Comprehensive Primary Health CareHigh quality

Universally accessible,

Free

Close to where people live and work

CPHC is value for money and would reduce morbidity and mortality greatly at much lower costs and would significantly reduce the need for secondary and tertiary care.

Primary Health Care to CPHCPrimary care has been very selective in the past, covering less than 20% of primary

health care needs. This has made primary care less responsive to felt health care needs and created the image of the under-performing system.

Primary Health Care is necessarily comprehensive- addressing primary care for all of reproductive and child health, communicable, and non-communicable diseases and accidents and injuries through appropriate health communication, technologies and

care provision.

Comprehensive primary health care package will also include nutrition, geriatric health care, palliative care and rehabilitative care services.

To denote this important policy change, facilities which start providing the larger package of comprehensive primary health care will be called Health and Wellness

centers.

Grass Roots Primary Health CareThe Village Health, Sanitation and Nutrition Committees supervised by the panchayats would ensure that there is no exclusion and that locally felt health priorities are included.

Community based monitoring will be strengthened to ensure continuous feedback on equity, access and quality of services

Most elements of primary care can be delivered by suitably trained and authorized AYUSH doctor, Nurse practitioners, pharmacists or paramedical

Supported by ASHA, rural practitioners, health workers and anganwadi workers in rural and urban areas.

For chronic illness, a doctor/ specialist may have to initiate the treatment, but most elements of the continuity of care can be provided by the primary care team. The use of ICT tools including tele-medicine would support the primary care teams.

Community HealthCommunity based interventions strategies go beyond immunization to include ready availability and access to ORS and Zinc for diarrhea and appropriate antibiotics for pneumonia, better identification and management of anemia, and screening for developmental defects.

Good quality disease surveillance data should also include entomological information for which a dedicated team of entomologists with support staff is essential. Taken together the battle against vector borne disease is an example of how one needs to be ahead of the problem in biomedical research with very short lag time lab to field and in building public health capacity at district levels.

One important source of information is vital events reporting, especially cause of death reporting. Today, we have reliable medically certified causes for only about 28% of deaths

Nurses

Recognizing that nurses form about two-thirds of the health workforce in India, nurses are enabled to assume leadership positions, regulation of practice is improved, quality of nursing education is strengthened establishing cadres like nurse practitioners and public health nurses

DoctorsA positive determinant of voluntary rural location of doctors is a more rural location of medical colleges and a curriculum and medical education which provides exposure and motivation to work with communities. Equally important is to create a positive practice environment where professionals can stay in touch with peers and upgrade their skills and a positive social environment, through better housing, more flexible terms of employment and active measures of community support.

An upgradation of short term training to medical officers who are willing to work in these areas and providing them with a set of basic specialist skills as needed at the block and district level. MD courses in family medicine courses have started on a small scale and with the necessary support. Policy initiative needed to make this post interchangeable with any of the basic specialists sanctioned for CHC.

SpecialistsSpecialist attraction and retention is a challenge - the public sector has been performing very poorly on this. Most needs for specialist consultation would be met within a district. The requirement of patient care in super specialty services is very different from the General Specialties with regard to skills required to render effective care. This calls for developing human resources and training centres for super specialty care.

Convert National Board of Examinations as a statutory body to innovate new education and training models to train appropriate specialists. Technological innovations coupled with advances in cellular biology knowledge are influencing therapeutic interventions. Hence, developing teams comprising of clinicians, cellular biologists, researchers, academicians in each specialty who can deliver holistic care

Quality

Ensure that every public health care facility is measured and scored for quality, and certified and incentivized when it achieves a certain minimum score. Quality measurements would include clinical quality of care, also patient safety, comfort and satisfaction. Quality Improvement would require technical support and capacity building as well as institutional arrangements for measurement and certifying. In private sector accreditation process and quality of care provided would necessarily abide by criteria under the Clinical Establishments Act (2010).

Private ‘not for profit’ and ‘for–profit’ hospitals would be empanelled with preference for the former, for comparable quality and standards of care.