Ayushman Bharat Health Infrastructure Mission

Introduction
Healthcare is becoming one of the largest growth sectors in India, both in terms of revenue and employment. As per NITI Aayog, the Indian healthcare sector is projected to reach US$ 372 billion by 2022, from US$ 110 billion in 2016 at a compounded annual growth rate (CAGR) of ~22% between 2016 and 2022. The market growth is driven by the rising demand from citizens for healthcare services (e.g., health monitoring, medical check-ups, etc.). Current state of the coronavirus pandemic has also catalysed the long-term attitude of citizens towards personal health and hygiene, contributing to further rise of the healthcare services demand in India. Due to the accelerating demand, the healthcare sector has become one of the most attractive job markets. As per the National Skill Development Corporation (NSDC), the healthcare sector is estimated to generate ~2.7 million additional jobs in the country between 2017 and 2022 (i.e., >0.5 million new jobs per year).

To realise full potential of the Indian healthcare sector, the government has been taking several initiatives to strengthen the sector for further growth. The Aatmanirbhar Bharat (self-reliant India) initiative includes various measures such as production-linked incentive (PLI) schemes for enhancing domestic manufacturing of medical devices & pharmaceuticals and boosting the healthcare system. Further, India’s conducive policies for encouraging FDI (Foreign Direct Investment) have been instrumental in attracting investments. As per the Department of Industrial Policy and Promotion data, between April 2000 and June 2021, FDI inflow in the drugs and pharmaceuticals sector stood at US$ 18.12 billion, while hospitals & diagnostic centres and medical & surgical appliances attracted investments worth US$ 7.40 billion and US$ 2.22 billion, respectively.

The Indian government aims to further boost the sector by strengthening the infrastructure and providing universal access to affordable healthcare services in the country. Strengthening infrastructure would not only improve the well-being of citizens, but also boost employment opportunities in the sector and contribute to the economic growth of India.

Need for Ayushman Bharat Health Infrastructure Mission
India lags other developed countries in terms of healthcare infrastructure and manpower. To address this, the National Health Policy launched in 2017 highlighted the need to boost India’s public healthcare spending to meet the rising demand for healthcare infrastructure & services. India spent 1.8% of its GDP on public health expenditure in 2020-21. The government aims to increase the spending to 2.5% of the GDP by 2025.

To improve public access to health services and meet the spiralling demand for healthcare infrastructure & services, the government has introduced several schemes such as ‘Ayushman Bharat’ (in 2018)—including Ayushman Bharat-Health & Wellness Centres, Ayushman Bharat-PMJAY (Pradhan Mantri Jan Arogya Yojana) and Ayushman Bharat Digital Mission (September 2021). These schemes were introduced to make healthcare services more accessible and affordable to citizens.

However, in 2020, there was still a shortfall of health centres in the remote areas of major states such as Bihar, Madhya Pradesh, Uttar Pradesh and Jharkhand. In March 2021, Mr. Ashwini Kumar Choubey, Minister of State for Health and Family Welfare, stated in the Lok Sabha that the shortage of health subcentres stood at 23%, public health centres at 28% and community health centres at 37%.

To further reinforce the country’s healthcare infrastructure, especially in the rural areas, the government, introduced a Pradhan Mantri Ayushman Bharat Health Infrastructure Mission, a pan-India health infrastructure strengthening scheme, in October 2021. The mission is an addition to the National Health Mission and a part of the Ayushman Bharat initiative, which aims to offer universal access to high-quality and affordable healthcare services across India.

Details of Ayushman Bharat Health Infrastructure Mission
The ‘Pradhan Mantri Ayushman Bharat Health Infrastructure Mission’ aims to strengthen the critical healthcare infrastructure of the country at several levels (e.g., villages or blocks) over the next five years. The scheme aims to boost citizen’s access to the public health infrastructure by building facilities for primary and critical care in urban and rural areas of the country.

Through the mission, the government aims to address three areas in the public health sector in India. The three areas are as follows:

• Augment health facilities for treatment
  • The mission aims to offer high-class testing network for effective diagnosis and monitoring of diseases. In line with this, the government aims to set up ‘Integrated Public Health Labs’ across 730 districts and Block Public Health Units across 3,000 blocks in the country. In addition, the government plans to establish 5 regional centres for disease control, 20 metropolitan units and 15 biosafety level (BSL) labs to further strengthen the testing network.
• Establish integrated public health labs for diagnosis of diseases
  • The government aims to support health & wellness centres in the country to ensure effective and timely treatment. The mission covers 11,024 urban and 17,788 rural health & wellness centres. These centres will have facilities for early detection of diseases and offer free medical consultations, tests and medicines. In addition, the government also plans to set up 35,000 new critical care beds across 600 districts in the country to offer effective care to the seriously ill patients.
• Expand existing research institutions that study pandemics
  • The mission aims to build capabilities to conduct comprehensive research studies on the pandemic. In line with this, the government aims to strengthen the existing 80 viral diagnostic and research labs in the country. At a state level, the government plans to set up 15 new biosafety laboratories. At the national level, the government plans to establish one National Institute for One Health and four National Institutes of Virology.

Impact of the Ayushman Bharat Health Infrastructure Mission
The PM Ayushman Bharat Health Infrastructure Mission is expected to help achieve holistic healthcare in India. Measures under the scheme are a step towards addressing critical areas of public health through multinodal and multidimensional interventions in the healthcare system. Establishment of the health & wellness centres is expected to strengthen the country’s capacity to detect & diagnose new infections. Planned health labs are also expected to result in the availability of adequately trained professionals who can work on research and diagnosis in new pathogens. This would also help India reduce dependency on foreign laboratories and partners for research in novel pathogens and biological threats. This scheme also aligns with India’s ‘Atmanirbhar Bharat’ (self-reliant India) initiative.

The Road Ahead…
The healthcare infrastructure in India is expected to grow significantly. As per estimates by ‘The India Watch’ (a research company), size of the healthcare infrastructure market is projected to reach US$ 349.1 billion at ~17% annually until FY22 on the back of government’s efforts to boost the sector.

In the Union Budget 2021-22, the government increased healthcare expenditure by 137% YoY to Rs. 223,846 crore (US$ 30.70 billion), as against Rs. 94,452 crore (US$ 12.95 billion) in 2020-21. In the budget, the government also announced a Rs. 64,180 crore (US$ 8.80 billion) outlay for the healthcare sector over six years to strengthen the existing ‘National Health Mission’ by building capacities of primary, secondary and tertiary care, healthcare systems and institutions for early detection and cure of new & emerging diseases.

Also, increasing adoption of technology in the healthcare sector is radically transforming healthcare access and delivery in the remote areas. For instance, teleconsultations, which cover various clinical specialty areas (diabetology, endocrinology, neurology, etc.), augurs well for the population in remote areas to access affordable healthcare services. The Health Ministry’s eSanjeevani telemedicine service crossed 14 million teleconsultations as of October 2021 since launch in April 2020. Adoption of digital technologies in the healthcare system offer huge opportunities to the sector to widen reach of critical and primary care services across the country.

With the government’s continuous efforts to achieve universal health coverage, the PM Ayushman Bharat Health Infrastructure Mission would not only help India build capabilities to effectively manage any emergency (e.g., COVID-19 pandemic), but also has the potential to create investment avenues, employment opportunities and contribute to the economic growth.