• According to high-level expert group on universal health coverage, nearly 70% of government health spending should go to primary health care.
• National Health Policy (NHP) 2017 also advocated allocating resources of up to two-thirds or more to primary care.

Major concerns:

1. Lack of Government Funding to Primary Health Care

• The current outlay of ?1,600 crore by the government to transform existing sub-health centre into a health and wellness centre, which provide a wider range of primary care services, is less than half the conservative estimate.
• Government has proposed to transform 1.5 lakh sub-health centres into Primary health and wellness centres by 2022 and with the current estimates at the given rate, it can fulfil not even half the proposed target of 1.5 lakh health and wellness centres till 2022.

This is in contrast to several recommendations to increase the primary health care government expenditure.

2. Dismal situation of National Health Mission:

The overall situation with the NHM, India’s flagship programme in Primary health care, continues to be dismal.

• The NHM’s share in the health budget fell from 73% in 2006 to 50% in 2019 in the absence of uniform and substantial increases in health spending by States.
• Ministry of Finance had projected a 17% increase in allocation for the NHM in 2019-20. However, there has only been only an increase of 3.4% this year.
• NHM budget for this year (?31,745 crore) barely crosses the actual spending on the programme in 2017-18 (? 31,510 crore).

3. Dominance of private players:

• Centre has committed to increase access to hospitalisation care, predominantly through private players.
• There has been an increase in allocation this year by 167% for the Pradhan Mantri Jan Arogya Yojana (PMJAY) — the insurance programme.
• PMJAY aims to cover 10 crore poor families for hospitalisation expenses of up to ?5 lakh per family per annum.
• Government has also taken steps to incentivise the private sector to open hospitals in Tier II and Tier III cities.
• The increase in the PMJAY budget is a welcome step and should be increased further every year, however the same coming at the expense of other critical areas is ill-advised.

4. Shortage of PHCs and staffs

• There is a shortage of PHCs (22%) and sub-health centres (20%)
• Only 7% sub-health centres and 12% primary health centres meet Indian Public Health Standards (IPHS) norms.
• Numerous primary-level facilities need complete building reconstruction.
• They are operated out of rented apartments and thatched accommodations; lack basic facilities such as toilets, drinking water and electricity.
• There is a staggering shortage of medical and paramedical staff at all levels of care.

Importance of Primary Health Care:

• Vital for effective and efficient health system.
• Instrumental in reducing the out of pocket expenditure.
• Vital for achieving “distress-free and comprehensive wellness system for all”
• Crucial for the success of PMJAY

Conclusion:

• Adequate emphasis should be given on primary health care and there is a need to depart from the current trend of erratic and insufficient increases in health spending and make substantial and sustained investments in public health over the next decade.
• Without this, the ninth dimension (‘Healthy India’) of “Vision 2030” will remain unfulfilled.