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

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.