Table 1

Illustrative quotes from Indian policy documents

Focus ideologiesSample quotes from Indian policy documents
Preindependence
While the word PHC is not mentioned, many broad elements of the approach are justified in India’s original vision of the health system
Global influences:
National Health Service, UK
1.1.‘The closer the health service can be brought to the people whom it serves, the fuller will be the benefit it can confer on the community. The scheme must therefore provide for the creation of a large number of units……’ (Govt. of India, 1946)11
1.2.‘Suitable housing, sanitary surroundings and a safe drinking water supply are the primary conditions for securing such a measure of environmental hygiene as it is essential to ensure the prerequisites of a healthy life. Without these, our towns and villages will continue to be factories of disease which will help to maintain undiminished the demands on the curative side of the medical services.’ (Govt. of India, 1946)11
1.3. ‘Expenditure of money and effort on improving the nation’s health is a gild-edged investment which will yield not deferred dividends to be collected years later, but immediate and steady returns in substantially increased productive capacity. We need no further justification for attempting to evolve a comprehensive plan which must inevitably cover a very wide field and necessarily entail large expenditure, if it is to take into account all the more important factors which got the building up of a healthy, virile and dynamic people’ (Govt. of India, 1946)11
1.4.‘…in outlining the (short-term) programme, we have tried to bear in mind the necessity for tempering enthusiasm with a sense of reality. In the early years, the lack of sufficient trained staff and of adequate financial resources will inevitably limit the scope of practical achievement.’ (Govt. of India, 1946)11
Independence to 1970s
Originally proposed approach diluted. Ideologies shift to promoting verticalised interventions as ‘interim’ solutions.
Global influences: Rockefeller-focused technomanagerial intervention against malaria, ford foundation-family planning perspectives and funding
2.1 ‘Even with a 50% reduction in the rate of population growth between 1966–81 the increase in income will still not catch up with the increase in the population. The Family Planning Programme has, therefore, rightly come to occupy a key position in the Five Year Health Plans.’ (Govt. of India, 1961)37
2.2. ‘Although the Bhore Committee drew attention to the implications of the trends of population growth and suggested action to be taken on this behalf, the full-blooded ‘National Family Planning Programme’ today is a far cry from the faltering and half-hearted recommendations of that Committee in regard to population control.’ (Govt. of India, 1961)37
2.3. ‘In the early stages, certain services such as those for the control of malaria, filaria, tuberculosis, venereal diseases and leprosy may have to be rendered by special staff but, after adequate control has been attained, such services should form part of and be integrated with the normal activities of a health unit (Plan 2)12
Late 1970s to1980s
Revival of PHC approach. Selective PHC ethos adopted in India.
Global influences:
WHO: Alma Ata 1978, Unicef—focus on GOBI-FFF
3.1.‘We realise that the need for medical relief is so great in our country that to make medical officers concentrate so largely on preventive work may be met with criticism. We have however made this recommendation after careful consideration. Our view is that with the limited staff and funds at disposal of the country, our health programme will show more effective and lasting results if the effort is directed towards the creation of conditions conducive to healthy living instead of concentrating too largely on the administration of medical relief.’(ICSSR and ICMR, 1981).41
3.2.‘Establishment of curative centres based on western models which are inappropriate and irrelevant to the real needs of our people and the socioeconomic conditions in the country. The hospital-based disease and cure-oriented approach to the upper crust of society in urban areas. The proliferation of this approach has been at the cost of providing comprehensive primary healthcare services to the entire population’ (National Health Policy 1983)40
3.3 ‘The non-attainment of the birth rate targets adopted in the Plans is largely on account of our inability to carry forward the (family planning) programme throughout the country with the active involvement of the people. Public enthusiasm and community participation in the programme which is necessary for its success has not been generated in adequate measure.’ (Plan 6)12
Late 1980s to2005
Documents argue that to bring equity with limited resources, there is need to focus on issues not covered otherwise by the private sector. The revised health policy NHP 2002 does not mention comprehensive PHC.
Global influences:
World Bank,
Global Health Initiatives,
Millennium Development Goals
4.1. ‘Social sector planning therefore ensures that appropriate policies and programmes are formulated, and adequate investment provided by the State so that poor and vulnerable segments of the population can access essential commodities and facilities based on their needs and not on the ability to pay.’ (Plan 10)12
4.2. ‘During this period, health administrators wish to ensure that budgetary constraints do not reduce the scale, equity, and quality of health service provision, and they are prepared to take difficult decisions toward these ends. It is clearly perceived that any redistributions or cuts in resources to health must be accompanied and offset by operational improvements that enhance efficiency and equity. (World Bank 1992)47
4.3. NHP-1983, in a spirit of optimistic empathy for the health needs of the people, particularly the poor and under-privileged, had hoped to provide ‘Health for All by the year 2000 AD’, through the universal provision of comprehensive primary healthcare services. In retrospect, it is observed that the financial resources and public health administrative capacity which it was possible to marshal, was far short of that necessary to achieve such an ambitious and holistic goal’ (National Health Policy 2002)50
2005to current
Documents argue for strengthening health systems by increasing investments; and providing financial protection. Comprehensive PHC is referred to in terms of service coverage.
Global influences: New Global Health Initiatives. Debates on vertical programme versus horizontal strengthening,
Universal Health Coverage.
5.1. The key features of the mission include making public health delivery system fully functional and accountable to the community, human resource management, community involvement, decentralisation, rigorous monitoring and evaluation against standards, convergence of health and related program from village level upwards, innovations and flexible financing and also interventions for improving health indicators (NRHM 2005–12)51
5.2. Now 14 years after the last health policy, the context has changed in four major ways. First, the health priorities are changing. Although maternal and child mortality have rapidly declined, there is growing burden on account of noncommunicable diseases and some infectious diseases (National Health Policy 2017)54
  • NHP, National Health Policy; PHC, Primary Health Care.