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Primary Healthcare in India: are branded PHCs the way out?

Primary Health Centers or PHCs are said to be the first healthcare contact points between the population and healthcare delivery system in India. Until the rise of corporate hospital chains, which started off as tertiary healthcare delivery centers in India and later extended their healthcare models into primary healthcare services, the government PHCs were the only means to offer primary healthcare. In rural areas, the situation still holds true, but urban PHCs ecosystem has been taken over by the private sector. The health services at these centers come at a cost but their level of diagnosis, care and infrastructure are way forward as compared to government PHCs.

 

According to Anupriya Patel - Union Minister of State for Health and Family Welfare, Indian has 25,650 PHCs, out of which 15,700 (61.2%) has only one doctor each, while 1,974 (7.69%) PHCs even don’t have any doctor deployed for patients.

Stats:

  • One PHC on an average to serve 25,000 people or more in some areas

  • In some distant and tribal areas only one doctor available round the clock throughout a year

  • In 25,000 PHCs, there are about 9,000 vacancies for doctors.

As per a recent study published in ‘Journal of Health, Medicine and Nursing’ due to high treatment cost on visit to a private medical practitioner people are now increasingly visiting PHCs.

 

Key findings of this report were:

  • Average patients’ visit 30 per day, mostly in rural areas with majority of patients belonging to underprivileged section of the society

  • Low visits due to casual attitude of PHC staff and inability to diagnose critical health issues.

  • About 46% treatment requests are for child care and maternal issues, and medicinal supply in these centre often falls short – just about 22% of the total demand.

  • Hence government PHCs are unable to play a proactive role in healthcare delivery and non-availability of gynaecologist is also a big issue in rural centers.

  • Convenience of within reach location and proximity to local practitioner keeps people’s faith in PHCs, as waiting period for a diagnosis of ailment are very short.

 

On the other hand, branded PHCs have robust network of in-house labs and as well as dedicated outsourced medical test centers making the diagnosis accurate and quick, even for critical diseases. Availability of medicines also not a issues in branded PHCs.

Growing awareness and disposable incomes; lifestyle issues; and increased consciousness about individual and family health are fueling the demand for quality healthcare infrastructure at primary level. Branded hospital chains and dedicated clinic/PHC franchise models have re-defined the basic healthcare delivery in India during past decade. A successful PHC franchise model requires thorough research on demand and supply gaps, economies of scale, targeted service delivery points besides other necessary infrastructure and operational capacity.

Healthcare franchises have seen significant growth in past two decades, after the entry of private players in PHC segment. Branded primary healthcare chains are spreading tremendously with few plus points in their favor such as:

  • Insured Treatment: Growing penetration of health insurance across the masses, people do not bother about the high cost of diagnosis and treatment as their claim settlement process is easy and taken care of well now.

  • Brand Value: Name of a brand say as Apollo, Fortis, Max – with a proven track record in tertiary care across the country - give more confidence to people to avail healthcare in these PHCs. People also prefer to choose best healthcare for them. A trusted name helps in drawing business and expanding in other localities as well.

  • Government Schemes: Indian government also drafted various policies for healthcare sector to meet its real potential like universal health coverage and decrease in import duty on medical accessories, giving corporate franchises to make the most of this opportunity.

  • Socio-Economic Developments: India has witnessed several developments on socio-economic fronts like growth in nuclear families and subsequent compulsion of regular health checkups for the earning member in the family. Besides, increased awareness among people about health also making these franchise PHC models successful.

While growth of branded PHCs has remained phenomenal in the past but every private healthcare system has its own limitations w.r.to affordability and outreach to people living in far locations. Branded PHCs may remain urban phenomena by and large, it is the government PHC infrastructure that needs to be addressed and revived for universal and affordable healthcare. To achieve that goal government has to finance the PHCs healthcare, as people living in rural areas can’t afford the insurance premium or not aware of such facility. This will also help in reducing the burden on large tertiary care government hospitals. In addition, community participation and starting programmes oriented towards primary healthcare, besides infusing a feeling of pride among the nursing or caregivers at these centers.

 

Opportunities & Challenges

Give the current situation of government PHC infrastructure in tier2 and rural areas, the opportunity for coverage across the country is huge for branded PHCs. The precedent set by these corporate players in urban areas has undoubtedly brought best-in-class primary healthcare diagnosis and treatment closer to the people, and if this model can be translated to remote locations that will be a great service to human kind.

Secondly, sustainability from business point of view will be a concern for setting a good PHC in villages, as ROI will play a role here. Branded PHCs need to carefully look into these factors before going forward.

Tapping the potential in tier 2 and rural locations would be the real challenge for corporate PHCs. Basic infrastructure like 24/7 electricity, trained support staff and pulling talented pool of doctors in remote locations would be the real challenge for these players. And most importantly, in absence of any scheme for primary healthcare coverage and economic disparity in these location is the biggest hurdle for branded PHC chains.

 

PPP model: the Key

The percentage GDP expenditure on healthcare almost remain static at 1% for a decade, while the biggest private hospital chain in India – Apollo – invests 20% of the country’s total health budget of the country. In that sense, private healthcare offers must advanced healthcare infrastructure as compared to government facilities. This disparity clearly affects the marginalized section of the country; especially those belong to villages and non-urban locations.

The possible wayout could be a PPP model in primary healthcare delivery as government PHCs are already in place and serving in individual capacity to nearby areas. What lacks in these centers viz. lab technicians, doctors, support staffs or infrastructure can be managed by private players through collaborating with State and Centre governments and community participants. Any one scheme or policy or model may be insufficient for the last mile delivery of primary healthcare.

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