The dire need for primary care specialization in India: Concerns and challenges

Abstract

Primary health care is an evidence-based priority, but it is still inadequately supported in many countries. Ironically, on one hand, India is a popular destination for medical tourism due to the affordability of high quality of health care and, on the other hand, ill health and health care are the main reasons for becoming poor through medical poverty traps. Surprisingly, this is despite the fact that India was committed to 'Health for All by 2000’ in the past, and is committed to 'Universal Health Coverage’ by 2022! Clearly, these commitments are destined to fail unless something is done to improve the present state of affairs. This study argues for the need to develop primary care as a specialization in India as a remedial measure to reform its health care in order to truly commit to the commitments. Three critical issues for this specialization are discussed in this review: (1) The dynamic and distinct nature of primary care as opposed to other medical specializations, (2) the intersection of primary care and public health which can be facilitated by such a specialization, and (3) research in primary care including the development of screening and referral tools for early diagnosis of cancers, researches for evidence-based interventions via health programs, and primary care epidemiology. Despite the potential challenges and difficulties, India is a country in dire need for primary care specialization. India's experience in providing low-cost and high quality healthcare for medical tourism presages a more cost-effective and efficient primary care with due attention and specialization.

A qualitative study of facilitators and barriers to cardiovascular risk factor control in a semiurban population in India

“…[2] Risk factor control is an important domain in CVD prevention, one that needs to be undertaken starting with the primary care physician at the Peripheral Health Center (PHC) level. [34] It is therefore concerning that the prevalence of hypertension has doubled and that of diabetes, tripled over the last 30 years in India. [5] A meta-analysis of hypertension control across India noted that 75% of rural hypertensive patients were not aware of their diagnosis.…”

Universal health coverage - There is more to it than meets the eye

“…The essential elements for the proposed UHC should include the ingredients highlighted by the authors, especially financial cover for outpatient care and gatekeeping of tertiary-care facilities. [ 1 8 ] Much needs to be discussed and debated, and the Indian public health journals should take a cue from the Journal of Family Medicine and Primary Care and continue further academic discussions on UHC because any future health budget increase is likely to be spent on UHC. [ 1 ] In the absence of such analysis and discussions, the UHC in India may prove to be a failure of commitment at best, or another highly profitable venture for private healthcare at the cost of government's money at worst.…”

Ethics of cancer care: beyond biology and medicine

“…In the World Health Report 2007, three major issues were predicted to be affecting healthcare systems, namely, inequality in delivery of healthcare, the inability of nations to manage the increasing burden of non-communicable diseases, including cancer, and the lack of preparedness of health systems to keep pace with advancements in the field of medical science [69]. The global cancer burden is expected to rise beyond 20 million yearly new cases by 2025 [69]; 70% of all these cases are estimated to be from developing countries, leading to serious challenges affecting the healthcare economy [65]. And yet, many governments have been slow to address the health and economic consequences of cancer and the socio-demographic, political-economic factors that worsen the burden of disease.…”

“…There is a call for action from governments, policymakers and the global health community to enable healthcare systems to deliver equitable and ethical access to cancer care. In developing countries, there is an imminent need to evaluate more sustainable approaches such as integrating cancer screening and prevention with the primary care infrastructures, which has proven to be effective in many countries [69]. Furthermore, there remains a wide scope of research, especially in the developing country context, on the ethical, socio-cultural, economic and political barriers faced in cancer prevention and screening.…”