Adherence to Indian public health standards 2022 standards: a cross-sectional study on infrastructure of health and wellness centres in Amritsar district of Punjab

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Background: After independence since 1952 basic healthcare services are primarily being delivered through primary health centres (PHCs). Recently, the government has expanded services with health and wellness centres (HWCs) to offer comprehensive primary care. Indian public health standards (IPHS) has formed the basis of their updation since 2007 with latest coming up in 2022. It is a general belief that infrastructure is lacking but no studies have been conducted to assess them in the border district of state of Punjab. Methods: An observational cross‑sectional study was conducted among 8 urban PHCs (UPHCs), 17 rural PHCs (R-PHC) and 28 sub health centres (SHCs) of district Amritsar UPHCs selected by Simple random sampling whereas RPHCs and SHCs selected by two stages stratified random sampling) where available infrastructure was assessed using a checklist developed on basis of IPHS 2022. Data was collected by observation and interview with medical officer and community health officer. Based on the checklist, overall scores were calculated where presence/absence of infrastructure were scored as 1/0. The PHCs were then classified into very good (>80%), good (60-80%), average (40-60%), poor (<40%). Results: Basic utilities like 24-hour electricity and water supply were available in 100% of R-PHCs, 89% of SHCs, and 100% of UPHCs. Fire safety measures were present in 50% of UPHCs, 35% of R-PHCs, and none of the SHCs. Residential facilities were available in 35% of R-PHCs, 4% of SHCs, and none of the UPHCs. Regarding clinical infrastructure, 70% of R-PHCs (24×7 and non 24×7) had inpatient wards, but none were equipped with minor OTs. In comparison, 62% of UPHCs (24×7 and non 24×7) had inpatient wards, and only 25% had minor OTs. Among SHCs, 89% had consultation. Overall, 83% of R-PHCs and 75% of UPHCs were graded very good or good, while 82% of SHCs were rated average or poor. Conclusions: While basic amenities were widely available, significant gaps in clinical and support infrastructure were identified, particularly in SHCs, which lack fire safety measures, functional residential quarters, and dedicated health and wellness areas. These deficiencies underscore the need for targeted investments to enhance infrastructure across all HWC levels.