Final Pm-Abhim - 15-12-21
Final Pm-Abhim - 15-12-21
Final Pm-Abhim - 15-12-21
Government of India
Appendix 3.1. The Component-wise State wise breakup of Physical targets after
factoring-in the FC-XV Grants from 2021-22 to 2025-26- AB-HWCs 25
CHAPTER - 4: AYUSHMAN BHARAT - HEALTH & WELLNESS CENTRES (AB-HWCs)
IN URBAN AREAS 26
4.1 Background 26
4.2 Physical Deliverables for this Component under Pradhan Mantri Ayushman
Bharat Health Infrastructure Mission 27
4.3 Factors to be Considered, while Planning 27
4.4 Identification of Facility, Approvals and Operationalization 28
Appendix 4.1- State wise physical deliverable for this component under
Pradhan Mantri Ayushman Bharat Health Infrastructure Mission for the
period of 2021-22 to 2025-26 after factoring in the FC-XV Grants 30
CHAPTER - 5: BLOCK PUBLIC HEALTH UNITS (BPHUs) 32
5.1 Background 32
5.2 Physical Deliverables for this Component under Pradhan Mantri Ayushman
Bharat Health Infrastructure Mission 33
5.3 Factors to be Considered 33
5.4 Identification of Facility, Approvals and Operationalization 33
Appendix 5.1. State-wise Physical deliverables for establishing BPHUs for
the period of FY 2021-22 to 2025-26 under Pradhan Mantri Ayushman Bharat Health
Infrastructure Mission after factoring in the 15th FC grant 35
CHAPTER - 6: DISTRICT INTEGRATED PUBLIC HEALTH LABORATORIES 36
6.1 Background 36
6.2 Objectives for Establishment of District Integrated Public Health Laboratories 37
6.3 Physical Deliverables for this Component under Pradhan Mantri Ayushman
Bharat Health Infrastructure Mission 37
6.4 Factors to be Considered 37
6.5 Identification of Facility, approvals and operationalization 39
Appendix 6.1 The State wise breakup of physical deliverable for District IPHL
under Pradhan Mantri Ayushman Bharat Health Infrastructure Mission
from FY 2021-22 to 2025-26 42
iii
Contents
LIST OF CONTRIBUTORS 65
iv
1
Introduction to PM Ayushman Bharat Health
Infrastructure Mission
1.1.6. 27.5% of all deaths in India in 2016 were due to communicable diseases, maternal, neonatal
and nutritional disorders while non-communicable diseases and injuries accounted for
61.8% and 10.7% deaths respectively. Communicable diseases also contribute to 32.7% of
DALYs in India (Source: India: Health of the Nation’s States, ICMR) whereas injuries contribute
to 11.9% of DALYs in India, and 10.7% of deaths in India. It is anticipated that about 3-5% of
emergencies would require ICU facilities and oxygen supported beds for critical care. There is
an urgent need to strengthen these facilities and create additional amenities (infrastructure,
equipment etc.) including for dialysis, in existing district hospitals to meet such unforeseen
epidemics, disasters etc.
1.1.7 The present architecture of the public hospitals is not equipped fully to handle the critical
requirement of clinical management of affected patients while maintaining essential
services during periods of public health challenges posed by pandemics such as the current
COVID-19 pandemic. Many of the hospital buildings currently available do not have the
provision for segregating a part of the building as an infectious diseases treatment block\
wing. As a result, in order to avoid mixing of COVID and non-COVID patients, at many places
full hospitals were required to be designated as COVID Dedicated Facilities. Apart from
that, at many district headquarters, especially in districts with largely rural settings, district
hospital is the only hospital available where critical care services can be provided to people.
As a result, either large amounts of expenses are necessitated on account of transportation
of patients to other districts or in case the only available hospital is designated as the COVID
(pandemic) dedicated hospitals, there is a severe adverse impact on the other essential
services such as institutional deliveries, blood transfusion services, dialysis and chemotherapy
etc. Strengthening all the districts with Critical Care Hospital Blocks of 50-100 beds as per
the population size, will enable the public healthcare system at the district level to respond
adequately during the public health challenges posed by future pandemics and in periods
of epidemic outbreaks and enable the health systems to also maintain the essential health
services in such times. In other times when there is no epidemic, these blocks will continue
to provide health services, especially for critical care.
1.1.8. The disease burden in the country also demonstrates the need for provision of high
quality laboratory services at district and block levels. Delays in diagnosis compromise
early detection and initiation of appropriate treatment. In the case of infectious disease
outbreaks, such delays can lead to widespread community transmission.
1.1.9. Both general and out of hours laboratory services (e.g. emergency services, critical care
services) are being provided through laboratories that are largely fragmented. Also, public
health surveillance for abnormal morbidity/mortality, reporting of human or animal disease
patterns and testing of samples etc. for public health needs remains a weak area in most
districts.
1.1.10. The present public healthcare system structure at the Block level is not equipped to handle
public health emergencies and also to respond and monitor the healthcare services. Every
Block in the Country is envisaged to have a Community Health Centre (CHC) at the Block
headquarter and serve as a hub for referral from the Sub-Health Centres (SHCs) and Primary
Health Centres (PHCs) within the block. However, the status of availability of CHCs across
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Operational Guidelines for PM Ayushman Bharat Health Infrastructure Mission
states is highly variable, with the block level CHC in some states in effect being just another
PHC. In some other states, the block CHC, on the other hand, is also a First Referral Unit. The
functions of a Block CHC are mostly focused on clinical services that too largely RMNCH+A
and selected infectious diseases. The outbreak of COVID-19 has highlighted a constrained
public health response as a result of a suboptimal public health focus at the block level.
1.1.11. The COVID-19 pandemic has also highlighted the various challenges faced in provisioning
of trained human resources. Experience suggests that as the pandemic evolves and as the
experts gain a better understanding of the epidemiology and virulence of the disease,
the training needs also evolve. With a pandemic like COVID-19 which is a new infection,
experimentation in arriving at the best treatment protocol also leads to changing training
needs. The Ministry has set up the iGOT training platform for online training of healthcare
professionals. More importantly over a period of last 5 months, the Central Institutions of
Excellence such as the AIIMS Delhi, PGI Chandigarh etc. have assumed the much needed
mentorship role for building confidence of the healthcare professional providing treatment
services to the patients, be it about personal protection, infection prevention, plasma
therapy, patient monitoring or about the best possible line to treatment. These institutions
have also acted as training sites (albeit the trainings being largely offsite!!) for the healthcare
professional and for undertaking clinical studies to inform further policy direction. This
Ministry has set up INIs like AIIMS Delhi and several other large hospitals cum teaching
institutes such as Safdarjung and RML Hospital. Also, 22 new AIIMS are being established
under the Pradhan Mantri Swasthya Suraksha Yojana (PMSSY). These are tertiary healthcare,
medical education and research institutes. In addition, the Ministry of HRD also operates 2
advanced medical education and tertiary healthcare institutes/ hospitals. However, these
hospitals have not been designed to deal with infectious disease patients. Infectious disease
hospitals are specially designed, with negative pressure systems and other special features
to control spread of the infectious disease.
1.1.12. The complexity of COVID-19 pandemic, which has spread to over 150 Countries in the
World, has highlighted the need of having competent core capacities for surveillance and
response, diagnostic labs, logistics (including PPEs, Masks, Sanitizers and Disinfectants) and
appropriate quarantine and isolation facilities at various levels. During the course of past 3-4
months, the Country has faced numerous challenges like quarantine of evacuees (for China,
Iran, Italy), widespread migration, containment of complex clusters and development of
diagnostic capacities across the Country.
1.1.13. The 40 metro cities (including Tier I and Tier II cities) presently do not have any infrastructure
for regular surveillance for community based health measures and health facilities.
Similarly, implementation of the Integrated Health Information Platform (IHIP), an IT
enabled comprehensive surveillance platform has also only been implemented in 7 states.
Capacities for timely data collection, collation and analytics also need strengthening.
The Epidemiological Intelligence Service, housed in the NCDC has been instrumental in
containing recent out breaks of Nipah in Kerala and Zika in Rajasthan and Madhya Pradesh.
However, the EIS too needs to be strengthened to have the capacity to effectively lead the
technical response to pandemics of the magnitude of COVID-19.
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Operational Guidelines for PM Ayushman Bharat Health Infrastructure Mission
1.1.14. There is a need for an integrated surveillance program at all levels (Zonal and State
levels) and also its expansion to various metro cities. It is also envisaged that the IT level
surveillance network is developed, so that that there is uninterrupted data flow particularly
sites of screening to tracking in the community and further linking it up with diagnostic
laboratories and isolation hospitals. The proposal encompasses strengthening of all Divisions
of NCDC focused on applied public health and epidemiological intelligence, building
capacity for emerging and re-emerging infections, surveillance and its evaluation, National
program for anti-microbial resistance (AMR) containment under the One health approach,
biosafety-biosecurity, occupational safety & climate change, and building of competencies
among front line health care workers for strengthening community surveillance at National,
Regional and District levels.
1.1.15. A major impediment for quick response mechanism is non-availability of dedicated
secondary/ tertiary level medical facilities near the disaster site due to damage to the
health facilities. In major public health emergencies such as COVID-19, the health system
gets overwhelmed and there is need to deploy field hospitals. With increasing frequency of
natural and man-made disasters, incl. complex emergencies, a pressing need has been felt
for development of quick response medical clinical teams. Keeping this in mind, WHO under
its “Global EMT (Emergency Medical Team) Initiative” calls for quality assured, accredited,
self-sufficient in every aspect wherein, member countries deploy medical teams in another
member country during times of disasters, natural calamities as per the need of the host
country. This also gives an opportunity for countries providing EMTs not only to strengthen
its system to global standards but also deploy these teams for internal requirements. It is
envisaged to develop these capacities through the Health Emergency Operation Centres
(HEOCs) and the self-contained container based mobile hospitals.
1.1.16. Emerging infections continue to disrupt the health care system and are becoming
increasingly complicated to detect and treat successfully. The public health system is
continually reminded of the challenges posed by the unexpected, whether it is the pandemic
or a bioterrorist act. Thus, there is increasing need to strengthen the infrastructure for
creating favourable environment for epidemiological studies on virus outbreak and other
pathogens related to public health importance.
1.1.17. There is need for setting up institutions which can serve to advance an evolving science of
disease elimination to design and develop theoretical, quantitative, qualitative, behavioural
and applied research practice in order to better translate evidences to policy in partnership
with other research institutes, national programs and international organizations towards
making time bound promise of communicable disease elimination a reality.
1.1.18. Emergence of highly infectious and pathogenic viral infections cause significant burden
on public health system. It becomes difficult controlling such diseases, which are highly
infectious and pathogenic in nature and have zoonotic origin or spread by aerosols or
vectors. Recently, our country has witnessed recent emergence of infections like Ebola,
H5N1, CCHF, KFD, Nipah, H7N9, and MARS CoV, SARS CoV 1 & 2. This has shown countrywide
need of enhancing laboratory capacity, networking of institutions dealing with emerging
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Operational Guidelines for PM Ayushman Bharat Health Infrastructure Mission
viral diseases of zoonotic importance for by sharing the expertise, reagents and various
trainings including biosafety and biosecurity to laboratory management to deal with these.
1.1.19. COVID 19 has shown that significant investments are needed to strengthen public health
systems. Without additional funding, the health system will not only fail to respond to
outbreaks/disasters and other emergencies but also be ineffective in delivering other
essential services, delaying and disrupting the country’s progress towards the achievements
of the goals and targets of the National Health Policy 2017 (NHP, 2017) and the Sustainable
Development Goals. (SDGs).
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Operational Guidelines for PM Ayushman Bharat Health Infrastructure Mission
2. Ayushman Bharat - Health & Wellness Centres (AB-HWCs) in Urban areas: Support
for 11044 Urban Health & Wellness Centres across the country is proposed under this
component.
3. Block Public Health Units (BPHUs): Support for 3382 BPHUs in 11 High Focus States/
UTs (Assam, Bihar, Chhattisgarh, Himachal Pradesh, UT - Jammu and Kashmir, Jharkhand,
Madhya Pradesh, Odisha, Rajasthan, Uttar Pradesh and Uttarakhand), is proposed under
this component.
• For the remaining States, the support for establishing BPHUs is being provided under
FC-XV Health Grants through Local Governments.
• For the UTs, the proposed District Integrated Public Health Labs under the PM Ayushman
Bharat Health Infrastructure Mission at the Districts will be catering the needs of the
Blocks in the UTs.
4. Integrated District Public Health Laboratories in all districts.
5. Critical Care Hospital Blocks in all districts with a population more than 5 lakhs, in state
government medical colleges / District Hospitals.
Out of the five CSS Components, the components of Ayushman Bharat – Health and Wellness
Centres (AB-HWCs) in rural areas, Ayushman Bharat – Health and Wellness Centres (AB-HWCs)
in urban areas and Block Public Health Units are partially financed through the ‘FC-XV Health
Grants through Local Governments’.
B. Central Sector (CS) Components
The PM Ayushman Bharat Health Infrastructure Mission has the following CS components:
1. Critical Care Hospital Blocks in 12 Central Institutions.
2. Strengthening surveillance of infectious diseases and outbreak response. Support for
20 Metropolitan Surveillance Units, 5 Regional NCDCs and implementation of IHIP
in all states.
3. Strengthening surveillance capacities at Points of Entry. Support for 17 new Points of
Entry Health Units and Strengthening of 33 existing Units.
4. Strengthening Disaster and Epidemic Preparedness. Support for 15 Health Emergency
Operation Centres & 2 Container based mobile hospitals.
5. Bio-security preparedness and strengthening Pandemic Research and Multi-
Sector, National Institutions and Platforms for One Health. Support for setting up of
a National Institution for One Health, a Regional Research Platform for WHO South East
Asia Region, 9 Bio-Safety Level III Laboratories and 4 new Regional National Institutes of
Virology (NIVs).
The Central Sector components of the proposed Scheme will be implemented by the central agencies/
subordinate offices/ autonomous bodies under the Department of Health & Family Welfare and the
Department of Health Research, by following the existing procedure.
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Operational Guidelines for PM Ayushman Bharat Health Infrastructure Mission
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Operational Guidelines for PM Ayushman Bharat Health Infrastructure Mission
Table 3: Financial Year wise break-up of allocation of resources under PM Ayushman Bharat Health Infrastructure
Mission (Rs. In Crore)
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Operational Guidelines for PM Ayushman Bharat Health Infrastructure Mission
b. Each chapter provides the background and the rationale for the intervention proposed,
objectives, physical deliverables planned under the component with the indicative unit cost
particulars, factors to be considered while planning and the negative list for which the funds
should not be utilized. States/UTs are required to conduct comprehensive gap analysis before
submitting the proposals for approval.
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2
Implementation Framework
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Operational Guidelines for PM Ayushman Bharat Health Infrastructure Mission
2.1.8 Gap analysis will be done for preparing the project plans with adequate justification and
realistic timelines.
2.1.9 The implementation of the proposed components at district and sub district levels, and
especially at HWCs would focus on citizen centric services to enable better and easier access
to entitlements, establish referral linkages to AB-PMJAY for those who are covered by the
scheme to provide services across the full continuum of care.
2.1.10 Private sector capacities would be leveraged through suitable PPP and contracting
(outsourcing, insourcing etc.) arrangements. Investments from private sector would be
explored through mechanisms such as: Viability gap funding from the existing government
schemes. Partnerships with Civil Society Organisations will also be explored.
2.1.11 A multi-sectorial approach would be followed to address social determinants of health
specially for preventive and promotive care through the HWCs. Special focus will be
given to the wellness component to promote healthy lifestyles through Poshan Abhiyan,
Fit India, Eat Right and Eat Safe.
2.1.12 Recognizing that effective health care and particularly public health action relies on action
on social and environmental determinants, community engagement, participation and
ownership mechanisms shall be strengthened with increased involvement and role for
the Panchayati Raj Institutions, Urban Local Bodies, women Self Help Groups and Resident
Welfare Associations. 3 of the 5 CSS components are partially financed through the XV
FC Grants for Health Sector through the Local Bodies. In particular PRIs and ULBs would
be actively involved to leverage on their community connect, through capacity building
and a renewed focus on active participation in existing institutions such as Village Health,
Sanitation & Nutrition Committees (VHSNC) in rural areas, Sthaniya Swasthya Sabhas (SSS)
envisaged to be set up in urban areas, the Jan Arogya Samitis (JAS) being set up at the HWCs
and Rogi Kalyan Samitis at health facility level. Such capacity building would also include
management of outbreaks, pandemics/other emergencies and disasters, to better equip
such Local Self Government Institutions to lead the response.
2.1.13 Augmented infrastructure and HR are critical to achieve health outcomes but commensurate
investments need to be made in enabling quality improvements and patient centred care in
facilities and enable training and capacity building of all cadres of personnel, particularly for
in-service training. In addition to strengthening district hospitals as training hubs, the use
of digital technology platforms will be leveraged to provide refresher training, on the job
mentoring and support for all health workers, service providers and programme managers,
and multiskilling of HR wherever necessary. Medical Colleges will also be engaged to
provide specific skill based training and also mentor and support Health and Wellness
Centres in rural and urban areas. Learning from the COVID 19 experience, capacity building
for all cadres will include content to enable activities related to outbreak management so
that they can be repurposed for contacttracing/surveillance, etc in future pandemics.
2.1.14 Initiatives such as the Integrated Health Information Platform (IHIP) and the National Digital
Health ecosystem will enable the development of expertise and knowledge sharing across
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Operational Guidelines for PM Ayushman Bharat Health Infrastructure Mission
multiple institutions, improve capacity for epidemiological analysis, enhance ability for
forecasting and effective monitoring, strengthen real time surveillance in public health
emergencies, generate data for public health action, ensure portability of health information
at a national level, thus expanding and facilitating rapid and timely responses to future
pandemics. Wherever Information Technology is used, due care will be taken of the data
security and privacy of individual data
2.1.15 The indicative unit costs have been estimated based on detailed deliberation with
stakeholders, domain experts and implementing agencies i.e. NHM, NHSRC, Central Hospitals
division, ICMR, NCDC, eHealth Division, International Health Division and Emergency
Medical Relief (EMR) Division in the Ministry. The costs may vary depending upon prevailing
rates of construction, increase in prices of equipment and increases in Dearness Allowance
for employees, etc.
2.1.16 Indicative unit costs will be used for the purpose of preparation of proposals, budgeting
and for according approvals. However, given that variations in costs will be there especially
among the states, the capital and recurring costs of goods and services, shall be supported
at the prices discovered through a transparent procurement processes and by following
due process as per extant rules in this regard.
2.1.17 The continuum of care approach:
2.1.17.1 It is important to strengthen the public health system to not only enable public
health actions in case of future outbreaks, and pandemics, (such as early detection,
management and mitigation) but ensure that essential non pandemic related health
services are not compromised. Integrating these functions into primary health care
is the starting point.
2.1.17.2 Sustained and accelerated efforts to operationalize the Ayushman Bharat – Health
and Wellness Centres (AB-HWCs) will enable attention to community and system level
primary health care interventions for preventive, promotive, curative, rehabilitative
and palliative care. Services cover those related to RMNCHA+N communicable
diseases, common non-communicable diseases, including mental health, care for
the elderly, and basic emergency and trauma care. The provision of free medicines,
diagnostics and access to telemedicine services close to community is expected to
expand coverage and quality of primary health care and reduce patient hardship
and improve quality of care. Effective primary health care delivery also includes
undertaking public health functions throughcommunity and facility level action for
surveillance, screening and early detection, vector control, etc.
2.1.17.3 To provide seamless continuum of care between primary, secondary, and tertiary
levels, HWC would be linked with the AB-PMJAY for thosecovered under the scheme,
in rural and urban areas. Strengthening of secondary care facilities to provide high
quality care, initiated under NHM and continued under this proposal would be
universally available to those who seek care in public health facilities.
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Operational Guidelines for PM Ayushman Bharat Health Infrastructure Mission
2.1.17.4 In both rural and urban areas, HWC offer the opportunity to ensure that girls and
women would have access to care not just for reproductive health services, but also
for the newer elements of the Comprehensive Primary Health care package including
screening, diagnosis, and treatment for hypertension, diabetes and mental health.
Since services are provided close to community, access to essential services would be
sustained for such sub population groups. Teleconsultation services are of particular
importance in reducing access barriers for women and will ensure gender equity.
2.1.17.5 The annual health calendar for HWC in rural and urban areas which is an important
avenue for health promotion and prevention would include campaigns for disaster
preparedness, risk communication & health education. It is also envisaged that
greater community ownership and participation in service delivery would be
ensuredthrough institutions such as the Jan Arogya Samitis (JAS) in the rural HWCs
and the Sthaniya Swasthya Sabhas in urban areas.
2.1.17.6 States could also explore partnerships with the not for profit/private sector,
particularly in urban areas across a range of areas including service delivery,
community outreach, and capacity building. To compensate for the lack of service
delivery infrastructure, options such as Mobile Medical Units, Evening OPDs, use of
NGO clinics, religious spaces, etc could be considered.
2.2.2 State Health Society, established under National Health Mission (NHM), will be the
implementing agency at the State level and shall play a pivotal role in planning for the PM
Ayushman Bharat Health Infrastructure Mission. Similarly, at the district level, the District
Health Society, headed by the District Collector, will play a crucial role in not only planning
as per the guidelines and also, for effective implementation and robust monitoring of the
units of various components under PM Ayushman Bharat Health Infrastructure Mission,
under the overall supervision of the District Collector.
2.2.3 The National Health Systems Resource Centre (NHSRC) would provide technical support
including for capacity building, on CSS components of the scheme.
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Operational Guidelines for PM Ayushman Bharat Health Infrastructure Mission
(g) Prioritization: Preferential allocations are to be made to the Aspirational / Tribal / Left Wing
Extremism (LWE) / Remote / Hill districts. In other districts, such units may be prioritized where
critical inputs such as land, etc are readily available.
(h) Based on the information provided by the State Government (through the State Health Society),
the District Health Action Plans (DHAPs) will be prepared by the District Health Society under
NHM, duly factoring in the resources under FC-XV Health Grants (as applicable to them) and
the PM Ayushman Bharat Health Infrastructure Mission resources, duly ensuring that there is no
duplication. The DHAPs shall also clearly indicate the lists of units to be financed through the
XV FC Grants and the PM Ayushman Bharat Health Infrastructure Mission.
(i) Detailed gap analysis must be carried out and the costs must be carefully estimated. Wherever
the estimated costs are more than the indicative unit costs as given in para 2.33 of these
Guidelines, detailed justification must be provided.
(j) All such DHAPs will be scrutinized at the State level by the State Health Society and, the State
level proposals shall be recommended by the General Body (GB) of the State Health Society
(SHS) for the consideration of the Ministry.
(k) For preparing the specific Action plan for various CSS components under the scheme, details
are given in the subsequent respective chapters (Chapters 3 to 7) of the document.
(l) Critical parameters, to be factored, while preparing the plans, for each of the components are
given in Annexure II.
(m) The States/UTs have to prepare the proposals in the format given in the Appendix 2.1, along
with the required annexures.
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Operational Guidelines for PM Ayushman Bharat Health Infrastructure Mission
2025-26. Approvals shall be accorded to a State/UT only after the respective State/UT has formally
entered in to the MoU. The MoU outlines the responsibilities and commitments of both the Ministry
and the respective State/UT, inter alia including the following aspects -
• Timely release of central share by the Ministry and its subsequent timely transfer by the State/
UT government to the State Health Society.
• Timely release of corresponding State share to the State Health society
• Adherence to the technical and operational guidelines, issued by the Ministry, from time to
time.
• Commitments for taking required actions to achieve the mutually agreed physical deliverables,
within the specified timelines.
• Submission of required progress reports by the States, from time to time.
• Compliance with the principles of financial propriety and ensuring due diligence in
implementation of the Scheme.
Copy of the MoU is attached at Annexure I.
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Operational Guidelines for PM Ayushman Bharat Health Infrastructure Mission
The unit rates indicated for different CSS components of PM Ayushman Bharat Health Infrastructure
Mission above are utilized for the purpose of arriving the requirement of financial outlay under the
scheme and actual requirements will vary from State to State. Hence, while planning and sending
the proposals to the Ministry, the States/UTs may plan and propose their own unit cost, based on
their local context, with full justification. Decisions will be taken by the Ministry, after appraisal of the
proposals of States/UTs by the NPCC. States/UTs must exercise due diligence for discovering the actual
costs and must follow an open, transparent and competitive tendering process. The important aspects
to be considered are detailed as under:
i. Negative List: State is required to strictly comply to the negative lists, which is specified for
each of the components. States should not utilize the grants for the activities in the negative
list.
ii. Non-duplication: States should ensure that there is no duplication or overlap of proposals,
tasks, procurements, constructions, hiring of HR etc. for which funds have already been provided
under NHM, State budgets, any other funds.
iii. IT platform for approval and monitoring: The State have to prepare the proposals as per the
format given in the Appendix 2.1 and send along with the required annexures. Further, NHM-
PMS system will be utilized to enable the State to send the proposals in online-mode, to ensure
the easier appraisal and issuance of approvals. This will ensure, non-duplication with the units,
being funded under FC-XV Health Grants and also, enable easier monitoring of the progress.
The NHM-PMS system will also be used for the regular up-dation of the progress, which would
be essential for release of subsequent instalments of grants.
iv. Infrastructure works:
a) All the five components, barring Urban HWCs, have different proportions of the Infrastructure,
with the Building-less SHCs, PHCs, being purely infrastructure work.
b) In the component of BPHUs, the infrastructure support is provided for and the BPHU should
ideally be located in the Block Medical Offices or Block CHC premises and have a linked
laboratory also preferably located in the same premises for better synergy between clinical,
programmatic and public health functions.
c) Similarly, in the urban HWCs component, the refurbishing of existing space for running the
Urban HWCs is provisioned.
d) The components of Critical Care Blocks and District Integrated Public Health Labs have
infrastructure works, to be planned for timely completion of the units.
v. HR support under PM Ayushman Bharat Health Infrastructure Mission:
a) All the components except Rural HWCs, are being provided with the HR support under
recurring expenses. The States may carry out the recruitment/ engagement of HR for various
components under PM Ayushman Bharat Health Infrastructure Mission, in a timely manner,
so that the units may be made functional, as soon as the constructions are complete.
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Operational Guidelines for PM Ayushman Bharat Health Infrastructure Mission
b) For the component of Urban HWCs, as the minor infrastructure refurbishing of the existing
space of the ULBs or government buildings is likely to take very less time, simultaneous
action for engagement of HR is critical to make the Urban HWCs functional at the earliest,
providing services.
c) HR support is envisaged under PM Ayushman Bharat Health Infrastructure Mission
only till the scheme period only. States have to plan and take necessary action to support
the HR, including approval of additional positions and for filling up such additional posts,
from their own resources, after the scheme period.
2.7 REPORTING
States/UTs shall submit Monthly progress on the implementation of various CSS components of the
Scheme to the Ministry, as prescribed, from time to time and the same have to be updated in the
Progress Monitoring System, developed for PM Ayushman Bharat Health Infrastructure Mission. States/
UTs have to collect the progress from all the Districts and Institutions and same have to be submitted
and updated on regular basis. States/UTs have to establish a mechanism for collecting and compiling
the reports and will ensure entry of the progress on a regular basis.
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Operational Guidelines for PM Ayushman Bharat Health Infrastructure Mission
APPENDIX 2.1
Format for submission of State Proposals for FY 2021-22.
Proposal by States/UTs
Amount State
Code Activities Number Unit Cost
Proposed Remarks
of Units (In Rs)
(In Lakhs)
Grand Total PM Ayushman Bharat
Health Infrastructure Mission
Infrastructure Support for Building-
less Sub Health Centres in 7 high Focus
ANB.1 States and 3 NE States*
-No. of SHCs sanctioned for Capital
expenditure
Urban health and wellness centres
ANB.2
(HWCs)
No. of Urban HWCs, being established in
ANB.2.1 the ULB or other government or rented
premises
No. of urban health facilities (UPHCs /
ANB.2.2 Urban CHCs) where specialist services are
to be provided / Poly Clinics
Block Public Health Units in in 11 High
ANB.3
Focus States/UTs **
No of BPH units sanctioned for capital
ANB.3.1
works
No of BPH units supported for recurring
ANB.3.2
expenditure
Integrated Public Health Labs (IPHLs) in
ANB.4
all the Districts
No. of District IPHLs established newly–
ANB.4.1
Support for non-recurring expenditure
No. of District IPHLs established newly -
ANB.4.2
Support for recurring expenditure
No. of Existing District IPHLs Strengthened
ANB.4.3
- Support for non-recurring expenditure
No. of Existing District IPHLs Strengthened
ANB.4.4
- Support for recurring expenditure
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Operational Guidelines for PM Ayushman Bharat Health Infrastructure Mission
Proposal by States/UTs
Amount State
Code Activities Number Unit Cost
Proposed Remarks
of Units (In Rs)
(In Lakhs)
ANB.5 Critical Care Hospital Blocks
Critical Care Hospital Block/Wing (100
ANB.5.1
Bedded at District Hospitals)
No. of CCBs (100 bedded) established
ANB. 5.1.1 at District Hospitals- support for capital
works
No. of CCBs (100 bedded) established at
ANB. 5.2.1 District Hospitals- support for recurring
expenditure
Critical Care Hospital Block/Wing (50
ANB.5.2
Bedded at District Hospitals)
No. of CCBs (50 bedded) established at
ANB.5.2.1 District Hospitals- support for capital
works
No. of CCBs (50 bedded) established at
ANB.5.2.2 District Hospitals- support for recurring
expenditure
Critical Care Hospital Block/Wing
ANB.5.3 (50 Bedded at Government Medical
Colleges)
No. of CCBs (50 bedded) established at
ANB.5.3.1
GMCs- support for capital works
Grand Total PM Ayushman Bharat
Health Infrastructure Mission
* Ten High Focus States covered under the component of Building-less Sub Health Centres are Bihar, Jharkhand, Odisha, Punjab, Rajasthan, Uttar
Pradesh and West Bengal and three NE States viz. Assam, Manipur and Meghalaya
** 11 High Focus States/UTs covered under the Component of BPHUs are Assam, Bihar, Chhattisgarh, Himachal Pradesh, UT-Jammu and Kashmir,
Jharkhand, Madhya Pradesh, Odisha, Rajasthan, Uttar Pradesh and Uttarakhand
20
3
Infrastructure Support to ‘Building-less’
Sub Health Centre–Health & Wellness Centres
(SHC-HWCs) in Rural Areas
3.1 BACKGROUND
3.1.1 It is important to strengthen the Public Health System, not only, to enable public health
actions in case of future outbreaks and pandemics (such as early detection, management
and mitigation), but ensure that essential non-pandemic related health services are
not compromised. The Ayushman Bharat – Health and Wellness Centres (AB-HWCs), the
flagship programme of the Government, will enable attention to community and system
level primary health care interventions for preventive, promotive, curative, rehabilitative
and palliative care. The provision of free medicines, diagnostics and access to telemedicine
services closer to community is expected to expand coverage and quality of primary health
care and reduce patient hardship and improve quality of care. Effective primary health care
delivery also includes undertaking public health functions through community and facility
level action for surveillance, screening and early detection, vector control, etc.
3.1.2 AB-HWCs offer the opportunity to ensure that girls and women would have access to care not
just for reproductive health services, but also for the newer elements of the Comprehensive
Primary Health Care package including screening, diagnosis, and treatment for hypertension,
diabetes and mental health. Since services are provided close to community, access to
essential services would be sustained for such sub population groups. Teleconsultation
services are of particular importance in reducing access barriers for women and will ensure
gender equity. These centres will not only provide primary level clinical care services for an
expanded range of services as per Operational guidelines of Comprehensive Primary Health
Care and subsequent Operational Guidelines on the expanded range of services at the centre
but also ensure outreach services are provided to their catchment population.
3.1.3 Under the AB-HWCs programme, it is envisaged that 1,50,000 AB-HWCs shall be set up
in the country by December 2022. Out of these, 12,500 HWCs are being setup by the
Ministry of AYUSH as AYUSH-HWCs. As per Rural Health Statistics, 2020, as on 31st March
2020, there are 47,518 Sub Health Centres, which are functioning in rented buildings /
panchayat or voluntary society buildings and these SHCs require building to be constructed.
These infrastructure gaps of SHCs are significant especially in 7 High Focus States and
21
Operational Guidelines for PM Ayushman Bharat Health Infrastructure Mission
3 North-eastern states (seven High Focus States (Bihar, Jharkhand, Odisha, Punjab, Rajasthan,
Uttar Pradesh and West Bengal) and three NE States (Assam, Manipur and Meghalaya)) such
as in Uttar Pradesh (3654), Bihar (5356), Rajasthan (2859), etc. These gaps may not be
completed within a specific timeline with the support available under NHM. Therefore,
under PM Ayushman Bharat Health Infrastructure Mission, it is proposed that support will
be provided for necessary infrastructure for 17,788 SHC level AB-HWCs in rural areas in 7
High Focus States and 3 North-eastern states, at a total cost of ₹. 9,872.66 crore. Wherever
feasible, option for rental or renovation and repurposing of existing vacant buildings of
other departments will also be explored. Operational costs for managing AB-HWCs, would
be met through the existing scheme and mechanisms, i.e., through the National Health
Mission. Support for Infrastructure of 10,421 SHC level AB-HWCs will flow from the resources
from 15th Finance Commission (FC-XV) Health Grants through Local Governments in these 10
states and remaining support will be through PM Ayushman Bharat Health Infrastructure
Mission Assistance.
22
Operational Guidelines for PM Ayushman Bharat Health Infrastructure Mission
of services, lab infrastructure and space to conduct wellness activities; Priority may be
given to Sub Health Centres in Aspirational districts, Tribal and remote areas, to reduce
time to care and geographical barriers.
• New SHC buildings in lieu of Rent-Free Panchayat / Voluntary Society Building, especially
where space and infrastructure is inadequate to provide the entire range of 12 CPHC
services, lab infrastructure, for wellness activities.
• New buildings, if required as per shortfall of population norms (details given in
RHS 2020).
• States are informed that if the existing rented SHC buildings are located well
within the reach of the community, have sufficient space for carrying out all the
intended services and have sufficiently robust construction, then the State need
not plan for re-locating from these buildings.
3.3.3 The State shall mandate the quality check of the constructed facilities as per the norms set
by the State in accordance with the other construction works undertaken. The State should
ensure third party monitoring and quality checks (as pertinent to the GLs under FC-XV
Health Grants) to ensure that the works undertaken meet the required quality parameters
and are constructed as per the terms and conditions decided by the State. Pages No.51-
55 of Operational and Technical Guidelines of Implementation of FC-XV Health Grants
through Local Governments (https://nhsrcindia.org/sites/default/files/2021-09/FCXV%20
Technical%20and%20Operational%20GLs%20to%20States%20dated%2031082021.pdf )
may be referred for detailed Guidance on Infrastructure planning and design requirements.
23
Operational Guidelines for PM Ayushman Bharat Health Infrastructure Mission
3.4.3 The States /District may pool in additional funds from other sources like District Mineral
Fund (DMF), CSR funds, etc. as supplementary financial resources for addition of extra-
facilities in the select SHCs or to cover more number of building-less SHCs in the district /
State, so that by 2025-26, the entire district is saturated to have own government buildings
for all the SHC-HWCs in the districts.
3.4.4 The existing mechanism of State for construction of Building-less SHCs may be taken up,
involving the identified agencies for such works that are financed exclusively through the
FC-XV Health Grants through Local Governments. However, for the works financed through
the PM Ayushman Bharat Health Infrastructure Mission grants, as per the decision of State
Level Committee, the State/Districts have to involve the respective engineering wing as
identified by the SLC.
3.4.5 The Districts will also ensure that monitoring of the construction is under-taken, and UCs
are submitted on time as per the mandate under NHM, as elaborated in Chapter-1.
3.4.6 Negative List for this component of PM Ayushman Bharat Health Infrastructure
Mission: The funds under this component cannot be utilized for the following:
• Land should be available for the selected facilities and land purchase cost should not be
covered with this component.
• Repair and Renovation works already undertaken under the NHM Funds.
• Facilities or any of its components should not over-lap with the funds provided under
FC-XV grants.
• This amount should not be used for the construction of a single room /wellness area or
any other single project like boundary wall, toilets, water tanks etc.
• Construction of boundary walls, entrance, pavements, footpaths etc.
3.4.7 State is requested to send their proposals to the MoHFW, duly proposing under the
respective FMR Code of ANB -1 as given in Appendix 2.1.
24
APPENDIX 3.1
The Component-wise State wise breakup of Physical targets after factoring-in the FC-XV Grants from
2021-22 to 2025-26- AB-HWCs
2021-22 2022-23 2023-24 2024-25 2025-26 Total
Units Units Units Units Units Units
State
S. No.
Total
Total
Total
Total
Total
Total
15th FC
15th FC
15th FC
15th FC
15th FC
15th FC
Infrastructure Mission
Infrastructure Mission
Infrastructure Mission
Infrastructure Mission
Infrastructure Mission
Infrastructure Mission
Total 5699 2016 3683 5690 2006 3684 2066 2066 0 2113 2113 0 2220 2220 0 17788 10421 7367
25
14
Ayushman Bharat–Health & Wellness Centres
(AB-HWCs) in Urban Areas
4.1 BACKGROUND
4.1.1 The National Urban Health Mission (NUHM) was set up in 2013, as a sub mission of the National
Health Mission, to improve the health status of the urban population in general. Support is
provided to the States to have Urban PHCs @50,000 per population. Outreach functions in
this population, are undertaken by five ANMs and 20-25 ASHAs, with a normative coverage
of a population of 10,000 served by a team of one ANM and five ASHAs. Under Ayushman
Bharat, Urban PHCs are being strengthened as Health and Wellness Centres (UPHC-HWCs)
to deliver Comprehensive Primary Health Care (CPHC).
4.1.2 Healthcare needs and aspirations of urban residents are different from those in rural areas.
The current strategy of relying on outreach teams of ANM and ASHA alone to provide
selective services is not sufficient. State experiences demonstrate that provision of health
care services by trained service providers from facilities closer to poorer, and vulnerable
urban communities is likely to improve access to an expanded range of services, reduce
OOPE, improve disease surveillance, and strengthen referral linkages. At the same time,
state experiences also show that the establishment of “poly clinics / provision of specialist
services” in selected Urban PHCs, enables reach of specialist services to poor communities,
thus building trust in the public health system.
4.1.3 Lack of a frontline health workforce in our cities has emerged as one of the biggest limiting
factors in our response to the COVID-19 pandemic. Therefore, a paradigm shift is envisaged
in delivery of urban primary healthcare based on the learnings from the management
of COVID-19 pandemic which has affected urban areas disproportionately, especially
in metropolitan areas such as Delhi, Mumbai, Pune, Chennai, Bengaluru, Hyderabad,
Ahmedabad, Surat etc. A significant proportion of the urban population also constitutes
of the migrants from other states. Also, a large proportion of these are usually settled in
congested urban settings. Expansion and strengthening of the grass-root primary healthcare
delivery institutions has thus emerged as a pressing need in the changed context. Limited
capacities of health systems in urban areas and the disruption in non-COVID essential health
services also underlines the need for provision of Universal and CPHC capacities in urban
areas.
26
Operational Guidelines for PM Ayushman Bharat Health Infrastructure Mission
4.1.4 Accordingly, Universal CPHC is planned to be provided through Urban Health and Wellness
Centres (Urban HWCs) and Polyclinics, by providing support for setting up of 11,024 Urban
HWCs (UHWCs) in close collaboration with Urban Local Bodies. Such Urban HWCs would
enable decentralized delivery of primary health care services closer to people, thereby
increasing reach of the public health systems to the vulnerable and marginalized. The
availability of space to set up new infrastructure in urban areas could pose a challenge.
Therefore, the use of Mobile Medical Units and evening OPDs will be considered as alternate
service delivery modes. In addition, use of community infrastructure such as religious places,
NGO clinics and provision of space by the municipal bodies etc., would also be explored.
4.1.5 Support for 6,984 urban AB-HWCs (against a total of 11,024 urban AB-HWCs) will flow from
the resources from the FC-XV Health Grants through Local Governments, in 28 states under
the PM Ayushman Bharat Health Infrastructure Mission
4.1.6 Pages No.28-31 of Operational and Technical Guidelines of Implementation of FC-XV Health
Grants through Local Governments (https://nhsrcindia.org/sites/default/files/2021-09/
FCXV%20Technical%20and%20Operational%20GLs%20to%20States%20dated%20
31082021.pdf ) may be referred for detailed Guidance on components of Urban HWCs and
objectives intended under this component.
27
Operational Guidelines for PM Ayushman Bharat Health Infrastructure Mission
28
Operational Guidelines for PM Ayushman Bharat Health Infrastructure Mission
component, as resources of FC-XV Health Grants for this component have been factored-in
/ included under PM Ayushman Bharat Health Infrastructure Mission. Hence, depending on
the total resources (exclusive under PM Ayushman Bharat Health Infrastructure Mission +
FC-XV Health Grants) available for this component and the requirement for Urban HWCs in
the State, the State will determine the number of Urban HWCs that can be supported under
the PM Ayushman Bharat Health Infrastructure Mission.
4.4.2 State may give preference to the areas where the ULBs are able to arrange the physical
infrastructure and where poor and vulnerable populations reside and slum and slum-like
areas.
4.4.3 The process of transfer of buildings from ULBs or other government buildings or lease
agreements with the identified premises and completion of refurbishing works at these
premises, etc should be completed at the earliest once the locations are decided by the
States.
4.4.4 States have the flexibility to follow the norms of execution of Urban HWCs under FC-
XV Health Grants for the implementation of units under PM Ayushman Bharat Health
Infrastructure Mission funds as well. In such cases, the PM Ayushman Bharat Health
Infrastructure Mission portion of funds may also be sent to the respective Urban Local Bodies
in-time or in-advance. This will ensure uniformity in the execution of this component and
will also ensure ownership of the ULBs for the Urban HWCs within their jurisdiction. State
may execute the units under PM Ayushman Bharat Health Infrastructure Mission budgetary
support for this component, through State Health Department as well. In both the cases,
it is more important that Concerned Urban Local Bodies should be actively involved in the
planning and monitoring of all the functional urban-HWCs. To the extent possible, the city
level institutional arrangements should be utilized for this purpose.
4.4.5 Capacity of the urban local bodies need to be improved, by the state by undertaking the
requisite trainings through state level institutions as per the plan in this regard. The ULBs
are to be oriented on optimal utilisation of the grant and also on the aspects such as Human
Resources for Health, their training skills, salary and incentives, range of health care package
of services to be offered, drugs, equipment, IT infrastructure, community structures and
independent monitoring, all as defined in the Operational Guidelines on Ayushman Bharat -
Comprehensive Primary Health Care through Health and Wellness Centres issued by Ministry
of Health and Family Welfare and available at https://ab-hwc.nhp.gov.in/download/
document/45a4ab64b74ab124cfd853ec9a0127e4.pdf
4.4.6 Negative List for this component of PM Ayushman Bharat Health Infrastructure
Mission:
• The funds under this component cannot be utilized Repair and Renovation works
already undertaken under the NHM Funds.
• Construction of new buildings is not allowed.
• Procurement of land should not be undertaken under this component.
4.4.7 State is requested to send their proposals to the MoHFW, duly proposing under the
respective FMR Code of ANB -2.1 and 2.2 as given in Appendix 2.1.
29
APPENDIX 4.1
30
State wise physical deliverable for this component under PM Ayushman Bharat Health Infrastructure Mission for the
period of 2021-22 to 2025-26 after factoring in the FC-XV Grants
State / ULTs
Total
Total
Total
Total
Total
15th FC
15th FC
15th FC
15th FC
15th FC
PM Ayushman
PM Ayushman
PM Ayushman
PM Ayushman
PM Ayushman
structure Mission
structure Mission
structure Mission
structure Mission
structure Mission
Bharat Health Infra-
Andhra Pradesh 73 73 0 182 137 45 328 144 184 510 151 359 775 159 616
Arunachal
1 1 0 2 2 0 4 4 0 6 6 0 8 8 0
Pradesh
Chandigarh 9 0 9 23 0 23 41 0 41 64 0 64 92 0 92
Chhattisgarh 9 9 0 23 23 0 41 41 0 63 63 0 96 96 0
D & N Haveli 0 0 0 1 0 1 2 0 2 3 0 3 4 0 4
Delhi 107 0 107 268 0 268 482 0 482 749 0 749 1,139 0 1139
Goa 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Gujarat 64 64 0 159 159 0 286 286 0 445 383 62 677 402 275
Himachal Pradesh 4 2 2 10 2 8 18 2 16 28 2 26 40 2 38
Jammu & Kashmir 10 0 10 25 0 25 44 0 44 69 0 69 104 0 104
Karnataka 87 87 0 218 164 54 392 172 220 609 181 428 926 190 736
FY 21-22 FY 22-23 FY 23-24 FY 24-25 FY 25-26
State / ULTs
Total
Total
Total
Total
Total
15th FC
15th FC
15th FC
15th FC
15th FC
PM Ayushman
PM Ayushman
PM Ayushman
PM Ayushman
PM Ayushman
structure Mission
structure Mission
structure Mission
structure Mission
structure Mission
Bharat Health Infra-
Ladakh 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Lakshadweep 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Maharashtra 108 108 0 269 269 0 484 484 0 753 753 0 1,145 1145 0
Manipur 2 2 0 5 5 0 8 8 0 13 13 0 18 15 3
Meghalaya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mizoram 2 2 0 5 5 0 9 9 0 14 14 0 20 19 1
Nagaland 1 1 0 3 3 0 5 5 0 7 7 0 10 10 0
Puducherry 3 0 3 8 0 8 14 0 14 21 0 21 32 0 32
Punjab 3 3 0 8 8 0 14 14 0 22 22 0 34 34 0
Rajasthan 75 75 0 189 142 47 339 149 190 528 157 371 803 164 639
Sikkim 0 0 0 1 1 0 1 1 0 1 1 0 2 2 0
Tamil Nadu 93 93 0 232 232 0 417 417 0 648 524 124 986 550 436
Telangana 50 50 0 125 125 0 224 187 37 349 196 153 530 206 324
Tripura 1 1 0 3 3 0 5 5 0 7 7 0 10 10 0
Operational Guidelines for PM Ayushman Bharat Health Infrastructure Mission
Uttar Pradesh 125 125 0 312 312 0 562 562 0 874 624 250 1,329 655 674
Uttarakhand 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
West Bengal 90 90 0 224 224 0 403 403 0 627 423 204 954 444 510
31
Total 1038 907 131 2,604 2124 480 4,674 3442 1232 7,267 4381 2886 11,024 5341 5683
15
Block Public Health Units (BPHUs)
5.1 BACKGROUND
5.1.1 Every block in the country is envisaged as having a CHC/ Block PHC/ SDH at the Block
Headquarter (HQ) which serves as a hub for referral from the SHCs and PHCs of the block.
However, the situation across states is variable, with the Block CHC functioning as just
another PHC in some states. In some other states, on the other hand, the Block CHC also
serves as a First Referral Unit (FRU).
5.1.2 The present public healthcare system structure at the Block level is not equipped to handle
public health emergencies and also to respond and monitor the healthcare services.
Currently, the functions of a Block CHC are mostly focused on clinical services that too largely
RMNCH+A and selected infectious diseases. The outbreak of COVID-19 has highlighted a
constrained public health response as a result of a suboptimal public health focus at the
block level.
5.1.3 Block Public Health Units are proposed in all the 3382 blocks in 8 High Focus States and 3 Hill states
(Assam, Bihar, Chhattisgarh, Himachal Pradesh, UT-Jammu and Kashmir, Jharkhand, Madhya
Pradesh, Odisha, Rajasthan, Uttar Pradesh and Uttarakhand). Support for 1,048 Block Public
Health Units in these 11 states covered under the PM Ayushman Bharat Health Infrastructure
Mission, will flow from the resources from the FC-XV Health Grants through Local Governments.
5.1.4 The BPHU would encompass the service delivery facility (CHC/PHC/SDH), a Block Public
Health Laboratory, and a Block HMIS Cell. The goal of the Block Public Health Unit is to
protect and improve the health of the population in the block. Decentralization at this
level would enable a focus on reaching remote areas and unreached populations. It is
envisaged that the Block Headquarter level facility (variously referred to as Community
Health Centres (CHCs)/ Sub- Divisional Hospitals (SDHs)/Block Primary Health Centres
(PHCs), (the nomenclature may vary across states) would be strengthened to become a Block
Public Health Unit. Further details on Block PH Unit, Laboratory and HMIS Unit and the
objectives of BPHU may be referred from the Pages No.67-70 of Operational and Technical
Guidelines of Implementation of FC-XV Health Grants through Local Governments (https://
nhsrcindia.org/sites/default/files/2021-09/FCXV%20Technical%20and%20Operational%20
GLs%20to%20States%20dated%2031082021.pdf )
32
Operational Guidelines for PM Ayushman Bharat Health Infrastructure Mission
33
Operational Guidelines for PM Ayushman Bharat Health Infrastructure Mission
under PM Ayushman Bharat Health Infrastructure Mission + FC-XV Health Grants) available
for this component and the number of Blocks in the State, State may first prepare a five-
year Action Plan for the State and subsequently, District wise year wise Action plans may be
prepared accordingly. State should make efforts to initiate the capital works in majority of
the Blocks, where sufficient lands are available, in the first two years of implementation and
efforts should be made to identify the lands for other Blocks within this leeway time.
5.4.3 The States /District may pool in additional funds from other sources like District Mineral
Fund (DMF), CSR funds, etc. as supplementary financial resources required to cover the
additional / newly formed blocks in the State (as the support under PM Ayushman Bharat
Health Infrastructure Mission is planned based on the Number of Blocks in the States in
June-July 2020, based on the data available in LG Code database). These 11 States may utilize
the savings under PM Ayushman Bharat Health Infrastructure Mission + FC-XV Grants, for
covering additional Blocks, based on the Gap analysis.
5.4.4 The units/Blocks supported under two different funding sources i.e. FC-XV Health Grants
and PM Ayushman Bharat Health Infrastructure Mission are required to be kept distinct and
separate for all the years of support being provided under each scheme. Planning teams at
the State and Districts should have clear mapping of the Blocks / BPHUs supported under
these two different sources of funding.
5.4.5 As all the blocks located in these 11 States are covered, plan to be chalked out by the State/
District team, duly prioritizing the Blocks, where there are full contingent of HRH is already
available. Preferably, blocks with good infrastructure set-up and complete / near-complete
HR availability should be given preference in the first few years for this component.
5.4.6 The State/ UT may plan to initiate the infrastructure work for subsequent years BPHU units,
keeping in view the time taken to complete the infrastructure and other related works.
Procurement of the equipment and other accessories should be aligned with the infrastructure
completion along with efforts for ensuring availability of the required Human Resources.
5.4.7 States may follow the same mode of execution of BPHUs as under the FC-XV Health Grants
for the implementation of BPHUs under PM Ayushman Bharat Health Infrastructure Mission
funds as well. This will ensure uniformity in the execution of this component and will
also lead to synergies in engagement of economies of scale, standard processes, quality
assurance and Human Resources for Health to manage these BPHUs.
5.4.8 Negative List: The funds under this component cannot be utilized for the following:
i. Repair and Renovation works of Block level facilities already undertaken under the NHM
Funds, FC-XV Health Grants, State Funds, any other grants for health e.g. MOTA, MOMA,
CSR etc.
ii. Construction of boundary walls, entrance, pavements, footpaths etc.
iii. Purchase of Solar panels, electronic items like TVs, cameras etc., unless otherwise
provided under the norms by the Ministry.
5.4.9 State is requested to send their proposals to the MoHFW, duly proposing under the
respective FMR Code of ANB -3.1 and 3.2 as given in Appendix 2.1.
34
APPENDIX 5.1
State-wise physical deliverables for establishing BPHUs for the period of FY 2021-22 to 2025-26 under PM Ayushman
Bharat Health Infrastructure Mission after factoring in the 15th FC grant
S. No. State
Total
Total
Total
Total
Total
Total
15th FC
15th FC
15th FC
15th FC
15th FC
15th FC
Infrastructure Mission
Infrastructure Mission
Infrastructure Mission
Infrastructure Mission
Infrastructure Mission
Infrastructure Mission
PM Ayushman Bharat Health
PM Ayushman Bharat Health
PM Ayushman Bharat Health
Chhattis-
3 15 15 0 29 13 16 29 11 18 29 9 20 44 7 37 146 55 91
garh
Himachal
4 8 2 6 16 2 14 16 1 15 16 1 15 24 1 23 80 7 73
Pradesh
Jammu &
5 29 0 29 57 0 57 57 0 57 57 0 57 87 0 87 287 0 287
Kashmir
Madhya
7 31 31 0 63 28 35 63 23 40 63 19 44 93 16 77 313 117 196
Pradesh
Uttar
10 83 83 0 165 74 91 165 60 105 165 50 115 247 43 204 825 310 515
Pradesh
Uttara-
11 10 3 7 19 2 17 19 2 17 19 1 18 28 1 27 95 9 86
khand
35
Total 339 281 58 677 250 427 677 204 473 677 169 508 1012 144 868 3382 1048 2334
16
District Integrated Public Health Laboratories
6.1 BACKGROUND
6.1.1 The disease burden in the country demonstrates the need for provision of high-quality
laboratory services at district and block levels. COVID-19 highlighted that limited laboratory
capacity at all levels meant that functions of testing, case detection, surveillance and
outbreak management were challenging. Delays in diagnosis and reporting compromise
early detection and delay initiation of appropriate treatment and the necessary public
health action for controlling the spread of disease. Although, both general and out of
hours laboratory services (e.g. emergency services, critical care services) are currently being
provided through laboratories, the capacities for public health surveillance for abnormal
morbidity/mortality, reporting of human or animal disease patterns and testing of samples
etc. for public health needs remain limited in most districts.
6.1.2 Improving the efficiency and effectiveness of the laboratory services to support
programmatic scale-up, requires Integrated District Laboratory systems. This will optimise
access to laboratory services, quality assurance efforts, cost-effectiveness, and efficient use
of human resources. To address these gaps, an Integrated Public Health Laboratories in all
730 districts will be set-up under the scheme. An integrated model for the laboratory is
crucial to increase efficiency, avoid duplication of laboratory resources, improve patient
services, channelize resources for development of capacity for multi-disease testing and
to equip the laboratory in terms of better preparedness and response to emerging disease
threats.
6.1.3 The District Integrated Public Health Laboratory unit would also serve as the apex of a
network to link labs with block, state and regional public health and veterinary labs to support
multi-sectoral collaboration for clinical management and public health surveillance.
Integrated Public Health laboratories will establish multi-level linkages from blocks to
districts, to state and finally to zonal/regional and National level laboratories for providing a
comprehensive set of laboratory services which can also aid in timely prediction of outbreak
and supporting policy decisions. IPHLs at the District level will mentor and handhold BPH
Labs of the BPHUs and ensure regular training and capacity building of the staff. To allow
IPHL seamlessly blend into the existing laboratory services network, interconnected and
functional linkages both upwards and downwards are envisaged. The upward and downward
linkages with block and zonal/state/regional labs would be clearly defined and documented
36
Operational Guidelines for PM Ayushman Bharat Health Infrastructure Mission
37
Operational Guidelines for PM Ayushman Bharat Health Infrastructure Mission
38
Operational Guidelines for PM Ayushman Bharat Health Infrastructure Mission
6.4.8 The State shall mandate the quality check of the constructed facilities as per the norms set
by the State in accordance with the other construction works undertaken. The State should
ensure third party monitoring and quality checks to ensure that the works undertaken
meet the required quality parameters and are constructed as per the terms and conditions
decided by the State.
39
Operational Guidelines for PM Ayushman Bharat Health Infrastructure Mission
the available space in and around the existing lab and in case there is no scope within the
constructed area of the lab, some adjoining space/ area in the existing DH needs to be
identified for IPHL. The new space can be utilised ideally vertically but can be developed
horizontally if ample space is available.
6.5.7 The layout of the lab is based on the range of services to be provided. However, planning should
be prospective and taking into account expected burden of disease and epidemiological
transition. Thus, new structures should be planned, designed and constructed taking into
account the scope for future expansion. Broadly, the structure will include following units:
• Central sample collection facility and
• Integrated Laboratory (clinical and public health testing facility).
• Auxiliary Area
6.5.8 Human Resource:
i. The existing HR functional in various labs and norms suggested under IPHS shall be the
basis for calculating the existing lab staff and what is required for implementing IPHL.
Under District IPHL, the duplication of the staff will be eliminated, and HR will be utilized
comprehensive and inclusive of all programs. IPHS defines the minimum performance
standard for lab technicians as 200 tests per day. The HR requirement / support will be
based on this.
ii. There should be a system for regular induction and refresher training and each laboratory
staff should undergo at least trainings on documentation (specimen handling manual,
specimen request form, specimen logbook, acceptance/rejection criteria, critical alerts,
inventory management, result reporting format, IQC records etc.), SOP development,
sample collection, packaging and transport, laboratory safety, infection prevention and
biosafety cabinet certification and practical training on syndrome based-diagnostic
testing, including internal quality control.
iii. IPHL staff should be responsible for training and mentorship of Block Public Health
Laboratory staff. The laboratory in-charge will be responsible for training and
competency assessment of laboratory staff. A system for regular induction and refresher
training (yearly) shall be developed for different levels of laboratory staff.
6.5.9 A new addition in the PH lab is Lab Information Management system (LIMS). This needs to
be linked with existing data reporting system of the hospital which will ultimately feed into
the electronic health information system i.e. Integrated Health Information Platform (IHIP).
The lab data reporting system will include all the surveillance data being reported from the
integrated block PH unit. This will help in improving analyzing capacity of the local units so
that early response for mitigation can be taken.
6.5.10 Equipment: A list and specifications of important equipment is given in the revised free
diagnostic initiative guidelines. Support for diagnostics is available from various sources like
NHM, State resources and also under PM Ayushman Bharat Health Infrastructure Mission.
While projecting the needs of the facility, all the available equipment either under various
programs or from different sources must be taken into account.
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Operational Guidelines for PM Ayushman Bharat Health Infrastructure Mission
41
APPENDIX 6.1
42
The State wise breakup of physical deliverable for District IPHL under PM Ayushman Bharat Health Infrastructure Mis-
sion from FY 2021-22 to 2025-26
S.
State 2021-22 2022-23 2023-24 2024-25 2025-26 Total Units*
No.
1 Andaman and Nicobar Islands 0 1 1 1 0 3
2 Andhra Pradesh 1 3 3 3 3 13
3 Arunachal Pradesh 2 4 4 4 8 22
4 Assam 3 7 7 7 9 33
5 Bihar 4 8 8 8 10 38
6 Chandigarh 0 0 0 0 1 1
7 Chhattisgarh 3 6 6 6 7 28
8 D & N Haveli 0 0 0 0 1 1
9 Daman & Diu 0 0 0 0 2 2
10 Delhi 1 2 2 2 4 11
11 Goa 0 0 0 0 2 2
12 Gujarat 3 7 7 7 9 33
13 Haryana 2 4 4 4 8 22
14 Himachal Pradesh 1 2 2 2 5 12
15 Jammu & Kashmir 2 4 4 4 6 20
16 Jharkhand 2 5 5 5 7 24
Operational Guidelines for PM Ayushman Bharat Health Infrastructure Mission
17 Karnataka 3 6 6 6 9 30
18 Kerala 1 3 3 3 4 14
19 Ladakh 0 0 0 0 2 2
20 Lakshadweep 0 0 0 0 1 1
S.
State 2021-22 2022-23 2023-24 2024-25 2025-26 Total Units*
No.
21 Madhya Pradesh 6 11 11 11 16 55
22 Maharashtra 4 7 7 7 11 36
23 Manipur 2 3 3 3 4 15
24 Meghalaya 1 2 2 2 3 10
25 Mizoram 1 2 2 2 3 10
26 Nagaland 1 2 2 2 4 11
27 Odisha 3 6 6 6 9 30
28 Puducherry 0 1 1 1 1 4
29 Punjab 2 4 4 4 8 22
30 Rajasthan 3 7 7 7 9 33
31 Sikkim 0 1 1 1 0 3
32 Tamil Nadu 4 8 8 8 10 38
33 Telangana 3 7 7 7 9 33
34 Tripura 1 1 1 1 3 7
35 Uttar Pradesh 8 15 15 15 22 75
36 Uttarakhand 1 3 3 3 3 13
37 West Bengal 2 5 5 5 6 23
Total 70 147 147 147 219 730
*Units means number of District IPHL to be set-up by the respective State/UT in each FY from 2021-22 to 2025-26
Operational Guidelines for PM Ayushman Bharat Health Infrastructure Mission
43
17
Critical Care Hospital Blocks
7.1 BACKGROUND
7.1.1 The COVID pandemic has highlighted the need for critical care facilities, especially at
the level of the districts. The country’s increasing disease burden particularly related to
the sequelae of chronic communicable and non-communicable diseases and injury also
requires access to critical care. Non-communicable diseases and injuries account for 61.8%
and 10.7% deaths respectively. (Source: India: Health of the Nation’s States, ICMR).
7.1.2 Average medical expenditure per hospitalization (both rural and urban, private and
public combined) is Rs. 20135/- (as per NSSO 2017-18). It is anticipated that about 3-5% of
emergencies would require ICU facilities and oxygen supported beds for critical care. There is
an urgent need to strengthen these facilities and create additional amenities (infrastructure,
equipment etc.), in existing district hospitals to meet such unforeseen epidemics, disasters
etc.
7.1.3 The current architecture of the public hospitals is not equipped fully to handle the dual
burden of meeting critical care needs and maintaining essential services as was seen during
the two waves of the COVID-19 pandemic. Many hospital buildings especially in districts, do
not have provision for segregating a part of the building as an infectious disease treatment
block/wing. As a result, in order to avoid mixing of COVID and non-COVID patients, entire
hospitals were required to be designated as COVID Dedicated Facilities, thereby resulting
in inability to provide non COVID essential services such as institutional deliveries, blood
transfusion services, dialysis and chemotherapy etc.
7.1.4 Under PM Ayushman Bharat Health Infrastructure Mission , Government of India would
support 100 and 50-bedded Hospital Blocks/ Wings to augment the capacity of public health
facilities to provide assured critical care. These block/wings will enhance capacity to manage
patients requiring critical care from the sequelae of infectious diseases, during pandemics,
or are in need of critical care for any other condition, including during emergencies.
7.1.5 The 100 and 50-bedded Critical Care Hospital Block/Wings would be self-contained, and be
equipped with critical, supportive and ancillary services such as Emergency area, Intensive
Care Units (ICU), Isolation Wards/Oxygen supported beds, Surgical unit, two labour, delivery,
recovery rooms (LDRs) with one New-born care corner. The capacity of support services like
Imaging facility, Dietary services, CSSD with Mechanized Laundry, etc. needs to be linked
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Operational Guidelines for PM Ayushman Bharat Health Infrastructure Mission
Type of critical care units Capital Cost (in Rs.) Recurring Cost (in Rs.)
100 bedded 44.50 Cr 7.912 Cr
50 bedded 23.75 Cr 4.592 Cr
50 bedded in Medical Colleges 23.75 Cr -
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Operational Guidelines for PM Ayushman Bharat Health Infrastructure Mission
7.4.2 For critical care wings located within the district hospital, following factors should be
considered:
• The block should preferably have a distinct entry independent of the main entry for
outpatients, so that minimum time is lost in attending to cases which need resuscitation
and also to others requiring emergency management.
• There should be easy approach and access for ambulances with adequate space for the
free passage of vehicles and a covered area for alighting patients.
• Stretchers, wheelchairs and trolleys should be available at the entrance of the block at a
designated area.
• Lay out should be such that it follows the functional flow for clinical management of the
patient.
• Signage should be displayed at the entry of the hospital with additional signage at key
points.
• The Emergency area of the critical care block should have a dedicated triage and four
clinical management zones (red, yellow, green, black).
• The triage area should have dedicated space with wall mounted multipara monitors
and medical gas outlets.
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Operational Guidelines for PM Ayushman Bharat Health Infrastructure Mission
Specialists - round the clock for OT, ICU, Emergency, delivery unit and other areas as
per IPHS.
HR GDMO - 1 for 10 beds - critical care area and 1 for 20 beds non critical area
Norms Nurses - 1:1 ICU; 1:2 Step Down Unit; 1:6 wards and other areas; OT - 2 per OT per shift;
1 nurse round the clock for delivery unit
Support staff - as per IPHS/GoI guidelines
Depending upon the performance and case load, specialists, doctors and other staff can be
added further if required.
7.5.5 All the staff of the critical care block will undergo induction training and also specific
trainings for the area they will be posted in. The states will be advised to implement non-
rotational posting so that proficiency and capacity of the trained staff is properly utilized
and not diluted by their posting in such areas where specific skills cannot be utilized.
7.5.6 Drugs will be as per Essential medicine/drug list including drugs for critical care (HDU and
ICU) and Diagnostics as per essential and free diagnostic list. The Equipment will be ensured
as per the Technical Guidelines for Critical Care Blocks after gap analysis.
7.5.7 Negative List for this component of PM Ayushman Bharat Health Infrastructure
Mission: The funds under this component cannot be utilized for the following:
• Repair and Renovation works already undertaken under the NHM Funds.
• Facilities or any of its components should not over-lap with the funds provided under
FC-XV grants.
• This amount should not be used for the construction of a single room /wellness area or
any other single project like boundary wall, toilets, water tanks etc.
• Construction of boundary walls, entrance, pavements, footpaths etc.
7.5.8 Detailed Technical Guidelines on setting up of Critical Care Blocks, with the details of
infrastructure, HR , Equipment, Lab Information System and Layout plans shall be shared by
Ministry separately in due course.
7.5.9 State is requested to send their proposals to the MoHFW, duly proposing under the
respective FMR Code of ANB -5.1 to 5.3 as given in Appendix 2.1.
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Operational Guidelines for PM Ayushman Bharat Health Infrastructure Mission
APPENDIX 7.1
The State wise breakup of Physical deliverables for Critical Care Hospital Blocks under PM Ayush-
man Bharat Health Infrastructure Mission for FY 2021-22 to 2025-26
Grand Total for 5 years
S. No. State/ UT Total Critical 100 50 50 bedded in
Care Blocks bedded bedded Medical Colleges
1 Andaman and Nicobar Islands 1 0 0 1
2 Andhra Pradesh 13 2 0 11
3 Arunachal Pradesh 1 0 0 1
4 Assam 27 1 22 4
5 Bihar 38 18 13 7
6 Chandigarh 0 0 0 0
7 Chhattisgarh 23 1 16 6
8 D & N Haveli 0 0 0 0
9 Daman & Diu 1 0 0 1
10 Delhi 9 4 0 5
11 Goa 2 0 1 1
12 Gujarat 32 6 15 11
13 Haryana 22 0 17 5
14 Himachal Pradesh 8 0 2 6
15 Jammu & Kashmir 9 2 1 6
16 Jharkhand 22 2 14 6
17 Karnataka 30 3 10 17
18 Kerala 14 1 4 9
19 Ladakh 0 0 0 0
20 Lakshadweep 0 0 0 0
21 Madhya Pradesh 50 2 35 13
22 Maharashtra 36 7 11 18
23 Manipur 2 0 1 1
24 Meghalaya 2 0 0 2
25 Mizoram 1 0 0 1
26 Nagaland 1 0 0 1
27 Odisha 28 1 19 8
28 Puducherry 3 1 1 1
29 Punjab 21 4 14 3
30 Rajasthan 33 4 15 14
31 Sikkim 1 0 0 1
32 Tamil Nadu 37 5 13 19
33 Telangana 31 2 21 8
34 Tripura 1 0 0 1
35 Uttar Pradesh 74 30 22 22
36 Uttarakhand 7 0 4 3
37 West Bengal 22 6 3 13
Total 602 102 274 226
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Operational Guidelines for PM Ayushman Bharat Health Infrastructure Mission
APPENDIX 7.2
The State wise breakup of Physical deliverables for Critical Care Hospital Blocks–Category wise
- under PM Ayushman Bharat Health Infrastructure Mission for FY 2021-22 to 2025-26
(Year-wise distribution)
Medical colleges
Medical colleges
50 bedded in
50 bedded in
50 bedded in
100 bedded
100 bedded
100 bedded
for this year
50 bedded
50 bedded
S. No State/ UT
Andaman and
1 0 0 0 0 0 0 0 0 0 0 0 0
Nicobar Islands
2 Andhra Pradesh 1 0 0 1 2 0 0 2 2 0 0 2
3 Arunachal Pradesh 0 0 0 0 0 0 0 0 0 0 0 0
4 Assam 2 0 2 0 5 0 4 1 5 0 4 1
5 Bihar 4 2 1 1 8 4 3 1 8 4 3 1
6 Chandigarh 0 0 0 0 0 0 0 0 0 0 0 0
7 Chhattisgarh 3 0 2 1 4 0 3 1 4 0 3 1
8 D & N Haveli 0 0 0 0 0 0 0 0 0 0 0 0
9 Daman & Diu 0 0 0 0 0 0 0 0 0 0 0 0
10 Delhi 1 0 0 1 2 1 0 1 2 1 0 1
11 Goa 0 0 0 0 0 0 0 0 0 0 0 0
12 Gujarat 4 1 2 1 6 1 3 2 6 1 3 2
13 Haryana 3 0 2 1 4 0 3 1 4 0 3 1
14 Himachal Pradesh 1 0 0 1 1 0 0 1 1 0 0 1
15 Jammu & Kashmir 1 0 0 1 1 0 0 1 1 0 0 1
16 Jharkhand 2 0 1 1 4 0 3 1 4 0 3 1
17 Karnataka 3 0 1 2 6 1 2 3 6 1 2 3
18 Kerala 1 0 0 1 3 0 1 2 3 0 1 2
19 Ladakh 0 0 0 0 0 0 0 0 0 0 0 0
20 Lakshadweep 0 0 0 0 0 0 0 0 0 0 0 0
21 Madhya Pradesh 5 0 4 1 10 0 7 3 10 0 7 3
22 Maharashtra 4 1 1 2 7 1 2 4 7 1 2 4
23 Manipur 0 0 0 0 0 0 0 0 0 0 0 0
24 Meghalaya 0 0 0 0 0 0 0 0 0 0 0 0
25 Mizoram 0 0 0 0 0 0 0 0 0 0 0 0
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Operational Guidelines for PM Ayushman Bharat Health Infrastructure Mission
Medical colleges
Medical colleges
50 bedded in
50 bedded in
50 bedded in
100 bedded
100 bedded
100 bedded
for this year
50 bedded
50 bedded
S. No State/ UT
26 Nagaland 0 0 0 0 0 0 0 0 0 0 0 0
27 Odisha 3 0 2 1 6 0 4 2 6 0 4 2
28 Puducherry 0 0 0 0 0 0 0 0 0 0 0 0
29 Punjab 1 0 1 0 5 1 3 1 5 1 3 1
30 Rajasthan 3 0 2 1 7 1 3 3 7 1 3 3
31 Sikkim 0 0 0 0 0 0 0 0 0 0 0 0
32 Tamil Nadu 4 1 1 2 8 1 3 4 8 1 3 4
33 Telangana 3 0 2 1 6 0 4 2 6 0 4 2
34 Tripura 0 0 0 0 0 0 0 0 0 0 0 0
35 Uttar Pradesh 7 3 2 2 14 6 4 4 14 6 4 4
36 Uttarakhand 0 0 0 0 2 0 1 1 2 0 1 1
37 West Bengal 2 1 0 1 5 1 1 3 5 1 1 3
Total 58 9 26 23 116 18 54 44 18 54 44
50
Operational Guidelines for PM Ayushman Bharat Health Infrastructure Mission
51
Operational Guidelines for PM Ayushman Bharat Health Infrastructure Mission
2024-25 2025-26
Critical 50
50 bed- Total
S. No. State/UT Care bedded
100 50 ded in Critical 100 50
Blocks in
bedded bedded Medical Care bedded bedded
for this Medical
colleges Blocks
year colleges
32 Tamil Nadu 8 1 3 4 9 1 3 5
33 Telangana 6 0 4 2 10 2 7 1
34 Tripura 0 0 0 0 1 0 0 1
35 Uttar Pradesh 14 6 4 4 25 9 8 8
36 Uttarakhand 2 0 1 1 1 0 1 0
37 West Bengal 5 1 1 3 5 2 0 3
Total 116 18 54 44 196 39 86 71
52
PRADHAN MANTRI–AATMANIRBHAR
SWASTH BHARAT YOJANA
(PM-ASBY)
Between
1. PREAMBLE
1.1 WHEREAS the Pradhan Mantri – Aatmanirbhar Swasth Bharat Yojana, (hereinafter to be
referred as PM-ASBY), has been approved by the Union Cabinet in September 2021 and
launched in October 2021, to be implemented over a period of five until FY 2025- 2026
from FY 21-22, is a Centrally Sponsored Scheme with some Central Sector Components,
and aims at supporting the States and UTs to develop a robust health system to respond to
future pandemics, consistent with the outcomes envisioned in the Sustainable Development
Goals (SDG)-3 indicators falling within the health domain and general principles laid down
in the National and State policies, including the National Health Policy, 2017.
1.2 AND WHEREAS the key objective of the PM-ASBY would be to develop a Public Health System
to meet the needs of future pandemics by integrating essential public health functions and
service delivery with the objective to strengthen grass roots public health institutions in
rural and urban areas, to deliver universal comprehensive primary health care, including
surveillance, active community engagement and improved risk communication, health
education and prevention and to strengthen public health institutions and public health
governance capacities to meet challenges posed by the current and future pandemics/
epidemics with capacities for comprehensive diagnostic and treatment including for critical
care services.
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Operational Guidelines for Ayushman Bharat - Health Infrastructure Mission
1.3 And whereas the Operational Guidelines for implementation of the PM-ASBY provide for
the MoU to be signed between the MOHFW for such a participating State/UT for which the
state’s share of funds, commensurate to the central share of funds, is applicable;
1.4 And whereas, the state share is applicable to the participating state of _______(name of
State/UT);
NOW THEREFORE, the MOHFW and the State/UT Government/Administration of _________ (Name
of State/UT), being signatory to this MoU, hereby enter into this MoU and thereby commit to work
together for implementation of the PM-ASBY and have agreed as set out herein below –
3.1 The component-wise agreed outlay for the PM-ASBY for the Scheme period (from 2021-22
to 2025-26), with details of sources for the funding, is reflected in the Annexure 1A.
3.2 The component-wise agreed outlay for the PM-ASBY for the Scheme period (from 2021-22
to 2025-26) with details of heads of expenditure, i.e. capital and recurring, is reflected in the
Annexure 1B.
3.3 The component-wise and financial year-wise agreed deliverables for the PM-ASBY, for the
Scheme period (from 2021-22 to 2025-26), are reflected in the Annexure 2.
4. OVERARCHING PRINCIPLES
4.1 PM-ASBY is a Centrally Sponsored Scheme (CSS), with few Central Sector Components. The
CSS components of the PM-ASBY will be implemented by following the existing Framework,
institutions and mechanisms of the National Health Mission. For the CSS components, the
PM-ASBY would leverage the existing National Health Mission (NHM) structure available at
central and State levels for appraisal, approval, implementation and monitoring.
4.2 State Health Society, established under National Health Mission (NHM), will be the
implementing agency at the State level and shall play a pivotal role in planning for the
PM-ASBY. Similarly, at the district level, the District Health Society, headed by the District
Collector, will play a crucial role in not only planning as per the guidelines and also, for
effective implementation and robust monitoring of the units of various components under
PM-ASBY, under the overall supervision of the District Collector.
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Operational Guidelines for Ayushman Bharat - Health Infrastructure Mission
4.3 Institutional arrangements and Funds releases will be as per Operational Guidelines of the
implementation of the Prime Minister Aatmanirbhar Swasth Bharat Yojana (PM-ASBY) dated 25th
October 2021, as revised by the MOHFW, from time to time, in consultation with stakeholders.
4.4 The Guiding Principles set out in para 2.1of the Operational Guidelines of the implementation
of the Prime Minister Aatmanirbhar Swasth Bharat Yojana (PM-ASBY) dated 25th October
2021, shall be followed.
4.5 For the three components, namely, Infrastructure support to rural Health and Wellness
Centres / Building-less Sub Health Centres in Rural Areas, Block Public Health Units (BPHUs)
and Urban Health and Wellness Centres (Urban HWCs), will utilize the resources of FC-XV
Health Grants through Local Governments in the respective States, the mechanism for
planning, implementation, and monitoring shall be synergized as per the Technical and
Operational Guidelines for the implementation of FC-XV Health Grants through Local
Governments dated 31st August 2021, by the State.
` 4.6 A common Indicator framework and Output Outcome Framework would be prepared
encompassing all the components of PM-ASBY for providing a common results framework
and communicated to the state. The signatories shall take all necessary measures for
achievement of the Outputs and Outcomes so set out, in the prescribed timeframe.
4.7 Any necessary addition or modification in any of the clauses or Annexures of this MoU shall
be made only with mutual agreement and shall be recorded in writing. Such additions of
modifications shall be appended to this MoU.
5.1 Release of funds in accordance with the approved funding pattern and budget, compliance
to agreed performance indicators, within an agreed time. However, the funds committed
through this MoU may be enhanced or reduced, depending on the pace of implementation
of the State’s plans and achievement of the milestones relating to the agreed performance
Indicators.
5.2 Facilitating multilateral and bilateral development partners to co-ordinate their assistance,
monitoring and evaluation arrangements, data requirements and procurement rules etc.
within the framework of an integrated State Health Plan.
5.3 Assisting the States in mobilizing technical assistance inputs.
5.4 Developing and disseminating protocols, standards, training modules and other such
materials for improving implementation of the programme.
5.5 Consultation with States, on a regular basis, at least once a year, on the reform agenda and
review of progress.
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Operational Guidelines for Ayushman Bharat - Health Infrastructure Mission
5.6 Prompt consideration and response to requests from states for policy, procedural and
programmatic changes.
5.7 Holding joint annual reviews with the State, other linked Central Government Departments
and participating Development Partners;
5.8 Dissemination of and discussion on any evaluations reports etc., that have a bearing on
policy and have the potential to cause a change of policy.
6.1 The State Government shall ensure that the funds made available to support the agreed State Plan
under this MoU are used for financing the agreed State Plan approval in accordance with agreed
financing schedule and not used to substitute routine expenditures that are the responsibility of
the State Government.
6.2 The State share shall be 40% in all States and UTs with legislature except for Jammu & Kashmir,
Himachal Pradesh, Uttarakhand, North Eastern States where the State/UT contribution will be
10%.
6.3 The State shall ensure that the implementation of the programme/activities envisaged is as per
the PM-ASBY guidelines provided by Ministry and other guidance as updated from time to
time.
6.4 Representative of the MoHFW and/or development partners providing financial assistance
under the MoU mechanism as may be duly authorized by the MoHFW from time to time, may
undertake field visits to any part of the State and will have access to such information as may
be necessary to make an assessment of the progress of the health sector in general and PM-
ASBY in particular.
6.5 The accounts are maintained, and audit is conducted as per the rules and utilization
certificates are submitted within the period stipulated under General Financial Rules (GFR),
2017. The State Governments shall comply to the financial guidelines issued to the states by
the Financial Management Group established under National Health Mission by the Ministry
of Health and Family Welfare. In addition, states shall have to follow State Finance Rules related
to procurement and General Finance Rules in relation to furnishing of Utilization Certificate
and other related Matters
6.6 State shall follow the extant instructions of the Central Government for fund releases under
the Centrally Sponsored Schemes.
6.7 The State shall organize the audit of the PM-ASBY account of the State Health Society after
close of every financial year. The State Government will prepare and provide to the MoHFW,
a consolidated statement of expenditure, including the interest that may have accrued.
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Operational Guidelines for Ayushman Bharat - Health Infrastructure Mission
6.8 The funds provided for the PM-ASBY, including both central share, the state share and the
XV FC Grants for Health Sector, shall also be liable to statutory audit by the Comptroller and
Auditor General of India.
6.9 The State shall take prompt corrective action in the event of any discrepancies or deficiencies
being pointed out in the audit. Every audit report and the report of action taken thereon shall
be tabled in the next ensuing meeting of the Governing Body of the State Society. The State
Government shall also table the audit report of the scheme in the house of State Legislative
Assembly.
6.10 State shall endeavour to implement all the activities as indicated in the plan and take such
other action as is needed to achieve the plan objectives.
6.11 State shall make effort in filling up vacant posts as per the agreed institutional reforms.
6.12 State agrees and commits to achieve all the key deliverables as set out in Annexure 2, for
five years from FY 2021-22 till FY 2025-2026.
6.13 Recruitment/Appointment of HR:
6.13.1 Support for HR requirement for these components will be provided only up to the
scheme period, i.e. up to FY 25-26 and after that, states would be responsible for
maintaining the facilities including Human Resources. The State has taken into
consideration that the recurring HR expenditure will not be available beyond
the scheme period.
6.13.2 The State commits that it shall create and fill up the regular posts in the
required places, to manage and and ensure that the assets created under the
PM-ASBY are kept fully functional even beyond the scheme period.
6.13.3 Under PM-ASBY, only contractual/outsourced Human Resource is permissible to be
engaged. However, if the State Government appoints permanent human resources
either on its own or by virtue of orders of Hon’ble Court, then the State Government
shall be liable to maintain the same at its own cost, and the liability of the Central
Government will strictly be only to the extent of agreed and approved PM-ASBY-Plan.
6.13.4 The State Health Society is responsible for appointment (contractual/conditional)
employees, their transfers/termination of services, payment of wages, salary,
remuneration, etc. There would be no privity of contract between the Central
Government and the employees appointed by the State Health Society.
6.14 State agrees for an annual review of both progress of the plan and of the institutional reforms,
carried out by the State. This review would be integrated into the NHM’s annual Common
Review Mission, undertaken by a multi-disciplinary /multi -stakeholder team comprising
of Central Government officials, public health experts, civil society representatives, other
partners and stakeholders.
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Operational Guidelines for Ayushman Bharat - Health Infrastructure Mission
7. SUSPENSION
Non - compliance of the commitments and obligations set in the MoU and/or upon failure to make
satisfactory progress may require Ministry of Health & Family Welfare to review the assistance committed
through this MoU leading to suspension, reduction or cancellation thereof. The MoHFW commits to
issue sufficient alert to the State Government before contemplating any such action.
Signed this_______day of _________ (month) ____________(year) 2021
For and on behalf of
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Operational Guidelines for Ayushman Bharat - Health Infrastructure Mission
ANNEXURE-1
Total Allocation under CSS components of PM-ASBY for five years from FY 2021-22 for the State
of ______
A. Component-wise fund allocation for five CSS components under PM-ASBY for five years
from FY 21-22 to 25-26 (Central and State Share):
1. Rural AB-HWCs
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Operational Guidelines for Ayushman Bharat - Health Infrastructure Mission
B. Component-wise fund allocation for five CSS components under PM-ASBY for five years
from FY 21-22 to 25-26 (capital and recurring cost):
1. Rural AB-HWCs
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Operational Guidelines for Ayushman Bharat - Health Infrastructure Mission
ANNEXURE-2
Component-wise physical deliverables envisaged under PM-ASBY for five years
S.
2021-22 2022-23 2023-24 2024-25 2025-26 Total
No
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Operational Guidelines for Ayushman Bharat - Health Infrastructure Mission
ANNEXURE - II
Parameters, to be factored, while preparing Plans under PM-ASBY scheme
FC-XV
S.No. Critical Parameters, while preparing Action Plan
Component
All the Blocks in these 11 States to be covered / saturated, including those in
Tribal areas and Left Wing Extremism (LWE) affected areas. Calculations of the
Block Public support under PM-ASBY, are based on the number of Blocks in the States as on
1. July 2020 (LG Code database)
Health Units
Comprehensive gap analysis on the requirement, will enable, to cover also the
new blocks, created by the States subsequently.
Efforts should be made to Number of Building-less SHCs in these 10 States,
including those in Tribal areas and Left Wing Extremism (LWE) affected areas.
Calculations of the support under PM-ASBY, are based on the number of Building-
less SHCs in the States as per RHS 2019 and informal verifications with the State
health teams.
Comprehensive gap analysis on the requirement, will enable, to cover also the
Building-less SHCs in the State as on date.
The States may prioritize the constructions of Buildings for the Building-less
SHCs, especially those Sub Health Centres, that have been converted into
Health and Wellness Centres (AB-HWCs), and few factors to be considered in
this regard are:
Building-less • Run-down / dilapidated building structures which are required to be re-built.
2.
SHCs
• Construct new buildings, where services are being provided from rented
buildings especially in Aspirational districts, Tribal and remote areas, to
reduce time to care and geographical barriers.
• New buildings in lieu of existing rented buildings that may not have adequate
infrastructure/ space for carrying out the required activities.
• New buildings, if required as per shortfall of population norms as per details
given in RHS 2020.
States are informed that if the existing rented buildings are located well
within the reach of the community, have sufficient space for carrying out
all the intended services and have sufficiently robust construction, then the
State need not plan for re-locating from these buildings.
Based on the vulnerability assessment and mapping of the urban areas, the slum
/ vulnerable areas will be prioritized where presently no primary health care
Urban Health facility exists. The priority is to ensure that there is one Urban-HWC per 15,000-
and Wellness 20,000 population catering predominantly to poor and vulnerable populations,
3.
Centres in all resident in slum and slum-like areas. The norms are relaxable as per the local
the States/UTs context of the States. Decisions regarding the required number of Urban-HWCs,
would depend on population density, presence of slums & similar habitations,
vulnerable population, peri-urban areas and newly Notified Urban Areas.
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Operational Guidelines for Ayushman Bharat - Health Infrastructure Mission
FC-XV
S.No. Critical Parameters, while preparing Action Plan
Component
Depending on the gap analysis, some districts require establishment of new DIPH
District labs, and some districts requires strengthening of existing PH labs. Calculations
Integrated of the support under PM-ASBY, are based on the number of districts in the States
4. Public Health as on July 2020 (LG Code database)
Labs in all the
730 districts Comprehensive gap analysis on the requirement, will enable, to cover the
requirement for new districts, created by the States subsequently.
Based on the Population of 2011, under PM-ASBY, support will be provided to 602
districts across all States/ UTs.
For the 102 Districts having more than 20 lakh population, the Size of the Critical
Care Block are to be limited to 25% of the existing District Hospitals Beds capacity
subject to a minimum of 50 and a maximum of 100 beds.
Critical Care For 274 districts with 5-20 lakhs population, it is envisaged to set- up 50 bedded
5. Blocks in 602 Critical Care Hospital Block/Wing.
Districts Besides the above, 226 districts, with Government Medical Colleges, would also
be supported to establish a 50 bedded Critical Care Hospital Block / wing
All other districts (with less than 5 lakhs population) to be linked with the nearest
CCBs.
Comprehensive gap analysis on the requirement, will enable, to cover the
requirement for new districts, created by the States subsequently.
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Operational Guidelines for Ayushman Bharat - Health Infrastructure Mission
LISTS OF CONTRIBUTORS
Name Designation
Mr. Rajesh Bhushan Secretary, HFW
Ms. Vandana Gurnani Former Additional Secretary & Mission Director, NHM
Mr. Vikas Sheel Additional Secretary & Mission Director, NHM
Ms. Preeti Pant Former Joint Secretary, NUHM
Dr. Harmeet Singh Joint Secretary, NUHM
Mr. Vishal Chauhan Joint Secretary, Policy
Dr. N. Yuvaraj Director – NHM
Dr. Sachin Mittal Director – NHM
Name Designation
Maj Gen (Prof) Atul Kotwal Executive Director
Air Cmde (Dr.) Ranjan Choudhury VSM Advisor, HCT Division
Dr. Himanshu Bhushan Advisor, PHA Division
Ms. Mona Gupta Advisor, HRH-HPIP Division
Dr. J N Srivastava Advisor, QI Division
Dr. (Flt Lt) M A Balasubramanya Advisor, CP-CPHC Division
Dr. Ashoke Roy Director, RRCNE
Dr. Neha Dumka Lead Consultant, KMD Division
Dr. Joydeep Das Lead Consultant, RRCNE
Sh. Bhaswat K. Das Senior Consultant, HCT, RRCNE
Mr. Anjaney Senior Consultant, HCT Division
Dr. Anantha Kumar SR Senior Consultant, CP-CPHC Division
Ms. Sweta Roy Senior Consultant, HRH-HPIP Division
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Operational Guidelines for Ayushman Bharat - Health Infrastructure Mission
66
Ministry of Health and Family Welfare
Government of India