Barriers to implementing primary health care in villages in India

Priyanka Saurabh *

Healthcare in rural India is a constant struggle. Millions live with limited access to medical care, facing not only the absence of healthcare professionals but also the burden of outdated infrastructure. These aren’t the only challenges—they are the reasons behind delayed treatment and preventable diseases that take a toll on lives.

Primary healthcare is the foundation of any health system, especially in rural India, where more than 65% of the population lives. Yet, rural areas continue to face challenges in delivering effective healthcare services. Inadequate infrastructure: Most rural primary healthcare centers lack basic amenities such as electricity, clean water, and equipment.

According to Rural Health Statistics 2021, more than 8% of healthcare centers function without electricity. Rural healthcare centers face a severe shortage of trained medical personnel, including doctors and nurses. According to the Ministry of Health and Family Welfare 2022, there is a 23% shortage of doctors in healthcare centers in India.

Long distances and poor transport networks pose difficulties in remote areas, affecting patients' access to healthcare. More than 40% of villages in hilly areas like Uttarakhand do not have access to a nearby healthcare center.

Low literacy levels and lack of awareness about healthcare services lead to underutilization of healthcare facilities. In states like Bihar, immunization rates remain low due to low awareness. India spends 1.3% of its GDP on healthcare (Economic Survey 2023), which is inadequate to improve rural healthcare infrastructure and services.

Invest in improving infrastructure in PHCs, ensuring electricity, clean water, and essential equipment. The National Health Mission (NHM) can allocate additional funds to upgrade rural health centers. Increase recruitment and retention through incentives such as higher salaries, housing, and rural allowances for doctors and nurses.

States such as Tamil Nadu offer rural service benefits to encourage doctors to work in rural areas. Expand the use of telemedicine and mobile health units to provide healthcare in remote areas. e-Sanjeevani has been successfully used to provide teleconsultation in rural India. Run community-based awareness programs about primary healthcare, focusing on maternal and child health.

ASHA workers have been effective in promoting maternal care in rural areas. Increase public health expenditure to at least 2.5% of GDP as recommended by the National Health Policy 2017, focusing on rural healthcare. Countries such as Thailand have improved access to healthcare through sustained investment in public health.

The challenges in rural healthcare are not just limited to patients; they also place a heavy burden on the shoulders of healthcare professionals. The harsh realities faced by doctors are violence, inadequate housing, and crumbling infrastructure.

These factors deter many from working in government hospitals here. Despite efforts to bring in specialists, the lack of such professionals often means that patients must be referred to district hospitals for treatment.

“The COVID-19 pandemic was a wake-up call to improve our primary healthcare systems, yet there has been no additional investment in the sector. In the absence of accessible, affordable, and quality healthcare services, people in rural India, particularly those living in mountains, forests, and deserts, continue to fend for themselves when faced with illness—often delaying care until the disease is severe, not seeking care at all, or seeking care from informal, poor-quality providers. Even when they are able to seek healthcare, they are mistreated, receive poor quality healthcare, and often go into debt in the process.”

Telemedicine, a vital tool for increasing access to healthcare in rural and underprivileged areas, still faces significant challenges. Aligning the availability of specialists, ensuring that patients have access to necessary infrastructure such as internet and electricity, and managing the heavy clinical responsibilities often faced by specialists are all barriers that need to be addressed.

AI can streamline this process by optimizing telemedicine consultations, routing cases to the right centers based on availability, and supporting a district-wide, AI-enabled, hub-and-spoke model that can improve appointment satisfaction rates.

In addition, the potential of AI extends to improving auditing and fraud control mechanisms, which are critical to prevent resource leakage in programs such as Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY).

By ensuring that resources are used effectively and ethically, AI can help strengthen the overall integrity of rural healthcare delivery systems. Strengthening primary healthcare in rural India is essential to achieve universal health coverage (UHC) and improve rural health outcomes. Focused infrastructure development, workforce incentives, and digital innovation can bridge the existing gaps, ensuring healthcare for all.