Compassion in primary care in India

• The World Health Organization (WHO) has emphasized the importance of compassion in primary healthcare systems.
• Compassion, characterized by awareness, empathy, and action, is seen as a transformative force for primary health care (PHC).
• Compassionate primary healthcare involves responsiveness, adapting to community needs, and focusing on quality through training, audits, hand-holding, and on-the-job support.
• India has an extensive primary healthcare system, with sub-centres in remote areas, primary health centres (PHCs), and community health centres (CHCs).
• Three instances of compassion in health systems are presented, providing lessons for the rest of the country.
• In rural, urban, and tribal areas, these examples provide a sense of grounding and call for the display of courage to carry forward.
• In Rajasthan, a physician, Vidith Panchal, sees hundreds of patients at an Amrit clinic run by Basic Health Services (BHS), serving close to 90,000 people.
• Dr. Panchal’s decision to prioritize the patient’s needs at the center, referred to as “clinical courage,” is a testament to the importance of administrative and clinical workload, support from reporting officers, and capacity for support staff.
• The Amrit clinics have seen a rise in footfall, with the majority being members of Scheduled Tribes.
• Dr. Mohan emphasizes the importance of dignity and respect for staff at all levels, which has positive effects on patient interactions at all levels.

Helping Survivors of Violence in India
• Praveena Ben, an ASHA worker in Gujarat, trained to identify signs of abuse and encourage victims to seek help through the primary health system.
• SWATI, an NGO, designed an “upward referral” chain to address violence against women as a public health issue.
• SWATI has worked with over 400 ASHA workers and counsellors since 2012.
• ASHAs are empowered to refer while considering a patient’s needs, community relationships, and national health policies.
• Women are referred to district hospitals for mediation and further intervention, bypassing the primary health centers (PHCs).
• ASHAs address sensitive issues in a culturally appropriate manner and create a safe space to reduce fear and stigma associated with reporting violence.

Tamil Nadu’s Health Systems
• Research professor Monica Das Gupta studies public health systems in India and Sri Lanka and their response to disasters and epidemics.
• The Centre has tasked many basic services to be devolved from line agencies to elected local bodies without strong mechanisms to ensure accountability.
• Tamil Nadu’s disaster preparedness is lauded, with public health staff undergoing annual epidemic training.
• During the 2004 tsunami, health workers coordinated with other departments, ensuring proper disposal of dead bodies, timely removal of dead animals, fish, and fly control, and sanitary conditions in temporary housing for displaced populations.
• Chennai takes a considered approach to devolution, distributing responsibilities between line agencies, technical personnel, and elected representatives.

People-Centred Healthcare
• The WHO report emphasizes that compassionate human relationships are the bedrock of high-quality care delivery in primary healthcare systems.