Strengthening Primary Health Care

Table of Contents

Context: Strengthening Primary Health Care across the world would be a key goal of India’s G20 presidency.

Background: Why focus on Primary Health Care?

The Covid-19 pandemic has proved that health is a global public good. It has also underlined the critical role played by the State in shaping and delivering a public health vision, mainly because market forces often fail to address the medical needs of poor and vulnerable people.
Data has shown that the world is off track in its journey towards Universal Health Coverage (UHC) by 2030 on due to lack of concrete operational steps and inadequate public financing.
- A focus on Primary Health Care is likely to help correct the course.
Primary Health Care will address broader aspects of health and focuses on the comprehensive and interrelated aspects of physical, mental and social health and wellbeing.

Primary Health Care (PHC) is defined as essential health care that is based on scientifically sound and socially acceptable methods and technology. This enables access to universal Health Care to all individuals and families in a community.
Primary Health Care is committed to social justice, equity, solidarity and participation. It is based on the recognition that highest attainable standard of health is one of the fundamental rights of every human.
Features of PHC approach:
- Under PHC, services are provided at a cost that the community and the country can afford at every stage of their development.
- PHC includes different areas that play a role in health, such as access to health services, environment and lifestyle.
Three inter-related and synergistic components of primary Health Care:
- Comprehensive integrated health services that embrace primary care as well as public health goods and functions as central pieces.
- Multi-sectoral policies and actions to address the upstream and wider determinants of health.
- Engaging and empowering individuals, families, and communities for increased social participation and enhanced self-care and self-reliance in health.

The Alma-Ata declaration of 1978 identified primary health care as the key to attaining health for all. It was an initiative of World Health Organization and UNICEF.
It is based on principles of:
- Accessibility and fairness (equity);
- Relevance to the needs of the population.
- cost effective appropriate use of technology and health services.
- collaboration between health and other sectors to address underlying causes of ill health.
- integration between primary care and secondary and tertiary care.
- encouragement of self-care and community involvement in health service planning and provision.
- redistribution of resources to primary care, areas of need, to rural areas, and to disadvantaged groups.

Fulfill SDGs: Strengthening PHC will help in achieving four SDGs: No Poverty, Zero Hunger, Good Health and Wellbeing, and Gender Equality.
Wider health outcomes: Countries with stronger PHC usually have lower health costs, higher patient satisfaction, better population health, and fewer unnecessary hospital admissions.
Economic prosperity: Various studies have shown that an improvement in health outcomes have translated into greater economic prosperity.
Universal Health Coverage: Strengthening of PHC is likely to help achieve Universal Health Coverage, bringing poor and vulnerable group under quality health care.
Preventive focus: PHC will focus on preventive measures that will help in reduction of expenditure on treatment.

Quality: Qualities of health-care services across public and private sectors not uniform due to lack or inadequately enforced regulatory standards.
Affordability: Large population is unable to afford quality healthcare. Out-of-pocket (OOP) expenditure results in a high financial burden on families.
Penetration of health insurance: Only a small percentage of population is covered under health insurance, which further affects ability of families to afford quality healthcare.
Strengthening Primary Health Care in India:
- Planning and management: Planning and management is necessary to reduce wastage of public funds and resources. Focus can be given on priority areas.
- Skill development: PHC workers must be properly trained at recognized centers with regular appraisal and incentives to cater to rising demand.
- Research: Proper research must be carried out to provide evidence-based guidelines on an Indian perspective and bring uniformity in management.
- Innovative practices: Innovative practices in IT can help in better management and deliver of PHC. It will help in increased penetration of services.
  - Features such as Telemedicine can link PHC to tertiary health care and may be useful in remote areas.
- Budgetary expenditure: The government needs to increase its public expenditure on core health care so that it reaches a level of 2%–3% of GDP in coming years.

Inter-sectoral collaboration: Strengthening primary Health Care will require inter-sectoral coordination (economic, social, agricultural, environmental) and a “One Health” approach with whole-of-government and whole-of-society responses.
Use of technologies: There is a need to utilize digital health technologies and community-based services to strengthen and scale up primary Health Care approaches to achieve Universal Health Coverage (UHC).
Long term results: In short term, the spending may increase but the results will reflect in long-term advantages for society and country overall.
People-centered approach: It is necessary to move away from one-size-fits –all approach to people-centric approach that provides healthcare according to the needs of the community.

Primary care	Primary health care
Primary care focuses on the health problems of an individual.	Primary health care encompasses a wider population of a community.
It involves treating disease or managing the illness.	It goes beyond just treatment to include managing illness to include disease prevention and health promotion as well.
Primary Care describes a narrower concept of “family doctor-type” services delivered to individuals.	Primary Health Care is a broader term that finds origin in core principles articulated by the World Health Organization.