Supply-side Readiness for Universal Health Coverage: Assessing Service Availability and Barriers in Remote and Fragile Setting

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.