Setting up New Hospitals in Rural and Urban Areas

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The Ministry of Health and Family Welfare provides technical and financial support to the States/UTs,for their health system strengthening,including that of Primary Health Centres (PHCs), Community Health Centres (CHCs) and District Hospitals (DHs) through the National Health Mission (NHM). The States/UT Governments are also encouraged to meet the objective of making Health Care services equitable, accessible and affordable by increasing their health budgets each year.

In order to provide comprehensive primary health care, the Government of India has launched Ayushman Bharat Scheme in 2018. As part of this scheme, 1.5 lakh Ayushman Bharat-Health and Wellness Centres (AB-HWCs), are being set up across the country by upgrading Sub-Health Centres (SHCs), Primary Health Centres (PHCs) and Urban Primary Health Centres (UPHCs) which provide preventive healthcare and health promotion at the community level, with the continuum of care approach.

In addition to the above, though other schemes like Pradhan MantriSwasthya Suraksha Yojana (PMSSY) and Human Resources for Health and Medical Education (HRH&ME), efforts are being taken to improve the overall health sector of the country. PMSSY aims at setting up of new AIIMS like institutions and the up-gradation of existing Government Medical colleges while through HRH-ME, improves access to tertiary care in underserved areas as well as aims at increasing the availability of health professionals.

For the containment and management of the pandemic, which includes support for augmentation of infrastructure, oxygen supported beds, isolation beds, ICUs & Human Resources, supply of drugs, etc. States/UTs are being supported under the “India COVID-19 Emergency Response & Health System Preparedness Package”. During the financial year 2020-21, Rs. 8147.28 crores have been released to States under this package. In addition, Rs.110.60 Crs has been made available for insurance of Health Care workers. Thus, a total amount of Rs.8257.88 Crs has been provisioned for the States/ UTs. Details are in Annexure-I.

The Cabinet has also approved the scheme, “India Covid-19 Emergency Response and Health Systems Preparedness Package – Phase-II” (ECRP-Phase-II) on 8.07.2021 for an
amount of Rs.23,123 crores. This Scheme is aimed at preventing, detecting and responding to the continuing threat posed by COVID-19 as well as for strengthening national health systems for preparedness in similar health emergencies in India.

Also, the Fifteenth Finance Commission has recommended grants aggregating to Rs.70, 051 Crores, over the period of five years (2021-2026) through local governments, for strengthening the healthcare system at the primary health care level.

For better monitoring and improved quality of services, the Government is implementing National Quality Assurance Programme (NQAS), the Kayakalp award scheme and LaQshya initiatives. Details atAnnexure-III.

Annexure-I

India Covid-19 Emergency Response & Health System Preparedness Package: (ECRP-I)

The “India COVID-19 Emergency Response and Health System Preparedness Package” for Rs. 15,000 Crore (USD 2 billion) was approved by Cabinet on 22^nd April 2020 to prevent, detect and respond to the threat posed by COVID-19.

The package is co-financed by the World Bank (WB), Asian Infrastructure Investment Bank (AIIB), and Asian Development Bank (ADB) has been implemented through MoHFW and its implementation agencies namely the Indian Council of Medical Research (ICMR), National Centre for Disease Control (NCDC), National Health Mission (NHM), Central Procurement Division (CPD)&also through the Ministry of Railways (MoR).

Under the package, so far, a total of Rs.13719.22 Cr of committed expenditure has been reported by the implementation agencies. Rs.8147.29 Cr has been released to the States/UTs to prevent, detect, and respond to the threat posed by COVID-19.

Pursuant to the guidance on the management of the COVID-19 patients, dedicated facilities have been set up by the States for the management of the COVID-19 patients. Since April 2020 exponential growth has been made in the establishment of Health infrastructure. As of 30^th June 2021, the national progress made is as follows:

Category I. COVID dedicated hospitals increased from 163 to 4389 – a 27-fold increase.
Category II. Dedicated COVID health centres increased from 0 to 8340.
Category III. Dedicated COVID Centre increased from 0 to 10,015.
Oxygen supported beds increased from 50,583 to 4, 16,947 – an 8-fold increase in beds.
Total isolation beds (excluding ICU beds) increased from 41,000 to 1,811,850 – a 44-fold increase.
Total ICU beds increased from 2,500 to more than 121,671 beds – a 48-fold increase.
2.2 million health workers including ASHAs are insured to fight COVID-19.
Additional HR deployed in States/ UTs: Specialists – 3720, Medical Officers – 7030, Staff Nurses – 36,303.

Phenomenal progress in Testing: The testing capacity i.e., 30,000 per day from April 2020 has been increased to more than 20.60 lakhs samples per day. Cumulatively, over 41.40 Crore tests for COVID-19 through 2734 testing labs in the country (1288 government laboratories and 1446 private laboratories), have been conducted and the daily testing capacity has got a substantial boost.

ICMR has also supplied 85 RT-PCR machines, 125 automated RNA extraction machines, 4 COBAS machines to the States/UTs to strengthen the testing capacity for COVID.

MoHFW has also provided in-kind support to the states by procuring and distributing 4.23Crore – N95 masks, 1.77 crore – PPE kits, 11.16 Crore – HCQ tablets, 48,232 – Ventilators, 14,000 10ltr Oxygen Concentrators, 102,400 – Oxygen cylinders, 1,00,000 – SARS COV2 cartridges, 12 lakhs – COVID-19 PCR chip, 1.0 Crore – Remdesivir injections (as on 17^th June 2021).

Ministry of Railways also converted 5601 train coaches into COVID Care Centers and are being deployed as per demand by State Government. Testing capacity for COVID-19 for Railways was also augmented by the addition of 5 RTPCR Machines (including Truenat Machines).

Annexure-II

India Covid-19 Emergency Response & Health System Preparedness Package: (ECRP-II)

The “India COVID-19 Emergency Response and Health System Preparedness Package”: Phase II for Rs.23,123 Crore was approved by Cabinet on 8^th July 2021 and is being implemented from 1^st July 2021 to 31″ March 2022 with an aim to strengthening district and sub-district capacity for an effective and rapid response to the pandemic.

Central Sector components of the proposed package (ECRP-II) will flow through existing mechanism of the Central Procurement Division (CPD), Pradhan MantriSwasthya Suraksha Yojana (PMSSY), NCDC, Central Hospitals and Public Health Division and Allied Health Services division of the MoHFW.
The Central Sponsored components will flow through the existing NHM Framework to leverage the existing implementation framework, already approved by the Union Cabinet, for executing the proposed activities and to avoid any duplication.
The Central Sector components are proposed to be implemented by Departments, Agencies and Programme Divisions of the MoHFW. Components of this support are as under:

Support to Central Hospitals, AIIMS, and other institutions of national importance for COVID-19 management: Support is provisioned to provide quality Carefor about 6,688 repurposed beds for COVID at Central Hospitals under the Ministry and various All India Institute of Medical Sciences (AIIMS), including AIIMS, New Delhi.

Support for strengthening War Room and IT Interventions including for COVID-19 vaccination: These activities encompass strengthening the Central War room, IT systems including COVID-19 Portal and eSanjeevani Tele-consultation platform,1075 COVID-19 helpline, Cloud telephony and Call Centres, implementation of Hospital Management Information System in all Districts Hospitals of the country, strengthening COWIN platform, etc.

Support for strengthening NCDC for surveillance activities including for the Genome Sequencing related work: Support is provisioned forGenome sequencing, understanding the emergence, evolution and spread of the SARS-CoV-2 virus as well as identifying vaccine and drug targets, strengthening surveillance activities and provision of equipment for Genome Sequencing at NCDC, duly setting up the secretariat of India Genome Consortium, ieINSACOG in the package.

Support surveillance at 28 Points of Entry: Under this component, Surveillance at 16 International Airports, 11 Sea-Ports and one Land Border Crossing will be strengthened through Biosafety equipment, IT equipment and testing facilities.

Support to Centralized Procurement of essential drugs and supplies: Provision is made for the Centralized procurement of essential drugs and emerging drugs for COVID management.

These Central Sponsored components include support to State/UT level through NHM Framework with a State Share as is applicable in NHM. Components of this support are as under:

Establishing Paediatric Care units in all the Districts of the Country under the technical guidance and mentorship of State level Paediatric Centre of Excellence.

Augmenting additional beds at the facilities including those in rural, tribal and peri-urban areas closer to the community.

Augmenting ICU beds capacity of the country and establishing Field Hospitals and support for the additional fleet for Referral Transport.

Support to enhance the availability of medical Oxygen in the public healthcare system by providing Liquid Medical Oxygen Storage Tanks along with Medical Gas Pipeline System (MGPS) (at least one per district).

Supporting the States to utilize the UG and PG Residents, Final Year MBBS, BSc and GNM Nursing students for effective COVID-19 management.

Support to States for ensuring availability of essential drugs including a buffer stock of drugs for COVID19 management.

Support for procurement of Diagnostics to Strengthening district level laboratories for RT-PCR testing and Diagnostic Tests for COVID19 at sub district levels.

Infrastructure support to States Implementation of Hospital Management Information System (HMIS) ie, e-Hospital and e-Sushrut in all District Hospitals

Strengthening Hubs for Teleconsultation in all the Districts of the Country and establishing Spokes for Tele Consultation at COVID Care Centres

Support for Capacity Building and Training for all aspects of management of COVID-19.

Annexure-III

Ensuring quality standards in the delivery of healthcare service

NQAS: Quality and delivery of healthcare service is crucial in improving the health status of the population. It is aimed at enhancing accessibility, increasing efficiency, strengthening clinical effectiveness and improving user satisfaction. The NQAS is accredited by ISQua (International Society for Quality and healthcare), and these standards are also recognised by IRDA (Insurance Regulatory and Development Authority) and NHA (National Health Authority). Till 31st March 2021, cumulatively 3544 public health facilities achieved Quality Certification (813 nationally certified and 2731 health facilities certified at State level).

LaQshya: For ensuring quality and safety in ‘care bound birth’ LaQshya initiative was launched in 2017. Total 2,805 facilities are selected under LaQshya initiatives (including 193 Medical Colleges). Since Inception (till 31st March 2021), 765 Labour Rooms & 652 Maternity Operation Theatres are State LaQshya certified and 322 Labour Rooms & 271 Maternity Operation Theatres are National Laqshya certified

Kayakalp: For controlling hospital-acquired infection by promoting the practice of cleanliness, hygiene and sanitation, the Kayakalp award scheme is being implemented since 2015 for central Government institutions and State Public Health Facilities. Total 9815 health facilities (347 DHs, 1926 SDHs/CHCs, 4761 PHCs, 1025 UPHCs, 1756 HWCs) in Twenty- One States (Andhra Pradesh, Arunachal Pradesh, Assam, Chandigarh, Daman Diu &Dadar Nagar Haweli, Goa, Gujarat, Haryana, Himachal Pradesh, Jharkhand, Kerala, Madhya Pradesh, Meghalaya, Mizoram, Odisha, Puducherry, Punjab, Rajasthan, Sikkim, Tamil Nadu, and Tripura) have been awarded so far.