India’s health and wellness centres: realizing universal health coverage through comprehensive primary health care

ABSTRACT

In common with other countries in the World Health Organization South-East Asia Region, diseasepatterns in India have rapidly transitioned towards an increased burden of noncommunicable diseases.This epidemiological transition has been a major driver impelling a radical rethink of the structure ofhealth care, especially with respect to the role, quality and capacity of primary health care. In additionto the Pradhan Mantri Jan Arogya Yojana insurance scheme, covering 40% of the poorest and mostvulnerable individuals in the country for secondary and tertiary care, Ayushman Bharat is based on anambitious programme of transforming India’s 150 000 public peripheral health centres into health andwellness centres (HWCs) delivering universal, free comprehensive primary health care by the end of2022. This transformation to facilities delivering high-quality, efficient, equitable and comprehensivecare will involve paradigm shifts, not least in human resources to include a new cadre of mid-levelhealth providers. The design of HWCs and the delivery of services build on the experiences andlessons learnt from the National Health Mission, India’s flagship programme for strengthening healthsystems. Expanding the scope of these components to address the expanded service deliverypackage will require reorganization of work processes, including addressing the continuum of careacross facility levels; moving from episodic pregnancy and delivery, newborn and immunizationservices to chronic care services; instituting screening and early treatment programmes; ensuring highqualityclinical services; and using information and communications technology for better reporting,focusing on health promotion and addressing health literacy in communities. Although there are majorchallenges ahead to meet these ambitious goals, it is important to capitalize on the current high level ofpolitical commitment accorded to comprehensive primary health care.