Sabu K Kurian

Concept Note on Activating a Covid Response Centre Background & Description Currently Kerala fights a devastating second wave of COVID-19 that is killing hundreds of people each day, the human impact of the COVID-19 pandemic has been much wider than originally envisaged hence requiring greater and sustained efforts and investments in the emergency response activities. The proposed project of activating Covid (pandemic) Response centres in Kottayam or different regions of Kerala is an effort to help tackle the deadly health crisis by providing aid and support to the vulnerable communities. The health care system has been overwhelmed and is unable to respond adequately to the current medical needs. Scientific experts of WHO and leading Epidemiologists warns that the variant, B.1.617 which is the predominant variant reported here can overcome the vaccine and a third wave which is on anvil, is not going to spare even the children and adolescents. Based on the above situation the proposed Epidemic Response Centres can offer an integrated solution to execute various actions seamlessly under an umbrella in integration with various pre-existing solutions and it is a way for us to support and amplify the many ongoing and urgent efforts that aim to first safeguard lives, and then livelihoods, while helping communities that are dealing with the fallout of this global pandemic. Objective The proposed project development objective is to prevent, detect and respond to the threat posed by COVID-19 and strengthen the health systems for preparedness in Kerala, it aims to deliver a combination of emergency response and health system capacity building efforts which is consistent with the Covid-19 containment plan of Ministry of Health and family welfare, Government of India. Components The project has the following three components 1. Emergency Covid-19 Response: The aim of this component is to reduce the Covid mortality due to insufficient oxygen delivery systems. This will be achieved by Installing PSA Oxygen generation plant with Cylinder filling capacity at Kottayam branch and strengthening the delivery system by providing immediate logistics support to all parts of Kottayam and nearby districts. 2. Strengthening the health systems to support prevention and preparedness: This can be achieved by establishing NABL accredited Clinical Laboratory and Blood centre with 24 hr ambulance services to trace, test and treat the vulnerable community. Telemedicine facility also can be arranged to those who are under home quarantine or home isolation. 3. Community engagement & Risk communication: This can be achieved by preparing and equipping a Covid brigade (Volunteers) to address the possible negative externalities expected in the event of a wide spread pandemic outbreak and to engage them to educate, motivate for blood donation campaigns and even warn the public to follow the instructions during lockdowns. Rational & relevance of the project intervention With more than 3000 new cases reported on a daily basis in Kottayam, District administration has reported shortages and inadequacy of oxygen supplies, faster diagnostic systems, ambulances and blood donors. The situation is particularly dire in high density population areas, where several hospitals have appealed for oxygen supplies and the lack of it has already resulted in many deaths. WHO has declared that the viral variant, B.1.617, which is increasingly found here is a variant of global concern and it can even overcome vaccine, in the event of an imminent third wave, transmission rate will be more serious among children. So strengthening those healthcare institutions functions under severe stress is going to be crucial at this juncture. The surge is expected to peak after lifting up the lockdown restrictions. Currently Less than 2% of the district's population is only fully vaccinated until now, under the current scenario due to vaccine shortage it may take another 2 year to vaccinate the full population. Project implementation on an immediate basis can ensure the delay and impact of virus spread to some extent. Implementation strategy The project is planned for installing a PSA Oxygen Generator plant with 500 LPM capacity, a centralised laboratory &blood bank with ambulance facility at Kottayam Branch and satellite blood collection centres and mini labs in 5 thalook branches. This will operate in a hub and spoke model. IRCS, Kottayam District branch will mobilise and equip their Red Cross volunteers with proper training to engage for the requirements of all pandemic situations. Currently Oxygen generating plants are quite inadequate inside Kottayam and healthcare facilities operating here are primarily outsourced it through private distributers located outside Kottayam. Accessibility to faster Covid testing is also a serious issue faced by medical fraternity in Kottayam, NABL accredited labs are few, all the existing blood banks in the private sector hospitals are not inter connected, So blood transfusion in Kerala relies on a fragmented blood-supply system, where control is exercised by different levels of the government and private sector but at the point of delivery, the patient and his family have to run around arranging for blood themselves and there are myriad challenges ranging from shortage, wastage, lack of standardization to access the availability of safe blood and blood components. Developed countries have institutionalised a centralised blood transfusion service, which acts as a hub for the network connecting blood collection centres across a region. This centralised network caters efficiently to the demand-supply inconsistencies and shares resources and blood as and when required. Here In this scenario a centralised blood banking service under Red Cross brand is a solution for the non-existent connectivity in the region. This project is planned for partial centralisation of blood and diagnostic services through a hub-and-spoke model. The hub is proposed to be fully equipped to cater to multiple satellite laboratories in the region that perform routine functions. The main Hub will be high-volume blood-collection and processing centre equipped with state-of-the-art technology in laboratory medicine for component separation, blood processing and quality systems. In a hub-and-spoke model such as this, the highly-trained manpower in the regional hub can manage efficiencies of diagnostic tests in the other spoke area through constant interactions. Financial feasibility& sustainability As per the latest survey conducted by Kottayam Government Medical College, In addition to Covid pandemic, Kerala is fast emerging as the capital of all lifestyle diseases, monitoring of the bio chemistry parameters in regular interval is very essential for such patients, but due to inadequate government allocation, vulnerable society is pressed hardly to attend unreliable commercial private laboratories. In this Context Red Cross central laboratory and its satellite centres can offer high quality diagnostic services to vulnerable population in a subsidised rate than the counter parts. Even in the post Covid scenario demand for quality diagnostic services and oxygen supplies are highly required in this region. Medical Oxygen project is sustainable even after the post Covid period by distributing the Oxygen cylinder to Private sector hospitals on a daily basis with a nominal charge. Kerala Government and District administration will support, if Red Cross Kerala take such an initiative as part of its Pandemic Response programme. The difference between actual per test cost and market rate offered by the diagnostic centres in private sector is large due to so many reasons, Being a humanitarian voluntary organization, Red Cross centres can sustain even after offering 3040% subsidised rate to most vulnerable patients, it eventually increases the volume and bottom lines too. FINANCIAL CONCEPT NOTE The project is planned to involve installation of one 500 LPA capacity Oxygen generator plant, setting up of fully equipped NABL accredited central Blood bank& Laboratory with state of the art infrastructure& equipment at Kottayam, one ICU ambulance and 5 spoke (Satellite labs) at different places. This financial forecast does not include the land or space cost which has to be possessed by the concerned Thaluk branch (spoke) or District branch (HUB) either on long term lease( minimum 25 years) or ownership basis. Purchasing a fully integrated Mobile blood collecting &processing Vehicle is also not considered at the initial phase. Projected cost for Setting up a HUB (central Lab& blood bank) and PSA Oxygen plant Sl.No 1 Item Description Installation of 500 LPA PSA oxygen generator Estimated Cost INR 45,000,00/ plant 2 Infrastructure and accessory set up& purchase of 35,00,000/ empty cylinders 3 Renovation &interior partitioning including 50,000,00/ workstations of 5000 sq ft infrastructure for lab and blood bank 4 Furniture and Fixtures 5 Medical & Non-Medical Equipment& IT set up 10,00,000/ 2,70,00,000/ 6 ICU Ambulance with all accessories 7 Other Fixed assets like Diesel Generator (power 20,00,000/ 1,00,00,000/ backup) HT transformer. 8 Preliminary and Pre-Operative Expenses 10,00,000/ 9 Pre-Operative HR expenses 10,00,000/ 10 Total cost 11 Contingency (2%) 4,30,00,000/ 8,60,000/ Grand Total 4,38,60,000/ Projected cost for Setting up a SPOKE (Satellite lab) Sl.No 1 Item Description Renovation and interior partitioning including Estimated Cost INR 5,00,000/ workstation of 500 sq ft infrastructure 2 Furniture and Fixtures 2,50,000/ 3 Medical & Non-Medical Equipment& IT set up 12,000,00/ 4 Telemedicine unit set up 3,00,000/ 5 Preliminary and Pre-Operative Expenses 2,00,000/ 6 Total Cost 24,50,000/ 7 Contingency (2%) 49,000/ 9 Grant total for opening one spoke 24,99,000/ 10 Net budget required for opening 5 spoke across 1,24,95,000 Kottayam Projected Estimate for activating a Covid Response centre (hub & spoke model) in Kottayam is Rs.5, 63, 55,000/ (Five Crore 63 lakh fifty five thousand)