**Executive Summary:**
This document outlines the Indian government's efforts under the National Health Mission (NHM) to strengthen primary healthcare for all citizens, including those in Other Backward Classes (OBC), Scheduled Castes (SC), and Scheduled Tribes (ST) populations. It details progress in establishing and reinforcing Primary Health Centres (PHCs), Community Health Centres (CHCs), and Health and Wellness Centres (HWCs), addressing staff shortages, deploying Mobile Medical Units (MMUs), and improving maternal and child health indicators. Data is current as of December 2024, with health infrastructure data from the Health Dynamics of India 2022-23.
**Key Points / Main Content:**
* **Infrastructure and Population Norms:**
* The primary healthcare system consists of Sub Health Centres, Primary Health Centres, and Community Health Centres.
* Population norms for establishing SHCs, PHCs, and CHCs in tribal and hilly areas have been relaxed to 3,000, 20,000, and 80,000, respectively.
* For urban areas, specific norms exist for Urban Ayushman Arogya Mandirs, Urban Primary Health Centres (UPHCs), and Urban Community Health Centres (UCHCs) based on population size.
* Details of operational PHCs, CHCs, and District Hospitals are available in the Health Dynamics of India 2022-23.
* **Addressing Staff Shortages:**
* NHM provides incentives and honorariums to encourage specialists to practice in rural and remote areas.
* Incentives include hard area allowances, honorariums for specialists conducting Cesarean Sections, and special incentives for doctors and ANMs.
* States can offer negotiable salaries and non-monetary incentives, such as preferential admission to postgraduate courses.
* Multi-skilling of doctors and skill upgradation of existing HR are supported under NHM.
* **Mobile Medical Units (MMUs):**
* MMUs provide primary healthcare services to remote, tribal, and underserved populations.
* As of December 2024, 1498 MMUs are operational in the country, including in OBC, SC, and ST population areas.
* 694 MMUs are specifically operational in areas with Particularly Vulnerable Tribal Groups (PVTGs).
* **Maternal and Child Health Initiatives:**
* NHM implements various programs to improve maternal and child health services, including Janani Suraksha Yojana (JSY), Janani Shishu Suraksha Karyakram (JSSK), Surakshit Matritva Aashwasan (SUMAN), Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA), and Mothers Absolute Affection (MAA).
* Other initiatives include setting up Maternal and Child Health (MCH) Wings, Birth Waiting Homes (BWH), Anaemia Mukt Bharat (AMB), Facility Based Newborn Care, Kangaroo Mother Care (KMC), and the Universal Immunization Programme (UIP).
**Impact Analysis:**
* **OBC, SC, and ST Populations:**
* *Impact:* Improved access to healthcare services, including primary care, maternal and child health services, and specialized medical care in underserved areas.
* *Action Required:* Utilize available healthcare services and participate in health programs to improve health outcomes.
* **Healthcare Providers (Doctors, Nurses, Paramedical Staff):**
* *Impact:* Opportunities for employment and professional development, especially in rural and remote areas, with potential for financial incentives and career advancement.
* *Action Required:* Consider serving in underserved areas to improve healthcare access and take advantage of available incentives and training programs.
* **State Governments and Health Departments:**
* *Impact:* Responsibility for implementing NHM programs and ensuring equitable access to healthcare services for all populations, including marginalized communities.
* *Action Required:* Strengthen healthcare infrastructure, address staff shortages, monitor health indicators, and implement targeted interventions to improve maternal and child health outcomes.
Key Entities Referenced
Primary Health Centres PHCs: Primary healthcare facilities that form a key part of India's healthcare system, especially in rural areas.
Community Health Centres CHCs: Secondary level healthcare facilities in India, designed to provide specialized services in rural areas.
Health and Wellness Centres HWCs: Part of India's efforts to provide comprehensive primary healthcare, focusing on preventive care and health promotion.
Uttar Pradesh: A state in India, specifically mentioned in the context of PHC, CHC, and HWC strengthening.
National Health Mission NHM: A key initiative by the Government of India to improve the health system and health outcomes across the country.
Mobile Medical Units MMUs: Mobile healthcare clinics that provide services to remote, tribal, and underserved populations.
Janani Suraksha Yojana JSY: A conditional cash transfer scheme to promote institutional delivery and reduce maternal and infant mortality.
Infant Mortality Rate IMR: The number of deaths of infants under one year old per 1,000 live births, used as a key health indicator.
GOVERNMENTOFINDIA
MINISTRYOFHEALTH ANDFAMILYWELFARE
DEPARTMENTOFHEALTH ANDFAMILYWELFARE
LOK SABHA
UNSTARREDQUESTION NO. 3284
TOBE ANSWERED ON08thAUGUST2025
STRENGTHENING OFPHCs, CHCs AND HWCs
†3284. SHRIDHARMENDRAYADAV:
Will the Ministerof HEALTH AND FAMILYWELFAREbe pleasedtostate:
(a) the details of the progress achieved in setting up and strengthening of Primary Health Centres
(PHCs), Community Health Centres (CHCs) and Health and Wellness Centres (HWCs) in
accordance with the relaxation of population norms in tribal and OBC/SC dominated rural areas of
the country, State-wise particularlyin Uttar Pradesh;
(b) the steps being taken to address the shortage of doctors, nurses and paramedical staff in health
facilitiesserving OBC, SCand STpopulationsinthe country;
(c) the number of mobile medical units currently operational in areas with OBC, SC and ST
population along with their effectiveness in providing healthservices, especially for preventive care
andearlydiagnosis; and
(d) the specific strategies under National Health Mission (NHM) depicting explicit improvement in
maternalandchild healthindicatorsamongOBC, SCandSTwomen andchildreninthe country?
ANSWER
THE MINISTER OFSTATEIN THE MINISTRYOFHEALTHAND FAMILYWELFARE
(SHRIPRATAPRAOJADHAV)
(a): The healthcare system of the country involves a three-tier system with Sub Health Centre
(Rural), PrimaryHealth Centre (Urban andRural) andCommunityHealthCentre (Urban andRural)
as the three pillars of Primary Health Care System in India. National Health Mission (NHM)
envisages achievement of universal access to equitable, affordable & quality health care services
that are accountable and responsive to needs of the population including OBC, SC and ST
population.
Asperestablished norms, inrural areasa SubHealthCentre for a populationof5,000(inplain)
and3000(inhillyandtribalarea),aPrimaryHealthCentre fora populationof 30,000(inplains)and
20,000 (in hilly and tribal areas) and Community Health Centre for a population of 1,20,000 (in
plain)and80,000(inhillyandtribalarea)issuggested.Further, forurbanareaone Urban Ayushman
Arogya Mandir is recommended for a urban population of 15,000 to 20,000, one Urban-Primary
Health Centre (U-PHC) for a urban population of 30,000 to 50,000, One Urban-Community Health
Centre (U-CHC)for every2.5 lakhpopulationinnon-metrocities(above 5lakhpopulation)andone
U-CHCfor every5lakhpopulationinthe metrocities.The population norms for setting up SHC, PHC and CHC in tribal and hilly areas has been
relaxedfrom5,000,30,000,and1,20,000 to3000,20,000and80,000respectively.
As per Health Dynamics of India (HDI) 2022-23, details of Primary Health Centres (PHCs),
CommunityHealthCentres(CHCs) andDistrict Hospitals operationalinthecountryincludingUttar
Pradeshmaybe seenatthe followinglink:
https://mohfw.gov.in/sites/default/files/Health%20Dynamics%20of%20India%20%28Infrastructure
%20%26%20Human%20Resources%29%202022-23_RE%20%281%29.pdf
(b): Under NHM, following types of incentives and honorarium are provided for encouraging
Health Specialists to practice in different regions of the country including rural and remote areas of
the country:
(i) Hard area allowance to specialist doctors for serving in rural and remote areas and for their
residential quartersso thattheyfindit attractivetoserveinpublichealthfacilitiesinsuchareas.
(ii) Honorarium to Gynecologists/ Emergency Obstetric Care (EmoC) trained, Pediatricians &
Anesthetist/ Life Saving Anaesthesia Skills (LSAS) trained doctors is also provided to increase
availabilityofspecialists forconductingCesareanSectionsinrural&remote area.
(iii) Incentives like special incentives for doctors, incentive for ANM for ensuring timely ANC
checkup and recording, incentives for conducting Adolescent Reproductive and Sexual Health
activities.
(iv) States are also allowed to offer negotiable salary to attract specialist including flexibility in
strategiessuchas “YouQuoteWe Pay”.
(v) Non-Monetary incentives such as preferential admission in post graduate courses for staff
serving in difficult areas and improving accommodation arrangement in rural areas have also been
introducedunderNHM.
(vi) Multi-skilling ofdoctorsissupported underNHM toovercomethe shortage of specialists. Skill
upgradation of existing HR is another major strategy under NRHM for achieving improvement in
healthoutcomes.
(c): Mobile Medical Units (MMUs) provide primary healthcare services to remote, tribal, and
underserved populations which also include OBC, SC and ST population. These MMUs function as
mobile clinics, delivering preventive, promotive,and curative healthcareto areaslackingeasy access
to hospitals or health centers. As per NHM MIS December, 2024, there are a total of 1498 MMUs
operational in the country including OBC, SC and ST population areas under NHM. Out of these
1498 MMUs, a total of 694 MMUs are currently operational in areas with Particularly Vulnerable
Tribal Groups (PVTGs), providingbothpreventive andcurative care.
(d): The Government of India, through the National Health Mission (NHM), has implemented
various programs to improve maternal and child health services and outcomes including OBC, SC
and ST population throughout the country. These initiatives to reduce Maternal Mortality Rate
(MMR) and Infant Mortality Rate (IMR) include Janani Suraksha Yojana (JSY), Janani Shishu
Suraksha Karyakram (JSSK), Surakshit Matritva Aashwasan (SUMAN), Pradhan Mantri SurakshitMatritva Abhiyan (PMSMA), Mothers’ Absolute Affection (MAA), Setting up of Maternal and
Child Health (MCH) Wings, Birth Waiting Homes (BWH), Anaemia Mukt Bharat (AMB), Facility-
Based Newborn Care, Kangaroo Mother Care (KMC), Community-based care of Newborn and
Young Children, STOPDiarrhoea initiative, Nutrition Rehabilitation Centres (NRCs), and Universal
ImmunizationProgramme (UIP).
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