ANSWER
THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND
FAMILY WELFARE
(SHRI ASHWINI KUMAR CHOUBEY)
(a): The key health indicators such as Infant Mortality Rate (IMR), Under 5 Mortality Rate (U5MR), Total Fertility Rate (TFR), proportion of institutional deliveries etc are poor in rural areas as compared to urban areas due to gaps in availability of health human resources & health infrastructure in rural areas as compared to urban areas.
(b): As per Rural Health Statistics, 2018 the state-wise details of Rural Health Infrastructure is at Annexure-I & Annexure-II. The details of availability of human resources vis-à-vis requirements in public health facilities, State/UT-wise is given at Annexure-III to VII.
As per Health and Morbidity Survey 2014 of National Sample Survey Office (NSSO), Ministry of Statistics and Program Implementation, Out of Pocket Expenditure (OOPE) per hospitalized case (excluding child birth) in Public Health Facilities is Rs 5369 for Rural areas. The OOPE in public health facilities is much lower than the private sector.
(c): “Public Health & Hospital” being a State subject, the primary responsibility to provide healthcare to its citizens lies with the State Governments. To address the healthcare challenges, particularly in rural areas, the National Rural Health Mission (NRHM) was launched in 2005 to supplement the efforts of the State/UT governments to provide accessible, affordable and quality healthcare to all those who access public health facilities. Currently, NRHM is a sub-mission of National Health Mission.
This support under NHM includes provision of a host of free services such as 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.
Other major initiatives include Janani Shishu Suraksha Karyakram (JSSK) (under which free drugs, free diagnostics, free blood and diet, free transport from home to institution, between facilities in case of a referral and drop back home is provided), Rashtriya Bal Swasthya Karyakram (RBSK) (which provides newborn and child health screening and early interventions services free of cost for birth defects, diseases, deficiencies and developmental delays to improve the quality of survival), implementation of Free Drugs and Free Diagnostics Service Initiatives, PM National Dialysis Programme and implementation of National Quality Assurance Framework.
Mobile Medical Units (MMUs) & Telemedicine are also being implemented with NHM support to improve healthcare access particularly in rural areas.
As part of Ayushman Bharat, the Government is supporting the States for strengthening Sub Centres and Primary Health Centres as Health and Wellness Centres (AB-HWCs) for provision of comprehensive primary health care that includes preventive and health promotion at the community level with continuum of care approach. Further, Ayushman Bharat, Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) provides health coverage up to Rs. 5.00 lakh per family per year to around 10.74 crore poor and vulnerable families as per Socio Economic Caste Census (SECC).
To improve availability of doctors & specialists in underserved areas, the Government is upgrading District Hospitals to Medical Colleges in 82 districts which do not have any Medical College thereby providing at least one Medical College for every three contiguous Parliamentary Constituencies.
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