**Executive Summary**
This document provides the Minister of Health and Family Welfare's response to questions raised in Lok Sabha regarding fund release mechanisms under national health policies, the Clinical Establishments Act, and the National Digital Health Mission (NDHM). It highlights the government's efforts to ensure equitable access to healthcare, regulate clinical establishments, and protect citizens' health data. The questions were raised on December 5th, 2025.
**Key Points / Main Content**
* **National Health Mission (NHM) and Fund Release:**
* The Ministry of Health & Family Welfare is implementing the National Health Mission (NHM) to achieve universal access to equitable, affordable, and quality healthcare.
* The government provides technical and financial support to States/UTs for improving health infrastructure and resources, especially for underserved groups.
* Annual resource allocation to States is based on population, health lag, socio-economic factors, and State proposals in their Programme Implementation Plan (PIP).
* Funding is shared between the Centre and States, with variations for North Eastern, Himalayan States, and UTs without legislatures.
* Implementation is monitored through NPCC meetings, Common Review Missions (CRMs), Financial Monitoring Reports (FMRs), review meetings, and field visits.
* Releases under NHM & PM-ABHIM require compliance with Department of Expenditure guidelines.
* **Ayushman Bharat Digital Mission (ABDM):**
* ABDM is implemented as a Central Sector Scheme, providing funds to States/UTs for human resources, IEC, and capacity building.
* Fund release is determined based on the state category and population.
* **Clinical Establishments Act (CE Act):**
* The government enacted the CE Act to regulate clinical establishments (except those of the Armed Forces).
* The CE Act is currently applicable in 19 States/UTs.
* CE Rules require establishments to display rates, adhere to rate ranges set by the government, and follow standard treatment guidelines.
* States/UTs are primarily responsible for enforcing the Act. District Collectors/Magistrates can impose penalties and cancel registrations for non-compliance.
* **Data Privacy under ABDM:**
* ABDM ensures data privacy through privacy-by-design, consent-based data exchange, and no centralized repository.
* Digital health applications undergo validation and security audits to protect sensitive data and comply with the Health Data Management Policy, 2020.
**Impact Analysis**
* **States/UTs**
**Impact**
* Receive technical and financial support to improve healthcare infrastructure and resources.
* Required to adhere to Department of Expenditure guidelines for fund release under NHM & PM-ABHIM.
* Need to implement and enforce the Clinical Establishments Act (CE Act), if adopted.
* Required to follow ABDM guidelines for digital health initiatives.
**Action Required**
* Submit Programme Implementation Plans (PIP) to receive funding under NHM.
* Comply with CE Act and CE Rules if the state has adopted the Act.
* Implement ABDM following the central government's guidance
* **Citizens:**
**Impact**
* Improved access to equitable, affordable, and quality healthcare services.
* Protection of privacy and data security under the ABDM framework.
* Transparency in the rates charged by clinical establishments in States/UTs that have adopted the CE Act
**Action Required**
* Understand patient rights and consent procedures within ABDM.
* **Healthcare Providers (Clinical Establishments):**
**Impact**
* Subject to regulation under the Clinical Establishments Act in States/UTs that have adopted the Act.
* Must fulfill minimum standards, display rates, and adhere to treatment guidelines.
* Need to integrate with ABDM adhering to data privacy guidelines for handling patient data.
**Action Required**
* Register under the CE Act if required by the State/UT.
* Comply with CE Rules, including displaying rates, following treatment guidelines.
* Integrate with ABDM and adhere to its data privacy and security requirements.
Key Entities Referenced
Ministry of Health and Family Welfare (MoHFW): The Indian government ministry primarily responsible for health policies and programs. It is the implementing body for the National Health Mission (NHM) and provides support to states/UTs.
National Health Mission (NHM): A centrally sponsored scheme being implemented by the Ministry of Health and Family Welfare to provide universal access to equitable, affordable & quality healthcare services.
Clinical Establishments (Registration and Regulation) Act, 2010 (CE Act): An act enacted to provide for registration and regulation of all clinical establishments in the country with a view to prescribe minimum standards of facilities and services provided by them.
Ayushman Bharat Digital Mission (ABDM): A central sector scheme implemented in all States/UTs focused on creating a digital health ecosystem ensuring interoperability of health data and privacy.
States/UTs: Indian states and union territories, which are recipients of funding and implementers of various health programs mentioned in the document.
GOVERNMENTOFINDIA
MINISTRYOFHEALTH AND FAMILYWELFARE
DEPARTMENTOFHEALTH AND FAMILYWELFARE
LOK SABHA
UNSTARREDQUESTION NO. 934
TOBE ANSWERED ON 05TH DECEMBER, 2025
FUND RELEASE MECHANISM UNDER NATIONALHEALTH POLICIES
934.SHRISHYAMKUMAR DAULATBARVE:
Willthe Minister of HEALTHANDFAMILYWELFAREbe pleasedtostate:
(a) whether the Government is considering any plan to rebalance fund release mechanisms,
matching-share structures and output-based financial accountability under national health policies
and programmes—such as NHM, Ayushman Bharat, and PM-ABHIM—so that regional
inequalities in health outcomes do not widen, keeping in view the differences in capacity and
financialdisparities across the States,inthe country;
(b) if so, the detailsthereof;
(c) whether the Government is considering introducing a national regulatory reform framework to
make the Clinical Establishments Act mandatory across the country and to strengthen rate-
rationalisation, standard treatment guidelines and grievance-redressal structures in the private
healthcaresector;
(d) if so, the detailsthereof;
(e)whether underthe National Digital HealthMission, the Government isimplementingprivacy-by
-design architecture, anonymisation protocols, and independent oversight mechanisms to ensure
interoperability and consent-based exchange of citizens’ health data, so that the digital health
ecosystem doesnot pose a threattocitizens’ rights; and
(f) if so, the detailsthereof?
ANSWER
THE MINISTER OFSTATE INTHE MINISTRYOFHEALTHAND FAMILY
WELFARE
(SHRIPRATAPRAOJADHAV)
(a) to (f): With the objective of attainment of universal access to equitable, affordable and quality
healthcare services, the Ministry of Health & Family Welfare (MoHFW) isimplementing National
Health Mission (NHM). Government provides technical and financial support to the States/UTs for
improvement in health infrastructure, availability of adequate human resources to health facilities,
to improve availability and accessibility to quality health care especially for the underserved and
marginalizedgroups.Based on the proposals received from the States in their Programme Implementation Plan (PIP),
approvals are provided keeping in viewthe resource envelope of the States/UTs as well asexisting
norms. Under NHM, annual resource envelope of a State is decided based on its population and a
weightage factor which depends on area of the state, health lag and socio economic factor of the
State.
As perDepartment of Expenditureguidelines, the funding will be shared 60:40betweenthe Centre
and the State (90:10 for the 8 North Eastern and 3 Himalayan States) and 100:0 for UTs without
legislature.
Under NHM, regular interactions are held with States/UTs. Various mechanisms exist to assess the
implementation andprogress of NHM like:
Review of key deliverables of Record of Proceedings of previous financial year during the
National Programme CoordinationCommittee (NPCC) meetings,
Common Review Missions (CRM) are conducted regularly in the States/UTs which looks at
financial systems and physical implementation of the program. Reports on CRMs may be
accessed from belowlink:
https://www.nhm.gov.in/index1.php?lang=1&level=1&sublinkid=795&lid=195.
FinancialMonitoring Reports (FMRs) are submitted by the States/UTs on monthlybasis.
Further, monitoring and evaluation of the progress of all States/ UTs is assessed, through review
meetings, videoconferences& fieldvisits of senior officials.
During NPCC meetings, keydeliverablesmeetingswith respect tothe States are
measured against the pre-definedtargets.
Release of funds under NHM & PM-ABHIM is subject to compliance by States/UTs of the
guidelines prescribed inthisregardby Department of Expenditure,Ministry of Finance.
TheAyushmanBharatDigitalMission(ABDM)isimplementedinallStates/UTsasaCentralSector
SchemeunderwhichStates/UTsareprovidedfundsforsupportingthehumanresourcesdeployedfor
implementation of ABDM, IEC (information, education & communication) and capacity building
of various stakeholders, including front line workers. The quantum of fund release has been
prescribed in accordancewith the categoryof the State, which includesitspopulation.
The Government of India enacted the Clinical Establishments (Registration and Regulation) Act,
2010 (CE Act) and notified the Clinical Establishments (Central Government) Rules, 2012 (CE
Rules) to provide for registration and regulation of Government (except those of Armed Forces) as
well as private clinical establishments belonging to recognized systems of medicine. As per CEAct, the clinical establishments are requiredtofulfill the conditionsof minimumstandards for each
type of service provided.The CE Act isapplicable inthose States/UTswhich have adoptedthe Act.
At present CE Act hasbeenadoptedby 19States/UTs.
Forregistration of ClinicalEstablishments, the CE Rules, inter-alia,stipulatesthe following:
i. As perRule 9(i), everyclinicalestablishment shall displaythe rateschargedfor eachtype of
service providedand facilitiesavailable, for the benefitof the patientsat a conspicuous place
inthe localaswell asin English language.
ii. Rule 9(ii) of CE Rules stipulates that the clinical establishments shall charge the rates for
each type of procedures and services within the range of rates determined and issued by the
Central Government in consultation with the State Governments. The matter of
determination of range of rates, at present, is sub-judice in the Hon’ble Supreme Court of
India.
iii. Rule9(iii)ofCERulesmandatescompliancewithStandardTreatmentGuidelinesissuedby
the Central/State Government or the StateGovernment.
‘Health’ being a State subject, the States/UTs which have adopted the CE Act are primarily
responsible for enforcing/implementing the provisions of the CE Act in the respective States/UTs.
The Act has empowered a registering authority at the district level under the chairmanship of the
District Collector / District Magistrate to take actions including imposing penalties in respect of
violation of its provisions. The Act also provides for cancellation of registration, if the provisions
of the Act are not complied with. The clinical establishments in the States/UTs, which have not
adoptedand implementedthe CE Act, are registered andregulated bythe respective StateActs.
ABDM ensures privacy by design so that health data is exchanged between the intended
stakeholders on ABDM network only after the patient’s consent. Also, there is no centralised
repository of health data. Before integrating with ABDM, digital health applications are validated
in a sandbox environment and they also undergo security audits like Web Application Security
Audit ensuring that they are secure, protect sensitive patient data, and comply with ABDM's
Health Data Management Policy, 2020. These measures collectively ensure that interoperability
doesnot compromise citizens’ privacyanddata protection.
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