Health Care for the Elderly, National Child Health Programme, National Nutrition Policy, Online Sale of Drugs, Organ Donation and Rashtriya Arogya Nidhi

Mr. Bill Gates Meets Health Minister Shri J P Nadda

Appreciates initiatives in Immunization, Family Planning and Health Systems Strengthening

Gates Foundation can help in enhancing investment in Health Sector: JP Nadda

Mr. Bill Gates, Co-Chair & Trustee, Bill and Melinda Gates Foundation called on the Union Minister for Health & Family Welfare, Shri J P Nadda, here today and discussed various issues relating to the health sector in India. During the meeting, Mr. Gates expressed appreciation for the initiatives taken by the Ministry towards strengthening the health systems, particularly in the primary health care, in addition to the success of full immunization through Mission Indradhanush, the India launch of Inactivate Polio Vaccine (IPV) on 30th November and the resolve and commitment to launch new vaccines to protect the children and India’s population from various diseases.

The Health Minister Shri J P Nadda said, “We are looking forward to develop synergies and to use expertise of the Bill and Melinda Gates Foundation (BMGF) in crucial health related issues. The Gates Foundation can play an important role in capacity building and enhancing the investment for the health sector in India.”

The Health Minister appreciated the efforts of Gates Foundation in complimenting the efforts of the Government in the Health Sector, which has enhanced the capacity of the health workers for more effective implementation of the projects.

The Health Minister elaborated on the new initiatives of the Government such as Mission Indradhanush aimed to cover all missed-out and left-out children with cover of full immunization and the successes within the nation-wide initiative, the launch of new vaccines including Pentavalent, Pneumococcal, Rota Virus and the adult JE vaccine.

During the meeting, it was agreed that BMGF will support the Ministry in strengthening health systems further in order to enhance the capacity within the sector and to reduce out-of-pocket expenditure.

Mr. Gates stated: ‘India has made significant progress in improving access to healthcare services, and I believe the country has the political will and creative thinking to come up with solutions of transformative healthcare models that work for all its people, especially women and children so that they survive, thrive and reach their full potential. We look forward to working with the government to strengthen primary healthcare, which is key to accelerating health outcomes for every woman and child in India.’

During the meeting with the Health Minister, Mr. Bill Gates expressed appreciation for the switch from DDT to Synthetic Pyrethroid (SP) in some districts for fighting Kala Azar in the affected districts, the expanded choice provided to women through the injectable contraceptives under the reproductive health sector, and India’s attention to the nutrition issues.

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Welfare of New Born Children and Mothers

The Government of India under the National Health Mission (NHM) is implementing following interventions across all States and UTs of the country to improve the health of newborn babies and their mothers:-

1. Promotion of institutional deliveries through JananiSurakshaYojana.

2. Operationalization of sub-centres, Primary Health Centres, Community Health Centres and District Hospitals for providing 24x7 basic and comprehensive obstetric care services.

3. New guidelines have been prepared and disseminated to the states: Screening for Diagnosis and management of Gestational Diabetes Mellitus, Hypothyroidism during pregnancy, Training of General Surgeons for performing Caesarean Section, Calcium supplementation during pregnancy and lactation, De-worming during pregnancy, Maternal Near Miss Review, Screening for Syphilis during pregnancy and Dakshata guidelines for strengthening intra-partum care.

4. Name Based Web enabled tracking of Pregnant Women to ensure antenatal, intranatal and postnatal care.

5. Mother and Child Protection Card in collaboration with the Ministry of Women and Child Development to monitor service delivery for mothers and children.

6. Antenatal, intranatal and postnatal care including Iron and Folic Acid supplementation to pregnant and lactating women for prevention and treatment of anaemia.

7. Engagement of more than 9 lakhs Accredited Social Health Activists (ASHAs) to generate demand and facilitate accessing of health care services by the community.

8. Village Health and Nutrition Days in rural areas as an outreach activity, for provision of maternal and child health services.

9. The RashtriyaKishorSwasthyaKaryakram (RKSK) for adolescents to have better access to family planning, prevention of sexually transmitted Infections, Provision of counselling and peer education.

10. Health and nutrition education to promote dietary diversification, inclusion of iron and folate rich food as well as food items that promote iron absorption.

11. JananiShishuSurakshaKaryakaram (JSSK) entitles all pregnant women delivering in public health institutions to absolutely free and no expense delivery including Caesarean section. The initiative stipulates free drugs, diagnostics, diet, blood transfusion besides free transport from home to institution, between facilities in case of a referral and drop back home. Similar entitlements have been put in place for all sick infants, ate-natal and post-natal mothers accessing public health institutions for treatment.

12. Strengthening Facility based newborn care: Newborn care corners (NBCC) are being set up at all health facilities where deliveries take place; Special New Born Care Units (SNCUs) and New Born Stabilization Units (NBSUs) are also being set up at appropriate facilities for the care of sick newborn including preterm babies.

13. Home Based Newborn Care (HBNC): Home based newborn care through ASHA has been initiated to improve new born practices at the community level and early detection and referral of sick new born babies

14. India Newborn Action Plan (INAP) has been launched to reduce neonatal mortality and stillbirths.

15. Newer interventions to reduce newborn mortality- Vitamin K injection at birth, Antenatal corticosteroids for preterm labour, kangaroo mother care and injection gentamicin for possible serious bacillary infection.

16. Universal Immunization Programme (UIP): Vaccination protects children against many life threatening diseases such as Tuberculosis, Diphtheria, Pertussis, Polio, Tetanus, Hepatitis B and Measles. Infants are thus immunized against seven vaccine preventable diseases every year. The Government of India supports the vaccine programme by supply of vaccines and syringes, cold chain equipment and provision of operational costs.

17. Capacity building of health care providers: Various trainings are being conducted under National Health Mission (NHM) to build and upgrade the skills of health care providers in basic and comprehensive obstetric care of mother during pregnancy, delivery and essential newborn care.

18. To sharpen the focus on the low performing districts, 184 High Priority Districts (HPDs) have been prioritized for Reproductive, Maternal,Newborn, Child Health+Adolescent (RMNCH+A) interventions for achieving improved maternal and child health outcomes.

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

19.

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Rashtriya Arogya Nidhi

The RashtriyaArogyaNidhi (RAN) has been set up vide Resolution No. F-7-2/96-Fin-II dated 13/1/1997 and registered under the Society Registration Act, 1860, as a Society. The RAN was set up to provide financial assistance to patients, living below poverty line and who are suffering from major life threatening diseases, to receive medical treatment at any of the Government super speciality Hospitals/Institutes or other Government hospitals. The financial assistance to such patients is released in the form of ‘one-time grant’, which is released to the Medical Superintendent of the Hospital in which the treatment has been/is being received. An illustrative list of categories of treatment provided from the fund is given below. All Government hospitals/institutions are covered for treatment to poor patients under Rashtriya Arogya Nidhi.

An illustrative list of categories of treatment to be provided from this fund

(This list is reviewed by the Technical Committee from time to time )

1.Cardiology& Cardiac Surgery:

1. Pacemakers

2. CRT/Biventricular pacemaker

3. Automatic Implantable Cardioverter defibrillator (AICD)

4. Combo devices

5. Diagnostic Cardiac Catheterization including Coronary Angiography

6. Interventional procedure including Angioplasty, Balloon Valvuloplasty e.g. PTMC, Aortic & Pulmonary BallonValvulotomy, FFR, IVUS etc.

7. ASD, VSD and PDA device closure

8. Angioplasty including Peripheral Vascular Angioplasty, Aortic Angioplasty, Renal Angioplasty

9. Coil Embolization and Vascular plugs

10. Stents, Bare metal Stents as well as Drug Eluting Stents

11. Electrophysiological Studies (EPS) and Radio Frequency (RF)

Ablation

12. Heart surgery for Congenital and Acquired conditions including

C.A.B.G, Valve replacement etc.

13. Vascular Surgery

14. Cardiac Transplantation etc.

2. Cancer :

1. Radiation treatment of all kinds including Radio Therapy and

Gama Knife Surgery.

2. Anti-Cancer Chemotherapy supportive medication and antibiotic,

Growth factor,

3. Bone Marrow Transplantation- Allogenic& Autologous

4. Diagonostic Procedures- Flow cytometry/cytogenetics /IHC Tumour

Markers etc.

5. Surgery for cancer patients

3.Urology/Nephrology/Gastroenterology :

1. Dialysis and its consumable (Both haemodialysis as well as Peritoneal)

2. Plasmalpheresis including all consumbales.

3. Vascular access consumables (AV Grafts, catheters including perm catheters) for Dialysis

4. Renal transplant-cost of renal transplant varies, ceiling rate may be followed as per CGHS rates.

5. Lithotripsy ( for Stones)

6. Treatment of Acute Humoral/Cellular Rejaection in kidney transplant.

7. Treatment of Rapidly progressive Glomerulonephritis, Nephritis and Vasculitis.

8. Liver Transplantation and Surgery for portal hypertension.

4. Orthopedics:

1. Artificial prosthesis for limbs

2. Implants and total hip and knee replacement

3. External fixaters

4. AO implants, used in the treatment of bone diseases and

fractures

5. Spiral fixation Implant- Pedicle Screws (Traumatic,

Paraplegic, Quadriplegic)

6. Implant for Fracture fixation (locking plates & modular)

7. Replacement Hip –Bipolar /fixed

8. Bone Substitutes

5. Neurosurgery – Neurology :

1 Brain Tumors

2 Head injuries

3 Intracranial aneurysm

4 Vascular Malformations of brain & spinal cord.

5 Spinal tumors

6 Degenerative /Demyelinating diseases of brain/spinal cord

7 Stroke

8 Epilepsy

9 Movement disorders

10 Neurological infections

11 Traumatic Spine Injury

12 Occlusive Vascular Disease of Brain

6.Endocrinology :

1. Cases of complicated diabetes which require one time treatment

e.g. amputation or renal transplant

2. Hypo pituitarism

3. GH deficiency

4. Cushings Syndrome

5. Adrenal insufficiency

6. Endocrine surgery

7. Osteoporosis

7. Mental Illness :

1. Organic Psychosis acute and chronic

2. Functional psychosis including Schizophrenia, Bio-polar disorders, delusional disorders and other acute polymorphic psychosis

3. Severe OCD, Somatoform disorders, eating disorders.

4. Developmental disorders including autisms spectrum disorders and Severebehavioural disorders during childhood.

5. Psycho diagnosis, neuropsychological assessments, IQ assessments, blood tests like serum lithium and drug level of carbamazepine, valporate, phenytoin and any other similar medications: CSF studies screening for substances or abuse/toxicology.

8. Miscellaneous:

Other major illness/treatment/intervention considered appropriate for financial assistance by Medical Superintendent/Committee ofDoctors could be considered for grant.

Revolving funds have been set up in 12 designated Central Government Hospitals/Institutions and funds upto Rs. 50,00,000/- (fifty lakhs) are placed at their disposal for providing treatment to the BPL patients suffering from life threatening diseases.

Financial powers delegated to 12 designated Central Government Hospitals/Institutions have been enhanced from Rs. 2lakh to Rs. 5lakh for providing financial assistance in cases where emergency surgery is required.

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

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Organ Donation

As per Transplantation of Human Organs and Tissue Act, 1994 (as amended), the Central Government has been given the mandate tomaintain National registry of donors and recipients of human organs and tissues. National Organ and Tissue Transplant Organization (NOTTO) has been set up to maintain this registry based on the information received from the transplant/retrieval hospitals and other related organizations. The National registry has been launched on 27-11-2015.

There is a shortage of donated organs in the country as compared to the number of patients of organ failure who require transplants. Total number of persons who have pledged their organs for donations under the National Registry till 30-11-2015 is 568.

The Government of India has taken proactive steps to spur organ donation in the country. These include:

I. The importance of organ donation has been highlighted by the Hon’ble Prime Minister in Mann Ki BaatProgramme broadcast in October and November 2015;

II. Website of NOTTO namely www.notto.nic.in has been made functional for providing updated information to general public.

III. A 24x7 call centre with toll free helpline number (1800114770) has been established for providing information and facilitating networking of hospitals. The number has been widely publicized through print, SMS, electronic and social media.

IV. Indian Organ Donation Day is being observed annually since 2010. This year it was observed on 27th November 2015.

V. National Organ and Tissue Donation and Transplant Registry has been launched.

VI. Members of Donor families from different parts of the country and winners of national competition of slogan on organ donation were felicitated.

VII. Award has been given to the best performing State (Tamil Nadu) in the area of Organ Donation.

VIII. Organ Donation Publicity through print media, Display Boards, Frequently Asked Questions, Mobile SMSes, talks by experts, etc. is being undertaken.

IX. The networking of the transplant and/or retrieval hospitals has been commenced to ensure that any organ which is donated is not wasted.

X. Systems have now been put in place to register organ donation pledges. Those who want to pledge for organ donation can do so through both offline and online mode.

XI. Financial assistance has been provided for establishing four regional level organizations called Regional Organ and Tissue Transplant Organization (ROTTO) in the States of Tamil Nadu, Maharashtra, Assam and UT of Chandigarh and carrying out awareness and training of transplant coordinators.

XII. Training of Transplant Coordinators of Delhi and NCR has been conducted by NOTTO.

XIII. Transplant Hospitals in Delhi and National Capital Region have been instructed for placing Display Boards outside the Intensive Care Units and at strategic locations in the hospital, mentioning that Law requires the doctor on duty/transplant coordinator/counsellor to make inquiry and request for organ donation from the family members of brain stem dead persons.

XIV. As per the need, financial assistance is also provided under the National Organ Transplant Programme for hiring of transplant coordinators in Government Hospitals and Trauma Centres..

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

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Online Sale of Drugs

The sale and distribution of drugs in the country is regulated under the provisions of Drugs & Cosmetics Act, 1940 and Rules made thereunder. As per Drugs & Cosmetics Rules, 1945, Drugs specified in Schedule H, H1 or Schedule X cannot be sold except on and in accordance with the prescription of a Registered Medical Practitioner. The supply of prescription drugs can be effected only by or under the personal supervision of a registered pharmacist from a licensed premises.

A number of representations have been received from chemists and druggist associations against the online sale of prescription drugs. Similarly, a number of representations have also been received to permit such sales.

The representations received were discussed in detail in the 48th meeting of the Drugs Consultative Committee (DCC), held on 24th July, 2015. The DCC has constituted a Seven Member Sub-Committee to examine the issue of sale of drugs on the internet, while taking care of the risks and concerns related to such sales. All measures considered necessary for safeguarding the interests of Consumers are taken by the Government.

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

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National Nutrition Policy

National Nutrition Policy (NNP) has been adopted by the Government in 1993. The National Nutrition Policy (NNP) identified key action in various areas having impact on nutrition such as agriculture, food production, food supply, education, information, health care, social justice, tribal welfare, urban development, rural development, labour, women and child development, people with special needs and monitoring and surveillance.

The core strategy envisaged under NNP is to tackle the problem of nutrition through direct nutrition interventions for vulnerable groups as well as through various development policy instruments which will improve access and create conditions for improved nutrition.

The direct short-term nutrition intervention suggested by NNP include: (i) Nutrition interventions for specially vulnerable group such as children below 6 yrs, adolescent girls and pregnant and lactating women, expanding the safety nets, facilitating behaviour change among mothers, reaching the adolescent girls and ensuring better coverage of expectant women; (ii) Fortification of essential food items with appropriate nutrients; (iii) Popularization of low cost nutritious foods prepared from indigenous and locally available raw materials; (iv) Control of micronutrient deficiencies among vulnerable groups.

The indirect long term nutrition interventions leading to institutional and structural changes including: (i) Food security for improved availability of food grains; (ii) Improvement of dietary patterns through production and demonstration; (iii) Policies for effecting income transfers so as to improve the entitlement package of the rural and urban poor – improving the purchasing power and strengthening public distribution system; (iv) Land reforms measures for reducing vulnerabilities of landless and landed poor; (v) Strengthen health & family welfare programme; (vi) Imparting basis health and nutrition knowledge; (vii) Prevention of food adulteration; (viii) Improvement in nutrition surveillance; (ix) Monitoring of nutrition programmes; (x) Research into various aspects of nutrition; (xi) Equal remuneration for women; (xii) Communication through established media (xiii) Minimum wage administration to ensure its strict enforcement and timely revision and linking it with price rise through a suitable nutrition formula –a special legislation for providing agricultural women labourers the minimum support, and at least 60 days leave by the ‘employer in the last trimester of her pregnancy; (xiv) Community participation for generating awareness on NNP – active participation of community members in management nutrition programmes & related interventions through beneficiaries committees, participation of women in food production & processing, promoting kitchen gardens, food preservation, preparation of weaning food, generating demand of nutrition services; (xv) Education and literacy; (xvi) Improvement in status of women.

Further to this a National Plan of Action on Nutrition (NPAN) 1995 was laid down focusing on reducing under nutrition which entails a Multi-sectoral approach for accelerated action on determinants of malnutrition.

The NITI Aayog has been mandated to examine the emerging data on under-nutrition and prepare, in consultation with ministries of Women and Child Development and Health and Family Welfare, a specific strategy for poor performing states/districts.

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

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National Child Health Programme

Under the National Health Mission (NHM), the Government of India is implementing RashtriyaBalSwasthyaKaryakram (RBSK) since 2013, for screening of all the children from 0-18 years of age including school children for 4 Ds i.e. Defects at birth, Deficiencies, Diseases and Development delays including disability.

The State/UT wise number of children examined is given below:-

Number of children screened by RBSK mobile health teams

underRBSK programme in States/UTs in last three years

Sl. No	States/UTs	2013-14, as on March 2014	2014-15, as on March, 2015	2015-16, as on June, 2015
A. Non-NE High Focus States
1	Bihar		62,612	0
2	Chhattisgarh		63,399	4,357
3	Himachal Pradesh		8,99,502	0
4	Jammu & Kashmir	88,568	15,27,980	4,14,537
5	Jharkhand		8,833	32,800
6	Madhya Pradesh	7,93,205	90,82,774	35,68,066
7	Odisha	9,17,209	48,97,389	14,49,296
8	Rajasthan	59,96,254	21,04,888	0
9	Uttar Pradesh	1,22,29,486	1,82,06,135	41,00,181
10	Uttarakhand	15,50,876	13,82,535	2,34,353
B. NE States
11	Arunachal Pradesh	2,15,617	2,25,484	41,537
12	Assam	17,95,346	29,44,064	10,90,748
13	Manipur	1,807	83,167	36,140
14	Meghalaya	3,10,869	43,398	41,076
15	Mizoram	92,111	2,52,012	83,409
16	Nagaland	16,474	38,352	49,365
17	Sikkim	77,288	87,083	27,000
18	Tripura	56,258	1,41,422	13,176
C. Non High Focus States
19	Andhra Pradesh	26,34,427	3,79,066	73,136
20	Telangana	NA	0	0
21	Goa	2,24,875	2,17,848	28,533
22	Gujarat	1,49,83,485	1,23,38,318	43,47,072
23	Haryana	9,85,635	28,38,024	4,43,689
24	Karnataka	31,86,441	92,02,678	19,42,652
25	Kerala,	16,66,397	36,46,432	5,27,936
26	Maharashtra	1,46,62,378	1,93,35,990	17,85,849
27	Punjab	44,75,536	29,14,456	5,52,167
28	Tamil Nadu	68,08,232	65,57,027	8,19,830
29	West Bengal	52,44,968	66,17,918	29,98,246
D. Union Territories
30	Andaman and Nicobar		21,383	2,547
31	Chandigarh	96,114	2,22,249	67,008
32	Dadra and Nagar Haveli	69,317	85,364	11,614
33	Daman	31,022	38,329	1,570
34	Delhi	6,30,809	0	0
35	Lakshadweep		0	0
36	Puducherry	97,432	1,34,137	21,107
India		7.99 crore	10.66 Crores	2.48 crores

The state-wise/ UT wise financial allocation, utilization as reported by State/UT is given below:-

Financial allocation and utilization under RBSK programme for last three years

Sl. No	States/UTs	2013-14, as on March 2014		2014-15, as on March, 2015		2015-16, as on June, 2015
Sl. No	States/UTs	Approvals (Rs in Lakhs)	Utilisation (Rs in Lakhs)	Approvals (Rs in Lakhs)	Utilisation (Rs in Lakhs)	Approvals (Rs in Lakhs)	Utilisation (Rs in Lakhs) Till 2nd Qtr.
A. Non-NE High Focus States
1	Bihar	4626.01	153.98	5850.13	9.92	8739.89	196.69
2	Chhattisgarh	3564.40	4.46	3507.36	1641.46	3880.90	960.59
3	Himachal Pradesh	1245.76	352.62	927.20	543.86	1688.38	104.52
4	Jammu & Kashmir	1753.04	114.33	4459.11	1411.83	4656.04	1658.24
5	Jharkhand	3580.08	116.73	3500.73	0.00	2792.19	32.10
6	Madhya Pradesh	5135.98	588.62	8518.67	3925.12	13354.13	3084.63
7	Odisha	5991.35	986.90	7248.75	3957.82	8307.39	2732.89
8	Rajasthan	3026.24	1.24	2427.77	9.60	6871.45	127.99
9	Uttar Pradesh	15850.78	1909.02	19793.59	14881.12	24709.61	6237.13
10	Uttarakhand	2869.97	516.31	3523.09	2088.81	3390.78	966.15
B. NE States
11	Arunachal Pradesh	655.64	215.70	709.50	112.94	750.75	97.77
12	Assam	4854.93	501.58	7764.47	1507.69	6944.39	1198.77
13	Manipur	210.29	6.32	854.99	78.57	1745.97	9.06
14	Meghalaya	539.89	29.87	1092.03	87.53	1110.11	256.78
15	Mizoram	329.84	69.78	621.97	271.02	924.34	0.00
16	Nagaland	698.53	22.04	458.82	115.34	439.73	0.00
17	Sikkim	233.83	10.88	151.54	65.15	268.70	47.56
18	Tripura	401.57	8.86	324.77	55.73	604.66	109.30
C. Non High Focus States
19	Andhra Pradesh	8090.69	381.49	5197.92	423.90	3789.36	204.46
20	Telangana			3189.78	0.00	4184.78	71.73
21	Goa	213.97	11.37	293.76	116.12	312.69	76.58
22	Gujarat	10686.45	1074.71	7790.62	2863.75	9072.04	1808.86
23	Haryana	2081.10	353.07	3801.79	2028.18	3203.92	1170.17
24	Karnataka	4746.99	842.85	6460.84	3308.20	5991.94	1209.15
25	Kerala,	4851.69	418.98	4195.54	751.79	4097.35	1501.66
26	Maharashtra	12002.14	3284.54	15145.68	7157.76	12799.26	3163.11
27	Punjab	2455.56	545.03	3782.49	591.04	3749.24	1615.66
28	Tamil Nadu	4123.49	1277.13	4715.59	0.00	4389.05	52.00
29	West Bengal	12048.78	1026.32	11346.21	4682.81	11799.49	3992.82
D. Union Territories
30	Andaman & Nicobar	94.46	6.25	154.05		208.29	20.04
31	Chandigarh	24.87	0.00	171.11	121.31	207.63	0.00
32	Dadra & Nagar Haveli	103.05	28.53	205.84	0.00	201.55	32.20
33	Daman	80.31	4.64	102.26	91.30	114.09	20.11
34	Delhi	427.61	0.00	19.92	0.00		0.51
35	Lakshadweep	0.00	0.00	18.80	0.45	25.40	0.07
36	Puducherry	38.14	5.88	81.58		86.18	27.01
India		1176.37 Crores	148.70 Crores	1384.08 Crores	529 Crores	1554.12 crores	327.86 crores

Under the initiative, the children identified with any health condition are referred to an appropriate health facility for further management and linking with tertiary level institutions.

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

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Implementation of National Mental Health Programme (NMHP)

In 2005, the National Commission on Macroeconomics and Health reported that 10-20 million (1-2% of population) suffered from severe mental disorders such as schizophrenia and bipolar disorder and nearly 50 million (5% of population) from common mental disorders such as depression and anxiety, yielding an overall estimate of 6.5 per cent of the population. The data regarding casualties related to mental illness is not maintained centrally.

The Government of India is implementing the District Mental Health Programme (DMHP) under the National Mental Health Programme (NMHP) with the objectives to:

I. Provide mental health services including prevention, promotion and long term continuing care at different levels of district healthcare delivery system.

II. Augment institutional capacity in terms of infrastructure, equipment and human resource for mental healthcare.

III. Promote community awareness and participation in the delivery of mental health services.

IV. Broad-base mental health into other related programs.

To address the acute shortage of qualified mental health professionals in the country, the Government, under the National Mental Health Programme (NMHP), is implementing manpower development schemes for establishment of Centres of Excellence and strengthening/ establishing Post Graduate (PG) Departments in mental health specialties. Till date, support has been provided for establishment of 11 Centres of Excellence and strengthening/ establishing 27 PG Departments (in 11 Institutes) in mental health specialties in the country. The Government has approved a proposal for establishment of additional 10 Centres of Excellence and support to strengthen/establish 93 PG Departments during the 12^th Five Year Plan Period.

The list of Institutes supported under the Manpower Development Schemes is given below:-

Institutes supported under Manpower Development Schemes

Scheme – A : Centres of Excellence

1. Institute of Mental Health & Hospital, Agra, Uttar Pradesh

2. Hospital for Mental Health, Ahmadabad, Gujarat

3. State Mental Health Institute, Pandit Bhagwat Dayal Sharma University of Health Sciences, Rohtak, Haryana

4. Institute of Psychiatry- Kolkata, West Bengal

5. Institute of Mental Health, Hyderabad, Andhra Pradesh

6. Psychiatric Diseases Hospital, Government Medical College, Srinagar, Jammu & Kashmir

7. Department of Psychiatry, Govt. Medical College, Chandigarh

8. Mental Health Institute, Cuttack

9. Institute of Mental Health And Neuro Sciences, Kozhikode

10. Institute of Human Behaviour and Allied Sciences, Shahdra, Delhi

11. Maharashtra Institute of Mental Health, Pune

Scheme – B : Strengthening PG Departments

S.No.	Mental Hospital/ Institute	PG Course
1	PDU Medical College, Rajkot, Gujarat	Psychiatric Nursing
2	Government Medical College, Surat, Gujarat	Clinical Psychology
3	CSM Medical University, Lucknow, Uttar Pradesh	Psychiatry
4		Clinical Psychology
5		Psychiatric Social Work
6		Psychiatric Nursing
7	Ranchi Institute of Mental Health and Neuro Sciences, Ranchi,	Psychiatry
8		Clinical Psychology
9		Psychiatric Social Work
10		Psychiatric Nursing
11	Dr. RML Hospital, Delhi	Psychiatry
12		Clinical Psychology
13		Psychiatric Nursing
14	S.P Medical College, Bikaner, Rajasthan	Psychiatry
15	R. N. T. College, Udaipur, Rajasthan	Psychiatry
16	Institute of Mental Health, Chennai	Psychiatry
17	Institute of Mental Health, Chennai	Psychiatric Nursing
18	LGB Regional Institute of Mental Health, Tezpur, Assam	Psychiatry
19		Clinical Psychology
20		Psychiatric Social Work
21		Psychiatric Nursing
22	Government Medical College, Trivandrum	Psychiatry
23		Clinical Psychology
24		Psychiatric Social Work
25		Psychiatric Nursing
26	NIMHANS, Bangalore	Clinical Psychology
27	NIMHANS, Bangalore	Psychiatric Social Work

The details of funds released for the implementation of the DMHP and Manpower Development Schemes under the NMHP during the last three years and the current year are given below:-

Details of funds allocated and released under DMHP and NMHP

(In Rs.crore)

S. No.	Year	Allocation	Releases
1	2012-13	100	50.34
2	2013-14	130	74.34
3	2014-15	268.28	61.56
4	2015-16	*

* District level activities under the National Mental Health Programme along with the National Programme for Control of Blindness, National Tobacco Control Programme and National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Disease and Stroke are a part of the NCD Flexible Pool under the National Health Mission for which total allocation at BE stage for 2015-16 is Rs. 554.50 crores. Separately, budget provision of Rs. 35 crore has been made for implementation of tertiary level activities under the National Mental Health Programme.

During the previous plan periods, funds have also been provided for up-gradation of 88 Psychiatric Wings of Govt. Medical Colleges/ General Hospitals and modernization of 29 State run mental hospitals in the country.

The National Trust, under the Ministry of Social Justice and Empowerment, runs several schemes like Samarth (Residential centre), Niramaya (Health Insurance Scheme), Aspiration (Day Care Center), Gyan Prabha (Scholarship Scheme), Uddyam Prabha (Interest Subsidy Scheme), Sahyogi (Caregivers Training Scheme), GHARAUNDA etc. all over the country for the welfare of four disabilities i.e. Autism, Cerebral Palsy, Mental Retardation and Multiple Disabilities. The funds under the above schemes are provided by the Ministry of Social Justice and Empowerment.

No proposal for a centrally sponsored insurance scheme to cover mental illness is under consideration in this Ministry presently.

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

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Health Sector of the Country

The focus of the Government is to provide accessible, affordable and accountable healthcare facilities to all sections of the country. Accordingly, Government of India also provides financial assistance to State/UT Governments for supplementing their efforts in this direction as the health is a State subject. The public expenditure on healthcare provisioning has increased from Rs.88,054crore in 2009-10 to Rs. 1,54,567 crore in 2014-15 (BE) as per Economic Survey 2014-15.

The Government of India has formulated the draft of National Health Policy 2015 in the light of the changes that have taken place in the country’s health sector scenario since the formulation of the National Health Policy 2002.

The public expenditure on health as percentage of GDP stands at 1.2 percent for 2014-15 (BE) as per Economic Survey 2014-15. The Twelfth Five Year Plan envisages increasing total public health funding on core health to 1.87 percent of GDP by the end of the Plan period.

The primary responsibility to regulate the private health care sector rests with the State/UT Governments. The Central Government has enacted the Clinical Establishment (Registration and Regulation) Act, 2010, to provide a legislative framework for the registration and regulation of clinical establishments in the country and also seeks to improve the quality of health services through the National Council for Standards by prescribing minimum standards of facilities and services which may be provided. The Clinical Establishments Act has, however, been adopted only by the States of Sikkim, Mizoram, Arunachal Pradesh, Himachal Pradesh, Uttar Pradesh, Bihar, Jharkhand, Rajasthan, Uttarakhand and all Union Territories except Delhi.

Further, the Medical Council of India (MCI) grants recognition of medical qualifications, gives accreditation to medical colleges, grants registration to medical practitioners, and monitors medical practice in India, through the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002. Complaints against medical practitioners with regard to professional misconduct fall within the ambit of the Medical Council of India or the concerned State Medical Council, as the case may be.

In order to meet the country’s needs in health sector, the Government has taken several steps which inter-alia includes:-

• Initiatives under the National Health Mission (NHM) for providing free of cost health care in the public health facilities through a nationwide network of Community Health Centres (CHCs), Primary Health Centres (PHCs) and Sub Centres (SCs) in both rural and urban areas. Various programs such as National AYUSH Mission, RashtriyaKishorSwasthyaKaryakram, RashtriyaBalSwasthyaKaryakram, National Deworming day, Weekly Iron Folic Acid supplementation program, Menstrual Hygiene Program, Mission Indradhanush, KayakalpAbhiyan, Free Drugs and Diagnostic Initiative, Free care for family welfare services, JananiShishuSurakshaKaryakaram (JSSK), free medicines under the various national health programmes like Anti-Malaria and Anti-TB Programmesseek to strengthen various health components.

• Making available tertiaryhealth care services in the public sector through strengthening of hospitals, establishment of AIIMS institutions in the States and up-gradation of existing Government medical colleges across the country.

• Making available quality generic medicines at affordable prices to all, under ‘Jan Aushadhi Scheme’, in collaboration with the State Governments.

• RashtriyaSwasthyaBimaYojana (RSBY) which provides for smart card based cashless health insurance including maternity benefit on family floater basis

The Government has also taken several steps in the direction of preventive health care, which inter-alia include Universal Immunization of children against seven diseases; Pulse Polio Immunization; Family Planning services; Maternal and Reproductive Health Services; Child Health services that include both home based and facility based New born Care; Adolescent Reproductive and Sexual Health (ARSH) services; Investigation/ screening and treatment for Malaria; Kala-azar, Filaria, Dengue; Japanese Encephalitis and Chikungunya; Detection and treatment for Tuberculosis including MDR-TB; Detection and treatment for Leprosy; Detection, treatment and counseling for HIV/AIDs; Cataract surgery for Blindness control.

Further, under RashtriyaBalSwasthyaKaryakram (RBSK) support is being provided to States/UTs for child health screening and early intervention services through early detection and early management of common health conditions classified into 4 Ds i.e. Defects at birth, Diseases, Deficiencies, Development delays including disability. A comprehensive National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular diseases and Stroke (NPCDCS) for activities including health promotion, early detection and treatment of Cancer, Diabetes, Cardiovascular diseases and Stroke, has also been initiated.

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

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Health Care for the Elderly

Keeping in view the recommendations made in the “National Policy on Older Persons” as well as the State’s obligation under the “Maintenance & Welfare of Parents & Senior Citizens Act 2007”, the Ministry of Health & Family Welfare had launched the “National Programme for the Health Care of Elderly” (NPHCE) during 2010-11 to address various health related problems of the elderly people.

The major objectives of the NPHCE are establishment of Department of Geriatric in identified Medical Institutions as Regional Geriatric Centres for different regions of the country and to provide dedicated health facilities in District Hospitals, Community Health Centres (CHCs), Primary Health Centres (PHCs) and Sub-Centres (SCs) levels through State Health Society.

The following facilities are being provided under the programme:-

I. Geriatric OPD, 30 Bedded ward for in-patient care etc. at Regional Geriatric Centres.

II. Geriatric OPD and 10 bedded Geriatric Ward at District Hospitals.

III. Bi-weekly Geriatric Clinic at Community Health Centres (CHCs).

IV. Weekly Geriatric Clinic at Primary Health Centres (PHCs)

V. Provision of Aids and Appliances at Sub-centres.

As on date, a total of 104 districts of 24 States/UTs and 08 Regional Geriatric Centres have been covered under the programme. Details of activities undertaken at different levels under the NPHCE as per information available are enclosed below:-

Activities initiated at different levels under the NPHCE

Institution	Institutions covered under NPHCE	OPD	Indoor wards	Physiotherapy	Equipments
District Hospital	104	68	58	48	43
CHCs	832	403	NA	171	334
PHCs	4032	1018	NA	NA	646
SCs	27173	NA	NA	NA	4541

NA=Not applicable

Details of funds released to the States/Union Territories during 2012-13 to 2014-15 and the current year are given below:-

NATIONAL PROGRAMME FOR HEALTH CARE OF THE ELDLERY (NPHCE)
Statement Showing Allocation/Release of fund and Expenditure (As on 31.05.2015)
Sl. No	Name of the States		Rs. In Lakhs
		2012-13		2013-14		2014-15		2015-16*
		GIA Released by GOI	Expenditure Reported By the State	GIA Released by GOI	Expenditure Reported By the State	GIA Released by GOI	Expenditure Report By the States	GIA Released by GOI	Expenditure Report By the States
s1	Andhra Pradesh	871.52	0	0	1.37	0	0	0.00	0.00
2	Assam	0	23.44	0	128.61	142.27	53.55	3333.00	32.72
3	Bihar	446.72	13.28	0	83.02	150	134.91	597.00	0.00
4	Chhattisgarh	229.2	23.39	50.94	121.24	99	49.2	526.00	0.00
5	Gujarat	225.44	85.28	0	99.5	215.66	230.87	1551.00	71.54
6	Haryana	0	65.73	0	133.86	77.62	48.81	331.00	32.83
7	Himachal Pradesh	0	0	0	19.15	11.85	68.04	263.00	3.03
8	Jammu and Kashmir	0	218.29	0	126.76	0	84.94	629.00	0.00
9	Jharkhand	0	1.28	0	20.42	111	37.77	790.00	22.37
10	Karnataka	0	151.78	0	158.3	170.95	16.33	1187.00	13.65
11	Kerala	470.72	88.88	0	122.81	150	749.74	467.00	0.00
12	Madya Pradesh	391.84	150.26	0	237.09	209.45	81.54	2681.00	35.55
13	Maharashtra	426.96	412.22	0	145.36	203.64	239.44	2375.00	37.95
14	Odisha	374.56	109.35	33.89	354.15	116	140.71	1065.00	32.95
15	Punjab	196.24	31.51	0	171.31	111.36	48.14	312.00	0.10
16	Rajasthan	711.2	147.65	0	61.94	87.05	23.15	2704.00	476.53
17	Sikkim	0	77.46	31.08	43.27	44	0	66.00	53.10
18	Tamil Nadu	344.16	0	0	0	0.42	0	1300.00	0.00
19	Uttarakhand	81.04	56.77	0	94.14	0	11.24	624.00	1.11
20	Uttar Pradesh	1855.04	0	0	188.77	0	0	3626.00	40.66
21	West Bengal	231.2	0.95	0	88.9	150	18.58	0.00	12.98
22	Daman and Diu	0	0	0	0	24.34	0	35.00	0.00
23	Lakshadweep	0	0	0	0	95.66	0	0.00	0.00
24	Mizoram	0	0	0	0	119.06	0	137.00	0.00
	Total	6855.84	1657.52	115.91	2399.97	2289.33	2036.96	24599.00	867.07
* No separate allocation of funds has been made for National Programme for Health Care of the Elderly (NPHCE), during 2015-16. NPHCE is the part of NCD flexible pool under the National Health Mission for which total allocation at BE stage for 2015-16 is Rs. 527.36 crores.

At present, Government had launched following programmes/schemes i.e. under which, inter alia health care facilities are being provided to elderly people also in the country.

I. National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS)- The programme is being implemented under National Health Mission (NHM) for intervention upto the district level includes awareness generation for Cancer prevention, screenining, early detection and referral to an appropriate level institution for treatment.

II. National Programme for Control of Blindness (NPCB)This programme was launched in the year 1976 as a 100% centrally sponsored scheme with the goal of reducing the prevalence of blindness to 0.3% by 2020. Rapid Survey on Avoidable Blindness conducted under NPCB during 2006-07 showed reductionin the prevalence of blindness from 1.1% (2001-02) to 1% (2006-07. Under this programme there are provision for distribution of free spectacles to old persons suffering from presbyopia and free treatment for cataract surgery.

III. National Oral Health Programme: Taking into account the oral health situation in the country, Government of India has initiated a National Oral Health Programme to provide integrated, comprehensive oral health care in the existing health care facilities with a view to improve the determinants of oral health, reduce morbidity from oral diseases, integrate oral health promotion and provide preventive services.

IV. National Programme for Prevention and Control of Deafness (NPPCD): This Ministry has launched this programme on the pilot phase basis in the year 2006-07(January 2007). Under this programme, hearing-aid is provided as per synergy between Assistance to Disabled Persons (ADIP) Scheme of Ministry of Social Justice & Empowerment (MSJE) and National Programme for Prevention and Control of Deafness (NPPCD) of Ministry of Health & Family Welfare. At present, the Programme is being implemented in 281 districts of 27 States and 6 Union Territories.

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

*****

AIIMS Like Institutions in the Country

The AIIMS like Institutions at Bhopal, Bhubaneswar, Jodhpur, Patna, Raipur and Rishikesh, in the first phase of PradhanMantriSwasthyaSurakshaYojana(PMSSY), are functional. AIIMS at Rae Bareli, under the Phase-II of PMSSY, is under construction.

Proposals have been received from 13 states for setting up of new AIIMS like institutions and colleges. Land/site details furnished by the State Governments are given below:-

Land/site details furnished by the State Government

S.No.	State’s Name	Location as per requirement
(i)	Andhra Pradesh	Govt. of Andhra Pradesh identified single location at MangalgiriMandal in Guntur District for setting of up AIIMS in Andhra Pradesh.
(ii)	Arunachal Pradesh	Suggested only single location without proper details. 204 acres Located around 30 km (approx.) from Itanagar via NH 52 A (Hollongi-Itanagar road) under Tubung Village of Balijan Circle, Papum Pare District, Arunachal Pradesh.
(iii)	Assam	Suggested three locations- (a) DimoriaMouza in Kamrup (Metro) district. (b) Kamalpur revenue circle in Kamrup district. (c) ShahariMouza of Raha in Nagaon district Further, State Govt has identified another site at North Guwahati.
(iv)	Goa	State Government has identified only single location which is situated in Dhargar village of PernemTaluka
(v)	Gujarat	State Government has identified four suitable sites in two district of the State namely Rajkot and Vadodara: (a)Village-Chokari and Village Pavda, TalukaPadra, District, Vadodara; (b)Village- Khirasara (Ranmalji), Tehsil- Lodhika, District- Rajkot (c)Village-Khandheri, Tehsil- Padadhari, District Rajkot ; (d) Village-Para Pipaliya, Tehsil-Rajkot, District Rajkot
(vi)	Himachal Pradesh	Kothipura in BilaspurDistt
(vii)	Jharkhand	State Govt. has identified location for new AIIMS at Devipur in Deoghar
(viii)	Karnataka	State Government has identified three locations in the state – (a)Harohalli in Ramanagar District near Bangalore. (b)Itagatti in Dharwad District. (c)District Hospital Campus, Bijapur (Canter Distt. Head Quarters)
(ix)	Kerala	State Government has identified following four locations: (a) Thiruvananthapuram District-KattakadaTaluk, Kallikadu Village, Block 31, Resurvey 66 (b) Kottayam District-Arpookkara, Athirampuzha and Peraicakadu villages (c) Ernakulam District- Block No.5, 717/5, Block No.6, 321/1 (d) Kozhikode District- Kinalur and Kanthalad villages in PanangadGramaPanchayath, ThamarasseryTaluk.
(x)	Maharashtra	Govt. of Maharashtra identified location at Nagpur in Nagpur District for setting of up AIIMS in Maharashtra.
(xi)	Tamil Nadu	State has identified locations at: (a) Chengalpattu in Kancheepuram District (b) Pudukkottaitowm in Pudukkottai District (c) Sengipatti in Thanjavur District (d) Perundurai in Erode District (e) Thoppur in Madurai District
(xii)	Telangana	State Govt. has identified location for new AIIMS at Bibinagar in Telenagana
(xiii)	West Bengal	Govt. of West Bengal identified location at Kalyani in Nadia District for setting of up AIIMS in West Bengal.

Also, the Finance Minister in his Budget Speech for the year 2014-15, announced for setting up four AIIMS, one each in Andhra Pradesh, Vidarbha Region (Maharshtra), West Bengal and Purvanchal in Uttar Pradesh. In the Budget Speech for the year 2015-16, the FM has proposed to set up AllMS in Jammu and Kashmir, Punjab, Tamil Nadu, Himachal Pradesh and Assam. Of these, the Cabinet on October 7^th, 2015 has approved the setting up of AIIMS-like institute in Andhra Pradesh, West Bengal and Maharashtra. The Ministry has also finalized the site for the setting up of AIIMS-like institute in Punjab at Bathinda.The timeline for setting up of such tertiary level health care facilities would depend upon the receipt of due approvals.

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