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 Cold Chain System for Routine Immunization of Primary Health centres of the Bhojpur district of Bihar

Background: Immunization is an important among activity in the Public Health Services. The vaccines are highly temperature sensitive and vaccine potency once lost cannot be restored. A well-managed cold chain will increase the efficiency of immunization and reduce vaccine wastage. An assessment of cold chain system for vaccine storage was done in the all PHCs of the study area. Aims & Objectives: To evaluate the cold chain practices, with particular reference to assessing the availability of cold chain equipment, vaccine storage practices, monitoring of cold chain in primary health centres (PHCs) of Bhojpur district. Material & Methods: A cross-sectional study was conducted at all the cold chain points of 14 PHCs of Bhojpur district during January to May 2015. A predesigned, pretested checklist was used by the trained investigators during their visits. The information was evaluated on the basis of important components related to the cold chain points. Results: All the PHCs had a dedicated cold chain room with sufficient number of cold chain equipment. Consolidated effective vaccine management score for cold chain points of 8 (57.1%) PHCs were average (60-79%). None of the PHCs have satisfactory score (≥ 80%). Vaccine storage practice and availability of complete RI micro-plan were found satisfactory at 12 (85.7%) PHCs. Maintenance of cold chain equipment were satisfactory at 10 (71%) PHCs. But, temperature monitoring. (5) (35.7%) and waste disposal related to routine immunization 3 (21.4%) PHCs were disappointing. Conclusion: The primary health centres had average performance related to the cold chain system, which is a matter of concern warranting for the cold chain monitoring. We recommend supportive supervision as the key measures in improvement of cold chain system.

Primary Health Centres: Preferred Option for Birthing Care in Tamilnadu, India, from Users’ Perspectives.

Tamilnadu state of India witnessed an increasing trend of institutional deliveries since the beginning of 1990s, with decline of domiciliary deliveries to nearly zero now. Among the institutional deliveries, a shift has been observed since 2006 wherein primary health centres (PHC) have shown a four-fold increase in the number of deliveries while other public and private health facilities showed a decline, despite equal access by people to all categories of health facilities. A qualitative study was designed to explore the determinants that led to increased preference of PHCs for birthing care. In-depth interviews and FGDs were conducted with recently-delivering women and their spouses. User-friendly ambience, courteous attitude and behaviour of staff, good infrastructure, availability of qualified staff, and relative absence of informal payments have contributed to increased preference for birthing care in PHCs. Barriers to seeking care from secondary and tertiary-level public hospitals and private hospitals have also made women prefer PHCs.

A Cross Sectional Study of Intern’s Willingness to Serve in Rural Primary Health Centres of Andhra Pradesh, India

The shortage of health professionals in rural areas is a global problem. The urban and rural maldistribution of doctors results in severe problems regarding access to and performance of health care services. Retaining doctors in rural areas is a challenging task for a number of reasons, ranging from personal preferences to difficult work conditions and low remuneration. The objective of the study was to understand the factors influencing medical and dental intern’s choice to work in rural PHC’s as a basis for designing policies to redress geographic imbalances in health professional’s distribution. A total of 385 dental and medical interns in Andhra Pradesh provided a unique contingent valuation data in a cross sectional survey conducted in 4 medical and 4 dental colleges in Andhra Pradesh, using a questionnaire concerning their preferences, related incentives to work in various rural and remote primary health centres of Andhra Pradesh state, India. The response rate of the study was 89 %, (n= 344), with only 24% of interns expressing their willingness to serve in rural/remote primary health centres. Most of the interns stressed for increase in salary, better accommodation and infrastructure of the hospitals as the factors for increasing their retention in remote rural areas. Although most Indian students are motivated to study medicine and dentistry by the desire to help others, this does not translate into willingness to work in rural areas. Efforts from the government to build intrinsic motivation during medical and dental training to serve in these deprived areas should be in focus with addition to improved working and living conditions and better remuneration.

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.