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T1 0-69 Sentence denotes Health & Wellness Centers to Strengthen Primary Health Care in India:
T2 70-104 Sentence denotes Concept, Progress and Ways Forward
T3 106-114 Sentence denotes Abstract
T4 115-526 Sentence denotes In February 2018, the Indian Government announced Ayushman Bharat Program (ABP) with two components of (a) Health and Wellness Centres (HWCs), to deliver comprehensive primary health care (PHC) services to the entire population and (b) Pradhan Mantri Jan Arogya Yojana (PMJAY) for improving access to hospitalization services at secondary and tertiary level health facilities for bottom 40% of total population.
T5 527-664 Sentence denotes The HWC component of ABP aims to upgrade and make 150,000 existing Government Primary health care facilities functional by December 2022.
T6 665-784 Sentence denotes The first HWC was launched on 14 April 2018 and by 31 March 2020, a total 38,595 AB-HWCs were operational across India.
T7 785-914 Sentence denotes This article documents and analyses the key design aspects of HWCs, against core components of PHC & the health system functions.
T8 915-1068 Sentence denotes The article reviews the progress and analyses the potential of HWCs to strengthen PHC services and therefore, advance Universal Health Coverage in India.
T9 1069-1194 Sentence denotes Challenges emerged from COVID-19 pandemic & learnings thus far has also been analyzed to guide the scale up of HWCs in India.
T10 1195-1813 Sentence denotes It has been argued that effectiveness and success of HWCs will be dependent upon a rapid transition from policy to accelerated implementation stage; focus on both supply and demand side interventions, dedicated and increased funding by both union and state governments; appropriate use of information and communication technology; engagement of community and civil society and other stakeholders, focus on effective and functional referral linkages; attention on public health services & population health interventions; sustained political will & monitoring and evaluation for the mid-term corrections, amongst other.
T11 1814-1987 Sentence denotes Experience from India may have lessons and learnings for other low and middle-income countries to strengthen primary healthcare in journey towards universal health coverage.
T12 1989-2001 Sentence denotes Introduction
T13 2002-2222 Sentence denotes The primary health care system in India has evolved since independence and there is an elaborate network of nearly 200,000 Government Primary Health Care Facilities (GPHCFs), both in rural and urban areas (Box 1) [1–30].
T14 2223-2368 Sentence denotes The existing GPHCFs deliver a narrow range of services, due to variety of reasons including, at times, the non-availability of providers as well.
T15 2369-2589 Sentence denotes Thus, the GPHCFs in India are grossly underutilized & excluding for the mother and child health services, in 2013-14, only 11.5% of rural and 3.9% in urban people in need of health services used this vast network [1, 2].
T16 2590-2891 Sentence denotes People in India either choose higher level of government facilities for primary health care (PHC) needs (which results in an issue of subsidiarity) or attend a private provider (which results in the out of pocket expenditure or OOPE), both situations are not good for a well-functioning health system.
T17 2892-2978 Sentence denotes The challenge of weak PHC in India are increasingly being recognized and acknowledged.
T18 2979-3258 Sentence denotes The National Health Policy (NHP) 2017 of India proposed to strengthen PHC systems, invest two-third or more government health spending on PHC, with an increase in overall government funding for health to 2.5% of Gross Domestic Product (GDP) by 2025, against 1.18% in 2015–16 [3].
T19 3259-3672 Sentence denotes Following on the NHP 2017, the Government in India announced Ayushman Bharat Program (ABP) in February 2018 with two components of (a) Health and Wellness Centres (HWCs) to strengthen & deliver comprehensive Primary Health Care (cPHC) services for entire population and (b) Pradhan Mantri Jan Arogya Yojana (PMJAY) for secondary and tertiary level hospitalization services for bottom 40% of families in India [4].
T20 3673-3818 Sentence denotes The details of ABP in the context of Universal Health Coverage (UHC) has been published earlier [1] and a schematic of ABP is provided as Fig. 1.
T21 3819-3959 Sentence denotes These two arms, hence onwards, in this article, have also been referred as AB-HWCs and AB-PMJAY, to indicate that both are component of ABP.
T22 3960-4016 Sentence denotes Box 1 Evolution of Government PHC system in India [1–30]
T23 4017-4124 Sentence denotes Primary Health Care (PHC) has always been considered a foundation of stronger and efficient health systems.
T24 4125-4334 Sentence denotes The efforts to strengthen health services, based upon stronger PHC in India started when the ‘Health Survey and Development Committee’ was established in 1943 under the chairpersonship of Sir Joseph Bhore [5].
T25 4335-4551 Sentence denotes India started setting up primary health centres (PHCs) in 1952, when the first few PHCs were established in Najafgarh (Delhi), Singur (West Bengal) and Poonammalle (Tamilnadu) under Community Development Program [6].
T26 4552-4668 Sentence denotes This was part of establishing a three-tier healthcare system in the country, which has evolved since then [2, 7, 8].
T27 4669-4899 Sentence denotes India started efforts to build health system around the same time when National Health Services (NHS) in United Kingdom was set up and the constitution of World Health Organization (WHO) came into force, both in year 1948 [9, 10].
T28 4900-5093 Sentence denotes The successive governments continued to expand the network of PHCs, which received a major boost through various committees, set up nearly one to three in every decade for first 4 decades [11].
T29 5094-5193 Sentence denotes The efforts to strengthen PHC system in rural India have been made over the years [1, 3, 4, 12–20].
T30 5194-5299 Sentence denotes With these initiatives, by mid Sept 2019, country had an extensive network of 158,417 Health Sub Centres:
T31 5300-5461 Sentence denotes 25,743 Primary Health Centres in rural areas; 5,624 Urban PHCs; 764 district hospitals; 539 medical colleges and hospitals and 1,741 mobile medical units [7, 8].
T32 5462-5587 Sentence denotes The annual admission capacity in medical colleges was 80,000 for graduate medical seats and 41,000 for post graduate courses.
T33 5588-5803 Sentence denotes The efforts to strengthen PHC network in India apparently received a boost after Alma Ata conference on primary health care in 1978 and then with the release of India’s first National Health Policy in 1983 [14, 21].
T34 5804-6032 Sentence denotes A major initiative to further strengthen & make rural PHC system functional, started in April 2005, with the launch of National Rural Health Mission (NRHM) in India [22] soon after the second national health policy in 2002 [23].
T35 6033-6116 Sentence denotes The urban component as National Urban Health Mission was launched in May 2013 [24].
T36 6117-6206 Sentence denotes Two missions together were, thereafter, renamed as National Health Mission (NHM) [22–24].
T37 6207-6302 Sentence denotes The NRHM/NHM has focused on PHC system strengthening to make it functional to deliver services.
T38 6303-6727 Sentence denotes NRHM/NHM had a few strategies to strengthen health systems and PHC services: decentralized health planning; communization (community processes, behavior change communication and addressing social determinants of health); social protection function of public health services; partnership for NGOs and civil society; human resource strengthening; flexible funding for states, public health management and many others [22, 25].
T39 6728-6946 Sentence denotes The NRHM/NHM in India is attributed to improving several services, though mostly Reproductive Maternal, Newborn, Child and Adolescent Health (RMNCH+A) services through Government Primary Health Care Facilities (GPHCF).
T40 6947-7195 Sentence denotes The reduction in Infant Mortality Rate (IMR) and Maternal Mortality Ratio (MMR), which these programs specifically targeted, were reduced at accelerated manner and India reached very close to achieve Millennium Development Goals (MDG) 4 and 5 [26].
T41 7196-7425 Sentence denotes Yet, it was increasingly being recognized that health services for emerging burden of diseases and changing epidemiological profile, i.e., Non-communicable diseases (NCDs) through GPHCFs were either not available or insufficient.
T42 7426-7492 Sentence denotes The need for a new approach to deliver comprehensive PHC was felt.
T43 7493-7605 Sentence denotes It was also the time when various discourses on Universal Health Coverage (UHC) were happening in India [27–29].
T44 7606-7816 Sentence denotes The ongoing & identified challenges of GPHCFs include a narrow range of services, insufficient infrastructure, shortage of healthcare providers; lack of medicines and diagnostics, and limited referral services.
T45 7817-7954 Sentence denotes These challenges have been documented in various review missions and also captured in situation analysis document of NHP 2017 [1, 3, 30].
T46 7955-8007 Sentence denotes Fig. 1 Ayushman Bharat Program in India: a schematic
T47 8008-8261 Sentence denotes This review article describes the concepts, provides an update on implementation of two components of ABP; documents & critically analyzes initiatives under AB-HWC in context of delivery of comprehensive PHC (cPHC) service & proposes a few ways-forward.
T48 8262-8476 Sentence denotes Early reflections on how challenges posed by and initial learnings from the response to Corona virus (SARS-CoV-2) disease or COVID-19 pandemic could be used for scale-up of HWCs in India, have also been summarized.
T49 8478-8557 Sentence denotes Health & Wellness Centres (HWCs) and Comprehensive Primary Health Care in India
T50 8558-8701 Sentence denotes The first HWCs was launched in Jangla village in Bhairamgarh tehsil of Bijapur district of Chhattisgarh state in India on 14 April 2018 [1, 4].
T51 8702-8768 Sentence denotes The key events related to HWCs in India are summarized in Table 1.
T52 8769-8902 Sentence denotes As part of HWC components of ABP, the govt of India announced to make existing 150,000 GPHCFs in country functional by December 2022.
T53 8903-9095 Sentence denotes AB-HWCs are not new facilities and are being set up as an upgraded version of existing GPHCFs such as Health Sub-Centers (HSC); Primary Health Centers and Urban Primary Health Centers (UPHCs).
T54 9096-9306 Sentence denotes The proposed increase in provision of services (shift from erstwhile provision of 6 sub-group of services to 12 sub-group of services) and upgrade on other key design aspects are shown in Figs. 2 and 3 [1, 31].
T55 9307-9383 Sentence denotes Table 1 Evolution of Health & Wellness Centres (HWCs) in India [1, 3, 4, 30]
T56 9384-9414 Sentence denotes Timeline Specific developments
T57 9415-9503 Sentence denotes July- Dec 2013 Initial discussion on Health and Wellness Centres (HWCs) in India started
T58 9504-9624 Sentence denotes 2015–16 Task Force on Primary Healthcare in India recommended formation of HWCs, with initial suggestions on the design.
T59 9625-9687 Sentence denotes 2017 India’s third National Health Policy (NHP 2017) released.
T60 9688-9742 Sentence denotes Union Budget announcement for setting up HWCs in India
T61 9743-9861 Sentence denotes 2018 HWC became one of the two pillars under Ayushman Bharat (AB) program announced in Union Budget on 1 February 2018
T62 9862-9952 Sentence denotes 14 April 2018 Inauguration of India’s first AB-HWC at Jangla, Bijapur, Chhattisgarh, India
T63 9953-10022 Sentence denotes 31 March 2019 A total of 17,149 AB-HWCs made functional across India.
T64 10023-10163 Sentence denotes This includes 8,801 Primary Health Centres; 6,795 Health Sub-centres (HSC) and 1,553 Urban Primary Health Centres (UPHCs) converted to HWCs.
T65 10164-10271 Sentence denotes 2019–20 25,000 additional AB-HWCs to be set up with all UPHC to be converted to HWCs in the financial year.
T66 10272-10323 Sentence denotes A total of 38,595 HWCs were set up by 31 March 2020
T67 10324-10404 Sentence denotes 31 December 2022 Indian states to have 150,000 functional AB-HWCs in the country
T68 10405-10464 Sentence denotes Fig. 2 Key components and design aspects of AB-HWCs [1, 31]
T69 10465-10513 Sentence denotes Fig. 3 Service provision through AB-HWCs [1, 31]
T70 10514-10630 Sentence denotes Against the target of 15,000 of HWC in year 1, a total of 17,149 AB-HWCs were made functional by 31 March 2019 [30].
T71 10631-10693 Sentence denotes Cumulative target of 40,000 HWCs was set up for 31 March 2020.
T72 10694-10831 Sentence denotes There was slow-down in setting up HWCs in March 2020 due to COVID-19 pandemic and total of 38,595 HWCs were operational by 31 March 2020.
T73 10832-10949 Sentence denotes The cumulative target is 70,000 HWCs by 31 March 2021, then 110,000 by 31 March 2022 and 150,000 by 31 December 2022.
T74 10950-11030 Sentence denotes Alongside, all UPHC across India were to be converted to HWCs by March 2020 [1].
T75 11031-11204 Sentence denotes Official data on utilization of services from HWCs was available till 22 Sept 2019, when nearly 21,000 AB-HWCs were operational which had reported a foot-fall of 17 million.
T76 11205-11471 Sentence denotes In these Centres 950,000 yoga sessions were conducted; 7 million people received treatment for hypertension and 3.1 million for diabetes mellitus, Sixteen million beneficiaries received essential medicines and 4.9 million received free essential diagnostics [1, 32].
T77 11472-11597 Sentence denotes The second component of AB-PMJAY was launched on 23 Sept 2018 and progress on this component is summarised in Box 2 [32, 33].
T78 11598-11709 Sentence denotes Box 2 Progress under Pradhan Mantri Jan Arogya Yojana (PMJAY) component of Ayushman Bharat in India [1, 32, 33]
T79 11710-11784 Sentence denotes Ayushman Bharat Program, from the time of announcement has two components.
T80 11785-11884 Sentence denotes Other than Ayushman Bharat- Health and Wellness Centres (AB-HWC), AB-PMJAY is the second component.
T81 11885-11986 Sentence denotes It has built upon the erstwhile Rashtriya Swasthya Bima Yojana (RSBY), started in year 2008 in India.
T82 11987-12098 Sentence denotes Even since announcement of ABP, the scheme has witnessed a few evolutions in name before settling for AB-PMJAY.
T83 12099-12359 Sentence denotes It was announced as AB-National Health Protection scheme or AB-NHPS in February 2018, renamed as National Health Protection Mission (AB-NHPM) in early March 2018 and then Pradhan Mantri Rashtriya Swasthya Suraksha Mission (PM-RSSM) in third week of March 2018.
T84 12360-12528 Sentence denotes In mid August 2018, it was referred as Pradhan Mantri Jan Aarogya Abhiyan (PMJAA) (15 August 2018) before finally being renamed as AB-PMJAY towards the end of Aug 2018.
T85 12529-12610 Sentence denotes AB-PMJAY provides health cover of up to INR 500,000 (Exchange rate in April 2020:
T86 12611-12625 Sentence denotes 1 USD= approx.
T87 12626-12785 Sentence denotes 75 INR) per family per year on floater basis; covers 3-day pre-hospitalization and 15 d post hospitalization; expenses on medicines, follow up and diagnostics.
T88 12786-12899 Sentence denotes One thousand three hundred ninety three procedures in 24 specialties were part of the scheme, as on October 2019.
T89 12900-13015 Sentence denotes There is no cap on family size, age or gender, cashless and paperless treatment for beneficiaries at point of care.
T90 13016-13084 Sentence denotes Benefits are portable across the country in the empaneled hospitals.
T91 13085-13335 Sentence denotes The scheme was announced in Union Budget of India on 1 February 2018; Cabinet approval was received on 21 March 2018; National Health Agency got incorporated on 11 May 2018; AB-PMJAY was formally launched on 23 September 2018, from Ranchi, Jharkhand.
T92 13336-13432 Sentence denotes On completion of 100 d of launch on 2 January 2019; National Health Authority or NHA was formed.
T93 13433-13549 Sentence denotes At 1 y of completion of AB-PMJAY on 22 Sept 2019; a total of 32 states of 36 states/UT were implementing the scheme.
T94 13550-13600 Sentence denotes One hundred and three million e-cards were issued.
T95 13601-13816 Sentence denotes There were 18,236 hospitals empaneled [8,571 (47%) public and 9,665 (53%) private] and there were 4.65 million total hospital admissions with 2.18 million (47%) in govt. and 2.47 million (53%) in private facilities.
T96 13817-14003 Sentence denotes The total treatment equal to Indian Rupee (INR) 7,490 Cr (US$ 1.07 billion) was provided, which included INR 2,846 Cr (38%) in Public and INR 4,644 Cr (62%) in private sector facilities.
T97 14004-14206 Sentence denotes The HWCs aims to address the identified challenges in PHC systems in India, by focusing upon holistic PHC strengthening through various initiatives [Table 2 (structured as per health system functions)].
T98 14207-14277 Sentence denotes This is not first such initiative to strengthen PHC services in India.
T99 14278-14445 Sentence denotes Yet, why AB-HWCs appears more promising than all earlier initiatives to strengthen and deliver comprehensive PHC has been explained in Appendix 1 [1, 3, 27–29, 31–37].
T100 14446-14623 Sentence denotes This is relevant considering much of 14 y since the launch of National Rural Health Mission (NRHM) in the year 2005, had also focused on strengthening PHC system in the country.
T101 14624-14741 Sentence denotes Table 2 Challenges in PHC system, provisions through AB-HWCs and complementarity with NHM in India [1, 3, 27, 28, 31]
T102 14742-14911 Sentence denotes Health System Function Challenges in PHC system (Indicative) AB-HWC and related initiatives Ongoing and other proposed initiatives (including NHM & other state specific)
T103 14912-15041 Sentence denotes Service provision and delivery ▪ Narrow range of six services (mostly focused on Maternal & child health and infectious diseases)
T104 15042-15070 Sentence denotes ▪ Curative care predominance
T105 15071-15242 Sentence denotes ▪ ‘Continuum of care’ mostly for maternal and child health services ▪ Stronger focus on service delivery with an enhanced package of 12 services (from existing 6 services)
T106 15243-15379 Sentence denotes ▪ Attention on preventive and promotive health services; focus on wellness and lifestyle modification, specifically for chronic diseases
T107 15380-15529 Sentence denotes ▪ Integration with Indian systems of medicine, AYUSH, including the promotion of Yoga as form of lifestyle change to tackle non-communicable diseases
T108 15530-15604 Sentence denotes ▪ Population based screening for common conditions including three cancers
T109 15605-15719 Sentence denotes ▪ Attention on quality and patient safety; Develop standard treatment flows (STF) for peripheral health facilities
T110 15720-15780 Sentence denotes ▪ Extending prescription rights to CHO through legal process
T111 15781-15952 Sentence denotes ▪ Adopt ‘Resolve more & refer less’ approach at peripheral health facilities; strengthening of referral system to ensure continuity of care; Telemedicine and consultations
T112 15953-16135 Sentence denotes ▪ Enhanced provision of point of care diagnostics at both levels HWC- HSC and HWC-PHC ▪ Community based network of ASHA and VHNSC to support preventive and promotive health services.
T113 16136-16206 Sentence denotes ▪ State specific models of service delivery to provide cross learnings
T114 16207-16285 Sentence denotes ▪ Build on systems for emergency referral and transport; established under NHM
T115 16286-16388 Sentence denotes ▪ Utilise strengthening of secondary care services & District hospitals for effective referral linkage
T116 16389-16473 Sentence denotes ▪ Build upon quality standards and mechanism for ensuring use of treatment protocols
T117 16474-16606 Sentence denotes ▪ Community Health Officers (CHO) proposed in the National Medical Commission (NMC) Act to strengthen public health service delivery
T118 16607-16690 Sentence denotes Human resources and infrastructure ▪ Shortage of infrastructure and human resources
T119 16691-16717 Sentence denotes ▪ Inequitable distribution
T120 16718-16836 Sentence denotes ▪ Health Sub-centres (HSCs) led by one or two Auxiliary nurse midwife (ANM) who has focus on Mother and child services
T121 16837-17027 Sentence denotes ▪ Narrow range of skills and services at lower level PHC facilities ▪ Provision of Mid-level healthcare provider (MLHP), trained in 6-month course at AB-HWCs to address common health problem
T122 17028-17097 Sentence denotes ▪ Institutional strengthening for increased annual production of MLHP
T123 17098-17188 Sentence denotes ▪ Task shifting to different cadre of healthcare providers and team-based service delivery
T124 17189-17271 Sentence denotes ▪ Proposal to change the roles of ANMs as multi-purpose workers (female) or MPW- F
T125 17272-17452 Sentence denotes ▪ Services at the HWC-HSC, to be delivered through a team, led by a new cadre of non-physician health worker, a MLHP or CHO, supported by one or two multipurpose workers, and ASHAs
T126 17453-17584 Sentence denotes ▪ Shift from doctor centric facilities to a team-based service delivery where provision of providers is dependent upon service need
T127 17585-17689 Sentence denotes ▪ AYUSH providers to be mainstreamed in PHC systems ▪ Recruitment of contractual providers in the system
T128 17690-17763 Sentence denotes ▪ Flexibility to states in salary for HR, under NHM to ensure recruitment
T129 17764-17818 Sentence denotes ▪ Institutionalize the mechanisms for training of MLHP
T130 17819-17947 Sentence denotes ▪ Consider an All India cadre of specialist doctors to tackle shortage of specialist doctors & that of public health specialists
T131 17948-18022 Sentence denotes ▪ Innovation in human resources including incentives to recruit and retain
T132 18023-18078 Sentence denotes Health financing ▪ Limited government funding on health
T133 18079-18138 Sentence denotes ▪ High OOPE to the range of 60% of total health expenditure
T134 18139-18183 Sentence denotes ▪ Budget mostly line item-based funding only
T135 18184-18230 Sentence denotes ▪ Limited use of strategic purchasing services
T136 18231-18394 Sentence denotes ▪ People get poor because of health expenditures ▪ Reforms on provider payment mechanisms including the introduction of performance-linked incentives in PHC system
T137 18395-18514 Sentence denotes ▪ Mechanisms to reduce cost of health seeking through assured provision of more medicines and point of care diagnostics
T138 18515-18595 Sentence denotes ▪ Performance-linked payments to the MLHP and to the team of front-line workers.
T139 18596-18910 Sentence denotes ▪ MLHP to get salary on blended formula –a fixed component and incentives linked to key outcomes, measured through IT platform-based monitoring system with key performance indicators ▪ Increased government allocation for primary health care, through formula-based approach and sharing between union and state level
T140 18911-18960 Sentence denotes ▪ Capacity building of states in health financing
T141 18961-19096 Sentence denotes Medicines and vaccines ▪ Many states started free medicines and diagnostics scheme, yet govt spending as share on cost of medicines low
T142 19097-19193 Sentence denotes ▪ Medicines and access to diagnostics mostly at higher level facilities and no assured provision
T143 19194-19231 Sentence denotes ▪ Medicines major cost paid by people
T144 19232-19329 Sentence denotes ▪ Irrational use of medicines ▪ Revision and expansion of essential medicines & diagnostics lists
T145 19330-19439 Sentence denotes ▪ Assured provision of larger basket of medicines with inclusion of additional medicines for chronic diseases
T146 19440-19509 Sentence denotes ▪ Assured dispensing of medicines for longer duration of 4 wk or more
T147 19510-19579 Sentence denotes ▪ Attention on expanded range of diagnostic services of Point of Care
T148 19580-19681 Sentence denotes ▪ Proposal for rapid expansion of Pradhan Mantri Jan Aushadhi stores for low cost & generic medicines
T149 19682-19755 Sentence denotes ▪ Proposal for setting up state level procurement and supply corporations
T150 19756-19979 Sentence denotes ▪ Provision of dispensing medicines from HWCs, for patients who need long term treatment and initially attended care at higher level of facilities ▪ Provision of free medicines and diagnostics (as well as schemes) under NHM
T151 19980-20094 Sentence denotes ▪ Strengthening of Mission Indradhanush for increasing coverage with vaccines under Universal Immunization Program
T152 20095-20200 Sentence denotes ▪ Launch of state specific free medicines and free diagnostics schemes with enhanced budgetary allocation
T153 20201-20260 Sentence denotes Health information systems ▪ Weak health information system
T154 20261-20291 Sentence denotes ▪ Limited use of ICT platforms
T155 20292-20456 Sentence denotes ▪ Delay in recording and reporting of health data ▪ Attention to build a robust ICT system for population enumeration, enrolment, tracking and follow-up of patients
T156 20457-20528 Sentence denotes ▪ Attention on registration of beneficiaries at associated HWC facility
T157 20529-20593 Sentence denotes ▪ Increased use of mobile based technology and hand-held devices
T158 20594-20655 Sentence denotes ▪ Provision of tele-health and tele-medicine at each facility
T159 20656-20996 Sentence denotes ▪ Use of Digital technology and ICT platforms (proposed for) to ensure continuity of care through universal population empanelment and registration to a HWC, facilitating performance payments and ensuring continuity of care and also for improved recording & reporting system ▪ Telemedicine and tele-radiology services as per the local needs
T160 20997-21054 Sentence denotes ▪ Health Management Information System (HMIS) established
T161 21055-21098 Sentence denotes Governance and leadership ▪ Weak regulation
T162 21099-21149 Sentence denotes ▪ Limited transition of policy into implementation
T163 21150-21194 Sentence denotes ▪ Health state subject and variable priority
T164 21195-21371 Sentence denotes ▪ The job -descriptions of various health staff are not aligned with the activities they do ▪ High level political and administrative priority assigned to AB-HWCs at all levels
T165 21372-21457 Sentence denotes ▪ System and coordination mechanism being proposed to link PHC services with AB-PMJAY
T166 21458-21529 Sentence denotes ▪ National Knowledge Platform for implementation & operational research
T167 21530-21567 Sentence denotes ▪ Revisions of operational guidelines
T168 21568-21618 Sentence denotes ▪ Enhanced community-based monitoring for AB-HWCs.
T169 21619-21664 Sentence denotes ▪ Regular reviews on progress and performance
T170 21665-21931 Sentence denotes ▪ Revision in responsibilities of auxiliary nurse midwife to make them multi-purpose workers ▪ A number of governance and leadership mechanisms were established under NHM level including mission steering groups at top level to community based VHSNC at village level.
T171 21932-21998 Sentence denotes ▪ The Clinical Establishment Registration and Regulation Act, 2010
T172 21999-22070 Sentence denotes ▪ Stronger community and civil society participation in health services
T173 22071-22587 Sentence denotes AB-HWCs Ayushman Bharat- Health & Wellness Centres; AB-PMJAY Ayushman Bharat- Pradhan Mantri Jan Arogya Yojana; ASHA Accredited Social Health Activist; HR Human resources; HWC-HSC Health & Wellness Centres- Health Sub-Centers; HWC-PHC Health & Wellness Centres- Primary Health Care; ICT Information and communication technology; NHM National Health Mission; NMC Act The National Medical Commission Act; OOPE Out of pocket expenditure; PHC Primary Health care; VHNSC Village health, nutrition and sanitation committee
T174 22589-22635 Sentence denotes Making Health & Wellness Centres of India Work
T175 22636-22723 Sentence denotes HWCs aim to build upon what has been started under NRHM/ National Health Mission (NHM).
T176 22724-22919 Sentence denotes However, considering even in the past, the similar attempt to strengthen PHC services have met partial success, more is needed to ensure that AB-HWCs does better than the initiatives in the past.
T177 22920-23066 Sentence denotes Therefore, it will be important that learnings from past are used and challenges identified, and focused attention is given to effective scale up.
T178 23067-23104 Sentence denotes A few approaches could be as follows:
T179 23105-23228 Sentence denotes First, give sufficient attention, visibility and priority to AB-HWCs as vehicle to strengthen primary health care services.
T180 23229-23412 Sentence denotes Of the two components in ABP, the HWCs seem to be getting comparatively less attention, in spite of being recognized that cPHC can take care of up to 80% of health needs [30, 38, 39].
T181 23413-23499 Sentence denotes AB-HWCs is also a more difficult component to implement than insurance-based AB-PMJAY.
T182 23500-23608 Sentence denotes Getting less public and political attention may appear a minor issue but may result in lower prioritization.
T183 23609-23725 Sentence denotes There is a need to bring attention back on AB-HWCs and make these politically visible through advocacy and evidence.
T184 23726-23916 Sentence denotes There is role for technical experts, professional associations and civil society representatives in ensuring that cPHC is not lost in the noise for more secondary and tertiary care services.
T185 23917-24019 Sentence denotes People also need to demand for better primary healthcare services from their elective representatives.
T186 24020-24113 Sentence denotes Second, develop a detailed ‘primary health care investment plan’ for India and Indian states.
T187 24114-24177 Sentence denotes The policy announcements are often equated with political will.
T188 24178-24328 Sentence denotes The real test of the ‘political will’ is whether policy announcements have been followed by commensurate, sufficient & sustained financial allocation.
T189 24329-24426 Sentence denotes In 2015–16, around 45% of total government spending on health was allocated to PHC services [40].
T190 24427-24650 Sentence denotes Though National Health Policy (NHP) 2017 has proposed to increase government funding for PHC and health services, the reality is that government funding for health in India has increased only marginally in last two decades.
T191 24651-24834 Sentence denotes Similarly, the state government spending on health, proposed to be increased to 8% of state budget has remained at 5% of state budget since 2001–02 and increased very marginally [41].
T192 24835-24970 Sentence denotes There is a need for more and active public attention and prioritization to increase govt funding for health in India and Indian states.
T193 24971-25150 Sentence denotes The initial allocation to AB-HWCs in union budget while may be sufficient in the beginning; however, with each passing year the recurrent expenditure for each HWC would be needed.
T194 25151-25278 Sentence denotes This requires a detailed ‘primary healthcare investment plan’, preceded by, a detailed cost analysis for PHC services in India.
T195 25279-25491 Sentence denotes In addition, there is a need for capital expenditure for setting up additional GPHCFs to address the shortage of facilities and meeting the health care needs of growing population, especially in urban areas [42].
T196 25492-25631 Sentence denotes Third, the service availability through AB-HWCs need to be continuously upgraded and made locally adapted to meet 80% or more health needs.
T197 25632-25780 Sentence denotes In most of the HWCs set up till now, one additional package of services [the seventh package of non-communicable diseases (NCDs)] has been included.
T198 25781-25835 Sentence denotes However, 5 more packages need to be added and assured.
T199 25836-25977 Sentence denotes In efforts to achieve the number-based targets for AB-HWCs, for every financial year, focus should not be lost from already established HWCs.
T200 25978-26201 Sentence denotes The provision of services through these facilities, the utilization by public, assured availability of providers and functioning as per guidelines need to be ensured through continuous oversight, monitoring and innovations.
T201 26202-26425 Sentence denotes Another approach could be that all the eligible GPHCFs in single geographical area, a block or tehsil, need to be made functional simultaneously to increase utilization and change the perception about government facilities.
T202 26426-26558 Sentence denotes Fourth, focus on demand generation for health services through mechanisms such as community participation and social accountability.
T203 26559-26839 Sentence denotes Getting the facilities functional or strengthening supply side through HWCs (or other similar state specific initiatives) is important; however, it is unlikely to generate utilization; specifically when the previous encounter of people with these facilities has not been pleasant.
T204 26840-26908 Sentence denotes Simply an upgrade of government health facility might not be enough.
T205 26909-27027 Sentence denotes People need to come to the health system and experience the change, which will contribute to further demand genration.
T206 27028-27113 Sentence denotes The supply side strengthening through PHC needs to be augmented by demand generation.
T207 27114-27314 Sentence denotes This can be achieved with increased and active community involvement; accountability and involving local body representatives and civil society organizations in the process, from the very early stage.
T208 27315-27543 Sentence denotes In backdrop of recent policy dialogues and approaches adopted for Swachh Bharat Mission (clean Indian mission) and the approach to behavioral economics of nudge need to be examined for suitable adoption in health sector [43–45].
T209 27544-27645 Sentence denotes Fifth, the entire process should be guided by use of evidence to scale up interventions and services.
T210 27646-28059 Sentence denotes A recently published study reported a few common characteristics of better functioning government facilities in India, which included (a) an assured package health services with ‘limited intention to availability gap’; (b) Appropriate mix & sufficient availability of providers; (c) continuum of care with functional referral linkages; (d) initiatives to achieve quality standard; & (e) community engagement [46].
T211 28060-28148 Sentence denotes There is similar evidence from countries such as Brazil; Ghana and South Africa [47–49].
T212 28149-28445 Sentence denotes Mohalla Clinics of Delhi and Basthi Dawakhana of Telangana, are empirical evidence that people start attending the government facilities if the facilities are made functional and the services are available in an assured manner, people prefer PHC over complicated and overpowering large hospitals.
T213 28446-28591 Sentence denotes These initiatives have become popular amongst people and brought poor, marginalized, women and children to government health care system [50–52].
T214 28592-28705 Sentence denotes Sixth, ‘continuum of care’ through coordination between two arms of ABP will contribute to effective utilization.
T215 28706-28886 Sentence denotes Establishing a functioning referral linkage between HWCs/PHCs and from secondary and tertiary care services including AB-PMJAY should be focus for policy design and implementation.
T216 28887-29076 Sentence denotes A good coordination between AB-PMJAY and AB-HWCs is not only imperative for streamlining access to care but will be pivotal in providing timely and quality care to the target beneficiaries.
T217 29077-29362 Sentence denotes A few indicative approaches for ‘continuity of care’ could be: one, common process for registration of patients at AB-HWCs as well as for AB-PMJAY, through common health identifier with community linkage and registration; two, awareness generation for beneficiaries at grassroot level.
T218 29363-29540 Sentence denotes Three, the training curriculum of Accredited Social Health Activist (ASHA) and other field workers should include a module on AB-HWCs and services and provisions under AB-PMJAY.
T219 29541-29842 Sentence denotes For a forward referral, AB-HWC can become source of information for AB-PMJAY beneficiaries; fourth, develop effective and two-way referral and inclusion of some outpatient components in AB-PMJAY benefit package and fifth, AB-PMJAY and AB-HWCs to analyse disease and population health risks and trends.
T220 29843-30037 Sentence denotes The service delivery approach should be beyond referral and the PHC systems need to facilitate the care seeking by proactively seeking appointments for patient going to next level of facilities.
T221 30038-30206 Sentence denotes Once the treatment plan is prepared at next level of facility, the referral back to PHC level should also be ensured for continuity of treatment and required follow up.
T222 30207-30320 Sentence denotes This could prove extremely essential and important in context of NCD (including diabetes, hypertension) services.
T223 30321-30419 Sentence denotes Seventh, AB-HWCs also need to have dedicated focus on population-based and public health services.
T224 30420-30501 Sentence denotes It is not a PHC service, if focus is on curative services at facility level only.
T225 30502-30600 Sentence denotes A well-functioning PHC system needs to cater to those who are not attending the health facilities.
T226 30601-30735 Sentence denotes People in communities with undiagnosed health conditions need to be identified and brought to treatment, is also part of PHC services.
T227 30736-30830 Sentence denotes Establishing All India Public Health management Cadre could be one complementary step [3, 53].
T228 30831-30973 Sentence denotes A few more suggestions on how to make AB-HWCs more effective and better functional are provided in articles published earlier [1, 30, 45, 46].
T229 30975-30985 Sentence denotes Discussion
T230 30986-31082 Sentence denotes AB-HWC could, arguably, be termed as the second wave of PHC reforms in India after NRHM in 2005.
T231 31083-31195 Sentence denotes There is a higher likelihood of success of this initiative than all the earlier initiative, due to many factors.
T232 31196-31338 Sentence denotes The most important being that AB-HWCs start on an advantage of already strengthened and existing PHC system through NHM between 2005 and 2018.
T233 31339-31584 Sentence denotes The other factors being the ongoing attention on advancing UHC; states showing increasing and more than ever interest in improving PHC services through their own mechanism and increasing civil society participation and engagement in health [45].
T234 31585-31709 Sentence denotes The AB-HWCs could be considered a national initiative to harmonize PHC service delivery on a common platform for all states.
T235 31710-31815 Sentence denotes This is a major approach in federal system, where health is a state subject as per constitution of India.
T236 31816-32044 Sentence denotes In the recent years, a number of Indian states have started initiatives to strengthen PHC services, which should provide learnings for AB-HWC and potential harmonization between state initiatives and HWCs (Box 3) [50–52, 54–58].
T237 32045-32155 Sentence denotes Clearly, for success, the Indian states have to take leadership in designing their own additional initiatives.
T238 32156-32277 Sentence denotes Even when implementing AB-HWCs, innovative context specific approaches and adaptations for local setting would be needed.
T239 32278-32356 Sentence denotes Box 3 PHC strengthening initiatives by Indian states since 2015 [50–52, 54–58]
T240 32357-32394 Sentence denotes ▪ Mohalla Clinics, Delhi [50–52, 54]:
T241 32395-32524 Sentence denotes India’s first large scale state government led community clinics initiative in urban settings was launched in July 2015 in Delhi.
T242 32525-32739 Sentence denotes These clinics, one each for every 10,000 population, are two to three room facilities with provision of primary care services including consultation by doctor with provision of nurse or pharmacist and an attendant.
T243 32740-32899 Sentence denotes In addition to out-patient consultation services, there is provision of nearly 212 diagnostics tests and 108 medicines available free of cost at these clinics.
T244 32900-33016 Sentence denotes Soon after launch, these clinics had become immensely popular amongst target beneficiaries and political leadership.
T245 33017-33109 Sentence denotes As on March 2020, there were 480 clinics functioning with plan to set up 1,000 such clinics.
T246 33110-33146 Sentence denotes ▪ Basthi Dawakhana in Telangana[51]:
T247 33147-33230 Sentence denotes Basthi Dawakhana are arguably India’s first urban local body led community clinics.
T248 33231-33374 Sentence denotes These have been openly claimed to be replication of Mohalla Clinics of Delhi and started by the Greater Hyderabad Municipal Corporation (GHMC).
T249 33375-33432 Sentence denotes First few Basthi Dawakhana were launched on 6 April 2018.
T250 33433-33538 Sentence denotes By end of November 2019, there were 115 such clinics with plan to open additional 132 in Telangana state.
T251 33539-33807 Sentence denotes These clinics have been set up in close collaboration with state Govt of Telangana, Greater Hyderabad Municipal Corporation (the Urban local bodies); Mission for Poverty Elimination in Municipal Areas (MEPMA) and the union government led National Urban Health Mission.
T252 33808-34010 Sentence denotes There is an improvisation on Mohalla Clinics of Delhi by provision of more services such as public health, preventive and promotive, more integrated referral system and provision of specialist services.
T253 34011-34055 Sentence denotes ▪ Family Health Centres, Kerala, India [55]:
T254 34056-34254 Sentence denotes Government of Kerala in mid-2017 started to upgrade and transform all primary health centres in states as part of Mission Aardram program and renamed these facilities as Family Health Centres (FHC).
T255 34255-34444 Sentence denotes These facilities focus on upgrading the infrastructure, and provision of more doctors and staff, in closer collaboration with rural elected governments (Panchayati raj Institution) members.
T256 34445-34613 Sentence denotes There is attention of preventive and promotive health services and by mid of 2018, of nearly 700 PHC in state, nearly 170 were upgraded to Family Health Centres (FHCs).
T257 34614-34826 Sentence denotes The initial response to initiative has been very positive and utilization to most facilities has nearly doubled with wider community-based services and participation elected representatives and community members.
T258 34827-34901 Sentence denotes Such facilities are also being considered as future of rural PHC in India.
T259 34902-34960 Sentence denotes ▪ Community Clinics in other Indian states [50–52, 56–58]:
T260 34961-35125 Sentence denotes Inspired by Mohalla Clinics of Delhi, at least a dozen Indian states or Municipal Corporations have either set up or announced similar facilities in their settings.
T261 35126-35210 Sentence denotes First such clinics were started in Pune by the Municipal Corporation in August 2016.
T262 35211-35441 Sentence denotes Since then Appla Clinics in Mumbai, Maharashtra (June 2019) and Atal Clinics in Jharkhand (August 2019) have been started, though, the numbers of most such new clinics is in range of 10–50 with promise for more similar facilities.
T263 35442-35547 Sentence denotes States such as Punjab, Karnataka and Chhattisgarh governments have also planned to start similar clinics.
T264 35548-35691 Sentence denotes Most recent addition to this list are the ‘Sanjivani Clinics’ of Madhya Pradesh, & Janata Clinics of Rajasthan, both launched in December 2019.
T265 35692-35992 Sentence denotes In early February 2020, Govt of Andhra Pradesh had announced ‘Village Clinics’ for every 2,000 population in rural parts of state, which appear another promising approach to deliver PHC services in rural areas. However, success of each of these will be dependent upon how well these are implemented. 
T266 35993-36244 Sentence denotes As part of accountability and governance, the union government initiative such as ranking of states on health, and the proposed ranking of district hospitals should be further expanded to rank the states/districts on their performance on PHC [59, 60].
T267 36245-36359 Sentence denotes As a next step, responsibility for such ranking can be assigned to an independent & non-governmental organization.
T268 36360-36506 Sentence denotes The annual report on state of primary health care in India can be started, on the line of Annual Status of Education Reports (ASER) in India [61].
T269 36507-36613 Sentence denotes These could be built upon NITI Aayog’s state health index and proposed district hospital ranking [59, 60].
T270 36614-36870 Sentence denotes As India plans to strengthen cPHC, the learnings and initiatives from NRHM/NHM can facilitate the strengthening of AB-HWCs (and the harmonized and integrated NHM and ABP convergence) can help India to make rapid progress towards UHC as analyzed in Table 2.
T271 36871-36995 Sentence denotes The ongoing attention on health by various approaches should be optimally used to place health higher on development agenda.
T272 36996-37465 Sentence denotes These opportunities includes the reforms in medical education through the NMC Act, 2019 [34]; dialogue and discourse on the Right to Health [62] which has become stronger following three Indian states considering enactment of a legislation; the recommendation from health subcommittee of 15th Finance commission [62, 63] and the renewed global focus on UHC and PHC, as reflected in Astana 2018 and United Nations High Level Meeting (UNHLM) on UHC in Sept 2019 [17, 18].
T273 37466-37555 Sentence denotes This brings in an important question of when can AB-HWC be considered a success in India?
T274 37556-37675 Sentence denotes To answer this question, the performance of PHC system in India needs to be measured based upon health system outcomes.
T275 37676-37834 Sentence denotes There would be a need of explicit attention, engagement and linkage to deliver interventions to tackle Social Determinants of Health (SDH) through PHC system.
T276 37835-38059 Sentence denotes World over, including in India, while inputs to health systems are measured regualrly, the goals on improved health (outcomes  and equity), responsiveness, efficiency, and financial protection are not monitored sufficiently.
T277 38060-38179 Sentence denotes It is expected that this challenge would partially be resolved through initiative of the global UHC monitoring reports.
T278 38180-38320 Sentence denotes The progress and success of AB-HWCs should also need to be measured against some of the objectives of health systems and functions (Fig. 4).
T279 38321-38514 Sentence denotes AB-HWCs will be credited with the real and lasting fixing of the primary health care system in India, if people start using services at the upgraded facilities, for broad range of health needs.
T280 38515-38628 Sentence denotes A few more approaches and ideas for effective roll-out of AB-HWCs are provided in Appendix 2 [34, 35, 62, 64–68].
T281 38629-38704 Sentence denotes Fig. 4 AB-HWCs and potential to impact various components of health systems
T282 38705-38799 Sentence denotes In early 2020, novel Corona virus (SARS-CoV2) disease or COVID-19 pandemic hit the world [69].
T283 38800-38911 Sentence denotes Across the countries, hundreds of thousand people got affected and many thousands died due to the disease [70].
T284 38912-39191 Sentence denotes Experience from countries, affected at the start of pandemic indicated that the asymptomatic patients visiting hospitals for non-COVID-19 health reasons partly contributed in spread of infections to many other people- attending the same facility- for some other health condition.
T285 39192-39457 Sentence denotes Learning from these experiences, in India, from the start of cases being reported, except for the large hospitals, most of the private facilities were either partially functioning or out patient departments were completely closed, at least for short period of time.
T286 39458-39653 Sentence denotes There were reports of gross shortage of even essential health services for non-COVID-19 patients, which were mostly provided through government primary health care facilities and smaller clinics.
T287 39654-39804 Sentence denotes COVID-19 pandemic has underscored the relevance of stronger primary health care and is a proof that the world needs better health systems than it has.
T288 39805-40101 Sentence denotes The weak health systems and primary health care facilities are in those countries, where the burden of diseases are already high and the epidemics and pandemic can further devastate those settings, as had been experienced during the Ebola epidemic in three African countries around 2014 [71, 72].
T289 40102-40264 Sentence denotes In late March 2020, COVID-19 pandemic resulted in the government of India to release the guidelines to legalize prescription through telephonic consultation [73].
T290 40265-40339 Sentence denotes The home delivery of medicines were allowed during COVID-19 pandemic [74].
T291 40340-40464 Sentence denotes These initiatives may be continued through AB-HWCs and have potential to change the PHC service delivery in the years ahead.
T292 40465-40662 Sentence denotes COVID-19 has indicated that ensuring healthier population in the time ahead would need approaches such as mass education on hand washing, cough etiquettes, personal hygiene and physical distancing.
T293 40663-40726 Sentence denotes The mental health issues are a major health challenge in India.
T294 40727-40800 Sentence denotes However, there are not enough mental health services in the country [75].
T295 40801-40951 Sentence denotes COVID-19 is expected to exacerbate the psychosocial and mental health issues and the provision of such services should be prioritized through AB-HWCs.
T296 40952-41152 Sentence denotes COVID-19 challenge should be used as an opportunity to deliver broader public health messages and services and PHC system is expected to be the most appropriate as well as the cost-effective approach.
T297 41153-41484 Sentence denotes Alongside, while designing health services, the specific focus needs to be retained on how to make primary health care, in specific, and the health systems, in general, ready and resilient for epidemics, pandemics and natural calamities, which keep affecting, one or other part of the country (and the world), on regular intervals.
T298 41486-41497 Sentence denotes Conclusions
T299 41498-41635 Sentence denotes There is a global consensus that universal health coverage can only be achieved on the foundation of stronger primary health care system.
T300 41636-41785 Sentence denotes There is a renewed attention on strengthening and delivering comprehensive primary health care services in India through health and wellness centres.
T301 41786-42424 Sentence denotes While the AB-HWCs aims to address the existing challenges in PHC system, the effectiveness and success will be dependent upon a rapid transition from policy to implementation stage; focus on both supply and demand side interventions, engagement of community and civil society and other stakeholders, focus on effective and functional referral linkages; ongoing learnings, innovations and mid-course corrections, effective linkage and coordination between two components of Ayushman Bharat program, additional & complementary initiatives by Indian states, sustained political will & monitoring and evaluation of the process, amongst other.
T302 42425-42534 Sentence denotes COVID-19 pandemic has further underscored the need for strengthening the primary health care at the earliest.
T303 42535-42713 Sentence denotes The experience from India can have lessons and learnings for other low and middle-income countries to strengthen primary health care in journey towards universal health coverage.
T304 42715-42725 Sentence denotes Appendix 1
T305 42727-42821 Sentence denotes Why AB-HWCs hold the promise to strengthen and deliver comprehensive PHC? [1, 3, 27,29, 31,37]
T306 42823-42896 Sentence denotes System strengthening for better health by tackling identified challenges.
T307 42897-43063 Sentence denotes 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].
T308 43064-43179 Sentence denotes The new provision of services are better informed by emerging evidence as well as changing epidemiological reality.
T309 43181-43254 Sentence denotes Approaches to deliver new types of preventive and promotive health needs.
T310 43255-43442 Sentence denotes 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].
T311 43443-43545 Sentence denotes This also means a system design for provision of new type of preventive and promotive health services.
T312 43546-43679 Sentence denotes The preventive and promotive services of earlier period (Family planning, immunization and for disease control) need to be continued.
T313 43680-43995 Sentence denotes 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.
T314 43997-44113 Sentence denotes Shifting service delivery from ‘doctor centric’ to ‘team based’ with focus on mid-level healthcare providers (MLHP).
T315 44114-44232 Sentence denotes The MLHP and other group of such providers known as Community health officers (CHOs) are being deputed to the AB-HWCs.
T316 44233-44423 Sentence denotes 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].
T317 44424-44613 Sentence denotes 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.
T318 44614-44657 Sentence denotes These modules, have now been included in B.
T319 44658-44820 Sentence denotes 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].
T320 44822-44903 Sentence denotes I of ‘Illness’ proposed to be replaced with We to make it ‘Wellness’ care system.
T321 44904-45066 Sentence denotes 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.
T322 45067-45783 Sentence denotes 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.
T323 45784-45861 Sentence denotes All these are further expected to bring focus on wellness in health services.
T324 45862-45952 Sentence denotes This is also aligned to seven components of Swasth Nagrik Abhiyan as proposed in NHP 2017.
T325 45954-45964 Sentence denotes Appendix 2
T326 45966-46075 Sentence denotes Proposed additional measures to ensure success of AB-HWCs and to strengthen cPHC in India [34, 35, 60-66, 74]
T327 46077-46142 Sentence denotes Shift health planning unit from districts to sub-district levels.
T328 46143-46355 Sentence denotes Considering ‘Health’ is a state subject in India, it is appropriate that the discourse on health with financial protection and allocation by states for health services becomes part of state level policy dialogue.
T329 46356-46456 Sentence denotes Health planning units in India are at district level as is the case in most other countries as well.
T330 46457-46538 Sentence denotes However, in most countries, the districts are at population of 50,000 to 300,000.
T331 46539-46807 Sentence denotes Considering that an average district in India is around 20 Lakh (2 million) population, even district level planning may not be detailed enough and to ensure planning for every 200,000 to 300,000; the ‘sub-district level health planning’ should be considered in India.
T332 46808-46991 Sentence denotes A beginning can be made by selected Indian states and with time, there would be need for 8,000 planning units, one for each block, rather than nearly 760 at district level at present.
T333 46992-47077 Sentence denotes This could help in equitable planning and allocation of funds, HR and infrastructure.
T334 47079-47121 Sentence denotes Innovative approaches for setting up HWCs.
T335 47122-47495 Sentence denotes The states have used the opportunity to set up HWCs to develop appropriate and innovative approaches at various levels which includes, Partnerships with non-governmental organizations (NGOs) for Urban-PHCs in Karnataka; Public-Private Partnerships through E-urban PHCs in Andhra Pradesh & Telangana; as well as Medical Officer led models in Kerala, Tamil Nadu & Puducherry.
T336 47496-47925 Sentence denotes On the similar line, the Community Health Officers (CHOs) are being selected amongst various approaches such as B.Sc Community Health equivalent in Assam and Chhattisgarh; Ayurveda Practitioners in Maharashtra and Nurses in states such as Jharkhand, Madhya Pradesh, Uttar Pradesh, Andhra Pradesh, Punjab, Karnataka, Telangana, West Bengal, Andaman & Nicobar Island, Dadar & Nagar Haveli and all North Eastern states except Assam.
T337 47926-48135 Sentence denotes The selection of CHO is based upon a mix of health staff in Bihar, Odisha, Gujarat, Rajasthan, Jammu & Kashmir (J&K) Uttarakhand, Haryana, Daman and Diu, and Unani Practitioners as well in J&K and Maharashtra.
T338 48136-48266 Sentence denotes The enactment of the National Medical Commission (NMC) Act, 2019 is become a supporting legal instrument for empowering community.
T339 48267-48380 Sentence denotes The NMC act of 2019, which proposes to empower non-physician providers to prescribe a limited range of medicines.
T340 48381-48633 Sentence denotes In wake of COVID-19 pandemic, the Board of Governors for Medical Council of India had released new tele-consultation guidelines, which opens a new opportunity for making health services accessible in under-served and difficult areas, in the time ahead.
T341 48634-48744 Sentence denotes These, along with other opportunities should be used to re-design PHC system as team based and people centric.
T342 48745-48860 Sentence denotes However, success and effective implementation of this initiative need a stronger focused monitoring of the process.
T343 48862-48939 Sentence denotes Revival and expansion of community and civil society participation in health.
T344 48940-49197 Sentence denotes The engagement with communities, elected representatives, civil society organizations and interest groups in designing the system which people need, demanding for better health services and working together for common cause is increasingly being recognized.
T345 49198-49350 Sentence denotes This is resulting in opening and supporting many new avenues which directly or indirectly may contribute to better health outcomes and systems in India.
T346 49351-49634 Sentence denotes These include national knowledge platform; Innovation and learning centres; Ayushman Bharat Ambassadors & messengers in school; renewed focus on community clinics or frontline health service; health getting far more attention in media as well as Political agenda in general election.
T347 49635-49876 Sentence denotes There are Sustained expert engagement, research and evidence and Strengthened CSO/CBO engagement for health; Development/revision of many operational guidelines, broadly supplemented by global dialogues and commitments for PHC strengthening.
T348 49878-49933 Sentence denotes Appropriate use of digital and mobile health solutions.
T349 49934-50030 Sentence denotes Making PHC functional needs measuring the results of interventions and improving accountability.
T350 50031-50280 Sentence denotes Digital technologies can be leveraged to address health challenges in remote areas, generate awareness about health entitlement, deliver preventive and promotive health services, empower people and support communities to look after their own health.
T351 50281-50518 Sentence denotes Information and communication technology can be used for ensuring referral linkage; measuring results to enhance accountability is making information on health care entitlements and performance publicly available in a transparent manner.
T352 50519-50901 Sentence denotes The planning and early role out needs to be supported by a robust IT enabled monitoring and evaluation process; real time dash boards, amongst others would be needed to ensure that program designs are implemented, facilities so created are being utilized, services scaled up, the bottlenecks are regularly being identified and corrective measures being taken to improve performance.
T353 50903-50963 Sentence denotes Strengthen implementation and operational research capacity.
T354 50964-51037 Sentence denotes There are a few policy questions which need to be answered in due course.
T355 51038-51165 Sentence denotes ABP should also be an opportunity to strengthen operational research to support scale up based upon evidence and understanding.
T356 51166-51383 Sentence denotes There would be a very important role of technical support and implementation research for identifying operational questions and then seeking answers in a scientific way through operational and implementation research.
T357 51384-51517 Sentence denotes Dept. of Health Research (DHR) and National Knowledge Platform (NKP) as proposed under NHM can play an important role in the process.
T358 51518-51611 Sentence denotes The emerging policy questions with possible need for operational research need to be a focus.
T359 51612-51702 Sentence denotes There is a role of evidence, implementation research and capacity building in the process.
T360 51703-51859 Sentence denotes The institutional mechanisms at both national and sub-national level, with sufficient government funding to support implementation research would be needed.
T361 51860-51981 Sentence denotes Such platforms should bring policy makers, academic researchers and program managers and all other stakeholders together.
T362 51983-52049 Sentence denotes Renewed inter-sectoral collaboration between health and education.
T363 52050-52225 Sentence denotes One of the example of how HWC dialogue has broadened the scope of health beyond curative care and beyond health department is the concept of Ayushman ambassadors & Messengers.
T364 52226-52319 Sentence denotes As part of HWCs initiative, a coordination has been established with department of education.
T365 52320-52463 Sentence denotes Two teachers, preferably one male and one female, in every school were proposed to be designated “Health and Wellness or Ayushman Ambassadors”.
T366 52464-52610 Sentence denotes Prior to that the teachers are to be trained in health promotion and disease prevention for one hour every week, through a pre-decided curriculum.
T367 52611-52808 Sentence denotes The school children are selected as health and wellness or Ayushman messengers and key health messages such as vaccination and hand-washing are communicated to the families through school children.
T368 52809-52940 Sentence denotes This idea and concept was further formalized with the formulation of guidelines for school health under HWCs, released in Feb 2020.
T369 52941-52957 Sentence denotes Publisher’s Note
T370 52958-53076 Sentence denotes Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
T371 53078-53088 Sentence denotes Disclaimer
T372 53089-53155 Sentence denotes The author is the staff member of World Health Organization (WHO).
T373 53156-53335 Sentence denotes The views expressed in this article are of the author and does not reflects the views and opinion of the organizations he has been associated/affiliated in the past or at present.
T374 53337-53370 Sentence denotes Compliance with Ethical Standards
T375 53372-53392 Sentence denotes Conflict of Interest
T376 53393-53398 Sentence denotes None.