‘arogyam kendra’ - aiggpa.mp.gov.in

‘Arogyam Kendra’

Health and Wellness Centres in Madhya Pradesh:

An Assessment

June 2021

State Health Resource Centre

Atal Bihari Vajpayee Institute of Good Governance and

Policy Analysis, Bhopal

About Report

This report is the outcome of an attempt undertaken to bridge the existing information

gaps about the operational status of the Health and Wellness Centres of Madhya Pradesh

‘Arogyam Kendra’ and, recommend key actions for strengthening their present status.

AIGGPA has taken the initiative to prepare an evidence-based assessment report based

on analyses of primary data, generated through field observations and interactions.

This work has been undertaken by the State Health Resource Centre at Atal Bihari

Vajpayee Institute of Good Governance and Policy Analysis Bhopal. It is the first for the

state of Madhya Pradesh after the launch of ‘Ayushman Bharat- Health and Wellness

Centres’.

Acknowledgment

We are grateful to Dr. O. P. Tiwari, State Nodal Officer - Health and Wellness

CentresNational Health Mission-Madhya Pradesh for his continuous support. Our sincere

thanks to the district health officials, Health and wellness Centres staff and clients who

participated in the study without any hesitation and contributed to generating the

evidences that were absolutely essential for this assessment report.

We also acknowledge the support of Mrs. G V Rashmi, Chief Executive Officer- AIGGPA,

Mr. Girish Sharma Director - AIGGPA, Mr. Lokesh Sharma Additional Chief Executive

Officer-AIGGPA, Dr. Silja Sudhir, Principal Advisor, SHRC-AIGGPA.

Study Team

Ms. Preeti Upadhyay, Senior Advisor-SHRC

Mr. Praveen Khedale, Research Associate

Ms.Aparajita Pandharkar, Research Assistance

Data Collection and compilation

M/s Shaishavi Project Consultants Pvt. Ltd. Bhopal

Assessment of Health and Wellness Centres in Madhya Pradesh 1

Executive Summary

Today, we are an enormous country of 1.3 billion people, who are as diverse as they

come and spread across the length and breadth of the country; pose an enormous

challenge to the health care system1. This brings into focus, the WHO theme for

2018, which calls for ‘Universal Health Coverage- Everyone, everywhere’. Multiple

relentless efforts to bridge this gap in health care provision to the most needy and

lower decile of the Indian population have been made. Ayushman Bharat, is one

such program. Launched in 2018, Ayushman Bharat (AB) is an attempt to move

from a selective approach to health care to deliver comprehensive range of

services spanning preventive, promotive, curative, rehabilitative and palliative care.

It aims to provide these services in the remotest and the most neglected corners of

India (through upgradation of PHCs and SHCs), to crowded urban spaces (through

UPHCs), bringing to fore its aim of Universal coverage. Rapid transformation of

existing health centres and capacity building are its key focal points and, the rate at

which it is being done so is commendable.

It has been three years since the Health and Wellness Centres in Madhya Pradesh

became operational. With this backdrop, we aim to systematically undertake an

initial stage assessment of HWCs that are currently operational in the state,

understanding the operational processes, field-level challenges, and barriers

involved in the care giving process, while serving as a baseline on streamlining

inputs, modifying processes, and improving coverage and quality of services. The

study mainly tries to review the adequacy and quality of key processes and inputs

for HWC operationalization including the availability of HR, infrastructure

strengthening, medicines and diagnostics, financing, and IT. A detailed

understanding of the monitoring and review mechanism, while developing

performance indicators for effective care giving has also been carried out.

Chapter 1 provides a background to the study, while setting up context for the rest

of the work. A current status scenario discussion has also been done here. Chapter

2 describes the methodological approach used for assessment, gives a profile of

the sample facilities, data collection and report development techniques using

specific tools designed for the purpose. Chapter 3, the largest of all, is where the

survey results are presented in detail. Assessment on various fronts such as

Physical and civil infrastructure, Human Resources, IT and other facilities, Service

provision, and health promotion among others has been detailed out in this

section. Chapter 4, or the way ahead talks about how the system can be

1SRS Statistical Report, 2016. Office of the Registrar General & Census Commissioner. Ministry of Home Affairs,

Government of India


strengthened further, by exploring areas of scope and discarding processes that

lead to waste of time and resources at all levels. Overall, the report is expected to

provide early stage evidences for improving HWC operationalisation in the state,

while continuously working towards better service delivery patterns and

standardisation.

Percent of HWC with current Status of key parameters in Madhya Pradesh 2021

Sl. No.

Indicator

HWC-SHC (percent)

HWC-PHC (percent)

1 Type of building (%)

Own Building 49 53

Other Govt. Building 48 47

Rented Building 3 0

2 Facilities in HWC (%)

OPD 97 100

Lab/diagnostics 36 75

Pharmacy 33 83

Storeroom 42 85

Telemedicine 50 25

3 HWC with well ventilated (%) 83 98 4 HWC with sufficient space/ patient waiting area (%) 74 98 5 HWC with space for medical consultation (%) 77 98 6 HWC ever face electricity supply (24*7) problem (%) 62 45 7 HWC faced running water problem (%) 69 50 8 HWC ever face drinking water problem (%) 71 53

9 HWC with at least one Toilet(%) 97 100

10 Running water availability in the toilet (%)

Never 40 5

Regular 35 80

Sometime 25 15

11 HWC with condition of the structure (%)

Good 44 88

Needs major repair 25 0

Needs partial repair 31 12

12 HWC having residential facility (%) 66 88

Number of HWC surveyed 102 40


Sl. No.

Indicator

HWC-SHC (percent)

HWC-PHC (percent)

13 Occupancy status of residential facility (%) Fully Occupied 33 71 Kept Vacant 49 9 Partially Occupied 18 20

14 HWC with Branding visibility (%) 80 93 15 HWC with Internet connectivity (%) 100 100 16 HWC ever face any network problem (%) 47 38

17 Quality of net connectivity in HWC (%)

Always available 56 45

Available but slow 33 43

Disrupted most of the time 11 12

18 HWC equipped with (%)

Desktop 17 88

Laptop 76 38

Tablets 95 35

19 Functional status of IT equipment (%)

Desktop 10 46

Laptop 79 60

Tablets 87 69

20 HWC initiated Tele-Consultation (%) 57 15

21 HWC with status of CBAC records (%)

Completed 62 60

On Going 37 38

Yet to Start 1 2

22 HWC with type of CBAC records maintenance (%)

Digital 15 18

Hard copy 85 82

23 HWC with condition of drug storage facility (%)

Adequate and safe space 39 70

Adequate space but unsafe 22 23

Inadequate space but safe 31 7

Inadequate space and unsafe 8 0



Sl. No.

Indicator

HWC-SHC (percent)

HWC-PHC (percent)

24 HWC with use of e-Aushadhi (%) 49 88

25 HWC with key Services Provision (%)

Neonatal Health 72 95

Childhood & Adolescents Health Care 87 93

Family Planning & Contraceptives services 80 95

MTP (abortion) service FIXED DAY APPROACH 7 10

26 HWC measures taken up for Covid-19 pandemic (%)

Trained health staff (all) 7 5

Trained health staff (partial) 92 95

Staff is equipped with PPE 59 75

Awareness Covid appropriate behavior 95 100

Local initiative 75 78

Screening 75 85

Sample collection 23 40

Rapid Response Team member 21 40

27 HWC initiated National TB Programme (%) 79 73

28 HWC initiated National Leprosy Programme (%) 28 38

29 HWC initiated screening (in Dec 2020) (%)

Hypertension 94 88

Diabetes 93 93

Oral Cancer 32 25

Cervical Cancer 15 18

Eye sight 22 15

Mental Health 16 8

30 HWC with any health promotional activity (%) 76 75

31 HWC ccoordination with AYUSH for Yoga (%) 63 55



Contents

1 Introduction ............................................................................................................. 7

1.1 Background .......................................................................................................... 7

1.2 Current Status ...................................................................................................... 9

1.3 Objectives............................................................................................................ 11

2 Methodology .......................................................................................................... 12

2.1 Study Design .................................................................................................... 12

2.2 Study Facilities ................................................................................................. 12

2.3 Study tools ....................................................................................................... 13

2.4 Data collection ................................................................................................. 13

2.5 Data processing and report development .................................................... 14

2.6 Limitations ....................................................................................................... 15

3 Findings .................................................................................................................. 16

3.1 Respondents Profile ....................................................................................... 16

3.2 Physical Infrastructure ................................................................................... 18

3.3 Human Resource ............................................................................................ 26

3.4 Information Technology ................................................................................. 31

3.5 Drugs ............................................................................................................... 34

3.6 Service Provision ............................................................................................ 37

3.7 Service performance ...................................................................................... 42

3.8 Health Promotion ........................................................................................... 45

3.9 Integration with AYUSH ................................................................................. 47

3.10 Emergency Preparedness .............................................................................. 48

3.11 Client Response .............................................................................................. 52

3.12 Monitoring and review ................................................................................... 55

4 Way Ahead ............................................................................................................. 56

5 Cases need attention ............................................................................................. 59

6 Annexure ................................................................................................................ 63


1 Introduction

1.1 Background

References to the descriptions of the Indus Valley Civilisation (5500-1300 BCE) that

mention ‘Arogya’ as reflecting ‘full well-being’, often point towards the glorious

tradition of public health that our country began with.2 The Chinese traveller Fa-

Hien (tr.AD 399–414) takes this further, commenting on the excellent facilities for

curative care at the time.3 Fast forward a few centuries to the 1700s, when the

British started developing medical services in India, primarily for the benefit of their

people, the armed forces and privileged Indian civil servants. The values of the

Indian medical system remained largely neglected, and curative care was mainly

available in mega cities. At the same time, the health needs of the general public

took a backseat and was never considered something to be worked upon. The

strong inherent western bias led to the adoption of sophisticated modern medicine

for a few, ignoring the vital interests of the majority.4

In 2017, the Global burden of disease study reported major disease and risk factors

for every state in India., bringing attention to the Indian health policy scene by

identifying potential areas of work that the government could effectively address5.

It was recognized that, despite continued operation of various national and

regional level health schemes in India, there did not exist an umbrella health

scheme for the Indian population. As a result, the Indian Government first

announced the Ayushman Bharat Yojana as a universal health care plan in the 2018

Union Budget of India. The program itself was launched on 25 September 20186. It

aims to deliver a wider and more comprehensive range of services ranging from

promotive, curative, preventive, and palliative to rehabilitative care. There are two

major components of the Ayushman Bharat program – First being the Pradhan

Mantri Jan Arogya Yojana (PMJAY) that seeks to provide health insurance coverage

of up to Rs 5 lakhs per year to the most vulnerable decile of the Indian population

seeking secondary and tertiary care. The second component, which is also our

research interest, is the establishment of more than 1,50,000 Health and Wellness

2Roy S. Primary health care in India. Health Popul Perspect Issues. 1985;8:135–67. 3James L. A Record of Buddhist Kingdoms: Being an Account by the Chinese Monk Fa-Hien of His Travels in India and Ceylon (A.D. 399-414) Dover publications. 1991:79. 4Roy S. Primary health care in India. Health PopulPerspect Issues 1985;8:135-67. 5Lahariya, C. (2018). ‘Ayushman Bharat’ Program and Universal Health Coverage in India. Indian Pediatrics, 55(6), 495-506. Retrieved 3 15, 2021, fromhttps://link.springer.com/article/10.1007/s13312-018-1341-1 6Pareek,Manoj. (2018). Ayushman Bharat-National Health Protection Mission a way towards Universal Health Cover by reaching the bottom of the pyramid to be a game changer or non-starter. International Journal of Advanced and Innovative Research, 7(7), 1–10. http://doi.org/10.5281/zenodo.1341912

https://link.springer.com/article/10.1007/s13312-018-1341-1

https://link.springer.com/article/10.1007/s13312-018-1341-1

http://doi.org/10.5281/zenodo.1341912


Centres (HWCs) created to deliver Comprehensive Primary Health Care, that is

universal and free to users, with a focus on wellness and the delivery of an

expanded range of services closer to the community.

Healthcare provision through HWCs- an overview

Source: AB-HWC portal

Health and Wellness Centres are

envisaged to deliver an expanded range

services that go beyond Maternal and

child health care services to include care

for non -communicable diseases,

palliative, and rehabilitative care, Oral,

Eye and ENT care, mental health and first

level care for emergencies and trauma,

including free essential drugs and

diagnostic services. Operationalization of

health care through HWCs is a complex

task, requiring inputs at various levels

and coordination between different

parties. This coordination is absolutely

essential for the smooth running of

these wellness centres. The first HWC

was launched in Bijapur, Chhattisgarh on

April 18th, 2018. In the first year, over

17,000 HWCs were operationalised, more

than the target of 15,000, set for the FY

Areas of care under HWCs include:

1. Care in pregnancy and childbirth.

2. Neonatal and infant health care

services.

3. Childhood and adolescent health

care services.

4. Family planning, Contraceptive

services, and Other Reproductive

Health Care services.

5. Management of Communicable

diseases: National Health

Programs.

6. Management of Common

Communicable Diseases and

General Out-patient care for acute

simple illnesses and minor

ailments.

7. Screening, Prevention, Control and

Management of Non-

Communicable diseases and

chronic communicable disease like

TB and Leprosy.

8. Basic Oral health care.

9. Care for Common Ophthalmic and

ENT problems.

10. Elderly and Palliative health care

services.

11. Emergency Medical Services.

12. Screening and Basic management

of Mental health ailment


2018-197.Since then, considerable progress has been made on the establishment

front, with differential targets, set for each year. The roll out plan for the country,

includes transformation of more than 1,50,000 PHCs and SHCs to HWCs by 2022.

In Madhya Pradesh, most of the Primary Health Centres in rural and urban areas

have been converted to Health and Wellness Centres with special focus on Service

Delivery and Continuum of Care; use of Information and Communication

Technology (ICT); Planning and Infrastructure Up-gradation; Health Promotion,

Community Mobilization, and Ensuring Wellness.

Table 1: Year wise number of operational HWCs in Madhya Pradesh

Year PHC-HWCs UPHC-HWCs SHC-HWCs Total

2018-19 612 78 0 690

2019-20 1,139 136 1,592 2,867

2020-21 1124 135 5065 6324

Source: AB HWC portal- Madhya Pradesh report, last accessed on 14th May 2021

In Madhya Pradesh, the goal is to transform 7,307 SHCs and PHCs (in rural and

urban areas) to Health and Wellness Centres by March 2021. While the state has

achieved its operationalization targets in most districts, there has been below par

performance in some, which will be discussed in detail below.

1.2 Current Status

According to the AB HWC portal8, Madhya Pradesh has witnessed more than six

thousand HWCs upgrades, majorly Sub Health Centre and Primary Health Centre.

While the above figures are only representative of the current year, a more detailed

account of year wise improvements and target achievements has been shown

below.

7 AB HWC Portal. Retrieved from https://abhwc.nhp.gov.in/#:~:text=The%20first%20HWC%20was%20launch ed,set%20for%20FY%202018%2D19. 8AB HWC portal- Madhya Pradesh report, last accessed on 14th May 2021

135 HWC-UPHCs

5,065HWC-SHCs

1,124

HWC-PHCs

6,324

Total HWC

https://abhwc.nhp.gov.in/#:~:text=The%20first%20HWC%20was%20launch ed,set%20for%20FY%202018%2D19

https://abhwc.nhp.gov.in/#:~:text=The%20first%20HWC%20was%20launch ed,set%20for%20FY%202018%2D19


State-wide achievements in HWC operationalization over the years are quite

evident and dramatic. Every year, the number of operational HWCs has

continuously risen, with the highest rise seen in the year 2019-20. With some steady

growth observed even during the pandemic, the state aims to fully capacitate and

operationalise more than 10,500 HWCs by the end of 2022, a target it can achieve

with ease.

Since the launch of the programme, about 96 percent of all rural PHCs have been

upgraded to HWCs. 695 HWCs have been operationalised across eight aspiration

districts. The state has also initiated to undertake a Certificate Program in

community health training, in order to expedite the process of training and

certifying the cadre of Community Health Officers (CHOs). To improve access to

primary health care by the marginalised, the state has also created a network of

Sanjivani clinics in urban areas, below the level of urban PHCs, in Bhopal, Indore,

Gwalior and Jabalpur that covers a population of more than 10-20,000. These clinics

have been successful in addressing the gap in ambulatory care in urban areas,

which is quite evident by looking at the high daily outpatient attendance records.

However, devoid of any outreach function, they have been unable to improve

coverage of essential services, particularly to women and children belonging to

poor backgrounds.

In the HWCs that are currently operating, promotion of healthy lifestyle practices

and wellness is a key focus area. The CHOs have received additional training on

wellness aspects and most HWCs have been actively engaged in organising

wellness sessions. Madhya Pradesh has always used PLA to improve maternal and

neonatal outcomes, which coupled with community development programs in rural

areas, could lead to multi-sectoral convergence.

Image courtesy- AB HWC Portal


During the Corona virus pandemic, HWCs have played an indispensable role in

ensuring continuation of non-COVID essential services, conducting community

services, creating community level awareness against stigma, and promoting

COVID appropriate behaviour. In terms of operationalization, the state is on track

to meet the target for FY 2020-21. However, there are multiple challenges standing

tall against the goal of Universal Health Coverage (UHC), particularly those in the

health system- such as HR and infrastructural shortfalls, poor sanitation, and

inadequate attention to the huge Scheduled Tribe population of the state.

1.3 Objectives

It has been three years since the Health and Wellness Centres in Madhya Pradesh

became operational. Although, the up-gradation of PHCs and SHCs to HWCs is

being carried out in a phased manner, an early stage assessment would enable an

understanding of the operational processes, field-level challenges, and barriers

involved in the care giving process, while serving as a baseline on streamlining

inputs, modifying processes, and improving coverage and quality of services.

Insights from the ground level will also help suggest design adaptations. The results

of the study would further help in strengthening the management system of HWCs

in the state. In this context, the primary aim of this assessment was:

1. To review the adequacy and quality of key processes and inputs for HWC

operationalization including the availability of HR, infrastructure

strengthening, medicines and diagnostics, financing, and IT.

2. To study the monitoring and review mechanisms of the district for HWC

operationalization including service delivery, reporting and, factors that

facilitate or challenge the program implementation.

3. To develop performance indicators/measurements for HWCs in Madhya

Pradesh.

To address the above objectives, the following key questions related to

performance measurement at HWCs seem relevant:

1. What staff is involved in the HWCs?

2. What equipment and materials do the HWCs have?

3. How were all the inputs used by the HWCs?

4. What services are being delivered by these HWCs?

5. Who delivers these services?

6. What changes, if any, have been observed in the existing facilities turned

HWCs? Are these changes benefiting those in need?


2 Methodology

2.1 Study Design

Primarily a cross sectional study, the study uses a mix of quantitative and

qualitative technique for data collection. A semi structured assessment tool was

developed with reference to the Ayushman Bharat - Health Wellness Centres

Government of India operational guidelines.

2.2 Study Facilities

A survey was administered in a manner that maintained equal representation of the

7 divisions of the state. One district from each division was selected randomly.

Further, within the selected districts, 1 Urban Primary Health Centre (HWC), 15 Sub

Health Centres (HWC) and 5 Primary Health Centres (HWC) were chosen with

simple random technique without replacement, from the list of the facilities

provided by the National Health Mission, Madhya Pradesh. The data collection

exercise was done in the month of January and February 2021.

A sample of total 146 HWCs were chosen to visit and collect primary data from 7

district distributed across 7 divisions in the state. The study mainly focussed on

those SHCs, PHCs, and UPHCs in Madhya Pradesh that have been upgraded to an

HWC under the AB program since 2018. The sample distribution has been detailed

out in the table below.

Table 2: District wise Health and Wellness Centres visited by the Field team

Sl.

No.

District No of facilities visited No of facilities surveyed

HWC-

SHC

HWC-

PHC

HWC-

UPHC

HWC-

SHC

HWC-

PHC

HWC-

UPHC

Total

1 Bhopal 15 6 1 15 6 1 22

2 Sheopur 14 7 1 13 7 1 21

3 Khandwa 15 5 1 15 5 1 21

4 Mandsaur 16 5 1 15 5 1 21

5 Dindori 17 5 1 17 5 - 22

6 Satna 15 6 1 11 6 1 18

7 Tikamgarh 16 7 1 16 6 1 23

Total 108 41 7 102 40 6 148


2.3 Study tools

An intensive review of the HWC portal was done before designing the assessment

tool. A semi-structured open-ended questionnaire was developed for collection of

primary data. Before commencement of the data collection exercise, the tool had

been tested in the field for its accuracy, depth, and completeness. The AIGGPA

team visited Raisen district to test the study tool. Also, the assessment tool was

finalised in consultation with the National Health Mission Officials, Madhya

Pradesh. The final assessment tool was translated to Hindi language after

incorporating all the inputs from the field test and the NHM office.

2.4 Data collection

Primary data collection work was done by an external agency selected through

AIGGPA standard procedure. The orientation of field team was done before

commencement of the data collection work. The concerns and queries of field

investigators were resolved before they moved into their assigned locations. A

group consisting of two field investigators visited the assigned locations and

completed the work within stipulated time. The AIGGPA representative also visited

the field during the survey period to ensure the quality of data and for hand holding

of the study team.

Eight members from our team did the survey.

Responses on training are collected from 2018.

In many places HWCs were found to be closed / locked at the time of

visit. For some of HWCs our team made multiple visits before they could

find it open. This problem particularly affected data collection in Satna

district.

Most HWCs are currently reporting online.


2.5 Data processing and report development

After collection of primary data through mobile based application data cleaning

and secondary editing was done by the study team. Thereafter, primary tables

were generated as per the analysis plan. The analysis was limited to information

available through interaction with the health staff present at the time of facility

visit. The frequency tables with respect to infrastructure, human resource, health

services, and provision were then generated. Summary tables with appropriate

illustrations were then developed. Subsequently, the detailed study report was

prepared as per the chapter plan of the study.

The data was analyzed using a quantitative and qualitative analysis plan with

special focus on key performance indicators. This led to emergence of the following

sub-themes within the study:

Physical Infrastructure

Human Resources

ICT System

Drugs/Service provisions

Services performance

Health promotion

Integration with AYUSH

Emergency preparation

Client response

Monitoring and review system


2.6 Limitations

This assessment was an elementary stage exercise to understand the challenges

encountered during the initial operationalisation of Health and Wellness Centres

(by way of SHC upgradation and PHC strengthening) in the state. Despite putting in

efforts to make the study as comprehensive as possible, it suffers from some

limitations that have been enlisted below.

This assessment is a preparation before setting the baseline estimate. Hence,

the investigation is not critical in nature and is strictly limited to understanding

only the initial service provision extended by HWCs, based on which,

improvements can be made during operationalisation, in a phased manner.

During analysis, the HWCs have been classified into PHCs, SHCs and UPHCs,

however, the purpose of such segregation is not comparison. It has been done

to find systemic evidence that can be used to guide improvements on specific

fronts such as increasing standardisation and facilitating up-gradation.

Moreover, the number of UPHCs in the study sample is limited, owing to their

weak numbers in the state. Hence, no critical conclusions regarding their

performance have been drawn.

It must be noted that this is the initial stage of HWC operationalisation, hence,

many areas of service provision have either not been offered yet or, are in their

infant stage. As a result, the assessment does not cover all areas of service

provision and, in some cases, services have been clubbed into sub-groups for

better understanding.

The data analysed is based on primary discussion with the staff available at the

time of the visit. Many times, the head of the facility was not available to

respond. Since the background of the staff available differs in experience,

training, and educational achievements, qualitative views may not be uniform

across the facilities visited, nor do they always resonate with the head of the

facility.


Contractual68%

Regular32%

3 Findings

3.1 Respondents Profile

The survey questions were administered to both clients (service users) and health

staff (service providers). A total of 148 health care providers from different facilities

participated in the survey. The details of their designation by facility have been

given in the table below.

Table3.1: Respondents who participated in the survey

Designation HWC-SHC HWC-PHC HWC-UPHC Total

Medical Officer - 14 2 16

Ayush Medical Officer - 2 - 2

Community Health Officer 97 - - 97

LHV/Staff Nurse - 8 3 11

ANM/MPW/Other staff 5 16 1 22

Total 102 40 6 148

Figure 3.1: Respondent profile on the basis of tenure

As shown in the figure above, 32 percent of the service providers who were

administered the survey was regular while 68 percent of them were employed on a

contractual basis. The respondents were also questioned on major changes that

have taken place since the facility changed to an HWC. These have been grouped

and detailed out in the following figure.


Figure 3.2: Major changes reported by Health and wellness Centres staff during

survey

HWC-SHC

Increased awareness about services

Daily OPD

More patients

Medicine available

Personal attention to patient

Elderly patient can visit by themselves

Building trust

HWC-PHC

Increased aware about services

More Patients

More ANC

NCD Services

Medicine available

Lab test

Online facility

Emergency patient visits

Garden/solar facility


3.2 Physical Infrastructure

Physical infrastructure is one of the key inputs for an HWC, as specified by the

central guidelines. Each facility needs to cater to a population as large as that

prescribed by the IPHS norms, located in tough terrains and tribal, hilly, or desert

areas. While minor civil repair and infrastructure upgrade in existing buildings is

required to deliver patient friendly services, HWCs have an even wider spectrum of

service provision and, they would therefore require major civil upgrades including

well ventilated rooms for consultation, designated reception area, space for Yoga

and rehabilitative services; OPD etc. In this regard, the facilities have been surveyed

on the status of their physical infrastructure and any repairs that may be needed

thereof.

3.2.1 Facilities

The findings in figure 3.1 suggest that 20 percent HWCs do not have sufficient space

for patient waiting area, more than half are housed in a rented building and, one

fifth of them do not have any private space for patient consultation.

Figure 3.3: Percent of Health and Wellness Centres with provision of key facilities

(Total)

HWC-Primary Health Centres: While data describes that all the sample PHCs are

housed in a government building, they also have sufficient waiting space for

patients. Only 1 of the 40 PHCs in the sample is ill ventilated and does not have

adequate space for medical consultation. 2 PHCs from the sample do not have

space for patient privacy, which includes separate checking units, especially for

children and women.

49

87 80 83 79

51

13 20 17 21

Own Building Facility wellventilated

Sufficientspace for

patient waitingarea

Space formedical

consultation

Space forpatient privacy

duringconsultation

Available Not Available


Figure 3.3 (a): Percent of HWC–PHC with provision of key facilities

HWC-Sub Health Centres: Unlike HWC-PHCs, 2 of the 102 SHCs visited for the

purpose of the study were not housed in a government building. 28 of these SHCs

did not have sufficient space for patient waiting area, which is 26 percent of the

sample SHCs. Only 88 of these facilities were well ventilated, while 23 of them did

not have proper space for medical consultation. Patient privacy looks compromised

again with 29 SHCs not having enough space for private check-up.

Figure 3.3 (b): Percent of HWC–SHC with provision of key facilities

HWC-Urban Primary Health Centres: Of the 6 UPHCs visited for the purpose of the

study, half of them were not housed in a government building, something that the

guidelines deem mandatory over an extended period of time. There was

insufficient patient waiting space in one facility, lack of proper ventilation in

another and lack of space for private medical consultation in another. Incidentally,

90

98

98

98

53

10

2

2

2

47

Space for patient privacy during consultation

Space for medical consultation

Sufficient space for patient waiting area

Facility well ventilated

Own Building


74

77

74

83

49

26

23

26

17

51





Own Building



all UPHCs had private space for patient check-ups, something that both PHCs and

SHCs failed to achieve.

Figure 3.3 (c): Percent of HWC–UPHC with provision of key facilities

3.2.2 Amenities

Availability of repeat diagnosis facility, dedicated pharma support, storeroom for

medicines, branding and tele-consultation are just some of the essential amenities

that an HWC is stipulated to have. These amenities are expected to provide

additional support to the facility operations and make patient friendly. The data

related to various amenities across our survey sample has been presented below. A

facility wise discussion follows.

Figure 3.4: Number of Health and Wellness Centre with necessary health care services

While there exist limited gaps with respect to infrastructure, there are multiple

gaps in provision of amenities. Of the 40 PHCs visited, 28 did not practice any form

100

83

83

83

33

17

17

17

67





Own Building


145

72 73 8264

125

3

76 75 6684

23

OPD Lab/diagnostics Pharmacy Storeroom Telemedicine Branding

Available Not available


of telemedicine which is close to three fourths of the entire sample. 14 of these

facilities did not have a storeroom for medicines and 13 did not have any pharmacy.

Close to half these PHCs did not have maternity ward or any labs/diagnostic service,

which is of serious concern since one of the principals aims of HWC

operationalization is related to improvement of RMNCH+A health. While 11 of the

PHCs visited did not have an in-patient ward, 7 of them did not have OPD service.

SHCs fared the worst in terms of amenities available. Only a third of them had

telemedicine or storeroom facility available. While the figures for OPD were high, a

very large proportion of them did not have any Pharmacy or Lab/ Diagnostic service

available.

Of the total sample of 6 UPHCs, a third did not have any telemedicine service, or an

operational maternity ward. 50 percent of the sample was devoid of a medical

storeroom or any lab/diagnostic service. A third of the facilities did not have any

pharmacy store, an in-patient ward or an OPD.

3.2.3 Building status

Of the 40 Primary Health Centres visited by the study team, 5 needed partial repairs

while the rest 35 were in good condition. None of the PHCs or UPHCs needed any

major repairs. However, the picture is not so encouraging when looked at the

number of SHCs in need of urgent and major repairs. 23 SHCs needed major repairs

while, 33 needed partial repairs. A relatively smaller proportion of SHCs were in

good condition, iterating the need for developing infrastructure with respect to

HWCs.

Figure 3.5: Status of physical Infrastructure in study locations (n-148)

HWC data by facility type suggests that Mandsaur, followed by Satna, have the

highest number of facilities that need major repairs. Only Tikamgarh and Khandwa

do not have any facilities needing major repairs.

Good57%

Needs major repair

17%

Needs partial repair

26%


Figure 3.6: Number of Health and Wellness Centres with Current Physical

Infrastructure status by type

If looked at by facility type, only SHCs need major repairs while, only a few PHCs

and UPHCs need any minor repairs. This reflects that there exist civil deficiencies in

the Sub Centre spectrum which, must be resolved immediately.

3.2.4 Other facilities

Exactly half of the SHCs and UPHCs visited by the study team did not have any

residential service provision for service providers. This was not the case with PHCs

where only 4 of the 40 facilities visited lacked such an arrangement. At the same

time, more than half of all PHCs, SHCs and UPHCs reported having problems related

to availability of drinking and running water. The situation seems especially grave in

the case of SHCs with more than three fourths of them having no access to water.

45

35 5

32

5 125

HWC-SHC HWC-PHC HWC-UPHC

Needs major repair

Needs partial repair

Good


Table 3.2: Number of HWC by type with Infrastructure and facility

SHC PHC UPHC Total

Type of building

Own Building 50 21 2 73

Other Govt. Building 49 19 1 69

Rented Building 3 0 3 6


Yes 85 39 5 129

No 17 1 1 19


Yes 75 39 5 119

No 27 1 1 29


Yes 79 39 5 123

No 23 1 1 25


Yes 75 36 6 117

No 27 4 0 31

Facilities in HWC

OPD -Yes 99 40 6 145

OPD- No 3 0 0 3

Lab/diagnostics

Yes 37 30 5 72

No 65 10 1 76

Pharmacy

Yes 34 33 6 73

No 68 7 0 75

Storeroom

Yes 43 34 5 82

No 59 6 1 66

Telemedicine

Yes 51 10 3 64

No 51 30 3 84

Ever face electricity supply problem (24*7)

Yes 63 18 2 83

No 39 22 4 65

Frequency of electricity problem

Daily less often (1-2 hrs.) 14 6 0 20

Daily more often (>2 hrs.) 32 6 2 40

Rarely 6 7 2 15

Weekly some time 11 1 0 12


SHC PHC UPHC Total

Ever faced running water problem

Yes 70 20 2 92

No 32 20 4 56

Frequency of running water problem

Daily 42 10 0 52

Monthly 21 9 2 32

Weekly 8 3 0 11

Ever face drinking water problem

Yes 72 21 3 96

No 30 19 3 52

Availability of at least one Toilet

Yes 99 40 6 145

No 3 0 0 3

Toilet for

Common Toilet 82 21 3 106

Female Toilet 17 21 3 41

Male Toilet 15 23 3 41

Condition of Toilets

Clean 44 31 4 79

not clean 18 7 1 26

not in use 38 2 1 41

Running water availability in the toilet

Never 41 2 1 44

Regular 35 32 5 72

Sometime 24 6

30

Branding

Yes 82 37 6 125

No 20 3 0 23

Condition of the structure

Good 45 35 5 85

Needs major repair 25 0 0 25

Needs partial repair 32 5 1 38

HWC Equipped with

Solar Panels 17 15 1 33

Inverter 29 30 4 63

Residential facility

Yes 67 35 3 105

No 35 5 3 43


SHC PHC UPHC Total

Occupancy status

Fully Occupied 22 25 1 48

Kept Vacant 33 3 1 37

Partially Occupied 12 7 1 20

Accommodation occupied by

ANM 7 2 0 9

ANM and CHO 6 1 0 7

Staff 52 23 2 77

ANM and staff nurse 2 7 1 10

MO and staff nurse 0 2 0 2

Total number of HWC surveyed 102 40 6 148

Of the PHCs having reported any water problems, 7 said they had this problem on a

daily or monthly basis while 3 reported experiencing this problem on a weekly

basis. At the same time 33, 20 and 8 SHCs reported experiencing water problems

on a daily, monthly, and weekly basis, respectively. With regards to UPHCs, 2 of

them reported any such problem monthly. Over half the facilities visited did not

have separate toilets for men and women. While the situation was satisfactory in

the case of PHCs and UPHCs where 50 percent had either separate or common

toilets, only 18 SHCs had a separate female toilet and 16 of them had a separate

male one. While availability of toilets is important, without them being functional,

the entire purpose is lost.

The study results reveal that while 29, 46 and 4 toilets in PHCs, SHCs and UPHCs

were clean, many of them were either not clean or were not in use. Specifically, 6,

19 and 1 toilets in PHCs, SHCs and UPHCs remained unclean, while 2 of them in PHCs

and 38 of them in SHCs remained not in use. While most (30) PHCs had regular

supply of running water in the toilets, 1 of them reported having no water supply

while the other 6 claimed that water supply was available but only sometimes. All

UPHCs had regular water supply but only 37 SHCs could make such a claim. 42 SHCs

reported never having any water supply while 24 said running water was available

sometimes. With regards to supply of electricity, 19 of the 40 PHCs visited by the

study team reported having electricity related problems. A third of the UPHCs and

63 of the 102 SHCs visited reported having similar problems. With no water and

electrical supply, the health care system is really leaning on the edge of

dysfunctionality. When asked if any alternative provisions for electricity existed, 14

PHCs reported having solar panels. This figure stood at 18 and 2 for SHCS and


UPHCs, respectively. At the same time, 28 PHCs reported having an inverter while,

only 31 SHCs and 4 UPHCs could make such a claim.

3.3 Human Resource

It has been envisaged that the greater Human Resource requirement at the newly

operationalised HWCs needs a comprehensive plan strategy for their deployment.

This would require heavy recruitment and training in appropriate areas in order to

build the complete care package that has been promised to the general public and

service users. For the same purpose, we surveyed our facilities on the HR

availability and training front, the results of which have been presented below on a

section by section basis.

3.3.1 Availability

Availability of requisite HR has always been an issue with the health system in India.

However, there has been no assessment of the HR availability at these newly

operationalised HWCs. The figure below provides a comprehensive summary of the

study findings.

Figure 3.7 (a): Number of Health and Wellness Centres -SHC and PHC with

Current staff position

HWC-PHCs: According to guidelines, each PHC must be equipped with two Medical

Officers, Staff Nurses, one Lab Technician, Pharmacist, and two Lady Health Visitors

each. They must be skilled with regards to provision of preventive, promotive,

9

97

187

60

43

8

35

17

411

43

23 27 2822

MO(MBBS)

Ayush MO CHO LHV StaffNurse

MPW(Female)

MPW(Male)

Pharmacist LabTechnician

HWC-SHC HWC-PHC


curative, rehabilitative and palliative care for the expanded range of services that

HWCs offer. They must also have training, other support and, public health

management skills. Apart from handling administrative work, they are also

expected to use population based analytics for capacity building and carry out

dialogues with primary care teams to improve health outcomes.

In the sample facilities, of the 40 PHCs the team visited, 33 had a MO present on

site while the total number of MOs was 35. This covers 85 percent of the

requirement meaning that there exists a shortfall of 15 percent with respect to MOs

in PHCs. Even though AYUSH is an integral part of the HWC health system, less than

half of the PHCs visited by the study team had an AYUSH doctor appointed for

service provision, leading to a shortfall of more than 60 percent in PHCs alone. Only

10 PHCs reported having appointed Lady Health Visitors, leading to a serious

shortfall of 74 percent. The situation with staff nurses was better than that for

LHVs, but still dismal with a shortfall of close to 50 percent. Similar trends were

seen with respect to MPWs (both male and female). 28 PHCs reported having a

pharmacist while 21 of them reported having a lab technician, leading to a shortfall

of 28 and 54 percent, respectively. It is imperative to note that such shortfalls,

especially when observed at the most essential rungs of the health care system led

to serious inefficiencies in service delivery and provision of care, making it even

more difficult to achieve the outcomes and goals set.

HWC-SHCs: The guidelines for SHC- HWC mention mandatory posting of 2 Female

MPWs and 1 Male MPW while those for UPHCs mention posting 1 Female MPW per

10,000 population. Their core skills should include being trained to be a birth

assistant, RMNCH+A, testing, performing IUCDs, management of common ailments

and counselling including other administrative work such as maintaining folders

and individual health records.

There were no serious shortfalls in CHOs being present at SHC-HWCs with 97 of the

105 facilities having them, making the shortfall to be 5 percent. However, there

were serious shortfalls in positioning of Lady Health Visitors and staff nurses with a

shortfall percentage of 82 and 93 percent, respectively. In all, only 18 Lady Health

Visitors and 7 female staff nurses were posted at the 103 facilities visited by the

study team. The same figure was 60 and 43 for Female and Male MPWs, putting the

shortfall at 41 and 58 percent, respectively. Virtually no pharmacists and lab

technicians were available at SHCs with their availability being 6 and 11 percent,

respectively.


Figure 3.7 (b): Number of Health and Wellness Centres -UPHC with Current

staff position

HWC-UPHCs: At UPHCs, the number of MOs was more than required i.e. there were

7 MOs at the 6 UPHCs visited by the team, however, there were staggering

shortfall in the number of AYUSH MOs with only half of them having one such

officer. 3 of the 6 UPHCs visited did not have any Lady Health Visitor or Pharmacist

in position, which according to the guidelines is absolutely essential to have. There

was a 33 percent shortfall with respect to staff nurses and no female MPW was

present at any of the facility. 2 facilities reported having 1 Male MPW, which still

does not explain the staggering total shortfall of MPW workers.

Table 3.3: Number of health staff position in Health and Wellness Centres

In Position (HWC) Staff requirement as

per guideline* (HWC)

SHC PHC UPHC SHC PHC UPHC

1 Medical Officer (MBBS) - 35 7 - 80 80

2 Ayush Medical Officer 9 17 2 - - -

3 Community Health Officer (CHO) 97 4 - 102 40 0

4 Lady Health Visitor (HWC-PHC) 18 11 3 - 40 6

5 Staff Nurse 7 43 8 - 80 12

6 MPW (Female) 60 23

102 40 6

7 MPW (Male) 43 27 2 102 40 -

8 Pharmacist

28 3 0 40 6

9 Lab Technician 8 22 2 0 40 6

Note: staff calculated for 102 HWC-SHC, HWC-PHC

The table above compares the staff currently in position with the staff that has

been stipulated as per guidelines. One does not need to look hard to tell that there

7 2 3 8 3 2

73

37

72

402

37 38

MO (MBBS) Ayush MO LHV Staff Nurse MPW(Female)

MPW (Male) Pharmacist LabTechnician

HWC-UPHC Requirment


are shortfalls at each level of HR at HWCs. There are not enough LHVs, Lab Techs

and, Pharmacists to augment the care giving process. At the same time, there

exists shortfalls at the MO tier too, meaning that health is being compromised at all

levels.

3.3.2 Trainings

Multiskilling was emphasised as one of the core values behind HWCs, so as to

address the mismatch between service provision and level of training received by

primary care teams. This has been done considering the large amount of population

to be addressed by each facility and minimising the number of referrals at different

levels. According to guidelines- “MPW (Male and Female) would need skills to

function as paramedics for undertaking laboratory, pharmacy and counselling

functions” while, at the PHC level “staff would be appropriately skilled to function

as ophthalmic technicians, dental hygienists, physiotherapists, etc.” The study team

found the following information relating to trainings being conducted at HWCs.

Table3.4: Present Training status of staff posted in Health and wellness centres

Staff

Training Received

NCD Telemedicine Other(s)

MO (MBBS) 19 (3) 7 (2) 3 - (HIV, TB, MTP FIR)

AYUSH MO 5 (2) 1 1 (Modern medicine)

Lady Health Visitor 4 (2) 3 (1) 1- SBA TB CPID

Staff Nurse 19(2) 5(2) 3- FPT, FMCI GDM, SBI IUCD

MPW- Female 19 (3) 3(1) 2- Dastak

MPW- Male 5 (0) 3(1) 5- Dastak, TB, HIV, RCH, MO

Pharmacist 4 (1) 5(1) 2- IDSP, Hazard Training

CHO 71

(14)

45(14) 21- Iron sucrose, TB, STDs, HIV,

Malaria etc.

Note- Figures in parenthesis are number of which received online.

It was welcoming to note that trainings were received at each tier of the health

care system, right from nurses to Medical Officers. The trainings received were

mostly related HIV, TB, RCH, and DASTAK campaign for Communicable diseases.

Most trainings were received by CHOs followed by MOs and then Mid Health Level

Service Providers, among others. As per guidelines, the trainings were kept

continued even after the advent of the pandemic, by shifting to online dialogue

delivery platforms, hence, much of the trainings received were in online mode. A

detailed review of the trainings received by staff, can be looked up in table (3.3).


According to HWC operational guidelines, HWC staff must receive compulsory

training with regards to the following:

Training Guidelines for HWC staff

21 days of SBA Training

4-5 Days of Training for

IUCD insertion, NSSK,

HBNC Supervision,

Management of

Childhood Illnesses

Training on National

Health Program as per

program guidelines

3 days of Training on

Universal screening,

prevention, and

management of Non-

Communicable Diseases

1-day joint training with

ASHAs on universal

screening of NCDs

3 days training on

reporting and recording

information using digital

applications.

3-5 days training can be

planned every year

based on the expansion

of range of services.

For CHO/MLHP staff:

6 months Certificate Programme in

Community Health

5-7 days Supplementary Training on new

health programs, new skills, and refreshers

every year

3 Days Training on use of IT application and

telemedicine

Regular monitoring/ training through ECHO

platform

For PHC Staff-

10 days BEmONC training Basic Emergency

Obstetric Care; 11+2 days F.IMNCI + NSSK; Safe

abortion/MTP training, NSV skills, Conventional/

mini-lap training

Training on National Health Programs as per

program guidelines for respective cadre

5 days training for PHC Staff to play a

leadership role in the delivery of CPHC.

Online Certificate Course on Standard

Treatment Guidelines/ Continuity of Care

Protocols

5 days training in Population based screening,

prevention, and management of NCDs.

Other Distance mode certificate programs in

areas such as Family Medicine/ NCD

management/ MCH Care/Elderly Care/Mental

Health etc. to be planned in long term.

Short term certificate courses for paramedic

staff for multiskilling


All the 148 HWC

visited by the field

team found internet

connectivity.

3.4 Information Technology

The central guidelines have envisioned an IT system for HWCs that is interoperable

with the overall e-health plan for the centre and the

states. It would enable efficient service delivery at HWCs

while, the IT tool would support the HWC team in

recording the services delivered, enabling follow up of

users, reporting to superiors and performing population

based analytics.

It is pertinent to note that every facility visited by the study team has access to

internet/ had connectivity. However, 15 PHCs, 48 SHCs and, 2 UPHCs reported

having faced an internet related problem in the month of December 2020.In terms

of quality of internet connectivity 40 percent PHCs reported continued availability

of internet. However, more than half of them reported slow and disrupted

connectivity. The same was true for SHCs where 60 percent reported no issues with

connectivity while, the rest reported bad connectivity. The case for UPHCs in this

regard has also been laid out in the graph given here. No UPHC reported a

disruptive internet connection. With regards to centres having the required IT tools

that make work efficient and faster, our study generated the following evidence.

Figure 3.8: Ever faced network problem? (by HWC)

While most UPHCs had a functional desktop, PHCs and SHCs lagged far behind in

this regard. Surprisingly, a sizable number of SHCs reported having functional

laptops while, most PHCs and UPHCs could not claim the same. Following the same

trend, close to all SHCs reported having a tablet, while only 12 of the 37 PHCs had

one. No UPHC had a tablet. As a result, telemedicine numbers were really low,

especially among PHCs and UPHCs. Even though most SHCs had access to IT tools,

tele-consultation numbers were not especially encouraging.

Yes44%

No56%


Figure 3.9: Quality of net connectivity in HWCs by type, 2020

(Figures in percent)

Lack of basic IT tools, coupled with bad internet connection leads to a cycle of

inefficiency that, if not resolved, shall continue to defeat the purpose of HWC

transformation. A detailed summary stat of parameters related to availability of IT

infrastructure in the HWCs so visited has been presented below.

Data in following table show that while PHCs boast a higher number of desktops

(both functional and non-functional), SHCs have a higher number of laptops and

tablets (both functional and non-functional). However, these numbers bring out a

distorted picture. It must be noted that the total number of desktops held at PHCs

far outruns the number of PHCs itself, meaning that some PHCs have more than

one desktop available at their disposal (some of which might not be functional),

while other PHCs do not even have one. Although the same analysis does not hold

true for laptop availability at SHCs or UPHCs, this disparity must be investigated and

taken care of. Lack of computers also affects record keeping at the ground level,

thus leading to compromises being made on the overall quality of data collated.

More desktops translate into greater digital recordkeeping. In line, a large number

of HWCs kept both virtual and paper records. Very few kept only on paper records.

On must look into the reason behind this discrepancy at the earliest as, paper

records are prone to getting stolen, burned, or lost in floods. Tele consultation has

also not been initiated by a majority of the facilities. SHCs perform the best in his

case. Community Based Assessment Checklist-CBAC recording procedure is also

going on in full swing, with 91 facilities already having completed it. Only 2 facilities

remain to have kick started this process yet.

5645

67

3343

33

11 13


Disrupted most of the time

Available but slow

Always available


Table3.5: Number of HWCs by type with IT devices and its functional status

SHC PHC UPHC Total

Internet connectivity

Yes 102 40 6 148

No 0 0 0 0

Ever face any network problem

Yes 48 15 2 65

No 54 25 4 83

Quality of net connectivity

Always available 57 18 4 79

Available but slow 34 17 2 53

Disrupted most of the time 11 5 0 16

HWC equipped with

Desktop 17 35 6 58

Laptop 78 15 3 96

Tablets 97 14 0 111

No of devices

Desktop 20 63 8 91

Laptop 78 15 4 97

Tablets 126 16 0 142

Functional status

Desktop 2 29 5 36

Laptop 62 9 2 73

Tablets 109 11 0 120

Type of record maintenance

Digital 48 17 3 68

Paper 3 7 0 10

Both 51 16 3 70

Tele Consultation initiated

Yes 58 6 2 66

No 44 34 4 82

Status of CBAC records

Completed 63 24 4 91

On Going 38 15 2 55

Yet to Start 1 1 0 2

CBAC records maintenance

Digital 15 7 1 23

Hard copy 86 32 5 123

No of HWC surveyed 102 40 6 148


39

70 67

22

23 3331

88


Inadequate space and unsafe

Inadequate space but safe

Adequate space but unsafe

Adequate and safe space

3.5 Drugs

HWCs need to make available a wide range of essential and non-essential drugs in

order to serve a wider range of the health care needs of the population it serves.

With the expansion in care giving services, the government has also revised and

expanded its list of essential medicines and diagnostic services currently available.

3.5.1 Essential Drugs

Medicines listed as per essential list of medicines for a PHC/Sub health Centre need to be

ensured at all HWCs. Additional medicines will be required at HWCs as the range of services

expands. Suggestive essential medicine list for a SHC-HWC has been given by the

concerned authorities. This is updated periodically based on new protocols and states will

have the flexibility to adapt the list as appropriate. In this regard, the study results have

seemingly positive results. The objective of this query was to understand the procurement

process and availability of essential drugs. Most PHCs, SHCs and UPHCs are well stocked on

these essential drugs. The best performance is seen in the case of UPHCs where, 95

percent EDs are available while the availability percentage for both PHCs and SHCs is

similar at close to 78 percent at the time of the visit.

3.5.2Drug Storage

Of the facilities visited for the purpose of the study, only 27 of 40 PHCs, 43 of 102

SHCs and 4 of 6 UPHCs had adequate and safe storage for drugs. Some of these

facilities had adequate space for storage, however, the space was unsafe.

Unfortunately, 8 percent PHCs and 31 percent SHCs reported having a safe but

inadequate storage space. 8 percent SHCs reported having both, inadequate and

unsafe space for storage. This is unfortunate and defeats the purpose of providing

free of cost medical assistance to those, truly in need of it.

Figure 3.10: Percent of HWCs with adequate and safe storage for drugs


3.5.3 e-Aushadhi

Since it is of utmost importance for EDs and other drugs to be always available at

HWCs, it is important to address any supply side challenges associated with

medicine delivery and refills. While the ED list will guide the procurement and

demand of medicines, feeding real time patient data in the e-Aushadhi software

enables the HWCs to estimate real time need of medicines. Though this needs to be

augmented with the requisite infrastructure, it essentially leads to streamlined

distribution patterns, enabling resource utilisation.

Figure 3.11: No of HWCs that have initiated use of e-Aushadhi for drug procurement

The visual trend suggests that while e-Aushadhi is the norm for a majority of PHCs

and UPHCs, this fact does not stand true for SHCs where the practice has still not

caught up yet.

35

504

5

522

HWC-PHC HWC-SHC HWC-UPHC

Yes No


Table 3.6: Management of Drugs at Health and Wellness Centre by type

SHC PHC UPHC Total

HWC with Essential Drug as per EDL

Yes 102 40 6 148

No 0 0 0 0

Average ED available at the time of visit 86 90 83 87

Condition of drug storage at HWC

Adequate and safe space 40 28 4 72

Adequate space but unsafe 22 9 2 33

Inadequate space but safe 32 3 0 35

Inadequate space and unsafe 8 0 0 8

Updating of stock register

More often (daily) 11 11 3 25

Often (weekly) 13 4 1 18

Some time (fortnightly) 1 5 6

Less often (monthly) 68 17 2 87

Requirement basis 12 0 0 12

Use of e-Aushadhi

Yes 50 35 4 89

No 52 5 2 59

No of HWCs surveyed 102 40 6 148

As far as record keeping for medical stock registers is concerned, it was observed

that most HWCs update their stock registers on a monthly basis. Others either

update it daily, or on a weekly basis. A few SHCs also update it as and when

required, although it is advisable to do so regularly.


3.6 Service Provision

According to HWC operational guidelines, apart from population enumeration and

empanelment services, the HWCs have been designed to provide a variety of other

health care services, including- Care in pregnancy and child-birth; Neonatal and

infant health care services; Childhood and adolescent health care services; Family

planning, Contraceptive services and other Reproductive Health Care services;

Management of Communicable diseases including National Health Programmes;

Management of Common Communicable Diseases and Outpatient care for acute

simple illnesses and minor ailments; Screening, Prevention, Control and

Management of Non-Communicable diseases; Care for Common Ophthalmic and

ENT problems; Basic Oral health care; Elderly and Palliative health care services;

Emergency Medical Services; and Screening and Basic management of Mental

health ailments. In this regard, the study oversaw whether these services were

being provided to seekers.

3.6.1 Key service areas

Data suggests that most PHCs function as a point of care for Neonatal and infant

Health, RMNCHA, Immunization, family planning and Communicable Diseases.

However, the numbers were not full, meaning that there were some PHCs that did

not even provide these basic services. Similarly, more than a fourth of the SHCs

visited, did not offer Neonatal and Infant related Health services, something that is

pivotal to the framework of HWCs. The best numbers can probably be seen in

Management of Communicable Diseases under the NHP. All the HWCs visited by

the study team actively engaged in this spectrum of health care provision, of

managing communicable diseases under the NHP. The numbers for provision of

Contraceptive and RCH facilities also look encouraging and are near par. The table

below provides a detailed picture of our study results, with respect to multiple

areas of service offered by HWCs in the state.

Figure 3.12: Key service provision areas in HWCs by type

72 87 93 100

95 93 93 100

67100 100 100

Neonatal Health care Childhood &Adolescents Health

Care

Contraceptives andRCH

Management ofCommunication

Disease



Table 3.7: Number of Health and wellness Centres by type having service provision

Services Provision SHC PHC UPHC Total

Neonatal Health 73 38 4 115

Delivery Point

Yes 14 34 1 49

No 88 6 5 99

Delivery conducted last month (Dec 2020)

Yes 9 32 1 42

No 5 2 0 7

No of delivery conducted last month (Dec 2020) 98 817 12 927

No of HWC ever report Still Birth 12 25 1 38

Childhood & Adolescents Health Care

Yes 89 37 6 132

No 13 3 0 16

Available Iron supplement

Yes 79 39 4 122

No 23 1 2 26

Children screened Birth deformity (Dec 2020) 31 95 126

Family Planning & Contraceptives services

Yes 82 38 5 125

No 20 2 1 23

No of HWC having FP methods

Condom 81 38 5 124

Oral Pills/Weekly Pills 80 33 5 118

IUCD 27 26 3 56

Inject able 17 12 1 30

MTP (abortion) service FIXED DAY APPROACH 7 4 2 13

No of HWC Surveyed 102 40 6 148

While the guidelines specify that all HWCs with a female MPW and SBA (Skilled

Birth Assistant) are eligible to and, must function as institutional delivery points,

most SHCs and UPHCs do not function like that. According to records, 32 of 35

PHCs, 9 of 105 SHCs and 1 of 6 UPHCs reported having facilitated an institutional

birth in the month of December. PHCs conducted the highest number of deliveries,

followed by UPHCs and then SHCs.

Most HWCs had iron supplements available for delivery. Still births have been

reported by facilities of all type in every district, barring Satna and Sheopur that

reported having only one such case. Screening for birth deformities was also


carried out fairly regularly. A majority of the facilities offered family planning and

contraceptive services with almost all of them having some or the other form of

contraceptive available at the time of the survey. Only a few facilities (13) practiced

MTP.

3.6.2 Response during Covid-19 pandemic

While it is important to note how regular service provision is carried out in HWCs, it

is also pertinent to know how these facilities have adapted to the changing times,

especially with regards to the current COVID-19 pandemic. Our study team set out

to gauge the measures taken up by these centres for combating the pandemic and

was able to generate the following results.

Figure 3.13: Measures taken up for Covid-19 pandemic by total surveyed HWC

(Figures in percent)

Most HWCs have adopted the good practices of handwashing, carrying out local

initiatives, and raising awareness about the use of mask. While the number of

HWCs involved in screening is very high, their sample collection rates are low,

meaning that either information about screening at HWCs is not widespread or,

there are inefficiencies in the sample collection system. A few facilities also

reported being members of the Rapid Response Team against COVID-19. Shortage

of PPE kits at these centres is clearly visible in the number of facilities equipped

with them.

6

93

64

97

7678

29 28

Trainedhealth staff

(all)

Trainedhealth staff

(partial)

Staff isequippedwith PPE

Awarenessabout Covi-Appropratebehaviour

Localinitiative

Screening Samplecollection

RRTmember


The only stark inefficiency observed is related to trainings where, only 6 percent of

the HWC health manpower is fully trained to fight against the pandemic virus.

While 93 percent have received partial training in some form or the other, care

must be taken to ensure that the health staff does not miss out on trainings that

are essential to care for the diseased.

The national guidelines on HWCs stress on the importance of management of both

communicable diseases- both under the aegis of NHP and those outside it. It talks

about preventive care, identification, referral, symptomatic care, and awareness

generation necessary to combat the chain. In case of diseases such as TB and

Leprosy, HWCs are expected to provide DOTS and MDT respectively for head

starting the treatment.

As for the survey results, most PHCs, SHCs and UPHCs in the sample had performed

screening for TB. However, only a subset of them had collected sputum samples

and referred patients to a higher facility. The number of people having been

referred during Dec-20 for leprosy was also high in SHCs and most of the cases had

been reported from Tikamgarh district. No screening for leprosy has ever been

carried out in Bhopal. There has been one screening in Satna, and two screenings

each in Mandsaur and Sheopur for the same. Screening for leprosy is most

prevalent in HWCs located in Khandwa, Dindori and Tikamgarh districts.


Table 3.8: Number of Health and wellness Centres by type with management of

communicable disease

Management of Communicable Disease SHC PHC UPHC Total

Measures taken up for Covid-19 pandemic

Trained health staff (all) 7 2 0 9

Trained health staff (partial) 94 38 6 138

Staff is equipped with PPE 60 30 5 95

Awareness – Covid appropriate behavior 97 40 6 143

Local initiative 76 31 5 112

Screening 76 34 6 116

Sample collection 23 16 4 43

RRT member 21 16 4 41

National TB Programme

Yes 81 29 3 113

No 21 11 3 35

No of cases screened (in Dec 2020) 698 664 18 1380

Sample collected (in Dec 2020) 339 639 22 1000

No of cases referred (in Dec 2020) 504 357 16 877

National Leprosy Programme - any case

Yes 29 15 3 44

No 73 25 3 104

Number cases referred (Dec 2020) 1090 43 16 1149

No of HWC Surveyed 102 40 6 148


Less than 10 yrs

14%

10-20 yrs20%

21-55 yrs46%

56 yrs and above

20%Male41%

Female59%

3.7 Service performance

3.7.1 Outpatient Department

For this assessment, the OPD records

for the month of December 2020 were

collected by the field team. They have

been enumerated below. While

absolute patient numbers for

December in the HWCs visited by the

team are more than 60,000, the

monthly averages of these facilities are

around 500, on the whole.

Figure3.14: Percent distribution of OPD cases by age group and gender

It is pertinent to note that most of the patients were 21 or older and there was

lower utilisation of services among children. At the same time, more women

choosing HWCs for their health care needs exudes a success story yet to be known.

3.7.2 Diagnosis services

More than half of the PHCs visited by the study team had a fully equipped diagnosis

centre, the same was true for SHCs. Only one UPHC reported as having been ill

equipped in relation to diagnostic services. Even though the facilities seem

relatively well equipped, on an average, only 51 people were referred for a lab test.

No of OPD Registered (in Dec 2020)

In 148 HWCs: 66,583

Monthly Average OPD:

HWC-SHC: 398

HWC-PHC: 518

HWC-UPHC: 872


Specifically, PHCs referred a total of 162, SHCs referred only 18 while UPHC referred

73 people for a lab test.

Record maintenance for diagnostic services is similar to that of OPD register

maintenance. All UPHCs and 66 SHCs maintained records related to diagnostics.

The same figure was 30 for PHCs. Some facilities also maintained irregular records.

3.7.3 Screening services

HWC guidelines mention regular screening, treatment compliance, and follow up

for various occupational and non-occupational NCDs such as Hypertension,

Diabetes, Respiratory diseases, various types of cancers, and epilepsy, among

others. Recently, mental health has also been taken care of under this purview.

Work for NCDs under HWCs has been keeping pace with targets. Some crucial

figures related to NCD screening in the sample facilities have been enumerated in

the figure below.

Figure 3.15: Percent Health and Wellness Centres started screening of various Non

Communicable Diseases

As is quite evident from the figure, while most HWCs have started screening for

Hypertension and Diabetes, the number of places currently screening for cancerous

diseases is extremely low. On the same footing, very few HWCs have actively

started screening for ophthalmic and mental disorders.

93 93

30

1520

14

Hypertension Diabities Oral Cancer Cervical Cancer Eye sight Mental Health


WASTE DISPOSAL

The ‘Equipment, consumables and miscellaneous supplies at SHC-HWC’ guideline

checklist for HWCs clearly mentions having the presence of colour coated dustbins for

proper medical waste disposal. There must be 4 dustbins of colours- blue, black, red, and

yellow.

Study results suggested that while 27 PHCs, 56 SHCs and 3 UPHCs reported following the

bio-medical waste disposal guidelines laid by the government, less than half of the HWCs

in the sample had all 4 dustbins available. While most of them had a red dustbin, the

count for the other three was very low.

Table 3.9: Key service performance of Health and Wellness centres by type

Key Service Performance SHC PHC UPHC Total

Maintenance of OPD register

Regular 91 38 6 135

Irregular 11 0 0 8

No maintenance 3 2 0 5

HWC equipped with diagnosis services

Yes 64 27 5 96

No 38 13 1 52

Maintenance of Diagnosis service register

Regular 13 1 0 14

Irregular 36 25 5 66

No maintenance 15 1 0 16

No of patients recommend for lab test (Dec 2020) 3954 513 36 4503

No of HWC conducted screening (Dec 2020)

Hypertension 96 35 6 137

Diabetes 95 37 6 138

Oral Cancer 33 10 2 45

Cervical Cancer 15 7 0 22

Eye sight 22 6 1 29

Mental Health 16 3 1 20


The detailed service performance data enumerated above stipulates regular OPD

register maintenance across all facilities in the state. However, diagnostic registers

are not being maintained by a majority of them. Regular referrals for lab tests have

also been made at each level of the health spectrum, with SHCs accounting for the

highest number of the same. Most NCD screenings have been made for

hypertension followed by diabetes, cancers, eyesight, and then mental health. The

high number of screenings for heart diseases may be pointing out some serious

issues that need to be addressed at the community level.


3.8 Health Promotion

Health promotion and information provision at the community level is an integral

part of the expanded range of services under Comprehensive Primary Health Care.

Health is affected by various social and environmental determinants. Often, actions

to address these issues do not fall in the purview of health systems alone, and

therefore require inter-sectoral convergence and people’s participation.

Under HWC operational guidelines, there are four target groups as far as health

promotion is concerned viz. the general population; population at risk; individuals

with symptoms and population with known disorders. As the figure shows, most

HWCs have initiated some form of health promotion activity. Only the UPHCs lag

behind in this regard with only two thirds of them having done so.

Figure 3.16: Percent HWC initiated health promotional activity

In order to understand the health promotional activities conducted in last three

months preceding the survey, some other parameters were also tested for,

including inquiring about the number of health awareness days celebrated by the

facilities in the sample. A list of such awareness days that fell between October to

December 2020 was made and, administered as a checklist during the survey itself.

Results show that of the 148 facilities in the sample, more than 100 celebrated

World Elderly Day and National Cancer Awareness Day. A lower number of facilities

celebrated the UHC Day and other days that fell in the same time bracket. A

detailed picture of the same can be obtained from the table in sight. On the

surface, it is clear that organising health camps is the most popular method of

health promotion, followed by community engagement programs. Other activities

seem less frequently undertaken.

76 7567

24 2433


Yes No


Figure 3.17: Number of events conducted by Health and wellness Centres (Oct-Dec 2020)

Table 3.10: Various Health Promotional activities conducted by Health and wellness

Centres from October to December 2020

SHC PHC UPHC Total

Any health promotional activity

Yes 78 30 4 112

No 24 10 2 36

Special Day conducted by HWC

World Elderly Day (1st October) 76 26 3 105

Health camp 50 21 2 73

Community engagement 24 5 0 29

Other activity 18 5 3 26

National Cancer Awareness Day

(7th November) 97 31 3 131




Universal Health Coverage Day

(12th December) 66 23 3 92




Other day 67 27 3 97


105

131

92 97

World Elderly Day(1st October)

National CancerAwareness Day(7th November)

Universal HealthCoverage Day

(12th December)

Other days


3.9 Integration with AYUSH

According to the HWC operational guidelines given by the centre, one of the most

important features of HWCs is to undertake health promotional activities while

engaging the community and alternate system of medicines. Accordingly, the

services of all AYUSH system (such as Ayurveda, Yoga & Naturopathy, Unani,

Siddha and Homoeopathy) would be made available in different areas based on

their use and acceptability. While all states have the free hand to decide on which

services they will be providing in their region, Yoga would be an integral part of all

the HWCs to be developed under Ayushman Bharat.

In this direction, information was gathered regarding HWCs having initiated any

coordination activity with AYUSH to undertake yoga sessions. The results show

that more than half of the sample HWCs reported having initiated coordination for

conducting Yoga sessions.

HWCs surveyed: 148

HWCs coordinated

with Ayush:

89 (60%)

HWCs any Yoga session:

81 (91%)

HWCs visited by an

Ayush Coordinator:

52 (64%)


Data analysis entails encouraging figures for AYUSH integration and indicates that

the approach to encompass alternate systems of medicine under preventive care is

working out to some extent. The table below provides a facility wise summary stat

for Yoga integration within HWCs in the state.

Table 3.11: Number of HWC Initiated coordination with AYUSH for Yoga sessions

SHC PHC UPHC Total

Coordination with AYUSH for Yoga sessions

Yes 64 22 3 89

No 38 18 3 59

Any Yoga session conducted (in Dec 2020)

Yes 60 18 3 81

No 4 4 0 8

No of Yoga session conducted (in Dec 2020) 218 100 7 325

AYUSH coordinator visited HWC (in Dec 2020)

Yes 34 16 2 52

No 26 2 1 29


3.10 Emergency Preparedness

The HWC guidelines state that facilities must be fully equipped to provide

emergency medical services (including, but not limited to burns and trauma) even

in case of a disaster. They would have to then take complete responsibility for

stabilization, referral management and continued care. In light of this, the

assessment took to finding out what HWCs had been doing to combat the COVID-

19 Pandemic.

Across the country, a very large number of HWCs have been operationalised within

the period of the pandemic itself, to ensure that their services reach the vast

community of citizens they serve. HWCs had also been transformed into testing

and screening points, for ease of identification and quick referral of suspects. To

check for this, we surveyed our sample on the level of their engagement and the

extent of trainings, if any, provided to the health workers, during the first wave of

the pandemic.


Figure 3.18: Percent HWC engaged during first wave of Covid-19 pandemic

As can be seen from the figure above, only 25 SHCs, 18 PHCs and 1 UPHC had been

engaged in providing any relief activities related to COVID-19 in the first wave. This is

less than 30 percent of the entire sample population.

Despite only a few facilities providing support, the first wave saw HWCs perform

many duties across an even wider spectrum of health care services than they are

originally used to. Their work ranged from awareness generation and door to door

testing in the first wave, to serving as dedicated vaccination centres from March

onwards, when the Government of India first approved vaccine administration by

select providers.

Figure 3.19: Engagement of HWC and its staff during first wave of Covid-19 pandemic

On a broader note, the incidence of the first and the second wave that came with

ensuring continued COVID care duty by those in charge, has given the system many

2518

144

7722

5104

HWC-SHC HWC-PHC HWC-UPHC Total

Yes No

HWC-SHC

•Training - Covid

approprite behaviour

•Awareness generation -

social distance, hygiene,

hand wash and use of

mask

•Door to door survey

•Covid-19 duty

•Maintaining records

•Testing

•Medicine distribution

HWC-PHC

•Training – Covid

appropriate behaviour

•Support for conducting

Yoga sessions

•Awareness - social

distance, hygiene, hand

wash and use of mask

•covid-19 duty

•Door to door survey

•Testing

• Medicine distribution

HWC-UPHC

•Awareness- social

distance, hygiene, hand

wash and use of mask


lessons to learn from. It has also stressed the need for proper planning and

management of medical resources, so that they can be employed for the care of

those who truly need them.

In this regard, it is important to recognise the role of HWCs as not only points for

screening and testing, but also as points of dedicated and continued care for those

suffering from the disease. From the survey results, it is quite evident that most

HWCs are currently not equipped with the requisite infrastructure to support a

greater influx of patients that need isolation and other facilities. For that matter,

the infographic below details out the resources that HWCs should be provided with

to combat with the ongoing pandemic and others that might follow it.

Figure 3.20: Emergency preparedness requirement at HWCs

HWC-SHC

1. Bed

2. Dressing facility

3. Stretcher/ Wheelchair

4. Internet

5. Oxygen

6. Nebulizer

7. IV stand

8. Neonatal care

9. Training

10. SOPs

HWC-PHC

1. Medical Officer

2. Lab Diagnosis

3. Oxygen

5. Access to ambulance

6. Training

7. SOPs

8. Stretcher

HWC-UPHC

1. Training

2. SOPs


Key learning

All the staff of HWC received training on COVID-19

Some PHC-HWCs had been converted into COVID care centres.

57 HWCs responded that they don’t need anything for emergency preparedness, most of these are from Mandsaur, Tikamgarh and Bhopal districts

Some SHC-HWC response for requirement for emergency preparedness includes stretchers, Oxygen cylinders and kit, wheel chairs, neo-natal care facility.

HWC staff did awareness drives and door to door survey COVID-19

All HWCs were provided with required supplies for COVID-19 cases like masks, sanitizers and PPE kits barring a few which are very small and had no COVID-19 handling responsibilities

Most of the HWC team thinks that more training is required for handling COVID pandemic.


152

107

Female Male

3.11 Client Response

Since the entire Health and wellness centre infrastructure has been made to

provide quality services to those who seek it, it is pertinent to note what they think

of the entire health ecosystem so created. Their suggestions towards capacity

building and service provision will let out the best of government’s efforts to better

health outcomes at all levels.

Table 3.12: Number of patients and care takers contacted during survey in Health and

wellness centres

HWC-SHC HWC-PHC HWC-UPHC Total

Number of Patients 159 71 10 240

Number of Caretakers 13 4 2 19

Total 172 75 12 259

The field team interacted with a total of 240 patients and 19 attendants at the

sample HWCs. Out of these, 69 were at PHCs, 12 at UPHCs and, the remaining 178 at

SHCs. The share of female respondents stands at 60 percent. The age of the

patients ranges between 7 to 85 years.

Figure 3.21: Number of Female and Male Patients or/and care takers contacted during

survey in Health and wellness centres

The major reasons for respondents to visit an HWC are fever, cold and, body pain.

Many patients also came for Blood Pressure and Diabetes check-up. Other reasons

for visiting include, but are not limited to, wound treatment, loose-motion,

vaccination, stomach-ache, TB, vaccination during pregnancy, pneumonia etc.


HWC-SHC

Cold and Fever

BP/Sugar Checkups

Pain -Stomach/body/head

ANC/ Immunization

Vomiting/loose motion

Pneumonia

TB

HWC-PHC

Cold and Fever

BP/Sugar checkups

ANC/ Immunization

Wound treatment

Itching/ Pain

HWC-UPHC

Cold and Fever

BP/Sugar checkups

ANC/ Immunization

Eye check up

Ring warm

The infographic below provides a facility wise report, documenting the most

common ailments that make them visit an HWC.

Figure 3.22: Key reasons by patients’ /care takers to visit HWC

With regards to the changes in quality of health care provision, the general

perception in the last two years is perceptible and positive. Still there are

challenges and 26 HWCs reported that there has been no significant change has

been observed in the last two years.

Community Voice –Changing paradigms

Rama Bai (name changed) is a 60-year-old woman from Pamakhedi village of

Punasa block in Khandwa district. She has been privy to the days when one had

to travel to Punasa or Khandwa, even for curing minor ailments. However, with

the opening of an HWC-SHC in her own village, she no longer has to travel far off

for treatment. She recalls how people in her village would ignore seeking

immediate medical care, purely because of the distance they had to travel. Now,

she says, the village folk, especially the women, can comfortably visit the facility

as and when they like and, most importantly, do not have to depend on men for

their care seeking transportation needs. The staff behaves very well and having

a lady CHO makes women feel safer and more comfortable with regards to their

medical needs.


Figure 3.23: Significant changes observed by patients in last two years in sampled HWCs

To summarise the response table above, clients believe that doctors are now

available and timely treatment is also possible. Staff attendance has improved, and

the quality of treatment has also amped up significantly. Most of them also believe

that infrastructure and hygiene standards are better than before and, the need to

travel long distances for treatment has also lessened to some extent.

HW

C-S

HC •Better building

•Medicines

available

•Staff available

•No need to go

out of the village

for consultationH

WC

-PH

C •Medicines

available

•Staff available

•Diagnosis facility

•Hospital opens on

time

HW

C-U

PH

C •Better Building

•Medicine

available

Key Changes after facility transformed

into an HWC

Activities like awareness

programs have increased

Patients have started trusting

the HWC for treatment and coming in more

numbers

Now patient don’t have to

travel more for treatment

Patient says that facility remain

open now

Now patient get proper treatment

and medicines on a daily basis.

Emergency facilities are available

Staff availability at HWC have increased


3.12 Monitoring and review

An attempt has been made to understand the programme monitoring and review

mechanism followed by district and block officers. A summary of feedback received

from district and block officers has been presented below:

•Skill gap

•Hand holding

•Emergency/pandemic

•Information Technology

•District Programme

Manager

•Block community

Manager

•Monthly meeting

•Whatapp Group

•Surprise visits

•Report verification

Monitoring system

Responsible staff

ChallengesEnableing

factors


4 Way Ahead

Ayushman Bharat – Health and Wellness Centres envisage meeting the prevention

and treatment aspect of the health and wellness of the population by providing

comprehensive primary health care services with easy access. The present

assessment is based on primary data collected in the month of January and

February 2021 from 148 Health and Wellness Centres, a sample taken from 7

districts in Madhya Pradesh. These districts were selected randomly considering the

representation of each division of the state. The assessment results highlight the

key operational status at the initial stage of the Ayushman Bharat-Arogyam Kendra

in the state of Madhya Pradesh. Although the programme is yet to meet the target

set by the Government of India, it is imperative to know the current operational

status of the health and wellness centres in the state to take the corrective action

before it is highlighted. The purpose of this assessment is to understand key

operational challenges before we set the baseline for health and wellness Centres

for Madhya Pradesh. The major observations would be:

Infrastructure: Infrastructure is one of the key areas in health service provision.

While there always exists scope for improvement in civil and physical

infrastructure, the analysis has brought out some serious challenges faced by HWCs

in the state. These include the most basic of amenities such as daily and

uninterrupted supply of running water, and continuous supply of electricity and the

internet. Going forward, the concerned must ensure that operationalisation should

be accompanied with provision of these basic facilities in each HWC. On the same

note, major repairs relating to physical infrastructure should be addressed on a

priority basis, with a focus to shift ownership from rented to government in a

phased manner. Innovative methods to efficiently utilise the vacant quarters

allocated for health care providers currently not occupied should also be

encouraged.

Primary health care team: Considering the staggering shortfall in Human Resources

for health across all geographies and facilities, the state must consider developing

alternate recruitment mechanisms for filling up the gaps so observed. Also, there is

a dire need for repeat training, orientation and skill building of the staff currently in

position, especially with regards to RMNCH+A. Owing to current times, these

trainings may be delivered completely online, with requisite SOPs in place.


Digitization: Consultations with DPMs brought out the fact that digitisation of

medical needs has been extremely helpful in maintaining regular supplies of

medicines at every HWC. The same approach can be adopted for refilling and

stocking up of other medical equipment as well, which would greatly help reduce

the time lost in manually passing such information. On the same note, CBAC form

digitisation is also an essential element, ensuring which would greatly benefit the

system.

Service provision: On the diagnostic front, opportunities to integrate the screening

and diagnosis process with national players such as the NPCDS (National

Programme for prevention and Control of Cancer, Diabetes,

Cardiovascular Diseases and stroke, in case of Non communicable Diseases) by

following nationally standardised guidelines and ensuring its continuum could go a

long way in ensuring well-being.

Health promotion and integration: Specific observations from the field also

mentioned unwillingness on part of the HWC population in terms of their

engagement with the health staff on account of AYUSH activities, especially YOGA.

In this regard, opportunities to increase community mobilisation by way of active

participation must be explored and implemented.

Urban Health and Wellness Centres: The assessment covers only 6 HWC-UPHC to

get a preliminary understanding of their current operational status in the state. It is

suggested to conduct a separate assessment exercise for Urban Health and

Wellness Centres.


Suggested Action Plan

Key Inputs Proposed actions Meeting essential output

Infrastructure Use of ITC for monitoring the

repair work

Ensure availability of running

water as top priority

1. HWC Data Base

2. Increased Access to

primary health care

services

3. Health Cards and

Family Health Folders

Logistics

e-Aushadhi like system for

maintenance of equipment can

be explore

Telemedicine/ICT

Review of functional status of

all the digital devices

Measures for ensuring net

connectivity

Plan for expansion of Tele-

medicine

Periodic review of digitization

of CBAC

Primary health

care team

Regular skill

building/reorientation plan at

district/state level

Continuous hand holding check

list

SOPs should be in place

Health

Promotion

Monthly calendar of events

displays at HWC, AWW and

Panchayat Building for wider

publicity and awareness

Develop community feedback

mechanism


5 Cases need attention

Case Study I

Where are improvements needed?

Village level SHCs are the first resort for people suffering from illness, who live in

the vicinity. In this case, sturdy infrastructure and good hygiene standards naturally

ensure the confidence of both, care seekers and care givers, in the facility.

Adilapidated SHC building gives the aura of ‘not being good’ among its visitors.

SHC MahuharKatra of Amarpatan block, Satna district is one such HWC. The CHO of

this facility has been posted here for the last eight months. According to her,

infrastructure is a major problem in the facility. The building is old and in a

dilapidated condition. Some repair work is going on but it is mostly superficial and

not sufficient.

The facility is also in need of very basic amenities like water and toilets. The staff

carries their drinking water from their homes; there is no running water in the

toilet. Paucity of running water affects the hygiene standards of the premises,

specifically the toilets. There is only one common toilet in the facility. The patients,

as well as the staff, suffer from the repercussions of staying in unhygienic

conditions. The SHC also does not have adequate and safe storage space for

medicines. This SHC had more than 200 OPD patients in the month of Dec-2020 and

most of them were women. In this case, having a hygienic toilet is a must for

enhancing confidence and comfort level of female patients.


Case Study II

The ideal infrastructure- pictures that speak for themselves

With a population of more than 64 percent belonging to the Scheduled Tribe

category, Dindori is quite a surprising success story. PHC Chanda in Block Bajag of

the district shows what infrastructure one should expect of a good HWC. It exudes

a very slick look owing to the presence of vitrified tiles on the floor as well as on the

walls. This helps keep the facility clean at all times. There is presence of a very clean

toilet facility, sitting area, ramp for differently abled etc., all of which were part of

the renovation program. Overall, the facility gives a positive vibe with regards to

efficiency and enhances the confidence and comfort of a patient. The only

challenge with this facility is availability of staff. Being a PHC, an MBBS MO should

be posted here, which is currently not the case.


Case Study III

Health and wellness Centre - Serving the purpose

HWC-SHC Syawani in Palera

Block of Tikamgarh district is

one good example of Health

and wellness Centres where

patients are getting the

intended facilities. Patients

are comfortable with the

CHO and other staff available

at the facility for providing

regular medical facilities. For

more sophisticated medical

care, they are referred to a

nearby PHC. Confidence and

comfort level of the patients

visiting was observed to be

very high. The general

perception among patients is

that the facility has improved

a lot over the years,

specifically due to posting of

the CHO and availability of

essential medicines without

which they would have

preferred going to a PHC or private doctors. The facility provides all basic medicines

and diagnostic services like blood pressure, diabetes etc. General maintenance is

good. However, drinking water amenities are in need of a check.


Case Study IV

Contrasting Facilities

A comparison between two HWC- SHCs of Mandsaur district brings out the

differences that revamping and renovation can bring about. A picture of SHC

Bukhari of Karhal block and SHC Umarikalan of Vijaypur block has been presented

below. SHC Umarikalan is a relatively newer building and in good shape, whereas

SHC Bukhari operates in an old and dilapidated building.

The insides are equally different. SHC Bukhari does not have any toilet facility,

space for consultation, running water provision or medicine storage facility. Even

the most basic mandates such as branding outside/painted walls have not been

taken care of. However, a CHO is available and EDs are promptly provided. While

SHC Umrikalan does not suffer from these inefficiencies, cleanliness of toilets,

availability of running water and lack of boundary walls is an issue that both HWCs

have been facing.


6 Annexure

Table A: Position of various Health Staff in HWC portal Vs Survey data, Jan -2021

S.no. District Facility MO CHO SN

MPW

(M)

MPW

(F) MO CHO SN

MPW-

(M)

MPW-

(F)

1 Bhopal SHC Khajoorisadak 0 1 NA 1 1 0 1 0 0 1

2 Bhopal SHC Kurana 0 1 NA 1 1 0 1 0 0 1

3 Bhopal SHC Mugaliyahat 0 1 NA 1 0 0 1 0 0 0

4 Bhopal SHC Imaliya 0 1 NA 1 1 0 1 0 0 0

5 Bhopal SHC Dillod 0 1 NA 1 0 0 1 0 1 1

6 Bhopal SHC Beelko 0 1 NA 1 0 0 1 0 0 0

7 Bhopal SHC Bagsi 0 1 NA 1 0 0 1 0 0 1

8 Bhopal SHC Khitwas 0 1 NA 1 0 0 1 0 0 1

9 Bhopal SHC Deepadi 0 1 NA 1 1 0 1 0 0 1

10 Bhopal SHC Semra Kala 0 1 NA 1 0 0 1 0 0 1

11 Bhopal SHC Jammusar kala 0 1 NA 1 0 0 0 1 0 1

12 Bhopal

SHC

BarkhedaBaramad 0 1 NA 1 0 0 1 0 1 0

13 Bhopal SHC BarkeraNathu 0 1 NA 1 1 0 1 0 1 0

14 Bhopal SHC Kodiya 0 1 NA 1 1 0 1 0 0 0

15 Bhopal SHC Kotra Chopra 0 1 NA 1 1 0 1 2 0 1

16 Bhopal PHC Ratibad 1 0 0 7 3 1 0 1 0 1

17 Bhopal PHC Toomda 1 0 1 1 0 1 0 1 0 0

18 Bhopal PHC Dhamarra 1 0 0 4 1 1 0 0 0 1

19 Bhopal PHC Phanda 1 0 1 2 2 1 0 1 0 0

20 Bhopal PHC Gunga 1 0 1 2 0 1 0 2 0 2

21 Bhopal PHC Barkhedi Dev 1 0 0 3 0 0 1 0 1 0

22 Bhopal UPHC Kotra 1 0 0 0 0 1 0 1 0 1

23 Dindori SHC Kanchanpur 0 1 NA 3 1 0 1 0 0 0

24 Dindori SHC Baraudi 0 1 NA 1 1 0 1 0 1 1

25 Dindori SHC Tikariya 0 1 NA 1 1 0 0 1 0 0

26 Dindori

SHC

TendumerMohthra 0 1 NA 1 1 0 1 0 0 1

27 Dindori SHC Jatadongri 0 1 NA 2 1 0 1 0 0 1

28 Dindori SHC Bondar 0 1 NA 2 1 0 1 0 1 0

29 Dindori SHC Kikratalab 0 1 NA 2 1 0 0 0 1 0

30 Dindori SHC Jalda 0 1 NA 2 1 0 1 0 0 0

31 Dindori SHC Mohanjhir 0 1 NA 1 1 0 0 0 0 0

32 Dindori SHC Jaldamudhiya 0 1 NA 1 1 0 1 0 0 0

33 Dindori SHC Sakka 0 1 NA 1 1 0 1 0 0 0

34 Dindori SHC Bilgarha 0 1 NA 1 1 0 1 1 0 0

35 Dindori SHC Harra 0 1 NA 2 1 0 1 0 0 0

36 Dindori SHC Mohtara 0 1 NA 1 1 0 1 0 1 1

37 Dindori SHC Chatuaa 0 1 NA 1 1 0 1 0 1 1



MPW

(M)

MPW

(F) MO CHO SN

MPW-

(M)

MPW-

(F)

38 Dindori SHC Ganeshpur 0 1 NA 1 1 0 1 0 7 0

39 Dindori SHC Madiyaras 0 1 NA 1 1 0 1 0 1 1

40 Dindori PHC Manikpur 1 0 1 1 1 1 0 1 0 0

41 Dindori PHC Kasturi Piperiya 1 0 1 1 1 1 0 1 0 0

42 Dindori PHC Chanda 1 0 0 1 1 0 0 1 0 0

43 Dindori PHC Kisalpuri 1 0 1 1 1 1 0 0 0 1

44 Dindori

PHC

Kamkomohaniya 1 0 1 1 1 0 0 1 1 0

45 Khandwa SHC Village 0 1 NA 1 0 0 1 0 0 0




49 Khandwa SHC Atutkhas 0 1 NA 1 0 0 1 0 1 0


51 Khandwa SHC Bhamgarh 0 1 NA 1 0 0 1 1 1 0


53 Khandwa SHC Vilage 0 1 NA 1 1 0 1 0 1 1


55 Khandwa SHC Pamakhedi 0 1 NA 1 1 0 1 0 1 0



58 Khandwa SHC Sivriya 0 1 NA 1 0 0 1 0 1 0


60 Khandwa PHC Village 1 0 0 5 1 0 0 1 1 0

61 Khandwa PHC Village 1 0 1 4 0 1 0 1 0 1

62 Khandwa PHC Jawar 1 0 1 3 1 2 0 1 0 2

63 Khandwa PHC Roshani 1 0 1 1 1 1 0 2 0 1

64 Khandwa PHC Singhada 1 0 1 1 1 1 0 2 1 1

65 Khandwa UPHC Village 1 0 1 3 1 1 0 1 0 0

66 Mandsaur SHC Sagra 0 1 NA 1 1 0 1 0 0 1

67 Mandsaur SHC Paronia 0 1 NA 1 1 0 1 0 0 0

68 Mandsaur SHC Dhariyakhedi 0 1 NA 1 1 0 1 0 0 1

69 Mandsaur SHC Borda 0 1 NA 1 1 0 1 0 0 1

70 Mandsaur

SHC

BarkhedaGangasa 0 1 NA 1 1 0 1 0 0 0

71 Mandsaur

SHC Barkheda

Rathore 0 1 NA 1 1 0 1 0 0 1

72 Mandsaur SHC Bhimpura 0 1 NA 2 0 0 1 0 0 0

73 Mandsaur SHC Goverdhanpura 0 1 NA 1 1 0 1 0 0 1

74 Mandsaur SHC Limbawas 0 1 NA 1 0 0 1 0 0 0

75 Mandsaur SHC Mundedi 0 1 NA 1 1 0 1 0 0 1

76 Mandsaur SHC Umriya 0 1 NA 1 1 0 1 0 1 1

77 Mandsaur SHC KachriyaJat 0 1 NA 1 0 0 1 0 0 1

78 Mandsaur SHC Khajurinag 0 1 NA 1 1 0 1 0 0 0



MPW

(M)

MPW

(F) MO CHO SN

MPW-

(M)

MPW-

(F)

79 Mandsaur SHC Eriya 0 1 NA 1 1 0 1 0 0 1

80 Mandsaur SHC Billod 0 1 NA 2 1 0 1 0 0 1

81 Mandsaur PHC Babulda 1 0 0 2 1 1 0 1 0 0

82 Mandsaur PHC Antaraliya 1 0 0 1 1 0 0 0 0 0

83 Mandsaur PHC Digaonmali 1 0 2 1 1 1 0 4 0 0

84 Mandsaur PHC Pawti 1 0 0 1 1 1 0 1 0 1

85 Mandsaur

PHC

DhablaMadhosingh 1 0 1 1 1 1 0 1 0 0

86 Mandsaur UPHC Narsinghpura 1 0 1 5 0 1 0 1 0 0

87 Satna SHC Bela 0 1 NA 1 0 0 1 0 2 0

88 Satna SHC Bhitari 0 1 NA 1 0 0 1 0 1 0

89 Satna SHC Dhobahat 0 1 NA 1 0 0 1 0 1 0

90 Satna SHC Gangwariya 0 1 NA 1 0 0 1 0 1 1

91 Satna SHC Gauhari 0 1 NA 1 0 0 1 0 1 0

92 Satna SHC Jamuna 0 1 NA 1 1 0 1 0 4 1

93 Satna SHC Villege 0 1 NA 1 1 0 1 0 1 1

94 Satna SHC Lohraura 0 1 NA 1 0 0 1 0 7 0

95 Satna SHC Madkara 0 1 NA 1 0 0 1 0 1 0

96 Satna SHC Mauhari 0 1 NA 2 1 0 1 0 2 1

97 Satna SHC Ramgarh 0 1 NA 1 1 0 1 0 1 1

98 Satna PHC Block 1 0 0 1 1 0 0 0 0 1

99 Satna PHC Birsinghpur 1 0 1 3 1 3 0 3 4 2

100 Satna PHC Jaso 1 0 1 3 0 1 1 2 1 1

101 Satna PHC Kuaan 2 0 2 1 0 1 0 1 1 3

102 Satna PHC Madhavgarh 1 0 0 1 0 1 0 0 2 2

103 Satna PHC Sajjanpur 1 0 0 1 1 1 1 2 0 2

104 satna UPHC Tikuriyatola 1 0 1 5 0 1 0 1 0 1

105 Sheopur SHC Budhera 0 1 NA 1 1 0 1 0 0 1

106 Sheopur SHC Bukhari 0 1 NA 1 0 0 1 0 0 1

107 Sheopur SHC Girdharpur 0 1 NA 1 1 0 1 0 0 1

108 Sheopur SHC Partwada 0 1 NA 1 0 0 1 0 0 0

109 Sheopur SHC Patonda 0 1 NA 1 0 0 1 0 0 0

110 Sheopur PHC Salapura 0 1 NA 1 0 0 1 0 0 0

111 Sheopur SHC Salmanya 0 1 NA 1 0 0 1 0 0 0

112 Sheopur SHC Sesaipura 0 1 NA 1 1 0 1 0 0 1

113 Sheopur SHC Silpuri 0 1 NA 1 0 0 1 0 0 0

114 Sheopur SHC Soikala 0 1 NA 1 0 0 1 0 0 0

115 Sheopur SHC Sonthwa 0 1 NA 1 1 0 1 0 0 1

116 Sheopur SHC Subkara 0 1 NA 1 0 0 1 0 1 0

117 Sheopur SHC Umarikalan 0 1 NA 1 0 0 1 0 0 0

118 Sheopur PHC Agra 1 0 1 9 1 1 0 1 0 0

119 Sheopur PHC Bargawa 1 0 0 8 2 1 0 1 0 1

120 Sheopur PHC Dantarda 1 0 1 4 2 1 0 2 0 0

121 Sheopur PHC Dhodhar 1 0 1 3 0 1 0 1 1 0



MPW

(M)

MPW

(F) MO CHO SN

MPW-

(M)

MPW-

(F)

122 Sheopur PHC Durgapuri 1 0 0 3 1 1 0 0 0 0

123 Sheopur PHC Premsar 2 0 0 4 2 1 0 1 0 0

124 Sheopur PHC Sahasram 1 0 1 7 2 1 0 1 0 1

125 Sheopur UPHC Hospital 2 0 1 7 0 2 0 1 0 0

126 Tikamgarh SHC Dhajrai 0 1 NA 1 0 0 0 0 0 1

127 Tikamgarh SHC Ranipura 0 1 NA 1 0 0 1 0 0 0

128 Tikamgarh SHC Maughat 0 1 NA 1 0 0 1 0 0 1

129 Tikamgarh SHC Acharra 0 1 NA 1 0 0 1 0 1 0

130 Tikamgarh SHC Alampura 0 1 NA 1 0 0 1 0 1 0

131 Tikamgarh SHC Deri 0 1 NA 1 1 0 1 0 1 0

132 Tikamgarh SHC Goar 0 1 NA 1 1 0 1 0 1 0

133 Tikamgarh SHC Hiranagar 0 1 NA 1 0 0 1 0 1 1

134 Tikamgarh SHC Kanjana 0 1 NA 1 1 0 1 0 1 0

135 Tikamgarh SHC Khiriya 0 1 NA 1 1 0 1 0 1 0

136 Tikamgarh SHC Syawani 0 1 NA 1 1 0 1 0 1 0

137 Tikamgarh SHC Lar 0 1 NA 1 0 0 1 0 1 1

138 Tikamgarh SHC Kundeshawar 0 1 NA 1 1 0 1 1 0 1

139 Tikamgarh SHC Samarra 0 1 NA 1 1 0 1 0 1 1

140 Tikamgarh SHC Nanni tehri 0 1 NA 1 0 0 1 0 0 0

141 Tikamgarh SHC Madhumar 0 1 NA 1 0 0 1 0 1 0

142 Tikamgarh PHC Lidhora 1 0 1 1 1 1 1 1 1 2

143 Tikamgarh PHC Astoan 1 0 0 1 1 0 0 1 3 0

144 Tikamgarh PHC Baisa 1 0 1 1 1 1 0 0 1 0

145 Tikamgarh PHC Bamhori kala 1 0 1 1 1 1 0 1 3 0

146 Tikamgarh PHC Dingora 1 0 1 1 1 0 0 1 1 1

147 Tikamgarh PHC Mohangarh 1 0 1 1 1 1 0 1 1 0

148 Tikamgarh UPHC Tikamgarh 1 0 3 5 0 1 0 3 0 0


Table B: Physical Infrastructure status as per HWC portal Vs Survey data, Jan -2021

S.

no. District Facility

Type of

building Branding

Renovation

left?

Type of

building Branding

Renovation

left?

1 Bhopal SHC Khajoorisadak Government yes yes Government yes need repair

2 Bhopal SHC Kurana Government yes yes Government yes need repair

3 Bhopal SHC Mugaliyahat Government yes yes Government yes need repair

4 Bhopal SHC Imaliya Government yes yes Government yes need repair

5 Bhopal SHC Dillod Government yes yes Government yes no

6 Bhopal SHC Beelko Government yes yes Government no no

7 Bhopal SHC Bagsi Government yes yes Government yes no

8 Bhopal SHC Khitwas Government yes yes Government no need repair

9 Bhopal SHC Deepadi Government yes yes Government yes no

10 Bhopal SHC Semra Kala Government yes yes Government yes no

11 Bhopal SHC Jammusar kala Government yes yes Government yes no

12 Bhopal

SHC

BarkhedaBaramad Government yes yes Government yes need repair

13 Bhopal SHC BarkeraNathu Government yes yes Government yes need repair

14 Bhopal SHC Kodiya Government yes yes Government yes need repair

15 Bhopal SHC Kotra Chopra Government yes yes Government yes need repair

16 Bhopal PHC Ratibad Government yes yes Government yes no

17 Bhopal PHC Toomda Government yes yes Government yes no

18 Bhopal PHC Dhamarra Government yes yes Government yes no

19 Bhopal PHC Phanda Government yes yes Government yes no

20 Bhopal PHC Gunga Government yes yes Government yes no

21 Bhopal PHC Barkhedi Dev Government yes yes Government no no

22 Bhopal UPHC Kotra Rented yes yes government Yes no

23 Dindori SHC Kanchanpur Government yes yes Government yes no

24 Dindori SHC Baraudi Government yes yes Government yes need repair

25 Dindori SHC Tikariya Government yes no Government yes need repair

26 Dindori

SHC

TendumerMohthra Government yes no Government yes need repair

27 Dindori SHC Jatadongri Government yes yes Government yes need repair

28 Dindori SHC Bondar Government yes yes Government yes no

29 Dindori SHC Kikratalab Government yes yes Government yes no

30 Dindori SHC Jalda Government yes yes Government yes no

31 Dindori SHC Mohanjhir Government yes no Government yes need repair

32 Dindori SHC Jaldamudhiya Government yes no Government yes no

33 Dindori SHC Sakka Government yes yes Government yes need repair

34 Dindori SHC Bilgarha Government yes no Government yes need repair

35 Dindori SHC Harra Government yes yes Government yes need repair

36 Dindori SHC Mohtara Government yes yes Government yes no

37 Dindori SHC Chatuaa Government yes yes Government yes need repair

38 Dindori SHC Ganeshpur Rented no no Rented no need repair


S.


Type of

building Branding

Renovation

left?

Type of

building Branding

Renovation

left?

39 Dindori SHC Madiyaras Government yes no Government yes no

40 Dindori PHC Manikpur Government yes yes Government yes no

41 Dindori

PHC Kasturi

Piperiya Government yes no Government yes need repair

42 Dindori PHC Chanda Government yes yes Government yes no

43 Dindori PHC Kisalpuri Government yes yes Government yes no

44 Dindori

PHC

Kamkomohaniya Government yes yes Government yes no

45 Khandwa SHC Village Government yes no Government yes no

46 Khandwa SHC Village Government yes no Government yes no

47 Khandwa SHC Village Government yes yes Rented yes no

48 Khandwa SHC Village Government yes yes Government yes need repair

49 Khandwa SHC Atutkhas Government yes no Government no need repair

50 Khandwa SHC Village Government yes no Government no no

51 Khandwa SHC Bhamgarh Government yes yes Government yes need repair

52 Khandwa SHC Village Government yes yes Government yes no

53 Khandwa SHC Vilage Government yes yes Government yes no

54 Khandwa SHC Village Government yes yes Government no need repair

55 Khandwa SHC Pamakhedi Government yes yes Government yes no

56 Khandwa SHC Village Government yes yes Government no need repair

57 Khandwa SHC Village Government yes yes Rented no need repair

58 Khandwa SHC Sivriya Government yes no Government no need repair

59 Khandwa SHC Village Government yes yes Government no no

60 Khandwa PHC Village Government yes yes Government yes no

61 Khandwa PHC Village Government yes yes Government yes no

62 Khandwa PHC Jawar Government yes yes Government yes no

63 Khandwa PHC Roshani Government yes yes Government yes no

64 Khandwa PHC Singhada Government yes yes Government yes no

65 Khandwa UPHC Village Rented yes no Rented yes no

66 Mandsaur SHC Sagra Government yes yes Government no need repair

67 Mandsaur SHC Paronia Government yes yes Government yes need repair

68 Mandsaur SHC Dhariyakhedi Government yes yes Government yes need repair

69 Mandsaur SHC Borda Government yes yes Government no need repair

70 Mandsaur

SHC

BarkhedaGangasa Government yes yes Government no need repair

71 Mandsaur

SHC Barkheda

Rathore Government yes yes Government yes need repair

72 Mandsaur SHC Bhimpura Government yes yes Government yes need repair

73 Mandsaur

SHC

Goverdhanpura Government yes yes Government yes need repair

74 Mandsaur SHC Limbawas Government yes yes Government yes need repair

75 Mandsaur SHC Mundedi Government yes yes Government no no


S.


Type of

building Branding

Renovation

left?

Type of

building Branding

Renovation

left?

76 Mandsaur SHC Umriya Government yes yes Government yes need repair

77 Mandsaur SHC KachriyaJat Government yes yes Government yes need repair

78 Mandsaur SHC Khajurinag Government yes yes Government yes no

79 Mandsaur SHC Eriya Government yes yes Government yes need repair

80 Mandsaur SHC Billod Government yes yes Government yes need repair

81 Mandsaur PHC Babulda Government yes yes Government yes no

82 Mandsaur PHC Antaraliya Government yes yes Government yes need repair

83 Mandsaur PHC Digaonmali Government yes yes Government yes no

84 Mandsaur PHC Pawti Government yes yes Government yes no

85 Mandsaur

PHC

DhablaMadhosingh Government yes yes Government yes no

86 Mandsaur

UPHC

Narsinghpura Rented yes yes Rented yes no

87 Satna SHC Bela Government yes no Government yes need repair

88 Satna SHC Bhitari Government yes no Government yes need repair

89 Satna SHC Dhobahat Government yes no Government yes need repair

90 Satna SHC Gangwariya Government yes no Government yes need repair

91 Satna SHC Gauhari Government yes no Government yes no

92 Satna SHC Jamuna Government yes no Government yes no

93 Satna SHC Villege Government yes no Government yes no

94 Satna SHC Lohraura Government yes no Government no need repair

95 Satna SHC Madkara Government yes no Government no need repair

96 Satna SHC Mauhari Government yes no Government no need repair

97 Satna SHC Ramgarh Government yes no Government yes no

98 Satna PHC Block Government yes yes Government no no

99 Satna PHC Birsinghpur Government yes yes Government yes no

100 Satna PHC Jaso Government yes no Government yes no

101 Satna PHC Kuaan Government yes yes Government yes no

102 Satna PHC Madhavgarh Government yes no Government yes no

103 Satna PHC Sajjanpur Government yes no Government yes no

104 satna UPHC Tikuriyatola Rented no no Rented yes no

105 Sheopur SHC Budhera Government yes yes Government yes need repair

106 Sheopur SHC Bukhari Government yes yes Government no need repair

107 Sheopur SHC Girdharpur Government yes yes Government yes need repair

108 Sheopur SHC Partwada Government yes yes Government yes no

109 Sheopur SHC Patonda Government yes yes Government yes need repair

110 Sheopur PHC Salapura Government yes yes Government yes need repair

111 Sheopur SHC Salmanya Government yes yes Government yes no

112 Sheopur SHC Sesaipura Government yes yes Government yes need repair

113 Sheopur SHC Silpuri Government yes yes Government yes need repair

114 Sheopur SHC Soikala Government yes yes Government no need repair


S.


Type of

building Branding

Renovation

left?

Type of

building Branding

Renovation

left?

115 Sheopur SHC Sonthwa Government yes yes Government no need repair

116 Sheopur SHC Subkara Government yes yes Government yes need repair

117 Sheopur SHC Umarikalan Government yes yes Government yes need repair

118 Sheopur PHC Agra Government yes yes Government yes no

119 Sheopur PHC Bargawa Government yes yes Government yes no

120 Sheopur PHC Dantarda Government yes yes Government yes no

121 Sheopur PHC Dhodhar Government yes yes Government yes need repair

122 Sheopur PHC Durgapuri Government yes yes Government yes need repair

123 Sheopur PHC Premsar Government yes yes Government yes no

124 Sheopur PHC Sahasram Government yes yes Government yes need repair

125 Sheopur UPHC Hospital Government yes yes Government yes need repair

126 Tikamgarh SHC Dhajrai Government yes yes Government yes no

127 Tikamgarh SHC Ranipura Government yes yes Government yes no

128 Tikamgarh SHC Maughat Government yes yes Government yes no

129 Tikamgarh SHC Acharra Government yes yes Government yes no

130 Tikamgarh SHC Alampura Government yes yes Government yes no

131 Tikamgarh SHC Deri Government yes yes Government yes no

132 Tikamgarh SHC Goar Government yes yes Government yes no

133 Tikamgarh SHC Hiranagar Government yes yes Government yes no

134 Tikamgarh SHC Kanjana Government yes yes Government yes no

135 Tikamgarh SHC Khiriya Government yes yes Government yes no

136 Tikamgarh SHC Syawani Government yes yes Government yes no

137 Tikamgarh SHC Lar Government yes yes Government yes no

138 Tikamgarh SHC Kundeshawar Government yes yes Government yes no

139 Tikamgarh SHC Samarra Government yes yes Government yes no

140 Tikamgarh SHC Nanni tehri Government yes yes Government yes no

141 Tikamgarh SHC Madhumar Government yes yes Government yes no

142 Tikamgarh PHC Lidhora Government yes yes Government no no

143 Tikamgarh PHC Astoan Government yes yes Government yes no

144 Tikamgarh PHC Baisa Government yes yes Government yes no

145 Tikamgarh PHC Bamhori kala Government yes yes Government yes no

146 Tikamgarh PHC Dingora Government yes yes Government yes no

147 Tikamgarh PHC Mohangarh Government yes yes Government yes no

148 Tikamgarh UPHC Tikamgarh Rented yes yes Government yes no


Table C: Various health screening activities undertaken by HWC as per HWC portal Vs Survey data, Jan -2021

S.no. District Facility Hyper-tension

Diabetes Oral

Cancer Breast Cancer

Cervical Cancer

Yoga initiated

Hyper-tension

Diabetes Oral


Cervical Cancer

Yoga initiated

1 Bhopal SHC Khajoorisadak yes yes yes yes no yes Yes Yes no no no Yes

2 Bhopal SHC Kurana yes yes yes yes yes yes Yes Yes no no no Yes

3 Bhopal SHC Mugaliyahat yes yes yes yes no yes Yes Yes no no no Yes

4 Bhopal SHC Imaliya yes yes yes yes no yes Yes Yes no no no Yes

5 Bhopal SHC Dillod yes yes yes yes no yes Yes Yes no no no Yes

6 Bhopal SHC Beelko yes yes yes yes no yes Yes Yes no no no Yes

7 Bhopal SHC Bagsi yes yes yes yes no yes Yes Yes no no no Yes

8 Bhopal SHC Khitwas yes yes yes yes no yes Yes Yes no no no Yes

9 Bhopal SHC Deepadi yes yes yes yes no yes Yes Yes no no no Yes

10 Bhopal SHC Semra Kala yes yes yes yes no yes Yes Yes no no no Yes

11 Bhopal SHC Jammusar kala yes yes yes yes no yes Yes Yes no no no Yes

12 Bhopal SHC BarkhedaBaramad yes yes yes yes no yes Yes Yes Yes no no Yes

13 Bhopal SHC BarkeraNathu yes yes yes yes no yes Yes Yes Yes no Yes Yes

14 Bhopal SHC Kodiya yes yes yes yes no yes Yes Yes Yes no no Yes

15 Bhopal SHC Kotra Chopra yes yes yes yes no yes Yes Yes no no no Yes

16 Bhopal PHC Ratibad yes yes yes yes yes yes Yes no no no no Yes

17 Bhopal PHC Toomda yes yes yes yes yes yes Yes Yes no no no Yes

18 Bhopal PHC Dhamarra yes yes yes yes yes yes Yes Yes no no no Yes

19 Bhopal PHC Phanda yes yes yes yes yes yes Yes Yes no no no Yes

20 Bhopal PHC Gunga yes yes yes yes yes yes no Yes no no no Yes

21 Bhopal PHC Barkhedi Dev yes yes yes yes yes yes Yes Yes no no no Yes

22 Bhopal UPHC Kotra yes yes yes yes yes yes Yes Yes no no no Yes

23 Dindori SHC Kanchanpur yes yes yes yes no yes Yes Yes no no no Yes

24 Dindori SHC Baraudi yes yes yes yes no yes Yes Yes no no no Yes

25 Dindori SHC Tikariya yes yes yes yes no yes Yes Yes no no no Yes

26 Dindori SHC TendumerMohthra yes yes yes yes no yes Yes Yes no no no Yes

27 Dindori SHC Jatadongri yes yes yes yes no yes Yes Yes no no no Yes

28 Dindori SHC Bondar yes yes yes yes no yes Yes Yes no no no Yes

29 Dindori SHC Kikratalab yes yes yes yes no yes Yes no no no no no

30 Dindori SHC Jalda yes yes yes yes no yes Yes Yes no no no Yes



Diabetes Oral


Cervical Cancer

Yoga initiated

Hyper-tension

Diabetes Oral


Cervical Cancer

Yoga initiated

31 Dindori SHC Mohanjhir yes yes yes yes no yes Yes Yes no no no Yes

32 Dindori SHC Jaldamudhiya yes yes yes yes no yes Yes Yes no no no Yes

33 Dindori SHC Sakka yes yes yes yes no yes Yes no no no no Yes

34 Dindori SHC Bilgarha yes yes yes yes no yes Yes Yes no no no Yes

35 Dindori SHC Harra yes yes yes yes no yes Yes Yes Yes no Yes Yes

36 Dindori SHC Mohtara yes yes yes yes no yes Yes Yes no no no Yes

37 Dindori SHC Chatuaa yes yes yes yes no yes no no no no no no

38 Dindori SHC Ganeshpur yes yes yes yes no yes Yes Yes Yes no no no

39 Dindori SHC Madiyaras yes yes yes yes no yes Yes Yes no no no Yes

40 Dindori PHC Manikpur yes yes yes yes no no Yes Yes no no no Yes

41 Dindori PHC Kasturi Piperiya yes yes yes yes no no Yes Yes no no no Yes

42 Dindori PHC Chanda yes yes yes yes no yes Yes Yes no no no Yes

43 Dindori PHC Kisalpuri yes yes yes yes yes yes Yes Yes Yes no Yes Yes

44 Dindori PHC Kamkomohaniya yes yes yes yes no yes Yes Yes Yes no no no

45 Khandwa SHC Village yes yes yes yes no yes Yes Yes Yes no no Yes

46 Khandwa SHC Village yes yes yes yes no yes Yes no no no no Yes

47 Khandwa SHC Village yes yes yes yes no yes Yes Yes no no no Yes


49 Khandwa SHC Atutkhas yes yes yes yes no yes Yes Yes Yes no no Yes


51 Khandwa SHC Bhamgarh yes yes yes yes no yes Yes Yes no no no no

52 Khandwa SHC Village yes yes yes yes no yes Yes Yes Yes no Yes no

53 Khandwa SHC Vilage yes yes yes yes no yes Yes Yes Yes no no no

54 Khandwa SHC Village yes yes yes yes no yes Yes Yes Yes no no no

55 Khandwa SHC Pamakhedi yes yes yes yes no yes Yes Yes Yes no Yes Yes

56 Khandwa SHC Village yes yes yes yes no yes Yes Yes Yes no Yes Yes


58 Khandwa SHC Sivriya yes yes yes yes no yes Yes Yes Yes no no Yes


60 Khandwa PHC Village yes yes yes yes yes no Yes Yes no no no no

61 Khandwa PHC Village yes yes yes yes yes yes Yes Yes no no no Yes

62 Khandwa PHC Jawar yes yes yes yes yes no Yes Yes Yes no Yes Yes



Diabetes Oral


Cervical Cancer

Yoga initiated

Hyper-tension

Diabetes Oral


Cervical Cancer

Yoga initiated

63 Khandwa PHC Roshani yes yes yes yes yes no Yes Yes no no no no

64 Khandwa PHC Singhada yes yes yes yes yes no Yes Yes Yes no Yes Yes

65 Khandwa UPHC Village yes yes yes yes yes no Yes Yes Yes no no Yes

66 Mandsaur SHC Sagra yes yes yes yes no yes Yes Yes Yes no no no

67 Mandsaur SHC Paronia yes yes yes yes no yes Yes Yes Yes no no no

68 Mandsaur SHC Dhariyakhedi yes yes yes yes no yes Yes Yes Yes no no no

69 Mandsaur SHC Borda yes yes yes yes no yes Yes Yes Yes no Yes Yes

70 Mandsaur SHC BarkhedaGangasa yes yes yes yes no yes Yes Yes Yes no Yes no

71 Mandsaur SHC Barkheda Rathore yes yes yes yes no no Yes Yes Yes no Yes no

72 Mandsaur SHC Bhimpura yes yes yes yes no yes no no Yes no no no

73 Mandsaur SHC Goverdhanpura yes yes yes yes no yes Yes Yes Yes no no no

74 Mandsaur SHC Limbawas yes yes yes yes no yes Yes Yes Yes no Yes no

75 Mandsaur SHC Mundedi yes yes yes yes no yes Yes Yes Yes no Yes no

76 Mandsaur SHC Umriya yes yes yes yes no yes Yes Yes Yes no Yes no

77 Mandsaur SHC KachriyaJat yes yes yes yes no yes Yes Yes Yes no Yes no

78 Mandsaur SHC Khajurinag yes yes yes yes no yes Yes Yes Yes no Yes no

79 Mandsaur SHC Eriya yes yes yes yes no yes Yes Yes Yes no Yes no

80 Mandsaur SHC Billod yes yes yes yes no yes Yes Yes Yes no Yes no

81 Mandsaur PHC Babulda yes yes yes yes yes yes Yes Yes Yes no no no

82 Mandsaur PHC Antaraliya yes yes yes yes yes yes Yes Yes no no no Yes

83 Mandsaur PHC Digaonmali yes yes yes yes no yes Yes Yes Yes no Yes no

84 Mandsaur PHC Pawti yes yes yes yes yes yes Yes Yes Yes no no Yes

85 Mandsaur PHC DhablaMadhosingh yes yes yes yes yes no Yes Yes Yes no Yes no

86 Mandsaur UPHC Narsinghpura yes yes yes yes yes yes Yes Yes Yes no no no

87 Satna SHC Bela yes yes yes yes no yes Yes Yes no no no Yes

88 Satna SHC Bhitari yes yes yes yes no yes Yes Yes no no no no

89 Satna SHC Dhobahat yes yes yes yes no yes Yes Yes no no no Yes

90 Satna SHC Gangwariya yes yes yes yes no yes no no no no no no

91 Satna SHC Gauhari yes yes yes yes no yes Yes no no no no no

92 Satna SHC Jamuna yes yes yes yes no yes Yes Yes no no no Yes

93 Satna SHC Villege yes yes yes yes no yes Yes Yes Yes no no no

94 Satna SHC Lohraura yes yes yes yes no yes Yes Yes Yes no no no



Diabetes Oral


Cervical Cancer

Yoga initiated

Hyper-tension

Diabetes Oral


Cervical Cancer

Yoga initiated

95 Satna SHC Madkara yes yes yes yes no yes Yes Yes no no no Yes

96 Satna SHC Mauhari yes yes yes yes no yes Yes Yes no no no no

97 Satna SHC Ramgarh yes yes yes yes no yes Yes Yes no no no Yes

98 Satna PHC Block yes yes yes yes yes no no no no no no no

99 Satna PHC Birsinghpur yes yes yes yes yes yes Yes Yes no no no Yes

100 Satna PHC Jaso yes yes yes yes yes no no no no no no Yes

101 Satna PHC Kuaan yes yes yes yes yes yes Yes Yes no no no no

102 Satna PHC Madhavgarh yes yes yes yes yes no Yes Yes no no no Yes

103 Satna PHC Sajjanpur yes yes yes yes yes no Yes Yes no no no no

104 satna UPHC Tikuriyatola yes yes yes yes no no Yes Yes no no no no

105 Sheopur SHC Budhera yes yes yes yes no yes Yes Yes Yes no no no

106 Sheopur SHC Bukhari yes yes yes yes no yes Yes Yes no no no Yes

107 Sheopur SHC Girdharpur yes yes yes yes no yes Yes Yes no no no Yes

108 Sheopur SHC Partwada yes yes yes yes no yes Yes Yes no no no Yes

109 Sheopur SHC Patonda yes yes yes yes no yes Yes Yes no no no Yes

110 Sheopur PHC Salapura yes yes yes yes no yes Yes Yes no no no Yes

111 Sheopur SHC Salmanya yes yes yes yes no yes Yes Yes no no no Yes

112 Sheopur SHC Sesaipura yes yes yes yes no yes Yes Yes no no no Yes

113 Sheopur SHC Silpuri yes yes yes yes no yes Yes Yes no no no Yes

114 Sheopur SHC Soikala yes yes yes yes no yes Yes Yes no no no Yes

115 Sheopur SHC Sonthwa yes yes yes yes no yes Yes Yes no no no Yes

116 Sheopur SHC Subkara yes yes yes yes no yes Yes Yes no no no Yes

117 Sheopur SHC Umarikalan yes yes yes yes no yes Yes Yes no no no no

118 Sheopur PHC Agra yes yes yes yes no no no Yes no no no no

119 Sheopur PHC Bargawa yes yes yes yes no yes Yes Yes no no no no

120 Sheopur PHC Dantarda yes yes yes yes no no Yes Yes no no no no

121 Sheopur PHC Dhodhar yes yes yes yes no no Yes Yes no no no Yes

122 Sheopur PHC Durgapuri yes yes yes yes no no Yes Yes no no no no

123 Sheopur PHC Premsar yes yes yes yes no no Yes Yes no no no no

124 Sheopur PHC Sahasram yes yes yes yes no no Yes Yes no no no Yes

125 Sheopur UPHC Hospital yes yes yes yes no no Yes Yes no no no no

126 Tikamgarh SHC Dhajrai yes yes yes yes no yes Yes Yes no no no Yes



Diabetes Oral


Cervical Cancer

Yoga initiated

Hyper-tension

Diabetes Oral


Cervical Cancer

Yoga initiated

127 Tikamgarh SHC Ranipura yes yes yes yes no yes Yes Yes Yes no no no

128 Tikamgarh SHC Maughat yes yes yes yes no yes no Yes no no no no

129 Tikamgarh SHC Acharra yes yes yes yes no yes Yes Yes no no no no

130 Tikamgarh SHC Alampura yes yes yes yes no yes Yes Yes no no no Yes

131 Tikamgarh SHC Deri yes yes yes yes no yes Yes Yes no no no Yes

132 Tikamgarh SHC Goar yes yes yes yes no yes Yes Yes no no no no

133 Tikamgarh SHC Hiranagar yes yes yes yes no yes Yes Yes no no no no

134 Tikamgarh SHC Kanjana yes yes yes yes no yes Yes Yes no no no no

135 Tikamgarh SHC Khiriya yes yes yes yes no yes Yes Yes no no no Yes

136 Tikamgarh SHC Syawani yes yes yes yes no no no Yes no no no Yes

137 Tikamgarh SHC Lar yes yes yes yes no no Yes Yes no no no no

138 Tikamgarh SHC Kundeshawar yes yes yes yes no yes Yes Yes no no no no

139 Tikamgarh SHC Samarra yes yes yes yes no yes Yes Yes no no no no

140 Tikamgarh SHC Nanni tehri yes yes yes yes no yes Yes Yes no no no Yes

141 Tikamgarh SHC Madhumar yes yes yes yes no yes no Yes no no no Yes

142 Tikamgarh PHC Lidhora yes yes yes yes yes yes Yes Yes Yes no Yes no

143 Tikamgarh PHC Astoan yes yes yes yes no yes Yes Yes Yes no Yes no

144 Tikamgarh PHC Baisa yes yes yes yes yes yes no Yes no no no no

145 Tikamgarh PHC Bamhori kala yes yes yes yes no yes Yes Yes no no no Yes

146 Tikamgarh PHC Dingora yes yes yes yes yes yes Yes Yes no no no no

147 Tikamgarh PHC Mohangarh yes yes yes yes yes yes Yes Yes no no no Yes

148 Tikamgarh UPHC Tikamgarh yes yes yes yes no yes Yes Yes no no no Yes

Atal Bihari Vajpayee Institute of Good Governance and Policy Analysis (ISO 9001:2015)

A Regd. Body of Govt. of M.P. under Public Service Management Department, Sushasan Bhavan, Bhadbhada

Square, Bhopal - 462003, Madhya Pradesh Website: www.aiggpa.mp.gov.in

‘arogyam kendra’ - aiggpa.mp.gov.in

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