Indian Public Health Standards Research Articles

Exploring health worker absenteeism at public healthcare facilities in Chhattisgarh, India.

This study aims to assess the health worker absenteeism and factors associated with it in a high-focus district in Chhattisgarh, India. Human resources for health are among the key foundations to build resilient healthcare systems. Chhattisgarh is a high-focus Indian state with a severe shortage of health care workers, and absenteeism further aggravates the shortage. This study was conducted as a mixed-methods study employing sequential explanatory design. Absenteeism was defined as the absence of health worker in the designated position without a formal leave or official reason in two different unannounced visits. A facility survey across all the public healthcare facilities in Jashpur district, Chhattisgarh, was conducted through random, unannounced visits employing a checklist developed based on Indian Public Health Standards. Twelve participants were purposively sampled and interviewed from healthcare facilities to explore factors associated with absenteeism. Survey data were analysed descriptively, and thematic analysis was employed to analyse qualitative interviews. Among all the positions filled at primary health centre level (n = 339), close to 8% (n = 27) were absent, whereas among the positions filled at community health centre level (n = 285), only 1.14% (n = 4) were absent. Absenteeism was not found in the district hospital. Qualitative interviews reveal that macro-level (geographical location and lack of connectivity), meso-level (lack of equipment and amenities, makeshift health facilities, doctor shortage, and poor patient turnover), and micro-level (unmet expectations) factors contribute to health worker absenteeism. Health worker absenteeism was more at PHC level. Systemic challenges, human resource shortages, and infrastructural shortcomings contributed to health worker absenteeism.

Framework for responsive financing of district hospitals of India.

The current financing of public-sector district hospitals in India relies on historical budget allocations rather than actual utilization or healthcare needs. We utilized empirical data on healthcare delivery costs to develop the financing framework for these hospitals using a blended payment approach. The primary data on cost of delivering services in 27 district hospitals across nine states of India was analysed along with indicators influencing the demand and supply of health services. Payment for outpatient, inpatient, and indirect services was assessed using the risk adjusted global budget, case-based bundled payment, and per-bed-global budget, respectively. Risk adjustment weights were computed by regressing the cost of outpatient care with demand and supply side factors which are likely to influence the utilization or the prices. Budget impact analysis was conducted to assess the fiscal implications of this payment approach, accounting for current care standards and two scenarios: upgrading district hospitals to Indian Public Health Standards (IPHS) or medical colleges. The average annual budget for a district hospital in India is estimated at ₹326 million (US$3.35 million), ranging from ₹66 million to ₹2.57 billion (US$0.8-31.13 million). Inpatient care comprises the largest portion (78%) of the budget. Upgrading to IPHS-compliant secondary hospitals or medical colleges would increase average budgets by 131 and 91.5%, respectively. Implementing a blended payment approach would align funding with healthcare needs, enhance provider performance, and support ongoing financing reforms aimed at strategic purchasing and universal health coverage.

Assessment of Primary Laboratory Facilities for Rural Health Care Preparedness in Osmanabad District, India

Government of India has provided Indian Public Health Standards to improve rural health care services and health status, but still rural laboratory is a cause of concern. This study is performed to understand the laboratory facility-level gaps that need to be addressed to improve the public primary health centres (PHCs) present in rural areas. The laboratory assessment is performed for governance, financing, resources and services, and results are validated with the PHC laboratory performance. The current assessment shows critical gaps in the facilities regarding governance, services, resources and financing required for the laboratory services at the rural primary health care level. Governance and services need to be strengthened the most, followed with sustained availability of resources and financing. Poor health status in rural areas necessitates public health response based on health systems. Therefore, health system preparedness in the form of laboratory services is essential in primary health care facilities.

Can the Emergency Medical Service (EMS) System Help in Improving the Healthcare Access - Evidence from Maharashtra EMS.

For many people in the remote regions of India, medical help is inaccessible as 66% of rural Indians do not have access to critical medicine and 31% of the population travel more than 30 km seeking health care in rural India. Timely non-availability of doctors in healthcare facilities, especially in primary health centers (PHCs), leads to more dependency on the private healthcare practitioners for the out-patient department services. This needs immediate attention. The healthcare authority in Maharashtra has allowed doctors in 108 emergency ambulances to provide consulting services. The current study is based on the total consultations managed by the doctors on-board on the 108 ambulances in the state of Maharashtra in the years 2020, 2021, and 2022. The data are procured from the state-run Emergency Response Centre, and the analysis is done by using the basic statistical technique in MS Excel and SPSS16.0. More than 9.35 lakh medical consultations were provided with an average 856 consultations per ambulance in the year 2022, showing a significant growth of 452% over the consultations in 2020. The base location of the 32% ambulance (298) in the PHCs has improved the round the clock accessibility in 16% of the total PHCs in the state of Maharashtra. The availability of the doctors in the state-run emergency ambulances for general healthcare services has improved the adherence of Indian Public Health Standards, and such practice must be examined for implementation in other states.

Quality of maternal and newborn health services and their impact on maternal-neonatal outcome at a primary health center.

The utilization of the maternal and newborn health services has increased, but mere increase in utilization of services does not ensure that quality services are being provided. The aim of the study was to assess the quality of maternal and newborn services and their impact on maternal and neonatal outcome at a primary health center of Western Rajasthan in India. An exploratory study was undertaken at a conveniently selected primary health center providing 24-hour delivery services. Information regarding the availability of services was collected from the available medical officer in charge using an Indian Public Health Standards (IPHS) Proforma. Assessment of quality of services was performed by using WHO standards of care based on assessment of quality of maternal and newborn services tool by the perspectives of the provider as well as the mothers utilizing the services. 36 mothers who delivered at the selected PHC were interviewed. All basic obstetric care services were available at the selected primary health centers including the 24 × 7 delivery services. The assessment of quality by provider's perspective revealed that the system of referral could be improved. Quality of maternal and newborn services assessment revealed that the practice of skin to skin contact between the mother and newborn just after the delivery was not being followed and few (30%) mothers informed that they could not start breastfeeding within 1 hours of birth. 47% mothers reported that they were not given the freedom to ask questions during delivery. Maternal and newborn outcome revealed that all mothers (100%) had a normal vaginal delivery, and 22% mothers had an episiotomy. All (100%) newborns cried immediately after birth, and average birthweight was 2.89 kg. PHCs are the first point of contact of mothers and healthcare delivery system. Assessment of quality of services is an important tool for quality assurance. Inclusion of evidence-based practices like skin-to-skin contact and early initiation of breastfeeding is important to improve the maternal and newborn well-being.

Provisioning Oral Health Care through Indian Public Health Standards, 2022

The Indian Public Health Standards (IPHS) were initially developed in 2007 to provide an effective and optimal level of quality health care in our country. IPHS was later revised in 2012, and more recently, in 2022. IPHS revised guidelines for 2022 take into account several new initiatives and programs, including Ayushman Bharat Health and Wellness Centers, the introduction of the National Urban Health Mission and Urban Primary Health Centers (polyclinics) in urban areas. These revised guidelines also make provision for the delivery of oral health services at each facility level. This review highlights the oral health-care services and delivery mechanisms mentioned in all the four volumes of IPHS revised guidelines 2022 under the headings of infrastructure, human resource, service provisions and essential drugs, diagnostics, and equipment required at all the levels of health care.

Functionality of Tribal Health Care Centres of Himachal Pradesh: An Empirical Study

An effective regulatory system is a fundamental prerequisite for attracting and sustaining investment in Maternal and Child Health (MCH) services. This study aimed to assess the functionality of tribal health care centres of Himachal Pradesh with respect to Indian Public Health Standard. A quantitative cross sectional design was adopted. Data was collected from tribal Primary Health Centres and Sub-Centres of district Sirmour using modified observational checklist related to infrastructure, manpower and MCH services for monitoring Sub-centre and PHC by external mechanism given under Indian Public Health Standards. Data was analysed using SPSS Version 21. The result revealed that there was shortage of manpower and infrastructure facilities as per Indian Public Health Standards in selected health care centres for adequate distribution of MCH services. It is concluded that there is an urgent need to take State Governmental efforts for effective implementation of MCH services in tribal areas.

Does rural India need a new primary healthcare delivery model?

There has been a continuous downfall in equipping the Primary Health Centres (PHCs) with infrastructure, facilities, and workforce to provide basic minimum primary healthcare services to the underserved population in the Indian context. The main goal of this research is to look at the infrastructure and manpower in a sample of PHCs in the Kanpur district of Uttar Pradesh, India. The interview template exclusively for Product-Service System (PSS) by Singapore University of Technology and Design-Massachusetts Institute of Technology (SUTD-MIT) was used to study randomly selected samples of 51 PHCs. The data were examined using the Indian Public Health Standards (IPHS) of the Indian government. Some of the key findings included the lack of workforce and their commitment, shortage of space, electricity, and water supply. To find a solution for the found lacunae, this article also discusses about the functioning of Mobile Hospitals (MHs) depending upon the contexts and thus extracting lessons for a new intervention in the primary health care system delivery model. Finally, a new healthcare delivery model in the form of a mobile Primary Health Centre (mPHC) is proposed based on the field study and the synthesis of historical literature on MH.

Adherence to Quality in District Hospitals of Haryana: A Recent Assessment as per Indian Public Health Standards (IPHS)

The article assesses the quality standards of available health care services as per the Indian Public Health Standards (IPHS) at all the 22 District Hospitals (DHs) in Haryana and also brings out a ranking of districts within the State based on these parameters. A structured schedule was prepared using IPHS norms and guidelines, and data was collected from all the DHs in the State on required components of quality standards. The article uses different statistical tools such as mean, standard deviation, coefficient of variation (CV) for analysis and attempts preparing a composite IPHS Index based on the type and number of services available. It found that the overall mean percentage score of observed quality standards was 66.5% across 22 DHs in Haryana (8 DHs>70%, 11 DHs between 60% and 70% and 3 DHs < 60%). Further, ranking across the State shows DH Panchkula on top with rank one whereas DH Charkhi Dadri appears at last with rank 22 based on the laid IPHS parameters. The article asserts that the observed quality standards are not fully matched with expected quality standards at DHs in Haryana and recommends the need for periodic reviews, perpetual monitoring of these standards and functioning, and emphasises on systemic management of the required IPHS parameters to ensure provisioning of optimal healthcare services at these hospitals.

Facilitating quality improvement by implementing quality accreditation standards at primary health care centre in Panvel taluka of Raigad district Maharashtra

Background: The Indian public health standard and Kayakalp guidelines are the main driver for continuous improvement in quality and bench mark for assessing the functional and cleanliness status of health facilities. Objectives were to assess PHC on IPHS and Kayakalp standard for continuous quality improvement. To conduct baseline and peer assessment of quality parameters using Indian public health standards and Kayakalp standard at primary health centre. To perform gap analysis and suggest quality improvement measures for meeting accreditation standards. To establish public private partnership for strengthening health services at PHC level. Methods: Descriptive observational study was conducted from September 2022 to June 2023 at Ajiwali PHC-Panvel taluka was selected using simple random sampling technique. Sample size of 83 patients was calculated as per the monthly case load of PHC. IPHS and Kayakalp assessment checklist, patient satisfaction forms were used for the survey. Various statistical tests like frequency, mean, percentage, S.E of difference between two proportions and two means were applied. Results: Kayakalp checklist baseline assessment score was 52.5% while post assessment score 72.5% showing significant improvement. Patient satisfaction survey pre and post assessment shows significant improvement where p value was <0.001 which was highly significant. IPHS survey shows partial improvement in training and quality parameters while other indicator remained the same. Conclusions: Regular quality assessment and accreditation leads to continuous quality improvement. Training and capacity building of PHC staff should be undertaken at regular intervals. Public private partnership modelling for various departments or service delivery components should be undertaken.

Analysis of public health-care facilities in rural India

PurposeThis paper aims to analyze the status of infrastructure, workforce and basic amenities at public health-care facilities in rural India and draw a comparison with its urban counterparts.Design/methodology/approachRural Health Statistics data and National Sample Survey Office Report for the period 2019–10 were used to analyze lower-level public health facilities, namely, subcenters, primary health centers and community health centers (CHCs). Selected tracer indicators under World Health Organization’s (WHO) Service Availability and Readiness Assessment (SARA) mechanism such as health center density, core health workforce density and basic amenities were used to carry out the analysis. The extent of facility coverage was measured using the National Rural Health Mission (NRHM) guidelines and the proportion of facilities satisfying the Indian Public Health Standards (IPHS) was measured to assess the service provision quality in rural public health-care facilities.FindingsResults indicated that the density of public health centers is higher in rural areas than in urban areas. Almost all public health-care facilities lack basic amenities in rural areas. Working positions for health specialists in CHCs barely meet the total requirement. Almost all of the public health facilities functioning in rural areas do not meet the IPHS norms.Originality/valueTo the best of the authors’ knowledge, the present paper is the first initiative to assess the status of rural public health-care facilities on the national level using WHO’s SARA indicators as well as NRHM and IPHS guidelines. The study is significant in terms of policy input for achieving universal health coverage in India.

Assessment of available health services at subcentres as per Indian public health standards guidelines in a district of Jammu and Kashmir India: A cross sectional study.

Subcentre is the lowest rung of a referral pyramid of health facilities. The purpose of health subcentre is mainly providing preventive and promotive services, but it also provides a basic level of curative services. To assess the existing services availability at subcentres and identification of gaps between minimum requirements as per Indian public health standards and actual availability of services at subcentres. It was a cross sectional observational study. Study units were subcentres. Fifty percent of subcentres of the district were selected using simple random sampling method. Check list prepared from Indian public health standards facility survey formats was used for data collection and collected data were analysed using statistical package for social sciences. Majority (58.8%) of the subcentres were catering a population in the range of 1000-3000. Ante-natal and child care related services were available in all subcentres. Intra-natal services were available in only two subcentres. Eighty five percent of subcentres were involved in providing school health related services. Most of the services as recommended by Indian public health standards were available in the studied subcentres. The lack of some services was mainly due to inadequate staff and infrastructure at subcentres. Comprehensive efforts are required to ensure adequate service delivery at all health centres.

Spatial patterns of the availability of community health centres in rural India, 2005 and 2019

Community health centres, also known as community health services (CHSS), are located throughout the state and try to offer a wide variety of services and health promotion activities to the local population, especially for those who have the worst health or are at the risk of developing it and most deprived in context to economic and social needs. Community health centres are part of the rural health system. A considerable portion of the population lives in rural India. This study attempted to examine the changes in the availability and requirements of CHCs across the states in India from 2005 to 2019. Data is from Rural Health Statistics (RHS) (2005, 2019). MS Excel and ArcGIS are used for data analysis and mapping. Maharashtra (382), Rajasthan (298), Uttar Pradesh (294), Gujrat (271), and the lowest in Sikkim (4), Goa (5), and Tripura (9) had the highest number of CHCs in 2005, according to Indian Public Health Standards (IPHS). On the other hand, in 2019, Uttar Pradesh (679), Rajasthan (571), Tamil Nadu (385), and Orissa (377) had the highest number of CHCs, whereas the lowest was found in Sikkim (2), Goa (5), Mizoram (9). As per IPHS standards, Uttar Pradesh (917), Bihar (571), and West Bengal (420) had the highest requirements of CHCs in 2005, while the states with the highest requirements of CHCs in 2019 were Uttar Pradesh (857), Bihar (646), and Andhra Pradesh (491).

Health System Preparedness in Provision of Noncommunicable Diseases’ Services in Lakhimpur District, Assam State, India

Background: While noncommunicable diseases (NCDs) are one of the leading causes of mortality in the world today, we are unsure of the preparedness of the public health system in terms of provision for and utilization of NCD services in Assam. Methods: Preparedness of public health facility was assessed using WHO-SARA (Service Availability and Readiness Assessment) tool and Indian Public Health Standards tool. Ethics approval was obtained from the Institutional Human Ethics Committee of the Central University of Kerala. Results: The overall readiness of primary health centers (PHCs) ranged from 60% to 76% for NCD services, community health centers (CHCs) ranged from 72% to 87%, subdivisional hospitals from 70% to 87%, and district hospitals from 76% to 100%. Deficiencies were also noted in terms of the availability of equipment and medicines. Conclusion: The deficiencies in the PHCs and CHCs highlighted in the study emphasize the need to strengthen the health system, thereby strengthening the response of the health system to NCDs in India.

Quality of reproductive health care provided by community health centers of a district located in western India- a mixed method study

Background: Under National Rural Health Mission in 2007, Indian Public Health Standards (IPHS) were introduced to strengthen health care services. As majority of health infrastructure is in existence before introduction of IPHS, there was scant information available on assessment of these standards. This study was carried out with the objective to assess quality of reproductive health care provided by community health centers (CHC).Methods: A cross-sectional study was carried out in 2013. All of the 17 community health centers from 12 talukas of the district were studied. Data collection was carried out by administering pilot tested checklist and interviewing clients.Results: All the CHCs had adequate infrastructure. Highest score was obtained for input (64%). The overall score in process section was 45%. None of the CHCs had a full-time anesthetist, physician, public health programme manager or public health nurse. At only three CHCs, general surgeon was available. Availability of MOs was 85% and Pharmacist was 88% respectively.Conclusions: Deployment and availability of specialist is the need of the hour. Adequate emphasis needs to be given to processes and outputs as well, apart from inputs. Public private partnership can be explored for better utilization of services. There is a need of up gradation of existing CHCs keeping in the view of IPHS norms.

Paradigm Shift in Peripheral Health Post

Indian Public Health Standards (IPHS) provides standards and guidance quality health rendered by public health system components such as infrastructure, human resource, drugs, diagnostics, equipment, quality and governance requirements for delivering health services at health facilities at all levels. Setting up a protocol at all health care levels is a dynamic process and needs to update with the introduction of new and existing National Health Programmes as per the epidemiological shift of diseases in the country. The Indian Public Health Standards (IPHS) for Sub-centre and Health and Wellness-Sub centre provide a guidance on essential package of services that are to be delivered at Health and Wellness-SC level, the population norms for its establishment, infrastructure, human resource, drugs & diagnostics, equipment & supplies and quality care assurance.

Assessment of infrastructure facilities, manpower and services at health sub-centres from a rural block of Haryana, North India

Background: A sub-centre is the most peripheral and first point of contact between the health care system and the Community. The success of any nationwide programme largely depends on well-functioning sub-centres providing services of acceptable standard to people. Indian Public Health Standards (IPHS) were programmed with an objective to standardize the health care infrastructure and services. Current study was undertaken with the aim to assess the infrastructure facilities, manpower and services of a sample of sub-centers from North India against the IPHS standards.Methods: A cross sectional study was carried out from February 2014 to October 2014 in 30 of the 32 sub-centres in a rural block of district Ambala in the state of Haryana, North India using a specially designed semi structured questionnaire to compare the existing physical infrastructure, manpower, quality control and service delivery in these sub-centres against the IPHS standards.Results: Significant gaps existed in available physical infrastructure and availability of manpower (especially male worker). The parameters designed for quality control like citizen’s charter, internal and external monitoring were also found to be deficient. Record keeping and reporting was also unsatisfactory. However, availability of the requisite services and service delivery was found to be satisfactory.Conclusions: There is urgent need to equip the sub-centres with the necessary infrastructure and logistics along with need of regular monitoring and supervision of the sub-centers by internal and external agencies so as to improve the quality of facilities and services provided by them.

Assessment of Services at Primary Health Center of Jaipur District as Per Indian Public Health Standards

Background:. These standards are to underpin the delivery of quality services which are fair and responsive to client’s needs, which should be provided equitably and which deliver improvements in the health and well-being of the population. Aim and Objectives: to identify the existing gap with respect to Indian Public Health Standards (IPHS) for availability of infrastructure, human resources, investigative services and emergency services at 24 × 7 primary health centers (PHCs) of Jaipur district of Rajasthan state. Methods: It is a cross-sectional quantitative study was conducted from March 2018 – March 2019 in Jaipur district of Rajasthan state. Jaipur is divided into 7 blocks,73 PHC and 18 CHC. Out of these 7 blocks 3blocks were selected by simple random sampling. From these 3 blocks 3 PHC from each block was selected by simple random sampling. 3 sub center from each PHC was selected by simple random sampling and then 30 households were selected from each Sub-centre by systematic random sampling. Results: In terms of staff availability found critical status, Essential services were adequate, but not at all PHCs, Infrastructure and facilities was satisfactory. Conclusion: Even after more than a decade of Indian Public Health Standards (IPHS) in place for the Public Health Facilities this study reveals a huge gap in the availability of the manpower (Medical, Para medical and support manpower), Services, Drugs, equipment, infrastructure and Quality control measure

Assessment of Services at Primary Health Center of Jaipur District as Per Indian Public Health Standards

Background:. These standards are to underpin the delivery of quality services which are fair andresponsive to client’s needs, which should be provided equitably and which deliver improvements inthe health and well-being of the population. Aim and Objectives: to identify the existing gap withrespect to Indian Public Health Standards (IPHS) for availability of infrastructure, human resources,investigative services and emergency services at 24 × 7 primary health centers (PHCs) of Jaipur districtof Rajasthan state. Methods: It is a cross-sectional quantitative study was conducted from March 2018– March 2019 in Jaipur district of Rajasthan state. Jaipur is divided into 7 blocks,73 PHC and 18 CHC.Out of these 7 blocks 3blocks were selected by simple random sampling. From these 3 blocks 3 PHCfrom each block was selected by simple random sampling. 3 sub center from each PHC was selectedby simple random sampling and then 30 households were selected from each Sub-centre by systematicrandom sampling. Results: In terms of staff availability found critical status, Essential services wereadequate, but not at all PHCs, Infrastructure and facilities was satisfactory. Conclusion: Even aftermore than a decade of Indian Public Health Standards (IPHS) in place for the Public Health Facilitiesthis study reveals a huge gap in the availability of the manpower (Medical, Para medical and supportmanpower), Services, Drugs, equipment, infrastructure and Quality control measures.

Status of public sector dental health-care services in Nellore District, Andhra Pradesh, India

Background and Objectives: Primary health centers (PHCs) are the foundation of rural health services in India. The nonavailability of reports on the status of dental care services at public health-care centers in rural Andhra Pradesh prompted us to describe the status of dental care services provided at public health-care centers in the Nellore district of Andhra Pradesh. Materials and Methods: This cross-sectional study was conducted using a semi-structured interview guide, based on the Indian Public Health Standards (IPHSs) guidelines. Data were collected on the dental health workforce, equipment, and facilities available, dental care services provided in all government dental care units, and dental care services provided by PHCs without dentists in the Nellore district, from dental and medical doctors, respectively. The descriptive statistics (frequencies) were performed describing the availability of workforce, equipment, and facilities, and the type of dental care services provided. Results: Of 95 public health-care centers in the Nellore district, only 18 centers provided dental care services. No single center was furnished with the prescribed dental health workforce, equipment, and facilities to render comprehensive dental care services to an optimum level according to IPHS guidelines. There were neither oral health promotional activities nor outreach programs targeting rural children, families, and communities carried out at these PHCs as per the IPHS guidelines. Conclusion: An inadequate dental health workforce, deficient dental equipment, and facilities, and very limited dental care services were found at these public health-care centers in the Nellore district, making these services almost nonexistent to rural populations.