PMC:7340764 / 3960-7954
Annnotations
{"target":"https://pubannotation.org/docs/sourcedb/PMC/sourceid/7340764","sourcedb":"PMC","sourceid":"7340764","source_url":"https://www.ncbi.nlm.nih.gov/pmc/7340764","text":"Box 1 Evolution of Government PHC system in India [1–30]\nPrimary Health Care (PHC) has always been considered a foundation of stronger and efficient health systems. 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]. 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]. This was part of establishing a three-tier healthcare system in the country, which has evolved since then [2, 7, 8]. 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]. 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]. The efforts to strengthen PHC system in rural India have been made over the years [1, 3, 4, 12–20]. With these initiatives, by mid Sept 2019, country had an extensive network of 158,417 Health Sub Centres: 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]. The annual admission capacity in medical colleges was 80,000 for graduate medical seats and 41,000 for post graduate courses.\nThe 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]. A major initiative to further strengthen \u0026 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]. The urban component as National Urban Health Mission was launched in May 2013 [24]. Two missions together were, thereafter, renamed as National Health Mission (NHM) [22–24]. The NRHM/NHM has focused on PHC system strengthening to make it functional to deliver services. 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].\nThe 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). 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]. 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. The need for a new approach to deliver comprehensive PHC was felt. It was also the time when various discourses on Universal Health Coverage (UHC) were happening in India [27–29]. The ongoing \u0026 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. These challenges have been documented in various review missions and also captured in situation analysis document of NHP 2017 [1, 3, 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