Student Dissertation

Agency : Primary Health Care Services; Tribal Block; NHM Rajasthan; IPHS guidelines

Objective : • To study and analyse the existing infrastructure, manpower and other facilities available to ensure Primary health care services in the tribal blocks of Rajasthan as per IPHS guidelines. • To identify the facilitating and hindering factors in the achievement of desired outputs and suggest measures to correct them.

Background : A meeting had been conducted between WISH Foundation India, NHM Rajasthan officials and district CM&HO about primary health care status of every block of the 13 districts where Scale Rajasthan project will be implemented. Initially 30 PHCs were selected to be handed over to WISH foundation for the next five years by NHM Rajasthan to manage on their own.

Methodology : Cross-Sectional, Descriptive Study was conducted to assess the primary healthcare services which involved both Qualitative and Quantitative type of study. Checklist was prepared by the help of Karuna Trust (working as an NGO partner with Wish Foundation) in which revised IPHS guidelines for PHCs were used as reference. Non probability sampling (Purposive sampling) method was used and 6 facilities were selected in which 2 were from each district Sawai Madhopur (PHC Surwal and Bhadoti), Baran (PHC Jepla and Pali) and Banswara (Timeda Bada PHC Ramgarh).

Findings : Huge gap found between existing status in comparison with IPHS standards as only two PHCs, surwal 11 and bhadoti had more than 50% staff required. Doctor and nursing staff were in positioned but posts of Pharmacist, data entry operators and health activists etc. were vacant. PHC pali and bhadoti were good as they had 91% and 82% availability of infrastructure facilities respectively, but in others residential quarters for doctors and other staffs were not available and PHCs were facing difficulties to manage 24*7 deliveries and other emergency cases. Primary health care centres were phenomenally sound in terms of equipments availability as 4 out of 6 PHCs had more than 75% of listed equipments. Equipments unavailable were steam sterilizer, MTP instruments, radiant wormer, fumigation machine and photo therapy units. Supply of Vitamin A, anti snake venom, anti rabies vaccine and emergency drug trays were irregular. Data entry operators were not positioned so HMIS data were not generated other than that computer/ internet facility were also not there. Status of services delivery was not well as citizen’s charter was not there, fumigation was not done and cleaning and drainage system were also in poor state. Seepage was present in some of them and disposal of bio medical waste was not done as per guidelines. Overall status of primary health care services was in poor state as (1) Doctor and nursing staff were in positioned but others were vacant, (2) Residential quarters were not available, (3) Equipments like sterilizer, MTP instruments, radiant wormer etc. were absent, (4) Supply of drugs and consumables were irregular,(5) 24*7 delivery and infants cases were not managed, (6) HMIS data were not generated and maintained and others as citizen’s charter were absent, cleaning and drainage system were also in poor state. Seepage was present and disposal of bio medical waste was not done as per guidelines.