Name of the Scheme- PM Ayushman Bharat Health Infrastructure Mission
Department – Department of Health and Family Welfare
Scheme for : Institutions (implemented by Govt.)
Where to Apply : NA
When to Apply : NA
PM Ayushman Bharat Health Infrastructure Mission is a Centrally Sponsored Scheme, with few Central Sector Components. The CSS components of the PM Ayushman Bharat Health Infrastructure Mission will be implemented by following the existing Framework, institutions and mechanisms of the National Health Mission. For the CSS components, the PM Ayushman Bharat Health Infrastructure Mission would leverage the existing National Health Mission (NHM) structure available at central and State levels for appraisal, approval, implementation and monitoring. This will ensure to avoid duplication especially, w.r.t FC-XV Health Grants support and NHM Support for the similar activities.
State Health Society, established under National Health Mission (NHM), will be the implementing agency at the State level and shall play a pivotal role in planning for the PM Ayushman Bharat Health Infrastructure Mission. Similarly, at the district level, the District Health Society, headed by the District Collector, will play a crucial role in not only planning as per the guidelines and also, for effective implementation and robust monitoring of the units of various components under PM Ayushman Bharat Health Infrastructure Mission, under the overall supervision of the District Collector. 2.2.3 The National Health Systems Resource Centre (NHSRC) would provide technical support including for capacity building, on CSS components of the scheme.
COMPONENTS OF PM AYUSHMAN BHARAT HEALTH INFRASTRUCTURE MISSION The Scheme is a Centrally Sponsored Scheme with some Central Sector components. The Scheme has following components: A. Centrally Sponsored Scheme (CSS) Components: 1. Ayushman Bharat – Health & Wellness Centres (AB-HWCs) in rural areas: Support for infrastructure development for 17788 Sub-Health Centres is proposed in 7 High Focus States (Bihar, Jharkhand, Odisha, Punjab, Rajasthan, Uttar Pradesh and West Bengal) and 3 North Eastern States (Assam, Manipur and Meghalaya). • For the remaining States, the infrastructure support for building-less SHCs is already being provided under FC-XV Health Grants through Local Governments and through NHM as well. For the UTs, the support is provided through NHM. This arrangement will continue.
Ayushman Bharat – Health & Wellness Centres (AB-HWCs) in Urban areas: Support for 11044 Urban Health & Wellness Centres across the country is proposed under this component. 3. Block Public Health Units (BPHUs): 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), is proposed under this component. • 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 Ayushman Bharat Health Infrastructure Mission at the Districts will be catering the needs of the Blocks in the UTs. 4. Integrated District Public Health Laboratories in all districts. 5. Critical Care Hospital Blocks in all districts with a population more than 5 lakhs, in state government medical colleges / District Hospitals. Out of the five CSS Components, the components of Ayushman Bharat – Health and Wellness Centres (AB-HWCs) in rural areas, Ayushman Bharat – Health and Wellness Centres (AB-HWCs) in urban areas and Block Public Health Units are partially financed through the ‘FC-XV Health Grants through Local Governments
1.2.1 RESOURCE ENVELOPE OF THE CSS COMPONENTS OF PM AYUSHMAN BHARAT HEALTH INFRASTRUCTURE MISSION IS GIVEN IN TABLE 1.
| S. No. | Component | Central Share | State Share | 15th FC Share | Grand Total |
| Centrally Sponsored Scheme components | |||||
| 1 | AB-HWCs in rural areas in seven High Focus States and three NE States – Infrastructure of 17788 rural AB-HWCs* | 2608.89 | 1479.8 | 5783.97 | 9872.66 |
| 2 | AB-HWCs in urban areas (11,024 urban HWCs) | 4863.41 | 2945.55 | 12146.25 | 19955.2 |
| 3 | Block Public Health Units (BPHUs) in 11 High Focus States/UTs – 3382 BPHUs** | 1712.27 | 775.04 | 1342.21 | 3829.52 |
| 4 | Integrated Public Health Labs (IPHLs) in all the Districts | 990.4 | 492.2 | 0 | 1482.6 |
| 5 | Critical Care Hospital Blocks in the districts | 11952.4 | 7112.37 | 0 | 19064.8 |
| Sub-total of CSS components | 22127.4 | 12805 | 19272.43 | 54204.8 | |
* Ten States covered under Infrastructure support to Building-less SHCs are Bihar, Jharkhand, Odisha, Punjab, Rajasthan, Uttar Pradesh and West Bengal and three NE States viz. Assam, Manipur and Meghalaya
** 11 High Focus States/UTs covered under BPHUs are Assam, Bihar, Chhattisgarh, Himachal Pradesh, UT-Jammu and Kashmir, Jharkhand, Madhya Pradesh, Odisha, Rajasthan, Uttar Pradesh and Uttarakhand.
1.2.2 PHYSICAL DELIVERABLES ENVISAGED UNDER CSS COMPONENTS UNDER PM AYUSHMAN BHARAT HEALTH INFRASTRUCTURE MISSION IS GIVEN IN TABLE 2.
| Component | 2021-2022 | 2022-2023 | 2023-2024 | 2024-2025 | 2025-2026 | Total |
| Infrastructure support to Building-less SHCs in rural areas | 3683 | 3684 | 2066 | 2113 | 2220 | 17788 |
| Urban – Health & Wellness Centres (Urban -HWCs) in Urban areas | 1038 | 2604 | 4674 | 7267 | 11024 | 11024 |
| Block Public Health Units in 11 High Focus States/UTs. | 339 | 677 | 677 | 677 | 1012 | 3382 |
| Integrated District Public Health Laboratory (No of districts) | 70 | 147 | 147 | 147 | 219 | 730 |
| Critical Care Hospital Blocks in the districts | 58 | 117 | 117 | 117 | 193 | 602 |
2.1 UNIT COSTS
The unit costs for each component have been derived based on the norms devised for various components of the scheme. These costs are indicative, and may vary based on the local context and conditions. Indicative Unit costs for the various components are given below:
(Amount in lakhs)
| S. No. | Component | Capital Cost | Recurring Cost | Remarks |
| 1 | Infrastructure support to 17788 Building- less SHCs in rural areas | 55.5 | 0 | in seven High Focus States and three NE States * |
| 2 | Setting up of 11,024 Urban HWCs in urban areas | 0 | 75.00 | |
| 3 | Setting up of 3382 Block Public Health Units (BPHUs) | 80.96 | 20.145 | in 11 High Focus States/UTs** |
| 4 | Integrated Public Health Labs (IPHLs) in all the districts | 1.25 Cr | 49.05 | |
| 5 | Critical Care Hospital Blocks in the districts | |||
| i. 100 bedded CCBS at DHs | 44.50 Cr | 7.912 Cr | ||
| ii. 50 bedded CCBs at DHs | 23.75 Cr | 4.592 Cr | ||
| iii. 50 bedded CCBs at Govt Medical College Hospitals | 23.75 Cr | – |
Infrastructure Support to ‘Building-less’ Sub Health Centre–Health & Wellness Centres (SHC-HWCs) in Rural Areas
3.1 BACKGROUND
3.1.1 It is important to strengthen the Public Health System, not only, to enable public health actions in case of future outbreaks and pandemics (such as early detection, management and mitigation), but ensure that essential non-pandemic related health services are not compromised. The Ayushman Bharat – Health and Wellness Centres (AB-HWCs), the flagship programme of the Government, will enable attention to community and system level primary health care interventions for preventive, promotive, curative, rehabilitative and palliative care. The provision of free medicines, diagnostics and access to telemedicine services closer to community is expected to expand coverage and quality of primary health care and reduce patient hardship and improve quality of care. Effective primary health care delivery also includes undertaking public health functions through community and facility level action for surveillance, screening and early detection, vector control, etc.
3.1.2 AB-HWCs offer the opportunity to ensure that girls and women would have access to care not just for reproductive health services, but also for the newer elements of the Comprehensive Primary Health Care package including screening, diagnosis, and treatment for hypertension, diabetes and mental health. Since services are provided close to community, access to essential services would be sustained for such sub population groups. Teleconsultation services are of particular importance in reducing access barriers for women and will ensure gender equity. These centres will not only provide primary level clinical care services for an expanded range of services as per Operational guidelines of Comprehensive Primary Health Care and subsequent Operational Guidelines on the expanded range of services at the centre but also ensure outreach services are provided to their catchment population.
3.1.3 Under the AB-HWCs programme, it is envisaged that 1,50,000 AB-HWCs shall be set up in the country by December 2022. Out of these, 12,500 HWCs are being setup by the Ministry of AYUSH as AYUSH-HWCs. As per Rural Health Statistics, 2020, as on 31st March 2020, there are 47,518 Sub Health Centres, which are functioning in rented buildings / panchayat or voluntary society buildings and these SHCs require building to be constructed. These infrastructure gaps of SHCs are significant especially in 7 High Focus States and
Three North-eastern states (seven High Focus States (Bihar, Jharkhand, Odisha, Punjab, Rajasthan, Uttar Pradesh and West Bengal) and three NE States (Assam, Manipur and Meghalaya)) such as in Uttar Pradesh (3654), Bihar (5356), Rajasthan (2859), etc. These gaps may not be completed within a specific timeline with the support available under NHM. Therefore, under PM Ayushman Bharat Health Infrastructure Mission, it is proposed that support will be provided for necessary infrastructure for 17,788 SHC level AB-HWCs in rural areas in 7 High Focus States and 3 North-eastern states, at a total cost of ₹. 9,872.66 crore. Wherever feasible, option for rental or renovation and repurposing of existing vacant buildings of other departments will also be explored. Operational costs for managing AB-HWCs, would be met through the existing scheme and mechanisms, i.e., through the National Health Mission. Support for Infrastructure of 10,421 SHC level AB-HWCs will flow from the resources from 15th Finance Commission (FC-XV) Health Grants through Local Governments in these 10 states and remaining support will be through PM Ayushman Bharat Health Infrastructure Mission Assistance.
Ayushman Bharat–Health & Wellness Centres (AB-HWCs) in Urban Areas
4.1 BACKGROUND
4.1.1 The National Urban Health Mission (NUHM) was set up in 2013, as a sub mission of the National Health Mission, to improve the health status of the urban population in general. Support is provided to the States to have Urban PHCs @50,000 per population. Outreach functions in this population, are undertaken by five ANMs and 20-25 ASHAs, with a normative coverage of a population of 10,000 served by a team of one ANM and five ASHAs. Under Ayushman Bharat, Urban PHCs are being strengthened as Health and Wellness Centres (UPHC-HWCs) to deliver Comprehensive Primary Health Care (CPHC).
4.1.2 Healthcare needs and aspirations of urban residents are different from those in rural areas. The current strategy of relying on outreach teams of ANM and ASHA alone to provide selective services is not sufficient. State experiences demonstrate that provision of health care services by trained service providers from facilities closer to poorer, and vulnerable urban communities is likely to improve access to an expanded range of services, reduce OOPE, improve disease surveillance, and strengthen referral linkages. At the same time, state experiences also show that the establishment of “poly clinics / provision of specialist services” in selected Urban PHCs, enables reach of specialist services to poor communities, thus building trust in the public health system.
4.1.3 Lack of a frontline health workforce in our cities has emerged as one of the biggest limiting factors in our response to the COVID-19 pandemic. Therefore, a paradigm shift is envisaged in delivery of urban primary healthcare based on the learnings from the management of COVID-19 pandemic which has affected urban areas disproportionately, especially in metropolitan areas such as Delhi, Mumbai, Pune, Chennai, Bengaluru, Hyderabad, Ahmedabad, Surat etc. A significant proportion of the urban population also constitutes of the migrants from other states. Also, a large proportion of these are usually settled in congested urban settings. Expansion and strengthening of the grass-root primary healthcare delivery institutions has thus emerged as a pressing need in the changed context. Limited capacities of health systems in urban areas and the disruption in non-COVID essential health services also underlines the need for provision of Universal and CPHC capacities in urban areas.
4.1.4 Accordingly, Universal CPHC is planned to be provided through Urban Health and Wellness Centres (Urban HWCs) and Polyclinics, by providing support for setting up of 11,024 Urban HWCs (UHWCs) in close collaboration with Urban Local Bodies. Such Urban HWCs would enable decentralized delivery of primary health care services closer to people, thereby increasing reach of the public health systems to the vulnerable and marginalized. The availability of space to set up new infrastructure in urban areas could pose a challenge. Therefore, the use of Mobile Medical Units and evening OPDs will be considered as alternate service delivery modes. In addition, use of community infrastructure such as religious places, NGO clinics and provision of space by the municipal bodies etc., would also be explored.
4.1.5 Support for 6,984 urban AB-HWCs (against a total of 11,024 urban AB-HWCs) will flow from the resources from the FC-XV Health Grants through Local Governments, in 28 states under the PM Ayushman Bharat Health Infrastructure Mission
4.1.6 Pages No.28-31 of Operational and Technical Guidelines of Implementation of FC-XV Health Grants through Local Governments (https://nhsrcindia.org/sites/default/files/2021-09/ FCXV%20Technical%20and%20Operational%20GLs%20to%20States%20dated%20 31082021.pdf) may be referred for detailed Guidance on components of Urban HWCs and objectives intended under this component.
Block Public Health Units (BPHUs)
5.1 BACKGROUND
5.1.1 Every block in the country is envisaged as having a CHC/ Block PHC/ SDH at the Block Headquarter (HQ) which serves as a hub for referral from the SHCs and PHCs of the block. However, the situation across states is variable, with the Block CHC functioning as just another PHC in some states. In some other states, on the other hand, the Block CHC also serves as a First Referral Unit (FRU).
5.1.2 The present public healthcare system structure at the Block level is not equipped to handle public health emergencies and also to respond and monitor the healthcare services. Currently, the functions of a Block CHC are mostly focused on clinical services that too largely RMNCH+A and selected infectious diseases. The outbreak of COVID-19 has highlighted a constrained public health response as a result of a suboptimal public health focus at the block level.
5.1.3 Block Public Health Units are proposed in all the 3382 blocks in 8 High Focus States and 3 Hill states (Assam, Bihar, Chhattisgarh, Himachal Pradesh, UT-Jammu and Kashmir, Jharkhand, Madhya Pradesh, Odisha, Rajasthan, Uttar Pradesh and Uttarakhand). Support for 1,048 Block Public Health Units in these 11 states covered under the PM Ayushman Bharat Health Infrastructure Mission, will flow from the resources from the FC-XV Health Grants through Local Governments.
The BPHU would encompass the service delivery facility (CHC/PHC/SDH), a Block Public Health Laboratory, and a Block HMIS Cell. The goal of the Block Public Health Unit is to protect and improve the health of the population in the block. Decentralization at this level would enable a focus on reaching remote areas and unreached populations. It is envisaged that the Block Headquarter level facility (variously referred to as Community Health Centres (CHCs)/ Sub- Divisional Hospitals (SDHs)/Block Primary Health Centres (PHCs), (the nomenclature may vary across states) would be strengthened to become a Block Public Health Unit. Further details on Block PH Unit, Laboratory and HMIS Unit and the objectives of BPHU may be referred from the Pages No.67-70 of Operational and Technical Guidelines of Implementation of FC-XV Health Grants through Local Governments (https://nhsrcindia.org/sites/default/files/2021-09/FCXV%20Technical%20and%20Operational%20GLs%20to%20States%20dated%2031082021.pdf
District Integrated Public Health Laboratories
6.1 BACKGROUND
6.1.1 The disease burden in the country demonstrates the need for provision of high-quality laboratory services at district and block levels. COVID-19 highlighted that limited laboratory capacity at all levels meant that functions of testing, case detection, surveillance and outbreak management were challenging. Delays in diagnosis and reporting compromise early detection and delay initiation of appropriate treatment and the necessary public health action for controlling the spread of disease. Although, both general and out of hours laboratory services (e.g. emergency services, critical care services) are currently being provided through laboratories, the capacities for public health surveillance for abnormal morbidity/mortality, reporting of human or animal disease patterns and testing of samples etc. for public health needs remain limited in most districts.
6.1.2 Improving the efficiency and effectiveness of the laboratory services to support programmatic scale-up, requires Integrated District Laboratory systems. This will optimise access to laboratory services, quality assurance efforts, cost-effectiveness, and efficient use of human resources. To address these gaps, an Integrated Public Health Laboratories in all 730 districts will be set-up under the scheme. An integrated model for the laboratory is crucial to increase efficiency, avoid duplication of laboratory resources, improve patient services, channelize resources for development of capacity for multi-disease testing and to equip the laboratory in terms of better preparedness and response to emerging disease threats.
6.1.3 The District Integrated Public Health Laboratory unit would also serve as the apex of a network to link labs with block, state and regional public health and veterinary labs to support multi-sectoral collaboration for clinical management and public health surveillance. Integrated Public Health laboratories will establish multi-level linkages from blocks to districts, to state and finally to zonal/regional and National level laboratories for providing a comprehensive set of laboratory services which can also aid in timely prediction of outbreak and supporting policy decisions. IPHLs at the District level will mentor and handhold BPH Labs of the BPHUs and ensure regular training and capacity building of the staff. To allow IPHL seamlessly blend into the existing laboratory services network, interconnected and functional linkages both upwards and downwards are envisaged. The upward and downward linkages with block and zonal/state/regional labs would be clearly defined and documented.
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