ONGOING INITIATIVES TO STRENGTHEN HEALTHCARE INFRASTRUCTURE

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The government of India has provided the required technical support and has also supported the states through logistic and financial support to further strengthen the existing health infrastructure to tackle the COVID-19 pandemic.

Some of the ongoing initiatives to further strengthen healthcare infrastructure include:

With the intent to reduce the risk of cross-infection to non-COVID patients as well as to maintain continuity of non-COVID essential health services in the country, a three-tier arrangement of dedicated COVID-19 health facilities [(i) COVID Care Center (CCC); (ii) Dedicated COVID Health Centre (DCHC) and (iii) Dedicated COVID Hospital (DCH)] has been implemented in the country.
The government of India, to supplement the hospital facilities has roped in tertiary care hospitals under ESIC, Defence, Railways, paramilitary forces, Steel Ministry etc. Further, many large temporary treatment facilities were established by DRDO to manage the surge in COVID-19 cases in the country.
The isolation bed capacity and ICU bed capacity which were only 10,180 and 2,168 before the first lockdown (as on 23^rd March 2020) is being enhanced continuously and is currently at 18,03,266 isolation beds and 1,24,598 ICU beds (as on 3^rd August 2021).
The daily liquid medical oxygen (LMO) supply, which was about 1292 MTs per day in February 2021 increased to 8593 MTs in April 2021. On 28^th May 2021, a total of 10,250 MTs of LMO was allocated to the states. This was done by enhancement of LMO production in steel plants as well as in other LMO plants. Restrictions were imposed on the industrial use of oxygen.
A dynamic and transparent framework for allocation of medical oxygen in consultation with States/UTs and all the stakeholders such as relevant Ministries, manufacturers/suppliers of liquid oxygen, etc. was prepared.
Online digital solutions viz. Oxygen Demand Aggregation system (ODAS) and Oxygen Digital Tracking System (ODTS) have been developed to ascertain the demand for medical oxygen from all medical facilities and to track their transportation.
To avoid wastage of medical oxygen, guidelines on rational use of oxygen were issued on 25^th September 2020, and further revised and disseminated to States on 25^th April 2021.
1,02,400 oxygen cylinders were procured in April and May of 2020 and distributed to States. Further orders for additional 1,27,000 cylinders have been placed on 21.04.2021 (54,000 jumbo cylinders (D type) and 73,000 regular cylinders (B type). Deliveries of the same have started and 73,352 (56,108 B-type and 14,244 D-type) cylinders have been delivered as on 3^rd August 2021.
To generate oxygen at the health facility level, PSA plants are being established in each district hospital, especially in far-flung areas enabling the hospitals to become self-sufficient in the generation of oxygen for their needs and thereby, reduce the burden on the medical oxygen supply grid across the country.
Further, to fast-track the availability of Medical Oxygen in rural and peri-urban areas, more than 39,000 oxygen concentrators have been allocated to various States.
A COVID Drugs Management Cell (CDMC) has been set up in the Department of Pharmaceuticals (DoP) to oversee the management of the smooth supply of drugs used in COVID-19 management.
A Drugs Coordination Committee (DCC) has been constituted as an institutional mechanism under the Department of Pharmaceuticals for efficient decision making on all the issues with respect to COVID-19 related drugs including availability through inter-departmental consultations.
Remdesivir is a patented drug, manufactured in India under voluntary licenses granted by Gilead Life Sciences USA (the patent holder) to 7 Indian pharmaceutical companies. Manufacturing capacity was augmented from 38 lakh vials per month in March 2021 to nearly 122 lakh vials per month in June 2021. In addition, 40 additional manufacturing sites were approved by the CDSCO, thus increasing the manufacturing sites from 22 (in March 2021) to 62 (June 2021).
All States/UT and State Drugs Controllers have been requested to verify stock of drugs and check other malpractices and take effective steps to curb hoarding and black marketing of some drugs like Remdesivir.
Department of Pharmaceuticals and the Drug Controller General of India (DCGI) have actively coordinated with the industry to enhance the availability of Amphotericin B through identification of manufacturers, alternate drugs and expeditious approvals of new manufacturing facilities.
Besides, the existing five manufacturers, DCGI had issued permissions to manufacturing/marketing of Amphotericin B Liposomal Injection to six additional firms.
The guiding principle to avert/ minimize the risk of future resurgence of COVID-19 cases in the country remains the five-fold strategy of test-track-treat-vaccinate and COVID appropriate behavior.
Ministry of Health & Family Welfare continues to provide technical guidance for managing various aspects of COVID-19. So far more than 150 guidelines/advisories/SoPs/plans have been provided to States/UTs. Taking note of the ingress of COVID-19 pandemic in peri-urban and rural areas, the Ministry of Health & Family Welfare on 16^th May 2021 issued an SOP on COVID-19 Containment & Management in Peri-urban, Rural & Tribal areas.
Further COVID-19 treatment protocols and advisories both for adults as well as pediatric age groups were issued and widely disseminated to promote rational use of drugs and oxygen.
During the F.Y. 2019-20. funds to the tune of Rs.1113.21 crore were released to the States/UTs under NHM towards management and containment of the COVID-19 pandemic.
In September 2020, the Union Government further allowed the use of SDRF by the States for oxygen generation and storage plants in hospitals; strengthening ambulance services for the transport of patients; and setting up containment zones, COVID-19 care centers. States were allowed to spend a maximum of 35% of the annual allocation of funds under SDRF for the financial year 2019-20. The ceiling was further enhanced to 50% during the financial years 2020-21 and 2021-22 for containment measures of COVID-19.
During the FY 2020-21, funds to the tune of Rs.8257.88 crore has been released to the States/UTs towards the India COVID-19 Emergency Response and Health System Preparedness Package.
In addition, ‘India COVID-19 Emergency Response & Health System Preparedness Package: Phase-II’ has also been approved by the Cabinet with Rs 23,123 crores (with Rs. 15,000 Cr as Central Component & Rs 8,123 Cr as State component) and is to be implemented from 1^st July 2021 to 31^st March 2022. So far Rs. 1827.78 crore has been released to States/UTs in 2021-22 under ECRP Phase-II in FY 2021-22.

It includes support to the State/UT level for ramping up Health Infrastructure including those in rural, tribal and peri-urban areas closer to the community, providing support for procurement of drugs and diagnostics to enhance service delivery at district and sub-district levels for management of COVID-19 cases (including pediatric care) and for maintaining a buffer of drugs, support for IT Interventions such as the implementation of Hospital Management Information System and expanding access to teleconsultations in all districts, and support for capacity building and training for all aspects of management of COVID-19.

Further, under the National COVID Vaccination Program, the Government of India is procuring vaccines and providing them free of cost to States and UTs. As on 3^rd August 2021, a total of about 50.21 crore doses have been supplied to States/UTs from all sources i.e., Government of India’s Covid vaccine supply free of cost to all States/UTs, State/UTs and Private Hospitals procured Covid vaccine.

The COVID-19 response strategy since inception is supported by expert groups comprised of epidemiologists, scientists, microbiologists, clinicians etc. drawn from eminent institutions including the World Health Organization. Further, the research community and pharmaceutical industry including vaccine manufacturers have supported COVID-19 response in terms of research and development of vaccines, as well as their production.

Union Ministry of Health through the Department of Health Research has also been commissioning studies to find answers to pressing research questions related to COVID-19. These projects have been awarded and funds provided to ICMR and non-ICMR scientists in various important areas.

In addition, recently Indian Council of Medical Research had put out a call for proposals, inviting concept proposals in various areas related to COVID-19. These include clinical research, epidemiology, operational & socio-behavioral research and diagnostics & biomarkers. Selected proposals with public health translational value will be funded after scientific review by ICMR.