Primary Health Center ( Issues , Strength and Scope)

The Primary Health Care (PHC) strategy hasü      A desk analysis of available
proved to be a turning point in the history ofdocuments and reports specific to the country
health care policy. PHC was defined asand extensive analysis of all available published and
“essential health care based on practical,unpublished documents and materials.
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 the country can afford to 
maintain at every stage of development in the 
spirit of self-reliance and self determination”. 
PHC was expected to form an integral part of 
both the country’s health system, of which itA Review of the Rural Health Care System in
is the central function and main focus, and theIndia:
overall social and economic development of the 
community. It would be the first level of contact 
of individuals, the family and community with the Rural Health Care System – the structure
national health system, bringing health care asand current scenario
close as possible to where people work and live, 
and constitute the first element of a continuingThe health care infrastructure in rural areas has
healthcare process.been developed as a three tier system (see
 Chart 1) and is based on the following population
 norms:
PHC comprises eight elements: 
  
ü      education concerning prevailing health1.                  Centre
problems and the methods of preventing andPopulation Norms
controlling them,2.                  Plain Area
ü      promotion of food supply and properHilly/Tribal/Difficult Area
nutrition,Sub-Centre
ü      adequate supply of safe water and5000
basic sanitation,3000
ü      maternal and child health care,Primary Health Centre
including family planning,30,000
ü      immunization against major infectious20,000
diseases,Community Health Centre
ü      prevention and control of locally1,20,000
endemic diseases,80,000
ü      appropriate treatment of common 
diseases and injuries, and 
ü      provision of essential drugs. 
 Sub-Centres (SCs)
The ideology and principles behind PHC closely 
match what was and has since been advocated inThe Sub-Centre is the most peripheral and first
human development such as social justice, equity,contact point between the primary health care
human rights, universal access to services, givingsystem and the community.  Each Sub-Centre is
priority to the most vulnerable and underprivileged,manned by one Auxiliary Nurse Midwife (ANM)
and community involvement. It is a recognizedand one Male Health Worker MPW (M) (for details
fact that the promotion and protection of theof staffing pattern, see Box 1).  One Lady Health
health of the people is essential to sustainedWorker (LHV) is entrusted with the task of
economic and social development and contributessupervision of six Sub-Centres. Sub-Centres are
to better quality of life and to world peace. Theseassigned tasks relating to interpersonal
prioritized PHC as the main strategy for achievingcommunication in order to bring about behavioral
health for all. Despite this commitment and severalchange and provide services in relation to
years of work, not much has been achieved.maternal and child health, family welfare, nutrition,
 immunization, diarrhea control and control of
There is a need to examine the implementationcommunicable diseases programmes.  The
of primary health care and identify strategicSub-Centres are provided with basic drugs for
interventions needed to cope with the newminor ailments needed for taking care of essential
challenges facing health systems, as a contributionhealth needs of men, women and children. The
to developing an agenda for strengthening PHC inDepartment of Family Welfare is providing 100%
the 21st century.Central assistance to all the Sub-Centres in the
 country since April 2002 in the form of salary of
 ANMs and LHVs, rent at the rate of Rs. 3000/-
 per annum and contingency at the rate of Rs.
 3200/- per annum, in addition to drugs and
 equipment kits. The salary of the Male Worker is
 borne by the State Governments.  Under the
 Swap Scheme, the Government of India has
 taken over an additional 39554 Sub Centres from
 State Governments / Union Territories since April,
Key ISSUES that may need TO BE REVIEWED2002 in lieu of 5434 number of Rural Family
addressed for strengthening PHC’s are:Welfare Centres transferred to the State
 Governments / Union Territories. There are
 146026 Sub Centres functioning in the country as
ü      PHC policy formulation: How was theon September, 2005 as compared to 142655 in
PHC policy formulated? What was the process ofSeptember, 2004.
formulating PHC policy, the content of the PHC 
policy etc. 
  
ü      PHC policy implementation: How are 
the PHC policies being implemented? Aspects to 
examine include advocacy and marketing, actorsPrimary Health Centres (PHCs)
and partners, structures and processes etc.. 
 PHC is the first contact point between village
ü      PHC resources: What resources arecommunity and the Medical Officer. The PHCs
available for PHC implementation, for examplewere envisaged to provide an integrated curative
human and financial resources, as well as PHCand preventive health care to the rural population
physical resources and structures?with emphasis on preventive and promotive
 aspects of health care. The PHCs are established
ü      PHC monitoring and review: How areand maintained by the State Governments under
PHC policy and strategies being monitored andthe Minimum Needs Programme (MNP)/ Basic
reviewed?Minimum Services Programme (BMS). At present,
 a PHC is manned by a Medical Officer supported
ü      Health trends: What are the trendsby 14 paramedical and other staff.  It acts as a
of the main health and health-related challenges?referral unit for 6 Sub Centres.  It has 4 - 6
 beds for patients.  The activities of PHC involve
 curative, preventive, primitive and Family Welfare
 Services.  There are 23236 PHCs functioning as
 on September, 2005 in the country as compared
 to 23109 in September, 2004.
PROCESS 
  
Data for the review to be obtained from the 
following sources: Community Health Centres (CHCs)
      
ü      Unstructured interviews withCHCs are being established and maintained by the
interviewees/informants that have intimateState Government under MNP/BMS programme .
knowledge of PHC implementation, such as policyIt is manned by four medical specialists i.e.
makers, implementers at all levels, other sectorsSurgeon, Physician, Gynecologist and Pediatrician
involved, WHO and other partners.supported by 21 paramedical and other staff.  It
 has 30 in-door beds with one OT, X-ray, Labour
ü      Discussions with a wider audience ofRoom and Laboratory facilities.  It serves as a
people who have intimate knowledge of PHCreferral centre for 4 PHCs and also provides
implementation. These included policy makersfacilities for obstetric care and specialist
implementers, NGOs, private sector, health relatedconsultations. As on September, 2005, there are
institutions, WHO and other partners3346 CHCs functioning in the country.