How many chc in india

In Nellore district, In our study, we determined that The reason may be that the Government of Andhra Pradesh has provided ambulance services, which play a vital role in the case of referrals.

Therefore, the need for individual ambulances in the PHCs is practically nonexistent, so there are no drivers in the PHCs except in cases where there is a separate vehicle for the MO.

The findings of our study in Nellore district showed that But all PHCs had contingent workers who were employed as needed for purposes such as cleaning. In this study, This means that half of the PHCs cannot be reached throughout the year, which causes severe access barriers. A boundary wall is essential for maintaining cleanliness and for prevention of encroachment of government land, which is quite common in many parts of India.

In our study, The findings of our study are slightly lower than that of the state average for Andhra Pradesh as reported by Sekhar et al. Therefore, only about half of the PHCs had a slope for wheelchairs, which shows that there was a failure either in the planning stage or the implementation stage.

Creating a slope for wheelchairs is not an activity that would require considerable resources. Not having a slope indicates that those PHC facilities are insensitive to the needs of people with disabilities. India has many regional languages that are understandable by the majority of the local population, but many of the official communications are written in English, which is understandable mostly by the educated population.

Having the name of the PHC displayed in the local language is vital for the poor and uneducated people to access the services. None of the PHCs in our study had a complaint box.

This is a very bad situation, since the feedback from the public about problems with the services or facilities cannot be obtained by the authorities, leaving no opportunity for improvement.

This is significantly better than the PHCs in Punjab, which reported that a water supply was available in only A study done in Bihar reported that essential drugs required for various health centers were in short supply or unavailable in medical stores. All the PHCs in our district had a labor room for deliveries, but many of the facilities in the labor rooms were inadequate. The findings of our study were much better than that of Punjab.

Although the availability of labor rooms was adequate, the facilities inside the labor rooms need to be improved. The manpower and infrastructure in the PHCs in Nellore district are severely lacking. Although the presence of MOs in the PHCs is adequate, the presence of para-medical staff and supporting staff is insufficient. Steps should be taken by the state governments and district administration to fill the vacancies of para-medical and supporting staff in the PHCs.

Many aspects of the infrastructure of the PHCs need improvement. All-weather road facilities to reach the PHCs should be improved to reduce access barriers. Proper slopes should be provided for the movement of wheelchairs, making the PHCs sensitive to the needs of disabled people. Health education leaflets in Telugu should be made available in the patient waiting area. Labor rooms with separate areas for septic and aseptic deliveries for effective infection control should be provided.

India already has high rates of maternal and infant mortality; to help avoid increasing these rates, PHCs should be well equipped to conduct normal deliveries, as well as manage emergencies. Equipment for assisted forceps delivery and episiotomies should be provided to provide safe delivery services. The supply of some categories of drugs, such as antifungal, anticonvulsants, and ointments, needs to be improved.

The condition of the wards also needs to be improved by providing mattresses on beds and maintaining cleanliness. Although commitment from both the state and central governments is necessary to improve the health infrastructure and manpower in the PHCs, it is the primary duty of the state governments to address this issue, since public health is a state subject, while the central government provides directive and technical guidance.

In the absence of readily available official records, MOs, staff nurses, and pharmacists in the PHCs furnished some of the information from their knowledge and memory.

Thus, there is a possibility that some of the information may be inaccurate due to recall bias. Although appointments were made in advance with MOs, some of them were not available during the time of our visit due to some unforeseen reason, so the para-medical staff provided information in these centers. Facility surveys were undertaken to assess the capital and physical infrastructure such as building, space, furniture and other equipments present in the health facilities.

The infrastructure details were ascertained room wise along with the purpose for which they were being used. All the staff members were interviewed with semi structured interview schedule on time allocation for different services in the last one week. Interviews included information on frequency of the activities like daily, weekly, fortnightly, monthly, quarterly, semi annually or annually; the time spent per activity and the total number of patients seen on the day of activity.

The less frequent activities, for instance immunization days, pulse polio days, trainings, etc were performed for whole day. Thus, the complete day was allocated to the same activity. Time spent by staff members on the administrative work was also collected in the time allocation sheets.

All respondents were interviewed after obtaining written informed consent. The estimates of the time spent by each staff on various activities were also supplemented with observations on time spent on daily activities during the period of data collection.

Costs of capital resources were annualized by considering the life of the capital item. Capital resources such as building and space were estimated as the floor area in square feet. The information about the quantity of resources was obtained from stock registers, accounts records of District Health Office and health facility surveys. The opportunity costs of capital resources like land and building were estimated by interviewing key informants to obtain the prevalent market rental price.

For furniture and equipments, standard literature on the life of capital items was reviewed [ 17 , 18 ]. The local staff at the health facility was also interviewed to know their perceptions on the same.

The costs of equipments were also obtained from local distributors and from internet search of relevant websites [ 19 ]. The costs of all recurrent resources like drugs, consumables etc were obtained from the rate contract list of state governments estimated by applying the price to the quantity of resources consumed. Average prevailing market prices for the year — were used.

All the prices were then converted to the price in the year — using prevailing gross domestic product deflators [ 20 ]. Certain resources in the facility were used solely for one activity while the others for instance, furniture, equipment and room space were used in more than one activity.

If the resources were directed for one service, then the complete cost was allocated to that service only but if any resource is utilized jointly in two or more services then it was apportioned among those services using appropriate statistics.

This indicator of apportionment combined the effect of the number of clients for a particular service and time spent on each client for that service. The costing assumptions are mentioned in detail in S3 Table. The overall costs of health services provided at primary and community health centers were presented as inpatient, outreach and outpatient services; promotive, preventive, curative and indirect administrative services.

The overall costs for human resource, capital, consumables, equipment, drugs, overheads, IEC were also estimated for each of the functional group of services. Along with the overall annual costs at health facilities, per capita unit cost of service provision per year was also computed.

They were also calculated for curative services used i. It was computed by combining the value of all the resources spent on provision of care during a year and dividing it by the total clients who used the service in respective facility in that year. The sample was simulated times using the bootstrap method.

SPSS 21 was utilized for analyzing the data. We also estimated the sensitivity of the annual cost and unit cost for providing overall services to variations in discount rates i. A total of fourteen primary and community health centers were studied in three states of north India—Haryana, Himachal Pradesh and Punjab. The average population covered by a PHC and CHC is the study sample was 37, and , respectively, while the number of beds was as per norms i.

Table 1. The ratio of doctor to nurse and doctors to bed varied from and respectively at PHC level, and from 1. In terms of volume of services provided, a CHC catered a 2. Table 2 provides the annual mean costs of various components of health service delivery at primary and community health centers.

Cost of human resource alone accounted for The proportional cost of providing drugs and consumables was Ref Table 2 , Fig 1. Fig 2 shows that Refer Fig 3. Unit costs per service provided were estimated as the ratio of total annual costs for the particular service and total number of beneficiaries in one year period.

Table 3 lists unit costs per service delivery per year for provision of various health services at the mentioned health facilities.

There was not much difference in the annual and unit costs with the change in discount rates. Similarly, the unit cost per capita changed minimal i. The sensitivity analysis to see the effect of variation in input costs on annual cost at CHCs and PHCs showed that the annual costs at PHCs were most sensitive to drugs Refer S1 and S2 Figs.

Primary and community health centres in public health sector provide health care services to a large proportion of population in India. Detailed analysis of cost of provision of primary health care services through community health workers in sub-centres and primary health centres is available [ 8 , 21 ]. However, the evidence base for cost of provision of health care through community health services is very weak.

We undertook this study in fourteen health centers in three states of north India to generate evidence on cost of health services provided at the public sector primary and community health centers.

To our knowledge, this is the first comprehensive study to assess the cost of primary health care services at PHCs and CHCs covering facilities from three states.

We used standardized costing methodology and took data for one complete year to exclude the seasonal variation of diseases and service utilization. Standard method for analyses was used to present detailed costing of services provided. In our analyses, we found that the unit costs of providing an entire range of preventive, curative and promotive care were INR Salaries constitute more than half of the total cost of service delivery at both the levels.

Unit costs per specific services were INR Evidence from couple of previous studies were either too old or rely on only one health facility data to determine cost. For example, Anand et al. The findings of our study are comparable to those reported in that study. The difference in reported costs could be attributed to the time difference of two decades between both studies and it is a possibility that the inflation might have changed the currency values many folds between two time frames.

Discounting for the time difference and adjusting for inflation, unit cost of service comes out to be INR Relatively higher unit cost of services at PHCs in our study, even after adjusting for inflation, could be as a result of relatively higher inflation of health care costs as compared to general inflation rate.

Mathur et al estimated the cost of providing curative services at three primary care centers in a city in Gujarat in year [ 14 ]. The unit cost of curative care services in this study ranged from INR These centres are however fulfilling the tasks entrusted to them only to a limited extent. For the first time under National Rural Health Mission, an effort had been made to develop Indian Public Health Standards IPHS for a vast network of peripheral public health institutions in the country to provide optimal specialized care to the community and achieve and maintain an acceptable standard of quality of care.

Full Text: PDF. Remember me. Arriving at the PHC, Kamla is in a quandary. Wading through crowded corridors, she sees the one doctor available. Gopi is critical and needs to be admitted. I have observed run-down establishments, unhygienic labour rooms, absence of qualified doctors and unskilled nurses in numerous facilities.

This may needlessly end up a tragic journey for Kamla. Undeniably, facilities require urgent attention. One is fundamental—strengthen infrastructure, improve physical access and ensure adequate human resources. This itself need not take time. These would provide comprehensive healthcare including free essential drugs and diagnostics.

The allocation for this is Rs1, crore. Assuming this is spent on revamping just half the target, it amounts to Rs1. It will take orders of magnitude more than that to achieve transformation. But useful things can be done in the interim. Nurse mentoring is one recourse. A mentoring team to cascade knowledge on proper delivery, birth care and managing complications can plug gaps.