Primary Healthcare in Rural Areas- A collective approach

As awareness is increasing towards health related issues, entrepreneurs & companies are coming forward with various initiatives for providing healthcare services in urban & rural India. Urban landscape is still satisfactory but rural areas are still void of such services.  These Initiatives vary from use of technology like telemedicine to tackling financial issue through rural insurance with microfinance or public-private partnership to setup health centres and many more. But sometime I wonder that what would be chances of setting up a successful rural healthcare model when the efforts are made in isolation keeping specific areas in mind. Is it feasible to apply it across country without understanding what the rural India wants & what is their needs?

I prefer to see the issue from patient’s perspective as what they require from healthcare delivery system. In my view, basic but affordable treatment at appropriate time by an adequately skilled physician is enough for the most of the rural population. For preventing diseases we should also address issues like basic hygiene, malnutrition & sanitation.

Incidence of non-communicable disease is around 35% in rural areas which contribute almost 68% of total Indian population in 2009. NCD anyways require tertiary care with advance intervention but must be diagnosed in early stage to reduce the adverse impact. Major cause of mortality among rural population is communicable diseases which usually require medical treatment not surgical intervention hence a basic infrastructure with proper medication in sufficient.

Then what are the obstacles for providing primary healthcare to rural India? Do we require magic to get it changed? I see it’s a mix of Infrastructure, Financing, cost of care and administrative policies issues. This is combined with absence of people awareness towards their health needs.

We already have an old infrastructure but needs to be expended so that PHC get setup in every small town having mix of doctors from different discipline of medicine (Allopath, Ayurveda, Homeopathy) to have cross discipline plan of care. These PHC to be covered by BLS equipped ambulances stationed strategically and shared between nearby villages. Cluster of PHCs to be supported by secondary care hospital. These PHC & secondary care hospital can be run by private healthcare providers on a contract basis that will give efficiency and effectiveness to the system. Comprehensive system to be setup for collecting, evaluating & monitoring healthcare performance indicators to be setup for future planning & identifying the effectiveness.

There is a need of various awareness campaigns focusing separately on preventive aspect of communicable diseases & life style alterations to prevent non-communicable disease. A nation-wide network of NGOs, healthcare providers should be built for training and developing local resources.

Policy makers should focus on promoting innovation in field of affordable medical consumable, equipment & technology by creating favourable environment for entrepreneurs & investors. Separate tax structure for the doctor and health care workers working in rural area, Conducive environment for pharmaceutical companies supplying in rural areas, tax exemptions for equipment used in rural areas & promoting new comers in healthcare delivery are some of the measures that may inspire service providers to work in rural areas. Healthcare should be priority in the local government’s agenda.

Promoting & structuring medical tourism is important to strengthen private sector financially and make them to lower indigenous pricing by cross subsidization. State sponsored health insurance coverage including medicines and making health insurance as mandatory. NGOs can initiate and create a pool of volunteers willing to support rural family for their healthcare needs by financing their health insurance.

Controlling the cost of care is the most important aspect for continuing primary healthcare delivery model. Now it’s time to realize the power of indigenous medicines system (AYUSH) which is known to most of the rural India. Focusing on preventive medicine & lifestyle improvements, wide use of technology for communication and information sharing and developing resources in local community for spreading awareness can help us to reduce the cost of care. Inventory management system to be developed & run by the private sector including medicine & consumable.

It doesn’t require Magic to create primary healthcare as right to every citizen. It can be achieved by a collective & systemic approach with full commitment. This has to be a joint effort from policy makers, healthcare industry, NGOs and every individual that can make a difference.

Disclaimer: The views expressed in this post are purely the thought of the author and are not meant to be derogatory to any institution or organisation. The author is open to further discussions. Thank you for your patience and tolerance.

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3 thoughts on “Primary Healthcare in Rural Areas- A collective approach

  1. I think thats a brilliant framework, currently all our rural initiatives are so piece meal that there impact just becomes so isolated and in the long term less effective. I mean either they are purely government or there could be ngos involved but then they do there own thing, the thing is theres no stated organised common goal. Where PPP approach is used and NGOS are involved with changes in management, the programs loose focus.I completely agree with you that we need to rely on the entire system of medicine, because boy are we short staffed. Non governmental associations must be involved but as i said as there are localised organisations and holistic care can be a problem but then regional partnerships i mean like north south west etc can be forged with slightly bigger NGOS or NGOS can come together to form one body in a region that then takes responsibility and some sort of continuity is maintained. I think an approach like the NHS where regional boards are formed is a good idea and board members can be healthcare professionals , nurses , management and partners like local businessmen, governmental employees, NGO partners Private healthcare partners.
    Good one Dr. Prem.

  2. Hello,
    Congrats for deriving such wonderful tablet of solution on medicare system.
    I am working with an NGO in healthcare sector for last 10 years and am on the verge of frustration, as doing own bit is so miniscule and non-effective when seen grossly.
    I would like to extend my contribution, if something concrete takes place towards development of such system.
    Best regards,
    preeti Damle
    Samavedana, Pune

  3. This is what our 12th five year plan says
    http://www.himssindia.org/links/Draft.pdf
    20.93. A new category of mid-level health-workers named Community Health Officers, could be devel- oped for primary health care. These workers would be trained after Class XII for a three year period to become competent to provide essential preven- tive and primary care and implement public health activities at sub-centre level. Details of their func- tions, qualifications, designations, placement and career tracks within the health system need to be worked out. This new category offers an opportunity to break through professional silos, develop compe- tencies that draw upon different but complementary streams of knowledge and help generate employment while meeting health needs of under-served popula- tions. These Community Health Officers would be groomed to discharge public health functions.

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