Tag Archives: Comprehensive Primary Health Care

Ayushman Bharat Health and Wellness Centres: The basics

This article will provide basic information about Ayushman Bharat Health and Wellness Centres (AB-HWCs).

Background Information:

India’s National Health Policy 2017 (NHP 2017) first mentioned Health and Wellness Centres that were envisioned as the foundation of India’s health system.

Essentially, the National Health Policy 2017 acknowledged the heavy focus on reproductive/maternal and child health care (MCH), and selected diseases (in the form of National Programmes) within the public health care system. This meant that people had to seek other health care providers for services not offered at the Primary Health Centres (PHCs) or Community Health Centres (CHCs). Typically, this resulted in out of pocket expenditure on health as most often these services were availed from the private sector health care institutions. With a large proportion of the population not having health insurance, many had to take large loans to meet health care expenses in the private sector.

The proposed Health and Wellness Centres were envisaged as a means of offering comprehensive health care to people in public sector health care institutions. This would potentially result in out of pocket expenditure on health while enabling progress towards universal health coverage.

Key Messages:

Health and Wellness Centres (HWCs) constitute one of two inter-related components under Ayushman Bharat (the other being Pradhan Mantri Jan Arogya Yojana [PM-JAY]).

The Ayushman Bharat – Health and Wellness Centres (AB-HWCs) were launched under the Ayushman Bharat Programme in order to move away from selective health care to a more comprehensive range of services covering preventive, promotive, curative, rehabilitative and palliative care for all ages.

The AB-HWCs Programme is a set of multiple reforms that spans all aspects of the health care systems such as:

  • service delivery
  • human resources
  • financing
  • access to essential medicines and diagnostics
  • community participation, and
  • ownership and governance

Existing Sub Health Centres (SHCs)/ Sub-Centres (covering 3,000-5,000 population), and Primary Health Centres (PHCs)/ Urban Primary Health Centres (UPHCs) are being converted to AB-HWCs to provide Comprehensive Primary Health Care.

Comprehensive Primary Health Care includes a package of 12 services:

  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. Management of common communicable diseases, and out-patient care for acute simple illnesses and minor ailments
  7. Screening, prevention, control and management of Non-Communicable Diseases (NCDs) and communicable diseases like Tuberculosis and Leprosy
  8. Basic oral health care
  9. Care for common ophthalmic and ENT problems
  10. Screening and basic management of mental health ailments
  11. Elderly and palliative health care services
  12. Emergency medical services including burns and trauma

Of the above, the first seven are available at AB-HWCs, while #8 through #12 are being added in an incremental manner.

Service delivery through AB-HWCs is at three levels:

  • Family/Household/Community: Through outreach OPDs, health mela, village panchayat, village and home visits, school and anganwadi visits.
  • AB-HWCs
  • Referral Sites/Facilities

Several changes are expected after the implementation of AB-HWCs. These are briefly mentioned below:

Before AB-HWCsAfter AB-HWCs
Selective Primary Health Care addresses only ~20% of health care needsComprehensive Primary Health Care
Focused on men and women of reproductive age group (RCH oriented)Life cycle approach addressing all men and women across all ages
Limited availability of medicines at peripheral centres leading to out-of-pocket expenditureIncreased availability of medicines (172 essential medicines) reducing expenditure on medicines
Low utilization of Sub-Health Centres and Primary Health Centres (PHCs)Transforming SHC/PHC to AB-HWCs will ensure Comprehensive Primary Health Care
Limited focus on preventive care and promotive care related to chronic diseases like diabetes and hypertensionFocused efforts for health promotion and wellness by primary health care team would address risk factors for chronic diseases and other conditions
Primary level of health care facilities do not serve gate-keeping functions, leading to crowded secondary level health care facilitiesA strong network of AB-HWCs at sub-district level would facilitate resolving more cases at primary level and reduce overcrowding at secondary and tertiary level facilities
People visiting peripheral health facilities had no access to tele-healthImproved network and referral linkages through teleconsultation/tele medicine platforms
Limited focus on wellness componentWellness activities are mainstreamed into the health care delivery system.

The first AB-HWC was inaugurated on 14 April 2018 at Jangla in Gurdaspur District of Punjab.

As on 31st March 2022, 1,17,440 AB-HWCs were operational.

Useful Link:

Link to National Health Authority page on Ayushman Bharat PM-JAY:

https://nha.gov.in/PM-JAY