● COVID-19 had exposed several weaknesses in India’s underfunded health system.
● During the pandemic, it could not assuredly provide affordable care or deliver vaccines
in large parts of India.
● There was a disconnect between the various levels of care within the public system,
and the private system operated in a separate universe.
POOR STATE OF HEALTHCARE SECTOR
● Rural primary care is underfunded and has shortages of staff, equipment, drugs and
infrastructure in many parts of the country.
● Urban primary health care has still not emerged as an active programme in many
● District and medical college hospitals suffer shortages of specialist doctors and
● The private sector ranges from advanced tertiary care hospitals in big cities to informal
and often unqualified care providers in villages.
NEED FOR NEW SCHEME
● Alerted by the experience of the first wave of 2020, the government proposed in the
Budget greater investment in the health system.
● The Fifteenth Finance Commission too recommended strengthening of urban and
rural primary care, stronger surveillance systems and laboratory capacity as well
as creation of critical care capacity at different levels of the health system.
● The new scheme – Pradhan Mantri Ayushman Bharat Health Infrastructure Mission
(ABHIM), announced recently, links all these elements.
PRADHAN MANTRI AYUSHMAN BHARAT HEALTH INFRASTRUCTURE MISSION (ABHIM)
● To provide a continuum of care at different levels, HWCs will be linked with the
Pradhan Mantri Jan Arogya Yojana, for all entitled beneficiaries.
○ Also, the scheme will support infrastructure development for rural health
and wellness centres (HWCs) in seven high-focus States and three
○ In addition, urban HWCs will be established in close collaboration with Urban
● The various measures of this scheme will extend primary healthcare services across
○ Areas like hypertension, diabetes and mental health will be covered, in
addition to existing services.
● The network of centres will build a trained public health workforce that can
perform routine public health functions while responding to a public health emergency.
● Support for block public health units (BPHUs) in 11 high-focus States and
establishment of integrated district public health laboratories in all 730 districts
will strengthen capacity for information technology-enabled disease surveillance.
○ Further to enhance the capabilities for microbial surveillance, a National
Platform for One Health will be established.
○ Four Regional National Institutes of Virology will be established.
○ Laboratory capacity under the National Centre for Disease Control, the Indian
Council of Medical Research and national research institutions will be
○ Fifteen bio-safety level III labs will augment the capacity for infectious
disease control and biosecurity.
● Critical care hospital blocks will be established in 602 districts, to enable care for
those with serious infectious diseases without disrupting other services.
○ In non-pandemic situations, this capacity will be utilised for providing critical
care for other disease conditions.
● For enhancing the level of disaster response readiness, 15 health emergency
operation centres and two container-based mobile hospitals will be created.
● There is a need to train and deploy a larger and better skilled health workforce.
● Public health expertise will be needed for programme design, delivery, implementation
and monitoring in many sectors that impact health. Hence, there is an urgent need to
scale up institutional capacity for training public health professionals.
● Many independently functioning programmes will have to work with a common purpose
by leaping across boundaries of separate budget lines and reporting structures.
○ That calls for a change of bureaucratic mindsets and a cultural shift in
○ This can be catalyse through the platforms for active citizen engagement.
● ABHIM, if financed and implemented efficiently, can strengthen India’s health system
by augmenting capacity in several areas and creating a framework for coordinated
functioning at district, state and national levels.
● It can also enable data-driven decentralised decision-making and
people-partnered primary care at the block level while strengthening national
connectivity for delivering universal healthcare.