Kurukshetra November 2018: Rural Health (Part 1) (Download PDF)


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Key Topics included in this Article: Ayushman Bharat – Pradhan Mantri Jan Aarogya Yojana, Poshan Abhiyan, Rashtriya Kishor Swasthya Karyakram, SAATHIYA Resource Kit & ‘Saathiya Salah’ Mobile App for adolescents.

  • Tele-Medicine: A New Healthcare Opportunity

  • Kaya Kalp (Clean Hospital) Campaign

  • Accredited Social Health Activist (ASHA)

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Rural Health - Kurukshetra November 2018 (In English)

Dr. Manishika explained Kurukshetra November 2018: Rural Health

Forthcoming Issue: Science & Technology for Rural India

  • 👌 📹 Ayushman Bharat – Pradhan Mantri Jan Aarogya Yojana (PMJAY) will provide cover of upto Rs. 5 lakhs per family per year, for secondary & tertiary care hospitalization.

  • Over 10.74 cr. vulnerable entitled families (approx. 50 cr. beneficiaries) will be eligible for these benefits.

  • PMJAY will provide cashless & paperless access to services for beneficiaries at point of service when fully implemented.

Building Clean & Healthy Villages

  • No community & society can be successful sans cleanliness.

  • 👌 22 states, 468 dist. & more than 4 lakh 68 thousand villages in country have become Open Defecation Free (ODF).

Clean Village: Healthy life

Women Members of Self Help Groups have extended financial help to many families who were trapped in financial crisis.

SBM: Mass Movement now

  • Swachh Bharat Mission has acquired form of mass movement & w/aim to take it forward; Rural Development Ministry has taken number of measures thru its ambitious scheme Mahatma Gandhi National Rural Employment Guarantee Act – MGNREGA.

  • This includes awareness promotion among village panchayats towards cleanliness in rural areas & encouraging & training villagers to take up activities related to livelihood creation.

  • For waste water management in Telangana soakage pits are being constructed thru MGNREGA at family & community level.

  • In Nanded dist. , Maharashtra MGNREGA funds were utilized for making soakage pits which has helped in villages to get rid of mosquitoes.

  • Construction of Lingpui water tank of Tlenguam R G Block in Aizawl dist. , Mizoram was started as innovative experiment under MGNREGA.

Map of water tank of Tlenguam R G Block in Aizawl

Map of Water Tank of Tlenguam R G Block in Aizawl

Map of Construction of Lingpui water tank of Tlenguam R G Block in Aizawl

Ayushman Bharat: India’s Road to Universal Health Coverage

  • 📹 📝 Ayushman Bharat comprises 2 pillars –

    • 1st is provision of universal & Comprehensive Primary Health Care (CPHC) delivered in formulation of Health & Wellness Centres (HWCs); which are transformed 1st 2 tiers of public health system i. e. Sub Health Centres (SHC) & Primary Health Centres (PHC).

    • 2nd is Pradhan Mantri Jan Aarogya Abhiyan (PMJAY), for provision of health coverage of upto Rs. 5,00,000/family for nearly 10.34 cr. households to obtain secondary & tertiary in-patient care.

  • Implementation of Ayushman Bharat rests on health systems strengthening achieved thru National Health Mission (NHM).

  • Input related investments in infrastructure & human resources, at most primary & to limited extent in secondary care, coupled w/support for strengthening procurement systems, improving governance, establishing referral & transport systems, incentives for performance have yielded accelerated positive outcomes for mothers & children & to extent in communicable diseases as well.

  • Under – 5 Mortality Rate (U5MR) in India is 39/1000 live births w/rate of decline increasing from 2.5 % in 2013 - 14 to 8.1 % in 2015 - 16.

  • At current rate of decline India will achieve Sustainable Development Goal (SDG) target of U5MR & MMR by 2023 itself.

  • World Bank estimates that just 10 % of medical conditions require more complex treatment in hospitals or specialist care.

Image of CPHC through HWC

Image of CPHC through HWC

Image of CPHC through HWC

Impetus on Ayushman Bharat – HWC is aimed at paradigm shift in provisioning CPHC to people:

  • HWC will enable expansion of package of services that go beyond Maternal & Child Health (MCH), to include care for non-communicable diseases, palliative & rehabilitative care, mental health & first level care for emergencies & trauma.

  • In order to provide these services at Sub Health Centre (SHC) – HWC, new cadre of worker – Mid-Level Health Provider (MLHP) – who is either nurse or Ayurveda practitioner, trained in competencies of public health & primary health care, clinical management, continuum of care, dispensation of drugs & close follow up for those w/chronic illness/patients.

  • While expanded primary health care package will be available at SHC & Primary Health Centre (PHC), focus of SHC – HWC is to promote wellness thru social & behavioral change communication for emphasis on preventive & promotive health.

  • 📝 Other Important elements of HWCs include:

    • Robust IT system for population enumeration (such that every individual & family is mapped to particular SHC – HWC & uses it as 1st port of call),

    • Use of digital apps for frontline workers for enumeration, recording of services, reporting & payment of team based incentives, serve as clinical decision support system

    • Regular up-gradation of skills of all providers thru distance learning & use of platforms such as ECHO for clinical support, supervision & mentoring.

  • 👌 Other component of Ayushman Bharat which makes it programme for ensuring UHC is PMJAY.

  • 👌 Launched on 23rd Sept. , 2018, it has subsumed Rashtriya Swasthya Bima Yojana (RSBY) & Senior Citizen Health Insurance Scheme (SCHIS).

  • Poised to be largest public-funded health insurance scheme in world, PMJAY will ensure continuum of care from AB-HWCs & substantial reduction in OOPE on catastrophic healthcare.

Image of Pradhan Mantri Jan Arogya Yojana

Image of Pradhan Mantri Jan Arogya Yojana

Image of Pradhan Mantri Jan Arogya Yojana

  • PMJAY is entitlement based scheme. This scheme covers poor & vulnerable families based on deprivation & occupational criteria as per Socio-Economic & Caste Census (SECC) data. It will cover 10 cr. poor & vulnerable families (approx. 50 cr. beneficiaries) providing coverage upto Rs. 5 lakh per family per year for secondary & tertiary hospitalization.

  • 👌 AB-PMJAY is being managed by National Health Agency (NHA). Current status of implementation of schemes is that 33 States/UTs have signed MoUs or agreed to sign MoU w/Centre (remaining being Odisha, Telangana & Delhi) & out of these 26 States have started implementation.

Ayushman Bharat: Silver Lining in Health Care

  • WHO defines quality of care as “extent to which health care services provided to individuals & patient populations improve desired health outcomes”.

  • To achieve this, health care must be safe, effective, timely, efficient, equitable & people centred.

Ayushman Bharat

  • HWCs are proposed to provide Comprehensive Primary Health Care (CPHC), covering both Mother & Child Health services, Communicable as well as Non-Communicable Diseases (NCD), including free essential drugs & diagnostic services.

  • PMJAY by far “world’s largest fully govt. funded health insurance program” is aimed at providing financial protection for those seeking hospitalized care.

  • PMJAY will provide cover of Rs. 5 lakhs per family per year, against 1350 most commonly occurring disease conditions requiring secondary & tertiary care hospitalization.

  • Min. of 10.74 cr. (approx. 50 cr. beneficiaries) of poorest & most vulnerable families will be covered.

  • It undertakes path breaking interventions to holistically address health; adopting continuum of care approach-addressing prevention, promotion, primary & ambulatory care; as well as secondary & tertiary care requiring hospitalized treatment.

- Published/Last Modified on: November 26, 2018


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