The National Health Accounts for 2021–2022 indicate a slight rise in healthcare expenditures

Status of Primary Health Care in India:

India's public health system comprises 175,000 Ayushman Arogya Mandirs (AAMs), which facilitate 3.5 billion consultations (MoHFW, 2024). Although per capita out-of-pocket health expenditure (OOPHE) has decreased, the private sector continues to dominate, accounting for 68% of total health spending. The National Quality Assurance Standards (NQAS) are designed to enhance service quality; however, public trust in healthcare services remains low.

The Necessity of Primary Healthcare in India

Early Disease Detection and Prevention: Primary care enables timely interventions that facilitate the early detection and management of diseases, thereby alleviating the pressure on tertiary care facilities. For instance, routine screenings for diabetes and hypertension are conducted at Ayushman Arogya Mandirs.

Reducing Out-of-Pocket Expenditure (OOPE): A strong primary healthcare system can significantly lower costly hospitalization expenses by providing early treatment. According to the NHA report, OOPE has decreased from 62.6% in 2014-15 to 39.4% in 2021-22.

Bridging the Rural-Urban Healthcare Divide: Primary Health Centres (PHCs) serve as the initial point of contact for healthcare in rural and tribal regions. For example, the establishment of 175,000 Ayushman Arogya Mandirs aims to provide healthcare services directly to communities.

Managing Non-Communicable Diseases (NCDs): Primary care plays a crucial role in the long-term management of lifestyle-related diseases such as cancer, diabetes, and cardiovascular conditions. Health and Wellness Centres now incorporate NCD screenings as part of the National Health Mission (NHM).

Strengthening Health System Resilience: A well-established primary care network is vital for addressing pandemics, alleviating hospital congestion, and ensuring community health readiness. For example, PHCs and Community Health Centres (CHCs) functioned as frontline vaccination sites during the COVID-19 pandemic across India.

Challenges in Primary Healthcare:

Visibility:

Trust Deficit: A lack of confidence in public healthcare systems leads to decreased usage, with many opting for private hospitals due to perceived higher quality (NHA 2021-22).

Limited Awareness: A significant portion of the population is unaware of initiatives such as Ayushman Bharat Arogya Mandir, which diminishes community participation.

Accessibility:

Geographical Disparities: Remote and tribal regions continue to experience insufficient distribution of primary health centers, with an 18% shortfall in hilly areas.

Infrastructure Shortcomings: The absence of modern facilities, particularly diagnostic tools, adversely affects the quality of healthcare services in rural areas.

Affordability:

Private Sector Prevalence: The private healthcare sector dominates, leading to high treatment costs despite the existence of public schemes.

Hidden Expenses: Additional costs such as transportation, diagnostics, and non-listed treatments impose financial strain on rural households.

Path Forward for Primary Healthcare:

Enhancing Visibility:

Community Awareness Initiatives: Leverage village health committees to disseminate information about free services available at Ayushman Bharat Health Centres.

Publish Service Quality Reports: Regularly release reports on service quality ratings to foster trust and confidence among the public.

Improving Accessibility:

Mobile Health Units: Introduce mobile clinics in remote and underserved areas to address access challenges, inspired by Kerala’s e-Sanjeevani initiative.

Enhance Digital Health Services: Broaden telemedicine offerings through e-health platforms to ensure comprehensive consultation support.

Increasing Affordability:

Broaden PMJAY Coverage: Expand free healthcare coverage to include near-poor and vulnerable middle-income populations.

Enhance Availability of Generic Medicines: Increase the number of Pradhan Mantri Bhartiya Janaushadhi Pariyojana outlets to significantly reduce medication costs.

Conclusion:

To strengthen India’s primary healthcare system, a comprehensive strategy is essential, focusing on building trust, upgrading infrastructure, and ensuring financial protection. With initiatives like Ayushman Bharat and ongoing health system reforms, India is progressing towards universal healthcare access.