Health Care Facilities in Rural Areas

356. DR. HEENA VIJAYKUMAR GAVIT

        SHRIMATI SUPRIYA SULE 

state: Will the Minister of HEALTH AND FAMILY WELFARE be pleased to 

• (a) whether healthcare in the rural areas of the country is a major concern, if so, the details thereof and the reasons therefor; 

• (b) the details of availability of healthcare facilities/infrastructure including manpower and affordability of facilities to the rural people vis-a-vis urban people; 

• (c) the details of steps taken to address the problems of rural health both at macro and micro levels and to improve the healthcare sector in rural areas of the country; and 

• (d) whether there is any proposal to draw a long term perspective plan to address the prevailing inequalities in the rural health sector and if so, the details thereof indicating the programmes/schemes being implemented/proposed to be implemented by the Government to reduce rural-urban gap in access to quality healthcare and advanced treatment and diagnostic facilities in the country? 

ANSWER 

THE MINISTER OF HEALTH AND FAMILY WELFARE 

(SHRI JAGAT PRAKASH NADDA) 

(a) to (d) : A Statement is laid on the Table of the House. 

STATEMENT REFERRED TO IN REPLY TO LOK SABHA STARRED QUESTION NO.356 FOR 4TH JANUARY, 2019 

(a) & (b) The key health indicators such as Infant Mortality Rate (IMR), Under 5 Mortality Rate (U5MR), Total Fertility Rate (TFR), proportion of institutional deliveries etc and availability of health human resources & health infrastructure are poor in rural areas as compared to urban areas. 

     As per National Health Profile 2018, there are 19810 Rural Government Hospitals with 279588 beds & 3772 Urban Government hospitals with 431173 beds in India. The state wise details are at Annexure. 

     As per Health Management Information System (HMIS), there are 86342 doctors in rural areas (including doctors in District Hospitals) and 15964 doctors in urban areas. 

      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 and Rs 7189 for Urban areas. The OOPE in public health facilities is much lower than the private sector. 

(c) & (d) “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 such as Malaria, Dengue and Kala Azar, Leprosy etc. 

   Other major initiatives for which states are being supported 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), Rashtriya Kishor Swasthya Karyakram (RKSK), implementation of NHM 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 for provision of comprehensive primary health care that includes preventive and health promotion at the community level with continuum of care approach. Further, the Government has launched Pradhan Mantri Jan Arogya Yojana (PMJAY) under Ayushman Bharat to provide affordable quality inpatient care. 

    To improve availability of doctors & specialists in under served 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. 

Annexure

S.No.	State/UT/Division	Rural Hospitals (Govt.) No.	Urban Hospitals (Govt.) No.	Total Hospitals (Govt.) No.	Rural Hospitals (Govt.) Beds	Urban Hospitals (Govt.) Beds	Total Hospitals (Govt.) Beds
	India	19810	3772	23582	279588	431173	710761
1	Andhra Pradesh	193	65	258	6480	16658	23138
2	Arunachal	208	10	218	2136	268	2404
3	Assam *	1176	50	1226	10944	6198	17142
4	Bihar	930	103	1033	6083	5936	12019
5	Chhattisgarh	169	45	214	5070	4342	9412
6	Goa*	17	25	42	1405	1608	3013
7	Gujarat	364	122	486	11715	20565	32280
8	Haryana*	609	59	668	6690	4550	11240
9	Himachal	705	96	801	5665	6734	12399
10	Jammu & Kashmir	56	76	132	7234	4417	11651
11	Jharkhand	519	36	555	5842	4942	10784
12	Karnataka*	2471	374	2845	21072	49093	70165
13	Kerala	981	299	1280	16865	21139	38004
14	Madhya Pradesh	334	117	451	10020	18819	28839
15	Maharashtra	273	438	711	12398	39048	51446
16	Manipur	23	7	30	730	697	1427
17	Meghalaya*	143	14	157	1970	2487	4457
18	Mizoram*	56	34	90	604	1393	1997
19	Nagaland	21	15	36	630	1250	1880
20	Odisha*	1655	149	1804	6339	12180	18519
21	Punjab*	510	172	682	5805	12128	17933
22	Rajasthan	602	150	752	21088	10760	31848
23	Sikkim*	24	9	33	260	1300	1560
24	Tamil Nadu*	692	525	1217	40179	37353	77532
25	Telangana*	802	61	863	7668	13315	20983
26	Tripura*	99	56	155	1140	3277	4417
27	Uttar Pradesh*	4442	193	4635	39104	37156	76260
28	Uttarakhand	410	50	460	3284	5228	8512
29	West Bengal	1272	294	1566	19684	58882	78566
30	A&N Island	27	3	30	575	500	1075
31	Chandigarh	0	4	4	0	778	778
32	D&N Haveli*	10	1	11	273	316	589
33	Daman & Diu	5	0	5	240	0	240
34	Delhi	0	109	109	0	24383	24383
35	Lakshadweep	9	0	9	300	0	300
36	Puducherry	3	11	14	96	3473	3569