Health and Wellness Centers and Noncommunicable Disease Care: Opportunities and Challenges in the New Government Strategy

Ariarathinam Newtonraj

Department of Community Medicine, Pondicherry Institute of Medical Sciences, Puducherry, India

Corresponding Author: Ariarathinam Newtonraj, Department of Community Medicine, Pondicherry Institute of Medical Sciences, Puducherry, India, Phone: +91 9489455994, e-mail: newton2203@gmail.com

How to cite this article Newtonraj A. Health and Wellness Centers and Noncommunicable Disease Care: Opportunities and Challenges in the New Government Strategy. J Postgrad Med Edu Res 2020;54(2):64–65.

Source of support: Nil

Conflict of interest: None

The Government of India has recently upgraded all subcenters (SCs) and primary health centers (PHCs) as health and wellness centers (HWCs).¹ By this, around 1.5 lakh of PHCs and SCs were converted to HWCs.¹ This is in response to the commitment of providing universal health coverage to all—through affordable, accessible, and acceptable health care, which is also a main mandate for India’s National Health Policy 2017.² This is a great leap in the Indian public health system after a long time, with a major change of reaching the unreached by further stepping down from PHCs (which usually covers around 30,000 population) to SCs (usually covers around 5,000) population.¹ After the proposal of this HWCs in 2017, government has started implementing this throughout the country in a stepwise manner.

One of main strategy in the HWCs is prevention and management of noncommunicable diseases (NCDs) at their level.¹ There is a common observation that the rural areas in India are neglected in providing proper NCD care.³ But the HWCs model will positively bridge this gap if planned and implemented properly. As per the HWCs guideline, there will a midlevel health care provider [community health officer (CHO)—BSc in community health or AYUSH medical practitioner] along with three multipurpose health workers (MPHWs) who will be serving a population of around 3,000–5,000 (at present only two health workers posted in SCs).¹ In terms of NCD care, these workers will be screening the population for common NCDs (hypertension, diabetes, oral, cervical, and breast cancers) and will provide health education for them at different levels (individual, family, and community). They will also be ensuring the adherence of medications for NCDs and promoting physical activity in the community.¹

Apart from a brief operational guideline for HWCs, there is no detailed guideline available on the strategies, approaches, and activities to manage NCDs at HWCs. As HWC is a new initiative, many interesting researches are initiated and ongoing in India by various public health organizations, but at present there is a paucity of published articles in the research arena.^4–6

From our experience on rural health care, following are the six suggestions to improve HWCs at beginning itself.^7–10 First, there is a need for a detailed common population/village enumeration guideline for frontline health workers (MPHWs, ASHAs—accredited social health activists, and Anganwadi workers) for family and individual enumeration of health information. At present, there is a guideline specific for NCD—prevention, screening, and control by MPHWs is available; but this should be updated according to the current scenario (method of implementation at HWCs, indicators calculation, and roles and responsibilities of HWC workers, etc.) and should be disseminated to all the HWCs to maintain uniformity throughout the country.¹¹ Second, from the family and individual enumeration list, screening activities should be planned in a systematic way by the HWCs health workers (MPHWs). Third, there is a need for training of frontline health workers for NCD care. Fourth, among the population diagnosed with NCDs, there should be a quarterly review to assess their adherence to treatment. Fifth, at present consultation for NCDs is delivered at the PHC level and not at the HWC level. In the place of midlevel health care provider (AYUSH or CHO), if an MBBS (bachelor of medicine and bachelor surgery) doctor is appointed, pharmacological management will be further tapered down at the HWC level itself. Understanding this at present, Tamil Nadu and Puducherry governments have taken steps to appoint MBBS doctors in the places of CHOs,¹² whereas for other states, especially North Indian states, this would be a herculean task, which needs a lot of commitments from the government side to adapt various strategies like increasing MBBS seats in the state, attractive pay, etc.

REFERENCES

1. Ministry of Health and Welfare—Government of India. AYUSHMAN BHARAT—Comprehensive Primary Health Care through Health and Wellness Centers, Operational Guideline [Internet]. 2018 [cited 2019 Dec 21]. Available from: http://nhsrcindia.org/sites/default/files/Operational Guidelines For Comprehensive Primary Health Care through Health and Wellness Centers.pdf.

2. Ministry of Health and Family Welfare—Government of India. National Health Policy 2017 [Internet]. 2018 [cited 2019 Dec 21]. Available from: https://mohfw.gov.in/sites/default/files/9147562941489753121.pdf.

3. Swaminathan K, Veerasekar G, Kuppusamy S, et al. Noncommunicable disease in rural India: are we seriously underestimating the risk? The Nallampatti noncommunicable disease study. Indian J Endocrinol Metab 2017;21(1):90–95. DOI: 10.4103/2230-8210.196001.

4. Chatterjee P. Modi’s health reforms: between hope and hype. Lancet 2019;394(10208):1495–1498. DOI: 10.1016/S0140-6736(19)32601-7.

5. Angell BJ, Prinja S, Gupt A, et al. The Ayushman Bharat Pradhan Mantri Janarogya Yojana and the path to universal health coverage in India: overcoming the challenges of stewardship and governance. PLoS Med 2019;16(3):e1002759. DOI: 10.1371/journal.pmed.1002759.

6. Patel V, Parikh R, Nandraj S, et al. Assuring health coverage for all in India. Lancet 2015;386(10011):2422–2435. DOI: 10.1016/S0140-6736(15)00955-1.

7. Newtonraj A, Selvaraj K, Purty AJ, et al. Feasibility and outcome of community-based screening for cardiovascular disease risk factors in a remote rural area of South India: The Chunampet rural–cardiovascular health assessment and management program. Indian J Endocrinol Metab 2019;23(6):628–634. DOI: 10.4103/ijem.IJEM_528_19.

8. Newtonraj A, Vincent A, Gowtham PJ, et al. Level of insufficient physical activity among adults in a rural area of South India: a population-based cross-sectional study. J Curr Res Sci Med 2019;5(2):105. DOI: 10.4103/jcrsm.jcrsm_25_19.

9. Newtonraj A, Arun S, Bazroy J, et al. Lay perspectives on causes and complications of hypertension; and barrier to access health care by known hypertensive patients: a qualitative study from a rural area of South India. Int J Community Med Public Health 2017;4(3):704–707. DOI: 10.18203/2394-6040.ijcmph20170743.

10. Konduru R, Newtonraj A, Arun S, et al. Oral cancer awareness of the general public in coastal village areas of Tamil Nadu, India: a population based cross sectional study. Int J Community Med Public Health 2016;3(7):1932–1939. DOI: 10.18203/2394-6040.ijcmph20162068.

11. Ministry of Health and Family Welfare—Government of India. Module for Multi-Purpose Workers (MPW)—Female/Male on prevention, screening and control of common Non-Communicable Diseases [Internet].New Delhi; [cited 2019 Dec 21]. Available from: http://nhsrcindia.org/.

12. National Rural Health Mission of Puducherry. Posting Medical Officers on Contract Basis [Internet]. 2019 [cited 2020 Feb 5]. Available from: https://www.nhmpuducherry.org.in/WebResources/uploads/99.pdf.

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