Lok Sabha Question No. 282 (STARRED), answered on 2015-08-07
Subject: Mobile Medical Vans
Ministry: HEALTH AND FAMILY WELFARE
Asked by: MAHENDRA NATH PANDEY, VIRENDRA  KUMAR

**GOVERNMENT OF INDIA**

**MINISTRY OF HEALTH AND FAMILY WELFARE**

**DEPARTMENT OF HEALTH AND FAMILY WELFARE**

**LOK SABHA**

**STARRED QUESTION NO. 282**

**TO BE ANSWERED ON THE 7** **TH** **AUGUST, 2015**

**Mobile Medical Vans**

**†*282. DR. MAHENDRA NATH PANDEY:**

**DR. VIRENDRA KUMAR:**

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 populace 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;

(c) the funds allocated, approved, released and utilized for the purpose, State/ UT-wise; and

(d) the time by which the said service is likely to be introduced in all the uncovered areas of the country?

**ANSWER**

**THE MINISTER OF HEALTH AND FAMILY WELFARE**

**(SHRI JAGAT PRAKASH NADDA)**

(a) to (d)  A statement is laid on the Table of the House

**STATEMENT REFERRED TO IN REPLY TO LOK SABHA**

**STARRED QUESTION NO.282 FOR 7** **TH** **AUGUST, 2015**

1. The State/UT wise details of Mobile Medical Units (MMUs) operational in  States/UTs across the country may be seen at Annexure-I. Mobile Medical units have been envisaged to provide preventive, promotive and curative care primarily in underserved or unserved areas. Services provided by the MMUs vary from State to State. However,  suggested package of services to be provided in MMU may be seen at  Annexure-II

1. A statement showing proposals received from the States/UTs for setting up Mobile Medical vans/dispensaries/units as per their PIP of 2015-16 is provided at Annexure-III. These have been appraised by the National Programme Coordination Committee.

1. Funds to States under NRHM Flexipool are released as lumpsum and not for individual activity. Statements showing approval and utilization of funds during the years 2012-13, 2013-14 and 2014-15 for MMUs are enclosed as Annexure-IV.

1. Under National Health Mission (NHM), funds are provided to States/UTs as per the requirements projected in the Annual Programme Implementation Plans (PIPs). NHM Framework allows MMUs to be provided to provide services in unserved and underserved areas. However, approval of MMUs for any area is subject to states including such a proposal in their PIP within their resource envelope and recommendation by National Programme Coordination Committee.

**Annexure-I**

**Statement Showing Number of MMUs Operational under NHM**

| **Sl. No**   | **State/UT**      | **No. of MMUs operational under NHM**   |
|--------------|-------------------|-----------------------------------------|
| 1            | Bihar             | 7                                       |
| 2            | Chattisgarh       | 0                                       |
| 3            | Himachal Pradesh  | 0                                       |
| 4            | Jammu & Kashmir   | 11                                      |
| 5            | Jharkhand         | 101                                     |
| 6            | Madhya Pradesh    | 84                                      |
| 7            | Odisha            | 0                                       |
| 8            | Rajasthan         | 202                                     |
| 9            | Uttar Pradesh     | 0                                       |
| 10           | Uttarakhand       | 0                                       |
| 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         | 200                                     |
| 29           | West Bengal       | 32                                      |
| 30           | A & N Islands     | 0                                       |
| 31           | Chandigarh        | 5                                       |
| 32           | D & N Haveli      | 1                                       |
| 33           | Daman & Diu       | 0                                       |
| 34           | Delhi             | 2                                       |
| 35           | Lakshadweep       | 0                                       |
| 36           | Puducherry        | 8                                       |
| **TOTAL**    |                   | **1307**                                |

*As per MIS 31.03.2015*

**Annexure II**

**Suggested Package of Services to be provided in MMU**

|    |   1. | Maternal Health                                                                     | Early diagnosis of pregnancy, Early registration, MCH Cards, Birth planning (and preparing mothers and families in remote areas to shift to a facility at least one week before the due date, or to a  maternity hut), Regular Ante-natal check-ups;  includes Screening for Hypertension, Diabetes, Anemia, TT Immunization for  mother, Iron-folic Acid & Calcium Supplementation, Identification and referral of High Risk Pregnancy, Post Natal Cases, Counselling, support and motivation for  institutional delivery, Nutrition,  Enabling Take Home Rations (THR) for pregnant woman through Anganwadi Worker.                                                                         |
|----|------|-------------------------------------------------------------------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
|    |    2 | Neonatal and Infant  Health ( 0 to 1 year old)                                      | Examination of low birth weight/preterm newborn/other high risk newborns and management or referral as required), Counselling and support for early Breast Feeding, improved weaning Practices, Identification of congenital anomalies, other disabilities and appropriate referral, Family/community education of Prevention of infections, Complete Immunization, Vitamin A Supplementation, Care of Common illnesses of new born, AGE with mild dehydration, pneumonia case management.                                                                                                                                                                                                    |
|    |    3 | Child and Adolescent Health                                                         | Growth Monitoring, Prevention through IYCF counselling, access to food supplementation- convergence with ICDS, De-worming, Immunization- , prompt and appropriate treatment of diarrhoea/ARI, referral where needed, detection of Severe Acute malnutrition (SAM), referral and follow up care for SAM, Prevention of anaemia, use of iodised salt; Prevention of diarrhoea,  Pre-school and School Child: Biannual Screening, School Health Records, Eye care, De-worming; Early detection of growth abnormalities, delays in development and disability, Adolescent Health services: personal hygiene, Detection & Treatment of Anaemia and other deficiencies in children and adolescents. |
|    |    4 | Reproductive health and Contraceptive Services                                      | Identifying eligible couples, and motivating for Family Planning- delaying first child, spacing between two children,  Access to spacing methods- OCP, ECP, condoms, IUCD insertion and removal, RTI treatment- Syndromic management/partner treatment, First aid for GBV- link to referral centre and legal support centre.                                                                                                                                                                                                                                                                                                                                                                  |
|    |    5 | Management of chronic Communicable Diseases                                         | Tuberculosis; HIV, leprosy, Malaria, Kala-Azar, Filariasis, Other vector borne disease- identification, use of RDT/prompt treatment initiation, vector control measures, Sputum collection for TB, RDK + Lab testing and treatment for all vector borne disease examination, follow up medication compliance, Prevention – mass drug administration in filariasis, immunization for JE,                                                                                                                                                                                                                                                                                                       |
|    |    6 | Management of Common Communicable Diseases & Basic OPD care- (acute simple illness) | Diagnosis and management of common fevers, ARI and diarrhoea, Urinary Tract infections, skin infections. (scabies, abscess), indigestion, acute gastritis. Symptomatic care for aches and pains                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               |
| 7  |    7 | Management of Common Non- Communicable Diseases                                     | Undertake screening  for over 35 age group , at MMU on an annual basis or Opportunistic Screening for diabetes and hypertension, Hypertension / Diabetes mellitus –Medication, follow up diagnostics, refer for  specialist consultation and early referral for complications, Silicosis, Fluorosis – follow up care, Diagnosis of common respiratory morbidities (COPD and bronchial asthma) and treatment in all “chest symptomatic”, Epilepsy- early case identification, enable specialist consultation through referral.                                                                                                                                                                 |
|    |    8 | Management of Mental Illness                                                        | Community education and Preventive measures against Tobacco use and Substance Abuse, Identification of people for De-Addiction Centres, Referral of cases with mental illness, follow up medication,  counselling/support.                                                                                                                                                                                                                                                                                                                                                                                                                                                                    |
|    |    9 | Dental Care                                                                         | Education on Oral Hygiene & Substance Abuse, in community and schools- recognition of dental fluorosis- Referral for gingivitis, dental caries, oral cancers, Treatment for glossitis, candidiasis, fever blisters, aphthous ulcers;                                                                                                                                                                                                                                                                                                                                                                                                                                                          |
|    |   10 | Eye Care/ENT care                                                                   | School : Screening for blindness and refractive errors, Community screening for congenital disorders and referral, Counselling and support for care seeking for blindness, other eye disorders  -first aid for nosebleeds,  recognizing congenital deafness,  other common ENT conditions and referral,  Eye care in newborn, Screening for visual acuity, cataract and for Refractive Errors, Identification & Treatment of common eye problems- conjunctivitis; spring catarrh, xerophthalmia, first aid for injuries, referral, Management of common colds, Acute Suppurative Otitis media, (ASOM), injuries, pharyngitis, laryngitis, rhinitis, URI, sinusitis                        |
|    |   11 | Geriatric Care                                                                      | Management of common geriatric ailments; counselling, supportive treatment, and Pain Management                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               |
|    |   12 | Emergency Medicine                                                                  | Snake bites, scorpion stings, insect bites, dog bites, Stabilization care in poisoning and referral first aid, trauma of any cause, Minor injury, abscess management.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         |

**Annexure-III**

**Statement showing Numbers of MMUs and funds Proposed for MMUs under NHM in 2015-16** **(Rs. In Lakhs)**

| **State/UT**            | **Number of MMUs/MMVs/Boat Clinics Proposed**   | **Amount Proposed for MMUs/MMVs/Boat Clinics**   |
|-------------------------|-------------------------------------------------|--------------------------------------------------|
| **A & N Islands**   | 0                                               | 0.00                                             |
| **Andhra Pradesh**      | 116                                             | 6018.50                                          |
| **Arunachal Pradesh**   | 19                                              | 407.40                                           |
| **Assam**               | 97                                              | 4740.91                                          |
| **Bihar**               | 80                                              | 1819.20                                          |
| **Chandigarh**          | 7                                               | 53.44                                            |
| **Chhattisgarh**        | 0                                               | 0.00                                             |
| **D & N Haveli**    | 1                                               | 16.86                                            |
| **Daman & Diu**     | 0                                               | 0.00                                             |
| **Delhi**               | 4                                               | 68.70                                            |
| **Goa**                 | 0                                               | 0.00                                             |
| **Gujarat**             | 72                                              | 715.80                                           |
| **Haryana**             | 9                                               | 241.96                                           |
| **Himachal Pradesh**    | 0                                               | 0.00                                             |
| **Jammu & Kashmir** | 11                                              | 926.34                                           |
| **Jharkhand**           | 101                                             | 3225.95                                          |
| **Karnataka**           | 0                                               | 0.00                                             |
| **Kerala**              | 21                                              | 341.38                                           |
| **Lakshadweep**         | 0                                               | 0.00                                             |
| **Madhya Pradesh**      | 144                                             | 3863.14                                          |
| **Maharashtra**         | 51                                              | 1052.23                                          |
| **Manipur**             | 9                                               | 190.59                                           |
| **Meghalaya**           | 7                                               | 196.74                                           |
| **Mizoram**             | 9                                               | 558.33                                           |
| **Nagaland**            | 11                                              | 192.16                                           |
| **Odisha**              | 0                                               | 0.00                                             |
| **Puducherry**          | 4                                               | 84.54                                            |
| **Punjab**              | 33                                              | 606.86                                           |
| **Rajasthan**           | 202                                             | 4296.59                                          |
| **Sikkim**              | 3                                               | 124.10                                           |
| **Tamil Nadu**          | 407                                             | 7800.09                                          |
| **Telangana**           | 100                                             | 3010.00                                          |
| **Tripura**             | 4                                               | 174.00                                           |
| **Uttar Pradesh**       | 283                                             | 1086.72                                          |
| **Uttarakhand**         | 15                                              | 270.00                                           |
| **West Bengal**         | 55                                              | 2059.20                                          |
| **Total**               | **1875**                                        | **44141.73**                                     |

**Annexure IV**

**Statement showing the SPIP Approval & Expenditure under MMU for the  F.Ys 2012-13 to 2014-15** **(Rs. In Crore)**

|                              | **States/ UTs**      | **2012-13**       |                 | **2013-14**       |                 | **2014-15**       |                 |
|------------------------------|----------------------|-------------------|-----------------|-------------------|-----------------|-------------------|-----------------|
|                              |                      | **SPIP Approval** | **Expenditure** | **SPIP Approval** | **Expenditure** | **SPIP Approval** | **Expenditure** |
| **A. High Focus States**     |                      |                   |                 |                   |                 |                   |                 |
| 1                            | Bihar                | 24.90             | 8.41            | 19.44             | 7.38            | 15.84             | 3.06            |
| 2                            | Chhatisgarh          | 0.60              | 2.04            | 7.20              | 5.18            | 7.20              | 1.07            |
| 3                            | Himachal             | 3.78              | 0.00            | 0.00              | 0.00            | 1.90              | 0.00            |
| 4                            | J & K                | 2.41              | 0.69            | 0.00              | 2.87            | 3.08              | 1.10            |
| 5                            | Jharkhand            | 24.62             | 20.35           | 24.72             | 20.02           | 24.24             | 19.32           |
| 6                            | Madhya Pradesh       | 14.66             | 16.17           | 21.79             | 17.32           | 23.64             | 12.15           |
| 7                            | Orissa               | 0.00              | 0.00            | 0.00              | 0.00            | 0.00              | 0.00            |
| 8                            | Rajasthan            | 28.79             | 11.01           | 34.85             | 16.35           | 38.54             | 21.46           |
| 9                            | Uttar Pradesh        | 76.95             | 0.00            | 0.00              | 0.00            | 0.00              | 0.00            |
| 10                           | Uttarakhand          | 3.94              | 1.50            | 2.97              | 1.80            | 2.70              | 0.52            |
|                              | **Sub Total**        | **180.64**        | **60.17**       | **110.96**        | **70.93**       | **117.14**        | **58.68**       |
| **B. NE States**             |                      |                   |                 |                   |                 |                   |                 |
| 11                           | Arunachal Pradesh    | 1.01              | 0.52            | 0.00              | 0.35            | 2.02              | 1.11            |
| 12                           | Assam                | 12.34             | 7.27            | 7.04              | 7.08            | 14.93             | 7.85            |
| 13                           | Manipur              | 1.81              | 1.22            | 1.38              | 0.81            | 1.54              | 0.59            |
| 14                           | Meghalya             | 1.79              | 0.46            | 1.79              | 0.60            | 1.79              | 1.38            |
| 15                           | Mizoram              | 1.94              | 1.75            | 2.06              | 1.54            | 2.23              | 1.31            |
| 16                           | Nagaland             | 2.27              | 2.10            | 1.75              | 1.79            | 1.78              | 1.08            |
| 17                           | Sikkim               | 0.95              | 0.75            | 0.84              | 0.76            | 0.84              | 0.57            |
| 18                           | Tripura              | 0.92              | 0.26            | 1.00              | 0.27            | 0.99              | 0.55            |
|                              | **Sub Total**        | **23.02**         | **14.34**       | **15.85**         | **13.19**       | **26.12**         | **14.43**       |
| **C. Non-High Focus States** |                      |                   |                 |                   |                 |                   |                 |
| 19                           | Andhra Pradesh       | 31.59             | 25.94           | 0.00              | 8.21            | 2.58              | 2.40            |
| 20                           | Telangana            |                   |                 |                   |                 | 1.54              | 0.09            |
| 21                           | Goa                  | 0.59              | 0.31            | 0.06              | 0.10            | 0.00              | 0.02            |
| 22                           | Gujarat              | 6.44              | 3.91            | 8.90              | 3.90            | 6.10              | 3.76            |
| 23                           | Haryana              | 0.39              | 0.24            | 1.21              | 1.03            | 1.48              | 1.05            |
| 24                           | Karnataka            | 0.00              | 0.12            | 0.00              | 0.00            | 0.00              | 0.02            |
| 25                           | Kerala               | 4.09              | 2.21            | 1.96              | 2.40            | 1.54              | 1.90            |
| 26                           | Maharashtra          | 8.02              | 7.36            | 11.21             | 9.00            | 13.85             | 9.68            |
| 27                           | Punjab               | 3.60              | 4.16            | 3.60              | 4.35            | 6.07              | 3.96            |
| 28                           | Tamilnadu            | 39.85             | 24.22           | 36.05             | 32.78           | 40.48             | 43.50           |
| 29                           | West Bengal          | 2.56              | 0.71            | 18.88             | 13.62           | 15.40             | 10.04           |
|                              | **Sub Total**        | **97.13**         | **69.18**       | **81.85**         | **75.38**       | **89.03**         | **76.42**       |
| **D. Small States/UTs**      |                      |                   |                 |                   |                 |                   |                 |
| 30                           | Andaman & Nicobar    | 0.00              | 0.00            | 0.00              | 0.00            | 0.00              | 0.00            |
| 31                           | Chandigarh           | 0.49              | 0.36            | 0.24              | 0.43            | 0.00              | 0.00            |
| 32                           | Dadra & Nagar Haveli | 0.15              | 0.08            | 0.00              | 0.07            | 0.17              | 0.08            |
| 33                           | Daman                | 0.22              | 0.07            | 0.00              | 0.11            | 0.00              | 0.01            |
| 34                           | Delhi                | 0.46              | 0.00            | 1.80              | 0.00            | 0.00              | 0.99            |
| 35                           | Lakshadweep          | 0.00              | 0.00            | 0.00              | 0.00            | 0.00              | 0.00            |
| 36                           | Puducherry           | 0.79              | 0.64            | 0.77              | 0.64            | 0.85              | 0.69            |
|                              | **Sub Total**        | **2.12**          | **1.15**        | **2.81**          | **1.24**        | **1.01**          | **1.78**        |
|                              | **Grand Total**      | **302.91**        | **144.84**      | **211.47**        | **160.74**      | **233.31**        | **151.30**      |

Notes:

1. The above mentioned Expenditure figures are as per FMR  hence provisional.
2. For some States there is no SPIP approval during the particular year, but utilization have been made which is due to Committed Unspent balances of previous years lying with the states.
3. SPIP Stands for State Programme Implementation Plan