Primary Healthcare Initiative (PHI), a joint initiative of the Indian Institute of Management Udaipur and Basic Healthcare Services, Udaipur organized a day-long Consultation on Financing Primary Healthcare at IIM Udaipur on 16 November 2019.

The Consultation was attended by 20 Academicians and Practitioners, representing healthcare, livelihood and academic organizations such as LV Prasad Eye Institute, iKure, ARTH, DHAN Foundation, Karuna Trust, Karma Healthcare, Shram Sarathi, PGIMER Chandigarh, Health Systems Transformation Platform, and Basic Healthcare Services.

Active discussions throughout the day highlighted key insights from the experiences and evidence shared by the participants on the ways and means of leveraging sustained financing for primary healthcare services, especially for marginalized populations. It began with a global perspective on primary healthcare, critical in setting the context for the subsequent discussions.

The different models of primary healthcare, as well as the financing models powering the services, were presented by representatives from the different healthcare organizations. These novel models varied from privately financed, publicly provided services to privately provided, publicly financed services; primary healthcare for specialized services such as eye care, reproductive health, use of telemedicine; comprehensive primary healthcare provided to remote, impoverished populations as well as an integrated comprehensive primary healthcare model sustained on community financing.

These initiatives were discussed in the light of the current health provision split between public and private providers, with the public health system emphasizing preventive and promotive services, while curative services being largely provided by private providers, usually at a high cost. The participants opined that synergy between the public health system and private (for-profit and not-for-profit) institutions would be required to address the large disparities in disease burden and access to care.

However, a challenge flagged off during the discussion was that despite having made an impactful transformation in the overall health status of marginalized communities, these innovative models in primary healthcare are limited in geography and scale. The group identified significant scope for expanding and replicating such innovative models to supplement the services of the public health system and contributing to universal coverage of primary healthcare in the country.

A crucial component that the discussions touched upon was the meansof leveraging sustained financing in primary healthcare. Insights into the financing mechanism ineach of the models brought out discussions about possibilities: public-private partnership in financing and implementation, user fees, equitable pricing mechanism, social franchise model and community financing model. The discussion was further enhanced by global evidence on financing healthcare that has aimed at reducing out-of-pocket expenditure. The participants discussed ways of drawing in community contribution for financing healthcare in an equitable manner.

These discussions coalesced with a contextual understanding of the Salumbar block- a rural, predominantly tribal block with health indicators lower than the state and national average. The Initiative aims to design, implement and evaluate a model of primary healthcare in Salumbar block driven on the lines of sustainable financing, equitable access and comprehensive care for all.

IIM Udaipur is a premier management institute specializing in cutting-edge research and providing transformative student experience; Basic Healthcare Services is a well-acclaimed not-for-profit with demonstrated experience of primary healthcare for marginalized populations. The Primary Healthcare Initiative, conceived by the two institutions, is aimed at building knowledge and informing policies for advancing primary healthcare for the marginalized. The lessons drawn from the Consultation will feed into the proposed implementation research within the Initiative aimed at testing out the primary healthcare model.