Health Sub-centers Research Articles

Analysis of Availability and Spatial Distribution Patterns and Accessibility of Health Facilities in Regional Development

This study aims to analyze the availability, spatial distribution patterns, and accessibility of health facilities in Batam Kota District in order to support regional development. The availability of health facilities in Batam Kota District consists of hospitals, health centers, sub-health centers, clinics, and pharmacies spread across various sub-districts. Spatial analysis methods are used to identify the distribution patterns of health facilities, while accessibility analysis is carried out by taking into account the distance and travel time from the center of the settlement. The results of the study indicate that health facilities in Batam Kota District have a clustered distribution pattern in hospitals and a random pattern in health centers, clinics, and pharmacies. Accessibility to health facilities is quite good, but there is an imbalance in the distribution of facilities, especially in sub-districts with high population density. SWOT analysis identifies the strengths, weaknesses, opportunities, and threats related to the development of health facilities in this area. In conclusion, there needs to be more equitable development of health facilities, additional medical personnel, and utilization of infrastructure to improve access and quality of health services, in order to support sustainable regional development in Batam Kota District.

Human Resource Compliance with Indian Public Health Standards 2022: An Assessment of Health and Wellness Centers in a District of Northwestern India

Abstract Since 1952, basic health care in India has been provided through primary health centers (PHCs). Recently, the government has expanded services with health and wellness centers (HWCs) to offer comprehensive primary care. The Indian Public Health Standards (IPHS) were last updated in 2022 to guide these enhancements. Despite concerns about insufficient human resources, no studies have assessed HR compliance with the 2022 IPHS in Punjab’s border district. An observational cross-sectional study was conducted among eight urban primary health centers (UPHCs), 17 rural PHCs (R-PHC), and 28 sub-health centers (SHCs) of Amritsar district (selected by simple random sampling), where available human resource was assessed using a checklist developed on basis of IPHS 2022. Data were collected by observation, record review and interview with medical officer and community health officer. Based on the checklist, overall scores were calculated where availability/nonavailability of HR was scored as 1 and 0, respectively. The HWCs were then classified into very good (>80%), good (60–80%), average (40–60%), poor (<40%). 24 * 7 UPHCs showed only 7% deficiency compared to 48% in non-24 * 7 UPHCs. SHCs demonstrated just 3% overall deficiency, while R-PHCs faced significant challenges about 45–46% deficiency in both 24 * 7 and non-24 * 7 facilities. Overall, 66% of all centers were rated very good or good. 24 * 7 UPHCs and SHCs were generally performing better than non-24 * 7 UPHCs and RPHCs. Targeted efforts should be made to address HR shortages in underperforming centers, with emphasis on equitable distribution of human resources between urban and rural areas.

Designing and Planning of a Hospital Building.

Sub-health centers, as the first point of contact between the community and the primary health care system, require adequate physical infrastructure to function effectively. According to the Indian Public Health Standards (IPHS), each sub-center should have a designated building within the village, equipped with basic amenities such as electricity, water supply, and sanitation facilities. The building should include separate spaces for consultation, immunization, and storage of medical supplies. Adequate furniture and equipment are essential to ensure the smooth delivery of health services. Despite these guidelines, many sub-centers face challenges such as inadequate infrastructure and lack of continuous utilities, which hinder their ability to provide quality care

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

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.

High Responsibility, limited authority, and endless expectations: a policy critique of the Community Health Officer’s role in the government healthcare delivery systems in India

BackgroundThe shortage of qualified healthcare providers in rural areas of India has led to a emergence informal and unqualified practitioners and poses significant risks to population health. Community Health Officers (CHOs) were introduced as mid-level health providers (MLHP) at Sub-health Centres (SHC) to bridge the healthcare resource gap and serve as the primary point of contact for rural communities.MethodsThis qualitative cross-sectional study aimed to explore the CHOs experiences and performance at sub-health centre Health and Wellness Centres (SHC-HWCs) in India. CHOs and Medical Officers (MOs) from randomly selected SHC-HWCs and Primary Health Centre-Health and Wellness Centres (PHC-HWCs) across different geographic zones were interviewed. Semi-structured interviews were conducted with CHOs, MOs, and State Nodal Officers (SNOs) to gather information on drug provisioning, prescription practices, and perspectives on the roles and capacities of CHOs. The study is based on 40 in-depth interviews of health providers sampled at different levels of healthcare system in India.ResultsThe study revealed barriers and challenges faced by CHOs in meeting the expectations outlined in the Comprehensive Primary Health Care (CPHC) guidelines. These included a lack of agency, difficulties in team dynamics with existing healthcare professionals, and inadequate availability of medicines at sub-health centres. Due to the existing contradictions and prescription restrictions, CHOs found themselves failing to meet community expectations and foster trust.ConclusionCHOs encounter significant challenges in fulfilling their roles as mid-level health providers. Addressing these challenges is crucial for optimizing their effectiveness and strengthening the delivery of primary healthcare in rural areas. Clear protocols, supportive policies, and capacity-building initiatives are necessary to enhance the role and impact of CHOs in the healthcare system.

A Study of Primary Health Services in Tribal Areas in Himachal Pradesh

Tribal areas in Himachal Pradesh face unique challenges in accessing primary health services due to their remote locations and distinct cultural practices. This study aims to understand the availability, accessibility, and quality of primary health services in these regions.The main goal of this research is to evaluate the state of primary health services in tribal areas of Himachal Pradesh and identify the barriers faced by the tribal population in accessing these services.The study was conducted using a mixed-methods approach. Data was collected through surveys and interviews with healthcare providers and residents of tribal areas. Additionally, visits to primary health centers and sub-centers were made to assess infrastructure and service delivery.The findings reveal significant gaps in healthcare infrastructure, a shortage of medical staff, and limited availability of essential medicines. Many tribal residents reported difficulties in accessing health facilities due to long distances and lack of transportation. Cultural factors and lack of awareness also contributed to the underutilization of available services.The study highlights the urgent need for improving healthcare infrastructure, increasing medical staff, and enhancing transportation facilities to ensure better access to primary health services in tribal areas of Himachal Pradesh. Tailored health awareness programs that respect cultural practices can also help in bridging the gap.

Assessment of prevalence and need for screening of diabetic retinopathy using non-mydriatic fundus camera in rural and tribal diabetic populations in Maharashtra.

To assess the prevalence of DR and the need for screening and management of DR with medical management of diabetes in rural and tribal population in Maharashtra. The known diabetics of rural area and tribal area were screened at corresponding primary health centers, subcenters, and village level with the help of local healthcare workers using a portable non-mydriatic fundus camera. The prevalence of blindness among known diabetics in rural area was 1.29%, and 0.84% in tribal area. In the rural area, the prevalence of diabetic retinopathy (DR) was 5.67% ( n = 776), out of those 18.18% had sight threatening diabetic retinopathy (STDR). The prevalence of DR was 7.73% ( n = 711) in tribal areas, out of those, 30.90% had STDR. The significant risk factors were identified to be the duration of diabetes and poor glycemic control. Implementation of targeted interventions for screening and management are required to reduce the risk of blindness among known diabetics in rural and tribal areas.

Job analysis of vaccination health workers at public health centers and sub-centers.

To analyze duties, tasks, and task elements of health workers in charge of vaccination at public health centers in South Korea. Descriptive study using a survey. Health workers in charge of vaccination for more than 1 year at 254 public health centers in South Korea. Of 631 health workers, 401 responded to the questionnaire, and 379 responses were included in the analysis after excluding 22 incomplete responses. The Developing A Curriculum (DACUM) workshop was conducted to identify the frequency, importance, and difficulty of duties, tasks, and task elements. Four duties (vaccination promotion, vaccination administration and symptom management, execution of vaccination, and vaccination education), 18 tasks, and 81 task elements were identified. "Execution of vaccination" exhibited the highest determinant coefficient. "Implementing the budget" exhibited the highest determinant coefficient among tasks, and "dealing with an emergency in the case of adverse events" exhibited the highest determinant coefficient among task elements. Duty, task, and task elements with high determinant coefficients have high educational needs. Education demands was higher for administrative work than for direct vaccination. Developing an educational curriculum based on DACUM results could contribute to the professional education of vaccine workers.

Examining maternal influences on low birth weight of baby: a study in Washim district

Background: This research investigated low birth weight (LBW) in Washim district, Maharashtra, India, recognizing its profound impact on infant health. With a prevalence of 13.3%, lower than state and national averages, the study focuses on maternal factors such as anemia, premature deliveries, and inadequate weight gain during pregnancy as contributors to LBW. Methods: A cross-sectional study involving LBW infants and mothers was conducted in Washim district. The census approach (universal sampling) was employed in this study, encompassing the entire population of low birth weight babies born across all blocks in the Washim district and could be tracked by healthcare workers. This involved every eligible individual, eliminating the need for traditional sampling techniques. Data were collected from 6 Blocks, 153 Health sub-centers, and 25 primary health centers between April 1, 2022, and March 31, 2023, using a standardized questionnaire administered by healthcare workers. The study included 876 babies and mothers. Results: Washim district reported a 13.3% LBW rate, lower than the state (20.1%) and national (17.8%) averages. High LBW incidence was noted among mothers with anemia (91.4%), premature deliveries (78.18%), and inadequate weight gain during pregnancy (average gain: 7.9 kg). Conclusions: The study identified anemia during pregnancy, premature deliveries, and inadequate weight gain as primary contributors to LBW in the district.

Nutrition Training Policy among Health Professionals in Community Health Centers and Sub-Centers in Indonesia

Professional health workers in community health centers and sub-centers are required to provide nutrition services. However, nowadays not all community health centers and sub-centers have nutritionists, so all health workers need to have strong teamwork to ensure nutrition programs can occur effectively. This study aimed to describe the types of professional health workers and their history of receiving training in nutrition. This study used IFLS (Indonesia Family Life Survey) 2014-15 from the Community Facility Book to address the health worker's experience in nutrition training. The result of this study revealed that medical doctors had more experience in attending the training in nutrition. Even though there was limited training in the last 12 months. This situation might occur due to the limited number of health workers who can join the training or the limited budget to provide training to all health workers. Education about nutrition is essential to all health workers, not only nutritionist because community health center/sub-centers is the closest health services in the community. Preventing the prevalence of stunting and other health-related nutrition problems can be done by educating health workers immediately.

The Availability and Accessibility of Healthcare Facilities in Haryana, India

Abstract This study concerns a geospatial analysis of public healthcare infrastructure in Haryana, India, focusing on the availability and accessibility of healthcare facilities. The analysis revealed significant disparities in the distribution of such infrastructure in Haryana. A shortfall was found in the presence of community health centers (CHCs), primary health centers (PHCs), dispensaries, and health subcenters (HSCs). The findings in terms of disparities strongly point to and signify the shortfall of national and regional public health policies. There is a pressing need for strategic planning to address the escalating demand for and access to new health facilities among Haryana's population. Personal and population health—and therefore healthcare infrastructure—is a crucial component and indicator of the Human Development Index, and is a key factor in increasing labor productivity, obtaining higher levels of well-being, and boosting economic prosperity, as are “health promotion” measures in welfare and other societal dimensions and the heeding of societal ethics.

Situational Analysis of Water, Sanitation, and Hygiene in Health-care Facilities of a District in Central India.

Water, sanitation, and hygiene (WASH) in health-care facilities is fundamental for providing quality, people-centered care and critical to achieving quality and accessible health services. This study aimed to assess the status of the WASH infrastructure in health-care facilities of Raipur district, Chhattisgarh, India. This was a hospital-based cross-sectional study carried out in all public health-care facilities of Abhanpur block, Raipur district, Chhattisgarh, India, between 2019 and 2020 using an adapted version of joint monitoring program's (JMP) core questions, indicators, and service ladder framework. A total of 2 community health centers (CHCs), 7 primary health centers (PHCs), and 34 subhealth centers (SHCs) were included in the present study. All CHCs (100%) had essential water, sanitation, hygiene, and waste management services. Among PHCs, 85.7% had water from improved and hygienic sources, only 57.1% had basic sanitation, and 100% had vital essential waste management services. Among SHCs, 55.9% had essential water, 2.9% had basic sanitation, 20.6% had basic hygiene, and 35.3% had necessary waste management services. Overall, it was found that 62.8% of health-care facilities had necessary water services, 16.3% had basic sanitation services, 34.9% had essential hygiene services, and 48.8% had basic waste management services. The status of WASH infrastructure in health-care facilities of Raipur district is either limited or not available, especially concerning sanitation services, hygiene, and waste management services. It is the need of the hour to ensure a coordinated response that in all health-care facilities, WASH services are made available and accessible.

Ayushman Bharat: An Account of Roles and Responsibilities of Stakeholders toward Universal Health Coverage

Abstract Ayushman Bharat Program was started by the Government of India as an ambitious scheme to provide financial protection to families across the country. The program also envisions to upgrade the existing grassroots level health system and converting the existing subhealth centers into health and wellness centers which would cater to a range of services based on the principle of comprehensive primary healthcare. The program is believed to bring in changes in the country however the same is not devoid of criticism owing to several of the reasons built into it. Thus, there are applauses in some parts and by certain sections of the society and there is criticism as well. The program can be made successful with the involvement of several stakeholders with their pertinent contributions and participation. The program is also said to bring in positive changes in the much-awaited universal health coverage arena however there are still some criticism on this. As the program is rightly said as the National Health Protection Mission thus it is expected that the insurance sector can contribute positively by risk pooling among the beneficiaries. The health system, both public and private, are the key pillars in the program as they would render critical health services to the masses who would otherwise access the health services at their doorstep. The nongovernmental organizations and the civil society organizations, being the proximate part of the society, can disseminate the message and bring about positive changes in their concerned communities. The state government has a pivotal role to play on many fronts, be it implementation or financial contribution. The political parties, both in power and in opposition as well, should come in one tune to make the program successful. The health-care providers and the pharmaceutical industry also play an important role as they are directly involved in the service provision. Most importantly the common citizen should also act proactively and be aware of the benefits of such schemes which would ultimately bring about fruition in the program. This opinion paper takes into account the roles and responsibilities of all these stakeholders in implementing such a grand program in the country with a focus on universal health coverage.

Interpersonal Challenges Faced By Community Health Officers at Health and Wellness Centres in Delivery of Comprehensive Primary Health Care in Tribal Setting of Gujarat: A Mixed Methods Study

Introduction: Multi skilling and expansion of the team members involved in operationalizing Sub-Health Centres (SHCs) to Sub-health Centres-Health and Wellness Centres (SHC-HWCs) in India tends to be a challenge. New roles are being assigned to Community Health Officer (CHO) in an exponential manner. Objective: To identify the team-based interpersonal challenges encountered by Community Health Officers (CHOs)in terms of human relations in professional forefront and extract probable solutions from them for overcoming these challenges. Method: It was a sequential type of mixed method done in two-step process, quantitative survey of the defined indicators at SHC-HWCs followed by group discussion among CHOs for qualitative data. Quantitative survey was aimed at finding utilization of services. (Triangulation of both the data) whereas qualitative survey was aimed at finding out interpersonal challenges faced for adequate service delivery. Authors targeted to collect data from all the SHC-HWCs (N=53) in Dahod block for quantitative and qualitative survey. Results: The service utilization related to Maternal health and child health; childhood and adolescent health were found in range of 90-95%, followed by community participation (70%). The qualitative analysis of data revealed that CHOs were overburdened by their superiors and perceived lack of co-operation, dedication, and accountability from fellow team members. Conclusion: Utilization of certain services like non-communicable diseases (NCD), palliative care, mental health was found to be suboptimal. Significant lack of motivation and coordination were possibly some of the contributors.

MODEL ANALISIS DYNAMIC LIMBAH MEDIS RUMAH SAKIT DI DENPASAR BALI

Denpasar has 18 hospitals, 11 health centers, and 25 sub-health centers located at South Denpasar, East Denpasar, West Denpasar, and North Denpasar (Dinkes, 2020). The average medical waste generated every day is 1800 kg/day or 1.8 tons day (DLHK, 2018). The methods to develop solid medical waste management include minimizing medical waste from its source, sorting, storing, reusing and recycling, collecting, transporting, storing, processing, and destroying it (Health Ministry of the Republic of Indonesia, 2018). Dynamic analysis is the right approach to examine a complex problem with limited data. This research uses quantitative and qualitative based on primary and secondary data. Research where located in 15 public hospitals in Denpasar City. The time of research starts in November – December 2021 with a prediction period of 10 years until 2030. According to the result he weight of solid medical waste increased from year to year. In 2022 the weight of medical waste was redicted to reach 727.75 kg or 730 tons. The weight of solid medical waste becomes 436.136 kg or 436 tons with a 40% reduction policy implemented in its entirety. The cost aspect of simulation without hospital policy will cost more than IDR 9 billion per year. The proposed solution to maximize the combination of solid medical waste reduction and management policies in Bali. These efforts can minimize costs and reduce the production of solid medical waste from source to utilization.
 Keywords: Dynamic Analysis Model, Technical Aspect, Hospital, Medical Waste

Feasibility of population-based screening of sickle cell disease through the primary health care system in tribal areas of India.

To describe the development and implementation of a population-based screening programme for sickle cell disease (SCD) implemented in 12 SCD-endemic and tribal-dominated primary/community health centres (PHCs/CHCs) across six districts of India. India reports a huge burden of SCD, especially among indigenous (tribal) communities. However, there is no state-led SCD programme in many places, and systematic screening is absent. This situation necessitates developing a model of population screening. This programme was meant to screen all people and was carried out in three tiers. The first tier was a symptomatic survey carried out by community health workers. Regular health workers then screened those referred by sickle cell solubility test at sub-health centres as the second tier. The third tier was confirmation by haemoglobin electrophoresis at PHCs/CHCs. Communities were mobilised and prepared to accept the screening. Capacity building of health facilities was ensured through training and supply of equipment and material. Initial observation based on six months' data revealed that out of the 110,754 tribal population of 12 PHCs/CHCs, 8418 (7.6%) were identified in the symptomatic survey. Subsequently, 9416 people, including the above 8418, underwent the solubility test, and 2607 (27.7%) were found to be positive. Of these, 1978 (78.9%) underwent electrophoresis. About 64.2% were found to be positive for sickle haemoglobin (233 (18.4%) SCD and 1036 (81.6%) SCD trait). The study demonstrates the feasibility of establishing a population-based screening programme in the primary health care system. It is easy to implement in tribal habitations as part of the proposed national SCD/haemoglobinopathies programme.

Health and Wellness Centres as a strategic choice to manage noncommunicable diseases and universal health coverage

Noncommunicable diseases (NCDs) are the leading cause of death globally. On its road to ensuring universal health coverage (UHC) for its population, India initiated the Ayushman Bharat mission in 2018. Under this flagship initiative, the primary health care component is being implemented by establishing Health and Wellness Centers (HWCs) across the country. HWCs are being established by converting and upgrading the primary health centers and subhealth centers. The unmet need for NCDs at the primary care level is high. Under the HWCs, NCD services are being expanded at the community and facility levels. States have brought local innovations in the NCD management. NCD ticker bags, an innovation to ensure treatment adherence, follow-up, and reduce drop-outs, are being done under the HWCs. Gaps in NCD management include a lack of awareness about NCDs' risk factors and management in rural areas and an erratic supply of NCD drugs and diagnostics. Challenges in the NCD management in the primary care settings include capacity building of the health manpower in NCD management, the flow of information for ensuring a continuum of care, and low community participation in the screening and management of NCDs. The challenges that remain in operationalizing the envisaged package in the HWCs must be acknowledged and worked upon. This will enable us to continue on the path toward UHC, stick to the action plan on NCDs, and assist us in achieving the NCD-related targets.

Utilization of Dental Health-Care Services by Accredited Social Health Activist and Anganwadi Workers in Lucknow District

Background: Accredited Social Health Activists (ASHAs) and Anganwadi workers are grassroots-level health activists who are involved in health education and community mobilization and form a bond between the community and the primary health-care delivery system in India. The cross-sectional study was conducted to assess the dental health-care utilization and to estimate the dentition and periodontal status of ASHA and Anganwadi workers. Materials and Methods: The study was conducted at the primary health centers and subcenters of Lucknow District. ASHA and Anganwadi workers presented on the day of the examination were included in the study. The study pro forma was used to record demographic details and dental utilization. Dentition status and periodontal status were used to record dental caries and periodontal status using the World Health Organization Oral Health Assessment Form 2013. Data were analyzed using the SPSS version 21; descriptive statistics, Chi-square test, and regression analysis were used to assess factors related to health-care utilization and P < 0.005 was considered statistically significant. Results: The final study sample comprised 500 health-care workers (220 ASHA and 280 Anganwadi workers). Among the study population, 30% utilized dental services and was found to be statistically significant with age, occupation, and oral findings. However, 56.0% had both dental caries and periodontal diseases followed by dental caries[FIGURE DASH]32.0%, periodontal disease[FIGURE DASH]8.0%. There was a significant difference (P < 0.005) in the proportion of dental care utilization and oral diseases among participants. Conclusions: The dental care utilization was found to be short and is not comparative to the diseases among participants.

Efficiency analysis of primary healthcare facilities in Afghanistan

BackgroundAfghanistan’s health system is unique in that primary healthcare is delivered by non-governmental organizations funded by multilateral or bilateral donors, not the government. Given the wide range of implementers providing the basic package of health services, there may be performance differences in service delivery. This study assessed the relative technical efficiency of different levels of primary healthcare services and explored its determinants.MethodData envelopment analysis was used to assess the relative technical efficiency of three levels of primary healthcare facilities (comprehensive, basic, and sub-health centers). The inputs included personnel and capital expenditure, while the outputs were measured by the number of facility visits. Data on inputs and outputs were obtained from national health information databases for 1263 healthcare facilities in 31 provinces. Bivariate analysis was conducted to assess the correlation of various elements with efficiency scores. Regression models were used to identify potential factors associated with efficiency scores at the health facility level.ResultsThe average efficiency score of health facilities was 0.74 when pooling all 1,263 health facilities, with 102 health facilities (8.1%) having efficiency scores of 1 (100% efficient). The lowest quintile of health facilities had an average efficiency score of 0.36, while the highest quintile had a score of 0.96. On average, efficiency scores of comprehensive health centers were higher than basic and sub-health centers by 0.11 and .07, respectively. In addition, the difference between efficiency scores of facilities in the highest and lowest quintiles was highest in facilities that offer fewer services. Thus, they have the largest room for improvement.ConclusionsOur findings show that public health facilities in Afghanistan that provide more comprehensive primary health services use their resources more efficiently and that smaller facilities have more room for improvement. A more integrated delivery model would help improve the efficiency of providing primary healthcare in Afghanistan.

Public health facility quality and child immunization outcomes in rural India: A decomposition analysis

Universal coverage of routine childhood vaccines remains a challenge in many low- and middle-income countries (LMICs). In India, vaccination campaigns have increased full immunization coverage among 12–23 month old children from an estimated 62% in 2015–2016 to 76% in 2019–2020. Long-term improvements in coverage will likely require systemic changes to both the supply and demand sides of immunization programs. However, the effect of health system inputs on child vaccination outcomes remains poorly quantified in India. We examined the association between the quality of public health facilities and child vaccination outcomes in rural India using data from the nationally representative Integrated Child Health and Immunization Survey (2015–2016) which covered 1,346 public primary health sub-centers and 44,571 households. We constructed two indices of sub-center quality using multiple correspondence analysis: one related to the general health infrastructure quality and the other measuring vaccine service delivery. Using probit regression, we analyzed the relationship between vaccination outcomes in children under 2 years of age and sub-center quality, controlling for household socioeconomic characteristics. Additionally, we conducted Fairlie decomposition analysis by wealth group — bottom wealth quintile relative to the top four wealth quintiles— to examine factors contributing to gaps in immunization between rich and poor households. Infrastructure quality index was positively associated with completion of seven vaccination outcomes: full immunization, DPT-1 (first dose of diphtheria, pertussis, and tetanus), DPT-2, DPT-3, Bacillus Calmette–Guérin (BCG), hepatitis B (birth dose), and on-time vaccination (OTV). Vaccine service delivery index was positively associated with completion of measles vaccination. The distribution of infrastructure quality contributed to increased gaps in full immunization and OTV between rich and poor households, while greater proximity to vaccination site for poorer households reduced these gaps. Improved quality of health facilities, particularly facilities used by low-income households, may improve vaccination outcomes.