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LitCovid-PMC-OGER-BB

{"project":"LitCovid-PMC-OGER-BB","denotations":[{"id":"T29","span":{"begin":2193,"end":2202},"obj":"GO:0007612"},{"id":"T30","span":{"begin":2671,"end":2676},"obj":"SP_6;NCBITaxon:9606"},{"id":"T31","span":{"begin":3960,"end":3965},"obj":"SP_6;NCBITaxon:9606"},{"id":"T32","span":{"begin":4229,"end":4235},"obj":"NCBITaxon:1"},{"id":"T33","span":{"begin":5221,"end":5227},"obj":"NCBITaxon:9606"},{"id":"T34","span":{"begin":5778,"end":5787},"obj":"CHEBI:23888;CHEBI:23888"},{"id":"T35","span":{"begin":6572,"end":6576},"obj":"UBERON:0002398"},{"id":"T36","span":{"begin":7974,"end":7984},"obj":"GO:0065007"},{"id":"T37","span":{"begin":8222,"end":8227},"obj":"SP_6;NCBITaxon:9606"}],"text":"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)]. This is not first such initiative to strengthen PHC services in India. 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]. 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.\nTable 2 Challenges in PHC system, provisions through AB-HWCs and complementarity with NHM in India [1, 3, 27, 28, 31]\nHealth System Function Challenges in PHC system (Indicative) AB-HWC and related initiatives Ongoing and other proposed initiatives (including NHM \u0026 other state specific)\nService provision and delivery ▪ Narrow range of six services (mostly focused on Maternal \u0026 child health and infectious diseases)\n▪ Curative care predominance\n▪ ‘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)\n▪ Attention on preventive and promotive health services; focus on wellness and lifestyle modification, specifically for chronic diseases\n▪ Integration with Indian systems of medicine, AYUSH, including the promotion of Yoga as form of lifestyle change to tackle non-communicable diseases\n▪ Population based screening for common conditions including three cancers\n▪ Attention on quality and patient safety; Develop standard treatment flows (STF) for peripheral health facilities\n▪ Extending prescription rights to CHO through legal process\n▪ Adopt ‘Resolve more \u0026 refer less’ approach at peripheral health facilities; strengthening of referral system to ensure continuity of care; Telemedicine and consultations\n▪ 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.\n▪ State specific models of service delivery to provide cross learnings\n▪ Build on systems for emergency referral and transport; established under NHM\n▪ Utilise strengthening of secondary care services \u0026 District hospitals for effective referral linkage\n▪ Build upon quality standards and mechanism for ensuring use of treatment protocols\n▪ Community Health Officers (CHO) proposed in the National Medical Commission (NMC) Act to strengthen public health service delivery\nHuman resources and infrastructure ▪ Shortage of infrastructure and human resources\n▪ Inequitable distribution\n▪ Health Sub-centres (HSCs) led by one or two Auxiliary nurse midwife (ANM) who has focus on Mother and child services\n▪ 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\n▪ Institutional strengthening for increased annual production of MLHP\n▪ Task shifting to different cadre of healthcare providers and team-based service delivery\n▪ Proposal to change the roles of ANMs as multi-purpose workers (female) or MPW- F\n▪ 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\n▪ Shift from doctor centric facilities to a team-based service delivery where provision of providers is dependent upon service need\n▪ AYUSH providers to be mainstreamed in PHC systems ▪ Recruitment of contractual providers in the system\n▪ Flexibility to states in salary for HR, under NHM to ensure recruitment\n▪ Institutionalize the mechanisms for training of MLHP\n▪ Consider an All India cadre of specialist doctors to tackle shortage of specialist doctors \u0026 that of public health specialists\n▪ Innovation in human resources including incentives to recruit and retain\nHealth financing ▪ Limited government funding on health\n▪ High OOPE to the range of 60% of total health expenditure\n▪ Budget mostly line item-based funding only\n▪ Limited use of strategic purchasing services\n▪ People get poor because of health expenditures ▪ Reforms on provider payment mechanisms including the introduction of performance-linked incentives in PHC system\n▪ Mechanisms to reduce cost of health seeking through assured provision of more medicines and point of care diagnostics\n▪ Performance-linked payments to the MLHP and to the team of front-line workers.\n▪ 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\n▪ Capacity building of states in health financing\nMedicines and vaccines ▪ Many states started free medicines and diagnostics scheme, yet govt spending as share on cost of medicines low\n▪ Medicines and access to diagnostics mostly at higher level facilities and no assured provision\n▪ Medicines major cost paid by people\n▪ Irrational use of medicines ▪ Revision and expansion of essential medicines \u0026 diagnostics lists\n▪ Assured provision of larger basket of medicines with inclusion of additional medicines for chronic diseases\n▪ Assured dispensing of medicines for longer duration of 4 wk or more\n▪ Attention on expanded range of diagnostic services of Point of Care\n▪ Proposal for rapid expansion of Pradhan Mantri Jan Aushadhi stores for low cost \u0026 generic medicines\n▪ Proposal for setting up state level procurement and supply corporations\n▪ 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\n▪ Strengthening of Mission Indradhanush for increasing coverage with vaccines under Universal Immunization Program\n▪ Launch of state specific free medicines and free diagnostics schemes with enhanced budgetary allocation\nHealth information systems ▪ Weak health information system\n▪ Limited use of ICT platforms\n▪ 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\n▪ Attention on registration of beneficiaries at associated HWC facility\n▪ Increased use of mobile based technology and hand-held devices\n▪ Provision of tele-health and tele-medicine at each facility\n▪ 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 \u0026 reporting system ▪ Telemedicine and tele-radiology services as per the local needs\n▪ Health Management Information System (HMIS) established\nGovernance and leadership ▪ Weak regulation\n▪ Limited transition of policy into implementation\n▪ Health state subject and variable priority\n▪ 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\n▪ System and coordination mechanism being proposed to link PHC services with AB-PMJAY\n▪ National Knowledge Platform for implementation \u0026 operational research\n▪ Revisions of operational guidelines\n▪ Enhanced community-based monitoring for AB-HWCs.\n▪ Regular reviews on progress and performance\n▪ 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.\n▪ The Clinical Establishment Registration and Regulation Act, 2010\n▪ Stronger community and civil society participation in health services\nAB-HWCs Ayushman Bharat- Health \u0026 Wellness Centres; AB-PMJAY Ayushman Bharat- Pradhan Mantri Jan Arogya Yojana; ASHA Accredited Social Health Activist; HR Human resources; HWC-HSC Health \u0026 Wellness Centres- Health Sub-Centers; HWC-PHC Health \u0026 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"}

LitCovid-PD-FMA-UBERON

{"project":"LitCovid-PD-FMA-UBERON","denotations":[{"id":"T2","span":{"begin":409,"end":417},"obj":"Body_part"},{"id":"T3","span":{"begin":6572,"end":6576},"obj":"Body_part"}],"attributes":[{"id":"A2","pred":"fma_id","subj":"T2","obj":"http://purl.org/sig/ont/fma/fma14542"},{"id":"A3","pred":"fma_id","subj":"T3","obj":"http://purl.org/sig/ont/fma/fma9712"}],"text":"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)]. This is not first such initiative to strengthen PHC services in India. 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]. 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.\nTable 2 Challenges in PHC system, provisions through AB-HWCs and complementarity with NHM in India [1, 3, 27, 28, 31]\nHealth System Function Challenges in PHC system (Indicative) AB-HWC and related initiatives Ongoing and other proposed initiatives (including NHM \u0026 other state specific)\nService provision and delivery ▪ Narrow range of six services (mostly focused on Maternal \u0026 child health and infectious diseases)\n▪ Curative care predominance\n▪ ‘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)\n▪ Attention on preventive and promotive health services; focus on wellness and lifestyle modification, specifically for chronic diseases\n▪ Integration with Indian systems of medicine, AYUSH, including the promotion of Yoga as form of lifestyle change to tackle non-communicable diseases\n▪ Population based screening for common conditions including three cancers\n▪ Attention on quality and patient safety; Develop standard treatment flows (STF) for peripheral health facilities\n▪ Extending prescription rights to CHO through legal process\n▪ Adopt ‘Resolve more \u0026 refer less’ approach at peripheral health facilities; strengthening of referral system to ensure continuity of care; Telemedicine and consultations\n▪ 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.\n▪ State specific models of service delivery to provide cross learnings\n▪ Build on systems for emergency referral and transport; established under NHM\n▪ Utilise strengthening of secondary care services \u0026 District hospitals for effective referral linkage\n▪ Build upon quality standards and mechanism for ensuring use of treatment protocols\n▪ Community Health Officers (CHO) proposed in the National Medical Commission (NMC) Act to strengthen public health service delivery\nHuman resources and infrastructure ▪ Shortage of infrastructure and human resources\n▪ Inequitable distribution\n▪ Health Sub-centres (HSCs) led by one or two Auxiliary nurse midwife (ANM) who has focus on Mother and child services\n▪ 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\n▪ Institutional strengthening for increased annual production of MLHP\n▪ Task shifting to different cadre of healthcare providers and team-based service delivery\n▪ Proposal to change the roles of ANMs as multi-purpose workers (female) or MPW- F\n▪ 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\n▪ Shift from doctor centric facilities to a team-based service delivery where provision of providers is dependent upon service need\n▪ AYUSH providers to be mainstreamed in PHC systems ▪ Recruitment of contractual providers in the system\n▪ Flexibility to states in salary for HR, under NHM to ensure recruitment\n▪ Institutionalize the mechanisms for training of MLHP\n▪ Consider an All India cadre of specialist doctors to tackle shortage of specialist doctors \u0026 that of public health specialists\n▪ Innovation in human resources including incentives to recruit and retain\nHealth financing ▪ Limited government funding on health\n▪ High OOPE to the range of 60% of total health expenditure\n▪ Budget mostly line item-based funding only\n▪ Limited use of strategic purchasing services\n▪ People get poor because of health expenditures ▪ Reforms on provider payment mechanisms including the introduction of performance-linked incentives in PHC system\n▪ Mechanisms to reduce cost of health seeking through assured provision of more medicines and point of care diagnostics\n▪ Performance-linked payments to the MLHP and to the team of front-line workers.\n▪ 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\n▪ Capacity building of states in health financing\nMedicines and vaccines ▪ Many states started free medicines and diagnostics scheme, yet govt spending as share on cost of medicines low\n▪ Medicines and access to diagnostics mostly at higher level facilities and no assured provision\n▪ Medicines major cost paid by people\n▪ Irrational use of medicines ▪ Revision and expansion of essential medicines \u0026 diagnostics lists\n▪ Assured provision of larger basket of medicines with inclusion of additional medicines for chronic diseases\n▪ Assured dispensing of medicines for longer duration of 4 wk or more\n▪ Attention on expanded range of diagnostic services of Point of Care\n▪ Proposal for rapid expansion of Pradhan Mantri Jan Aushadhi stores for low cost \u0026 generic medicines\n▪ Proposal for setting up state level procurement and supply corporations\n▪ 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\n▪ Strengthening of Mission Indradhanush for increasing coverage with vaccines under Universal Immunization Program\n▪ Launch of state specific free medicines and free diagnostics schemes with enhanced budgetary allocation\nHealth information systems ▪ Weak health information system\n▪ Limited use of ICT platforms\n▪ 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\n▪ Attention on registration of beneficiaries at associated HWC facility\n▪ Increased use of mobile based technology and hand-held devices\n▪ Provision of tele-health and tele-medicine at each facility\n▪ 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 \u0026 reporting system ▪ Telemedicine and tele-radiology services as per the local needs\n▪ Health Management Information System (HMIS) established\nGovernance and leadership ▪ Weak regulation\n▪ Limited transition of policy into implementation\n▪ Health state subject and variable priority\n▪ 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\n▪ System and coordination mechanism being proposed to link PHC services with AB-PMJAY\n▪ National Knowledge Platform for implementation \u0026 operational research\n▪ Revisions of operational guidelines\n▪ Enhanced community-based monitoring for AB-HWCs.\n▪ Regular reviews on progress and performance\n▪ 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.\n▪ The Clinical Establishment Registration and Regulation Act, 2010\n▪ Stronger community and civil society participation in health services\nAB-HWCs Ayushman Bharat- Health \u0026 Wellness Centres; AB-PMJAY Ayushman Bharat- Pradhan Mantri Jan Arogya Yojana; ASHA Accredited Social Health Activist; HR Human resources; HWC-HSC Health \u0026 Wellness Centres- Health Sub-Centers; HWC-PHC Health \u0026 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"}

LitCovid-PD-UBERON

{"project":"LitCovid-PD-UBERON","denotations":[{"id":"T4","span":{"begin":6572,"end":6576},"obj":"Body_part"}],"attributes":[{"id":"A4","pred":"uberon_id","subj":"T4","obj":"http://purl.obolibrary.org/obo/UBERON_0002398"}],"text":"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)]. This is not first such initiative to strengthen PHC services in India. 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]. 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.\nTable 2 Challenges in PHC system, provisions through AB-HWCs and complementarity with NHM in India [1, 3, 27, 28, 31]\nHealth System Function Challenges in PHC system (Indicative) AB-HWC and related initiatives Ongoing and other proposed initiatives (including NHM \u0026 other state specific)\nService provision and delivery ▪ Narrow range of six services (mostly focused on Maternal \u0026 child health and infectious diseases)\n▪ Curative care predominance\n▪ ‘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)\n▪ Attention on preventive and promotive health services; focus on wellness and lifestyle modification, specifically for chronic diseases\n▪ Integration with Indian systems of medicine, AYUSH, including the promotion of Yoga as form of lifestyle change to tackle non-communicable diseases\n▪ Population based screening for common conditions including three cancers\n▪ Attention on quality and patient safety; Develop standard treatment flows (STF) for peripheral health facilities\n▪ Extending prescription rights to CHO through legal process\n▪ Adopt ‘Resolve more \u0026 refer less’ approach at peripheral health facilities; strengthening of referral system to ensure continuity of care; Telemedicine and consultations\n▪ 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.\n▪ State specific models of service delivery to provide cross learnings\n▪ Build on systems for emergency referral and transport; established under NHM\n▪ Utilise strengthening of secondary care services \u0026 District hospitals for effective referral linkage\n▪ Build upon quality standards and mechanism for ensuring use of treatment protocols\n▪ Community Health Officers (CHO) proposed in the National Medical Commission (NMC) Act to strengthen public health service delivery\nHuman resources and infrastructure ▪ Shortage of infrastructure and human resources\n▪ Inequitable distribution\n▪ Health Sub-centres (HSCs) led by one or two Auxiliary nurse midwife (ANM) who has focus on Mother and child services\n▪ 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\n▪ Institutional strengthening for increased annual production of MLHP\n▪ Task shifting to different cadre of healthcare providers and team-based service delivery\n▪ Proposal to change the roles of ANMs as multi-purpose workers (female) or MPW- F\n▪ 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\n▪ Shift from doctor centric facilities to a team-based service delivery where provision of providers is dependent upon service need\n▪ AYUSH providers to be mainstreamed in PHC systems ▪ Recruitment of contractual providers in the system\n▪ Flexibility to states in salary for HR, under NHM to ensure recruitment\n▪ Institutionalize the mechanisms for training of MLHP\n▪ Consider an All India cadre of specialist doctors to tackle shortage of specialist doctors \u0026 that of public health specialists\n▪ Innovation in human resources including incentives to recruit and retain\nHealth financing ▪ Limited government funding on health\n▪ High OOPE to the range of 60% of total health expenditure\n▪ Budget mostly line item-based funding only\n▪ Limited use of strategic purchasing services\n▪ People get poor because of health expenditures ▪ Reforms on provider payment mechanisms including the introduction of performance-linked incentives in PHC system\n▪ Mechanisms to reduce cost of health seeking through assured provision of more medicines and point of care diagnostics\n▪ Performance-linked payments to the MLHP and to the team of front-line workers.\n▪ 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\n▪ Capacity building of states in health financing\nMedicines and vaccines ▪ Many states started free medicines and diagnostics scheme, yet govt spending as share on cost of medicines low\n▪ Medicines and access to diagnostics mostly at higher level facilities and no assured provision\n▪ Medicines major cost paid by people\n▪ Irrational use of medicines ▪ Revision and expansion of essential medicines \u0026 diagnostics lists\n▪ Assured provision of larger basket of medicines with inclusion of additional medicines for chronic diseases\n▪ Assured dispensing of medicines for longer duration of 4 wk or more\n▪ Attention on expanded range of diagnostic services of Point of Care\n▪ Proposal for rapid expansion of Pradhan Mantri Jan Aushadhi stores for low cost \u0026 generic medicines\n▪ Proposal for setting up state level procurement and supply corporations\n▪ 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\n▪ Strengthening of Mission Indradhanush for increasing coverage with vaccines under Universal Immunization Program\n▪ Launch of state specific free medicines and free diagnostics schemes with enhanced budgetary allocation\nHealth information systems ▪ Weak health information system\n▪ Limited use of ICT platforms\n▪ 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\n▪ Attention on registration of beneficiaries at associated HWC facility\n▪ Increased use of mobile based technology and hand-held devices\n▪ Provision of tele-health and tele-medicine at each facility\n▪ 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 \u0026 reporting system ▪ Telemedicine and tele-radiology services as per the local needs\n▪ Health Management Information System (HMIS) established\nGovernance and leadership ▪ Weak regulation\n▪ Limited transition of policy into implementation\n▪ Health state subject and variable priority\n▪ 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\n▪ System and coordination mechanism being proposed to link PHC services with AB-PMJAY\n▪ National Knowledge Platform for implementation \u0026 operational research\n▪ Revisions of operational guidelines\n▪ Enhanced community-based monitoring for AB-HWCs.\n▪ Regular reviews on progress and performance\n▪ 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.\n▪ The Clinical Establishment Registration and Regulation Act, 2010\n▪ Stronger community and civil society participation in health services\nAB-HWCs Ayushman Bharat- Health \u0026 Wellness Centres; AB-PMJAY Ayushman Bharat- Pradhan Mantri Jan Arogya Yojana; ASHA Accredited Social Health Activist; HR Human resources; HWC-HSC Health \u0026 Wellness Centres- Health Sub-Centers; HWC-PHC Health \u0026 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"}

LitCovid-PD-MONDO

{"project":"LitCovid-PD-MONDO","denotations":[{"id":"T7","span":{"begin":1017,"end":1027},"obj":"Disease"},{"id":"T8","span":{"begin":2549,"end":2552},"obj":"Disease"},{"id":"T9","span":{"begin":2785,"end":2788},"obj":"Disease"},{"id":"T10","span":{"begin":8425,"end":8428},"obj":"Disease"}],"attributes":[{"id":"A7","pred":"mondo_id","subj":"T7","obj":"http://purl.obolibrary.org/obo/MONDO_0005550"},{"id":"A8","pred":"mondo_id","subj":"T8","obj":"http://purl.obolibrary.org/obo/MONDO_0005563"},{"id":"A9","pred":"mondo_id","subj":"T9","obj":"http://purl.obolibrary.org/obo/MONDO_0011539"},{"id":"A10","pred":"mondo_id","subj":"T10","obj":"http://purl.obolibrary.org/obo/MONDO_0005563"}],"text":"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)]. This is not first such initiative to strengthen PHC services in India. 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]. 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.\nTable 2 Challenges in PHC system, provisions through AB-HWCs and complementarity with NHM in India [1, 3, 27, 28, 31]\nHealth System Function Challenges in PHC system (Indicative) AB-HWC and related initiatives Ongoing and other proposed initiatives (including NHM \u0026 other state specific)\nService provision and delivery ▪ Narrow range of six services (mostly focused on Maternal \u0026 child health and infectious diseases)\n▪ Curative care predominance\n▪ ‘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)\n▪ Attention on preventive and promotive health services; focus on wellness and lifestyle modification, specifically for chronic diseases\n▪ Integration with Indian systems of medicine, AYUSH, including the promotion of Yoga as form of lifestyle change to tackle non-communicable diseases\n▪ Population based screening for common conditions including three cancers\n▪ Attention on quality and patient safety; Develop standard treatment flows (STF) for peripheral health facilities\n▪ Extending prescription rights to CHO through legal process\n▪ Adopt ‘Resolve more \u0026 refer less’ approach at peripheral health facilities; strengthening of referral system to ensure continuity of care; Telemedicine and consultations\n▪ 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.\n▪ State specific models of service delivery to provide cross learnings\n▪ Build on systems for emergency referral and transport; established under NHM\n▪ Utilise strengthening of secondary care services \u0026 District hospitals for effective referral linkage\n▪ Build upon quality standards and mechanism for ensuring use of treatment protocols\n▪ Community Health Officers (CHO) proposed in the National Medical Commission (NMC) Act to strengthen public health service delivery\nHuman resources and infrastructure ▪ Shortage of infrastructure and human resources\n▪ Inequitable distribution\n▪ Health Sub-centres (HSCs) led by one or two Auxiliary nurse midwife (ANM) who has focus on Mother and child services\n▪ 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\n▪ Institutional strengthening for increased annual production of MLHP\n▪ Task shifting to different cadre of healthcare providers and team-based service delivery\n▪ Proposal to change the roles of ANMs as multi-purpose workers (female) or MPW- F\n▪ 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\n▪ Shift from doctor centric facilities to a team-based service delivery where provision of providers is dependent upon service need\n▪ AYUSH providers to be mainstreamed in PHC systems ▪ Recruitment of contractual providers in the system\n▪ Flexibility to states in salary for HR, under NHM to ensure recruitment\n▪ Institutionalize the mechanisms for training of MLHP\n▪ Consider an All India cadre of specialist doctors to tackle shortage of specialist doctors \u0026 that of public health specialists\n▪ Innovation in human resources including incentives to recruit and retain\nHealth financing ▪ Limited government funding on health\n▪ High OOPE to the range of 60% of total health expenditure\n▪ Budget mostly line item-based funding only\n▪ Limited use of strategic purchasing services\n▪ People get poor because of health expenditures ▪ Reforms on provider payment mechanisms including the introduction of performance-linked incentives in PHC system\n▪ Mechanisms to reduce cost of health seeking through assured provision of more medicines and point of care diagnostics\n▪ Performance-linked payments to the MLHP and to the team of front-line workers.\n▪ 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\n▪ Capacity building of states in health financing\nMedicines and vaccines ▪ Many states started free medicines and diagnostics scheme, yet govt spending as share on cost of medicines low\n▪ Medicines and access to diagnostics mostly at higher level facilities and no assured provision\n▪ Medicines major cost paid by people\n▪ Irrational use of medicines ▪ Revision and expansion of essential medicines \u0026 diagnostics lists\n▪ Assured provision of larger basket of medicines with inclusion of additional medicines for chronic diseases\n▪ Assured dispensing of medicines for longer duration of 4 wk or more\n▪ Attention on expanded range of diagnostic services of Point of Care\n▪ Proposal for rapid expansion of Pradhan Mantri Jan Aushadhi stores for low cost \u0026 generic medicines\n▪ Proposal for setting up state level procurement and supply corporations\n▪ 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\n▪ Strengthening of Mission Indradhanush for increasing coverage with vaccines under Universal Immunization Program\n▪ Launch of state specific free medicines and free diagnostics schemes with enhanced budgetary allocation\nHealth information systems ▪ Weak health information system\n▪ Limited use of ICT platforms\n▪ 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\n▪ Attention on registration of beneficiaries at associated HWC facility\n▪ Increased use of mobile based technology and hand-held devices\n▪ Provision of tele-health and tele-medicine at each facility\n▪ 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 \u0026 reporting system ▪ Telemedicine and tele-radiology services as per the local needs\n▪ Health Management Information System (HMIS) established\nGovernance and leadership ▪ Weak regulation\n▪ Limited transition of policy into implementation\n▪ Health state subject and variable priority\n▪ 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\n▪ System and coordination mechanism being proposed to link PHC services with AB-PMJAY\n▪ National Knowledge Platform for implementation \u0026 operational research\n▪ Revisions of operational guidelines\n▪ Enhanced community-based monitoring for AB-HWCs.\n▪ Regular reviews on progress and performance\n▪ 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.\n▪ The Clinical Establishment Registration and Regulation Act, 2010\n▪ Stronger community and civil society participation in health services\nAB-HWCs Ayushman Bharat- Health \u0026 Wellness Centres; AB-PMJAY Ayushman Bharat- Pradhan Mantri Jan Arogya Yojana; ASHA Accredited Social Health Activist; HR Human resources; HWC-HSC Health \u0026 Wellness Centres- Health Sub-Centers; HWC-PHC Health \u0026 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"}

LitCovid-PD-CLO

LitCovid-PD-CHEBI

{"project":"LitCovid-PD-CHEBI","denotations":[{"id":"T15","span":{"begin":1413,"end":1421},"obj":"Chemical"},{"id":"T16","span":{"begin":2019,"end":2022},"obj":"Chemical"},{"id":"T17","span":{"begin":3290,"end":3293},"obj":"Chemical"},{"id":"T18","span":{"begin":6626,"end":6634},"obj":"Chemical"},{"id":"T19","span":{"begin":8243,"end":8246},"obj":"Chemical"}],"attributes":[{"id":"A15","pred":"chebi_id","subj":"T15","obj":"http://purl.obolibrary.org/obo/CHEBI_23888"},{"id":"A16","pred":"chebi_id","subj":"T16","obj":"http://purl.obolibrary.org/obo/CHEBI_50443"},{"id":"A17","pred":"chebi_id","subj":"T17","obj":"http://purl.obolibrary.org/obo/CHEBI_50443"},{"id":"A18","pred":"chebi_id","subj":"T18","obj":"http://purl.obolibrary.org/obo/CHEBI_23888"},{"id":"A19","pred":"chebi_id","subj":"T19","obj":"http://purl.obolibrary.org/obo/CHEBI_50443"}],"text":"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)]. This is not first such initiative to strengthen PHC services in India. 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]. 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.\nTable 2 Challenges in PHC system, provisions through AB-HWCs and complementarity with NHM in India [1, 3, 27, 28, 31]\nHealth System Function Challenges in PHC system (Indicative) AB-HWC and related initiatives Ongoing and other proposed initiatives (including NHM \u0026 other state specific)\nService provision and delivery ▪ Narrow range of six services (mostly focused on Maternal \u0026 child health and infectious diseases)\n▪ Curative care predominance\n▪ ‘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)\n▪ Attention on preventive and promotive health services; focus on wellness and lifestyle modification, specifically for chronic diseases\n▪ Integration with Indian systems of medicine, AYUSH, including the promotion of Yoga as form of lifestyle change to tackle non-communicable diseases\n▪ Population based screening for common conditions including three cancers\n▪ Attention on quality and patient safety; Develop standard treatment flows (STF) for peripheral health facilities\n▪ Extending prescription rights to CHO through legal process\n▪ Adopt ‘Resolve more \u0026 refer less’ approach at peripheral health facilities; strengthening of referral system to ensure continuity of care; Telemedicine and consultations\n▪ 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.\n▪ State specific models of service delivery to provide cross learnings\n▪ Build on systems for emergency referral and transport; established under NHM\n▪ Utilise strengthening of secondary care services \u0026 District hospitals for effective referral linkage\n▪ Build upon quality standards and mechanism for ensuring use of treatment protocols\n▪ Community Health Officers (CHO) proposed in the National Medical Commission (NMC) Act to strengthen public health service delivery\nHuman resources and infrastructure ▪ Shortage of infrastructure and human resources\n▪ Inequitable distribution\n▪ Health Sub-centres (HSCs) led by one or two Auxiliary nurse midwife (ANM) who has focus on Mother and child services\n▪ 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\n▪ Institutional strengthening for increased annual production of MLHP\n▪ Task shifting to different cadre of healthcare providers and team-based service delivery\n▪ Proposal to change the roles of ANMs as multi-purpose workers (female) or MPW- F\n▪ 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\n▪ Shift from doctor centric facilities to a team-based service delivery where provision of providers is dependent upon service need\n▪ AYUSH providers to be mainstreamed in PHC systems ▪ Recruitment of contractual providers in the system\n▪ Flexibility to states in salary for HR, under NHM to ensure recruitment\n▪ Institutionalize the mechanisms for training of MLHP\n▪ Consider an All India cadre of specialist doctors to tackle shortage of specialist doctors \u0026 that of public health specialists\n▪ Innovation in human resources including incentives to recruit and retain\nHealth financing ▪ Limited government funding on health\n▪ High OOPE to the range of 60% of total health expenditure\n▪ Budget mostly line item-based funding only\n▪ Limited use of strategic purchasing services\n▪ People get poor because of health expenditures ▪ Reforms on provider payment mechanisms including the introduction of performance-linked incentives in PHC system\n▪ Mechanisms to reduce cost of health seeking through assured provision of more medicines and point of care diagnostics\n▪ Performance-linked payments to the MLHP and to the team of front-line workers.\n▪ 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\n▪ Capacity building of states in health financing\nMedicines and vaccines ▪ Many states started free medicines and diagnostics scheme, yet govt spending as share on cost of medicines low\n▪ Medicines and access to diagnostics mostly at higher level facilities and no assured provision\n▪ Medicines major cost paid by people\n▪ Irrational use of medicines ▪ Revision and expansion of essential medicines \u0026 diagnostics lists\n▪ Assured provision of larger basket of medicines with inclusion of additional medicines for chronic diseases\n▪ Assured dispensing of medicines for longer duration of 4 wk or more\n▪ Attention on expanded range of diagnostic services of Point of Care\n▪ Proposal for rapid expansion of Pradhan Mantri Jan Aushadhi stores for low cost \u0026 generic medicines\n▪ Proposal for setting up state level procurement and supply corporations\n▪ 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\n▪ Strengthening of Mission Indradhanush for increasing coverage with vaccines under Universal Immunization Program\n▪ Launch of state specific free medicines and free diagnostics schemes with enhanced budgetary allocation\nHealth information systems ▪ Weak health information system\n▪ Limited use of ICT platforms\n▪ 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\n▪ Attention on registration of beneficiaries at associated HWC facility\n▪ Increased use of mobile based technology and hand-held devices\n▪ Provision of tele-health and tele-medicine at each facility\n▪ 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 \u0026 reporting system ▪ Telemedicine and tele-radiology services as per the local needs\n▪ Health Management Information System (HMIS) established\nGovernance and leadership ▪ Weak regulation\n▪ Limited transition of policy into implementation\n▪ Health state subject and variable priority\n▪ 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\n▪ System and coordination mechanism being proposed to link PHC services with AB-PMJAY\n▪ National Knowledge Platform for implementation \u0026 operational research\n▪ Revisions of operational guidelines\n▪ Enhanced community-based monitoring for AB-HWCs.\n▪ Regular reviews on progress and performance\n▪ 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.\n▪ The Clinical Establishment Registration and Regulation Act, 2010\n▪ Stronger community and civil society participation in health services\nAB-HWCs Ayushman Bharat- Health \u0026 Wellness Centres; AB-PMJAY Ayushman Bharat- Pradhan Mantri Jan Arogya Yojana; ASHA Accredited Social Health Activist; HR Human resources; HWC-HSC Health \u0026 Wellness Centres- Health Sub-Centers; HWC-PHC Health \u0026 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"}

LitCovid-PD-GO-BP

{"project":"LitCovid-PD-GO-BP","denotations":[{"id":"T6","span":{"begin":2193,"end":2202},"obj":"http://purl.obolibrary.org/obo/GO_0007612"},{"id":"T7","span":{"begin":2249,"end":2258},"obj":"http://purl.obolibrary.org/obo/GO_0006810"},{"id":"T8","span":{"begin":7084,"end":7094},"obj":"http://purl.obolibrary.org/obo/GO_0065007"},{"id":"T9","span":{"begin":7974,"end":7984},"obj":"http://purl.obolibrary.org/obo/GO_0065007"}],"text":"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)]. This is not first such initiative to strengthen PHC services in India. 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]. 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.\nTable 2 Challenges in PHC system, provisions through AB-HWCs and complementarity with NHM in India [1, 3, 27, 28, 31]\nHealth System Function Challenges in PHC system (Indicative) AB-HWC and related initiatives Ongoing and other proposed initiatives (including NHM \u0026 other state specific)\nService provision and delivery ▪ Narrow range of six services (mostly focused on Maternal \u0026 child health and infectious diseases)\n▪ Curative care predominance\n▪ ‘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)\n▪ Attention on preventive and promotive health services; focus on wellness and lifestyle modification, specifically for chronic diseases\n▪ Integration with Indian systems of medicine, AYUSH, including the promotion of Yoga as form of lifestyle change to tackle non-communicable diseases\n▪ Population based screening for common conditions including three cancers\n▪ Attention on quality and patient safety; Develop standard treatment flows (STF) for peripheral health facilities\n▪ Extending prescription rights to CHO through legal process\n▪ Adopt ‘Resolve more \u0026 refer less’ approach at peripheral health facilities; strengthening of referral system to ensure continuity of care; Telemedicine and consultations\n▪ 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.\n▪ State specific models of service delivery to provide cross learnings\n▪ Build on systems for emergency referral and transport; established under NHM\n▪ Utilise strengthening of secondary care services \u0026 District hospitals for effective referral linkage\n▪ Build upon quality standards and mechanism for ensuring use of treatment protocols\n▪ Community Health Officers (CHO) proposed in the National Medical Commission (NMC) Act to strengthen public health service delivery\nHuman resources and infrastructure ▪ Shortage of infrastructure and human resources\n▪ Inequitable distribution\n▪ Health Sub-centres (HSCs) led by one or two Auxiliary nurse midwife (ANM) who has focus on Mother and child services\n▪ 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\n▪ Institutional strengthening for increased annual production of MLHP\n▪ Task shifting to different cadre of healthcare providers and team-based service delivery\n▪ Proposal to change the roles of ANMs as multi-purpose workers (female) or MPW- F\n▪ 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\n▪ Shift from doctor centric facilities to a team-based service delivery where provision of providers is dependent upon service need\n▪ AYUSH providers to be mainstreamed in PHC systems ▪ Recruitment of contractual providers in the system\n▪ Flexibility to states in salary for HR, under NHM to ensure recruitment\n▪ Institutionalize the mechanisms for training of MLHP\n▪ Consider an All India cadre of specialist doctors to tackle shortage of specialist doctors \u0026 that of public health specialists\n▪ Innovation in human resources including incentives to recruit and retain\nHealth financing ▪ Limited government funding on health\n▪ High OOPE to the range of 60% of total health expenditure\n▪ Budget mostly line item-based funding only\n▪ Limited use of strategic purchasing services\n▪ People get poor because of health expenditures ▪ Reforms on provider payment mechanisms including the introduction of performance-linked incentives in PHC system\n▪ Mechanisms to reduce cost of health seeking through assured provision of more medicines and point of care diagnostics\n▪ Performance-linked payments to the MLHP and to the team of front-line workers.\n▪ 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\n▪ Capacity building of states in health financing\nMedicines and vaccines ▪ Many states started free medicines and diagnostics scheme, yet govt spending as share on cost of medicines low\n▪ Medicines and access to diagnostics mostly at higher level facilities and no assured provision\n▪ Medicines major cost paid by people\n▪ Irrational use of medicines ▪ Revision and expansion of essential medicines \u0026 diagnostics lists\n▪ Assured provision of larger basket of medicines with inclusion of additional medicines for chronic diseases\n▪ Assured dispensing of medicines for longer duration of 4 wk or more\n▪ Attention on expanded range of diagnostic services of Point of Care\n▪ Proposal for rapid expansion of Pradhan Mantri Jan Aushadhi stores for low cost \u0026 generic medicines\n▪ Proposal for setting up state level procurement and supply corporations\n▪ 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\n▪ Strengthening of Mission Indradhanush for increasing coverage with vaccines under Universal Immunization Program\n▪ Launch of state specific free medicines and free diagnostics schemes with enhanced budgetary allocation\nHealth information systems ▪ Weak health information system\n▪ Limited use of ICT platforms\n▪ 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\n▪ Attention on registration of beneficiaries at associated HWC facility\n▪ Increased use of mobile based technology and hand-held devices\n▪ Provision of tele-health and tele-medicine at each facility\n▪ 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 \u0026 reporting system ▪ Telemedicine and tele-radiology services as per the local needs\n▪ Health Management Information System (HMIS) established\nGovernance and leadership ▪ Weak regulation\n▪ Limited transition of policy into implementation\n▪ Health state subject and variable priority\n▪ 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\n▪ System and coordination mechanism being proposed to link PHC services with AB-PMJAY\n▪ National Knowledge Platform for implementation \u0026 operational research\n▪ Revisions of operational guidelines\n▪ Enhanced community-based monitoring for AB-HWCs.\n▪ Regular reviews on progress and performance\n▪ 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.\n▪ The Clinical Establishment Registration and Regulation Act, 2010\n▪ Stronger community and civil society participation in health services\nAB-HWCs Ayushman Bharat- Health \u0026 Wellness Centres; AB-PMJAY Ayushman Bharat- Pradhan Mantri Jan Arogya Yojana; ASHA Accredited Social Health Activist; HR Human resources; HWC-HSC Health \u0026 Wellness Centres- Health Sub-Centers; HWC-PHC Health \u0026 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"}

LitCovid-sentences

LitCovid-PubTator

2_test

{"project":"2_test","denotations":[{"id":"32638338-29978817-47199303","span":{"begin":421,"end":422},"obj":"29978817"},{"id":"32638338-29978817-47199304","span":{"begin":720,"end":721},"obj":"29978817"},{"id":"T20260","span":{"begin":421,"end":422},"obj":"29978817"},{"id":"T32071","span":{"begin":720,"end":721},"obj":"29978817"}],"text":"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)]. This is not first such initiative to strengthen PHC services in India. 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]. 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.\nTable 2 Challenges in PHC system, provisions through AB-HWCs and complementarity with NHM in India [1, 3, 27, 28, 31]\nHealth System Function Challenges in PHC system (Indicative) AB-HWC and related initiatives Ongoing and other proposed initiatives (including NHM \u0026 other state specific)\nService provision and delivery ▪ Narrow range of six services (mostly focused on Maternal \u0026 child health and infectious diseases)\n▪ Curative care predominance\n▪ ‘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)\n▪ Attention on preventive and promotive health services; focus on wellness and lifestyle modification, specifically for chronic diseases\n▪ Integration with Indian systems of medicine, AYUSH, including the promotion of Yoga as form of lifestyle change to tackle non-communicable diseases\n▪ Population based screening for common conditions including three cancers\n▪ Attention on quality and patient safety; Develop standard treatment flows (STF) for peripheral health facilities\n▪ Extending prescription rights to CHO through legal process\n▪ Adopt ‘Resolve more \u0026 refer less’ approach at peripheral health facilities; strengthening of referral system to ensure continuity of care; Telemedicine and consultations\n▪ 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.\n▪ State specific models of service delivery to provide cross learnings\n▪ Build on systems for emergency referral and transport; established under NHM\n▪ Utilise strengthening of secondary care services \u0026 District hospitals for effective referral linkage\n▪ Build upon quality standards and mechanism for ensuring use of treatment protocols\n▪ Community Health Officers (CHO) proposed in the National Medical Commission (NMC) Act to strengthen public health service delivery\nHuman resources and infrastructure ▪ Shortage of infrastructure and human resources\n▪ Inequitable distribution\n▪ Health Sub-centres (HSCs) led by one or two Auxiliary nurse midwife (ANM) who has focus on Mother and child services\n▪ 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\n▪ Institutional strengthening for increased annual production of MLHP\n▪ Task shifting to different cadre of healthcare providers and team-based service delivery\n▪ Proposal to change the roles of ANMs as multi-purpose workers (female) or MPW- F\n▪ 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\n▪ Shift from doctor centric facilities to a team-based service delivery where provision of providers is dependent upon service need\n▪ AYUSH providers to be mainstreamed in PHC systems ▪ Recruitment of contractual providers in the system\n▪ Flexibility to states in salary for HR, under NHM to ensure recruitment\n▪ Institutionalize the mechanisms for training of MLHP\n▪ Consider an All India cadre of specialist doctors to tackle shortage of specialist doctors \u0026 that of public health specialists\n▪ Innovation in human resources including incentives to recruit and retain\nHealth financing ▪ Limited government funding on health\n▪ High OOPE to the range of 60% of total health expenditure\n▪ Budget mostly line item-based funding only\n▪ Limited use of strategic purchasing services\n▪ People get poor because of health expenditures ▪ Reforms on provider payment mechanisms including the introduction of performance-linked incentives in PHC system\n▪ Mechanisms to reduce cost of health seeking through assured provision of more medicines and point of care diagnostics\n▪ Performance-linked payments to the MLHP and to the team of front-line workers.\n▪ 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\n▪ Capacity building of states in health financing\nMedicines and vaccines ▪ Many states started free medicines and diagnostics scheme, yet govt spending as share on cost of medicines low\n▪ Medicines and access to diagnostics mostly at higher level facilities and no assured provision\n▪ Medicines major cost paid by people\n▪ Irrational use of medicines ▪ Revision and expansion of essential medicines \u0026 diagnostics lists\n▪ Assured provision of larger basket of medicines with inclusion of additional medicines for chronic diseases\n▪ Assured dispensing of medicines for longer duration of 4 wk or more\n▪ Attention on expanded range of diagnostic services of Point of Care\n▪ Proposal for rapid expansion of Pradhan Mantri Jan Aushadhi stores for low cost \u0026 generic medicines\n▪ Proposal for setting up state level procurement and supply corporations\n▪ 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\n▪ Strengthening of Mission Indradhanush for increasing coverage with vaccines under Universal Immunization Program\n▪ Launch of state specific free medicines and free diagnostics schemes with enhanced budgetary allocation\nHealth information systems ▪ Weak health information system\n▪ Limited use of ICT platforms\n▪ 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\n▪ Attention on registration of beneficiaries at associated HWC facility\n▪ Increased use of mobile based technology and hand-held devices\n▪ Provision of tele-health and tele-medicine at each facility\n▪ 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 \u0026 reporting system ▪ Telemedicine and tele-radiology services as per the local needs\n▪ Health Management Information System (HMIS) established\nGovernance and leadership ▪ Weak regulation\n▪ Limited transition of policy into implementation\n▪ Health state subject and variable priority\n▪ 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\n▪ System and coordination mechanism being proposed to link PHC services with AB-PMJAY\n▪ National Knowledge Platform for implementation \u0026 operational research\n▪ Revisions of operational guidelines\n▪ Enhanced community-based monitoring for AB-HWCs.\n▪ Regular reviews on progress and performance\n▪ 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.\n▪ The Clinical Establishment Registration and Regulation Act, 2010\n▪ Stronger community and civil society participation in health services\nAB-HWCs Ayushman Bharat- Health \u0026 Wellness Centres; AB-PMJAY Ayushman Bharat- Pradhan Mantri Jan Arogya Yojana; ASHA Accredited Social Health Activist; HR Human resources; HWC-HSC Health \u0026 Wellness Centres- Health Sub-Centers; HWC-PHC Health \u0026 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"}

PMC:7340764 / 14004-22587 JSONTXT

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PMC:7340764 / 14004-22587 JSON TXT