Comprehensive Primary Health Care in India: A Detailed Analysis

This report provides a comprehensive analysis of primary health care (PHC) in India, focusing on its role in the healthcare system and the factors that influence its implementation. It examines the importance of equitable distribution of health services, community participation, inter-sectoral coordination, and appropriate technology in PHC. The report also delves into the challenges faced by the Indian healthcare system, including the rise of chronic and non-communicable diseases, the increasing elderly population, and the HIV/AIDS pandemic. Furthermore, it discusses the rigid healthcare structure and disparities between rural and urban areas. The report highlights the crucial role of the government in addressing these challenges and improving health equity, while also acknowledging the contributions of both public and private sectors. The analysis covers the structure of the healthcare system, including Primary Health Centers (PHCs) and Community Health Centers (CHCs), providing a detailed overview of the current state and future prospects of PHC in India.

Running Head: PRIMARY HEALTH CARE 1
Comprehensive Primary Health Care
Name:
Institution:

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Introduction
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).
Role of Comprehensive PHC Approach to Health System in India
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.

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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).
2. 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)
3. 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.
4. Appropriate Technology
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).

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Factors Facilitating and Constraining the Implementation of Comprehensive PHC
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).
2. 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).

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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.
3. Increase in the Chronic and Non-communicable Diseases
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

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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
Noncommunicabl
e
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

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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.
4. 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).

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5. HIV/AIDS Pandemics
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).
6. Extremely Rigid Healthcare System

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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.
Structure of the Healthcare System in India
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).

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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.
2. 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

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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).
3. 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.
4. 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.
The relevance of the Comprehensive PHC Approach in India
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.
2. 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

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(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.
3. 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).
4. 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.
Future Potential of Comprehensive PHC Approach to Health in India
1. UK-India partnership