Background

Aardram is one among the four missions under the Navakerala program launched by the Government of Kerala. Mission Aardram with the main objective to completely transform public health sector was launched in the backdrop of the WHOs Sustainable Development Goals 2030.

One among the objectives of Aardram Mission is to transform the public health sector making it Patient Friendly and affordable for all citizens of our state especially the poor. The government has designed various strategies to provide effective healthcare system to the people in the public domain with better infrastructure and quality services. The existing public health institutions, particularly the tertiary level institutions are currently not able to manage the large volume of patients who approach them for treatments. The only way to resolve this problem is to strengthen the primary level hospitals where the health issues of majority of the population can be effectively addressed. An effective primary health care system can reduce the referral cases to tertiary centres by preventing and managing many of the health problems there itself.

The objective of 'Aardram' mission is to deliver patient friendly quality health care services in Government Hospitals and to add specialty and super specialty facilities in District and Taluk Hospitals. It also envisages to develop Primary Health Centre into Family Health Centres, capable of meeting the healthcare needs of all members of the family through personalized service packages and to address the preventive, promotive, curative, palliative and rehabilitative health care interventions of local community. The highlight of this transformation is that the LSGs play the most important role in providing and maintaining both of the above.

Objectives of Aardram Mission

• All government hospitals will be converted to people friendly hospitals through OP transformation
• The treatment facilities of District/Taluk hospitals will be standardized by improving the infrastructure and human resources
• All Primary Health Centres will be converted to Family Health Centres
• Treatment from government hospitals at different levels will be standardized and made evidence based using standard treatment guidelines
• The health service providers and staff will be protected from occupational hazards by implementing different quality standards and guidelines
• There will be focus on improving the human resources and skills in nursing area.

OP transformation

The number of OP counters will be in proportion to the number of patients. Token system will be installed in all counters. Implementation of eHealth will connect the OP registration counter, doctor’s cubicle, pharmacy, laboratory, ECG, X ray rooms. Each doctor will have separate cubicle. Adequate seating arrangement, drinking water, audiovisual aids, reading materials, fans and light in the waiting areas will be arranged in the family health centres.

Improvement of quality

Standardising the infrastructure and equipments at all levels of care, introducing guidelines for treatment at all levels, improving the lab facilities and pharmacies, improving the human resources by creating new posts, filling up of vacancies and continuous training for all category of staff are some of the strategies for delivering quality services through public hospitals.

Development of the tertiary care system

All Government medical colleges will be transformed into centres of excellence by improving the trauma care, super specialty services and facilities for managing severe illnesses and emergency cases. There will be provision to book prior appointments through kiosks and mobile apps.

District/General Hospital

Patient friendly transformation of outpatient departments, introducing USG, CT and MRI facilities, setting up ICU, CCU, level 2 trauma care & cathlab facilities, ensuring SNCU, improving DEICs, starting chemotherapy, stroke care units, and super specialty services are some of the strategies for expansion of District/General hospitals.

Taluk hospitals

Each taluk will have all major specialties like Medicine, Surgery, Gynaecology, Paediatrics and minor specialties like ENT, Ophthalmology and Dental specialties. More doctors will be appointed to strengthen the services offered. Starting dialysis units, casualty, imaging facilities and improving laboratories and pharmacies are some of the strategies.

Family Health Centres

Vision: To provide comprehensive health care for each and every individual residing within its jurisdiction.

Mission: To achieve the SDG targets through the provision of equitable, affordable and quality care for all

Strategies: Strengthening primary health care by improving quality of services, addressing social determinants of health and enhancing community participation is the strategy.

Services

An FHC will be more than just a hospital and will function as a centre for the promotion of good health and well being. The quality of services at FHCs will be ensured by improving the standards of care through the provision of patient-friendly infrastructure, adequate equipment and implementation of clinical guidelines. FHCs will also function as the nodal centre for community based interventions for addressing social determinants of health. FHCs will take the lead in planning the activities of the Panchayat with community participation.

Curative services (OP services, emergency, laboratory and referral services), field-level activities, institutional services (hostels, schools, offices and work places), and specific services for marginalized and vulnerable population will be provided by incorporating appropriate social security schemes.

FHCs will strictly follow the Comprehensive Primary Health Care (CPHC) treatment guidelines in attending to patients coming to the OP clinics. Patients who may require treatment at a higher level will be identified and referred early to the appropriate level of institution in accordance with the treatment guidelines. FHCs will also follow up all cases which are referred back from taluk or district hospitals.

Health care Service Delivery Plan

The service delivery from the FHC should be based on the defined health plan of the state and health service delivery plan conceived for the FHC. There are four types of service packages viz. Individual packages, Family packages, Ward level packages, Panchayat-level packages

Role of LSG in FHCs

LSGs should develop specific targets to be achieved by the panchayat. They should adopt a proactive role in identifying potential issues which could affect the health care delivery and utilization, and in rectifying them in advance. Local self-governments should play a leadership role in the planning, funding, implementation, maintenance, monitoring and evaluation of family health centers.

Monitoring and Evaluation

The monitoring committee should be constituted at different levels as ward, sub centre, FHC and panchayat. Social monitoring and evaluation should be addressed by local self government.