Well-prepared to handle any surge in Covid-19 cases: Ayushman Bharat CEO

Ayushman Bharat CEO Indu Bhushan said As states are leading the response to this pandemic, NHA has provided flexibility to them in fixing the prices
The National Health Authority (NHA), the apex body responsible for implementing India’s flagship public health insurance scheme, Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) has been playing a key role managing the Covid 19 crisis. Indu Bhushan, CEO of AB-PMJAY and NHA, in an email interview with Namrata Acharya, apprises about the government’s plans to fight the pandemic. Edited Excerpts:

How has NHA (National Health Authority) dealt with Covid-19? 

The NHA is actively supporting the Ministry of Health and Family Welfare as part of the whole-of-the-government response. Experience of Ebola epidemic in West Africa has shown that the crisis like this needs a whole-of-society response. The NHA has focused on how to get private sector more actively involved in the response. We need greater participation from private sector hospitals for both Covid-19 as well as non-Covid-19 health conditions. 

As several hospitals are converted into dedicated Covid-19 facilities, the need for addressing critical non-Covid-19 health conditions, such as hemodialysis, cardiovascular procedures, and chemotherapy becomes even more important. NHA has accelerated its efforts to empanel more hospitals to address these needs. Since 1 April 2020, we have empaneled more than 1,000 new hospitals, mostly private. We also started an express process of empanelment of private hospitals under AB-PMJAY. The new mechanism called ‘HEM Lite’ was setup for swift empanelment under a simpler, less stringent criteria for temporary empanelment of hospitals.

We have designed and notified packages for testing and treatment for Covid-19 that would cover all 53 crore beneficiaries with free services. As states are leading the response to this pandemic, NHA has provided flexibility to them in fixing the prices. Some states have decided to provide these services free to all patients including non-PMJAY patients. 

How are you leveraging IT to support Covid-19 response?

NHA has been actively following the outbreak of Covid-19 in India. We analyse the trends related to Severe Acute Respiratory Illnesses (SARI) and Influenza-like Illnesses (ILI) on a daily basis.  Any spike in these cases can be a leading indicator of spread of Covid-19. We report any spike in such cases from our scheme across the country to the concerned state, the Ministry of Health and Family Welfare and ICMR for necessary action. 

NHA has a database of high-risk individuals.  We have made calls to disseminate precaution advisory to beneficiaries of AB-PMJAY who are at higher risk of contracting and mortality due to Covid-19 such as those above 60 years of age and have recently received treatment under PMJAY or those having co-morbidities. This data gathered will also be used to strengthen the government’s efforts at identifying such potential cases and ensure optimal utilisation of testing facilities and resources. We regularly keep in touch with them through telephone to ensure that they are well and do not have any Covid-19 like symptoms. We also advise them about how to deal with the pandemic. We have made more than 30 million such calls.
NHA’s state-of-the-art call centre is also being used as Covid-19 helpline. More than 600-700 dedicated agents are answering calls by citizens round the clock. 

What is your view on apprehensions about privacy issues related to Aarogya Setu app?

Aarogya Setu app has been designed to improve our effectiveness in identifying potential Covid-19 patients, support our citizens in assessing their risk, and tracing contacts of Covid-19 cases. I believe, the app has played an effective role in that direction. It has also helped citizens in getting information about testing and treatment facilities and monitoring own condition and risk factors. The app has strong security and privacy features in my view.  

The NHA is also supporting the Aarogya Setu app in ensuring that citizens take necessary steps to protect themselves. NHA has been making outbound calls through its call centre to people who have reported Covid-19 like symptoms in their self-assessment. NHA has contacted more than 600,000 citizens and facilitated more than 15,000 tele-consultations with doctor. 

There are no defined packages for Covid-19 under PMJAY, which is leading to confusion among hospitals about charges. Your views? How many states have so far come up with such packages and why some states still so slow in devising one?

This is not correct. Based on the national trend of the outbreak of this pandemic and in-line with the government of India response, in March this year, we designed and notified the packages under Ayushman Bharat PMJAY for testing for Covid-19, for treatment for Covid-19 and gave states the flexibility to fix rates. In addition, we have identified the packages which are already present in HBP of AB PMJAY and can be used for booking treatment for a case of Covid-19.
Various states are adopting different approaches for involving private sector in the treatment. Most states, including Maharashtra and Jharkhand have fixed their prices. Constant follow up is being done with other states for finalizing the packages. 

Many states are still relying exclusively on public sector hospitals to provide testing and treatment free of cost and are depending on their own resources for these. Therefore, even though number of tests and treatments in various public sector hospitals has been very high, the same is perhaps not optimally being undertaken under PMJAY. However, as the situation evolves and there is greater demand for Covid-19 treatment, the states will need to ramp up their capacities and the private sector will need to step in to ensure continued timely treatment to patients. 

Reports suggest average daily hospitalisation under PMJAY has dropped by over 70 per cent during the Covid-19 lockdown, which means a lot of hardships for non-Covid patients looking for treatment. How can this problem be addressed? 

This is correct. The daily average hospitalisation has come down to around 12,000-13,000 now from about 25,000 before the lockdown. We have been analysing the trends and there has been a bigger decline in non-critical and non-elective treatments. Critical treatments have reduced by about 20 per cent only. The reason for the decline is lack of mobility, and fear of infection. The supply of hospital services has gone down as many hospitals have temporarily closed or scaled down their services. 

We are encouraging private hospitals to start their operations. The numbers are slowly picking up. In last two weeks, there has been increase in hospitalisation rate by about 20 per cent. 

Given the rising graph of Covid-19 in India, how prepared is the healthcare infrastructure in India, particularly rural infrastructure, to handle the peak of Covid-19, particularly after the lockdown phase?

I believe, we are well prepared to handle any potential surge in Covid-19 cases. The states have done a tremendous job of identifying health facilities for Covid-19 care and equipping them well. They have created sufficient capacity for Covid-19 care, ICU services, including ventilators and oxygen supply. The lockdown gave us sufficient time to strengthen these services and be ready for any potential surge in the future.  

While it is difficult to predict the course of Covid-19, how long do you think India needs to wait for a vaccine? 

The situation is still evolving. Multiple scientists and leading research labs are making efforts to develop a vaccine. The government of India is also supporting these efforts through the PM Cares Fund. After the development, creating the capacity for mass production to cater to all humanity might also take some time. In the meantime, we will need to learn to live with the virus.

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