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Chapter: Sociology of Health : Health services

Challenges for Primary Healthcare System in India with few suggested remedies

Delivering quality primary care to large populations is always challenging, and that is certainly the case in India.

Challenges for Primary Healthcare System in India with few suggested remedies:


Delivering quality primary care to large populations is always challenging, and that is certainly the case in India. In India, communicable diseases, maternal, perinatal, and nutritional deficiencies continue to be important causes of deaths. Noncommunicable diseases like diabetes, cardiovascular diseases, respiratory disorders, cancers, and injuries are showing the rising trends.


Mental health disorders are also on the rise also taking a substantial toll of human lives.




The health issues related to elderly population are common due to increase in life expectancy. Within the next few decades, we will see an extraordinary increase in the number of older people worldwide. The public health benefit of preventive medicine in old age comes from the compression of the time spent in dependency to a minimum. The rising morbidities clearly showed that a regular, complete health checkup of the elderly should be embedded in the essential elements of the primary healthcare.


India has been witnessing rapid urbanization particularly in recent decades. Currently onefourth of the urban population lives in slums with severely compromised health and sanitary conditions.



It has been observed that there is poor level of client satisfaction in rural as well as urban areas of India regarding primary healthcare services.


Client satisfaction is an important measure of the quality of healthcare and needs to be addressed in order to improve the utilization of primary healthcare services. Patients often complain of rude and abrupt health workers that discriminate against women and minorities from scheduled castes or tribes.



The current primary healthcare infrastructure and manpower is also deficient. According to Rural Health Survey (RHS) 2011, as on March 2011 there are 148,124 subcenters; 23,887 PHCs; and 4,809 community health centers (CHCs) functioning in India.

The norms set for the population coverage for subcenter, PHC, and CHC for plane areas are 5,000; 30,000; and 120,000; respectively. As per RHS, 2011 the average population covered by a subcenter, PHC, and CHC was 5,624; 34,876; and 173,235; respectively. As on March, 2011 the overall shortfall in the posts of health worker (female (F))/auxiliary nurse midwife was 3.8% of the total requirement. For allopathic doctors at PHCs, there was a shortfall of 12.0% of the total requirement for existing infrastructure as compared to manpower in position. Similarly, in case of health worker (male (M)), there was a shortfall of 64.7% of the requirement. In case of health assistant (female)/lady health visitor, the shortfall was 38% and that of health assistant (male) was 43.3%. For allopathic doctors at PHC, there was a shortfall of 12.0% of the total requirement. As compared to requirement for existing CHC infrastructure, there was a shortfall of 75% of surgeons, 65.9% of obstetricians and gynecologists, 80.1% of physicians, and 74.4% of pediatricians. Overall, there was a shortfall of 63.9% specialists at the CHCs as compared to the requirement for existing CHCs.


As per 2011 census, India's population is more than 121 crores. 83.3 crores (68.84%) of Indians live in rural areas. Considering the population norms for PHC of 30,000 in plane areas (here the population norms for PHC of 20,000 for tribal and hilly areas is not considered), India requires more than 27,700 PHCs. So when compared with RHS, 2011; India requires 3,800 more PHCs.



There is urgent need to address inadequate infrastructure as well as manpower for better service and delivery of primary healthcare. Only after addressing these issues we can think of applying Indian Public Health Standards to all healthcare infrastructures.


The current primary healthcare structure is extremely rigid, making it unable to respond effectively to local realities and needs. The lack of resources, which is acute in some states, is certainly a contributing factor to the poor performance of the primary healthcare system.



There is a need to explore and understand the reasons that prompt people to visit health facilities and the reasons driving them away from free government care.


Ubiquitous absenteeism, low clientprovider interaction, poor referral systems, and a low perceived quality of care could emerge as possible reasons for this situation.



Large diversity in India calls for local adaptation of the basic healthcare package and its delivery mechanism.

The question confronting health systems in India is how best to reform, revitalize, and resource primary health systems to deliver different levels of service aligned to local realities, ensuring universal coverage, equitable access, efficiency and effectiveness, through an empowered cadre of health personnel.



To encourage accountability, access should be monitored at district level by an independent agency.


There is growing need of research in improving the service delivery of primary healthcare.



Qualitative research into this area could yield lessons for the delivery of future services. Research into factors influencing service utilization could lead us to developing a public health marketing strategy for care access.


A conjoint effort by the state and the institutes can thus be used to reinvent primary healthcare and bring it to the forefront.


Several opportunities can be explored within the facilitating atmosphere of National Rural Health Mission (NRHM).


Thus, it is evident that the success of health systems exists in tapping the existing potential and making appropriate structural changes.



The role of primary care should not be defined in isolation but in relation to the constituents of the health system.


The Millennium Development Goals (MDGs) which include eight goals were framed to address the world's major development challenges with health and its related areas as the prime focus. In India, considerable progress has been made in the field of basic universal education, gender equality in education, and global economic growth. However, there is slow progress in the improvement of health indicators related to mortality, morbidity, and various environmental factors contributing to poor health conditions.



As rightly mentioned by Nath, even though the government has implemented a wide array of programs, policies, and various schemes to combat these health challenges,further intensification of efforts and redesigning of outreach strategies is needed to give momentum to the progress toward achievement of the MDGs.



India's progress towards achieving MDGs is slow and it is evident that role of primary healthcare is essential in the progress towards achieving them. To conclude, the primary healthcare system in India has evolved in due course of time but the challenges of future are needed to be addressed effectively to achieve the MDGs.


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