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In India, rural--urban health disparities have been persisting over a period. Migration of patients from rural to urban is an integral part of population dynamics thereby creating an additional burden on urban hospitals. Over the decade, India has made significant advances in health in reducing the rural-urban gap. The article highlights how the strengthening of rural healthcare facilities has reduced the burden of urban hospitals. Secondary data on the usage of public and private healthcare facilities from two rounds of the National Family Health Survey (NFHS) conducted in 2016 and 2021 and the Rural Health Statistics 2021-2022 were analyzed. The proportion of beneficiaries seeking care from public health facilities has increased from 41.9% to 45.7% in rural areas and 31% to 35.3% in urban areas between 2014 to 2017. The institutional deliveries have increased from 56% to 69.2% in rural areas and from 42% to 48.3% in urban areas. The State and local level interventions such as the upgradation of existing physical infrastructure, human resources, regular supply of medicines and consumables, development of referral linkages, patient transportation, and enhancing community participation have strengthened the rural healthcare system. Adequate utilization of the resources is crucial to addressing the lag and alleviating the rural-urban divide. [ABSTRACT FROM AUTHOR]

Background: Launched in September 2018, the ABPMJAY is the world's largest publicly funded health insurance (PFHI) program with population coverage of 500 million. A systematic review was conducted. Methods: A comprehensive literature search was conducted in four databases: PubMed, Web of Science, Scopus, and Google Scholar. The literature search was conducted with the search terms: "Ayushman Bharat OR ABPMJAY OR modicare AND RSBY." The search was set to title and abstract. Gray literature and government websites were also searched for relevant documents. A total of 881 documents were identified (PubMed: 53, Web of Science: 46, Scopus: 97, Google Scholar: 681, government websites: two, and gray literature: two). Fifty-two duplicates were identified. After the elimination of the duplicates, 829 unique documents were identified. These 829 unique citations were then subjected to a review of title and abstract independently by 2 reviewers. Six-hundred and ninety-two articles were rejected after review of title and abstract. One-hundred and thirty-seven articles were screened for full text independently by two reviewers. Sixty-six articles were rejected after review of the full text. Disagreements were resolved by discussion. Seventy-one unique articles were included in the final review. To attain the objective of the study, which is to critically analyze and provide an overview of Ayushman Bharat, a narrative synthesis was performed. Results: Seven themes were identified from the review: (1) health and wellness centers (HWCs); (2) out-of-pocket health expenditure (OOPHE); (3) fraud; (4) upcoding and provision of unnecessary medical care; (5) moving focus away from primary care; (6) coverage; and (7) lop-sided access, exclusion at the periphery, and brain drain. There is very little impact evidence of the ABPMJAY available. Conclusions: The government could plan impact evaluation studies in every state that the ABPMJAY is functional in. Any high-quality feedback generated might enable the National Health Authority, the government body leading and coordinating the ABPMJAY, to take necessary steps operationally and advice the government on strategy. Another concern is that the ABPMJAY PFHI might negatively impact the ongoing process of continuous strengthening and development of the government health-care system at all levels-primary, secondary, and tertiary. Continual recalibration and course corrections on the basis of high-quality feedback might enable ABPMJAY reduce catastrophic OOPHE for 500 million Indians. This is more than 6% of humanity: the largest block of people served by a single PFHI in history. [ABSTRACT FROM AUTHOR]

Introduction: Brands for services and health-care services for that matter can permeate unique meanings to consumers. Objective: The main objective of this study was to understand the perception and experiences of service providers about the health and wellness enter (HWC) branding. Materials and Methods: The study adopted a qualitative research method in which in-depth interviews of health-care service providers were carried out to capture their perceptions and experiences on HWC branding. Results: Two thematic areas emerged after the analysis of the collected data. Bada Hospital (Big Hospital): the service providers stated that the local inhabitants ask about the six thematic circles portrayed on the wall of HWCs and their role in this newly renovated building. After knowing the six priority service packages available, the locals perceived that this facility has now become a Bada hospital that can cater to their wider health-care needs. Incremental Trust: the service providers stated that the local tribal inhabitants, after perceiving this as a Bada Hospital, have started accessing health services in HWCs with less trust in faith healers. The locals also knew that the HWCs can provide them with medications including the injectables that they prefer the most and can also conduct some procedures, both medical and surgical, with adequate drugs, instruments, and consumables, thereby creating an incremental trust of the locals with 3–4 times more outpatient department footfall. Conclusion: The service providers perceive that the branding has created trust for the HWCs and improved the health-seeking behavior in the catchment areas. [ABSTRACT FROM AUTHOR]

Background: The Government of India launched the Ayushman Bharat (AB) program in 2018 which aims to transform 150,000 existing Sub Health Centres and Primary Health Centres into Ayushman Bharat Health and Wellness Centres (HWCs). In this study, we assessed health system readiness for establishment of HWCs. Methods: The assessment comprised of a cross sectional facility assessment and a knowledge assessment of community health officers (CHOs) and female multipurpose health workers also known as auxiliary nurse midwives (ANMs), in 26 HWCs in one community development block of Punjab state. HWCs were assessed for key input and process parameters such as a human resource, physical infrastructure, supplies, capacity building etc., and processes including health promotion, community participation, digitization of management information system, and service delivery. Results: It was observed that only 7 of the 26 HWCs had all human resources as per guidelines. The median knowledge score of CHOs and ANMs was 54% and 51% respectively. 11 of the 26 HWCs were co-located with Zila Parishad SHCs. Out of the 15 standalone HWCs, while 9 had independent buildings, 5 were located in buildings of other community level institutions. 50 percent of the HWCs were not able to perform diabetes screening due to lack of glucometers or testing supplies. While services for non-communicable diseases were available, a two-way referral tracking system for patients was missing. The mean job satisfaction rated by the newly appointed CHOs was 3.12 on a scale of 1 to 5, where 5 represented very high job satisfaction. Conclusion: The operationalization of HWCs requires State and local level interventions for strengthening of existing physical infrastructure, ensuring a regular supply of medicines and consumables, development of referral mechanisms for patients and enhancing community participation. [ABSTRACT FROM AUTHOR]

The development in the country's health status has not kept pace with its economic development. Although India along with most countries of the world was a signatory to the Alma Ata Declaration of 1978, its performance particularly on health equity and quality issues, so far, has been far from satisfactory. There are vast variations in health-care status by states, by ethnic groups, gender, and urban-rural difference. Till recently, government policies and people's perceptions also seemed to be on the wrong track. Our priorities seemed to be all wrong - we seemed to prefer setting up of high-cost tertiary health institutions at the expense of the primary health centers. The recently launched Swachh Bharat and Ayushman Bharat schemes offer hope of addressing these asymmetries. This paper briefly dwells on these issues. [ABSTRACT FROM AUTHOR]

Primary care has traditionally meant different concepts for developed and developing economies/countries. Immediately after independence, India pushed aside the recommendations of the Bhore committee, which was for implantation of comprehensive primary healthcare. Instead, we opted for the path of selective primary care modeled on vertical disease–based programs under the guidance of international development agencies. After several decades of implementing selective primary healthcare, India has now embarked upon ambitious journey of universal health coverage (UHC) with announcement of Ayushman Bharat – National Health Protection Mission. How much we resolve and how much we refer (90% vs 10% and 10% vs 90%) within primary care will determine the overall cost of the health system, be it out of pocket or publicly funded. Implementation of comprehensive primary healthcare and UHC along with existing disease focused vertical public health programs is a unique situation to India. Will the Indian economy be able to sustain the double burden of UHC and the vertical programs? Or is it indeed the time to dismantle the vertical programs and implement comprehensive primary care towards containing over all cost of the health system to the country. Continuing both may be a good bankruptcy plan. [ABSTRACT FROM AUTHOR]