IPHS Guidelines: Health and Wellness Centres (Ayushman Arogya Mandir) and Comprehensive Primary Health Care Package

Background

IPHS Structural/HR Norms for AAM

• Headed by a Community Health Officer (CHO) - a B.Sc./GNM Nurse or Ayurveda (BAMS) practitioner trained in primary care and public health, certified through a 6-month Certificate in Community Health programme (delivered via IGNOU/state universities).
• Supported by Multi-Purpose Workers (Male and Female) and ASHAs.
• 105 free essential medicines and 14 diagnostic tests available.

• Staffed additionally with a Medical Officer, along with nursing and paramedical staff as per IPHS norms.
• 171 free essential medicines and 63 diagnostic tests available.
• Park's Textbook of Preventive and Social Medicine, p. (Ayushman Bharat Programme)

The 12 Packages of Comprehensive Primary Health Care at AAM

1. Care in pregnancy and childbirth
2. Neonatal and infant health care services
3. Childhood and adolescent health care services
4. Family planning, contraceptive services, and other reproductive health care services
5. Management of communicable diseases - National Health Programmes
6. Management of common communicable diseases and general out-patient care for acute simple illness and minor ailments
7. Screening, prevention, control, and management of Non-Communicable Diseases (NCDs) and chronic communicable diseases like TB and Leprosy
8. Basic oral health care
9. Care for common ophthalmic and ENT problems
10. Elderly and palliative health care services
11. Emergency medical services
12. Screening and basic management of mental health ailments

Key Operational Pillars Supporting the Package (per NHSRC/IPHS framework)

1. Expanded service delivery - moving beyond RCH and communicable disease care to NCDs, palliative/rehabilitative care, oral/eye/ENT care, mental health, and emergency/trauma first-level care.
2. Continuum of care - referral and tele-health - AAM functions as the first point of contact (gatekeeping) with a two-way referral linkage to secondary/tertiary care; teleconsultation supports case management and specialist advice.
3. Human resources - CHO-led team model at SHC level, Medical Officer-led team at PHC level, with ASHAs and MPWs.
4. Medicines and diagnostics - expanded essential drug list (105 at SHC-AAM, 171 at PHC-AAM) and diagnostic tests (14 at SHC-AAM, 63 at PHC-AAM) available free of cost.
5. Infrastructure - upgraded and rebranded facilities with space for services, dispensing, diagnostics, and wellness activities.
6. Community processes - health promotion, wellness activities (Yoga, cyclathons, tobacco cessation, open gyms).
7. Partnerships - collaboration with development/technical partners for implementation support, research, and advocacy.

Financial Protection Component

SHC-AAM vs PHC-AAM: Population, Staffing, Medicines & Diagnostics (IPHS 2022)

1. Population Norms

2. Staffing Pattern

• Led by a Community Health Officer (CHO) - the Mid-Level Health Provider (MLHP): a B.Sc./GNM Nurse or a BAMS (Ayurveda) practitioner, certified through the 6-month Certificate in Community Health programme.
• Team: Auxiliary Nurse Midwife (ANM), male Multi-Purpose Worker (MPW), and ASHAs.
• No doctor posted permanently; CHO manages under teleconsultation/supervision of the PHC Medical Officer.

• Non-24x7 R-PHC: Medical Officer x1, Pharmacist x1, Staff Nurse x2, Health Worker (female) x1, Health Worker (male) x1, Lady Health Visitor (LHV) x1, Lab Technician x1, plus sanitation staff.
• 24x7 R-PHC: Medical Officer x2 (higher case load/delivery load), Pharmacist x1, Staff Nurse x7, Health Worker (female/male) x1 each, LHV x1, Lab Technician x2, LDC/Accountant x1, Data Entry Operator x1, Dresser x1, Sanitation staff x4.
• An AYUSH Medical Officer is also co-located at many PHC-AAMs to provide AYUSH OPD services.
• The PHC Medical Officer additionally holds supervisory responsibility for CPHC service delivery across all SHC-AAMs under that PHC.

3. Medicines and Diagnostics

4. Complexity of Care

• SHC-AAM: first-level screening, health promotion, basic NCD/RCH services, minor ailment management, referral gatekeeping.
• PHC-AAM: higher complexity of care as defined in IPHS-issued care pathways and standard treatment guidelines - includes 24x7 emergency care, normal deliveries (at 24x7 PHCs), AYUSH OPD, expanded lab services (Hb, blood sugar, urine, etc.), and family welfare/school health programmes, plus supervisory oversight of the SHC-AAMs feeding into it.

Caveat

Primary Health Care in Urban Areas and USHA

National Urban Health Mission (NUHM) - Framework for Urban PHC

• NUHM covers all state capitals, district headquarters, and about 779 other cities/towns with population ≥ 50,000 (2011 Census), rolled out in a phased manner.
• Towns below 50,000 population continue to be covered under NRHM/rural framework.
• The 7 megacities (Mumbai, New Delhi, Chennai, Kolkata, Hyderabad, Bengaluru, Ahmedabad) are treated differently, managed directly through their Municipal Corporations.

1. Urban poor living in listed and unlisted slums
2. Other vulnerable groups: homeless, rag-pickers, street children, rickshaw pullers, construction/brick-kiln workers, sex workers, temporary migrants
3. Public health thrust on sanitation, safe drinking water, vector control
4. Strengthening public health capacity of Urban Local Bodies (ULBs)

• Park's Textbook of Preventive and Social Medicine (NUHM section)

Urban Health Care Delivery Structure (IPHS tiered model)

Female Health Workers (Outreach)

• Report to the U-PHC and move out to their designated outreach areas on fixed days for slum/vulnerable-group services
• On other days, conduct immunization and ANC clinics at the U-PHC itself

USHA (Urban Social Health Activist) / Urban ASHA

1. Active promoter of good health practices, enjoying community support/trust
2. Facilitates awareness on essential RCH services - sexuality, gender equality, age at marriage/pregnancy; motivates for contraception adoption, MTP, and sterilization
3. Counsels on birth preparedness, importance of safe delivery, breastfeeding, immunization, contraception
4. Mobilizes the community and facilitates access to health/related services at the U-PHC/Anganwadi centre
5. Acts as a depot holder for essential provisions (ORS, IFA tablets, DOTS drugs, contraceptives, etc.) as per state protocols
6. Escorts/accompanies pregnant women and sick children to the health facility
7. Provides information on existing health/sanitation services and promotes health education and awareness

• Park's Textbook of Preventive and Social Medicine (NUHM section)

Note on Sourcing

Comparison Table: SHC-AAM vs PHC-AAM (Rural/Urban) vs U-PHC

Key Takeaways

1. Staffing gradient: SHC-AAM is nurse/CHO-led with no doctor; PHC-AAM and U-PHC are Medical Officer-led with progressively larger multidisciplinary teams (nursing, pharmacy, lab, clerical, sanitation).
2. Population load: Roughly a 6x jump in catchment population from SHC-AAM to PHC-AAM/U-PHC (5,000-30,000-50,000).
3. Medicines/diagnostics scale up sharply from SHC-AAM to PHC-AAM (105→171 medicines; 14→63 tests), reflecting the shift from screening/promotive care to definitive OPD and minor procedural care.
4. Urban-specific cadre: USHA and Mahila Arogya Samiti (MAS) are urban-only structures replacing/complementing the ASHA model, specifically targeting slum and vulnerable migrant populations that rural ASHA norms don't address.
5. U-PHC vs rural PHC: structurally similar staffing/service framework, but U-PHC (and multi-specialty polyclinics) add specialist OPD (medicine, pediatrics), oral care, physiotherapy, and optometry, plus hub-and-spoke linkage for advanced diagnostics (X-ray, USG, CT) rather than having them on-site.