Primary Health Care Facility Preparedness for Outpatient Service Provision During the COVID-19 Pandemic in India: Cross-Sectional Study

Abstract

Background Primary health centers (PHCs) represent the first tier of the Indian health care system, providing a range of essential outpatient services to people living in the rural, suburban, and hard-to-reach areas. Diversion of health care resources for containing the coronavirus disease (COVID-19) pandemic has significantly undermined the accessibility and availability of essential health services. Under these circumstances, the preparedness of PHCs in providing safe patient-centered care and meeting the current health needs of the population while preventing further transmission of the severe acute respiratory syndrome coronavirus 2 infection is crucial. Objective The aim of this study was to determine the primary health care facility preparedness toward the provision of safe outpatient services during the COVID-19 pandemic in India. Methods We conducted a cross-sectional study among supervisors and managers of primary health care facilities attached to medical colleges and institutions in India. A list of 60 faculties involved in the management and supervision of PHCs affiliated with the community medicine departments of medical colleges and institutes across India was compiled from an accessible private organization member database. We collected the data through a rapid survey from April 24 to 30, 2020, using a Google Forms online digital questionnaire that evaluated preparedness parameters based on self-assessment by the participants. The preparedness domains assessed were infrastructure availability, health worker safety, and patient care. Results A total of 51 faculties responded to the survey. Each medical college and institution had on average a total of 2.94 (SD 1.7) PHCs under its jurisdiction. Infrastructural and infection control deficits at the PHC were reported in terms of limited physical space and queuing capacity, lack of separate entry and exit gates (n=25, 49%), inadequate ventilation (n=29, 57%), and negligible airborne infection control measures (n=38, 75.5%). N95 masks were available at 26 (50.9%) sites. Infection prevention and control measures were also suboptimal with inadequate facilities for handwashing and hand hygiene reported in 23.5% (n=12) and 27.4% (n=14) of sites, respectively. The operation of outpatient services, particularly related to maternal and child health, was significantly disrupted (P<.001) during the COVID-19 pandemic. Conclusions Existing PHC facilities in India providing outpatient services are constrained in their functioning during the COVID-19 pandemic due to weak infrastructure contributing to suboptimal patient safety and infection control measures. Furthermore, there is a need for effective planning, communication, and coordination between the centralized health policy makers and health managers working at primary health care facilities to ensure overall preparedness during public health emergencies.

COVID-19 and Child Vaccination: A Systematic Approach to Closing the Immunization Gap

“…4 Infant vaccinations were also disrupted in India and across several LMICs. 5 Widespread travel restrictions and border closures have negatively impacted the availability of vaccines and other supplies needed to provide safe vaccination services. A survey of frontline health workers from 81 LMICs and high-income countries reported shortages of healthcare providers due to illness, transportation challenges, fear of infection, and insufficient personal protective equipment (PPEs), 3 , 5 , 6 and infection prevention and control measures.…”

Ensaio acerca das curvas de sobrecarga da COVID-19 sobre a atenção primária

“…10,13 Assim, há redução de diagnósticos em tempo oportuno, de detecção de atraso no desenvolvimento infantil ou na evolução da gestação, bem como da cobertura vacinal. 13,14 No Brasil, o papel estratégico que a APS desempenha deve-se a capilaridade e, sobretudo, aos Agentes Comunitários de Saúde (ACS). 15 Para atenuar o risco de sobrecarga da segunda onda, devem ser utilizados instrumentos de comunicação, consolidando o vínculo entre serviços de saúde e população.…”

Measures of Preventing Covid-19 Transmission

“…All should take suf icient precautions at their level to prevent transmission and should spread the right information in villages to prevent spreading of wrong information in the community and to avoid the generation of panic mode. They should inform in government allotted hospital if any suspected case is detected as soon as possible, and should be isolated to break the chain of virus transmission in the community (Garg et al, 2020).…”