Quality healthcare that is accessible

A responsive healthcare system will ensure Universal Health Coverage (UHC) by providing healthcare and financial protection to all citizens. Towards this end, the Budget announcement of converting 1.5 lakh health sub-centres (HSCs) to Health and Wellness Centres (HWCs) in Indian villages is a transformational and innovative move.

Covering a population of 5,000, the sub-centre is the best venue for offering health and wellness services, as they are most peripheral and provide the first contact to the community for accessing the health system. Positioned as a component of Comprehensive Primary Healthcare (CPHC), HWCs  would ensure the provision of affordable, quality healthcare by the public health system.

The draft National Health Policy 2015 mooted the idea of HWCs as a move to strengthen and widen the package of services for primary healthcare. Subsequently, the Task Force Report on Primary Healthcare of Ministry of Health and Family Welfare (MoHFW), Government of India (GoI) defined the operational contours and detail­ed several components to allow the HWCs to interact with other factors of the health system.

About 11 states in the country have already started the initial efforts of establishing HWCs as a response to a proposal by MoHFW, GoI; shared with health secretaries of all the states about two years ago requesting to pilot the interventions of HWCs. Th­rough these, the onus is placed on the public health system with an accountable, comprehensive responsibility of assuring the healthcare needs of the people.

Unlike the commercial usage of the term “wellness centres,” the GoI’s move is to offer wide-ranging, essential, high-quality primary health services, including health promotion. GoI envisages that HWCs would serve as the main platform of social protection. Delivery of CPHC will be ensured through the strengthening of HWCs linking to sector-level primary health centres in a block and 24x7 operational PHCs as the first point of referral.

As per the guidelines, HWCs will offer a package of CPHC services ranging from the Reproductive, Maternal, New Born, Child and Adolescent Health Care (RMNCH+A), management of communicable diseases, acute simple illnesses, comprehensive management of non-communicable diseases (NCD) (diabetes, hypertension, COPD, common cancers etc), basic ophthalmic care services, basic ENT care services, screening and basic management of mental health ailments, geriatric care and dental health.
In addition to rolling out newer programmes such as NCD screening, the services currently provided (RMNCH+A and communicable diseases) will be strengthened through better linkages of HWCs with higher facilities for care coordination.

NCDs affect a majority of Indians and result in catastrophic healthcare expenditure. The plan of strengthening CPHC involves initially prioritising the select diseases with high burd­en, and then incorporating services for other diseases gradually.

In addition to Auxiliary Nurse Mid-Wife (ANM), male multipurpose worker and a group of five ASHAs serving every 5,000 population, the increased fund allocation in the current budget in the HSCs will ensure placing an additional Mid-Level Care Provider (BSc/GNM nurses).

Continuity of care
Aided by a bridge Programme in Public Health and primary healthcare services, they will deliver quality services. The funding will enable an IT platform to help the team record the services provided, provide continuity of care across time and across levels, perform population-based analytics and enable monitoring.

The HWC team would maintain family folders and an individual health card through the ASHA, who will also inform the family of what services the centre offers and who the members of the primary care team are.

A digital format would be implemented depending on the state of readiness so as to facilitate referrals and enable a continuum of care. In essence, the HWCs will make the barrier of geographical access nearly extinct; with at least one centre accessible, within a 30-minute walking distance.

The substantial incremental support proposed by the GoI with a budget at Rs 1.5 million per HSC includes the cost towards additional human resources, training, together comprising of an additional services package. Most importantly, additional funds of Rs 10 per capita are allocated to support screening activities for management of NCDs and related services for persons aged 30 years and abo­ve. This does not include expenditure on drugs and supplies, (including) diagnostics and emergency transport, which will be borne from other existing allocations and will be distributed from district level.

Finance Minister Arun Jaitley’s Union Budget on health for Financial Year 2017-18 has elicited a mixed bag of responses ac­ross the country. However, none of them undermine the inherent transformational value of the cr­eation of new accessible, world-class quality healthcare centres much nearer to the homes of the vulnerable population.

In addition to the visible increases in flagship programmes such as NHM, this year may be the watershed period for heralding public health reforms in the country.

(Babu is an additional professor, epidemiology, and Singh is the state project manager of Universal Health Coverage Pilots, PHFI, Bengaluru)