Health system readiness for roll out of the Ayushman Bharat Health and Wellnes Centres - Early experiences from Punjab State.

Abstract

Background:The Government of India launched the Ayushman Bharat (AB) program in 2018 which aims to transform 150,000 existing Sub Health Centres and Primary Health Centres into Ayushman Bharat Health and Wellness Centres (HWCs). In this study, we assessed health system readiness for establishment of HWCs.Methods:The assessment comprised of a cross sectional facility assessment and a knowledge assessment of community health officers (CHOs) and female multipurpose health workers also known as auxiliary nurse midwives (ANMs), in 26 HWCs in one community development block of Punjab state. HWCs were assessed for key input and process parameters such as a human resource, physical infrastructure, supplies, capacity building etc., and processes including health promotion, community participation, digitization of management information system, and service delivery.Results:It was observed that only 7 of the 26 HWCs had all human resources as per guidelines. The median knowledge score of CHOs and ANMs was 54% and 51% respectively. 11 of the 26 HWCs were co-located with Zila Parishad SHCs. Out of the 15 standalone HWCs, while 9 had independent buildings, 5 were located in buildings of other community level institutions. 50 percent of the HWCs were not able to perform diabetes screening due to lack of glucometers or testing supplies. While services for non-communicable diseases were available, a two-way referral tracking system for patients was missing. The mean job satisfaction rated by the newly appointed CHOs was 3.12 on a scale of 1 to 5, where 5 represented very high job satisfaction.Conclusion:The operationalization of HWCs requires State and local level interventions for strengthening of existing physical infrastructure, ensuring a regular supply of medicines and consumables, development of referral mechanisms for patients and enhancing community participation.