Lok Sabha Question No. 5027 (UNSTARRED), answered on 2022-04-01
Subject: Last mile delivery of Healthcare Services
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Locket Chatterjee

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

## LOK SABHA UNSTARRED QUESTION NO. 5027

## TO BE ANSWERED ON 1 ST  APRIL, 2022

## LAST MILE DELIVERY OF HEALTHCARE SERVICES

## 5027.   MS. LOCKET CHATTERJEE:

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

- (a) whether  the  Government  is  contemplating  to  ensure  last  mile  delivery  of  various health related services across the country;
- (b) if so, the details thereof;
- (c) whether the Government is prepared to handle any upcoming COVID-19 wave in the country without compromising daily economical activities; and
- (d) if so, the details thereof?

## ANSWER

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

- (a) & (b):  'Public  Health  and  Hospitals'  is  a  State  subject,  hence,  the  primary responsibility of providing healthcare services to the people of the country lies with the State  Governments.  However,  Ministry  of  Health  and  Family  Welfare,  Government  of India provides technical and financial support to the States/UTs to strengthen the public healthcare facilities reach to the last mile. Support is provided to States/UTs under the National Health Mission (NHM) for universal access to equitable, affordable & quality health  care  services  to  all  citizens  of  the  country  based  on  the  requirements  posed  by States/UTs in their Programme Implementation Plans (PIPs).

Regarding last mile delivery of various health services across the country, the Government  of  India  has  launched  Ayushman  Bharat  Yojana  in  2018  which  has  two components  namely,  Ayushman  Bharat-Health  and  Wellness  Centres  (AB-HWCs)  and Pradhan  Mantri  Jan  ArogyaYojana  (PMJAY).  Under  Ayushman  Bharat-  Health  & Wellness  Centres,  all  the  existing  sub  centres  and  primary  healthcare  centres  are upgraded and strengthened as Health and Wellness Centres (HWCs).  These centres are envisioned to provide the 12 packages of Comprehensive Primary Health Care (CPHC)

including services for maternal and child health, services to address communicable and non-communicable  diseases  and  services  for elderly and  palliative care, bringing healthcare closer to the homes of people with an expanded range of services to address needs  of  the  entire  population  in  their  area,  expanding  access,  universality,  and  equity close to the community. AB-HWCs also provisioned to provide free essential medicines and  diagnostic  services,  teleconsultation,  and  health  promotion  including  wellness activities  like  Yoga.  Under  Pradhan  Mantri  Jan  Arogya  Yojana  (PMJAY),  a  health assurance  scheme,  Government  of  India  provides  a  health  cover  of  Rs.  5.00  lakhs  per family per year for secondary and tertiary care hospitalization to cover 10.74 crores poor and vulnerable families (approximately 50 crore beneficiaries).

The Mobile Medical Units (MMU) are supported under NHM to increase the access in remote,  difficult,  and  hard  to  reach  areas.States  have  the  flexibility  to  deploy  more numbers of ambulance and MMUs in hilly, tribal, and remotest areas to provide better coverage of outreach services. Further, to ensure the quality of health services in public health facilities, Indian Public Health Standards guidelines are in place.

(c)  &  (d):  COVID-19  pandemic  has  highlighted  unprecedented  healthcare  demand, requirements  and  challenges  in  India,  particularly  in  terms  of  health  infrastructure  and laboratory  capacity.  The  schemes  namely,  India  COVID-19  Emergency  Response  and Health Systems Preparedness Package (ECRP-I), India COVID-19 Emergency Response and Health Systems Preparedness Package-Phase-II (ECRP-II), XV Finance Commission Grants (XV-FC) and PM Ayushman Bharat Health Infrastructure Mission (PM-ABHIM) has been lunched to manage and deal most efficiently the future similar pandemics in the country without compromising daily economical activities. Details are given at Annexure.

## Details of the Initiatives for any upcoming Covid-19 Wave in the Country

COVID  -19  pandemic  has  highlighted  unprecedented  healthcare  demand,  requirements  and challenges in every country globally including India. GOI has taken several initiatives to handle any upcoming wave in the country without compromising daily economical activities. Some of the key initiatives are placed below:

1. ECRP Phase-I has a Central Sector Component, in which the main activities which includes strengthening of existing health facilities, the support was expanded to establish critical care oxygen  supported  beds at  identified  Dedicated  COVID  Health  Centre  (DCHC)  and Dedicated COVID Hospital (DCH) and also isolation beds at COVID Care Centre including expanding  network  of  diagnostic  laboratories  &  testing  capacity  and  also  procurement  of essential  equipment's  for  management  of  COVID  19.  A  guideline  in  this  regard  was  also shared  with  the  states  to  expedite  the  process  of  creating  a  robust  emergency  response system.
2. Under India Covid 19 Emergency Response and Health Systems Preparedness PackagePhase-II  (ECRP-II), in  rural,  peri-urban/small  towns  and  tribal  areas,  Government  is supporting the health Infrastructure which includes establishment of dedicated Paediatric care units  in  all  the  Districts;Paediatric  Centre  of  excellence;  support  for  augmentation  of Additional Beds by provision of Prefab Units of varying capacity closer to the people (SHC, PHC and CHC level); Augmentation of 20,000 ICU beds in public healthcare facilities in the states including 20% paediatric ICU beds; Support for establishing and operating 50-bedded and 100-bedded Field Hospitals; Strengthening the referral transport system by augmentation of  existing  fleet  of  ambulances  and  Support  for  Liquid  Medical  Oxygen  (LMO)  tank  and Medical Gas Pipeline System (MGPS) in the public healthcare facilities @ at least one LMO facility per district.
3. XV-Finance Commission Health Grants through Local Government announced as part of  Union  Budget  2021-22,  for  strengthening  the  healthcare  system  at  primary  healthcare level.  The  Grants  recommends  support  for  diagnostic  infrastructure  in  Sub  Health  Centres (SHC), Primary Health Centres (PHC) and Urban Health and Wellness Centres (U-HWC), support for converting SHC and PHC to HWCs; Construction of Building-less SHCs, PHCs, CHCs, U-HWCs and polyclinics.
4. Under PM-ABHIM ,  support is provided to fill critical gaps in public health infrastructure especially  in  critical  care  facilities  and  primary  care  in  both  urban  and  rural  areas.  The support is provided for infrastructure development for 17788 SHCs to HWCs in seven High Focus  States  and  three  NE  states;  infrastructure  support  for  11024  Urban  HWCs;  3382 Block Public Health Units (BPHUs); 602 Critical Care Hospital Blocks; and one Integrated Public Health Labs in each district.