INTRODUCTION
As per 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.
It provides whole-person care for health needs throughout the lifespan, not just for a set of specific diseases. Primary health care ensures people receive comprehensive care – ranging from promotion and prevention to treatment, rehabilitation and palliative care – as close as feasible to people’s everyday environment.
Stronger primary health care is essential to achieving the health-related Sustainable Development Goals (SDGs) and universal health coverage. It contributes to the attainment of other goals beyond the health goal (SDG3), including those on poverty, hunger, education, gender equality, clean water and sanitation, work and economic growth, reducing inequality and climate action.
As recognized in the 2018 Astana Declaration, Primary Health Care (PHC) approach is the most effective way to sustainably solve today’s health and health system challenges.
PHC system can tackle up to 80% of health needs and can reduce the need for specialized health care services. Thailand started on strengthening PHC in 1971, nearly 30 years before starting on famed Universal Coverage Scheme in 2001.
ISSUES
- Overburdened Hospitals: Major hospitals like AIIMS experience overcrowding, with daily outpatient visits exceeding 10,000 somedays, due to inadequate primary care, causing long wait times and resource strain.
- Rural Doctor Shortage: Rural regions, housing 65% of the population, have only 25% of doctors. For example, Bihar has a doctor-patient ratio of 1:3207, well below recommended standards.
- High Out-of-Pocket Costs: With 73% of Indians uninsured, many face financial hardship from healthcare expenses. Improved primary care could reduce these costs.
- Preventable Diseases: Conditions such as diarrhea and tuberculosis, which are preventable, still account for 30% of the disease burden, underscoring the need for enhanced primary care.
- Low Health Spending: India allocates approximately 2% of GDP to public health, resulting in inadequate primary care infrastructure, especially in rural areas.
- Rising NCD Burden: Non-communicable diseases like diabetes and heart disease account for over 60% of deaths, highlighting the need for early detection and management at the primary care level.
- Lack of Preventive Care: The focus on treatment rather than prevention in India’s healthcare system can be shifted by strengthening primary care, improving early detection and outcomes.
IMPLICATIONS
ADVANTAGES
- Improved Health Outcomes: Enhancing primary healthcare can result in better overall health by providing timely and essential community-based care.
- Reduced Healthcare Costs: Effective primary care lowers out-of-pocket expenses by managing health issues early and minimizing expensive hospital treatments.
- Increased Access to Care: Primary healthcare centers in rural areas improve access to essential services, ensuring that even remote populations receive adequate care.
- Early Disease Detection: Strong primary healthcare systems enable early disease detection, allowing for timely intervention and better health management.
- Lower Hospital Overcrowding: A robust primary care system helps reduce hospital patient loads by managing common health issues locally.
- Enhanced Health Equity: Primary healthcare promotes equal access to services, reducing disparities and improving outcomes for underserved populations.
DISADVANTAGES
- Resource Shortages: Many PHCs lack essential supplies and equipment, limiting their ability to provide comprehensive care.
- Underfunding: Insufficient funding results in poor infrastructure and low-quality care in many PHCs.
- Staff Shortages: There is a significant shortage of trained healthcare professionals, particularly in rural areas, affecting service delivery.
- Inconsistent Care: Quality of care varies widely across PHCs due to differences in resources and management.
- Limited Services: PHCs often provide only basic services, necessitating referrals for more complex care.
- Bureaucratic Delays: Bureaucratic inefficiencies can lead to delays in funding and resource allocation, impacting PHC operations.
INITIATIVES
- Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (PMJAY): Launched in 2018, this scheme offers health insurance up to ₹5 lakh per family per year for secondary and tertiary care to economically vulnerable families.
- National Health Mission (NHM): Includes the National Rural Health Mission (NRHM) and National Urban Health Mission (NUHM), focusing on enhancing healthcare infrastructure and services in both rural and urban areas.
- Pradhan Mantri Swasthya Suraksha Yojana (PMSSY): Aims to address regional disparities in healthcare by establishing AIIMS-like institutions and upgrading government medical colleges.
- Mission Indradhanush: Launched in 2014, this immunization program seeks to boost vaccination coverage for children and pregnant women, reducing preventable diseases and mortality.
- Janani Shishu Suraksha Karyakram (JSSK): Provides free maternity and infant care services in public health institutions, including free drugs, diagnostics, and transportation.
INNOVATION
- Mobile Health Units: Portable clinics bring essential healthcare services to remote and hard-to-reach areas, effectively addressing local health needs.
- Digital Health Records: Integrated electronic health record systems enhance patient data management, improving accuracy and accessibility across healthcare providers.
- AI-Powered Health Chatbots: Chatbots offer instant medical advice, answer health queries, and guide patients, aiding in triage and care direction.
- Predictive Analytics for Disease Outbreaks: Uses big data to forecast disease outbreaks and track health trends, enabling proactive measures and better resource management.
- Health Education Apps: Mobile apps provide educational resources and self-management tools to help individuals maintain their health and manage chronic conditions.
CONCLUSION
India stands at a pivotal moment to leverage its previous efforts and significantly improve health outcomes for a healthier, more prosperous nation. By advancing and expanding current initiatives, India can achieve Universal Health Coverage as outlined in the National Health Policy 2017 and meet Sustainable Development Goal 3 for good health and well-being ahead of the 2030 target. Embracing innovative approaches and strengthening primary healthcare systems will be key to realizing these goals, ensuring comprehensive, equitable healthcare for all citizens and setting a benchmark for sustainable health improvements.
KEY FACTS
- Over 1 billion people worldwide are at risk of falling into poverty due to out-of-pocket health spending of 10% or more of their household budget.
- Scaling up primary health care (PHC) interventions across low and middle-income countries could save 60 million lives and increase average life expectancy by 3.7 years by 2030.
- The majority of essential interventions (90%) for universal health coverage can be delivered using a PHC approach.
- An estimated 75% of the projected health gains from the Sustainable Development Goals could be achieved through PHC.
- Achieving the targets for PHC requires an additional investment of around US$ 200 to US$ 328 billion a year for a more comprehensive package of health services