A 52-year-old man with uncontrolled hypertension and type 2 diabetes presents to a primary health centre (PHC) in rural Maharashtra. He requires regular monitoring and medication refills. The PHC staff inform him that they lack the capacity for chronic disease management. According to the Ayushman Bharat – Health and Wellness Centres (AB-HWC) initiative, what is the most appropriate next step in his management?

Question

Accepted Answer

B. Enrol him in the AB-HWC programme at the PHC for integrated chronic disease management and preventive care. ## Ayushman Bharat – Health and Wellness Centres (AB-HWC) Framework

**Key Point:** AB-HWC is a cornerstone of the National Health Mission (NHM) aimed at strengthening primary health care through integrated chronic disease management and preventive services at the grassroots level.

### Core Components of AB-HWC

The AB-HWC initiative mandates that PHCs and sub-centres be equipped to:

1. Provide **integrated chronic disease management** (hypertension, diabetes, COPD, mental health)
2. Deliver **preventive and promotive health services**
3. Conduct **community health screening and surveillance**
4. Ensure **continuity of care** through trained health workers

### Why Enrolment in AB-HWC is Appropriate

**High-Yield:** The AB-HWC model decentralizes chronic disease care from tertiary centres to PHCs, reducing burden on hospitals and improving accessibility for rural populations. This patient's conditions (hypertension and diabetes) are **explicitly covered** under AB-HWC protocols.

### Management Pathway Under AB-HWC

| Aspect | AB-HWC Provision |
|--------|------------------|
| **Screening** | Free screening at PHC/sub-centre |
| **Diagnosis** | Point-of-care testing (BP, blood glucose) |
| **Treatment** | Essential medicines provided free under NHM |
| **Follow-up** | Regular monitoring by trained ANM/ASHA |
| **Referral** | Tiered referral to CHC/district hospital if needed |

**Clinical Pearl:** AB-HWC leverages existing PHC infrastructure and ASHA/ANM workforce to make chronic disease management accessible and affordable in rural settings, eliminating the need for unnecessary tertiary referrals for stable patients.

[cite:National Health Mission Guidelines 2017-2022]

Answer

A. Advise him to purchase medications from private pharmacies as the PHC cannot support his care

Answer

C. Refer him to the nearest ASHA worker for community-based care only without any facility-based support

Answer

D. Refer him directly to a tertiary care hospital for all future management

Explanation

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