The Primary Health Care (PHC) strategy has proved to be a turning point in the history of health care policy. PHC was defined as essential health care based on practical, scientifically sound and socially acceptable methods and technology, made universally accessible to individuals and families in the community through their full participation and at a cost that the community and the country can afford to maintain at every stage of development in the spirit of self-reliance and self-determination?
PHC was expected to form an integral part of both the country’s health system, of which it is the central function and main focus, and the overall social and economic development of the community. It would be the first level of contact of individuals, the family and community with the national health system, bringing health care as close as possible to where people work and live, and constitute the first element of a continuing health care process.
PHC comprises eight elements:
- education concerning prevailing health problems and the methods of preventing and controlling them,
- promotion of food supply and proper nutrition,
- adequate supply of safe water and basic sanitation,
- maternal and child health care, including family planning,
- immunization against major infectious diseases,
- prevention and control of locally endemic diseases,
- appropriate treatment of common diseases and injuries, and
- provision of essential drugs.
The ideology and principles behind PHC closely match what was and has since been advocated in human development such as social justice, equity, human rights, universal access to services, giving priority to the most vulnerable and underprivileged, and community involvement. It is a recognized fact that the promotion and protection of the health of the people is essential to sustained economic and social development and contributes to better quality of life and to world peace. These prioritized PHC as the main strategy for achieving health for all. Despite this commitment and several years of work, not much has been achieved.
There is a need to examine the implementation of primary health care and identify strategic interventions needed to cope with the new challenges facing health systems, as a contribution to developing an agenda for strengthening PHC in the 21st century.
Key ISSUES that may need TO BE REVIEWED/addressed for strengthening PHCs are:
PHC policy formulation: How was the PHC policy formulated? What was the process of formulating PHC policy, the content of the PHC policy etc.
PHC policy implementation: How are the PHC policies being implemented? Aspects to examine include advocacy and marketing, actors and partners, structures and processes etc.
PHC resources: What resources are available for PHC implementation, for example human and financial resources, as well as PHC physical resources and structures?
PHC monitoring and review: How are PHC policy and strategies being monitored and reviewed?
Health trends: What are the trends of the main health and health-related challenges?
Data for the review to be obtained from the following sources:
Unstructured interviews with interviewees/informants that have intimate knowledge of PHC implementation, such as policy makers, implementers at all levels, other sectors involved, WHO and other partners.
Discussions with a wider audience of people who have intimate knowledge of PHC implementation. These included policy makers implementers, NGOs, private sector, health related institutions, WHO and other partners
A desk analysis of available documents and reports specific to the country and extensive analysis of all available published and unpublished documents and materials.
A Review of the Rural Health Care System in India:
Rural Health Care System: the structure and current scenario
The health care infrastructure in rural areas has been developed as a three tier system (see Chart 1) and is based on the following population norms:
- Plain Area
Primary Health Centre
Community Health Centre
The Sub-Centre is the most peripheral and first contact point between the primary health care system and the community. Each Sub-Centre is manned by one Auxiliary Nurse Midwife (ANM) and one Male Health Worker MPW (M). One Lady Health Worker (LHV) is entrusted with the task of supervision of six Sub-Centres. Sub-Centres are assigned tasks relating to interpersonal communication in order to bring about behavioral change and provide services in relation to maternal and child health, family welfare, nutrition, immunization, diarrhea control and control of communicable diseases programmes. The Sub-Centres are provided with basic drugs for minor ailments needed for taking care of essential health needs of men, women and children.
The Department of Family Welfare is providing 100% Central assistance to all the Sub-Centres in the country since April ‘02 in the form of salary of ANMs and LHVs, rent at the rate of Rs. 3000/- per annum and contingency at the rate of Rs. 3’0/- per annum, in addition to drugs and equipment kits. The salary of the Male Worker is borne by the State Governments. Under the Swap Scheme, the Government of India has taken over an additional 39554 Sub Centres from State Governments / Union Territories since April, ‘02 in lieu of 5434 number of Rural Family Welfare Centres transferred to the State Governments / Union Territories. There are 146026 Sub Centres functioning in the country as on September, ‘05 as compared to 142655 in September, ‘04.
Primary Health Centres (PHCs)
PHC is the first contact point between village community and the Medical Officer. The PHCs were envisaged to provide an integrated curative and preventive health care to the rural population with emphasis on preventive and promotive aspects of health care. The PHCs are established and maintained by the State Governments under the Minimum Needs Programme (MNP)/ Basic Minimum Services Programme (BMS). At present, a PHC is manned by a Medical Officer supported by 14 paramedical and other staff. It acts as a referral unit for 6 Sub Centres. It has 4 – 6 beds for patients. The activities of PHC involve curative, preventive, primitive and Family Welfare Services. There are 23236 PHCs functioning as on September, ‘05 in the country as compared to 23109 in September, ‘04.
Community Health Centres (CHCs)
CHCs are being established and maintained by the State Government under MNP/BMS programme. It is manned by four medical specialists i.e. Surgeon, Physician, Gynecologist and Pediatrician supported by 21 paramedical and other staff. It has 30 in-door beds with one OT, X-ray, Labour Room and Laboratory facilities. It serves as a referral centre for 4 PHCs and also provides facilities for obstetric care and specialist consultations. As on September, ‘05, there are 3346 CHCs functioning in the country.