ABSTRACT
India’s attention to primary healthcare increased with the introduction of the National Rural Health Mission (NRHM)/National Health Mission (NHM) and subsequently the Health and Wellness Centres, among other initiatives. The progress has been evident, but the country’s primary healthcare system continues to face challenges on several fronts including access and quality, with large out-of-pocket expenditures (OOPEs) incurred at point of service, especially on drugs and diagnostics. Challenges in quality access have had implications of utilisation, leading to a large proportion of primary care users seeking care through private facilities. Importantly, the system remains predominantly curative in nature, driven by patients seeking care at the time of health episodes, undermining a system-driven focus on population health. It is in the context of the above that this chapter will draw out global insights to inform discussions on strengthening India’s primary healthcare system. The chapter will be based on the experience of six comparable countries (Brazil, China, Indonesia, Mexico, Thailand, and Turkey) in terms of the organisation and delivery of primary healthcare, the context within which these were developed and implemented and their experience – both successes and challenges. It will conclude with a discussion on drawing out lessons relevant for India. The chapter will draw extensively from six country case studies conducted by Centre for Social and Economic Progress (CSEP) on health systems across these countries and will complement these studies with additional literature surveys. The chapter will largely be based on secondary literature.
