Introduction Outpatient services are crucial for strengthening primary healthcare and reducing out-of-pocket spending, which has been one of the major causes of impoverishment. So it is also critical to comprehend the people’s preferences in accessing primary healthcare facilities, as government primary healthcare facilities in India are underutilized. The current paper explores the factors that construct the individual’s decision to seek outpatient care in primary healthcare facilities in India’s largest state Rajasthan. Methods It was a cross-sectional survey conducted in 72 primary sample units of 24 primary health centers in 11 districts of Rajasthan, India, from November 2019 to January 2020. The study selected 368 households through purposive sampling. Out of 368 households, 460 people reported any illness and 326 reported outpatient visit to any health facility in the last 30 days from the date of the survey. Analysis The focus was on analyzing the data in the context of public and private health facilities to understand the factors influencing people’s choice to access outpatient services. The principal component analysis is used to understand the relationship between facility preparedness and OPD uptake. Also, multivariate logistic regression is applied to assess the significant predictors in using primary health facility services. Result Except for the 29% of patients who received no care, the proportion of patients attended public health facilities was 35%, and the rest were utilizing private health facilities. Those who sought care at PHCs were mostly over 45 years age, non-literate, and from the lowest wealth quintile. Logistic regression suggests that people belong to upper wealth quintile (OR = 0.298; 95% 0.118–0.753) are less likely to visit PHCs for treatment. Also, increase in distance of PHC (OR = 0.203; 95% CI 0.076–0.539) reduces the likelihood of their visit outpatient care. People are 9.7 times (OR = 9.740; 95% CI 2.856–33.217) more likely to visit a PHCs that are better equipped in terms of human resources, equipment, and medicine. Conclusion The uptake of PHCs depends on several factors, which should be considered to ensure that all segments of society have equitable access to them. Through improved accessibility and quality of service, PHCs can be made more appealing to the larger population.

Background This paper examines the role of individual, facility and system level preparedness in reducing the physiological and psychological vulnerability among primary-level health care providers (HCPs) of COVID19 pandemic in Rajasthan, India. Method and Material Online and telephonic interviews are conducted among 274 HCPs working in 24 PHCs (17 rural and 7 urban), across 13 districts of Rajasthan. Five dimensions of vulnerability covering awareness, exposure to infection (daily contact; contact with high risk individuals), physical and mental health conditions, while three aspects of preparedness at individual (personal care) and facility (provider safety; management and supervision) level are measured by employing factor analysis. Generalized ordered logit regression model is used to measure the effect of preparedness on COVID19 related vulnerability. Result: Among the 274 HCPs, majority of the staff are from rural PHCs (76 %), less than 35 years (87%), female (57%) and married (57 %). Almost half have high level exposure to COVID19, with mean contact rate is 90. Overall, 26% have comprehensive knowledge on COVID19, and 32% have any mental health issues. Although more than 70% of HCPs have reported more than one individual level preparedness, mental health measures adopted by the HCPs are comparably low. The facility level preparedness for enhancing safety are high such as social distance (79%) and maintaining record of each visitor (75%). However, management related measures adopted by the PHCs are perceived to be lower than the safety measures. The regression analyses suggest that safety related preparedness is significantly associated with reduction of vulnerability by 50%. The management-level preparedness has statistically no significant effect in explaining the variations in level of vulnerability. Conclusion: The facility-level safety measures, which lowers chances of acquiring infection has a positive effect on reducing vulnerability of COVID19. However, the HCPs do not have adequate preparedness at individual, facility management (PHC) and system level to reduce COVID19 vulnerability. Findings suggest that there is a need for a non-conventional approach of monitoring and supervision, in the absence of such measures there is a chance of moral injury that will make the HCPs at the primary level vulnerable to both physiologically and psychologically.