ORIGINAL RESEARCH article
Front. Health Serv.
Sec. Patient Centered Health Systems
General Service and Immunization-Specific Readiness Assessment in the Primary Health Centres of District Bagh, Azad Kashmir, Pakistan
Provisionally accepted
Waqas Farooq1
Humaira Mahmood2*Syed Hasnain Ali Abbas3Rida Ali1Mubeen Alif4Khursand Binte Azam1Syed Hassan Bin Usman Shah5
Abdul Momin Rizwan Ahmad6*- 1National University of Medical Sciences, Rawalpindi, Pakistan
- 2Health Services Academy, Islamabad, Pakistan
- 3Climate Resilient WASH Programme, Norwegian Church Aid, Oslo, Norway
- 4Health Department, District Headquarters Hospital, Bagh, Bagh, Pakistan
- 5University of New South Wales, Sydney, Australia
- 6University of York, York, United Kingdom
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Abstract Introduction: Primary health centres (PHCs) are the initial contacts of the national health system with the patients and hence are extremely important in achieving universal health coverage. Perhaps, immunization is the most impactful PHC interventions which have alone by many folds brought down morbidity and mortality by vaccine-preventable infections. Despite these efforts at the national level to increase immunization at scale through the Expanded Program on Immunization (EPI), however, immunization coverage is suboptimal. Assessment of PHC facility readiness to offer immunization will contribute more importantly to strengthening health systems and enhancing immunization outcomes. Objective: This study aims to assess the general service readiness and immunization-specific capacity of primary health centers in District Bagh, Azad Jammu & Kashmir (AJK), using the WHO Service Availability and Readiness Assessment (SARA) tool. Methods: A simple random sample design was used to select 32 primary health centres in District Bagh for a cross-sectional facility-based assessment from November 2024 to April 2025. The Service Availability and Readiness Assessment (SARA) manual developed by World Health Organization (WHO) was used to collect data in five key domains i.e. basic amenities, availability of equipment, infection prevention protocols, diagnostic capacity, and availability of essential medicines. Immunization-specific readiness was assessed in relation to staffing, equipment, and vaccine supply. All the data were analyzed via the SARA manual. Results: PHCs were moderately ready in core service areas, with major gaps in diagnostic capability, basic infrastructure, and essential medicine availability. Major gaps were restricted access to malaria, HIV, hemoglobin, and pregnancy tests, and emergency transport and communication system weaknesses. Immunization services were highly ready, with good cold chain systems and trained personnel, although logistical issues and vaccine hesitancy remained. Conclusion: Even with strong immunization preparedness, the PHCs of District Bagh require urgent strengthening of infrastructure, diagnostic capacity, and access to medicines. Strengthening PHC systems to deliver equitable access to health and improved health outcomes requires strategic investments, legislative reforms, and enhanced community engagement.
Keywords: Health Facilities, Immunization, Primary Health Care, Service readiness, Sara
Received: 22 Sep 2025; Accepted: 28 Nov 2025.
Copyright: © 2025 Farooq, Mahmood, Abbas, Ali, Alif, Azam, Shah and Ahmad. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Humaira Mahmood
Abdul Momin Rizwan Ahmad
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.