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

Original Article
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Abstract

Background

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.

Aim

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

Methods

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.

Results

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.

Conclusion

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.

Keywords

Health care facility Vulnerability assessment Laboratory services Primary Health Centre India 

Abbreviations

CHC

Community Health Centre

DH

District Hospital

DHO

District Health Office

HPR

high prevalence rate

IPHS

Indian Public Health Standards

LPR

low prevalence rate

LT

laboratory technician

MCH

Maternity and Child Hospital

MD

medical doctor

NRHM

National Rural Health Mission

PHC

Primary Health Centre

RKS

Rogi Kalyan Samiti

SC

Subcentre

SDH

Sub-District Hospital

WHO

World Health Organization

Notes

Acknowledgements

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)

References

  1. Abelson J, Forest P, Eyles J, Smith P, Martin E, Gauvin F (2003) Deliberations about deliberative methods: issues in the design and evaluation of public participation processes. Soc Sci Med 57:239–251CrossRefPubMedGoogle Scholar
  2. Abimbola S, Olanipekun T, Igbokwe U, Negin J, Jan S, Martiniuk A, Ihebuzor N, Aina M (2015) How decentralisation influences the retention of primary health care workers in rural Nigeria. Glob Health Action 8:1–11Google Scholar
  3. Balarajan Y, Selvaraj S, Subramanian SV (2011) Health care and equity in India. Lancet 377:505–515CrossRefPubMedPubMedCentralGoogle Scholar
  4. Balfour E, Stallone R, Castagnaro J, Poczter H, Schron D, Martone J, Breining D, Simpkins H, Neglia T, Kalish P, Crawford JM (2016) Strengths of the Northwell Health Laboratory Service Line: maintaining performance during threatened interruptions in service. Acad Pathol 3:1–13CrossRefGoogle Scholar
  5. Basu R, Jana A, Bardhan R (2016) A health care facility allocation model for expanding cities in developing nations: strategizing urban health policy implementation. Appl Spatial Anal Policy 9:1–16CrossRefGoogle Scholar
  6. Bhore J, Amesur R, Banerjee A (1946) Report of the Health Survey and Development Committee. Government of India, DelhiGoogle Scholar
  7. Blake J (1999) Overcoming the “value–action gap” in environmental policy: tensions between national policy and local experience. Local Environ 4:257–278CrossRefGoogle Scholar
  8. Chalkidou K, Li R, Culyer AJ, Glassman A, Hofman KJ, Teerawattananon Y (2016) Health technology assessment: global advocacy and local realities. Int J Health Policy Manag 6:233–236.  https://doi.org/10.15171/ijhpm.2016.83 CrossRefPubMedPubMedCentralGoogle Scholar
  9. Devane-Padalkar A, Deshpande S, Yakkundi D (2016) Laboratory services at primary health centers under the lens: a need for overhaul. Int J Trop Dis Health 13:1–6CrossRefGoogle Scholar
  10. Forsman RW (1996) Why is the laboratory an afterthought for managed care organizations? Clin Chem 42:813–816PubMedGoogle Scholar
  11. Hurley J, Birch S, Eyles J (1995) Geographically-decentralized planning and management in health care: some informational issues and their implications for efficiency. Soc Sci Med 41:3–11CrossRefPubMedGoogle Scholar
  12. Jain R, Rao B (2015) Medical diagnostic laboratories provisioning of services in India. CHRISMED J Health Res 2:19–31CrossRefGoogle Scholar
  13. Jain R, Rao B (2016) Taxonomy of challenges in medical laboratory diagnostic services. In: 22nd International Academic Conference. International Institute of Social and Economic Sciences, LisbonGoogle Scholar
  14. Krajewski-Siuda K, Romaniuk P (2008) Poland — an “ experimental range ” for health care system changes . Two reforms: decentralization and centralization and their consequences. J Public Health (Bangkok) 16:61–70.  https://doi.org/10.1007/s10389-007-0118-0 CrossRefGoogle Scholar
  15. Lehmann U, Dieleman M, Martineau T (2008) Staffing remote rural areas in middle- and low-income countries: a literature review of attraction and retention. BMC Health Serv Res 8:1–10CrossRefGoogle Scholar
  16. MoHFW (Ministry of Health and Family Welfare) (2005) National Rural Health Mission: framework for Implementation (2005–2012). Government of India, New DelhiGoogle Scholar
  17. MoHFW (Ministry of Health and Family Welfare) (2012a) Indian Public Health Standards (IPHS) for primary health centres revised guidelines 2012. Government of India, New DelhiGoogle Scholar
  18. MoHFW (Ministry of Health and Family Welfare) (2012b) Indian Public Health Standards (IPHS) guidelines for sub-centres revised 2012. Government of India, New DelhiGoogle Scholar
  19. Office of Registrar General and Census Commissioner (2011) Census 2011: Population Enumeration Data. Ministry of Home Affairs (India), New Delhi. http://www.censusindia.gov.in/2011census/population_enumeration.html. Accessed 11 Jan 2016
  20. Pakhare A, Kumar S, Goyal S, Joshi R (2015) Assessment of primary care facilities for cardiovascular disease preparedness in Madhya Pradesh, India. BMC Health Serv Res 15:408CrossRefPubMedPubMedCentralGoogle Scholar
  21. Pandey A, Ploubidis GB, Clarke L, Dandona L (2017) Horizontal inequity in outpatient care use and untreated morbidity: evidence from nationwide surveys in India between 1995 and 2014. Health Policy Plan 32:969–979CrossRefPubMedGoogle Scholar
  22. Planning Commission of India (1999) Report of working group on requirements for supportive and diagnostic services at primary, secondary and tertiary level. Planning Commission of India, New DelhiGoogle Scholar
  23. Pyone T, Smith H, Van Den Broek N (2017) Frameworks to assess health systems governance: a systematic review. Health Policy Plan 32:710–722.  https://doi.org/10.1093/heapol/czx007 CrossRefPubMedPubMedCentralGoogle Scholar
  24. Rachiotis G, Kourousis C, Kamilaraki M, Symvoulakis E, Dounias G, Hadjichristodoulou C (2014) Medical supplies shortages and burnout among Greek health care workers during economic crisis: a pilot study. Int J Med Sci 11:442–447CrossRefPubMedPubMedCentralGoogle Scholar
  25. Ranson MK, Jayaswal R, Mills AJ (2012) Strategies for coping with the costs of inpatient care: a mixed methods study of urban and rural poor in Vadodara District, Gujarat, India. Health Policy Plan 27:326–338CrossRefPubMedGoogle Scholar
  26. Rao KS (2017) Challenging times for public health towards attaining sustainable development goals. Indian J Community Med 42:65–68CrossRefPubMedPubMedCentralGoogle Scholar
  27. Reddy KS, Patel V, Jha P, Paul VK, Shivakumar AK, Dandona L (2011) Towards achievement of universal health care in India by 2020: a call to action. Lancet 377:760–768CrossRefPubMedPubMedCentralGoogle Scholar
  28. Reddy NB, Prabhu GR, Sai TSR (2012) Study on the availability of physical infrastructure and manpower facilities in sub-centers of Chittoor district of Andhra Pradesh. Indian J Public Health 56:290.  https://doi.org/10.4103/0019-557X.106417 CrossRefPubMedGoogle Scholar
  29. Siddiqi S, Masud TI, Nishtar S, Peters DH, Sabri B, Bile KM, Jama MA (2009) Framework for assessing governance of the health system in developing countries: gateway to good governance. Health Policy (New York) 90:13–25.  https://doi.org/10.1016/j.healthpol.2008.08.005 CrossRefGoogle Scholar
  30. Smith PC, Anell A, Busse R, Crivelli L, Healy J, Karin A, Westert G, Kene T (2012) Leadership and governance in seven developed health systems. Health Policy (New York) 106:37–49.  https://doi.org/10.1016/j.healthpol.2011.12.009 CrossRefGoogle Scholar
  31. Travis P, Bennett S, Haines A, Pang T, Bhutta Z, Hyder AA (2004) Overcoming health-system constraints to achieve the millennium development goals. Lancet 364:900–906CrossRefPubMedGoogle Scholar
  32. Trydegård GB, Thorslund M (2010) One uniform welfare state or a multitude of welfare municipalities? The evolution of local variation in Swedish elder care. Soc Policy Adm 44:495–511CrossRefGoogle Scholar
  33. WHO (2010) Key components of a well functioning health system. WHO, GenevaGoogle Scholar
  34. WHO (2013) Arguing for universal health coverage. WHO, GenevaGoogle Scholar
  35. Wickremasinghe D, Hashmi IE, Schellenberg J, Avan BI (2016) District decision-making for health in low-income settings: a systematic literature review. Health Policy Plan 31:ii12–ii24CrossRefPubMedPubMedCentralGoogle Scholar
  36. World Bank (2017) World Development Indicators: Health expenditure (% of GDP). http://data.worldbank.org/indicator/SH.XPD.PUBL.ZS?year_high_desc=false. Accessed 23 Aug 2017

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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