Appendix 1

Why AB-HWCs hold the promise to strengthen and deliver comprehensive PHC? [1, 3, 27,29, 31,37]

System strengthening for better health by tackling identified challenges.
The components of HWCs are arguably well thought through and designed keeping in the mind the existing and identified challenges in GPHCF in India [1, 3, 27, 28, 31]. The new provision of services are better informed by emerging evidence as well as changing epidemiological reality.

Approaches to deliver new types of preventive and promotive health needs.
The design of HWCs seems to be cognizant that to tackle triple burden of MCH, ongoing burden of infectious diseases and emerging burden of NCDs, a comprehensive approach is required [29]. This also means a system design for provision of new type of preventive and promotive health services. The preventive and promotive services of earlier period (Family planning, immunization and for disease control) need to be continued. However, new preventive and promotive health services to tackle emerging burden of non-communicable diseases (NCDs): healthy diet, no smoking, physical activity and moderate use of alcohol, require regular participation of individual from the beginning, need to be accelerated and continued to be followed for long.

Shifting service delivery from ‘doctor centric’ to ‘team based’ with focus on mid-level healthcare providers (MLHP).
The MLHP and other group of such providers known as Community health officers (CHOs) are being deputed to the AB-HWCs. The CHO/MLHP approach has been made institutional and has been given legal status by their inclusion in National Medical Commission (NMC) Act, 2019 with limited prescription rights [31, 34]. This process has witnessed a number of innovations and state public universities (Tamil Nadu, Maharashtra, West Bengal, Gujarat and Jammu & Kashmir) also offering the certificate programme. These modules, have now been included in B. Sc and Post Basic Nursing Curriculum – which will enable course to be offered in 2,500 Nursing Colleges with annual admission capacity of 112,546 candidates [35].

I of ‘Illness’ proposed to be replaced with We to make it ‘Wellness’ care system.
This has been proposed through change in the approach to service delivery from routine curative care to more of community engagement and other cadre of providers. The traditional health systems are also being mainstreamed in health services and includes, regular Yoga sessions and Health promotion activities at AB-HWCs; Awareness on ‘Eat Right India’ and promotion of ‘Fit India initiatives’ [36, 37]; provision of Food adulteration detection kits at PHCs; Nutritional counseling at AB-HWCs using the provisions of POSHAN Abhiyan under Ministry of Women & Child Development; Preventive and Promotive Healthcare Services involving Behavior change communication through Self Help Groups, youth and other organized groups, School Health Ambassadors, Village Health Sanitation and Nutrition Committees (VHSNCs), Panchayati raj Institutions (PRIs) and urban local bodies (ULBs), etc. All these are further expected to bring focus on wellness in health services. This is also aligned to seven components of Swasth Nagrik Abhiyan as proposed in NHP 2017.