Research to policy on defining accessibility of public health facilities to ensure universal health coverage

BACKGROUND: The mandate to ensure the availability of doctors under Universal Health Coverage has been one of the most difficult issues to address in India. It is believed that the geographic location of health facilities has influenced the availability of doctors in rural areas, which may have resulted in long-standing vacancies. There was a need to classify facilities based on location and access, to propose policies and strategies. The classification was arrived through a consultative process, which led to ambiguity. AIM: The aim of this study is to develop a criteria to identify health facilities based on location considering accessibility indicators. SETTINGS AND DESIGN: A cross-sectional operational research was conducted during 2010–2011 to collect data for public-health facilities above subcenters and below district hospitals across India. MATERIALS AND METHODS: Data was collected for geographic, environmental, housing, and vacancy status of doctors; for which scores were assigned for each health facility. RESULTS: A total of 20,528 (76%) were included for analysis out of 26,876 health facilities. Following application of criteria, 3,011 (11%) facilities were identified as eligible; of these, 1%, 3%, and 7% facilities were identified as inaccessible, most-difficult, and difficult facilities, respectively. The consultative meetings with state governments resulted in agreement on the criteria adopted. CONCLUSION: The study demonstrated more robust criteria to define access to health care facilities by applying composite scoring methods, which was validated through a consultative process with key stakeholders. The study results were applied to incentivize doctors serving in difficult areas in a move to address human resource gaps in rural areas and ensure universal health coverage.