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Background The policy attention to primary health care has seen a global upswing in recent years, including in India. Earlier assessments had shown that a very small proportion of Indian population used the government primary health facilities. Starting in 2018, Indian government has established more than 100,000 Health and Wellness Centres (HWCs) to increase rural population’s access to primary health care. It is crucial to know how useful people find the services of HWCs. Methods A qualitative inquiry was made to understand the perceptions, experiences and expectations of the rural communities regarding HWCs in Chhattisgarh state. Fourteen focus group discussions were conducted with community members. The study areas were chosen to include both the central and remote districts of the state. The study used accessibility, availability, acceptability and quality (AAAQ) framework to assess HWCs. Results Community members felt that the most important change brought about by HWCs was to offer a wider range of curative services than previously available. Services for noncommunicable diseases such as hypertension and diabetes were seen as a key value addition of HWCs. People felt improvements in services for acute ailments also. The services people found missing in HWCs were for injuries, dental care and mental health. In people’s experience, the availability of essential medicines and point-of-care tests at HWCs was satisfactory and the treatment was effective. People appreciated the supportive behaviour of health workers in HWCs. They did not find the referrals from HWCs as excessive but often faced difficulties in receiving necessary services at higher facilities. Conclusions The assessment based on community perceptions showed that the services of HWCs matched well with people’s needs of curative primary care. It shows that people are willing to use the government facilities for primary health care if the services are relevant, adequately functional and accessible.
Background The policy attention to primary health care has seen a global upswing in recent years, including in India. Earlier assessments had shown that a very small proportion of Indian population used the government primary health facilities. Starting in 2018, Indian government has established more than 100,000 Health and Wellness Centres (HWCs) to increase rural population’s access to primary health care. It is crucial to know how useful people find the services of HWCs. Methods A qualitative inquiry was made to understand the perceptions, experiences and expectations of the rural communities regarding HWCs in Chhattisgarh state. Fourteen focus group discussions were conducted with community members. The study areas were chosen to include both the central and remote districts of the state. The study used accessibility, availability, acceptability and quality (AAAQ) framework to assess HWCs. Results Community members felt that the most important change brought about by HWCs was to offer a wider range of curative services than previously available. Services for noncommunicable diseases such as hypertension and diabetes were seen as a key value addition of HWCs. People felt improvements in services for acute ailments also. The services people found missing in HWCs were for injuries, dental care and mental health. In people’s experience, the availability of essential medicines and point-of-care tests at HWCs was satisfactory and the treatment was effective. People appreciated the supportive behaviour of health workers in HWCs. They did not find the referrals from HWCs as excessive but often faced difficulties in receiving necessary services at higher facilities. Conclusions The assessment based on community perceptions showed that the services of HWCs matched well with people’s needs of curative primary care. It shows that people are willing to use the government facilities for primary health care if the services are relevant, adequately functional and accessible.
Background: In India, the Ayushman Bharat Program aims to provide comprehensive healthcare coverage to underprivileged communities, guided by the 2017 National Health Policy and aligned with Sustainable Development Goals. This study explores healthcare workers’ perspectives on the implementation, impact, and challenges of Ayushman Bharat Yojana (ABY) in Kashmir, focusing on primary care services. Methods: A mixed-methods study was conducted over ten months (October 2020 to August 2021) across ten districts in Kashmir. Fifty healthcare professionals, including 30 mid-level healthcare providers (MLHPs) and 20 medical officers, participated in semi-structured interviews and completed structured questionnaires. Data were analyzed using thematic analysis for qualitative data and descriptive statistics for quantitative data. Results: Demographics: Among the respondents, 64% were under 30 years, and 56% were female. Positions included 40% medical officers and 60% MLHPs. Qualitative Findings: Both MLHPs and medical officers had varying levels of awareness about ABY. Key challenges included inadequate infrastructure, staffing shortages, additional duties, and long commutes. Effective communication and collaboration between MLHPs and medical officers were deemed crucial for successful implementation. Ongoing training and support were highlighted as essential needs. Quantitative Findings: Significant issues included irregular payments (66.6% MLHPs reported receiving regular incentives), staffing shortages (50% medical officers), and lack of training (35% medical officers). Common ailments managed included hypertension (33.33%) and infections (26.66%). Conclusion: The study highlights the challenges and insights from healthcare workers regarding the ABY program in Kashmir. Addressing infrastructure deficiencies, improving communication, and providing ongoing training and financial stability are essential for enhancing the program’s effectiveness. Policymakers must consider these findings to improve healthcare delivery and ensure the sustained success of the Ayushman Bharat initiative.
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