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A Prescription for Their Revival

The Fragmentation and Weakening of Institutions of Primary Healthcare

Originally envisioned to offer preventive, promotive, curative and rehabilitative services as per the needs of people at affordable costs, the health services in India are currently grappling with varied forms of fragmentation, at the macro-level institutions as well as at the level of primary healthcare. To arrest this crisis, it is necessary to revive referral services needed for primary-level curative care, by focusing on strengthening community health centres and developing a strong public health workforce at the grassroots level. The only way forward is to strengthen institutions of primary healthcare by effectively balancing people’s public health with their curative care needs.

Health services in India are envisaged as those which offer preventive, promotive, curative and rehabilitative services as per the needs of the people, at an affordable cost. They are organised in a comprehensive manner through a three-tier institutional infrastructure, close to the places where people live, owing to the principles of the Bhore Committee of 1946 (Banerji 1985). The Alma-Ata Declaration of 1978 formulated the idea of comprehensive primary healthcare (CPHC), which later became an ideology to restructure every country’s health services according to the global context. India too was influenced partly by the idea, though the country has implemented a narrow framework of selective primary healthcare. Primary healthcare was defined as

essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain … It forms an integral part of the country’s health system of which it is the central function and main focus, and of the social and economic development of the community. It is the first level of contact on individuals, the family and community … bringing health care as close as possible to where people live and work, and constitutes the first element of a continuing health care process. (Sanders and Schaay 2008: 4)

Despite having a broader framework, there have been several challenges in implementing CPHC in its true spirit. This includes the overemphasis on vertical disease control programmes, including immunisation programmes, followed by health sector reforms of the 1990s that further reduced the already constrained funding in health, supplemented with the crisis in developing grassroots-level health workers and the dominant influence of the newer global health initiatives that adopted a kind of “selective” approach (Qadeer 1995; Sanders and Schaay 2008).

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Updated On : 20th Oct, 2020

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