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Rolling Out CPHC Through HWCs One Year On.....

Rolling Out CPHC Through HWCs One Year On. April 8 th 2019. Key Milestones. Operational Guidelines on Comprehensive Primary Health Care finalized. Operationalization of 1.5 Lakh Health & Wellness Centres. Inauguration of 1 st HWC and NCD Application at Jaangla, Bijapur.

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Rolling Out CPHC Through HWCs One Year On.....

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  1. Rolling Out CPHC Through HWCsOne Year On..... April 8th 2019

  2. Key Milestones Operational Guidelines on Comprehensive Primary Health Care finalized Operationalization of 1.5 Lakh Health & Wellness Centres Inauguration of 1st HWC and NCD Application at Jaangla, Bijapur National Consultation on Comprehensive Primary Health Care Operationalization of 17149 Health & Wellness Centres Budget announcement Feb 2018 July 2018 2022 May 2018 March 31st 2019 14th April, 2018

  3. Progress Made In One Year The challenge would be to maintain the status of functional Health & Wellness Centre, with expansion of services. Source: HWC Portal as on 1st, April 2019

  4. Progress • Made • So • Far

  5. National Consultation Workshop of State Programme Officers March 13 -15, 2019Summary of Key Recommendations

  6. Thematic Areas • Expanding Service Delivery and Continuum of Care • Community mobilization and Health Promotion • Human Resources • Medicines and Diagnostics • Urban Health and Wellness Centres • Information Technology

  7. Expanding Service DeliveryandContinuum Of Care

  8. Expanding Service Delivery • RMNCAH continues to be a priority: women and children are vulnerable population sub-groups and lifestyle changes among adolescents is important to prevent adult onset of chronic diseases. • Expanding services like NCDs- in view of the changing disease burden. • The sequence of new service packages to be prioritized by states, based on local context and available resources.

  9. Expanding Service Delivery • Revision of existing guidelines of all National Health Programmes is essential – so that services begin at the level of HWCs as first point of contact, to ensure continuum of care and follow up. • Frontline workers to be trained to prioritize health promotion and life style modification and raising community awareness on expanded services available at HWCs. • PHC-MO to undertake weekly visit to SHC- HWC to improve the service delivery at HWCs.

  10. Continuum Of Care • Operationalize all Sub-Centres below PHC-HWCs- to enable sector saturation and ensuring continuum of care. • Need for clear mapping of referral sites and strong logistics mechanisms especially drugs and diagnostics. • Strengthening of secondary level facilities to be undertaken to ensure effective referral. • HWC to play gate keeping function for referrals as well as follow up to secondary and tertiary facilities including AB-PMJAY.

  11. Continuum Of Care: Tele-consultation • Devise team based incentives for various levels of health facilities i.e. SHC – PHC- CHC – DH to ensure continuum of care. • Standard case history and examination formats and improved coordination with Medical Colleges required for Tele-consultation services. • Clarity required on accountability of virtual Tele-consultation and digital prescription. • Mechanism of clinical audits required to ensure rational use of medicines and diagnostics. • Tele-consultation protocol for CHO should be through MBBS-MO to maintain the centrality of PHC.

  12. Community Mobilization and Health Promotion

  13. Community Mobilization and Health Promotion • Community Participation platform similar to RKS to be established at the level of HWC with representation of PRI, VHSNC members and Patient Support Groups. • VHND Guidelines to be revised to provide wide range of services through outreach. • Monitoring of HWCs, for service delivery and OOPE through social audits and Jan Samvad anchored by VHSNCs. • Citizen Charter, Wall Writings, Folk Media to be used to create awareness about availability of newer services at HWCs.

  14. Community Mobilization and Health Promotion • Creating Patient Support Groups especially for NCDs and chronic illnesses to ensure treatment compliance. • Using recognition as the key • Promote wellness as a “movement”- Conceptualize “Wellness Village/ Swasth Gaon”. • Award VHSNCs/Panchayats for addressing social determinants like Eat Right, Tobacco and Alcohol Free Village, ODF Village etc, by developing “Star Rating System”. • Training for CHOs and MPWs using MOOC (Massive Open Online Courses) to be planned on counselling for health promotion.

  15. Human Resources

  16. Selection, Training and Retention of Community Health Officers • Introduction of two- step selection process with a written exam as a qualifier, followed by OSCE (Objective Structured Clinical Examination). • OSCE guidelines to be customized for CHOs and prepared at the national level. • Creation of pool of state mentors for periodic assessment of training quality. • Continuing involvement of programme officers in capacity building of CHOs to enable understanding their roles in various National Health Programmes.

  17. Selection, Training and Retention of Community Health Officers • Training on soft skills like communication, team work, attitude etc. to be integrated in training of CHOs. • To ensure retention of CHOs - • Creation of regular cadre with clear career progression pathways • Assignment of HWC prior to training. • Undertake operational research to assess effectiveness of CHOs with different professional backgrounds

  18. Ensuring Effective HWC Team • Ensuring full complement of HR at HWC through gap assessment and rational deployment. • Joint trainings and sensitization of HWC team including MO highlighting specific roles and responsibilities. • Review and updation of curriculum and revitalizing training infrastructure for MPW-Male. • Use of Zoom/ECHO for supplementary/ refresher trainings and service packages requiring less complex skills.

  19. Performance Linked Payments • Wider dissemination and training on process of performance linked payments. • Expedite supply of smart phones/tablets/desktops for HWC teams to enable performance linked payments. • Manual/paper- based recording formats for reporting & data collection to be used till IT applications are fully integrated and operational.

  20. Medicines And Diagnostics

  21. Medicines And Diagnostics • In-house Hub and Spoke model to be strengthened for diagnostics with Hub at PHC/CHC, linked with HWCs as Spokes. • Extension of IT based inventory management system like e-Aushdhi up to the level of SHC- HWCs to be expedited. • Guidelines needed for transport and storage facility for expanded range of medicines / consumables at SHC- HWCs. • Drug inspection committees may be constituted to oversee the transport and storage. • 10% of the total budget to be earmarked for local purchase in emergency or stock out at HWC level.

  22. Medicines And Diagnostics • Essential Medicine and Diagnostic Lists to be updated periodically to align with changing epidemiological context. • Treatment protocols and same medicines to be made available at all levels of care (i.e., SHC- PHC- CHC- DH) to improve treatment compliance. • Periodic review and updation of Standard Treatment Guidelines (STGs). • Training of service providers at HWCs on STGs and regular prescription audit to ensure quality of care. • Exploring possibilities of expanding Point Of Care (POC) diagnostics suitable for primary level like complete blood count etc., to address the challenge of anti-microbial resistance and irrational drug use.

  23. Urban Health And Wellness Centres

  24. Urban Health and Wellness Centres • Comprehensive Primary Health Care approach to be prioritized in urban areas rather than OPD/ curative services based clinic models. • HR requirements – • Positioning of MPW (Male) at the UPHCs to cater to the health needs of male community members. • Provision of ASHAs/ existing Community Workers of different systems, even in non-slum/ slum like areas. • Urban areas with no ASHAs, may engage volunteers to support population enumeration.

  25. Urban Health and Wellness Centres • To improve access to care for Migrant/ Transient communities- • Existing mechanisms established under PULSE Polio, Polling Station, etc. may be used to achieve universal enumeration. • Leveraging MMUs to enable reach to urban/ peri-urban areas like construction sites and homeless under the flyovers etc. • Flexible OPD timings for slum population. • Voluntary enrolment by citizens to be promoted wherever feasible through an online entry page/ kiosks (Delhi model).

  26. Urban Health and Wellness Centres • Leveraging funds from other departments e.g. 1% of construction funds earmarked for developmental purposes and CSR. • Constraint of physical space may be addressed by promoting use of - • Unused spaces / buildings of other government departments. • Portable structures (e.g. Porta-cabin). • Open community spaces like parks, school buildings, etc. to be utilized for undertaking wellness activities. • Service providers need to be sensitized towards health needs arising from occupational hazards.

  27. Information Technology

  28. Information Technology • Need to expedite integration / consolidation of IT applications to reduce additional work load. • Integration of existing state specific applications with central server needs to be explored and expedited. • Review of current “Tablet Specifications” to accommodate integration of multiple applications like NIKSHAY, RCH-Portal and new modules of CPHC. • Centralized Procurement of IT equipment with pre-loaded applications and MDM (Mobile Device Management). • IT application to function in both laptop/desktop and android phones in addition to tablets.

  29. Information Technology • Updated versions for IT application to be introduced with a gap of at least six months, as frequent launches affects learning and user adaptability. • Since Continuum of Care is the key output of IT application, more efforts are needed to improve the use of IT application at PHC / CHC level. • States to be given full access to data. • Training and handholding of Front Line Workers (FLWs) - • Data dictionary to be made available to FLWs in local language. • Continuous handholding of the FLWs on the use of IT application to improve utilization and enable trouble shooting.

  30. Information Technology • Efforts to ensure availability of tribal and gender disaggregated data for analysis of service coverage. • Creation of state level IT programme unit to support the implementation of multiple IT related components. • Build capacity of existing technical HR such as IT coordinators and Data Entry Operators at district and block level to maximize sustainability. • Piloting of new features of CPHC-IT application to be done at Innovation and Learning Centres (ILC). Once the new features stabilizes it can be scaled up. • Exploring alternate connectivity possibilities for remote and forest areas.

  31. HWC Ongitikrey, A&N Islands HWC Ulnar, Chhattisgrah HWC Siddharthnagar, UP Transforming Primary Health care HWC Mundala, Rajasthan HWC Gandhinagar, Gujarat HWC Pati, Dadar & Nagar Haveli

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