Ten months, 1.5 crore registered PMJAY beneficiaries and 10,252 health and wellness centres (HWC) later, the two arms of Ayushman Bharat have finally started talking about integration. However, while the National Health Authority wants it bottom up — that is HWCs would be the hub that sends patients for secondary and tertiary care to PMJAY-empanelled hospitals — the health ministry maintains it is the Ayushman Mitras — the first responders on the ground in hospitals for PMJAY beneficiaries — who should refer patients back to HWCs for follow-up.
In a recent letter to Union Health Secretary Preeti Sudan, NHA CEO Dr Indu Bhushan wrote: “The staff of HWCs should create beneficiary awareness at the grass-root level about both legs of Ayushman Bharat i.e. HWC and PMJAY. This also needs to be supplemented by branding of PMJAY at HWCs to create a cost-effective information, education and communication at the field level… All HWCs must have the capability to determine the eligibility of beneficiary under PMJAY and should have the capability to issue PMJAY e-cards to beneficiaries.”
Significant step in success of programme
Integration of the two arms of Ayushman Bharat is the key to the success of the programme and India’s eventual progression to Universal Health Coverage. That is why when the chain of command was emphatically bifurcated with the creation of the National Health Agency, there were concerns even within the government. The fact that the two entities have started talking on the matter is a good first step.
HWCs are currently screening for diabetes, hypertension and three types of cancer. According to data available with the ministry, of the 69,13,781 people screened for oral cancer, 13,735 were found to be positive and 1,484 were treated. Of the 16,67,032 screened for breast cancer, 12,087 were found positive and 1,837 put on treatment. Of the 12,26,783 screened for cervical cancer, 11,919 were found positive and 869 put on treatment. However, there is no data on how many of these people are PMJAY beneficiaries or were told about PMJAY and were treated under it. The ministry, however, has created a National Medical College Network under which each medical college will be given a catchment area of HWCs to mentor and provide teleconsultation.
Health Secretary Sudan did not agree that HWCs need to be able to issue PMJAY cards. The issue, she said, is not the “upward movement” of patients from HWCs to hospitals but their downward movement for follow-up. “In the early days, when we were preparing, it was the ASHAs who went door to door verifying the beneficiary list… integration will take time, service integration will happen faster than data integration… upward movement will happen now that we are training ASHAs in consultation with NHA but I think we should also give this component of a little training of Ayushman Mitras so that it (movement of patients) happens both ways,” Sudan said.
Bhushan wrote in his letter that PMJAY IT systems will publish details of treatment provided in the personal health record of the individual for HWCs to retrieve for follow-up. “HWCs are requested to create appropriate follow-up processes to ensure patients can get the best continuum of care.”
Additional Secretary and Mission Director, National Health Mission, Manoj Jhalani said the process of integration of IT systems of HWCs and PMJAY is currently on. A committee was formed under UIDAI Chairman Dr J Satyanarayan whose mandate included seamless integration of the two IT systems. “The IT team of PMJAY and that of HWCs are talking… to create that seamless integration through the creation of a health id,” Jhalani said.