PHC doctors — a case where the caregivers need care
Primary Health Centre (PHC) doctors form the unshakable foundation of the Indian public health system. They serve not merely as doctors but also as planners, coordinators and leaders. For millions in India’s hinterlands, they are the only accessible face of medicine.
Their role extends far beyond clinical care — from public health programmes to disease surveillance. PHC doctors bridge the health system and the last person in a remote village. They stand at the intersection of community needs and policy intent, holding together a vast and fragile health-care network.
A PHC typically serves a diverse population of around 30,000 people, including women, children, the elderly with chronic illnesses, and other vulnerable groups. In hilly and tribal regions, it is around 20,000 people; in urban areas, it stretches to 50,000 people. With a modest team and finite resources, PHC doctors shoulder the care of entire communities. Their work draws upon the founding principles of primary health care: equitable access, community involvement, intersectoral coordination, and pragmatic use of technology, delivered not just in policy papers but in the actual lives of people.
Their responsibilities go well beyond the examination table. They coordinate immunisation campaigns, conduct door-to-door surveys, manage vector control, run school health programmes along with Medical Officers from the Rashtriya Bal Swasthya Karyakram (RBSK), and respond to field outbreaks. They organise health education sessions, engage in inter-sectoral meetings, and participate in gram sabhas to promote community health.
Visiting Anganwadis and sub-centres, mentoring Accredited Social Health Activists (ASHA), Auxiliary Nurse Midwives (ANM), and village health workers, conducting review meetings and audits are all a part of their daily rhythm. These are not checkboxes. They are the threads tying public health programmes to people, and keeping national health policies alive at the grass-root level.
Yet, these efforts are rarely acknowledged in workforce metrics or planning. While national programmes lean heavily on field-level execution, the pressure these duties place on already stretched personnel often goes unnoticed.
A crushing clinical load
On a busy day, a PHC doctor sees around 100 outpatients. In centres far away from a Basic/Comprehensive Emergency Obstetric and Newborn care (BEmONC/CEmONC) facility, nearly 100 pregnant women attend antenatal outpatient (OP) service on designated days. Each consultation is a race against time. In that brief time, they must listen with care, examine the patient thoroughly, arrive at a diagnosis, and offer the right treatment, without compromising clinical rigour or compassion. The burden of meeting programme-driven targets only intensifies the strain.
Unlike specialists focused on one domain, PHC doctors must stay updated across the entire medical spectrum — from newborn care to geriatrics, infectious diseases to mental health, and trauma and chronic illnesses — and are expected to treat emergencies of every specialty without having time to summon help. Added to this daily crush, they are expected to keep pace with updated treatment protocols, national guidelines and the steady churn of medical knowledge.
The space for learning or reflection has become a rarity, a quiet casualty of a system that never slows down. Hence, even simple research becomes a luxury, despite being the primary contributors of health data.
Administrative work, burnout
Perhaps the most overlooked burden is administrative work. What began as a support task has quietly grown into a parallel job. PHCs today maintain over 100 physical registers: outpatient records, maternal and child health, non-communicable diseases, drug inventory, and sanitation, among others.
To this, digital systems have been added: the Integrated Health Information Platform (IHIP), Population Health Registry (PHR), Ayushman Bharat Portal, Integrated Disease Surveillance Programme (IDSP), Health Management Information System (HMIS), and UWIN for immunisation. These were meant to streamline documentation. In reality, they have created duplication. Many doctors now enter the same data twice — on paper and electronically. The wrangle between digitisation and physical records is a false dichotomy; PHC doctors are made to juggle both, with neither system fully supporting them.
Support staff receive devices for data entry, but the need for parallel paper records persists. With limited assistance, physicians often stay late to complete documentation after their clinical duties. The second shift, filled with paperwork, has become routine. Ironically, those trained to treat are now consumed by computers.
The result of this multi-dimensional burden is a slow, invisible erosion: burnout. It is not a term widely used in the Indian public health context, but the signs are hard to miss.
The Lancet has termed physician burnout as a global public health crisis, marked by emotional exhaustion, detachment and a sense of futility. The International Classification of Diseases (ICD-11) issued by the World Health Organization (WHO) recognises it as an occupational phenomenon, underscoring the need for systemic, not just clinical, solutions. Dr. Vivek Murthy, former Surgeon General of the United States, wrote in The New England Journal of Medicine that burnout stems not just from long hours but from the growing gap between a health worker’s calling and the system they are trapped in.
A meta-analysis in the WHO Bulletin found that in low- and middle-income countries, nearly one-third of primary care physicians report emotional exhaustion. In Saudi Arabia, a Ministry of Health study cited administrative overload as a key driver of burnout among PHC doctors.
The mismatch between expectations and systemic support is glaring. Physicians are tasked with delivering quality care, driving national programmes, and maintaining detailed documentation, with little staffing, compensation, or recognition.
Even in States such as Tamil Nadu, known for its commitment to primary care, where around 650 PHCs were National Quality Assurance Standards (NQAS) certified by January 2025, systemic stressors remain. Certification, though commendable, often emphasises checklists. True quality must mean care that is enabling, humane and sustainable.
What is needed is not just external validation, but internal reformation.
Rethinking the system
Strengthening primary care requires more than new buildings and names. It requires redesigning systems with empathy. Documentation must be meaningful. Redundant registers should go. Where possible, automation must replace manual entry. Non-clinical tasks must be delegated.
Global efforts offer direction. The 25 by 5 campaign, led by the U.S. National Library of Medicine and Columbia University, aims to reduce clinician documentation time by 75% by 2025. India must adopt similar, implementable goals.
The Bhore Committee rightly envisioned that primary health care must rest on preventive services and community involvement. Nearly eight decades on, PHCs remain central to that vision. But its flag bearers are caught in a web of tasks that the system was never designed to hold. We must shift from a culture of compliance to one of facilitation. Primary care must be supported by systems, not smothered by them.
Primary health care is the gateway to Universal Health Coverage (UHC), enshrined in Target 3.8 of the Sustainable Development Goals (SDG). It promises access to essential health services, safe medicines, and financial protection. Without strong PHCs, SDG 3, which aims to ensure health and well-being for all, will remain aspirational.
Any investment in public health must begin with those who make it work. A system cannot be built on the backs of fatigued doctors. Their physical and emotional well-being is not a fringe concern. It is the foundation. We must value not just what physicians do, but what they endure. Only then can we build a system that is not just responsive, but resilient.
India has the opportunity and the responsibility to reimagine primary care not as a cost centre, but as its most vital investment. If care is to be truly Ayushman, it must start with those who deliver it.
Dr. A. Chandiran Joseph is a postgraduate in Community Medicine, Chennai. The views expressed are personal
