Implementation Assessment of Ayushman Arogya Mandirs in Andhra Pradesh, India: A Mixed-methods Study of Facilitators and Barriers

Abstract

Aim: This study assesses the performance, challenges, and best practices of Ayushman Arogya Mandirs (AAMs) in Andhra Pradesh, focusing on their ability to provide the expanded package of 12 Comprehensive Primary Health Care (CPHC) services. Study Design: It is a cross-sectional study with a mixed methods approach. Methodology: Utilizing a quantitative research approach, we evaluated service delivery, infrastructure, and community perception and qualitative study tools were used to elicit challenges encountered and best practices. The facilities were assessed using a checklist, and healthcare staff and beneficiaries were interviewed. Results: Findings revealed significant achievements in teleconsultations (average of 202, 112, 63 teleconsultations in AAM Sub-health Centre, AAM Urban Primary Health Centre, AAM Primary Health Centre, respectively), the Family Doctor Program, and essential diagnostics (100% facilities assessed had availability of diagnostics through in-house mode). The study identified gaps in infrastructure (only 58% facilities had a boundary wall, and 58% had an uninterrupted electricity supply), emergency services (58% facilities lacked provision of 24*7 emergency care services), and data management can be further strengthened. 24*7 potable water supply, dedicated space each for laboratory, pharmacy, wellness activities were found in 100% of the visited healthcare facilities. 100% of the facilities were well equipped in data connectivity and teleconsultation services. Conclusion: The AAM centres assessed are functioning well with dedicated manpower, well-equipped with diagnostics, and optimally utilizing digital platforms like teleconsultation. Recommendations include strengthening referral linkage, infrastructure upgrades such as improving accessibility features and ensuring power backup, streamlining digital platforms, and implementing all the aspects of Indian Public Health Standards (IPHS) guidelines. These insights are intended to guide strengthening AAMs in Andhra Pradesh and in a broader perspective, throws light upon how Ayushman Arogya Mandirs can optimally provide qualitative healthcare services to the community.