Vol. 29 No. 2 (2026) Cover Image
Vol. 29 No. 2 (2026)

Published: June 20, 2026

Pages: 364-370

Articles

A Digital Systems and Infrastructure Assessment for Resilient Primary Healthcare Delivery in Paschim Bardhaman, India

Sudipta Das 1 Dibyendu Chattaraj 2 Sayandip Gangopadhyay 3
1 University of Engineering & Management, Kolkata-India, NSHM Knowledge Campus, Durgapur-India
2 Department of Business Administration (BBA), Institute of Engineering & Management, UEM, Kolkata-India
3 Department of Public Health, KIIT University, Bhubaneswar-India.
History
  • Received: March 20, 2026
  • Revised: April 16, 2026
  • Accepted: April 20, 2026
  • Available Online: June 20, 2026
DOI

https://doi.org/10.29194/NJES.29020364

Abstract

Primary healthcare institutions are highly important socio-technical systems, where infrastructure, digital technologies, and service delivery processes collaborate to establish service resilience and performance. Digital systems and sustainable infrastructure may not be integrated as well in a limited environment with resources, which may lead to reduced system robustness and efficiency. This paper is a systematic digital systems and infrastructure evaluation of the process of providing primary healthcare in Paschim Bardhaman District, India, through an engineering-based, multi-criteria analysis framework._x000D_ Cross-sectional engineering analysis was carried out on 25 Primary Health Centers (PHCs) chosen based on the rural and semi-urban settings. They have developed a composite system performance index by incorporating five domains of engineering, namely infrastructure robustness, operational workflow efficiency, outcome performance, digital systems readiness (ICT), and environmental sustainability systems. Information was gathered based on formal auditing of facilities, check of readiness of ICT equipment and software, field observation of operations and review of documents. Domain-specific scores were also summed up to create a Composite Quality and Resilience Index (CQRI). Statistical analyses were made to provide measures of description, correlation analysis and comparative testing between rural and semi-urban facilities._x000D_ Findings showed that there was moderate system performance (mean CQRI = 1.21 ± 0.24) and there was high inter-facility difference. The positive correlation of infrastructure robustness and the efficiency of operational workflow were found to be strong with composite system performance (r = 0.67 and r = 0.74, respectively). The readiness to digital systems, and environmental sustainability scored relatively low, which points out to the underutilization of ICT infrastructure, lack of telemedicine adoption, and the integration of renewable energy sources. The composite performance of semi-urban PHCs was much better than that of rural facilities (p < 0.05), which highlights the importance of infrastructure accessibility and digital connectivity to system resilience._x000D_ The results show that integration of digital systems and infrastructure design that is sustainable are important engineering determinants of resilient primary healthcare delivery. The suggested composite assessment framework can be used as a scalable engineering-based tool to estimate and optimize the performance of low-resource healthcare infrastructure in supporting the resilience of the system and its long-term sustainability and efficiency in delivering the services.

Keywords

References

  1. J. Das, A. Holla, A. Mohpal, and K. Muralidharan, “Quality and accountability in health care delivery: Audit-study evidence from primary care in India,” American Economic Review, vol. 106, no. 12, pp. 3765–3799, Dec. (2016). https://doi.org/10.1257/aer.20151138
  2. V. Sharma and M. Dash, “Household energy use pattern in rural India: A path towards sustainable development,” Environmental Challenges, vol. 6, Art. no. 100404, Jan. (2022). https://doi.org/10.1016/j.envc.2021.100404
  3. S. Suram, V. G. Rudra, R. K. Miryala, and N. R. Parine, “Knowledge, attitude, and practices toward biomedical waste management among healthcare workers,” Asian Journal of Water, Environment and Pollution, vol. 22, no. 5, pp. 204–213, (2025). https://doi.org/10.36922/AJWEP025090058
  4. A. Donabedian, “The quality of care. How can it be assessed?” JAMA, vol. 260, no. 12, pp. 1743–1748, Sep. (1988). https://doi.org/10.1001/jama.260.12.1743
  5. J. Karliner, S. Slotterback, R. Boyd, B. Ashby, and K. Steele, Health Care’s Climate Footprint: How the Health Sector Contributes to the Global Climate Crisis and Opportunities for Action. Health Care Without Harm and Arup, (2019). [Online]. Available: https://global.noharm.org/sites/default/files/documents-files/5961/HealthCaresClimateFootprint_092319.pdf [Accessed: Mar. 6, 2026].
  6. S. Keesara, A. Jonas, and K. Schulman, “Covid-19 and health care’s digital revolution,” The New England Journal of Medicine, vol. 382, no. 23, Apr. (2020). [Online]. Available: https://doi.org/10.1056/NEJMp2005835 . [Accessed: Mar. 6, 2026].
  7. M. E. Kruk et al., “High-quality health systems in the SDG era: Time for a revolution,” The Lancet Global Health, vol. 6, no. 11, pp. e1196–e1252, Nov. (2018). [Online]. Available: https://www.thelancet.com/pdfs/journals/langlo/PIIS2214-109X%2818%2930386-3.pdf . [Accessed: Mar. 6, 2026] .
  8. Ministry of Health and Family Welfare, Government of India, Rural Health Statistics 2019–20. New Delhi, India, (2021). [Online]. Available: https://mohfw.gov.in/sites/default/files/RHS%202019-20_2.pdf. [Accessed: Mar. 6, 2026].
  9. I. Zakowska and M. Godycki-Cwirko, “Data envelopment analysis applications in primary health care: A systematic review,” Family Practice, vol. 37, no. 2, pp. 147–153, Mar. (2020). http://doi.org/10.1093/fampra/cmz057
  10. U. S. Mishra, S. Yadav, and W. Joe, “The Ayushman Bharat Digital Mission of India: An assessment,” Health Systems & Reform, vol. 10, no. 2, Art. no. 2392290, Dec. (2024). http://doi.org/10.1080/23288604.2024.2392290
  11. M. Roy and L. Aggarwal, “A strategic roadmap to the successful implementation of digital health records in India,” in Uniting Knowledge: Integrated Scientific Research for Global Development, Editora Seven, pp. 1–30, Dec. (2023). http://doi.org/10.56238/uniknowindevolp-153
  12. R. Scott and M. Mars, “Telehealth in the developing world: Current status and future prospects,” Smart Homecare Technology and TeleHealth, vol. 3, pp. 25–37, (2015). [Online]. Available: https://doi.org/10.2147/SHTT.S75184 . [Accessed: Mar. 6, 2026].
  13. M. Mansoor and J. Paul, “Impact of energy efficiency-based ICT adoptions on prosumers and consumers,” Journal of Cleaner Production, vol. 331, Art. no. 130008, Jan. (2022). http://doi.org/10.1016/j.jclepro.2021.130008
  14. World Health Organization, Primary Health Care on the Road to Universal Health Coverage: 2019 Global Monitoring Report – Executive Summary, (2019). [Online]. Available: https://www.who.int/publications/i/item/WHO-HIS-HGF-19.1. [Accessed: Mar. 6, 2026].
  15. . M. El Khatib, A. Al-Nakeeb, S. Binkhadim, and O. Shehata, “Modern digitization, technical integration, and social sustainability: Together toward better quality of life,” in Proc. 2024 2nd International Conference on Cyber Resilience (ICCR), Feb. (2024). http://doi.org/10.1109/ICCR61006.2024.10532784
  16. S. Chatterjee and A. Laha, “Association between public health care access and financing of health infrastructure in India: An interstate analysis,” Journal of Health Management, vol. 18, no. 2, pp. 258–273, (2016). http://doi.org/10.1177/0972063416637718