State plans a pilot project to revamp primary healthcare sector
As Kerala aspires to move towards Universal Health Coverage (UHC), as envisaged in the 12 Plan, the government is preparing to strengthen the primary healthcare system of the State by revamping the structure, reworking the role of healthcare providers, and by envisaging a greater role for local communities.
If the project proposal, included in the Plan Implementation Programme of the National Rural Health Mission (NRHM) this year, gets the Centre’s approval, Kerala could be the first State in the country to pilot an experiment in UHC.
The Health Department has selected three institutions in Thiruvananthapuram district to pilot the UHC project — the primary health centres (PHC) of Kallikkad and Chemmaruthi and the community health centre (CHC) of Venpakal.
The project will have the technical support of the National Health Service (NHS) of U.K. The department is being assisted by Mala Rao, Professor of International Health, University of East London, who has a wealth of experience in strengthening public health systems, having been the Director of Public Health, NHS, for several years. Dr. Rao has been working with a group here for a while now.
“The concept of UHC cannot happen unless there is a well-functioning primary healthcare system — the friendly neighbourhood PHCs — where a chunk of the healthcare needs of local communities will be met. Good, quality care at the primary healthcare-level alone can bring down the healthcare costs. The focus will be on better infrastructure, more staff, and a total revision of the traditional roles played by our health workers,” says Dr. Rao.
The current three-tier primary healthcare system consists of sub-centres, PHCs and CHCs. While the sub-centres are inadequately staffed, the PHCs have just one doctor who ends up doing clinics, field work, immunisation, and a host of other administrative jobs. CHCs too have no takers among the public.
The UHC pilot project envisages sub-centres as service delivery centres more involved in screening programmes, and delivery of elderly care and palliative care through trained field workers and ASHAs.
The PHCs are to be equipped with more facilities and manpower to deliver most of the healthcare requirements of the community. Every PHC will have at least three doctors and four staff nurses. Nurses will have a more pro-active role, on the lines of ‘nurse-practitioners’ of U.K.’s NHS. Team work, multi-tasking, skill development and a better use of technology are some of the watch words here.
A shift is being envisaged in the role of CHCs, with these becoming training centres and also offering rehabilitative care.
Training is to be a crucial area. The Community Medicine Department at Thiruvananthapuram Medical College is thus being primed as a Primary Healthcare Department, which will give academic inputs for training doctors and nurses to be posted at PHCs. It will chart out the guidelines for CHCs, draw up clinical protocols, take up primary care research, and develop care pathways and curriculum for doctors and nurses.
The State has already received approval for a Rs.96 crore e-health initiative from the Centre, to support the pilot project. Utilisation of information technology to build up a health database of communities; equipping field workers with tablets or PDA devices for data collection; and creating portable workstations with Wi-Fi connectivity to ease workflow are being envisaged under the project
“A lot of ground work needs to be done before we can achieve the vision of UHC. We will have to work on building the infrastructure as well as the professional competency of doctors and nurses. Within a regulatory framework, the State can also rope in private sector healthcare providers,” points out a senior Health Department official.