Ayushman Arogya Mandir — Free Comprehensive Healthcare at Your Village Sub-Centre

Ayushman Arogya Mandir (AAM) is the first component of the Ayushman Bharat programme — India's most ambitious attempt at Universal Health Coverage. While the second component (GJAY/AB-PMJAY) provides health insurance for hospitalisation, AAMs provide the far more fundamental service: comprehensive primary health care, free of cost, at the doorstep — through transformed Sub Health Centres and Primary Health Centres that every rural population of 3,000-5,000 people is entitled to.

The core principle: "time to care no more than 30 minutes." Every citizen should be able to reach an AAM within half an hour of their home. What they find there should no longer be limited to maternal and child health services — it should be a full-spectrum primary care facility that handles non-communicable diseases, mental health, palliative care, oral health, eye care, and ear-nose-throat conditions in addition to the traditional reproductive and child health services.

The scale achieved is genuinely significant: a total of 1,73,881 Ayushman Arogya Mandirs have been established and operationalized as of 31 July 2024, recording 317.34 crore footfall. That is more than 2 billion patient visits — a number that anchors the AAM as the primary point of contact between India's rural poor and its health system.

Every AAM is mandated to deliver 12 comprehensive primary health care packages, making it fundamentally different from the traditional sub-centre that was limited to maternal and child health:

1. Care in pregnancy and childbirth (ANC, safe delivery facilitation, postnatal care)
2. Neonatal and infant health (HBNC, immunisation support, growth monitoring)
3. Childhood and adolescent health (school health, RKSK services)
4. Family planning and reproductive health (contraception counselling and provision)
5. Communicable diseases (TB, malaria, dengue, kala-azar, leprosy — screening, treatment, and surveillance)
6. Non-communicable diseases (diabetes, hypertension, oral cancer, breast cancer, cervical cancer — population-based screening, treatment initiation, and chronic disease management)
7. Mental health and neurological conditions (depression, anxiety, epilepsy screening and basic counselling)
8. Oral health (basic dental screening and preventive services)
9. ENT care (basic screening)
10. Eye care (vision screening, referral for cataract)
11. Geriatric health (elderly care, falls prevention, mobility support)
12. Palliative care (pain management, end-of-life support at home)

The NCD package is the most transformative. In communities where hypertension and diabetes were diagnosed only during hospitalisation for a crisis — when the disease had already progressed — the AAM's population-based NCD screening creates a system of early detection. A Community Health Officer (CHO) doing household-level NCD screening in their catchment area identifies hypertension before stroke, diabetes before blindness and kidney failure. This is the prevention that India's health system has historically lacked.

As of 30 November 2024, there are 1,16,978 CHOs in position across India. The CHO is a new cadre of health worker — a trained nurse (GNM, B.Sc Nursing, or B.Sc Community Health) who leads the primary care team at the Sub Health Centre-level AAM. The CHO is the highest-qualified paramedic in the community health infrastructure — above the ANM, above the ASHA — and is trained to prescribe a defined list of medicines, initiate treatment for common conditions, and manage the AAM as a clinical facility.

The CHO's role: facility-in-charge of the AAM; supervisor of the ANM, MPW, and ASHAs in their catchment; population-based NCD screener; conductor of weekly Health Melas (health camps); telehealth consultation facilitator; manager of the AAM's diagnostic equipment; and data entry operator for all services on the AB-AAM portal.

For NGOs: the CHO is the primary government counterpart for all community health work at sub-centre level. They are the link between the ASHA's community work and the PHC's clinical capacity.

Every AAM must constitute a Jan Arogya Samiti (JAS) — a community oversight committee that monitors AAM service quality, redresses patient grievances, and ensures community participation in health planning. 1,35,343 Jan Arogya Samitis have been constituted at AAMs across the country as of 30 November 2024.

The JAS is the community governance mechanism that makes AAM accountability possible. In practice, JAS functionality is highly variable — in many sub-centres it exists on paper without meaningful meetings. NGOs with community institution-building experience can help JAS committees become functional — with regular meetings, minutes, and actual patient feedback mechanisms.

Odisha has a specific and important AAM background. The state was one of the early implementors of AB-HWC under NHM, with CHOs deployed across rural sub-centres. The state's AAM network has been significant in extending NCD screening — particularly for hypertension and diabetes — to tribal populations that previously had no systematic access to chronic disease management.

Key context for Odisha NGOs:

• Odisha's tribal blocks have CHO deployment in their sub-centres — but CHO vacancies and equipment gaps persist in the most remote blocks
• The NHM–AAM convergence in Odisha includes specific tribal health focus through ITDAs in scheduled areas
• Odisha has a relatively strong ASHA network that supports the CHO-led primary care team — making the AAM model more functional here than in states with weak ASHA infrastructure
• Fluoride-affected areas (Nayagarh, Ganjam) have specific AAM provisions for fluorosis screening