Abstract
In resource-constrained settings, primary health centers (PHCs) are critical for universal health coverage. Laboratory service is one of its important components. While PHC and its performance are focused, its laboratory service has been neglected in developing countries like India. To determine the role of different level of PHC laboratory services on the overall PHC performance. Cross-sectional study based on 42 PHCs of Osmanabad District, Maharashtra, India was performed. The study used levels of laboratory services in PHC as independent parameter and PHC outpatient department (OPD) visits per day (≤ 80 versus > 80) as dependent parameter. The control parameters used in the study were number of medical doctors, availability of laboratory technicians (LTs) and population coverage by PHC. Field visit was done to collect data on levels of laboratory services, but secondary source was used for other parameters. The logistic regression analysis was performed in study. The study found variation in PHC population coverage (10788-74702) and OPD visits per day (40-182) across PHC. Strong positive association was observed between levels of laboratory services and number of OPD visits per day in PHC. PHC offering both malaria and tuberculosis in-house testing had higher odds (4.81) of getting more OPDs (≥ 80 OPD visits per day) as compared to PHC not offering in-house testing facility for malaria and tuberculosis. This association was stronger in PHCs with lower population coverage (0-75 quartile) as compared to PHCs with higher population coverage (75-100 quartile). Focus on laboratory services is needed to enhance the existing PHCs performance. Skill-up gradation of existing LT could help in improving the contribution of the existing laboratories in PHC functioning.
Highlights
Primary Health Centers (PHCs) enable cost-effective, accessible and universal coverage of health to the individual and community (World Health Organization, 1991)
The number of primary health centers (PHCs) is divided between daily outpatient department (OPD) visits of less than 80 and daily OPD visits of more than 80
None of the PHCs is without medical doctor, many PHCs (45.24 % ) do not have the laboratory technicians (LTs), so they cannot perform the malaria and tuberculosis tests
Summary
Primary Health Centers (PHCs) enable cost-effective, accessible and universal coverage of health to the individual and community (World Health Organization, 1991). Studies have been focused on laboratory service in PHC regarding its type, quality (Jain and Rao, 2015; Devane-Padalkar et al, 2016), functioning (Nanjunda, 2011), utilization (Zunic et al, 2011; Baig et al, 2014) and relevance in disease control (George, 2011; Rizwan et al, 2013; Pakhare et al, 2015) Despite such focus on PHC laboratory in the literature, 35.80 % of 25 354 Indian PHCs lack a laboratory technician (LT) to run the laboratory (Ministry of Health & Family Welfare, 2017). In India, field experience indicates that district health officials may evaluate the PHC performance primarily for the non-laboratory outcomes like OPD visits and Maternal and Child Health services This suggests that policy-makers may not be adequately convinced with laboratory relevance to ensure LT in all PHCs. In resource-constrained settings, primary health centers (PHCs) are critical for universal health coverage. Skill-up gradation of existing LT could help in improving the contribution of the existing laboratories in PHC functioning
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