Id |
Subject |
Object |
Predicate |
Lexical cue |
T101 |
0-117 |
Sentence |
denotes |
Table 2 Challenges in PHC system, provisions through AB-HWCs and complementarity with NHM in India [1, 3, 27, 28, 31] |
T102 |
118-287 |
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 |
288-417 |
Sentence |
denotes |
Service provision and delivery ▪ Narrow range of six services (mostly focused on Maternal & child health and infectious diseases) |
T104 |
418-446 |
Sentence |
denotes |
▪ Curative care predominance |
T105 |
447-618 |
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 |
619-755 |
Sentence |
denotes |
▪ Attention on preventive and promotive health services; focus on wellness and lifestyle modification, specifically for chronic diseases |
T107 |
756-905 |
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 |
906-980 |
Sentence |
denotes |
▪ Population based screening for common conditions including three cancers |
T109 |
981-1095 |
Sentence |
denotes |
▪ Attention on quality and patient safety; Develop standard treatment flows (STF) for peripheral health facilities |
T110 |
1096-1156 |
Sentence |
denotes |
▪ Extending prescription rights to CHO through legal process |
T111 |
1157-1328 |
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 |
1329-1511 |
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 |
1512-1582 |
Sentence |
denotes |
▪ State specific models of service delivery to provide cross learnings |
T114 |
1583-1661 |
Sentence |
denotes |
▪ Build on systems for emergency referral and transport; established under NHM |
T115 |
1662-1764 |
Sentence |
denotes |
▪ Utilise strengthening of secondary care services & District hospitals for effective referral linkage |
T116 |
1765-1849 |
Sentence |
denotes |
▪ Build upon quality standards and mechanism for ensuring use of treatment protocols |
T117 |
1850-1982 |
Sentence |
denotes |
▪ Community Health Officers (CHO) proposed in the National Medical Commission (NMC) Act to strengthen public health service delivery |
T118 |
1983-2066 |
Sentence |
denotes |
Human resources and infrastructure ▪ Shortage of infrastructure and human resources |
T119 |
2067-2093 |
Sentence |
denotes |
▪ Inequitable distribution |
T120 |
2094-2212 |
Sentence |
denotes |
▪ Health Sub-centres (HSCs) led by one or two Auxiliary nurse midwife (ANM) who has focus on Mother and child services |
T121 |
2213-2403 |
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 |
2404-2473 |
Sentence |
denotes |
▪ Institutional strengthening for increased annual production of MLHP |
T123 |
2474-2564 |
Sentence |
denotes |
▪ Task shifting to different cadre of healthcare providers and team-based service delivery |
T124 |
2565-2647 |
Sentence |
denotes |
▪ Proposal to change the roles of ANMs as multi-purpose workers (female) or MPW- F |
T125 |
2648-2828 |
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 |
2829-2960 |
Sentence |
denotes |
▪ Shift from doctor centric facilities to a team-based service delivery where provision of providers is dependent upon service need |
T127 |
2961-3065 |
Sentence |
denotes |
▪ AYUSH providers to be mainstreamed in PHC systems ▪ Recruitment of contractual providers in the system |
T128 |
3066-3139 |
Sentence |
denotes |
▪ Flexibility to states in salary for HR, under NHM to ensure recruitment |
T129 |
3140-3194 |
Sentence |
denotes |
▪ Institutionalize the mechanisms for training of MLHP |
T130 |
3195-3323 |
Sentence |
denotes |
▪ Consider an All India cadre of specialist doctors to tackle shortage of specialist doctors & that of public health specialists |
T131 |
3324-3398 |
Sentence |
denotes |
▪ Innovation in human resources including incentives to recruit and retain |
T132 |
3399-3454 |
Sentence |
denotes |
Health financing ▪ Limited government funding on health |
T133 |
3455-3514 |
Sentence |
denotes |
▪ High OOPE to the range of 60% of total health expenditure |
T134 |
3515-3559 |
Sentence |
denotes |
▪ Budget mostly line item-based funding only |
T135 |
3560-3606 |
Sentence |
denotes |
▪ Limited use of strategic purchasing services |
T136 |
3607-3770 |
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 |
3771-3890 |
Sentence |
denotes |
▪ Mechanisms to reduce cost of health seeking through assured provision of more medicines and point of care diagnostics |
T138 |
3891-3971 |
Sentence |
denotes |
▪ Performance-linked payments to the MLHP and to the team of front-line workers. |
T139 |
3972-4286 |
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 |
4287-4336 |
Sentence |
denotes |
▪ Capacity building of states in health financing |
T141 |
4337-4472 |
Sentence |
denotes |
Medicines and vaccines ▪ Many states started free medicines and diagnostics scheme, yet govt spending as share on cost of medicines low |
T142 |
4473-4569 |
Sentence |
denotes |
▪ Medicines and access to diagnostics mostly at higher level facilities and no assured provision |
T143 |
4570-4607 |
Sentence |
denotes |
▪ Medicines major cost paid by people |
T144 |
4608-4705 |
Sentence |
denotes |
▪ Irrational use of medicines ▪ Revision and expansion of essential medicines & diagnostics lists |
T145 |
4706-4815 |
Sentence |
denotes |
▪ Assured provision of larger basket of medicines with inclusion of additional medicines for chronic diseases |
T146 |
4816-4885 |
Sentence |
denotes |
▪ Assured dispensing of medicines for longer duration of 4 wk or more |
T147 |
4886-4955 |
Sentence |
denotes |
▪ Attention on expanded range of diagnostic services of Point of Care |
T148 |
4956-5057 |
Sentence |
denotes |
▪ Proposal for rapid expansion of Pradhan Mantri Jan Aushadhi stores for low cost & generic medicines |
T149 |
5058-5131 |
Sentence |
denotes |
▪ Proposal for setting up state level procurement and supply corporations |
T150 |
5132-5355 |
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 |
5356-5470 |
Sentence |
denotes |
▪ Strengthening of Mission Indradhanush for increasing coverage with vaccines under Universal Immunization Program |
T152 |
5471-5576 |
Sentence |
denotes |
▪ Launch of state specific free medicines and free diagnostics schemes with enhanced budgetary allocation |
T153 |
5577-5636 |
Sentence |
denotes |
Health information systems ▪ Weak health information system |
T154 |
5637-5667 |
Sentence |
denotes |
▪ Limited use of ICT platforms |
T155 |
5668-5832 |
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 |
5833-5904 |
Sentence |
denotes |
▪ Attention on registration of beneficiaries at associated HWC facility |
T157 |
5905-5969 |
Sentence |
denotes |
▪ Increased use of mobile based technology and hand-held devices |
T158 |
5970-6031 |
Sentence |
denotes |
▪ Provision of tele-health and tele-medicine at each facility |
T159 |
6032-6372 |
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 |
6373-6430 |
Sentence |
denotes |
▪ Health Management Information System (HMIS) established |
T161 |
6431-6474 |
Sentence |
denotes |
Governance and leadership ▪ Weak regulation |
T162 |
6475-6525 |
Sentence |
denotes |
▪ Limited transition of policy into implementation |
T163 |
6526-6570 |
Sentence |
denotes |
▪ Health state subject and variable priority |
T164 |
6571-6747 |
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 |
6748-6833 |
Sentence |
denotes |
▪ System and coordination mechanism being proposed to link PHC services with AB-PMJAY |
T166 |
6834-6905 |
Sentence |
denotes |
▪ National Knowledge Platform for implementation & operational research |
T167 |
6906-6943 |
Sentence |
denotes |
▪ Revisions of operational guidelines |
T168 |
6944-6994 |
Sentence |
denotes |
▪ Enhanced community-based monitoring for AB-HWCs. |
T169 |
6995-7040 |
Sentence |
denotes |
▪ Regular reviews on progress and performance |
T170 |
7041-7307 |
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 |
7308-7374 |
Sentence |
denotes |
▪ The Clinical Establishment Registration and Regulation Act, 2010 |
T172 |
7375-7446 |
Sentence |
denotes |
▪ Stronger community and civil society participation in health services |
T173 |
7447-7963 |
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 |