Evaluation of health care services in health centres attached to a tertiary care hospital in Northern India

Abstract

Background: India’s achievements are lagging behind the proposed goals under National Health Mission or the Sustainable Development Goals. Studies shown that inconvenient and ineffective services in primary health care institutions are leading cause of non-utilization. The aim and objectives was to evaluate the adequacy of health services being provided to the patients by Urban and Rural Health Training Centres under GMCH, Chandigarh. Methods: It was a cross sectional study was adopted among patients attending special clinics at Urban Health Training Centre and Rural Health Training Centre, attached with GMCH, Chandigarh. A stratified random sampling technique with proportional allocation was adopted. Based on this 50% anticipated satisfaction rate, 10% permissible error, and 95% confidence interval the optimum sample size was found to be 384. The data was collected using checklists, interview schedules, and consulting medical records at the centres as well as the records with the clients. Services were evaluated using checklists and exit interviews. Results: Our study found that the filling of registration cards of antenatal mothers and blood investigations were done properly. Clinical components like measurement of pulse (14.1%), pallor (9%), oedema (12.8%), examination of breasts (33.3%), fundal height (46.2%) and foetal heart rate (15.4%) were not done as per protocol. Forty percent of patients were not compliant to iron folic acid tablets. Deliveries were conducted in less than 10% of total beneficiaries. Checklist was not filled in most of the cases; following of clean practices, partograph plotting and APGAR scoring was not done properly. Over all antenatal and postnatal counselling part was unsatisfactory. Conclusions: It can be concluded that in spite of adequate manpower, utilization rates of services provided are not very good. The training and health education component had some gaps. Efforts should be made to fill the gaps by corrective measures like deploying counsellors and health educators, in-service training of the staff and strengthening of referral linkages to ensure optimum utilization of services and better manpower management.