Student Dissertation

Agency : Gap Analyses; Healthcare Delivery System; Baseline Assessment; Quality of Services

Objective : • To assess the existing service delivery system of the PHC as per NQAS MoHFW, GoI. • To identify the gaps in various departments of the PHC as per NQAS MoHFW, GoI. • To suggest viable recommendation for bridging the gaps in various departments based on customized requirements for the PHC. • To help the hospital management to take appropriate managerial actions so as to bridge the varies gaps and to improve the quality of the services.

Background : This report outlines the preliminary results of an assessment survey on the quality of services provided by PHC Chandi, Bihar

Methodology : Data has been collected using National Quality Assurance Standard checklist • Observation of the processes at the facility • Document Review at the facility • Discussion with MOI/C, Department in charge and Process owners • Patient Interview Major Findings: • Assisted vaginal delivery service is not available. • Mothers are discharged within 24 hours of delivery against the recommended stay of at least 48 hours following delivery • Facility is not providing Ayush clinic and separate female OPD. • Essential tests for ANC are not available in the Lab. • There is no defined and established procedure for maintaining, updating of patient’s clinical records and storage. • Nutritional Assessment of patient not being done. • Equipment’s are not covered under AMC. No preventive and corrective maintenance system exists. • Standard practices for decontamination, cleaning, disinfection and sterilization of instruments and procedure area are not in practice. • There is lack of well-defined system for protection, easy retrieval, retention and disposal of Medical Records. • There are total 14 national programs. Among them at present in PHC Chandi only 5 national programs are functional or operational. • Entitlement under different schemes, important numbers like MO I/C, ANM, Ambulance, nearest FRU, List of sub centres are not displayed. • There is no process to redress their complaints to enhance patient’s satisfactions. • Bio Medical waste drums and instructions of segregation have in existence in some area of the PHC. • PHC has not established policy for providing all drugs as per EDL.

Findings : • Overall PHC Scored 42%. • Performance of the PHC is comparatively better in Clinical ‘Areas of concerns’ and support services and departments as compared to non-clinical. • Highest scoring area is ‘Service Provision’, ‘Patient Rights’, ‘Input’ & ‘Support Services’ with score of 56.89%, 52.21%, 51.82% & 50% respectively. Lowest scoring areas are Quality Management & outcome with scores of 8.84% & 6.42% respectively. Detail area of concern wise score are as follows: - Table name: Area of Concern Wise Score S. No. Area of Concern Score 1 Service Provision 56.89 2 Patient Rights 52.21 3 Input 51.82 4 Support Services 50 5 Clinical Services 43.95 6 Infection Control 33.66 7 Quality Management 8.84 System 8 Outcome 6.42 • Among departments, Labour room score is highest with score of (52.91) followed by NHP (46%) & General Administration (42.81%). Lesser performing departments include In Patient Department (27.77%) & Laboratory Department (24.29%).

Recommendations : Hence hospital can start a Quality Assurance programme with creation of Quality Assurance team, which would be supervised by District Quality Assurance Committee at District Level, State Quality Assurance Committee at State level as per operational guideline of GoI.