Ayushman Bharat Programme

ABY or National Health Protection Mission is a national initiative launched in order to achieve the vision of Universal Health Coverage

It comprises of two inter-related components

1. Establishment of Health and Wellness Centre

2. Pradhan Mantri Jan Arogya Yojana (PMJAY)

Health and Wellness Centre - National Health Policy, 2017 envisioned Health and Wellness Centres as the foundation of India‘s health system.

Under this, 1.5 lakh centres will bring health care system closer to the homes of people.

The centres will provide comprehensive health care, including for non-communicable diseases and maternal and child health services. 2

These will also provide free essential drugs and diagnostic services.

Contributions through CSR and philanthropic institutions in adopting these centres are also envisaged.

First 'health and wellness centre' has been inaugurated in Bijapur district in Chhattisgarh.

Pradhan Mantri Jan Arogya Yojana (PMJAY) - It aims to reduce out of pocket hospitalisation expenses by providing health insurance coverage upto Rs.5 lakh/family/year for secondary and tertiary care hospitalization.

The scheme will integrate two ongoing centrally sponsored schemes Rashtriya Swasthya Bima Yojana (RSBY) and Senior Citizen Health Insurance Scheme (SCHIS).

The NHPS remains disconnected from primary health care services.

Also, a beneficiary covered under the scheme will be allowed to take cashless benefits from any public/private empanelled hospitals across the country.

Coverage - The scheme will aim to target over 10 crore families based on SECC (Socio-Economic Caste Census) database.

Rashtriya Swasthya Bima Yojna (RSBY) beneficiaries in state where it is active is also included.

Rashtriya Swasthya Bima Yojana (RSBY)

It is a centrally sponsored health insurance scheme with a main objective of this scheme is to

1. Provide financial protection against catastrophic health costs

2. Improve access to quality health care for BPL and other vulnerable groups

The premium cost is shared by Centre and the State.

The beneficiaries are entitled to hospitalization coverage up to Rs. 30,000/- per annum on family floater basis i.e can be utilised by any family member.

The coverage extends to maximum 5 members of the family which includes the head of household, spouse and up to three dependents including the provision to pay transport expense.

The beneficiaries need to pay only Rs. 30 as registration fee.

Beneficiaries get a biometric-enabled smart card containing their fingerprints and photographs and this Single central smart card also to include other welfare schemes like Aam Aadmi Bima Yojana and national old age pension scheme.

To ensure that nobody from the vulnerable group is left out of the benefit cover, there will be no cap on family size and age in the scheme.

The insurance scheme will cover pre and post-hospitalisation expenses.

All pre-existing diseases are also covered.

It will also pay defined transport allowance per hospitalization to the beneficiary.

Funding - The expenditure incurred in premium payment will be shared between central and state governments in a specified ratio

1. 60:40 for all states and UTs with their own legislature. 2. 90:10 in NE states and the 3 Himalayan states of J&K, HP and Uttarakhand. 3. 100% central funding for UTs without legislature.

The State governments have the main responsibility of health service delivery.

States will be allowed to expand the scheme both horizontally and vertically.

Mode of funding - In a trust model, bills are reimbursed directly by the government.

Andhra Pradesh, Telangana, Madhya Pradesh, Assam, Sikkim and Chandigarh are the states that will use a trust model for the mission.

In an insurance model, the government pays a fixed premium to an insurance company, which pays the hospitals.

Gujarat and Tamil Nadu have opted for mixed mode implementation.

The scheme is creating a cadre of certified frontline health service professionals called Pradhan Mantri Aarogya Mitras (PMAMs).

PMAM will be primary point of facilitation for the beneficiaries to avail treatment at the hospital and thus, act as a support system to streamline health service delivery.

Besides, 24 new Government Medical Colleges and Hospitals will be set up, by up-grading existing district hospitals in the country.

This would ensure that there is at least 1 Medical College for every 3 Parliamentary Constituencies.

Also, at least 1 Government Medical College in each State of the country.

National Health Mission

 The broad objectives of National Health Mission includes the following

1. Reduce MMR to 1/1000 live births

2. Reduce IMR to 25/1000 live births

3. Reduce TFR to 2.1

4. Prevention and reduction of anaemia in women aged 15–49 years

5. Prevent and reduce mortality & morbidity from communicable, non- communicable; injuries and emerging diseases

6. Reduce household out-of-pocket expenditure on total health care expenditure

7. Reduce annual incidence and mortality from Tuberculosis by half

8. Reduce prevalence of Leprosy to <1/10000 population and incidence to zero in all districts

9. Annual Malaria Incidence to be <1/1000

10. Less than 1 per cent microfilaria prevalence in all districts

11. Kala-azar Elimination by 2015, <1 case per 10000 population in all blocks

The Mission has two sub missions such as National Rural Health Mission and National Urban Health Mission.

Public health being a state subject, the aim is to support States/UTs through NHM, for strengthening their health care delivery systems

National Rural Health Mission (NRHM 2005-2012)

Rural Health Care forms an integral part of the National Health Care System. Provision of Primary Health Care is the foundation of all rural health care Programmes.

For developing vast public health infrastructure and human resources of the country, accelerating the socio-economic development and attaining improved quality of life, the Primary health care is accepted as one of the main instruments of action.

Thus, recognizing the importance of Health in the process of economic and social development and improving the quality of life of our citizens, the Government of India has launched the National Rural Health Mission to carry out necessary architectural correction in the basic health care delivery system.

• Launched: April 2005
• Aims to provide accessible, affordable & quality healthcare to the rural population, especially to the vulnerable sections.
• Ministry: Department of Health & Family Welfare.

Vision

• NRHM seeks to provide effective health care to rural population throughout country with special focus on 18 states which have weak public health indicator.
• Raise public spending on health from 0.9% of GDP to 2-3% of GDP.
• Seeks decentralization of programmes for district management of Health.
• Seeks to neutralize local health traditions & mainstream AYUSH into the public health system.
• Shall define time bound goals & report publicly on their progress.

Goals

 (i) Reduction in Infant Mortality Rate (IMR) & Maternal Mortality Rate (MMR)

(ii) Universal access to public health.

(iii) Prevention & control of communicable & non-communicable diseases including locally endemic disease.

(iv) Population stabilization, gender & demographic balance.

(v)  Access to integrated comprehensive primary healthcare.

(vi) Revitalize local health traditions and mainstream AYUSH.

ASHA: Accredited Social Health Activist

• Every village will have a female accredited social health activist chosen by and accountable to the panchayat.
• Link between community & health system.
• She will be a honorary volunteer, receiving performance based compensation for promoting universal immunization & other healthcare delivery programmes.

Outcome

• IMR reduced to 30/1000 live births.
• MMR reduced to 100/100,000
• TRR reduced to 2.1
• Engaging 2,50,000 ASHAS

Pradhan Mantri Swasthya Suraksha Yojana (PMSSY)

Launched – March 2006

Ministry: Department of Health & Family Welfare

Objective – Correcting the imbalance in availability of affordable / reliable tertiary level healthcare in country.

To augment facilities for quality medical education in the under served states.

PMSSY envisages:

• The first phase in the PMSSY has two components - setting up of six institutions in the line of AIIMS; and upgradation of 13 existing Government medical college institutions.
• In the second phase of PMSSY, the Government has approved the setting up of two more AIIMS-like institutions, one each in the States of West Bengal and Uttar Pradesh and upgradation of six medical college institutions
• In the third phase of PMSSY, it is proposed to upgrade the existing specific medical college institutions

It is hoped that consequent to the successful implementation of PMSSY, better and affordable healthcare facilities will be easily accessible to one and all in the country.

Janani Suraksha Yojana (JSY)

Centrally Sponsored scheme

Ministry: Department of Health & Family Welfare

Launched – 2003, modified existing National Maternal Benefit Scheme which was connected with providing a better diet for the pregnant women from BPL.

Objective – Reducing maternal & infant mortality rate by promoting institutional delivery among the poor women.

Beneficiaries – All pregnant women belonging to households below poverty line, above 19 years of age & upto 2 live births.

JSY integrates help in form of cash with antenatal care during pregnancy, institutional care during delivery as well as post partum care.

Central Government Health Scheme (CGHS)

Objective: Provide Health care facilities to CGHS beneficiaries including All central government servants paid through civil estimates, pensioners drawing pension from civil estimates, Members of Parliament, Ex MPs, Judges of SC, former Governors, former PM, employees &pensions of autonomous bodies & freedom fighters.

Ministry: Department of Health & Family Welfare

Health services are provided through Allopathic, Homeopathic & Indian system of medicines, which comes under the Department of AYUSH.

EmployeeState insurance scheme (ESIS)

• Integrated social sector scheme
• Administered by: Employees’ State Insurance Corporation (ESIC), a statutory body established under the Union Ministry of Labour
• Objective: Provides social protection to workers & their dependants in the organized sector, in contingencies such as sickness, maternity & death or disablement due to an employment injury or occupational hazard.
• Beneficiaries: Applies to any premise where 10 or more persons are employed.Employees of covered units drawing wages upto 15,000 per month come under purviews of scheme.

Janani Shishu Suraksha Karyakram (JSSK)

Funding	Centrally Sponsored scheme
Launched	June 1, 2011 at Mandi Khera, District Mewat in Haryana. For providing better facilities for women and child health services
Ministry	Ministry of Health and Family Welfare
Features	JSSK would provide completely free and cashless services[1] to pregnant women including normal deliveries and caesarean operations and sick new born (up to 30 days after birth) in Government health institutions in both rural and urban areas. JSSK supplements the cash assistance given to a pregnant woman under Janani Suraksha Yojana (JSY) and is aimed at mitigating the burden of out of pocket expenses incurred by pregnant women and sick newborns
Reach	The new JSSK initiative is estimated to benefit more than one crore pregnant women & newborns that access public health institutions every year in both urban & rural areas. Besides it would be a major factor in enhancing access to public health institutions and help bring down the Maternal Mortality and Infant mortality rates.

 

Universal Immunization Programme

 The UIP basket has vaccines for ten diseases i.e

1. BCG for TB, OPV for poliomyelitis,

2. monovalent measles vaccine for measles,

3. Rota Virus vaccine for Diarrhoea,

4. JEV for Japanese Encephalitis &

5. Pentavalent Vaccine for DPT (diphtheria, pertussis i.e whooping cough & tetanus) and

6. Vaccine for Hepatitis B & Pneumonia due to Hib.

7. Measles-rubella vaccine (MR) is also added now to the UIP

 India has set a target of eliminating measles and controlling congenital rubella syndrome (CRS), caused by the rubella virus, by 2020.

Mothers? Absolute Affection Program

The program aims to enhance optimal breastfeeding practices in the country through Community awareness generation, Strengthening inter personal communication through ASHA, skilled support for breastfeeding and Award/recognition .

LaQshya Initiative

Labour Room Quality Improvement Initiative‘s objective is to reduce preventable maternal and new-born mortality, morbidity and stillbirths by improving the quality of care provided in the labour room.

It will be implemented in Government Medical Colleges besides District Hospitals, and Sub- District Hospitals and Community Health Centres.

The initiative plans to conduct quality certification of labour rooms and also incentivize facilities achieving the targets outlined.

National Strategic Plan and Mission Sampark

They were launched on the occasion of World AIDS Day, 2017.

The National Strategic Plan on HIV/AIDS and Sexually Transmitted Infections (STI), 2017-24 was released.

The plan will pave a roadmap not only for achieving the target of 90:90:90 but also strive along with partners towards fast track strategy of ending the AIDS epidemic by 2030.

By 2020, 90% of all people living with HIV will know their HIV status. By 2020, 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy. By 2020, 90% of all people receiving antiretroviral therapy will have viral suppression.

The strategic plan is aimed at eradicating HIV/AIDS by 2030.

It also aimed to achieve elimination of mother-to-child transmission of HIV and Syphilis as well as elimination of HIV/AIDS related stigma and discrimination by 2020.

The ?Mission Sampark? was launched to bring People Living with HIV who has left treatment back to Anti Retro Viral Treatment (ART).

Mission Parivar Vikas

It was launched on the occasion of World Population Day to accelerate access to high quality family planning.

It focuses on family planning initiatives and targeted approaches for population stabilisation through better services delivery approach.

It will focus on 146 high fertility districts in 7 states with high TFR (Total Fertility Rate).

A new program named ?Antara was launched under this mission.

Under this, an injectable hormonal contraceptive method for women that prevents pregnancy for 3 months.

AYUSH

A Department of Indian system of Medicines & Homeopathy (ISM&H) was created in 1995.It was renamed AYUSH in November 2003.

A – Ayurveda

Y – Yoga & Naturopathy

U – Unani

S – Siddha

H – Homeopathy

Traditional Knowledge Digital Library

It is a collaborative Project of CSIR and Ministry of AYUSH.

It is an Indian initiative to prevent exploitation and to protect Indian traditional knowledge from wrongful patents mainly at International Patent Offices.

It contains Indian traditional medicine knowledge in a digitized format and is available in five international languages (English, French, German, Spanish and Japanese).

Funds under the scheme are provided only to CSIR and no funds have been allocated to any state.

Council of Scientific and Industrial Research (CSIR) is an autonomous body under Ministry of S&T.

Scheme for Promoting Pharmacovigilance of AYUSH Drugs

It is a new central sector scheme that aims to develop the culture of documenting adverse effects and undertake safety monitoring of AYUSH drugs.

It also entails surveillance of misleading advertisements appearing in the print and electronic media.

It intends to facilitate the establishment of three-tier network of National Pharmacovigilance Centre (NPvCC), Intermediary Pharmacovigilance Centres (IPvCCs) and Peripheral Pharmacovigilance Centres (PPvCC).

All India Institute of Ayurveda, New Delhi, an autonomous body under the Ministry of AYUSH, has been designated as National Pharmacovigilance Centre for coordinating various activities of the initiative.

It will facilitate detection of potentially unsafe ASU&H medicine.

National Deworming Initiative

Union Minister for Health and Family Welfare  has  launched National Deworming initiative to benefit more than 270 million children. This was launched by declaring 10 Feb as National deworming day. Inititally, The Ministry of Health and Family Welfare had first launched National Deworming Day (NDD) in 2015 which was implemented in 11 States and Union Territories (UTs) covering all Government and Government-aided schools and Anganwadi centres targeting children aged 1 to 19 years. Now, the initiative will be extended to cover the whole country.

Main Aim:

• It is aimed at protecting more than 24 crore children in the ages of 1-19 years from intestinal worms[2].
• Through this initiative, the government aims to create mass awareness about the most effective and low-cost Soil- Transmitted Helminths (STH) treatment— administering Albendazole tablets.
• Along with Albendazole administration, behaviour change practices in terms of cleanliness, hygiene, use of toilets, wearing shoes/chappals, washing hands etc. is also important to reduce incidents of re-infection.

Need of this programme:

• WHO indicates that India has the highest burden of soil-transmitted helminths (STH) in the world, with 220 million children aged 1-14 estimated to be at risk of worm infections. Almost 7 in 10 children between 6 month and 5 years are anaemic, with even higher rates of anaemia in rural areas, according to the 2006 National Family Health Survey.
•  There are at least two randomized trials in India in the last decade that demonstrate the positive impact of deworming in the country. A health intervention that provided iron, Vitamin A, and deworming drugs to Indian preschool children in the slums of Delhi found a significant gain in children’s weight and school participation compared to intervention with Vitamin A alone. Absenteeism was reduced by one-fifth in the treatment group (Bobonis et al, 2006). A cluster-randomized controlled trial found children aged 1-5 that were treated with five rounds of the deworming drug, resulted in a greater weight gain compared to non-treated groups (Awasthi S. et al 2008).
•  Soil-transmitted helminth (STH) infections are among the most common infections worldwide and a­ct the poorest and most deprived communities. They are transmitted by eggs present in human faeces, which in turn contaminate soil in areas where sanitation is poor. Several studies show the detrimental e­ects of STH on children’s educational performance and school attendance. Children with the highest intensity of STH infestation are often too sick or too tired to concentrate at school or attend school at all. STHs interfere with nutrient uptake in children; can lead to anaemia, malnourishment and impaired mental and physical development. Rigorous research has shown that they also pose a serious threat to children’s education and productivity later in life.Mass deworming leads to significant improvement in outcomes related to education, earnings, and long-term well-being.

Health Protection Scheme (HPS)

•  The Health Protection Scheme (HPS) was announced in the Union Budget 2016 .
• With this, the government has announced its plans to roll out a health protection scheme, which will offer a cover of up to INR 1 lakh per family to cover medical treatment costs. For senior citizens (either gender, of age 60 years and above) eligible for this cover benefits, the government will offer an additional top-up package up to INR 30,000.
• One of the key challenges to obtaining proper health care and treatment is obtaining quality medicines at affordable prices. To counter this concern, the government will also be opening up 3,000 medicine stores across the country (in 2016-17). Generic drugs will be made available in these stores under Prime Minister’s Jan Aushadhi Yojana.
• Ths scheme is likely to replace the existing Rashtriya Swasthya Bima Yojana (RSBY) scheme which works on a center-state partnership model and provides a cover of INR 30,000 for a family of 5 members.

Jan Aushadhi Scheme

• This scheme seeks to make available quality medicines at affordable prices for all, especially the poor and the disadvantaged.
• Under this, less priced quality unbranded generic medicines will be made available through Jan Aushadhi stores which inherently are less priced but are of same and equivalent quality, efficacy and safety as compared to branded generic medicines.
•  Under this Scheme, the State Government has to provide space in Government Hospital premises for the running of the outlets (JAS). Government hospitals, NGOs, Charitable Organisations and public societies like Red Cross Society, Rogi Kalyan Samiti typically constituted for the purpose can be operating agencies for the JAS.
• The operating agency for JAS is nominated on the basis of the recommendations of the State government. Operational expenditure is met from trade margins admissible for the medicines.
• The State Government has to ensure prescription of unbranded generic medicines by the Government doctors.
• The Jan Aushadhi Programme is accordingly a self sustaining business model not dependent on government subsidies or assistance. It is run on the principle of “Not for Profits but with Minimal Profits”.
• BPPI (Bureau of Pharma Public Sector Undertakings of India) has been established under the Department of Pharmaceuticals, Govt. of India, with the support of all the CPSUs for co-coordinating procurement, supply and marketing of generic drugs through the Jan Aushadhi Stores.

Benefits:

• This will help in reducing cost of life saving drugs  in India
• It will encourage doctors to prescribe generic drugs to patient
• This will increase in saving of household
•  It will encourage participation of private institutions, NGO and other individuals to set up outlets
• This will increase the health coverage in India.

Challenges:

• To provide infrastructure of new outlets
• Maintenance of quality of product
• Private companies may not show much interest due to lack of profit margin
• Co-ordination between state and centre

Mission Indradhanush

• The government has launched “Mission Indradhanush” depicting seven colours of the rainbow, aiming to cover all those children by 2020 who are either unvaccinated, or are partially vaccinated against seven vaccine preventable diseases which include diphtheria, whooping cough, tetanus, polio, tuberculosis, measles and hepatitis B, on Good Governance Day.
• Under Mission Indradhanush, four special vaccination campaigns conducted between January and June 2015 with intensive planning and monitoring. The learnings from the successful implementation of the polio programme will be applied in planning and implementation of the mission. While 201 districts will be covered in the first phase, 297 will be targeted for the second phase in the year 2015.
• Of the 201 districts, 82 districts are in just four states of UP, Bihar, Madhya Pradesh and Rajasthan and nearly 25% of the unvaccinated or partially vaccinated children of India are in these 82 districts of 4 states.
• Immunization drive is going  through a “catch-up” campaign mode where the aim is to cover all the children who have been left out or missed out for immunization.
• The Ministry is technically supported by WHO, UNICEF, Rotary International and other donor partners. Mass media, interpersonal communication, and effective mechanisms of monitoring and evaluating the scheme are crucial components of Mission Indradhanush.