Ayushmaan bharat

Ayushmaan Bharat

1. AYUSHMAAN BHARAT BY Dr. KRITI SINGH JR-1(Community Medicine) G.S.V.M.Medical College,Kanpur 1

2. CONTENTS Total no. of slides:40 Introduction About PM-JAY Rationale Aim Continuum of Care Organization of CPHC Initiatives Health and Wellness Centre National Protection Scheme Comprehensive Primary Health Care Team Beneficiary Level Health System Key Features 2

3. INTRODUCTION Ayushman Bharat Yojana  or  Ayushman Bharat – Pradhan Mantri Jan Aarogya Yojana (AB-PMJAY). Ayushman Bharat is a fundamental restructuring of the manner in which beneficiaries access healthcare services at the primary, secondary and tertiary care levels. It represents a transition from segmented, sectoral and fragmented program implementation models towards a comprehensive, holistic, need-based healthcare system.  3

4. It encapsulates a progression towards promotive , preventive, curative, palliative and rehabilitative aspects through access of Health and Wellness Centers (HWCs) at the primary level. It provides provision of financial protection for access of curative care at the secondary and tertiary levels through engagement with both public and private sector. 4

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7. Rationale Healthcare in India is largely underpenetrated with government expenditure at around 1.25% of the GDP(Gross Domestic Product). Nearly 55-60 million Indians are pushed into poverty every year to meet medical needs. The hospitalisation expenses for critical ailments had shot up by 300 per cent over a decade. An estimated 6 million families sink into poverty each year due to hospitalisation. 7

8. Aim Ayushman Bharat aims to undertake path breaking interventions to holistically address health( covering prevention, promotion and ambulatory care), at primary, secondary and tertiary. 8

9. Source :www.abnhpm.gov.in 9

10. Source :www.abnhpm.gov.in 10

11. The Initiatives Health and Wellness Centre: National Health Protection Scheme: 11

12. Health and Wellness Centre The first component, pertains to creation of 1,50,000  Health and Wellness Centres. Comprehensive Primary Health Care (CPHC), covering both maternal and child health services and non-communicable diseases, including free essential drugs and diagnostic services. The first Health and Wellness Centre was launched by the Hon’ble Prime Minister at Jangla , Bijapur , Chhatisgarh on 14 April 2018. 12

13. Launch of AYUSHMAN BHARAT 14 th April 2018 -Honorable Prime Minister launched the first Health and Wellness Centre at Jangla , Bijapur , Chattissgarh

14. National Health Protection Scheme The second component is the  Pradhan Mantri Jan Arogya Yojana (PM-JAY). It provides health protection cover to poor and vulnerable families. About 62.58% of our population has to pay for their own health and hospitalization expenses and are not covered through any form of health protection. Source:www.abnhpm.gov.in 14

15. Comprehensive Primary Health Care Team Health & Wellness Centre – SHC(Sub Health Centre) Mid-level health provider 5: BSc / GNM(General Nursing and Midwifery) or Ayurveda Practitioner trained in 6 months Certificate Programme in Community Health/ Community Health Officer ( BSc -CH). MPW F- 2 per SHC IPHS MPW M- 1 to be provided from state resource 5 ASHAs as outreach team per SHC Health & Wellness Centre – PHC (@30,000) / UPHC (@50,000) PHC team – ( Atleast - 1 MBBS Doctor, 1 Staff nurses, 1 Pharmacist, 1 Lab Technician and LHV) + MPW + ASHAs s Services (IPHS +) - Screening of NCDs and wellness room

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17. CPHC - ESSENTIAL PACKAGE OF SERVICES Care in Pregnancy and Child-birth. 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 Programmes General Out-patient Care for Acute Simple Illnesses and Minor Ailments Screening, Prevention, Control and Management of Non-communicable Diseases Care for Common Ophthalmic and ENT Problems Basic Oral Health Care Elderly and Palliative Health Care Services Emergency Medical Services including Burns and Trauma Screening and Basic Management of Mental Health Ailments

18. Village/Urban Ward ASHA/MPW Population Enumeration Outreach Services Community Based Screening Risk Assessment Awareness Generation Follow up of confirmed cases Counselling: Lifestyle changes; treatment compliance M LHP/CHO SHC PHC/UPHC 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 CHC/SDH/DH Advanced diagnostics Complication assessment Telehealth Tertiary linkage/PMRSSM Community – Facility: Maintaining Continuum of Care 18

19. Mid Level Health Provider (MLHP) Selection process of candidates for MLHP to be designed so as to attract competent and motivated candidates- Preferential Local Selection MLHPs trained in a six month, IGNOU accredited “Certificate Programme In Community Health” to build competencies in public health and primary care- theory, Skill and experiential learning Career progression pathways for MLHPs in public health functions to be charted at least up to district level – to synergize with Public Health Cadre

20. Multi-Skilling of Frontline Health Workers

21. Training of PHC Team- Staff Nurses, Medical Officers Training for Five days for screening and Management of NCDs. 21 days for screening for Cancer-VIA for CA Cervix and further management Online Training through Massive Open Online Courses (MOOC) and Extension for Community Health Outcomes (ECHO) Other Distance mode certificate programmes in areas such as- NCD management/MCH Care/Elderly Care/Mental Health etc. to be planned in long term. Additional Incentives/ rewards can be introduced Partnerships with AIIMS/Regional Cancer Centres/Knowledge networks to act as training resource centres.

22. Medicines and diagnostics require early attention Essential List of Medicines to be expanded and in place across all states MLHP to be able to dispense medicines for chronic diseases on the prescription of the Medical Officer Uninterrupted Availability of medicines to ensure continuation of care ( Eg : HT/DM/ Epilepsy/COPD) DVDMS (Drugs and Vaccine Distribution Management System)implemented in 28 states and implementation in remaining states to be completed over a period of six months - Expansion to the level of HWC- PHCs/UPHC and HWC-SHC Robust Implementation of Free drugs and Diagnostics schemes in all states to eliminate OOPE(Out of Programme Clinical Experience.)

23. Robust IT System – to meet diverse needs of different stake holders Patient centric – Unique Individual ID Individual health record Family health folder-SECC data/mapping PMRSSM Facilitates continuum of care through alerts Facilitates access to patient care information Service Providers - Enables continuity of care across levels Generates workplans/serves as job aids Facilitates use of platforms like MOOC and ECHO 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 Overarching system – integration of all existing IT systems Eg - RCH portal/ NIKSHAY/ IDSP/ HMIS/ PMRSSPM

24. Infrastructure Branding / Colour code Citizen Charting – commitements made by the organization regarding the standards being delivered to the people. Space for – Examination room with adequate privacy and Telehealth Diagnostics and medicine dispensation Wellness room Waiting area IEC Labour room at delivery points 4. 3-4 Alternate prototype designs will be provided 5. Display boards – Contact Details of Primary Care Team and referral centres Jurisdiction of Gram Panchayat/ Urban Local body representatives

25. Ayushman Ambassdors 25

26. Quality of Care Key principles - 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

27. Task Forces Care for Common Ophthalmic and ENT Problems Basic Oral Health Care Elderly and Palliative Health Care Services Screening and Basic Management of Mental Health Ailments Emergency Medical Services including Burns and Trauma – under process Operational Guidelines/Training Manuals for Primary Health Care Team –is being developed 27

28. Task Forces Review existing packages for care at community, HWC and secondary levels Define specific interventions and organization of services at each level of care Delineate referral pathways from primary to secondary care levels Review existing STGs(Standard Treatment Guidelines) for each disease condition –recommended updation or new development Highlight key areas that require preventive and promotive action, Recommend areas for research to enable the delivery and effective coverage of primary health care Identify institutions at state and national level to support states in enabling effective integration, research and service delivery for Comprehensive Primary Health Care

29. HWCs in Urban Areas One UPHC for every 50,000-60,000 All existing Urban Primary Health Centers (roughly 4000) to be strengthened as HWCs by March 2020 Where dispensaries exist, they could be upgraded to serve as H&WC, based on the HR available and geographical context Frontline workers- 4-5 ASHAs and 1 MPW(F) for 10,000 population - trained to deliver preventive and promotive services through outreach, including monitoring drug compliance for chronic diseases. MLHP would not be required, as MO MBBS is already approved for UPHCs

30. Immediate Next Steps Strengthen Programme Management (2 consultants in small states and 3-5 in big states as per requirement) Establish technical support from Training institutions/ Research Organizations / SHSRC(State Health System Resource Centre)/ Medical College Based on annual Targets of HWCs- commensurate selection/ enrolment in IGNOU Certificate Programme in Community Health Completion of training of ASHAs, MPWs, PHC Staff-Medical Officers and Staff Nurses in NCD Undertake gap analysis against the requirement of equipment/medicines/ consumable. Roll out of IT Systems and Training of Providers in NCD App/MO Portal

31. Key Areas for Priority Action Appoint Senior State Nodal Officer : Director/Additional Director/Joint Director level officer Periodic reviews by Principal Secretary at all levels Road Map for converting all SHCs to HWCs by Dec,2022 Annual Plans for financial year 19-20, 20-21, 21-22 and 2022-23 (up to December,2022) Prioritizing Aspirational Districts/ NPCDCS( National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke) Districts Resources Mobilization from non –Health sources Sources-Urban Local Bodies/ State Development Programmes/District Mineral Funds/District Innovation Funds

32. Beneficiary Level Government provides health insurance cover of up to Rs. 5,00,000 per family per year . More than 10.74 crore poor and vulnerable families (approximately 50 crore beneficiaries) covered across the country. All families listed in the SECC(Socioeconomic Caste Census) database. No cap on family size and age of members. Priority to girl child, women and senior citizens. Free treatment available at all public and empanelled private hospitals in times of need. 32

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35. Process Flow at Empanelled Hospital 35 Source :www.abnhpm.gov.in

36. Covers secondary and tertiary care hospitalization. 1,350 medical packages covering surgery, medical and day care treatments, cost of medicines and diagnostics. All pre-existing diseases covered. Hospitals cannot deny treatment. Cashless and paperless access to quality health care services. Hospitals will not be allowed to charge any additional money from beneficiaries for the treatment. Eligible beneficiaries can avail services across India, offering benefit of national portability. 36

37. Health System Ensure improved access and affordability, of quality secondary and tertiary care services through a combination of public hospitals Significantly reduce out of pocket expenditure for hospitalization. Mitigate financial risk arising out of catastrophic health episodes and consequent impoverishment for poor and vulnerable families. 37

38. Enhanced used of evidence based health care and cost control for improved health outcomes. Strengthen public health care systems through infusion of insurance revenues. Enable creation of new health infrastructure in rural, remote and under-served areas. Increase health expenditure by Government as a percentage of GDP. Enhanced patient satisfaction. Improved health outcomes. Improvement in population-level productivity and efficiency Improved quality of life for the population   38

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