Primary Healthcare Infrastructure and Reproductive Healthcare in Rural India: A District Level Analysis
Investment in public health centers on provisoning of basic health services is the cornerstone of health policy in developing countries. Post Alma-Ata, numerous studies recommended the need to strengthen the primary healthcare to improve healthcare utilization. Though the overall health care utilisation has been improving, the utilization of health services in public health centres has been declining in many countries. This chapter examines the state of health infrastructure in primary health centres (PHC) and its effect on utilisation of reproductive health services in rural India. District is the unit of analysis. Reproductive healthcare utilization is measured using institutional delivery and antenatal check-up at public health centres. Individual level data from the recently conducted National Family Health Survey-4, 2015–2016 has been used to obtain district estimates of institutional delivery and antenatal care. The infrastructural facilities of PHCs are estimated from the Facility Survey of District Level Household Survey-4, 2012–2013. Descriptive statistics, ordinary least-square regression and a set of composite indices are used in the analyses.
Results suggest that only one in five PHCs in India conformed to the Indian Public Health Standards (IPHS) norms of health human resources and population coverage. In only 2.2% of the districts in India, all sampled PHCs conformed to IPHS norms. None of the sampled PHCs in about half of the districts in empowered action group (EAG) states conformed to IPHS norms. The PHCs in rural India account for 8.5% of deliveries and 11.3% of three and more antenatal check-up among rural women. A notable heterogeneity was observed both in terms of utilization and infrastructure in the states and districts. We found positive and significant association between infrastructure at PHCs and utilization of antenatal care and institutional delivery in the districts of India. Districts with poor health infrastructure were clustered mostly in the Empowered Action Group (EAG) and North-Eastern states of India. Most of the PHCs in these states were deficient in health human resources, connectivity, accessibility and physical infrastructure. There was large heterogeneity in infrastructural parameters even within PHCs. Differential effect of the various health infrastructure indicators on the utilization variables is imperative to appropriate resource allocation based on detailed and critical empirical research.
KeywordsHealth infrastructure Primary health centres Reproductive healthcare India Ante-natal care Institutional Delivery
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