The Government of India announced the launch of the Ayushman Bharat Health Infrastructure Mission late last month. The mega policy initiative is being seen as one of the largest pan-India schemes for creating and strengthening public healthcare infrastructure. The government will spend Rs 64,180 crore on the scheme from the financial year 2021-22 to 2025-26.
Through the ABHIM, the government aims to strengthen the critical healthcare network from village to block to the district to the regional and national level in the next four to five years. A government statement mentioned that the Mission will “provide a much-needed fillip to India’s capacity to address emergent public health issues. This will bring about a paradigm shift in India’s healthcare infrastructure and make it more resilient.”
The ABHIM will fill gaps in public health infrastructure, especially in critical care facilities and primary care in both urban and rural areas. The ABHIM is an addition to the Ayushman Bharat initiative that aims to provide universal access to equitable, accessible, and high-quality healthcare that is accountable and responsive to people’s needs. The central government had recently launched another scheme, the Ayushman Bharat Digital Mission (ABDM), a flagship digital initiative involving the creation of a unique health ID for every citizen and a digital healthcare professionals and facilities registry.
AMHIM will ensure access to services in all districts of the country with over five lakh population through ‘Exclusive Critical Care Hospital Blocks’. The remaining districts will be covered through referral services. Integrated public health labs will also be set up in all districts, giving people access to a range of diagnostic services through a network of laboratories across the country.
The COVID 19 pandemic highlighted that essential public health functions needed to respond to a pandemic were weak. Limited laboratory capacity at all levels meant that functions of testing, case detection, surveillance and outbreak management were inadequate and facilities for critical care provision lacked enough Intensive Care Units, isolation beds, oxygen supply, and ventilators. COVID 19 also illustrated that despite using the health systems approach to horizontal integration between programmes, there needs to be more convergence between institutions created for vertical disease control programmes and the district and sub district service delivery systems.
The ABHIM is set up with an objective to strengthen grass root public health institutions to deliver universal Comprehensive Primary Health Care, including surveillance, active community engagement and improved risk communication, health education and prevention; and to strengthen public health institutions and public health governance capacities, to meet challenges posed by the current and future pandemics/epidemics with capacities for comprehensive diagnostic and treatment including for critical care services.
ABHIM will seek to work in three important areas of India’s public health sector: augmenting health facilities for treatment; setting up of integrated public health labs for diagnosis of disease and surveillance, and expansion of existing research institutions that study pandemics and the health systems’ preparedness for them. The three components that make up the ABHIM include the following.
ABHIM will establish an IT-enabled disease surveillance system through a network of surveillance laboratories at block, district, regional and national levels. At the district level, Integrated Public Health laboratories in all 730 districts will be set up. At the state level, five regional branches and 20 metropolitan units of the National Centre for Disease Control will be established. At the national level, an Integrated Health Information Platform (IHIP) will be established. All the public health labs will be connected through the Integrated Health Information Portal, which will be expanded to all states and UTs.
Diagnostics and treatment facilities:
The second component of the ABHIM is the creation of comprehensive diagnostics and treatment facilities. At the district level, 17,788 new rural health and wellness centres will be set up; 11,024 new urban health and wellness centres will be set up; critical care hospital blocks will be established in each of 602 districts, with a population of more than 5 lakh.
At the state level, 15 health emergency operation centres will be set up. At the national level, two container-based mobile hospitals will be set up; and critical care hospital blocks in 12 Government of India hospitals will be set up which will also act as mentor institutions for training and capacity building.
An important component of the ABHIM will be comprehensive pandemic research. In the context of the coronavirus pandemic, the mission aims to set up a robust system for detecting, investigating, preventing, and combating public health emergencies and disease outbreaks. For this, 17 new public health units will be set up, while the 33 existing public health units will be strengthened. It will also train frontline and healthcare workers to respond to public health emergencies effectively.
At the district level, strengthening of existing 80 viral diagnostics and research labs will be undertaken. At the state level, 15 new bio-safety level III laboratories will be operationalised.
At the national level, four new regional national institutes for virology will be operationalized and a regional research platform (digital) for WHO southeast Asia Region will also be set up.
Under the scheme, a national institution for one health, four new national institutes for virology, a regional research platform for WHO South East Asia Region, nine biosafety level-III laboratories, and five new regional national centre for disease control will be set up.
Apart from this, the mission will set up other infrastructure, including a national institution for one health, four national institutes for virology, a regional research platform for WHO’s South East Asia region, nine biosafety level-III laboratories, and five regional centres for disease control.
In addition, the mission looks to boost the availability of health professionals, correct the existing regional imbalance in the distribution of medical colleges and make better use of district hospital infrastructure. For the same, around 157 new medical colleges have been sanctioned across the country spanning three phases of the project, with 63 of them being presently operational.
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