The recently announced government’s flagship healthcare programme Ayushman Bharat rests on two pillars – primary healthcare and financial protection. While a National Health Protection Scheme (NHPS) was announced to provide financial protection to poor families during illnesses, the other component is setting up 1.5 lakh Health and Wellness Centres (HWCs).
Interestingly, the health and wellness centers are yet to capture adequate media attention, even though they are set to be a major contributor to the success of NPHS by way of acting as a gatekeeper to it. Unlike the existing health sub-centres, which aimed at delivery of selective care at a community level, the new health and wellness centers would focus on comprehensive primary health care. Undoubtedly, these centers will be the backbone of Ayushman-Bharat and will be pivotal in reducing catastrophic health expenditure.
In India, delivery of healthcare through public institutions has followed a three-tier model. Sub-centers for a population of 5,000 at the bottom, Primary Health Centres catering to 30,000 population in the middle, and Community Health Centres at the top for 1.2 lakh people. Sub-Centre, the most peripheral and first contact point, is manned by one Auxiliary Nurse Midwife (ANM) and one male health worker and five-link workers called ASHA.
Health and Wellness Centres are envisioned to be the highly improved avatar of sub-centers to provide a larger package of comprehensive primary health care. Besides a package of 12 essential health services, they will integrate AYUSH, Yoga, and lifestyle changes and screen people for non-communicable diseases, aside from basic diagnostics and drug dispensing. By acting as gatekeepers for secondary and tertiary care through NHPS, they will ensure the continuum of care.
With an eight-member health and wellness team, each center will have to serve a population of 5,000. The team will comprise a mid-level provider, who will be either be a nurse practitioner or an Ayurveda practitioner, two Multi-Purpose workers and 5 ASHAs. As per the roadmap presented by the government’s premier think tank Niti Aayog in post Budget announcements, all the 1.5 lakh centers will be functional by December 2022.
A bigger challenge would be arranging trained and qualified manpower at these centres. Already, there is a vacancy of one lakh male health workers and 26,172 Auxiliary Nurse Midwife at the sub-centres, and 4,243 of them were without a single health worker as on March 31, 2017.
The leadership of these centres will devolve on the mid-level care provider, to be called the Community Health Officer(CHOs). This new breed of health practitioners is to be recruited from the pool of staff nurses and Ayurveda graduates. However, staff nurses are already difficult to find, with the existing Primary Health Centres grappling with the shortage of 11,288 nurses against 77,956 sanctioned positions.
An enabling legal framework may also be needed to guard against legal challenges which may jeopardise the plan. Attempts in the recent past to create such mid-level care providers have seen vehement opposition. This includes attempts to start the Bachelor of Rural Medicine and Surgery (BRMS), Bachelor of Rural Health Care (BRHC), and the Bachelor of Science in Community Health (BScCH).
Even the Parliamentary Standing Committee on Health and Family Welfare recommended against starting the BScCH course. Once operational, attrition of the CHOs could be a big problem at the centres. Once trained and experienced, they may be preyed upon by the private sector. However, no challenge is insurmountable. With the government’s firm commitment and weight behind Ayushman Bharat, and liberal financial allocations, healthcare in the country is set to see a massive transformation. And these centres are soon going to be the face of the New India.