Evaluation of 24x7 PHCs in 7C Districts of North Karnataka 1 - PowerPoint PPT Presentation

Evaluation of 24x7 PHCs in 7C Districts of North Karnataka 1

Agenda • Background of the study • Findings – Snapshot of performance – Snapshot of resources – Contextual factors – Aiding and Hindering factors • Analysis • Recommendations

Background • Primary health centres upgraded to work 24x7 • Increased emphasis on maternal and child health • Increased human resources: 3 staff nurses, 3 doctors • Higher priorities for delivery and related services • Process began in 2008. • Higher priority to PHCs in North Karnataka – Regional disparities, backwardness and distribution of PHCs are important parameters

Objectives and methodology • Snapshot of functionality of 24X7 PHCs • Aiding and hindering factors for performance • Operational and policy level changes • Use existing frameworks for analysis - WHO's six blocks • Understand the influence of contextual factors • Use a 'small n' framework

WHO's 6 Building Blocks However, performance affected by systemic factors as well as contextual factors

Performance of 24x7 PHC • Performance • Systemic factors – IMR, MMR – Infrastructure – Medicine – OPD – HR – In Patients – Funds – Delivery – Emergencies • Contextual factors – Other services – Competence – Access and coverage – Fund disbursal – Stability of staff 'deliveries per thousand population – Disease intensity per year' is the primary indicator to – Social & demographic issues assess the performance of 24x7 PHCs

Methodology, field sites and tools • • Small n, and hence Gulbarga (6) 7C districts associations rather • Yadgir (5) • than strict correlations Bagalkot (5) • • Raichur (5) Cross tabulation of • Bijapur (6) different explanatory • Koppal (5) • variables with PHC Bidar (5 ) levels • – Interviews with 3 categories of Tools Doctors, Staff performance – PHC Nurses, Pregnant – High level (15) observations women and – Low level (13) mothers – Document – Group discussions – Median level (9) observations

Findings – Snapshot of performance District PHCs in HMIS Deliveries per thousand per year Deliveries per thousand per (sample in brackets) (based on HMIS data) year (sampled PHCs) Max Min Avg St. dev H M L 1 2 3 4 5 6 7 8 9 Bagalkot 46 (5) 15.61 0 5.27 3.61 15.08 5.82 0.95 Bidar 48 (5) 18.01 0 5.11 4.38 18.26 5.82 3.77 Bijapur 64 (6) 19.82 0 6.54 5.53 19.93 4.69 1.28 Gulbarga 76 (6) 18.6 0 7.44 4.21 19.29 9.35 0.38 Koppal 42 (5) 29.38 3.13 8.32 5.13 21.57 7.16 3.45 Raichur 46 (5) 20.77 0.95 6.82 3.74 21.68 9.52 3.31 Yadgir 42 (5) 44.82 0 10.66 8.01 41.26 11.35 2.6 Total 364 (37) 44.82 0 7.1 5.3 22.27 7.53 2.32 ● Deliveries observed in the chosen PHCs indeed reflect the respective level of performance reported in each of the districts ● This indicator is also known as CBR. ● CBR in the region is between 19 – 22. ● About 1/3rd of the deliveries are covered by 24x7 PHCs

Population and distance of PHCs • Population and distance to taluk HQnot linked with performance Population H M L Total Number of PHCs in each level Distance to covered Taluk Hospital H M L Total 1 2 3 4 5 1 2 3 4 5 0-9999 1 1 5-14 2 4 1 7 10000-19999 4 1 2 7 15-24 5 1 6 12 20000-29999 4 5 4 13 25-34 3 2 3 8 30000-39999 4 2 2 8 35-44 5 3 8 40000-50000 2 1 2 5 45-54 2 2 >50000 3 3 Total 15 9 13 37 Total 15 9 13 37

Snapshot of PHC services District H M L 1 2 3 4 • OPD, In patient rates and Bagalkot 118.78 28.88 13.84 other services in general are Bidar 48.27 8.06 34.54 higher in H level PHCs. Bijapur 23.13 29.74 21.54 – Doesn't hold good Gulbarga 26.14 26.66 20.93 Koppal 43.58 80.41 54.80 uniformly Raichur 37.34 16.51 10.31 Y adgir 69.81 46.34 18.47 District H M L Total 50.48 32.56 25.18 1 2 3 4 Services provided H M L Bagalkot 17.67 18.00 63.33 1 2 3 4 Bidar 12.83 13.83 15.71 Emergency services (April+July) 11.93 9.22 7.46 Bijapur 26.11 50.63 8.42 Lab tests performed (Average) 687.90 619.61 465.31 Gulbarga 82.88 19.50 32.33 Number of PHCs providing services (2013-14) Koppal 38.08 52.50 35.38 Family planning camps 9 3 4 Raichur 139.13 56.67 37.75 ENT Camps 0 0 0 Yadgir 123.08 42.92 19.42 Eye camps 3 2 1 Total 60.38 36.02 32.02 Provision of birth certificates 15 8 13 Death Certificates 3 0 1

Deliveries Monthly deliveries Patterns in deliveries in 24x7 PHCs Night deliveries 50 • PHCs that facilitated higher Complicated deliveries 45 number of deliveries also 40 tend to have higher number 35 30 Monthly averages of night deliveries and 48.5 25 complicated deliveries. 20 • Uniformly applicable in all 15 26.34 22.03 18.22 10 districts 11.42 5 7.11 6.38 4.67 Average Monthly Deliveries 2.49 2.15 1.78 0.46 District 0 H M L H (15) M (9) L (13) T otal (37) 1 2 3 4 24x7 PHC Delivery category Bagalkot 14.50 13.00 4.75 Bidar 35.00 14.50 8.25 Bijapur 50.50 10.75 2.50 Gulbarga 49.50 20.00 1.00 Koppal 40.25 6.50 5.50 Raichur 55.75 24.50 14.75 Yadgir 93.00 44.00 6.00 Total 48.50 18.22 6.38

Mortality PHC Level Total Deaths deaths H M L Infants (PHC Area) 126 64 164 351 Mothers (PHC Area) 5 1 3 9 • Average infant deaths in the PHC areas in H level PHCs is 9, in M level PHCs it is 7.11 and in L level PHCs, it is 12.38 • 1 L level PHC reported that no infant deaths occurred in its area. • Majority of H level PHCs (57%) and M level PHCs (66%) reported infant deaths in the range of 1- 10. • About 46% of L level PHCs had infant deaths in the 11 – 30 range.

Provision of JSY and Madilu Kit Timeliness in provision of JSY • Based on 5 random Delayed Not provided Not PHC Level Given on time provision yet (Oct 2014) applicable Total samples in each 1 2 3 4 5 6 PHC H 31 (41.33%) 29 (38.67%) 12 (16% ) 3 (4%) 75 M 8 (18.18%) 16 (36.36%) 20 (45.45%) 44 • H level PHCs L 6 (9.52%) 44 ( 69.84%) 13 (20.64%) 63 provide more timely Total 45 (24.72% ) 89 ( 48.90%) 45 (24.72%) 3 (1.65%) 182 services than others. Timeliness in the provision of Madilu Kit • Roughly, 25% of PHC Level Total Given on Delayed Not provided Not time provision yet (Oct 2014) applicable eligible JSY beneficiaries and 1 2 3 4 6 7 H 37 (49.33% ) 18 ( 24%) 15 (20% ) 5 ( 6.67%) 75 31% of Madilu kit M 14 (31.82%) 19 (43.18% ) 10 (22.73%) 1 (2.27% ) 44 beneficiaries yet to L 7 (11.11% ) 16 (25.40%) 32 (50.79%) 8 (12.70% ) 63 58 (31.87% ) 53 receive entitlements Total 57 (31.32% ) 14 (7.69% ) 182 ( 29.12%)

Provision of resources Doctors H M L Total • 1 2 3 4 5 Infrastructure and No doctor 2 2 medicine provision did 1 3 7 7 17 not show significant 2 9 2 4 15 3 3 3 differences Total PHCs 15 9 13 37 • Bidar in general lagged behind other districts. Influence of lady doctors on deliveries in PHCs • 16 Most PHCs had at least Avereage deliveries per thousand per year 14 one doctor 12 • Presence of lady doctors 10 14.95 8 was crucial 11.68 6 8.03 4 Number of PHCs Presence of Total lady doctor H M L 2 1 2 3 4 5 0 No 4 4 9 17 No Yes T otal Yes 11 5 4 20 Presence of lady doctor Total 15 9 13 37

Human Resources SN H M L Total 1 2 3 4 5 • 25 out of 37 PHCs had 3 or more 1 2 2 2 2 5 3 10 staff nurses 3 9 4 8 21 – 13 out of 15 H level had more 4 4 4 Total 15 9 13 37 than 3 staff nurses • Other staff vacancies not directly Vacant ANM positions District related to PHC performance No vacancies 1-2 3-4 1 2 3 4 • ANM vacancy high Bagalkot 2 3 Bidar 2 2 1 Number of PHCs having vacant Bijapur 2 2 2 positions Positions Gulbarga 4 1 1 H M L Koppal 2 3 1 2 3 4 Raichur 1 2 2 Lab Technician 3 2 2 Y adgir 1 2 2 MHV(more than 2) 5 4 4 Total Result 14 15 8 LHV 2 3 1 Pharmacist 1 2 3

Funds received • Funds received in 2 tranches: July and Nov-Dec • Koppal PHCs didn't receive the full amount. • Tangadagi in Muddebihal of Bijapur: No funds received • 7 PHCs couldn't identify which funds have been received Overall funds received (in categories) in 2013-14 • Funding patterns based on district District No decisions rather than performance < 50000 50001-100000 100001-150000 > 150000 Total funds • 2 PHCs from Sedam taluk of 1 2 3 4 5 6 7 Gulbarga; K R Palli and Yadaga Bagalkot 2 3 5 received their final tranches of Bidar 5 5 funds in February and March 2014. Bijapur 1 1 1 3 6 • PHC staff doesn't relate fund Gulbarga 1 5 6 release and expenditures with Koppal 5 5 PHC action plans Raichur 1 4 5 Yadgir 2 3 5 Total 1 1 5 7 23 37

Contextual factors Head-quarter stay of Doctors and Staff Nurses Deliveries conducted by PHC staff 1 14 100% 1 90% 12 80% 10 70% 13 Number of PHCs 8 24 58 60% ANM 21 14 Doctor Staff Nurse Staff Nurse 50% 6 Doctor 10 40% 8 4 7 30% 2 20% 2 2 5 6 15 0 10% 4 H M L 0% PHC performance level H M L All PHCs