Health & Family Welfare Schemes

AYUSHMAN BHARAT DIGITAL MISSION (ABDM) -- Detailed Notes

To support the integrated digital health infrastructure of the country to bridge the gaps in existing digital health solutions. Objective Central Sector Components Critical Care Hospital Blocks in 12 Central Institutions. Strengthening Disaster and Epidemic Preparedness: Support for 15 Health Emergency Operation Centres & 2 Container based mobile hospitals. Strengthening surveillance of infectious diseases and outbreak response: Support for 20 Metropolitan Surveillance Units, 5 Regional NCDCs and implementation of IHIP in all states.

Strengthening surveillance capacities at Points of Entry: Support for 17 new Points of Entry Health Units and Strengthening of 33 existing Units. Bio-security preparedness and strengthening Pandemic Research and Multi Sector, National Institutions and Platforms for One Health: Support for setting up of a National Institution for One Health, a Regional Research Platform for WHO South East Asia Region, 9 Bio-Safety Level III Laboratories and 4 new Regional National Institutes of Virology (NIVs).

Unified Health Interface (UHI): Envisioned as an open protocol for various digital health services. - UHI will enable service including appointment, teleconsultation, etc. Microsite Project: A Microsite is a defined universe of healthcare stakeholders (all healthcare providers, labs, pharmacies etc.) interconnected by a common characteristic which among others include - a defined geographical area, - common ownership, - part of a common association/group etc. Microsites are implemented with the objective to counter various challenges encountered in ABDM adoption, especially for Private sector providers.

Focused outreach efforts within a Microsite can increase awareness about ABDM and showcase different benefits of ABDM for both patients and providers. Building blocks of ABDM includes Ayushman Bharat Health Account (ABHA) and ABHA App Health Facility Registry Healthcare Professionals Registry Unified Health Interface (UHI) Type: Centrally Sponsored Scheme Purpose: Achievement of universal access to equitable, affordable & quality Health care services Support to states: Financial and technical support is provided to States / Union Territories (UTs) for improving infrastructure Mission Head: Mission Director of the rank of Additional Secretary.

Beneficiaries: Universal benefit – i.e., covers entire population with a special focus on the vulnerable

Quick Facts

AYUSHMAN BHARAT - PRADHAN MANTRI JAN AROGYA YOJANA (AB-PMJAY) -- Detailed Notes

Salient Features

Pradhan Mantri Jan Arogya Yojana (PM-JAY) Background: The erstwhile National Health Protection Scheme (NHPS) has been rechristened as PM- JAY. It is the largest health assurance scheme in the world. Beneficiaries: - Identified through Socio-Economic Caste Census-2011 (SECC-2011). - Also, families that were covered under Rastriya Swasthya Bima Yojana (RSBY) but did not form

3 modes of implementation - Insurance: SHA pays premium to the insurance company per eligible family for the policy period. - Assurance/Trust: SHA directly reimburse the healthcare providers. - Mix: Mix of above two. Implementing Agencies: National Health Authority (NHA) an autonomous body chaired by the Union Minister of Health & Family Welfare. State: SHA headed by CEO appointed by the state government. District: District Implementing Unit (DIU) chaired by DC/DM/Collector of the district. Transparency and accountability:

4 modes of verification of beneficiaries-Aadhar based e-KYC, Finger print, iris scan, and face authentication. Whistle Blower Policy issued by the NHA. Anti-Fraud Cell in the state for carrying out surprise inspections, imposing penalties, de-empanelment, etc. Key initiatives Ayushman Bhava campaign: To extend comprehensive healthcare coverage to every village and town, transcending geographical barriers and ensuring that no one is left behind. It aims to saturate coverage of health services through its three components Ayushman - Apke Dwar 3.0, Ayushman Melas at Health and Wellness Centres (HWCs) and Community Health Centres (CHCs) and Ayushman Sabhas in every village and panchayat Benefits Benefits will be portable across the country Service available across public and private EHCP No cap on family size or age All pre-existing conditions are covered from day one Technologically driven, enables cashless and paperless transaction Coverage of 3 days of pre- hospitalisation and 15 days of post-hospitalisation expenses including medicines, follow up consultation and diagnostics.

Treatment of COVID-19 patients had also been covered from April 2020. Rs 5 lakhs per family per year for secondary and tertiary care hospitalization

Purpose: To establish a health system which will respond effectively to the future pandemics/disasters. Type: Centrally Sponsored Scheme with Some Central Sector Components. Focus: Developing capacities of health systems and institutions across the continuum of care at all levels viz. primary, secondary and tertiary. Tenure: 6 years from 2021 to 2026. Quick Facts To strengthen grass root public health institutions to deliver universal Comprehensive Primary Health Care. Strengthen public health institutions to meet challenges posed by the current and future pandemics/ epidemic.

To expand and build an IT enabled disease surveillance system for effectively detecting, investigating, preventing and combating Public Health Emergencies and Disease Outbreaks. To support research on COVID-19 and other infectious diseases and to develop core capacity to deliver the One Health Approach. Objective

AYUSHMAN BHARAT HEALTH INFRASTRUCTURE MISSION (ABHIM) -- Detailed Notes

Background: Announced in, 2021 as ‘Prime Minister Atmanirbhar Swasth Bharat Yojana’ (PMASBY)

This scheme is in addition to the National Health Mission. Centrally Sponsored Scheme Components ‘Ayushman Arogya in rural areas: support for infrastructure development is proposed in 7 High Focus States (Bihar, Jharkhand, Odisha, Punjab, Rajasthan, UP and WB) and 3 North Eastern States (Assam, Manipur and Meghalaya). ‘Ayushman Arogya Mandir’ in Urban areas: Support for 11044 Urban Health & Wellness Centres across the country is proposed under this component. Block Public Health Units: Support for 3382 BPHUs in 11 High Focus States/ UTs (Assam, Bihar, Chhattisgarh, Himachal Pradesh, UT - Jammu and Kashmir, Jharkhand, Madhya Pradesh, Odisha, Rajasthan, Uttar Pradesh and Uttarakhand) - For the remaining States, the support for establishing BPHUs is being provided under FC-XV Health Grants through Local Governments .

• For the UTs, the proposed District Integrated Public Health Labs under the PM ABHIM at the Districts will be catering the needs of the Blocks in the UTs. Integrated District Public Health Laboratories in all districts. Critical Care Hospital Blocks in all districts with a population more than 5 lakhs, in state government medical colleges / District Hospitals. Salient Features

Key components ABHA and ABHA App - ABHA is a 14-digit identification number, generated using an Aadhaar or mobile number. A hassle- free method of accessing and sharing your health records digitally. - ABHA App allows self-uploading/scanning of existing physical health records such as diagnostic reports, prescriptions, etc. Health Facility Registry: Comprehensive repository of all health facilities (Includes both public and private health facilities ) of country across different systems of medicine.

Healthcare Professionals Registry: Comprehensive repository of all healthcare professionals involved in healthcare delivery services across both modern and traditional systems of medicine. Salient Features Purpose: To integrate digital health solutions for continuum of care, and effective utilization of resources Type: Central Sector Scheme Tenure: 5 years Implementing Agency: National Health Authority (NHA) Quick Facts

NATIONAL HEALTH MISSION (NHM) -- Detailed Notes

Reduction in child and maternal mortality. Prevention and control of communicable and non-communicable diseases. Access to integrated comprehensive primary health care. Population stabilisation , gender and demographic balance. Revitalize local health traditions & mainstream AYUSH Universal access to public services for food and nutrition, sanitation and hygiene and universal access to public health care. Promotion of healthy lifestyles. Objective

Background: The National Rural Health Mission (NRHM) was launched in 2005. In 2012, the National Urban Health Mission (NUHM) was conceptualized and the NRHM was rechristened as the National Health Mission (NHM) with the two Sub Missions viz. the NRHM and the NUHM. Scheme is divided in 2 Sub-Mission National Urban Health Mission (NUHM): Focuses on improving health infrastructure and services in urban areas. National Rural Health Mission (NRHM): Focuses on improving health infrastructure and services in rural areas.

National Urban Health Mission (NUHM) Coverage: all State capitals, district headquarters and cities/towns with a population of more than 50000. Decentralised: Need based city specific urban health care system and implemented in partnership with community and local bodies and NGOs. External aide: Funding is being provided by the Asian Development Bank (ADB) based on progress related to certain indicators. Service Delivery Infrastructure: Urban–Primary Health Centre, Urban-Community Health Centre (U-CHC) and Referral Hospitals and Outreach services.

National Rural Health Mission The thrust of the mission is on establishing a fully functional, community owned, decentralized health delivery system with inter-sectoral convergence at all levels. The mission will ensure simultaneous action on a wide range of determinants of health such as water, sanitation, education, nutrition, social and gender equality. Programme Implementation Plan (PIP): The financing to the state is based on the state’s Programme Implementation Plan (PIP) which is based on:

NRHM RCH Flexipool NUHM Flexipool Flexible Pool for Communicable Diseases Flexible Pool for Non Communicable Diseases, Injury and Trauma Part Infrastructure Maintenance Performance Incentive to states: States that show improved progress made on key Outcomes/Outputs such as IMR, MMR, etc. can receive additional funds as incentives. Key implementing bodies Apex body for technical support: National Health Systems Resource Centre (NHSRC) Apex body for training: National Institute of Health and Family Welfare (NIHFW) Policy direction at national level: Provided by the Mission Steering Group (MSG) chaired by the Union Minister of Health & Family Welfare Key initiatives under NHM Janani Suraksha Yojana:

It is also a demand promotion and conditional cash transfer scheme for promoting institutional delivery. Salient Features

Type: It is 100% Centrally Sponsored Scheme. Safe Motherhood Intervention Objective: Reducing maternal mortality by promoting institutional delivery among pregnant women belonging to weaker sections of society. Beneficiaries of JSY Low performing states *-all pregnant women after institutional delivery High performing states - Below Poverty Line (BPL) women and the SC and ST women after institutional delivery, up to 2 live births *States with low institutional delivery rate Launched in 2005 ASHA act as a link between poor pregnant women and public health sector Focus on 10 low performing states Incentives for ASHA and mother for each institutional delivery Low performing states Rural areas Urban areas High performing states Rural areas Urban areas Rs. 1400 Rs. 1000 Rs. 700 Rs. 600 Rs. 600 Rs. 400 Rs. 600 Rs. 400

Janani Shishu Suraksha Karyakram (JSSK) Objectives: To provide better health facilities for pregnant women and neonates and mitigate the problem of out-of-pocket expenses. Facilitates ‘zero expense deliveries’ to pregnant women who access Government health facilities for their delivery (refer to the infographics). Free assured ambulance services & transport from home to facility & drop back Similar facilities extended to infants up to a year old Free drugs, diagnostics and blood transfusion Free delivery/ caesarean section Janani Shishu Suraksha Karyakram Rashtriya Bal Swasthya Karyakram (RBSK) Aim: Early identification and early intervention for children to cover 4 ‘D’s viz. Defects at birth, Deficiencies, Diseases, Development delays including disability.

Intended beneficiary: All children of 0-6 years of age group in rural areas and urban slums, and children up to 18 years of age enrolled in classes 1st to 12th in Government and Government aided schools. Child Health Screening and Early Intervention Services envisages to cover 30 selected health conditions for Screening, early detection and free management. Rashtriya Kishor Swasthya Karyakram (RKSK) Beneficiaries: Adolescents, in the age group of 10-19 years The programme envisions enabling all adolescents in India to realize their full potential by making informed and responsible decisions related to their health and well-being.

Students are screened in schools and then referred to health facilities for early detection of diseases, particularly the non-communicable diseases (NCDs). Community-based interventions through peer educators called Saathiya . Saathiya resource kit to help peer educators, especially in villages, discuss sensitive issues and answer teenage queries.

National Adolescent Health Strategy has been developed by the MoHFW in collaboration with UN Population Fund (UNFPA). Menstrual Hygiene Scheme (MHS) provides subsidized sanitary napkins among adolescent girls residing primarily in rural areas. RMNCH+A (Reproductive, Maternal, Newborn, Child and Adolescent Health): The RMNCH+A strategy promotes links between various interventions across thematic areas to enhance coverage throughout the lifecycle to improve child survival in India. The “plus” within the strategy focuses on:

Inclusion of adolescence as a distinct life stage within the overall strategy. Linking maternal and child health to reproductive health and other components like family planning, adolescent health, HIV, gender, and preconception and prenatal diagnostic techniques. Linking home and community-based services to facility-based services. Ensuring linkages, referrals, and counter-referrals between and among various levels of health care system to create a continuous care pathway, and to bring an additive /synergistic effect in terms of overall outcomes and impact.

Pradhan Mantri Surakshit Matritva Abhiyan - Aim: To provide assured, comprehensive and quality antenatal care, free of cost, universally to all pregnant women on the 9th of every month. - PMSMA guarantees a minimum package of antenatal care services to women in their 2nd / 3rd trimesters of pregnancy at designated government health facilities. - Provides for engagement with private sector like motivating private practitioners to volunteer for the campaign; etc. Universal Immunisation Programme (UIP) It is a 100% Funded by the central government.

It was launched in 1985, and is one of the largest immunizations programmes in the world. Background: In 2014, India launched Mission Indradhanush (MI), flagship programme with the aim to improve Routine Immunization coverage. Subsequently MI 2 and MI3 were also launched. IMI4.0 was launched to catch up on gaps that might have emerged due to the COVID-19 pandemic. IMI 5.0 ensures that routine immunization services reach the missed-out and dropped out children and pregnant women across the country.

Pradhan Mantri Surakshit Matritva Abhiyan Improve the quality of care during ante-natal visits Antenatal checkup for pregnant women in second or third trimester Identification & line-listing of high risk pregnancies based on medical history Appropriate birth planning and complication readiness Emphasis on early diagnosis, appropriate management of women with malnutrition R e p r o d u c t i v e a n d S e x u a l H e a l t h M e n t a l a n d E m o t i o n a l W e l l - b e i n g H e a l t h y L i f e s t y l e V i o l e n c e - f r e e L i v i n g i m p r o v e d n u t r i t i o n a l s t a t u s S u b s t a n c e M i s u s e P r e v e n t i o n R e d u s e S u b s t a n c e A b u s e Health Promotion for Healthy Community Strengthened Clinical Services Strategic Partnerships Community based approach Making Informed Decisions for Health and Well-being Objectives of RKSK

• Special focus is on improvement of Measles and Rubella vaccination coverage with the aim of Measles & Rubella elimination by 2023. - It will ensure reach out to unvaccinated and partially vaccinated children and pregnant women across Country. Diphtheria Vaccine Pertussis Vaccine Tetanus Vaccine Polio Vaccine Measles Vaccine Hepatitis B Vaccine Pentavalent Vaccine Rotavirus Vaccine Rubella Vaccine Adult JE Vaccine Japanese Encephalitis Vaccine Bivalent Oral Polio Vaccine (bOPV) Measles-Rubella Vaccine (MR) Inactivated Polio Vaccine (IPV)

under UIP Communicable Disease Control Programme National Vector Borne Disease Control Programme (NVBDCP) for prevention and control of vector borne diseases namely Malaria, Japanese Encephalitis, Dengue, Chikungunya, Kala-azar and Lymphatic Filariasis. National Tuberculosis Elimination Programme (NTEP) to strategically reduce TB burden in India by 2025, five years ahead of the Sustainable Development Goals. - Nikshay Poshan Yojana (NPY) scheme for provides incentives for nutritional support to TB patients.

• Financial incentive of Rs.500/- per month in cash or Kind for each notified TB patient for duration for which the patient is on anti-TB treatment is given through DBT in Aadharenabled bank account of beneficiary. National Leprosy Eradication Programme (NLEP) to provide quality leprosy services free of cost to all sections of the population. Integrated Disease Surveillance Programme (IDSP) to strengthen/maintain decentralized laboratory based IT enabled disease surveillance system for epidemic prone diseases.

Non-Communicable Disease Control Programmes National Programe For Control Of Blindness & Visual Impairment (NPCBVI): - Aim: Reducing the prevalence of avoidable blindness to 0.25% by the year 2025. - The programmes is focused on cataract, refractive errors, childhood blindness and other eye diseases like glaucoma, diabetic retinopathy, etc. associated with lifestyle diseases like diabetes and aging process. Other programmes - National Programme for prevention & Control of Cancer, Diabetes, Cardiovascular Diseases & stroke (NPCDCS) - National Mental Health Programme (NMHP) - National Programme for healthcare of Elderly (NPHCE) - National Programme for Palliative care (NPPC) - National Programme for the Prevention & Control of Deafness (NPPCD) - National Tobacco Control Programme (NTCP) - National Programme for Prevention & Management of Burn Injuries (NPPMBI) - National Oral Health Programme(NOHP)

Electronic Vaccine Intelligence Network (e-VIN) It combines state-of-the-art technology, a strong IT infrastructure and trained human resource to enable real time monitoring of stock and storage temperature of the vaccines kept in multiple locations across the country. It is implemented under the National Health Mission (NHM). Emergency Response and Health Systems Preparedness Package (ECRP) Phase-I NHM is the implementing agency for the ECRP Phase-I. ECRP-I was launched to accelerate health system preparedness for immediate responsiveness for early prevention, detection and management of COVID-19.

It is a 100% centrally supported intervention to supplement existing resources for health systems strengthening. Integrated Disease Surveillance Programme (IDSP) Objective: To strengthen/maintain decentralized laboratory based IT enabled disease surveillance system for epidemic prone diseases. It helps to monitor disease trends and to detect and respond to outbreaks in early rising phase through trained Rapid Response Team (RRTs). eSanjeevani A national telemedicine service that strives to provide an alternative to conventional physical consultations via digital platform.

2 Verticals of eSanjeevani Connects ‘Ayushman Bharat-Health and Wellness Centers’ (HWCs) with Specialty/Super-Specialty doctors at zonal level in 'Hub-and-Spoke' model. Enabling doctor consultations to be accessible from the patient’s residence regardless of location e-Sanjeevani OPD e-Sanjeevani AB-HWC The National Health Authority (NHA) announced the successful integration of eSanjeevani with ABDM (Ayushman Bharat Digital Mission). The integration allows the existing eSanjeevani users to easily create their Ayushman Bharat Health Account (ABHA) and use it to link and manage their existing health records.