Investment in Primary Health Care: COVID-19 and beyond
Dr. Swati Mahajan, Chief of Party, NISHTHA/programme director, Jhpiego and Dr. Mayank Shersiya, senior programme officer- health systems development, NISHTHA/Jhpiego.
As the world gears up to advance towards universal health coverage (UHC), primary health care (PHC) is a driving force to help achieve this ambitious goal of ensuring everyone, everywhere has access to quality healthcare, irrespective of who they are or where they live. Health systems with focus on PHC bring enormous benefits but require substantial financial investments. Investing in primary healthcare is foundational for achieving UHC and Sustainable Development Goals. Government of India (GoI) has made concerted efforts in strengthening the healthcare system with an increase in government health expenditure as share of total health expenditure to 40.8%. With the launch of Ayushman Bharat programme, the country has set the ball rolling to achieve comprehensive primary health care.
The advent of the Covid-19 pandemic made the steadily improving health systems vulnerabilities more profound. The pandemic has brought into forefront the importance of a robust and resilient health system and has shown the governments, decision-makers, implementation agencies and communities, that, what happens when health systems stall to thrive. It further reiterated the need for enhancing primary health care to not only manage the pressure on the health systems, but also function as a gate-keeping mechanism to avoid burdening the tertiary care facilities. The disruption in the non-Covid essential services, highlighted the felt need to revitalise PHC, and provide health services in comprehensive and equitable manner. Investing in primary health care will enable access to quality healthcare for vulnerable populations and bring health care closer to the communities, thereby reducing the out of pocket expenditure on health. A robust primary health care system is essential to help tackle any future unforeseen adversity, the pandemic has emphasised this aspect now more than ever.
The GoI acknowledged the shortcomings in the country’s health systems and in the endeavour to mitigate COVID-19 pandemic the government focused on strengthening the health infrastructure along with rapid COVID-19 vaccination.
In the effort to build a resilient public health system and have a robust response to pandemic, GoI allocated financial resources to States/UTs through various schemes, namely, India Covid-19 Emergency Response and Health Systems Preparedness Package (referred as ECRP), 15th Finance Commission (FC-XV), Pradhan Mantri Ayushman Bharat Health Infrastructure Mission (PM-ABHIM). ECRP-I, primarily focused on development of dedicated Covid hospitals, additional human resources, procurement of Personal Protection Equipment and masks; enhancing surveillance system; and strengthening of laboratories and diagnostic capacities.
The health system was further augmented with additional resources during the unprecedented second wave of Covid-19, through ECRP Phase-II. The central sector component of ECRP was leveraged to strengthen central hospitals and AIIMS for Covid-19 management, enhanced laboratory surveillance capacities including genome sequencing, strengthened surveillance at port of entry points, promoted IT interventions for Covid-19 vaccination. ECRP-II supported States/UTs in strengthening health infrastructure, increase the availability of essentials drugs, along with enhancing testing capacities through establishing RT-PCR labs.
ECRP-II is a scheme which dovetails the quintessential support required for Covid management, and layers on the foundation to develop resilient comprehensive public health system. The hospital management information system (HMIS) aims to streamline the processes and provide digitized patients’ data. The teleconsultation platforms will enable access to health care for remote patient management especially the vulnerable section of the communities. The prefab units being set up at primary care level will be repurposed for comprehensive primary health care services post-pandemic. The ambulatory services strengthened in this process will aid in better referral linkages.
The government is investing in healthcare with an integrated and comprehensive approach through FC-XV and PM-ABHIM schemes as well. The aim is to upgrade the health infrastructure and services in rural and urban areas. This will be achieved through infrastructural support to primary health care facilities with prioritisation of geographical inaccessible areas, and increase in urban HWCs catering to poor and vulnerable populations. These schemes will bolster block level healthcare planning through establishing Block Public Health Units which will encompass HMIS cell at block level with strengthened clinical and public health laboratory facilities. FC-XV will also give an additional push in conversion of rural Primary Health Centres and Sub-Health Centres to Health and Wellness Centres and ensure effective delivery of comprehensive primary health care. A huge focus has also been provided towards developing effective and efficient diagnostic and laboratory services, wherein an integrated district public health lab will be established under PM-ABHIM, and diagnostic infrastructure at primary facilities will be strengthened through FC-XV.
A systematic and effective implementation of the activities planned under these schemes will aid the health system to reduce the out of pocket expenditure on health, and build a more resilient, robust and responsive public health system. India has a unique socio-epidemiological ecosystem which requires sustained investment in primary health to fulfil our goal of universal health coverage, and these investments of today are a step towards reaping dividends for a healthier tomorrow.
(Dr. Swati Mahajan, Chief of Party, NISHTHA/programme director, Jhpiego and Dr. Mayank Shersiya, senior programme officer- health systems development, NISHTHA/Jhpiego.)