Strengthening Primary Care in India

Abstract

India has made significant progress in improving primary healthcare delivery, but its focus, until recently, has largely remained on the provision of reproductive and child health services. Given the growing burden of non-communicable diseases (NCDs), and the overall demographic transition, the Government of India launched the Ayushman Bharat-Health and Wellness Centres scheme (renamed Ayushman Arogya Mandir) in 2018. The scheme aimed at transitioning from selective to comprehensive primary care in a phased manner by converting sub-centres (SCs) and primary health centres (PHC) into Health and Wellness Centres (HWCs). Nearly five years after its implementation, India has made progress in attaining some of its primary health goals, yet challenges remain in terms of the inadequacy of funding, inequities in the availability of physical and human infrastructure, and a fragmented, low-accountability, and quality assurance system. This paper identifies some of the key gaps in policy design and implementation and reflects on the key insights from comparable countries, which experienced similar challenges to India in the recent decades. The paper makes a case for: 1) A system-initiated model of primary healthcare that focuses on population health, 2) A care system integrated across primary, secondary, and tertiary levels of care, 3) Re-thinking of the workforce mix and improving the density of frontline workers, 4) Design elements that improve quality and accountability of services, and 5) Greater budgetary allocation towards primary healthcare, with a dedicated administrative structure within the Ministry of Health and Family Welfare (MoHFW) focused on the strengthening of the primary healthcare system.