Paradigm Shift from Selective Primary Care to Comprehensive Primary Care: A Framework for Universal Health Coverage in India
TL;DR
It is argued that universal health coverage in India will remain incomplete unless the country makes a decisive paradigm shift from selective primary care to comprehensive primary care.
Abstract
India is at a defining moment in the evolution of its health system. For decades, primary health care has largely developed through selective, program-driven interventions directed toward specific diseases, population groups, and health priorities. These programs have contributed significantly to public health, but India’s health needs have become increasingly complex. Noncommunicable diseases, multimorbidity, mental health conditions, aging, adolescent health, women’s health, oral health, communicable diseases, and emerging health threats require a health system that can care for the whole person across the life course. The original vision of primary health care, articulated at Alma-Ata and reaffirmed through the Astana Declaration, was not selective disease control but comprehensive, accessible, equitable, and people-centered health care. India’s Ayushman Bharat initiative and the development of Health and Wellness Centers, now Ayushman Arogya Mandirs, represent an important policy transition toward comprehensive primary health care. The next challenge is to translate this policy intent into a strong clinical primary care system supported by family physicians, multidisciplinary teams, appropriate diagnostics, essential medicines, digital health, and effective referral networks. This editorial argues that universal health coverage in India will remain incomplete unless the country makes a decisive paradigm shift from selective primary care to comprehensive primary care.