7 PM | Bihar AES deaths -What’s ailing India’s primary healthcare? | 3rd July, 2019

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Context: Issues with the Primary Health Care in general in India and particularly in Bihar.

More in News:  The outbreak of Acute Encephalitis Syndrome (AES) in Bihar and Uttar Pradesh.

Primary Health Care: According to World Health Organisation (WHO), Primary health care is a whole-of-society approach to health and well-being centered on the needs and preferences of individuals, families and communities.  It addresses the broader determinants of health and focuses on the comprehensive and interrelated aspects of physical, mental and social health and wellbeing. 

Outbreak of AES in Bihar: Recently 154 children in Bihar died due to AES. AES is largely preventable both before and after the onset of disease. The first signs of outbreak must prompt strong prevention measures. These include:

• Replenishing primary health care centres with essential supplies.
• Extensive deployment of peripheral health workers (ASHA).
• Ambulance services to facilitate rapid identification and management of suspected cases.
• Scaling up of Poshan Abhiyan and supplementary nutrition at Anganwadis along with take home ration for mothers, and distribution of ORS packets.

Due to lack of preventive measures, along with the issues of PHCs, aggravated the out-break of AES.

Issues with Primary Health Care:

• Manpower: The manpower in Bihar is miserably low.
  • Out of 1900 PHCs in Bihar, three fourth have just one doctor. The doctor-population ratio of Bihar was 1: 17,685 in 2018, which is about 60% higher than the national average.
  • There is one fifth shortage of ASHA workers.
  • Nearly one third of sub health centres have no worker at all.
• Infrastructure: Generally 1 PHC caters about 30,000 people, but in Bihar, it caters to 1 lakh people.
• Behavioural factors: Even those PHCs with adequate supplies remain unutilised, primarily because of the behavioural perception that PHCs are inept for general health care and are primarily centres for family planning and immunisation.
• With the decades of hospital-centric growth, people have lost faith in community based  health care.
• Also, the government health expenditure is about 1.15% of GDP. However, there is still scope of improvement in health expenditure. As done in most of the developing countries and developed countries. For example, China spends about 5.3% of its GDP on health.

Along with the issues of PHCs, there is issue with the supplementary nutrition programme. Recently a study found that around 71% and 38% of funds meant for cooked meals and take home ration were stolen.

Solution: The solution to the problem doesn’t lies in just strengthening the tertiary care sector, but also,

• Ayushman Bharat- Health and wellness centres: in order to expand access to comprehensive health care, health and wellness centre (HWCs), sub health centres (SHCs) and primary health centres (PHCs) are being strengthened. The HWCs are to provide preventive, promotive, rehabilitative and curative care for an expanded range of services encompassing reproductive child health services, communicable diseases, non-communicable diseases and basic emergency care.
• Scaling up the cadres of ASHA workers; salary hikes, as recently done in the state of Andhra Pradesh can be helpful.
• Efficient implementation of PDS system as done in Chhattisgarh. In Chhattisgarh model, digitization and automation with appropriate intervention of ICT made it to work efficiently and equitably.
• Strict monitoring of nutrition programme as implemented in Andhra Pradesh: the government focussed on better monitoring of Integrated Child Development Services (ICDS) Systems Strengthen And Nutrition Improvement Project (ISSNIP) by creating an APP, which is being tracked on cell phones distributed by the government, behavioural change at community level and regular counselling by organising community based events such as ‘Sree Mantams’ and ‘Anna Prasanams’.
• Addressing the mal-distribution of doctors and medical colleges: Under Pradhan Mantri Swasthya Suraksha Yojana (PMSSY), government is planning to set up 20 AIIMS across country. Passing of National Medical Commission Bill, 2017 as soon as possible to replace Medical Council of India (MCI) with National Medical Commission (NMC).
• Need to work on inculcating confidence in community based care.

Way forward: With the implementation of the above strengthening measures, will result into robust primary care system that can be geared towards being more responsive to future outbreaks. At the same time community should be made aware of the preventive measures of such diseases, as it is known that “Prevention is far better than Cure”.