PRIMARY HEALTH CARE: A MAJOR CONCERN IN INDIA
With the Pandemic hitting hard the entire world, the threat to health is a matter of serious worry. India being the country with the highest population, the primary health care seems to be of major concern. The outbreak of covid19 indeed is an eyeopener to the Indian Health Department to awake and strengthen the primary health care system to further strengthen and address the broader determinants of health and wellbeing of the public. For sustainable development growths in India is yet to attain which can be possible only enhancing the primary health care in the country.
The access to health care in the rural areas in India still remains a challenge although advances are far better than before. Thousands of migrant workers were seen daily during this crisis crowding the railway stations and bus stands in various cities, to take them home. With the flock of migrants moving towards their respective destinations in rural areas, our administration must consider whether our healthcare infrastructure is equipped enough to contain the spread of this pandemic in rural areas.
The need of time is to strengthen the budget on primary health care centres testing and treatment infrastructure, and contact-tracing capabilities in these rural areas (which constitute 70% of the population), and if it is adequate to handle the demands of a pandemic where timely testing and lockdown is the key. The official figures are rising at an alarming rate and some case histories seem to strongly indicate that community transmission has already begun already no confirmed report has been received yet. Considering this, the preparedness of government Primary Health Centres (PHCs) will be crucial in terms of their response to prevent the further transmission of COVID-19 with respect to screening of patients with symptoms, and in responding, either with treatment or referral.
Sonik Sourabh, a specialist e-Pharmacy for Medlife.com on being asked about the present state of the health care in the states, states,
“The assistance we need as of now is Stringent Supply Chain systems, we are facing issues in timely delivery to the patients. In addition, the manpower is also a big issue because most of the delivery persons are low wage earners and they have moved to their hometowns which is affecting the operations. In the pharma manufacturing hubs in Baddi, Solan, Haridwar, Vadodra, Ankleshwar and Sikkim they are experiencing manpower issues as there were daily wage labourers who have left the places and industries are shut down.
Indian Pharma manufacturers rely heavily on imports of their APIs from China. As a result of the lockdowns and closures, slowed production of APIs resulted in less availability and higher costs for the materials required for generics production. Cost of paracetamol has gone up from Rs 250-300 kg to 400-450 kg. Similarly, the prices of vitamins and penicillin have also increased tremendously.
Government need to facilitate the APIs production facility in India and should support entrepreneurs in it.
Lab and diagnostics services will be on full spree after this lockdown as normally scheduled tests of peoples will be done after that. Collection of samples from home should be encouraged.
Healthcare at home services should be subsidized as people will hesitate visiting hospitals and getting hospitalized.
When we go for focussing primary healthcare States should focus on making healthcare accessible specially to the pregnant ladies, infants and elderly people with chronic diseases. We have observed that people have to move atleast to their district headquarters in some places to get their checkups done and get medicines. So a accessible healthcare faculties should be provided may be via a mobile van or something like the concept of mohalla clinic, opening up checkup camps in govt schools biweekly
PSUs and Corporates can be requested to drive their huge CSR budgets in these areas and build the ecosystem.”
Dr. Nilakanta Siva, a scientist who is a Cancer Warrior and a prolific writer of health books, emphasised on the grim situation in rural areas,
“I am not a doctor. However, with primary health essentially a state responsibility it is essential they step up the allocation for PHCs in rural areas rather than creating more super specialty hospitals in large towns.”
With the need of more technical aids and manpower in the present scenario in the healthcare domain in the urban areas too, the development in the rural areas is a long route. The big question now lies on how the authorities concerned in rural areas going to meet the challenges that have been posed by the Covid-19 threat.
According to Dr M Wasim Ghori, Fellow, Royal Society of Public Health, London & Executive Director – Medical & Health Information Management Association (MaHIMA), “Given the Covid-19 threat and subsequent mass exodus of migrant workers from cities to rural areas, India should use this opportunity to strengthen its rural primary healthcare system. First, prepare healthcare providers for what is coming; second, educate patients about what the coronavirus is and how to deal with it; and third, make strategic investments in telemedicine, remote diagnostics and creative surveillance systems that can help get ahead of the epidemic.”
India has an extensive network of about 25,000 primary health centres and 5,300 community health centres spread across all regions and States. In addition, large numbers of private and non-governmental organisations provide primary healthcare in urban and rural areas. But even with this and the district hospitals gearing up, the penetration to the lowest level of the healthcare system in remote corners is practically impossible, and certainly not at the rate at which the virus spreads.
At this juncture, they can play a critical role in managing the epidemic and providing continuity of services. An investment in strengthening primary healthcare at these times will also go a long way in rejuvenating and creating resilient health systems.
India could find itself in an acute health crisis over the next few months and the direct cause of it will not be the SARS-CoV-2 virus. Hundreds of thousands of children might already have missed vital immunizations, shows a Mint analysis of the latest health ministry data. Thousands of adults may have missed potentially life-saving medical treatment as the novel coronavirus epidemic spread and a lockdown came into force. A range of hundreds of indicators shows a worrying disruption in India’s basic health services in March as local administrations focused on containing the spread of covid-19. These include curtailed immunization schedules, restricted inpatient, outpatient and emergency treatment for infectious and non-communicable diseases, reduced laboratory investigations, and lowered access to mental health treatment.
Sameer Bhati, Director – Star Imaging & Path Lab Ltd, New Delhi, said, “As per Rural Health Statistics 2018-19, the status of rural healthcare infrastructure as on March 31, 2019 stood at Sub centres at 1,57,411, which accounted for 75.3% in government buildings, Primary Health Centres at 24,855 that stood at 94.5% and Community Health Centres totalled to 5,335 with 99.3%.
The Covid-19 outbreak has exposed many things: the truth of our economy on the one side and the state of our healthcare system on the other. In spite of whatever GDP numbers, we have posted so far, the naked truth is that we are still far from providing suitable healthcare to crores of people at their native place.”
“This situation is a great lesson for all of us, that without developing rural India we cannot become a sustainable country. The health sector in rural India should be our prime objective. The three SC, PHC and CHC numbers need to be enhanced with the highest level of quality standards. If we have an effective rural healthcare system in our country, then there will be no need ever to get panicked in any way because of such pandemics or epidemics,” he said.
In rural India, where the number of Primary Health Centres (PHCs) is limited, studies show that 8% of the facilities do not have doctors or medical staff, 39% do not have lab technicians and 18% PHCs do not even have a pharmacist. Availability of medical equipment and essential disposables is a major challenge.
Government reluctance toward the health care appears in that the roughly 0.9% of the total gross domestic product is allocated for health care. Spending average 14% of the household income on health care by the poor house hold varying from 1.3% in Tamil Nadu to about 37% in Jalore (Rajasthan) suggests people’s reluctance toward health care putting it in a side corner than other priorities.
The chief minister of Andhra Pradesh government, Shri. YS Jagan Mohan Reddy, directed the officials to establish YSR Health Clinics at every village secretariat at the earliest.
At a review meeting of the healthcare sector on Friday, Reddy said better medical facilities round the clock at the village level while revamping the existing sub-centres as YSR Health Clinics will also help control spread of COVID-19 pandemic.
Reddy has directed the officials to set up seven super speciality hospitals in the tribal regions. Similarly, all states are on the way and must be prepared to raise their budgets on primary health care.
The need of the hour today demands the quick reformation and development in the primary Health Care in all the States of the country with immediate warrants and concrete steps to put an end to the ongoing tug of war between growth and human resource development.