The Role of Integrated Primary Health Care in India
By Hao Yi Tan
Overview of India’s Healthcare
Over the past 20 years, India has experienced significant population growth and undergone notable demographic changes (1). With a population surpassing 1.4 billion people in 2024, India has overtaken China to become the most populous country in the world (2). Despite a declining fertility rate, the population continues to expand due to high birth rates and improved healthcare leading to longer life expectancies. India's population growth trajectory has been influenced by various factors including socioeconomic development, urbanization, healthcare infrastructure, and cultural norms. While the Indian government has made significant efforts to improve healthcare provision across both rural and urban settings, uneven population distribution, resource strain and economic disparities persist. India also faces the strain of the epidemiologic transition where there is still high levels of communicable diseases, but also rising levels of non-communicable diseases (NCDs) (3). This highlights the importance of reforming the healthcare system to one that is cohesive, integrated and able to cope with rising demands across the board.
Current Issues with India’s Healthcare System
India's healthcare system grapples with a myriad of challenges that hinder its ability to adequately meet the healthcare needs of its vast population. They can be mainly categorized into:
Urban-Rural Divide: One of the most pressing issues is the stark disparity in healthcare accessibility and quality between urban and rural areas. While urban centers boast modern healthcare facilities and skilled medical professionals, rural regions often lack basic infrastructure and face acute shortages of healthcare personnel (4).
Insufficient Funding: A significant challenge is the insufficient funding allocated to the healthcare sector, which limits the availability of essential resources and impedes the expansion of healthcare services. This underfunding contributes to overcrowded hospitals, long waiting times, and inadequate access to crucial medical treatments and medications, particularly for marginalized communities (5).
Healthcare Workforce Shortage: India's healthcare system struggles with a shortage of skilled healthcare professionals, including doctors, nurses, and specialists. Absenteeism is a significant issue in clinics and hospitals. The inadequate healthcare workforce exacerbates the burden on existing healthcare facilities and compromises the quality of care delivered to patients (6).
Inefficiency and Poor Quality of Care: India's healthcare system faces challenges related to poor quality medical care and inefficiency, impacting trust and confidence. In urban areas, medical care is provided by a mixture of privately owned healthcare corporations and government hospitals. In rural areas, healthcare is provided through a combination of publicly funded Health and Wellness Centres (HWCs) and privately owned general practitioner (GP) clinics, pharmacies, and practices, including those run by unlicensed practitioners. Though theoretically free for citizens, India’s public healthcare services are typically overcrowded, understaffed and plagued by medication shortages. In contrast, patients who go to private institutions typically pay out-of-pocket for services, resulting in high costs. This mix of healthcare providers contributes to fragmented and sometimes inadequate care, particularly in rural regions, highlighting discrepancies in healthcare quality between rural and urban areas (7).
The Importance of PHC-based Integrated Delivery Systems in India’s Growing Population
As India progresses economically and experiences demographic growth, the necessity for resilient healthcare systems becomes increasingly evident. Failure to strengthen integrated delivery mechanisms in the forthcoming decades could expose the nation to a surge in chronic diseases as its population ages and the demographic structure skews towards an elderly majority. The urgency to establish primary care-based integrated delivery systems in India thus arises not only as a response to existing healthcare challenges but also as a proactive measure to mitigate potential health crises accompanying the nation's developmental trajectory.
Therefore, it is important that India builds a primary care oriented integrated delivery healthcare system. Such a system holds the potential to address prevailing health concerns and lay the foundation for a resilient healthcare infrastructure capable of navigating the complexities of India's evolving healthcare landscape. As the nation progresses towards development, the investment in integrated healthcare delivery emerges as a crucial step towards safeguarding the health and well-being of its populace for generations to come.
References
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