Lok Sabha Question No. 4531 (UNSTARRED), answered on 2016-08-12
Subject: Mobile Dispensaries
Ministry: HEALTH AND FAMILY WELFARE
Asked by: NISHIKANT  DUBEY

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

## LOK SABHA UNSTARRED  QUESTION NO. 4531 TO BE ANSWERED ON 12 TH AUGUST, 2016

## MOBILE DISPENSARIES

## 4531. SHRI NISHIKANT DUBEY:

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

- (a) the States/UTs where mobile medical vans/dispensaries/units are presently in operation along with the facilities available especially for the rural population therefrom;
- (b) whether the Government has received proposals from various States for setting up mobile medical vans/dispensaries/ units, if so, the details thereof and the follow - up action taken by the Government thereon, State/UT - wise including Jharkhand;
- (c) the funds allocated, released and utilized for the purpose during each of the last three years and current year, State/UTwise; and
- (d)  the  time  by  which  the  said  service  is likely  to  be  introduced  in  all  the  uncovered areas including rural and backward areas of the country?

## ANSWER THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE (SHRI FAGGAN SINGH KULASTE)

- (a): The details about number of Mobile Medical Units (MMUs) operational in States/UTs across the country during 2015 - 16 are placed at Annexure - I . Mobile Medica l units have been envisaged  to  provide  preventive,  promotive  and  curative  care  primarily  in  underserve unserved areas. Services provided by the MMUs vary from State to State. However, sugges package of services to be provided in MMU may be seen at A nnexure- II .
- (b): A  statement  showing  proposals  received  from  the  States/UTs  for  setting  up  Mobi Medical  vans/dispensaries/units  as  per  their  PIP  of  2016 - 17  is  provided  at Annexure - III . Except  for  Dadra  & Nagar  Haveli,  these  have  been  appraised  by  the  National  Programme Coordination Committee.
- (c): Funds to States under NRHM Flexipool are released as lumpsum and not for individua activity. Statements showing approval and utilization of funds during the y ears 2013 - 14, 2014 - 15 and 2015 - 16 for MMUs are given at Annexure - IV . Data for the current year is not available.
- (d): Under  National  Health  Mission  (NHM),  funds  are  provided  to  States/UTs  as  per  th requirements  projected  by  them  in  their  Programme  Implem entation  Plans  (PIPs).  NHM Framework allows MMUs to be provided to render services in unserved and underserved area However, approval of MMUs for any area is subject to states including such a proposal in PIP within their resource envelope.

## Statement Showing Number of MMUs Operational under NHM

| MMUs operational under NRHM   | MMUs operational under NRHM   | MMUs operational under NRHM   |
|-------------------------------|-------------------------------|-------------------------------|
| Sl.no.                        | State                         | 2015-16                       |
| 1                             | Bihar                         | 7                             |
| 2                             | Chhatisgarh                   | 0                             |
| 3                             | Himachal Pradesh              | 0                             |
| 4                             | Jammu & Kashmir               | 11                            |
| 5                             | Jharkhand                     | 94                            |
| 6                             | Madhya Pradesh                | 80                            |
| 7                             | Orissa                        | 0                             |
| 8                             | Rajasthan                     | 202                           |
| 9                             | Uttar Pradesh                 | 0                             |
| 10                            | Uttarakhand                   | 8                             |
| 11                            | Arunachal Pradesh             | 16                            |
| 12                            | Assam                         | 50                            |
| 13                            | Manipur                       | 9                             |
| 14                            | Meghalaya                     | 7                             |
| 15                            | Mizoram                       | 9                             |
| 16                            | Nagaland                      | 11                            |
| 17                            | Sikkim                        | 4                             |
| 18                            | Tripura                       | 4                             |
| 19                            | Andhra Pradesh                | 0                             |
| 20                            | Goa                           | 0                             |
| 21                            | Gujarat                       | 30                            |
| 22                            | Haryana                       | 9                             |
| 23                            | Karnataka                     | 0                             |
| 24                            | Kerala                        | 25                            |
| 25                            | Maharashtra                   | 40                            |
| 26                            | Punjab                        | 33                            |
| 27                            | Tamil Nadu                    | 407                           |
| 28                            | Telangana                     | 0                             |
| 29                            | West Bengal                   | 48                            |
| 30                            | A&N Island                    | 0                             |
| 31                            | Chandigarh                    | 7                             |
| 32                            | D&N Haveli                    | 1                             |
| 33                            | Daman & Diu                   | 0                             |
| 34                            | Delhi                         | 2                             |
| 35                            | Lakshadweep                   | 0                             |
| 36                            | Puducherry                    | 8                             |
| All                           | India                         | 1122                          |

As per MIS 31.03.2016

## Suggested Package of Services to be provided in MMU

| 1.   | Maternal Health                                                                     | Early diagnosis of pregnancy, Early registration, Birth planning (and preparing mothers and families in to shift to a facility at least one week before the maternity hut), Regular -Ante natal check - ups; includes S creening for Hypertension, Diabetes, Anemia, TT mother, Iron - folic Acid & Calcium Identification and referral of High Risk Pregnancy, Cases, Counselling, support and motivation for delivery, Nutr ition, Enabling Take Home Rations pregnant woman through Anganwadi Worker.                                                                                       |
|------|-------------------------------------------------------------------------------------|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| 2    | Neonatal and Infant Health ( 0 to 1 year old) Examination of low birth              | weight/preterm newborn/other newborns and management or referral as required), Counselling and support for early Breast Feeding, improved weaning Identification of congenital anomalies, other appropriate referral, Family/community education of infections, Complete Immunization, Vitamin A Supp lementation, Care of Common illnesses of new born, AGE with dehydration, pneumonia case management.                                                                                                                                                                                      |
| 3    | Child and Adolescent Health                                                         | Growth Monitoring, Prevention through IYCF counselling , to food supplementation - convergence with ICDS, De - worming, Immunization - , prompt and appropriate treatment diarrhoea/ARI, referral where needed, detection of malnutrition (SAM), referral and follow up care Prevention of anaemia, use of iodised salt; Prevention of Pre- school and School Child: Biannual Screening, Records, Eye care, -De worming; Early detection of abnormalities, delays in development and disability, Health services: personal hygiene, Detection & Anaemia and other deficiencies in children and |
| 4    | Reproductive health and Contraceptive Services                                      | Identifying eligible couples, and motivating for - delaying first child, spacing between two children, spacing methods - OCP, ECP, condoms, IUCD insertion removal, RTI treatment - Syndromic management/partner treatment, First ai d for GBV - link to referral centre support centre.                                                                                                                                                                                                                                                                                                       |
| 5    | Management of chronic Communicable Diseases                                         | Tuberculosis; HIV, leprosy, Malaria, Kala - Azar, Filariasis, vector borne disease -identification, use of RDT/prompt initiation, vec tor control measures, Sputum collection RDK + Lab testing and treatment for all vector examination, follow up medication compliance, - mass drug administration in filariasis, immunization for                                                                                                                                                                                                                                                          |
| 6    | Management of Common Communicable Diseases & Basic OPD care -(acute simple illness) | Diagnosis and management of common fevers, ARI and Urinary Tract infections, skin infections. indigestion, acute gastritis. Symptomatic care for                                                                                                                                                                                                                                                                                                                                                                                                                                               |
| 7 7  | Management of Common Non - Communicable Diseases                                    | Undertake screening for over 35 age group , at annual basis or Opportunistic Screening for hypertension, Hypertension / Diabetes mellitus - Medication, follow up diagnostics, refer for specialist referral for complications, Silicosis, Fluorosis - follow up Diagnosis of common respiratory morbidities bronchial asthma) and treatment in all 'chest symptomatic',                                                                                                                                                                                                                       |

Immunization for

Supplementation, mild

treatment of

- Azar, Filariasis, Other

(scabies, absc

diabetes and

(COPD

and

- Referral  for  gingivitis,

,  first  aid pharyngiti

|    |                              | Epilepsy - early case identification, enable specialist through referral.                                                                                                                                                                                                                                                                                                                                                                                                                                                                              |
|----|------------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
|  8 | Management of Mental Illness | Community education and Preventive measures against use and Substance Abuse, Identification of people for - Addiction Centres, Referral of cases with mental medication, counselling/support.                                                                                                                                                                                                                                                                                                                                                          |
|  9 | Dental Care                  | Education on Oral Hygiene & Substance Abuse, in schools - recognition of dental fluorosis - Referral for dental caries, oral cancers, Treatment for glossitis, fever blisters, aphthous ulcers;                                                                                                                                                                                                                                                                                                                                                        |
| 10 | Eye Care/ENT care            | School : Screening for blindness and refractive errors, screening for congenital disorders and referral, support for care seeking for blindness, other eye - first aid for nosebleeds, recognizing congenital er common ENT conditions and referral, Eye care in newborn, Screening for visual acuity, Refractive Errors, Identification & Treatment of problems - conjunctivitis; spring catarrh, xerophthalmia , first for injuries, referral, Management of common Suppurative Otitis media, (ASOM), injuries, laryngitis, rhinitis, URI, sinusitis |
| 11 | Geriatric Care               | Management of common geriatric ailments; counselling, supportive treatm ent, and Pain Management                                                                                                                                                                                                                                                                                                                                                                                                                                                       |
| 12 | Emergency Medicine           | Snake bites, scorpion stings, insect bites, dog care in poisoning and referral first aid, trauma of injury, abscess management.                                                                                                                                                                                                                                                                                                                                                                                                                        |

## Statement showing Numbers of MMUs and funds Proposed for MMUs under NHM in 2016-17

| State/UT          | Number of MMUs/MMVs/Boat Clinics Proposed (In Units)   |   Amount Proposed for MMUs/MMVs/Boat Clinics (Rs. In Lakhs) |
|-------------------|--------------------------------------------------------|-------------------------------------------------------------|
| A &NIslands       | 0                                                      |                                                        0    |
| Andhra Pradesh    | 52                                                     |                                                      905.74 |
| Arunachal Pradesh | 20                                                     |                                                      418.8  |
| Assam             | 65*                                                    |                                                     3208.88 |
| Bihar             | 80                                                     |                                                     1669.8  |
| Chandigarh        | 0                                                      |                                                        0    |
| Chhattisgarh      | 0                                                      |                                                        0    |
| D &NHaveli        | 1                                                      |                                                       17.71 |
| Daman &Diu        | 0                                                      |                                                        0    |
| Delhi             | 4                                                      |                                                       68.45 |
| Goa               | 0                                                      |                                                        0    |
| Gujarat           | 67                                                     |                                                     1389.74 |
| Haryana           | 11                                                     |                                                      154.25 |
| Himachal Pradesh  | 0                                                      |                                                        0    |
| Jammu &Kashmir    | 11                                                     |                                                      171.61 |
| Jharkhand         | 101                                                    |                                                     2940    |
| Karnataka         | 50                                                     |                                                     1143.25 |
| Kerala            | 21                                                     |                                                      111.4  |
| Lakshadweep       | 0                                                      |                                                        0    |
| Madhya Pradesh    | 144                                                    |                                                     3024    |
| Maharashtra       | 60                                                     |                                                     1377.96 |
| Manipur           | 9                                                      |                                                      512.14 |
| Meghalaya         | 4                                                      |                                                      255.31 |
| Mizoram           | 9                                                      |                                                      399.48 |
| Nagaland          | 11                                                     |                                                      191.04 |
| Odisha            | 3*                                                     |                                                       66.1  |
| Puducherry        | 4                                                      |                                                       97.3  |
| Punjab            | 33                                                     |                                                      606.86 |
| Rajasthan         | 202                                                    |                                                     7833.98 |
| Sikkim            | 3                                                      |                                                      116.7  |
| Tamil Nadu        | 395                                                    |                                                     4438.17 |
| Telangana         | 50                                                     |                                                      389.4  |
| Tripura           | 4                                                      |                                                       92.63 |
| Uttar Pradesh     | 0                                                      |                                                        0    |
| Uttarakhand       | 0                                                      |                                                        0    |
| West Bengal       | 58                                                     |                                                     2115.2  |
| Total             | 1472                                                   |                                                    33715.9  |

|                          |                   | 2013-14                                                         | 2013-14                                                         | 2013-14                                                         | 2014-15                                                         | 2015-16                                                         | 2015-16                                                         |                                                                 |
|--------------------------|-------------------|-----------------------------------------------------------------|-----------------------------------------------------------------|-----------------------------------------------------------------|-----------------------------------------------------------------|-----------------------------------------------------------------|-----------------------------------------------------------------|-----------------------------------------------------------------|
| S.No.                    | State             | National Mobile Medical Vans (Including recurring expenditures) | National Mobile Medical Vans (Including recurring expenditures) | National Mobile Medical Vans (Including recurring expenditures) | National Mobile Medical Vans (Including recurring expenditures) | National Mobile Medical Vans (Including recurring expenditures) | National Mobile Medical Vans (Including recurring expenditures) | National Mobile Medical Vans (Including recurring expenditures) |
|                          |                   | Approval                                                        | Expenditure                                                     | Approval                                                        | Expenditure                                                     | Approval                                                        | Expendi- ture                                                   |                                                                 |
| A. High Focus States     |                   |                                                                 |                                                                 |                                                                 |                                                                 |                                                                 |                                                                 |                                                                 |
| 1                        | Bihar             | 1944.00                                                         | 738.46                                                          | 1584.00                                                         | 306.03                                                          | 1306.88                                                         | 61.41                                                           |                                                                 |
| 2                        | Chattisgarh       | 720.00                                                          | 517.59                                                          | 720.00                                                          | 106.91                                                          | 3667.20                                                         | 3297.24                                                         |                                                                 |
| 3                        | Himachal Pradesh  | 0.00                                                            | 0.00                                                            | 190.08                                                          | 0.00                                                            | 0.00                                                            | 0.00                                                            |                                                                 |
| 4                        | Jammu& Kashmir    | 0.00                                                            | 287.37                                                          | 308.00                                                          | 109.57                                                          | 329.61                                                          | 75.64                                                           |                                                                 |
| 5                        | Jharkhand         | 2472.00                                                         | 2001.87                                                         | 2424.00                                                         | 1931.89                                                         | 2580.30                                                         | 1826.50                                                         |                                                                 |
| 6                        | Madhya Pradesh    | 2179.00                                                         | 1732.31                                                         | 2363.63                                                         | 1215.23                                                         | 3467.63                                                         | 1657.47                                                         |                                                                 |
| 7                        | Orissa            | 0.00                                                            | 0.00                                                            | 0.00                                                            | 0.00                                                            | 88.67                                                           | 0.00                                                            |                                                                 |
| 8                        | Rajasthan         | 3484.56                                                         | 1634.78                                                         | 3854.40                                                         | 2145.89                                                         | 3745.72                                                         | 2356.93                                                         |                                                                 |
| 9                        | Uttar Pradesh     | 0.00                                                            | 0.00                                                            | 0.00                                                            | 0.00                                                            | 27.54                                                           | 0                                                               |                                                                 |
| 10                       | Uttarakhand       | 296.55                                                          | 180.47                                                          | 270.00                                                          | 52.26                                                           | 224.00                                                          | 65.41                                                           |                                                                 |
|                          | Sub Total         | 11096.11                                                        | 7092.85                                                         | 11714.11                                                        | 5867.78                                                         | 15437.55                                                        | 9340.57                                                         |                                                                 |
| B. NE States             |                   |                                                                 |                                                                 |                                                                 |                                                                 |                                                                 |                                                                 |                                                                 |
| 11                       | Arunachal Pradesh | 0.00                                                            | 34.88                                                           | 201.60                                                          | 110.87                                                          | 201.60                                                          | 223.56                                                          |                                                                 |
| 12                       | Assam             | 703.94                                                          | 707.52                                                          | 1493.19                                                         | 785.30                                                          | 1854.95                                                         | 897.01                                                          |                                                                 |
| 13                       | Manipur           | 137.70                                                          | 81.31                                                           | 153.60                                                          | 58.97                                                           | 185.63                                                          | 81.85                                                           |                                                                 |
| 14                       | Meghalaya         | 178.85                                                          | 60.17                                                           | 178.85                                                          | 137.54                                                          | 242.85                                                          | 133.75                                                          |                                                                 |
| 15                       | Mizoram           | 205.55                                                          | 153.73                                                          | 223.15                                                          | 130.64                                                          | 229.85                                                          | 166.21                                                          |                                                                 |
| 16                       | Nagaland          | 174.51                                                          | 178.54                                                          | 178.38                                                          | 108.16                                                          | 178.96                                                          | 115.75                                                          |                                                                 |
| 17                       | Sikkim            | 84.00                                                           | 75.67                                                           | 84.00                                                           | 56.92                                                           | 84.00                                                           | 74.27                                                           |                                                                 |
| 18                       | Tripura           | 100.03                                                          | 27.45                                                           | 99.12                                                           | 54.55                                                           | 108.00                                                          | 59.76                                                           |                                                                 |
|                          | Sub Total         | 1584.58                                                         | 1319.27                                                         | 2611.89                                                         | 1442.95                                                         | 3085.84                                                         | 1752.16                                                         |                                                                 |
| C. Non-High Focus States |                   |                                                                 |                                                                 |                                                                 |                                                                 |                                                                 |                                                                 |                                                                 |
| 19                       | Andhra Pradesh    | 0.00                                                            | 820.87                                                          | 257.54                                                          | 240.23                                                          | 768.17                                                          | 416.00                                                          |                                                                 |
| 20                       | Goa               | 6.44                                                            | 9.84                                                            | 0.00                                                            | 1.99                                                            | 0.00                                                            | 0.00                                                            |                                                                 |
| 21                       | Gujarat           | 889.50                                                          | 389.96                                                          | 609.82                                                          | 376.27                                                          | 646.20                                                          | 289.20                                                          |                                                                 |
| 22                       | Haryana           | 120.82                                                          | 102.85                                                          | 148.18                                                          | 105.09                                                          | 198.01                                                          | 83.44                                                           |                                                                 |
| 23                       | Karnataka         | 0.00                                                            | 0.00                                                            | 0.00                                                            | 1.92                                                            | 200.00                                                          | 0.00                                                            |                                                                 |
| 24                       | Kerala            | 195.90                                                          | 240.30                                                          | 154.00                                                          | 189.77                                                          | 154.00                                                          | 186.02                                                          |                                                                 |
| 25                       | Maharashtra       | 1120.54                                                         | 899.59                                                          | 1385.14                                                         | 967.95                                                          | 1175.07                                                         | 913.53                                                          |                                                                 |
| 26                       | Punjab            | 360.00                                                          | 434.99                                                          | 606.86                                                          | 396.32                                                          | 606.86                                                          | 468.60                                                          |                                                                 |

Rs. In lakhs

| 27                  | Tamil Nadu                | 3604.62   | 3277.83   | 4047.64   | 4350.09   | 3745.04   | 3598.92   |
|---------------------|---------------------------|-----------|-----------|-----------|-----------|-----------|-----------|
| 28                  | Telangana                 |           |           | 153.94    | 8.64      | 803.40    | 0.00      |
| 29                  | West Bengal               | 1887.60   | 1361.69   | 1540.00   | 1003.89   | 1320.00   | 1635.00   |
|                     | Sub Total                 | 8185.42   | 7537.92   | 8903.12   | 7642.16   | 9616.75   | 7590.71   |
| D. Small States/UTs |                           |           |           |           |           |           |           |
| 30                  | Andaman & Nicobar Islands | 0.00      | 0.00      | 0.00      | 0.00      | 0.00      | 0.00      |
| 31                  | Chandigarh                | 23.91     | 42.52     | 0.00      | 0.00      | 0.00      | 0.00      |
| 32                  | Dadra & Nagar Haveli      | 0.00      | 7.13      | 16.86     | 8.43      | 16.86     | 9.90      |
| 33                  | Daman &Diu                | 0.00      | 10.98     | 0.00      | 0.88      | 0.00      | 0.00      |
| 34                  | Delhi                     | 180.23    | 0.00      | 0.00      | 98.74     | 0.00      | 0.00      |
| 35                  | Lakshadwee p              | 0.00      | 0.00      | 0.00      | 0.00      | 0.00      | 0.00      |
| 36                  | Puducherry                | 76.77     | 63.74     | 84.53     | 69.49     | 84.54     | 69.69     |
|                     | Sub Total                 | 280.91    | 124.37    | 101.39    | 177.54    | 101.40    | 79.59     |
|                     | Grand Total               | 21147.02  | 16074.41  | 23330.51  | 15130.44  | 28241.54  | 18763.02  |

## Note:

1. SPIP - State Program Implementation Plan
2. Above Expenditure includes expenditure against Central Release, State share & unspent balances at the beginning of the year.
3. The above figures are as per FMR reported by State/UTs.