The health landscape of India is confronted with a multitude of challenges that demand immediate and concerted
efforts.
These health issues that range from the unfinished agenda of Reproductive Maternal, Newborn, Child, and
Adolescent Health (RMNCHA),
to the accelerating burden of non-communicable diseases (NCDs) including TB, mental health, emerging, and
reemerging diseases, and injuries and road traffic
accidents (RTAs). The prevalence of non-communicable diseases (NCDs) among children and newborns in India is
also a growing concern. According to an Indian
Council of Medical Research (ICMR) study, it is estimated that the proportion of deaths due to
non-communicable diseases (NCDs) in India have increased from
37.9% in 1990 to 61.8% in 2016.
According to WHO estimates, NCDs contribute to 5.87 million deaths that constitutes 60% of all deaths in
India.
Malnutrition too poses a significant challenge for children and newborns in India. Both undernutrition and
overnutrition,
continues to affect children, leading to stunted growth, delayed cognitive development, and compromised immune
systems. Poor
awareness on balanced diet, essential nutrients, excusive breastfeeding practices and complementary feeding
exacerbates the problem.
India has made significant strides in improving in nutrition status of children. However, the burden still
remains enormous considering the vast population size
of India. According to the NFHS 5 data, prevalence of
stunting has reduced from 38.4% to 35.5%, Wasting has reduced from 21.0% to 19.3% and Underweight prevalence
has reduced from 35.8% to 32.1%.
The National Health Policy 2017 envisages a goal of attainment of the highest possible level of health and
wellbeing for all,
through provision of promotive, preventive, curative, rehabilitative and palliative health care services,
universally, with focus on quality and
without anyone facing financial hardship. The policy also highlights adoption of key principles of equity,
affordability,
accountability, patient-centeredness, pluralism, inclusive partnership and decentralization of plan and
delivery of health care.
Ayushman Bharat is a flagship program of Government of India, launched in 2018,
translating the policy intent to budgetary commitment, to achieve the Universal Health Coverage (UHC)
underscoring the commitment of “leave no one behind.”
Ayushman Bharat has four pillars, which are:
Ayushman Bharat - Health and Wellness Centres (AYUSHMAN AROGYA MANDIR)
Ayushman Bharat - Pradhan Mantri Jan Aarogya Yojana (AB-PM-JAY)
Pradhan Mantri- Ayushman Bharat Health Infrastructure Mission (PM-ABHIM)
Pradhan Mantri- Ayushman Bharat Digital Mission (PM-ABDM)
Under AYUSHMAN AROGYA MANDIRs, more than 1,60,000 Ayushman Bharat Health and Wellness Centres (AYUSHMAN AROGYA MANDIRs) have been established
by transforming the
existing Sub Health Centres and Primary Health Centres. They provide an expanded range of primary health care
services such as pregnancy related care,
reproductive and child health care, communicable diseases, non-communicable diseases,
elderly care, eye, ear-nose-throat and oral care, emergency care and palliative care, including free essential
drugs and diagnostic services.
The PMJAY provides financial protection of up to ₹5 lakh per annum for secondary and tertiary care,
benefiting approximately 40% of India's socially vulnerable and low-income households. The Ayushman Bharat
Digital Mission (ABDM)
has facilitated the creation of
Ayushman Bharat Health Account (ABHA), a unique Health ID for every citizen,
enhancing the efficiency and effectiveness of our healthcare systems.
The Ayushman Bharat Digital Health Mission (ABDM) is providing the necessary backbone for
attainment of universal health coverage, by creating a seamless online platform “through the provision of
a wide-range of data, information and infrastructure, duly leveraging open, interoperable,
standards-based digital systems”.
Our commitment to transforming healthcare is further strengthened by financial support from multiple sources.
The 15th Finance Commission-Health Grants and the Pradhan Mantri Ayushman Bharat Health Infrastructure Mission
(PM-ABHIM) are playing a
crucial role in filling critical gaps in health infrastructure, surveillance, and health research. These
financial initiatives, combined with
our political will, have been instrumental in strengthening
primary healthcare with linkages with secondary and tertiary care and bringing quality and safe healthcare
closer to the people.
The AYUSHMAN AROGYA MANDIRs endeavour to shift the focus from illness to wellness and wellbeing, from fragmented care to
continuum of care, from disease-centric
care to personalized-care inclusive of family support, from healthcare being just a
facility event to making it a community movement.
To realize the vision of ‘universal health coverage’ people’s ownership of their health is important.
Health Melas/ fairs are popular among the masses for providing health services, such as awareness on health
and wellness, preventive measures,
early detection, and treatment, and a potent vehicle for inculcation of health-seeking behaviour. Thus,
organisation of health melas at
each of the Ayushman Bharat - Health and Wellness Centres will optimize the uptake of services. The health
melas provide platform to people to express
their issues and concerns about the healthcare services and aid people-centric planning and implementation.
Melas with
their wide reach also augment behaviour change among people through group wellness activities that are
integral to such events.
This operational guideline provides a broad framework for facility and block health teams to organize and
realize the objectives of health melas at the AYUSHMAN AROGYA MANDIRs.
Objectives
Objectives of the AYUSHMAN AROGYA MANDIR Health Mela are to:
Provide early diagnosis through screening, comprehensive primary health care services with drugs and
diagnostics,
teleconsultation with health specialists,
and appropriate referrals, with a special focus on marginalized people, for a continuum of care
Build awareness through behavior change communication among the people about health and healthy lifestyles
to
maintain well-being and different health
schemes and services provided by the Government
Bridge the gaps in:
Creation of ABHA (Health IDs) and issuance of Ayushman Bharat Cards under PM-JAY for eligible citizens
Community-based risk assessment and population-based screening for diseases like hypertension, diabetes,
cancer, cataract, tuberculosis, hepatitis B
Routine Immunization
Follow-up PM-JAY treated beneficiaries
Services available at AYUSHMAN AROGYA MANDIRs-Operationalization of Health Mela at the AYUSHMAN AROGYA MANDIRs
Health Mela aims to address the health needs of the underserved population,
thereby enhancing the accessibility, availability, affordability, and acceptability of
comprehensive health services.
Each mela should be organized keeping in mind the disease prevalence,
risk profile evident from CBAC assessment and the existing health facilities of
the area where the mela is to be organized.
It is recommended that the health mela be conducted at SHC-AYUSHMAN AROGYA MANDIR, PHC-AYUSHMAN AROGYA MANDIR, UPHC-AYUSHMAN AROGYA MANDIR, and URBAN AYUSHMAN AROGYA MANDIR in
collaboration with CHC/SDH/District hospital.
Lifestyle modification and wellness promotion activities are to be conducted using multimedia including
local art and culture.
Screening will help build awareness of health risks and provide information on lifestyle modifications to
enhance their health.
Support from community-based youth groups shall be taken for the same.
It is recommended that health mela information is disseminated both pre and post-event for publicity on
print/audio-visual/ social media especially on radio channels,
nukkad natak, miking campaigns etc.
Mobile Medical Units and RBSK teams can also be leveraged to fulfil the requirement of medical officers
and other staff
Schedule of Health Melas
Health melas at Ayushman Bharat- Health and Wellness centres should be conducted weekly, on Saturday of
each week.
Every mela shall have a main theme with *other services. Below table shows weekly main themes
Table 4: Themes for Health Melas
Week
Week 1
Week 2
Week 3
Week 4
Theme
NCDs
Tuberculosis, Leprosy and other Communicable Diseases
Maternal and Child Health, and Nutrition
State Specific Theme (such as Tribal areas Sickle Cell Disease & Non-tribal area-Eye care
services)
*Along with main theme other common services will also be available in weekly health melas such
as ABHA ID and Ayushman Bharat card creation, comprehensive primary healthcare services, AYUSH, mental
health services,
elderly and palliative care, wellness support and activities, free drugs and diagnostics and
Teleconsultation services.
Core Planning and Implementing team
It is advised to have a representative from the following groups in the core planning and implementing
team:
Health professionals: Medical Officer in-charge, staff nurses, CHOs, yoga practitioners and other wellness
instructors
Representation from community platforms- JAS, VHSNC, MAS, self-help groups- NRLM/NULM
Anganwadi worker
PRI members
School teachers, staff etc.
Local media
Some prominent members of the community
Members of the youth groups
CHC/SDH/DH shall be engaged. Medical College in the block/district should also be involved.
Collaborations- Block level officials from other departments like Block health authority,
Indian Medical Association, ICDS, AYUSH, Women and Child Development, Social Welfare,
Education, PRI, School Health & Wellness Ambassadors, etc. to make concerted efforts for successful
health mela at AYUSHMAN AROGYA MANDIR
Cooperative Societies such Society of Fishery, Agriculture, Horticulture, Animal Husbandry etc.
Roles and Responsibilities of Implementing team members
Overall mentoring shall be provided by MD, NHM in the State/UT and CMO in each District for coordination
and other necessary arrangements.
Health Mela shall be planned in a way that adequate Teleconsultation hubs should be available for convenient
connections with the Spokes.
Chairman of JAS at the Ayushman Bharat - Health and Wellness Centres shall take the
lead under the guidance of Block Health Officer/Taluk Health Officer.
VHSNC/ MAS and JAS members shall proactively mobilize people for the mela from their villages or locality.
CHO and PHC Medical Officer shall be responsible for implementing the health mela with the support of JAS
members, PRI members and community.
It is recommended that ASHAs should undertake intensive CBAC assessments in a
campaign mode prior to the scheduled Health Melas, and inform about the mela to each household in her area.
Necessary medicines, diagnostics and supplies should be arranged through the respective AYUSHMAN AROGYA MANDIR well in
advance
Certificate of appreciation/ award to the SHC-AYUSHMAN AROGYA MANDIR, PHC-AYUSHMAN AROGYA MANDIR and UPHC-AYUSHMAN AROGYA MANDIR, URBAN AYUSHMAN AROGYA MANDIR with highest participation
in the mela can also be considered.
Community based Youth groups and CBOs can be leveraged for the mobilization and spreading awareness
Common services to be provided during each Health mela:
Table 5: Services during Health Mela
Services
Details
Registration
ABHA (Health ID) creation
Population enumeration and CBAC filling by ASHAs/ MPWs
Updating family folders
PM-JAY Ayushman Bharat card issuance to eligible beneficiaries
Healthy Lifestyle Promotion
Wellness activities such as yoga, meditation sessions, Cyclathon and Walkathon
Lifestyle modification and diet counselling
Wellness support for children and youth by Health and Wellness Ambassadors
Promote balanced diet with affordable, nutritive and locally available food
Teleconsultation
Teleconsultation
Teleconsultation for specialist consultation for both Modern medicine and AYUSH services
Theme specific services to be provided in the Health Melas:
Table 6: Weekly Themes of Health Melas
Week 1
Week 2
Week 3
Week 4
Theme: NCDs
On first Saturday of the month, health mela will be organized at the SHC-AYUSHMAN AROGYA MANDIR, PHC-AYUSHMAN AROGYA MANDIR and
UPHC-AYUSHMAN AROGYA MANDIR, URBAN AYUSHMAN AROGYA MANDIR with special theme of NCDs such as diabetes, hypertension, common cancers such as
Oral, Cervical and Breast
Theme: Tuberculosis, Leprosy, Hepatitis, HIVAIDS, Malaria, Kala-azar, Filariasis and Other
vector borne diseases)
On second Saturday of the month, health mela will be organized at the SHC-AYUSHMAN AROGYA MANDIR, PHC-AYUSHMAN AROGYA MANDIR and
UPHC-AYUSHMAN AROGYA MANDIR, URBAN AYUSHMAN AROGYA MANDIR with special theme of Tuberculosis, Leprosy, Hepatitis, HIVAIDS, Malaria,
Kala-azar, Filariasis and Other vector borne diseases)
Theme: Women and child health, and Nutrition
On third Saturday of the month, health mela will be organized at the SHC-AYUSHMAN AROGYA MANDIR, PHC-AYUSHMAN AROGYA MANDIR and
UPHC-AYUSHMAN AROGYA MANDIR, URBAN AYUSHMAN AROGYA MANDIR with special theme of Maternal and child health, and Nutrition
*State Specific Theme and services on fourth Saturday of the month (Sickle cell
Anaemia for Tribal Areas and Eye care for non-tribal areas)
Screening and treatment of hypertension and diabetes, and referral, as needed
Screening of oral, breast and cervical cancer (VIA screening) and referral, as needed
Screening of mental health issues using PHQ -9 by CHOs and other standard screening tools,
psychosocial management, and referral as needed
Screening and follow-up care for occupational diseases (Pneumoconiosis, dermatitis, lead
poisoning); fluorosis; respiratory disorders (COPD and asthma) and epilepsy
Vulnerability assessment of the beneficiary for TB
Screening for symptoms of TB during population screening using Community Based Assessment
Checklist (CBAC)
HIV and blood sugar testing of all TB cases/ presumptive cases
Treatment, refilling of drugs and referral, as needed
Promoting health awareness and encouraging individuals to adopt proactive health-seeking
behaviours, including awareness on symptoms of TB, TB during pregnancy, Coughing etiquettes, and
patient support programs/ benefit schemes like Nikshay Poshan Yojana and transportation assistance
for Drug Resistant Tuberculosis (DRTB) patients. Leprosy screening and initiation of treatment,
referral as needed
Provision of DOTS/ensuring treatment adherence as per protocols in cases of TB
Collection of blood slides in case of fever outbreak in malaria prone areas
Awareness generation and addressing stigma and discrimination associated with Tuberculosis and
Leprosy
HIV Screening (in Type B SHC), appropriate referral and support for HIV treatment
Early diagnosis of pregnancy
Early registration of pregnancy and issuing of ID number and Mother and Child protection card
Antenatal check-up including screening of Hypertension, Diabetes, Anaemia, Immunization for
pregnant women-TT, IFA and Calcium supplementation
Counselling regarding care during pregnancy including information about nutritional requirements
Identifying high risk pregnancies
Follow up to ensure compliance with IFA in normal and anaemic cases
Post- partum care visits
Counselling and support for early exclusive breast feeding, complimentary feeding practices
Adoption of Safe and hygiene WASH practices
Growth monitoring
Counselling for Early Childhood Growth and Development
Identification of birth asphyxia, sepsis and referral after initial management
Identification of congenital anomalies and appropriate referral
Family /community education for prevention of infections and keeping the baby warm
Routine Immunization
Child Health
Growth Monitoring, IYCF continued and enable access to food supplementation- all linked to ICDS
Detection of SAM, referral and follow up care for SAM
Prevention of Anaemia, iron supplementation and deworming
Prevention of diarrhoea/ ARI, prompt, and appropriate treatment of diarrhoea/ ARI with referral
where needed
Pre-school and School Child Health: Biannual Screening, School Health Records, Eye care,
De-worming
Screening of children under national program to cover 4’D’s Viz. Defect at birth, Deficiencies,
Diseases, Development delay including disability
Adolescent Health
Adolescent friendly health clinic with Counselling on- Improving nutrition, Sexual and
reproductive health, enhancing mental health/Promoting favourable attitudes for preventing
injuries and violence, Prevent substance misuse, Promote healthy lifestyle, Personal hygiene- Oral
Hygiene and Menstrual hygiene
Prevention of Anaemia, identification, and management, with referral if needed
Provision of IFA under National Program for Iron Supplementation
Screening and Early diagnosis
Treatment of the diseases
Free drug distribution
IEC activities
WEEK 4
*Theme: State specific theme
On fourth Saturday of the month, health mela will be organized at the SHC-AYUSHMAN AROGYA MANDIR, PHC-AYUSHMAN AROGYA MANDIR and
UPHC-AYUSHMAN AROGYA MANDIR, URBAN AYUSHMAN AROGYA MANDIR with
special state specific theme like Sickle Cell for tribal areas and Eye care services for non-tribal
areas.
Health mela will provide comprehensive primary health care services with special focus based on the health
priority of state.
All the counters will be organized in same manner except a special weekly counter of specific theme such
as NCDs, TB,
Leprosy and other communicable diseases, Women and Child health may be replaced with a
counter of theme decided by the state based on their health priorities or prevalence of diseases.
Facilitating continuum of care:
Directory of functional secondary and tertiary health facilities should be readily available in
the health mela so that the doctors
attending the patients can refer the case for subsequent follow up.
All referral cases must be entered into a register indicating the name of the patient, reason of referral
and the hospital where the
patient has been referred.
Referred patients shall be mapped village-wise or locality-wise and linked to the nearest SHC-AYUSHMAN AROGYA MANDIR/PHC-AYUSHMAN AROGYA MANDIR/
UPHC-AYUSHMAN AROGYA MANDIR/ URBAN AYUSHMAN AROGYA MANDIR and shall be shared with
the CHO/PHC MO for following-up on the status/outcome of the referrals to health institutions.
Finance and Resource Management
Resources in terms of human resources, drugs & diagnostics, etc. from respective AYUSHMAN AROGYA MANDIRs.
Untied fund or fund for IEC activities approved in the ROPs can be utilized for conducting health melas at
Ayushman Bharat - Health and Wellness
Centre.
Mobilization of additional resources through PRIs/ ULBs/local NGOs/ CSR funds/ MPLADs funds etc.
Support for specialist services may be sought from linked CHCs/SDH/ DH/ Medical Colleges.
Reporting
Each AYUSHMAN AROGYA MANDIR will submit a monthly consolidated report of all the completed melas in a month
as per
the reporting form (Annexure - 1) and Feedback (Annexure - 2). Furthermore,
the State/ UT NHM shall adopt and issue these guidelines to the districts for implementation.
Weekly online reporting will also be done on the AYUSHMAN AROGYA MANDIR portal with uploading of photos of weekly melas.
The AYUSHMAN AROGYA MANDIRs should share photos of the health mela on the Ministry’s and AYUSHMAN AROGYA MANDIR’s Social media accounts i.e
@MoHFW_India and @AyushmanAYUSHMAN AROGYA MANDIRs, respectively.
Operational Guidelines of Medical Camps to be organized by Medical Colleges at CHC Level
The healthcare facilities of the country form a large base of primary health centres and health and wellness
centres, which are
closest to the people. The secondary care facilities are positioned above the primary health services, which
include community health centres,
sub-district hospitals and district hospitals. The apex is formed by tertiary care hospitals, which include
medical college hospitals.
Medical colleges at the apex of the pyramid are also responsible for training medical doctors and providing
high-end clinical care.
The potential of the medical colleges needs to be utilized for overall health system strengthening through
existing well-established
support systems as envisaged in the National Health Policy. Various initiatives in this direction are
underway, and a systems approach
is now being impressed for achieving universal health coverage. As a step towards achieving UHC, a target of
SDG, the Government of India (GoI)
has contemplated Ayushman Bhav, an umbrella of various health schemes. This campaign will ensure saturation
coverage of health schemes and an initiative
to ensure optimal delivery of health services. Out of the four activities under this, Ayushman Mela aims to
utilize the potential of existing medical colleges
in strengthening specialist and outreach services at CHCs following the whole-of-government and
whole-of-society approach.
Introduction:
There have been noteworthy improvements in health indicators such as life expectancy,
the infant mortality rate (IMR), achieving the MDGs target of maternal mortality ratio (MMR) etc. as well due
to
increasing penetration of healthcare services across the country, extensive health campaigns, sanitation
drives, increase
in the number of government and private hospitals in India, improved immunization, growing literacy etc. A
significant decrease in
mortality from communicable, maternal, perinatal and nutritional causes has been reported from 25.2% to
16.1%.[1] However, there
is a projected rise in deaths due to non-communicable diseases from 63.5% in 2015 to 72% in 2030, which is a
cause for concern.
To address this, various initiatives such as Janani Shishu Suraksha Karyakarm, Janani Suraksha
Yojana PMSMA, and national programmes to curb incidences of diseases such as polio, HIV, TB, leprosy, cataract
etc., have also played pivotal roles in
improving India’s health indicators by providing the specialized care closer to the community.
The vision to move from Ayushman panchayat to Swasthya Panchayat will ensure last-mile coverage.
Indian Public Health Standards 2022 enumerates population norms for each level of the facility creating
bidirectional referral
(backward linkages for a continuum of care and forward linkages for referrals). At the block level, Community
Health Centers (CHCs) constitute the
secondary level of health care and are envisaged at a
population of 80,000 to 1,20,000 for rural areas depending upon the terrain and 2,50,000 for urban areas
(5,00,000 in metros).
All essential services are available, including routine and emergency care in surgery, medicine,
obstetrics and gynaecology, paediatrics, dental and AYUSH, in addition to the implementation of national
health programs.
CHCs are designed to provide referral as well as specialist health care to the rural and urban populations.
The CHCs function as a nucleus for all the
health-related activities at the block level and act as block-level health administrative units and
gatekeepers for referrals to higher facilities.
As per the recent available data, 5480 CHCs are functional in rural areas and 548 in Urban areas. (Rural
Health Statistics 2021-22)
In this new era of reinvigorating medical education, the Government of India launched Pradhan Mantri-
Swasthya Suraksha Yojana (PM-SSY) in the year 2006 has been setting up new AIIMS to provide a major thrust for
the creation of advanced tertiary healthcare infrastructure, medical education in different parts of the
country. Currently, 22 new AIIMS has been announced, and 75 government medical colleges have been considered
for upgradation. In furtherance to it, The Hon’ble Prime Minister of India has visioned establishing Medical
College in every district with the forethought that it will further improve health services and increase
people's accessibility
to advance care. At present, out of the 765 districts identified,
395 districts have 648 medical colleges. (National Health Profile 2022)
Although the medical colleges have the nuanced potential for coordinated implementation
and innovative strategies to provide Behaviour Change Communication, Counselling, Research &
Clinical Epidemiology, Collection/compilation/analysis and utilization of data, and support in the
national programmes under NHM, in addition to their core responsibility of teaching and training, however,
there is a felt need to strengthen public health services through Medical Colleges in varied capacities.
As of now, the mandate of having Rural Health Training Centres and Urban Health Training Centres in the
Medical
Colleges has a limited intervention in providing day-care services and is limited as a training site for
medical graduates.
With the existing conducive environment and focus on epistemes of medical education like never before,
there is a need to leverage the medical colleges for overall health system strengthening and re-establishing
the suggestions of the Shrivastav
committee report in 1975 of Reorientating Medical Education (ROME) and linking medical colleges to rural
health.
To achieve this, outreach services play a significant role by delivering health services to cover
the unreached, underserved, inaccessible vulnerable population. Such outreach services have been catalogued in
our
existing health system, and departments of medical colleges
in various states are discretely supporting public health facilities to provide assured services in remote
areas.
In the same direction, Ayushman melas are being organized to increase health
awareness and provide preventive, promotive and curative functions as comprehensive primary
healthcare services. The need for secondary care, which includes specialized services, including operative
care in such Ayushman melas,
can be augmented by involving the medical colleges by bringing in their expertise and thereby providing
holistic services.
CHCs have the available infrastructure and Human Resources for Health to provide secondary
care services and can be efficiently utilized in providing the services in a camp-based mode and fixed-day
approach for bringing specialized services
closer to the community, thereby enhancing the service delivery as envisaged through Ayushman Bharat.
Through an effectively orchestrated coordination, health needs assessment of the community
and mobilization of resources, periodic camps at CHCs will help in improving the reliance of the community
towards the public health facilities, handhold the CHC staff in improving healthcare provision, and increase
the health literacy of the population in addition to gatekeeping the tertiary health facilities,
refining the referral linkage mechanisms and help in improving the overall
quality of health services being offered to the community.
Through this guideline, the operational aspects of organizing such medical camps at CHC level hospitals under
the Ayushman Bhav initiative have
been outlined, and the responsibilities of stakeholders have been defined for guiding the implementors.
Scope
Medical Colleges would build a synergism in implementing national programs, public
health functions and overall benefit the community as a whole. In addition to the objectives
defined under the guidelines for conducting the health mela at the block level, the medical college would
provide screening, diagnosis,
and basic and advanced health care services through specialized care, including referrals to tertiary care
setup utilizing the existing CHCs.
Objective(s)
Engaging Medical Colleges would build a synergism in
implementing public health functions and overall benefitting the community as
a whole. The primary objective of the medical camp is to:
Provide screening, diagnosis, and basic and advanced health care services through specialized care,
including referrals to tertiary care setup and specialized and diagnostic services.
To make available specialist services up to the block level.
To enhance the clinical material and training of medical college students/faculty.
Expected Outcomes:
Increased access to specialized care ensure a continuum of Care.
Building the trust of the community.
Improved health-seeking behaviours and health literacy of the community.
Increased ownership of Medical Colleges.
Reaching the Unreached: Leaving no one Behind.
The objective of the guideline is to define:
Figure 1: Modalities of Medical college health camps
Modalities and periodicity of organising a camp.
Range of services.
Roles and responsibilities.
Operationalising the health camp.
Reporting mechanism.
Modalities and periodicity of organising a camp:
Operational Framework
An overseeing committee may be constituted for planning the medical camp with representation from
State/UTs, Medical Colleges,
CHC and a “block health mela planning committee” as defined in the national guidelines for conducting Block
Level Health Melas.
Figure 2:Committees monitoring Health Melas
The Director/ Dean of the Medical College would be in charge of providing technical
expertise and specialised care at CHCs and may nominate a Departmental Head of Preventive and Social
Medicine/Community and Family Medicine to plan/coordinate with the other departments of the medical
college for the nomination of staff for the medical camp.
The camp activities would also be supported by staff viz.,
Assistant Professor, Senior and Junior Residents etc., as per need and decision of the appropriate
authority.
The overall administrative responsibility for conducting a camp at the CHC shall be entrusted with state
and district administration.
Staffing pattern at Medical Camp: The human resource allocated for the camp from the
medical college shall comprise a medical officer,
a medical specialist (Physician), a gynaecologist, a paediatrician, a Surgeon, an Anaesthetist, an Eye
specialist, an ENT specialist, a Dermatologist,
a psychiatrist, a dental surgeon, two staff nurses, one lab technician, one counsellor and one Medical
Social Worker.
Financing and resource management: Untied funds or funds for IEC activities approved in
RoPs may be utilised for medical camps at CHCs.
Additional resources may be mobilised by
leveraging funds available with State/District administration, PRIs, ULBs, CSR/MPLAD funds, NGOs, CBOs etc.
Partnership and collaboration-
The collaboration and partnership with Indian Medical Association (IMA), Charitable Trusts, NGOs, etc.,
for providing human resources may be explored by State/District level committees.
Site Selection and Assessment of CHCs
Selection of CHC: The medical college is envisaged to provide camp-based outreach functions
to the community at the
selected Community Health Centres (CHCs) of the district. The CHCs planned to provide health services would
require consultation with the
overseeing committee (defined under the operational framework). The selection of the camp should be
prioritised based on the following:
Aspirational District/Blocks.
CHC covers the remote//vulnerable population/slums in rural areas and in urban areas.
High population density.
The medical college will support 4 CHCs, and one camp shall be conducted by all the medical colleges once a
week,
such that the camps are held in each CHC once a month. Each camp may last for 1 to 2 days as per need and
shall preferably be conducted from 9 AM to 4 PM.
Such camps need to be widely publicised for community awareness
and to increase the uptake of services through campaigning, hoardings and leveraging community platforms such
as VHSNC/MAS/UHND/VHND.
Figure 3:Representation of Health Melas organized by a Medical College
Assessment of CHC: The gap assessment of health facilities for the available resources
(infrastructure,
equipment, HR etc.) needs to be conducted by CHC In-charge as per IPHS 2022
(https://nhsrcindia.org/sites/default/files/CHC IPHS 2022 Guidelines pdf.pdf)
which would thereby help to plan for providing specialised services such as conducting operative care, USGs,
family planning services, diagnostic,
therapeutic dental care etc., based on the local morbidity profile. The services to be provided will be
discussed in the subsequent section.
Range of services
Service Delivery
In addition to the service envisaged at CHCs, fixed-day OT services may be provided particularly for
cataracts
(National Blindness Control Programme), hydrocele (National Filaria Control Programme) and family planning
(RMNCH+A) as per the requirement of national
programmes. The following services
may be provided in a camp-based mode. The list is non-exhaustive; therefore, additional services can be
added based on felt needs.
General OPD: Identification and management of cardiac, neurological, GI, endocrine and
other related disorders.
Surgeries: performing major and minor surgical procedures such as hernia repair,
laparoscopic cholecystectomy, hydrocele, appendectomy etc.
RMNCHA+N services: ANC, immunisation, USG of ANC mothers, counselling, MTPs
Ophthalmology services: diagnosing vision-related disorders, RoP screening, treating
common ophthalmic ailments through surgery like glaucoma and cataract, screening for diabetic retinopathy
etc
ENT services: diagnosis of hearing loss, medical management of acute and chronic otitis
media, surgical correction of DNS etc.
Psychiatric services: diagnosis, management and counselling for common medical disorders
such as dementia, depression, OCD, parkinsonism, substance abuse, erectile dysfunction etc.
Dermatology services: diagnosis and management of skin disorders such as tinea, psoriasis,
STIs, vitiligo, candidiasis etc.
Palliative services: pain management of chronic illnesses such as RA, osteoarthritis,
peripheral neuropathy, cancers etc.
Diagnostic services: endoscopy, colonoscopy, DEXA scan, mammography, 2-D Echo etc.
Oral health services: endodontics, prosthodontics, pedodontics and orthodontic related
procedures
Healthy Lifestyle Promotion: Lifestyle modification and diet counselling
Other activities which can be performed by health staff at CHC:
Ayushman card issuance to eligible beneficiaries.
ABHA (Health ID) creation.
Population enumeration and CBAC filling by ASHAs.
MPWs.
Updating family folders.
Identifying the newly diagnosed beneficiaries who can avail of services under various national programs.
Based on the requirement of the CHC, week-wise planning may be done for each facility to ensure the
delivery of specialist and operative services.
Facilitating Continuum of Care
The cases which require prolonged hospital admission/ specialist care shall be identified for being
treated at the medical college or a higher tertiary care centre as feasible.
Beneficiaries under PMJAY may be provided with surgical services required at the CHC. Any higher mediation
required can be referred to medical college. However,
the beneficiaries requiring services and type of intervention should be line-listed prior.
All the referral cases must be entered into a register indicating the name of the patient and the hospital
where the patient has been referred.
Referred patients shall be mapped and linked to the neared AYUSHMAN AROGYA MANDIR-PHC, and the list shall be shared with
respective MO-PHC for following up on the status/ outcome of the referrals to health institutions.
Facilitate the coordination between the Medical College and the District Administration for identifying
the CHCs where the camps shall be conducted and ensure CHCs preparedness before the conduction of the
camp.
Research
Medical Colleges with their undergraduates and postgraduates shall undertake implementation and operational
research for strengthening delivery of secondary care services.
Mentorship
The medical college should envisage creating a pool of experts to improve the delivery of acute care and
promote learning opportunities. Also, demonstrating proficiency in performing clinical procedures, capacity
building, monitoring and implementing appropriate treatment plans may also be provided to health care staff of
CHCs. Need-based short workshops, simulation exercises on common acute care scenarios and communication skills
may be part of the mentorship.
Roles and Responsibilities
As a fact of reiteration, the overall administrative responsibility for conducting a camp at the CHC shall be
entrusted to state, and district administration and providing technical expertise and specialised care shall
be the responsibility of the Medical College.
The roles of the potential stakeholders have been defined, which are not exhaustive and, therefore, may be
added based on mutual agreement of district administration/CHCs and the Medical College. The responsibilities
are shared and not binding and limiting to any stakeholder
Table 7: Roles and Responsibilities of State/UT
Stakeholder
Role and Responsibilities
State/UTs
The state shall support in implementation and prepare the budgetary requirements for the camp
under State PIPs.
Exploring Collaboration and Partnerships:
Leveraging CSR/MPLAD Funds
IMA, NGOs, CBOs etc.
District Administration
The proposal for organising a health camp shall be sent to the District Administration and must
be a part of the District Health Action Plan.
Wide publicity for community awareness and to increase the uptake of services through
campaigning, hoardings and leveraging community platforms such as VHSNC/MAS/UHND/VHND should
essentially be done at least two weeks before the camp is scheduled.
Engagement of MPs/MLAs, counsellors/Pradhan/sarpanch and other local leaders for enhancing
service uptake and increasing the visibility of camp.
Enable the selection of CHCs in the District by the Medical College.
Monitor and review the activities of the camp. Also, to undertake the review of the camp as one
of the agenda in the DHS meeting.
Identify priority areas in health for research and innovations in coordination with medical
colleges.
Exploring Collaboration and Partnerships
Table 8: Roles and Responsibilities of Medical College
Stakeholder
Role and Responsibilities
Medical College
The Medical Colleges will assign mutual roles and responsibilities (inter and intra-department)
for health staff visiting the camp.
Promotion of health camp and communication by developing a communication plan to raise awareness
about the health camp in the targeted community.
Deployment and Training of Staff:
Coordinate with medical professionals and recruit volunteers and support staff for the health
camps.
Conduct training sessions to familiarise staff with camp protocols, procedures, and specific
health issues prevalent in the target community.
Provide training on topics such as triage, basic medical procedures, patient communication, and
emergency response.
Develop Standard Operating Procedures (SOPs):
Create a comprehensive set of SOPs for the health camps, covering all key aspects of operations.
Include guidelines for patient registration, medical examination, treatment protocols, referral
systems, medication administration, and record-keeping.
Ensure SOPs are clear, concise, and easily understandable by all staff members.
Develop a roaster for health staff visiting the camp.
Logistic support to the health staff posted for a camp.
Organise awareness campaigns/nukkad natak at the CHCs by interns.
Extract and analyse the data/relevant case studies for scientific documentation.
Generate evidence through operational research on various aspects of public health and its
implications on health outcomes.
Support for pooling of resources, if required.
Table 9: Roles and responsibility of Medical college and CHC
Stakeholder
Role and Responsibilities
CHC
The CHC in charge or any appointed nodal (of the same facility) will oversee the activity
to be planned at the camp every month.
Assess Needs and the resources which may be required:
Identify the target community and their specific healthcare needs.
Evaluate available resources, including medical personnel, equipment, and supplies.
Determine the scope and objectives of the health camps.
Publicising the camp scheduled for a month and the specialist services to be organised.
Plan and Schedule for the health camps:
Establish a timeline for organising the health camps.
Allocate specific dates and locations for each camp, considering accessibility for the target
population.
Coordinate with relevant stakeholders, including local authorities, community leaders, and
healthcare professionals.
Field visits by the appointed health staff to oversee the mobilisation activity.
Facilitating documentation and reporting of the activities being undertaken.
Preparing the periodic work reports and submitting them to the District Health Society.
Any other job assigned by the Nodal Officer.
Plan for Services and facilities during the camp in coordination with the local team:
CHC and Medical Colleges
Determine the types of medical services to be offered at the health camps based on community
needs and available resources.
Arrange for medical equipment, supplies, and medications required for the camp.
Coordinate with local healthcare facilities for emergency services, referrals, and follow-up
care.
Promotion of health camps and Communications:
Develop a communication plan to raise awareness about the health camps in the target community.
Utilise various channels such as social media, local newspapers, radio, and community
organisations to disseminate information.
Provide clear instructions on registration procedures, camp dates, and any prerequisites for
participation.
Ensuring Quality Assurance at and during the Camps:
Establish a monitoring and evaluation system to assess the effectiveness of the health camps.
Implement mechanisms to collect and analyse data, including patient demographics, health
conditions, treatment outcomes, and patient satisfaction.
Regularly review the data and make improvements to enhance the quality of services provided.
Operationalising the health camp
The following activities shall be carried out for the successful implementation of a health camp:
Infrastructural considerations
The camp should be in CHC only
Clear access for vehicles and ambulances should be maintained.
The plan for arranging the consultation/specialisation room should be in such as way that it maximises the patient's movement.
Arrangements for fire safety should be adhered to.
If the surgeries are to be planned, the Operation Theatre at the CHCs should be well-equipped and must follow due infection prevention protocols.
Each camp planned should ensure that there is a designated central waste collection area which, after collection, should immediately be shifted the storage area of BMW away from the reach of the common public till the waste is picked and transported for treatment and disposal at a Common Biomedical Waste Treatment Facility.
Other operational aspects
The decision on the type of specialized services to be provided in addition to the routine services in the camp shall depend upon the health needs assessment performed by the CHC staff.
Necessary medicines, equipment and supplies should be arranged through the district health department well in advance. An adequate number of health staff from medical colleges may be drawn depending upon the services planned.
A display of the services being provided room-wise in the local language shall be displayed at the entrance of the CHC to guide the community members.
The duty chart of the doctors and other staff should be clearly visible.
An enquiry office with duty charts of the doctors and other staff with a layout map should be functional for at least from two days before the start of the camp.
An adequate number of registration counters need to be set up so that people are not inconvenienced and can easily get themselves registered. Online registration through ABHA IDs should be encouraged.
The initial check-up and examination of the patients shall be performed by the residents/medical officers from the department of community medicine and, if required, shall be referred to the specialists posted for the camp.
The patients who have been assessed previously by the medical officers/specialists of the CHCs who require a specific intervention shall not follow the above-mentioned protocol.
Lifestyle modification and wellness promotion using multimedia, including local art and culture along with the services, shall help build awareness of health risks and provide information on how an individual can make changes in their lifestyle to enhance their health.
Medicine for a full course of therapy in case of acute illness and at least for one month in case of a lifestyle disorder/mental illness will be distributed or as prescribed by the treating doctor by the pharmacist. Adequate storage and distribution facilities should be arranged.
The organisers will take due care of hygiene and infection prevention at the campsite. Arrangements for drinking water and sanitation at the campsite should be made.
Reporting mechanism
The CHC shall submit a quarterly physical work report and annual financial report to the
District Health Society regarding the camps conducted. The medical camp OPD will be counted as OPD under
medical college and will be monitored using Health Management Information System (HMIS). It should be linked with ABHA ID.
Also, the existing platforms under State NHM and District
Health Society (DHS) should be utilised for review. The CHCs may share photos of medical camps on the Ministry’s social media account.
The review may be done based on the pre-defined indicators mentioned below and to be updated in HMIS.
The number of cases seen monthly can be categorised by:
Number of camps conducted (Target: 50 camps annually)
Total number of patients registered in the camps (Target: 15000-20000 annually)
Number of major/minor surgeries performed
Number of specialist OPD
Number of general OPD
Patients diagnosed with confirmed HT/Diabetes/cancer (oral/breast/cervical)
High Risk /Complicated Pregnancies.
Number of Non-Scalpel Vasectomy (NSV) / Conventional Vasectomy conducted.
Number of Laparoscopic sterilizations (excluding post-abortion) conducted.
