Lok Sabha Question No. 5057 (UNSTARRED), answered on 2022-04-01
Subject: Maternal and Child Health Services in Rural Areas
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Balashowry Vallabbhaneni

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

## LOK SABHA UNSTARRED PARLIAMENT QUESTION 5057 TO BE ANSWERED ON 1 ST  APRIL 2022

## MATERNAL AND CHILD HEALTH SERVICES IN RURAL AREAS

## 5057:  SHRI BALASHOWRY VALLABHANENI:

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

(a)  whether  the  Government is  aware of recent  revelation  by  Census  Office  that  children born in urban areas have much higher chance of survival compared to children born in rural areas;

(b) whether it is due to poor quality of maternal and child health services and limited access to them in rural areas;

(c) whether the Government justifies Infant Mortality Rate (IMR) of urban areas at 20/1000 and rural 34/1000 and if so, the response of the Government thereto; and

(d) the steps taken/being taken by the Government to bridge the rural-urban gap on IMR?

## ANSWER

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

## (DR. BHARATI PRAVIN PAWAR)

(a) to (d): As per Sample Registration System Report 2019 of Registrar General of India, The Infant Mortality Rate (IMR) is 20 per 1000 live births in urban areas in comparison to 34 per 1000 live births in rural areas at national level.

The primary responsibility to provide adequate healthcare services in public health facilities across  the  country  including  rural  areas  lies  with  the  State  Governments.  To  address  the healthcare challenges, particularly in rural areas, the National Rural Health Mission (NRHM) was  launched  in  2005  to  supplement  the  efforts  of  the  State/UT  governments  to  provide accessible, affordable and quality healthcare to all those who access public health facilities. Currently, NRHM is a sub-mission of National Health Mission (NHM).

This  support  under  NHM  includes  provision  of  a  host  of  free  services  related  to  maternal health, child health, adolescent health, family planning, universal immunisation programme, and for major diseases such as Tuberculosis, HIV/ AIDS, vector borne diseases like Malaria, Dengue and Kala Azar, Leprosy etc.Mobile Medical Units (MMUs) and Telemedicine are also implemented with NHM support to improve healthcare access particularly in rural areas.

As part of Ayushman Bharat, the Government is supporting the States for strengthening Sub Centres  and  Primary  Health  Centres  as  Health  and  Wellness  Centres  (AB-HWCs)  for provision  of  comprehensive  primary  health  care  that  includes  preventive  healthcare  and health  promotion  at  the  community  level  with  continuum  of  care  approach.  Further, Ayushman  Bharat,  Pradhan  Mantri  Jan  ArogyaYojana  (AB-PMJAY)  provides  health coverage  up  to  Rs.  5.00  lakh  per  family  per  year  as  per  Socio  Economic  Caste  Census (SECC).

The States  are  also  encouraged  to  adopt  flexible  norms  for  engaging  specialists  for  public health facilities.

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

The  Ministry  of  Health  and  Family  Welfare  (MoHFW)  is  supporting  all  States/UTs  in implementation of Reproductive, Maternal, New-born, Child, Adolescent health and Nutrition  (RMNCAH+N)  strategy  under  National  Health  Mission  (NHM)  based  on  the Annual Programme Implementation Plan (APIP) submitted by States/ UTs to reduce Infant Mortality Rate. The details of interventions are placed at Annexure I.

## Interventions for improving Infant Mortality Rate (IMR):

-  Facility  Based  New-born  Care: Sick  New-born  Care  Units  (SNCUs)  are established at District Hospital and Medical College level, New-born Stabilization Units (NBSUs) are established at First Referral Units (FRUs)/ Community Health Centres (CHCs) for care of sick and small babies.
-  Community  Based  care  of  New-born  and  Young  Children: Under  Home Based  New-born  Care  (HBNC)  and  Home-Based  Care  of  Young  Children (HBYC) program, home visits are performed by ASHAs to improve child rearing practices and to identify sick new-born and young children in the community.
-  Mothers' Absolute Affection (MAA): Early initiation and exclusive breastfeeding for first six months and appropriate Infant and Young Child Feeding (IYCF) practices are promoted under Mothers' Absolute Affection (MAA).
-  Social Awareness and Actions to Neutralize Pneumonia Successfully (SAANS) initiative implemented since 2019 for reduction of childhood morbidity and mortality due to Pneumonia.
-  Universal Immunization Programme (UIP) is implemented to provide vaccination  to  children  against  life  threatening  diseases  such  as  Tuberculosis, Diphtheria, Pertussis,  Polio,  Tetanus,  Hepatitis  B,  Measles,  Rubella,  Pneumonia and Meningitis caused by Haemophilus Influenzae B. The Rotavirus vaccination has  also  been  rolled  out  in  the  country  for  prevention  of  Rota-viral  diarrhoea. Pneumococcal Conjugate Vaccine (PCV) has been introduced in all the States and UTs.
-  Rashtriya Bal Swasthya Karyakaram (RBSK): Children from 0 to 18 years of age are screened for 30 health conditions (i.e. Diseases, Deficiencies, Defects and Developmental  delay)  under  Rashtriya  Bal  Swasthya  Karyakaram  (RBSK)  to improve  child  survival.  District  Early  Intervention  Centres  (DEICs)  at  district health facility level are established for confirmation and management of children screened under RBSK.
-  Nutrition Rehabilitation Centres (NRCs) are set up at public health facilities to treat  and  manage  the  children  with  Severe  Acute  Malnutrition  (SAM)  admitted with medical complications.
-  Intensified  Diarrhoea  Control  Fortnight  /  Defeat  Diarrhoea  (D2) initiative implemented for promoting ORS and Zinc use and for reducing diarrhoeal deaths.
-  Anaemia Mukt Bharat (AMB) strategy as a part of POSHAN Abhiyan aims to strengthen the existing mechanisms and foster newer strategies to tackle anaemia which  include  testing  &  treatment  of  anaemia  in  school  going  adolescents  & pregnant women, addressing non-nutritional causes of anaemia and a comprehensive communication strategy.
-  Capacity Building: Several capacity building programs of health care providers are taken up for improving maternal and child survival and health outcomes.