Co-founder & Executive Trustee, Smile Foundation
As India battles the second wave of Covid-19, it has become clear that our country must work expeditiously to iron out deficiencies in its vast network of Primary Healthcare Centers. Primary Healthcare Centers (PHCs) are the first and in most cases the only access to medical support in rural and remote areas. While the pandemic has put to test the entire healthcare infrastructure, it has highlighted the need for a robust PHC network with adequate and skilled staff to curb escalations.
PHCs are envisaged to provide integrated curative and preventive healthcare to our population. There are three tiers of rural health institutions – Sub Health Centre, Primary Health Centre (PHCs), and Community Health Centre. As per data from the Union Ministry of Health and Family Welfare, as on March 2019, there were 24,855 rural PHCs and 5,190 urban PHCs functional across the country. This translates to one center per 30,000 population in general areas and one center per 20,000 population in difficult/tribal and hilly areas. Although the numbers appear alright, the functional status of these centers needs to be studied carefully in terms of the physical infrastructure, manpower, equipment, drugs, and other logistical supplies available with these centers. One then arrives at the conclusion that there is a great need for quality infrastructure and manpower to ensure these centers can deliver high quality healthcare services.
A few gaps
We have established that the PHC is the first point of contact between village communities and the Medical Officer. Manpower in PHCs includes a Medical Officer supported by paramedical and other staff. Let’s look at the shortfall of staffing at these centers. In the case of PHCs, for Health Assistant (Female), the shortfall is 47.9% and in the case of Health Assistants (Male), the shortfall increases to 59.8%. For allopathic doctors at a PHC, there is a shortfall of 6.0% of the total requirement at an all-India level. Also, as on March 31, 2019, 9.6% PHCs were without a doctor, 33.4% reported to be working without a Lab Technician and 23.9% had no pharmacist. This data raises serious questions about the functionality of the centers.
Reclaim the primary health sector
More than three lakh active cases of Covid-19 are being detected across India on a daily basis, and this has come as a rude shock to the country. While there is a need to dramatically enhance preparedness, there is also an urgent requirement to fill vacancies at PHCs properly. According to guidelines of the Indian Public Health Standards, to allow these centers to work effectively, every PHC should have at least four to six beds, with earmarked wards for males and females. It is also necessary that these wards have separate toilets for males and females. But less than 77% of PHCs have the minimum requirement of four beds.
Telemedicine as an alternative
Thanks to the pandemic, telemedicine has emerged as a major tool in consultative and preventive healthcare. It must be made more robust. Since mid-April, e-health, and online toolkits have become foundational in providing medical services and increasing access to them across this vast country of ours. This has demonstrated the penetration of internet services across India and presents an opportunity to strengthen, modernize and revamp the public health care system. Appreciating the role that telemedicine can play in improving access to healthcare in the country, the Medical Council of India released practice guidelines for telemedicine in March 2020. Telemedicine can save money and effort, especially for rural patients, as they do not need to travel long distances for medical consultation and treatment. Telemedicine, integrated with existing healthcare centers, can provide timely access and last mile connectivity for peri-urban and rural populations.
Smile Foundation closely works with the government and private sector organizations to ensure that telemedicine centers are strategically located and provide healthcare services to the most underserved sections of society.
Smile is cognizant of the out-of-pocket expenses people have to pay for basic healthcare. So, through the Smile on wheel initiative, for patients who can’t afford marginal out of pocket expenses, we have implemented a model where a patient pays less than INR 200/- for consulting a doctor, and for receiving medicine and diagnostic services.
Covid-19 has underlined the need for not just greater budgetary allocation for health, but also highlighted the importance of public private partnerships, the need to improve the functioning of PHCs to ensure immediate healthcare support across the country.
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