Ayushman Bharat aims to transform 150,000 sub-centers and primary health centers into Health and Wellness Centers across India to provide comprehensive primary healthcare services. In Odisha, 1615 centers have been operationalized so far, reaching about half of the current yearly target. Some best practices in Odisha include conducting a month-long NCD screening campaign that screened over 30 lakh people, and improving competencies for community health certificate programs through skills labs. However, with 40% of its population from vulnerable groups, Odisha faces ongoing challenges to achieve universal health coverage through expanding coverage of its Ayushman Bharat program.

1. Reports of
AB – HWC
ODISHA
Amitosh Dandsena
Master in public health (MPH)
AIPH University Bhubaneswar
Odisha ,

2. About Health and Wellness Center:
 Ayushman Bharat (AB) is an attempt to move from a selective approach to health care to
deliver comprehensive range of services spanning preventive, promotive, curative, rehabilitative and palliative care.
 It has two components which are complementary to each other.
 Under its first component, 1,50,000 Health & Wellness Centre (HWCs) will be created to deliver Comprehensive Primary
Health Care, that is universal and free to users, with a focus on wellness and the delivery of an expanded range of services
closer to the community.
 The second component is the Pradhan Mantri Jan Arogya Yojana (PM-JAY) which provides health insurance cover of Rs.
5 lakhs per year to over 10 crore poor and vulnerable families for seeking secondary and tertiary care.
 HWC are envisaged to deliver expanded range services that go beyond Maternal and child health care services to include
care for non -communicable diseases, palliative and rehabilitative care, Oral, Eye and ENT care, mental health and first
level care for emergencies and trauma , including free essential drugs and diagnostic services.

3. Functional strategy to implicate For the HWCs in Odisha state :
 Under Ayushman Bharat – Health & Wellness Centres (AB-HWCs), 1.5 lakh Sub Health Centres and Primary
Health Centres are to be transformed into Health and Wellness Centres.
 Across the country for provision of Comprehensive Primary Health Care (CPHC) that includes preventive
healthcare and health promotion at the community level with continuum of care approach by December,
The roll out plan of AB - HWCs is given as below:
• FY 2018-19 = 15,000
• FY 2019-20 = 25,000 (Cumulative 40,000)
• FY 2020-21 = 30,000 (Cumulative 70,000)
• FY 2021-2022 = 40,000 (Cumulative 1,10,000)
• Till 31st December 2022 = 40,000 (Cumulative 1,50,000)
 “Public Health and Hospitals” being a State subject, the States have been accorded the flexibility to identify the
facilities to be upgraded as Health and Wellness Centres based on the availability of Health Infrastructure and
Human Resources.

4. State Name HWCs Functional
TOTAL
Odisha
SHC
107
PHC
822
UPHC
83
1,012
 As per AB-HWCs portal, the state-wise details of functional AB-HWCs as on 03.02.2020 are
given below:
 Odisha was join AB-HWC scheme at march 2020. as according to the report of Govt of Odisha .

5. SUBTITLE
Ayushman Bharat Health and Wellness Centres Accelerating towards health for all April 2018-September 2019
SOURCE- Reports of AB-HWCs accelerating towards health for all 2018-2019

6. Best Practices in Odisha:
As according to report of AB-HWCs towards health for publics by Health & family welfare Government india
, Odisha conducting some best practice in the community and the domain field .
in two way
 NCD disease campaign
 Improving the competency of the candidates of the certificate course in community health
NCD disease campaign:
• The state launched a month long NCD campaign across AB-HWCs to screen all the individuals above 30 years
of age for common NCDs.
• The target was to fulfill the PIP conditionality related to AB-HWCs and move closer to universal health coverage
by providing an expanded range of health services closer to the communities.
• The service providers from the targeted facilities (MO, SN, MPW (M and F) and ASHA) were trained on NCD
services. Other activities that were conducted as part of the campaign were facility-level micro-planning,
• special IEC/BCC materials, provisioning of funds for different activities, mentoring visits by state and district level
officials and patient support group meetings at community level.
• By the end of campaign, more than 30 lakh people were screened for common NCDs out of which
screening data of more than 17 lakhs individuals was updated in NCD app.
• 18% of the total eligible population were screened, exceeding the target of 15% and more than 50% of the
screened data was updated in NCD app thereby strengthening timely reporting mechanisms as well.

7. Improving the competency of the candidates of the certificate course in community health
• The state of Odisha decided to strategically establish the Program Study Centres (PSCs) at those nursing
midwifery institutions which have functional nursing laboratories (skills lab) to conduct the certificate course
community health.
• This was done to ensure supervised demonstration and practice skills of the candidates at these nursing
laboratories to improve their competencies during the certificate course.
• Structured checklists were developed and academic counselors were oriented on competency based
education. Rosters were developed in consultation with the skills lab in-charge so that routine practice of
ANM/GNM student.
• It also ensured optimal utilization of skills lab which were established using NHM funds during preceding
years.
Source : As according toReports of AB-HWCs accelerating towards health for all 2018-2019

8. Progress Report from Ayushman Bharat Health and wellness center at dt of 5.8.2020
Sl. No. State Name District Name Total Functional
No of Wellness sessions including Yoga
conducted
Total Screenings For Hypertension Total Screenings For Diabetes Total Screenings For Oral Cancer Total Screenings For Breast Cancer Total Screenings For Cervical Cancer
Male Female Others Total
1 Odisha Ganjam 129 460355 436882 137 897374 1127 90729 68454 10604 3805 2362
2 Odisha Sonapur 31 143393 99559 85 243037 20 33444 26260 18166 7848 1391
3 Odisha Baudh 17 78069 68415 70 146554 337 6695 5493 3406 1207 957
4 Odisha Kandhamal 50 263554 274827 29 538410 869 33098 22255 10843 3302 727
5 Odisha Gajapati 22 119517 114800 12 234329 24 19806 8409 1361 785 779
6 Odisha Puri 63 364271 318835 54 683160 1780 40204 38620 23047 7245 5510
7 Odisha Khordha 85 860930 812227 1637 1674794 1587 155162 125282 87855 40349 19311
8 Odisha Nayagarh 40 296834 262209 2 559045 1607 13950 7422 1825 317 157
9 Odisha Rayagada 39 201473 176435 95 378003 44 31558 16465 998 178 8
10 Odisha Malkangiri 27 173270 158116 5 331391 1213 71172 57827 49660 21156 2107
11 Odisha Koraput 57 321554 287392 130 609076 656 103009 65056 27491 11793 5215
12 Odisha Nabarangapur 45 201962 201109 1332 404403 840 43259 38946 32704 14564 10823
13 Odisha Kalahandi 70 251964 222675 270 474909 1793 32153 18944 4221 717 316
14 Odisha Nuapada 28 70405 60610 279 131294 901 14015 9609 2245 908 329
15 Odisha Balangir 59 302808 257966 206 560980 601 116062 103890 59403 20596 8825
16 Odisha Debagarh 12 48071 44429 12 92512 9 4304 3870 3055 1419 1187
17 Odisha Mayurbhanj 111 633645 595516 118 1229279 5402 146871 116104 87252 35363 22001
18 Odisha Kendujhar 73 308709 282392 109 591210 741 135615 134579 125991 58644 17767
19 Odisha Sundargarh 75 281385 305064 437 586886 3366 113667 98190 74895 24728 11652
20 Odisha Baleshwar 90 615867 594153 374 1210394 1307 243435 226103 201211 83061 82772
21 Odisha Sambalpur 42 319856 319297 174 639327 227 125558 119283 66315 12935 0
22 Odisha Jharsuguda 25 157060 142042 138 299240 36 92820 72408 54328 28049 6314
23 Odisha Bargarh 62 370163 350335 165 720663 1249 126973 118400 87543 14696 1944
24 Odisha Cuttack 87 782273 707536 1849 1491658 6184 138701 117852 51699 3062 1667
25 Odisha Anugul 22 78083 65463 2 143548 9 33597 32425 23860 7000 356
26 Odisha Dhenkanal 47 224743 194348 65 419156 1135 23454 17458 12994 6909 10710
27 Odisha Jajapur 63 452501 356006 128 808635 833 31508 26070 7795 3400 2636
28 Odisha Jagatsinghapur 33 186471 154153 492 341116 177 41229 35663 30489 14580 14580
29 Odisha Kendrapara 52 400145 337102 2 737249 1564 136560 135136 131187 57284 31679
30 Odisha Bhadrak 59 353521 295214 2999 651734 1532 66288 47231 6462 3040 2741
1615 17829366 9322852 8495107 11407 37170 2264896 1913704 1298905 488940 266823
Total Footfalls
TOTAL
Sources – Ayushman Bharat health portal india (hwc.nhp.gov.in)

9. Progress Report from Ayushman Bharat Health and wellness center at dt of 5.8.2021
HWC PORTAL : hwc.nhp.gov.in

10. Total functional Report of HWCs Odisha 2020-21
p
o
p
u
l
a
ti
o
n
year
 This graph shows progress
report of the AB-HWCs program
Odisha from the year of 2020
to 2021.
66458
footfalls
150097
Yoga session
3614237
Diabetes
4853491
Hypertension
854805
Brest Cancer
518999
Cervical Cancer
2223128
Oral Cancer

11. Source :Ayushman Bharat – Health and Wellness Center portal 2021

12. Source: Roll out plane for HWCs for all state 2019-2022 (AB-HWCs portal)

13. Operationalization of AB-HWCs of Odisha state:
Numbers of Indicate Operational AB-HWCs
 Aspirational District
Photo source -Towards universal Health Coverage AB-HWC, A compendium of HWC Operationalization April
2018-nov-2020

14. Source- Report from Towards universal Health Coverage AB-HWC, Acompendium of HWC Operationalization April 2018-nov-
2020
Demography:
Total Population) Crore 4.1
Rural 83.3%
urban 16.7%
SC/ST population SC (crore) 0.71(17.1%)
ST(crore) 0.95(22.8%)
Literacy Rate State Female 64.01%
Total 72.87%
India Female 64.64%
Total 72.99%
Total fertility Rate (TFR) State 1.9
India 2.2
Crude Birth Rate (CBR) 18.2
Projection (2021) of Elderly
Population
11.8%
Finance :
Per capital government Health
Expenditure
State 1,108
India 1,418
Out of Pocket Expenditure as
share of total Health Expenditure
State 68.9%
India 58.7%

15. Source -Towards universal Health Coverage AB-HWC, A compendium of HWC Operationalization April 2018-nov-2020

16. Source -Towards universal Health Coverage AB-HWC, A compendium of HWC Operationalization April 2018-nov-2020

17.  The state of Odisha with nearly two fifths of its population belonging to either the Scheduled Class or
Scheduled Tribes category, faces significant challenges to Universal Health Coverage (UHC).
 After a high initial momentum with the launch of Ayushman Bharat-Health and Wellness Centres (AB-HWC),
in 2018-19, progress has plateaued.
 So far, 1615 HWCs have been operationalized, which is half the target for this current year, and about one quarter
of the total target.
 State has saturated all Primary Health Centres (PHCs) and Urban - PHCs as HWCs, but concerted efforts are
required for Operationalising of SHC-HWCs.
 Around 445 HWCs are operational across ten aspirational districts in the State.
 In order to address issues related to retention of Human Resources, the state is in the process of creating a
regular cadre for staff nurses to be placed at SHC-HWCs as Community Health Officers (CHOs).
 This policy decision, which is laudable, in that CHOs will become part of the regular cadre in the state, rather than
remain contractual staff, has slowed the pace of up-gradation of SHCs to HWCs.
Operational of HWCs:

18.  During the COVID-19 pandemic, CHOs played a significant role in screening and addressing the basic health
requirements of migrants at Temporary Medical Camps (TMC) established during the lockdown period.
 About 565 PHC-HWCs are being developed as model HWCs where adolescent health days are organized, Active
Case Finding (ACF) for TB is undertaken by ASHAs on Sundays, community engagement is undertaken through TB
champions and two high schools under each HWC are designated as ‘Tobacco Free Educational Institutions.
 The state is making concerted efforts through long term strategic decisions to reach the goal of providing
universal primary health care but infrastructure and HR shortfalls, and remote geography in many parts of the
state, are key barriers.
 To achieve Universal Health Coverage the state would need to look at alternate models of primary health care
service delivery, building upon its strong community processes structures, and engaging in partnerships with other
stakeholders.
Benefits of HWCs: During COVID
Source: Towards universal Health Coverage AB-HWC, A compendium of HWC Operationalization April 2018-nov-2020

19. Photo Source : AB-HWCs portal Odisha photo gallery of HWCs
 During the COVID-19 pandemic, CHOs played a significant role in screening and addressing the basic health requirements of
migrants at Temporary Medical Camps (TMC) established during the lockdown period in Ganjam district Odisha .

20.  AB-HWCs –SHC are participate to provide the range service for universal health coverage ,screening and provide
skill based training to CHO for oral cancer.
Photo Source: AB-HWCs portal Odisha HWCs gallery

21. Nominated PHC of Odisha for best performing AB-HWC Level :
Source : National health mission official Twitter Account on dt 12.12.2020

22.  Since public health is handled by the states, planning by states becomes imperative and all the states/ Uts should
develop a clear Road Map for delivery of CPHC services through AB-HWCs as discussed below:
Way Forward :
o Move towards a structural reform of health systems :
Provision of CPHC services through AB-HWCs requires a larger systemic change. There is a need to move from ad-hoc
mechanisms to a more comprehensive and structured planning and vision to bring out a structural reform in the health
systems.
o Rigorous financial Planing :
As recommended in the National Health Policy, 2017, the states should strive to allocate two third of their health budget to
primary health care. This is a key step towards ensuring availability of adequate financial resources for strengthening
delivery of comprehensive primary healthcare through AB-HWCs.
o Strengthening infrastructure at all levels for better functioning AB-HWCs Besides :
strengthening existing public health newly transformed facilities basic amenities such as regular water supply and
electricity, it is important to do need analysis on the infrastructure requirement of different levels of public healthcare
facilities as per population norms.

23.  Assigning population to AB-HWCs :
 Success of CPHC lies in definite assignment of population to the primary health care facility. In the context of AB-HWCs,
far as rural areas are concerned, service area population under SHC AB-HWCs needs tobe assigned to them.
Ensuring continuum of care as a key :
Principle It is essential to focus on ensuring continuum of care across the ABHWCs operationalized. There is a need to
establish bidirectional referral linkages to ensure continuum of care.
o Building a robust primary healthcare team at AB-HWCs :
o Primary healthcare teams are the foundation for ensuring the delivery of quality healthcare services to the community.
essential that all facilities have adequate staff posted across the levels as per IPHS norms.
 Ensuring availability of free essential medicines and diagnostics :
 Essential medicines and diagnostics form the foundation for providing primary healthcare through AB-HWCs, which will
increase footfall at AB-HWCs, thereby, resulting in the reduction of Out of Pocket Expenditure (OOPE) of the service
population.
Source:Reports of AB-HWCs accelerating towards health for all 2018-2019 , state CPHC strategy report 2020.

24. As according to
report from
Operationalization
AB-HWC data as of
October 2019,
Service delivery
as of September
2019 , where ODISHA
HWCs are 41-60% in
operational .
SOURCE- Reports of AB-HWCs accelerating towards health for all 2018-2019

25. Expanded range of services: AB-HWCs for all state-
 The expansion of services has been planned in incremental manner. As a first step, Screening, Prevention,
Control and Management of Non-communicable Diseases and Chronic Communicable diseases like
Tuberculosis and Leprosy has been introduced at HWCs.
•Care in pregnancy and childbirth.
•Neonatal and infant health care services
•Childhood and adolescent health care services.
•Family planning, Contraceptive services and Other Reproductive Health Care services
•Management of Communicable diseases: National Health Programs
•Management of Common Communicable Diseases and General Out-patient care for acute simple illnesses and
minor ailments
•Screening, Prevention, Control and Management of Non-Communicable diseases and chronic communicable
disease like TB and Leprosy
•Basic Oral health care
•Care for Common Ophthalmic and ENT problems
•Elderly and Palliative health care services
•Emergency Medical Services
•Screening and Basic management of Mental health ailment
• Key Components:
• The delivery of CPHC through HWCs involve is complex task as it requires a paradigm shift at all levels
of health systems. The operationalization of HWCs requires several inputs

26.  Provision of Comprehensive Primary Health
Care through Ayushman Bharat - Health and
Wellness Centres (AB-HWCs):
 In the last few decades, concerted efforts have been made
towards improvement in provision of quality healthcare in the
country.
 India has adopted a holistic approach towards healthcare to
realize the mantra of:
May All be Happy, May All be Free from Illness
 As we move from the Millennium Development Goals
to the more ambitious and universal Sustainable
Development Goals (SDGs).
 our efforts with a holistic approach towards
Comprehensive Primary Health Care (CPHC) would be
critical.
 With the Astana Declaration, we aim to re-focus our
efforts on primary health care to ensure equitable
access to all with highest possible standard of health
and well-being.
Photo Source : AB-HWCs portal Odisha photo gallery of HWCs

27. Thank you ..
Reference –State report AB-HWC health for all 2020, NHM portal , Ayushman Bhart Health &
wellness portal ,UHC state report 2020.