Executive Summary:
The Ministry of Health and Family Welfare addresses concerns regarding inadequate facilities in rural Primary Health Centres (PHCs) and Sub-Centres (SCs). The National Health Mission (NHM) supports states/UTs in strengthening healthcare systems and implementing the RMNCAH+N strategy. The government has undertaken steps to ensure safe deliveries and improve healthcare access, including establishing delivery points, birth waiting homes, capacity building programs, and ambulance services.
Key Points / Main Content:
Safe Delivery Initiatives:
* Delivery Points: Established at PHCs and SCs, staffed with trained healthcare professionals (ANMs, CHOs, Staff Nurses, MOs).
* Birth Waiting Homes (BWH): Established in remote and tribal areas to promote institutional delivery.
* Capacity Building: Training programs for healthcare professionals on safe delivery practices (SBAs, Daksh, Dakshata).
* Janani Shishu Suraksha Karyakram (JSSK): Entitles pregnant women to free delivery in public health institutions, including free drugs, diagnostics, blood, diet, and transportation.
* Exemption from user charges for pregnant women.
Ambulance Services:
* National Ambulance Services (NAS): Launched in 2012, includes 108 (ALS/BLS) for emergency response and 102 for basic patient transport (primarily for pregnant women and children).
* As of 31.12.2024, there are 3173 ALS and 15455 BLS ambulances available under NHM.
Infrastructure and Standards:
* Indian Public Health Standards (IPHS) 2022: Sets norms for services, infrastructure, human resources, diagnostics, and equipment in public health facilities.
* Open Data Kit (ODK) Toolkit: Used to conduct baseline assessments, identify gaps, and implement corrective measures in line with IPHS.
* NHM Support: Provides support to address gaps and ensure essential standards are met.
Impact Analysis:
States/Union Territories:
* Impact: Receive technical and financial support from the Ministry to strengthen their public healthcare systems and implement RMNCAH+N strategies based on their Programme Implementation Plans (PIPs).
* Action Required: Submit Programme Implementation Plans (PIPs) to the Government of India, conduct baseline assessments using the ODK toolkit to identify gaps, and implement corrective measures to meet IPHS standards.
Healthcare Professionals (ANMs, CHOs, Staff Nurses, MOs):
* Impact: Expected to deliver safe and quality healthcare services, particularly for pregnant women and newborns, at PHCs and SCs. Will be provided with capacity building through training programs.
* Action Required: Participate in training programs (SBAs, Daksh, Dakshata) to enhance skills, provide services as per JSSK guidelines, and utilize established delivery points and birth waiting homes.
Pregnant Women and Sick Infants:
* Impact: Entitled to free and no-expense delivery in public health institutions, including free drugs, diagnostics, blood, diet, transportation, and exemption from user charges. Improved access to healthcare facilities, especially in remote and tribal areas, through BWHs and ambulance services.
* Action Required: Utilize available services, including delivery points, birth waiting homes, JSSK benefits, and ambulance services (102 and 108).
Poor and Vulnerable Populations:
* Impact: Improved access to quality healthcare services in urban, rural, and tribal/hilly areas through strengthened public healthcare systems and NHM support.
* Action Required: Utilize available public health facilities and services, including those provided under NHM.
Key Entities Referenced
National Health Mission NHM: A program providing support for health infrastructure and resources, focusing on vulnerable populations in urban, rural, and tribal areas.
Ministry of Health and Family Welfare: The government ministry providing technical and financial support to states/UTs for strengthening the public healthcare system.
Reproductive, Maternal, Newborn, Child, Adolescent Health and Nutrition RMNCAH N: A strategy implemented with support from the Ministry of Health and Family Welfare, focusing on these specific areas of health.
Programme Implementation Plans PIPs: Proposals received from States/UTs under NHM, based on which Government of India provides approval.
Primary Health Centres PHCs: Healthcare facilities in rural areas where efforts are being made to ensure safe deliveries and improve basic facilities.
SubCentres SCs: Healthcare facilities in rural areas, similar to PHCs, where deliveries are conducted and healthcare is provided.
Janani Shishu Suraksha Karyakram JSSK: A program entitling all pregnant women delivering in public health institutions to free and no-expense delivery, including caesarean section.
Indian Public Health Standards IPHS 2022: Standards laid down by the Government of India to improve health infrastructure and services in public health facilities, including norms for services, infrastructure, human resources, diagnostics, equipment, and medicines.
GOVERNMENTOFINDIA
MINISTRYOFHEALTH AND FAMILYWELFARE
DEPARTMENTOFHEALTH AND FAMILYWELFARE
LOK SABHA
UNSTARREDQUESTION NO. 1004
TO BE ANSWERED ON 25th JULY,2025
MEDICALSERVICES IN RURALAREAS
†1004.SHRISANJAYHARIBHAU JADHAV:
Will the Ministerof HEALTH AND FAMILYWELFAREbe pleasedtostate:
(a) whether the basic facilities like essential equipment, availability of blood, neonatal
care and 24-hour ambulance are unavailable in many Primary Health Centres (PHCs)
andSub-Centresinrural areas of the countryandif so, the detailsthereof;
(b) whether the Government has taken cognizance of the said issues, if so, the details of
the immediate actiontakenbythe Government inthisregard;
(c) whether the Government has taken cognizance of the fact that pregnant women have
to travel a distance of 100 km or more for safe delivery due to lack of basic facilities
required for delivery at Primary Health Centres (PHCs) and Sub-Centres in many rural
areas;
(d) if so, the details thereof including the steps taken to ameliorate the condition on the
ground; and
(e) the details of the rural areas facing unavailability of the said facilities across the
country, State-wise?
ANSWER
THE MINISTER OFSTATE INTHE MINISTRYOFHEALTH & FAMILY
WELFARE
(SHRIPRATAPRAOJADHAV)
(a) to (e): The National Health Mission (NHM) provides support for improvement in
health infrastructure, availability of adequate human resources in health facilities, to
improve availability, affordability and accessibility to quality health care especially for
the poor and vulnerable sections in urban, rural, and tribal/hilly areas. The Ministry of
Health and Family Welfare provides technical and financial support to the States/UTs to
strengthen the public healthcare system and in implementation of Reproductive,
Maternal, Newborn, Child, Adolescent Health and Nutrition (RMNCAH + N) strategy,
based on the proposals received in the form of Programme Implementation Plans (PIPs)
under NHM. Government of India provides approval for the proposals in the form of
Recordof Proceedings(RoPs) aspernorms& availableresources.
Under National Health Mission (NHM), Government of India has undertaken the
followings steps to ensure the safe deliveries of pregnant women at Primary Health
Centres(PHCs) andSub-Centres(SCs) inrural area across the country. Delivery Points established at PHCsand SCs to deliver the pregnant women by
the trained health care professionals including Auxiliary Nurse Midwives
(ANMs), Community Health Officers (CHOs), Staff Nurses and Medical
Officers(MOs).
BirthWaitingHomes(BWH) established in remote andtribal areasto promote
institutional delivery andimprove accesstohealthcarefacilities.
Capacity buildings of healthcare professionals to ensure safe delivery of
pregnantwomen at PHCsandSCs
Skilled BirthAttendant(SBAs) trainingfor ANMs, CHOs andStaff Nurses
Daksh trainingfor ANMs, CHOs, Staff Nurses andmedicalofficers
Dakshtatrainingfor Staff Nurses andmedicalofficers
Janani Shishu Suraksha Karyakram (JSSK) entitles all pregnant women
delivering in public health institutions to have free and no-expense delivery,
including caesarean section. The entitlements under JSSK for Pregnant women
andSickinfantsare:
Freedrugs, diagnostics, bloodandconsumables
Free diet during stay infacilities (up to 3 days incase of normal delivery and
7daysincase of caesarean-section)
Free transportation from home to healthcare facilities, inter-facilities and
drop backfrom healthcare facilitiestohome.
Exemptionfrom all kindsof user charges
National Ambulance Services (NAS) under NHM was launched in the year 2012. Two
types of ambulance services 108 (ALS/BLS) and 102 were launched. Dial 108 is
predominantlyanemergencyresponsesystem,primarilydesignedtoattendtocriticalcare
patients, trauma, accident victims, etc. Dial 102 services essentially consists of basic
patient transport aimed to cater the needs of pregnant women and children though other
categoriesare also takingbenefitandare not excluded.AsperNHMMIS on31.12.2024,
thereare3173ALSand15455BLSavailableunderNHMinthecountry.
To improve health infrastructure and services in public health facilities, the Government
of India has laid down Indian Public Health Standards (IPHS) 2022. These standards
include norms for services, infrastructure, human resources, diagnostics, equipment,
medicinesetc.TheIPHSalsodefinespopulationnormsforestablishmentandupgradation
ofthehealthcarefacilities.MinistryofHealthandFamilyWelfarehasdevelopedanOpen
Data Kit (ODK) toolkit under IPHS to conduct baseline assessments, identify gaps, and
planandimplementcorrectivemeasures.NHMisprovidingsupporttoaddressthesegaps,
ensuringthereachandmeetingofessentialstandardsforthesefacilities.
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