ABCE data reveal progress and challenges in health system capacity in India

Health facilities in India report providing a range of health services, but a lack of key equipment, medical tests, and medications may compromise their full capacity to deliver care. This is one of many findings from the Access, Bottlenecks, Costs, and Equity (ABCE) project in India, a study carried out across six states that aims to assess the drivers of health system performance and costs of care.

Recently released datasets from the ABCE project provide a unique opportunity for researchers, policymakers, and development partners to use facility-level information to better understand health system needs. State-focused results for Andhra Pradesh and Telangana, Gujarat, Madhya Pradesh, Odisha, and Tamil Nadu are also highlighted in a series of policy reports. These aim to provide relevant and actionable information for health system programming and resource allocation in India, helping decision-makers to identify both areas of success and targets for improving health service provision.

“The public release of such detailed data on health facility capacity, service production, and finance across the different public-sector health platforms in five states, representing the range of health development in India, opens up many possibilities” says Dr. Rakhi Dandona, Professor at the Public Health Foundation of India and principal investigator for the ABCE project in India. “These data can now be used by a variety of stakeholders to identify aspects of the health system that need attention in order to provide more effective health services.”

While specific findings varied by state, several cross-cutting results emerged, including the following:

• The average efficiency of health facilities varied widely between and even within facility types. Overall, however, health facilities could treat many more patients with the same resources if they improved the efficiency of their service delivery. Researchers identified this potential for service expansion by assessing how observed facility resources, such as medical staff and beds, aligned with facility production of services.
• At a time when India’s states are seeing a rise in rates of non-communicable diseases, their health systems may not be adequately prepared to address them, as few facilities had the equipment for testing and treating NCDs, or offered services such as cardiology, psychiatry, or chemotherapy.
• Health facilities report high availability of certain services, but there were substantial gaps between facilities’ reported and actual ability to deliver several types of services such as antenatal care, routine delivery, and general surgery. Many facilities reported providing a given service but lacked full capacity to properly deliver it, due to a lack of functional equipment or medications.
• Considerable progress has been made in improving facility infrastructure, particularly with regard to electricity and water supply. Access to emergency vehicles remains a challenge for many facilities, particularly at lower levels of the health system.
• Patients generally experienced short travel and wait times at facilities and gave generally favorable ratings to service providers. Facility characteristics such as cleanliness and privacy tended to score lower ratings. Most patients did not encounter problems getting prescribed medications.

The ABCE project is a multi-country study that began in 2011. ABCE in India was led by the Public Health Foundation of India (PHFI) and the Institute for Health Metrics and Evaluation (IHME), with important contributions from UNICEF in Madhya Pradesh.

To learn more about the ABCE project or ask specific ABCE-related data questions, please contact e[email protected].