| Id |
Subject |
Object |
Predicate |
Lexical cue |
| T97 |
0-202 |
Sentence |
denotes |
The HWCs aims to address the identified challenges in PHC systems in India, by focusing upon holistic PHC strengthening through various initiatives [Table 2 (structured as per health system functions)]. |
| T98 |
203-273 |
Sentence |
denotes |
This is not first such initiative to strengthen PHC services in India. |
| T99 |
274-441 |
Sentence |
denotes |
Yet, why AB-HWCs appears more promising than all earlier initiatives to strengthen and deliver comprehensive PHC has been explained in Appendix 1 [1, 3, 27–29, 31–37]. |
| T100 |
442-619 |
Sentence |
denotes |
This is relevant considering much of 14 y since the launch of National Rural Health Mission (NRHM) in the year 2005, had also focused on strengthening PHC system in the country. |
| T101 |
620-737 |
Sentence |
denotes |
Table 2 Challenges in PHC system, provisions through AB-HWCs and complementarity with NHM in India [1, 3, 27, 28, 31] |
| T102 |
738-907 |
Sentence |
denotes |
Health System Function Challenges in PHC system (Indicative) AB-HWC and related initiatives Ongoing and other proposed initiatives (including NHM & other state specific) |
| T103 |
908-1037 |
Sentence |
denotes |
Service provision and delivery ▪ Narrow range of six services (mostly focused on Maternal & child health and infectious diseases) |
| T104 |
1038-1066 |
Sentence |
denotes |
▪ Curative care predominance |
| T105 |
1067-1238 |
Sentence |
denotes |
▪ ‘Continuum of care’ mostly for maternal and child health services ▪ Stronger focus on service delivery with an enhanced package of 12 services (from existing 6 services) |
| T106 |
1239-1375 |
Sentence |
denotes |
▪ Attention on preventive and promotive health services; focus on wellness and lifestyle modification, specifically for chronic diseases |
| T107 |
1376-1525 |
Sentence |
denotes |
▪ Integration with Indian systems of medicine, AYUSH, including the promotion of Yoga as form of lifestyle change to tackle non-communicable diseases |
| T108 |
1526-1600 |
Sentence |
denotes |
▪ Population based screening for common conditions including three cancers |
| T109 |
1601-1715 |
Sentence |
denotes |
▪ Attention on quality and patient safety; Develop standard treatment flows (STF) for peripheral health facilities |
| T110 |
1716-1776 |
Sentence |
denotes |
▪ Extending prescription rights to CHO through legal process |
| T111 |
1777-1948 |
Sentence |
denotes |
▪ Adopt ‘Resolve more & refer less’ approach at peripheral health facilities; strengthening of referral system to ensure continuity of care; Telemedicine and consultations |
| T112 |
1949-2131 |
Sentence |
denotes |
▪ Enhanced provision of point of care diagnostics at both levels HWC- HSC and HWC-PHC ▪ Community based network of ASHA and VHNSC to support preventive and promotive health services. |
| T113 |
2132-2202 |
Sentence |
denotes |
▪ State specific models of service delivery to provide cross learnings |
| T114 |
2203-2281 |
Sentence |
denotes |
▪ Build on systems for emergency referral and transport; established under NHM |
| T115 |
2282-2384 |
Sentence |
denotes |
▪ Utilise strengthening of secondary care services & District hospitals for effective referral linkage |
| T116 |
2385-2469 |
Sentence |
denotes |
▪ Build upon quality standards and mechanism for ensuring use of treatment protocols |
| T117 |
2470-2602 |
Sentence |
denotes |
▪ Community Health Officers (CHO) proposed in the National Medical Commission (NMC) Act to strengthen public health service delivery |
| T118 |
2603-2686 |
Sentence |
denotes |
Human resources and infrastructure ▪ Shortage of infrastructure and human resources |
| T119 |
2687-2713 |
Sentence |
denotes |
▪ Inequitable distribution |
| T120 |
2714-2832 |
Sentence |
denotes |
▪ Health Sub-centres (HSCs) led by one or two Auxiliary nurse midwife (ANM) who has focus on Mother and child services |
| T121 |
2833-3023 |
Sentence |
denotes |
▪ Narrow range of skills and services at lower level PHC facilities ▪ Provision of Mid-level healthcare provider (MLHP), trained in 6-month course at AB-HWCs to address common health problem |
| T122 |
3024-3093 |
Sentence |
denotes |
▪ Institutional strengthening for increased annual production of MLHP |
| T123 |
3094-3184 |
Sentence |
denotes |
▪ Task shifting to different cadre of healthcare providers and team-based service delivery |
| T124 |
3185-3267 |
Sentence |
denotes |
▪ Proposal to change the roles of ANMs as multi-purpose workers (female) or MPW- F |
| T125 |
3268-3448 |
Sentence |
denotes |
▪ Services at the HWC-HSC, to be delivered through a team, led by a new cadre of non-physician health worker, a MLHP or CHO, supported by one or two multipurpose workers, and ASHAs |
| T126 |
3449-3580 |
Sentence |
denotes |
▪ Shift from doctor centric facilities to a team-based service delivery where provision of providers is dependent upon service need |
| T127 |
3581-3685 |
Sentence |
denotes |
▪ AYUSH providers to be mainstreamed in PHC systems ▪ Recruitment of contractual providers in the system |
| T128 |
3686-3759 |
Sentence |
denotes |
▪ Flexibility to states in salary for HR, under NHM to ensure recruitment |
| T129 |
3760-3814 |
Sentence |
denotes |
▪ Institutionalize the mechanisms for training of MLHP |
| T130 |
3815-3943 |
Sentence |
denotes |
▪ Consider an All India cadre of specialist doctors to tackle shortage of specialist doctors & that of public health specialists |
| T131 |
3944-4018 |
Sentence |
denotes |
▪ Innovation in human resources including incentives to recruit and retain |
| T132 |
4019-4074 |
Sentence |
denotes |
Health financing ▪ Limited government funding on health |
| T133 |
4075-4134 |
Sentence |
denotes |
▪ High OOPE to the range of 60% of total health expenditure |
| T134 |
4135-4179 |
Sentence |
denotes |
▪ Budget mostly line item-based funding only |
| T135 |
4180-4226 |
Sentence |
denotes |
▪ Limited use of strategic purchasing services |
| T136 |
4227-4390 |
Sentence |
denotes |
▪ People get poor because of health expenditures ▪ Reforms on provider payment mechanisms including the introduction of performance-linked incentives in PHC system |
| T137 |
4391-4510 |
Sentence |
denotes |
▪ Mechanisms to reduce cost of health seeking through assured provision of more medicines and point of care diagnostics |
| T138 |
4511-4591 |
Sentence |
denotes |
▪ Performance-linked payments to the MLHP and to the team of front-line workers. |
| T139 |
4592-4906 |
Sentence |
denotes |
▪ MLHP to get salary on blended formula –a fixed component and incentives linked to key outcomes, measured through IT platform-based monitoring system with key performance indicators ▪ Increased government allocation for primary health care, through formula-based approach and sharing between union and state level |
| T140 |
4907-4956 |
Sentence |
denotes |
▪ Capacity building of states in health financing |
| T141 |
4957-5092 |
Sentence |
denotes |
Medicines and vaccines ▪ Many states started free medicines and diagnostics scheme, yet govt spending as share on cost of medicines low |
| T142 |
5093-5189 |
Sentence |
denotes |
▪ Medicines and access to diagnostics mostly at higher level facilities and no assured provision |
| T143 |
5190-5227 |
Sentence |
denotes |
▪ Medicines major cost paid by people |
| T144 |
5228-5325 |
Sentence |
denotes |
▪ Irrational use of medicines ▪ Revision and expansion of essential medicines & diagnostics lists |
| T145 |
5326-5435 |
Sentence |
denotes |
▪ Assured provision of larger basket of medicines with inclusion of additional medicines for chronic diseases |
| T146 |
5436-5505 |
Sentence |
denotes |
▪ Assured dispensing of medicines for longer duration of 4 wk or more |
| T147 |
5506-5575 |
Sentence |
denotes |
▪ Attention on expanded range of diagnostic services of Point of Care |
| T148 |
5576-5677 |
Sentence |
denotes |
▪ Proposal for rapid expansion of Pradhan Mantri Jan Aushadhi stores for low cost & generic medicines |
| T149 |
5678-5751 |
Sentence |
denotes |
▪ Proposal for setting up state level procurement and supply corporations |
| T150 |
5752-5975 |
Sentence |
denotes |
▪ Provision of dispensing medicines from HWCs, for patients who need long term treatment and initially attended care at higher level of facilities ▪ Provision of free medicines and diagnostics (as well as schemes) under NHM |
| T151 |
5976-6090 |
Sentence |
denotes |
▪ Strengthening of Mission Indradhanush for increasing coverage with vaccines under Universal Immunization Program |
| T152 |
6091-6196 |
Sentence |
denotes |
▪ Launch of state specific free medicines and free diagnostics schemes with enhanced budgetary allocation |
| T153 |
6197-6256 |
Sentence |
denotes |
Health information systems ▪ Weak health information system |
| T154 |
6257-6287 |
Sentence |
denotes |
▪ Limited use of ICT platforms |
| T155 |
6288-6452 |
Sentence |
denotes |
▪ Delay in recording and reporting of health data ▪ Attention to build a robust ICT system for population enumeration, enrolment, tracking and follow-up of patients |
| T156 |
6453-6524 |
Sentence |
denotes |
▪ Attention on registration of beneficiaries at associated HWC facility |
| T157 |
6525-6589 |
Sentence |
denotes |
▪ Increased use of mobile based technology and hand-held devices |
| T158 |
6590-6651 |
Sentence |
denotes |
▪ Provision of tele-health and tele-medicine at each facility |
| T159 |
6652-6992 |
Sentence |
denotes |
▪ Use of Digital technology and ICT platforms (proposed for) to ensure continuity of care through universal population empanelment and registration to a HWC, facilitating performance payments and ensuring continuity of care and also for improved recording & reporting system ▪ Telemedicine and tele-radiology services as per the local needs |
| T160 |
6993-7050 |
Sentence |
denotes |
▪ Health Management Information System (HMIS) established |
| T161 |
7051-7094 |
Sentence |
denotes |
Governance and leadership ▪ Weak regulation |
| T162 |
7095-7145 |
Sentence |
denotes |
▪ Limited transition of policy into implementation |
| T163 |
7146-7190 |
Sentence |
denotes |
▪ Health state subject and variable priority |
| T164 |
7191-7367 |
Sentence |
denotes |
▪ The job -descriptions of various health staff are not aligned with the activities they do ▪ High level political and administrative priority assigned to AB-HWCs at all levels |
| T165 |
7368-7453 |
Sentence |
denotes |
▪ System and coordination mechanism being proposed to link PHC services with AB-PMJAY |
| T166 |
7454-7525 |
Sentence |
denotes |
▪ National Knowledge Platform for implementation & operational research |
| T167 |
7526-7563 |
Sentence |
denotes |
▪ Revisions of operational guidelines |
| T168 |
7564-7614 |
Sentence |
denotes |
▪ Enhanced community-based monitoring for AB-HWCs. |
| T169 |
7615-7660 |
Sentence |
denotes |
▪ Regular reviews on progress and performance |
| T170 |
7661-7927 |
Sentence |
denotes |
▪ Revision in responsibilities of auxiliary nurse midwife to make them multi-purpose workers ▪ A number of governance and leadership mechanisms were established under NHM level including mission steering groups at top level to community based VHSNC at village level. |
| T171 |
7928-7994 |
Sentence |
denotes |
▪ The Clinical Establishment Registration and Regulation Act, 2010 |
| T172 |
7995-8066 |
Sentence |
denotes |
▪ Stronger community and civil society participation in health services |
| T173 |
8067-8583 |
Sentence |
denotes |
AB-HWCs Ayushman Bharat- Health & Wellness Centres; AB-PMJAY Ayushman Bharat- Pradhan Mantri Jan Arogya Yojana; ASHA Accredited Social Health Activist; HR Human resources; HWC-HSC Health & Wellness Centres- Health Sub-Centers; HWC-PHC Health & Wellness Centres- Primary Health Care; ICT Information and communication technology; NHM National Health Mission; NMC Act The National Medical Commission Act; OOPE Out of pocket expenditure; PHC Primary Health care; VHNSC Village health, nutrition and sanitation committee |
