHCARE IN RURAL AREAS

## 926: SHRI DHARAMBIR SINGH:

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

- a) whether  attempts  have  been  made  to  improve  access  to  healthcare  in  rural  areas  of  the country, if so, the details thereof; and
- b) the plan adopted by the Ministry to improve the information dissemination regarding COVID-19 in the rural parts?

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

- (a) Public  Health  &  Hospital  is  a  State  subject,  the  responsibility  of  strengthening  public healthcare system especially in rural areas including setting up of new hospitals, dissemination of information regarding COVID-19, up gradation and strengthening of existing health facilities lies with  the  respective  State/  UT  Governments.  The  proposals  from  State/UT  Governments  are received in the form of Programme Implementation Plans (PIPs) under National Health Mission (NHM) and Government of India provides approval for the proposals in the form of Record of Proceedings (RoPs) as per available resources.

Under  National  Health  Mission,  States/UTs  in  their  programme  implementation  plans have been given flexibility to propose for filling of gaps measured against IPHS including that of services. This is then appraised by the National Programme Co-ordination Committee and as per its recommendations, approved by Ministry of Health and Family Welfare (MoHFW).

To  provide  assured  access  to  health  care  services,  Government  of  India  has  defined population norm for public health  facilities through  Indian Public Health Standards  (IPHS) in rural areas as stated below:

|   Sr. No. | Public health facilities   | Plain area   | Hilly/tribal/difficult area   |
|-----------|----------------------------|--------------|-------------------------------|
|         1 | SC                         | 5000         | 3000                          |
|         2 | PHC                        | 30000        | 20000                         |
|         3 | Non FRU CHC                | 1,20000      | 80000                         |
|         4 | FRU CHC                    | 500000       | NA                            |

As  per  Rural  Health  Statistics,  2019-20,  there  are  155404  Rural  Sub-Centres  including 18610 Ayushman Bharat Health & Wellness Centres - Sub Centres (AB-HWC-SCs), 24918 nos. of  Rural  Primary  Health  Centres  (PHCs)  including  16635  AB-HWC-PHCs  and  5183  nos.  of Community Health Centres (CHCs).

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.

Further,  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:

- o Strengthening  of  Health  and  Wellness  Centres  in  villages  and  cities  for  early detection of diseases.
- o Addition of new critical care-related beds at district level hospitals.
- o Support for Block Public Health Units (BPHU) in 11 high focus States
- o Integrated district public health laboratories in all districts

Government of India in implementation of National Ambulance Service under NHM for free transportation to health facilities. This service is extended to remote and rural tribal areas also. States are free to place these Ambulances at a lower population norms or as per time to care approach so that these ambulances are easily accessible to all.

States  are  encouraged  to  adopt  flexible  norms  for  engaging  specialists  at  public  health facilities.  These  include  various  mechanisms  for  'contacting  in'  and  'contracting  out'  of specialist  services,  empaneling  private  medical  facilities  to  provide  requisite  Specialists  and other  methods  of  engaging  specialists  outside  the  government  system  for  service  delivery  at public  facilities  and  the  mechanism  to  include  requests  for  these  in  the  state  Program Implementation Plans (PIP) under the NHM.

NHM provides following types of incentives and honorarium to staff for ensuring service delivery in rural and remote areas of the country:

-  Hard area allowance to specialist doctors for serving in rural and remote areas and for their residential quarters so that they find it attractive to serve in public health facilities in such areas.
-  Honorarium to Gynecologists/ Emergency Obstetric Care (EmoC) trained, Pediatricians & Anesthetist/  Life  Saving  Anaesthesia  Skills  (LSAS)  trained  doctors  is  also  provided  to increase availability of specialists for conducting Cesarean Sections in rural & remote area.
-  Incentives like special incentives for doctors, incentive for ANM for ensuring timely ANC checkup  and  recording,  incentives  for  conducting  Adolescent  Reproductive  and  Sexual Health activities.
-  States are also allowed to offer negotiable salary to attract specialist including flexibility in strategies such as 'You Quote We Pay'.

Another  essential  component  of  Ayushman  Bharat  Health  &  Wellness  Centres  (ABHWCs) 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.

b) MoHFW have made use of social media platforms, IVRS based platforms, TV, Radio, and other mass media in disseminating information regarding COVID-19 in rural areas.

MoHFW has released various guidance documents and Standard Operating Procedures (SOPs) for COVID-19 containment and management in peri-urban, rural, and tribal areas. Such guidance documents and SOPs are being amended and disseminated in a timely manner. Risk Communication materials on infection prevention and COVID appropriate behavior have been developed  and  are  available  to  be  displayed  at  strategic  locations  in  the  villages  and  in  the COVID-19 Care Centers (CCCs).

Guidance note has been shared by MoHFW regarding the role of VHSNC and MAS in COVID-19  related  activities.  These  community  platforms  (VHSNC  and  MAS)  have  been involved in generating community-level awareness on COVID-19.

Comprehensive  guidance  note  was  shared  with  States/UT  for  enabling  delivery  of essential health services  during the COVID-19 outbreak covering several important aspects of health  systems  preparedness  including  re-organisation  of  service  delivery,  human  resources, supply of medicines and diagnostics, programme management, etc.

Similarly,  the  World's  largest  vaccination  drive,  National  COVID-19  Vaccination Programme (NCVP) utilizes the infrastructure and logistic arrangements created under Universal Immunization  Programme (UIP). The  entire  immunization  programme  relies  on  the  platforms created by NHM.

Also,  the  training  of  healthcare  providers  across  the  spectrum  for  effective  COVID-19 management utilizes the NHM Training framework.