In order to expand Comprehensive Primary Health Care (CPHC) to improve community access, Sub Centres/ Primary Health Centre have been strengthened as Health and Wellness Centres (H&WCs) The H&WC provides Preventive, Promotive, Rehabilitative and Curative care for RMNCH+A, Communicable diseases, Non-communicable diseases, Ophthalmology, ENT, Dental, Mental, Geriatric care, Palliative care, treatment for acute simple medical conditions and emergency & trauma services.

•  CPHC through  HWC
• Continuum of Care –  Telehealth /Referral
• Expanded Service Delivery
• Expanding HR – MLHP & Multiskilling
• Medicines & Expanding Diagnostics – point of care & new technologies 
• Community Mobilisation and Health Promotion
• Infrastructure
• Financing/Provider Payment Reforms
• Robust IT System
• Partnership for Knowledge & Implementation

CPHC – ESSENTIAL PACKAGE OF SERVICES

1. Care in Pregnancy and Child-birth.
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. General Out-patient Care for Acute Simple Illnesses and Minor Ailments
7. Screening, Prevention, Control and Management of Non-communicable Diseases
8. Care for Common Ophthalmic and ENT Problems
9. Basic Oral Health Care
10. Elderly and Palliative Health Care Services
11. Emergency Medical Services including Burns and Trauma
12. Screening and Basic Management of Mental Health Ailments

AB-HWC operationalization In the state of Goa, all 24 Primary Health Centres, 30 Rural Medical Dispensaries, 4 Urban Health Centres, 1 RHTC Mandur and 1 UHTC St. Cruz have been converted to Health and Wellness Centres.  There are 32 HWCs in North Goa and 28 HWCs in South Goa as follows: Urban Health Centres (UHC’s) as Health and Wellness Centre

Sr.No.	North Goa	South Goa
1.	UHC Panaji	UHC Vasco
2.	UHTC St. Cruz	UHC Margao
3.	UHC Mapusa

Primary Health Centres (PHC’s) as Health and Wellness Centre

Sr.No.	North-Goa PHC’s	Sr. No.	South-Goa  PHC’s
1.	PHC Siolim	1.	PHC Quepem
2.	PHC Cansarvarnem	2.	PHC Sanguem
3.	PHC Colvale	3.	PHC Balli
4.	PHC Candolim	4.	PHC Chinchinim
5.	PHC Porvorim	5.	PHC Casaulim
6.	PHC Aldona	6.	PHC Loutolim
7.	PHC Bicholim	7.	PHC Shiroda
8.	PHC Mayem	8.	PHC Navelim
9.	PHC Corlim	9.	PHC Cortalim
10.	PHC  Chimbel	10.	PHC Ponda
11.	PHC Betki	11.	PHC Dharbandora
		12.	PHC Marcaim
		13.	PHC Curtorim
Total PHC’s=24

Out of the total 24 PHCs, following 14 PHCs are operational 24 x 7:

Sr.No.	North-Goa PHC’s operational 24×7	Sr. No.	South-Goa  PHC’s operational 24×7
1.	PHC Aldona	1.	PHC Balli
2.	PHC Betki	2.	PHC Cansaulim
3.	PHC Bicholim	3.	PHC Curtorim
4.	PHC Candolim	4.	PHC Marcaim
5.	PHC Cansarvanem	5.	PHC Quepem
6.	PHC Siolim	6.	PHC Sanguem
		7.	PHC Shiroda
		8.	PHC Dharbandora

The other PHCs, RMDs and UHCs are operational from 9 am to 4.30 pm. Rural Medical Dispensaries (RMD’s) as Health and Wellness Centres

Sr. No.	North-Goa RMD’s	Sr. No.	South-Goa  RMD’s
1.	RMD Mandrem	1.	RMD Molorem
2.	RMD Arambol	2.	RMD Maxem
3.	RMD Morjim	3.	RMD Agonda
4.	RMD Guleli	4.	RMD Dabal
5.	RMD Thane	5.	RMD Rivona
6.	RMD Chapora	6.	RMD Neturlem
7.	RMD Dhargal	7.	RMD Cuncolim Bhivsa
8.	RMD Revora	8.	RMD Velim
9.	RMD Dodamarg	9.	RMD Varca Orlim
10.	RMD Chorao	10.	RMD Sancoale
11.	RMD Pale / Velguem	11.	RMD Agapur
12.	RMD Keri	12.	RMD Usgao
13.	RMD Diwar	13.	RMD Collem
14.	RMD Volvoi	14.	RMD Sada
15.	RMD Cumbharjua
16.	RMD St. Estevem
17.	RHTC Mandur
Total RMD’s=30; RHTC=1

2. Branding and Community Awareness:

Branding has been undertaken for all HWCs. IEC Material has been distributed to all HWCs and placed at strategic location. Village Health Sanitation Committes (VHSCs), Panchayats are involved in community awareness about the services provided under HWCs. RBSK doctors also create awareness amongst school children. The Sub-Centres are located in close proximity and well connected to the PHCs/ RMDs. MBBS Medical Officer visits the Sub Centre on fixed days of the week for OPDs. The drugs are dispensed by the ANMs at the Sub Centre level under the supervision of Medical Officer. As per the NPCC meeting held on 1st Jan 2020, in addition to the existing 60 HWCs, 6 more Subcentres will be converted to HWCs in peripheral blocks in 2020-21–

• Gaon dongri (Canacona)
• Kavre Pilla(Quepem)
• Ibrampur(Cansarvanem)
• Keri(Ponda)
• Pissurlem (Valpoi)
• Harvallem (Sankhali). 

3. Infrastructure:

The infrastructure has been adequate at all PHC-HWCs, UHC- HWCs, and some RMD-HWCs. At RMDs where infrastructure was not adequate, additional funds have been provided to carry out necessary / additional changes.

4. IT Infrastructure

Computers along with Printers have been procured and installed at all the HWCs. 222 Tablets have been procured for data entry in NCD GOI Application by the ANMS at the level of Subcentre. Webcams, Headphones-microphones are procured and installed for implementation of Telemedicine at all HWCs. Computers shall be procured for the same at both the District Hospitals and Sub-district Hospitals.

5. Human Resource:

In Health and Wellness Centres, health services are provided by MBBS Medical Officers. MO In charge/ Health Officers (qualified MBBS) in each HWCs are designated as a Community Health Officer. The ANMs are recruited under State as well as NHM. Trainings Undertaken:

• Hands on Training for online entry on PHC-MO NCD portal conducted for 7 batches for various cadres of staff in the month of April-May 2019. Total Staff trained = 308
• Refresher training for NCD MO Portal on 26th & 27th August 2019 to sort out the issues pertaining to the MO NCD Portal.

• Training of ANMs/MPHW (M) for using NCD App on Tablet held in Nov 2019 in block wise batches at SIHFW (for North Goa health facilities) & at UHC Margao (for South Goa health facilities). Total 420 ANMs/MPHWs trained
• Training of Health Officers & Medical Officers for review of Ayushman Bharat Portal & NCD Portal performance in Jan 2020.
• Review meetings for performance of HWCs are undertaken quarterly with the Health Officers and Medical Officers IC (HWC/NCD).
• NCD Portal/ app refresher training for Medical Officers and ANMs on 29th June and 30th June 2020.

6. 6. Services 

1. General OPD services
2. Dental OPD services
3. Ophthalmic OPD on selected days
4. Laboratory services
5. Pharmacy
6. Obstetrics and Gynaecology, ENT, Psychiatry, and services are provided in selected HWCs on fixed days
7. Ultrasound facilities and X ray facilities are available in selected HWCs
8. Yoga at selected HWCs on fixed days

7. Supplies 

Pharmacy Inventory Management System (PIMS) is used at all HWCs. The supplies are provided from State Medical Store Depot. In case of shortage of supplies funds are released for local purchase after following Codal procedure.

8. Celebration of Health Days:

Ayushman Bharat Health and Wellness Centres(AB-HWCs) are envisaged to deliver Comprehensive Primary Health Care (CPHC), with a focus on wellness and the delivery of expanded range of services closer to the community. As Preventive and Promotive Healthcare is one of the essential components of AB-HWCs, an annual Health & Wellness Calendar detailing a list of health related days have been circulated. At least two health promotion actives in a month are organised at all functional HWCs. Fit India Movement, Eat Right Movement: to take the nation on a path of fitness and wellness and provides a unique and exciting opportunity to work towards a healthier community. Full involvement of HWCs as vehicles in journey towards a Fit India. Activities under FIT INDIA are carried out with maximum community participation at all operational HWCs on specified days of HWC Calendar.

9. Any other

Population Enumeration Total Population: 1413481 Population enumerated in June 2018- March 2019 (North & South Goa): 116445 Population enumerated in April 2019- March 2020 (North & South Goa): 354776 Population enumerated April 2020- June 2020 (North & South Goa): 9476 Universal Screening of NCDs (2018-2019 & April 2019- Feb 2020: 263168 Telemedicine Services: The Telemedicine service is an important component under the expanded range of services to be provided under Ayushman Bharat – Health and Wellness Centres. With this regards, e-Sanjeevani software has been developed by CDAC Mohali to provide Telemedicine services in Hub & Spoke model. ‘e-Sanjeevani’ is implemented in all 60 Health & Wellness Centres from the month of July 2020. Tele-consultation is provided by the Medical Officers from the primary health facilities from 2.30 pm to 4.30 pm. In addition, Tele-psychiatry services will be piloted with IPHB Hospital as a Hub and CHC Canacona as spoke Hospital.

10. Reducing Out of the Pocket Expenditure

Free diagnostics and medicines are available at all the Health Facilities. The patients are referred to higher centres where diagnostics are available for further evaluation and management. Some private diagnostic centres have been identified where patients are referred for investigations as and when the need arises and the bills are settled by the State Government. The residents of Goa are covered under the State Insurance Policy under Deen Dayal Swasthya Seva Yojana (DDSSY). The insurance is also available under Pradhan Mantri Jan Aarogya Yojana (PMJAY) and also under State Mediclaim Scheme. In case the drugs are stocked out, full powers are delegated to all the In- charges of hospitals/ CHCs/ PHCs/ UHCs to make local purchase under NHM

• Essential Medicines:

Adequate medicines are available at each Health Facility. Each Health Facility sends the indent as per the requirement through Pharmacy Inventory Management System. The medicines are then supplied to the respective Health Facility. In case of shortage of medicines, funds are available under NHM for local purchase of the medicines after following codal procedures.

• Diagnostics:

Most Primary Health Centres, Community Health Centres, District Hospitals have semi-auto Analyzers / fully automated Analyzers. X-ray machines and USG machines are also available at selected Health Facilities. District Hospitals have identified the private laboratories for getting the tests for which facilities are not available. Most Rural Medical Dispensaries/ Sub-Centres are in close proximity of PHCs/ CHCs and the samples are collected and sent to these PHCs/CHCs or the patients are referred to these Health Facilities for investigations. FUTURE PLANS:

1. Expand 6 Subcentres as HWCs:

1. Gaon dongri (Canacona)
2. Kavre Pilla(Quepem)
3. Ibrampur(Cansarvanem)
4. Keri(Ponda)
5. Pissurlem (Valpoi)
6. Harvallem (Sankhali)

1. Telemedicine: As per the directives of MOHFW, to be implemented as Hub & Spoke model. The HWCs shall act as Spokes with Hub at GMC & both District Hospitals.

1. Performance Linked Payment (PLP) for frontline health workers: ANM/MPHW