Transforming health care to center around the needs and preferences of individuals and their ecosystem is the focus of a Comprehensive Primary Health Care (CPHC) approach.
The pandemic reinforced the need for a comprehensive health care model that grants autonomy to individuals involved and translates across national and regional levels of operations. The CPHC Alliance is where the public and private sectors coalesce to strengthen the CPHC network across the country through collaboration.
Different stakeholders were brought together, and their values were aligned to develop a collective vision of creating a country where everyone is able to maintain health and wellness through affordable health care.
To build a country where everyone has the capacity to maintain health and wellness through affordable and accessible health care.
To catalyze collective action to achieve universal and comprehensive primary health care in the country and the region.
To transform how comprehensive primary health care is delivered in India and the region, especially for the most vulnerable populations.
Evolution of Comprehensive Primary Health Care
With the Alma Ata conference came the general consensus that health was a human right, broadening the perception of health beyond doctors and hospitals and extending it to social determinants and justice.
Experiences in policy implementation over the last 40 years indicate the need to understand Primary Health Care (PHC) as a complex process that considers context, culture, politics, economics and social concerns.
Importance of CPHC
CPHC reduces fragmentation and focuses on the individual as a whole, placing them in a context of family, community and society. This helps to move away from episodic treatment to a prevention-treatment-care continuum.
CPHC also aids in analyzing data at aggregate levels to understand trends, outbreaks and other patterns to proactively address and move from illness to wellness. Going beyond typical health sector boundaries, CPHC works with a range of stakeholders to directly address social determinants.
Economic Benefits of CPHC
CPHC saves money (for individuals and society), avoids admission and builds a healthier and stronger society. Most of the data on the economic impact of PHC reflect the health services component.
International studies have found that strong primary care led to improved population health and lower health expenditure. There is compelling evidence of a tenfold return on investment from community health workers (CHWs) and significant economic benefit from the provision of preventive services in PHC.
Universal Health Coverage and CPHC
The report published by the WHO Commission on the Social Determinants of Health gave evidence that social determinants, including income, education, daily living conditions and the social, economic and political context of countries were critical to health improvements.
While there is evidence that a strong PHC system improves access to health care, there has not been much debate on how best to improve health system performance in the context of the global push for Universal Health Coverage (UHC). UHC and the health-related SDGs can only be sustainably achieved with a stronger PHC system.
India and Comprehensive Primary Health Care
India was one of the first countries to recognize the merits of the primary health care approach. Long before the Declaration of Alma-Ata, India adopted a primary health care model based on the principle that an inability to pay should not prevent people from accessing health services.
The Government of India recognized the importance of health in the process of economic and social development along with improving the quality of life of our citizens. The government thus launched the National Rural Health Mission in 2005, Urban Mission in 2014 and Ayushman Bharat-Health and Wellness Centers (AB-HWCs) in 2018.
Challenges to Achieving CPHC
The epidemiological and demographic profile of all the country’s states necessitates differential approaches and experiments with varying service delivery models for the rollout of AB-HWCs. With challenges manifold, the efforts are currently fragmented and isolated.
For India’s PHC system to address the complex needs of multiple communities and uphold its responsibility of the Alma-Ata Declaration of Universal Health Coverage, it needs innovative, flexible, scalable and cost-effective solutions.
Need for an Alliance for CPHC
Given the comprehensive nature of the ambition for CPHC, to truly reach the envisioned health outcomes and address its fragmented approach, there is a need to develop a collective consciousness.
An Alliance in all its neutrality can bring all three sectors, public, private and civil society, together and create a canvas of visions, ideas, models, approaches and tools, which can be shaped together and used based on context, purpose and stakeholder requirements.
Alliance’s Suggested Approach to CPHC
Developing a more people-centric model will produce significant benefits to both individuals and society. The vision of this WHO framework entails providing access to health care services that are coordinated around people’s needs, preferences, safety and affordability while providing good quality.
The system is easily adaptable in any set-up of a country; low-income, high-income, fragile or mature. The conceptual framework developed for the approach is presented here and can be co-opted as the approach of this alliance towards CPHC.
