|Year : 2012 | Volume
| Issue : 4 | Page : 290-292
Study on the availability of physical infrastructure and manpower facilities in sub-centers of Chittoor district of Andhra Pradesh
N Bayapa Reddy1, G Ravi Prabhu2, T S R Sai2
1 Assistant Professor, Chennai Medical College Hospital and Research Centre, Irungalur, Trichy, India
2 Professor, Department of Community Medicine, SV Medical College, Tirupati, Andhra Pradesh, India
|Date of Web Publication||24-Jan-2013|
N Bayapa Reddy
Assistant Professor, Department of Community Medicine, Chennai Medical College Hospital and Research Centre, Irungalur, Trichy-621105, Tamil Nadu
Source of Support: None, Conflict of Interest: None
| Abstract|| |
The sub-centers (SCs) are under constant criticism for their inability to deliver quality services due to the nonavailability of adequate infrastructure, manpower and supply of drugs.A cross-sectional study was conducted in Chittoor District of Andhra Pradesh to assess the availability of physical infrastructure and manpower in the SCs. A total of 34 SCs were selected by multistage and stratified random sampling technique. The data was statistically analyzed by using Microsoft Excel. The deficiency in the availability of health workers male and female were found to be 67.7% and 27.5%, respectively. The residential facility for health workers was available only in 26.4% SCs. Only 20.6% of SCs had stethoscope and B.P apparatus. The physical infrastructure and manpower availability at the SCs needs considerable improvement as per the Indian Public Health Standard (IPHS). Facilities to conduct the normal delivery and 24-hours emergency referral services need to be addressed at the earliest.
Keywords: Infrastructure, Primary health centers, Sub-centers
|How to cite this article:|
Reddy N B, Prabhu G R, Sai T. Study on the availability of physical infrastructure and manpower facilities in sub-centers of Chittoor district of Andhra Pradesh. Indian J Public Health 2012;56:290-2
|How to cite this URL:|
Reddy N B, Prabhu G R, Sai T. Study on the availability of physical infrastructure and manpower facilities in sub-centers of Chittoor district of Andhra Pradesh. Indian J Public Health [serial online] 2012 [cited 2019 Jun 17];56:290-2. Available from: http://www.ijph.in/text.asp?2012/56/4/290/106417
As per the population norms, one SC is established for every 5000 population in the plain areas and for every 3000 population in hilly, tribal, and desert areas. , The SCs are under constant criticism for their inability to deliver quality services. The main reasons are the nonavailability of health workers, inadequate infrastructure and facilities, and insufficient supply of drugs.
In the above context, the present study was undertaken with the objective to assess the infrastructure facilities and availability of manpower in the SCs of Chittoor district.It was planned to study at least 25% of the existing means primary health centers (PHCs), that is, 22 PHCs. A multistage and stratified random sampling technique was employed for selecting the required SCs. From each of the four health administrative regions, five PHCs were randomly selected. To make up the required 25% (22 PHCs), one more PHC was selected randomly from two of the regions randomly selected. From each of selected PHC the list of SCs was procured and after excluding the head quarter SC, one SC was selected randomly out of the remaining SCs. If there were more than six SCs in any PHC, one more SC was selected. Thus a total of 34 SCs were selected for this study. The study was conducted for a period of 10 months from June 2009 to March 2010. A pretested questionnaire was used to collect the necessary information and the data was computed and analyzed using Microsoft Excel.
The average population covered by SC was 4833 (median 4277 and range 1173-10,250); the average number of SCs per PHC was 9.5; median 10 (range 5-35).All the SCs had at least one Multipurpose Health Worker Female (MPHW Female). Two MPHW Female and one MPHW Male were available in 16 (47.0%) and 11 (32.3%) SCs, respectively. Only 50 out of 68 (73.5%) Female and 11 out of 34 (32.3%) Male MPHWs were posted in 34 studied SCs.
It was found out that only 3 (8.8%) of the SCs were being visited once in a month on a fixed day by the medical officer. The supervisors (male or female health assistants) were regularly visiting only 21 (61.7%) of SCs.
Out of 34 SCs studied, 17 (50%) SCs were housed in government buildings and the remaining 17 (50%) were being operated in rented buildings. Out of 17 SCs were housed in government buildings, 14 (41.2%) were in designated government buildings, and 3 (8.8%) were in the government buildings of other departments. Out of 14 (41.2%) SCs housed in designated government buildings, only 9 (26.4%) were in good condition, with a residential facility with all amenities for MPHW Female and room with all equipment for health care delivery.
All the SC buildings were located in easily accessible area within the village. Average distance of the farthest village of SC was 5.4 km (median 5.0 km, range 3-15 km) with the average time to reach the SC being 32.9 minutes (median 29.4 minutes, range 15-60 minutes) by bus.The average distance between the SC and the PHC was 6.5 km (median 5.9 km, range 2-15 km). The distance between the SC and the first referral centre (Community Health Centre, CHC) was 18 km (median 22.4 km).
Out of 34 SCs only 7 (20.6%) had stethoscope and B.P apparatus, whereas delivery tables, Sahli'shemoglobinometer was present only in 4 (11.7%) and 3 (8.8%) SCs, respectively. On the whole, none of the SCs had delivery kits and deliveries were not being conducted in any of the SC. All the SCs had good supply of OPV, DPT, DT, TT, and Hepatitis B vaccines from the PHC, but BCG and measles vaccines were regularly supplied to only 26 (76.4%) SCs. All the SCs had sufficient quantity of drugs to treat minor ailments and anemia, while none of the SCs had the requisite quantity of essential obstetric drugs such as methyl ergometrine maleate, magnesium Sulfate, oxytocin injections and Tab. misoprostol 200 μg (as per IPHS).
State of water supply, electricity, waste disposal, communication facilities, and residential facility for staff are shown in [Table 1].
The variation in population covered by each SC was too high (1173-10,250). Number of SCs being in one PHC was, on an average of 9.5. It is impossible for one PHC to deliver services and supervise the SCs. Similar study conducted in Mandla district (Tribal area) found that average population covered by each SC was 3600, whereas in Madhya Pradesh it is 5447; and average numbers of SCs covered by each PHC was 8.26 SCs in Mandala district and 7.07 in Madhya Pradesh state.  This issue needs to be addressed at the country and new SCs need to be established as per the IPHS.
The deficiency in the availability of two MPHW Females and one MPHW Male were to the extent of 27.5% and 67.7%, respectively. In a similar study conducted in Kerala they found that only in 56.4 % of SCs had two MPHW Females.  The deficiency of the manpower will definitely affect healthcare delivery.
As per IPHS, the SCs should provide residential facility for auxiliary nurse midwives(ANMs); this study found that only 26.4% of SCs have residential facilities for ANMs. In similar studies conducted in Kerala,  Mandla,  and facility survey India  found that only in 54.4%,27.5%, and 30%of SCs had own building, out of these only 31.1%, 75.7%, and 30% female health workers were staying in SCs or in the SC village.This will definitely impair the level of functioning of the respective SCs.
In Jain et al., and Pal et al., studies,  SCs were graded and ranked according to available physical facilities and basic amenities. SCs were graded 44% and 10% as good, 12% and 42.5% as average, and 44% and 47.5% as poor, respectively. But in this study, we found that only 26.4% were good, 23.5% average, and 50.1% were poor.
In this study we found that medical officer visited SCs once in a month only in 8.8% SCs, whereas in the Kerala study, 58.9% of the SC were visited by medical officer every month.  That could be one of the reasons for better health care delivery and better health status in Kerala.
All SCs should have regular power supply, safe water supply, biomedical waste disposal, communication, and basic sanitation facilities. Pal et al. study also found the same results, except regular water supply, in 35% of SCs.  Better cared SCs with all basic facilities will encourage workers to stay there, and that could improve the services. More than 90% of the SCs did not have the vital equipments. Pal et al. also found similar results.  In Facility Survey India they found that 10-50% of the SCs conducted deliveries. In our study, none of the SCs were conducting deliveries.
Although there is sufficient quantity of vaccines, contraceptives, and essential drugs for minor ailments,the IPHS norms specify that all the SCs should have the sufficient basic equipment for carrying out routine Maternal and Child Health (MCH) and other patient care, apart from facilities for conducting a normal delivery. Without these facilities the Millennium Development Goals (MDGs) cannot be achieved.
The present study was taken up to provide some useful inputs regarding the existing level of infrastructural and manpower facilities at SCs. SCs play a crucial role to decrease the infant mortality rate (IMR) and maternal mortality rate (MMR) in the rural areas, deficient manpower would definitely impair the level of health care provided to the community. The presence of the ANM all 24 hours at the SCs is essential for the people to avail the health services.
SCs need to be brought to IPHS norms in terms of MPHW Female working there, residential facilities for workers, number of rooms, electricity, water supply, and communication facilities. The basic distribution of population in the SCs area needs to be kept to standard and the number of SCs per PHC also needs to be regulated as per the norm, for better functioning and supervision of the SCs. There needs to be a better control of medical officers and health supervisors visiting the SCs at least once in 2 weeks.
| References|| |
|1.||Ministry of Health & Family Welfare Government of India. NRHM Indian Public Health Standard (IPHS) [about 3 screens]. Guidelines, Sub-Centre (SC)revised draft 2010 Available from: http://www.mohfw.nic.in/NRHM/IPHS_Revised_Draft_2010/Sub-Centre_Revised_Draft.pdf. [Last cited on 2011 Mar 22]. |
|2.||Park K. Health Care System. In: Park K, editor. Park′s Textbook of Preventive and Social Medicine. 20 th ed. Jabalpur, India: Banarasidas Bhanot Publishers; 2009. p. 802-06. |
|3.||Pal DK, Tiwari R, Kasar PK, Sharma A, Verma S, Gautam P, et al. Regional Medical Research centre for Tribals. Jabalpur: PublicationsProceeding of National Symposium on Tribal Health. Available from: http://www.rmrct.org/files_rmrc_web/centre′s_publications/NSTH_06/NSTH06_24.DK.Pal.pdf. [Last cited on 2012 March 22]. |
|4.||Nair VM,Thankappan KR,Vasan RS,Sarma PS. Community utilisation of subcentres in primary health care - An analysis of determinants in Kerala. Indian J Public Health 2004;48:17-20. |
|5.||Ram F, Paswan B, Singh LL. District Level Household & Facility Survey (Under Reproductive and Child Health Project). Publication: National facility report DLHS II. Facility Survey 2003. Available from: http://www.rchiips.org/pdf/rch2/National_Facility_Report_RCH-II.pdf. [Last cited on 2012 Mar 22]. |
|6.||Jain S, Singh J, Bhatnagar M, Garg S, Chopra H, Bajpai S. Evaluation of Physical Facilities Available At SCs In District Meerut. Indian J Community Med 1999;24:27-9. |