Primary Healthcare in Developing Countries: A Focus on India

This essay explores the primary healthcare system in developing countries, with a focus on India. It discusses the demographic and epidemiological profile of India, the disease burden in the country, and the relationship between health and development. It also compares the healthcare systems in India and Australia, highlighting the challenges and strategies for improving primary healthcare in developing countries.

Running head: HEALTHCARE
Healthcare
Name of the Student
Name of the University
Author Note

HEALTHCARE
Introduction
According to Jamali and Carroll (2017), a developing country is a low-to-middle
income country (LMIC). These countries have weaker financial and industrial bases along
with lower qualities of life relative to the prevailing global norms. In other words it can be
said that classification of developing countries is done on the basis of poor levels of
industrialization and Human Development Index (HDI). A low HDI signifies that population
of that country have poor life expectancy, low educational attainment, higher fertility rates
and low per capita in comparison to the other countries. Majority of the countries in Africa,
Central Europe, Asia, Eastern Europe, South America and Central America are enlisted under
developing countries. The following essay is based on the primary healthcare in the
developing countries. The main developing country of focus will be India. The essay will
initiate with throwing light over the demographic and epidemiological profile, development
status and relevant social and political features of India. This will be followed by the main
population groups that are bearing the highest disease burden in India. The essay will also
identify the patterns in which the illness differs in wealthier nations like Australia while
understanding the relationship between health and development in developed and developing
countries.
Demography and Epidemiology of India
India, a developing country has an estimated population of 1.37 billion as per the
statistics highlighted by the United Nations in 2019. India is world's 7th largest country and
2aznd most populous country. As per the demographic data 72% are Indo-Aryan, 25% are
Dravidian and 3% or Mongoloids. Hinduism is the most common religion in India and this is
followed by Islam, Christians, Buddhists and Jains (All India Institute of Hygiene and Public
Health 2019). Top 10 causes of death in India as per Centre of Disease Control and

HEALTHCARE
Prevention (CDC 2019) include cardiovascular diseases, diarrheal diseases, neonatal
disorders, non-communicable diseases, chronic respiratory diseases, diabetes, mental
disorders, nutritional deficiencies, unintentional injuries and neoplasms. Arokiasamy (2018)
highlighted in their study that non-communicable diseases like diabetes, cardiovascular
disease, nutritional diseases, cancer and respiratory complications, is an important public
health problem in India causing high levels of mortality and morbidity. Changes in the
demographic structure, unhealthy lifestyle habits along with robust urbanization are the major
reasons behind the increased incidence of non-communicable diseases (NCDs) in India.
Disease burden and relation of socio-economic status
Cardiovascular diseases (CVD)
According to the World Health Organisations, at least 80% of the deaths occurring in
LMIC like India, occurs from cardiovascular disease. The main target population are the
people between the age group of 35 to 64 years. The percentage of death tolls is high both in
rural and in urban areas (Sekhri et al. 2014). However, Nag and Ghosh (2013) are of the
opinion that the people in urban areas are more prone towards getting affected with
cardiovascular diseases due to gap in health lifestyle management like unhealthy diet plan,
lack of physical activity and high consumption of alcohol and tobacco. Gupta et al.
highlighted that one of the fatal disease under the category of CVD is stroke and India has an
annual incidence of stroke between 100 to 150 people per 100,000 populations. Sekhri et al.
(2014) also evidenced that urbanization in India is leading to the increases incidence of stroke
by 17.5% during the last five years.
Diabetes Mellitus
India is currently experiencing an epidemic state of Type 2 Diabetes Mellitus
(T2DM). As per the reports of the International Diabetes Federation (IDF), at least 50.8

HEALTHCARE
million people in India are a victim of T2DM. Initially the people residing in the rural areas
are the main victims of the T2DM however, the survey conducted by the American Diabetes
Association highlighted that people residing in the urban areas of India are also becoming
victims of diabetes (Sosale et al. 2014). Kaveeshwar and Cornwall (2014) highlighted that
lack of proper disease awareness is the reason behind the high rate of occurrence of T2DM in
urban areas. On the other hand, poor lifestyle habits or sedentary lifestyles are reason behind
high rate of occurrence of T2DM in rural areas. Sosale et al. (2014) reported that rate of
incidence of diabetes is high in males in comparison to females.
Cancer
Nearly 56% of estimated deaths occur from cancer in the developing countries. In
India, tobacco related cancers constitute 40.43% of death among the make population.
Whereas in females the highest reported cases include the cervical cancer, breast and ovarian
cancer. While in female, the cancer occurrence is attribute to increase exposure to pollution
and poor lifestyle and in male, the cancer of the pulmonary organs like lung cancer,
oesophagus, pharynx and larynx cancer is mainly attributable to increased rate of smoking
that comes under the poor lifestyle habits (Mallath et al. 2014). Pramesh, Badwe and Sinha
(2014) reported in their study that lack of proper employment, financial crisis and social
exclusion is the reason behind higher occurrence of lung cancer and oral cancer in the rural
areas. In urban areas, constant exposure to pollution and the fever of urbanization have made
urban female population of India to become victims of ovarian and cervical cancers.
Infectious Disease in India
Laxminarayan and Chaudhury (2016) reported that reported that increase in the
outbreak of the infectious diseases in India is mainly attributed to incomplete usage of the
antibiotic dosage for the management of the infectious diseases or use of the broader

HEALTHCARE
spectrum antibiotics for the treatment of specific viral or bacterial diseases. Moreover,
increase in the access of the over-the counter medication has lead to the increased occurrence
of the infectious or communicable disease like tuberculosis, typhoid, influenza, malaria.
Apart from the antibiotic resistance, India is also experiencing high rate of occurrence of
other infectious diseases like dengu, chikungunya, zika, nipah virus and Meningococcal
disease (World Health Organization 2019). Study conducted by Clasen et al. (2014)
highlighted that in comparison to the urban areas, the rural areas of India mainly experience
high level of disease burden coming from the infectious disease. For example, rural states of
India like Bihar, Jharkhand, Chattisgarh, West Bengal and Rajasthan lack proper sanitization
programme leading to an increase in the spread of the diseases like diarrhoea, soil transmitted
helminth infection. Das et al. (2015) reported that increased in the rural areas the post
menstrual women suffer from lack of sanitization leading to increased spread of Candida
infections. Clasen et al. (2014) also reported that apart from lack of proper sanitization, the
people who are residing in the rural areas of India suffers from lack of proper immunization
and nutrition (mainly the children) and thus increasing the disease burden of infectious
disease in rural areas of India.
Social Determinants of Health and Disease Burden in India
The systematic review conducted by Allen et al. (2017) highlighted that in spite of
having heterogeneity in the overall exposure along with outcome measurement, clear
evidence highlights that the overall burden of the behavioural risk factors is affected by the
socio-economic position within LMIC. The population groups that are victims of the high
disease burden in India include the children and the infants in the rural areas of Bengal. They
are mainly the victims of the infectious or communicable disease. The people in the urban
areas are the victims of the communicable diseases. However, the rate of mortality and

HEALTHCARE
morbidity arising from the non-communicable diseases in the urban areas of India are
significant less in comparison to the population residing in the rural areas. Overall it can be
said that apart from wide range of the heterogeneity, in the disease burden across different
regions, both the communicable and non-communicable disease in India is one of the leading
cause of death in the poor states or the rural areas of India. The progression towards the
epidemic is mainly characterised by the negative relationship with the socio-economic
gradients like use of tobacco, poor intake of fresh fruits and vegetables. Moreover, the
population hailing from the poor socio-economic status also fails to receive the standard
therapy leading to poor disease outcomes (Prabhakaran, Jeemon and Roy 2016). Apart from
the poor socio-economic status, Faizi et al. (2016) reported that developing countries like
India lack proper primary healthcare setup in the rural or the remote areas with proper
person-centred approaches leading to high prevalence of disease burden in Indian rural and
remote areas.
Australian Health Care System and Indian Health Care System in Primary Health Care
Primary Healthcare is an evidence-based priority. However, it is inadequately
supported in the majority of the developing countries. Ironically, on one side it can be stated
that India is a popular destination for the medical tourism due to easy affordability of high
quality healthcare, and on the other hand it can be said that poor health and healthcare are the
main reasons before become poor via traps of the medical poverty. In in-spite of this fact,
India is surprisingly committed towards “Health for All by 2020”. However, India is failing
miserably to achieve the same due to increased political unrest, corruption, lack of proper
support from the ruling government and other unwanted state affairs (Faizi et al. 2016). ()
reported that in developing countries like India, the main barriers towards effective
implementation of the primary healthcare in order to reduce the disease burden is lack of

HEALTHCARE
trained professionals. In India the percentage of doctors is extremely less in comparison to
the ailing population in the rural areas. Moreover, India also lags proper trained nursing
professionals who are one of the prime pillars of the primary healthcare. There is also a lack
of evidence-based practice, person-centred care approach and trascultural nursing in India
that further creates a gap in effective implementation of the primary healthcare services for
the reduction of the disease burden (Mills 2014). Australian Government Department of
Health (2014) plan for the effective implementation of the primary healthcare highlights
person-centered strategy for the effective implementation of the primary healthcare service.
Other specific approaches include improving the overall access to the primary healthcare
while reducing the health-equity, effective management of the chronic health conditions,
increasing the overall focus on prevention and quality of the health care. Eckersley (2015)
reported that Australia too suffers for health inequality. The main victims of the health
inequality are the Aboriginals and the Torres Strait Islanders. However, the Australian
government has taken pro-active approach in reducing this health inequality by
implementation of the primary healthcare strategy, Close the Gap: Indigenous Health
Campaign. This campaign is mainly lead by the Australian Human Rights Commission for
reducing the health inequalities among the Aboriginals and the Torres Strait Islanders. This
primary healthcare strategy is based in person-centered community based approaches for the
prevention of both communicable and non-communicable diseases in Aboriginals and the
Torres Strait Islanders. Australian government has set-up primary healthcare set-up in the
rural areas of Australia. Where early detection and effective implementation of the
interventions is done in order to reduce the disease burden among the Aboriginals and the
Torres Strait Islanders. Moreover, the government of Australia has also taken pro-active
approaches for including culturally and linguistically diverse nurse (CLAD) in the nursing
team in order to overcome the communication barrier and promote effective health education

HEALTHCARE
among Aboriginals and the Torres Strait Islanders and thus reducing the disease burden and
health-inequalities (Australian Human Rights Commission 2019).
Cornwall (2014) reported that technology is an important issue in primary healthcare
and at present it is becoming increasingly affordable under the use of the mobile phones that
allows 24x7 access of internet. Patient’s now have easy access of the ever-increasing number
of healthcare sites and information. This easy access of internet and technological
advancement under the Australian Healthcare system is helping Australia to reduce the
disease burden and health inequalities. Kuhn et al. (2014) reported that in order to reach put
to the people residing in the remote areas the government of Australia is making use of the
tele-health services and triage nursing. This is not only helping the healthcare system
professionals to reduce the rates of the unwanted admission to the hospitals but at the same
time helping them to promote effective self-management of the disease and early disease
diagnosis. Moran (2016) stated that developing countries like India, that fall under the LMIC
lack from proper funding in order to make use of the technological advancement in the
healthcare. Moreover, in India, there is a lack of proper-trained nursing professionals and
CLAD nurses and this further reduces the healthcare access in the rural areas. Mithal, Bansal
and Kalra (2015) reported that in India T2DM and Gestational Diabetes is the major
healthcare concern in the rural areas of the developing countries like India. However, India
government has used education campaign and disease awareness program, the overall
outcome is poor. The reason behind this, the majority of the people residing in the rural
regions of India are illiterate. Such that use of poster campaigns fails to generate proper
results. Moreover, the lack of proper access to the internet services creates a barrier in
promotion of the social media services. Mithal, Bansal and Kalra (2015) also report that
women in the rural areas of India are more comfortable with the midwives in order to discuss
their pregnancy related healthcare concerns. However, in the rural areas there is lack a of

HEALTHCARE
trained midwives leading to gap in-knowledge. Kane, Calnan and Radkar (2015) reported
people in India who belongs to the minority class like the people from the Islamic origin
suffers from trust issues with the primary healthcare providers leading to increase in the
disease burden and lack of effective implementation of the healthcare services. In Australia
however, the application of the transcultural nursing principle and increase in the recruitment
of the CALD nurses and aboriginals nursing workforce in the rural areas is helping to spread
the disease awareness and thus reducing the disease burden from infectious diseases and
increases access to healthcare (Charles et al. 2014). Kane, Calnan and Radkar (2015) stated
that in India there is lack of funding and proper educational support in the medical education
that is creating a barrier in the effective recruitment of CLAD nurses.
Conclusion
Thus from the above discussion, it can be concluded that rural population of India is
the main target of the disease burden. The main disease burden includes both increased
prevalence of the communicable and non-communicable diseases in the rural and the remote
areas of India. However, in comparison to the developed country like Australia, the primary
healthcare setup of India lacks proper funding, properly trained healthcare professionals and
proper use of the technological advancement and use of the evidence-based practices. Thus
from the perspective of the primary healthcare delivery of the Australian Government
Department of Health, it can be highlighted that in order to prevent the spread of the
epidemic or reduce the health inequalities in rural areas of India, the Government of India
must follow the path of Australian Healthcare system like effective formulation and
implementation of evidence-based policy, reinforcement of the proper healthcare services in
remote areas while giving emphasis on the early detection, treatment and prevention of the

HEALTHCARE
diseases by the use of both conventional and innovative approaches under community health
set-up (Prabhakaran, Jeemon and Roy 2016).

HEALTHCARE
References
All India Institute of Hygiene and Public Health. 2019. Department of Epidemiology. Access
date: 29th April 2019. Retrieved from: http://aiihph.gov.in/department-of-epidemiology/
Allen, L., Williams, J., Townsend, N., Mikkelsen, B., Roberts, N., Foster, C. and
Wickramasinghe, K., 2017. Socioeconomic status and non-communicable disease
behavioural risk factors in low-income and lower-middle-income countries: a systematic
review. The Lancet Global Health, 5(3), pp.e277-e289.
Arokiasamy, P., 2018. India's escalating burden of non-communicable diseases. The Lancet
Global Health, 6(12), pp.e1262-e1263.
Australian Government Department of Health. 2014. Primary Health Care Research,
Evaluation and Development (PHCRED) Strategy: Phase three: 2010-2014. Access date: 29th
April 2019. Retrieved from:
http://www.health.gov.au/internet/main/publishing.nsf/Content/phcred-strategy-publication
Australian Human Rights Commission. 2019. Close the Gap: Indigenous Health Campaign.
Access date: 29th April 2019. Retrieved from:
https://www.humanrights.gov.au/our-work/aboriginal-and-torres-strait-islander-social-
justice/projects/close-gap-indigenous-health
Charles, L., Maltby, H., Abrams, S., Shea, J., Brand, G. and Nicol, P., 2014. Expanding
worldview: Australian nursing students’ experience of cultural immersion in
India. Contemporary nurse, 48(1), pp.67-75.
Clasen, T., Boisson, S., Routray, P., Torondel, B., Bell, M., Cumming, O., ... & Ray, S.
(2014). Effectiveness of a rural sanitation programme on diarrhoea, soil-transmitted helminth

HEALTHCARE
infection, and child malnutrition in Odisha, India: a cluster-randomised trial. The Lancet
Global Health, 2(11), e645-e653.
Cornwall, J., 2014. The future of primary healthcare in Australia: Where to from here?. The
Australasian medical journal, 7(2), p.78.
Das, P., Baker, K. K., Dutta, A., Swain, T., Sahoo, S., Das, B. S., ... & Mishra, P. R. (2015).
Menstrual hygiene practices, WASH access and the risk of urogenital infection in women
from Odisha, India. PloS one, 10(6), e0130777.
Eckersley, R., 2015. Beyond inequality: Acknowledging the complexity of social
determinants of health. Social Science & Medicine, 147, pp.121-125.
Faizi, N., Khalique, N., Ahmad, A. and Shah, M.S., 2016. The dire need for primary care
specialization in India: Concerns and challenges. Journal of family medicine and primary
care, 5(2), p.228.
Jamali, D. and Carroll, A., 2017. Capturing advances in CSR: Developed versus developing
country perspectives. Business Ethics: A European Review, 26(4), pp.321-325.
Kane, S., Calnan, M. and Radkar, A., 2015. Trust and trust relations from the providers’
perspective: the case of the healthcare system in India. Indian journal of medical
ethics, 12(3), pp.157-168.
Kaveeshwar, S.A. and Cornwall, J., 2014. The current state of diabetes mellitus in India. The
Australasian medical journal, 7(1), p.45.
Kuhn, L., Page, K., Rolley, J.X. and Worrall-Carter, L., 2014. Effect of patient sex on triage
for ischaemic heart disease and treatment onset times: a retrospective analysis of Australian
emergency department data. International emergency nursing, 22(2), pp.88-93.

HEALTHCARE
Laxminarayan, R. and Chaudhury, R.R., 2016. Antibiotic resistance in India: drivers and
opportunities for action. PLoS medicine, 13(3), p.e1001974.
Mallath, M.K., Taylor, D.G., Badwe, R.A., Rath, G.K., Shanta, V., Pramesh, C.S., Digumarti,
R., Sebastian, P., Borthakur, B.B., Kalwar, A. and Kapoor, S., 2014. The growing burden of
cancer in India: epidemiology and social context. The Lancet Oncology, 15(6), pp.e205-e212.
Mills, A., 2014. Health care systems in low-and middle-income countries. New England
Journal of Medicine, 370(6), pp.552-557.
Mithal, A., Bansal, B. and Kalra, S., 2015. Gestational diabetes in India: Science and
society. Indian journal of endocrinology and metabolism, 19(6), p.701.
Mithal, A., Bansal, B. and Kalra, S., 2015. Gestational diabetes in India: Science and
society. Indian journal of endocrinology and metabolism, 19(6), p.701.
Moran, M., 2016. The grand convergence: closing the divide between public health funding
and global health needs. PLoS biology, 14(3), p.e1002363.
Nag, T. and Ghosh, A., 2013. Cardiovascular disease risk factors in Asian Indian population:
A systematic review. Journal of cardiovascular disease research, 4(4), pp.222-228.
Prabhakaran, D., Jeemon, P. and Roy, A., 2016. Cardiovascular diseases in India: current
epidemiology and future directions. Circulation, 133(16), pp.1605-1620.
Pramesh, C.S., Badwe, R.A. and Sinha, R.K., 2014. The national cancer grid of India. Indian
journal of medical and paediatric oncology: official journal of Indian Society of Medical &
Paediatric Oncology, 35(3), p.226.

HEALTHCARE
Sekhri, T., Kanwar, R.S., Wilfred, R., Chugh, P., Chhillar, M., Aggarwal, R., Sharma, Y.K.,
Sethi, J., Sundriyal, J., Bhadra, K. and Singh, S., 2014. Prevalence of risk factors for coronary
artery disease in an urban Indian population. BMJ open, 4(12), p.e005346.
Sosale, A., Kumar, K.P., Sadikot, S.M., Nigam, A., Bajaj, S., Zargar, A.H. and Singh, S.K.,
2014. Chronic complications in newly diagnosed patients with type 2 diabetes mellitus in
India. Indian journal of endocrinology and metabolism, 18(3), p.355.
World Health Organization. 2019. Emergencies preparedness, response. Access date: 29th
April 2019. Retrieved from: https://www.who.int/csr/don/archive/country/ind/en/