Protocol for case study of - jan swasthya abhiyan



Protocol for case study of Community Health CentreOr Rural Hospital (RH)Note:The organizational structure of a Community Health Centre (CHC) is slightly different from that of a Rural Hospital (RH). There may also be inter-state variations in the structure of a CHC / RH. In some states they may be known as Additional PHCs. Therefore, some of the questions in this checklist may not be applicable to any given CHC/RH. Wherever such is the case, please write ‘NOT APPLICABLE’ against the concerned question(s).Kindly put a tick mark() against the option applicable in the question given. In cases where more than one answer is applicable, please tick mark against the options applicable. If required, you may write out any other answers that may not have been enlisted in the options given. Kindly make a report of all that you observe at the CHC/ RH (behaviour of staff, locked wards, etc.) and send it along with this filled up checklist Questions to be asked from Medical Officer-in-charge of CHC or any other doctor presentGive the Informed Consent to MO and get it signed from him/herGeneral Information about CHCName of the Community Health Centre (CHC)/ RH: ____________Taluka/Block in which CHC/ RH is located: _______________ Is this Taluka in a Tribal / hilly area or general? Tribal/hilly General Total number of Primary Health Centres (PHCs) under the CHC / RH: InfrastructureWhere is this hospital located? Within Village LocalityFar from village locality If far from locality specify in km__________Is a designated government building available for the RH/CH? YesNoIf there is no designated government building, then where does the hospital function? Rented premises Other government building PHC Any other specify______________________Does the hospital building have following facilities?Sr. no.StructureYesNo 1Wards of total 30 beds 2Major Operation Theatre3Minor Operation Theatre4Labour Room with delivery table5Laboratory Room6X-ray Room7Pharmacy8Staff Quarters9Disinfecting RoomWater: Is water available on tap in the RH/CHC? YesNo Electricity: Is there electricity supply to the CHC/RH? YesNo If there is irregular electricity supply, then, is a generator available as a backup measure? YesNo Sometimes What is the state of the building of the RH/CHC?Satisfactory construction Leaking Dilapidated Water logged sections What is the present observed state of the premises?Quite clean Somewhat dirty Very dirty Are the following facilities available in the CHC/ RH for patients and their relatives?Waiting room YesNo Toilets (that are in working condition) YesNoDrinking water YesNoHow many wards are there? 1 2 3 How many beds are there in one ward? 10 15 more than 15 If labour room is present, are deliveries carried out in the labour room? Yes No Sometimes If labour room is present, but deliveries are not being conducted there, then what are the reasons for the same?Non-availability of doctors / staff Seepage in the labour room No power supply in the labour room Any other reason (specify) ________________If operation theatre is present, are surgeries carried out in the operation theatre? Yes No Sometimes If operation theatre is present, but surgeries are not being conducted there, then what are the reasons for the same?Non-availability of doctors / anaesthetist / staff Lack of equipment / poor physical state of the operation theatre No power supply in the operation theatre Any other reason (specify) ________________Is post- Mortem conducted in CHC/ RH? YesNoIs an ambulance available for the RH/CHC? YesNoIs the ambulance in working condition? YesNoIs the ambulance service provided even if the patient cannot pay for it? YesNoAs of today, what is the status of the following equipments at the RH/CHC?Sr. noEquipments Present Not present If present, thenWorkingNot working1X-ray machine2Laboratory microscope,3Examination table 4Ice Lined Refrigerator5Oxygen cylinderAvailability of Staff at CHC/RHDoes the RH/Cottage have the following staff? Sr. noDesignationMinimum normFilled PostVacant post 1Medical Superintendent12Specialist Medical Officers33General medical officers34Sister in Charge15Staff Nurses76X – Ray Technician17Laboratory Technician18Pharmacist29Driver1Who are the specialists currently posted at the RH/CHC?Paediatrician Yes No Gynaecologist Yes No Surgeon Yes No Anaesthetist Yes No Specialist physician Yes No Any other specialists in position (specify) ____________Is there any additional post Sanctioned in RH/CHC?Dental Surgeon Yes No Ophthalmologic Assistant Yes No Any other post (specify)___________________Is there a female medical doctor at the RH/CHC? Yes NoHow many of the posted doctors stay at the headquarters? All Some of them NoneTimings of CHC/RH, charges, transport facilities, etcIs the RH/CHC open for outpatient services for the stipulated OPD time?Yes, on all days excepting designated holidays No, it always closes before time Only on some days itfunctions for the stipulated timeIn cases where a patient needs to be admitted for inpatient care, is s/he admitted?Yes, patients who can be managed at CHC are always admitted Some deserving patients are not admitted but are referred to other facilities Patientsusually refused admissionCharges at CHC/RH if anyIf a patient is admitted for inpatient care, then does she have to pay for certain types of goods/ services? Yes NoIf the patient has to pay for some goods and/ or services, what are those?Purchase of drugs Purchase of cotton, syringe, bandage etcBribes to doctor, nurse, sweeper, etcAny other (specify)_____________Does the RH/CHC provide treatment to emergency patients (victims of accident, burns, medical emergencies etc) at any time of the day/ night?Emergency patients are given treatment. Where necessary, they are referred to a higher level Govt. hospital Emergency patients are often not treated, referred to a public health care facility Emergency patients are often not treated, referred to a private medical facilityIs there any public-private partnership arrangement (PPP) with the private medical facility for such referrals? If yes, then give details? Does the patient have to make payments at the facility?Are the following types of patients given emergency treatment at the RH/CH at any time of the day/ night?Snake bite victims Yes No Sometimes Dog bite victims Yes No Sometimes If referred to a higher-level health care facility, how is the patient taken there?Free transport by hospital ambulance By hospital ambulance, but fuel and other charges have to be made by the patient Private/ personal conveyanceIs there any PPP arrangement for ambulance facility? If yes, then give details of how it is executed? Do patients have to pay for it?Reproductive and Child health servicesAre regular antenatal clinics conducted by the CHC/RH? Yes No Are normal deliveries carried out in the CHC/ RH? Yes NoWho carries out the normal deliveries in the CHC/ RH? Male doctor Female doctor Staff nurseOther If normal deliveries are not conducted at the CHC, then where are the cases sent?Cases are referred to a higher level govt. hospital Casesare referred to a private health care facilityAre deliveries by Caesarean Section conducted in the CHC/ RH? Yes No SometimesIf they are not conducted, then where are patients sent? If there is a PPP then give details.Are hysterectomies conducted at CHC/ RH? Yes No Sometimes What are the expenses for hysterectomy? Is medical termination of pregnancy (Abortion) carried out at the RH/CHC? Yes, always No, never Sometimes Is there any precondition imposed for doing MTP (like compulsory Copper T insertion or sterilization after MTP etc.)? Yes, alwaysNo, neverSometimes Is husband’s signature obligatory for carrying out MTP? Yes, always No, never Sometimes Does the RH/CHC provide services for Reproductive Tract Infections (RTIs)? Yes, always No, never Sometimes Are family planning services provided by the RH/CH? Condom distribution Yes No Distribution of Oral contraceptive pills Yes No IUD insertion Yes No Female sterilization Yes No Male sterilization Yes No Injectable contraceptives (Depoprovera) Yes No Are the facilities required for providing these contraceptives available at RH/CHC? Like trained health workers for insertion and removal of IUD, following aseptic conditions for insertion of IUD etc.Are newborn babies requiring neonatal care managed at the CHC?Usually Sometimes NeverAre infants / children needing critical care for pneumonia treated at the CHC?Usually Sometimes NeverAre infants / children needing critical care for diarrhoea with dehydration treated at the RH/CHC?Usually Sometimes NeverWhat are the days on which immunization services are offered?Select days of the week Only in campsBoth on certain days of the week and also in camps IrregularlyOther services at the RH/CHCAre surgeries carried out at the RH / CHC?Yes, always Yes, sometimes No, never If surgeries are carried out at the RH/CHC, then please tick mark the type of surgeries being conducted here against the availability of the services.Minor surgeries (e.g. stitches on wounds, drainage of abscess, etc)Yes, always Yes, sometimes No, never Major surgeries with general anaesthesia where required (e.g. appendicitis operation, hernia repair, management of fractures, etc)Yes, always Yes, sometimes No, never What are the expenses incurred while undergoing surgeries at the CHC/ RH?Service is provided freeBribes need to given to hospital staff (doctors/ nurse/ sweeper , etc)Drugs and other materials like syringes, cotton, surgical gloves ,etc need to be purchased. Is the treatment for tuberculosis given in RH/ CHC?Yes, always Yes, sometimes No, never Is sputum examination done in suspected cases of tuberculosis?Yes, always Yes, sometimes No, never Is the X-ray facility available in this RH/CH?Yes, always Yes, sometimes No, never Are the blood tests done regularly in this RH/CH?Yes, always Yes, sometimes No, never Is the facility for urine examination available at CHC/RH?Yes, always Yes, sometimes No, never Is the facility for Stool examination available at CHC/RH?Yes, always Yes, sometimes No, never Is the facility of Pap smear test available for diagnosis of cervical cancer at CHC/ RH? Yes, always Yes, sometimes No, never Is there facility for blood transfusion available in the CHC?Yes, always Yes, sometimes No, never If the above facilities are not available, then where are patients sent? Is there any PPP arrangement made for these services? If there is, then give details – with which facility, what are the terms for payment – do patients have to pay, etc.Availability of medicines at CHCAre the following medicines available at the CHCNo.MedicineAvailabilityRemarks1.Adrenaline Inj.2.Albendazole Tab.for worm infection3.ASV Inj.(Anti-snake venominjection) for snake bite4.Atenolol tab. or Envas(enalapril) Tab.5.Ciprofloxacin Tab.6.Cefotaxime inj.7.Clotrimazole vaginal tab.8.Dexamethasone inj.9.Diazepam Tab.10.Diclofenac Tab.Bodyache11.Dicyclomine Tab.12.Domperidone Tab.To stop vomiting13.Fluconazole Tab.Anti-fungal medicine14.Furazolidine Tab.Dysentery caused bygerm infection15.GlibenclamideTab.16.MetochlopropamideInj.17.Metronidazole Tab.for amoeba & othergerm infections18.Oxytocin 2ml. Amp.Inj. (Pitocin)19.Paracetamol SyrupFor children in case offever & body-ache20.Paracetamol Tab.Fever & body-ache21.Rabipur Inj. (Antirabies vaccine)In case of bite bysuspected rabid dog22.Ringer Lactate I.V.Saline to preventdehydration23.Salbutamol tab.24.Septran D. S. Tab.orCotrimexazol Tab.25.Septran Syrup26.Sodabicarb inj. 10 ml vial27.Soframycin creamGermicidal cream28.Tetanus Toxoid Inj.To avoid Tetanus29.Xylocaine inj.Which are the medicines that are not regularly available and why?Do patients have to pay for any medicines at the CHC? If so, which ones and why?Role of CHC / RH in promotion of community healthHow often do personnel from the CHC/ RH go to schools for school health checkups?NeverOnce in 6 months Once in a year IrregularlyAre health checkups carried out by CHC / RH personnel in Anganwadi?Yes, on both children and pregnant/ nursing women Yes, but only on children Yes, but only on pregnant and nursing womenNo, health checkups are never carried out in AnganwadiIs there a community health officer appointed in the CHC to supervise public health measures? Yes No Has there been an epidemic of any of the following in the coverage area of the CHC in the last three years?MalariaGastroenteritis (diarrhoea and vomiting)MeaslesJaundice (infective hepatitis)DengueAny other outbreakIf yes, what were the steps taken by the CHC staff to control the outbreak?Do you face any problems in providing services at this PHC? YesNo.If yes, then what are the kind of problems you have?Protocol for Case Study of CHCQuestions to be asked from one or two VHSCs or a group of patients at the CHC Read out Informed Consent form and get it signed from some people in the groupSpecify here with whom you have had the discussion - VHSCGroup of patients Group of women in the villageAre doctors regularly available at the CHC? Do any doctor and nurses reside at the CHC? Availability of Medicines in the CHCIs the Anti-snake Venom regularly available in the CHC? YesNo No informationIs the Anti-rabies Vaccine regularly available in the CHC? YesNo No informationAre the drugs for malaria regularly available in the CHC? YesNo No informationAre the drugs for Tuberculosis regularly available in the CHC? YesNo No informationAre all medicines given free of charge in the CHC?Yes, all the medicines are given free of chargeSome medicines are given free of charge while others have to be bought from medical storeMost of the medicines have to be bought from medical store – are you told to go to any specific medical store?No informationWhich medicines have to be brought from the medical store? (If possible get a doctor’s prescription)Availability of Services at the CHCIs surgery for cataract done in the CHC? YesNo No informationAre woundstreated at the CHC? (Stitches, dressing etc.)YesNo No informationIs the primary management of fracture done at the CHC? YesNo No informationAre minor surgeries like draining of abscess etc. done at the CHC?YesNo No informationIs the primary management of cases of poisoning done at the CHC? YesNo No informationIs the primary management of burns done at the CHC? YesNo No informationAvailability of Reproductive and Child health servicesAre antenatal clinics organized by the CHC regularly? YesNo (Registration of pregnant women, their check-up, distribution of iron tablets for them, etc)Is the facility for normal delivery available in the CHC for 24 hours? YesNoIs the facility for tubectomy and vasectomy (FP services) available at the CHC? YesNoIs the treatment for gynecological disorders like leucorrhoea, menstrual disorders available at the PHC?Yes, treatment is availableNo, women are referred to other health care facilities Women do not disclose their illnesses No ideaIf women do not usually go to the CHC, then what is the reason behind it? Is the facility for MTP (abortion) available at the CHC? YesNoIs there any precondition for doing MTP such as enforced use of contraceptives after MTP or asking for husband’s consent for MTP?No precondition Precondition only for some womenPrecondition for all women No idea Do women have to pay for MTP? YesNoIs treatment for anaemia given to both pregnant as well as non-pregnant women? All women given treatment for anaemiaOnly pregnant women given treatment for anaemiaNo women given treatment for anaemiaAre the low birth weight babies managed at the CHC? YesNo Is the treatment of children with pneumonia available at the CHC? YesNoIs the management of children suffering from diarrhea with severe dehydration done at the CHC? YesNoAvailability of laboratory services at the CHCIs Blood examination for anaemia done at the CHC? YesNoIs detection of malaria parasites by Blood smear examination done at the CHC? YesNoIs Sputum examination done to diagnose tuberculosis at the CHC? YesNoIs urine examination for pregnant women done at the CHC? YesNoIf these services are not available at the CHC then are you sent to any private diagnostic centre? If you are sent, then are you given a referral slip? Do you have to pay at the diagnostic centre? Do you know whether there is any public-private partnership with the diagnostic centre for doing the tests? If you know, then what are the details?General Questions about the functioning of the CHC/ RHHow is the behaviour of the CHC staff with the patients?CourteousCasual / indifferent Insulting / derogatory Is there corruption in terms of charging extra money for any of the service provided?Yes No Is a receipt always given for the money charged at the CHC? Yes NoIs there any incidence of any sexual advances, oral or physical abuse, sexual assault or harassment by the doctors or any other paramedical staff? Yes NoAre there instances where patients from particular social background (dalits, adivasis, minorities, villagers) have faced derogatory or discriminatory behaviour, or services of poorer quality? Have patients with specific health problems (HIV/AIDS, leprosy, TB) faced discrimination in any form? Such issues may be recorded in the form of recurring perceptions or specific instances.Are examinations on woman patients conducted in presence of a woman attendant, and procedures conducted under conditions that ensure privacy? Is inpatient care provided to patients for the entire duration needed? Do patients with chronic illnesses receive adequate care and drugs for the entire duration required?If the health centre is unequipped to provide the services needed, are patients transferred immediately without delay, with all the relevant papers, to a site where the desired service is available?Is there a publicly displayed mechanism, whereby a complaint/grievance can be registered?(If the group wishes to share any other information that you feel is relevant or important, then write it down on a separate sheet of paper)FORMAT FOR ANALYSIS OF CASE STUDY DATA OF CHCThis format is for analyzing the data regarding CHCs, collected using given protocol.Introduction Brief information about the survey area Table exhibiting names of districts, Tahsils/Blocks and CHCs surveyedName of the district Tahsils/ Blocks CHCs TOTALI. Availability of the Staff in the CHCStaff position How many CHCs had the staff appointed in this positionappointed?In how many CHCs, the staff on this positionis appointed but remains absent frequently?In how many CHCs the staff on this position is not appointed?One medical SuperintendentThree specialist MOsThree General MOsOne Sister-in-charge7 Staff NursesOne X-ray technician2 Pharmacists1 Laboratory TechnicianDriverPaediatricianSurgeonGynaecologistAnaesthetistSpecialist PhysicianAny other specialistII. Availability of Infrastructure at the CHCNo.Type of infrastructural facility Number of CHCs having this facility Number of CHCs not having these facility1Designated government building in good physical condition and clean surrounding2Regular water supply3Regular electricity supplyWorkingNot working4Toilet facility5Ice Lined Refrigerator / Deep Freezer6Labour room 7Delivery table 8Wards with 30 beds9Laboratory, with microscope 10X-ray room with x-ray 11Minor operation theatre 12Major operation theatre 13Pharmacy14Disinfecting room15Oxygen cylinder16Round the clock ambulance service which is free of cost17Neo-natal intensive care (NICU)III. Availability of Medicines in the CHCNo.Name of the medicine Number of CHCs where this medicine is available regularly Number of CHCs where this medicine is not available regularlyNumber of CHCs where this medicine is not available at all1Anti-snake Venom2Anti-rabies Vaccine3Drugs for malaria4Drugs for Tuberculosis5Albendazole6Atenolol tab. orEnvas(enalapril) Tab.7Ciprofloxacin Tab.8Metronidazole9Paracetamol syrup10Septran syrup 11Ringer lactate12Tetanus toxoid inj.Availability of all medicinesNumber of CHCs where medicines are given free of chargeNumber of CHCs where some medicines are given free of charge while others have to be bought from medical storeNumber of CHCs where most of the medicines have to be bought from medical storeIV. Availability of Services for emergency at the CHCNo.Type of service Number of CHCs where this service is providedNumber of CHCs wherethis service ssnot provided1Minor surgeries-draining abscess,stitching wounds, etc2Surgery for cataract3Management of fractures4Appendicitis surgery5Hernia operation6Blood transfusion7Treatment for TB8In patient care –patient admittedV. Availability of Reproductive health servicesNo.Type of service Number of CHCs where this service is providedNumber of CHCs where this service is not provided1Regular antenatal clinics2Round the clock facility for normal delivery 3Facility for Tubectomy and Vasectomy4Facility for internal examination and treatment for gynecological conditions like leucorrhoea, menstrual disorders etc.5Facility for MTP (abortion) without any condition and free of charge 6Treatment for anaemia given to both pregnant as well as non-pregnant women7Caesarean sections8MTP (abortion)VI. Availability of Child health servicesNo.Type of service Number of CHCs where this service is providedNumber of CHCs where this service is not provided1Management of low birth weight babies2New born requiring critical care(neo-natal care)3Fixed immunization day4Treatment of children with pneumonia5Management of children suffering from diarrhea with severe dehydrationVII. Availability of laboratory services at the PHCNo.Type of service Number of PHCs where this service is providedNumber of PHCs where this service is not provided1Blood examination for anaemia2Blood smear examination for detection of malarial parasites3Sputum examination done to diagnose tuberculosis4Urine examination for pregnant womenVIII. Other informationIn how many CHC areas there were outbreaks / epidemics of the following diseases, in the last three years?Name of the disease Number of CHCs with outbreak/ epidemic of this diseaseMalariaMeaslesGastroenteritis (diarrhea and vomiting)JaundiceDengueJapanese encephalitisAny other (specify)(Write in brief about the outbreak giving information about how many people were affected, how many deaths occurred, did the CHC staff respond immediately to stop the further spread of the epidemic? If yes, what steps did the CHC staff take?etc.)Number of CHCs where there is corruption in terms of charging extra money for any of the service provided:Number of CHCs where the doctor does private practice during or after the duty hours:Number of CHCs where doctors/MOs mentioned that they faced problems in providing services: _______________________What were the problems mentioned by these MOs/doctors of CHCs: ................
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