The project undertook a baseline evaluation study focused on assessing key parameters such as availability of infrastructure, human resources, equipment, and quality of services delivered at the subcentre level, to understand the optimum utilization of healthcare services by the community and identify factors that lead to high out-of-pocket expenditure.
Establishing baseline data and evaluating service delivery, health-seeking behavior, and financial impact at SCs to enhance community health services.
Establish baseline status of SCs including input resources, service delivery, population coverage, access, and quality of care.
Assess the current mechanism of non-communicable disease identification, treatment, and follow-ups.
Evaluate health-seeking behavior of the local community for MCH and non-communicable diseases.
Analyze patient load at the SC, nearest Primary Health Centre, and secondary care public health facility.
Assess out-of-pocket expenditure of the local community on seeking primary healthcare services covered under HWCs service package.
Determine the present health profile for the local community pertaining to HWCs’ service package ambit.
Mixed Methodology (Qualitative Quantitative)
The study was carried out at the community and facility levels using separate tools. Multistage cluster sampling was adopted to select the subcentres, while purposive sampling was used for selecting households in both tribal and non-tribal areas.
Overall, the service delivery at the SCs was found to be optimal, with strong reporting systems for Maternal and Child Health, despite the challenges posed by COVID-19.
Among the sampled SCs, some were housed in government buildings, while others operated in rented spaces, old schools, and dilapidated structures, or were in a kaccha state. Approximately half of the SCs lacked a proper water supply.
The introduction of Gram Secretariats ensured an adequate number of Auxiliary Nurse Midwives (ANMs) in all facilities.
The availability of vaccines and other medicines was observed to be around 70-80% across districts.
Furniture and IT equipment, as recommended by the Indian Public Health Standards (IPHS) guidelines, were present in 60-70% of SCs.
The average annual OOPE on health was INR 6,159. Emergency care and MCH services, including delivery, were identified as key drivers of OOPE, with NCDs contributing significantly to catastrophic health expenditure, crossing a 10% threshold.
Approximately 77% of respondents sought treatment at public health facilities, or at least used them as their first point of contact.
Quality of care, cleanliness, and overall experience at public facilities were the primary reasons why a notable percentage of individuals opted for private healthcare.
