ISSN: 2642-6250
Authors: Suresh K*
With recent Coronal virus Pandemic India, hopefully public health in general and comprehensive primary health care will come to the forefront. The focus will shift from private hospitals to government hospitals as private hospitals are too small to handle large-scale health emergencies and care of the poor. And instead of sourcing medical devices and equipment and drugs from abroad, everything will be sourced from India. In February 2017, Government of India promised to upgrade 150,000 existing HSCs and PHCs into Health and Wellness Centres (HWCs) that will switch from “selective†to “comprehensive primary health care†and start providing the larger package of services in Public Sector Health. Empowering paramedical workers for early diagnosis and dispensing pre-decided drugs began way back in 1953 for Malaria control. The training of Multipurpose Health Workers (Male and Female) introduced capacity building for minor ailments treatment in 1974. Later vertical interventions at community level, like Control of diarrheal diseases (1980), Acute Respiratory infections (1990), standalone new-born care and integrated management of neonatal and childhood illnesses (IMNCI) in early 2000 were added in the job descriptions of the health workers. NHP 2017 makes it mandatory to run outpatient clinics for 6 hours every day at the HWCs, institutionalizing regular sickness care services at the community level for comprehensive health care. The design of HWCs and the delivery of services build on the experiences and lessons learnt from the National Health Mission, India’s flagship programme for strengthening health systems. To address the expanded service delivery package will require reorganization of work processes, addressing the continuum of care across facility levels; moving from episodic pregnancy and delivery, new born and immunization services to chronic care services; instituting screening and early treatment programmes; ensuring high-quality clinical services; using information and communications technology, focusing on health promotion and addressing health literacy.The announcement of HWCs received wide coverage and attention. However, promises are an integral part of Indian polity; the challenge is implementation as witnessed being part of the health system by the author since 1968. The first Health and Wellness Centre (HWC) under Ayushman Bharat was inaugurated by the Prime Minister at on 14/04/2018. Since then 29214 AB-HWC are reported functional as on 30.01.2020. The word functional is used for issuing government order or at the most change of the sign board of the facility. Two years down the line there is hardly any visible change in the strategy ofproviding sickness care for six hours a day as envisaged and starting of the new interventions included in service package on the ground level. The availability of services would evolve in different states gradually, depending on three factors- a) the availability of suitably skilled human resources at the HWC, b) the capacity at district/sub-district level to support the HWC in the delivery of that service, and c) the ability of the state to ensure uninterrupted supply of medicines and diagnostics at the level of HWC. This article analyses the existing primary health care system in the country, challenges of establishing HWCs for CPHC specially at HSC level and the way forwards.
Keywords: Comprehensive Primary Health Care; Health Sub-centre; Health and Wellness Centres; Middle Level Health Provider; Universal Health Coverage
