Primary Health Care Matters
The India Primary Health Care Support Initiative is pleased to share the first issue of Primary Health Care Matters. Through this Series we would like to share commentaries on primary health care and health systems, news from IPSI, and other content on primary health care and health systems.
A little over a year ago, in March 2020, India went into one of the most stringent lockdowns in the world in an effort to contain the spread of COVID-19 and buy time to strengthen existing health system resources to manage an outbreak. Twelve months, and a brief respite from the pandemic later, COVID-19 is back with its second and third waves in India and globally, even as the world scrambles to prevent, identify and manage COVID-19 cases, alongside efforts to vaccinate people against the disease. The initial (and hopefully) global cooperation that one was hopeful for last year towards fighting the pandemic led to the rapid development of many vaccines which can prevent COVID-19, and yet the inequities in vaccine access remind of the deep inequities which continue to exist in access to care for COVID-19, and indeed reflect the inequitable access to health care in general. This series also launches on World Health Day – a day to mark the anniversary of the First Health Assembly in 1948, and now commemorated annually by creating awareness on health issues. This past year has reaffirmed how important a role primary health care plays in ensuring health care services to some of the most vulnerable, and its critical role in health security and resilient health systems. This year’s World Health Day theme is Building a fairer, healthier world, and PHC is a critical pathway towards that.
The Primary Health Care Matters series is an effort to create a space for dialogue, and evidence for policy on primary health care. We welcome your comments, thoughts, and feedback. Enjoy your reading!
World Health Day 2021
Building a fairer, healthier world – World Health Day 2021
By Dr. Anand Krishnan
Achieving equity in health care is an important goal of most primary health care (PHC) system reforms. Equity in healthcare means that it should be provided solely on the basis of “need” and not on other extraneous considerations like – social or economic situation, gender etc. Social and structural factors play important roles in the development of disparities in health and health care. Research has identified low education, living in a disadvantaged area, and low socioeconomic status, as factors contributing to inequality in access to and utilization of health care.
Equity of health care has been divided into three domains: equal access to health care for people in equal need; equal treatment for people in equal need; and equal outcomes for people in equal need. However, need is not easy to define. Needs may be ‘normative need’ (defined by an ‘expert’) or ‘felt need’ (what people think they need assuming that they are knowledgeable); ‘expressed need’ (service utilisation). As not all ‘felt need’ gets turned into ‘expressed need’, there will be people who experience “unmet” need.
Equity could be either horizontal (equal treatment for individuals/groups with similar levels of need) or vertical (differential treatment of individuals/groups according to their need). Understanding the equity of primary healthcare services requires us to map, understand, and analyse the reasons for existing equalities using appropriate indicators to monitor access, treatment, and outcomes. If we do not measure inequities, then we have no chance of addressing them.
Primary health care is one of the most efficient ways of closing the equity gap and addressing the needs of those most disadvantaged. The central attributes of primary care are eminently suitable to address inequities: first contact with the health system (accessibility), people-centered comprehensive care (preventive, promotive, curative, and rehabilitative), continuum of care (including referrals towards secondary and tertiary care). Another cardinal feature of PHC is its engagement with the community and the bottom-up approach while promoting increased social cohesion and empowerment. Strong primary health care systems are critical component towards building a fairer, healthier world.
An introduction to the India Primary Health Care Support Initiative
The India Primary Health Care Support Initiative was established in July 2020 under a grant from the Bill & Melinda Gates Foundation. Led by the Johns Hopkins Bloomberg School of Public Health and the All India Institute of Medical Sciences, Delhi, IPSI aims to create a PHC focused ecosystem in select states by pursuing three “pillars”:
- Building capacity: Aims to build technical capacity through courses, advance trainings, workshops, and exchange visits related to primary health care, focused on state health departments, and supporting organizations.
- Implementation research on PHC: Aims to conduct short- or medium-term research studies to help program managers and decision makers improve implementation of PHC programs.
- Evidence informed PHC policies: Aims to generate evidence from research and global best practices and promote its use for effective PHC policies.
Find out more about our project, partners, and team members on our website https://jhu-ipsi.com
Feature Articles
Authors: Madhavi Misra, Harsha Joshi, Rakesh Sarwal, and Krishna D Rao. Introduction In response to the ongoing COVID-19 pandemic, countries…
Krishna D. Rao
Director IPSI, and Associate Professor, Johns Hopkins Bloomberg School of Public Health
Pandemics are highly inequitable. They impose a disproportionate burden of morbidity and mortality on countries and people at the lower end of the income distribution. Moreover, as in the case of COVID-19, control efforts through social distancing and population lockdowns have brought additional deprivations on vulnerable populations. In low- and middle- income countries (LMIC) and elsewhere, the slowdown in economic activity has resulted in rapidly rising unemployment, particularly in the informal sector, where the majority of workers are employed and without adequate social safety nets. The effects of COVID-19 and population lockdowns will have short and long term effects on health, human capital, and income of vulnerable populations. It is now increasingly clear that economically vulnerable groups are being forced to sacrifice disproportionately more for the better health of society. To mitigate the deprivation due to COVID-19 it is necessary for government safety net programs to provide long term support focused on specific vulnerable populations.
Dr. Baridalyne Nongkynrih, Dr. Mohan Bairwa
Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi
Globally, NCDs are responsible for about 70% of all deaths, resulting in nearly 15 million “premature” deaths globally (i.e., deaths between the ages of 30 and 69 years). The majority of these deaths at 85% occur in in low and middle-income countries (LMICs). NCDs (cancer, CVD, CRD, diabetes and mental health – can result in a cumulative output loss of US$ 47 trillion over the period 2011-2030 i.e. nearly 75% of the global GDP in 2010. CVDs and mental health diseases are the two main contributors to the global economic burden of NCDs. In India and other South-East Asian countries, NCDs affect a relatively younger population as compared to the western countries.
Harsha Joshi
Program Officer, India Primary Health Care Support Initiative (IPSI)
The year 2020 brought global attention to public health and health systems. Faced with the COVID-19 pandemic, governments across the world are prioritizing the health sector and its resource requirements. In India, recent developments such as the 15th Finance Commission (FC) report, and the Union Budget 2021-22 indicate increased government attention to the health sector. Importantly, there is a renewed focus primary health care reforms and increased financing for primary health care.
IPSI Courses
Courses for Capacity Building
Strengthening institutional capacity within States to build stronger primary health care systems is one of the aims of the IPSI project. Two short courses for state program officers are currently being designed in partnership with the All India Institute of Medical Sciences, New Delhi under the capacity building component of IPSI. These are (a). Future Primary Healthcare Systems; (b). Implementation Research.
The training on ‘Future Primary Health Care Systems’ aims to foster thinking on primary health care system models, to develop understanding and practical competencies for key essential public health functions. Learning from global and Indian primary health care experience and models will be integral to the content of this course.
The short course on ‘Implementation Research’ aims to develop understanding about implementation research among the program managers. This will enable program managers to build to articulate relevant research questions and collaborate with researchers and to use the generated evidence to strengthen delivery of health services and program implementation.
An initial needs assessment has been conducted to understand the status and requirements of state program officers before designing the course modules. In person interviews were conducted with 16 state program officers at Haryana and Rajasthan for this in March 2021. The exercise helped us identify areas of study of relevance for our target group, preferred mode of study, and identify appropriate stakeholders for the course.
Courses are designed to be delivered through didactic lectures, examination of case studies, group-based discussions, and skill-building sessions to make it participatory. IPSI will support the cost of training for the development of these course, and participation. Trainees will be provided with a Certificate of Participation from partner academic institutions after successful completion of the course.
Click here to download our course brochures
Johns Hopkins India Health System Institute
IPSI Global Health Scholars Program offers scholarships for short-term courses to eligible candidates interested in enhancing their competency in the field of primary health care. The program is currently accepting applications for the India Health Systems Institute (IHSI). IHSI is a new initiative by the Health Systems Program in the Department of International Health at the Johns Hopkins Bloomberg School of Public Health (JHSPH), and the India Primary Health Care Support Initiative (IPSI). The IHSI features fully online courses designed specifically for participants from India and are taught by leading faculty at JHSPH. The Institute is offering eight courses between the 7th to the 19th of June 2021:
- Evaluation of District-Level Primary Health Care Implementation in Low-and Middle-income
- High Performing Organizations in LMIC Settings
- Design and Implementation of Incident Management Systems in Low- and Middle-Income
- Global Health Entrepreneurship: from Ideas to innovations
- Essential Skills for Women’s Leadership in Global Health
- Introduction to Household Surveys for Evaluation of Primary Health Care Programs in Low- and Middle- Income Resource Settings
- Introduction to Design and Implementation of Digital Health Programs in LMIC Settings
- Modeling and Simulation for Health Workforce Analysis
The IPSI Global Health Scholars program will sponsor the fees for one IHSI course per scholar. Last date for applications is May 15th, 2021
Click here to visit the IPSI fellowships page for eligibility requirements, application process and more information.
IPSI Updates
Launch of Public Health Matters – IPSI Webinar Series
IPSI Webinar 1: Primary care in the COVID-19 response: Global Experiences
On the 24th of February 2021, the India Primary Health Care Support Initiative (IPSI) launched its online webinars series ‘Public Health Matters’. The first virtual panel discussion was on Primary care in the COVID-19 response: Global Experiences. The panel, moderated by the IPSI Director Krishna D. Rao, comprised of health system experts from different countries. Mr. Manoj Jhalani, Director, Department of UHC/Health Systems & Life Course, WHO SEARO started the session with a discussion on the response to COVID-19 from countries in the SEARO region. Dr. Anand Krishnan, Professor Centre for Community Medicine, and member of the AIIMS team (IPSI National Partner) introduced the response to the disease outbreak in India. Dr. Titiporn Tuangratananon, Research Fellow IHPP, Ministry of Public Health Thailand gave an overview of the primary health system in Thailand – and how its structure served to respond to the COVID-19 health emergency. Lastly, Professor David Bishai from the Johns Hopkins Bloomberg School of Public Health brought in a wider global health perspective to the discussions.
Click here to watch the webinar on Primary care in the COVID-19 response: Global Experiences
IPSI Webinar 2: A tale of two cities: urban primary health care and the COVID-19 response in Rio and Mumbai
The second IPSI webinar focused on the response to COVID-19 at the primary health care level in urban areas in two BRICS countries – India and Brazil. Dr. Padmaja Keskar, who recently retired from the Greater Mumbai Municipal Corporation, India brought in her experience in the COVID-19 response at the critical initial few months of the outbreak. Dr. Claudia Pereira, associate professor, Fiocruz introduced the audience to the experience of the COVID-19 response in Rio.
Click here to watch the webinar on urban primary health care and the COVID-19 response in Rio and Mumbai
Resources
Readings
The significance of primary health care for building back better: lessons from COVID-19 “The coronavirus disease 2019 (COVID-19) pandemic, with its overlapping public health and economic emergencies, is a global reminder of the importance of addressing social and environmental determinants of health and inequality, and investing in health systems oriented towards primary care, all of which are components of a primary health care (PHC) approach.”
Strengthening primary health care in the COVID-19 era: a review of best practices to inform health system responses in low- and middle-income countries “Successful PHC strengthening initiatives required substantial reform across all four of the framework’s strategic levers – political commitment and leadership, governance and policy, funding and allocation of resources, and engagement of communities and other stakeholders. Importantly, strategic reforms must be accompanied by operational reforms; the strongest evidence of improvements in access, coverage and quality related to service delivery models that promote integrated services, workforce strengthening and use of digital technologies. Strengthening PHC is a “hard grind” challenge involving multiple and disparate actors often taking years or even decades to implement successful reforms. Despite major health system adaptation during the pandemic, change is unlikely to be lasting if underlying factors that foster health system robustness are not addressed.”
Read the full issue of the WHO South-East Asia Journal of Public Health here
PRIMASYS: a health policy and systems research approach for the assessment of country primary health care systems “There is no one-size-fits-all model of a country-level PHC system, and countries have implemented diverse models, adapted to and conditioned by their respective social, economic and political contexts. This paper applies advances in the field of health policy and systems research (HPSR) to propose an approach to the assessment of country PHC systems, using a compendium of 70 elements of enquiry requiring mixed quantitative and qualitative assessment. The approach and elements of enquiry were developed based on a review of policy and guidance documents and literature on PHC and HPSR and were finalized as part of a consultation of experts on PHC. Key features of the approach include sensitivity to context, flexibility in allowing for in-depth enquiry where necessary, systems thinking, a learning emphasis, and complementarity with existing frameworks and efforts. Implemented in 20 countries to date, the approach is anticipated to have further utility in a single country as well as in comparative assessments of PHC systems.”
Events
IPHACON 2021
The 65th Annual National Conference of the Indian Public Health Association (IPHACON 2021) will take place between the 24th to 26th of September 2021. The conference is being organised by the Department of Preventive and Social Medicine, JIPMER International school Of Public Health, and the Indian Public Health Association.
Early Bird Registrations ongoing for the 14th International Health Economics Association Congress
The biennial Congress will be hosted virtually in 2021.