Multi-cadre human resource gaps and their association with service delivery and NCD screening in urban health and wellness centres, Ahmedabad: a cross-sectional study

Abstract

Background: Urban health and wellness centres (HWCs) under India’s Ayushman Bharat programme provide comprehensive primary health care, including universal screening for non-communicable diseases (NCDs). Achieving screening targets depends heavily on multi-cadre workforce availability. To assess multi-cadre human resource gaps in Urban HWCs across Ahmedabad and analyse their association with service delivery and universal NCD screening.

Methods: A cross-sectional analytical study was conducted from January 2022 to December 2022 in 14 Urban HWCs selected purposively. Staffing availability across clinical and outreach cadres was benchmarked against Indian public health standards (IPHS) 2022 guidelines. A composite human resource gap index (HRGI) was formulated and analysed against different health outcomes. Predictive models were evaluated using bivariate linear and logistic regression.

Results: Facility-based clinical cadres demonstrated robust baseline adequacy in comparison to community outreach cadres, which showed severe deficits. Multi-Purpose Workers faced 83.1% vacancy rate and Accredited Social Health Activist (ASHA) placement was highly erratic (10%–100%). The composite HRGI revealed significant inverse linear relationships with population-level CBAC coverage (β=-0.420, p<0.001, R2=0.710) and monthly average OPD attendance (β=-18.600, p<0.001, R2=0.640). Facilities operating with low overall staffing gaps (HRGI<30%) had significantly higher odds of achieving adequate universal NCD screening outputs (COR=3.812, 95% CI: 2.104–6.908; p<0.001).

Conclusions: Physical expansion of urban HWCs failed to achieve preventive primary health targets especially NCD screening due to depleted community-level outreach workforces. Bridging frontline staffing deficits is a critical prerequisite to optimizing universal NCD risk identification.