Health, Sanitation & Nutrition

India’s healthcare system is characterised by a three-tier structure of primary, secondary and tertiary care services. In India, the delivery of primary health care (PHC) is delivered to the rural population through sub-centres, primary health centers (PHCs), and community health centers (CHCs), secondary care is delivered through district and sub-district hospitals and tertiary care is extended at regional/central level institutions or super specialty hospitals. Despite an elaborate structure, India’s healthcare infrastructure is insufficient to cater to the needs of India’s vast population. As per studies, India has roughly 20 health workers per 10,000 population, as against the WHO recommended average of 2.5 medical staff per 1,000 people. Though healthcare needs at all the levels have to be catered to, it is primary healthcare that needs urgent attention as the PHC is the most inclusive, equitable, cost-effective and efficient approach to enhancing people’s physical and mental health, as well as social well-being. Evidence of wide-ranging impacts of investment in PHCs continues to grow around the world, particularly in times of the COVID-19 pandemic. In this context, there is a need to improve primary health care as a public good. A public good is a good that is non-excludable and non-rivalrous, where no one can be excluded from its use and where the use by one does not diminish the availability of the good to others. Improving primary health care as a public good would help in the following:

• Equitable access to healthcare: Investment in primary healthcare will improve equity and access to healthcare, healthcare performance, accountability of health systems, and health outcomes. The PHC is also critical to making health systems more resilient to situations of crisis and being more proactive in detecting early signs of epidemics. Further, strengthening of PHCs will lead to early response during surges in demand for services.
• Manage patient load: Even prior to the outbreak of the COVID-19 pandemic, primary healthcare facilities felt the strain of unmanageable patient load and shortage of healthcare workers. Besides the existing 46 per cent shortfall of doctors in PHCs, 74 per cent of the current graduate doctors reside in urban India leaving a large chunk of the rural population underserved.
  • Also, proper training of PHC workers should be regularly carried out. In addition, there is a need to upgrade the role of the Accredited Social Health Activists (ASHAs) and Urban Social Health Activist workers by training them to meet the growing healthcare demands.
• Ensure health for all: The National Health Policy (NHP), 2017 highlights the ‘Health for All’ approach to provide assured healthcare for all at an affordable cost. Strengthening of PHCs is a step forward in this direction.
• Reduce out-of-pocket expenditure: Out-of-pocket expenses account for about 62.6% of total health expenditure in India. It is one-of-the highest in the world, contributing directly to the high incidence of catastrophic expenditures and poverty. Further, approximately 60% of inpatient and 70% of outpatient treatments are provided by the private sector.
• Meeting SDGs: Primary healthcare is the basis of the health Infrastructure of the country. An adequate health infrastructure can help India achieve health-related Sustainable Development Goals (SDGs).

Thus, it is important to upgrade and expand the PHCs. In this context, India’s National Health Policy (2017) commits the government to invest a major proportion (>2/3rds) of resources to PHCs through Health and Wellness Centers. Also, the Fifteenth Finance Commission has recommended grants aggregating Rs. 70,000 crores, over a period of five years (2021-2026) through local governments, for strengthening the healthcare system at the primary healthcare level.