5 min readNew DelhiMay 17, 2021 07:01 AM IST
First published on: May 17, 2021 at 04:12 AM IST
With at least 516 districts returning a positivity rate of more than 10 per cent, and increased mortality being reported in rural India, the Centre on Sunday directed states to set up a three-tier health infrastructure to manage the epidemic in the hinterland, including makeshift 30-bed Covid Care Centres (CCCs) in villages, each equipped with at least two oxygen cylinders.
The Health Ministry said that schools, community halls, and panchayat buildings should be turned into CCCs to manage mild cases of the disease.
Primary Health Centres (PHCs), Community Health Centres (CHCs), and Sub-district Hospitals — which constitute the backbone of India’s rural health infrastructure — shall be designated as 30 oxygen-bed facilities to handle moderate cases of the disease, where the oxygen saturation level has fallen below 94, the Ministry said.
The guidelines also recommend that Rapid Antigen Test (RAT) kits should be made available at all public health facilities including Sub-centres (SCs)/Health and Wellness Centres (HWCs) and PHCs, for early testing and treatment.
At the lowest level of the three-tier structure, peri-urban and rural areas will plan a minimum 30-bed CCC, which would have makeshift facilities under the supervision of the nearest PHC/CHC. These centres will treat mild cases — upper respiratory tract symptoms without breathlessness and with oxygen saturation of more than 94 per cent, or asymptomatic patients with comorbidities.
The Community Health Officer or ANM (Auxillary Nurse Midwife) will be the nodal person from the health sector, who will be trained to carry out rapid antigen tests, the guidelines state. ASHA or Anganwadi workers will support the health team.
The 30-bed CCC can be set up in schools, community halls, marriage halls, and panchayat buildings in close proximity to healthcare facilities, according to the guidelines. District authorities will provide one pulse oximeter for every 10 beds at the CCC; two 5-litre oxygen cylinders; and one basic life support ambulance (BLSA), with sufficient oxygen support on a 24×7 basis.
The guidelines mandate that these should be mapped to one or more Dedicated Covid Health Centres (DCHCs) that will manage moderate cases; the CCCs shall also be mapped to at least one Dedicated Covid Hospital (DCH) for referral purposes in severe cases.
The guidelines states that qualified AYUSH doctors, final year AYUSH students, or final year B.Sc nurses may be considered to run the CCCs.
In tier 2, the guidelines state, a PHC, CHC, or Sub-district Hospital will act as a DCHC for moderate cases — defined as a Covid patient with a respiratory rate of more than 24 per minute, or saturation between 90% to <94% on room air.
The guidelines state that the DCHC shall have a minimum of 30 beds, and the district should be prepared to increase DCHC beds as per the case trajectory and expected surge.
At the 30-bed DCHC, the district authorities have been asked to provide one pulse oximeter per bed; one oxygen source (cylinder or piped medical oxygen supply or oxygen concentrator) per bed; five self-inflating resuscitation bags; one X-ray unit; a facility for blood and biochemistry tests; and one basic life support ambulance (BLSA), with sufficient oxygen support on a 24×7 basis.
In the third tier, the guidelines state, a district hospital or a private hospital in the district will act as a dedicated Covid-19 hospital to manage severe cases. If a block-level or a sub-district level hospital fulfills the requirements, it can also be designated as a Covid-19 hospital, they state.
On testing, the guidelines state that Community Health Officers (CHOs) and ANMs should be trained in performing rapid antigen testing. RAT kits should be provided at all public health facilities including Sub-centres (SCs)/HWCs, and PHCs, the guidelines state.
On surveillance, the guidelines state that in every village, active surveillance should be done for influenza-like illness/ severe acute respiratory infections (ILI/SARI) periodically by ASHA with help of Village Health Sanitation and Nutrition Committees (VHSNC).
It recommends that symptomatic cases can be triaged at the village level after teleconsultation with the CHO, and cases with comorbidity or low oxygen saturation should be sent to higher centres.
At the lowest level of the three-tier structure, peri-urban and rural areas will plan a minimum 30-bed CCC, which would have makeshift facilities under the supervision of the nearest PHC/CHC. (Express Photo) 
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