British medical enthusiasts Sir Chadwick and Sir John Simon first popularized the concept of Primary Health Care (PHC) in colonial India. The Bhore Committee recommended the estabishment of a PHC system, and independent India's Planning Commission approved its extension. The goal of "Health for All by 2000" has not been fully achieved in India and we can locate the successes and failures of the government's health policies in the strengths and weaknesses of its PHC system.

Health Profile of India
Per capita GNP 450 (US$)
Life expectancy 62 years
Maternal Mortality Ratio 4 per 1,000 live births
Infant mortality 70 per 1,000 live births
Annual number of births 24.5 million (1.8% growth rate)
Infants with low birth rate 33%
Tuberculosis annual rates 2-2.5 million cases; 500,000 deaths
Malaria 35% increase incidence of P.Falciparum
Polio (after pulse polio drive) 70 cases between 1999 and 2000
Leprosy prevalence 53 per 100,000
AIDS 5% of population infected in the South

Accomplishments

The system, with a total of approximately 24,000 centres in rural areas, is the only approachable help for 74% of the Indian population. The teamwork performed by doctors and extension-service providers in PHC has enabled handling cases "from paediatrics to geriatrics". Primary due to the efforts of the PHC, maternal and infant mortality has come down as well as deaths from diarrheal diseases. More couples get easy access to contraception. Epidemic control measures, immunizations drives and disease control programmes, such as the Pulse Polio Programme, have certainly improved the level of health care.

Problems

PHC failed in controlling India's surging population, which exceeded one billion on May 1, 2000 or one-sixth of entire world's population. Many National Programmes for health have fallen short of their targets. Most alarming for the health scene is the reappearance of once controlled diseases or the development of newly resistant ones. The wide disparity in the level of public amenities like electricity, drinking water, food and civil supplies between rural and urban areas discourages city-dwelling medical graduates from choosing to work in villages (PHCS).

Organisational faults at various levels have prevented the PHC system from working properly, with Government bureaucracy leading to mismatch in staff appointments and conflicting health prioirities. Difficulties in the medical supply chain have compounded these problems and often result in patients having to be referred to higher tiers of the health care system, defeating the main goal of PHC.

Dr. Arti Sinha
Arti_sinha@hotmail.com
(From the Royal College of General Practitioners International Newsletter, Dr. Mike Thompson MRCGP editor)