RESUMEN
India is a signatory to the Alma Ata Declaration and is committed to attaining Health for All. Primary healthcare is the point of entry for a person to the national health system.1 A health subcentre is the most peripheral facility that connects the primary healthcare system and the community.2 While India lacks adequate healthcare infrastructure, it is also a fact that the available public health system remains largely underutilized, and curative treatment is mostly provided by underregulated private healthcare providers.3,4 Strengthening of the public health system for delivery of promotive, preventive and curative health services is required in India.5 To achieve universal health coverage, the primary healthcare system will need to reinvent itself. Thus, it is imperative to assess the functioning of subcentres which were established to serve people in rural areas. We did a cross-sectional study in the district of Jhansi, Uttar Pradesh from June 2011 to June 2013. Of the eight community development blocks, two—Badagoan and Chirgoan—were selected for the study. Ten subcentres from each block were selected to get a representative sample. The data were collected by the facility survey and interview technique on a schedule designed as per the Indian Public Health Standards (IPHS) norms for subcentres.2,6 The average population covered by each study subcentre was 4282 (median 4170, range 2012–6868), the average number of villages per subcentre was 2.5 (median 3, range 1–6) and the distance of two blocks from the medical college was 12 km and 30 km, respectively (Table I). No subcentre had separate utilities for men and women, nor did they have a suggestion and complaint box. A hand pump was the major source of water supply at most subcentres, and only 9 subcentres had functioning hand pumps. No transport facility was available for staff or patients at any of the subcentres. Only 3 (15%) subcentres had a second or additional auxiliary nurse midwife (ANM) and 4 (20%) had a safai karamchari (a person for cleaning) on a contractual basis. A male health worker was not present at any subcentre. Most ANMs cited lack of electricity, their husband staying at another location, and education of their children as the reasons for not staying at the subcentres.