Shortcomings of Urban Health and Wellness Centres in Kochi flagged before NUHM

The reported operational challenges faced by Urban Health and Wellness Centres (UHWCs) in Kochi, particularly concerning doctor commitment and the absence of critical facilities like sample collection, serve as a critical case study illuminating broader systemic issues within India's urban primary healthcare delivery. This situation, flagged before the National Urban Health Mission (NUHM), underscores the complexities of implementing ambitious national health programs at the grassroots level.

Historically, India's public health focus was predominantly on rural areas, with the establishment of Primary Health Centres (PHCs) and Sub-Centres. However, with rapid urbanization, the health needs of the urban population, especially the urban poor living in slums and informal settlements, became increasingly apparent. Recognizing this gap, the National Health Mission (NHM), launched in 2005, was bifurcated to include the National Rural Health Mission (NRHM) and, later, the National Urban Health Mission (NUHM) in 2013. NUHM specifically aimed to address the health challenges of urban areas by improving the health status of the urban poor and vulnerable sections through a decentralized, community-owned, and comprehensive primary healthcare system. The concept of Health and Wellness Centres (HWCs), a cornerstone of the Ayushman Bharat program launched in 2018, further expanded this vision, intending to transform existing Sub-Centres and PHCs into HWCs to provide comprehensive primary healthcare closer to the community, including preventive, promotive, curative, palliative, and rehabilitative services.

The specific issues in Kochi – alleged lack of commitment among doctors and the absence of critical facilities like sample collection – directly undermine the core objectives of UHWCs. UHWCs are designed to be the first point of contact for healthcare, offering services such as maternal and child health, non-communicable disease screening, common ailments management, and basic diagnostics. The inability to collect samples means patients must travel to larger facilities, defeating the purpose of accessible, decentralized care and adding to their financial and logistical burden. A lack of doctor commitment, whether due to inadequate staffing, poor working conditions, or motivation issues, directly impacts service quality and patient trust.

Key stakeholders in this scenario include the Union Ministry of Health and Family Welfare, which frames national policies and allocates funds; the State Health Department (Kerala, in this case), responsible for implementation and oversight; the National Health Mission (NHM) and its urban component (NUHM), which provides technical and financial support; and the local Urban Local Bodies (ULBs) or Municipal Corporations (Kochi Corporation), which are crucial for local planning, infrastructure, and community engagement. Healthcare workers, including doctors, nurses, and ASHA workers, are frontline implementers, while the citizens are the ultimate beneficiaries. The shortcomings highlight a breakdown in coordination and accountability across these layers.

This situation matters significantly for India's public health landscape. Firstly, it impedes the achievement of Sustainable Development Goal (SDG) 3, which calls for ensuring healthy lives and promoting well-being for all at all ages, particularly targets related to universal health coverage. Secondly, it exacerbates health inequalities, as the urban poor, who rely heavily on public health facilities, are disproportionately affected. Failure to provide timely and comprehensive primary care can lead to delayed diagnosis, progression of diseases, and increased burden on secondary and tertiary care facilities. Economically, this translates into lost productivity and higher healthcare expenditures. Politically, it reflects on the effectiveness of governance and policy implementation, potentially eroding public trust in government initiatives. The National Health Policy 2017 explicitly advocates for a comprehensive primary health care approach, and such operational issues challenge the realization of this vision.

Looking ahead, addressing these shortcomings is paramount. Future implications include the urgent need for robust human resource policies, ensuring adequate staffing, fair remuneration, and continuous training for healthcare professionals in urban areas. Stronger monitoring and evaluation mechanisms are required to track performance and identify bottlenecks. Investments in infrastructure, equipment, and digital health solutions (like electronic health records and telemedicine) can enhance service delivery. Furthermore, strengthening the capacity of ULBs to manage and oversee urban health initiatives is crucial for effective decentralization. Promoting community participation and feedback mechanisms can also foster greater accountability and responsiveness. Ultimately, the success of India's urban primary healthcare system hinges on sustained commitment from all stakeholders to translate policy vision into tangible, accessible, and high-quality services for every urban citizen.

From a constitutional perspective, while health is primarily a State subject (Entry 6 of List II, State List, Seventh Schedule), the Union government plays a significant role in policy formulation, funding, and coordination. Article 47 of the Directive Principles of State Policy mandates that the State shall regard the raising of the level of nutrition and the standard of living of its people and the improvement of public health as among its primary duties. The operational failures in UHWCs directly challenge the fulfillment of this constitutional directive, emphasizing the State's responsibility to ensure equitable access to healthcare.