One step ahead towards self-reliance for effective care in health emergencies

Dr Bharati Pravin Pawar
As they say, when you fight a battle, you prepare for a war. We now know the enemy well, we know ourselves, and now we are preparing for bigger foes and fights that may come our way.
COVID-19 was an eye-opener when it comes to the capacity of our health system and its limitations in responding to such an outbreak. While it overburdens the entire country’s health system and services in managing the Covid and non-COVID induced essential services, the early months were particularly taxing for the States with weaker health systems. The inability of the private sector to step up and share the burden, despite a 60% share in the country’s health care, drove the point home that health care services being of paramount importance to the public cannot be left to independent forces.
To expand our efforts against COVID-19 and to ensure our preparedness for any such pandemic in future, PM Ayushman Bharat-Health Infrastructure Mission is another addition to our arsenal with an outlay of Rs. 64,180 crore over a period of five years. In addition to the National Health Mission, the PM Ayushman Bharat-Health Infrastructure Mission with its Centrally Sponsored Scheme (CSS) with some Central Sector Components will be working towards strengthening public health institutions and governance capacities for wide-ranging diagnostic and treatment, including critical care services. The latter goal would be met with the establishment of Critical Care Hospital Blocks in 12 Central Institutions like All India Institute of Medical Sciences, and in 602 districts in Government medical colleges and district hospitals.
It is pertinent to emphasize that under the able guidance of Hon’ble Prime Minister Shri Narendra Modiji, all efforts are being made, including sufficient budgetary provisions under various schemes, to fight the biggest calamity in human history.
The importance of laboratories and their lack of readiness in times of outbreak in terms of a robust surveillance system and diagnostic interface was also never more pronounced. The Government of India will be establishing 730 Integrated District Public Health Labs across the country to provide comprehensive laboratory services for minimum 134 tests, including infectious disease diagnostics. The current labs for different programmes shall be integrated to deliver clinical, public health surveillance and diagnostic services for predicting outbreaks, epidemics, and more.
A time-tested method of tackling any problem has been to prepare yourself with knowledge about it. That is the reason why PM Ayushman Bharat-Health Infrastructure Mission has focussed on supporting research on COVID-19 and other infectious diseases, including biomedical research to generate evidence to inform short-term and medium-term response to such pandemics. We will also develop a core capacity to deliver the One Health Approach to prevent, detect, and respond to infectious disease outbreaks in humans and animals. The plan to achieve that bio-security preparedness and pandemic research strengthening would be realised via four regional National Institutes for Virology, regional research platform for World Health Organization South-East Asia Region, and nine Biosafety Level (BSL) III laboratories.
In our endeavour to keep one step ahead of the infectious organisms that bring our life to a halt, expanding and building an IT-enabled disease surveillance system is on the cards too. A network of surveillance laboratories will be developed at block, district, regional and national levels, points of entry, and in metropolitan areas, for effectively detecting, investigating, preventing, and combating health emergencies and outbreaks.
The surveillance will get a huge boost with 20 Metropolitan Surveillance Units, five regional National Centre for Disease Control (NCDC) branches, and Integrated Health Promotion Platform (IHIP) in all states.
The points of entry will be reinforced with 17 new Points of Entry Health Units upgrading 33 existing units. The upgraded and intensified system of surveillance will be in addition to a state-of-the-art National Digital Health Ecosystem for IT-enabled healthcare service delivery, for managing the core digital health data, and for ensuring national portability in the provision of health services through a secure system of Electronic Health Records (EHR). It will not only be based on international standards but easily accessible to the citizens too.
A major highlight of the current pandemic has been the requirement of local capacities in urban areas. The required paradigm shift in the urban health care is noted and acted upon in the PM Ayushman Bharat-Health Infrastructure Mission.
The scheme aims to meet the unique dynamics and varied socio-cultural needs with a comprehensive approach to the health challenges. The services from the existing Urban Primary Health Centres (UPHCs) will be expanded to smaller units – Ayushman Bharat Urban Health and Wellness Centres (AB-UHWCs) and polyclinics or specialist clinics. The UHWCs would be established closer to the community to meet the needs of urban population and polyclinics would guarantee care through improved access to expanded high quality services and establish referral linkages.
The CSS Components of the scheme envisage 11,044 new UHWCs across the country with a focus on slum and slum like areas. Another key component is providing infrastructure support for 17,788 AB-HWCs in rural areas of seven high focus states. Also, 3,382 blocks in 11 high focus states will be developed as Block Public Health Units (BPHUs) to improve healthcare by strengthening integration between clinical and public health services, improve disease surveillance, and improved public health data reporting and follow up.
The PM Ayushman Bharat-Health Infrastructure Mission goals and steps, though, do not end with these. Such detailed reorientation of health systems and services under an intensively action and result driven scheme would ensure we are not got stuck by anything posing threat to the health and wellness of our public at large in future.
The writer is Minister of State, Minister of Health & Fa mily Welfare PIB