HWC AND CHC -AYUSHMAN BHARATH

THE UP GRADATION OF SUBCENTRE INTO HEALTH AND WELLNESS CENTRE(HWC) AND CONCEPT OF COMPREHENSIVE PRIMARY HEALTH CARE

1. AYUSHMAN
BHARATH
Health and wellness centre
CPHC &Service delivery
Continumof care
Presented by:
Mrs.Anuradha.S, Assoc Prof
SGCON
Parumala

2. ❖InordertoensuredeliveryofComprehensivePrimaryHealthCare
(CPHC)services,existingSubHealthCentrescoveringa
populationof3000-5000wouldbeconvertedtoHealthand
WellnessCentres(HWC),withtheprinciplebeing“timetocare”to
benomorethan30minutes.
❖PrimaryHealthCentresinruralandurbanareaswouldalsobe
convertedtoHWCs.Suchcarecouldalsobeprovided/
complementedthroughoutreachservices,MobileMedicalUnits,
healthcamps,homevisitsandcommunity-basedinteraction

3. ➢TheHWCatthesubhealthcentrelevelwouldbeequippedand
staffedbyanappropriatelytrainedPrimaryHealthCareteam,
comprisingofMulti-PurposeWorkers(maleandfemale)&ASHAs
andledbyaMid-LevelHealthProvider(MLHP).
➢Togethertheywilldeliveranexpandedrangeofservices.Insome
states,subhealthcentreshaveearlierbeenupgradedtoAdditional
PHCs.SuchAdditionalPHCswillalsobetransformedtoHWCs.

4. ❑TheMedicalOfficeratthePHCwouldberesponsibleforensuringthatCPHC
servicesaredeliveredthroughallHWCsinher/hisareaandthroughthePHC
itself.
❑ThenumberandqualificationsofstaffatthePHCwouldcontinueasdefinedin
theIndianPublicHealthStandards(IPHS).
❑ForPHCstobestrengthenedtoHWCs,supportfortrainingofPHCstaff
(MedicalOfficers,StaffNurses,Pharmacist,andLabTechnicians),andprovision
ofequipmentfor“WellnessRoom”,thenecessaryITinfrastructureandthe
resourcesrequiredforupgradinglaboratoryanddiagnosticsupportto
complementtheexpandedrangesofserviceswouldbeprovided.
❑StatescouldchoosetomodifystaffingatHWCandPHC,basedonlocalneeds.

5. Expanded Range of Services
❖Careinpregnancyandchild-birth.
❖Neonatalandinfanthealthcareservices.
❖Childhoodandadolescenthealthcareservices.
❖Familyplanning,ContraceptiveservicesandotherReproductiveHealthCareservices.
❖ManagementofCommunicablediseasesincludingNationalHealthProgrammes.
❖ManagementofCommonCommunicableDiseasesandOutpatientcareforacutesimpleillnesses
andminorailments.Screening,Prevention,ControlandManagementofNon-Communicable
diseases.
❖CareforCommonOphthalmicandENTproblems.
❖BasicOralhealthcare.
❖ElderlyandPalliativehealthcareservices.
❖EmergencyMedicalServices.
❖ScreeningandBasicmanagementofMentalhealthailments.

6. ELEMENTS OF COMPREHENCIVE PRIMARY
HEALTH CARE-CPHC

7. Impact
❖Improvedpopulationhealthoutcomes:Improvedavailability,accessandutilization
willinturncontributetoequitablehealthoutcomes.
❖Increasedresponsiveness:Provisionofcarebyprimarycareteamwillbebasedon
principlesoffamilyledcareincludingdignityandrespectforindividualsand
communitieswithparticularfocusonmarginalized,informationsharing,
encouragingparticipation,includingintersectoralcollaboration
❖Thiswillleadtoincreasedtrustbuilding,comfortinaccesstocareandenable
addressingsocialandenvironmentaldeterminants.

8. Service Delivery Framework
❑TheservicesenvisagedattheHWClevelwillincludeearlyidentification,basic
management,counselling,ensuringtreatmentadherence,followupcare,ensuing
continuityofcarebyappropriatereferrals,optimalhomeandcommunityfollowup,
andhealthpromotionandpreventionfortheexpandedrangeofservices.
❑TheprimaryhealthcareteamledbytheMid-levelhealthproviderwouldbetrainedto
providefirstlevelofmanagementandtriagei.e.referthepatienttotheappropriate
healthfacilityfortreatmentandfollowup.
❑Careprovisionateverylevelwouldbeprovidedasperclinicalpathwaysandstandard
treatmentguidelines.
❑TheHWCwouldalsoplayanimportantroleinundertakingpublichealthfunctionsin
thecommunityleveragingthefrontlineworkersandcommunityplatforms.

9. Continuity of Care and Patient Centric Care
✓ContinuityofcareisoneofthekeytenetsofPrimaryHealthCare.
✓Continuumofcarespansfortheindividualsfromthesamefacilitytoher/hishome
andcommunity,andacrosslevelsofcare-primary,secondaryandtertiary.
✓Caremustbeensuredfromthelevelofthefamilythroughthefacilitylevel.
✓Community/Household:TheASHAwouldundertakehomevisitstoensurethatthe
patientistakingactionsforriskfactormodification,providescounsellingand
support,includingremindersforfollowupappointmentsatHWCandcollectionof
medicines.
✓HWC:Dispensationofmedicines,repeatdiagnosticsasrequired,identificationof
complicationsandfacilitatingreferralsatahigher-levelfacility/teleconsultation
withaspecialistasrequiredareundertakenattheHWC,includingmaintenanceof
records.

10. ➢ThereferringHWCusesaclearreferralformattoprovideinformationonreason
forreferralandcarealreadybeingprovidedandotherdetailsasnecessary
(especiallyoninsurancecoverage).
➢ThereferringHWCalsoensuresthattheappropriatespecialistsareavailablein
thatfacilityandtotheextentpossible,facilitatethereferralappointment.
➢Higher-LevelFacility:Thereferredmedicalofficerorspecialistswouldexamine
thepatientanddevelop/modifythetreatmentplan,includinginstructionsforthe
patientaswellasanotetotheHWCprovider,indicatingtheneedforchange.

11. ❑DevelopingReferralLinkages:Ineffect,everyexistingHWCprovidingthe
expandedrangeofservices,wouldmanagethelargestproportionofdisease
conditionsandorganizereferralforconsultationandfollowupwithanMBBS
doctoratthelinkedPrimaryHealthCentre-HWC,(oneper30,000
population/20000inhillyareas)thatwouldalsoprovideasimilarsetofservices
asthesubcentreHWC,butofahigherorderofcomplexity.
❑TheBlockPHCsandCHCswouldnowneedtoprovidereferralservicesbeyond
emergencyobstetriccare,toincludegeneralmedicalandspecialist
consultation.
❑StrengtheningofhealthfacilitiesasFRUsandfirstlevelofhospitalizationwould
needtobedoneinaphasedmannerbasedontheavailabilityofinfrastructure,
equip-mentandHumanResourcesforHealthattheidentifiedhealthfacilities.
❑Forexample,casesofacutesimpleill-nessneednotbereferredtoDH/FRUbut
canbehandledatPHCitself.Ontheotherhand,high-riskpregnancy,sicknew
born,careforseriousmentalhealthailmentsmaybereferreddirectlytoa
DistrictHospital.

12. ❖Ensuringtwo-wayreferralsbetweenvariousfacilitylevels:Thedeliveryof
ComprehensivePrimaryHealthCareparticularlyforchronicconditionsrequires
periodicspecialistreferral.
❖TreatmentforchronicconditionscanbepreferablyinitiatedbyMOatPHC,in
consultationwithconcernedspecialistatsecondary/tertiarycarefacilities.
❖AnITsystem/teleconsultationcanconsiderablyfacilitatethisprocess.
❖Theloopbetweentheprimarycaremedicalproviderandthespecialistmustbe
closed.Thiscanbeachievedwhenthespecialistsatdistrictfacilityorhigherareable
tocommunicatetothemedicalofficeroftheadequacyoftreatment,anychangein
treatmentplans,andfurtherreferralaction.
❖UsingMobileMedicalUnitstoIncreaseAccess:Inordertoexpandaccessto
services,andreachremotepopulations,MMUswouldenableanexpansionofservice
deliveryandservetheroleofenablingtheprovisionofComprehensivePrimary
HealthCareandservingtoestablishcontinuumofcare.

13. THANK YOU