The movement towards universal health coverage (UHC) is now one of the most prominent global health policies. Emphasis should be placed on the role of primary healthcare in achieving universal health coverage. Health for all is an indispensable need, which must be integrated into an overall framework for organizing and delivering care based on a patient-centered, efficient, fair and cost-effective way. The recently launched Ayushman Bharat program aims to strengthen access to comprehensive primary healthcare services through revamping existing sub health centers, and highlights importance of bringing services closer to people. In 1978, the famous Alma-Ata declaration gave a clarion call of health for all by 2000, which could not be achieved as it was never given serious attention by policy makers and program planners in developing countries, including India. As per a high-level expert group report on universal healthcare in 2011, overall investments in primary healthcare centers (PHC) should be nearly 70 percent of public spending to take care of preventive and promotive health, non-communicable diseases (NCDs) and also health problems of the aging population, whereas government (center and states) spending on PHC has never been more than 40 percent.
Global experiences indicate vastly improved health gains in countries such as Thailand and Sri Lanka, which invested substantially in the primary healthcare strategy. Over the years, India has developed an impressive and vast network of public healthcare delivery institutions in rural areas, which includes sub centers, PHCs and community healthcare centers (CHCs). However, as per the rural health statistics bulletin, 2017, huge input gaps still persist. As per the National Sample Survey Office (NSSO) data (71th Round), only 28 percent in rural areas and 21 percent in urban areas sought care in the public sector; of which only 11 percent and 3 percent, respectively, sought any form of care at a level below the CHC (other than child birth related services). So, these forms a vicious cycle as non-functional facilities don’t get any footfalls. In this context, the phased roll-out of health and welfare centers in the next five years with a proposed network of more than 150,000 sub-centers being upgraded to health and wellness centers provides a huge opportunity to boost access to affordable and quality primary healthcare. For the first time, there is discernible effort for moving from selective primary healthcare (maternal and child health and family planning) to a broader package of comprehensive primary healthcare. Emphasis on health promotion and specific protection, screening, early diagnosis and prompt treatment, as well as public health, is evident.
This, along with provision of free drugs, point-of-care diagnostics and organizing tele-consultation would reduce out-of-pocket expenditures and improve quality of services for poor people, who end up visiting a large number of informal and less-than-qualified providers in rural areas and urban slums. Keeping in mind the sustainable development goal #3 on health and well-being, the proposed health and wellness centers should be seen as integral to community. For this to happen, these should be anchored within the local tier of governance, since the majority of these are co-terminus with gram panchayats. These alliances can be further broad-based by inviting self-help groups, youth groups, mandalas and other socio-cultural organizations.
The writer Dinesh Aggarwal is senior technical advisor–Health, Nutrition, IPE Global Ltd. – Livemint