Lok Sabha Question No. 2154 (UNSTARRED), answered on 2015-12-11
Subject: Tribal Healthcare
Ministry: HEALTH AND FAMILY WELFARE
Asked by: KAMAKHYA PRASAD TASA, B. SREERAMULU, AJAY NISHAD, SUBHASH RAMRAO BHAMRE, VISHNU DAYAL RAM, KINJARAPU RAM MOHAN NAIDU, MEENAKASHI LEKHI, NISHIKANT  DUBEY

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

## LOK SABHA UNSTARRED QUESTION NO. 2154 TO BE ANSWERED ON 11 TH DECEMBER, 2015

## TRIBAL HEALTHCARE

## 2154. SHRI KAMAKHYA PRASAD TASA:

SHRI B. SRIRAMULU:

SHRI AJAY NISHAD:

DR. SUBHASH BHAMRE:

SHRI VISHNU DAYAL RAM:

SHRI RAM MOHAN NAIDU KINJARAPU:

SHRIMATI MEENAKASHI LEKHI:

SHRI NISHIKANT DUBEY:

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

- (a) whether the Government has undertaken any study/survey regarding the health indicato tribals and the status of tribal healthcare in the country, if so, the details and outc along with the aberrations noticed therein;
- (b)  whether  the  Government  is  aware  that  infrastructural  challenges  to  the  tribal  hea shortages of doctors and medical personnel and the paucity of health related knowledge a tribals are the reasons due to which they exhibit signs of poor nutri tional status, higher levels of morbidity and mortality and reduced utilization of ante - natal and post - natal services;
- (c) if so, the details thereof and the reaction of the Government thereto along with the measures taken/being taken by the Gov ernment in this regard;
- (d) the number of public health centres and sub - centres functioning in the tribal areas along with the funds sanctioned, released and ut ili zed for tribal healthcare during each of the last three ye and the current year, State/U T-wise; and
- (e)  the  details  of  the  schemes  formulated/being  formulated  by  the  Government  to  pro free/affordable healthcare services to the tribal population?

## ANSWER THE MINISTER OF HEALTH AND FAMILY WELFARE (SHRI JAGAT PRAKASH NADDA)

(a)& (b):Nationa l surveys such as National Family Healt h Survey (NFHS), District Level

Contd……

Household  Survey  (DLHS),  Annual  Health  Survey  (AHS),  National  Sample  Survey  (NSSO), Sample Registration System (SRS), and Rural Health Statistics (RHS) and the  Population C nsus undertaken by the Government capture some information on tribal health.

The information regarding some health indicators including nutrition and utilisation ante natal and post - natal services by scheduled tribes are at Annexure -I - A and IBrespectively.

(c): Public Health being a State subject, the primary responsibility to provide affordable health care services to the people including tribal population lies with State/UT Governments . However, under the National Health Mission (NHM), support is provided to States /UTs to strengthen their health  system s including for  setting  up /upgradingpublic  health  facilities , augmenting  health human  resource  on  contractual  basis  for  provision  of  equitable,  affordable  healthcare  t citizens particularly the  poor  and  vulnerable  population  including  tribal  population based  on requirements  posed  by  the  States  in  their  Programme  Implementation  Plans. Under  NHM,  all tribal majoritydistricts  whose  composite  health  index  is  below  the  State  average  ha ve  been identified as High Priority Districts (HPDs) and these districts aretoreceive more resources per capita under the NHM as compared to the rest of the districts in the State. These districts also receive focused attention and supportive supervision .Norms for infrastructure, Human resource, ASHAs, MMUs etc. under NHM are relaxed for tribal and hilly areas.

(d): The number of S ub- Centres, Primary Health centres (PHCs) and Community Health Centres (CHCs) functioning in tribal areas as per Rural Health Statistics, 2015 is at Annexure -II.

utlilized

The State/UT wise details of funds sanctioned, released and upgradation/strengthening of CHCs, PHCs, District Hospitals, & New Constructions/ Renova during each of the last three years and the current year is at Annexure -III.

(e): As  mentioned  above, Public  Health  being  a  State  subject,  the  primary  responsibility provide affordable health care services to the people including tribal population lies with State/UT Governments.  However,  u nder  the  National  Health  Mission  (NHM),  support  is  provided  to States /UTs to strengthen their health system s for provision of free and affordable healthcare to al its  citizens  including  tribal  populati on based  on  requirements  posed  by  the  States  in  their Programme Implementation Plans.

……………

Annexure - I- A Information regarding Various Health Indicators of Scheduled Tribes

(I)  Proportion of children 12 - 23 months receiving full immunization

|                        |   Total |   ST |
|------------------------|---------|------|
| NFHS - III (2005 - 06) |    43.5 | 31.3 |
| DLHS - III(2007 - 08)  |    53.5 | 45.5 |
| CES (2009)             |    61   | 49.8 |

## (II)  Proportion of 12 - 23 months old children immunised

against measles

|                        |   Total |   ST |
|------------------------|---------|------|
| NFHS - III (2005 - 06) |    58.8 | 46.1 |
| DLHS - III(2007 - 08)  |    69.1 | 65   |
| CES (2009)             |    74.1 | 67   |

(III)  Proportion of delivery attended by skilled health personnel

|                        |   Total |   ST |
|------------------------|---------|------|
| NFHS - III (2005 - 06) |    46.6 | 25.4 |
| DLHS - III(2007 - 08)  |    52.3 | 37.6 |
| CES (2009)             |    76.2 | 61.3 |

(IV)  Proportion of  institutional deliveries

|                        |   Total |   ST |
|------------------------|---------|------|
| NFHS - III (2005 - 06) |    38.7 | 17.7 |
| DLHS - III(2007 - 08)  |    46.9 | 32.5 |
| CES (2009)             |    72.9 | 57   |

| NFHS -III (2005 - 06)     | Total   | ST   |
|---------------------------|---------|------|
| Infant Mortality Rate     | 57.0    | 62.1 |
| Under 5 Mortality Rate    | 74.3    | 95.7 |
| DLHS - III (2007 - 08)    | Total   | ST   |
| Any ante- natalcheck- up  | 75.1    | 65.9 |
| Number of ANC visits (3+) | 49.7    | 42.2 |

## Annexure - IB

| Nutritional Status, prevalence of anaemia among children and women, place and assistance during post -natal Care-India and ST   | Nutritional Status, prevalence of anaemia among children and women, place and assistance during post -natal Care-India and ST   | Nutritional Status, prevalence of anaemia among children and women, place and assistance during post -natal Care-India and ST   | Nutritional Status, prevalence of anaemia among children and women, place and assistance during post -natal Care-India and ST   |
|---------------------------------------------------------------------------------------------------------------------------------|---------------------------------------------------------------------------------------------------------------------------------|---------------------------------------------------------------------------------------------------------------------------------|---------------------------------------------------------------------------------------------------------------------------------|
| (I) Nutritional Status of Children                                                                                              | (I) Nutritional Status of Children                                                                                              | India                                                                                                                           | ST                                                                                                                              |
| Prevalence of age (%)                                                                                                           | of stunting in children under (5)                                                                                               | years 48.0                                                                                                                      | 53.9                                                                                                                            |
| Prevalence of age (%)                                                                                                           | wasted children under (5) years                                                                                                 | of 19.8                                                                                                                         | 27.6                                                                                                                            |
| Prevalence of of age (%)                                                                                                        | underweight children under (5)                                                                                                  | years 42.5                                                                                                                      | 54.5                                                                                                                            |
| (II) Nutritional Status of Women                                                                                                | (II) Nutritional Status of Women                                                                                                | (II) Nutritional Status of Women                                                                                                | (II) Nutritional Status of Women                                                                                                |
| Percentage of whose "Body                                                                                                       | women age 15 -49 below 145 cm Mass Index (BMI) is below 18.5 (total thin)                                                       | 35.6                                                                                                                            | 46.6                                                                                                                            |
| (III) Prevalence of anaemia among children and women                                                                            | (III) Prevalence of anaemia among children and women                                                                            |                                                                                                                                 |                                                                                                                                 |
| Percentage of anaemia (<11.0                                                                                                    | children age -596months having any g/dl)                                                                                        | 69.5                                                                                                                            | 76.8                                                                                                                            |
| Percentage of anaemia (<12.0                                                                                                    | women age 15 -49 having any g/dl)                                                                                               | 56.2                                                                                                                            | 68.5                                                                                                                            |
| (IV) Place and assistance during delivery                                                                                       | (IV) Place and assistance during delivery                                                                                       | (IV) Place and assistance during delivery                                                                                       | (IV) Place and assistance during delivery                                                                                       |
| (a)                                                                                                                             | Proportion of delivery attended by skilled personnel,                                                                           | health                                                                                                                          |                                                                                                                                 |
| NFHS -III                                                                                                                       | (2005 -06)                                                                                                                      | 46.6                                                                                                                            | 25.4                                                                                                                            |
| (b)                                                                                                                             | Proportion of institutional deliveries                                                                                          |                                                                                                                                 |                                                                                                                                 |
| NFHS -III                                                                                                                       | (2005 -06)                                                                                                                      | 38.7                                                                                                                            | 17.7                                                                                                                            |
| (V) Mother's first postnatal check -up                                                                                          | (V) Mother's first postnatal check -up                                                                                          |                                                                                                                                 |                                                                                                                                 |
| (c)                                                                                                                             | Percent distribution of women giving birth in five years preceding the survey received post -natal check-up                     | the                                                                                                                             |                                                                                                                                 |
| NFHS -III within 2 days                                                                                                         | (2005 -06) (first postnatal check -up                                                                                           | 37.3                                                                                                                            | 23.0                                                                                                                            |
| Source: National Family Health Survey, 2005 -06                                                                                 | Source: National Family Health Survey, 2005 -06                                                                                 | Source: National Family Health Survey, 2005 -06                                                                                 | Source: National Family Health Survey, 2005 -06                                                                                 |

## Annexure - II

| NUMBER OF SUB CENTRES, PHCs & CHCs IN TRIBAL AREAS   | NUMBER OF SUB CENTRES, PHCs & CHCs IN TRIBAL AREAS    | NUMBER OF SUB CENTRES, PHCs & CHCs IN TRIBAL AREAS   | NUMBER OF SUB CENTRES, PHCs & CHCs IN TRIBAL AREAS   | NUMBER OF SUB CENTRES, PHCs & CHCs IN TRIBAL AREAS   |
|------------------------------------------------------|-------------------------------------------------------|------------------------------------------------------|------------------------------------------------------|------------------------------------------------------|
| S. No.                                               | are 23 other State/UT                                 | As on 31st March, 2015                               | As on 31st March, 2015                               | As on 31st March, 2015                               |
| ++ State                                             | informed that there                                   | functioning in tribal area Sub centre                | are equal level facilities PHCs                      | PHCs CHCs                                            |
| 2 The 1                                              | population is less than the norm (CHC) Andhra Pradesh | 80,000. 691                                          | 130                                                  | 11                                                   |
| ^ Data for 2                                         | 2013 - 14 repeated Arunachal Pradesh #                | 286                                                  | 117                                                  | 52                                                   |
| + Data for 3                                         | 2010 repeated Assam                                   | 1283                                                 | 283                                                  | 31                                                   |
| 4                                                    | Bihar+                                                | 23                                                   | 6                                                    | 0                                                    |
| NA -Data 5                                           | not available Chhattisgarh                            | 2950                                                 | 411                                                  | 85                                                   |
| 6                                                    | Goa                                                   | 66                                                   | 8                                                    | 1                                                    |
| 7                                                    | Gujarat                                               | 2775                                                 | 382                                                  | 70                                                   |
| 8                                                    | Haryana *                                             | 0                                                    | 0                                                    | 0                                                    |
| 9                                                    | Himachal Pradesh                                      | 104                                                  | 43                                                   | 10                                                   |
| 10                                                   | Jammu & Kashmir                                       | 307                                                  | 48                                                   | 11                                                   |
| 11                                                   | Jharkhand                                             | 2333                                                 | 160                                                  | 104                                                  |
| 12                                                   | Karnataka                                             | 321                                                  | 64                                                   | 7                                                    |
| 13                                                   | Kerala                                                | 831                                                  | 137                                                  | 12                                                   |
| 14                                                   | Madhya Pradesh                                        | 2952                                                 | 332                                                  | 104                                                  |
| 15                                                   | Maharashtra                                           | 2057                                                 | 315                                                  | 67                                                   |
| 16                                                   | Manipur^                                              | 226                                                  | 45                                                   | 7                                                    |
| 17                                                   | Meghalaya #                                           | 428                                                  | 110                                                  | 27                                                   |
| 18                                                   | Mizoram #                                             | 370                                                  | 57                                                   | 9                                                    |
| 19                                                   | Nagaland #                                            | 396                                                  | 128                                                  | 21                                                   |
| 20                                                   | Odisha++                                              | 2689                                                 | 426                                                  | 135                                                  |
| 21                                                   | Punjab *                                              | 0                                                    | 0                                                    | 0                                                    |
| 22                                                   | Rajasthan                                             | 1574                                                 | 210                                                  | 63                                                   |
| 23                                                   | Sikkim                                                | 48                                                   | 12                                                   | 0                                                    |
| 24                                                   | Tamil Nadu                                            | 564                                                  | 66                                                   | 20                                                   |
| 25                                                   | Telangana                                             | 698                                                  | 93                                                   | 23                                                   |
| 26                                                   | Tripura                                               | 499                                                  | 45                                                   | 7                                                    |
| 27                                                   | Uttarakhand                                           | 176                                                  | 10                                                   | 8                                                    |
| 28                                                   | Uttar Pradesh                                         | NA                                                   | NA                                                   | NA                                                   |
| 29                                                   | West Bengal                                           | 3195                                                 | 304                                                  | 108                                                  |
| 30                                                   | A&N Island                                            | 41                                                   | 4                                                    | 1                                                    |
| 31                                                   | Chandigarh *                                          | 0                                                    | 0                                                    | 0                                                    |
| 32                                                   | D&N Haveli #                                          | 56                                                   | 7                                                    | 1                                                    |
| 33                                                   | Daman & Diu                                           | 5                                                    | 0                                                    | 0                                                    |
| 34                                                   | Delhi *                                               | 0                                                    | 0                                                    | 0                                                    |
| 35                                                   | Lakshadweep# (2)                                      | 14                                                   | 4                                                    | 3                                                    |
| 36                                                   | Puducherry *                                          | 0                                                    | 0                                                    | 0                                                    |
|                                                      | India                                                 | 27958                                                | 3957                                                 | 998                                                  |

#:States are predominently tribal areas ++ State informed that there are 23 other hospitals functioning in tribal area which are equal to PHCs level facilities 2 The population is less than the norm (CHC) of 80,000. ^ Data for 2013 - 14 repeated + Data for 2010 repeated NA -Data not available

## Annexure - III

Statement showing the Allocation of funds & utilization by the State/UTs from the F.Y. 2012 - 13 to 2015 - 16 (30/10/2015)

Rs. In crore

| Sl. No.   |                   | 2012- 13                          | 2012- 13    | 2013- 14                          | 2013- 14    | 2014- 15                          | 2014- 15    | 2015- 16                          | 2015- 16    |
|-----------|-------------------|-----------------------------------|-------------|-----------------------------------|-------------|-----------------------------------|-------------|-----------------------------------|-------------|
| Sl. No.   | State             | Allocation (Approval as per SPIP) | Utilization | Allocation (Approval as per SPIP) | Utilization | Allocation (Approval as per SPIP) | Utilization | Allocation (Approval as per SPIP) | Utilization |
| 1         | Bihar             | 9505.11                           | 1610.19     | 3753.02                           | 1503.11     | 7112.39                           | 3987.45     | 1005.82                           | 224.82      |
| 2         | Chattisgarh       | 7366.57                           | 896.69      | 12132.06                          | 648.73      | 8545.62                           | 11692.57    | 3103.70                           | 1588.23     |
| 3         | Himachal Pradesh  | 8356.57                           | 1548.36     | 2505.40                           | 1886.06     | 4290.72                           | 3139.61     | 2148.34                           | 328.15      |
| 4         | Jammu & Kashmir   | 11754.82                          | 2645.30     | 9107.57                           | 10463.92    | 15367.75                          | 14906.61    | 5086.07                           | 334.76      |
| 5         | Jharkhand         | 7839.43                           | 791.38      | 5694.64                           | 3883.86     | 4448.72                           | 3019.21     | 155.30                            | 230.05      |
| 6         | Madhya Pradesh    | 17461.82                          | 4512.59     | 7879.40                           | 1924.04     | 7195.39                           | 6139.88     | 5840.30                           | 2174.28     |
| 7         | Orissa            | 28743.15                          | 7071.80     | 14465.02                          | 10638.17    | 17098.42                          | 21072.32    | 10029.27                          | 6983.69     |
| 8         | Rajasthan         | 7366.57                           | 558.36      | 24502.80                          | 16737.50    | 29638.44                          | 23850.44    | 23416.30                          | 11614.62    |
| 9         | Uttar Pradesh     | 36194.66                          | 7048.32     | 37664.02                          | 2577.67     | 4925.25                           | 31119.88    | 48454.63                          | 15778.17    |
| 10        | Uttarakhand       | 8765.03                           | 1012.80     | 1842.27                           | 1203.54     | 4653.99                           | 3660.40     | 272.77                            | 242.09      |
| 11        | Arunachal Pradesh | 7366.57                           | 858.36      | 2544.72                           | 735.82      | 5682.25                           | 3596.34     | 977.81                            | 519.25      |
| 12        | Assam             | 7466.57                           | 658.36      | 18264.40                          | 4948.96     | 11652.79                          | 7280.54     | 10134.42                          | 2424.05     |
| 13        | Manipur           | 8139.00                           | 614.66      | 1536.88                           | 332.77      | 4332.72                           | 3557.69     | 587.17                            | 266.44      |

|   14 | Meghalaya                 |   7804.07 |   1086.39 |   2343.40 |   759.29 |   5366.96 |   3556.08 |   1634.30 |   552.10 |
|------|---------------------------|-----------|-----------|-----------|----------|-----------|-----------|-----------|----------|
|   15 | Mizoram                   |   7366.57 |    801.8  |   1554.47 |   816.57 |   4380.22 |   2922.44 |    155.3  |   214.25 |
|   16 | Nagaland                  |   7444.57 |    566.26 |   3015.69 |  1224.72 |   4969.38 |   2931.94 |    895.75 |   214.25 |
|   17 | Sikkim                    |   7707.77 |    572.74 |   1568.22 |   422.1  |   4614.14 |   3077.14 |    354.56 |   214.38 |
|   18 | Tripura                   |   8510.1  |   1681.79 |   3742.56 |  1678.23 |   4421.72 |   3367.28 |    380.3  |   412.46 |
|   19 | Andhra Pradesh            |  30958.2  |   9813.64 |   9052.4  |  3068.02 |  12276.5  |  10648.1  |    155.3  |   214.25 |
|   20 | Goa                       |   7371.37 |    558.75 |   1540.2  |   313.78 |  13041.8  |   8714.44 |    170.6  |   215    |
|   21 | Gujarat                   |  12716.3  |   2440.59 |   9033.99 | 10287    |   4344.85 |   2930.04 |    155.3  |  1039.98 |
|   22 | Haryana                   |   7527.85 |    641.48 |   3782.33 |   392.39 |   6155.52 |   8306.39 |    733.22 |   237.8  |
|   23 | Karnataka                 |   9348.61 |   2318.39 |  15268.4  |  7406.53 |   4857.78 |   3354.46 |   6635.73 |  2583.52 |
|   24 | Kerala                    |  11621.6  |   2312.68 |   9232.73 |  3342.67 |  14113.3  |  11862.8  |   4628.3  |  1957.95 |
|   25 | Maharashtra               |  23505.9  |  16250.1  |  12641.6  | 10933    |   9363.75 |   6121.25 |   2781.49 |   243.28 |
|   26 | Punjab                    |  11048.6  |   4193.18 |   7981.4  |  3281.82 |   9043.1  |   5711.15 |   3824.34 |  1660.05 |
|   27 | Tamil Nadu                |  17724.4  |   4555.59 |  21430.3  | 22573.2  |   4950.72 |   5228.01 |   5685.15 |  4605.04 |
|   28 | Telangana                 |   7366.57 |    558.36 |   1505.4  |   311.06 |  24156.3  |  37355.8  |    155.3  |   214.25 |
|   29 | West Bengal               |  16349.5  |   8715.19 |   6707.1  | 12332.6  |  10114    |   8216.38 |   2001.38 |  1430.54 |
|   30 | Andaman & Nicobar Islands |   7636.39 |    611.7  |   1505.4  |   461.45 |   4305.72 |   3012.25 |    155.3  |   214.25 |
|   31 | Chandigarh                |   7366.57 |    558.36 |   1505.4  |   311.06 |   4290.72 |   2922.44 |    155.3  |   214.25 |
|   32 | Dadra & Nagar Haveli      |   7366.6  |    564.28 |   1505.4  |   311.06 |   4290.72 |   2922.44 |    165.3  |   214.25 |

| 33   | Daman & Diu   |   7370.07 |   558.85 |   1508.40 |    312.02 |   4293.96 |   2922.98 |   159.86 |   214.68 |
|------|---------------|-----------|----------|-----------|-----------|-----------|-----------|----------|----------|
| 34   | Delhi         |   7379.57 |   565.93 |    2151.3 |    329.81 |  10290.7  |   8360.73 |    335.3 |   214.25 |
| 35   | Lakshadweep   |   7366.87 |   558.36 |    1505.7 |    311.06 |   4290.72 |   2922.44 |    155.3 |   214.25 |
| 36   | Puducherry    |   7366.57 |   558.36 |    1505.4 |    311.06 |   4290.72 |   2922.44 |    155.3 |   214.25 |
|      | Total         | 412551    | 90870    |  263479   | 138975    | 297168    | 287312    | 142840   | 60217.9  |

Note:

1. Utilization is inclusive of previous years unspent balance.
2. The above data comprises of Hospital Strengthening -Up gradation of CHCs, PHCs, Dist. Hospitals, Strengthening of Districts , Hospitals, CHCs,  PHCs and Sub Centre Rent and Contingencies & New Constructions/ Renovation and Setting up -CHCs, PHCs, SHCs/Sub Centres, Setting up Infrastructure wing for Civil works, Govt. Dispensaries/ others renovations and Construction of BHO, lity improvement, ci work, BemOC and CemOC centres, Major civil works for opera tionalization of FRUS, Major civil works for operationalization of 24 PHCs, Civil Works for Operationalising Infection Management & Environment Plan at health facilities, Infrastructure of Tr g Institutions, SDH DH and Civil work of D EIC (RBSK)