Physical Environment and Performance Measurement: A Data Envelopment Analysis of Ayushman Aarogya Mandirs in Kanpur Nagar

Abstract

Under the flagship Ayushman Bharat Mission, the government of India established Health and Wellness Centres (HWCs)as pivotal points for delivering comprehensive primary healthcare, including non-communicable disease (NCD) management, screening, wellness sessions, mental health and so on. Evaluating their operational efficiency is crucial for optimizing resource utilization, process improvement and enhancing service delivery. Suboptimal physical environments—such as poor ventilation, accumulation of waste, inadequate infrastructural facilities including colour-coded bins potentially constrain both access and appropriate delivery of health services. This study assesses the technical efficiency of 12HWCs in a district of Uttar Pradesh, employing Data Envelopment Analysis (DEA) to quantify performance variations based on outpatient visits and NCD patient care. Two DEA models were constructed: Model1 considered out patient visits as output with physical infrastructure and ANM personnel as inputs; Model 2 focused on hyper tensive and diabetic patient management with ASHA and blood sugar tests as inputs. Efficiency scores were calculated under Variable Returns to Scale (VRS) assumptions. The significant heterogeneity in efficiency under scores the need for targeted interventions focusing on workforce capacity building, on the job training, upgradation of health technology, and strenghtening of the clinical capacity to enhance HWCs’ performance. Integrating DEA findings with qualitative inputs can guide policy towards achieving equitable and effective primary care crucial for Universal Health Coverage in India.