Availability of public health facilities and utilization of maternal and child health services in districts of India

Objective: This study aims to address the spatial variation in the availability of public health facilities and uti-lization of Maternal and Child Health (MCH) services at district level in India.Methods: Two nationally representative secondary data sources such as the National Family Health Survey 2015-16 and Census of India, 2011 were used to identify districts, which are lagging behind in terms of the availability and utilization of MCH services. Mapping and spatial clustering analyses was performed to identify under-performing districts in India. Further, Ordinary least square and spatial autoregressive models were used to determine the predictor for utilization of MCH services at the district level.Results: Significantly, less availability of public health facilities and utilization of MCH services were observed in districts of Jharkhand, Bihar, Uttar Pradesh, Madhya Pradesh, Chhattisgarh, and North-Eastern states as compared to the national average. A shortage of 72,198 (21.9%) doctors and 165,791 (17.5%) paramedical staff found at the country level. After controlling for socio-economic factors, we observed that availability of sub -centre, dispensary, and population hospital bed ratio were significant positive predictors for Antenatal Care (ANC) service utilization whereas, shortage of paramedical staff was a negative predictor for full immunization at district level in India.Conclusions: Adequate availability of health facilities, and human resources are needed in districts, which are underperforming in terms of availability and utilization of MCH services to improve utilization of MCH services.