Health Education to be imparted to community by treating physicians should be multilingual so that the language does not become the barrier for it. I have given the recording on the subject of diabetes for a news channel on health sponsored by Piramal Health Group on dated 1-09-09 at Jaipur. This was in English language which is beyond understanding of masses in India. There were six pertinent questions to explained to community through this talk.
How does diabetes affect heart?
How to control these complications?
What are the effects of diabetes on Kidney?
What is the treatment of diabetes nephropathy?
What is hypoglycemia?
Any other serious consequence of diabetes?
All went well and feed back from the community will help in further improving the talk. Certainly it was different than my previous recordings for TV Channels.
Wednesday, September 2, 2009
Monday, August 17, 2009
Patient Satisfaction for underserved population
Is Your Doctor Meeting Your Needs?
Since the working relationship between a doctor and patient is so important, it is imperative that patients feel that their needs are being met .This is very important when we are evaluating the patient satisfaction and the over all quality of health acre delivery
· Are most patients happy with their doctors at public health facilities?
· Are they satisfied with their treatment plan as per their expectations from the doctor?
· Does their doctor leave them feeling that their health care is under control? And communicating to patient and their relatives timely.
· Does their doctor encourage questions?
· Do most feel their doctor understands them or there are some social, economic, cultural or other barriers?
· Do most feel they understand the directives and decisions made by their doctor or feel like irrationality in the prescription?
· Do most feel confident in the ability of their doctor?
· Have they built the trust in their patient-physician relationship that seems so imperative even the BPL patients?
· Do patients feel any discrimination between BPL and Non BPL patients during treatment at public hospitals made by service providers?
· Do the patient is satisfied by the medicine and other supports provided by public health care delivery institutions specifically in case of BPL patien6ts
Or, are they sticking with a particular doctor because they have considered no alternative, sought no other medical facility available.
Since the working relationship between a doctor and patient is so important, it is imperative that patients feel that their needs are being met .This is very important when we are evaluating the patient satisfaction and the over all quality of health acre delivery
· Are most patients happy with their doctors at public health facilities?
· Are they satisfied with their treatment plan as per their expectations from the doctor?
· Does their doctor leave them feeling that their health care is under control? And communicating to patient and their relatives timely.
· Does their doctor encourage questions?
· Do most feel their doctor understands them or there are some social, economic, cultural or other barriers?
· Do most feel they understand the directives and decisions made by their doctor or feel like irrationality in the prescription?
· Do most feel confident in the ability of their doctor?
· Have they built the trust in their patient-physician relationship that seems so imperative even the BPL patients?
· Do patients feel any discrimination between BPL and Non BPL patients during treatment at public hospitals made by service providers?
· Do the patient is satisfied by the medicine and other supports provided by public health care delivery institutions specifically in case of BPL patien6ts
Or, are they sticking with a particular doctor because they have considered no alternative, sought no other medical facility available.
Thursday, August 6, 2009
Behaviour Change and Communication for service Providers in Government Hospitals of rajasthan
Capacity Building for Healthcare Staff through
Behavior Change Communication Training
Rajasthan Health System Development Project (RHSDP) has embarked on strengthening the secondary level health care institutions in the state by improving the health care infrastructure and assuring quality health care delivery along with the improved behavior and performance of healthcare personnel.
In order to improve the quality of health services, a comprehensive training on Behaviour Change Communication was identified for medical and paramedical staff, as they are the crucial contact point between the Health services and the Community. The behaviour change communication training is meant to sensitize the providers for patient friendly behaviour, increase the sense of team and develop ownership of the system among the service providers, provide client centered services, behave with dignity and respect particularly with marginalized and deprived segment of population.
MAFOI Consulting Solutions Ltd., Chennai was identified as the nodal agency for this training. Members of MAFOI are key resource persons of national repute & have been associated with Behavior Change Communication Training in many other states of our country
This training was organized in six priority districts namely Jhalawar, Jodhpur, Tonk, Bharatpur, Chittorgarh and Dungarpur covering 50 facilities in phase manner. In the first phase of this training, 30 facilities of these six districts were trained, And in the second phase new training at remaining 20 facilities with in the same six districts have also been trained along with refresher training programs by the consultant agency. The actual training load to be covered in 6-priority district under phase II was 5895 out of which 4640 participant attended the training.
The review and feedback of the training reflects that such trainings may be repeated at yearly interval to sensitize the hospital staff and may further be scaled up to other districts of the state.
To ensure the sustainability of this training intervention and initiatives launched under RHSDP, the concept may be incorporated into NRHM(National Rural Health Mission)
Photographs of the BCC Training
Behavior Change Communication Training
Rajasthan Health System Development Project (RHSDP) has embarked on strengthening the secondary level health care institutions in the state by improving the health care infrastructure and assuring quality health care delivery along with the improved behavior and performance of healthcare personnel.
In order to improve the quality of health services, a comprehensive training on Behaviour Change Communication was identified for medical and paramedical staff, as they are the crucial contact point between the Health services and the Community. The behaviour change communication training is meant to sensitize the providers for patient friendly behaviour, increase the sense of team and develop ownership of the system among the service providers, provide client centered services, behave with dignity and respect particularly with marginalized and deprived segment of population.
MAFOI Consulting Solutions Ltd., Chennai was identified as the nodal agency for this training. Members of MAFOI are key resource persons of national repute & have been associated with Behavior Change Communication Training in many other states of our country
This training was organized in six priority districts namely Jhalawar, Jodhpur, Tonk, Bharatpur, Chittorgarh and Dungarpur covering 50 facilities in phase manner. In the first phase of this training, 30 facilities of these six districts were trained, And in the second phase new training at remaining 20 facilities with in the same six districts have also been trained along with refresher training programs by the consultant agency. The actual training load to be covered in 6-priority district under phase II was 5895 out of which 4640 participant attended the training.
The review and feedback of the training reflects that such trainings may be repeated at yearly interval to sensitize the hospital staff and may further be scaled up to other districts of the state.
To ensure the sustainability of this training intervention and initiatives launched under RHSDP, the concept may be incorporated into NRHM(National Rural Health Mission)
Photographs of the BCC Training
Hospital Admintrators in district hospitals of Rajasthan
The District Hospitals at present are being managed by PMO’s who being clinicians are unable to devote time for day to day management of the hospital. In order to assist PMO, it has been proposed to appoint Hospital Administrators in all 33 district hospitals. The hospital administrator shall report to the PMO and assist him in all administrative matters. He will develop and administer, with staff assistance, policies and directions of the hospital governing, discharge of support services in the area of finance, personnel, materials and property, housekeeping, laundry, security, transport, engineering, maintenance of building including landscaping, in particular all the matters pertaining to patient care and patients welfare including medico legal and all extension programmes and medical welfare service departmentsTasks to be carried out by the Hospital Administrator:
He shall coordinate and supervise the following services in particular:
Þ Provide support services in
Þ Purchasing & Store management
Þ Inventory Control
Þ Laundry & Linen Supply
Þ Transportation
Þ Cleanliness & Sanitation of the hospital
Þ MRS related issues
Þ Hospital infection control
Þ HCWM
Þ Referral management including referral transport
Þ Building maintenance
Þ BPL & related issues
Þ Citizen charter
Þ OPD/IPD/Drug store/OT/HR/Contract services/PPP management
Þ Security
Þ Arranging local meetings at facility level
Þ Issues related to health insurance ( where applicable)
Þ Public grievances & right of information
Þ To assist in developing institutional strengthening strategies and staff positioning and training status of each of the staff to trained
Þ Other works as and when assigned by the PMO.
He shall coordinate and supervise the following services in particular:
Þ Provide support services in
Þ Purchasing & Store management
Þ Inventory Control
Þ Laundry & Linen Supply
Þ Transportation
Þ Cleanliness & Sanitation of the hospital
Þ MRS related issues
Þ Hospital infection control
Þ HCWM
Þ Referral management including referral transport
Þ Building maintenance
Þ BPL & related issues
Þ Citizen charter
Þ OPD/IPD/Drug store/OT/HR/Contract services/PPP management
Þ Security
Þ Arranging local meetings at facility level
Þ Issues related to health insurance ( where applicable)
Þ Public grievances & right of information
Þ To assist in developing institutional strengthening strategies and staff positioning and training status of each of the staff to trained
Þ Other works as and when assigned by the PMO.
Patient Counselor for Below Powerty line Patients
Rajasthan Health system development Project has taken up Patients Counselors to increase access and equity of under served of the state. They are being placed at 50 bede and above hospitals across the state and assisting at the facility and at community level to utilise quality health care delivered at public health facilities. They are being empowered with repeated training to them regarding the health rights of BPL Patients, Antinatal Counselling, Neonatal counselling and Family Welfare issues,record keeping of exepmtion Schemes 's patients, immediate attention to serious patients. They are key persons for IEC at facility level. This concept is helping to overcome the barriers of access at pulic health care delivery institutions in the state mainly the barriers of economy( money), social, cultural, and transport. They are facilitating the referral System in health Sector in the state.Dr. P.C.ranka
Tuesday, August 4, 2009
Autoheamo therepy in eczema
AUTOHEAMOTHEREPY IN ECZEMA Study Conduted-at--GOVT. BARKAT NAGAR HOSPITAL JAIPUR.
Paper presented in XVIII Rajasthan Medical Conference at Sampurnanand Medical College Jodhpur.27-28th Nov. 1981.
Eczema which is known to be a highly allergic disease present with a varying morbidity and not fully responding to conventional antihistaminics and even with corticosteroids.
Relapses and recurrences are rule.
Thirty patients were studied in present study.
Patient receiving AUTOHEAMOTHEREPY WITH SYMPTOMATIC therapy experienced improvement in symtomatology earlier as corroborated by clinical assessment. Cure rate too was improved.
The absence of untoward side effects make this regime much safer and effective in at the secondary level hospitals
Paper presented in XVIII Rajasthan Medical Conference at Sampurnanand Medical College Jodhpur.27-28th Nov. 1981.
Eczema which is known to be a highly allergic disease present with a varying morbidity and not fully responding to conventional antihistaminics and even with corticosteroids.
Relapses and recurrences are rule.
Thirty patients were studied in present study.
Patient receiving AUTOHEAMOTHEREPY WITH SYMPTOMATIC therapy experienced improvement in symtomatology earlier as corroborated by clinical assessment. Cure rate too was improved.
The absence of untoward side effects make this regime much safer and effective in at the secondary level hospitals
Art of living in Project Setup
ART OF LIVING IN PROJECT SETUP
Expectations reduce joy in life.
Responsibility is equals to power & Irresponsibility is equals to complaint
.
Don’t say I will try but say I will do all efforts to do the task
.
Be 100% in the work.
Accept the person, situation and things as they are.
Do not react rather respond.
Show of anger, don’t be anger.
Prayerful listening and meaningful questioning.
Prepared in the interest of project
By----
Dr. P.C.Ranka,
MD (Med),MA (Soc). PGDHA
Expectations reduce joy in life.
Responsibility is equals to power & Irresponsibility is equals to complaint
.
Don’t say I will try but say I will do all efforts to do the task
.
Be 100% in the work.
Accept the person, situation and things as they are.
Do not react rather respond.
Show of anger, don’t be anger.
Prayerful listening and meaningful questioning.
Prepared in the interest of project
By----
Dr. P.C.Ranka,
MD (Med),MA (Soc). PGDHA
TamilNadu visit for health sector Reforms
Tamilnadu Visit Report
By
Dr. P.C.Ranka & Ashutosh Bajpeyee
The visit to Tamilnadu state
The Tamilnadu state Health systems Development Project (TNHSDP) office was visited on April 16, 2009. Detailed discussions were held with the Project Director and other project officials, this interaction also included exchange of views regarding various activities undergoing in both the projects. There was also a discussion on the issues forthcoming in both the project including the proposals for utilization of savings etc.
The project Director was kind enough to arrange for all visits for next two three days and took special interest to facilitate with all requisites.
The visit subsequently started with the project office itself.
1. Equipments Management System
Meeting with Bio-Medical Engineers and Visit to Health Facility
1.1 A monthly review meeting of all the Bio-medical engineers was attended which was scheduled for the same day incidentally. A detailed interaction with all field functionaries was held. In addition to this detailed discussion was also held with one of the BME at the Government Hospital Sri Perumbudur. Following issues were understood;
1. In Tamilnadu there are 15 BMEs have been recruited and they are serving at TNMSC. The recruitment was done by TNHSDP.
2. Each BME covers almost three districts as far as the equipment management in the health facilities is concerned.
3. These BMEs are required to travel and attend each health facility and inspect all the equipments installed therein.
4. In case of any problem and non-functionality reported for any equipment the BME feeds the required information in to the computerized health management system which in turn reaches to the TNMSC.
5. The BMEs do have kind of a tool-kit with them and are supposed to attend all minor problems at the site itself.
1.2 This system is existence is functioning well in the state and BMEs have contributed positively for equipments management. The project is also considering recruitment of additional 10 BMEs in near future.
The management system is administered by the TNMSC at the apex level and sufficient logistics and other arrangements are well organized. TNMSC controls all equipment supply and management system including repair and AMCs for each equipments. These AMC contracts are managed centrally at the TNMSC headquarters only. No health facility in the state has independent AMCs and other repair systems of their own.
1.3 Despite all the positive impacts of the BME based equipments repair and management systems of Tamilnadu there are few potential bottlenecks that were observed.
1. Although each BME has a tool-kit with them but hardly any of them carries the same while visiting a health facility. Reason for this is mainly the inconvenience in carrying the tool kit. The traveling arrangements are not smooth for BMEs. They have to travel on their own.
2. Once a snag is detected in any equipment at any health facility the BME has to report the problem to the health facility in charge in addition to reporting it to the TNMSC through computer. This is not much effective process though seems to be working in principal only.
3. The health facility in charge has limited financial powers and it takes quite long in arranging or purchasing any minor spare parts and till it is arranged the equipment lies unattended and un-repaired.
4. The BME has no such facility to arrange the required spare part on its own. The tool-kit does not contain any such part.
5. BMEs were effective in timely reporting the outages in all major equipments but this was also mainly because of the timely action by the health facility in charge also.
6. One BME has to cover three districts at one time and therefore the timely attending each health facility is quite infrequent. As a result the timely reporting of outages of minor equipments is severely hampered.
1.4 As a whole the system of equipments management is functioning with moderate success in the state of Tamilnadu. There are several minor issues must be addressed well in case the same system is replicated and implemented elsewhere. Attending the outages of major equipments can always be covered up through the well managed Annual Maintenance Contracts at central level but addressing the multiple minor issues becomes extremely critical.
2. District Hospital Functions
Visit to the District Hospital –Kanchipuram
The visit to the district hospital at Kanchipuram was very exhaustive. Almost all the major activities and functions being carried out at the district hospital were understood. Detailed discussions and interactions were also held with in charge of the hospital, other doctors and staff . Following issues were understood and analyzed in detail;
CME : Tele-medicine
The hospital had a dedicated tele-medicine center. This was a well equipped center and was a good center facilitating CME. While visiting a class was already undergoing and para-medical staff was attending the session.
The in-charge of the hospital explained that the tele-medicine is helping functionaries to a great extent. However, doctors find less time for attending these sessions.
2.2.1 Public Drug Distribution System
The district hospitals (DH) in Tamilnadu have 24 X 7 drug distribution system in place and it is very effective. The drug logistics system is totally computerized and all the drugs are distributed at the hospital itself. There are no drugs and medicines prescribed to any patient(s) that can be purchased from outside the hospitals. Similarly, all the testing are also conducted at the hospital itself and these are completely free or with minimum charges.
There is a specific drug distribution center at the each hospital across the state. The stores in the hospitals are connected with the computerized logistics system in some of the district hospitals where a pilot is underway. These district hospital stores enter their consumptions and requirements on daily basis in to the designated software (hospital management system).This in turn collected with all data and informations at the central server at DMS. The demand and supply arrangements are accomplished by the by DMS at present.
There are normally two window drug delivery and distribution system at each hospital. There is spate window for men and women exclusively. In addition to this the drugs and medicines are also delivered and distributed to the wards and ICU etc depending upon the demand generated each day.
There is no connectivity with the district drug warehouse and the hospitals within the district. Presently the drugs and medicines demand and supply mechanism is based on manual systems and drugs supply is ensured by the drug ware house in the district on the bsaisi of demand generated and reported.
The health facilities including the district hospitals will have to collect their drug supplies from the drug ware house of the district in particular. For small health institutions this is a problematic logistics where they have to approach the drug ware houses and collect their supplies. Although, there is a system of reimbursement of payment of transportation charges, It is based on the assumptive diesel consumption charges per kilometer of 9km/lit.
Doctors have no problem with it but the supply goes slow if the connectivity is slow. And it is so after 9.30 AM when the OPD is its peek especially on Mondays, Wednesdays and Fridays when specialty medicines are dispensed.
Essential drug list is revised every year. The committee is as follows
MD. TNMSC ,Director PH, Dir. Rural Health, Dir. FW ,Dir. Med. Edu., Dir Drug Controller, Prof. of Medicine and Surgery.
Total Budget of the of the corporation is 200 Crores per year.
Stock position and need assessment is done on the basis of 1% rise of last year Per Monthly calculation of need multiplied by months minus stock remained in that month.
Drug Testing System with Drug Testing Laboratories
Tamilnadu has 10 designated drug testing laboratories (DTL) in all. Drug samples are derived from across the state as and when required and sent to these drug testing laboratories.
On an average it takes around 7-21 days in testing the submitted drug samples and reporting the quality check back to the consignee.
In case of a sample fails in its testing to the standard norms and pharmacopeia standards , a second check is conducted and the supplier is asked to take away the goods else pay 2% penalty ( material stocking charges) on spurious supplies.
It was reported that the average drug sample failure rate is 0.23% in the state.
They have recommended that state may initially use the state ware house corporation or FCI / district hospital stores.
District drug ware house corporation Man Power is as follows
Pharmacist 2
Data entry Operator 1
Pickers 2
By
Dr. P.C.Ranka & Ashutosh Bajpeyee
The visit to Tamilnadu state
The Tamilnadu state Health systems Development Project (TNHSDP) office was visited on April 16, 2009. Detailed discussions were held with the Project Director and other project officials, this interaction also included exchange of views regarding various activities undergoing in both the projects. There was also a discussion on the issues forthcoming in both the project including the proposals for utilization of savings etc.
The project Director was kind enough to arrange for all visits for next two three days and took special interest to facilitate with all requisites.
The visit subsequently started with the project office itself.
1. Equipments Management System
Meeting with Bio-Medical Engineers and Visit to Health Facility
1.1 A monthly review meeting of all the Bio-medical engineers was attended which was scheduled for the same day incidentally. A detailed interaction with all field functionaries was held. In addition to this detailed discussion was also held with one of the BME at the Government Hospital Sri Perumbudur. Following issues were understood;
1. In Tamilnadu there are 15 BMEs have been recruited and they are serving at TNMSC. The recruitment was done by TNHSDP.
2. Each BME covers almost three districts as far as the equipment management in the health facilities is concerned.
3. These BMEs are required to travel and attend each health facility and inspect all the equipments installed therein.
4. In case of any problem and non-functionality reported for any equipment the BME feeds the required information in to the computerized health management system which in turn reaches to the TNMSC.
5. The BMEs do have kind of a tool-kit with them and are supposed to attend all minor problems at the site itself.
1.2 This system is existence is functioning well in the state and BMEs have contributed positively for equipments management. The project is also considering recruitment of additional 10 BMEs in near future.
The management system is administered by the TNMSC at the apex level and sufficient logistics and other arrangements are well organized. TNMSC controls all equipment supply and management system including repair and AMCs for each equipments. These AMC contracts are managed centrally at the TNMSC headquarters only. No health facility in the state has independent AMCs and other repair systems of their own.
1.3 Despite all the positive impacts of the BME based equipments repair and management systems of Tamilnadu there are few potential bottlenecks that were observed.
1. Although each BME has a tool-kit with them but hardly any of them carries the same while visiting a health facility. Reason for this is mainly the inconvenience in carrying the tool kit. The traveling arrangements are not smooth for BMEs. They have to travel on their own.
2. Once a snag is detected in any equipment at any health facility the BME has to report the problem to the health facility in charge in addition to reporting it to the TNMSC through computer. This is not much effective process though seems to be working in principal only.
3. The health facility in charge has limited financial powers and it takes quite long in arranging or purchasing any minor spare parts and till it is arranged the equipment lies unattended and un-repaired.
4. The BME has no such facility to arrange the required spare part on its own. The tool-kit does not contain any such part.
5. BMEs were effective in timely reporting the outages in all major equipments but this was also mainly because of the timely action by the health facility in charge also.
6. One BME has to cover three districts at one time and therefore the timely attending each health facility is quite infrequent. As a result the timely reporting of outages of minor equipments is severely hampered.
1.4 As a whole the system of equipments management is functioning with moderate success in the state of Tamilnadu. There are several minor issues must be addressed well in case the same system is replicated and implemented elsewhere. Attending the outages of major equipments can always be covered up through the well managed Annual Maintenance Contracts at central level but addressing the multiple minor issues becomes extremely critical.
2. District Hospital Functions
Visit to the District Hospital –Kanchipuram
The visit to the district hospital at Kanchipuram was very exhaustive. Almost all the major activities and functions being carried out at the district hospital were understood. Detailed discussions and interactions were also held with in charge of the hospital, other doctors and staff . Following issues were understood and analyzed in detail;
CME : Tele-medicine
The hospital had a dedicated tele-medicine center. This was a well equipped center and was a good center facilitating CME. While visiting a class was already undergoing and para-medical staff was attending the session.
The in-charge of the hospital explained that the tele-medicine is helping functionaries to a great extent. However, doctors find less time for attending these sessions.
2.2.1 Public Drug Distribution System
The district hospitals (DH) in Tamilnadu have 24 X 7 drug distribution system in place and it is very effective. The drug logistics system is totally computerized and all the drugs are distributed at the hospital itself. There are no drugs and medicines prescribed to any patient(s) that can be purchased from outside the hospitals. Similarly, all the testing are also conducted at the hospital itself and these are completely free or with minimum charges.
There is a specific drug distribution center at the each hospital across the state. The stores in the hospitals are connected with the computerized logistics system in some of the district hospitals where a pilot is underway. These district hospital stores enter their consumptions and requirements on daily basis in to the designated software (hospital management system).This in turn collected with all data and informations at the central server at DMS. The demand and supply arrangements are accomplished by the by DMS at present.
There are normally two window drug delivery and distribution system at each hospital. There is spate window for men and women exclusively. In addition to this the drugs and medicines are also delivered and distributed to the wards and ICU etc depending upon the demand generated each day.
There is no connectivity with the district drug warehouse and the hospitals within the district. Presently the drugs and medicines demand and supply mechanism is based on manual systems and drugs supply is ensured by the drug ware house in the district on the bsaisi of demand generated and reported.
The health facilities including the district hospitals will have to collect their drug supplies from the drug ware house of the district in particular. For small health institutions this is a problematic logistics where they have to approach the drug ware houses and collect their supplies. Although, there is a system of reimbursement of payment of transportation charges, It is based on the assumptive diesel consumption charges per kilometer of 9km/lit.
Doctors have no problem with it but the supply goes slow if the connectivity is slow. And it is so after 9.30 AM when the OPD is its peek especially on Mondays, Wednesdays and Fridays when specialty medicines are dispensed.
Essential drug list is revised every year. The committee is as follows
MD. TNMSC ,Director PH, Dir. Rural Health, Dir. FW ,Dir. Med. Edu., Dir Drug Controller, Prof. of Medicine and Surgery.
Total Budget of the of the corporation is 200 Crores per year.
Stock position and need assessment is done on the basis of 1% rise of last year Per Monthly calculation of need multiplied by months minus stock remained in that month.
Drug Testing System with Drug Testing Laboratories
Tamilnadu has 10 designated drug testing laboratories (DTL) in all. Drug samples are derived from across the state as and when required and sent to these drug testing laboratories.
On an average it takes around 7-21 days in testing the submitted drug samples and reporting the quality check back to the consignee.
In case of a sample fails in its testing to the standard norms and pharmacopeia standards , a second check is conducted and the supplier is asked to take away the goods else pay 2% penalty ( material stocking charges) on spurious supplies.
It was reported that the average drug sample failure rate is 0.23% in the state.
They have recommended that state may initially use the state ware house corporation or FCI / district hospital stores.
District drug ware house corporation Man Power is as follows
Pharmacist 2
Data entry Operator 1
Pickers 2
FRUs: SWOT Analysis on management issues of FRUS on Secondary data collected under RHSDP from CHCs
FRUs:
SWOT Analysis on management issues of FRUS on Secondary data collected under RHSDP from CHCs
Strenghts
Renovated large number of health facilities
Well established bureaucracy for monitoring even at Block Level
Regular supply of medicines and hospital supplies
Most of the FRUS have vehicles or connected with 108 Services or mobile clinics
RHSDP has established referral System in health sector
Flexibility to hire services of specialists under NRHM
FRU In charges financially empowered to take timely decision out of flaxy fund under MRS pooled through NRHM
Weakness
Some the FRUs function for few hours
Doctors are not residing at HQS
Shortage of subject specialists, non availability of skill mix for round the clock duties, shortage of back up staff for specialists.
Training requirement for skill development teamwork and motivation
Poor linking between supply of equipment and medicine, manpower, monitoring and feed back mechanism
Quality of service delivery is not up to mark
Delegated staff for FRU working is not at facilities.
Most of the staff works for the targets of FW work
Laboratory. Technicians are in shortage or unable to support system during emergencies
Transfers and posting at FRUs is not inter- FRUs
Opportunities
More funding for strengthening of FRUs under RHSDP and NRHM
Communication and transportation has improved in rural areas still it requires attention while selecting FRUs..
National AIDS control Program is providing safe blood bank services as well as coming up private blood banks in the state.
Flexibility of hiring of specialist under NRHM
FRUs can be selected on PPP models. Model Contract Documents have been developed by RHSDP
Threats:
Key threats are of barriers of access to health care: Economic barrier, social or the cultural barrier, information barrier
Problem of retaining manpower with system and designated staff for FRUs.
Poverty and high female illiteracy
SWOT Analysis on management issues of FRUS on Secondary data collected under RHSDP from CHCs
Strenghts
Renovated large number of health facilities
Well established bureaucracy for monitoring even at Block Level
Regular supply of medicines and hospital supplies
Most of the FRUS have vehicles or connected with 108 Services or mobile clinics
RHSDP has established referral System in health sector
Flexibility to hire services of specialists under NRHM
FRU In charges financially empowered to take timely decision out of flaxy fund under MRS pooled through NRHM
Weakness
Some the FRUs function for few hours
Doctors are not residing at HQS
Shortage of subject specialists, non availability of skill mix for round the clock duties, shortage of back up staff for specialists.
Training requirement for skill development teamwork and motivation
Poor linking between supply of equipment and medicine, manpower, monitoring and feed back mechanism
Quality of service delivery is not up to mark
Delegated staff for FRU working is not at facilities.
Most of the staff works for the targets of FW work
Laboratory. Technicians are in shortage or unable to support system during emergencies
Transfers and posting at FRUs is not inter- FRUs
Opportunities
More funding for strengthening of FRUs under RHSDP and NRHM
Communication and transportation has improved in rural areas still it requires attention while selecting FRUs..
National AIDS control Program is providing safe blood bank services as well as coming up private blood banks in the state.
Flexibility of hiring of specialist under NRHM
FRUs can be selected on PPP models. Model Contract Documents have been developed by RHSDP
Threats:
Key threats are of barriers of access to health care: Economic barrier, social or the cultural barrier, information barrier
Problem of retaining manpower with system and designated staff for FRUs.
Poverty and high female illiteracy
No PG without year- long rural posting after MBBS
No PG without year- long rural posting after MBBS
In spite of it we will not be able to ensure that doctors will stay at the place of posting for one year in the rural areas. These doctors will spend most of the time on preparation for pre PG examination and now most of them are taking up tuitions and coaching for pre PG which is available in the cities only. There is apprehension that physical presence in rural areas will not be ensured with this change
We do need specialist also in the system and present seats for PG are unable to meet the demand in the sector and situation analysis reflects that under utilization of infrastructure is because of non availability of specialist.
In most of the situations the stipend given to PG student is higher than regular salary which makes more inclination for PG. This will promote migration of talented doctors out of country
Fresh graduate posted in the village will not be competent enough to handle Obstetrics, Medico legal &Emergency cases even if he is ranked gold medalist at MBBS examination. Such doctors require technical support of seniors & at the same time Govt. can not afford training program for these doctors.
In situations where doctor availed loan for studies the repayment will be delayed by another one year in the want of it doctor may go for private sector.
If human resource in health sector is reviewed there is gradual reduction in the no. of students in the Science Biology stream which is the entry point of the funnel for human resources in health sector
The positive version of it would be that we should create incentives for doctors willing for rural services, rapid promotion avenues on performance basis if possible time bound, recognition of services on the parameters of quality health care delivery and efforts to increase access and equity of underserved population and punishment for those who are not adhering to it..
It is the time when we should work on how to retain manpower in public sector.
In spite of it we will not be able to ensure that doctors will stay at the place of posting for one year in the rural areas. These doctors will spend most of the time on preparation for pre PG examination and now most of them are taking up tuitions and coaching for pre PG which is available in the cities only. There is apprehension that physical presence in rural areas will not be ensured with this change
We do need specialist also in the system and present seats for PG are unable to meet the demand in the sector and situation analysis reflects that under utilization of infrastructure is because of non availability of specialist.
In most of the situations the stipend given to PG student is higher than regular salary which makes more inclination for PG. This will promote migration of talented doctors out of country
Fresh graduate posted in the village will not be competent enough to handle Obstetrics, Medico legal &Emergency cases even if he is ranked gold medalist at MBBS examination. Such doctors require technical support of seniors & at the same time Govt. can not afford training program for these doctors.
In situations where doctor availed loan for studies the repayment will be delayed by another one year in the want of it doctor may go for private sector.
If human resource in health sector is reviewed there is gradual reduction in the no. of students in the Science Biology stream which is the entry point of the funnel for human resources in health sector
The positive version of it would be that we should create incentives for doctors willing for rural services, rapid promotion avenues on performance basis if possible time bound, recognition of services on the parameters of quality health care delivery and efforts to increase access and equity of underserved population and punishment for those who are not adhering to it..
It is the time when we should work on how to retain manpower in public sector.
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