ISSN (Print) - 0012-9976 | ISSN (Online) - 2349-8846

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An Assessment of the Quality of Primary Health Care in India

There is limited evidence on the quality of primary health care provision in India. Using data on the availability of inputs from a nationally representative survey of primary health centres, a composite measure of structural quality of care for primary health centres was developed with a view to examine its geographical variation, associations with mortality and healthcare utilisation, and the determinants of better quality, giving particular attention to the role of management. The mean quality score was 52%, with large differences across regions, states and districts. Quality of care was the worst and the variation greatest in states designated by the government as low performing. Good management practices in a facility were highly correlated with better quality of care. The majority of primary health facilities in India fall far short of government minimum standards, in part explaining why most people in rural areas use private providers for outpatient care. Future research should explore the causal relationship between management practices, quality of care and patient outcomes.

Inequities in Access to Health Services in India: Caste, Class and Region

Despite India's impressive economic performance after the introduction of economic reforms in the 1990s, progress in advancing the health status of Indians has been slow and uneven. Large inequities in health and access to health services continue to persist and have even widened across states, between rural and urban areas, and within communities. Three forms of inequities have dominated India's health sector. Historical inequities that have their roots in the policies and practices of British colonial India, many of which continued to be pursued well after independence; socio-economic inequities manifest in caste, class and gender differentials; and inequities in the availability, utilisation and affordability of health services. Of these, critical to ensuring health for all in the immediate future will be the effectiveness with which India addresses inequities in provisioning of health services and assurance of quality care.
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