AYUSHMAN BHARAT: Comprehensive Primary Health Care ... - …

1 AYUSHMAN BHARAT: Comprehensive Primary Health Care through Health and wellness CentersAYUSHMAN BHARAT Comprehensive Primary Health Care through Health and wellness CentersOperational GuidelinesThe launch of these Operational Guidelines for Comprehensive Primary Health Care through Health and wellness Centres marks a major milestone in the history of public Health in India. They are based on the premise of an effective Health systems, acknowledging the changing disease burden and it also includes interventions that account for high proportions of morbidity and mortality leveraging a slew of programmes launched in the past few years to reduce out of pocket expenditures.

2 The operational guidelines are Comprehensive and draw on the lessons of the National Health Mission in various contexts. They are ambitious in their scope and scale and include guidance on physical and financial requirements, service packages, IT requirements, monitorable targets and also suggest reforms in payment packages including team-based incentives. The delivery of Comprehensive Primary Health Care is not without challenges, since it involves a paradigm shift at all levels of the Health system. The NHM has paved the way for effective implementation of HWC, and states must leverage this learning for effective implementation of guidelines, albeit very Comprehensive , are a road-map, and states will need to adapt these to their contexts.

3 However, I do hope that states will use the guidelines to develop a state specific road map, and build shared accountability at district and sub district level, so that there is a clear goal and focus to help us reach the target of operationalizing lakh Health and wellness Operational Guidelines are based on inputs from states which have been valuable in strengthening these guidelines. I would also like to thank the team at the National Health Systems Resource Centre, experts and state government officials whose relentless efforts have made the launch of these guidelines possible. Manoj jhalani Manohar agnani rajani r.

4 VedAdditional Secretary & Mission Director Joint Secretary (Policy) Executive Director, NHSRCMESSAGEAYUSHMAN BHARAT: Comprehensive Primary Health Care through Health and wellness CentersLiST Of ABBReviATiONSANMA uxiliary Nurse MidwifeAWCsAnganwadi CentresAYUSHA yurveda, Yoga and Naturopathy, Unani, Siddha And HomeopathyBCCB ehaviour Change CommunicationBCMB lock Community ManagerBMOB lock Medical OfficerBPMB lock Programme ManagerCHCC ommunity Health CentreCHOC ommunity Health Officer COPDC hronic Obstructive Pulmonary DiseaseCOTPAC igarettes and Other Tobacco Products ActCPHCC omprehensive Primary Health CareCSRC orporate Social ResponsibilityDCMD istrict Community ManagerDHDistrict HospitalDPMD istrict Programme ManagerEMLE ssential Medicines ListFRUF irst Referral UnitGNMG eneral Nursing And MidwiferyHRHH uman Resource for Health SHCSub Health Centres ICDSI ntegrated Child Development ServicesICPSI

5 Ntegrated Child Protection SchemeIECI nformation Education CommunicationIGNOUI ndira Gandhi National Open UniversityMASM ahila Arogya SamitiMDMMid Day MealMLAM ember of Legislative AssemblyAYUSHMAN BHARAT: Comprehensive Primary Health Care through Health and wellness CentersxivMLHPMid Level Health ProviderMMUsMobile Medical UnitsMNREGAM ahatma Gandhi National Rural Employment Guarantee ActMOMedical OfficerMOICM edical Officer In chargeMPMember of ParliamentMPWM ulti Purpose WorkerNACON ational Aids Control OrganisationNGONon-Governmental OrganisationNPCDCSN ational Programme For Prevention And Control Of Cancer, Diabetes.

6 Cardiovascular Diseases And StrokeOOPEOut of Pocket ExpenditureOPDOut Patient DepartmentPHCP rimary Health CentreRCHR eproductive and Child HealthSBAS killed Birth AttendantSHGsSelf Help GroupsSHSRCS tate Health Systems Resource CentreSTGsStandard Treatment GuidelinesUHCU niversal Health CoverageUHNDU rban Health and Nutrition DayULBU rban Local BodyUPHCU rban Primary Health CentreVHSNCV illage Health Sanitation And Nutrition CommitteeWCDW omen and Child DevelopmentAYUSHMAN BHARAT: Comprehensive Primary Health Care through Health and wellness CentersSection 1 Introduction 01 Section 2 Defining Health and wellness Centres 05 Section 3 Service Delivery and Continuum of Care 11 Section 4 Human Resources 21 Section 5 Information and Communication Technology (ICT)

7 29 Section 6 Planning, Location and Infrastructure Upgrade of Health and wellness Centres 33 Section 7 Medicines, Diagnostics and other Supplies 37 Section 8 Quality of Care 41 Section 9 Health Promotion, Community Mobilization and Ensuring wellness 43 Section 10 Programme Management 49 Section 11 Financing 55 Annexure 59 CONTeNTSAYUSHMAN BHARAT: Comprehensive Primary Health Care through Health and wellness CentersThe National Health Mission (NHM), the country s flagship Health systems strengthening programme, particularly for Primary and secondary Health care envisages attainment of universal access to equitable, affordable and quality Health care which is accountable and responsive to the needs of people.

8 Investments during the life of the NHM in its earlier phases were targeted to strengthen Reproductive and Child Health (RCH) services and contain the increasing burden of communicable diseases such as Tuberculosis, HIV/AIDS and vector borne diseases. While such a focus on selective Primary Health care interventions, enabled improvements in key indicators related to RCH and select communicable diseases, the range of services delivered at the Primary care level did not consider increasing disease burden and rising costs of care on account of chronic diseases. Studies show that households in rural areas and about only 4% in urban areas, reported seeking any form of OPD care - at or below the CHC level (except for childbirth) Primary care facilities, indicating low utilization of the public Health systems for other common ailments1.

9 National Sample Survey estimates for the period-2004 to 2014 show a 10% increase in households facing catastrophic healthcare expenditures. This could be attributed to the fact that private sector remains the major provider of Health services in the country and caters to over 75% and 62% of outpatient and in-patient care respectively. India is also witnessing an epidemiological and demographic transition, where non-communicable diseases such as cardiovascular diseases, diabetes, cancer, respiratory, and other chronic diseases, account for over 60% of total is global evidence that Primary Health Care is critical to improving Health outcomes.

10 It has an important role in the Primary and secondary prevention of several disease conditions, including non-communicable diseases. The provision of Comprehensive Primary Health Care reduces morbidity and mortality at much lower costs and significantly reduces the need for secondary and tertiary care. For Primary Health care to be Comprehensive , it needs to span preventive, promotive, curative, rehabilitative and palliative aspects of care. Primary Health Care goes beyond first contact care, and is expected to mediate a two-way referral support to higher-level facilities (from first level care provider through specialist care and back)