AYUSHMAN BHARAT T owards UHC and Continuum of Care

1. AYUSHMAN BHARATTowards UHC and Continuum of Care Dr Manohar Agnani Joint Secretary, MoHFW Arogya Manthan 1.10.2019 Vigyan Bhavan, New Delhi

2. PM’s Address at UNGA 2019 on UHC Hon’ble PM outlined about 4 Pillars of UHC in India at UNGA Sep 2019! • Preventive and Promotive Healthcare • 1.5 lakhs Ayushman Bharat Health and Wellness Centres (AB-HWCs) • Wellness through YOGA / Ayurveda / Fitness Activities • Ban on e-Cigarattes • Clean India Mission / Swachha Bharat • Universal Immunization duly introducing New Vaccines • Affordable Health Care • Pradhan Mantri Jan ArogyaYojana (PMMJAY) – Financial Protection to 50 Crore people for 5 lakhs of Secondary & Tertiary Care • 5000 Jan Aushadhi Stores • Prime Minister Dialysis Programme • Introduction of Tele Medicine Services

3. PM’s Address at UNGA 2019 on UHC • Strengthening Supply Side Requirements • Quality Medical Education and Medical Infrastructure • Mission Mode Interventions • National POSHAN Abhiyan • Elimination of TB by 2025 • Programme for preventing Air Borne and Zoonotic Diseases

4. Ayushman Bharat: Universal Health Coverage • PMJAY empanelled Public & Private Healthcare facilities • CHCs/SDHs/District Hospitals/Medical Colleges TERTIARY SECONDARY Gatekeeping Referral/Return Preventive, Promotive, Curative, Rehabilitative & Palliative Care PRIMARY CPHC through AB-HWCs Existing services: RMNCH+A Unmet needs: NCDs/other Chronic Diseases CONTINUUM OF CARE

5. Sub Groups • Committee formed four sub groups with specific ToRs • including representatives from NHA / MoHFW / State Governments / CSOs / Subject experts in each group • Group for Continuum of Care • Chair: Dr Narendra Gupta, Prayaas • Group for IT Systems • Chair: Dr Selvavinayagam, Additional DPH, Govt of Tamil Nadu • Group for Capacity Building • Chair: Dr H Sudarshan, KarunaTrust • Group for Community Action • Chair: Dr Abhay Shukla, CEHAT

6. Defining Geographical Area for AB-HWCs • Rural areas: • Area under the SHCs which are upgraded as AB-HWCs. • For PHC levelAB-HWCs, it will be the area of the co-located SHC. • For referral from SHC level AB-HWCs PHC level AB-HWCs as first port of call for the entire Service area of PHC • Urban areas: • Demarcation and mapping of area under urban AB-HWCs to be done on the basis of Ward (with a special focus on slum areas) and to be followed by enumeration of population.

7. Enrolment of Households & Members • IT enabled Patient Unique Health Identifier to be created for each member of Household with a provision for Family Folders. • SECC database/PDS data base or any other database which is largely representative of the population can be used as the base database. • The missing HHs can be additionally added by the AB-HWC team/ASHA annually to ensure that no HH is left out.

8. Enrolment of Households & Members • Every household to be linked to the nearest AB-HWC and Family folders created for each HH. • This folder will have • demographic, • socio-economic information and • information about chronic diseases: TB, leprosy, diabetes, epilepsy, hypertension, COPD, cancers, heart ailments, HIV/AIDS, disabilities, inherited blood disorders, SAM children, etc. • In addition to the family folder, each member to be issued a health diary which will be used to update treatment given at the AB-HWC.

9. Enrolment of Households & Members • Family folder and health diary to be digitalised at the earliest. • Family folders to be kept at AB-HWCs and health diary will be available with the members of the enrolled HHs. • AB-HWCs should be the first port of call for all OPD treatment for every person seeking care through the public system. • The nearest AB-HWC could be found through by calling toll free telephone number (can be integrated with 104 service) and on Google maps.

10. Referral & Return Linkages • From AB-HWCs, Patients will be referred to the First Referral Unit of the Public Healthcare System • either CHCs / SDHs / DHs / Medical College Hospitals • CHCs / DHs will inform the patients about the various options available for Secondary and Tertiary care at Public facilities and PMJAY empanelled Hospitals. • Patient has the right to choose • Sharing of patients’ information on discharge electronically with CMHOs. • Individuals discharged from AB-PMJAY services will approach DHs / CMHOs for getting continuous (Rehabilitative or palliative) treatment from appropriate AB-HWCs.

11. Masters Registry / UHID / Family Folder • National Health Repository Registry (NHRR) and NIN to be leveraged for creating facility / Provider Registry • Patient Unique Health Identifier to be created leveraging Aadhaar and other identity documents • A Concept of family folder having longitudinal health records of family members to be created

12. Compliance for EHR / Privacy / Security Standards • All applications to conform to EHR Standards • Security Management of data is crucial and shall be a policy imperative • Patient being the owner of his records, Organizations including Government have only fiduciary rights; Hence, consent framework is a must

13. Community action and Social audits Structures Key Actors Processes District Mentoring and Resource Group AB-HWC- RKS Monitoring committee • Quarterly meetings of RKSs • Annual social audit with community feedback • Report cards for each AB-HWC • Jan samvad covering all AB-HWCs PRI Members Social auditors ASHAs VHSNC and Gram Sabha VHSNC members Involvement of activated Health care users, Patients groups, Women’s groups, Civil society groups, COMMUNITY

14. THANK YOU