The Vice President has talked about the worrisome state of rural areas that are lagging behind with limited access to primary healthcare. He also said that to bridge this gap, solutions must be explored in telehealth to reach remote areas.
PRIMARY HEALTH CARE
- Early detection of diseases: Primary Health Care is a key enabler for higher life expectancy, better health outcomes and lower costs for the nation. Primary Health interventions help in early detection of diseases early, well before complications set in, thus pre-empting need for secondary and tertiary care.
- Primary healthcare in developed nations:Developed nations such as the UK, Australia, Canada, Netherlands and Sweden spend a large share of the Federal Health Care budget on primary care.
- Primary healthcare system in India:In India primary care infrastructure exists as a network of sub centers, Primary Health centers and community health centers.
- However, the focus of services has remained the narrow - largely prioritised around reproductive, maternal and child health care and some communicable diseases (notably malaria).
- The battle against non communicable diseases can only be won through a Primary Health care system that ensures that chronic diseases are not only detected early, but also that preventive action is taken to ensure an improved lifestyle.
- The national health policy (NHP), 2017: it envisages comprehensive Primary Health Care delivered through HWC's.
- The Policy also commits that two-thirds or more of Government spending would be targeted at primary care.
- Additionally, the announcement of Ayushman Bharat by the government is a game changer.
- Limited Scope:The existing Primary Health Care model in the country is limited in scope.
- Even where there is a well-functioning public Primary Health Centre, only services related to pregnancy care, Limited child care and certain services related to National Health programs are provided, which represent only 15% of all morbidities for which people seek care.
- Lack of good quality services: Supply side deficiencies, poor management skills and lack of appropriate training and supportive supervision for health workers prevent delivery of the desired quality of Health Services.
- Lack of focus on urban care:A Primary Health Care model for the growing urban population has not been conceptualised, notwithstanding a few assorted initiatives by some States.
- Community participation:Although the National Health Mission focuses on engaging communities through village health, nutrition and sanitation, society's health has not yet become a people's movement.
- Financial constraints:Funding for health is inadequate, leading to low spending on primary care.
- Citizens have to incur out-of-pocket expenditure on primary Healthcare,of which the largest expenditure is on drugs.
- Lack of adequate human resources:There is a shortage of adequately trained and motivated personnels.
- HWC's should provide services such as screening and management of non communicable diseases; screening and basic management of Mental Health ailments; care for common ophthalmic and ENT problems; basic dental health care; geriatric and Palliative health care, and trauma care and emergency care.
- The key features of New India's Primary Health care system would be:
- A primary Healthcare nucleus comprising 5 to 6 upgraded subcenters coupled with a Primary Health Center, and population outreach
- Planning of health facility distribution in the districts to ensure that the continuum of care is available on the principles of 'time to care' through a strong referral linkage.
- Digitization of family records and information from the community to the facility level.
- Use of real-time data to guide public health action and implementation monitoring.
- The HWC's would act as the 'gateway' for access to secondary and tertiary health services.
- Other measures
- Established special National and state level task forces and 'command centres'
- Create mechanisms for Rapid scaling up of training.
- Develop an empowered governance mechanism for efficient decision making
- Mobilize corporate social responsibility (CSR) and Non- resident Indians for funding HWC's.
- Coordinate action for disease prevention and Public Health Promotion and address social determinants of health.
- Provide preventive services to improve Health behaviours for Family health and control the incidence of communicable and noncommunicable diseases among the population covered by HWC's.
- Facilitate partnership between HWC teams and other Frontline development teams (nutrition, Education, swachh Bharat etc.) to engage with communities to address the socio-cultural and environmental determinants of health at the local level.
- Catalyze people's participation for healthy India: SWASTH BHARAT JAN ANDOLAN.
- Mandate and motivate teams to work closely with the village health, sanitation and nutrition societies, Panchayati Raj Institutions as well as other constituents of Civil society in rural and urban spaces.
- This is vital because people are not just targets of Health Services but partners and multipliers of health related activities.
- Emphasize concurrent learning operations research and innovation: Undertake a well-funded research programme to find the best ways for effective and context-specific scaling up of Primary Health Care.
- This is critical because it is well-known that a single model of Primary Health Care may not work for all districts/states in the country.
- Conduct research to assess the population-level health impact of the programme and effects on out-of-pocket expenses. Develop urban adaptation of comprehensive primary care.
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