Reiterating the Importance of Publicly Funded and Provided Primary Healthcare for Non-communicable Diseases: The Case of India Comment on "Universal Health Coverage for Non-communicable Diseases and Health Equity: Lessons From Australian Primary Healthcare".

Sulakshana Nandi

doi:10.34172/ijhpm.2021.137

Abstract

India has established health and wellness centres (HWCs) and appointed mid-level healthcare providers (community health officers, CHOs) to provide free and comprehensive primary healthcare (PHC), through screening, prevention, control, management and treatment for non-communicable diseases (NCDs), in addition to existing services for communicable diseases, and reproductive and child health. The range of services being provided and the number of people accessing ambulatory care in these government centres have increased, leading to more equitable healthcare access and financial protection. In policy debates, contestations exist prioritising between PHC or hospital services, and between publicly-provided healthcare or privatised and "purchased" services. Nationally and globally the influence of industries and corporations in health governance has weakened the response against NCDs. PHC initiatives for NCDs must be publicly funded and provided, located within communities, and necessitate action on the determinants of health. The experiences from Australia (a high-income country) and India (a low-and middle-income country) amply illustrate this.

Highlights

The article by Fisher et al[1] on lessons from Australia for universal health coverage (UHC) for non-communicable diseases (NCDs) and health equity, paves way for a much needed discussion on the strategies and policies for comprehensive primary healthcare (PHC) in the context of NCDs, and the continued relevance of the Alma Ata declaration.[2]
Fisher et al[1] assess the dominant ideas, key actors and interests shaping policy and implementation and financing structures around PHC and NCDs and provide recommendations on PHC design. They highlight how the current model influenced by a biomedical approach, the health industry and medical professionals, is geared towards curative services and episodic care rather than comprehensive PHC, and has services inequitably distributed.[1]
Using India’s recent experiences of expanding PHC for NCDs as an illustration, the present commentary argues that the findings and recommendations presented by Fisher et al[1] are relevant to other high-income countries, and significant for low-income and lower-middle-income countries.[3]

Summary

Introduction

The article by Fisher et al[1] on lessons from Australia for universal health coverage (UHC) for non-communicable diseases (NCDs) and health equity, paves way for a much needed discussion on the strategies and policies for comprehensive primary healthcare (PHC) in the context of NCDs, and the continued relevance of the Alma Ata declaration.[2].

Results

Conclusion