Strengthening Comprehensive Primary Health Care through Ayushman Bharat: Role of Demand and Supply-side Interventions.
Journal
Indian journal of public health
ISSN: 0019-557X
Titre abrégé: Indian J Public Health
Pays: India
ID NLM: 0400673
Informations de publication
Date de publication:
01 Oct 2023
01 Oct 2023
Historique:
received:
04
07
2022
accepted:
27
10
2023
medline:
27
6
2024
pubmed:
27
6
2024
entrez:
27
6
2024
Statut:
ppublish
Résumé
Comprehensive primary health care (CPHC) is an effective way to respond to the challenges of changing epidemiology, growing population expectations, and universal health coverage. A set of demand and supply improvement strategies was developed to support primary health center provision and pilot tested in three model health and wellness centers (HWCs) in Punjab. The study aimed to assess the early effects of interventions on the inputs, processes, and outputs for optimal implementation of the AyushmanBharat-HWC (AB-HWC) program. Cross-sectional facility assessments were conducted using a standardized methodology at three time points to identify the changes in inputs and processes at subcenter-HWCs from 2019 to 2021. In addition, daily and month-wise service utilization data of model HWCs and nonmodel HWCs in the intervention block and control block in a district of Punjab from the AB-HWC portal were analyzed from May 2020 to April 2021. The difference-in-difference analysis indicated that the CPHC strengthening interventions in the model HWCs improved the mean number of people screened for noncommunicable diseases, mean newly diagnosed patients with hypertension and diabetes, mean hypertensive and diabetic patients on treatment, mean outpatient attendance, and mean number of wellness sessions by 265.71, 21.31, 29.48, 102.17, and 4.88 units per month, compared to control HWCs. The success of the initiatives can be attributed to an integrated approach encompassing multistakeholder planning of interventions, community involvement, empowerment of service providers, and consistent supportive supervision. The long-term success will be contingent on the quality of training, team dynamics, community participation, social accountability, and supervision support.
Sections du résumé
BACKGROUND
BACKGROUND
Comprehensive primary health care (CPHC) is an effective way to respond to the challenges of changing epidemiology, growing population expectations, and universal health coverage. A set of demand and supply improvement strategies was developed to support primary health center provision and pilot tested in three model health and wellness centers (HWCs) in Punjab.
OBJECTIVE
OBJECTIVE
The study aimed to assess the early effects of interventions on the inputs, processes, and outputs for optimal implementation of the AyushmanBharat-HWC (AB-HWC) program.
MATERIALS AND METHODS
METHODS
Cross-sectional facility assessments were conducted using a standardized methodology at three time points to identify the changes in inputs and processes at subcenter-HWCs from 2019 to 2021. In addition, daily and month-wise service utilization data of model HWCs and nonmodel HWCs in the intervention block and control block in a district of Punjab from the AB-HWC portal were analyzed from May 2020 to April 2021.
RESULTS
RESULTS
The difference-in-difference analysis indicated that the CPHC strengthening interventions in the model HWCs improved the mean number of people screened for noncommunicable diseases, mean newly diagnosed patients with hypertension and diabetes, mean hypertensive and diabetic patients on treatment, mean outpatient attendance, and mean number of wellness sessions by 265.71, 21.31, 29.48, 102.17, and 4.88 units per month, compared to control HWCs.
CONCLUSION
CONCLUSIONS
The success of the initiatives can be attributed to an integrated approach encompassing multistakeholder planning of interventions, community involvement, empowerment of service providers, and consistent supportive supervision. The long-term success will be contingent on the quality of training, team dynamics, community participation, social accountability, and supervision support.
Identifiants
pubmed: 38934822
doi: 10.4103/ijph.ijph_885_22
pii: 01586002-202367040-00018
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
568-574Informations de copyright
Copyright © 2023 Copyright: © 2023 Indian Journal of Public Health.
Références
World Health Organization and United Nations Children’s Fund. Vision for Primary Health Care in the 21st Century: Towards Universal Health Coverage and the Sustainable Development Goals. Geneva: World Health Organization and the United Nations Children’s Fund (UNICEF); 2018. Available from: https://www.who.int/docs/default-source/primary-health/vision.pdf. [Last accessed on 2022 Apr 27].
Maher D, Sekajugo J, Harries AD, Grosskurth H. Research needs for an improved primary care response to chronic non-communicable diseases in Africa. Trop Med Int Health 2010;15:176–81.
NHSRC. Government of India. Ayushman Bharat. Comprehensive Primary Health Care through Health and Wellness Centres. Operational Guidelines. Available from: https://ab-hwc.nhp.gov.in/download/document/45a4ab64b74ab124cfd853ec9a0127e4.pdf. [Last accessed on 2022 Apr 27].
Ved RR, Gupta G, Singh S. India’s health and wellness centres: Realizing universal health coverage through comprehensive primary health care. WHO South East Asia J Public Health 2019;8:18–20.
National Health Mission. Ministry of Health and Family Welfare. Government of India. Essential Medicine List for SHC and PHC Level. Ayushman Bharat-Health and Wellness Centres; 2020. Available from: https://nhm.gov.in/New_Updates_2018/Om_and_orders/CPHC/Others/H_WC_SHC_and_PHC_updated_EML_as_on_March_2020_-pdf. [Last accessed on 2022 Apr 27].
Brar S, Purohit N, Singh G, Prinja S, Kaur M, Lakshmi PV. Health system readiness for roll out of the Ayushman Bharat Health and Wellnes Centres – Early experiences from Punjab state. J Family Med Prim Care 2022;11:1354–60.
Brar S, Purohit N, Prinja S, Singh G, Bahuguna P, Kaur M. What and how much do the community health officers and auxiliary nurse midwives do in health and wellness centres in a block in Punjab? A time-motion study. Indian J Public Health 2021;65:275–9.
World Health Organization. Service Availability and Readiness Assessment (SARA). Geneva: World Health Organization; Available from: https://www.who.int/data/data-collection-tools/service-availability-and-readiness-assessment-(sara)?ua=1. [Last accessed on 2022 Jun 02].
van Weel C, Kidd MR. Why strengthening primary health care is essential to achieving universal health coverage. CMAJ 2018;190:E463–6.
Bowen DJ, Kreuter M, Spring B, Cofta-Woerpel L, Linnan L, Weiner D, et al. How we design feasibility studies. Am J Prev Med 2009;36:452–7.
Maimela E, Alberts M, Bastiaens H, Fraeyman J, Meulemans H, Wens J, et al. Interventions for improving management of chronic non-communicable diseases in Dikgale, a rural area in Limpopo province, South Africa. BMC Health Serv Res 2018;18:331.
Maher D, Harries AD, Zachariah R, Enarson D. A global framework for action to improve the primary care response to chronic non-communicable diseases: A solution to a neglected problem. BMC Public Health 2009;9:355.
Anand TN, Joseph LM, Geetha AV, Prabhakaran D, Jeemon P. Task sharing with non-physician health-care workers for management of blood pressure in low-income and middle-income countries: A systematic review and meta-analysis. Lancet Glob Health 2019;7:e761–71.
Kamvura TT, Dambi JM, Chiriseri E, Turner J, Verhey R, Chibanda D. Barriers to the provision of non-communicable disease care in Zimbabwe: A qualitative study of primary health care nurses. BMC Nurs 2022;21:64.
Lall D, Engel N, Devadasan N, Horstman K, Criel B. Team-based primary health care for non-communicable diseases: Complexities in South India. Health Policy Plan 2020;35:i22–34.
Heller DJ, Kumar A, Kishore SP, Horowitz CR, Joshi R, Vedanthan R. Assessment of barriers and facilitators to the delivery of care for noncommunicable diseases by nonphysician health workers in low- and middle-income countries: A systematic review and qualitative analysis. JAMA Netw Open 2019;2:e1916545.
Hanifi SM, Hossain A, Chowdhury AH, Hoque S, Selim MA, Mahmood SS, et al. Do community scorecards improve utilisation of health services in community clinics: Experience from a rural area of Bangladesh. Int J Equity Health 2020;19:149.
Gullo S, Galavotti C, Sebert Kuhlmann A, Msiska T, Hastings P, Marti CN. Effects of the community score card approach on reproductive health service-related outcomes in Malawi. PLoS One 2020;15:e0232868.
Kiracho EE, Namuhani N, Apolot RR, Aanyu C, Mutebi A, Tetui M, et al. Influence of community scorecards on maternal and newborn health service delivery and utilization. Int J Equity Health 2020;19:145.
World Health Organization. Monitoring The Building Blocks of Health Systems: A Handbook of Indicators and their Measurement Strategies. Geneva: World Health Organization; 2010. Available from: https://apps.who.int/iris/bitstream/handle/10665/258734/9789241564052-eng.pdf. [Last accessed on 2022 Apr 28].
Dieleman M, Harnmeijer JW. Improving health worker performance: In search of promising practices. Geneva: World Health Organization; 2006.
Bulthuis SE, Kok MC, Raven J, Dieleman MA. Factors influencing the scale-up of public health interventions in low- and middle-income countries: A qualitative systematic literature review. Health Policy Plan 2020;35:219–34.