Department of Global Health and Epidemiology, Emory University, Atlanta, USA.
Centre for Chronic Disease Control, New Delhi, India.
BMC Health Serv Res. 2021 Oct 15;21(1):1101. doi: 10.1186/s12913-021-06999-9.
There is substantial interest in leveraging digital health technology to support hypertension management in low- and middle-income countries such as India. The potential for healthcare infrastructure and broader context to support such initiatives in India has not been examined. We evaluated existing healthcare infrastructure to support digital health interventions and examined epidemiologic, socioeconomic, and geographical contextual correlates of healthcare infrastructure in 544 districts covering 29 states and union territories across India.
The study was a cross-sectional analysis of India's Fourth District Level Household and Facility Survey (DLHS-4; 2012-2014), the most up-to-date nationally representative district-level healthcare infrastructure data. Facilities were the unit of analysis, and analyses accounted for clustering within states. The main outcome was healthcare system infrastructural context to implement hypertension management programs. Domains included diagnostics (functional BP instrument), medications (anti-hypertensive medication in stock), essential clinical staff (e.g., staff nurse, medical officer, pharmacist), and IT specific infrastructure (regular power supply, internet connection, computer availability). Descriptive analysis was conducted for infrastructure indicators based on the Indian Public Health Standards, and logistic regression was conducted to estimate the association between epidemiologic and geographical context (exposures) and the composite measure of healthcare system.
Data from 32,215 government facilities were analyzed. Among lowest-tier subcenters, 30% had some IT infrastructure, while at the highest-tier district hospitals, 92% possessed IT infrastructure. At mid-tier primary health centres and community health centres, IT infrastructure availability was 28 and 51%, respectively. For all but sub-centres, the availability of essential staff was lower than the availability of IT infrastructure. For all but district hospitals, higher levels of blood pressure, body mass index, and urban residents were correlated with more favorable infrastructure. By region, districts in Western India tended towards having the best prepared health facilities.
IT infrastructure to support digital health interventions is more frequently lacking at lower and mid-tier healthcare facilities compared with apex facilities in India. Gaps were generally larger for staffing than physical infrastructure, suggesting that beyond IT infrastructure, shortages in essential staff impose significant constraints to the adoption of digital health interventions. These data provide early benchmarks for state- and district-level planning.
利用数字健康技术支持印度等中低收入国家的高血压管理引起了广泛关注。印度在医疗保健基础设施和更广泛的背景下支持此类举措的潜力尚未得到检验。我们评估了现有的医疗保健基础设施以支持数字健康干预，并研究了印度 544 个地区的医疗保健基础设施的流行病学、社会经济和地理背景相关性，这些地区覆盖了印度 29 个邦和联邦属地。
这是对印度第四次地区层面家庭和设施调查（DLHS-4；2012-2014 年）的横断面分析，这是最新的全国代表性地区层面医疗保健基础设施数据。设施是分析的单位，分析考虑了各州内的聚类。主要结果是实施高血压管理项目的医疗保健系统基础设施背景。领域包括诊断（功能血压仪）、药物（库存中的抗高血压药物）、基本临床人员（例如，护士、医生、药剂师）和特定于 IT 的基础设施（定期供电、互联网连接、计算机可用性）。根据印度公共卫生标准，对基础设施指标进行描述性分析，并进行逻辑回归，以估计流行病学和地理背景（暴露）与医疗保健系统综合措施之间的关联。
分析了来自 32215 个政府设施的数据。在最低级别的次中心中，30%的设施拥有一些 IT 基础设施，而在最高级别的地区医院中，92%的设施拥有 IT 基础设施。在中级别的初级保健中心和社区保健中心，IT 基础设施的可用性分别为 28%和 51%。除了次中心外，所有设施的基本工作人员的可用性都低于 IT 基础设施。除了地区医院外，血压、体重指数和城市居民水平较高与更有利的基础设施相关。按地区划分，印度西部的地区往往拥有准备更充分的卫生设施。
与印度的顶点设施相比，数字健康干预所需的 IT 基础设施在较低和中级医疗保健设施中更为缺乏。人员配备方面的差距通常比物质基础设施更大，这表明除了 IT 基础设施外，基本工作人员的短缺对数字健康干预措施的采用构成了重大限制。这些数据为州和地区层面的规划提供了早期基准。
