2. Primary Health Care and Resilience of Health Systems

There is now a considerable volume of literature that points to the primacy of primary health care in dealing with pandemics and epidemics. The paper discusses the centrality of primary health care in pandemic preparedness by giving the example of India. It starts by attempting to understand the debate around excess deaths during the COVID-19 pandemic and the possible reasons for this to make the point that it is possible that India saw a greater impact of the pandemic than is officially believed. It elaborates on the current gaps in the existing primary care from four angles: health financing, the capacity of the primary health care system which includes infrastructure and personnel, performance in terms of health outcomes, and equity in terms of access, affordability, and availability of primary care. In this context, the paper looks at the extent of prioritization of the health sector in the three years after COVID-19 started by looking at budget allocations. It concludes that unless the health sector is urgently prioritized in government spending, it is unlikely that the state of primary care will improve anytime soon, with a concomitant impact not only on health outcomes and equity during normal times, but aggravated impact from future pandemics and epidemics.