Strengthening critical care in districts

Surging COVID-19 cases in different districts across Assam is pushing the Health system to the brink. It has also uncovered the vulnerability of over-centralised Healthcare system. Development in this sector here has been skewed and primarily Guwahati-centric. Till the outbreak of COVID-19 pandemic last year, setting up of intensive care units (ICUs) in the district hospitals was not in the list of priorities. The State Health department initiated the move for setting up ICU units with 10-15 beds in 24 district hospitals under the 'Assam Critical Care Project'. Completion of these ICU units will ensure availability critical-care support in the district hospitals. This will reduce the load of ICU patients in seven government medical colleges in the State. It will also cut down the patients' medical expenses required to travel to hospitals at Guwahati, Dibrugarh, Jorhat, and other towns as well as in accommodation there. Expediting the work of ICU units in district hospitals is also needed to reduce the pressure of COVID-19 patients requiring intensive care in the current wave as well as subsequent waves. The Health department must be lauded for recruiting and imparting training to 215 ICU technicians and 1,000 nurses in September last year. These trained Health personnel will be deployed in these district ICU units. This has ensured that as soon as construction work is over, these ICU units will be made functional. The 15th Finance Commission is of the view that in the light of pandemic, establishment of critical-care hospitals is absolutely essential to build resilience in the country's Health system and ensure preparedness for future epidemics/pandemics. The Ministry of Health & Family Welfare in its memorandum to the Finance Commission, proposed the need for construction of 100-bedded critical-care hospitals in districts with more than 20 lakh population and 50-bedded hospitals for districts with less than 20 lakh population. The Commission recommend Rs 15,265 crore for the 205 hundred-bedded and 157 fifty-bedded critical-care hospitals in the entire country which includes Rs 13,367 crore for the States and Rs 1,898 crore for the north-eastern and Himalayan States. The Finance Commission also recommended an award of Rs 970 crore over the next five years from the current financial year to 2025-26 for setting up three 100-bedded and 29 fifty-bedded critical-care hospitals in Assam. The Commission also recommended Rs 7 crore over the five years for setting up district-integrated public health laboratories. Drawing lessons for the acute oxygen shortage in the current wave of the pandemic, the Central government has also announced setting up one oxygen plant in each district. Timely completion of these Health projects aimed at providing critical-care support at the district level close to the community will help the country and the States to wage a stronger battle in future pandemics. It is hoped that these Health projects will top the list of priorities of the new government to be installed in the State next month.

It is reassuring to know that Assam has augmented its oxygen-production capacity to 61 MT as against the daily requirement of 20 MT. The State has also expanded oxygen-storage capacity to 468 MT. Care must be taken not to allow any room for complacency over oxygen availability; and, the State must remain prepared for the worst. The COVID-19 virus mutating to more infectious variants in the second wave overwhelming the Health systems in advanced States sound caution against the accuracy of estimates of the Health departments. Vaccines are building resilience among the population; but, the process is going to take time to cover the population at large. So far, less than 4.5 lakh people have been given both the doses; and, the number of fully vaccinated people is expected to increase to around 20 lakh as against the 3.12 crore population in the State. The demand for vaccines has gone up in the State; but, setting up more vaccination centres to ramp up the process is easier said than done. There are logistics constraints to set up the cold chains and supply constraints of vaccine productions besides the requirement of additional human resources of doctors and nurses to run the vaccination programmes. Shutting down of educational institutions in Guwahati and imposition of night curfew in the entire State are necessitated with the rapid rise in infections and hospital beds inching towards the saturation limits. The citizens must behave responsibly and strictly adhere to the COVID-appropriate behaviour so that infection can be contained to prevent the Health system from being overwhelmed. As the COVID-19 positive cases continue to rise, the Election Commission has banned taking out victory rallies on May 2 when counting of votes cast by electors in the Assembly elections is scheduled to be taken up. Enforcement of the EC restrictions will be critical to prevent the pandemic situation in the State from going out of hand. For now, wearing the facemasks properly and frequent hand sanitising must be the first priorities of the people when they step out of their homes.