Quality of Care and the Bypassing of Primary Health Centers in India-Implications for Ayushman Bharat

NCAER hosted a seminar on “Quality of Care and the Bypassing of Primary Health Centers in India—Implications for Ayushman Bharat” with Krishna Dipankar Rao, Johns Hopkins University. Shailender Swaminathan, Principal Economist, Leveraging Evidence for Access and Development (LEAD), KREA University, was the discussant. The seminar was attended by members of the NCAER Research Team, and invited guests from various eminent institutions including, Bill & Melinda Gates Foundation, Integrated Research and Action for Development, Federation of Indian Chambers of Commerce and Industry, International Food Policy Research Institute, and IDinsight.

Dr Rao pointed out that India is among many low- and middle-income countries that have invested substantial resources for strengthening facility-based and community-based primary health care services to provide affordable care for improving population health. Yet, patients in India often bypass the nearest government health centres offering free or subsidised services and seek more expensive care, often from private service providers. Dr Rao focused on the quality of care (clinical and structural) and its implications for new efforts to strengthen primary care through the Government of India’s recently launched Ayushman Bharat initiative. While tracing the genesis of the primary health care system in the country, he highlighted various issues that have brought this sector into recent focus, including the predominantly informal nature of primary health care and non-availability of certain crucial services at the primary centres; lessons from the National Rural Health Mission; the role of Accredited Social Health Activists (ASHAs) in the health care system, particularly in rural areas; and wide variations in competencies for health care across the country.

The discussant, Dr Swaminathan stressed the need to mould the primary health care system to align with the goals of Ayushman Bharat. He also suggested the introduction of competency scores for various health centres to assess the quality of services delivered by them and to determine the actual drivers of health-seeking behaviour among patients, especially the factors motivating them to veer towards private health care providers.

Krishna Dipankar Rao is an Associate Professor in the Health Systems Program, Department of International Health, Johns Hopkins University. He is also Research Advisor, National Health Systems Resource Center, Ministry of Health and Family Welfare, Government of India. His research interests lie in the areas of health systems, primary health care, human resources for health, health financing, and economic evaluation. He teaches two graduate courses at Johns Hopkins– economic evaluation, and health financing in low- and middle-income countries.