Context
Primary Health Centres (PHCs) form the first layer of India’s public healthcare system. However, doctors posted at PHCs are experiencing severe work-related stress and burnout, which threatens India’s journey towards Universal Health Coverage (UHC) under SDG 3.8.
Role and Importance of PHC Doctors
- PHC doctors are responsible for healthcare delivery to nearly 30,000 people in rural India (20,000 in tribal/hilly regions and up to 50,000 in urban settings).
- They handle clinical care, implement national health programs, support disease surveillance, and engage in community health promotion.
- They serve as key connectors between district-level health administration and grassroots communities.
Multifaceted Responsibilities
PHC doctors:
- Lead immunisation drives, vector control campaigns, and school health programmes.
- Supervise frontline health workers like ASHAs, ANMs, and health inspectors.
- Conduct gram sabhas and village meetings to spread awareness on public health.
- Provide multi-speciality care without specialist support, managing everything from maternal care to geriatric issues and medical emergencies.
Mounting Pressures and Systemic Challenges
- Many PHC doctors treat nearly 100 outpatients daily, alongside field visits and emergency cases.
- Administrative overload is a major burden. They must maintain over 100 registers while simultaneously entering data on multiple platforms:
IHIP, PHR, HMIS, IDSP, UWIN, Ayushman Bharat portal, etc. - This results in duplicate documentation, reducing time for patient care and contributing to professional fatigue.
Burnout: A Threat to Health Workforce Sustainability
- The WHO and The Lancet describe physician burnout as a global health challenge.
- Symptoms among PHC doctors include:
- Emotional exhaustion
- Professional detachment
- Declining job satisfaction
- These issues stem from a mismatch between expectations and the harsh realities of rural healthcare delivery.
Case Study: Tamil Nadu Experience
- Tamil Nadu boasts 650 NQAS-certified PHCs, reflecting strong primary healthcare infrastructure.
- Yet, doctors in the State face similar stressors—heavy documentation, manpower gaps, and role overload—highlighting a national pattern of neglect of primary care physicians.
Reforms and Solutions
To support PHC doctors and strengthen primary healthcare:
- Reduce paperwork: Implement campaigns like the global “25 by 5” initiative that seeks to cut clinical documentation time by 75% before 2025.
- Use automation to eliminate duplicate data entry.
- Delegate administrative work to trained support staff.
- Provide emotional and professional support through better HR policies and work-life balance strategies.
- Recognise and invest in primary care physicians to build a resilient health system.
Conclusion
India’s dream of Universal Health Coverage is achievable only when the frontline healthcare workforce is protected and valued. Caring for the caregivers, particularly PHC doctors, is essential not only for their well-being but for the overall effectiveness and credibility of the public health system.