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Background & objectives: Information and communications technology (ICT) has often been endorsed as an effective tool to improve primary healthcare. However, evidence on the cost of ICT-enabled primary health centre (PHC) is lacking. The present study aimed at estimating the costs for customization and implementation of an integrated health information system for primary healthcare at a public sector urban primary healthcare facility in Chandigarh. Methods: We undertook economic costing of an ICT-enabled PHC based on health system perspective and bottom-up costing. All the resources used for the provision of ICT-enabled PHC, capital and recurrent, were identified, measured and valued. The capital items were annualized over their estimated life using a discount rate of 3 per cent. A sensitivity analysis was undertaken to assess the effect of parameter uncertainties. Finally, we assessed the cost of scaling up ICT-enabled PHC at the state level. Results: The estimated overall annual cost of delivering health services through PHC in the public sector was ? 7.88 million. The additional economic cost of ICT was ? 1.39 million i.e. 17.7 per cent over and above a non-ICT PHC cost. In a PHC with ICT, the cost per capita increased by ? 56. On scaling up to the state level (with 400 PHCs), the economic cost of ICT was estimated to be ? 0.47 million per year per PHC, which equates to approximately six per cent expenditure over and above the economic cost of a regular PHC. Interpretation & conclusions: Implementing a model of information technology-PHC in a state of India would require an augmentation of cost by about six per cent, which seems fiscally sustainable. However, contextual factors related to the availability of infrastructure, human resources and medical supplies for delivering quality PHC services will also need to be considered.
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Background: This study was conducted to assess the current status of functioning of health facilities in Punjab.Methods: A checklist based on six building blocks of health system proposed by WHO and the IPHS was developed, validated and pretested. District hospital (DH), one sub district hospital (SDH) and two Community Health Centres or Block Primary Health Centres (CHCs/BPHCs) were randomly selected from each of 22 districts of Punjab and evaluated against checklist. Total score was thus assigned to each facility. Additionally, workload of healthcare workforce, presence of health functionaries as against total posted strength and feedback from administrators of these facilities were also recorded.Results: Health services are concentrated at the DH and SDH. Functional equipment like ECG, oxygen, mask, ambubag etc. are deficient at all levels of health facilities. Nearly 50% of expected medicines were in stock at the DH and SDH and 66% at CHC/BPHC level. Patient to doctor ratio is highest at SDH in outpatient department and CHC/BPHC in emergency section. Number of lab tests per lab technician are highest at CHC/BPHC level. Administrators express the need for reducing staff shortage, more intensive training in the financial and administrative processes and simplification of procedures for management of equipment.Conclusions: Strengthening CHC/BPHC level institutions may improve utilization of public health system and reduce referrals. Lifesaving drugs and equipment need to be available and operational at all levels of facilities. Content of training to administrators needs to be tailored to the felt needs.
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Background: Habits get established during the transitional age of adolescence making it important to conduct surveillance to detect high risk behaviours at an early age. Feasibility of such a surveillance system was tested for monitoring the risk factors in schools.Methods: A cross sectional survey was conducted in randomly selected schools of Chandigarh in India, by enrolling 226 students of class V to XII. A pretested structured questionnaire on dietary pattern, physical activity, tobacco and alcohol consumption, drug abuse, mental health, sexual behaviour etc., was administered after ensuring privacy and confidentiality.Results: A total of 226 students with a mean age of 14years (range 10 to 19years) participated in the study. The prevalence of tobacco use was 8%, alcohol consumption was 3%, and drug abuse was 4%. About 47% were involved in a physical fight. Around 7% students were overweight. About 50% of the students skipped breakfast during previous week, and 6% had no intake of fruits and vegetables in last one month. Only 53% reported consistent use of seat belts.Conclusions: Several behavioral risk factors were prevalent among school children in Chandigarh. Behaviour surveillance to monitor trends should be conducted at regular intervals
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Background: Prevalence and underlying reasons of psychoactive substance use vary across different age, gender and societal groups. It is an important concern among females as female physiology and psychology makes them more vulnerable to substance dependence. The primary objective of study was to find prevalence, pattern and factors affecting psychoactive substance use among female students (18-25 years).Methods: In a cross-sectional survey, 250 female students were recruited from a university in Chandigarh using multistage cluster random sampling. Survey tool developed by World Health Organization was used in a self administrated format using paper based survey method. Associations among various factors leading to psychoactive substance use were tested using logistic regression model.Results: Lifetime prevalence of psychoactive substance use was 13.6% [95% CI 9.3-17.8, n=34]. Participants reported their use out of curiosity, for having fun, personal problems, easy availability, familial use, etc. 52.9% (18/250) students reported their use within last 3 months; out of them health problems were faced by two. Association of psychoactive substance use was significant for age, socioeconomic status and family history of psychoactive substance use.Conclusions: Due to sensitive nature of reporting substance use, the lifetime prevalence of 13.6% among female young students may be an underestimation. Familial psychoactive substance use exposes their wards to its use, especially under psychological stress. Qualitative research should be performed to understand why some female students use psychoactive substances while others abstain themselves from using these at all or abstain from their use for a long time after first exposure.
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BACKGROUND: Adverse drug reaction (ADR) monitoring is slowly developing as an important aspect of healthcare. The aim of the study was to study the pattern of adverse drug reactions in the Oncology department of a tertiary care hospital. MATERIALS AND METHODS: This was a prospective study conducted in the Oncology department of a tertiary care hospital in which ADRs were reported spontaneously. The ADRs were noted from 1st January, 2007 to 30th June, 2011. Following were noted: demographics, premedication (if any), diagnosis, chemotherapy (regimen, cycles), medication history, and alteration in the treatment or co morbidities, ADRs (severity and management). Adverse drug reactions were noted by patient interview, collaborating with information on file, recording changes in the prescribing chart and investigations, consulting the doctor on duty. RESULTS: During this study period, there were total of 14,475 visits of patients from which 2500 ADRs were recorded. Maximum number of ADRs were noted with platinum compounds (25.52%) followed by pyrimidine antagonists (19.88%). The most common malignancy reported in our hospital was Carcinoma breast (20%) followed by leukemia (12%) and Ca ovary (12%). Alopecia (27.76%) was the most common ADR followed by anemia (7.48%), thrombocytopenia (6.96%) and constipation (6.16%). CONCLUSION: Alopecia is the most common ADR and platinum compounds were responsible for the maximum number of ADRs. The most common carcinoma reported during this period was carcinoma breast.