Executive Summary:
The Ministry of Health and Family Welfare addresses concerns regarding healthcare infrastructure shortages, particularly in rural areas, and outlines steps to improve accessibility and quality. The response refers to the Health Dynamics of India (HDI) 2022-23 report for infrastructure and human resource data. The Pradhan Mantri Ayushman Bharat Health Infrastructure Mission (PMABHIM) with an outlay of Rs. 64,180 Crores for the period 2021-22 to 2025-26 and Fifteenth Finance Commission (FCXV) grants spanning FY 2021-22 to FY 2025-26 with an amount of Rs. 70,000 crores aims to strengthen healthcare systems.
Key Points / Main Content:
* **Data and Assessment:**
* The Health Dynamics of India (HDI) 2022-23 provides state/UT-wise details of healthcare facilities and professionals.
* The data is available on the Ministry's website.
* **National Health Mission (NHM):**
* Aims for universal access to equitable, affordable, and quality healthcare.
* Includes the National Rural Health Mission (NRHM) and the National Urban Health Mission (NUHM).
* Focuses on health system strengthening, RMNCHA, and communicable/non-communicable diseases.
* **Pradhan Mantri Ayushman Bharat Health Infrastructure Mission (PMABHIM):**
* A centrally sponsored scheme with central sector components.
* Outlay of Rs. 64,180 Crores for the period 2021-22 to 2025-26.
* Focuses on developing capacities of health systems at primary, secondary, and tertiary levels.
* **Fifteenth Finance Commission (FCXV) Grants:**
* Recommended grants through local governments for health sector components.
* Spans FY 2021-22 to FY 2025-26 with an amount of Rs. 70,000 crores.
* Aims to strengthen primary care through SHCs, PHCs, CHCs, Ayushman Arogya Mandirs (AAMs), diagnostic infrastructure, and Block Level Public Health Units.
* **Mobile Medical Units (MMUs):**
* Support provided to States/UTs based on their Programme Implementation Plans (PIPs).
* Deployment norm: 1 MMU per 10 lakhs population.
* **eSanjeevani Telemedicine:**
* Doctor-to-doctor and patient-to-doctor consultation services.
* Operates on a hub and spoke model, with specialists serving rural Health and Wellness Centers (HWCs).
* **Free Drugs Service Initiative (FDSI):**
* Supports drug procurement, quality assurance, supply chain management, and warehousing.
* Includes prescription audits, grievance redressal, and IT-enabled platform (DVDMS).
* **Essential Medicines List (EML):**
* Facility-wise EML recommended, including maternal, child, adolescent health, family planning, immunization, and major diseases.
* Number of medicines varies by facility level (106 at SHC to 381 at District Hospital).
* States have flexibility to add more medicines.
* **National Ambulance Service (NAS):**
* Technical and financial support to States/UTs for emergency medical services.
* Toll-free numbers 108/102.
* Dial 108 for critical care, trauma, and accident victims.
* Dial 102 for basic patient transport, especially for pregnant women and children.
* Norms: 1 BLS ambulance per 100,000 population and 1 ALS per 500,000 population.
* GPS tracked and performance monitored; some states use bike/boat ambulances.
* **Ayushman Bharat:**
* Emergency care services included in the expanded package.
* Provided through Urban and Rural Ayushman Arogya Mandirs.
Impact Analysis:
* **Rural Population:**
* Impact: Improved access to healthcare services, infrastructure, and emergency medical assistance.
* Action Required: Utilize available healthcare facilities, ambulance services, and telemedicine options.
* **State/UT Governments:**
* Impact: Receive financial and technical support to strengthen healthcare systems.
* Action Required: Develop and implement Programme Implementation Plans (PIPs), utilize funds for infrastructure development, and ensure effective service delivery.
* **Healthcare Professionals (Doctors, Nurses, etc.):**
* Impact: Opportunity to serve in rural areas through NHM, telemedicine, and other initiatives.
* Action Required: Participate in training programs, provide quality healthcare services, and utilize available resources effectively.
* **Central Government (Ministry of Health and Family Welfare):**
* Impact: Responsible for overseeing and monitoring the implementation of various schemes and initiatives.
* Action Required: Ensure timely release of funds, provide technical guidance, and evaluate the impact of interventions.
Key Entities Referenced
National Urban Health Mission NUHM: A sub-mission of the National Health Mission (NHM) focused on strengthening healthcare in urban areas.
National Health Mission NHM: A program by the Ministry of Health and Family Welfare to provide universal access to equitable, affordable, and quality healthcare services.
National Rural Health Mission NRHM: A sub-mission of the National Health Mission (NHM) focused on strengthening healthcare in rural areas.
Pradhan Mantri Ayushman Bharat Health Infrastructure Mission PMABHIM: A centrally sponsored scheme focused on developing capacities of health systems and institutions across the continuum of care.
Primary Health Centres PHCs: Government-run healthcare facilities providing primary care services in rural and urban areas.
Community Health Centres CHCs: Government-run healthcare facilities providing secondary care services in rural areas, serving as referral centers for PHCs.
Ayushman Arogya Mandir AAM: Health and Wellness Centres (HWCs) that provide an expanded package of services, both in urban and rural areas, under the Ayushman Bharat scheme.
Fifteenth Finance Commission FCXV: Recommended grants through local governments for specific components of the health sector to strengthen the health system at the grassroot level.
GOVERNMENTOFINDIA
MINISTRYOFHEALTH AND FAMILYWELFARE
DEPARTMENTOFHEALTH AND FAMILYWELFARE
LOK SABHA
UNSTARREDQUESTION NO. 3368
TO BE ANSWERED ON08.08.2025
SHORTAGEOFHEALTHCAREINFRASTRUCTURE
3368. SHRIYSAVINASHREDDY:
Will the Ministerof HEALTH AND FAMILYWELFAREbe pleasedtostate:
(a) whether lack of adequate healthcare infrastructure, such as Primary Health Centres (PHCs)
andhospitals, isaffecting the rural populationinthe country;
(b) if so, the steps taken/proposed to be taken by the Government to make healthcare accessible
inrural areas;
(c) the difference in the availability of emergency medical services, including ambulances in
rural andurbanareasalongwith the steps takentoreduce thisgap;
(d) the primary reasons for the shortage of qualified doctors, nurses and other healthcare
professionals inrural India; and
(e)the mannerinwhich uneven distribution of healthcareworkers inurbanandrural areas
affect the qualityof healthcarefacilities inthe country?
ANSWER
THE MINISTER OFSTATE IN THE MINISTRYOFHEALTH AND
FAMILYWELFARE
(SHRIPRATAPRAO JADHAV)
(a) to (e) : Health Dynamics of India (HDI) (Infrastructure & Human Resources), 2022-23 is an
annualpublication, based on healthcareadministrative data reportedbyStates/UTs. The State/UT
-wise details of Primary Health Centers (PHCs) and other healthcare facilities in rural areas and
details of doctors, nurses and other healthcare professionals in rural healthcare facilities in thecountry, is available at website of Ministry of Health and Family Welfare at Uniform Resources
Locator(URL) asunder:
https://mohfw.gov.in/sites/default/files/Health%20Dynamics%20of%20India%20%28Infrastruct
ure%20%26%20Human%20Resources%29%202022-23_RE%20%281%29.pdf
The National Health Mission (NHM) envisages achievement of universal access to equitable,
affordable & quality health care services that are accountable and responsive to people’s needs.
NHM encompasses its two Sub-Missions, the National Rural Health Mission (NRHM) and the
National Urban Health Mission (NUHM). The main programmatic components include Health
System Strengthening in rural and urban areas, Reproductive-Maternal- Neonatal-Child and
Adolescent Health (RMNCH+A), Health Systems Strengthening and Communicable and Non-
Communicable Diseases.
Pradhan Mantri Ayushman Bharat Health Infrastructure Mission (PM-ABHIM) is a
Centrally Sponsored Scheme (CSS) with some Central Sector Components (CS) which has an
outlayof Rs. 64,180 Crores for the scheme period (2021-22 to2025-26). The measures underthe
PM-ABHIM focus on developing capacities of health systems and institutions across the
continuum of care at all levels, primary, secondary and tertiary, to prepare health systems in
responding effectively tothe current andfuture pandemics/disasters.
The Fifteenth Finance Commission (FC-XV) has recommended grants through local
governments for specific components of the health sector and spread over the five-year period
from FY 2021-22 to FY 2025-26 to facilitate strengthening of health system at the grass-root
levelfor anamountof Rs. 70,000crores. These grantsare for strengthening primarycare through
specified components such as Building-less Sub-Health Centres (SHCs), Primary Health Centres
(PHCs), Community Health Centres (CHCs), Conversion of rural PHCs and Sub- Centres to
Ayushman Arogya Mandir (AAM), Support for diagnostic infrastructure to the primary
healthcarefacilities, BlockLevelPublicHealthUnits andUrban - AAMs.
Further, to improve access to quality healthcare services in remote and rural areas support for
Mobile Medical Unit(MMU) isprovidedtoStates/UTs, based onthe requirementsposed bythem
in their Programme Implementation Plans (PIPs), subject to availability of resources.
Deployment of MMUs is based on a normal population norm with 1 MMU per 10 lakhs
population. Also, Ministry of Health and Family Welfare has developed eSanjeevani, atelemedicine application, which provides doctor to doctor (HWC module) and patient to doctor
consultation services (OPD module). This application works on a hub and spoke model. At hub
level,a specialist doctorprovidesservices toHealthandWellnessCenters(HWCs) inrural areas.
Under FreeDrugs Service Initiative (FDSI), Government of India supports procurement of drugs
and strengthening robust systems of procurement, Quality Assurance, Supply chain management
and warehousing, Prescription audit, grievance redressal, dissemination of Standard Treatment
Guidelines and Establishment of IT enabled platform DVDMS (Drugs & Vaccine Distribution
Management System) for monitoring the real status of procurement and availability of essential
medicines. Ministry of Health and Welfare (MoHFW) has recommended facility wise Essential
Medicines List (EML) to be made available at the public healthcare facilities which includes
provision of a variety of free services related to maternal health, child health, adolescent health,
family planning, universal immunisation programme, and for major diseases such as
Tuberculosis, HIV/ AIDS, vector borne diseases like Malaria, Dengue and Kala Azar, Leprosy
etc. The facility wise number of medicines in the EML includes 106 drugs at Sub Health Centre
level, 172 at Primary Health Centre level, 300 at Community Health Centre level, 318 at Sub-
district Hospital level and 381 drugs at district Hospital level. However, States have the
flexibilitytoaddmore medicines.
NHM provides technical and financial support to the States/UTs for emergency medical services
through a functional National Ambulance Service (NAS) network which is linked with a
centralized toll-free number 108/102. Dial 108 is primarily designed to attend to patients of
critical care, trauma and accident victims etc. Dial 102 services includes basic patient transport
thataimstocater tothe needsof pregnantwomen andchildrenandotherstoo.
As per NHM norms, one Basic Life Support (BLS) ambulance per 100,000 population and one
Advanced Life Support (ALS) per 500,000 population is provided. The National Ambulance
Code (AIS-125)sets technical andsafety norms. Emergency services like 102and 108are GPS-
trackedandperformance-monitored. Somestates use bike andboat ambulances inremote areas.
Emergency care services is one of the expanded package of services under Ayushman Bharat.
Urban Ayushman Arogya Mandir and rural Ayushman Arogya Mandir are providing the
expandedpackage& services.
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