Bengaluru: India’s rural healthcare continues to suffer from a severe shortage of doctors, but a recent study suggests a fix: Training community health officers (CHOs) in family medicine to strengthen primary care delivery. Published in Springer’s Journal of Public Health Policy, the research argues that equipping these mid-level providers with advanced skills could transform access in remote areas.The study — Why training community health officers in family medicine could transform rural healthcare in India — draws on Indian and global evidence to propose a scalable, policy-relevant solution. Under Ayushman Bharat initiative, CHOs or mid-level health providers (MLHPs) were introduced to bridge gaps in primary healthcare at health and wellness centres (HWCs). These trained personnel, including nurses and Ayurveda doctors, serve as frontline providers.
Authored by IIM-Bangalore’s Allen P Ugargol, Ashitha Vijayan, and Adisri Swain of Georgetown University, the study notes that CHOs’ current responsibilities are limited to abortion services, mental health beyond perinatal depression and emergency care. It recommends expanding their role to crisis response — including disaster management and emerging threats — alongside routine screening and prevention.“Since CHOs form the front end for a gamut of healthcare services being offered through HWCs, equipping and training them in more complex medical skills, such as physical examinations and diagnostic investigations, can be the cornerstone of a reinvigorated curriculum,” the study states.It also stresses addressing the iceberg phenomenon in mental health, where visible symptoms mask deeper issues like trauma or biological factors, often neglected in current training. At higher levels of care, physicians could benefit from short courses in family medicine to meet rising demands for long-term and palliative care as India’s population ages.The study cites Chhattisgarh’s Mitanin workers (community health workers), who conduct rapid malaria tests and drive improvements in maternal and child health. Globally, Bangladesh’s use of MLHPs has cut maternal and child mortality, with similar successes in Ethiopia, Nepal, Brazil, Afghanistan and East Africa.Quote (mug mailed)The traditional ‘family doctor’ norm has seen a sharp decline over the years, and there is an increased demand for specialists and tertiary care facilities without necessary referral pathways being instituted. A common practice in India nowadays is seeking out specialist care without going through appropriate gatekeeping and skipping the primary care physician or first point of care completely. CHOs who can be trained in the principles of family medicine, can be empowered to act as gatekeepers to further healthcare needs and if need be, specialised care, thereby preventing the overburdening of secondary and tertiary care centres — Allen P Ugargol, IIMB professor and one of the authors of the study
