What makes primary healthcare facilities functional, and increases the utilization? Learnings from 12 case studies

Chandrakant Lahariya; T Sundararaman; Rajani R Ved; G S Adithyan; Hilde De Graeve; Manoj Jhalani; Henk Bekedam

doi:10.4103/jfmpc.jfmpc_1240_19

What makes primary healthcare facilities functional, and increases the utilization? Learnings from 12 case studies

J Family Med Prim Care. 2020 Feb 28;9(2):539-546. doi: 10.4103/jfmpc.jfmpc_1240_19. eCollection 2020 Feb.

Authors

Chandrakant Lahariya¹, T Sundararaman², Rajani R Ved³, G S Adithyan⁴, Hilde De Graeve¹, Manoj Jhalani⁵, Henk Bekedam⁶

Affiliations

¹ Department of Health Systems, World Health Organization (WHO) Country Office for India, New Delhi, India.
² School of Health Systems Studies, Tata Institute of Social Sciences, Mumbai, Maharashtra, India.
³ National Health Systems Resource Centre, Ministry of Health and Family Welfare, Govt of India, New Delhi, India.
⁴ National Health Mission, Department of Health and Family Welfare, Govt of Tamil Nadu, Chennai, India.
⁵ National Health Mission, Ministry of Health and Family Welfare, Govt of India, New Delhi, India.
⁶ World Health Organization (WHO) Country Office for India, New Delhi, India.

Abstract

Background: The last few decades have witnessed a number of innovative approaches and initiatives to deliver primary healthcare (PHC) services in different parts of India. The lessons from these initiatives can be useful as India aims to strengthen the PHC system through Health and Wellness Centers (HWCs) component under Ayushman Bharat Program, launched in early 2018.

Materials and methods: Comparative case study method was adopted to systematically document a few identified initiatives/models delivering the PHC services in India. Desk review was followed by field visits and key informant interviews. Twelve PHC case studies from 14 Indian states, with a focus on equity and "potentially replicable designs" were included from the government as well as the "not-for-profit" sector. The cases studies comprised of initiatives/models having the provision of PHC services, whether exclusively or as part of broader hospital services. The data was collected from May 2016 to March 2017.

Results: The "political will" for government facilities and "leadership and motivation" for "not-for-profit" facilities adjudged to contribute towards improved functioning. A comprehensive package of services, functional 'continuity of care' across levels, efforts to meet one or more type of quality standards and limited "intention to availability" gap (or assured provision of promised services) were considered to be associated with increased utilization. A total of 10 lessons and learnings derived from the analysis of these case studies have been summarised.

Conclusions: The case studies in this article highlights the components which makes PHC facilities functional and have potential for increased utilization. The article underscores the need for institutional mechanisms for health system research and innovation hubs at both national and state level in India, for the rapid scale of comprehensive primary healthcare. Lessons can be applied to other low- and middle-income countries intending to deliver comprehensive PHC services to advance towards universal health coverage.

Keywords: Ayushman Bharat Program; India; case studies; primary healthcare; universal health coverage; urban health.

Grants and funding

001/WHO_/World Health Organization/International