A Study to Review
National Institute of Health and Family WelfareBaba Gang Nath Marg, Munirka, New Delhi - 110067
The Health Care Delivery System Provided by PHSC
PunjabPunjab Health Systems Corporation
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Study to Review The Health Care Delivery System provided by PHSC, Punjab i
Report
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A Study to Review
The Health Care Delivery System
Provided by
Punjab Health Systems Corporation (PHSC), Punjab
National Institute of Health and Family WelfareBaba Gang Nath Marg, Munirka, New Delhi – 110067
Email: [email protected]: www.nihfw.org
2008
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 18 B. Sub-divisional Hospitals (SDHs) 35 C. Community Health Centres (CHCs) 50
Views of the Benefi ciaries on Quality of Services 64
1. In-patient Department 64 2. Out-patient Department 74
Evaluation of the Training Institutes 84
Community Voice 91
Views of the Stakeholders 100
• At District Level 100 Deputy Commissioners (D.C) 100 MLA/Elected Representative 102 Civil Surgeons 104 SMO in charge – District Hospitals 106
• At Sub-Division Level 109 MLA/Elected Representative 109 SMO – Sub Divisional Hospitals 110
• At CHC Level 113 Elected Representatives at CHC 113 Senior Medical Offi cers - CHC 114
Observations and Discussion 118
Facility Survey 118 Views of the Benefi ciaries 121 Views of the Community (through FGDs’) 125 Views of the Stakeholders 125
Conclusion and Recommendations 127
CO
NT
EN
TS
iii
List of Tables
1 District Hospitals
1.1 General Profi le 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
2 Sub Divisional Hospitals
2.1 General Profi le 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
2.14 Central Supply Department 194
2.15 Five Year Performance Report 196
2.16 Utilisation of User Charges 198
2.17 Medical Offi cers in Position 201
2.18 Staff Positions 203
3 Community Health Centres
3.1 General Profi le 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 Offi cers in Position 227
3.19 Five Year Performance Report 229
3.20 Staff Positions 231
3.21 Utilisation of User Charges 233
4 Distribution of Patients in Wards 2365 Admissions in Different Hospitals 2386 User Charges for Services in Various Hospitals 2397 Experience at Facility and Quality of Care 2408 Patient Responses on Quality of Services 2429 Patient Responses on Behaviour of Staff 24410 Availability of Medicines (patients’ responses) 24511 Money Spent (patients’ responses) 24512 Rules and Regulations at Facilities (patients’ responses) 24613 Satisfaction from the Services 246
Study to Review The Health Care Delivery System provided by PHSC, Punjab v
14 Suggestions for Further Improvement 247
15 Distribution of Out-patients 248
16 User Charges for Services (patients’ responses) 250
17 Observations on Facility Profi le (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
vi Study to Review The Health Care Delivery System provided by PHSC, Punjab
List of Abbreviations
ANC Ante Natal Care
ANM Auxiliary Nurse Midwife
ASHA Accredited Social Health Activist
BOR Bed Occupancy Rate
BTR Bed Turnover Rate
CHA Community Health Administration
CHC Community Health Centre
CSSD Central Sterile Supply Department
DC Deputy Commissioner
DD-cum-CS Deputy Director-cum-Civil Surgeon
DH District Hospital
DMC Deputy Medical Commissioner
ECG Electro Cardiogram
FGDs Focus Group Discussions
GDMO General Duty Medical Offi cer
ICU Intensive Care Unit
IPF In-Patient Facilities
LP Lumbar Puncture
MLA Member, Legislative Assembly
MO Medical Offi cer
NHP National Health Programmes
OPD Out-patient Department
OT Operation Theatre
PHC Primary Health Centre
PHSC Punjab Health Systems Corporation
PPS Population Proportionate to Size
RKS Rogi Kalyan Samiti
SDH Sub-divisional Hospital
SHC Subsidiary Health Centre
SMO Senior Medical Offi cer
SP Hospital Special Hospital
VED Vital, Essential, Desirable
Study to Review The Health Care Delivery System provided by PHSC, Punjab vii
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
Preface
Study Team
Team Leader Prof. Deoki Nandan, Director, NIHFW
Amritsar Dr. U. Datta, Reader and Acting Head, Deptt. of Education and TrainingMrs. Rita Dhingra, Research Offi cerMr. G.P. Devrani, Asstt. Research Offi cerDr. B.S. Diwan, PG (CHA) student and Dr. Yashika, PG (CHA) student
Bhatinda Prof. J.K. Das, Head, Deptt. of Epidemiology and MCHAMrs. Reeta Dhingra, Research Offi cerMr. G.P. Devrani, Asstt. Research Offi cerDr. Devinder Megha, PG (CHA) student and Dr. Vartika, PG (CHA) student
Firozpur Dr. Vivek Adhish, Reader, Department of CHAMrs. Vandana Bhattacharya, Research Offi cer Mr. S.S. Mehra, Asstt. Research Offi cerDr. B.S. Diwan, PG (CHA) student and Dr. Jagriti, PG (CHA) student
Gurdaspur Dr. Sanjay Gupta, Reader, Department of CHA and Sub DeanDr. Rachna Agarwal, Asstt. Research Offi cer and Mr. S.P. Singh, Research AssistantDr. Nishant, PG (CHA) student and Dr. Ashu, PG student
Hoshiarpur Dr. V. Adhish, Reader, Department of CHAMrs. Vandana Bhattacharya, Research Offi cerMr. S.S. Mehra, Asstt. Research Offi cerDr. Sonia, PG (CHA) student and Dr. Vijaydeep, PG (CHA) student
Jallandhar Dr. Gyan Singh, Chief Medical Offi cer, Department of CHAMr. S.S. Mehra, Asstt. Research Offi cerMrs. Vaishali, Research AssistantDr. Vartika, PG (CHA) student and Dr. Devendra Megha, PG (CHA) student
Ludhiana Prof. M. Bhattacharya, Head, Department of CHA, and DeanMr. Parimal Pariya, Research Offi cerMr. Ramesh Gandotra, Asstt. Research Offi cerDr. Kumud, PG (CHA) student and Dr. Naveen, PG (CHA) student
Muktsar Dr. Sanjay Gupta, Reader, Department of CHA, and Sub DeanMr. Parimal Pariya, Research Offi cerDr. Rachna Agarwal, Asstt. Research Offi cerDr. Shailender, PG (CHA) student and Dr. Sudha Goel, PG (CHA) student
Sangrur Prof. J.K. Das, Head, Deptt. of Epidemiology and MCHAMrs. Reeta Dhingra, Research Offi cerMr. G.P. Devrani, Asstt. Research Offi cerDr. Rakesh, PG (CHA) student and Dr. Madhu, PG (CHA) student
Tarantaran Prof. J.K. Das, Head, Deptt. of Epidemiology and MCHAMr. J.P. Shivdasani, Research Offi cerMrs. Vinod, Asstt. Research Offi cerDr. 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
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 to Review The Health Care Delivery System provided by PHSC, Punjab ix
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 fi nancial 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 Offi cers) 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
x Study to Review The Health Care Delivery System provided by PHSC, Punjab
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 defi cient 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 in-patient 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.
Study to Review The Health Care Delivery System provided by PHSC, Punjab 1
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 effi ciency and quality of the health care provided at fi rst 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 fl exibility 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 effi ciency in the allocation and use of health resources in the Project States
1.0 Introduction
2 Study to Review The Health Care Delivery System provided by PHSC, Punjab
through policy and institutional development; andb) 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 fi rst 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 Benefi ts to the General Public
a. Free consultation for allb. 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.
c. Full availability of equipment and chemicals, etc. for diagnostic facilities.
Study to Review The Health Care Delivery System provided by PHSC, Punjab 3
As mentioned above, the Health Systems Development Project started under PHSC in 1996 with fi nancial 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 Chairman V.C.Punjab Planning Board
ii) Dr. K.K. Talwar Member Director, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh
iii) Dr. P.K. Dave Member Former Director, All India Institute of
Medical Sciences (AIIMS), New Delhi
iv) Dr. Deoki Nandan Member Director, National Institute of Health and Family Welfare (NIHFW), New Delhi
v) Dr. Shakti Gupta Member Medical Superintendent, AIIMS, New Delhi
vi) Dr. Sukhdev Singh Member Director, Family Welfare, Punjab
vi) Dr. Roshan Sunkaria, IAS Member Managing Director, PHSC Convener Member
viii) Shri Tejveer Singh, IAS Coordinator Special Secretary to Government of Punjab Member Department of Planning
2.0 Rationale
4 Study to Review The Health Care Delivery System provided by PHSC, Punjab
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 effi ciency and effectiveness of management system so far established.
ii) To conduct site visits to a specifi ed number of District Hospitals, special hospitals, sub divisional hospitals and community health centres and assess the quality and effi ciency 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 effi cient management of PHSC as well as of hospitals and training institutions under its control and management.
The fi eld work, data collection, analysis, interpretation and report writing was done by National Institute of Health and Family Welfare, New Delhi.
Study to Review The Health Care Delivery System provided by PHSC, Punjab 5
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. 50% of 20 District Hospitals (DHs) 10 DHs2. 26% of 37 Sub Divisional Hospitals (SDHs) 10 SDHs3. 10% of 111 Community Health Centres (CHCs) 11 CHCs4. All the Special Hospitals (SHs) 02 SHs5. All the Training Centres (TCs) 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. Amritsar2. Gurdaspur3. Taran Taran
Doaba
1. Hoshiarpur2. Jalandhar
3.0 Methodology
6 Study to Review The Health Care Delivery System provided by PHSC, Punjab
Malwa
1. Bhatinda2. Ferozpur3. Muktsar4. Sangrur 5. Ludhiana
3.5 Data Collection Tools and Techniques
1) Interview schedule for health functionaries/service providers2) Exit interview schedule for patient satisfaction3) Checklist for Facility Survey4) Questionnaire for trainers 5) Interview schedule for other stakeholders including community
The health functionaries, other stakeholders, sample of benefi ciaries (i.e. patients selected randomly) and facility surveys of health institutions for study were as follows:
3.5.1 At district level
a) District Collector 1x10 = 10 in no.b) Civil Surgeon 1x10 = 10 in no.c) Local MLA/MP 1x10 = 10 in no.d) SMO/MS at District Hospitals 1x10 = 10 in no.e) Indoor patients 10% of the total admitted in hospital or minimum of
10 patientsf) Outdoor patients (OPD) 5% of the OPD attendance or minimum of 20 patientsg) Facility Survey of 1x10 = 10 in no. District Hospitals
3.5.2 At sub-divisional level
a) Local elected representatives at sub-divisional level 1x10 = 10 in no.b) SMOs/MS at Sub-Divisional Hospitals 1x10 = 10 in no.c) Indoor patients 10% of the total admitted in hospital or minimum of
6 patientsd) Outdoor patients (OPD) 5% of the OPD attendance or minimum
of 20 patientse) Facility Survey of 1x10 = 10 in no. Sub-Divisional Hospitalsf) FGD (Male Community Members) 1x10 = 10 in no.
Study to Review The Health Care Delivery System provided by PHSC, Punjab 7
3.5.3 At CHC level
a) Local elected representatives at CHCs 1x11 = 11 in no.b) SMO/MS at CHC 1x11 = 11 in no.c) Indoor patients 10% of the total admitted in hospital or minimum of
3 patientsd) Outdoor patients (OPD) 5% of the OPD attendance or minimum of 10 patientse) Facility Survey of the CHCs 1x11 = 11 in no.f) FGD (female community members) 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) SMO/MS at Special Hospitals 1x2 = 2 in no.b) Indoor patients 10% of the total admitted in hospital or minimum of
10 patientsc) Outdoor patients (OPD) 5% of the OPD attendance or minimum of 20 patients
3.5.5 Training institutes
a) Facility Survey 1x3 = 3 in no.b) Interview of the faculty
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.
8 Study to Review The Health Care Delivery System provided by PHSC, Punjab
Following are the study fi ndings 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 fi ndings 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 fl exibility 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, 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. 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.
4.0 Study Findings
Study to Review The Health Care Delivery System provided by PHSC, Punjab 9
B
GF
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
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
PHSC Jt. Secretary Health
Health-I, II & IV Branches
Under Secretary Health
Health - V, VI & VII
Branches
PSACS
A
C D E
PHSC Punjab Health Systems Corporation
PSACS Punjab State Aids Control Society
SI Social Insurance (ESI)
10 Study to Review The Health Care Delivery System provided by PHSC, Punjab
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 174.07
Major/Minor equipment, Surgical Packs and Furniture 66.09
Vehicles and Ambulances 8.49
Medicines, Medical Lab, Supplies 26.51
Information Systems and Computers 11.14
Training and Workshop 12.45
Salaries and Offi ce 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 offi cer 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 Offi cers.
(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
Study to Review The Health Care Delivery System provided by PHSC, Punjab 11
Punjab Health Systems Corporation
Chairman
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)
Executive Engineer (Works)
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)
EE (C) Jalandhar
AAO
EE (C) Mohali
EE (C) Patiala
AM AuditAMFADMA
Accountants AMFA Assistant Manager (Finance & Accounts)
AAO Assistant Accounts Offi cer
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
A
12 Study to Review The Health Care Delivery System provided by PHSC, Punjab
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 Offi cer 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 Offi cer 12. Medical Offi cer 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 offi cers in the fi eld of Quality Assurance, HMIS, Waste Management, Surveillance, Referral, Training, IEC, Hospital Services, Blood Bank have been positioned at headquarters level. Separate offi ces were set-up for Deputy Medical Commissioners (DMC). Apart from this, in order to enhance the data collection and analysis capabilities, the offi ce of DMCs have been strengthened by providing manpower in the fi eld of accounts and HMIS which support the hospitals in proper record keeping and monitoring.
Study to Review The Health Care Delivery System provided by PHSC, Punjab 13
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 hospitalsg) 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 fi nancing 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 effi cient 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. Chance of foreign training for all doctors and para-medical staff;2. Substantial training opportunities and fellowships etc. within the country;3. 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 Offi cer 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
14 Study to Review The Health Care Delivery System provided by PHSC, Punjab
District Headquarters
Deputy Director-cum-Civil Surgeon{1 Post at each district}
(Total = 18)
Assistant Civil Surgeon
District Immunisation
Offi cer
District Family Planning Offi cer
Deputy Medical Commissioner
Senior Medical Offi cers ofPHC/SHCs
LHV (Lady Health Visitor)
M+F (Male & Female)
MPHW (Multipurpose Health Worker)
PHC (Primary Health Centres)
SHC (Subsidiary Health Centre)
SMO (Senior Medical Offi cer)
X
District Health Offi cer
1 Primary Health Centre for appropriately (100,000) populationTotal in the State 118SMO - 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)
SMO (Hospitals)
Authority and implementation of different schemes in the District under National Family Welfare Programme through District Family Welfare Offi cer and District Immunisation Offi cer.
4.6.2 At block level
The Civil Surgeon is supported by Senior Medical Offi cers, I/c of PHCs and Medical Offi cers 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 Offi cers are supported by Medical Offi cer 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 Offi cers 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.
Study to Review The Health Care Delivery System provided by PHSC, Punjab 15
(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 Offi cer 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 fi nancial 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 effi ciency 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 effi cient Hospital Administrator these are very important tools.
16 Study to Review The Health Care Delivery System provided by PHSC, Punjab
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 96-97 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 defi ned 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 Offi cer of one speciality on transfer was replaced by a Medical Offi cer of another speciality or a general duty medical offi cer, because in Punjab, there is only one cadre for Medical Offi cers.
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
Study to Review The Health Care Delivery System provided by PHSC, Punjab 17
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-fl ung 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 effi cient 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 modifi cation 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 confi dence 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 effi cient 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 scientifi c 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.
18 Study to Review The Health Care Delivery System provided by PHSC, Punjab
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 profi le 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 154bedded 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.
5.0 Facility Assessment
Study to Review The Health Care Delivery System provided by PHSC, Punjab 19
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 fi ve 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 fi ve ambulances each.
20 Study to Review The Health Care Delivery System provided by PHSC, Punjab
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
0
500
1000
1500
2000
2500
3000
3500
4000
Amritsar
Ferozp
ur
Gurdaspur
Hoshiar
pur
Jalan
dhar
Ludhiana
Muktsar
Patiala
(SH)
Sangrur
Taran tar
an
Bhatinda(S
H)
Districts
No.
of n
orm
al d
eliv
erie
s
1st Yr2nd Yr3rd Yr4th Yr5th Yr
Study to Review The Health Care Delivery System provided by PHSC, Punjab 21
Fig 2: Caesarians done in District Hospitals (Punjab) in the last five years
0
200
400
600
800
1000
1200
1400
1600
Amritsa
r
Ferozp
ur
Gurdas
pur
Hoshiar
pur
Jalan
dhar
Ludhiana
Muktsar
Patiala
(SH)
Sangru
r
Taran ta
ran
Bhatinda(S
H)
Districts
No.
of c
aesa
rians
1st Yr2nd Yr3rd Yr4th Yr5th Yr
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 verifi cation 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.
22 Study to Review The Health Care Delivery System provided by PHSC, Punjab
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 fi ve 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.
Study to Review The Health Care Delivery System provided by PHSC, Punjab 23
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)
24 Study to Review The Health Care Delivery System provided by PHSC, Punjab
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.
Fig 3: No. of OPD Patients in District Hospital (Punjab) in last five years
0
50000
100000
150000
200000
250000
300000
Amritsa
r
Bathinda
Ferozp
ur
Gurdas
pur
Hoshiar
pur
Jalan
dhar
Ludhiana
Muktsar
Patiala
(SH)
Sangru
r
Taran ta
ran
Bhatinda(S
H)
Districts
No.
of O
PD p
atie
nts
1st Yr2nd Yr3rd Yr4th Yr5th Yr
Study to Review The Health Care Delivery System provided by PHSC, Punjab 25
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 offi cer 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 fi ve.
Fig 4: No. of emergency patients in District Hospitals (Punjab) in the last five years
0
2000
4000
6000
8000
10000
12000
14000
16000
18000
20000
Batinda Ferozpur Gurdaspur Hoshiarpur Jalandhar Sangrur Taran taran Bhatinda(SH)
Districts
No.
ofpa
tient
s
1st Yr2nd Yr3rd Yr4th Yr5th Yr
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.
26 Study to Review The Health Care Delivery System provided by PHSC, Punjab
Fig 5: Admissions through emergency in District Hospitals (Punjab) in the last five years
0
1000
2000
3000
4000
5000
6000
7000
8000
Bhatinda
Ferozp
ur
Gurdas
pur
Hoshiar
pur
Jalan
dhar
Ludhiana
Muktsar
Sangru
r
Taran tar
an
Bhatinda(S
H)
Districts
No.
of a
dmis
sion
s th
roug
h em
erge
ncy 1st Yr
2nd Yr3rd Yr4th Yr5th Yr
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.
Suffi cient 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.
Study to Review The Health Care Delivery System provided by PHSC, Punjab 27
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 fi ve 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 qualifi ed pathologist was available in nine District Hospitals and both the special hospitals. A qualifi ed biochemist was present in only three District Hospitals and a qualifi ed 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 profi le 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 fi ve 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.
28 Study to Review The Health Care Delivery System provided by PHSC, Punjab
All hospitals were collecting specimens centrally except Gurdaspur District Hospital.
All the hospitals were having suffi cient 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 qualifi ed medical offi cers 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 fi re-fi ghting equipments and knowledge to use them were found to be in all OTs except two District Hospitals and one special hospital.
Study to Review The Health Care Delivery System provided by PHSC, Punjab 29
Fig 6: Surgeries performed in District Hospitals (Punjab) in the last five years
0
5000
10000
15000
20000
25000
30000
35000
Amritsa
r
Bhatinda
Ferozp
ur
Gurdas
pur
Hoshiar
pur
Jalan
dhar
Ludhiana
Muktsar
Patiala
(SH)
Sangru
r
Taran ta
ran
Bhatinda(S
H)
Districts
No.
of s
urge
ries
1st Yr2nd Yr3rd Yr4th Yr5th Yr
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 fl oor 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
30 Study to Review The Health Care Delivery System provided by PHSC, Punjab
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 Offi cer)/MO (Medical Offi cer) 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 fi ve District Hospitals were found up-keeping the expiry date register which was regularly inspected by the Medical offi cer.
Fig 7: No. of In-patients in District Hospitals (Punjab) in the last five years
0
2000
4000
6000
8000
10000
12000
14000
16000
18000
Amritsa
r
Bhatinda
Ferozp
ur
Gurdas
pur
Hoshiar
pur
Jalan
dhar
Ludhiana
Muktsar
Patiala
(SH)
Sangru
r
Taran ta
ran
Bhatinda(S
H)
Districts
No.
of I
n-pa
tient
s
1st Yr2nd Yr3rd Yr4th Yr5th Yr
Study to Review The Health Care Delivery System provided by PHSC, Punjab 31
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 fi ve District Hospitals and both the special hospitals, the medical store was submitting certifi ed bills to offi ce 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 fi re-fi ghting 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 fi ve 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 offi cer or technician in 50% of District Hospitals and both the special hospitals.
Case records were maintained as per WHO classifi cation 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 scientifi c way.
All the records were found to be maintained for ten years in fi ve District Hospitals and special hospital at Patiala, fi ve years in two District Hospitals and one special hospital, seven years in Amritsar and fourteen and fi fteen 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 fi ve 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
32 Study to Review The Health Care Delivery System provided by PHSC, Punjab
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 offi cer. 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 fi ve District Hospitals laundry was of conventional (dhobi) type, while it was mechanised at the remaining fi ve.
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
Study to Review The Health Care Delivery System provided by PHSC, Punjab 33
Fig 8: Percent of expenditure of the user charges on Medicine of different District Hospitals (Punjab)
0.00
10.00
20.00
30.00
40.00
50.00
60.00
70.00
80.00
90.00
Bhatinda Ferozpur Gurdaspur Hoshiarpur Jalandhar Ludhiana Patiala (SH)
Perc
ent c
ost (
Rs)
2003-04 2004-05 2005-06 2006-07 2007-08
Fig 9: Percent of expenditure of the user charges in IPF of different District Hospitals (Punjab)
0.00
5.00
10.00
15.00
20.00
25.00
30.00
35.00
Bhatinda Ferozpur Gurdaspur Hoshiarpur Jalandhar Ludhiana Patiala (SH)
Perc
ent c
ost (
Rs)
2003-04 2004-05 2005-06 2006-07 2007-08
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.
34 Study to Review The Health Care Delivery System provided by PHSC, Punjab
Fig 10: Percent of expenditure of the user charges on buildings of different District Hospitals (Punjab)
0
10
20
30
40
50
60
70
Bhatinda Ferozpur Gurdaspur Hoshiarpur Jalandhar Ludhiana Patiala (SH)
Per
cent
cos
t (R
s)
2003-04 2004-05 2005-06 2006-07 2007-08
Fig 11: Percent of expenditure of the user charges on equipments of different District Hospitals (Punjab)
0
2
4
6
8
10
12
14
16
18
Bhatinda Ferozpur Gurdaspur Hoshiarpur Jalandhar Ludhiana Patiala (SH)
Perc
ent c
ost (
Rs)
2003-04 2004-05 2005-06 2006-07 2007-08
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 fi rst year, which was recorded around 63%.
Study to Review The Health Care Delivery System provided by PHSC, Punjab 35
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 pre-structure32d checklist. These Sub-Divisional Hospitals were at Ajnala, Batala, Dasuya, Fazilaka, Jagraon, Maler Kotla, Malout, Nakodar, Patti and Talwandi. The General Profi le 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.
36 Study to Review The Health Care Delivery System provided by PHSC, Punjab
5.2.7 Status of buildings
Buildings of eight Sub-Divisional Hospitals were found to be in good condition while at two Sub-Divisional 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.
Study to Review The Health Care Delivery System provided by PHSC, Punjab 37
5.2.14 Drugs and equipment management
Out of the ten Sub-Divisional Hospitals assessed, fi ve 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 fi ve SDHs.
Short wave diathermy (Physiotherapy) unit was available and functional at Fazilaka and Nakodar SDH.
38 Study to Review The Health Care Delivery System provided by PHSC, Punjab
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 fi ve SDHs whereas guidelines for how to refer were present at six places.
Colour coded referral cards were available at fi ve and feedback mechanism existed at four Sub-Divisional 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, fi ve 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 fi ve 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.
Study to Review The Health Care Delivery System provided by PHSC, Punjab 39
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 fi ve 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 fi ve 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 offi cer available round the clock for emergency situations in seven Sub-Divisional Hospitals out of ten. Glow sign board displaying emergency service department
Fig 12: No. of OPD Patients in Sub-Divisional Hospitals (Punjab) in the last five years
0
20000
40000
60000
80000
100000
120000
140000
160000
180000
Ajnala
Batala
Dasuya
Fazila
ka
Jagrao
n
Malerko
tka
Malout
Nakodar
Patti
Talwan
di
Sub-divisional Hospitals
No.
of O
PD P
atie
nts
1st Yr2nd Yr3rd Yr4th Yr5th Yr
40 Study to Review The Health Care Delivery System provided by PHSC, Punjab
was seen at fi ve 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 suffi cient 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.
Fig 13: Emergency Patients in Sub-Divisional Hospitals (Punjab) in the last five years
0
1000
2000
3000
4000
5000
6000
Ajnala Batala Dasuya Jagraon Malerkotka Malout Nakodar Patti Talwandi
Sub-divisional Hospitals
No.
of p
atie
nts
1st Yr2nd Yr3rd Yr4th Yr5th Yr
Study to Review The Health Care Delivery System provided by PHSC, Punjab 41
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 specifi cally 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. Defi brillator 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. Qualifi ed pathologists and microbiologists were found present at four of these hospitals respectively. None of the hospitals were having a qualifi ed 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 fi ve SDHs, lipid profi le 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.
42 Study to Review The Health Care Delivery System provided by PHSC, Punjab
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 bio-safety 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 qualifi ed medical offi cer as Blood Transfusion Offi cer was present at Batala, Dasuya, Fazilaka and Nakodar SDH, while no such offi cer 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 fi ve 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 fi ve 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
Study to Review The Health Care Delivery System provided by PHSC, Punjab 43
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
0
100
200
300
400
500
600
700
800
900
Ajnala
Batala
Dasuya
Fazila
ka
Jagrao
n
Malerko
tka
Malout
Nakodar
Patti
Talwan
di
Sub-divisional Hospitals
No.
of N
orm
al D
eliv
erie
s
1st Yr2nd Yr3rd Yr4th Yr5th Yr
Fig 14: Caesarians done in Sub-Divisional Hospitals (Punjab) in the last five years
0
100
200
300
400
500
600
Ajnala Batala Dasuya Fazilaka Jagraon Malerkotka Nakodar Patti Talwandi
Sub-divisional Hospitals
No.
of c
aesa
rians
1st Yr2nd Yr3rd Yr4th Yr5th Yr
44 Study to Review The Health Care Delivery System provided by PHSC, Punjab
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 defi brillators 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 fi re-fi ghting equipments and knowledge to use them was found in OTs of fi ve 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
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
10000
Ajnala
Batala
Dasuya
Fazila
ka
Jagrao
n
Malerko
tka
Malout
Nakodar
Patti
Talwan
di
Sub-divisional Hospitals
No.
of P
atie
nts
1st Yr2nd Yr3rd Yr4th Yr5th Yr
Study to Review The Health Care Delivery System provided by PHSC, Punjab 45
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 fl oor 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 offi cer 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
46 Study to Review The Health Care Delivery System provided by PHSC, Punjab
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 certifi ed bills to offi ce for release of payment with in three days. Auction to clear the empty material from store was found to be done regularly at only fi ve SDHs.
Availability of fi re-fi ghting equipments and knowledge of staff to use them was found in medical stores of fi ve SDHs.
Standing drug committee and availability of regularly updated hospital drug formulary was found at only fi ve SDHs out of ten.
5.2.29 Medical record department
Only fi ve 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 offi cer 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 scientifi c way.
Case records were maintained as per WHO classifi cation 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.
Study to Review The Health Care Delivery System provided by PHSC, Punjab 47
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 offi cer, 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, fi ve were having in house laundry service while the remaining fi ve were found to have outsourced laundry services. Laundry was of conventional (dhobi) type in fi ve 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 fi rst 2-3 years. But after that, it steadily increased (though at a slower rate) during the recent years.
However, the fi gures for the delivery services were not found very encouraging, during the last 5 years and in almost all the districts, these fi gures fl uctuated on either side. Therefore, it is not only very diffi cult 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.
48 Study to Review The Health Care Delivery System provided by PHSC, Punjab
Fig 16: Percent of expenditure of the user charges in medicine of different Sub-Divisional Hospitals (Punjab)
0
20
40
60
80
100
120
Dasuya Fazilka Ajnala Batala Jagraon Malar Kotla Malout Patti Talwan-di Saboo
Perc
ent c
ost (
Rs)
2003-04 2004-05 2005-06 2006-07 2007-08
Fig 17: Percent of expenditure of the user charges in IPF of different Sub-Divisional Hospitals (Punjab)
0
10
20
30
40
50
60
70
Dasuya Fazilka Ajnala Batala Jagraon Malar Kotla Malout Patti Talwan-di Saboo
Perc
ent c
ost (
Rs)
2003-04 2004-05 2005-06 2006-07 2007-08
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 fi rst 4 years (2002-06) whereas very low during the year 2006-07.
Study to Review The Health Care Delivery System provided by PHSC, Punjab 49
Fig 18: Percent of expenditure of the User charges in building of different Sub-Divisional Hospitals (Punjab)
0
5
10
15
20
25
Dasuya Fazilka Ajnala Batala Jagraon Malar Kotla Malout Patti Talwan-diSaboo
Perc
ent c
ost (
Rs)
2003-04 2004-05 2005-06 2006-07 2007-08
Fig 19: Percent of expenditure of the user charges in equipment of different sub-divisional hospitals (Punjab)
0
5
10
15
20
25
30
35
Dasuya Fazilka Ajnala Batala Jagraon Malar Kotla Malout Patti Talwan-diSaboo
Perc
ent c
ost(R
s)
2003-04 2004-05 2005-06 2006-07 2007-08
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.
50 Study to Review The Health Care Delivery System provided by PHSC, Punjab
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 profi le 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 fi ve 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.
Study to Review The Health Care Delivery System provided by PHSC, Punjab 51
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 verifi cation 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.
52 Study to Review The Health Care Delivery System provided by PHSC, Punjab
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 fi ve 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.
Study to Review The Health Care Delivery System provided by PHSC, Punjab 53
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 fi ghters 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
0
10000
20000
30000
40000
50000
60000
70000
80000
Badal
Fate
garh
Fero
jsha
h
Gonia
na
Karta
rpur
Khem
kara
n
Long
wal
Mah
ilpur
Moj
itha
Mac
hiw
ra
Man
awal
a
Community Health Centres
Nu
mb
er
of
OP
D P
ati
en
ts
1st Yr
2nd Yr
3rd Yr
4th Yr
5th Yr
54 Study to Review The Health Care Delivery System provided by PHSC, Punjab
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 fi ve 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 offi cer 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 fi ve 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.
Suffi cient 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.
Study to Review The Health Care Delivery System provided by PHSC, Punjab 55
Fig 21: No. of emergency patients at CHC Hospitals (Punjab) in the last five years
0
500
1000
1500
2000
2500
3000
Badal Fategarh Ferojshah Goniana Khemkaran Longowal Mahilpur Mojitha ManawalaCommunity Health Centres
No.
of p
atie
nts
1st Yr2nd Yr3rd Yr4th Yr5th Yr
Fig 22: Admission through emergency at CHC Hospitals (Punjab) in the last five years
0
100
200
300
400
500
600
700
800
900
Fatehgarh Ferojshah Goniana Kartarpur Khemkaran Longowal Mahilpur Mojitha MachiwaraCommunity Health Centres
No.
of a
dmis
sion
s in
the
Emer
genc
y
1st Yr2nd Yr3rd Yr4th Yr5th Yr
56 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 nine CHCs. Only seven CHCs were having staff trained in basic life support.
5.3.20 Disaster management
Only fi ve 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 qualifi ed 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.
Study to Review The Health Care Delivery System provided by PHSC, Punjab 57
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 fi re-fi ghting 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
0
50
100
150
200
250
Badal
Fatehgarh
Ferojsh
ah
Goniana
Kartarp
ur
Khemka
ran
Longwal
Mahilp
ur
Mojitha
Machiw
ara
Community Health Centres
No.
of N
orm
al d
eliv
erie
s
1st Yr2nd Yr3rd Yr4th Yr5th Yr
58 Study to Review The Health Care Delivery System provided by PHSC, Punjab
Fig 24: Caesarians done at CHC Hospitals (Punjab) in the last five years
0
20
40
60
80
100
120
Fatehgarh Goniana Kartarpur Longowal Mahilpur Mojitha Machiwara
Community Health Centres
No.
of c
aesa
rians
1st Yr2nd Yr3rd Yr4th Yr5th Yr
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 fl oor 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 non-functional. Only three CHCs were having functional venesection/LP/tracheotomy tray. Nine CHCs were found having functional emergency light/wheel chairs/stretcher trolley.
Study to Review The Health Care Delivery System provided by PHSC, Punjab 59
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 fi ve CHCs were up-keeping the expiry date register, which was regularly inspected by a medical offi cer.
Only fi ve 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.
0
500
1000
1500
2000
2500
3000
3500
Badal Fatehgarh Ferojshah Goniana Kartarpur Khemkaran Longowal Mahilpur Mojitha Machiwara
Community Health Centres
Num
ber o
f Inp
atie
nts
1st Yr2nd Yr3rd Yr4th Yr5th Yr
Fig 25: No. of patients admitted at CHC Hospitals (PUNJAB) in the last five years
60 Study to Review The Health Care Delivery System provided by PHSC, Punjab
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 certifi ed bills to offi ce for release of payment within three days. Auction to clear the empty material from store was done regularly at only fi ve CHCs.
Availability of fi re-fi ghting 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 suffi cient 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 offi cer 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 scientifi c way.
Case records were maintained as per WHO classifi cation 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.
Study to Review The Health Care Delivery System provided by PHSC, Punjab 61
5.3.29 Central sterile supply department
Only six CHCs were having CSSD under supervision of trained staff/senior nursing offi cer, 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 fi ve 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 fi ve 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 fi rst 2-3 years. But after that, it has steadily increased during the recent years, though at a slower rate.
However, the fi gures for service delivery were not found very encouraging. For the last 5 years, the fi gures had fl uctuated on either side in almost all the districts. Therefore, not only it is very diffi cult 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)
62 Study to Review The Health Care Delivery System provided by PHSC, Punjab
Fig 26: Percent of expenditure of the user charges in medicine of different CHCs of PHSC (Punjab)
0
10
20
30
40
50
60
70
Badal FatehgarhChurian
Ferojshah Goniana Kartarpur Khemkaran Longowal Mahilpur Majitha Machiwara Manawala
Per
cent
cos
t (R
s)
2003-04 2004 -05 2005-06 2006-07 2007-08
Fig 27: Percent of expenditure of the user charges in IPF of different CHCs of PHSC (Punjab)
0.00
10.00
20.00
30.00
40.00
50.00
60.00
70.00
Badal FatehgarhChurian
Ferojshah Goniana Kartarpur Khemkaran Longowal Mahilpur Majitha Machiwara Manawala
Perc
ent c
ost (
Rs)
2003-04 2004 -05 2005-06 2006-07 2007-08
Study to Review The Health Care Delivery System provided by PHSC, Punjab 63
Fig 28: Percentage of expenditure of the user charges in buildings of different CHCs of PHSC (Punjab)
0
5
10
15
20
25
30
35
Badal FatehgarhChurian
Ferojshah Goniana Kartarpur Khemkaran Longowal Mahilpur Majitha Machiwara Manawala
Perc
ent c
ost (
Rs)
2003-04 2004 -05 2005-06 2006-07 2007-08
Fig 29: Percentage of expenditure of the user charges in equipment of different CHCs of PHSC (Punjab)
0
5
10
15
20
25
30
Badal FatehgarhChurian
Ferojshah Goniana Kartarpur Khemkaran Longowal Mahilpur Majitha Machiwara Manawala
Perc
ent c
ost (
Rs)
2003-04 2004 -05 2005-06 2006-07 2007-08
64 Study to Review The Health Care Delivery System provided by PHSC, Punjab
6.0 Views of the Benefi ciaries 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 profi le 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
1.9 0 04.5
43.8
54.4
48.3
68.2
18.1
25
13.8
22.722.9
8.8
24.1
4.5
13.3 11.8 13.8
00
10
20
30
40
50
60
70
80
Dist. Hospital(105) Sub-Divisional(68) CHC(29) SP. Hospital(22)
Perc
enta
ge o
f Pat
ient
s
Less than 15 15-30 31-45 46-60 Above 60
Study to Review The Health Care Delivery System provided by PHSC, Punjab 65
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 specifi cally at different health institutions, it was revealed that 86.2% respondents from CHCs; 80.9% from Sub-divisional 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 satisfi ed with the admission procedure. (Refer Table 5)
Fig 31: Income distribution of in-patients at various health care institutions in Punjab
39 38.2
55.2
31.8
44.8
39.7
31
22.7
11.4
16.2
6.9
27.3
3.85.9
3.4
13.6
1 03.4 4.5
0
10
20
30
40
50
60
Dist. Hospital (105) Sub-Divisional (68) CHC (29) SP. Hospital (22)
Perc
enta
ge o
f pat
ient
s
Less than 2000 2001-5000 5001-10000 10001-15000 Above 15000
• 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)
66 Study to Review The Health Care Delivery System provided by PHSC, Punjab
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 32: Opinion of in-patients about admission procedure at various health care
institutions in Punjab
73.3080.90
86.2077.30
0
10
20
30
40
50
60
70
80
90
100
Dist. Hospital (105) Sub-Divisional (68) CHC (29) SP. Hospital (22)
Perc
enta
ge o
f Pat
ient
s
Good Average Poor
10.5011.404.40
11.803.40
10.304.50
18.20
Fig 33: Distribution of in-patients regarding user charges at various health care
institutions in Punjab
96.6
0
20
40
60
80
100
120
Dist. Hospital (105) Sub-Divisional (68) CHC (29) SP. Hospital (22)
Perc
enta
ge o
f Pat
ient
s
Slip/card Admission charges Investigation charges Consultancy charges
87.6 84.8 83.8 85.3
8.6
64.7
10.3
79.3
96.6
10.3
86.490.9
86.4
18.2
Study to Review The Health Care Delivery System provided by PHSC, Punjab 67
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
61 60.3
79.3
95.5
36.2 35.3
20.7
4.52.9 4.4 0 00
20
40
60
80
100
120
Dist. Hospital (105) Sub-Divisional (68) CHC (29) SP. Hospital (22)
Perc
enta
ge o
f Pat
ient
s
Good Average Poor
68 Study to Review The Health Care Delivery System provided by PHSC, Punjab
• 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
60 63.2
100
86.4
33.327.9
0
13.66.7 8.8
0 00
20
40
60
80
100
120
Dist. Hospital (105) Sub-Divisional (68) CHC (29) SP. Hospital (22)
Perc
enta
ge o
f Pat
ient
s
Good Average 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
• 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 69
Fig 37: Opinion of in-patients about cleanliness of toilets in wards at various health
care institutions in Punjab
41.947.1
55.2
63.6
38.1
23.5
37.931.8
18.1
27.9
6.901.9 1.5 0
4.5
0
10
20
30
40
50
60
70
Dist. Hospital (105) Sub-Divisional (68) CHC (29) SP. Hospital (22)
Perc
enta
ge o
f Pat
ient
s
Good Average Poor Can't say
facilities, it was found that 95.5% respondents from Special Hospitals, 94.1% from Sub-Divisional 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,
Fig 36: Opinion of in-patients about availability of light & fans in wards at various health care institutions in Punjab
77.1 77.982.8
90.9
19 22.117.2
9.13.8 0 0 0
0102030405060708090
100
Dist. Hospital (105) Sub-Divisional (68) CHC (29) SP. Hospital (22)
Perc
enta
ge o
f Pat
ient
s
Good Average Poor
70 Study to Review The Health Care Delivery System provided by PHSC, Punjab
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 in-patient 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 38: Opinion of in-patients about behaviour of nurses at various health care
institutions in Punjab
87.6
67.6
82.8 81.8
11.4
30.9
6.9
18.2
1 1.56.9
00 03.4
00
10
20
30
40
50
60
70
80
90
100
Dist. Hospital (105) Sub-Divisional (68) CHC (29) SP. Hospital (22)
Perc
enta
ge o
f Pat
ient
s
Good Average Poor Can't say
Fig 39: Opinion of in-patients about behaviour of doctors at various health care
institutions in Punjab
78.1
69.1 69
77.3
18.120.6 20.7
18.2
1 06.9 4.52.9
10.3
3.40
0
10
20
30
40
50
60
70
80
90
Dist. Hospital (105) Sub-Divisional (68) CHC (29) SP. Hospital (22)
Perc
enta
ge o
f Pat
ient
s
Good Average Poor Can't say
Study to Review The Health Care Delivery System provided by PHSC, Punjab 71
• 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 Sub-Divisional Hospitals and 69% from CHCs stated that the behaviour of other staff members was good.
• The fi ndings 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
65.7
54.451.7
86.4
25.722.1
37.9
4.51 2.9
0 0
7.6
20.6
10.3 9.112.4
8.813.8
31.8
51.4 52.9
72.4
63.6
34.336.8
10.34.51.9 1.5 3.4 0
0
10
20
30
40
50
60
70
80
90
100
Dist. Hospital (105) Sub-Divisional (68) CHC (29) SP. Hospital (22)
Per
cent
age
of P
atie
nts
Good Average Poor Can't say All available Some available None available Can't say
72 Study to Review The Health Care Delivery System provided by PHSC, Punjab
Fig 41: Opinion of in-patients about availability of medicines at various health care
institutions in Punjab
12.48.8
13.8
31.8
51.4 52.9
72.4
63.6
34.3 36.8
10.34.5
1.9 1.5 3.40
0
10
20
30
40
50
60
70
80
Dist. Hospital (105) Sub-Divisional (68) CHC (29) SP. Hospital (22)
Perc
enta
ge o
f Pat
ient
s
All available Some available None available Can't say
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.
Study to Review The Health Care Delivery System provided by PHSC, Punjab 73
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 fi ndings 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 satisfi ed 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
96.2
86.8
100 100
3.8
13.2
0 00
20
40
60
80
100
120
Dist. Hospital (105) Sub-Divisional (68) CHC (29) SP. Hospital (22)
Perc
enta
ge o
f Pat
ient
s
Yes No
74 Study to Review The Health Care Delivery System provided by PHSC, Punjab
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 satisfi ed 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 satisfi ed 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 fi ndings have emerged based on the interview of respondents in the outpatient department.
6.2.1 Socio-economic profi le 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
5.3 4.41.8
25.5
38.7
34.1
19.3
55.3
30.326.7
37.7
12.8
19.0 20.7
25.4
2.1
6.7
14.1 15.8
4.3
0
10
20
30
40
50
60
Dist. Hospital (284) Sub-Divisional (135) CHC (114) SP. Hospital (47)
Perc
enta
ge o
f Pat
ient
s
Less than 15 15-30 31-45 46-60 Above 60
Study to Review The Health Care Delivery System provided by PHSC, Punjab 75
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 Sub-Divisional 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)
Fig 44: Educational status of patients attending OPD at various health care institutions in Punjab
28.9
38.5
49.1
25.522.9
25.2
15.8
27.728.2
19.316.7 17
10.6 11.9 11.4
21.3
6.73.7 4.4
8.5
2.8 1.5 2.60
0
10
20
30
40
50
60
Dist. Hospital (284) Sub-Divisional (135) CHC (114) SP. Hospital (47)
Perc
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ient
s
Illiterate Primary Secondary Senior Secondary Graduate Above Graduate
76 Study to Review The Health Care Delivery System provided by PHSC, Punjab
Fig 46: Views of patients attending OPD about general cleanliness at various health
care institutions in Punjab
73.971.1
64
87.2
22.927.4
34.2
12.8
2.5 0 1.8 00.7 1.5 0 00
102030405060708090
100
Dist. Hospital (284) Sub-Divisional (135) CHC (114) SP. Hospital (47)
Perc
enta
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ient
s
Good Average Poor Cannot say
• 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 45: User charges at OPD in various health care institutions in Punjab
94.498.5
93 91.5
6971.9 71.1
68.1
4.6 3.7 3.5
12.8
0
20
40
60
80
100
120
Dist. Hospital (284) Sub-Divisional (135) CHC (114) SP. Hospital (47)
Perc
enta
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OPD card charges Investigation charges Consultancy charges
Study to Review The Health Care Delivery System provided by PHSC, Punjab 77
Fig 47: Views of patients attending OPD about drinking water facility at various health care institutions in Punjab
88
97
78.1
100
10.93
14
01.1 07.9
00
20
40
60
80
100
120
Dist. Hospital (284) Sub-Divisional (135) CHC (114) SP. Hospital (47)
Perc
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Yes No 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 facility-wise, 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.
78 Study to Review The Health Care Delivery System provided by PHSC, Punjab
Fig 48: Distribution of OPD patients informed about the diseases and treatment by the treating doctor at various health care institutions in Punjab
85.9
78.571.9
85.1
0.9
12.6
22.8
10.6
1.15.2
1.8 4.32.1 3.7 3.50
0102030405060708090
100
Dist. Hospital (284) Sub-Divisional (135) CHC (114) SP. Hospital (47)
Perc
enta
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s
Good Average Poor 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
• 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 79
Fig 49: Opinion of patients attending OPD about availability of medicines at various health care institutions in Punjab
6
1714
8.5
54.2
68.172.8 74.5
39.1
14.1 13.2
7
0.7 0.7 0 00
10
20
30
40
50
60
70
80
Dist. Hospital (284) Sub-Divisional (135) CHC (114) SP. Hospital (47)
Perc
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All available Some available None available No response
Fig 50: Opinion of patients attending OPD about Lab. & radiological facilities at various health care institutions in Punjab
53.951.9
36
63.8
23.2
17
32.5
4.31.4 2.2 3.5
0
21.5
28.9 28.131.9
0
10
20
30
40
50
60
70
Dist. Hospital (284) Sub-Divisional (135) CHC (114) SP. Hospital (47)
Perc
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Good Average Poor 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
80 Study to Review The Health Care Delivery System provided by PHSC, Punjab
Fig 51: Opinion of patients attending OPD about behaviour of staff at various health care institutions in Punjab
5660
50
70.2
34.530.4
40.4
6.41.8 3 0.9 2.1
7.7 6.7 8.8
21.3
0
10
20
30
40
50
60
70
80
Dist. Hospital (284) Sub-Divisional (135) CHC (114) SP. Hospital (47)
Perc
enta
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s
Good Average Poor 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
• 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 confi rmed 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 81
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)
Fig 52: Opinion of patients attending OPD about availabilty of doctors at various health care institutions in Punjab
95.1 97.8
89.5
97.9
4.9 2.2
10.5
2.1
0
20
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60
80
100
120
Dist. Hospital (284) Sub-Divisional (135) CHC (114) SP. Hospital (47)
Perc
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s
Available Not available
82 Study to Review The Health Care Delivery System provided by PHSC, Punjab
Fig 53: Views of patients attending OPD about waiting area at various health care institutions in Punjab
82.777
59.6
93.6
15.820.7
36.8
6.40.7 0 2.6 00.7 2.2 0.9
10
0
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60
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100
Dist. Hospital (284) Sub-Divisional (135) CHC (114) SP. Hospital (47)
Perc
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Good Average Poor Cannot say
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 54: Rating of patient’s experience attending OPD at various health care institutions in Punjab
71.5 72.6
57
70
26.423.7
39.5
27.4
1.1 0 0.9 1.41.1 0.7 0 1.2
0
10
20
30
40
50
60
70
80
Dist. Hospital (284) Sub-Divisional (135) CHC (114) SP. Hospital (47)
Perc
enta
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ient
s
Good Average 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)
Study to Review The Health Care Delivery System provided by PHSC, Punjab 83
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 satisfi ed with the services of various health institutions, whereas 22.1% respondents were not satisfi ed 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 satisfi ed 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
78.5 77
60.5
93.6
18.7 18.5
36
6.41.8 2.2 0 01.1 2.2 3.5
00
10
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40
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60
70
80
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100
Dist. Hospital (284) Sub-Divisional (135) CHC (114) SP. Hospital (47)
Perc
enta
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s
Good Average Poor 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 satisfi ed with the services of the out-patient department. (Refer Table 22)
84 Study to Review The Health Care Delivery System provided by PHSC, Punjab
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 identifi ed in the existing training programmes such as:i. Training often does not bear directly on an employee’s offi cial 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.
7.0 Training Institutes
Study to Review The Health Care Delivery System provided by PHSC, Punjab 85
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 fi eld 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 fi eld practice and demonstration areas for providing practical experience to the trainees and utilise the area as fi eld 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. Training• Professional development course• Basic training for MPHW male• In-service training for medical and para medicals• TOT for key trainers (RCH) trainings
2. Research and evaluation studies in collaboration with medical health and related organisation.3. Service cum training counseling clinics.4. Monitoring and evaluation of the trainings under Health and Family Welfare departments
in the State.5. 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 offi cers and the nursing tutors, having an average experience of 15-20 years of service. The job responsibilities given to them were teaching, planning for ongoing trainings and different administrative responsibilities.
86 Study to Review The Health Care Delivery System provided by PHSC, Punjab
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 specifi cally 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, fi rst 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.
Study to Review The Health Care Delivery System provided by PHSC, Punjab 87
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. BSc. (Nursing)- a four year full time course with a capacity of 50 admissions (recently started)2. General Nursing & Midwifery course- Three and a half years with a capacity of 50 admissions3. Diploma in Radiography- a two year course with a capacity of 10 admissions4. 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 lowb. Civil hospital Bhatinda- good daily attendancec. Women and Children Hospital Bhatinda- around 70-80, attendanced. Civil hospital Malout- daily attendance of around 50e. Mata Kaushalya hospital Patiala- around 200 daily attendancef. Institute of Mental Health, Amritsarg. Rajindra Hospital and Medical college Patiala
88 Study to Review The Health Care Delivery System provided by PHSC, Punjab
h. Baba Faridkot (GGS Medical college) for Radiographyi. 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. The intake in the BSc (Nursing) and GNM courses is very good and generally the fi fty seats allocated are fi lled up with very few drop outs during the academic year.
2. The Diploma in Radiography has generally 50-60% occupancy. This year there are only two students enrolled against 10 seats.
3. The Diploma in Medical Lab Technology does not attract enough number of students- in this batch there is only one student against 20 seats.
4. There is shortage of faculty. 10 out of the required 18 nursing tutor posts are fi lled up. Further there are only 2 MSc. qualifi ed nurses (including the Principal) for training the BSc. Nursing students.
5. As there is no hospital within the premises and for all practical purposes the civil hospital Badal has very few patients, it is diffi cult 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.
6. The eligibility criteria for DMLT course needs to be re-looked at. Punjab technical University is admitting Arts students too.
7. 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.
8. 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.
9. There is also requirement for a full time student counsellor and one health offi cer.10. Upgradation of the library with more books, journal and computers with internet connectivity
is a must.11. Modern AV aids are required- especially LCD projector12. Funds for repair and maintenance of the hostel are needed as many repairs and renovations
are pending13. 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 89
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 diffi cult 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 Paramedical Sciences, Badal (in the district of Muktsar)
Mental Hospital, Amritsar
Strength Well designed complex spread over 5 Acers of land having
• Teaching Block• Hostel Block• Administration Block• Residential Block
Well designed complex having • A vast Teaching Block• Two Hostel Blocks• Administration Block• Residential Block
• Suffi cient 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 Paramedical Sciences, Badal (in the district of Muktsar)
Mental Hospital, Amritsar
Well equipped• Auditorium• Lecture Halls• Seminar Room• Committee Room• Computer Lab• Demonstration Room• Library
Well Furnished• 64 Hostel Rooms• Guest House• Recreation Room• Common Room• Mess• Gym
Operational• Two Buses
Well equipped• Auditorium• Lecture Halls• Seminar Room• Committee Room• Demonstration Room
Modestly Furnished
Hostel Rooms
• Common Room
• Mess (run as a cooperative mess with contractual staff)
Operational• Three Buses- one 52 seater, one32 seater, one an 18 seater,One Tata Sumo
• Availability of class rooms.• Availability of transport facilities for fi eld visit.• Availability of library
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.
• Only experience in nursing training
• Library has adequate space. It does not have enough books. There are only 797 books and 13 nursing 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.
1. Only experience of Psychiatric training, no experience of other training methodology.2. Very limited faculty and that too psychiatric specialist.3. No proper hostel or mess facilities.
Opportunities • Very good linkages with Punjab Health System Corporation having the facilities in the same premises.
• Established linkages with NIHFW and other central training institute
• Good political support 1. On going mess facilities for patients, may be used for trainees.2. Existing dharamshala may be used as hostel.
Director of the institute is a very much known personality in the health fi eld and having good network which may help in the mobilisation of trainer.
Threats • Depends upon Punjab Health System Corporation.
No apparent threat 1. Funds for the training may be used in the hospital services for the psychiatric patients.
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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 in-charge.
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”.
8.0 Community Voice
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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 non-availability 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 specifi c 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 Sub-Divisional 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:
• 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 diffi culties 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 refl ected 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 specifi c 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
• Responses were varied among different groups. In the Sub-divisional hospital areas, which are running fi ne due to good administration, people are somewhat satisfi ed 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
• 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 diffi cult 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 refl ected 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 specifi c 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 satisfi ed with the government facilities.
• Very few of them commented that services are fi ne 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 fl oors 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-fl ung 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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Interviews were conducted with senior administrators and other stakeholders to get their views on the functioning of the health system. The fi ndings 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 defi nitely 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 fulfi lment of community needs
• Regarding the extent of fulfi lment of health needs of the community, 40% of the DCs stated that it is being partially fulfi lled (upto 50%) while 40% DCs stated that large extent of
9. Views of the Stakeholders
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community needs are being fulfi lled (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 fl ow
• Regarding the fund fl ow it was felt by 30% DCs that there is no problem with respect to the fund fl ow, 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 fl ow. 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 Sub-Divisional 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 suffi cient 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 fulfi lment of community needs
• Regarding the extent of fulfi lment of health needs of the community, 40% gave a satisfactory response that the health needs are being fulfi lled for >60% of the community. 50% of them
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reported low levels of community needs fulfi lment (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 qualifi ed 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 diffi cult 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 fi eld 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 40-60% in their CHCs, 20% reported between 10-20% and 20% were not able to provide any exact fi gure.
• 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 fulfi lment of community needs
• Regarding the extent of fulfi lment of the health needs of the community, 50% civil surgeons gave a satisfactory response, while 40% reported average level of fulfi llment of community and 10% reported that the needs are not being fulfi lled 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 fl ow
• It was stated by 40% of the Civil Surgeons that there is no problem regarding the fund fl ow. 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, fi lling 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 Offi cers) In-charge of District Hospitals
Senior Medical Offi cers 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
• 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).
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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 fl ow and RKS
• About 40% SMOs stated no problem in fund fl ow 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 non-availability 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 fulfi lment
• Regarding the extent of fulfi lment of health needs of the community, 50% SMOs felt that they are able to fulfi l 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 confl icts 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
• 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.
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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 suffi cient 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 fulfi lment of community needs:
• In response to this question, 50% of them gave a good response, with the health needs being fulfi lled for more than 75% of the community. 10% stated that only average level of need fulfi lment is being achieved. Remaining 20% reported low levels of community needs fulfi lment (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 fi eld 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 Offi cers 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 fulfi lment
• Regarding the extent of fulfi lment of health needs of the community, 20% of the SMOs felt that they are able to fulfi l 100% of health related needs; while other 30% stated this level of fulfi lment upto 75% and rest 30% upto 50%.
• 10 % of the SMOs opined that health needs of the community are fulfi lled 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 specifi ed.
• 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 fl ow
• 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 fl ow 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 non- availability 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
• Vacant staff positions should be fi lled 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.
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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 fulfi lment of community needs
• In response to this question, 40% stated that the needs are being fulfi lled to a large extent; another 30% felt that only 50% of the health needs are being fulfi lled and the rest 30% felt that only 10% of the community health needs are being fulfi lled 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 Offi cers – CHC
• A total of 11 Senior Medical Offi cers 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
• 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 fulfi lment
• 20% SMOs felt that they are able to fulfi l upto 90-100% needs of the community; 20% stated they are able to fulfi l 70-80% of the health needs, 20% stated satisfactory level of needs fulfi lment, 20% reported that the CHCs are under-utilised and no defi nite 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 fl ow
• While 50% SMOs reported no problem of fund fl ow 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 offi cers.
• 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 diffi culties 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, non-availability 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 fi lled. 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 infl ation, as patients are ready to pay
for quality services.
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10.1 Facility Survey
Based on the analysis of quantitative and qualitative data, the following
observations are drawn forth:
10.1.1 Infrastructure
a) Almost all the hospitals under study were easily accessible from the Bus Stop and nearest Railway Station and easily approachable by a motorable road.
b) 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.
c) 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.
d) The surrounding of these health care facilities was not found in good condition. Almost every health facility required paying serious attention towards this aspect.
e) The cleanliness of the hospital premises was not up to the mark.
10.1.2 Human resources
a) Almost all the hospitals under study have vacant posts including post of Doctors and Support Staff.
b) 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.
c) 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.
d) There is an acute shortage of Radiologist, Anaesthetists, Paediatrician and Gynaecologist in almost all the hospitals, particularly in Sub Divisional Hospitals and CHCs.
e) There is also an acute shortage of the support staff, particularly the Technical staff in Sub Divisional Hospitals and CHCs.
f) Frequent transfers of the doctors has also been refl ected 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.
10.0 Observations and Discussion
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10.1.3 Availability of medicines
a) It was observed in all the hospitals and reported by almost everybody that medicines are not available in adequate quantity.
b) The patients were found to purchase the medicines from outside.c) 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.
d) 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) 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.
b) The patients are forced to get the tests done from outside laboratory services due to lack of reagents and equipments..
c) Regarding the radiological services, X-ray Units were found to be non-functional due to erratic electric supply and non-availability of fi lms.
d) Moreover, Radiologists were also not available in all the hospitals.
10.1.5 Emergency and maternity services
a) 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.
b) 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.
c) 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 confi dence 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) None of the hospitals, including District Hospitals were found to be properly prepared to deal with any Disaster situation.
b) 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.
120 Study to Review The Health Care Delivery System provided by PHSC, Punjab
b) Mostly the patients are transferred from the lower health centre to the higher centre without any feedback loop.
c) 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) None of the hospitals were having a properly planned and organised Medical Record Department.
b) 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.
c) Most of the case-sheets kept in the Medical Record Departments were found to be incomplete and mostly not maintained as per any defi nite standard indexing/procedure.
10.1.9 Stores management
a) The Medical Store management was not found to be very organised, and following the modern techniques of store management.
b) In almost all the hospitals, only few medicines could be found in the medical stores of health facilities.
c) 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”.
d) The scientifi c ‘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) None of the hospitals were providing regular diet to their in-patients, except in one Sub-divisional hospital (Meler Kotla).
b) 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) 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.
b) Similarly, the basic facilities like toilets, particularly separate toilets for ladies were not available in every OPD.
c) These facilities must also have other services like STD booths, canteen and subsidised chemist shop.
d) 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 121
10.1.12 Rogi Kalyan Samiti
a) Though on papers Rogi Kalyan Samitis existed in all the hospitals, but due to their internal administrative problems and non fulfi lment of the required pre-requisites, these Samitis were found to be non functional or yet to be made functional in almost all the hospitals.
b) Funds under these Samitis were found to be un-utilised in all these hospitals.
10.2 Views of the Benefi ciaries
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) 77.7% of the respondents were not satisfi ed with the admission procedures and 86.2% of respondents at CHC and 81% at sub divisional hospitals rated it poor.
b) 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) 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.
b) According to the fi ndings, 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.
c) There is a need to improve the general cleanliness and cleanliness of linen in Sub-divisional hospitals and District hospitals.
d) 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.
122 Study to Review The Health Care Delivery System provided by PHSC, Punjab
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) 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.
b) 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.
c) 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) 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.
b) 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.
c) 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) 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 123
10.2.9 Availability and behaviour of doctors, nurses and staff
a) 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.
b) 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.
c) 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%).
d) 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.
e) 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) 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.
b) 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) Only 46.4% respondents of all the health institutions perceived that the security at these facilities is good, whereas 17% respondents perceived it poor.
b) It means that 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 with more focus on CHCs and sub divisional hospitals.
10.2.12 Quality of care
a) 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.
b) Overall 77.9% respondents in OPD were satisfi ed with the services of various health institutions. However, only 2.3% respondents were fully satisfi ed with the services of the out-patient department. 22.1% respondents were not satisfi ed with the services available at the health institutions. 94.2% respondents of the in-patient department were satisfi ed and
124 Study to Review The Health Care Delivery System provided by PHSC, Punjab
only 5.8% were not satisfi ed with the services of the health institutions. c) 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.d) 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) Majority of respondents utilising PHSC were females having poor education and low income levels.
b) 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.
c) General cleanliness and cleanliness of linen in Sub-Divisional Hospitals and District Hospitals need to be improved.
d) 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.
e) Majority of the respondents stated that the medicines are not available, and that they have to buy it from market, as advised by doctors.
f) 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.
g) 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.
h) Behaviour of staff members in the OPDs was not rated to be satisfactory by majority of the respondents.
i) A good percentage of respondents stated that availability of doctors, nurses and staff in the OPDs is good, except at CHCs. However, the fi nding 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.
j) 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.
k) 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.
l) 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 125
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 rectifi cation. This includes cleanliness, recruitment of the staff, doctors with specialties, drinking water arrangement, toilets on all the fl oors & 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-fl ung 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 facilitieso) 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.
126 Study to Review The Health Care Delivery System provided by PHSC, Punjab
ix) Transport services should be improved.x) Health insurance should be made available for poor patients.xi) Cleanliness should be emphasised.xii) 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 fi eld 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 fi lled 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.
Study to Review The Health Care Delivery System provided by PHSC, Punjab 127
Based on above quantitative, qualitative and triangulation of data, the following
recommendations are proposed:
11.1 Human Resource
a) An assessment may be done for the State of Punjab to fi nd out the staff position for all categories of health workers including doctors.
b) An exercise to fi nd out the strength of the sanctioned and vacant posts needs to be undertaken.
c) Urgent efforts may be made to fi ll up the vacant positions.d) Two separate cadres for the doctors i.e. one for GDMOs and one for specialists instead of
having only one single cadre of Medical Offi cers should be created.e) Category wise GIS mapping of all types of human resources including Medical offi cers 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.
f) 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.
g) This exercise will help in planning and recruitment of the required specialists and GDMOs.h) Moreover based on the norms of IPHS, posts for GDMOs and other essential categories of
specialists may be created and fi lled up. i) Availability of basic specialists in the respective health centres will surely build up the
confi dence among the community and hence result in increased utilisation of services. j) Separate administrative cadre may be developed for the administrative posts of district,
sub-division and CHCs so that a full time and well qualifi ed/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.
k) 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.
l) 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.
11.0 Conclusion and Recommen-
128 Study to Review The Health Care Delivery System provided by PHSC, Punjab
11.2 Availability of Drugs
a) At all the health care institutions, the benefi ciaries 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.
b) Hence, the availability of these medicines specially the vital and essential ones should be necessary in all health facilities..
c) 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.
d) 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.
e) By applying scientifi c Inventory Control Techniques of ABC and VED analysis, they should fi nd 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).
f) These medicines should be procured through state level and distributed to the districts for onwards supply.
g) Alternatively the state may fi x 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 fi xed by the state.
h) 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.
i) By this partial de-centralised procurement, the availability of the medicines will defi nitely improve and quality of the medicines can also be ensured.
j) Every hospital/health centre should have proper antibiotic policy and standard treatment guidelines.
k) There should be regular practice of prescription audit.
11.3 Community Education and Community Rights
Regarding Health Facilities
a) Every hospital/health centre should clearly display the citizen charter and the name, designation and telephone numbers of the concerned offi cers to whom they can approach at the time of any dispute or complaint.
b) The benefi ciaries should also be informed about the routine procedures they are expected to follow in that health centre and their rights.
11.4 Cleanliness
a) 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 129
b) 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.
c) The toilets should be kept clean and the drainage system in particular to be fl ushed routinely at regular intervals. Drainage system should be regularly cleaned and monitored.
d) 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.
e) For house keeping and sanitation, the services may be out sourced and may be given to the professional organisation like sulabh etc.
f) A separate toilet for the females should be there in the OPDs of every hospital/health centre.
11.5 Diagnostic Facilities
a) Efforts should be made to ensure that all the required reagents and equipments in the laboratories are available.
b) 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 fi xed rates.
c) With these arrangements, the benefi ciaries can be referred to these laboratories and they will not end up paying a higher price.
d) 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
130 Study to Review The Health Care Delivery System provided by PHSC, Punjab
(especially for the poor population) who are forced to go to the private sector for availing emergency services.
b) This calls for taking into account, that the emergency services are taken very seriously and action needs to be taken immediately.
c) 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) 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.
b) Main reasons found out for this was non-availability of gynaecology and obstetrics specialists. c) Hence efforts should be made to ensure that every hospital upto CHC level has atleast one
gynaecologist with all required facilities.d) 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) 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.
b) Cleanliness of linen in Sub-Divisional Hospitals and District Hospitals needs to be improved.
c) STD/PCO booth to be installed for convenience of the patients and relatives as per IPHS standards and NRHM.
d) CHCs were lacking in many facilities and PHSC should look into this matter immediately to provide quality service to rural people.
e) Inpatients should also be provided by adequate information regarding disease and treatment.f) 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.
g) Hence to increase the utilisation of the facilities, evening OPDs may be started. h) 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.
i) The amount paid to the doctors as honorarium may be in consonance to the number of patients they are attending.
j) Proper and well maintained residential accommodation for doctors and other staff may be provided at all levels of health centres.
k) 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 131
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 defi nitely 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.
132 Study to Review The Health Care Delivery System provided by PHSC, Punjab
Tab
le 1
.1. G
en
era
l P
rofi
le a
nd
Fa
cilit
y S
urv
ey o
f D
istr
ict
Ho
sp
itals Nam
e of
the
Dis
tric
t
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tsar
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inda
Fero
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Gurd
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oshi
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land
har
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Muk
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atia
laSa
ngru
rTa
ran
Tara
nSH
Bh
atin
da
Acce
ssib
ility
to
Railw
ay/
Bus
Stat
ion
Yes
Yes
Yes
Yes
Yes
Yes
Yes
NoYe
sYe
sYe
sYe
s
Dist
ance
fro
m R
ail S
tati
on
km2
33
23
32
31
12
3
Dist
ance
fro
m B
us S
tati
on
km1
12
11
34
21
13
1
All W
eath
er R
oads
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Bed
Stre
ngth
5010
020
060
100
-300
-200
100
164-
100
5060
Sour
ce o
f W
ater
Sup
ply
Mun
icip
al
supp
lyBo
re w
ell
Bore
wel
lBo
re w
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Bore
wel
lM
unic
ipal
su
pply
Mun
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supp
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nal
wat
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re w
ell
Mun
icip
al
supp
lyBo
re w
ell
Bore
wel
l
Wat
er S
uppl
y (Q
uant
ity)
Adeq
uate
Inad
equa
teAd
equa
teAd
equa
teAd
equa
teAd
equa
teAd
equa
teIn
adeq
uate
Adeq
uate
Adeq
uate
Adeq
uate
Adeq
uate
Wat
er S
uppl
y (s
tora
ge
capa
city
ava
ilabl
e fo
r no
. of
day
s)
11
33
23
23
33
31
Elec
tric
ity
(sup
ply)
Irre
gula
rRe
gula
rRe
gula
rRe
gula
rRe
gula
rRe
gula
rRe
gula
rIr
regu
lar
Regu
lar
Regu
lar
Irre
gula
rRe
gula
r
Elec
tric
ity
(pha
se)
Phas
e-th
ree
Phas
e-th
ree
Phas
e-th
ree
Phas
e-th
ree
Phas
e-th
ree
Phas
e-th
ree
Phas
e-th
ree
Phas
e-th
ree
Phas
e-th
ree
Phas
e-th
ree
Phas
e-do
uble
Phas
e-th
ree
Elec
tric
ity
(Bac
kup
Gene
rato
r /U
PS A
vaila
ble
)Av
aila
ble
Avai
labl
eAv
aila
ble
Avai
labl
eAv
aila
ble
Avai
labl
eAv
aila
ble
Avai
labl
eAv
aila
ble
Avai
labl
eAv
aila
ble
Avai
labl
e
If m
ore
than
one
sto
rey
build
ing
(Lif
t Av
aila
ble)
Yes
Yes
NoNo
NoYe
sNo
NoNo
Yes
NoNo
If m
ore
than
one
sto
rey
build
ing
(Ram
p Av
aila
ble
)Ye
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
s
Gene
ral I
mpr
essi
on-
up
keep
of
gard
enGo
odAv
erag
eGo
odAv
erag
eGo
odGo
odAv
erag
eGo
odGo
odAv
erag
eAv
erag
eAv
erag
e
Gene
ral I
mpr
essi
on-
clea
nlin
ess
Good
Aver
age
Good
Good
Good
Good
Aver
age
Good
Good
Aver
age
Aver
age
Aver
age
Gene
ral I
mpr
essi
on-
sign
po
stin
gGo
odGo
odGo
odGo
odGo
odGo
odAv
erag
eGo
odGo
odpo
orGo
odAv
erag
e
Gene
ral I
mpr
essi
on-
road
s an
d lig
htin
gPo
orGo
odGo
odGo
odGo
odGo
odAv
erag
eGo
odGo
odAv
erag
eAv
erag
eGo
od
(Con
td..
.)
Study to Review The Health Care Delivery System provided by PHSC, Punjab 133
Nam
e of
the
Dis
tric
t
Amri
tsar
Bhat
inda
Fero
zpur
Gurd
aspu
rH
oshi
arpu
rJa
land
har
Ludh
iana
Muk
tsar
SH P
atia
laSa
ngru
rTa
ran
Tara
nSH
Bh
atin
da
Gene
ral I
mpr
essi
on-
Stat
e of
Bui
ldin
gGo
odAv
erag
eGo
odGo
odGo
odGo
odAv
erag
eGo
odGo
odAv
erag
eAv
erag
eGo
od
Any
Publ
ic U
tilit
y Se
rvic
e av
aila
ble
in H
ospi
tal
Prem
ises
NoGo
odNo
NoNo
NoNo
Good
NoNo
NoGo
od
Any
publ
ic U
tilit
y Se
rvic
e Av
aila
ble
in H
ospi
tal
Prem
ises
-Che
mis
t
Yes
Yes
NoYe
sNo
NoYe
sYe
sYe
sYe
s No
Yes
Any
Publ
ic U
tilit
y Se
rvic
e av
aila
ble
in
Hos
pita
l Pre
mis
es-S
ulab
h Sa
ucha
laya
Yes
Yes
Yes
Yes
Yes
Yes
Yes
NoYe
sYe
sNo
Yes
Any
Publ
ic U
tilit
y Se
rvic
e Av
aila
ble
in H
ospi
tal
Prem
ises
-Can
teen
NoYe
sYe
sYe
sYe
sYe
sYe
sNo
Yes
Yes
NoYe
s
Any
Publ
ic U
tilit
y Se
rvic
e Av
aila
ble
in H
ospi
tal
Prem
ises
-STD
/PCO
boo
th
NoNo
Yes
Yes
Yes
Yes
Yes
NoYe
sNo
NoNo
Ambu
lanc
e Se
rvic
esYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
s
Ambu
lanc
e Se
rvic
es if
av
aila
ble
Part
ially
Eq
uipp
edFu
lly
Equi
pped
Fully
Eq
uipp
edPa
rtia
lly
Equi
pped
Part
ially
Eq
uipp
edPa
rtia
lly
Equi
pped
Part
ially
Eq
uipp
edPa
rtia
lly
Equi
pped
Fully
Eq
uipp
edPa
rtia
lly
Equi
pped
Fully
Eq
uipp
edPa
rtia
lly
Equi
pped
Tota
l Num
ber
of V
ehic
les
(Nos
.)1
105
34
43
21
32
1
No.
of O
pera
tion
The
atre
s-
Min
or (
Nos.
)1
11
11
41
31
11
1
No.
of O
pera
tion
The
atre
s-
Maj
or (
Nos.
)4
31
23
42
32
12
1
ICU
typ
esYe
sYe
sNo
Yes
NoYe
sYe
sNo
NoYe
sNo
No
ICU
no.
of
beds
86
NA6
NA10
4NA
NA5
NANA
(Con
td..
.)
134 Study to Review The Health Care Delivery System provided by PHSC, Punjab
Nam
e of
the
Dis
tric
t
Amri
tsar
Bhat
inda
Fero
zpur
Gurd
aspu
rH
oshi
arpu
rJa
land
har
Ludh
iana
Muk
tsar
SH P
atia
laSa
ngru
rTa
ran
Tara
nSH
Bh
atin
da
Emer
genc
y Se
rvic
esRo
und
the
Cloc
kRo
und
the
Cloc
kRo
und
the
Cloc
kRo
und
the
Cloc
kRo
und
the
Cloc
kRo
und
the
Cloc
kRo
und
the
Cloc
kRo
und
the
Cloc
kRe
stric
ted
Roun
d th
e Cl
ock
Roun
d th
e Cl
ock
Roun
d th
e Cl
ock
Dent
al S
ervi
ces
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
Deliv
ery
Serv
ices
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Faci
litie
s fo
r Po
st-m
orte
mNo
Yes
Yes
Yes
Yes
Yes
Yes
Yes
NoNo
Yes
No
Mor
tuar
y se
rvic
es w
ith
cold
sto
rage
& o
ther
pr
eser
vati
ve f
acili
ties
av
aila
ble.
NoYe
sYe
sNo
Yes
Yes
Yes
Yes
NoNo
Yes
No
Drug
for
mul
ary
com
mit
tee
NoNo
NoYe
sNo
Yes
NoNo
Yes
NoYe
sNo
Hos
pita
l Ant
ibio
tic
com
mit
tee
NoNo
NoYe
sYe
sNo
NoNo
NoNo
Yes
No
Hos
pita
l Inf
ecti
on C
ontr
ol
Com
mit
tee.
Yes
NoNo
Yes
Yes
Yes
NoYe
sNo
NoYe
sNo
Stor
e Pu
rcha
se C
omm
itte
eYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
s
Stor
e ve
rifi c
atio
n Co
mm
itte
eYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sNo
Yes
Yes
Yes
Med
ical
Aud
it/
Deat
h Re
view
Com
mit
tee
Yes
NoYe
sNo
Yes
Yes
Yes
NoYe
sYe
sNo
No
Syst
em o
f Su
pply
of
Drug
it
ems
thro
ugh
Push
Push
Pull
Pull
Push
Pull
Push
Push
Pull
Push
Push
Pull
% o
f Dr
ug it
ems
aske
d fo
r is
sup
plie
d50
6050
9010
040
5020
5060
% o
f pa
tien
ts g
etti
ng a
ll th
e m
edic
ines
pre
scri
bed
5040
5070
100-
indo
or
5-10
-OPD
4025
7550
70
Is t
he d
rug
form
ular
y av
aila
ble
NoNo
NoNo
Yes
Yes
NoNo
NoNo
NoNo
Is b
uffe
r st
ock
mai
ntai
ned
Yes
Yes
Yes
NoYe
sYe
sYe
sNo
Yes
NoNo
Yes
(Con
td..
.)
Study to Review The Health Care Delivery System provided by PHSC, Punjab 135
Nam
e of
the
Dis
tric
t
Amri
tsar
Bhat
inda
Fero
zpur
Gurd
aspu
rH
oshi
arpu
rJa
land
har
Ludh
iana
Muk
tsar
SH P
atia
laSa
ngru
rTa
ran
Tara
nSH
Bh
atin
da
Annu
al m
aint
enan
ce
proc
edur
e fo
r co
stly
Eq
uipm
ents
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Log
book
/ H
isto
ry s
heet
m
aint
aine
d fo
r th
e Eq
uipm
ents
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
NoNo
Yes
Pres
ent
stat
us/s
itua
tion
s of
the
exi
stin
g Eq
uipm
ents
:
Good
Good
Good
Good
Good
Good
Good
Good
Good
Good
Good
Good
136 Study to Review The Health Care Delivery System provided by PHSC, Punjab
Tab
le 1
.2 Facilit
ies A
vailab
le a
t D
istr
ict
Ho
sp
itals
Nam
e of
the
Dis
tric
t
Bhat
inda
Fero
zpur
Gurd
aspu
rH
oshi
arpu
rJa
land
har
Ludh
iana
Muk
tsar
SH P
atia
laSa
ngru
rTa
ran
Tara
nSH
Bh
atin
da
Baby
Inc
ubat
ors
NoNo
Yes
Yes
Yes
Yes
Yes
Yes
NoYe
sYe
sYe
s
Baby
Inc
ubat
ors
NANA
Non
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Non
Func
tion
alFu
ncti
onal
NAFu
ncti
onal
Func
tion
alFu
ncti
onal
Boyl
es A
ppar
atus
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Boyl
es A
ppar
atus
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
al
Card
iac
Mon
itor
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Card
iac
Mon
itor
Non
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Non
Func
tion
alFu
ncti
onal
Func
tion
al
Dent
al C
hair
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
Dent
al C
hair
Non
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
N
Dosi
met
erNo
NoNo
NoNo
NoNo
NoNo
NoYe
sYe
s
Dosi
met
erNA
NANA
NANA
NANA
NANA
NAFu
ncti
onal
Func
tion
al
ECG
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
ECG
Func
tion
alNo
n Fu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
al
Emer
genc
y Re
susc
itat
ion
Kit
Yes
Yes
Yes
Yes
Yes
Yes
Yes
NoYe
sYe
sYe
sYe
s
Emer
genc
y Re
susc
itat
ion
Kit
Func
tion
alNo
n Fu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
NAFu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
al
Endo
scop
e
(fi b
er o
ptic
)
NoNo
Yes
Yes
Yes
Yes
Yes
NoNo
NoNo
No
Endo
scop
e(fi b
er o
ptic
)NA
NAFu
ncti
onal
Non
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
NANA
NANA
NA
Opht
halm
o-sc
opes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
Opht
halm
o-sc
opes
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
NA
(Con
td..
.)
Study to Review The Health Care Delivery System provided by PHSC, Punjab 137
Nam
e of
the
Dis
tric
t
Bhat
inda
Fero
zpur
Gurd
aspu
rH
oshi
arpu
rJa
land
har
Ludh
iana
Muk
tsar
SH P
atia
laSa
ngru
rTa
ran
Tara
nSH
Bh
atin
da
Peri
met
erNo
NoNo
Yes
Yes
Yes
Yes
NoYe
sNo
NoNo
Peri
met
erNA
NANA
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
NANA
NA
Phot
o Th
erap
y Un
itYe
sYe
sYe
sYe
sYe
sYe
sYe
sNo
Yes
Yes
Yes
Yes
Phot
o Th
erap
y Un
itFu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
alNA
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Reti
nosc
ope
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
NoYe
sNo
Reti
nosc
ope
Func
tion
alNo
n Fu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
NAFu
ncti
onal
NA
Shor
t W
ave
Diat
herm
y (P
hysi
o th
erap
y)No
Yes
Yes
Yes
Yes
Yes
Yes
NoYe
sYe
sNo
Yes
Shor
t W
ave
Diat
herm
y (P
hysi
o th
erap
y)NA
Non
Func
tion
alNo
n Fu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
NAFu
ncti
onal
Func
tion
alNA
Non
Func
tion
al
Sigm
oido
scop
esNo
Yes
Yes
Yes
Yes
Yes
NoNo
NoYe
sNo
Sigm
oido
scop
esNA
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
alNA
NANA
Func
tion
alNA
Slit
lam
p
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
NoYe
sYe
sNo
Slit
lam
pFu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
NAFu
ncti
onal
Func
tion
alNA
Ult
ra s
ound
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
NoYe
sNo
Ult
ra s
ound
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
NAFu
ncti
onal
NA
X ra
yYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
s
X ra
yFu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Othe
r M
ajor
and
Min
or
Oper
atio
n eq
uipm
ents
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Othe
r M
ajor
and
Min
or
Oper
atio
n eq
uipm
ents
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Any
Refe
rral
Sys
tem
in
plac
eYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
s
(Con
td..
.)
138 Study to Review The Health Care Delivery System provided by PHSC, Punjab
Nam
e of
the
Dis
tric
t
Bhat
inda
Fero
zpur
Gurd
aspu
rH
oshi
arpu
rJa
land
har
Ludh
iana
Muk
tsar
SH P
atia
laSa
ngru
rTa
ran
Tara
nSH
Bh
atin
da
Refe
rral
man
ual a
vaila
ble
NoNo
Yes
Yes
Yes
Yes
Yes
NoNo
NoNo
No
Guid
elin
es f
or-
Wha
t to
re
fer
NoNo
Yes
Yes
NoYe
sYe
sYe
sNo
Yes
NoNo
Guid
elin
es-W
hen
to r
efer
NoNo
Yes
Yes
NoYe
sYe
sYe
sNo
Yes
NoNo
Guid
elin
es-
How
to
refe
rNo
NoYe
sYe
sYe
sYe
sYe
sYe
sNo
Yes
NoNo
Colo
ur c
oded
ref
erra
l car
ds
avai
labl
eNo
Yes
Yes
Yes
NoYe
sYe
sYe
sNo
NoNo
Yes
Feed
-bac
k M
echa
nism
ex
isti
ng:
NoNo
NoNo
Yes
Yes
Yes
NoNo
NoNo
No
Tran
spor
t fa
cilit
y pr
ovid
ed:
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Mai
nten
ance
of
reco
rds/
regi
ster
sYe
sNo
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
Ince
ntiv
e fo
r fo
llow
ing
refe
rral
rou
teNo
NoYe
sNo
NoYe
sYe
sNo
NoNo
Yes
Yes
If Y
es,
wha
tNA
NAVe
hicl
e pr
ovid
edNA
NAVe
hicl
e pr
ovid
edNo
pro
per
Answ
erNA
NANA
No p
rope
r An
swer
No A
nsw
er
Proc
edur
e fo
llow
ed f
or
refe
rral
:H
ighe
r Ce
ntre
NoM
edic
al
Colle
geCo
lour
cod
ed
card
-Med
ical
co
llege
Vehi
cle
prov
ide
to
Med
ical
Co
llege
Vehi
cle
wit
h co
lour
ca
rd
Hig
her
Cent
reW
ith
refe
rral
ca
rd
PGI
Chan
diga
rhRe
fer
to
Pati
ala
Refe
r to
M
edic
al
Colle
ge
Not
Serv
e
Tie-
up w
ith
othe
r ho
spit
al
(bot
h pu
blic
and
pvt
) fo
r di
agno
stic
NoYe
sYe
sNo
NoYe
sYe
sNo
NoNo
Yes
Yes
Hos
pita
l has
a t
ie-u
p w
ith:
(M
edic
al C
olle
ge/
othe
r go
vern
men
t/ p
vt.
inst
itut
ions
)
None
Othe
r Go
vern
men
t H
ospi
tals
Med
ical
Co
llege
Med
ical
Co
llege
&
Oth
er
Gove
rnm
ent
Hos
pita
ls
None
Priv
ate
Hos
pita
lsPv
t.
Hos
pita
lsNo
neNo
neNo
ne1
2
Does
the
Hos
pita
l hav
e an
y Ou
trea
ch A
rea
NoYe
sYe
sNo
NoNo
Yes
NoNo
NoNo
Yes
(Con
td..
.)
Study to Review The Health Care Delivery System provided by PHSC, Punjab 139
Nam
e of
the
Dis
tric
t
Bhat
inda
Fero
zpur
Gurd
aspu
rH
oshi
arpu
rJa
land
har
Ludh
iana
Muk
tsar
SH P
atia
laSa
ngru
rTa
ran
Tara
nSH
Bh
atin
da
Stat
isti
cal B
ulle
tin:
Avai
labl
eNo
t Av
aila
ble
Not
Avai
labl
eNo
t Av
aila
ble
Avai
labl
eNo
t Av
aila
ble
Not
Avai
labl
eNo
t Av
aila
ble
Avai
labl
eNo
t Av
aila
ble
Not
Avai
labl
e
Avai
labi
lity
of d
hara
msh
ala
NoYe
sNo
NoNo
Yes
NoNo
NoYe
sNo
Yes
Avai
labi
lity
of r
esid
enti
al
acco
mm
odat
ion
for
the
esse
ntia
l
NoYe
sYe
sYe
sYe
sYe
sYe
sNo
Yes
Yes
Yes
Yes
if a
vaila
ble,
wha
t %
is n
ot
gett
ing
acco
mm
odat
ion
(In
% )
NA80
00
5015
50NA
4040
7090
Secu
rity
arr
ange
men
t:Co
ntra
-ct
ual
In h
ouse
In h
ouse
In h
ouse
In h
ouse
Cont
ract
ual
Cont
ract
ual
NAIn
hou
seIn
hou
seIn
hou
seIn
hou
se
140 Study to Review The Health Care Delivery System provided by PHSC, Punjab
Tab
le 1
.3 Lab
ora
tory
Tests
Nam
e of
the
Dis
tric
t
Amri
tsar
Bhat
inda
Fero
zpur
Gurd
aspu
rH
oshi
arpu
rJa
land
har
Ludh
iana
Muk
tsar
SH P
atia
laSa
ngru
rTa
ran
Tara
nSH
Bh
atin
da
Com
plet
e Bl
ood
Hae
mog
ram
An
alys
is
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
Com
plet
e U
rine
Ex
amin
atio
nYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
s
stoo
l tes
tYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
s
Bloo
d ur
eaYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
s
Bloo
d su
gar
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Live
r fu
ncti
on t
est
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Lipi
d pr
ofi le
Yes
Yes
NoYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sNo
PAP
smea
rYe
sYe
sNo
NoYe
sYe
sYe
sYe
sYe
sYe
sNo
Yes
FNAC
Yes
Yes
NoYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sNo
Bloo
d Gr
oupi
ng
and
Mat
chin
g te
stYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
s
Biop
sy t
est
NoNo
NoNo
Yes
Yes
NoNo
NoYe
sNo
No
Cult
ure
and
smea
r ex
amin
atio
nYe
sNo
NoNo
Yes
Yes
NoYe
sNo
NoYe
sNo
Sem
en E
xam
inat
ion
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Vagi
nal d
isch
arge
ex
amin
atio
nYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sNo
Yes
Yes
Bone
Mar
row
Ex
amin
atio
nNo
NoNo
Yes
NoYe
sNo
Yes
NoNo
NoNo
VDRL
tes
tYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
s
Othe
r ro
utin
e te
sts.
Yes
Yes
Yes
Yes
Yes
NoYe
sYe
sNo
NoYe
s
Study to Review The Health Care Delivery System provided by PHSC, Punjab 141
Tab
le 1
.4 O
ut
Pati
en
t D
ep
art
men
t
Out
Pati
ent
Depa
rtm
ent
Nam
e of
the
Dis
tric
tTo
tal
Amri
tsar
Bhat
inda
Fero
zpur
Gurd
aspu
rH
oshi
arpu
rJa
land
har
Ludh
iana
Muk
tsar
SH P
atia
laSa
ngru
rTa
ran
Tara
nSH
Bh
atin
da
Rece
ptio
n &
Re
gist
rati
on
Coun
ter
(man
ual/
co
mpu
teri
sed)
Man
ual
Com
pute
rise
dCo
mpu
teri
sed
Com
pute
rise
dCo
mpu
teri
sed
Com
pute
rise
dM
anua
lCo
mpu
teri
sed
Com
pute
rise
dCo
mpu
teri
sed
Com
pute
rise
dM
anua
l3
Man
aged
by
cler
kNo
NoNo
NoNo
NoNo
Yes
NoYe
sNo
No2
Man
aged
by
MSW
NoNo
NoNo
NoNo
NoNo
NoNo
NoNo
10
Man
aged
by
staf
f nu
rse
NoNo
NoNo
NoNo
NoNo
NoYe
sNo
No1
Man
aged
by
com
pute
r op
erat
orNo
Yes
Yes
Yes
Yes
Yes
NoYe
sYe
sYe
sYe
sNo
9
Know
ledg
eabl
e ab
out
the
OPD
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
12
Sepa
rate
regi
stra
tion
fo
r m
ale
Yes
Yes
Yes
Yes
NoYe
sNo
NoYe
sYe
sYe
sNo
8
Sepa
rate
regi
stra
tion
fo
r fe
mal
eYe
sYe
sYe
sYe
sNo
Yes
NoNo
Yes
Yes
Yes
No8
Sepa
rate
regi
stra
tion
fo
r se
nior
cit
izen
sYe
sYe
sYe
sNo
Yes
Yes
Yes
NoYe
sYe
sNo
No8
Sepa
rate
regi
stra
tion
fo
r st
aff
NoNo
Yes
NoNo
NoNo
NoYe
sNo
NoNo
2
Regi
stra
tion
re
gist
ers
are
prop
erly
mai
ntai
ned
and
Yes
Yes
Yes
Yes
Yes
Yes
Yes
NoYe
sYe
sYe
sYe
s11
(Con
td..
.)
142 Study to Review The Health Care Delivery System provided by PHSC, Punjab
Out
Pati
ent
Depa
rtm
ent
Nam
e of
the
Dis
tric
tTo
tal
Amri
tsar
Bhat
inda
Fero
zpur
Gurd
aspu
rH
oshi
arpu
rJa
land
har
Ludh
iana
Muk
tsar
SH P
atia
laSa
ngru
rTa
ran
Tara
nSH
Bh
atin
da
All s
ecti
ons
of
the
OPD
havi
ng
prop
er s
igna
ge a
nd
dire
ctio
nal s
ign
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
NoYe
sYe
s10
Wai
ting
are
a is
ad
equa
teYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
s12
Prop
er s
itti
ng
arra
ngem
ent
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
12
Drin
king
wat
er
faci
lity
Yes
Yes
Yes
Yes
Yes
Yes
NoYe
sYe
sYe
sYe
sYe
s11
Ceili
ng F
ans
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
12
Toile
t fa
cilit
yYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sNo
Yes
11
Doct
or’s
Cham
bers
ar
e ha
ving
ade
quat
e sp
ace
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
12
Exam
inat
ion
tabl
e w
ith
prop
er s
heet
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
12
Stoo
l for
the
pat
ient
to
sit
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
12
Exam
inat
ion
equi
pmen
ts (
like
BP a
ppar
atus
Tor
ch,
ham
mer
, et
c.)
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
12
Adeq
uate
ill
umin
atio
nYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
s12
Inje
ctio
n Ro
om
alon
g w
ith
faci
litie
s an
d to
dea
l wit
h Em
erge
ncy
situ
atio
n
Yes
Yes
Yes
Yes
Yes
Yes
NoYe
sYe
sYe
sNo
Yes
10
(Con
td..
.)
Study to Review The Health Care Delivery System provided by PHSC, Punjab 143
Out
Pati
ent
Depa
rtm
ent
Nam
e of
the
Dis
tric
tTo
tal
Amri
tsar
Bhat
inda
Fero
zpur
Gurd
aspu
rH
oshi
arpu
rJa
land
har
Ludh
iana
Muk
tsar
SH P
atia
laSa
ngru
rTa
ran
Tara
nSH
Bh
atin
da
Min
or O
T /
Dres
sing
Ro
om w
ith
all t
he
basi
c Eq
uipm
ents
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
NoYe
s11
Disp
ensa
ries
/ Ph
arm
acy
wit
h se
para
te c
ount
ers
for
mal
e/fe
mal
e/se
nior
cit
izen
NoYe
sYe
sYe
sNo
NoYe
sNo
Yes
Yes
NoYe
s8
Labo
rato
ry &
Im
agin
g Se
rvic
es
easi
ly a
cces
sibl
e
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
12
Cent
ral C
olle
ctio
n Ce
ntre
for
La
bora
tory
Ser
vice
s
Yes
NoYe
sYe
sYe
sYe
sYe
sYe
sYe
sNo
Yes
Yes
10
144 Study to Review The Health Care Delivery System provided by PHSC, Punjab
Tab
le 1
.5 E
merg
en
cy M
ed
ical S
erv
ices (
Casu
alt
y)
Nam
e of
the
Dis
tric
t
Amri
tsar
Bhat
inda
Fero
zpur
Gurd
aspu
rH
oshi
arpu
rJa
land
har
Ludh
iana
Muk
tsar
SH P
atia
laSa
ngru
rTa
ran
Tara
nSH
Bh
atin
da
EMER
GENC
Y M
EDIC
AL
SERV
ICES
(CA
SUAL
TY)
Sepa
rate
Med
ical
Of
fi cer
(s)
avai
labl
e ro
und
the
cloc
k
Yes
Yes
Yes
NoYe
sYe
sYe
sYe
sYe
sNo
Yes
No
Boar
d di
spla
ying
on
call
doct
ors/
spec
ialis
t an
d ot
her
staf
f on
dut
y
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
NoNo
Yes
Yes
Glow
sig
n bo
ard
indi
cati
ng ‘E
mer
genc
y Se
rvic
es D
epar
tmen
t’
Yes
Yes
Yes
Yes
Yes
Yes
NoYe
sYe
sNo
NoNo
Emer
genc
y W
ard
atta
ched
to
Emer
genc
y De
part
men
t
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Tria
ge a
rea
Yes
Yes
Yes
Yes
Yes
Yes
NoYe
sNo
Yes
NoYe
s
Obse
rvat
ion
Beds
(fi l
l nu
mbe
r, fo
r No
fi ll
00)
319
37
108
43
45
36
Trol
leys
(fi l
l num
ber,
for
No fi
ll 00
)4
33
35
52
02
23
2
Whe
el c
hair
s (fi
ll
num
ber,
for
No fi
ll 00
)2
21
14
52
01
22
1
Exam
inat
ion
room
s (fi
ll
num
ber,
for
No fi
ll 00
)0
01
12
11
01
11
2
All t
he r
egis
ters
in
clud
ing
MLR
ava
ilabl
e fo
r pr
oper
reg
.
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Reti
ring
roo
m w
ith
toile
ts f
or t
he d
octo
rsYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
s
Call
book
in p
resc
ribe
d fo
rmat
ava
ilabl
eYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sNo
NoYe
s
(Con
td..
.)
Study to Review The Health Care Delivery System provided by PHSC, Punjab 145
Nam
e of
the
Dis
tric
t
Amri
tsar
Bhat
inda
Fero
zpur
Gurd
aspu
rH
oshi
arpu
rJa
land
har
Ludh
iana
Muk
tsar
SH P
atia
laSa
ngru
rTa
ran
Tara
nSH
Bh
atin
da
Wai
ting
are
a fo
r th
e at
tend
ants
of
the
pati
ents
wit
h th
e ba
sic
Faci
litie
s lik
e si
ttin
g ar
rang
emen
ts, dr
inki
ng
wat
er,
toile
t et
c.
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
NoYe
s
Publ
ic t
elep
hone
av
aila
ble
Yes
NoNo
Yes
Yes
Yes
NoNo
NoNo
NoYe
s
Trea
tmen
t ro
om-c
um-
min
or O
TYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
s
Maj
or O
TYe
sYe
sNo
NoYe
sYe
sNo
NoYe
sYe
sNo
Yes
Suffi
cien
t st
ock
of
esse
ntia
l and
life
sav
ing
drug
s
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Oxyg
en c
ylin
ders
wit
h at
tach
men
tsYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
s
Labo
rato
ry s
ervi
ces
Yes
NoNo
Yes
Yes
Yes
Yes
NoYe
sNo
Yes
Yes
Radi
olog
y Se
rvic
esYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
s
Ambu
lanc
e se
rvic
esYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
s
Staf
f tr
aine
d in
BLS
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Trea
tmen
t fa
cilit
ies
for
Dog/
sna
ke b
ite
&
Pois
onin
g
Yes
Yes
Yes
Yes
Yes
Yes
NoNo
NoYe
sYe
sNo
Avai
labi
lity
of D
isas
ter
man
ual
NoNo
NoNo
Yes
Yes
NoNo
NoNo
NoNo
Disa
ster
Ale
rt C
ode,
re
call
& d
eplo
ymen
tNo
NoNo
NoYe
sYe
sNo
NoNo
NoNo
No
Mai
nten
ance
of
dedi
cate
d Dr
ug s
tore
for
di
sast
er s
itua
tion
Yes
Yes
Yes
NoYe
sYe
sYe
sYe
sNo
Yes
NoNo
Plas
ter
Room
Yes
Yes
Yes
Yes
NoYe
sNo
Yes
NoYe
sNo
No
146 Study to Review The Health Care Delivery System provided by PHSC, Punjab
Tab
le 1
.6 In
ten
siv
e C
are
Un
it (
ICU
)
Nam
e of
the
Dis
tric
t
Amri
tsar
Bhat
inda
Fero
zpur
Gurd
aspu
rH
oshi
arpu
rJa
land
har
Ludh
iana
Muk
tsar
SH P
atia
laSa
ngru
rTa
ran
Tara
nSH
Bh
atin
da
Inte
nsiv
e Ca
re U
nit
(ICU
)No
Yes
NoYe
sNo
Yes
Yes
NoNo
Yes
NoNo
Tota
l num
ber
of b
eds
avai
labl
e:NA
6NA
6NA
104
NANA
5NA
NA
Air-
cond
itio
ned
ICU
wit
h ge
nera
tor
supp
ort
NAYe
sNA
Yes
NAYe
sYe
sNA
NAYe
sNA
NA
Staf
f sa
ncti
oned
for
the
ICU
- no
. of
doc
tors
NA0
NA2
NA0
1NA
NA0
NANA
Staf
f sa
ncti
oned
for
the
ICU
- no
. of
nur
ses
NA0
NA3
NA0
2NA
NA0
NANA
Staf
f sa
ncti
oned
for
the
ICU
- no
. of
tec
hnic
al s
taff
NA0
NA0
NA0
0NA
NA0
NANA
Study to Review The Health Care Delivery System provided by PHSC, Punjab 147
Tab
le 1
.7 C
lin
ical Lab
ora
tori
es
Nam
e of
the
Dis
tric
t
Amri
tsar
Bhat
inda
Fero
zpur
Gurd
aspu
rH
oshi
arpu
rJa
land
har
Ludh
iana
Muk
tsar
SH P
atia
laSa
ngru
rTa
ran
Tara
nSH
Bh
atin
da
Type
of
labo
rato
ries-
pa
thol
ogy
Yes
Yes
NoYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
s
Type
of
labo
rato
ries-
m
icro
biol
ogy
Yes
Yes
NoNo
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
Qual
ifi ed
-Pat
holo
gist
Yes
Yes
NoYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
s
Qual
ifi ed
-Bio
chem
ist
NoNo
NoNo
Yes
Yes
Yes
NoNo
NoNo
No
Qual
ifi ed
-Mic
ro b
iolo
gist
NoNo
NoNo
NoYe
sNo
NoNo
NoNo
No
Follo
win
g th
e Un
iver
sal
Prec
auti
on P
roce
dure
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
s
Usin
g Pr
otec
tive
Mea
sure
s i.e
. gl
oves
/gow
ns/m
asks
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Spec
imen
Col
lect
ion
done
Ce
ntra
llyYe
sYe
sYe
sNo
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Avai
labi
lity
of a
ll th
e Ch
emic
als
and
Reag
ents
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Obse
rvin
g al
l the
Bio
-sa
fety
mea
sure
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
s
Accu
racy
of
the
Repo
rts
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
NoYe
s
Regu
lar
Inte
rnal
Qua
lity
Cont
rol M
easu
res
Unde
rtak
en
NoYe
sYe
sYe
sYe
sYe
sNo
Yes
Yes
Yes
NoYe
s
Regu
lar
Exte
rnal
Qua
lity
Cont
rol M
easu
res
Unde
rtak
en
Yes
Yes
Yes
Yes
NoYe
sYe
sNo
Yes
Yes
NoYe
s
148 Study to Review The Health Care Delivery System provided by PHSC, Punjab
Tab
le 1
.8 B
loo
d B
an
kin
g F
acilit
ies
Amri
tsar
Nam
e of
the
Dis
tric
t
Amri
tsar
Bhat
inda
Fero
zpur
Gurd
aspu
rH
oshi
arpu
rJa
land
har
Ludh
iana
Muk
tsar
SH P
atia
laSa
ngru
rTa
ran
Tara
nSH
Bh
atin
da
BLOO
D BA
NK (
If N
o bl
ood
bank
fi ll
“8”
for
sect
ion
E)No
Yes
Yes
Yes
Yes
Yes
Yes
Yes
NoYe
sYe
sNo
Trai
ned
or Q
ualifi
ed
Med
ical
Offi
cer
Post
ed a
s B.
T.O.
NAYe
sYe
sYe
sYe
sYe
sYe
sYe
sNA
Yes
Yes
NA
Roun
d th
e Cl
ock
Avai
labi
lity
of T
rain
ed S
taff
an
d Se
rvic
es
NAYe
sYe
sYe
sYe
sYe
sYe
sYe
sNA
Yes
Yes
NA
Chec
king
& C
ross
Mat
chin
g by
B.T
.O.
NAYe
sYe
sYe
sYe
sYe
sYe
sYe
sNA
Yes
Yes
NA
Prop
er M
aint
enan
ce o
f Co
ld
Chai
n an
d Re
frig
erat
ors
NAYe
sYe
sYe
sYe
sYe
sYe
sYe
sNA
Yes
Yes
NA
Aust
ralia
ant
igen
, H
CV,
VDRL
, M
.P.
and
HIV
tes
ts
done
for
Eve
ry B
lood
Bo
ttle
of
dono
r.
NAYe
sYe
sYe
sYe
sYe
sYe
sYe
sNA
Yes
Yes
NA
Effo
rts
mad
e to
Col
lect
Bl
ood
thro
ugh
Volu
ntar
y Or
gani
sati
on C
amps
NAYe
sYe
sYe
sYe
sYe
sYe
sYe
sNA
Yes
Yes
NA
Rene
wal
of
Bloo
d Ba
nk/
HIV
Lic
ense
as
per
Rule
sNA
Yes
Yes
Yes
Yes
Yes
Yes
Yes
NAYe
sYe
sNA
Study to Review The Health Care Delivery System provided by PHSC, Punjab 149
Tab
le 1
.9 R
ad
iolo
gy &
Im
ag
ing
Nam
e of
the
Dis
tric
t
Amri
tsar
Bhat
inda
Fero
zpur
Gurd
as p
urH
oshi
arpu
rJa
land
har
Ludh
iana
Muk
tsar
SH P
atia
laSa
ngru
rTa
ran
Tara
nSH
Bh
atin
da
Avai
labi
lity
of t
he D
ark
Room
w
ith
all F
acili
ties
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Use
of D
osim
eter
and
the
y Re
gula
rly s
ent
to B
ARC
NoNo
NoNo
NoNo
NoYe
sNo
NoYe
sYe
s
Spec
ial I
nves
tiga
tion
like
IVP
, Co
ntra
st M
edia
etc
.No
NoNo
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
Roun
d th
e cl
ock
avai
labi
lity
of
X-ra
y se
rvic
es/
Sono
grap
hyYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sNo
Yes
Yes
No
Sepa
rate
Reg
iste
r fo
r M
LC
Reco
rds
Yes
NoYe
sNo
Yes
Yes
Yes
Yes
NoNo
Yes
No
Mai
nten
ance
of
His
tory
Bo
ok a
nd L
og b
ook
of X
-ray
M
achi
nes
Yes
Yes
Yes
Yes
Yes
Yes
NoYe
sYe
sYe
sYe
sNo
150 Study to Review The Health Care Delivery System provided by PHSC, Punjab
Tab
le 1
.10 O
pera
tio
n T
heatr
e
Nam
e of
the
Dis
tric
t
Amri
tsar
Bhat
inda
Fero
zpur
Gurd
aspu
rH
oshi
arpu
rJa
land
har
Ludh
iana
Muk
tsar
SH P
atia
laSa
ngru
rTa
ran
Tara
nSH
Bh
atin
da
No.
of O
pera
tion
s Th
eatr
es-
maj
or4
31
23
43
32
11
2
No.
of O
pera
tion
s Th
eatr
es-
min
or1
11
11
41
31
11
1
Zoni
ng c
once
pts
stric
tly
follo
wed
NoYe
sYe
sNo
Yes
Yes
Yes
Yes
NoNo
Yes
Yes
Emer
genc
y lig
ht o
r ge
nera
tor
faci
litie
s pr
ovid
ed t
o O.
T.
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Avai
labi
lity
of fi
re
fi ght
ing
equi
pmen
ts a
nd
know
ledg
e to
use
the
m
NoNo
Yes
NoYe
sYe
sYe
sYe
sYe
sYe
sYe
sNo
Regu
lar
disi
nfec
tion
s &
st
erili
sati
on p
roce
dure
s do
ne a
t O.
T.
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Study to Review The Health Care Delivery System provided by PHSC, Punjab 151
Tab
le 1
.11 In
-pati
en
ts W
ard
Nam
e of
the
Dis
tric
t
Amri
tsar
Bhat
inda
Fero
zpur
Gurd
aspu
rH
oshi
arpu
rJa
land
har
Ludh
iana
Muk
tsar
SH P
atia
laSa
ngru
rTa
ran
Tara
nSH
Bh
atin
da
Sati
sfac
tory
cle
anlin
ess
of
the
war
ds w
ith
adeq
uate
ho
use
keep
ing
Yes
Yes
Yes
NoYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
s
Colo
ur c
odes
of
Yello
w,
Blue
, Re
d, W
hite
bin
&
Blue
tra
nspa
rent
PPF
for
w
aste
col
lect
ion
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
NoYe
s
Tabl
e to
p sy
ring
e &
nee
dle
dest
roye
rYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
s
Prop
er U
tilis
atio
nYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
s
Adeq
uate
wat
er s
uppl
y an
d up
kee
p of
san
itar
y bl
ocks
.Ye
sYe
sYe
sYe
sNo
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Adeq
uate
& C
lean
Toi
lets
an
d Ba
thro
oms
Yes
Yes
Yes
NoNo
Yes
Yes
Yes
Yes
Yes
Yes
Yes
All t
he b
eds
are
havi
ng
prop
er &
ade
quat
e lin
enYe
sYe
sYe
sNo
Yes
Yes
Yes
Yes
Yes
NoYe
sYe
s
Floo
r be
ds/d
oubl
ing
of
beds
in t
he w
ards
NoNo
Yes
NoNo
NoYe
sYe
sNo
NoNo
No
if Y
es,
Anal
yse
the
Reas
onNA
NARa
re c
ases
of
Gas
tro
&
Pead
.
NANA
NANA
NANA
NA
Sati
sfac
tory
up
Keep
of
cots
, m
attr
esse
s, b
edsi
de
lock
ers,
line
n
Yes
Yes
Yes
NoYe
sYe
sYe
sYe
sYe
sNo
Yes
No
Use
of H
ospi
tal U
nifo
rms
by a
ll Pa
tien
tsNo
NoNo
NoNo
NoNo
Yes
NoNo
NoNo
Avai
labi
lity
and
Func
tion
ing
of S
ucti
on
appa
ratu
s (E
lect
ric &
Foo
t Op
erat
ed)
Avai
labl
eNo
t Av
aila
ble
Avai
labl
eAv
aila
ble
Avai
labl
eAv
aila
ble
Avai
labl
eAv
aila
ble
Avai
labl
eAv
aila
ble
Avai
labl
eNo
t Av
aila
ble
(Con
td..
.)
152 Study to Review The Health Care Delivery System provided by PHSC, Punjab
Nam
e of
the
Dis
tric
t
Amri
tsar
Bhat
inda
Fero
zpur
Gurd
aspu
rH
oshi
arpu
rJa
land
har
Ludh
iana
Muk
tsar
SH P
atia
laSa
ngru
rTa
ran
Tara
nSH
Bh
atin
da
If a
vaila
ble
(Fun
ctio
nal/
No
t)Fu
ncti
onal
NAFu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
alNo
t Fu
ncti
onal
NA
Avai
labi
lity
and
func
tion
ing
of o
xyge
n cy
linde
r w
ith
acce
ssor
ies
Avai
labl
eAv
aila
ble
Avai
labl
eAv
aila
ble
Avai
labl
eAv
aila
ble
Avai
labl
eAv
aila
ble
Avai
labl
eAv
aila
ble
Avai
labl
eav
aila
ble
If a
vaila
ble
(fun
ctio
nal)
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Avai
labi
lity
and
func
tion
ing
of v
enes
ecti
on t
ray,
LP,
tr
ache
otom
y tr
ay.
Avai
labl
eNo
t Av
aila
ble
Avai
labl
eNo
t Av
aila
ble
Not
Avai
labl
eAv
aila
ble
Not
Avai
labl
eAv
aila
ble
Avai
labl
eAv
aila
ble
Not
Avai
labl
eNo
t Av
aila
ble
If a
vaila
ble
(fun
ctio
nal)
Func
tion
alNA
Func
tion
alNA
NAFu
ncti
onal
NAFu
ncti
onal
Func
tion
alFu
ncti
onal
NANA
Avai
labi
lity
and
func
tion
ing
of e
mer
genc
y lig
ht,
whe
el
chai
r, tr
olle
y
Avai
labl
eAv
aila
ble
Avai
labl
eAv
aila
ble
Avai
labl
eAv
aila
ble
Avai
labl
eAv
aila
ble
Avai
labl
eAv
aila
ble
Avai
labl
eAv
aila
ble
If a
vaila
ble
(fun
ctio
nal)
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Stat
ione
ries,
for
ms,
upt
o da
te v
ario
us r
egis
ters
etc
.Ye
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sNo
NoNo
Yes
Conc
ept
of p
rogr
essi
ve
pati
ent
care
Yes
Yes
Yes
Yes
Yes
Yes
NoYe
sYe
sYe
sNo
Yes
Adeq
uacy
and
wor
king
of
fans
and
ligh
tsYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
s
Sati
sfac
tory
ava
ilabi
lity
of
diet
,No
NoOw
n ar
rang
emen
tNo
Yes
NoNo
NoNo
NoNo
Yes
Qual
ity
of c
are
NoYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sNo
Yes
Mai
nten
ance
of
vario
us
regi
ster
s, r
ecor
ds,
etc.
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
NoYe
s
Study to Review The Health Care Delivery System provided by PHSC, Punjab 153
Tab
le 1
.12 H
osp
ital M
ed
ical S
tore
s
Nam
e of
the
Dis
tric
t
Amri
tsar
Bhat
inda
Fero
zpur
Gurd
aspu
rH
oshi
arpu
rJa
land
har
Ludh
iana
Muk
tsar
SH P
atia
laSa
ngru
rTa
ran
Tara
nSH
Bh
atin
da
Med
ical
sto
re s
uita
bly
loca
ted
wit
h ad
equa
te s
pace
and
pr
otec
tion
of
drug
s an
d no
n-dr
ugs
item
s fr
om p
ilfer
age,
te
mpe
ratu
re,
hum
idit
y
Yes
Yes
Yes
Yes
Yes
Yes
NoYe
sYe
sYe
sNo
Rest
ricti
on o
n en
try
for
unau
thor
ised
per
sonn
el’s
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Staf
f kn
owle
dgea
ble
in m
ater
ials
m
anag
emen
tYe
sNo
Yes
NoYe
sYe
sNo
Yes
NoNo
Yes
Insp
ecti
on o
f st
ores
by
the
Civi
l Su
rgeo
n /
M.O
. I/
c at
reg
ular
in
terv
al t
o ve
rify
sto
ck b
ooks
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
NoYe
sYe
s
Avai
labi
lity
of V
ital
, es
sent
ial
drug
s in
suf
fi cie
nt Q
uant
ity
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
NoYe
sYe
s
Upk
eep
of e
xpir
y da
te r
egis
ter
and
its
regu
lar
insp
ecti
on b
y M
O I/
c
Yes
Yes
Yes
NoYe
sYe
sNo
NoNo
NoNo
Effo
rts
mad
e to
red
istr
ibut
e la
rge
stoc
k of
slo
w m
ovin
g dr
ugs
or n
ear
expi
ry f
or it
s ut
ilisa
tion
.
NoYe
sYe
sNo
Yes
Yes
Yes
Yes
NoYe
sYe
s
Prop
er a
rran
gem
ents
to
keep
the
dr
ugs
as p
er A
BC/V
ED c
ateg
ory
and
stor
age
of r
ubbe
r go
ods
as
per
guid
elin
es
Yes
NoYe
sNo
Yes
Yes
NoNo
NoNo
No
Appr
opria
te s
teps
tak
en t
o pr
even
t pi
lfera
ge o
fYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sNo
Yes
A co
nven
ient
arr
ange
men
t of
is
suin
g dr
ugs
to v
ario
usNo
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
(Con
td..
.)
154 Study to Review The Health Care Delivery System provided by PHSC, Punjab
Nam
e of
the
Dis
tric
t
Amri
tsar
Bhat
inda
Fero
zpur
Gurd
aspu
rH
oshi
arpu
rJa
land
har
Ludh
iana
Muk
tsar
SH P
atia
laSa
ngru
rTa
ran
Tara
nSH
Bh
atin
da
Regu
lar
send
ing
of s
ampl
es t
o ch
emic
al la
bora
tory
to
chec
k it
as
per
spe
cifi c
atio
n an
d st
anda
rd
& a
ctio
n ta
ken
ther
eon
NoNo
Yes
NoYe
sYe
sYe
sNo
NoNo
No
Circ
ulat
ion
of li
sts
of a
vaila
ble
drug
s to
all
the
MOs
, OP
D&
war
ds a
s pe
r ge
neric
nam
es
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Subm
issi
on o
f ce
rtifi
ed b
ills
to
offi c
e fo
r re
leas
e of
pay
men
ts
wit
hin
thre
e da
ys.
Yes
Yes
Yes
NoYe
sYe
sNo
Yes
NoNo
Yes
Auct
ion
to c
lear
the
em
pty
mat
eria
l fro
m s
tore
don
e re
gula
rly.
NoYe
sNo
NoYe
sYe
sYe
sNo
Yes
NoYe
s
Avai
labi
lity
of F
ire F
ight
ing
equi
pmen
ts a
nd k
now
ledg
e of
st
aff
to o
pera
te it
NoNo
NoNo
Yes
Yes
NoYe
sNo
Yes
No
Avai
labi
lity
of r
egul
arly
upd
ated
H
ospi
tal D
rug
Form
ular
yNo
Yes
NoNo
NoYe
sNo
NoNo
NoNo
Exis
tenc
e of
sta
ndin
g Dr
ug
Com
mit
tee
Yes
Yes
NoNo
Yes
Yes
NoNo
NoYe
sNo
Study to Review The Health Care Delivery System provided by PHSC, Punjab 155
Tab
le 1
.13
M
ed
ical R
eco
rd D
ep
art
men
t
Nam
e of
the
Dis
tric
t
Amri
tsar
Bhat
inda
Fero
zpur
Gurd
as
pur
Hos
hiar
pur
Jala
ndha
rLu
dhia
naM
ukts
arSH
Pat
iala
Sang
rur
Tara
n Ta
ran
SH
Bhat
inda
Avai
labi
lity
of M
edic
al R
ecor
d Ro
om w
ith
enou
gh n
umbe
r of
ra
cks
NoYe
sYe
sYe
sYe
sYe
sNo
Yes
NoYe
sNo
Yes
Med
ical
rec
ord
NoNo
NoNo
Yes
NoNo
NoNo
NoNo
No
Is it
man
aged
by
a tr
aine
d m
edic
al r
ecor
d of
fi cer
/
tech
nici
an o
r
NoYe
sYe
sNo
Yes
NoNo
Yes
Yes
NoYe
sYe
s
Case
rec
ord
is m
aint
aine
d as
per
W
HO
clas
sifi c
atio
n of
dis
ease
s (I
CD-X
)
NoNo
NoNo
Yes
Yes
Yes
NoNo
NoYe
s
Regu
lar
subm
issi
on o
f th
e m
orbi
dity
, m
orta
lity
repo
rts
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
NoYe
s
For
wha
t du
rati
on a
ll th
e re
cord
s be
ing
mai
ntai
ned
(In
year
s)7
1510
105
510
1410
1010
5
Is t
he b
acku
p fa
cilit
y av
aila
ble
to s
afeg
uard
the
se r
ecor
dsNo
NoYe
sNo
Yes
No b
acku
pNo
Man
ual
Yes
Yes
NoNo
Wha
t is
the
eff
ecti
ve r
etrie
val
syst
em f
ollo
wed
by
this
hos
pita
lNo
new
&
old
crno
.,
alph
a in
dex
As p
er
adm
issi
on
No.
& y
ear
wis
e
Adm
issi
on
No.,
bu
ndle
of
100
Com
pute
rNo
NoYe
sNo
NoNo
Regu
lar
deat
h au
dit
mee
ting
s he
ld &
min
utes
of
mee
ting
Yes
NoYe
sNo
Yes
NoNo
NoYe
sNo
NoNo
Med
ical
aud
it d
one
at r
egul
ar
inte
rval
Yes
Yes
Yes
NoYe
sYe
sNo
Yes
Yes
NoNo
No
156 Study to Review The Health Care Delivery System provided by PHSC, Punjab
Tab
le 1
.14 H
osp
ital W
aste
Man
ag
em
en
t
Nam
e of
the
Dis
tric
t
Amri
tsar
Bhat
inda
Fero
zpur
Gurd
aspu
rH
oshi
arpu
rJa
land
har
Ludh
iana
Muk
tsar
SH P
atia
laSa
ngru
rTa
ran
Tara
nSH
Bh
atin
da
Are
the
adeq
uate
num
ber
of
bins
and
the
bag
s of
req
uire
dNo
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Are
thes
e pl
aced
str
ateg
ical
ly
in a
ll pa
tien
t ca
re a
reas
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Segr
egat
ion
of d
iffe
rent
ca
tego
ries
of w
aste
s do
ne a
t th
e
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Colle
ctio
n of
was
te,
pack
agin
g, la
belli
ng,
reco
rd
keep
ing
done
in s
cien
tifi c
NoYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
s
Prop
er t
rans
port
atio
n of
the
w
aste
so
colle
cted
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Stor
age
faci
litie
s an
d du
rati
onNo
Yes
Yes
NoYe
sNo
Yes
Yes
Yes
Yes
Yes
Yes
Disp
osal
/ re
cycl
ing
met
hods
fo
r va
rious
cat
egor
ies
ofNo
Yes
NoYe
sYe
sNo
Yes
NoYe
sYe
sYe
sYe
s
Whe
ther
was
te d
ispo
sal i
s ou
tsou
rced
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
NoYe
sYe
s
Study to Review The Health Care Delivery System provided by PHSC, Punjab 157
Tab
le 1
.15 S
UP
PO
RT
SE
RV
ICE
S
Cen
tral S
teri
le S
up
ply
Dep
art
men
t
Nam
e of
the
Dis
tric
t
Amri
tsar
Bhat
inda
Fero
zpur
Gurd
aspu
rH
oshi
arpu
rJa
land
har
Ludh
iana
Muk
tsar
SH P
atia
laSa
ngru
rTa
ran
Tara
nSH
Bh
atin
da
Unde
r th
e Su
perv
isio
n of
a
Trai
ned
Tech
nica
l Sta
ff/
Seni
or N
ursi
ng O
ffi ce
r
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
NAYe
sNo
Yes
Hav
ing
all t
he r
equi
red
equi
pmen
ts &
Aut
ocla
ves
Yes
Yes
Yes
NoYe
sYe
sYe
sYe
sNA
Yes
NoYe
s
Qual
ity
cont
rol m
easu
res
are
stric
tly
follo
wed
-ph
ysic
alYe
sNo
Yes
NoYe
sYe
sYe
sYe
sNA
Yes
NoYe
s
Qual
ity
cont
rol m
easu
res
are
stric
tly
follo
wed
- ch
emic
alYe
sYe
sYe
sNo
Yes
Yes
Yes
NoNA
Yes
NAYe
s
Qual
ity
cont
rol m
easu
res
are
stric
tly
follo
wed
- bi
olog
ical
Yes
NoYe
sNo
Yes
Yes
Yes
NoNA
Yes
NAYe
s
158 Study to Review The Health Care Delivery System provided by PHSC, Punjab
Lau
nd
ry S
erv
ices
Nam
e of
the
Dis
tric
t
Amri
tsar
Bhat
inda
Fero
zpur
Gurd
aspu
rH
oshi
arpu
rJa
land
har
Ludh
iana
Muk
tsar
SH P
atia
laSa
ngru
rTa
ran
Tara
nSH
Bh
atin
da
Laun
dry
Serv
ices
(M
echa
nise
d/
conv
enti
onal
)
Conv
enti
onal
Mec
hani
sed
Conv
enti
onal
Mec
hani
sed
Mec
hani
sed
Mec
hani
sed
Mec
hani
sed
conv
enti
onal
Mec
hani
sed
Conv
enti
onal
Conv
enti
onal
Mec
hani
sed
Laun
dry
Serv
ices
-sta
ff(A
dequ
ate)
Adeq
uate
Adeq
uate
Adeq
uate
Adeq
uate
Adeq
uate
Adeq
uate
Not
Adeq
uate
Not
Adeq
uate
Adeq
uate
Not
Adeq
uate
Adeq
uate
Adeq
uate
Qual
ity
of
was
hGo
odAv
erag
eGo
odGo
odGo
odGo
odAv
erag
eGo
odGo
odAv
erag
eGo
odGo
od
Qual
ity
of
linen
Good
Good
Good
Aver
age
Good
Good
Aver
age
Good
Good
Aver
age
Good
Good
Study to Review The Health Care Delivery System provided by PHSC, Punjab 159
Die
tary
Serv
ices
Nam
e of
the
Dis
tric
t
Amri
tsar
Bhat
inda
Fero
zpur
Gurd
aspu
rH
oshi
arpu
rJa
land
har
Ludh
iana
Muk
tsar
SH P
atia
laSa
ngru
rTa
ran
Tara
nSH
Bh
atin
da
Prop
er &
saf
e ar
rang
emen
t fo
r st
orag
e of
raw
mat
eria
lsNo
NANA
NANA
NANA
NANA
NANA
NA
Mea
sure
s fo
r Pe
st &
Rod
ent
cont
rol
NoNA
NANA
NANA
NANA
NANA
NANA
Sani
tati
on a
nd h
ygie
ne o
f th
e co
okin
g ar
ea p
rope
rly
mai
ntai
ned
NoNA
NANA
NANA
NANA
NANA
NANA
Regu
lar
heal
th c
heck
-up
for
food
han
dler
sNo
NANA
NANA
NANA
NANA
NANA
NA
Avai
labi
lity
of m
oder
n co
okin
g eq
uipm
ents
NoNA
NANA
NANA
NANA
NANA
NANA
Avai
labi
lity
of p
rope
rly
mai
ntai
ned
reco
rds
&
regi
ster
s
NoNA
NANA
NANA
NANA
NANA
NANA
Diet
ser
vice
und
er t
he
supe
rvis
ion
of a
qua
lifi e
d Di
etic
ian
NoNA
NANA
NANA
NANA
NANA
NANA
160 Study to Review The Health Care Delivery System provided by PHSC, Punjab
Tab
le 1
.16 U
ser
Ch
arg
es in
Dif
fere
nt
Dis
tric
t H
osp
itals
Nam
e of
Di
stri
ct
Hos
pita
l
Year
sTo
tal I
ncom
e (C
olle
ctio
n)To
tal
Expe
ndit
ure
Deta
iled
Expe
ndit
ure
Med
icin
eI.
F.P.
Build
ings
Equi
pmen
tER
F A/
cSa
lary
to
Cont
ract
ual
Staf
f
Rogi
Kal
yan
Sam
iti
Amri
tsar
2003
-04
1900
185
2004
-05
2374
199
2005
-06
2741
536
2006
-07
3050
132
2007
-08
3301
463
Tota
l13
3675
15
Bati
nda
2003
-04
5138
784
6517
634
2944
683
1611
906
3193
0631
9306
--
-
2004
-05
5045
995
4323
803
2249
330
9849
0824
1353
2413
53-
4889
59-
2005
-06
6313
724
5711
847
2386
983
1310
739
5370
0747
1309
5386
0446
7205
-
2006
-07
6162
264
6209
016
2193
207
1485
296
3459
7710
4595
863
6396
5021
82-
2007
-08
5290
741
4718
401
1653
431
9439
8846
9782
7902
7251
2474
3484
54-
Tota
l27
9515
0827
4807
0111
4276
3463
3683
733
5375
828
6819
816
8747
418
0680
0-
Fero
zpur
2003
-04
2179
219
2129
219
8741
4343
5635
2913
8129
1381
-23
6679
-
2004
-05
2840
423
2840
423
1162
196
6456
6438
7398
3873
98-
2577
67-
2005
-06
2908
548
4673
865
2908
548
6343
5038
0910
3809
10-
3691
47-
2006
-07
3074
681
3074
681
1186
566
6592
0339
5522
3955
22-
4378
68-
2007
-08
3275
538
3275
538
1312
560
7292
0143
7521
4375
21-
3587
35-
Tota
l14
2784
0914
2784
0974
4401
331
0405
318
9273
218
9273
2-
1660
196
-
Gurd
aspu
r
2003
-04
3875
328
2586
302
1290
006
7548
2820
8792
1755
4800
0015
7128
0000
2004
-05
4889
763
3229
772
1480
509
8202
6944
0287
2971
0100
0019
1606
0000
2005
-06
5213
162
3365
249
1610
770
6594
3743
3148
1456
7727
9392
2366
2500
00
2006
-07
6519
411
4482
801
2061
622
8662
3666
6745
2758
8236
4511
2478
0500
00
2007
-08
NA38
8227
317
1231
476
1250
3659
0526
1018
4461
2623
5660
1000
00
Tota
l20
4976
6417
5463
9781
5522
138
6222
021
1487
711
5522
610
9002
910
6882
410
0000
(Con
td..
.)
Study to Review The Health Care Delivery System provided by PHSC, Punjab 161
Nam
e of
Di
stri
ct
Hos
pita
l
Year
sTo
tal I
ncom
e (C
olle
ctio
n)To
tal
Expe
ndit
ure
Deta
iled
Expe
ndit
ure
Med
icin
eI.
F.P.
Build
ings
Equi
pmen
tER
F A/
cSa
lary
to
Cont
ract
ual
Staf
f
Rogi
Kal
yan
Sam
iti
Hos
hiar
pur
2003
-04
2004
-05
2005
-06
2006
-07
2007
-08
5826
166
6027
980
2404
437
1399
160
6118
8252
7801
6194
7546
5225
-
Tota
l58
2616
660
2798
024
0443
713
9916
061
1882
5278
0161
9475
4652
25-
Jala
ndha
r
2003
-04
2004
-05
2005
-06
9419
098
9630
442
4747
258
2315
901
9670
0033
5006
5127
1475
2563
-
2006
-07
1349
9437
1072
4214
5622
143
2127
532
7559
4446
0244
1194
458
5638
93-
2007
-08
1541
6929
1585
8716
6393
457
3189
803
1056
121
1355
608
3234
468
6292
59-
Tota
l38
3355
464
3621
3372
1676
2858
7633
236
2779
065
2150
858
4941
640
1945
715
-
Ludh
iana
2003
-04
3101
683
3777
674
2643
851
5214
4033
5221
1299
08-
1472
54-
2004
-05
3803
090
3607
862
2948
549
3347
3758
076
2058
13-
6068
7-
2005
-06
4544
871
4573
092
3326
884
5246
3018
9417
1678
3011
5586
2487
45-
2006
-07
4811
096
3183
321
1976
830
3496
6123
7645
4191
8559
9608
7206
8-
2007
-08
5024
987
3864
421
2007
813
7705
1179
6861
2892
3633
138
4580
-
Tota
l21
2857
2719
0063
7012
9039
2727
0097
916
1722
012
1197
274
8332
5332
54-
Muk
tsar
2003
-04
2004
-05
2005
-06
2006
-07
2007
-08
Tota
l
(Con
td..
.)
162 Study to Review The Health Care Delivery System provided by PHSC, Punjab
Nam
e of
Di
stri
ct
Hos
pita
l
Year
sTo
tal I
ncom
e (C
olle
ctio
n)To
tal
Expe
ndit
ure
Deta
iled
Expe
ndit
ure
Med
icin
eI.
F.P.
Build
ings
Equi
pmen
tER
F A/
cSa
lary
to
Cont
ract
ual
Staf
f
Rogi
Kal
yan
Sam
iti
Pati
ala
(Sp.
H
ospi
tal)
2003
-04
6030
396
4212
300
8040
5043
3198
2674
019
5234
9-
2486
84-
2004
-05
4575
8115
1368
779
6653
3010
8642
819
4795
8-
3251
71-
2005
-06
5476
548
2529
041
1201
486
4896
7988
679
8539
734
2852
3209
48-
2006
-07
6887
658
3027
748
1499
017
3710
0913
7009
1153
5547
7461
4278
97-
2007
-08
Tota
l18
8521
8311
2827
7643
0120
615
9497
229
4252
630
1059
8203
1313
2270
0-
Sang
rur
2003
-04
3188
235
2011
939
--
--
--
-
2004
-05
4054
724
2072
265
--
--
--
-
2005
-06
4687
936
3129
318
--
--
--
-
2006
-07
4454
628
3777
499
--
--
--
-
2007
-08
4745
583
4782
224
--
--
--
-
Tota
l21
1311
0615
7732
45-
--
--
--
Tara
n Ta
ran
2003
-08
Not
Avai
labl
e Du
e to
For
mat
ion
of N
ew D
istr
ict
Sp. H
ospi
tal
Bhat
inda
2003
-04
9517
9698
2268
5045
91-
--
--
-
2004
-05
1133
336
5619
0721
6541
2304
1957
573
5737
4-
--
2005
-06
1431
652
1062
972
4233
7633
8376
1569
6243
467
1007
91-
-
2006
-07
1541
913
1160
399
5812
0519
9501
8726
916
2740
1189
5910
725
-
2007
-08
1223
898
9678
3650
0471
1397
8870
660
1190
3912
2744
1513
4-
Tota
l62
8259
547
3538
222
2618
411
3092
544
5485
5644
3534
2494
2585
9-
Study to Review The Health Care Delivery System provided by PHSC, Punjab 163
Tab
le 1
.17
P
erf
orm
an
ce R
ep
ort
of
Dis
tric
t H
osp
ital
Perf
orm
ance
(An
nual
)N
ame
of t
he D
istr
ict
Amri
tsar
Bhat
inda
Fero
zpur
Gurd
aspu
rH
oshi
arpu
rJa
land
har
Ludh
iana
Muk
tsar
SH P
atia
laSa
ngru
rTa
ran
Tara
nSH
Bh
atin
da
OPD
atte
ndan
ce
last
5 y
ears
1st Y
r68
726
1709
3611
2815
1152
4718
9243
--
9696
112
3171
1439
4988
942
4775
3
2nd Y
r10
4203
1780
8310
0355
1340
421
5921
--
9559
114
8476
1517
4311
2667
5473
3
3rd Y
r10
9836
1936
8788
901
1609
5423
5353
1698
9117
6891
1068
4116
2196
1582
6812
0134
6172
5
4th Y
r12
5668
2211
8795
306
1831
9624
2693
2226
6918
2811
1343
3518
8125
2014
8112
6646
6256
5
5th Y
r13
9137
2202
1710
4298
1764
3223
1386
1568
2715
6942
9371
316
2518
1742
5912
1578
6795
5
1st Y
r20
4162
9368
0591
8410
188
--
3149
6093
1016
544
9123
61
2nd Y
r33
7070
5363
1494
6712
476
--
3149
6093
1016
544
9123
61
3rd Y
r43
7190
4560
7210
713
1317
012
538
1024
940
6988
0211
492
4804
4518
4th Y
r52
7198
0861
4611
564
1321
916
054
1024
138
8110
495
1232
348
6849
06
5th Y
r78
5310
657
6340
1200
412
731
5106
8366
3956
1152
213
051
4728
5958
No.
of
Surg
erie
s do
ne1st
Yr
1330
3567
1110
339
25-
--
1708
3355
5751
2114
859
2nd Y
r29
3036
6510
113
4177
9214
--
3071
3977
9072
2490
2197
3rd Y
r94
3871
0985
1665
9612
217
2508
113
607
4403
4201
8590
3845
2554
4th Y
r98
8560
8982
3463
2511
494
2930
113
304
4201
8652
8223
5056
2033
5th Y
r10
819
6965
9095
6272
1097
327
245
1359
629
4410
619
8642
5181
3442
No.
of
Emer
genc
ies
1st Y
r-
4543
2596
4621
--
--
0$53
5321
4734
5
2nd Y
r-
4983
3167
4715
1302
2-
--
0$62
4125
7994
1
3rd Y
r-
4689
2735
5396
1343
813
385
--
0$58
0225
9097
7
4th Y
r-
7370
3626
5570
1508
318
073
--
0$64
2226
1411
76
5th Y
r-
6496
4735
5973
1549
025
41-
-0$
7140
3059
1792
No.
of
adm
issi
ons
thro
ugh
emer
genc
y
1st Y
r-
3580
1317
4687
--
-10
430$
2817
2016
345
2nd Y
r-
3328
1610
4822
6905
--
1514
0$34
1922
0494
1
3rd Y
r-
3631
2171
4919
6708
4596
3275
1814
0$32
8820
1597
7
4th Y
r-
3461
1525
4925
6989
6647
4295
1902
0$39
2420
1711
76
5th Y
r-
4229
1495
5594
6523
1891
3039
1912
0$50
5519
2217
92
(Con
td..
.)
164 Study to Review The Health Care Delivery System provided by PHSC, Punjab
Perf
orm
ance
(An
nual
)N
ame
of t
he D
istr
ict
Amri
tsar
Bhat
inda
Fero
zpur
Gurd
aspu
rH
oshi
arpu
rJa
land
har
Ludh
iana
Muk
tsar
SH P
atia
laSa
ngru
rTa
ran
Tara
nSH
Bh
atin
da
No.
of
med
ico-
lega
l cas
es1st
Yr
1350
-11
8154
4-
-95
4256
10$
1016
-0$
2nd Y
r27
3712
8210
1065
461
2-
9734
701
0$75
219
20$
3rd Y
r23
6396
210
8572
167
019
9810
116
666
0$58
042
10$
4th Y
r25
9315
7513
4374
195
115
7012
168
903
0$90
953
50$
5th Y
r27
3311
6713
4470
189
616
0514
049
908
0$81
550
90$
No.
of
post
-mor
tum
done
1st Y
r-
392
173
186
--
1439
-0$
123
186
0$
2nd Y
r-
460
233
203
294
-14
35-
0$10
419
00$
3rd Y
r-
524
180
223
258
644
1492
-0$
8520
10$
4th Y
r-
580
158
279
293
827
1731
-0$
110
910$
5th Y
r-
610
184
270
375
790
1703
-0$
192
950$
No.
of
norm
al
deliv
erie
s co
nduc
ted
1st Y
r15
80*
268
578
--
-60
1966
1058
258
331
2nd Y
r23
70*
310
595
577
--
7624
5214
5725
961
0
3rd Y
r27
20*
520
567
781
476
222
185
2802
1477
234
558
4th Y
r40
90*
296
577
742
737
298
265
3268
1177
152
811
5th Y
r45
70*
317
615
554
738
196
301
3671
1557
9210
14
No
of C
aesa
rean
do
ne1st
Yr
114
0*25
541
4-
--
3057
153
020
512
4
2nd Y
r22
10*
308
514
350
--
2185
271
416
230
5
3rd Y
r31
20*
269
483
460
314
164
4911
2353
123
037
8
4th Y
r39
20*
291
463
387
379
147
4012
4151
913
733
3
5th Y
r32
40*
367
653
376
362
196
3114
0947
010
128
1
* Al
l del
iver
ies
wer
e co
nduc
ted
at S
peci
al h
ospi
tal B
hati
nda
$ Th
ere
was
no
regu
lar
emer
genc
y de
part
men
t. T
here
wer
e sp
ecia
l hos
pita
ls f
or w
omen
and
chi
ld.
Study to Review The Health Care Delivery System provided by PHSC, Punjab 165
Tab
le 1
.18
S
taff
Po
sit
ion
of
Dis
tric
t H
osp
ital
Nam
e of
Pos
tPo
siti
on o
f Po
stN
ame
of t
he D
istr
ict
Hos
pita
l
Amri
tsar
Bhat
inda
Fero
zpur
Gurd
aspu
rH
oshi
arpu
rJa
land
har
Ludh
iana
Muk
tsar
SH P
atia
laSa
ngru
rTa
ran
Tara
nSH
Bh
atin
da
M.S
.Sa
ncti
oned
--
--
-1
--
1-
--
Vaca
nt-
--
--
--
--
--
-
S.M
.O.
In-p
osit
ion
--
--
-1
--
1-
--
Sanc
tion
ed2
11
12
4-
12
2-
1
Vaca
nt1
--
--
--
1-
1-
1
Doct
ors
G.D.
M.O
.
In-p
osit
ion
11
11
24
--
21
--
Sanc
tion
ed27
69
118
448
134
5-
-
Vaca
nt2
11
3-
24
3-
1-
-
Doct
ors
Spec
ialis
tIn
-pos
itio
n25
58
88
424
10
(Adh
oc-1
)4
4-
-
Sanc
tion
ed-
1211
820
3425
-29
1913
17
Vaca
nt-
-4
-2
-5
-2
4-
1
Nurs
ing
Staf
fIn
-pos
itio
n-
157
818
3426
-27
1513
16
Sanc
tion
ed40
3327
2840
110
4511
5427
1238
Vaca
nt4
73
--
107
38
1-
18
Adho
c-
--
-8
--
--
--
-
Tech
nici
anIn
-pos
itio
n36
2624
2840
100
38+1
1(*)
846
2612
20
Sanc
tion
ed-
1614
1610
449
34
47
2
Vaca
nt-
41
--
4-
2-
1-
1
Adho
c/co
n-
--
--
-3
con.
--
--
-
Adm
inis
trat
ive
Staf
fIn
-pos
itio
n35
1213
1610
409
14
37
1
Sanc
tion
ed-
99
713
2010
21
102
9
Vaca
nt-
-1
--
22
--
--
2
(Con
td..
.)
166 Study to Review The Health Care Delivery System provided by PHSC, Punjab
Nam
e of
Pos
tPo
siti
on o
f Po
stN
ame
of t
he D
istr
ict
Hos
pita
l
Amri
tsar
Bhat
inda
Fero
zpur
Gurd
aspu
rH
oshi
arpu
rJa
land
har
Ludh
iana
Muk
tsar
SH P
atia
laSa
ngru
rTa
ran
Tara
nSH
Bh
atin
da
Clas
s-IV
In-p
osit
ion
-9
87
1318
4+1
(*)
+5($
)2
110
27
Sanc
tion
ed-
7166
6780
110
7432
101
7126
28
Vaca
nt-
22
19-
--
-22
1-
1
Othe
rsIn
-pos
itio
n-
6964
4880
110
36+3
8($)
3279
7026
29+6
(*)
Sanc
tion
ed2
96
6-
858
738
--
7
Vaca
nt-
36
--
182
211
--
3
In-p
osit
ion
96
-6
-67
10+4
(*).
527
--
4
* Pl
aced
on
Depu
tati
on$
Gone
on
depu
tati
on t
o ot
her
dist
ricts
/pla
ces
Study to Review The Health Care Delivery System provided by PHSC, Punjab 167
Tab
le 1
.19 P
osit
ion
of
Sp
ecia
list
in D
istr
ict
Ho
sp
ital
Nam
e of
Sp
ecia
lity
Degr
eeN
ame
of t
he D
istr
ict
Hos
pita
l
Amri
tsar
Bhat
inda
Fero
zpur
Gurd
aspu
rH
oshi
arpu
rJa
land
har
Ludh
iana
Muk
tsar
SH
Pati
ala
Sang
rur
Tara
n Ta
ran
SH
Bhat
inda
Med
icin
eM
.D.
21
12
52
11
12
11
Surg
ery
Gyna
ecol
ogis
t &
Ob
stet
ricia
n
M.S
21
21
35
31
12
11
M.D
.2
11
22
43
-3
11
3
Paed
iatr
icM
BBS
--
--
--
--
--
--
M.D
.2
1-
12
33
-2
21
2
Dipl
oma
--
--
--
-1
--
--
Opth
amol
ogy
M.D
.-
1-
12
-3
11
11
1
ENT
M.D
.-
--
22
22
1-
11
1
Orth
o.M
.S1
21
11
Derm
atol
ogy
M.D
.-
1-
-2
22
11
11
1
Psyc
hiat
ric
Anae
sthe
sia
M.D
.-
--
-1
2-
-1
-1
-
M.D
.-
1-
12
53
1-
11
2
Bloo
d Ba
nkDi
plom
a-
--
--
--
-1
--
-
M.D
.-
--
-1
11
1-
1-
-
MBB
S-
1-
--
--
--
--
-
Path
olog
yM
.D.
-1
-1
12
11
11
-1
Bioc
hem
istr
yM
.D.
--
--
11
--
--
-
Mic
ro-B
iolo
gyM
.D.
--
--
-1
--
--
--
Radi
olog
y
Dent
al
M.D
.-
1-
-2
21
--
-1
-
B.D.
S.-
1-
13
21
-1
11
1
MBB
S-
--
--
--
1-
--
-
168 Study to Review The Health Care Delivery System provided by PHSC, Punjab
Tab
le 2.1
Gen
era
l P
rofi
le &
Facilit
y S
urv
ey o
f S
ub
-Div
isio
nal H
osp
itals
Gene
ral P
rofi l
e of
Hos
pita
lsN
ame
of t
he S
ub-D
ivis
iona
l Hos
pita
ls
Ajna
laBa
tala
Dasu
yaFa
zilk
aJa
grao
nM
aler
Kotl
aM
alou
tN
akod
arPa
tti
Talw
andi
Acce
ssib
ility
to
Railw
ay/B
us S
tati
onYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
s
Wat
er S
uppl
yBo
re w
ell
Bore
wel
lBo
re w
ell
Bore
wel
lBo
re w
ell
Mun
icip
al
supp
lyM
unic
ipal
su
pply
Bore
wel
lBo
re w
ell
Mun
icip
al
supp
ly
Wat
er S
uppl
yAd
equa
teAd
equa
teAd
equa
teAd
equa
teAd
equa
teAd
equa
teAd
equa
teAd
equa
teAd
equa
teAd
equa
te
Wat
er S
uppl
y1
day
1 da
y1
day
3 da
ys3
days
3 da
ys3
days
3 da
ys3
days
3 da
ys
Elec
tric
ity
Regu
lar
Irre
gula
r su
pply
Regu
lar
Irre
gula
r su
pply
Irre
gula
r su
pply
Regu
lar
Regu
lar
Regu
lar
Regu
lar
Irre
gula
r su
pply
Elec
tric
ity-
Phas
eTh
ree
Thre
eTh
ree
Doub
leTh
ree
Thre
eTh
ree
Thre
eTh
ree
Thre
e
Elec
tric
ity-
Back
up
(Gen
erat
or/U
PS)
Avai
labl
eAv
aila
ble
Avai
labl
eAv
aila
ble
Avai
labl
eAv
aila
ble
Avai
labl
eNo
t Av
aila
ble
Avai
labl
eAv
aila
ble
Avai
labi
lity
of li
ftNo
t Av
aila
ble
Not
Avai
labl
eNo
t Av
aila
ble
Not
Avai
labl
eNo
t Av
aila
ble
Not
Avai
labl
eAv
aila
ble
Not
Avai
labl
eNo
t Av
aila
ble
Not
Avai
labl
e
Avai
labi
lity
of r
amp
Avai
labl
eNo
t Av
aila
ble
Avai
labl
eNo
t Av
aila
ble
Not
Avai
labl
eAv
aila
ble
Avai
labl
eNo
t Av
aila
ble
Avai
labl
eAv
aila
ble
General Impression
• U
p ke
ep o
f ga
rden
• Cl
eanl
ines
s
• Si
gn p
osti
ng
• Ro
ads
and
light
• St
ate
of b
uild
ing
Poor
Aver
age
Good
Good
Poor
Good
NAGo
odAv
erag
eAv
erag
e
Good
Good
Good
Good
Good
Good
Good
Good
Aver
age
Aver
age
Aver
age
Good
Good
Good
Good
Aver
age
Good
Good
Aver
age
Aver
age
Aver
age
Good
Good
Good
Good
Good
Good
Good
Aver
age
Good
Good
Good
Good
Good
Good
Good
Good
Good
Aver
age
Aver
age
Any public utility service available in hospital premises
• Ch
emis
tNo
NoNo
Yes
Yes
NoNo
Yes
NoNo
• Su
labh
sau
chal
aya
Yes
Yes
NoYe
sNo
Yes
Yes
NoNo
No
• Ca
ntee
nNo
Yes
Yes
Yes
Yes
NoNo
NoYe
sNo
• Gr
ocer
y sh
ops
NoYe
sNo
NoNo
NoNo
NoNo
No
• ST
D/PC
O bo
oth
NoYe
sNo
Yes
NoNo
NoNo
NoNo
• Ot
her
-cyc
le s
tand
Yes
NoNo
NoNo
NoNo
NoNo
No (Con
td..
.)
Study to Review The Health Care Delivery System provided by PHSC, Punjab 169
Gene
ral P
rofi l
e of
Hos
pita
lsN
ame
of t
he S
ub-D
ivis
iona
l Hos
pita
ls
Ajna
laBa
tala
Dasu
yaFa
zilk
aJa
grao
nM
aler
Kotl
aM
alou
tN
akod
arPa
tti
Talw
andi
Ambu
lanc
e Se
rvic
es
Avai
labl
eAv
aila
ble
Avai
labl
eAv
aila
ble
Avai
labl
eAv
aila
ble
Avai
labl
eAv
aila
ble
Avai
labl
eAv
aila
ble
Part
ially
Eq
uipp
edFu
lly
Equi
pped
Part
ially
Eq
uipp
edFu
lly
Equi
pped
Part
ially
Eq
uipp
edFu
lly
Equi
pped
Part
ially
Eq
uipp
edPa
rtia
lly
Equi
pped
Part
ially
Eq
uipp
edPa
rtia
lly
Equi
pped
Tota
l num
ber
of v
ehic
les
12
32
22
22
23
No.
of
oper
atio
n th
eatr
es
Min
or1
11
11
12
21
1
Maj
or2
23
12
21
21
2
ICU
typ
esGe
nera
lGe
nera
lNo
Gene
ral
NoNo
NoNo
Gene
ral
Gene
ral
ICU
no.
of
beds
25
NANI
LNA
NANA
NA4
6
Emer
genc
y Se
rvic
esRo
und
the
cloc
kRo
und
the
cloc
kRo
und
the
cloc
kRo
und
the
cloc
kRo
und
the
cloc
kRo
und
the
cloc
kRo
und
the
cloc
kRo
und
the
cloc
kRo
und
the
cloc
kRo
und
the
cloc
k
Dent
al S
ervi
ces
Yes
Yes
Yes
NoYe
sYe
sYe
sYe
sYe
sYe
s
Deliv
ery
Serv
ices
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Faci
litie
s fo
r Po
st-m
orte
mYe
sYe
sYe
sNo
Yes
Yes
Yes
Yes
Yes
No
Mor
tuar
y se
rvic
es w
ith
cold
sto
rage
&
oth
er p
rese
rvat
ive
faci
litie
s av
aila
ble.
NoYe
sYe
sYe
sNo
Yes
Yes
Yes
Yes
No
Drug
for
mul
ary
com
mit
tee
NoNo
NoNo
NoNo
NoYe
sYe
sNo
Hos
pita
l Ant
ibio
tic
com
mit
tee
NoNo
NoNo
NoNo
NoYe
sNo
No
Hos
pita
l Inf
ecti
on C
ontr
ol
Com
mit
tee.
NoYe
sNo
NoNo
NoNo
Yes
Yes
No
Stor
e Pu
rcha
se C
omm
itte
eYe
sYe
sYe
sYe
sYe
sNo
Yes
Yes
Yes
Yes
Stor
e ve
rifi c
atio
n Co
mm
itte
eYe
sYe
sYe
sNo
Yes
NoYe
sYe
sYe
sYe
s
Med
ical
Aud
it/
Deat
h Re
view
Co
mm
itte
eYe
sNo
Yes
NoNo
NoYe
sYe
sYe
sNo
Is t
he d
rug
form
ular
y av
aila
ble
Yes
NoYe
sNo
Yes
NoYe
sYe
sNo
No (Con
td..
.)
170 Study to Review The Health Care Delivery System provided by PHSC, Punjab
Gene
ral P
rofi l
e of
Hos
pita
lsN
ame
of t
he S
ub-D
ivis
iona
l Hos
pita
ls
Ajna
laBa
tala
Dasu
yaFa
zilk
aJa
grao
nM
aler
Kotl
aM
alou
tN
akod
arPa
tti
Talw
andi
Syst
em o
f su
pply
of
drug
item
s th
roug
hPu
shPu
llPu
shPu
llPu
shPu
shPu
ll &
Pus
hPu
llPu
shPu
sh
Is b
uffe
r st
ock
mai
ntai
ned
NoYe
sYe
sYe
sYe
sYe
sYe
sYe
sNo
Yes
Reor
der
leve
l mai
ntai
ned
Yes
NoYe
sNo
Yes
NoNo
Yes
NoNo
Annu
al m
aint
enan
ce p
roce
dure
for
co
stly
Equ
ipm
ents
NoYe
sYe
sYe
sYe
sYe
sYe
sYe
sNo
Yes
Log
book
/ H
isto
ry s
heet
mai
ntai
ned
for
the
Equi
pmen
tsYe
sYe
sYe
sNo
Yes
NoYe
sYe
sNo
Yes
Pres
ent
stat
us/s
itua
tion
s of
the
ex
isti
ng E
quip
men
ts:
Aver
age
Good
Good
Aver
age
Aver
age
Aver
age
Good
Aver
age
Aver
age
Aver
age
Study to Review The Health Care Delivery System provided by PHSC, Punjab 171
Tab
le 2
.2 A
vailab
ilit
y o
f eq
uip
men
t
Nam
e of
the
Sub
-Div
isio
nal H
ospi
tals
Ajna
laBa
tala
Dasu
yaFa
zilk
aJa
grao
nM
aler
Kot
laM
alou
tN
akod
arPa
tti
Talw
andi
Baby
Inc
ubat
ors
Yes
Yes
Yes
Yes
NoYe
sNo
Yes
NoNo
Func
tion
alFu
ncti
onal
Func
tion
alNo
n Fu
ncti
onal
NAFu
ncti
onal
NAFu
ncti
onal
NANA
Boyl
es A
ppar
atus
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Func
tion
alFu
ncti
onal
Func
tion
alNo
n Fu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Card
iac
Mon
itor
Yes
Yes
NoYe
sNo
Yes
Yes
Yes
Yes
Yes
Non
Func
tion
alFu
ncti
onal
Func
tion
alNo
n Fu
ncti
onal
NAFu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Dent
al C
hair
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Non
Func
tion
alFu
ncti
onal
Func
tion
alNo
n Fu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Dosi
met
er
NoNo
NoNo
NoYe
sYe
sNo
NoNo
NANA
NANA
NANo
n Fu
ncti
onal
Func
tion
alNA
NANA
ECG
Yes
Yes
Yes
NoYe
sYe
sYe
sYe
sYe
sYe
s
Func
tion
alFu
ncti
onal
Func
tion
alNA
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Emer
genc
y Re
susc
itat
ion
Kit
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Endo
scop
e (fi
ber
opt
ic)
NoNo
NoNo
NoNo
NoNo
NoNo
NANA
NANA
NANA
NANA
NANA
Opht
halm
osco
pes
Yes
Yes
Yes
Yes
Yes
Yes
NoYe
sYe
sYe
s
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
NAFu
ncti
onal
Func
tion
alFu
ncti
onal
Peri
met
erNo
NoNo
NoNo
Yes
NoNo
NoNo
NANA
NANA
NAFu
ncti
onal
NANA
NANA
Phot
o Th
erap
y Un
itYe
sYe
sYe
sYe
sNo
NoNo
Yes
NoNo
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
NANA
NAFu
ncti
onal
NANA
(Con
td..
.)
172 Study to Review The Health Care Delivery System provided by PHSC, Punjab
Nam
e of
the
Sub
-Div
isio
nal H
ospi
tals
Ajna
laBa
tala
Dasu
yaFa
zilk
aJa
grao
nM
aler
Kot
laM
alou
tN
akod
arPa
tti
Talw
andi
Reti
nosc
ope
NoYe
sYe
sFu
ncti
onal
NoYe
sNo
NoYe
sNo
NAFu
ncti
onal
Func
tion
alFu
ncti
onal
NAFu
ncti
onal
NANA
Func
tion
alNA
Shor
t W
ave
Diat
herm
y (P
hysi
o th
erap
y)
NoNo
NoYe
sNo
NoNo
Yes
NoNo
NANA
NAFu
ncti
onal
NANA
NAFu
ncti
onal
NANA
Sigm
oido
scop
esNo
Yes
NoNo
NoNo
Yes
NoNo
No
NANo
n Fu
ncti
onal
NANA
NANA
Non
Func
tion
alNA
NANA
Slit
lam
pNo
Yes
NoYe
sNo
Yes
NoYe
sYe
sNo
NAFu
ncti
onal
NAFu
ncti
onal
NAFu
ncti
onal
Non
Func
tion
alFu
ncti
onal
Func
tion
alNA
Ult
ra s
ound
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Non
Func
tion
alNA
X ra
yYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
s
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Othe
r M
ajor
and
Min
or
Oper
atio
n eq
uipm
ents
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Study to Review The Health Care Delivery System provided by PHSC, Punjab 173
Tab
le 2
.3 Lab
ora
tory
Facilit
ies A
vailab
le a
t S
ub
-Div
isio
nal H
osp
itals
Labo
rato
ry T
ests
Nam
e of
the
Sub
-Div
isio
nal H
ospi
tals
Ajna
laBa
tala
Dasu
yaFa
zilk
aJa
grao
nM
aler
Kot
laM
alou
tN
akod
arPa
tti
Talw
andi
Com
plet
e Bl
ood
Hae
mog
ram
An
alys
isYe
sNo
Yes
Yes
Yes
Yes
Yes
Yes
NoYe
s
Com
plet
e U
rine
Exa
min
atio
nYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
s
Stoo
l tes
tNo
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Bloo
d ur
eaYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sNo
Yes
Bloo
d su
gar
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
NoYe
s
Live
r fu
ncti
on t
est
NoYe
sYe
sNo
NoYe
sNo
Yes
NoYe
s
Lipi
d pr
ofi le
NoNo
Yes
Yes
NoNo
NoYe
sNo
Yes
PAP
smea
rNo
NoNo
NoNo
NoNo
NoNo
No
FNAC
NoNo
NoYe
sNo
NoNo
NoNo
No
Bloo
d Gr
oupi
ng a
nd
Mat
chin
g te
stYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
s
Biop
sy t
est
NoNo
NoNo
NoNo
NoNo
NoNo
Cult
ure
and
smea
r ex
amin
atio
nNo
NoNo
NoNo
NoNo
Yes
NoNo
Sem
en E
xam
inat
ion
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
NoNo
Vagi
nal d
isch
arge
ex
amin
atio
nNo
NoNo
NoNo
Yes
NoYe
sNo
No
Bone
Mar
row
Exa
min
atio
nNo
Yes
NoNo
NoNo
NoNo
NoNo
VDRL
tes
tYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
s
Othe
r ro
utin
e te
sts.
H
IV/P
regn
ancy
Tes
tYe
sYe
sNo
Yes
Yes
NoYe
sNo
NoYe
s
(Con
td..
.)
174 Study to Review The Health Care Delivery System provided by PHSC, Punjab
Labo
rato
ry T
ests
Nam
e of
the
Sub
-Div
isio
nal H
ospi
tals
Ajna
laBa
tala
Dasu
yaFa
zilk
aJa
grao
nM
aler
Kot
laM
alou
tN
akod
arPa
tti
Talw
andi
Any
Refe
rral
Sys
tem
in p
lace
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Refe
rral
man
ual a
vaila
ble
Yes
Yes
Yes
Yes
Yes
NoNo
Yes
NoNo
Guid
elin
es f
or-
Wha
t to
ref
erYe
sYe
sNo
Yes
Yes
NoNA
Yes
NANo
Guid
elin
es-W
hen
to r
efer
Yes
Yes
NoYe
sYe
sNo
NAYe
sNA
No
Guid
elin
es-
How
to
refe
rYe
sYe
sYe
sYe
sYe
sNo
NAYe
sNA
No
Colo
ur c
oded
ref
erra
l car
ds
avai
labl
eNo
Yes
NoYe
sNo
NoNo
Yes
Yes
Yes
Feed
-bac
k M
echa
nism
ex
isti
ng:
NoYe
sNo
Yes
NoYe
sNo
Yes
NoNo
Tran
spor
t fa
cilit
y pr
ovid
ed:
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Mai
nten
ance
of
reco
rds/
regi
ster
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sNo
Ince
ntiv
e fo
r fo
llow
ing
refe
rral
rou
teNo
NoNo
Yes
NoNo
NoYe
sNo
No
if Y
es w
hat
NANA
NAAm
bula
nce
Prov
ided
NANA
NANo
Wai
ting
For
Pati
ent
NANA
Proc
edur
e fo
llow
ed f
or
refe
rral
:Go
vern
men
t.
Hos
pita
lsGo
vern
men
t.
Hos
pita
lsDi
stt.
H
ospi
tals
Med
ical
Co
llege
Gove
rnm
ent.
H
ospi
tals
Gove
rnm
ent.
H
ospi
tals
Dist
t.
Hos
pita
lsNo
neGo
vern
men
t.
Hos
pita
lsNo
ne
Tie-
up w
ith
othe
r ho
spit
al
(bot
h pu
blic
and
pri
vate
) fo
r di
agno
stic
NoNo
NoYe
sYe
sNo
NoYe
sYe
sYe
s
Hos
pita
l has
a t
ie-u
p w
ith:
None
Med
ical
Co
llege
None
Med
ical
Co
llege
Med
ical
Co
llege
Othe
r Go
vern
men
t.
Hos
pita
ls
None
None
Med
ical
Co
llege
Othe
r Go
vern
men
t.
Hos
pita
ls
Does
the
Hos
pita
l hav
e an
y Ou
trea
ch A
rea
NoNo
NoYe
sYe
sYe
sNo
NoNo
Yes
If Y
es,
wha
t se
rvic
es a
re
prov
ided
NANA
NAEy
e ca
mp,
IE
CM
CH,
Eye
cam
p
Bloo
d Co
ll.
Cam
p,
Eye
cam
p
NANA
NAM
CH (Con
td..
.)
Study to Review The Health Care Delivery System provided by PHSC, Punjab 175
Labo
rato
ry T
ests
Nam
e of
the
Sub
-Div
isio
nal H
ospi
tals
Ajna
laBa
tala
Dasu
yaFa
zilk
aJa
grao
nM
aler
Kot
laM
alou
tN
akod
arPa
tti
Talw
andi
Stat
isti
cal B
ulle
tin
Yes
NoNo
Yes
NoYe
sNo
Yes
NoNo
Mon
thly
NANA
Fort
nigh
tly
NAFo
rtni
ghtl
yNA
Mon
thly
NANA
Avai
labi
lity
of D
hara
msh
ala
NoNo
NoNo
NoNo
NoNo
NoNo
Avai
labi
lity
of r
esid
enti
al
acco
mm
odat
ion
for
the
esse
ntia
l sta
ff
NoYe
sYe
sYe
sNo
Yes
Yes
Yes
Yes
Yes
If a
vaila
ble,
Wha
t %
is n
ot
Gett
ing
Acco
mm
odat
ion
NA00
90%
25%
NA70
%25
%`2
5%50
%65
%
Secu
rity
Arr
ange
men
t:No
NAIn
hou
seIn
hou
seNo
In h
ouse
NoNo
In h
ouse
No
176 Study to Review The Health Care Delivery System provided by PHSC, Punjab
Tab
le 2.4
O
ut
Pati
en
t D
ep
art
men
t at
Su
b-D
ivis
ion
al H
osp
itals
Out
Pati
ent
Depa
rtm
ent
Nam
e of
the
Sub
-Div
isio
nal H
ospi
tals
Ajna
laBa
tala
Dasu
yaFa
zilk
aJa
grao
nM
aler
Kot
laM
alou
tN
akod
arPa
tti
Talw
andi
Rece
ptio
n &
Reg
istr
atio
n Co
unte
rM
anua
lCo
mpu
teri
sed
Com
pute
rise
dM
anua
lM
anua
lCo
mpu
teri
sed
Com
pute
rise
dM
anua
lM
anua
lM
anua
l
Man
aged
by
cler
kNo
NoNo
Yes
Yes
Yes
NoNo
Yes
No
Man
aged
by
MSW
Yes
NoNo
Yes
Yes
NoNo
NoNo
No
Man
aged
by
staf
f nu
rse
NoNo
NoNo
NoNo
NoNo
NoNo
Man
aged
by
com
pute
r op
erat
orNo
Yes
Yes
NoNo
Yes
Yes
Yes
NoNo
Know
ledg
eabl
e ab
out
the
OPD
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Sepa
rate
reg
istr
atio
n fo
r m
ale
Yes
Yes
NoNo
NoYe
sNo
NoNo
No
Sepa
rate
reg
istr
atio
n fo
r fe
mal
eYe
sYe
sNo
NoNo
Yes
NoNo
NoNo
Sepa
rate
reg
istr
atio
n fo
r se
nior
cit
izen
sYe
sYe
sYe
sNo
NoYe
sNo
NoNo
No
Sepa
rate
reg
istr
atio
n fo
r st
aff
Yes
Yes
NoNo
NoYe
sNo
NoNo
No
regi
stra
tion
reg
iste
rs a
re p
rope
rly
mai
ntai
ned
Yes
Yes
Yes
Yes
Yes
Yes
NoYe
sYe
sYe
s
All s
ecti
ons
of t
he O
PD h
avin
g pr
oper
si
gnag
e an
d di
rect
iona
l sig
nNo
Yes
Yes
Yes
Yes
NoYe
sYe
sYe
sYe
s
Wai
ting
are
a is
ade
quat
eYe
sNo
Yes
Yes
Yes
Yes
NoNo
Yes
No
Prop
er s
itti
ng a
rran
gem
ent
Yes
NoYe
sYe
sYe
sYe
sNo
NoNo
No
Drin
king
wat
er f
acili
tyYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
s
Ceili
ng F
ans
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Toile
t fa
cilit
yYe
sYe
sYe
sYe
sYe
sYe
sYe
sNo
Yes
Yes
Doct
or’s
Cham
bers
are
hav
ing
adeq
uate
sp
ace
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Exam
inat
ion
tabl
e w
ith
prop
er s
heet
Yes
Yes
Yes
Yes
NoYe
sYe
sYe
sYe
sYe
s
Stoo
l for
the
pat
ient
to
sit
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Exam
inat
ion
equi
pmen
ts (
like
BP
appa
ratu
s To
rch,
ham
mer
, et
c.)
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
(Con
td..
.)
Study to Review The Health Care Delivery System provided by PHSC, Punjab 177
Out
Pati
ent
Depa
rtm
ent
Nam
e of
the
Sub
-Div
isio
nal H
ospi
tals
Ajna
laBa
tala
Dasu
yaFa
zilk
aJa
grao
nM
aler
Kot
laM
alou
tN
akod
arPa
tti
Talw
andi
Adeq
uate
Illu
min
atio
nYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
s
Inje
ctio
n Ro
om a
long
wit
h fa
cilit
ies
and
to d
eal w
ith
Emer
genc
y si
tuat
ion
Yes
Yes
Yes
Yes
Yes
NoYe
sYe
sNo
Yes
Min
or O
T/ D
ress
ing
Room
wit
h al
l the
ba
sic
Equi
pmen
tsYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sNo
No
Disp
ensa
ries/
Pha
rmac
y w
ith
sepa
rate
co
unte
rs f
or m
ale/
fem
ale/
seni
or c
itiz
enNo
Yes
Yes
NoNo
NoYe
sYe
sNo
Yes
Labo
rato
ry &
Im
agin
g Se
rvic
es e
asily
ac
cess
ible
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Cent
ral C
olle
ctio
n Ce
ntre
for
Lab
orat
ory
Serv
ices
Yes
Yes
Yes
Yes
Yes
NoYe
sYe
sYe
sYe
s
178 Study to Review The Health Care Delivery System provided by PHSC, Punjab
Tab
le 2.5
E
merg
en
cy M
ed
ical S
erv
ices (
Casu
alt
y)
at
Su
b-D
ivis
ion
al H
osp
itals
Nam
e of
the
Sub
-Div
isio
nal H
ospi
tals
Ajna
laBa
tala
Dasu
yaFa
zilk
aJa
grao
nM
aler
Kot
laM
alou
tN
akod
arPa
tti
Talw
andi
Sepa
rate
Med
ical
Offi
cer(
s) a
vaila
ble
roun
d th
e cl
ock
Yes
NoYe
sYe
sYe
sYe
sNo
Yes
NoYe
s
Boar
d di
spla
ying
on
call
doct
ors/
spec
ialis
t an
d ot
her
staf
f on
dut
yYe
sYe
sYe
sYe
sYe
sNo
Yes
Yes
Yes
No
Glow
sig
n bo
ard
indi
cati
ng
‘Em
erge
ncy
Serv
ices
Dep
artm
ent’
NoYe
sYe
sYe
sYe
sNo
NoYe
sNo
No
Emer
genc
y W
ard
atta
ched
to
Emer
genc
y De
part
men
tNo
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Tria
ge a
rea
Yes
NoYe
sYe
sYe
sNo
Yes
Yes
NoNo
Obse
rvat
ion
Beds
(fi l
l num
ber,
for
No
fi ll 0
0)02
0412
0403
0407
0501
06
Trol
leys
(fi l
l num
ber,
for
No fi
ll 00
)4
22
41
24
21
1
Whe
el c
hair
s (fi
ll n
umbe
r, fo
r No
fi ll
00)
0401
0203
0103
0202
0001
Exam
inat
ion
room
s (fi
ll n
umbe
r, fo
r No
fi ll
00)
0101
0102
0101
0101
0102
All t
he R
egis
ters
incl
udin
g M
LR
avai
labl
e fo
r Pr
oper
Reg
.Ye
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
s
Reti
ring
roo
m w
ith
toile
ts f
or t
he
doct
ors
Yes
Yes
Yes
Yes
Yes
Yes
NoYe
sYe
sYe
s
Call
book
in p
resc
ribe
d fo
rmat
av
aila
ble
NoYe
sYe
sNo
Yes
NoNo
Yes
NoNo
Wai
ting
are
a fo
r th
e at
tend
ants
of
the
pati
ents
wit
h th
e ba
sic
Faci
litie
s lik
e si
ttin
g ar
rang
emen
ts,
drin
king
w
ater
, to
ilet
etc.
Yes
NoYe
sYe
sYe
sYe
sYe
sYe
sNo
No
Publ
ic t
elep
hone
ava
ilabl
eNo
Yes
NoYe
sNo
NoNo
NoNo
No
Trea
tmen
t ro
om-c
um-m
inor
OT
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
(Con
td..
.)
Study to Review The Health Care Delivery System provided by PHSC, Punjab 179
Nam
e of
the
Sub
-Div
isio
nal H
ospi
tals
Ajna
laBa
tala
Dasu
yaFa
zilk
aJa
grao
nM
aler
Kot
laM
alou
tN
akod
arPa
tti
Talw
andi
Maj
or O
TYe
sNo
NoYe
sNo
Yes
Yes
Yes
NoNo
Suffi
cien
t st
ock
of E
ssen
tial
and
Lif
e Sa
ving
Dru
gsNo
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Oxyg
en C
ylin
ders
wit
h At
tach
men
tsYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
s
Labo
rato
ry S
ervi
ces
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Radi
olog
y Se
rvic
esYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
s
Ambu
lanc
e Se
rvic
esYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
s
Staf
f Tr
aine
d in
BLS
Yes
Yes
Yes
Yes
Yes
Yes
NoYe
sYe
sNo
Trea
tmen
t Fa
cilit
ies
for
Dog/
Snak
e Bi
te &
Poi
soni
ngYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sNo
No
Avai
labi
lity
of D
isas
ter
Man
ual
NoNo
Yes
Yes
NoNo
NoYe
sNo
No
Disa
ster
Ale
rt C
ode,
Rec
all &
De
ploy
men
tNo
NoYe
sYe
sNo
NoYe
sYe
sNo
No
Mai
nten
ance
of
Dedi
cate
d Dr
ug s
tore
fo
r Di
sast
er S
itua
tion
NoYe
sYe
sYe
sYe
sNo
Yes
Yes
NoYe
s
Plas
ter
Room
Yes
Yes
Yes
Yes
NoYe
sNo
Yes
NoNo
180 Study to Review The Health Care Delivery System provided by PHSC, Punjab
Tab
le 2
.6 In
ten
siv
e C
are
Un
it a
t S
ub
-Div
isio
nal H
osp
itals
Nam
e of
the
Sub
-Div
isio
nal H
ospi
tals
Ajna
laBa
tala
Dasu
yaFa
zilk
aJa
grao
nM
aler
Kot
laM
alou
tN
akod
arPa
tti
Talw
andi
Ava
ilabi
lity
of I
CUYe
sYe
sNo
NoNo
NoNo
NoYe
sYe
s
Tota
l num
ber
of b
eds
avai
labl
e:02
05NA
NANA
NANA
NA04
06
Air-
cond
itio
ned
ICU
wit
h Ge
nera
tor
Supp
ort
NoNo
NANA
NANA
NANA
NoNo
Staf
f sa
ncti
oned
for
the
ICU
- no
. of
Do
ctor
s01
00NA
NANA
NANA
NA00
00
Staf
f sa
ncti
oned
for
the
ICU
- no
. of
Nu
rses
0100
NANA
NANA
NANA
0000
Staf
f Sa
ncti
oned
for
the
ICU
- no
. of
Te
chni
cal S
taff
0100
NANA
NANA
NANA
0000
Staf
f sa
ncti
oned
for
the
ICU
- no
. of
Cl
ass
IV01
00NA
NANA
NANA
NA00
00
Reco
rd K
eepi
ng o
f th
e Pa
tien
tsYe
sNo
NANA
NANA
NANA
No00
Avai
labi
lity
of o
xyge
n/ s
ucti
on
appa
ratu
s/ c
ompr
esse
d ai
rYe
sYe
sNA
NANA
NANA
NANo
Yes
Defi b
rilla
tor
NoNo
NANA
NANA
NANA
NoNo
ECG
mac
hine
NoYe
sNA
NANA
NANA
NANo
No
Vent
ilato
rNo
NoNA
NANA
NANA
NANo
No
All t
he li
fe s
avin
g Vi
tal d
rugs
NoYe
sNA
NANA
NANA
NANo
Yes
Stric
t as
epti
c pr
oced
ures
are
fol
low
edNo
Yes
NANA
NANA
NANA
NoNo
Study to Review The Health Care Delivery System provided by PHSC, Punjab 181
Tab
le 2.7
C
lin
ical Lab
ora
tori
es a
t S
ub
-Div
isio
nal H
osp
itals
Clin
ical
Lab
orat
orie
sN
ame
of t
he S
ub-D
ivis
iona
l Hos
pita
ls
Ajna
laBa
tala
Dasu
yaFa
zilk
aJa
grao
nM
aler
Kot
laM
alou
tN
akod
arPa
tti
Talw
andi
Type
of
Labo
rato
ries-
Pat
holo
gyYe
sYe
sNo
Yes
NoNo
NoYe
sNo
Yes
Type
of
Labo
rato
ries-
Mic
robi
olog
yYe
sNo
NoNo
Yes
Yes
NoYe
sNo
Yes
Qual
ifi ed
- Pa
thol
ogis
tNo
Yes
NoYe
sNo
NoNo
Yes
NoNo
Qual
ifi ed
- Bi
oche
mis
tNo
NoNo
NoNo
NoNo
NoNo
No
Qual
ifi ed
- M
icro
Bio
logi
stNo
NoNo
NoNo
NoNo
Yes
NoNo
Follo
win
g th
e Un
iver
sal P
reca
utio
n Pr
oced
ures
NoYe
sYe
sYe
sNo
Yes
NoYe
sYe
sNo
Usin
g Pr
otec
tive
Mea
sure
s i.e
. gl
oves
/go
wns
/mas
ksYe
sNo
Yes
Yes
NoYe
sNo
Yes
Yes
No
Spec
imen
Col
lect
ion
done
Cen
tral
lyYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
s
Avai
labi
lity
of a
ll th
e Ch
emic
als
and
Reag
ents
NoYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
s
Obse
rvin
g al
l the
bio
-saf
ety
mea
sure
sNo
Yes
Yes
Yes
Yes
NoYe
sYe
sYe
sYe
s
Accu
racy
of
Repo
rts
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
NoYe
s
Regu
lar
Inte
rnal
Qua
lity
Cont
rol
Mea
sure
s Un
dert
aken
NoYe
sYe
sYe
sNo
Yes
NoYe
sNo
No
Regu
lar
Exte
rnal
Qua
lity
Cont
rol
Mea
sure
s Un
dert
aken
NoYe
sYe
sNo
Yes
Yes
Yes
Yes
NoYe
s
182 Study to Review The Health Care Delivery System provided by PHSC, Punjab
Tab
le 2.8
B
loo
d B
an
kin
g F
acilit
ies
Nam
e of
the
Sub
-Div
isio
nal H
ospi
tals
Ajna
laBa
tala
Dasu
yaFa
zilk
aJa
grao
nM
aler
Kot
laM
alou
tN
akod
arPa
tti
Talw
andi
BLOO
D BA
NK (
If N
o bl
ood
bank
fi ll
“8”
for
sect
ion
E)No
Yes
Yes
Yes
NAYe
sNA
Yes
Yes
Trai
ned
or q
ualifi
ed
med
ical
offi
cer
post
ed a
s B.
T.O.
NAYe
sYe
sYe
sNA
NoNA
Yes
NoNA
Roun
d th
e cl
ock
avai
labi
lity
of t
rain
ed
staf
f an
d se
rvic
esNA
Yes
Yes
Yes
NANo
NAYe
sYe
sNA
Chec
king
& c
ross
mat
chin
g by
B.T
.O.
NAYe
sYe
sYe
sNA
Yes
NAYe
sYe
sNA
Prop
er m
aint
enan
ce o
f co
ld c
hain
and
re
frig
erat
ors
NAYe
sYe
sYe
sNA
Yes
NAYe
sYe
sNA
Aust
ralia
ant
igen
, H
CV,
VDRL
, M
.P.
and
HIV
tes
ts d
one
for
Ever
y bl
ood
bott
le o
f do
nor.
NAYe
sYe
sYe
sNA
Yes
NAYe
sYe
sNA
Effo
rts
mad
e to
col
lect
blo
od t
hrou
gh
Volu
ntar
y Or
gani
sati
on C
amps
NAYe
sYe
sYe
sNA
NoNA
Yes
Yes
NA
Rene
wal
of
bloo
d ba
nk/H
IV L
icen
se a
s pe
r Ru
les
NAYe
sYe
sYe
sNA
Yes
NAYe
sYe
sNA
Disp
osal
of
HIV
Pos
itiv
e Bl
ood
Bags
&
bio-
safe
ty m
easu
res
unde
rtak
enNA
Yes
Yes
Yes
NAYe
sNA
Yes
Yes
NA
Avai
labi
lity
of T
able
Top
Syr
inge
&
need
le d
estr
oyer
and
Col
our
Code
d Ba
gsNA
Yes
Yes
Yes
NAYe
sNA
Yes
Yes
NA
Feed
back
of
Tran
sfus
ion,
and
Rec
ord
mai
nten
ance
of
unto
war
d in
cide
nces
NAYe
sYe
sNo
NAYe
sNA
Yes
NoNA
Study to Review The Health Care Delivery System provided by PHSC, Punjab 183
Tab
le 2.9
R
ad
iolo
gy a
nd
Im
ag
ing
Serv
ices a
t S
ub
-Div
isio
nal H
osp
itals
Nam
e of
the
Sub
-Div
isio
nal H
ospi
tals
Ajna
laBa
tala
Dasu
yaFa
zilk
aJa
grao
nM
aler
Kot
laM
alou
tN
akod
arPa
tti
Talw
andi
Rad
iolo
gist
ava
ilabl
eNo
NoNo
NoYe
sNo
NoYe
sNo
No
X-ra
y M
achi
nes
Mob
ile C
-arm
- To
tal N
o.
Avai
labl
e0
01
11
00
11
0
X-ra
y M
achi
nes
Mob
ile C
-arm
Wor
king
Co
ndit
ion
00
01
10
01
10
X-ra
y M
achi
nes
Mob
ile C
-arm
Und
er
Repa
irs
00
00
00
00
00
X-ra
y M
achi
nes
Mob
ile C
-arm
Pen
ding
for
Co
ndem
nati
on0
00
00
00
00
0
X-ra
y M
achi
nes
500/
300
mA
Tota
l No.
Av
aila
ble
11
21
12
11
01
X-ra
y M
achi
nes
500/
300
mA
Wor
king
10
01
12
11
01
X-ra
y M
achi
nes
500/
300
mA
Unde
r Re
pair
s0
00
00
00
00
0
X-ra
y M
achi
nes
500/
300
mA
Pe
ndin
g fo
r Co
ndem
nati
on0
00
00
00
00
0
X-ra
y M
achi
nes
200/
100
mA
Tota
l No.
Av
aila
ble
10
01
00
10
12
X-ra
y M
achi
nes
200/
100
mA
Wor
king
Co
ndit
ion
10
01
00
00
02
X-ra
y M
achi
nes
200/
100
mA
Unde
r Re
pair
s0
00
00
00
00
0
X-ra
y M
achi
nes
200
/ 10
0 m
A Pe
ndin
g fo
r Co
ndem
nati
on0
00
00
01
01
0
X-ra
y M
achi
nes
Mob
ile /
60
mA
Tota
l No.
Av
aila
ble
11
01
11
10
00
X-ra
y M
achi
nes
Mob
ile /
60
mA
Wor
king
Co
ndit
ion
11
01
11
10
00
(Con
td..
.)
184 Study to Review The Health Care Delivery System provided by PHSC, Punjab
Nam
e of
the
Sub
-Div
isio
nal H
ospi
tals
Ajna
laBa
tala
Dasu
yaFa
zilk
aJa
grao
nM
aler
Kot
laM
alou
tN
akod
arPa
tti
Talw
andi
X-ra
y M
achi
nes
Mob
ile /
60
mA
Unde
r Re
pair
s0
00
00
00
00
0
X-ra
y M
achi
nes
Mob
ile /
60
mA
Pend
ing
for
Cond
emna
tion
00
00
00
00
00
Avai
labi
lity
of t
he d
ark
room
wit
h al
l fa
cilit
ies
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Use
of d
osim
eter
and
the
y re
gula
rly s
ent
to B
ARC
NoNo
NoNo
NoYe
sYe
sNo
NoNo
Spec
ial i
nves
tiga
tion
s lik
e IV
P, c
ontr
ast
med
ia e
tc.
NoNo
Yes
Yes
Yes
Yes
NoNo
NoNo
Roun
d th
e cl
ock
avai
labi
lity
of X
-ray
se
rvic
es/S
onog
raph
yNo
Yes
NoYe
sYe
sNo
Yes
Yes
NoYe
s
Sepa
rate
reg
iste
r fo
r M
LC r
ecor
dsYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
s
Study to Review The Health Care Delivery System provided by PHSC, Punjab 185
Tab
le 2.1
0 O
pera
tio
n T
heatr
es A
t S
ub
-Div
isio
nal H
osp
itals
Nam
e of
the
Sub
-Div
isio
nal H
ospi
tals
Ajna
laBa
tala
Dasu
yaFa
zilk
aJa
grao
nM
aler
Kot
laM
alou
tN
akod
arPa
tti
Talw
andi
No.
of O
pera
tion
Th
eatr
esM
ajor
22
31
22
12
12
Min
or1
11
10
11
21
1
Zoni
ng c
once
pts
stric
tly
follo
wed
NoNo
Yes
Yes
Yes
NoYe
sYe
sNo
Yes
Boyles Apparatus
Tota
l No.
Ava
ilabl
e1
23
21
11
21
1
Unde
r Re
pair
00
01
00
10
00
Pend
ing
for
Cond
emna
tion
10
00
00
00
00
Hydraulic Operation
Table
Tota
l No.
Ava
ilabl
e2
42
12
22
22
3
Unde
r Re
pair
s0
20
00
12
00
0
Pend
ing
for
Cond
emna
tion
00
00
00
10
00
Shadow less lamp
Tota
l No.
Ava
ilabl
e1
23
22
21
42
2
Unde
r Re
pair
s0
00
10
10
00
0
Pend
ing
for
Cond
emna
tion
00
00
00
00
00
Fumigation apparatus
Tota
l No.
Ava
ilabl
e1
01
12
10
00
1
Unde
r Re
pair
s0
NA0
01
00
00
0
Pend
ing
for
Cond
emna
tion
0NA
00
00
00
00
Suction Apparatus
Tota
l No.
Ava
ilabl
e3
22
23
21
62
3
Unde
r Re
pair
s0
00
00
00
01
0
Pend
ing
for
Cond
emna
tion
00
00
00
00
00
Air conditioner
Tota
l No.
Ava
ilabl
e2
26
13
12
32
3
Unde
r Re
pair
s0
00
00
00
00
0
Pend
ing
for
Cond
emna
tion
00
00
00
00
00
(Con
td..
.)
186 Study to Review The Health Care Delivery System provided by PHSC, Punjab
Nam
e of
the
Sub
-Div
isio
nal H
ospi
tals
Ajna
laBa
tala
Dasu
yaFa
zilk
aJa
grao
nM
aler
Kot
laM
alou
tN
akod
arPa
tti
Talw
andi
Electric cautery
Tota
l No.
Ava
ilabl
e1
11
12
11
11
1
Unde
r Re
pair
s1
10
01
00
00
0
Pend
ing
for
Cond
emna
tion
00
00
00
00
00
Endoscope
Tota
l No.
Ava
ilabl
e0
00
10
00
00
0
Unde
r Re
pair
s0
00
00
00
00
0
Pend
ing
for
Cond
emna
tion
00
00
00
00
00
Laparo-scope
Tota
l No.
Ava
ilabl
e0
11
10
10
10
0
Unde
r Re
pair
s0
00
00
00
00
0
Pend
ing
for
Cond
emna
tion
00
00
00
00
00
Cardiac monitor
Tota
l No.
Ava
ilabl
e0
10
11
11
00
1
Unde
r Re
pair
s1
00
00
00
00
0
Pend
ing
for
Cond
emna
tion
00
00
00
00
00
Cardiac defi brillators
Tota
l No.
Ava
ilabl
e1
00
00
00
10
0
Unde
r Re
pair
s0
00
00
00
00
0
Pend
ing
for
Cond
emna
tion
00
00
00
00
00
Pulse oxymeter
Tota
l No.
Ava
ilabl
e1
22
11
01
10
1
Unde
r Re
pair
s0
10
01
00
00
0
Pend
ing
for
Cond
emna
tion
00
00
00
00
00
Portable mobile x ray
machine
Tota
l No.
Ava
ilabl
e1
01
11
30
10
0
Unde
r Re
pair
s0
00
00
00
00
0
Pend
ing
for
Cond
emna
tion
00
00
00
00
00
(Con
td..
.)
Study to Review The Health Care Delivery System provided by PHSC, Punjab 187
Nam
e of
the
Sub
-Div
isio
nal H
ospi
tals
Ajna
laBa
tala
Dasu
yaFa
zilk
aJa
grao
nM
aler
Kot
laM
alou
tN
akod
arPa
tti
Talw
andi
Up-
to-d
ate
mai
nten
ance
of
O.T.
rec
ords
lik
e O.
T. r
egis
ters
, em
erge
ncy
O.T.
, M
onth
ly a
bstr
act
disc
iplin
e w
ise,
m
ajor
/min
or e
tc
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Mai
nten
ance
of
oper
atio
n po
stpo
nem
ent
regi
ster
NoYe
sNo
Yes
NoNo
NoNo
NoNo
Emer
genc
y lig
ht o
r ge
nera
tor
faci
litie
s pr
ovid
ed t
o O.
T.Ye
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
s
Avai
labi
lity
of fi
re fi
ghti
ng e
quip
men
ts
and
know
ledg
e to
use
the
mNo
NoYe
sYe
sYe
sYe
sNo
NoYe
sNo
Regu
lar
disi
nfec
tion
s &
ste
rilis
atio
n pr
oced
ures
don
e at
O.T
.Ye
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
s
188 Study to Review The Health Care Delivery System provided by PHSC, Punjab
Tab
le 2
.11
In
Pati
en
t W
ard
s a
t S
ub
-Div
isio
nal H
osp
itals
Nam
e of
the
Sub
-Div
isio
nal H
ospi
tals
Ajna
laBa
tala
Dasu
yaFa
zilk
aJa
grao
nM
aler
Kot
laM
alou
tN
akod
arPa
tti
Talw
andi
Sati
sfac
tory
cle
anlin
ess
of t
he w
ards
wit
h ad
equa
te h
ouse
kee
ping
Yes
NoYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
s
Colo
ur c
odes
of
Yello
w, B
lue,
Red
, W
hite
bi
n &
Blu
e tr
ansp
aren
t PP
F fo
r w
aste
co
llect
ion
Yes
NoYe
sYe
sYe
sYe
sYe
sYe
sYe
sNo
Tabl
e to
p sy
ring
e &
nee
dle
dest
roye
rYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sNo
Prop
er u
tilis
atio
nNo
NoYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
s
Adeq
uate
wat
er s
uppl
y an
d up
kee
p of
sa
nita
ry b
lock
s.Ye
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sNo
Adeq
uate
& c
lean
Toi
lets
and
Bat
hroo
ms
Yes
NoYe
sYe
sYe
sYe
sYe
sYe
sYe
sNo
All t
he b
eds
are
havi
ng p
rope
r &
ade
quat
e lin
enYe
sNo
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Floo
r be
ds/d
oubl
ing
of b
eds
in t
he w
ards
NoNo
NoNo
NoNo
NoNo
NoNo
if Y
es,
anal
yse
the
reas
onNA
NANA
NANA
NANA
NANA
NA
Sati
sfac
tory
up
keep
of
cots
, m
attr
esse
s,
beds
ide
lock
ers,
line
nYe
sNo
Yes
Yes
Yes
Yes
NoYe
sYe
sYe
s
Use
of h
ospi
tal u
nifo
rms
by a
ll pa
tien
tsNo
NoNo
NoYe
sNo
NoNo
NoNo
Avai
labi
lity
and
func
tion
ing
of s
ucti
on
appa
ratu
s (
elec
tric
& f
oot
oper
ated
)Av
aila
ble
Avai
labl
eAv
aila
ble
Avai
labl
eAv
aila
ble
Avai
labl
eNo
t Av
aila
ble
Avai
labl
eAv
aila
ble
Avai
labl
e
If A
vaila
ble
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Not
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Avai
labi
lity
and
func
tion
ing
of o
ygen
cy
linde
r w
ith
acce
ssor
ies
Avai
labl
eAv
aila
ble
Avai
labl
eAv
aila
ble
Avai
labl
eAv
aila
ble
Avai
labl
eAv
aila
ble
Avai
labl
eAv
aila
ble
If a
vaila
ble
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Avai
labi
lity
and
func
tion
ing
of
vene
sect
ion
tray
, LP
, tr
ache
osto
my
tray
.Av
aila
ble
Avai
labl
eAv
aila
ble
Avai
labl
eAv
aila
ble
Avai
labl
eNo
t Av
aila
ble
Avai
labl
eNo
t Av
aila
ble
Not
Avai
labl
e
If a
vaila
ble
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
NAFu
ncti
onal
NANA
(Con
td..
.)
Study to Review The Health Care Delivery System provided by PHSC, Punjab 189
Nam
e of
the
Sub
-Div
isio
nal H
ospi
tals
Ajna
laBa
tala
Dasu
yaFa
zilk
aJa
grao
nM
aler
Kot
laM
alou
tN
akod
arPa
tti
Talw
andi
Avai
labi
lity
and
func
tion
ing
of e
mer
genc
y lig
ht,
whe
el c
hair,
tro
lley
Avai
labl
eNo
t Av
aila
ble
Avai
labl
eAv
aila
ble
Avai
labl
eAv
aila
ble
Avai
labl
eAv
aila
ble
Not
Avai
labl
eAv
aila
ble
If a
vaila
ble
Func
tion
alNA
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
NAFu
ncti
onal
Stat
ione
ries,
for
ms,
upt
o da
te v
ario
us
regi
ster
s et
c.Ye
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
s
Conc
ept
of p
rogr
essi
ve p
atie
nt c
are
NoYe
sYe
sYe
sNo
Yes
Yes
Yes
Yes
Yes
Adeq
uacy
and
wor
king
of
fans
and
ligh
tsYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
s
Sati
sfac
tory
ava
ilabi
lity
of d
iet,
NANA
NoNo
NoNo
Yes
NoNo
No
Qual
ity
of c
are
Yes
Yes
Yes
Yes
Yes
NoYe
sYe
sNo
Yes
Mai
nten
ance
of
vario
us r
egis
ters
, re
cord
s,
etc.
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
190 Study to Review The Health Care Delivery System provided by PHSC, Punjab
Tab
le 2.1
2 H
osp
ital M
ed
ical S
tore
s a
t S
ub
-Div
isio
nal H
osp
itals N
ame
of t
he S
ub-D
ivis
iona
l Hos
pita
ls
Ajna
laBa
tala
Dasu
yaFa
zilk
aJa
grao
nM
aler
Kot
laM
alou
tN
akod
arPa
tti
Talw
andi
Med
ical
sto
re s
uita
bly
loca
ted
wit
h ad
equa
te s
pace
and
pro
tect
ion
of d
rugs
an
d no
n-dr
ugs
item
s fr
om p
ilfer
age,
te
mpe
ratu
re,
hum
idit
y
NoNo
Yes
Yes
Yes
NoNo
Yes
NoNo
Rest
ricti
on o
n en
try
for
unau
thor
ised
pe
rson
nel’s
Yes
Yes
Yes
Yes
Yes
NoYe
sYe
sNo
Yes
Staf
f kn
owle
dgea
ble
in m
ater
ials
m
anag
emen
tNo
NoYe
sYe
sYe
sYe
sYe
sYe
sYe
sNo
Insp
ecti
on o
f st
ores
by
the
Civi
l Sur
geon
/ M
.O.
I/c
at r
egul
ar in
terv
al t
o ve
rify
sto
ck
book
s
Yes
Yes
Yes
Yes
Yes
NoYe
sYe
sYe
sYe
s
Avai
labi
lity
of V
ital
, es
sent
ial d
rugs
in
suffi
cien
t Qu
anti
tyNo
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Upk
eep
of e
xpir
y da
te r
egis
ter
and
its
regu
lar
insp
ecti
on b
y M
O I/
cNo
Yes
NoYe
sYe
sNo
Yes
Yes
NoYe
s
Effo
rts
mad
e to
red
istr
ibut
e la
rge
stoc
k of
sl
ow m
ovin
g dr
ugs
or n
ear
expi
ry f
or it
s ut
ilisa
tion
.
NoYe
sYe
sNo
Yes
Yes
Yes
Yes
Yes
Prop
er a
rran
gem
ents
to
keep
the
dru
gs
as p
er A
BC/V
ED c
ateg
ory
and
stor
age
of
rubb
er g
oods
as
per
guid
elin
es
NoNo
Yes
Yes
Yes
NoNo
Yes
NoNo
Appr
opria
te s
teps
tak
en t
o pr
even
t pi
lfera
ge o
fNo
Yes
Yes
NoYe
sNo
Yes
Yes
NoYe
s
A co
nven
ient
arr
ange
men
t of
issu
ing
drug
s to
var
ious
NoYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
s
Regu
lar
send
ing
of s
ampl
es t
o ch
emic
al
labo
rato
ry t
o ch
eck
it a
s pe
r sp
ecifi
cati
on
and
stan
dard
& a
ctio
n ta
ken
ther
eon
NoYe
sYe
sYe
sNo
Yes
Yes
Yes
NoNo
(Con
td..
.)
Study to Review The Health Care Delivery System provided by PHSC, Punjab 191
Nam
e of
the
Sub
-Div
isio
nal H
ospi
tals
Ajna
laBa
tala
Dasu
yaFa
zilk
aJa
grao
nM
aler
Kot
laM
alou
tN
akod
arPa
tti
Talw
andi
Circ
ulat
ion
of li
sts
of a
vaila
ble
drug
s to
al
l the
MOs
, OP
D& w
ards
as
per
gene
ric
nam
es
Yes
Yes
Yes
Yes
Yes
NoYe
sYe
sYe
sYe
s
Subm
issi
on o
f ce
rtifi
ed b
ills
to o
ffi ce
for
re
leas
e of
pay
men
ts w
ithi
n th
ree
days
.Ye
sYe
sYe
sYe
sNo
Yes
Yes
Yes
Yes
Yes
Auct
ion
to c
lear
the
em
pty
mat
eria
l fro
m
stor
e do
ne r
egul
arly
.No
NoYe
sYe
sNo
Yes
NoYe
sYe
sNo
Avai
labi
lity
of F
ire F
ight
ing
equi
pmen
ts
and
know
ledg
e of
sta
ff t
o op
erat
e it
NoNo
Yes
NoYe
sYe
sYe
sNo
Yes
No
Avai
labi
lity
of r
egul
arly
upd
ated
Hos
pita
l Dr
ug F
orm
ular
yNo
NoYe
sYe
sYe
sNo
Yes
Yes
NoNo
Exis
tenc
e of
sta
ndin
g Dr
ug C
omm
itte
eNo
Yes
Yes
NoYe
sNo
NoYe
sYe
sNo
192 Study to Review The Health Care Delivery System provided by PHSC, Punjab
Tab
le 2.1
3 M
ed
ical R
eco
rds D
ep
art
men
t at
Su
b-D
ivis
ion
al H
osp
itals
Nam
e of
the
Sub
-Div
isio
nal H
ospi
tals
Ajna
laBa
tala
Dasu
yaFa
zilk
aJa
grao
nM
aler
Kot
laM
alou
tN
akod
arPa
tti
Talw
andi
Avai
labi
lity
of m
edic
al r
oom
w
ith
enou
gh n
o. o
f ra
cks
and
cup-
boar
d et
c.
Yes
Yes
Yes
Yes
Yes
NoNo
NoNo
No
Med
ical
rec
ord
Man
ual
Man
ual
Man
ual
Man
ual
Com
pute
rise
dM
anua
lM
anua
lM
anua
lM
anua
lM
anua
l
Is it
man
aged
by
a tr
aine
d m
edic
al r
ecor
d of
fi cer
/ te
chni
cian
or
Yes
Yes
Yes
Yes
Yes
NoYe
sYe
sYe
sYe
s
Case
rec
ord
is m
aint
aine
d as
per
WH
O cl
assi
fi cat
ion
of
dise
ases
(IC
D-X)
NoYe
sYe
sYe
sNo
NoNo
NoNo
No
Regu
lar
subm
issi
on o
f th
e m
orbi
dity
, m
orta
lity
repo
rts
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
NoYe
s
Dura
tion
for
all
the
reco
rds
bein
g m
aint
aine
d (I
n ye
ars)
5 yr
s.9
yrs.
5 yr
s.10
yrs
.No
t Av
aila
ble
6 yr
s.10
yrs
.5
yrs.
Not
Avai
labl
e8
yrs
Is t
he b
acku
p fa
cilit
y av
aila
ble
to s
afeg
uard
the
se r
ecor
dsYe
sNo
Yes
Yes
NoNo
Yes
NoNo
No
Is t
he e
ffec
tive
ret
rieva
l sy
stem
fol
low
ed b
y th
is
hosp
ital
NoNo
Com
pute
rise
dYe
sNo
BLS
In-p
atie
nt
no.
NoNo
Corr
espo
nden
ce
Regu
lar
deat
h au
dit
mee
ting
s he
ld &
min
utes
of
mee
ting
Yes
NoYe
sYe
sYe
sNo
Yes
Yes
NoNo
Med
ical
aud
it d
one
at r
egul
ar
inte
rval
Yes
NoYe
sYe
sYe
sYe
sNo
Yes
NoNo
Are
the
adeq
uate
num
ber
of
bins
and
the
bag
s of
req
uire
dYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sNo
Are
thes
e pl
aced
str
ateg
ical
ly
in a
ll pa
tien
t ca
re a
reas
NoNo
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
(Con
td..
.)
Study to Review The Health Care Delivery System provided by PHSC, Punjab 193
Nam
e of
the
Sub
-Div
isio
nal H
ospi
tals
Ajna
laBa
tala
Dasu
yaFa
zilk
aJa
grao
nM
aler
Kot
laM
alou
tN
akod
arPa
tti
Talw
andi
Segr
egat
ion
of d
iffe
rent
ca
tego
ries
of w
aste
s do
ne a
t th
e
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
Colle
ctio
n of
was
te,
pack
agin
g,
labe
lling
, re
cord
kee
ping
don
e in
sci
enti
fi c
NoYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sNo
Prop
er t
rans
port
atio
n of
the
w
aste
so
colle
cted
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Stor
age
faci
litie
s an
d du
rati
onYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
s
Disp
osal
/ re
cycl
ing
met
hods
for
va
rious
cat
egor
ies
of W
aste
NoYe
sYe
sYe
sNo
Yes
NoYe
sNo
Yes
Avai
labi
lity
of a
utoc
lave
s,
shre
dder
sNo
Yes
Yes
NoYe
sYe
sNo
Yes
Yes
Yes
Whe
ther
was
te d
ispo
sal i
s ou
tsou
rced
Ye
sYe
sYe
sYe
sYe
sNo
NoYe
sYe
sYe
s
194 Study to Review The Health Care Delivery System provided by PHSC, Punjab
Tab
le 2.1
4 C
en
tral S
up
ply
Dep
art
men
t at
Su
b-D
ivis
ion
al H
osp
itals
Nam
e of
the
Sub
-Div
isio
nal H
ospi
tals
Ajna
laBa
tala
Dasu
yaFa
zilk
aJa
grao
nM
aler
Kot
laM
alou
tN
akod
arPa
tti
Talw
andi
Unde
r th
e su
perv
isio
n of
a t
rain
ed
tech
nica
l sta
ff/
seni
or n
ursi
ng
offi c
er
Yes
Yes
Yes
Yes
Yes
NoNo
Yes
Yes
Yes
Hav
ing
all t
he r
equi
red
equi
pmen
ts
& A
utoc
lave
sYe
sYe
sYe
sYe
sYe
sNo
NoYe
sYe
sYe
s
Qual
ity
cont
rol m
easu
res
are
stric
tly
follo
wed
-ph
ysic
alNo
Yes
Yes
Yes
Yes
Yes
NoYe
sYe
sNo
Qual
ity
cont
rol m
easu
res
are
stric
tly
follo
wed
- ch
emic
alNo
Yes
Yes
Yes
Yes
Yes
NoYe
sYe
sNo
Qual
ity
cont
rol m
easu
res
are
stric
tly
follo
wed
- bi
olog
ical
NoYe
sYe
sNo
Yes
Yes
NoYe
sYe
sNo
Laun
dry
Serv
ices
In h
ouse
In h
ouse
In h
ouse
Out
sour
ced
In h
ouse
Out
sour
ced
Out
sour
ced
In h
ouse
Out
sour
ced
Out
sour
ced
Laun
dry
Serv
ices
Conv
enti
onal
Mec
hani
sed
Mec
hani
sed
Conv
enti
onal
Mec
hani
sed
Conv
enti
onal
Mec
hani
sed
Mec
hani
sed
Conv
enti
onal
Conv
enti
onal
Laun
dry
Serv
ices
- st
aff
Not
adeq
uate
Not
adeq
uate
Adeq
uate
Adeq
uate
Not
adeq
uate
Not
adeq
uate
Not
adeq
uate
Not
adeq
uate
Adeq
uate
Adeq
uate
Qual
ity
of w
ash
Aver
age
Aver
age
Good
Good
Good
Aver
age
Good
Aver
age
Aver
age
Aver
age
Qual
ity
of li
nen
Aver
age
Aver
age
Good
Good
Good
Aver
age
Good
Aver
age
Aver
age
Aver
age
Diet
ary
Serv
ices
(If
no
diet
ary
serv
ices
fi ll
“8”)
Ade
quat
e sp
ace
for
kitc
hen
NANA
NANA
NAYe
sNA
NANA
NA
Prop
er &
saf
e ar
rang
emen
t fo
r st
orag
e of
raw
mat
eria
lsNA
NANA
NANA
Yes
NANA
NANA
Mea
sure
s fo
r Pe
st &
Rod
ent
cont
rol
NANA
NANA
NANA
NANA
NANA
Sani
tati
on a
nd h
ygie
ne o
f th
e co
okin
g ar
ea p
rope
rly m
aint
aine
dNA
NANA
NANA
NoNA
NANA
NA
(Con
td..
.)
Study to Review The Health Care Delivery System provided by PHSC, Punjab 195
Nam
e of
the
Sub
-Div
isio
nal H
ospi
tals
Ajna
laBa
tala
Dasu
yaFa
zilk
aJa
grao
nM
aler
Kot
laM
alou
tN
akod
arPa
tti
Talw
andi
Regu
lar
heal
th c
heck
-up
for
food
ha
ndle
rsNA
NANA
NANA
NoNA
NANA
NA
Avai
labi
lity
of m
oder
n co
okin
g eq
uipm
ents
NANA
NANA
NANo
NANA
NANA
Avai
labi
lity
of p
rope
rly m
aint
aine
d re
cord
s &
reg
iste
rsNA
NANA
NANA
NoNA
NANA
NA
Diet
ser
vice
und
er t
he s
uper
visi
on o
f a
qual
ifi ed
Die
tici
anNA
NANA
NANA
NoNA
NANA
NA
196 Study to Review The Health Care Delivery System provided by PHSC, Punjab
Tab
le 2
.15 Fiv
e Y
ears
Perf
orm
an
ce R
ep
ort
of
Su
b-d
ivis
ion
al H
osp
itals
Perf
orm
ance
(Ann
ual)
Nam
e of
the
Sub
-Div
isio
n ho
spit
al
Ajna
laBa
tala
Dasu
yaFa
zilk
aJa
grao
nM
alar
kot
laM
alou
tN
akod
arPa
tti
Talw
andi
OPD
Atte
ndan
ce la
st
5 ye
ars
1st Y
r80
500
8787
783
843
-74
417
1321
4493
452
1078
4613
2857
5589
6
2nd Y
r79
500
1238
5387
245
-83
174
1399
5489
208
NA12
9245
5776
2
3rd Y
r78
300
1189
5190
957
7185
191
738
1458
1688
343
NA12
5296
4387
8
4th Y
r81
000
9488
992
177
7673
411
4972
1566
2282
641
1072
4612
4884
5566
7
5th Y
r 72
000
1106
3393
716
8357
614
0825
1651
3380
273
1538
7712
2326
5705
0
In-p
atie
nt A
dmit
ted
1st Y
r28
1059
3242
97-
3593
6062
1882
3697
4525
1554
2nd Y
r27
2960
6651
23-
4340
7370
2022
-38
7115
63
3rd Y
r29
1560
2556
1039
9746
8084
7724
80-
3620
985
4th Y
r26
7057
2362
6542
2150
1286
3128
0853
1530
0117
28
5th Y
r 27
5063
4876
5348
6752
4092
4228
8245
1327
7119
11
No.
of
Surg
erie
s do
ne
1st Y
r34
1925
7318
90-
3045
1925
931
4196
1939
853
2nd Y
r33
3545
2152
12-
5847
4647
649
-34
3276
6
3rd Y
r38
4048
0382
3377
762
0865
1910
87-
5220
508
4th Y
r38
5341
7674
4224
0460
0210
474
1567
5891
4832
1282
5th Y
r 35
2440
1194
1629
2661
7984
5641
4159
7741
1514
18
No.
of
Emer
genc
ies
1st Y
r14
7042
5725
81-
2956
3991
1627
2083
1303
617
2nd Y
r13
9041
8928
63-
2305
4264
1997
-14
0553
1
3rd Y
r12
2039
8430
72-
3432
4610
2104
-12
4839
2
4th Y
r14
1040
8635
12-
4111
4260
2039
2352
2267
745
5th Y
r 15
2437
7745
22-
4144
4984
2351
2463
1479
943
No.
of
adm
issi
ons
thro
ugh
emer
genc
y
1st Y
r14
7033
8419
90-
1271
2915
1013
1230
1303
405
2nd Y
r13
9029
3822
80-
1540
3582
1271
-14
1047
9
3rd Y
r12
2023
8424
5221
3916
9037
5813
95-
1486
392
4th Y
r14
1026
0726
9623
8019
2535
4912
0316
1813
4973
9
5th Y
r 15
2425
9935
4527
9620
4635
9614
8418
7215
2579
5
(Con
td..
.)
Study to Review The Health Care Delivery System provided by PHSC, Punjab 197
Perf
orm
ance
(Ann
ual)
Nam
e of
the
Sub
-Div
isio
n ho
spit
al
Ajna
laBa
tala
Dasu
yaFa
zilk
aJa
grao
nM
alar
kot
laM
alou
tN
akod
arPa
tti
Talw
andi
No.
of
Med
ico-
lega
l ca
ses
1st Y
rNe
w
Hos
pita
ls85
015
0-
625
-39
0NA
502
NA
2nd Y
rNA
870
154
-88
360
944
4NA
484
234
3rd Y
rNA
880
180
1120
740
635
445
NA48
923
7
4th Y
rNA
902
229
1445
934
790
321
NA47
141
7
5th Y
r NA
900
318
1711
838
-41
726
246
736
3
No.
of
post
-mor
tem
Do
ne
1st Y
rNA
118
150
-12
512
676
8513
70
2nd Y
rNA
126
150
-10
198
89-
141
0
3rd Y
rNA
136
148
137
119
9091
-12
10
4th Y
rNA
178
149
151
129
118
110
210
151
0
5th Y
r NA
159
160
129
169
103
223
108
0
No.
of
norm
al
deliv
erie
s co
nduc
ted
1st Y
r91
244
427
-17
586
-11
104
9
2nd Y
r85
333
516
-14
706
9-
133
7
3rd Y
r77
313
574
198
2779
810
-23
925
4th Y
r82
270
677
9044
848
3914
037
493
5th Y
r 45
214
724
138
141
8819
236
511
7
No.
of
Caes
aria
n do
ne
1st Y
r12
026
115
2-
6256
2752
0
2nd Y
r12
532
128
2-
9911
6-
100
0
3rd Y
r15
246
135
676
9614
7-
265
0
4th Y
r13
728
641
364
6220
750
269
3
5th Y
r 36
230
556
9310
573
344
4
198 Study to Review The Health Care Delivery System provided by PHSC, Punjab
Tab
le 2.1
6 U
tilisati
on
of
user
Ch
arg
es in
dif
fere
nt
Su
b-d
ivis
ion
al H
osp
itals
SDH
Year
sTo
tal I
ncom
e (C
olle
ctio
n)To
tal
Expe
ndit
ure
Deta
iled
Expe
ndit
ure
Rogi
Kal
yan
Sam
iti
Med
icin
eI.
F.P.
Build
ings
Equi
pmen
tER
F A/
cSa
lary
to
Cont
ract
ual
Staf
f
Ajna
la
2002
-03
6278
561
842
3445
015
9042
1500
9950
--
2003
-04
6883
198
998
8621
065
9361
95-
--
2004
-05
1288
8718
6126
1123
6552
071
1734
043
50-
-
2005
-06
6431
062
204
1408
716
1050
50-
-
2006
-07
6714
031
069
765
1545
018
2576
76-
5353
Tota
l 4,
42,3
452,
95,9
941,
04,1
4328
,470
27,0
26-
5.35
3
Bata
la
2003
-04
2856
930
1455
379
7095
5441
2825
6578
3-
2133
89
2004
-05
2501
043
1254
498
7496
4232
3472
4432
3-
1291
08
2005
-06
2564
636
1359
199
7979
7947
256
3816
820
1324
1207
10
2006
-07
2591
846
9858
2175
1368
4557
2622
5669
5786
911
5393
2007
-08
2781
007
1208
331
6356
9751
3302
3079
53-
1157
24
Tota
l 1,
32,9
5,46
262
,63,
228
36,4
4,24
017
,52,
581
6,81
,896
2,59
,193
6,94
,324
Dasu
ya
2003
Jan
to
Dec
1937
123
1906
015
9496
3048
1342
1177
0820
4455
_15
2880
2004
2569
442
2118
990
9992
9951
7145
2399
9113
6185
_22
6370
2005
2724
788
2560
358
1138
910
6248
3925
6041
2104
2914
0035
1841
04
2006
3236
033
3824
239
1019
279
1737
364
2462
7040
0142
2194
1220
1772
2007
3555
379
2944
546
1007
892
8046
2836
1026
2627
5752
4273
1761
77
Tota
l 1,
40,2
2,76
51,
33,5
4,14
851
,15,
010
41,6
5,30
012
,21,
036
12,1
3,96
88,
83,7
209,
41,3
03
Fazi
lka
2003
NANA
NANA
NANA
__
2004
1498
695
2109
466
1331
367
5114
2416
8746
9792
9_
_
2005
1526
801
1643
986
8247
5136
8495
3186
4713
2093
__
2006
-07
1417
432
1184
084
5922
1532
3291
2201
2548
453
__
2007
-08
1713
121
1405
856
6282
6942
3310
2276
5712
6620
__
Tota
l 61
,56,
049
63,4
3,39
233
,76,
602
16,2
6,52
09,
35,1
754,
05,0
95-
-
(Con
td..
.)
Study to Review The Health Care Delivery System provided by PHSC, Punjab 199
SDH
Year
sTo
tal I
ncom
e (C
olle
ctio
n)To
tal
Expe
ndit
ure
Deta
iled
Expe
ndit
ure
Rogi
Kal
yan
Sam
iti
Med
icin
eI.
F.P.
Build
ings
Equi
pmen
tER
F A/
cSa
lary
to
Cont
ract
ual
Staf
f
Jagr
aon
2003
-04
7673
8481
6526
1895
5347
9142
1273
5820
473
--
2004
-05
1280
104
1171
531
5390
2633
2573
1319
2716
8005
--
2005
-06
1526
969
1166
907
4646
1431
8339
1253
4913
0561
1128
4215
202
2006
-07
1586
933
1089
631
3852
5535
4189
1709
9517
9192
1632
2111
520
2007
-08
1949
779
1224
822
5037
0231
9985
1920
5420
9081
1787
44-
Tota
l 71
,11,
169
54,6
9,41
720
,82,
150
18,0
4,22
87,
47,6
837,
07,3
124,
54,8
0726
,722
Mal
ar
Kotl
a
2003
-04
2401
730
1845
039
8612
8149
6054
5865
892
452
_33
6599
2004
-05
2911
828
2913
691
1341
339
7001
8472
985
2339
49_
5652
34
2005
-06
3074
958
2643
327
1290
855
6509
5723
4480
2148
23_
2522
12
2006
-07
3843
699
3096
277
1544
136
8653
8389
337
1876
15_
4098
06
2007
-08
3431
073
3232
796
1894
129
7682
8397
998
2692
02_
2031
84
Tota
l 1,
56,6
3,28
81,
37,3
1,13
069
,31,
740
34,8
0,86
15,
53,4
589,
98,0
41-
17,6
7,03
5
Mal
out
2002
-03
8830
8478
6189
2596
1017
7339
7449
729
124
024
5619
2003
-04
1170
491
9064
1442
7686
1245
3759
033
3252
50
2626
33
2004
-05
1218
956
1045
483
4977
8984
062
6344
368
380
033
1809
2005
-06
1485
141
1543
708
2021
5951
9310
1593
4314
6260
051
6636
2006
-07
1643
569
1194
926
2691
9929
6156
2655
664
820
1611
2437
7071
2007
-08
1785
796
1229
213
3148
7624
6211
5972
197
408
1746
1133
6386
Tota
l 81
,87,
037
67,0
5,93
319
,71,
319
14,4
7,61
54,
42,5
934,
38,5
173,
35,7
3520
,70,
154
Nak
odar
2002
-03
9843
1974
8091
--
--
--
2003
-04
1088
831
1217
550
--
--
--
2004
-05
1564
222
1747
670
--
--
--
2005
-06
1919
253
1658
387
--
--
--
2006
-07
1178
820
9932
77-
--
--
-
2007
-08
Tota
l67
,35,
445
63,6
4,97
5
(Con
td..
.)
200 Study to Review The Health Care Delivery System provided by PHSC, Punjab
SDH
Year
sTo
tal I
ncom
e (C
olle
ctio
n)To
tal
Expe
ndit
ure
Deta
iled
Expe
ndit
ure
Rogi
Kal
yan
Sam
iti
Med
icin
eI.
F.P.
Build
ings
Equi
pmen
tER
F A/
cSa
lary
to
Cont
ract
ual
Staf
f
Patt
i
2003
1447
955
1664
515
6828
5644
0026
1344
1124
0122
_16
7100
2004
1664
189
1821
980
8132
0659
0521
1286
2114
5632
_14
4000
2005
1941
864
4010
536
1020
627
6007
3222
1555
8175
8_
1440
00
2006
1895
881
3840
986
1111
049
5263
8653
579
1179
34_
1361
57
2007
2132
756
2234
989
9271
0839
6859
1342
7564
0747
_13
6000
Tota
l 90
,82,
645
1,35
,73,
006
45,5
4,84
625
,54,
524
6,72
,441
12,2
6,19
3-
7,27
,257
Talw
an D
e Sa
boo
2003
-04
3784
6137
0944
1559
8013
7884
3619
940
881
--
2004
-05
3204
3929
9001
9347
284
821
3511
235
671
-49
925
2005
-06
3927
5140
2239
1393
5510
0269
3114
827
951
9455
9406
1
2006
-07
5641
2252
4283
1566
1312
2462
6741
073
995
1725
786
546
1000
00
2007
-08
4759
7446
5776
1889
3111
5123
6974
151
674
7632
3267
510
0000
Tota
l 21
,31,
747
20,6
2,24
37,
34,3
515,
60,5
592,
39,6
102,
30,1
7234
,344
2,63
,207
2,00
,000
Study to Review The Health Care Delivery System provided by PHSC, Punjab 201
Tab
le 2.1
7 M
ed
ical O
ffi c
ers
in
Po
sit
ion
Nam
e of
Pos
tPo
stAj
nala
Bata
laDa
suya
Fazi
lka
Jagr
aon
Mal
er k
otla
Mal
aout
Nak
odar
Path
iTa
lwan
diTo
tal
Med
icin
e
M.D
.1
22
12
12
23
-16
Dipl
oma
--
--
--
--
--
-
MBB
S-
--
--
--
1-
-1
Surg
ery
M.D
.1
12
12
11
12
113
Dipl
oma
--
--
--
--
--
-
MBB
S-
--
--
--
--
--
OBG
M.D
.1
11
-1
2-
11
19
Dipl
oma
--
--
--
--
--
-
MBB
S-
--
--
--
--
--
Paed
iatr
ics
M.D
.2
-1
-1
--
--
-4
Dipl
oma
-1
-1
--
--
--
2
MBB
S-
--
--
--
--
--
ENT
M.D
.1
11
12
1-
11
-9
Dipl
oma
--
--
--
--
--
-
MBB
S-
--
--
--
--
--
Orth
opae
dics
M.D
.2
11
-1
--
11
-7
Dipl
oma
-1
-1
--
--
--
2
MBB
S-
--
--
--
--
--
Derm
atol
ogis
t
M.D
.1
1-
11
-1
1-
-6
Dipl
oma
--
--
--
--
--
-
MBB
S-
--
--
--
--
--
Psyc
hiat
ry
M.D
.-
--
--
-1
--
-1
Dipl
oma
--
--
--
--
--
-
MBB
S-
--
--
--
--
--
(Con
td..
.)
202 Study to Review The Health Care Delivery System provided by PHSC, Punjab
Nam
e of
Pos
tPo
stAj
nala
Bata
laDa
suya
Fazi
lka
Jagr
aon
Mal
er k
otla
Mal
aout
Nak
odar
Path
iTa
lwan
diTo
tal
Anae
sthe
sia
M.D
.1
11
2-
--
11
-7
Dipl
oma
--
--
--
--
--
-
MBB
S-
--
--
--
--
--
Bloo
d Ba
nk
M.D
.-
1-
--
1-
1-
-3
Dipl
oma
--
--
--
--
--
-
MBB
S-
--
--
--
--
--
Path
olog
y
M.D
.-
--
1-
1-
1-
-3
Dipl
oma
--
--
--
--
--
-
MBB
S-
--
--
--
--
--
Bio-
chem
istr
y
MD/
MSc
--
--
--
--
--
Dipl
oma
--
--
--
--
--
-
MBB
S-
--
--
--
--
--
Mic
robi
olog
y
MD/
MSc
--
--
-1
-1
--
2
Dipl
oma
--
--
--
--
--
-
MBB
S-
--
--
--
--
--
Radi
olog
y
M.D
.-
11
-1
--
--
-3
Dipl
oma
--
--
--
--
--
-
MBB
S-
--
--
-1
--
-1
Dent
alBD
S1
11
11
11
11
110
Dipl
oma
--
--
--
--
--
-
Study to Review The Health Care Delivery System provided by PHSC, Punjab 203
Tab
le 2.1
8 P
resen
t S
taff
Po
sit
ion
of
Su
b-D
ivis
ion
al H
osp
itals
Un
der
PH
SC
Nam
e of
Pos
tPo
stAj
nala
Bata
laDa
suya
Fazi
lka
Jagr
aon
Mal
ar k
otla
Mal
out
Nak
odar
Patt
iTa
lwan
di
SMO
Sanc
tion
11
11
-1
11
11
Vaca
nt-
1-
--
--
--
-
Ad h
ock
--
--
--
--
--
Tota
l in
posi
tion
11
(offi
ce)
11
-1
11
1-
Med
ical
Offi
cer
(G
DMO
& Sp
ecia
lists
)
Sanc
tion
1421
2114
1410
1313
1211
Vaca
nt1
32
31
-6
-1
7
Ad h
ock
--
--
--
--
--
Tota
l in
posi
tion
1318
1911
1310
713
114
Nur
sing
Sta
ff
Sanc
tion
1214
2524
1624
1112
1310
Vaca
nt-
--
7-
23
3-
2
Ad h
ock
-12
(con
t.)
7-
--
--
-
Tota
l10
+2($
)14
1217
1622
+2 (
depu
.)*
89
138
Tech
nici
an
Sanc
tion
43
92
54
23
3-
Vaca
nt-
-1
--
--
--
-
Ad h
ock
--
1-
--
--
--
Tota
l in
posi
tion
2+2(
*)3
82
54
23
3-
Adm
inis
trat
ive
staf
f
Sanc
tion
25
31
27
12
35
Vaca
nt-
--
--
--
--
-
Ad h
ock
--
--
--
--
--
Tota
l in
posi
tion
25
31
27
12
35
Driv
er
Sanc
tion
35
2-
-3
--
22
Vaca
nt-
--
--
--
--
-
Ad h
ock
-3
--
--
2-
--
Tota
l in
posi
tion
2+1(
*)2
2-
-3
--
22
204 Study to Review The Health Care Delivery System provided by PHSC, Punjab
Nam
e of
Pos
tPo
stAj
nala
Bata
laDa
suya
Fazi
lka
Jagr
aon
Mal
ar k
otla
Mal
out
Nak
odar
Patt
iTa
lwan
di
Clas
s IV
Sanc
tion
2332
3030
2847
726
1921
Vaca
nt2
97
73
9-
7-
1
Ad h
ock
--
--
--
--
--
Tota
l in
posi
tion
19+2
(*)
2323
2325
387
1919
20
Othe
rs
Sanc
tion
153
57
--
42
25-
Vaca
nt-
--
--
-1
--
-
Ad h
ock
-1
--
--
--
--
Tota
l in
posi
tion
152
57
--
32
25-
• On
dep
utat
ion
plac
ed in
the
SDH
$ Go
ne d
eput
atio
n in
oth
er p
lace
s/ou
tsid
e SD
H
Study to Review The Health Care Delivery System provided by PHSC, Punjab 205
(Con
td..
.)
Tab
le 3.1
G
en
era
l P
rofi
le &
Facil
ity S
urv
ey o
f C
HC
s U
nd
er
PH
SC
Desc
ript
ion
of f
acili
ties
Nam
e of
the
CH
C
Bada
lFa
tehg
arh
Fero
zsha
hGo
nian
aKa
rtar
pur
Khem
kara
nLo
ngow
alM
achi
war
aM
ahilp
urM
ajit
haM
anaw
ala
Acce
ssib
ility
to
Railw
ay/B
us
Stat
ion
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Wat
er S
uppl
yM
unic
ipal
Bore
wel
lBo
re w
ell
Mun
icip
alBo
re w
ell
Bore
wel
lBo
re w
ell
Bore
wel
lBo
re w
ell
Bore
wel
lBo
re w
ell
Avai
labi
lity
of w
ater
Ad
equa
teAd
equa
teAd
equa
teAd
equa
teAd
equa
teAd
equa
teAd
equa
teAd
equa
teAd
equa
teAd
equa
teIn
adeq
uate
Stor
age
capa
city
of
Wat
er
Supp
lyTh
ree
day
One
day
Thre
e da
yTh
ree
day
Thre
e da
yTw
o da
yTw
o da
yOn
e da
yTw
o da
yOn
e da
yOn
e da
y
Elec
tric
ity
-Ir
regu
lar
Irre
gula
rIr
regu
lar
Irre
gula
rRe
gula
rIr
regu
lar
Irre
gula
rIr
regu
lar
Regu
lar
Regu
lar
Irre
gula
r
Phas
e of
Ele
ctric
ity
Thre
eTh
ree
Doub
leTh
ree
Thre
eTh
ree
Thre
eTh
ree
Thre
eTh
ree
Thre
e
Back
up G
ener
ator
/ U
PSAv
aila
ble
Avai
labl
eAv
aila
ble
Avai
labl
eAv
aila
ble
Avai
labl
eAv
aila
ble
Avai
labl
eAv
aila
ble
Avai
labl
eAv
aila
ble
Avai
labi
lity
of li
ft
Not
avai
labl
eNo
t av
aila
ble
Not
avai
labl
eNo
t av
aila
ble
Not
avai
labl
eNo
t w
orki
ngNo
t av
aila
ble
Not
avai
labl
eNo
t av
aila
ble
Not
avai
labl
eNo
t av
aila
ble
Ram
p fa
cilit
y Av
aila
ble
Avai
labl
eNo
t av
aila
ble
Avai
labl
eAv
aila
ble
Not
avai
labl
eAv
aila
ble
Not
avai
labl
eNo
t av
aila
ble
Avai
labl
eAv
aila
ble
Gene
ral I
mpr
essi
on -
Up
keep
of
gar
den
Aver
age
Aver
age
Good
Not
Appl
icab
leGo
odAv
erag
eAv
erag
eAv
erag
ePo
orAv
erag
eAv
erag
e
Clea
nlin
ess
Good
Aver
age
Good
Aver
age
Good
Aver
age
Good
Good
Aver
age
Good
Aver
age
Sign
pos
ting
Good
Aver
age
Good
Good
Good
Poor
Aver
age
Good
Aver
age
Good
Aver
age
Road
s &
ligh
ting
Good
Aver
age
Good
Good
Good
Aver
age
Good
Good
Good
Poor
Aver
age
Stat
e of
bui
ldin
gGo
odGo
odGo
odGo
odGo
odAv
erag
eGo
odGo
odAv
erag
eGo
odGo
od
Any
publ
ic u
tilit
y se
rvic
e av
aila
ble
in h
ospi
tal
prem
ises
che
mis
tNo
NoNo
NoNo
NoNo
NoNo
NoNo
Sula
bh S
ocha
laya
NoYe
sNo
NoNo
NoYe
sNo
NoYe
sNo
Rest
aura
nts/
can
teen
NoNo
Yes
NoNo
NoNo
NoNo
NoNo
Groc
ery
shop
sNo
NoNo
NoNo
NoNo
NoNo
NoNo
206 Study to Review The Health Care Delivery System provided by PHSC, Punjab
Desc
ript
ion
of f
acili
ties
Nam
e of
the
CH
C
Bada
lFa
tehg
arh
Fero
zsha
hGo
nian
aKa
rtar
pur
Khem
kara
nLo
ngow
alM
achi
war
aM
ahilp
urM
ajit
haM
anaw
ala
Ambu
lanc
e Se
rvic
esAv
aila
ble
Avai
labl
eAv
aila
ble
Avai
labl
eAv
aila
ble
Avai
labl
eAv
aila
ble
Avai
labl
eAv
aila
ble
Avai
labl
eAv
aila
ble
If A
vaila
ble
Part
ially
eq
uipp
edPa
rtia
lly
equi
pped
Fully
eq
uipp
edPa
rtia
llyeq
uipp
edPa
rtia
lly
equi
pped
Part
ially
eq
uipp
edFu
lly
equi
pped
Part
ially
eq
uipp
edPa
rtia
lly
equi
pped
Part
ially
eq
uipp
edPa
rtia
lly
equi
pped
Tota
l No.
of
Vehi
cles
21
41
32
11
31
1
No.
of O
pera
tion
The
atre
s-M
inor
11
10
10
11
01
1
No.
of O
pera
tion
The
atre
s
-Maj
or2
10
21
11
12
11
Inte
nsiv
e Ca
re U
nits
NoNo
NoNo
NoNo
NoNo
NoNo
No
No.
of b
eds
in I
CUNA
NANA
NANA
NANA
NANA
NANA
Emer
genc
y Se
rvic
es
Roun
d th
e cl
ock
Roun
d th
e cl
ock
Roun
d th
e cl
ock
Roun
d th
e cl
ock
Roun
d th
e cl
ock
Roun
d th
e cl
ock
Roun
d th
e cl
ock
Roun
d th
e cl
ock
Roun
d th
e cl
ock
Roun
d th
e cl
ock
Roun
d th
e cl
ock
Dent
al S
ervi
ces
Yes
Yes
NoYe
sYe
sYe
sNo
Yes
Yes
Yes
Yes
Deliv
ery
Serv
ices
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Faci
litie
s fo
r Po
st-m
orte
mNo
NoNo
NoNo
NoNo
NoNo
NoNo
Mor
tuar
y se
rvic
es w
ith
cold
st
orag
e &
oth
er p
rese
rvat
ive
faci
litie
s av
aila
ble
NoNo
NoNo
NoNo
NoNo
NoNo
No
Vario
us m
anag
emen
t co
mm
itte
es,
Drug
for
mul
ary
com
mit
tee
NoNo
NoNo
Yes
NoNo
NoNo
NoNo
Hos
pita
l Ant
ibio
tic
com
mit
tee
NoNo
NoNo
Yes
NoNo
NoNo
NoNo
Hos
pita
l Inf
ecti
on C
ontr
ol
Com
mit
tee
NoNo
NoYe
sNo
Yes
NoNo
NoYe
sNo
Stor
e Pu
rcha
se C
omm
itte
eYe
sYe
sNo
Yes
Yes
Yes
NoYe
sYe
sYe
sNo
Stor
e ve
rifi c
atio
n Co
mm
itte
eYe
sYe
sNo
Yes
Yes
Yes
NoYe
sNo
Yes
Yes
(Con
td..
.)
Study to Review The Health Care Delivery System provided by PHSC, Punjab 207
Desc
ript
ion
of f
acili
ties
Nam
e of
the
CH
C
Bada
lFa
tehg
arh
Fero
zsha
hGo
nian
aKa
rtar
pur
Khem
kara
nLo
ngow
alM
achi
war
aM
ahilp
urM
ajit
haM
anaw
ala
Med
ical
Aud
it/
Deat
h Re
view
Co
mm
itte
eYe
sNo
NoNo
NoYe
sNo
NoNo
NoYe
s
Syst
em o
f Su
pply
of
Drug
it
ems
thro
ugh
Pull
Pull
Pull
Push
Push
Push
Pull
Push
Pull
Pull
&
Push
Push
Is t
he d
rug
form
ular
y av
aila
ble
NoNo
NoNo
Yes
NoYe
sNo
Yes
NoNo
Is b
uffe
r st
ock
mai
ntai
ned
Yes
Yes
NoYe
sYe
sNo
Yes
Yes
Yes
NoNo
Is R
eord
er le
vel m
aint
aine
dNo
NoNo
Yes
Yes
NoNo
Yes
Yes
NoNo
Annu
al m
aint
enan
ce p
roce
dure
fo
r co
stly
Equ
ipm
ents
Yes
NoNo
Yes
NoNo
Yes
Yes
NoYe
sNo
Log
book
/ H
isto
ry s
heet
m
aint
aine
d fo
r th
e Eq
uipm
ents
NoNo
NoYe
sYe
sYe
sYe
sYe
sNo
Yes
No
208 Study to Review The Health Care Delivery System provided by PHSC, Punjab
Tab
le 3.2
E
qu
ipm
en
t availab
le a
t C
HC
s
Desc
ript
ion
of f
acili
ties
Nam
e of
the
CH
C
Bada
lFa
tehg
arh
Fero
zsha
hGo
nian
aKa
rtar
pur
Khem
kara
nLo
ngow
alM
achi
war
aM
ahilp
urM
ajit
haM
anaw
ala
Boyl
es a
ppar
atus
wit
h ci
rcle
ab
sorb
erYe
sYe
sNo
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Func
tion
alFu
ncti
onal
NAFu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
al
Dent
al c
hair
NoYe
sNo
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
NAFu
ncti
onal
NAFu
ncti
onal
Non
Func
tion
alNo
n Fu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
al
Emer
genc
y Re
susc
itat
ion
Kit
NoYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
s
Not
appl
icab
leFu
ncti
onal
Func
tion
alFu
ncti
onal
Non-
func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
al
Opht
halm
osco
pes
NoYe
sYe
sYe
sNo
Yes
Yes
Yes
NoYe
sYe
s
Not
appl
icab
leNo
n -
Func
tion
alFu
ncti
onal
Func
tion
alNA
Func
tion
alFu
ncti
onal
Func
tion
alNA
Func
tion
alFu
ncti
onal
Sigm
oido
scop
esNo
Yes
NoYe
sNo
NoNo
NoNo
Yes
No
NAFu
ncti
onal
NAFu
ncti
onal
Not
appl
icab
leNA
NANA
NAFu
ncti
onal
NA
X-Ra
yYe
sYe
sYe
sNo
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Func
tion
alFu
ncti
onal
Func
tion
alNo
t ap
plic
able
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
al
Othe
r M
ajor
and
Min
or
Oper
atio
n eq
uipm
ents
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
NA
Study to Review The Health Care Delivery System provided by PHSC, Punjab 209
Tab
le 3
.3 Lab
ora
tory
tests
Desc
ript
ion
of f
acili
ties
Nam
e of
the
CH
C
Bada
lFa
tehg
arh
Fero
zsha
hGo
nian
aKa
rtar
pur
Khem
kara
nLo
ngow
alM
achi
war
aM
ahilp
urM
ajit
haM
anaw
ala
Com
plet
e U
rine
Exa
min
atio
nYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
s
Stoo
l Tes
tNo
Yes
Yes
Yes
Yes
NoYe
sYe
sYe
sYe
sYe
s
Spec
ial T
est
Like
:-bl
ood
urea
Yes
NoYe
sYe
sYe
sNo
Yes
Yes
Yes
Yes
Yes
Bloo
d Su
gar
Yes
NoYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
s
Bloo
d Gr
oupi
ng a
nd
Mat
chin
g te
stYe
sYe
sNo
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Man
y ot
her
rout
ine
test
s.Ye
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
s
210 Study to Review The Health Care Delivery System provided by PHSC, Punjab
Tab
le 3
.4
Refe
rral Facilit
ies
Desc
ript
ion
of f
acili
ties
Nam
e of
the
CH
C
Bada
lFa
tehg
arh
Fero
zsha
hGo
nian
aKa
rtar
pur
Khem
kara
nLo
ngow
alM
achi
war
aM
ahilp
urM
ajit
haM
anaw
ala
Any
Refe
rral
Sys
tem
in
plac
eYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sNo
Refe
rral
man
ual a
vaila
ble
NAYe
sYe
sYe
sYe
sNo
Yes
Yes
Yes
Yes
No
Guid
elin
es g
iven
reg
ardi
ng:
Wha
t to
ref
erNo
Yes
Yes
NoYe
sNA
Yes
Yes
Yes
Yes
No
Whe
n to
ref
erNo
Yes
Yes
NoYe
sNA
Yes
Yes
Yes
Yes
No
How
to
refe
rNo
Yes
Yes
NoYe
sNA
Yes
Yes
Yes
Yes
No
Colo
ur c
oded
ref
erra
l car
ds
avai
labl
eNo
Yes
NoYe
sYe
sNA
Yes
NoNo
Yes
No
Feed
-bac
k M
echa
nism
ex
isti
ngNo
NoNo
NoNo
NoYe
sNo
NoNo
No
Tran
spor
t fa
cilit
y pr
ovid
edYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sNo
Mai
nten
ance
of
reco
rds/
regi
ster
sYe
sYe
sYe
sYe
sYe
sNo
Yes
Yes
Yes
Yes
No
Ince
ntiv
e fo
r fo
llow
ing
refe
rral
rou
teNo
NoYe
sNo
Yes
Yes
NoYe
sNo
Yes
No
Proc
edur
e fo
llow
ed f
or
refe
rral
*No
Yes
Yes
Don’
t kn
owDo
n’t
know
Yes
Yes
Yes
Yes
Yes
No
Tie-
up w
ith
othe
r ho
spit
al
(bot
h pu
blic
and
pri
vate
) fo
r di
agno
stic
or
refe
rral
pu
rpos
es
NoNo
NoYe
sYe
sYe
sYe
sYe
sYe
sNo
Yes
Hos
pita
l has
a t
ie-u
p w
ith
NANA
NAOt
her
Pvt.
H
ospi
tals
Med
ical
Co
llege
&
Othe
r Ot
her
Othe
r M
edic
al
Colle
geOt
her
(Con
td..
.)
Study to Review The Health Care Delivery System provided by PHSC, Punjab 211
Desc
ript
ion
of f
acili
ties
Nam
e of
the
CH
C
Bada
lFa
tehg
arh
Fero
zsha
hGo
nian
aKa
rtar
pur
Khem
kara
nLo
ngow
alM
achi
war
aM
ahilp
urM
ajit
haM
anaw
ala
If A
vaila
ble
NANA
NANA
Mon
thly
NAM
onth
lyNA
Fort
nigh
tly
Mon
thly
NA
Does
the
Hos
pita
l hav
e an
y Ou
trea
ch A
rea
Yes
NoNo
Yes
Yes
Yes
Yes
Yes
NoNo
No
If y
es,
wha
t se
rvic
es a
re
prov
ided
MCH
NANA
MCH
MCH
Nat
. he
alth
pr
og.
Hea
lth
Ed.
MCH
MCH
MCH
NANA
NA
Avai
labi
lity
of D
hara
msh
ala
NoNo
NoNo
NoNo
NoNo
NoNo
No
Avai
labi
lity
of r
esid
enti
al
acco
mm
odat
ion
for
the
esse
ntia
l sta
ff w
ith
in t
he
cam
pus
Yes
NoYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
s
Secu
rity
arr
ange
men
tNo
In-h
ouse
In-h
ouse
NoNo
In-h
ouse
In-h
ouse
NoNo
In-h
ouse
In-h
ouse
212 Study to Review The Health Care Delivery System provided by PHSC, Punjab
Tab
le 3
.5 O
utp
ati
en
t D
ep
art
men
t
Desc
ript
ion
of f
acili
ties
Nam
e of
the
CH
C
Bada
lFa
tehg
arh
Fero
zsha
hGo
nian
aKa
rtar
pur
Khem
kara
nLo
ngow
alM
achi
war
aM
ahilp
urM
ajit
haM
anaw
ala
MSW
NoNo
NoNo
NoNo
NoNo
NoNo
No
Staf
f Nu
rse
NoYe
sYe
sNo
NoNo
NoNo
Yes
Yes
No
Phar
mac
ist
NoYe
sNo
Yes
Yes
Yes
Yes
Yes
NoNo
Yes
Know
ledg
eabl
e ab
out
the
OPD
(by
obse
rvat
ion)
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Sepa
rate
reg
istr
atio
n fo
r M
ale
NoNo
NoNo
NoNo
Yes
Yes
NoNo
No
Fem
ale
NoNo
NoNo
NoNo
Yes
Yes
NoNo
No
Free
dom
fi gh
ters
NoNo
NoNo
NoNo
Yes
Yes
NoNo
No
Seni
or c
itiz
ens
NoNo
NoNo
NoNo
NoYe
sNo
NoNo
Staf
fNo
NoNo
NoNo
NoYe
sNo
NoNo
No
The
regi
stra
tion
reg
iste
rs
are
prop
erly
mai
ntai
ned
and
entr
ies
are
mad
e ne
atly
Yes
NoYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
s
All s
ecti
ons
of t
he O
PD
havi
ng p
rope
r si
gnag
e an
d di
rect
iona
l sig
n
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Wai
ting
are
a is
ade
quat
eYe
sNo
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Prop
er s
itti
ng a
rran
gem
ent
Yes
NoYe
sYe
sYe
sNo
Yes
Yes
Yes
Yes
Yes
Drin
king
wat
er f
acili
tyNo
NoYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
s
Ceili
ng F
ans
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Toile
t fa
cilit
y(Se
para
te f
or
Mal
e an
d Fe
mal
e)No
Yes
Yes
Yes
Yes
NoYe
sNo
Yes
Yes
Yes
Doct
or’s
Cham
bers
are
hav
ing
adeq
uate
spa
ceYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
s
(Con
td..
.)
Study to Review The Health Care Delivery System provided by PHSC, Punjab 213
Desc
ript
ion
of
faci
litie
sN
ame
of t
he C
HC
Bada
lFa
tehg
arh
Fero
zsha
hGo
nian
aKa
rtar
pur
Khem
kara
nLo
ngow
alM
achi
war
aM
ahilp
urM
ajit
haM
anaw
ala
Exam
inat
ion
tabl
e w
ith
prop
er s
heet
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Stoo
l for
the
pat
ient
to
sit
NoYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
s
Exam
inat
ion
equi
pmen
ts
(lik
e BP
app
arat
us
Torc
h, h
amm
er,
etc.
)
NoYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
s
Adeq
uate
illu
min
atio
nYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
s
Inje
ctio
n Ro
om a
long
w
ith
faci
litie
s an
d to
de
al w
ith
Emer
genc
y si
tuat
ion
NoYe
sYe
sNo
Yes
Yes
NoYe
sYe
sYe
sNo
Min
or O
T /
Dres
sing
Ro
om w
ith
all t
he b
asic
Eq
uipm
ents
Yes
NoYe
sNo
NoYe
sYe
sYe
sNo
Yes
No
Disp
ensa
ries
/ Ph
arm
acy
wit
h se
para
te c
ount
ers
for
mal
e/fe
mal
e/se
nior
ci
tize
n/st
aff
Yes
NoNo
NoNo
Yes
NoYe
sYe
sNo
Yes
Labo
rato
ry &
Im
agin
g Se
rvic
es e
asily
ac
cess
ible
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Cent
ral C
olle
ctio
n Ce
ntre
fo
r La
bora
tory
Ser
vice
sNo
NoYe
sYe
sYe
sNo
NoYe
sYe
sYe
sYe
s
214 Study to Review The Health Care Delivery System provided by PHSC, Punjab
Tab
le 3
.6 E
merg
en
cy (
Casu
alt
y)
Serv
ices a
t C
HC
s
Desc
ript
ion
of f
acili
ties
Nam
e of
the
CH
C
Bada
lFa
tehg
arh
Fero
zsha
hGo
nian
aKa
rtar
pur
Khem
kara
nLo
ngow
alM
achi
war
aM
ahilp
urM
ajit
haM
anaw
ala
Boar
d di
spla
ying
on
call
doct
ors/
spec
ialis
t an
d ot
her
staf
f on
dut
yYe
sYe
sYe
sNo
Yes
Yes
NoYe
sYe
sYe
sYe
s
Glow
sig
n bo
ard
indi
cati
ng
‘Em
erge
ncy
Serv
ices
Dep
artm
ent’
NoYe
sYe
sNo
Yes
NoNo
NoYe
sNo
No
Emer
genc
y W
ard
atta
ched
to
Emer
genc
y De
part
men
tYe
sNo
Yes
NoYe
sYe
sNo
Yes
Yes
Yes
Yes
If Y
es,
the
no.
of b
eds
Tria
ge a
rea
2NA
2NA
16
Not
men
tion
ed1
2No
t m
enti
oned
3
Yes
NoYe
sNo
Yes
NoNo
Yes
Yes
Yes
No
Obse
rvat
ion
Beds
If Y
es,
No.
of b
eds
Yes
Yes
Yes
Yes
Yes
Yes
NoYe
sYe
sYe
sNo
21
14
Not
men
tion
ed6
NA2
2No
t m
enti
oned
NA
Trol
leys
and
Whe
el c
hair
s av
aila
ble
If y
es,
exac
t No
.Ye
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
s
23
21
12
13
35
2
Exam
inat
ion
room
s w
ith
all b
asic
eq
uipm
ents
NoNo
Yes
NoYe
sYe
sNo
Yes
NoYe
sYe
s
All t
he r
egis
ters
incl
udin
g M
LR
avai
labl
e fo
r pr
oper
reg
istr
atio
nYe
sYe
sYe
sNo
Yes
Yes
NoYe
sYe
sYe
sYe
s
Reti
ring
roo
m w
ith
toile
ts f
or t
he
doct
ors
NoNo
Yes
NoYe
sNo
Yes
Yes
NoYe
sYe
s
Call
book
in p
resc
ribe
d fo
rmat
av
aila
ble
NoNo
NoNo
NoNo
NoNo
Yes
NoNo
(Con
td..
.)
Study to Review The Health Care Delivery System provided by PHSC, Punjab 215
Desc
ript
ion
of f
acili
ties
Nam
e of
the
CH
C
Bada
lFa
tehg
arh
Fero
zsha
hGo
nian
aKa
rtar
pur
Khem
kara
nLo
ngow
alM
achi
war
aM
ahilp
urM
ajit
haM
anaw
ala
Wai
ting
are
a fo
r th
e at
tend
ants
of
pati
ents
wit
h th
e ba
sic
faci
litie
s lik
e si
ttin
g ar
rang
e-m
ents
, dr
inki
ng
wat
er,
toile
t et
c
Yes
NoYe
sYe
sYe
sNo
Yes
Yes
Yes
Yes
No
Publ
ic t
elep
hone
ava
ilabl
eYe
sNo
NoNo
NoNo
NoNo
NoNo
No
Trea
tmen
t ro
om-c
um-m
inor
OT
NoYe
sYe
sNo
Yes
NoYe
sYe
sNo
Yes
Yes
Maj
or O
TYe
sNo
NoNo
Yes
NoYe
sYe
sNo
Yes
No
Suffi
cien
t st
ock
of e
ssen
tial
an
d lif
e sa
ving
dru
gsYe
sYe
sYe
sYe
sYe
sNo
Yes
Yes
Yes
Yes
Yes
Oxyg
en c
ylin
ders
wit
h at
tach
men
tsYe
sNo
NoYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
s
Labo
rato
ry s
ervi
ces
NoNo
Yes
NoYe
sNo
Yes
Yes
Yes
Yes
Yes
Radi
olog
y Se
rvic
esYe
sNo
Yes
NoYe
sNo
Yes
Yes
Yes
Yes
Yes
Ambu
lanc
e se
rvic
esYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
s
Staf
f tr
aine
d in
BLS
NoNo
Yes
NoYe
sNo
Yes
Yes
Yes
Yes
Yes
Trea
tmen
t fa
cilit
ies
for
Dog/
sn
ake
bite
& P
oiso
ning
NoYe
sYe
sYe
sNo
Yes
Yes
Yes
Yes
Yes
Yes
Avai
labi
lity
of D
isas
ter
Man
ual
NoNo
Yes
Yes
Yes
NoNo
Yes
Yes
NoNo
Disa
ster
Ale
rt C
ode,
rec
all &
de
ploy
men
tNo
NoYe
sYe
sNo
NoNo
Yes
Yes
NoNo
Mai
nten
ance
of
dedi
cate
d dr
ug s
tore
for
dis
aste
r si
tuat
ion
NoNo
Yes
Yes
Yes
NoNo
Yes
Yes
NoNo
216 Study to Review The Health Care Delivery System provided by PHSC, Punjab
Tab
le 3
.7 C
lin
ical Lab
ora
tori
es a
t C
HC
s
Desc
ript
ion
of f
acili
ties
Nam
e of
the
CH
C
Bada
lFa
tehg
arh
Fero
zsha
hGo
nian
aKa
rtar
pur
Khem
kara
nLo
ngow
alM
achi
war
aM
ahilp
urM
ajit
haM
anaw
ala
Type
of
labo
rato
ries
Bioc
hem
istr
yYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
s
Path
olog
yNo
NoNo
Yes
Yes
NoNo
NoNo
Yes
No
Mic
robi
olog
yNo
NoNo
Yes
NoNo
Yes
Yes
NoYe
sNo
Qual
ifi ed
Pat
holo
gist
av
aila
ble
NoNo
NoNo
NoNo
NoNo
NoNo
No
Bioc
hem
ist
avai
labl
eNo
NoNo
NoNo
NoNo
NoNo
NoNo
Mic
robi
olog
ist
avai
labl
eNo
NoNo
NoNo
NoNo
NoNo
NoNo
Follo
win
g th
e un
iver
sal
prec
auti
on p
roce
dure
sNo
Yes
Yes
Yes
Yes
NoYe
sYe
sYe
sYe
sNo
Usin
g pr
otec
tive
mea
sure
s i.e
. gl
oves
/gow
ns/m
asks
NoNo
NoYe
sYe
sNo
Yes
Yes
Yes
Yes
No
Spec
imen
col
lect
ion
done
ce
ntra
llyNo
NoYe
sYe
sYe
sNo
NoYe
sYe
sYe
sNo
Avai
labi
lity
of a
ll th
e ch
emic
als
and
reag
ents
Yes
Yes
NoNo
Yes
Yes
Yes
Yes
Yes
Yes
No
Obse
rvin
g al
l the
bio
-saf
ety
mea
sure
sNo
NoYe
sYe
sYe
sNo
NoYe
sYe
sYe
sNo
Reg
ular
Inte
rnal
Qua
lity
cont
rol m
easu
res
unde
rtake
n
No
No
Yes
Yes
Yes
No
No
No
Yes
No
No
Reg
ular
Ext
erna
l Qua
lity
cont
rol m
easu
res
unde
rtake
n
No
No
Yes
Yes
Yes
No
No
No
No
No
No
(Con
td..
.)
Study to Review The Health Care Delivery System provided by PHSC, Punjab 217
Tab
le 3
.8 B
loo
d B
an
kin
g F
acilit
ies
Desc
ript
ion
of f
acili
ties
Nam
e of
the
CH
C
Bada
lFa
tehg
arh
Fero
zsha
hGo
nian
aKa
rtar
pur
Khem
kara
nLo
ngow
alM
achi
war
aM
ahilp
urM
ajit
haM
anaw
ala
Avai
labi
lity
of B
lood
Ban
k
NoNo
NoNo
NoNo
NoNo
NoNo
No
Trai
ned
or q
ualifi
ed
med
ical
of
fi cer
pos
ted
as B
.T.O
.NA
NANA
NANA
NANA
NANA
NANA
Roun
d th
e cl
ock
avai
labi
lity
of t
rain
ed s
taff
and
ser
vice
sNA
NANA
NANA
NANA
NANA
NA
Chec
king
& c
ross
mat
chin
g by
B.T
.ONA
NANA
NANA
NANA
NANA
NANA
Prop
er m
aint
enan
ce o
f co
ld
chai
n an
d re
frig
erat
ors
NANA
NANA
NANA
NANA
NANA
NA
Aust
ralia
ant
igen
, H
CV,
VDRL
, M
.P.
and
HIV
tes
ts d
one
for
Ever
y bl
ood
bott
le o
f do
nor.
NANA
NANA
NANA
NANA
NANA
NA
Effo
rts
mad
e to
col
lect
bl
ood
thro
ugh
Volu
ntar
y Or
gani
sati
on C
amps
NANA
NANA
NANA
NANA
NANA
NA
Rene
wal
of
bloo
d ba
nk/H
IV
Lice
nse
as p
er R
ules
NANA
NANA
NANA
NANA
NANA
NA
Disp
osal
of
HIV
pos
itiv
e bl
ood
bags
& b
io-s
afet
y m
easu
res
unde
rtak
en.
NANA
NANA
NANA
NANA
NANA
Avai
labi
lity
of T
able
Top
Sy
ring
e &
nee
dle
dest
roye
r an
d co
lour
cod
ed b
ags
NANA
NANA
NANA
NANA
NANA
NA
Feed
bac
k of
tra
nsfu
sion
, an
d re
cord
mai
nten
ance
of
unto
war
d in
cide
nces
NANA
NANA
NANA
NANA
NANA
NA
Radi
olog
ist
avai
labi
lity
NoNo
Yes
NoNo
NoNo
NoNo
NoNo
Avai
labi
lity
of t
he d
ark
room
w
ith
all f
acili
ties
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Use
of d
osim
eter
and
the
y re
gula
rly s
ent
to B
ARC
NoNo
NoNo
NoNo
NoNo
NoNo
Yes
218 Study to Review The Health Care Delivery System provided by PHSC, Punjab
Tab
le 3
.9 S
pecia
l In
vesti
gati
on
s a
t C
HC
s
Desc
ript
ion
of f
acili
ties
Nam
e of
the
CH
C
Bada
lFa
tehg
arh
Fero
zsha
hGo
nian
aKa
rtar
pur
Khem
kara
nLo
ngow
alM
achi
war
aM
ahilp
urM
ajit
haM
anaw
ala
Spec
ial i
nves
tiga
tion
s lik
e IV
P, c
ontr
ast
med
ia e
tcNo
NoNo
NoNo
NoNo
NoNo
NoNo
Roun
d th
e cl
ock
avai
labi
lity
of X
-ray
ser
vice
s/
Sono
grap
hy
Yes
Yes
NoYe
sNo
NoYe
sYe
sNo
Yes
Yes
Sepa
rate
reg
iste
r fo
r M
LC
reco
rds
Yes
Yes
Yes
Yes
Yes
Yes
NoYe
sYe
sYe
sYe
s
Mai
nten
ance
of
hist
ory
book
and
log
book
of
X-ra
y m
achi
nes
Yes
NoNo
Yes
NoYe
sYe
sYe
sNo
NoNo
Study to Review The Health Care Delivery System provided by PHSC, Punjab 219
Tab
le 3
.10
O
pera
tio
n T
heatr
es a
t C
HC
s’
Desc
ript
ion
of f
acili
ties
Nam
e of
the
CH
C
Bada
lFa
tehg
arh
Fero
zsha
hGo
nian
aKa
rtar
pur
Khem
kara
nLo
ngow
alM
achi
war
aM
ahilp
urM
ajit
haM
anaw
ala
No.
of m
ajor
OT
11
02
11
11
21
1
No.
of m
inor
OT
11
10
10
11
01
1
Zoni
ng C
once
pt S
tric
tly
Follo
wed
NoNo
NoYe
sNo
NoNo
Yes
Yes
NoNo
Mai
nten
ance
of
OT r
ecor
dsYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sNo
Mai
nten
ance
of
OT
post
pone
men
t re
cord
sNo
NoNo
NoNo
Yes
NoYe
sYe
sNo
No
Emer
genc
y lig
ht-g
ener
ator
fa
cilit
y fo
r OT
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Avai
labi
lity
of fi
re fi
ghti
ng
equi
pmen
t &
kno
wle
dge
to
use
them
NoNo
NoNo
NoNo
Yes
NoNo
NoYe
s
Regu
lar
disi
nfec
tion
&
ster
ilisa
tion
don
e at
OT
Yes
NoYe
sNo
Yes
Yes
Yes
Yes
Yes
Yes
No
220 Study to Review The Health Care Delivery System provided by PHSC, Punjab
Tab
le 3
.11 In
pati
en
t w
ard
s a
t C
HC
s
Desc
ript
ion
of f
acili
ties
Nam
e of
the
CH
C
Bada
lFa
tehg
arh
Fero
zsha
hGo
nian
aKa
rtar
pur
Khem
kara
nLo
ngow
alM
achi
war
aM
ahilp
urM
ajit
haM
anaw
ala
Sati
sfac
tory
cle
anlin
ess
of w
ards
w
ith
adeq
uate
hou
se k
eepi
ngNo
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Colo
ur c
odes
of
yello
w,
blue
,red
,whi
te b
in &
blu
e tr
ansp
aren
t PP
F fo
r w
aste
co
llect
ion,
tab
le t
op s
yrin
ge &
ne
edle
des
troy
er&
uti
lisat
ion
NoYe
sYe
sYe
sYe
sNo
Yes
Yes
Yes
Yes
Yes
Adeq
uate
wat
er s
uppl
y an
d up
keep
of
san
itar
y bl
ocks
NoYe
sYe
sYe
sYe
sNo
Yes
Yes
Yes
Yes
No
Adeq
uate
and
cle
an t
oile
ts a
nd
bath
room
sNo
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
Prop
er a
nd a
dequ
ate
linen
on
beds
NoYe
sNo
Yes
Yes
Yes
NoYe
sYe
sYe
sYe
s
Floo
r be
ds/d
oubl
ing
of b
eds
invo
lved
NoNo
NoNo
NoNo
NoNo
NoNo
No
Sati
sfac
tory
upk
eep
of c
ots,
m
attr
esse
s, lo
cker
s, li
nen
etc.
NoYe
sYe
sYe
sYe
sYe
sNo
Yes
Yes
Yes
Yes
Use
of h
ospi
tal u
nifo
rms
by
pati
ents
NoNo
NoNo
NoNo
NoYe
sNo
NoNo
Avai
labi
lity
and
func
tion
ing
of
suct
ion
appa
ratu
sNo
t av
aila
ble
Avai
labl
eNo
t av
aila
ble
Avai
labl
eAv
aila
ble
Not
avai
labl
eAv
aila
ble
Avai
labl
eNo
t av
aila
ble
Avai
labl
eAv
aila
ble
Cond
itio
n on
ava
ilabi
lity
Not
avai
labl
eNo
n Fu
ncti
onal
NAFu
ncti
onal
Func
tion
alNA
Func
tion
alFu
ncti
onal
NAFu
ncti
onal
Func
tion
al
Avai
labi
lity
and
func
tion
ing
of
oxyg
en c
ylin
ders
wit
h ac
cess
orie
sAv
aila
ble
Avai
labl
eAv
aila
ble
Avai
labl
eAv
aila
ble
Avai
labl
eAv
aila
ble
Avai
labl
eAv
aila
ble
Avai
labl
eAv
aila
ble
Cond
itio
n on
ava
ilabi
lity
Func
tion
alFu
ncti
onal
Non
func
tion
alFu
ncti
onal
Func
tion
alNo
n fu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
al
(Con
td..
.)
Study to Review The Health Care Delivery System provided by PHSC, Punjab 221
Desc
ript
ion
of f
acili
ties
Nam
e of
the
CH
C
Bada
lFa
tehg
arh
Fero
zsha
hGo
nian
aKa
rtar
pur
Khem
kara
nLo
ngow
alM
achi
war
aM
ahilp
urM
ajit
haM
anaw
ala
Avai
labi
lity
and
func
tion
ing
of v
enes
ecti
on/
LP/
trac
heos
tom
y tr
ay
Not
avai
labl
eNo
t av
aila
ble
Not
avai
labl
eAv
aila
ble
Avai
labl
eNo
t av
aila
ble
Not
avai
labl
eAv
aila
ble
Not
avai
labl
eNo
t av
aila
ble
Not
avai
labl
e
Cond
itio
n on
ava
ilabi
lity
NANA
NAFu
ncti
onal
Func
tion
alNA
NAFu
ncti
onal
NANA
NA
Avai
labi
lity
and
func
tion
ing
of e
mer
genc
y lig
ht /
whe
el
chai
rs/s
tret
cher
tro
lley
Avai
labl
eAv
aila
ble
Not
avai
labl
eAv
aila
ble
Avai
labl
eNo
t av
aila
ble
Avai
labl
eAv
aila
ble
Avai
labl
eAv
aila
ble
Avai
labl
e
Cond
itio
n on
ava
ilabi
lity
Func
tion
alFu
ncti
onal
NAFu
ncti
onal
Func
tion
alNA
Func
tion
alFu
ncti
onal
Func
tion
alFu
ncti
onal
Func
tion
al
Stat
ione
ries,
for
ms
and
vario
us u
pdat
ed r
egis
ters
etc
.Ye
sYe
sNo
Yes
Yes
Yes
NoYe
sYe
sYe
sYe
s
Conc
ept
of p
rogr
essi
ve
pati
ent
care
NoYe
sYe
sYe
sYe
sNo
NoNo
Yes
NoYe
s
Adeq
uacy
and
wor
king
of
fans
an
d lig
hts
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Sati
sfac
tory
ava
ilabi
lity
of
diet
Not
avai
labl
eNo
t av
aila
ble
Not
avai
labl
eNo
t av
aila
ble
Not
avai
labl
eNo
t av
aila
ble
Not
avai
labl
eNo
t av
aila
ble
Not
avai
labl
eNo
t av
aila
ble
Not
avai
labl
e
Qual
ity
of c
are
NoYe
sYe
sYe
sYe
sNo
Yes
Yes
Yes
NoNo
Mai
nten
ance
of
vario
us
regi
ster
s, r
ecor
ds,
etc.
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
222 Study to Review The Health Care Delivery System provided by PHSC, Punjab
Tab
le 3
.12 H
osp
ital M
ed
ical S
tore
s a
t C
HC
s
Desc
ript
ion
of f
acili
ties
Nam
e of
the
CH
C
Bada
lFa
tehg
arh
Fero
zsha
hGo
nian
aKa
rtar
pur
Khem
kara
nLo
ngow
alM
achi
war
aM
ahilp
urM
ajit
haM
anaw
ala
rest
ricti
on o
n en
tery
for
un
auth
oris
ed p
erso
nnel
sYe
sYe
sYe
sYe
sYe
sNo
NoYe
sNo
Yes
Yes
Staf
f kn
owle
dge
on m
ater
ial
man
agem
ent,
sys
tem
of
FIFO
,bin
ca
rds,
lead
tim
e, b
uffe
r st
ock
reor
der
leve
l
NoNo
Yes
Yes
Yes
Yes
Yes
NoYe
sYe
sNo
Avai
labi
lity
of v
ital
,ess
enti
al d
rugs
in
suf
fi cie
nt q
uant
ity
Yes
Yes
NoYe
sYe
sNo
Yes
Yes
Yes
Yes
No
Upk
eep
of e
xpir
y da
te r
egis
ter
and
its
regu
lar
insp
ecti
on b
y M
O i/
cNo
NoYe
sNo
Yes
Yes
NoYe
sYe
sNo
No
Effo
rts
mad
e to
red
istr
ibut
e la
rge
stoc
ks o
f sl
ow m
ovin
g dr
ugs
or n
ear
expi
ry f
or it
s ut
ilisa
tion
NoNo
Yes
Yes
Yes
NoNo
Yes
Yes
NoNo
Prop
er a
rran
gem
ents
to
keep
dru
gs
as p
er A
BC/V
ED c
ateg
ory
and
stor
age
of r
ubbe
r go
ods
as p
er
guid
elin
es
NoNo
NoYe
sYe
sNo
NoNo
Yes
NoNo
Appr
opria
te s
teps
tak
en t
o pr
even
t pi
lfera
ge o
r dr
ugs
NoYe
sYe
sYe
sYe
sYe
sNo
Yes
Yes
Yes
No
Conv
enie
nt a
rran
gem
ent
of is
suin
g dr
ugs
to v
ario
us w
ards
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Regu
lar
send
ing
of s
ampl
es t
o ch
emic
al la
bora
tory
for
che
ckin
g st
anda
rds
of d
rugs
NoNo
NoNo
Yes
NoNo
NoNo
NoNo
Circ
ulat
ion
of li
st o
f av
aila
ble
drug
s to
all
MOs
, OP
D& w
ards
as
per
gene
ric n
ame
Yes
Yes
NoYe
sYe
sYe
sNo
Yes
Yes
Yes
No
Subm
issi
on o
f ce
rtifi
ed b
ills
to
offi c
e fo
r re
leas
e of
pay
men
ts w
ith
in t
hree
day
s
NoYe
sYe
sYe
sYe
sNo
NoYe
sYe
sYe
sNo
Auct
ion
to c
lear
the
em
pty
mat
eria
l fr
om s
tore
don
e re
gula
rlyYe
sNo
NoYe
sYe
sNo
NoNo
Yes
NoYe
s
Avai
labi
lity
of fi
re fi
ghti
ng
equi
pmen
t &
kno
wle
dge
to u
se t
hem
Yes
NoNo
NoNo
NoYe
sNo
NoNo
No
Avai
labi
lity
of r
egul
arly
upd
ated
ho
spit
al d
rug
form
ular
yNo
NoYe
sNo
Yes
NoNo
NoYe
sNo
No
Exis
tenc
e of
sta
ndin
g dr
ug
com
mit
tee
Yes
NoNo
Yes
Yes
NoNo
NoNo
NoNo
Study to Review The Health Care Delivery System provided by PHSC, Punjab 223
Tab
le 3
.13 M
ed
ical R
eco
rd D
ep
art
men
t at
CH
Cs’
Desc
ript
ion
of f
acili
ties
Nam
e of
the
CH
C
Bada
lFa
tehg
arh
Fero
zsha
hGo
nian
aKa
rtar
pur
Khem
kara
nLo
ngow
alM
achi
war
aM
ahilp
urM
ajit
haM
anaw
ala
Avai
labi
lity
of m
edic
al r
ecor
d ro
om w
ith
enou
gh n
o. o
f ra
cks
etc.
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Is t
he m
edic
al r
ecor
d co
mpu
teri
sed
or m
anua
lM
anua
lM
anua
lM
anua
lM
anua
lM
anua
lM
anua
lM
anua
lM
anua
lM
anua
lM
anua
lM
anua
l
Is it
man
aged
by
trai
ned
med
ical
re
cord
offi
cer/
tech
nici
an &
su
perv
isio
n pr
ovid
ed b
y M
Oi/c
Yes
NoYe
sNo
NoNo
NoYe
sNo
Yes
No
Case
rec
ord
is m
aint
aine
d as
per
W
HO
clas
sifi c
atio
n of
dis
ease
s (I
CD-X
)
NoNo
NoNo
NoNo
NoYe
sYe
sNo
No
Regu
lar
subm
issi
on o
f m
orbi
dity
, m
orta
lity
repo
rts
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
Is t
he b
acku
p fa
cilit
y ke
pt t
o sa
fe g
uard
the
se r
ecor
dsNo
NoYe
sNo
NoNo
NoNo
Yes
NoNo
Is t
he e
ffec
tive
ret
rieva
l sys
tem
fo
llow
edYe
sNo
NoNo
NoNo
Yes
NoYe
sNo
Yes
Regu
lar
deat
h au
dit
mee
ting
he
ld/m
inut
es o
r m
eeti
ng
reco
rded
/ co
rrec
tive
act
ion
take
n
Yes
NoNo
NoYe
sNo
NoYe
sNo
NoNo
Med
ical
aud
it d
one
at r
egul
ar
inte
rval
Yes
Yes
NoYe
sYe
sYe
sYe
sNo
Yes
NoNo
224 Study to Review The Health Care Delivery System provided by PHSC, Punjab
Tab
le 3
.14 H
osp
ital W
aste
Man
ag
em
en
t at
CH
Cs
Desc
ript
ion
of f
acili
ties
Nam
e of
the
CH
C
Bada
lFa
tehg
arh
Fero
zsha
hGo
nian
aKa
rtar
pur
Khem
kara
nLo
ngow
alM
achi
war
aM
ahilp
urM
ajit
haM
anaw
ala
Adeq
uate
no.
of
bins
and
ba
gs o
f re
quire
d co
lour
cod
es
are
avai
labl
e
NoYe
sYe
sYe
sYe
sNo
Yes
Yes
Yes
Yes
Yes
Are
thes
e pl
aced
str
ateg
ical
ly
in a
ll pa
tien
t ca
re a
reas
NoYe
sYe
sYe
sYe
sNo
Yes
Yes
Yes
Yes
Yes
Segr
egat
ion
of d
iffe
rent
ca
tego
ries
of w
aste
don
e at
po
int
of g
ener
atio
n
NoYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
s
Colle
ctio
n of
was
te,
pack
agin
g, la
belin
g, r
ecor
d ke
epin
g do
ne in
sci
enti
fi c
way
NoYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
s
Prop
er t
rans
port
atio
n of
w
aste
col
lect
edNo
NoYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
s
Stor
age
faci
lity
and
dura
tion
NoYe
sNo
Yes
NoYe
sYe
sNo
NoNo
No
Disp
osal
/ re
cycl
ing
met
hods
fo
r va
rious
cat
egor
ies
of
was
te
NoNo
NoYe
sNo
NoYe
sYe
sYe
sNo
No
Avai
labi
lity
of a
utoc
lave
, sh
redd
ers
, inc
iner
ator
s et
c.
No
No
No
Yes
Yes
Yes
Yes
Yes
No
No
Yes
Study to Review The Health Care Delivery System provided by PHSC, Punjab 225
Tab
le 3
.15
C
en
tral S
teri
le S
up
ply
Dep
art
men
t at
CH
Cs
Desc
ript
ion
of f
acili
ties
Nam
e of
the
CH
C
Bada
lFa
tehg
arh
Fero
zsha
hGo
nian
aKa
rtar
pur
Khem
kara
nLo
ngow
alM
achi
war
aM
ahilp
urM
ajit
haM
anaw
ala
CS
SD
(und
er s
uper
visi
on
of tr
aine
d st
aff/
seni
or
nurs
ing
offi c
er
No
No
Yes
Yes
No
No
Yes
Yes
No
Yes
Yes
Hav
ing
all t
he re
quire
d eq
uipm
ents
& a
utoc
lave
sYe
sN
oYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
s
Qua
lity
cont
rol m
easu
res
are
stric
tly fo
llow
edN
oN
oYe
sYe
sYe
sYe
sN
oYe
sYe
sN
oYe
s
Tab
le 3
.16 Lau
nd
ry S
erv
ices a
t C
HC
s
Desc
ript
ion
of f
acili
ties
Nam
e of
the
CH
C
Bada
lFa
tehg
arh
Fero
zsha
hGo
nian
aKa
rtar
pur
Khem
kara
nLo
ngow
alM
achi
war
aM
ahilp
urM
ajit
haM
anaw
ala
Laun
dry
serv
ices
if in
-hou
se
In-h
ouse
In-h
ouse
In-h
ouse
In-h
ouse
In-h
ouse
Outs
ourc
edOu
tsou
rced
Outs
ourc
edOu
tsou
rced
Outs
ourc
edIn
-hou
se
Conv
enti
onal
(d
hobi
)Co
nven
tion
al
(dho
bi)
Conv
enti
onal
(d
hobi
)Co
nven
tion
al
(dho
bi)
Conv
en-
tion
al (
dhob
i)Co
nven
-ti
onal
(dh
obi)
Conv
en-
tion
al (
dhob
i)Co
nven
tion
al (
dhob
i)Co
nven
tion
al
(dho
bi)
Conv
enti
onal
(d
hobi
)Co
nven
tio
nal
(dho
bi)
Laun
dry
staf
fNo
t ad
equa
teNo
t ad
equa
teNo
t ad
equa
teAd
equa
teAd
equa
teNA
NANA
NANA
Adeq
uate
Qual
ity
of w
ash
Aver
age
Aver
age
Aver
age
Good
Good
Aver
age
Aver
age
Good
Aver
age
Good
Aver
age
Qual
ity
of li
nen
Aver
age
Aver
age
Aver
age
Good
Good
Aver
age
Aver
age
Good
Good
Good
Good
226 Study to Review The Health Care Delivery System provided by PHSC, Punjab
Tab
le 3
.17 D
ieta
ry S
erv
ices
Desc
ript
ion
of
faci
litie
sN
ame
of t
he C
HC
Bada
lFa
tehg
arh
Fero
zsha
hGo
nian
aKa
rtar
pur
Khem
kara
nLo
ngow
alM
achi
war
aM
ahilp
urM
ajit
haM
anaw
ala
Avai
labi
lity
of
kitc
hen
Faci
lity
Not
avai
labl
eNo
t av
aila
ble
Not
avai
labl
eNo
t av
aila
ble
Not
avai
labl
eNo
t av
aila
ble
Not
avai
labl
eNo
t av
aila
ble
Not
avai
labl
eNo
t av
aila
ble
Not
avai
labl
e
Prop
er a
nd s
afe
arra
ngem
ent
for
stor
age
of r
aw
mat
eria
l
NANA
NANA
NANA
NANA
NANA
NA
Mea
sure
s fo
r pe
st
and
rode
nt c
ontr
olNA
NANA
NANA
NANA
NANA
NANA
Sani
tati
on a
nd
hygi
ene
of t
he
cook
ing
area
pr
oper
ly m
aint
aine
d
NANA
NANA
NANA
NANA
NANA
NA
Regu
lar
heal
th
chec
kup
for
food
ha
ndle
rs
NANA
NANA
NANA
NANA
NANA
NA
Avai
labi
lity
of
mod
ern
cook
ing
equi
pmen
ts
NANA
NANA
NANA
NANA
NANA
NA
Avai
labi
lity
of
prop
erly
mai
ntai
ned
reco
rds
& r
egis
ters
NANA
NANA
NANA
NANA
NANA
NA
Diet
ser
vice
und
er
the
supe
rvis
ion
of a
qu
alifi
ed d
ieti
tian
NANA
NANA
NANA
NANA
NANA
NA
Study to Review The Health Care Delivery System provided by PHSC, Punjab 227
Tab
le 3
.18 M
ed
ical O
ffi c
ers
in
Po
sit
ion
Nam
e of
Pos
tPo
stN
ame
of C
HC
Bada
lFa
tega
rhFe
roz
shah
Goni
ana
Kart
arpu
rKh
emKa
ran
Long
o w
alM
achi
-W
ara
Mah
il-Pu
rM
ajit
haM
ana-
wal
aTo
tal
Med
icin
e
M.D
.-
1-
1-
11
1-
41
10
Dipl
oma
1-
--
--
--
--
-1
MBB
S-
-1
--
--
1-
-2
4
Surg
ery
M.S
.1
11
11
1-
1-
--
7
Dipl
oma
--
--
--
--
--
--
MBB
S-
--
--
--
--
--
-
OBG
M.S
.-
--
--
1-
-1
--
2
Dipl
oma
--
--
--
--
--
--
MBB
S-
--
--
--
--
--
-
Pedi
atric
s
M.D
.-
11
--
--
--
-1
3
Dipl
oma
--
--
--
--
--
--
MBB
S-
--
--
--
--
--
-
ENT
M.S
.-
--
-1
--
-1
--
2
Dipl
oma
--
--
--
--
--
--
MBB
S-
--
--
--
--
--
-
Orth
oped
ics
M.S
.-
--
--
--
--
--
-
Dipl
oma
1-
--
--
--
--
-1
MBB
S-
--
--
--
--
--
-
Derm
atol
ogis
t
M.D
.-
--
--
--
--
--
-
Dipl
oma
--
--
--
--
--
--
MBB
S-
--
--
--
--
--
-
Psyc
hiat
ry
M.D
.-
--
--
--
--
--
-
Dipl
oma
--
--
--
--
--
--
MBB
S-
--
--
--
--
--
-
(Con
td..
.)
228 Study to Review The Health Care Delivery System provided by PHSC, Punjab
Nam
e of
Pos
tPo
stN
ame
of C
HC
Bada
lFa
tega
rhFe
roz
shah
Goni
ana
Kart
arpu
rKh
emKa
ran
Long
o w
alM
achi
-W
ara
Mah
il-Pu
rM
ajit
haM
ana-
wal
aTo
tal
Anae
sthe
sia
M.D
.1
1-
--
--
1-
--
3
Dipl
oma
--
--
--
--
--
--
MBB
S-
--
--
--
--
--
-
Bloo
d Ba
nk
M.D
.-
--
--
--
--
--
-
Dipl
oma
--
--
--
--
--
--
MBB
S-
--
--
--
--
--
-
Path
olog
y
M.D
.-
--
--
--
--
--
-
Dipl
oma
--
--
--
--
--
--
MBB
S-
--
--
--
--
--
-
Bio-
chem
istr
y
MD/
MSc
--
--
--
--
--
--
Dipl
oma
--
--
--
--
--
--
MBB
S-
--
--
--
--
--
-
Mic
robi
olog
y
MD/
MSc
--
--
--
--
--
--
Dipl
oma
--
--
--
--
--
--
MBB
S-
--
--
--
--
--
-
Radi
olog
y
M.D
.-
--
--
--
-1
--
1
Dipl
oma
--
--
--
--
--
--
MBB
S1
--
--
--
--
--
1
Dent
alBD
S-
1-
-1
1-
1-
11
6
MBB
S1
--
1-
--
--
--
2
Study to Review The Health Care Delivery System provided by PHSC, Punjab 229
Tab
le 3
.19 Fiv
e Y
ears
Perf
orm
an
ce R
ep
ort
of
CH
C H
osp
itals
(P
un
jab
)
Perf
orm
ance
(An
nual
)N
ame
of t
he C
HC
Bada
lFa
tega
rhFe
roz
shah
Goni
ana
Kart
arpu
rKh
emKa
ran
Long
o w
alM
achi
-W
ara
Mah
il-Pu
rM
ajit
haM
ana-
wal
a
OPD
atte
ndan
ce
last
5 y
ear
1st Y
r30
492.
3767
386
8841
371
5915
2-
1779
728
788
2036
144
498
1968
3
2nd Y
r17
531
3920
913
792
4424
968
949
-13
504
3474
826
459
4140
621
263
3rd Y
r15
594
4705
210
804
3501
356
222
2100
814
038
3516
624
531
5157
820
980
4th Y
r18
881
5271
099
4047
352
5903
023
310
1706
629
461
3381
1-
2038
7
5th Y
r27
901
5003
411
354
4092
562
492
2875
613
061
3515
837
977
-25
980
In-p
atie
nt
Adm
itte
d
1st Y
r64
914
8227
231
1617
95-
843
426
413
--
2nd Y
r25
614
7652
329
4020
17-
629
719
631
--
3rd Y
r28
114
0149
920
8919
5074
860
214
1562
112
19-
4th Y
r60
811
7643
125
9218
6771
363
612
6632
811
42-
5th Y
r76
591
954
729
6617
2812
2946
512
6310
7214
10-
No.
of S
urge
ries
done
1st Y
r35
667
516
915
7624
1-
386
573
255
--
2nd Y
r10
5210
8442
515
0324
9-
345
784
474
--
3rd Y
r15
7012
4270
370
627
180
714
079
151
881
4-
4th Y
r20
8712
9360
511
2128
274
156
072
564
980
5-
5th Y
r22
7217
5959
015
2429
210
2030
296
46
1314
-
No.
of
emer
genc
ies
1st Y
r12
028
013
979
1-
-52
614
7813
--
2nd Y
r61
348
293
735
--
533
1756
131
-76
8
3rd Y
r66
258
164
616
-40
422
1791
167
-95
6
4th Y
r10
724
772
823
-55
189
1933
106
-12
96
5th Y
r37
522
577
874
-11
422
626
7538
7-
1703
No.
of
adm
issi
on
thro
ugh
emer
genc
y
1st Y
r-
233
5174
454
7-
257
344
13-
-
2nd Y
r-
242
3765
347
3-
250
364
131
--
3rd Y
r-
141
4546
949
331
264
263
167
509
-
4th Y
r-
174
6159
476
232
100
453
106
558
-
5th Y
r-
261
7162
769
710
610
446
636
550
0-
(Con
td..
.)
230 Study to Review The Health Care Delivery System provided by PHSC, Punjab
Perf
orm
ance
(An
nual
)N
ame
of t
he C
HC
Bada
lFa
tega
rhFe
roz
shah
Goni
ana
Kart
arpu
rKh
emKa
ran
Long
o w
alM
achi
-W
ara
Mah
il-Pu
rM
ajit
haM
ana-
wal
a
No.
of m
edic
o-le
gal c
ases
1st Y
r-
197
49NA
203
-13
328
10
378
208
2nd Y
r-
169
4328
322
5-
122
315
041
525
7
3rd Y
r-
145
4924
823
7-
104
300
038
526
4
4th Y
r-
9172
354
305
-68
400
036
523
9
5th Y
r-
148
6828
239
0-
6735
20
293
218
No.
of
Post
mor
tem
1st Y
r-
-NI
L0
--
0-
0-
-
2nd Y
r-
-0
0-
-0
-0
--
3rd Y
r-
-0
0-
NA0
-0
--
4th Y
r-
-0
0-
NA0
-0
--
5th Y
r-
-0
0-
NA0
-0
--
No.
of N
orm
al
deliv
erie
s co
nduc
ted
1st Y
r18
636
230
942
NA1
--
2nd Y
r23
5613
102
2343
NA-
--
3rd Y
r10
169
1078
5664
3072
628
-
4th Y
r84
139
7882
8638
151
-32
-
5th Y
r8
47
7671
139
4354
-40
-
No.
of
Caes
aria
ns d
one
1st Y
r-
104
NIL
64-
-4
NA-
--
2nd Y
r-
73Do
47-
-0
NA1
--
3rd Y
r-
670
113
NIL
031
11
-
4th Y
r-
470
010
NIL
041
-3
-
5th Y
r-
90
07
NIL
05
-7
-
Study to Review The Health Care Delivery System provided by PHSC, Punjab 231
Tab
le 3
.20 S
taff
Po
sit
ion
at
CH
C
Nam
ePo
stBa
dal
Fate
garh
Fero
z sh
ahGo
nian
aKa
rtar
pur
Khem
Kara
nLo
ngo
wal
Mac
hi-
War
aM
ahil-
Pur
Maj
itha
Man
a-w
ala
Doct
ors/
GDM
O
Sanc
tion
111
55
61
-6
11
6
Vaca
nt6
-3
22
1-
1-
--
Ad h
ock
1-
--
--
--
--
-
Tota
l in
Posi
tion
41
23
4-
-5
11
6
Doct
ors
spec
ialis
t
Sanc
tion
34
11
-5
43
45
-
Vaca
nt2
1-
--
13
1-
1 (L
.L)
-
Ad h
ock
--
--
--
--
--
-
Tota
l in
Posi
tion
13
11
-4
12
44
-
Nurs
ing
Staf
f
Sanc
tion
104
95
57
710
64
5
Vaca
nt5
--
2-
55
11
--
Ad h
ock
3-
--
--
--
4-
1
Tota
l in
Posi
tion
24+
3(*)
93
52
29
5+1(
*)3+
7(*)
4
Tech
nici
an(M
LT)
Sanc
tion
13
33
24
34
12
5
Vaca
nt-
--
2-
1-
1-
-1
Ad h
ock
1-
1-
--
--
--
-
Tota
l in
Posi
tion
-3
21
23
33
12
4
Adm
inis
trat
ive
staf
f
Sanc
tion
1-
32
-1
-5
1-
6
Vaca
nt-
--
--
1-
1-
--
Ad h
ock
--
--
--
--
--
1
Tota
l in
Posi
tion
1-
32
--
-4
1 m
issi
ng-
5
Clas
s IV
Sanc
tion
220
96
414
723
110
40
Vaca
nt-
-1
--
2-
3-
-7
Ad h
ock
--
--
--
--
--
-
Tota
l in
Posi
tion
2+7(
*)20
86
412
720
17+
3(*)
33
(Con
td..
.)
232 Study to Review The Health Care Delivery System provided by PHSC, Punjab
Nam
ePo
stBa
dal
Fate
garh
Fero
z sh
ahGo
nian
aKa
rtar
pur
Khem
Kara
nLo
ngo
wal
Mac
hi-
War
aM
ahil-
Pur
Maj
itha
Man
a-w
ala
Safa
i Sew
ak
Sanc
tion
23
-3
--
33
12
5
Vaca
nt-
--
--
--
1-
--
Ad h
ock
--
--
--
--
--
-
Tota
l in
Posi
tion
2+3(
*)3
-3
--
32
1+2(
*)2+
2(*)
5
Phar
mac
ists
Sanc
tion
3-
23
12
--
1-
3
Vaca
nt-
--
--
--
--
--
Ad h
ock
--
--
--
--
--
-
Tota
l in
Posi
tion
3+4(
*)-
23
12
--
1-
8+1(
LL)
Opht
halm
olo-
Gist
s
Sanc
tion
-1
11
-1
--
--
-
Vaca
nt-
--
--
--
--
--
Ad h
ock
--
--
--
--
--
-
Tota
l in
Posi
tion
-1
11
-1
--
--
-
Radi
ogra
pher
Sanc
tion
-1
11
-1
--
1-
-
Vaca
nt-
--
--
--
--
--
Ad h
ock
--
--
-1
--
--
-
Tota
l in
Posi
tion
-1
11
--
--
1-
-
BEE
& C
ompu
ter
Sanc
tion
--
22
-2
--
--
-
Vaca
nt-
-1
1-
--
--
--
Ad h
ock
--
--
--
--
--
-
Tota
l in
Posi
tion
--
11
-2
--
--
-
MPW
/ Tr
aine
d Da
i
Sanc
tion
--
33
--
--
--
-
Vaca
nt-
--
--
--
--
--
Ad h
ock
--
--
--
--
--
-
Tota
l in
Posi
tion
--
33
--
--
--
-
Othe
rs (
Driv
er
Cook
)
Sanc
tion
--
--
-2
--
1-
-
Vaca
nt-
--
--
2-
--
--
Ad h
ock
--
--
--
--
--
-
Tota
l in
Posi
tion
--
--
--
--
1-
-
* Pl
aced
on
Depu
tati
on in
CH
C
LL S
taff
on
long
leav
e
Study to Review The Health Care Delivery System provided by PHSC, Punjab 233
Tab
le 3
.21
U
tilisati
on
of
User
Ch
arg
es in
dif
fere
nt
CH
C o
f P
HS
C (
Pu
nja
b)
Nam
e of
CH
CYe
ars
Tota
l Inc
ome
(Col
lect
ion)
Tota
l Ex
pend
itur
eDe
taile
d Ex
pend
itur
eRo
gi K
alay
an
Med
icin
eI.
F.P.
Build
ings
Equi
pmen
tER
F A\
cSa
lary
to
cont
ract
ual s
taff
Bada
l
2002
-03
5652
6464
4881
1270
3659
777
1783
247
650
-39
2586
2003
-04
3992
1147
0469
8357
551
130
1837
816
423
-23
7963
2004
-05
3485
7927
8619
8086
660
687
1580
911
391
-10
9866
2005
-06
3103
1723
5849
7205
448
060
1565
962
61-
9381
5
2006
-07
3687
9232
3920
6584
186
891
4742
917
888
1476
591
106
2007
-08
5332
0769
0227
1407
2718
2053
8734
811
0842
9123
1601
34
Tota
l25
,25,
370
25,8
0,96
55,
70,0
994,
88,5
982,
02,4
552,
10,4
5523
,888
10,8
5,47
0
Fate
h Ga
rh
Chur
ian
2003
-04
2150
0035
5131
1120
2311
2701
4880
672
215
-93
86-
2004
-05
4000
0043
4410
1598
5913
8416
4518
486
282
-46
33-
2005
-06
2804
2533
1667
1387
8090
569
3838
850
205
1372
500
0000
00
2006
-07
3665
2032
3200
8593
192
113
6007
475
812
9270
0000
0000
2007
-08
2192
4038
9692
1008
7014
0129
9395
3989
300
0000
0099
405
Tota
l14
8118
518
,34,
100
5,97
,499
5,73
,928
2,01
,847
3,24
,407
22,9
9514
,019
99,4
05
Fero
zsha
h
2004
-05
7021
347
001
1134
518
558
8337
8761
--
-
2005
-06
5834
442
493
2664
513
685
2080
83-
--
2006
-07
5126
321
298
6886
1000
035
2289
0-
--
2007
-08
3695
335
426
4658
1297
659
4459
04-
--
Tota
l2,
66,0
951,
79,2
1857
,465
75,5
7123
,468
16,7
70-
--
Goni
ana
2003
-04
2503
6680
1568
4291
9816
5769
9875
210
7849
--
-
2004
-05
7133
9154
3636
2189
8916
2089
2917
487
476
-45
908
-
2005
-06
6966
3674
4866
2788
5113
7195
3116
611
5240
6792
911
4485
-
2006
-07
9112
8667
4991
1672
4619
0755
2768
962
794
1265
07-
-
2007
-08
5628
0060
4410
1974
5610
2112
2150
093
508
1456
0344
231
1000
00
Tota
l35
5999
834
6947
113
9174
075
7920
2082
8146
6867
3400
3920
4624
1000
00
(Con
td..
.)
234 Study to Review The Health Care Delivery System provided by PHSC, Punjab
Nam
e of
CH
CYe
ars
Tota
l Inc
ome
(Col
lect
ion)
Tota
l Ex
pend
itur
eDe
taile
d Ex
pend
itur
eRo
gi K
alay
an
Med
icin
eI.
F.P.
Build
ings
Equi
pmen
tER
F A\
cSa
lary
to
cont
ract
ual s
taff
Kart
arpu
r
2003
-04
4317
6542
6968
2172
2116
9371
3104
993
27-
--
2004
-05
4503
1535
9099
1660
5715
3339
3787
618
27-
--
2005
-06
4788
4357
2262
3229
7315
0704
3281
334
387
--
-
2006
-07
4923
7341
3679
2111
4910
4888
5494
842
694
--
-
2007
-08
4749
5946
9563
2202
6858
670
1381
5252
473
--
-
Tota
l23
,28,
255
22,4
1,57
111
,37,
668
6,36
,972
2,94
,838
1,40
,708
--
-
Khem
kara
n
2003
-04
1034
4789
751
4399
830
681
8732
6340
000
1072
243
-
2004
-05
1302
7079
366
2978
720
491
1419
314
855
000
1260
697
-
2005
-06
1280
9798
388
4818
222
396
4745
2070
523
6084
4840
-
2006
-07
1617
1215
9780
4150
851
864
4876
914
430
3309
1907
024
-
2007
-08
2070
6824
1751
1080
7494
624
9228
2493
048
95-
Tota
l7,
30,5
946,
69,0
362,
71,5
492,
20,0
5685
,667
81,2
6010
,564
-
Long
owal
2003
-04
1242
2915
8285
3612
820
271
1204
312
043
-78
000
-
2004
-05
7906
579
434
3304
518
359
1101
511
015
-60
00-
2005
-06
6650
580
028
3601
320
007
1200
412
004
-00
00-
2006
-07
5489
565
543
2949
416
386
9831
9832
-00
00-
2007
-08
1645
6413
0702
5881
632
676
1960
519
605
-00
00-
Tota
l3,
89,2
585,
13,9
921,
93,4
961,
07,4
9964
,498
64,4
99-
84.0
00-
Mah
ilpur
2003
-04
2810
5521
5745
1066
3644
143
5765
073
16-
--
2004
-05
3661
5228
5383
1234
7797
184
5276
611
056
--
-
2005
-06
5193
938
2006
2106
7214
8645
9839
1285
0-
--
2006
-07
3227
1933
0901
1386
0814
3693
2907
919
521
--
-
2007
-08
NANA
NANA
NANA
--
-
Tota
l13
,21,
865
12,1
4,03
55,
80,2
934,
33,6
651,
49,3
3450
,743
--
-
(Con
td..
.)
Study to Review The Health Care Delivery System provided by PHSC, Punjab 235
Nam
e of
CH
CYe
ars
Tota
l Inc
ome
(Col
lect
ion)
Tota
l Ex
pend
itur
eDe
taile
d Ex
pend
itur
eRo
gi K
alay
an
Med
icin
eI.
F.P.
Build
ings
Equi
pmen
tER
F A\
cSa
lary
to
cont
ract
ual s
taff
Maj
itha
2003
-04
1355
1013
5119
4597
012
824
1125
517
070
-48
000
-
2004
-05
1829
3018
7379
5849
240
568
1571
723
037
-49
565
-
2005
-06
1846
7818
7891
8429
948
859
1198
220
660
3456
1913
5-
2006
-07
2887
3521
9896
7488
466
133
3927
932
305
7295
--
2007
-08
2667
7026
6790
1255
6757
703
3858
540
025
4910
--
Tota
l10
,58,
623
9,97
,075
3,89
,212
2,26
,087
1,16
,318
1,33
,097
15,6
611,
16,7
00-
Mac
hiw
ara
2003
-04
2507
1714
8554
5085
362
351
1430
621
044
--
2004
-05
3633
8432
5598
1537
0810
7985
4562
518
280
--
2005
-06
3185
8023
3467
1119
3591
636
1055
491
0738
2564
10-
2006
-07
2931
9322
7145
9849
766
777
1870
843
163
2799
--
2007
-08
4014
4240
4630
1303
9214
9071
1784
110
7326
1393
5-
-
Tota
l16
,27,
316
13,3
9,39
45,
45,3
854,
77,8
201,
07,0
341,
98,9
2020
,559
6,41
0-
Man
awal
a
2003
-04
NANA
NANA
NANA
NANA
2004
-05
3,29
,175
1,07
,777
1,02
,643
49,9
4964
,581
-4,
225
-
2005
-06
4,36
,904
1,79
,740
1,27
,786
14,8
011,
08,2
97-
6,28
0-
2006
-07
3,20
,209
1,22
,149
1,08
,489
34,4
5249
,541
-5,
578
-
2007
-08
5030
435,
32,9
642,
20,7
401,
37,2
6192
,839
66,9
75-
15,1
4910
0000
Tota
l16
,19,
252
6,30
,406
4,76
,179
1,92
,041
2,89
,394
-31
,232
1,00
,000
236 Study to Review The Health Care Delivery System provided by PHSC, Punjab
Ta
ble
4. D
istr
ibu
tio
n o
f In
pati
en
ts b
y S
ex, A
ge G
rou
p, E
du
cati
on
, In
co
me &
ty
pe o
f H
ealt
h F
acilit
y U
tilised
N=2
24
Soci
oeco
nom
ic d
imen
sion
of
inpa
tien
tDi
stri
ct H
ospi
tal
Sub-
Divi
sion
al H
ospi
tal
CHC
Spec
ial H
ospi
tal
TOTA
L
Age
grou
p
Less
tha
n 15
21.
9%0 0%
0 .0%
14.
5%3
1.3%
15-3
046
43.8
%37
54.4
%14
48.3
%15
68.2
%11
250
.0%
31-4
519
18.1
%17
25.0
%4
13.8
%5
22.7
%45
20.1
%
46-6
024
22.9
%6
8.8%
724
.1%
14.
5%38
17.0
%
Abov
e 60
1413
.3%
811
.8%
413
.8%
0 .0%
2611
.6%
Sex
Mal
e47
44.8
%30
44.1
%19
65.5
%2
9.1%
9843
.8%
Fem
ale
5855
.2%
3855
.9%
1034
.5%
2090
.9%
126
56.3
%
Educ
atio
n
Illit
erat
e45
42.9
%19
27.9
%12
41.4
%4
18.2
%80
35.7
%
Prim
ary
2321
.9%
1826
.5%
724
.1%
731
.8%
5524
.6%
Seco
ndar
y26
24.8
%24
35.3
%6
20.7
%3
13.6
%59
26.3
%
Seni
or s
econ
dary
98.
6%3
4.4%
413
.8%
418
.2%
20 8.9%
Grad
uate
21.
9%1
1.5%
0 .0%
29.
1%5
2.2%
> Gr
adua
te0 .0%
34.
4%0 .0%
29.
1%5
2.2%
(Con
td..
.)
Study to Review The Health Care Delivery System provided by PHSC, Punjab 237
Soci
oeco
nom
ic d
imen
sion
of
inpa
tien
tDi
stri
ct H
ospi
tal
Sub-
Divi
sion
al H
ospi
tal
CHC
Spec
ial H
ospi
tal
TOTA
L
Inco
me
grou
p
Less
tha
n 20
0041
39.0
%26
38.2
%16
55.2
%7
31.8
%90
40.2
%
2001
-500
047
44.8
%27
39.7
%9
31.0
%5
22.7
%88
39.3
%
5001
-100
0012
11.4
%11
16.2
%2
6.9%
627
.3%
3113
.8%
1000
1-15
000
43.
8%4
5.9%
13.
4%3
13.6
%12 5.4%
Abov
e 15
000
11.
0%0 .0%
13.
4%1
4.5%
31.
3%
238 Study to Review The Health Care Delivery System provided by PHSC, Punjab
Ta
ble
5. A
dm
issio
n In
Dif
fere
nt
Cate
go
ries o
f H
osp
itals
Soci
oeco
nom
ic d
imen
sion
of
inpa
tien
tDi
stri
ct H
ospi
tal
Sub-
Divi
sion
al H
ospi
tal
CHC
Spec
ial H
ospi
tal
TOTA
L
Adm
issi
on t
hrou
gh
Emer
genc
y55
52.4
%38
55.9
%16
55.2
%6
27.3
%11
551
.3%
OPD
4946
.7%
3044
.1%
1344
.8%
1672
.7%
108
48.2
%
Can’
t sa
y1
1.0%
0 .0%
0 .0%
0 .0%
1 .4%
Study to Review The Health Care Delivery System provided by PHSC, Punjab 239
Tab
le 6
. U
ser
Ch
arg
es f
or
Serv
ice
s in
Vari
ou
s H
osp
itals
in
Pu
nja
b
Paym
ent
Type
of
Hos
pita
lTo
tal
Dist
rict
Hos
pita
lSD
HCH
CSp
ecia
l Hos
pita
l
Slip
/car
d m
akin
g
Yes
9287
.6%
5885
.3%
2896
.6%
1986
.4%
197
87.9
%
No13
12.4
%9
13.2
%1
3.4%
313
.6%
2611
.6%
No r
espo
nse
0 .0%
11.
5%0 .0%
0 .0%
1 .4%
Cons
ulta
ncy
char
ges
Yes
98.
6%7
10.3
%3
10.3
%4
18.2
%23
10.3
%
No96
91.4
%60
88.2
%21
72.4
%18
81.8
%19
587
.1%
No r
espo
nse
0 .0%
11.
5%5
17.2
%0 .0%
62.
7%
Paym
ent
for
adm
issi
on c
harg
es
Yes
8984
.8%
4464
.7%
2379
.3%
2090
.9%
176
78.6
%
No16
15.2
%23
33.8
%6
20.7
%2
9.1%
4721
.0%
No r
espo
nse
0 .0%
11.
5%0 .0%
0 .0%
1 .4%
Paym
ent
for
inve
stig
atio
n ch
arge
s
Yes
8883
.8%
5885
.3%
2896
.6%
1986
.4%
193
86.2
%
No16
15.2
%8
11.8
%0 .0%
313
.6%
2712
.1%
No r
espo
nse
11.
0%2
2.9%
13.
4%0 .0%
41.
8%
Paym
ent
for
any
othe
r
Yes
2725
.7%
2232
.4%
1034
.5%
313
.6%
6227
.7%
No62
59.0
%39
57.4
%12
41.4
%16
72.7
%12
957
.6%
No r
espo
nse
1615
.2%
710
.3%
724
.1%
313
.6%
3314
.7%
240 Study to Review The Health Care Delivery System provided by PHSC, Punjab
Ta
ble
7. E
xp
eri
en
ce a
t O
PD
/em
erg
en
cy/r
ecep
tio
n/A
dm
issio
n, Q
uality
of
Tre
atm
en
t, S
ecu
rity
& A
dm
issio
n P
roced
ure
of
Vari
ou
s H
osp
itals
Rati
ng e
xper
ienc
eTy
pe o
f H
ospi
tal
Tota
l
Dist
rict
Hos
pita
lSu
b-Di
visi
onal
Hos
pita
lCH
CSp
ecia
l Hos
pita
l
OPD/
Emer
genc
y
Good
79
75.2
%56
82.4
%19
65.5
%20
90.9
%17
477
.7%
Aver
age
20
19.0
%9
13.2
%9
31.0
%2
9.1%
4017
.9%
Poor
1
1.0%
34.
4%0 .0%
0 .0%
41.
8%
Can’
t sa
y
43.
8%0 .0%
13.
4%0 .0%
52.
2%
No r
espo
nse
1
1.0%
0 .0%
0 .0%
0 .0%
1 .4%
Rece
ptio
n/ad
mis
sion
Good
87
82.9
%59
86.8
%20
69.0
%20
90.9
%18
683
.0%
Aver
age
13
12.4
%7
10.3
%8
27.6
%2
9.1%
3013
.4%
Poor
0 .0%
11.
5%0 .0%
0 .0%
1 .4%
Can’
t sa
y
43.
8%0 .0%
13.
4%0 .0%
52.
2%
No r
espo
nse
1
1.0%
11.
5%0 .0%
0 .0%
2 .9%
Qual
ity
of t
reat
men
t in
hos
pita
l
Good
85
81.0
%50
73.5
%21
72.4
%21
95.5
%17
779
.0%
Aver
age
16
15.2
%14
20.6
%7
24.1
%1
4.5%
3817
.0%
Poor
1
1.0%
34.
4%0 .0%
0 .0%
41.
8%
Can’
t sa
y
32.
9%1
1.5%
13.
4%0 .0%
52.
2% (Con
td..
.)
Study to Review The Health Care Delivery System provided by PHSC, Punjab 241
Rati
ng e
xper
ienc
eTy
pe o
f H
ospi
tal
Tota
l
Dist
rict
Hos
pita
lSu
b-Di
visi
onal
Hos
pita
lCH
CSp
ecia
l Hos
pita
l
Secu
rity
of
hosp
ital
Good
54
51.4
%26
38.2
%13
44.8
%11
50.0
%10
446
.4%
Aver
age
20
19.0
%11
16.2
%1
3.4%
731
.8%
3917
.4%
Poor
15
14.3
%14
20.6
%8
27.6
%1
4.5%
3817
.0%
Can’
t sa
y
1615
.2%
1725
.0%
724
.1%
313
.6%
4319
.2%
Rati
ng o
f ad
mis
sion
pr
oced
ure
of h
ospi
tal
Good
11
10.5
%3
4.4%
13.
4%1
4.5%
16 7.1%
Aver
age
12
11.4
%8
11.8
%3
10.3
%4
18.2
%27
12.1
%
Poor
77
73.3
%55
80.9
%25
86.2
%17
77.3
%17
477
.7%
242 Study to Review The Health Care Delivery System provided by PHSC, Punjab
Tab
le 8
. P
ati
en
t’s R
esp
on
ses o
n Q
uality
of
Serv
ices in
Term
s o
f G
en
era
l C
lean
lin
ess, B
asic
Su
pp
ort
Serv
ices in
Ward
in
Vari
ou
s H
ealt
h S
ett
ing
s
War
d &
bed
- Ge
nera
l cha
ract
eris
tics
Type
of
Hos
pita
lTo
tal
Dist
rict
Hos
pita
lSu
b-Di
visi
onal
Hos
pita
lCH
CSp
ecia
l Hos
pita
lN=
224
War
d &
bed
- Ge
nera
l cl
eanl
ines
s
Good
64
61.0
%41
60.3
%23
79.3
%21
95.5
%14
966
.5%
Aver
age
38
36.2
%24
35.3
%6
20.7
%1
4.5%
9944
.2%
Poor
3
2.9%
34.
4%0 .0%
0 .0%
31.
3%
War
d &
bed
- lin
en
Good
63
60.0
%43
63.2
%29
100.
0%19
86.4
%14
966
.5%
Aver
age
35
33.3
%19
27.9
%0 .0%
313
.6%
6930
.8%
Poor
7
6.7%
68.
8%0 .0%
0 .0%
62.
7%
War
d &
bed
- co
mfo
rt
Good
76
72.4
%45
66.2
%26
89.7
%19
86.4
%16
674
.1%
Aver
age
28
26.7
%21
30.9
%3
10.3
%3
13.6
%57
25.4
%
Poor
1
1.0%
22.
9%0 .0%
0 .0%
13 5.8%
War
d &
bed
- lig
ht
& f
an
Good
81
77.1
%53
77.9
%24
82.8
%20
90.9
%17
879
.5%
Aver
age
20
19.0
%15
22.1
%5
17.2
%2
9.1%
4218
.8%
Poor
4
3.8%
0 .0%
0 .0%
0 .0%
31.
3%
(Con
td..
.)
Study to Review The Health Care Delivery System provided by PHSC, Punjab 243
War
d &
bed
- Ge
nera
l cha
ract
eris
tics
Type
of
Hos
pita
lTo
tal
Dist
rict
Hos
pita
lSu
b-Di
visi
onal
Hos
pita
lCH
CSp
ecia
l Hos
pita
lN=
224
War
d &
bed
- to
ilet
Good
4441
.9%
3247
.1%
1655
.2%
1463
.6%
106
47.3
%
Aver
age
4038
.1%
1623
.5%
1137
.9%
731
.8%
7433
.0%
Poor
1918
.1%
1927
.9%
26.
9%0 .0%
4017
.9%
Can’
t sa
y2
1.9%
11.
5%0 .0%
14.
5%4
1.8%
War
d &
bed
- fo
od
Good
1716
.2%
811
.8%
724
.1%
418
.2%
3616
.1%
Aver
age
32.
9%3
4.4%
0 .0%
14.
5%7
3.1%
Poor
0 .0%
11.
5%0 .0%
0 .0%
1 .4%
Can’
t sa
y85
81.0
%56
82.4
%22
75.9
%17
77.3
%18
080
.4%
244 Study to Review The Health Care Delivery System provided by PHSC, Punjab
Ta
ble
9. P
ati
en
ts O
bserv
ati
on
ab
ou
t th
e B
eh
avio
ur
& A
ttit
ud
e o
f N
urs
es, D
octo
rs, S
taff
du
rin
g s
tay in
Ho
sp
ital
Type
of
Hos
pita
lTo
tal
Dist
rict
Hos
pita
lSu
b-Di
visi
onal
Hos
pita
lCH
CSp
ecia
l Hos
pita
l
Beha
viou
r of
nur
ses
duri
ng s
tay
in
hosp
ital
Good
9287
.6%
4667
.6%
2482
.8%
1881
.8%
180
80.4
%
Aver
age
1211
.4%
2130
.9%
26.
9%4
18.2
%39
17.4
%
Poor
11.
0%1
1.5%
26.
9%0 .0%
41.
8%
Can’
t sa
y0 .0%
0 .0%
13.
4%0 .0%
1 .4%
Beha
viou
r of
doc
tors
du
ring
sta
y in
ho
spit
al
Good
9792
.4%
6494
.1%
2793
.1%
2195
.5%
209
93.3
%
Aver
age
76.
7%3
4.4%
26.
9%1
4.5%
13 5.8%
Can’
t sa
y1
1.0%
11.
5%0 .0%
0 .0%
2 .9%
Beha
viou
r of
res
t of
st
aff
duri
ng s
tay
in
hosp
ital
Good
8278
.1%
4769
.1%
2069
.0%
1777
.3%
166
74.1
%
Aver
age
1918
.1%
1420
.6%
620
.7%
418
.2%
4319
.2%
Poor
11.
0%0 .0%
26.
9%1
4.5%
41.
8%
Can’
t sa
y3
2.9%
710
.3%
13.
4%0 .0%
11 4.9%
Atti
tude
of
sist
ers
at
adm
issi
on
Good
8480
.0%
4972
.1%
2275
.9%
1986
.4%
174
77.7
%
Aver
age
2019
.0%
1623
.5%
517
.2%
313
.6%
4419
.6%
Poor
0 .0%
11.
5%2
6.9%
0 .0%
31.
3%
Can’
t sa
y1
1.0%
22.
9%0 .0%
0 .0%
31.
3%
Study to Review The Health Care Delivery System provided by PHSC, Punjab 245
Tab
le 1
0.
Pati
en
t’s R
esp
on
ses o
n Q
uality
of
Serv
ices in
Term
s o
f A
vailab
ilit
y o
f M
ed
icin
es in
th
e W
ard
Lab
ora
tory
&
Rad
iolo
gic
al S
erv
ices
Type
of
Hos
pita
lTo
tal
Dist
rict
Hos
pita
lSu
b-Di
visi
onal
Hos
pita
lCH
CSp
ecia
l Hos
pita
l
Avai
labi
lity
of
med
icin
es in
the
w
ard
All a
vaila
ble
1312
.4%
68.
8%4
13.8
%7
31.8
%30
13.4
%
Som
e av
aila
ble
5451
.4%
3652
.9%
2172
.4%
1463
.6%
125
55.8
%
None
ava
ilabl
e36
34.3
%25
36.8
%3
10.3
%1
4.5%
6529
.0%
Can’
t sa
y2
1.9%
11.
5%1
3.4%
0 .0%
41.
8%
Faci
litie
s fo
r la
bora
tory
&
radi
olog
ical
in
vest
igat
ions
Good
6965
.7%
3754
.4%
1551
.7%
1986
.4%
140
62.5
%
Aver
age
2725
.7%
1522
.1%
1137
.9%
14.
5%54
24.1
%
Poor
11.
0%2
2.9%
0 .0%
0 .0%
31.
3%
Can’
t sa
y8
7.6%
1420
.6%
310
.3%
29.
1%27
12.1
%
Tab
le 1
1.
Pati
en
t’s R
esp
on
se in
Term
s o
f an
y M
on
ey S
pen
t o
n M
ed
icin
e
Any
mon
ey s
pend
on
med
icin
e
Yes
9893
.3%
6810
0.0%
2069
.0%
1881
.8%
204
91.1
%
No 7
6.7%
0 .0%
931
.0%
418
.2%
20 8.9%
Paid
any
mon
ey t
o st
aff
mem
ber
duri
ng
stay
in h
ospi
tal
Yes
0 .0%
11.
5%0 .0%
0 .0%
1 .4%
No10
510
0.0%
6798
.5%
2910
0.0%
2210
0.0%
223
99.6
%
246 Study to Review The Health Care Delivery System provided by PHSC, Punjab
Tab
le 1
2. P
ati
en
t’s R
esp
on
ses o
n Q
uality
of
Serv
ices in
Term
s o
f A
deq
uacy o
f In
form
ati
on
Ab
ou
t R
ule
s, R
eg
ula
tio
n, D
isease
& T
reatm
en
t In
Healt
h S
ett
ing
s
Type
of
Hos
pita
lTo
tal
Dist
rict
Hos
pita
lSu
b-Di
visi
onal
Hos
pita
lCH
CSp
ecia
l Hos
pita
l
Info
rmat
ion
abou
t ru
les
and
regu
lati
on
Yes
60
57.1
%38
55.9
%13
44.8
%11
50.0
%12
254
.5%
No 43
41.0
%30
44.1
%15
51.7
%11
50.0
%99
44.2
%
No r
espo
nse
2
1.9%
0 .0%
13.
4%0 .0%
31.
3%
Info
rmat
ion
abou
t di
seas
e &
tre
atm
ent
by d
octo
r
Com
plet
e
6965
.7%
4566
.2%
2482
.8%
1777
.3%
155
69.2
%
Part
ial
33
31.4
%16
23.5
%3
10.3
%3
13.6
%55
24.6
%
Inad
equa
te
11.
0%7
10.3
%1
3.4%
29.
1%11 4.9%
Can’
t sa
y
21.
9%0 .0%
13.
4%0 .0%
31.
3%
Tab
le 1
3.
Sati
sfa
cti
on
s o
f th
e P
ati
en
ts w
ith
Serv
ices o
f H
osp
ital at
the V
ari
ou
s H
ealt
h F
acilit
ies
Sati
sfac
tion
wit
h se
rvic
es o
f ho
spit
al
Yes
101
96.2
%59
86.8
%29
100.
0%22
100.
0%21
194
.2%
No4
3.8%
913
.2%
0 .0%
0 .0%
13 5.8%
Study to Review The Health Care Delivery System provided by PHSC, Punjab 247
Tab
le 1
4.
Su
gg
esti
on
s f
or
Fu
rth
er
Imp
rovem
en
t in
th
e S
erv
ices b
y t
he In
-pati
en
ts
S.N
oSu
gges
tion
s fo
r Im
prov
emen
t of
the
Ser
vice
s fo
r In
-pat
ient
Dep
artm
ent
N =
224
Perc
enta
ge
1.M
edic
ines
sho
uld
be a
vaila
ble
in t
he h
ospi
tal/
prov
ide
all m
edic
ines
.42
18.7
5
2.M
edic
ines
sho
uld
be p
rovi
ded
free
of
cost
or
subs
idis
e ra
te.
156.
7
3.H
ealt
h fa
cilit
ies
shou
ld b
e pr
ovid
ed f
ree
of c
ost
to B
PL/p
oor
fam
ilies
146.
25
4.Qu
alit
y of
med
icin
e sh
ould
be
impr
oved
, th
ose
are
supp
lied
by t
he h
ospi
tals
31.
34
5.Ne
eds
regu
lar
visi
ts o
f hi
gher
aut
hori
ties
for
day
-to-
day
wor
k of
the
hos
pita
ls/f
emal
e do
ctor
s/sp
ecia
list
shou
ld t
reat
gyn
ae. pr
oble
ms
&
doct
ors
shou
ld b
e av
aila
ble
in O
PD c
linic
on
fi xed
day
s.10
4.46
6.Do
ctor
s sh
ould
be
avai
labl
e in
hos
pita
ls a
t ni
ght
shif
ts/n
eeds
pro
per
care
at
nigh
t sh
ifts
in e
mer
genc
y.3
1.34
7.Be
havi
our
of s
taff
nur
ses
& c
lass
-IV
empl
oyee
s sh
ould
be
impr
oved
tow
ards
pat
ient
s.3
1.34
8.Ot
her
faci
litie
s ne
eds
to b
e im
prov
ed:
i) P
rovi
sion
of
food
for
the
pat
ient
s on
sub
sidi
se r
ate
ii) N
eeds
cle
anlin
ess
of t
oile
ts/s
epar
ate
toile
ts f
or m
ale
& f
emal
e.iii
) H
ospi
tal c
lean
lines
s.iv
) Dr
inki
ng w
ater
fac
iliti
es s
houl
d be
ava
ilabl
e /i
mpr
oved
.v)
All
diag
nost
ic f
acili
ties
for
tre
atm
ent
shou
ld b
e av
aila
ble
in t
he h
ospi
tals
on
subs
idis
e ra
te o
r fr
ee o
f co
st.
vi)
Prop
er S
ecur
ity
arra
ngem
ents
for
war
ds &
Hos
pita
l.vi
i) P
riva
te r
oom
s sh
ould
be
avai
labl
e in
hos
pita
ls f
or p
atie
nts
on p
aym
ent
basi
s/ne
eds
sitt
ing
arra
ngem
ents
& p
atie
nt’s
atte
ndan
ts.
12 15 11 5 4 4 4
5.36 6.7
4.91
2.23
1.79
1.79
1.79
9.Sa
tisfi
ed
wit
h th
e H
ealt
h Se
rvic
es.
94.
02
10No
res
pons
e11
250
248 Study to Review The Health Care Delivery System provided by PHSC, Punjab
Tab
le 1
5.
Dis
trib
uti
on
of
Ou
tpati
en
t b
y S
ex, A
ge G
rou
p, E
du
cati
on
, In
co
me a
nd
Typ
e o
f Facilit
y U
tilised
N=58
0
Type
of
Hos
pita
lTo
tal
Dist
rict
Hos
pita
lSu
b-Di
visi
onal
Hos
pita
lCH
CSp
ecia
l Hos
pita
l
Sex
Mal
e11
6 (4
0.8)
65(4
8.1)
57 (50)
6(1
2.8)
244
(42.
1)
Fem
ale
168
(59.
2)70
(51.
9)57 (50)
41(8
7.2)
336
(57.
9)
Age
Less
tha
n 15
15 (5.3
)6
(4.4
)2
(1.8
)12
(25.
5)35 (6.0
)
15-3
011
0(3
8.7)
46(3
4.1)
22(1
9.3)
26(5
5.3)
204
(35.
2)
31-4
586
(30.
3)36
(26.
7)43
(37.
7)6
(12.
8)17
1(2
9.5)
46-6
054 (19)
28(2
0.7)
29(2
5.4)
1(2
.1)
112
(19.
3)
Abov
e 60
19 (6.7
)19
(14.
1)18
(15.
8)2
(4.3
)58
(10.
0)
Educ
atio
n
Illit
erat
e82
(28.
9)52
(38.
5)56
(49.
1)12
(25.
5)20
2(3
4.8)
Prim
ary
65(2
2.9)
34(2
5.2)
18(1
5.8)
13(2
7.7)
130
(22.
4)
Seco
ndar
y80
(28.
2)26
(19.
3)19
(16.
7)8
(17.
0)13
3(2
2.9)
Seni
or S
econ
dary
30(1
0.6)
16(1
1.9)
13(1
1.4)
10(2
1.3)
69(1
1.9)
Grad
uate
19 (6.7
)5
(3.7
)5
(4.4
)4
(8.5
)33 (5.7
)
>Gra
duat
e8
(2.8
)2
(1.5
)3
(2.6
)0
(0.0
)13 (2.2
) (Con
td..
.)
Study to Review The Health Care Delivery System provided by PHSC, Punjab 249
Type
of
Hos
pita
lTo
tal
Dist
rict
Hos
pita
lSu
b-Di
visi
onal
Hos
pita
lCH
CSp
ecia
l Hos
pita
l
Inco
me
Less
tha
n 20
0085
(29.
9)49
(36.
3)52
(45.
6)11
(23.
4)19
7(3
4.0)
2001
-500
012
0(4
2.3)
42(3
1.1)
36(3
1.6)
22(4
6.8)
220
(37.
9)
5001
-100
0048
(16.
9)30
(22.
2)10 (8.8
)6
(12.
8)94
(16.
2)
1000
1-15
000
14 (4.9
)5
(3.7
)5
(4.4
)2
(4.3
)26 (4.5
)
Abov
e 15
000
16 (5.6
)6
(4.4
)2
(1.8
)5
(10.
6)29 (5.0
)
Don’
t Kn
ow1
(0.4
)3
(2.2
)9
(7.9
)1 (2.1
14 (2.4
)
250 Study to Review The Health Care Delivery System provided by PHSC, Punjab
Tab
le 1
6.
User
Ch
arg
es f
or
Serv
ices in
Vari
ou
s H
ealt
h C
are
Sett
ing
s
Type
of
Hos
pita
lTO
TAL
Dist
rict
Hos
pita
lSu
b-Di
visi
onal
Hos
pita
lCH
CSp
ecia
l Hos
pita
l
OPD
card
cha
rges
Yes
268
(94.
4)13
3(9
8.5)
106
(93.
0)43
(91.
5)55
0(9
4.8)
No16 (5.6
)2
(1.5
)8
(7.0
)4
(8.5
)30 (5.2
)
Cons
ulta
ncy
char
ges
Yes
13
(4.6
)5
(3.7
)4
(3.5
)6
(12.
8)28 (4.8
)
No26
9 (9
4.7)
130
(96.
3)10
9 (9
5.6)
41
(87.
2)54
9(9
4.7)
Can’
t sa
y2
(0.7
)0
(0.0
)1
(0.9
)0
(0.0
)3
(0.5
)
Inve
stig
atio
n ch
arge
s
Yes
196
(69.
0)97
(7
1.9)
81
(71.
1)32
(6
8.1)
406
(70.
0)
No82
(2
8.9)
33
(24.
4)29
(2
5.4)
15
(31.
9)15
9(2
7.4)
Can’
t sa
y6
(2.1
)5
(3.7
)4
(3.5
)0
(0.0
)15 (2.6
)
Mon
ey s
pent
on
med
icin
e
Up
to 1
0071
46.4
%27
17.6
%34
22.2
%21
13.7
%15
310
0.0%
101
- 20
068
51.5
%29
22.0
%26
19.7
%9
6.8%
132
100.
0%
201-
500
5859
.2%
2222
.4%
1111
.2%
77.
1%98
100.
0%
Abov
e 50
035
57.4
%12
19.7
%10
16.4
%4
6.6%
6110
0.0%
Study to Review The Health Care Delivery System provided by PHSC, Punjab 251
Tab
le 1
7. P
ati
en
ts O
bserv
ati
on
s a
bo
ut
Cle
an
lin
ess, B
asic
Su
pp
ort
Serv
ices a
nd
Pri
vacy D
uri
ng
Exam
inati
on
in
Vari
ou
s
Healt
h C
are
Sett
ing
s in
Pu
nja
b
Type
of
Hos
pita
lTO
TAL
Dist
rict
Hos
pita
lSu
b-Di
visi
onal
Hos
pita
lCH
CSp
ecia
l Hos
pita
l
Gene
ral c
lean
lines
s
Good
210
(73.
9)96
(71
.1)
73 (
64.0
)41
(87
.2)
420
(72.
4)
Aver
age
65 (
22.9
)37
(27
.4)
39 (
34.2
)6
(12.
8)14
7 (2
5.3)
Poor
7 (2
.5)
0 (0
.0)
2 (1
.8)
0 (0
.0)
9 (1
.6)
Cann
ot s
ay2
(0.7
)2
(1.5
)0
(0.0
)0
(0.0
)4
(0.7
)
Wai
ting
are
a
Good
235
(82.
7)10
4 (7
7.0)
68 (
59.6
)44
(93
.6)
451
(77.
8)
Aver
age
45 (
15.8
)28
(20
.7)
42 (
36.8
)3
(6.4
)11
8 (2
0.3)
Poor
2 (0
.7)
0 (0
.0)
3 (2
.6)
0 (0
.0)
5 (0
.9)
Cann
ot s
ay2
(0.7
)3
(2.2
)1
(0.9
)0
(0.0
)6
(1.0
)
Ligh
t an
d fa
n
Good
225
(79.
2)11
3 (8
3.7)
59 (
51.8
)42
(89
.4)
439
(75.
7)
Aver
age
52 (
18.3
)18
(13
.3)
32 (
28.1
)5
(10.
6)10
7 (1
8.4)
Poor
3 (1
.1)
1 (0
.7)
22 (
19.3
)0
(0.0
)26
(4.
5)
Cann
ot s
ay4
(1.4
)3
(2.2
)1
(0.9
)0
(0.0
)8
(1.4
)
STD/
PCO
Boot
h
Yes
138
(48.
6)71
(52
.6)
19 (
16.7
)22
(46
.8)
250
(43.
1)
No13
5 (4
7.5)
54 (
40.0
)84
(73
.7)
25 (
53.2
)29
8 (5
1.4)
Can’
t sa
y11
(3.
9)10
(7.
4)11
(9.
6)0
(0.0
)32
(5.
5)
Sepa
rate
toi
let
for
wom
en
Yes
250
(88.
0)11
6 (8
5.9)
87 (
76.3
)46
(97
.9)
499
(86.
0)
No27
(9.
5)16
(11
.9)
15 (
13.2
)1
(2.1
)59
(10
.2)
Cann
ot s
ay7
(2.5
)3
(2.2
)12
(10
.5)
0 (0
.0)
22 (
3.8)
Drin
king
Wat
er
Yes
250
(88.
0)13
1 (9
7.0)
89 (
78.1
)47
(10
0.0)
517
(89.
1)
No31
(10
.90)
4 (3
.0)
16 (
14.0
)0
(0.0
)51
(8.
8)
Cann
ot s
ay3
(1.1
)0
(0.0
)9
(7.9
)0
(0.0
)12
(2.
1)
Confi
den
tial
ity
(scr
eene
d ex
amin
atio
n ro
om)
Yes
245
(86.
3)11
9 (8
8.1)
95 (
83.3
)47
(10
0.0)
506
(87.
2)
No34
(12
.0)
13 (
9.6)
5 (4
.4)
0 (0
.0)
52 (
9.0)
Cann
ot s
ay5
(1.8
)3
(2.2
)14
(12
.3)
0 (0
.0)
22 (
3.8)
252 Study to Review The Health Care Delivery System provided by PHSC, Punjab
Tab
le 1
8.
Qu
ality
of
Serv
ices in
Term
s o
f A
deq
uacy o
f In
form
ati
on
, A
vailab
ilit
y o
f M
ed
icin
e, Lab
ora
tory
Serv
ices,
Beh
avio
ur
of
Sta
ff
Type
of
Hos
pita
lTo
tal
Dist
rict
Hos
pita
lSu
b-Di
visi
onal
Hos
pita
lCH
CSp
ecia
l Hos
pita
l
Adeq
uacy
of
info
rmat
ion
give
n to
pat
ient
abo
ut
dise
ase
and
trea
tmen
t by
do
ctor
Good
244(
85.9
)10
6 (7
8.5)
82(7
1.9)
40(8
5.1)
472
(81.
4)
Aver
age
31(1
0.9)
17(1
2.6)
26(2
2.8)
5(10
.6)
79 (
13.6
)
Poor
3(1.
1)7(
5.2)
2(1.
8)2
(4.3
)14
(2.4
)
Can
not
say
6(2.
1)5(
3.7)
4(3.
5)0(
0.0)
15(2
.6)
Avai
labi
lity
of m
edic
ines
All a
vaila
ble
17(6
.0)
23(1
7.0)
16(1
4.0)
4(8.
5)60
(10.
3)
Som
e av
aila
ble
154(
54.2
)92
(68.
1)83
(72.
8)35
(74.
5)36
4(62
.8)
None
ava
ilabl
e 11
1(39
.1)
19(1
4.1)
15(1
3.2)
8(17
.0)
153(
26.4
)
No r
espo
nse
2(0.
7)1(
0.7)
0(0.
0)0(
0.0)
3(0.
5)
Faci
litie
s fo
r la
bora
tory
and
ra
diol
ogic
al in
vest
igat
ion
Good
15
3(53
.9))
70(5
1.9)
41(3
6.0)
30(6
3.8)
294(
50.7
)
Aver
age
66(2
3.2)
23(1
7.0)
37(3
2.5)
2(4.
3)12
8(22
.1)
Poor
4(
1.4)
3(2.
2)4(
3.5)
0(0.
0)11
(1.9
)
Can
not
say
61(2
1.5)
39(2
8.9)
32(2
8.1)
15(3
1.9)
147(
25.3
)
Beha
viou
r of
res
t of
the
st
aff?
Good
15
9(56
.0)
81(6
0.0)
57(5
0.0)
33(7
0.2)
330(
56.9
)
Aver
age
98(3
4.5)
41(3
0.4)
46(4
0.4)
3(6.
4)18
8(32
.4)
Poor
5(
1.8)
)4(
3.0)
1(0.
9)1(
2.1)
11(1
.9)
Can
not
say
22(7
.7)
9(6.
7)10
(8.8
)10
(21.
3)51
(8.8
)
Paym
ent
to a
ny s
taff
m
embe
r
Yes
9(3.
2)4(
3.0)
3(2.
6)1(
2.1)
17(2
.9)
No
275(
96.8
)13
1(97
.0)
111(
97.4
)46
(97.
9)56
3(97
.1)
Rati
ng t
he q
ualit
y of
tr
eatm
ent
in t
he h
ospi
tal
Good
22
3(78
.5)
104(
77.0
)69
(60.
5)44
(93.
6)44
0(75
.9)
Aver
age
53(1
8.7)
25(1
8.5)
41(3
6.0)
3(6.
4)12
2(21
.0)
Poor
5(
1.8)
3(2.
2)0(
0.0)
0(0.
0)8(
1.4)
Can
not
say
3(1.
1)3(
2.2)
4(3.
5)0(
0.0)
10(1
.7)
(Con
td..
.)
Study to Review The Health Care Delivery System provided by PHSC, Punjab 253
Type
of
Hos
pita
lTo
tal
Dist
rict
Hos
pita
lSu
b-Di
visi
onal
Hos
pita
lCH
CSp
ecia
l Hos
pita
l
Beha
viou
r of
res
t of
the
st
aff?
Good
15
9(56
.0)
81(6
0.0)
57(5
0.0)
33(7
0.2)
330(
56.9
)
Aver
age
98(3
4.5)
41(3
0.4)
46(4
0.4)
3(6.
4)18
8(32
.4)
Poor
5(
1.8)
)4(
3.0)
1(0.
9)1(
2.1)
11(1
.9)
Can
not
say
22(7
.7)
9(6.
7)10
(8.8
)10
(21.
3)51
(8.8
)
Sati
sfac
tion
wit
h th
e se
rvic
es o
f th
e ho
spit
al
Yes
223(
78.5
)10
8(80
.0)
91(7
9.8)
30(6
3.8)
452(
77.9
)
No61
(21.
5)27
(20.
0)23
(20.
2)17
(36.
2)12
8(22
.1)
254 Study to Review The Health Care Delivery System provided by PHSC, Punjab
Tab
le 1
9.
Pati
en
ts’ O
bserv
ati
on
s R
eg
ard
ing
Healt
h M
an
Po
wer
in V
ari
ou
s H
ea
lth
Care
Sett
ing
s in
Pu
nja
b
Type
of
Hos
pita
l
Dist
rict
Hos
pita
lSu
b-Di
visi
onal
Hos
pita
lCH
CSp
ecia
l Hos
pita
l
Coop
erat
ion
at t
he r
ecep
tion
of
the
coun
ter
Good
225
(79.
2)10
4 (7
7.0)
80 (
70.2
)44
(93
.6)
Aver
age
50 (
17.6
)30
(22
.2)
33 (
28.9
)3
(6.4
)
Poor
5 (1
.8)
1 (0
.7)
1 (0
.9)
0 (0
.0)
Can
not
say
4 (1
.4)
0 (0
.0)
0 (0
.0)
0 (0
.0)
Avai
labi
lity
of d
octo
rsAv
aila
ble
270
(95.
1)13
2 (9
7.8)
102
(89.
5)46
(97
.9)
Not
avai
labl
e14
(4.
9)3
(2.2
)12
(10
.5)
1 (2
.1)
Avai
labi
lity
of s
peci
alis
tsAv
aila
ble
256
(90.
1)11
6 (8
5.9)
74 (
64.9
)43
(91
.5)
Not
avai
labl
e28
(9.
9)19
(14
.1)
40 (
35.1
)4
(8.5
)
Avai
labi
lity
of n
urse
sAv
aila
ble
229
(80.
6)10
4 (7
7.0)
89 (
78.1
)36
(76
.6)
Not
avai
labl
e55
(19
.4)
31 (
23.0
)25
(21
.9)
11 (
23.4
)
Beha
viou
r of
doc
tors
Good
264
(93.
0)12
4 (9
1.9)
98 (
86.0
)44
(93
.6)
Aver
age
16 (
5.6)
9 (6
.7)
13 (
11.4
)3
(6.4
)
Poor
1 (0
.4)
0 (0
.0)
0 (0
.0)
0 (0
.0)
Can
not
say
3 (1
.1)
2 (1
.5)
3 (2
.6)
0 (0
.0)
Beha
viou
rs o
f sp
ecia
lists
Good
245
(86.
3)10
6 (7
8.5)
66 (
57.9
)41
(87
.2)
Aver
age
13 (
4.6)
10 (
7.4)
12 (
10.5
)3
(6.4
)
Poor
3 (1
.1)
0 (0
.0)
0 (0
.0)
0 (0
.0)
Can
not
say
23 (
8.1)
19 (
14.1
)36
(31
.6)
3 (6
.4)
Beha
viou
r of
nur
ses
Good
179
(63.
0)84
(62
.2)
78 (
68.4
)33
(70
.2)
Aver
age
41 (
14.4
)21
(15
.6)
16 (
14.0
)4
(8.5
)
Poor
3 (1
.1)
2 (1
.5)
1 (0
.9)
0 (0
.0)
Can
not
say
61 (
21.5
)28
(20
.7)
19 (
16.7
)10
(21
.3)
Study to Review The Health Care Delivery System provided by PHSC, Punjab 255
Tab
le 2
0. W
ait
ing
Tim
e f
or
Reg
istr
ati
on
, C
on
su
ltati
on
wit
h D
octo
rs a
nd
Sp
ecia
list,
In
vesti
gati
on
s a
nd
Receiv
ing
Med
icin
es
Type
of
Hos
pita
lTO
TAL
Dist
rict
Hos
pita
lSu
b-Di
visi
onal
Hos
pita
lCH
CSp
ecia
l Hos
pita
l
Regi
stra
tion
tim
e
Up
to 1
5 m
inut
es23
583
.6%
123
91.1
%10
995
.6%
4595
.7%
512
88.7
%
16 -
30
min
utes
3512
.5%
10 7.4%
54.
4%2
4.3%
52 9.0%
Abov
e 30
min
utes
11 3.9%
21.
5%13 2.3%
Tota
lCo
unt
Col %
281
100.
0%13
510
0.0%
114
100.
0%47
100.
0%57
710
0.0%
Spec
ialis
t co
nsul
ting
ti
me
Up
to 1
5 m
inut
es89
55.6
%63
79.7
%36
72.0
%13
46.4
%20
163
.4%
16 -
30
min
utes
3823
.8%
1316
.5%
1326
.0%
828
.6%
7222
.7%
Abov
e 30
min
utes
3320
.6%
33.
8%1
2.0%
725
.0%
4413
.9%
Tota
lCo
unt
Col %
160
100.
0%79
100.
0%50
100.
0%28
100.
0%31
710
0.0%
Inve
stig
atio
n ti
me
Up
to 3
0 m
inut
es17
380
.5%
7291
.1%
7386
.9%
2978
.4%
347
83.6
%
31 -
60
min
utes
2411
.2%
45.
1%7
8.3%
616
.2%
41 9.9%
Abov
e 60
min
utes
18 8.4%
33.
8%4
4.8%
25.
4%27 6.5%
Tota
lCo
unt
Col %
215
100.
0%79
100.
0%84
100.
0%37
100.
0%41
510
0.0%
Tim
e ge
ttin
g m
edic
ine
Up
to 1
0 m
inut
es13
474
.0%
8581
.0%
9490
.4%
3286
.5%
345
80.8
%
11 -
20
min
utes
3921
.5%
1413
.3%
65.
8%5
13.5
%64
15.0
%
Abov
e 20
min
utes
84.
4%6
5.7%
43.
8%18 4.2%
Tota
lCo
unt
Col %
181
100.
0%10
510
0.0%
104
100.
0%37
100.
0%42
710
0.0%
256 Study to Review The Health Care Delivery System provided by PHSC, Punjab
Tab
le 2
1. P
ati
en
t’s E
xp
eri
en
ce (
Rati
ng
) at
OP
D o
f V
ari
ou
s H
ealt
h C
are
Sett
ing
s
N=58
0
Type
of
Hos
pita
lTo
tal
Dist
rict
Hos
pita
lSu
b-Di
visi
onal
Hos
pita
lCH
CSp
ecia
l Hos
pita
l
Good
203
(71.
5)98
(72
.6)
65 (
57.0
)40
(85
.1)
406
(70.
0)
Aver
age
75 (
26.4
)32
(23
.7)
45 (
39.5
)7
(14.
9)15
9 (2
7.4)
Poor
3 (1
.1)
4 (3
.0)
1 (0
.9)
0 (0
.0)
8 (1
.4)
Can’
t sa
y3
(1.1
)1
(0.7
)3
(2.6
)0
(0.0
)7
(1.2
)
Study to Review The Health Care Delivery System provided by PHSC, Punjab 257
Tab
le 2
2.
Su
gg
esti
on
s f
or
Fu
rth
er
Imp
rovem
en
t in
th
e S
erv
ices
Type
of
Hos
pita
lTO
TAL
Dist
rict
Hos
pita
lSu
b-Di
visi
onal
Hos
pita
lCH
CSp
ecia
l Hos
pita
l
No s
ugge
stio
n82
(29.
0)33
(24.
6)30
(26.
8)18
(38.
3)16
3(2
8.3)
Pro
vide
all
med
icin
e at
leas
t to
poo
r pe
ople
151
(53.
4)58
(43.
3)56
(50.
0)26
55.3
%29
150
.5%
Prop
er s
uper
visi
on o
f hi
gher
offi
cial
s2
(0.7
)0 .0%
1 .9%
0 .0%
3 .5%
Pro
per
care
/ em
erge
ncy
care
sho
uld
be
prov
ided
7(2
.5)
75.
2%6
5.4%
12.
1%21 3.6%
Pro
vide
mor
e do
ctor
s or
spe
cial
ists
10 (3.5
)14
10.4
%13
11.6
%0 .0%
37 6.4%
Cle
anlin
ess
20 (7.1
)7
5.2%
0 .0%
12.
1%28 4.9%
Pro
visi
on o
f fe
mal
e do
ctor
s0
(0.0
)2
1.5%
0 .0%
0 .0%
2 .3%
Pu
nctu
alit
y of
sta
ff s
houl
d be
mai
ntai
ned
0(0
.0)
21.
5%1 .9%
0 .0%
3 .5%
Goo
d be
havi
our
of s
taff
1(0
.4)
21.
5%0 .0%
12.
1%4 .7%
Pro
vide
mor
e st
aff
1 .4%
1 .7%
0 .0%
0 .0%
2 .3%
Pro
visi
on f
or f
emal
e pr
ivac
y2 .7%
0 .0%
0 .0%
0 .0%
2 .3%
Sat
isfi e
d w
ith
pres
ent
cond
itio
n4
1.4%
86.
0%1 .9%
0 .0%
13 2.3%
Sho
uld
get
cost
ly m
edic
ines
1 .4%
0 .0%
32.
7%0 .0%
4 .7%
Pro
visi
on o
f fo
od2
(0.7
)0 .0%
1 .9%
0 .0%
3 .5%
258 Study to Review The Health Care Delivery System provided by PHSC, Punjab
Typ
e o
f H
ealt
h In
sti
tute
= D
istr
ict
Ho
sp
ital
Regi
stra
tion
tim
eDo
ctor
s co
nsul
ting
ti
me
Spec
ialis
ts c
onsu
ltin
g ti
me
Inve
stig
atio
ns t
ime
Tim
e in
get
ting
m
edic
ines
Mon
ey s
pent
to
buy
med
icin
e
Mea
n12
.19
30.4
822
.24
29.9
19.
5244
9.77
Med
ian
10.0
025
.00
12.5
020
.00
10.0
020
0.00
Mod
e10
300
3010
150
Std.
Dev
iati
on13
.005
27.4
8123
.133
32.9
197.
375
1378
.487
Rang
e10
420
912
030
750
1300
0
Min
imum
11
00
00
Max
imum
105
210
120
307
5013
000
Typ
e o
f H
ealt
h In
sti
tute
= S
ub
-Div
isio
nal H
osp
ital
Stat
isti
csRe
gist
rati
on t
ime
Doct
ors
cons
ulti
ng
tim
eSp
ecia
lists
con
sult
ing
tim
eIn
vest
igat
ions
tim
eTi
me
in g
etti
ng
med
icin
esM
oney
spe
nt t
o bu
y m
edic
ine
Mea
n8.
0917
.21
11.9
921
.67
9.50
245.
56
Med
ian
5.00
10.0
010
.00
15.0
010
.00
200.
00
Mod
e5
510
3010
200
Std.
Dev
iati
on7.
581
19.8
7515
.931
27.2
088.
266
226.
589
Rang
e44
120
120
180
6012
60
Min
imum
10
00
020
Max
imum
4512
012
018
060
1280
Study to Review The Health Care Delivery System provided by PHSC, Punjab 259
Typ
e o
f H
ealt
h In
sti
tute
= C
HC
Stat
isti
csRe
gist
rati
on t
ime
Doct
ors
cons
ulti
ng
tim
eSp
ecia
lists
con
sult
ing
tim
eIn
vest
igat
ions
tim
eTi
me
in g
etti
ng
med
icin
esM
oney
spe
nt t
o bu
y m
edic
ine
Mea
n6.
6818
.37
11.4
019
.71
7.47
216.
67
Med
ian
5.00
10.0
010
.00
10.0
05.
0015
0.00
Mod
e5
100
55
200
Std.
Dev
iati
on5.
112
18.0
1713
.288
27.3
015.
951
220.
623
Rang
e29
119
6015
030
999
Min
imum
11
00
01
Max
imum
3012
060
150
3010
00
Typ
e o
f H
ealt
h In
sti
tute
= S
pecia
l H
osp
ital
Stat
isti
csRe
gist
rati
on t
ime
Doct
ors
cons
ulti
ng
tim
eSp
ecia
lists
con
sult
ing
tim
eIn
vest
igat
ions
tim
eTi
me
in g
etti
ng
med
icin
esM
oney
spe
nt t
o bu
y m
edic
ine
Mea
n7.
2618
.87
26.2
526
.14
8.59
195.
93
Med
ian
5.00
12.5
020
.00
20.0
010
.00
100.
00
Mod
e5
515
3010
100
Std.
Dev
iati
on4.
623
17.6
4218
.540
19.4
054.
524
186.
691
Rang
e19
5755
7819
988
Min
imum
13
52
112
Max
imum
2060
6080
2010
00
260 Study to Review The Health Care Delivery System provided by PHSC, Punjab
Tab
le 2
3. R
esp
on
ses o
f th
e D
ep
uty
Co
mm
issio
ners
Faci
lity/
Nam
e of
the
Di
stri
ctAm
rits
arBa
thin
daFe
rozp
urGu
rdas
pur
Jala
ndha
rLu
dhia
naM
ukts
arSa
ngru
rTa
ran
Ta
Leng
th o
f se
rvic
e5
mon
ths
8 m
onth
s1
yrs.
2 m
onth
s<
2 yr
s.<
2 yr
s.1
yrs.
1 yr
.5
mon
ths
Over
all f
unct
ioni
ng o
f CH
C, S
DH a
nd D
HO.
KAv
erag
eNo
t w
ell
Good
Can’
t sa
yGo
odOK
Lack
of
doct
ors
Good
Avai
labi
lity
of s
taff
-Sh
orta
ge o
f st
aff
Shor
tage
of
staf
fSh
orta
ge o
f st
aff
--
Shor
tage
of
staf
fLa
ck o
f do
ctor
sSh
orta
ge o
f st
aff
Exte
nt o
f fu
lfi lm
ent
of h
ealt
h ne
eds
of
com
mun
ity
50%
Part
ially
70 -
80%
Good
Can’
t sa
yLa
rge
Not
Good
Larg
e Ex
tent
40%
Refe
rral
ser
vice
s No
Ide
aNo
n-av
aila
bilit
y is
a p
robl
emAm
bula
nce
not
fully
equ
ippe
dNo
t Go
odCa
n’t
say
Yes
Not
Good
Sati
sfac
tory
Sati
sfac
tory
Know
ledg
e of
RKS
BPL
Card
sYe
sYe
sYe
s-
-Ye
sNo
Yes
Fund
fl o
wNo
pro
blem
Not
thro
ugh
DC-
Not
full
utili
sed
Inad
equa
te-
-No
pro
blem
Not
thro
ugh
D.C.
Poor
pat
ient
s ex
empt
fr
om U
ser
Char
ges
BPL
Card
ho
lder
sRe
d Cr
oss
Yes
Yes
part
ially
-BP
L Ca
rds
Yes
part
ially
Red
Cros
sYe
s
Mot
ivat
ion
Leve
l-
Very
low
Good
Good
--
Good
Not
low
Low
Perc
eive
d Ba
rrie
rs
Avai
labi
lity
Nil
Nil
Nil
Nil
Yes
-Ye
sNi
l↓
CHC
Acce
ssib
ility
Nil
Nil
Nil
Nil
Yes
-Ye
sN
il↓
CHC
Utili
sati
onNi
lNi
lNi
lNi
lYe
s-
No↓
↓ CH
C
Acce
ptab
ility
Nil
Nil
Nil
Nil
Yes
-No
↓↓
CHC
Study to Review The Health Care Delivery System provided by PHSC, Punjab 261
Tab
le 2
4. R
esp
on
ses o
f th
e M
LA
/ele
cte
d R
ep
resen
tati
ve a
t D
istr
ict
Level
Amri
tsar
Bath
inda
Fero
zpur
Gurd
aspu
rH
oshi
arpu
rJa
land
har
Ludh
iana
Muk
tsar
Sang
rur
Tara
n Ta
Leng
th o
f se
rvic
e>
2 yr
s.-
>2 y
rs.
1.5
yrs.
1 yr
.1.
5 yr
s.>2
yr
s.>
2 yr
s.>
2 yr
s.>
2 yr
s.
Over
all f
unct
ioni
ng
Good
Aver
age
Sati
sfac
tory
OKAv
erag
eGo
odGo
odW
ell
Poor
in C
HC
Not
very
goo
d
Avai
labi
lity
of s
taff
Yes
Doct
ors
post
va
cant
Shor
tage
of
D&N
Shor
tage
Som
etim
esSc
arci
tyYe
s, B
ut
shor
tage
of
Doct
ors
Less
in n
o.No
doc
tors
Yes
Avai
labi
lity
of M
edic
ines
in
OPD
NoNo
Yes
Less
NoSo
me
Yes
Not
enou
ghNo
t en
ough
NoSo
me
Over
all s
ervi
ces
of
Hos
pita
lO.
K.Av
erag
eSa
tisf
acto
ryAv
erag
e-
Good
Aver
age
Gyna
e-Ba
dSa
tisf
acto
ryAv
erag
e
Exte
nt o
f fu
lfi lm
ent
of h
ealt
h ne
eds
of
Com
mun
ity
80%
30%
Good
no.
60%
Only
poo
r us
e it
< 50
%To
som
e ex
tent
60%
60-7
0%40
%
Wai
ting
Tim
e2
- 5
min
s.No
t m
uch
20-3
0 m
ins.
2-3
hrs.
Not
muc
h2-
3 hr
s.30
-60
min
s.No
t m
uch
Not
muc
hNo
t m
uch
Clea
nlin
ess
Good
Not
prop
erGo
odGo
odO.
K.Go
odGo
odNo
t go
odSa
tisf
acto
ryGo
od
Beha
viou
r of
sta
ff
Good
Not
sati
sfac
tory
Good
Good
Fine
Rude
Nur
ses
& C
lass
IV
Good
OKVe
ry G
ood
Good
Refe
rral
ser
vice
s No
pro
blem
-Sa
tisf
acto
ryN.
A.No
t go
odSc
arci
ty o
f Am
bula
nce
Yes
Not
avai
labl
eVe
ry G
ood
No a
mbu
lanc
e
Know
ledg
e of
RKS
Yes
NoYe
sYe
sNo
Yes
BPL
Card
s Ye
s.No
NoNo
Poor
pat
ient
s ex
empt
ed
from
tre
atm
ent
char
ges
Yes
-Ye
sYe
sNo
NoNo
Red
Cros
s Fu
nds
From
NGO
s-
Perc
eive
d Ba
rrie
rs
Avai
labi
lity
Nil
Nil
Nil
Nil
Nil
Less
Med
icin
eNi
lAm
bula
nce
Serv
ice
Nil
Nil
Acce
ssib
ility
Nil
Nil
Nil
Refe
rral
Requ
ires
mon
eyNi
lNi
lNi
lNi
lNi
l
Utili
sati
onNi
lNi
lNi
lM
edic
ines
Med
icin
es n
ot
avai
labl
eSc
arci
ty o
f M
edic
ine
-Le
ss f
acili
ties
↓ CH
C↓
Acce
ptab
ility
Nil
Nil
Nil
Nil
Nil
Non
avai
labi
lity
of
equi
pmen
ts
-Ni
l↓
CHC
↓
262 Study to Review The Health Care Delivery System provided by PHSC, Punjab
Tab
le 2
5: R
esp
on
ses o
f th
e C
ivil S
urg
eo
ns
Amri
tsar
Bath
inda
Fero
zpur
Gurd
aspu
rH
oshi
arpu
rJa
land
har
Ludh
iana
Muk
tsar
Sang
rur
Tara
n Ta
ran
Leng
th o
f se
rvic
e<1
yea
r2
year
s1.
5 ye
ars
-1.
5 ye
ars
1.5
year
s2.
5 m
onth
s2
mon
ths
-1.
5 ye
ars
Over
all f
unct
ioni
ng o
f CH
C, S
DH a
nd D
HOP
D -
O.K,
In
door
- Pr
oble
m
Over
uti
lised
Wel
lW
ell
CHC-
poor
DH
-Go
odEx
cept
CH
C re
st w
ell
Wel
lCH
C OP
D la
cks
man
pow
er
rest
O.K
.
Not
fully
Ut
ilise
dCH
C-Av
erag
e, S
DH-
Good
, DH
-New
, co
min
g up
Bed
Occu
panc
y (%
)
CHC
5050
-10
- 1
5%-
6050
2050
40
SDH
5070
-10
0%50
.870
.890
9080
.990
D.H
.50
100
-10
0%50
.870
8710
080
.990
Exte
nt o
f fu
lfi lm
ent
of h
ealt
h ne
eds
of
Com
mun
ity
Full
60%
50 -
60%
Sati
sfac
tory
Larg
e ex
tent
Not
fulfi
lled
at V
illag
e le
vel
90%
70%
60 -
70%
Larg
e ex
tent
Med
icin
e in
OPD
Ye
sNo
NoNo
Yes
NoNo
NoNo
No
Wai
ting
Tim
eNi
lLe
ssLo
ngLe
ssLo
ngLo
ngLe
ssLo
ngLo
ngLe
ss
Clea
nlin
ess
Not
prop
erNo
t go
odGo
odVe
ry G
ood
Good
Not
good
Good
O.K.
Not
clea
nAv
erag
e
Beha
viou
r of
sta
ff
Over
wor
k le
ads
to
irri
tati
on
Good
Good
Doct
ors
- Go
odNu
rses
-O.K
Good
Sati
sfac
tory
Cord
ial
Good
Aver
age
Need
s im
prov
emen
t
Refe
rral
ser
vice
s No
dri
ver,
only
1
ambu
lanc
e
Sati
sfac
tory
Not
good
No p
robl
emGo
odAm
bula
nce
shor
tage
-Le
ss n
o. o
f am
bula
nce
Ambu
lanc
e w
ith
paym
ent
Sati
sfac
tory
Fund
fl ow
No p
robl
emOn
ly u
ser
char
ges
User
cha
rges
No p
robl
emNo
fun
dsNo
pro
blem
-Sl
ight
del
ayNo
pro
blem
Only
und
er N
RHM
Man
pow
er M
anag
emen
t
Mot
ivat
ion
leve
lLo
wGo
odSa
tisf
acto
ryV.
Good
O.K.
Low
Good
Good
Low
Low
Perc
eive
d Ba
rrie
rs
Avai
labi
lity
Nil
CHC
±Ni
lNi
l-
Nil
Nil
Lack
of
Man
pow
er in
SD
H &
CH
C
O.K.
O.K.
Acce
ssib
ility
Nil
Nil
Nil
Nil
-Ni
lNi
lYe
sNi
l↓
CHC
Uti
lisat
ion
Nil
↓ CH
CNi
lNi
l-
Nil
Med
icin
e fa
cilit
yNo
O.K.
↓ CH
C
Acce
ptab
ility
Nil
↓ CH
CNi
lNi
l-
Nil
Nil
No↓
CHC
↓ CH
C
Study to Review The Health Care Delivery System provided by PHSC, Punjab 263
Tab
le 2
6. R
esp
on
ses o
f T
he S
MO
s In
ch
arg
e o
f D
istr
ict
Ho
sp
itals
Amri
tsar
Bath
inda
Fero
zpur
Gurd
aspu
rH
oshi
arpu
rJa
land
har
Ludh
iana
Muk
tsar
Sang
rur
Tara
n Ta
ran
Leng
th o
f se
rvic
e<
2 yr
s.>
2 yr
s.<
2 yr
s.15
day
s>
2 yr
s.4
yrs.
< 2
yrs.
3 yr
s.3
year
s5
mon
ths
OPD
Serv
ices
- St
aff
stre
ngth
Adeq
uate
Shor
tage
of
para
med
ics,
st
aff
Nurs
es
Less
Sp
ecia
lists
Adeq
uate
Suffi
cien
t Do
ctor
s. L
ess
clas
s IV
Shor
tage
of
nur
ses
&
Jr.d
octo
rs
No s
ecur
ity
guar
dsSp
ecia
lists
la
ckin
g
Radi
olog
ist
– ab
sent
. EM
O,
Psyc
hiat
rist
vac
ant
Shor
tage
of
staf
f
Bed
Occu
panc
y R
ate
(%)
80%
100%
98-1
00%
100%
75-7
6%70
%75
%60
-70%
74%
60-7
0%
Med
icin
es t
o po
or in
OPD
Yes
BPL
Yes
Yes
Yes
Yes
Som
e-
Very
few
Mos
tly
all
Not
all
Exis
tenc
e of
RKS
Yes
Yes
(Rec
entl
y)Ye
sNo
Yes
Yes
Yes
Yes
(Rec
entl
y)Ye
sYe
s
Info
rmat
ion
rega
rdin
g NH
PAv
aila
ble
Avai
labl
eYe
sYe
sYe
sYe
sYe
sYe
sNo
t un
der
PHSC
Yes
Exte
nt o
f fu
lfi lm
ent
of
heal
th n
eeds
of
Com
mun
ity
By p
oor
and
mid
dle
clas
sFu
ll10
0%10
0%-
Full
By p
oor
pati
ents
m
ostl
y
Mor
e fo
r OP
D80
%Ov
er u
sed
IPD
Serv
ices
Nur
se/B
ed
rati
o1:
2Nu
rses
Les
s (1
:40)
1:4.
51:
20-
--
1:5
1:5
1:6
Staf
f St
reng
th D
octo
rs/B
ed
rati
o1:
21:
71:
61:
25-
--
-1:
51:
5
Clea
nlin
ess
Sati
sfac
tory
Not
good
O.K.
OKOu
tsou
rced
-On
con
trac
tOn
con
trac
tDi
ffi cu
lt t
o m
aint
ain
On c
ontr
act
Emer
genc
y Se
rvic
e Av
aila
ble
roun
d th
e cl
ock
Yes
Yes
Yes
Yes
Yes
Yes
Yes
On c
all
Yes
Yes
Fund
fl ow
No p
robl
emSh
orta
geNo
pro
blem
No p
robl
emNo
fun
ds o
nly
User
Cha
rges
No m
oney
gi
ven
No p
robl
emSa
ncti
ons
from
CS/
DMC
No r
ole
of S
MO
No f
und
Perf
orm
ance
app
rais
al
syst
emYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
sYe
s
Perc
eive
d Ba
rrie
rs
Avai
labi
lity
Nil
No p
robl
emNi
lNi
lSh
orta
ge o
f st
aff
Nil
Lack
of
info
rmat
ion
Not
Good
Lack
of
Staf
fNi
l
Acce
ssib
ility
Nil
No p
robl
emNi
lNi
lSh
orta
ge o
f M
edic
ines
Nil
Lack
of
info
rmat
ion
Not
Good
Nil
Nil
Utili
sati
onNi
lNo
pro
blem
Nil
Nil
Shor
tage
of
Faci
litie
sNi
lLa
ck o
f in
form
atio
nNi
lNi
lNi
l
Acce
ptab
ility
Yes
No p
robl
emNi
lNi
l-
Nil
Nil
Nil
Nil
Nil
Biom
edic
al W
aste
M
anag
emen
tYe
sYe
sYe
sYe
sYe
sYe
sYe
sOn
con
trac
tYe
sNo
Bag
s su
pplie
d
264 Study to Review The Health Care Delivery System provided by PHSC, Punjab
Tab
le 2
7. R
esp
on
ses o
f T
he M
LA
/ele
cte
d R
ep
resen
tati
ve a
t S
ub
Div
isio
nal Lev
el
Faci
lity
Nam
e of
the
Dis
tric
t
Bhat
inda
(Tal
wad
di)
Fero
zpur
(Faz
ilzka
)Gu
rdas
pur
(Bat
ala)
Hos
hiar
pur
(Das
uya)
Jala
ndha
r(N
avod
ar)
Ludh
iana
(Jag
rrao
n)M
ukts
ar(M
alou
t)Sa
ngru
r(M
alar
kott
a)Ta
ran
Tara
n(P
atti
)
Leng
th o
f se
rvic
e>2
yrs
>2 y
rs<2
yrs
>2 y
rs>2
yrs
>2 y
rs>2
yrs
>2 y
rs<2
yrs
Func
tion
ing
of h
ealt
h se
rvic
es in
the
dis
tric
tSa
tisf
acto
rySa
tisf
acto
ryOK
Sati
sfac
tory
Good
Good
OKNo
t m
uch
impr
oved
Good
Avai
labi
lity
of s
taff
Doct
ors
not
avai
labl
eSh
orta
geSN
, Do
ctor
sYe
sYe
sYe
sSp
ecia
list
not
avai
labl
eDo
ctor
s no
t av
aila
ble
Yes
Avai
labi
lity
of M
edic
ines
in
OPD
Mos
tly
Not
avai
labl
eYe
sLe
ssVe
ry f
ewNo
t al
lNo
t al
l.On
ly 7
es
sent
ial o
nes
OKLe
ss
avai
labi
lity
No a
ntib
ioti
cs
Over
all s
ervi
ces
of H
ospi
tal
Not
Very
. Go
odSa
tisf
acto
ryOK
OPD,
Em
erge
ncy
&
lab
good
Good
Good
OKLe
ss
deve
lope
dSa
tisf
acto
ry
Exte
nt o
f fu
lfi lm
ent
of
heal
th n
eeds
of
Com
mun
ity
30%
- 4
0%-
Good
Full
To q
uite
an
exte
ntGo
odAv
erag
e20
%80
%
Wai
ting
Tim
eVa
riabl
e, d
epen
ding
up
on t
he a
vaila
bilit
y of
doc
tors
15 -
30 m
inut
es2-
3 hr
sDe
pend
s on
no
of p
atie
nts
Not
muc
h30
min
– 2h
rsNo
t be
tter
Quit
e so
me
tim
eVe
ry le
ss
Clea
nlin
ess
Sati
sfac
tory
Good
OKBa
dBa
dGo
odAv
erag
eNo
t cl
ean
Good
Beha
viou
r of
sta
ff
Frie
ndly
Good
OKOn
ly d
octo
rs
good
, re
st b
adO.
K.
Good
Not
good
Varia
ble
Very
goo
d
Refe
rral
ser
vice
s Go
odSa
tisf
acto
ryNA
Ambu
lanc
e on
pa
ymen
t-
Avai
labl
eGo
odAm
bula
nce
on
Paym
ent
No t
rans
port
Know
ledg
e of
RKS
Yes
Yes
NoNo
NoYe
sYe
sNo
No id
ea
Poor
pat
ient
s ex
empt
ed
from
tre
atm
ent
char
ges
Yes
Yes
Yes
No-
Yes
Yes
NoYe
s
Perc
eive
d Ba
rrie
rs
Avai
labi
lity
Nil
Nil
Nil
Med
icin
e &
eq
uipm
ents
Nil
Nil
Yes
Nil
Nil
Acce
ssib
ility
Nil
Nil
Nil
Nil
Nil
Nil
Nil
Nil
Nil
Utili
sati
onLo
wNi
lNi
lNi
lUS
G m
achi
neNi
lNi
lNi
lNi
l
Acce
ptab
ility
Low
Nil
Nil
Nil
Nil
Nil
Nil
Nil
Nil
Study to Review The Health Care Delivery System provided by PHSC, Punjab 265
Tab
le 2
8. R
esp
on
ses o
f th
e S
MO
In
ch
arg
es o
f S
ub
-div
isio
nal H
osp
itals
Amri
tsar
(Ajn
ala)
Bhat
inda
(Tal
wad
di)
Fero
zpur
(Faz
ilzka
)Gu
rdas
pur
(Bat
ala)
Hos
hiar
pur
(Das
uya)
Jala
ndha
r(N
avod
ar)
Ludh
iana
(Jag
rrao
n)M
ukts
ar(M
alou
t)Sa
ngru
r(M
alar
kott
a)Ta
ran
Tara
n(P
atti
)
Leng
th o
f se
rvic
e6
mon
ths
< 2
yrs.
3 m
onth
s<
2 yr
s.<
2 yr
s.7
mon
ths
> 2
yrs.
1 yr
.3
year
s<
2 yr
s.
OPD
staf
f st
reng
thGo
odPo
orAd
equa
tele
ssSh
orta
ge o
fCl
ass
IVSp
ecia
lists
sh
orta
geAd
equa
teLe
ssAd
equa
teGo
od
Bed
Occu
panc
y Ra
te (
%)
40-6
5%50
-60%
90%
100%
70%
100%
90-1
00%
50-5
5%70
%85
-90%
Med
icin
e to
poo
r in
OPD
Yes
Yes
Yes
Tedi
ous
Proc
edur
eYe
sM
ostl
ySo
me
Som
eSo
me
Yes
Exis
tenc
e of
RKS
Yes
Yes
Yes
Not
func
tion
ing
Not
func
tion
ing
Yes
Yes
Yes-
not
clea
rM
oney
was
re
ceiv
edYe
s
Info
rmat
ion
rega
rdin
g NH
PYe
s (e
xcep
t M
alar
ia)
Yes
(exc
ept
STD)
Yes
Yes
Yes
Yes-
all
Yes
Yes
Yes
exce
pt
for
STD
Yes
Exte
nt o
f fu
lfi lm
ent
of h
ealt
h ne
eds
of
com
mun
ity
75%
50%
100%
80%
-10
0%50
%OP
D-H
igh
IPD-
Low
Aver
age
75%
IPD
Serv
ices
(Nu
rse/
Bed
rati
o)1:
31:
41:
41:
3.5
-Su
ffi ci
ent
Nurs
es1:
121:
51:
5O.
K.
Doct
or/B
ed r
atio
1:3
1:10
1:10
1: 4
--
1:5
1;7
1:6
O.K.
Clea
nlin
ess
Good
Staf
f ab
sent
O.K.
Good
Shor
tage
of
staf
fO.
K.On
con
trac
tPo
orNo
pro
blem
O.K.
Emer
genc
y se
rvic
esYe
sYe
sYe
sOn
cal
lYe
sYe
sYe
sYe
sYe
sYe
s
Fund
fl ow
Only
Use
r ch
arge
sNo
pro
blem
Not
muc
h pr
oble
mO.
K.No
pro
blem
No f
unds
No p
robl
emNo
del
ayOn
ly U
ser-
char
ges
No f
und
Perf
orm
ance
app
rais
al
syst
emYe
s-AC
RYe
s-AC
R &
Be
nch
mar
ksNo
Benc
h m
arks
fo
r do
ctor
sPe
rson
al
perc
epti
onYe
s-w
eekl
y re
view
Yes
Doct
ors
Benc
h m
ark,
ACR
ACR
Yes-
ACR
Perc
eive
d Ba
rrie
rs
Avai
labi
lity
-Do
ctor
s no
t av
aila
ble
Nil
Nil
Doct
ors
Over
burd
ened
Nil
-Sp
ecia
list
abse
ntLa
ck o
f st
aff
& m
edic
ine
Nil
Acce
ssib
ility
-Ni
lNi
lNi
l-
Nil
-Ni
lNi
lNi
l
Utili
sati
on-
Nil
Nil
Nil
-Ni
lIn
fras
truc
ture
an
d st
aff
Beha
viou
r
Nil
Nil
Nil
Acce
ptab
ility
-Ni
lNi
lNi
l-
Nil
-Ni
lNi
lNi
l
Bio-
med
ical
was
te
man
agem
ent
Yes
Yes
Yes
Outs
ourc
edYe
s (s
hort
age
of b
ags)
Yes
Yes
Yes
Yes
– On
co
ntra
ctBa
gs n
ot
avai
labl
e
266 Study to Review The Health Care Delivery System provided by PHSC, Punjab
Tab
le 2
9. R
esp
on
ses o
f th
e E
lecte
d R
ep
resen
tati
ves o
f C
HC
Are
as
Nam
e of
the
Dis
tric
t (C
HC)
Amri
tsar
(Man
awal
a)Bh
atin
da(G
onia
na)
Fero
zpur
(Fir
ozsh
ah)
Gurd
aspu
r((
Fata
ihga
rh
Chur
ian)
Hos
hiar
pur
(Mah
ilpur
)Ja
land
har
(Kar
tarp
ur)
Ludh
iana
(Mac
hhiw
ara)
Muk
tsar
(Bad
al)
Sang
rur
(Lon
gwal
)Ta
ran
Tara
n(K
hem
Ka
ran)
Leng
th o
f se
rvic
e>5
yrs
.>2
yrs
.>2
yrs
.>2
yrs
.>
2 yr
s.>2
yrs
.>2
yrs
.>2
yrs
.>
2 yr
s.<
2 yr
s.
Over
all f
unct
ioni
ng o
f CH
C, S
DH a
nd D
HGo
odV.
Good
Not
good
Doct
ors
not
avai
labl
e (g
o fo
r pv
t.
prac
tice
)
Good
Bett
er n
owBe
tter
now
Quie
t sa
tisf
acto
ryGo
od
Avai
labi
lity
of S
taff
Yes
Yes
Yes
No
gyna
ecol
ogis
tBa
dYe
sYe
sO.
K.No
doc
tors
Yes
Avai
labi
lity
of M
edic
ine
in O
PDPa
rtly
Mos
tly
Yes
Yes
V.Fe
wYe
sNo
t al
lLe
ssYe
sNo
t al
l
Over
all s
ervi
ces
of t
he
Hos
pita
lNo
t go
odGo
odO.
K.O.
K.Av
erag
eGo
odAv
erag
eO.
K.O.
K.Sa
tisf
acto
ry
Exte
nt o
f fu
lfi lm
ent
of h
ealt
h ne
eds
of
Com
mun
ity
50%
50%
10%
O.K.
Only
MLC
ca
ses
(<10
%)
Suffi
cien
t ex
tent
Larg
e ex
tent
Larg
e ex
tent
10 -
20%
80%
Wai
ting
Tim
e5
min
utes
45 m
ins.
- 1
hr
s.Ni
lNo
t m
uch
Not
muc
hLo
ngLo
ng
som
etim
esNo
t m
uch
Not
muc
hNo
t m
uch
Clea
nlin
ess
Good
V.Go
odGo
odO.
K.Ve
ry B
adGo
odGo
odNe
eds
impr
ovem
ent
Sati
sfac
tory
Good
Refe
rral
ser
vice
s No
Yes
Lack
ing
Yes
No a
mbu
lanc
e-
Avai
labl
e bu
t no
t al
way
sNo
am
bula
nce
Good
No
Know
ledg
e of
RKS
-No
NoYe
sNo
Yes
Yes
Yes
NoNo
Beha
viou
r of
sta
ffGo
odV.
Good
Good
Good
Not
Good
Bad
Nurs
es
beha
viou
rGo
odNo
t Go
odVe
ry .
Good
Very
Goo
d
Poor
pat
ient
s ex
empt
ion
from
Use
r ch
arge
sNo
No-
NoNo
NoYe
sYe
sNo
-
Perc
eive
d Ba
rrie
rs
(Con
td..
.)
Study to Review The Health Care Delivery System provided by PHSC, Punjab 267
Nam
e of
the
Dis
tric
t (C
HC)
Amri
tsar
(Man
awal
a)Bh
atin
da(G
onia
na)
Fero
zpur
(Fir
ozsh
ah)
Gurd
aspu
r((
Fata
ihga
rh
Chur
ian)
Hos
hiar
pur
(Mah
ilpur
)Ja
land
har
(Kar
tarp
ur)
Ludh
iana
(Mac
hhiw
ara)
Muk
tsar
(Bad
al)
Sang
rur
(Lon
gwal
)Ta
ran
Tara
n(K
hem
Ka
ran)
Avai
labi
lity
Nil
Nil
No m
edic
ine
Nil
Doct
ors
not
avai
labl
eLe
ss M
edic
ine
Nil
Mor
e do
ctor
sNi
lVe
ry .
Far
Acce
ssib
ility
Nil
Nil
Nil
Nil
Nil
Nil
Nil
Yes
Nil
Nil
Utili
sati
onNi
lNi
lLe
ss d
octo
rsNi
lLa
ck o
f m
edic
ines
Lack
of
Med
icin
eNi
lNi
l↓↓
Nil
Acce
ptab
ility
Nil
Nil
Rest
ricte
dNi
lLa
ck o
f Se
rvic
esNi
lQu
alit
y of
Fa
cilit
y to
be
impr
oved
Nil
↓↓Ni
l
268 Study to Review The Health Care Delivery System provided by PHSC, Punjab
Tab
le 3
0.
Resp
on
ses o
f th
e S
MO
In
ch
arg
es o
f C
HC
S
Nam
e of
the
Dis
tric
t (C
HC)
Amri
tsar
(Maz
itha
)Am
rits
ar(M
anaw
ala)
Bhat
inda
(Gon
iana
)Fe
rozp
ur(F
iroz
shah
)Gu
rdas
pur
((Fa
taih
garh
Ch
uria
n)
Hos
hiar
pur
(Mah
ilpur
)Ja
land
har
(Kar
tarp
ur)
Ludh
iana
(Mac
hhiw
ara)
Muk
tsar
(Bad
al)
Sang
rur
(Lon
gwal
)Ta
ran
Tara
n(K
hem
Ka
ran)
Leng
th o
f se
rvic
e<
2 yr
s.1
mon
th>
2 yr
s.7
mon
ths
2.5
yrs.
6 m
onth
s6
mon
ths
>2 y
ears
< 2
yrs.
6 m
onth
s16
mon
ths
OPD
Staf
f st
reng
thSh
orta
geSh
orta
ge o
f do
ctor
sSh
orta
geAd
equa
teO.
K.Le
ss n
o. o
f do
ctor
s &
Cl
ass
IV
Shor
tage
Adeq
uate
. On
ly M
.O p
ost
vaca
nt
Spec
ialis
ts
lack
ing
Exce
pt
med
icin
e al
l av
aila
ble
Shor
tage
Bed
Occu
panc
y Ra
te
(%)
5-10
Bed
s ar
e oc
cupi
ed10
-15%
100%
10%
50%
5 –
10%
-25
.04
15-
20%
10 –
15%
30-4
0%
Med
icin
es t
o po
or
in O
PDYe
sSo
me
Yes
Yes
Yes
Yes
Yes
Yes
-Ye
sYe
s (s
ome
to b
e pu
rcha
sed)
Exis
tenc
e of
RKS
Yes
Yes
Yes
Yes
Not
func
tion
ing
Not
yet
form
edYe
sYe
s-
Yes
Yes
Info
rmat
ion
rega
rdin
g NH
PYe
sOn
ly T
.B.
&
Mal
aria
Yes
Yes
-No
to
all
exce
pt T
.BYe
sYe
s al
l exc
ept
STD
-Ye
s ex
cept
ST
DNo
t al
l (i.e
. M
alar
ia,
STD)
Exte
nt o
f fu
lfi lm
ent
of h
ealt
h ne
eds
of
Com
mun
ity
90%
50%
70%
Unde
r ut
ilise
d-
OPD
60-8
0%IP
D=5-
10%
100%
Sati
sfac
tory
-Ve
ry L
ess
70.8
0%
IPD
Serv
ices
(Nu
rse/
Bed
rati
o)-
1:5
1;10
1:1.
2-
1:5
Staf
f sh
orta
ge1:
3-
1:7
1:10
Doct
or/B
ed r
atio
-1:
301:
71:
61:
21:
5St
aff
shor
tage
1:5
O.K.
1:15
1:4
Clea
nlin
ess
O.K.
Not
upto
th
e m
ark
Good
Good
O.K.
O.K
Good
Shor
tage
of
staf
fO.
K.M
anag
ed b
y ow
n st
aff
O.K.
Fund
fl ow
No p
robl
emM
anag
ed b
y C.
S.No
pro
blem
No p
robl
em-
No p
robl
emNo
Bud
get
rece
ived
No p
robl
em-
N.A
Thro
ugh
C.S
Perf
orm
ance
ap
prai
sal s
yste
mYe
sAC
RYe
sRe
cord
s &
m
eeti
ngs
Doct
ors-
Benc
h m
ark
Yes
– AC
RAp
prec
iati
on
lett
erAn
nual
C.R
Doct
ors-
Benc
h m
ark
Yes
– AC
RYe
s (A
CR)
(Con
td..
.)
Study to Review The Health Care Delivery System provided by PHSC, Punjab 269
Nam
e of
the
Dis
tric
t (C
HC)
Amri
tsar
(Maz
itha
)Am
rits
ar(M
anaw
ala)
Bhat
inda
(Gon
iana
)Fe
rozp
ur(F
iroz
shah
)Gu
rdas
pur
((Fa
taih
garh
Ch
uria
n)
Hos
hiar
pur
(Mah
ilpur
)Ja
land
har
(Kar
tarp
ur)
Ludh
iana
(Mac
hhiw
ara)
Muk
tsar
(Bad
al)
Sang
rur
(Lon
gwal
)Ta
ran
Tara
n(K
hem
Ka
ran)
Perc
eive
d Ba
rrie
rs
Avai
labi
lity
Nil
-St
aff/
Med
icin
e no
t av
aila
ble
Doct
or n
ot
avai
labl
e-
Nil
Staf
f sh
orta
geNi
l-
Staf
f no
t av
aila
ble
Less
sta
ff
Acce
ssib
ility
Nil
-No
pro
blem
sNi
l-
Nil
Nil
Nil
-Ni
lYe
s Bo
rder
ar
ea
Utili
sati
onNo
Sp
ecia
list
-Ni
lUn
der
utili
sed
-Ni
lLe
ss d
ue t
o la
ck o
f fu
nds
Need
s to
be
incr
ease
d-
Low
Shor
tage
of
Drug
s
Acce
ptab
ility
Nil
Non
avai
labi
lity
of s
taff
/
med
icin
es
Nil
Low
-Ni
lNi
lNi
l-
Less
no.
of
doct
ors
-
Bio-
med
ical
Was
te
Man
agem
ent
Yes
Yes
Yes
Yes
-2
colo
ured
ba
gs u
sed
Yes
Yes
Cont
ract
edYe
s –
on
cont
ract
Yes
A Study to Review
National Institute of Health and Family WelfareBaba Gang Nath Marg, Munirka, New Delhi - 110067
The Health Care Delivery System Provided by PHSC
PunjabPunjab Health Systems Corporation
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