Dr Renu John from the George Institute of Global Health talks about the roll out of comprehensive primary health care in two Indian States of Haryana (north India) and Andhra Pradesh (south India).
India’s most recent health care reforms started in 2005 with the National Rural Health Mission, which specifically targeted to strengthen rural primary health care services in India. Next set of reforms through National Health Policy 2017, introduced the concept of CPHC addressing both communicable and non-communicable diseases through PHC centres with multi-disciplinary teams, and to strengthen the health system through increased government spending. In 2018, with a vision to achieve Universal Health Coverage, the Government of India introduced Ayushman Bharat Program (ABP), which covers prevention and promotion as well as primary, secondary and tertiary care. There are two components of ABP (1) Strengthening of existing Sub Health Centres (SCs) and PHCs to Health and Wellness Centres (HWCs) which aim to deliver an expanded range of services close to the community, and (2) Pradhan Mantri Jan Arogya Yojana (PMJAY) which focuses on providing financial protection to people below the poverty line for secondary and tertiary level hospitalisation services.
Health system in India:
Sub Centres: As on 31st March 2020, there are a total of 157921 Sub Centres (SCs) functioning both in rural and urban areas of India. These consist of 155404 SCs in rural areas & 2517 SCs in urban areas.
Primary Health Centres: There are 30813 Primary Health Centres (PHCs) functioning in both rural and urban areas in India. These consists of 24918 PHCs in rural areas and 5895 PHCs in urban areas.
Community Health Centres: There are 5649 Community Health Centres (CHCs) functional in the country, consisting of 5183 rural and 466 urban CHCs.
Health and Wellness Centres (HWCs): These centers were established as a component of Ayushman Bharat to provide comprehensive primary healthcare to the population. The program aimed at transforming existing 150,000 Sub- Health Centres and Primary Health Centres into HWCs by December 2022. As of 31st March 2020, there is a total of 38595 HWCs functional in India. This includes 18610 SCs that have been converted into HWC-SCs, and 19985 PHCs have been converted into HWC-PHCs. Out of the total HWC-PHCs, 16635 PHCs has been converted into HWCs in rural areas and 3350 in urban areas
Below is a snapshot of HWC operationalisation in two diverse Indian States:
| Andhra Pradesh (South India) • As of 31st March 2020, there are a total of 7458 Sub-Health Centres and 1388 PHCs functioning both in rural and urban areas of Andhra Pradesh state. • All the Primary Health Centres in rural and urban areas has been transformed to Ayushman Bharat- Health and Wellness Centres (AB-HWC). • 40% of the target Sub-Health Centres has also been operationalised into AB-HWCs. • The state has also been a forerunner in the use of technology in health care delivery at HWCs, namely – use e-Aushadhi at the level of the SHC-HWCs creation of teleconsultation hubs at the district hospital use of e-Sanjivanee, an integrated telemedicine solution CPHC-NCD application being adapted to include a citizen database Application under development to link health worker screening data obtained during FIT worker campaign (all healthcare workers would be screened for non- communicable diseases (NCDs)) to a health facility for follow up. Public Private Partnerships (PPP) in urban areas where all Urban PHCs are converted to e-UPHCs (with teleconsultation facility and an IT system for managing internal patient flow). Haryana (North India) • As of 31st March 2020, there are a total of 2617 Sub-Health Centres and 485 PHCs functioning both in rural and urban areas of Haryana state. • Only 25% of the target facilities have been upgraded to AB-HWCs. • All SHC- HWCs are being mapped with HMSCL Online Drug and Inventory Management System for improving the indent and management systems. • The state has built a knowledge partnership with the All India Institute of Medical Sciences, Delhi and the National Health Systems Resource Centre to support the district of Mewat (aspirational district) in navigating the operationalizing of HWC and enabling the necessary change management. • The state is planning to roll out teleconsultation to provide specialist consultation. | Haryana (North India) • As of 31st March 2020, there are a total of 2617 Sub-Health Centres and 485 PHCs functioning both in rural and urban areas of Haryana state. • Only 25% of the target facilities have been upgraded to AB-HWCs. • All SHC- HWCs are being mapped with HMSCL Online Drug and Inventory Management System for improving the indent and management systems. • The state has built a knowledge partnership with the All India Institute of Medical Sciences, Delhi and the National Health Systems Resource Centre to support the district of Mewat (aspirational district) in navigating the operationalizing of HWC and enabling the necessary change management. • The state is planning to roll out teleconsultation to provide specialist consultation. |
