Supply-side Readiness for Universal Health Coverage: Assessing Service Availability and Barriers in Remote and Fragile Setting
It has been unanimously acknowledged that strong health systems are paramount to achieving health system goals. Indicator 3.8.1 of Sustainable Development Goal targets coverage of essential health services defined as average coverage of essential services based on tracer interventions including reproductive, maternal, newborn and child health, infectious diseases, non-communicable diseases (NCDs), service capacity and access among general and most disadvantaged population. Underpinning the need to strengthen fragile, resource-constrained health systems is the recognition that weak health systems impede the attainment of global and national targets and are insufficiently resilient to prepare for—and respond to—crises.
This study was conducted to a) Evaluate the service readiness and b) Ascertain supply-side barriers inhibiting service provisioning in rural, remote, and fragile district in India. A mixed method study design was employed encompassing Service Provisioning Assessment of entire network of public health facilities using Service Availability and Readiness Assessment (SARA) module of WHO in conjunction with Indian Public Health Standards Guidelines (IPHS). Qualitative information was collected via Field Observations, Key informant interviews and Focus group discussions with stakeholders ranging from leaders to laggards. A concise index of General Service Availability, Service Specific Availability and Facility Readiness was computed along with exploratory data analysis using Principal Component Analysis.
Despite strong consensus on the need to strengthen health systems, there are inadequate methods to assess hordes of indices that can inform policymakers on priority areas for improvement. Albeit, current research does not adequately capture the complex, interconnected relationship between health system building blocks and the setting in which they are situated. Assessing the quality of care requires that certain criteria and standards are identified to translate general dimensions of quality into something parsimonious that can be measured and interpreted.
Structural measures in the Donabedian’s paradigm of structure, process and outcomes gauge the care attributes of healthcare delivery settings in the setting where care occurs. The assessment of the structural quality of care divulges if the care provided under conditions are conducive or contrary to the provision of care. These measures are symptomatic with the system’s readiness, comprehensive assessment of which is pertinent to evidence-based policymaking and optimal resource allocation by transcribing identification of bottlenecks in service delivery. Data for measuring the structural dimension of quality care including facility infrastructure, staffing and clinical training are extracted from health facility records and surveys. Previous literature delving into health systems performance over-represent tertiary and secondary health facilities, circumventing lower-level peripheral facilities providing 1st contact of care. Assessing facility readiness is paramount as it connotes the capacity of facilities to provide essential care for resilience to health challenges. As countries around the world agreed to the Declaration of Astana, reaffirming their commitment to strengthen primary healthcare systems as an essential step towards achieving Universal Health Coverage (UHC), it is opportune to explore strategies for targeted action by tracking the progress towards UHC in different contexts.
In the context of health being a state subject in India, it is incumbent upon state governments to implement policies to achieve the provisioning of accessible and affordable healthcare. Local governance must formulate a framework to provide an essential basic package to its citizens and have critical discourses and conjectures on a benefits package in a regional context that can be transmuted into increased access at the community level. Also, in the context of decentralisation, estimation of standardised, replicable and comparable supply-side readiness metrics at subnational and disaggregated level is imperative for context-specific evidence for prioritisation of interventions but remains a colossal challenge due to lack of dependable and representative data sources.
The conflation of quantitative and qualitative insights highlighted the need to augment peripheral health facilities specifically for services such as obstetric and newborn care, NCD care and emergency preparedness. The efficacy of these facilities was particularly constrained by a lack of diagnostics and essential medicines. Targeted interventions entrenched in the Central Government’s flagship schemes such as setting up of government pharmacies dispensing generic drugs at affordable prices and pharmacies specially established to provide drugs, implants, surgical disposables and other consumables for cancer and heart disease at heavily discounted rates should be prioritised to complement the drug supply via the medical corporation.
Supply-side Readiness for Universal Health Coverage: Assessing Service Availability and Barriers in Remote and Fragile Setting
Veenapani Rajeev Verma, Umakant Dash
First Published September 8, 2021 Research Article
DOI: 10.1177/09720634211035211
From Journal of Health Management