The Alma-Ata declaration of 1978 (Primary Health Care 1978) affirmed that health, including mental health and social well-being, is a fundamental human right, and primary health care is the key to attain this worldwide goal. The World Health Organization (WHO) in its World Health Report of 2008 stressed the urgent need to strengthen primary health care worldwide. The existing health delivery systems fail to meet the populations’ health care needs. People all over the world deserve a health system that is person centred and comprehensive, provides continuity, and is well integrated. A well-planned primary-care health system can meet all these objectives.

Mental health despite being a leading cause of disability worldwide is not well incorporated at the primary-care level even in the most developed countries. Patients with mental illnesses remain under-treated in both low- and high-income countries (Ormel et al. 2008; Sharma and Copeland 2009). Most people with mental illness seek help from their primary-care doctors and many of them present with physical symptoms. Health professionals in general often fail to recognise mental illnesses, especially when they coexist with physical conditions. It is worth noting that people with physical illness have a raised psychiatric morbidity. A cross-national study (Scott et al. 2009) of the joint effect of mental and physical conditions on disability found that co-morbidity exerts detrimental synergistic effects. It therefore recommended that clinicians need to deal with both mental and physical conditions giving them equal priority, if they are to manage co-morbidity and reduce disability. Overall, about one-third of patients admitted to medical wards also suffer from diagnosable mental illness ranging from acute organic brain syndrome, dementia, depression, anxiety, and psychosis and somatisation disorder to adjustment disorders and alcohol abuse. However, only a few of them undergo a mental health assessment or receive appropriate treatment. This is consistently reported in different parts of the world and among patients of all age groups (Sim et al. 2001; Hansen et al. 2001; Ames and Tuckwell 1994; Ndetei et al 2009). Untreated mental illness leads to longer times spent in the hospital with increased health care costs (Verbosky et al. 1993).

India has a complex system of health-care delivery ranging from largely unregulated indigenous practitioners to highly equipped private hospitals. People have the complete freedom to choose between these services depending on their beliefs, access to services, and their ability to pay for these services. The health delivery system is far from a comprehensive and well integrated one. In that context, the primary-care health service is largely underdeveloped in most parts of the country, and there is no universal health-care coverage for its population as compared to developed countries such as the UK, where primary care is the backbone of its National Health Service.

The 12th Five Year Plan (2012–2017) of the Planning Commission of India highlights the following weaknesses of health-care system:

Inadequate resources and coverage: Health-care services from the public and private sectors put together are quantitatively inadequate. The numbers of doctors is only half, and the numbers of nurses and auxiliaries merely one-fourth of the expected numbers required to provide adequate services. Rural areas are served even worse (Khandelwal et al. 2004).

Future trends of health–care needs: The problems are likely to worsen in future due to several factors e.g. rising life expectancy with increasing long-term medical conditions, increase in public awareness of treatment possibilities leading to rise in demand for quality medical care, increase in lifestyle related diseases such as diabetes and heart conditions with rising prosperity, and an increase in accidents and injuries.

These enormous challenges have led the commission to formulate a health planning and delivery strategy under the 12th Five Year Plan that may take two or three planning cycles to implement. The new strategy focuses on universal health coverage. Addressing all the key issues, the strategy emphasises on the efficient and effective use of resources, a holistic approach of care delivery, public–private partnerships, and greater integration in health delivery systems. The health planning and delivery strategy also proposes a major role for primary health care in its national health package, i.e. a high quality primary care provided free at the point of delivery.

Good quality primary-care health services are lacking in both rural as well as urban communities in India. The National Rural Health Mission (NRHM), (National Rural Health Mission 2010) a government funded public health system set up subcentres with health workers serving 5–6 villages, primary health centres with doctors (PHCs) for 30–40 villages, and community health centres (CHCs), based on a polyclinic model to serve about 100 villages. In addition private qualified and non-qualified health workers fill the gap to large extent. In urban areas, the lion’s share of diagnostic and treatment services is provided by private clinics and hospitals with limited training in primary care (Rao and Mant 2012).