Primary Health Care – What is the Hullabaloo all about?

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 graphic

“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.”

http://www.who.int/primary-health/en/

The health related Sustainable Development Goals are :-

You can also check out the World Health Statistics data visualizations dashboard  here

http://apps.who.int/gho/data/node.sdg.tp-1?lang=en

If you were to trace the history of the Public Health system in India, it would be wise to have a quick look-see at the seminal Bhore Committee Report.

Bhore Committee Report Vol 1

Bhore Committee Report Vol 2

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 ….

Alma Ata Declaration 1978 WHO

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.

Primary Care Chapter World Health Report 2008

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…

Report of Task Force on Comprehensive PHC Rollout

For an overview of the strategic process for Integrated Patient Centred Care, have a look at this….

Overview_IPCHS_final

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….

Astana Declaration

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 Primary Health Centre (PHC), Community Health Centre
      (CHC) and District Hospital (DH).

 

  • 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

Primary Health Care graphic 2

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.

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 will be converted to Health and Wellness Centres (HWC). There would now be one Health and Wellness Centre for every 5000 population. Such HWC would provide the services listed above by a primary health
    care team, led by a train ed mid level health care provider. Health Sub centres would be upgraded to provide this larger package of services, which is comparable to the range of services presently being provided in the sector level Primary Health
    Centre (PHCs). Existing Sector level PHC (one per 30,000) would also continue to provide the set of services as envisaged in the Indian Public Health
    Standards (IPHS). In effect, therefore, every existing health sub-centre (now to be renamed the Health and Wellness Centres) would provide the package of services described above, and referral for consultation with an MBBS doctor and follow up.

IPHS Guidelines for SCs 2012

  • 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.

IPHS Guidelines-PHC-2012

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. 

 

Published by Delta Zulu Consultancy

I am a Public Health Specialist with a passion for sustainable promotion of human co-existence with the environment! My areas of interest and expertise are Health Risk Communication and Community Engagement, Food Safety, Environmental Medicine and Mass Gathering Medicine. I believe in leveraging the power of technology to capture the imagination of people to inspire them to achieve their health potential, in a sustainable manner. I aspire to empower my partners and motivate stake holders to consistently seek 'work around' solutions, while hoping to achieve an utopian ideal balance.

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