The India Primary Health Care Support Initiative (IPSI) was established in July 2020 under a grant from the Bill & Melinda Gates Foundation. The Initiative is led by the Johns Hopkins University (JHU) in partnership with the All India Institute of Medical Sciences-Delhi. National Health Systems Resource Center (NHSRC) is the nodal agency for this project, on behalf of Ministry of Health and Family Welfare (MoHFW), Government of India, and IPSI is working closely with NHSRC and MoHFW.
IPSI aims to support MoHFW in developing a framework to assess the performance of the Primary Health Care system in India. IPSI will also support one district each from the three states- Gujarat, Odisha and Meghalaya to strengthen the delivery of Comprehensive Primary Health Care and improve the primary healthcare system’s performance.
Why primary health care and the role of IPSI
Strong primary health care systems are associated with better access to health care and population health. Long before the 1978 Alma-Ata declaration, health system planners in India envisioned a publicly funded and administered primary health care system to provide affordable primary health care to all. The establishment of a primary health care system as a core component of India’s public health system was one of the primary recommendations of the Health Survey and Development Committee (popularly known as the Bhore Committee), chaired by Sir Joseph Bhore. Recommendations made under the report of the Committee, which was submitted in 1946, continue to be relevant for India even today. Yet today, India’s primary health care system remains highly fragmented and inadequate.
Preventive health services are mostly provided by the public sector while curative care is largely provided by private (qualified and unqualified) providers. There is limited provision of promotive health care services. The vast network of government primary care facilities is mostly bypassed by patients. Further, studies report poor quality of primary care by both public and private providers. With the ready availability of private providers in the primary care space, and pre-payment mechanisms for financial protection like health insurance still in early stages of development, out-of-pocket expenditures for outpatient visits comprises a large share of direct payments for health care. This not only deters needed care for those who cannot afford it, but also places substantial financial hardship on patients leading to impoverishment, particularly for the economically vulnerable.
IPSI is based on the philosophy that strong primary health care systems are foundational for achieving universal health coverage. India has a long-standing commitment to comprehensive primary health care. The National Health Mission, and the government’s new flagship health program, Ayushman Bharat (particularly the Health and Wellness Center-HWC component), represent important efforts to strengthen state primary health care systems. The high dual burden of non-communicable and communicable diseases, population aging, rapid urbanization, and rising health expenditures, have made it even more critical to strengthen primary health care systems. Furthermore, the ongoing COVID-19 outbreak has highlighted the important role of primary health care services and strategies for containing infectious disease epidemics.
IPSI seeks to support the important Government initiatives by strengthening select states and districts to deliver Comprehensive Primary Health Care.
Achieving these outcomes is important for several reasons.
The potential gains of strong primary care systems on access to health care, and population health remains underutilized in India. This is particularly important as the role of Primary Health Care is critical in (a). the prevention, screening, and management of the increase in burden of chronic conditions; (b). to strengthen the health system to prevent and respond to health emergencies; (c). build a stronger and more resilient health system, one which provides better quality and equitable care.
The IPSI approach
To achieve its objectives in creating a Primary Health Care focused ecosystem in India, IPSI will work on the following three “pillars”:
- Measure: develop and deploy a state and district-level performance measurement index for assessing primary health care performance which integrates the primary health care approach and components of the HWC operational guidelines issued by MoHFW.
- Demonstrate: provide design, implementation and capacity building support to the three selected states and one district from each state for improving primary health care system performance and coverage of the 12 packages of services at HWCs.
- Recognize: Reward district performance improvement efforts towards HWC implementation and primary health care outcomes.