Ayushman bharat

SHARON TREESA ANTONY
ASSISTANT PROFESSOR
GOVT.COLLEGE OF NURSING
ALAPPUZHA

 A flagship scheme of government of India
 Launched as recommended by the national
health policy 2017
 To achieve the vision of universal health
coverage (UHC).
 This initiative has been designed to meet
Sustainable Development Goals (SDGs) and
its underlining commitment, which is to
"leave no one behind.“
 Launched on 23 September 2018

 It is an attempt to move from sectoral and
segmented approach of health service
delivery to a comprehensive need-based
health care service.
 This scheme aims to undertake path breaking
interventions to holistically address the
healthcare system (covering prevention,
promotion and ambulatory care) at the
primary, secondary and tertiary level.

 Ayushman Bharat adopts a continuum of care
approach, comprising of two inter-related
components, which are
1. Health and Wellness Centres (HWCs)
2. Pradhan Mantri Jan Arogya Yojana (PM-JAY)

 In February 2018, the Government of India
announced the creation of 1,50,000 Health and
Wellness Centres (HWCs) by transforming the
existing Sub Centres and Primary Health Centres.
 These centres are to deliver Comprehensive
Primary Health Care (CPHC) bringing healthcare
closer to the homes of people.
 They cover both, maternal and child health
services and non-communicable diseases,
including free essential drugs and diagnostic
services.

 The second component under Ayushman
Bharat is the Pradhan Mantri Jan Arogya
Yojana or PM-JAY as it is popularly known.
 This scheme was launched on 23rd
September, 2018 in Ranchi, Jharkhand by the
Hon’ble Prime Minister of India, Shri
Narendra Modi.

 Ayushman Bharat PM-JAY is the largest health
assurance scheme in the world which aims at
providing a health cover of Rs. 5 lakhs per
family per year for secondary and tertiary
care hospitalization to over 10.74 Crores
poor and vulnerable families.
 The households included are based on the
deprivation and occupational criteria of
Socio-Economic Caste Census 2011 (SECC
2011) for rural and urban areas respectively.

 Earlier known as the national health
protection scheme (NHPS) .
 Subsumed the then existing Rashtriya
Swasthya Bima Yojana (RSBY) which had been
launched in 2008.
 The coverage mentioned under PM-JAY,
therefore, also includes families that were
covered in RSBY but are not present in the
SECC 2011 database.
 PM-JAY is fully funded by the government
and cost of implementation is shared
between the central and state governments.

 PM-JAY is the world’s largest health insurance/
assurance scheme fully financed by the
government.
 It provides a cover of Rs. 5 Lakhs per family per
year for secondary and tertiary care
hospitalization across public and private
empanelled hospitals in India.
 Over 10.74 Crore poor and vulnerable entitled
families (approximately 50 Crore beneficiaries)
are eligible for these benefits.
 PM-JAY provides cashless access to health care
services for the beneficiary at the point of
service, that is, the hospital.

 PM-JAY envisions to help mitigate
catastrophic expenditure on medical
treatment which pushes nearly 6 crore
Indians into poverty each year.
 It covers up to 3 days of pre-hospitalization
and 15 days post-hospitalization expenses
such as diagnostics and medicines.
 There is no restriction on the family size, age
or gender.
 All pre–existing conditions are covered from
day one.

 Benefits of the scheme are portable across
the country i.e. a beneficiary can visit any
empanelled public or private hospital in India
to avail cashless treatment.
 Services include approximately 1,393
procedures covering all the costs related to
treatment, including but not limited to
drugs, supplies, diagnostic services,
physician's fees, room charges, surgeon
charges, OT and ICU charges etc.

 Medical examination, treatment and consultation
 Pre-hospitalization
 Medicine and medical consumables
 Non-intensive and intensive care services
 Diagnostic and laboratory investigations
 Medical implantation services (where necessary)
 Accommodation benefits
 Food services
 Complications arising during treatment
 Post-hospitalization follow-up care up to 15 days

 Karunya Arogya Suraksha Paddhati is a
healthcare scheme in the State of Kerala
which covers an additional 19 lakh families
with the benefits of PM-JAY.

 Number of PM-JAY eligible families as per
SECC/RSBY data -2,187,933
 Number of PM-JAY additional families
covered by the State- 19,40,393

 In order to expand access to comprehensive
primary health care (CPHC), government of India
has launched Ayushman Bharat - Pradhan Mantri
Jan Arogya Yojana (PMJAY) in Sept, 2018.
 PMJAY is a centrally sponsored scheme. Under
this scheme - sub health centres (SHCs), and
primary health centres (PHCs) are being
strengthened as health and wellness centres
(HWCs).
 The services in HWCs will be provided through a
mid-level health care provider
(MLHP)/community health officer (CHO) placed
at a HWCs and medical officer at PHC
(rural/urban).

 In order to ensure delivery of Comprehensive
Primary Health Care (CPHC) services, existing
Sub Health Centres covering a population of
3000-5000 would be converted to Health and
Wellness Centres (HWC), with the principle
being “time to care” to be no more than 30
minutes.

 1. Transform existing Sub Health Centres and
Primary Health Centres to Health and
Wellness Centers to ensure universal access
to an expanded range of Comprehensive
Primary Health Care services.
 2. Ensure a people centered, holistic, equity
sensitive response to people’s health needs
through a process of population
empanelment, regular home and community
interactions and people’s participation

 . 3. Enable delivery of high quality care that
spans health risks and disease conditions
through a commensurate expansion in
availability of medicines & diagnostics, use
of standard treatment and referral protocols
and advanced technologies including IT
systems.
 4. Instill the culture of a team-based
approach to delivery of quality health care
encompassing: preventive, promotive,
curative, rehabilitative and palliative care.

 5. Ensure continuity of care with a two way
referral system and follow up support.
 6. Emphasize health promotion (including
through school education and individual
centric awareness) and promote public
health action through active engagement and
capacity building of community platforms
and individual volunteers.

 7. Implement appropriate mechanisms for
flexible financing, including performance-
based incentives and responsive resource
allocations.
 8. Enable the integration of Yoga and AYUSH
as appropriate to people’s needs.

 9. Facilitate the use of appropriate
technology for improving access to health
care advice and treatment initiation, enable
reporting and recording, eventually
progressing to electronic records for
individuals and families.
 10. Institutionalize participation of civil
society for social accountability.

 11. Partner with not for profit agencies and
private sector for gap filling in a range of
primary health care functions.
 12. Facilitate systematic learning and sharing
to enable feedback, and improvements and
identify innovations for scale up.
 13. Develop strong measurement systems to
build accountability for improved
performance on measures that matter to
people

 The HWC at the sub health centre level
would be equipped and staffed by an
appropriately trained Primary Health Care
team, comprising of
 Multi-purpose workers (male and female)
 ASHAs
 A Mid-Level Healthcare Provider (MLHP).

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 including National
Health Programmes.
6) Management of Common Communicable Diseases and
Outpatient care for acute simple illnesses and minor ailments.
7) Screening, Prevention, Control and Management of Non-
Communicable diseases.
8) Care for Common Ophthalmic and ENT problems.
9) Basic Oral health care.
10) Elderly and Palliative health care services.
11) Emergency Medical Services.
12) Screening and Basic management of Mental health ailments.

• Organization of Services Delivery of an
expanded range of services, closer to the
community at HWCs would require re-
organization of the existing workflow
processes.
• The delivery of services would be at three
levels i.e.,
• i) Family/Household and community levels
• ii) Health and Wellness Centres
• iii) Referral Facilities/Sites.

 Continuity of care is one of the key tenets of
Primary Health Care
 Continuum of care spans for the individuals
from the same facility to her/his home and
community, and across levels of care-
primary, secondary and tertiary.

Community/Household: The ASHA would
undertake home visits to:
 Ensure that the patient is taking actions for
risk factor modification,
 To provides counselling and support,
including reminders for follow up
appointments at HWC and collection of
medicines.

 HWC:
 Dispensation of medicines
 Repeat diagnostics as required
 Identification of complications
 Facilitating referrals at a higher-level facility/teleconsultation
with a specialist as required are undertaken at the HWC,
including maintenance of records

Higher-Level Facility:
 The referred medical officer or specialists would
examine the patient and develop/modify the
treatment plan, including instructions for the patient
as well as a note to the HWC provider, indicating the
need for change.
 Systems need to be in place so that a medicine
prescribed by a specialist is made available to the
patient at the HWC where she/he is empanelled.
 Periodic meetings (whether in person or through
virtual platforms) between HWC team and the
specialists/ medical officers referred to, are also
essential.

 In effect, every existing HWC providing the expanded
range of services, would manage the largest proportion of
disease conditions and organize referral for consultation
and follow up with an MBBS doctor at the linked Primary
Health Centre- HWC, (one per 30,000 population/20000 in
hilly areas).
 The Block PHCs and CHCs would now need to provide
referral services beyond emergency obstetric care, to
include general medical and specialist consultation.
 Patient centric care, trust building by primary care team,
adopting standard treatment protocols, and assured supply
of medicines would facilitate in resolving more cases at
the HWC level and reduce direct seeking of care at
secondary level facilities.

 Ensuring two-way referrals between various facility
levels:
The delivery of Comprehensive Primary Health Care
particularly for chronic conditions requires periodic specialist
referral. The loop between the primary care medical provider
and the specialist must be closed. This can be achieved when
the specialists at district facility or higher are able to
communicate to the medical officer of the adequacy of
treatment, any change in treatment plans, and further referral
action.
 Using Mobile Medical Units to Increase Access:
In order to expand access to services, and reach remote
populations, MMUs would enable an expansion of service
delivery and serve the role of enabling the provision of
Comprehensive Primary Health Care and serving to establish
continuum of care.

 1. Ensure that all households in the service areas are
listed, empanelled and a database is maintained in
digital format/ paper format as required by the state.
 2. Provide clinical care as specified in the care
pathways and standard treatment guidelines for the
range of services expected of the HWC.
 3. Clinical care provision would include coordinating
for care/ case management for chronic illnesses
based on the diagnosis and treatment plan made by the
Medical Officer/specialists who will initiate treatment
for chronic diseases, dispense drugs as per standing
orders by the medical officer.
 4. Such coordination could be facilitated through
processes such as telehealth. However, MLHPs can
also provide medicines.

 . 5. Focus attention in screening for chronic conditions on
screening, enabling suspected cases confirmed and initiating
treatment on basis of plans made by medical
officer/specialists. As a team, ensure adherence, along
with counselling and support as needed for primary and
secondary prevention efforts.
 6. Coordinate and lead local response to diseases
outbreaks, emergencies and disaster situations and
support the medical team or joint investigation teams for
disease outbreaks.
 7. Support the team of MPWs and ASHAs on their tasks,
including on the job mentoring, support and supervision and
undertaking the monitoring, management, reporting and
administrative functions of the HWC such as inventory
management, upkeep and maintenance, and management of
untied funds.

 8. Support and supervise the collection of population based data by
frontline workers, collate and analyse data for planning and report
the data to the next level in an accurate and timely fashion. Use HWC
and population data to understand key causes of mortality, morbidity in
the community and work with the team to develop a local action plan
with measurable targets, including a particular focus on vulnerable
communities.
 9. Coordinate with community platforms such as the
VHSNC/MAS/SHGs and work closely with PRI/ ULB, to address social
determinants of health and promote behaviour change for improved
health outcomes.
 10. Address issues of social and environmental determinants of health
with extension workers of other departments related to gender based
violence, education, safe potable water, sanitation, safe collection of
refuse, proper disposal of waste water, indoor air pollution, and on
specific environmental hazards such as fluorosis, silicosis, arsenic
contamination, etc.
 11. Guide and be actively engaged in community health promotion
including behaviour change communication.

 Public Health Skills
 General Skills of Bio Medical Waste management, medicine
dispensation, medicine refills and injections, suturing of
superficial wounds
 Laboratory Skills
 Skills for Management of common conditions Fever, aches and
pains
 First aid Stabilization care for common emergencies z Maternal
Health Skills
 Reproductive and Adolescent Health Skills
 Newborn and Child Health Skills
 Skills to use digital applications wherever applicable for
reporting, inventory management, record maintenance and use
population based
 Maintaining Family Health Folders and Individual Health Records
 Supportive supervision of field level functionaries

 6 months Certificate Programme in
Community Health
 5-7 days Supplementary Training on new
health programmes, new skills and refreshers
every year.
 3 Days Training on use of IT application and
telehealth
 Regular monitoring/ training through ECHO
platform

Ayushman bharat

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