Ministry of Health and Family Welfare
Ayushman Bharat is a centrally sponsored programme anchored in the Ministry of Health and Family Welfare (MoHFW). It is an umbrella of two major health initiatives, namely 1. Health and Wellness Centres (HWCs) and 2. Pradhan Mantri Jan Arogya Yojna (PMJAY). Brief details of these components are as following:
Ayushman Bharat-Health & Wellness Centres (AB-HWC)
Nearly 1.5 lakh Sub-Centres and Primary Health Centres would be transformed as Health & Wellness Centres by 2022 to provide comprehensive and quality primary care close to the community while ensuring the principles of equity, affordability and universality. Till date, 4503 HWCs have been operationalized in various states.
Key components of AB-HWC:
- Additional Human Resource – New cadre of health care professionalreferred to as the Mid-Level Health Provider- who is a nurse or an Ayurvedic Practitioner trained and accredited for a set of competencies related to primary health care and public health.
- Mid-Level Health Provider will lead the team of MPWs and ASHAs at SHC level
- Multiskilling/ Training of existing service providers – upgrading skills to provide expanded package of services
- Efficient logistics system to ensure availability of wide range of drugs and point of care diagnostics
- Robust IT system – to create unique health id and longitudinal health record of all individuals and provision of tele-consultation services
- Provision of services related to indigenous health system and yoga etc for promotion of wellness
- Linkages with schools to train Health and Wellness Ambassadors to enable creating healthy habits in schools
The package of services envisaged at AB-HWC are:
▪ Care in pregnancy and child-birth.
▪ Neonatal and infant health care services
▪ Childhood and adolescent health care services
▪ Family planning, Contraceptive services and other Reproductive Health Care services
▪ Management of Communicable diseases including National Health Programmes
▪ Management of common communicable diseases and outpatient care for acute simple illness and minor ailments.
▪ Screening, Prevention, Control and Management of non-communicable diseases.
▪ Care for Common Ophthalmic and ENT problems
▪ Basic Oral health care
▪ Elderly and palliative health care services
▪ Emergency Medical Services
▪ Screening and Basic management of Mental health ailments
Key benefits for community under AB-HWC:
- Expanded package of primary care services –ranging from maternal and child health, communicable diseases to non-communicable diseases (universal screening, prevention, control and management of five common communicable diseases: hypertension, diabetes and three common cancers – those of the oral cavity, breast and cervix, primary health care for diseases for the eye, oral health, ENT, mental health, provision of palliative care and care for the elderly, and medical emergencies)
- Wide range of free drugs
- Point of care diagnostics at the centres.
- Tele-consultation services with Medical Officers for complications
- Continuum of care ensured through referral linkages and protocols
- Unique health id – longitudinal health record for each individual
- Services related to indigenous health system and yoga for promotion of wellness.
- Ayushman Bharat- Pradhan Mantri Jan Arogya Yojana (AB-PMJAY)
- Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (PMJAY) aims to cover over 10 crore poor and vulnerable families (approx. 50 crore beneficiaries) providing coverage up to Rs. 5 lakh per family per year for secondary and tertiary hospitalization.
- PMJAY has been launched on September 23, 2018.
- After the launch of PMJAY, RSBY and SCHIS got subsumed in it.
▪ PMJAY is an entitlement based scheme. This scheme covers poor and vulnerable families based on deprivation and occupational criteria as per SECC (Socioeconomic caste census) data.
▪ PMJAY provides cashless and paperless access to services for the beneficiary at the point of service in any (both public and private) empaneled hospitals across India.
▪ All beneficiary families of RSBY and SCHIS are entitled for benefits under PMJAY.
▪ Under PMAJY, the States are free to choose the modalities for implementation. They can implement the scheme through insurance company or directly through the Trust/ Society or mixed model.
- There is no restriction on family size, ensuring all members of designated families specifically girl child and senior citizens get coverage.
- At National level, National Health Agency (NHA) in the form of Society has been registered under the Societies Registration Act, 1860, to implement the scheme.
- NHA is responsible for all operational matter of PMJAY. NHA is functioning w.e.f. 11.05.2018.
- Ayushman Bharat National Health Protection Mission Council, as an Apex body has been set up to provide policy direction to the scheme.
- More than 1350 packages have been finalized by an expert committee headed by Director General, Health Services and peer reviewed by NITI Aayog.
AUGMENTATION OF ASHA BENEFITS:
The Cabinet Committee on Economics Affairs had on 19th September, 2018 approved a proposal to introduce an ASHA Benefit Package w.e.f from October, 2018 (to be paid in November, 2018) with two components, namely,
- Coverage of ashas and ASHA facilitators meeting the eligibility criteria under the pradhan mantri jeevan jyoti bima yojana and pradhan mantri suraksha bima yojana and
- An increase in the amount of routine and recurring incentives under national health mission for ashas from rs. 1000/- per month to rs. 2000/-per month.
▪As part of this ASHA Benefit Package, the Union Cabinet has also approved proposal of enhancing supervisory visit charges for ASHA Facilitators from Rs. 250/-per visit to Rs. 300/- per visit for 2018-2019 to 2019- 2020.
▪ASHA Facilitator will undertake about 20 supervisory visits per month.
▪With this approval ASHA Facilitators would receive about Rs 6000 per month against Rs 5000 per month
▪Estimated 1063670 ASHAs and ASHA Facilitators to be covered under Pradhan Mantri Jeevan Jyoti Bima Yojana (PMJJBY)
▪Estimated 9573032 ASHAs and ASHA Facilitators to be covered under Pradhan Mantri Suraksha Bima Yojana
▪Estimated 10,22,265 ASHAs will get at least minimum of Rs`2000 per month from current Rs 1000 per Month for routine and recurring activities.
▪41,405 ASHA facilitators to be benefitted with increased supervisory charges.
NATIONAL HEALTH POLICY 2017
▪ The National Health Policy of the country was launched after a gap of 15 years.
▪ The Cabinet in its meeting held on 15th March, 2017 approved the National Health Policy (NHP) 2017.
▪ NHP 2017 addresses the current and emerging challenges necessitated by the changing socio-economic, technological and epidemiological landscape.
▪ The process of formulation of the new Policy entailed wide consultation with multiple stakeholders and regional consultations before its approval by the Central Council of Health and Family Welfare and Group of Ministers.
- The major commitment of the NHP 2017 is raising public health expenditure progressively to 2.5% of the GDP by 2025.
- It envisages providing larger package of assured comprehensive primary healthcare through the Health and Wellness Centres.
- The Policy aims to attain the highest possible level of health and wellbeing for all at all ages through a preventive and promotive healthcare and universal access to quality health services without anyone having to face financial hardship as a consequence.
- This would be achieved through increasing access, improving quality and lowering the cost of healthcare delivery.
- NHP 2017 advocates allocating major proportion (two-thirds or more) of resources to primary care and
- aims to ensure availability of two beds per 1,000 population distributed in a manner to enable access within golden hour.
- The Policy also takes a fresh look at strategic purchase from the private sector and leveraging their strengths to achieve national health goals and seeks stronger partnership with the private sector.
Besides this, the highlights of the Policy are as following:
- Assurance based approach – The Policy advocates progressively incremental assurancebased approach with focus on preventive and promotive healthcare
- Health Card linked to health facilities- The Policy recommends linking the health card to primary care facility for a defined package of services anywhere in the country.
- Patient Centric Approach- The Policy recommends the setting up of a separate, empowered medical tribunal for speedy resolution to address disputes /complaints regarding standards of care, prices of services, negligence and unfair practices, standard regulatory framework for laboratories and imaging centers, specialized emerging services, etc
- Micronutrient Deficiency- There is a focus on reducing micronutrient malnourishment and systematic approach to address heterogeneity in micronutrient adequacy across regions.
- Quality of Care- Public hospitals and facilities would undergo periodic measurements and certification of level of quality. Focus on Standard Regulatory Framework to eliminate risks of inappropriate care by maintaining adequate standards of diagnosis and treatment.
- Make-in-India Initiative- The Policy advocates the need to incentivize local manufacturing to provide customized indigenous products for Indian population in the long run.
- Application of Digital Health- The Policy advocates extensive deployment of digital tools for improving the efficiency and outcome of the healthcare system and aims at an integrated health information system which serves the needs of all stake-holders and improves efficiency, transparency, and citizen experience.
- Private sector engagement for strategic purchase for critical gap filling and for achievement of health goals.
ALLIED AND HEALTHCARE PROFESSIONS BILL, 2018
The Union Cabinet approved the Allied and Healthcare Professions Bill, 2018 on 22nd November 2018 for regulation and standardization of education and services by allied and healthcare professionals. The Bill provides for setting up of an Allied and Healthcare Council of India and corresponding State Allied and Healthcare Councils which will play the role of a standard-setter and facilitator for professions of Allied and Healthcare.
- Establishment of a Central and corresponding State Allied and Healthcare Councils; 15 major professional categories including 53 professions in Allied and Healthcare streams.
- The Bill provides for Structure, Constitution, Composition and Functions of the Central Council and State Councils,
- The Central Council will comprise 47 members, who mainly represent the 15 professional categories.
- The State Councils are also envisioned to mirror the Central Council
- The Bill will also have an overriding effect on any other existing law for any of the covered professions.
- The State Council will undertake recognition of allied and healthcare institutions.
- Offences and Penalties clause have been included in the Bill to check malpractices.
- The Bill also empowers the Central and State Governments to make rules.
- Central Govt. also has the power to issue directions to the Council, to make regulations and to add or amend the schedule.
- Opportunity to create qualified, highly skilled and competent jobs in healthcare by enabling professionalism of the allied and healthcare workforce.
- High quality, multi-disciplinary care in line with the vision of Ayushman Bharat,
- Moving away from a ‘doctor led’ model to a ‘care accessible and team based’ model.
- Opportunity to cater to the global demand (shortage) of healthcare workforce which is projected to be about 15 million by the year 2030, as per the WHO Global Workforce, 2030 report.
NOTIFICATION FOR MEDICAL DEVICES RULES, 2017
MoHFW has notified Medical Devices Rules, 2017 for comprehensive regulation of Medical devices notified under the Drugs and Cosmetics Act, including their import, clinical investigation, manufacture, sale and distribution. The new rules are harmonised with the international regulatory practices and provide comprehensive legislation for the regulation of Medical Devices to foster India specific innovation and provide a fillip to ‘Make in India’. Presently 15 notified categories of medical devices are regulated under the provisions of Drugs and Cosmetics Act, 1940 and Rules 1945.
NATIONAL MEDICAL COMMISSION BILL, 2017
Cabinet approved the National Medical Commission Bill 2017 on 15thDecember, 2017 The Bill envisages to:
▪replace the Medical Council 1956 Act.
▪enable a forward movement in the area of medical education reform.
▪move towards outcome-based regulation of medical education rather than process-oriented regulation.
Expected benefits of the new legislation:
▪ a shift towards outcome based monitoring.
▪ Introduction of a national licentiate examination.
▪ This will be the first time such a provision is being introduced in any field of higher education in the country, as was the introduction of NEET and common counseling earlier.
▪ significant addition in the number of UG and PG seats and substantial new investment in this infrastructure sector.
▪ Better coordination with AYUSH systems of treatment.
▪Regulation of up to 40% seats in medical colleges to enable all meritorious students to have access to medical seats irrespective of their financial status
NATIONAL NUTRITION MISSION (NNM)
The Cabinet has recently approved the National Nutrition Mission, a joint effort of MoHFW and the Ministry of Women and Child development (WCD) towards a life cycle approach for interrupting the intergenerational cycle of under nutrition. The impact of the mission is envisioned to reduce the level of stunting, under-nutrition, anemia and low birth weight babies. It will create synergy, ensure better monitoring, issue alerts for timely action, and encourage States/UTs to perform, guide and supervise the line Ministries and States/UTs to achieve the targeted goals.
The mission aims to benefit more than 10 crore people.
▪ Major components/features of the Mission:
▪ Mapping of various Schemes contributing towards addressing malnutrition
▪ Introducing a very robust convergence mechanism
▪ ICT-based real time monitoring system
▪ Incentivizing States/UTs for meeting the targets
▪ Incentivizing Anganwadi Workers (AWWs) for using IT based tools
▪ Eliminating registers used by AWWs
▪ Introducing measurement of height of children at the Anganwadi Centres (AWCs)
▪ Social Audits
▪ Setting-up Nutrition Resource Centres, involving masses through Jan Andolan for their participation on nutrition through various activities, among others.
Mental healthcare act, 2017
- The act adopts a rights-based statutory framework for mental health in india in order to protect the rights of people with mental health problem the act strengthens the institutional mechanisms for improving access quality and appropriate mental healthcare services.
- The act increases accountability of both government and private sectors in delivery of mental healthcare with
- Representation of persons with mental health problem and their care-givers in statutory authorities such as central and state mental health authority.
- The most progressive features of the act are provision of advance directive, nominated representative, special clause for women and children related to admission, treatment, sanitation and personal hygiene;
- Restriction on use of electro-convulsive therapy and psychosurgery.
- Decriminalization of suicide is another significant facet of the act, which will ensure proper management of severe stress as a precursor for suicide attempts.
HIV & AIDS (Prevention & Control) Act, 2017
- It aims to end the epidemic by 2030 in accordance with the Sustainable Development Goals set by the United Nations.
- A person living with AIDS cannot be treated unfairly at employment, educational establishments, renting a property, standing for public or private office or providing healthcare and insurance services
- The Act also aims to enhance access to healthcare services by ensuring informed consent and confidentiality for HIV-related testing, treatment and clinical research.
- Every HIV infected or affected person below the age of 18 years has the right to reside in a shared household and enjoy the facilities of the household.
- No person shall be compelled to disclose his/her HIV status except with their informed consent, and if required by a court order.
- Every person in the care and custody of the State shall have right to HIV prevention, testing, treatment and counselling services.
- The Act suggests that cases relating to HIV positive persons shall be disposed’ off by the court on a priority basis and duly ensuring the confidentiality.
Universal Immunization Programme (UIP)
India’s UIP is one of the largest public health programmes in the world. It targets 3 crore pregnant women and 2.7 crore new borns annually. More than 90 lakh immunization sessions are conducted annually. It is the most cost-effective public health intervention and largely responsible for reduction of vaccine preventable under-5 mortality rate.
Mission Indradhanush: Government of India has launched Mission Indradhanush (MI) in December 2014
Intensified Mission Indradhanush (IMI) has been launched by Hon’ble Prime Minister of India on 8th October 2017 from Vadnagar, Gujarat.
Introduction of new vaccines
- Inactivated Polio Vaccine (IPV)
- Adult Japanese Encephalitis (JE) Vaccine
- Rotavirus Vaccine: Rotavirus is one of the leading causes of severe diarrhea
- Measles-Rubella (MR) Vaccine
- Pneumococcal Vaccine (PCV):
- MoHFW launched the National Viral Hepatitis Control Program on World Hepatitis Day, 2018 – 28th July
LABOUR ROOM QUALITY IMPROVEMENT INITIATIVE – LaQshya
- MoHFW launched LaQshya to improve the quality of care that is being provided to the pregnant mother in the Labour Room and Maternity Operation Theatres