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Study of Civil Dispensaries & Urban-Primary Health Centers In Project Report Study of Civil Dispensaries & Urban-Primary Health Centers in Madhya Pradesh Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis FINAL REPORT Study of Civil Dispensaries & Urban-Primary Health Centres in Madhya Pradesh September 2018 STATE HEALTH RESOURCE CENTER (SHRC) ATAL BIHARI VAJPAYEE INSTITUTE OF GOOD GOVERNANCE AND POLICY ANALYSIS A Study of Civil Dispensaries & Urban Primary Health Centres in Madhya Pradesh 2018 About the Report This study report is an attempt to bridge the information gap on current situation of urban health initiatives undertaken by the Urban Health Mission Madhya Pradesh. The State Health Resource Centre is the technical support unit for Department of Health and Family Welfare, Government of Madhya Pradesh. Based on their request to conduct study and develop report reflecting current situation of Civil Dispensaries and Urban Primary Health Centre’s. The basis of the current report is analysis of department records, Health Portal HMIS and facility survey data. It is part of a series of SHRC Reports for strengthening the Public Health System of Madhya Pradesh. Ms. Preeti Upadhyay Advisor- SHRC prepared the report under the guidance of Mr. Madan Mohan Upadhyay, Principal Advisor- Social Sector Development and Mr. Akhilesh Argal, Director AIGGPA. Study Team Mr. Madan Mohan Upadhyay Principal Advisor Ms. Preeti Upadhyay Advisor Dr. Konika Jain Research Associate Dr. Sapna Anchal Research Associate Dr. Sumit Chouhan Research Associate Dr. Karan Dandotiya Research Associate Ms. Leena Singh Research Associate Atal Bihari Vajpayee Institute of Good Governance and Policy Analysis Page 2 of 84 A Study of Civil Dispensaries & Urban Primary Health Centres in Madhya Pradesh 2018 Abbreviation ANC Antenatal Care ANM Auxiliary Nurse Midwife CD Civil Dispensary DHFW Department of Health and Family Welfare HCF Health Care Facility IEC Information Education Communication IUD Intra Uterine Device JNNURM Jawaharlal Nehru National Urban Renewal Mission MCH Maternal and Child Health MoHFW Ministry of Health and Family Welfare MP Madhya Pradesh MPW Multi-Purpose Worker NUHM National Urban Health Mission UPHC Urban Primary Health Centre Atal Bihari Vajpayee Institute of Good Governance and Policy Analysis Page 3 of 84 A Study of Civil Dispensaries & Urban Primary Health Centres in Madhya Pradesh 2018 Executive Summary Background: With the introduction of the NUHM, the state systematically addresses the issues of primary health care services in urban areas in year 2013. Similar to the rural PHC, the urban PHCs envisaged as the nodal point for delivery of health care services under the NUHM. Government of India has recognised that urban areas are shrinking due to increased population and have congested especially slum and slum like habitations, and with poor or no proper sanitation, water supply, garbage disposal mechanism there is resurgence in urban infectious diseases in these areas. It is expected that Urban PHC’s shall be responsible for health needs/vulnerability assessment, facility based service provision, outreach services, referral services, disease surveillance and epidemic control and convergence with other national programs. This study conducted to get an overview of the current situation of civil dispensaries and urban primary health centers in the state. The special focus is to understand the availability of health facilities, physical infrastructure and human resource and services provisions. Quantitative and qualitative data collected and analyzed to meet the study objectives. The In-depth discussion and observation tools were prepared for facility survey. The staff and OPD related HMIS records collected from health department. Detailed report based on the primary and secondary data has tried to capture the following: Geo location of the Civil Dispensary and Urban Primary Health Centers in MP. Status of human resource and out patient load as per the records of the HMIS portal. Availability and accesses to infrastructure, services and management of the selected urban primary health centers for the study. Major Findings: Service Records The urban health centers were Geo-mapped as per HMIS records of the existing health facilities. The geo mapping of the health facilities reveal that urban health Centres are prominently present in the densely populated urban areas. Data from Gwalior, Bhopal, Indore, Jabalpur and Sagar regions show high density of urban health facilities. However, substantial non-functional health facilities are also located in the same regions. The study highlights that there is great shortage of manpower at UPHC. In total 125 UPHC, only 537 persons posted which is about 30.7 percent of the recommended staff strength. The study finds that staff is very limited as compared to the responsibility and workload assigned to the UPHC and Civil Dispensaries. There are only 54 Medical officers and 9 contractual Medical officers in total 109 Civil Dispensaries covered that Atal Bihari Vajpayee Institute of Good Governance and Policy Analysis Page 4 of 84 A Study of Civil Dispensaries & Urban Primary Health Centres in Madhya Pradesh 2018 means the functional status of CDs are doubtful. The proportion of non-functional Civil Dispensaries are large than Urban-PHC in Madhya Pradesh. The HMIS OPD record of last year reveals about the types of health related reasons for which patients visited the urban health facilities. As per the OPD records people visited health facility for general health reasons, treatment of hypertension, diabetes, ophthalmic care, dental care and general illness including psychological and emotional ones. About 170 health centers inclusive of Urban PHCs and Civil Dispensaries provide services related to maternal health, child health & nutrition and Vector borne disease. The essential services confined to general consultation and they mostly referred to nearby government health facility. Major Findings: Facility Survey All the surveyed Urban-PHCs are situated within the prescribed limit of distance and they either are situated within slum or are adjacent to them. However, it was difficult to locate some of the facilities due to incorrect location address and absence of direction signs. Facilities like separate dressing room, seating arrangement and appropriate waiting space were not available in all the facilities. The provision of safe drinking water for staff and patients was not found in a portion of the health facilities. It is important to mention here that internet facility was also not available at any facility. Facilities follow the practice of manual registration of OPD cases. The facilities do not have separate arrangement for examination of patients related to RCH and this highlights the fact that there is no emphasis on arrangements for privacy and confidentiality. The government has attempted to establish UPHCs and other health facilities in the urban areas. At present majority of the facilities are being run from the rented buildings that were not constructed for running health facilities and that is the reason of shortage of space for almost all the activities. Majority of the Urban-PHCs follow the GOI pattern for operating the OPD services and are providing service from12 noon to 8 pm. Few UPHCs depend on the staff attached to the facility and due to this reason, the facilities are forced to operate for a lesser period of time that is 4 hours in a day. Civil Dispensaries have a different practice and the either provide OPD services in the morning or in morning or evening both. At present, most of the health staff working in urban health facilities has very limited exposure and knowledge about their wider role of UPHC and other urban health institutions. Data also highlights the fact that limited efforts taken to protect the staff from health risks. At present, the health facilities lack basic infrastructure to offer basic lab services. This forces the doctors and health staff either to refer the cases to district hospital or to get tests done through private pathology. Moreover, almost all the facilities face the problem of limited or non-availability of necessary equipment. Atal Bihari Vajpayee Institute of Good Governance and Policy Analysis Page 5 of 84 A Study of Civil Dispensaries & Urban Primary Health Centres in Madhya Pradesh 2018 The situation of availability of basic drugs is much better than other indicators. Health staff informed that basic drugs are always available in the facility. In case of shortage or requirement of any particular drug, demand of drugs to the district authorities that is send and these drugs are available to the facility within 7-10 days. Study also identified key barriers vis-à-vis access to basic services provided by urban health facilities and the barriers are linked to the lack of basic physical amenities in the buildings in terms of adequate space for different service, provision for privacy and confidentiality, separate toilets, safe drinking water. Lack of sufficient staff also increases the workload on the existing staff and pending decisions demotivates them from taking initiatives. The status of managing and disposing biomedical waste is very poor due to shortage of staff, proper orientation of existing staff, and lack of necessary facilities. Proper segregation of the biomedical waste was not in place. The sharp edge waste items were mixed with the other waste items. In some facilities, infectious and noninfectious waste was observed in the same bins. The study also found that the Medical
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