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The strengthening of PHCs and CHCs is an important component of the Mission, which is central to the upgradation of health services in rural areas. The intention to adopt and operationalise Indian Public Health Standards (IPHS) for CHCs is a definite step forward.
However, while operationalizing this process of strengthening, certain key issues may be kept in mind: In contrast to a current trend which looks at PHCs as being expendable, it is necessary to ensure that PHCs are substantially upgraded to provide a full range of basic services including primary medical care, institutional deliveries, basic emergency care, and referral transport services. This would require renovation of infrastructure, provisioning of adequate and regular drug supply, functional ambulance facilities, adequate all-round staffing, multi-skilling of paramedicals, and adequate facilities for health professionals with time-bound postings in difficult areas with necessary incentives.

While the formulation of 'Indian Public Health Standards' for CHCs is a welcome step, such standards should also be formulated for PHCs, and should mandate Charters of Patient's Rights applicable at various levels. Accountability committees for PHCs and CHCs should involve not only Panchayat leaders, but also representatives of local community based organizations, women's groups, locally active NGOs, and village health committees.

A 'Generic Model for Hospital Management Societies' has been circulated as an annexure to the Mission manual, which would presumably guide societies which would manage CHCs and other hospitals being dealt with by the Mission. This document includes under the Aim & Objectives of the Society - 'Generate resources locally through donations, user fees and other means'. Under the scope of functions of such societies, points include - 'Entering into partnership arrangement with the private sector (including individuals) for the improvement of support services' and 'Developing / leasing out vacant land in the premises of the hospital for commercial purposes'.

Such provisions raise an apprehension about the processes that might be followed while managing such hospital societies, and whether these could lead to semi-privatization of such public hospitals. Specifically, implementation of such societies and related committees should not be accompanied by any introduction of user fees or any resort to privatization; rather the improvement of services should be provisioned through enhanced public funds. The experience of user fees in rural public health facilities, in other developing countries as well as in India, is that such fees can form a significant barrier to utilization of services by the poorest. Exclusion mechanisms (such as the 'BPL' criteria) frequently do not work, and the genuinely poor often end up paying while certain politically influential individuals may avail the benefits.

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Dr. Gursharan Singh Kainth started his career as Lecturer at Post Graduate Dept. of Economics, Government College, Gurdaspur, and later at Khalsa College; Amritsar, specializes in Quantitative & Development Economics. Has the distinction of serving Punjab Agricultural Univ, Ludhiana, for more than 2 decades and remained Director-Principal of Saint Soldier Management & Technical Institute, Jalandhar. Currently, heading GAD Institute of Development Studies, Amritsar, a self-financed research institute. Has been honoured with various awards, including Guru Draunacharya Samman, Vijay Rattan Award, etc.
Article posted on December 14, 2008.