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Dr. Mansukh Mandaviya, Union Minister for Health and Family Welfare, released the findings of a third-party assessment of Ayushman Bharat – Health and Wellness Centres (AB-HWC) in 18 states of India, in the presence of Dr. Vinod Paul, Member (Health), NITI Aayog and Shri Rajesh Bhushan, Union Health Secretary, here today.
Appreciating the findings of the report, Dr Mandaviya stated that, “AB-HWC was envisioned by the hon’ble Prime Minister to provide affordable and accessible healthcare to the last mile. In this regard, third-party evaluation is important for proper assessment of the functioning and implementation of the scheme”. He stated that the report will act as a “guiding principle” to plan better in the future.
Underscoring the importance of feedback and monitoring, the Union Health Minister noted that necessary steps will be taken to further strengthen the scheme. He highlighted that the Union government is coordinating with states to ensure last mile delivery through teleconsultation. He stated that “the govt is committed to provide best healthcare to all”.
Dr VK Paul congratulated the research teams for the assessment report and suggested that a governance structure should be established for daily monitoring and review of AB-HWCs. He also highlighted the need to further train the human resources at AB-HWCs.
Shri Rajesh Bhushan noted that this report will work like a foundation for future independent assessments of AB-HWCs and help in planning and redirecting efforts for ensuring the implementation of the objectives of the scheme.
The assessment of AB-HWCs in 18 states has been done in two phases by non-governmental entities, GRAAM and JHPIEGO as well as AIIMS, New Delhi from Govt. Sector for the year 2020-21.
The primary aim of this exercise was to assess the pace of rollout of AB-HWCs in different states and to identify specific challenges in their rollout. Given the early stage of implementation, the assessment focussed primarily on the inputs and processes that contribute to the functionality of HWC and reviewed any gains in short-term outputs including community use of the expanded range of services with a focus on chronic non-communicable diseases care.
In keeping with the priorities for AB-HWC, the assessment specifically focussed on free essential medicines, diagnostic services, teleconsultation services and health promotion activities. Given that the ongoing COVID-19 pandemic occurred during the process of the implementation, this assessment also allowed an evaluation of the bidirectional impact of HWC roll-out and the COVID pandemic.
The assessment was undertaken using a cross-sectional study design with a mixed-methods approach. The 18 states were selected to cover the spectrum of epidemiological transition levels as defined by the Global Burden of Disease India study with a higher focus on North-Eastern states. The study covered a sample of 317 facilities across eighteen states with 117 PHCs/UPHCs and 220 SHCs. 1,002 users from upgraded and 1,015 users from non-upgraded facilities were interviewed. The assessment covered both types of comparisons – a) pre and post conversion of the HWCs; and b) HWCs and non-HWCs within the same district.
The following are the key findings of the report:
- The launch of AB-HWC has enabled translation of the vision of moving from selective to comprehensive primary health care package enunciated in the National Health Policy 2017.
- The implementation of AB-HWC scheme is on track in most states with a clear roadmap for achieving targets set for December 2022.
- Overall, there has been an improvement in equity in access, despite existing constraints such as infrastructure availability and status of peripheral health facilities.
- Effective communication was noted from district to PHC-HWC and SHC-HWC resulting in translation of policy decisions into action, faster and better.
- Client satisfaction with the services provided was much higher among those who received services from HWCs as compared to those who received services from non-HWCs across all the four parameters measured – treatment, medicines, diagnostics and cleanliness.
- The Evaluation also brought out requirement of a definite timeline for rolling out all the services packages. The timelines have now been fixed.
Shri Vikas Sheel, AS & MD (NHM), Health Ministry, Shri Vishal Chauhan, JS, Health Ministry and other senior officials of the Union Health Ministry were present in the meeting along with NHM Mission Directors and other officials from States/UTs.
