Community Health Center Level Research Articles

Literatur Review Management Analysis of Medical Record Management System in Puskesmas

The medical record management system at the community health center level is the same as the hospital medical record management system. This study aims to determine the management of the medical record system in health centers. This study is a literature review using methods of traditional review to seek, identify, evaluate, and interpret theoretical references relevant to the management of medical record systems in public health centers. The numbering system used in the health center is the Unit Numbering System, The medical record naming system uses a direct naming system, a centralized medical record document storage system at the health center, and a medical record document alignment system at the health center, namely a direct number alignment system and alignment system per region area. According to alphabetical order, assembly activities have not been carried out properly because there is no standard operating procedure for their implementation. The coding implementation at the community health centers did not use the ICD-10 book as a guideline for providing disease codes, the community health centers did not have a fixed retention schedule, so the retention and destruction of medical record documents at the community health centers had not been implemented. Conclusion: The numbering and naming system implemented at the community health centers is inappropriate, and the implementation of the medical record data processing system at the community health centers has not been optimal.

Implementation of Information Technology in Increasing the Effectiveness of Recording and Reporting the Nutritional Status of Stunted Toddlers at Community Health Centers

This research aims to evaluate and implement information technology to increase the effectiveness of recording and reporting the nutritional status of stunted toddlers at Community Health Centers. Accurate recording and fast reporting are crucial in efforts to prevent and overcome stunting in children under five. By utilizing information technology, this research designs and implements an integrated system to facilitate the collection, storage and analysis of nutritional status data on stunted toddlers in real-time. The research methodology includes user needs analysis, system design, and implementation in several Community Health Centers. The use of information technology is expected to increase data accuracy, speed up the recording process, and provide information more quickly to related parties. Evaluation is carried out through measuring indicators of effectiveness, efficiency and user satisfaction. It is hoped that the research results will provide a clear view of the impact of using information technology in managing nutritional data for stunted toddlers at the Community Health Center level. The practical implications involve improving the recording system, faster reporting, and the use of information technology as a strategic tool in improving public health, especially in efforts to prevent stunting in toddlers.

Knowledge and Awareness of Diabetic Retinopathy in People Living with Diabetes Mellitus (PLWD): A Hospital-based Cross-sectional study

Title: Knowledge and awareness of Diabetic Retinopathy in People Living with Diabetes Mellitus (PLWD): A Hospital-based Cross-sectional study. Purpose: To assess knowledge and awareness of Diabetic Retinopathy (DR) among adults with Diabetes Mellitus (DM) visiting the hospital. Results: Out of 218 participants about 77.5% were aware that DM could affect the eye. However, only 34.4% were aware that it could cause blindness. About 54 (24.8%) had their HbA1c levels tested regularly while 107 (49.1%) tested only when asked. About 33.5% of the patients were not aware of any of the treatment modalities for DR such as laser photocoagulation, surgery, intravitreal injection. While the rest (66.5%) had heard about at least one of these treatment modalities. 32.6% of patients thought that the control of blood glucose is enough to control DR without any further intervention. Conclusion: The study concluded that diabetes, as a global epidemic, requires attention from patients and health care professionals. Furthermore, the survey found that the majority of people with diabetes are fully aware of the need of eye screening and the fact that diabetes can affect the eye, but had little knowledge of diabetic retinopathy and its effects. To reduce visual impairment caused by diabetes, it is vital to increase community awareness about diabetic retinopathy and the necessity of retinal screening. It is necessary to conduct awareness programs aimed primarily at rural populations. Screening services should be improved at the community health centre level as well.

Digital Health Intervention of Healthy Indonesia Program with Family Approach: Does it Work?

Background: The digital age holds out the promise of innovative technology. Along with the development of technology, healthcare management has been changing. Indonesia was implementing The Healthy Indonesia Program with a Family Approach (PISPK) that aimed at increasing access of families and their members to comprehensive health services, promotive, preventive, curative, and basic rehabilitative. Every household data related to 12 health indicators was digitally recorded and analyzed on a specific website to provide a database for determining suitable health and empowerment programs according to health problems experienced by the community. Objectives: This study aimed to assess the performance of The Healthy Indonesia Program with a Family Approach website in East Java Province, Indonesia. Method: The study design is cross-sectional with a descriptive exploratory study. Data was collected through an online survey utilizing Google Forms service and analyzed descriptively with a thematic content approach. Result: Respondents of this research involving 232 health workers from community health centers in East Java Province that running Healthy Indonesia with a Family Approach. This research result found that the PIS-PK website met the criteria of a digital health monitoring tool recommended by WHO with the score of Functionality (70.54%), Stability (62.89%), Fidelity (58.17%), Quality (73.81%), Implementation (77.41%), and Judgement (67.92%). Conclusion: Healthy Indonesia with Family Approach Website was beneficiary to be used as the baseline in designing and developing a community empowerment program targeting specific indicators at the community health center level. However, several issues were noticed including, stability, fidelity, privacy, and data governance that should immediately take into account to improve the website’s performance.

Human Resources for Health in Haryana, India: What can be Done Better?

Health systems in developing countries suffers from both input and productivity issues. We examined the status of three domains of human resources for health, i.e., availability and distribution, capacity and productivity, and motivation and job-satisfaction, of the health-care workforce employed in the public health system of Haryana, a North Indian state. The primary data were collected from 377 public health facilities and 1749 healthcare providers across 21 districts. The secondary data were obtained from government reports in the public domain. Bivariate and multivariate statistical techniques were used for evaluating district performances, making inter-district comparisons and identifying determinants of motivation and job-satisfaction of the clinical cadres. We found 3.6 core health-care workers (doctors, staff nurses, and auxiliary nurses-midwives) employed in the public health-care system per 10,000 population, ranging from 1.35 in Faridabad district to 6.57 in Panchkula district. Around 78% of the sanctioned positions were occupied. A number of inpatient hospitalizations per doctor/nurses per month were 17 at the community health center level and 29 at the district hospital level; however, significant differences were observed among districts. Motivation levels of community health workers (85%) were higher than clinical workforce (78%), while health system administrators had lowest motivation and job satisfaction levels. Posting at primary healthcare facility, contractual employment, and co-habitation with family at the place of posting were found to be the significant motivating factors. A revamp of governance strategies is required to improve health-care worker availability and equitable distribution in the public health system to address the observed geographic variations. Efforts are also needed to improve the motivation levels of health system administrators, especially in poorly performing districts and reduce the wide gap with better-off districts.

Covid-19 Countermeasure Policy in the Province of Jakarta Capital City

Jakarta is the highest province of positive Covid-19 cases nationally and the epicenter region in Indonesia. This study aims to analyze the development of the number of cases and Covid-19 countermeasure policy in the Province of Jakarta Capital City. This study uses a qualitative method with in-depth interviews and document review. Primary data was collected from selected informants, namely the Head of Jakarta Health Office and Assistant to the Provincial Secretary for Governmental. Secondary data is taken from legal and policy documents, reports, websites, and press releases. The fluctuation of Covid-19 cases in Jakarta depends on the capacity of the examining laboratory and the capacity of contact tracing. Until April 30, 2020, The Provincial Government of Jakarta Capital City has made 74 policies. They made Covid-19 as a serious policy agenda and collaborates with the whole of government, privates, professional/community/ religious organizations, and society. Situational factors are the most influential factors in the policymaking process. The Provincial Government of Jakarta Capital City concerns early since the Wuhan Pneumonia case with the epidemiological surveillance system of the Health Office, which has been running regularly monitoring infectious diseases from the community health center level. Policy formulation is based on research and scientific studies. Monitoring and evaluation are carried out both formatively and summatively to address problems and obstacles in policy implementation. The Provincial Government of Jakarta Capital City took the early response to collaborates with the whole of government, privates, and society in policymaking and implementation.

Evaluation of the fluorescent-thin layer chromatography (f-TLC) for the diagnosis of Buruli ulcer disease in Ghana.

BackgroundBuruli ulcer is a tissue necrosis infection caused by an environmental mycobacterium called Mycobacterium ulcerans (MU). The disease is most prevalent in rural areas with the highest rates in West and Central African countries. The bacterium produces a toxin called mycolactone which can lead to the destruction of the skin, resulting in incapacitating deformities with an enormous economic and social burden on patients and their caregivers. Even though there is an effective antibiotic treatment for BU, the control and management rely on early case detection and rapid diagnosis to avert morbidities. The diagnosis of Mycobacterium ulcerans relies on smear microscopy, culture histopathology, and PCR. Unfortunately, all the current laboratory diagnostics have various limitations and are not available in endemic communities. Consequently, there is a need for a rapid diagnostic tool for use at the community health centre level to enable diagnosis and confirmation of suspected cases for early treatment. The present study corroborated the diagnostic performance and utility of fluorescent-thin layer chromatography (f-TLC) for the diagnosis of Buruli ulcer.Methodology/Principal findingsThe f-TLC method was evaluated for the diagnosis of Buruli ulcer in larger clinical samples than previously reported in an earlier preliminary study Wadagni et al. (2015). A total of 449 patients suspected of BU were included in the final data analysis out of which 122 (27.2%) were positive by f-TLC and 128 (28.5%) by PCR. Using a composite reference method generated from the two diagnostic methods, 85 (18.9%) patients were found to be truly infected with M. ulcerans, 284 (63.3%) were uninfected, while 80 (17.8%) were misidentified as infected or noninfected by the two methods. The data obtained was used to determine the discriminatory accuracy of the f-TLC against the gold standard IS2404 PCR through the analysis of its sensitivity, specificity, positive (+LR), and negative (–LR) likelihood ratio. The positive (PPV) and negative (NPV) predictive values, area under the receiver operating characteristic curve Azevedo et al. (2014), and diagnostic odds ratio were used to assess the predictive accuracy of the f-TLC method. The sensitivity of f-TLC was 66.4% (85/128), specificity was 88.5% (284/321), while the diagnostic accuracy was 82.2% (369/449). The AUC stood at 0.774 while the PPV, NPV, +LR, and–LR were 69.7% (85/122), 86.9% (284/327), 5.76, and 0.38, respectively. The use of the rule-of-thumb interpretation of diagnostic tests suggests that the method is good for use as a diagnostic tool.Conclusions/SignificanceLarger clinical samples than previously reported had been used to evaluate the f-TLC method for the diagnosis of Buruli ulcer. A sensitivity of 66.4%, a specificity of 88.5%, and diagnostic accuracy of 82.2% were obtained. The method is good for diagnosis and will help in making early clinical decisions about the patients as well as patient management and facilitating treatment decisions. However, it requires a slight modification to address the challenge of background interference and lack of automatic readout to become an excellent diagnostic tool.

Spectrum of obstetric referral and their outcome at a Tertiary Care Center of Eastern Uttar Pradesh: An insight

Background: Pregnancy and childbirth, especially in high-risk women, necessitate proper antenatal, intranatal, and immediate postpartum care. Early detection of complications and prompt referral to the higher level of care can reduce the associated adverse maternal outcomes. Aims and Objectives: The aim of the study was to evaluate the spectrum of pregnancy-related referrals to our hospitals and their outcomes. Materials and Methods: A prospective observational study was conducted in the Department of Obstetrics and Gynecology, B.R.D Medical College, Gorakhpur, U.P, India, over a period of 1 year (October 2020–September 2021). All the referred cases of obstetric indications ≥28 weeks of gestation were analyzed for reasons of referral and their outcomes. Results: Obstetrics referral accounted for 31.15% of the total obstetrics admissions (1416/4545). The average age of study participants was 26.92 years and majority being primigravida. The major reasons for referring patient were hypertensive disorders of pregnancy (16.74%), previous cesarean section (12.78%), and severe anemia (7.70%). There were 70 maternal deaths leading to case fatality rate of 4.94% while 94.2% of patient were discharged healthy. Conclusion: Lack of knowledge, ignorance, and poor transport facilities are major contributors of poor pregnancy outcome. Timely and appropriate referral is crucial in improving maternal outcome. Improvement in the quality of Maternal Child Health care at Primary Health Centre, Community Health Centre level; regular training of health-care providers in emergency obstetrics care is required to curb unnecessary referrals and consequently in reducing fetomaternal morbidity and mortality.

Community Health Centers’ Performance in Cancer Screening and Prevention

Little is known about what clinic-level factors differentiate community health centers that achieve high performance on cancer-preventive care metrics. This study aims to describe the longitudinal trends in the delivery of 3 cancer-preventive care metrics (cervical and colorectal cancer screenings and tobacco-cessation intervention) and define and compare community health centers with high cancer-preventive care performance with those with low cancer-preventive care performance. This observational study used 2012-2019 community health center data (N=933) from the Uniform Data System. High/low performance was based on Healthy People 2020 targets and sample distribution. For each cancer-preventive care metric, the percentage of community health centers that met high (≥70.5% at cervical or colorectal cancer screening or >80% tobacco-cessation intervention) and low thresholds at 1, 2, and all the 3 screenings was estimated. Multivariable generalized estimating equations logistic regression modeling was used to assess the community health center‒level factors associated with screening performance. The community health centers' performance for tobacco-cessation intervention remained at ≥80%, with a small increase over time. Performance for cervical cancer screening remained unchanged with about 50% of patients screened. Colorectal cancer screening performance increased from around 30% in 2012 to 44% in 2019. Very few community health centers reached high performance (3%) in all the 3 indicators, and 13% of community health centers were high in any 2 of the outcomes in 2019. Higher patient volume, a greater proportion of Hispanic patients, fewer uninsured patients, and community health centers located in the Northeast region were associated with high performance in 2019. Very few community health centers meet all Healthy People 2020 goals in cancer screenings and may struggle to achieve the 2030 goals. Very few indicators differentiated high performers from low performers.

Analyzing of implementation maternal audit program in community health center: a qualitative study

Background: Maternal audits are part of quality control that is routinely carried out and aims as an essential learning material in evaluating maternal services in an area so that the expected outcome is a decrease in maternal mortality in an area. The maternal audit program that is carried out will undoubtedly benefit health facilities that provide services in the maternal sector, such as primary, secondary, and tertiary health facilities.Methods: This study used a qualitative case study method with a purposive sampling technique. The data collection technique was carried out by interviewed using the in-depth interview method, and triangulation was carried out using observation and document review.Results: The community health center has contributed to implementing maternal audits, starting from the data collection process, participating in district audit forums, and implementing the recommendations. Four factors influence the implementation of the maternal audit program at the community health center in reducing maternal mortality, namely the knowledge of health workers, the involvement of health workers in the community health center in the audit process, the recommendations for the results of the audit process and the implementation of follow-up on the results of the audit recommendations at the community health center.Conclusions: The maternal audit program can reduce maternal mortality and improve the maternal and child service system at the community health center level, although there are still several obstacles in implementing the recommendations of the audit results.

Baseline measures of primary health care team functioning and overall primary health care performance at Du Noon Community Health Centre.

BackgroundResearch consistently demonstrates the importance of effective team work for improving the quality of health care. We conducted a baseline measure of primary health care (PHC) team effectiveness and overall PHC performance at a primary care facility.AimTo improve PHC team effectiveness and ultimately the quality and user experience of primary care at a community health centre (CHC).SettingDu Noon CHC in the southern and western substructure of the Cape Town Metro district services (MDHS).MethodsA cross-sectional study using a combination of the Nominal Group Technique (NGT) consensus method and the South African Primary Care Assessment Tool (ZA PCAT) to assess PHC team effectiveness and PHC organisation and performance.ResultsThe ZA PCAT was administered to 110 CHC users (patients) and 12 providers (doctors and clinical nurse practitioners). Data from 20 PHC team members showed they perceived their team as well functioning (70% agreement on a 7-item PHC team assessment tool incorporated into the ZA PCAT). The NGT method achieved participant (20) consensus on communication and leadership as the main challenges to effective team functioning and on ideas to overcome the challenges. The ZA PCAT user data showed 18.2% of users rated first contact access as acceptable to good; 47.3% of users rated ongoing care as acceptable to good. Provider data showed that 33% of providers rated first contact access as acceptable to good; 25% of providers rated ongoing care as acceptable to good. First contact access received the lowest acceptable to good score (18.2%) and comprehensiveness (services available) the highest score (88.2%) from users. For the providers, the lowest acceptable to good score was for ongoing care (25%) and the highest acceptable to good score was for primary health care team availability (100%). The ZA PCAT total primary scores were good (above 60%) for both users and providers but moderately higher for the providers.ConclusionKnowledge of how teams perceive their effectiveness can motivate them to generate ideas for improving performance. There were discrepancies between providers’ assessment of team functioning using the ZA PCAT measure and the NGT method results. The ZA PCAT also showed differences between providers’ and users’ perceptions of PHC performance – consistent with the findings of the multi-CHC Western Cape ZA PCAT study. These findings should encourage and support CHC and district level staff in their efforts to improve the quality and user experience of primary care, as well as PHC team performance.

Monitoring and evaluation of intranatal facilities at community health centre level in Siddharth Nagar district

Background: Despite WHO and UNICEF are leaving no stone unturn to promote breastfeeding in health facilities globally, there is poor status of breastfeeding in rural India till today. in 2012, U.P had one of the poorest maternal and neonatal health outcomes in India. Assessment the implementation of practice of skin to skin contact and early initiation of breastfeeding.Methods: It was a descriptive longitudinal study. This study was carried out in CHC Khisraha and CHC Mithwal in Siddharthnagar, over a period of 3 months. All pregnant women admitted for normal delivery during data collection period and had positive outcome was our study sample. A total of 101 samples were observed and interviewed.Results: Most of the beneficiaries were from age group 20-22 years (46.5%). Pre-term delivery was high (26.7%) in present study. Only in 12% of cases radiant warmer were switched on 20-30 minutes before delivery. Only 3% of babies born were dried with pre-warmed towel/cloth. Practice of skin to skin contact was observed in 97% of cases. Only in 18.8% of cases babies followed breast crawl. All babies were given pre-lacteal feed. Only in 8.9% of cases initiation of breastfeeding was done within 30 minutes.Conclusions: Supportive supervision of staff nurses for STS contact and BF initiation is needed. Counselling and training of ASHA worker about benefits of early BF and STS contact for both mother and baby.

In the dark even after a decade! A 10-year analysis of India's National Rural Health Mission: Is family medicine the answer to the shortage of specialist doctor in India?

The National Rural Health Mission (NRHM) has been successful in reducing maternal, infant, and child mortality rates in India. In addition, it has tremendously improved the infrastructure of India's public health system. It has also placed at least one Accredited Social Health Activist worker in every village of India. However, the NRHM has not been able to overcome the shortage of specialist doctors at Community Health Centre (CHC) level. During 10 years of NRHM, only 81 gynecologists, 34 physicians, and 290 pediatricians have been added at the CHC level. Family medicine specialist can be a viable alternative to these specialist doctors, fill the existing gap, and drastically improve the quality of health care provided at CHC level.

Clinical and Etiological Study of Maternal Near-Miss at a Tertiary Referral Hospital of Central India

Background: Analyzing the maternal near miss provides a good opportunity for assessing the factors responsible for maternal mortality in that area. Objective: To study the clinicoetiological profile of severe maternal morbidity/near misses in a tertiary public maternity using WHO identification criteria. Material and Methods: A prospective observational study included patients admitted to Obstetrical ICU of Kamla Raja Hospital, G R Medical College, Gwalior between April 2014 and October 2014. The patients who fulfilled the WHO criteria of maternal near miss were enrolled; their clinical and investigation parameters were recorded. Results: Out of 4481 deliveries, 168 (3.74%) were near-miss cases. The mean age of the near-miss patients (168) was 28 ± 3.11 years. Near-miss incidence ratio was 37.65 per 1000 live birth. Most of the patients of near-miss were of multipara (71.42%). The majority of the patients were unbooked (65.24%).The major causes of near miss were hypertensive disorders (44.04%), severe hemorrhage (26.19%) and severe anemia (10.71%). Discussion: The study of maternal near miss provides an insight into the causes of maternal mortality in this region. The maternal morbidity and mortality can be reduced by providing proper antenatal care at primary and community health centre level and good intensive care at tertiary level. Key words: Near-miss, Maternal mortality, Maternal death

English

BACKGROUND: In central India (M.P.) there is high prevalence of hepatitis; of which hepatitis B contributes as a major cause of hepatitis. In our area there were no major efforts to contain the disease. According to one estimate most of the hepatitis B occurs due to negligence transfusion of infected blood (Hepatitis B). Therefore we have tried to found percentage of population infected with this disease. MATERIAL AND METHODS: Study design – Prospective study. For screening donors we have used one step rapid test for the detection of HBsAg and confirmatory test was done by ELISA method. STATISTICAL ANALYSIS: Statistical analysis was done by using Minitab 17 Pennsylvania, USA. RESULTS: In our study we found 2.8% HBsAg infected blood among healthy donors; which was significantly (P < 0.05) more in voluntary donors in comparison to replacement donors. Male between age groups 39-48 were found highly infected in comparison with other age groups. We also found prevalence was highest in Hindu community (2.9%) and more in working group (3.9%) in comparison to students and farmers. CONCLUSION: For effective control of transfusion of infected blood and to prevent its spread, we have to improve community knowledge towards vaccination; educational programs for blood bank personals; and government should open blood banks at Community Health Center level.

Trends in Behavioral Health Care Service Provision by Community Health Centers, 1998–2007

Trends in Behavioral Health Care Service Provision by Community Health Centers, 1998–2007

An Analysis of Utilisation of Health Services Under National Rural Health Mission: A Case Study of a Selected District of Uttar Pradesh, India 2009

Introduction: Government of India launched the National Rural Health Mission (NRHM) on 12th April 2005 throughout the India with special focus on 18 states which have weak public health indicators and/or weak infrastructure. The NRHM was launched with a view to bring about dramatic improvement in the health system and health status of the people, especially those living in rural areas by the end of 2012. The NRHM has a clear objective of providing quality health care in the remotest rural areas by making it accessible, affordable and accountable. Are the services provided under NRHM really reaching the beneficiaries? This particular study was designed with the overall goals of assessing the utilization of health care facilities provided under NRHM. Methods: The study was conducted in the State of Uttar Pradesh, India. Uttar Pradesh has been identified as one of the low performing state, both in terms of health system indicators and health outcome parameters. The study was carried out during March, 2009 to August, 2009. A multistage purposive random sampling method was used to collect the appropriate sample from the selected state. Selection of the district and the ‘block’ (a block is an admnistrative unit within a district) was done randomly. Once the block was identified, one of the Community Health Centre (CHC) was selected randomly withing that block. Sudsequently, one primary health centre (PHC), nearest to the CHC, was selected randomly. Data was collected from Out Patient and Inpatient Registers maintained at each level of health facility i.e. Disrict hospital, Community Health Centre (CHC) and Primary Health Center (PHC) with the help of Pre-designed Proforma in the state of Uttar Pradesh. Data coding, entry and analysis of quantitative data was conducted in soft form of excel sheets. Results: From the analysis it is evident that service delivery capacity of the public health system has increased at each level. It is also found that Outdoor Patient visits have increased at all three levels, though with variation. The maximum improvement is found at the PHC (129%) level followed by almost similar increase (86%) at the district and CHC level. The main beneficiaries of indoor services at each level were invariably women followed by children and men respectively. Conclusions: Preliminary analysis suggests that there is an increasing trend in the utilization of health facilities at each level, which reflects strengthening of public health system in the recent years. However, the changes are not uniform especially where peripheral facilities are showing less improvement in comparison to the district hospital. There is still much to be done to call all health facilities ‘fully functional’ as per the Indian Public Health Standards (IPHS) guidelines. We therefore conclude that NRHM appears to be a well designed program and lots of thought process has gone into it prior to its implementation. However, it would be too early to predict its outcome in terms of success or failure.