Lok Sabha Question No. 3056 (UNSTARRED), answered on 2019-12-06
Subject: Challenges of Ayushman Bharat Scheme
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Midhun Reddy

## GOVERNMENT OF INDIA MINISTRY OF HEALTH AND FAMILY WELFARE DEPARTMENT OF HEALTH AND FAMILY WELFARE

## LOK SABHA UNSTARRED QUEST ION NO. 3056 TO BE ANSWERED ON 6 TH DECEMBER, 2019

## CHALLENGES OF AYUSHM AN BHARAT SCHEME

## 3056. SHRI P.V. MIDHUN REDDY:

Will the Minister of HEALTH AND FAMILY WELFARE be pleased to state:

(a) whether it is a fact that Ayushman Bharat is posed with a number of challenges tha from  covering/treating  non -communicable  diseases to women's  health  and check infant mortali ty;

- (b) if so, the reasons therefor; and
- (c) the steps taken by the Government to overcome these challenges?

## ANSWER THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE (SHRI ASHWINI KUMAR CHOUBEY)

(a) to (c) : Under Ayushman Bharat -Health & Wellness Centres (AB -HWCs), 1.5 lakh Health Sub Centres and Primary Health Centres are to be transformed into Health and Well Centres across the country by December, 2022. AB - HWCs would provide service delivery of a package  of  preven tive,  promotive,  curative  and  rehabilitative  services  delivered  clos communities  to  overcome  the  challenge  of  dual  burden  of  disease.  The  expanded  range services would include services related to Non - Communicable diseases (NCDs), Mental health, ENT, Ophthalmology,  Oral  health,  Geriatric  and  palliative  health  care  and  Trauma  care addition  to  the  existing  services  of  Reproductive  Child  Health  and  communicable  dise Services at AB - HWCs are free and universal to all.

The challenges in the implementation of AB - HWCs  and  steps taken to overcome the challenges are at Annexure I and II respectively.

Under Ayushman Bharat -Pradhan Mantri Jan Arogya Yojana (AB - PMJAY), health cover  up  to  Rs.  5  lakh  per  family  per  annum  i s  provided  to  around  10.74  crore  poor  and vulnerable  families  as  per  Socio - Economic  Caste  Census  data.  For  providing  care  to beneficiaries, a set of 1392 health benefit packages across 24 specialties, which also in General medicine, Obstetrics & Gynae cology, Neonatal care and Paediatric medical management,  have  been  defined.  These  Packages  include  treatment  of  non - communicable diseases and also cover women's & infants' health.

Further, AB -PMJAY also has a provision of an 'Unspecified package' to cover surgical conditions  not  defined  within  the  package  list.  The  details  of  packages  are  available website www.pmjay.gov.in .

## Challenges in the Implementation of AB - HWCs

- Ensuring adequate, well skilled and well equipped human resources at Health Sub Centre level and Primary Health Centre level AB - HWCs.
- Strengthening  supply  chain  to  ensure  availability  of  free  essential  drugs  and  diag required  for  providing  expanded  package  of  Comprehensive  Primar y  Healthcare  (CPHC) services at AB - HWC level.
- To strengthen the infrastructure of targeted Health Sub Centres and Primary Health Ce for  transformation  into  AB - HWCs  especially  those  public  healthcare  facilities  in  rente buildings and dilapidated condi tions besides creation of new facilities as per norms.
- Training and skill upgradation of primary healthcare team for expanded range of service
- Behaviour change communication strategy increasing for awareness on healthy life style eat right practices amongst the community.
- Creation of a robust IT system for registration of population covered by AB - HWC, creation of family folder, referral and return services, linkage with screening, diagnosis, tre follow up.
- Strengthening higher level faciliti es to manage the referrals from AB - HWCs.
- Addressing the NCDs in urban context due to the complexities of migration.
- Commensurate allocation of financial resources by government for creation of all the mentioned services and facilities.
- Issues relatin g to governance and capacity, especially in the high focus states.
- Unavailability of proven community outreach strategies and ways to create ownership by community of the AB - HWC are additional challenges.

## Annexure I

## Steps taken to overcome challenges in the implementation of HWCs

- Recently States/UTs were oriented on the challenges and way forward by conducting four regional workshops on Operationalization of AB - HWCs.
- The Health Ministers of the States during the recently concluded meeting of the Central Council  of  Health  and  Family  Welfare  (CCHFW)  held  in  October  2019  passed  a resolution to strengthen AB - HWC and Comprehensive Primary Healthcare (CPHC) as a measure towards Health for all in their States/ UTs and another resolution was pa regarding  increasing  the  budget  for  health  as  stated  in  national  Health  Policy, which  will  increase  the  financial  resources  to  expand  and  strengthen  AB - HWCs  an d Comprehensive Primary Healthcare.
- Under National Health Mission (NHM), technical and financial support is provided the  States  to  strengthen  their  healthcare  system  including  for  transformatio healthcare facilities to AB - HWCs viz, support for enga ging required Human Resources, multiskilling and capacity building of the existing primary healthcare team, expa range  of  medicines  and  diagnostics,  upgraded  infrastructure,  digitization  in  ter availability of tablets/desktops, use of telemedicine / information technology platforms, inclusion  of  health  promotion  activities,  community  mobilization  and  additio financial  resources as  per  the  norms  prescribed  in  the  Operational  guidelines  on Ayushman Bharat -Comprehensive Primary Healthcare throughHealth and Wellness Centres.
- Besides this, NHM Conditionality framework and mechanisms of additional incentive encourage  states  to  utilise  the  resources  for  transforming  Primary  Health  Centre Health Sub Centres a  AB- HWCs.