RESUMO
BACKGROUND: Changing trends of privatization and globalization of health care compel the hospitals to practice cost accounting for providing accurate information about the cost of patient care. OBJECTIVES: The objectives were to determine unit cost and to identify major cost areas of outpatient department (OPD) services provided by the community health center (CHC) of Bankura district, West Bengal. MATERIALS AND METHODS: A cross-sectional study was conducted at Amarkanan CHC in 2016. Work sampling (WS) and time motion (TM) study were conducted for assessing the workforce cost, otherwise complete enumeration was done to assess the cost of different service areas such as medicine, logistic, maintenance, transport, electricity, building, equipment, and furniture. A predesigned pro forma and a questionnaire were used for WS and TM study and for interviewing the key informants for collection of information pertaining to different costs. Unit cost of different services as well as overall unit cost was estimated. RESULTS: If a patient received injection, undergone dressing, and had electrocardiogram and X-ray both done in a day, then the total cost of OPD services for workforce was Rs. 85.33/. Cost of logistics per patient per day was maximum in X-ray room. Manpower exerted the maximum cost incurred by the government to conduct OPD in Amarkanan CHC. Overall, the unit cost in OPD incurred by the government was Rs. 44.53/-. CONCLUSION: Close monitoring is required by aligning the staffing pattern and patient activities and having adequate number of staff with right skill at right place and time for efficiency, productivity, and cost-effectiveness.
RESUMO
BACKGROUND: Early childhood education (ECE) is an important service provided by Integrated Child Development Services (ICDS). It is largely responsible for developing school readiness in children. OBJECTIVE: The objective of this study is to assess ECE component of ICDS services through measurement of school readiness and find out other correlates. METHODS: A cross-sectional evaluation study was carried out among Anganwadi centers (AWCs) under Bankura Municipality, West Bengal, India from July to November 2015. AWCs were selected by 30 cluster sampling. From each selected center Anganwadi worker (AWW), 7 randomly selected children of 5 years of age and their caregivers were included in the study. Data were collected by assessment of children, interview of AWWs and caregivers of children, observation of ECE activity and record review using ECE Program Evaluation Package developed by World Bank and predesigned schedule. Mean, standard deviation, proportions were estimated for description and correlation, unpaired t-test, analysis of one-way variance, multivariable linear regression were performed to find out correlates of school readiness using SPSS 22.0 version. RESULTS: Average duration of ECE activity was 66.0 min/day which was far less than the norm. Overall average score of school readiness of 210 children was 14.0 out of 40. Inadequate physical facility, poor classroom performance acted as deterrents for school readiness. Help in the study at home was revealed to be a determinant of school readiness. CONCLUSION: For the preparation of formal schooling of children most important needs of the hour are physical facility of AWCs, supportive supervision of AWWs, and creation of congenial environment at home.
