New Initiatives Of The Ministry Of Health And Family Welfare During The Year 2021

Pradhan Mantri Ayushman Bharat Health Infrastructure Mission (PM-ABHIM)

Pradhan Mantri Atmanirbhar Swasth Bharat Yojana scheme (now renamed as Pradhan Mantri Ayushman Bharat Health Infrastructure Mission) with an outlay of about Rs. 64,180 Cr over till FY 2025-26 was launched by Hon'ble Prime Minister on 25th October, 2021. This is the largest pan-India scheme for strengthening healthcare infrastructure across the country.

The measures under the scheme focus on developing capacities of health systems and institutions across the continuum of care at all levels viz. primary, secondary and tertiary and on preparing health systems in responding effectively to the current and future pandemics/disasters.

The Mission targets to build an IT-enabled disease surveillance system by developing a network of surveillance laboratories at block, district, regional and national levels, in Metropolitan areas & strengthening health units at the Points of Entry, for effectively detecting, investigating, preventing, and combating public health emergencies and disease outbreaks. Increased investments are also targeted to support research on COVID-19 and other infectious diseases, including biomedical research to generate evidence to inform short-term and medium-term response to COVID-19 like pandemics and to develop core capacity to deliver the One Health Approach to prevent, detect, and respond to infectious disease outbreaks in animals and humans.

The main interventions under the 'Pradhan Mantri Ayushman Bharat Health Infrastructure Mission' scheme to be achieved by FY 2025-26 are:

Centrally Sponsored Components:

1. Support for 17,788 rural Health and Wellness Centres in 10 High Focus States. Support for other States/UTs under XV Finance Commission Health Sector Grants and NHM.

2. Establishing 11,024 urban Health and Wellness Centres in all the States.

3. 3382 Block Public Health Units in11 High Focus states. Support for other States/UTs under XV Finance Commission Health Sector Grants and NHM.

4. Setting up of Integrated Public Health Labs in all districts.

5. Establishing Critical Care Hospital Blocks in all districts with population more than 5 lakhs.

Central Sector Components:

1. 12 Central Institutions as training and mentoring sites with 150 bedded Critical Care Hospital Blocks.

2. Strengthening of the National Centre for Disease Control (NCDC), 5 New Regional NCDCs and 20 metropolitan health surveillance units;

3. Expansion of the Integrated Health Information Portal to all States/UTs to connect all public health labs;

4. Operationalisation of 17 new Public Health Units and strengthening of 33 existing Public Health Units at Points of Entry, that is at 32 Airports, 11 Seaports and 7 land crossings;

5. Setting up of 15 Health Emergency Operation Centres and 2 container based mobile hospitals; and Setting up of a national institution for One Health, 4 New National Institutes for Virology, a Regional Research Platform for WHO South East Asia Region and 9 Biosafety Level III laboratories.

Pradhan Mantri Swasthya Suraksha Yojana (PMSSY)

The Pradhan Mantri Swasthya Suraksha Yojana (PMSSY) aims at correcting regional imbalances in the availability of affordable/reliable tertiary healthcare services and also augmenting facilities for quality medical education in the country. The scheme has two broad components:

·         Setting up of All India Institute of Medical Sciences (AIIMS)

·         Up-gradation of existing Government Medical Colleges/Institutions (GMCIs) So far, establishment of 22 new AIIMS and 75 up-gradation Projects of existing Government Medical Colleges/Institutions (GMCIs) have been approved under this scheme.

Six AIIMS under Phase-I: Six AIIMS approved under Phase-I (AIIMS-Bhopal, AIIMS-Bhubaneswar, AIIMS-Jodhpur, AIIMS-Patna, AIIMS-Raipur and AIIMSRishikesh) are already fully functional.

Other New AIIMS under Phase-II, IV, V, VI & VII: 16 AIIMS have been sanctioned/approved by the Cabinet in subsequent phases. Limited OPD services are functional in 7 AIIMS viz. Nagpur, Rae Bareli, Mangalagiri, Gorakhpur, Bathinda, Bibinagar and Kalyani. Limited IPD Facilities for treatment of CoVID -19 patients started at AIIMS Mangalagiri, AIIMS Nagpur and AIIMS Bathinda during this year. CoVID test Lab is also functional in AIIMS Mangalagiri, AIIMS Nagpur and AIIMS Bathinda. 300 bedded IPD has started at AIIMS Gorakhpur with effect from 7-12-2021. Undergraduate MBBS course with 100 seats per annum per AIIMS is already functional at eight new AIIMS viz. Mangalagiri, Nagpur, Rae Bareli, Kalyani, Gorakhpur, Bathinda, Deoghar, Bibinagar and 50 seats each at AIIMS Guwahati, Jammu, Rajkot and Bilaspur.

Construction is in advanced stages in 8 AIIMS, viz. AIIMS Raebareli, Nagpur, Mangalagiri, Kalyani, Gorakhpur, Bathinda, Bilaspur, and Deoghar. Also, construction work is in progress for AIIMS at Guwahati (Assam), Awantipura (Kashmir), Sambha (Jammu) and Rajkot (Gujarat).

Up-gradation of existing GMCIs: Since the inception of the Scheme, 53 upgradation projects of existing Government Medical Colleges / Institutions have been completed, adding more than 12000 Super-specialty beds including 2000 ICU beds. The Super Specialty Blocks /Trauma Centres constructed in these upgradation projects are also being used as COVID Hospital Blocks. Four projects including the Goa Medical College, Panaji, Rajiv Gandhi Institute of Medical Sciences, Adilabad, Agartala Govt Medical College, Tripura, and Regional Institute of Ophthalmology (RIO), IMS, BHU, Varanasi have been completed during 2021-22 (upto November, 2021).

Ayushman Bharat

Ayushman Bharat aims to holistically address health (covering preventive, promotive, curative, rehabilitative and palliative care), at primary, secondary and tertiary level by adopting a continuum of care approach. Under this scheme, the ministry continued to formulate and implement Comprehensive Primary Health Care (CPHC) through Ayushman Bharat Health and Wellness Centres (AB-HWCs).

AB-HWCs

·         Approvals for around 1,52,130 Ayushman Bharat-Health & Wellness Centres have been accorded to the States/UTs (except Delhi) and as reported by the States/UTs on the AB-HWC Portal, 81,518 Health & Wellness Centres have been operationalized till 20th December, 2021 which includes 55,458 SHC level ABHWCs, 21,894 PHC level AB-HWCs and 4166 UPHC level AB-HWCs.

·         App version of the AB-HWC portal was launched by the ministry on the 12th July 2021 to enable geo-tagging of location of AB-HWCs and entering the daily service delivery parameters by the frontline healthcare workers.

·         The screening, prevention and management of chronic illnesses including NCDs, TB and Leprosy have been introduced as part of comprehensive primary healthcare at AB-HWCs. To roll out these services, training and skill upgradation of the primary health team in all the functional AB-HWCs and use of IT application was undertaken.

·         To promote wellness and healthy lifestyle, orientation of the public on wellness activities for lifestyle modification like increased physical activity (cyclathons and marathons), eat right and eat safe, cessation of tobacco and drugs, meditation, laughter clubs, open gyms, etc were undertaken in States. Besides, Yoga sessions were carried out at these centres on a regular basis.

·         The telemedicine guidelines have also been provided to the States to initiate specialist consultations from the PHCs to the Hub Hospitals. So far, 56,927 ABHWCs have initiated tele-consultations.

Human Resources The National Health Mission (NHM) attempted to fill the gaps in human resources by providing nearly 2.74 lakh additional health human resources to the States including 13,074 GDMOs, 3,376 Specialists, 73,847 Staff Nurses, 85,834 ANMs, 48,332 Paramedics, 439 Public Health Managers and 17,086 Programme Management staffs appointed on contractual basis. Apart from providing financial support for hiring human resources, NHM also focused on multi-skilling of human resources and providing technical support for human resources in the health sector in the form of technical guidance and training. NHM also supported co-location of AYUSH services in health facilities such as (Primary Health Care Centres (PHCs), Community Health Care Centres (CHCs) and District Hospitals (DHs). A total of 27,737 AYUSH (Ayurveda, Yoga, Naturopathy, Unani, Siddha, Sowa-Rigpa and Homoeopathy) doctors and 4564 have been deployed in the states with NHM funding support.

Mainstreaming of AYUSH

Mainstreaming of AYUSH has been taken up by allocating AYUSH services in 7,452 PHCs, 2,811 CHCs, 487 DHs, 4,022 health facilities above Sub Centres (SC) but below block level and 456 health facilities other than CHC at or above block level but below district level.

Infrastructure

Up to 33% of NHM funds in High Focus states can be used for infrastructure development. Details of new construction/renovation as on 30.06.2021 undertaken across the country under NHM are as follows:

* These facilities are above SCs but below block level

Additional support to ASHAs

There are 9.83 lakh Accredited Social Health Workers (ASHAs) across the country in rural and urban areas (except Goa and Chandigarh) under the NHM who act as a link between the community and the public health system. The Union Cabinet has approved increase in amount of routine and recurring incentives under National Health Mission for ASHAs that will now enable ASHAs to get at least Rs 2000/- per month against Rs 1000 earlier. The cabinet has also approved a proposal to cover all ASHAs and ASHA facilitators meeting eligibility criteria under Pradhan Mantri Jeevan Jyoti Bima Yojana and Pradhan Mantri Suraksha Bima Yojana which would be fully funded by Government of India.

Maternal and Child Health

Medical Termination of Pregnancy (Amendment) Act & Rules 2021: The MTP Act recognized the importance of providing safe, affordable, accessible and legal abortion services to woman who needs to terminate a pregnancy due to certain therapeutic, eugenic, humanitarian or social grounds. The Act was amended for expanding base of beneficiaries to provide safe abortion services.

MusQan: As per the latest report of Sample Registration System (SRS) released in October 2021 by the Registrar General of India (RGI), Infant Mortality Ratio (IMR) of India has declined from 32 per 1000 live births for the year 2018 to 30 per 1000 live births for the year 2019. Under the ambit of the National Quality Assurance Standards (NQAS), to ensure delivery of benchmarked quality and safe care to children at Public Health, a new initiative named "MusQan" was launched by the Hon'ble Health Minister on 17th September 2021. The objective of MusQan is to reduce child mortality and morbidity and improve nutrition status, growth, and early childhood development of young children through strengthening clinical protocols and management processes and provision of respectful and dignified care to newborns and children.

E-Health

Ayushman Bharat Digital Mission (ABDM): On 27th September, 2021, the Hon'ble Prime Minister announced the nationwide rollout of the Ayushman Bharat Digital Mission (ABDM) - earlier known as National Digital Health Missionwith the aim to develop the backbone necessary to support the integrated digital health infrastructure of the country.

National Telemedicine Services: The National Telemedicine Service "eSanjeevani" is a digital health initiative of the Ministry supports two types of teleconsultation servicesDoctor-to-Doctor (eSanjeevani) and Patient-to-Doctor (eSanjeevani OPD) Tele-consultations. eSanjeevani has completed around 2 crore consultations. Over 1,00,000 patients are seeking health services on a daily basis in 35 States/UTs. The top ten States which have registered highest consultations through eSanjeevani and eSanjeevani OPD platforms are Andhra Pradesh (7665939), Karnataka (3281070), Tamil Nadu (1744038), Uttar Pradesh (1537339), West Bengal (1262330), Bihar (632474), Gujarat (590564), Madhya Pradesh (577513), Maharashtra (574457), Uttarakhand (345342).

Medical Education

National Commission for Allied and Healthcare Professions Act 2021: To address the long standing vacuum of a regulatory body for various professions included in the allied and healthcare sector, a National Commission for Allied and Healthcare Professions Act 2021 has been enacted. The basic premise and principled change that is happening in all these professional education sectors is that the Regulator is now being 'selected on merits', as opposed to an 'elected' regulator. Moreover, the constitution of the National Medical Commission has ushered in a landmark reform in the sector of Medical Education. On similar lines, the Government is striving to bring institutional reforms in nursing and dental education sectors by bringing reformative legislations to replace the existing Indian Nursing Council Act, 1947 and Dentists Act, 1948.

Draft National Dental Commission Bill: In order to revamp the Dental Education System in the country to bring it at par with global standards, a draft National Dental Commission Bill (the Bill), to replace the existing Dentists Act, 1948, has been prepared and is under consideration of the Parliament. The Commission shall frame guidelines and conduct a uniform entrance test at undergraduate level i.e. National Eligibility cum Entrance Test, a uniform exit test i.e. National Exit Test (Dental), common counselling for admission to undergraduate and postgraduate dental courses etc. The Bill provides for the constitution of a National Dental Commission, four Autonomous Boards, a Dental Advisory Council and State Dental Councils. The Bill further provides for constitution of four Autonomous Boards namely Undergraduate Dental Education Board (UGDEB), Postgraduate Dental Education Board (PGDEB), Dental Assessment and Rating Board (DARB) and Ethics and Dental Registration Board (EDRB) - to regulate the education, examination, training and services of dental professionals and dental auxiliaries like dental hygienists, dental technicians and dental operating room assistants. The Bill empowers the Central Government to give directions to the Commission and the Autonomous Boards on questions of policy and also to the State Governments for carrying out all or any of the provisions of this Act. The draft Bill is under consideration.

Increase in number of medical seats: During the last six years, MBBS seats increased by 72%, from 51,348 seats in 2014 to 88,120 seats in 2021 and the number of PG seats increased by 78% from 30,185 seats in 2014 to 55,595 seats in 2021.

New Medical Colleges: During the same period, 209 new medical colleges have been established and now the country has 596 (Govt: 313, Pvt: 283) medical colleges. Under the Central Sponsored Scheme for establishment of new medical colleges, establishment of 157 medical colleges have been approved in three phases, of which 70 are functional and remaining will be functional in a few years. Of these 157 colleges, 39 are coming up in the Aspirational Districts of the country thereby addressing the issues of inequity in medical education.

(Source: Press Information Bureau)