Providing healthcare services in remote rural and tribal areas

Providing healthcare services in remote rural and tribal areas

Public health is a State subject, the primary responsibility to provide quality health care services to the people including in rural, tribal and hilly areas lies with State/UT Governments. To supplement the efforts of State Governments of improving the healthcare services, particularly in rural areas including hilly & tribal areas, National Rural Health Mission (NRHM) was launched in 2005. NRHM has now been subsumed as a Sub Mission of the overarching National Health Mission (NHM) with the National Urban Health Mission as the other Sub Mission.


The healthcare services in tribal areas of the country vary from state to state. Under the National Health Mission (NHM), support is provided to States/UTs to strengthen their health systems including for setting up/upgrading public health facilities, augmenting health human resource on contractual basis, drugs and equipment, diagnostics, Ambulances, Mobile Medical Units, etc for provision of equitable, affordable healthcare to all its citizens including the poor and vulnerable population including tribal population based on requirements posed by the States in their Programme Implementation Plans.

To ensure focus on quality, States are also supported for implementation of National Quality Assurance Framework and Kayakalp. Under NHM, all tribal majority districts whose composite health index is below the State average have been identified as High Priority Districts (HPDs) and these districts are expected to receive more resources per capita under the NHM as compared to the rest of the districts in the State. These districts also receive focused attention and supportive supervision. Norms for infrastructure, Human resource, ASHAs, MMUs etc. under NHM are relaxed for tribal and hilly areas.

The Health Minister, Shri J P Nadda stated this in a written reply in the Rajya Sabha here today.

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Public health is a State subject, the primary responsibility to provide quality health care services to the people including in rural, tribal and hilly areas lies with State/UT Governments.
Public health is a State subject, the primary responsibility to provide quality health care services to the people including in rural, tribal and hilly areas lies with State/UT Governments. To supplement the efforts of State Governments of improving the healthcare services, particularly in rural areas including hilly & tribal areas, National Rural Health Mission (NRHM) was launched in 2005. NRHM has now been subsumed as a Sub Mission of the overarching National Health Mission (NHM) with the National Urban Health Mission as the other Sub Mission.

The healthcare services in tribal areas of the country vary from state to state. Under the National Health Mission (NHM), support is provided to States/UTs to strengthen their health systems including for setting up/upgrading public health facilities, augmenting health human resource on contractual basis, drugs and equipment, diagnostics, Ambulances, Mobile Medical Units, etc for provision of equitable, affordable healthcare to all its citizens including the poor and vulnerable population including tribal population based on requirements posed by the States in their Programme Implementation Plans.

To ensure focus on quality, States are also supported for implementation of National Quality Assurance Framework and Kayakalp. Under NHM, all tribal majority districts whose composite health index is below the State average have been identified as High Priority Districts (HPDs) and these districts are expected to receive more resources per capita under the NHM as compared to the rest of the districts in the State. These districts also receive focused attention and supportive supervision. Norms for infrastructure, Human resource, ASHAs, MMUs etc. under NHM are relaxed for tribal and hilly areas.

The Health Minister, Shri J P Nadda stated this in a written reply in the Rajya Sabha here today.

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Progress Made in Setting up New AIIMS


Government of India has approved for establishment of three new AIIMS at Mangalagiri near Guntur in Andhra Pradesh at the cost of Rs. 1618 crore, Nagpur in Maharashtra at the cost of Rs 1577 crore and Kalyani in West Bengal at the cost of Rs 1754 crore under PradhanMantriSwasthyaSurakshaYojana(PMSSY), involving a total financial implication of Rs 4949 crore.

Details of progress made by Government in setting up of three new AIIMS aregiven below:

There are no hurdles that stand in the way of making progress. MoUs have been signed with State Governments of Andhra Pradesh, West Bengal and Maharashtra. Taking over of the land at Andhra Pradesh and West Bengal has been done and same will be done at Nagpur by April, 2016.

The establishment of each of the new AIIMS will be completed in a period of 60 months from the zero date ( that is the date of the approval of Government of India ), broadly comprising a Pre-construction phase of 12 months, a Construction phase of 42 months and a Stabilization/Commissioning phase of 6 months.

Status of 3 new AIIMS at Guntur, Nagpur and Kalyani

Cabinet approved 03 new AIIMS at Manglagiri, Nagpur and Kalyani on 07th October 2015. So far, following steps have been taken-

·        MoUs have been signed with State Governments of Andhra Pradesh, West Bengal and Maharashtra, under which State Governments have agreed to provide encumbrance free land, free of cost, for execution of the work.


·        The Pre-Investment activity for these AIIMS has been assigned to HSCC India Limited at cost of Rs. 50 crore and Rs. 10.00 crore has been released for pre-investment activities.


·        Pre-investment activities of soil survey, topographical survey, etc. has been completed at all three sites.



·        Taking over of the land at Andhra Pradesh and West Bengal has been done and same will be done at Nagpur in March, 2016.


·        Tender for boundary wall for all the three new AIIMS has been opened and is under finalization.


·        HSCC(I) has been appointed as executing agency for project of these three AIIMS on turn-key basis.


·        Global EOI for design and architecture has been floated by HSCC(I) and pre-bid conference for EOI has been conducted on 24th Feb, 2016.

The Health Minister, Shri J P Nadda stated this in a written reply in the RajyaSabha here today.


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Separate Hospital Ward for Victims of Child Abuse

Since health is a State subject, it is the responsibility of the respective State Government/UT Administration to take action for setting up of such wards in the Hospitals in their States.

As far as three Central Government hospitals viz. Safdarjung Hospital, Dr. RML Hospital, Lady Hardinge Medical College are concerned, Ministry of Health & Family Welfare has set up ‘One Stop Centre’ in each of these hospitals. The concept of One Stop Centre emanates from the fact that the sexual assault survivor is not required to move from one department to other department and all facilities such as medical treatment, collection of forensic evidence, psycho-social support, etc. are available under one roof. This Centre is functional in above mentioned Hospitals.

The Health Minister, Shri J P Nadda stated this in a written reply in the Rajya Sabha here today.

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Action Against Spurious Drugs Rackets

The Central Government is implementing the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) under National Health Mission (NHM) for interventions upto the district level. The programme components include awareness generation for Cancer prevention, screening, early detection and referral to an appropriate level institution for treatment. For Cancer, the focus is on three sites, namely breast, cervical and oral Cancer. The Government of India has also approved a “Tertiary Care for Cancer” Scheme in the year 2013-14. Under the said scheme, Government of India is assisting to establish/set up State Cancer Institutes (SCI) and Tertiary Care Cancer Centres (TCCC) in different parts of the country. The maximum assistance inclusive of State share for SCI is upto Rs.120 crore and for TCCC is upto Rs.45 crore subject to eligibility as per scheme guidelines and availability of funds.

The treatment for cancer in Government Hospitals is either free or subsidized. In addition to Cancer diagnosis and treatment by the State Governments Health Institutes, the Central Government Institutions such as All India Institute of Medical Sciences, Safdurjung Hospital, Dr Ram ManoharLohia Hospital, PGIMER Chandigarh, JIPMER Puducherry, Chittaranjan National Cancer Institute, Kolkata, etc. provide facilities for diagnosis and treatment of Cancer.

Oncology in its various aspects has focus in case of new AIIMS and many upgraded institutions under PradhanMantriSwasthyaSurakshaYojna (PMSSY). Setting up of National Cancer Institute at Jhajjar (Haryana) and 2nd campus of Chittranjan National Cancer Institute, Kolkata has also been approved.

The list of medicines specified in the National List of Essential Medicines (NLEM) which are included in the First Schedule of Drug Pricing Control Order (DPCO), 2013 also contain drugs used for the treatment of Cancer. NLEM (drug formulations) medicines for which ceiling prices have been notified under DPCO, 2013, includes 47 anti-Cancer medicines.

Presently one Affordable Medicines and Reliable Implants for Treatment (AMRIT) outlet has been opened at All India Institute of Medical Sciences, New Delhi. Approval has also been accorded for opening of such outlets at 6 new AIIMS and major Central Government Hospitals. Further, M/s HLL Lifecare Ltd, which is a 100% Government of India owned PSU under this Ministry, has been directed to contact all States which may like to open AMRIT outlets in major State Government hospitals/institutions. As per the approval accorded for setting up AMRIT, the prices of the products are to be reasonable and significantly lower than the market price. AMRIT pharmacy has been opened with an objective to make available Cancer and Cardiovascular drugs and implants at reasonable prices to the patients.

Financial assistance to Below Poverty Line (BPL) patients is available under the RashtriyaArogyaNidhi (RAN). Besides this, the Health Minister’s Cancer Patient Fund (HMCPF) within the RashtriyaArogyaNidhi has been set up in 2009 wherein 27 erstwhile Regional Cancer Centres (RCCs) are provided with revolving funds to provide immediate financial assistance upto Rs.2.00 lakh to BPL Cancer patients.

Assistance for Palliative care can now be a part of the National Health Mission. The States can incorporate their proposals related with initiation/enhancement of palliative care services in their respective State Project Implementation Plans.

Moreover, certain amendments were effected in the Narcotic Drugs and Psychotropic Substances (NDPS) Act, 1985 in 2014, which are aimed at removing the regulatory barriers for adequate access to morphine and other opioids for medical needs such as pain relief and palliative care.

The Health Minister, Shri J P Nadda stated this in a written reply in the RajyaSabha here today.

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Augmenting Dialysis Treatment Facilities

Data regarding availability of infrastructural facilities for dialysis treatment in the country is not maintained centrally.

Health being a State subject, it is primarily the responsibility of the State Governments to provide health care including dialysis facilities for the patients. The Central Government, through the hospitals under it, supplements the efforts of the State Governments.

Dialysis facility is available at the Central Government hospitals including All India Institute of Medical Sciences (AIIMS) Delhi; Dr. Ram ManoharLohia Hospital, Delhi; Safdarjung Hospital, Delhi; Jawaharlal Nehru Institute of Post Graduate Medical Education and Research (JIPMER), Puducherry, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong and Regional Institute of Medical Sciences (RIMS), Imphal.

To enhance treatment facilities, the Central Government has approved setting up of AIIMS type of Institutions in 9 States. Assistance for up gradation of tertiary care facilities at 70 medical colleges is also approved.

State Governments can also consider providing dialysis services at District Hospitals through Public Private Partnership (PPP) mode under National Health Mission. A scheme for dialysis has also been announced in the 2016-17 budget speech by the Finance Minister.

The Health Minister, Shri J P Nadda stated this in a written reply in the RajyaSabha here today.

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ARV Drugs for HIV/AIDS Patients

All People Living with HIV (PLHIV) accessing public ART Centres and eligible for ART as per the national guidelinesare provided free ART.

There are no reports of HIV/AIDS patients being denied access to treatment. However, there have been occasions when patients have been given drugs for 15 days at a time, instead of the norm of 30 days.

Under the National AIDS Control Programme, (NACP) Phase-IV, National AIDS Control Organization is committed to provide universal access to comprehensive and equitable care, support and treatment services to all People Living with HIV/AIDS (PLHIV). At present there are 524 ART Centres and 1,094 Link ART Centres in the country providing free Antiretroviral treatment, treatment for opportunistic infections, and counseling services to 9.25 lakh PLHIV.

The Ministry is aware of World Health Organization’s ‘treat all’ recommendations. These guidelines will be discussed in the Technical Resource Group (TRG) on ART and with other stakeholders before a considered decision is arrived at.

Currently all PLHIV with WHO clinical stage III and IV, all positive pregnant women, all HIV/TB co-infected patients, all patients with HIV & hepatitis with severe liver disease and all children less than 5 years are covered under ‘test & treat’ i.e they are initiated on ART treatment irrespective of CD4 count. Those PLHIV who have WHO clinical stage I and II are initiated on ART, if CD4 is less than 350 according to the national guidelines for ART treatment.

Under National AIDS Control Programme, (NACP) Phase-IV, there is currently no plan to achieve universal anti-retroviral treatment in the country.

The Minister of State (Health and Family Welfare), ShriShripadYessoNaik stated this in a written reply in the RajyaSabha here today.

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Addressing the Problems of Rural Health

The health status of the population, especially that of rural population, does require improvement. However, the condition of the health services in rural areas of the country has improved after the launch of the National Rural Health Mission.

As per the National Health Profile, 2015, the number of beds in rural hospitals is 183602 as against 492177 beds in urban hospitals.

Public health being a State subject, the primary responsibility to provide health care facilities 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. The National Rural Health Mission (NRHM) has now been subsumed under the National Health Mission (NHM) as its Sub-Mission, along with National Urban Health Mission (NUHM) as the other Sub-Mission.Support under NHM is provided to State/UTs for setting up new facilities or renovation of existing facilities, health human resource on contractual basis, drugs, equipment, diagnostics, Ambulances, Mobile Medical Units etc based on the requirement posed by the States/UTs in their Programme Implementation Plans (PIPs).

The government has already taken steps towards provision of free services for maternal health, child health, adolescent health, family planning, universal immunization programme, and for major diseases such as TB, vector borne diseases such as Malaria, dengue and Kala Azar, leprosy etc. Other major initiatives for which states are being supported include JananiShishuSurakshaKaryakram (JSSK), RashtriyaBalSwasthyaKaryakram (RBSK), RashtriyaKishorSwasthyaKaryakram (RKSK), implementation of National Health Mission Free Drugs Service Initiative and National Health Mission Free Diagnostics Service Initiative, Strengthening District Hospitals and implementation of National Quality Assurance Framework. To address health inequities, 184 High Priority Districts have been identified for enhanced fund allocation and focused attention.

The Government has formulated a draft National Health Policy 2015, which among others, recommends setting up of medical colleges in rural areas in addition to realigning pedagogy and curriculum to suit rural health needs.

The Health Minister, Shri J P Nadda stated this in a written reply in the RajyaSabha here today.

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Impact of Passive Smoking on Children

As per Global Youth Tobacco Survey, a school-based survey of students in grades 8, 9, and 10 conducted in 2009, one in five students live in homes where others smoke, and more than one-third of the students are exposed to smoke around others outside of the home; one-quarter of the students have at least one parent who smokes.

Exposure to second hand smoke results in lung cancer and heart diseases among adults, and SIDS (Sudden Infant Death Syndrome), chronic respiratory infections, exacerbation/worsening of asthma, reduced lung function growth, middle ear diseases, and acute respiratory illnesses among children. Smoking in the home affects babies and young children as well as the elderly and other adults, especially women.

The Government has taken measures including, inter alia, the following to curb smoking: (i) Enactment of the “Cigarettes and other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act, (COTPA) 2003”.

(ii) Ratification of WHO Framework Convention on Tobacco Control.

(iii) Launch of the National Tobacco Control Programme (NTCP) in the year 2007-08, with the objectives to (a) create awareness about the harmful effects of tobacco consumption, (b) reduce the production and supply of tobacco products, (c) ensure effective implementation of the anti-tobacco laws and (d) help the people quit tobacco use through Tobacco Cessation Centres.

(iv) Notification of rules to ban smoking in public places.

(v) Notification of rules to regulate depiction of tobacco products or their use in films and TV programmes.

(vi) Notification of rules on new pictorial health warnings on tobacco product packages.

(vii) Launch of public awareness campaigns through a variety of media. v Government of India has banned certain kinds of smokeless tobacco products like gutkha and chewing tobacco through the notification issued under the Food Safety and Standards Act, 2006. Other tobacco products are regulated by the Cigarettes and other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act, 2003 (COTPA 2003), which contain provisions, inter alia, relating to ban on sale of tobacco products by/to minors, ban on sale of tobacco products within 100 yards of educational institutions, ban on promotions/advertisements of tobacco products, etc.

The State Governments/UTs of Uttarakhand, Punjab, Rajasthan, Haryana, Mizoram, Chandigarh, Uttar Pradesh, and Jharkhand have issued orders/notifications banning the sale of loose cigarettes.

The Health Minister, Shri J P Nadda stated this in a written reply in the Rajya Sabha here today.

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Timely treatment protocol for Cardiovascular Patients

As per the estimates in the World Health Organisation NCD Country Profile 2014, Cardio Vascular Disease (CVD) the leading cause of deaths in India and accounts for 26% of all deaths.

Management of Acute Coronary Event (MACE) registry’s feasibility study by Indian Council of Medical Research undertaken in small number of patients from 13 hospitals in 12 Indian states (including registries in difficult terrains of the country) showed a medium time of symptoms onset to door of 15 hours and that of onset of symptoms to first medical contact of 2.5 hours indicating a delay in transfer of these cases to Acute Coronary Event care hospitals.

The Health Minister, Shri J P Nadda stated this in a written reply in the Rajya Sabha here today.

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Establishment of New AIIMS



TheGovernment has cleared the proposal to establish three new AIIMS, at Mangalagiri near Guntur in Andhra Pradesh at the cost of Rs. 1618 crore, Nagpur in Maharashtra at the cost of Rs 1577 crore and Kalyani in West Bengal at the cost of Rs 1754 crore under PradhanMantriSwasthyaSurakshaYojana(PMSSY), involving a total financial implication of Rs 4949 crore.

The establishment of each of the new AIIMS will be completed in a period of 60 months from the zero date ( that is the date of the approval of Government of India ), broadly comprising a Pre-construction phase of 12 months, a Construction phase of 42 months and a Stabilization/Commissioning phase of 6 months.

The capacity of each of these hospitals and other amenities is annexed in the List.

Facilities in each AIIMS under PMSSY

Ø  Intake of 100 under-graduate students at each of the Medical College, besides the facilities for imparting PG/doctoral courses in various disciplines.

Ø  Provision of Nursing College as a Centre of Excellence for pursuing programme in B.Sc (Nursing) and M.Sc (Nursing) students.

Ø  Total bed strength comes to 960 beds, with 42 specialty/super-specialty departments, as below:-

                                                                                i.            500 beds –     Hospital

                                                                             ii.            300 beds –     Specialty/Super-specialty

                                                                           iii.            100 beds –     ICU/Accident Trauma

                                                                           iv.            30 beds –       AYUSH

                                                                              v.            30 beds –       Physical Medicine & Rehabilitation

Ø  Details of specialties and super specialties are as under:-


SPECIALITY DEPARTMENTS
1.      General Medicine

2.      General Surgery

3.      Obstetrics & Gynecology

4.      Orthopedics and Traumatology

5.      Pediatrics

6.      Dermatology & STD

7.      Auto-Rhino laryngology (ENT)

8.      Ophthalmology

9.      Rheumatology

10. Pathology with Central Lab

11. Microbiology & Infectious diseases

12. Radio-diagnosis & Imaging

13. Radiotherapy

14. Anesthesiology

15. Transfusion Med. & Blood Bank

16. Psychiatry

17. TB & chest

18. Dentistry

SUPER SPECIALITY DEPARTMENTS

19. Cardiology

20. Cardiothoracic and Vascular Surgery

21. Gastroenterology

22. Surgical Gastroenterology

23. Nephrology

24. Urology

25. Neurology

26. Neurosurgery

27. Medical Oncology

28. Surgical Oncology

29. Endocrinology and Metabolic diseases

30. Clinical hematology

31. Pediatric Surgery

32. Burns and Plastic Surgery

33. Pulmonary medicine and critical care

34. Nuclear Medicine

BASIC SCIENCE DEPARTMENT

35. Anatomy

36. Physiology

37. Bio-chemistry

38. Pharmacology

39. Community Med/Public health

40. Forensic Medicine

OTHER DEPARTMENTS

41. Physical Med. & Rehabilitation

42. Hospital Administration

The Health Minister, Shri J P Nadda stated this in a written reply in the RajyaSabha here today.


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Zika Virus Outbreaks

Zika virus disease has local transmission in 41 countries during 2015-16, mainly involving Latin America. World Health Organization (WHO) has declared Zika virus disease to be a Public Health Emergency of International Concern (PHEIC) on 1st February, 2016.

Aedes mosquito which transmits Zika virus disease is widely prevalent in tropical and sub-tropical areas of the Americas, South East Asia, Africa, Eastern Mediterranean and the Western Pacific. WHO has informed that Zika virus is likely to be transmitted and detected in countries within the geographical range of the vector Aedes mosquito.

Technical guidelines and travel advisory were issued and disseminated and also made available on the website of the Ministry. States where Dengue transmission is on, namely Maharashtra, Kerala, Tamil Nadu and UT of Puducherry have been alerted. National Centre for Disease Control (NCDC), Delhi has been identified as the nodal agency for investigation of outbreak in any part of the country. Fifteen International Airports and nine major ports have displayed signages providing information for travelers on Zika virus disease and advising the travelers to report if they are returning from any of the affected countries and suffering from febrile illness. Immigration authorities at these Airports have been sensitized. Directorate General of Civil Aviation, Ministry of Civil Aviation has issued instruction to all international airlines to follow the recommended aircraft disinsection guidelines. Vector control measures have been implemented at International Airports and Ports. National Centre for Disease Control, Delhi and National Institute of Virology (NIV), Pune, have established the capacity to provide laboratory diagnosis of Zika virus disease in acute febrile stage. National Vector Borne Disease Control Programme has alerted all its field units for enhanced vector (Aedes mosquitoes) control. National AIDS Control Organization has issued advisory for blood banks and potential blood donors to prevent transmission of Zika virus infection by blood transfusion. A 24x7 control room cum Help Line has started functioning from Directorate General of Health Services. Public has been made aware about Zika virus disease through press releases issued by Ministry of Health and Family Welfare. The situation is being monitored regularly.

There is no specific treatment for Zika virus Disease. People affected with Zika virus are advised to take plenty of rest, drink enough fluids, and treat pain and fever with paracetamol. They are also advised to take personal protective measures against mosquito bite.

The Health Minister, Shri J P Nadda stated this in a written reply in the Rajya Sabha here today.

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Measures to Reduce Anaemia in Women 

As per National Family Health Survey (NFHS) - III (2005-06), prevalence of anaemia in women is 55.3%.  State-wiseprevalence of anaemia in women of reproductive age group (15-49 years) as per the latest survey data is given below.

The steps taken by Government to prevent and treat anaemia amongst women are as follows:

        i.            Ministry of Health and Family Welfare in 2013 launched “National Iron Plus Initiative” as a comprehensive strategy to combat the public health challenge of Iron Deficiency Anaemia prevalent across the life cycle. There are age specific interventions with Iron and Folic Acid Supplementation and Deworming for improving the haemoglobin levels and reducing the prevalence of anaemia for all age groups, that is children 6-59 months, 5 – 10 years, adolescent girls and boys (11-19 years), pregnant and lactating women and women in reproductive age group (20 – 49 years).

     ii.            Universal screening of pregnant women for anaemia is a part of ante-natal care and all pregnant women are provided iron and folic acid tablets during their ante-natal visits through the existing network of sub-centers and primary health centres and other health facilities as well as through outreach activities at Village Health & Nutrition Days (VHNDs). 

   iii.            Every pregnant woman is given iron and folic acid, after the first trimester, to be taken 1 tablet daily for 6 months during ante-natal and post-natal period.  Pregnant women, who are found to be clinically anaemic, are given additional tablet for taking two tablets daily.

   iv.            Government of India has given directions to the States for identification and tracking of severely anaemic cases at all the sub centres and PHCs for their timely management.

      v.            Health and nutrition education through IEC & BCC to promote dietary diversification, inclusion of iron folate rich food as well as food items that promotes iron absorption.  

   vi.            To tackle the problem of anemia due to malaria particularly in pregnant women and children, Long Lasting Insecticide Nets (LLINs) and Insecticide Treated Bed Nets (ITBNs) are being distributed in endemic areas.

 vii.            Health management information system & Mother Child tracking system is being implemented   for reporting the cases of anemic and severely anaemic pregnant women.

viii.            MCP Card and Safe Motherhood Booklet are being distributed to the pregnant women for educating them on dietary diversification and promotion of consumption of IFA.

   ix.            184 High Priority Districts (HPDs) have been identified and prioritized for Reproductive Maternal Newborn Child Health+ Adolescent (RMNCH+A) interventions for achieving improved maternal and child health outcomes.

State-wise prevalence of anaemia in women of reproductive age group (15-49 years)
Sl. No	States	(NFHS 3, 2005 -06)	DLHS-4 2012-13)	AHS-CAB (2014)	NFHS 4 (2015-16)
1	All India	55.3	NA	NA	NA
2	AN Islands	NA	70.1	NA	65.8
3	Andhra P.	62.9	68.1	NA	60.2
4	Arunachal P.	50.6	56.7	NA	NA
5	Assam	69.5	NA	90	NA
6	Bihar	67.4	NA	87.2	60.4
7	Chandigarh	NA	47.7	NA	NA
8	Chhattisgarh	57.5	NA	76.4	NA
9	D N Haveli	NA	NA	NA	NA
10	Daman & Diu	NA	NA	NA	NA
11	Delhi	44.3	NA	NA	NA
12	Goa	38	63.4	NA	31.4
13	Gujarat	55.3	NA	NA	NA
14	Haryana	56.1	57.7	NA	63.1
15	Himachal P.	43.3	44	NA	NA
16	J & K	52.1	NA	NA	NA
17	Jharkhand	69.5	NA	83.5	NA
18	Karnataka	51.5	62.5	NA	44.8
19	Kerala	32.8	32.7	NA	NA
20	Lakshadweep	NA	NA	NA	NA
21	Madhya P.	56	NA	83.7	52.4
22	Maharashtra	48.4	65.3	NA	48
23	Manipur	35.7	65.3	NA	26.4
24	Meghalaya	47.2	53.9	NA	56.5
25	Mizoram	38.6	64.1	NA	NA
26	Nagaland	NA	50.2	NA	NA
27	Odisha	61.2	NA	77.7	NA
28	Puducherry	NA	52.2	NA	53.4
29	Punjab	38	52.7	NA	NA
30	Rajasthan	53.1	NA	82.6	NA
31	Sikkim	60	70.6	NA	35.2
32	Tamil Nadu	53.2	49.2	NA	55.4
33	Telengana	NA	57.7	NA	56.9
34	Tripura	65.1	45.6	NA	54.5
35	Uttar P.	49.9	NA	NA	NA
36	Uttarakhand	55.2	NA	92.9	45.1
37	West Bengal	63.2	76.3	NA	62.8

The Health Minister, Shri J P Nadda stated this in a written reply in the RajyaSabha here today.

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Steps taken towards elimination of Kala-Azar 

To achieve the Kala-azar elimination goal by 2017 set by the WHO, the following steps have been taken:

1.      National Roadmap for Kala-azar Elimination (2014) has been circulated to states with clear goal, objectives, strategies, timelines with activities and functions at appropriate level. This document has been developed for focused intervention at national, state, district and sub-district  and village levels.

2.      Treatment of Kala-azar patient with single day single dose Liposomal Amphotericin B (AmBisome) injection has improved treatment compliance. Unintrupted  free supply of AmBisome  is ensured by WHO.

3.      Regular supply of diagnostic kit (rapid diagnostic test) and drugs in states is ensured.

4.      Funds are provided to states for incentive of Rs. 500/- to Kala-azar patient   and Rs. 2,000/- to PKDL case from GoI  to compensate loss of wages.

5.      Incentive of Rs. 300/- to ASHA /health volunteer  to bring Kala- azar suspected case to health facility and to ensure  complete treatment. ASHA is also being paid Rs. 200/- during  indoor residual spray for social mobilization and community acceptance to allow spray in their rooms.

6.      Active search of Kala azar and  Post Kala-azar Dermal Leishmaniasis (PKDL) case and IEC/BCC with the help of development partners.

7.      In 21 high endemic districts of Bihar (15 districts), Jharkhand (4 districts) and West Bengal (2 districts), DDT has been replaced by Syenthetic Pyrethroid where vector showed tolerance towards DDT. All endemic Kala-azar villages are covered with focal spray where new case is found during non IRS period. Hand Compression pumps are being used for spraying.

8. Govt. of India is closely working with development partners like  Bill Melinda Gates Foundation(BMGF); KalaCORE Consortium; Rajendra Memorial Research Institute (RMRI); National Centre for Disease Control (NCDC), Patna and World Health Organisation (WHO) for achieving the desired goal of elimination.

9.  The Kala-azar Elimintion is being reviewed on monthly basis by Prime Minister’s Office (PMO) and higher officials of Ministry of Health & Family Welfare.

Programme is striving hard to achieve elimination within the target set by WHO. With the supportive monitoring, regular reviews and  field visits, 502 (80%) blockPHCs out of 625 endemic block PHCs have shown less than one case per 10,000 population in 2015 at block PHC level.

The funds allocated for the vector borne disease control programme including Kala-azar elimination under NVBDCP  during the last four years and current year are given below:

                                                                                    (Rs. In Lakhs)

Year	Bihar	Jharkhand	West Bengal	Uttar Pradesh
2011-12	4096.92	482.76	282.24	187.32
2012-13	5009.80	113.45	195.39	153.76
2013-14	1150.98	319.34	212.89	38.32
2014-15	3740.02	784.49	410.49	230.33
2016-16*	5432.14	3053.37	713.42	1724.31

         *Released under NVBDCP upto 31.01.2016

The Health Minister, Shri J P Nadda stated this in a written reply in the Rajya Sabha here today.

*****

Eradicating Malaria 

The reported number of confirmed Malaria cases has declined in Jharkhand and Gujarat in 2015 as compared to last three years 2012, 2013 & 2014. However, a marginal increase has been noticed for the country as a whole. A statement showing the malaria cases in Jharkhand, Gujarat & the country from 2012 to 2016 (till January) is as under:

Year	Malaria Cases
	Jharkhand	Gujarat	Country
2012	131476	76246	1067824
2013	97786	58513	881730
2014	103735	41608	1102205
2015(Prov.)	90251	41422	1126661
2016(upto Jan.)	5344	674	54613

The main strategies for prevention and control of malaria are as under:

Ø  Early Case Detection and Prompt Treatment (EDPT) to provide relief to the patient, and reduce reservoir of the infection.

Ø  Integrated Vector Management (IVM) by appropriate insecticidal spray in rural areas, anti-larval measures including biological methods like use of larvivorous fish and promotion of bio-environmental control measures, protective promotion of personal measures including use of Long Lasting Insecticidal Net (LLIN) Insecticide Treated Mosquito Nets (ITMN),

Ø  Emphasis on Information, Education and Communication (IEC) to promote community participation for prevention and control and Intersectoral Collaboration. Capacity building for optimal utilization of the technical manpower for the programme.

Ø  Monitoring and Evaluation of the Programme.

A statement showing  the allocation and release of funds to Gujarat and Jharkhand  during the last 3 years is as under:

                                                                                                            (Rs. In Lakhs)

Year	Gujarat		Jharkhand
	Allotted Fund	Release	Allotted Fund	Release
2012-13	1750.00	812.54	4638.60	1404.27
2013-14	1612.71	736.94	3836.09	1161.29
2014-15	2380.00	1198.20	4139.50	3162.25
2015-16*	1160.00	1143.11	4819.00	3647.37

*As on 8-3-2016

           

The cases and deaths due to malaria have declined in Jharkhand and Gujarat in 2015 as compared to previous years and under National Framework for Malaria Elimination, it has been envisaged to eliminate malaria in Gujarat by 2022 & in Jharkhand and entire country by 2027.

The Health Minister, Shri J P Nadda stated this in a written reply in the RajyaSabha here today.

*****

Effective Measures to Check Female Foeticide 

As per the information received from the National Crime Records Bureau (NCRB), NCRB has started collecting data on female foeticide since 2014. A total of 50 cases were reported under female foeticide in 2014.  State/UT-wise data of cases registered for offences relating to female foeticideare given in the table:

Cases Registered under Female Foeticide in 2014

S. No.	States/UTs	Cases Registered under Female Foeticide
1.	ANDHRA PRADESH	0
2.	ARUNACHAL PRADESH	0
3.	ASSAM	0
4.	BIHAR	0
5.	CHHATTISGARH	2
6.	GOA	0
7.	GUJARAT	0
8.	HARYANA	4
9.	HIMACHAL PRADESH	3
10.	JAMMU & KASHMIR	0
11.	JHARKHAND	0
12.	KARNATAKA	0
13.	KERALA	0
14.	MADHYA PRADESH	15
15.	MAHARASHTRA	1
16.	MANIPUR	0
17.	MEGHALAYA	0
18.	MIZORAM	0
19.	NAGALAND	0
20.	ODISHA	0
21.	PUNJAB	7
22.	RAJASTHAN	11
23.	SIKKIM	0
24.	TAMIL NADU	0
25.	TELANGANA	2
26.	TRIPURA	0
27.	UTTAR PRADESH	4
28.	UTTARAKHAND	1
29.	WEST BENGAL	0
30.	TOTAL (STATES)	50
31.	A&N ISLANDS	0
32.	CHANDIGARH	0
33.	D&N HAVELI	0
34.	DAMAN & DIU	0
35.	DELHI	0
36.	LAKSHADWEEP	0
37.	PUDUCHERRY	0
	TOTAL (UTs)	0
	TOTAL (ALL-INDIA)	50

Source: Crime in India

The Government has enacted the Pre-conception and Pre-natal Diagnostic Techniques (Prohibition of Sex Selection) Act, 1994 and also framed rules there under for prohibition of sex selection and prevention of misuse of pre-conception and pre-natal diagnostic techniques for sex determination before or after conception.

Government has adopted a multi-pronged strategy entailing schemes and programmes and awareness generation/advocacy measures to build a positive environment for the girl child through gender sensitive policies, provisions and legislation. The details of important measures taken for implementation of various provisions of PC&PNDT Act, 1994 and Rules made thereunder, as amended from time to time, are given below:

Measures taken for implementation of the PC & PNDT Act/Rules

·  The Government has intensified effective implementation of the Pre-conception and Pre-natal Diagnostic Techniques (Prohibition of Sex Selection) Act, 1994 and amended various provisions of the Rules.

·  The Government is rendering financial support to the States and UTs for operationalization of PNDT Cells, Capacity Building, Orientation &Sensitisation Workshop, Information, Education and Communication campaigns and for strengthening structures for the implementation of the PC & PNDT Act under the National Health Mission (NHM).

· A National review under the chairmanship of Additional Secretary and Mission Director, MoHFW was held on 21^stSeptember, 2015 through video conference.

· Program review at the state level has been intensified.  Five regional review workshops for North, West, Central, North East and Southern regions were organized during 2014-15.  During 2015-16 three regional review workshops have been organized for Northern Eastern, Northern and Eastern States in Imphal, Chandigarh and Bhubaneswar respectively.

· National campaign “BetiBachao, BetiPadhao” was launched in 100 gender critical districts in partnership with the Ministry of Woman and Child Development and the Ministry of Human Resource Development.

· Directions given by the Hon’ble Supreme Court in the matter of WP(C) 349/2006 (Voluntary Health Association of Punjab vs. UOI & others), were communicated to the States/ UTs time to time for ensuring compliance.

· Inspections by the National Inspection and Monitoring Committee (NIMC) have been scaled up. In year 2014-15, 19 inspection visits have been undertaken in different States.  During 2015-16, 22 NIMC inspections have been undertaken in the States of Punjab, Puducherry, Tripura, Sikkim, Uttar Pradesh, Odisha, Bihar, Mizoram, Andhra Pradesh, Haryana, Rajasthan, Maharashtra, Gujarat, Telangana, Chhattisgarh, Jharkhand, Assam, Uttarakhand, Karnataka, Tamilnadu, Madhya Pradesh and West Bengal.

·  States have been advised to focus on Districts/Blocks/Villages with low Child Sex Ratio to ascertain the causes, plan appropriate behaviour change communication campaigns and effectively implement provisions of the PC & PNDT Act.

As per Quarterly Progress Reports (QPRs) submitted by States/ UTs following actions have been taken against the violators since inception of the Act:

(i) A total of 1573 ultrasound machines have been sealed and seized for violations of the PC & PNDT Act and rules made there under.

(ii)   A total of 2152 court cases have been filed by various State Appropriate Authorities and 306 convictions have so far been secured under the Act.

(iii)  Registration of 100 medical professionals convicted under the Act has been suspended/cancelled by the concerned State Medical Councils.

The Health Minister, Shri J P Nadda stated this in a written reply in the RajyaSabha here today.