Site photo: Fields of Pipraich Block , Gorakhpur District, Uttar Pradesh, Oct 2018
Conventionally, ” primary health care is about caring for people, rather than simply treating specific diseases or conditions.”
“Primary Health Care is made up of three main areas:-
- empowered people and communities;
- multisectoral policy and action;
- primary care and essential public health functions as the core of integrated health services.”
“Primary Health Care can meet the majority of an individual’s health needs over the course of their life.
A health system with a strong Primary Health Care system as its core delivers better health outcomes, efficiency and improved quality of care compared to other models.
We need health systems with strong Primary Health Care if we are to achieve universal health coverage and the health related Sustainable Development Goals.”
The health related Sustainable Development Goal is:-
The targets for SDG 3 are as follows (https://unric.org/en/sdg-3/)
- 3.1 By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births.
- 3.2 By 2030, end preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births and under-5 mortality to at least as low as 25 per 1,000 live births.
- 3.3 By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases.
- 3.4 By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.
- 3.5 Strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol.
- 3.6 By 2020, halve the number of global deaths and injuries from road traffic accidents.
- 3.7 By 2030, ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes.
- 3.8 Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.
- 3.9 By 2030, substantially reduce the number of deaths and illnesses from hazardous chemicals and air, water and soil pollution and contamination.
- 3.A Strengthen the implementation of the World Health Organization Framework Convention on Tobacco Control in all countries, as appropriate.
- 3.B Support the research and development of vaccines and medicines for the communicable and noncommunicable diseases that primarily affect developing countries, provide access to affordable essential medicines and vaccines, in accordance with the Doha Declaration on the TRIPS Agreement and Public Health, which affirms the right of developing countries to use to the full the provisions in the Agreement on Trade Related Aspects of Intellectual Property Rights regarding flexibilities to protect public health, and, in particular, provide access to medicines for all.
- 3.C Substantially increase health financing and the recruitment, development, training and retention of the health workforce in developing countries, especially in least developed countries and small island developing States.
- 3.D Strengthen the capacity of all countries, in particular developing countries, for early warning, risk reduction and management of national and global health risks.
If you were interested to delve into the history of the Public Health system in India, it would be prudent to have a quick look-see at the seminal Bhore Committee Report.
Over the years, the concept of Primary Health Care has evolved, one would like to say , keeping pace with times, however public health practitioners are well aware of the time lag delay in such grand public schemes……
The watershed moment in Public Health for the people should be considered to be the Health for All Declaration of 1978.
You can check out this bold declaration here ….
In the succeeding years, as Govts across the world struggled with different models of health care and the aspirations of their people, the 2008 World Health Report focused on this issue, as it was realised reluctantly that possibly Health for All by 2000 was an utopian dream.
The Govt of India, constituted a Task Force for the roll out of Comprehensive Primary Health Care, the report of which can be read here…
For an overview of the strategic process for Integrated Patient Centred Care, have a look at this….
In the present times, nearly 40 years after visionary world leadership set the pace for progress in Primary Health Care, there has been a Global Conference on Primary Health Care held at Astana, Kazakhstan in end Oct 2018 from which has emerged the Astana Declaration , which you can read here….
The Political Declaration of the High-level Meeting on Universal Health Coverage “Universal health coverage: moving together to build a healthier world” from 2019 is here….
It is hoped that the ensuing years shall see the full operationalization of the principles of Primary Health Care in regions that need this the most. Let us not just wait and watch, let us be a part of the change ……
So , what is this comprehensive package of Primary Health Care Services all about ?
- Comprehensive Primary Health Care includes the delivery of a package of preventive, promotive, curative and rehabilitative services delivered close to communities by health care providers who are sensitive, have an understanding of local health needs, cultural traditions and socioeconomic realities, and are able to provide care for most common ailments, enable referral for doctor or specialist consultations and can undertake follow-up.
- Services include those that :-
- can be delivered at the level of the household and outreach sites in the community by suitably trained frontline workers,
- services that would be delivered by a team headed by a mid level provider
- the referral support and continuity of care within the district health system comprising the Health & Wellness Centre (HWC), Primary Health Centre (PHC), Block Public Health Unit (BPHU), Community Health Centre (CHC) and District Hospital (DH) with Critical Care Blocks (CCB).
- The conditions listed for preventive, promotive or curative action can be broadly categorised into the following groups:-
- Care in pregnancy and child-birth.
- Neonatal and infant health care services
- Childhood and adolescent health care services including immunization.
- Family planning, Contraceptive services and Other Reproductive Health Care services
- Management of Common Communicable Diseases and General Out-patient care for acute simple illnesses and minor ailments
- Management of Communicable diseases:
- Screening and Management of Non-Communicable diseases
- Screening and Basic management of Mental health ailments
- Care for Common Ophthalmic and ENT problems
- Basic Dental health
- Geriatric and palliative health care services
- Trauma Care (that can be managed at this level) and Emergency Medical Services
As per the Report of the Govt of India Task Force, for the ‘Organization of Service Delivery: Institutional Architecture’ , Primary Health Care has been conceptualized as the care provided for a local community, by a primary health care team. Each of the services listed above has preventive, promotive, curative and rehabilitative components.
The National Health Systems Resource Centre of the Ministry of Health and Family Welfare, Govt of India has a repository of all the relevant materials for the Comprehensive Primary Health Care focused processes, being spearheaded by the Govt of India’s flagship Ayushman Bharat Health Mission.
The latest Indian Public Health Standards for 2022 are available here,….
Services for each of these components can be provided at various levels.
- Family/Household and Community Level: This would be provided by community level workers-ASHA, Anganwadi Workers (AWW), community volunteers, school teachers, etc. Services at this level include counselling, health communication in addition to basic screening and community level curative care. It also requires the active support of the Village Health, Sanitation and Nutrition Committee (VHSNC) functioning in coordination with and under the leadership of the Panchayati Raj Institution (PRI). The ASHA and AWW would be considered members of the Primary Care team.
- Health and Wellness Centres: In order to move Comprehensive Primary Health Care closer to people, existing sub centres are being converted to Health and Wellness Centres (HWC) at a rapid pace across the country. There would now be one Health and Wellness Centre for every 5000 population. Such HWC would provide a set of defined services (packages) led by a trained mid level health care provider (the Community Health Officer).
- First Referral Level: Referral support is an essential component of primary health care. It includes general medical and specialist consultation as relevant and the first level of hospitalization at the level of the First Referral Unit (FRU), which would now need to provide services beyond emergency obstetric care. While FRUs should be at the level of the block level PHC and/or CHC, in practice in many parts of the country for now, such first level referral service package would be available only at the level of the Sub Divisional Hospital (SDH) or District Hospital.
It is indeed a deep insight into the reality of the situation, that there has been specific recognition of the fact that for a person with a health care need, irrespective of whether in rural India or in the urban areas of the country, that the experience of care should be one of seamless continuity.
The categorization into promotive, preventive, curative or rehabilitative care, or into self care, home care, primary care, secondary or tertiary or even into modern medicine and indigenous medicine, etc., are secondary considerations, for the individual.
The primary concern that every affected individual has, is in attaining and retaining a state of well being and relief from pain and suffering and, where possible, averting death, for himself /herself and his / her family.
Can we deliver ? As a progressive / progressing nation, with aspirations to the world stage? Do we have a choice? Do we have answers, or do we only pose questions? Let us all be a part of the change, and let us reach out to the very root of a great nation, its people.