Aim: The present study aims to assess the extent of spatial and structural variation in quality of Primary Healthcare facilities in West Bengal.

Method: Using data from Health Management Information System, Govt. Of West Bengal, India, on availability of structural inputs for the year 2013-14in Primary Healthcare Centres (PHCs) from 341 Blocks, the district level Overall Development Index (ODI) is constructed. ODI is a composite measure of the relative importance of all available structural inputs in PHCs. A spatial variation of ODI is then depicted in map to present the shortfall of existence of structural inputs across different districts. To understand structural (domain-specific) variation and its inequality in PHCs, at the district level, Modified Overall Gini and IMR-based Concentration Index from Overall Development Indices (ODI) are used.

Results: The study reveals that inter-district variation in quality of healthcare across West Bengal ranges from 0.68 (Bankura) to 0.17 (Murshidabud). Domain-specific inequality is highest for laboratory facilities (25.92 %) and lowest for manpower (17.20 %). Moreover, the (IMR-based and MMR-based) Concentration Index, disease-based measure is used to present the inequality in the use of structural facilities at PHCs and show contrasting scenario with that of inequality in availability of Domain-specific facility. Here the inequality is highest for Services (29%) for IMR and (32%) for MMR while it is lowest for equipment facilities (6.5%) for IMR and (3.13%) for MMR.

Conclusion: Spatial variation of healthcare facilities as well as the Domain-specific inequality across the blocks as unit analysis from different districts are prominently distorting even under same flagship programme NRHM in West Bengal. Moreover there is huge gap between inequality in availability of facilities and inequality in use of facilities at PHCs in West Bengal. The present findings may help to review the health policies towards effective involvement of PHCs for wide intervention in primary healthcare facilities at District level in West Bengal.