CNS: Person-centred care is the gateway to health for all

The irony of current times is that despite the writing on the wall "health is a fundamental human right," the ground reality cannot be farther from the truth. Over 70% people die of non-communicable diseases (NCDs) - a significant number of them are preventable. An infectious disease like TB, which is preventable and curable, continues to be the deadliest infectious disease worldwide - especially in the Global South. When HIV combination prevention should be a reality, along with treatment as prevention, over 630,000 people died of AIDS-related illnesses in 2024 - and 1.3 million were newly diagnosed with HIV in 2024 (hardly any change when compared with 2023 data). If every life matters, then why is A for accountability, missing from global health?

After funding cuts by the US earlier in 2025 and other nations, the situation has become grimmer. "Global health suffers from sudden funding cuts, compromised logistic supply and massive reduction of the number of healthcare givers. The current time necessitates to establish the principle of achieving much more with much less by rapid enhancement of the quality of the services and healthcare," said Dr Sugata Mukhopadhyay, a noted global health thought leader who has worked on improving person-centred healthcare with governments as well as other stakeholders in several countries of the Global South, notably India and Mozambique as well as Indonesia, Nepal and Thailand. He also consults for a range of organisations including Humana People to People India (HPPI), which has demonstrated groundbreaking results in reaching the unreached high-risk people with best of public TB services and social support.

Let us first serve those who are farthest behind

Mahatma Gandhi's talisman is perhaps the best guiding light to reform the public health and social justice system: "I will give you a talisman. Whenever you are in doubt, or when the self becomes too much with you, apply the following test- "Recall the face of the poorest and the weakest man [woman] whom you may have seen, and ask yourself if the step you contemplate is going to be of any use to him [her]. Will he [she] gain anything by it? Will it restore him [her] to a control over his [her] own life and destiny? In other words, will it lead to swaraj [freedom] for the hungry and spiritually starving millions? Then you will find your doubts and your self melt away," said Gandhi ji.

Our health system must meet the needs of the poorest of the poor and weakest of the weak. And the same quality of service which goes to this person should be a benchmark for everyone else.

Person-centred care helps us reach those currently unreached with equity and rights

"Stronger engagement of the affected, infected and vulnerable community members in the decision-making process and promoting cost-effective interventions which have both scalability and impact, are critical priorities," said Dr Sugata. He was speaking in an affiliated event of the world's largest HIV science conference (13th International AIDS Society - IAS - Conference on HIV Science or IAS 2025), and right after 10th Asia Pacific AIDS and Co-infections Conference (APACC 2025) concluded in Japan.

"Person-centred care is focused and organised around the health needs and expectations of people and communities - rather than just on the diseases. In a people-centred care, everyone is as important as anyone else. There is no hierarchy. Everyone - from patients to healthcare providers to families, social workers and community members - involved co-contribute to a coordinated effort in the delivery of healthcare and services," he said.

"Person-centric healthcare aims to replace unidirectional clinical approach with a health system and community partnership approach where the people, families and communities are no more regarded merely as the beneficiaries of the healthcare services but are equally engaged in the crucial decision-making processes regarding policies, overall disease management and continuum of care," said Dr Sugata Mukhopadhyay.

Patient-centred care versus person-centred care

"We also use a terminology like 'patient-centred healthcare' which is focused on the individuals seeking healthcare as patients. However, person-centred healthcare should be much beyond the patient-centred care. Patients should not be reduced to or defined by their 'diseases' or 'illnesses' and 'conditions.' They are persons with individual preferences, needs and abilities who are full partners in their healthcare. They are people - not cases or merely a number - to count and analyse," rightly said Dr Sugata.

Differentiated service delivery model

"We also use a terminology like 'differentiated service delivery models' which are already in place in HIV programmes, and are also being initiated in TB. This model focusses on more customised treatment and care according to the specific health and non-health needs of the people as an integral part of client-centred approach to reflect the preferences, expectations and needs of the people while reducing unnecessary burden on the health system. The idea is not only to treat the health conditions but also help the clients to overcome their health-related dysfunction and disabilities that can enhance their cure and sustain good health thereafter," he added.

Should not we utilise person-centred healthcare to equally address the emotional and economic stability of the affected and infected people?

We must address stigma (as well as intersectional stigma), discrimination, violation of rights, gender equity, reduction of out-of-pocket expenditure, organise livelihood opportunities and social protection to maximise impact of the treatment outcomes in TB and HIV," said Dr Sugata Mukhopadhyay. "For example, the expected outcomes of a person-centred TB care is the successful completion of both curative and preventive treatment. Expected outcomes of a person-centred HIV care would be sustained viral suppression which can finally reduce new TB and HIV cases and premature mortality - and ensure that undetectable equals untrabnsmittable or #UequalsU is a reality for all with HIV."

"It takes a village to raise a child"

Dr Sugata commends the important and critical roles played by a number of stakeholders to reap benefits of person-centred care, such as those played by civil society and community-based partners, people who have survived TB and risen to champion the cause, people living with HIV, among others. "They are playing a critical role to achieve these goals. There should be sustained advocacy to mobilise the Ministry of Health of high-burden nations to adopt patient-friendly policies for integrated and holistic care and that should be a priority in the context of Global South."

Dr Sugata's Triple Mantra

1. "Instead of merely increasing collaboration between TB and HIV interventions, can we think about a merged and unified TB-HIV elimination programme rather than separated TB and HIV control programmes, because that is what the people need: one programme, one strategy, one implementation at the same healthcare settings by the same service providers," said Dr Mukhopadhyay. "Incidentally, it is the same group of poor and vulnerable people of HIV programmes who are also in the need of TB care and vice versa. So when clients are the same, why not the programmes?"

2. "Enhance the treatment of contacts of TB and HIV index-cases," he added. Index-case is the first identified case in a group of related cases of a particular infectious disease like TB or HIV. "We have to understand that a TB patient or a person living with HIV is part of a group of potential-affected and -infected people whom we call 'close contacts.' The index cases of TB and HIV should be treated in tandem with all their possible contacts with the help of an appropriate curative and preventive treatment package and should be monitored together to ensure completion of the curative and preventive treatment. People should be empowered to demand screening and treatment of their partners as part of the person-centred care."

3. "More capacities for person-centred care for TB and HIV have to be built at the national (or sub-national) level. And there should be appropriate guidance and cross learning materials for strengthening person-centred care, both for providers and people (like operational manuals, lesson learnt documents, patient information materials, patient charters, stigma assessment tools, etc). Equally, we should encourage community members for self- and community-monitoring for the progresses of the health condition status of services and they should be also encouraged to utilise available digital applications for such monitoring," said Dr Mukhopadhyay.

Governments must ensure that people come before profit when it comes to accelerating progress towards promises enshrined in the domestic goals as well as in the United Nations Sustainable Development Goals or SDGs. Person-centred care is a critical cog-in-the-wheel to deliver on SDG-3, SDG-5 as well as other SDGs. Healthcare service delivery model should be reformed keeping person-centred care approach in the centre along with equity and rights.

Shobha Shukla, Bobby Ramakant - CNS

(Citizen News Service)

27 July 2025