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PM ABHIM - Pradhan Mantri Ayushman Health Infrastructure Mission
- 1. Pradhan Mantri - Ayushman Bharat Health Infrastructure Mission Presenter Dr Venkatesh Karthikeyan JR – 3 CFM, AIIMS Patna Moderators Dr Pragya Kumar, Additional Professor Dr Prashanth Singh, Senior Resident CFM, AIIMS Patna 1
- 2. Content • Introduction • Objectives • Guiding principles • Components of PM-ABHIM • Funding • SWOC analysis • Summary 2
- 3. Specific Learning Objectives • To understand the need and rational behind the establishment of PM- ABHIM • To discuss the key components of PM-ABHIM • To understand the financial outlay and allocation of funds under PM- ABHIM 3
- 4. Introduction • Affordable, available and accessible healthcare • Lessons from COVID-19 • Dedicated COVID hospitals • Laboratory services • Blocks • Need for Funding 4
- 5. Objectives of PM-ABHIM • To strengthen grass root public health institutions to deliver universal comprehensive primary health care • To expand and build IT enabled disease surveillance system • To support Research 5
- 6. Guiding Principles • Convergence • Outcome based financing • Assessing existing structures • Aspirational Districts • Gap analysis • Public Private Partnership • Multisectoral approach 6
- 7. Guiding Principles • Augmented infrastructure and Human Resources • Integrated Health Information Platform • Transparent procurement process • Continuum of Care • Access to newer elements of CPHC • Community engagement 7
- 8. Components PM-ABHIM Centrally Sponsored Scheme (CSS) Components 1) AB-HWCs in rural areas 2) AB-HWCs in urban areas 3)Block Public Health Units 4)Integrated District Public Health Laboratories 5) Critical Care hospital blocks Central Sector (CS) Components 1) Critical Care Hospital Blocks 2) Support for Metropolitan Surveillance Units, Regional NCDCs and implementation of IHIP 3) Strengthening surveillance capacitates at Points of Entry 4) Strengthening Disease and Epidemic preparedness 5) Biosecurity preparedness and strengthening pandemic research 8
- 9. Infrastructure support to Building-less SHCs in Rural Areas 9
- 10. 10
- 11. 11
- 12. Infrastructure support to Building-less SHCs in Rural Areas • Factors to be considered while planning • No duplication • Prioritize • Need not relocate • Construction as per norms • Negative list 12
- 13. AB-HWCs in Urban areas • Why Urban-HWCs are needed? 13
- 14. 14
- 15. 15
- 16. AB-HWCs in Urban areas 16
- 17. 17
- 18. AB-HWCs in Urban areas • Factors to be considered while planning • Population Norms • Role of Urban local bodies & NGOs • Negative list • Repair and renovation works • Construction of new buildings • Procurement of land 18
- 19. Block Public Health Units • Hub & Spoke model • Current focus of Block CHC • Objectives of BPHU • Integration between clinical & public health services • Disease surveillance • Decentralized planning • Emergency preparedness & response • Multisectoral convergence • BPHU = Service delivery facility + BPHL + Block HMIS cell 19
- 20. 20
- 21. 21
- 22. 22
- 23. Block Public Health Units • Monitoring • Accountability • Prioritizing • Role of Local bodies • Negative list 23
- 24. District Integrated Public Health Laboratories • Rationale • Role of IPHL • Bidirectional linkage • Capacity building 24
- 25. Integrated Public Health Laboratories 25
- 26. Integrated Public Health Laboratories 26 • Mapping • Components of IPHL • Physical, Functional and Data integration • Human Resources • Comprehensive gap analysis • Negative list
- 27. Critical Care Hospital Blocks • Average expenditure per hospitalization - Rs.20,135 • Current level of preparedness • Objectives: • Augment capacity district for assured treatment • Ensure health system preparedness 27
- 28. 28
- 29. 29
- 30. 30
- 31. Critical Care Hospital Blocks 31 • Critical care wing at new site • Critical care wing within district hospital • Number of CCHB Beds • Districts > 20 lakh population = 50 to 100 beds (25% of existing DH capacity) • District with 5 – 20 lakhs population = 50 beds • Government medical colleges = 50 beds • Access within 30 minutes
- 32. Implementation mechanism • Leveraging the NHM framework • Government of India Commitments • Role of State & District Health Society • National Health Systems Resource Center 32
- 33. Funding 33
- 34. 34
- 35. Unit Costs 35
- 37. 37 STRENGTHS • Convergence • Focus on improving infrastructure • Leveraging technology • Comprehensive operation guidelines • Well defined monitoring mechanism • Strong political commitment • Transparent procurement process WEAKNESSES • Support for HR only till 2026 • Contractual HR • Discrepancies in fund allocation • Less focus on South Indian states OPPORTUNITIES • Involvement of NGOs • Collaboration with other ministries & departments • Tender based procurement • Community participation • Employment generation Challenges • Lack of sufficient funds • Flow of funds • Changing environment/epidemiology • Changing priority of Government HELPFUL In achieving the objectives HARMFUL In achieving the objectives INTERNAL FACTORS EXTERNAL FACTORS
- 38. Summary PM-ABHIM Centrally Sponsored Scheme (CSS) Components 1) AB-HWCs in rural areas 2) AB-HWCs in urban areas 3)Block Public Health Units 4)Integrated District Public Health Laboratories 5) Critical Care hospital blocks Central Sector (CS) Components 1) Critical Care Hospital Blocks 2) Support for Metropolitan Surveillance Units, Regional NCDCs and implementation of IHIP 3) Strengthening surveillance capacitates at Points of Entry 4) Strengthening Disease and Epidemic preparedness 5) Biosecurity preparedness and strengthening pandemic research 38
- 39. References 1. Operational Guideline (CSS Component)_PM-ABHIM.pdf [Internet]. [cited 2023 Aug 1]. Available from: https://main.mohfw.gov.in/sites/default/files/Operational%20Guideline%20%28CSS%20Component%29_PM-ABHIM.pdf 2. Annexure to Secretary(HFW) letter-Bihar.pdf [Internet]. [cited 2023 Aug 1]. Available from: https://nhsrcindia.org/sites/default/files/2021-10/Annexure%20to%20Secretary%28HFW%29%20letter-Bihar.pdf 3. Guideline on Critical Care Hospital Blocks_PM-ABHIM.pdf [Internet]. [cited 2023 Aug 1]. Available from: https://main.mohfw.gov.in/sites/default/files/Guideline%20on%20Critical%20Care%20Hospital%20Blocks_PM-ABHIM.pdf 4. Guideline on District Integrated Public Health Laboratories_PM-ABHIM_1.pdf [Internet]. [cited 2023 Aug 1]. Available from: https://main.mohfw.gov.in/sites/default/files/Guideline%20on%20District%20Integrated%20Public%20Health%20Laboratories_PM- ABHIM_1.pdf 5. Note+on+PMABHIMM+(Annexure-1)-1.pdf [Internet]. [cited 2023 Aug 1]. Available from: https://main.mohfw.gov.in/sites/default/files/Note%2Bon%2BPMABHIMM%2B%28Annexure-1%29-1.pdf 6. PM- Ayushman Bharat Health lnfrastructure Mission (PM-ABHIM) | Ministry of Health and Family Welfare | GOI [Internet]. [cited 2023 Aug 1]. Available from: https://main.mohfw.gov.in/Major-Programmes/basicpage-22 7. State Wise Physical and Financial Deliverables | National Health Systems Resource Centre [Internet]. [cited 2023 Aug 1]. Available from: https://nhsrcindia.org/pradhan-mantri-aatmanirbhar-swasthya-bharat-pm-asby/state-wise-physical-and-financial- deliverables 39
- 40. Thank you 40
Editor's Notes
- The goal of our government is to make healthcare affordable, available and accessible for all citizens of the country India has learnt few important lessons from COVID – 19. First of all, it highlighted the fact that the essential public health functions necessary to respond to such outbreaks are weak – like there is limited laboratory capacity, lack of manpower and lack of adequate infrastructure. It also highlighted the need to streghten convergence between various healthcare delivery institutions via horizontal integrations-------------more importantly, we saw a significant decline in delivery of Non COVID services including the MCH services And during COVID, we realised that we do not have provision for segrating a part of building as an infectious diasease block- and in order to avoid mixing of COVID and non COVID patients, at may places, full hospitals were required to be designated as Dedicated COVID hospital, just like ours. – When we look at bigger picture, in many districts which mainly consists of rural population, district hospital is the only hospital to provide critical care services to the patients. And when such district hospitals were converted into dedicated COVID hospital, it resulted in increase in non availing of services for non covid patients and in cases where they are transported to other districts, it increased the OOPE As of now, timely and accurate diagnosis is possible when we have good quality laboratory services and only when we diagnose in timely fashion, we can facilitate initiation of appropriate treatment – this is important particularly in case of communicable diseases like COVID, where delay in diagnosis will lead to widespread community transmission – apart from these lab services, public health surveillance, reporting of disease patterns among humans as well as animals and testing of samples for public health needs still remains as a weak area in many districts Every block in the country is envisaged to have CHC at block HQs and serve as a hub for referral from SHCs and PHCs within the block. However, the status and availability of CHCs across state is highly variable – and moreover, COVID has shown that the block hospitals are not equipped to handle public health emergencies and also to respond and monitor healthcare services COVID has also shown that significant investments are needed to strengthen public health system. Without additional funding, helath system will not only fail to respond to outbreak like covid, but also will become ineffective in delivering essential services. This ultimately will lead to delay and disruption of country’s progress towards the achievement of goals and targets of National health policy and SDG
- UPHC, including surveillance, active community engagement and improve risk communication, health education and prevention, strengthen public helath institutions and public health governance capacitites, to meet challenges posed by current and future epidemics/pandemics with capacities for comprehensive diagnostic and treatment including for critical care services To expand and build IT enabled disease surveillance system by developing a network of surveillance laboratories at block, district, regional and national level, for effectively detecting, investigating, preventing and combating public health emergencies and disease outbreaks To support research on COVID 19 and other infectious diseases, including biomedical research to generate evidence to inform response to pandemics and to develop core capacity to develop One health approach to prevent, detect and respond to infectious disease outbreaks in animals and humans
- All the components of ABHIM are designed in such a way that it will help to achieve the objectives set by NHP. Convergence with existing schemes and programs will be ensured, along with ensuring that there is no overlap in deployement of resources – this convergence is focused to help achieve the citizen centric healthcare delivery In the CSS components, options for outcome based financing will be adopted wherever feasible. Initially, suitable benchmarks for intende outcomes will be developed – support will be provided to states to achieve the prefixed benchmarks – by this way states will be incentivized to economize and take up faster roll out and implementation of ABHIM Alll the interventions pertaining to establishment of infrastructure would assess existing structures so as to leverage earlier investments Aspirational districts will be prioritized for rolling out the program Gap analysis will be done for preparing project plans with adequate justification and realistic timelines Private sector capacitites will be leveraged through suitable PPP and contracting arrangements. Partnerships with Civil society organizations will also be explored Multisectoral approach would be followed to address the social determinants of health specially for preventive and promotive care through HWCs. Special focus is to be given to wellness comonents to promote helathy lifestyles through Poshan Abhiyan, Fit india and other initiatives
- Augmentation of infrastructure and HR as crucial to achieve helath outcomes. However, significant investments need to be made in enabling quality improvement. Also the district hospitals are to be strengthened as training hubs. Medical colleges will also be engaged to provide specific skill based training and to mentor and support HWCs, just like our department providing supporting supervision to Jehanabad Newer initiatives like Integrated health information platform and national digital health ecosystem will enable the development of expertise and knowledge sharing across multiple institutions, imporove the capacity for epidemiological analysis, enhance the ability for forcasting and effective monitoring, strengthen real time surveillance in pubich health emergencies, generate data for public health action, ensure portability of health information at national level and factilitating rapid response in times of pandemic. Indicative unit cost will be used for purpose of preparation of proposal, budgeting and for according approvals. However, the original price should be discovered by transparent procurement process ABHIM aims to provide Seamless continuum of care between primary, Secondar and Tertiary levesl. Also, HWCs will be linked with PMJAY Apart from ensuring access to reproductive health services, women and girls should be provided access to screening, diagnosis and treatment of NCDs. Facilitating the involvement and strengthening the role of Panchayati raj institutions, urban local bodies, women self help groups ,e tc will be done.
- The components of ABHIM can be split into two – one is CSS components and the other is CS components So under CSS components, we have support for HWCs in rural areas, where infrastructure development for 17,788 SHCs are proposed in 7 high focus states like Bihar, UP, odisha and begal along with 3 north eastern states). For remaining states, infrastructure support for building SHCs are already provided by the FC-15 health grants through local governments and NHMS. For UTs, support is provided through NHM For HWCs in urban areas, support for around 11,000 HWCs across the country are proposed under this component Support for 3400 BPHs in 11 high focus states are prposed under this componenet. For remainin states, support for establishing BPHU will be provided under FC XV health grants through local governments ABHIM will support for establishment of IDPHL in all districts Critical care hospital blocks will be established in all districts --------------------------------------------------------------------------------------------- Under Central sector components, Critical care hospital blocks will be established in 12 central institutions Surveillance for infectious diseases and outbreak responses will be strengthened. Support of 20 metropolitan surveillance units, 5 regional NCDs and implementation of Integrated Helath information platform in all states will be provided Surveillance capacities at points of evntry will be strengthened. Support for 17 new points of entry health units and strengthening of 33 existing units will be done Stregthening disaster and epidemic preparedness will be done. Support will be provided for 15 health emergency operation centers and 2 container based mobile hospitals will be provided Biosecurity preparedness and strengthening pandemic research and multi sector national institutons and platforms for one health will be done. Support will be provided to set up national instittuino for one health, a regional research platform for WHO south east asia region, 9 bio safety level 3 labs and 4 new regional NIVs (National institute of virology) will be done
- The GoI launched the Ayushman Bharat – Health and wellness cetners to provide primary health care interventions for preventive, promotive, curative, rehabilitative and palliative care. Apart from these, effective healthcare delivery includes undertaking public health functions through community and facility level actions for surveillance, screening, early detection, vector control, etc We can see, roughly 1.6 lakh HWCs are functional in the countyr, which incluses about 1.2 lakhs SHCs. Of these 1.2 laksh SHC, around 48 thousand SHCs are functioning on rental building /panchayat/voluntary society buildings and there is a need for own building This infrastructure gap is significant in 7 high focus states (Bihar, Jharkahtn, Odisha, Punjab, Rajasthan, UP and WB) and three NE states (Assam, Manipur and Meghalaya). Of the 48 thousand SHCs functioning on rental buildings, around 18 thousand SHCs are in these 10 states by allotting around 10,000 crores. This funding is allotted cumulatively for five year duration from FY 21-22 to FY 25-26. For each buildingless HWC-SHC, PM ABHIM will provide 55.5 lakhs per SHC
- I will share few factors that needs to be considered while planning First of all, we should ensure that there is no duplication while planning for construction of buildings for SHCs. The states should prioritize those SHC which lack required space and infrastructure to provide the comprehensive package of services, lab infrastructure and space to conduct wellness activities. Priority should be given for centers in tribal and remote areas and to aspirational districts. New buildings will be built if there is a shortfall according to population norms or in place in already existing buildings if they are in rented facility And, the states are also informed that if the exisiting rented SHC buildings are located well within the reach of the community, have sufficient space for carrying out all the services and have sufficiently roubust construction, then state need not plan for relocation of such buildings The construction of new SHC whould be done as per norms – details of which are provide in 15th financial commission – health grants ----------------------------- The funds under this component cannot be utilized for certain things, which we call as negative list: for example, the funds under ABHIM should not be used for covering the land purchase cost. It should be used for repair and renovation works, which are already undertaken with NHM funds. The components should not overlap with the funds provided under 15th FC grant. The money cannot be used for construction of single room/wellness area/any single project like boundary wall, toilets, water taknks, pavements, etc.
- Similar to HWCs in rural areas, the government is committed to establish HWCs in urban areas as well, so that we are able to provide decentralized comprehencsive primary health care, and iporve public health action especially focusing of the slums and similar habitations, vulnerable populations and areas with limited access to public health interventions. By establishing HWCs in urban areas , we can strenghtehn the public health surveillance, timely reporting and analysis. Apart from these we can promote community engagement to ensure universal reach of public health interventions and more importantly, we can increase access to specialist services via polyclinics Here, we can see that the government is planning to facilitate opening of 11000 U HWCs by the year 2025-26 Of these, 202 U-HWCs will be in Bihar
- The unit cost for UHWC is Rs. 75 lakhs, of which around 28 lakhs is spent for one time cost like 47 lakhs is spent for recurring cost like
- One urban HWCs should be established for 15k-20k population, predominatly catering to the poor and vulnerable populations like that of slums. And all these UHWCs will be linked to UPHC_HWCs for administrative , financial, reporting and supervisory purposes, which caters to a population of 50k. The states work closely with the Urban local bodies to manage these UHWCs. States can also take help of NGOs and other competent organizations for managing these UHWCs, including support for providing outreach services, diagnostic services and capacity building. The funds received under ABHIm cannot be utilized for repair and renovation works already undertaken by using NHM funds. The construction of new building and procurement off land is not allowed under this component
- Every block in our country is envisaged to have a CHC/Block PHC/Subdistrict hospital at block level, which serves as a huh for referral from SHCs and PHCs of the block – however, in many states, the Block CHC/PHC is functioning as just another PHC Currently, if we see, the public healthcare system at block level is not equipeed to handle public health emergencies and to respond & monitor the healthcare services. Currently, the functions of Block PHCs is mostly clinical services that too mainly RMCHA and selected infectious diseases like TB and AIDS. COVID 19 has highlighted that there is suboptimal public health focus at block level. Thus BPHU are established to improve healthcare within blocks by strengthening integaration between clinical and publcih health services. It will focus on imporivng disease surveillance (both human and animal) to support in generating evidence/forecast of potential outbreaks. It will help in improve public health data reporting and followup action for clinical and public health functions. It will enable decentralized planning for service delivery and public health activities for the block, with support from rural local bodies BPHU will undertake preparatory activities for emergenceis to which the area is pone and in case of emergency and outbreak, BPHU will serve as a coordinating hub for community engagement & risk communication, organizing frontiline workers and volunteers, collecting health information and providing health interventions BPHU will be a platform for multisectoral convergence to address social and environmental determinants of health (for example, coordinating with WCD, ICDS, water and sanitation, school eduction, department of earth sciences, etc) ---------------- To attain these objectives, BPHU would be established, which will contain 3 major components. First is the service delivery facility like CHC/PHC/SDH, second is Block public health laboratory and third is a block HMIS cell. The vision is that the block level CHC/PHC/SDH would be strengthened to become BPHU States/Uts covered under BPHU include Assam, bihar, chattisgarh, HP, JK , Jharkhand, MP, Odisaha, Rajasthan, UP and Uttarakand. In these 11 states, all the 3382 blocks are proposed to have BPHU. A total of around 4000 crores are allotted for BPHU establishment.
- For each BPHU, the capital cost will be 80 lakhs (which will be utilised for infrastrucrutre, equipments, for IT infrastructure,e tch) and 20 lakhs for recurring cost, which is utilized for human resources, consumables, monitoring, etc
- Integrated public health labs (IPHL) at district level will mentor and handhold labs of BPHU. BPHU would support, supervise and monitor the existing community based platforms like VHSNC BPHU will be established in all blocks, with priority given to triabl/backward/remote areas of a district Local bodies shoul dbe actively involved in monitoring of BPHU The funds allotted for BPHU should be utilized for repair and renovation activities already undertaken under NHM funds. It cannot be used for purchase of solar panels/electronic items/ for building boundary walls, pavements, etc
- COVID has taught us the importance of early diagnosis and initiation of treatment, particularly for communicable diseases. Althought the current health system is providing routine laboratory services, the capacity for public health surveillance for abnormal morbidity/morality, reporting of human/ animal disease patterns and testing of samples,etc – which are mainly for public health needs – remains limited in most district. So, inorder to improve the efficiency and effectiveness of lab services, IPHL is planned to be set up in all 730 districts across the country. Thus, these IPHL would serve as apex of a network to link labs within a block, state and regional public helath & veteriniary labs – to support multisectoral collaboration for clinic management and public health surveillance. These IPHL will connect the blocks to district, to state, and to national level labs, which will aid in timely prediction of outbreaks and to support policy decisions. They will also mentor and handhold the labs of BPHU and they also serve as a diagnostic hub for block CHC labbs Therefore, the IPHL will strengthen the capacity fo health system to respond to all public health needs and threats comprehensively through integreated system of networks. IPHLs will be set up in all districts of the country in a timespan of five years, for which 1500 crores is allotted . So for each IPHL, Rs. 1.25 crore will be spent as capital cost and Rs. 50 lakhs will be spent per annum as recurring cost
- These are the different laboratory services provided under IPHL. Along with this, as and when needed, the IPHL may perform environmental investigations (such as water culture for coliforms) and also rapid diagnostic tests to support outbreak invesetigations.
- The existing clinical laboratories, public health laboratories or any other program laboratory needs to be mapped and restructured to provide comprehensive services An ideal IPHL should have two components – one is a central sample collection facility and another is the integrated diagnostic testing facility. Both these components should be established as a combined unit on same floor whenever possible Development of IPHL will involve physical, functional and data integration of different sections of district hospital laboratories. Physical integration include establishment of central sample collection facility in a patient friendly location. Functional integration will require various vertical program sections to operate as the coordinated limbs of a single body, so that duplication and disconnect can be avoided. When it comes to data integration,new new addition here is the introduction of LIMS (Lab information management system). This needs to be linked with existing data reporting system of the hospital, which will ultimately feed the Integrated health information platform.This includes surveillance data reported from the ingtegrated BPHU. This will improve the analysing capacity of local units, so that early response for mitigation can be taken Under district IPHL, the duplication of staff will be eliminated and the HR will be utilized comprehensive and inclusive of all programs. To get a rough idea about number of technicians required, we can consider the IPHS norms that a lab technician perfroms atleast 200 tests per day and based on this number, we can calculate the HR required. No standalone purchase of equipemnts will be encouraged, without following the open, competititve and transparent process. Before purchasing any new equipment, a comprehensive gap analysis is mandatory to be undertaken Coming to negative list, it is similar to other components of ABHIM
- According to National Sample survey office, the average medical expenditure per hospitalizatioin is Rs 20,135 (as per NSSO 2017-18). This includes both urban & rural, both private and public combined. It is anticipated that 3-5% of emergencies would require ICU facilities and oxygen supported beds for critical care. Currently, many hospitals even at district levels do not have provision for segregating a part of the building ass infectious disease treatment block/wing. As a result during COVID, in order to avoid mixing of COVID and Non COVID patients,The entire hospital was converted to COVID dedicated hospital in many places, a result of which such hospitals are unable to provide NON covid essential services like institutional deliveries, blood transfusion services, dialysis, etc Hence, under ABHIM, Critical care hospital blocks/wings will be created so that capacity of district is augmented and patient gets assured treatment for any critical illness/infectious disease. With the creation of critical care hospital blocks at district hospitals/medical colleges, health system will be prepared to handle future outbreaks
- If critical care wing/block is created in new site, it should be ensured that it located in a well accessible location, it is build in compliance with the state and central government guidleines for diasters, it is not lying in low lying flood prone area, it is elderly & disability friendly access If it constructed within a district hospital, then this CCHB should have distinct entry independent of main entry for outpatinets, easy approach & access for ambulances, dedicated triage and four clinical management zones, etc Number of CCHB beds CCHB is expected to be a part of district hospital or medical college hospital. If space is not available, then linkages and access to district hospital from CCHb should be within 30 mins Drugs and diagnostic facilities will be as per IPHS guidelines. The negative lists are also similar to other components of ABHIM
- Coming to the implementation mechanism, CSS componenets will be implemented following the existing framework, institutions and mechanisms of NHM.For CSS componnents, the ABHIM would leverage the existing NHM structure available at state and central level for approval, appraisal, implementation and monitoring – by this way duplication can be avoided. The GOI signs a MoU with the state, where the roles of both state and central government is clearly defined. With regards to commitments by GOI, the central government will enable timely release of funds, facilitating collaborations with agencis, assisting states in mobilizing technical assistant inputs, developing and dissemination of protocols, standards and training modules, holding review meetings, etc The state health society, will be the implementing agency at state level and will play a key role in planning for ABHIM implementation. Similarly, District health society under the district collector will play a crucial role in planning and implemention, along with robust monitoring. The state will use the funds for the agreed program activities and not as a substitute for routing expenditures that are state government responsibilities. State share will be 40% in most states and 10% in selected states. Audits will be conducted regularly and they are liable to audit by auditor general of india. States are also expected to prepare an annual program implementation plan and submit progress reports The NHSRC would provide technical support including capacity building and other components of ABHIM
- Here we can see, 15th FC is not supporting IPHLs and CCHBs initiative.
- All these unit costs are in lakhs The states must excerise due diligence for discovering the actual cost and must follow an open, transparent and competitive tendering prcess. State must comply to the negative lists, which is specific for each componenets. It should also ensure that is no duplication or overlap of proposals, tasks, procurements, constructions, hiring of HR, etc for which funds are already provided under other provisions
- Coming to the monitoring mechanisms, at the national level, the ministry will monitor the progress of implementation of different components fo the country. Overall, oversight will be provided by the mission steering group At State/UT level, the additional chief secretary/Principal Secretary/Health Secretary will be the chairperson of State health society – he will be responsible for monitoring the progress and implementation status of various componenents of PM ABHIM At district level, District health society will monitor the impelementation of components of district under PM ABHIM on periodic basis The state shall be submitting monthly progress report on the implementation of various CSS components to the minsistry
- *discrepancy in fund allocation between FC 15 and ABHIM for recurring cost of UHWCs
- The components of ABHIM can be split into two – one is CSS components and the other is CS components So under CSS components, we have support for HWCs in rural areas, where infrastructure development for 17,788 SHCs are proposed in 7 high focus states like Bihar, UP, odisha and begal along with 3 north eastern states). For remaining states, infrastructure support for building SHCs are already provided by the FC-15 health grants through local governments and NHMS. For UTs, support is provided through NHM For HWCs in rural areas, support for around 11,000 HWCs across the country are proposed under this component Support for 3400 BPHs in 11 high focus states are prposed under this componenet. For remainin states, support for establishing BPHU will be provided under FC XV health grants through local governments ABHIM will support for establishment of IDPHL in all districts Critical care hospital blocks will be established in all districts with a population of more than 5 lakhs, in state medical colleges or district hospitals --------------------------------------------------------------------------------------------- Under Central sector components, Critical care hospital blocks will be established in 12 central institutions Surveillance for infectious diseases and outbreak responses will be strengthened. Support of 20 metropolitan surveillance units, 5 regional NCDs and implementation of Integrated Helath information platform in all states will be provided Surveillance capacities at points of evntry will be strengthened. Support for 17 new points of entry health units and strengthening of 33 existing units will be done Stregthening disaster and epidemic preparedness will be done. Support will be provided for 15 health emergency operation centers and 2 container based mobile hospitals will be provided Biosecurity preparedness and strengthening pandemic research and multi sector national institutons and platforms for one health will be done. Support will be provided to set up national instittuino for one health, a regional research platform for WHO south east asia region, 9 bio safety level 3 labs and 4 new regional NIVs (National institute of virology) will be done