Granular evaluation of public primary healthcare accessibility in rural India

Purpose India lacks a comprehensive, village-level assessment of primary healthcare accessibility needed to guide policies for improving access. This article provides a nationwide, village-level baseline measure of public primary healthcare accessibility in India using three distinct spatial metrics. Design/methodology/approach A geocoded census of public healthcare facilities from the National Health Resource Repository is merged with spatial and demographic data for rural census villages. A multi-dimensional framework is developed to assess healthcare accessibility using three metrics: (1) a regional availability metric that captures infrastructure shortfalls relative to Indian Public Health Standards (IPHS) norms; (2) a measure using Euclidean distance to the nearest facility and (3) a capacity-constrained, catchment-based propensity-of-access metric conceptually aligned with the two-step floating catchment area method. Descriptive and spatial analyses are conducted at national and sub-national levels to highlight geographic variation in accessibility. Findings The first metric shows that a rural Primary Health Centre (PHC) serves an average of 33,800 people, exceeding the Indian Public Health Standards norm of 30,000. The second indicates an average village-to-PHC distance of 5.49 kilometres. The third shows that, when population pressure and distance are considered jointly, residents in 20% of villages are effectively crowded out, even at the national average distance. Originality/value This nationwide, village-level assessment is the first to integrate availability, proximity and capacity-adjusted access across India. The analysis challenges single-metric planning approaches and suggests that upgrading or expanding infrastructure alone cannot resolve persistent spatial and capacity gaps in rural healthcare. The insights extend beyond India, where similar metrics often misstate healthcare accessibility.