The Health Care Delivery System - National Institute of Health

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A Study to Review

The Health Care Delivery System Provided by

PHSC Punjab Health Systems Corporation Punjab

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National Institute of Health and Family Welfare Baba Gang Nath Marg, Munirka, New Delhi - 110067

A Study to Review The Health Care Delivery System Provided by Punjab Health Systems Corporation (PHSC), Punjab

Report 2008

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National Institute of Health and Family Welfare Baba Gang Nath Marg, Munirka, New Delhi – 110067 Email: [email protected] Website: www.nihfw.org

Study to Review The Health Care Delivery System provided by PHSC, Punjab

i

CONTENTS

List of Abbreviations

vi

Preface

vii

Acknowledgement

viii

Study Team

viii

Executive Summary

ix

Introduction

1

Objectives of the Punjab Health Systems Corporation Project

1

Rationale

3

Study Objectives

4

Methodology

5

Study Findings

8

Structural and Operational Framework of Punjab Health Systems Corporation (PHSC)

8

Facility Assessment

18

A. District Hospitals B. Sub-divisional Hospitals (SDHs) C. Community Health Centres (CHCs)

18 35 50

Views of the Beneficiaries on Quality of Services 1. In-patient Department 2. Out-patient Department

64 64 74

Evaluation of the Training Institutes

84

Community Voice

91

Views of the Stakeholders

100

• At District Level Deputy Commissioners (D.C) MLA/Elected Representative Civil Surgeons SMO in charge – District Hospitals

100 100 102 104 106

• At Sub-Division Level MLA/Elected Representative SMO – Sub Divisional Hospitals

109 109 110

• At CHC Level Elected Representatives at CHC Senior Medical Officers - CHC

113 113 114

Observations and Discussion Facility Survey Views of the Beneficiaries Views of the Community (through FGDs’) Views of the Stakeholders Conclusion and Recommendations

118 118 121 125 125 127

List of Tables 1

2

District Hospitals 1.1

General Profile and Facility Survey

132

1.2

Facilities Available

136

1.3

Laboratory Facilities

140

1.4

Out-patient Department

141

1.5

Emergency Services

144

1.6

Intensive Care Unit

146

1.7

Clinical Laboratories

147

1.8

Blood Banking Facilities

148

1.9

Radiology and Imaging

149

1.10 Operation Theatre

150

1.11 In-patient Wards

151

1.12 Hospital Medical Stores

153

1.13 Medical Record Department

155

1.14 Hospital Waste Management

156

1.15 Support Services

157

1.16 User Charges

160

1.17 Performance Report

163

1.18 Staff Position

165

1.19 Specialist Position

167

Sub Divisional Hospitals 2.1

General Profile and Facility Survey

168

2.2

Availability of Equipment

171

2.3

Laboratory Facilities

173

2.4

Out-patient Department

176

2.5

Emergency Medical Services

178

2.6

Intensive Care Unit

180

2.7

Clinical Laboratories

181

2.8

Blood Banking Facilities

182

2.9

Radiology and Imaging Services

183

2.10 Operation Theatres

185

2.11 In-patient Department

188

2.12 Hospital Medical Stores

190

2.13 Medical Record Department

192 iii

3

4 5 6 7 8 9 10 11 12 13

2.14 Central Supply Department

194

2.15 Five Year Performance Report

196

2.16 Utilisation of User Charges

198

2.17 Medical Officers in Position

201

2.18 Staff Positions

203

Community Health Centres 3.1

General Profile and Facility Survey

205

3.2

Equipment available at CHCs

208

3.3

Laboratory Facilities

209

3.4

Referral Facilities

210

3.5

Out-patient Department

212

3.6

Emergency Medical Services

214

3.7

Clinical Laboratories

216

3.8

Blood Banking Facilities

217

3.9

Special Investigations

218

3.10 Operation Theatres

219

3.11 In-patient Department

220

3.12 Hospital Medical Stores

222

3.13 Medical Record Department

223

3.14 Hospital Waste Management

224

3.15 Central Supply Department,

225

3.16 Laundry Services

225

3.17 Dietary Services

226

3.18 Medical Officers in Position

227

3.19 Five Year Performance Report

229

3.20 Staff Positions

231

3.21 Utilisation of User Charges

233

Distribution of Patients in Wards Admissions in Different Hospitals User Charges for Services in Various Hospitals Experience at Facility and Quality of Care Patient Responses on Quality of Services Patient Responses on Behaviour of Staff Availability of Medicines (patients’ responses) Money Spent (patients’ responses) Rules and Regulations at Facilities (patients’ responses) Satisfaction from the Services

236 238 239 240 242 244 245 245 246 246

14

Suggestions for Further Improvement

247

15

Distribution of Out-patients

248

16

User Charges for Services (patients’ responses)

250

17

Observations on Facility Profile (patients’ responses)

251

18

Quality of Services (patient responses)

252

19

Health Manpower (patient responses)

254

20

Waiting Time (patient responses)

255

21

Patients’ Experience (Rating)

256

22

Suggestions for Further Improvement (out patients)

257

23

Responses of Deputy Commissioners

260

24

Responses of MLA/Elected Representatives

261

25

Responses of Civil Surgeons

262

26

Responses of SMOs of District Hospitals

263

27

Responses of Elected Representatives at Sub-division Level

264

28

Responses of SMOs of SDH

265

29

Responses of Elected Representatives at CHC Areas

266

30

Responses of SMOs of CHC

268

Study to Review The Health Care Delivery System provided by PHSC, Punjab

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List of Abbreviations

ANC ANM ASHA BOR BTR CHA CHC CSSD DC DD-cum-CS DH DMC ECG FGDs GDMO ICU IPF LP MLA MO NHP OPD OT PHC PHSC PPS RKS SDH SHC SMO SP Hospital VED

vi

Ante Natal Care Auxiliary Nurse Midwife Accredited Social Health Activist Bed Occupancy Rate Bed Turnover Rate Community Health Administration Community Health Centre Central Sterile Supply Department Deputy Commissioner Deputy Director-cum-Civil Surgeon District Hospital Deputy Medical Commissioner Electro Cardiogram Focus Group Discussions General Duty Medical Officer Intensive Care Unit In-Patient Facilities Lumbar Puncture Member, Legislative Assembly Medical Officer National Health Programmes Out-patient Department Operation Theatre Primary Health Centre Punjab Health Systems Corporation Population Proportionate to Size Rogi Kalyan Samiti Sub-divisional Hospital Subsidiary Health Centre Senior Medical Officer Special Hospital Vital, Essential, Desirable

Study to Review The Health Care Delivery System provided by PHSC, Punjab

Preface

The Punjab Health Systems Corporation (PHSC) was created as a non-commercial statutory corporation in 1996 vide Punjab Act no. 6 of 1996, with the purpose to establish, expand, improve and administer curative and preventive services at secondary level health care institutions in the state of Punjab. The corporation has taken over the District Hospitals, Sub-Divisional Hospitals (SDHs) and Community Health Centres (CHCs) along with some rural and urban Medical Institutions. Training Institutes viz. State Institute of Health and Family Welfare (SIHFW), Mohali, and State Institute of Nursing and Paramedical Sciences (SINPS), Badal, Distt. Muktsar and Institute of Mental Health, Amritsar have also been included under PHSC institutions. The present study was conducted with the aim to review the extent to which the objective of the Health Systems Development Project II focusing on improving the health care delivery at the secondary level of health care has been achieved. It was an exploratory study for situational analysis in order to identify the areas of sub-optimal utilisation and suggest the measures for improvement. The study was conducted through the in-depth review of structural organisational and operational framework of PHSC. The site visits to review at least 50% of the 20 District Hospitals located in the different regions of the state and 26% of 37 SDHs and 10% of the 111 CHCs were made along with two special hospitals (Patiala & Bhatinda) and all the training institutions. Ten teams each comprising of faculty and research staff from National Institute of Health and Family Welfare (NIHFW) visited each of the 10 selected sample districts of Punjab and collected the data from respective district areas comprising of District Hospital, Sub divisional Hospital and Community Health Centre. It is hoped that the report of this study will be of considerable help to the State Government and other stakeholders in improving health care delivery system at secondary level of health care.

Prof. Deoki Nandan Director, NIHFW

Study to Review The Health Care Delivery System provided by PHSC, Punjab

vii

Acknowledgement The leadership and guidance provided by Prof. J.S. Bajaj, Vice Chairman, Punjab State Planning Board, Government of Punjab, support extended by Health and Family Welfare Department and various stakeholders towards conduction of this study is greatly acknowledged.

Study Team Team Leader

Prof. Deoki Nandan, Director, NIHFW

Amritsar

Dr. U. Datta, Reader and Acting Head, Deptt. of Education and Training Mrs. Rita Dhingra, Research Officer Mr. G.P. Devrani, Asstt. Research Officer Dr. B.S. Diwan, PG (CHA) student and Dr. Yashika, PG (CHA) student

Bhatinda

Prof. J.K. Das, Head, Deptt. of Epidemiology and MCHA Mrs. Reeta Dhingra, Research Officer Mr. G.P. Devrani, Asstt. Research Officer Dr. Devinder Megha, PG (CHA) student and Dr. Vartika, PG (CHA) student

Firozpur

Dr. Vivek Adhish, Reader, Department of CHA Mrs. Vandana Bhattacharya, Research Officer Mr. S.S. Mehra, Asstt. Research Officer Dr. B.S. Diwan, PG (CHA) student and Dr. Jagriti, PG (CHA) student

Gurdaspur

Dr. Sanjay Gupta, Reader, Department of CHA and Sub Dean Dr. Rachna Agarwal, Asstt. Research Officer and Mr. S.P. Singh, Research Assistant Dr. Nishant, PG (CHA) student and Dr. Ashu, PG student

Hoshiarpur

Dr. V. Adhish, Reader, Department of CHA Mrs. Vandana Bhattacharya, Research Officer Mr. S.S. Mehra, Asstt. Research Officer Dr. Sonia, PG (CHA) student and Dr. Vijaydeep, PG (CHA) student

Jallandhar

Dr. Gyan Singh, Chief Medical Officer, Department of CHA Mr. S.S. Mehra, Asstt. Research Officer Mrs. Vaishali, Research Assistant Dr. Vartika, PG (CHA) student and Dr. Devendra Megha, PG (CHA) student

Ludhiana

Prof. M. Bhattacharya, Head, Department of CHA, and Dean Mr. Parimal Pariya, Research Officer Mr. Ramesh Gandotra, Asstt. Research Officer Dr. Kumud, PG (CHA) student and Dr. Naveen, PG (CHA) student

Muktsar

Dr. Sanjay Gupta, Reader, Department of CHA, and Sub Dean Mr. Parimal Pariya, Research Officer Dr. Rachna Agarwal, Asstt. Research Officer Dr. Shailender, PG (CHA) student and Dr. Sudha Goel, PG (CHA) student

Sangrur

Prof. J.K. Das, Head, Deptt. of Epidemiology and MCHA Mrs. Reeta Dhingra, Research Officer Mr. G.P. Devrani, Asstt. Research Officer Dr. Rakesh, PG (CHA) student and Dr. Madhu, PG (CHA) student

Tarantaran

Prof. J.K. Das, Head, Deptt. of Epidemiology and MCHA Mr. J.P. Shivdasani, Research Officer Mrs. Vinod, Asstt. Research Officer Dr. Sunil, PG (CHA) student and Dr. Indu, PG (CHA) student

Editorial Team

Prof. J.K. Das, Dr. Neera Dhar, Reader, Mr. Jai Shivdasani, RO, Dr. Poonam Khattar, Reader, Department of Education and Training, Dr. Manish Jain, MD, and Ramesh Chand, ARO

Executive Summary

The Punjab Health Systems Corporation (PHSC), has been enacted through “The Punjab Health Systems Corporation Act, 1996 (Punjab Act No. 6 of 1996)”. The ‘Second State Health Systems Development Project’ was started under PHSC in the year 1996, with financial assistance from World Bank, with an objective to upgrade health services at secondary level. This project ended in the year 2002, and since then the Government of Punjab is supervising it through PHSC. Today, PHSC has 166 health institutions throughout the state of Punjab (86 in rural and 80 in urban areas), including District Hospitals, Sub Divisional Hospitals and Community Health Centres. Three Training Institutions viz. State Institute of Health and Family Welfare (SIHFW), Mohali, State institute of Nursing and Paramedical Sciences (SINPS), Badal, and Institute of Mental Health, Amritsar have also been included under PHSC. The present study is an in-depth review of structural organisation and operational framework of the PHSC, and an assessment of the achievements/success of the Health Systems Development Project in improving health care delivery at secondary health care level. The assessment also meant to bring to light the gaps in delivery of health care services and to provide practical recommendations for further strengthening the system. For the present review, a Review Committee was constituted and it conducted on site visits to 10 District Hospitals, 10 Sub Divisional Hospitals, 11 Community Health Centres, 2 Speciality Hospitals and 3 Training Institutions, which were selected using Population Proportionate Sampling Technique (PPS). Key quantitative information was collected using Facility Survey Checklist, Interview Schedules (for health staff), Exit Interviews of clients, and Interviews with other stakeholders. The information obtained was further triangulated with qualitative observations by conducting Focus Group Discussions with the community. The study was conducted between 15th January 2008 and 5th March 2008. It was revealed following the study that health facilities under PHSC are well accessible and the buildings and other infrastructure are appropriate. But the cleanliness of facility and surroundings, as well as landscape requires more attention. Some health facilities were not having the required equipment and among those which were having them, there were few where these equipment were either not being used or was non-functional. Shortage of manpower was revealed as a generalised observation in almost all the health facilities, particularly the specialists, laboratory technicians and Class IV employees. This issue was of grave concern in Sub Divisional Hospitals (SDHs) and Community Health Centres (CHCs). Another observation was that there is no separate cadre for GDMOs (General Duty Medical Officers) and Specialists, which is leading to poor OPD (Out patient department) services since the specialist doctors have to do emergency duties as well. Availability of medicines, particularly of the essential medicines was lacking in almost all the health facilities, and patients had to buy it from private medical shops, which was a matter of dissatisfaction among majority of patients as well as community. Health facilities were also found purchasing few essential drugs from the user charges and were not being supplied from State Study to Review The Health Care Delivery System provided by PHSC, Punjab

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or district level. Besides this although laboratory facilities were available in all the institutions visited, it was observed that they were not able to provide services most of the time due to lack of reagents and equipment. Radiologists and lab technicians were also not available in majority of these institutions. Emergency services were also found grossly compromised, particularly in the sub divisional hospitals, mainly due to staff vacancy and security reasons. Overall the health facilities visited were found deficient with regard to disaster preparedness, referral linkages, record keeping, store management and in provision of basic facilities like toilets to the visiting clients. It was observed that majority of clients approaching PHSC institutions were females belonging to poor socio-economic strata of the community. It was revealed that well to do families prefer to visit private doctors, because of better quality and prompt services there as compared to Government facilities. Major reasons for this discontentment were more waiting time due to lack of doctors and other staff, lack of medicines and other investigative facilities and poor behaviour of some of the health staff. Overall experience of respondents at OPDs of the various health institutions was not found to be very satisfactory. This observation was in particular for CHCs and District Hospitals, which require prompt attention. The community also opined and favoured the observations obtained at the OPD and inpatient departments of the health facilities. Lack of medicines, specialised doctors particularly gynaecologists, lack of diagnostic equipment, investigation facilities, appropriate emergency services, and referrals including ambulance service were major issues raised by the community, which needs to be addressed for improving the acceptability of these services. In brief, it was revealed from the community, clients and other stakeholders, that the project has succeeded in building the infrastructure. But its further maintenance, its capacity to address the community needs and satisfaction and provision of quality health care services through public health facilities still need to be addressed for better utilisation of the available resources.

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Study to Review The Health Care Delivery System provided by PHSC, Punjab

1.0 Introduction

Hospital services at secondary level play a vital and complimentary role to the tertiary and primary health care systems and together form a comprehensive district based health care system. It was observed that in the state of Punjab, District Hospitals, Sub-divisional Hospitals and Community Health Centres were having critical gaps in buildings, equipment, manpower, and skills and were unable to provide basic health care services. With an objective to improve efficiency and quality of the health care provided at first referral level hospitals, the State Government took an initiative to prepare a proposal for seeking aid from the World Bank. On the request of the State Government, the World Bank team visited the State in March 1995 to review preparation and pre-appraisal of the proposal for the “Health Systems Development Project-II”. On March 21st, 1996, the International Development Association (IDA) approved credit of SDR 235.5 million (US$350 million equivalent) under the multi-states Health Systems Development Project for implementation in the States of Karnataka, Punjab and West Bengal. The Development Credit Agreement and the Project Agreements were signed on April 18, 1996 on behalf of the Government of India and respective states. Thus, Punjab Health Systems Corporation was incorporated through enactment of Legislative act “The Punjab Health Systems Corporation Act, 1996 (Punjab Act No. 6 of 1996)”. The Corporation was incorporated through measures by the Government of Punjab to bring more administrative flexibility for implementation of the ‘Second State Health Systems Development Project’ with World Bank assistance to upgrade Health Services at secondary level. The Corporation took over 166 Institutions, which included District Hospitals, Sub-Divisional Hospitals and Community Health Centres. 86 Medical Institutions are situated in rural areas and 80 are in urban areas. Two training institutes viz. State Institute of Health and Family Welfare, Mohali and State institute of Nursing and Paramedical Sciences, Badal, Distt. Muktsar have also been constructed and were included under PHSC institutions. The World Bank sanctioned the Second State Health Systems Development Project of US$106.10 million to upgrade the envisaged areas means clinical, diagnostic and other services provided by community/rural, sub-divisional/taluka/state general and District Hospitals in the State of Punjab.

1.1 Objectives of the Punjab Health Systems Corporation Project a) To improve efficiency in the allocation and use of health resources in the Project States Study to Review The Health Care Delivery System provided by PHSC, Punjab

1

through policy and institutional development; and b) To improve the performance of the health care system in the Project States through improvements in the quality, effectiveness and coverage of health services at the first referral level and selective coverage at the primary level, so as to improve the health status of the people, especially the poor, by reducing mortality, morbidity and disability. As per the suggestions, the Project for revamping the Secondary Level Health Care Services was proposed to help in: • Adding and renovating hospital building at the block, sub-divisional and district headquarters; • Supplementation of accommodation for essential staff; • Provision of more ambulances and better machinery and equipment; • Increase in body strength at some places; • Additional hospital linen and accessories; • Maintenance funds for building, vehicles, machinery and equipment; • Cleanliness, repair and up-keep of all buildings. The whole of the State was to be covered through 86 Government Health Centres in the rural areas.

1.2 The Benefits to the General Public a. b.

c.

2

Free consultation for all Free diagnostic analysis, medicines and also treatment like operations, etc. for Yellow Card holders, Punjab Government Employees, Pensioners, past and present Members of Legislative Assembly, Hon’ble Judges, Freedom Fighters, under trial Prisoners, under emergencies and natural calamities and under National Programmes. Full availability of equipment and chemicals, etc. for diagnostic facilities.

Study to Review The Health Care Delivery System provided by PHSC, Punjab

2.0 Rationale

As mentioned above, the Health Systems Development Project started under PHSC in 1996 with financial assistance from World Bank and concluded in the year 2002. Since then Government of Punjab is supervising it through a duly constituted corporation i.e. Punjab Health Systems Corporation (PHSC). The present study was conducted with the aim of reviewing as to how far the objective of this Project (HSDP II) has been achieved in improving health care delivery at the secondary level of health care. Also to bring to light any lacunae or gaps observed in delivering the health care services to the community. The study is an In-depth review of the Punjab Health System by the Review Committee constituted for the purpose.

2.1 Constitution of Committee i)

Dr. J.S. Bajaj V.C.Punjab Planning Board

Chairman

ii) Dr. K.K. Talwar Director, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh

Member

iii) Dr. P.K. Dave Former Director, All India Institute of Medical Sciences (AIIMS), New Delhi

Member

iv) Dr. Deoki Nandan Director, National Institute of Health and Family Welfare (NIHFW), New Delhi

Member

v)

Member

Dr. Shakti Gupta Medical Superintendent, AIIMS, New Delhi

vi) Dr. Sukhdev Singh Director, Family Welfare, Punjab

Member

vi) Dr. Roshan Sunkaria, IAS Managing Director, PHSC

Member Convener Member

viii) Shri Tejveer Singh, IAS Special Secretary to Government of Punjab Department of Planning

Coordinator Member

Study to Review The Health Care Delivery System provided by PHSC, Punjab

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2.2 Terms of Reference The Committee was to make on site visits and to review at least 50% of the 20 District Hospitals located in different regions of the State, along with a similar inspection of 2 Special Hospitals (Patiala and Bhatinda), as well as of 10% of 37 Sub Divisional Hospitals (SDHs) and 5% of the 111 Community Health Centres (CHCs).

2.3 Study Objectives i)

To conduct an in-depth review of structural organisational and operational framework of Punjab Health System Corporation (PHSC) and to assess the efficiency and effectiveness of management system so far established. ii) To conduct site visits to a specified number of District Hospitals, special hospitals, sub divisional hospitals and community health centres and assess the quality and efficiency of the delivery of health care at each of the health institutions. iii) To visit the three special Training and Teaching Institutions which are under the management control of PHSC and conduct a short academic review of the physical facilities as well as of the process of education. iv) To propose requisite remedial measures aimed at optimising a cost-effective and efficient management of PHSC as well as of hospitals and training institutions under its control and management. The field work, data collection, analysis, interpretation and report writing was done by National Institute of Health and Family Welfare, New Delhi.

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Study to Review The Health Care Delivery System provided by PHSC, Punjab

3.0 Methodology

3.1 Type of Study This was an exploratory study conducted in the state of Punjab with an objective to undertake situational analysis, identify areas of sub optimal functioning and suggest remedial measures.

3.2 Duration of Study 15th January to 5th March 2008.

3.3 Sample Size 1. 2. 3. 4. 5.

50% of 20 District Hospitals (DHs) 26% of 37 Sub Divisional Hospitals (SDHs) 10% of 111 Community Health Centres (CHCs) All the Special Hospitals (SHs) All the Training Centres (TCs)

10 DHs 10 SDHs 11 CHCs 02 SHs 03 TCs

Total

36

3.4 Sampling Technique Selection of the Districts was done by using the Population Proportionate to Size (PPS) Technique. These Districts were selected proportionately from the 3 existing geographical regions i.e. Majha, Doaba and Malwa. Hence the region wise sample of the Districts drawn was as follows:

Majha 1. 2. 3.

Amritsar Gurdaspur Taran Taran

Doaba 1. 2.

Hoshiarpur Jalandhar

Study to Review The Health Care Delivery System provided by PHSC, Punjab

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Malwa 1. 2. 3. 4. 5.

Bhatinda Ferozpur Muktsar Sangrur Ludhiana

3.5 Data Collection Tools and Techniques 1) 2) 3) 4) 5)

Interview schedule for health functionaries/service providers Exit interview schedule for patient satisfaction Checklist for Facility Survey Questionnaire for trainers Interview schedule for other stakeholders including community

The health functionaries, other stakeholders, sample of beneficiaries (i.e. patients selected randomly) and facility surveys of health institutions for study were as follows:

3.5.1 At district level a) b) c) d) e) f) g)

District Collector Civil Surgeon Local MLA/MP SMO/MS at District Hospitals Indoor patients Outdoor patients (OPD) Facility Survey of District Hospitals

1x10 = 10 in no. 1x10 = 10 in no. 1x10 = 10 in no. 1x10 = 10 in no. 10% of the total admitted in hospital or minimum of 10 patients 5% of the OPD attendance or minimum of 20 patients 1x10 = 10 in no.

3.5.2 At sub-divisional level a)

c)

Local elected representatives at sub-divisional level SMOs/MS at Sub-Divisional Hospitals Indoor patients

d)

Outdoor patients (OPD)

e)

Facility Survey of Sub-Divisional Hospitals FGD (Male Community Members)

b)

f)

6

1x10 = 10 in no. 1x10 = 10 in no. 10% of the total admitted in hospital or minimum of 6 patients 5% of the OPD attendance or minimum of 20 patients 1x10 = 10 in no. 1x10 = 10 in no.

Study to Review The Health Care Delivery System provided by PHSC, Punjab

3.5.3 At CHC level a) b) c)

Local elected representatives at CHCs SMO/MS at CHC Indoor patients

d) e) f)

Outdoor patients (OPD) Facility Survey of the CHCs FGD (female community members)

1x11 = 11 in no. 1x11 = 11 in no. 10% of the total admitted in hospital or minimum of 3 patients 5% of the OPD attendance or minimum of 10 patients 1x11 = 11 in no. 1x11 = 11 in no.

Due care was taken to select the SDHs and CHCs from the same district from which District Hospital was selected so as to study the referral linkages.

3.5.4 Special hospitals a) b)

SMO/MS at Special Hospitals Indoor patients

c)

Outdoor patients (OPD)

1x2 = 2 in no. 10% of the total admitted in hospital or minimum of 10 patients 5% of the OPD attendance or minimum of 20 patients

3.5.5 Training institutes a) b)

Facility Survey Interview of the faculty

1x3 = 3 in no.

3.6 Data Collection Team 10 Teams, each comprising of 1 faculty member, 2 research staff and 2 students from NIHFW visited their respective sample district and collected the above mentioned data from whole of the district area. Training Institutes were also evaluated during these visits.

Study to Review The Health Care Delivery System provided by PHSC, Punjab

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4.0 Study Findings

Following are the study findings as per the terms of reference provided:

4.1 Structural and Operational Framework of Punjab Health Systems Corporation (PHSC) A review of structural, organisational and operational framework of Punjab Health Systems Corporation (PHSC) was carried out. The detailed findings are as follows: The World Bank team on the request of the State Government visited the State in March-95 to review preparation and pre-appraisal of the proposal for the “Health Systems Development Project-II”. Thus, Punjab Health Systems Corporation had been incorporated through enactment of Legislative act “The Punjab Health Systems Corporation Act, 1996 (Punjab Act No. 6 of 1996)’. The Corporation has been incorporated through measures by the State Government of Punjab to bring more administrative flexibility for implementation with assistance of World Bank to upgrade Health Services at secondary level. The PHSC was incorporated on October 20, 1995 to establish, expand, improve and administer medical care at secondary level of health care services. The project activities were undertaken by the PHSC and the State Government has ensured that PHSC should function as an autonomous body. For its effective implementation, a Strategic Planning Cell is functioning under the overall supervision of the MD, PHSC-cum-Secretary Health. Under this project, PHSC had taken over 166 Institutions, which includes District Hospitals, Subdivisional Hospitals and Community Health Centres. 86 Medical Institutions are situated in rural areas and 80 are in urban areas. Two training institutes viz. State Institute of Health and Family Welfare, Mohali and State Institute of Nursing and Paramedical Sciences, Badal, Distt. Mukatsar have also been constructed and were included under PHSC institutions. The World Bank sanctioned the Second State Health Systems Development Project of US$106.10 million (approximately Rs. 422 crores) to upgrade the envisaged areas means clinical, diagnostic and other services provided by community/rural, sub-divisional/taluka/state general and District Hospitals in the State of Punjab.

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Study to Review The Health Care Delivery System provided by PHSC, Punjab

Organogram of Department of Health & Family Welfare Health & Family Welfare Minister

Parliamentary Secretary Health & Family Welfare

Principal Secretary Health & Family Welfare

Secretary Health cum Managing Director PHSC

PHSC

Special Secretary Health cum Mission Director NRHM cum PD AIDS

Director Health Services

Director Family Welfare

Director (SI)

Secretary Health cum Commissioner AYUSH

Head of Department Homeopathy

C

D

E

F

G

Jt. Secretary Health

A Health-I, II & IV Branches

PSACS Under Secretary Health

PHSC Health - V, VI & VII Branches

B

Punjab Health Systems Corporation

PSACS Punjab State Aids Control Society SI

Social Insurance (ESI)

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The major heads under which the funds were provided were Loan Rs. 252.00 crore, Grant Rs. 127.00 crore and Share of the State Government. Rs.43.00 crore. Break up of the budget was as follows: Head

Rs. in Crore

Civil works for renovation, new construction and extension Major/Minor equipment, Surgical Packs and Furniture Vehicles and Ambulances

174.07 66.09 8.49

Medicines, Medical Lab, Supplies

26.51

Information Systems and Computers

11.14

Training and Workshop

12.45

Salaries and Office Expenses

49.66

Price Contingencies

73.47

Total

Rs. 421.88

4.2 The Corporation consists of: (a) The Chairman who shall be the Secretary to the Government of Punjab in the Department of Health and Family Welfare or a distinguished and eminent medical person. (b) The Vice Chairman of the Punjab Health Systems Corporation is the Secretary Health and Family Welfare and is the overall in charge of the department. He is the Chairman of the Punjab AIDS Control Society, Chairman of SCOVA (RCH Society), TB society and Leprosy Society. (c) Secretary Health-cum-Managing Director, who shall be an officer of the Indian Administrative Service. He assists the Vice chairman of the PHSC in connection with the administrative issues concerning to the PCMS doctors, which include Recruitment, Posting, Transfers, Disciplinary Actions, Service Rules etc. In addition to this, he has also been designated as Head of Department (HOD) of Government Mental Hospital, Amritsar. He is assisted by Superintendents of Health – I and II Branches of the Department and is supported by the Director, General Manager (F&A), Executive Engineers and other Programme Officers. (d) A Board of Directors; and such other employees, as may be determined by the Board of Directors.

4.3 Constitution of Board of Directors The Board of Directors consisting of the following members namely: (a) The Secretary to the Government of Punjab in the Department of Finance, (b) The Secretary to the Government of Punjab in the Department of Rural Development and Panchayats, (c) The Secretary to the Government of Punjab in the Department of Local Government, (d) Representative of the Government of India in the Ministry of Health, (e) The Director of Health Services, Punjab, (f) Six eminent persons as given below nominated by the Government for a period of three years, (provided that no nominee shall be a member of the Board of Directors for more than

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Study to Review The Health Care Delivery System provided by PHSC, Punjab

Punjab Health Systems Corporation Chairman

A

Vice Chairman-cum-Principal Secretary, Health & Family Welfare

Managing Director

Director cum Principal S.I.H.F.W. Mohali

Director (Institute of Mental Health Amritsar)

General Manager (F&A cum Secy Board)

DMA

AM Audit

AMFA

Executive Engineer (Works)

EE (C) Mohali

EE (C) Patiala

Principal State Institute (Badal) Dy Dir. (Admn) Dy Dir. (P&T) Asst. Dir. (Admn) Asst. Dir. (Sur) Asst. Dir. (HS) Asst. Dir. (BB) Asst. Dir (Equip)

Accountants

EE (C) Jalandhar AAO

AMFA

Assistant Manager (Finance & Accounts)

AAO

Assistant Accounts Officer

Acct

Accountant

Admn

Administration

BB

Blood Bank

DMA

Deputy Manager Accounts

DMC

Deputy Medical Commissioner

EE (C)

Executive Engineer (Civil)

F&A

Finance and Accounts

HMIS

Health Management Information Systems

HS

Hospital Services

Med Supdt

Medical Superintendent

P&T

Procurement and Transport

Stat Anyst

Statistical Analyst

Sur

Surveillance

Study to Review The Health Care Delivery System provided by PHSC, Punjab

11

two terms or six years whichever is less): (i) A representative of medical institution of excellence in the country, (ii) Two distinguished experts in professions related to medicine and health, (iii) An experienced professionals in Systems Management or Telecommunication, (iv) The Director of the National Institute of Pharmaceutical Education and Research; and (v) A representative of a reputed industrial house manufacturing pharmaceuticals.

4.4 The Managing Director •





The Managing Director is the Executive Officer of the Corporation and he shall implement the decisions of the Board of Directors and shall exercise such other powers and perform such other functions, as may be delegated to him from time by the Broad of Directors. The Managing Director exercise general control and supervision over the dispensaries and hospitals in the effective performance of their functions under this Act or the regulations made there under. Corporate Level Departments 1. Strategic Planning Cell (SPC) 2. Department of Administration 3. Department of Procurement 4. Engineering Wing 5. Department of Finance and Accounts 6. Computer Cell.



District Level Management of the Corporation 7. Deputy Medical Commissioner 8. District Health Committee 9. Assistant Medical Commissioner 10. Other medical and Paramedical Staff



Hospital Level Staff 11. Senior Medical Officer 12. Medical Officer 13. Other medical and Paramedical Staff

4.5 Functions of the Corporation In order to ensure the focused approach for management of secondary level health care services, additional programme officers in the field of Quality Assurance, HMIS, Waste Management, Surveillance, Referral, Training, IEC, Hospital Services, Blood Bank have been positioned at headquarters level. Separate offices were set-up for Deputy Medical Commissioners (DMC). Apart from this, in order to enhance the data collection and analysis capabilities, the office of DMCs have been strengthened by providing manpower in the field of accounts and HMIS which support the hospitals in proper record keeping and monitoring. 12

Study to Review The Health Care Delivery System provided by PHSC, Punjab

The functions of the Corporation are as follows: a) to formulate and implement the schemes for the comprehensive development of the dispensaries and hospitals; b) to construct and maintain dispensaries and hospitals including cleanliness; c) to implement National Health Programmes as per the directions of the State. The State Government and Central Government shall make funds available for this purpose; d) to purchase, maintain and allocate quality equipment to various dispensaries and hospitals; e) to procure, stock and distribute drugs, diet, linen and other consumable among the dispensaries and hospitals; f) to provide services of specialists and super-specialist in various hospitals g) to enter into collaboration for super specialities with health institutions both within the country and abroad to provide better medical care; h) to receive donations, funds and the like from the general public and institutions from both within and outside India; i) to receive grants or contributions which may be made by the Government on such conditions as it may impose; j) to provide for construction of houses to the employees of the dispensaries and hospitals, and the maintenance thereof by mobilising resources for financing institutions; k) to plan, construct and maintain commercial complexes, paying wards and providing diagnostic services and treatment on payment basis and to utilise the receipts for the improvement of the dispensaries and hospitals; l) to run public utility services and undertake any other activity of commercial nature for the delivery of health care within or without the hospital premises directly or in collaboration with private or voluntary agency on contract basis; m) to engage specialised agencies or individuals in the relevant disciplines, directly or from external sources for the efficient conduct of the functions; and n) to provide immediate treatment in case of emergency and for unaccompanied patients.

4.6 Steps for the betterment of employees 1. 2. 3.

Chance of foreign training for all doctors and para-medical staff; Substantial training opportunities and fellowships etc. within the country; No change in the terms and conditions of the services, establishment matters will remain wherever they are.

4.6.1 At district headquarter level There is one Deputy Director cum Civil Surgeon (DD cum CS) in each district and hence a total 20 DD cum CS in Punjab. DD cum CS supports the Directorate of Health Services through taking care of implementation of various National and State Health Programmes, Implementation of Registration of Births and Deaths Act and Prevention of Food Adulteration Act. The Deputy Medical Commissioner (DMC) supports the DD cum CS in the provision of hospital services in the district. The District Health Officer assists the DD cum CS in the implementation of the Disease Control Programmes. S/he also supports the Directorate of Family Welfare (DFW) in enforcement of PNDT Act as District Appropriate Study to Review The Health Care Delivery System provided by PHSC, Punjab

13

Authority and implementation of different schemes in the District under National Family Welfare Programme through District Family Welfare Officer and District Immunisation Officer.

4.6.2 At block level The Civil Surgeon is supported by Senior Medical Officers, I/c of PHCs and Medical Officers I/c of Subsidiary Health Centre (SHC) in implementation of various National and State Health Programmes at grassroot level.

4.6.3 At subsidiary health centre level The Senior Medical Officers are supported by Medical Officer I/c SHC for Implementation of different schemes in the SHC area under National Family Welfare Programme through Multipurpose Health Worker (Male and Female). Medical Officers I/c are supported by Multipurpose Health Worker (Male/Female) in implementation of (i) Universal Immunisation Programme (DPT, Polio, BCG, Measles and TT for Pregnant mothers). (ii) Maternal & Child Health (Antenatal Check Up, Institutional Delivery & Post Natal Check Up). (iii) Family Planning: Counseling/motivation.

District Headquarters Deputy Director-cum-Civil Surgeon {1 Post at each district} (Total = 18)

Assistant Civil Surgeon

District Health Officer

District Immunisation Officer

X

District Family Planning Officer

Senior Medical Officers of PHC/SHCs

SMO (Hospitals)

1 Primary Health Centre for appropriately (100,000) population Total in the State 118 SMO - 1 MO - 2 at each PHC

SHC (Subsidiary Health Centre/Dispensary) For 10,000 population each total in the State: 1200

Sub-centre Total with State: 2858+ (5000 population) LHV, Multi-Purpose Supervisor – For a Population of 30,000 (MPHW – M+F)

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Study to Review The Health Care Delivery System provided by PHSC, Punjab

Deputy Medical Commissioner

LHV

(Lady Health Visitor)

M+F

(Male & Female)

MPHW

(Multipurpose Health Worker)

PHC

(Primary Health Centres)

SHC

(Subsidiary Health Centre)

SMO

(Senior Medical Officer)

(iv) Management of diarrhoea especially in infants. (v) Health Education: educating the community about the various available services. (vi) Control of Acute Respiratory Infection especially in infants. (vii) Identify the women requiring help for medical termination of pregnancy and refer them to nearest approved institution (viii) Health Survey.

4.6.4 Deputy Medical Commissioner (DMC) The DMC looks after the hospital services in District Hospitals, Sub Divisional Hospitals, and Block level Community Health Centres, which are headed by Sr. Medical Officer or In-charge of the hospital. In two special hospitals, i.e. MKH Patiala and Civil Hospital Jalandhar, there are Medical Superintendents who directly report to headquarters. Apart from this, Principal, State Institute of Nursing and Paramedical Sciences, Badal reports to MD-PHSC through Director cum Principal, State Institute of Health & Family Welfare, Mohali and Director, Institute of Mental Health i.e. Government Mental Hospital, Amritsar reports directly to the Managing Director. Recently the SINPS, Dadal has been handed over to Baba Faridkot University.

4.7 Review of functioning of PHSC To give more autonomy to the Hospitals, PHSC took the steps like (i) Higher financial powers to hospital in-charge, DMCs and CSs were given; (ii) Full powers were given to hospital incharge for commercial exploitation for support services for revenue raising, outsourcing of sanitation services, maintenance services of equipment and hospital building and condemnation of unserviceable articles; (iii) Clear-cut guidelines were given for the procedures to be adopted for retention and utilisation of user charges; (iv) Direct recommendation for recruitment of critical manpower on contractual terms. This is a very encouraging move. Higher accountability is possible only when more autonomy is given to the institutions. In more than 50 hospitals and 20 districts headquarters, capacity has been developed for computerised record keeping, which covers records of HMIS, Accounts, OPD/IPD, Blood Banks, and Diagnostic Services. For this purpose, the concerned staff has been trained and computer operators have been provided. In-house capabilities have been developed for commercially negotiating with the private partners for outsourcing. Slowly this capacity is being decentralised for effective implementation. Though computer was provided for computerised record keeping in hospitals/health centres at all levels, but in reality these computers were being used only for the registration purposes and these were not being used for record keeping or generation of HMIS. Only at few of the places, the medical records department was being managed by trained persons. Computerised HMIS systems were in position and regular data of the hospital activity and efficiency indicators were supposed to be collected and analysed. This was found to be one of the weakest areas in all most all the hospitals/health centres that were evaluated. There was hardly any well planned and organised Medical Record Department. Most of the centres were not even fully computerised, as the computers were there in the registration areas only. Even in some places untrained clerical staff manned it. The data so generated were not properly analysed to get the right information (like BOR, Average Length of stay, BTR, Death Rates etc.) required for effective management and to take right policy decisions. For an effective and efficient Hospital Administrator these are very important tools. Study to Review The Health Care Delivery System provided by PHSC, Punjab

15

Hence, efforts should be made to strengthen these aspects by planning and organising a good Medical Record Department for hospitals at every level. Also these Medical Record Departments should be Computerised and manned by properly trained and dedicated staff, which will take care of all the required Management Information System used for Hospital Administration. Overall percentage of the total Government expenditure on health sector increased from 3.54% in FY 94-95 to 4.27% in FY 03-04 (BE). In absolute term, the allocations have increased from Rs. 2057 million in FY 94-95 to Rs. 7117.20 million in FY 03-04 (BE) against the projected level of Rs. 2956 million. The per capita expenditure on Health at current price has increased from Rs.101 in FY 94-95 to Rs.292 in FY 03-04. Policy as regard to implementation of user charges was placed right from the very beginning. Reports showed the User Charges collections have increased sharply from Rs. 4 million in FY 9697 to Rs. 125.37 million in FY 03-04. This increase has been established by introducing better collection method and increase in the services offered. Retained user charges are being utilised on defined priorities of essential drugs (45%), patient’s facilities (25%), equipment maintenance (15%) and building maintenance (15%). During the study it was observed that in almost all the hospitals at all level about 40-50% of retained revenue from User Charges were used to procure medicines and 20-30% amount on IFP purpose. But utilisation on building maintenance and equipment maintenance were found to be less utilised than its actual allotment. In the year 1996 & 1998, the State Government recruited 279 & 785 doctors. But since then no new recruitments were made. As a result there were some shortages of doctors in the regular cadre which is having its adverse effect on the overall functioning. Efforts were made to ensure that core team of specialists to be made available in every hospital. But in reality the availability of all the basic specialists in respective hospitals could not be ensured. Some times it was observed that a Medical Officer of one speciality on transfer was replaced by a Medical Officer of another speciality or a general duty medical officer, because in Punjab, there is only one cadre for Medical Officers. 100% equipment as per the norms was supposed to be in position in all the newly commissioned hospitals along with preventive maintenance of the vital equipment to be undertaken through AMCs. But in reality it was found not to be always in place. Availability of the drugs was to be monitored on monthly basis as a part of the hospital grading exercise. The State Government has continued providing the supplies of the medicines in hospitals. But in practice this was one of the major lacunas on the part of service providers. Most of the places it was told that the hospitals were not getting any regular supply of Drugs from the State, rather, they were told to arrange the same from funds generated through User Charges. Support services i.e. ambulance maintenance services, sanitation services and general maintenance services had been contracted out as a time gap arrangement. Waste disposal activities were also contracted out. This initiative was a very good move and it was reported that there were some visible improvements. But later on due to some policy decision the regular Class IV employees

16

Study to Review The Health Care Delivery System provided by PHSC, Punjab

working in the peripheral health centres were deployed and contractual staff was removed. As a result, situation of general maintenance services in the hospitals were not one of the best. Main reasons told were absenteeism and unionism. Comprehensive referral system was to be established by introducing procedures at the primary level, through Out Reach Camps held in the rural and far-flung areas and by providing incentives for the referred cases at the higher level institutions. Referral manual has been prepared containing guidelines that specify ‘what’ ‘when’ and ‘how’ of referral. Colour coded referral cards have been introduced for sub centre level to district level for referring the patients. Training to doctors and paramedics for implementation of referral system was given. Incentive for referred patients (queue jump, exemption of OP/Admission Charges) have been introduced, referral routes have been established and displayed in all the hospitals. Special tie-up has been made at tertiary level facilities for creation of special window for the referred patients. But in practice none of these measures could be observed in exact desired manner. This is a very important aspect for an effective and holistic Health Care delivery system and hence all efforts should be made to further strength it and effectively implement it. A set of core indicators is being used to grade all the 154 hospitals. External lab quality assurance programme has been introduced. This was found to be a very useful and an effective mechanism for better and quality service output. Overall, as per the objectives of the PHSC and its policy implementations it was found to be quite cost effective with management efficient system. All the aspects are properly implemented. Many of these aspects are already mentioned above. For ensuring better availability of drugs and other consumables in hospitals/health centres at every level the Model of Tamil Nadu Medical Corporation may be followed. As this model is followed by many states with some modification as per their needs. Referral System needs to made more effective and extreme care needs to be taken to make it two way system and not one way, which was found to be followed in present situation. This was found to be more of Transfer System of patient than of Referral System. In this process the patients will tend to lose their confidence on the lower centres and as a result these centres will become under utilised. The examples for successful two way Referral Systems which are being followed in India are CGHS, ESIC, Railways, Army, etc. Further, for developing an effective and efficient system the National Health Scheme (NHS) followed at United Kingdom (UK) may be studied for its implementation. Efforts should be made to ensure the availability of all the services required for diagnostic and therapeutic processes by applying the modern scientific management techniques. There should be atleast two separate cadres for doctors. One for General Duty and other for the Specialists as it is followed in Central Health Scheme (CHS), ESIC, Railways, Army, etc.

Study to Review The Health Care Delivery System provided by PHSC, Punjab

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5.0 Facility Assessment

A survey was conducted to assess the existing facilities with respect to various indicators at each health set up.

5.1 District Hospitals Facility assessment was done in ten District Hospitals selected as sample, which were Amritsar, Bhatinda, Ferozpur, Gurdaspur, Hoshiarpur, Jalandhar, Ludhiana, Muktsar, Sangrur and Taran Taran. Along with these hospitals, two special hospitals were also studied viz. women and child hospital in Patiala and Bhatinda. The general profile and facility assessment of District Hospitals is given in the Table Section (Refer Table – 1).

5.1.1 Accessibility All District Hospitals and special hospitals were easily accessible from the railway station and bus stand and well connected with the road. Average distance from the railway station and bus station ranged from one to four kilometres respectively.

5.1.2 Bed strength Six District Hospitals were 50 to 100 bedded, three were 100 to 200 bedded and one District Hospital of Jalandhar was found to be 300 bedded hospital. Special hospital at Patiala was 154 bedded and one at Bhatinda was 50 bedded hospital.

5.1.3 Water supply Almost all district and special hospitals were having adequate water supply except Bhatinda and Muktsar. Five District Hospitals and two special hospitals were having bore well water supply and four hospitals were having municipal water supply. District hospital, Muktsar was having canal water supply. Water storage capacity was available for one day at 2 District Hospitals and one special hospital, three days at 6 District Hospitals along with Patiala special hospital and two days at the remaining two District Hospitals.

5.1.4 Electricity supply Electricity supply was found to be regular in most of the district and special hospitals. Only three District Hospitals viz. Amritsar, Muktsar and Taran Taran, were having irregular supplies. However, only one District Hospital was having double phase electric supply, while, rest of the nine District Hospitals and two special hospitals were having three phase electric supply. Back up generator system was available in all the ten District Hospitals and two special hospitals.

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Study to Review The Health Care Delivery System provided by PHSC, Punjab

5.1.5 Lifts and ramps Lifts were available in only four District Hospitals out of ten District Hospitals and two special hospitals included in the study. All hospitals were having ramps.

5.1.6 General impression on cleanliness and maintenance of gardens Six district hospitals (60%) were having good cleanliness and four (40%) were average. Among special hospitals, the cleanliness standard was good in Patiala and average in Bhatinda. Five District Hospitals (50%) were found to be having good upkeep of garden and rest five were having average landscaping. Among special hospitals, Patiala was found to have good while Bhatinda hospital with average upkeep of garden/landscaping.

5.1.7 Status of Buildings The status of the buildings in six District Hospitals was good, while it was average in the remaining four District Hospital buildings. Both the special hospitals included in the study were having a good building status.

5.1.8 Signs, roads and lighting Signage system was poor in Sangrur and average in Ludhiana District Hospitals. Rest of the eight District Hospitals were having good sign post system. Among special hospitals Patiala was having good while Bhatinda was having average sign posting. Roads and lighting of six District Hospitals were good, three were average and only one hospital (Amritsar) was found to be poor. Both the special hospitals under study were having good roads and lighting.

5.1.9 Public utility facilities Among all the District Hospitals covered under the study, six had a chemist shop within the premises; majority of District Hospitals (70%) had a canteen as well. Only two District Hospitals did not have Sulabh Shochalaya (Toilet facility) out of 10 District Hospitals. Five District Hospitals had STD/PCO booth within the premises. Both the special hospitals had a chemist shop, canteen and Sulabh Shochalaya within the hospital premises. Bhatinda Hospital did not have STD/PCO booth in the premises.

5.1.10 Ambulance service Ambulance facility was available among all the district and special hospitals covered under the study, with the District Hospital in Bhatinda having ten ambulances and rest of the district and special hospitals having one to five ambulances each.

Study to Review The Health Care Delivery System provided by PHSC, Punjab

19

Majority of these ambulances were found to be partially equipped. Only three District Hospitals had fully equipped ambulances. Out of the two special hospitals assessed, only one had a fully equipped ambulance.

5.1.11 Operation Theatres (OT) Majority of the District Hospitals were having at least one minor OT, except Jalandhar and Muktsar hospitals, which were having four and three minor OTs’ respectively. Regarding major OTs, two District Hospitals were having one major OT, three District Hospitals were having three major OTs, three District Hospitals had two major OTs and two hospitals were having four major OTs. Patiala special hospital had two major OTs while Bhatinda special hospital had only one major OT.

5.1.12 Dental services Only the special hospital at Bhatinda, where no Dental Department exists, was without dental services out of the ten District Hospitals and two special hospitals covered under the study.

5.1.13 Maternity services All the hospitals were having maternity services.

Fig 1: Normal deliveries conducted in District Hospitals (Punjab) in the last five years 4000

1st Yr 2nd Yr

3500

No. of normal deliveries

3rd Yr 4th Yr

3000

5th Yr 2500 2000 1500 1000 500 0

r sa r it Am

Fe

ur zp o r

ur sp a d ur G

r pu ar i sh Ho

ar dh n la Ja

na ia h d Lu

ar ts uk M

Districts

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Study to Review The Health Care Delivery System provided by PHSC, Punjab

Pa

) SH a( l tia

ur gr n Sa

r Ta

an

n ra ta

H) (S a d in at h B

Fig 2: Caesarians done in District Hospitals (Punjab) in the last five years 1600

1st Yr 2nd Yr 3rd Yr 4th Yr 5th Yr

1400

1000 800 600 400 200

(S H ) tin da B ha

ta ra n Ta ra n

ru r Sa ng

Pa tia la (S H )

uk ts ar M

a ia n dh Lu

Ja la nd ha r

H os

hi ar p

ur

ur G ur da sp

pu r Fe ro z

rit sa r

0

A m

No. of caesarians

1200

Districts

5.1.14 Mortuary Out of ten, seven of the District Hospitals (70%) were having a Mortuary whereas two of them did not have post mortem facilities. Both the special hospitals were without Mortuary and post mortem facilities.

5.1.15 Various hospital management committees Only three District Hospitals were having a drug formulary and hospital antibiotic committee. None of the two special hospitals had a Hospital antibiotic committee, although Patiala special hospital was having a drug formulary committee. All the ten district and two special hospitals were having a store purchase and store verification committee except special hospital at Patiala. Four District Hospitals were not having a Hospital Infection Control Committee and medical audit/death review committee. Both the special hospitals were without Hospital Infection Control Committee, although Patiala hospital had a medical audit/death review committee.

5.1.16 Drugs and equipment management Almost all District Hospitals and special hospitals were having dual drug supply. They get drugs and equipment supply from the state and they can also purchase these supplies on their own, utilising the user charge money.

Study to Review The Health Care Delivery System provided by PHSC, Punjab

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Percentage of drug items which were requested and received were found to be 50 % in four District Hospitals, 40% in one, 60% in one District Hospital and one special hospital, 90% in one District Hospital, 100% in another and only 20% in Patiala special hospital. Percentage of patients getting all the prescribed medicines was found to range between 40% to 75% in most of the hospitals, except in Muktsar where it was only 25% and in Hoshiarpur it ranged from 5% to 10% for OPD patients. However, indoor patients in Hoshiarpur District Hospital were found to receive 100% of the prescribed medicines. Only two District Hospitals were having their own drug formulary. Six District Hospitals and both the special hospitals maintained buffer stock. All the hospitals were having annual maintenance contracts for maintenance of costly equipment and all hospitals maintained a logbook and history sheet for the equipment except two District Hospitals at Sangrur and Taran Taran. Current functional status of all the existing equipment was found to be good at the time of assessment.

5.1.17 Major equipment Only two District Hospitals at Amritsar and Bhatinda and special hospital at Patiala were not found to have baby incubators. The same were not functional in two out of the remaining District Hospitals having baby incubators. All the District Hospitals were having functional Boyle’s apparatus with circle absorber. All the hospitals were having a cardiac monitor though it was non functional in two of these District Hospitals. One special hospital did not have dental chairs. Dosimeter was present only in Taran Taran and one special hospital. ECG facility was available at all the hospitals; however, the same was not functional in Ferozpur hospital. Emergency resuscitation kit was available in all District Hospitals, except at Muktsar District Hospital. The emergency resuscitation kit was not found functional in Ferozpur hospital. Endoscope was available only in five District Hospitals, although it was non functional in Gurdaspur District Hospital. Endoscope was not available in any of the special hospitals assessed. All the ten District hospitals were having a functional ophthalmoscope. Out of two special hospitals, it was available only at Bhatinda special hospital. Four District Hospitals and one special hospital were having a perimeter. Only one District Hospital at Muktsar was not having phototherapy unit. Only Sangrur District Hospital and one special hospital were not having retinoscope. Shortwave diathermy was not present in three District Hospitals and it was found to be non functional in two District Hospitals and one special hospital. Sigmoidoscope was available at six District Hospitals out of ten. X-ray facility was present in all the hospitals, but ultrasound facility was not present in Sangrur and special hospital, Bhatinda. Slit lamp was available at all District Hospitals, but nowhere at special hospitals. 22

Study to Review The Health Care Delivery System provided by PHSC, Punjab

5.1.18 Referral system Referral facilities were available in almost all hospitals, though referral manual was not present in half of the District Hospitals and both the special hospitals. Guidelines for referring patients were not available in four District Hospitals and in both the special hospitals. Colour coded referral cards were available only in six District Hospitals and one special hospital at Bhatinda. Feedback mechanism existed only in three District Hospitals. Transport facilities were provided by all the hospitals. Only one District Hospital and one special hospital was not maintaining records and registers for the same. Incentives for following referral route for patients were provided only in four District Hospitals and one special hospital; they are mainly providing the vehicle for referral. Five District Hospitals along with special hospital at Bhatinda had a tie-up with other hospitals (both public and private) for diagnostic or referral purposes and most of them were with Government hospitals or Medical colleges except District Hospital at Jalandhar which was having tie-ups with private hospitals also. Statistical Bulletin was available only in four District Hospitals.

5.1.19 Outreach services and residential area Three District Hospitals and one special hospital at Bhatinda were having an outreach area and the services provided were mainly related to maternal and child health. All hospitals were having residential accommodation for the essential staff except at Amritsar and Muktsar. Though residential accommodation was available but still staff members were not getting it. 80% of staff was not getting accommodation in Bhatinda, 70% in Taran Taran, 50% in Hoshiarpur and Ludhiana, 40% in Sangrur and 15 % in Jalandhar. Among special hospitals, 40% of the staff was not getting accommodation in Patiala and 90% in Bhatinda. Ferozpur and Gurdaspur were having full accommodation and all staff members were getting the accommodation. All hospitals were having a security service. Among them three District Hospitals were having contractual security service and rest were having in-house security service. Three District Hospitals and one special hospital were having Dharamshala facility.

5.1.20 Out-patient department (OPD) Reception and registration counter was computerised in nine District Hospitals and in one special hospital at Patiala. It was found to be managed by a clerk in two District Hospitals, staff nurse in one, pharmacist in six and by a computer operator in eight District Hospitals and one special hospital. (See Fig 3)

Study to Review The Health Care Delivery System provided by PHSC, Punjab

23

Fig 3: No. of OPD Patients in District Hospital (Punjab) in last five years 300000 1st Yr 2nd Yr

250000

4th Yr 200000

5th Yr

150000

100000

50000

B ha tin

da (S

H )

ta ra n Ta ra n

ru r Sa ng

Pa tia la (S H )

M uk ts ar

dh ia na Lu

Ja la nd ha r

ur ar p H os hi

da sp ur G ur

Fe ro zp ur

da in B at h

sa r

0 A m rit

No. of OPD patients

3rd Yr

Districts

There were separate registration counters for male, female and senior citizens in most of the hospitals, except in three District Hospitals and one special hospital where only one District Hospital and one special hospital were having a separate registration counter for the staff. Registration registers were properly maintained and entries were made neatly in all hospitals except District Hospital at Muktsar. In all the hospitals, OPDs were having proper signage and directional signage in every section except at District Hospital Muktsar. Waiting area and sitting arrangement were found to be adequate in all the ten District Hospitals and two special hospitals. Only one District Hospital at Ludhiana was not having proper drinking water facility and District Hospital at Sangrur was not having separate toilet facility for male and female. Ceiling fans were present in all the hospitals. All doctor’s rooms were having adequate space, proper illumination and the examination tables covered by proper sheets, along with stools for seating the patients. All of them were having examination equipment like BP apparatus, torch, hammer etc. Minor OT dressing room was present in all the hospitals except at Taran Taran District Hospital. Injection room within the OPD was available in eight district and two special hospitals. Five District Hospitals and both the special hospitals were having a dispensary/pharmacy with separate counters for male/female/senior citizens/staff.

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Study to Review The Health Care Delivery System provided by PHSC, Punjab

Laboratory and imaging services were easily accessible from the OPD in all the hospitals. Out of all these hospitals only two District Hospitals were not having central collection centre for laboratory services.

5.1.21 Emergency/casualty services A separate medical officer was found available round the clock for emergency cases at eight District Hospitals out of ten and at one special hospital out of two. Glow sign board display at Emergency service department was observed in seven District Hospitals and one special hospital. Board displaying names of doctors/specialists on call in emergency, was found available in nine District Hospitals and one special hospital. Emergency wards were attached along with emergency in all hospitals. However, two of these District Hospitals and one special hospital was not having any triage area. Maximum number of observation beds were in Bhatinda, i.e 19 beds, followed by Hoshiarpur with 10 beds. In rest of the hospitals, observation beds ranged from three to eight. Trolleys and wheel chairs were present in all hospitals except Muktsar. The number varied between one to five.

Fig 4: No. of emergency patients in District Hospitals (Punjab) in the last five years 20000

1st Yr

18000

2nd Yr 16000

3rd Yr 4th Yr

14000

No.of patients

5th Yr 12000 10000 8000 6000 4000 2000 0

Batinda

Ferozpur

Gurdaspur

Hoshiarpur

Jalandhar

Sangrur

Taran taran

Bhatinda(SH)

Districts

At least one examination room with all basic equipments was present in emergency departments of seven District Hospitals and both the special hospitals assessed. Out of these, one District Hospital and one special hospital had two examination rooms. All the registers including MLR were available in all district and special hospitals assessed. Call book in the prescribed format was not available at two District Hospitals. Study to Review The Health Care Delivery System provided by PHSC, Punjab

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Fig 5: Admissions through emergency in District Hospitals (Punjab) in the last five years

No. of admissions through emergency

8000 1st Yr

7000

2nd Yr 3rd Yr

6000

4th Yr 5th Yr

5000 4000 3000 2000 1000

(S H ) tin da B ha

ta ra n Ta ra n

ru r Sa ng

uk ts ar M

Lu

dh

ia n

a

Ja la nd ha r

ur hi ar p H os

G ur da sp ur

pu r Fe ro z

B ha tin da

0

Districts

Waiting area for the attendants, with basic facilities like sitting arrangement, drinking water, toilets etc. were present in emergency department of all hospitals except Taran Taran District Hospital. Public telephone facility was found in only four District Hospitals and one special hospital. Emergency department of all the hospitals had a retiring room for doctors with toilet facility. All the hospitals were having minor OTs for emergency procedures. Sufficient stock of essential and life saving drugs was observed in all the hospitals and all of them were having oxygen cylinders with attachments too. Separate laboratory services in emergency department was observed in six District Hospitals and both the special hospitals assessed. All the hospitals were having imaging and ambulance services in their emergency departments. Treatment facilities for dog/snake bite and poisoning were available in emergency departments of eight District Hospitals only. Similarly only seven District Hospitals were having plaster room in their emergency departments. Almost all hospitals were having staff trained in basic life support practices/system except in Gurdaspur and Muktsar District Hospitals.

5.1.22 Disaster management Only two District Hospitals were having disaster manual and disaster alert code, recall and deployment arrangements. Eight District Hospitals were maintaining a separate drug store for disaster situations.

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Study to Review The Health Care Delivery System provided by PHSC, Punjab

5.1.23 Intensive care unit (ICU) Five District Hospitals out of ten were having Intensive Care Unit, while none of the two special hospitals assessed were having this facility. Numbers of beds available in the ICU of these five hospitals were 10 in Jalandhar, 6 each in Bhatinda and Gurdaspur, 5 in Sangrur and 4 in Ludhiana. All of these ICUs were air conditioned with generator support. Regarding separate sanctioned staff in these ICUs, Gurdaspur was having two doctors and three nurses; Ludhiana was having one doctor and two nurses and ICU at other hospitals were without any sanctioned staff. None of these ICUs were having sanctioned technical staff.

5.1.24 Clinical laboratory Pathology laboratories were present in all District Hospitals and special hospitals assessed except Ferozpur District Hospital. Microbiology laboratories did not exist in Gurdaspur District Hospital and the special hospital at Bhatinda. A qualified pathologist was available in nine District Hospitals and both the special hospitals. A qualified biochemist was present in only three District Hospitals and a qualified microbiologist was present only in one i.e. Jalandhar District Hospital. All hospitals were having facility for complete urine examination, stool test, blood urea, blood sugar, liver function test, blood grouping and matching test, semen examination and VDRL (Venereal disease research laboratory) test. Special hospital at Bhatinda was not doing complete blood haemo analysis, while all other District Hospitals and special hospitals were doing it. All hospitals were doing lipid profile and FNAC (Finel Needle Aspiration Cytology Biopsy) except Bhatinda special hospital and Ferozpur District Hospital. Three District Hospitals were not doing Pap smear. Biopsies were done only by three District Hospitals and culture and smear examination by only five District Hospitals. Out of ten districts and two special hospitals under study only District Hospital Sangrur was not doing vaginal discharge examination. Bone marrow examination was done in only three District Hospitals out of ten District Hospitals assessed. All these laboratories were found following universal precaution procedures and were using protective measures like gown, gloves, masks etc. Study to Review The Health Care Delivery System provided by PHSC, Punjab

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All hospitals were collecting specimens centrally except Gurdaspur District Hospital. All the hospitals were having sufficient chemicals and reagents and were observing all bio safety measures. Laboratories of three District Hospitals were not having regular internal quality and external quality control measures.

5.1.25 Blood banking services Blood banking facility was not available at one District Hospital i.e. Amritsar and both the special hospitals. Among the hospitals with blood bank facility, trained qualified medical officers and other staff were present round the clock. All these blood banks were maintaining proper cold chain and refrigerators and doing proper checking and cross matching of blood. Australia antigen, HCV, VDRL, MP and HIV tests were done for every blood bottle of the donor in all these blood banks and efforts were made to collect blood through organising camps. All these blood banks have been renewing the blood banks and HIV licensing as per the rules.

5.1.26 Radiology and imaging services Round the clock availability of X-ray services/sonography was present in all the District Hospitals assessed during the study. All hospitals were having a dark room with all facilities. Moreover, only two District Hospitals and one special hospital were using a dosimeter. Seven District Hospitals and special hospital at Patiala were conducting special investigations like IVP, contrast media etc. Separate register for MLC records was not found to be maintained in three District Hospitals and both the special hospitals. History book and log book of X-ray machines were maintained in all except in Ludhiana District Hospital and Bhatinda special hospital.

5.1.27 Operation theater (OT) All the hospitals were having major and minor OT. Out of ten, two District Hospitals were having four major OTs each, four were having three major OTs, and one District Hospital and both the special hospitals were having two major OTs each. Rest were having at least one major OT. District hospital Jalandhar was having four minor OTs Muktsar hospital having three and rest of the hospitals having one minor OT each. Zoning concept was strictly followed in seven District Hospitals out of ten and one special hospital out of two. All the hospitals were having emergency light- generator facility for the OT. Regular disinfection and sterilisation were done in the OT of all hospitals assessed in this study. Availability of fire-fighting equipments and knowledge to use them were found to be in all OTs except two District Hospitals and one special hospital.

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Study to Review The Health Care Delivery System provided by PHSC, Punjab

Fig 6: Surgeries performed in District Hospitals (Punjab) in the last five years 35000

1st Yr 2nd Yr 3rd Yr

30000

4th Yr 5th Yr

20000

15000

10000

5000

(S H ) tin da

B ha

ta ra n

ru

r

Ta ra n

ng Sa

Pa tia la (S H )

uk ts ar M

a ia n dh Lu

Ja la nd ha r

G ur da sp ur H os hi ar pu r

pu r Fe ro z

da tin ha B

rit sa r

0

A m

No. of surgeries

25000

Districts

5.1.28 In-patient wards Almost all the hospitals were having satisfactory cleanliness of wards with adequate housekeeping services except District Hospital Gurdaspur. Wards of hospitals in Hoshiarpur and Gurdaspur were not having adequate and clean toilets and bathrooms. Only at wards of District Hospital Taran Taran, proper bio medical waste management guidelines for collection and segregation of bio medical waste were not followed, but they were having table top syringe and needle destroyer as in other hospitals. Wards in all hospitals were having adequate water supply and upkeep of sanitary blocks except Hoshiarpur. Adequate linen on bed was found in all district and special hospitals except in Gurdaspur and Sangrur hospitals. Three District Hospitals viz. Ferozpur, Ludhiana and Muktsar were having doubling of beds or floor beds. Eight District Hospitals and one special hospital were having satisfactory upkeep of cots, mattresses, lockers, linen etc. in the wards. Only one District Hospital was using uniform for the patients. Regarding availability of necessary equipments in the wards it was observed that nine District Hospitals and one special hospital had functional suction apparatus while in one District Hospital, although it was available but was non-functional. All hospitals were having functional oxygen cylinders with accessories while only six hospitals including one special hospital were having functional venesection/LP/tracheotomy tray. All hospitals were found having functional Study to Review The Health Care Delivery System provided by PHSC, Punjab

29

Fig 7: No. of In-patients in District Hospitals (Punjab) in the last five years 18000 16000

No. of In-patients

1st Yr

14000

2nd Yr

12000

3rd Yr 4th Yr

10000

5th Yr

8000 6000 4000 2000

) H ha

B

Ta

ra

tin

n

da

ta

(S

ra

ru ng Sa

(S la tia

n

r

) H

ar Pa

uk M

ia dh Lu

la Ja

ts

na

r nd

pu ar H

os

hi

da ur G

ha

r

ur sp

ur zp ro Fe

tin ha B

A

m

rit

sa

da

r

0

Districts

emergency light, wheel chairs and stretcher trolleys. Only two District Hospitals and one special hospital wards were not having stationery, forms and various updated registers. Two District Hospitals were not found following the concept of progressive patient care. All hospitals were having adequate fans and lights. None of the hospitals assessed were providing diet to the inpatients.

5.1.29 Hospital medical store Medical store, suitably located with adequate space was found available in eight District Hospitals and one special hospital. In six hospitals including both the special hospitals, staff members of the medical stores were found to have knowledge on material management, system of FIFO, bin cards, lead time, buffer stock etc. and CMO (Chief Medical Officer)/MO (Medical Officer) were found regularly inspecting the medical store and verifying stock books in all hospitals except Ludhiana and Sangrur. All hospitals were having restriction on entry of unauthorised personnel in the medical store. Vital and essential drugs were found available in the medical stores of all hospitals under study except Sangrur and Ludhiana. Only five District Hospitals were found up-keeping the expiry date register which was regularly inspected by the Medical officer.

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Study to Review The Health Care Delivery System provided by PHSC, Punjab

Eight hospitals including both the special hospitals were found making efforts to redistribute large stocks of slow moving drugs or near expiry drugs for its timely utilisation, while only four District Hospitals were having proper arrangements to keep drugs as per ABC/VED category and storage of rubber goods as per guidelines. Medical stores of all the hospitals, except Taran Taran and Ludhiana, were not taking appropriate steps to prevent pilferage of drugs. All hospitals, except Ludhiana and Amritsar, were found having convenient arrangements of issuing drugs to various wards. Only four District Hospitals were found regularly sending samples to chemical laboratory for checking the standard of drugs. All hospitals except Ludhiana were circulating list of available drugs to all MOs, OPD and wards as per generic name. At five District Hospitals and both the special hospitals, the medical store was submitting certified bills to office for release of payment within three days. Auction to clear the empty material from store was done regularly in six hospitals only, including one special hospital. Availability of fire-fighting equipments and knowledge to use them were found at medical stores of only four hospitals including one special hospital. Standing drug committees were found in only five District Hospitals, and only two District Hospitals were having a regularly updated hospital drug formulary.

5.1.30 Medical record department Seven District Hospitals and one special hospital were having a medical record room with enough number of racks. Medical record room was found to be managed by a trained medical record officer or technician in 50% of District Hospitals and both the special hospitals. Case records were maintained as per WHO classification of disease (ICD-X schedule) in only three District Hospitals and one special hospital. All hospitals were found regularly submitting morbidity and mortality reports except in District Hospital of Taran Taran. None of these hospitals were found maintaining the basic hospital utilisation indices like Bed Occupancy Rate, Average Length of Stay, Bed Turnover Interval, Death Rate etc. on a regular basis and in a proper scientific way. All the records were found to be maintained for ten years in five District Hospitals and special hospital at Patiala, five years in two District Hospitals and one special hospital, seven years in Amritsar and fourteen and fifteen years in Muktsar and Bhatinda District Hospitals respectively. Only three District Hospitals and one special hospital were having back up facility to safe guard these records and only five hospitals including one special hospital were following effective retrieval system. Medical audit was done at regular intervals in seven hospitals including one special hospital and

Study to Review The Health Care Delivery System provided by PHSC, Punjab

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regular death audit meetings were held and corrective action was taken in only three District Hospitals and special hospital at Patiala.

5.1.31 Hospital waste management Adequate number of bins and bags of the required colour codes were available and placed strategically in all patient care areas in all the hospitals except Amritsar District Hospital. Proper segregation and collection of waste was done with proper packaging and record keeping in almost all hospitals except Amritsar District Hospital. Gurdaspur, Amritsar and Jalandhar hospitals were also found lacking in proper storage facilities of waste. All hospitals were found following proper transportation of the collected waste. Waste disposal was outsourced in all hospitals assessed except at Sangrur District Hospital. Six District Hospitals along with both the special hospitals were found following the disposal/ recycling methods appropriately for various categories of waste.

5.1.32 Central sterile supply department (CSSD) Nine District Hospitals and one special hospital at Bhatinda were having CSSD under supervision of trained staff/senior nursing officer. Special hospital at Patiala was not having any CSSD. Eight District Hospitals and one special hospital were also having all the required equipments and autoclaves. Physical and chemical quality control measures were followed in seven District Hospitals and special hospital Bhatinda and biological quality control measures were followed in six District Hospitals along with special hospital at Bhatinda.

5.1.33 Laundry services Out of ten District Hospitals, nine were having in-house laundry services, while this service was found to be outsourced at only one hospital. Both the special hospitals were having mechanised in-house laundry service. At five District Hospitals laundry was of conventional (dhobi) type, while it was mechanised at the remaining five. Quality of wash and linen was good in seven District Hospitals and both the special hospitals. In rest of the District Hospitals it was average.

5.1.34 Kitchen facility Kitchen facility was not found available in any of the studied district and special hospitals.

5.1.35 Utilisation of patient care services Analysis of the last 5 years’ data showed that in all the District Hospital the number of patients

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Study to Review The Health Care Delivery System provided by PHSC, Punjab

utilising various medical care facilities including diagnostic and therapeutic, from in-patient and out-door either marginally or steadily increased almost all the District Hospitals.

5.1.36 Utilisation of user charges Year-wise expenditure of the User Charges made under the following major heads i.e. medicines, improvement of In-patient Facilities (IPF), Building Maintenance and Equipments Maintenance. The expenditure made under the head Medicines was 40% to 50% in most of the District Hospitals except at Ludhiana where it went upto 80% and then came down to 50% over the next 4 years. Fig 8: Percent of expenditure of the user charges on Medicine of different District Hospitals (Punjab) 90.00

80.00

70.00

Percent cost (Rs)

60.00 50.00

40.00 30.00 20.00 10.00

0.00 Bhatinda

Ferozpur

Gurdaspur 2003-04

Hoshiarpur

2004-05

2005-06

Jalandhar 2006-07

Ludhiana

Patiala (SH)

2007-08

Fig 9: Percent of expenditure of the user charges in IPF of different District Hospitals (Punjab) 35.00

30.00

Percent cost (Rs)

25.00

20.00

15.00

10.00

5.00

0.00 Bhatinda

Ferozpur

Gurdaspur 2003-04

Hoshiarpur

2004-05

2005-06

Jalandhar 2006-07

Ludhiana

Patiala (SH)

2007-08

Study to Review The Health Care Delivery System provided by PHSC, Punjab

33

Regarding expenditure on IPF head, it was found to be to be around 20% in most of the District Hospitals. In maintenance of buildings the expenditure was 5% to 10% over the years except for the Special Hospital of Patiala in the first year, which was recorded around 63%.

Fig 10: Percent of expenditure of the user charges on buildings of different District Hospitals (Punjab) 70

60

Percent cost (Rs)

50

40

30

20

10

0

Bhatinda

Ferozpur

Gurdaspur 2003-04

Hoshiarpur

2004-05

2005-06

Jalandhar 2006-07

Ludhiana

Patiala (SH)

2007-08

Fig 11: Percent of expenditure of the user charges on equipments of different District Hospitals (Punjab) 18 16

Percent cost (Rs)

14 12 10 8 6 4 2

0 Bhatinda

Ferozpur

Gurdaspur 2003-04

34

Hoshiarpur

2004-05

Study to Review The Health Care Delivery System provided by PHSC, Punjab

2005-06

Jalandhar 2006-07

Ludhiana 2007-08

Patiala (SH)

In most of the District Hospitals, expenditure on medical equipments recorded less than 10% over the years, except at Bhatinda, Ferozpur and Ludhiana where in some years it was more than 10%.

5.2 Sub-divisional Hospitals (SDHs) Total ten Sub-Divisional Hospitals (SDH) were assessed and facility survey was done as per the prestructure32d checklist. These Sub-Divisional Hospitals were at Ajnala, Batala, Dasuya, Fazilaka, Jagraon, Maler Kotla, Malout, Nakodar, Patti and Talwandi. The General Profile and facility survey of Sub- Divisional hospitals is given in the Tables Section (Refer Table – 2.)

5.2.1 Accessibility All Sub-Divisional Hospitals (SDHs) were easily accessible from the railway station and bus stand and were well connected with the roads.

5.2.2 Water supply All SDH were having adequate water supply. Seven SDH were having bore well supply, while three of them i.e. Maler Kotla, Malout and Talwandi were having Municipal water supply. One day storage capacity of water was found available at three SDH, while rest seven were having storage capacity of three days.

5.2.3 Electricity supply Electricity supply was found to be regular in six SDHs, while it was irregular in rest of the hospitals. Only one hospital (Fazilaka) was having double phase electric supply, while rest of the nine hospitals were having three phase electric supply. All the hospitals were found having back up generator system except Nakodar Sub-Divisional Hospital.

5.2.4 Availability of lift and ramps Most of the Sub-Divisional Hospital were single storey buildings. Facility of lifts was available only at Malout Sub-Divisional Hospital. Ramp was available at all hospitals except Batala, Fazilaka and Jagraon.

5.2.5 General impression on cleanliness and maintenance of gardens Eight hospitals were having good cleanliness whereas it was found average at two hospitals. Upkeep of garden was found to range from `average to good’ at most of the Sub-Divisional Hospitals except Ajnala and Jagraon.

5.2.6 Signs, roads and lighting Signage was found good in six Sub-Divisional Hospitals. Rest of the four hospitals were having average sign postings. Roads and lighting of eight hospitals were found good and two average.

Study to Review The Health Care Delivery System provided by PHSC, Punjab

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5.2.7 Status of buildings Buildings of eight Sub-Divisional Hospitals were found to be in good condition while at two SubDivisional Hospitals (Patti and Talwandi) it was average.

5.2.8 Public utility facilities Out of all the Sub-Divisional Hospitals studied, three were having chemist shops, two were having STD/PCO booths, and only one was having a grocery shop and a cycle stand within the hospital premises. Fifty percent (five out of ten) of the Sub-Divisional Hospitals studied were having a functional canteen. Five hospitals were also found to have Sulabh Shochalaya.

5.2.9 Ambulance service Although facility of ambulance services was available at all the Sub-Divisional Hospitals but only three of them, namely Batala, Fazilaka and Maler Kotla were fully equipped. Seven SDH were having two ambulances while another two viz Dasuya and Talwandi were having three ambulances. Ajnala hospital had only one ambulance and that too was found to be only partially equipped.

5.2.10 Dental services All the Sub-Divisional Hospitals were found providing dental services except one hospital at Fazilaka.

5.2.11 Maternity services Maternity services were provided at all the Sub-Divisional Hospitals assessed in the present study.

5.2.12 Mortuary services Mortuary services with cold storage and other preservative facilities were found to be present at seven out of ten Sub-Divisional Hospitals, whereas facilities of post mortem were available at eight hospitals. Fazilaka was the only SDH where although the mortuary services were available, facilities for post mortem were absent.

5.2.13 Various hospital management committees Only Nakodar and Patti SDH’s were having a drug formulary committee. Nakodar SDH was found to be the only one with a hospital antibiotic committee. Hospital infection control committee was present at Batala, Nakodar and Patti SDH. Store purchase committee was present at all SDH except at Maler Kotla. Similarly, store inspection committee was present at all SDHs except Maler Kotla and Fazilaka. Five of the ten SDH assessed were found having a Medical Audit/Death Review Committee.

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Study to Review The Health Care Delivery System provided by PHSC, Punjab

5.2.14 Drugs and equipment management Out of the ten Sub-Divisional Hospitals assessed, five were having a drug formulary. Almost all hospitals were found to have dual drug supply. They get drugs and equipment supply directly from the state and they can also purchase on their own through user charges money. Buffer stock was found to be maintained at all the SDHs, except Ajnala and Patti. Reorder levels were found to be maintained only at Ajnala, Dasuya, Jagraon and Nakodar SDH. All the SDHs except Ajnala and Patti were found having annual maintenance procedures for costly equipment. Fazilaka, Maler Kotla and Patti SDH were not maintaining log book and history sheet for the equipment. The present status of the existing equipments was found to be average at seven SDHs and good at Batala, Dasuya and Malout SDH.

5.2.15 Major equipment Six out of the ten Sub-Divisional Hospitals were having baby incubators but the incubator at Fazilaka SDH was not found functional at the time of visit. Boyle’s apparatus was available and functional at all the SDH except Fazilaka, where it was not functional. Cardiac monitor was available in all SDHs except Dasuya and Jagraon. The cardiac monitors at Ajnala and Fazilaka SDH were found to be non-functional. Dental chair was available at all SDHs but it was not functional at Ajnala and Fazilaka. Dosimeter was available only at Maler Kotla and Malout SDH and out of these it was found functional only at Malout SDH. ECG machine was available and functional at all the SDHs except Fazilaka. Emergency resuscitation kit was available and functional at all the SDHs. Fibre-optic Endoscope was not available at any of the SDH assessed. Malout was the only Sub-Divisional Hospital without an ophthalmoscope, while rest of the SDH were having a functional ophthalmoscope. Perimeter was available only at Maler Kotla and it was found to be functional. Five of the ten SDHs assessed were having a Retinoscope, which was functional. Slit lamps, which were also in working condition, were present only at five SDHs. Short wave diathermy (Physiotherapy) unit was available and functional at Fazilaka and Nakodar SDH.

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Sigmoidoscopes were present only in two Sub-Divisional Hospitals but these were found to be non-functional. X-ray facility was available and functional in all Sub-Divisional Hospitals. Ultrasound was present at all SDH except Talwandi. The ultrasound at Patti SDH was not functional.

5.2.16 Referral system Referral facilities were available in all SDH but referral manual was present only at six out of ten SDH’s studied. Guidelines for what to refer and when to refer were present at five SDHs whereas guidelines for how to refer were present at six places. Colour coded referral cards were available at five and feedback mechanism existed at four SubDivisional Hospitals. Transport facility was provided by all the SDHs. Maintenance of records and registers was done at all except Talwandi SDH. Incentive for following the referral route in the form of provision of ambulance was available only at Fazilaka SDH. All the SDHs were found to refer their patients to government/District Hospitals/medical colleges except Nakodar and Talwandi SDH. For diagnostic purposes, five SDHs were found to have a tie-up with other hospitals (both public and private). Statistical Bulletin was available only in four SDHs and out of them two were also having monthly bulletin and two fortnightly bulletins.

5.2.17 Outreach services Out-reach area services in the form of MCH camp, Eye camp, Blood donation camp and IEC were found to be available only at Fazilaka, Jagraon, Maler Kotla and Talwandi SDH.

5.2.18 Residential area Residential accommodation for the essential staff members was available at all SDHs except Ajnala and Jagraon. However, only four of these were having in house security services. Non availability of accommodation at four of these places was more than 50%. None of the Sub-Divisional Hospitals were found to have the facility of Dharamshalas.

5.2.19 Out-patient department Reception and registration counters were present in all the Sub-Divisional Hospitals (four were having computerised registration and rest of them manual). These counters were managed by a clerk in one SDH, by MSW in another one, by clerk/MSW in two others and a computer operator in five SDHs. Staff manning these counters was knowledgeable about the OPD procedures. There were separate registration counters for male, female and staff members at three SDHs. Four SDHs were having a separate registration counter for senior citizens as well. Registration registers were properly maintained and entries were made in all SDHs except at Malout.

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Study to Review The Health Care Delivery System provided by PHSC, Punjab

Fig 12: No. of OPD Patients in Sub-Divisional Hospitals (Punjab) in the last five years 180000 1st Yr

160000

3rd Yr

120000

4th Yr 5th Yr

100000 80000 60000 40000 20000

Ta

lw

an

di

tti Pa

od ak N

al M

M

al

er

ar

t ou

a tk ko

ao gr Ja

la zi Fa

n

ka

a uy D

as

al at B

jn

al

a

a

0

A

No. of OPD Patients

2nd Yr 140000

Sub-divisional Hospitals

In all SDHs, all sections of OPD were having proper signage and directional sign except at Ajnala and Maler Kotla. Waiting area was found to be adequate in six out of ten SDHs and only five SDHs were having proper sitting arrangement. Drinking water facility, Ceiling fans, Toilet facility, doctor’s chamber with adequate space, examination table with proper sheet, stool for patients to sit and examination equipments (like torch, BP apparatus and hammer etc.) were available in almost all the Sub-Divisional Hospitals. However toilet facility was not available at Nakodar. Examination table with proper sheet was not present at Jagraon SDH. All the hospitals were having adequately illuminated OPDs. Injection room along with facilities to deal with emergency situations was not available at Maler Kotla and Patti SDH. Similarly, Talwandi and Patti SDH were not having Minor OT/Dressing room with all the basic equipments. Only five Sub-Divisional Hospitals were having dispensaries/pharmacy with separate counters for male/female/senior citizens/staff. Laboratory and imaging services were easily accessible from the OPD in all the Sub-Divisional Hospitals. All SDHs were having a central collection centre for laboratory services except Maler Kotla SDH.

5.2.20 Emergency/casualty services All the Sub-Divisional Hospitals assessed were found having round the clock emergency services, with almost all the basic facilities. There was a separate medical officer available round the clock for emergency situations in seven Sub-Divisional Hospitals out of ten. Glow sign board displaying emergency service department

Study to Review The Health Care Delivery System provided by PHSC, Punjab

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Fig 13: Emergency Patients in Sub-Divisional Hospitals (Punjab) in the last five years 6000

1st Yr 2nd Yr 3rd Yr

5000

4th Yr 5th Yr

No. of patients

4000

3000

2000

1000

0

Ajnala

Batala

Dasuya

Jagraon

Malerkotka

Malout

Nakodar

Patti

Talwandi

Sub-divisional Hospitals

was seen at five SDHs and board displaying doctors/specialists on call in emergency was seen at eight SDHs. Emergency wards were found attached to the emergency department in all SDHs except Ajnala, with observation bed strengths ranging from 1 to 12. Four of these ten SDHs were not having any triage area. Trolleys and wheel chairs (ranging from 1 to 4 in number) were present in all SDHs. Examination rooms with all basic equipments and all the registers including MLR were available in emergencies of all SDHs. Emergency department at all SDHs also had a retiring room for doctors with toilet facility except at Malout hospital. Call book in the prescribed format was seen only at four SDHs assessed. Waiting area for the attendants of the patients with basic facilities like sitting arrangements, drinking water, toilets etc were available in emergency departments of seven SDHs, but public telephone facility was found at only two places. Five SDHs had Major OT for emergency services whereas treatment room cum minor OT for various emergency procedures was present in emergency departments of all SDHs. All SDHs were having oxygen cylinders with attachments and sufficient stock of essential and life saving drugs was available in almost all the SDHs except at Ajnala. Laboratory, imaging, and ambulance services were available at emergency departments of all the Sub-Divisional Hospitals. All the SDHs were having staff trained in basic life support except at Malout and Talwandi.

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Study to Review The Health Care Delivery System provided by PHSC, Punjab

Treatment facilities for dog/snake bite and poisoning were available at emergency departments of eight SDHs (except Patti and Talwandi).

5.2.21 Disaster management Only three SDHs (viz. Dasuya, Fazilaka and Nakodar) were having Disaster manual and all these three were having disaster alert code, as well as recall and deployment arrangements. Seven SDHs were maintaining a drug store for disaster situation. Plaster room was present at six SDHs.

5.2.22 Intensive care unit (ICU) ICU was available at only four SDHs viz. Ajnala, Batala, Patti and Talwandi, with the bed strength ranging from 2 to 6 beds. None of these ICUs were found to be air-conditioned and were also not having any back up generator support. Staff sanctioned specifically for ICU was present only at Ajnala Sub-Divisional Hospital (Doctor-1, Nurse-1, Technical staff-1 and class IV-1). Similarly record keeping of the patients was found to be done only at Ajnala SDH. Oxygen/suction apparatus/compressed air were available at Ajnala, Batala and Talwandi SDH. Defibrillator and ventilator were not available at any of the SDH, whereas ECG machine was available only at Batala SDH. Only Batala and Talwandi SDH were found to have all the life saving vital drugs. Strict aseptic procedures were found to be followed only at the Batala SDH.

5.2.23 Clinical laboratory A pathology as well as microbiology laboratory was present in half of the Sub-Divisional Hospitals assessed during the study. Qualified pathologists and microbiologists were found present at four of these hospitals respectively. None of the hospitals were having a qualified biochemist. All Sub-Divisional Hospitals were having facility for complete blood haemogram analysis except Batala and Patti SDHs. Complete urine examination was available at all the Sub-Divisional Hospitals. Ajnala SDH was found not conducting stool tests whereas Blood Urea and Blood sugar tests were not conducted by Patti SDH. All of the rest SDHs were providing these laboratory facilities. Facility of liver function test was available at five SDHs, lipid profile at four, FNAC at one, culture and smear examination at one, semen examination at eight, vaginal discharge examination at two, bone marrow examination at one and other routine tests like HIV/pregnancy tests at six SDHs. Blood grouping and matching test and VDRL tests were done at all the SDHs. Pap smear and biopsy were not done at any of the SDH.

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Six of ten SDHs were found following universal precaution procedures and were using some protective measures like the use of gown, gloves, masks etc. All necessary laboratory chemicals and reagents were available at all SDHs except at Ajnala Sub-Divisional Hospital. Specimens were collected centrally in all the ten SDHs. All of them were observing the biosafety measures except Ajnala and Maler Kotla SDH. Regular internal and external quality control measures were found being undertaken by twelve SDHs respectively.

5.2.24 Blood banking services Batala, Dasuya, Fazilaka, Maler kotla, Nakodar and Patti SDH were having the facility of a blood bank. Trained or qualified medical officer as Blood Transfusion Officer was present at Batala, Dasuya, Fazilaka and Nakodar SDH, while no such officer was available at Maler, Kotla and Patti SDH. Round the clock availability of trained staff and services was a feature of all SDHs except Maler Kotla. All SDHs having blood banks were found following all the procedures like - checking and cross matching of blood by B.T.O; proper maintenance of cold chain and refrigerators; Australia antigen, HCV, VDRL, MP and HIV tests for every blood unit of donor; renewal of blood bank/HIV license as per rules; disposal of HIV positive blood bags and undertaking bio-safety measures and availability of table top syringe and needle destroyer and, colour coded bags. Efforts were made to collect blood through voluntary blood donation camps at five sub divisional hospitals out of the six having a blood bank. Feedback of transfusion and record maintenance of untoward incidences was found being done at Batala, Dasuya, Maler kotla and Nakodar SDH.

5.2.25 Radiology services Round the clock availability of X-ray services/sonography was present at six SDHs. However, radiologists were available only at two out of these. X-ray machines (500/300mA) were available at all the SDHs visited, but they were not found working at Batala and Dasuya SDH. X-ray machines (200/100mA) were available at five SDH and out of these only three were found functional; rest two were pending for condemnation. X-ray machines (moblie/60mA) were available at six SDHs and all of them were in functional status. All SDH were having a dark room with all the required facilities. Dosimeter was used only at Maler Kotla and Malout SDH and they send these dosimeters regularly to BARC for evaluation. Special investigations like IVP; contrast media etc. were available and conducted at four SDHs. Separate register for MLC records was found to be maintained at all the SDHs; and all of them except Patti SDH were found maintaining history sheet and log book of X-ray machines.

5.2.26 Operation theatre Dasuya Sub-Divisional Hospital was having three major operation theatres whereas hospitals at Fazilaka, Malout and Patti were having one major operation theatre each. Rest of the hospitals 42

Study to Review The Health Care Delivery System provided by PHSC, Punjab

were found to have two operation theatres. All the hospitals assessed were having at least one minor operation theatre with the exception of Malout and Nakodar hospitals with two minor operation theatres. All SDHs were having major and minor OTs, except Jagraon SDH, which was not having a minor OT. Zoning concept in OT was followed at six SDHs.

Fig 13: Normal Deliveries conducted in Sub-Divisional Hospitals (Punjab) in the last five years 900

1st Yr 2nd Yr

800

3rd Yr No. of Normal Deliveries

700

4th Yr 5th Yr

600 500 400 300 200 100

di an lw Ta

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a tk ko

ao gr Ja

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Sub-divisional Hospitals

Fig 14: Caesarians done in Sub-Divisional Hospitals (Punjab) in the last five years 600

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500

4th Yr

No. of caesarians

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Ajnala

Batala

Dasuya

Fazilaka

Jagraon

Malerkotka

Nakodar

Patti

Talwandi

Sub-divisional Hospitals

Study to Review The Health Care Delivery System provided by PHSC, Punjab

43

Boyle’s apparatus was available in OT of all the SDHs and the same was found under repair at two of them. Boyle’s apparatus at Ajnala SDH was found pending for condemnation. All the SDH were having hydraulic operation tables. Operation tables at three of these hospitals were found to be under repair and at one for condemnation. Shadowless lamps were available at all the hospitals. One lamp each at Fazilaka and Maler kotla SDHs were under repair. Fumigation apparatus was available at six SDHs. One out of the two available fumigation apparatus at Jagraon SDH was found to be under repair. Suction apparatus was available at all the SDHs, but one of the two suction apparatus at Patti SDH was under repair. All SDHs were having air conditioned OTs. Electrical cautery was available at all the SDHs. However, it was not functional and under repair at Ajnala, Batala and Jagraon SDH. Endoscope in the operation theatre was available at Fazilaka SDH only while laryngoscope was available at Batala, Dasuya, Fazilaka, Maler Kotla and Nakodar SDH. Facility of cardiac monitor was available at six SDHs and that of cardiac defibrillators at two SDHs. Pulse oxymeters were found to be available at all the SDHs except at Batala and Jargaon. All SDHs were found to maintain OT records, but maintenance of OT postponement records were done only at two SDHs. Emergency light or back up generator facilities to the OTs were available in all SDHs. Availability of fire-fighting equipments and knowledge to use them was found in OTs of five SDHs. Regular disinfection and sterilisation procedures were done at OTs of all sub divisional hospitals.

5.2.27 In-patient wards Almost all SDHs were having satisfactory cleanliness of wards, with adequate housekeeping Fig 15: Patients admitted in Sub-divisional Hospitals (Punjab) in the last five years 1st Yr

10000

2nd Yr

9000

3rd Yr

No. of Patients

8000

4th Yr

7000

5th Yr

6000 5000 4000 3000 2000 1000

Study to Review The Health Care Delivery System provided by PHSC, Punjab

Ta

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services. All SDHs had adequate and clean toilets and bathrooms and; adequate and proper linen for all the beds except at the Batala SDH. At Batala and Talwandi SDH, the wards were not found to follow proper bio medical waste management guidelines for collection and segregation of bio medical waste; Talwandi SDH, in addition, was not having table top syringe and needle destroyer, whereas at Ajnala and Batala SDH, although the table top syringe and needle destroyer were available, they were not properly utilised. Wards in all SDH except Talwandi were having adequate water supply and upkeep of sanitary blocks. None of the SDH had doubling of beds or floor beds. All SDHs under study were having satisfactory upkeep of cots, mattresses, lockers, linen etc. in the wards except at Batala and Malout. Uniform for the patients was found to be used only at Jagraon SDH. Regarding availability of necessary equipments in the wards, it was observed that all SDHs were having functional suction apparatus except Malout, where it was not available. Oxygen cylinders with accessories were available in functional condition at all SDHs. Functional venesection/LP/ tracheotomy tray were available at all SDHs, except Malout, Patti and Talwandi. Eight SDH were having functional emergency light/wheel chairs/stretcher trolley. All SDHs were found to have adequate stationery, forms and various updated registers, and they were found maintaining various registers and records required in the ward. Concept of progressive patient care was not followed at Ajnala and Jagraon SDH. All SDHs were having adequate and working fans and lights. Only Malout SDH was providing diet to the inpatients.

5.2.28 Hospital medical store Medical stores were found suitably located with adequate space and protection of drugs and non-drug items from pilferage, temperature and humidity at Dasuya, Fazilaka, Jagraon and Nakodar SDH. There was no restriction on entry of unauthorised personnel in the medical store at Maler kotla and Patti SDH. At seven SDHs, staff members of the medical stores had knowledge on material management, system of FIFO, bin cards, lead time, buffer stock etc., while at the remaining three hospitals the staff responsible was not having this knowledge. CMO/MO were found regularly inspecting the medical stores and verifying stock books at all SDHs except Maler Kotla. Availability of vital and essential drugs was found at medical stores of all SDHs except Ajnala. Up-keep of the expiry date register and its regular inspection by the medical officer was observed at six out of the ten SDHs under study. At seven SDHs, efforts were made to redistribute large stocks of slow moving drugs or near expiry drugs for its timely utilisation, while only four SDHs were having proper arrangements

Study to Review The Health Care Delivery System provided by PHSC, Punjab

45

to keep drugs as per ABC/VED category and storage of rubber goods as per guidelines. Medical stores of six SDHs were taking appropriate steps to prevent pilferage of drugs, while all SDHs except Ajnala were having convenient arrangements of issuing drugs to various wards. Six out of ten SDHs were regularly sending samples to a chemical laboratory for checking the standard of drugs and to take necessary action thereon. All SDHs except Maler Kotla were circulating list of available drugs to all MOs, OPDs and wards as per their generic names. Medical stores of all SDHs except Jagraon, were submitting certified bills to office for release of payment with in three days. Auction to clear the empty material from store was found to be done regularly at only five SDHs. Availability of fire-fighting equipments and knowledge of staff to use them was found in medical stores of five SDHs. Standing drug committee and availability of regularly updated hospital drug formulary was found at only five SDHs out of ten.

5.2.29 Medical record department Only five SDHs were having medical record room with enough number of racks and cup boards. Record keeping in medical record room was manual in all the SDH assessed, except Jagraon where it was computerised. Trained staff comprising medical record officer or technician was present at all SDHs, except Maler Kotla. However, in spite of this, the condition of the medical records was not found satisfactory. None of these hospitals were found maintaining some of the basic hospital utilisation indices like Bed Occupancy Rate, Average Length of Stay, Bed Turnover Interval, Death Rate etc. on regular basis and in proper scientific way. Case records were maintained as per WHO classification of disease (ICD-X schedule) at only three SDHs. All SDHs except Patti were regularly submitting their morbidity and mortality reports. Duration for which the record was maintained ranged from 5 to 10 years. Back up facility to safe guard these records was present at Ajnala, Dasuya, Fazilaka and Malout SDH. Five SDHs were having effective retrieval system. Six SDHs were found holding regular death and medical audit.

5.2.30 Hospital waste management Adequate number of bins and bags of required colour codes were found available at all SDH except Talwandi; and these were found placed strategically in all patient care areas at seven out of these SDHs.

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Study to Review The Health Care Delivery System provided by PHSC, Punjab

Proper segregation, collection of waste with proper packaging and record keeping, proper transportation and storage of waste was seen in almost all SDHs except Talwandi, where proper segregation and collection were lacking and Ajnala, where proper collection, packaging, labelling and record keeping were lacking. All SDHs were having proper storage facility and transportation for the biomedical waste. Waste disposal was found to be outsourced at all SDHs except Maler Kotla and Malout. Disposal/ recycling methods for various waste categories were done at six SDHs. Autoclaves and shredders were not available at Ajnala, Fazilaka and Malout SDH.

5.2.31 Central sterile supply department (CSSD) All SDHs except Maler kotla and Malout were having CSSD under supervision of trained staff/senior nursing officer, and these SDH were having all the required equipments and autoclaves. Physical and chemical quality control measures were found to be followed at CSSD of seven; whereas biological quality control measures were followed at six SDHs.

5.2.32 Laundry services Among ten SDHs under study, five were having in house laundry service while the remaining five were found to have outsourced laundry services. Laundry was of conventional (dhobi) type in five SDHs and mechanised in rest of the SDH. Laundry staff was found to be adequate only at four SDHs. Quality of linen as well as quality of wash was good at four SDHs only, while in rest SDHs it was found average.

5.2.33 Kitchen facility Kitchen facility was present only at Maler Kotla Sub-Divisional Hospital, with proper and safe arrangement for storage of raw material.

5.2.34 Utilisation of patient care services Analysis of the last 5 years’ data showed that at all SDHs the number of patients utilising various medical care including diagnostic and treatment from in-patient and outdoor came down in first 2-3 years. But after that, it steadily increased (though at a slower rate) during the recent years. However, the figures for the delivery services were not found very encouraging, during the last 5 years and in almost all the districts, these figures fluctuated on either side. Therefore, it is not only very difficult to conclude anything from this data, but it was found very much disturbing, that in some places the numbers have actually come down. One of the reasons may be irregular availability of the gynaecologist and its associated basic facilities in these hospitals.

Study to Review The Health Care Delivery System provided by PHSC, Punjab

47

5.2.35 Utilisation of user charges Year-wise expenditure of the user charges made under the following major heads i.e. medicines, improvement in-patient’s facilities (IPF), maintenance of buildings and equipments. The expenditure made under the head medicines was 40% to 45% in most of the Sub-Divisional Hospitals except at Ajnala where maximum expenditure made on first 4 years (2002-06) whereas very low during the year 2006-07.

Fig 16: Percent of expenditure of the user charges in medicine of different Sub-Divisional Hospitals (Punjab) 120

Percent cost (Rs)

100

80

60

40

20

0 Dasuya

Fazilka

Ajnala 2003-04

Batala 2004-05

Jagraon 2005-06

Malar Kotla 2006-07

Malout

Patti

Talwan-di Saboo

2007-08

Fig 17: Percent of expenditure of the user charges in IPF of different Sub-Divisional Hospitals (Punjab) 70

60

Percent cost (Rs)

50

40

30

20

10

0 Dasuya

Fazilka

Ajnala 2003-04

48

Batala 2004-05

Jagraon 2005-06

Study to Review The Health Care Delivery System provided by PHSC, Punjab

Malar Kotla 2006-07

Malout 2007-08

Patti

Talwan-di Saboo

Regarding IPF, most of the Sub-Divisional Hospitals utilised 20% to 25% of the user charges over the years. In maintenance of buildings, majority of the Sub-Divisional Hospitals used less than 15% of the users charges except Fazilka, Batala and Jagraon. In maintenance of equipment majority of the Sub-Divisional Hospitals spent less than 10% of the user charges over the year, except the hospitals at Ajnala, Jagraon and Talwan-di Saboo where it was more than 10% in some years. Fig 18: Percent of expenditure of the User charges in building of different Sub-Divisional Hospitals (Punjab) 25

Percent cost (Rs)

20

15

10

5

0 Dasuya

Fazilka

Ajnala

Batala

2003-04

Jagraon

2004-05

2005-06

Malar Kotla 2006-07

Malout

Patti

Talwan-di Saboo

2007-08

Fig 19: Percent of expenditure of the user charges in equipment of different sub-divisional hospitals (Punjab) 35

Percent cost(Rs)

30 25 20 15 10 5 0

Dasuya

Fazilka 2003-04

Ajnala

Batala 2004-05

Jagraon 2005-06

Malar Kotla 2006-07

Malout

Patti

Talwan-di Saboo

2007-08

Study to Review The Health Care Delivery System provided by PHSC, Punjab

49

5.3 Community Health Centres (CHCs) Facility survey was done at total of eleven CHCs as per the pre-structured checklist. These CHCs were Badal, Fatehgarh, Ferozshah, Goniana, Kartarpur, Khemkra, Longowal, Machiwar, Mahilpur, Majitha and Manawala. The general profile and facility survey of CHCs is given in the Tables Section (Refer Table – 3).

5.3.1 Accessibility All CHCs assessed were easily accessible from the railway station and bus stand and were well connected with the roads.

5.3.2 Water supply Almost all CHCs were having adequate water supply except CHC Manawala. Nine CHCs were having bore well supply while two CHCs i.e. Badal and Goniana were with Municipal water supply. Water storage capacity was found to be one day at 4 CHCs, three days at another 4 CHCs and for two days at remaining three CHCs.

5.3.3 Electricity supply Electricity supply was found to be irregular in most of the CHCs and only three CHCs at Kartarpur, Mahilpur and Majitha, were having regular supply to some extent. Only one CHC was with double phase electric supply, while rest of the CHCs were having three phase electric supply. Back up generator system was available at all the eleven CHCs.

5.3.4 General impression on cleanliness and up keep of gardens Six CHCs maintained good cleanliness while five were found to be average. Only two CHCs were having good upkeep of the garden and rest were having average landscaping. Only one CHC was found to have poor upkeep of the garden.

5.3.5 Status of Buildings Regarding status of the building, nine CHCs were in good condition and at two CHCs i.e. Khemkara and Mahilpur, buildings were in average condition.

5.3.6 Sign, roads and lighting Signage was found poor in Khemkara CHC whereas, it was good at six CHCs. Rest of the CHCs were having average sign posting. Roads and the lighting system were good at seven CHCs, average at three and found poor at one CHC.

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Study to Review The Health Care Delivery System provided by PHSC, Punjab

5.3.7 Public utility facilities Out of all the CHCs studied, none were having a chemist shop or a grocery shop within the premises and only one CHC was having a canteen. Three out of 11 CHCs were having Sulabh Shochalaya.

5.3.8 Ambulance service Ambulance facility was available in all the CHCs studied. Out of these, six CHCs were having at least one ambulance and rest were having two or more ambulances. These ambulances were found to be partially equipped except at two CHCs, where ambulances were well equipped to some extent.

5.3.9 Intensive care unit None of the CHCs were having intensive care unit; however all the CHCs were found to have round the clock emergency services.

5.3.10 Other services (patient care) Except two CHCs all were having dental services and all eleven CHCs were having delivery services.

5.3.11 Mortuary None of the CHCs were having mortuary or post mortem facilities.

5.3.12 Various hospital management committees Out of eleven, only one CHC was having a drug formulary and hospital antibiotic committee, eight CHCs were having a store purchase and store verification committee, while only three CHCs were having hospital infection control committee and medical audit/death review committee.

5.3.13 Drugs and equipment management Almost all CHCs were having dual drug supply. They receive drugs and equipment supply through the state and also buy on their own utilising user charge money. Only three CHCs were found to have their own drug formulary. Seven CHCs were maintaining buffer stock, while only four CHCs followed reorder level. Five CHCs were having annual maintenance contracts for costly equipment, while six CHCs maintained log book and history sheet for the available equipment.

5.3.14 Major equipments Only one CHC was not having Boyle’s apparatus with circle absorber and two CHCs were lacking the facility of dental chairs. Emergency resuscitation kit was present at all CHCs except Badal CHC.

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Eight CHCs were having ophthalmoscope, but it was found to be non functional at one of these CHCs. Sigmoidoscope was only present in three CHCs. Other major and minor operation equipment was not found present at CHC Manawala. X-ray facility was available in all CHC except in one CHC i.e Manawala.

5.3.15 Referral system Referral facilities were available in all CHCs except Manawala; however, proper referral manual and guidelines for referring patients were not present in most of the CHCs. Colour coded referral cards were found to be present only at five CHCs and feedback mechanism existed only at CHC Longowal. Transport facilities were provided by almost all the CHCs except CHC Manawala, as referral facilities were not present here. Only one CHC was not maintaining records and registers other than CHC Manawala. Seven CHCs were found to have a tie-up with other hospitals (both public and private) for diagnostic or referral purposes and most of them were with government hospitals or medical colleges except CHC Kartarpur, which had a tie-up only with private hospitals. Statistical bulletins were available only at four CHCs; and out of these three were also having monthly bulletin and one CHC fortnightly bulletin.

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Study to Review The Health Care Delivery System provided by PHSC, Punjab

5.3.16 Outreach services Six CHCs were having an outreach area and services provided were mainly maternal and child health.

5.3.17 Residential area Only one CHC was not having residential accommodation for the essential staff. Besides this, six CHCs mentioned that they were having some sort of security services, which was mainly in house. None of the CHCs had the facility of dharamshala.

5.3.18 Out-patient department Reception and registration counter was maintained by a clerk at one CHC, by a staff nurse at three CHCs, by a pharmacist at six CHCs and remaining one CHC was found to be managed by either staff nurse or pharmacist. Separate registration counters for male, female and freedom fighters were available only at two CHCs, while rest of them were having single registration counters. Only one CHC was having separate registration counters for staff and senior citizens. Registers used for registration were properly maintained and entries were found to be made at all CHCs. At all CHCs, OPDs were having proper signage and directional sign in every section. Waiting area was found to be adequate at ten CHCs, and proper sitting arrangements were available at 9 CHCs.

Fig 20: No. of OPD attendance at CHC hospitals (Punjab) in the last five years 80000

1st Yr 2nd Yr 3rd Yr

60000

4th Yr 5th Yr

50000 40000 30000 20000 10000

a aw al M an

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Two CHCs were not having drinking water facility, and three were not having separate toilet facility for male and female. Ceiling fans were present at all eleven CHCs. Doctor’s rooms were having adequate space and proper illumination with examination table covered by proper sheet at all eleven CHCs’. Only one CHC was not having a stool for seating the patient and examination equipments like BP apparatus, torch, hammer etc. Seven CHCs were having an injection room along with OPD facility, to deal with emergency situation; minor OT/dressing room was present at six CHCs. Only five CHCs were having dispensaries/pharmacy with separate counters for male/female/senior citizens/staff. Laboratory and imaging services were easily accessible from OPD at all the CHCs, with only seven CHCs having a central collection centre for laboratory services.

5.3.19 Emergency/casualty services A separate medical officer was found to be available round the clock in emergency departments of eight CHCs. Glow sign board displaying ‘emergency service department’ was found only at four CHCs, while board displaying ‘doctors/specialists on call in emergency’ was found at nine CHCs. Emergency wards were attached along with emergency departments at eight CHCs, with bed strengths ranging from 1 to 6 in number. However, two of these eight CHCs were not having triage area. Observation beds were available at nine CHCs, with beds ranging from one to four in number. Trolleys and wheel chairs were present at all CHCs, mostly ranging from 1 to 3 in number. Only one CHC had five trolleys/wheel chairs. Examination rooms with all basic equipments were available in emergency departments of six CHCs and all the registers including MLR were available at nine CHCs. Call book in prescribed format was not found at any of the eleven CHCs. Waiting area for the attendants of the patients, with basic facilities like sitting arrangement, drinking water, toilets etc. were available at emergency departments of eight CHCs, but public telephone facility was found to be present only at one CHC. Emergency departments of six CHCs were having a retiring room for doctors with toilet facility. Seven CHCs were having minor OT in emergency department for various emergency procedures. Sufficient stock of essential and life saving drugs were available at almost all the CHCs except CHC Khemkar; two CHCs were not having oxygen cylinders with necessary attachments. Separate laboratory service and imaging service in emergency department was available in seven and eight CHCs respectively. All CHCs were having ambulance services.

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Study to Review The Health Care Delivery System provided by PHSC, Punjab

Fig 21: No. of emergency patients at CHC Hospitals (Punjab) in the last five years 3000

1st Yr 2nd Yr 2500

3rd Yr 4th Yr 5th Yr

No. of patients

2000

1500

1000

500

0

Badal

Fategarh

Ferojshah

Goniana Khemkaran Longowal Community Health Centres

Mahilpur

Mojitha

Manawala

Fig 22: Admission through emergency at CHC Hospitals (Punjab) in the last five years 900

No. of admissions in the Emergency

1st Yr

800

2nd Yr 3rd Yr

700

4th Yr 5th Yr

600 500 400 300 200 100 0

Fatehgarh Ferojshah

Goniana

Kartarpur Khemkaran

Longowal

Mahilpur

Mojitha

Machiwara

Community Health Centres

Study to Review The Health Care Delivery System provided by PHSC, Punjab

55

Treatment facilities for dog/snake bite and poisoning were available at emergency departments of nine CHCs. Only seven CHCs were having staff trained in basic life support.

5.3.20 Disaster management Only five CHCs were having a disaster manual, and four CHCs out of them were having disaster alert code, recall and deployment arrangements as well. Five CHCs were found to maintain a drug store for disaster situation.

5.3.21 Clinical laboratory All CHCs were having facility for complete blood haemogram analysis and complete urine examination. Two CHCs were not conducting stool test and special tests like blood urea; rest all CHCs’ were providing these services. Blood sugar test and blood grouping and matching tests were available in all CHCs except one. Biochemistry laboratory was present at all CHCs with pathology lab only at three CHCs and microbiology lab at four. However, none of the CHCs were having a qualified pathologist, biochemist or microbiologist. Only three CHCs were not found following universal precaution procedures; laboratories at six CHCs were found having some protective measures like gown, gloves, masks etc. Five CHCs were collecting specimens centrally. Three CHCs’ were not having all the necessary laboratory chemicals and reagents.

5.3.22 Blood banking services None of the CHCs under the study were having blood bank facility.

5.3.23 Radiology services Round the clock availability of X-ray services/sonography were found available at seven CHCs. However, a radiologist was present only at CHC Ferojshah. All CHCs were having a dark room with all the facilities, but none of the CHCs were using dosimeter or conducting special investigations like IVP, contrast media etc. Only CHC Longowal was not found maintaining separate register for MLC records. Five CHCs were found maintaining history book and log book of X-ray machines.

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Study to Review The Health Care Delivery System provided by PHSC, Punjab

5.3.24 Operation theatre (OT) All the CHCs were having major OT except CHC Ferojshah, and out of these two CHCs were having two major OTs. CHC Goniana, Mahilpur and Khemkaran were not having any minor OTs, while rest of the eight CHCs were having one minor OT each. Zoning concept in the OT was found to be followed only at three CHCs. All the CHCs were having emergency light-generator facility for OT. All CHCs were maintaining OT records except CHC Manawala. However, maintenance of OT postponement records was done only at three CHCs. Regular disinfection and sterilisation were found being done in OTs of eight CHCs out of eleven CHCs under this study. Availability of fire-fighting equipments and knowledge to use them were found at OTs of only two CHCs.

5.3.25 In-patient wards All the CHCs, except CHC Badal, were having satisfactory cleanliness of wards with adequate housekeeping services. At nine CHCs wards were found to have adequate and clean toilets and bathrooms. Wards at only two CHCs were not following proper bio medical waste management guidelines for collection and segregation of bio medical waste, and were not having table top syringe and needle destroyer.

Fig 23: Nornal deliveries conducted at CHC Hospitals (Punjab) in the last five years 250 1st Yr 2nd Yr 3rd Yr 4th Yr 5th Yr

150

100

50

a w ar M

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Fig 24: Caesarians done at CHC Hospitals (Punjab) in the last five years 120 1st Yr 2nd Yr 3rd Yr

100

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60

40

20

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Fatehgarh

Goniana

Kartarpur

Longowal

Mahilpur

Mojitha

Machiwara

Community Health Centres

Wards in eight CHCs were having adequate water supply and upkeep of sanitary blocks with proper and adequate linen on bed. None of the CHCs were found having doubling of beds or floor beds. Nine CHCs were found having satisfactory upkeep of cots, mattresses, lockers, linen etc. in the wards. Only one of the 11 CHCs was having uniforms for the patients. Regarding availability of necessary equipments in the wards, it was found that six CHCs were having functional suction apparatus, while another CHC which although was having the suction apparatus, but it was non functional. All CHCs were having oxygen cylinders with accessories; however, at two CHCs, they were nonfunctional. Only three CHCs were having functional venesection/LP/tracheotomy tray. Nine CHCs were found having functional emergency light/wheel chairs/stretcher trolley.

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Study to Review The Health Care Delivery System provided by PHSC, Punjab

Fig 25: No. of patients admitted at CHC Hospitals (PUNJAB) in the last five years 3500

1st Yr 2nd Yr 3rd Yr

3000

4th Yr 5th Yr Number of Inpatients

2500

2000

1500

1000

500

0

Badal

Fatehgarh Ferojshah

Goniana

Kartarpur Khemkaran Longowal Mahilpur

Mojitha

Machiwara

Community Health Centres

Wards at only two CHCs were not having adequate stationery, forms and various updated registers; however, all were found maintaining various registers and records required in the ward. All CHCs were having adequate fans and light. None of the CHCs were providing diet to the inpatients.

5.3.26 Hospital medical store Medical stores suitably located with adequate space were found at eight CHCs. At seven CHCs, the medical store staff had knowledge on material management, system of FIFO, bin cards, lead time, buffer stock etc. CMO/MO were found to regularly inspect the medical store and verify stock books at all CHCs except CHC Manawala. Eight CHCs were having restriction on entry of unauthorised persons in medical store. Availability of vital and essential drugs was found at medical stores of eight CHCs, while only five CHCs were up-keeping the expiry date register, which was regularly inspected by a medical officer. Only five CHCs were making efforts to redistribute large stocks of slow moving drugs or near expiry drugs for its timely utilisation. Three CHCs were having proper arrangements to keep drugs as per ABC/VED category and storage of rubber goods as per the guidelines.

Study to Review The Health Care Delivery System provided by PHSC, Punjab

59

Medical stores of three CHCs were not found to take appropriate steps to prevent pilferage of drugs. All CHCs were having convenient arrangements of issuing drugs to various wards. Only CHC Kartarpur was found to send samples regularly to chemical laboratory for checking standards of drugs. Eight CHCs were circulating list of available drugs to all MOs, OPD and wards as per their generic names. Medical store at seven CHCs was submitting certified bills to office for release of payment within three days. Auction to clear the empty material from store was done regularly at only five CHCs. Availability of fire-fighting equipments and knowledge to use them were found to be in the medical stores of only two CHCs. Standing drug committee was found to exist only at three CHCs, and only these CHCs were having regularly updated hospital drug formulary.

5.3.27 Medical record department All eleven CHCs were having medical record room with sufficient numbers of racks. Record keeping in medical record room was manual in all the CHCs assessed, but at only four CHCs, this was managed by medical record officer or technician having some training in medical record keeping. None of these hospitals were found to maintain some of the basic hospital utilisation indices like bed occupancy rate, average length of stay, bed turnover interval, death rate etc. on the regular basis and in proper scientific way. Case records were maintained as per WHO classification of disease (ICD-X schedule) at only two CHCs. However, all eleven CHCs were found regularly submitting morbidity and mortality report except CHC Manawala. Only two CHCs were having back-up facility to safe guard these records and only four CHCs were found following some kind of retrieval system.

5.3.28 Hospital waste management Adequate number of bins and bags of required colour codes were available and placed strategically in all patient care areas in nine out of eleven CHCs included in the study. Proper segregation and collection of waste was found to be done with proper packaging and record keeping at almost all CHCs except Badal. CHC Fatehgarh and Badal were found lacking in proper transportation of waste. Only four CHCs were having proper storage facility for the biomedical waste.

60

Study to Review The Health Care Delivery System provided by PHSC, Punjab

5.3.29 Central sterile supply department Only six CHCs were having CSSD under supervision of trained staff/senior nursing officer, nine CHCs were having all required equipments and autoclaves. Quality control measures were found to be followed at all six CHCs having CSSD.

5.3.30 Laundry services Among eleven CHCs under study, six were having in-house laundry services, while remaining five had outsourced it. At all CHCs, laundry was of conventional (dhobi) type. Quality of wash was found good at four CHCs only, while in rest of the CHCs, it was found to be average. Quality of linen was good at six CHCs and average in the remaining five CHCs.

5.3.31 Kitchen facility Kitchen facility was not available at any of the CHCs assessed.

5.3.32 Utilisation of Patient care services At all the CHC hospitals, analysis of last 5 year data, revealed that the number of patients utilising various medical care services, including diagnostics and treatment, from in-patient and outdoor had came down in first 2-3 years. But after that, it has steadily increased during the recent years, though at a slower rate. However, the figures for service delivery were not found very encouraging. For the last 5 years, the figures had fluctuated on either side in almost all the districts. Therefore, not only it is very difficult to conclude anything, but is very much disturbing, that in some places the numbers have even come down. One of the reasons may be irregular availability of a gynaecologist and its associated basic facilities in these hospitals.

5.3.33 Utilisation of user charges Year-wise expenditure of the user charges made under the following major heads i.e. medicines, improvement of the in-patient’s facilities (IPF), maintenance of buildings and equipments. The expenditure made under the head medicines was 40% to 50% in most of the community health centre (CHC) except the CHC at Badal, Fatehgarh Churian and Manawala. Regarding IFP, most of the CHC spent 20% to 30% of the user charges over the years except at Longowal. (See Fig 26 and 27) The utilisation of User charges in maintenance of buildings at the CHCs under study were observed to be varying very widely in the CHCs, over the years as shown in the graph. 10% to 15% of user charges were found to be used for equipment maintenance in all the CHCs over the years except for Badal, Kartarpur and Mahilpur where it was even less then 5% except in few years. (See Fig 28 and 29)

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61

Fig 26: Percent of expenditure of the user charges in medicine of different CHCs of PHSC (Punjab) 70

60

Percent cost (Rs)

50

40

30

20

10

0 Badal

Fatehgarh Churian

Ferojshah

Goniana

2003-04

Kartarpur

Khemkaran

2004 -05

2005-06

Longowal

2006-07

Mahilpur

Majitha

Machiwara

Manawala

2007-08

Fig 27: Percent of expenditure of the user charges in IPF of different CHCs of PHSC (Punjab) 70.00 60.00

Percent cost (Rs)

50.00 40.00 30.00 20.00 10.00 0.00 Badal

Fatehgarh Churian

Ferojshah

Goniana

2003-04

62

Kartarpur Khemkaran

2004 -05

Study to Review The Health Care Delivery System provided by PHSC, Punjab

2005-06

Longowal

2006-07

Mahilpur

2007-08

Majitha

Machiwara Manawala

Fig 28: Percentage of expenditure of the user charges in buildings of different CHCs of PHSC (Punjab) 35

30

Percent cost (Rs)

25

20

15

10

5

0 Badal

Fatehgarh Churian

Ferojshah

Goniana

Kartarpur

Khemkaran

Longowal

2003-04

2004 -05

2005-06

2006-07

Mahilpur

Majitha

Machiwara

Manawala

2007-08

Fig 29: Percentage of expenditure of the user charges in equipment of different CHCs of PHSC (Punjab) 30

Percent cost (Rs)

25

20

15

10

5

0 Badal

Fatehgarh Ferojshah Churian

Goniana

2003-04

Kartarpur Khemkaran Longowal

2004 -05

2005-06

2006-07

Mahilpur

Majitha

Machiwara Manawala

2007-08

Study to Review The Health Care Delivery System provided by PHSC, Punjab

63

6.0 Views of the Beneficiaries on Quality of Services

6.1 In-patient Department A total of 224 respondents were interviewed from various health institutions like CHCs, Sub-divisional hospitals, District hospitals and Special Hospitals of Punjab Health Systems Corporation.

6.1.1 Socio-economic profile of respondents •





Out of 224 respondents, the services of Punjab Health Systems Corporation were utilised more by females (56.3%) as compared to males (43.8%). When observed separately at the in-patient department of special hospitals, more female patients (90.9%) were found admitted as compared to the males (9.1%). This may be because these hospitals were mainly for women and children. Similarly at Sub-divisional hospitals, more female patients (55.9%) were found admitted as compared to the male patients (44.1%). At District hospitals the service utilisation was found to be 55.2% by females as compared to 44.8% by males. But at CHCs, the service utilisation by males was found to be more (65.5%) as compared to the females (34.5%). Utilisation of services by less than 15 years age group was very little (1.3%). Half of the respondents (50%) were in the age group of 15-30 years, while 20.1% respondents were in 31-45 years age group. Remaining respondents were above 46 years of age.

Fig 30: Age distribution of in-patients at various health care institutions in Punjab 80 68.2

Percentage of Patients

70 60

54.4 48.3

50

43.8

40 30

25

22.9

24.1

22.7

18.1

20

13.3 8.8

10 1.9

13.8

11.8

13.8 4.5

0

4.5 0

0

0

64

Dist. Hospital(105)

Sub-Divisional(68)

Less than 15

15-30

31-45

Study to Review The Health Care Delivery System provided by PHSC, Punjab

CHC(29) 46-60

SP. Hospital(22) Above 60



Literacy level of respondents was low. 35.7% were illiterate and 24.6% were just educated up to primary level. 26.3% respondents were educated upto senior secondary level and 2.2% were graduate and post graduate. Economic status of the respondents was low, as monthly income of 40.2% respondents was less than Rs.2000 per month; of 39.3% respondents was between Rs.2000-Rs.5000 per month and only that of 1.3% respondents using PHSC health services was more than Rs. 15000 per month. (Refer Table 4)



Fig 31: Income distribution of in-patients at various health care institutions in Punjab

Percentage of patients

60

55.2

50

44.8 39

40

38.2

39.7 31.8

31

27.3

30 22.7

20

16.2 13.6

11.4 10

6.9

5.9

3.8 1

3.4

4.5

3.4

0

0

Dist. Hospital (105) Less than 2000

Sub-Divisional (68) 2001-5000

CHC (29)

5001-10000

10001-15000

SP. Hospital (22) Above 15000

6.1.2 Admission procedure •



51.3% of the respondents were found to be admitted through emergency, while 48.2% of the admissions were through regular OPD. This indicates that, nearly half of the respondents came for utilisation of PHSC services only in the case of emergency. This might be because they do not have access to other health facilities due to economic reasons and are left with no other alternative except to seek emergency care in these facilities. When respondents were asked to rate their experience about the admission procedure at these institutions, 77.7% respondents rated it as being poor while another 12.1% stated that the procedure was average. When this poor rating was assessed specifically at different health institutions, it was revealed that 86.2% respondents from CHCs; 80.9% from Subdivisional hospitals and 77.3% from Special Hospitals had rated the admission procedure as poor. At District hospitals percentage rating was slightly less than the other health institutions (73.3%). This is indicative of the fact that the majority of respondents were not satisfied with the admission procedure. (Refer Table 5)

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65

Fig 32: Opinion of in-patients about admission procedure at various health care institutions in Punjab 100

86.20

Percentage of Patients

90

80.90

80

77.30

73.30

70 60 50 40 30 20

18.20

10.50 11.40

11.80

10

10.30

4.40

4.50

3.40

0

Dist. Hospital (105)

Sub-Divisional (68) Good

CHC (29)

Average

SP. Hospital (22)

Poor

6.1.3 User charges • •

More than 3/4th of respondents (87.9%) were found to have paid charges for making slip/ card; 78.6% for admission and 86.2% for investigations as user charges. 69.2% respondents stated that adequacy of information imparted to them by the doctor about their disease and treatment was perceived as adequate; however 24.6% respondents

Fig 33: Distribution of in-patients regarding user charges at various health care institutions in Punjab

Percentage of Patients

120 100

96.6 87.6 84.8

85.3

83.8

96.6 86.4

79.3

80

90.9

86.4

64.7 60 40 18.2

20

10.3

8.6

10.3

0

Dist. Hospital (105) Slip/card

66

Sub-Divisional (68)

Admission charges

CHC (29)

Investigation charges

Study to Review The Health Care Delivery System provided by PHSC, Punjab

SP. Hospital (22) Consultancy charges



said that the information given to them was incomplete. When the issue about the adequacy of information was looked at from the perspective of health-institution, it was found to be highest at CHCs (82.8%), followed by Special Hospitals (77.3%), District Hospital (65.7%) and at last the Sub-Divisional Hospitals (66.2%). 54.5% respondents stated that they were informed about the rules and regulations of health institutions, while 44.2% respondents stated that they did not receive any such information. (Refer Table 6)

6.1.4 Experience of respondents at OPD/Emergency •



17.9% of respondents rated their experience at the emergency/OPD as average for various health care institutions. 1.8% respondents rated their experience as poor and 2.2% respondents preferred not to express their experience regarding services at emergency/OPD. When an analysis was done in terms of health facility, it was found that 90.9% respondents at Special Hospitals, 82.4% respondents at Sub-Divisional Hospitals, 75.2% respondents at District Hospitals and 65.5% respondents at CHCs rated their experience as good. Thus, there is a scope of improving the services at CHCs level. (Refer Table 7)

6.1.5 Cleanliness and comfort in the wards Out of all respondents, 66.5% rated general cleanliness of wards and beds as good while 44.2% respondents rated it as average. When percentage rating was done separately for different facilities with respect to the in-patient department for general cleanliness, it was found to be rated as good by 95.5% respondents in Special Hospitals, 79.3% respondents in CHCs, 63.3% respondents in Sub-Divisional Hospitals and 64% in District Hospitals.

Fig 34: Opinion of in-patients about general cleanliness of beds/wards at various health care institutions in Punjab

120 95.5

100 Percentage of Patients



79.3

80 61

60.3

60 40

36.2

35.3 20.7

20 2.9

4.4

4.5

0

0

0 Dist. Hospital (105) Good

Sub-Divisional (68) Average

CHC (29)

SP. Hospital (22) Poor

Study to Review The Health Care Delivery System provided by PHSC, Punjab

67



66.5% respondents perceived the cleanliness of bed linen as good and 30.8% respondents perceived it as average. Facility wise 100% of respondents at CHCs, 86.4% at Special Hospitals, 63.2% at Sub-Divisional Hospitals and 60% at the District Hospitals perceived cleanliness of bed linen as good. Fig 35: Opinion of in-patients about general cleanliness of ward bed-linen at various health care institutions in Punjab 120

100

Percentage of Patients

100

86.4 80

63.2

60 60 40

33.3 27.9

20

6.7

13.6

8.8 0

0

0

0 Dist. Hospital (105) Good







Sub-Divisional (68) Average

CHC (29)

SP. Hospital (22) Poor

Among the respondents from different health institutions, 74.1% respondents perceived that the degree of comfort in the ward was good while 30% perceived it as average. When different facilities were compared, it was revealed that respondents perceived comfort better in the wards of CHCs (86.7%) and Special Hospitals (86.4%); as compared to District Hospitals (72.4%) and Sub-Divisional Hospitals (66.2%). Overall 79.5% respondents stated that good facilities e.g. lights and fans were available in the wards whereas 18.8% respondents considered these facilities as average. Respondents had perceived these facilities better at the wards of Special Hospitals (90.9%) and CHCs (82.8%), as compared to SDH (77.9%) and District Hospitals (77.1%). (See Fig 25) Regarding toilet facilities, overall 47.3% respondents perceived that toilets were clean. However, when assessed facility wise, 63.6% respondents from Special Hospitals, 55.2% from CHCs, 47.1% from Sub-Divisional Hospitals and 41.9% from District Hospitals perceived that toilets in the wards were clean. (Refer Table 8)(See Fig 26)

6.1.6 Behaviour of doctors, nurses and staff during stay in hospitals •

68

Overall 93.3% respondents stated that the behaviour of the doctors with the patients is good, while 5.8% respondents considered it as average. Remaining 0.9% respondents did not make any comment. When the percentage distribution was seen separately at different

Study to Review The Health Care Delivery System provided by PHSC, Punjab

Fig 36: Opinion of in-patients about availability of light & fans in wards at various health care institutions in Punjab 100

90.9

Percentage of Patients

90 80

82.8

77.9

77.1

70 60 50 40 30

22.1

19

20 10

17.2 9.1

3.8

0

0 Dist. Hospital (105)

0

Sub-Divisional (68)

Good

0

CHC (29)

SP. Hospital (22)

Average

Poor

Fig 37: Opinion of in-patients about cleanliness of toilets in wards at various health care institutions in Punjab

Percentage of Patients

70

63.6

60

55.2 47.1

50 41.9 40

38.1

37.9

20

31.8

27.9

30

23.5 18.1 6.9

10

1.9

1.5

Dist. Hospital (105)

Sub-Divisional (68)

4.5 0

0

0

Good



Average

CHC (29) Poor

SP. Hospital (22) Can't say

facilities, it was found that 95.5% respondents from Special Hospitals, 94.1% from SubDivisional Hospitals, 92.4% from District Hospitals and 93.1% patients from CHCs considered the behaviour of doctors as good. This indicates that the overall behaviour of doctors in the health institutions has been good. Regarding the behaviour of nurses in the in-patient departments, 80.4% respondents perceived it as good, 17.4% as average, 1.8% as poor and the remaining 0.4% did not comment on their behaviour. Health facility-wise, 87.6% patients from District Hospitals,

Study to Review The Health Care Delivery System provided by PHSC, Punjab

69

Fig 38: Opinion of in-patients about behaviour of nurses at various health care institutions in Punjab 100

Percentage of Patients

90

87.6 82.8

81.8

80 67.6

70 60 50 40

30.9

30 18.2

20

11.4 6.9

10

1

1.5

0

6.9

0

3.4

0

0

0

Dist. Hospital (105) Good

Sub-Divisional (68) Average

CHC (29)

SP. Hospital (22)

Poor

Can't say

82.8% from CHCs, 81.8% from Special hospitals and 67% respondents from Sub-divisional hospitals considered the behaviour of nurses as good. Overall, 74.1% respondents stated that the behaviour of staff members was good in the inpatient department of various health institutions. 19.2% patients considered the behaviour as average, 1.8% considered it poor, while remaining 4.9% respondents did not say anything.



Fig 39: Opinion of in-patients about behaviour of doctors at various health care institutions in Punjab 90

Percentage of Patients

80

78.1

77.3 69.1

69

70 60 50 40 30 20

20.7

20.6

18.1

10.3 10

1

2.9

18.2

6.9

0

4.5

3.4

0

0

Dist. Hospital (105) Good

70

Sub-Divisional (68) Average

Study to Review The Health Care Delivery System provided by PHSC, Punjab

CHC (29) Poor

SP. Hospital (22) Can't say



When the respondents were asked about the attitude of nurses at the time of admission, it was revealed that 77.7% respondents considered it good, 19.6% considered it average, 1.3% considered it poor while remaining 1.3% did not comment on this. Facility-wise it was found that 86.4% respondents from Special Hospitals, 80% respondents from District Hospitals, 75.9% from CHCs and 72.1% from Sub-Divisional Hospitals considered the behaviour of nurses as good. Regarding behaviour of other staff members, health facility-wise assessment revealed that 78.1% respondents from District Hospitals, 77.3% from Special Hospitals, 69.1% from SubDivisional Hospitals and 69% from CHCs stated that the behaviour of other staff members was good. The findings revealed that 99.6 % respondents had not paid any money to staff members of the health facility. It was found that none of the respondents from District Hospitals, CHCs and Special Hospitals had to pay any money to staff members of the hospital. However, at the Sub-Divisional Hospital, 1.5% respondents stated that they had paid to the staff members of the hospital. (Refer Table 9)





6.1.7 Availability of diagnostic services •

Out of 224 respondents, 65.6% stated that the facilities e.g. laboratory and radiological investigations were good, 24.1% respondents considered the facilities as average, 1.3% considered them poor and remaining 12.1% respondents did not respond to it. When percentage of laboratory and radiological investigation facilities were seen at different health institutions separately, it was revealed that 86.4% respondents of Special Hospitals considered them as good. But in other health facilities such as District Hospitals (65.7%), Sub-Divisional Hospitals (54.4%) and CHCs (51.7%) these percentages were lower than the Special Hospitals. (Refer Table 10)



Fig 40: Opinion of in-patients about availability of Lab. facilities at various health care Institutions in Punjab 100 86.4

90

Percentage of Patients

80 70

72.4 65.7

63.6

60

54.4

51.4

52.9

51.7

50 40 30

36.8

34.3 25.7

31.8 22.1

20

12.4

20.6 13.8 10.3

8.8

7.6

10

37.9

1.9

1

1.5

2.9

0 Dist. Hospital (105) Good

Average

Poor

Sub-Divisional (68) Can't say

All available

Some available

10.3

9.1 4.5

3.4 0

CHC (29) None available

4.5 0

0

SP. Hospital (22) Can't say

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71

6.1.8 Availability of medicines in the In-patient department •

Only 13.4% respondents stated that all the medicines were available, 55.8% stated that some medicines were available and 29% respondents stated that no medicine was available in the ward of the concerned health facility.



When the percentage was seen separately for the various health institutions, then the comparative availability of medicines was found to be more at Special Hospitals (31.8%) as compared to CHC (13.8%), District hospital (12.4%) and Sub-Divisional Hospitals (8.8%). (Refer Table 10) (See Fig 41)

6.1.9 Money spent on medicines by the respondents •

Out of the total respondents interviewed, 91.1% respondents spent money on medicines while remaining 8.9% respondents did not have to spend any money.



In different health institutions, the percentage of respondents who spent money on medicines was 100% at Sub-Divisional Hospitals, 93.3% at District Hospitals, 81.8% at Special Hospitals and 69% at CHCs. (Refer Table 11)

6.1.10 Food supply to the patients •

Since, at most of the institutions, food was not supplied from the hospitals, therefore, majority of respondents (80.4%) did not comment on this aspect of the questionnaire.

6.1.11 Quality of care •

83.0% respondents rated their experience at the reception counter as good, 13.4% rated it as average and 0.4% respondents rated it poor. 2.2% respondents did not comment. Fig 41: Opinion of in-patients about availability of medicines at various health care institutions in Punjab 80 72.4

Percentage of Patients

70

63.6

60

52.9

51.4

50 40

36.8

34.3

31.8

30 20

13.8

12.4 8.8

10

1.9

10.3 4.5

3.4

1.5

0

0

72

Dist. Hospital (105)

Sub-Divisional (68)

All available

Some available

Study to Review The Health Care Delivery System provided by PHSC, Punjab

CHC (29) None available

SP. Hospital (22) Can't say

Facility-wise experience of respondents revealed that services were rated well by 90.9% respondents at Special Hospitals, 86.8% at Sub-Divisional Hospitals, 82.9% at the District Hospitals and 69% at the CHCs. Out of all, 79.0% respondents stated that the overall quality of treatment was good, 17.0% considered it average, 1.8% stated that the quality of treatment was poor while remaining 2.2% respondents did not comment. When assessed for different facilities, quality of treatment was found to be better at Special Hospitals (95.5%) and District Hospitals (81%) as compared to Sub-Divisional Hospitals (73.5%) and CHCs (72.4%).



6.1.12 Security in the In-patient department •

Nearly half (46.4%) of the respondents from all the health institutions perceived that the security at health facilities was good. This was perceived as average by 17.4%, poor by 17% respondents and 2.2% respondents did not made any comment about their perception on security. About half of the respondents at District Hospitals (51.4%) and Special Hospitals (50%) and less than half at CHCs (44.8%) and at Sub-Divisional Hospitals (38.2%) perceived the security as good. The above findings suggest that more than half of the respondents did not feel adequately secure in the in-patient department and there is scope to improve security in the health institutions.





6.1.13 Overall satisfaction of the respondents •

Overall, 94.2% respondents of the in-patient department expressed satisfaction and only 5.8% were not satisfied with the services of the health institutions. When their satisfaction percentage was observed separately for the different health facilities,



Fig 42: Opinion of in-patients about satisfaction on over all services at various health care institutions in Punjab

Percentage of Patients

120

100

100

96.2

100

86.8

80

60

40

20

13.2 3.8

0

0

0

Dist. Hospital (105)

Sub-Divisional (68) Yes

CHC (29)

SP. Hospital (22)

No

Study to Review The Health Care Delivery System provided by PHSC, Punjab

73

it was revealed that 100% of the patients from in-patient department of CHCs and Special Hospitals, 96.2% patients from District Hospitals and 86.8% from the Sub-Divisional Hospitals were satisfied with the services provided. (Refer Table 13)

6.1.14 Suggestions given by the respondents The major suggestions given by the respondents were as below: • • •

About 25.5% of the patients were of the view that the medicines should be provided free of cost or atleast on subsidised rates. Quality of medicines should be improved; food should be provided, clean toilets, regular visits by the higher authorities to check the facilities of the hospital etc. Only 4.2% of the patients were satisfied with the services being provided by the hospitals. (Refer Table 14)

6.2 Outpatient Department A total of 580 respondents were interviewed in the outpatient department of various health institutions like CHCs, Sub-Divisional Hospitals, District Hospitals and Special Hospitals of Punjab Health System Corporation. The following findings have emerged based on the interview of respondents in the outpatient department.

6.2.1 Socio-economic profile of respondents •

Out of 580 respondents interviewed the services of PHSC were more utilised by females (57.9%) as compared to males (42.1%). When analysed for health facilities it was found that in the outpatient department of Special Hospitals more female respondents (87.2%) utilised

Fig 43: Age distributon of patients attending OPD at various health care institutions in Punjab

Percentage of Patients

60

55.3

50 38.7

40

37.7 34.1 30.3

30

26.7

20

19.3 15.8

14.1

10

5.3

25.5

25.4 20.7

19.0

12.8

6.7 4.4

2.1

1.8

4.3

0

Dist. Hospital (284) Less than 15

74

Sub-Divisional (135) 15-30

31-45

Study to Review The Health Care Delivery System provided by PHSC, Punjab

CHC (114) 46-60

SP. Hospital (47) Above 60

Fig 44: Educational status of patients attending OPD at various health care institutions in Punjab

Percentage of Patients

60 49.1

50 38.5

40

30

28.9

28.2 25.5

25.2

27.7

22.9

21.3

19.3 20

17

15.8 16.7

11.9

10.6 10

11.4 8.5

6.7 3.7

2.8

4.4 1.5

2.6 0

0

Dist. Hospital (284) Illiterate

• • • •

Primary

Sub-Divisional (135) Secondary

Senior Secondary

CHC (114) Graduate

SP. Hospital (47) Above Graduate

the services as compared to the male respondants (12.8%). Similarly in District Hospitals, the service utilisation was 59.2% by females as compared to 40.8% by males. But at SubDivisional Hospitals and CHCs, the utilisation of services by both males and females was almost same. Majority of respondents were in the age group of 15-30 years (35.2%) and 31-45 years (29.5%). The literacy level of majority of the respondents was found to be low, as 34.8% were illiterate and 22.4% were just educated up to primary level. (See Fig 44) Their economic status was also low, as 34.0% respondants’ income was less than Rs.2000 per month and 37.9% respondents’ income was between Rs.2000-Rs.5000. This indicates that majority of respondents utilising PHSC were females having poor education and low income. (Refer Table 15)

6.2.2 User charges • •

Majority of the respondents (94.8%) were paying user charges for getting an OPD card and 70% of the respondents were found to have paid for investigation charges. (Refer Table 16) The amount of user charge was found to be a token amount of Re.1, which could be the reason for higher proportion of respondents paying for OPD card. (See Fig 45)

6.2.3 General cleanliness •

Out of total 580 respondents, 72.4% rated general cleanliness of OPD as good whereas 25.3% respondents rated it average. When the percentage rating was seen separately at outpatient department of different facilities, the general cleanliness was rated good by 87.2% respondents in Special Hospitals, 73.9% respondents in District Hospitals, 71.1% in Sub-Divisional Hospitals and 64% in CHCs. (See Fig 46)

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75

Fig 45: User charges at OPD in various health care institutions in Punjab 120 98.5

Percentage of Patients

100

94.4

93

80

91.5

71.9

69

71.1

68.1

60 40 20

12.8 4.6

3.7

3.5

0 Dist. Hospital (284)

Sub-Divisional (135)

OPD card charges





CHC (114)

Investigation charges

SP. Hospital (47)

Consultancy charges

Overall 77.8% respondents rated the waiting area of OPD as good and 20.3% respondents rated it average. Facility-wise the waiting area of OPD was perceived as good by 93.6% respondents in the Special hospitals, 82.7% in District Hospitals, 77% in Sub-Divisional Hospitals and 59.6% in CHCs. Thus, overall rating of general cleanliness of the OPD along with basic facilities was found to be better in the Special Hospitals in comparison to CHCs. (Refer Table 17) Fig 46: Views of patients attending OPD about general cleanliness at various health care institutions in Punjab 100 87.2

Percentage of Patients

90 80

73.9

71.1

70

64

60 50 40 30

34.2 27.4 22.9

20 10

12.8

2.5

0.7

0

1.8

1.5

0

0

0

0 Dist. Hospital (284) Good

76

Sub-Divisional (135) Average

CHC (114) Poor

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SP. Hospital (47) Cannot say

6.2.4 Availability of basic facilities •









Overall 75.7% respondents stated that facilities such as light and fan were good where as 18.4% respondents considered these facilities as average. These facilities were perceived to be better at the OPD of Special Hospitals (89.4%), Sub-Divisional Hospitals (83.7%) and District Hospitals (79.2%), as compared to CHCs’ where 51.8% respondents were positive. The availability of STD/PCO booth was 43.1% in various health institutions. Health facilitywise, 52.6% Sub-Divisional Hospitals 48.6% District Hospitals, 46.8% Special Hospitals and 16.7% CHCs were having the STD/PCO facility. Separate toilets for women were available in 86% of the health facilities. Facility wise separate toilets for women were available at 97.9% Special Hospitals, 88% District Hospitals, 85.9% Sub-Divisional Hospitals and 76.3% of CHCs. This is indicative of the fact that separate toilet facilities need to be made available to the female respondents when more number of females are utilising the OPD services at various institutions. Availability of drinking water was 89.1% in various health institutions. The same was 100% at Special Hospitals, 97% at Sub-Divisional Hospitals, 88% at District Hospitals and 78.1% at the CHCs. (See Fig 47) Overall availability of screened examination room was found to be 87.2%. However this was 100% at Special Hospitals, while the availability of screened examination room was 88.1% in Sub-Divisional Hospitals, 86.3% in District Hospitals and 83.3% in CHCs. (Refer Table 17)

6.2.5 Adequacy of information about disease and treatment Overall 81.4% respondents stated that adequacy of information given to them about their disease and treatment by the doctor was good, while 13.6% respondents stated that the information given was average. Fig 47: Views of patients attending OPD about drinking water facility at various health care institutions in Punjab

120

Percentage of Patients



100

100

97 88 78.1

80 60 40 20

14

10.9

7.9 1.1

3

0

0

0

0 Dist. Hospital (284) Yes

Sub-Divisional (135) No

CHC (114)

SP. Hospital (47)

Cannot say

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Fig 48: Distribution of OPD patients informed about the diseases and treatment by the treating doctor at various health care institutions in Punjab

100

Percentage of Patients

90

85.9

85.1 78.5

80

71.9

70 60 50 40 30

22.8

20 10

12.6 0.9

1.1

10.6

5.2

2.1

3.7

1.8

4.3

3.5

0

0 Dist. Hospital (284) Good



Sub-Divisional (135) Average

CHC (114) Poor

SP. Hospital (47) Cannot say

When the adequacy of information given to respondents about disease and treatment by doctors was assessed facility-wise, it was found that adequacy of information was maximum in District Hospitals (85.9%), followed by Special Hospitals (85.1%), Sub-Divisional Hospitals (78.5%) and CHCs (71.9%) respectively. (Refer Table 18) (See Fig 48)

6.2.6 Availability of medicines •



Out of all the respondents, only 10.3% respondents stated that all medicines were available in the OPD, whereas other respondents (62.8%) stated that not all medicines were available. Rest of the respondents (26.4%) stated that none of the medicines were available in the OPD. (Refer Table 18) When the issue was analysed health facility-wise, it was revealed that the availability of all medicines in Sub-Divisional Hospitals and CHCs was 17% and 14% respectively. At other health facilities such as Special Hospitals (8.5%) and District Hospitals (6%) the availability of all medicines was less. (See Fig 49)

6.2.7 Availability of diagnostic facilities •

Most of the respondents stated that the facilities like laboratory and radiological investigations were good (50.7%), whereas 22.1% respondents stated that they were average and 1.95% stated them as poor. (Refer Table 18) (See Fig 50)

6.2.8 Behaviour of staff members •

78

Overall 56.9% respondents stated that behaviour of staff members was good in the OPD of various institutions. Out of the remaining respondents, 32.4% respondents stated that the Study to Review The Health Care Delivery System provided by PHSC, Punjab

Fig 49: Opinion of patients attending OPD about availability of medicines at various health care institutions in Punjab

80 70

Percentage of Patients

74.5

72.8 68.1

60

54.2

50 39.1

40 30 17

20 10

14.1

14

13.2 8.5

6

0.7

0.7

7

0

0

0

Dist. Hospital (284) All available

Sub-Divisional (135) Some available

CHC (114)

SP. Hospital (47)

None available

No response

Fig 50: Opinion of patients attending OPD about Lab. & radiological facilities at various health care institutions in Punjab

Percentage of Patients

70 60

63.8

53.9

51.9

50 40

36 32.5

31.9

28.9

30 23.2

28.1

21.5 17

20 10 1.4

4.3

3.5

2.2

0

0

Dist. Hospital (284) Good



Sub-Divisional (135) Average

CHC (114) Poor

SP. Hospital (47) Cannot say

overall behaviour of the staff was average, 8.8% respondents did not say anything about their behaviour and 1.9% said that the behaviour was poor. (See Fig 51) When the percentage distribution was seen separately for different facilities, it was found that 70.2% respondents of Special Hospitals, 60% respondents of Sub-Divisional

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Fig 51: Opinion of patients attending OPD about behaviour of staff at various health care institutions in Punjab

80 70.2

Percentage of Patients

70 60

60

56 50

50 40.4

40

34.5 30.4

30 21.3

20 7.7

10

8.8

6.7 3

1.8

6.4

2.1

0.9

0

Dist. Hospital (284) Good



Sub-Divisional (135) Average

CHC (114) Poor

SP. Hospital (47) Cannot say

Hospitals, 56% respondents of District Hospitals and 50% respondents of CHCs stated that the behaviour of staff members was good. Almost all the respondents (97.1%) said that they did not have to pay any money to the staff members of the hospitals, while 2.9% respondents reported to have paid to staff members of the hospitals. When this was looked for at different health institutions, it was found that 3.2% respondents from District Hospitals, 3% from Sub-Divisional Hospitals, 2.6% from CHCs and 1% from Special Hospitals had paid to staff members at the respective hospitals. (Refer Table 19)

2.9 Availability of doctors, nurses and staff in the OPD •





80

Overall availability of doctors as stated by the respondents at the health institutions was 94.8%. When respondents were asked about doctor’s behaviour towards them, 91.4% reported the doctor’s behaviour being good. When availability of doctors was assessed for different facilities, then 97.9% respondents of Special Hospitals, 95.1% of Sub-Divisional Hospitals, 95.1% of District Hospitals and 89.5% respondents of CHCs stated that doctors were available. Overall availability of nurses was confirmed by 79% of the respondents and 64.5% said that the behaviour of nurses was good towards the patients. Facility wise percentages of the availability of nurses and their good behaviour towards patients were found to be 80.6% & 63% at District Hospitals, 78.1% & 68.4% at CHCs, 77% & 62.2% at Sub-Divisional Hospitals and 76.6% & 70.2% at Special Hospitals respectively. (Refer Table 19) (See Fig 52)

Study to Review The Health Care Delivery System provided by PHSC, Punjab

Fig 52: Opinion of patients attending OPD about availabilty of doctors at various health care institutions in Punjab

Percentage of Patients

120

100

97.9

97.8

95.1

89.5

80

60

40

20

10.5 4.9

2.2

2.1

0

Dist. Hospital (284)

Sub-Divisional (135)

Available

CHC (114)

SP. Hospital (47)

Not available

6.2.10 Waiting time •









When respondents were asked about the waiting time at various health facilities, a majority of the respondents (88.7%) stated that they have to wait upto 15 minutes. Rest of the patients stated that they waited longer i.e. 9% for 16-30 minutes and 2.3% for more than 30 minutes. At District Hospital, waiting time for 83.6% respondents was up to 15 minutes where as at rest of the facilities more than 91% respondents reported to have got themselves registered in less than 15 minutes (95.7% at Special Hospitals, 95.6% at CHCs and 91.1% at District Hospitals). Time spent in waiting for specialist consultation in the OPD was less than 15 minutes for 63.4% respondents. 22.7% respondents stated that they had waited between 16–30 minutes for specialist consultation where as 13.9% waited for more than 30 minutes. When it was seen for different institutions, 79.7% respondents at Sub-Divisional Hospitals, 72% respondents at CHCs, 55.6% respondents at District Hospitals and 46.4% respondents at Special Hospitals waited upto 15 minutes. Time spent for getting investigations done at the OPD was found to be less than 15 minutes for 83.6% respondents. Between 9.9% respondents waited for 16–30 minutes for getting the investigations done where as 6.5%% waited for more than 30 minutes. When it was seen for different institutions, 91.1% respondents at Sub-Divisional Hospitals, 86.9% respondents at CHCs, 80.5% respondents at District Hospitals and 78.4% respondents at Special Hospitals waited for up to 15 minutes. Waiting time for getting the medicine in the OPD was up to 10 minutes for 80.8% respondents, between 11-20 minutes for 15% respondents and more than 20 minutes for 4.2% respondents. At different health institutions it was up to 10 minutes for 90.4% respondents at CHCs, 86.5% at Special Hospitals, 81% at Sub-Divisional Hospitals and 74% at District Hospitals. (Refer Table 20) Study to Review The Health Care Delivery System provided by PHSC, Punjab

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2.11 Experience of respondents at OPD •

Out of 580 respondents, 70% rated their experience at OPD as good and 27.4% rated it as being average at the OPD of various health care settings. 1.4% respondents rated their experience as poor and 1.2% respondents did not respond. (See Fig 53)

Fig 53: Views of patients attending OPD about waiting area at various health care institutions in Punjab 100

93.6

Percentage of Patients

90

82.7 77

80 70

59.6

60 50 36.8

40 30

20.7 15.8

20 10

0.7

0.7

2.6

2.2

0

10

6.4

0.9

0

0

Dist. Hospital (284) Good



Sub-Divisional (135) Average

CHC (114)

SP. Hospital (47)

Poor

Cannot say

For different health facilities, it was found that 85.1% respondents at Special Hospitals, 72.6% at Sub-Divisional Hospitals, 71.5% at District Hospitals and 57% at CHCs rated their experience as good. (Refer Table 21) (See Fig 54) Fig 54: Rating of patient’s experience attending OPD at various health care institutions in Punjab 80 72.6

71.5

70

Percentage of Patients

70 57

60 50

39.5

40 30

27.4

26.4

23.7

20 10 1.1

1.1

0

0.9

0.7

0

1.4

1.2

0 Dist. Hospital (284)

Good

82

Sub-Divisional (135)

Average

CHC (114)

Poor

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SP. Hospital (47)

Cannot say

6.2.12 Quality of treatment •







Overall 75.9% respondents rated the quality of treatment in the hospitals as good. Whereas 21% respondents rated quality of treatment as average, 1.4% stated it as poor and 1.7% respondents did not respond. When percentage distribution was seen separately at different facilities, it was revealed that 93.6% respondents of Special Hospitals, 78.5% respondents of District Hospitals, 77% respondents of Sub-Divisional Hospitals and 60.5% respondents of CHCs rated their experience as good. Overall 77.9% respondents were satisfied with the services of various health institutions, whereas 22.1% respondents were not satisfied with the services of health institutions. Health facility-wise analysis reveals that 80% respondents of Sub-Divisional Hospitals, 79.8% respondents of CHCs, 78.5% respondents of District Hospitals and 63.8% respondents of Special Hospitals were satisfied with the services. In the overall rating about the level of cooperation at the reception counter at various institutions, 93.6% respondents rated it as good and 6.4% respondents rated it as average. Health facility-wise, 80% respondents of CHCs, 79.2% respondents of District Hospitals, 77% respondents of Sub-Divisional Hospitals and 70.2% respondents of CHCs, rated the level of cooperation as good. (See Fig 55)

Fig 55: Opinion of patients attending OPD about quality of treatment received at various health care institutions in Punjab 100

93.6

Percentage of Patients

90 80

78.5

77

70 60.5

60 50 36

40 30 20 10

18.7

18.5

1.8

2.2

1.1

2.2

0

3.5

6.4

0

0

0

Dist. Hospital (284) Good

Sub-Divisional (135) Average

Poor

CHC (114)

SP. Hospital (47)

Cannot say

6.2.13 Suggestions for improvement of services • •

Regarding all facilities, 28.3% respondents did not offer any suggestion. 50.5% respondents suggested for free provision of all medicines to everyone, especially to the poor. Other suggestions from respondents were; provision of more doctors or specialists (6.4%), cleanliness of OPD and toilets (4.9%) and proper care of respondents and emergency care (3.6%). 2.3% respondents were fully satisfied with the services of the out-patient department. (Refer Table 22) Study to Review The Health Care Delivery System provided by PHSC, Punjab

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7.0 Training Institutes

7.1 Introduction Last two decades have witnessed major shift in the health system and concerns have been expressed regarding health issues, critical to women, children and people in the rural and tribal areas. The health sector being no exception, has very heavily relied upon and included in-built components like systematic training. Training has been used as a planned strategy towards development of human resource for the achievement of total health in the country. The training system helps in continuing the review of current needs of state and national programmes and policies to match with the training personnel at all levels in the health care system. In addition to strengthening the functional performance of human resources, it also caters to aspects like cost containment, quality of care and creation of new categories of health personnel. However, several lacunae have been identified in the existing training programmes such as: i. Training often does not bear directly on an employee’s official duties. ii. Duplication of training programmes and the same participants receiving training frequently. iii. Lack of written course evaluations with an objective to provide feedback after training while one has resumed one’s job. Realising these gaps in the existing health care delivery system it was felt that training institutes would also be evaluated along with the other health service facilities in the state of Punjab during conduction of the study. Training institutes evaluated were: 1. State Institute of Health and Family Welfare, Mohali. 2. State Institute of Nursing and Paramedical Sciences, Badal (in the district of Muktsar). 3. Mental Hospital, Amritsar.

7.2 State Institute of Health and Family Welfare (SIHFW), Mohali The State Institute of Health and Family Welfare (Kharar) was established under a WB aided project in 1992 after upgrading the Health and Family Welfare Training Centre, Kharar. Now, State Institute of Health and Family Welfare, Phase-VI, Mohali, Punjab, has been established under IPP VII (Year 1997-1999), under World Bank aided project as an apex institute to cater to the training needs of the northern states like Punjab, U.P, Chandigarh, J&K and Haryana. The Institute has been declared as Collaborative Training Institute (CTI, Mohali) with NIHFW, New Delhi being the nodal agency. The institute from Kharar has been shifted to a new campus at Mohali and is made operational with effect from 1st April, 2004 as State Institute of Health and Family Welfare, Phase-VI, Mohali.

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Study to Review The Health Care Delivery System provided by PHSC, Punjab

7.2.1 Objectives • • • • •

To develop trained health manpower resources for better delivery of health care services and effective health management. To conduct policy relevant and field based research studies on areas relating to population health and family welfare. To monitor, supervise and provide technical guidance to regional training centre/School/DTC and NGOs. To render advisory and consultancy services to government, and other health related organisations for developing programmes and policies on population and health. To provide training to other departments/organisations.

7.2.2 Functions • • • • • • • •

To plan, conduct, evaluate and follow up of the training programmes for the health personnel in the region. Develop the urban and rural field practice and demonstration areas for providing practical experience to the trainees and utilise the area as field labs. To develop a training curriculum. Conduct simple studies and research, to improve training techniques and tools. Serve as a technical resource for the region Plan, conduct and evaluate special health and family welfare campaigns Provide consultative services on family planning and training to voluntary and allied agencies. Maintain a close liaison with central training institutions for technical help and guidance.

7.2.3 Major components 1.

2. 3. 4. 5.

Training • Professional development course • Basic training for MPHW male • In-service training for medical and para medicals • TOT for key trainers (RCH) trainings Research and evaluation studies in collaboration with medical health and related organisation. Service cum training counseling clinics. Monitoring and evaluation of the trainings under Health and Family Welfare departments in the State. Computer HMIS.

7.2.4 Trainers of the training institute This survey was conducted in SIHFW, Mohali. Questions were asked from trainers, considering them as an important stakeholders in this survey. A total of 7 respondents were interviewed. The trainers were mainly medical officers and the nursing tutors, having an average experience of 1520 years of service. The job responsibilities given to them were teaching, planning for ongoing trainings and different administrative responsibilities. Study to Review The Health Care Delivery System provided by PHSC, Punjab

85

The activities mainly carried out by them were training, administrative, planning, session teaching and sometimes data collection for different research projects. After the inception of PHSC, there have been special training programmes sponsored to nominate specialists like surgeons, physicians etc. to improve the quality of different training programmes. One of the respondents was of the view that there is not much change; everything is as it is as it was before. Another respondent indicated that there is an improvement in the quality of work, but she could not specifically point out the type of quality being referred to. After the inception of PHSC, more emphasis is given to Behaviour Change Communication and on counseling which was not the case earlier. All the respondents have done many training programmes over the years like on disaster management, capacity building, RCH, counseling skills, integrated course for NRHM, adolescent and reproductive health, first aid course, workshop on community participation etc. It indicates that trainers are given relevant training, which is of importance to keep them updated with the new emerging trends. They can apply this while conducting different training sessions. Almost all the respondents were positive about the need of more training in the areas like leadership, management. Skills of Trainers: Faculty of training institute were asked basic information regarding organisation of trainings. • When asked about the concept of systems approach to training, all the seven respondents could not speak about it. Though few responded that it should be based on needs assessment followed by a systematic approach to training. • The response on pre-requisites for preparation of training calendar, the respondents most of them reported as training load, availability of resources (man, money and material) and availability of venue. • According to the respondents the training methods used for skill development are hands on training, demonstrations, powerpoint presentations, group discussion and role-play. The above analysis shows that the trainers have fairly good knowledge about the organisation of training programmes. Common complaints of trainees attending training programmes: When asked about the nature of complaints by the trainees who attended the training programmes, some of the common complaints were: Shortage of faculty members, duration of the lectures being very long, quality of food is not very good, and poor hostel facilities. The quality of training programmes is usually assessed by the trainers from pre and post evaluation, participant’s evaluation report and through informal communication with the participants.

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Study to Review The Health Care Delivery System provided by PHSC, Punjab

The procedure for the preparation of training report includes compiling data and taking feedback from the participants. The impact evaluation is not done in the institute, however, according to one of respondent, reaction feedback (immediate) from the participants is taken on completion of training programme.. Some programmes which are proposed to be started shortly are on NRHM, BCC, HISM, Leadership and Disaster Management. Changes required in the existing training structures: Opinion of the respondents was taken to identify the changes required in the existing training structure for the staff in their district. • • • •

Guidelines for organising training programmes should be more clear and freely available More class rooms are required Training calendar should be spread uniformly throughout the year There should be more training programmes for the nursing personnel

7.3 State Institute of Nursing and Paramedical Sciences, Badal (in the district of Muktsar) The State Institute of Nursing and Paramedical Sciences was established in the year 2001 at Badal in the district of Muktsar. The main objective of this training institute was to have a good quality training institute available in the rural area of Punjab which can teach and train the candidates from the rural community. It was till recently under the Punjab Health Systems Corporation and has now been transferred to Baba Faridkot University.

7.3.1 Major courses being offered 1. 2. 3. 4.

BSc. (Nursing)- a four year full time course with a capacity of 50 admissions (recently started) General Nursing & Midwifery course- Three and a half years with a capacity of 50 admissions Diploma in Radiography- a two year course with a capacity of 10 admissions Diploma in Medical Laboratory Technology- a two year course with a capacity of 20 admissions.

7.3.2 Practical training of students The practical training of a student is done in a number of hospitals on a rotational basis. The hospitals are: a. Civil hospital Badal- not very suitable as daily attendance is very low b. Civil hospital Bhatinda- good daily attendance c. Women and Children Hospital Bhatinda- around 70-80, attendance d. Civil hospital Malout- daily attendance of around 50 e. Mata Kaushalya hospital Patiala- around 200 daily attendance f. Institute of Mental Health, Amritsar g. Rajindra Hospital and Medical college Patiala

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87

h. i.

Baba Faridkot (GGS Medical college) for Radiography Sub Centre Singhewala under PHC Lumbi for Community Health Nursing

7.3.3 Fees structure The fee structure is as follows: For BSc Nursing the annual fees is Rs. 43,500/For GNM course the annual fees I Rs. 41,500/For DMRT and DMLT courses, the annual fees is Rs. 17,000/-

7.3.4 Salient features 1. 2. 3. 4.

5.

6. 7. 8. 9. 10. 11. 12. 13.

88

The intake in the BSc (Nursing) and GNM courses is very good and generally the fifty seats allocated are filled up with very few drop outs during the academic year. The Diploma in Radiography has generally 50-60% occupancy. This year there are only two students enrolled against 10 seats. The Diploma in Medical Lab Technology does not attract enough number of students- in this batch there is only one student against 20 seats. There is shortage of faculty. 10 out of the required 18 nursing tutor posts are filled up. Further there are only 2 MSc. qualified nurses (including the Principal) for training the BSc. Nursing students. As there is no hospital within the premises and for all practical purposes the civil hospital Badal has very few patients, it is difficult for the students to go for training to Bhatinda and other places. The students have to commute to and fro to Bhatinda as the hostel facilities are not there. This suggests that there is a need of a hostel for the nursing students which will help in cutting down on the commuting time and promote better learning. The eligibility criteria for DMLT course needs to be re-looked at. Punjab technical University is admitting Arts students too. There is lot of dissatisfaction amongst the staff as regards the pay scales. Further as many of the tutors are on contract, they are not able to deliver their best. There is a need for atleast one staff bus for the employees and one more bus for the students as the public transport system is not functioning well. There is also requirement for a full time student counsellor and one health officer. Upgradation of the library with more books, journal and computers with internet connectivity is a must. Modern AV aids are required- especially LCD projector Funds for repair and maintenance of the hostel are needed as many repairs and renovations are pending The institute was more comfortable under the PHSC as regards funds and sanctions for different tasks. It is facing more problems after being transferred to the Baba Faridkot University.

Study to Review The Health Care Delivery System provided by PHSC, Punjab

7.4 Mental Hospital, Amritsar This hospital is catering to services of psychiatric patients from Punjab and other states. All the available staff has the expertise in psychiatric and related areas. Training programme of nurses in care of psychiatric patients is also being organised by the hospital. There is a capacity of 350 students for the training programme with a fee structure of Rs. 1500 per student for 1 month training. This is one of the sources of income for the hospital. By virtue of this training programme being organised for the nursing categories, the institute may be considered as one of the potential training institutes. However, before considering that, the following points may be taken into account. • •

• •







The faculty of the institute is tuned to the psychiatric care services and due to shortage of them; it would be very difficult for them to carry out other training activities. The institute does not have any professional trainer or faculty who has been trained in Training Technology. Furthermore, their experiences were not matched with the primary health care service delivery. Hence, in the context of declaring a training institute for primary health care service delivery, Institute will have to depend totally on external resource persons. In lieu of the above context, a major part of the training budget might be utilised in the payment of honorarium to the guest faculty. In addition to this, training programmes would likely be earning source for the institute and it will enhance the training budget more. The institute does not have established hostel with mess facilities. Dharamshala for the attendants of in-patients is being used as hostel for the trainee, nurses and kitchen for the patients was being used for the food for them on adhoc basis. As the ongoing in-service training was limited to the psychiatric ward only, institute has not developed any Field Practice Demonstration Area (FPDA), which is essential for Primary Health Care Skill training. On the other side, the Director of the institute, a retired Principal from Medical College, has vast experience and good networking with the health system in Punjab. Furthermore, all the teaching aids space for the training programme is available in the institute.

A summarised SWOT analysis is being projected below:

7.5 SWOT analysis of training institutes Variable

State Institute of Health and Family Welfare, Mohali

State Institute of Nursing and Mental Hospital, Amritsar Paramedical Sciences, Badal (in the district of Muktsar)

Strength

Well designed complex spread over 5 Acers of land having

Well designed complex having • A vast Teaching Block • Two Hostel Blocks • Administration Block • Residential Block

• Teaching Block • Hostel Block • Administration Block • Residential Block

• Sufficient infrastructure. • Had experiences in the conduction of Nursing training • Availability of training and teaching aids

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Variable

State Institute of Health and Family Welfare, Mohali

State Institute of Nursing and Mental Hospital, Amritsar Paramedical Sciences, Badal (in the district of Muktsar)

Well equipped • Auditorium • Lecture Halls • Seminar Room • Committee Room • Computer Lab • Demonstration Room • Library

Well equipped • Auditorium • Lecture Halls • Seminar Room • Committee Room • Demonstration Room

Well Furnished • 64 Hostel Rooms • Guest House • Recreation Room • Common Room • Mess • Gym Operational • Two Buses

• Availability of class rooms. • Availability of transport facilities for field visit. • Availability of library

Modestly Furnished Hostel Rooms • Common Room • Mess (run as a cooperative mess with contractual staff) Operational • Three Buses- one 52 seater, one 32 seater, one an 18 seater, One Tata Sumo

Generating income through hostel charges. Weakness

• Very limited faculty. • Consultant posts are vacant • No full time director. • Too much dependence on external funding training programmes

• Staff shortage.

1. Only experience of Psychiatric training, no experience of other • Only experience in nursing training methodology. training 2. Very limited faculty and that too psychiatric specialist. • Library has adequate space. It does not have enough books. There 3. No proper hostel or mess are only 797 books and 13 nursing facilities. journals available. Seven types of health related journals are also available. There is no internet connectivity in the library and no facilities for the students to browse the internet.

Opportunities • Very good linkages with Punjab Health System Corporation having the facilities in the same premises.

• Good political support

Director of the institute is a very much known personality in the health field and having good network which may help in the mobilisation of trainer.

• Established linkages with NIHFW and other central training institute Threats

90

• Depends upon Punjab Health System Corporation.

1. On going mess facilities for patients, may be used for trainees. 2. Existing dharamshala may be used as hostel.

No apparent threat

Study to Review The Health Care Delivery System provided by PHSC, Punjab

1. Funds for the training may be used in the hospital services for the psychiatric patients.

8.0 Community Voice

For listening to the community voice, focus group discussions (FGDs) were conducted to take care of qualitative dimensions. Ten (10) FGDs among the females were undertaken in nearby villages of community health centres and 10 FGDs among the males were conducted in nearby villages of sub divisional hospitals. Let us read and understand their issues.

8.1 Observations among Male Groups 8.1.1 Accessibility to health care facility: a) Health care facility availed by villagers •

Local people are interested in availing the government facilities. However due to various reasons most of them are not utilising these facilities.



People of low socio-economic group are utilising the government facilities due to their very little paying capacities. These are the people who primarily try to avail the services. The people belonging to lower–middle group and above, generally utilise private facilities as per their paying capacities.



Few Sub-divisional hospital’s /CHCs attract large number of patients, even from the far off places, only because of the good administration and services offered by the hospital incharge.

b) Reasons for non-utilisation of Government health facilities Varied reasons emerged following the discussions in different districts. Following are the few common reasons from all the districts: •

If the distance of the health facility is more, then local people tend to utilise private facility only. “Anay janay may he to sara kharcha ho jana hai, Time waste hoga who alag. Isliye hum to pas ke doctor ke pas he chaley jatey hain”.



People are primarily unhappy with the fact that they have to spend the money for availing health services. “Private mein jayen ya serkari mein, kharcha to dono mein he karna hai, Private vale doctor per to hum jor bhi dal sakte hain”.

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“Sui se le kar glucose, davaiyan, injection sab bahar se he khareedna padta hai”. •

In most of the emergency departments, 24 hour services are not available due to nonavailability of staff. Therefore people prefer to go to the private hospitals/nursing homes only. “aise jaedah hai jadon police case hove, emergency which to koi sahuliat nahin hai”.



Availability of the doctor in the hospital/CHC is not sure. “Asain doron jaidai doctor ravey na ravey, sanu to kuch pata nahin,”.

(Once we reach most of the time doctor is on leave or gone for some meeting or other commitment, our whole day is gone and even the money). •

Majority mentioned that the government doctors prefer to see the patients in their private settings, charging heavy consultation fees. Besides specific investigations, like ultrasound etc. are required to be done from outside private centres.

c) Distance from home and connectivity from the road •

Majority pointed out that distance is an important factor, but if all the facilities are available with good doctors, people would prefer to utilise those health facilities, e.g. Dasua SubDivisional Hospital is known to be good so far as deliveries are concerned. People from far off places utilise the services available there.



There are places where the hospitals/health centres are near the villages or in the residential area, but people still do not utilise the services and go to private hospitals/nursing homes which are far away.



Many of the groups commented - “as the same doctors give good treatment in private nursing homes, so we go there only”.

d) Transport facilities and cost of travel •

Sub-divisional hospitals are generally situated near the main roads, which are well connected with the local transport as well. Travel cost depends on the economic status of the family and for the poor patients it is a cause of concern. ‘Panchayat aur local loki madad kar den dey , chanda ekthda ker key de den de”.

(Villagers help their native people by contributing money for the medical expenses etc.) e) Services: •

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The services in the hospital are on payment basis. One group said that they need to buy everything needed during hospitalisation or otherwise. As outpatient also, majority of them have to purchase the medicines from outside.

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“We can only save the visiting fees of the doctor otherwise there is no difference in going to either Government or Pvt. Facilities.

8.1.2 Availability of the facilities in the hospital a) Waiting time in OPD •

Majority commented that waiting time in OPD depends on the number of the patients. If the doctor is available and fewer patients are there. It takes 20-25 minutes.



Whereas if the number of the patients is more, than it may take even 2-3 hours. As far as timings of the OPD are concerned, all of them feel it is convenient for them.

b) Availability of the doctors •

Different opinions emerged. Most of them agreed that availability of the staff is there, but there is a scarcity of the staff.



The participants also put forth that the availability of the doctors /staff etc. depends on the administrator of that place. “Bade doctor sakht jadon honge sab changa chalta hey”.

c) Availability of the medicines •

All emphasised on the non-availability of the medicines. Whatever the patient needs while hospitalisation or in OPD, they are asked to buy. Very few people mentioned that for economically weaker section some medicines are given from the hospital. “sarkari aspatalan bich to asan garib loki e jaedah hai, davaiyan kuch bhi nahi dende”

‘Why should we go to the Government hospitals, as only visiting the doctor is not going to help, we need to buy the medicines also “Local private doctors give the medicines also within the Fees”. d) Availability of the laboratory and radiological services •

All were unhappy with the functioning of the laboratory and radiological services.



It was pointed out that in case of emergency, there are great difficulties in availing any of these facilities. They were of the opinion that at few of the places, machines/equipment are either not in working condition or the technician is not available.

“If it is only the availability, ‘yes’, it is available but if we talk about the functioning aspect, it is questionable”.

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“Whole day goes off only for one investigation to be done”. Again they were required to collect the report from the lab and then visit the doctor.

8.1.3 Behaviour of health care providers towards patients •

Most expressed happiness with the doctors’ behaviour.



Few reflected that doctor’s behaviour is more prompt and appropriate when they visit the same doctors in their clinics.



It emerged that the staff does not ask for any money for any reason.



They are at times cooperative.

8.1.4 Outreach services offered by Government facility •

Most pointed out that though ANMs exists in the area, but they are not conducting group meetings. Home visits were also very less.



ANC is not a regular agenda. Women themselves go to the hospital to get registered.



Few of the respondents said that ANM is active and take due care of the pregnant women.



Visits of the ANM/ASHA are actually restricted to specific areas.



These workers are more centred to areas near their residence. The far off villages are not taken care off. As such there is no coverage for family planning services.



No medicines have been distributed by the ANM since 4-5 years.



Iron and folic acid tablets are also not available with them. Only hospitals provide these medicines for 3-5 days to each pregnant women.

8.1.5 Coverage •

Remote areas are not being served. People are forced to utilise private services, sometimes with the same government doctor of the hospital in their private clinics.



Most emphasised that health facilities are not fully equipped. They need to go to the other specialised hospitals/referrals to avail some of the facilities.

8.1.6 Satisfaction with the services provided by the Government health facility •

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Responses were varied among different groups. In the Sub-divisional hospital areas, which are running fine due to good administration, people are somewhat satisfied with it. Whereas those, where there is bad administration like no doctors on duty or shortage of doctors, people are not at all happy with them.

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They feel that government has invested so much in the infrastructure for the betterment of the general public, but the ultimate purpose has not been achieved.

8.2 Observations among the Female Groups 8.2.1 Accessibility to health care facility a) Health care facility availed by villagers •

Women primarily want to avail the government facilities. This is either due to their positive experiences in the past or those of the friends/relatives.



Most of the women said that for delivery they primarily feel safe in going to the government hospital but due to various reasons most of them actually are not utilising these facilities. Women from the villages need to travel long distances, as CHCs are not situated in the villages but near the main roads.



Various groups with single voice stated that delivery occurs most of time during odd hours or in emergency, and for that, one could not depend on the present health system. They added that doctors are not available and for the reasons not known to them, they refer the patient to either private hospital or to the District Hospital. “Wahan hota hi kon hay”. ‘asan to aes lai privaton e jainda hega”



For this reason they go to either private or to the District Hospital. Few of the women also added that the government doctors, who are practicing privately also provide good treatment in their nursing homes, and so it is better to go to them.



Parishad CHCs are more popular in some of the areas as compared to the PHSC’s CHCs.

b) Reasons for non-utilisation of Government health facilities •

Most of the rural women visit the CHCs for their reproductive health problems.



Most of the places gynaecologists are not available.



If the distance of the health facility is more, the local people utilise private facility only. “For delivery we cannot take any chances” was the version of most of the respondents.



People were found unhappy because they have to spend the money for availing health services. They were of the opinion that at least delivery facility should be provided by the Government free of cost. “Madam suin se ley kar glucose, davaina, injection sab bahar se he khareedna padta hai”. “Serkari aspatal witch to sab kokh hi milna chaida hay”

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At night time nobody can think of going to the CHC for any emergency as hardly anybody would be available there. People prefer to go the private hospitals /nursing homes only. It was commented that in general, these government health service providers provide no emergency facilities.



Availability of the doctor in the hospital/CHC is not very sure.



Laboratory testing, ultrasound etc. are required to be done from private centres. At many places, women groups stated that these centres are also in someway or other related to the government hospital doctors. Most commented that the government doctors prefer to see the patient in their private settings charging consultation fees..

c) Distance from home and connectivity from the road •

Although distance is an important factor, but if good doctors are available at health facilities, people will most likely utilise these health facilities.



Most of the rural women visit Parishad CHC, as it provides the services. The nearby CHCs under PHSCs with 6 doctors are not being visited.



At places, where the CHC are nearby the villages or even in the residential area, people still do not utilise the services and rather go to private hospitals/nursing homes which are situated at distance. “The same doctors give good treatment in private nursing homes, so we go there only’.

d) Transport facilities and cost of travel •

CHCs are found to be mainly situated near the main roads but away from many villages. These roads are however, well connected with the local transport also. Still the paying capacity for the cost of travel depends on the economic status of the family, which is a matter of concern for the poor patients.



Those who cannot afford to bear these costs prefer to call for TBAs for conducting the delivery, irrespective of the fact whether she is trained or untrained.

e) Services •

It was stated that they have to purchase everything needed during hospitalisation or otherwise. Even as outpatients, majority of the medicines have to be purchased from outside.

8.2.2 Availability of the facilities in the hospital a) Waiting time at OPD •

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Waiting time in OPD depends on the number of the patients. If doctor is available and few patients are there it only takes 20-25 minutes. Whereas if the number of the patients is more, than it may take even 5-6 hours. As far as timings of the OPD are concerned, all of them felt it is convenient for them.

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Few opined that if a gynaecologist is there, women will feel comfortable in going to them and would not even mind the waiting time. Very few deliveries are being conducted at the CHCs.

b) Availability of the doctors •

Different members were having different opinions on this issue. Though most of them agreed that availability of the doctors is there but there are also some places where there is scarcity of the staff. Few of the women added that if doctor is from the same area, there are chances that they will be available.

c) Availability of the medicines •

Almost all mentioned about the non-availability of the medicines. Whatever the patient needed whether as in-patients or as out-patients, they are being asked to buy almost everything. Even for the delivery, everything is to be purchased. No medicines are being provided from the hospitals. Very few people mentioned that for economically weaker sections, some medicines are given from the hospital.

c) Availability of the laboratory and radiological investigation •

All were not very happy with the functioning of the laboratory and radiological investigations. The respondents pointed out the fact that in emergency, it becomes a great problem in availing any of these facilities. Few respondents opined that it is difficult for a pregnant woman to collect the report from the lab and then visit the doctor.



It was revealed that at few of the places, machines/equipments are either not in working condition or else the technician is not available.

“If it is only the availability ‘Yes’, it is available but if we talk about the functioning aspect, it is questionable”. “Whole day goes off only for one test to be done”

8.2.3 Behaviour of health care providers towards patients •

In general, members experienced happiness with the general doctors. But few commented that gynaecologists are available only sometimes.



It was reflected that the doctors’ behaviour is more prompt and appropriate when they go to visit the same doctors in their private clinics as compared to government facility.



Behaviour of the nursing staff was reported to be good. It was also mentioned that the staff did not ask for any money for any reason and that they are at times cooperative.

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8.2.4 Outreach services offered by Government facility •

Though ANM is available but home visits are very less.



No health related discussion takes place ever. “ab to sub jante hai kya achha hai kya kharab”



All were happy about the pulse polio. However, ANC is not a regular agenda. Women generally go by themselves to the hospital to get registered.



Families were found to be well aware about the institutional deliveries. Few stated that ANM is active and takes due care of the pregnant women.



Visits of ANM/ASHA is generally restricted to specific area. It was stated that they are more centred towards their residential area.



Far off villages are not taken care of. Some women commented that as such there is hardly any coverage for family planning services. They use contraceptives, based on whatever information they get from various sources.



No medicines are distributed by the ANM. Iron and folic acid tablets are also not available with them. CHCs provide these medicines for 3-5 days to each pregnant women.



Women who go to the private doctors get prescription for iron and folic acid tablets and they purchase it. The people from poor background only visit the hospitals for delivery and that also was when local dais tell them that about some problem during home delivery.

8.2.5 Coverage •

Remote areas are not being properly served. People are forced to utilise private services sometimes with the same government doctor of the hospital in their private clinics. The centres are like “ujada chaman, wahan kon jayga”.



Health facilities are not fully equipped. They need to go to the other specialised hospitals/ referrals.

8.2.6 Satisfaction with the services provided by the Government health facility •

Most were not satisfied with the government facilities.



Very few of them commented that services are fine to an extent but almost all women were of the opinion that the services need improvement.

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8.2.7 Suggestions for improvements •

There should be improvement in basic facilities in hospitals including cleanliness, recruitment of the staff, specialised doctors, drinking water arrangement, toilets on all the floors and wards, electricity (lighting arrangement), generator, water tank, timely repair of accessories and machines etc.



Medicines should be provided by the hospital. If not possible, at least the BPL families should get the facility. For the other patients, subsidised medicines can also be a good option.



In emergency delivery cases, at least hospital should provide everything.



Provision for laboratory and ultrasound, especially in emergency, should be in perfect condition.



On call doctors should be arranged for emergency departments.



Fee for the investigations should be subsidised.



Community oriented programmes e.g. Camps, health Melas, health education etc. should be organised especially in far-flung areas.



Local community participation should be enhanced for utilisation of health services. Mahila Mandals should be strengthened.



Emergency departments, ambulances should be arranged at very minimum rates. For transport of delivery cases, there should be no charge.



Doctor on emergency duty should be available for 24 hours.



The private practice of the Government doctors should be stopped.



Every village should have a trained dai and a lady doctor.

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9. Views of the Stakeholders

Interviews were conducted with senior administrators and other stakeholders to get their views on the functioning of the health system. The findings of interviews as per facility are given below:

9.1 At District Level 9.1.1 Deputy Commissioners (DC) Out of the 10 districts visited in Punjab for evaluation of the health System, the Deputy Commissioners (DC) of only 9 districts could be interviewed as the DC of Hoshiarpur district was not available at the time the study team visited the district. All the DCs interviewed had less than 2 years of service as D.C. The revelations from these interviews are as follows: (Refer Table 23) 9.1.1.1 Overall functioning •



• •



Out of the total 9 DCs interviewed from the various districts visited, DCs of 50% districts reported that the overall functioning of health facilities in their district is good, while 30% reported average (mainly due to shortage of staff) and 20% reported poor and gave lack of doctors as one reason for poor functioning. Regarding availability of staff, 60% DCs admitted shortage of staff, while 30% of the DCs could not say anything definitely on this matter. DCs of district Muktsar, Sangrur and Gurdaspur felt that the decrease in utilisation of health services by the community is mainly due to the shortage of staff particularly the specialists viz., gynaecologist, orthopedician and eye-specialist. Shortage of O.T staff at most places was reported by DC, Muktsar. He also reported that cancer is a big problem in Muktsar and no focus has been given to that. It was emphasised mostly that the general cleanliness is not good and needs further improvement. Maternity services in most of the District Hospitals also need improvement. Long waiting time was also reported as a big problem in the delivery of services (Sangrur District). Besides this, lack of staff, lack of supervision to ensure punctuality and to check absenteeism, improper monitoring systems as well as negative interference (on non-health issues) were reported as other constraints in the delivery of services.

9.1.1.2 Extent of fulfilment of community needs •

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Regarding the extent of fulfilment of health needs of the community, 40% of the DCs stated that it is being partially fulfilled (upto 50%) while 40% DCs stated that large extent of

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community needs are being fulfilled (upto 80%). Remaining 10% DCs did not have any conclusive comment on this issue. Regarding the perceived barriers among facilities in utilising public health services, 30% felt that availability and accessibility are a barrier mainly for CHCs. 20% felt that there are some barriers in terms of utilisation and acceptability of services. Remaining 50% DCs felt that there are no barriers for the availability, accessibility, utilisation and acceptability at services at District hospitals, but for Sub-divisional hospitals and CHCs it requires further improvement.

9.1.1.3 Referral services •

According to 40% DCs non availability and not fully equipped ambulance are a problem, 30% DCs opined that referral services are satisfactory in their districts and the remaining 20% DCs had no idea about this.

9.1.1.4 Knowledge of RKS (Rogi Kalyan Samiti) •

More than 60% of DCs were found to have knowledge of RKS while rest were unaware. 10% DCs told about BPL cards being given to poor patients for free treatment.

9.1.1.5 Fund flow •

Regarding the fund flow it was felt by 30% DCs that there is no problem with respect to the fund flow, 20% stated that it is not through DC. Other 10% DCs stated that funds are not adequate and another 10% felt that the funds are not being fully utilised. 20% did not have any comment regarding the funds flow. It was suggested that funds should be given for the purchase of C.T. Scan and MRI. Medical Insurance for poor and economically backward people should be introduced at state level.

9.1.1.6 Manpower management •

About 40% DCs reported good levels of motivation amongst their staff, 20% reported low to very low motivation level, over load of work and low salaries being the main reasons for low motivation. 30% DCs did not give any comments. Frequent transfers were also opined as one of the main reasons for low motivation level.

9.1.1.7 Constraints in delivery of services •

About 30% of the D.C felt that lack of staff is a major constraint in the delivery of health care services. 10% felt that lack of supervision, absenteeism, lack of punctuality, lack of funds, lack of super specialists, lack of facilities and high load of work are some other constraints in the delivery of quality health care services.

9.1.1.8 Suggestions The following suggestions were given by DCs: • More infrastructure facilities and equipments should be provided. • Salary of doctors should be increased otherwise they will go for private practice. • More contractual employees should be placed – especially class IV and lab technician.

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• • • • • • • •

PPP model need to be introduced. Telemedicine should be promoted. Performance linked appraisal should be there. Number and quality of drugs need to be increased and improved. Paid wards should be started. Transport services should be improved. Health insurance should be done for poor patients. Cleanliness should be emphasised upon.

9.1.2 MLA/Elected Representative A total of 10 districts were visited in Punjab for evaluation of the health system and elected representatives of all these districts were interviewed. Elected representatives of 60% districts had a length of service of more than 2 years and 30% had 1 – 1.5 yrs. of service. (Refer Table 24) 9.1.2.1 Overall functioning •





About 50% reported that the overall functioning of health facilities in their district is good, while 10% reported it as average and 20% reported as poor (mainly the CHCs). Remaining 20% did not give any comments. The overall services of hospitals were reported to be satisfactory by 40%, 20% reported as average and 10% reported them bad mainly due to poor gynaecological facility. No comments were received from 30% of the representatives. MLA of Jalandhar opined that for improving the functioning of the hospitals, the SubDivisional Hospitals should be upgraded to 100 beds, since the load of patients is more in these hospitals.

9.1.2.2 OPD services •







With regard to the availability of staff it was felt by 20% of MLAs that the adequate staff is available in the District Hospitals, however, it was felt by 70% of them that there is shortage of doctors in most of the hospitals. With regard to the availability of medicines in OPD, 60% stated that medicines are available but are not sufficient as per the requirement, 40% felt that the medicines are not at all available. They felt the need and suggested that the costly medicines, which the people purchase from outside should be provided at subsidised rates by the District Hospital. With regard to the waiting time, 60% of the elected representatives felt that the waiting time is not much (<30 minutes), while 30% of them felt that it could range anywhere from 1-3 hours. With regard to cleanliness, 70% felt that the District Hospitals are maintaining good and/or satisfactory level of cleanliness while 20% felt that the cleanliness is not good.

9.1.2.3 Extent of fulfilment of community needs •

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Regarding the extent of fulfilment of health needs of the community, 40% gave a satisfactory response that the health needs are being fulfilled for >60% of the community. 50% of them

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reported low levels of community needs fulfilment (30 – 50%) and that mostly poor people are the only ones using it. 9.1.2.4 Behaviour of staff • •

60% of the elected representatives felt that the overall behaviour of health staff is good/ satisfactory while the rest 20% felt that it is not satisfactory. It was stated that the behaviour of nurses and class IV in particular is rude towards the patients. No conclusive comments were given by 20% of the elected representatives.

9.1.2.5 Referral services •





Regarding the ambulance services, 40% reported that there are good services while the other 40% said that the ambulance services are either not available or wherever available are not functioning well. 20% did not give any comments. When asked to rate the services in a government hospital as compared to Private/NGO/ Charitable hospital, it was stated that government doctors are better qualified than private, but in odd hours and emergency and due to non-availability of the doctors, they have to go to private facilities. Otherwise government services are better. One of the MLA stated that private facilities are better but one needs to pay for that. They stressed on more number of ambulances to be made available and further increase in IEC activity at government hospitals.

9.1.2.6 RKS and poor patients’ treatment • •

About 40% of the elected representatives were having the knowledge of RKS while the other 30% had no knowledge and 30% did not give any comments. With regard to free treatment of poor patients, 20% stated that free treatment is being given to poor while 30% said that no free treatment is being provided to the poor. 20% said that treatment for poor is being provided from Red Cross fund or from NGOs. 30% did not give any comments which might be due to lack of knowledge.

9.1.2.7 Perceived barriers •







When asked about the perceived barriers, the responses received were as follows: Regarding availability, 20% felt that less availability of medicines and ambulance service is a barrier. One serious issue which was reported from Civil Hospital Firozpur was that anti-rabies vaccine is not available and with an increase in the number of street dogs, it is becoming difficult to tackle the situation. With regard to the accessibility, 80% felt that there is no barrier, rather, health facilities upto CHCs are easily accessible, whereas 20% felt that referral service is a barrier as this requires money. Regarding utilisation, 20% of the elected representatives felt that it is not low, while 40% felt that the scarcity of medicines is a barrier and 20% felt that utilisation is low mainly due to lack of diagnostic equipments and laboratory facilities in CHCs. With regard to the acceptability, 20% felt that it is a barrier in CHCs only and 10% felt that non-availability of equipments is a barrier.

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9.1.2.8 Suggestions • • • • • • • • • •

Most elected representatives suggested that more equipment for diagnostic facility (i.e. C.T. Scan, MRI) should be made available for poor patients. More number of ambulances should be made available. They advocated sanction of vehicle for SMO for field visits. Extra water facility should be provided. Security guards should be recruited at health facilities. They suggested increasing plantation in and around hospital complex. Night and emergency services should be improved and more doctors should be made available. The hospital should be upgraded from 50 to 100 beds to adequately meet the patient load. A Generator with greater capacity and power should be installed to improve functioning. Technicians for ultrasound must be recruited.

9.1.3 Civil Surgeons Civil Surgeons of all 10 districts of Punjab included in the assessment for evaluation of the Health System were interviewed. (Refer Table 25) 9.1.3.1 Overall functioning •





CHCs:  Civil surgeons of 40% district stated that overall functioning of health facilities in their district is good, while 40% reported poor service condition of CHCs and 20% reported over utilisation of OPD.  Problem with indoor facilities was reported by 10%. Main problem reported by civil surgeons was shortage of staff especially at CHCs.  Regarding bed occupancy, 60% Civil Surgeons stated bed occupancy in the range of 4060% in their CHCs, 20% reported between 10-20% and 20% were not able to provide any exact figure. Sub-Divisional hospitals:  70% Civil Surgeons stated bed occupancy in their districts in the range of 70-100% in Sub divisional hospitals, 20% Civil Surgeons stated bed occupancy as 50%, while remaining 10% did not give any comments. District hospitals:  70% civil surgeons stated bed occupancy in the range of 70-100% in the District Hospitals and 20% reported bed occupancy of 50%. No comments were given by 10% civil surgeons.

9.1.3.2 Extent of fulfilment of community needs •

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Regarding the extent of fulfilment of the health needs of the community, 50% civil surgeons gave a satisfactory response, while 40% reported average level of fulfillment of community and 10% reported that the needs are not being fulfilled at all.

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Most of the civil surgeons opined that the health services are not being fully utilised by the community because of the following main reasons:  Lack of specialists  Shortage of technical staff  Non-availability of medicines It was stated by most of the civil surgeons that the patients had to spend money on laboratory and radiological investigations. Some civil surgeons also felt that lack of infrastructure for building is also one of the constraints in utilisation of services by the community. It was also stated that due to the shortage/non-availability of staff, patients had to wait for considerable time for receiving consultation from specialists/doctors, for getting medicines and getting investigations done. Civil surgeons were of the view that patients of well off families are not availing their health care facilities because of poor cleanliness, lack of privacy for admitted patients, inferior quality of nursing care and low client satisfaction level. It was stated by civil surgeons that one of the constraints in delivery of health services is due to non-staying doctors at the health facility, which again is due to lack of good accommodation facility and irregular supply of electricity. Civil surgeon of Taran Taran district felt that there is a need to improve the obstetrics & gynaecology services in these facilities.

9.1.3.3 Availability of medicines • • •

Only 20% civil surgeons stated that medicines are available in OPD while 80% of them reported that the medicines are lacking. With regard to the waiting time, 50% civil surgeons felt that it is not much, while another 50% felt that the waiting time is long. About 40% civil surgeons stated that cleanliness is not good in their hospitals, while 50% reported it to range from good to average and only 10% felt that it is of very good standard.

9.1.3.4 Behaviour of staff • •

80% civil surgeons felt that the overall behaviour of health staff is in range of good to satisfactory while the rest 20% felt that it needs improvement. Regarding referral services it was stated by 30% civil surgeons that there is no problem while 50% reported that there is shortage of ambulances and drivers at some places.

9.1.3.5 Funds flow •



It was stated by 40% of the Civil Surgeons that there is no problem regarding the fund flow. 30% of them reported that funds are not being provided and they are managing only through the user charges. 10% civil surgeons stated that there is a slight delay in getting the funds and the remaining 10% said that funds are available only under NRHM (National Rural Health Mission).

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9.1.3.6 Manpower management • •

About 30% of civil surgeons reported low levels of motivation amongst their staff, 40% reported good motivation level and 20% reported average levels of motivation. For improving the motivational level among staff members, they laid importance on increasing the salary of staff, constructing the residential quarters, giving desired place of posting of job, incentives for good workers and reducing mismatch with specialist and GDMO regarding place of posting.

9.1.3.7 Perceived barriers • • •





Regarding availability, 20% civil surgeons felt that lack of manpower in SDH and CHC is a barrier while other 70% reported no barriers in availability of services. Regarding accessibility, 10% felt that it is a barrier especially for the CHC while the other 70% did not report any barriers. 30% civil surgeons felt that the utilisation of services at CHCs is low by the community, 10% felt that short supply of medicines is a barrier in effective utilisation, while the rest 40% felt that there are no barriers as such with regard to utilisation. Regarding acceptability, 30% civil surgeons felt that there are barriers with regard to CHC while 50% reported no barriers. No conclusive comments were received from 20% civil surgeons. According to most of the civil surgeons interviewed, the areas which require attention are cleanliness of toilets, proper working condition of certain equipments, IEC activity among community, filling up of vacant posts of Class IV, sweepers, ambulances for the hospital, increase in allotment of funds and staff for O.T and pharmacists.

9.1.4 SMO (Senior Medical Officers) In-charge of District Hospitals Senior Medical Officers In-charge of all District Hospitals from 10 districts visited were interviewed. It was observed that out of the 10 District Hospital SMOs interviewed, 50% had their length of service for less than 2 years while other 50% had more than 2 yrs. of service in their respective District Hospitals. (Refer Table 26) 9.1.4.1 OPD services •

• • •

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Regarding the staff strength of OPD, 20% SMOs felt that the staff strength is adequate, while 60% felt that there is shortage of nursing staff, Paramedics, Class IV, and radiologists. 20% felt shortage of specialists especially paediatricians in their OPDs. Staff of OPD is overworked in opinion of some SMOs. SMOs of all districts stated that the OPD timings are adequate and the quality of treatment provided from OPD is also quite good. Bed occupancy was estimated 100% in 30% of the hospitals, more than 70% in 40% of the hospitals and less than 70% in 20% hospitals as stated by the SMOs. 60 % SMOs stated that poor patients are being provided with free medicines. 30% SMOs stated that very few medicines are actually available (mainly the 5 basic medicines i.e. Antibiotics, B-Complex, Paracetamol, Ibuprofen & Metronidazole).

Study to Review The Health Care Delivery System provided by PHSC, Punjab

9.1.4.2 Services provided • •



In opinion of the SMOs, patients are spending money mainly on the transport, medicines and lab investigations. No dietary service is available in any of the District hospitals but it was revealed that at 10% of the hospitals only one meal is being provided to them free of charge by Voluntary organisations. While most SMOs were of the opinion that their services are up to 80% at par with the private sector, some were of the opinion that private sector is giving better services. However, most of the SMOs felt that they are giving best services and value for money particularly to the poor patients.

9.1.4.3 National Health Programmes (NHP) •

About 80% of the SMOs were having information regarding various National Health Programmes. However, 10% SMOs stated that this information is not available under PHSC.

9.1.4.4 Fund flow and RKS •



• • •

About 40% SMOs stated no problem in fund flow in their hospitals. But 30% SMOs (viz; Tarantaran, Jalandhar and Hoshiarpur) stated that no funds are being provided and they are managing from User Charges alone; 10% SMOs reported shortage of funds while another 10% (i.e., Sangrur) stated that SMO has got no role in this regard. While 80% SMOs were found to be aware of the Rogi Kalyan Samiti, 20% were not sure about its functioning, since they have been recently constituted. They reported that there are some problems in constitution of the committee and conducting the regular meetings. It was revealed that money is mostly being used for infrastructure development, e.g. building etc. At some places, free dentures, dental check-ups and Cataract Operation are being done for poor patients. All the SMOs stated that efforts are being made to provide medicines to all, but due to nonavailability of medicines, some medicines are to be purchased through user charges (e.g. vital and life saving drugs).

9.1.4.5 Extent of community needs fulfilment •



Regarding the extent of fulfilment of health needs of the community, 50% SMOs felt that they are able to fulfil up to 100% needs; while 30% stated that they are mainly catering to the needs of the poor. The community was found to be utilising OPD facility to its maximum.

9.1.4.6 In-patient services •



It was stated by SMOs that at some places (20%) there is shortage of nursing staff and junior doctors, with nurse to bed ratio ranging from 1:20–1:40. 50% SMOs stated that nurse to bed ratio is adequate, in the range 1:2 to 1:6. Doctor/Bed ratio also showed a lot of variation.

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It was revealed that job of cleanliness is given on contract in more than 50% of health facilities. It was also commented by SMOs that at many places drinking water is not being treated and is supplied for usage as such.

9.1.4.7 Manpower management and other services •



90% SMOs stated that they have a system of performance appraisal in their hospitals. The problem of conflicts between the staff and patients was not found to be a big issue in most of the hospitals. Regarding Emergency services, SMOs stated that they run for 24 hours a day with Specialists and Surgeons available on call. One doctor is always present for night duty. Emergency supply of drugs is ensured and Lab. Technician is also available on call during emergency.

9.1.4.8 Community participation and manpower management •



• •



Regarding community participation, it was revealed that at some places food is being provided by Voluntary Organisations and at others there are NGOs and charitable organisations that are providing medicines and blankets other than food. At most places no barriers/challenges are being faced for effective community participation, whereas at one place (Amritsar) some political interference was found leading to some administrative problems, like transfer of staff etc. SMOs were found to adopt a variety of methods for monitoring and effective supervision e.g. ACRs, Daily rounds, monthly meetings, surprise checks, checking of medicine registers, feed backs etc. Some SMOs also stated that they undertake efforts for reducing the stress levels of the staff by counselling them, appreciating them, motivating, following appraisal system, by directly talking and by obliging the person. To increase motivation level, doctors are also being sent outside to receive trainings. Bio-medical waste management was found to be undertaken in most (90%) of the District Hospitals; however 10% of them reported shortage of bags.

9.1.4.9 Perceived barriers to avail health facilities •

• • •

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Regarding the perceived barriers for availability of health services, 20% SMOs felt that there is lack of information and shortage of staff which is a barrier while the rest 60% did not felt that any barrier existed. Regarding accessibility, 20% SMOs felt that shortage of medicines and lack of staff is a barrier. 60% the SMOs opined that there is no perceived barrier for ‘Utilisation’, while 20% felt that shortage of facilities and lack of information is a barrier in effective utilisation of health services. Regarding acceptability of health facilities only 10% reported these as barriers.

Study to Review The Health Care Delivery System provided by PHSC, Punjab

9.2 At Sub-division Level 9.2.1 MLA/Elected Representative–Sub Divisional Hospital Elected representatives of 9 out of 10 districts were interviewed at SDH level. Elected representative of Amritsar district was not available for interview. Elected representatives of 70% districts had more than 2 years of length of service while 20% had less than 2 yrs. of service. (Refer Table 27) 9.2.1.1 Overall functioning •



About 30% of elected representatives reported that the overall functioning of health facilities in their district is good, while 50% reported it as satisfactory and 10% as poor (mainly at CHCs). The overall services of hospitals were reported to be in ranges from good to satisfactory by 70% of them, while 20% reported them as not very good.

9.2.1.2 OPD services •



• •



With regard to the availability of staff, 40% of elected representatives stated that the staff was available at the Sub Divisional hospitals, whereas 50% felt that there is shortage of doctors/specialists in the hospitals. Regarding availability of medicines in the OPD, only 20% stated that medicines are available, while 60% stated that sufficient medicines are not available so as to meet the requirement. 10% stated that most of the time no medicines are available. They opined that, all the medicines which the people purchase from outside should be provided from the hospital itself. Regarding the waiting time, 40% of the representatives stated that the waiting time is not much, while 50% of them stated that it is long and it depends on the number of patients and availability of doctors. Regarding cleanliness in OPD, 30% felt that the Sub Divisional Hospitals are maintaining good level of cleanliness, while 30% stated that it is of average level. Rest 30% representatives felt that the cleanliness is not good.

9.2.1.3 Extent of fulfilment of community needs: •

In response to this question, 50% of them gave a good response, with the health needs being fulfilled for more than 75% of the community. 10% stated that only average level of need fulfilment is being achieved. Remaining 20% reported low levels of community needs fulfilment (20 – 40%) and mentioned that the services are being mostly utilised by poor people.

9.2.1.4 Behaviour of staff •

Regarding behaviour of staff in Sub Divisional hospitals, 40% elected representatives felt that the overall behaviour ranges from good to satisfactory. 40% felt that it varies and reported the behaviour of staff as average while 10% reported that the behaviour is not good. It was stated that the behaviour of Nurses and class IV in particular is not good.

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9.2.1.5 Referral services •

Regarding the Ambulance services, 40% stated that the services are available and satisfactory, while another 40% stated that the ambulance services are either not available or wherever available, these are on payment basis.

9.2.1.6 RKS and treatment of poor patients • •

About 40% of the elected representatives were having the knowledge of RKS, while another 50% were having no knowledge about it. Regarding free treatment of poor patients, 60% stated that these facilities are providing free treatment to poor, while 20% stated that no free treatment is being given to the poor patients.

9.2.1.7 Perceived barriers to avail health facilities When asked about the perceived barriers the responses were as follows: • • •



Regarding the availability, 20% felt that less availability of medicines and equipments is a barrier, while 70% perceived that availability as such is no barrier. With regard to the accessibility, all of them opined that there is no barrier. 70% of the elected representatives also felt that there is no perceived barrier for utilisation, while 20% stated that it is a barrier due to non-availability of USG machine and other diagnostic facilities. Regarding acceptability, 80% elected representatives stated that it is no barrier, while 10% felt that the acceptability of health services by community is low.

9.2.1.8 Suggestions • • • • • • •

Most of the elected representatives suggested that more equipment for diagnostic facility (i.e. C.T.Scan, MRI) should be made available for poor patients. They advocated sanction of vehicle for SMO for field visits. Extra water facility should be provided; and security guards must be recruited to ensure patient security. They even suggested increasing plantation in and around hospital complex. Technician for Ultrasound must be recruited. Medicines should be available in good quantity There should be a Blood bank at these health facilities More staff, medicines, funds and ambulances should be made available.

9.2.2 SMO – Sub Divisional Hospitals Senior Medical Officers of all Sub divisional hospitals included in the study were interviewed. It was found that out of SMOs of 10 Sub divisional hospitals, 80% had their length of service less than 2 yrs. and 10% had more than 2 yrs. of service in their respective Sub divisional hospitals. (Refer Table 28)

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9.2.2.1 OPD services • • •

Regarding the OPD Services, 50% SMOs felt that the staff strength is adequate, while other 50% stated that it is poor due to shortage of Class IV employees and specialist doctors. Bed occupancy was stated as 85-100% in 50% of the hospitals, while the rest 40% SMOs’ reported 40-70% bed occupancy. Poor patients were being given free medicines in opinion of 60% of the SMOs, while in other 30% hospitals, only some of the medicines are available as free.

9.2.2.2 National Health Programmes (NHP) •

Most of the SMOs (70%) were having information regarding various National Health Programmes, but at few facilities (30%) information regarding malaria and STD programmes were not available.

9.2.2.3 Extent of community needs fulfilment •



Regarding the extent of fulfilment of health needs of the community, 20% of the SMOs felt that they are able to fulfil 100% of health related needs; while other 30% stated this level of fulfilment upto 75% and rest 30% upto 50%. 10 % of the SMOs opined that health needs of the community are fulfilled to high level by the OPD; however, this is comparatively lower for in patient departments.

9.2.2.4 In-patient department • • • • •

It was found that Nurse to bed ratio in most (80%) hospitals was in the range 1:3 to 1:5, while at 10% of the hospital (Ludhiana) this ratio was 1:12. Doctor/Bed ratio was found to be of range 1:3 to 1:6 at 50% of the hospitals, while it is in the range of 1:7 to 1:10 at 30% hospitals. For the rest 20% the ratio was not specified. Dietary services are not organised in the hospitals and this is mostly managed by patient’s attendants. Level of cleanliness was opined to be good at 20% of the hospitals, average level at 30% and poor at 10% of the hospitals. 20% of the SMOs reported shortage of staff and 10% reported that they had recruited the staff on contract basis.

9.2.2.5 RKS and fund flow •

• •

While 60% SMOs were aware of the Rogi Kalyan Samiti, its exact status and functioning was not known to 10% of them and 20% reported that RKS is not functioning in their hospitals. 60% SMOs reported no problem of fund flow in their respective hospitals, while 20% of them (Tarantaran and Jalandhar) reported that no funds are being provided to them. SMO of Amritsar Sub-Divisional Hospital stated that they are managing only from the user charges.

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9.2.2.6 Manpower management and other services •



• •

Most of the SMOs (70%) stated that they have a system of performance appraisal in their hospitals, which included benchmarking for doctors and ACRs. 10% stated they do not have any appraisal system, while 10% said that they have their own personal perception. Almost all (90%) hospitals were having Emergency services running 24 hours a day with specialists and surgeons available on call, in the opinion of SMOs. They stated that at least one doctor is always present for night duty. Only major constraint brought out following interview with SMOs was that of the nonavailability of doctors. Bio-medical waste management was found being followed at most (80%) of the Sub divisional hospitals, however, 20% SMOs reported shortage of disposal bags.

9.2.2.7 Perceived barriers to avail health services Responses received regarding the perceived barriers are as follows: •

• •



Regarding availability, 30% SMOs stated that there is lack of specialists and doctors, which are barriers at their hospitals, 10% SMOs stated lack of medicines and staff as a barrier. Rest 40% SMOs stated that no barrier exist in terms of availability. Regarding accessibility, 70% SMOs felt that it is no barrier, while the other 30% did not comment on this aspect. 10% of the SMOs felt that lack of infrastructure and behaviour of staff are being perceived as barriers for the utilisation of services, while 70% stated that it is not a perceived barrier. Rest 20% did not give any comment on this. With regard to the acceptability, it was felt by 70% SMOs that it is not a barrier and no comments were received from the rest 30% of the respondents.

9.2.2.8 Suggestions • • • • • • • • • • • •

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Vacant staff positions should be filled up. Regular training for the staff should be provided. Repair and maintenance of staff quarters should be done. Manpower shortage, especially of gynaecologists, radiologists and Class IV employees should be looked into. Fully equipped ambulance and CT scan service should be provided. Private wards should be created at these health facilities. There should be provision of seminar room in these facilities. SMOs should be given authority to cut down on non-performing staff. Security services should be provided on contract basis to ensure security. Costly equipments should have annual maintenance contracts. More and regular supply of medicines should be ensured. Awareness generation regarding available services should be done through the media.

Study to Review The Health Care Delivery System provided by PHSC, Punjab

9.3 At CHC Level 9.3.1 Elected Representatives Elected representatives were interviewed for assessment of the functioning of CHCs in their respective areas, in all districts included in the study.. Out of the total 10 districts visited, elected representatives of 90% districts had more than 2 years of length of service while remaining 10% had less than 2 years of service. (Refer Table 29) 9.3.1.1 Overall functioning •



When asked about the functioning of CHCs in their districts, about 50% of them reported that the overall functioning of CHCs in their area is good, while 20% stated that it is getting better now and 20% reported that the functioning of CHCs is not good, mainly because the doctors are not available as they were going for private practice. The overall services of CHCs were opined as good by 30% of them, 60% reported the services as average and 10% reported them as ‘not good’.

9.3.1.2 OPD services •



• •

Regarding the availability of staff it was stated by 70% of the elected representatives that the staff is available in the CHCs, however, 30% of them opined that there is shortage of doctors in most places, especially of the gynaecologist. With regard to the availability of medicines in OPD, 50% felt that medicines are available, however rest 50% stated that the medicines are either less or only partly available. They also stated that, all the medicines should be provided at the CHC. Regarding the waiting time, 70% of the representatives felt that the waiting time is not much (<30 minutes), while 30% of them felt that it is long. With regard to cleanliness, 80% stated that the CHCs are maintaining satisfactory/good level of cleanliness; while 10% felt that the level of cleanliness is bad (Hoshiarpur) and 10% felt that this needs improvement (Muktasar).

9.3.1.3 Extent of fulfilment of community needs •

In response to this question, 40% stated that the needs are being fulfilled to a large extent; another 30% felt that only 50% of the health needs are being fulfilled and the rest 30% felt that only 10% of the community health needs are being fulfilled and only medico legal cases generally go to CHCs.

9.3.1.4 Behaviour of staff • •

Regarding behaviour of staff in CHCs, 70% elected representatives felt that the overall behaviour is good and the rest 30% felt that it is not good. It was commented upon that the behaviour of nurses in particular is bad.

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9.3.1.5 Referral services • •

Regarding Ambulance services at CHCs, 30% stated that the services are available, while 60% stated that the ambulance services are either not available or only partially available. It was stated by the elected representatives that in the emergency situation they utilise the untied funds available with Panchayats to hire a vehicle.

9.3.1.6 RKS and poor patients’ treatment • •

About 40% of the elected representatives were found to have knowledge of RKS, while the other 50% were having no knowledge and 10% did not comment on this issue. Regarding free treatment of poor patients, only 20% said that they are being given free treatment, while majority of them (60%) said that no free treatment is being offered to the poor. 20% were not able to give any conclusive comments.

9.3.1.7 Perceived barriers to avail health facilities Regarding perceived barriers to avail health facilities the views of elected representatives were as follows: •

• • •

Regarding the availability, 40% of them felt that less availability of medicines and absence of doctors is a perceived barrier, 10% felt that far off location is a barrier, while the rest 50% opined that there are no perceived barriers in terms of availability. Regarding accessibility, 10% felt that referral services are a barrier since these referral facilities are located very far, while 90% stated that there no barriers. 40% felt that scarcity of medicines and less availability of doctors is a barrier in utilisation of services available CHCs, while the other 60% reported no barrier. With regard to the Acceptability, it was felt by 40% that it is a barrier in CHCs due to restricted or lack of quality facilities, no barriers were reported by the other 60%.

9.3.2 Senior Medical Officers – CHC •

A total of 11 Senior Medical Officers from 11 CHCs were interviewed in 10 districts visited in Punjab for evaluation of the Health System. One SMO from each of the sampled district CHC and 2 from Amritsar were interviewed. It was found that out of 11 SMOs interviewed, 80% had their length of service as more than 2 yrs. while rest 30% had more than 2 yrs. of service at their respective CHCs’. (Refer Table 30)

9.3.2.1 OPD services •

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Regarding the OPD Services, only 30% stated that the staff strength is adequate; while the other 70% felt opined there is shortage of staff.

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• •

Bed occupancy rate was found to be between 10-20% in 60% of the CHCs, 30-50% in 20% of the CHC and 100% at only one CHC (Bhatinda). Poor patients were being given free medicines in the opinion of 90% of the SMOs interviewed; while 10% stated that they are providing only few medicines and the remaining 10% SMOs did not comment on this.

9.3.2.2 RKS and National Health Programmes •



About 80% SMOs were aware of the Rogi Kalyan Samiti. Though some initiatives had already been taken in other areas, but it found not functioning/not formed in 30% of the CHCs due to various administrative reasons. About 40% of the SMOs were having information regarding various National Health Programmes, while 50% stated that not all information is available to them (i.e., Malaria, T.B and STD). Rest 20% SMOs did not give any comments in this regard.

9.3.2.3 Extent of community needs fulfilment •

20% SMOs felt that they are able to fulfil upto 90-100% needs of the community; 20% stated they are able to fulfil 70-80% of the health needs, 20% stated satisfactory level of needs fulfilment, 20% reported that the CHCs are under-utilised and no definite comments were obtained from remaining 20% of the SMOs.

9.3.2.4 In-patient department (IPD) •

• • • • •

With regard to the IPD Services it was found that Nurse to bed ratio in about 20% CHCs was about 1:10, another 40% CHCs had this ratio between 1:3 –and 1:7, while CHC at Ferozpur reported this ratio as 1:1.2. CHC Jalandhar reported shortage of staff. No conclusive comments were received from 30% of the SMOs on issue of services in in-patient departments. Doctor/Bed ratio at 20% of the CHCs was between 1:2 and 1:4 and at the other 40% CHC sit was in the range of 1:5 to 1:7. Doctor-bed ratio was 1:30 at Manawala CHC in Amritsar. Staff shortage was reported form Jalandhar; Sangrur CHC reported high i.e., 1:15 doctor/bed ratio. Level of cleanliness was opined as good by 30% of the SMOs and as average by 70%. 10% SMOs stated that level of cleanliness is not up to the mark.

9.3.2.5 Fund flow •

While 50% SMOs reported no problem of fund flow in their respective CHCs, 10% of them reported that no funds are being provided to them. Rest 40% SMOs stated that this is being handled by civil surgeons.

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9.3.2.6 Manpower management •



About 90% of the SMOs stated that they have a system of performance appraisal by means of ACRs in their CHCs, which also includes laying down benchmarking indicators for doctors and medical officers. 20% SMOs stated that they are doing appraisals through records and meetings as well as through appreciation letters, other than ACRs.

9.3.2.7 Other services •

• •

About 90% SMOs stated about availability of emergency services running 24 hours a day, with specialists and surgeons being available on call. Only 10% said that there is shortage of staff but still somehow they are providing services. Doctors were mostly available on call. 10% stated that they take help from mini PHCs. Bio-medical waste management was being followed in opinion of 90% of the SMOs, rest SMOs did not provide any conclusive information regarding this aspect.

9.3.2.8 Perceived barriers • • •



Regarding the availability of services, 30% SMOs felt that there is lack of doctors and shortage of staff, which is a barrier, while the rest 30% did not feel any barrier existed. With regard to the Accessibility, only 10% stated that difficulties are there as CHC is in a border area while 60% reported no problem. Regarding utilisation of services at CHC, 60% of the SMOs felt that due to lack of funds, nonavailability of specialists, shortage of drugs, poor investigation facilities and poor quality of services, there is low utilisation. With regard to the acceptability, it was felt by 20% SMOs that it is low due to less number of doctors, while 40% did not perceive this as a barrier.

9.3.2.9 Suggestions The following suggestions were made: • Regular Investigation and X-ray facility should be made available even after 3 p.m., so that patients do not suffer. • Essential drugs should be adequately available. • Bed linen should be provided in adequate quantity. Laundry unit should be made available in CHC. • Services should be made accountable to general public/community. • Assured career plan should be developed for all cadres comparable to bench marks. • Manpower must be provided in places where it is lacking. Vacant posts should be filled. The available services can be improved a lot by providing a gynaecologist, paediatrician and dentists in the CHCs’. • Medicines should be supplied and ‘border area’ allowances also be given where the CHC is located near the border.

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• • • • • • •

Doctors and staff should be provided good accommodation facility at par with their status. CHCs should be provided with uninterrupted supply of electricity. There should be AMC for all equipments. Computer operators should be provided. Junior Engineer should visit CHCs twice a month. Availability of Diesel for generator should be ensured at all times. User charges should be increased according to rising inflation, as patients are ready to pay for quality services.

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10.0 Observations and Discussion

10.1 Facility Survey Based on the analysis of quantitative and qualitative data, the following observations are drawn forth:

10.1.1 Infrastructure a) b)

c)

d) e)

Almost all the hospitals under study were easily accessible from the Bus Stop and nearest Railway Station and easily approachable by a motorable road. The building and general infrastructure for all the health care facilities were found to be reasonably well constructed. But as most of them are newly constructed, this infrastructure needs proper maintenance so that its life can be prolonged. Most of the hospitals were not found to be equipped with the required equipments. In some hospitals, equipment was there but there was mismatch as some were found to be either not in use and some were reported to be out of order. The surrounding of these health care facilities was not found in good condition. Almost every health facility required paying serious attention towards this aspect. The cleanliness of the hospital premises was not up to the mark.

10.1.2 Human resources a) b)

c)

d) e) f)

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Almost all the hospitals under study have vacant posts including post of Doctors and Support Staff. The doctors posted in these hospitals are from one single cadre. There is no separate cadre for GDMO and Specialists. As a result, particularly in CHCs and Sub Divisional Hospitals, the Specialists were also doing night duties/emergency duties and hence were not available for regular OPDs. Doctors including specialists in the hospitals under study were supposed to perform other duties like, the VIP duties, attend court cases and remain involved in various public health activities and health fairs. If regular GDMO would have been available, these duties could well be undertaken by GDMOs. There is an acute shortage of Radiologist, Anaesthetists, Paediatrician and Gynaecologist in almost all the hospitals, particularly in Sub Divisional Hospitals and CHCs. There is also an acute shortage of the support staff, particularly the Technical staff in Sub Divisional Hospitals and CHCs. Frequent transfers of the doctors has also been reflected as a cause of concern and problems in these hospitals. For example, in case where a doctor of one speciality is transferred, he is most likely to be replaced by doctor of another speciality. This disrupts the services of hospital for that particular speciality and patients suffer on this account.

Study to Review The Health Care Delivery System provided by PHSC, Punjab

10.1.3 Availability of medicines a) b) c)

d)

It was observed in all the hospitals and reported by almost everybody that medicines are not available in adequate quantity. The patients were found to purchase the medicines from outside. Though there is a provision of supply from the State and District level, but in practice most of these centres reported that they are asked to buy the medicines from the User Charges fund. It was also observed that purchasing medicines from User Charges fund have become a routine practice in almost every hospital/health centre under study.

10.1.4 Laboratory and diagnostic services a) b) c) d)

Though the laboratories and diagnostic services were available in all the hospitals assessed, but functioning of the labs was not reported to be up to the mark. The patients are forced to get the tests done from outside laboratory services due to lack of reagents and equipments.. Regarding the radiological services, X-ray Units were found to be non-functional due to erratic electric supply and non-availability of films. Moreover, Radiologists were also not available in all the hospitals.

10.1.5 Emergency and maternity services a)

b) c)

Emergency and Maternity services found to be worst effected mainly in Sub Divisional Hospitals and CHCs. Main reason for this was non-availability of the doctors for Emergency and Maternity services. Even Nursing staff was not feeling comfortable to do the duty in the night and odd hours due to security reasons, as other staff and people are not available during night hours. It was revealed that due to non-availability of the staff and other facilities, the patients have to return back from the facility. As a result, the community is losing confidence in the hospitals. This is one reason of low utilisation of health facilities and also for this trend to down further.

10.1.6 Disaster preparedness a) b)

None of the hospitals, including District Hospitals were found to be properly prepared to deal with any Disaster situation. None of the hospitals including District Hospitals were having any well-prepared Disaster Action Plan. Nor they are having any disaster drill or any disaster manual.

10.1.7 Referral linkages a)

Though on paper all these hospitals are having a well laid down referral system but in practice this is not very meticulously followed.

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b) c)

Mostly the patients are transferred from the lower health centre to the higher centre without any feedback loop. No guidelines are available at the facilities for “whom to refer”, “how to refer” “when to refer” and “where to refer”.

10.1.8 Medical records An analysis of all medical records revealed the following: a) b) c)

None of the hospitals were having a properly planned and organised Medical Record Department. All the data and statistics from Medical records were found to be maintained manually. None of the Medical Record Departments were found to be computerised. Most of the case-sheets kept in the Medical Record Departments were found to be incomplete and mostly not maintained as per any definite standard indexing/procedure.

10.1.9 Stores management a) b) c) d)

The Medical Store management was not found to be very organised, and following the modern techniques of store management. In almost all the hospitals, only few medicines could be found in the medical stores of health facilities. The record maintenance of the stores was not found to be in proper order and they were not maintaining any “Buffer Stock” or calculating the “Reorder Level”. The scientific ‘Inventory Control Techniques’ were not practiced in any of the stores visited and the staff was also not having much knowledge about these techniques.

10.1.10 Diet services a) b)

None of the hospitals were providing regular diet to their in-patients, except in one Subdivisional hospital (Meler Kotla). It has been suggested that if the patients are provided diet from the hospitals, this would be highly appreciated.

10.1.11 Basic facilities a)

b) c) d)

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The relatives of the patients, particularly those who are coming from distant places, were not having any proper place to stay (Dharmshala) and were having no access to other facilities like toilet, kitchen etc. As a result they were found loitering all over the places in and around the hospital. Similarly, the basic facilities like toilets, particularly separate toilets for ladies were not available in every OPD. These facilities must also have other services like STD booths, canteen and subsidised chemist shop. Residential accommodation available was not found to be fully utilised, mostly due to poor maintenance of residential accommodation. Study to Review The Health Care Delivery System provided by PHSC, Punjab

10.1.12 Rogi Kalyan Samiti a)

b)

Though on papers Rogi Kalyan Samitis existed in all the hospitals, but due to their internal administrative problems and non fulfilment of the required pre-requisites, these Samitis were found to be non functional or yet to be made functional in almost all the hospitals. Funds under these Samitis were found to be un-utilised in all these hospitals.

10.2 Views of the Beneficiaries A total of 580 respondents were interviewed in the outpatient department and 224 respondents from inpatient departments of various health institutions like CHCs, Sub-divisional hospitals, District hospitals and two Special Hospitals of Punjab Health System Corporation to obtain their opinion about the available health services.

10.2.1 Socio-economic dimension of the respondents a)

Majority of respondents utilising PHSC were females having poor education and low income in age group of 15-30 years.

10.2.2 User charges a)

Majority of the respondents were paying user charges for getting OPD card and for getting investigations done. More than 3/4th of respondents were paying the charges for making slip/card required for admission.

10.2.3 Admission procedure a) b)

77.7% of the respondents were not satisfied with the admission procedures and 86.2% of respondents at CHC and 81% at sub divisional hospitals rated it poor. Only half of the respondents were informed about rules and regulation of these health facilities regarding admission procedures.

10.2.4 General cleanliness and comfort in wards a) b)

c) d)

Overall ratings of general cleanliness of the OPD along with basic facilities were found to be better in the Special Hospitals and the same was comparatively lower in the CHCs. According to the findings, 66.5% rated general cleanliness of wards and beds as good whereas 44.2% respondents rated it average. 66.5% respondents had perceived the cleanliness of bed linen as good, while 30.8% respondents perceived it average. There is a need to improve the general cleanliness and cleanliness of linen in Sub-divisional hospitals and District hospitals. Out of various health institutions 74.1% respondents perceived that the level of comfort in the wards was good but 30% perceived comfort as average, with better comfort in CHCs and special hospitals.

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e)

Only 47.3% respondents perceived that toilets were clean. This was further low in case of District Hospitals and Sub divisional hospitals.

10.2.5 Availability of basic facilities a)

b)

c)

Facilities like fan and lights were found to be good according to 75.7% of respondents in OPD and 79.5% for inpatients. These facilities were not up to the mark in OPD of CHCs, although it was good in wards of CHC. District hospitals need improvement for both outpatients and inpatients services. STD/PCO booths were not present in 57% of health institutions and only 16.7% of CHCs were having STD/PCO booths out of these health institutions. 14% of health institutions were not having a separate toilet facility which was 23.7% in case of CHCs. 11% of health institutions were lacking in drinking water facilities and again CHCs were lacking more in context of this facility. Separate toilet facilities need to be made available to the female respondents, particularly when more number of females are utilising the services of the OPD of various institutions. 16.7% of CHCs were not having screens in the examination room.

10.2.6 Adequacy of information about disease and treatment a)

Among OPD patients, 81.4% said that adequacy of information given to them about their disease and treatment by doctor was good. 69.2% inpatients reported the adequacy of information as good. In the case of OPD, information given was least in CHCs as compared to other institutions, but on the contrary, CHCs were found better in case of inpatient services.

10.2.7 Availability of medicines a)

b)

c)

Only 10.3% respondents stated that all medicines are available in the OPD and 26.4% stated that none of the medicines are available in the OPD. When the percentage was seen separately in the various health institutions than the availability of medicines was more in Sub-divisional hospitals and least in District hospitals. In case of Inpatient department, only 13.4% respondents stated that all the medicines are available and 29% respondents stated that none of the medicine were available in the wards. When the percentage was seen separately in the various health institutions then availability of medicines was found to be more in Special hospitals and least in Sub-divisional hospitals. Among the in-patients, 91.1% respondents were found to have spent money on medicines and in case of different health institutions, the percentage of respondents who spent money on medicines was as high as 100% at Sub-divisional hospitals and up to 69% at CHCs.

10.2.8 Availability of diagnostic facilities a)

122

Out of all respondents interviewed at OPD, 50.7% stated that the facilities like laboratory and radiological investigations are good. In case of inpatients, 65.6% stated that the facilities such as laboratory and radiological investigations are good.

Study to Review The Health Care Delivery System provided by PHSC, Punjab

10.2.9 Availability and behaviour of doctors, nurses and staff a)

b)

c)

d) e)

Overall availability of doctors as stated by the respondents at the health institutions was 94.8% and when respondents were asked about doctor’s behaviour towards them, 91.4% respondents from OPD and 93.3% from in patient departments stated that doctor’s behaviour is good. Availability and behaviour of staff was found to be similar in case of specialists. When percentage availability of doctors and specialists were seen separately, then it was found lower in case of CHCs and District Hospitals among all the institutions. Availability and behaviour of nurses was not found to be as good as in case of doctors. Availability of nurses was found to be 79% and good behaviour of nurses in OPD as 64.5%. On the other hand 80.4% nurse’s behaviour was good in the in-patient department of various health institutions with lowest in Sub-Divisional Hospitals (67%). Overall 56.9% staff member’s behaviour was perceived as good by the respondents in the OPD of various institutions, which was 74% in case of in-patient services. Behaviour of staff was rated lowest in CHCs as compared to other health institutions. In case of OPD 2.9% respondents had to pay to staff members of the hospitals other than user fees for getting services.

10.2.10 Waiting time in OPD a)

b)

Time spent in waiting for specialist consultation in the OPD was less than 15 minutes for 63.4% respondents and more than 30 minutes for other 13.9%. In case of investigations, 83.6% respondents were found to have waited for 15 minutes and 6.5%% for more than 30 minutes. Waiting time for getting the medicine in the OPD was up to 10 minutes for 80.8% respondents. Patients at District Hospitals and special hospitals were found to have waited for more time period.

10.2.11 Security in the in-patient department a) b)

Only 46.4% respondents of all the health institutions perceived that the security at these facilities is good, whereas 17% respondents perceived it poor. It means that more than half of the respondents did not feel adequately secure in the inpatient department. Security in the health institutions needs to be improved with more focus on CHCs and sub divisional hospitals.

10.2.12 Quality of care a)

b)

Overall 75.9% of OPD and 79% of in-patient respondents rated the quality of treatment in the hospitals as good. CHCs and Sub-Divisional Hospitals were rated low in quality in comparison to the other institutions. Overall 77.9% respondents in OPD were satisfied with the services of various health institutions. However, only 2.3% respondents were fully satisfied with the services of the out-patient department. 22.1% respondents were not satisfied with the services available at the health institutions. 94.2% respondents of the in-patient department were satisfied and

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c) d)

only 5.8% were not satisfied with the services of the health institutions. Overall rating about the cooperation at the reception counter of the various institutions was found to be good, but CHCs need to have improvement in this regard. 70% respondents rated their experience at OPD as good and this proportion is only 57% at CHCs. This indicates that services at CHCs need overall improvement.

10.2.13 To sum up a) b)

c) d)

e) f) g)

h) i)

j)

k)

l)

124

Majority of respondents utilising PHSC were females having poor education and low income levels. Patients approach mainly PHSC for utilisation of emergency services. This may be because at that time they do not have access to other health facilities and they have no other alternative left due to economic reasons. General cleanliness and cleanliness of linen in Sub-Divisional Hospitals and District Hospitals need to be improved. Overall behaviour of doctors, nurses and other staff members in the health institutions was stated to be good by majority of the respondents. Only a minor proportion of them rated it unsatisfactory. Majority of the respondents stated that the medicines are not available, and that they have to buy it from market, as advised by doctors. More than half of the respondents did not feel adequately secure in the in-patient department. Security in the health institutions needs to be improved. Availability of basic facilities, in general, was not very satisfactory in all type of health institutions and particularly in District Hospitals and CHCs. These include:  Availability of STD/PCO booth,  Better toilet facilities and mainly separate toilets for women in all types of health institutions,  Availability of safe drinking water,  Availability of screen in the examination room. Behaviour of staff members in the OPDs was not rated to be satisfactory by majority of the respondents. A good percentage of respondents stated that availability of doctors, nurses and staff in the OPDs is good, except at CHCs. However, the finding on the similar issue in the community was very different. Rather this was reported to be as one of the major issues underlying low utilisation of health services provided by PHSC. The facilities like laboratory and radiological investigations were not rated to be satisfactory by majority of the respondents as most of the time these facilities are not available. Because of this, patients are forced to go to private facilities to get the required investigations done. Overall experience of respondents at OPDs of the various health institutions under study was not found to be very satisfactory. This observation holds true in particular for CHCs and District hospitals and needs further attention. A good percentage of respondents felt that the quality of treatment in the hospitals needs to be improved, mainly in the CHCs, as these are in the rural areas and mostly the community was not having any other alternative option for health care. Study to Review The Health Care Delivery System provided by PHSC, Punjab

10.3 Views of the Community based on Focus Group Discussions The following observations are noted based on focus group discussion in the community: a)

General administration of the hospital needs rectification. This includes cleanliness, recruitment of the staff, doctors with specialties, drinking water arrangement, toilets on all the floors & wards, electricity (lightening arrangement), generator, water tank, timely repair of accessories and machines etc. b) All necessary medicines should be provided by the hospital. If not possible, at least the BPL families should get this facility. For the other patients subsidised medicines can also be a good option. c) At least in the emergency situation hospital should provide every facility like diagnostic services or medicines. d) Provision for laboratory and ultrasound should also be in perfect situation. e) Surgeons can be arranged for emergencies on call. f) Fee for the diagnostic tests should also be subsidised. g) There is a need to organise community campaigns such as camps, health melas, health education etc. especially in far-flung areas. h) Local community participation should be enhanced for utilisation of health services. i) For strengthening emergency services, ambulances need to be arranged at very minimum rates. j) Doctor on emergency duty should be available for 24 hours a day. k) The private practice of the Government doctors should be stopped. l) Every village should have a trained dai and a lady doctor. m) It was desired that at least delivery facility for pregnant women should be provided by the government free of cost. n) If all the facilities with the good doctors were available people would prefer to utilise those health facilities o) It was observed in the discussion that the parishad CHCs were more popular in the areas as compared to the PHSCs/CHCs.

10.4 Views of other Stakeholders The view of the other stakeholders is as given below: i) More infrastructure facilities and equipments need to be provided. ii) Salaries of doctors are not very lucrative as a result they go for private practice. iii) More contractual employees are required – especially class IV and lab technicians. iv) Public Private Partnership model needs to be introduced. v) Telemedicine should be promoted. vi) Performance linked appraisal should be adopted. vii) Number and quality of drugs need to be increased and improved for increasing acceptance of the services. viii) Paid wards should be started.

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ix) x) xi) xii)

Transport services should be improved. Health insurance should be made available for poor patients. Cleanliness should be emphasised. More equipment for diagnostic facility (i.e. CT Scan, MRI) should be made available for poor patients. xiii) More number of ambulances should be made available. xiv) A separate vehicle should be made available for SMO for field visits. xv) Extra water facility and clean, treated water should be provided. xvi) Security guards must be recruited to improve security of in patients. xvii) Plantation in and around hospital complex should be increased. xviii) Night and emergency services should be improved and more doctors should be made available. xix) The 50 bedded hospitals need to be upgraded to 100 beds to meet the community needs. xx) Generators with more power and capacity should be made available to improve functioning, as frequent power failure is a perpetual problem in many areas. xxi) Technician for Ultrasound must be recruited. xxii) Vacant staff positions should be filled up. xxiii) Regular training should be provided to the staff. xxiv) Repair and maintenance of staff quarters should be done. xxv) Manpower shortage especially that of radiologist, anaesthetist, paediatrician and gynaecologist and obstetrician, along with class IV employees, should be seriously looked into. xxvi) Fully equipped ambulance and CT scan should be provided. xxvii) There should be provision of a seminar room. xxviii) Facility in charge should be given authority to cut down on non-performing staff. xxix) Security services should be provided on contract. xxx) Costly equipments should have AMC. xxxi) Awareness of services should be done through media.

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Study to Review The Health Care Delivery System provided by PHSC, Punjab

11.0 Conclusion and Recommen-

Based on above quantitative, qualitative and triangulation of data, the following recommendations are proposed:

11.1 Human Resource a) b) c) d) e)

f) g) h) i) j)

k) l)

An assessment may be done for the State of Punjab to find out the staff position for all categories of health workers including doctors. An exercise to find out the strength of the sanctioned and vacant posts needs to be undertaken. Urgent efforts may be made to fill up the vacant positions. Two separate cadres for the doctors i.e. one for GDMOs and one for specialists instead of having only one single cadre of Medical Officers should be created. Category wise GIS mapping of all types of human resources including Medical officers and various Specialists for all the Health Institutions may be done for the entire state. By this exercise, a clear picture will emerge regarding the exact availability against the requirement of each category of health personnel. It is suggested that PHSC may take policy decisions whereby all the doctors are paid a basic minimum salary so as to motivate them to work at government health facilities. This exercise will help in planning and recruitment of the required specialists and GDMOs. Moreover based on the norms of IPHS, posts for GDMOs and other essential categories of specialists may be created and filled up. Availability of basic specialists in the respective health centres will surely build up the confidence among the community and hence result in increased utilisation of services. Separate administrative cadre may be developed for the administrative posts of district, sub-division and CHCs so that a full time and well qualified/trained doctor can be assigned to these jobs. A specialist may not be given this responsibility by virtue of his/her seniority as this effects his clinical practice in the hospital. As reported, the salaries of the doctors under PHSC were not at par with the private sector and this could be one of the reasons for high attrition rate among the doctors. Performance based incentives may be considered not only for retaining the existing specialists, but also State may explore the possibility of involvement of private practitioners under public private partnership as per market rate. This exercise can be done under human resource innovation which is one of the components in NRHM. A similar performance assessment system was already in practice i.e. ‘Bench Marking’. Also, by this method, it may be easier to retain the specialist category of radiology, anaesthesia, paediatric, gynaecology etc.

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127

11.2 Availability of Drugs a)

b) c)

d) e)

f) g)

h)

i) j) k)

At all the health care institutions, the beneficiaries reported to have expectations that the medicines, particularly the vital ones, should be provided by the health centre. Moreover, it becomes a moral obligation for the authorities to provide at least the vital and essential medicines. Hence, the availability of these medicines specially the vital and essential ones should be necessary in all health facilities.. Therefore it is recommended that every health centre should prepare the list of medicines (drug formulary) to be used at that centre and the same to be sent to their concerned authorities for procurement/indent. At the State level, these lists of drugs, coming from various types of health facilities through their respective district headquarters to be compiled and a common list to be prepared. By applying scientific Inventory Control Techniques of ABC and VED analysis, they should find out the list of all the vital and essential drugs and the costlier one (which shall not be more than 20% of the total procured drugs). These medicines should be procured through state level and distributed to the districts for onwards supply. Alternatively the state may fix up the rate contract of each item after following the laid down procurement procedures for drug items and supply this information with the required authority letter to the respective districts so that they can directly procure these medicines from the suppliers at the rate fixed by the state. In this way, the state headquarters need not to worry about their budget and every district health centre and below will be procuring these medicines by using funds of Rogi Kalyan Samitis or user charges. By this partial de-centralised procurement, the availability of the medicines will definitely improve and quality of the medicines can also be ensured. Every hospital/health centre should have proper antibiotic policy and standard treatment guidelines. There should be regular practice of prescription audit.

11.3 Community Education and Community Rights Regarding Health Facilities a)

b)

Every hospital/health centre should clearly display the citizen charter and the name, designation and telephone numbers of the concerned officers to whom they can approach at the time of any dispute or complaint. The beneficiaries should also be informed about the routine procedures they are expected to follow in that health centre and their rights.

11.4 Cleanliness a)

128

Special efforts should be taken to maintain the cleanliness of the hospital. CHCs should focus more on this so that it is at par with basic required standards.

Study to Review The Health Care Delivery System provided by PHSC, Punjab

b)

c) d)

e) f)

The general up keep of surroundings of the hospital should also be maintained properly. For this reason, special efforts should be taken for regular repair, maintenance and landscaping. The toilets should be kept clean and the drainage system in particular to be flushed routinely at regular intervals. Drainage system should be regularly cleaned and monitored. For the support staff a training capsule having role and responsibilities\ including basics of hygiene and sanitation, preventive and promotive health care, motivation, attitudinal changes, services available in the health facility may be developed and continuing exercise should be regularly undertaken. For house keeping and sanitation, the services may be out sourced and may be given to the professional organisation like sulabh etc. A separate toilet for the females should be there in the OPDs of every hospital/health centre.

11.5 Diagnostic Facilities a) b) c) d)

Efforts should be made to ensure that all the required reagents and equipments in the laboratories are available. For those special investigations, which are not carried out in the respective centres, the authorities should tie up with the private laboratories at pre-negotiated fixed rates. With these arrangements, the beneficiaries can be referred to these laboratories and they will not end up paying a higher price. Even for the poor patients, respective health centre may pay their charges from the funds available from user charges/Rogi Kalyan Samitis.

11.6 Medical Record Department a)

For any good administration, the correct and timely information is very important. This information can only be made available, if the respective data is generated in outpatient and In-door facilities. Hence, to have proper information, every hospital needs to have a well planned and organised medical record department. The information in medical records, helps hospital administrator to monitor the utilisation pattern of their respective hospital and to help them to take required necessary decision for improvement. The following observations are made in this regard: • All the case sheets and medical records pertaining to patient care is required to be maintained following some standard indexing system so that in future, retrieval becomes easy. • Every hospital should come out with the routine statistical bulletin, which should include some of the important Hospital Utilisation Indices like bed occupancy rate, average length of stay, bed turnover interval, gross and net death rate etc.

11.7 Emergency Services a)

Due to paucity of doctors and other support staff in various hospitals, the emergency services are not functioning properly. This creates a problem for the community

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b) c)

(especially for the poor population) who are forced to go to the private sector for availing emergency services. This calls for taking into account, that the emergency services are taken very seriously and action needs to be taken immediately. To start with, doctors may be posted in these hospitals, particularly at sub divisional hospital and CHC, exclusively to run emergency services.

11.8 Maternity Services a)

b) c) d)

Emergency obstetric services: Non-availability of satisfactory obstetric services is another major drawback in the system. The community is compelled to seek care from the private sector due to the non availability of emergency obstetric services in the public sector. Main reasons found out for this was non-availability of gynaecology and obstetrics specialists. Hence efforts should be made to ensure that every hospital upto CHC level has atleast one gynaecologist with all required facilities. A model of public private partnership like the one followed in Gujarat (Chiranjeevi scheme) may be looked into for strengthening the maternity services.

11.9 Other Aspects a) b) c) d) e) f)

g) h)

i) j) k)

130

Admission procedures need improvement with more focus on CHC and sub divisional hospitals. Rules and regulations of health institutions should be properly informed to the patients. Cleanliness of linen in Sub-Divisional Hospitals and District Hospitals needs to be improved. STD/PCO booth to be installed for convenience of the patients and relatives as per IPHS standards and NRHM. CHCs were lacking in many facilities and PHSC should look into this matter immediately to provide quality service to rural people. Inpatients should also be provided by adequate information regarding disease and treatment. The inclination of community to use private services is due to ensured availability of the services including holidays, at night, clean environment and at a time convenient to the people in the community. Hence to increase the utilisation of the facilities, evening OPDs may be started. On the experimental basis, it may be made as pay clinics, with the choice of the patient to select the doctor. A good share of the earning (say about 60-70%) from these pay clinics may be paid to the doctors. The amount paid to the doctors as honorarium may be in consonance to the number of patients they are attending. Proper and well maintained residential accommodation for doctors and other staff may be provided at all levels of health centres. Security in the health institutions needs to be improved with more focus on CHCs and sub divisional hospitals.

Study to Review The Health Care Delivery System provided by PHSC, Punjab

l) Every Hospital should have a hospital infection control committee. m) There should be a regular grand clinical rounds for all the health centres i.e. CHCs and above. This should be attended by all the doctors. Hence, to sum up, the utilisation of health care services will definitely improve if along with the availability of doctors and required specialists, the medicines (at least the vital ones), basic laboratory and radiological investigations are made available. Further, the emergency services and the delivery services could be improved and made available round the clock for the satisfaction of the community. This would result in increased utilisation of the facilities provided by PHSC.

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132

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The Health Care Delivery System provided by PHSC, Punjab

Yes Good Good Good Poor

If more than one storey building (Ramp Available )

General Impression- up keep of garden

General Impressioncleanliness

General Impression- sign posting

General Impression- roads and lighting

Available

Electricity (Backup Generator /UPS Available ) Yes

Phasethree

Electricity (phase)

If more than one storey building (Lift Available)

Irregular

1

Water Supply (storage capacity available for no. of days)

Electricity (supply)

Adequate

50

Bed Strength

Water Supply (Quantity)

Yes

All Weather Roads

Municipal supply

1

Distance from Bus Station km

Source of Water Supply

3

2

Distance from Rail Station km

Good

Good

Average

Average

Yes

Yes

Available

Phasethree

Regular

1

Inadequate

Bore well

100

Yes

1

Yes

Yes

Bhatinda

Accessibility to Railway/ Bus Station

Amritsar

Good

Good

Good

Good

Yes

No

Available

Phasethree

Regular

3

Adequate

Bore well

200

Yes

2

3

Yes

Ferozpur

Good

Good

Good

Average

Yes

No

Available

Phasethree

Regular

3

Adequate

Bore well

60

Yes

1

2

Yes

Gurdaspur

Good

Good

Good

Good

Yes

No

Available

Phase-three

Regular

2

Adequate

Bore well

100

Yes

1

3

Yes

Hoshiarpur

Good

Good

Good

Good

Yes

Yes

Available

Phasethree

Regular

3

Adequate

Municipal supply

-300

Yes

3

3

Yes

Jalandhar

Average

Average

Average

Average

Yes

No

Available

Phasethree

Regular

2

Adequate

Municipal supply

-200

Yes

4

2

Yes

Ludhiana

Name of the District

Table 1.1. General Profile and Facility Survey of District Hospitals

Good

Good

Good

Good

Yes

No

Available

Phasethree

Irregular

3

Inadequate

Canal water

100

Yes

2

3

No

Muktsar

Good

Good

Good

Good

Yes

No

Available

Phasethree

Regular

3

Adequate

Bore well

164-

Yes

1

1

Yes

SH Patiala

Average

poor

Average

Average

Yes

Yes

Available

Phasethree

Regular

3

Adequate

Municipal supply

100

Yes

1

1

Yes

Sangrur

Average

Good

Average

Average

Yes

No

Available

Phasedouble

Irregular

3

Adequate

Bore well

50

Yes

3

2

Yes

Taran Taran

(Contd...)

Good

Average

Average

Average

Yes

No

Available

Phasethree

Regular

1

Adequate

Bore well

60

Yes

1

3

Yes

SH Bhatinda

The Health Care Delivery System provided by PHSC, Punjab

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133

No

Yes Partially Equipped

Any Public Utility Service Available in Hospital Premises-STD/PCO booth

Ambulance Services

Ambulance Services if available

4 Yes 8

No. of Operation TheatresMajor (Nos.)

ICU types

ICU no. of beds

1

No

Any Public Utility Service Available in Hospital Premises-Canteen

No. of Operation TheatresMinor (Nos.)

Yes

Any Public Utility Service available in Hospital Premises-Sulabh Sauchalaya

1

Yes

Yes

Any public Utility Service Available in Hospital Premises-Chemist

Total Number of Vehicles (Nos.)

Good

No

Any Public Utility Service available in Hospital Premises

6

Yes

3

1

10

Fully Equipped

Yes

No

Yes

Yes

Average

Good

Bhatinda

General Impression- State of Building

Amritsar

NA

No

1

1

5

Fully Equipped

Yes

Yes

Yes

Yes

No

No

Good

Ferozpur

6

Yes

2

1

3

Partially Equipped

Yes

Yes

Yes

Yes

Yes

No

Good

Gurdaspur

NA

No

3

1

4

Partially Equipped

Yes

Yes

Yes

Yes

No

No

Good

Hoshiarpur

10

Yes

4

4

4

Partially Equipped

Yes

Yes

Yes

Yes

No

No

Good

Jalandhar

4

Yes

2

1

3

Partially Equipped

Yes

Yes

Yes

Yes

Yes

No

Average

Ludhiana

Name of the District

NA

No

3

3

2

Partially Equipped

Yes

No

No

No

Yes

Good

Good

Muktsar

NA

No

2

1

1

Fully Equipped

Yes

Yes

Yes

Yes

Yes

No

Good

SH Patiala

5

Yes

1

1

3

Partially Equipped

Yes

No

Yes

Yes

Yes

No

Average

Sangrur

NA

No

2

1

2

Fully Equipped

Yes

No

No

No

No

No

Average

Taran Taran

(Contd...)

NA

No

1

1

1

Partially Equipped

Yes

No

Yes

Yes

Yes

Good

Good

SH Bhatinda

134

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The Health Care Delivery System provided by PHSC, Punjab

Yes Yes No No

No No Yes Yes Yes Yes Push 50 50

No Yes

Delivery Services

Facilities for Post-mortem

Mortuary services with cold storage & other preservative facilities available.

Drug formulary committee

Hospital Antibiotic committee

Hospital Infection Control Committee.

Store Purchase Committee

Store verification Committee

Medical Audit/ Death Review Committee

System of Supply of Drug items through

% of Drug items asked for is supplied

% of patients getting all the medicines prescribed

Is the drug formulary available

Is buffer stock maintained

Round the Clock

Dental Services

Emergency Services

Amritsar

Yes

No

40

60

Push

No

Yes

Yes

No

No

No

Yes

Yes

Yes

Yes

Round the Clock

Bhatinda

Yes

No

50

50

Pull

Yes

Yes

Yes

No

No

No

Yes

Yes

Yes

Yes

Round the Clock

Ferozpur

No

No

70

90

Pull

No

Yes

Yes

Yes

Yes

Yes

No

Yes

Yes

Yes

Round the Clock

Gurdaspur

Yes

Yes

5-10-OPD

100-indoor

100

Push

Yes

Yes

Yes

Yes

Yes

No

Yes

Yes

Yes

Yes

Round the Clock

Hoshiarpur

Yes

Yes

40

40

Pull

Yes

Yes

Yes

Yes

No

Yes

Yes

Yes

Yes

Yes

Round the Clock

Jalandhar

Yes

No

Push

Yes

Yes

Yes

No

No

No

Yes

Yes

Yes

Yes

Round the Clock

Ludhiana

Name of the District

No

No

25

50

Push

No

Yes

Yes

Yes

No

No

Yes

Yes

Yes

Yes

Round the Clock

Muktsar

Yes

No

75

20

Pull

Yes

No

Yes

No

No

Yes

No

No

Yes

Yes

Restricted

SH Patiala

No

No

50

50

Push

Yes

Yes

Yes

No

No

No

No

No

Yes

Yes

Round the Clock

Sangrur

No

No

Push

No

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Round the Clock

Taran Taran

(Contd...)

Yes

No

70

60

Pull

No

Yes

Yes

No

No

No

No

No

Yes

No

Round the Clock

SH Bhatinda

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Yes

Yes

Good

Log book/ History sheet maintained for the Equipments

Present status/situations of the existing Equipments:

Good

Yes

Yes

Bhatinda

Annual maintenance procedure for costly Equipments

Amritsar

Good

Yes

Yes

Ferozpur

Good

Yes

Yes

Gurdaspur

Good

Yes

Yes

Hoshiarpur

Good

Yes

Yes

Jalandhar

Good

Yes

Yes

Ludhiana

Name of the District

Good

Yes

Yes

Muktsar

Good

Yes

Yes

SH Patiala

Good

No

Yes

Sangrur

Good

No

Yes

Taran Taran

Good

Yes

Yes

SH Bhatinda

136

Study to Review

The Health Care Delivery System provided by PHSC, Punjab

Non Yes

Cardiac Monitor

Dental Chair

Yes

ECG

Yes

Ophthalmo-scopes

Ophthalmo-scopes

NA

No

Endoscope(fiber optic)

(fiber optic)

Endoscope

Emergency Resuscitation Kit

Emergency Resuscitation Kit

Yes

NA

Dosimeter

ECG

No

No

Dosimeter

Functional

Yes

NA

No

Functional

Yes

Functional

Yes

NA

Non Functional

Dental Chair

Yes

Functional

Yes

Yes

Yes

Cardiac Monitor

Boyles Apparatus

No NA

Functional

Yes

Baby Incubators

Boyles Apparatus

No NA

Baby Incubators

Bhatinda

Functional

Yes

Functional

Yes

Non Functional

Yes

Non Functional

Yes

NA

No

Functional

Yes

Functional

Yes

Functional

Yes

Non Functional

Yes

Ferozpur

Functional

Yes

Non Functional

Yes

Functional

Yes

Functional

Yes

NA

No

Functional

Yes

Functional

Yes

Functional

Yes

Functional

Yes

Gurdaspur

Table 1.2 Facilities Available at District Hospitals

Functional

Yes

Functional

Yes

Functional

Yes

Functional

Yes

NA

No

Functional

Yes

Functional

Yes

Functional

Yes

Functional

Yes

Hoshiarpur

Functional

Yes

Functional

Yes

Functional

Yes

Functional

Yes

NA

No

Functional

Yes

Functional

Yes

Functional

Yes

Functional

Yes

Jalandhar

Functional

Yes

Functional

Yes

Functional

Yes

Functional

Yes

NA

No

Functional

Yes

Functional

Yes

Functional

Yes

Non Functional

Yes

Ludhiana

Name of the District

Functional

Yes

NA

No

NA

No

Functional

Yes

NA

No

Functional

Yes

Functional

Yes

Functional

Yes

Functional

Yes

Muktsar

Functional

Yes

NA

No

Functional

Yes

Functional

Yes

NA

No

Functional

Yes

Functional

Yes

Functional

Yes

NA

No

SH Patiala

Functional

Yes

NA

No

Functional

Yes

Functional

Yes

NA

No

Functional

Yes

Non Functional

Yes

Functional

Yes

Functional

Yes

Sangrur

Functional

Yes

NA

No

Functional

Yes

Functional

Yes

Functional

Yes

Functional

Yes

Functional

Yes

Functional

Yes

Functional

Yes

Taran Taran

(Contd...)

NA

No

NA

No

Functional

Yes

Functional

Yes

Functional

Yes

N

No

Functional

Yes

Functional

Yes

Functional

Yes

SH Bhatinda

The Health Care Delivery System provided by PHSC, Punjab

Study to Review

137

Yes

Photo Therapy Unit

Yes

Yes

Any Referral System in place

Yes

Functional

Yes

Functional

Yes

Functional

Yes

Yes

Yes

Other Major and Minor Operation equipments

Other Major and Minor Operation equipments

X ray

X ray

Ultra sound

Ultra sound

Slit lamp

Functional

Yes

Yes

Slit lamp

Functional

NA

Sigmoidoscopes

Yes

Non Functional

No

NA

Short Wave Diathermy (Physio therapy)

Yes

Functional

Yes

Functional

Yes

NA

No

Sigmoidoscopes

No

Short Wave Diathermy (Physio therapy)

Retinoscope

Retinoscope

Yes

NA

Perimeter

Photo Therapy Unit

No

Perimeter

Bhatinda

Yes

Functional

Yes

Functional

Yes

Functional

Yes

Functional

Yes

Functional

Yes

Non Functional

Yes

Non Functional

Yes

Functional

Yes

NA

No

Ferozpur

Yes

Functional

Yes

Functional

Yes

Functional

Yes

Functional

Yes

Functional

Yes

Functional

Yes

Functional

Yes

Functional

Yes

Gurdaspur

Yes

Functional

Yes

Functional

Yes

Functional

Yes

Functional

Yes

Functional

Yes

Functional

Yes

Functional

Yes

Functional

Yes

Functional

Yes

Hoshiarpur

Yes

Functional

Yes

Functional

Yes

Functional

Yes

Functional

Yes

Functional

Yes

Functional

Yes

Functional

Yes

Functional

Yes

Functional

Yes

Jalandhar

Yes

Functional

Yes

Functional

Yes

Functional

Yes

Functional

Yes

Functional

Yes

Functional

Yes

Functional

Yes

Functional

Yes

Functional

Yes

Ludhiana

Name of the District

Yes

Functional

Yes

Functional

Yes

Functional

Yes

Functional

Yes

NA

No

NA

No

Functional

Yes

NA

No

Functional

No

Muktsar

Yes

Functional

Yes

Functional

Yes

NA

No

NA

No

Functional

Yes

Functional

Yes

Functional

Yes

Functional

Yes

SH Patiala

Yes

Functional

Yes

Functional

Yes

NA

No

Functional

Yes

NA

No

Functional

Yes

NA

No

Functional

Yes

NA

No

Sangrur

Yes

Functional

Yes

Functional

Yes

Functional

Yes

Functional

Yes

Functional

Yes

NA

No

Functional

Yes

Functional

Yes

NA

No

Taran Taran

(Contd...)

Yes

Functional

Yes

Functional

Yes

NA

No

NA

No

NA

No

Non Functional

Yes

NA

No

Functional

Yes

NA

No

SH Bhatinda

138

Study to Review

The Health Care Delivery System provided by PHSC, Punjab

No No No No Yes Yes No NA

Guidelines-When to refer

Guidelines- How to refer

Colour coded referral cards available

Feed-back Mechanism existing:

Transport facility provided:

Maintenance of records/ registers

Incentive for following referral route

If Yes, what

No

None

No

Tie-up with other hospital (both public and pvt) for diagnostic

Hospital has a tie-up with: (Medical College/ other government/ pvt. institutions)

Does the Hospital have any Outreach Area

Higher Centre

No

Guidelines for- What to refer

Procedure followed for referral:

No

Referral manual available

Yes

Other Government Hospitals

Yes

No

NA

No

No

Yes

No

Yes

No

No

No

No

Bhatinda

Yes

Medical College

Yes

Medical College

Vehicle provided

Yes

Yes

Yes

No

Yes

Yes

Yes

Yes

Yes

Ferozpur

No

Medical College & Other Government Hospitals

No

Colour coded card-Medical college

NA

No

Yes

Yes

No

Yes

Yes

Yes

Yes

Yes

Gurdaspur

No

None

No

Vehicle provide to Medical College

NA

No

Yes

Yes

Yes

No

Yes

No

No

Yes

Hoshiarpur

No

Private Hospitals

Yes

Vehicle with colour card

Vehicle provided

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Jalandhar

Yes

Pvt. Hospitals

Yes

Higher Centre

No proper Answer

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Ludhiana

Name of the District

No

None

No

With referral card

NA

No

Yes

Yes

No

Yes

Yes

Yes

Yes

No

Muktsar

No

None

No

PGI Chandigarh

NA

No

Yes

Yes

No

No

No

No

No

No

SH Patiala

No

None

No

Refer to Patiala

NA

No

Yes

Yes

No

No

Yes

Yes

Yes

No

Sangrur

No

1

Yes

Refer to Medical College

No proper Answer

Yes

Yes

Yes

No

No

No

No

No

No

Taran Taran

(Contd...)

Yes

2

Yes

Not Serve

No Answer

Yes

No

Yes

No

Yes

No

No

No

No

SH Bhatinda

The Health Care Delivery System provided by PHSC, Punjab

Study to Review

139

Contractual

NA

if available, what % is not getting accommodation (In % )

Security arrangement:

Yes

No

Availability of residential accommodation for the essential

In house

80

Yes

No

Available

Availability of dharamshala

Statistical Bulletin:

Bhatinda

In house

0

Yes

No

Not Available

Ferozpur

In house

0

Yes

No

Not Available

Gurdaspur

In house

50

Yes

No

Not Available

Hoshiarpur

50

Yes

No

Not Available

Ludhiana

Contractual Contractual

15

Yes

Yes

Available

Jalandhar

Name of the District

NA

NA

No

No

Not Available

Muktsar

In house

40

Yes

No

Not Available

SH Patiala

In house

40

Yes

Yes

Available

Sangrur

In house

70

Yes

No

Not Available

Taran Taran

In house

90

Yes

Yes

Not Available

SH Bhatinda

140

Study to Review

The Health Care Delivery System provided by PHSC, Punjab

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

Yes

Yes

Yes

No

Yes

Yes

Blood urea

Blood sugar

Liver function test

Lipid profile

PAP smear

FNAC

Blood Grouping and Matching test

Biopsy test

Culture and smear examination

Semen Examination

Vaginal discharge examination

Bone Marrow Examination

VDRL test

Other routine tests.

Yes

Complete Urine Examination

stool test

Yes

Complete Blood Haemogram Analysis

Amritsar

Yes

Yes

No

Yes

Yes

No

No

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Bhatinda

Table 1.3 Laboratory Tests

Yes

Yes

No

Yes

Yes

No

No

Yes

No

No

No

Yes

Yes

Yes

Yes

Yes

Yes

Ferozpur

Yes

Yes

Yes

Yes

Yes

No

No

Yes

Yes

No

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Gurdaspur

Yes

No

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Hoshiarpur

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Jalandhar

No

Yes

No

Yes

Yes

No

No

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Ludhiana

Name of the District

Yes

Yes

Yes

Yes

Yes

Yes

No

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Muktsar

Yes

Yes

No

Yes

Yes

No

No

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

SH Patiala

No

Yes

No

No

Yes

No

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Sangrur

No

Yes

No

Yes

Yes

Yes

No

Yes

Yes

No

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Taran Taran

Yes

Yes

No

Yes

Yes

No

No

Yes

No

Yes

No

Yes

Yes

Yes

Yes

Yes

No

SH Bhatinda

The Health Care Delivery System provided by PHSC, Punjab

Study to Review

141

Manual

No

No

No

No

Yes

Yes

Yes

Yes

No

Yes

Managed by clerk

Managed by MSW

Managed by staff nurse

Managed by computer operator

Knowledgeable about the OPD

Separate registration for male

Separate registration for female

Separate registration for senior citizens

Separate registration for staff

Registration registers are properly maintained and

Amritsar

Reception & Registration Counter (manual/ computerised)

Out Patient Department Ferozpur

Gurdaspur

Hoshiarpur

Jalandhar

Yes

No

Yes

Yes

Yes

Yes

Yes

No

No

No

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

No

No

Yes

No

No

Yes

Yes

Yes

Yes

No

No

No

Yes

No

Yes

No

No

Yes

Yes

No

No

No

Yes

No

Yes

Yes

Yes

Yes

Yes

No

No

No

Yes

No

Yes

No

No

Yes

No

No

No

No

Manual

Ludhiana

Name of the District

Computerised Computerised Computerised Computerised Computerised

Bhatinda

Table 1.4 Out Patient Department

No

No

No

No

No

Yes

Yes

No

No

Yes

Computerised

Muktsar

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

No

No

Computerised

SH Patiala

Yes

No

Yes

Yes

Yes

Yes

Yes

Yes

No

Yes

Computerised

Sangrur

Yes

No

No

Yes

Yes

Yes

Yes

No

No

No

Computerised

Taran Taran

Yes

No

No

No

No

Yes

No

No

No

No

11

2

8

8

8

12

9

1

10

2

3

(Contd...)

Manual

SH Bhatinda

Total

142

Study to Review

The Health Care Delivery System provided by PHSC, Punjab

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Waiting area is adequate

Proper sitting arrangement

Drinking water facility

Ceiling Fans

Toilet facility

Doctor’s Chambers are having adequate space

Examination table with proper sheet

Stool for the patient to sit

Examination equipments (like BP apparatus Torch, hammer, etc.)

Adequate illumination

Injection Room along with facilities and to deal with Emergency situation

Amritsar

All sections of the OPD having proper signage and directional sign

Out Patient Department

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Bhatinda

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Ferozpur

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Gurdaspur

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Hoshiarpur

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Jalandhar

No

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

Yes

Yes

Yes

Ludhiana

Name of the District

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Muktsar

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

SH Patiala

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

Sangrur

No

Yes

Yes

Yes

Yes

Yes

No

Yes

Yes

Yes

Yes

Yes

Taran Taran

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

10

12

12

12

12

12

11

12

11

12

12

10

(Contd...)

SH Bhatinda

Total

The Health Care Delivery System provided by PHSC, Punjab

Study to Review

143

Yes

Yes

No

Yes

Yes

Dispensaries / Pharmacy with separate counters for male/female/ senior citizen

Laboratory & Imaging Services easily accessible

Central Collection Centre for Laboratory Services

No

Yes

Bhatinda

Yes

Amritsar

Minor OT / Dressing Room with all the basic Equipments

Out Patient Department

Yes

Yes

Yes

Yes

Ferozpur

Yes

Yes

Yes

Yes

Gurdaspur

Yes

Yes

No

Yes

Hoshiarpur

Yes

Yes

No

Yes

Jalandhar

Yes

Yes

Yes

Yes

Ludhiana

Name of the District

Yes

Yes

No

Yes

Muktsar

Yes

Yes

Yes

Yes

SH Patiala

No

Yes

Yes

Yes

Sangrur

Yes

Yes

No

No

Taran Taran

Yes

Yes

Yes

Yes

SH Bhatinda

10

12

8

11

Total

144

Study to Review

The Health Care Delivery System provided by PHSC, Punjab

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes 3 4 2 0 Yes

Yes Yes

EMERGENCY MEDICAL SERVICES (CASUALTY) Separate Medical Officer(s) available round the clock

Board displaying on call doctors/specialist and other staff on duty

Glow sign board indicating ‘Emergency Services Department’

Emergency Ward attached to Emergency Department

Triage area

Observation Beds (fill number, for No fill 00)

Trolleys (fill number, for No fill 00)

Wheel chairs (fill number, for No fill 00)

Examination rooms (fill number, for No fill 00)

All the registers including MLR available for proper reg.

Retiring room with toilets for the doctors

Call book in prescribed format available

Yes

Yes

Yes

0

2

3

19

Yes

Yes

Bhatinda

Amritsar

Yes

Yes

Yes

1

1

3

3

Yes

Yes

Yes

Yes

Yes

Ferozpur

Yes

Yes

Yes

1

1

3

7

Yes

Yes

Yes

Yes

No

Gurdaspur

Table 1.5 Emergency Medical Services (Casualty)

Yes

Yes

Yes

2

4

5

10

Yes

Yes

Yes

Yes

Yes

Hoshiarpur

Yes

Yes

Yes

1

5

5

8

Yes

Yes

Yes

Yes

Yes

Jalandhar

Yes

Yes

Yes

1

2

2

4

No

Yes

No

Yes

Yes

Ludhiana

Name of the District

Yes

Yes

Yes

0

0

0

3

Yes

Yes

Yes

Yes

Yes

Muktsar

Yes

Yes

Yes

1

1

2

4

No

Yes

Yes

No

Yes

SH Patiala

No

Yes

Yes

1

2

2

5

Yes

Yes

No

No

No

Sangrur

No

Yes

Yes

1

2

3

3

No

Yes

No

Yes

Yes

Taran Taran

(Contd...)

Yes

Yes

Yes

2

1

2

6

Yes

Yes

No

Yes

No

SH Bhatinda

The Health Care Delivery System provided by PHSC, Punjab

Study to Review

145

Yes Yes Yes Yes

No No Yes

Yes

Radiology Services

Ambulance services

Staff trained in BLS

Treatment facilities for Dog/ snake bite & Poisoning

Availability of Disaster manual

Disaster Alert Code, recall & deployment

Maintenance of dedicated Drug store for disaster situation

Plaster Room

Yes

Sufficient stock of essential and life saving drugs

Yes

Yes

Major OT

Laboratory services

Yes

Treatment room-cumminor OT

Yes

Yes

Public telephone available

Oxygen cylinders with attachments

Yes

Waiting area for the attendants of the patients with the basic Facilities like sitting arrangements, drinking water, toilet etc.

Amritsar

Yes

Yes

No

No

Yes

Yes

Yes

Yes

No

Yes

Yes

Yes

Yes

No

Yes

Bhatinda

Yes

Yes

No

No

Yes

Yes

Yes

Yes

No

Yes

Yes

No

Yes

No

Yes

Ferozpur

Yes

No

No

No

Yes

Yes

Yes

Yes

Yes

Yes

No

Yes

Yes

Yes

Gurdaspur

No

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Hoshiarpur

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Jalandhar

No

Yes

No

No

No

Yes

Yes

Yes

Yes

Yes

Yes

No

Yes

No

Yes

Ludhiana

Name of the District

Yes

Yes

No

No

No

Yes

Yes

No

Yes

Yes

No

Yes

No

Yes

Muktsar

No

No

No

No

No

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

Yes

SH Patiala

Yes

Yes

No

No

Yes

Yes

Yes

Yes

No

Yes

Yes

Yes

Yes

No

Yes

Sangrur

No

No

No

No

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

Yes

No

No

Taran Taran

No

No

No

No

No

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

SH Bhatinda

146

Study to Review

The Health Care Delivery System provided by PHSC, Punjab

No NA NA NA NA NA

Intensive Care Unit (ICU)

Total number of beds available:

Air-conditioned ICU with generator support

Staff sanctioned for the ICUno. of doctors

Staff sanctioned for the ICUno. of nurses

Staff sanctioned for the ICUno. of technical staff

Amritsar

0

0

0

Yes

6

Yes

Bhatinda

Table 1.6 Intensive Care Unit (ICU)

NA

NA

NA

NA

NA

No

Ferozpur

0

3

2

Yes

6

Yes

Gurdaspur

NA

NA

NA

NA

NA

No

Hoshiarpur

0

0

0

Yes

10

Yes

Jalandhar

0

2

1

Yes

4

Yes

Ludhiana

Name of the District

NA

NA

NA

NA

NA

No

Muktsar

NA

NA

NA

NA

NA

No

SH Patiala

0

0

0

Yes

5

Yes

Sangrur

NA

NA

NA

NA

NA

No

Taran Taran

NA

NA

NA

NA

NA

No

SH Bhatinda

The Health Care Delivery System provided by PHSC, Punjab

Study to Review

147

Yes No No Yes Yes Yes Yes Yes Yes No

Qualified-Pathologist

Qualified-Biochemist

Qualified-Micro biologist

Following the Universal Precaution Procedures

Using Protective Measures i.e. gloves/gowns/masks

Specimen Collection done Centrally

Availability of all the Chemicals and Reagents

Observing all the Biosafety measures

Accuracy of the Reports

Regular Internal Quality Control Measures Undertaken Yes

Yes

Type of laboratoriesmicrobiology

Regular External Quality Control Measures Undertaken

Yes

Type of laboratoriespathology

Amritsar

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

No

Yes

Yes

Yes

Bhatinda

Table 1.7 Clinical Laboratories

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

No

No

No

No

Ferozpur

Yes

Yes

Yes

Yes

Yes

No

Yes

Yes

No

No

Yes

No

Yes

Gurdaspur

No

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

Yes

Yes

Yes

Yes

Hoshiarpur

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Jalandhar

Yes

No

Yes

Yes

Yes

Yes

Yes

Yes

No

Yes

Yes

Yes

Yes

Ludhiana

Name of the District

No

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

No

Yes

Yes

Yes

Muktsar

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

No

Yes

Yes

Yes

SH Patiala

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

No

Yes

Yes

Yes

Sangrur

No

No

No

Yes

Yes

Yes

Yes

Yes

No

No

Yes

Yes

Yes

Taran Taran

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

No

Yes

No

Yes

SH Bhatinda

148

Study to Review

The Health Care Delivery System provided by PHSC, Punjab

Yes Yes

NA

NA NA NA

NA

NA

Round the Clock Availability of Trained Staff and Services

Checking & Cross Matching by B.T.O.

Proper Maintenance of Cold Chain and Refrigerators

Australia antigen, HCV, VDRL, M.P. and HIV tests done for Every Blood Bottle of donor.

Efforts made to Collect Blood through Voluntary Organisation Camps

Renewal of Blood Bank/ HIV License as per Rules Yes

Yes

Yes

Yes

Yes

NA

Trained or Qualified Medical Officer Posted as B.T.O.

Yes

Bhatinda

No

Amritsar

BLOOD BANK (If No blood bank fill “8” for section E)

Amritsar

Table 1.8 Blood Banking Facilities

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Ferozpur

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Gurdaspur Hoshiarpur

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Jalandhar

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Ludhiana

Name of the District

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Muktsar

NA

NA

NA

NA

NA

NA

NA

No

SH Patiala

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Sangrur

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Taran Taran

NA

NA

NA

NA

NA

NA

NA

No

SH Bhatinda

The Health Care Delivery System provided by PHSC, Punjab

Study to Review

149

No

No No Yes Yes Yes

Use of Dosimeter and they Regularly sent to BARC

Special Investigation like IVP, Contrast Media etc.

Round the clock availability of X-ray services/ Sonography

Separate Register for MLC Records

Maintenance of History Book and Log book of X-ray Machines

Yes

No

Yes

No

Yes

Yes

Bhatinda

Availability of the Dark Room with all Facilities

Amritsar

Table 1.9 Radiology & Imaging

Yes

Yes

Yes

No

No

Yes

Ferozpur

Yes

No

Yes

Yes

No

Yes

Yes

Yes

Yes

Yes

No

Yes

Gurdas pur Hoshiarpur

Yes

Yes

Yes

Yes

No

Yes

Jalandhar

No

Yes

Yes

Yes

No

Yes

Ludhiana

Name of the District

Yes

Yes

Yes

Yes

Yes

Yes

Muktsar

Yes

No

No

Yes

No

Yes

SH Patiala

Yes

No

Yes

Yes

No

Yes

Sangrur

Yes

Yes

Yes

Yes

Yes

Yes

Taran Taran

No

No

No

No

Yes

Yes

SH Bhatinda

150

Study to Review

The Health Care Delivery System provided by PHSC, Punjab

Yes Yes

No Yes

No

Yes

Zoning concepts strictly followed

Emergency light or generator facilities provided to O.T.

Availability of fire fighting equipments and knowledge to use them

Regular disinfections & sterilisation procedures done at O.T.

Yes

No

1

1

No. of Operations Theatres- minor

3

4

Bhatinda

No. of Operations Theatres- major

Amritsar

Table 1.10 Operation Theatre

Yes

Yes

Yes

Yes

1

1

Ferozpur

Yes

No

Yes

No

1

2

Gurdaspur

Yes

Yes

Yes

Yes

1

3

Hoshiarpur

Yes

Yes

Yes

Yes

4

4

Jalandhar

Yes

Yes

Yes

Yes

1

3

Ludhiana

Name of the District

Yes

Yes

Yes

Yes

3

3

Muktsar

Yes

Yes

Yes

No

1

2

SH Patiala

Yes

Yes

Yes

No

1

1

Sangrur

Yes

Yes

Yes

Yes

1

1

Taran Taran

Yes

No

Yes

Yes

1

2

SH Bhatinda

The Health Care Delivery System provided by PHSC, Punjab

Study to Review

151

NA

Yes

if Yes, Analyse the Reason

Satisfactory up Keep of cots, mattresses, bedside lockers, linen

Available

No

Floor beds/doubling of beds in the wards

Availability and Functioning of Suction apparatus (Electric & Foot Operated)

Yes

All the beds are having proper & adequate linen

No

Yes

Adequate & Clean Toilets and Bathrooms

Use of Hospital Uniforms by all Patients

Yes Yes

Yes

Table top syringe & needle destroyer

Adequate water supply and up keep of sanitary blocks.

Yes

Colour codes of Yellow, Blue, Red, White bin & Blue transparent PPF for waste collection

Proper Utilisation

Yes

Satisfactory cleanliness of the wards with adequate house keeping

Amritsar

Table 1.11 In-patients Ward

Not Available

No

Yes

NA

No

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Bhatinda

Available

No

Yes

Rare cases of Gastro & Pead.

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Ferozpur

Available

No

No

NA

No

No

No

Yes

Yes

Yes

Yes

No

Available

No

Yes

NA

No

Yes

No

No

Yes

Yes

Yes

Yes

Gurdaspur Hoshiarpur

Available

No

Yes

NA

No

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Jalandhar

Available

No

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Ludhiana

Name of the District

Available

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Muktsar

Available

No

Yes

NA

No

Yes

Yes

Yes

Yes

Yes

Yes

Yes

SH Patiala

Available

No

No

NA

No

No

Yes

Yes

Yes

Yes

Yes

Yes

Sangrur

Available

No

Yes

NA

No

Yes

Yes

Yes

Yes

Yes

No

Yes

Taran Taran

(Contd...)

Not Available

No

No

NA

No

Yes

Yes

Yes

Yes

Yes

Yes

Yes

SH Bhatinda

152

Study to Review

The Health Care Delivery System provided by PHSC, Punjab

Available

Available

Functional Available

Functional Available

Functional Yes Yes Yes No No Yes

Availability and functioning of oxygen cylinder with accessories

If available (functional)

Availability and functioning of venesection tray, LP, tracheotomy tray.

If available (functional)

Availability and functioning of emergency light, wheel chair, trolley

If available (functional)

Stationeries, forms, upto date various registers etc.

Concept of progressive patient care

Adequacy and working of fans and lights

Satisfactory availability of diet,

Quality of care

Maintenance of various registers, records, etc.

Yes

Yes

No

Yes

Yes

Yes

Functional

Available

NA

Not Available

Functional

NA

Functional

Bhatinda

If available (Functional/ Not)

Amritsar

Yes

Yes

Own arrangement

Yes

Yes

Yes

Functional

Available

Functional

Available

Functional

Available

Functional

Ferozpur

Yes

No

Yes

Yes

Yes

Functional

Available

NA

Not Available

Functional

Available

Functional

Yes

Yes

Yes

Yes

Yes

Yes

Functional

Available

NA

Not Available

Functional

Available

Functional

Gurdaspur Hoshiarpur

Yes

Yes

No

Yes

Yes

Yes

Functional

Available

Functional

Available

Functional

Available

Functional

Jalandhar

Yes

Yes

No

Yes

No

Yes

Functional

Available

NA

Not Available

Functional

Available

Functional

Ludhiana

Name of the District

Yes

Yes

No

Yes

Yes

Yes

Functional

Available

Functional

Available

Functional

Available

Functional

Muktsar

Yes

Yes

No

Yes

Yes

No

Functional

Available

Functional

Available

Functional

Available

Functional

SH Patiala

Yes

Yes

No

Yes

Yes

No

Functional

Available

Functional

Available

Functional

Available

Functional

Sangrur

No

No

No

Yes

No

No

Functional

Available

NA

Not Available

Functional

Available

Not Functional

Taran Taran

Yes

Yes

Yes

Yes

Yes

Yes

Functional

Available

NA

Not Available

Functional

available

NA

SH Bhatinda

The Health Care Delivery System provided by PHSC, Punjab

Study to Review

153

No

A convenient arrangement of issuing drugs to various

Yes

Proper arrangements to keep the drugs as per ABC/VED category and storage of rubber goods as per guidelines Yes

No

Efforts made to redistribute large stock of slow moving drugs or near expiry for its utilisation.

Appropriate steps taken to prevent pilferage of

Yes

Yes

Inspection of stores by the Civil Surgeon / M.O. I/c at regular interval to verify stock books

Upkeep of expiry date register and its regular inspection by MO I/c

Yes

Staff knowledgeable in materials management

Yes

Yes

Restriction on entry for unauthorised personnel’s

Availability of Vital, essential drugs in sufficient Quantity

Yes

Medical store suitably located with adequate space and protection of drugs and nondrugs items from pilferage, temperature, humidity

Amritsar

Yes

Yes

No

Yes

Yes

Yes

Yes

No

Yes

Yes

Bhatinda

Table 1.12 Hospital Medical Stores

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Ferozpur

Yes

Yes

No

No

No

Yes

Yes

No

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Gurdaspur Hoshiarpur

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Jalandhar

Ludhiana

Name of the District

Yes

Yes

No

Yes

No

Yes

Yes

No

Yes

No

Muktsar

Yes

Yes

No

Yes

No

Yes

Yes

Yes

Yes

Yes

SH Patiala

Yes

Yes

No

No

No

No

No

No

Yes

Yes

Sangrur

Yes

No

No

Yes

No

Yes

Yes

No

Yes

Yes

Taran Taran

(Contd...)

Yes

Yes

No

Yes

No

Yes

Yes

Yes

Yes

No

SH Bhatinda

154

Study to Review

The Health Care Delivery System provided by PHSC, Punjab

Yes

Yes

Yes

No

No

No Yes

Circulation of lists of available drugs to all the MOs, OPD& wards as per generic names

Submission of certified bills to office for release of payments within three days.

Auction to clear the empty material from store done regularly.

Availability of Fire Fighting equipments and knowledge of staff to operate it

Availability of regularly updated Hospital Drug Formulary

Existence of standing Drug Committee

Yes

Yes

No

Yes

Yes

No

Bhatinda

Regular sending of samples to No chemical laboratory to check it as per specification and standard & action taken thereon

Amritsar

No

No

No

No

Yes

Yes

Yes

Ferozpur

No

No

No

No

No

Yes

No

Yes

No

Yes

Yes

Yes

Yes

Yes

Gurdaspur Hoshiarpur

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Jalandhar

Ludhiana

Name of the District

No

No

No

Yes

No

Yes

Yes

Muktsar

No

No

Yes

No

Yes

Yes

No

SH Patiala

No

No

No

Yes

No

Yes

No

Sangrur

Yes

No

Yes

No

No

Yes

No

Taran Taran

No

No

No

Yes

Yes

Yes

No

SH Bhatinda

The Health Care Delivery System provided by PHSC, Punjab

Study to Review

155

No No

Yes

Is the backup facility available to safeguard these records

What is the effective retrieval system followed by this hospital

Regular death audit meetings held & minutes of meeting Yes

7

For what duration all the records being maintained (In years)

Medical audit done at regular interval

Yes

No

Case record is maintained as per WHO classification of diseases (ICD-X)

Regular submission of the morbidity, mortality reports

Yes

No

Is it managed by a trained medical record officer / technician or

Yes

No

new & old crno., alpha index

No

15

Yes

No

No

No

Medical record

Yes

No

Bhatinda

Availability of Medical Record Room with enough number of racks

Amritsar

Table 1.13 Medical Record Department

Yes

Yes

As per admission No. & year wise

Yes

10

Yes

No

Yes

No

Yes

Ferozpur

No

No

Admission No., bundle of 100

No

10

Yes

No

No

No

Yes

Gurdas pur

Yes

Yes

Computer

Yes

5

Yes

Yes

Yes

Yes

Yes

pur

Hoshiar

Yes

No

No

No backup

5

Yes

Yes

No

No

Yes

Jalandhar

No

No

No

10

Yes

Yes

No

No

No

Ludhiana

Name of the District

Yes

No

No

Manual

14

Yes

No

Yes

No

Yes

Muktsar

Yes

Yes

Yes

Yes

10

Yes

No

Yes

No

No

SH Patiala

No

No

No

Yes

10

Yes

No

No

No

Yes

Sangrur

No

No

No

No

10

No

Yes

No

No

Taran Taran

No

No

No

No

5

Yes

Yes

Yes

No

Yes

SH Bhatinda

156

Study to Review

The Health Care Delivery System provided by PHSC, Punjab

Yes

Yes

Yes

No

Yes No No Yes

Segregation of different categories of wastes done at the

Collection of waste, packaging, labelling, record keeping done in scientific

Proper transportation of the waste so collected

Storage facilities and duration

Disposal/ recycling methods for various categories of

Whether waste disposal is outsourced

Yes

Yes

Yes

Yes

Yes

Yes

Are these placed strategically in all patient care areas

Yes

No

Bhatinda

Are the adequate number of bins and the bags of required

Amritsar

Name of the District

Yes

No

Yes

Yes

Yes

Yes

Yes

Yes

Ferozpur

Table 1.14 Hospital Waste Management

Yes

Yes

No

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Gurdaspur Hoshiarpur

Yes

No

No

Yes

Yes

Yes

Yes

Yes

Jalandhar

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Ludhiana

Yes

No

Yes

Yes

Yes

Yes

Yes

Yes

Muktsar

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

SH Patiala

No

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Sangrur

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Taran Taran

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

SH Bhatinda

The Health Care Delivery System provided by PHSC, Punjab

Study to Review

157

Yes Yes

Quality control measures are strictly followed -physical

Quality control measures are strictly followed- chemical Yes

Yes

Having all the required equipments & Autoclaves

Quality control measures are strictly followed- biological

Yes

Under the Supervision of a Trained Technical Staff/ Senior Nursing Officer

Amritsar

No

Yes

No

Yes

Yes

Bhatinda

Central Sterile Supply Department

Table 1.15 SUPPORT SERVICES

Yes

Yes

Yes

Yes

Yes

Ferozpur

No

No

No

No

Yes

Gurdaspur

Yes

Yes

Yes

Yes

Yes

Hoshiarpur

Yes

Yes

Yes

Yes

Yes

Jalandhar

Yes

Yes

Yes

Yes

Yes

Ludhiana

Name of the District

No

No

Yes

Yes

Yes

Muktsar

NA

NA

NA

NA

NA

SH Patiala

Yes

Yes

Yes

Yes

Yes

Sangrur

NA

NA

No

No

No

Taran Taran

Yes

Yes

Yes

Yes

Yes

SH Bhatinda

158

Study to Review

The Health Care Delivery System provided by PHSC, Punjab

Bhatinda

Ferozpur

Gurdaspur

Hoshiarpur

Jalandhar

Ludhiana

Name of the District Muktsar

SH Patiala

Sangrur

Good

Good

Quality of linen

Adequate

Good

Average

Adequate

Good

Good

Adequate

Average

Good

Adequate

Good

Good

Adequate

Good

Good

Adequate

Average

Average

Not Adequate

Good

Good

Not Adequate

Good

Good

Adequate

Average

Average

Not Adequate

Conventional Mechanised Conventional Mechanised Mechanised Mechanised Mechanised conventional Mechanised Conventional

Quality of wash

Laundry Services-staff (Adequate)

Laundry Services (Mechanised/ conventional)

Amritsar

Laundry Services

Good

Good

Adequate

Conventional

Taran Taran

Good

Good

Adequate

Mechanised

SH Bhatinda

The Health Care Delivery System provided by PHSC, Punjab

Study to Review

159

No

Diet service under the supervision of a qualified Dietician

No

Availability of modern cooking equipments No

No

Regular health check-up for food handlers

Availability of properly maintained records & registers

NA

No

Sanitation and hygiene of the cooking area properly maintained

NA

NA

NA

NA

NA

No

Measures for Pest & Rodent control

NA

Bhatinda

No

Amritsar

Proper & safe arrangement for storage of raw materials

Dietary Services

NA

NA

NA

NA

NA

NA

NA

Ferozpur

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

Gurdaspur Hoshiarpur

NA

NA

NA

NA

NA

NA

NA

Jalandhar

NA

NA

NA

NA

NA

NA

NA

Ludhiana

Name of the District

NA

NA

NA

NA

NA

NA

NA

Muktsar

NA

NA

NA

NA

NA

NA

NA

SH Patiala

NA

NA

NA

NA

NA

NA

NA

Sangrur

NA

NA

NA

NA

NA

NA

NA

Taran Taran

NA

NA

NA

NA

NA

NA

NA

SH Bhatinda

160

Study to Review

The Health Care Delivery System provided by PHSC, Punjab

Gurdaspur

Ferozpur

Batinda

Amritsar

Name of District Hospital

5290741 27951508 2179219 2840423 2908548 3074681 3275538

2007-08

Total

2003-04

2004-05

2005-06

2006-07

2007-08

17546397

6519411 NA 20497664

2006-07

2007-08

Total

3882273

5213162

2005-06 4482801

3365249

3229772

4889763

2004-05

2586302

3875328

14278409

3275538

3074681

4673865

2840423

2129219

6209016

5711847

2003-04

14278409

27480701

6162264

2006-07

Total

4718401

6313724

4323803

2005-06

6517634

5045995

3301463

2007-08

2004-05

3050132

2006-07

5138784

2741536

2005-06

2003-04

2374199

2004-05

13367515

1900185

2003-04

Total Expenditure

Total

Total Income (Collection)

Years

8155221

1712314

2061622

1610770

1480509

1290006

7444013

1312560

1186566

2908548

1162196

874143

11427634

1653431

2193207

2386983

2249330

2944683

Medicine

Table 1.16 User Charges in Different District Hospitals

3862220

761250

866236

659437

820269

754828

3104053

729201

659203

634350

645664

435635

6336837

943988

1485296

1310739

984908

1611906

I.F.P.

2114877

365905

666745

433148

440287

208792

1892732

437521

395522

380910

387398

291381

3353758

469782

345977

537007

241353

319306

Buildings

1155226

261018

275882

145677

297101

175548

1892732

437521

395522

380910

387398

291381

2868198

790272

1045958

471309

241353

319306

Equipment

Detailed Expenditure

-

-

1090029

446126

364511

279392

0000

0000

-

-

-

-

-

-

1687474

512474

636396

538604

ERF A/c

1068824

235660

247805

236625

191606

157128

1660196

358735

437868

369147

257767

236679

1806800

348454

502182

467205

488959

-

Salary to Contractual Staff

(Contd...)

100000

100000

0000

0000

0000

0000

-

-

-

-

-

-

-

-

-

-

-

-

Rogi Kalyan Samiti

The Health Care Delivery System provided by PHSC, Punjab

Study to Review

161

Muktsar

Ludhiana

Jalandhar

Hoshiarpur

Name of District Hospital

383355464

19006370

4544871 4811096 5024987 21285727

2005-06

2006-07

2007-08

Total

2007-08

2006-07

2005-06

2004-05

2003-04

Total

3864421

3803090

2004-05

3183321

4573092

3607862

3101683

2003-04

3777674

36213372

15416929

2007-08

Total

15858716

13499437

10724214

9630442

2006-07

2005-06

2004-05 9419098

6027980

5826166

Total

2003-04

6027980

Total Expenditure

5826166

Total Income (Collection)

2007-08

2006-07

2005-06

2004-05

2003-04

Years

12903927

2007813

1976830

3326884

2948549

2643851

16762858

6393457

5622143

4747258

2404437

2404437

Medicine

2700979

770511

349661

524630

334737

521440

7633236

3189803

2127532

2315901

1399160

1399160

I.F.P.

1617220

796861

237645

189417

58076

335221

2779065

1056121

755944

967000

611882

611882

Buildings

1211972

289236

419185

167830

205813

129908

2150858

1355608

460244

335006

527801

527801

Equipment

Detailed Expenditure

748332

33138

599608

115586

-

-

4941640

3234468

1194458

512714

619475

619475

ERF A/c

533254

4580

72068

248745

60687

147254

1945715

629259

563893

752563

465225

465225

Salary to Contractual Staff

(Contd...)

-

-

-

-

-

-

-

-

-

-

-

-

Rogi Kalyan Samiti

162

Study to Review

The Health Care Delivery System provided by PHSC, Punjab

Sp. Hospital Bhatinda

Taran Taran

Sangrur

Patiala (Sp. Hospital)

Name of District Hospital

5476548

2005-06

15773245

4054724 4687936 4454628 4745583 21131106

2004-05

2005-06

2006-07

2007-08

967836 4735382

1133336 1431652 1541913 1223898 6282595

2004-05

2005-06

2006-07

2007-08

Total

1160399

1062972

561907

951796

982268

3777499

3129318

2072265

2003-04

2003-08

Total

4782224

3188235

2003-04

2011939

18852183

11282776

3027748

2529041

1513687

4212300

Total Expenditure

Total

2007-08

6887658

457581

2006-07

6030396

2004-05

Total Income (Collection)

2003-04

Years

2226184

500471

581205

423376

216541

504591

-

-

-

-

-

-

4301206

1499017

1201486

796653

804050

Medicine

-

-

-

-

-

-

2942526

137009

88679

42819

2674019

Buildings

1130925

139788

199501

338376

230419

-

445485

70660

87269

156962

57573

-

564435

119039

162740

43467

57374

-

-

-

-

-

-

-

301059

115355

85397

47958

52349

Equipment

Not Available Due to Formation of New District

-

-

-

-

-

-

1594972

371009

489679

301086

433198

I.F.P.

Detailed Expenditure

-

342494

122744

118959

100791

-

-

-

-

-

-

-

-

820313

477461

342852

ERF A/c

25859

15134

10725

-

-

-

-

-

-

-

-

-

1322700

427897

320948

325171

248684

Salary to Contractual Staff

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

Rogi Kalyan Samiti

The Health Care Delivery System provided by PHSC, Punjab

Study to Review

163

6965 4543 4983 4689

10819 -

1 Yr

nd

No. of admissions through emergency

No. of Emergencies

6089

9885

4th Yr

7370 6496 3580 3328 3631 3461 4229

-

1 Yr

nd

3 Yr

th

5 Yr

th

4 Yr

rd

2 Yr

st

5 Yr

th

-

4 Yr

th

3 Yr

rd

2 Yr

st

5 Yr

th

7109

9438

9808

5271

4th Yr

3rd Yr

9045

4371

3rd Yr

3665

7053

3370

2nd Yr

2930

6293

2041

1st Yr

3567

220217

139137

5th Yr

1330

221187

125668

4th Yr

No. of Surgeries 1st Yr done 2nd Yr

193687

109836

3rd Yr

10657

178083

104203

7853

170936

68726

OPD attendance 1st Yr last 5 years 2nd Yr

5th Yr

Bhatinda

Amritsar

Performance (Annual)

1495

1525

2171

1610

1317

4735

3626

2735

3167

2596

9095

8234

8516

10113

11103

6340

6146

6072

6314

6805

104298

95306

88901

100355

112815

Ferozpur

5594

4925

4919

4822

4687

5973

5570

5396

4715

4621

6272

6325

6596

4177

3925

12004

11564

10713

9467

9184

176432

183196

160954

13404

115247

Gurdaspur

Table 1.17 Performance Report of District Hospital

6523

6989

6708

6905

-

15490

15083

13438

13022

-

10973

11494

12217

9214

-

12731

13219

13170

12476

10188

231386

242693

235353

215921

189243

Hoshiarpur

1891

6647

4596

-

-

2541

18073

13385

-

-

27245

29301

25081

-

-

5106

16054

12538

-

-

156827

222669

169891

-

-

Jalandhar

3039

4295

3275

-

-

-

-

-

-

-

13596

13304

13607

-

-

8366

10241

10249

-

-

156942

182811

176891

-

-

Ludhiana

Name of the District

1912

1902

1814

1514

1043

-

-

-

-

-

2944

4201

4403

3071

1708

3956

3881

4069

3149

3149

93713

134335

106841

95591

96961

Muktsar

5353 6241 5802

$ $

7140 2817 3419 3288 3924 5055

$ $ $ $ $ $

0

0

0

0

0

0

6422

$

0

0

0

0

8642 $

8223

8590

9072

5751

13051

12323

11492

10165

10165

174259

201481

158268

151743

143949

Sangrur

10619

8652

4201

3977

3355

11522

10495

8802

6093

6093

162518

188125

162196

148476

123171

SH Patiala

1922

2017

2015

2204

2016

3059

2614

2590

2579

2147

5181

5056

3845

2490

2114

4728

4868

4804

4491

4491

121578

126646

120134

112667

88942

Taran Taran

(Contd...)

1792

1176

977

941

345

1792

1176

977

941

345

3442

2033

2554

2197

859

5958

4906

4518

2361

2361

67955

62565

61725

54733

47753

SH Bhatinda

164

Study to Review

The Health Care Delivery System provided by PHSC, Punjab

1282 962 1575 1167 392 460 524 580 610 0* 0* 0* 0* 0* 0* 0* 0* 0* 0*

2737 2363 2593 2733 158 237 272 409 457 114 221 312 392 324

2nd Yr

3rd Yr

4th Yr

5th Yr

1st Yr

2nd Yr

3rd Yr

4th Yr

5th Yr

1st Yr

2nd Yr

3rd Yr

4th Yr

5th Yr

No of Caesarean 1st Yr done 2nd Yr

3rd Yr

4th Yr

5th Yr

367

291

269

308

255

317

296

520

310

268

184

158

180

233

173

1344

1343

1085

1010

1181

Ferozpur

653

463

483

514

414

615

577

567

595

578

270

279

223

203

186

701

741

721

654

544

Gurdaspur

376

387

460

350

-

554

742

781

577

-

375

293

258

294

-

896

951

670

612

-

Hoshiarpur

* All deliveries were conducted at Special hospital Bhatinda $ There was no regular emergency department. There were special hospitals for women and child.

No. of normal deliveries conducted

No. of post-mortum done

-

Bhatinda

1350

Amritsar

1st Yr

No. of medicolegal cases

Performance (Annual)

362

379

314

-

-

738

737

476

-

-

790

827

644

-

-

1605

1570

1998

-

-

Jalandhar

196

147

164

-

-

196

298

222

-

-

1703

1731

1492

1435

1439

14049

12168

10116

9734

9542

Ludhiana

Name of the District

31

40

49

21

30

301

265

185

76

60

-

-

-

-

-

908

903

666

701

561

Muktsar

580 909 815 123 104 85 110 192

0$ 0$ 0$ 0$ 0$ 0$ 0$ 0$

1409

1241

1123

852

571

3671

3268

2802

2452

470

519

531

714

530

1557

1177

1477

1457

1058

752

0$

1966

1016

Sangrur

0$

SH Patiala

101

137

230

162

205

92

152

234

259

258

95

91

201

190

186

509

535

421

192

-

Taran Taran

281

333

378

305

124

1014

811

558

610

331

0$

0$

0$

0$

0$

0$

0$

0$

0$

0$

SH Bhatinda

The Health Care Delivery System provided by PHSC, Punjab

Study to Review

165

35 -

Administrative In-position Staff Sanctioned -

9

-

Adhoc/con

Vacant

12

-

Vacant

-

-

4

16

-

26

-

Sanctioned

-

Adhoc

7

36

4

Vacant

33

15

-

12

5

1

6

1

-

1

-

-

-

Bhatinda

In-position

Technician

40

Sanctioned

-

Vacant

In-position

-

Sanctioned

Nursing Staff

25

In-position

Doctors Specialist

2

27

Sanctioned

Vacant

1

1

Vacant

In-position

2

Sanctioned

G.D.M.O.

Doctors

-

In-position

-

Vacant

S.M.O.

-

Sanctioned

M.S.

Amritsar

Position of Post

Name of Post

1

9

13

-

1

14

24

-

3

27

7

4

11

8

1

9

1

-

1

-

-

-

Ferozpur

Table 1.18 Staff Position of District Hospital

-

7

16

-

-

16

28

-

-

28

8

-

8

8

3

11

1

-

1

-

-

-

Gurdaspur

-

13

10

-

-

10

40

8

-

40

18

2

20

8

-

8

2

-

2

-

-

-

Hoshiarpur

2

20

40

-

4

44

100

-

10

110

34

-

34

42

2

44

4

-

4

1

-

1

Jalandhar

2

10

9

3 con.

-

9

38+11(*)

-

7

45

26

5

25

4

4

8

-

-

-

-

-

-

Ludhiana

3

13

-

1

1

-

-

-

Muktsar

-

2

1

-

2

3

8

-

3

11

-

-

-

10 (Adhoc-1)

Name of the District Hospital

-

1

4

-

-

4

46

-

8

54

27

2

29

4

-

4

2

-

2

1

-

1

SH Patiala

-

10

3

-

1

4

26

-

1

27

15

4

19

4

1

5

1

1

2

-

-

-

Sangrur

-

2

7

-

-

7

12

-

-

12

13

-

13

-

-

-

-

-

-

-

-

-

Taran Taran

(Contd...)

2

9

1

-

1

2

20

-

18

38

16

1

17

-

-

-

-

1

1

-

-

-

SH Bhatinda

166

Study to Review

The Health Care Delivery System provided by PHSC, Punjab

2 9

Sanctioned

Vacant

In-position

-

Vacant -

-

Sanctioned

In-position

-

Amritsar

In-position

Position of Post

* Placed on Deputation $ Gone on deputation to other districts/places

Others

Class-IV

Name of Post

6

3

9

69

2

71

9

Bhatinda

-

6

6

64

2

66

8

Ferozpur

6

-

6

48

19

67

7

Gurdaspur

-

-

-

80

-

80

13

Hoshiarpur

67

18

85

110

-

110

18

Jalandhar

-

10+4(*).

2

8

36+38($)

74

4+1 (*) +5($)

Ludhiana

Name of the District Hospital

5

2

7

32

-

32

2

Muktsar

27

11

38

79

22

101

1

SH Patiala

-

-

-

70

1

71

10

Sangrur

-

-

-

26

-

26

2

Taran Taran

4

3

7

29+6(*)

1

28

7

SH Bhatinda

The Health Care Delivery System provided by PHSC, Punjab

Study to Review

167

-

Diploma

-

M.D.

M.D.

M.D.

Dermatology

Psychiatric

-

MBBS

B.D.S.

MBBS

-

M.D.

Radiology

Dental

-

M.D.

Micro-Biology

-

-

M.D.

-

-

-

M.D.

M.D.

-

Diploma

Biochemistry

Pathology

Blood Bank

Anaesthesia

-

M.S

Ortho. -

M.D.

-

-

2

M.D.

M.D.

-

ENT

Opthamology

Paediatric

MBBS

2

M.D.

Gynaecologist & Obstetrician

2

M.S

2

M.D.

Amritsar

Surgery

Degree

Medicine

Name of Speciality

-

1

1

-

-

1

1

-

-

1

-

1

-

1

-

1

-

1

1

1

Bhatinda

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

1

2

1

Ferozpur

-

1

-

-

-

1

-

-

-

1

-

-

1

2

1

-

1

-

2

1

2

Gurdaspur

Table 1.19 Position of Specialist in District Hospital

-

3

2

-

1

1

-

1

-

2

1

2

2

2

2

-

2

-

2

3

5

Hoshiarpur

-

2

2

1

1

2

-

1

-

5

2

2

2

-

-

3

-

4

5

2

Jalandhar

-

1

1

-

-

1

-

1

-

3

-

2

2

3

-

3

-

3

3

1

Ludhiana

Name of the District Hospital

1

-

-

-

-

1

-

1

-

1

-

1

1

1

1

-

-

-

1

1

Muktsar

-

1

-

-

1

-

-

1

-

1

1

-

1

-

2

-

3

1

1

SH Patiala

-

1

-

-

-

1

-

1

-

1

-

1

1

1

1

-

2

-

1

2

2

Sangrur

-

1

1

-

-

-

-

-

-

1

1

1

1

1

1

-

1

-

1

1

1

Taran Taran

-

1

-

-

-

1

-

-

-

2

-

1

1

1

1

-

2

-

3

1

1

SH Bhatinda

The Health Care Delivery System provided by PHSC, Punjab

Three Available

Electricity-Phase

Electricity-Back up

Good Good Good Good

Good Average Average Good No Yes No No No Yes

• Cleanliness

• Sign posting

• Roads and light

• State of building

• Chemist

• Sulabh sauchalaya

• Canteen

• Grocery shops

• STD/PCO booth

• Other -cycle stand

No

Yes

Yes

Yes

Yes

No

Average

No

No

No

Yes

No

No

Good

Good

Good

Good

Good

Not Available Available

Poor

Available

Availability of ramp

Available

Three

Regular

1 day

Adequate

Bore well

Yes

Dasuya

Available

Double

Irregular supply

3 days

Adequate

Bore well

Yes

Fazilka

Available

Three

Irregular supply

3 days

Adequate

Bore well

Yes

Jagraon

Available

Three

Regular

3 days

Adequate

Municipal supply

Yes

Maler Kotla

No

Yes

No

Yes

Yes

Yes

Good

Good

Good

Good

Good

No

No

No

Yes

No

Yes

Good

Good

Good

Good

Poor

No

No

No

No

Yes

No

Good

Good

Average

Good

Good

Not Available Not Available Available

No

No

No

No

Yes

No

Good

Good

Good

Good

NA

Available

Available

Available

Three

Regular

3 days

Adequate

Municipal supply

Yes

Malout

Name of the Sub-Divisional Hospitals

Not Available Not Available Not Available Not Available Not Available

Available

Three

Irregular supply

1 day

Adequate

Bore well

Yes

Batala

• Up keep of garden

Not Available

Availability of lift

(Generator/UPS)

1 day Regular

Adequate

Water Supply

Electricity

Bore well

Water Supply

Water Supply

Yes

Ajnala

Accessibility to Railway/Bus Station

General Profile of Hospitals

Table 2.1 General Profile & Facility Survey of Sub-Divisional Hospitals

General Impression

Study to Review

Any public utility service available in hospital premises

168 Three

Regular

3 days

Adequate

Bore well

Yes

Patti

Available

Three

Irregular supply

3 days

Adequate

Municipal supply

Yes

Talwandi

No

No

No

No

No

Yes

Good

Good

Good

Good

Good

No

No

No

Yes

No

No

Average

Average

Average

Average

Average

Not Available Available

(Contd...)

No

No

No

No

No

No

Average

Good

Average

Average

Average

Available

Not Available Not Available Not Available

Not Available Available

Three

Regular

3 days

Adequate

Bore well

Yes

Nakodar

The Health Care Delivery System provided by PHSC, Punjab

Study to Review

169

No Yes

Hospital Infection Control Committee.

Store Purchase Committee

Yes

No

Hospital Antibiotic committee

Is the drug formulary available

No

Drug formulary committee

Yes

No

Mortuary services with cold storage & other preservative facilities available.

Yes

Yes

Facilities for Post-mortem

Medical Audit/ Death Review Committee

Yes

Delivery Services

Store verification Committee

Yes

Round the clock

Emergency Services

Dental Services

2

ICU no. of beds

2

Major General

1

Minor

1

No

No

Yes

Yes

Yes

No

No

Yes

Yes

Yes

Yes

Round the clock

5

General

2

1

2

Fully Equipped

Available

Available Partially Equipped

Batala

Ajnala

ICU types

No. of operation theatres

Total number of vehicles

Ambulance Services

General Profile of Hospitals

Yes

Yes

Yes

Yes

No

No

No

Yes

Yes

Yes

Yes

Round the clock

NA

No

3

1

3

Partially Equipped

Available

Dasuya

No

No

No

Yes

No

No

No

Yes

No

Yes

No

Round the clock

NIL

General

1

1

2

Fully Equipped

Available

Fazilka

Yes

No

Yes

Yes

No

No

No

No

Yes

Yes

Yes

Round the clock

NA

No

2

1

2

Partially Equipped

Available

Jagraon

No

No

No

No

No

No

No

Yes

Yes

Yes

Yes

Round the clock

NA

No

2

1

2

Fully Equipped

Available

Maler Kotla

Yes

Yes

Yes

Yes

No

No

No

Yes

Yes

Yes

Yes

Round the clock

NA

No

1

2

2

Partially Equipped

Available

Malout

Name of the Sub-Divisional Hospitals

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Round the clock

NA

No

2

2

2

Partially Equipped

Available

Nakodar

No

Yes

Yes

Yes

Yes

No

Yes

Yes

Yes

Yes

Yes

Round the clock

4

General

1

1

2

Partially Equipped

Available

Patti

(Contd...)

No

No

Yes

Yes

No

No

No

No

No

Yes

Yes

Round the clock

6

General

2

1

3

Partially Equipped

Available

Talwandi

170

Study to Review

The Health Care Delivery System provided by PHSC, Punjab

Average

No

Annual maintenance procedure for costly Equipments

Present status/situations of the existing Equipments:

Yes

Reorder level maintained

Yes

No

Is buffer stock maintained

Log book/ History sheet maintained for the Equipments

Push

Ajnala

System of supply of drug items through

General Profile of Hospitals

Good

Yes

Yes

No

Yes

Pull

Batala

Good

Yes

Yes

Yes

Yes

Push

Dasuya

Average

No

Yes

No

Yes

Pull

Fazilka

Average

Yes

Yes

Yes

Yes

Push

Jagraon

Average

No

Yes

No

Yes

Push

Maler Kotla

Good

Yes

Yes

No

Yes

Pull & Push

Malout

Name of the Sub-Divisional Hospitals

Average

Yes

Yes

Yes

Yes

Pull

Nakodar

Average

No

No

No

No

Push

Patti

Average

Yes

Yes

No

Yes

Push

Talwandi

The Health Care Delivery System provided by PHSC, Punjab

Study to Review

171

Photo Therapy Unit

Perimeter

Ophthalmoscopes

Endoscope (fiber optic)

Emergency Resuscitation Kit

ECG

Dosimeter

Dental Chair

Cardiac Monitor

Boyles Apparatus

Baby Incubators

Functional Yes

Functional Yes

Yes Functional

Functional

Yes

Yes

Yes

NA

NA

NA

No

No

NA

Functional

Functional

No

Yes

Yes

No

Functional

Functional

Functional

Yes

Yes

Functional

NA

No

Functional

NA

No

Non Functional

Yes

Yes

Yes

Yes

Functional

Functional

Functional

Yes

Yes

Non Functional

Batala

Ajnala

Table 2.2 Availability of equipment

Functional

Yes

NA

No

Functional

Yes

NA

No

Functional

Yes

Functional

Yes

NA

No

Functional

Yes

Functional

No

Functional

Yes

Functional

Yes

Dasuya

Functional

Yes

NA

No

Functional

Yes

NA

No

Functional

Yes

NA

No

NA

No

Non Functional

Yes

Non Functional

Yes

Non Functional

Yes

Non Functional

Yes

Fazilka

NA

No

NA

No

Functional

Yes

NA

No

Functional

Yes

Functional

Yes

NA

No

Functional

Yes

NA

No

Functional

Yes

NA

No

Jagraon

NA

No

Functional

Yes

Functional

Yes

NA

No

Functional

Yes

Functional

Yes

Non Functional

Yes

Functional

Yes

Functional

Yes

Functional

Yes

Functional

Yes

Maler Kotla

Yes

NA

No

Malout

NA

No

NA

No

NA

No

NA

No

Functional

Yes

Functional

Yes

Functional

Yes

Functional

Yes

Functional

Yes

Functional

Name of the Sub-Divisional Hospitals

Functional

Yes

NA

No

Functional

Yes

NA

No

Functional

Yes

Functional

Yes

NA

No

Functional

Yes

Functional

Yes

Functional

Yes

Functional

Yes

Nakodar

NA

No

NA

No

Functional

Yes

NA

No

Functional

Yes

Functional

Yes

NA

No

Functional

Yes

Functional

Yes

Functional

Yes

NA

No

Patti

(Contd...)

NA

No

NA

No

Functional

Yes

NA

No

Functional

Yes

Functional

Yes

NA

No

Functional

Yes

Functional

Yes

Functional

Yes

NA

No

Talwandi

172

Study to Review

The Health Care Delivery System provided by PHSC, Punjab

Other Major and Minor Operation equipments

X ray

Ultra sound

Slit lamp

Sigmoidoscopes

Short Wave Diathermy (Physio therapy)

Retinoscope

Functional

Yes

Yes

Functional

Functional

NA

Yes

Yes

No

Yes

Non Functional

NA

Functional

Yes

No

Functional

NA

NA

Yes

No

No

Yes

Functional

NA

Functional

Yes

No

Functional

Batala

Ajnala

Functional

Yes

Functional

Yes

Functional

Yes

NA

No

NA

No

NA

No

Functional

Yes

Dasuya

Functional

Yes

Functional

Yes

Functional

Yes

Functional

Yes

NA

No

Functional

Yes

Functional

Functional

Fazilka

Functional

Yes

Functional

Yes

Functional

Yes

NA

No

NA

No

NA

No

NA

No

Jagraon

Functional

Yes

Functional

Yes

Functional

Yes

Functional

Yes

NA

No

NA

No

Functional

Yes

Maler Kotla

Yes

NA

No

NA

No

Malout

Functional

Yes

Functional

Yes

Functional

Yes

Non Functional

No

Non Functional

Name of the Sub-Divisional Hospitals

Functional

Yes

Functional

Yes

Functional

Yes

Functional

Yes

NA

No

Functional

Yes

NA

No

Nakodar

Functional

Yes

Functional

Yes

Non Functional

Yes

Functional

Yes

NA

No

NA

No

Functional

Yes

Patti

Functional

Yes

Functional

Yes

NA

No

NA

No

NA

No

NA

No

NA

No

Talwandi

The Health Care Delivery System provided by PHSC, Punjab

Study to Review

173

No Yes Yes No No No No Yes No No Yes No No Yes

Stool test

Blood urea

Blood sugar

Liver function test

Lipid profile

PAP smear

FNAC

Blood Grouping and Matching test

Biopsy test

Culture and smear examination

Semen Examination

Vaginal discharge examination

Bone Marrow Examination

VDRL test Yes

Yes

Complete Urine Examination

Other routine tests. HIV/Pregnancy Test

Yes

Ajnala

Complete Blood Haemogram Analysis

Laboratory Tests

Yes

Yes

Yes

No

Yes

No

No

Yes

No

No

No

Yes

Yes

Yes

Yes

Yes

No

Batala

No

Yes

No

No

Yes

No

No

Yes

No

No

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Dasuya

Yes

Yes

No

No

Yes

No

No

Yes

Yes

No

Yes

No

Yes

Yes

Yes

Yes

Yes

Fazilka

Yes

Yes

No

No

Yes

No

No

Yes

No

No

No

No

Yes

Yes

Yes

Yes

Yes

Jagraon

No

Yes

No

Yes

Yes

No

No

Yes

No

No

No

Yes

Yes

Yes

Yes

Yes

Yes

Maler Kotla

Name of the Sub-Divisional Hospitals

Table 2.3 Laboratory Facilities Available at Sub-Divisional Hospitals

Yes

Yes

No

No

Yes

No

No

Yes

No

No

No

No

Yes

Yes

Yes

Yes

Yes

Malout

No

Yes

No

Yes

Yes

Yes

No

Yes

No

No

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Nakodar

No

Yes

No

No

No

No

No

Yes

No

No

No

No

No

No

Yes

Yes

No

Patti

(Contd...)

Yes

Yes

No

No

No

No

No

Yes

No

No

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Talwandi

174

Study to Review

The Health Care Delivery System provided by PHSC, Punjab

Medical College

Yes Yes No No Yes Yes No NA Government. Hospitals No

None

Guidelines-When to refer

Guidelines- How to refer

Colour coded referral cards available

Feed-back Mechanism existing:

Transport facility provided:

Maintenance of records/ registers

Incentive for following referral route

if Yes what

Procedure followed for referral:

Tie-up with other hospital (both public and private) for diagnostic

If Yes, what services are provided

Does the Hospital have any Outreach Area

Hospital has a tie-up with:

No

Yes

Guidelines for- What to refer

No NA

No NA

Government. Hospitals

NA

No

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Referral manual available

Yes

Batala

Yes

Ajnala

Any Referral System in place

Laboratory Tests

NA

No

None

No

Distt. Hospitals

NA

No

Yes

Yes

No

No

Yes

No

No

Yes

Yes

Dasuya

Eye camp, IEC

Yes

Medical College

Yes

Medical College

Ambulance Provided

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Fazilka

Eye camp

MCH,

Yes

Medical College

Yes

Government. Hospitals

NA

No

Yes

Yes

No

No

Yes

Yes

Yes

Yes

Yes

Jagraon

Eye camp

Blood Coll. Camp,

Yes

Other Government. Hospitals

No

Government. Hospitals

NA

No

Yes

Yes

Yes

No

No

No

No

No

Yes

Maler Kotla

Malout

NA

No

None

No

Distt. Hospitals

NA

No

Yes

Yes

No

No

NA

NA

NA

No

Yes

Name of the Sub-Divisional Hospitals

NA

No

None

Yes

None

No Waiting For Patient

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Nakodar

NA

No

Medical College

Yes

Government. Hospitals

NA

No

Yes

Yes

No

Yes

NA

NA

NA

No

Yes

Patti

(Contd...)

MCH

Yes

Other Government. Hospitals

Yes

None

NA

No

No

Yes

No

Yes

No

No

No

No

Yes

Talwandi

The Health Care Delivery System provided by PHSC, Punjab

Study to Review

175

Yes

No

NA No

Availability of residential accommodation for the essential staff

If available, What % is not Getting Accommodation

Security Arrangement:

NA

00

No

NA

Monthly No

No

Yes

Ajnala

Availability of Dharamshala

Statistical Bulletin

Laboratory Tests Batala

In house

90%

Yes

No

NA

No

Dasuya

In house

25%

Yes

No

Fortnightly

Yes

Fazilka

No

NA

No

No

NA

No

Jagraon

In house

70%

Yes

No

Fortnightly

Yes

Maler Kotla

Malout

No

25%

Yes

No

NA

No

Name of the Sub-Divisional Hospitals

No

`25%

Yes

No

Monthly

Yes

Nakodar

In house

50%

Yes

No

NA

No

Patti

No

65%

Yes

No

NA

No

Talwandi

176

Study to Review

The Health Care Delivery System provided by PHSC, Punjab

No Yes No No Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes

Managed by MSW

Managed by staff nurse

Managed by computer operator

Knowledgeable about the OPD

Separate registration for male

Separate registration for female

Separate registration for senior citizens

Separate registration for staff

registration registers are properly maintained

All sections of the OPD having proper signage and directional sign

Waiting area is adequate

Proper sitting arrangement

Drinking water facility

Ceiling Fans

Toilet facility

Doctor’s Chambers are having adequate space

Examination table with proper sheet

Stool for the patient to sit

Examination equipments (like BP apparatus Torch, hammer, etc.)

Manual

Ajnala

Managed by clerk

Reception & Registration Counter

Out Patient Department Dasuya

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

No

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

No

No

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

Yes

No

No

Yes

Yes

No

No

No

Computerised Computerised

Batala

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

No

No

No

Yes

No

No

Yes

Yes

Manual

Fazilka

Yes

Yes

No

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

No

No

No

Yes

No

No

Yes

Yes

Manual

Jagraon

Malout

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

No

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

No

Yes

No

No

No

No

No

Yes

Yes

No

No

No

Computerised Computerised

Maler Kotla

Name of the Sub-Divisional Hospitals

Table 2.4 Out Patient Department at Sub-Divisional Hospitals

Yes

Yes

Yes

Yes

No

Yes

Yes

No

No

Yes

Yes

No

No

No

No

Yes

Yes

No

No

No

Manual

Nakodar

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

Yes

Yes

Yes

No

No

No

No

Yes

No

No

No

Yes

Manual

Patti

(Contd...)

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

No

Yes

Yes

No

No

No

No

Yes

No

No

No

No

Manual

Talwandi

The Health Care Delivery System provided by PHSC, Punjab

Study to Review

177

Yes Yes Yes No Yes Yes

Injection Room along with facilities and to deal with Emergency situation

Minor OT/ Dressing Room with all the basic Equipments

Dispensaries/ Pharmacy with separate counters for male/female/senior citizen

Laboratory & Imaging Services easily accessible

Central Collection Centre for Laboratory Services

Ajnala

Adequate Illumination

Out Patient Department

Yes

Yes

Yes

Yes

Yes

Yes

Batala

Yes

Yes

Yes

Yes

Yes

Yes

Dasuya

Yes

Yes

No

Yes

Yes

Yes

Fazilka

Yes

Yes

No

Yes

Yes

Yes

Jagraon

No

Yes

No

Yes

No

Yes

Maler Kotla

Yes

Yes

Yes

Yes

Yes

Yes

Malout

Name of the Sub-Divisional Hospitals

Yes

Yes

Yes

Yes

Yes

Yes

Nakodar

Yes

Yes

No

No

No

Yes

Patti

Yes

Yes

Yes

No

Yes

Yes

Talwandi

178

Study to Review

The Health Care Delivery System provided by PHSC, Punjab

Yes Yes No No Yes 02 4 04 01 Yes Yes No Yes

No Yes

Separate Medical Officer(s) available round the clock

Board displaying on call doctors/ specialist and other staff on duty

Glow sign board indicating ‘Emergency Services Department’

Emergency Ward attached to Emergency Department

Triage area

Observation Beds (fill number, for No fill 00)

Trolleys (fill number, for No fill 00)

Wheel chairs (fill number, for No fill 00)

Examination rooms (fill number, for No fill 00)

All the Registers including MLR available for Proper Reg.

Retiring room with toilets for the doctors

Call book in prescribed format available

Waiting area for the attendants of the patients with the basic Facilities like sitting arrangements, drinking water, toilet etc.

Public telephone available

Treatment room-cum-minor OT

Ajnala

Yes

Yes

No

Yes

Yes

Yes

01

01

2

04

No

Yes

Yes

Yes

No

Batala

Yes

No

Yes

Yes

Yes

Yes

01

02

2

12

Yes

Yes

Yes

Yes

Yes

Dasuya

Yes

Yes

Yes

No

Yes

Yes

02

03

4

04

Yes

Yes

Yes

Yes

Yes

Fazilka

Yes

No

Yes

Yes

Yes

Yes

01

01

1

03

Yes

Yes

Yes

Yes

Yes

Jagraon

Yes

No

Yes

No

Yes

Yes

01

03

2

04

No

Yes

No

No

Yes

Maler Kotla

Yes

No

Yes

No

No

Yes

01

02

4

07

Yes

Yes

No

Yes

No

Malout

Name of the Sub-Divisional Hospitals

Table 2.5 Emergency Medical Services (Casualty) at Sub-Divisional Hospitals

Yes

No

Yes

Yes

Yes

Yes

01

02

2

05

Yes

Yes

Yes

Yes

Yes

Nakodar

Yes

No

No

No

Yes

Yes

01

00

1

01

No

Yes

No

Yes

No

Patti

(Contd...)

Yes

No

No

No

Yes

Yes

02

01

1

06

No

Yes

No

No

Yes

Talwandi

The Health Care Delivery System provided by PHSC, Punjab

Study to Review

179

Yes No Yes Yes Yes Yes Yes Yes No No No Yes

Major OT

Sufficient stock of Essential and Life Saving Drugs

Oxygen Cylinders with Attachments

Laboratory Services

Radiology Services

Ambulance Services

Staff Trained in BLS

Treatment Facilities for Dog/Snake Bite & Poisoning

Availability of Disaster Manual

Disaster Alert Code, Recall & Deployment

Maintenance of Dedicated Drug store for Disaster Situation

Plaster Room

Ajnala

Yes

Yes

No

No

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

Batala

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

Dasuya

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Fazilka

No

Yes

No

No

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

Jagraon

Yes

No

No

No

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Maler Kotla

No

Yes

Yes

No

Yes

No

Yes

Yes

Yes

Yes

Yes

Yes

Malout

Name of the Sub-Divisional Hospitals

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Nakodar

No

No

No

No

No

Yes

Yes

Yes

Yes

Yes

Yes

No

Patti

No

Yes

No

No

No

No

Yes

Yes

Yes

Yes

Yes

No

Talwandi

180

Study to Review

The Health Care Delivery System provided by PHSC, Punjab

Yes 02 No 01 01 01 01 Yes Yes No No No No No

Availability of ICU

Total number of beds available:

Air-conditioned ICU with Generator Support

Staff sanctioned for the ICU- no. of Doctors

Staff sanctioned for the ICU- no. of Nurses

Staff Sanctioned for the ICU- no. of Technical Staff

Staff sanctioned for the ICU- no. of Class IV

Record Keeping of the Patients

Availability of oxygen/ suction apparatus/ compressed air

Defibrillator

ECG machine

Ventilator

All the life saving Vital drugs

Strict aseptic procedures are followed

Ajnala

Yes

Yes

No

Yes

No

Yes

No

00

00

00

00

No

05

Yes

Batala

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

No

Dasuya

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

No

Fazilka

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

No

Jagraon

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

No

Maler Kotla

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

No

Malout

Name of the Sub-Divisional Hospitals

Table 2.6 Intensive Care Unit at Sub-Divisional Hospitals

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

No

Nakodar

No

No

No

No

No

No

No

00

00

00

00

No

04

Yes

Patti

No

Yes

No

No

No

Yes

00

00

00

00

00

No

06

Yes

Talwandi

The Health Care Delivery System provided by PHSC, Punjab

Study to Review

181

No No

Regular External Quality Control Measures Undertaken

Yes

Specimen Collection done Centrally

Regular Internal Quality Control Measures Undertaken

Yes

Using Protective Measures i.e. gloves/ gowns/masks

Yes

No

Following the Universal Precaution Procedures

Accuracy of Reports

No

Qualified- Micro Biologist

No

No

Qualified- Biochemist

Observing all the bio-safety measures

No

Qualified- Pathologist

No

Yes

Type of Laboratories- Microbiology

Availability of all the Chemicals and Reagents

Yes

Ajnala

Type of Laboratories- Pathology

Clinical Laboratories

Yes

Yes

Yes

Yes

Yes

Yes

No

Yes

No

No

Yes

No

Yes

Batala

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

No

No

No

No

Dasuya

No

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

No

Yes

No

Yes

Yes

No

Yes

Yes

Yes

Yes

No

No

No

No

No

Yes

No

Jagraon

Yes

Yes

Yes

No

Yes

Yes

Yes

Yes

No

No

No

Yes

No

Maler Kotla

Yes

No

Yes

Yes

Yes

Yes

No

No

No

No

No

No

No

Malout

Name of the Sub-Divisional Hospitals Fazilka

Table 2.7 Clinical Laboratories at Sub-Divisional Hospitals

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

Yes

Yes

Yes

Nakodar

No

No

No

Yes

Yes

Yes

Yes

Yes

No

No

No

No

No

Patti

Yes

No

Yes

Yes

Yes

Yes

No

No

No

No

No

Yes

Yes

Talwandi

182

Study to Review

The Health Care Delivery System provided by PHSC, Punjab

No NA NA NA NA NA

NA NA NA NA NA

BLOOD BANK (If No blood bank fill “8” for section E)

Trained or qualified medical officer posted as B.T.O.

Round the clock availability of trained staff and services

Checking & cross matching by B.T.O.

Proper maintenance of cold chain and refrigerators

Australia antigen, HCV, VDRL, M.P. and HIV tests done for Every blood bottle of donor.

Efforts made to collect blood through Voluntary Organisation Camps

Renewal of blood bank/HIV License as per Rules

Disposal of HIV Positive Blood Bags & bio-safety measures undertaken

Availability of Table Top Syringe & needle destroyer and Colour Coded Bags

Feedback of Transfusion, and Record maintenance of untoward incidences

Ajnala

Table 2.8 Blood Banking Facilities

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Batala

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Dasuya

No

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Fazilka

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

Jagraon

Yes

Yes

Yes

Yes

No

Yes

Yes

Yes

No

No

Yes

Maler Kotla

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

Malout

Name of the Sub-Divisional Hospitals

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Nakodar

No

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

Yes

Patti

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

Talwandi

The Health Care Delivery System provided by PHSC, Punjab

Study to Review

183

1 1

X-ray Machines Mobile / 60 mA Working Condition

0

X-ray Machines 200/100 mA Under Repairs

X-ray Machines Mobile / 60 mA Total No. Available

1

X-ray Machines 200/100 mA Working Condition

0

1

X-ray Machines 200/100 mA Total No. Available

X-ray Machines 200 / 100 mA Pending for Condemnation

0

1

X-ray Machines 500/300 mA Total No. Available

X-ray Machines 500/300 mA Pending for Condemnation

0

X-ray Machines Mobile C-arm Pending for Condemnation

0

0

X-ray Machines Mobile C-arm Under Repairs

X-ray Machines 500/300 mA Under Repairs

0

X-ray Machines Mobile C-arm Working Condition

1

0

X-ray Machines Mobile C-arm- Total No. Available

X-ray Machines 500/300 mA Working

No

Radiologist available

Ajnala

1

1

0

0

0

0

0

0

0

1

0

0

0

0

No

Batala

0

0

0

0

0

0

0

0

0

2

0

0

0

1

No

Dasuya

1

1

0

0

1

1

0

0

1

1

0

0

1

1

No

Fazilka

1

1

0

0

0

0

0

0

1

1

0

0

1

1

Yes

Jagraon

1

1

0

0

0

0

0

0

2

2

0

0

0

0

No

Maler Kotla

1

1

1

0

0

1

0

0

1

1

0

0

0

0

No

Malout

Name of the Sub-Divisional Hospitals

Table 2.9 Radiology and Imaging Services at Sub-Divisional Hospitals

0

0

0

0

0

0

0

0

1

1

0

0

1

1

Yes

Nakodar

0

0

1

0

0

1

0

0

0

0

0

0

1

1

No

Patti

(Contd...)

0

0

0

0

2

2

0

0

1

1

0

0

0

0

No

Talwandi

184

Study to Review

The Health Care Delivery System provided by PHSC, Punjab

0 0 Yes No No No Yes

X-ray Machines Mobile / 60 mA Under Repairs

X-ray Machines Mobile / 60 mA Pending for Condemnation

Availability of the dark room with all facilities

Use of dosimeter and they regularly sent to BARC

Special investigations like IVP, contrast media etc.

Round the clock availability of X-ray services/Sonography

Separate register for MLC records

Ajnala

Yes

Yes

No

No

Yes

0

0

Batala

Yes

No

Yes

No

Yes

0

0

Dasuya

Yes

Yes

Yes

No

Yes

0

0

Fazilka

Yes

Yes

Yes

No

Yes

0

0

Jagraon

Yes

No

Yes

Yes

Yes

0

0

Maler Kotla

Yes

Yes

No

Yes

Yes

0

0

Malout

Name of the Sub-Divisional Hospitals

Yes

Yes

No

No

Yes

0

0

Nakodar

Yes

No

No

No

Yes

0

0

Patti

Yes

Yes

No

No

Yes

0

0

Talwandi

The Health Care Delivery System provided by PHSC, Punjab

Study to Review

185

2 1 No 2 0 0 4 2

2 1 No 1 0 1 2 0

Major

Minor

Total No. Available

Under Repair

Pending for Condemnation

Total No. Available

Under Repairs

2 0 0 0 NA NA 2 0 0

1 0 0 1 0 0 3 0 0 2 0 0

Total No. Available

Under Repairs

Pending for Condemnation

Total No. Available

Under Repairs

Pending for Condemnation

Total No. Available

Under Repairs

Pending for Condemnation

Total No. Available

Under Repairs

Pending for Condemnation

0

0

2

0

0

Pending for Condemnation

Zoning concepts strictly followed

No. of Operation Theatres

Batala

Ajnala

0

0

6

0

0

2

0

0

1

0

0

3

0

0

2

0

0

3

Yes

1

3

Dasuya

0

0

1

0

0

2

0

0

1

0

1

2

0

0

1

0

1

2

Yes

1

1

0

0

3

0

0

3

0

1

2

0

0

2

0

0

2

0

0

1

Yes

0

2

Jagraon

0

0

1

0

0

2

0

0

1

0

1

2

0

1

2

0

0

1

No

1

2

Maler Kotla

0

0

2

0

0

1

0

0

0

0

0

1

1

2

2

0

1

1

Yes

1

1

Malout

Name of the Sub-Divisional Hospitals Fazilka

Table 2.10 Operation Theatres At Sub-Divisional Hospitals

Boyles Apparatus

Hydraulic Operation Table

Shadow less lamp

Fumigation apparatus

Suction Apparatus

Air conditioner

0

0

3

0

0

6

0

0

0

0

0

4

0

0

2

0

0

2

Yes

2

2

Nakodar

0

0

2

0

1

2

0

0

0

0

0

2

0

0

2

0

0

1

No

1

1

Patti

(Contd...)

0

0

3

0

0

3

0

0

1

0

0

2

0

0

3

0

0

1

Yes

1

2

Talwandi

The Health Care Delivery System provided by PHSC, Punjab

Electric cautery

Endoscope

Laparoscope

Cardiac monitor

Cardiac defibrillators

Pulse oxymeter

Study to Review

Portable mobile x ray machine

186 1 1 0 0 0 0 0 0 0 0 1 0 1 0 0 1 0 0 1 0 0

Total No. Available

Under Repairs

Pending for Condemnation

Total No. Available

Under Repairs

Pending for Condemnation

Total No. Available

Under Repairs

Pending for Condemnation

Total No. Available

Under Repairs

Pending for Condemnation

Total No. Available

Under Repairs

Pending for Condemnation

Total No. Available

Under Repairs

Pending for Condemnation

Total No. Available

Under Repairs

Pending for Condemnation

Ajnala

0

0

0

0

1

2

0

0

0

0

0

1

0

0

1

0

0

0

0

1

1

Batala

0

0

1

0

0

2

0

0

0

0

0

0

0

0

1

0

0

0

0

0

1

Dasuya

0

0

1

0

0

1

0

0

0

0

0

1

0

0

1

0

0

1

0

0

1

Fazilka

0

0

1

0

1

1

0

0

0

0

0

1

0

0

0

0

0

0

0

1

2

Jagraon

0

0

3

0

0

0

0

0

0

0

0

1

0

0

1

0

0

0

0

0

1

Maler Kotla

0

0

0

0

0

1

0

0

0

0

0

1

0

0

0

0

0

0

0

0

1

Malout

Name of the Sub-Divisional Hospitals

0

0

1

0

0

1

0

0

1

0

0

0

0

0

1

0

0

0

0

0

1

Nakodar

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

1

Patti

(Contd...)

0

0

0

0

0

1

0

0

0

0

0

1

0

0

0

0

0

0

0

0

1

Talwandi

The Health Care Delivery System provided by PHSC, Punjab

Study to Review

187

Yes

No Yes No Yes

Up-to-date maintenance of O.T. records like O.T. registers, emergency O.T., Monthly abstract discipline wise, major/minor etc

Maintenance of operation postponement register

Emergency light or generator facilities provided to O.T.

Availability of fire fighting equipments and knowledge to use them

Regular disinfections & sterilisation procedures done at O.T.

Ajnala

Yes

No

Yes

Yes

Yes

Batala

Yes

Yes

Yes

No

Yes

Dasuya

Yes

Yes

Yes

Yes

Yes

Fazilka

Yes

Yes

Yes

No

Yes

Jagraon

Yes

Yes

Yes

No

Yes

Maler Kotla

Yes

No

Yes

No

Yes

Malout

Name of the Sub-Divisional Hospitals

Yes

No

Yes

No

Yes

Nakodar

Yes

Yes

Yes

No

Yes

Patti

Yes

No

Yes

No

Yes

Talwandi

188

Study to Review

The Health Care Delivery System provided by PHSC, Punjab

Yes Yes

Yes No Yes Yes Yes No NA Yes No Available Functional Available Functional Available Functional

Satisfactory cleanliness of the wards with adequate house keeping

Colour codes of Yellow, Blue, Red, White bin & Blue transparent PPF for waste collection

Table top syringe & needle destroyer

Proper utilisation

Adequate water supply and up keep of sanitary blocks.

Adequate & clean Toilets and Bathrooms

All the beds are having proper & adequate linen

Floor beds/doubling of beds in the wards

if Yes, analyse the reason

Satisfactory up keep of cots, mattresses, bedside lockers, linen

Use of hospital uniforms by all patients

Availability and functioning of suction apparatus ( electric & foot operated)

If Available

Availability and functioning of oygen cylinder with accessories

If available

Availability and functioning of venesection tray, LP, tracheostomy tray.

If available

Ajnala

Functional

Available

Functional

Available

Functional

Available

No

No

NA

No

No

No

Yes

No

Yes

No

No

Batala

Functional

Available

Functional

Available

Functional

Available

No

Yes

NA

No

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Dasuya

Table 2.11 In Patient Wards at Sub-Divisional Hospitals

Functional

Available

Functional

Available

Functional

Available

No

Yes

NA

No

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Fazilka

Functional

Available

Functional

Available

Functional

Available

Yes

Yes

NA

No

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Jagraon

Functional

Available

Functional

Available

Functional

Available

No

Yes

NA

No

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Maler Kotla

NA

Not Available

Functional

Available

Not Functional

Not Available

No

No

NA

No

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Malout

Name of the Sub-Divisional Hospitals

Functional

Available

Functional

Available

Functional

Available

No

Yes

NA

No

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Nakodar

NA

Not Available

Functional

Available

Functional

Available

No

Yes

NA

No

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Patti

(Contd...)

NA

Not Available

Functional

Available

Functional

Available

No

Yes

NA

No

Yes

No

No

Yes

No

No

Yes

Talwandi

The Health Care Delivery System provided by PHSC, Punjab

Study to Review

189

NA Yes Yes

Maintenance of various registers, records, etc.

Yes

Adequacy and working of fans and lights

Quality of care

No

Concept of progressive patient care

Satisfactory availability of diet,

Yes

Functional

If available

Stationeries, forms, upto date various registers etc.

Available

Availability and functioning of emergency light, wheel chair, trolley

Ajnala

Yes

Yes

NA

Yes

Yes

Yes

NA

Not Available

Batala

Yes

Yes

No

Yes

Yes

Yes

Functional

Available

Dasuya

Yes

Yes

No

Yes

Yes

Yes

Functional

Available

Fazilka

Yes

Yes

No

Yes

No

Yes

Functional

Available

Jagraon

Yes

No

No

Yes

Yes

Yes

Functional

Available

Maler Kotla

Yes

Yes

Yes

Yes

Yes

Yes

Functional

Available

Malout

Name of the Sub-Divisional Hospitals

Yes

Yes

No

Yes

Yes

Yes

Functional

Available

Nakodar

Yes

No

No

Yes

Yes

Yes

NA

Not Available

Patti

Yes

Yes

No

Yes

Yes

Yes

Functional

Available

Talwandi

190

Study to Review

The Health Care Delivery System provided by PHSC, Punjab

No Yes

No Yes

No No No

No

No No No

Staff knowledgeable in materials management

Inspection of stores by the Civil Surgeon/ M.O. I/c at regular interval to verify stock books

Availability of Vital, essential drugs in sufficient Quantity

Upkeep of expiry date register and its regular inspection by MO I/c

Efforts made to redistribute large stock of slow moving drugs or near expiry for its utilisation.

Proper arrangements to keep the drugs as per ABC/VED category and storage of rubber goods as per guidelines

Appropriate steps taken to prevent pilferage of

A convenient arrangement of issuing drugs to various

Regular sending of samples to chemical laboratory to check it as per specification and standard & action taken thereon

Yes

Yes

Yes

No

Yes

Yes

Yes

Yes

Yes

Restriction on entry for unauthorised personnel’s

No

No

Batala

Medical store suitably located with adequate space and protection of drugs and non-drugs items from pilferage, temperature, humidity

Ajnala

Yes

Yes

Yes

Yes

Yes

No

Yes

Yes

Yes

Yes

Yes

Dasuya

Yes

Yes

No

Yes

No

Yes

Yes

Yes

Yes

Yes

Yes

Fazilka

No

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Jagraon

Yes

Yes

No

No

No

Yes

No

Yes

No

No

Maler Kotla

Yes

Yes

Yes

No

Yes

Yes

Yes

Yes

Yes

Yes

No

Malout

Name of the Sub-Divisional Hospitals

Table 2.12 Hospital Medical Stores at Sub-Divisional Hospitals

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Nakodar

No

Yes

No

No

Yes

No

Yes

Yes

Yes

No

No

Patti

(Contd...)

No

Yes

Yes

No

Yes

Yes

Yes

Yes

No

Yes

No

Talwandi

The Health Care Delivery System provided by PHSC, Punjab

Study to Review

191

Yes

Yes No No No No

Circulation of lists of available drugs to all the MOs, OPD& wards as per generic names

Submission of certified bills to office for release of payments within three days.

Auction to clear the empty material from store done regularly.

Availability of Fire Fighting equipments and knowledge of staff to operate it

Availability of regularly updated Hospital Drug Formulary

Existence of standing Drug Committee

Ajnala

Yes

No

No

No

Yes

Yes

Batala

Yes

Yes

Yes

Yes

Yes

Yes

Dasuya

No

Yes

No

Yes

Yes

Yes

Fazilka

Yes

Yes

Yes

No

No

Yes

Jagraon

No

No

Yes

Yes

Yes

No

Maler Kotla

No

Yes

Yes

No

Yes

Yes

Malout

Name of the Sub-Divisional Hospitals

Yes

Yes

No

Yes

Yes

Yes

Nakodar

Yes

No

Yes

Yes

Yes

Yes

Patti

No

No

No

No

Yes

Yes

Talwandi

192

Study to Review

The Health Care Delivery System provided by PHSC, Punjab

Yes

No

Yes 5 yrs. Yes No

Yes Yes Yes No

Case record is maintained as per WHO classification of diseases (ICD-X)

Regular submission of the morbidity, mortality reports

Duration for all the records being maintained (In years)

Is the backup facility available to safeguard these records

Is the effective retrieval system followed by this hospital

Regular death audit meetings held & minutes of meeting

Medical audit done at regular interval

Are the adequate number of bins and the bags of required

Are these placed strategically in all patient care areas

Manual

Yes

Is it managed by a trained medical record officer/ technician or

Medical record

Availability of medical room with enough no. of racks and cup-board etc.

Ajnala

No

Yes

No

No

No

No

9 yrs.

Yes

Yes

Yes

Manual

Yes

Batala

Yes

Yes

Yes

Yes

Computerised

Yes

5 yrs.

Yes

Yes

Yes

Manual

Yes

Dasuya

Yes

Yes

Yes

Yes

Yes

Yes

10 yrs.

Yes

Yes

Yes

Manual

Yes

Fazilka

Yes

Yes

Yes

Yes

No

No

Not Available

Yes

No

Yes

Computerised

Yes

Jagraon

Yes

Yes

Yes

No

BLS

No

6 yrs.

Yes

No

No

Manual

No

Maler Kotla

Yes

Yes

No

Yes

In-patient no.

Yes

10 yrs.

Yes

No

Yes

Manual

No

Malout

Name of the Sub-Divisional Hospitals

Table 2.13 Medical Records Department at Sub-Divisional Hospitals

Yes

Yes

Yes

Yes

No

No

5 yrs.

Yes

No

Yes

Manual

No

Nakodar

Yes

Yes

No

No

No

No

Not Available

No

No

Yes

Manual

No

Patti

(Contd...)

No

No

No

No

Correspondence

No

8 yrs

Yes

No

Yes

Manual

No

Talwandi

The Health Care Delivery System provided by PHSC, Punjab

Study to Review

193

Yes Yes No No

Proper transportation of the waste so collected

Storage facilities and duration

Disposal/ recycling methods for various categories of Waste

Availability of autoclaves, shredders Yes

No

Collection of waste, packaging, labelling, record keeping done in scientific

Whether waste disposal is outsourced

Yes

Segregation of different categories of wastes done at the

Ajnala

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Batala

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Dasuya

Yes

No

Yes

Yes

Yes

Yes

Yes

Fazilka

Yes

Yes

No

Yes

Yes

Yes

Yes

Jagraon

No

Yes

Yes

Yes

Yes

Yes

Yes

Maler Kotla

No

No

No

Yes

Yes

Yes

Yes

Malout

Name of the Sub-Divisional Hospitals

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Nakodar

Yes

Yes

No

Yes

Yes

Yes

Yes

Patti

Yes

Yes

Yes

Yes

Yes

No

No

Talwandi

194

Study to Review

The Health Care Delivery System provided by PHSC, Punjab

No No No

Quality control measures are strictly followed -physical

Quality control measures are strictly followed- chemical

Quality control measures are strictly followed- biological In house

Yes

Yes

Yes

Yes

Yes

Batala

NA NA NA

Proper & safe arrangement for storage of raw materials

Measures for Pest & Rodent control

Sanitation and hygiene of the cooking area properly maintained

Average

Quality of linen NA

Average

Quality of wash

Dietary Services (If no dietary services fill “8”) Adequate space for kitchen

Not adequate

NA

NA

NA

NA

Average

Average

Not adequate

Conventional Mechanised

Laundry Services- staff

Laundry Services

In house

Yes

Having all the required equipments & Autoclaves

Laundry Services

Yes

Under the supervision of a trained technical staff/ senior nursing officer

Ajnala

NA

NA

NA

NA

Good

Good

Adequate

Mechanised

In house

Yes

Yes

Yes

Yes

Yes

Dasuya

NA

NA

NA

NA

Good

Good

Adequate

Conventional

Out sourced

No

Yes

Yes

Yes

Yes

Fazilka

NA

NA

NA

NA

Good

Good

Not adequate

Mechanised

In house

Yes

Yes

Yes

Yes

Yes

Jagraon

No

NA

Yes

Yes

Average

Average

Not adequate

Conventional

Out sourced

Yes

Yes

Yes

No

No

Maler Kotla

NA

NA

NA

NA

Good

Good

Not adequate

Mechanised

Out sourced

No

No

No

No

No

Malout

Name of the Sub-Divisional Hospitals

Table 2.14 Central Supply Department at Sub-Divisional Hospitals

NA

NA

NA

NA

Average

Average

Not adequate

Mechanised

In house

Yes

Yes

Yes

Yes

Yes

Nakodar

Out sourced

No

No

No

Yes

Yes

Talwandi

NA

NA

NA

NA

Average

Average

Adequate

(Contd...)

NA

NA

NA

NA

Average

Average

Adequate

Conventional Conventional

Out sourced

Yes

Yes

Yes

Yes

Yes

Patti

The Health Care Delivery System provided by PHSC, Punjab

Study to Review

195

NA NA NA NA

Regular health check-up for food handlers

Availability of modern cooking equipments

Availability of properly maintained records & registers

Diet service under the supervision of a qualified Dietician

Ajnala

NA

NA

NA

NA

Batala

NA

NA

NA

NA

Dasuya

NA

NA

NA

NA

Fazilka

NA

NA

NA

NA

Jagraon

No

No

No

No

Maler Kotla

NA

NA

NA

NA

Malout

Name of the Sub-Divisional Hospitals

NA

NA

NA

NA

Nakodar

NA

NA

NA

NA

Patti

NA

NA

NA

NA

Talwandi

196

Study to Review

The Health Care Delivery System provided by PHSC, Punjab

123853

79500

nd

94889 110633 5932 6066 6025 5723 6348 2573 4521 4803 4176 4011 4257 4189 3984 4086 3777 3384 2938

81000 72000 2810 2729 2915 2670 2750 3419 3335 3840 3853 3524 1470 1390 1220 1410 1524 1470 1390

th

5 Yr

1st Yr

2nd Yr

3rd Yr

th

1 Yr

nd

1 Yr

nd

3 Yr

th

1 Yr

nd

rd

2 Yr

st

5 Yr

th

4 Yr

th

4 Yr

118951

78300

3 Yr

rd

2 Yr

87877

80500

1 Yr

No. of admissions through emergency

No. of Emergencies

2607 2599

1410 1524

th

5 Yr

th

4 Yr

2384

1220

3 Yr

rd

2 Yr

st

5 Yr

th

4 Yr

rd

2 Yr

st

5 Yr

th

4 Yr

th

No. of Surgeries done 3 Yr

In-patient Admitted

OPD Attendance last 5 years

Batala

st

Ajnala

Performance (Annual)

3545

2696

2452

2280

1990

4522

3512

3072

2863

2581

9416

7442

8233

5212

1890

7653

6265

5610

5123

4297

93716

92177

90957

87245

83843

Dasuya

2796

2380

2139

-

-

-

-

-

-

-

2926

2404

777

-

-

4867

4221

3997

-

-

83576

76734

71851

-

-

Fazilka

2046

1925

1690

1540

1271

4144

4111

3432

2305

2956

6179

6002

6208

5847

3045

5240

5012

4680

4340

3593

140825

114972

91738

83174

74417

Jagraon

3596

3549

3758

3582

2915

4984

4260

4610

4264

3991

8456

10474

6519

4647

1925

9242

8631

8477

7370

6062

165133

156622

145816

139954

132144

Malar kotla

Name of the Sub-Division hospital

Table 2.15 Five Years Performance Report of Sub-divisional Hospitals

1484

1203

1395

1271

1013

2351

2039

2104

1997

1627

4141

1567

1087

649

931

2882

2808

2480

2022

1882

80273

82641

88343

89208

93452

Malout

1872

1618

-

-

1230

2463

2352

-

-

2083

5977

5891

-

-

4196

4513

5315

-

-

3697

153877

107246

NA

NA

107846

Nakodar

1525

1349

1486

1410

1303

1479

2267

1248

1405

1303

4115

4832

5220

3432

1939

2771

3001

3620

3871

4525

122326

124884

125296

129245

132857

Patti

(Contd...)

795

739

392

479

405

943

745

392

531

617

1418

1282

508

766

853

1911

1728

985

1563

1554

57050

55667

43878

57762

55896

Talwandi

The Health Care Delivery System provided by PHSC, Punjab

Study to Review

197

No. of Caesarian done

No. of normal deliveries conducted

No. of post-mortem Done

No. of Medico-legal cases

850 870 880 902 900 118 126

New Hospitals NA NA NA NA NA NA

1st Yr

2nd Yr

3 Yr

th

4 Yr

5th Yr

1st Yr

2nd Yr

5th Yr

36

230

286

137

321

125

2nd Yr

4th Yr

261

120

1st Yr

461

214

45

5th Yr

152

270

82

4th Yr

3rd Yr

313

77

333

85

2nd Yr

3rd Yr

244

159

NA

5th Yr 91

178

NA

4th Yr

1st Yr

136

NA

3rd Yr

rd

Batala

Ajnala

Performance (Annual)

556

413

356

282

152

724

677

574

516

427

160

149

148

150

150

318

229

180

154

150

Dasuya

93

64

76

-

-

138

90

198

-

-

129

151

137

-

-

1711

1445

1120

-

-

Fazilka

105

62

96

99

62

141

44

27

14

17

169

129

119

101

125

838

934

740

883

625

Jagraon

207

147

116

56

848

798

706

586

118

90

98

126

-

790

635

609

-

Malar kotla

Name of the Sub-Division hospital

88

39

10

9

-

103

110

91

89

76

417

321

445

444

390

Malout

73

50

-

-

27

192

140

-

-

11

223

210

-

-

85

262

NA

NA

NA

NA

Nakodar

344

269

265

100

52

365

374

239

133

104

108

151

121

141

137

467

471

489

484

502

Patti

4

3

0

0

0

117

93

25

7

9

0

0

0

0

0

363

417

237

234

NA

Talwandi

198

Study to Review

The Health Care Delivery System provided by PHSC, Punjab

Fazilka

Dasuya

Batala

Ajnala

SDH

2501043 2564636 2591846 2781007

2004-05

2005-06

2006-07

2007-08

1713121

2007-08 61,56,049

1417432

2006-07

Total

1526801

1,40,22,765

Total

2005

3555379

2007

NA

3236033

2006

1498695

2724788

2005

2004

2569442

2004

2003

1937123

2003 Jan to Dec

63,43,392

1405856

1184084

1643986

2109466

NA

1,33,54,148

2944546

3824239

2560358

2118990

1906015

1,32,95,462

2856930

2003-04

Total

4,42,345

Total

31069

67140

186126

2006-07

128887

2004-05

98998

64310

68831

2003 -04

61842

Total Expenditure

2005-06

62785

Total Income (Collection)

2002-03

Years

33,76,602

628269

592215

824751

1331367

NA

51,15,010

1007892

1019279

1138910

999299

949630

62,63,228

1208331

985821

1359199

1254498

1455379

2,95,994

765

62204

112365

86210

34450

Medicine

16,26,520

423310

323291

368495

511424

NA

41,65,300

804628

1737364

624839

517145

481342

36,44,240

635697

751368

797979

749642

709554

1,04,143

15450

14087

52071

6593

159042

I.F.P.

9,35,175

227657

220125

318647

168746

NA

12,21,036

361026

246270

256041

239991

117708

17,52,581

513302

455726

47256

323472

412825

28,470

1825

1610

17340

6195

1500

Buildings

4,05,095

126620

48453

132093

97929

NA

12,13,968

262757

400142

210429

136185

204455

6,81,896

307953

225669

38168

44323

65783

27,026

7676

5050

4350

-

9950

Equipment

Detailed Expenditure

Table 2.16 Utilisation of user Charges in different Sub-divisional Hospitals

-

-

-

-

-

-

-

-

-

_

_

_

_

_

8,83,720

524273

219412

140035

_

_

2,59,193

-

57869

201324

ERF A/c

-

_

_

_

_

_

9,41,303

176177

201772

184104

226370

152880

6,94,324

115724

115393

120710

129108

213389

5.353

5353

-

-

-

-

Salary to Contractual Staff

(Contd...)

Rogi Kalyan Samiti

The Health Care Delivery System provided by PHSC, Punjab

Study to Review

199

Nakodar

Malout

Malar Kotla

Jagraon

SDH

1526969 1586933 1949779

2005-06

2006-07

2007-08

3074958 3843699 3431073

2005-06

2006-07

2007-08

1218956 1485141 1643569 1785796

2004-05

2005-06

2006-07

2007-08

1564222 1919253 1178820

2004-05

2005-06

2006-07

Total

67,35,445

1088831

2003-04

2007-08

984319

2002-03

81,87,037

1170491

2003-04

Total

883084

2002-03

1,56,63,288

2911828

2004-05

Total

2401730

2003-04

71,11,169

1280104

2004-05

Total

767384

Total Income (Collection)

2003-04

Years

63,64,975

993277

1658387

1747670

1217550

748091

67,05,933

1229213

1194926

1543708

1045483

906414

786189

1,37,31,130

3232796

3096277

2643327

2913691

1845039

54,69,417

1224822

1089631

1166907

1171531

816526

Total Expenditure

-

-

-

-

-

19,71,319

314876

269199

202159

497789

427686

259610

69,31,740

1894129

1544136

1290855

1341339

861281

20,82,150

503702

385255

464614

539026

189553

Medicine

-

-

-

-

-

14,47,615

246211

296156

519310

84062

124537

177339

34,80,861

768283

865383

650957

700184

496054

18,04,228

319985

354189

318339

332573

479142

I.F.P.

-

-

-

-

-

4,42,593

59721

26556

159343

63443

59033

74497

5,53,458

97998

89337

234480

72985

58658

7,47,683

192054

170995

125349

131927

127358

Buildings

-

-

-

-

-

4,38,517

97408

64820

146260

68380

32525

29124

9,98,041

269202

187615

214823

233949

92452

7,07,312

209081

179192

130561

168005

20473

Equipment

Detailed Expenditure

-

-

-

-

-

-

-

3,35,735

174611

161124

0

0

0

0

-

_

_

_

_

_

4,54,807

178744

163221

112842

ERF A/c

-

-

-

-

-

20,70,154

336386

377071

516636

331809

262633

245619

17,67,035

203184

409806

252212

565234

336599

26,722

-

11520

15202

-

-

Salary to Contractual Staff

(Contd...)

Rogi Kalyan Samiti

200

Study to Review

The Health Care Delivery System provided by PHSC, Punjab

Talwan De Saboo

Patti

SDH

475974

2007-08 21,31,747

564122

2006-07

Total

392751

90,82,645

Total

320439

2132756

2007

2005-06

1895881

2006

2004-05

1941864

2005

378461

1664189

2004

2003-04

1447955

Total Income (Collection)

2003

Years

20,62,243

465776

524283

402239

299001

370944

1,35,73,006

2234989

3840986

4010536

1821980

1664515

Total Expenditure

7,34,351

188931

156613

139355

93472

155980

45,54,846

927108

1111049

1020627

813206

682856

Medicine

5,60,559

115123

122462

100269

84821

137884

25,54,524

396859

526386

600732

590521

440026

I.F.P.

2,39,610

69741

67410

31148

35112

36199

6,72,441

134275

53579

221555

128621

134411

Buildings

2,30,172

51674

73995

27951

35671

40881

12,26,193

640747

117934

81758

145632

240122

Equipment

Detailed Expenditure

-

-

-

_

_

_

_

_

34,344

7632

17257

9455

ERF A/c

2,63,207

32675

86546

94061

49925

-

7,27,257

136000

136157

144000

144000

167100

Salary to Contractual Staff

2,00,000

100000

100000

Rogi Kalyan Samiti

The Health Care Delivery System provided by PHSC, Punjab

Study to Review

201

Psychiatry

Dermatologist

Orthopaedics

ENT

Paediatrics

OBG

Surgery

Medicine

Name of Post

1

M.D.

-

MBBS

-

M.D.

Diploma

-

MBBS

-

-

MBBS

Diploma

-

2

M.D.

Diploma

-

MBBS

1

M.D. -

-

MBBS

Diploma

-

2

M.D.

Diploma

-

MBBS

1

M.D. -

-

Diploma

-

1

M.D.

MBBS

-

MBBS

Diploma

-

1

M.D.

Diploma

Ajnala

Post

-

-

-

-

-

1

-

1

1

-

-

1

-

1

-

-

-

1

-

-

1

-

-

2

Batala

Table 2.17 Medical Officers in Position

-

-

-

-

-

-

-

-

1

-

-

1

-

-

1

-

-

1

-

-

2

-

-

2

Dasuya

-

-

-

-

-

1

-

1

-

-

-

1

-

1

-

-

-

-

-

-

1

-

-

1

Fazilka

-

-

-

-

-

1

-

-

1

-

-

2

-

-

1

-

-

1

-

-

2

-

-

2

Jagraon

-

-

-

-

-

-

-

-

-

-

-

1

-

-

-

-

-

2

-

-

1

-

-

1

Maler kotla

-

-

1

-

-

1

-

-

-

-

-

-

-

-

-

-

-

-

-

-

1

-

-

2

Malaout

-

-

-

-

-

1

-

-

1

-

-

1

-

-

-

-

-

1

-

-

1

1

-

2

Nakodar

-

-

-

-

-

-

-

-

1

-

-

1

-

-

-

-

-

1

-

-

2

-

-

3

Pathi

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

1

-

-

1

-

-

-

Talwandi

(Contd...)

-

-

1

-

-

6

-

2

7

-

-

9

-

2

4

-

-

9

-

-

13

1

-

16

Total

202

Study to Review

The Health Care Delivery System provided by PHSC, Punjab

Dental

Radiology

Microbiology

Bio-chemistry

Pathology

Blood Bank

Anaesthesia

Name of Post

1 -

MBBS

BDS

Diploma

-

M.D. -

-

MBBS

Diploma

-

-

MD/MSc

Diploma

-

MBBS

-

MD/MSc -

-

MBBS

Diploma

-

-

M.D.

Diploma

-

MBBS

-

M.D. -

-

MBBS

Diploma

-

1

M.D.

Diploma

Ajnala

Post

-

1

-

-

1

-

-

-

-

-

-

-

-

-

-

-

1

-

-

1

Batala

-

1

-

-

1

-

-

-

-

-

-

-

-

-

-

-

-

-

-

1

Dasuya

-

1

-

-

-

-

-

-

-

-

-

-

-

1

-

-

-

-

-

2

Fazilka

-

1

-

-

1

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

Jagraon

-

1

-

-

-

-

-

1

-

-

-

-

-

1

-

-

1

-

-

-

Maler kotla

-

1

1

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

Malaout

-

1

-

-

-

-

-

1

-

-

-

-

-

1

-

-

1

-

-

1

Nakodar

-

1

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

1

Pathi

-

1

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

Talwandi

-

10

1

-

3

-

-

2

-

-

-

-

3

-

-

3

-

-

7

Total

The Health Care Delivery System provided by PHSC, Punjab

Study to Review

203

Driver

Administrative staff

Technician

Nursing Staff

Medical Officer (GDMO & Specialists)

SMO

Name of Post

-

Ad hock

2+1(*)

-

Ad hock

Total in position

-

2

Total in position 3

-

Ad hock

Vacant

-

Vacant

Sanction

2

Sanction

2+2(*)

-

Vacant

Total in position

4

Sanction

2

3

-

5

5

-

-

5

3

-

-

3

14

10+2($)

-

Total

-

Vacant

14

-

12

Sanction

18

-

3

21

1 (office)

-

1

1

Batala

Ad hock

13

Total in position

14

Sanction

-

1

Total in position

Ad hock

-

Ad hock

1

-

Vacant

Vacant

1

Ajnala

Sanction

Post

2

-

-

2

3

-

-

3

8

1

1

9

12

12(cont.)

-

25

19

-

2

21

1

-

-

1

Dasuya

-

-

-

-

1

-

-

1

2

-

-

2

17

7

7

24

11

-

3

14

1

-

-

1

Fazilka

-

-

-

-

2

-

-

2

5

-

-

5

16

-

-

16

13

-

1

14

-

-

-

-

Jagraon

Table 2.18 Present Staff Position of Sub-Divisional Hospitals Under PHSC

3

-

-

3

7

-

-

7

4

-

-

4

22+2 (depu.)*

-

2

24

10

-

-

10

1

-

-

1

Malar kotla

-

2

-

-

1

-

-

1

2

-

-

2

8

-

3

11

7

-

6

13

1

-

-

1

Malout

-

-

-

-

2

-

-

2

3

-

-

3

9

-

3

12

13

-

-

13

1

-

-

1

Nakodar

2

-

-

2

3

-

-

3

3

-

-

3

13

-

-

13

11

-

1

12

1

-

-

1

Patti

2

-

-

2

5

-

-

5

-

-

-

-

8

-

2

10

4

-

7

11

-

-

-

1

Talwandi

204

Study to Review

The Health Care Delivery System provided by PHSC, Punjab

-

Ad hock

15 15

Sanction

Vacant

Ad hock

Total in position

19+2(*)

2

Vacant

Total in position

23

Ajnala

Sanction

Post

• On deputation placed in the SDH $ Gone deputation in other places/outside SDH

Others

Class IV

Name of Post

2

1

-

3

23

-

9

32

Batala

5

-

-

5

23

-

7

30

Dasuya

7

-

-

7

23

-

7

30

Fazilka

-

-

-

-

25

-

3

28

Jagraon

-

-

-

-

38

-

9

47

Malar kotla

3

-

1

4

7

-

-

7

Malout

2

-

-

2

19

-

7

26

Nakodar

25

-

-

25

19

-

-

19

Patti

-

-

-

-

20

-

1

21

Talwandi

The Health Care Delivery System provided by PHSC, Punjab

Study to Review

205

Three day Irregular

Storage capacity of Water Supply

Electricity -

Good Good Good Good No No No No

Roads & lighting

State of building

Any public utility service available in hospital premises chemist

Sulabh Sochalaya

Restaurants/ canteen

Grocery shops

Average

General Impression -Up keep of garden

Sign posting

Available

Ramp facility

Cleanliness

Not available

Available

Availability of lift

Backup Generator/ UPS

Three

Adequate

Availability of water

Phase of Electricity

Municipal

Yes

Badal

Water Supply

Accessibility to Railway/Bus Station

Description of facilities

No

No

Yes

No

Good

Average

Average

Average

Average

Available

Not available

Available

Three

Irregular

One day

Adequate

Bore well

Yes

Fatehgarh

No

Yes

No

No

Good

Good

Good

Good

No

No

No

No

Good

Good

Good

Average

No

No

No

No

Good

Good

Good

Good

Good

Not Applicable

Good

Available

Available

Not available

Not available

Available

Three

Regular

Three day

Adequate

Bore well

Yes

Kartarpur

Not available

Available

Three

Irregular

Three day

Adequate

Municipal

Yes

Goniana

Not available

Available

Double

Irregular

Three day

Adequate

Bore well

Yes

Ferozshah

Table 3.1 General Profile & Facility Survey of CHCs Under PHSC

No

No

No

No

Average

Average

Poor

Average

Average

Not available

Not working

Available

Three

Irregular

Two day

Adequate

Bore well

Yes

Khemkaran

Name of the CHC

No

No

Yes

No

Good

Good

Average

Good

Average

Available

Not available

Available

Three

Irregular

Two day

Adequate

Bore well

Yes

Longowal

No

No

No

No

Good

Good

Good

Good

No

No

No

No

Average

Good

Average

Average

Poor

Not available

Not available Average

Not available

Available

Three

Regular

Two day

Adequate

Bore well

Yes

Mahilpur

Not available

Available

Three

Irregular

One day

Adequate

Bore well

Yes

Machiwara

No

No

Yes

No

Good

Poor

Good

Good

Average

Available

Not available

Available

Three

Regular

One day

Adequate

Bore well

Yes

Majitha

(Contd...)

No

No

No

No

Good

Average

Average

Average

Average

Available

Not available

Available

Three

Irregular

One day

Inadequate

Bore well

Yes

Manawala

206

Study to Review

The Health Care Delivery System provided by PHSC, Punjab

No No

No

No No Yes Yes

Mortuary services with cold storage & other preservative facilities available

Various management committees, Drug formulary committee

Hospital Antibiotic committee

Hospital Infection Control Committee

Store Purchase Committee

Store verification Committee

Round the clock

Emergency Services

Facilities for Post-mortem

NA

No. of beds in ICU

Yes

No

Intensive Care Units

Delivery Services

2

No. of Operation Theatres -Major

Yes

1

No. of Operation TheatresMinor

Dental Services

2

Partially equipped

If Available

Total No. of Vehicles

Available

Badal

Ambulance Services

Description of facilities

Yes

Yes

No

No

No

No

No

Yes

Yes

Round the clock

NA

No

1

1

1

Partially equipped

Available

Fatehgarh

No

No

No

No

No

No

No

Yes

No

Round the clock

NA

No

0

1

4

Fully equipped

Available

Ferozshah

Yes

Yes

Yes

No

No

No

No

Yes

Yes

Round the clock

NA

No

2

0

1

Partially equipped

Available

Goniana

Yes

Yes

No

Yes

Yes

No

No

Yes

Yes

Round the clock

NA

No

1

1

3

Partially equipped

Available

Kartarpur

Yes

Yes

Yes

No

No

No

No

Yes

Yes

Round the clock

NA

No

1

0

2

Partially equipped

Available

Khemkaran

Name of the CHC

No

No

No

No

No

No

No

Yes

No

Round the clock

NA

No

1

1

1

Fully equipped

Available

Longowal

Yes

Yes

No

No

No

No

No

Yes

Yes

Round the clock

NA

No

1

1

1

Partially equipped

Available

Machiwara

No

Yes

No

No

No

No

No

Yes

Yes

Round the clock

NA

No

2

0

3

Partially equipped

Available

Mahilpur

Yes

Yes

Yes

No

No

No

No

Yes

Yes

Round the clock

NA

No

1

1

1

Partially equipped

Available

Majitha

(Contd...)

Yes

No

No

No

No

No

No

Yes

Yes

Round the clock

NA

No

1

1

1

Partially equipped

Available

Manawala

The Health Care Delivery System provided by PHSC, Punjab

Study to Review

207

Yes Pull No Yes No Yes No

System of Supply of Drug items through

Is the drug formulary available

Is buffer stock maintained

Is Reorder level maintained

Annual maintenance procedure for costly Equipments

Log book/ History sheet maintained for the Equipments

Badal

Medical Audit/ Death Review Committee

Description of facilities

No

No

No

Yes

No

Pull

No

Fatehgarh

No

No

No

No

No

Pull

No

Ferozshah

Yes

Yes

Yes

Yes

No

Push

No

Goniana

Yes

No

Yes

Yes

Yes

Push

No

Kartarpur

Yes

No

No

No

No

Push

Yes

Khemkaran

Name of the CHC

Yes

Yes

No

Yes

Yes

Pull

No

Longowal

Yes

Yes

Yes

Yes

No

Push

No

Machiwara

No

No

Yes

Yes

Yes

Pull

No

Mahilpur

Yes

Yes

No

No

No

Pull & Push

No

Majitha

No

No

No

No

No

Push

Yes

Manawala

208

Study to Review

The Health Care Delivery System provided by PHSC, Punjab

Other Major and Minor Operation equipments

X-Ray

Sigmoidoscopes

Ophthalmoscopes

Emergency Resuscitation Kit

Dental chair

Boyles apparatus with circle absorber

Description of facilities

Yes Functional

Functional

Functional

Functional Yes

Yes

Functional

NA Yes

Yes

Non Functional

Not applicable No

Yes

Functional

Not applicable No

Yes

Functional

NA No

Yes

Functional

Functional No

Yes

Fatehgarh

Yes

Badal

Table 3.2 Equipment available at CHCs

Functional

Yes

Functional

Yes

NA

No

Functional

Yes

Functional

Yes

NA

No

NA

No

Ferozshah

Functional

Yes

Not applicable

No

Functional

Yes

Functional

Yes

Functional

Yes

Functional

Yes

Functional

Yes

Goniana

Functional

Yes

Functional

Yes

Not applicable

No

NA

No

Nonfunctional

Yes

Non Functional

Yes

Functional

Yes

Kartarpur

Functional

Yes

Functional

Yes

NA

No

Functional

Yes

Functional

Yes

Non Functional

Yes

Functional

Yes

Khemkaran

Name of the CHC

Functional

Yes

Functional

Yes

NA

No

Functional

Yes

Functional

Yes

Functional

Yes

Functional

Yes

Longowal

Functional

Yes

Functional

Yes

NA

No

Functional

Yes

Functional

Yes

Functional

Yes

Functional

Yes

Machiwara

Functional

Yes

Functional

Yes

NA

No

NA

No

Functional

Yes

Functional

Yes

Functional

Yes

Mahilpur

Functional

Yes

Functional

Yes

Functional

Yes

Functional

Yes

Functional

Yes

Functional

Yes

Functional

Yes

Majitha

NA

No

Functional

Yes

NA

No

Functional

Yes

Functional

Yes

Functional

Yes

Functional

Yes

Manawala

The Health Care Delivery System provided by PHSC, Punjab

Study to Review

209

No Yes Yes Yes Yes

Stool Test

Special Test Like:-blood urea

Blood Sugar

Blood Grouping and Matching test

Many other routine tests.

Yes

Badal

Complete Urine Examination

Description of facilities

Table 3.3 Laboratory tests

Yes

Yes

No

No

Yes

Yes

Fatehgarh

Yes

No

Yes

Yes

Yes

Yes

Ferozshah

Yes

Yes

Yes

Yes

Yes

Yes

Goniana

Yes

Yes

Yes

Yes

Yes

Yes

Kartarpur

Yes

Yes

Yes

No

No

Yes

Khemkaran

Name of the CHC

Yes

Yes

Yes

Yes

Yes

Yes

Longowal

Yes

Yes

Yes

Yes

Yes

Yes

Machiwara

Yes

Yes

Yes

Yes

Yes

Yes

Mahilpur

Yes

Yes

Yes

Yes

Yes

Yes

Majitha

Yes

Yes

Yes

Yes

Yes

Yes

Manawala

210

Study to Review

The Health Care Delivery System provided by PHSC, Punjab

Yes NA No No No No No Yes Yes No No No

NA

Referral manual available

Guidelines given regarding: What to refer

When to refer

How to refer

Colour coded referral cards available

Feed-back Mechanism existing

Transport facility provided

Maintenance of records/ registers

Incentive for following referral route

Procedure followed for referral *

Tie-up with other hospital (both public and private) for diagnostic or referral purposes

Hospital has a tie-up with

Badal

Any Referral System in place

Description of facilities

Table 3.4 Referral Facilities

NA

No

Yes

No

Yes

Yes

No

Yes

Yes

Yes

Yes

Yes

Yes

Fatehgarh

NA

No

Yes

Yes

Yes

Yes

No

No

Yes

Yes

Yes

Yes

Yes

Ferozshah

Other

Yes

Don’t know

No

Yes

Yes

No

Yes

No

No

No

Yes

Yes

Goniana

Pvt. Hospitals

Yes

Don’t know

Yes

Yes

Yes

No

Yes

Yes

Yes

Yes

Yes

Yes

Kartarpur

Medical College &

Yes

Yes

Yes

No

Yes

No

NA

NA

NA

NA

No

Yes

Khemkaran

Name of the CHC

Other

Yes

Yes

No

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Longowal

Other

Yes

Yes

Yes

Yes

Yes

No

No

Yes

Yes

Yes

Yes

Yes

Machiwara

Other

Yes

Yes

No

Yes

Yes

No

No

Yes

Yes

Yes

Yes

Yes

Mahilpur

Medical College

No

Yes

Yes

Yes

Yes

No

Yes

Yes

Yes

Yes

Yes

Yes

Majitha

(Contd...)

Other

Yes

No

No

No

No

No

No

No

No

No

No

No

Manawala

The Health Care Delivery System provided by PHSC, Punjab

Study to Review

211

No No

MCH

No Yes

No

If yes, what services are provided

Availability of Dharamshala

Availability of residential accommodation for the essential staff with in the campus

Security arrangement

In-house

NA

No

Yes

Does the Hospital have any Outreach Area

NA

Fatehgarh

NA

Badal

If Available

Description of facilities

In-house

Yes

No

NA

No

NA

Ferozshah

No

Yes

No

MCH

Yes

NA

Goniana

No

Yes

No

MCH Nat. health prog.

Yes

Monthly

Kartarpur

In-house

Yes

In-house

Yes

No

MCH

Health Ed. MCH No

Yes

Monthly

Longowal

Yes

NA

Khemkaran

Name of the CHC

No

Yes

No

MCH

Yes

NA

Machiwara

No

Yes

No

NA

No

Fortnightly

Mahilpur

In-house

Yes

No

NA

No

Monthly

Majitha

In-house

Yes

No

NA

No

NA

Manawala

212

Study to Review

The Health Care Delivery System provided by PHSC, Punjab

Yes Yes

No Yes

No No No No No Yes

Yes

Yes Yes No Yes No Yes

Pharmacist

Knowledgeable about the OPD (by observation)

Separate registration for Male

Female

Freedom fighters

Senior citizens

Staff

The registration registers are properly maintained and entries are made neatly

All sections of the OPD having proper signage and directional sign

Waiting area is adequate

Proper sitting arrangement

Drinking water facility

Ceiling Fans

Toilet facility(Separate for Male and Female)

Doctor’s Chambers are having adequate space

Yes

Yes

Yes

No

No

No

Yes

No

No

No

No

No

No

Yes

No

Staff Nurse

No

Fatehgarh

No

Badal

MSW

Description of facilities

Table 3.5 Outpatient Department

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

No

No

No

No

Yes

No

Yes

No

Ferozshah

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

No

No

No

No

Yes

Yes

No

No

Goniana

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

No

No

No

No

Yes

Yes

No

No

Kartarpur

Yes

No

Yes

Yes

No

Yes

Yes

Yes

No

No

No

No

No

Yes

Yes

No

No

Khemkaran

Name of the CHC

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

Yes

Yes

Yes

Yes

Yes

No

No

Longowal

Yes

No

Yes

Yes

Yes

Yes

Yes

Yes

No

Yes

Yes

Yes

Yes

Yes

Yes

No

No

Machiwara

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

No

No

No

No

Yes

No

Yes

No

Mahilpur

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

No

No

No

No

Yes

No

Yes

No

Majitha

(Contd...)

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

No

No

No

No

Yes

Yes

No

No

Manawala

The Health Care Delivery System provided by PHSC, Punjab

Study to Review

213

Yes

No

Laboratory & Imaging Services easily accessible

Central Collection Centre for Laboratory Services

No

Yes

No

Yes

Dispensaries / Pharmacy with separate counters for male/female/senior citizen/staff

Yes

No

Injection Room along with facilities and to deal with Emergency situation No

Yes

Yes

Adequate illumination

Yes

Yes

No

Examination equipments (like BP apparatus Torch, hammer, etc.)

Minor OT / Dressing Room with all the basic Equipments

Yes

No

Stool for the patient to sit

Yes

Fatehgarh

Yes

Badal

Examination table with proper sheet

Description of facilities

Yes

Yes

No

Yes

Yes

Yes

Yes

Yes

Yes

Ferozshah

Yes

Yes

No

No

No

Yes

Yes

Yes

Yes

Goniana

Yes

Yes

No

No

Yes

Yes

Yes

Yes

Yes

Kartarpur

No

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Khemkaran

Name of the CHC

No

Yes

No

Yes

No

Yes

Yes

Yes

Yes

Longowal

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Machiwara

Yes

Yes

Yes

No

Yes

Yes

Yes

Yes

Yes

Mahilpur

Yes

Yes

No

Yes

Yes

Yes

Yes

Yes

Yes

Majitha

Yes

Yes

Yes

No

No

Yes

Yes

Yes

Yes

Manawala

214

Study to Review

The Health Care Delivery System provided by PHSC, Punjab

No

2 Yes

If Yes, the no. of beds Triage area

Yes No No

All the registers including MLR available for proper registration

Retiring room with toilets for the doctors

Call book in prescribed format available

No

No

Yes

No

3

2 No

Yes

1

2 Yes

Yes

No

Yes

Examination rooms with all basic equipments

Trolleys and Wheel chairs available If yes, exact No.

Observation Beds If Yes, No. of beds

NA

Yes

Emergency Ward attached to Emergency Department

Yes

No

Glow sign board indicating ‘Emergency Services Department’

Yes

Fatehgarh

Yes

Badal

Board displaying on call doctors/ specialist and other staff on duty

Description of facilities

No

Yes

Yes

Yes

2

Yes

1

Yes

Yes

2

Yes

Yes

Yes

Ferozshah

Table 3.6 Emergency (Casualty) Services at CHCs

No

No

No

No

1

Yes

4

Yes

No

NA

No

No

No

Goniana

No

Yes

Yes

Yes

1

Yes

Not mentioned

Yes

Yes

1

Yes

Yes

Yes

Kartarpur

No

No

Yes

Yes

2

Yes

6

Yes

No

6

Yes

No

Yes

Khemkaran

Name of the CHC

No

Yes

No

No

1

Yes

NA

No

No

Not mentioned

No

No

No

Longowal

No

Yes

Yes

Yes

3

Yes

2

Yes

Yes

1

Yes

No

Yes

Machiwara

Yes

No

Yes

No

3

Yes

2

Yes

Yes

2

Yes

Yes

Yes

Mahilpur

No

Yes

Yes

Yes

5

Yes

Not mentioned

Yes

Yes

Not mentioned

Yes

No

Yes

Majitha

(Contd...)

No

Yes

Yes

Yes

2

Yes

NA

No

No

3

Yes

No

Yes

Manawala

The Health Care Delivery System provided by PHSC, Punjab

Study to Review

215

Yes No No No No No

Staff trained in BLS

Treatment facilities for Dog/ snake bite & Poisoning

Availability of Disaster Manual

Disaster Alert Code, recall & deployment

Maintenance of dedicated drug store for disaster situation

Yes

Oxygen cylinders with attachments

Ambulance services

Yes

Sufficient stock of essential and life saving drugs

Yes

Yes

Major OT

Radiology Services

No

Treatment room-cum-minor OT

No

Yes

Public telephone available

Laboratory services

Yes

Badal

Waiting area for the attendants of patients with the basic facilities like sitting arrange-ments, drinking water, toilet etc

Description of facilities

No

No

No

Yes

No

Yes

No

No

No

Yes

No

Yes

No

No

Fatehgarh

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

Yes

No

Yes

No

Yes

Ferozshah

Yes

Yes

Yes

Yes

No

Yes

No

No

Yes

Yes

No

No

No

Yes

Goniana

Yes

No

Yes

No

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

Yes

Kartarpur

No

No

No

Yes

No

Yes

No

No

Yes

No

No

No

No

No

Khemkaran

Name of the CHC

No

No

No

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

Yes

Longowal

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

Yes

Machiwara

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

No

No

Yes

Mahilpur

No

No

No

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

Yes

Majitha

No

No

No

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

Yes

No

No

Manawala

216

Study to Review

The Health Care Delivery System provided by PHSC, Punjab

Yes

No No No No No No No No Yes No No

No

Pathology

Microbiology

Qualified Pathologist available

Biochemist available

Microbiologist available

Following the universal precaution procedures

Using protective measures i.e. gloves/gowns/masks

Specimen collection done centrally

Availability of all the chemicals and reagents

Observing all the bio-safety measures

Regular Internal Quality control measures undertaken

Regular External Quality control measures undertaken

Badal

Type of laboratories Biochemistry

Description of facilities

No

No

No

Yes

No

No

Yes

No

No

No

No

No

Yes

Fatehgarh

Table 3.7 Clinical Laboratories at CHCs

Yes

Yes

Yes

No

Yes

No

Yes

No

No

No

No

No

Yes

Ferozshah

Yes

Yes

Yes

No

Yes

Yes

Yes

No

No

No

Yes

Yes

Yes

Goniana

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

No

No

No

Yes

Yes

Kartarpur

No

No

No

Yes

No

No

No

No

No

No

No

No

Yes

Khemkaran

Name of the CHC

No

No

No

Yes

No

Yes

Yes

No

No

No

Yes

No

Yes

Longowal

No

No

Yes

Yes

Yes

Yes

Yes

No

No

No

Yes

No

Yes

Machiwara

No

Yes

Yes

Yes

Yes

Yes

Yes

No

No

No

No

No

Yes

Mahilpur

No

No

Yes

Yes

Yes

Yes

Yes

No

No

No

Yes

Yes

Yes

Majitha

(Contd...)

No

No

No

No

No

No

No

No

No

No

No

No

Yes

Manawala

The Health Care Delivery System provided by PHSC, Punjab

Study to Review

217

NA

NA NA

NA

NA

Efforts made to collect blood through Voluntary Organisation Camps

Renewal of blood bank/HIV License as per Rules

Disposal of HIV positive blood bags & bio-safety measures undertaken.

Availability of Table Top Syringe & needle destroyer and colour coded bags

Feed back of transfusion, and record maintenance of untoward incidences

No

NA

Australia antigen, HCV, VDRL, M.P. and HIV tests done for Every blood bottle of donor.

Use of dosimeter and they regularly sent to BARC

NA

Proper maintenance of cold chain and refrigerators

Yes

NA

Checking & cross matching by B.T.O

Availability of the dark room with all facilities

NA

Round the clock availability of trained staff and services

No

NA

Trained or qualified medical officer posted as B.T.O.

Radiologist availability

No

Badal

Availability of Blood Bank

Description of facilities

No

Yes

No

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

No

Fatehgarh

Table 3.8 Blood Banking Facilities

No

Yes

Yes

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

No

Ferozshah

No

Yes

No

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

No

Goniana

No

Yes

No

NA

NA

NA

NA

NA

NA

NA

NA

No

Kartarpur

No

Yes

No

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

No

Khemkaran

Name of the CHC

No

Yes

No

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

No

Longowal

No

Yes

No

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

No

Machiwara

No

Yes

No

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

No

Mahilpur

No

Yes

No

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

No

Majitha

Yes

Yes

No

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

No

Manawala

218

Study to Review

The Health Care Delivery System provided by PHSC, Punjab

No Yes

Yes Yes

Round the clock availability of X-ray services/ Sonography

Separate register for MLC records

Maintenance of history book and log book of X-ray machines

Badal

Special investigations like IVP, contrast media etc

Description of facilities

No

Yes

Yes

No

Fatehgarh

No

Yes

No

No

Ferozshah

Table 3.9 Special Investigations at CHCs

Yes

Yes

Yes

No

Goniana

No

Yes

No

No

Kartarpur

Yes

Yes

No

No

Khemkaran

Name of the CHC

Yes

No

Yes

No

Longowal

Yes

Yes

Yes

No

Machiwara

No

Yes

No

No

Mahilpur

No

Yes

Yes

No

Majitha

No

Yes

Yes

No

Manawala

The Health Care Delivery System provided by PHSC, Punjab

Study to Review

219

No Yes

Maintenance of OT postponement records

Emergency light-generator facility for OT

Yes

Yes

Maintenance of OT records

Regular disinfection & sterilisation done at OT

No

Zoning Concept Strictly Followed

No

1

No. of minor OT

Availability of fire fighting equipment & knowledge to use them

1

Badal

No. of major OT

Description of facilities

No

No

Yes

No

Yes

No

1

1

Fatehgarh

Yes

No

Yes

No

Yes

No

1

0

Ferozshah

Table 3.10 Operation Theatres at CHCs’

No

No

Yes

No

Yes

Yes

0

2

Goniana

Yes

No

Yes

No

Yes

No

1

1

Kartarpur

Yes

No

Yes

Yes

Yes

No

0

1

Khemkaran

Name of the CHC

Yes

Yes

Yes

No

Yes

No

1

1

Longowal

Yes

No

Yes

Yes

Yes

Yes

1

1

Machiwara

Yes

No

Yes

Yes

Yes

Yes

0

2

Mahilpur

Yes

No

Yes

No

Yes

No

1

1

Majitha

No

Yes

Yes

No

No

No

1

1

Manawala

220

Study to Review

The Health Care Delivery System provided by PHSC, Punjab

Functional

Condition on availability

No

Use of hospital uniforms by patients

Available

No

Satisfactory upkeep of cots, mattresses, lockers, linen etc.

Availability and functioning of oxygen cylinders with accessories

No

Floor beds/doubling of beds involved

Not available

No

Proper and adequate linen on beds

Condition on availability

No

Adequate and clean toilets and bathrooms

Not available

No

Adequate water supply and upkeep of sanitary blocks

Availability and functioning of suction apparatus

Yes

No

Colour codes of yellow, blue,red,white bin & blue transparent PPF for waste collection, table top syringe & needle destroyer& utilisation

Functional

Available

Non Functional

Available

No

Yes

No

Yes

Yes

Yes

Yes

Fatehgarh

No

Badal

Satisfactory cleanliness of wards with adequate house keeping

Description of facilities

Table 3.11 In patient wards at CHCs

Non functional

Available

NA

Not available

No

Yes

No

No

Yes

Yes

Yes

Yes

Ferozshah

Functional

Available

Functional

Available

No

Yes

No

Yes

Yes

Yes

Yes

Yes

Goniana

Functional

Available

Functional

Available

No

Yes

No

Yes

Yes

Yes

Yes

Yes

Kartarpur

Non functional

Available

NA

Not available

No

Yes

No

Yes

Yes

No

No

Yes

Khemkaran

Available

No

No

No

No

Yes

Yes

Yes

Yes

Longowal

Functional

Available

Functional

Name of the CHC

Functional

Available

Functional

Available

Yes

Yes

No

Yes

Yes

Yes

Yes

Yes

Machiwara

Functional

Available

NA

Not available

No

Yes

No

Yes

Yes

Yes

Yes

Yes

Mahilpur

Functional

Available

Functional

Available

No

Yes

No

Yes

Yes

Yes

Yes

Yes

Majitha

(Contd...)

Functional

Available

Functional

Available

No

Yes

No

Yes

No

No

Yes

Yes

Manawala

The Health Care Delivery System provided by PHSC, Punjab

Study to Review

221

No Yes

Maintenance of various registers, records, etc.

Not available

Quality of care

Satisfactory availability of diet

Yes

No

Concept of progressive patient care

Adequacy and working of fans and lights

Yes

Yes

Yes

Not available

Yes

Yes

Yes

Functional

Functional

Condition on availability

Stationeries, forms and various updated registers etc.

Available

Available

Availability and functioning of emergency light /wheel chairs/stretcher trolley

Not available

Fatehgarh

NA

Not available

Badal

NA

Condition on availability

Availability and functioning of venesection/ LP/ tracheostomy tray

Description of facilities

Yes

Yes

Not available

Yes

Yes

No

NA

Not available

NA

Not available

Ferozshah

Yes

Yes

Not available

Yes

Yes

Yes

Functional

Available

Functional

Available

Goniana

Yes

Yes

Not available

Yes

Yes

Yes

Functional

Available

Functional

Available

Kartarpur

Yes

No

Not available

Yes

No

Yes

NA

Not available

NA

Not available

Khemkaran

Name of the CHC

Yes

Yes

Not available

Yes

No

No

Functional

Available

NA

Not available

Longowal

Yes

Yes

Not available

Yes

No

Yes

Functional

Available

Functional

Available

Machiwara

Yes

Yes

Not available

Yes

Yes

Yes

Functional

Available

NA

Not available

Mahilpur

Yes

No

Not available

Yes

No

Yes

Functional

Available

NA

Not available

Majitha

Yes

No

Not available

Yes

Yes

Yes

Functional

Available

NA

Not available

Manawala

222

Study to Review

The Health Care Delivery System provided by PHSC, Punjab

Yes No

Yes No No

No

No Yes No

Yes

No

Yes Yes No Yes

Staff knowledge on material management, system of FIFO,bin cards, lead time, buffer stock reorder level

Availability of vital,essential drugs in sufficient quantity

Upkeep of expiry date register and its regular inspection by MO i/c

Efforts made to redistribute large stocks of slow moving drugs or near expiry for its utilisation

Proper arrangements to keep drugs as per ABC/VED category and storage of rubber goods as per guidelines

Appropriate steps taken to prevent pilferage or drugs

Convenient arrangement of issuing drugs to various wards

Regular sending of samples to chemical laboratory for checking standards of drugs

Circulation of list of available drugs to all MOs, OPD& wards as per generic name

Submission of certified bills to office for release of payments with in three days

Auction to clear the empty material from store done regularly

Availability of fire fighting equipment & knowledge to use them

Availability of regularly updated hospital drug formulary

Existence of standing drug committee

Badal

restriction on entery for unauthorised personnels

Description of facilities

No

No

No

No

Yes

Yes

No

Yes

Yes

No

No

No

Yes

No

Yes

Fatehgarh

No

Yes

No

No

Yes

No

No

Yes

Yes

No

Yes

Yes

No

Yes

Yes

Ferozshah

Table 3.12 Hospital Medical Stores at CHCs

Yes

No

No

Yes

Yes

Yes

No

Yes

Yes

Yes

Yes

No

Yes

Yes

Yes

Goniana

Yes

Yes

No

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Kartarpur

No

No

No

No

No

Yes

No

Yes

Yes

No

No

Yes

No

Yes

No

Khemkaran

No

No

Yes

No

No

No

No

Yes

No

No

No

No

Yes

Yes

No

Longowal

Name of the CHC

No

No

No

No

Yes

Yes

No

Yes

Yes

No

Yes

Yes

Yes

No

Yes

Machiwara

No

Yes

No

Yes

Yes

Yes

No

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

Mahilpur

No

No

No

No

Yes

Yes

No

Yes

Yes

No

No

No

Yes

Yes

Yes

Majitha

No

No

No

Yes

No

No

No

Yes

No

No

No

No

No

No

Yes

Manawala

The Health Care Delivery System provided by PHSC, Punjab

Study to Review

223

Yes

No

Yes No Yes Yes

Yes

Case record is maintained as per WHO classification of diseases (ICD-X)

Regular submission of morbidity, mortality reports

Is the backup facility kept to safe guard these records

Is the effective retrieval system followed

Regular death audit meeting held/minutes or meeting recorded/ corrective action taken

Medical audit done at regular interval

Manual

Yes

Badal

Is it managed by trained medical record officer/technician & supervision provided by MOi/c

Is the medical record computerised or manual

Availability of medical record room with enough no. of racks etc.

Description of facilities

Yes

No

No

No

Yes

No

No

Manual

Yes

Fatehgarh

No

No

No

Yes

Yes

No

Yes

Manual

Yes

Ferozshah

Table 3.13 Medical Record Department at CHCs’

Yes

No

No

No

Yes

No

No

Manual

Yes

Goniana

Yes

Yes

No

No

Yes

No

No

Manual

Yes

Kartarpur

Yes

No

No

No

Yes

No

No

Manual

Yes

Khemkaran

Name of the CHC

Yes

No

Yes

No

Yes

No

No

Manual

Yes

Longowal

No

Yes

No

No

Yes

Yes

Yes

Manual

Yes

Machiwara

Yes

No

Yes

Yes

Yes

Yes

No

Manual

Yes

Mahilpur

No

No

No

No

Yes

No

Yes

Manual

Yes

Majitha

No

No

Yes

No

No

No

No

Manual

Yes

Manawala

224

Study to Review

The Health Care Delivery System provided by PHSC, Punjab

Yes

Yes

No

No

No No No

No

Segregation of different categories of waste done at point of generation

Collection of waste, packaging, labeling, record keeping done in scientific way

Proper transportation of waste collected

Storage facility and duration

Disposal/ recycling methods for various categories of waste

Availability of autoclave, shredders , incinerators etc.

No

No

Yes

No

Yes

No

Are these placed strategically in all patient care areas

Yes

Fatehgarh

No

Badal

Adequate no. of bins and bags of required colour codes are available

Description of facilities

No

No

No

Yes

Yes

Yes

Yes

Yes

Ferozshah

Table 3.14 Hospital Waste Management at CHCs

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Goniana

Yes

No

No

Yes

Yes

Yes

Yes

Yes

Kartarpur

Yes

No

Yes

Yes

Yes

Yes

No

No

Khemkaran

Name of the CHC

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Longowal

Yes

Yes

No

Yes

Yes

Yes

Yes

Yes

Machiwara

No

Yes

No

Yes

Yes

Yes

Yes

Yes

Mahilpur

No

No

No

Yes

Yes

Yes

Yes

Yes

Majitha

Yes

No

No

Yes

Yes

Yes

Yes

Yes

Manawala

The Health Care Delivery System provided by PHSC, Punjab

Study to Review

225

No

Yes No

Having all the required equipments & autoclaves

Quality control measures are strictly followed

In-house

Fatehgarh In-house

Ferozshah

Yes

Yes

Ferozshah

In-house

Goniana

Yes

Yes

Yes

Goniana

In-house

Kartarpur

Yes

Yes

No

Kartarpur

Outsourced

Khemkaran

Longowal

No

Yes

Yes

Longowal

Outsourced

Name of the CHC

Yes

Yes

No

Khemkaran

Name of the CHC

Outsourced

Machiwara

Yes

Yes

Yes

Machiwara

Outsourced

Mahilpur

Yes

Yes

No

Mahilpur

Outsourced

Majitha

No

Yes

Yes

Majitha

In-house

Manawala

Yes

Yes

Yes

Manawala

Not adequate Average Average

Quality of wash

Quality of linen

Average

Average

Not adequate

Average

Average

Not adequate

Good

Good

Adequate

Good

Good

Adequate

Average

Average

NA

Average

Average

NA

Good

Good

NA

Good

Average

NA

Good

Good

NA

Good

Average

Adequate

Conventional Conventional Conventional Conventional ConvenConvenConvenConven Conventional Conventional Conven tional (dhobi) (dhobi) (dhobi) (dhobi) tional (dhobi) tional (dhobi) tional (dhobi) tional (dhobi) (dhobi) (dhobi) (dhobi)

In-house

Badal

Laundry staff

Laundry services if in-house

Description of facilities

Table 3.16 Laundry Services at CHCs

No

No

Fatehgarh

No

Badal

CSSD (under supervision of trained staff/ senior nursing officer

Description of facilities

Table 3.15 Central Sterile Supply Department at CHCs

226

Study to Review

The Health Care Delivery System provided by PHSC, Punjab

NA NA

NA

NA

NA

NA

NA

NA

Measures for pest and rodent control

Sanitation and hygiene of the cooking area properly maintained

Regular health checkup for food handlers

Availability of modern cooking equipments

Availability of properly maintained records & registers

Diet service under the supervision of a qualified dietitian NA

NA

NA

NA

NA

NA

Proper and safe arrangement for storage of raw material

Not available

Fatehgarh

Not available

Badal

Availability of kitchen Facility

Description of facilities

Table 3.17 Dietary Services

NA

NA

NA

NA

NA

NA

NA

Not available

Ferozshah

NA

NA

NA

NA

NA

NA

NA

Not available

Goniana

NA

NA

NA

NA

NA

NA

NA

Not available

Kartarpur

NA

NA

NA

NA

NA

NA

NA

Not available

Khemkaran

Name of the CHC

NA

NA

NA

NA

NA

NA

NA

Not available

Longowal

NA

NA

NA

NA

NA

NA

NA

Not available

Machiwara

NA

NA

NA

NA

NA

NA

NA

Not available

Mahilpur

NA

NA

NA

NA

NA

NA

NA

Not available

Majitha

NA

NA

NA

NA

NA

NA

NA

Not available

Manawala

The Health Care Delivery System provided by PHSC, Punjab

Study to Review

227

Psychiatry

Dermatologist

Orthopedics

ENT

Pediatrics

OBG

Surgery

Medicine

Name of Post

-

MBBS

-

M.D. -

-

MBBS

Diploma

-

Diploma

-

-

MBBS

M.D.

1

-

M.S.

Diploma

-

MBBS

-

M.S. -

-

MBBS

Diploma

-

-

M.D.

Diploma

-

MBBS

-

M.S. -

-

Diploma

-

1

M.S.

MBBS

-

MBBS

Diploma

1

-

Badal

Diploma

M.D.

Post

-

-

-

-

-

-

-

-

-

-

-

-

-

-

1

-

-

-

-

-

1

-

-

1

Fategarh

Table 3.18 Medical Officers in Position

-

-

-

-

-

-

-

-

-

-

-

-

-

-

1

-

-

-

-

-

1

1

-

-

Feroz shah

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

1

-

-

1

Goniana

-

-

-

-

-

-

-

-

-

-

-

1

-

-

-

-

-

-

-

-

1

-

-

-

Kartarpur

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

1

-

-

1

-

-

1

Khem Karan

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

1

Longo wal

Name of CHC

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

1

1

-

1

MachiWara

-

-

-

-

-

-

-

-

-

-

-

1

-

-

-

-

-

1

-

-

-

-

-

-

MahilPur

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

4

Majitha

-

-

-

-

-

-

-

-

-

-

-

-

-

-

1

-

-

-

-

-

-

2

-

1

Manawala

(Contd...)

-

-

-

-

-

-

-

1

-

-

-

2

-

-

3

-

-

2

-

-

7

4

1

10

Total

228

Study to Review

The Health Care Delivery System provided by PHSC, Punjab

Dental

Radiology

Microbiology

Bio-chemistry

Pathology

Blood Bank

Anaesthesia

Name of Post

1 1

MBBS

BDS

MBBS

-

M.D.

Diploma

-

MBBS

-

MD/MSc -

-

MBBS

Diploma

-

Diploma

-

-

M.D.

MD/MSc

-

MBBS

-

-

Diploma

MBBS

-

M.D.

-

-

MBBS

Diploma

-

1

Badal

Diploma

M.D.

Post

-

1

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

1

Fategarh

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

Feroz shah

1

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

Goniana

-

1

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

Kartarpur

-

1

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

Khem Karan

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

Longo wal

Name of CHC

-

1

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

1

MachiWara

-

-

-

-

1

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

MahilPur

-

1

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

Majitha

-

1

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

Manawala

2

6

1

-

1

-

-

-

-

-

-

-

-

-

-

-

-

-

-

3

Total

The Health Care Delivery System provided by PHSC, Punjab

Study to Review

229

No. of admission through emergency

No. of emergencies

No. of Surgeries done

In-patient Admitted

OPD attendance last 5 year 18881 27901

4th Yr

5th Yr

256

nd

1052

nd

375 -

5th Yr

1st Yr

nd

-

3 Yr

4th Yr

5th Yr

rd

2 Yr

107

4th Yr

3rd Yr 66

61

nd

2 Yr

120

1 Yr

st

5 Yr

th

2272

2087

th

4 Yr

1570

3 Yr

rd

2 Yr

356

1 Yr

st

5 Yr

th

765

608

th

4 Yr

281

3 Yr

rd

2 Yr

649

1 Yr

st

15594

17531

3rd Yr

30492.

2nd Yr

Badal

1st Yr

Performance (Annual)

261

174

141

242

233

225

247

258

348

280

1759

1293

1242

1084

675

919

1176

1401

1476

1482

50034

52710

47052

39209

37673

Fategarh

71

61

45

37

51

77

72

164

293

139

590

605

703

425

169

547

431

499

523

272

11354

9940

10804

13792

8688

Feroz shah

627

594

469

653

744

874

823

616

735

791

1524

1121

706

1503

1576

2966

2592

2089

2940

3116

40925

47352

35013

44249

41371

Goniana

697

762

493

473

547

-

-

-

-

-

292

282

271

249

241

1728

1867

1950

2017

1795

62492

59030

56222

68949

59152

Kartarpur

106

32

31

-

-

114

55

40

-

-

1020

741

807

-

-

1229

713

748

-

-

28756

23310

21008

-

-

Khem Karan

Name of the CHC

Table 3.19 Five Years Performance Report of CHC Hospitals (Punjab)

104

100

264

250

257

226

189

422

533

526

302

560

140

345

386

465

636

602

629

843

13061

17066

14038

13504

17797

Longo wal

466

453

263

364

344

2675

1933

1791

1756

1478

964

725

791

784

573

1263

1266

1415

719

426

35158

29461

35166

34748

28788

MachiWara

365

106

167

131

13

387

106

167

131

13

6

649

518

474

255

1072

328

621

631

413

37977

33811

24531

26459

20361

MahilPur

500

558

509

-

-

-

-

-

-

-

1314

805

814

-

-

1410

1142

1219

-

-

-

-

51578

41406

44498

Majitha

(Contd...)

-

-

-

-

-

1703

1296

956

768

-

-

-

-

-

-

-

-

-

-

-

25980

20387

20980

21263

19683

Manawala

230

Study to Review

The Health Care Delivery System provided by PHSC, Punjab

No. of Caesarians done

No. of Normal deliveries conducted

No. of Postmortem

No. of medicolegal cases

-

-

4th Yr

5th Yr

23

nd

-

nd

5 Yr

th

-

-

th

4 Yr

-

3 Yr

rd

2 Yr

-

1 Yr

st

5 Yr

th

8

84

th

4 Yr

101

3 Yr

rd

2 Yr

18

1 Yr

st

-

-

2nd Yr

3rd Yr

-

1 Yr

st

5 Yr

th

-

-

th

4 Yr

-

3 Yr

rd

2 Yr

-

nd

Badal

1st Yr

Performance (Annual)

9

47

67

73

104

4

13

69

56

63

-

-

-

-

-

148

91

145

169

197

Fategarh

0

0

0

Do

NIL

7

9

10

13

6

0

0

0

0

NIL

68

72

49

43

49

Feroz shah

0

0

1

47

64

76

78

78

102

230

0

0

0

0

0

282

354

248

283

NA

Goniana

7

10

13

-

-

71

82

56

23

9

-

-

-

-

-

390

305

237

225

203

Kartarpur

NIL

NIL

NIL

-

-

139

86

64

NA

NA

NA

-

-

-

-

-

-

-

Khem Karan

Name of the CHC

0

0

0

0

4

43

38

30

43

42

0

0

0

0

0

67

68

104

122

133

Longo wal

5

41

31

NA

NA

54

151

72

NA

NA

-

-

-

-

-

352

400

300

315

281

MachiWara

-

-

1

1

-

-

-

6

-

1

0

0

0

0

0

0

0

0

0

0

MahilPur

7

3

1

-

-

40

32

28

-

-

-

-

-

-

-

293

365

385

415

378

Majitha

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

218

239

264

257

208

Manawala

The Health Care Delivery System provided by PHSC, Punjab

Study to Review

231

Class IV

Administrative staff

Technician (MLT)

Nursing Staff

Doctors specialist

Doctors/ GDMO

Name

10 5 3 2 1 1 1 -

Sanction

Vacant

Ad hock

Total in Position

Sanction

Vacant

Ad hock

Total in Position

Sanction

Vacant

Ad hock

Total in Position

2+7(*)

-

1

Total in Position

Ad hock

-

Ad hock

-

2

Vacant

Vacant

3

Sanction

2

4

Total in Position

Sanction

1

Ad hock

1

6

Vacant

Total in Position

11

Badal

Sanction

Post

Table 3.20 Staff Position at CHC

20

-

-

20

-

-

-

-

3

-

-

3

4+3(*)

-

-

4

3

-

1

4

1

-

-

1

Fategarh

8

-

1

9

3

-

-

3

2

1

-

3

9

-

-

9

1

-

-

1

2

-

3

5

Feroz shah

6

-

-

6

2

-

-

2

1

-

2

3

3

-

2

5

1

-

-

1

3

-

2

5

Goniana

4

-

-

4

-

-

-

-

2

-

-

2

5

-

-

5

-

-

-

-

4

-

2

6

Kartarpur

12

-

2

14

-

-

1

1

3

-

1

4

2

-

5

7

4

-

1

5

-

-

1

1

Khem Karan

7

-

-

7

-

-

-

-

3

-

-

3

2

-

5

7

1

-

3

4

-

-

-

-

Longo wal

20

-

3

23

4

-

1

5

3

-

1

4

9

-

1

10

2

-

1

3

5

-

1

6

MachiWara

1

-

-

1

1 missing

-

-

1

1

-

-

1

5+1(*)

4

1

6

4

-

-

4

1

-

-

1

MahilPur

7+3(*)

-

-

10

-

-

-

-

2

-

-

2

3+7(*)

-

-

4

4

-

1 (L.L)

5

1

-

-

1

Majitha

(Contd...)

33

-

7

40

5

1

-

6

4

-

1

5

4

1

-

5

-

-

-

-

6

-

-

6

Manawala

232

Study to Review

The Health Care Delivery System provided by PHSC, Punjab

-

Ad hock

-

Ad hock

-

Total in Position

Sanction

Vacant

Ad hock

Total in Position

-

Vacant -

-

Sanction

Ad hock

-

Total in Position

-

Vacant -

-

Sanction

Ad hock

-

-

Vacant

Total in Position

-

Sanction

-

-

Total in Position

Ad hock

-

-

Vacant

Ad hock

-

Sanction

3+4(*)

-

Vacant

Total in Position

3

Sanction

2+3(*)

-

Vacant

Total in Position

2

Badal

Sanction

Post

* Placed on Deputation in CHC LL Staff on long leave

Others (Driver Cook)

MPW/ Trained Dai

BEE & Computer

Radiographer

Ophthalmolo-Gists

Pharmacists

Safai Sewak

Name

-

-

-

-

-

-

-

-

-

-

-

-

1

-

-

1

1

-

-

1

-

-

-

-

3

-

-

3

Fategarh

-

-

-

-

3

-

-

3

1

-

1

2

1

-

-

1

1

-

-

1

2

-

-

2

-

-

-

-

Feroz shah

-

-

-

-

3

-

-

3

1

-

1

2

1

-

-

1

1

-

-

1

3

-

-

3

3

-

-

3

Goniana

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

1

-

-

1

-

-

-

-

Kartarpur

-

-

2

2

-

-

-

-

2

-

-

2

-

1

-

1

1

-

-

1

2

-

-

2

-

-

-

-

Khem Karan

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

3

-

-

3

Longo wal

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

2

-

1

3

MachiWara

1

-

-

1

-

-

-

-

-

-

-

-

1

-

-

1

-

-

-

-

1

-

-

1

1+2(*)

-

-

1

MahilPur

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

2+2(*)

-

-

2

Majitha

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

8+1(LL)

-

-

3

5

-

-

5

Manawala

The Health Care Delivery System provided by PHSC, Punjab

Study to Review

233

Goniana

Ferozshah

Fateh Garh Churian

Badal

Name of CHC

348579 310317 368792 533207

2004 -05

2005-06

2006-07

2007-08

280425 366520 219240

2005-06

2006-07

2007-08

51263 36953

2006-07

2007-08

696636 911286 562800

2005-06

2006-07

2007-08 3559998

713391

2004-05

Total

250366

2003-04

2,66,095

58344

2005-06

Total

70213

2004-05

1481185

400000

2004-05

Total

215000

2003-04

25,25,370

399211

2003-04

Total

565264

Total Income (Collection)

2002-03

Years

3469471

604410

674991

744866

543636

801568

1,79,218

35426

21298

42493

47001

18,34,100

389692

323200

331667

434410

355131

25,80,965

690227

323920

235849

278619

470469

644881

Total Expenditure

1391740

197456

167246

278851

218989

429198

57,465

4658

6886

26645

11345

5,97,499

100870

85931

138780

159859

112023

5,70,099

140727

65841

72054

80866

83575

127036

Medicine

757920

102112

190755

137195

162089

165769

75,571

12976

10000

13685

18558

5,73,928

140129

92113

90569

138416

112701

4,88,598

182053

86891

48060

60687

51130

59777

I.F.P.

208281

21500

27689

31166

29174

98752

23,468

5944

3522

2080

8337

2,01,847

9395

60074

38388

45184

48806

2,02,455

87348

47429

15659

15809

18378

17832

Buildings

466867

93508

62794

115240

87476

107849

16,770

5904

890

83

8761

3,24,407

39893

75812

50205

86282

72215

2,10,455

110842

17888

6261

11391

16423

47650

Equipment

Detailed Expenditure

Table 3.21 Utilisation of User Charges in different CHC of PHSC (Punjab)

340039

145603

126507

67929

-

-

-

-

-

-

-

22,995

0000

9270

13725

-

-

23,888

9123

14765

-

-

-

-

ERF A\c

204624

44231

-

114485

45908

-

-

-

-

-

-

14,019

0000

0000

0000

4633

9386

10,85,470

160134

91106

93815

109866

237963

392586

Salary to contractual staff

(Contd...)

100000

100000

-

-

-

-

-

-

-

-

-

99,405

99405

0000

0000

-

-

Rogi Kalayan

234

Study to Review

The Health Care Delivery System provided by PHSC, Punjab

Mahilpur

Longowal

Khemkaran

Kartarpur

Name of CHC

478843 492373 474959

2005-06

2006-07

2007-08

128097 161712 207068

2005-06

2006-07

2007-08

66505 54895 164564

2005-06

2006-07

2007-08

13,21,865

NA

2007-08

Total

51939 322719

2006-07

366152

2004-05

2005-06

281055

2003-04

3,89,258

79065

2004-05

Total

124229

2003-04

7,30,594

130270

2004-05

Total

103447

2003-04

23,28,255

450315

Total

431765

2004-05

Total Income (Collection)

2003-04

Years

12,14,035

NA

330901

382006

285383

215745

5,13,992

130702

65543

80028

79434

158285

6,69,036

241751

159780

98388

79366

89751

22,41,571

469563

413679

572262

359099

426968

Total Expenditure

5,80,293

NA

138608

210672

123477

106636

1,93,496

58816

29494

36013

33045

36128

2,71,549

108074

41508

48182

29787

43998

11,37,668

220268

211149

322973

166057

217221

Medicine

4,33,665

NA

143693

148645

97184

44143

1,07,499

32676

16386

20007

18359

20271

2,20,056

94624

51864

22396

20491

30681

6,36,972

58670

104888

150704

153339

169371

I.F.P.

1,49,334

NA

29079

9839

52766

57650

64,498

19605

9831

12004

11015

12043

85,667

9228

48769

4745

14193

8732

2,94,838

138152

54948

32813

37876

31049

Buildings

50,743

NA

19521

12850

11056

7316

64,499

19605

9832

12004

11015

12043

81,260

24930

14430

20705

14855

6340

1,40,708

52473

42694

34387

1827

9327

Equipment

Detailed Expenditure

-

-

-

-

-

-

-

-

-

-

-

-

10,564

4895

3309

2360

000

000

-

-

-

-

-

-

ERF A\c

-

-

-

-

-

-

84.000

0000

0000

0000

6000

78000

1907024

844840

1260697

1072243

-

-

-

-

-

-

Salary to contractual staff

(Contd...)

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

Rogi Kalayan

The Health Care Delivery System provided by PHSC, Punjab

Study to Review

235

Manawala

Machiwara

Majitha

Name of CHC

184678 288735 266770

2005-06

2006-07

2007-08

318580 293193

2005-06

2006-07

5,32,964

2007-08 16,19,252

3,20,209

2006-07

Total

4,36,904

2005-06

503043

3,29,175

2004-05

13,39,394 NA

16,27,316

404630

227145

233467

325598

148554

9,97,075

266790

219896

187891

187379

135119

Total Expenditure

2003-04

Total

401442

363384

2004-05

2007-08

250717

2003-04

10,58,623

182930

Total

135510

2004-05

Total Income (Collection)

2003-04

Years

6,30,406

2,20,740

1,22,149

1,79,740

1,07,777

NA

5,45,385

130392

98497

111935

153708

50853

3,89,212

125567

74884

84299

58492

45970

Medicine

4,76,179

1,37,261

1,08,489

1,27,786

1,02,643

NA

4,77,820

149071

66777

91636

107985

62351

2,26,087

57703

66133

48859

40568

12824

I.F.P.

1,92,041

92,839

34,452

14,801

49,949

NA

1,07,034

17841

18708

10554

45625

14306

1,16,318

38585

39279

11982

15717

11255

Buildings

2,89,394

66,975

49,541

1,08,297

64,581

NA

1,98,920

107326

43163

9107

18280

21044

1,33,097

40025

32305

20660

23037

17070

Equipment

Detailed Expenditure

-

-

-

-

-

NA

20,559

13935

2799

3825

-

-

15,661

4910

7295

3456

-

-

ERF A\c

31,232

15,149

5,578

6,280

4,225

NA

6,410

-

-

6410

-

-

1,16,700

-

-

19135

49565

48000

Salary to contractual staff

1,00,000

100000

-

-

-

NA

-

-

-

-

-

-

-

-

-

-

Rogi Kalayan

236

Study to Review

The Health Care Delivery System provided by PHSC, Punjab

Education

Sex

Age group

58 55.2% 45 42.9% 23 21.9% 26 24.8%

Female

Illiterate

Primary

Secondary

0 .0%

47 44.8%

Male

> Graduate

14 13.3%

Above 60

2 1.9%

24 22.9%

46-60

Graduate

19 18.1%

31-45

9 8.6%

46 43.8%

15-30

Senior secondary

2 1.9%

District Hospital

Less than 15

Socioeconomic dimension of inpatient

3 4.4%

1 1.5%

3 4.4%

24 35.3%

18 26.5%

19 27.9%

38 55.9%

30 44.1%

8 11.8%

0 .0%

0 .0%

4 13.8%

6 20.7%

7 24.1%

12 41.4%

10 34.5%

19 65.5%

4 13.8%

7 24.1%

4 13.8%

17 25.0% 6 8.8%

14 48.3%

0 .0%

CHC

37 54.4%

0 0%

Sub-Divisional Hospital

2 9.1%

2 9.1%

4 18.2%

3 13.6%

7 31.8%

4 18.2%

20 90.9%

2 9.1%

0 .0%

1 4.5%

5 22.7%

15 68.2%

1 4.5%

Special Hospital

Table 4. Distribution of Inpatients by Sex, Age Group, Education, Income & type of Health Facility Utilised N=224

(Contd...)

5 2.2%

5 2.2%

20 8.9%

59 26.3%

55 24.6%

80 35.7%

126 56.3%

98 43.8%

26 11.6%

38 17.0%

45 20.1%

112 50.0%

3 1.3%

TOTAL

The Health Care Delivery System provided by PHSC, Punjab

Study to Review

237

Income group

41 39.0% 47 44.8% 12 11.4% 4 3.8% 1 1.0%

2001-5000

5001-10000

10001-15000

Above 15000

District Hospital

Less than 2000

Socioeconomic dimension of inpatient

0 .0%

1 3.4%

1 3.4%

2 6.9%

11 16.2% 4 5.9%

9 31.0%

16 55.2%

CHC

27 39.7%

26 38.2%

Sub-Divisional Hospital

1 4.5%

3 13.6%

6 27.3%

5 22.7%

7 31.8%

Special Hospital

3 1.3%

12 5.4%

31 13.8%

88 39.3%

90 40.2%

TOTAL

238

Study to Review

The Health Care Delivery System provided by PHSC, Punjab

Admission through

55 52.4% 49 46.7% 1 1.0%

OPD

Can’t say

District Hospital

Emergency

Socioeconomic dimension of inpatient

13 44.8% 0 .0%

0 .0%

16 55.2%

CHC

30 44.1%

38 55.9%

Sub-Divisional Hospital

Table 5. Admission In Different Categories of Hospitals

0 .0%

16 72.7%

6 27.3%

Special Hospital

1 .4%

108 48.2%

115 51.3%

TOTAL

The Health Care Delivery System provided by PHSC, Punjab

Study to Review

239

Payment for any other

Payment for investigation charges

Payment for admission charges

Consultancy charges

Slip/card making

Payment

0 .0% 9 8.6% 96 91.4% 0 .0%

No response

Yes

No

No response

16 15.2%

No response

27 25.7%

Yes

62 59.0%

1 1.0%

No response

No

16 15.2%

No

88 83.8%

0 .0%

No response

Yes

16 15.2%

No

89 84.8%

13 12.4%

No

Yes

92 87.6%

Yes

District Hospital

7 10.3%

39 57.4%

22 32.4%

2 2.9%

8 11.8%

58 85.3%

1 1.5%

23 33.8%

44 64.7%

1 1.5%

60 88.2%

7 10.3%

1 1.5%

9 13.2%

58 85.3%

SDH

Type of Hospital

Table 6. User Charges for Services in Various Hospitals in Punjab

7 24.1%

12 41.4%

10 34.5%

1 3.4%

0 .0%

28 96.6%

0 .0%

6 20.7%

23 79.3%

5 17.2%

21 72.4%

3 10.3%

0 .0%

1 3.4%

28 96.6%

CHC

3 13.6%

16 72.7%

3 13.6%

0 .0%

3 13.6%

19 86.4%

0 .0%

2 9.1%

20 90.9%

0 .0%

18 81.8%

4 18.2%

0 .0%

3 13.6%

19 86.4%

Special Hospital

33 14.7%

129 57.6%

62 27.7%

4 1.8%

27 12.1%

193 86.2%

1 .4%

47 21.0%

176 78.6%

6 2.7%

195 87.1%

23 10.3%

1 .4%

26 11.6%

197 87.9%

Total

240

Study to Review

The Health Care Delivery System provided by PHSC, Punjab

Quality of treatment in hospital

Reception/admission

OPD/Emergency

Rating experience

85 81.0% 16 15.2% 1 1.0% 3 2.9%

Good

Average

Poor

Can’t say

13 12.4%

Average

1 1.0%

87 82.9%

Good

No response

1 1.0%

No response

4 3.8%

4 3.8%

Can’t say

Can’t say

1 1.0%

Poor

0 .0%

20 19.0%

Average

Poor

79 75.2%

Good

District Hospital

1 1.5%

3 4.4%

14 20.6%

50 73.5%

1 1.5%

0 .0%

1 1.5%

7 10.3%

59 86.8%

0 .0%

0 .0%

3 4.4%

9 13.2%

56 82.4%

Sub-Divisional Hospital

Type of Hospital

1 3.4%

0 .0%

7 24.1%

21 72.4%

0 .0%

1 3.4%

0 .0%

8 27.6%

20 69.0%

0 .0%

1 3.4%

0 .0%

9 31.0%

19 65.5%

CHC

0 .0%

0 .0%

1 4.5%

21 95.5%

0 .0%

0 .0%

0 .0%

2 9.1%

20 90.9%

0 .0%

0 .0%

0 .0%

2 9.1%

20 90.9%

Special Hospital

(Contd...)

5 2.2%

4 1.8%

38 17.0%

177 79.0%

2 .9%

5 2.2%

1 .4%

30 13.4%

186 83.0%

1 .4%

5 2.2%

4 1.8%

40 17.9%

174 77.7%

Total

Table 7. Experience at OPD/emergency/reception/Admission, Quality of Treatment, Security & Admission Procedure of Various Hospitals

The Health Care Delivery System provided by PHSC, Punjab

Study to Review

241

20 19.0% 15 14.3% 16 15.2% 11 10.5%

Average

Poor

Can’t say

Good

Poor

77 73.3%

12 11.4%

54 51.4%

District Hospital

Good

Rating of admission Average procedure of hospital

Security of hospital

Rating experience

55 80.9%

8 11.8%

3 4.4%

17 25.0%

14 20.6%

11 16.2%

26 38.2%

Sub-Divisional Hospital

Type of Hospital

25 86.2%

3 10.3%

1 3.4%

7 24.1%

8 27.6%

1 3.4%

13 44.8%

CHC

17 77.3%

4 18.2%

1 4.5%

3 13.6%

1 4.5%

7 31.8%

11 50.0%

Special Hospital

174 77.7%

27 12.1%

16 7.1%

43 19.2%

38 17.0%

39 17.4%

104 46.4%

Total

242

Study to Review

The Health Care Delivery System provided by PHSC, Punjab

Ward & bed- light & fan

Ward & bed- comfort

Ward & bed- linen

Ward & bed- General cleanliness

7 6.7% 76 72.4% 28 26.7% 1 1.0% 81 77.1%

Poor

Good

Average

Poor

Good

4 3.8%

35 33.3%

Average

Poor

63 60.0%

Good

20 19.0%

3 2.9%

Poor

Average

38 36.2%

64 61.0%

District Hospital

Average

Good

Ward & bed- General characteristics

0 .0%

15 22.1%

53 77.9%

2 2.9%

21 30.9%

45 66.2%

6 8.8%

19 27.9%

43 63.2%

3 4.4%

24 35.3%

41 60.3%

Sub-Divisional Hospital

Type of Hospital

0 .0%

5 17.2%

24 82.8%

0 .0%

3 10.3%

26 89.7%

0 .0%

0 .0%

29 100.0%

0 .0%

6 20.7%

23 79.3%

CHC

0 .0%

2 9.1%

20 90.9%

0 .0%

3 13.6%

19 86.4%

0 .0%

3 13.6%

19 86.4%

0 .0%

1 4.5%

21 95.5%

Special Hospital

(Contd...)

3 1.3%

42 18.8%

178 79.5%

13 5.8%

57 25.4%

166 74.1%

6 2.7%

69 30.8%

149 66.5%

3 1.3%

99 44.2%

149 66.5%

N=224

Total

Table 8. Patient’s Responses on Quality of Services in Terms of General Cleanliness, Basic Support Services in Ward in Various Health Settings

The Health Care Delivery System provided by PHSC, Punjab

Study to Review

243

Ward & bed- food

Ward & bed- toilet 19 18.1% 2 1.9% 17 16.2% 3 2.9% 0 .0%

Poor

Can’t say

Good

Average

Poor 85 81.0%

40 38.1%

Average

Can’t say

44 41.9%

District Hospital

Good

Ward & bed- General characteristics

56 82.4%

1 1.5%

3 4.4%

8 11.8%

1 1.5%

19 27.9%

16 23.5%

32 47.1%

Sub-Divisional Hospital

Type of Hospital

22 75.9%

0 .0%

0 .0%

7 24.1%

0 .0%

2 6.9%

11 37.9%

16 55.2%

CHC

17 77.3%

0 .0%

1 4.5%

4 18.2%

1 4.5%

0 .0%

7 31.8%

14 63.6%

Special Hospital

180 80.4%

1 .4%

7 3.1%

36 16.1%

4 1.8%

40 17.9%

74 33.0%

106 47.3%

N=224

Total

244

Study to Review

The Health Care Delivery System provided by PHSC, Punjab

47 69.1% 14 20.6% 0 .0% 7 10.3% 49 72.1% 16 23.5% 1 1.5% 2 2.9%

82 78.1% 19 18.1% 1 1.0% 3 2.9% 84 80.0% 20 19.0% 0 .0% 1 1.0%

Good

Average

Poor

Can’t say

Good

Average

Poor

Can’t say

Attitude of sisters at admission

Behaviour of rest of staff during stay in hospital

1 1.5%

64 94.1%

97 92.4%

Good

1 1.0%

0 .0%

0 .0%

Can’t say

Can’t say

1 1.5%

1 1.0%

Poor

3 4.4%

21 30.9%

12 11.4%

Average

7 6.7%

46 67.6%

92 87.6%

Good

Behaviour of doctors during stay in Average hospital

Behaviour of nurses during stay in hospital

Sub-Divisional Hospital

District Hospital

Type of Hospital

0 .0%

2 6.9%

5 17.2%

22 75.9%

1 3.4%

2 6.9%

6 20.7%

20 69.0%

0 .0%

2 6.9%

27 93.1%

1 3.4%

2 6.9%

2 6.9%

24 82.8%

CHC

0 .0%

0 .0%

3 13.6%

19 86.4%

0 .0%

1 4.5%

4 18.2%

17 77.3%

0 .0%

1 4.5%

21 95.5%

0 .0%

0 .0%

4 18.2%

18 81.8%

Special Hospital

Table 9. Patients Observation about the Behaviour & Attitude of Nurses, Doctors, Staff during stay in Hospital

3 1.3%

3 1.3%

44 19.6%

174 77.7%

11 4.9%

4 1.8%

43 19.2%

166 74.1%

2 .9%

13 5.8%

209 93.3%

1 .4%

4 1.8%

39 17.4%

180 80.4%

Total

The Health Care Delivery System provided by PHSC, Punjab

Study to Review

245

1 1.0% 8 7.6%

Poor

Can’t say

69 65.7%

Good 27 25.7%

2 1.9%

Can’t say

Average

36 34.3%

14 20.6%

2 2.9%

15 22.1%

37 54.4%

1 1.5%

25 36.8%

36 52.9%

54 51.4%

None available

Some available

6 8.8%

13 12.4%

Sub-Divisional Hospital

Paid any money to staff member during stay in hospital

105 100.0%

No

67 98.5%

1 1.5%

0 .0%

7 6.7% 0 .0%

68 100.0%

98 93.3%

Yes

Yes Any money spend on medicine No

Table 11. Patient’s Response in Terms of any Money Spent on Medicine

Facilities for laboratory & radiological investigations

Availability of medicines in the ward

All available

District Hospital

Type of Hospital

29 100.0%

0 .0%

9 31.0%

20 69.0%

3 10.3%

0 .0%

11 37.9%

15 51.7%

1 3.4%

3 10.3%

21 72.4%

4 13.8%

CHC

22 100.0%

0 .0%

4 18.2%

18 81.8%

2 9.1%

0 .0%

1 4.5%

19 86.4%

0 .0%

1 4.5%

14 63.6%

7 31.8%

Special Hospital

223 99.6%

1 .4%

20 8.9%

204 91.1%

27 12.1%

3 1.3%

54 24.1%

140 62.5%

4 1.8%

65 29.0%

125 55.8%

30 13.4%

Total

Table 10. Patient’s Responses on Quality of Services in Terms of Availability of Medicines in the Ward Laboratory & Radiological Services

246

Study to Review

The Health Care Delivery System provided by PHSC, Punjab

43 41.0% 2 1.9% 69 65.7% 33 31.4% 1 1.0% 2 1.9%

No

No response

Complete

Partial

Inadequate

Can’t say

60 57.1%

0 .0%

7 10.3%

16 23.5%

45 66.2%

0 .0%

30 44.1%

38 55.9%

Sub-Divisional Hospital

1 3.4%

1 3.4%

3 10.3%

24 82.8%

1 3.4%

15 51.7%

13 44.8%

CHC

0 .0%

2 9.1%

3 13.6%

17 77.3%

0 .0%

11 50.0%

11 50.0%

Special Hospital

Satisfaction with services of hospital

101 96.2% 4 3.8%

Yes

No

9 13.2%

59 86.8%

0 .0%

29 100.0%

0 .0%

22 100.0%

Table 13. Satisfactions of the Patients with Services of Hospital at the Various Health Facilities

Information about disease & treatment by doctor

Information about rules and regulation

Yes

District Hospital

Type of Hospital

13 5.8%

211 94.2%

3 1.3%

11 4.9%

55 24.6%

155 69.2%

3 1.3%

99 44.2%

122 54.5%

Total

Table 12. Patient’s Responses on Quality of Services in Terms of Adequacy of Information About Rules, Regulation, Disease & Treatment In Health Settings

The Health Care Delivery System provided by PHSC, Punjab

Study to Review

247

Suggestions for Improvement of the Services for In-patient Department

Medicines should be available in the hospital/provide all medicines.

Medicines should be provided free of cost or subsidise rate.

Health facilities should be provided free of cost to BPL/poor families

Quality of medicine should be improved, those are supplied by the hospitals

Needs regular visits of higher authorities for day-to-day work of the hospitals/female doctors/specialist should treat gynae. problems & doctors should be available in OPD clinic on fixed days.

Doctors should be available in hospitals at night shifts/needs proper care at night shifts in emergency.

Behaviour of staff nurses & class-IV employees should be improved towards patients.

Other facilities needs to be improved: i) Provision of food for the patients on subsidise rate ii) Needs cleanliness of toilets/separate toilets for male & female. iii) Hospital cleanliness. iv) Drinking water facilities should be available /improved. v) All diagnostic facilities for treatment should be available in the hospitals on subsidise rate or free of cost. vi) Proper Security arrangements for wards & Hospital. vii) Private rooms should be available in hospitals for patients on payment basis/needs sitting arrangements & patient’s attendants.

Satisfied with the Health Services.

No response

S.No

1.

2.

3.

4.

5.

6.

7.

8.

9.

10

Table 14. Suggestions for Further Improvement in the Services by the In-patients

112

9

12 15 11 5 4 4 4

3

3

10

3

14

15

42

N = 224

50

4.02

5.36 6.7 4.91 2.23 1.79 1.79 1.79

1.34

1.34

4.46

1.34

6.25

6.7

18.75

Percentage

248

Study to Review

The Health Care Delivery System provided by PHSC, Punjab

Education

Age

Sex

57 (50)

65 (48.1) 70 (51.9) 6 (4.4) 46 (34.1) 36 (26.7) 28 (20.7) 19 (14.1) 52 (38.5) 34 (25.2) 26 (19.3) 16 (11.9) 5 (3.7) 2 (1.5)

116 (40.8) 168 (59.2) 15 (5.3) 110 (38.7) 86 (30.3) 54 (19) 19 (6.7) 82 (28.9) 65 (22.9) 80 (28.2) 30 (10.6) 19 (6.7) 8 (2.8)

Male

Female

Less than 15

15-30

31-45

46-60

Above 60

Illiterate

Primary

Secondary

Senior Secondary

Graduate

>Graduate

3 (2.6)

5 (4.4)

13 (11.4)

19 (16.7)

18 (15.8)

56 (49.1)

18 (15.8)

29 (25.4)

43 (37.7)

22 (19.3)

2 (1.8)

57 (50)

CHC

Sub-Divisional Hospital

District Hospital

Type of Hospital

0 (0.0)

4 (8.5)

10 (21.3)

8 (17.0)

13 (27.7)

12 (25.5)

2 (4.3)

1 (2.1)

6 (12.8)

26 (55.3)

12 (25.5)

41 (87.2)

6 (12.8)

Special Hospital

Table 15. Distribution of Outpatient by Sex, Age Group, Education, Income and Type of Facility Utilised

(Contd...)

13 (2.2)

33 (5.7)

69 (11.9)

133 (22.9)

130 (22.4)

202 (34.8)

58 (10.0)

112 (19.3)

171 (29.5)

204 (35.2)

35 (6.0)

336 (57.9)

244 (42.1)

Total

N=580

The Health Care Delivery System provided by PHSC, Punjab

Study to Review

249

Income

85 (29.9) 120 (42.3) 48 (16.9) 14 (4.9) 16 (5.6) 1 (0.4)

Less than 2000

2001-5000

5001-10000

10001-15000

Above 15000

Don’t Know

District Hospital

3 (2.2)

6 (4.4)

5 (3.7)

30 (22.2)

42 (31.1)

49 (36.3)

Sub-Divisional Hospital

Type of Hospital

9 (7.9)

2 (1.8)

5 (4.4)

10 (8.8)

36 (31.6)

52 (45.6)

CHC

1 (2.1

5 (10.6)

2 (4.3)

6 (12.8)

22 (46.8)

11 (23.4)

Special Hospital

14 (2.4)

29 (5.0)

26 (4.5)

94 (16.2)

220 (37.9)

197 (34.0)

Total

250

Study to Review

The Health Care Delivery System provided by PHSC, Punjab

Money spent on medicine

Investigation charges

Consultancy charges

OPD card charges

133 (98.5) 2 (1.5) 5 (3.7) 130 (96.3) 0 (0.0) 97 (71.9) 33 (24.4) 5 (3.7) 27 17.6% 29 22.0% 22 22.4% 12 19.7%

16 (5.6) 13 (4.6) 269 (94.7) 2 (0.7) 196 (69.0) 82 (28.9) 6 (2.1) 71 46.4% 68 51.5% 58 59.2% 35 57.4%

No

Yes

No

Can’t say

Yes

No

Can’t say

Up to 100

101 - 200

201-500

Above 500

Sub-Divisional Hospital

268 (94.4)

Yes

District Hospital

Type of Hospital

Table 16. User Charges for Services in Various Health Care Settings

10 16.4%

11 11.2%

26 19.7%

34 22.2%

4 (3.5)

29 (25.4)

81 (71.1)

1 (0.9)

109 (95.6)

4 (3.5)

8 (7.0)

106 (93.0)

CHC

4 6.6%

7 7.1%

9 6.8%

21 13.7%

0 (0.0)

15 (31.9)

32 (68.1)

0 (0.0)

41 (87.2)

6 (12.8)

4 (8.5)

43 (91.5)

Special Hospital

61 100.0%

98 100.0%

132 100.0%

153 100.0%

15 (2.6)

159 (27.4)

406 (70.0)

3 (0.5)

549 (94.7)

28 (4.8)

30 (5.2)

550 (94.8)

TOTAL

The Health Care Delivery System provided by PHSC, Punjab

Study to Review

251

Confidentiality (screened examination room)

Drinking Water

Separate toilet for women

STD/PCO Booth

Light and fan

Waiting area

General cleanliness

5 (1.8)

34 (12.0)

No

Cannot say

245 (86.3)

3 (1.1)

31 (10.90)

Yes

Cannot say

No

250 (88.0)

7 (2.5)

Cannot say

Yes

27 (9.5)

250 (88.0)

11 (3.9)

135 (47.5)

No

Yes

Can’t say

No

138 (48.6)

4 (1.4)

Cannot say

Yes

3 (1.1)

52 (18.3)

Average

Poor

225 (79.2)

2 (0.7)

Cannot say

Good

2 (0.7)

45 (15.8)

Average

Poor

235 (82.7)

2 (0.7)

Cannot say

Good

7 (2.5)

65 (22.9)

Average

Poor

210 (73.9)

Good

District Hospital

3 (2.2)

13 (9.6)

119 (88.1)

0 (0.0)

4 (3.0)

131 (97.0)

3 (2.2)

16 (11.9)

116 (85.9)

10 (7.4)

54 (40.0)

71 (52.6)

3 (2.2)

1 (0.7)

18 (13.3)

113 (83.7)

3 (2.2)

0 (0.0)

28 (20.7)

104 (77.0)

2 (1.5)

0 (0.0)

37 (27.4)

96 (71.1)

Sub-Divisional Hospital

Type of Hospital

14 (12.3)

5 (4.4)

95 (83.3)

9 (7.9)

16 (14.0)

89 (78.1)

12 (10.5)

15 (13.2)

87 (76.3)

11 (9.6)

84 (73.7)

19 (16.7)

1 (0.9)

22 (19.3)

32 (28.1)

59 (51.8)

1 (0.9)

3 (2.6)

42 (36.8)

68 (59.6)

0 (0.0)

2 (1.8)

39 (34.2)

73 (64.0)

CHC

0 (0.0)

0 (0.0)

47 (100.0)

0 (0.0)

0 (0.0)

47 (100.0)

0 (0.0)

1 (2.1)

46 (97.9)

0 (0.0)

25 (53.2)

22 (46.8)

0 (0.0)

0 (0.0)

5 (10.6)

42 (89.4)

0 (0.0)

0 (0.0)

3 (6.4)

44 (93.6)

0 (0.0)

0 (0.0)

6 (12.8)

41 (87.2)

Special Hospital

22 (3.8)

52 (9.0)

506 (87.2)

12 (2.1)

51 (8.8)

517 (89.1)

22 (3.8)

59 (10.2)

499 (86.0)

32 (5.5)

298 (51.4)

250 (43.1)

8 (1.4)

26 (4.5)

107 (18.4)

439 (75.7)

6 (1.0)

5 (0.9)

118 (20.3)

451 (77.8)

4 (0.7)

9 (1.6)

147 (25.3)

420 (72.4)

TOTAL

Table 17. Patients Observations about Cleanliness, Basic Support Services and Privacy During Examination in Various Health Care Settings in Punjab

252

Study to Review

The Health Care Delivery System provided by PHSC, Punjab

3(1.1) 6(2.1) 17(6.0) 154(54.2) 111(39.1)

Poor Can not say All available Some available None available

Good

Rating the quality of treatment in the hospital

Payment to any staff member

Behaviour of rest of the staff? 5(1.8)) 22(7.7) 9(3.2) 275(96.8) 223(78.5) 53(18.7) 5(1.8) 3(1.1)

Yes No Good Average Poor Can not say

98(34.5)

Average

Can not say

159(56.0)

Good

Poor

61(21.5)

3(2.2)

3(2.2)

25(18.5)

104(77.0)

131(97.0)

4(3.0)

9(6.7)

4(3.0)

41(30.4)

81(60.0)

39(28.9)

3(2.2)

4(1.4)

Can not say

23(17.0)

70(51.9)

1(0.7)

19(14.1)

92(68.1)

23(17.0)

5(3.7)

7(5.2)

17(12.6)

106 (78.5)

Sub-Divisional Hospital

66(23.2)

153(53.9))

2(0.7)

31(10.9)

Average

No response

244(85.9)

Good

Facilities for laboratory and Average radiological investigation Poor

Availability of medicines

Adequacy of information given to patient about disease and treatment by doctor

District Hospital

3(2.6)

10(8.8)

1(0.9)

46(40.4)

57(50.0)

32(28.1)

4(3.5)

37(32.5)

41(36.0)

0(0.0)

15(13.2)

83(72.8)

16(14.0)

4(3.5)

2(1.8)

26(22.8)

82(71.9)

CHC

4(3.5)

0(0.0)

41(36.0)

69(60.5)

111(97.4)

Type of Hospital

0(0.0)

0(0.0)

3(6.4)

44(93.6)

46(97.9)

1(2.1)

10(21.3)

1(2.1)

3(6.4)

33(70.2)

15(31.9)

0(0.0)

2(4.3)

30(63.8)

0(0.0)

8(17.0)

35(74.5)

4(8.5)

0(0.0)

2 (4.3)

5(10.6)

40(85.1)

Special Hospital

(Contd...)

10(1.7)

8(1.4)

122(21.0)

440(75.9)

563(97.1)

17(2.9)

51(8.8)

11(1.9)

188(32.4)

330(56.9)

147(25.3)

11(1.9)

128(22.1)

294(50.7)

3(0.5)

153(26.4)

364(62.8)

60(10.3)

15(2.6)

14(2.4)

79 (13.6)

472 (81.4)

Total

Table 18. Quality of Services in Terms of Adequacy of Information, Availability of Medicine, Laboratory Services, Behaviour of Staff

The Health Care Delivery System provided by PHSC, Punjab

Study to Review

253

Satisfaction with the services of the hospital

Behaviour of rest of the staff?

61(21.5)

22(7.7)

Can not say

No

5(1.8))

Poor

223(78.5)

98(34.5)

Average

Yes

159(56.0)

Good

District Hospital

27(20.0)

108(80.0)

9(6.7)

4(3.0)

41(30.4)

81(60.0)

Sub-Divisional Hospital

Type of Hospital

23(20.2)

91(79.8)

10(8.8)

1(0.9)

46(40.4)

57(50.0)

CHC

17(36.2)

30(63.8)

10(21.3)

1(2.1)

3(6.4)

33(70.2)

Special Hospital

128(22.1)

452(77.9)

51(8.8)

11(1.9)

188(32.4)

330(56.9)

Total

254

Study to Review

The Health Care Delivery System provided by PHSC, Punjab

Behaviour of nurses

Behaviours of specialists

Behaviour of doctors

Availability of nurses

Availability of specialists

Availability of doctors

Cooperation at the reception of the counter

3 (1.1)

Can not say

179 (63.0) 41 (14.4) 3 (1.1) 61 (21.5)

Good Average Poor Can not say

23 (8.1)

1 (0.4)

Poor

Can not say

16 (5.6)

Average

3 (1.1)

264 (93.0)

Good

Poor

55 (19.4)

Not available

13 (4.6)

229 (80.6)

Available

Average

28 (9.9)

Not available

245 (86.3)

256 (90.1)

Available

Good

14 (4.9)

4 (1.4)

Can not say

Not available

5 (1.8)

Poor

270 (95.1)

50 (17.6)

Average

Available

225 (79.2)

Good

District Hospital

28 (20.7)

2 (1.5)

21 (15.6)

84 (62.2)

19 (14.1)

0 (0.0)

10 (7.4)

106 (78.5)

2 (1.5)

0 (0.0)

9 (6.7)

124 (91.9)

31 (23.0)

104 (77.0)

19 (14.1)

116 (85.9)

3 (2.2)

132 (97.8)

0 (0.0)

1 (0.7)

30 (22.2)

104 (77.0)

Sub-Divisional Hospital

Type of Hospital

19 (16.7)

1 (0.9)

16 (14.0)

78 (68.4)

36 (31.6)

0 (0.0)

12 (10.5)

66 (57.9)

3 (2.6)

0 (0.0)

13 (11.4)

98 (86.0)

25 (21.9)

89 (78.1)

40 (35.1)

74 (64.9)

12 (10.5)

102 (89.5)

0 (0.0)

1 (0.9)

33 (28.9)

80 (70.2)

CHC

Table 19. Patients’ Observations Regarding Health Man Power in Various Health Care Settings in Punjab

10 (21.3)

0 (0.0)

4 (8.5)

33 (70.2)

3 (6.4)

0 (0.0)

3 (6.4)

41 (87.2)

0 (0.0)

0 (0.0)

3 (6.4)

44 (93.6)

11 (23.4)

36 (76.6)

4 (8.5)

43 (91.5)

1 (2.1)

46 (97.9)

0 (0.0)

0 (0.0)

3 (6.4)

44 (93.6)

Special Hospital

The Health Care Delivery System provided by PHSC, Punjab

Study to Review

255

89 55.6%

Up to 15 minutes

Total

Time getting medicine

Total

Investigation time

Total

134 74.0%

Up to 10 minutes

181 100.0%

215 100.0%

Count Col %

Count Col %

18 8.4%

Above 60 minutes

8 4.4%

24 11.2%

31 - 60 minutes

Above 20 minutes

173 80.5%

Up to 30 minutes

39 21.5%

160 100.0%

Count Col %

11 - 20 minutes

33 20.6%

Above 30 minutes

38 23.8%

281 100.0%

11 3.9%

Above 30 minutes

Count Col %

35 12.5%

16 - 30 minutes

Specialist consulting 16 - 30 minutes time

Total

Registration time

235 83.6%

Up to 15 minutes

District Hospital

105 100.0%

6 5.7%

14 13.3%

85 81.0%

79 100.0%

3 3.8%

4 5.1%

72 91.1%

79 100.0%

3 3.8%

13 16.5%

63 79.7%

135 100.0%

2 1.5%

10 7.4%

123 91.1%

Sub-Divisional Hospital

Type of Hospital

104 100.0%

4 3.8%

6 5.8%

94 90.4%

84 100.0%

4 4.8%

7 8.3%

73 86.9%

50 100.0%

1 2.0%

13 26.0%

36 72.0%

114 100.0%

5 4.4%

109 95.6%

CHC

37 100.0%

5 13.5%

32 86.5%

37 100.0%

2 5.4%

6 16.2%

29 78.4%

28 100.0%

7 25.0%

8 28.6%

13 46.4%

47 100.0%

2 4.3%

45 95.7%

Special Hospital

427 100.0%

18 4.2%

64 15.0%

345 80.8%

415 100.0%

27 6.5%

41 9.9%

347 83.6%

317 100.0%

44 13.9%

72 22.7%

201 63.4%

577 100.0%

13 2.3%

52 9.0%

512 88.7%

TOTAL

Table 20. Waiting Time for Registration, Consultation with Doctors and Specialist, Investigations and Receiving Medicines

256

Study to Review

The Health Care Delivery System provided by PHSC, Punjab

203 (71.5) 75 (26.4) 3 (1.1) 3 (1.1)

Good

Average

Poor

Can’t say

District Hospital

1 (0.7)

4 (3.0)

32 (23.7)

98 (72.6)

Sub-Divisional Hospital

Type of Hospital

3 (2.6)

1 (0.9)

45 (39.5)

65 (57.0)

CHC

Table 21. Patient’s Experience (Rating) at OPD of Various Health Care Settings

0 (0.0)

0 (0.0)

7 (14.9)

40 (85.1)

Special Hospital

7 (1.2)

8 (1.4)

159 (27.4)

406 (70.0)

Total

N=580

The Health Care Delivery System provided by PHSC, Punjab

Study to Review

257

82 (29.0) 151 (53.4) 2 (0.7) 7 (2.5) 10 (3.5) 20 (7.1) 0 (0.0) 0 (0.0) 1 (0.4) 1 .4% 2 .7% 4 1.4% 1 .4% 2 (0.7)

No suggestion

Provide all medicine at least to poor people

Proper supervision of higher officials

Proper care/ emergency care should be provided

Provide more doctors or specialists

Cleanliness

Provision of female doctors

Punctuality of staff should be maintained

Good behaviour of staff

Provide more staff

Provision for female privacy

Satisfied with present condition

Should get costly medicines

Provision of food

District Hospital

Type of Hospital

0 .0%

0 .0%

8 6.0%

0 .0%

1 .7%

2 1.5%

2 1.5%

2 1.5%

7 5.2%

14 10.4%

7 5.2%

0 .0%

58 (43.3)

33 (24.6)

Sub-Divisional Hospital

Table 22. Suggestions for Further Improvement in the Services

1 .9%

3 2.7%

1 .9%

0 .0%

0 .0%

0 .0%

1 .9%

0 .0%

0 .0%

13 11.6%

6 5.4%

1 .9%

56 (50.0)

30 (26.8)

CHC

0 .0%

0 .0%

0 .0%

0 .0%

0 .0%

1 2.1%

0 .0%

0 .0%

1 2.1%

0 .0%

1 2.1%

0 .0%

26 55.3%

18 (38.3)

Special Hospital

3 .5%

4 .7%

13 2.3%

2 .3%

2 .3%

4 .7%

3 .5%

2 .3%

28 4.9%

37 6.4%

21 3.6%

3 .5%

291 50.5%

163 (28.3)

TOTAL

258

Study to Review

The Health Care Delivery System provided by PHSC, Punjab

10.00

10

13.005

104

1

105

Median

Mode

Std. Deviation

Range

Minimum

Maximum

210

1

209

27.481

30

25.00

30.48

Doctors consulting time

44 1 45

Minimum

Maximum

7.581

Range

Std. Deviation

5

5.00

Median

Mode

8.09

Registration time

Mean

Statistics

120

0

120

19.875

5

10.00

17.21

Doctors consulting time

Type of Health Institute = Sub-Divisional Hospital

12.19

Mean

Registration time

Type of Health Institute = District Hospital

120

0

120

15.931

10

10.00

11.99

Specialists consulting time

120

0

120

23.133

0

12.50

22.24

Specialists consulting time

180

0

180

27.208

30

15.00

21.67

Investigations time

307

0

307

32.919

30

20.00

29.91

Investigations time

50

0

50

60

0

60

8.266

10

10.00

9.50

Time in getting medicines

7.375

10

10.00

9.52

Time in getting medicines

1280

20

1260

226.589

200

200.00

245.56

Money spent to buy medicine

13000

0

13000

1378.487

150

200.00

449.77

Money spent to buy medicine

The Health Care Delivery System provided by PHSC, Punjab

Study to Review

259

1 30

Minimum

Maximum

19 1 20

Minimum

Maximum

4.623

Range

Std. Deviation

5

5.00

Median

Mode

7.26

Registration time

Mean

Statistics

60

3

57

17.642

5

12.50

18.87

Doctors consulting time

120

1

119

18.017

10

10.00

18.37

Doctors consulting time

Type of Health Institute = Special Hospital

29

5.112

Range

Std. Deviation

5

5.00

Median

Mode

6.68

Registration time

Mean

Statistics

Type of Health Institute = CHC

60

5

55

18.540

15

20.00

26.25

Specialists consulting time

60

0

60

13.288

0

10.00

11.40

Specialists consulting time

80

2

78

19.405

30

20.00

26.14

Investigations time

150

0

150

27.301

5

10.00

19.71

Investigations time

20

1

19

4.524

10

10.00

8.59

Time in getting medicines

30

0

30

5.951

5

5.00

7.47

Time in getting medicines

1000

12

988

186.691

100

100.00

195.93

Money spent to buy medicine

1000

1

999

220.623

200

150.00

216.67

Money spent to buy medicine

260

Study to Review

The Health Care Delivery System provided by PHSC, Punjab

Nil Nil Nil Nil

Accessibility

Utilisation

Acceptability

-

Availability

Perceived Barriers

Motivation Level

BPL Card holders

No problem

Fund flow

Poor patients exempt from User Charges

BPL Cards

Knowledge of RKS

50%

Extent of fulfilment of health needs of community No Idea

-

Availability of staff

Referral services

O.K

5 months

Amritsar

Overall functioning of CHC, SDH and DH

Length of service

Facility/ Name of the District

Nil

Nil

Nil

Nil

Very low

Red Cross

Not through DC

Yes

Non-availability is a problem

Partially

Shortage of staff

Average

8 months

Bathinda

Nil

Nil

Nil

Nil

Good

Yes

-

Yes

Ambulance not fully equipped

70 - 80%

Shortage of staff

Not well

1 yrs.

Ferozpur

Table 23. Responses of the Deputy Commissioners

Nil

Nil

Nil

Nil

Good

Yes partially

Not full utilised

Yes

Not Good

Good

Shortage of staff

Good

2 months

Gurdaspur

Yes

Yes

Yes

Yes

-

-

Inadequate

-

Can’t say

Can’t say

-

Can’t say

< 2 yrs.

Jalandhar

-

-

-

-

-

BPL Cards

-

-

Yes

Large

-

Good

< 2 yrs.

Ludhiana

No

No

Yes

Yes

Good

Yes partially

-

Yes

Not Good

Not Good

Shortage of staff

OK

1 yrs.

Muktsar

↓ CHC ↓ CHC ↓ CHC ↓ CHC

Nil ↓ ↓

Low

Yes

Not through D.C.

Yes

Satisfactory

40%

Shortage of staff

Good

5 months

Taran Ta

Nil

Not low

Red Cross

No problem

No

Satisfactory

Large Extent

Lack of doctors

Lack of doctors

1 yr.

Sangrur

The Health Care Delivery System provided by PHSC, Punjab

Study to Review

261

Good No problem Yes Yes

Behaviour of staff

Referral services

Knowledge of RKS

Poor patients exempted from treatment charges

Nil Nil Nil Nil

Availability

Accessibility

Utilisation

Acceptability

Perceived Barriers

Good

80%

Extent of fulfilment of health needs of Community 2 - 5 mins.

O.K.

Overall services of Hospital

Cleanliness

30%

No

Availability of Medicines in OPD

Waiting Time

Average

Yes

Availability of staff

Nil

Nil

Nil

Nil

-

No

-

Not satisfactory

Not proper

Not much

No

Doctors post vacant

Average

Good

Overall functioning

-

> 2 yrs.

Bathinda

Length of service

Amritsar

Nil

Nil

Nil

Nil

Yes

Yes

Satisfactory

Good

Good

20-30 mins.

Good no.

Satisfactory

Yes

Shortage of D&N

Satisfactory

>2 yrs.

Ferozpur

Nil

Medicines

Referral

Nil

Yes

Yes

N.A.

Good

Good

2-3 hrs.

60%

Average

Less

Shortage

OK

1.5 yrs.

Gurdaspur

Nil

Medicines not available

Requires money

Nil

No

No

Not good

Fine

O.K.

Not much

Only poor use it

-

No

Sometimes

Average

1 yr.

Hoshiarpur

Non availability of equipments

Scarcity of Medicine

Nil

Less Medicine

No

Yes

Scarcity of Ambulance

Rude Nurses & Class IV

Good

2-3 hrs.

< 50%

Good

Some Yes

Scarcity

Good

1.5 yrs.

Jalandhar

Table 24. Responses of the MLA/elected Representative at District Level

-

-

Nil

Nil

No

BPL Cards Yes.

Yes

Good

Good

30-60 mins.

To some extent

Average

Not enough

Yes, But shortage of Doctors

Good

>2 yrs.

Ludhiana

Nil

Less facilities

Nil

Ambulance Service

Red Cross Funds

No

Not available

OK

Not good

Not much

60%

Gynae-Bad

Not enough

Less in no.

Well

> 2 yrs.

Muktsar

↓ CHC

↓ CHC

Nil

Nil

From NGOs

No

Very Good

Very Good

Satisfactory

Not much

60-70%

Satisfactory

No

No doctors

Poor in CHC

> 2 yrs.

Sangrur





Nil

Nil

-

No

No ambulance

Good

Good

Not much

40%

Average

Some

Yes

Not very good

> 2 yrs.

Taran Ta

262

Study to Review

The Health Care Delivery System provided by PHSC, Punjab

<1 year

50 Full

Yes Nil

Not proper

Overwork leads to irritation

No driver, only 1 ambulance

No problem

D.H.

Extent of fulfilment of health needs of Community

Medicine in OPD

Waiting Time

Cleanliness

Behaviour of staff

Referral services

Fund flow

↓ CHC

Nil Nil Nil

Accessibility

Utilisation

Acceptability

↓ CHC

Nil

Nil

CHC ±

Good

Only user charges

Satisfactory

Good

Not good

Less

No

60%

100

70

50

Over utilised

2 years

Bathinda

Availability

Perceived Barriers

Motivation level

Low

50

Manpower Management

50

SDH

OPD - O.K, IndoorProblem

CHC

Bed Occupancy (%)

Overall functioning of CHC, SDH and DH

Length of service

Amritsar

Nil

Nil

Nil

Nil

Satisfactory

User charges

Not good

Good

Good

Long

No

50 - 60%

-

-

-

Well

1.5 years

Ferozpur

Table 25: Responses of the Civil Surgeons

Nil

Nil

Nil

Nil

V.Good

No problem

No problem

Doctors Good Nurses-O.K

Very Good

Less

No

Satisfactory

100%

100%

10 - 15%

Well

-

Gurdaspur

-

-

-

-

O.K.

No funds

Good

Good

Good

Long

Yes

Large extent

50.8

50.8

-

CHC-poor DHGood

1.5 years

Hoshiarpur

Nil

Nil

Nil

Nil

Low

No problem

Ambulance shortage

Satisfactory

Not good

Long

No

Not fulfilled at Village level

70

70.8

60

Except CHC rest well

1.5 years

Jalandhar

Nil

Medicine facility

Nil

Nil

Good

-

-

Cordial

Good

Less

No

90%

87

90

50

Well

2.5 months

Ludhiana

No

No

Yes

Lack of Manpower in SDH & CHC

Good

Slight delay

Less no. of ambulance

Good

O.K.

Long

No

70%

100

90

20

CHC OPD lacks manpower rest O.K.

2 months

Muktsar

↓ CHC

O.K.

Nil

O.K.

Low

No problem

Ambulance with payment

Average

Not clean

Long

No

60 - 70%

80.9

80.9

50

Not fully Utilised

-

Sangrur

↓ CHC

↓ CHC

↓ CHC

O.K.

Low

Only under NRHM

Satisfactory

Needs improvement

Average

Less

No

Large extent

90

90

40

CHC-Average, SDHGood, DH-New, coming up

1.5 years

Taran Taran

The Health Care Delivery System provided by PHSC, Punjab

Study to Review

263

Nil Yes

Utilisation

Acceptability Yes

Nil

Accessibility

Biomedical Waste Management

Nil

Yes

No problem

Yes

Availability

Perceived Barriers

Performance appraisal system

Fund flow

Emergency Service Available round the clock

Satisfactory

1:2

Staff Strength Doctors/Bed ratio

Cleanliness

1:2

By poor and middle class

Extent of fulfilment of health needs of Community

IPD Services Nurse/Bed ratio

Available

Information regarding NHP

Yes

Yes BPL

Medicines to poor in OPD

Existence of RKS

80%

OPD Services- Staff strength

Bed Occupancy Rate (%)

< 2 yrs. Adequate

Length of service

Amritsar

Yes

No problem

No problem

No problem

No problem

Yes

Shortage

Yes

Not good

1:7

Nurses Less (1:40)

Full

Available

Yes (Recently)

Yes

100%

Shortage of paramedics, staff Nurses

> 2 yrs.

Bathinda

Yes

Nil

Nil

Nil

Nil

Yes

No problem

Yes

O.K.

1:6

1:4.5

100%

Yes

Yes

Yes

98-100%

Less Specialists

< 2 yrs.

Ferozpur

Yes

Outsourced

-

-

-

Yes

Yes

Yes

75-76%

Sufficient Doctors. Less class IV

> 2 yrs.

Hoshiarpur

Yes

Nil

Nil

Nil

Nil

Yes

Yes

-

Shortage of Facilities

Shortage of Medicines

Shortage of staff

Yes

No problem No funds only User Charges

Yes

OK

1:25

1:20

100%

Yes

No

Yes

100%

Adequate

15 days

Gurdaspur

Table 26. Responses of The SMOs Incharge of District Hospitals

Yes

Nil

Nil

Nil

Nil

Yes

No money given

Yes

-

-

-

Full

Yes

Yes

Some

70%

Shortage of nurses & Jr.doctors

4 yrs.

Jalandhar

Yes

Nil

Lack of information

Lack of information

Lack of information

Yes

No problem

Yes

On contract

-

-

By poor patients mostly

Yes

Yes

-

75%

No security guards

< 2 yrs.

Ludhiana

On contract

Nil

Nil

Not Good

Not Good

Yes

Sanctions from CS/DMC

On call

On contract

-

1:5

More for OPD

Yes

Yes (Recently)

Very few

60-70%

Specialists lacking

3 yrs.

Muktsar

Yes

Nil

Nil

Nil

Lack of Staff

Yes

No role of SMO

Yes

Difficult to maintain

1:5

1:5

80%

Not under PHSC

Yes

Mostly all

74%

Radiologist – absent. EMO, Psychiatrist vacant

3 years

Sangrur

No Bags supplied

Nil

Nil

Nil

Nil

Yes

No fund

Yes

On contract

1:5

1:6

Over used

Yes

Yes

Not all

60-70%

Shortage of staff

5 months

Taran Taran

264

Study to Review

The Health Care Delivery System provided by PHSC, Punjab

Good Yes Yes

Referral services

Knowledge of RKS

Poor patients exempted from treatment charges

Nil Nil Low Low

Availability

Accessibility

Utilisation

Acceptability

Perceived Barriers

Friendly

Behaviour of staff

Satisfactory

30% - 40%

Extent of fulfilment of health needs of Community

Cleanliness

Not Very. Good

Overall services of Hospital

Variable, depending upon the availability of doctors

Mostly Not available

Availability of Medicines in OPD

Waiting Time

Doctors not available

Satisfactory

>2 yrs

Bhatinda (Talwaddi)

Availability of staff

Functioning of health services in the district

Length of service

Facility

Nil

Nil

Nil

Nil

Yes

Yes

Satisfactory

Good

Good

15 -30 minutes

-

Satisfactory

Yes

Shortage

Satisfactory

>2 yrs

Ferozpur (Fazilzka)

Nil

Nil

Nil

Nil

Yes

No

NA

OK

OK

2-3 hrs

Good

OK

Less

SN, Doctors

OK

<2 yrs

Gurdaspur (Batala)

Nil

Nil

Nil

Medicine & equipments

No

No

Ambulance on payment

Only doctors good, rest bad

Bad

Depends on no of patients

Full

OPD, Emergency & lab good

Very few

Yes

Satisfactory

>2 yrs

Hoshiarpur (Dasuya)

Nil

USG machine

Nil

Nil

-

No

-

O. K.

Bad

Not much

To quite an extent

Good

Not all

Yes

Good

>2 yrs

Jalandhar (Navodar)

Name of the District

Table 27. Responses of The MLA/elected Representative at Sub Divisional Level

Nil

Nil

Nil

Nil

Yes

Yes

Available

Good

Good

30min– 2hrs

Good

Good

Not all. Only 7 essential ones

Yes

Good

>2 yrs

Ludhiana (Jagrraon)

Nil

Nil

Nil

Yes

Yes

Yes

Good

Not good

Average

Not better

Average

OK

OK

Specialist not available

OK

>2 yrs

Muktsar (Malout)

Nil

Nil

Nil

Nil

No

No

Ambulance on Payment

Variable

Not clean

Quite some time

20%

Less developed

Less availability

Doctors not available

Not much improved

>2 yrs

Sangrur (Malarkotta)

Nil

Nil

Nil

Nil

Yes

No idea

No transport

Very good

Good

Very less

80%

Satisfactory

No antibiotics

Yes

Good

<2 yrs

Taran Taran (Patti)

The Health Care Delivery System provided by PHSC, Punjab

Study to Review

265

Yes

Existence of RKS

-

-

Utilisation

Acceptability Yes

-

Accessibility

Bio-medical waste management

-

Availability

Perceived Barriers

Yes-ACR

Performance appraisal system

Yes

Emergency services Only User charges

Cleanliness

Fund flow

1:3 Good

Doctor/Bed ratio

1:3

75%

IPD Services (Nurse/Bed ratio)

Extent of fulfilment of health needs of community

Yes (except Malaria)

Yes

Medicine to poor in OPD

Information regarding NHP

40-65%

Good

OPD staff strength

Bed Occupancy Rate (%)

6 months

Length of service

Amritsar (Ajnala)

Yes

Nil

Nil

Nil

Doctors not available

Yes-ACR & Bench marks

No problem

Yes

Staff absent

1:10

1:4

50%

Yes (except STD)

Yes

Yes

50-60%

Poor

< 2 yrs.

Bhatinda (Talwaddi)

Yes

Nil

Nil

Nil

Nil

No

Not much problem

Yes

O.K.

1:10

1:4

100%

Yes

Yes

Yes

90%

Adequate

3 months

Ferozpur (Fazilzka)

Outsourced

Nil

Nil

Nil

Nil

Bench marks for doctors

O.K.

On call

Good

1: 4

1: 3.5

80%

Yes

Not functioning

Tedious Procedure

100%

less

< 2 yrs.

Gurdaspur (Batala)

Yes (shortage of bags)

-

-

-

Doctors Overburdened

Personal perception

No problem

Yes

Shortage of staff

-

-

-

Yes

Not functioning

Yes

70%

Shortage of Class IV

< 2 yrs.

Hoshiarpur (Dasuya)

Table 28. Responses of the SMO Incharges of Sub-divisional Hospitals

Yes

Nil

Nil

Nil

Nil

Yes-weekly review

No funds

Yes

O.K.

-

Sufficient Nurses

100%

Yes-all

Yes

Mostly

100%

Specialists shortage

7 months

Jalandhar (Navodar)

Yes

-

Infrastructure and staff Behaviour

-

-

Yes

No problem

Yes

On contract

1:5

1:12

50%

Yes

Yes

Some

90-100%

Adequate

> 2 yrs.

Ludhiana (Jagrraon)

Yes

Nil

Nil

Nil

Specialist absent

Doctors Bench mark, ACR

No delay

Yes

Poor

1;7

1:5

OPD-High IPDLow

Yes

Yes-not clear

Some

50-55%

Less

1 yr.

Muktsar (Malout)

Yes – On contract

Nil

Nil

Nil

Lack of staff & medicine

ACR

Only Usercharges

Yes

No problem

1:6

1:5

Average

Yes except for STD

Money was received

Some

70%

Adequate

3 years

Sangrur (Malarkotta)

Bags not available

Nil

Nil

Nil

Nil

Yes-ACR

No fund

Yes

O.K.

O.K.

O.K.

75%

Yes

Yes

Yes

85-90%

Good

< 2 yrs.

Taran Taran (Patti)

266

Study to Review

The Health Care Delivery System provided by PHSC, Punjab

Good No Good No

Cleanliness

Referral services

Knowledge of RKS

Behaviour of staff

Poor patients exemption from User charges

Perceived Barriers

5 minutes

50%

Waiting Time

Extent of fulfilment of health needs of Community

Not good

Overall services of the Hospital

Yes

Availability of Staff Partly

Good

Overall functioning of CHC, SDH and DH

Availability of Medicine in OPD

>5 yrs.

Length of service

Amritsar (Manawala)

No

V.Good

No

Yes

V.Good

45 mins. - 1 hrs.

50%

Good

Mostly

Yes

V.Good

>2 yrs.

Bhatinda (Goniana)

-

Good

No

Lacking

Good

Nil

10%

O.K.

Yes

Yes

Not good

>2 yrs.

Ferozpur (Firozshah)

No

Good

Yes

Yes

O.K.

Not much

O.K.

O.K.

Yes

No gynaecologist

>2 yrs.

Gurdaspur ((Fataihgarh Churian)

No

Not Good

No

No ambulance

Very Bad

Not much

Only MLC cases (<10%)

Average

V.Few

Bad

Doctors not available (go for pvt. practice)

> 2 yrs.

Hoshiarpur (Mahilpur)

No

Bad Nurses behaviour

Yes

-

Good

Long

Sufficient extent

Good

Yes

Yes

Good

>2 yrs.

Jalandhar (Kartarpur)

Name of the District (CHC)

Table 29. Responses of the Elected Representatives of CHC Areas

Yes

Good

Yes

Available but not always

Good

Long sometimes

Large extent

Average

Not all

Yes

Better now

>2 yrs.

Ludhiana (Machhiwara)

Yes

Not Good

Yes

No ambulance

Needs improvement

Not much

Large extent

O.K.

Less

O.K.

Better now

>2 yrs.

Muktsar (Badal)

No

Very .Good

No

Good

Satisfactory

Not much

10 - 20%

O.K.

Yes

No doctors

Quiet satisfactory

> 2 yrs.

Sangrur (Longwal)

(Contd...)

-

Very Good

No

No

Good

Not much

80%

Satisfactory

Not all

Yes

Good

< 2 yrs.

Taran Taran (Khem Karan)

The Health Care Delivery System provided by PHSC, Punjab

Study to Review

267

Nil Nil Nil Nil

Availability

Accessibility

Utilisation

Acceptability

Amritsar (Manawala)

Nil

Nil

Nil

Nil

Bhatinda (Goniana)

Restricted

Less doctors

Nil

No medicine

Ferozpur (Firozshah)

Nil

Nil

Nil

Nil

Gurdaspur ((Fataihgarh Churian)

Lack of Services

Lack of medicines

Nil

Doctors not available

Hoshiarpur (Mahilpur)

Nil

Lack of Medicine

Nil

Less Medicine

Jalandhar (Kartarpur)

Name of the District (CHC)

Quality of Facility to be improved

Nil

Nil

Nil

Ludhiana (Machhiwara)

Nil Nil

↓↓ ↓↓

Nil Nil

Very .Far

Taran Taran (Khem Karan)

Nil

Nil

Sangrur (Longwal)

Nil

Yes

More doctors

Muktsar (Badal)

268

Study to Review

The Health Care Delivery System provided by PHSC, Punjab

Yes

Yes

90%

-

Existence of RKS

Information regarding NHP

Extent of fulfilment of health needs of Community

IPD Services (Nurse/ Bed ratio)

Doctor/Bed ratio

Performance appraisal system

Yes

No problem

Yes

Medicines to poor in OPD

Fund flow

5-10 Beds are occupied

Bed Occupancy Rate (%)

O.K.

Shortage

OPD Staff strength

Cleanliness

< 2 yrs.

Length of service

Amritsar (Mazitha)

ACR

Managed by C.S.

Not upto the mark

1:30

1:5

50%

Only T.B. & Malaria

Yes

Some

10-15%

Shortage of doctors

1 month

Amritsar (Manawala)

Yes

No problem

Good

1:7

1;10

70%

Yes

Yes

Yes

100%

Shortage

> 2 yrs.

Bhatinda (Goniana)

Records & meetings

No problem

Good

1:6

1:1.2

Under utilised

Yes

Yes

Yes

10%

Adequate

7 months

DoctorsBench mark

-

O.K.

1:2

-

-

-

Not functioning

Yes

50%

O.K.

2.5 yrs.

Yes – ACR

No problem

O.K

1:5

1:5

OPD 60-80% IPD=5-10%

No to all except T.B

Not yet formed

Yes

5 – 10%

Less no. of doctors & Class IV

6 months

Hoshiarpur (Mahilpur)

Appreciation letter

No Budget received

Good

Staff shortage

Staff shortage

100%

Yes

Yes

Yes

-

Shortage

6 months

Jalandhar (Kartarpur)

Name of the District (CHC) Ferozpur Gurdaspur (Firozshah) ((Fataihgarh Churian)

Table 30. Responses of the SMO Incharges of CHCS

Annual C.R

No problem

Shortage of staff

1:5

1:3

Satisfactory

Yes all except STD

Yes

Yes

25.04

Adequate. Only M.O post vacant

>2 years

Ludhiana (Machhiwara)

DoctorsBench mark

-

O.K.

O.K.

-

-

-

-

-

15- 20%

Specialists lacking

< 2 yrs.

Muktsar (Badal)

Yes – ACR

N.A

Managed by own staff

1:15

1:7

Very Less

Yes except STD

Yes

Yes

10 – 15%

Except medicine all available

6 months

Sangrur (Longwal)

(Contd...)

Yes (ACR)

Through C.S

O.K.

1:4

1:10

70.80%

Not all (i.e. Malaria, STD)

Yes

Yes (some to be purchased)

30-40%

Shortage

16 months

Taran Taran (Khem Karan)

The Health Care Delivery System provided by PHSC, Punjab

Study to Review

269

No Specialist

Utilisation

Bio-medical Waste Management

Yes

Nil

Nil

Accessibility

Acceptability

Nil

Availability

Perceived Barriers

Amritsar (Mazitha)

Yes

Non availability of staff / medicines

-

-

-

Amritsar (Manawala)

Yes

Low

Nil

Yes

Under utilised

Nil

Doctor not available

-

-

-

-

-

Ferozpur Gurdaspur (Firozshah) ((Fataihgarh Churian)

Nil

No problems

Staff/ Medicine not available

Bhatinda (Goniana)

2 coloured bags used

Nil

Nil

Nil

Nil

Hoshiarpur (Mahilpur)

Yes

Nil

Less due to lack of funds

Nil

Staff shortage

Jalandhar (Kartarpur)

Name of the District (CHC)

Yes

Nil

Needs to be increased

Nil

Nil

Ludhiana (Machhiwara)

Contracted

-

-

-

-

Muktsar (Badal)

Yes – on contract

Less no. of doctors

Low

Nil

Staff not available

Sangrur (Longwal)

Yes

-

Shortage of Drugs

Yes Border area

Less staff

Taran Taran (Khem Karan)

A Study to Review

The Health Care Delivery System Provided by

PHSC Punjab Health Systems Corporation Punjab

vkjksX;e~ lq[klEink

National Institute of Health and Family Welfare Baba Gang Nath Marg, Munirka, New Delhi - 110067

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A Study to Review The Health Care Delivery System Provided by PHSC Punjab Health Systems Corporation Punjab vkjksX;e~ lq[klEink National Institute...

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