Abstract
The 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. We employed a mixed method study design 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 discussion 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. Further, determinants of facility readiness were elucidated using Generalized Ordinal Logistic Model. Qualitative findings were analyzed via content analysis. Results indicated poorest readiness in lower-tier facilities with particularly abysmal readiness for basic amenities, diagnostic capacity and preparedness for emergencies and non-communicable diseases. The estimates for logistic model revealed that degree of vulnerability of facilities, type of facility and frequency of monitoring and supervision significantly impacted the readiness. Qualitative analysis divulged lack of incentives for health workers, political interference, topographical constraints and security disruptions as major barriers stymieing service provisioning in study area.
Highlights
It has been unanimously acknowledged that strong health systems are paramount to achieve health system goals
The study intended to augment the understanding of various components of supply side readiness and its associated factors
Same findings reverberates through other studies across different regions in LMICs where hospitals were found to report significantly greater input availability and concentration of resources than health centers and dispensaries(Bintabara et al, 2019; Ssempiira et al; 2018; Winter et al; 2017; Iyer et al, 2015; Boyer et al,2015)
Summary
It has been unanimously acknowledged that strong health systems are paramount to achieve health system goals. Underpinning the need to strengthen fragile, resource-constrained health systems is the recognition that weak health systems impede attainment of global and national targets, and are insufficiently resilient to prepare for – and respond to – crises. Despite strong consensus on need to strengthen health systems there are inadequate methods to assess hordes of indices which can inform policy makers on priority areas for improvement (Wanzala et al, 2019). `. The study hinged upon unravelling supply side readiness and barriers in attaining universal health coverage in a difficult setting. This district representative study is conducted in a fragile, remote, rural district of Jammu and Kashmir in India with unprecedented geographical barriers and heavy military deployment. Military skirmishes and sporadic militant attacks, rudimentary/absence of road network and absolute poverty are quintessential to this area
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