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Insights into Editorial: Preparing for outbreaks

 

 

Context:

COVID-19 overburdened the country’s health system and services. The early months of the outbreak were particularly taxing for the States with weaker health systems.

The inability of the private sector to share the burden drove the point home that healthcare services cannot be left to independent forces.

 

Public health experience in India:

In India, health-related public policies and healthcare infrastructure have often been a matter of discussion among policymakers.

Yet, they rarely become a political issue. However, it would be a mistake to imagine that citizens do not care about health facilities. Years before the ongoing pandemic drew attention to these issues, a study (‘State of Democracy in South Asia (SDSA)–Round 3’) by Lokniti-CSDS in 2019 found that people expect the government to take maximum responsibility for providing basic medical care.

But when it comes to voting, health never becomes an electoral issue for voters; nor do political parties generally focus on health infrastructure in their manifesto or campaign.

 

Ayushman Bharat Health Infrastructure Mission (ABHIM):

It is one of the largest pan-India schemes for strengthening healthcare infrastructure across the country.

It will provide support to 17,788 rural Health and Wellness Centres in 10 ‘high focus’ states and establish 11,024 urban Health and Wellness Centres across the country.

Through this, critical care services will be available in all the districts of the country with more than five lakh population through exclusive critical care hospital blocks, while the remaining districts will be covered through referral services.

Under the scheme, a national institution for one health, four new national institutes for virology, a regional research platform for WHO (World Health Organization) South East Asia Region, nine biosafety level-III laboratories, and five new regional national centres for disease control will be set up.

 

Aims of ABHIM:

  1. The Pradhan Mantri Ayushman Bharat Health Infrastructure Mission (ABHIM) is another addition to the arsenal we have to prepare for such oubreaks in the future.
  2. This was launched with an outlay of Rs.64,180 crore over a period of five years.
  3. In addition to the National Health Mission, this scheme will work towards strengthening public health institutions and governance capacities for wide-ranging diagnostics and treatment, including critical care services.
  4. The latter goal would be met with the establishment of critical care hospital blocks in 12 central institutions such as the All India Institute of Medical Sciences, and in government medical colleges and district hospitals in 602 districts.
  5. The importance of laboratories and their lack of readiness during an outbreak in terms of having a robust surveillance system and diagnostic interface has never been more pronounced than in recent times.
  6. The government will be establishing integrated district public health labs in 730 districts to provide comprehensive laboratory services.
  7. The current labs for different programmes shall be integrated to deliver clinical, public health surveillance and diagnostic services for predicting outbreaks, epidemics, and more.
  8. ABHIM will focus on supporting research on COVID-19 and other infectious diseases, including biomedical research to generate evidence to inform short-term and medium-term responses to such pandemics.
  9. The government also aims to develop a core capacity to deliver the ‘one health’ approach to prevent, detect, and respond to infectious disease outbreaks in humans and animals.
  10. The plan to achieve that bio-security preparedness and pandemic research strengthening would be realised via four regional National Institutes for Virology, the regional research platform for the World Health Organization Southeast Asia Region, and nine Biosafety Level III laboratories.

 

Why is the scheme significant?

  1. India has long been in need of a ubiquitous healthcare system. A study (‘State of Democracy in South Asia (SDSA)–Round 3’) by Lokniti-CSDS in 2019 highlighted how access to public health care remained elusive to those living on the margins.
  2. The study found that 70 per cent of the locations have public healthcare services. However, availability was less in rural areas (65 per cent) compared to urban areas (87 per cent).
  3. In 45 per cent of the surveyed locations, people could access healthcare services by walking, whereas in 43 per cent of the locations they needed to use transport.
  4. The survey also found that proximity to healthcare services is higher in urban localities: 64 per cent of the enumerators in urban areas observed that people can access healthcare services by walking, while only 37 per cent in rural areas can do so
  5. The Prime Minister had recently launched another scheme, the Ayushman Bharat Digital Mission (ABDM), a flagship digital initiative involving the creation of not just a unique health ID for every citizen, but also a digital healthcare professionals and facilities registry.

 

Boosting surveillance will prevent and combat health emergencies and outbreaks:

  1. In India’s endeavour to keep 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.
  2. A network of surveillance labs will be developed at the block, district, regional and national levels for detecting, investigating, preventing, and combating health emergencies and outbreaks.
  3. Surveillance will get a huge boost with 20 metropolitan surveillance units, five regional National Centre for Disease Control branches, and an integrated health promotion platform in all the States.
  4. The points of entry will be reinforced with 17 new points of entry health units upgrading 33 existing units.
  5. 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.
  6. This will be based on international standards and easily accessible to citizens.
  7. A major highlight of the current pandemic has been the requirement of local capacities in urban areas.
  8. The services from the existing urban primary health centres will be expanded to smaller units – Ayushman Bharat Urban Health and Wellness Centres and polyclinics or specialist clinics.
  9. The urban primary health centres will be established closer to the community to meet the needs of the urban population and polyclinics will guarantee care through improved access to expanded high-quality services and establish referral linkages.

 

Conclusion:

The healthcare system in India needs to be made accessible to the needy and people living on the margins of society.

The absence of a positive experience with public healthcare not only pushes people towards private healthcare facilities, but also pushes the issue of health out of public political considerations.