Thiruvananthapuram: The Kerala government is preparing to strengthen the primary healthcare system of the State by revamping the structure, reworking the role of healthcare providers, and by envisaging a greater role for local communities.
The state has proposed a Universal Health Coverage (UHC) project to the Centre for approval to implement it on a pilot basis. The project proposal has been included in the Plan Implementation Programme of the National Rural Health Mission (NRHM) this year.
The State has already received approval for a Rs 96 crore e-Health initiative from the Centre, to support the pilot project. Utilisation of information technology to build up a health database of communities; equipping field workers with tablets or PDA devices for data collection; and creating portable workstations with Wi-Fi connectivity to ease workflow are being envisaged under the project.
The current three-tier primary healthcare system consists of sub-centres, PHCs and CHCs. While the sub-centres are inadequately staffed, the PHCs have just one doctor who ends up doing clinics, field work, immunisation, and a host of other administrative jobs. CHCs too have no takers among the public.
The UHC pilot project envisages sub-centres as service delivery centres more involved in screening programmes, and delivery of elderly care and palliative care through trained field workers and ASHAs.
The Kerala Health Department has selected three institutions in Thiruvananthapuram district to pilot the UHC project ” the primary health centres (PHC) of Kallikkad and Chemmaruthi and the community health centre (CHC) of Venpakal.
The PHCs are to be equipped with more facilities and manpower to deliver most of the healthcare requirements of the community. Every PHC will have at least three doctors and four staff nurses. Nurses will have a more pro-active role, on the lines of nurse-practitioners of U.K.s NHS. Team work, multi-tasking, skill development and a better use of technology are some of the watch words here.
A shift is being envisaged in the role of CHCs, with these becoming training centres and also offering rehabilitative care.
The project will have the technical support of the National Health Service (NHS) of U.K. The department is being assisted by Mala Rao, Professor of International Health, University of East London, who has a wealth of experience in strengthening public health systems, having been the Director of Public Health, NHS, for several years.
The Community Medicine Department at Thiruvananthapuram Medical College is being primed as a Primary Healthcare Department, which will give academic inputs for training doctors and nurses to be posted at PHCs. It will chart out the guidelines for CHCs, draw up clinical protocols, take up primary care research, and develop care pathways and curriculum for doctors and nurses.