Shortly after attaining the major milestone of administering 100 crore vaccines in its successful fight against the COVID-19 pandemic, India’s health infrastructure received a booster doze in the form of the PM Ayushman Bharat Health Infrastructure Mission on 25th October 2021. The scheme looks at providing medical treatment to the middle class and the poor segments of the society through an all-round development of India’s healthcare system. The launch of the mission was a much awaited step towards a world class and accessible Indian health care sector, as put forth by the Prime Minister himself, the mission can be touted as “India’s largest scheme to scale-up health infrastructure”. The Ayushman Bharat Health Infrastructure Mission is an addition to the National Health Mission, as a part of the Ayushman Bharat initiative, which aims to provide universal access to equitable, accessible, and high-quality health care that is accountable and responsive to people's needs.
Challenges to Indian Health Care System
Before advancing further into the particulars of the scheme it would be beneficial to take a glance at the contemporary challenges in the India health care sector that are acting as road blocks to its development. While most issues within the Indian health care system can be largely seen as a continuous battle between lack of institutions and lesser availability of adequate human resources, the need of the hour was for the government to address and improve primary healthcare as a ‘public good’ by overcoming the following challenges:
Lack of proper Infrastructure: For a long time, India struggled with the issue of inadequate infrastructure in the form of a dearth of well-equipped medical institutes, more importantly the rate of construction of such medical teaching or training institutions remains low in comparison to the urgent requirement. More recently, with the coming up of commissions like the National Medical Commission, attention is being brought to the need for facilities like libraries, well equipped modern laboratories and proper living conditions for medical students.
Shortage of trained manpower: In India, the ratio of doctor to patient remains abysmally low when compared to the guidelines set by the World Health Organisation (WHO), which sets the average doctor to people ratio at 2.5 doctors per 1000 people. In India this ratio is a mere 0.7 doctors per 1,000 people. The process to bridge this gap would require a sustained effort through capacity building of current medical institutes in addition to building new ones.
Increased patient load due to COVID-19: The task of managing the spread of a disease as contagious as the COVID-19 was a mammoth task in itself, let alone doing the same for a population as large as India’s which stands at 1.2 billion. The resultant strain on the country’s existing healthcare facilities due to huge amounts of patient inflow hence became unavoidable. As a consequence, streamlining of operational and clinical processes became the foremost priority to efficiently manage patient inflow. In this scenario the focus on building efficient and quality health care centres becomes even more crucial.
Skewed ratio of Health Care Infrastructure: Out of the 1.14 million registered modern medicine (allopathic) doctors in India, over 80 per cent operate in cities, which account for only 31 per cent of the country's population. Similarly, when it comes to physical infrastructure, such as Community Health Centres (CHCs), Primary Health Centres (PHCs), District Health Centres and hospitals there is a skewed geographical placement of resources in favour of the urban population. Accessing quality health care hence becomes difficult for the rural populace not only due to lack of requisite medical infrastructure, but also on account of high consultation fees and long travel distances which in most cases has to be undertaken on foot owing to lack of proper transportation facilities.
Highlights of PM Ayushman Bharat Health Infrastructure Mission
In the context of the above discussed challenges the PM Ayushman Bharat Health Infrastructure Mission can be seen as a step in the right direction, as the scheme seeks to address several of these outstanding issues through phased targeting approach. The mission rightfully addresses the health care sector with the aim of strengthening the critical healthcare infrastructure at various levels form the grassroots (village/block) to the national level over the next 5 years.
The said mission looks at doing this through three broad pillars:
i) Provide Effective Treatment: To enable effective and timely treatment, the government will support 17,788 rural health and wellness centres and 11,024 urban health and wellness centres. Besides early detection of diseases these centres would also provide free medical consultation, free medicine and free tests. To provide care for the seriously ill, the mission will create 35,000 new critical care beds in 600 districts across the nation.
ii) Elaborate Testing Network: The mission will provide high class testing network so as to undertake effective diagnosis and monitoring of diseases. For the same, Integrated Public Health labs will be established in 730 districts of the country as also, Block Public Health Units would be set up in 3,000 blocks. Apart from this, 5 Regional Centres for Disease Control, 20 Metropolitan units and 15 Biosafety Level labs will also be established to add strength to the testing network.
iii) World Class Pandemic Research Institutes: Against the backdrop of the COVID-19 pandemic, this aspect bears special significance. As a part of this, existing 80 viral diagnostic and research labs will be strengthened while 15 new biosafety labs will be created. In addition, 4 National Institutes of Virology and one National Institute for One Health would also be established.
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. In addition to the above discussed scheme, the Prime Minister also inaugurated nine medical colleges during his recent visit to UP.
According to PM Modi, the Ayushman Bharat Health Infrastructure Mission looks at a healthier India by providing affordable health care to the marginalised segments of the country. Infact, the scheme along with other schemes such as Swachh Bharat Mission, Jal Jeevan Mission, Ujjwala, Poshan Abhiyan, Mission Indradhanush looks at wellness and good health as a wholesome package. The government has therefore looked at the addressing the Indian healthcare system holistically by the implementation of the well thought out and conceived Ayushman Bharat initiative that has besides this mission other schemes such as Ayushman Bharat Yojna (that has provided free treatment to more than 2 crore poor Indians) and Ayushman Bharat Digital Mission (that looks at providing an efficient electronic portal for health care) as a part of it.
The measures under the new scheme are a step towards addressing the long-pending demands of various experts in the health care sector as it aims to bridge several critical gaps in health infrastructure. For a developing country like India, where public health spending are approximately only around 1-1.4 per cent of the country’s GDP, the infrastructural improvements suggested under the scheme appear to be significant to bring increased investments in the sector from both private and public avenues.
Many experts believe that the first step towards the execution of the mission should be to strengthen and optimally use the existing medical infrastructure, the same could also mean bringing in an increased participation from the private sectors. According to Dr MC Misra, former director of All India Institute of Medical Sciences (AIIMS) Delhi, Ayushman Bharat is a fantastic example of putting the already-existing private hospitals to use by enlisting them to give treatment to the scheme's underprivileged beneficiaries. The model can also be further replicated because there are several big peripheral hospitals in the private sector that have bed occupancy rates of less than 20% to 25%. Moreover, such facilities can be utilised by the government effectively since most of them already have well-equipped infrastructure. It would be fair to say that through the launch of the Ayushman Bharat health infrastructure mission, the government has put in a place a program that would enable a healthier India in the days to come!
This article is co-authored by Devika Chawla and Ishita Sirsikar.
