7 PM | India needs to revamp Primary Health care system | 4 March, 2019

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Introduction to health care system

Primary Health care system

It is the first point of contact between health system and person, in case a person falls sick.  Its main aim is to provide local care to a patient because professionals related to primary care are normal generalists.

In India, Primary Healthcare is provided through a network of Sub centres and Primary Health Centres in rural areas, whereas in urban areas, it is provided through Health posts and Family Welfare Centres. PHCs helps in prevention of diseases.

Secondary healthcare

Secondary Healthcare refers to a second tier of health system, in which patients from primary health care are referred to specialists in higher hospitals for treatment. In India, the health centres for secondary health care include District hospitals and Community Health Centre at block level.

Tertiary health care

Tertiary health care is known as specialized consultative healthcare usually on referral from primary and secondary healthcare for advanced medical investigation and treatment. In India, under public health system, tertiary care service is provided by medical colleges and advanced medical research institutes.

Why Primary health care is important?

• Primary health interventions help detect diseases early, well before complications set in.
• It reduces the need for expensive secondary and tertiary healthcare.
• Of the total current expenditure on health classified by healthcare functions, preventive care accounts for 6.7 per cent, while spending on curing people account for 51% of the total expenditure on health.
• Developed nations such as the UK, Australia, Canada, Netherlands and Sweden spend a large share of their federal healthcare budgets on primary care.
• India has been spending huge amount in cure of non-communicable diseases, which can only be won through a primary health system that ensures that chronic diseases are not only detected early, but also that preventive action is taken to ensure improved lifestyles.
• Unavailability of PHC from government leads to heavy burden of out of pocket expenses on consultations and drugs.

Problems of PHC in India

Limited services: Although Primary Health Care system exists in India but its scope is limited to pregnancy care, limited childcare and certain services related to national health programmes.

Training and manpower problems: PHCs are suffering from poor management skills, lack of appropriate training and supportive supervision for health workers.

Conversion in Health and Wellness centres: Government announced conversion of 150,000 sub centres into HWCs in 2017 budget and also in National Health policy 2017, only few thousand such centres have been sanctioned.

Urban neglect: Primary Health care for growing urban population has not been conceptualized. It’s focus is still limited to the rural population of India.

Funding: Funding for overall health care is very low, leaving insufficient amount that requires to be spend on Primary Health Care.

Staff shortage: PHCs are also suffering from inadequate skilled and trained manpower. There is a shortfall of about 9,000 doctors in about 25,000 PHCs in the country.

Poor facilities: Primary level facilities need complete building reconstruction, as they operate out of rented apartments and thatched accommodations, and lack basic facilities such as toilets, drinking water and electricity.

Overburdened PHCs: India has a large network of primary health centres (PHCs), each supposed to serve a population of 25,000. But in states such as Madhya Pradesh, Bihar and Jharkhand, however, a PHC covers as many as 45,000, 49,000 and 76,000 people.

Government measures

The National Health Policy (NHP) 2017 advocated allocating resources of up to two thirds of total health budget to Primary Health care.

Last year, an outlay of ₹_1,200 crore was proposed to transform 1.5 lakh sub-health centres into health and wellness centres(HWC) by 2022, which would provide a wider range of primary care services than existing sub and primary health centres (PHC).

Each HWC is to be operated by a well-trained, mid-level health provider (nurse practitioner or community health officer) who will be supported by a team of front line health workers to provide an expanded package of services.

Best national and international Practices

• Cuba has one of the most effective primary healthcare systems in the world, the system provides community-based polyclinic, each polyclinic serves a catchment area hosting between 30,000 and 60,000 people.
• Polyclinic facility is further extended by neighborhood-based family doctor-and-nurse offices closer to the communities, one such office for 1,000-2,000 people. Prevention is the cornerstone of these services, complemented by community analysis and treatment.
• In a cross-country analysis of governance systems and health outcomes, countries with higher fiscal decentralisation (Citizens participation) were found to have consistently lower infant mortality rates that those with more centralised forms.
• In West Bengal and Kerala in India – states in which primary healthcare is co-managed by panchayats – health outcomes are better than in most other states at similar levels of economic development.

Way forward

• Government must fasten the process of conversion of Sub-health canters into health and wellness centres so that it can achieve its target by 2022-23.
• Digitization of family records and information from the community to the facility level, to provide better treatment.
• An important requirement of primary healthcare is the active participation of those whom the care serves – akin to citizen participation in democracy. Such systems are likely to be more responsive to public needs.
• Government should delegate the responsibility of managing these health facilities to communities and local self-government institutions.
• Nursing staff must be prepared to provide treatment to the patient in case doctor is absent from clinic. Adequate orientation and training must be provided to nursing staff for that.
• Government must increase budgetary allocations to healthcare to at least 3-4% of GDP so that public expenditure on healthcare is at least 70% of total health expenditure.
• Undertake a well-funded research programme to find the best pathways for effective and context-specific scaling up of primary health care.