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Clinical Review

Managing patients with multimorbidity in primary care

BMJ 2015; 350 doi: (Published 20 January 2015) Cite this as: BMJ 2015;350:h176

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The concept of multimorbidity management in primary health care settings is innovative. Can such an approach be initiated in the Indian health care system ? If the current status of organizing health care delivery in India is analyzed, one can say that there are numerous problems that plague the system. There is a problem of inequitable distribution of health centres, though the government aims to provide equitable health care to the people. Another problem is that of lack of manpower, which is again distributed in a skewed manner. In some states in the north-eastern India, it has been reported that there is an excess of doctors viz. in Assam, Manipur, Sikkim and Tripura, whereas other states require more doctors such as Arunachal Pradesh (5.15%), Meghalaya (4.59%), Mizoram (35.09%), Nagaland (19.84%), while all India figures shows a deficiency of 12% doctors (1). In such a condition, there could be wide variations in the provision of primary health care in various states of India.

Under normal circumstances, primary health care in India attends to minor ailments, and those that can be tackled at the primary care level without supportive advanced laboratory facilities. This situation cannot deal with multiple problems of the older age or with patients having multiple problems. At best, we cannot expect a patient to be hospitalized at the primary health centre (PHC) in absence of adequate manpower, supportive nursing staff, equipments, and medications. A person coming with myocardial infarction at the PHC may not get appropriate primary management and it needs only referral to a district hospital having cardiac care unit (which in many hospitals is still lacking). Considering the above facts, India still needs to focus on the basic primary care approach of dealing with minor ailments at the PHC level, and treating multiple morbid conditions remains a distant goal to achieve.

1. Saikia D, Das KK. Status of rural health infrastructure status of rural health infrastructure status of rural health infrastructure in the north-east india. Available at: (accessed 27th January 2015)

Competing interests: No competing interests

27 January 2015
Mongjam Meghachandra Singh
Reeta Devi
Maulana Azad Medical College, New Delhi, co-author- Indira Gandhi National Open University, New Delhi
Department of Community Medicine, Maulana Azad Medical College, New Delhi; co-author- School of Health Sciences, Indira Gandhi National Open University, New Delhi