India has crossed a landmark milestone on the journey of universal healthcare. More than 50,000 (50,025) Ayushman Bharat – Health and Wellness Centres (AB-HWCs) are now operational across the country. Aiming at providing Comprehensive Primary Health Care (CPHC) services to the communities closer to their homes, 1.5 lakh AB-HWCs are to be established by December 2022. With more than 50,000 having been established, 1/3 of the target has been met. This has led to improved access to affordable primary healthcare services for more than 25 crore people.
Dr Harsh Vardhan, Union Minister of Health & Family Welfare congratulated the States/UTs for their efforts in operationalising the HWCs despite the challenges posed by the COVID-19 pandemic. “This has been possible due to the joint efforts of the Center and the States/UTs in planning, monitoring at all levels, standardization of processes, the flexibility for adaptation provided to the States/UTs, and building on the health systems created thus far”, he stated. The HFM specially thanked the frontline health workers, the Medical Officers, the Community Health Officers and ASHAs for their dedication to the cause of providing Comprehensive Primary Health Care services and for supporting millions of people with necessary services in these difficult times. “They are the backbone of the healthcare delivery system. Their contribution during the COVID period has been exemplary”, he said. HWCs have helped in interventions such as risk communication, contact tracing, community surveillance and early identification of cases, and seamless provisioning of non-COVID essential health services for ensuring protection of vulnerable groups, such as the newborn, elderly and those with co-morbidities.
#COVID19 screening at a HWC in Assam
Ayushman Bharat was launched in 2018 with its twin pillars of Health & Wellness Centers (HWCs) and Pradhan Mantri Jan Arogya Yojana (PMJAY) with bidirectional linkages between the two for providing the full range of services across the continuum of care. The first AB-HWC was launched by Hon. Prime Minister Narendra Modi on the 14th of April 2018 at Jhangla in Bijapur District of Chhattisgarh.
The Health & Wellness Centers provide CPHC services to people and sustain the efforts for provision of reproductive, maternal, neonatal, child, adolescent and nutrition (RMNCHA+N) services and control of communicable diseases. They also focus on disease prevention, especially for chronic and non-communicable diseases, wellness through community engagement and creating awareness about health lifestyles, appropriate nutrition and physical activities such as Yoga. The HWC team consists of a trained Community Health Officer, one or two Health Workers and 5-8 ASHAs. This team has well defined tasks which intend to deliver public health functions and primary health care by bringing health-care services closer to the community.
The 50,025 operational AB-HWCs are now spread across 678 districts, and include 27,890 Sub Health Centres, 18,536 Primary Health Centres and 3,599 Urban Primary Health Centres. Together, these AB-HWC have witnessed over 28.10 crore footfalls of which over 53% percent are women who sought care at these centres. More than 6.43 crore people have been screened for hypertension, 5.23 crore for diabetes and 6.14 crore people for cancers. About 1.0 crore people are being provided free drugs for treatment of hypertension and about 60 lakhs for diabetes.
Community Health Officer screening for hypertension at a HWC in Tripura
Focus on wellness is one of the novel interventions under the ABHWC Programme. Over 30 lakhs wellness sessions have been conducted at these centres including activities such as Yoga, Zumba, Community Walks, Shirodhara, Meditation etc.
#Yoga session at Phubasahi Khordha HWC, Odisha
HWCs also provide a strong backbone for the implementation of the eSanjeevani platform of Health Ministry which includes the eSanjeevani Patient-to-Doctor OPD and eSanjeevani-HWC which provides Doctor-to-Doctor teleconsultation service. 23,103 HWCs have started providing teleconsultation services to citizens. More than 7.5 lakh teleconsultations have already been conducted through these platforms. The eSanjeevani-HWC was rolled out in November 2019. It is to be implemented in all the 1.5 lakh Health and Wellness Centres in a ‘Hub and Spoke’ model, by December 2022. States need to set up dedicated ‘Hubs’ in Medical Colleges and District hospitals to provide tele-consultation services to ‘Spokes’, i.e. Health & Wellness Centres (HWC).
State wise functional AB-HWCs as on 18.11.2020
| SN | STATE | Functional AB-HWCs as on 18112020 | |||
| SHC | PHC | UPHC | TOTAL | ||
| 1 | Andaman & Nicobar Islands | 58 | 17 | 5 | 80 |
| 2 | Andhra Pradesh | 1122 | 1145 | 241 | 2508 |
| 3 | Arunachal Pradesh | 91 | 38 | 4 | 133 |
| 4 | Assam | 878 | 379 | 52 | 1309 |
| 5 | Bihar | 207 | 877 | 98 | 1182 |
| 6 | Chandigarh | 33 | 2 | 35 | |
| 7 | Chhattisgarh | 1450 | 402 | 45 | 1897 |
| 8 | Dadra & Nagar Haveli | 52 | 8 | 0 | 60 |
| 9 | Daman & Diu | 26 | 4 | 0 | 30 |
| 10 | Delhi | Not implementing the Programme | |||
| 11 | Goa | 9 | 54 | 5 | 68 |
| 12 | Gujarat | 3523 | 1108 | 222 | 4853 |
| 13 | Haryana | 159 | 364 | 100 | 623 |
| 14 | Himachal Pradesh | 275 | 422 | 6 | 703 |
| 15 | Jammu & Kashmir | 505 | 305 | 16 | 826 |
| 16 | Jharkhand | 852 | 132 | 52 | 1036 |
| 17 | Karnataka | 1572 | 1896 | 336 | 3804 |
| 18 | Kerala | 0 | 733 | 83 | 816 |
| 19 | Ladakh | 0 | 0 | 0 | 0 |
| 20 | Lakshadweep | 0 | 3 | 0 | 3 |
| 21 | Madhya Pradesh | 3026 | 1128 | 130 | 4284 |
| 22 | Maharashtra | 4117 | 1825 | 439 | 6381 |
| 23 | Manipur | 111 | 39 | 1 | 151 |
| 24 | Meghalaya | 70 | 34 | 19 | 123 |
| 25 | Mizoram | 44 | 54 | 8 | 106 |
| 26 | Nagaland | 101 | 47 | 7 | 155 |
| 27 | Odisha | 304 | 1225 | 86 | 1615 |
| 28 | Puducherry | 77 | 37 | 2 | 116 |
| 29 | Punjab | 1607 | 346 | 93 | 2046 |
| 30 | Rajasthan | 131 | 1859 | 116 | 2106 |
| 31 | Sikkim | 43 | 13 | 0 | 56 |
| 32 | Tamil Nadu | 858 | 1371 | 453 | 2682 |
| 33 | Telangana | 274 | 624 | 221 | 1119 |
| 34 | Tripura | 266 | 32 | 5 | 303 |
| 35 | Uttar Pradesh | 3509 | 1468 | 391 | 5368 |
| 36 | Uttarakhand | 262 | 246 | 36 | 544 |
| 37 | West Bengal | 2311 | 268 | 325 | 2904 |
| Total | 27890 | 18536 | 3599 | 50025 | |