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Context:
- The Union Minister of State for Health and Family Welfare recently provided an alarming report on the availability of doctors in Primary Health Centre(PHCs).
Highlights of the report:
- Out of 25,650 primary health centers (PHCs) in the country, 15,700 (61.2%) function with one doctor each.
- As many as 1,974 (7.69%) PHCs do not have even a single doctor.
- 9,183 (35.8%) of the total number of PHCs do not have a lab technician.
- 4,744 (18.4%) do not have a pharmacist.
State wise ranking of PHC’s functioning with only one doctor: worst performing states:
- Gujarat – 100% of 1,392 PHCs
- Sikkim, Himachal Pradesh and Mizoram’s – ranges between 84% and 87%
- Karnataka – 6% of 1,973 PHCs
- Kerala – 7%
State wise ranking of PHC’s functioning with only one doctor: better performing states:
- Tamil Nadu – 4% of 1,362 PHCs
- Maharashtra – 8% of 1814 PHCs
Major reasons for doctors keeping away for rural areas:
- lack of safety and adequate protection for doctors,
- political interference,
- pest-infested accommodation,
- lack of basic amenities like electricity and potable water, and
- blame game of the locals without holistic approach to an issue.
Primary health centers:
- Primary Health Centre(PHCs) is state-owned rural health care facilities in India.
- They are essentially single-physician clinics usually with facilities for minor surgeries.
- They are part of the government-funded public health system.
- Note: Presently there are 28,863 PHCs in India.
- The Alma Ata Declaration in 1978 gave an insight into the understanding of primary health care.
According to the Alma Ata Declaration, primary health care should include:
- education concerning prevailing health problems
- methods of identifying, preventing and controlling health problems,
- promotion of food supply and proper nutrition and adequate supply of safe water and basic sanitation,
- maternal and child health care, including family planning,
- immunization against major infectious diseases,
- prevention and control of locally endemic diseases,
- appropriate treatment of common diseases and injuries,
- promotion of mental health and
- provision of essential drugs.
According to the Indian Public Health Standards (IPHS) guidelines, each 24/7 PHC should include:
- a minimum of two doctors,
- a desirable third doctor,
- three nurses,
- one lab technician and
- one pharmacist.
Significance of primary health centers:
The primary health centers are:
- essential to meet most healthcare needs,
- first point of contact for patients, and
- core of preventive, promotive, curative and rehabilitative healthcare.
Role of primary health centers:
Main principles of primary health centers are:
- equity,
- health promotion and disease prevention,
- community participation,
- appropriate health technology and
- multisectoral approach.
Organizational and management key elements:
- strategic management,
- decentralization,
- coordination and
- development of strategic systems.
Way ahead:
- Increasing usage of tele-medicine,
- Note: Telemedicineis the use of telecommunication and information technology to provide clinical health care from a distance.
- Renovation of the public health infrastructure,
- Reorientation of policies, and
- Adequate national health system in place to take care of both patients and doctors.
- As a major government initiative, the umbrella scheme Ayushman Bharat programme, sounds promising enough.
- The programme aims to address health holistically, in primary, secondary and tertiary care systems, covering both prevention and health promotion.
