Punjab Expands Healthcare Access During the Pandemic

This article originally appeared in Think Global Health.

New results from Punjab’s Health and Wellness Center (HWC) program show that it’s possible to expand access to primary healthcare services even during a pandemic.

Since October last year, the number of HWCs in the Punjab has more than tripled, to 2,042 this August. Over the same time period, more than 1,000 community health officers and district program managers were trained to provide care. From April through August, HWCs conducted more than 2.8 million consultations with patients, including one million consultations on diabetes and hypertension. How was all this accomplished during a national lockdown?

“Healthy India”

Expanding access to HWCs is a critical component of India’s strategy to deliver quality health care to all at an affordable cost. The country’s Ayushman Bharat (or “Healthy India”) initiative, launched in February 2018, calls for the creation of 150,000 HWCs across the country to provide comprehensive primary healthcare, including free essential drugs and diagnostic services, close to people’s homes. The initiative also aims to cover low-income patients and vulnerable families against financial risk arising from medical catastrophes.

Ayushman Bharat is an attempt to move India from a sectoral, segmented approach to health service delivery to one that is needs-based and holistic, covering prevention and ambulatory care at primary, secondary and tertiary levels. HWCs operate in both rural and urban areas, each serving between 3,000 and 5,000 residents to keep “time to care” below 30 minutes.

Throughout the ongoing COVID-19 emergency, while India was under lockdown, Punjab’s HWCs continued to expand access to health services to the underserved in hard-to-reach areas. These services included maternal and child health, non-communicable and communicable diseases prevention and treatment, and the distribution of free essential drugs and diagnostic services. As a result, Punjab received Ayushman Bharat’s top ranking for state HWC program operations.

Keys to success

What was behind the Punjab’s success? First, an emphasis on human resources. More than 1000 Community Health Officers (CHOs) and District Program Managers (DPMs) were trained by district learning centers and HCW “nodal units” to support the rapid scale-up of HWCs. The state-run nodal units conducted periodic supervision and monitoring visits to HWCs across the state. Punjab is now the leading state in India opening new HWCs with the required human resources and logistical support.

Another factor was a focus on telemedicine. The Global Health Advocacy Incubator (GHAI), a U.S.-based nonprofit, provided support for Internet connectivity at 200 HWCs, along with technical advisory services, online capacity-building programs for CHOs, supportive monitoring and evaluation, and an improved system for patients to provide feedback. The Post Graduate Institute of Medical Education and Research (PGIMER) and SIPHER, Chandigarh, an Indian nongovernmental organization, helped implement the hub and spoke model for telemedicine services. This allowed HWCs to expand the range of consultation services they were able to provide. Based on the initial results, Punjab expanded telemedicine services to more than 700 HWCs across the state. More than 6,000 teleconsultations were provided from April through August 2020.

As important as the technical and institutional improvements were, their scale-up depended on political will and public awareness. GHAI collaborated with the state government to plan for the HWCs’ expansion and conducted an outreach campaign to the public. Partly as a result, more people visited the HWCs, including for the screening, diagnosis and treatment of non-communicable diseases (NCDs).

Game-changers

HWCs were designed to be game-changers that can help bring universal health coverage to underserved areas. They are meant to provide care that is context-specific, locally adaptive and sustainable.

Although HWCs are public facilities, civil society partnership contributed to their success in Punjab. Nonprofit organizations helped the government to rapidly identify bottlenecks, assess community needs, cultivate local champions, pilot and demonstrate new programs, and provide strategic feedback to facilitate finetuning and mid-course corrections.

As COVID-19 presents new challenges to already-stressed health systems, Punjab’s success with HWCs provides a promising example, and a potential model, for other countries attempting to achieve universal health coverage.

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