ROLE OF PRIMARY HEALTH CARE CENTRES IN KARNATAKA

Introduction :

The task of saving the lives of millions of women and children

throughout the world, who die every year from easily prevented

illness, is daunting. The outrage provoked by so many needless

deaths however can now be tempered by hope because this demands

for better health care and improved quality of health care and

quality of life for women are being voiced by communities health

personnel, researchers and policy makers. Keeping in view the

constitutional obligations, the Government of India planned

several approaches for the health care delivery. However, the

basis for organization of health services in India through the

primary health care in modern time, was laid by the

recommendations and guidance provided by the 'Health Survey and

Development Committee' (Bhore Committee) in 1946. The community

development programme was launched in October 1952 as the first

integrated all-round rural development programme. It was proposed

to establish one primary health centre 136 (PHC) for each

community development block. At that time, the operational

responsibilities of the PHC were to cover medical care, control of

communicable diseases, maternal and child health (MCH), nutrition,

health education, school health, environmental sanitation and the

collection of vital statistics. Each PHC had three sub-centres,

being looked after by a trained midwife for providing MCH

services.

The Declaration of Alma-Ata was adopted at the international

conference on Primary Health Care (Almaty, Kazakhstan, 6-12

September 1978) It expressed the need for urgent action by all

governments, all health and development workers and the world

community to protect and promote health care approach has since

then been accepted by member countries of the World Health

organisation as the key to achieving the goal of ‘Health For All’.

CONCEPT AND DIMENSIONS OF HEALTH AND PRIMARY HEALTH CARE

Health

Health is a state of complete physical, mental and social well-

being which is essential for leading a productive life, and it is

not merely the absence of disease or infirmity. Provision for

health should be considered a fundamental human right, and

attainment of highest level of health is a most important social

goal.

Primary Health Care

An essential health care should be based on practical,

scientifically sound and socially acceptable methods and

technology. It should be made universally accessible to the

individuals and the family in the community through their full

participation. It is to be made available at a cost which the

community and the country can afford to maintain at every stage of

its development in a spirit of self-reliance and self-

determination. Primary health care is the first level of contact

of the individuals, the family and the community with the national

health system bringing health care as close as possible to where

the people live and work. It constitutes the first element of the

process of continuing health care, and this should get full

support from the rest of the health system. This support would be

required in the following areas: (a) consultation on health

problems; (b) referral of patients to local or other specialized

institutions; (c) supportive supervision and guidance; and (d)

logistic support and supplies.

For achieving success in HFA development, at least eight essential

components of primary health care need to be properly implemented.

For this the cooperation and support of other social and economic

development sectors, such as education, social and women's

welfare, food and agriculture, animal husbandry, water resources,

housing, rural development, energy, environmental protection,

industry, communication, etc. would be vital. It would be well to

recognize that planning, organization and operation of primary

health care is a long process, and total population coverage may

be achieved progressively in stages, both in terms of geographical

coverage and the contents.

Today, Primary Health Centres are State owned health care

facilities in India. They are essentially single-doctor clinics

usually with facilities for minor surgeries too. They are a part

of the government funded public health system in India, and are in

fact the most basic units of this system. The 6th Five Year Plan

(1983-88) proposed reorganisation of PHCs which covers population

of 30,000 in plain areas and 20,000 in hilly and tribal areas.

Community Health Centres are upgraded from PHCs to cover primary

and curative services. They also act as first referral units to

the surrounding PHCs. For many in rural areas PHCs stresses on

preventions rather than cure. It relies on home self-help,

community participation and technology that the people find

acceptable, appropriate and affordable. It combines modern,

scientific knowledge and feasible health technology with

acceptable, effective traditional healing practices of special

importance for women is that the effectiveness of PHCs depends

very much upon community acceptance of primary health care

workers, most of who are women and who in most cases are recruited

form and selected with the participation of the community.

There are 23,673 PHCs functioning in the country as on March 2010

as per Rural Health Statistics Bulletin, 2010. The number of PHCs

functioning on 24/7 basis are 9107 and number of PHCs where three

staff nurses have been posted are 7629(2011). PHCs are referral

units for 6 sub-centres and refer out cases to CHC and higher

order public hospitals at sub-district and district hospitals. It

has 4-6 indoor beds for patients.

Essential components of PHC

In the Alma Ata Declaration, it is stated that at least the following

components should be included in primary health care which are

also the objectives of PHC :

1. Educate people about prevailing health problems and methodsof preventing and controlling them.

2. Promotion of food supply and proper nutrition.

3. Adequate supply of safe water and basic sanitation.

4. Maternal and child health care and 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.

Areas of medical treatments by PHCs

Infant immunisation programmes

Anti-epidemic programmes

Birth control programmes

Pregnancy and related care

Emergencies – Anti-venoms, anti-rabies etc.

By strengthening PHCs a health care delivery activity in the

areas as per government of India pattern is adopted. PHCs

provide primary health care in the areas through the network

of Sub-centres and other Para medical staff. PHCs include

preventive services, curative services, environmental

sanitation, health education, family welfare services and

recording of health statistics of various National Health

Programmes which are in force from time to time and also

implementing through a network of PHCs.

IPHS guidelines for PHCs

Directorate General of Health Services, Ministry of Health

and Family Welfare Government of India, under Indian Public

Health Standards (IPHS) guidelines for PHC frames certain

rules for all the PHCs in its functioning. The rules are with

regard to:

Infrastructure

Manpower- Number of doctors required (both male and female)

Staff nurses, Para medical staff and others.

Transport facilities with assured referral linkages

Laundry services – for maintenance of hygiene

Dietary facilities for indoor patients – mother, new born

infants and other patients

Waste management at PHC level

Quality assurance at PHCs

Monitoring of PHC functioning

Accountability of PHC

Statutory and regulatory compliance

PRIMARY HEALTH CARE IN KARNATAKA

Karnataka is one of the pioneer States in the country in providing

comprehensive public services to people. Even before the concept

of PHCs were conceived by the Government of India, the State had

already made a beginning in establishing a number of PHCs for

proving comprehensive health care and a delivery system consisting

of curative preventive and rehabilitative health care to its

people. Primary Health Care in Karnataka has a better public

service with respect to child care and health care. The State has

a birth rate of 0.7%, 2.2 % death rate and 5.5% of infant

mortality rate. As of 2004 State’s health and family welfare

services , Karnataka had 8,143 sub-centres, doctor population

ration 1:10, 581 primary health units, 1,679 PHCs at village

level, 17 urban PHCs and 110 community health centres . The

responsibility for maternal health care is mainly at the sub-

centre and PHC which provides pre-natal, childbirth and post-natal

services through the auxiliary nurse mid wives(ANMs) .

Map showing PHC’s in Karnataka

At the first level the duties of ANMs are important. These

auxiliary nurses and midwives are the paramedical staff trained in

reproductive health care and are based in sub centres or at the

PHC itself. They have multiple responsibilities. They maintain

health department records, document information related to

fertility, pregnancies, child birth details and immunization. They

enrol pregnant women are expected to provide postnatal care.

At the second level of service which is at PHC , a medical doctor

and nurse are available for consultation and child birth. However,

not all PHCs have complete facilities for maternal care. There are

1700 PHCs in Karnataka, and the status and quality services

provided by them are important indicators of the quality of

reproductive health services.

The next level of services is the community health centres (CHCs)

and referral hospitals at the sub-district level and General

hospitals and maternity hospitals at the district level.

According to the statistics provided by 11th FP (2007-2012) the

status of PHCs in Karnataka can be clearly understood.

Sub Centres PHCs CHCs0

10002000300040005000600070008000900010000

Shortfall of Health infrastructure as per 2011 , Population of

India

Required Provided Shortage0

100020003000400050006000700080009000

Sub CentresPHCsCHCs

Graph showing availability of Doctors and Health workers (female)

010002000300040005000600070008000900010000

DoctorsHealth workers

Graph indicating Every single PHC with doctors/without doctors

4 Doctors 3 Doctors 2 Doctors 1 Doctor Without Doctor

0

500

1000

1500

2000

2500

Nursing staff at PHCs and CHCs

Registered Available0

500

1000

1500

2000

2500

3000

3500

4000

4500

5000

Average rural population per PHC

Karnataka rural health statistics as per 2011

The statistics have revealed that, the condition of PHCs in the

State are comparatively better with regard to other states of the

country. However, there are certain loop holes in its effective

functioning such as , non- availability of doctors at the time of

emergency, unwillingness of doctors to serve in rural areas ,

irregularity of doctors in urban areas, poor infrastructure , non-

availability of medicines and lack of para medical staff .

PHCs should become functional round the clock, select PHCs

especially in large blocks where the CHC is over one hour of

journey time away , may be upgraded to provide 24 hours emergency

hospital care for a number of conditions by increasing the number

of medical officers preferably such PHCs should have the same IPHS

norms as for CHC.

Challenges for PHCs

Non availability of doctors is a major problem faced by PHCs.

Lack of education among people about health matters

Malnutrition among nursing mothers, infants and children.

Non availability of safer drinking water and basic sanitation

facilities.

High rate of maternal mortality(4to5 per 1000 live births) due

to anaemia , illegal abortion and malnutrition during

pregnancy.

High infant mortality (105/1000 births) due to poor maternal

health, inadequate care of mothers, lack of infrastructure in

hospitals and low birth weight

Malnutrition among children in the age group of 0-5 years.

Lack of awareness among people about family planning

Suggestions to improve the working of PHCs in Karnataka

People and the community need to be convinced and satisfied

with the services being provided at the primary and secondary

contact levels

Bypassing the local facilities which causes overcrowding at

referral centres/urban centres needs to be regulated as a

result of which the quality of care at referral hospitals can

be improved

Physical facilities, back-up support and supervision, mobility

of health personnel, communication between government and PHCs

needs to be improved.

Transport during emergency cases and effective logistic and

supply system should be given importance.

Priority should be given to the referred cases by the

consultants of the Urban/referral centres

Conclusion

While poor infrastructure and staff shortage are leading to loss

of lives in government hospitals, people going to Community Health

centres and Primary Health Centres have to turn to pharmacies with

empty shelves. Over 3000 health institutions have not received

drug supplies during 2007-12, according to the Controller and

Audit General of India audit. The Karnataka State Drug Logistics

and Warehousing society is responsible for ensuring the drug

supply to health centres. The CAG audit found that KDLWS does not

have evidence to show that 3,093 health institutions in the state

received drug supplies during 2007-12.

Its scrutiny also revealed that 2,360 PHCs and CHCs with sub-

centres , 277PHcs and three CHCs were denied drug supplies in this

period due to ineffective monitoring by the society . The report

said ‘This evidently affected delivery of healthcare services to

the needy public’. Karnataka has been the IT hub and this has been

India’s pride. .When the state has earned such laurels, why should

the most basic facilities of health be denied to the rural areas?

With this regard the PHCs and CHCs needs to be given highest

priority in order to streamline the rural and urban health .

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