PHC's in India

Statistics of PHC's (Primary Health Center) in India:

There is 1 PHC for every 25,000 population
PHC for - Promotive, Preventive, Curative and Rehabilitative Care
This implies offering a wide range of services such as health education, promotion of nutrition, basic sanitation, the provision of mother and child family welfare services, immunization, disease control and appropriate treatment for illness and injury.

Each PHC is a hub for 5-6 Sub-Centers.
Each PHC is covers 3-4 Villages.
Each PHC is coordinated by a ANM (Auxiliary Mid Wife)

PHC's will be referral centers for Community Health Centers (CHC), which is a minimum 30 bedded-hospital or higher at the Taluk or District Levels.

WHO Report
According to WHO, PHC's in India specifically attribute to deterioration of quality services due to parameters like - lack of political commitment, inadequate allocation of financial resources to PHC's and stagnation of inter-sectoral strategies and community participation. Also in the list of reasons are bureaucratic approach to HealthCare implementation, lack of accountability and responsiveness from general public.

Key Points to observe:
1. PHC's through out the country have the same number of ANM's even though the fertility rate varies in different parts of the country.
2. Political interference in creating PHC's.
3. Government departments are more involved in ensuring government norms are implemented, salaries are paid and minimum facilities are available rather than concentrating on measuring Health System Performance.
4. The DHO (District Health Officer), responsible for implementation of Public Health Systems are not adequately trained.

Strengthening the capacity for Public Health Management at the District and Taluk level is crucial to improving public sector performance.

Why the system is not working as required?
1. Lack of accountability in the system.
2. No formal feedback mechanism to ensure proper implementation of the system.
3. No incentives for Doctors to work in the Rural areas.
4. Irresponsible mind-set of ANM's (this happens as there is no feedback mechanism)
5. Lack of resources (staff).
6. Current budget allocation of Rs. 75,000 / PHC / Annum is very less when considering the population each PHC has to cater to (5000 people).

What do we do?
1. Periodic HealthCare Education in Schools, Panchayat/Taluk Offices - NGO, Private Institutions and Social Entrepreneurs.
2. Community involvement - Government / Private Partnership
3. Public Health Training programs for DMO's and other staff - Government / Private Partnership.
4. Appropriate and functioning feedback mechanism to ensure people understand that they are cared for and their feedback is valued for betterment of the system - Government

I will revisit this topic of what we can do better in my forthcoming writings.

Due credits to Neesha Patel, author of Evaluating the role of Primary Health Centers in India.