Primary health care


The Health Index 2019 report released by NITI Aayog makes an interesting reading when it compares the healthcare facilities of different states and Union Territories across India. Leaving aside Nagaland, which again was at the bottom of the list among smaller list, it makes an important point that some states and UTs are doing better on health, medical facilities and well being even with a lower economic output, while others are not improving upon high standards. It is also interesting to note that some of the states with better economic resources are worse off because they are not allocating more money for health and medical facilities for their own people. Some of the states with better resources are slipping in performance due to careless attitude and lack of monitoring for delivery of healthcare facilities to the people at the grassroot level. The states with better resources should have been doing better and providing high standards of medical facilities to people at the primary health care sector. Lack of planning and unpreparedness in dealing with the emerging situation on this front have been the causes of high mortality rates among the children when diseases in an epidemic form have struck the states and UTs despite the fact that their past experiences should have made them wiser. In the assessment made of some of the states during financial year 2017-18, a few large states present a very dismal picture, reflecting the low priority their governments have accorded to health and human development since the NITI Aayog produced its first ranking for 2015-16. The disparities among the states and UTs are stark. Populous and politically important Uttar Pradesh comes up at the rear on the overall Health Index with a low score of 28.61, while the national leader, Kerala, has scored 74.01. Kerala is credited with providing universal health and medical facilities goal compared to international standards. Similarly, Andhra Pradesh and Maharashtra join Kerala as the other top performers, with the additional distinction of making incremental progress from the base year. The NITI Aayog Index is a composite based on 23 indicators, covering such aspects as neonatal and infant mortality rates, fertility rate, low birth weight, immunisation coverage and progress in treating tuberculosis, HIV and other communicable infections. The states are also assessed on improvements to administrative capability and public health infrastructure. For a leading state like Tamil Nadu, the order of merit in the report should serve as a sobering reminder to stop resting on its oars. It is unfortunate that it has slipped from third to ninth rank on parameters such as low birth weight, functioning public health centres and community health centre grading. For making both Health Index and education as priorities and encourage the states and UTs to put into action their efforts, public health must become part of the mainstream politics instead of what is ruling the roost at present. The politics of ultra nationalism has to shift to basic health care facilities in the country for the welfare of the common masses. While the Centre has devoted greater attention to tertiary care and reduction of out-of-pocket expenses through financial risk protection initiatives such as Ayushman Bharat, several states are lagging behind when it comes to creating a primary health care system with well-equipped PHCs as the unit. This was first recommended in 1946 by the Bhore Committee and further propounded by an economist as priority sector for South Asian countries in early 1990s. The neglect of such a reliable primary care approach even after so many decades affects states such as Bihar, where much work needs to be done to reduce infant and neonatal mortality rate and low birth weight, and create specialist departments at district hospitals. There is a need for special attention to shore up standards of primary care in Odisha, Madhya Pradesh, Uttarakhand, Rajasthan, Assam, Jharkhand and Nagaland, which are at the bottom of the scale, as per the NITI Aayog assessment report. The Health Index does not capture other related dimensions, such as non-communicable diseases, infectious diseases and mental health. It also does not assess reliable data, especially from the growing private sector. It is clear is that state governments now have greater resources at their command under the new scheme of financial devolution, and, in partnership with the Centre, they must use the funds to transform primary health care.