PM-ABHIM can boost affordable health infrastructure in hospitals

Since health is a state subject, funds crunch is always cited as a reason in providing upgraded healthcare to people in district and sub-divisional hospitals. What makes the going tougher is the lack of nationwide blanket ban on private practice by government hospital doctors. It is an unfortunate situation and the Centre must intervene

Only recently the Union Government and the World Bank signed two complementary loans of $ 500 million each to support and enhance the country’s health sector. The combined financing of $1 billion from the World Bank will support India’s flagship Pradhan Mantri-Ayushman Bharat Health Infrastructure Mission (PM-ABHIM), launched in October 2021, and improve the public healthcare infrastructure across the nation.

A country of 135 crore people and most of them being dependent on health facilities in the public sector, the process of building and expanding health infra must continue at a scorching speed. The World Bank continues to extend financial support to India in upgrading its health facilities, which is praiseworthy.

In the words of Auguste Tano Kouamé, Country Director, India, World Bank, “Covid-19 brought to the fore the urgent need for pandemic preparedness and health system strengthening around the world. It was pointed reminder that pandemic preparedness is a global public good.”

It is laudable that India is making concerted efforts to increase resilience and preparedness of the country’s health system against future pandemics. It is true that Covid-19 undermined the pressing need to refurbish public health set up from primary to tertiary care as the vast chunk of Indian populace still spends from their own pockets to meet their health expenses.

Ayushman Bharat Pradhan Mantri – Jan Arogya Yojana (AB-PMJAY) with nearly 22 crore verified beneficiaries is something big towards finding an absolute answer to the country’s massive health needs. As of March 9, 2023, around 23.19 crore Ayushman cards have been created against the verified beneficiaries. Over 4.44 crore hospital admissions worth Rs. 53,350.20 crore have been authorized through a network of 25,969 empaneled healthcare providers including 11,700 private hospitals. As of March 13, 2023, approximately 5.99 lakh hospital admissions worth Rs. 1393 crore have been authorized under the portability feature. It is an impressive number.

The scheme provides health cover of Rs five lakh per family per year for secondary and tertiary care hospitalization to over 10.7 crore poor and vulnerable families, approximately 50 crore beneficiaries forming the bottom 40 per cent of the country’s population identified based on deprivation and occupational criteria of the Socio-Economic Caste Census 2011 (SECC 2011) and other state schemes. It is not a mean achievement. However, there is no scope for any complacency, whatsoever.

Till the time AB-PMJAY covers 80 per cent of the country’s population, efforts must continue to expand primary and secondary health infra in the country. Over 1.54 lakh Ayushman Bharat – Health and Wellness Centres (AB-HWCs) have been operationalised across the country by upgrading Sub-Health Centres (SHCs) and Primary Health Centres (PHCs) in rural and urban areas. AB-HWCs provide comprehensive primary health care by expanding and strengthening the existing reproductive and child health services and communicable diseases services and by including services related to non-communicable diseases such as hypertension, diabetes and three common cancers, namely, oral, breast and cervix.

If one goes by the data, one has every reason to afford a smile. As on December 31, 2022, more than 135 crore cumulative footfalls have been reported from over 1.54 lakh HWCs, over 87 crore cumulative screening of non-communicable diseases and more than 1.6 crore wellness sessions, including yoga. The larger impact picture will be in front of the policy makers and experts when the comprehensive audit-cum-outcome report on HWCs is out. It may take some time but there should be no let-up in the ongoing efforts to transform the ease of accessing quality, affordable and reliable health facilities in Amrit Kaal.

Constraints and obstacles should be overcome with collective determination. India must have a robust and affordable health infra as hospitalization leaves most of the people poorer for many years.

According to the World Bank estimates, India’s life expectancy — at 69.8 in 2020, up from 58 in 1990 —is higher than the average for the country’s income level. The under-five mortality rate (36 per 1,000 live births), infant mortality rate (30 per 1,000 live births), and maternal mortality ratio (103 per 100,000 live births) are all close to the average for the country’s income level, reflecting significant achievements in access to skilled birth attendance, immunizations and other priority services. However, there is a huge scope to improve upon the ease of availing emergency and routine health services in the country. There is a massive rush of patients in emergencies and OPDs at the country’s top government hospitals because of affordability and quality of treatment.

Leveraging digital health solutions for effective health service delivery perhaps may not be possible if physical infrastructure is not expanded. For example, the capacity of emergency blocks of centres of excellence and private hospitals should be in commensurate with average flow of patients every month. Accordingly, the number of doctors, nurses and other paramedical staff should be enhanced. Similarly, the name-based database of 200 plus million eligible couples, 140 million pregnant women and 120 million children, who are being monitored for ante-natal, post-natal and immunization related health services, should be used in establishing their exposure to possible ailments caused by poverty, which factors majorly in most of non-communicable diseases (NCD) among the masses.

The focus on comprehensive primary and secondary healthcare is paramount. Online monitoring of health facilities engaged in providing primary and secondary healthcare should be rigorous.

Since health is a state subject, funds crunch is always cited as a reason in providing upgraded healthcare to people in district and sub-divisional hospitals. What makes the going tougher is the lack of nationwide blanket ban on private practice by government hospital doctors.It is an unfortunate situation and the Centre must intervene.

Digitization of health services is fine but real time improvement in delivering services won’t be possible. How to avoid repeated diagnostics, ensure accurate diagnosis, precision medicine, increased quality of care, timely response in emergencies and lowering out of pocket expenses can be taken up effectively only when the basics of the health system are stronger and expanded.

With due respect to all stakeholders, there is a need to work harder to improve the ease of accessing health services.

(The writer is a senior journalist, columnist and author. The views expressed are his personal)