Implementing Family Physician Programme in Rural Andhra Pradesh

Primary health care is the cornerstone of the health system of any country and a strong and resilient primary health care system can provide the entire population with inclusive, cost efficient, effective, and quality services. With the launch of the flagship program called Ayushman Bharat (2018), the primary healthcare policies in India reflects the global trend towards a comprehensive primary health care (CPHC) system and is transitioning from a selective to CPHC approach. The delivery of CPHC through Ayushman Bharat health and wellness centers (HWC) promotes continuity of treatment through a two-way referral system and follow-up support across multiple health care levels. In Andhra Pradesh state, however, concerns have been raised about the quality and efficiency of health care services provided through the HWC network. A dysfunctional referral system between the HWC and doctors and between doctors and specialists was reported that made it difficult for villages to access health care. The concept of family physicians was thus introduced in Andhra Pradesh to address these challenges and bring quality health care closer to the community. The family physician concept is centered around the principle of continuity of care, which is one of the fundamental principles of the concept of family medicine. Provision of care must begin at the family level and extend to the level of the facility. This concept will be implemented in 1142 primary health care facilities throughout the state.

This initiative aims to enhance the quality of health care at the village level by bringing physicians to the doorsteps of the people. As per the Indian Public Health Standards (IPHS), two medical officers are assigned to every PHC. One medical officer will be assigned to the PHC, while another will be assigned to the field. The medical officer assigned to the field who will henceforth be considered the family physician will visit the allocated village to provide health services such as general outpatient care for all illnesses and point-of-care diagnostics that can be accessed during the morning session. House calls and visits will be conducted by the ASHA with support and collaboration from the ANMs to mobilize the community towards family doctors. Following the morning session, the physician and his team will make home visits to follow up on discharged patients and address practical needs while providing palliative care to enhance the quality of life of people with life-limiting illnesses. In addition, they will assist in the implementation of national health programmes. Referral care and sites will depend on the illness, its treatment pathway, and the availability of specialists. The implementation of the family physician concept in Andhra Pradesh is still at an early stage, but if implemented well, will contribute significantly to achieving universal health coverage. Community participation at the micro level, trained primary health care workers at the meso level, and sustained political commitment at the macro level can help implement this concept effectively and ultimately strengthen the health system.