By Preeti Sudan
In 2017, the Government of India announced the National Health Policy 2017. Developed through an extensive consultation process, it envisioned the provision of comprehensive health care with the integration of preventive and curative services at all administrative levels, the development primary health care in stages and the creation of a system of medical education including preventive and social medicine.
In one year, 2018, we saw the operational manifestation of the policy with the announcement of Ayushman Bharat (AB) with its two pillars of Pradhan Mantri Jan Arogya Yojana (PMJAY) and Ayushman Bharat – Health and Welfare Centers -be (AB-HWC).
PMJAY, the largest health insurance scheme in the world, offers protection against catastrophic expenses for the most needy, as the government becomes the payer of hospital expenses up to Rs 5 lakhs per family for about 50 crore population.
AB-HWCs were set up to provide universal and comprehensive primary health care and have multiple components that are based on two fundamental premises –
The first is to introduce welfare as a key aspect of service delivery and to ensure that the spectrum of preventive, promotional, rehabilitative and palliative care receives as much attention as curative care. In fact, it changes the concept of health from simply being the absence of ill health or disease and focuses on wellness.
The second is to expand the set of services include non-communicable diseases, mental health, ENT, ophthalmology, oral health, geriatric and palliative care and trauma care, in addition to the continued focus on care for mothers and newborns and on the communicable diseases identified.
It is by emphasizing these two fundamental premises that April 14and In 2018, India embarked on the journey of comprehensive, preventive and promotional healthcare with the Honorable Prime Minister inaugurating the first Ayushman Bharat Health and Wellness Center (AB-HWC) in the remote district from Jangla from Bijapur to Chattisgarh. It is with pride that we note that the country has not only achieved the set target of 1.1 lakh AB-HWCs by 31st March 2022 but also exceeded to have 1,17,440 AB-HWCs already operational.
The transformation of SHC, PHC and UPHC into AB-HWC is a 9-point reform covering all aspects of health systems, such as an expanded set of services, human resources with the introduction of a new cadre of providers mid-level health care, viz. Community health workers, financing, access to an expanded range of essential medicines and diagnostics, creation of IT systems to facilitate the continuum of care and the paradigm shift in service delivery, community participation, ownership and governance .
Why are AB-HWCs important and different from current sub-centres and primary health care centres? The four pillars of primary health care including community participation, appropriate technology, equitable distribution and cross-sectoral coordination are embedded in and around AB-HWCs to enable every Indian citizen to access healthcare of quality, free of charge, close to his home. AB-HWCs is a major transformation of primary healthcare from disease-focused has a the whole society approach.
The focus of primary health care until recently has been on maternal and child health needs. The HWCs that are operational now provide services not only for pregnant women, mothers, newborns and children, but also for communicable and non-communicable diseases, mental health, geriatric and palliative care and for diseases single treble. Screening for the primary prevention of chronic diseases such as hypertension, diabetes and common cancers also shows an encouraging trend. With more than 85.87 crores of steps in HWCs at the end of March 2022, 17.95 crores were screened for hypertension, 14.87 for diabetes and 17.75 crores for three cancers: oral cancer, breast cancer and the cervix. The increase in the number of women accessing HWCs for non-communicable disease services is particularly encouraging as until now these services have not been easily accessible to them.
The availability of free essential drugs, especially for chronic diseases in CHFs, not only reduces patient suffering, but also has the potential to reduce out-of-pocket expenses and prevent secondary complications, thereby ensuring well-being and healthy life for many.
Yoga and wellness are an integral part of Indian culture, hence their inclusion as part of health service delivery is long overdue. In September 2019, at the first-ever High-Level Meeting on Universal Health Coverage at the United Nations, the Honorable Prime Minister called preventive health care the first pillar. Through the HWCs, the Indian government has integrated the rich Indian tradition of indigenous health system and yoga into the health care delivery system. Yoga and well-being sessions are organized in the AB-HWCs and from 14and In April 2022, a total of 1.05 crore wellness sessions were held at AB-HWCs across the country. Health and wellness centers also become the venue for other physical activities (such as regular yoga sessions, organizing cyclathons and marathons), meditation, laughter clubs, campaign talks Eat Right and the Fit India movement, tobacco and drug cessation and a place for sharing best practices within the community. Through an annual health calendar, planned activities at these centers for a range of lifestyle modifications lead to increased public awareness and preventative fitness measures. Additionally, school teachers are trained as Ayushman Ambassadors or Health and Wellness Ambassadors to enable the integration of lifestyle changes during the formative years, which has the potential to prevent or delay the onset of chronic diseases in adulthood.
The sustenance and impact of AB-HWCs largely depends on community ownership of the facilities and people’s trust in the services. AB-HWC’s Jan Arogya Samitis (JAS) is being established to build people’s ownership of public health facilities and accountability of the health care team to citizens. Each JAS has nearly 20 members, with the elected local government representative serving as the chairperson. This gives citizens the ability to leverage public health resources that they rightfully own. These JAS should work in tandem with community platforms such as Village Health and Sanitation Committees (VHSNC) in rural areas and Mahila Arogya Samitis (MAS) in urban areas, to strengthen action on social determinants and health and enable village health planning at the local level. level. Social auditing through self-help groups will strengthen both the local accountability of the centers and the community’s sense of ownership. The Swachh Bharat Abhiyan and the Jal Jeevan Mission are the interventions that will positively contribute to India’s journey towards wellness. The increase in the untied fund to Rs 50,000 for the Health and Welfare Center of the Health Sub Center is a welcome step in this direction.
The celebrations of the 4and anniversary of AB-HWC began on the 16and April 2022. Nationwide congratulations are conducted under the theme “eSanjeevani HWC – Health and well-being by teleconsultation”. The theme echoes the vision established in the early years of the Ayushman Bharat program – reaching the excluded by leveraging technology. It is amazing to know that more than 2.47 crores of teleconsultations were conducted in 94,049 AB-HWCs as of 12and April 2022 and increasing hour by hour.
Today, after four successful years, thanks to the meticulous efforts of the government, health workers and the community, we have been able to meet the anticipated challenges in improving primary health care. Personally, for me, it’s gratifying to see this vision now in mission mode. Although the trip was long, the 4and AB-HWC’s anniversary is an opportunity to honor India’s march towards universal health coverage by recognizing and celebrating the health warriors who have worked tirelessly to “reach out to the excluded”, s committed to a healthier and happier India.
(The author is the former Union Health Secretary of the Government of India. The views expressed are personal and do not reflect the position or official policy of Financial Express Online. Reproduction of this content without permission is prohibited) .
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