Assessment of primary health centres of a district in North Karnataka according to Indian Public Health Standards 2012 guidelines: a cross sectional study

Background: Primary health centre (PHC) is a basic health unit to provide an integrated curative and preventive health care to the rural population as close to the people as possible, with emphasis on preventive and promotive aspects of health care.Methods: A facility based cross-sectional study was conducted in Belagavi district of Karnataka in India. Twenty PHCs, two PHCs from each of the 10 talukas of Belagavi district were selected by simple random sampling. The study period was from 1st January 2014 to 31st December 2014. Data was collected using a predesigned and structured questionnaire for IPHS facility survey.Results: In this study, only 60% of primary health centres covered the population as per the IPHS norms. All the PHCs were providing the regular outpatient department (OPD) services, referral services, antenatal care, family planning and in-patient services. Bed occupancy rate was less than 40% in 55% of PHCs. Building area in 75% of PHCs were inadequate according to IPHS norms. Residential facility for staff was available only in half of the studied PHCs.Conclusions: IPHS guidelines were not fully being followed at PHC level in the district. Though the requirement of medical officers and pharmacists was fulfilled in almost all the PHCs, deficiency was seen in the appointing of Ayush doctors and staff nurses at PHCs. There is an urgent need of recruiting the deficient staff for efficient functioning of the PHCs.

Assessment of available health services as per Indian public health standards at sub-centers of Vadodara district of middle Gujarat, India

Background: Setting standards are a dynamic process. To provide quality care at sub-centers (SC), Indian Public Health Standards (IPHS) standards are prescribed by Government of India. Objective: The objective of the study was to assess the availability of health services provided by SCs of Vadodara district. Materials and Methods: It was a cross-sectional study carried out at SCs of Primary Health Centres (PHCs) using IPHS standards as a checklist. The assessment was made by visiting 40 SCs of Vadodara district in Gujarat by a single observer. Descriptive statistics were used to present data. Results: About 36 (90%) of the SCs were located within the village and 38 (95%) SCs were easily accessible. The median distance of SC from PHC was 6 km. About 72.5% of SCs were having designated government building. About 52.5% SCs had a residential facility for frontline health workers. Availability for most of the drugs was very poor (below 25% age). Records of oral contraceptive pills usages were available in 34 (85%) of the SCs. The antenatal care services were improved by up to 25% in 10 SCs, while it was decreased to 25% in 13 SCs. Conclusion: The gaps existed in the availability of facilities and its standards at sub-centers. The availability of physical infrastructure and furniture was poor. There was worsening of the performance indicators in the majority of the components as compared to previous year records.

Provisioning of dental health in public hospitals: A case study of District Jalandhar, Punjab.

Background: The Government of India is increasingly emphasizing the provisioning of dental services in public hospitals, but the rural and deprived sections are struggling to get basic dental procedures done in public hospitals. Aim: To study variations within and across public hospitals for provisioning of dental health settings in Jalandhar district of Punjab. Settings and Design: The study area consisted of four Community Health Centers (CHCs) and District Hospital situated in Jalandhar, Punjab, India. Materials and Methods: The dental infrastructure and dental procedures performed in the public hospital were checked with the help of a checklist as listed in the Indian Public Health Standards 2012 for CHCs and district hospital, and then, the variations within and across these public hospitals were compared. Statistical Analysis: Percentages were used to make comparisons within and across the public health institutions. Results and Conclusions: The results showed that out of total outpatient department (OPD) of the public hospitals, dental OPD formed 5%–10% in public hospitals and extraction was the most frequently performed procedure. There is no availability of prosthodontic and orthodontic procedures in the public hospitals. There were no dental auxiliaries in the CHCs, and there was lack of proper dental materials needed in the dental clinics.

Burden of non communicable diseases in India: Setting priority for action.

Non-communicable diseases (NCDs) are defined as diseases of long duration, and are generally slow in progression. NCDs are replacing communicable diseases, maternal and child health as well as malnutrition as the leading cause of death. Non-communicable diseases are the leading cause of death in the world, responsible for 63% deaths worldwide in 2008. NCDs accounts for 53 percent of deaths in India. Based on available evidence cardiovascular diseases (24 percent), chronic respiratory diseases (11 percent), cancer (6 percent) and diabetes (2 percent) are the leading cause of mortality in India. Treatment cost is almost double for NCDs as compared to other conditions and illnesses. Burden of non-communicable diseases and resultants mortality is expected to increase unless massive efforts are made to prevent and control NCDs and their risk factors. India could develop a strategy for reducing out of pocket expenditure. Underlying determinants of NCDs mainly exist in non-health sectors, such as agriculture, urban development, education and trade. Inter-sectoral collaboration is therefore essential to create an enabling environment. Government of India had launched various vertical programmes such as National Cancer Control Programmes, National Tobacco Control Programme, National Programme for Prevention and Control of Cancer, Diabetes, CVD and Stroke (NPCDCS) etc. Strong surveillance, monitoring and evaluation system is required for successful implementation of the programmes. Public health facilities should be strengthened for providing services of screening; early diagnosis and treatment within the public health care delivery system. Efforts need to be done on implementing the clinical standards and guidelines developed under the Indian Public Health Standards (IPHS), and integrating NCD training into training curricula of health workforce.

Assessing Indian public health standards for community health centers: A case study with special reference to essential newborn care services.

The main objective of the study is to identify the availability of infrastructure facility, human resources, investigative services, and facility based newborn care services with respect to Indian Public Health Standards (IPHS) at community health centers (CHC) of Bharatpur District of Rajasthan State. Data were collected from service providers at CHC through well structured questionnaire at thirteen CHCs situated at Bharatpur District of Rajasthan State. It was found that infrastructure facilities were available in almost all the CHCs, but shortage of manpower especially specialists was observed. Availability of investigative services was found quite satisfactory except ECG. It was also observed that none of the CHCs have fully equipped facility based newborn care services (including newborn corner and newborn care stabilization unit). As per IPHS suggested in the revised draft (2010) important deficiencies were revealed in the studied CHCs of Bharatpur district and by additional inputs such as recruiting staff, improving infrastructure facilities, CHCs can be upgraded.

An application of Indian public health standard for evaluation of primary health centers of an EAG and a Non-EAG state.

National Rural Health Mission (NRHM) has provided the opportunities to develop a standard for Sub centers, PHCs and CHCs in the country, popularly known as Indian Public Health Standards (IPHS). The study was carried out to find out and compare to what extent the IPHS were followed by the PHCs in the selected districts of both the Empowered Action Group (EAG) state of Assam and non EAG state of Karnataka. It was a Cross sectional observational study conducted during September-October 2008 where the quality of care and services provided in the selected PHCs as per the IPHS norms was assessed. All the PHCs in both the studied districts were rendering the assured services of OPD, 24hrs general emergency service and referral services while 24 hour delivery services were being provided by 80% of the PHCs of the selected districts of both the states. Functional labor rooms were available only in 80% and 90% of the studied PHCs in Assam and Karnataka respectively. Basic laboratory facilities, for routine blood, urine and stool examination were available in 80% of the studied PHCs in the non-EAG state of Karnataka while it was only in 20% of the studied PHCs of the EAG state of Assam. The findings of the present study revealed important deficiencies as per IPHS norms in the studied PHCs of both Assam and Karnataka.