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Primary health care in India refers to the fundamental health care services provided at the community level to meet the basic health needs of individuals and communities. It encompasses a range of services, including health promotion, disease prevention, treatment, rehabilitation, and palliative care. India's primary health care system includes a network of primary health centers, sub-centers, community health centers, and district hospitals.
The establishment of primary health centers in India dates back to 1952, aimed at addressing people's health needs and promoting a patient-centric approach. In recent years, there has been a renewed emphasis on strengthening the primary healthcare system in India to enhance access to quality healthcare services and reduce the disease burden in the population. This has been achieved through various initiatives, such as the National Health Mission, the Ayushman Bharat program, and the Pradhan Mantri Jan Arogya Yojana (PMJAY).
The primary health care (PHC) system plays a crucial role in the healthcare sector in India. Here are some of the key roles of PHCs in India:
Overall, India's primary health care system is critical in ensuring access to essential health services for individuals in rural and urban areas. It plays a significant role in reducing the population's disease burden and promoting public health.
Primary healthcare in India provides basic healthcare services to people in both rural and urban areas, which ensures access to healthcare services even in remote areas and to vulnerable populations. This approach is cost-effective and focuses on preventing diseases, promoting healthy behaviors and lifestyles, and detecting illnesses early, which leads to improved health outcomes. Additionally, community participation and involvement in health promotion activities empower communities to take ownership of their health and work towards improving their health outcomes.
Strengthening primary healthcare services is a critical component of any healthcare system, as it builds a robust healthcare system that can effectively respond to the health needs of the population. By improving access to healthcare services, reducing healthcare costs, and promoting healthy behaviors and lifestyles, primary healthcare in India can contribute to the country's overall development.
Most primary health centers merely provide limited, disease-specific curative services. The current emphasis on vertical disease control programs, such as tuberculosis and leprosy, contributes to the need for comprehensive, integrated service delivery. The vertical disease program structure identifies a clear flow of funds and delineates activities at various levels of health care. Vertical programs efficiently manage healthcare delivery, usually driven from the 'top'. People are at the receiving end of such arrangements rather than at the center of planning or delivery as envisaged in primary health care. The underlying distinction between vertical and horizontal approaches is the contradiction of power. The horizontal approach responds to patients' needs, and the vertical approach is more suited to the state's requirements. The vertical arrangement of services becomes a challenge because it impedes the integration of services and a person-centered approach that are the hallmarks of primary health care. Further, it restricts participatory approaches to designing and delivering healthcare in a bottom-up approach central to primary healthcare.
Health Systems Transformation Platform, Swasti, and CMS partnered to conduct a systematic review of the Primary Healthcare Landscape in India, with the aim of informing policy and decision-makers on potential options for comprehensive primary health care innovations and models. The review included theory papers, reference papers, system reviews, impact evaluations, and case studies, which were analyzed and extracted for this study. The dataset included 404 publications, with 239 impact evaluations categorized and extracted.
The review identified 241 innovations gleaned from the dataset, with many studies including more than one innovation. The innovations were presented in four formats: impact evaluations, reviews, models, and case studies. The case studies provided a deep dive into four primary health care models and four primary health care innovations that showed promise, novelty, and impact. These innovations and case studies have key insights that should be advocated for and utilized by primary healthcare actors both in the field and within policy.
Providing primary health care in India is a significant challenge due to the increasing number of emerging infectious diseases, such as Covid-19. The government has implemented several infection control policies and guidelines to protect citizens from these diseases. The review aims to build accountability and strengthen health systems from an advocacy point of view, pushing Swasti's vision of creating healthy and "well-thy" days for the most marginalized. The primary health care database is a central location where primary health care innovations and healthcare information are systematically categorized for improved understanding and easier dissemination for the Indian subcontext.
The primary healthcare database system was developed as a comprehensive resource that will serve as a tool for researchers, decision-makers, and influencers in the healthcare system to more effectively design primary health care interventions in India while improving the efficiency and effectiveness of PHC in the country.
The articles that are reviewed and listed under the database have various subcategories. These are cross analyzed for learnings and mapping resources under financing, geographies, and the administrative system in place. The insights page records the primary health care system's experiences, approaches, and patterns through blogs, policy briefs and reports.