Identifying the Scope, Relevance and Integration Challenges for Mid-Level Health Providers in India: Perspectives on Advancing Primary Care

In line with the demographic and epidemiological transition and persisting health disparities, the need for accessible primary health care and access to medical facilities is becoming more relevant than ever today. This demand and deficit is acutely observed in low-and-middle-income countries (LMICs) that harbour a larger proportion of the world’s population and entail a wider disparity in their healthcare access and primary care delivery. One of the modes to overcome this primary care deficit is potentially bridged through community-appropriate staffing, task sharing and augmenting primary care through the introduction of mid-level health providers (MLHPs) now known as the Community Health Officer (CHO). India depicts a very skewed urban-rural distribution of healthcare professionals due to the lack of a supportive rural public health ecosystem coupled with disinterest and lack of motivation among healthcare workers to serve in the rural areas. This has adversely impacted primary healthcare delivery in the rural and tribal pockets of India. It is in this realm that we attempt to provide perspective to the emergence of the Community Health Officer (CHO), the scope they offer and the significance of integrating MLHPs into the public health system in India.