Evaluating the service readiness of a Paraguay public healthcare center for the primary healthcare system using the WHO SARA tool

Early Abstract:

Introduction: Universal Health Coverage (UHC) aims to ensure access to quality healthcare for all individuals without financial hardship. In upper-middle-income countries like Paraguay, UHC can be achieved by strengthening the primary healthcare (PHC) system. However, current studies primarily focus on expanding the universality of PHC as a key aspect of UHC, with limited research evaluating the service readiness of healthcare facilities providing PHC services in such settings. Therefore, this cross-sectional, quasi-experimental study aimed to characterize the service readiness of public healthcare facilities in Paraguay using the WHO Service Availability and Readiness Assessment (SARA) tool. The study sought to identify areas for improvement and inform health policies and decisions to enhance the quality and accessibility of healthcare services. Additionally, it addressed the need for standardized assessment tools to evaluate and improve the capacity of PHC facilities in countries like Paraguay.
Methods: This study was conducted in Limpio, Central Department, Paraguay, encompassing both urban and rural areas with a population of 155,465. As part of a health system strengthening initiative, 13 public health centers were constructed, accompanied by the allocation of medical resources, human resource training, and operational support. Data were collected before (2018) and after (2021) the intervention. A difference-in-differences (DID) method was applied to compare changes between the intervention and control groups. The WHO SARA tool was utilized to assess seven key service readiness domains. Additionally, the Mann–Whitney U test was conducted to evaluate statistical differences in SARA index scores.
Results: The results revealed a shortage of healthcare professionals and lower WHO SARA scores in the intervention area before the intervention. Following the intervention in 2021, the intervention area showed significant improvements compared to the control area in basic amenities (p = .003), basic equipment (p = .018), and diagnostic capability (p = .024). However, no significant changes were observed in infection prevention (p = .745) and essential medicines (p = .483). The DID analysis indicated a statistically significant improvement in the overall SARA score by 16.2 points (p = .030).
Conclusion: This study demonstrates that merely implementing health system-related policies, such as national health plans or service coverage mandates, is insufficient without targeted strategies addressing health workforce distribution, resource allocation, and health infrastructure development. The term "inequality gaps" refers specifically to disparities in healthcare access, particularly in the distribution of healthcare workers and essential medical resources. This study provides novel quantitative evidence on how integrated interventions – combining infrastructure development, workforce capacity building, and resource optimization—can significantly enhance PHC service readiness in an upper-middle-income country like Paraguay. These findings offer valuable insights for policymakers aiming to improve healthcare accessibility and service delivery.
Keywords: healthcare accessibility, healthcare human resources, healthcare quality, healthcare services, Korea International Cooperation Agency, Paraguay, primary healthcare system, Service Availability and Readiness Assessment, universal health coverage, World Health Organization.