New Delhi: Primary health centres (PHC) and community health centres (CHC) in India fail to meet the national standards for basic newborn care, revealed a study published in British Medical Journal. About 30% of PHCs and 5% of CHCs in the country do not offer any basic delivery and newborn care.
The study conducted by the Harvard TH Chan School of Public Health, USA, and The George Institute for Global Health in New Delhi stated that basic newborn care capacity in Indian public primary care facilities is weak in both rural and urban areas, especially lacking in the poorest states with worst health outcomes.
The researchers used data from the nationally representative 2012– 2014 District Level Household and Facility Survey, which includes a census of 4,810 CHCs and sample of 8,536 PHCs across 30 states and union territories in India. The researchers developed a summative index of 33 structural and process capacity items matching the Indian public health standards for PHCs as a metric of minimum facility capacity for newborn care.
“Round-the-clock newborn care services were available only in 60% of PHCs and 94% of CHCs. Both PHCs and CHCs offering these services had critical deficiencies in routine and emergency care practices, infrastructure and staffing, fulfilling an average of only 63% and 75% of an index of basic newborn care capacity, respectively," said Jigyasa Sharma, the author of the study. Gaps were most striking in availability of skilled human resources and emergency obstetric services. Although all PHCs and CHCs are expected to provide childbirth care, about 30.2% of PHCs and 5.2% of CHCs reported not providing any childbirth services round the clock or providing them only during daytime. Only 59.7% of rural and 62.7% of urban PHCs and only 92.7% of rural and 94.9% of urban CHCs offered 24-hour newborn care, the study found.
Although CHCs, as the referral centres for PHCs, are expected to offer more comprehensive care, they frequently lacked the basic infrastructure required. Human resource availability and training in both CHCs and PHCs were comparably low. Particularly large gaps were seen in process capacity indicators such as provision of assisted vaginal deliveries, administration of parenteral magnesium sulfate and management of postpartum haemorrhage.
“Improving maternal and newborn health outcomes will require focused attention to quality measurement, accountability mechanisms and quality improvement. Policies to address deficits in skilled providers and emergency service availability are urgently required," Sharma said.
Over the past decade, India’s health system has operated in an extremely resource-constrained environment: From 2004 to 2014, government health expenditure has remained approximately around 1% of country’s gross domestic product.
“The Indian government will need to increase investment in the health system, in providers and in research, to harness the full benefit of its public health infrastructure. Improving quality of care and strengthening public health infrastructure is integral to India’s path to universal health coverage," said Sharma.