Lok Sabha Question No. 982 (UNSTARRED), answered on 2021-12-03
Subject: Preparation for future waves of COVID-19
Ministry: HEALTH AND FAMILY WELFARE
Asked by: K. Muraleedharan, A. Chellakumar, Mahesh Sahoo, S. Jothimani

(a) to (e)

Government of India is supporting States in their endeavor to manage COVID-19 since the beginning  of  pandemic.  Requisite  support  is  being  provided  to  States/UTs  to  enhance preparedness and response capacities against COVID-19 and other public health emergencies.  Various  initiatives  have  been  undertaken  by  the  Government  to  provide technical  guidance  and  further  strengthen  health  infrastructure,  availability  of  essential logistics including drugs and medical oxygen supply to manage COVID-19.

A few of the interventions are as below:

## GOVERNMENT OF INDIA MINISTRY OF HEALTH AND FAMILY WELFARE DEPARTMENT OF HEALTH AND FAMILY WELFARE

## LOK SABHA UNSTARRED Q. No. 982 TO BE ANSWERED ON 03 rd  DECEMBER 2021

## PREPARATION FOR FUTURE WAVES OF COVID-19

982. SHRI K. MURALEEDHARAN Dr. A. CHALLAKUMAR: SHRI MAHESH SAHOO: MS. S. JOTHIMANI:

Will the Minister of HEALTH AND FAMILY be pleased to state:

- a) the details of steps taken by the Government to ensure that the Indian Health care system is equipped to handle future waves of COVID-10 and /or other epidemics.
- b) whether the Government has recommended any Standard operating procedure (SOP) for the States/UTs to manage and respond to health emergencies, if so, the details thereof and if not, the reasons therefore;
- c) whether the Government has recommended any SOP for State / UTs to lift COVID-19 restrictions, if so, the details thereof and if not, the reasons therefore;
- d) whether Government has adequate healthcare staff to cater to COVID patients in case of resurgence of COVID pandemic, if so, the details thereof and if not, the steps taken in this regard to increase the healthcare force, State/UT-wise particularly Odisha; and
- e) the initiative taken by the Government to counter COVID-19 in far flung rural areas?

## Answer MINISTER OF STATE FOR HEALTH & FAMILY WELFARE

## (DR. BHARTI PRAVIN KUMAR)

-  Ministry  of  Health  &  Family  Welfare  continues  to  provide  technical  guidance  for managing various aspects of COVID-19. So far more than 150 guidelines/advisories/SoPs/plans have been provided to States/UTs.
-  Guidelines on Clinical management of COVID-19 continues to be updated with emerging scientific evidence. The treatment protocol for adults was last updated on 24.05.2021 and has been widely circulated.
-  Guidelines for management of COVID-19 in children was issued on 18th June 2021. The guideline covers guidance on management of acute presentation of COVID-19 as well as Multisystem Inflammatory Syndrome  (MIS-C)  in  children and adolescents found temporally related to COVID-19.
-  Guidelines and checklists on prevention and clinical management of Mucormycosis was disseminated to all States/UTs.
-  A  Comprehensive  Guidelines  for  Management  of  Post-Covid  Sequelae  was  issued  by MoHFW  on  21 st October  2021  after  expert  consultations  to  guide  doctors  on  postCOVID-19 complications and their management.
-  To  further  provide  on-field  assistance  to  the  States/UTs,  a  total  of  170  Central  multidisciplinary  team  comprising  of  epidemiologists,  clinicians,  microbiologists  and  senior officials from the Ministry have been deployed to 33 States/Districts reporting increased trajectory of cases.
-  States are supported in terms of supply of logistics which includes PPE Kits, N-95 masks, ventilators and drugs like Hydroxychloroquine, Remdesivir etc.
-  States have been supported with supply of oxygen cylinders and oxygen concentrators. States  are  also  being  supported  in  terms  of  installation  of  Oxygen  concentrator  plants/ PSA (Pressure Swing Adsorption plants) plants. All the States have been advised rational use of oxygen and to prohibit the wasteful usage by strict monitoring. States have also been  advised  to  undertake  oxygen  consumption  audit  in  hospitals  including  private hospitals  and  to  undertake  facility-wise/hospital-wise  oxygen  inventory  mapping  and advance planning for timely replenishment so that there is no stock out.
-  COVID-19 vaccine is made available free of cost for all citizens of the country aged 18 years and above, irrespective of their socio-economic status, at all Government COVID19  Vaccination  Centres  (CVCs).  Provisions  have  been  made  to  improve  access  for elderly,  specially-abled  citizens,  vaccination  of  persons  in  Mental  Health  Institutions, destitute  &  vagabonds  etc.  Under  the  'Har  Ghar  Dastak'  campaign  for  improving COVID-19 vaccination rate, various initiatives including community awareness campaigning in collaboration with local religious and community leaders, CSOs, NGOs, NSS,  NYK  etc.  is  being  taken  to  ensure  mobilisation  and  counselling  of  the  eligible population.

Funding support is also being provided to States/UTs through various avenues:

-  During  the  F.Y.  2019-20.  funds  to  the  tune  of  Rs.1113.21  crore  was  released  to  the States/UTs under NHM towards management and containment of COVID-19 pandemic.
-  Since  September  2020,  the  Union  Government  has  allowed  use  of  State  Disaster Response Funds (SDRF) for various COVID-19 related activities.

-  During the FY 2020-21, funds to the tune of Rs. 8257.88 crore has been released to the States/UTs  towards  the  India  COVID-19  Emergency  Response  and  Health  System Preparedness Package. This provided support to States for health infrastructure strengthening, expansion of laboratory network, surveillance and contact tracing, procurement of PPEs, N-95 masks, ventilators etc.
-  In  addition,  'India  COVID-19  Emergency  Response  &  Health  System  Preparedness Package: Phase-II' has also been approved by the Cabinet with Rs 23,123 crores (with Rs. 15,000  Cr  as  Central  Component  &  Rs  8,123  Cr  as  State  component)  and  is  being implemented from 1 st July 2021. This includes support to State/UT level for ramping up health  infrastructure  including  those  in  rural,  tribal  and  peri-urban  areas  closer  to  the community,  providing  support  for  procurement  of  drugs  and  diagnostics  to  enhance service  delivery  at  district  and  sub  district  levels  for  management  of  COVID-19  cases (including pediatric care) and  for maintaining  a  buffer  of drugs, support  for IT Interventions  such  as  implementation  of  Hospital  Management  Information  System (HMIS)  and  expanding  access  to  tele-consultations  in  all  districts,  and  support  for capacity building and training for all aspects of management of COVID-19.
-  Further,  PM  Ayushman  Bharat  Health  Infrastructure  Mission  (PM-ABHIM)  with  an outlay of Rs. 64,180 crores over 6 years envisages increased investments in public health and other health reforms  to safeguard against future resurgences of COVID-19, if any, and future public health emergencies by:
- o Strengthening  of  Health  and  Wellness  Centers  in  villages  and  cities  for  early detection of diseases
- o Addition of new critical care-related beds at district level hospitals.
- o Operationalization of Regional National Centers for Disease Control (NCDC).
- o Establishment  of  metropolitan  units  in  urban  areas  and  BSL-III  labs  across  the country to strengthen the laboratory network.
- o Strengthening  of  existing  Viral  Diagnostic  and  Research  Labs  (VRDLs)  and creation of new National institutes of Virology (NIVs) and a National Institute for One Health through ICMR.
- o Strengthening of Public Health Units at international Points of Entry (PoEs)

For preparedness and response against health emergencies, the National Disaster Management Authority in 2008 has issued detailed guidance on  management of biological disasters (available at https://ndma.gov.in/sites/default/files/PDF/Guidelines/biological\_disasters.pdf). Further, National  Disaster  Management  Authority  has  also  issued  and  widely  circulated  National Disaster Management Plan 2019 which provides an all-hazard plan with clarification on roles and responsibilities for preparedness and response activities against biological emergencies. The Ministry of Health & FW has also finalized and circulated Model Crisis Management Plans for biological disasters in 2017 and again in 2019 to serve as template for preparation of their own respective crisis management plans.

Ministry of Health & FW vide letter dated 28 th June  2021  has  circulated  to  all  States/UTs guiding principles for imposition of restrictions or allowing relaxation in context of COVID-

19 based on COVID-19 testing confirmation rates and hospital bed occupancy rates. This has been  reiterated  by  Ministry  of  Home  Affairs  under  Disaster  Management  Act,  2005  vide order dated 29 th June 2021.

To  build  the  capacities  of  human  resources  including  the  medical  manpower  who  help managing patients  in  hospitals;  as  well  as  non-medical  personnel,  front-line  workers,  who may be  involved  in  non-medical  duties  such  as  logistics,  surveillance  etc.,  for  COVID-19 management in the country including Odisha, an 'Advisory for Human  Resource Management  of  COVID-19'  has  been  prepared  providing  guidance  to  States/UTs  on  the human resources that can be mobilized for COVID-19 management along with possible role assignments and their training requirements.

Training  Modules  have  also  been  made  available  on  iGOT  online  platform  by  DOPT (https://igot.gov.in/igot)  where  pre-curated  content  can  be  accessed  on  all  devices-  smart phones, tablets, laptops, PCs - by multiple learners simultaneously at the time and place of their choice. The training modules have been translated to regional language.

With a view to increase the availability of trained human resources to tackle the Covid-19 pandemic situation, Ministry of Health & FW on 3 rd May 2021 has issued an advisory for Augmenting Human resources for COVID - 19. As per the advisory, the States have been advised to explore avenues  for utilization of services of Medical  Interns in  Covid Management duties under the supervision of their faculty, also Final Year MBBS students can  be  utilized  for  providing  services  like  tele-consultation  and  monitoring  of  mild  Covid cases after due orientation by and supervision of Faculty. States have also been advised that the services of Final Year PG Students (broad as well as super-specialities) as residents may continue to be utilized until fresh batches of PG Students have joined. Likewise, the services of  the  senior  residents  /  registrars  may  continue  to  be  utilized  until  new  recruitments  are made. B.Sc./GNM Qualified Nurses may be utilized in full-time Covid nursing duties in ICU, etc., under the supervision of Senior Doctors and Nurses. Final Year GNM or B.Sc. (Nursing) students  awaiting  Final  Exam  may  be  given  full  time  Covid      Nursing      duties      at Government/Private   facilities   under   the   supervision   of   Senior Faculty. The services of Allied Health Care professionals may be utilized for assistance in Covid Management, based on their training and certification.

Further, under National Health Mission (NHM), Government of India provides financial and technical support to States / UTs to strengthen their healthcare systems including support for recruitment of doctors and other health human resources on contractual basis. Under NHM, support  is  also  provided  to  States  /  UTS  for  hard  area  allowance  to  specialist  doctors  for serving in rural and remote areas

Taking note of spread of the disease to peri-urban, rural and tribal areas in many Districts, Ministry of Health and Family Welfare on 16th May 2021 has issued an 'SoP on Covid-19 Containment and Management in Peri-Urban, Rural and Tribal Areas". The SOP provides for strengthening  primary  level  healthcare  infrastructure  at  all  levels  to  intensify  COVID-19

response in peri-urban, rural & tribal areas, while continuing to provide other essential health services through  inter-sectoral approach  by  involving  community-based  organizations, Village Health Sanitation and Nutrition Committees (VHSNCs), Pachayati Raj institutions, Urban Local bodies, etc.