Health care facility vulnerability in developing nations: strengthening health care policy-making and implementation

  • Rahi Jain
  • Bakul Rao
Original Article



In developing countries such as India, inadequate importance and consideration given to assessment of health care facilities negatively affects progress towards achieving health targets. India has focused on developing Primary Health Centres (PHCs) for rural basic laboratory and curative services. The local decision-makers do not have any national-level framework to evaluate the vulnerability of PHCs which are not meeting national PHC standards, nor do they have resources to meet national PHC standards.


The study proposed a framework to assess the public health care facilities for vulnerability.


A cross-sectional questionnaire survey was performed. The study used PHC laboratory services of 42 PHCs of Osmanabad District, India as a case study for proposed framework. The data assessment was carried out at district level, block level, PHC cluster level, and PHC level to provide flexibility to local decision-makers in taking remedial measures.


Staff workload (73.17%), physician’s need (51.22%), and organization structure (36.59%) are the most prevalent challenges across PHCs. Multiple challenges are prevalent in the PHCs across districts. The PHCs with poor medical doctor (MD) capability or many challenges have shown poor laboratory performance.


Governance need to be strengthened in PHCs, followed by sustained support in resources and financing. Poor health status in developing nations necessitates a public health response based on health systems. Therefore, an assessment of health facility vulnerability in the form of laboratory services is essential in primary health care facilities.


Health care facility Vulnerability assessment Laboratory services Primary Health Centre India 



Community Health Centre


District Hospital


District Health Office


high prevalence rate


Indian Public Health Standards


low prevalence rate


laboratory technician


Maternity and Child Hospital


medical doctor


National Rural Health Mission


Primary Health Centre


Rogi Kalyan Samiti




Sub-District Hospital


World Health Organization



We would like to acknowledge the support provided by Dr. Prashant Narnaware, District Collector, Osmanabad, Maharashtra for granting us permission and providing support during our stay in Osmanabad. We would also like to acknowledge the support of District Health Office, Osmanabad, Maharashtra and all the respondents.

Compliance with ethical standards

Conflict of interest

Author Rahi Jain declares that he has no conflict of interest. Author Bakul Rao declares that she has no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors. The respondents themselves were not the focus of the study; rather, the focus of the study was the framework to adopt for quality assessment and improvement activity. No personal identifying information was collected, and response was voluntary. Nevertheless, oral informed consent was obtained from all individual participants included in the study.

Supplementary material

10389_2018_911_MOESM1_ESM.doc (168 kb)
ESM 1 (DOC 168 kb)
10389_2018_911_MOESM2_ESM.xls (41 kb)
ESM 2 (XLS 41 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Centre for Technology Alternatives for Rural Areas (CTARA)Indian Institute of Technology Bombay (IITB)Powai, MumbaiIndia

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