The deeper intricacies of public healthcare facilities go way beyond what meets the eye. We’re usually predisposed to visuals of its deteriorating physical infrastructure where lack of equipment, expertise and medical supplies - create a sense of urgency for all the onlookers. The harrowing condition of its existing facilities, in turn, shoulders medical staff with overwhelming responsibilities leading to thousands of unattended patients. There is also a common notion that only people from the lower strata of society opt to avail of services at public healthcare facilities.
But are such characteristics entirely true, depicting the laid-back approach toward public healthcare facilities?
What we need is an all-encompassing lens where we see the system of public healthcare facilities as a whole rather than just parts of it. We need a systems change to be inculcated where every stakeholder perceives and acts towards such spaces with a changed mindset. This also involves evoking a trust quotient amongst all the parties involved. Patients who seek to avail services at public healthcare centres need to have trust that their ailments will be addressed timely and effectively, while the staff members should also be empowered with the latest equipment and expertise to perform their duties. However, building a foundation of trust will require a multi-pronged approach.
Let’s uncover a few components of enabling a systems change for primary healthcare centres in the context of the most populous state of India – Uttar Pradesh.
Lucknow, Varanasi and Fatehpur are amongst the most prominent cities of Uttar Pradesh, each with a unique character and story. However, when it comes to their healthcare systems, a common thread emerges: a system straining under its own weight. While infrastructure upgrades are crucial, the true path to healthier futures lies in a more comprehensive and far-reaching approach.
Figure 1: UPHC Mawaiyya, Lucknow
Urban Primary Health Centres
While Lucknow boasts 52 functional UPHCs (Urban Primary Health Centres) and plans for 74 more Health and Wellness Centres (HWCs), Varanasi has 29 UPHCs with 41 HWCs in the pipeline. Fatehpur, however, faces a shortfall with only one UPHC. In terms of numerical capacity and the population they aim to serve, the UPHCs are generally sufficient, with only a minor shortfall.
Beyond the Numbers: A Community Perspective
Figure 2 & 3: Focused Group Discussions (FGDs) conducted in Lucknow and Varanasi
Discussions with residents, particularly those from low-income settlements, reveal a surprising preference for private healthcare. In Lucknow, a staggering 70% reported using private clinics for minor ailments, while in Varanasi and Fatehpur, the figure soars to 90%. Conversely, for major ailments, district-level public and special hospitals are preferred for hospitalization due to cost constraints and a variety of health services available under one roof.
Why Private? Decoding the Preference:
The reasons for this private healthcare preference are complex and multifaceted. The belief in superior quality and service delivery at private facilities plays a significant role. Even the most economically disadvantaged individuals prioritize quality healthcare when it comes to their health. Additionally, inadequate infrastructure and a lack of trust in public primary healthcare systems contribute to the shift towards private options.
Figure 4: UPHC Madhopur, Varanasi
The Missing Pieces: Specialists and System Strengthening
The Ayushman Bharat Health and Wellness Scheme seeks to address this gap by providing specialized care through gynaecologists, paediatricians, and orthopaedics at the community level. However, assessments reveal a shortage of human resources, with specialist positions at UPHCs remaining vacant. This creates a critical gap in healthcare service delivery.
Behaviour Change: The Foundation for Healthier Cities
Simply building bricks and mortar won't magically transform health outcomes. It's about understanding the social, cultural, and economic factors that influence health choices. We need to empower communities through education, awareness campaigns, and creating trust in the UPHCs that are already there.
Figure 5: UPHC Pakka Talab, Fatehpur
The Road Ahead: A Collaborative Effort
Lucknow, Varanasi, and Fatehpur are just microcosms of a larger challenge. Each city has its unique story. By strengthening health systems, addressing infrastructure gaps, and prioritizing behaviour change, we can truly build a resilient, accessible, and effective primary healthcare system for not just these three cities, but for the cities across Uttar Pradesh.
About the Author
Ms. Eilaaf Fatima
Ms. Eilaaf Fatima is a Program Coordinator at the Urban Management Centre. An architect, urban planner and researcher, she has been involved in City Health Plans for Lucknow, Varanasi and Fatehpur, while also contributing to UNICEF's Child Friendly City Initiative and Ahmedabad's Placemaking Project. Her past experience includes piloting
LAP and TPS formulations for Aizawl and Dehradun under
AMRUT, and crafting implementation guidelines for
Dehradun's TPS during her Masters in Urban Planning
from CEPT University. She finds solace in poetry and
calligraphy, and thrives on engaging discussions over
delicious food, showcasing a well-rounded individual
dedicated to building not just structures, but fostering
vibrant communities.