Readiness of NCD Services at Ayushman Arogya Mandirs (AAMs) in India: A Review of Recent Studies

Introduction

Non-communicable diseases (NCDs) such as hypertension, diabetes, cardiovascular diseases, and cancers account for nearly 60% of deaths in India, posing a major public health challenge [1, 2]. In response, the Government of India launched the Ayushman Bharat Program in 2018 to transform 1.5 lakh sub-centres and primary health centres into Ayushman Arogya Mandirs (AAMs), equipped to provide comprehensive primary care, including robust NCD services.

However, the readiness of these centres varies widely across India due to disparities in infrastructure, workforce, logistics, and community mobilization. Evaluating the preparedness of AAMs to manage NCDs is essential for optimizing resource allocation, informing policy, and ensuring equitable service delivery. This review aims to synthesize findings from peer-reviewed studies and government assessments between 2020 and 2024 to examine the status of NCD service readiness at AAMs across different states.

Methodology

A desk-based literature review was conducted, sourcing peer-reviewed journals, government evaluation reports, and implementation assessments published between 2020 and 2024. Searches were conducted in PubMed, PMC, and Google Scholar using keywords such as “NCD readiness”, “Ayushman Bharat”, “Health and Wellness Centres”, and “primary healthcare India”.

Exclusion Criteria:

1. Non-Indian studies
2. Studies focused solely on secondary or tertiary hospital-based NCD care

Figure 1 show a PRISMA flow diagram depicting the selection process of studies for the review.

Results

The Table 1 summarizes key findings from various states regarding the readiness of AAMs to deliver NCD services:

Discussion

The review indicates wide variation in the readiness of AAMs to deliver NCD services, with southern and western states like Maharashtra and Tamil Nadu demonstrating relatively stronger systems. These states benefit from better training, infrastructure, and digitalization, contributing to higher NCD screening and treatment rates.

However, challenges persist across multiple states, especially in eastern, northern, and northeastern regions. Common cross-cutting issues include:

1. Human Resource Gaps: High CHO vacancies, especially in rural and remote districts [3–10].
2. Infrastructure Deficiencies: Shortages of glucometers, BP apparatus, and essential drugs are common in states like Bihar, Punjab, and Odisha [4, 6, 10].
3. Training Needs: Community Health Officers (CHOs) often lack regular refresher training on NPCDCS protocols and mental health services [5, 15].
4. Referral and Continuum of Care: Referral linkages between primary, secondary, and tertiary care are poorly structured and weakly monitored [5, 16].
5. Community Engagement: Accredited Social Health Activists (ASHAs) and Village Health, Sanitation and Nutrition Committee (VHNSCs) are underutilized; low awareness and screening demand observed, particularly in states like Uttar Pradesh and Rajasthan [5, 17].

In response, states like Maharashtra have adopted IT integration for real-time data monitoring [6], while Tamil Nadu and Karnataka are attempting to scale digital health records and follow-up tracking [8, 9].

There is also an emerging emphasis on convergence, both horizontal (with local governance, education, and WCD departments) and vertical (between health system levels), to strengthen health promotion and continuity of care [18, 19].

Conclusion

Ayushman Arogya Mandirs are pivotal in India’s effort to address the growing burden of NCDs. However, the evidence reveals that certain challenges need to be addressed. To realise the full potential of AAMs, focused interventions are required, including: a) filling human resource gaps and reducing CHO vacancies; b) ensuring an uninterrupted supply of essential drugs and diagnostics; c) standardising CHO training, including refresher modules and mental health components; d) strengthening IT systems for referral tracking, reporting, and data use; and e) mobilising communities through ASHAs, SHGs, and local bodies to increase screening coverage.

Evidence-based investments, targeted support to underperforming states, and fostering cross-learning among better-performing states will be critical to strengthening India’s primary healthcare foundation and achieving equitable NCD care delivery.

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