The health and wellness centres (HWCs) under the Ayushman Bharat scheme have the potential to help achieve the Universal Health Coverage goal, but inadequate infrastructure and an insufficiently skilled workforce remain major roadblocks. A new model needs to be developed to manage population health efficiently through both the Ayushman Bharat components, the HWCs and Pradhan Mantri Jan Arogya Yojana (PMJAY).
The vision for a distress-free and comprehensive wellness system was converted into action on a mission mode last year. Close to 20,000 HWCs are delivering comprehensive primary health care free of cost, and providing universal prevention, promotion, and ambulatory care at the community-level. Their number is projected to reach at least 1.5 lakh by 2022.
Diagnostics plays a critical role in the prevention and treatment of diseases. From a diagnostic point of view, pathology and simple X-rays are the backbone of health care delivery systems at well-equipped centres, run by trained health care professionals. Ideally, all HWCs should have pathology, radiology, and ultrasound facilities. But there is a huge gap in terms of human resources in health care. This needs to be bridged with skilling, technologies and innovations.
The public-private partnership (PPP) model has been adopted in different states, with varying results. It is evident that the “hub-and-spoke” model can be successful in pathological services, where only the biological samples, such as blood and urine, have to be transported. This model would not work for X-ray and ultrasound as the scans have to be done at the HWC itself.
As per existing laws, only radiologists or MBBS doctors with special training in ultrasonography can perform ultrasound. Given the huge shortage of these specialists, it is not possible to post one specialist in every HWC. Even for performing simple x-ray examinations, there is a severe dearth of trained radiographers.
Innovative solutions can help bridge the vast gap between equipping these HWCs with basic radiological diagnostic facilities and providing a skilled workforce for its operation. For X-ray, the Atomic Energy Regulatory Board (AERB) should consider tweaking its existing norms on courses for radiographers, without compromising radiation safety for the patient and staff.
Currently, the shortest course takes one year, but paramedics can be trained to perform simple radiography tests at the HWCs in about two to three months. The government should consider training and upskilling paramedics working in the Primary Health Centres (PHCs) to multi-task and perform X-rays in addition to their routine work.
Since an ultrasound is a very important basic test, it would be possible to house the machine in a mobile van. One doctor, specialising in ultrasonography, can then provide once-a-week service to a dozen HWCs that are geographically close. The van could even be stationed at different centres at given times, depending on the patient load. A mammography machine, too, can be installed in this van to screen the population for breast cancer. Tele-radiology can provide remote diagnosis on X-rays and mammograms generated by these machines, which will make it a viable model for delivering quality services at the grassroots level.
The adoption of Artificial Intelligence (AI) in health care is radically changing the face of health care delivery. AI can play a critical role in empowering Ayushman Bharat’s HWCs, as it will enable millions of X-rays conducted by trained radiographers to be read by AI algorithms under a radiologist’s supervision.
Innovators and start-ups need to work closely with private and public hospitals and research institutes to quickly bring AI algorithms into clinical use. The government must facilitate such partnerships.
Mahajan Imaging (full disclosure: I am the founder of Mahajan Imaging), for example, is paving the way for a new deployment strategy of AI in radiology at its Centre for Advanced Research in Imaging, Neuroscience and Genomics (CARING). Using the new AI Deployment Platform, CARPEL, we validate the accuracy of AI algorithms from different parts of the world, including India, to demonstrate a comparison between reports auto-generated by a deep-learning algorithm and a practising radiologist. The findings have been validated and published in scientific journals and presented at international conferences.
Nothing happens in isolation, and, therefore, a holistic approach towards universal health coverage is needed. India has many unique challenges and the solutions for these will also ultimately come from within the country. Since a skilled workforce for HWCs will be a continuing challenge as we scale up, the health care sector must quickly adapt to address it through technological interventions and innovations.
Dr Harsh Mahajan is vice president, NATHEALTH, and former national president of the Indian Radiological and Imaging Association
The views expressed are personal
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