NEW DELHI: A latest union health ministry report on Ayushman Bharat Health and Wellness Centres (AB-HWC) assessment in 18 states has flagged infrastructure as a 'key bottleneck' in the implementation of the ambitious scheme, followed by the non-availability of trained doctors, nurses and other healthcare workers.
Delayed allocation of funds from the states to the districts; lack of electricity and poor internet infrastructure, leading to hampered teleconsultation services and doubling staff workload; delay in payment to staff, and providing timely incentives to the workforce, are the other main findings of the assessment report of 317 health facilities.
The only state, which faced no healthcare workers shortage, was Mizoram.
The state had the required workforce of doctors, nurses, lab technicians, and pharmacists in its primary health care centres (PHCs) and at its sub-centres, the report said.
Mizoram is followed by Sikkim, Arunachal Pradesh, Nagaland, Chhattisgarh and Gujarat, which met the criteria.
Uttar Pradesh, Bihar and Jharkhand were the two states that acutely faced the non-availability of the medical staff at the PHC level, it added.
"Most states failed to ensure a full staff complement at the Health and Wellness Centres (HWCs)," it added.
However, it said the implementation of the AB-HWC scheme is on track in most states to achieve the December 2022 target, the report said.
"Overall, there has been an improvement in inequity in access, despite existing constraints such as infrastructure availability and status of peripheral health facilities," said the report, which assessed the rollout's pace and to identify specific challenges.
"Some states, notably Bihar identified the current infrastructure status as a key bottleneck in achieving the target," it added.
It was also noted that apart from the workforce shortage, there was friction between Community Health Officers, who headed the centres, with AYUSH and nursing care.
AB-HWC was rolled out in 2018 with the idea to shift from selective healthcare services to comprehensive primary health care. The central government plans that by December 2022, 150,000 HWCs will be made functional by transforming the existing sub-health centres and primary health centres. Until February 28, 2022, 90,808 HWCs had been established.
To provide a comprehensive healthcare package at the primary level, the government had expanded the scope by including various other health services, including management of infectious diseases, elderly and palliative services, basic management of mental health ailments, emergency medical services, free essential drugs, diagnostic services and teleconsultation, and even yoga sessions.
Among the various recommendations made to the states to improve infrastructure, the report also suggested ways to generate more funds for the upkeep of these facilities. They have also suggested that states need to identify gaps in the availability of basic amenities like electricity, water and internet connectivity.