Primary Healthcare 2.0 (PHC) under India’s G20 presidency

The Covid-19 pandemic gave added urgency to pandemic preparedness and the Indonesian presidency in 2022 made it the major focus. The Indian presidency needs to advance these agendas by concerning primary healthcare.

• Health has been one of the priority areas for G20 deliberations since 2017, when the first meet of health ministers of G20 countries was organised by the German presidency. 
• The Berlin Declaration 2017 of the G20 health ministers provided a composite approach focusing on pandemic preparedness, health system strengthening and tackling antimicrobial resistance.
• The concept of Universal Health Coverage (UHC) was born in the 2000s to prevent catastrophic medical expenditures due to secondary and tertiary level hospital services by universalising health insurance coverage.
  • The UHC has been the big global approach for health systems strengthening since 2010, also adopted in 2015 as the strategy for Sustainable Development Goal-3 on ensuring healthcare for all at all ages.
• However, the limited impact of this narrow strategy was soon evident, with expenditures on outdoor services becoming not accessed for poor households and preventing access to necessary healthcare and medicines, while many unnecessary/irrational medical interventions were being undertaken.

Need of a holistic approach:

• A PHC-with-UHC approach: It means strengthening primary level care linked to non-medical preventive action (food security and safety, safe water and air, healthy workspaces, and so on) through whole-of-society and whole-of-government approaches, and extending the “PHC principles” to secondary and tertiary care services.
  • This could be the most cost-effective systems design, the comprehensive game changer for the global healthcare requirements.
• A broad global consensus: Commitment for more sustainable (i.e. cost-effective and affordable, inclusive and just, environment-sensitive in infrastructural and technology choices) and people-empowering health system.

India’s role as a global health facilitator:

• Pursuing agenda for universalization of primary healthcare would involve much dialogue within countries, regions and globally.
• This process could be started by working through the G20 Indian presidency year, towards a call for organising a global conference on rethinking healthcare systems that moves a Declaration on Sustainable and Empowering Health Care for the 21st Century.
• The G20, with its membership of the G7 high income countries and the emerging Low and Middle Income Countries, and its think-tank structures, is an appropriate platform to take up this long unfinished agenda.

Government Interventions:

India has several pioneering initiatives that can contribute to the PHC-with-UHC discussion:

• Lessons from the National Health Mission for strengthening public health delivery;
• The HIV-control programme’s successful involvement of affected persons/communities and a complex well-managed service structure;
• Pluralism of health knowledge systems, each independently supported within the national health system;
• Health personnel such as the ASHAs, mid-level health providers and wellness centres, traditional community healthcare providers with voluntary quality certification;
• Research designed for validation of traditional systems; pharmaceutical and vaccines production capacity;
• Developments in digital health;
• Social insurance schemes and people’s hospital models by civil society.