Funds Allocated and Key Achievements made under National Health Mission

The Government has continued to allocate more funds to strengthen the National Health Mission (NHM). Allocation under NHM has increased from Rs.27,989crore in 2020-21 to Rs.31,100 crore in 2021-22 Budget Estimate. Further, the National Health Policy, 2017, also envisages the States to increase their health spending to at least 8% of their health budget and the policy advocates allocating major proportion (up to two-thirds or more) of resources to primary care followed by secondary and tertiary care.

The ‘India COVID-19 Emergency Response and Health System Preparedness Package-I’ (ECRP-I) of Rs.15,000crore has been approved with an objective to prevent, detect and respond to the threat posed by COVID-19. Further, the Cabinet has also approved the scheme, “India Covid-19 Emergency Response and Health Systems Preparedness Package -II” (ECRP-II) for an amount of Rs.23,123crore. This is a Centrally Sponsored Scheme (CSS) with some Central Sector (CS) components. The Scheme is aimed further to prevent, detect and respond to the continuing threat posed by COVID-19 and strengthen the national health system for preparedness in India. In order to ensure implementation of critical activities at the State/District levels to prepare the public healthcare system in response to the evolving pandemic, 50% of the Central Share of Resource Envelope of the State/UT, has been released in advance to the States/UTs.

The PM-Ayushman Bharat Health Infrastructure Mission (PM-ABHIM) was launched by Hon’ble Prime Minister of India for an amount of Rs.64,180crore. The measures under the scheme focus on developing capacities of health systems and institutions across the continuum of care at all levels viz. tertiary and primary, secondary preparing health systems effectively pandemics/disasters.

Further, the Government of India continues to keep a close watch over the COVID-19 situation in the country and globally. The government is supporting states in their endeavor to manage COVID-19 since the beginning of the pandemic. Requisite support is provided to States/UTs to enhance preparedness and response capacities against COVID-19 and other public health emergencies. Some of the major areas of intervention include:

• Ministry of Health & Family Welfare continues to provide technical guidance for managing various aspects of COVID-19. So far more than 150 guidelines/advisories/SoPs/plans have been provided to States/UTs.
• Guidelines on Clinical management of COVID-19 continue to be updated with emerging scientific evidence. The treatment protocol for adults was last updated on 24^th May 2021 and has been widely circulated.
• Guidelines for the management of COVID-19 in children were issued on 18th June 2021. The guideline covers guidance on the management of acute presentation of COVID-19 as well as Multisystem Inflammatory Syndrome (MIS-C) in children and adolescents found temporally related to COVID-19.
• A Comprehensive Guidelines for Management of Post-COVIDSequelae was issued by MoHFW on 21st October 2021 after expert consultations to guide doctors on post-COVID-19 complications and their management.
• Travel advisories for international travelers have been revised from time to time based on the epidemiological situation of COVID-19 including circulation of Variants of Concern (including Omicron) of SARS-CoV-2. In view of the declaration of the Omicron variant as a Variant of Concern by the World Health Organization, guidelines for international arrivals were updated on 28^th November 2021. As per the current guidelines, all travelers (irrespective of COVID-19 vaccination status) coming from countries deemed ‘at-risk’ are required to mandatorily undergo post-arrival COVID-19 testing at the arrival. Such travelers will also need to undergo a mandatory home quarantine for 7 days followed by repeat testing on 8^th day of arrival in India to be monitored by State Health Authorities. Additionally, 2% of travelers from countries not deemed ‘at-risk’ shall also be subjected to post-arrival COVID-19 testing in India.
• Union Ministry of Health & FW has advised all States to (i) ensure rigorous follow-up and testing of travelers from ‘at-risk’ countries, (ii) send positive samples for genome sequencing to INSACOG labs in a prompt manner, (iii) ramp up testing for COVID-19, (iv) ensure preparedness of health infrastructure (availability of ICU, O2 beds, ventilators, etc.), (v) ramp up COVID-19 vaccination rates and (vi) ensure adherence to COVID appropriate behavior etc.
• To further provide on-field assistance to the States/UTs, a total of 172 Central multi-disciplinary teams comprising of epidemiologists, clinicians, microbiologists and senior officials from the Ministry has been deployed to States/Districts reporting increased trajectory of cases.

Achievements of NHM:

Key achievements of NHM inter-alia include the following: 

1. Reduction in Out of Pocket Expenditure (OOPE): The OOPE has reduced over the years from 64.21% in FY 2013-14 to 48.8% in FY 2017-18 as per the National Health Account of 2017-18.
2. Maternal Mortality Rate (MMR) has declined from 556/lakh live births in 1990 to 113/lakh live births in 2016-2017. The rate of decline of MMR in India at 77% is much higher than the global average decline of 44% over the same period.
3. Infant Mortality Rate (IMR), declined from 80 in 1990 to 32 in the year 2018.
4. Under 5 Mortality Rate (U5MR), declined from 52 in 2012 to 36 in 2018,
5. The total Fertility Rate (TFR) declined from 2.3 in 2013 to 2.2 in the year 2018.
6. The incidence of Tuberculosis per 1,00,000 population reduced from 234 in 2012 to 193 in 2019. The mortality due to TB per 1,00,000 populations also reduced from 42 in 2012 to 33 in 2019.
7. The number of districts that achieved the target of leprosy elimination increased from 543 districts in 2011-2012 to 554 by March 2017 and to 571 districts by March 2018. The prevalence rate of Leprosy reduced to less than 1/10000 population in 610 Districts in 2020.
8. For Malaria, the Annual Parasitic Index (API) was sustained at levels of less than 1 and declined from 0.89 in 2014 to 0.32 in 2018, and 0.25, in 2019. Malaria cases and deaths declined from 21.27% and 20% respectively in 2019 to 2018.
9. By the end of December 2019, 94% of Kala-azar endemic blocks have achieved the elimination target of <1 KA case per 10,000 population at the block level.
10. The National target for sustaining Dengue-related case fatality rate to less than 1% was met. Dengue-related case fatality rate in 2014 was 0.3% and reduced to 0.1% in 2019.
11. The prevalence of blindness (visual acuity <3/60) has reduced to 0.36% in 2019) from 0.68% in 2010.
12. There is a 17.3% relative reduction in the prevalence of tobacco use from 34.6% to 28.6% from 2009-10 to 2016-17.
13. The proportion of those seeking care from public health facilities increased from 28.3% to 32.5% in rural areas and 21.2% to 26.2% in urban areas between 2014 to 2017.; and utilization of public health facilities for institutional deliveries increased from 56% to 69.2% in rural areas and from 42% to 48.3% in urban areas.

Annexure-IV