There have been some media reports alleging inconsistency from the Government of India response in providing adequate healthcare infrastructure and services and ‘scaling of the tragedy’ in rural areas, terming it as ‘invisibilisation of rural India’ during the pandemic.

Government of India has been proactively working towards effective COVID-19 management in rural India by sustained strengthening of the multi-level health infrastructure, and through focussed Public Health Measures in active collaboration with the States. Development of health infrastructure is a continuous activity. Guided by a sharp focus on the underserved geographical regions and through various policies, schemes, public health interventions and active partnership with the States and UTs, Government of India is committed to strengthening the rural health infrastructure.

There is a widespread network of government health facilities in rural areas. As on 31.03.2020, there are 1,55,404 Sub Health Centres (SHCs) and 24,918 Primary Health Centres (PHCs) in rural area and 5,895 urban PHCs across the country.

Additionally, the Ayushman Bharat- Health and Wellness Centres (AB-HWC) (launched in April 2018) marked a watershed moment in India’s public health history. As on date, there are 75,995 functional Health and Wellness Centres (HWCs) in the country (50,961 SHC-HWCs, 21,037 PHC-HWCs and 3,997 urban PHCs).

A total of 1,50,000 Sub-Health Centres and Primary Health Centres in urban and rural areas will be transformed to AB-HWCs by December 2022 and deliver comprehensive primary health care that includes preventive and health promotion at the community level with continuum of care and which is universal, free and close to community in rural and urban areas, with focus also on wellness.

Addition of a new cadre of workforce, a trained non-physician health worker with BSc Nursing/BAMS qualification, designated as Community Health Officer (CHO)leads the Sub-Health Centre AB-HWC’s primary care team of health workers and AHSAs. 

• Besides expanding and strengthening the existing Reproductive and Child Health (RMNCHA+N) services and Communicable Diseases services, the functional AB-HWCs provide services related to Non-Communicable Diseases (NCDs) (screening and management for NCDs such as Hypertension, Diabetes and 3 common cancers of Oral, Breast and Cervix) and incrementally adding other primary healthcare services for mental health, ENT, Ophthalmology, oral health, geriatric and palliative health care and trauma care etc.
• Free essential diagnostics are provided – 14 diagnostic tests at HSC level and 63 diagnostic tests at PHC level.

• Free essential medicines are provided- 105 medicines at SHC level and 172 medicines at PHC level.
• HWCs demonstrate a high potential for positive outcomes in terms of gender equity for care seeking, and promoting wellness as a critical component of primary health care.  To date, about 50.29 crore people have accessed care in these AB-HWCs. About 54% of them are women.
• Preventive Health Care is the essential component of the services delivered through HWCs. Population enumeration of 30+ population through Community Based Assessment Checklist (CBAC) is done through community health workers (ASHA and ANMs) and based on risk stratification, the screening of the individuals for NCDs have been carried out. The identified individuals with the chronic conditions are put on treatment with necessary follow-up. So far, 10.98 crore screenings for Hypertension, 9.01 crore screenings for Diabetes, 5.73 crore screenings for oral cancer, 2.94 crore screenings for Breast Cancer in women and 2.0 crore screenings for cervical cancer in women have been done. 
• Tele-consultation services are another key component of the HWCs. More than 6 million Teleconsultations have been done through e-Sanjeevani Platform and out of this, 26.42 lakhs Teleconsultations have been done at the HWCs.
• During the COVID-19 pandemic, AB-HWCs played a significant role in undertaking public health action related to COVID prevention and enabling non-COVID essential health services.  About 75% of total NCD Screenings have been conducted during this COVID period (between 1^st February 2020 to till date) itself, showing the confidence reposed by people in these AB-HWCs during the present public health challenge.

A glimpse at the performance of HWCs as on 11^th June 2021

Further, taking note of the spread of the disease to peri-urban and rural areas in many districts, Ministry of Health and Family Welfare (MoHFW) on 16th May 2021 had issued an “SOP on Covid19 Containment and Management in Peri-Urban, Rural and Tribal Areas". (available at:

https://www.mohfw.gov.in/pdf/SOPonCOVID19Containment&ManagementinPeriurbanRural&tribalareas.pdf)

The SOP recommends that provision of Rapid Antigen Test (RAT) kits should be made at all public health facilities including Sub-centres (SCs)/ Health and Wellness Centres (HWCs) and Primary Health Centres (PHCs). It has also been advised that Community Health Officer (CHO) and Auxiliary Nursing Midwife (ANMs) should be trained in performing Rapid Antigen Testing.

In order to facilitate the uptake of RAT and ensure its maximum utilization, it is requested that all State Government/UT Administration have been advised by MoHFW to undertake training at appropriate level of CHO, ANMs etc., on RAT testing, sample collection, IPC protocol to be followed, data management etc.

On the COVID vaccination front, India is conducting one of the largest COVID-19 Vaccination Drive since 16^th January 2021. Till date, over 24 crore doses of vaccines have been administered across all States/UTs.

Special initiatives have been taken under the vaccination drive to improve the coverage of COVID-19 vaccination in the rural and tribal areas.

India is using Co-WIN digital platform for this COVID-19 Vaccination drive. This platform provides the facility of both online and offline registration for beneficiaries. The beneficiaries can avail the facility of ‘walk-in registration’ at the nearest COVID Vaccination Centre (CVC). They can visit the nearest CVC and get themselves registered for the vaccination.

Further, community-based approach has been followed for the COVID-19 Vaccination drive by bringing vaccination sessions nearer to home at Panchayat Ghar, Health sub-centres, Community Centre, School buildings etc. for the elderly and differently abled.

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MV