Author: Ms. Deepa Jha, General Manager, Projects, ECHO India, and Dr. Anisha Mathew, Senior Executive, Monitoring, Evaluation, and Research, ECHO India

India's healthcare system is on a path towards achieving Universal Health Coverage (UHC) by addressing the significant gaps in healthcare delivery, particularly in rural and underserved areas.(1) One of the pivotal steps toward this goal is the establishment of Ayushman Bharat Health and Wellness Centres (AB-HWCs), which have now been renamed Ayushman Arogya Mandirs, carrying the tagline “Arogyam Parmam Dhanam”.(2) This national initiative was launched in April 2018, with the first center inaugurated in Jaangla, Bijapur, Chhattisgarh.(3) Its vision is to provide preventive, promotive, curative, rehabilitative, and palliative care, aligning with the Sustainable Development Goal (SDG) 3 for good health and well-being. (4)

The Vision Behind Ayushman Arogya Mandir

The National Health Policy (NHP) of 2017 envisaged the establishment of Ayushman Bharat Health and Wellness Centres to provide universal, free, and community-centred comprehensive primary healthcare. The program aimed to operationalize 1,50,000 Ayushman Arogya Mandirs by December 2022, transforming existing Sub-Health Centres (SHCs) and Primary Health Centres (PHCs) into wellness centers offering a broad range of primary care services to the community.(3)

Ayushman Arogya Mandirs focus on delivering an expanded range of services under comprehensive primary healthcare. These services extend beyond reproductive, maternal, newborn and child care, including services for non-communicable diseases, palliative care, oral, eye, ENT care, mental health support, and first-level emergency care. These centers also ensure access to free essential drugs and diagnostic services, aiming to improve healthcare accessibility and quality.(5)

India’s primary healthcare system faces persistent challenges, including inadequate infrastructure and a shortage of trained healthcare providers, especially in rural areas. These issues often leave many communities without access to essential healthcare services.(6)

To address this gap, ECHO India, in collaboration with key partners, leverages technology to support the capacity building of healthcare providers in underserved regions.

A notable partnership with the National Health System Resource Centre (NHSRC) enabled ECHO India to provide training for Accredited Social Health Activists (ASHAs) through a tele-mentoring model on primary care services amid the COVID pandemic. This one-year program was conducted with NHM Himachal Pradesh, DPH-Tamil Nadu, KMC West Bengal, and NHM Sikkim, significantly enhancing ASHAs’ knowledge and skills in areas like maternal and child health, mental health, oral health, and palliative care. A total of 2293 participants were trained through the program. Of the 610 participants who took part in the pre-test at the start of the program, 490 completed the post-test at the end, achieving an 80% follow-up rate.(7)

Participants shared positive feedback, expressing increased confidence and continuous learning.

“The doubt was whether a mother can breastfeed the baby when suffering from COVID-19. I got clarity about that… many such topics were cleared.” (ASHA, Himachal Pradesh)

“Earlier we wouldn’t know if ear related issues had a resolution – But following the ear related training we are aware that such issues can be cured or have treatments.” (ASHA, Tamil Nadu)

“We get to learn things more properly and it was like a quick revision. So, I am very satisfied with the ECHO training." (ASHA, Sikkim)

In alignment with the Ayushman Bharat, Comprehensive Primary Health Care (CPHC) package, ECHO India also launched a capacity-building initiative for Community Health Officers (CHOs) in Almora, Uttarakhand, to evaluate the impact of ECHO tele-mentoring on improving CHOs' knowledge of primary health care services. National Health Mission (NHM), Uttarakhand, and Soban Singh Jeena Government Institute of Medical Science & Research (SSJGIMSR) acted as the knowledge hubs. Of the 167 participants, 97 CHOs were trained by SSJGIMSR and 70 by NHM Uttarakhand. 52 participants completed both pre- and post-assessment, demonstrating a statistically significant increase in knowledge after completing the ECHO training program, and 89% of participants indicated they would definitely use what they learned in their work while delivering service to the community.

Over the years, ECHO India has conducted more than 50 capacity-building programs for healthcare workers across India, focusing on comprehensive primary healthcare. In January 2024, ECHO India launched a new initiative in six states—Uttarakhand, Andhra Pradesh, Gujarat, Tamil Nadu, Maharashtra, and Madhya Pradesh—to train and mentor 2,000 frontline healthcare workers (FLHWs) over 16 months. This program aims to empower approx. 350 FLHWs in each state, including ASHAs, ANMs, nurses, and CHOs, equipping them with the skills and knowledge necessary to provide high-quality primary care. By establishing a learning network for continued training and mentoring, ECHO India is ensuring that healthcare workers are well-equipped to meet the healthcare needs of their communities, contributing to India’s UHC goals. A third-party evaluation agency is evaluating this project. The Study design correlates to levels 1-6 of Moore’s Framework for continuing medical education, i.e. up to patient outcomes. (8)

The Ayushman Bharat Mission marks a significant step toward transforming India’s healthcare landscape by addressing gaps in primary healthcare and ensuring accessible services, especially in rural and underserved regions. Through its innovative capacity-building programs, ECHO India is playing a vital role in this transformation, empowering healthcare workers to deliver comprehensive, high-quality care and helping India progress toward Universal Health Coverage.

References:

1. Kalita A, Carton-Rossen N, Joseph L, Chhetri D, Patel V. The Barriers to Universal Health Coverage in India and the Strategies to Address Them: A Key Informant Study. Ann Glob Health. 89(1):69.

2. Perappadan BS. Ayushman Bharat Health and Wellness Centres (AB-HWCs) to be called ‘Ayushman Arogya Mandir.’ The Hindu [Internet]. 2023 Nov 26 [cited 2024 Sep 30]; Available from: https://www.thehindu.com/news/national/centre-renames-ayushman-bharat-health-and-wellness-centres-as-ayushman-arogya-mandir/article67576634.ece

3. Comprehensive Primary Health Care | National Health Systems Resource Centre [Internet]. [cited 2024 Sep 19]. Available from: https://nhsrcindia.org/practice-areas/cpc-phc/comprehensive-primary-health-care

4. Ved RR, Gupta G, Singh S. India’s health and wellness centres: realizing universal health coverage through comprehensive primary health care. WHO South-East Asia J Public Health. 2019 Apr;8(1):18.

5. Official Website Ayushman Arogya Mandir [Internet]. [cited 2024 Sep 19]. Available from: https://ab-hwc.nhp.gov.in/

6. Kasthuri A. Challenges to Healthcare in India - The Five A’s. Indian J Community Med Off Publ Indian Assoc Prev Soc Med. 2018;43(3):141–3.

7. Panda R, Lahoti S, Mishra N, Prabhu RR, Singh K, Rai AK, et al. A mixed methods evaluation of the impact of ECHO® telementoring model for capacity building of community health workers in India. Hum Resour Health. 2024 Apr 23;22(1):26.

8. Moore DEJ, Green JS, Gallis HA. Achieving desired results and improved outcomes: Integrating planning and assessment throughout learning activities. J Contin Educ Health Prof. 2009 Winter;29(1):1.