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ImportanceThere 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 the public healthcare system in India has not been examined.ObjectiveWe 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.DesignCross-sectional analysis of India’s Fourth District Level Household and Facility Survey (DLHS-4; 2012-2014), the most up-to-date district-level healthcare infrastructure data. Facilities were the unit of analysis and analyses accounted for clustering within states.SettingNationally representative data of health facilities across India.ParticipantsThe target sample was all health facilities within the government healthcare system.ExposuresEpidemiologic, socioeconomic, and geographical context.Main Outcome(s) and Measure(s)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). Infrastructure indicators were based on the Indian Public Health Standards.ResultsData 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 29% 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.Conclusions and RelevanceIT 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 pose as significant constraints to the adoption of digital health interventions. These data provide early benchmarks for state- and district level planning. |
