nursing

1. AYUSHMAN BHARAT
INTRODUCTION:-
The National Health Mission (NHM), the country’s flagship health system 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.” Investments during the life of the NHM were made to
strengthen reproductive and child health (RCH) services and limit the increasing burden of
communicable disease 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 communicable diseases, the range of services delivered at the primary care
level did not take into account increasing disease burden and rising cost of care on account of
chronic diseases.
The National Health Policy, 2017 recommended strengthening the delivery of primary health
care, through establishment of “health and wellness centres” as the platform to deliver
comprehensive primary health care and called for the commitment of two thirds of the health
budget to primary health care.
The report of the primary health care task force, Ministry of health and family welfare,
Government of India while reiterating that primary health care is the only affordable and
effective path for India to universal health coverage (UHC), also provided valuable insights into
structure and processes in health systemto enable comprehensive primary health care (CPHC).
AYUSHMAN BHARAT or “HEALTHY INDIA” national initiative was launched as recommended by
the National Health Policy 2017, to achieve the vision of universal health coverage. This
initiative has been designed on the lines as to meet SDG and its underlining commitment, which
is “leave no one behind”
AYUSHMAN BHARAT is an attempt to move from sectoral and segmented approach of health
service delivery to comprehensive need based health care service.
OBJECTIVE:-
Ayushman Bharat aims to undertake path breaking intervention to holistically address health
(covering preventions, promotions, and ambulatory care) at primary, secondary and tertiary
level.

2. INITIATIVES:-
1) PMJAY (PRADHANMANTRI JANAROGYA YOJANA):- Coverage for poor and
vulnerable families for secondary and tertiary care hospitalization.
2) CPHC(COMPREHENSIVEPRIMARYHEALTH CARE):- through health and wellness
centres.
PMJAY(PRADHAN MANTRI JAN AROGYA YOJANA):-
 A cover of INR 5 lakh per family per year.
 Over 10 crore poor and vulnerable families are eligible.
 State given flexibility to decide on mode of implementation.
 Benefits will be portable across the country.
 Entitlement based scheme.
CONTINUM OF CARE:-

3. COMPREHENSIVEPRIMARY HEALTH CARE(CPHC):-
 Selective primary health care- RCH focused, addresses only 20% of health care
needs.
 Low utilizationof public healthfacilities- 28% in rural and 21% in urban areas.
 Epidemiological transition- four major communicable diseases account for 62% of
all death in India.
HWCs- THE CONCEPT:
 Expanded package of services.
 Health promotion and wellness.
 Reaching the last mile.
 Ensuring continuum of care.
 Team based approach.
KEY ELEMENTS TO ROLL OUT CPHC:-
 Expended service delivery.
 Expanding HR-MLHP & multiskilling.
 Expanding diagnostic point of care and new technologies.
 Health promotions.
 Infrastructure.
 Financing/ providing payment reforms.
 Robust IT system.
 Essential drug and supplies.
 Continuum of care- telehealth/ referral.
12 EXPANDED PACKAGE OF SERVICES:-
 Care in pregnancy and childbirth.
 Neonatal and infant health care services.
 Childhood and adolescent health care services.
 Family planning and other reproductive health care services.
 Comprehensive management of communicable disease.
 Screening and comprehensive management of NCDs.
 Basic ophthalmic care services.

4.  Basic ear, nose, throat care services.
 Screening & basic management of mental health ailments.
 Basic dental health care.
 Basic geriatric health care services.
 Emergency medical services.
THE TEAM- HUMAN RESOURCE:-
HWCs-SHC(SUB HEALTH CENTRE):-
 One community health officer: B.Sc/ GNM or Ayurveda practitioner trained in 6 month
certificate course in community health or BSC. Nsg. Candidate who studied integrated
CHO course or BSC. Community health.
 2 multipurpose workers- male/ female.
 5 ASHAs for outreach.
HWCs- PHC/UPHC:-
 PHC team as per IPHS norms- at least 1 MBBS Doctor, 1 staff NURSE, 1 Pharmacist , 1 lab
technician and LHV(Lady health visitor) + MPW + ASHAs.
 At PHCs where cervical cancer screening is being planned an additional staff nurse can
be posted.
CAPACITY BUILDING & MULTI SKILLING:-
HWCs – frontline health workers:-
 ASHAs- 5 day in NCD training package in first phase + refresher and newer
package annually. (15 days)
 MPWs (F&M) - 4 days for NCD package and new packages for additional services.
 Joint training of MPWs with ASHAs wherever possible.
 Reporting and recording information using digital applications.

5. PHCs- Medical officers and Staff nurses:-
 3 days for NCD screening and management.
 14 days for screening for cancer via for ca cervix.
 Online training through massive open online course(MOOC) and ECHO.
 Certificate course in NCD management/ MCH care/ elderly care / mental health.
 Partnership with AIIMS/ Regional cancer centres / knowledge network to act as training
resource centres.
DRUGS AND DIAGNOSTICS SUPPLY:-
 Drugs and Supply
• Essential Drug Lists (with expanded drugs for NCDs)
• MLPs to dispense medicines for chronic diseases on prescription of Medical Officer
• Uninterrupted availability of medicines to ensure adherence and continuation of care
• DVDMS expansion to level of HWCs – PHCs, UPHCs and SCs
 Point of care diagnostics
• 7 investigations at SHC HWC (Hb Blood Sugar, Nischay Kit, RDT for Malaria and
Dengue,Sputum forAFB,Urine Protein & Urine Sugar) & 19 at PHC HWC
• Blood collection point for Hub & Spoke Model at different levels .
INFRASTRUCTURE:-
BRANDING-
 As per facility branding instructions of Goal.
 Citizen Charter.

6. A HWC should have space for:
 Examination room with adequate privacy & Telehealth
 Diagnostics
 Medicine dispensation
 Storage of documents, health cards and registers
 Wellness:Yoga, Physiotherapy, Group meetings
 Waiting area
 IEC display
 Labour room at delivery points
 Separate male and female toilets
 Other requirements
• Assured water & electricity supply.
• Proper systemfor drainage .
• Deep burial / sharp pit for Biomedical Waste Management.
• Internet connectivity.
• Display boards.
• Contact Details of Team.
• Details of referral centres.
• Jurisdiction of Gram Panchayat/ Urban Local body.

7. IT SYSTEM:-
• Patient centric
 Unique Individual ID & Individual health record
 Family health folder
 Facilitates continuum of care through alerts
• Service Providers
 Tablets for MPW and MLHP withANMOL app/ RCH portal and NCD
module of CPHC IT system uploaded
 Internet connectivity.
 Facilitates use of platforms like ECHO
• Program Managers
 Dashboards
 Provide monitoring reports to assess performance for payments
TELECONSULTATION:-
• Phased introduction of teleconsultation –as a mechanismfor improved referral services
and ensuring continuum of care
• HWC staff to be equipped for tablets/ smart phones/ laptops for teleconsultation
• Capture and transmit images, prescriptions and diagnostic reports
• Use of teleconsultation for:
 Emergency consultation- at appropriate levels
 Dedicated time for specialist consultation
 Capacity building
 Standing orders for prescription

8. PROMOTING WELLNESS THROUGH YOGA:-
• Close coordination with Ministry of AYUSH/ Department of AYUSH at the state and
district level
• Training and certification of local yoga teachers to be steered by Department of AYUSH
• Pool of local yoga instructors at HWC level to be identified
• Weekly/ monthly sessions for Community yoga training at HWCs
• Provision for additional remuneration to in house yoga teacher or in sourced yoga
instructor
COMMUNITY OUTREACH AND SCREENING:-
• Population enumeration and family folder – entire population of the village
• Filling up of CBAC (Community Based Assessment Check List) form – 30 yrs and above
• Raising public awareness of HWC and CPHC by ASHA
• Fixed day screening in HWC and community for 5 common NCD
• Yearly screening for HTN and DM
• 5Yearly screening for CA oral cavity, CA cervix and CA breast
• Referral and follow up – Maintaining continuum of care.
HWC PORTRAL:-
• Reporting, Monitoring and Evaluation tool to assess the progress in upgradation and
service delivery of HWC
 Objective is to,
• Support accurate and timely submission of HWC progress data. Facilitate regular review
of the progress in operationalizing HWCs. Identify challenges faced by states/ districts
in operationalizing HWCs .

10. BIBLIOGRAPHY:-
 Narendramodi.co.in
 National CPHC guideline
 http:/ab-hwc.nhp.gov.in/home/aboutus
 www.nhm.co.in