Introduction:

• Primary health care is in crisis. It is underdeveloped in many countries, underfunded in others, and facing a severe workforce recruitment and retention challenge.
• Half the world’s population has no access to the most essential health services.

Do you know?

• 1978 Declaration of Alma-Ata – It united health leaders and highlighted the importance of primary health care as key to delivering better health for all, and to the value of social justice, health equity, and the social determinants of health.
• But even after 40 years later, this vision has not been realised.
• Hence, world leaders declared their commitment to ‘Primary Care’ in recently held (October 2018) Declaration on Primary Health Care at Astana, Kazakhstan.
• Now the Sustainable Development Goals also provide new impetus to reach universal health coverage via strengthened primary health care.
• The Astana Declaration would “aim to meet all people’s health needs across the life course through comprehensive preventive, promotive, curative, rehabilitative services and palliative care”.

List of primary care services

According to Astana Declaration, the following services are part of PHC services –

• vaccination;
• screenings;
• prevention, control and management of non-communicable and communicable diseases;
• care and services that promote, maintain and improve maternal, newborn, child and adolescent health; and
• mental health and sexual and reproductive health

Aardram mission of Kerala

• In 2016, Kerala attempted to re-design its primary care via Aardram mission.
• It aimed to transform health care, address the current and future epidemiological situation.
• In the revamped primary care, Kerala tried to provide the above provided PHC services.
• These services cannot be provided without adequate human resources. It is nearly impossible to provide them with the current Indian norm of one primary care team for a population of 30,000. Kerala tried to reduce the target population to 10,000. Even the reduced target turned out to be too high to be effective.

Kerala’s experience suggests that providing comprehensive primary care would require at least one team for 5,000 populations.

Lessons learnt from Kerala’s experience could provide insights into what needs to be done to ensure the objectives of the Astana Declaration do not remain a statement of pious intentions in India.

Providing the entire set of services is beyond the capacity of medical and nursing graduates without specialised training.  Building the capacity of medical and nursing graduates will be even more of a challenge and time taking.

Hence, Kerala has tried to get over this through short courses in specific areas such as management of diabetes mellitus, hypertension, chronic obstructive pulmonary disease, and depression.

Conclusion:

• Primary Health Care is the most effective, efficient and equitable approach to enhance health, making it a necessary foundation to achieve universal health coverage (UHC).
• The primary care system will be effective only when the providers assume responsibility for the health of the population assigned to them and the population trusts them for their health needs.
• Both are linked to capacity, attitude and support from referral networks and the systemic framework.
• Involving private sector will help in providing good quality primary care.
• The private sector provides primary care in most countries though it is paid for from the budget or insurance. The private sector can provide good quality primary care if there are systems to finance care and if the private sector is prepared to invest in developing the needed capacities. (Therefore, efforts to include of Private Health Provider in Government Policy will help)
• Achieving Universal Health Coverage, one of the Sustainable Development Goals to which India is committed, is not possible without universal primary health care.
• The experience of Kerala in transforming primary care reveals the steepness of the path India will have to cover to reach the goals committed to in the Astana Declaration.