From physical access to effective primary care: Awareness, utilisation and user experience of Ayushman Arogya Mandirs in rural Bihar, India

India’s Ayushman Arogya Mandirs (AAMs) were established to bring comprehensive primary health care closer to communities through an expanded package of preventive, promotive and curative services. However, physical availability of primary care does not necessarily translate into population awareness, utilisation or positive service experience. This study assessed awareness and utilisation of AAMs and examined user-reported access and service-quality indicators among rural households in Gaya district, Bihar. A community-based cross-sectional survey was conducted in ten villages across Bodh Gaya, Manpur and Paraiya blocks using a multistage sampling approach. Data were collected from 426 households comprising 1,907 household members through a structured questionnaire covering sociodemographic characteristics, healthcare-seeking behaviour, AAM awareness and utilisation, geographical access, waiting time, medicine availability and perceived service quality. Only 30.4% of household members were aware of AAMs, and 10.9% reported utilisation, indicating a substantial gap between service expansion and population uptake. Among the 219 respondents with valid facility-experience information, 89.0% reported an AAM within 1 km of their village and 85.9% waited 25 minutes or less to see a health worker. Prescribed medicines were fully available to 54.3% and partially available to 43.8%, suggesting substantial inconsistency in medicine availability. Service quality was rated as fair by 73.5%, good by 18.7% and poor by 7.8%. These findings suggest that geographic proximity and relatively short waiting times alone are insufficient to ensure effective primary care utilisation. Strengthening community awareness of the expanded AAM service package, ensuring reliable availability of essential medicines and improving perceived service quality are important for converting physical access into effective, trusted and sustained primary health care use in resource-constrained rural settings.