It has been unanimously acknowledged that strong health systems are paramount to achieve health system goals. Indicator 3.8.1 of Sustainable Development Goal targets coverage of essential health services (defined as average coverage of essential services based on tracer interventions including reproductive, maternal, newborn and child health, infectious diseases, non-communicable diseases (NCDs), service capacity and access among general and most disadvantaged population). Underpinning the need to strengthen fragile, resource-constrained health systems is the recognition that weak health systems impede attainment of global and national targets, and are insufficiently resilient to prepare for—and respond to—crises. Despite strong consensus on need to strengthen health systems there are inadequate methods to assess hordes of indices which can inform policy makers on priority areas for improvement. Albeit, current research does not adequately capture the complex, inter-connected relationship between health system building blocks and the setting in which they are situated. Assessing quality of care requires that certain criteria and standards are identified in order to translate general dimensions of quality into something parsimonious that can be measured and interpreted.
Structural measures in the Donabedian’s paradigm of structure, process and outcomes gauges the care attributes of healthcare delivery settings in the setting where care occurs. The assessment of structural quality of care divulges if the care provided under conditions are conducive or inimical to provision of care. These measures are symptomatic with system’s readiness, comprehensive assessment of which is pertinent to evidence based policymaking and optimal resource allocation by transcribing identification of bottlenecks in service delivery. Data for measuring structural dimension of quality care including facility infrastructure, staffing and clinical training are extracted from health facility records and surveys. Previous literature delving into health systems performance over-represent tertiary and secondary health facilities, circumventing lower level peripheral facilities providing 1st contact of care. Assessing facility readiness is paramount as it connotes the capacity of facilities to provide essential care for resilience to health challenges. As countries around the world agreed to Declaration of Astana, reaffirming their commitment to strengthen primary healthcare systems as an essential step towards achieving Universal Health Coverage (UHC), it is opportune to explore strategies for targeted action by tracking the progress towards UHC in different contexts.
In the context of health being state subject in India, it is incumbent upon state governments to implement policies to achieve provisioning of accessible and affordable healthcare. Thus, it is imperative for local governance to formulate framework to provide essential basic package to its citizens and have critical discourses and conjectures on benefit package in regional context that can be transmuted into increased access at community level. Also, in the context of decentralisation, estimation of standardised, replicable and comparable supply-side readiness metric at subnational and disaggregated level is imperative for context specific evidence for prioritisation of interventions but remains a colossal challenge due to lack of dependable and representative data sources.
The conflation of quantitative and qualitative insights highlighted the need to augment peripheral health facilities specifically for services such as obstetric and newborn care, NCD care and emergency preparedness. The efficacy of these facilities was particularly constrained by lack of diagnostics and essential medicines. Targeted interventions entrenched in Central Government’s flagship schemes such as setting up of government pharmacies dispensing generic drugs at affordable prices and pharmacies specially established to provide drugs, implants, surgical disposables and other consumables for cancer and heart disease at heavily discounted rates should be prioritised to complement the drug supply via medical corporation.