| Id |
Subject |
Object |
Predicate |
Lexical cue |
| T13 |
0-220 |
Sentence |
denotes |
The primary health care system in India has evolved since independence and there is an elaborate network of nearly 200,000 Government Primary Health Care Facilities (GPHCFs), both in rural and urban areas (Box 1) [1–30]. |
| T14 |
221-366 |
Sentence |
denotes |
The existing GPHCFs deliver a narrow range of services, due to variety of reasons including, at times, the non-availability of providers as well. |
| T15 |
367-587 |
Sentence |
denotes |
Thus, the GPHCFs in India are grossly underutilized & excluding for the mother and child health services, in 2013-14, only 11.5% of rural and 3.9% in urban people in need of health services used this vast network [1, 2]. |
| T16 |
588-889 |
Sentence |
denotes |
People in India either choose higher level of government facilities for primary health care (PHC) needs (which results in an issue of subsidiarity) or attend a private provider (which results in the out of pocket expenditure or OOPE), both situations are not good for a well-functioning health system. |
| T17 |
890-976 |
Sentence |
denotes |
The challenge of weak PHC in India are increasingly being recognized and acknowledged. |
| T18 |
977-1256 |
Sentence |
denotes |
The National Health Policy (NHP) 2017 of India proposed to strengthen PHC systems, invest two-third or more government health spending on PHC, with an increase in overall government funding for health to 2.5% of Gross Domestic Product (GDP) by 2025, against 1.18% in 2015–16 [3]. |
| T19 |
1257-1670 |
Sentence |
denotes |
Following on the NHP 2017, the Government in India announced Ayushman Bharat Program (ABP) in February 2018 with two components of (a) Health and Wellness Centres (HWCs) to strengthen & deliver comprehensive Primary Health Care (cPHC) services for entire population and (b) Pradhan Mantri Jan Arogya Yojana (PMJAY) for secondary and tertiary level hospitalization services for bottom 40% of families in India [4]. |
| T20 |
1671-1816 |
Sentence |
denotes |
The details of ABP in the context of Universal Health Coverage (UHC) has been published earlier [1] and a schematic of ABP is provided as Fig. 1. |
| T21 |
1817-1957 |
Sentence |
denotes |
These two arms, hence onwards, in this article, have also been referred as AB-HWCs and AB-PMJAY, to indicate that both are component of ABP. |
| T22 |
1958-2014 |
Sentence |
denotes |
Box 1 Evolution of Government PHC system in India [1–30] |
| T23 |
2015-2122 |
Sentence |
denotes |
Primary Health Care (PHC) has always been considered a foundation of stronger and efficient health systems. |
| T24 |
2123-2332 |
Sentence |
denotes |
The efforts to strengthen health services, based upon stronger PHC in India started when the ‘Health Survey and Development Committee’ was established in 1943 under the chairpersonship of Sir Joseph Bhore [5]. |
| T25 |
2333-2549 |
Sentence |
denotes |
India started setting up primary health centres (PHCs) in 1952, when the first few PHCs were established in Najafgarh (Delhi), Singur (West Bengal) and Poonammalle (Tamilnadu) under Community Development Program [6]. |
| T26 |
2550-2666 |
Sentence |
denotes |
This was part of establishing a three-tier healthcare system in the country, which has evolved since then [2, 7, 8]. |
| T27 |
2667-2897 |
Sentence |
denotes |
India started efforts to build health system around the same time when National Health Services (NHS) in United Kingdom was set up and the constitution of World Health Organization (WHO) came into force, both in year 1948 [9, 10]. |
| T28 |
2898-3091 |
Sentence |
denotes |
The successive governments continued to expand the network of PHCs, which received a major boost through various committees, set up nearly one to three in every decade for first 4 decades [11]. |
| T29 |
3092-3191 |
Sentence |
denotes |
The efforts to strengthen PHC system in rural India have been made over the years [1, 3, 4, 12–20]. |
| T30 |
3192-3297 |
Sentence |
denotes |
With these initiatives, by mid Sept 2019, country had an extensive network of 158,417 Health Sub Centres: |
| T31 |
3298-3459 |
Sentence |
denotes |
25,743 Primary Health Centres in rural areas; 5,624 Urban PHCs; 764 district hospitals; 539 medical colleges and hospitals and 1,741 mobile medical units [7, 8]. |
| T32 |
3460-3585 |
Sentence |
denotes |
The annual admission capacity in medical colleges was 80,000 for graduate medical seats and 41,000 for post graduate courses. |
| T33 |
3586-3801 |
Sentence |
denotes |
The efforts to strengthen PHC network in India apparently received a boost after Alma Ata conference on primary health care in 1978 and then with the release of India’s first National Health Policy in 1983 [14, 21]. |
| T34 |
3802-4030 |
Sentence |
denotes |
A major initiative to further strengthen & make rural PHC system functional, started in April 2005, with the launch of National Rural Health Mission (NRHM) in India [22] soon after the second national health policy in 2002 [23]. |
| T35 |
4031-4114 |
Sentence |
denotes |
The urban component as National Urban Health Mission was launched in May 2013 [24]. |
| T36 |
4115-4204 |
Sentence |
denotes |
Two missions together were, thereafter, renamed as National Health Mission (NHM) [22–24]. |
| T37 |
4205-4300 |
Sentence |
denotes |
The NRHM/NHM has focused on PHC system strengthening to make it functional to deliver services. |
| T38 |
4301-4725 |
Sentence |
denotes |
NRHM/NHM had a few strategies to strengthen health systems and PHC services: decentralized health planning; communization (community processes, behavior change communication and addressing social determinants of health); social protection function of public health services; partnership for NGOs and civil society; human resource strengthening; flexible funding for states, public health management and many others [22, 25]. |
| T39 |
4726-4944 |
Sentence |
denotes |
The NRHM/NHM in India is attributed to improving several services, though mostly Reproductive Maternal, Newborn, Child and Adolescent Health (RMNCH+A) services through Government Primary Health Care Facilities (GPHCF). |
| T40 |
4945-5193 |
Sentence |
denotes |
The reduction in Infant Mortality Rate (IMR) and Maternal Mortality Ratio (MMR), which these programs specifically targeted, were reduced at accelerated manner and India reached very close to achieve Millennium Development Goals (MDG) 4 and 5 [26]. |
| T41 |
5194-5423 |
Sentence |
denotes |
Yet, it was increasingly being recognized that health services for emerging burden of diseases and changing epidemiological profile, i.e., Non-communicable diseases (NCDs) through GPHCFs were either not available or insufficient. |
| T42 |
5424-5490 |
Sentence |
denotes |
The need for a new approach to deliver comprehensive PHC was felt. |
| T43 |
5491-5603 |
Sentence |
denotes |
It was also the time when various discourses on Universal Health Coverage (UHC) were happening in India [27–29]. |
| T44 |
5604-5814 |
Sentence |
denotes |
The ongoing & identified challenges of GPHCFs include a narrow range of services, insufficient infrastructure, shortage of healthcare providers; lack of medicines and diagnostics, and limited referral services. |
| T45 |
5815-5952 |
Sentence |
denotes |
These challenges have been documented in various review missions and also captured in situation analysis document of NHP 2017 [1, 3, 30]. |
| T46 |
5953-6005 |
Sentence |
denotes |
Fig. 1 Ayushman Bharat Program in India: a schematic |
