Bringing Care Closer to Home: Decentralisation of Morbidity Management and Disability Prevention (MMDP) Services for Lymphatic Filariasis through Ayushman Arogya Mandirs in Bihar, India

Background:

Lymphatic filariasis (LF) remains a major cause of chronic, preventable disability in endemic regions of India. Bihar carries a substantial share of this burden, with all 38 districts classified as endemic. Although Mass Drug Administration (MDA) has advanced transmission interruption, Morbidity Management and Disability Prevention (MMDP) services for lymphoedema, elephantiasis and hydrocele have historically remained centralised at Community Health Centres (CHCs) and Primary Health Centres (PHCs), limiting access for affected individuals.

Objective:

To describe and evaluate a field-tested model for decentralising MMDP services to the Ayushman Arogya Mandir (AAM) level in Bihar, and to document the roles of frontline health functionaries and community platforms in sustaining self-care practices.

Methods:

A structured, eight-step operational framework, spanning burden assessment, role definition, clinic infrastructure, workforce capacity building, clinical service delivery, self-care kit distribution, community engagement, and monitoring, was implemented under the SETU-LF (Strengthening Elimination Through Unified CPHC for LF) initiative. The model was piloted through a Learning Lab established at AAM Dhanushi, Vaishali district, and subsequently extended to four additional AAMs. Results: Improved screening and community engagement at AAM Dhanushi increased the number of registered LF cases from 61 to over 90. Five AAMs in Vaishali district became functional MMDP service points, with 40-50 patients engaged in regular follow-up at any given time. Programme observations indicated improved self-care adherence, reduced frequency of acute adenolymphangitis (ADLA) episodes, and greater community trust in Community Health Officer (CHO)-led care.

Conclusion:

Embedding MMDP services within the existing Comprehensive Primary Health Care (CPHC) platform at Ayushman Arogya Mandirs, without creating a parallel vertical structure, offers a feasible and scalable approach to reducing the distance-related barriers that have historically limited MMDP uptake. Sustained self-care counselling, community ownership through Jan Arogya Samitis (JAS) and Village Health Sanitation and Nutrition Committees (VHSNCs), and same-day digital reporting emerge as the pillars of a replicable, statewide model.