16 AIIMS or 1.2 Lakh Health & Wellness Centres Can Come up from Central Vista Funds

Experts and citizens have raised concerns and continue to criticise the Centre on going ahead with the Central Vista Redevelopment Project amid the raging COVID-19 pandemic, questioning the need to spend an estimated Rs 20,000 crore on a redevelopment project while the more important task of saving lives and livelihoods are crying out for attention. It is another matter that a number of loopholes have been pointed out in the project plan, wherein laws have been flouted and the manner in which clearances have been obtained. However, work has not stopped even in during the lockdown phase of the pandemic.

In response, the Ministry of Housing and Urban Affaris issued a statement to dispel “myths” around the Central Vista project. The best comeback the Government could come up with regarding its plans to invest such a huge amount on an apparently unnecessary exercise, is that the Rs 20,000 crore expenditure would be “over several years”.

The statement added: “If the strength of the Parliament is increased after the freeze on its expansion lifts in 2026, it will be necessary to ensure that Parliament House has the facilities for a larger Parliament to function.”

One only wishes that had such a level of concern been shown towards strengthening the public health system, India would not have suffered as much in trying to fight the pandemic.

Let us just try and do that; assess what could be probable alternate uses of the resources which will be used for the project.

Setting up AIIMS

The Pradhan Mantri Swasthya Suraksha Yojana (PMSSY), launched in 2003, had the setting up of AIIMS-like institutions with the objective of correcting regional imbalances in the availability of affordable tertiary healthcare services, as a component. It seen new AIIMS campuses being announced in about eight phases with a plan of a total of 22 such institutions.

However, until now, only six such institutions which were announced in the first phase, have become fully functional. The other AIIMS announced in other phases in different years from 2009 to 2020 are only partially functional in varying degrees. For instance the AIIMS at Rae Bareli, which was approved by the Cabinet in 2009, is still 92% complete. AIIMS Gorakhpur, which got approval in 2016, was to be finished by April 2020 but is still under construction with only 76% of physical progress made so far. Most of the proposed AIIMS have already crossed their approved timelines for the completion of work.

If we take the cost estimate of the latest one, AIIMS Darbhanga, which got the Cabinet nod in 2020 and is to be completed by 2024, its cost estimate is about Rs 1,264 crore. If the amount laid out for the Central Vista (Rs 20,000 crore) project had been spent on building such a facility, which is expected to cater to 2,000 OPD patients daily and 1,000 IPD patients in a month, nearly 16 such more AIIMS campuses could have been constructed over the next three to four years.

With the given footfall for one AIIMS, assuming that it is operational for 250 days in a year, the 16 AIIMS can cater about 80 lakh OPD through the funds likely to be spent on the Central Vista. With one AIIMS catering to 1,000 IPD patients monthly, 16 AIIMS can cater to two lakh IPDs annually!

Converting Sub-Centres to Health and Wellness Centres

One of the components under the Centre's flagship programme Ayushman Bharat isthe creation of Health and Wellness Centres (HWCs). It aims at creating 1,50,000 HWCs to deliver comprehensive Primary Health Care that is universal and free to users, with a focus on wellness and the delivery of an expanded range of services closer to the community. The expanded range of services in HWCs goes beyond maternal and child health care services, to include care for non-communicable diseases, palliative and rehabilitative care, Oral, Eye and ENT care, mental health and first level care for emergencies and trauma, and free essential drugs and diagnostic service.

According to the cost estimates from a recent study from May this year, the average incremental start-up cost of upgrading a sub-centre to HWC standards in the first year was estimated to be Rs 17.8 lakh; in the subsequent years the incremental cost of delivering health care at the HWC was found to be about Rs 10 lakh. As the scheme is a centrally sponsored one, the costs are shared between the Centre and states in the ratio of 60:40. Taking 60% of the Rs 28 lakh cost of upgrading one sub-centre and the incremental cost of one year, the Centre’s share is about Rs. 16,80,000 per sub-centre.

Keeping this cost in mind, if the amount of Rs 20,000 crore envisaged for the Central Vista project is utilised for converting sub-centres to Health and Wellness Centres, the Centre can contribute towards upgrading and making nearly 1.2 lakh sub-centres functional (assuming an assured states’ share).

As per norms, one sub-centre is established for every 5,000 people in the plains and for every 3,000 people in hilly/tribal/desert areas. If we assume that the footfall at a sub-centre is about 50 people on a daily basis and the Centre operates it for about 250 days, this would mean that the Central Vista resources may cater about 150 crore OPDs annually!

In a snapshot, given how the alternate uses of the probable expenditure to be made on the Central Vista project look like, the choice does not seem to be too difficult to make! On the one hand is the need for saving people's lives and ensuring their fundamental right to healthcare, on the other it is the megalomania of a dispensation which has failed to save those exact things during the pandemic. Given the devastating experience during the first two waves of the pandemic, the Government should be planning on dealing with more such surges or pandemics, instead of planning for a possible expansion in the strength of the Parliament after 2026!

While there is a lurking fear of an impending third wave striking the country with newer variants of the novel coronavirus, the need of the hour is to focus all resources and energies on ensuring that we are not caught off guard this time around. Scores of bodies waiting to be cremated, floating corpses and people gasping for one breath of oxygen at the gates of hospitals should still be very fresh in our minds...