|Year : 2010 | Volume
| Issue : 1 | Page : 36-39
An application of Indian public health standard for evaluation of primary health centers of an EAG and a Non-EAG state
Forhad Akhtar Zaman, Nasrin Banu Laskar
Assistant Professor, Community Medicine, Khaja Banda Nawaz Institute of Medical Sciences, Gulbarga, Karnataka, India
|Date of Web Publication||29-Sep-2010|
Nasrin Banu Laskar
Assistant Professor, Community Medicine, Khaja Banda Nawaz Institute of Medical Sciences, Gulbarga, Karnataka
Source of Support: None, Conflict of Interest: None
| Abstract|| |
National Rural Health Mission (NRHM) has provided the opportunities to develop a standard for Sub centers, PHCs and CHCs in the country, popularly known as Indian Public Health Standards (IPHS). The study was carried out to find out and compare to what extent the IPHS were followed by the PHCs in the selected districts of both the Empowered Action Group (EAG) state of Assam and non EAG state of Karnataka. It was a Cross sectional observational study conducted during September-October 2008 where the quality of care and services provided in the selected PHCs as per the IPHS norms was assessed. All the PHCs in both the studied districts were rendering the assured services of OPD, 24hrs general emergency service and referral services while 24 hour delivery services were being provided by 80% of the PHCs of the selected districts of both the states. Functional labor rooms were available only in 80% and 90% of the studied PHCs in Assam and Karnataka respectively. Basic laboratory facilities, for routine blood, urine and stool examination were available in 80% of the studied PHCs in the non-EAG state of Karnataka while it was only in 20% of the studied PHCs of the EAG state of Assam. The findings of the present study revealed important deficiencies as per IPHS norms in the studied PHCs of both Assam and Karnataka.
Keywords: Indian Public Health Standards, EAG and Non-EAG States, Primary Health Centres
|How to cite this article:|
Zaman FA, Laskar NB. An application of Indian public health standard for evaluation of primary health centers of an EAG and a Non-EAG state. Indian J Public Health 2010;54:36-9
|How to cite this URL:|
Zaman FA, Laskar NB. An application of Indian public health standard for evaluation of primary health centers of an EAG and a Non-EAG state. Indian J Public Health [serial online] 2010 [cited 2020 Sep 18];54:36-9. Available from: http://www.ijph.in/text.asp?2010/54/1/36/70551
Health has been declared as a fundamental human right. The health care services are designed to meet the health needs of the community through the use of available knowledge and resources. In fact health services are now seen as a part of the basic social services of a country  . Thus, primary health care approach came into existence in 1978 and this approach became the cornerstone of rural health services  , which are provided by the Primary Health Centers as per the propositions of the Bhore Committee  . For continuous improvement in quality of care, standards are the main drive. In order to provide optimal level of quality health care, a set of standards were developed for Sub-centers, PHCs and CHCs, to be called Indian Public Health Standards (IPHS) following the launching of the National Rural Health Mission (NRHM) on 12 th April 2005  .
Under NRHM more emphasis has been given upon the Empowered Action Group (EAG) states because of their poor health indicators. It is therefore expected that the quality and standards of care provided by the PHCs in the EAG states will improve and more adequately satisfy the IPHS to reach the level of the non-EAG states. Therefore, A cross sectional observational study was carried out during September - October 2008 to find out how far the Indian Public Health Standards (IPHS) have been followed by the selected PHCs in the EAG state of Assam as well as in the non-EAG state of Karnataka. The EAG and Non-EAG states were selected based upon the convenience of the researchers. Two districts, Dhubri from Assam and Gulbarga from Karnataka were selected purposively. All the PHCs of all the Talukas or Subdivisions in the selected districts were enumerated and one PHC representing each Taluka/ Subdivision was randomly selected. In Gulbarga there were 10 Talukas while in Dhubri there were 5 subdivisions. Accordingly the study was carried out in 10 PHCs of Gulbarga district and 5 PHCs of Dhubri district.
The quality of care and services provided in the selected PHCs as per the IPHS were assessed using the standard proforma and compared with the check list prescribed by the Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India  . The following components were considered for evaluation: the services provided, monitoring and supervision of activities conducted by PHCs, availability of Manpower and infrastructure, laboratory facilities in the PHCs.
The study was conducted by interview technique carried out personally by both the authors followed by record analysis for confirmation and also by observation. Observation along with record analysis was done regarding all the above mentioned components considered for evaluation except monitoring and supervision of activities conducted by PHCs, where evaluation was done by record analysis only. The Medical officer - in-charge of the selected PHCs were interviewed. The results of the study were analyzed using suitable statistical methods and expressed in percentages.
The findings of the study revealed that all the PHCs in both the studied areas were rendering the assured services of OPD, 24 hrs general emergency and referral services. Assured services cover all the essential elements of preventive, promotive, curative and rehabilitative primary health care  . Provision of In-patient services were found to be comparatibly better (90%) in PHCs of the selected district of Gulbarga (non-EAG state) as compared to Dhubri district of the EAG state (80%) of Assam.
It was observed that in both the selected areas, 100% of the PHCs were providing basic package of MCH services like ante-natal care, immunization and family planning services (temporary methods). IPHS suggested provision of terminal methods of contraception at the PHC level  . Despite this, the provision of terminal methods of contraception was non-existing in Dhubri (Assam), whereas it was better in Gulbarga district of Karnataka (40%). Observation of absence of terminal methods corroborated with the poor couple protection rate of 15.2% in the EAG state of Assam  . However, neither of the states, till now has achieved the couple protection rate of 65% as per the national target  .
However, in both the studied districts of the EAG state of Assam and the non-EAG state of Karnataka, 24 hour delivery services were being provided by 80% of the PHCs. This might be due to non-availability of functional labour room, which was available only in 80% and 90% of the studied PHCs of Assam and Karnataka respectively. RCH program is aiming to improve the coverage of institutional deliveries to the extent of 80% by 2010  . So, even if, one single PHC is not equipped to conduct deliveries (without functional labour room), it would mean that the whole population of 30 000, covered by the concerned PHC would have no access to institutional delivery, thereby making it difficult to achieve the target of 80% institutional delivery. The situation is likely to be graver in the EAG state of Assam, where PHCs were found to be catering a population of 2 to 3.5 lakhs.
Provision of management of general emergencies like wounds (100%) and snake bite (80%) was better in the PHCs of Gulbarga district of Karnataka The IPHS has suggested provision of appropriate management of emergencies like snake bite, scorpion bite etc  .
New born care services like facilities and care for neonatal resuscitation and management of neonatal hypothermia/jaundice  were found to be completely absent in the studied district of the EAG state of Assam while in Karnataka, 70% of the studied PHCs were providing the services. Though new born care has been considered as an essential component under RCH II  and additional inputs had also been given under IMNCI,  it is concerning to find that new born care services were completely absent in the studied district of Assam. Under this situation, if new born care services in the PHCs were not strengthened, the challenge of RCH phase II, to accelerate reduction in infant deaths to reach the national goal of < 30 per 1000 live births by 2010  could not be achieved neither in the EAG nor in Non-EAG state.
There was no provision for cataract surgery in the PHCs of both the study areas. Though the Indian Public Health Standard evaluation proforma included a question on cataract surgery at PHC level; the IPHS document specifies only detection of cataract cases and referral for cataract surgery at appropriate level  .
In the studied district of Karnataka, other health activities like Health education, School health programme and promotion of safe drinking water and sanitation were being provided by 90%, 100% and 80% of the PHCs respectively. Although 100% and 80% of the studied PHCs of the EAG state of Assam were performing health education activities and school health programmes respectively, only 40% of the selected PHCs were involved in promotion of safe drinking water and proper sanitation. However the implementation of AYUSH services was better in the studied district of the EAG state of Assam.
In Dhubri district of the EAG state of Assam, monitoring and supervision of Sub-Centers by Health Assistants was being carried out in 80% of the PHCs, and by Medical Officers in 60% of the PHCs while in the studied non-EAG state of Karnataka, all the PHCs were covered by them. However, it was found that 80% of the PHCs in the selected district of the EAG state of Assam were conducting monitoring and supervision of ASHA, whereas it was there in only 10% of the PHCs in the non-EAG state of Karnataka. The PHCs in the studied district of Assam were catering a population size of 2-3.5 lakhs making it impossible to carry out the activities of monitoring and supervision. This population size was about 6-12 times more than the defined norm and was even larger than the population covered by a Block PHC or CHC. It was also noted that most of the PHCs of the studied non-EAG state of Karnataka were catering a population below the recommended norm of 30,000. Coverage of large population by a PHC in large majority of the cases is indicative of the facts that adequate numbers of PHCs have not been established against their requirement leading to deterioration of the quality and delivery of health care services and also accentuated the problem of overcrowding in CHCs and district hospitals.  The better monitoring of ASHA in Assam could be attributed to the more stringent implementation of NRHM in this EAG state particularly in respect of ASHA, whereas the poor state of supervision activities of ASHA in the non-EAG state of Karnataka might be due to recent implementation of NRHM / ASHA, where appointment of ASHA had just started during the time this study was undertaken.
The availability of manpower as per recommendation was found to be better amongst the PHCs of Dhubri (Assam) in contrast to those in Gulbarga (Karnataka) [Table 1].
|Table 1 :Manpower availability status in PHCs of Dhubri (Assam) and Gulbarga (Karnataka)|
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The infrastructure availability was slightly better in the studied PHCs of Assam than in Karnataka [Table 2]. No separate wards for males or females were found in PHCs in both the study areas. Functional operation theatres were completely lacking in the studied PHCs of the EAG state of Assam whereas it was available in 70% of the studied PHCs in Karnataka. Availability of computers and vehicles were found to be better (80% and 100% respectively) in the selected district of the EAG state of Assam and this was again a reflection of the comparatively better implementation of these components of NRHM in the state of Assam. Residential facilities for staff (Medical officers, pharmacists and nurses) was lacking in both the study areas. [Table 2]. Here again the study tools of GOI did not have a scope to know how far these equipments and residential facilities were functional.
|Table 2 :Physical infrastructure of the PHCs in Dhubri (EAG) and Gulbarga (non-EAG)|
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Basic laboratory facilities like routine blood, urine and stool examination were provided by 80% of the studied PHCs in Karnataka and by only 20% in the EAG state of Assam. However the malaria and tuberculosis diagnostic activities were provided by 100% of the studied PHCs of the EAG state of Assam whereas in the non- EAG state of Karnataka only 40% and 80% of the studied PHCs were carrying out the sputum testing for tuberculosis and blood smear examinations for malaria respectively. All the studied PHCs in Assam were Designated Microscopy Centers for tuberculosis. The availability of diagnostic facilities for RTIs and STDs (wet mounting and gram staining)  were very poor in the studied PHCs (10%) of Karnataka while it was not available at all in Assam. Rapid test for HIV detection was better (70%) in the non- EAG state of Karnataka while it was non-existing in the PHCs of the EAG state of Assam.
Better facilities for testing malaria and TB reflect the better implementation of the concerned National programmes i.e. National Anti Malaria programme and Revised National Tuberculosis Control Programme  respectively. Better facilities for HIV testing in the selected district of the non-EAG state (70%) might be due to the fact that Karnataka was among the high prevalence states for HIV/AIDS in India and is thereby getting an additional input from NACO  .
The findings of the present study revealed many deficiencies in both the studied EAG and non- EAG states of Assam and Karnataka. However, due to some additional input provided by NRHM in EAGstates, some improvements were observed. Thus instead of dividing the states as EAG and non EAG, it would be better if individual state wise deficiencies were identified and action taken by the Government to correct those deficiencies.
| References|| |
|1.||WHO. Tech Rep Ser. no 472. 1971. p 3. |
|2.||WHO. Alma Ata 1978; Primary Health Care, HFA Series. No. 1. 1978. p. 6. |
|3.||Park′s Text Book of Preventive and Social Medicine. 19 th ed. Prem Nagar, Jabalpur: M/s Banarsidas Bhanot Publishers; 2007. p. 726. |
|4.||Govt. of India. Indian Public Health Standards (IPHS) for Primary Health Centers, Directorate General of Health Services, Ministry of Halth and Family Welfare, GOI, Feb 2007. |
|5.||Park′s Text book of Preventive and Social Medicine. 19 th ed. Prem Nagar, Jabalpur: M/s Banarsidas Bhanot Publishers; 2007. p. 391. |
|6.||DK Taneja′s Health policies and programmes in India, 7 th ed. GTB Enclave, Delhi: Doctors Publications; 2008. p. 40. |
|7.||Evaluation Study on Functioning of Primary Health Centers (PHCs) assisted under Social Safety Net Programme (SSNP), Programme Evaluation Organization Planning Commission Government of India New Delhi, Aug 2001. |
|8.||Govt. of India. RNTCP Training module for medical practitioners. Central TB division, DGHS, M/O Health and FW, Govt. of India. 2006. p. 9. |
|9.||NACO (2006). Available from: http://www.naco.nic.in ; HIV [last update on 2008 Jun]. |
[Table 1], [Table 2]