EVEN before the Union government announced the Ayushman Bharat programme to set up 1.5 lakh health and wellness centres, the Maharashtra government has already conducted a soft launch of the flagship scheme with 30 sub-centres in Palghar and Malegaon districts. The state now proposes to upgrade a total of 1,270 sub-centres run by the public health department into such health and wellness centres.
According to state government officials, a batch of BAMS doctors is currently undergoing a six-month training programme before they are posted at these centres to cater to 12 services, including maternal and child care, geriatrics, palliative care, screening and treatment of non-communicable diseases, mental health, ophthalmic and ENT, trauma care, dental care, neonatal and infant care, and family planning.
“This is unique to Maharashtra. Only here, BAMS doctors are legally allowed to prescribe allopathic medicines. We are hoping this will be a game changer,” said Pradeep Vyas, principal secretary (Health). Maharashtra faces a huge vacancy in its public health system with vacancies for anaesthetists at 64 per cent, for general physicians at 48 per cent, general surgeons at 45 per cent and paediatricians and gynaecologists at 35 and 26 per cent respectively, according to data from the Directorate of Health Services until October 2017.
State officials hope introduction of BAMS doctors in the rural sub-centres will help bring “family physicians for a large population”.
The government also plans to introduce ayurveda in these centres. The proposal outlines the role of the BAMS doctor to train local, rural and tribal population on cultivation of medicinal plants for home remedies for minor ailments, to teach yoga and to prescribe ayurvedic medicines.
In 2016-17, the state government chose 30 sub-centres for upgradation that started functioning last year. In 2017-18, 250 sub-centres were chosen of which 200 are in process of upgradation. For 2018-19, a total of 1,270 sub-centres have been proposed for upgradation.
“Maharashtra is the first state to undertake this project on a pilot basis,” said Dr Umesh Tagade, in-charge of the Ayush programme.
Each sub-centre caters to a population of 5,000. Currently, a sub-centre has one auxiliary nurse midwifery (ANM) and one multi-purpose health worker (MPW). These centres will be upgraded at a cost of Rs 7 lakh each, and staff will be expanded to include four to five Accredited Social Health Activists (ASHAs), two ANMs, a MPW and a BAMS doctor. While doctor will be paid Rs 25,000 fixed salary, the other staff will be paid on incentive basis.
“These health and wellness centres will be gatekeepers between primary and secondary healthcare. Each BAMS doctor will act as family physician for a population of 5,000 people,” said Tagade.
The health and wellness centre will also maintain a family folder, linked to Aadhaar cards, to create an online database of every family’s health records, past history of ailments, treatment of any family member and future line of medication. “The idea is to allow this information to be accessed from any government hospital should the patient be referred from one hospital to another,” added Tagade.
While sub-centres will act as first point of contact for any health-related issue, referrals to primary health centres or rural hospital will only happen in critical cases. Government also hopes to divert all normal deliveries towards sub-centres.
“The concept of these centres is to ultimately reduce burden of tertiary level hospitals. These centres will look into curative, preventive, and palliative healthcare,” said Dr Sanjeev Kumar, director, National Health Mission and in-charge of Directorate of Health Services.