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Introduction

Primary Health Centres (PHCs) are the first point of contact in India’s public health system, especially for rural and underserved communities. PHC doctors play multiple roles as clinicians, planners, coordinators, and leaders, making them indispensable to the system. However, they face structural and operational challenges that hinder effective delivery of care.

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Key Challenges Confronting PHC Doctors in India

• Overburdened Clinical Responsibilities: PHC doctors cater to nearly 30,000 people (20,000 in hilly/tribal regions, 50,000 in urban areas) and often see over 100 outpatients daily, leaving little time for quality consultations.
  Eg: Each consultation becomes a race against time, especially on antenatal OP days with nearly 100 pregnant women attending.
• Administrative Overload: Maintenance of 100+ physical registers and multiple digital portals (IHIP, PHR, HMIS, IDSP, UWIN, etc.) causes duplication and reduces clinical time.
  Eg: Doctors often stay late after clinical duties to finish paperwork, essentially working a “second shift.”
• Inadequate Systemic Support: Limited staff, resources, and recognition, despite PHCs being the first contact point for national programmes and community health initiatives.
• Risk of Burnout: Emotional exhaustion due to high workload, lack of learning opportunities, and mismatch between expectations and systemic support.
  Eg: WHO Bulletin meta-analysis shows nearly one-third of primary care physicians in LMICs report emotional exhaustion; The Lancet calls physician burnout a global public health crisis.
• Skill Stretch Across Specialties: Unlike specialists, PHC doctors must handle everything from neonatal care to geriatrics, infectious diseases to trauma, with limited access to referral support.
  

Measures to Strengthen PHC Doctors’ Capacities

• Streamline Documentation: Reduce redundant registers, integrate digital systems, and automate data entry wherever possible.
  Eg: Inspired by the U.S. “25 by 5” campaign to cut clinician documentation time by 75% by 2025.
• Delegation of Non-Clinical Work: Employ trained administrative and technical staff to handle record-keeping, inventory, and digital reporting.
  Eg: Current dependence on PHC doctors for both manual and electronic data entry creates avoidable inefficiencies.
• Enhance Staffing and Support Teams: Expand the pool of ASHAs, ANMs, and health workers, with continuous mentoring and proper incentives.
  Eg: PHC doctors already mentor ASHAs and ANMs, but require more manpower to sustain community engagement.
• Ensure Continuous Medical Education: Provide time and structured opportunities for PHC doctors to update knowledge across domains.
• Focus on Physician Well-being: Recognise burnout as an occupational hazard and integrate measures like counselling, peer-support groups, and reduced non-clinical load.
  Eg: ICD-11 acknowledges burnout as an occupational phenomenon, highlighting the need for systemic solutions.

Conclusion

Strengthening PHCs is vital for achieving Universal Health Coverage and Sustainable Development Goal 3. Any reform must value doctors’ time, reduce systemic stressors, and empower them to deliver people-centric care. A resilient health system begins with resilient PHC doctors, and investing in their well-being is the surest path to inclusive health for all.

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