India marked another key milestone in universalising Primary Health Care today. The planned target of operationalizing 70,000 Ayushman Bharat- Health and Wellness Centres (AB-HWCs) by 31st March 2021 has been realised ahead of time.
The feat of scaling up at this pace despite the COVID pandemic was enabled by a high degree of coordination between the Centre and States/UTs, foresight in planning, flexibility in adaptation, standardization of processes, and regular interactions at all levels which enabled supportive monitoring and prompt redressal of issues. This is testimony to the process of effective decentralization and cooperative federalism.
The launch of Ayushman Bharat- Health and Wellness Centres (AB-HWC) in April 2018 marked a watershed moment in India’s public health history. By December 2022, 1,50,000 Sub-Health Centres and Primary Health Centres in urban and rural areas were targeted to be transformed to AB-HWCs and deliver comprehensive primary health care that includes preventive and health promotion at the community level with a continuum of care and which is universal, free and close to the community in rural and urban areas, with focus also on wellness. This mission mode approach also aimed at realising India’s vision of Universal Health Coverage.
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.
Essential diagnostics list expanded to complement all CPHC services, to be provided as point of care or hub and spoke services.
HSC-HWCs: existing 7 to 14 tests
PHC-HWCs: existing 19 to 63 tests
List of Essential Medicines has been expanded at all SHC and PHC AB-HWCs and the same is being supported under National Free Drugs Service Initiative of National Health Mission to ensure uninterrupted supply of drugs to patients including for treatment for Hypertension and Diabetes
SHC-HWCs: from existing 57 to 105 medicines
PHC-HWCs: from existing 232 to 172 medicines
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 41.35 crore people have accessed care in these AB-HWCs. About 54% of them are women.
The HWCs also focus on wellness and healthy lifestyles through various activities. So far, these Centres have conducted 64.4 lakhs wellness sessions. Depending on the local context, States are undertaking various wellness activities including Yoga, local sports, Zumba (in NE States), etc. These centres also follow a calendar of 39 health promotion days spread over a year.
Preventive Health Care is the essential component of the services delivered through HWCs. Population enumeration of 30yrs+ 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, 9.1 crore screenings for Hypertension, 7.4 crores screenings for Diabetes, 4.7 crore screenings for oral cancer, 2.4 crores screenings for Breast Cancer in women and 1.7 crore screenings for cervical cancer in women have been done.
Tele-consultation services are another key component of the HWCs. More than 9.45 lakh 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 1st February 2020 to till date) itself, showing the confidence reposed by people in these AB-HWCs during the present public health challenge.
More than 60% of team leaders (CHOs and Medical Officers) and more than 90% of field workers of HWC teams are women. This is a testimony to a gender sensitive approach to healthcare. Community ownership and community management of these Centres are envisaged through the institutional mechanism of Jan Arogya Samitis (JASs) and JAS are being formed at all functional AB-HWCs to enable accountability of the health care teams.
AB-HWCs are proving to be a pivotal force for India’s Health Systems. The quantum of services delivered and the pace of implementation, inspire confidence that the programme is on track to realize the vision to deliver affordable Comprehensive Primary Health Care services closer to people.
Expanded Service Packages provided under AB-HWC are as follows:
Care in Pregnancy and Child Birth.
Neonatal and Infant health care services.
Childhood and Adolescent health care services.
Family planning, contraceptive services and other reproductive health care services
Management of communicable diseases: National Health programmes
General out-patient care for acute simple illnesses and minor ailments
Screening, prevention, control and management of non-communicable diseases and chronic communicable diseases like tuberculosis and leprosy
Basic oral health care
Screening and basic management of mental Health ailments
Care for common ophthalmic and ENT problem
Elderly and palliative health care services
Emergency medical services including burns and trauma.