The Union government's policy push for developing health and wellness centers is a well thought out step for renewing focus on comprehensive primary care. The experiences of several countries show that investing in primary healthcare leads to allocative efficiency by bringing to a range of preventive, curative, promotive and rehabilitative services closer to the people. Countries with greater primary care orientation have a lower rate of mortality and better health outcomes .
The UK allocates a large proportion of the total budgeted expenditure to primary care. In India, despite several policy statements to improve primary care, this has never been a priority until recently, when the Union government announced the introduction of health and wellness center under its Ayushman Bharat program , which will be the foundation for public health system in the country .
These centers are intended to provide outpatient care, immunization, maternal and child health services, non-communicable diseases (NCDs) and other services. These centers will be linked to secondary and medical care and will be provided with adequate drugs and diagnostic services.
Once developed, these centers will help ameliorating basic health problems including early diagnosis and treatment of NCDs, without complications in the latter stage and that, lessening costs of treatments. This would translate into reduction of costs at the secondary- and tertiary-care levels.
India's progress towards achieving universal health coverage (UHC), although it could be a quick start with a comprehensive primary-care approach as it provides healthcare to all of the irrespective of income, income and religion, with higher coverage and at lower cost. Historically, India's health systems bear the brunt of low public spending, causing the health systems to function sub-optimally and forcing millions of people to spend from their pocket at the point of care.
However, Ayushman Bharat—a component of which intends to provide insurance coverage of `5 lakh to 500 million people—is envisaged to alleviate household out-of-pocket expenditure to a large extent. This, along with wellness centres—if designed and implemented properly—will provide ample impetus to achieve universal healthcare. This can contribute to realising India’s SDG commitments that aim to provide appropriate and high-quality healthcare to all with adequate financial protection.
The current approach, though admirable in many respects, requires re-emphasising the missing priority on PHCs and CHCs for developing comprehensive primary care. Focusing on health and wellness centres for improving primary care may fall short of achieving the desired target if there is no intention to invest in and restructure PHCs and CHCs.
A higher percentage of primary care expenditure is on personalized, curative care, leaving a paltry sum for population-based primary preventive care. Reorienting resources towards population-based preventive programs will help set the allocation of scare resources for larger social benefits right. Since the states have higher responsibility than the Center in matters related to health, the blueprints of primary care can be redefined in view of the local needs. This should be the policy agenda for the low-performing and resource-constrained states.