Ayushman Bharat Vs. Coronavirus

India has just entered the fourth stage of lockdown after domestic COVID-19 cases surpassed those reported in China. What role can Ayushman Bharat's scheme play in Lockdown 4.0?

It seems that despite having the latest in health technology, coupled with top doctors and scientists, the Indian healthcare system is still not ready to weather a pandemic. Most of the country's metropolitan hospitals are running out of beds and doctors.

A comprehensive action plan should ideally address necessary actions of the central government, local administration in states and cities, and needs of the healthcare sector and institutions such as schools. The World Health Organization first published its own pandemic guide in 1999, but many Indian states never had a domestic pandemic playbook in place.

Needless to say, India's government is now scrambling to put a cap on COVID-19.

India is a victim of its own unpreparedness

The Union Health Ministry recently issued guidelines on measures to be adopted by healthcare workers deployed in both COVID and non-COVID hospitals. These measures ask hospitals to activate a Hospital Infection Control Committee for implementing infection prevention and control. Guidelines were also issued regarding the usage of personal protective equipment (PPE) in non-COVID hospitals.

Overall, the Indian government has tried to adopt the Chinese model of pandemic control, instead of a paradigm based on demography or the number of ICU beds. The pandemic has revealed the social and economic inequities present throughout India, as migrant workers, marginalized people and small businesses bear the massive cost of this approach.

Philanthropist Bill Gates said in 2015 that death from a virus would be more likely than a nuclear war. Flu pandemics occurred in 1918, 1957 and even in 1968, but many in a position to prepare for such future events did not do so in the subsequent years.

The Bharatiya Janata Party (BJP) last week published a video celebrating its six years in power and spotlighting accomplishments of Prime Minister Narendra Modi's administration. The BJP commended some of its own initiatives, which it clearly feels have been crucial in updating India's healthcare system. Two such initiatives were the Swachh Bharat (Clean India) drive, launched in 2014 to eradicate public defecation and the Ayushman Bharat health insurance scheme.

At the onset of the COVID-19 pandemic, India's healthcare sector was initially focused on avoiding a shortage of beds and medical personnel. Uttar Pradesh CM Yogi Adityanath announced that all enrolled hospitals and nursing homes under the PM-JAY should be given PPE kits at subsidized prices. He also instructed the Principal Secretary of Medical Health to lengthen the enrolment of such clinics in subsidization for six months.

The State Executive Committee of Goa has ruled that all travellers to Goa should pay Rs 2,000 for compulsory COVID-19 testing, except for people covered under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana or any other exempted category, like government staff on duty.

One of the primary concerns in controlling the pandemic throughout India right now is the fact that people in confinement, exiles, refuge seekers and displaced populations are difficult to reach. It's not clear whether Ayushman Bharat can provide adequate healthcare resources to these distinct populations.

Will the economic stimulus package bring relief?

There are substantial economic implications brought on by the worldwide pandemic. Union Finance Minister Nirmala Sitharaman delivered the details of the Rs 20 lakh-crore Economic Stimulus Package last week. The package, first announced by Prime Minister Narendra Modi, is meant to assist companies in recuperating from the shock of COVID-19, to promote growth and to help create a self-reliant (atma-nirbhar) country.

The 2003 SARS epidemic, which claimed the lives of fewer than 800 people, cost the global economy $54 billion. Much of that amount was from lost trade, transportation disruption and healthcare costs. The World Bank estimates that the toll from a severe flu pandemic could run to $4 trillion.

Satyam Shivam Sundaram, Partner and Government and Public Sector Advisory at EY India, says, "National Health Policy 2017 aims to increase public health expenditure to 2.5% of GDP by FY25 from ~1.6% of GDP in FY 20. The announcement to advance public health expenditure is a welcome move and would help strengthen comprehensive primary healthcare in particular. Further, India has a unique challenge of dealing with dual disease burdens of communicable (27.5%) and non-communicable diseases (61.8%). Enhanced health and wellness centres would facilitate screening and early detection of NCDs. Medical isotopes getting produced on PPP would help in the treatment of Cancer (one of the critical NCDs). Setting up of infectious disease blocks and public health labs in all the districts are the right augmentation needed for public health systems in coming years. Along with Ayushman Bharat, we should witness a better continuum of care in the coming years.

Overall, announcements related to the health sector would not only positively impact both efficiency and effectiveness but also enhance equity in the delivery of healthcare services. Further, with rapid technological advancements, digital health blueprint from the central government is the need of the hour. It's a welcome move."

Beijing-headquartered Asian Infrastructure Investment Bank is in the process of disbursement of funds to India under its COVID-19 Crisis Recovery Facility. The bank has approved a loan worth USD 500 million to support India's fight against COVID-19. The project aligns with the Ayushman Bharat Scheme.

Grassroots Reality and Health Insurance

In a recent webinar, CEO of Thyrocare, A Velumnani, pointed out that the Indian population has not understood the importance of insurance. He remarked that the disadvantaged population would not use insurance unless the government incorporates them. Ayushman Bharat will help the underprivileged.

A month after the National Health Authority (NHA) rolled out free COVID-19 testing and treatment for low-income families in private hospitals under Ayushman Bharat, only about 300 patients have used the government's universal health insurance scheme.

Today we still don't know how many people have been infected, because not every state is careful with testing. We also don't know how many people have recovered. Because of those data gaps, we can't calculate what the actual case-fatality rate may be. Furthermore, much of the public has not been made aware of the fact that whatever the case-fatality rate is, is it not a static number. Case-fatality rates are affected by local demographics and healthcare systems.

The entire situation must have seemed so avoidable to experts, especially considering that just two years ago at the Johns Hopkins Centre for Health Security, a Cladex Simulation exercise predicted the pandemic death of 150 million people across the globe. The reasons for pandemic success cited in that simulation included a lack of protective vaccines and the lack of a proactive plan for tackling the spread of a virus.

Pandemic planning in India at this stage is at best a reflex reaction. The last big pandemic India faced was the swine flu pandemic, but even this was not a cause to prepare for a bigger version. Ayushman Bharat has a great deal of work to do to enable access of necessary care to all the citizens.