Lok Sabha Question No. 883 (UNSTARRED), answered on 2024-07-26
Subject: Adequate Funds to Public Sector Health Services
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Shri Subbarayan K, Com. Selvaraj V

## GOVERNMENTOFINDIA

## MINISTRYOF HEALTH AND FAMILYWELFARE DEPARTMENTOFHEALTH AND FAMILYWELFARE

## LOK SABHA

## UNSTARRED QUESTION NO. 883 TO BE ANSWERED ON 26-07-2024

## ADEQUATE FUNDS TO PUBLIC SECTOR HEALTH SERVICES

## 883. SHRI SUBBARAYAN K:

## COM. SELVARAJ V:

Will the Minister of Health and Family Welfare be pleased to state :

- (a) whether as per the National Family Health Survey report, 70 percent of health care in India

is in private sector;

- (b) if so, the details thereof and the Government's reaction thereto;
- (c) whether the Government proposes to provide adequate funds to expand public sector health services;
- (d) if so, the details thereof and the plan of the Government for expansion of the health services; and
- (e) if so, the details thereof along with time limit in this regard?

## ANSWER

## THE MINISTER OF STATE IN THE MINISTRY OF HEALTH & FAMILY WELFARE (SMT. ANUPRIYAPATEL)

(a) to (e): As per the National Family Health Survey-5 (2019-2021), 48.2% of household members generally use private sector health facilities when they get sick, whereas, 50.1% of the household members use public sector health facilities ( Annexure-I ). NFHS-5 India Report can be accessed at https://rchiips.org/NFHS/index.shtml

The National Health Mission (NHM) is a Centrally Sponsored Scheme which envisages achievement of universal access to equitable, affordable & quality health care services that are accountable and responsive to people's needs across the country. NHM encompasses its two Sub -Missions, the National Rural Health Mission (NRHM) and the National Urban Health Mission (NUHM). The main programmatic components include Health System Strengthening in rural and urban areas, Reproductive-Maternal- Neonatal-Child and Adolescent Health (RMNCH+A), and Communicable and Non-Communicable Diseases.

The primary responsibility for ensuring healthcare services lies with respective State/UT Governments. Under National Health Mission (NHM), Ministry of Health & Family Welfare, Government of India provides financial and technical support to States/UTs to strengthen their healthcare systems.

The Government of India has taken several steps to provide healthcare facility which inter-alia includes Free Drugs and Free Diagnostics initiative to provide essential drugs and diagnostics free of cost in public health facilities. Under NHM, States are supported for augmenting the referral network in the country by Advanced Life Support (ALS), Basic Life Support (BLS) and Patient Transport Vehicle (PTV) ambulance system in both rural and urban areas. Support is also provided for Mobile Medical Units (MMUs) and Telemedicine under NHM to improve healthcare affordability. MMUs conduct outreach activities to offer range of services in remote, difficult and hard to reach areas. States/ UT-wise details of Central Release under NHM for the FY 2021-22 to FY 2023-24 is given at Annexure-II.

The Government has launched four mission mode projects, namely PM-Ayushman Bharat Health Infrastructure Mission (PM-ABHIM), Ayushman Arogya Mandir erstwhile Ayushman Bharat Health & Wellness Centres (AB-HWCs), Pradhan Mantri Jan Arogya Yojana (PMJAY) and Ayushman Bharat Digital Mission (ABDM).

PM-ABHIM was launched to develop the capacities of primary, secondary, and tertiary healthcare systems, strengthen existing national institutions and create new institutions to cater to detection and cure of new and emerging diseases. PM-ABHIM is a Centrally Sponsored Scheme with some Central Sector Components. States/ UT-wise details of Central Release under PMABHIM for the FY 2021-22 to FY 2023-24 is given at Annexure-III.

The Fifteenth Finance Commission (FC-XV) has recommended grants through local governments for specific components of the health sector to the tune of Rs 70,051 Crore Grants for health and the same have been accepted by the Union Government. These grants for health through Local Governments are spread over the five-year period from FY 2021-22 to FY 202526 and will facilitate strengthening of health system at the grass-root level.

Through 1.64 lakh Ayushman Arogya Mandir, comprehensive primary healthcare is provided by strengthening Sub Health Centres (SHCs) and Primary Health Centres (PHCs). These Ayushman Arogya Mandir (AAM) provide preventive, promotive, rehabilitative and curative care for an expanded range of services encompassing reproductive and child healthcare services, Communicable diseases, Non-communicable diseases and other health issues.

Ayushman Bharat Pradhan Mantri - Jan Arogya Yojana (AB PM-JAY) provides health cover of Rs. 5 lakh per family per year for secondary and tertiary care hospitalization to approximately 55 Crore beneficiaries corresponding to 12.34 Crore families constituting the bottom 40% of India's population. Hospitals are empanelled under the scheme for providing cashless healthcare services. The budget allocation for AB PMJAY has increased from Rs. 3,975.00 Crore in 201718 (BE) to Rs. 10,200 crore in 2023-24 (BE).

The Ayushman Bharat Digital Mission (ABDM) aims to develop the backbone necessary to support the integrated digital health infrastructure of the country. It will bridge the existing gap amongst different stakeholders of Healthcare ecosystem through digital highways. As on February, 2024, 55 Crore Ayushman Bharat Health Accounts (ABHA) have been created.

The budget allocation for DoHFW has increased by 85% from Rs. 47,353 Crore in 2017-18 (BE) to Rs. 87,657 crore in 2024-25 (BE).

*****

Annexure-I

Percentage distribution of households by the source of health care which household

## members generally use when they get sick - NFHS-5 (2019-21)

| Source                          |   Total |
|---------------------------------|---------|
| Public Health Sector            |    50.1 |
| Government/ Municipal Hospital  |    20.2 |
| Government Dispensary           |     1.9 |
| UHC/UHP/UFWC                    |     1.5 |
| CHC/rural hospital/Block PHC    |    14.6 |
| PHC/additional PHC              |    10.3 |
| Sub-centre                      |     1.2 |
| Vaidya/hakim/homeopath (AYUSH)  |     0.2 |
| Other public health sector      |     0.2 |
| NGO or trust hospital/clinic    |     0.5 |
| Private health sector           |    48.2 |
| Private hospital                |    17.6 |
| Private doctor/clinic           |    28.2 |
| Private paramedic               |     0.4 |
| Vaidya/hakim/ homeopath (AYUSH) |     0.1 |
| Traditional healer              |     0.1 |
| Pharmacy/drug store             |     0.7 |
| Other private health sector     |     1   |
| Other Source                    |     1.2 |
| Shop                            |     0.1 |
| Home treatment                  |     0.1 |
| Other                           |     1   |
| Total                           |   100   |

Source: NFHS-5 National report; http://rchiips.org/nfhs/index.shtml

Annexure-II

State/UT-wise Central Release under National Health Mission for the FY 2021-22 to FY 2023-24 Rs. In Crore

|   S. No. | Name of the State/UT               | 2021-22   | 2022-23   | 2023-24   |
|----------|------------------------------------|-----------|-----------|-----------|
|        1 | Andaman and Nicobar Islands        | 43.68     | 45.26     | 37.84     |
|        2 | Andhra Pradesh                     | 1,199.37  | 1,489.45  | 1,096.01  |
|        3 | Arunachal Pradesh                  | 188.53    | 233.82    | 404.55    |
|        4 | Assam                              | 1,955.93  | 1,981.83  | 2,257.06  |
|        5 | Bihar                              | 1,748.76  | 1,586.57  | 2,032.95  |
|        6 | Chandigarh                         | 17.47     | 38.09     | 30.58     |
|        7 | Chattisgarh                        | 969.61    | 1,195.08  | 875.80    |
|        8 | Dadra &Nagar Haveli and Daman &Diu | 38.59     | 58.28     | 39.92     |
|        9 | Delhi                              | 127.37    | 35.15     | 150.54    |
|       10 | Goa                                | 26.01     | 55.42     | 48.97     |
|       11 | Gujarat                            | 1,094.48  | 1,120.06  | 1,506.96  |
|       12 | Haryana                            | 577.07    | 681.21    | 524.01    |
|       13 | Himachal Pradesh                   | 555.09    | 494.65    | 470.36    |
|       14 | Jammu &Kashmir                     | 459.10    | 651.52    | 805.22    |
|       15 | Jharkhand                          | 640.18    | 810.30    | 958.06    |
|       16 | Karnataka                          | 1,274.71  | 1,246.67  | 1,187.60  |
|       17 | Kerala                             | 771.47    | 1,036.76  | 189.15    |
|       18 | Ladakh                             | 44.79     | 94.94     | 120.44    |
|       19 | Lakshadweep                        | 8.41      | 9.97      | 3.79      |
|       20 | Madhya Pradesh                     | 2,295.66  | 2,582.10  | 2,545.68  |
|       21 | Maharashtra                        | 1,769.67  | 2,187.13  | 2,729.30  |
|       22 | Manipur                            | 95.59     | 61.40     | 169.12    |
|       23 | Meghalaya                          | 282.46    | 261.56    | 261.39    |
|       24 | Mizoram                            | 93.82     | 111.82    | 134.42    |
|       25 | Nagaland                           |           |           |           |

|    |               | 126.66   | 91.38    | 184.84   |
|----|---------------|----------|----------|----------|
| 26 | Odisha        | 1,263.07 | 1,284.69 | 1,901.77 |
| 27 | Puducherry    | 21.33    | 20.73    | 30.80    |
| 28 | Punjab        | 349.21   | 448.89   | 91.49    |
| 29 | Rajasthan     | 1,924.95 | 1,460.80 | 2,785.46 |
| 30 | Sikkim        | 51.86    | 73.30    | 68.17    |
| 31 | Tamil Nadu    | 1,631.91 | 1,652.24 | 1,996.06 |
| 32 | Telangana     | 725.67   | 683.77   | 564.93   |
| 33 | Tripura       | 217.95   | 231.90   | 264.31   |
| 34 | Uttar Pradesh | 3,235.46 | 5,133.59 | 4,928.14 |
| 35 | Uttarakhand   | 553.47   | 505.01   | 711.33   |
| 36 | West Bengal   | 1,654.26 | 1,252.32 | 890.42   |

Note: The above releases relate to Central Govt. Grants & do not include State share contribution.

Annexure-III State/UT-wise Central Release under Pradhan Mantri Ayushman Bharat Health Infrastructure Mission for the FY 2021-22 to FY 2023-24

Rs. In Crore

|   S. No. | Name of the State/UT               | 2021-22   | 2022-23   | 2023-24   |
|----------|------------------------------------|-----------|-----------|-----------|
|        1 | Andaman and Nicobar Islands        | -         | 1.11      | -         |
|        2 | Andhra Pradesh                     | 3.75      | 15.76     | 35.78     |
|        3 | Arunachal Pradesh                  | 0.56      | 0.1       | 8.83      |
|        4 | Assam                              | 57.9      | 2.26      | 91.45     |
|        5 | Bihar                              | 125.86    | 7.17      | -         |
|        6 | Chandigarh                         | -         | 4.79      | 10.38     |
|        7 | Chattisgarh                        | 11.25     | 1.34      | 32.23     |
|        8 | Dadra &Nagar Haveli and Daman &Diu | -         | 0.24      | 0.28      |
|        9 | Delhi                              | -         | -         | -         |
|       10 | Goa                                | -         | 0.06      | 3.75      |
|       11 | Gujarat                            | -         | 29.54     | 46.04     |
|       12 | Haryana                            | 11.06     | 1.31      | 17.67     |
|       13 | Himachal Pradesh                   | -         | 28.05     | 15.69     |
|       14 | Jammu &Kashmir                     | 16.11     | 1         | 44.01     |
|       15 | Jharkhand                          | 44.7      | 183.04    | 102.27    |
|       16 | Karnataka                          | 11.25     | 37.1      | 100.57    |
|       17 | Kerala                             | 3.75      | 24.89     | -         |
|       18 | Ladakh                             | -         | 0         | 0.62      |
|       19 | Lakshadweep                        | -         | 0.63      | -         |
|       20 | Madhya Pradesh                     | 22.85     | 98.7      | 228.52    |
|       21 | Maharashtra                        | 17.45     | 4.07      | 31.76     |
|       22 | Manipur                            | 4.56      | 10.92     | 13.78     |
|       23 | Meghalaya                          | 9.65      | 43.28     | 4.42      |
|       24 | Mizoram                            | 0.28      | 1.52      | 4.52      |
|       25 | Nagaland                           | 0.28      | 0.08      | 4.42      |
|       26 | Odisha                             | 32.15     | 211.46    | 174.89    |
|       27 | Puducherry                         | 0.42      | 0.19      | 2.67      |
|       28 | Punjab                             | -         | 24.16     | -         |
|       29 | Rajasthan                          | 45.37     | 83.59     | 173.06    |
|       30 | Sikkim                             | -         | 0.75      | 3.88      |
|       31 | Tamil Nadu                         | 17.45     | 150.42    | 279.36    |
|       32 | Telangana                          | 11.25     | 53.88     | 95.21     |
|       33 | Tripura                            | -         | 0.9       | 2.48      |
|       34 | Uttar Pradesh                      | 124.63    | 173.71    | 247.96    |
|       35 | Uttarakhand                        | 1.56      | 32.31     | -         |
|       36 | West Bengal                        | 9.95      | -         | 30.91     |

Note: The above releases relate to Central Govt. Grants & do not include State share contribution.