A Task Force Study on Community-Level Situational Analysis in Urban and Rural Bhopal: Assessing the Availability and...

Background Equitable access to health care remains a persistent challenge in India, particularly among underprivileged urban and rural populations. Despite initiatives like Ayushman Bharat and Health and Wellness Centres, disparities in awareness, accessibility, and affordability persist. This study, conducted as part of the Indian Council of Medical Research (ICMR) Task Force project, aimed to assess the availability, awareness, and acceptability of doorstep health-care and diagnostic services in Bhopal, Madhya Pradesh. Methods A community-based cross-sectional survey was conducted from November 2022 to May 2023 among 5,000 individuals (2,500 each from rural and urban sites) representing socioeconomically disadvantaged populations. Study blocks were selected from the enlisted blocks by the probability proportional to size (PPS) method. Data were collected using a pre-validated questionnaire covering health-care awareness, service utilisation, preferences, and digital health identity status through the Ayushman Bharat Health Account status (ABHA) ID. The statistical analysis was performed using Epi Info 7 (Centers for Disease Control and Prevention, Atlanta, GA). Results Awareness of existing health-care facilities was moderate (urban: 49.6%; rural: 45.0%), with most respondents identifying primary health centres (PHC)/Wellness Centres and community health centres (CHC). Allopathy was the preferred system of care (>97%), and government doctors were favoured by 76.1% of urban and 54.5% of rural participants. Diagnostic service utilisation was extremely low, with over 97% reporting no tests in the last three months. Acceptability for doorstep diagnostic services was high and consistent across both urban (66.8%) and rural (66.6%) sites. Only 4.1% of participants possessed an ABHA ID, reflecting limited digital health integration. The main barriers included lack of awareness (17.3%) and unlinked Aadhaar-mobile connections (46.9%)(Aadhaar number is a 12-digit random number issued by the Unique Identification Authority of India (UIDAI) ('Authority') to the residents of India after satisfying the verification process laid down by the Authority). Conclusion The study highlights significant gaps in health-care awareness, diagnostic access, and digital health adoption among disadvantaged communities. However, the high acceptability of doorstep services offers a promising avenue for improving early diagnosis and continuity of care. Strategic implementation of mobile diagnostic technologies, targeted community awareness, and strengthening of frontline health workers are essential to bridge these gaps and advance towards universal health coverage (UHC).