India’s primary healthcare model is based on the idea that monetary constraints should never come in the way of ensuring public health. As a result of the recommendations of the Health Survey and Development Committee Report (1946), the Government of India had set on the task of improving health services for rural communities in the country. Introducing schemes such as the national family planning programme, launched in 1952, and the policy of one community health worker per 1,000 people in the 1970s, India had moved towards bolstering its healthcare scenario. Then in 2005, the UPA Government launched the National Rural Health Mission (NRHM), as a move to improve access to quality healthcare, especially for poor rural women and children. All these efforts have led to signicant achievements which resulted in decline of maternal mortality ratio (MMR) by 77%, from 556 per 100,000 live births in 1990 to 130 per 100,000 live births in 2016. This accomplishment puts the country on track to achieve the Sustainable Development Goal (SDG) of MMR below 70 per 100,000 by 2030.
Also the present NDA government has launched schemes like Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA), that allow women access to antenatal check-ups, obstetric gynaecologists and to track high-risk pregnancies. Another scheme Janani Shishu Suraksha Karyakram (JSSK) is helping the nation on the path of healthcare for all.
At present, the newly introduced Ayushman Bharat insurance scheme is creating the right amount of buzz across all segments. The policy emphasises both on Health and Wellness in all-inclusive primary healthcare services and National Health Protection Mission for secondary and tertiary care that aims to cover around 500 million families across the country. In fact, the current development goal focuses on chosen targets and slots the health system into vertical disease programmers and segmented health services for specific diseases and age groups.
This has brought fruitful results. Fiy ve percent of the Ministry of health and family welfare budget in 2018-19 was for the National Health Mission, of which maternal and child health component accounted for 74%, while rest were for other segments. This was achieved, despite the insurgent mortality that came with the non-communicable diseases (NCD) such as hypertension, cancer and diabetes. It was noted that close to 61% of Indians succumbed to a host of NCDs in 2016.
Shortage of staff
Yet, the problems surrounding public healthcare are far from over. The shortage of doctors and trained staff has been reported from all across the nation. This has led to the under-utilisation of medical equipment such as blood-storage units, ultrasound The Comptroller and Auditor General of India report on the National Health Mission said 428 machines and other equipment worth Rs 30.39 crore were not being used at several healthcare facilities in the district and village health centres. In fact, at some places, there is no space to install the equipment.
The services shortfall at sub-centres, primary health centres and community health centres in 28 states and Union Territories ranged between 24% and 38%. But the shortfall was over 50% in ve states — Bihar, Jharkhand, Sikkim, Uttarakhand and West Bengal. That CAG report also highlighted that in 13 states; at least 67 PHCs were functioning without a doctor, exposing the state of affairs at the primary healthcare centres to treat patients.
What is even more alarming is the fact that there isn’t enough trained manpower to run basic lifesaving equipment, with many hospitals not using ultrasound machines, X-ray, ECG, cardiac monitors, auto-analyser, and incinerator.
The way forward
The need of the hour is the government must intensify recruitment of manpower in an attempt to provide better and affordable healthcare at the grass-root level. In case of absence of trained and qualied, what the government can do is to provide continuous medical education and motivate doctors to encourage them to deliver better primary.
Also, effective teamwork and local ownership are common features to ensure successful healthcare delivery. And this can be achieved by multi-disciplinary clinical teams led by family physicians. Organisations such as Gramin Healthcare are advocating this through their awareness and training programmes, to sensitise the medical fraternity. With such positive approaches, primary health care is being elevated to newer levels. – DH Deccan Herald