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Indu Bhushan, chief executive officer, Ayushman Bharat–Pradhan Mantri Jan Arogya Yojana (AB-PMJAY).
Indu Bhushan, chief executive officer, Ayushman Bharat–Pradhan Mantri Jan Arogya Yojana (AB-PMJAY).

‘Covid management calls for active participation of the private sector’

We should focus on the number of deaths rather than number of cases. The number of deaths per 100,000 people is still fairly low, says Indu Bhushan, chief executive officer, AB-PMJAY

Coronavirus infections in India have shot past 300,000, swelling the demand for medical care. The country’s healthcare infrastructure is creaking, especially in urban areas. With poor and vulnerable sections potentially requiring expensive medical care, Dr Indu Bhushan, chief executive officer of Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), spoke about the covid-19 strategy of the central government’s flagship health insurance scheme; impact of lockdown and the outbreak situation in India. Edited excerpts from an interview:

What role is your organization playing in tackling the covid-19 pandemic?

AB-PMJAY is supporting the efforts led by the ministry of health and family welfare in fighting the health crisis in several ways.

The National Health Authority (NHA) has put in place specific packages for testing and treatment of covid-19 to ensure that no vulnerable person is financially constrained in seeking testing or treatment. Several thousand beneficiaries have been supported under the scheme.

We have also empaneled more than 1,500 hospitals recently to increase access to both covid-19 and more importantly, non-covid-19 health conditions. NHA has started empaneling the Indian Council of Medical Research (ICMR)-approved private labs directly for covid testing. The NHA is using its call centre to manage the covid-19 helpline 1075. We have fielded and followed up with more than 5 million calls so far. We are also using our large database to identify people who are at a high risk of mortality from covid infection, in particular —elderly people with co-morbidities. We are also using our daily hospitalization reports to see if there is a spike in respiratory or influenza-like illnesses in any part of the country. These spikes could be the leading indicators of covid-19 spread. NHA alerts the local authorities about such spikes on a daily basis. We identify such hotspots and report to the state authorities for undertaking on-ground verification.

Covid-19 cases in India have crossed 300,000. How do you think the disease is evolving in India?

We have almost 20% of the world’s population and all our numbers look large. We should carefully look at these numbers in the context of our country. It is correct that the numbers are increasing. Let us face it, in a pandemic, infection was always expected to spread. We have a mobile and dynamic population and in several pockets, the density of population is high. Therefore, we should not be surprised by these numbers.

However, in my view, we should focus on number of deaths rather than number of confirmed cases. The number of deaths per 100,000 people is still fairly low (less than 0.6/100,000) and one of the lowest in the world. This shows that our approach and strategy in responding to the pandemic have been very effective so far. We have to make sure that triaging at hospitals is done efficiently so that we can optimally use our existing capacity. We have to ensure that our ICUs and health system do not get overwhelmed.

Contract tracing is useful when the prevalence of a disease is low and there is a possibility of containing the spread. The prevalence is still quite low and therefore, contact tracing, isolation of patients and early treatment should remain the critical components of our strategy.

This strategy will be even more important in rural areas and districts where the incidence of the disease has been extremely low so far.

How can private sector be involved in covid-19 response?

While the government, at all levels, has been leading the response to covid-19 pandemic, it is clear that this requires a whole-of-society approach. The private sector needs to become a key contributor and active participant in the management of the pandemic as well as in the rebuilding of the economy.

In AB-PMJAY, the private sector is already an integral part, with close to 50% of the empaneled hospitals being private. At the same time, there is a need for greater participation from private sector hospitals for both covid-19 as well as non-covid-19 health conditions. As several hospitals have been converted into dedicated covid facilities, the need to continue providing critical non-covid health services, such as haemodialysis, cardiovascular procedures, and chemotherapy becomes even more important.

From our side, we are making active efforts to address the needs of private hospitals by ensuring timely reimbursement, sensitizing them on protocols and providing training support.

We will witness various public-private partnership (PPP) models aimed at strengthening the existing healthcare infrastructure, augmenting availability of new infrastructure especially in tier-2 and 3 cities and developing new technologies aimed at delivering a higher quality of healthcare.

Do you think technology implementation can help tackling covid-19 pandemic?

For covid pandemic, we have designed and deployed several technology components to increase the implementation efficiency and support the covid-19 response.

As the demand for both covid and non-covid ailments started rising against limited supply of providers, we realized the need to expedite the empanelment of more labs and hospitals. To address these new needs, NHA has brought about process innovation in its digital empanelment mechanism to bring on-board more labs (exclusively for covid testing) and hospitals through “HEM Lite", a simpler fast-tracked digital mechanism for swift empanelment on a temporary basis.

Since 1 April, we have empaneled more than 1,500 new hospitals, mostly private, bringing the total number of hospitals under Ayushman Bharat to 22,000.

Through our call centre, we are managing the tele-consultation for self-reported Aarogya Setu cases and PM-JAY high-risk beneficiaries wherein we are extensively using technology to drive the decision making and overall implementation.

How do you see the efficacy of lockdown as a strategy? India is finding it difficult to sustain the lockdown for too long considering the socio-economic situation and if it opens up, chances are high of covid-19 flare-ups. Your take?

The lockdown was necessary and timely, brought into place by the government and supported by all state governments. It has given states sufficient time to strengthen their health systems to respond to covid-19 by identifying health facilities for covid-19 care and equipping them well with ICU services, including ventilators and oxygen supply.

I am confident that combined with the capacity of Ayushman Bharat, the states will be ready for a potential surge in the future. However, being a country where a large proportion of the population works in the unorganized sector and dependent on agriculture and manufacturing, India or for that matter, any middle to low income economy cannot continue forever in a lockdown. We have to get back to work and adopt widely different ways of life to contain the risk of infection yet continue working. This will involve massive behaviour change at individual and community levels, developing a new kind of civic understanding and engagement.

India has been criticized for not testing enough. How feasible is mass testing in the country?

Testing is definitely very critical to managing the pandemic. Our strategy for testing has been finely calibrated in line with our needs and evolving capacity. We have witnessed a surge in testing capacity within last two months. Currently, we are testing more than 150,000 samples in a day across 724 laboratories, of which 217 are private labs.

At the same time, the testing capacity is augmented on an everyday basis. The spread of the availability of testing has also become more equitable. This increase, both in terms of volume and geographical access, is massively helping the nation in effectively responding to the crisis. Going forward, the focus is on increasing testing capacity and collection centres in underserved geographies. Mass testing is surely possible. Pooled sampling can help in boosting the capacity. However, we do not need mass testing at this stage. It is essential to ensure that citizens who are on a higher risk can easily access testing services.

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