Govt issues guidelines to set up health infra in rural areas

The Union health ministry on Sunday recommended building health infrastructure in peri-urban and rural areas to tackle rising cases of coronavirus infections in villages.

The health infrastructure planned for peri-urban, rural and tribal areas shall be aligned to the already mentioned 3-tier structure—Covid Care Centre (CCC) to manage mild or asymptomatic cases, Dedicated Covid Health Centre (DCHC) to manage moderate cases and Dedicated Covid Hospital (DCH) to manage severe cases, according to the document titled—standard operating procedures (SOPs) for covid-19 containment and management in peri-urban, rural and tribal areas.

CCCs are makeshift facilities under the supervision of nearest primary or community health centre and maybe set up in schools, community halls, marriage halls or panchayat buildings in close proximity to hospitals or healthcare facilities.

The CCCs should be mapped to one or more DCHCs and at least one DCH for referral purposes, the document said.

Such covid care centres should also have a basic life support ambulance networked among such CCCs equipped with sufficient oxygen support on 24×7 basis, for ensuring safe transport of patients to dedicated higher facilities if the symptoms progress from mild to moderate or severe, the government said.

Primary health centres or community health centres and sub-district hospitals in these areas should be the DCHC for management of covid-19. Districts should be prepared to increase DCHC beds as per the case trajectory and expected surge of cases, the document stated.

These centres shall offer care for all cases that have been clinically assigned as moderate (patient breathless; respiratory rate more than 24 per minute; oxygen saturation between 90 to <94% on room air).

District hospitals or other identified private hospitals or a block of these hospitals should be converted to DCH, the document said.

In addition, sub-district or block-level hospitals that fulfil the requirements may also be designated as dedicated covid hospitals for the identified CCC and DHCC in their catchment area. The upgradation in health facilities should be undertaken based on case trajectory or the surge in cases, the SOP stated.

According to guidelines, the Union health ministry said that in every village, active surveillance should be done for influenza-like illness/severe acute respiratory infections periodically by volunteers with help of village health sanitation and nutrition committee.

Symptomatic cases can be triaged at the village level by teleconsultation with community health officer, and cases with comorbidity or low oxygen saturation should be sent to higher centres, the government guidelines said. As nearly 80-85% covid -19 cases are asymptomatic/mildly symptomatic, they do not require hospitalization and may be managed at home or in covid-care isolation facilities.

As monitoring of oxygen saturation is important for covid patients, it is desirable that each village have an adequate number of pulse oximeters and thermometers, the SOP said advising to develop a system of providing pulse oximeters and thermometers on loan to families with a confirmed case of covid through Anganwadi workers and village-level volunteers.

Suspected covid cases should link for testing to health facilities either through covid-19 rapid antigen testing or by referral of samples to nearest covid -19 testing laboratory, in accordance with ICMR guidelines.