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ANSWERED ON:  19.07.2019
Health Infrastructure in Tribal Areas
Achyutananda Samanta
Will the Minister of

HEALTH AND FAMILY WELFARE be pleased to state:-

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

(a) whether the Government proposes to launch any specific schemes towards development of health infrastructure in tribal areas and if so, the details thereof;

(b) whether the Government is aware that Kandhamal district of Odisha which is covered with dense forests and hilly terrain is deprived of any advanced medical facility;

(c) if so, the details of the funds sanctioned and utilized for development of health facilities in this region during the last five years; and

(d) whether there is any proposal to build a super-speciality hospital and medical college in Kandhamal region, if so, the details thereof and time frame fixed for the same?


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


(a) Public health and hospitals being a State subject, the primary responsibility of development of health infrastructure in tribal areas lies with the States/UTs. However, under National Health Mission, financial and technical support is provided to States/UTs for strengthening the public healthcare system including development of health infrastructure in tribal areas based on the priorities, felt need and context projected by the States/UTs in their annual Programme Implementation Plans.

For schemes/parameters available for development of health infrastructure, preferential treatment and relaxed norms exist for tribal areas, which are as under:-

i. The population norms for setting up Public Health Facilities in tribal areas are relaxed. Against the population norms of 5000, 30000, and 1, 20,000 for setting up of Sub Centre, PHC and CHC respectively, in tribal and desert areas its 3000, 20,000 and 80, 0000, respectively. A new norm of “time to care” has also been adopted for setting up sub health Centres in tribal areas, which can be set up within 30 minutes of walk from habitation.

ii. All tribal districts whose composite health index is below the State average have been identified as High Priority Districts (HPDs) and State Governments/UTs are advised to allocate 1.3 times more resources per capita as compared to the rest of the districts in the State. These districts also have enhanced monitoring, focussed supportive supervision, and are encouraged to adopt innovative approaches to address their peculiar health challenges.

iii. Approved norms for Mobile Medical Unit (MMU) is one MMU per district with a normative population of 10 lakh, with a cap of five MMUs per district. This can be further relaxed for hilly and tribal areas, where the populations are widely dispersed and the geographical terrain is difficult.

iv. States have been provided with the flexibility of relaxing the norm of one ASHA per 1000 population to one ASHA per habitation in Tribal/hilly and difficult areas.

v. Tribal Sub-Plan (TSP) is a dedicated source of funds for tribal development across the country. Ministry of health allocates 8.6% of the total Scheme budget under different schemes towards TSP as per norms fixed by Ministry of Finance. A statement showing allocation of funds under Tribal Sub-Plan in respect of various schemes/programmes, for the last three years, is attached as per Annexures I to III.

vi. Ministry of Tribal Affairs through its schemes ‘Special Central Assistance to Tribal Sub-Scheme (SCA to TSS)’ and Grants under Article 275(1) of the Constitution, provides funds to the State Governments as an additive towards development of various sectors including health, based on their proposal after approval of Project Appraisal Committee in the Ministry.

vii. Since North-eastern States have a higher percentage of tribal population (>25%), North-Eastern Council has been established to improve the healthcare infrastructure in these states to ensure greater availability & accessibility to good quality public health services.

(b) & (c) Kandhamal district has been identified as one of the Aspirational districts for giving focused attention for development. As per Rural Health Statistics, 2018, as on 31.03.2018, there are 172 Sub-centres, 40 Primary Health Centres, 14 Community Health Centres and 1 each of Sub-District Hospital and District Hospital functioning in Kandhamal district.

As intimated by the State Government, the details of the funds sanctioned and utilized for development of health infrastructure (civil works) under NHM in this district during the last five years from 2014-15 to 2018-19 are as under:
Sl No Financial Year Approved Budget
(In Lakhs.) Expenditure
(In Lakhs.)
1 2014-15 309.05 425.56
2 2015-16 215.60 429.61
3 2016-17 892.26 400.78
4 2017-18 268.53 66.59
5 2018-19 570.26 564.11
Total 2255.70 1886.65

The State has further intimated that due attention has been given for provisioning of advance medical facilities in all districts including Kandhamal. Various steps are being taken for establishment of different critical healthcare units like Cancer Chemotherapy, Free Dialysis, Free diagnostic including high-end pathology test, digitalisation & reporting of X-Ray, MCH wings, Digital Dispensaries etc. at Kandhamal district. Funds to the tune of Rs. 16179.97 lakhs have been allocated under NHM and State budget from 2014-15 to 2018-19 towards

improvement of healthcare facilities in the district. The year-wise details are as under:-
Rs. in lakhs
Years Release under NHM Release under State Budget Total
2014-15 1,760.68 171.94 1,932.62
2015-16 2,100.56 210.54 2,311.10
2016-17 3,589.51 875.88 4,465.39
2017-18 2,067.88 392.19 2,460.07
2018-19 3,738.26 1,272.52 5,010.78
Total 13,256.88 2,923.08 16,179.97

(d) There is no such proposal for establishment of any Super speciality Hospital and Medical College in Kandhamal. However, the State Government is always free to propose advanced medical facilities for the district under any of the schemes of Government of India.

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