By Dr. Prakash Tyagi, Executive Director, GRAVIS
As the first line of healthcare, primary care is the foundation for healthcare services and systems. However, a long history of underinvestment and a fragmented health system have hindered primary care. GRAVIS, HelpAge’s affiliate in India, has sought to improve access to primary care and ensure it is integrated into the health ecosystem.
Integrated Primary Care Model
As the goals around the Decade of Healthy Aging take shape, the importance of primary care for older people at the ground level is becoming ever more evident. GRAVIS, a primary care provider, knows from direct experience how critical these services are to prolong health, functioning, and longevity in older adults. Our health programs focus on preventive, rehabilitative, and curative services because of it.
With the Decade of Healthy Aging ahead of us, we see an opportunity to improve primary (and secondary) level medical services as well as public health interventions so that they are better equipped to serve older people—who are among the heaviest users of health services. Our integrated care model hinges on a three-pronged approach.
Self-care education is an important part of primary care services, focused on the prevention and management of both communicable diseases and non-communicable diseases (NCDs). After providing education on basic concepts of self-care to 2,000 older people, GRAVIS envisions focusing on specific disease-based trainings. We have started with diabetes, developing training content with the help of our academic partners, and will gradually expand to hypertension, mental health, and renal disease. These specific priorities have been identified in consultation with older people in local communities. Steps were taken to make sure older women were included in consultations and self-care trainings as systemic social disadvantages due to gender often put older women at higher risk of neglect and specific health issues.
Double Burden of Disease
The term double burden of disease refers to the prevalence of having one or more communicable and non-communicable diseases concurrently. It’s a growing phenomenon GRAVIS increasingly addresses in our programming because of its sweeping impact on the demand for health services and long-term care. Without appropriate changes to our health system, the affordability and accessibility of critical services may be at risk.
Having one or more conditions will influence a patient’s care plan and service delivery as well as the design of public health interventions. GRAVIS focuses on the prevention and management of many common NCDs and some endemic diseases like silicosis, as well as acute and chronic infectious diseases, such as tuberculosis (TB), which is prevalent among older people. HIV is a serious problem in India as well, but little is known about its impact on older people as few studies look at the interplay between the disease and older age. GRAVIS is keen to explore research opportunities that bridge this data gap on HIV and older people while combatting stigma and discrimination against older people living with HIV. GRAVIS hospital, its satellite clinics, and Mobile Medical Units are an important source of medical support for older people with HIV and other conditions in rural areas of the Thar Desert, covering nearly 100,000 older people.
Building Local Capacity
Building capacity and knowledge at the local level are important aspects of our integrated model. GRAVIS trains Village Health Workers (VHWs) who work as health educators, counselors, and referral linkages for rural communities. Over 500 such VHWs work with us. Beyond self-care trainings for older people, caregivers are also trained by our resource team. Moving forward, we intend to offer a more advanced curriculum that caters to formal health workers and nurses.
Through the provision of self-care education and health worker trainings, we are seeing significant improvements in the health-seeking behaviors of older people. Promoting locally-driven knowledge and skill-building is sustainable in the long term because the delivery of health outcomes is cost-effective. Self-care education and primary care services are generally less expensive than other interventions and lead to measurable progress on indicators of health and well-being.
GRAVIS sees opportunities in government programs to scale an integrated primary care model across India. These include the National Program for the Health Care of Elderly (NPHCE) and Ayushman Bharat (Long Live India – a State health insurance program) among others.
From the initial success we’ve had in rural areas, GRAVIS intends to extend the model to more older people across India and to share our learnings with other organizations. Our vision is to build broad-based support in India for primary care that promotes healthy aging and a health system where no one is left behind because of old age.