Primary health care in India

A new approach to health care came into existence in 1978 following an international conference at Alma-Ata. This is known as "primary health care". It has all the hallmarks of a primary health care delivery, first proposed by the Bhore Committee in 1946 and now espoused worldwide by international agencies and national governments.

Before Alma-Ata, primary health care was regarded as synonymous with "basic health services", "first contact care", "easily accessible care", "services provided by generalists", etc. The Alma-Ata international conference gave primary health care a wider meaning.

Definition of Primary Health Care

The Alma-Ata conference defined primary health care as follows:

"Primary health care is essential health care made universally accessible to individuals and acceptable to them, through their full participation and at a cost the community and country can afford"

Elements of primary health care

Although specific services provided will vary in different countries and communities, the Alma-Ata Declaration has outlined 8 essential components of primary health care.

1. Education concerning prevailing health problems and the methods of preventing and controlling them.
2. An adequate supply of safe water and basic sanitation.
3. Promotion of food supply and proper nutrition.
4. Maternal and child health care, including family planning.
5. Immunization against major infectious diseases.
6. Prevention and control of locally endemic diseases.
7. Appropriate treatment of common diseases and injuries.
8. Provision of essential drugs.

Principles of primary health care

1. Equitable distribution

The first key principle in the primary health care strategy is equity or equitable distribution of health services, i.e., health services must be shared equally by all people irrespective of their ability to pay, and all (rich or poor, urban or rural) must have access to health services. At present, health services are mainly concentrated in the major towns and cities resulting in inequality of care to the people in rural areas. Primary health care aims to redress this imbalance by shifting the centre of gravity of the health care system from cities to the rural areas, and bring these services as near people's homes as possible.

2. Community participation 

Notwithstanding the overall responsibility of the Central and State Governments, the involvement of individuals, families, and communities in promotion of their own health and welfare, is an essential ingredient of primary health care. Countries are now conscious of the fact that universal coverage by primary health care cannot be achieved without the involvement of the local community. There must be a continuing effort to secure meaningful involvement of the community in the planning, implementation and maintenance of health services, besides maximum reliance on local resources such as manpower, money and materials. In short, primary health care must be built on the principle of community participation.

3. Intersectoral coordination

There is an increasing realization of the fact that the components of primary health care cannot be provided by the health sector alone. The Declaration of Alma-Ata states that " primary health care involves in addition to the health sector, all related sectors and aspects of national and community development, in particular agriculture, animal husbandry, food, industry, education, housing, public works, communication and others sectors". To achieve such cooperation, countries may have to review their administrative system, reallocate their resources and introduce suitable legislation to ensure that coordination can take place.

4. Appropriate technology

Appropriate technology has been defined as "technology that is scientifically sound, adaptable to local needs, and acceptable to those who apply it and those for whom it is used, and that can be maintained by the people themselves in keeping with the principle of self reliance with the resources the community and country can afford". The term 'appropriate' is emphasized because in some countries, large, luxurious hospitals that are totally inappropriate to the local needs, are built, which absorb a major part of the national health budget, effectively blocking any improvement in general health services.