Practice Notes

The Ministry of Health and Family Welfare’s ‘Ayushman Bharat’ program aims to strengthen Comprehensive Primary Health Care (CPHC) through Health and Wellness Centers (HWCs, now known as Ayushman Arogya Mandir or AAM). The AB-HWC program seeks to transition from a selective approach to a comprehensive model of delivering primary healthcare services.

Evidence informed decision-making using routine health information systems has been an ongoing challenge due to various factors. In the current context of Health and Wellness Centres (HWCs), information is available across multiple, disease- or program-specific data portals; however, there is no integrated system that can enable facility and block/district managers to make decisions on comprehensive health of the population.

The state of Meghalaya, in north-eastern India, has been at the forefront of promoting community involvement through Village Health Councils (VHCs). VHCs are elected bodies comprising key village representatives. VHC are mandated to organise efforts around improving nutrition and health in their communities, and thereby bridge the gap between the community and primary health care system.

Team-based models of delivering primary health care services are widely recognized as necessary for providing people with comprehensive and continuous health care. While health policy guidelines in India identify roles and responsibilities of each team member at Sub-Health Centers (now known as Ayushman Arogya Mandir; previously Health and Wellness Centers), there is a need to obtain a grounded understanding of team functions and corresponding team competencies (i.e. key knowledge, skills, abilities, and attitudes) that teams should possess to deliver health services effectively.

Digital health information systems are essential for collecting information on population health. However, data collection challenges including technological barriers and redundant data entry processes increase the workload for data collection. In West Garo Hills in the state of Meghalaya, health workers put significant time and effort into data collection, fragmented data management systems and inefficient processes mean that the data collected is not effectively used to improve service delivery.

The Government of India launched the Ayushman Bharat (AB) scheme with a strategic focus on Comprehensive Primary Health Care (CPHC). The delivery of high-quality primary health care services requires health facility staff to possess specific primary care and public health competencies. To identify current and future training needs we undertook a training needs assessment among primary healthcare providers in the states of Gujarat, Meghalaya and Odisha.

Bottom-up decision making requires free space to think and prioritize. To facilitate this, a workshop was conducted using the human-centered design approach with district level managers and health facility staff responsible for improving the quality of care in public health facilities in Kalahandi, Odisha. Human-centered design approaches are increasingly being used in health research settings globally, but practical experiences of using such tools have been less documented. In this practice note, we outline the steps followed in the human-centered design workshop, the types of solutions developed by the implementers, and key insights that emerged.

The National Quality Assurance Standards (NQAS) certification is an important government initiative to improve and maintain quality standards at public sector health facilities in India. Health facilities are assessed through a set of comprehensive, pre-defined standards derived from global best practices. However, achieving and maintaining certification is an ongoing challenge for many health facilities in India. Bhavnagar district in Gujarat has managed to achieve high levels of primary health care facility certification within a relatively short time. In this note, we discuss the reasons for this success.