Ayushman Bharat is a centrally sponsored programme anchored in the Ministry of Health and Family Welfare (MoHFW). It is an umbrella of two major health initiatives, namely Health and Wellness Centres (HWCs) and Pradhan Mantri Jan Arogya Yojna (PMJAY).
Brief details of these components are as following:
Ayushman Bharat-Health & Wellness Centres (AB-HWC)
Delivery of comprehensive primary health care services through Health &Wellness Centres is a critical component of the newly announced Ayushman Bharat scheme. It places people and communities at the centre of the health care delivery system, making health services responsive, accessible and equitable.
Nearly 1.5 lakh Sub-Centres and Primary Health Centres would be transformed as Health & Wellness Centres by 2022 to provide comprehensive and quality primary care close to the community while ensuring the principles of equity, affordability and universality.
Till date, 4503 HWCs have been operationalized in various states.
Key components of AB-HWC:
- Additional Human Resource – New cadre of health care professional- referred to as the Mid-Level Health Provider- who is a nurse or an Ayurvedic Practitioner trained and accredited for a set of competencies related to primary health care and public health. Mid-Level Health Provider will lead the team of MPWs and ASHAs at SHC level.
- Multiskilling / Training of existing service providers – upgrading skills to provide expanded package of services
- Efficient logistics system to ensure availability of wide range of drugs and point of care diagnostics
- Robust IT system – to create unique health id and longitudinal health record of all individuals and provision of tele-consultation services
- Provision of services related to indigenous health system and yoga etc for promotion of wellness
- Linkages with schools to train Health and Wellness Ambassadors to enable creating healthy habits in schools
- The packages of services envisaged at AB-HWC are:
- 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 including National Health Programmes
- Management of common communicable diseases and outpatient care for acute simple illness 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
- Screening and Basic management of Mental health ailments
Key benefits for community under AB-HWC:
- Expanded package of primary care services –ranging from maternal and child health, communicable diseases to non-communicable diseases (universal screening, prevention, control and management of five common communicable diseases: hypertension, diabetes and three common cancers – those of the oral cavity, breast and cervix, primary health care for diseases for the eye, oral health, ENT, mental health, provision of palliative care and care for the elderly, and medical emergencies)
- Wide range of free drugs
- Point of care diagnostics at the centres.
- Tele-consultation services with Medical Officers for complications
- Continuum of care ensured through referral linkages and protocols
- Unique health id – longitudinal health record for each individual
- Services related to indigenous health system and yoga for promotion of wellness.
Ayushman Bharat- Pradhan Mantri Jan Arogya Yojana (AB-PMJAY)
Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (PMJAY) aims to cover over 10 crore poor and vulnerable families (approx. 50 crore beneficiaries) providing coverage up to Rs. 5 lakh per family per year for secondary and tertiary hospitalization.
PMJAY has been launched on September 23, 2018. After the launch of PMJAY, RSBY and SCHIS got subsumed in it.
- PMJAY is an entitlement based scheme. This scheme covers poor and vulnerable families based on deprivation and occupational criteria as per SECC (Socio-economic caste census) data.
- PMJAY provides cashless and paperless access to services for the beneficiary at the point of service in any (both public and private) empanelled hospitals across India. All beneficiary families of RSBY and SCHIS are entitled for benefits under PMJAY.
- Under PMAJY, the States are free to choose the modalities for implementation. They can implement the scheme through insurance company or directly through the Trust/ Society or mixed model.
- There is no restriction on family size, ensuring all members of designated families specifically girl child and senior citizens get coverage.
- At National level, National Health Agency (NHA) in the form of Society has been registered under the Societies Registration Act, 1860, to implement the scheme. NHA is responsible for all operational matter of PMJAY. NHA is functioning w.e.f. 11.05.2018.
- Ayushman Bharat National Health Protection Mission Council, as an Apex body has been set up to provide policy direction to the scheme.
- More than 1350 packages have been finalized by an expert committee headed by Director General, Health Services and peer reviewed by NITI Aayog.
- Operational Guidelines on various operational matters of PMJAY, Model tender documents etc are in place. Details are available on official website i.e. abnhpm.gov.in.
Augmentation of Asha Benefits:
- The Cabinet Committee on Economics Affairs had on 19th September, 2018 approved a proposal to introduce an ASHA Benefit Package w.e.f from October, 2018 (to be paid in November, 2018) with two components, namely, coverage of ASHAs and ASHA Facilitators meeting the eligibility criteria under the Pradhan Mantri Jeevan Jyoti Bima Yojana and Pradhan Mantri Suraksha Bima Yojana and an increase in the amount of routine and recurring incentives under National Health Mission for ASHAs from Rs. 1000/- per month to Rs. 2000/-per month.
- The total estimated cost of the Scheme is Rs 1905.46 Crore of which Central share is Rs 1224.97 Crore for two years i.e. 2018-19 and 2019-20.
- As part of this ASHA Benefit Package, the Union Cabinet has also approved proposal of enhancing supervisory visit charges for ASHA Facilitators from Rs. 250/-per visit to Rs. 300/- per visit for 2018-2019 to 2019- 2020 w.e.f from October 2018 (to be paid in November, 2018) on 24th October 2018.
- ASHA Facilitator will undertake about 20 supervisory visits per month. With this approval ASHA Facilitators would receive about Rs 6000 per month against Rs 5000 per month that is an increase of Rs 1000/- per month.
- The estimated additional expenditure to be incurred is Rs 74.53 crore in 2018 -19 and 2019-20 with central share of Rs.46.95 crore comprising of Rs 15.65 crore during 2018-19 (for six months) and Rs. 31.30 crore during 2019-20.
- Estimated 1063670 ASHAs and ASHA Facilitators to be covered under Pradhan Mantri
- Jeevan Jyoti Bima Yojana (PMJJBY)
- Estimated 9573032 ASHAs and ASHA Facilitators to be covered under Pradhan Mantri Suraksha Bima Yojana
- Estimated 10, 22,265 ASHAs will get at least a minimum of Rs`2000 per month from current Rs 1000 per Month for routine and recurring activities.
- 41,405 ASHA facilitators to be benefitted with increased supervisory charges.
Allied and Healthcare Professions Bill, 2018
The Union Cabinet approved the Allied and Healthcare Professions Bill, 2018 on 22nd November 2018 for regulation and standardisation of education and services by allied and healthcare professionals.
The Bill provides for setting up of an Allied and Healthcare Council of India and corresponding State Allied and Healthcare Councils which will play the role of a standard-setter and facilitator for professions of Allied and Healthcare.
- Establishment of a Central and corresponding State Allied and Healthcare Councils; 15 major professional categories including 53 professions in Allied and Healthcare streams.
- The Bill provides for Structure, Constitution, Composition and Functions of the Central Council and State Councils, e.g. Framing policies and standards, Regulation of professional conduct, Creation and maintenance of live Registers, provisions for common entry and exit examinations, etc.
- The Central Council will comprise 47 members, of which 14 members shall be ex-officio representing diverse and related roles and functions and remaining 33 shall be non-ex-officio members who mainly represent the 15 professional categories.
- The State Councils are also envisioned to mirror the Central Council, comprising 7 ex-officio and 21 non-ex officio members and Chairperson to be elected from amongst the non-ex officio members.
- Professional Advisory Bodies under Central and State Councils will examine issues independently and provide recommendations relating to specific recognised categories.
- The Bill will also have an overriding effect on any other existing law for any of the covered professions.
- The State Council will undertake recognition of allied and healthcare institutions.
- Offences and Penalties clause have been included in the Bill to check malpractices.
- The Bill also empowers the Central and State Governments to make rules.
- Central Govt. also has the power to issue directions to the Council, to make regulations and to add or amend the schedule.
- Bring all existing allied and healthcare professionals on board during the first few of years from the date of establishment of the Council.
- Opportunity to create qualified, highly skilled and competent jobs in healthcare by enabling professionalism of the allied and healthcare workforce.
- High quality, multi-disciplinary care in line with the vision of Ayushman Bharat, moving away from a ‘doctor led’ model to a ‘care accessible and team based’ model.
- Opportunity to cater to the global demand (shortage) of healthcare workforce which is projected to be about 15 million by the year 2030, as per the WHO Global Workforce, 2030 report.
- Allied & Healthcare Professionals’ Database Portal. More than 3000 professionals have already registered on the portal during the testing phase. The website portal is www.a2hp.mohfw.gov.in.
- The portal has a capacity of capturing more than 10 lakhs Allied and Healthcare Professionals’ data. It will help the Government to track the number of professionals and streams of allied and healthcare professions in the country. It may further prove helpful in expediting the envisaged processes viz. licensing of professionals, workforce policy planning and bringing transparency in the system by maintaining standards of educational and clinical practice etc.
- Budget Dashboard on Budget, Expenditure and Bill Payment position of MoHFW. The Budget Dashboard also incorporates Ministry of AYUSH and Department of Health Research. Budget and expenditure is available in a snapshot and also drilled down details in various categories, such as flagship schemes, Central sector expenditure, North East, SC/ST, Centrally Sponsored Schemes, etc. Various related presentations, Demand for Grants and all relevant budget circulars are also available on the dashboard. The dashboard has the unique feature of Bill Position for All India Pay & Accounts Offices (PAOs) of this Ministry and also reason for return of bills. It is another step towards transparency.
- Soft-launch of the Integrated Disease Surveillance Programme (IDSP) segment of Integrated Health Information Platform (IHIP) in seven states. The path-breaking initiative will provide near-real-time data to policy makers for detecting outbreaks, reducing the morbidity and mortality and lessening disease burden in the populations and better health systems. The first one-of-its-kind initiative by the GoI, IHIP uses the latest technologies and digital health initiatives. The State Secretaries have been urged to be earnest in adopting this platform to strengthen early outbreak detection and informed public health response. Further, for effective implementation of the platform, 32,000 people at the block level, 13,000 at the district level and 900 at the state level have been trained. The IHIP vision and a ready-reckoner have also been launched to navigate the platform.
- National Health Portal (NHP) is functioning as citizen portal for healthcare providing health related information to citizens and stakeholders in different languages (currently six languages). A voice portal, providing information through a toll-free number 1800-180-1104 and Mobile App has also been launched. It serves as a single point access for information on Health and Diseases including health messages; on Regulations, Standards, Policies, Programs, Commissions etc.; Directory Services – Hospitals, Blood Banks, Ambulances.
- Hospital Information System (HIS) is being implemented in hospitals for automation of hospital processes to achieve better efficiency and service delivery in Public Health facilities upto CHC level.
- A case based web based reporting system called NIKSHAY is established and this has been scaled-up nationwide to capture all TB cases in the public health system.
- For adherence monitoring 99DOTS has been implemented wherein the patient just has to give a missed call to a toll free number and the system captures the adherence information.
- E-CGHS card enables self-printing of CGHS cards from any location.
- SUGAM by Central Drugs Standards Control Organisation (CDSCO) enables online submission of applications, their tracking, processing & grant of approvals online mainly for drugs, clinical trials, ethics committee, medical devices, vaccines and cosmetics. Provides a single window for multiple stakeholders (Pharma Industry, Regulators, Citizens) involved in the processes of CDSCO.
- Drugs and Vaccines Distribution Management System (DVDMS) (‘eAushidhi’) deals with purchase, inventory management and distribution of various drugs, sutures and surgical items to various District Drug Warehouses of State / UT, District Hospitals (DH), their sub stores at CHC, PHC etc by automating the workflow of procurement, supply chain, quality control and finance department in State / UT level.
- eRakt Kosh is being rolled out for all the licensed blood banks in public and private health facilities in States / UTs. eRakt Kosh piloted in blood banks in the State of Madhya Pradesh, West Bengal and IRCS Delhi.
- Mother and Child Tracking System (MCTS)/Reproductive Child Health (RCH) application is an individual-based tracking system across all the States & UTs to facilitate timely delivery of antenatal and postnatal care services and immunization to children with an objective of improving IMR, MMR, & morbidity. A total of 15.31 crore pregnant women and 13.11 crore children aged registered on MCTS / RCH portal.
- Kilkari application has been launched to deliver free weekly audio messages about pregnancy, child birth and care. Assam, Bihar, Chhattisgarh, Delhi, Haryana, Himachal Pradesh, Jharkhand, Madhya Pradesh, Odisha, Rajasthan, Uttar Pradesh and Uttarakhand are presently covered under Kilkari. Approximately 16.93 crore successful calls (average duration of content played in each call: approximately 1 minute) were made under Kilkari.
- Mobile Academy is a free audio training course designed to expand and refresh the knowledge base of ASHAs and improve their communication skills. Launched in 2016, Bihar, Chhattisgarh, Delhi, Haryana, Himachal Pradesh, Jharkhand, Madhya Pradesh, Odisha, Rajasthan, Uttar Pradesh and Uttarakhand are presently covered under Mobile Academy. A total of 1.52 Lakh ASHAs registered in MCTS / RCH portal have started the Mobile Academy course, out of which 1,22,194 ASHAs have completed the course till November, 2018.
- ANM on Line (ANMOL) a tablet based application for Integrated RCH Register which allows ANMs to enter and update data for beneficiaries of their jurisdiction has been piloted in the State of Andhra Pradesh and Currently 11,941 ANMs in Andhra Pradesh are using ANMOL. It is being further rolled out in Madhya Pradesh, Orissa and Telangana.
MOHFW (Ministry of Health and Family Welfare) has designed an ICT-based Patient Satisfaction System (PSS) for implementation in public and empanelled private hospitals. The application has been named ‘मेरा अस्पताल’ (‘My Hospital’ in English). A multi-channel approach i.e. web portal, mobile application, Short Message Service (SMS) and Interactive Voice Response System (IVRS) is being used to collect patients’ feedback. The application automatically contacts the patient to collect information on patient’s experience in government hospitals.
- Under Phase I, more than 1000 hospitals have been covered and more than 14 lakh feedback received so far.
- ONLINE REGISTRATION SYSTEM (ORS) is a framework to link various hospitals for online registration, payment of fees and appointment, online diagnostic reports, enquiring availability of blood online etc. As on date, around 124 hospitals including Central hospitals like AIIMS –New Delhi & other AIIMS (Jodhpur; Bihar, Rishikesh, Bhubaneswar, Raipur, Bhopal); RML Hospital; SIC, Safdarjung Hospital; NIMHANS; Agartala Government Medical College; JIPMER etc. are on board ORS. So far around 13 lakh appointments have been transacted online.
Mobile Apps: Various mobile apps have been launched namely –
- Indradhanush (for immunisation tracker)
- India Fights Dengue (enables a user to check Dengue Symptoms, get nearest Hospital / Blood bank information and also share feedback)
- NHP Swasth Bharat (information dissemination on Disease, Lifestyle, First Aid)
- NHP Directory Services Mobile App. (provides information related to Hospital and Blood banks across India have been hosted.
- No More Tension Mobile App. (information on stress management related aspects)
- Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) Mobile App. (for providing pregnancy care by volunteer doctors across states)
- National Medical College Network (NMCN) is being established with the purpose of e-Education and e-Healthcare delivery, wherein 50 Government Medical Colleges are being interconnected, riding over NKN (National Knowledge Network – high speed bandwidth connectivity). National Resource Centre has been established at SGPGI, Lucknow.
- National Telemedicine Network (NTN): It is envisaged to provide Telemedicine Services to the remote areas by upgrading existing Government Healthcare Facilities (MC, DH, SDH, PHC, and CHC) in States. In the current financial year 4 States/UTs (previous 7) have been provided financial assistance for providing Tele-Medicine services by establishes NTN.
- Tele-Medicine Nodes at Pilgrim places: In line with the Prime Minister vision of using space technology to deliver health services, MoHFW & Department of Space (DoS) jointly have been taking steps to set up Satellite communication based Telemedicine nodes at various unreachable geographical locations including Chardhams and other important pilgrimage centres (Amarnath, Ayappa and Kedarnath)for health awareness, screening of non-communicable disease (NCD) and for providing specialty consultation to the devotees visiting these places. So far, Telemedicine nodes have been setup at Amarnath Cave-J&K, Ayappa Temple-Kerala, Dwarkadheesh Temple-Gujarat, Kashi Vishwanath Temple-U.P and Vidhyanchal Devi Temple, UP.
- Tele-Evidence: Tele-evidence is a modality via which doctors can testify in the judicial process utilizing the video conferencing facility without visiting the courts in person. This service was launched by Hon’ble HFM on 30.12.2015 at PGIMER, Chandigarh. As per reports, till date more than 4000 Tele-Evidences have been successfully conducted. After this successful implementation MoHFW has decided to rollout the service in every State/UT.
National Vector Borne Disease Control Programme (NVBDCP)
- India is committed to malaria elimination by 2030 in response to the global call by WHO for eliminating malaria by the end of the year 2030.
- In response to the above, India drafted National Framework for malaria elimination and was launched by HFM in February, 2016 which was followed by drafting of National Strategic Plan (NSP) for malaria elimination (2017-2022). Both the above documents give clear vision as well as time bound strategies for malaria elimination by 2027.
- After the call for malaria elimination, India strengthened its interventions by providing and increasing the outreach of malaria diagnosis by using Rapid Diagnostic Kits (for both Pv&Pf), effective anti-malarials like Artemisinine combinations, provision of Long Lasting Insecticidal Nets (LLINs) – 50 million already distributed in North-eastern states and Orissa (more in pipeline for high endemic areas of Chhattisgarh, Odisha and Jharkhand).
- Decrease in total malaria cases from 805804 in 2017 to 375845 (53.36% decline) in 2018 till November.
- Decrease in Pf cases from 509229 in 2017 to 183889 (63.89% decline) in 2018 till November.
Dengue & Chikungunya
- Disease surveillance is carried out through identified Sentinel Surveillance Hospitals (SSHs) with laboratory facility networked across the country and linked with Apex Referral Laboratories (ARLs) with advanced diagnostic facility for backup support.
- Number of SSHs and ARLs increased to 646 and 16 respectively.
- Case Fatality Rate (deaths per 100 cases) for Dengue is sustained at less than 1.0% (National target) since 2008 due to training of clinicians on case management as per National guidelines.
- May 16 observed as National Dengue Day throughout country.
- Dengue cases declined by 36% and deaths by 33% compared to 2017.
- Chikungunya cases declined by 22% in 2018 compared to 2017.
Japanese Encephalitis (JE)
- Constitution of National Programme for Prevention and Control of JE/AES to reduce morbidity, mortality and disability due to JE/AES.
- A total of 139 Sentinel Surveillance Site Laboratories (SSSHs) and 15 Apex Referral Labs identified in the country for testing of JE in AES cases.
- JE vaccination campaign in children (1-15 yrs) completed in 229 out of 231 JE endemic districts.
- Adult vaccination (15-65 years): Completed in all 31 districts identified in Assam, Uttar Pradesh and West Bengal.
- States have been requested to make JE a Notifiable disease.
- Kala-azar is a notifiable disease in all four endemic states.
- Kala-azar elimination programme has made significant progress, Reduction of 70.6% in cases of Kala-azar from 13869 (2013) to 4073 (2018 Till Nov.).
- Reported deaths due to Kala-azar have also reduced to 100% as being Nil deaths in 2017 as compared to 11 in 2014. There is Nil death reported in 2018 (Nov.)
- Intensification of disease surveillance activities to identify the cases early and ensuring their complete treatment.
- Single day single dose treatment with Liposomal Ambisome, is available for cases of visceral leishmaniasis, which has improved the treatment compliance and outcome.
- Synthetic pyrethroid is used for indoor residual spraying, in all the endemic areas.
- GoI is providing wage loss compensation of INR. 500 to the Kala-azar cases and INR 4000 to cases of Post Kala-Azar Dermal Leishmaniasis for complete treatment.
- An incentive of INR. 500/- to ASHA workers for ensuring complete treatment of kala-azar case and INR. 200/- for two rounds during Indoor Residual Spray (IRS) for generating community awareness and community mobilization.
- Out of 256 Lymphatic Filariasis endemic districts, till 2018 99 (36.8%) districts have cleared Transmission Assessment Survey (TAS) and Mass Drug Administration (MDA) compare to 5 districts clearing TAS by 2013.
- A new intervention Triple Drug Therapy, Ivermectin+DEC+Albendazole (IDA)has been approved and to be implemented in 5 districts namely Arwal (Bihar), Simdega (Jharkhand), Nagpur (Maharashtra), Yadgir (Karnataka) and Varanasi (Uttar Pradesh).
- IDA has been successfully launched in Arwal district.
Pradhan Mantri Swasthya Suraksha Yojana (PMSSY)
The PMSSY envisages creation of tertiary healthcare capacity in medical education, research and clinical care, in the underserved areas of the country. It aims at correcting regional imbalances in the availability of affordable/reliable tertiary healthcare services and also augmenting facilities for quality medical education in the country.
PMSSY has two components- setting up of new AIIMS like institutes in underserved regions of the country: and up-gradation of existing Govt Medical Colleges (GMCs). Under PMSSY, the progress so far is:
- The derailed contractual arrangements for six new AIIMS (AIIMS-Patna, AIIMS- Rishikesh, AIIMS-Jodhpur, AIIMS-Bhopal, AIIMS-Bhubaneswar and AIIMS- Raipur) put back on track and construction expedited. Since July 2014, 3000 hospital beds added in the six functional AIIMS (including about 1000 beds added in the last one year). 2 new AIIMS announced for Jharkhand and Gujarat in 2017-18.
- Basket of services in six AIIMS expanded and presently, on an average, about 3000 major surgeries are getting performed every month.
- OPD services started in AIIMS Rae Bareli.
- Sites finalized for 3 AIIMS in Jammu, Kashmir, and Gujarat and sanction of Cabinet obtained for AIIMS in Maharashtra, Andhra Pradesh, W. Bengal, Punjab, Poorvanchal in UP, Assam, Himachal Pradesh, Jharkhand, Telangana and Tamil Nadu.
- Undergraduate MBBS courses started at AIIMS Mangalagiri & Nagpur with induction of first batch of 50 students each.
- Construction of Super Specialty Block in 10 GMCs Trauma Centres in f our GMCs completed.
- Construction work of Super Specialty Block in progress for 01GMCs under Phase-I & II and 39 GMCs under Phase-III of PMSSY.
- 15 Government Medical Colleges taken up for upgradation in Phase-IV & V (A) out of which work has been awarded for 11 GMCs upgradation projects.
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