Comprehensive Primary Health Care Approach: of India - Case Study Example

Comprehensive Primary Health Care Approach India Introduction The Constitution of India envisions the founding of an innovative social order based on equal opportunity, liberty, fairness and the dignity of the human being. It aspires at the eradication of poverty, lack of knowledge and infirmity and give direction to the State to consider the increase of the level of nutrition and the standard of living of its people and the development of public health as amongst its most important responsibilities, securing the health and strength of employees, men and women, particularly making sure that children are given opportunities and amenities to grow in a healthy ambiance. Ever since the commencement of the development process in the nation, the consecutive Five Year Plans were making the agenda that the States may build up their health services system, amenities for medical education, research, and so forth. Such direction required to be supplied through the negotiations and decisions taken at in the Joint Conferences of the Central Councils of Health and Family. In addition, Central legislation has been endorsed to control standards of medical education, avoidance of food tarnishing, upholding of standards in the production and sale of licensed drugs, and so on. Even as the large strategies enclosed in the consecutive Plan documents and dialogue in the meetings may perhaps have usually served the requirements of the state of affairs in the past, it is considered that an incorporated, complete strategy towards the future progress of medical education, research and health services needs to be setup to provide the genuine health needs of the country. Under this background it is considered that to evolve a National Health Policy (pharmaceuticals.indiabizclub.com, ND). The Main Features of Primary Health Care The essential qualities of primary care are: accessibility, individual focused preventive and curative care, patient-oriented comprehensiveness and management. In addition to taking care of the requirements of the persons, primary health care teams are also looking at the society, particularly when dealing with social determinants of health. And as well significant is the communication of the team with diverse systems, for example education, work, finance, accommodation that are related to key sectors. With these methods, primary health care teams endorse health equity through the involvement to improved social unity and authority. The basis for the benefits for primary care for health has been found in better access to required services, improved quality of care, a superior focus on prevention, early management of health problems, the increasing outcome of the main primary care delivery uniqueness, and the responsibility of primary care in dropping needless specialist care. When the primary health care system functions as a guide through secondary and tertiary care and other sectors, it can be a tactic for attaining cost-effectiveness (De Maeseneer, et.al.2007). Demographics: India India is the second biggest nation considering the population size. India has population of 1.1 billion that is corresponding to 16% of total world population. Approximately 70% population of lives in villages and is working in primary sector. India is a secular democracy more or less all the religions of world can be seen in this country. India’s literacy rate is 65.38% as per 2001 census. However this rate is not uniform and may differ according to region, religion and gender. Urban literacy rate is higher than rural and also male literacy rate is more than the female literacy rate. There are 22 officially recognized languages spoken in different regions of the country. Hindi is considered as the official language of the country and English as second official language (Mapsofindia.com, 1999). Diarrhea in India Diarrhea disease is a major health problem in India especially among children below five years of age. A study was conducted in a primary health care centre in Faridabad district of the state of Haryana in India. Formative study identified views of caregivers concerning childhood diarrhea, causation and management, care seeking sources and caregivers expectations from healthcare providers. Caregivers in households with children under 5 years old were interviewed in a cross sectional survey to ascertain family features, Oral Rehydration Salts (ORS) prescription and use rates, drug prescription rates by healthcare providers and other medical practitioners. An intervention that incorporated caregiver education on the use of zinc and ORS during childhood diarrhea and provision of both zinc and ORS by health care providers to caregivers was linked with considerable health benefits to children. These benefits incorporated decrease in the occurrence of diarrhea and pneumonia. The intervention as well caused an easier access to diarrhea case management within the village itself, decrease in the use of unnecessary oral and injection drugs during diarrhea and reduction in the costs for care of diarrhea to the family. ORS use increased considerably in the intercession areas, and there was no sign that use of zinc during diarrhea compromised the use of ORS, which is the core of diarrhea treatment. The inclusion of private providers in the program was a significant reason in achieving high rates of intervention fulfillment. The decrease in the use of unnecessary drug treatment in diarrhea may have caused from the more frequent use of health care workers for basis of treatment, and drop in diarrhea morbidity. The decrease in medicine prescriptions by private providers is reliable with provider attitude that prescribing zinc and ORS in concert would be perceived by families of affected children as nearer to their hope of a suitable treatment package.This study shows that an intervention to progress diarrhea treatment with ORS and zinc is practicable and greatly acceptable in rural Indian communities. The outcomes of health benefits are significant and gifted with a decrease in the cost to families for diarrhea treatment from present practice. Additionally this intervention should be given main concern in India and other nations with elevated disease burden as of diarrhea and pneumonia (Bhandari, et. al. 2008) The present scenario Since Independence, substantial growth has been attained in the promotion of the health condition of India’s people. The diseases like smallpox have been eradicated; plague is no longer a problem; death from cholera and associated illness has reduced and malaria brought under control. The death rate per thousand of population has been reduced from 27.4 to 14.8 and the life expectancy at birth has improved from 32.7 to over 52. Comparatively wide-ranging network of dispensaries, hospitals and organizations offering dedicated healing care has developed and a large stock of medical and health personnel, of various levels, has become available. Significant native capability has been built up for the manufacture of drugs and pharmaceuticals, vaccines, and hospital equipment. Despite such notable progress, the demographic and fitness depiction of the country still represents basis for a grave and burning concern. The soaring rate of population increase encompasses an adverse result on the health of the people and the quality of their living standard. The high mortality rates among women and children are still frightening. Approximately one third of the total deaths happen among children below the age of 5 years; infant mortality is around 129 per thousand among the newborn. The efforts of increasing the nutritional levels for the people have not yet realized and the degree and harshness of malnutrition go on to be very high. Communicable and non- communicable ailments have not effectively brought under control and eliminated. Loss of sight, leprosy and T.B. are still having a high occurrence. Merely 31% of the rural populations have access to a clean water supply and 0.5% enjoys basic sanitation. There are incidence of diarrhea diseases and other preventive and contagious diseases, particularly among infants and children. Scarcity of safe drinking water and poor sanitation, poverty and lack of knowledge are among the major causes of the high occurrence of ailment and mortality. The present circumstances has been mainly produced by the health development strategies and the institution of healing centers based on the Western models, which are unsuitable and inappropriate to the actual needs of the people and the socioeconomic conditions prevailing in the country. The hospital-based treatment and cure approach towards the formation of medical services has offered benefits to the upper class of people; particularly those live in in the city areas. This strategy has been at the cost of offering comprehensive primary health care services to the whole populace, whether residing in city or village areas. Additionally, the sustained high stress on healing care has led to the neglect of disease avoidance, health promotion, public health and rehabilitative features of health care. The offered strategy, instead of providing consciousness and building self-reliance, has been inclined to improve dependence and deteriorated the community's capability to cope with its troubles. The present plans concerning education and training of medical and health personnel, at different stages, has caused increase of a cultural gap linking the people and the staff providing care. The diverse health plans have abortive to engage persons and families in creating a self-reliant society. In previous years, the policy maker were mainly unaware of the fact that the crucial goal of attaining the acceptable health status for all the people cannot be achieved without linking the society in the identification of their health requirements and precedence’s. In the same way, the accomplishment and running of the diverse health and associated agendas cannot be attained without the commitment of the people for whom they are intended. India’s goal for attaining ‘Health for All by the Year 2000’ through the universal provision of comprehensive primary health care services could not realize. However, this require a systematic renovation of the existing strategies towards education and training of medical and health workers and the restructuring of the health services. In addition, it is essential to secure the whole incorporation of all policies for health and human progress with the general national socioeconomic growth procedure. This is particularly proper in the health linked areas concerned with the preservation of values and the production of drugs and sales of pharmaceuticals. This as well applicable to farming, food production and preservation of the ecosystem, village progress, education and social welfare, accommodation, water supply and sanitation and the avoidance of food tarnishing. It is essential that the ideology of the National Health Policy have to go on to advance within an entirely incorporated planning structure that offer collective, comprehensive primary health care services, pertinent to the real requirements and precedence of the society and at a price that the public can afford. Simultaneously must make sure that the planning and execution of the different health agendas is all the way through the planned participation and contribution of the society, effectively using the services provided by private voluntary institutions that are dynamic in the health region (Sheriff, & Roberts, 2001). The Alma Ata Declaration 1978 The Alma Ata Declaration in the year 1978 bestowed awareness into the understanding of primary health care. It visualized health as a vital part of the socioeconomic progress of a nation. It offered the real knowledge to health and the outline that States required to follow to attain the objectives of growth. The Declaration suggested that primary health care must comprise as a minimum of: education relating to existing health problems and techniques of identifying, averting and controlling them; support of food supply and appropriate nutrition, and sufficient supply of safe water and necessary sanitation; motherly and child health care, as well as family planning; vaccination against major contagious diseases; avoidance and control of prevalent diseases; suitable treatment of common ailments and injuries; support of psychological health and provision of necessary medicines. India accepted the welfare state policy after its independence. Like the majority of post-colonial nations, India as well endeavored to streamline its model of investment. India's leaders visualized a national health system in which the State would have a leading responsibility in deciding priorities and funding, and offer services to the people. ‘If it were feasible to evaluate the loss, which this country yearly suffers through the preventable ravage of precious human material and the reducing of human effectiveness through undernourishment and avoidable morbidity that the consequence would be so shocking that the entire nation would be stirred up and would not rest until a drastic transform had been brought about' (Bhore Committee Report, 1946). This is the first planned set of health care information for India. The poor health condition was ascribed to the occurrence of: in-sanitary conditions; starvation and under nutrition causing high child and maternal mortality rates; insufficiency of the existing medical and preventive health institutions; lack of regular health education; joblessness and poverty that created bad effects on health and caused scarce nourishment; inappropriate accommodation and lack of medical care. Inter sectoral connections were well explained with nutrition, accommodation and employment as indispensable precursors for wellbeing. It considered that the health system in India must be developed on the basis of preventive health work and proceeds in association with the management of medical relief. The Committee suggested a health services system established on the needs of the people, the bulk of whom were underprivileged and poor. The Committee understood that huge sections of the people were living under the standard subsistence level and they could not pay for or contribute to the health care system. Hence it was decided that medical cares would have to be offered free to every one at the point of delivery and those who could afford to pay should pay by the system of taxation. According to Bhore Committee Report 1946, it was very clear that no person should fail to get enough medical care, remedial and preventive because of the incapacity to pay for it. The committee suggested that State Governments must spend at least 15% of the revenues on health aspects. The recommendations of the Bhore Committee Report was appreciated and observed that it was ‘of the greatest significance' (Banerji, 1985). The Eighth Plan (1992-97) noticeably promoted private initiatives, private hospitals, clinics and appropriate proceeds from tax incentives. With the start of structural modification programs and cuts in social sectors, extreme importance was given to vertical programs for example those for the control of AIDS, tuberculosis, polio and malaria financed by multilateral organizations with specific goals and conditions attached. The National Health Policy (2002) comprises all that is required from an advanced outlook and yet it looks over the idea of NHP 1983 to defend and offer primary health care to all. The Policy document talks of incorporation of vertical programs, intensification of the infrastructure, offering collective health services, delegation of the health care delivery system through panchayati raj institutions (PRIs) and other independent organizations, and guidelines for private health care, however fall short to specify how it attains the objectives (Nundy, M. ND). Revival of primary healthcare strategy for encouraging health, safeguarding the environment, preventing disease and making healthcare available to every one has become a big challenge. Facing such up-coming challenges, primary healthcare models and approaches need to be re-stressed. The Health Field Concept, (Lalonde, 1974) Alma Ata Declaration, the environmental Perspective and Health Promotion Strategy have enhanced the discipline. Shelter, food, water, income, a stable ecology, social fairness and impartiality are the basic necessities for human survival. The community physicians have to promote constantly for social action to accomplish these basics and intercede among diverse interests of society in order to permit people to attain their complete health potential. In this respect, the United Nations Millennium Development Goals provide a complete outline for action (un.org/millenniumgoals, 2008). The contemporary information technology, which has led to the shrinkage of space and time, must be exploited for encouragement, social mobilization and for creating coalition at society, nationwide and global levels. Learning chances must be improved for the making of socially approachable health labor force. Adequate number of positions ought to be made for them in the public health system so that all improvement plans are evaluated for their impact on populace health and the State can carry out its leadership function more efficiently in order to attain the objective of right to health and healthcare for every one in the future. In recent times, the National Commission on Macroeconomics and Health has as well offered a plan for the provision of comprehensive primary and secondary healthcare to the Indian populace (Ministry of Health and Family Welfare, 2005). Nevertheless, the dispute is to assign adequate capital. India consumes approximately 4.6% of its gross domestic product (GDP) for healthcare although the majority of the spending is privately done by the people as the government spends only 0.9% of the GDP on health (National Health Accounts Cell, 2005). Comparing many developing countries, this is very low and has been waning; however a change has happened recently. The Government of India has intended to increase health-spending to 2 - 3% to finance the National Rural Health Mission, (Ministry of Health and Family Welfare, 2005) which is a progressive step towards the right direction. However modernization and forethought is necessary to develop primary healthcare delivery alternatives so that complete coverage is attained rapidly not only in rural regions but also in urban slum populations. An autonomous monitoring and appraisal method is as well necessary to gauge the exposure and impact of the health and development agendas (Kumar, 2008). Conclusion The outline of the plans and policy reports not only show the gap between the oratory and truth but as well the structure within which the strategies have been devised. The strength of primary health care has been abridged to just primary level care. The health reports and plans typically intense on structuring the health services infrastructure and even this not have a sense of integration. The majority of the policy reports lacks on the significance of a strong referral method. The Bhore committee statement and afterward, the Primary Health Care Declaration discussed the operational features of incorporating the other sectors of growth linked to health. The multi-sector strategy that is required and the inter sector association that are vital for a lively health system have not been carefully planned, and there has been no plan made out for it afterward. The outline of plan credentials and their accomplishment have been incremental rather than being holistic. It is essential to think whether it is the low outlay in health care that is the main cause for the present condition of the health system or is it as well to do with the structure, intend and strategy within which the policies have been planned (Nundy, M., ND). References Banerji D. (1985) Health and family planning services in India: An epidemiological, socio-cultural and political analysis and a perspective. Bhandari, et. al. (2008) Effectiveness of Zinc Supplementation Plus Oral Rehydration Salts Compared With Oral Rehydration Salts Alone as a Treatment for Acute Diarrhea in a Primary Care Setting [On line] PEDIATRICS Vol. 121 Available from: [13 June 2009] Bhore, (1946). Report of the Health Survey and Development Committee, Vol. II. Government of India Delhi, Manager of Publications. De Maeseneer, J.; Willems, S.; De Sutter, A.; Van de Geuchte, I.; Billings, M. (2007) Primary health care as a strategy for achieving equitable care: a literature review commissioned by the Health Systems Knowledge Network [On line] Available from: [03 June 2009] Kumar, R. (2008) Revitalize Primary Health Care [On line] Indian Journal of Community Medicine Vol. 33, No. 1, January 2008 Available from: [03 June 2009] Lalonde M. (1974). A new perspective on the health of Canadians: A working document. Ministry of Supply and Services, Government of Canada: Ottawa, [On line] Available from: [03 June 2009] Mapsofindia.com, (1999) India Demographics [On line] Available from: [13 June 2009] Ministry of Health and Family Welfare (2005). Report of the National Commission on Macroeconomics and Health. Government of India, New Delhi. Ministry of Health and Family Welfare (2005) National Rural Health Mission (2005-2012): Mission Document. Government of India: New Delhi. National Health Accounts Cell (2005). National Health Accounts: India 2001-02. Ministry of Health and Family Welfare, Government of India: New Delhi. Nundy, M. (ND) Primary Health Care in India: Review of Policy, Plan and Committee Reports [On line] Available from: [03 June 2009] pharmaceuticals.indiabizclub.com, (ND) Goverment Policy for Health Care [On line] Available from: [03 June 2009] Sheriff, D.S. & Roberts, S. (2001) Medical Education, Health Policy and Societal Needs of India - A General Perspective [On line] The Meducator, Volume 1; Issue 1 April 2001 Available from: [03 June 2009] un.org/millenniumgoals, (2008) UN Millium Development Goals. [On line] Available from: http://www.un.org/millenniumgoals/ [03 June 2009] Read More