Have India’s health centres really ‘collapsed’?

In the news

Public health centres in India have long been shrouded in infamy, perceived as symbols of systemic failure.
The effectiveness of primary healthcare in India has always been a topic of discussion, with calls for strengthening these services through government commitment to accessibility, affordability, and quality care.

Q. “Besides being a moral imperative of a Welfare State, primary health structure is a necessary precondition for sustainable development.” Analyse.

Primary Health Centres (PHCs) also known as Public HCs play a crucial role in providing comprehensive healthcare services to the population.
The first PHC in India was established following the proposal of the PHC concept in a paper submitted to the Executive Board of the World Health Organization (WHO) in January 1975.
The establishment of PHCs gained further momentum with the International Conference on PHC held in Alma Ata, Kazakhstan in 1978.
They are a fundamental component of the healthcare system, with Medical Officers at these centers required to hold an MBBS degree.
India boasts a vast public health infrastructure with 23,391 PHCs and 145,894 sub-centers, serving a substantial percentage of the population.
PHCs cover a significant portion of outpatient care, including services for non-communicable diseases, maternal health, and child health.

Foundational Role: Health centres form the backbone of India’s public health system, providing primary care to millions.
Access and Affordability: With nearly two lakh centres across the country, they aim to offer accessible and affordable healthcare, particularly in rural areas.
Impact on Equity: Effective health centres can mitigate social and health inequities, reducing reliance on costly private healthcare and preventing households from falling into poverty due to healthcare expenses.

Evidence of Progress: Surveys conducted across five states reveal a pattern of improving quality and utilization of health services over time, albeit at a slow pace.

1. In Himachal Pradesh, functional health centres serve 83% of the population.
2. Chhattisgarh has shown a radical expansion in the public provision of healthcare, with increased facilities, medicines, and staff presence.
3. Bihar lags behind, with dismal quality of health centres and some sub-centres being dormant or non-existent.

Policy Interventions: Increased health expenditure, initiatives like the National Rural Health Mission, and state-specific schemes have contributed to incremental improvements.
1. The share of health expenditure in the Union Budget increased drastically.
2. The National Health Mission’s share shrank from 69% to 44%, while allocations for the Ayushmann Bharat program and new AIIMS hospitals surged.
3. COVID-19 led to a sustained increase in patient utilization of public health facilities, indicating growing trust in the system.

Underutilization: Despite improvements, health centres still face challenges such as high staff absenteeism, limited services, and poor infrastructure.
Lacunas: Health workers report irregular flow of funds, lack of facilities like toilets and transport, and inadequate supply of drugs and testing equipment.
Social Discrimination: Caste and gender dynamics influence access to and quality of healthcare, perpetuating inequalities. Upper-caste doctors display disparaging attitudes towards marginalized communities, while upper-caste families disrespect Dalit ANMs.
Gender Disparities: Women, particularly frontline health workers, play a crucial role in rural health settings but often face neglect and discrimination.

Holistic Investment: While progress has been made, it remains patchy, with allocations often prioritizing tertiary healthcare over primary care.
Designated allocations: The composition of the healthcare budget has remained stagnant, with minimal increases in the share allocated to primary healthcare.
Policy Reform: The paper advocates for substantial support from the central government to enable poorer states to replicate successful initiatives and enhance the role of health centres in public healthcare delivery.

India’s health centres, though fraught with challenges, embody resilience and potential.
By addressing systemic gaps and prioritizing primary healthcare, the nation can harness the transformative power of these centres to achieve equitable and accessible healthcare for all.