JMIR Publications

ABSTRACT

Background:

Primary healthcare centers (PHCs) represent the first tier of the Indian healthcare system, provides a range of essential outpatient services to people living in the rural, suburban, and hard to reach areas. Moreover, several secondary and tertiary care hospitals in India which cater to millions of daily outpatients have been converted into temporary COVID-19 hospitals which has deprived millions of patients of essential outpatient care. Under these circumstances, the preparedness of PHCs in providing safe patient-centered care for meeting the current health needs of the population and prevent further transmission of the SARS-CoV2 infection is crucial.

Objective:

To determine the primary healthcare facility preparedness towards 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 healthcare facilities attached to medical colleges and institutions in India. A list of 60 faculty involved in the management and supervision of PHCs affiliated to 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 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 faculty responded to the survey. Each medical college/institution was having on average (SD) a total of 2.94 (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, separate entry and exit gates (49%), suboptimal ventilation (57%), and negligible airborne infection control measures (75.5%). Some sites also lacked adequate handwashing (23.5%) and hand hygiene (27.4%) facilities. The operation of outpatient services, particularly related to maternal and child health, was significantly reduced (p < 0.001) during the COVID-19 pandemic.

Conclusions:

Existing PHC facilities in India providing outpatient services are constrained in their functioning by weak infrastructure contributing to suboptimal patient safety and infection control measures. Healthcare managers must address the risks of nosocomial infection in these settings when operationalizing simultaneous COVID-19 screening and special OPD clinics for NCDs, ANC, and immunization services that cater to highly vulnerable COVID-19 populations.