A Study to Assess the Skills of Mid-level Healthcare Providers/Community Health Officers in Delivering Primary Healthcare Services in Selected Districts of Andhra Pradesh and Haryana

Background:In order to achieve Universal Health Coverage through comprehensive primary healthcare services and attain sustainable development goals (SDGs), the Government of India (GOI) has taken an initiative to create a new cadre called community health officers (CHOs)/mid-level healthcare providers (MLHP) under the Ayushman Bharat scheme at the Ayushman Arogya Mandir [erstwhile Health and Wellness Center (HWC)].Aim: To assess the skills of CHOs in the provision of comprehensive primary healthcare services across selected districts in two Indian states.Subjects and methods: A descriptive cross-sectional study was conducted among 366 CHOs [225 from Andhra Pradesh (AP), 141 from Haryana] selected using multistage random sampling.The core skills of CHOs were assessed through an objective structured clinical examination (OSCE) using a model and categorized as inadequate (≤50%), moderately adequate (50-75%), or adequate (>75%).Results: Out of the total 366 participants, 79.2% were female, and 61% were aged 21-30 years; 68.8% held a BSc Nursing qualification.Mid-level healthcare providers/CHOs in Haryana (68%) had over 1 year of experience compared to AP (36%).Community health officers had adequate skills in blood pressure measurement (manual -100%), random blood sugar (RBS) monitoring (83%), breast cancer screening (74%), and oral cancer screening (62%).Only 6% in Haryana and 41% of CHOs in AP could perform the procedure of newborn resuscitation accurately.Similarly, only 22% of CHOs of both states knew when to start the partograph. Conclusion:The assessment of overall skills of CHOs in the provision of primary healthcare services indicated that, except for blood pressure recording, urine testing, and RBS monitoring, their skills in other key areas such as neonatal resuscitation, plotting and interpreting the partograph to assess the progress of labor, elderly assessment, and screening for breast and oral cancers were found to be inadequate.This highlights the need for continuing education programs to strengthen their clinical competencies and enhance the quality of primary healthcare delivery.