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Strengthening Health Ecosystem through Ayushman Bharat Health & Wellness Centres

Bal Raksha Bharat, in collaboration with Mondelez India Foods Pvt Ltd, has implemented a project titled “Strengthening Health Ecosystem through Ayushman Bharat Health & Wellness Centres (AB-HWCs).” The objective of the project is to support 200 selected Health & Wellness Centres (HWCs) across four states—Madhya Pradesh, Maharashtra, Himachal Pradesh, and Andhra Pradesh. The aim is to enhance their facilities and outreach services, benefiting over 1.45 million people. The health system strengthening initiative operates in close coordination with Chief Medical Health Officers, Block Health Officers, Nodal Officers of AB-HWCs, Medical Officer In-charges, nursing staff, ANMs, and ASHAs at these centres located near Mondelez factory locations.

The specific objectives of the project include strengthening the HWCs to deliver quality Comprehensive Primary Health Care (CPHC) services through system improvements and technical assistance. A focus has been placed on prioritizing services for new-borns, children, and adolescents while establishing forward and backward referral linkages. Additionally, the project aims to scale up learning and replicable models for health system strengthening, with a focus on gender-inclusive health and wellness centres.

The implementation process involved several key steps. Initially, sufficient manpower was positioned to ensure effective execution. Partnerships were formed with the health departments of the states, and facilities in need of transformation were identified. The project provided continuous handholding support and conducted extensive documentation to record progress and challenges.

User-Friendly Health and Wellness Centres

The Ayushman Bharat Health & Wellness Centres are designed to provide comprehensive services, including preventive, promotive, curative, rehabilitative, and palliative care. These services ensure the clinical management of patients, care coordination, and continuity of care, particularly for chronic and critical cases. Public health functions such as health promotion, disease prevention, and outcome measurement for the population served are integral to these centres.

A key principle guiding the design of user-friendly health facilities is to ensure that services are delivered in a manner sensitive to gender, religious, and cultural needs. Discrimination on economic or social grounds is strictly prohibited. Care is collaborative, coordinated, and accessible, with an emphasis on physical comfort and emotional well-being. The viewpoints of patients and families are respected, and they are always included in decision-making processes.

Before finalizing the design of the HWCs, key cultural characteristics of the local community are identified and integrated into the design process. The aim is to ensure minimal environmental disturbance while considering local language, social and family structures, gender relations, spirituality, and social issues. These aspects are vital in creating a culturally appropriate health facility.

Transformational Process of HWCs

The government envisions the delivery of comprehensive healthcare services at the community level with high quality, supported by an efficient referral system. The Ayushman Bharat guidelines for health and wellness centres encapsulate this vision. The Bal Raksha Bharat (BRB) program took this vision and applied it to select blocks in the four states, working with the health departments to transform select Primary Health Centres (PHCs) and Sub Health Centres (SHCs) into HWCs.

The transformation process involved an eight-step approach. The first step was conducting a need assessment to understand the specific requirements of each facility. Following this, the team mapped out space for the construction of essential facilities like toilets, handwashing stations, and breastfeeding corners. After receiving approval, infrastructure construction began, followed by the supply of necessary equipment, including examination beds and medical kits. The health personnel received training on Ayushman Bharat requirements and how to use the equipment.

A significant focus was placed on creating gender-friendly HWCs by developing a Gender-Friendly and Social Inclusion Package. This included displaying IEC materials, orienting the staff, and organizing outreach sessions. Collaboration with Panchayati Raj Institutions (PRI) was essential, as local governance bodies could leverage untied funds for facility improvements.

The efforts resulted in remarkable improvements in the condition of the facilities. Waiting areas with proper seating, toilets for patients and caregivers, handwashing stations, and breastfeeding corners were introduced. The construction of boundary walls and pits for safe medical waste disposal further enhanced the facilities. These improvements have led to a significant increase in outpatient footfall across all four states. For instance, in Maharashtra, SHCs supported by BRB have seen a 30-40% increase in service seekers due to the improved facilities.

Functional Jan Arogya Samitis

The Jan Arogya Samiti (JAS) plays a crucial role in effective health planning and monitoring at the community level. Formed with representation from healthcare staff, elected representatives, frontline workers, and community members, the JAS is empowered to plan and monitor health services. However, in many areas, JAS has remained a paper activity without real engagement at the ground level. Many individuals were unaware of their selection as members, and as a result, the envisaged role of JAS as a monitoring body became diluted.

The BRB program aimed to reinvigorate JAS as an effective community monitoring mechanism. This was achieved by establishing rapport between the Medical Officers (MOs) or CHOs and the PRI heads. Following this, JAS members were identified, motivated, and trained. Stationery and meeting registers were provided, and monthly meetings were organized to set agendas and manage fund disbursements.

The Mondelez-supported BRB initiative facilitated the functioning of 116 Jan Arogya Samitis, many of which now have operational bank accounts. Before the intervention, none of these committees had active accounts. In Maharashtra, one JAS was able to mobilize INR 3 lakh to construct a new health centre. JAS members have also secured resources for purchasing medicine, installing water purifiers, repairing buildings, connecting electricity, and hiring helpers for sanitation.

The BRB program helped address apprehensions and power dynamics between JAS and healthcare workers. Initially, health staff feared that engaging with the community would attract unwanted attention and hinder their duties. However, the program’s success in improving facilities and fostering cooperation demonstrated that these fears were unfounded. The JAS has now become a vital community monitoring tool, helping to ensure the smooth functioning of HWCs and contributing to improved healthcare services at the grassroots level.

Impact and Learning

The project has had a considerable impact, with 200 Ayushman Arogya Mandirs strengthened through the provision of maternal, new-born, and child health equipment. The establishment of 24 user-friendly Ayushman Arogya Mandirs has led to a 58% increase in patient footfall, and 11 centres have received Kayakalp accreditation for hygiene standards. Moreover, 861 health staff members have been trained in gender and social inclusion services, and 5,096 high-risk pregnancies and 1,477 under-five children were identified and referred for additional care. The success of this project underscores the importance of infrastructure, training, and community engagement in transforming healthcare facilities into effective centres of care.

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Eat Right Schools

Bal Raksha Bharat (BRB), in partnership with Mondelez India Foods Pvt. Ltd. and Food Safety and Standards Authority of India (FSSAI), has launched the Eat Right Schools programme, aimed at fostering a culture of safe, nutritious, and sustainable eating practices among schoolchildren. The initiative seeks to build awareness on the importance of nutrition, food safety, and hygiene in shaping the physical and cognitive development of children, thereby supporting their overall well-being.

At the heart of this programme lies the objective to transform schools into nutrition-conscious environments, where students, staff, and families collectively engage in healthy food practices. Through structured activities such as the formation of Sehat Clubs, the implementation of nutrition gardens, and food safety training (FoSTaC) for kitchen staff, BRB strives to instil long-lasting dietary habits in students.

The Eat Right Schools programme goes beyond classroom instruction, incorporating interactive and innovative Behaviour Change Communication (BCC) tools to actively engage students in health education. These tools, combined with the rigorous certification and hygiene rating of school kitchens, ensure that schools set the standard for safe food consumption, making them model institutions for promoting health and nutrition.

By creating empowered, health-conscious students, the programme aims to inspire a new generation to lead healthier lives and advocate for improved nutritional practices within their communities.

During the reporting period, significant initiatives were implemented to improve the overall effectiveness of Bal Raksha Bharat’s (BRB) programs, ensuring alignment with the brand’s objectives of promoting health, nutrition, and safety in schools. These innovations reflect BRB’s commitment to enhancing the well-being of children through sustainable, educational, and impactful strategies. Below is an overview of the key approaches and their measurable impacts on the program’s stakeholders and beneficiaries.

Strengthening of Sehat Clubs to Promote Healthy Habits in Schools

One of the most impactful initiatives has been the establishment and strengthening of Sehat Clubs, designed to foster a holistic approach to health education in schools. These clubs act as a dynamic platform for promoting not only physical health and hygiene but also mental well-being and nutritional education. The Sehat Clubs empower children as health advocates, where they learn and disseminate important messages on Safe and Nutritious Food (SNF) within their school environments.

The introduction of Sehat Clubs has played a critical role in creating a participatory and inclusive atmosphere for learning. With 200 clubs formed across five states, and a membership base of 3,467 children democratically elected by their peers, these clubs have reached and sensitized over 34,327 students. This initiative has laid the foundation for an informed, health-conscious generation by equipping children with the tools and knowledge to make healthier choices. The engagement with students has also fostered leadership skills as children actively participate in shaping the health agenda of their schools, promoting a culture of well-being that extends to their communities.

Development of Nutrition Gardens in Schools

To supplement the nutrition education provided by the Sehat Clubs, BRB introduced the development of nutrition gardens within school premises. These gardens offer a sustainable and cost-effective means of enhancing dietary intake with fresh, organic ingredients grown on-site. By connecting children with nature, these gardens promote self-sufficiency, foster a sense of responsibility, and provide an engaging, therapeutic form of horticulture.
The initiative was implemented across schools in Madhya Pradesh, Himachal Pradesh, and Tamil Nadu, resulting in the development of 30 kitchen gardens. BRB partnered with the local agricultural university in Tamil Nadu to provide technical guidance, ensuring the success of the initiative. An exposure visit was also conducted in Chhatarpur district, Madhya Pradesh, where BRB collaborated with the local NGO Darshana Mahila Kalyan Samiti. This visit highlighted the importance of safe wash practices and natural tools for growing kitchen gardens in both schools and communities. The project not only provides fresh produce for the mid-day meals but also serves as a practical learning tool for students, reinforcing healthy eating habits that they can replicate at home.

Promoting Healthy behaviour through Interactive behaviour Change Communication (BCC) Tools

The focus on fostering health and nutrition awareness within schools has been further strengthened by the use of behaviour Change Communication (BCC) tools. BRB has implemented various communication initiatives using Information, Education, and Communication (IEC) materials. These include the development of creative and engaging resources like the “Healthy Diary,” digital wall paintings, nutrition garden books, and sun boards for School Management Committees (SMC). Key messages such as “Eat Healthy, Eat Secure, Eat Sustainable” were communicated through fruit and vegetable calendars, posters, and interactive games like the Snake & Ladder activity.

These materials have had a transformative impact, not only by making classrooms more visually engaging but also by encouraging students to adopt healthier dietary practices. The behavioural change catalysed by these resources has been far-reaching, influencing not only students but their families as well. Children are now better equipped to make informed choices about their nutrition and hygiene. The concept of the “Rainbow Thali” (a plate representing diverse food groups) and awareness about the “5 F’s” (Fly, Finger, Food, Faeces, and Fomites) have been central to driving home the importance of safe food handling and hygiene practices.

Food Safety Training (FoSTaC) and Hygiene Ratings for School Kitchens

Ensuring food safety in schools has been a priority for BRB, leading to the introduction of FoSTaC (Food Safety Training and Certification) training for kitchen handlers and a hygiene rating certification process for auditing school kitchens. This initiative supports the broader goal of certifying schools as “Eat Right Schools,” as part of the Eat Right School portal of the Food Safety and Standards Authority of India (FSSAI). The process includes comprehensive training on proper food handling, storage, kitchen layout, and personal hygiene for mid-day meal staff.

Through this program, 246 food handlers were trained, and 97 kitchens were audited, ensuring that food safety standards are consistently met across the board. The initiative has fostered a culture of continuous improvement, leading to safer, cleaner environments for preparing and consuming food. The structured audit and certification process ensures that schools adhere to high standards, reflecting BRB’s commitment to food safety and hygiene in educational institutions.

Impact on Stakeholders and Beneficiaries

The initiatives implemented by Bal Raksha Bharat have had a profound impact on both students and school communities. The introduction of Sehat Clubs, the development of nutrition gardens, and the use of behaviour Change Communication (BCC) tools have collectively led to a significant increase in health awareness and positive behavioural changes among students. These programs have successfully created a more inclusive and dynamic learning environment, where the focus on health, well-being, and safety is integrated into daily school activities. Children have not only become more informed about healthy habits but have also developed leadership skills through their involvement in the Sehat Clubs. By taking ownership of health initiatives, they are now actively engaged in promoting well-being within their schools and communities. This has extended beyond the classroom, as students influence their families and local networks to adopt healthier practices.

Additionally, the implementation of FoSTaC training for kitchen staff has resulted in safer and more nutritious meals being provided in schools. The enhanced food safety standards ensure that children are nourished in a secure environment, fostering better physical and cognitive development. Together, these initiatives have created a holistic framework that supports the overall growth and well-being of students, ensuring they thrive both academically and personally.

During the reporting period, several key quantitative milestones were achieved, reflecting the success and scale of the initiatives implemented by Bal Raksha Bharat. A total of 200 Sehat Clubs were activated, with 3,467 children participating as active members. These clubs collectively reached and sensitized an impressive 34,327 students, fostering a widespread understanding of health and nutrition within schools.

In addition, 30 nutrition gardens were developed across three states, providing a sustainable source of fresh, organic produce for school meals while offering students hands-on learning opportunities in gardening and healthy eating.

On the food safety front, 246 food handlers were trained according to the Food Safety Training and Certification (FoSTaC) standards, ensuring that staff members were equipped with the knowledge and skills to maintain high standards of hygiene and food safety. Furthermore, 97 kitchens were audited for hygiene ratings, underscoring the programme’s commitment to providing safe and nutritious meals in school environments.
By weaving health and nutrition awareness into the fabric of school life, BRB has taken significant strides towards realizing its vision of nurturing healthier, more informed, and empowered young citizens.