Context and Significance
- WHO’s January 2024 report highlighted compassion as a transformative force in primary healthcare (PHC).
- Compassion includes awareness, empathy, and action, and is key to quality care and system transformation.
- In India’s vast but often overstretched PHC system, incorporating compassion can significantly improve patient outcomes and trust.
Relevance : GS 2(Social Issues ,Health)
India’s Primary Healthcare Structure
- Sub-Centres (SCs): Serve 3,000–5,000 people.
- Primary Health Centres (PHCs): Serve 20,000–30,000 people.
- Community Health Centres (CHCs): Serve 80,000–120,000 people.
- Total: ~1.6 lakh SCs, 26,636 PHCs, 6,155 CHCs (National Health Mission).
Case Study 1: Clinical Courage in Rural Rajasthan (Amrit Clinics, BHS)
- Dr. Vidith Panchal treated a 22-year-old TB patient, Tukaram, in a remote tribal PHC.
- Tukaram had failed treatment across 3 states; weighed only 23kg and had relapsed twice.
- Instead of referral, Dr. Panchal chose palliative, community-based care, reducing physical and financial burden.
- Termed “clinical courage” — prioritising patient dignity over system defaults.
- Barriers to compassionate care: Overloaded PHC doctors managing 40+ national programs.
- Outcome: Amrit Clinics saw footfall increase from 40,000 (2021) to 51,930 (2024).
- BHS Model: Emphasises staff dignity → better morale → more respectful patient care.
Case Study 2: Addressing Violence in Gujarat through ASHAs
- Praveena Ben, an ASHA in Gujarat, trained by SWATI NGO to support violence survivors.
- Used her routine visits to discreetly identify domestic violence cases and refer survivors.
- Referral system: From ASHA → Sub-centre counselling → Direct referral to district hospitals (bypassing PHCs).
- Protects survivor identity (PHCs are community-staffed, risking exposure).
- Culturally sensitive, trust-based approach improved survivor outreach.
- Since 2012, SWATI has worked with 400+ ASHAs and counsellors.
- Recommendation: Embed gender-sensitive, trauma-informed care into PHC protocols.
Case Study 3: Disaster Preparedness in Tamil Nadu
- Compared with Odisha/West Bengal, TN’s PHC system is better integrated in disaster response.
- Annual epidemic training equips health workers for sanitation, outbreak control, and coordination.
- Example: 2004 Tsunami response — swift corpse disposal, sanitation in shelters, food safety.
- Tamil Nadu’s governance model:
- Defined roles via Chennai Municipal Corporation Act.
- Annual district-level planning meetings.
- Strong coordination among technical staff, line departments, and elected bodies.
- In contrast, other states show fragmented responsibility and poor inter-departmental collaboration.
Key Takeaways and Lessons
- Compassion strengthens system responsiveness, especially in crises or vulnerable settings.
- Trust-based human relationships are foundational for quality care.
- Compassionate care includes:
- Home visits
- Respecting patient context
- Minimising stigma (e.g., in abuse or TB)
- Supporting overburdened staff (ASHAs, ANMs)
- Structural support + empathetic delivery = resilient primary healthcare system.
Policy Implications and Recommendations
- Invest in training for compassion and trauma-informed care.
- Recognise and reward compassionate health workers (like ASHAs, PHC doctors).
- Formalise inter-agency coordination (Tamil Nadu model) for public health disaster preparedness.
- Address workforce dignity as a system-level priority for sustained motivation and care quality.
- Scale community-based models like BHS, SWATI for wider reach.
