Centre’s Rs 64,000 cr plan for future pandemics: What does it consist of?

The Government of India has announced a new scheme to revamp the health infrastructure of the country so that India is prepared to face future pandemics like the ongoing novel coronavirus disease (COVID-19) pandemic. The Rs 64,180 crore allotted for the scheme will be spent over the next five years.

The scheme — known as PM Ayushman Bharat Health Infrastructure Mission — was launched by Prime Minister Narendra Modi in Varanasi October 25. Its details were spelt out October 26 by Union Health Minister Mansukh Manadaviya and Additional Secretary, Vikas Sheel, at a press conference in New Delhi.

Critical care hospital blocks would be created in 602 districts which have a population of more than 500,000 each. There will be 50-100 beds in each block.

Sheel said:

We saw this time (COVID-19) that if all healthcare facilities are directed to patients of one disease, healthcare in other sectors suffers. So, if such dedicated healthcare is required again in the future, these blocks would cater to the routine healthcare.

The remaining 128 districts would have referral linkage to the 602 critical care blocks.

At the national level, 12 critical care blocks would be established at hospitals that belong to the central government. They are envisaged to serve as mentor institutions. At state level, 15 ‘health emergency operation centres’ would also be built.

The establishment of 17,788 rural health and wellness centres and another 11,024 will be undertaken in accordance with the existing Ayushman Bharat scheme.

The focus is on increasing diagnostics at primary and secondary levels. Therefore, one of the envisaged outcomes of this scheme is to ensure availability of 14 types of investigations at sub-health centres, 63 at primary health centres, 97 at community health centres and 134 at district hospitals by the end of the scheme period, that is 2025-26.

X-Ray, CT scan, liver function tests, kidney function tests and viral culture studies would be done at all 730 district hospitals.

A few of these services are already a part of the National Health Mission (NHM) — Rural and Urban.

“There are limitations to spending money on a number of these things like diagnostics as part of the NHM. So, this scheme would supplement the existing resources,” Sheel said on the sidelines of the press conference, in response to a Down To Earth query.

“Also, district hospitals are not adequately equipped to handle critical care. That is not part of NHM. So, we aim to better tertiary care at the district level,” he added.

The Centre has also introduced, for the first time, two ‘container-based mobile hospitals’, as part of the scheme. One mobile unit will have 33 containers (that are used for transporting goods) which will together make a complete hospital entity.

The two container-based mobile hospitals will be stationed in New Delhi and Chennai. They can be airlifted, or transported by road or water, as and when a disaster strikes, the ministry said.

Disease surveillance

Improving surveillance has also been a priority, the government said. Therefore, four new regional National Institutes for Virology will be operationalised. Currently, there is one at Pune.

The existing National Centre for Disease Control (NCDC), which has a mandate to cover disease outbreaks, would be strengthened by adding three new divisions.

These would be the climate change division, occupational health division, disaster management division. The overall epidemiological intelligence services would also be upgraded.

Five regional branches of NCDC — one each in the north, south, east, west and central regions — would be established. Twenty metropolitan branches too would come up in the metros of the country. 

All these efforts are aimed at making the disease surveillance system of the country decentralised. Most of these announcements, incidentally, were made by Union Finance Minister Nirmala Sitharaman in her Budget speech this year.

For research on pathogens, better safety level labs are needed so that they can be handled without any accident. As such, the government has said 15 biosafety level-III labs would be made.

In order to work on the increasing threat of zoonotic diseases in the country, the government announced a slew of steps.

Centre-state coordination

The central government will spend Rs 54,204.78 crore in the next five years on the components of this scheme which would be centrally sponsored. Like other centrally-sponsored schemes, the Centre will bear 60 per cent of the cost while the states will have to shell out the remaining.

Have states come on board? “We have done a prior consultation with the states. Most of them have agreed to be part of the scheme,” Sheel said on the sidelines, adding that the demand would have to come primarily from the states.

“They will have to make an assessment and tell us where the money is required and how much. We will give the money. The implementation will have to be carried out by the states. We can only monitor to the best of our capacity,” he said.

The central sector components of the scheme like creation of critical care units in central government hospitals, strengthening disease surveillance, surveillance at points of entry, strengthening disaster preparedness, creation of biosecurity labs and additional needs for COVID-19 response would require another Rs 9,339.78 crore, which would be spent totally by the Centre.

The creation of infrastructure would also have to be matched with additional human resources. On this, the additional secretary, without giving many details, said: “We have given a thought to it and additional recruitment would be done as and when needed.”

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