Indian Public Health Standards Research Articles

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.

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.

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.

Strengthening health system through outsourcing of non-clinical services: inputs for improving management

Background: Public-Private Partnership (PPP) as a strategic management policy to improve hospital health services standards to the Indian Public Health Standards level, specially the non-clinical services. The studies on the qualitative as well quantitative aspects of services by identifying components that are suitable for execution Public Private partnerships for improving hospital services specially for non-clinical services are needed. There is also a need to identify probable modalities for the sustainability of the same. Objectives: The aim was to propose management inputs in improving non-clinical services of cleaning, security, diet, driver, and laundry in the hospitals under Public Health Department Maharashtra. The objectives were to assess the scope and feasibility of specific managerial inputs to promote the Public-Private Partnership under the National Rural Health Mission in emphasizing the qualitative aspect of service. To identify components where Public-Private Partnership can be evolved for hospital services, develop probable modalities for sustainability. Material and methods: The study adopted an experimental, epidemiological study design involving a study and control group. The study group of six sub-districts hospitals received an intervention package, and the control group of 14 sub-district hospitals did not receive an intervention package. Which included interventions to improve performance of clinical quality indicators, training, monitoring, and corrections. The author randomly selected the hospitals from betterperforming hospitals. The focus was mainly on “outsourcing'' components such as non-clinical services and their impact on the quality of services. In the evaluation of non-clinical services, the focus was on the quality of performance and cost-saving, compared to expenditure if regularly appointed employees would have delivered the services. Results and impact: Only 25% of patients were satisfied with non-clinical services. The contractors did not pay as per Minimum Wages Act 1948. The department accepted the checklist for monitoring cleaning and security services and disseminated it across the state as a circular.

A model for national assessment of barriers for implementing digital technology interventions to improve hypertension management in the public health care system in India

BackgroundThere is substantial interest in leveraging digital health technology to support hypertension management in low- and middle-income countries such as India. The potential for healthcare infrastructure and broader context to support such initiatives in India has not been examined. We evaluated existing healthcare infrastructure to support digital health interventions and examined epidemiologic, socioeconomic, and geographical contextual correlates of healthcare infrastructure in 544 districts covering 29 states and union territories across India.MethodsThe study was a cross-sectional analysis of India’s Fourth District Level Household and Facility Survey (DLHS-4; 2012–2014), the most up-to-date nationally representative district-level healthcare infrastructure data. Facilities were the unit of analysis, and analyses accounted for clustering within states. The main outcome was healthcare system infrastructural context to implement hypertension management programs. Domains included diagnostics (functional BP instrument), medications (anti-hypertensive medication in stock), essential clinical staff (e.g., staff nurse, medical officer, pharmacist), and IT specific infrastructure (regular power supply, internet connection, computer availability). Descriptive analysis was conducted for infrastructure indicators based on the Indian Public Health Standards, and logistic regression was conducted to estimate the association between epidemiologic and geographical context (exposures) and the composite measure of healthcare system.ResultsData from 32,215 government facilities were analyzed. Among lowest-tier subcenters, 30% had some IT infrastructure, while at the highest-tier district hospitals, 92% possessed IT infrastructure. At mid-tier primary health centres and community health centres, IT infrastructure availability was 28 and 51%, respectively. For all but sub-centres, the availability of essential staff was lower than the availability of IT infrastructure. For all but district hospitals, higher levels of blood pressure, body mass index, and urban residents were correlated with more favorable infrastructure. By region, districts in Western India tended towards having the best prepared health facilities.ConclusionsIT infrastructure to support digital health interventions is more frequently lacking at lower and mid-tier healthcare facilities compared with apex facilities in India. Gaps were generally larger for staffing than physical infrastructure, suggesting that beyond IT infrastructure, shortages in essential staff impose significant constraints to the adoption of digital health interventions. These data provide early benchmarks for state- and district-level planning.

Supply-side Readiness for Universal Health Coverage: Assessing Service Availability and Barriers in Remote and Fragile Setting

The study was conducted to a) Evaluate the service readiness and b) Ascertain supply side barriers inhibiting service provisioning in rural, remote and fragile district in India. We employed a mixed method study design encompassing Service Provisioning Assessment of entire network of public health facilities using Service Availability and Readiness Assessment (SARA) module of WHO in conjunction with Indian Public Health Standards Guidelines (IPHS). Qualitative information was collected via Field Observations, Key informant interviews and Focus group discussion with stakeholders ranging from leaders to laggards. A concise index of General Service Availability, Service Specific Availability and Facility Readiness was computed along with exploratory data analysis using Principal Component Analysis. Further, determinants of facility readiness were elucidated using Generalized Ordinal Logistic Model. Qualitative findings were analyzed via content analysis. Results indicated poorest readiness in lower-tier facilities with particularly abysmal readiness for basic amenities, diagnostic capacity and preparedness for emergencies and non-communicable diseases. The estimates for logistic model revealed that degree of vulnerability of facilities, type of facility and frequency of monitoring and supervision significantly impacted the readiness. Qualitative analysis divulged lack of incentives for health workers, political interference, topographical constraints and security disruptions as major barriers stymieing service provisioning in study area.

Situation analysis of medical laboratories in primary health centres

Background: This study was conducted with the objective to assess the medical laboratories attached with primary health centres (PHCs) focusing on the current needs, gaps and to understand the utilization pattern of the laboratory services. There are hardly any relevant studies that are known to have investigated the functioning of laboratories attached with PHCs based on quality of service they are providing.Methods: This study was a cross sectional study based on observations and assessment made at 33 randomly selected medical laboratories attached with PHCs in Ahmedabad district, Gujarat. Checklist adapted from National Quality Assurance Standards (NQAS) and Indian Public Health Standards (IPHS) were used as a tool for data collection.Results: Though all the laboratories have been found to be functioning effectively based on the indicators in this study, some of the laboratories were not performing basic important tests like rapid plasma reagin (RPR) (18%) and hepatitis B surface antigen (HbSAg) (21%). None of the laboratories attached to the PHCs under study performed Widal test. There was very low utilization of urinary pregnancy test (UPT) (1.81%) in the first quarter of the year.Conclusions: Although most of the indicators reflect satisfactory performance of the laboratories, there exists certain gaps and needs that are essential in provision of quality laboratory services in the primary level of health care. The laboratory information management system (LIMS) was the major issue in the laboratories.