India’s Primary Healthcare Sector: Status & Key Concerns

• Primary healthcare is pivotal in addressing global and national health challenges, ranging from Non-Communicable Diseases (NCDs) and antimicrobial resistance (AMR) to mental and zoonotic diseases. A holistic, integrated approach is essential to build a sustainable and inclusive health system.

Primary Health Care: Key Statistics

• Healthcare Centres Network in India: India has 1,69,615 Sub-Centres (SCs), 31,882 Primary Health Centres (PHCs), and 6,359 Community Health Centres (CHCs) serving urban and rural populations.
• Healthcare Standards: Only 3.4% of Sub-Centres and 13% of Primary Health Centres adhere to Indian Public Health Standards (IPHS).
• Health and Wellness Centres Expansion: India has established 1.6 lakh+ HWCs, which deliver comprehensive services such as NCD care and maternal and child health.
• Improved Doctor-Population Ratio in India: India’s doctor-population ratio currently stands at 1:834, surpassing the WHO standard of 1:1000, indicating progress in healthcare access.
• Healthcare Spending: India invests 2.1% of its GDP in health, emphasising the strengthening of primary care through Ayushman Bharat and HWCs.

Changing Nature of Health Care

• Evolving Public Health Landscape: India’s public health challenges are evolving due to urbanisation, lifestyle changes, and economic growth, necessitating updated health strategies.
• Rise of Non-Communicable Diseases (NCDs): NCDs like diabetes, cardiovascular diseases, and cancers account for over 60% of global deaths, with a projected 17% increase in the next decade (WHO).
• Antimicrobial Resistance (AMR): AMR poses a critical threat due to antibiotic overuse, endangering effective treatments and increasing mortality and healthcare costs.
• Mental and Zoonotic Health Threats: Mental health disorders are rising across all ages, and diseases like COVID-19 highlight the need for integrated health systems.
• Need for a Holistic Approach: Effective public health today requires an integrated view that considers environmental conditions, social determinants, and individual health behaviours.

Key Concerns in Primary Health Care

• Inadequate Infrastructure: Many primary health centres (PHCs) lack basic facilities; E.g., only 30% of PHCs operate with all the required infrastructure (Rural Health Statistics).
• Shortage of Human Resources: There is a significant shortage of doctors, nurses, and lab technicians. E.g., over 65% of Community Health Centres (CHCs) specialist posts were vacant.
• High Out-of-Pocket Expenditure (OOP): Despite public schemes, more than 48% of health expenditure in India is covered out-of-pocket by individuals, often leading to catastrophic health spending.
• Limited Access in Rural and Remote Areas: Nearly 8% of sub-centres and PHCs are in hard-to-reach areas with poor connectivity, hampering healthcare delivery to tribal and hilly populations.
• Overburdened Facilities: PHCs often serve populations significantly larger than the recommended 1 PHC per 30,000 people (20,000 in tribal areas), compromising quality of care.
• Fragmented Preventive and Curative Care: Preventive, promotive, and curative services lack integration; mental health services are available in fewer than 20% of primary care facilities.

Way Forward

• Strengthen Health Infrastructure: Upgrade Sub-Centres, PHCs, and CHCs with essential facilities and a reliable medicine supply.
• Integrate Preventive and Holistic Care: Promote Health and Wellness Centres (HWCs) for comprehensive services including prevention, mental health, and lifestyle management.
• Promote Digital Health Solutions: Implement the National Digital Health Mission (NDHM) for better health record management and telemedicine.
• Enhance Community Engagement: Use ASHAs and Village Health Committees to boost health awareness and service uptake.
• Encourage Public-Private Partnerships: Collaborate with NGOs and the private sector to innovate and improve service delivery.
• Increase Financing and Governance: Raise public health spending to 2.5% of GDP, focusing on transparent governance.
• Improve Quality and Accountability: Regularly audit and gather patient feedback to uphold Indian Public Health Standards (IPHS) and National Quality Assurance Standards (NQAS).

Strengthening primary healthcare is not just a policy imperative but a moral one to ensure accessible, affordable, and equitable health for every Indian, especially in underserved regions. A resilient primary healthcare system acts as the first line of defence against NCDs, pandemics, and mental health crises, while reducing the burden on tertiary care.

Reference: The Hindu | PMFIAS: Healthcare Expenditure in India

UPSC Mains PYQs – Theme – Health

1. [UPSC 2021] “Besides being a moral imperative of a Welfare State, primary health structure is a necessary precondition for sustainable development.” Analyse.
2. [UPSC 2016] Professor Amartya Sen has advocated important reforms in the realms of primary education and primary health care. What are your suggestions to improve their status and performance?

PMF IAS Pathfinder for Mains – Question 160

Q. “Accessible, equitable, and affordable primary healthcare is the cornerstone of a resilient and inclusive public health system.” Discuss the key challenges in achieving ‘Health for All’ in India and suggest measures to strengthen the primary healthcare system. (250 Words) (15 Marks)

Approach

• Introduction: Introduce the answer by briefly summarising primary health care and its importance.
• Body: Discuss the key challenges in achieving ‘Health for All’ in India & suggest measures to strengthen the primary healthcare system.
• Conclusion: Write a futuristic conclusion mentioning the importance of equitable, resilient, and preventive health architecture for the new India.