Are the subcenters adequately equipped to deliver primary healthcare? A study of public health manpower and infrastructure in the health district in Andhra Pradesh, India

BACKGROUND: India has a vast public health infrastructure, with 23,391 primary health centers (PHCs) and 145,894 subcenters (SCs) providing health services to 72.2% of the country's population living in rural areas. Although the numbers look impressive, their functional status needs to be studied in terms of physical infrastructure, manpower, equipment, drugs, and other logistical supplies that are greatly needed for ensuring quality services. This work aims to study the infrastructure facilities and manpower in a sample of SCs in the district of Nellore in the state of Andhra Pradesh in India. METHODS: Thirty SCs selected by multistage sampling have been studied using a structured and pretested performance standard questionnaire. Data have been analyzed with reference to the Indian Public Health Standards (IPHS) for SCs. RESULTS: Many deficiencies were identified in the infrastructure and manpower in the SCs studied. Some of the important findings were that the deficiency of health workers (HWs) (male) was 76.7%. Only 6.7% of the SCs operate in a designated government building. Communication facilities, such as telephones, are present in only 3.3% of the SCs. About 73% of the SCs were located more than 5 km from the remotest village in the coverage area. Residential accommodations for HWs (female) were available in only 3.3% of the SCs. There is also a severe deficiency of drugs and equipment in the SCs as per the IPHS. CONCLUSION: SCs lack the manpower and vital infrastructure necessary to function and deliver services effectively to the rural population.