Health and wellness center is one of the two component of Ayushmann Bharat. HWC ensures comprehensive, quality, and affordable care to be achieved by all.

1. Health and Wellness Center
• Presenter: Dr Jitender Kumar, Junior Resident
• Moderator: Dr Kathirvel S., Assistant Professor
(For Dr JS Thakur, Professor)
Department of Community Medicine and School of Public
Health, PGIMER Chandigarh

2. Outline
• Universal Health Coverage (UHC)
• Role of Primary Health Care in UHC
• Challenges to UHC
• Rationale of Health and Wellness Centres (HWCs)
• Key elements to roll out HWC
• Progress so far
• Opportunities
• Challenges
• Way forward

3. Health and Wellness
• “A state of complete physical, mental and social well-being and not
merely the absence of disease or infirmity” *
• Wellness : active process of becoming aware of and making choices
towards a healthy and fulfilling life. It is more than being free from
illness, it is a dynamic process of change and growth
*WHO definition of health- 1948

4. Universal Health Coverage (UHC)
All people have access to effective and high-quality health services, without
experiencing financial hardship (WHO)
1948: Universal declaration of human rights
Article 25 : Everyone has the right to a standard of living adequate for
health, including medical care, and the right to security in the event of
sickness or disability
1977: Health for all by the year 2000 (World Health Assembly)
2012: United Nations General Assembly adopt a resolution calling for countries
to toe the path of UHC
2016: UHC became a global development agenda target - target 8 of SDG 3

5. UHC and Primary Health Care
• Focus of the global community: To achieve UHC, and Primary Health
Care is a necessary foundation for these efforts
• Primary Health care: Essential health care made universally
accessible to individuals and families in the community through their
full participation and at a cost that community can afford*
• Astana Conference, 2018: Aims to commemorate the 1978
declaration, reaffirm its original principles and renew political
commitment to placing primary health care (PHC) at the heart of
achieving universal health coverage and the SDGs
*Alma Ata Declaration-1978

6. Primary Health Care (PHC)
• Primary Health Care : Critical to improving health outcomes- Important
role in the 1⁰ and 2⁰ prevention of diseases
• Comprehensive Primary Health Care reduces morbidity and mortality at
much lower costs; also reduces the need for secondary and tertiary care.
• For primary health care to be comprehensive: 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

7. Challenges to achieve UHC
• Selective Primary Health Care: limited to RCH and few
Communicable Diseases- addresses about 20% of health care needs
• Low utilization of public health facilities: 28% in rural areas and 21%
in urban areas sought care in the public sector; of which only 11.5%
and 4% respectively sought any form of care at a level below the
CHC
• Health care is fragmented –disrupts continuity of care
• High Out of Pocket Expenditure
National Sample Survey 71st Round, 2014

8. Challenges to achieve UHC
• Lack of gate keeping function – raises the load on secondary and
tertiary facilities and compromises quality
• Epidemiologic Transition: Death from the four major NCDs –Cancer,
CVD, Diabetes, and Respiratory Diseases accounts for nearly 62% of
all mortality among men and 52% among women –of which 56% is
premature*
• Unfinished Agenda of RCH and Communicable Diseases -Persistent
challenge
* WHO. Non Communicable Diseases; Country Profile for India; 2014

9. High Level Expert Group (HLEG) on UHC
• HLEG on UHC: By Planning Commission of India in October, 2010
• The final framework on achieving UHC for India by 2022: submitted
on the 21st of October, 2011
• The recommendations for the provision of UHC pertain to the critical
areas: health financing, health infrastructure, health services norms,
skilled human resources, access to medicines and vaccines,
management and institutional reforms, and community participation

10. National Health Policy 2017
• National Health Policy 2017 : Prioritized primary healthcare as a
principal component of health system strengthening
– Strengthening the delivery of Primary Health Care, through
establishment of “Health and Wellness Centres”
– Two thirds of health budget to be committed to PHC
• WISH Health and Wellness Centre Model
• India launched Ayushman Bharat - one of the most ambitious health
missions ever to achieve UHC

11. WISH Health and Wellness Centre Model
• Based on the vision of NHP,2017
• Designed a solution for addressing the primary healthcare needs &
launched a demonstration of a Health & Wellness Center in
Rajasthan in July 2017
Features:
• Human Resource: 2 ANMs, 1 MPW
• Drugs, equipment, consumables as per the standard IPHS guidelines
• Swasthya ATM
• Use of Point of Care innovative devices for NCD Screening (Diabetes,
Hypertension, Cancer)

12. PRIMARY
SECONDARY
TERTIARY
CONTINUUM OF CARE – CPHC & PM JAY
Unmet need:
NCDs/other
Chronic Diseases Existing
services:
RMNCHA
PM JAY
Referral Preventive,
Promotive,
Curative,
Rehabilitative
&
Palliative
Care
AYUSHMAN BHARAT – Rationale

13. Ayushman Bharat
• 1.5 lakh sub-centres and
primary health centres will
be transformed as health
and wellness centres by
2022 to provide
Comprehensive Primary
Health Care (CPHC) close
to the community
• Cover over 10 crore poor
and vulnerable families
providing coverage up to
Rs 5 lakh per family per
year for secondary and
tertiary hospitalization
Health and Wellness Centers
Pradhan Mantri Jan Arogya
Yojana (PMJAY)

14. • 14th April 2018-Honorable Prime Minister launched the first Health
and Wellness Centre at Jangla, Bijapur, Chhattisgarh
Launch of Health and Wellness Centre

15. Health and Wellness Centers
• Sub centres covering a
population of 3000-5000
• PHC: Population 30000
• Urban PHC: Population 50000
Health & Wellness Centre – Sub
Centre
Health & Wellness Centre –
PHC
PHC
SHC
SHC
SHC
SHC
SHC

16. Sub Centre: Manpower (IPHS,2012)
Type of Sub- centre Sub Centre A Sub Centre B
Staff Essential Desirable Essential Desirable
ANM/ Health Worker
(F)
1 +1 2
Health Worker (M) 1 1
Staff Nurse (or ANM, if
Staff Nurse is not
available)
1*
Safai- Karamchari 1
(Part time)
1
(Full term)
* If no. of deliveries at the Sub centre is 20 or more in a month

17. Health & Wellness Centre – Sub Centre
Primary Health Care Team:
• Mid-level health provider (MLHP): BSc/ GNM or Ayurveda
Practitioner trained in 6 months Certificate Programme in
Community Health/ Community Health Officer (BSc-CH)
• MPW F: 2 per Sub Centre
• MPW M: 1 to be provided from state resource
• 5 ASHAs as outreach team per Sub Centre
Source: Ayushman Bharat: Comprehensive Primary health care through HWCs

18. PHC: Manpower (IPHS,2012)
Staff Essential Desirable
Medical Officer- MBBS 1
Medical Officer- AYUSH 1
Pharmacist 1
Pharmacist AYUSH 1
Staff Nurse 3 +1
Health Worker (F) 1
Health Assistant (M) 1
Health Assistant (F)/ LHV
Accountant Cum DEO 1
Lab Technician 1
Health Educator 1
Cold Chain & Vaccine Logistic Assistant 1
Sanitary worker cum watchman 1

19. Health & Wellness Centre – PHC
Primary Health Care Team: as per IPHS
• 1 MBBS Doctor at least
• Staff nurses
• Pharmacist
• Lab Technician
• MPW-F*
• ASHAs*
• Support for training of PHC staff
• Provision of “Wellness Room”
• Necessary IT infrastructure
• Resources required for upgrading
laboratory and diagnostic support to
complement the expanded ranges of
services
* In Urban area
Source: Ayushman Bharat: Comprehensive Primary health care through HWCs

20. • Current norm is one UPHC per 50,000 population
• All existing Urban Primary Health Centers to be strengthened as HWCs
by March 2020
• Frontline workers- 4-5 ASHAs and 1 MPW(F) for 10,000 population
• MLHP would not be required, as MO MBBS is already approved for
UPHCs
• Explore partnerships with not for profit and private sector to provide
primary health care, where UPHCs do not exist, as a gap filling measure
HWCs in Urban Areas

21. Health & Wellness Centre
• Primary Health Care
team
• Logistics
• Infrastructure
• Digitization
• Telemedicine/IT
Platforms
• Capacity Building
• Health Promotion
• Community
Mobilization
• HWC Database
• Health cards and
Family Health Folders
• Increased access to
Services
INPUTS OUTPUTS OUTCOMES
• Improved population
coverage
• Reduced OOPE
• Risk factor mitigation
• Decongestion of 2⁰
and 3⁰ level facilities

22. Key
Elements
to
Roll
out
CPHC
CPHC
through
HWC
Continuum
of Care –
Telehealth
/Referral
Expanded
Service
Delivery
Expanding
HR - MLHP
&
Multiskilling
Medicines
&
Expanding
Diagnostics
Community
Mobilisation
and Health
Promotion
Infrastructure
Financing/
Provider
Payment
Reforms
Robust IT
System
Partnership
for
Knowledge &
Implementati
on

23. Service Delivery and Continuum of Care

24. Sub Centre: Services (IPHS,2012)
• Maternal Health Services
• Child Health Services
• Family planning
• School health services
• Control of local endemic diseases
• IDSP
• National Health Programmes
• Minimum Diagnostic services

25. PHC: Services (IPHS,2012)
• Medical Care: OPD, Emergency, Referral, In patient services
• Maternal Health Services
• Child Health Services
• Family planning
• School health services
• National Health Programmes
• Training
• Basic Lab & Diagnostic Services
• Monitoring and supervision
• Minor surgery

26. 1. Care in Pregnancy and Child-birth
2. Neonatal and Infant Health Care Services
3. Childhood and Adolescent Health Care Services
4. Family Planning, Contraceptive Services and other Reproductive Health
Care Services
5. Management of Communicable Diseases: National Health Programmes
6. General Out-patient Care for Acute Simple Illnesses and Minor Ailments
Expanded Service Delivery

27. 7. Screening, Prevention, Control and Management of Non-
communicable Diseases
8. Care of Common Ophthalmic and ENT problems
9. Basic Oral Health Care
10. Elderly and Palliative Health Care Services
11. Emergency Medical Services including Burns and Trauma
12. Screening and Basic Management of Mental Health Ailments
Expanded Service Delivery

28. Community – Facility: Maintaining Continuum of Care
• Population Enumeration
• Outreach Services
• Community Based Screening
• Risk Assessment
• Awareness Generation
• Follow up of confirmed cases
• Counselling: Lifestyle changes;
treatment compliance
• First Level Care
• Screening
• Use of Diagnostics
• Drug Dispensation
• Record keeping
• Telehealth
• Referral to MO at PHC for
confirmation/complications
• Diagnosis
• Prescription and Treatment Plan
• Referral of complicated cases
• Telehealth
• Real time monitoring
• Advanced diagnostics
• Complication assessment
• Telehealth
• Tertiary linkage/ PM JAY
Village/Urban
Ward
SHC
PHC/UPHC
CHC/SDH/DH
ASHA/MPW MLHP/CHO

29. Expanding Human Resources - MLHP & Multi-
skilling of Frontline Workers

30. • Community Health Officer (CHO): BSc in Community Health/ a Nurse
(GNM or BSc)/ an Ayurveda Practitioner
• Trained in a six month, IGNOU/State Public Health/ Medical Universities
accredited “Certificate Programme in Community Health” to build
competencies in public health and primary care
• Selection process: Attract competent and motivated candidates-
Preferential Local Selection
• Career progression pathways: At least up to district level
Mid Level Health Provider (MLHP)

31. Roles:
1. Ensure all households in service area are listed, empanelled
2. Clinical care
3. Coordination for care/ case management as per T/T plan
4. Provide medicines
5. Screening for chronic conditions, enabling confirmation of diagnosis,
treatment initiation, ensure adherence, counseling
6. Coordinate and lead local response to public health emergencies
7. Support the MPW and ASHAs on their tasks
8. Reporting
9. Coordinate with Community platforms
Mid Level Health Provider (MLHP)

32. • Skills appropriate at that level should be available within the team at
the HWC
• Services are assured to the population and the team is able to resolve
more at their level including through telehealth with fewer referrals
• MPW (M & F): Skills to function as paramedics for undertaking
laboratory, pharmacy and counseling functions
• HWC-PHC staff : Skills to function as ophthalmic technicians, dental
hygienists, physiotherapists
Multi-Skilling of Frontline Health Workers

33. • ASHAs: 5 Days in Package for NCDs in first phase + refresher and newer
packages annually (15 days)
• MPWs(Female and Males):
- 3 days for package for NCD to begin with and new packages (ENT &
Ophthalmology, Oral, Elderly and Palliative, Basic Emergency Services
and Mental Health) to be added
- Joint training of MPWs with ASHAs wherever possible
- Reporting and Recording information using digital applications-
Additional 3 days
Addition of Skills for Frontline Workers

34. • 5 days for screening and Management of NCDs
• 21 days for screening for Cancer-VIA for CA Cervix and further
management
• Other Distance mode certificate programmes in areas such as- NCD
management/MCH Care/Elderly Care/Mental Health etc. to be
planned
Training of PHC Team

35. Medicines and Diagnostics

36. • Essential Drug List: to be expanded and in place across all states
• MLHP: Dispense medicines for chronic diseases on the prescription of
the Medical Officer
• Uninterrupted Availability of medicines to ensure adherence and
continuation of care
• DVDMS implemented in 28 states to streamline logistics
• Robust Implementation of Free drugs and Diagnostics schemes in all
states to eliminate OOPE
Medicines

37. Sub Centre: Drug List (IPHS,2012)
Drugs:
• ORS
• T. IFA-large & small
• T. Folic Acid
• T. Septran- Pediatric
• T. Zinc sulphate
• Syp. IFA
• Syp. Vitamin A
• T. Albendazol
• T. Paracetamol

38. Essential Drug List for Sub Centre HWC
Category Drugs
Oxygen
Anaesthetic Lignocaine
Analgesic Diclofenac, PCM
Anti allergic Cetrizine
Chlorpheniramine
Anti helminthes Albendazole
DEC
Antibacterial Ciprofloxacin
Gentamycin
Metronidazole
Amoxycillin
Antifungal Fluconazole
Anti malarial Chloroquine
Primaquine
ASP Combi pack
Anemia IFA, FA
Category Drugs
Topical Clotrimazole, Gen Vilot,
Povidone Iodine, Silver Sulpha
Vitamins Vit A, Vit C, Vit K1
Cholecalciferol
GI Medicine Domperidone, Dicyclomine
ORS, Zinc Sulphate
Contraceptives Ethinylestradiol+ Norethisterone,
IUDs Condom, Ethinylestradiol, LNG
Oxytocics Methylergometrin, Misoprostol
ENT Medicines G. Ciprofloxacin, G.N Saline, G.
Xylometazoline, G. Wax-solvent ear
drops

39. • Establishment of effective Hub and Spoke models for diagnostic
services at different levels (Hub- Central Diagnostic Unit at CHC/ Block
PHC for 20-30 HWCs)
- minimize the movement of the patient
- improve the timeliness of reporting
• Point of care diagnostics will be expanded
Diagnostics

40. Robust IT System – to meet diverse needs of
different stake holders
Patient centric :
• Unique Individual ID
• Individual health record
• Family health folder
• Facilitates continuum of care through
alerts
• Facilitates access to patient care
information
Service Providers :
• Enables continuity of care
• Generates workplans /serves as job aids
• Facilitates follow up and compliance to
treatment
• Decision Support System for service
providers at various levels
Programme Managers:
• Dashboard for monitoring at different levels
• Provide monitoring reports to assess performance for payments

41. Health Promotion, Community mobilization and
Intersectoral Convergence

42. NHP 2017 Recommendations - Coordinated action on seven priority
areas for improving the environment for health as part of CPHC:
• Swachh Bharat Abhiyan
• Balanced, healthy diets and regular exercises
• Addressing tobacco, alcohol and substance abuse
• Yatri Suraksha – preventing deaths due to rail and road traffic
accidents
• Nirbhaya Nari –action against gender violence
• Reduced stress and improved safety in the work place
• Reducing indoor and outdoor air pollution
“Swasth Nagrik Abhiyan” –a social movement for health
“Health in All” Approach

43. General Population: Targeted for primary prevention
Population at Risk: Regular screening of adults for NCDs
Individuals with Symptoms: Early identification of symptoms, prompt
referral and follow up of cases
Population with Known Disorders: Individual and family counselling- for
treatment compliance and lifestyle modifications
Target Groups for Health Promotion

44. • Yoga to be mainstreamed into the health care delivery system
• Close coordination with Ministry of AYUSH
• Pool of Local Yoga Instructors at the HWC level to be identified
• Training and certification of local Yoga Teachers
• Weekly/monthly schedule of classes for Community Yoga Training
• Provision for incentive for these YOGA teachers
Promoting Wellness through Yoga

45. Health Promotion by Ayushman Ambassadors
• Age appropriate, skill-oriented, theme based, graded curriculum for the
teachers
• 2 teachers in every school as “Ayushman Ambassadors”, trained to
transact health promotion/disease prevention through interesting
activities for one hour every week
• 20 hour sessions delivered through weekly interactive classroom-based
activities
• All Tuesday -Health and Wellness Day in the schools
• Students will act as Health and Wellness Messengers in the society

46. Flexible financing
Performance based Payments:
For MLHP:
 Contractual - About 40 % of total salary (Rs. 40,000) of MLHP to be
linked with performance
 Regular- Difference between Rs. 40,000 and existing salary to be
linked with performance
Facility Budget:
• Increase in untied funds for HWC –Sub Centres to Rs. 50,000
• Incentives after getting NQAS certification

47. • Branding / Colour code
Infrastructure Upgrade for Health and Wellness
Centre

48. • Citizen Charter
• Space for –
 Examination room with adequate privacy and
Telehealth
 Diagnostics and medicine dispensation
 Wellness room
 Waiting area
 IEC
 Labour room at delivery points
Infrastructure Upgrade for Health and Wellness
Centre

49. • 3-4 Alternate prototype designs will be
provided
• Display boards –
 Contact Details of Primary Care Team and referral centres
 Jurisdiction of Gram Panchayat/ Urban Local body
representatives
Infrastructure Upgrade for Health and Wellness
Centre

52. • Provision of Patient Centred Care
• Enable Patient Amenities at HWC
• Adhere to standard treatment guidelines and clinical protocols for
care provision
• Achieve Indian Public Health Standards with regards to HR,
infrastructure, equipment, service delivery and supplies
• National Quality Assurance Standards for HWCs will be developed
• Patient satisfaction to be captured through IT systems
Quality of Care

53. Monitoring
Constitution
of RKS
VHSNCs /
SHGs
Community
based
Monitoring
Facility based
Monitoring

54. Roll Out Plan of HWCs
15000
25000
30000
40000
40000
0
20000
40000
60000
80000
100000
120000
140000
160000
2018-19 2019-20 2020-21 2021-22 Dec, 2022
No.
of
HWCs
Financial year
40,000
70,000
1.1 Lakh
1.5 Lakh
ACHIEVEMENT =
17149

55. HWC Portal (https://ab-hwc.nhp.gov.in/)
Key Features:
• Facility wise information on all
functionality criteria
• Daily Reporting on service utilization
• Monthly Service Delivery Reporting
Format
• HWC and CPCH planning sheet
• NIN and RCH Code mapping
• HWC – CHO / MO Directory
• Platform to upload photos, videos
AB-HWC, 3rd Regional Workshop, Amritsar; Punjab, 5th & 6th September,2019

56. Functionality Criteria
Criteria for PHC- HWC:
1. MBBS MO in position +
2. Training on NCD completed for
MO or Staff Nurse +
3. Diagnostics available +
4. Medicines available +
5. Branding completed if the facility
is in Government Building
Criteria for SHC-HWC:
1. CHO in position +
2. Training on NCD completed for
MPW(F) and ASHA
3. Diagnostics available +
4. Medicines available +
5. Branding completed if the facility
is in Government Building
HWCs Progressive
HWCs Operational
HWCs Progressive + Screening of NCDs: Hypertension, Diabetes, Oral
Cancer, Breast Cancer started

57. NCD Screening status as per AB- HWC Portal
State Name Chandigarh Haryana HP Punjab
Total- all
states
Community
Outreach
Individuals
Empanelled
0 425657 124997 86480 24301255
CBAC Filled 0 155963 67303 589909 15989930
Hypertension Screening 3038 44180 149607 262494 15440445
Newly Diagnosed 10 4198 15926 55115 1279294
On Treatment 0 7584 30374 76767 7058852
Diabetes Screening 1336 37889 82970 151105 14456811
Newly Diagnosed 7 3138 9983 27666 1572479
On Treatment 0 5676 16926 50003 3127345
AB-HWC, 3rd Regional Workshop, Amritsar; Punjab, 5th & 6th September,2019

58. NCD Screening status as per AB- HWC Portal
State Name Chandigarh Haryana HP Punjab
Total- all
states
Oral Cancer Screening 1101 19816 28210 59313 7680756
Newly Diagnosed 8 9 131 15128
On Treatment 0 45 43 735 10218
Breast CancerScreening 605 10013 7532 44163 5293008
Newly Diagnosed 0 57 3 232 20408
On Treatment 0 17 4 538 9742
Cervical
Cancer
Screening 386 2923 3169 15858 3730142
Newly Diagnosed 0 60 1 146 17785
On Treatment 0 7 3 416 10075
AB-HWC, 3rd Regional Workshop, Amritsar; Punjab, 5th & 6th September,2019

59. • Based on-
Data entered on HWC Portal which reflects readiness and initial
service delivery at HWCs.
Combined score determined from weightage linked with seven
criteria
• Done on quarterly basis
• Overtime the scoring criteria will be refined to reflect service
delivery ,quality and outcomes.
Process for Ranking of HWCs

60. Criteria Definition Weight
age
1
% of SHCs, PHCs and UPHCs
operationalized as HWCs out of total
SHCs, PHCs and UPHCs in the state
Source – HWC Portal
Numerator – Number of SHCs/
PHCs and UPHCs indicated as
progressive on HWC portal
Denominator - Number of SHCs
and PHCs and UPHCs available in
state
25%
2
% of HWC functionality criteria met
against the total target functionality
criteria
Source – HWC Portal
Numerator – Total number of
criteria met by the HWCs
Denominator – Total number of
criteria estimated based on
number of HWCs proposed on
HWC portal
20%

61. Criteria Definition Weightag
e
3 % of population
enumerated (against the
target population) under
HWCs
Source – CPHC – NCD IT
application
Numerator – Number of individuals
reported under population enumeration for
all HWCs
Denominator – Total population under the
health facility
15%
4
% of Pregnant Women who
received full ANC
Source – RCH portal / ANMOL
Numerator – Number of pregnant women
who received full ANC checkups (at least 4
ANC checkups)
Denominator- Total number of pregnant
women registered under the facility
5%
5 % of institutional deliveries
Source – RCH portal / ANMOL
Numerator- Number of pregnant women
who delivered in a health care facility (public
and private both)
Denominator- Total number of pregnant
women reported under the health facility
5%

62. Criteria Definition Weighta
ge
6 % of Newborns who received
HBNC visits
Source – RCH portal / ANMOL
Numerator- No. of newborn (0-28 days) who
received HBNC visits as per the schedule (0,
3, 7, 14, 21 and 28 days).
Denominator- Total no. of newborn reported
under the health facility
5%
7 % of Children up to 2 years of
age who received full
immunization
Source – RCH portal / ANMOL
Numerator- No. of children up to 2 years
who received full immunization (BCG,
measles, and 3 doses each of polio and DPT)
Denominator- Total no. of children up to 2
years reported under the health facility
5%
8 % of Individuals over 30
screened for Hypertension
against the target under
HWCs
Source – CPHC – NCD IT application
Numerator – Total no. of individuals
screened for Hypertension
Denominator – Total no. of individuals over
30 (estimated using 37% of the total
population reported under each health
facility)
5%

63. Criteria Definition Weighta
ge
9 % of Individuals over 30
screened for Diabetes
against the target under
HWCs
Source : CPHC – NCD IT
application
Numerator – Total number of individuals
screened for Diabetes
Denominator – Total number of individuals over
30 (estimated using 37%4 of the total population
reported under each health facility)
5%
10 % of Individuals over 30
screened for oral cancer
against the target under
HWCs
Source : CPHC – NCD IT
application
Numerator – Total number of individuals
screened for Oral Cancer
Denominator – Total number of individuals over
30 (estimated using 37%4 of the total population
reported under each health facility)
5%
11 % of women over 30
screened for breast cancer
against the target under
HWCs
Source : CPHC – NCD IT
Numerator – Total number of women screened
for Breast Cancer
Denominator – Total number of women over 30
(estimated using 49% of the total population
over 30)
5%

64. Rank State Name
1 Andhra Pradesh
2 Telangana, Punjab
3 Arunachal Pradesh, Haryana
4 Sikkim, Tamil Nadu, Gujarat, Chhattisgarh
5 Jharkhand, Assam, Maharashtra, Odisha
6 Meghalaya, Uttar Pradesh, Rajasthan,
Karnataka
7 Kerala, Manipur, Tripura, Goa, Mizoram,
Jammu and Kashmir
8 Bihar
9 Himachal Pradesh, Uttarakhand, West Bengal
10 Madhya Pradesh
11 Nagaland
Ranking based on first two
criteria
• Percentage of SHCs, PHCs
and UPHCs operationalized
as HWCs out of total SHCs,
PHCs and UPHCs in the
state
• Percentage of HWC
functionality criteria met
against the total target
functionality criteria
State Rank

65. Rank UT Name
1 Daman & Diu
2 Chandigarh
3 Dadra & Nagar Haveli
4 Puducherry
5 Andaman & Nicobar Islands
UT Rank
Ranking based on first two criteria

66. Kayakalp Scheme For Health and Wellness
Centers
Scores based on:
1. HWC upkeep
2. Sanitation and Hygiene
3. Support services
4. Hygiene Promotion
5. Waste Management
6. Infection Control
7. Beyond Facility
Boundary
State
No. of HWCs
Operational
in HSC
Award
Category A 10-25 Rs 1 Lakh
Category B 26-50 • Winner- Rs 1 Lakh
• Runner up- 50K
Category C > 50 • Winner- Rs 1 Lakh
• 1st Runner up- 50K
• 2nd Runner up- 35K

67. Evaluation of AB-HWCs for NITI Aayog’s State Health
Index
67
1. An independent authority to conduct an evaluation of least 2 % of
the functional AB-HWCs in each State / UT is to be conducted.
2. Planned for Q4 – January 2020-March 2020
3. AB-HWCs made functional Dec 2019 will be covered
4. ToRs will be finalized in consultation with States shortly
5. IIT / IIM / AIIMS / ICMR / State specific CSOs / DPs would be
coopted
6. During this process VHSNCs / MAS / SHGs / PRI would also get
oriented on Social Audit.

68. Areas of Opportunities
• Expansion of Primary Health Care to CPHC
• Up gradation of Infrastructure
• Employment Opportunities
• Fostering Partnerships
• Inter- Sectoral Convergence
• Improved Knowledge and Awareness
• Research Opportunities
• Monetary Gains

69. Challenges
• Low public health spending
• Community involvement and trust in these centers
• Lack of required human recourses especially in rural areas
• Recruitment of the required no. of health workers
• Existing no. of rural health facilities not sufficient to meet the
population norms- New facilities to be build
• Challenges related to development and implementation of IT system

70. Way Forward
• A much higher level of public health spending in general and much
higher outlays for HWCs in particular
• Proper recruitment, comprehensive training, effective control and
oversight and timely and adequate payments for the various health
functionaries
• An effective and efficient management structure for the HWCs

71. Way Forward
• Commensurate physical infrastructure and human resources in the
sub-centers and the Primary Health Centers converted into the
HWCs with the growing needs of the regions
• A mechanism for tracking referred patients, on treatment follow up
patients
• Research to evaluate the outcome/ impact of HWCs

72. Thank You…