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Wellness Centres :  Soul of Ayushman Bharat

Wellness Centres : Soul of Ayushman Bharat

Dr. R.Kumar

Senior eye specialist, President ‘Society for promotion of Ethical and Affordable health Care’

Setting up of 1.5 lakhs of Health and wellness centres (HWCs) all over the country can be a game changer to realize the dream of universal healthcare for the teeming millions of the vast and varied population of India. Incidentally, health insurance component and mission Inderdhanush have stolen the limelight and HWCs component has been eclipsed, which is more important part of Prime minister’s Jan Arogya Yojna (PM -JAY), also called Ayushman Bharat (AB). Before analyzing the feasibility and merits of HWC, it would be prudent to define wellness. It also requires a critical look at the proposed doctor-nurse model of HWCs.
India cannot afford the luxury to insure patient-care to all or even 40% poor citizens under AB, preserving health for all is more practical proposition. Emphasis on prevention is sine qua non of AB’s success.

Wellness and well-being

Wellness means that a person is free of risk factors for disease and does not practice adverse health behaviors e g smoking, drinking, drugs that could jeopardize health. The term “wellness” and “health” are not synonymous. Wellness is the “active process of becoming aware of and making choices toward a healthy lifestyle, fitness and well-being.

Essentially, if health is the goal, wellness is the way to achieve it. Wellness is the action while health is the desired outcome. If wellness is practiced, diseases can be kept at bay.

No doubt, a conscious effort to improve wellness can ultimately, cost less money in treatment- costs to the family and nation.  If 80% of persons who at present throng to hospitals as patients do not fall sick, it will be easier to give health insurance cover or provide treatment to  remaining 20% of them in the hospitals.

Viewed on a larger canvass, setting up of HWCs will be of great benefit to the employers of corporate houses for enhancing their productivity. This is applicable to the journalists as well, who have to sit glued to the desks for long hours, unmindful of wellness practices. Taking to educate workforce about wellness and lifestyle changes like drinking plenty of water instead of soda or tea, walking to office instead of using a vehicle or taking a walk during breaks instead of sitting, reduce screen time on mobile etc, and packing fruits and vegetables or home prepared lunch instead of ordering fast food or junk food can help people achieve their wellness goals. Government can intervene to reduce the content of excessive salt, sugar and trans-fats in packaged foods. Advice on good sleep for 7-8 hours and basking in the Sun regularly will be equally useful.  Obesity should be a strict No for all kind of workers. Setting up gyms or outdoor sports in the corporate or institution premises will enhance wellness and increase productivity.  This will be of great importance for health- insurance companies also, if they administer wellness to their policyholders rather than waiting for them to fall sick and then reimburse medical treatment costs, their own profitability will increase. This will also promote penetration of universal health insurance in the community.

HWCs component eclipsed

The Much hyped health insurance in AB, which offers to meet the cost of hospitalization up to Rs 5 lacs per family, has made a good beginning. Dr Indu Bhushan CEO of AB and National health authority vouches for its initial success with 7 lakhs hospitalizations, 900 crores of disbursements and 45 lakhs of registrations under AB, in the first 100 days.

However, insurance is only a palliative for 40% poor population, leaving aside the remaining 60%. But, have we got resources and infrastructure to spend 5 lakhs per family for over 10 crores poor families? How to ensure that it will be implemented ethically? HWCs when set up, will provide primary medical care, free drugs and diagnostic services. It will handle more than 70% of outpatient care.  It will also ensure medication compliance and follow up care. This will save the community from exploitative and unethical practices, allegedly rampant during hospitalization.

Mention of preventive care has also been made, but lacks transparency. AB has not elaborated how it will offer prevention of diseases.

Will it be practical to implement?

Estimates show that it will cost about Rs 20 lakh to set up and run a HWC, thus the annual spend on HWCs alone will be Rs 30,000 crore. The health ministry has not allocated the resources, nor has the national health budget been raised from about 1% of GDP as at present to promised 2.5%. However, it will be unfair to condemn AB as utopia or election stunt. If a nationwide network of HWCs is set up and, if resources are provided, it can achieve healthy India.

Studies from countries like Brazil show achieving good health through preventive and primary healthcare. Closer home, a study from Tamil Nadu of 67 HWCs shows that out-of-pocket expenditure on medical treatment has reduced dramatically and people’s access and utilization of medical treatment has greatly improved.

Wellness and well-being coach

In the Indian context, where there is a perennial shortage of doctors, an institution of ‘wellness and well-being coach’ (WWC) need to be created. You don’t need a doctor for remaining healthy!  For the training of WWC you don’t require a medical college! It can be a 4 years B. Sc in wellness and well being from any college. WWCs can take charge of wellness practices and preventive health of entire population, and administer health education at their door steps. In case of illness, WWC can refer the patient for primary, secondary or tertiary care under AB.  Institution of WWCs has the potential to create millions of jobs and reduce expenditure on opening medical institutes as well as tertiary patient care.

 The Tribune 12th February 2019

 

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