In continuation of my earlier blog wherein, we touched upon the first level of community mobilization for improved care seeking, screening, risk assessments and follow up thru the continuum, we now come to the critical phase of treatment and tracking for an expanded range of services closer to the communities.
The National Health Policy, 2017 recommended strengthening delivery of Primary Healthcare, through establishment of “Health & Wellness Centers” as a platform to deliver CPHC. HWCs are envisioned to be game changers to enhance system responsiveness by bringing healthcare services closer to communities and being able to address the needs of the most marginalized, through the primary healthcare team. These are key to prevention and management of the rising disease burden for Communicable & NCDs to provide Comprehensive Primary Healthcare (CPHC) by delivering an expanded range of healthcare services by improving access, universality, and equity in service delivery.
National Sample Survey estimates for the period-2004 to 2014 show a 10% increase in households facing catastrophic healthcare expenditures. This could be attributed to the fact that private sector remains the major provider of health services in the country and caters to over 75% and 62% of outpatient and in-patient care respectively. India is also witnessing an epidemiological and demographic transition, where non-communicable diseases such as cardiovascular diseases, diabetes, cancer, respiratory, and other chronic diseases, account for over 60% of total mortality.
* Information sourced from Operational Guidelines of CPHC
Primary healthcare to be comprehensive needs to span preventive, promotive, curative, rehabilitative and palliative aspects of care. Provision of CPHC, therefore reduces morbidity and mortality at much lower costs and significantly reduces the need for secondary & tertiary care. Delivery of CPHC through HWCs rests substantially on the institutional mechanisms, governance structures, and systems created under the National Health Mission (NHM).
Implementation of the Ayushman Bharat – Health & Wellness Centers program has been progressing briskly, wherein a total of 80,701 health and wellness centres (AB-HWCs) out of 150,000 planned in 2018 have been operationalized across the country. This includes 54,618 Sub-Health Centres (SHC), 21,898 Primary Health Centres (PHC) and 4,155 Urban Primary Health Centres (UPHC), as of December 2021.
All the operationalised AB-HWCs are required to screen all people above 30 years of age in their area, for five common non-communicable diseases – Hypertension, Diabetes Mellitus, Oral Cancer, Breast cancer and Cervical Cancer.
The SHC-HWCs screen people for non-communicable diseases (NCDs) and PHC-HWCs or secondary/tertiary health centres ensure diagnosis and treatment initiation for people identified with the diseases. The AB-HWCs also enable a continuum of care as patients diagnosed at secondary/tertiary health centres are referred back to the SHC-HWCs for follow-up care.
The previous blog on Reducing premature mortality .. covered screening within communities as activity relevant to the SHC -HWC using Healthkon digital health and transformative solutions. We have covered local population in a NE state (India) in excess of 300,000 in the past few months and aim to complete a Million by Mar ’23. Risk evaluation for chronic disease and communicable disease was completed simultaneously using our Ai evaluator and an NLP summary is provided for High & Medium risk individuals to the Command Center / Hub for further evaluation using our tier-2 solution with a comprehensive Remote Patient Monitoring (RPM) & Teleconsultation solution. Continuum of care is enabled via forward & backward integration from the command centers in a Hub & spoke arrangement.
Our Tier -2 solution comprises a bedside intermediate step-down device (Digit01) coupled with the Sanjivani Android application for RPM & Teleconsultation. RPM along with Ai inputs for decision support enables GPs at Health Centers recommend treatment that is more informed for quality care.
More than 10,000 people have been treated through this solution during the past few months to help harness & manage chronic diseases at the HWCs.
Pranay Garg – Founder & MD