Primary health care is at the bottom of the pyramid of the healthcare ecosystem. It carries the most volume in terms of patient healthcare needs. But, the Law of Scarcity simply states: If what we desire “appears” to be in limited supply, the perception of its value increases significantly. Unfortunately, ICU care and tertiary care have developed the power equation. If a state is providing these two aspects, it is considered a big achievement as the resource and skill sets required for these setups are cost-intensive. We hardly see that Primary Healthcare Centre (PHC) establishment does not fit in or is being prioritised in this power equation. In fact, visibility, attention, and focus on PHC is considered a simple task and thus because of its simplicity, it is perceived that it does not hold any substantial potential and value.
Our healthcare system, right from the beginning, is focused on treating the symptoms in the system but not focussing and treating the root cause of the challenges. The same holds true for our simple but neglected primary healthcare delivery. We feel that by building state-of-the-art big-size tertiary care and ICU we can answer all the questions and solve the challenges? Here we need deep thinking and introspection about our priorities in health care administration.
If our primary health care foundation is robust, then it is obvious that the burden on our tertiary and critical care will be reduced. Poor performance of PHC is a problem of our mindset. We do have the infrastructure, but we are not performing in the operations, processes and implementation of service aspects. A doctor, PHC physician, and critical care physician… How do we perceive them? Why do we compare them? This perception itself is a hindrance. Digital health, if prioritised and implemented in primary health, will gradually add to capacity building, and so will be the shift in the perceptual zone of inferiority to the zone of importance. Systematic, real-time data with high-level integration and analytics from all the PHC’s will speak for itself.
We need this digital revolution and connectivity at all levels. For instance, at the policy level, we need intervention in the form of real-time data from all the PHC’s and their integration. This, in turn, will give impetus to actual resource utilisation. Disease burden in the community will be mapped with a click of a button, which will facilitate effective decision-making for policymakers. At the implementation level, health care teams-doctors, nurses, and paramedics, including allied health workers, will be empowered, and psychologically this digital movement at PHC’s efforts will equate them in responsibility and accountability, balancing the game of administration. Identity at the workplace and feeling of being important is the key to transforming PHC delivery as organisations are made by humans and not by infrastructure, schemes or any other heavy fancy words or structures. At the community level, underutilisation or overburden of PHC needs the analysis and deep-down exploration of why? Digital health is the key to guiding us about these reasons based on scientific and systematic public health and behaviour analytics.
Why can’t we focus on state of art and modern PHC’s of true comprehensive nature at an equal footing for tertiary and ICU care? Highly integrated PHC’s with respect to diagnosis, prescription, integrated point of care devices, pharmacy and clinical decision support including referrals is the only key to a strong foundation of the health care ecosystem.
To conclude, prioritising PHC which is the cornerstone of the entire healthcare ecosystem and real-time data analytics is the only way to plan, organise, coordinate, direct, report and budget. Administration with a blind approach is a disaster that we should not face in visionary India and also at the global level. Forgetting the COVID 19 disaster and ignoring the learning from it will make us face unseen future pandemic disasters. Let’s create India as the best primary healthcare model.
Views expressed by Dr Manisha K Palaskar, President, Primary Healthcare Foundation