- Understandings of PHC as enunciated in Alma Ata and more recently in the [*Declaration of Astana*](https://www.who.int/docs/default-source/primary-health/declaration/gcphc-declaration.pdf) where in October 2018, WHO member-states reaffirmed the commitment to PHC Apart from this there is ongoing interest in 1. [[Substance use disorders]] 2. [[Screening for cancers at Primary Health Care settings]] 3. [[Urban health]] Ongoing collaborative work for raising the profile for relatively *intangible* gains in universal health coverage (UHC) through investments/strengthening of PHC under the PHC4UHC project. See for example some of the outputs showcased in this presentation to grantees of Wipro Foundation in Jan 2025 on *Reimagining primary healthcare for a resilient and inclusive future in India* where we basically make the case for innovation in UHC as originating in strengthening PHC (rather than investments in specific healthcare financing schemes in secondary & tertiary care which too are necessary but not sufficient for UHC) <iframe src="https://www.slideshare.net/slideshow/embed_code/key/M9kaDhaW7Y2CxY?startSlide=1" width="597" height="486" frameborder="0" marginwidth="0" marginheight="0" scrolling="no" style="border:1px solid #CCC; border-width:1px; margin-bottom:5px;max-width: 100%;" allowfullscreen></iframe><div style="margin-bottom:5px"><strong><a href="https://www.slideshare.net/slideshow/reimagining-primary-healthcare-for-a-resilient-and-inclusive-future-in-india/276387262" title="Reimagining primary healthcare for a resilient and inclusive future in India" target="_blank">Reimagining primary healthcare for a resilient and inclusive future in India</a></strong> from <strong><a href="https://www.slideshare.net/PrashanthSrinivas" target="_blank">Prashanth N S</a></strong></div> A talk conceptualised around how "innovations" tend to "distort" primary health care if this kind of thinking is not integrated into designing innovations in an integrative manner - talk given at Wipro Foundation Annual Healthare partenrs meet 2025 with key insights from the ongoing PHC4UHC work happening at IPH in partnership with Ekjut, IIMB and George Institute for Global Health India <iframe width="560" height="315" src="https://www.youtube.com/embed/41jfvmvPfGA?si=QhIbozs2eOCILrZ4" title="YouTube video player" frameborder="0" allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share" referrerpolicy="strict-origin-when-cross-origin" allowfullscreen></iframe> Key discussions from the PHC4UHC meeting at IIC (7-9 April 2025) - Evolution of the health and wellness centers into *Ayushman Arogya Mandirs* - What's in a name? - Karnataka's(?) ANM's move to be called *PHC Officers (PHCOs)* a la CHOs....the quest for "officer" status and its implications for PHC - could PHC be a field with much greater ownership by non-MBBS/Dr staff - an arena for non-clnical leadership in health? - In some settings in Jharkhand, there appears to be a shift of healthcare seeking from traditional (*jholachaap*) to AAM/HWC - why some? Perhaps because of instances where healthcare seekign is not driven by trust but based on geographical proximity, availability of care and such - cf. idea of "self-reliance" on traditional care may be seen in a diff light than classcially being due to a "wish" for self-reliance...soemtimes self-reliance oriented explanations for seeking traditional care could be driven more by proximity/comfort and such.....while the former too can happen...lesson being that IF HWCs are made functional, then it might "pull" folks from traditional & private healthcare providers - How do we trigger a sense of *belonging* (a mechanism in the [[Realist evaluation|realist sense]]) among new cadres such as CHOs? That willb e crucial in getting the HWC/AAMs to function as per their vision to become decentralised centers for seeking health (and wellness!) - 40-50 registers and 15-20 apps at HWC/AAM! - The case of "hijack" of integration by "mission mode" - shared the case of National Sickle Cell Elimination Mission in Karnataka where higher level over-ruling of integration of services in favour of meeting mission targets - The trend of men seeking care in HWC/AAM is a new trend and favourable towards UHC - Approaches like Ekjut's PLA and the (much smaller in scale - IPH's [learning site appraoch](https://journals.ub.umu.se/index.php/jcsh/article/view/1102) are "innovations" in terms of changing power relationships, processes and ways of engagement. They help reconfigure local norms and attitudes - often we struggle to link these to "outcomes", but that is futile because their power is in creating a new process through "reconfiguration", through building a new "platform" (cf. Arogya Samvaada) and such... - **Measuring PHCs and comparing them** - This is a very tough thing to crack and AM's efforts invovle building an index that conceptualises PHC index as a fucntion of (a) integrated servcies, (b) empowering communities, (c) multisectoral action - How do we bring "equity" into such indices? Given that disaggrated and intersectional data is unavailable - Finding a proxy for CHE at PHC level is a challenge - becuse most survey data like NSS measure CHE (40% of HH expenses on health) but the argument is that a lot of this is on hospitals - but if we conceptualise PHC as thigns done near home for which no money was paid IF it was functioning well, by design surveys like NSS will never capture expenses that did not occur on PHC - How do we know what proportion of CHE is occurring due to PHCs not functioning? -