PMC:7340764 / 14624-22587 JSONTXT

{"project":"LitCovid-PMC-OGER-BB","denotations":[{"id":"T29","span":{"begin":1573,"end":1582},"obj":"GO:0007612"},{"id":"T30","span":{"begin":2051,"end":2056},"obj":"SP_6;NCBITaxon:9606"},{"id":"T31","span":{"begin":3340,"end":3345},"obj":"SP_6;NCBITaxon:9606"},{"id":"T32","span":{"begin":3609,"end":3615},"obj":"NCBITaxon:1"},{"id":"T33","span":{"begin":4601,"end":4607},"obj":"NCBITaxon:9606"},{"id":"T34","span":{"begin":5158,"end":5167},"obj":"CHEBI:23888;CHEBI:23888"},{"id":"T35","span":{"begin":5952,"end":5956},"obj":"UBERON:0002398"},{"id":"T36","span":{"begin":7354,"end":7364},"obj":"GO:0065007"},{"id":"T37","span":{"begin":7602,"end":7607},"obj":"SP_6;NCBITaxon:9606"}],"text":"Table 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"}

{"project":"LitCovid-PD-FMA-UBERON","denotations":[{"id":"T3","span":{"begin":5952,"end":5956},"obj":"Body_part"}],"attributes":[{"id":"A3","pred":"fma_id","subj":"T3","obj":"http://purl.org/sig/ont/fma/fma9712"}],"text":"Table 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"}

{"project":"LitCovid-PD-UBERON","denotations":[{"id":"T4","span":{"begin":5952,"end":5956},"obj":"Body_part"}],"attributes":[{"id":"A4","pred":"uberon_id","subj":"T4","obj":"http://purl.obolibrary.org/obo/UBERON_0002398"}],"text":"Table 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"}

{"project":"LitCovid-PD-MONDO","denotations":[{"id":"T7","span":{"begin":397,"end":407},"obj":"Disease"},{"id":"T8","span":{"begin":1929,"end":1932},"obj":"Disease"},{"id":"T9","span":{"begin":2165,"end":2168},"obj":"Disease"},{"id":"T10","span":{"begin":7805,"end":7808},"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":"Table 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"}

{"project":"LitCovid-PD-CLO","denotations":[{"id":"T87","span":{"begin":106,"end":108},"obj":"http://purl.obolibrary.org/obo/CLO_0050509"},{"id":"T88","span":{"begin":358,"end":365},"obj":"http://purl.obolibrary.org/obo/CLO_0009985"},{"id":"T89","span":{"begin":526,"end":531},"obj":"http://purl.obolibrary.org/obo/CLO_0009985"},{"id":"T90","span":{"begin":676,"end":681},"obj":"http://purl.obolibrary.org/obo/CLO_0009985"},{"id":"T91","span":{"begin":1131,"end":1134},"obj":"http://purl.obolibrary.org/obo/CLO_0002421"},{"id":"T92","span":{"begin":1131,"end":1134},"obj":"http://purl.obolibrary.org/obo/CLO_0052479"},{"id":"T93","span":{"begin":1131,"end":1134},"obj":"http://purl.obolibrary.org/obo/CLO_0052480"},{"id":"T94","span":{"begin":1131,"end":1134},"obj":"http://purl.obolibrary.org/obo/CLO_0052483"},{"id":"T95","span":{"begin":1131,"end":1134},"obj":"http://purl.obolibrary.org/obo/CLO_0052484"},{"id":"T96","span":{"begin":1131,"end":1134},"obj":"http://purl.obolibrary.org/obo/CLO_0052485"},{"id":"T97","span":{"begin":1399,"end":1402},"obj":"http://purl.obolibrary.org/obo/CL_0000037"},{"id":"T98","span":{"begin":1879,"end":1882},"obj":"http://purl.obolibrary.org/obo/CLO_0002421"},{"id":"T99","span":{"begin":1879,"end":1882},"obj":"http://purl.obolibrary.org/obo/CLO_0052479"},{"id":"T100","span":{"begin":1879,"end":1882},"obj":"http://purl.obolibrary.org/obo/CLO_0052480"},{"id":"T101","span":{"begin":1879,"end":1882},"obj":"http://purl.obolibrary.org/obo/CLO_0052483"},{"id":"T102","span":{"begin":1879,"end":1882},"obj":"http://purl.obolibrary.org/obo/CLO_0052484"},{"id":"T103","span":{"begin":1879,"end":1882},"obj":"http://purl.obolibrary.org/obo/CLO_0052485"},{"id":"T104","span":{"begin":1983,"end":1988},"obj":"http://purl.obolibrary.org/obo/NCBITaxon_9606"},{"id":"T105","span":{"begin":2051,"end":2056},"obj":"http://purl.obolibrary.org/obo/NCBITaxon_9606"},{"id":"T106","span":{"begin":2174,"end":2177},"obj":"http://purl.obolibrary.org/obo/CLO_0051582"},{"id":"T107","span":{"begin":2178,"end":2183},"obj":"http://purl.obolibrary.org/obo/CLO_0009985"},{"id":"T108","span":{"begin":2630,"end":2636},"obj":"http://purl.obolibrary.org/obo/UBERON_0003100"},{"id":"T109","span":{"begin":2670,"end":2673},"obj":"http://purl.obolibrary.org/obo/CL_0000037"},{"id":"T110","span":{"begin":2699,"end":2700},"obj":"http://purl.obolibrary.org/obo/CLO_0001020"},{"id":"T111","span":{"begin":2714,"end":2715},"obj":"http://purl.obolibrary.org/obo/CLO_0001020"},{"id":"T112","span":{"begin":2758,"end":2759},"obj":"http://purl.obolibrary.org/obo/CLO_0001020"},{"id":"T113","span":{"begin":2768,"end":2771},"obj":"http://purl.obolibrary.org/obo/CLO_0002421"},{"id":"T114","span":{"begin":2768,"end":2771},"obj":"http://purl.obolibrary.org/obo/CLO_0052479"},{"id":"T115","span":{"begin":2768,"end":2771},"obj":"http://purl.obolibrary.org/obo/CLO_0052480"},{"id":"T116","span":{"begin":2768,"end":2771},"obj":"http://purl.obolibrary.org/obo/CLO_0052483"},{"id":"T117","span":{"begin":2768,"end":2771},"obj":"http://purl.obolibrary.org/obo/CLO_0052484"},{"id":"T118","span":{"begin":2768,"end":2771},"obj":"http://purl.obolibrary.org/obo/CLO_0052485"},{"id":"T119","span":{"begin":2871,"end":2872},"obj":"http://purl.obolibrary.org/obo/CLO_0001020"},{"id":"T120","span":{"begin":3340,"end":3345},"obj":"http://purl.obolibrary.org/obo/NCBITaxon_9606"},{"id":"T121","span":{"begin":4013,"end":4014},"obj":"http://purl.obolibrary.org/obo/CLO_0001020"},{"id":"T122","span":{"begin":5739,"end":5740},"obj":"http://purl.obolibrary.org/obo/CLO_0001020"},{"id":"T123","span":{"begin":5962,"end":5969},"obj":"http://purl.obolibrary.org/obo/OBI_0000968"},{"id":"T124","span":{"begin":6041,"end":6048},"obj":"http://www.ebi.ac.uk/efo/EFO_0000881"},{"id":"T125","span":{"begin":6183,"end":6184},"obj":"http://purl.obolibrary.org/obo/CLO_0001020"},{"id":"T126","span":{"begin":6644,"end":6654},"obj":"http://purl.obolibrary.org/obo/CLO_0001658"},{"id":"T127","span":{"begin":7136,"end":7137},"obj":"http://purl.obolibrary.org/obo/CLO_0001020"},{"id":"T128","span":{"begin":7602,"end":7607},"obj":"http://purl.obolibrary.org/obo/NCBITaxon_9606"},{"id":"T129","span":{"begin":7623,"end":7626},"obj":"http://purl.obolibrary.org/obo/CL_0000037"}],"text":"Table 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"}

{"project":"LitCovid-PD-CHEBI","denotations":[{"id":"T15","span":{"begin":793,"end":801},"obj":"Chemical"},{"id":"T16","span":{"begin":1399,"end":1402},"obj":"Chemical"},{"id":"T17","span":{"begin":2670,"end":2673},"obj":"Chemical"},{"id":"T18","span":{"begin":6006,"end":6014},"obj":"Chemical"},{"id":"T19","span":{"begin":7623,"end":7626},"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":"Table 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"}

{"project":"LitCovid-PD-GO-BP","denotations":[{"id":"T6","span":{"begin":1573,"end":1582},"obj":"http://purl.obolibrary.org/obo/GO_0007612"},{"id":"T7","span":{"begin":1629,"end":1638},"obj":"http://purl.obolibrary.org/obo/GO_0006810"},{"id":"T8","span":{"begin":6464,"end":6474},"obj":"http://purl.obolibrary.org/obo/GO_0065007"},{"id":"T9","span":{"begin":7354,"end":7364},"obj":"http://purl.obolibrary.org/obo/GO_0065007"}],"text":"Table 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"}

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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"}

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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▪ 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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 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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 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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"}