The Adequacy of Health System Measures in Reducing Vulnerability to COVID-19 Among the Health Care Providers Working in Primary Health Care in Rajasthan, India: A Cross-sectional Study

  1. Arup Kumar Das
  2. Ambey Kumar Srivastava
  3. Saswata Ghosh
  4. Ruchi Bhargava
  5. Rajan Gupta
  6. Rajesh Ranjan Singh

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Abstract

This article examines the role of individual, facility and system-level preparedness in reducing physiological and psychological vulnerability among primary-level health care providers (HCPs) during the COVID-19 pandemic in Rajasthan, India. Online and telephonic interviews are conducted among 274 HCPs working in 24 primary health centres (PHCs) (17 rural and 7 urban) across 13 districts of Rajasthan. Five dimensions of vulnerability, covering awareness, exposure to infection (daily contact; contact with high-risk individuals), physical and mental health conditions, while three aspects of preparedness—at individual (personal care) and facility (provider safety; management and supervision) level—are measured by employing factor analysis. Generalised ordered logit regression model is used to measure the effect of preparedness on COVID-19-related vulnerability. Among the 274 HCPs, majority of the staff are from rural PHCs (76%), less than 35 years old (87%), female (57%) and married (57%). Almost half have high level of exposure to COVID-19, with mean contact rate of 90. Overall, 26% have comprehensive knowledge of COVID-19, and 32% have any mental health issues. Although more than 70% of HCPs have reported more than one individual-level preparedness, mental health measures adopted by the HCPs are comparably low. The facility-level preparedness for enhancing safety is high such as social distancing (79%) and maintaining record of each visitor (75%). However, management-related measures adopted by the PHCs are perceived to be lower than the safety measures. The regression analyses suggest that safety-related preparedness is significantly associated with reduction of vulnerability by 50%. The management-level preparedness has statistically no significant effect in explaining the variations in level of vulnerability. The facility-level safety measures, which lower chances of acquiring infection, have a positive effect on reducing vulnerability to COVID-19. However, the HCPs do not have adequate preparedness at individual, facility management (PHC) and system levels to reduce COVID-19 vulnerability. Findings suggest that there is a need for a non-conventional approach of monitoring and supervision. In the absence of such measures, there is a chance of moral injury that will make the HCPs at the primary level vulnerable both physiologically and psychologically.

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  1. Version published to 10.1177/09720634241227310
  2. ScreenIT

    SciScore for 10.1101/2020.07.21.20149443: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: We also obtained ethical approval from the IRB Sigma ethical review board.
    RandomizationWe have used a virtual meeting platform to train all interviewers., and randomly selected interviews were monitored for quality assurance.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: An explicit section about the limitations of the techniques employed in this study was not found. We encourage authors to address study limitations.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

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  3. Version published to 10.1101/2020.07.21.20149443v1 on medRxiv