Facility infrastructure captures the physical availability and physical quality of facilities, including facility density and distribution, facility design, facility amenities, and safety equipment and precautions.
Facility density and distribution
Ensuring that all populations have timely, geographic access to care requires sufficient facility infrastructure1. The density and distribution of primary care facilities refers to the physical locations of primary care facilities and their spread relative to the population. The number and type of facilities needed in a country or region depends on two categories of factors. The first is population needs, including burden of disease and population distribution. The second is models of care, including the availability of services at facilities, staffing of facilities, and referral expectations. Because a range of factors and needs influence facility density and distribution, there are not specific global normative guidelines for making these decisions. Instead, it is important for countries to assess their own facility density and distribution needs and set targets that respond to these needs and the local context 1. Note: Geographic access from the patient perspective is explored in the Geographic Access module.
One of the guiding principles behind the design of health facilities is being able to meet the most common problems in a community. This is achieved in part through close understanding of the health status and needs of community members 2. Person-centered care begins in large part with facility design. The close attention to patient-centeredness in primary health care facilities means that their design is, or should be, quite different from other kinds of health care facilities. Facility design is a critical component to achieving high quality, person-centered care, but is often not taken into consideration – or is thought to be a “luxury” in resource-constrained settings. Additionally, much of the research on evidence-based facility design has focused on hospitals rather than PHC settings 3. However, patient-centeredness is core to PHC and needs to be included in PHC facility design from the start. Evidence has shown that patient-centered design can facilitate improved access, improve the waiting experience, privacy, and physician/staff-patient communication, reduce patient anxiety, and reduce the risk of infection 4.
More on person-centered care can be found in the Person-centered Care module.
Facility amenities are the most basic essential features and utilities that enable primary care facilities to be ready and able to provide quality, person-centered primary health care. Facility amenities are a core component of a health facility’s readiness to provide services5.
According to the WHO Building Blocks of Health Systems, essential facility amenities include electricity, safe water, exam rooms with privacy from sight and sound, light sources, sanitation facilities (such as flush or pour toilets to piped sewer system or septic tank, pit latrines, and/or composting toilets), communications equipment (such as cell phones, landline telephones, and/or shortwave radios), computers with internet or network connectivity, and access to emergency transportation15.
Standard safety precautions and equipment
Standard safety precautions and equipment are the processes and materials that support safe primary care service delivery and prevent transmission of communicable diseases. Standard safety precautions and equipment, sometimes called standard precautions on prevention of infections, are a core component of health facility readiness to provide high-quality services and ensure the safety of patients and providers5.
Standard safety equipment and precautions include basic safety tools such as sterilization equipment, safe final disposal of sharps and medical waste, sharps boxes or containers in exam rooms, waste bins with lids and liners in exam rooms, surface or environmental disinfectant, single-use standard disposable or auto-disposable syringes, bar or liquid soap along with running water or alcohol-based hand sanitizer, latex gloves, and guidelines for standard precautions against infection15.
Visual aid - Facility Infrastructure