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Efficient Management of Community Health Centre, Rajasthan
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Subject Area="Management structures and systems." Objective="Improve the quality of service delivery."
Details for Reform Option "Efficient Management of Community Health Centre, Rajasthan"
Summary

Background: Sadri Community Health Centre (CHC) is located in the southeast region of Pali district, about 90 kms from the district headquarters. Six Primary Health Centres (PHCs) and 4 sub-centres are directly providing outreach services under this CHC. It serves a population of 28,000 that is pre-dominantly poor and tribal. The CHC also caters to the needs of patients from adjoining districts such as Udaipur and Rajsamand. The CHC is housed in a building largely constructed in 1931 but with later additions made through contributions from various donors. The campus is located in a 35,000 sq. ft. area. The staff at the CHC are sanctioned for a 30-bed hospital. They include 5 doctors, 7 male nurses, two staff nurses, one radiographer, one assistant radiographer, two clerks, one lab technician, three Lady Health Visitors (LHVs), one driver, 10 ward boys, two sweepers, one sector supervisor and two Male Multipurpose Workers MPWs. The CHC does not have sanctioned posts for gynaecologist, paediatrician and anaesthetist though the existing doctors are trained in the same and are providing services to people. The three main departments are Medical, Surgical and Gynaecology and Obstetrics. The sanctioned beds are 30 but the CHC has added 34 more beds. There are 22 beds in the medical ward; 8 surgical; 18 beds for gynaecological patients; 6 cottage beds (paid beds for INR 50) and 10 beds in in a room which was until recently not being used. The CHC also runs a TB outpatient department (see PROD entry ref no 141). Due to availability of a trained anaesthetist, the CHC is able to undertake major surgery including caesarian section delivery. However, blood must be brought from Pali the district headquarter since the CHC is not declared as a First Referral Unit (FRU). Since 2001, Rajasthan Medicare Relief Society (RMRS) has become operational (see PROD entry ref no 134) and from July 2005 life line drug store has become operational (see PROD entry ref no 135). Action: In order to effectively manage all the services, the following activities were undertaken fifteen years back by the current Medical officer in-charge: (i) A Personnel Management System developed including the following steps: All decisions are taken jointly by the staff. The staffs are divided into categories- ancillary, nursing and doctors. For each category, a team leader is selected who is totally responsible for all the services provided by that category of staff. In each of the categories, the personnel have demarcated geographical areas of work for which they are responsible. Penalties are jointly decided. If staff fails to complete their work, then two compensatory holidays are deducted. The CHC in charge interacts with team leaders for progress and problems/gaps instead of talking to all personnel individually. The CHC in-charge has tapped human resources available among the staff by identifying interest and skills for staff within ancillary category. The staff was effectively used for maintenance, minor repairs and for this each month some incentive was given for the extra work they did through available RMRS funds. Currently, the CHC has contracted out services pertaining to repairs of overhead tank and pipe for minimal honorarium. The payments have been made through RMRS funds. Instruments requiring repairs are sent by local bus to Pali or Jaipur and are sent back the same way after repair. (ii) Personnel are sent for training organized at state and district level. Recently, staff had undergone computer training and doctors have participated in training on management of RMRS arranged for one day by State Institute for Health and Family Welfare, Rajasthan on medico legal issues. (iii) Community Participation: As the CHC serves tribal and poor people from far-flung areas the institution undertook the following activities: (a) Catering: staff did need assessment. Raw materials are procured without charge from local donors. Cooking is done in the hospital and food provided to patients, relatives and all the CHC staff for one rupee. The money collected is used to pay the cook. A local donor was given the responsibility of managing the food. (b) Accommodation for relatives: A dharmashala (rest house/ Shelter) adjacent to the CHC is constructed by local donors and is freely available to relatives who come along with the indoor patients. Maintenance of the dharmashala is the responsibility of the local donor. Infrastructure development: The local donors have contributed for construction of wards, furniture, equipment, renovations, operation theatre, toilets, room for life line fluid store, underground and overhead water tanks etc. Eg. Ranakpur temple trust donated one 15 kv generators. (c) Camps: For good quality specialist services, camps are organized – two eye camps are organized with support donors; 4-5 family welfare camps every year. The CHC is also planning a mega mobile surgical camp for December 2005, where all types of surgeries will be performed. (d) Communication: Public Call Office (PCO): As patients come from far-flung areas, a coin facility PCO was started in 2004. A telephone was installed early 2005 through funding from sector investment programme of European commission. (iv) An autonomous society (Rajasthan Medical Relief Society) was started in 2001 to manage the smooth functioning of the CHC by collecting user fees and through donor contributions. (v) Strengthening Management Information Systems (MIS) through computerization of all data and financial transactions including laboratory and drugs. (vi) For provision of good quality and low cost drugs, a lifeline fluid store was opened in July 2005. (See PROD entry ref no 135). Result The CHC is well maintained and clean. Every month 50 deliveries are conducted and on an average the CHC conducts 5 caesarian sections. The CHC in-charge informed that the X-ray machine and ECG machine available with the CHC has been working very well for last 15 years without major problem. In the last three to four years RMRS has made a collection of 4 to 5 lakhs and most of it is spent on repairs and maintenance of CHC. There has been increase in the utilization of the services.

Cost Sector Investment Programme European Commission gave INR 1 lakh for RMRS and provided a computer system including UPS, scanner and furniture (through national informatics center). In addition, INR 3000/ was also provided for installing a telephone connection.
Place CHC Sadri, Pali District, Rajasthan.
Time Frame One to three months.
Advantages

Cleanliness: Well-maintained and clean facility. Efficient: Good use of human resources without outsourcing ancillary services. Better services: Provision of quality of services and availability of good and cheap drugs within the CHC premises. Incentives: Motivated staff. In addition, Medical Officers do not request transfers as they are from local area. Community Participation: Support of local donors in improving the quality of services. No political interference.

Challanges

Transfer: Shifting of motivated staff from the CHC to other facilities. Limited service: Not designated as a First Referral Unit so the CHC does not have a blood storage unit and blood has to be brought from far off place.

Prerequisites

No political interference from local leaders. Financial support from local donors. Finance available with CHC and authority to use it for improvement of services. Motivated leader.

Who needs to be consulted

CHC In charge, Sadri, Pali.

Risks

Sustainability

Yes, if the above mentioned prerequisites are in place.

Chances of Replication

Participatory procedures adopted to manage human resources can be adopted in any health facility. Similarly, other strategies adopted by CHC can also be replicated elsewhere.

Comments

The CHC reports a real need for a blood storage unit to meet the needs of the community it serves. It also serves three adjoining mountainous regions which are also places of piligrimage (Ranakpur, Parsuram Mahadev and Desuri). This increases the trauma caseload during festive season. This caseload increases significantly during religious festivals.The CHC is now being developed as an FRU with Indian Public Health Standards (IPHS) norms and INR 20 lakhs have been sanctioned under NRHM.

Contact

Submitted By

Dr. Nandini Roy, HS-PROD Research Consultant, NIMS. September 2005. Last Updated: Prabha Sati, Research Consultant, ECTA, December 2006.

Status Active
Reference Files
scan.pdf
Workdivisionchart.pdf
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