Revitalizing primary health care and family medicine/primary care in India--disruptive innovation?
BACKGROUND
India has rudimentary and fragmented primary health care (PHC) and family medicine systems, yet it also has the policy expectation that PHC should meet the needs of extremely large populations with slums and difficult to reach groups, rapid social and epidemiological transition from developing to developed nation profiles. Historically, the system has lacked impetus to achieve PHC.


OBJECTIVE
To provide an overview of PHC approaches and the current state of PHC and family medicine in India in order to assess the opportunities for their revitalization.


METHODS
A narrative review of the published and grey literature on PHC, family medicine, Web2.0 and health informatics key papers and policy documents, pertinent to India.


RESULTS
A conceptual framework and recommendations for policy makers and practitioner audiences.


RESULTS
PHC is constructed through systems of local providers who address individual, family and local community basic health needs with strong community participation. Successful PHC is a pre-eminent strategy for India to address the determinants of health and the almost chaotic of massive social transition in its institutions and health care sector. There is a lack of an articulated comprehensive framework for the publicly stated goals of improving health and implementing PHC. Also, there exists a very limited education and organization of a medical and PHC workforce who are trained and resourced to address individual, family and local community health and who have become increasingly specialized. However, emerging technology, Health2.0 and user generated health care informatics, which are largely conducted through mobile phones, are co-evolving patient-driven health systems, and potentially enhance PHC and family medicine workforce development.


CONCLUSIONS
In order to improve health outcomes in an equitable manner in India, there is a pressing need for a framework for implementing PHC. The co-emergence of information technologies accessible to the mass population and user-driven health care provide a potential catalyst or innovation for this transition.
Biswas
Rakesh
R
Department of Medicine, People's College of Medical Sciences, Bhopal, India. rakesh7biswas@gmail.com
Joshi
Ankur
A
Joshi
Rajeev
R
Kaufman
Terry
T
Peterson
Chris
C
Sturmberg
Joachim P
JP
Maitra
Arjun
A
Martin
Carmel M
CM
D004059:Diffusion of Innovation; D005194:Family Practice / Q000193:education / Q000458:organization & administration*; D018166:Health Care Reform; D054625:Healthcare Disparities; D007194:India; D007256:Information Systems; D011320:Primary Health Care / Q000458:organization & administration*; D012196:Review Literature as Topic