Myth Vs Facts: Government working towards effective COVID-19 management through focused Public Health Measures in rural India.
GG News Bureau
New Delhi, 13th June. There have been some media reports alleging inconsistency from the Government of India response in providing adequate healthcare infrastructure and services and ‘scaling of the tragedy’ in rural areas, terming it as ‘invisibilisation of rural India’ during the pandemic.
The government of India has been proactively working towards effective COVID-19 management in rural India by the sustained strengthening of the multi-level health infrastructure, and through focussed Public Health Measures in active collaboration with the States. The development of health infrastructure is a continuous activity. Guided by a sharp focus on the underserved geographical regions and through various policies, schemes, public health interventions and active partnership with the States and UTs, the Government of India is committed to strengthening the rural health infrastructure.
There is a widespread network of government health facilities in rural areas. As of 31.03.2020, there are 1,55,404 Sub Health Centres (SHCs) and 24,918 Primary Health Centres (PHCs) in rural area and 5,895 urban PHCs across the country.
Additionally, the Ayushman Bharat- Health and Wellness Centres (AB-HWC) (launched in April 2018) marked a watershed moment in India’s public health history. As of date, there are 75,995 functional Health and Wellness Centres (HWCs) in the country (50,961 SHC-HWCs, 21,037 PHC-HWCs and 3,997 urban PHCs).
A total of 1,50,000 Sub-Health Centres and Primary Health Centres in urban and rural areas will be transformed to AB-HWCs by December 2022 and deliver comprehensive primary health care that includes preventive and health promotion at the community level with a continuum of care and which is universal, free and close to the community in rural and urban areas, with focus also on wellness.
In addition to a new cadre of the workforce, a trained non-physician health worker with BSc Nursing/BAMS qualification, designated as Community Health Officer (CHO)leads the Sub-Health Centre AB-HWC’s primary care team of health workers and AHSAs.
Besides expanding and strengthening the existing Reproductive and Child Health (RMNCHA+N) services and Communicable Diseases services, the functional AB-HWCs provide services related to Non-Communicable Diseases (NCDs) (screening and management for NCDs such as Hypertension, Diabetes and 3 common cancers of Oral, Breast and Cervix) and incrementally adding other primary healthcare services for mental health, ENT, Ophthalmology, oral health, geriatric and palliative health care and trauma care etc. Free essential diagnostics are provided – 14 diagnostic tests at HSC level and 63 diagnostic tests at PHC level. Free essential medicines are provided- 105 medicines at SHC level and 172 medicines at PHC level. HWCs demonstrate a high potential for positive outcomes in terms of gender equity for care-seeking and promoting wellness as a critical component of primary health care. To date, about 50.29 crore people have accessed care in these AB-HWCs. About 54% of them are women.
Preventive Health Care is the essential component of the services delivered through HWCs. Population enumeration of 30+ population through Community Based Assessment Checklist (CBAC) is done through community health workers (ASHA and ANMs) and based on risk stratification, the screening of the individuals for NCDs have been carried out. The identified individuals with chronic conditions are put on treatment with necessary follow-up. So far, 10.98 crore screenings for Hypertension, 9.01 crore screenings for Diabetes, 5.73 crore screenings for oral cancer, 2.94 crore screenings for Breast Cancer in women and 2.0 crore screenings for cervical cancer in women have been done.
Tele-consultation services are another key component of the HWCs. More than 6 million Teleconsultations have been done through the e-Sanjeevani Platform and out of this, 26.42 lakhs Teleconsultations have been done at the HWCs.
During the COVID-19 pandemic, AB-HWCs played a significant role in undertaking public health action related to COVID prevention and enabling non-COVID essential health services. About 75% of total NCD Screenings have been conducted during this COVID period (between 1st February 2020 to date) itself, showing the confidence reposed by people in these AB-HWCs during the present public health challenge.