Role of Comprehensive PHC Approach to Health System in India

Discuss about the Comprehensive Primary Health Care.

Primary Health Care (PHC) is the approach used by an organization that provides health care services to provide ambulatory care in health-related problems. These problems that are handled by the PHC may include a range of diagnostics services on the health-related problem, rehabilitative care services and palliative services. There is numerous factor that facilitates and constrain the implementation of comprehensive PHC in India, and these include the increase of the chronic and non-communicable diseases, growth of the elderly population and environmental changes (Lakshminarayanan, 2011, p.26). Moreover, the challenges that hinder the implementation of PHC are unfinished agendas that improve child and maternal mortality and HIV/AIDs pandemics. Furthermore, the PHC in India is concerned with controlling and prevention of disease at the population level by having organized and informed choices of the public and private communities. Therefore, the government plays a vital role in addressing these challenges that affect India and improving health equity in the region. However, the healthcare system in India constitutes of majorly the public and private sector where the government is responsible for policy-making, evaluation and coordination of healthcare services at various provincial health authorities. The government also provides funds that are essential in the implementation of national programs that improve healthcare provision in India (Stockholm, 2013, p.12).

1. Equitable Distribution of Health Services

It is essential that health services are distributed equally among the people in the Indian population irrespective of their ability to pay for the services and accessibility of healthcare services by anyone from the rich to the poor and from the urban areas of India to the rural areas. Therefore, equitable distribution not only ensures the provision of healthcare services but also reduces the difference in healthcare outcomes in different regions and people of the Indian population (Lahariya et al., 2010, p. 284).

1. Community Participation

According to Lahariya et al. (2010, p.284), the community can know their health situation better and are encouraged to solve their common problems which enable them to become agents of their healthy development. Therefore, the knowledge of the PHC reduces the dependency on development aids since they have an understanding of their health situations. Furthermore, the PHC highlights that poverty and provision of poor health are caused by inequality in the resource distribution and changes in the existing health systems (Welschhoff, 2007, p.21)

1. Inter-sectoral Coordination

Health development aims at satisfying the basic needs of the Indian population by giving the poor the access to economic opportunities which raises their education level and improving the nutritional status of the population (Lahariya et al., 2010, p.285). Moreover, PHC also helps in ensuring availability and distribution of food and improving the women status of the Indian population.

1. Appropriate Technology

Factors Facilitating and Constraining the Implementation of Comprehensive PHC

PHC also enables the use of appropriate technology which can adapt to the needs of the local people which should be reliable and affordable to the community. Therefore, the PHC approach helps in the development of technology that improve healthcare systems which enable the status of the people in the Indian population (Lahariya et al., 2010, p.284).

1. Disability and Cross-based Rehabilitation

According to Kumar et al. (2012, p. 69), the primary challenge that affects the implementation of comprehensive PHC is understanding the disability concepts and the cross-based rehabilitation. Most of the hospital-based rehabilitation services may lead to knowledge mystifications due to social isolation and low service efficiency which will benefit only a few. Moreover, resources such as finance and human resources are critical issues to be considered in facilitating the implementation of comprehensive PHC. Also, lack of coordination between the government and the non-governmental organizations result in the absence of a stable community-level strategy which limits the competence and capacity of decentralization services. Hence, this hinders the provision of PHC in the community in India. It is essential that the services cover various disabled people who need rehabilitation services and it also gets used in the community’s development. Another vital issue is the multi-sectoral approach which includes social integration interventions and healthcare education which influence rehabilitation services (Kumar et al., 2012, p.69).

1. Lack of Economic Growth and High Mortality Rate

The Indian population faces challenges which are mainly influenced by the business and management environment in India which affects the link between social sector investments with economic performance. It has dramatically changed the provision of PHC in that it influences the economic growth of Indian population. Moreover, the issue of high maternal and child mortality in India has not got addressed because of healthcare norms which affect the allocation of resources which are needed by the public health sector (Eisenberg and Leslie, 2017, p.256). Also, the lack of funding by the government has resulted in unfinished agendas that can improve the healthcare system which has affected the delocalization of basic equitability among the Indian population (Joe et al., 2015, p.19). Furthermore, the Indian government has paid less attention to the mortality rate since the launch of the Child Survival and Safe Motherhood (CSSM) in 1992, and this has led to high mortality rate since India is a low-income country. Moreover, if the women in the Indian population are educated and empowered, these would enable them to contribute to the economic growth of the community. The women would also be able to provide better nutrition, sanitation, and healthcare to their children but since most of the women are illiterate, the growth of the primary care has been slow.

1. Increase in the Chronic and Non-communicable Diseases

Challenges of the Healthcare System in India

The increase in the Non-communicable Diseases (NCDs) has affected the national health system in India and the socioeconomic developments increasing the country’s disparities level. In spite of the improvements made in the health sector, the healthcare system in India continues to get unevenly distributed due to the burden of the non-communicable diseases.  The healthcare system in India is structured such that it comprises of the primary, secondary and tertiary care services. According to Sinha and Pati (2017, p.701), the implementation and delivery of interventions in the healthcare system face challenges due such as lack of affordability of the healthcare services both at the community and individual level. Furthermore, the prevention and treatment approach of chronic diseases are rooted in the PHC setting such that it affects the efficiency in which challenges on the management of the chronic conditions can get addressed. The factors that have influenced delivery of chronic care are fees charged for the service and lack of coordination within the disciplinary care team. Despite that, there is underdevelopment on the decision support system in the management of the chronic care which has increased in the chronic diseases (Sinha and Pati, 2017, p.701).

Disease Category	Number of Deaths 1990	% of all Deaths	Number of DALYs	Number of Deaths 2013	% of all Deaths	Number of DALYs
Noncommunicable Diseases	3,702,920	40	173,999	5,312,560	53	253,629
Cardiovascular Diseases	1,215,810	13	31,813	2,095,930	21	48,794
cancer	433,134	5	13,193	663,032	7	19,094
Chronic Respiratory Diseases	1,115,340	12	33,322	1,176,740	12	35,880

 

The presence of the Non-communicable Diseases (NCDs) which include cardiovascular diseases, chronic respiratory diseases and cancer have increased with age in the Indian population. The NCDs have exceeded the maternal and nutritional conditions that the Indian population faces which impose a severe threat in the provision of primary care in India since there are inadequate specialists who are equipped to treat these NCDs. According to Agarwal et al. (2016, p.7), mental illnesses have increased in the Indian population which is another non-communicable disease. In 2013, only 5.5% of the population had mental health issues and substance abuse disorders. It has increased from 1990 by more than 2% because about 3% of the Indian people have mental illnesses and other diseases due to substance abuse.

1. Increase of the Elderly Population and Environmental Changes

The increase in the longevity and decrease in fertility has led to the rise in the Indian population of adults from aged 60 upwards. This change has, in turn, presented a wide range of challenges that have affected the health complex of the healthcare system in India. Furthermore, the increase in the elderly population has resulted in economic and social difficulties which affect the distribution of healthcare across the country. Therefore, the vulnerabilities and the needs of the elderly tend to increase which impose pressure to the economic development sector that becomes inactive. The primary reasons for the constant growth in the elderly population in India are due to the improved access to contraceptives, decline in infant mortality, advancement in medicine which leads to longevity of life and improved sanitation and nutrition (Agarwal et al., 2016, p.4). Furthermore, in India, the fertility rate has decreased from 5.9 (1950) to 2.3 (2013) while the life expectancy at birth has increased rapidly from 36.2 years (1950) to 67.5 (2015). Moreover, the life expectancy in India is at age 80 which means most of the people in India live beyond age 60 which results in challenges that come with an old aged population. These challenges include the shift in the economic growth because the presence of the old community in India makes them more reliant on the younger demographic who are less compared to the elderly (Lakhan et al., 2015, p.523). It is essential to note that the Indian population gets mostly dominated by the children and the old meaning the dependency level on the young working population is high which causes strain in the economic growth of the country (Sivaramakrishnan, 2014, p.968).

1. HIV/AIDS Pandemics

Non-Communicable Diseases (NCDs) in India

The HIV epidemic is challenged by the lack of sustainable governance in the health sector in response to using the healthcare systems approach that gets required in the fight against HIV/AIDS in India (Kar, 2014, p.39). The Indian government faces challenges in controlling and prevention of the AIDS infection due to the uneven settlement of the Indian population. Moreover, the battle against HIV/AIDS depends solely on the emergency response rate to the care of the patient and health development interventions which make the policy difficult to implement (Kar, 2014, p.39).

1. Extremely Rigid Healthcare System

 The current PHC in India faces a significant challenge due to the rigid healthcare structure which makes it impossible to provide adequate primary care and is unresponsive to the needs of the local Indian population. Furthermore, one-fourth of the urban population lives in the slums which makes it difficult to provide the required primary care because the health care services are not available in these areas.  According to Pandev and Pandev (2013, p.125), the challenges that the health system faces in India is the lack of the required reforms and resources that get needed in delivering PHC.

India has one of the vast healthcare systems which include the public and private sector though there are numerous differences between the rural and urban areas and between the private and public healthcare. The rural areas often face physician shortages and disparities between states which makes the people in states to have less access to the required health care services. However, this is not the case for urban areas where the residents tend to have access to the necessary healthcare services (Gupta and Bhatia, 2017). Hence, the healthcare system in India is not even distributed among its population. Moreover, the government funds the public health sector which is responsible for providing healthcare services and health education. Hence, people begin relying on the Private sector for healthcare because they get funds from Non-governmental Organizations and other private companies that are will to invest in them (Gupta and Bhatia, 2017).

1. Primary Health Centers

The PHCs are established and maintained by the government which provides preventive health care to the Indian rural population under the Basic Minimum Services program (BMS). The activities that are carried out by the PHCs involve healthcare promotions and curative healthcare services.

1. Community Health Centers

The Community Health Centers (CHCs) are established and maintained by the Indian government under the BSM and get equipped by specialists and pediatricians. Furthermore, it serves as a referral center for the Primary Health Centers and also provides specialist consultation services and obstetric care (Chokshi et al., 2016, p.S9).

1. Sub-centers

According to Chokshi et al. (2016, p.S9), the Sub-centers (SCs) provide child and maternal healthcare services immunization, control programs of communicable diseases and nutrition. The Auxiliary Nurse Midwives (ANMs) are posted in these centers to treat minor ailments and provide first aid.

1. First Referral Units

This section in the Indian healthcare system provides emergency obstetric care which includes surgical interventions, care for the sick and small newborns and blood storage facility which operates on a 24-hour basis.

1. The Comprehensive PHC Approach to Strengthening Health Systems

According to Sambala et al. (2010, p.181), the concepts of the PHC is essential in providing excellent public health policies which help with general health constraints and causes of poor health; hence, PHC gets determined to meet the necessary healthcare needs. Moreover, the PHC makes strategies that identify appropriate health-related services which facilitate access to medication and proper food. It ensures adequate sanitation and nutrition of the Indian population.

1. Access to Essential Medicines in Different Regions

It is one of the most crucial functions of the PHC in India where there is inadequate medication for people in the Indian population because the healthcare services are not evenly distributed (Sambala et al., 2010, p.181). It is important because the healthcare services are essential to improving the quality of life and create accessibility of medication in different regions in India.

1. Access to Medication Using Public-Private Partnership

The structure of PHC gets aimed at providing a cooperative partnership between the main health sectors in India resulting to good working relationships; these main sectors include education, housing, agriculture, and transport. The collaboration between the private and public is useful in the pharmaceutical industries and addressing factors that hinder access to medication such as price barriers in India (Rao and Mant, 2012, p.9). Moreover, the partnership between government agencies and pharmaceutical industries help in the development of new drugs and increase the supply of medicines within the Indian country. Also, the collaboration between the donor-funded organizations and multinational drug companies in India help in addressing the problems that affect healthcare systems in India (Sambala et al., 2010, p.181).

1. Improve Access to Medicines in Research and Development Context

 The PHC is useful in addressing adequate and appropriate community participation, financing mechanisms and health information systems which are essential in research and development tasks that seek to get findings in new medications in India (Sambala et al., 2010, p.181).  Furthermore, PHC provides health information regarding new medical products and provide the medical expertise that is necessary for getting research findings. However, there have been inadequate trained researchers and technology in India due to limited function of the healthcare system.

1. UK-India partnership

This partnership between these two countries is meant to strengthen and improve the delivery of primary health care in India and improve the relationship between the two nations (Rao and Mant, 2012). Furthermore, India has the potential to have a lead in the employment of affordable technology through the partnership with the UK, and this would help in delivering PHC which has reduced care costs to the people of India. Through the connection, the medical personnel in India would receive education and training from the UK in the delivery of improved PHC. According to Rao and Mant (2012), the exercise would need to get extended to different disciplines in the health profession sector in India which includes nurses, managers, doctors and other health personnel in India. Therefore, this will create a dual benefit in ensuring the provision of PHC by trained healthcare personnel in India. Moreover, the partnership would improve both the public and commercial sector, and this would help in developing a stable clinical guideline and quality standard of PHC provision in India. Also, the partnership would assist in research and innovation which would help the public and private sectors in India in development of new medication and affordable technology that would enhance the provision of PHC in India (Rao and Mant, 2012).

1. Fixing the Broken Continuum of Care

 India has made credible progress in providing PHC to the general India public though the growth has not been as productive as expected. The Indian government is working on improving the shortage of qualified medical personnel by employing more medical staff and facilitating good medical supply. The  Auxiliary Nurse Midwives (ANMs) are not fully utilized in India because they get dedicated continuously on the data collection field, and the Indian government is striving to ensure that there is the redeployment of the ANMs so that they can be able to provide PHC to the general Indian population (Mathur, 2018). Also, the Indian government is striving to offer more medical facilities so that the average Indian can have access to the medical facility. Therefore, it got noted that the sub-centers used to cater for 5,000 people with only two ANMs and support staff and this provides an excellent future potential of the PHC in India.

1. Creating Healthcare Policies that Favor Provision of PHC

The provision of healthcare policies that favor the healthcare system in India would enable administration of improved PHC due to the lower healthcare costs in India (Rath and Deb, 2017, p.180). According to a study made, when the Indian government invests in improving PHC delivery would lead to a significant saving that would get required for secondary care. It is made possible by the reduction of emergencies in the emergency department in Indian facilities and the reduction in the Ambulatory Care Sensitive Conditions (ACSCs) admissions (Gera, 2017).

1. The ability of the Community to Participate in the Future of PHC

The healthcare system effectiveness is also majorly determined by the strength of the community to participate in implementing the delivery of healthcare services (Kumar, 2017). By providing a suitable healthcare system, this will empower the population in India to participate in the accountability and transparency of the PHC in India. Therefore, it is essential that the future of PHC in India to be inclusive of everyone in the Indian community and consultative to the people and the needs that they may be facing in the medical sector. Moreover, this can get achieved by employing suitable methodologies that got based on monitoring the Indian community’s needs (Kumar, 2017).

1. Strengthening the Partnership between the Public and Private Sectors

The private sector healthcare providers are virtually absent at the primary care level, and this has led to the need for an established partnership between the public and private sector (Kumar, 2017). It is essential because the public sector healthcare system will enable the availability of public resources which will benefit the private sector. Furthermore, the joined partnership of these two major players in the Indian healthcare system will help in the development of infrastructure and human skill sets that required in providing primary care in India (Gera, 2017).

1. Creating Effective Information Systems

 The essence of creating effective information systems is that they help in scaling the healthcare organizations and meeting the needs of the PHC. Moreover, the use of electronic medical devices and recording equipment help in primary care such that illnesses and medical conditions are analyzed and interpreted in time. According to Dimovska (2015), as the healthcare system grows, there is the need to keep track of all the data and information that received from various medical facilities in India.

1. Need to Adopt Broader Healthcare Approach

 The central government has outlined measures that target the development of primary care for instances focusing on Infant Mortality Rate (IMR), Total Fertility Rate (TFR) and Maternal Mortality Ratio (MMR). Furthermore, the provision of clean water for drinking and cooking purposes which has helped in providing proper sanitation and nutritional programs (Stockholm, 2013).

Conclusion

From the essay, we can note that PHC in India has had steady growth over the past few years through numerous hindrances affect the efficiency of primary care in India. There are essential roles that PHC plays in making sure that there is the accessibility of PHC to the majority of the Indian population. However, the Indian government has been a significant setback in the establishment of effective and dependable primary care services. The government has been reluctant in providing the necessary funds that are necessary for the development of infrastructure and providing the relevant technology needed for research and innovation purposes. In spite of that, the Indian population is mainly comprised of children and the elderly who are primarily dependent on the young community. It results in inputs pressure on the young population because they got hugely depended on by the old and children population resulting in the low economic growth of the Indian community. However, Indian is making the necessary steps in ensuring that the healthcare system in India improves by creating the essential partnerships by both the UK and private investors in providing that primary care is accessible to every Indian.

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