[Yojana August 2023 Summary] Integrated approach for holistic well-being – Explained, pointwise

Introduction

India’s healthcare landscape witnessed a remarkable transformation since the last decade as the Government focused on assured universal healthcare for all. Following the philosophy of Antyodaya- leaving no one behind and providing services to the last person in the queue, the government has emphasized improvement of public health facilities through ongoing systemic reforms and provide free of cost quality services at people’s doorsteps. The government is adopting a comprehensive approach in the healthcare system and focusing on both health and wellness.

Nation-building is successful when the population is healthy, which in turn contributes to healthy societies and national productivity. To continually keep pace with the political, economic, demographic, and epidemiologic transitions, evidence-based health policies and strong health systems are crucial. Therefore, it is important to create a responsive health system that enables its citizens to live productive lives and build healthy societies.

Continuum of care

The healthcare system provides a continuum of care through the primary, secondary, and tertiary levels. The three levels of care are intricately linked, and their interdependence is essential to ensure health for all. For instance, the National Rural Health Mission (NRHM), now known as the National Health Mission (NHM) initially adopted a targeted primary care strategy, with a specific emphasis on Reproductive and Child Health and communicable diseases, especially among vulnerable groups. Regardless of major gains, a shortcoming was that the programme was unable to address growing burden of non-communicable diseases.

Ayushman Bharat

The Ayushman Bharat initiative was launched in 2018, comprising Health and Wellness Centres (AB-HWCs) and the Pradhan Mantri Jan Arogya Yojana (AB-PMJAY). It has been instrumental in addressing healthcare challenges and reducing healthcare costs. AB-HWCs deliver comprehensive primary healthcare services and wellness activities to the community, while PIVIJAY offers free hospitalisation and inpatient services to the poor and vulnerable.

AB-HWCs were operationalised closer to the community to deliver Comprehensive Primary Health Care (CPHC) and promote wellness activities. Since its launch, the AB-HWCs have had a cumulative footfall of 172.13 crore.

Under the PMJAY, financial protection is provided to 40% of the eligible population across 33 States and Union Territories. Over 23 crore Ayushman cards were created, and it has empanelled over 28,368 hospitals to provide a higher level of care. Since its launch, PMJAY has successfully authorised over 5 crore admissions, amounting to over Rs 61,807 crore; thus, saving lives and easing the financial burden of the poor.

Digital Transformation

The Ayushman Bharat Digital Mission (ABDM) was launched to develop and support the integrated digital health infrastructure of the country. The Mission creates digital health ecosystem through the creation of Ayushman Bharat Health Accounts (ABHA). Earlier, patients had to travel long distances to avail themselves of specialist care or go to private providers. Now, e-health initiatives like eSanjeevani services available at over 1.11 Iakh AB-HWCs have reduced the gap in care access and brought specialist care closer to home. eSanjeevani has catered to 9 crore teleconsultations, where over 57% of beneficiaries were women and 12% were senior citizens.

Pandemic Response and Preparedness

India’s response to the Covid-19 pandemic showcased its global leadership and resilience. The nation rapidly expanded its testing capacity. The Atmanirbhar Bharat initiative facilitated competition in the diagnostic market and brought down the cost of diagnostic commodities.

Based on the learnings from the pandemic, the country opted for a ‘whole of society’ approach to develop a holistic health ecosystem across levels of care through the largest pan-India infrastructure scheme—the Pradhan Mantri Ayushman Bharat Health Infrastructure Mission (PMABHIM). PMABHIM focuses on advancing the capacities of health institutions across all levels of care.

Ayushman Bharat is a transformative initiative that provides essential support to strengthen the public health infrastructure for effective crisis management while ensuring the uninterrupted provision of routine and vital healthcare services at all levels.

Human Resources for Health (HRH)

The Government has made significant progress in increasing medical and nursing education capacities. The number of undergraduate and postgraduate medical education seats has grown substantially. The country currently has over 1.07 lakh undergraduate seats for medical education. There has been a 67% increase in medical colleges, a 93% increase in undergraduate seats, and a 105% increase in postgraduate seats. The Government has also recognised nursing institutions for various programmes, and now almost 1.25 lakh nursing graduates are entering the healthcare workforce annually. The Government has approved the establishment of 157 new nursing colleges in co-location with the existing medical colleges established since 2014. The step will add approximately 15,700 nursing graduates every year.

Immunization and Disease Control

The Universal Immunization Programme has converted immunization into a people’s social movement. Through Mission Indradhanush, many additional vaccines were delivered through routine immunization services, improving the immunization coverage from 62% (2015-16) to 76.4% (2019-21). Additionally, consistent efforts to reduce the burden of communicable diseases have yielded 85.3% reduction in malarial cases between 2014 and 2021. The extensive resources and infrastructure for routine immunization made the largest Covid-19 vaccination drive in the country a phenomenal success across the globe.

Pradhan Mantri TB-Mukt Bharat Abhiyan aims to raise awareness about free-TB treatment available at Government health facilities. The Government has introduced Ni-kshay 2.0, a unique platform that enhances patient support and community engagement.

Mental Health and Well-being

The National Mental Health Survey of India highlighted a 70-92% treatment gap for various mental health disorders. In response, the Government introduced Tele-MANAS, the digital arm of the District Mental Health Programme. With 42 established Tele-MANAS cells, the initiative has already received over 1.5 lakh calls. Providing anonymous support helps individuals seek assistance for their mental health concerns while reducing the associated stigma.

Acknowledging the Benefits of Traditional Medicines

Recognising the effectiveness of traditional medicine in managing chronic conditions and promoting well-being, the Government has taken steps to integrate these practices into the mainstream healthcare system. This has led to the development of standardised protocols, evidence-based guidelines, and safe and effective traditional medicine formulations.

The Ministry of AYUSH collaborates with allopathic institutions, research organisations, and healthcare professionals to facilitate an integrated approach to healthcare delivery. Establishing AYUSH Wellness Centres across the country has made traditional medicine accessible to a wider population, complementing allopathic healthcare services.

Conclusion

In the past decade, there has been a significant increase in per capita Government health expenditure, witnessing a growth of 74%. Additionally, Government-financed health insurance has experienced a substantial rise of 167%. Moreover, there has been a notable decline of 16 per cent points in out-of-pocket spending on health since FY 2013-14. These statistics demonstrate concerted efforts to strengthen the healthcare system and alleviate the financial burden on individuals seeking medical services.