scholarly journals Trends in the development of psychiatric services in India

1996 ◽  
Vol 20 (1) ◽  
pp. 43-45 ◽  
Author(s):  
Mohan Isaac
Keyword(s):  
Mentally Ill ◽  
Service Provision ◽  
Mental Hospital ◽  
Quality Of Services ◽  
Paper Briefly ◽  
The Past ◽  
Primary Health ◽  
Primary Health Centres ◽  
Health Centres

Over the past five decades, services for the mentally ill in India have steadily improved. From a predominantly mental hospital based service, provision has now moved to general hospitals and primary health centres. A variety of factors have contributed to changes in the quality of services. This paper briefly reviews the changes and discusses the relevance of some of them.

scholarly journals Improving quality of care during childbirth in primary health centres: a stepped-wedge cluster-randomised trial in India

2018 ◽  
Vol 3 (5) ◽  
pp. e000907 ◽  
Author(s):  
Ramesh Agarwal ◽  
Deepak Chawla ◽  
Minakshi Sharma ◽  
Shyama Nagaranjan ◽  
Suresh K Dalpath ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Management Strategy ◽  
Randomised Trial ◽  
Cluster Randomised Trial ◽  
Stepped Wedge ◽  
Primary Health ◽  
Cluster Randomised ◽  
Primary Health Centres ◽  
Health Centres

BackgroundLow/middle-income countries need a large-scale improvement in the quality of care (QoC) around the time of childbirth in order to reduce high maternal, fetal and neonatal mortality. However, there is a paucity of scalable models.MethodsWe conducted a stepped-wedge cluster-randomised trial in 15 primary health centres (PHC) of the state of Haryana in India to test the effectiveness of a multipronged quality management strategy comprising capacity building of providers, periodic assessments of the PHCs to identify quality gaps and undertaking improvement activities for closure of the gaps. The 21-month duration of the study was divided into seven periods (steps) of 3  months each. Starting from the second period, a set of randomly selected three PHCs (cluster) crossed over to the intervention arm for rest of the period of the study. The primary outcomes included the number of women approaching the PHCs for childbirth and 12 directly observed essential practices related to the childbirth. Outcomes were adjusted with random effect for cluster (PHC) and fixed effect for ‘months of intervention’.ResultsThe intervention strategy led to increase in the number of women approaching PHCs for childbirth (26 vs 21 women per PHC-month, adjusted incidence rate ratio: 1.22; 95% CI 1.17 to 1.28). Of the 12 practices, 6 improved modestly, 2 remained near universal during both intervention and control periods, 3 did not change and 1 worsened. There was no evidence of change in mortality with a majority of deaths occurring either during referral transport or at the referral facilities.ConclusionA multipronged quality management strategy enhanced utilisation of services and modestly improved key practices around the time of childbirth in PHCs in India.Trial registration numberCTRI/2016/05/006963.

scholarly journals Quality of Health Assistants in primary Health centres in Rural Maharashtra, India

2013 ◽  
Vol 6 ◽  
pp. HSI.S11226
Author(s):  
Enakshi Ganguly ◽  
Bishan S. Garg
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Primary Health Care System ◽  
Job Descriptions ◽  
Continuous Training ◽  
Primary Health ◽  
Primary Health Centres ◽  
Quality Assurance Mechanism ◽  
Health Centres

Introduction Health assistants are important functionaries of the primary health care system in India. Their role is supervision of field-based services among other things. A quality assurance mechanism for these health assistants is lacking. The present study was undertaken with the objectives of developing a tool to assess the quality of health assistants in primary health centres (PHCs) and to assess their quality using this tool. Methodology Health assistants from three PHCs in the Wardha district of India were observed for a year using a tool developed from primary health care management Aavancement program modules. Data was collected by direct observation, interview, and review of records for quality of activities. Results Staff strength of health assistants was 87.5%. None of the health assistants were clear about their job descriptions. A supervisory schedule for providing supportive supervision to auxiliary nurse midwives (ANMs) was absent; most field activities pertaining to maternal and child health received poor focus. Monthly meetings lacked a clear agenda, and comments on quality improvement of services provided by the ANMs were missing. Conclusion Continuous training with sensitization on quality issues is required to improve the unsatisfactory quality.

scholarly journals Where there is no nurse: an observational study of large-scale mentoring of auxiliary nurses to improve quality of care during childbirth at primary health centres in India

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e027147 ◽  
Author(s):  
Krishna D Rao ◽  
Swati Srivastava ◽  
Nicole Warren ◽  
Kaveri Mayra ◽  
Aboli Gore ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Postpartum Haemorrhage ◽  
Neonatal Resuscitation ◽  
Staff Nurses ◽  
Normal Delivery ◽  
Primary Health ◽  
Primary Health Centres ◽  
Significant Difference ◽  
Health Centres

ObjectiveClinician scarcity in Low and Middle-Income Countries (LMIC) often results in de facto task shifting; this raises concerns about the quality of care. This study examines if a long-term mentoring programme improved the ability of auxiliary nurse-midwives (ANMs), who function as paramedical community health workers, to provide quality care during childbirth, and how they compared with staff nurses.DesignQuasi-experimental post-test with matched comparison group.SettingPrimary health centres (PHC) in the state of Bihar, India; a total of 239 PHCs surveyed and matched analysis based on 190 (134 intervention and 56 comparison) facilities.ParticipantsAnalysis based on 335 ANMs (237 mentored and 98 comparison) and 42 staff nurses (28 mentored and 14 comparison).InterventionMentoring for a duration of 6–9 months focused on nurses at PHCs to improve the quality of basic emergency obstetric and newborn care.Primary outcome measuresNurse ability to provide correct actions in managing cases of normal delivery, postpartum haemorrhage and neonatal resuscitation assessed using a combination of clinical vignettes and Objective Structured Clinical Examinations.ResultsMentoring increased correct actions taken by ANMs to manage normal deliveries by 17.5 (95% CI 14.8 to 20.2), postpartum haemorrhage by 25.9 (95% CI 22.4 to 29.4) and neonatal resuscitation 28.4 (95% CI 23.2 to 33.7) percentage points. There was no significant difference between the average ability of mentored ANMs and staff nurses. However, they provided only half the required correct actions. There was substantial variation in ability; 41% of nurses for normal delivery, 60% for postpartum haemorrhage and 45% for neonatal resuscitation provided less than half the correct actions. Ability declined with time after mentoring was completed.DiscussionMentoring improved the ability of ANMs to levels comparable with trained nurses. However, only some mentored nurses have the ability to conduct quality deliveries. Continuing education programmes are critical to sustain quality gains.

scholarly journals Quality of Service of Primary Health Centres: Insights from a Field Study

2004 ◽  
Vol 29 (3) ◽  
pp. 71-82 ◽  
Author(s):  
P Rameshan ◽  
Shailendra Singh
Keyword(s):  
Health Care ◽  
Quality Of Service ◽  
Primary Health Care ◽  
Local Government ◽  
Health Care Facilities ◽  
Community Members ◽  
Primary Health ◽  
Primary Health Centres ◽  
Health Centres

This paper provides an evaluation of the quality of services and customer orientation of Primary Health Centres (PHCs) against the backdrop of the changed environment in the country with customer focus and efficiency emerging as the cornerstones of economic transactions in private and public sectors alike. It focuses on ten selected PHCs of Uttar Pradesh and covers the following stakeholders: Customers including patients who use the health care facilities of PHCs as well as the relatives and their personal attendants. Community members covering the village public, local shopkeepers, local government functionaries, local intelligentsia such as teachers and others having an interest or stake in PHC activities. Doctors and staff of the PHCs. District Medical Officials responsible for controlling and monitoring the PHC activities. The paper draws, among others, the following conclusions: The customers and community members of the villages perceived the facilities and services of PHCs to be deficient in many respects. Neither doctors and PHC staff nor the district officials are able to refute adequately the issues raised by villagers about the quality of service of PHCs. While villagers do not like the panchayat (local government) coming into the picture for improving the services of PHCs, district officials totally discount privatization as a means for providing effective primary health care in rural areas. While it is not very easy to solve the primary health care problems of the Indian villagers, yet the policy-makers can take recourse to the following measures to improve the facilities and services of PHCs in future: Form village committees to monitor PHC facilities, resources, and services. Identify industry patrons/sponsors for each PHC for developing infrastructure, facilities, and logistics without straining the scarce government resources. Constitute district-level user committees to monitor not only the PHC activities of a district but also the activities of the District Medical Offices. Enable panchayat and district administration to perform monitoring and supporting functions to ensure multiple checks on activities of the PHCs and District Medical Offices.

scholarly journals Nurse Mentor Training Program to Improve Quality of Maternal and Newborn Care at Primary Health Centres: Process Evaluation

2016 ◽  
Vol 06 (06) ◽  
pp. 458-469 ◽  
Author(s):  
Maryann Washington ◽  
Krishnamurthy Jayanna ◽  
Swarnarekha Bhat ◽  
Annamma Thomas ◽  
Suman Rao ◽  
...  
Keyword(s):  
Training Program ◽  
Newborn Care ◽  
Improve Quality ◽  
Mentor Training ◽  
Primary Health ◽  
Primary Health Centres ◽  
Health Centres ◽  
Maternal And Newborn Care ◽  
Maternal And Newborn

scholarly journals Assessment of the Quality of Antenatal and Postnatal Care Services in Primary Health Centres in Rural Nigeria

2020 ◽  
Vol 18 (2) ◽  
pp. 1-18
Author(s):  
Lorretta Favour C. Ntoimo ◽  
Friday E. Okonofua ◽  
Sanni Yaya ◽  
Blessing Omorodion ◽  
Wilson Imongan ◽  
...  
Keyword(s):  
Local Government ◽  
Low Income ◽  
Postnatal Care ◽  
National Bureau ◽  
Exit Interviews ◽  
Primary Health ◽  
Primary Health Centres ◽  
Health Centres ◽  
Antenatal And Postnatal Care

Maternal mortality ratio in Nigeria is estimated to be 512 deaths per 100,000 live births. As with other low-income countries, a higher proportion of these deaths occur among women living in rural areas and in poor communities where access to maternal health care is limited by several barriers including quality of care in health facilities. The objective of this study was to assess the quality of antenatal and postnatal care in Primary Health Centres (PHCs) in two rural Local Government Areas of Edo State in Southern Nigeria. The data were obtained from exit interviews with 177 women after completion of antenatal and postnatal care in eight randomly selected PHCs. The interview questionnaire was adapted from the 2017 results-based financing exit interviews conducted by the World Bank in collaboration with the Federal Ministry of Health and the National Bureau of Statistics. It consisted of questions on the treatment received by women. The data were analysed with descriptive statistics and logistic regression. The results showed the self-reporting by women of sub-optimal offerings of 20 signal antenatal treatments and 8 signal postnatal care treatments. Close to half (45.6%) of the respondents for antenatal care reported receiving sub-optimal antenatal treatments compared to about a third of postnatal care attendees. The predictors of sub-optimal offerings of standard PHC care included local government area, marital status and previous childbirths. We conclude that concerted actions by health providers and policymakers in the PHCs to develop policies and interventions will improve the quality of delivery of antenatal and postnatal services in rural PHCs in Nigeria.

scholarly journals Measuring oxygen access: lessons from health facility assessments in Lagos, Nigeria

2021 ◽  
Vol 6 (8) ◽  
pp. e006069
Author(s):  
Hamish R Graham ◽  
Omotayo E Olojede ◽  
Ayobami A Bakare ◽  
Agnese Iuliano ◽  
Oyaniyi Olatunde ◽  
...  
Keyword(s):  
Health Facility ◽  
Point Of Care ◽  
Assessment Tools ◽  
Operating Theatre ◽  
Facility Assessment ◽  
Primary Health ◽  
Primary Health Centres ◽  
Health Centres ◽  
The Cost

The COVID-19 pandemic has highlighted global oxygen system deficiencies and revealed gaps in how we understand and measure ‘oxygen access’. We present a case study on oxygen access from 58 health facilities in Lagos state, Nigeria. We found large differences in oxygen access between facilities (primary vs secondary, government vs private) and describe three key domains to consider when measuring oxygen access: availability, cost, use. Of 58 facilities surveyed, 8 (14%) of facilities had a functional pulse oximeter. Oximeters (N=27) were typically located in outpatient clinics (12/27, 44%), paediatric ward (6/27, 22%) or operating theatre (4/27, 15%). 34/58 (59%) facilities had a functional source of oxygen available on the day of inspection, of which 31 (91%) facilities had it available in a single ward area, typically the operating theatre or maternity ward. Oxygen services were free to patients at primary health centres, when available, but expensive in hospitals and private facilities, with the median cost for 2 days oxygen 13 000 (US$36) and 27 500 (US$77) Naira, respectively. We obtained limited data on the cost of oxygen services to facilities. Pulse oximetry use was low in secondary care facilities (32%, 21/65 patients had SpO2 documented) and negligible in private facilities (2%, 3/177) and primary health centres (<1%, 2/608). We were unable to determine the proportion of hypoxaemic patients who received oxygen therapy with available data. However, triangulation of existing data suggested that no facilities were equipped to meet minimum oxygen demands. We highlight the importance of a multifaceted approach to measuring oxygen access that assesses access at the point-of-care and ideally at the patient-level. We propose standard metrics to report oxygen access and describe how these can be integrated into routine health information systems and existing health facility assessment tools.

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