Primary Healthcare: The Foundation of India’s Healthcare System

Summary:
The COVID-19 pandemic highlighted the vital role of primary healthcare and frontline workers in detecting illnesses early, supporting communities, and preventing the spread of disease. India has strengthened this foundation through Ayushman Bharat, with over 1.86 lakh Ayushman Arogya Mandirs providing comprehensive healthcare services and increased government investment reducing out-of-pocket medical expenses. Supported by digital health technologies, mobile medical units, and community-based care, primary healthcare is expected to play a crucial role in improving access, managing chronic diseases, and achieving the country’s goal of a healthier population under the Viksit Bharat 2047 vision. 

The COVID-19 pandemic fundamentally changed the way healthcare is perceived, highlighting the critical role of community-based health services. During the crisis, frontline workers such as ASHA worker Suchitra Goala played a vital role by visiting households, identifying individuals with possible symptoms, encouraging adherence to quarantine guidelines, and monitoring 45 people in home isolation. Her work contributed to Assam’s wider public health response, where frontline personnel reached nearly 28,000 villages and connected suspected cases with screening teams.

Experiences such as these underscore the importance of primary healthcare in identifying illnesses at an early stage, limiting the spread of infectious diseases, guiding people toward appropriate medical services, and countering misinformation within communities.

Primary healthcare forms the foundation of any health system by delivering preventive and promotive services, including immunisation, disease screening, early diagnosis, maternal and child healthcare, health education, and mental health support. According to the World Health Organization (WHO), expanding primary healthcare services across low- and middle-income countries could save around 60 million lives, increase average life expectancy by 3.7 years by 2030, and contribute nearly 75% of the health improvements envisioned under the Sustainable Development Goals (SDGs). For India, whose population stands at an estimated 1.48 billion and is projected to approach 1.7 billion over the next four decades, strengthening primary healthcare through Ayushman Arogya Mandirs (AAMs) and Primary Health Centres (PHCs) will be central to achieving the vision of Viksit Bharat by 2047.

Significant progress has already been made under the Ayushman Bharat programme, which is transforming health sub-centres and Primary Health Centres into Ayushman Arogya Mandirs. At present, 1,86,412 functional AAMs provide a broad range of healthcare services, including reproductive and child health, communicable and non-communicable disease management, mental healthcare, elderly care, rehabilitation, and basic emergency treatment.

These centres act as the first point of contact with the formal healthcare system, delivering comprehensive medical services while helping reduce catastrophic out-of-pocket healthcare spending that drives many families into poverty each year. They also improve healthcare access for nearly 65% of India’s population residing in rural areas. National Health Accounts data reflects this growing investment, showing that government expenditure on primary healthcare increased from around ₹50,000 crore in 2013-14 to approximately ₹1.4 lakh crore in 2022-23. During the same period, out-of-pocket healthcare expenditure declined from 64.2% to 43.4% of total health spending.

Strengthening comprehensive primary healthcare is increasingly important as India continues to manage chronic and long-term health conditions that require regular screening, counselling, medication, treatment adherence, and continuous follow-up. Expanding access also means bringing healthcare closer to communities, a goal supported by technological advancements and mobile healthcare delivery. The Government of India currently operates more than 1,400 mobile medical units that extend healthcare services to underserved areas.

India is also accelerating the digital transformation of primary healthcare. A WHO report notes that technologies such as AI-enabled health systems, FHIR open standards, unique digital health records, and the ANMOL application used by Auxiliary Nurse Midwives are improving clinical decision-making at the primary care level. Community-based organisations can further strengthen these efforts by supporting implementation and improving healthcare access in underserved regions. However, assessments of primary healthcare systems across South Asia and ASEAN continue to identify challenges such as inadequate financing, workforce shortages, fragmented governance, and weak coordination between different levels of care. Leveraging technology to identify and address these issues at an early stage will be essential.

The experience of Suchitra Goala illustrates the true strength of primary healthcare: reaching people before illnesses become severe. Effective healthcare begins with frontline workers visiting communities, local clinics identifying health risks early, and an integrated system ensuring timely follow-up. As India’s population continues to grow and healthcare needs become more complex, reinforcing primary healthcare will remain critical to building a healthier population, improving quality of life, and preventing illnesses from developing into medical emergencies.