Mains Practice Questions

Approach

• Introduce by defining Primary Health Care and the need to focus on improving PHC system in India.
• Mention the steps that can be taken to improve the PHC system in India.
• Conclude by mentioning the goals of universal health coverage and SDGs.

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 ensures that people receive comprehensive care - ranging from promotion and prevention to treatment, rehabilitation and palliative care - as close as feasible to people’s everyday environment.
• 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.

Body

In India, the recent National Health Policy 2017 has proposed to spend two-thirds or more of Government spending on PHC system. However, there is still a long way to go to strengthen PHC system in India.

Following steps can be taken in this regard:

• Re-design PHC system based upon available local evidence:
  
  • Ensuring appropriate mix and sufficient availability of health service providers.
  • Continuum of care with functional referral linkages.
  • Ensuring appropriate quality standards.
  • Need for stronger local level leadership and community engagement.
• Correct the inverted pyramid of Health Services provision and utilisation:
  
  • A large proportion of health services in India are delivered and used at secondary and tertiary level. Ideally these should be available at PHC level facilities. Thus, pattern of service utilisation and delivery is inverted in India.
  • Indian states needs to develop strategies to correct the inverted pyramid by both reorganizing and strengthening the health services at PHC level (supply side) and hanging behaviour of people to use these services at PHC level (demand-side).
• Start focused initiatives to tackle social determinants of health:
  
  • Addressing social determinants of health like quality drinking water supply and sanitation, better nutritional outcomes, health and education for women and girls, improved air quality, safer roads is essential to improve the health of individuals and community.
• Establish sub-district based health system in India:
  
  • Considering the large size of districts in India, effective planning in health services and tackling inequities in health outcomes need a sub-district unit level planning.
  • There is a need to establish block level hospital, public health unit and the planning for health services (funding, human resources and detailed planning).
• Strengthen Urban Health governance for multi-sectoral collaboration:
  
  • Indian urban population is expected to reach 60 crore (600 million) by 2030.
  • Indian urban areas need faster and effective interventions for stronger governance of urban health services.
  • Delhi’s ‘Mohalla Clinics’ and Hyderabad’s ‘Bashti Dawakhanas’ are steps in the right direction.
• Use of behavioural economics for better health outcomes:
  
  • Health seeking behaviour of people can be significantly influenced by behavioral changes.
  • There is a need to ensure that people seek early care to prevent complications and later stage diseases and seek care at the appropriate level which will reduce burden from higher level of facilities.
• Focus on public health cadre:
  
  • Public awareness and education about good nutrition, improved sanitation and health promoting behaviour is an integral part of health service delivery.
  • Thailand has a vast cadre of health workers delivering preventive and promotive health services.
  • Indian states need a dedicated public health cadre and initiatives to deliver preventive and promotive health services

Conclusion

India is at a juncture, where it can build on past initiatives to transform health outcomes so as to have a healthy and prosperous nation. This would ensure that India achieves Universal Health Coverage as envisaged in the National Health Policy 2017 as well as achieve Sustainable Development Goal 3 of good health and well-being, well before the proposed timeline of 2030.