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Primary line of defence: Looking beyond the hospital-centric model to strengthen primary healthcare

| Updated on: Nov 17, 2021
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We must strengthen and expand our vital first line of defence to bolster quality healthcare delivery and create a future-ready health system.

India’s healthcare system is undergoing rapid transformations. In a short time, telemedicine solutions have been developed, new treatments and vaccines have been deployed and further investments in public health infrastructure have been announced. To sustain this momentum and lay a solid foundation for public health, strengthening the primary care ecosystem is essential.

As an individual’s first point of contact in their healthcare journey, primary care forms the backbone of the nation’s health strategy. A quality primary care system leverages the proximity of India’s state-owned rural health facilities to better service the population residing outside of main urban centres. A well-established and reliable primary care network promotes preventative care and immunization against high-burden diseases – this includes early screening, routine check-ups, and continuous monitoring of known conditions, enabling timely interventions. Spurring its growth can pave the way for a holistic healthcare ecosystem in India based on proximity and access to care to help address health needs in time.

To strengthen primary care delivered through state-owned rural health facilities, we need to start thinking beyond a hospital-centric model of care. Today, there is one doctor for roughly every 1,700 Indians, which is not in alignment with the World Health Organization recommended 1:1,000 doctor-patient ratio. Therefore, the imperative for the nation is to find innovative solutions to combat the discrepancies in the patient-practitioner ratio while meeting the country’s growing healthcare needs. But how can these objectives be achieved?

Integrated approach

Adopting an integrated approach to health infrastructure is an ideal first step. Interlinking existing care facilities with unified digital health tools can enhance resource utilization. For instance, the Government’s e-Sanjeevani telemedicine platform, which has served more than 10 million patients since April 2020 in English and regional languages, illustrates the promise of digital tools to rapidly scale health solutions. Moving forward, the integration of government-led health programmes, including the flagship Ayushman Bharat schemes, with the National Digital Health Mission will be a welcome move. Interlinking physical primary care infrastructure with technology helps streamline continuity of care, thus facilitating early risk identification and meaningful doctor-patient conversations.

Skilling healthcare practitioners

In parallel, skilling healthcare practitioners to navigate digital systems and remain updated with medical advancements is necessary for a smooth transition. Through public-private partnerships and the continuing education of practitioners, the adoption of digital infrastructure can be scaled, while also increasing skilled manpower in the sector.

The Government has operationalised 75,532 health and wellness centres, with 150,000 more to be functional soon. To further bridge gaps in rural healthcare, public-private partnerships can be leveraged to accelerate work done by Accredited Social Health Activists (ASHAs) and anganwaadi workers. They have played a pivotal role in delivering Covid-19 relief and facilitating rural care delivery, including providing medicines, conducting diagnostic tests and providing reliable health advice.

However, ASHA workers need the support of a larger healthcare system to be truly effective. There is a need to amplify incentives for healthcare practitioners to operate in rural areas through a combination of financial and non-financial compensation, university collaborations and rural development measures. This can ensure greater healthcare access for underserved communities.

In addressing areas of growth within the system, it is also important to uphold community engagement. Grassroots educational initiatives can raise health awareness, while driving better health outcomes by encouraging preventive care, including broad hygiene considerations or vaccinations for preventable diseases. Awareness spurs screening and early disease detection while limiting the number of patients referred to other tiers of the healthcare system.

Going beyond just treatment, we need to identify and curb escalating disease burden early on to truly strengthen the primary care system. For instance, driving greater vaccination coverage to promote preventive health while limiting vaccine-preventable diseases will help avoid further health complications.

Furthermore, by expanding the scope of disease areas studied through epidemiological surveys in India, we can understand local-level challenges for a number of diseases as they emerge. With this data, valuable health system resources can focus on addressing the most pressing needs, including rising prevalence of lifestyle diseases and expanding access for other important areas such as mental health, women’s healthcare and family planning. Strengthening primary care facilities, in addition to facilitating doctor training, can be vital to help overcome various preventable challenges faced by such patients, especially women across rural India.

Primary care is a cornerstone of healthcare, driving more accessible and equitable health coverage. Through integrated systems that leverage digital options such as telemedicine, upskilling of healthcare workers, public-private partnerships, incentives to bridge rural care-delivery gaps and engagement with communities, we can drive a stronger and more comprehensive approach to care in India. To bolster quality healthcare delivery and create a future-ready health system, we must thus strengthen and expand our vital first line of defence.

(The writer is Managing Director & General Manager, Primary Care (Pharmaceuticals), Abbott India. Views are personal.)

Published on November 17, 2021

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