Steps Taken to Improve Availability and Accessibility to Quality Healthcare Services in Remote Areas

1. At a Glance

• Umbrella set of initiatives under Ministry of Health & Family Welfare (MoHFW) to extend Comprehensive Primary Healthcare (CPHC) to tribal, hilly and hard-to-reach areas via NHM, PM-ABHIM, Ayushman Arogya Mandirs and PM-JANMAN convergence [1][2][3].
• Tests a UPSC aspirant on Centre–State health federalism, scheme architecture for PVTGs, and the Universal Health Coverage (UHC) equity agenda.

2. Why in the News

• May 2026 PIB release by MoHFW listing relaxations of NHM norms, expansion of Ayushman Arogya Mandirs (AAMs) and PM-ABHIM sanctioning in tribal districts [1].
• Feb 2026 data on MMU operationalisation under PM-JANMAN released [3].

3. Background & Evolution

• National Rural Health Mission (NRHM) launched 2005; subsumed under NHM in 2013 with NUHM [1].
• Ayushman Bharat announced 2018 — created Health & Wellness Centres (HWCs), rebranded Ayushman Arogya Mandir in 2023 [2].
• PM-ABHIM launched Oct 2021 — India's largest pandemic-preparedness health infrastructure scheme [4].
• PM-JANMAN launched 15 Nov 2023 (Janjatiya Gaurav Divas) for 75 Particularly Vulnerable Tribal Groups (PVTGs) [3].

4. Core Static Facts

• Nodal Ministry: MoHFW (NHM, PM-ABHIM, AAM); Ministry of Tribal Affairs (MoTA) is nodal for PM-JANMAN convergence [3].
• AAMs operational: 1.82 lakh (1,81,873) nationally as on 30.11.2025; 30,817 in tribal districts [1][2].
• AAM service package: 12 expanded CPHC services + teleconsultation; cumulative footfall 494.71 crore, teleconsultations 41.93 crore [2].
• PM-ABHIM outlay (FY 2021-22 to 2025-26): ₹33,081.82 crore approved [2].
• PM-ABHIM components sanctioned: 10,609 building-less AAMs; 5,456 Urban AAMs; 2,151 Block Public Health Units (BPHUs); 744 Integrated Public Health Labs (IPHLs); 621 Critical Care Hospital Blocks (CCBs) [2].
• In tribal districts: 168 IPHLs and 110 CCBs approved under PM-ABHIM [1].
• NHM norm relaxation: population norms for SHCs, PHCs, CHCs relaxed in tribal/hilly/hard-to-reach areas [1].
• MMU norm: baseline = 1 MMU per 10 lakh population, capped at 5 per district; relaxed to up to 10 MMUs per district in PVTG areas under PM-JANMAN [3].
• MMUs operational (as on 18.02.2026): 815 under PM-JANMAN and 320 under Dharti Aaba Janjatiya Gram Utkarsh Abhiyan (DA-JGUA) [3].
• ANM norm relaxation: one additional ANM per Multi Purpose Centre (MPC) built by MoTA under PM-JANMAN [3].
• Maternal health vehicles: RMNCAH+N, Janani Suraksha Yojana (JSY), Janani Shishu Suraksha Karyakram (JSSK), ASHA outreach target tribal women [1].
• CCBs in district hospitals: districts > 5 lakh population to get 50–100 bedded CCBs; smaller districts get referral linkages [2].

5. Multi-Dimensional Analysis

Social / Equity

• PVTG-specific norm relaxation addresses last-mile exclusion; ANM, MMU and ASHA outreach target tribal women's RMNCAH+N indicators [1][3].
• AAM penetration in 30,817 tribal-district sub-centres narrows the rural-urban CPHC gap [1].

Administrative / Federalism

• Operates through NHM Programme Implementation Plans (PIPs) — Centre provides technical + financial support; States execute [1].
• Convergence model: MoTA builds MPCs; MoHFW staffs them via NHM — a federal-functional split [3].

Scientific / Technological

• Interoperable Health Platforms, teleconsultation under e-Sanjeevani (41.93 crore consultations) extend specialist reach to remote zones [2].
• IPHLs enable district-level diagnostics, addressing TB, NCD, sickle cell burdens in tribal belts [2].

Economic / Fiscal

• ₹33,081.82 cr PM-ABHIM envelope is the largest single capex push in public health since NRHM [2].
• Reduces out-of-pocket expenditure (OOPE) by shifting tribal patients from private/quack care to public CPHC.

Ethical / Governance

• Embodies Article 47 (DPSP — duty to raise nutrition and public health) and Article 21 (right to health).
• Sickle cell elimination mission (2023) and PVTG focus operationalise the Constitution's 5th Schedule spirit.

6. Recent Developments (last 12-18 months)

• 18.02.2026: 815 PM-JANMAN MMUs + 320 DA-JGUA MMUs operational [3].
• 30.11.2025: 1,81,873 AAMs operational with 12-service package + teleconsultation [2].
• Oct 2025 PIB primer: PM-ABHIM positioned as "pandemic-ready" infrastructure backbone [2].
• 2025-26 PIP cycle: Continued NHM norm relaxations for tribal, hilly, hard-to-reach areas [1].

7. Prelims Hooks

• AAMs were earlier called Health & Wellness Centres (HWCs), rebranded in 2023 [2].
• PM-ABHIM is a Centrally Sponsored + Central Sector hybrid scheme launched in Oct 2021 [2].
• PM-JANMAN launched on 15 Nov 2023 (Janjatiya Gaurav Divas) — nodal: MoTA [3].
• Standard NHM MMU cap = 5 per district; relaxed to 10 per district in PVTG areas [3].
• 621 CCBs approved nationally under PM-ABHIM; 110 in tribal districts [1][2].
• 744 IPHLs approved nationally; 168 in tribal districts under PM-ABHIM [1][2].
• 2,151 Block Public Health Units (BPHUs) sanctioned under PM-ABHIM [2].
• AAMs deliver 12-service CPHC package including NCD screening and teleconsultation [2].
• Cumulative teleconsultations via AAMs: 41.93 crore (as on 30.11.2025) [2].
• One additional ANM per MPC sanctioned under PM-JANMAN [3].
• JSY is cash-incentive based; JSSK is entitlement-based (free C-section, drugs, diet, transport).
• DA-JGUA = Dharti Aaba Janjatiya Gram Utkarsh Abhiyan — runs 320 MMUs in tribal areas [3].

8. Mains Relevance

• GS-II: Governance — Issues relating to development & management of Social Sector/Services relating to Health; welfare schemes for vulnerable sections (STs, PVTGs).
• GS-III: Inclusive growth; issues related to direct & indirect farm subsidies — public-health expenditure.
• Probable stems: 1. "Evaluate the role of PM-ABHIM and Ayushman Arogya Mandirs in advancing Universal Health Coverage in India's tribal and remote regions." 2. "Relaxation of NHM norms for tribal/hilly areas is necessary but not sufficient for equitable health access. Discuss." 3. "Examine the convergence model between MoHFW and MoTA under PM-JANMAN for PVTG healthcare."

9. Related Topics to Study Next

• National Health Mission (NHM) — parent vehicle for PIPs and norms [1].
• Ayushman Bharat PM-JAY — secondary/tertiary insurance arm of Ayushman Bharat.
• National Sickle Cell Anaemia Elimination Mission (2023) — tribal-focused.
• e-Sanjeevani / Ayushman Bharat Digital Mission (ABDM) — digital backbone.
• Eat Right India / POSHAN Abhiyaan — nutritional determinants of tribal health.
• 5th & 6th Schedule administration — constitutional basis for tribal welfare.
• PVTGs (75 groups) — demographic target of PM-JANMAN.
• WHO Astana Declaration 2018 — global PHC framework AAMs operationalise.

10. Common Errors / Trap Areas

• AAM vs PM-JAY: AAM = primary care infrastructure; PM-JAY = ₹5 lakh secondary/tertiary insurance. Not interchangeable.
• PM-JANMAN nodal ministry: MoTA, not MoHFW — though health delivery is via NHM.
• PM-ABHIM launch year: 2021, not 2020 (often confused with COVID-era PM Cares).
• MMU cap numbers: baseline 5/district (NHM) vs 10/district (PVTG areas) — easy MCQ trap.
• IPHL vs BPHU vs CCB: IPHL = district lab; BPHU = block-level unit; CCB = critical care hospital block — distinct PM-ABHIM components.