Primary health centers at stake: one doctor for most PHCs

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.

Know more about Ayushman Bharat programme