Steps towards Universal Health Coverage through Health and Wellness Center under Ayushman Bharat Programme Delivering Comprehensive Primary Health Care in Bhandara District

Background: In 2018-19 as recommended by National Health Policy an Ambitious health care scheme as Ayushman Bharat programme was started by Government of India steps toward the Universal health coverage. Ayushman Bharat is also known as Healthy India having two major component. Creation of Health and Wellness Centres and Pradhan Mantri Jan Arogya Yojana (PMJAY). Comprehensive primary health care services will be delivered up gradation of existing health facility in various 10 core area and 13 different types of health services will be delivered at HWC health facility. Progress in Health and Wellness under Ayushman Bharat Programme: First HWC was inaugurated by GOI in state of Chhattisgarh within Bijapur district at jangla village of Bhairamgarh Taluka on On 18th April 2018. Till 06th Feb 2021 total 58961 Health and wellness cneters are operational in India and In Maharashtra total 8423 Health and wellness cneters are operational Review Article Ambekar et al.; JPRI, 33(34A): 34-38, 2021; Article no.JPRI.70589 35 where in Bhandara district total 177 Health and wellness cneters are operational which include 143 SHC Health and wellness center, 33 PHC Health and wellness center and 1 UPHC Health and wellness center. Achievements in Health and Wellness Center: In Bhandara district 98% of Medical Officer, 90% of Staff Nurse, 93% of MPW Female, 88% of MPW Male and 99% of ASHA trained NPCDCS Programme. Where 10,69,219 screening test for Hypertension and 10,81,901 screening test for Diabetes conducted in HWC health facility. Total 4097 Yoga sessions conducted at HWC health facility. Conclusion: 13 different types of health services which are delivered at Health and Wellness Centres health facility under Ayushman Bharat is step towards the Unvarsal health coverage provision in rural area of bhandara district.


INTRODUCTION
As per World health organization to provide Universal health coverage (UHC) promotive, preventive, curative , rehabilitation, and palliative health care services are essential health services provide in qualitative manner what they required without financial burden to community. UHC also enable all population for accessing services which required to avoid major causes of disease and death and improvement in the health of the population [1]. The Report on Primary Health Care Task Force by MOHFW GOI emphasise that to deliver Universal Health Coverage primary health care system is only the inexpensive and successful way [2]. The National Health Policy, 2017 had major focused on chagee from providing primary care services from very selective to comprehensive primary health care services at rural level in existing health care facilities converted into "Health and Wellness Centres". The policy recommends that Health and Wellness centres must be health centres be created on geographical norms without considering population norms with required human resources, development strategy, essential logistics support system [3].
In 2018-19 as recommended by National Health Policy an Ambitious health care scheme as Ayushman Bharat programme was started by Government of India steps toward the Unvarsal health coverage. Ayushman Bharat is also known as Healthy India having two major component. Comprehensive primary health care services will be delivered up gradation of existing health facility in following core area.

Initiation of E-Sanjeevani OPD for Online Consultation to Provide Specialist Services
In Bhandara district E Sanjeevani OPD was started to provide specialist health care services at HWC health facility in critical area through a tele consultation to hub. In this on line consultation the Community health Officer contacted Hub and give a patient's demographic details, history and complaints of patient to specialist doctor available at Hub . CHO help the patient to seek treatment from specialist doctor through telemedicine (video conference) for virtual consultation.

Fixed Day Approach to Provide Comprehensive Primary Health Care (CPHC) Services
In Bhandara fixed day approach was started at HWC health facility to cater maximum population and generate demand for CPHC services at HWCs. The fixed day approach was decided in consultation with all field level staff and Officers Following fixed day services are as follows:

Uniformity in Ayushman Bharat Health and Wellness Centre Facility
As per state policy to create uniform and patient friendly infrastructure of Health and Wellness center Stencils were given to all HWC health facility from district level and painted all HWC health facility with same colour and Logos.

DISCUSSION
A pilot project implemented on Universal Health coverage in 3 blocks of Tamilnadu in 2017 and report on this project shown that improvement in accessing primary health care services at sub center level. Over all dependence on Private health provider was decreased in rural area especially in those population those are taking care from private health care provider. There is fall in out of pocket expenditure for taking health care services in rural area [10]. In Bhandara district also utilization of HWC SC is increases for seeking health care services and specially for NCD care.
Article published in PLOS Medicine journal mentioned the challenge to achive universal health coverage through AB HWC programme is lack of resources available to provide fund, no availability of the skilled manpower and infrastructure to provide health care [11]. Few of the related articles were reviewed [12][13][14][15]. In Bhandara district, funds are regularly received for HWC programme, skilled manpower MLHP and ANM , MPW , ASHA are available to provide services and all Proposed SC are converted in HWC by branding and up gradation in infrastructure.

CONCLUSION
In Bhandara district 13 different types of health services which are delivered at Health and Wellness Centres SC health facility under Ayushman Bharat is step towards the Unvarsal health coverage provision in rural area of Bhandara district.

CONSENT
It is not applicable.

ETHICAL APPROVAL
It is not applicable.