Challenges in Meeting Community's Expectations for Effective Functioning of Primary Health Centres (PHC): Results of a Survey From Evaluating 17 PHCs in India

Moving towards achieving MDGs requires that health systems respond to challenges for better performance. A facility survey for Primary Health Centres (PHCs) was undertaken in selected blocks of two districts in India: Adilabad (Andhra Pradesh) and Ganjam (Orissa). Both districts have a significant proportion of their population below the poverty line and fall very low on human development indicators and public health indices with high maternal and child and mortality.

The facility survey, as per DLHS III guidelines, of 17 PHCs revealed significant findings in comparison to the Indian Public Health Standards (IPHS). Despite the essential requirements under IPHS for PHC’s to have at least one lady medical officer, staff nurse, and laboratory technician, 75% of the PHCs surveyed had no lady medical officer, 53% had no staff nurse, and nearly 60% had no laboratory technician. The PHC building is to be disaster proof and have regular access to water, electricity, generator and internet facility as per IPHS. However, the study’s findings reveal that 35% of the buildings were kutcha/semi pukka constructions, 48% did not receive regular power supply and 71% had no internet facility. The study also showed 94% had no residential facilities for staff nurses, which is an essential requirement. As per IPHS, PHCs are to provide family planning services, but it was found that 42% PHCs had no oral pill users, and 47% PHCs have no condom users.

Based upon the analysis and in order to attain the MDGs 4, 5 and 6 the study recommends: a) greater investment in primary health centres which in turn can prevent much of the disease burden and, b) routine monitoring and evaluation of state of PHCs, especially in backward regions. These would prove beneficial towards better organizing health services for effective performance of PHCs to meet people's needs and expectations.