Post on 12-Mar-2015
transcript
Compiled by
Lata Suresh
PREFACE
IIHMR being the premier institute of hospital and health management in the country has the prime responsibility to shape the direction
and dimensions of research and development in the field of health and hospital management. From the year of its inception; it is
committed to generating quality research in these fields.
The Institute offers a two-year full-time Postgraduate Programme with specialization in Hospital Management and Health
Management. It is a flag ship educational programme aiming at developing trained professional managers with requisite skills in
planning and operating management techniques; diagnosing and solving management problems; and acquiring consultancy skills,
with a view to preparing them to manage hospitals and pharmaceutical and healthcare institutions in developing countries both in the
public and the private sectors, and to meet the rising demand for quality care. For practical training the Institute has collaborative
arrangements with multi-specialty hospitals and several pharmaceutical companies, NGOs and healthcare organizations. As the
programme has set high standards of management education in the health sector, it has attained the status of a premier programme in the
country. Our students go for training and placement to as many as one hundred hospitals and pharmaceutical and healthcare
organizations. Hence, Institute decided to publish abstracts of the entire dissertations carried out by the students. This volume
summarizes the work done by the students of PGDHM batch 2008-2010.
We acknowledge the help and support provided by the PGDHM and PGDPM students batch 2009-2011 and the library staff for their
immense help provided during the final stage of this publication. We also acknowledge the help and support by Mr. Mukesh Gahlot,
computer department for his assistance.
Lata Suresh
1. Infection Control in Intensive Care Unit & Facility Based New
Born Care Unit
2. Efficient Work Flow Management in Radiology Department Anil Gupta L.P. Singh 2
3. Comparative Study on Incidence of VAP in ICU at a Hospital Anuj Dandotia 3
in Patna
4. Strategy Evolvement for Improving Turnaround Time for Bed Anurag Gupta Vinod Kumar 3
having Synergized Effect on Delivering Quality Health Care to
Patients in a 200 Bedded Hospital
5. Study on Factors Associated with Satisfaction and Motivation of Aparna Jha S.C. Gupta 3
the Class III & IV Employees in Government District Hospital
6. Quality Assessment of Radiology Department Archana Agarwal S.D. Gupta 4
7. Statistical Approach to Inventory Optimization with Focus on Arti Sharma Abhishek Dadhich 5
Medical Consumable Items
8. A Comprehensive Study of Gap Analysis of Facility Management Bhushan Sarmandal Anoop Khanna 5
& Safety (FMS) at Specialty Hospital, as per Joint Commission
International (JCI) Accreditation Standards
9. Quality Assurance in Biomedical Waste Management Deep Makkar Dipti Govil 5
10. Study of Process Compliance for Rationalization of Usage of Deepti Choudhari S.K. Puri 6
Restricted Antimicrobials in a Tertiary Care Hospital in India
11. A Study on Patient Satisfaction at Multi Super Specialized Hospital Divya P.R. Sodani 6
and Heart Institute, New Delhi
12. Compliance Percentage Assessment and Comparison (Pre and Post) Eesha Arora P.R. Sodani 7
to NABH Standards for Capacity Building
13. Rapid Assessment of a Model Initiative to Ensure Quality Family Esha Kalra Vivek Lal 7
Planning Services in Uttarakhand
Amritesh Mullick Goutam Sadhu 2
CONTENTS
HOSPITAL MANAGEMENT
S.No Title Students’ Name Advisor Pg No.
14. Formulation and Implementation of Performance Management
System at a Tertiary Care Hospital
15. Nosocomial Infection Management Garima Singh Meel Nutan P.Jain 8
16. Influence of ‘Post Surgical LOS’, ‘Surgeon’, ‘Insurance’ and Ginny Kaushal C.K. Aiyer 9
‘Bed Class’ on ‘Patient’s Hospital Expenses’ for MRM,
Amputation and Oesophagectomy Surgeries done in a quarter.
17. Measuring Operational Efficiency of 210 Beded Multi Super Heena Kausar Santosh Kumar 9
Specialty
18. Construction and Implementation of Information System for Indu Dhangar R.S. Goyal 10
TPA Department
19. Time Utilization of Operation Theatre Jitendra Kumar Hayaran Neetu Purohit 10
20. Internal Assessment of as per NABH Standards Jyoti Ahuja Barun Kanjilal 11
21. Benchmarking of Inventory and Stores Department of an Eye Kanwalpreet Grewal Neetu Purohit 11
Hospital
22. Application of Lean Principles to Improve Operational Efficiency Karan P. Mansukhani Santosh Kumar 12
in Health Check-up Department
23. Inventory Classification of Medicines at Multi Speciality Hospital Komal Jeet C.K. Aiyer 13
Gurgaon
24. PDCA Approach to Accreditation Kunal Jawahar Thakkar Suresh Joshi 13
25. Improving the Operational Efficiency by Assessing Quality Indicators Meetu Garg P.R. Sodani 13
26. Business Process Re-engineering of Admission, Discharge and Megha Ahuja Barun Kanjilal 14
Transfer in a Tertiary Care Hospital
27. Gap Analysis as per NABH Norms of a General Hospital in Gujarat Namrata Vivek Lal 14
28. Patient Satisfaction with Quality of Care: A Comparative Study of Nancy Gupta R.S. Goyal 15
Indoor Patients in Different Wards
29. Assessment of Adherence to Protocol in Medical Record Natasha Ahmad Suresh Joshi 15
Documentation in accordance with NABH Guidelines
Gargi Agarwal Jyoti Dua 8
S.No Title Students’ Name Advisor Pg No.
30. Implementation of Performance Appraisal System in Tertiary
Care Hospital
31. Study on Community Perception About a District Hospital in Neha Awasthi Goutam Sadhu 16
Relation to IPHS Norms
32. Need and Location Identification of Dialysis Units in Delhi Under Neha Garg Jyoti Dua 17
PPP Framework
33. Study on Patient Care Quality Standards at a General Hospital, Nehashree Dipti Govil 17
Gujarat
34. Study on Roles and Perspective of Nurses in CCC in India Nisha Kadyan S.K. Puri 18
35. Bridging the Gaps in the HIC Chapter of NABH Enhancing the Payal Ahuja J.P.Singh 18
Preparedness for NABH Accreditation
36. Assessment of Laboratory Services Against N.A.B.L. Standards Pooja Aggarwal Suresh Joshi 19
37. Gap Analysis for Phase II Expansion in a Tertiary Care Hospital Prabhat Govindan Vivek Lal 19
at Rajkot
38. Knowledge Attitude Practice (KAP) among the Staff Regarding Priyanka Maan Jyoti Dua 20
Biomedical Waste Management
39. A Study on the Bio-Medical Waste Management Priyanka Sharma Dipti Govil 20
40. Benchmarking Medical Records Department in Accordance with Priyanka Singh L.P.Singh 21
NABH Standards
41. Gap Analysis of District Hospital in Conformance to NABH Priyanka Vashishta Jyoti Dua 21
Standards
42. Medical Record Auditing at Delhi Rashmi Chaudhary Vinod Kumar 22
43. Study of Time Utilization of Operation Theatre at a General Hospital Richa Daftray L.P. Singh 22
44. Assessment of Bio-Medical Waste Management Practices Roshni Dilbagi Neetu Purohit 23
45. Performance Management in Operating Rooms at a Health Institute Ruchika Goyal Neetu Purohit 24
46. Benchmarketing of Medical Records at Eye Hospital at New Delhi Rupinder Sahota Santosh Kumar 24
Neha Agarwal S.C. Gupta 16
S.No Title Students’ Name Advisor Pg No.
47. Study of the Opinion of inpatients to Measure Patient Satisfaction in
an Emergency Hospital
48. Study on the Utilization of Radio Diagnostic Equipments, Ultrasound Sangeeta Ravindran Anoop Khanna 25
& Operation Theatre
49. Challenges & Opportunities of Medical Tourism in Hospitals Sanjhi Singh Barun Kanjilal 26
50. Quality Assessment for Training Needs Assessment Saumya Misra Alok K. Mathur 26
51. Flyover Feeds you more Momentum Expected Vs Perceived Hospital Shadad Mirza J.P. Singh 26
Services
52. Nosocomial Infections in Intensive Care Unit Sheetal Yadav S.D. Gupta 27
53. Bed Utilization in a General Hospital at Gujarat Shikha Jain Alok Mathur 27
54. Study of Employee Satisfaction at a General Hospital, Gujarat Shreyasi Sen Gupta Dipti Govil 28
55. Study on Disaster Management Plan Shruti Khanna S.K. Puri 29
56. Study the Operations, Medical / Clinical Record Keeping and Prepare Shweta Sandhu Goutam Sadhu 29
Functional Specifications for Clinical System for Oncology
57. Quality Improvement through Patient Satisfaction Survey Suhas Parnami Vinod Kumar 29
58. A Study on Control Measures of Hospital Acquired Infection in Suhasini S D Gupta 30
Intensive Care Unit
59. Assessment of a Hospital as per FFHI Guidelines Sunita Choudhary Goutam Sadhu 30
60. Internal Quality Assurance in Clinical Documentation Thirumalai N L.P. Singh 31
61. Human Resource for Health in a District Hospital at Rajasthan Trupti Khandelwal Nutan P.Jain 31
62. Study of Housekeeping Services Vatsala J.P. Singh 32
63. ICU per Bed Day Costing in a Charitable Hospital, Delhi Vijay Shankar Patel Vive Lal 33
64. Cost Analysis of Medical Imaging Modalities Vikas Goya Barun Kanjilal 33
65. Scope of IT in OPD and IPD Areas: First Step Towards a Paperless Vikash Tyagi J.P. Singh 33
Hospital
Samarth Tripathi Goutam Sadhu 25
S.No Title Students’ Name Advisor Pg No.
66. External Emergency Response Plan in a Multispeciality Hospital at
Jaipur
67. Study of Improving Effectiveness and Efficiency of the Linen and Vrajesh Shah Alok Mathur 34
Laundry Department
68. Comparative Analysis of two Multi-Superspeciality Hospitals for Vritti Lumba Alok K. Mathur 34
assessing the performance of Dialysis Unit
69. Monitoring and Strengthening of OPD and IPD Services in District Yatendra Kumar Sharma Abhishek Dadhich 35
Hospital, Sikar
Vikram Singh Chouhan P.R. Sodani 34
S.No Title Students’ Name Advisor Pg No.
1. Yashoda Assessment at District Hospital Aastha Srivastava Suresh Joshi 37
2. Quality of Ante-natal, Intra-natal and Post-natal Services in two Aishwarya Rathore S.K. Puri 37
Districts of Orissa
3. To Study the Relationship of JSY with Institutional Delivery/Maternal Akash Kumar Lal Nutan P.Jain 38
Complications and Its Utilization by the Beneficiaries
4. Human Resource in Health (HRH) in India Amandeep Singh Arindam Das 38
5. To Ascertain the Role of LBWs in Neonatal Mortality and Ambrish Kumar Chandan J.P. Singh 39
Development of Strategy for Preventing Deaths Due to LBWs in the
Tirbal District of Narmada
6. Customer Expectation Survey Regarding Health Insurance in Pune Amit Ray S.D. Gupta 39
7. Analysis of Low Institutional Delivery Rate in a District Block in Anamika Barun Kanjilal 40
Gujarat
8. Evaluation of Training Programme Conducted by State ASHA Anil Rajesh Dungdung S.K. Puri 40
Resource Centre
9. Training Need Assessment (TNA) on Health Management Anisha Saxena Santosh Kumar 41
Information System (HMIS) of Sub Centre Level Health Workers
(ANMs and LHVs) of Government of Bihar
10. Immunization Coverage in Mahadalit a District of Bihar: A Feedback Arunabh Ray S.C. Gupta 41
to Programme Manager
11. Comparison of Organ Transplant Scenario in 5EU and India W.R.T Deepa Raina Hemant Anand 42
Health Care Reforms and Immunosuppressant Therapy
12. Training Need Assessment (TNA) on Health Management Jaspreet Mahal Santosh Kumar 43
Information System (HMIS) of Block and District Level Health
Personnel (DEO/BHE/ BHM, M&E Officer/SA and DPM) of
Government of Bihar
13. Factors Governing Contraceptive use in the Northeastern States of Jaya Swarup Mohanty Arindam Das 43
India
S.No Title Students’ Name Advisor Pg No.
HEALTH MANAGEMENT
14. Study on Implementation of Referral System in District Rajsamand Jyoti Meena Neetu Purohit 44
15. Assessment of the Knowledge and Attitude of Participants, Pre and Kiran Madhukar Narkhede R.S. Goyal 44
Post Capacity Building Training for Village Health and Sanitation
Committee in Chittorgarh District of Rajasthan
16. Performance Assessment of IMNCI in District Valsad Mansi Shekhar S.D. Gupta 45
17. Evaluation of Functioning of Rogi Kalyan Samiti and Utilization Minu Manuhar Sinha P.R. Sodani 45
of RKS Grant Received byPHC in the District Navsari, Gujarat
(Financial Year 2009-10) for Improving the Standard of PHC
18. An Assessment of Mamta Diwas Programme in Urban Slums of a Mohit Sharma Santosh Kumar 46
Municipal Corporation at Gujarat
19. JBSY (Janani Baal Suraksha Yojana) Evaluation Study in Bihar Neha Dumka S.D. Gupta 47
20. To Assess the Service Delivery of IPHS Upgraded and Non IPHS Neha Maheshwari Suresh Joshi 47
PHCs in Gondia District, Maharashtra
21. Effect of Supervision on Service Delivery at Mamta Diwas in Nidhi Jain Vivek Lal 48
Vallabhipur Block of Bhavnagar District
22. Gender Bias and Status of Women in Nuh and Tauru Blocks of Nidhi Vats S.C. Gupta 48
Mewat
23. Factors Affecting Utilization of Chief Minister BPL Jeevan Raksha Poonam Yadav S.D. Gupta 49
Kosh
24. Analyzing the Functioning of Adolescent Friendly Health Services Puneet Gupta P.R. Sodani 49
(AFHS) Centre at PHC block, Gujarat
25. Assessment of Functioning of ASHA in District Dahod Ram Krishna Kumar Dipti Govil 50
26. HSS Data Analysis of HIV/AIDS in Sentinel Group of Rajasthan Richa Chaturvedy Santosh Kumar 50
27. Clients Perspective on Assessment of HIV Care Services: ART Rit Shukla Dipti Govil 51
Center vs. ART Center
28. Assessment of EmOC Services in Kachchh District, Gujarat Sabyasachi Mohapatra L.P. Singh 51
29. A Study on the Implementation Status of Janani Suraksha Yojana Sakshi Jain J.P. Singh 52
in General Hospital, Sirohi
S.No Title Students’ Name Advisor Pg No.
30. EPI Coverage Survey in Rural Areas of Sabarkantha District in
Gujarat
31. Review of Verbal Autopsy Reports of Infants and Maternal Deaths Shraddha S. Rajpur Jyoti Dua 53
32. Determinants of Maternal Healthcare Utilization in Jammu and Suhail Ismail Shiekh Arindam Das 54
Kashmir-a Regional Analysis
33. Geriatric Health Insurance: A Study in Bangalore City Sumana Arora Barun Kanjilal 54
34. Training Need Assessment (TNA) of Health Functionaries of Tukaram Khandade Santosh Kumar 55
Government of Bihar in Knowledge Attitude and Practice (KAP) in
Health Management Information System (HMIS) in three Blocks of
Munger
Shikha Bansal Alok K. Mathur 52
S.No Title Students’ Name Advisor Pg No.
1. Renal Cell Carcinoma: Therapeutic Segment Outlook and Pipeline
Analysis in Evalueserve, Gurgaon
2. Market Assessment of Biopharmaceuticals Round the Globe Kuldeep Dabas Hemant Anand 57
3. Assessment of Japanese Pharmaceutical Market to Search Business Pritika Garg Hemant Anand 58
Opportunities
4. Vitamin A Bi-annual Round Process and Knowledge Assessment Pushpendra Dixit Suresh Joshi 59
5. Market Assessment and Product Launching Strategy of Linezolid Rahul Gupta Hemant Anand 59
6. Assessment of Insulin Market in Jaipur, Gurgaon and Faridabad Ramneek Atreya Hemant Anand 60
Through Retail Chemist Audit
7. Analysis of Pharmacy Function and Work Load Reenu Bajapi Anoop Khanna 60
8. Market Assessment of Rheumatoid Arthritis in 5-European Countries Siyaram Sharma Hemant Anand 60
9. Pulmonary Arterial Hypertension: Futuristic Competitor Overview Sonal Ghura C.K. Aiyer 61
Gurgaon
10. Market Survey of Treatment Options for Osteoarthritis and Awareness Sumati Kumar Jain C.K.Aiyer 62
About Sodium Hyaluronate 1 % Solution in Medical Profession
11. Market Overview of Hepatitis C in Middle East and North African Vibha Chadha Hemant Anand 62
(MENA) Region
Ginni Kumar C.K. Aiyer 57
S.No Title Students’ Name Advisor Pg No.
PHARMACEUTICAL MANAGEMENT
HospitalManagement
2
Ab-1 Infection Control in Intensive Care Unit & Facility
Based New Born Care Unit
Amritesh Malik
Keywords: Infection Control, Intensive Care Unit, New Born
Care Unit
Objective : The main objective was to study the physical facilities
available for infection control in the intensive care unit and to study the
existing infection control procedures used in the intensive care unit.
Methodology : The study is carried out in the intensive care unit,
particularly medical intensive care unit and facility born new care
unit(FBNC) at a hospital at Bharatpur. The required data is collected
from nurses, doctors, hospital nursing assistance, staff of central sterile
supply department who is responsible for supplying sterile items to
medical intensive care unit & FBNC unit , house keeping staff who
work in medical intensive care & FBNC unit, through questionnaires,
personal observation and studying relevant record or infection control
maintained in medical intensive care unit. The tools adopted for study is
descriptive method and the required data is obtained from 26
respondents, consisting of nurses, doctors, hospital nursing assistance,
staff of central sterile supply department (supplying sterile items to
medical intensive care unit), house keeping staff who work in medical
intensive care unit through questionnaires, personal observation and
studying relevant record for infection control maintained in medical
intensive care unit.
Findings : It was found that hundred percent responded said that
surface of MICU, table and trolleys are been wet cleaned daily. Further
analysis revealed that, seventy six percent responded that walls are wet
cleaned monthly. higher than ¼ th (29 percent) of the respondent
reported that the monitoring sterilizing efficiency of autoclave was
done daily whereas little more than1/2 of the respondent (53 percent)
responded reported that sterilizing efficiency of autoclave was
monitored weekly, and rest 1/5 responded said that that it is done
monthly. Major discrimination was seen in frequency of monitoring.
majority of the respondent reported that there were adequate hand
washing facilities available in the hospital, where as 6 percent reported
that the facilities were not adequate. The study revealed that surfaces in
MICU & FBNC are wet cleaned daily walls are wet cleaned monthly.
The study revealed that according to fifty nine(59%) percent
respondents (nurses and doctors, N=17), the level of safety measures is
satisfactory. Fifty three percent have undergone periodic health check-
up and immunization relevant to their work.
Recommendations: Proper facilities and adequate resources may be
provided to support the infection control programme. It includes hand
washing facilities in all patient care areas and accessible to health care
providers and compliance with proper hand washing is monitored
regularly.
Ab-2 Efficient Work Flow Management in Radiology
Department
Anil Gupta
Keywords: Radiology Department, Work Flow Department, Hospital
Management, Hospital Profile
Background: Radiology diagnostic procedure has several steps from
billing and appointment to procedure and report collection in which
patient had to wait for his turn for procedure and then for collection of
report, increased waiting time and TAT for reporting adds to patient
dissatisfaction and inefficiency of radiology department.
Objective: To minimize the waiting time for test and minimum
turnaround time (TAT) for report generation for the efficient workflow
management in radiology department.
Methodology: The study was done in two steps, (1) the current
situation was analyzed for 2 weeks for busy days and busy hours. (2),
the current appointment system was revised and the situation after was
analyzed for 6 weeks for waiting time and report TAT.
Findings: After revising the current appointment system the waiting
time reduced from 10min to 6 min and reporting TAT reduced from 33
to 5 min. The percentage reporting in 15 minutes increased from 64% in
1st week to 97% in 6th week, which shows the increased efficiency of
the radiology department.
Recommendation: Timely revision of appointment system according
to the work load of the department. The quality of the billing process
can make or break a radiology practice. Extra manpower on billing
counters in busy hours of busy days and have roaster accordingly.
Extending the existing HIS system and using electronic requisition and
appointment system
3
Ab-3 Comparative Study on Incidence of VAP in ICU at a
Hospital in Patna
Anuj Dandotia
Keywords: IUC, Incidence of VAP, Nosocomial Infection;
Intensive Care Unit
Background: The study was done focusing on ICU services in developing VAP and also comparative study was done on incidence of VAP and suggested measures to reduce it. The study consists of two parts- understanding the working of the hospital, the infection control policies persisting in the hospital, working manual of infection control committee, review of literature and past studies done on Nosocomial infection. (2) collection, analyzing and summarizing of data collected from the ICU and thus calculating incidence of VAP.
Objective: To study the incidence of nosocomial infection, to study the incidence of VAP of patients on ventilator, to compare the incidence of infection rate at the hospital of study with the hospitals of similar capacity. Previous studies and literature available were also taken as reference.
Rationale: This was an emergency hospital and most of the patients which are being referred to the hospital of study are from its’ sister concern hospital. It is a multispecialty kidney Hospital where most of the patients are being admitted is of chronic kidney disease and at end stage renal disease with already immuno-compromised status. Many of them are on the immuno-compresive drugs so these patients are more susceptible to acquire infection after being admitted in the hospital thus it is quite necessary to develop and implement the infection control policy in this hospital to check out the morbidity as well as mortality.
Methodology: The study was based on data collected of all the patients being admitted in ICU of the hospital and their follow up during entire period of stay in the hospital. A descriptive study of exploratory nature was conducted within a stipulated time frame of two weeks was done in consciences with the higher authorities
Findings: The incidence of ventilator associated pneumonia (VAP) was found to be 28% which when compared with the other studies was found to be significantly higher as the study was done in MICU and incidence of VAP in MICU is considered to be 9-10%.Out of 141 patients being admitted in the ICU for various ailments most of them were of chronic kidney disease among them 46 required assisted ventilation and 13 of them developed VAP.
Ab-4Time for Bed having Synergized Effect on Delivering Quality Health Care to Patients in a 200 Bedded Hospital
Anurag Gupta
Keywords: Quality of Health Care, 200 Bedded Hospital, Synergized Effect, Intensive Care unit
Background: The study initially focused on one ward of a 200 bedded
hospital at Mohali. It has a multispecialty ward for patients of all
categories except CTVS patients, with 34 beds. Patients are received
from various entry points like direct admissions from OPD, triage and
ED, GICU. Room turnaround time is a vital measure of performance for
a number of service industries. For hospitals, reducing the room
turnaround time leads to increased revenues as well as increased patient
satisfaction. If a room is ready sooner, a waiting patient is required to
spend less time in the emergency department or less time in stepping
down from ICU, HDU.
Objective: To increase patient satisfaction through timely discharge
.Analysis of room clearance process and finding areas of delays.
Methodology: The operational efficiency study is retrospective –
prospective analytical study .The study is based on primary data.
Findings: The average room clearance turnaround time was 4 min 20
seconds in excess than the desirable 25 min standards. The discharges at
11 A.M were about 79% and planned discharges about
95%.Housekeeping taking more than required time in room clearance.
Patient dissatisfaction was due to delay in discharge. Admission of
patients delayed as room clearance not on time
Recommendations: Consultant should inform about discharge one
day prior and discharge summary should be made accordingly. Patient’s
attendants must also be informed a day prior. Bills should be prepared in
time. Proper guidance and training should be provided to the
housekeeping and general staff.
Ab-5 Study on Factors Associated with Satisfaction and
Motivation of the Class III & IV Employees in
Government District Hospital, Kota
Strategy Evolvement for Improving Turnaround
Aparna Jha
Background: The importance of human factor is very well realized by
the corporate and other private organizations. On the other hand, the
government organizations are still struggling with the problems of
workers union, strikes, lockouts, unaccountability of the workers who
consider their future secure after joining the government organization
even if they do not perform. Human resources are considered important
hence, this study was carried out to understand the problem faced by
the employees, which dissatisfy them and degraded their efficiency.
Objectives: To explore and compare the perceptions of the class III &
IV employees working in the Government tertiary care hospital at
Rajasthan with regard to the availability of motivators at their work-
place and to suggest some interventions to improve the work
environment in the hospital.
Methodology: The methodology used to conduct this study was both
quantitative and qualitative technique through personal interview,
questionnaire consisting both open and close ended questions. The
analysis was done using MS-excel and the findings were shown with
the help of pie and bar charts.
Findings: Findings revealed that all class III employees know about
their job responsibilities. No formal orientation or induction
programme was done when they join the organization. Majority
responded that they have some valuable suggestions to improve the
functioning of the hospital. The class IV employees neither get any kind
of appreciation from the senior officers nor get any promotion in job
which leads to lower satisfaction and motivation level in the employees.
More than half of the nurse face problem in getting the adequate amount
of supply of materials for efficient discharge of their duties. 25% staff
was not working according to their post. A majority of employees
doesn’t wear their uniforms on duty.
Recommendations: Job chart to be prepared for every worker including the daily wage employees. Manpower planning should be done for the proper allocation of the staff. Uniform policies should be formulated and strictly followed to ensure discipline. Discipline and punctuality should be improved and strictly observed. Good work should be appreciated not only in words but also in terms of remunerations or reward. Basic facilities like canteen, pure drinking
Keywords: IUC, Incidence of VAP, Nosocomial Infection; Intensive
Care Unit
4
water, rest rooms should be provided to the staff. Feedbacks can be taken from the staff for nay scope of improvements in the functioning of the hospital.
Ab-6
Archana Agarwal
Background: A focus on operational excellence in everything we do translate the focus on the quality of the service provided. Trying to improve something when the organization do not have a standard to measure against and improve a process without measuring the current status is like playing a game without knowing the score. Measurement and improvement of the processes are absolutely essential if operational excellence is required in the organization.
Objective: The study was done to measure performance of radiology department across three perspectives viz. Customer/patient, internal business processes and learning and growth at a tertiary care private sector hospital in Mumbai.
Methodology: Both qualitative and quantitative methods were used. Interview, Questionnaire and Checklists prepared to collect data. 55 patients were interviewed. The sampling for each investigation was done on random basis. 20 employee of radiology department were taken as per their designation.
Findings: The overall satisfaction of both employees and patients was found to be 61%. Majority of Customer/Patient showed their dissatisfaction in relation to waiting time, Infrastructure- Perception, Access. Employees were mainly dissatisfied with the present performance appraisal system. As a result there was no motivation to improve their efficiency. TAT was higher than desired for X RAY. Wastage of films were found to be more in X RAY and Ultrasound
Recommendation: Provision of LAN connectivity and other inter-units in radiology department is found to be essential. Majority of Customer/Patient showed their dissatisfaction in relation to waiting time, Infrastructure- Perception, Access. Employees were mainly dissatisfied with the present performance appraisal system. As a result there was no motivation to improve their efficiencyProper scheduling of investigation especially in-patients is recommended. It is also essential to motivate staff by arranging training programmes etc.
Quality Assessment of Radiology Department
Keywords: Quality Assessment, Radiology Department, TQM
5
Ab-7
Focus on Medical Consumable Items
Arti Sharma
Background: Cores of rupee are being spent every year for the
purchase of around thousands of varieties of medical consumable
items. As there is no formal inventory system in existence, it happens
that high value slow moving items are stocked in larger quantity
whereas fast moving less value items are stocked out.
Objective: This project study is aimed to introducing an improved
system of inventory control of medical consumable items used in
Healthcare Industry (Hospital). To analyze the efficiency of Inventory
Management as well as to classify the various components based on its
value and movements.
Methodology: The research design used in this project is analytical in
nature. The data are collected from the annual reports maintained by
the company and from the TP-Pospro Plus Software. ABC Analysis,
FSN Analysis, HML Analysis were used as study tools.
Findings: On the basis of unit cost involved, the various items were
classified into ABC categories. Category A needs the most rigorous
control, C requires minimum attention and B deserves less attention
than a but more than C. According to data analyzed by FSN analysis
techniques there are no non-moving items found and the company
maintains low percentage in moving items, which is not a good result. It
was also found that there was no selective control techniques like
economic ordering quantity, reorder level etc. are available to monitor
individually very often & to avoid stock outs. This is very laborious and
cumbersome. Also this consumes valuable time of higher officials.
Recommendations: Under ABC analysis, the management must have
more control on A than B&C, because A class constitutes more (70%) of
higher values. There should be tight control exercised on stock levels, to
avoid deterioration. The company must not go to the Non-moving items
as far as possible, because there will be unnecessary blocking of
working capital. This would hinder the other activities of the
organization. The company is required to maintain safety stock for its
components in order to avoid stock-out conditions & help in continuous
production flow. Items should be placed into the store based on their
Statistical Approach to Inventory Optimization with
Keywords: Inventory Control; Medical Consumable Items; Inventory
Management
consumption so that there would be no obsolescence and deterioration &
that would also help in taking decisions on disposal of none and slow
moving items.
Ab-8
Management & Safety (FMS) as per Joint
Commission International (JCI) Accreditation
Standards
Bhushan Sarmandal
Objective: This study was designed to analyze the available facility of
tertiary care hospital at, Ahemdabad to meet out JCI standards.
Methodology: In this study available facility and safety practices of
hospital compared against facility management and safety standards of
JCI accreditation and scoring is being done as per guidelines to know
about status. It is essential that hospital should analyze its facilities,
before going for JCI accreditation. As the hospital was a NABH &
NABL accredited, tertiary care referral hospital, and it is recognized as
centre of excellence for providing medical care, education and research
facilities of high order in the field of medical sciences
Findings: An aggregate score of at least “7” for each chapter is required
for achieving accreditation but this FMS chapter score obtained is 6.23.
An aggregate score of 8.5 is required for each standard but actually it is
below for all 11 FMS standard in this study.
Recommendations: Therefore there is need to finalize the time limits to
fulfil the non compliances and partial compliances especially utility
system, biomedical equipment and fire safety related standards and then
organisation should apply for JCI accreditation.
Ab-9 Quality Assurance in Biomedical Waste Management
Deep Makkar
Despite of statutory provision of biomedical waste management
practice, Indian hospitals have still not achieved the desired standard
A Comprehensive Study of Gap Analysis of Facility
Keywords: Gap Analysis, Facility Management, JCI, Accreditation
Standards
Keywords: Quality Assurance, Biomedical Waste, Waste Management
6
even after twelve years of enforcement of law ‘Biomedical Waste
(Management and Handling) Rules, 1998’.
Objective: The study was carried out in order to assess the
management of bio medical waste in Primus Super Speciality Hospital
and to carry out a Force Field analysis for the quality assurance in bio
medical waste management.
Methodology: The primary data was collected through observations
and interviews of the staff in various departments. The path of the bio
medical waste transport was also studied from the user site till the end.
Target group was housekeeping staff.
Findings: The awareness regarding bio medical waste management was found to be low and the identification of the cause was done which came out to be the lack of training among the staff. Force field analysis clearly depicted the positive and negative forces which led to the improper management of the bio medical waste. The positive force was that the housekeeping staff was not only practicing but also was having good knowledge of biomedical waste management. The negative force was lack of supervision and training towards housekeeping staff by their supervisor, which led to poor quality in practicing.
Recommendation: After analysis of by the various forces, action plan/recommendations were given which needs to be implemented in order to manage the bio medical waste in the appropriate manner and to fulfill the statutory requirements as well. One of the major recommendations is the provision of training to staff regarding bio medical waste management and then evaluation of the training needs to be done to assess the future training needs. There should be regular rotation of the duty places so that everyone could well acquaint with all aspects of his/her job.
Ab-10Usage of Restricted Antimicrobials in a Tertiary Care Hospital in India
Deepti Choudhari
Background: Antibiotics are life saving drugs. Irresponsible and erratic use of these life-saving instruments has resulted in the development of drug resistance in many organisms .
Study of Process Compliance for Rationalization of
Keywords: Rationalizaition; Restricted Antimicrobials; Tertiary Care Hospital; Rationalizaition of Usage
Objective: This study was done to monitor judicious use of restricted anti microbial agents in a health care organization and develop ways to improve policy practice compliance.
Methodology: Retrospective and concurrent audit of restricted antibiotics usage and rationalization forms. Review of RAB usage survey/audit forms. Interaction, interviews and questionnaire with medical and paramedical professionals was conducted. Literature review and comparisons with international standards was also done.
Findings: 255 RAm prescribed to 144 patients during March 2010. Of the 255 prescriptions documentation of justification for RAm usage is done for only 55 prescriptions which constitute only 21.5 %. No documentation of justification for addition of Ram prescriptions was found.
Recommendation: Improvement in compliance policy needs revision & amendments and implementation of restrictive and educative methods with feedback should be made compulsory. Inclusion of RAm usage compliance as performance & quality Indicator should also be there.
Ab-11Specialized Hospital and Heart Institute, New Delhi
Divya
Background: A brief study of patient satisfaction was done at a 150 bedded multi super specialized health care centre which is accredited with ISO 9001: 2000 & 14001: 2004 certification for quality healthcare services and management.
Methodology: A patient satisfaction questionnaire and a checklist for in-depth interviews with service providers were used as a study tools. In total of 100 inpatients were included in three departments of the hospital with highest patient inflow; medicine, gynecology and surgery. The aggregate scores of the questionnaire regarding patient satisfaction were calculated using MS Excel and SPSS version 12.
Findings: It was found that only 32% of patients were satisfied from the reception services and only 18% from the billing department. The service providers agree that billing and reception were the major areas in the hospital that need improvements. While the score for
A Study on Patient Satisfaction at Multi Super
Keywords: Patient Satisfaction, Multi Super Specialized Hospital, Quality of Health Care
7
interpersonal manner (86.3%) and communication (85.4%) were found well. The score for financial aspects was found low at only 61.6%. The study also gives some insight into the services available and suggestions for further improvement in the medical care services.
Ab-12
(Pre and Post) to NABH Standards for Capacity Building
Eesha Arora
Background: The study was done at tertiary care hospital in Mumbai
with the aim to study the compliance percentage assessment &
comparison (Pre & Post) to NABH Standards for capacity building.
National Accreditation Board for Hospitals & Healthcare Providers
(NABH) is a constituent board of Quality Council of India, set up to
establish and operate accreditation programe for healthcare
organizations. Research is beginning to show that good quality also
offers practical benefits to family planning clients and programs. It was
found that P.D Hinduja National Hospital & MRC, Mumbai got its
NABH Accreditation in the year 2009 with an aim to assure the best
outcome, build seamless service, create value & satisfy with
personalized care.
Objectives: The objectives were to assess the current compliance to
NABH standards, compare the current observations with the previous
study & to identify the training topics for capacity building of the staff.
Methodology: The departments / areas were assessed based on the
customized checklist prepared for each department. Based on the total
number of checkpoints the compliance of the departments / areas is
denoted in percentage.
Findings: In general, the hospital staffs were well aware of the
responsibilities and additional policies/practices included pertaining to
their core work. However, some points do exist on which the staff needs
to develop its knowledge and make them well versed with them. These
points mainly include-the knowledge about the mission, vision and
quality system (quality organization) being followed in the hospital,
safety from the hazardous materials/chemicals being used, spill
management procedures, cardiac emergency protocols and some of the
HR policies. The analysis of the data shows that although the current
Compliance Percentage Assessment and Comparison
Keywords: NABH Standards, Capacity Building, NABH
Accreditation
percentage compliance ranges in between 94% to 100%, few sensitive
findings are noted during internal assessment e.g. narcotics storage.
Recommendations: The corrective actions towards the list of “Non
compliances” as well as “unanswered questions” to be taken by taking
the “non compliances” and “unanswered questions” as training topics
in the forthcoming training module & monitoring & evaluation of the
training program.
Ab-13
Quality Family Planning Services in Uttarakhand
Esha Kalra
Background: Quality of Care, more commonly called as QOC, is an
integral part of the family planning services. A Project ‘Model Initiative
to Ensure Quality Family Planning Services in Uttarakhand’ has been
initiated by Population Foundation of India (PFI-New Delhi) in
collaboration with one of the hospital in Dehradun with a focus on
increasing access and reach of Quality family planning services in the
project area of Dehradun and Rishikesh. It aims to provide QOC
through the existing health infrastructure viz. training centers and the
government health facilities with which the partners have collaborated.
Objective: The study was planned by the partner organizations to
capture the quality indicators set by the project as the outcome
objectives.
Methodology: The study was done by assessing four health camps
being organised under the project through observation of the facility
and the client-provider interaction process with the help of a checklist.
The client satisfaction was assessed through exit-interviews. To capture
the QOC view from the sterilization facilities and to have a feedback
from the providers, data was collected for these also. A qualitative
analysis of the data from various collection methods have been used in
this study.
Findings: The study shows that the facilities are capable and ready to
provide quality care. Few re-arrangements are needed at one of the
camps like the judicious utilization of the free space in the facility to
convert it into a separate reception and a waiting area. A separate area
Rapid Assessment of a Model Initiative to Ensure
Keywords: Family Planning Services, Uttarakhand, Quality of Care,
Rapid Assessment
8
for counseling in the camps will also lead to quality care. The
introduction of a separate counselor under the project is seen as a
blessing to the project. All the providers are found to have the required
skills from the observational checklist. But few important components
of are not properly taken care of. These are also indicated by the client
exit interviews. The Urban Health Centre is seen as having the potential
for being developed as a centre of excellence for maternal, child health
and family planning services.
Recommendations: The study suggests that bio waste-management
and handling rules, a client feedback system, and regular up gradation
of the knowledge and skills of the providers including updates on
contraceptive advances can be added in the program to achieve high
levels of QOC. It has tried to find out the gaps and the required solutions
to fill those gaps. The mid-project corrections based on the study and
the regular assessments in future will help in ensuring that quality
family planning services are given in Uttarakhand. It will fulfill the
hope that more people of the state will have Planned Parenthood. As a
future scope of the study, the present study will be a part of the literature
on Rapid Assessment of Quality in Family Planning services in India.
Ab-14
Management System in Tertiary Care Hospital
Gargi Agarwal
Background: The urgent need for the study arose in because of proposal
from the senior management to implement the performance
management system (PMS) in the hospital. The PMS process would be
adapted and customized to the organizational needs of the hospital
which would help in stabilizing the process once formulated.
Objectives: To confirm the deeming application price, to develop a
business planning framework at the hospital taken for study,
expectation of management of all the employees.
Methodology: It was a qualitative study formulated with the help of
discussions with all the stakeholders of the PMS process that would be
implemented in the hospital. The stakeholders include General
Manager, representatives from doctors, human resources, Head-
Formulation and Implementation of Performance
Keywords: Performance Management, Performance Management
System, Hospital Administration
hospital administration and resident-hospital administration.
Considering the sensitivity and the importance of the topic, the problem
analysis was conducted in a very in-depth manner. Problem analysis
was conducted in three phases – Analysis of the PMS process in the
hospital, workshop cum FGDs and survey.
Findings: The study highlights many concerns which the employees
have regarding the current PMS process. Current key result areas are
not well defined for a particular position which leads to overlap. Lack of
communication between superiors and subordinates was found. Record
of critical events pertaining to officers were not made, which leads to
improper review of performance.
Recommendation: Proposed to shift to position-based KRA’s this
would help in setting of clear expectations in each superior-subordinate
pair. Proposed a workshop methodology for goal setting. Proposed to
create a mechanism to record critical incident pertaining to officers.
People development activities are proposed to increase employee
performance motivation and engagement levels. Also many changes
are required to be incorporated in the existing PMS process to
customize it to the specific organizational needs of the hospital.
Ab-15
Garima Singh Meel
Background: The study was done to know the facilities available to
control infection at Medical ICU.
Objective: The main objectives was to study the physical facilities
available for Infection control in intensive care unit (medical –ICU) and
also the existing infection control procedures used in the MICU. The
study also identified the gaps for infection control and suggested
measures to fill those gaps.
Methodology: The research approach adopted for the study was a
descriptive method. It includes collection of information regarding
infection control procedures and its measures and also existing physical
facilities available for infection control through questionnaires,
studying relevant record maintained in MICU.
Nosocomial Infection Management
Keywords: Nosocomial Infection, Infection Management, Intensive
Care Unit
9
Findings: The physical facilities available for infection control in
MICU are satisfactory but the infection control measures practiced in
MICU is poor and needs improvements and up-gradation. When
compared to the ISIS standards, the facilities available for infection
control in MICU are satisfactory and meets . Result show that current
physical facilities available for infection control are satisfactory but the
existing infection control measures practiced in MICU are poor.
Recommendation: Strict adherence to standard infection control
procedures need to be given under consideration and existing infection
control measures in MICU needs improvement and up-gradation.
Ab-16
‘Insurance’ and ‘Bed Class’ on ‘Patient’s Hospital
Expenses’ for MRM, Amputation and Oesophagectomy
Surgeries done in a quarter.
Ginny Kaushal
Background: The study discusses the pattern of influence of the factors
on the patient bills and correlation using the Pearson’s correlation
coefficient. Controlling hospital costs is central to lowering overall
health care costs. Fortunately, there are interventions that show promise
in decreasing hospital costs without harming quality. Studies also show
a significant amount of influence of Health Insurance on patient’s
hospital expenditure. It is important to know the factors which are
affecting the cost of healthcare and if possible then reduce the cost of
healthcare by controlling the factors which affecting the patient’s
hospital expenses. Patient’s hospital expenses i.e. the patient bills were
studied in detail for three different types of surgeries namely MRM,
Amputation and Oesophagectomy and a variation of more than ±1SD
from the mean was observed. The patient records were further studied
to find details related to presence of co-morbid condition, increase post
surgical length of stay (PSLOS), Surgeon, Insurance and Bed Class.
Objective: To investigate the influence of “Post Surgical LOS”,
“Surgeon”, “Insurance” and “Bed Class”on “Patient’s Hospital
Expenses” for MRM, Amputation and Oesophagectomy Surgeries
done in a quarter.
Influence of ‘Post Surgical LOS’, ‘Surgeon’,
Keywords: Post Surgical LOS, Oespohagectomy Surgery, Hospital
Expenses
Methodology: A total of 42 cases were taken in the study. 17 Unilateral
Modified Radical Mastectomy (MRM) cases, 18 Amputation (single
toe) cases and 7 Total Oesophagectomy cases operated between 1st
November’09 to 31 January’10. Clinical information was
retrospectively obtained from the OT database and medical records of
the patients
Findings: In addition to variation by patient co-morbidities and
procedure, findings show that the patient’s hospital expenses vary with
PSLOS, Bed Class, Surgeon and Insurance.
Ab-17
Multi Super Specialty Hospital
Heena Kausar
Background: Health care is becoming transparent and customer
focused. Patients and their relatives have the right to know the standard
of care and its cost. It is therefore becoming more and more mandatory
for the institution to monitor quality indicators/parameters and
compare their performance level with the national standard or
international bench marks. By monitoring operational efficiency and
further providing feedback based on indicator data can be effective in
changing health care professional practice.
Objective: The objective of this report is to measure the operational
efficiency of the hospital, as per set standards and to find out the gaps in
input/process/outcome for enhancing the overall quality of system.
Methodology: This operational efficiency study is retrospective -
prospective analytical study. The study is based on primary data.
Findings: The main outcome of this study is that although hospital is
following all the quality indicators still there is potential of
improvement. For example in initial nursing assessment (within 30
minutes) of inpatients comparative trend is higher from Feb. to March
i.e. 84% compliance to 92%. Initial assessment by consultant within 24
hrs there is initially only 62.7% cases received assessment within 24 hrs
which increased to 85.7% later on. In needle stick injury indicated only
one nurse suffered needle stick injury in the whole study period. Nurse
Measuring Operational Efficiency of 210 Beded
Keywords: 210 Bedded Hospital, Multi Super Specialty Hospital,
Operational Efficiency
10
patient ratio is 1:4 which is sufficient for providing quality nursing care
but in ICU it is not as per the standards which should be 1:1. The cases
of redoes which was 1.96% in the month of January falls to 1.58% in
Feb, which is an appreciable outcome but on the contrary the same has
risen up in march to 1.66%, though still less than Jan redoes. Records
without nursing care is also declining from Jan i.e. 25% to march i.e.
14.1%.
Recommendations: Suggested to have regular meeting with staff,
proper distribution of work between all the staff, negligence part should
to be looked upon by continuous monitoring, only personnel with
required qualification should be appointed, continuous training and
proper communication for staff should be there. Clarity of authority &
responsibility at all the level should be there to minimize gaps.
Ab-18
System for TPA Department
Indu Dhangar
Objective: This project is envisaged to enhance the productivity and
improvement in the operational efficiency of the functions routinely
performed in TPA department and reducing the time lag for getting
information to take key decisions.
Methodology: Implementation of HIS was done in six phases and the
method of data collection was observational and discussion with end
users. Total expenditure on health in India is nearly 6% of the entire
GDP. Indian health insurance industry stands at INR 5,125 crores with
only a small section of the total population (around 2%) covered so far.
CAGR of this sector is around 35% (FY 2002 – 08). This shows that the
health insurance industry is one of the largest and fastest growing of all
human activities. This huge growth has led to the development of a
number of third party administrators to manage the client base.
Currently there is 36 TPA’s working for different insurance companies.
Findings: CFS is in the panel of 31 TPA’s and thus it can serve most of
the insured patients. As the number of TPAs and PSUs that are in the
panel of CFS is large, keeping a track of all the cases, payments and
outstanding bills is very important to maintain the financial integrity of
Construction and Implementation of Information
Keywords: TPA Department, Information System, Hospital
Information System
the organization. The hospital is already having a hospital information
system (HIS) package that starts by the word 'i-care.' the HIS caters to
the front office operations like appointment ,IP and OP billing,
registration, pharmacy, examination, etc. However, back office
operations like procurement, accounts payable, accounts receivables,
TPA receivables and outstanding payments etc. could not be carried out
through the HIS and documents related to these processes exist in
independent files and folders on a shared documentation basis in the
back office systems. The lack of automation for these processes and the
'disconnect' with HIS lead to delays in monthly stock reconciliation,
financial status information, profitability analysis and cost center
accounting.
Recommendation: The need of the hour is streamlining of all the
hospital activities related to the interaction with TPA vis pre-
authorization, query reply, approval status, claim settlement, TPA
receivables and outstanding reconciliation. In this study , work is done
mainly on time saving activities for getting the approval, enlightening
the patients about their roles and responsibilities related to Cashless
hospitalization and introduction of information system in order to
improve the process of tracking financial data , its storage , retrieval and
reconciliation..
Ab-19
Jitendra Kumar Hayaran
Background: The study was conceived to assess the overall utilization
of the OT and also the type of surgeries for which it is being utilized at
Sola Hospital. The operation theatre complex of a hospital represents
an area of considerable expenditure in a hospital budget and requires
maximal utilization to ensure optimum cost-benefit. There is paucity of
data in India on the use of available operating time and the reasons for
less than optimal utilization have not been studied. In order to improve
the utilization of operating room it is essential to know how much time
is spent on each of the activities. Since Sola hospital has acquired pre
accreditation certification from NABH, it has relatively become a
centre of high activity.
Time Utilization of Operation Department
Keywords: Operation Department, Time Utilization, OT, NABH
Standards
11
Objectives: The objective of the study deals with to assess the overall
utilization of operation theaters in terms of hours to assess the extent to
which different departments are utilizing the allocated hours and to
identify the proportion of (unplanned or planned) of surgeries.
Methodology: This study is a descriptive in nature. Data was collected
from various sources.
Findings: It was found that highest number of unplanned surgeries
occurred in the department of orthopedics (48.57%) followed by
general surgery (28.57%). In three months 689 hours were utilized for
O.T. surgeries (Planned + Unplanned) & 511 hours were left unutilized.
Orthopedic was identified as a department where highest “no. of hours
wasted” for O.T. utilization was observed (216 hours un utilized in
comparison to only 144 hours utilized in 3 months); followed by
general surgery 189 hours unutilized in comparison to only 27 hours
utilized in 3 months. Orthopedic was identified as a department where
highest “no. of hours wasted” for O.T. utilization was observed (216
hours unutilized in comparison to only 144 hours utilized in 3 months);
followed by general surgery 189 hours un utilized in comparison to only
27 hours utilized in 3 months. In General Hospital, utilization of theater
shows that scope of operative services is wide but utilization in various
specialty shows that the distribution is not appropriate. While for some
specialties, the O.T. utilization is satisfactory, for others, it is far below
the expected level.
Ab-20
Standards
Jyoti Ahuja
Objective: The study was done to identify the gaps present in the
hospital to achieve NABH through the reference book of standards
given by NABH. An analysis tool have been developed which carries
the relevance of standard to the departments present in the hospital.
Later on grading was done according to NABH guidelines. The gaps
were communicated in the recommendations. This assessment focuses
on finding the gaps present in manpower available, equipments,
structural designs and statutory requirements as per the IPHS Standards
Internal Assessment of Hospital as per NABH
Keywords: Operation Department, Time Utilization, OT, NABH
Standards
and NABH guidelines; and suggests the ways to fulfill the gaps
Findings: An internal assessment report is necessarily a document,
which evolves as per circumstantial requirement of the organization
and to know scope of activities required to meet standards to achieve
NABH Accreditation status. It is necessary to review this report on
regular basis. This assessment is important as it guides the organization
to check the progress and success of the initiatives taken to fulfill these
gaps. The hospital can further plan its proceedings within the time
frame based on the analysis.
Recommendations: Government of Gujarat is very keen on getting the
NABH accreditation for district hospitals and medical colleges, so it
becomes necessary for the hospital to review its status on regular basis.
The hospital can focus on the areas where the gaps are more in
importance or in number and move ahead for the achieving the
accreditation status.
Ab-21
at an Eye Hospital
Kanwalpreet Grewal
Background: In hospitals, the supply chain is a key strategic activity to
generate profits by optimum utilization of resources, efficient
inventory control and cost containment models.
Objective: The objective of the study was to assess whether the
existing practices at the central store of the eye hospital at New Delhi,
meets the standards and to find the scope of improvement. Discussion
with the staff and the higher authorities led to a conclusion of need of
standardizing processes at the centre.
Methodology: The study design evaluates the primary and secondary
data collected from the centre. The central store department was
observed, had interview and informal talks with the department staff.
Findings: The hospital had processes in place but was not standardized.
There was a frequent problem of stock out and emergency requisition
orders from the entire peripheral centre, this lead to imbalance in the
stock in hand in the central store. This also led to frequent order
Benchmarking of Inventory and Stores Department
Keywords: Inventory Department, Store Department, Inventory
Control, Benchmarking
time is under/over producing by comparing ‘take time’ with mean cycle
time.
Methodology: This is an analytical study and the area of study selected
were -basic, comprehensive regular, comprehensive plus, special
regular, special ultra and premium. The Data collection tool used was
simple format consisting of in time and out time for each step of the
health checkups used to collect data for time analysis. The sample size
for the study was 100. (50 males and 50 females). Selection was based
on the percentage of health checkups frequencies for the period January
2009-December 2009. The sampling method is stratified random
sampling SIPOC, SWOT analysis, time analysis, vital defect analysis,
report delivery analysis and take time analysis was used to analyze the
data.
Findings: The special ultra and basic packages found to have the
maximum waiting time of 47 mins and the mean cycle time for basic
and comprehensive regular packages are similar at 85 and 86 mins
respectively (From Figure 4). However, their turn around time is 240
and 540 mins respectively. The only additions to basic are a
surgeon/gynaecologist consultation and a second physician
consultation 2 with reports. Special ultra, basic, premium female have
the maximum Waiting time beyond stated end time at 47, 36 and 31
minutes respectively. Premium male and comprehensive plus packages
also have a waiting time beyond stated end time, but to a lesser extent at
20 and 2 minutes respectively. Comprehensive regular and
comprehensive plus have the least percentage of cycle time to turn
around time ratio. This means these customers are idle for a larger
proportion of time, 83% and 73% respectively, with respect to the other
packages, which average 64%. The major defects in each of the
packages are the consultation with doctors like the physician
consultation (pre and post checkup), surgeon, gynecologist,
ophthalmologist, ears-nose throat consultations. The non compliance
of medical report turn around time is lowest for mammography and
sonography at 40 and 74.42 percent. The mean cycle time is greater than
takt time by 14,9.77,8.5,8.5,6.46 and 3.08 minutes for Ultrasound 14,
Ophthalmology consultation, Ears Nose Throat consultation,
pulmonary function test, Chest X-ray and ECG respectively.
Recommendations: There are a number of changes that can be made,
using the same resources available to reduce customer turn around time
and thus accommodate more health checkups. Implementing these
changes, will result in a decreased customer turn around time, and
12
placements. A set of safety stock for the hospital was calculated, by
analyzing the secondary data of a quarter year of the purchase order
master list maintained by the department. A sheet with the quantity of
safety stock for every item stored in the central store was prepared. The
safety stock is prepared both months wise as well as weekly.
Recommendation: To counter the problem of standardization and
stock outs, a policy as well as standard operating procedures for the
hospital was prepared. The results of the calculation of safety stock
were observed to be less in quantity; the reason was analyzed to be very
less lead time. This was because vendors shared a good relation with the
organization and gave timely delivery of the order. The standard
operating procedures as well as the policy is turned into the stores
manual, and serves as the guidelines for the staff as well and
management for strategic decisions. The safety stock lead to the fall in
stock out level, and there was a proper stock for emergency requisitions.
It also saved the cost of logistics for small quantity of material
Ab-22
Operational Efficiency in Health Check-up
Department
Karan P. Mansukhani
Background: A health checkup is a multi step process involving
various tests/ investigations/ consultations, and is dependant on various
departments for its completion. Lean principles are a set of tools which
assist in diagnosing and rectifying bottlenecks. Thus, if implemented
will increase operational efficiency of the department. This study was
done to improve operational efficiency in the Health Checkup
department, P.D. Hinduja Hospital and Medical Research Centre,
Mumbai.
Objectives: To map the health checkup customer, staff and information
flow. To conduct SWOT analysis of the health check up department. To
compare health checkup cycle time, Interval time, waiting time and turn
around time for each package. To isolate the critical defects/delays of
each health checkup package. To identify the medical reports those
have a low compliance of ‘complete and accurate’ reports for health
checkup executive. To identify activities where mean activity cycle
Application of Lean Principles to Improve
Keywords: Health Check-Up Department, Operational Efficiency,
Lean Principles, SWOT Analysis
13
enable department to accommodate a larger number of health checkups.
The recommendations that are an output of this study categorized in the
following categories i) Reduce turn around time, ii) System, iii)
Infrastructure, iv) Poka yoke/ mistake proofing.
Ab-23
Speciality Hospital, Gurgaon
Komal Jeet
Background and The study were carried at a multi speciality hospital
situated in Gurgaon. The Hospital pharmacy was five months old. The
purchase department purchases the medicines as per the requirement.
So, there is need to streamline the procurement by proper inventory
control and to reduce the shortage and delay in supply. For purchase of
drugs it is very essential to know the consumption of drugs on the basis
of value and volume as well as criticality. This will help in bulk
discounts as well help in getting supplies on time.
Objectives: The main objective of the study was to categorize all the
drugs available in pharmacy on value and volume basis as well
criticality. This was done efficiently by doing inventory analysis of the
pharmacy.
Methodology: The organization wants the categorization of drugs on
value and criticality bases, ABC-VED matrix was found appropriate
method for the inventory control.
Findings: The five month consumption of all the drugs was calculated
after multiplying unit cost by consumption and resulting figures were
arranged in descending order. The drugs then classified in to A B C
categories according to total cost consumed 70 %, 20 %, and 10 %. For
VED analysis, the entire drugs list was distributed to a panel of five
medical personnel comprising physician, surgeon, anaesthetist,
paediatrician and Head of Nursing Department.
Recommendation: They were asked to classify the drugs into vital,
essential and desirable. The drugs were categorised if more than 50 %
members of panel concurred.The data was coupled into an ABC and
VED matrix resulting in drug categorisation of Category I, II, and III.
Inventory Classification of Medicines at Multi
Keywords: Inventory Classification, Inventory Control of Medicines,
ABC Analysis, VED Analysis
Ab-24
Kunal Jawahar Thakkar
Background: In every organization, there is an opportunity to improve the quality and performance of the healthcare delivery. The problem frequently faced by organizations today is to know which quality approaches – complemented by and integrated with existent quality improvement systems – would have the greatest impact on the outcomes delivered by their healthcare providing systems.
Objectives: This study done at super specialty hospital provides organizations with an opportunity to strategize accreditation processes with a time tested approach. The hospital was going towards achieving NABH accreditation, as a first step towards it, with the question that “does the hospital fully compliant to NABH standards?” and with the objective of bringing a basic quality approach towards accreditation, this study on PDCA approach to accreditation was done.
Methodology & Findings: With scoring the hospital in comparison with standards as 0/5/10 and checking them as in which step of PDCA are the objective elements; it was found that the current status of operations at the hospital is about 70 percent compliant to NABH standards and out of 479 applicable objective elements, only 293 have completed their PDCA cycle of improvement. Percentage compliance and requisites for compliance to standards were found out for all the objective elements. Chapter HIC – hospital infection control among the patient centric standards and chapter CQI – continuous quality control among the organization centric standards were with the lowest scores.
Recommendation: The study revealed areas that need special focus and all the requisites to achieve NABH accreditation. It was emphasized and proved that accreditation is not mere buzzword but an extraordinary tool for health care institutions to improve their services. Application of PDCA approach to Accreditation is the right way for hospitals to trudge the path of quality healthcare provisioning.
Ab-25 Improving the operational efficiency by assessing quality indicators
Meetu Garg
PDCA Approach to Accreditation
Keywords: Health Care Delivery, NABH Standards, PDCA
Keywords: Quality Improvement, Employee Rights, Operational Efficiency
14
Objective: The main objective of this study was to identify area of
improvement and develop recommendation in coordination with
organization for strengthening and improving the quality of system.
Methodology: Both primary and secondary data was collected for the
study. For this purpose patient records audited, exit interviews of
staff(HR) was done, employee (HR)and inpatient feedback forms
were filled up.
Findings: The number of patients receiving initial assessment was 20%
in January which was risen upto 48% in March. In January the number
of patients receiving intitial assessment by doctors in one hour was 12%
which was risen upto 36% in March. Initial assessment by the dietician
hiked to 40% in march –regular status of the patient to be discharged
was also informed to the dietician. Hike in the percentage of operations
in month of March which was 34 out of 145 in total compared to 15 out
of 104 in jan and 15 out of 123 in feb.
Recommendation: It is recommended that proper inventory levels to
be maintained as per requirement. Regular awareness programmes
should be started for information related to employee rights and
responsibility.
Ab-26
Discharge and Transfer in a Tertiary Care Hospital
Megha Ahuja
India’s healthcare infrastructure has not kept pace with the economy’s
growth. The physical infrastructure is woefully inadequate to meet
today’s healthcare demands, much less tomorrows. While India has
several centres of excellence in healthcare delivery, these facilities are
limited in their ability to drive healthcare standards because of the poor
condition of the infrastructure in the vast majority of the country.
The total healthcare financing by the public sector is dwarfed by private
sector spending. In 2003, fee-charging private companies accounted for
82% of India’s $30.5 billion expenditure on healthcare. This is an
extremely high proportion by international standards. Private firms are
now thought to provide about 60% of all outpatient care in India and as
much as 40% of all in-patient care. It is estimated that nearly 70% of all
Business Process Re-engineering of Admission,
Keywords: Healthcare Infrastructure, Re-engineering of Admission,
Discharge
hospitals and 40% of hospital beds in the country are in the private
sector.
The healthcare industry faces a lot of challenges in todays world,
competition everywhere has ot left the hospitals untouched. The
hospitals strive for excellence and deliver their best to be at the top.
That’s where a BPR comes into the picture. Bpr revamps he process and
gives the process a new face which if not the best is the ideal in the
induatry with best practices an maximum patient friendly.
When hospitals put in the money the return on investments is a natural
phenomena and that’s wht the hospitals are expecting, a bpr should give
the hospital processes a boostup and help it come to a place where the
patients are benefitted the maximum and the working takes minimum
time with maximum efficiency.
Ab-27
Norms in a General Hospital, Gujarat
Namrata
Objective: The gap analysis of the General Hospital as per NABH
norms was done to assess the existing status of the hospital and prepare
it for NABH accreditation. As Government of Gujarat is very keen on
getting the NABH accreditation for district hospitals and medical
colleges, so it becomes necessary for the hospital to review its status on
regular basis. The hospital can focus on the areas where the gaps are
more in importance or in number and move ahead for the achieving the
accreditation status.
Methodology: The gap analysis was done with the help of NABH Self
Assessment Toolkit which comprised of 10 chapters, 100 standards and
514 objective elements. For getting the required data the various
activities in the hospital were observed, policy manuals and records
were referred and patients and hospital staff were interviewed.
According to the toolkit the documentation and implementation of each
objective element was checked and scores were given according to
NABH guidelines.
Findings: The study shows the findings of the existing status of the
hospital according to each chapter and average scores for all the
Gap Analysis of General Hospital as per NABH
Keywords: Gap Analysis, NABH Norms, NABH Accreditation,
General Hospital
15
standards and chapters. These were checked against the evaluation
criteria for accreditation. The study focuses on the gaps according to the
evaluation criteria for accreditation and suggests ways to fulfill the
gaps. The analysis shows that there are some gaps in the hospital as per
NABH norms. Mainly the gaps were in the chapters of management of
medication, quality management and information management system.
The hospital fulfills the required criteria partially and requires great
efforts and focus on the weak points so as to cover the gaps and to be
prepared for getting NABH accreditation.
Ab-28
A Comparative Study of Indoor Patients in Different
Wards
Nancy Gupta
Background: Many hospitals use lengthy surveys collected when the
patients discharge to better understand the quality of their own care. The
response rates for these surveys are generally good compared with
many other types of surveys. Understanding the implications of the
survey data can lead to new strategies that increase demand for services
in part by reducing inappropriate instances when patients leave the
system. The aim of the study is to compare the satisfaction level of
patients admitted in surgical ward, medical ward, orthopedics ward and
gynec ward at tertiary care general hospital of Gujarat:
Objective: The study is to provide a systematic and visible way to lead
and operate an organization working to improve performance by
patient feedback. Secondly was to measure the satisfaction level of the
patient getting treatment from the hospital and to work effectively on
the quality improvement procedure.
Methodology: The methodology which is used in study is cross
sectional and observational. Close ended questionnaire is used as a tool
for data collection and findings are elucidated with the help of graphical
representation.
Findings: Satisfaction level of the patients was highest in maternity
ward and least in surgical ward. Most of the patients were satisfied with
the Accessibility of the services and waiting time for registration.
Maternity ward scored highest that is 65% and 69% full satisfaction
Patient Satisfaction with Quality of Care:
Keywords: Patient Satisfaction, Quality of Care, Indore Patients
respectively in accessibility and safety and high quality coordinated
care .Orthopedic ward scored highest (77% of the patient fully satisfied
)in building relationship whereas in area of cleanliness, security and
nutrition all four ward showed high dissatisfaction .Patient
dissatisfaction was mostly due to .1)security service.2) accuracy of
diagnostic and imaging facility of the hospital .3) unhygienic condition
in the ward.4) summer temperature of the wards were rising high
specially surgical and orthopedics ward.5)drinking water facility.6)
privacy during stay and treatment in female wards patients.
Recommendation: Portable X ray machine in orthopedics ward.24hrs
pharmacy for IPD .Medication and treatment should be fully explained
to patients. In maternity ward privacy should be maintain for the
female. Appropriate airing should be done in wards. Frequent Mopping
& periodic washing of hospital Wards specially Surgical & Maternity
Ward. Periodic Medical Examination of cook's & Food handlers &
Surveillances. A grievance letter box/register should be made available
for the patients.
Ab-29
Record Documentation in accordance with NABH
Guidelines
Natasha Ahmad
Objective: The main objective of this study was to study medical
record department of the hospital, to audit manual according to the
NABH standards and to highlight major observations to recommend
implementable solutions.
Methodology: To enumerate various types of forms in use in ward
areas, OPD, different clinical department and laboratories a survey was
done using Checklist – keeping in mind the various quality standards,
checklist was prepared and filled by the data gathered, Interviewing the
doctors and nursing staff and the direct observation of the functioning
of various departments. 130 records were audited for the purpose of
assessing medical records for proper documentation. Medical Records
of 15 specialties were taken for the purpose of audit. Out of the 347 in
patients records 130 were picked up (38%). Data analyzed using
Microsoft excel.
Assessment of Adherence to Protocol in Medical
Keywords: Medical Record, NABH Guidelines, Audit Manual
16
Findings: It was found that many medical records were not sufficiently
well documented to provide adequate evidence of continuity of care. It
was found that in the 4 various parameters assigned Admission request
form, Doctors initial evaluation form, condition of the discharge time
mentioned and birth certificate matter comes into the poor segment,
whereas Elements in medical records and patients’ daily progress
comes into the excellent parameter.
Recommendation: The study needs further exploration as to identify
the gaps in process flow department wise. For the same reasons the
forms should be redesigned and redundant columns should be done
away with. MR contents for discharged patients should be arranged
prior to filing. And qualitative analysis of MR contents should be done
a regular basis to monitor completeness of information. It is
recommended that entries be recorded as closely as possible to the time
of the encounter, when the detail is most fresh in the physician’s mind.
This will allow physicians to deep records that are detailed, accurate
and comprehensive.
Ab-30
in a Tertiary Care Hospital
Neha Agarwal
Objective: the main objective was to include the Gap analysis of the
HR department in a tertiary care hospital in accordance with the NABH
Sstandards, performance appraisal of the nursing staff and feedback
analysis of the trainings done with adequate statistical evidence.
Methodology: This descriptive study was carried out using NABH
check list to do the Gap Analysis of the HR department and a feedback
questionnaire was used to do the feedback analysis
Findings: Only two training sessions out of the nine which were
conducted got good towards excellence ratings in the course content
and the training environment while the other training sessions were
rated average on same parameter. This implies that the course content
was not stimulating enough to develop the interest of the trainees; also
the temperature of the room was high making it difficult for the trainees
to concentrate. About 90% of the training sessions have got good and
Implementation of Performance Appraisal System
Keywords: Performance Appraisal, Gap Analysis, NABH Standards,
Appraisal System
excellent ratings in terms of the facilitator and the training given
showing that the trainers had excellent communication skills, they
explained the subject very well, answered questions to the trainees’
satisfaction, provided summary of the major points. The trainees have
given the training sessions a higher priority revealing the fact that they
are enthusiastic to learn and update their knowledge. Overall a positive
feedback has been received for the training sessions conducted for the
nursing staff.
Recommendations: More practice sessions have to be organized for
the HIS (Hospital Information system) Trainees. The training
environment needs to be improved making it comfortable for the
trainees to concentrate and learn. Time duration of the session has to be
increased and the pace at which the trainer delivers should be
decreased. Demonstration and orientation through videos and pictures
can be included for making the trainings more interesting to learn.
Ab-31 Study on Community Perception about a District
Hospital in Relation to IPHS Norms
Neha Awasthi
Background: A concern for patient satisfaction has been taken up by
many health care authorities worldwide with the aim of responding to
the client’s needs when addressing the issue of quality improvements in
public health care services. Standards are developed with intentions of
assuring quality services. Therefore, National Rural Health Mission has
provided the opportunity to set IPHS for various health institutions.
Objective: This study (dissertation) was designed to examine how the
consumers of services of secondary health care at District hospital, at
Jodhpur viewed their health-seeking experience, and this was
correlated with organizational aspects as well as the community
perceptions of the same. This study sought to understand community
perception; assess clients’ satisfaction and the facility survey against
IPHS norms.
Methedology: This is a descriptive study, conducted during 19
February, 2010 to 5 May, 2010. Methods of data collection employed
were schedules and collection through observation and by conducting
interviews. Study was conducted undertaken at the hospital and
Keywords: Community Perception, District Health, IPHS Norms,
NRHM
17
includes an area covered by four anganwadi centres.
Findings: In this area 80 percent of women who rely upon public health
sector for the child birth do not come to the hospital, 48 percent of
women do not know about the location of this hospital. Most women
who attended the hospital for came because trusted an employee who
was a relative and not because of the services of the hospital. Half of the
clients rated the hospital good,( 3 in scale of 1 to 5, where 1 is poor and 5
is excellent), 59 percent clients said that they visit this hospital for mall
ailments and two third (67 Percent) accepted that they would not like to
get admit in the hospital. Overall Hospital only complies with 17
percent of the IPHS norms. This data analysis depicts the discrepancy
between expectation of services from hospital and actual delivery of
services.
Recommendation: To improve the facility as per community
perception and IPHS norms it was recommended that a government
organization cannot develop at facility level itself. There several areas
where State and district level interventions are required.
Ab-32 Need and Location Identification of Dialysis Units in
Delhi Under PPP Framework
Neha Garg
Background: Delhi is the healthcare hub for a geographically large and
populated catchment area comprising of J&K, Punjab, Haryana, UP,
Bihar, MP and Rajasthan. Given the state’s current population it is
estimated that 3,000 patients are diagnosed with ESRD every year. Also
the expenditure of a dialysis patient in private facilities is significantly
high i.e Rs.20000 per month and there is inadequate facility in
government centres. Thereby this issue need to be addressed and PPP
framework has been found the most suitable option for the same.
Objective: The aim of the study was to assess the need and location
identification for setting up of dialysis units in Delhi under PPP
framework. The study was both quantitative and qualitative for finding
the number and location of dialysis units. The data was collected
through primary interactions with doctors, suppliers and government
hospitals.
Methodology: Primary data collection was done through detailed
questionnaire. Hence the demand supply study was done by collecting
Keywords: Dialysis Unit, PPP Framework, Dialysis Patients
both secondary and primary data. After finding a significant demand the
methodology for the referral and satellite centers was formulated by
visiting different Delhi government hospitals and getting information
of services provided there. Private center’s dialysis prices and volumes
were found and thereby provision to charge nominal fee was designed
so that maximum people can afford the services. This project helped to
understand patient behavior by primaries with various doctors.
Findings: It was found that here are only 500 machines in Delhi with
only 24 in government setup. If machines in centrally funded hospitals
and centres operated by quasi-government organisations also include
then also it accounts for only 60-70 machines. This means only the high
income category can afford treatment in private centres while a large
section of the middle and low income population does not have the
access to avail dialysis services. Thus there is a gap of around 600
machines facilities should be provided at least for sec A, B and C
population strata for which around 750 – 900 machines are required.
Thereby in the 1st phase government should look at the provision of
around 250 more machines. 25 government hospitals were visited and
were segmented based on presence of critical care and dialysis facility.
Based on this segmentation 13 – 19 hospitals were identified where
machines can be placed and also 3 clusters were formed to address the
issue of transportation which is significant for a dialysis patient as he
has to come 3 times a week for dialysis sessions. 3 – 4 hospitals were
identified in each cluster out of which one or two can be developed as
referral centres and in the rest of centres relatively fewer machines can
be placed.
Recommendation: It is recommended that there is need for setting up
more machines in Delhi and the government should look at the
provision of 250 to 300 additional dialysis beds to augment existing
supply of services.
Ab-33
Hospital, Rajkot
Nehashree
Background: The state of Gujarat has been regarded as one of the best
Study on Patient Care Quality Standards at General
Keywords: Patient Care, Quality Standards, General Hospital, TQM,
NABH Standards
18
performing state in India on various economic and health parameters. However, Gujarat health care system faced lack of adequate standards in public health services. With the effort to improve the quality of healthcare delivery, the GoG adopted Total Quality Management (TQM) system in 2007 to strengthen medical institutions as per NABH and NABL standards in three phases. General Hospital in District Rajkot was covered under the third phase of NABH implementation.
Objective: The present study is aimed to assess the health care service delivery the hospital against patient centric standards of NABH. The study assessed the current level of performance as per standards, identified the gaps and proposed recommendations. Few of the recommendations were implemented in the hospital under quality improvement programs.
Methodology: The study was conducted in General Hospital, Rajkot. All the staffs from the clinical departments, wards were questioned about the standards. The staff from support services like laboratory and radiology and utility services like house-keeping were also involved. The assessment of the hospital was conducted by using the self-assessment toolkit provided on NABH website. The toolkit was modified according to the study requirement. To fill the toolkit, the data was collected through primary as well as secondary sources.
Findings: The study showed that the hospital scored well on standards related to management of medication and was poorly compliant to standards for hospital infection control. Out of the total applicable objective elements hospital compliance was 43.9 percent, partial compliance was 20.8 percent and non-compliance was 35.3 percent. Overall the hospital was found to be 56.4 percent compliant to NABH patient centric standards. As per the results, quality improvement programs were initiated like signage system, training regarding basic life support, biomedical waste management, proposing hospital committees, hand washing practices, vaccination to employees etc.
Recommendation: Any journey starts with a single step and Quality Improvement Programs (QIPs) for these vital areas was the first step taken towards the journey of quality improvement in patient care services and achieving NABH accreditation.
Ab-34India
Nisha Kadyan
Study on Roles and Perspective of Nurses in CCC in
Keywords: Role of Nurses, Community Care Centers
Background: Community Care Centers (CCC) are the focal points to
provide short term institutional care to PLHA and Nurses play a central
role in delivering the care to PLHIV at CCC. Since the inception of
CCC is rather new and India, being the first of its kind to provide this
niche level of service in the service providers’ domain, it is essential to
understand the provision of care and support from the service
providers’ perspective.
Objective: The present study is an attempt to understand the Nurses
roles and perspectives, their responsibilities, their job satisfaction and
problems they face while working at CCC.
Methodology: In the CCC assessment, a sampling frame of all the
CCCs was prepared and out of 270 functional CCCs, 199 CCCs which
have been functioning for at least one year as on November 30, 2008
were included in the study. From each selected CCCs, the nurse with
maximum working experience was included in the study sample. A total
of 199 Nurses working in CCC across the India were interviewed using
semi-structured questionnaire. The data was analyzed using SPSS 16.
Findings: The results highlighted that the nurses were aware of their
roles and responsibilities and were also performing the same. To
effectively meet the needs of those living with the infection, nurses
have assumed multiple responsibilities in HIV care and treatment in the
resource restricted environment of CCC. They mentioned lack of
adequate infrastructure, lack of human resources and lack of proper
training as the main problems because of which they were not able to
give their best. Study recommends that the weak areas like Shortage of
manpower, staff training and infrastructure require attention not only to
achieve the targets quantitatively but also to improve the services
qualitatively.
Ab-35
Enhancing the Preparedness for NABH
Accreditation
Payal Ahuja
Objective: The study was to monitor the “OPD Waiting Time” so as to
know the patient flow in the hospital and to monitor the time from the
Registration to the consultation. Also this project was a major help in
data collection of monitoring for the NABH as this organization has
Bridging the Gaps in the HIC Chapter of NABH
Keywords: NABH Accreditation, OPD Waiting Time, HIC Chapter
19
already applied for NABH Pre Assessment. This project help in
monitoring the patient flow in the hospital as well as bringing out the
flaws in the process.
Methodology: The project was done in all the 11 OPDs. Total 20
patients were monitored and time lapse between the “times of
registration” till the “time of consultation” was seen and the causes of
deviations were observed in various OPDs. OPD waiting time analysis
is a comparative qualitative and observational study. The checklist were
filled in person targeting the high risk areas of the hospital and the
inpatient areas in which all the metrics of hand washing, needle stick
injury, biomedical waste management, linen management, surgical site
infection were covered.
Findings: Result of the above analysis suggested that only 50 %
standards of HIC of NABH were fully complied. Rest 50% of the work
is needed to be done in the other areas of the hospital. It was seen that
the compliance rate for the HIC chapter was relatively low than other
chapters of the NABH.
Recommendations : Recommendations were suggested and report
was submitted to the Chapter Head for the improvement. Major
learning was understanding of the standards their scoring and
implementation in an organization.
Ab-36
Hospital, Palanpur against N.A.B.L. Standards
Pooja Aggarwal
Background: A laboratory is a facility that supports patient care by
providing diagnostic & management information to the care giver. Its
ultimate goal is to provide accurate & timely results for diagnosis,
treatment & monitoring of ailing patients. Because of the increased
dependence of clinical services on the diagnostic procedures, a large
number of laboratories have started going for national and international
accreditations.
Objective: This report presents a research on the assessment of the
laboratory services, at general hospital, Palanpur, against the national
accreditation board for calibration and testing laboratories standards.
Assessment of Laboratory Services, at General
Keywords: Laboratory Services, General Hospital, Facility
Management, NABH Standards
The main aim of carrying out this research is to check the compliance of
laboratory services with NABL standards, so that a comprehensive
quality management system can be established.
Methodology: An observational and descriptive study was carried out
for a period of three months to explore the topic with the help of both
primary and secondary data.
Findings: The study revealed many interesting facts like the shortage
of manpower, poor conditions of the equipments, need for calibration,
AMC/CMC, lack of inter departmental and intradepartmental
coordination, faulty government policies regarding procurement and
maintenance of equipments, poor infrastructure and need of SOP
formulation.
Recommendations: Based on findings and address the objectives of
the study recommendations were made. It can be summarized that this
report proved to be a helpful tool in analyzing the gaps in the laboratory
service delivery. The results of the report will be useful in establishing a
well implemented and monitored quality management system that
generates services with elements of both patient safety and employee
safety. This will help in making the laboratory services error free and on
time.
Ab-37
hospital at Rajkot
Prabhat Govindan
Background: Proper planning is a key ingredient in starting a new
project as well as ramping up services and facility from one phase to
another. This study was conducted to analyze the gap in terms of two
key essential ingredients are manpower, and medical equipments.
Objective: The general objective of this study was to assess the gap that
exists and need to be fulfilled in terms of manpower and equipments, in
order to ramp up form stage 1 to stage 2 of the hospital services. Specific
objectives include equipment planning, manpower planning and setting
up timelines for completion of the ramp up.
Methodology: This was analyzed through a gap analysis done by mapping the existing equipments available and establishing the actual
Gap Analysis for Phase II Expansion in tertiary care
Keywords: Gap Analysis, Tertiary Care Hospital, Hospital Planning;
Equipment Planning
20
requirement as per the standard ratios used by the equipment planners.
Findings: It was seen that there is a major requirement in the form of syringe pumps, around sixty is required and patient monitors, twenty, ten ventilators and five each of defibrillators, pulse oxymeters and ECG machines. These are the basic equipments which are required to operationalize and admit patients in ward and ICU. In case of equipments, it was also found that additional equipments in the form of Patient monitors, ventilators, pulse oxymeters, defibrillators, syringe pumps, ECG machine need to be accounted for. In case of manpower it was seen that an additional number of specialists, doctors and nurses will be required to be recruited in order to push off the Phase II plans. Along with it the timelines for acquiring the additional task force and equipments were worked and displayed in the form of Gantt Charts, with task numbered in the order of priority.
Recommendations: It was seen that the recruitment process, can be completed in about four to six weeks, and the equipment purchase process will take about 8 weeks, hence once can start rolling the beds in two months or eight weeks time.
Ab-38Staff Regarding Biomedical Waste Management at Government Hospital, Jaipur
Priyanka Maan
Background: Despite the statutory provision of biomedical waste management, practice in Indian Hospitals has not achieved the desired standard even after so many years of enforcement of the law. In view of this, the present study on Knowledge, Attitude and Practice (KAP) on the subject was carried out in. Govt. Hospital, Jaipur The hospital under scrutiny for KAP is a 100 bedded hospital with all general specialties. The hospital has a work force of 30 doctors, 80 nursing, support and paramedical staff.
Objective: The objective of this study is to assess the knowledge, attitude and practice among the staff members by classifying them into categories of doctors, nurses, OT staff, technicians and sanitary workers.
Methodology: The study is based on a questionnaire designed to
Knowledge Attitude Practice (KAP) Among the
Keywords: Knowledge Attitude Practice, KAP, Biomedical Waste, Waste Management
understand the KAP of the staff involved in direct patient care facility
regarding the biomedical waste management practices.110
questionnaire were distributed out of which 89 were received back.
Findings: The study has shown a definite apathy of intellectuals
towards the operational aspects of the system. The medical
professionals have tubular vision on patient care services and pay very
little heed to support services in the overall context of comprehensive
patient welfare. Doctors are high on attitude and understanding of the
system with sound knowledge but need to improve on their practice
habits. OT staff and technicians also have understanding of the subject
but more attitudes to be developed in these functionaries. Practice
habits of nurses have large scope to improve. Sanitary staff is a matter of
concern as they have very low understanding of the subject and
resulting in poor practice habits.
Recommendations: In the field of medical practice statutory public
health guidelines for BMWM and close monitoring of its compliance
alone cannot achieve the ultimate goal, if it is not accompanied with
social science approach of mass education, motivation, training and
changes of mind set in all strata of medical practice. Thus a
comprehensive training module for all the functionaries is formulated
to get good results and improve the situation.
Ab-39
Priyanka Sharma
Background: The Bio-medical Waste (Management & Handling)
Rules, 1998 were notified under the Environment Protection Act, 1986
by the Ministry of Environment and Forest, Govt. of India on 20th July
1998. The rule regulates the disposal of biomedical wastes and lays
down the procedures for collection, treatment and disposal and
standards to be complied with.
Objective: The main objective of the study was to understand the
process followed in managing the bio-medical waste against the BMW
Management and Handling Rules (1998) of Government of India in
tertiary care hospital. Apart from studying the Bio- Medical Waste
Management Process, the project also tried to assess the level of
awareness about the BMWM, among the hospital staff and bottle necks
A Study on the Bio-Medical Waste Management
Keywords: Biomedical Waste, Waste Management, BMW Handling
Rules
21
while managing BMW.
Methodology: The study was of a descriptive type and was based on
the observations made in the hospital, checklist provided by NRHM,
and bio-medical records in the hospital. Awareness among the staff was
assessed using a questionnaire. The checklist and the observations were
filled during the visits to the departments in the hospital.
Findings: The required resources for the BMWM were present in the
Hospital. However, it was observed that the protective gears were not
properly used by the staff. The process of segregating the waste was not
appropriate in many deopartments in spite of the awareness among the
staff on Bio-medical Waste Management, as they were trained. The
waste collection bags were not closed properly due to unavailability of
means.
Recommendations: Based on the results it was recommended that it
should be made mandatory for the staff to wear the protective gears
while handling waste. The supplies for the waste collection bags should
be changed with new specifications so that they can be closed properly
before being disposed off. The Ward In- charge should check
periodically to ensure that proper segregation takes place. Staff should
be encouraged to put into practice their knowledge about BMWM.
Ab-40
Accordance with NABH Standards
Priyanka Singh
Background: The medical record section of a hospital serves as a basis
for planning patient care, documenting communication between the
health care provider and any other health professional contributing to
the patient's care, assisting in protecting the legal interest of the patient
and the health care providers responsible for the patient's care, and
documenting the care and services provided to the patient
Objective: This study analysis the current situation and quality of
medical records before the pre-assessment of the organization. The
purpose of the study was to find whether the organization was ready for
the upcoming accreditation and if not then assess the gap and fill them.
Methodology: The standards of the IMS were assessed in a self
assessment toolkit whereby most of the objective elements were found
Benchmarking Medical Records Department in
Keywords: Medical Records Department, NABH Standards
to be ZERO in scoring. Therefore new policies & procedures were
formulated and implemented and then reassessed. Data was collected
by one to one discussion with the staff from the MRD, nursing, and few
consultants & previous record and observation primarily and NABH
manual of other hospital, literature on internet secondarily
Findings: The retrieval of a file in MRD was found to be 22 minutes
and this by following the new policy decreased upto 11%. The
completeness of the medical records is very important because as also it
reflects the standard for IMS in continuity of care as per the guideline of
NABH, but this was found to be in very poor shape i.e. only 18% files
were found to be completed by the nursing staff. Similarly even the
doctors (mainly the consultants under which the patients was admitted)
showed a very poor data as only 28% files were found to be complete
(i.e. 72% incomplete in terms of doctors sign & stamp, daily notes and
updates in the treatment). This data after following the new policy went
upto 78% in the nursing staff and only 68% by the doctors for the
completion of the records. The medical records must reach the
department after 1 day of the discharge but only 16% of the files
reached around 84% reached the department in around 48 hours. This
data increased from 16 % to 78% after the new policy.
Recommendations: As for the scope of study in future, it can be used
as a literature on benchmarking of medical records & thus be received
as in similar research studies. The major limitation that existed was
majorly of the shortage of the qualified & skilled staff as the entire
MRD of a 200 bedded hospital was handled by only 2 people out of
which one was not at all qualified.
Ab-41
NABH Standards
Priyanka Vashishta
Background: A gap analysis report is necessarily a document, which
evolves as per circumstantial requirements of the client organization
and to know scope of activities required to meet standards to achieve
project goal i.e. National Accreditation Board of Hospital and health
care (NABH) accreditation status. The board is structured to cater to
much desired needs of the consumers and to set benchmarks for
progress of health.
Objectives: The objectives of the present study were to study the
Gap Analysis of District Hospital in Conformance to
Keywords: Gap Analysis, District Hospital, NABH Standards
22
different procedures at District Hospital for assurance and conformance
with the standards as laid by NABH and to identify the gap between the
NABH laid down practices and prevalent practices at hospital.
Methodology: Sources of data were both primary data (personal
interviews, observations.) and secondary data.(literatures, reports,
registers and records.)
Findings: The findings of the study shows that out of the total 514
objective elements,307 ( 60%) are in non compliance,149 (29%) are in
partial compliance and 58 (11%) are on compliance to N.A.B.H
standards. Gap analysis is the initial and one of the most critical
exercises of the entire process. It helps us to revisit existing system with
an eye to finding facts not faults.
Recommendations: The analysis that has been conducted has
divulged various quality related issues in clinical and non clinical
departments. It will take a long time to close the existing non
compliances. To close these non compliances the hospital has to bear a
huge financial implication in terms of infrastructure, manpower
equipments & other resources.
Ab-42
Rashmi Chaudhary
Background: Medical record serves as a means of doctor’s self
assessment.Medical records provide pertinent patient care information
to authorized organizations.The records are important to the public
health authorities as they contain reliable information regarding
morbidity and mortality patterns,Medical Records provide patient care
information to third party payers.Medical Records protects the patient,
physician, as well as the health care institution and its employees in the
event of litigation.
Objective: 1.To study medical record department of the Hospital and
suggesting best practices 2.To understand process flow of medical
records in different departments 3. To audit manual medical records, 4.
To study electronic medical record system in the hospital and Manual
Medical Record Auditing at Delhi
Keywords: Medical Record, Record Auditing, Electronic Medical
Record System
Records, identifying needs, problems and suggesting implementable
solutions, 5. To highlight major observations, 6. To recommend
implementable solutions.
Methodology: Stratified random selection of MRs to assess their
contents and the no. of records depends upon the no. of records
available the medical record department, selection of a respondent
(doctors & MR persons) and department visit to understand their record
flow process, records of patient admitted, records of patient getting
operated in hospital and consulting doctors was selected as tool.
Survey, Interview direct observation method was done to collect data.
Documents (MR files and forms, policies, procedures), HIS Hospital
and MR department persons & doctors were the data sources.
Findings: The study found that medical record department follows the
one-unit numbering and filing system (i.e. the patient has one MR for
outpatient visits, admission, and emergency). Filing systems are
standardized. There is cabinets and shelving system of record keeping.
Percentage of compliance of one unit numbering system ranges from
95% to 100% in the hospital.
Ab-43
General Hospital, Junagadh
Richa Daftray
Background: The operation time utilization varies in different
healthcare settings. Optimum utilization of the OT time has always
been a priority area for hospital administrators. Operation room
utilization analysis is essential to assess the existing workload as well as
to optimize facility functioning and patient scheduling for surgical
operations. It also aids in allocating reserve time for emergency
operations, asepsis measures and procedures, and provides decision
making information for augmentation or downsizing of the facility. The
study of Time utilization of operation theatre was carried out in all the
operation theatres which carried out major surgeries at general hospital
at Junagadh.
Objective: The project includes study conducted on 3 parameters time
spent on actual surgery, time spent on supportive services and time
waiting while operating room was being made ready for surgery.
Study of Time Utilization of Operation Theatre at
Keywords: Time Utilization, Operation Theatre, General Hospital
Objective: The attempt of the study was made to determine the
awareness about biomedical waste management policy, practices and to
assess attitude towards it.
Methodology: The sample size of the present study is 80. The
technique of sampling is purposive sampling. The methodologies used
in the study are mainly tools of questionnaire, interview and non
participatory observation of the practices of the staffs. Questionnaire
was prepared for the three groups of people i.e. Doctors, paramedical
(including nurses, technicians etc) and housekeeping staffs. The data
was coded on MS Excel and the same was analyzed.
Findings: The findings showed that 82% of the wastes generated were
non infectious and 18% were hazardous. Handling of those 18% was so
much difficult that is causes major Hazard. The study finding revealed
that on an average 124.8kg of the total waste was generated everyday
and 32.9 kg of biomedical waste was generated. Most of the doctors
were aware about the BMW management and they thought that it is
people’s responsibility. This is the group effort and not a single person
can brought about any change. Regarding BMW handling rules, most
of the paramedical heard for the first time. Half of them considered
sharps as the dangerous waste product. Three fourth of them had
knowledge that HIV was the most common disease spread by improper
disposal of hazardous waste. Paramedical did not seem to be
enthusiastic about having new training session for them. Housekeeping
staff that were in direct involvement of BMW handling were not
punctual. They were irregular to their work and their ignorance was
reflected in their practice. Most of them wanted that there should be
separate management unit for BMW, but they did not want to get
involve themselves. They had less knowledge about harmful impacts of
BMW as only 13.33% of people said it causes HIV/AIDS. Around 82%
of them said that they themselves are at highest risk of getting infection.
Their knowledge was very poor regarding BMW 66% of them had no
idea about color coding. They did not use protective measures. They
always complained that government had not provided anything to
them, but whatever government had provided to them, they were not
utilizing. They did not want to put extra effort in any additional work.
The study analyses the various aspects of the BMW management and
accordingly recommendations were made to bring required changes in
the district hospital’s BMW management and other aspects associated
with peoples KAP.
23
Methodology: Simple random sampling method used taking a sample
size of 35 % of total major surgeries. (130 out of 347 cases were taken
which includes 40 general surgeries, 40 orthopedic surgeries, 40 G&O
surgeries, 10 ENT surgeries). The format was based on specific
questions, asked to Anesthetists, staff nurse and housekeeping staff of
OT regarding times at which various activities and events was taking
place in operating room was recorded. Data sources include primary,
secondary data, observation and interview method.
Findings: Workload at operation theatres in Junagadh is high and no
proper scheduling of the operative cases has been noted and there were
no activity wise checklist found and filled during surgery so, it is
essential to know how much time is spent on which activity. The total
bed Strength of hospital is 510. The surgical beds utilizing Main OT is
120. No. of Operation Theatres is 5, the total no. of major operations
performed/year is 5000(apprx.). Out of the utilized time, time spent on
actual surgery was found to be 88 min., time spent on supportive
services was found to be 16 min. and time spent on making room ready
was found to be 4 min. Orthopedic department and O & G department
dealt with the highest work load out of the total inpatient department
and surgery cases, so these two operation theatres requires more
attention in the sense of new implementations.
Recommendations: Utilization of theatre can be increased by
anaesthetizing the patient in anesthesia room instead of operating room
and by lying of sterile trolleys in lay-up room instead of operating room,
by avoiding delayed starts, avoiding cancellation of cases, proper
scheduling of surgeries.
Ab-44
Practices
Roshni Dilbagi
Background: The need of the study came because of the fact that the
biomedical waste management practices is started in the health care
facilities of district hospital but although formal training has been given
but there awareness level was very low. This has led to conduct a
knowledge, attitude and practice study and assessment study among the
staffs of district hospital.
Assessment of Bio-Medical Waste Management
Keywords: Biomedical Waste, Waste Management, District Hospital,
Health Care Facilities
24
Recommendations: Study shows that there is an urgent need of audit
system with this respect. Doctors agreed that there should be
management team for waste management.
Ab-45
Ruchika Goyal
Background: As healthcare organizations look for ways to gain new
efficiencies and reduce costs, they are examining surgical services with
a critical eye. In many cases, the operating room (OR) was not included
in enterprise wide reengineering efforts, thereby limiting the positive
impact of those efforts. Healthcare organizations are recognizing that
every point along the patient care continuum is interrelated. To truly
maximize reengineering efforts, they need to integrate the entire
process and information flow within the OR and across the enterprise.
Objective: The study was carried out, to assess the efficiency in the
operating rooms. The purpose was to identify service-focused
opportunities for efficiency improvement, and to guide continuous
improvement activities within operating rooms and anesthesia services.
Methodology: A descriptive study was carried out and both primary
and secondary data was collected. An analysis of capacity utilization
was done by calculating the percentage utilization of the operating
rooms, percentage of first case start delays and the number of cases
cancelled and rescheduled. The scheduling process was studied and
reasons for delays in the surgeries were stated.
Findings: During the past seven months i.e. from July ‘09 to March ‘10
total 3577 surgeries were carried out. Avg. utilization of OR during the
elective hours is approximately 60%. On an average 45% were FCS
delays, 5.7% surgeries cancelled and approx. 21% were rescheduled.
OR six and seven were underutilized as compared to the others due to
inappropriate case mix. The OR’s were not differentiated specialty wise
leading to discrepancies in case mix and poor predicted time of case
length. Forecasting shows that the utilization of OR’s would increase
from the current utilization of 60% to 70%.
Recommendations: A large amount of cost is incurred to run the
operating rooms, under runs leads to opportunity cost during the un-
Performance Management in Operating Rooms
Keywords: Performance Management, Operating Room, Surgical
Services
utilized hours and lowers the contributing margin. So to streamline the
processes and to improve the efficiency in the operating room a
balanced scorecard approach was introduced as a performance
management tool.
Ab-46
at New Delhi
Rupinder Sahota
Objective: Detailed study was done to see how strong the information
system (Medical Records Department) at Eye hospital was done.
Relevant facts were taken from journals and internet as a part of
literature review and secondly, old patient records, direct interaction
with hospital staff was done to gather primary data.
Methodology: This retrospective study is based on, both secondary
and primary data. Relevant analysis was done to formulate strategies in
order to provide solution to the given objective. Random sampling was
done for retrospective part and whole population was studied for
prospective part. Fro content analysis 757 files were scanned out of
which 400 were taken form the past data and 357 files were taken for
prospective study. The strategies were divided according to the key
findings. Contribution was met with success, and thus further
recommendations were done.
Findings: MRD and general store should be in separate place. Lack of
signage found. Space of store room is cramped. Security is not
adequate. MRD policy is not implemented. The quality of consent
forms is very found to be very poor and the print is also not clear.
Coding system is not present. Records are not received every day. For
cataract occupies the least % of discrepancies were found. Procedures
like cyclocryotherapy, pupilloplasty, probing and syringing have 100%
discrepancy. Only 8 elements out of the 36 were seen in IMS 1 and IMS
5. Somewhat compliance is noted in IMS 7 (42.8%) which pertains to
the procedure laid down for medical audit. It was also found that
documented procedure is not present. Arrangement and configuration
of records is not standardized. A lack of awareness and training is there
amongst all the staff members specially doctors.
Recommendation: Formulating a medical records department policy
Benchmarketing of Medical Records at Eye Hospital
Keywords: Benchmarking, Medical Records, MRD Policy
25
is recommended on priority. Some Architectural suggestions were also
be implemented. Documents mentioned in the policy should be
maintained. Filled consent forms of OPD procedures should be taken
care off by the MRD.
Ab-47
Patient Satisfaction in an Emergency Hospital
Samarth Tripathi
Objective: To study the level of patient satisfaction in wards and the
different factors affecting patient satisfaction. To suggest measures for
improvement of services leading to better patient satisfaction and to
evaluate the services being provided to inpatients.
Methodology: The data collected on feedback project was a
prospective study. Primary data was collected through interviews and
discussions and direct communication with the patients the secondary
data was collected through literature available in pamphlets, journals,
booklets, through various records of the hospital, websites and
currently available national and international literature on the subject.
Semi-structured open-ended questionnaire for the purpose of the study
were developed.
Findings: 74.5% respondent ranked the consultants fees in the hospital
as moderate and the 4.5 % of respondent have ranked it low. 33.6%
respondent ranked the food service of the hospital as excellent and 32.7
% of the respondent has ranked it as good. 32.4 5 have claimed it as
excellent.26.4% respondent ranked the hospital support staff service of
the hospital as excellent and 50% ranked it as good. 89.7 % claimed
support staff service as excellent.
Recommendations: There should be some training on communication
skills for nurses as how to deal with patients. (English and Hindi). The
nurse who gives the charge to another on duty should clearly brief her
about everything related to patient’s condition, what all medication
needs to be given and so on. When a nurse joins, a feeling of
responsiveness should be incorporated in their mind so that they feel
accountable for the work assigned to them.
Study of the Opinion of inpatients to Measure
Keywords: Patient Satisfaction, Emergency Hospital, Inpatients
Ab-48
Equipments, Ultrasound & Operation Theatre
Sangeeta Ravindran
Background: Medical equipment plays a very significant role in the
healthcare delivery system. In the present healthcare scenario,
increasing operational efficiency and reducing costs, whilst
improving service provided to the patient, are a constant
challenge. Biomedical equipment accounts for nearly 50 percent of the
hospital project cost. Therefore, it is essential to ensure maximum
utilization of the equipment with minimum downtime. With the
adaptation of proper maintenance techniques and management systems
one can utilize resources optimally and reduce the breakdown and
related maintenance. Utilization index or use coefficient is one of the
important parameters to monitor the functional status of the equipment.
Objective: This study deals with the utilization rates of CT scan, X-
ray and Ultrasound machines in the Imaging department, Ultrasound
machine in the Gynecology OPD, and the utilization of the Pediatric &
Gynecology OT in a tertiary pediatric and neonatal referral center in
Andhra Pradesh and to suggest ways to increase the efficiency of these
equipments by better utilization. Objectives of the study was to record
the time taken for a scan/surgery , calculate the utilization
coefficient and see the trend of utilization.
Methodology: The study was an analytical one with valid quantitative
data as a background proof and time frame of three months.
Findings: The study revealed an optimum utilization for the ultrasound
machine used for pregnancy related scans in the gynecology OPD,
ultrasound scan machine in the radiology department and the pediatric
OT. The CT scan machine, X-ray machine and the Gynecology OT,
were found to be less utilized, the CT machine being grossly
underutilized. The Gynecology OT again is being underutilized owing
to the fact that the hospital is essentially a pediatric entity and the
gynecology department was started much later. The percentage
utilization of CT for the month of January, February & March was seen
to be 6%. This shows gross underutilization of the equipment. The
percentage utilization of Ultrasound in Gynecology department was
much higher than pediatric department. It was found that surgeons
Study on the Utilization of Radio Diagnostic
Keywords: Utilization of Radio Diagnostic Equipment, Ultrasound,
Operation Theatre
26
were exceeding the booked duration for a surgery by more than half an
hour in many cases.
Recommendations: The management was recommended to
increase marketing for the CT and X-ray services. Scans should be
started on Sundays to achieve optimum utilization of the equipment.
The department has well trained and experienced technicians working
in 3 shifts. Thus there is round the clock availability of staff. Regular
preventive maintenance of the equipment will assure lesser downtime
and ensure better functioning. Monthly report is generated to monitor
surgeries which were exceeding booked duration. Elective surgeries
can be planned on Sunday.
Ab-49
Hospitals of Delhi & NCR
Sanjhi Singh
Objective: To compare the performance of three hospitals in the
region in selected operations on the basis of Cost, Value added
services, Popular operations, promotional activities, approachability &
to analyze trends Indian medical and healthcare Industry. To study the
opportunities & challenges of medical tourism in Delhi and NCR.
Findings: Majority of the tourist consider India (Delhi) as a destination
for heart surgery followed by nephro surgeries (kidney related
problems) then orthopedic, Neuro and only a fraction of them come for
kidney transplants. The study also indicates that if proper investment is
made then India will be at the top level in the healthcare industry. The
graph shows in what ratios the investment should be done like on
medical equipment could account for 20-30% of investment in beds.
Recommendations: Aggressive marketing & awareness programs are
required. Hospitals should have JCI accreditation to enhance
international business. Web sites, list, details, telephone & E mail ids of
hospitals & executives dealing with medical tourism Establishment of
“Indian Medical Tourism Corporation”: - International Branches-
Liaison cell with all Indian & Foreign Missions, Regular Chartered
Medical Tourism should be announced, India International MT Media
is also essential. Corporate Hospitals Medical Tourism Consortium
with front offices in UK, USA, Canada, Middle East, South East Asian
Challenges & Opportunities of Medical Tourism in
Keywords: Medical Tourism, JCI Accreditation, Healthcare Industry
countries can be established. Medical Tourism Regulatory Body /Ethics
Committees should be formed.
Ab-50
Saumya Misra
Background: Measuring quality leads directly to the identification of
areas for improvement or enhancement—the first step in improving
quality. Successful improvement ultimately contributes to attaining
quality care, the goal of quality assurance. Quality assessment of the
facilities enables to track the practices, acceptability of the protocols
delivered during training as well as an important tool for training needs
assessment for capacity building in form of refresher training or further
trainings in new franchisees, as the network is gradually undergoing
expansion. Therefore the quality parameters need to be studied to trace
the needs.
Objective: To find out the issues regarding quality in the charitable
trust hospitals that need to be focused more during the capacity building
exercises so that the main aim of the project was fulfilled i.e. to provide
quality care at affordable prices.
Methodology: For this hospitals in 12 districts of Uttar Pradesh were
analysed which lead to inference that segments of quality parameter.
Findings: Study reveals the need of additional session on neonatal
resuscitation and refresher training to be conducted along with the
infection prevention session during the training and quality assurance
visits that could help in improving the quality of services being
delivered at the charitable trust hospitals.
Ab-51 Flyover feeds you more Momentum Expected Vs
Perceived Hospital Services
Shadad Mirza
Background: With the healthcare market turning from a seller’s
market into a buyer’s market, healthcare providers are turning more and
more towards marketing of their services. This requires a marketing
Quality Assessment for Training Needs Assessment
Keywords: Quality Assessment, Training Needs Assessment, Quality
of Services
Keywords: Hospital Services, Healthcare Market, Patient Satisfaction
27
information system, which provides information that is accurate,
timely and need-based. Market research can provide such information
to hospital administrators. A relevant tool for hospital administrators
today is a patient expectation survey, which reveals what patients
actually desire from hospitals.
Objective: A study was carried out to know the healthcare market and
patient satisfaction in a tertiary and secondary care hospital.
Methodology: Survey, interview and observation methods were used to
collect data.
Findings: Under this study as one of the quality/medical care attributes
100 % patients in both hospitals expect physicians to listen to their
problems and answer their queries, as against 73% & 63% in tertiary
and secondary hospital who were listened to respectively and 60% and
52% patients who were answered to respectively in the tertiary and
secondary hospital . The implications here was: Potential
dissatisfaction causing factor and sensitize doctors about above in both
hospitals
Recommendations: Here again in both hospitals, expectations were
not met and this needs attention. There is need to sensitize doctors about
patient expectations, which if heeded to, can improve the situation
without any additional input in terms of resources.
Ab-52
Sheetal Yadav
Background: Due to high dependency of ICU patients and their critical
conditions there are increased chances of getting hospital acquired
infections among these patients. Infections acquired in health care
settings are among the major causes of death and increased morbidity
among hospitalized patients. They are a significant burden both for the
patient and for hospital.
Objective: A prospective descriptive study in the ICU multispecialty
hospital at Gurgaon for a period of two & a half months has been
designed to elicit information on the rate of nosocomial infections and
Nosocomial Infections in Intensive Care Unit
Keywords: Nosocomial Infection, Intensive Care Unit, IUC, Hospital
Acquired Infection
their cost attributable to the patients.
Methodology: All the patients who were directly admitted to the ICU
and stayed for more than 2 days in ICU were included. The patients who
had bacteremia at the time of the admission and who stayed less than 2
days in ICU were excluded.
Findings: In a sample size of 129, 36 patients got infection during ICU
stay and remaining 93 did not get infection. The study revealed the
crude rate of ICU acquired infection was 27.9% comprising maximum
number (41.1%) suffered with ventilator-associated pneumonia. The
most prevalent pathogen for pneumonia and BSI was found to be
Acinetobacter. It was multi drug resistant organism for which costly
antibiotics [colostin] were required. Most prevalent organism for UTI
was candida. 55.5% of infected patients expired, where as only 17.2 %
of non-infected patients expired. The extra length of stay due to
infection was 8.11 days, which in turn amounts to, estimated 200,000
INR per patient.
Recommendations: There is a positive association on mortality rate
with infection hence it is estimated that if the infection rate is reduced
then the mortality rate will also get reduced. This will bring name and
fame to the hospital. If infection rate drops down patient turn over will
increase, which can lead to more revenue generation as compared to
existing situation, As per the literature, first three days of the hospital
stay of any patient are the most revenue-generating period.
Ab-53
Shikha Jain
Background: A hospital is an economic institution with a significant
social role in the community. It is not possible to discuss problems in
medical and health care intelligently without reference to hospitals
what they are, what they do, and how they do it. Economics of the
hospital sector has often received wide attention because it has been the
major consumer of the health care expenditure accounting for about 40-
60% of gross health care expenditure. Therefore it is essential to ensure
that services provide an excellent experience for customers i.e. the
patients.
Objective: The study on the bed utilization was conducted in the
Bed Utilization in General Hospital at Gujarat
Keywords: Bed Utilization, General Hospital, Health Care Expenditure
Hospital, Gujarat, to know the causes of their satisfaction as well as
dissatisfaction, To provide recommendations for the improvement of
the services.
Methodology: The primary data was collected with the help of
qualitative as well as quantitative research techniques. In total 50
employees were interviewed. The sample comprised doctors,
pharmacists, technicians, receptionists, data operators, security guards,
administrative staffs.
Findings: Results from the survey indicate that approximately 74 per
cent of the employees were satisfied with the organization. There were
several issues regarding the employee satisfaction survey. The
employees have many grievances as well as their problems regarding
some of the issues in the hospital. The issues should be handled very
carefully. In this survey it was found that 74% of employees were
satisfied. Majority of the employees i.e. 68% of the employees are on
contract basis. The majority of the age group is of age between 21yrs -
25yrs, which is of 42%. 66% believe that the organization treats them
like a person, not like a number, 42% believes that the
organization gives them enough recognition for good work, Majority
agrees that quality work and safety are the top priority of the
organization, 60% agreed that employees are treated fairly
regardless of race, gender, age, religion, or sexual orientation, 68%
agrees that employees are comfortable with their colleagues. When the
employees were asked about their relationship between the employees
with their immediate supervisors, majority agreed that their supervisor
treats fairly, with respect and acknowledges their work, and guide fairly
for the improvement in work and they also have trust in what the
supervisors suggests.
Recommendations: The work should be equally divided among the
employees; the employees should get the salary at right time as it is one
of the motivations for them to work. Employees need more training,
proper incentive should be given to the employees, work atmosphere
should be more improved, printers should be attached at every OPDs in
order to upload data on HMIS, work load should not be there. The work
should be equally divided among the employees; the employees should
get the salary at right time as it is one of the motivations for them to
work.
28
district hospital at Gujarat. The general objectives of this study is to
identify the various procedures at the Outpatient, Inpatient and Para
clinical services as well as to investigate the possible operational
problems those are leading to low bed utilization.
Methodology: The primary data was collected help of qualitative as
well as quantitative research techniques. In total 60 patients (40 out
patients and 20 in patients), 5 doctors and 5 nurses from various
specialties were interviewed. The secondary data comprised of last one
year monthly report of indicators of general hospital .
Findings: The study brought out the fact that overall bed occupancy
rate was low (about 30-40%) which is low compared to ideal bed
occupancy rate of 70-80%. Various reasons like patient’s lack of
knowledge about hospital functioning, lack of proper signage, lack of
confidentiality, respect and dignity of the patient, lesser OPD timings
etc lead to dissatisfaction among patients.
Recommendations: The low bed occupancy rate in the district hospital
can be improved by capacity building, planning for hospital budget, and
revision of OPD timings, improving internal communication and
strengthening of security services at the hospital campus. Thus a well
organized and professionally run hospital not only can help in avoiding
confusion, frustration and dissatisfaction by fearful patients but can
also manage the flow of inpatients to the hospitals, thus improving bed
utilization.
Ab-54
Gujarat
Shreyasi Sen Gupta
Background: The strength and the success of an organization depend
on the capacity of its employees. Employee satisfaction survey is one of
the important surveys which need to be done in any organization at
periodical basis. It helps the top level managers to understand their
employees and manage accordingly. Therefore the present study aimed
to conduct an employee satisfaction survey in the General Hospital
Gujarat.
Objectives: The basic objective of employee satisfaction survey were:
To understand the perspective of the employees about the General
Study of Employee Satisfaction at General Hospital,
Keywords: Employee Satisfaction, General Hospital, Motivations
29
Ab-55
Shruti Khanna
Objective: The main aim of the project was to make disaster
preparation of GGH effective by identifying all the grey areas and
removing all the loopholes, whatever there may be.
Methodology: An intensive research of the NDMA guidelines was
done and then the gap analysis was conducted to quantify how much
we’re lagging behind the industry standards and what should be done to
cover the gap.
Findings: The study revealed many interesting facts like the shortage
of manpower, poor conditions and improper utilization of funds , lack
of inter departmental and intradepartmental coordination, faulty Govt.
policies regarding condemnation of equipments, retrofitting of
buildings in accordance with NDMA guidelines, very poor
infrastructure, SOP formulations, pertaining to external and internal
disaster, Up gradation of disaster plan of the Hospital, no fire
evacuating system, lack of statutory requirements, Poor awareness and
preparedness in relation to disasters, disaster management committee
was never formed etc.
Recommendations: The study proved to be a helpful tool in analyzing
the gaps in the existing disaster plan, in the formation of disaster
management committee, in up gradation of the old plan. The results of
the report are being used in recommending a revised plan to the State
authorities.
Ab-56 Study the Operations, Medical / Clinical Record
Keeping and Prepare Functional Specifications for
Clinical System for Oncology
Shweta Sandhu
Objective: The main objective f the project was to understand the
operational process of a functioning oncology centre followed by
Study on Disaster Management Plan
Keywords: Disaster Management, Disaster Management Plan, Gap
Analysis, NDMA Guidelines
Keywords: Record Keeping, Medical Record, Clinical System,
Oncology
development of functional specifications for the clinical process
documentation with clinical backup. As a part of zero stage of
implementation cycle which consists of process change identification
workshop, detailed implementation planning and functional
specification document preparation.
Methodology: For process flow analysis a 150 bedded, state of art
leading oncology centre at Hyderabad was chosen. Operational process
flow, with step by step data capturing at every stage with documentation
was studied. Operational process flow, with step by step data capturing
at every stage with documentation was studied. Both qualitative and
quantitative method was used for the study.
Findings: Various stake holders at Cancer Hospital were interviewed.
Following, an elaborate document of their existing process flow was
made which was further sent to parent hospital for approval and
authentication. After analyzing the scope of the product and various
work rounds available voids in data capturing were identified. A
functional specification document was prepared for the technical team
consisting of what information has to be captured, which field shall
capture it, who shall capture it, which all other areas it will be displayed
in, master’s for the same were created after extensively. Data captured
were tabulated and a sample copy of the same was created and added on
to the existing report. Completing the stage zero of the project the
details were sent to the parent hospital for their approval post which it
shall be sent to the technical team for development. Another important
part that was deeply looked into was capturing and presentation of this
data according to existing standards in the healthcare.
Ab-57
Survey
Suhas Parnami
Background: The patient is the ultimate consumer to the hospital. It is
one of the yardsticks to measure the success of service that it produces.
The effectiveness of the hospital relates to provision of good patient
care as intended. The patient satisfaction is real testimony to the
efficiency of hospital administration.
Quality Improvement through Patient Satisfaction
Keywords: Quality Improvement, Patient Satisfaction, Hospital
Administration
30
Objectives: To study the satisfaction level of patients and understand
their expectations. To evaluate feedback and provide a remedial
suggestion.
Methodology: In order to understand the standing of the hospital from
the views of the customers, a closed ended questionnaire was designed.
100 patients were selected for the study. Questionnaire and interviews
methods were used.
Findings: This study helped to find the hidden problems and issues
which need to be dealt with immediate effect. After analyzing the
completed questionnaire of 100 patients/attendants, it was revealed that
the billing services at the time of discharge was the least satisfactory in
the hospital and was the root of all the dissatisfaction among the
patients. Reasons behind this dissatisfaction were: Billing done
manually, less manpower, no pre planned discharge intimation from the
floor. To which I proposed that have billing done on HIS, and pre
planned discharge intimation from the floor a day prior of discharge.
Next in dissatisfaction list was Radiology services. Major reasons
found out after studying the questionnaire in detail was: Delay in
procedures. 50% of the patients were found satisfied with the
registration process and 11% was dissatisfied. 88% patients were found
to be satisfied with the doctor’s ability and 55 were dissatisfied due to
the non availability of the doctor when required. 54% were satisfied
with the Nursing and Lab services and 8% were dissatisfied. 96% were
fully satisfied with the housekeeping services. 56% were satisfied with
the food quality and services.14% comprising of international patients
were dissatisfied with the menu of the food.
Recommendation: It is recommended to have a proper appointment
system to achieve maximum patient satisfaction.
Ab-58
Infection in Intensive Care Unit
Suhasini
Background: Hospital acquired infection creates a major problem to
the patient admitted to the hospital as well as to health care personnel,
affecting the reputation of hospital and making unnecessary cost to
A Study on Control Measures of Hospital Acquired
Keywords: Hospital Acquired Infection, Intensive Care Unit, Infection
Control, ICU
patient during the course of treatment.
Objectives: The main objectives is to study the physical facilities
available for infection control in intensive care unit and also the
existing infection control procedures used in the intensive care unit .
Methodology: The research approach adopted in the study was
descriptive method. It includes collection of information regarding
infection control procedures and its measures and also existing physical
facilities available for infection control through questionnaires,
studying relevant record maintained in ICU. The required data is
collected from nurses, doctors, hospital nursing assistance, staff of
central sterile supply department who are responsible for supplying
sterile items to medical intensive care unit and the, housekeeping staff
who work in medical intensive care unit.
Findings: Result show that current physical facilities available for
infection control are satisfactory and meet the ISI standard, but the
existing infection control measures practiced in ICU are poor. No
standard operating manual is maintained in ICU. Culture studies of
swabs from ICU floor / equipment are done. Bacteriological testing of
water is done but bacteriological testing of air is not done. No antibiotic
policy is available No protocol is followed for wearing gloves
Recommendation: Strict adherence to standard infection control
procedures need to be taken under consideration and existing infection
control measures in ICU needs improvement and up-gradation.
Ab-59
Sunita Choudhary
Background: Family Friendly Hospital Initiative (FFHI), a kind of
certification of health facilities wherein certain quality of services
needs to be ensured. The essential components for declaring a facility as
FFHI are (a) evidence based protocol; (b) quality of services; (c)
availability of essential drugs; (d) and availability of referral transport.
A Hospital at Rajkot has already got the certification for Baby friendly
hospital initiative some years ago. Assessment of the hospital was done
for “Family friendly hospital certification initiative”.
Assessment of a Hospital as Per FFHI Guidelines
Keywords: FFHI Guidelines, Family Friendly Hospital Initiative,
Health Facilities, Quality of Services
31
Objective : To review the existing system of the hospital. To have a best
possible H.R. measure study on employee satisfaction. To have patient
perspective study on patient satisfaction. To identify the lacunas in
hospital to become a family friendly hospital. To recommend the areas
of improvement for strengthening and improving the quality as per
FFHI check list, this helps to reduce the lacunae’s and variation.
Methodology: The project was descriptive in nature. Primary data was
collected by Observation Structured Interview method. Secondary
data was collected from hospital medical records. The primary data
collected was transferred to a standard format of “Quality Framework-
System approach” and then analysis done through Ishikawa fishbone
diagram (Root cause analysis).
Findings: Results shows that 90 percent patients were satisfied with the
cleanliness of hospital campus. Results of table 8 shows that almost 80
percent patients were found to be highly satisfied to the cleanliness of
bed sheet. Analysis pertaining to cleanliness of ward reveals that 96
percent patients were found satisfied from the cleanliness of the
hospital. Result reflects that 28 percent patients were not aware about
their treatment. Around 92 percent patients were found to be highly
satisfied with the behaviour of doctors. It was found that, 84 percent
patients were satisfied with food quality and time. The major gap was
related to the service environment like Non availability of display of
doctors’ availability and timings, Littering by the patients in the
hospital, Non availability of electronic display of token, Junks inside
the hospital. The second major gap was related to client provider
interaction like No feedback system from the patient, Non-availability
complaint box for the patients. The third gap was related to access to the
patient. Non availability of service guarantees character, non
availability of signage and directions. The forth gap was related to
professional standards and technical competence like Non availability
of check sheet for surgical patients.
Ab-60
Documentation
Thirumalai N
Objectives: The study was taken to examine and measure the quality of
Interna l Qual i ty Assurance in Cl in ica l
Keywords: Quality Assurance, Clinical Documentation, Quality of
Documentation
documentation in clinical areas. To suggest remedial and
corrective/preventive actions to sustain the quality of documentation in
clinical areas and to examine the effect of implementation the
preventive/corrective actions. The sole aim of the study is to identify
the areas to sustain or improve the documentation process and to
recommend the methods to achieve them.
Methodology: First phase, all departments in the hospital was
observed for the documentations process. Informal interview and group
discussion was carried out with people involved in the documentation.
Area of common mistakes and difficulties faced by the department in
clinical documentation was observed in detail. In second phase, a
check list is prepared based on non conformance/Partial conformance
of measurable elements which were identified during the NABH
external assessment. Final phase, medical records of the patient who
are treated in the hospital are audited with the help of check list and the
data was analyzed. Major contributing factors are identified using pare
to principle and recommendations for the same was formulated.
Findings: It was found that 94.6% of the medical officers are not
mentioning the time of assessment and reassessment. 91.9% Charge
nurse is not mentioning the date, time and signature in each valid
medication notes. General consent forms on admission were not duly
signed by 89.3%.patient. This was because patient comes to inpatient
department (wards) through the emergency department, so during
filling the admission patients relatives were signing the general consent
form.
Recommendation: To enhance the effectiveness and sustainability of
internal quality assurance efforts, internal hospital quality assurance
program should encompass all the aspect of the facility (not just one
type of service) and aim from the outset to construct a self sustaining
QA system that does not depends on external support.
Ab-61
Rajasthan
Trupti Khandelwal
Background: Shortage of human resource in health sector is a major
problem in India and more in rural areas. Similarly in Rajasthan, it is
Human Resource for Health in a District Hospital at
Keywords: Human Resources, District Hospital, NRHM
examine the efficiency of housekeeping staff or quality of their
working.
Methodology: A sample of 11 in-house housekeeping staff (providers)
was interviewed using a structured questionnaire to evaluate their
awareness about cleaning methods, frequency of cleaning, BMW, their
responsibilities in mass casualty etc and to determine the training given
to them and if they are getting housekeeping material timely so that
quality of service is not affected. A sample of 48 IPD patients/
attendants and 50 OPD patients/ attendants were also interviewed using
a questionnaire to evaluate user’s satisfaction regarding the level of
cleanliness and housekeeping services.
Findings: It was found that 55% knows the correct method of sweeping
a patient’s room while only 27% knows the correct method of mopping.
Only 9%answered all the 5 questions related to BMW correctly while
91% replied that they have got training on BMW (it was 6 months
before). 91% replied that they got training on BMWonly during their
work in organization, no other training was given. 67% answered that
they didn’t get equipments/ supplies on time. A time-motion study was
done to determine the activity schedule of housekeeping staff at
different timings. It was found that besides cleaning, they were also
performing nursing activities and others (activities of ward boy etc) A
check list was prepared to further assess the training needs of
housekeeping staff to increase their efficiency; the check list was filled
in by ward in charges (supervisors of housekeeping staff of their
respective ward). Maximum score (i.e. for the area in which training is
required immediately) was given to Induction training and training on
waste disposal. Another check list was prepared to examine the existing
practices of housekeeping services by checking the system of record-
keeping, training schedule, cleaning activities (performed or not), and
to determine if the existing system of supply of housekeeping material
was working efficiently by checking the availability of equipments/
supplies required in cleaning procedures.
Recommendation: It proposes proper organization and planning of
Housekeeping department with sufficient storage and work space, a
system to ensure availability of housekeeping material on time, an
annual training plan and its proper implementation, preparing
housekeeping records and monitoring of records and a monitoring
system to measure the efficacy of housekeeping services .
32
scarcer in terms of doctors. Nearly one nursing staff is available for
1000 population but even single doctor is not available for per thousand
populations.
Objective: A study on HRH was conducted in District Hospital,
Rajasthan. The study objective were: (i) to review the efforts made by
the GoR to attract and retain the health functionaries in health facilities,
(ii) to find out reasons for success/ failure of the efforts made in the
district, and (iii) to suggest about what more could be done in the
present context human resources for health encompass–health and
hospital mangers, medical officers, nursing staff and support staff to
study the current status at the District Hospital in Rajasthan
Methodology: Purposive sampling was done to understand the human
resource planning and other relevant issues. A total of 22 officials at the
district and state were conducted using a checklist. In addition,
secondary data was collected and analyzed.
Findings: The results revealed acute shortage of health functionaries,
especially Medical i.e. 44% following Government of Rajasthan rules.
It will be more if IPHS is followed. However, under NRHM,
Government of Rajasthan has initiated efforts for attracting and
retaining the medical officers. Moreover, the medical officers were
overburdened due to high rate of vacant positions, including voluntary
retirement scheme.
Recommendation: The study recommended a dedicated human
resource cell at the state level, decentralization and evidence-based
planning.
Ab-62
Vatsala Sharma
Background: Housekeeping services in a hospital is entrusted with
maintaining a hygienic and clean hospital environment conducive to
patient care. The housekeeping related activities have a direct effect on
the health, comfort and morale of the patient, staff and visitors and are
an important public relations variable. It is an essential ingredient in the
provision of quality assurance of hospital care.
Objective: This study was carried out in order to assess the existing
practices of housekeeping in the District Hospital at Karauli and to
Study of Housekeeping Services
Keywords: Housekeeping Services, Quality Assurance, Hospital Care
33
forming cost sheet .
Methodology: The scope of the study was limited to 4 investigations,
of which 1 is contrast based. The methodology utilized includes review
of literature, internet search, understanding market trend, enumeration
of services, cost heads and various resources required, meeting various
healthcare professionals including vendors supplying equipments and
consumables, etc. The data collection was both through primary and
secondary basis.
Findings: The study found that the imaging services provide a pool of
revenues if proper patient inflow is maintained; otherwise it may also
be a means for losses to the organization as in CT scan and X-Ray
procedures, while it is profit making in USG & Mammography units as
per the study and manpower, depreciation but without interest cost
contributions.
Ab-65
towards a Paperless Hospital
Vikash Tyagi
Objective: The purpose of the study was to see the adoption of IT in
OPD and IPD can help in streamlining the various processes and
improve the quality of the services. The study analyzes the role of
information technology in this regard through improved quality,
efficiency and ability to conduct research with the use of electronic
medical records.
Methodology: A random sample of the users of the computer system
was taken and informal interviews were conducted with them. They
were asked about the problems associated with the present system
specially related to their area of operations.
Findings: The areas of concern are duplication of entries, Lack of
interoperability between various modules and large and bulky paper
based records. The role of proper training and the integration between
various modules has been emphasized.
Scope of IT in OPD and IPD Areas: First Step
Keywords: OPD, IPD, Information Technology, Quality of Services,
Electronic Medical Records
Ab-63
Delhi
Vijay Shankar Patel
Objectives: The major objectives were to know the costing of per bed
day in ICT and to know cost and benefit from ICU.
Methodology: Depreciation method is used to calculate the cost of
instrument and there are some direct cost like doctor cost, nursing cost,
housekeeping and linen cost. Step down method is used to calculate the
cost of administration. Data observed and collected includes:-per bed
day doctor charge, nursing charge, administrative charge, electricity,
water and other charges.
Findings: Some indirect costs are electricity and water cost. The ICU
per bed day costing is Rs.2300.68. Per bed day cost charged from
patient is Rs 3500. Bed occupancy for month of March is 97%. Revenue
generation per bed par Day = Rs 3395. Total discounts in the month of
March for ICU patients- 132000 rupees. Discount per bed day in the
month of March is = Rs.488.88. Revenue generation per bed day in the
month of March is= Rs 2906.12. Benefit per bad day = Rs 2906.12-
Rs.2300.68 =Rs 605.44. Benefit for ICU per bed day for the month of
March is =26.31%
Ab-64 Cost Analysis of Medical Imaging Modalities
Vikas Goyal
Objective: The study t provides an analysis of departmental costs
involved in providing Imaging services and ascertain the costs of some
commonly done tests or procedures in the Imaging Department.
Bottom-up or Micro costing is applied in which all the inputs consumed
in undergoing the procedure are identified, measured and quantified,
finally converting into value terms to produce a cost estimate.
Absorption costing, a technique that assigns all costs, i.e., both fixed
cost and variable cost to product cost of service rendered is applied in
ICU per Bed Day Costing in a Charitable Hospital at
Keywords: ICU, Per Bed Costing, Cost Benefit
Keywords: Cost Analysis, Medical Imaging Services, Cost of Services,
Micro Costing
34
Recommendation: Hospitals may be more likely to adopt EMR if they
can reassure patients that their confidentiality is legally protected.
Among the barriers to implementation are a dearth of integrated
delivery systems, reluctant providers, and prohibitive costs.
Ab-66
Multispecialty Hospital at Jaipur
Vikram Singh Chouhan
Objective: The main objective was to study the o gap analysis and
preparing an external emergency response plan as per the requirement
of NABH.
Methodology: The study was descriptive and qualitative in nature. The
study was based on the standards of NABH. Comparing the existing
plan and requirements of NABH and doing gap analysis as well as
developing plan that fills the gap according to the NABH norms.
Findings: The findings of the study are described as gap analyses
which are as follows: The allocation of bed in case of mass casualty was
not appropriate, No Triage Area, No proper communication within the
hospital, No process flow for different departments which will play an
important role in emergency situation (Pharmacy, Laboratory, Blood
Bank, Medical Record, Material management and no description of
responsibilities of individuals in case of external disaster.
Recommendations: It is very necessary to have a policy for the
communication within the organization during external emergency to
avoid confusion and the staff and the department head get the right
information and start working according to their job description.
Ab-67 Study of Improving Effectiveness and Efficiency of
the Linen and Laundry Department
Vrajesh Shah
E x t e r n a l E m e r g e n c y R e s p o n s e P l a n i n
Keywords: Gap Analysis, NABH Standards, External Emergency
Response Plan
Keywords: Lean Department, Laundry Department, Hospital Support Services
Background: The hospital is supposed to provide well-laundered linen for all requirements of the hospital in adequate quantities, at the right place, at the right time and this is possible only if the means to attain these objectives are controlled by the hospital itself. Linen and Laundry department was comparatively weak area at Children’s Hospital.
Objective: The main objective was to streamline the process flow and to improve the effectiveness and efficiency of the department and to understand the structure and service flow of the linen and laundry department, to develop policy for linen department, to identify and analyze the flaws in the structure and service flow of linen and laundry department for improving its functioning,
Methodology: Observation, interview and linen satisfaction survey was carried out by identifying five quality indicators i.e. Clour, texture, timely availability, smell and adequate quantity of the linen services.
Findings: It was found that 28% were highly satisfied and 17% were not satisfied, rest was satisfied with the colour of the linen. 23% were highly satisfied, 60% were satisfied with and the 17% were not satisfied with the smell of the linen. 25% was highly satisfied, 60% satisfied and 15% were not satisfied with the texture of the linen. In the case of timely availability of the linen 30% were highly satisfied, 57% were satisfied and 13% were not satisfied. 32% was highly satisfied, 48% was satisfied and 20% was not satisfied with the adequate availability of the linen.
Recommendation: Major were to change the design of the linen, to dispose the linen whose life is completed, for the laundry department to change the detergent quality and lastly for the housekeeping department to follow the policy suggested by the surveyor for the department for improving quality of services of this department.
Ab-68Hospitals for assessing the performance of Dialysis Unit
Vritti Lumba
Background: Chronic kidney disease is increasing worldwide, but due
to lack of awareness the incidence is increasing in the developing
countries. In India, there is no existing data available and the patients
Comparative Analysis of two Multi-Superspeciality
Keywords: Dialysis Unit, Dialysis Unit Records, Quality Care Control
undergoing renal replacement therapy form only tip of the iceberg. In
India the setups providing dialysis are not doing a great job either.
Objective: To find out the gaps between the standard guidelines and the
processes followed. The objective of the study was to do a gap analysis
of the parameters that reflect the efficacy of the dialysis unit with
standard guidelines and to compare it with its older peers and then give
recommendations so as to improve the quality of life of dialysis
patients. In this endeavour studied.
Methodology: Secondary data available in hospital records in the form
of patient files, dialysis unit documentation registers and records on
hospital information system the patients who had been examined on
outpatient basis when they were in chronic kidney disease stage-IV was
studied. The data was analyzed using Microsoft excel.
Findings: It was found that the hospital is a new setup, its dialysis unit
was being underutilized, no. of dialysis being thrice weekly in 68%
patients; AVFistulas created prior to first hemodialysis in 52% patients;
improper documentation of time of vaccination for hepatitis and
pneumococcus; target hemoglobin of 11-12 achieved in 32%; serum
albumin of 52% patients meeting the standards. No seroconversions
and line infection rates of 14% more than the standards. When
compared to second hospital it was found that there was better
utilization of the dialysis unit but the staff patient ratio was not meeting
the standards; almost all patients had hemodialysis done twice/week
and AVFistulas were created prior to first dialysis in none of the
patients. Hemoglobin level was in the standard range in 20% patients
while urea reduction ratio was not evaluated, though serum albumin
was meeting standard in 48% but the lowest value was 2.2mg/dl.
Seroconversion rates for hepatitis B, C and HIV were 16%, 16%, and
4% respectively. There were no records available for the time of
immunization of patients and no records were there for line infections.
On comparing the two, the dialysis unit is doing better than its old
competitor, yet lot needs to be done in order to achieve the standards
and reach to a state where it can give real quality of life to its patients.
Recommendations: VIP rooms may be utilized by other patients when
there is no booking of VIP rooms. Night shifts to be started to incr5ease
the utilization of dialysis unit. Results should be monitored as part of
comprehensive quality care control programme. Proper documentation
needs to be done in order to ensure quality.
35
Ab-69
Services in District Hospital, Sikar
Yatendra Kumar Sharma
Background: District hospital is an integral part of the District Health
System (DHS). District Hospitals function as a secondary level of
healthcare which provides curative, preventive and primitive health
care services to the people in the district. It is also the fundamental
platform for implementing various health policies and delivery of
health care and management of health services for defined geographical
areas.
Objective: A study was conducted in District hospital at Sikar, with the
objective to know a broader perspective of the issues related to the OPD
and IPD services, and the behavioral aspect and attitudes of Hospital
staff, as well as patients and to strengthen the OPD and IPD services of
the hospital.
Methodology: Structured questionnaire was prepared and primary
data was collected on random basis by interviewing the patients.
Analysis was done using Ms-Excel.
Findings: From the aggregate of scores of 14 questions of satisfaction
questionnaire, it was found that 13.3% patients considered the services
at as excellent, 21% considered it as good, 30.1% say that it was average
and 12% of patients were poorly satisfied with the services. Item- wise
satisfaction score showed highest score for patient satisfaction of
excellent category regarding pharmacy (21%), followed by 11% about
registration and 11% regarding ambience of the hospital. Item wise
dissatisfaction score showed highest score for poor satisfaction i.e. 30%
regarding nursing staff behavior, followed by overall experience (25%)
and poor cleanliness of toilets and bathrooms (16%). 7% of patients
preferred to suggest this hospital for friends and relations and for future
consultations.
Recommendations: The hospital administrators should be aware of
the needs and expectations of the public as per the feedback of the
public relations department and accordingly take policy decisions.
These measures play a significant role in patient’s satisfaction. A good
communication between the patient and provider of health care is vital
factor for patient satisfaction. There should not develop any
communication bridge between the doctor and the patient.
Monitoring and Strengthening of OPD and IPD
Keywords: District Health System, Health Care Services, OPD
Services, IPD Services
HealthManagement
Keywords: Post-natal Services, Intra-natal Services, Ante-natal
Services, NRHM, MGDs, Quality of Services
Objective: This study was carried out under the aegis of staff of PHFI
for the project “Developing an Investment Case for Scaling up
Equitable Progress towards MDGs 4 and 5 in Asia Pacific Region.
According to State of World Children Report 2009 by UNICE lack of
proper antenatal care is responsible for the manifestation of these three
lethal causes. It says hemorrhage after delivery is the major cause of
high maternal mortality in Orissa followed by eclampsia, sepsis and
anemia. Sixty-eight per cent pregnant women in Orissa are anemic. 54
per cent births are not assisted by any health worker while the
institutional deliveries constitute only 39 per cent.
Rationale: To achieve MDG 4 & MDG 5, NRHM & RCH II was
launched. Since their inception & efforts quantitative figures have gone
up but the quality figures are not reviewed at any level.
Objective: To study the quality of Antenatal, Intra-natal and Post-natal
services in Kendrapara and Rayagada districts of Orissa. To see the
trends of Ante-natal, Intra-natal and Post-natal care from DLHS-2 to
DLHS-3. To identify gaps between quantitative figures and quality of
Ante-natal, Intra-natal and Post-natal care provided in Rayagada and
Kendrapara.
Methodology: Analysis of raw data from DLHS-2(2002-2004) &
DLHS-3(2007-2008) was done using Stata 10 statistical package &
Microsoft Excel for analysis The study analyzed the analysis of
secondary data from DLHS-3. The Study Areas were Rayagada and
Kendrapara district of Orissa
Findings: Coverage indicators for the districts Kendrapara &
Rayagada have improved from DLHS-2 to DLHS -3. This can be
attributed to the implementation of NRHM, RCH II. The increase is
more for Kendrapara than Rayagada, this can be due to difficult terrain.
Quality indicators are lagging behind the coverage indicators for both
the districts
Recommendations: Implementation of NRHM, RCH II has brought
about a drastic improvement in the coverage indicators for Ante-natal,
Intra-natal & Post-natal care but the quality indicators have not been
37
Ab-1 Yashoda Assessment at District Hospital Bharatpur
Aastha Srivastava
Objectives: The study was based on the intervention benefiting the
health system by improving the health care delivery system for mother
and newborn and also to check the efficiency and the effectiveness of
the work performed by Yashoda.
Methodology: The descriptive cross sectional study area was
Bhartpur district hospital. Target population are the mothers staying in
the institution after delivery. Sampling done is as per convenience. Tool
based on job assessment questionnaire and self administered
questionnaire for Yashoda. Checklist was also prepared to observe the
process under study. Frequency table and graph generated by manual
calculation using Microsoft Excel for analysis.
Findings: The finding reflects that initially Yashoda faced various
problems and they were not accepted by the staff and were not given the
recognition in the institution. Major Finding shows that most of the
Yashoda staff are not counseling for the new borne care, family
planning, proper nutrition and breast feeding. It was also observed that
cleaning the baby inside the labor room and motivating the mother for
follow up visits was also not done. It was also observed that 75% of
Yashoda are informing doctors about newborn who require more care
and attention. Very few are helping in making monitoring charts, in
registration and helping mother in choosing family planning tool. The
patient satisfaction increased with the efficiency of the staff. Good
coordination with floor staff and the nursing staff was also observed and
has increased quality service and care. Their presence in the hospital
has made increase in no. of weighing of babies, early initiation of breast
feeding, increase in immunization status of the district, increase in no of
stay hour i.e. more than 24-48 hours in the hospital.
Recommendations: Refresher training course should be conducted
regularly. Clarity in the job profile is essential. Nursing staff and the
floor staff must coordinate with them.
Ab-2 Quality of Ante-natal, Intra-natal and Post-natal Services
in Kendrapara and Rayagada Districts of Orissa
Aishwarya Rathore
Keywords: Health Care Delivery System, Yashoda Assessment, Health
System
38
reviewed at any level. There is a stark gap in the quality & quantity of
ANC, Intra-natal & PNC. Kendrapara is much ahead of Rayagada, this
can be due to the large chunk of tribal population & naxalite infestation
in the latter.
Ab-3
Delivery/Maternal Complications and Its Utilization
by the Beneficiaries
Akash Kumar Lal
Objective: Under NRHM JSY integrates cash assistance with delivery
and post delivery care for women, to have healthy outcomes of
pregnancy and childbirth. A study was undertaken in the AMRELI
district of Gujarat to (i) review the JSY under NRHM in the district;
(ii) conduct trend analysis of institutional deliveries under the JSY
scheme in the district; (iii) study the utilization of the JSY incentive by
the beneficiaries; and recommend for better utilization of JSY, and/or
sustain the progress even without cash incentives.
Methodology: The study was conducted in the five blocks of the
district AMRELI during February-April 2010. The methods of data
collection included interview with 50 JSY beneficiaries; and 10
medical officers, and 16 female health workers. In addition, district
health records for the last three years were also analyzed.
Findings: The study shows that around 44% beneficiaries spent the
cash (Rs. 700/-) received under JSY for supplementary nutrition which
is one of the prime purpose of the incentive. The record review shows
that the percentage of institutional delivery among JSY beneficiary has
been around 25% during 2006 to 2010 in the district. There was no
difference in reducing maternal complications. The JSY scheme has
proven to be more benefitting for the urban population rather than the
rural population. The MOs and the FHWs believed that the incentive is
very beneficial for the beneficiary who belong to very low
socioeconomic status but is not very much required by others who are
economically sound.
To Study the Relationship of JSY with Institutional
Keywords: NRHM, JSY, Institutional Delivery, Maternal Care, Post
Delivery Care
Recommendations: The study recommended that JSY incentive need
to cover all aspects of antenatal, postnatal care and the quality of care
rather than on institutional delivery only for example 25% for ANC,
50% during delivery, 25% for PNC. Attention need to be paid to
increase the facilities (infrastructure and human resources) at health
facilities. Adolescent girls need to be sensitized about benefits of
different health schemes. This effort will directly help in parent’s
awareness and acceptance of institutional deliveries in one way or the
other and they themselves will contribute in JSY in near future.
Ab-4
Amandeep Singh
Objective: Under NRHM JSY integrates cash assistance with delivery
and post delivery care for women, to have healthy outcomes of
pregnancy and childbirth. A study was undertaken in the AMRELI
district of Gujarat to (i) review the JSY under NRHM in the district;
(ii) conduct trend analysis of institutional deliveries under the JSY
scheme in the district; (iii) study the utilization of the JSY incentive by
the beneficiaries; and recommend for better utilization of JSY, and/or
sustain the progress even without cash incentives.
Methodology: The study was conducted in the five blocks of the
district AMRELI during February-April 2010. The methods of data
collection included interview with 50 JSY beneficiaries; and 10
medical officers, and 16 female health workers. In addition, district
health records for the last three years were also analyzed.
Findings: The study shows that around 44% beneficiaries spent the
cash (Rs. 700/-) received under JSY for supplementary nutrition which
is one of the prime purpose of the incentive. The record review shows
that the percentage of institutional delivery among JSY beneficiary has
been around 25% during 2006 to 2010 in the district. There was no
difference in reducing maternal complications. The JSY scheme has
proven to be more benefitting for the urban population rather than the
Human Resource in Health (HRH) in India
Keywords: NRHM, Human Resource in Health, Janani Surksha
Scheme
39
rural population. The MOs and the FHWs believed that the incentive is
very beneficial for the beneficiary who belong to very low
socioeconomic status but is not very much required by others who are
economically sound.
Recommendations: The study recommended that JSY incentive need
to cover all aspects of antenatal, postnatal care and the quality of care
rather than on institutional delivery only for example 25% for ANC,
50% during delivery, 25% for PNC. Attention need to be paid to
increase the facilities (infrastructure and human resources) at health
facilities. Adolescent girls need to be sensitized about benefits of
different health schemes. This effort will directly help in parent’s
awareness and acceptance of institutional deliveries in one way or the
other and they themselves will contribute in JSY in near future.
Ab-5 To Ascertain the Role of LBWs in Neonatal Mortality and
Development of Strategy for Preventing Deaths Due to
LBWs in the Tirbal District of Narmada
Ambrish Kumar Chandan
Background: Low birth weight has been defined by the World Health
Organization (WHO) as weight at birth of less than 2,500 grams (5.5
pounds). The goal of reducing low birth weight incidence by at least one
third between 2000 and 2010 is one of the major goals in ‘A World Fit
for Children’, the Declaration and Plan of Action adopted by the United
Nations General Assembly Special Session on Children in 2002.
Objective: The purpose of this study is to devise and promote a strategy
that prevents the neonatal deaths due to LBW in the tribal district of
Narmada and similar settings. This study presents an analysis of low
birth weights in the tribal area is an effort to understand the severity of
this public health problem, gain insight into existing assessment
strategies and map the regional distribution of LBWs.
Methodology: The statistics of live birth and linked infant death
records aggregated over the years 2008-09 and 2009- 10 by health dept.
of Narmada district is used for this study . The study has been done by
using Secondary data. Data extracted for that review and relevant to the
Keywords: Low Birth Weight, Neonatal Mortality, LBWs, Neonatal
Deaths
estimation of low birth rates are used for this study, along with data from
a supplementary qualitative discussion conducted with the medical
officers on LBWs for the years 2008-09 & 2009-10 to bring the
estimates up to date. Literature search strategy included reviewing
relevant databases, conducting manual searches, contacting experts
active in the field and various online resources on the subject. The total
sample size for this study is 560 infant deaths (0-1 yr.) over the year
2008-09 & 2009-10.The sample frame was 260 LBW babies over the
same year.
Findings: The figures clearly suggest that LBWs cases are higher
among the forest villages. This is one of the prime reasons for high
neonatal mortality in the district. This can also be taken as a poverty,
knowledge and health vicious cycle. The estimated 260 LBWs in this
small district that occurred in 2008 -2010 represent a substantial
problem for already overtaxed health department. A challenge for
future analyses is finding ways to distinguish and quantify very early,
early and late LBWs births.
Recommendations: Ensuring early registration of pregnant women,
strengthening Mamta divas, promotion of proper eating habits for
pregnant women, promotion of institutional deliveries, Installation of
sonography machine, Kangaroo Mother Care are some
recommendations that can be started as early as possible.
Ab-6
Insurance in Pune
Amit Ray
Objective: The study was focused on the consumer behavior towards
different types of Health Insurance Policies and also on consumer‘s
awareness, preference and consumption patterns. It also focused on the
determinants of image of a Health Insurance in the city of Pune .
Methodology: A study was conducted Health Insurance Industry
determining the factors influencing image of a Health Insurances
through consumer‘s opinion. Sample Selection: Non-probability
sampling technique, a convenience sampling method was used. Sample
consists of all those people who are above 18 year age in the city of
Pune. Sample Size was 100 for this study.
Customer Expectation Survey Regarding Health
Keywords: Health Insurance, Customer Expectation Survey, Consumer
Behavior
40
Personal interviews and a semi structured questionnaire were used for
data collection.
Findings: • 68% of the Respondents were not aware about health
insurance and 71% of the same were not aware about the benefits of
health insurance. 62% of those who had had a health policy had availed
benefit from their health policy, out of which 69% had faced Problems
during pre-auth/claims settlement. A sizeable 68% of the respondents
were not satisfied with the service of their current health insurer. 46%
thought that they did not need a health policy at their age, 23% had other
important financial Priorities and 11% thought that health insurance is a
bad investment as it does not yield good returns. 27% of the Study
sample strongly believes that there should be ease in pre-auth and
claims/reimbursement process. 18% ranked it as second most
important decisive parameter. Medical benefits (25%) sample ranked it
as No.1 and 22% ranked it No.2. Health risks / ailments covered was the
important decision variable as 21% of the respondents ranked it as no.1.
17% of the respondents’ ranked transparency as the No.1 decisive
parameter and 15% ranked as No.2.
Recommendations: Considering that 71% of the people were not
aware about the benefits of Health Insurance proper awareness
initiatives should be taken from the Health Insurance Companies.
Clients should be assisted during pre-authorizations and claims
settlement by the representatives of the Health Insurance Company.
Good coverage in terms of Medical Benefits should be inbuilt in the
policy without any loading premiums. Transparency regarding the
terms and conditions, exclusions, waiting periods at the point of sales is
also an important decision parameter for buying a policy. Critical health
risks can be covered in General Health Policies with a specific waiting
period.As 46% of the respondents are Private/Govt. Employees, Group
Policies for corporate tie ups should be also be introduced.
Ab-7 Analysis of Low Institutional Delivery Rate in
Ghoghamba Block of Panchmahal District in Gujarat
Anamika
Background: This study aims to find out the major demand side
barriers responsible for low institutional delivery in Ghoghamba Block
Keywords: Institutional Delivery, Institutional Delivery Rate, Low
Institutional Delivery
of Panchmahal district in Gujarat. In Panchmahal the institutional
delivery rate is 85.05%. Institutional delivery rate of Ghoghamba Block
in which the study is carried out is 57.87% , quite below the district
performance.
Objectives: 1. To identify and analyze the reasons for low institutional
deliveries in the most low performing block, Ghoghamba of the district
Panchmahal, in Gujarat. To find out the major demand side barriers
responsible for low institutional delivery rate in Ghoghamba block of
Panchmahal district.
Findings: The study shows that there are many prevalent myths
existing in the villages due to which females deliver at home, at the
same time the literacy rate of the females as well as males is very low
which adds to this problem. Also more than 50% of people were living
BPL and their family income are less than 10,000 per month so they
can’t afford the services. It is found that decision of delivery regarding
the place is taken by in laws. There is a very strong association of
trained and untrained dais in the villages in the block. These dais
convince the beneficiaries for home deliveries so that by assisting them
at home during delivery, they can earn some amount.
Recommendations: Rigorous IEC activities are needed to be done to
overcome these barriers responsible for substantially low institutional
delivery rate in Ghoghamba.
Ab-8
State ASHA Resource Centre
Anil Rajesh Dungdung
Objective: The study was done to assess and evaluate the ASHA
training programme.
Methodology: The investigator has made an effort to evaluate the
training programme by making field visits to 3 districts, observation of
cascade model of training and questionnaire method based on certain
criteria such as level of attendance etc.
Findings: Its main responsibility has been successful implementation
of the ASHA training programme so as to make the ASHA, the
Evaluation of Training Programme Conducted by
Keywords: ASHA Training Programme, Evaluation of Training,
NRHM
41
backbone of health care system in Assam. For this, it has recruited
community mobilizers, which has been actively involved in providing
training to the ASHA facilitators, who in turn, train the ASHAs in their
respective villages. The ASHA training programme has been following
the TOT model of training for ASHAs in the state of Assam. So far it has
conducted 4 TOT, to provide trainers in the respective districts. The
total no. of trainers as of March 31, 2010 were 111.These trainers in turn
have been conducting trainings in their districts in the stipulated time
given by the NRHM Assam. Finally this study opens up avenue for
further research, on ASHA training programme so as to assess, its long
term impact on the healthcare system of the state of Assam.
Limitations: This study does have certain limitation which has also
been mentioned.
Ab-9
Management Information System (HMIS) of Sub
Centre Level Health Workers (ANMs and LHVs) of
Government of Bihar
Anisha Saxena
Objective: This study was undertaken in order to upgrade the skills of
the health staff at different levels as well as to know the status of HMIS
in the state, with perception on HMIS from officials at district and block
level and also the training needs of the health personnel.
Methodology: The study was conducted in 9 zonal headquarter
districts of Bihar including; Patna, Saran, Muzaffarpur, Purnia,
Saharsa, Gaya, Munger, Bhagalpur and Darbhanga. The time frame of
the study includes data collection simultaneously in all the districts by
nine zonal coordinators of IIHMR, Patna office. A semi-structured
schedule was prepared for interviewing health workers at Sub center
level, which also included some qualitative aspects of the study.
Findings: The study was conducted in 9 zonal headquarter districts of
Bihar including; Patna, Saran, Muzaffarpur, Purnia, Saharsa, Gaya,
Munger, Bhagalpur and Darbhanga. The study has shown that about
33% of ANMs (age group more than 45 years) are the permanent staff
Training Need Assessment (TNA) on Health
Keywords: Health Management Information System, HMIS, Training
Need Assessment, Health Workers, ANMs, LHVs, Sub Centre Level
who find it difficult to collect data and prepare reports. The contractual
ANMs are young but they do not have any kind of training on data
collection and reporting. During the informal interaction, it was felt that
there was displeasure among the senior ANMs as they had been on the
same post since the time of recruitment. There has not been any kind of
promotion at their level and this has decreased their motivational level
regarding work. It was found that post of LHV in most of the blocks is
vacant and thus there is absence of handholding of ANMs at the field
level, which can again cause problems in obtaining support from higher
authority. The major problem felt by the ANMs is lack of understanding
of the formats since there are so many formats present at their level.
Knowledge about their activities 90.2 % had a positive answer but when
asked to list out their activities then out of all their job responsibilities
maximum percentage of 70 % were for maternal health and
immunization respectively. About 90 % of the ANMs just collect data
for the sake of completion of monthly reports which they have to submit
monthly. About 31% of ANMs had problems in maintaining the
registers and the major problem is found to be lack of understanding.
The results show that only 29% of the health workers have ever
received training on HMIS in past and 71 % has no idea about HMIS
which is a major point of concern.
Recommendations: Through discussion it was brought to light that the
HMIS system of Bihar is in a developmental phase, which needs
training of personnel in order to develop a strong base for quality data
generation. Some aspects which require immediate attention include
duplicate system of reporting in many districts leading to non-
uniformity of reports generated. The need for a support system,
especially at field level in order to improve the data quality parameters
is highly recommended.
Ab-10 Immunization Coverage in Mahadalit of Jamui District
Bihar: A Feedback to Programme Manager
Arunabh Ray
Background: This study discusses the use of trends in immunization
coverage data in Mahadalit Community in Jamui District in Bihar. The
study argues that these should be used as a proxy for monitoring overall
Keywords: Immunization, Mahadalit Community, Health Indicators
Methodology: The secondary data for 5EU countries and India was
collected for comparison from various sources. The findings were
compared on various parameters like donor policy, organ allocation
criteria, reimbursement, waiting list and role of transplant coordinators.
Findings: Spain is the most evolved market due to its policies and
effective implementation of the same with the donor population of 33.8
per million populations. Specific agencies in 5EU countries look after
the transplant related affairs where as in India there is no such
organization that is completely functional and maintains the organ
related transplant data. In India opt-in system of donor policy is
followed whereas in 5EU countries they follow the opt-out policy. This
supports the deceased donation of organs and brain deaths. There are
hurdles in sharing organs between government and private hospitals in
India. Where as in 5EU countries there is a channeled sharing of organs
between different regions All the 5EU countries have reimbursement
schemes for the transplant procedure and also for the lifelong
immunosuppressant usage by the government which is lacking in India.
In India transplant coordinators roles are not defined, whereas in 5EU
the transplant coordinators have a well defined role of procurement and
allocation of organs in hospital. In Indian immunosuppressant market it
is 1.6 billion rupees i.e. 35.83 m USD which when compared to the 5EU
market it is less than the half of sales of monoclonal antibodies class of
drug only.
Recomendations: The shortage of organs can be reduced by promoting
deceased organ donation with presumed consent awareness
programmes to the public. If only 5% of all the deceased patients go on
for donating their organs then there would be statistically no
requirement from the living donors. The government can also make a
policy to donate organs of brain dead patients. National insurance
policy can be introduced so that the patients can afford the procedure
and lifelong immunosuppressant therapy. An organization or society
should be given the task of keeping the country related transplant data
records. The transplant coordinators to provide the counseling to the
living donors as well as relatives of brain dead donor must be appointed
in various hospitals.
42
health indicators in most vulnerable group of the society. This also
discusses the need for special attention regarding the immunization in
the Mahadalit community.
Objective: In order to monitor progress in achieving this objective,
immunization coverage, if measured annually, can serve as an indicator
of a health system's capacity to deliver essential services to the most
vulnerable members of a population(in this study children of Mahadalit
community.
Finding: This is the most socially and economically backward
community and the health indicators, literacy, living places are in very
poor shape. Partial Immunization is around 50 percent in this
community. Illiteracy is around 92 percent and only 7 percent
populations are using toilet facility.
Recommendation: By protecting infants from VPDs, immunization
significantly lowers morbidity and mortality rates in children. The
security provided to families can lead to lower birth rates. This study
concludes with recommendations that urge for special emphasis and
planning to increase immunization coverage and overall development
of Mahadalit Community.
Ab-11
and India w.r.t Health Care Reforms and
Immunosuppressant Therapy
Deepa Raina
Background: The paper discusses the organ transplantation that takes
place in India. As per the data available total of road accidents in India is
roughly 90,000 per annum. Approximately 4000 transplants take place
in a year. These organs are taken from living donors and not cadaver
donors.
Objectives: To compare the existing system of organ transplant in India
with that of 5EU ( UK, Spain, Italy Germany, France) countries. To
analyse the existing gap between India and 5EU countries.To
recommend the suggestions for future improvements.
Comparison of Organ Transplant Scenario in 5EU
Keywords: Organ Transplant Scenario, Health Care Reforms,
Immunosuppressant Therapy.
43
Ab-12
Management Information System (HMIS) of Block and
District Level Health Personnel (DEO/BHE/ BHM, M&E
Officer/SA and DPM) of Government of Bihar
Jaspreet Mahal
The project of “Strengthening of HMIS in Bihar” is undertaken in order
to upgrade the skills of the health staff at different levels. Under this
project, the study was undertaken in order to know the status of HMIS
in the state, with perception of HMIS from officials at district and block
level and the training needs of the health personnel.
Methodology:. The study is exploratory in nature with both aspects of
Qualitative and Quantitative research methodology. The study was
conducted in 9 zonal headquarter districts of Bihar including; Patna,
Saran, Muzaffarpur, Purnia, Saharsa, Gaya, Munger, Bhagalpur and
Darbhanga. Data collection was done simultaneously from January 19-
26, 2010. Multi stage sampling was done as per convenience of the
researcher. Various sets of semi-structured schedules were prepared for
interviewing district and block level officials
Findings: Block level findings were - 71% of the respondents reported
the following of new reporting system (web portal system). The district
HMIS feedback mechanism mainly includes weekly meets (49%) with
no discussions on problems regarding reporting format. There is a
duplication of reporting in many districts and lack of standardization of
the state reporting formats and recording registers. Other weak areas of
HMIS cited by respondents include lack of understanding of the
formats by the ANMs (38%), Data entry operators unaware of the basic
concepts of health data, problems in internet connectivity (22%),
incomplete and late reporting by field level workers, untrained new
staff (80%), data used majorly for report preparation only (73%) and
low number of data quality checks (53%) due to high workload of block
level data officials. The need for HMIS training is felt by 91% of
respondents and mostly on all components of HMIS. The weak areas of
district level HMIS as perceived by district personnel were similar to
those of block level. The content analysis of the NRHM monthly
reporting formats of PHC level and District level data from MoHFW-
HMIS portal highlighted the common mistakes in filled in formats at
Training Need Assessment (TNA) on Health
Keywords: Health Management Information System, HMIS, Training
Need Assessment, Health Personnel
the PHC level, especially in immunization and Iron Folic Acid tablet
distribution data.
Recommendations: Through discussion it was brought to light that the
HMIS system of Bihar is in a developmental phase, which needs
training of personnel in order to develop a strong base for quality data
generation. There is need of training for block level workers especially
for improvement of data quality and importance of use of data as
information in decision making and planning. We also require
handholding of the field level staff for better data generation, regularize
the logistic supply and improved internet connectivity at block level
and strengthening of the monitoring system regarding HMIS on field.
Ab-13
Northeastern States of India
Jaya Swarup Mohanty
Objective: The study was conducted to have an understanding of the
various factors that are responsible for contraceptive use, as there was
variation in the TFR in eight different states (Arunachal Pradesh,
Assam, Manipur, Meghalaya, Mizoram, Nagaland, Sikkim and
Tripura).
Methodology: Data of RCH round 2 was analyzed in this study. First a
bivariate analysis was done followed by a binomial logistic regression.
The use of contraceptives was taken as the dependent variable and the
predictors were religion, caste, place of residence, standard of living
index, years of schooling of respondents and their husbands, sons ever
born, children ever born, age at consummation of marriage, marital
duration and awareness for temporary methods of contraception. In the
first bivariate analysis the background variables were analyzed against
the awareness about the female sterilization, male sterilization and
other modern methods of contraception. In the second bivariate
analysis the awareness variables were clubbed together with the
background variables and were analyzed against current use of
contraceptives. In the logistic regression current use of contraceptive
was used as the dependent variable (contraceptive use =1 contraceptive
non use =2) , to identify the predictor variables related to socio-
economic, demographic factors governing its use among the people of
the eight different states under study. Two models were used to
Factors Governing Contraceptive use in the
Keywords: Contraceptive Use, Northeastern States, RCH
44
demonstrate the effect of awareness regarding temporary methods of
contraception. The first model used only those background variables
which showed significant association with current use of
contraceptives. In the second model awareness was clubbed together
with background variables to observe effects on the current use of
contraceptives.
Findings: The major result that could be interpreted was the significant
effect of primary education of both respondents and husbands on the
use of contraceptives. The other factors that were significantly affecting
the use of contraceptives were religion, caste, place of residence,
standard of living index, sons ever born, children ever born, age at
consummation of marriage, marital duration and awareness of
temporary methods of contraception. It was found out that not all these
factors were significantly affecting the contraceptive use in all the
states. The result of the study confirms that to significantly increase the
contraceptive use in the North east part of India, the prevailing policies
and acts of the Government of India are enough if implemented in the
right spirit and with firm conviction.
Ab-14 S
District Rajsamand
Jyoti Meena
Background: With the up gradation of health facilities provision of
additional inputs, and enhancement of skills of service providers it is
expected that the health facilities would comply with the requirements
of the clients. The utilization of these institutions depends upon the flow
of the patients from the outreach areas. Referral at appropriate
institutions will reduce the gap between illness and seeking treatment
and out-of-pocket expenditure. The institutions below district level
would be able to screen the patients, limiting the load on district
hospitals. However, the above investments could really bring forth the
desired results if only they are backstopped by an effective referral
system. Usually between 5 and 10% of patients seen in the PHC/CHC
will be referred to a higher level for either diagnostic or more
specialized care.
Objectives: The main objectives of the study were to study the existing
structure of the referral system in the district Rajsamand. To study the
tudy on Implementation of Referral System in
Keywords: Referral System, Health Facilities, Quality Improvement
reasons behind non compliance of the referral system and to suggests
way to improve the referral system.
Methodology: The research approach adopted for the study was a
descriptive method. It includes informal interviews with doctors,
patient counselor, ward incharges & DPC and study of referral records.
Findings: In the month of January, February and March cases referred
to district hospital form
0.025 %, 0.037% and 0.081% respectively and cases referred from
district hospital form
0.50%, 0.46% and 0.37% respectively of total OPD. Average
percentage of referred cases from different CHCs of district Rajsamand
to tertiary care hospital in January, February and March is 0.47% ,
0.42%, 0.31% respectively of the total OPD.
Recommendation: The findings points towards two things: One is the
referral cases are very less and secondly the referral system is not being
followed. An effective referral system has to be designed by focusing
on three important areas: the structure of referral system, management
coordination and quality improvement.
Ab-15
Participants, Pre and Post Capacity Building
Training for Village Health and Sanitation
Committee in Chittorgarh District of Rajasthan
Kiran Madhukar Narkhede
Background: The Village Health & Sanitation Committee (VHSC) is a
simple and effective management structure at the lowest level,
comprising representatives from the village. Its key function is to
prepare the village health plan, implement it and manage the fund
which is earmarked as per the need of the community.
Objective: A small scale Knowledge and Attitude survey was
conducted during (Pre and Post) trainings of participants for Block TOT
of Village Health and Sanitation Committee capacity building training
for in Chittorgarh district of Rajasthan. The purpose of the study was to
assess the level of Knowledge and Attitude of the participants, before
Assessment of the Knowledge and Attitude of
Keywords: Capacity Building, Village Health, Management Structure,
Knowledge and Attitude
45
and after the VHSC training sessions and develop recommendations for
future implementation of VHSC trainings in other states in India.
Methodology: The study was carried out for 11 blocks of Chittorgarh
districts of Rajasthan. Survey conducted of all trainees’ pre and post
training. Convenience sampling was used. Closed ended self
administered questionnaire was prepared for the survey. Sample
achieved was 34.
Findings: It was found that, the knowledge and attitude improvement
was significant in each area of trainings. Knowledge and attitude has
been improved in every aspects of the training. So it is quite obvious
that pre-training the answers were distracted towards many options but
post-training responses were accumulated to the correct response
Medicine at PHC is out of stock should be informed to block CMO as a
advocacy protocol. 79% pre and 85% respondents post training were
for block CMO.
Recommendation: The survey reveals, Training is the effective tool
for the better functioning of VHSC. The knowledge and Attitude can be
improved by effective training sessions. Study can help and provide
data support to develop modus operandi for future implementation of
the VHSC trainings in other states in India. Information from this
survey shall be helpful for the other states to focus on the problem areas
and re route resources to conduct the VHSC trainings.
Ab-16
Valsad
Mansi Shekhar
Background: During the mid-1990s, the World Health Organization
(WHO), in collaboration with UNICEF and many other agencies,
institutions and individuals, responded to this challenge by developing
a strategy known as the Integrated Management of Childhood Illness
(IMCI). This strategy has been expanded in India to include all neonates
and renamed as ‘Integrated Management of Neonatal and Childhood
Illness (IMNCI)’. To start this scheme in India, it has been decided to
start its implementation in BDCS focused districts .district initially
with support from UNICEF. So in Gujarat state it has been started in
Valsad.
Performance Assessment of IMNCI in District
Keywords: Integrated Management, Neonatal and Childhood Illness,
IMNCI, Performance Assessment
Objectives: The goal of this study is to assess IMNCI implementation
in Valsad district of Gujarat to strategize for accelerating effective
implementation.
Methodology: For this data from IMNCI format filled on district level
quarterly and compiled yearly have been used for this study .we are
going to assess the implementation of IMNCI on the basis of mortality
pattern , morbidity pattern, and case management skills of the heath
staff.
Findings: The number of infant death reported has increased in both
the age groups 0-2 months and 2 months-5 years after the
implementation of IMNCI in Valsad district especially in the two tribal
blocks of Valsad District i.e. Kaprada and Dharampur,due to prompt
reporting from the health staff. Number of children, identified as sick,
followed-up, referred to a health facility shows increase. Percentage of
reported LBW babies has increased since 2008 to 2009 due to proper
weighing done by health worker. Morbidity due to diseases has been
reduced from 2008 to 2009.
Ab-17 Evaluation of Functioning of Rogi Kalyan Samiti and
Utilization of RKS Grant Received byPHC in the District
Navsari, Gujarat (Financial Year 2009-10) for Improving
the Standard of PHC
Minu Manuhar Sinha
Objective: The objective was to study the functioning of RKS in the
districts Navsari, Gujarat and to understand the process of
decentralized funding and the provision of providing untied funds at the
peripheral level (Primary Health Centre) from the central level. The
study also focused on the structure and functioning of RKS in health
facilities, the utilization of funds by RKS and to assess the facilitating
and inhibiting factors affecting the functioning of RKS. To study the
improvements made at the facilities and services provided for the
purpose of improving standards. The study also identified all possible
strength, weakness, opportunity and threat that is involved in proper
utilization of the provided funds.
Methodology: The study was a cross-sectional descriptive study done
Keywords: Rogi Kalyan Samity, RKS Grant, PHC, Decentralized
Funding
in the PHCs of district Navsari of Gujarat. 50 % PHCs were identified
from the district. Simple random sampling technique was adopted as
sampling design and Non Probability sampling was done on
convenience basis for the selection of Client in the hospitals.
Predesigned and pretested interview schedule was used for data
collection from the study subjects. The study subjects were RKS
members ( Medical Officer of the PHC and Kerawani Nirikshak ) and
clients (20% OPD and 10% IPD patients). Quantitative data were
entered and analyzed using Microsoft Excel.
Findings: It was observed that the RKS existed according to guidelines
at all the PHCs. A shortfall of members was however, noted. The flow of
the central grant of Rs. 1, 00, 000 was found to be smooth. The received
funds were mainly utilized for development of physical facilities and
infrastructure of the PHCs, provision of basic facilities for the patients,
purchase of medicines, development of basic laboratory facilities and
transportation. The expenditure however is below the mark in absence
of predefined protocols. The facilitating factors for the smooth
functioning of RKS include involvement of health personnel in the top
management, uninhibited flow of grants annually and people’s
involvement in decision -making. The inhibiting factors for the same
are multifaceted: ranging from non -availability of proper expenditure
guidelines to involvement of unmotivated members burdened with
additional responsibilities, as also low knowledge and awareness levels
among the community. Most of the community members and clients
were not aware regarding existence and objectives of RKS in the health
facilities, but they reported some improvements in the quality of the
health services within 2-3 years. However, most of the community
members were not satisfied with the provision of good quality of
medicine, availability of specialist care, high referral rates and higher
investigation.
Recommendations: Proper guidelines for expenditure of funds should
be framed, and audit mechanism defined. The barriers to the effective
functioning of RKS may be identified at the earliest and effective
measures to eliminate those may be initiated. Additional incentives for
additional work should be provided to the RKS members. Increase
community participation and have more informed clients. Sundry Fund
is to be maintained at PHCs for emergency. As there is no feedback
mechanism hence, it is recommended for the development of a proper
mechanism related to the decisions taken during the meetings of the
RKS members for the effective implementation.
46
Ab-18
Urban Slums of Junagadh Municipal Corporation,
Gujarat
Mohit Sharma
Background: For providing effective coverage for maternal and
childhood health and nutrition Mamta Divas was launched by the
Department of Health and Family Welfare and Department of Women
and Child Development, Government of Gujarat. Mamta Divas
programme was launched under NRHM, R.C.H-II that is considered as
platform for inter-sectoral convergence.
Objective: The present study was conducted in the urban slums
pockets of Junagadh city, under Junagadh Municipal Corporation,
describing the effectiveness in the implementation and utilization of the
services given during Mamta Divas. This study was done to assess the
implementation of “Mamta Divas” on the targeted mothers and
children and to study various factors related to knowledge and
awareness of the programme in the urban slum pockets of Junagadh
city.
Methodology; This qualitative research study was done in urban slums
for looking into various issues and components related to Mamta Divas.
Under this study, the service delivery, the knowledge and attitude of the
community with the factors responsible for the utilization of the
services of Mamta Divas was studied. A total of 60 Mamta Diwas
sessions were visited for the survey and 150 mothers those who are
either in their antenatal period or having a living child under 0-3 months
were interviewed in the survey these respondents were selected using
the Multi stage sampling based on 30 clusters methodology. In step 1,
30 clusters were selected and in next step 5 sample units were selected
from each cluster. The level of utilization of the services provided at the
Mamta Divas, the determinant factors against the knowledge and
utilization of services were also identifies. Research tool is interviews
with target population, questionnaires for the service providers and
beneficiaries and checklists for the assessment.
Findings: Study emphasis on effective and efficient implementation in
order to overcome loopholes of procedure .This Study reveals major
issues related to the implementation of Mamta Divas Programme in
urban slums, that prevents better out-reach to beneficiary. It was
An Assessment of Mamta Diwas Programme in
Keywords: Mamta Diwas, Urban Slum, NRHM, Maternal and
Childhood Health
47
evident from the findings of the study that there was lack of monitoring
and supervision activities by the higher cadre, which brings irregularity
in the working & reporting of field staff. A large chunk of the population
are aware of the Mamta sessions, but still no visits are done because of
the reasons like family’s’ apprehensiveness and lack of belief in the
health services.
Recommendations: Regular and focused IEC activities are required so
as to elevate community belief in the need for antenatal and post natal
care. This study may prove useful in chalking out targeted interventions
for the Mamta Diwas.
Ab-19
Study in Bihar
Neha Dumka
Background: The Janani Suraksha Yojana (JSY) is a centrally
sponsored intervention under the National Rural Health Mission, with
the objective of reducing maternal and neo-natal mortality. The
JSY’s main strategy is the promotion of institutional delivery by
empowering and enabling women to access safe delivery in health
facilities. The mechanism is the provision of a cash entitlement to the
family and an incentive to the ASHA.
Objective: An Evaluation study of Janani Baal Suraksha Yojana was
conducted in Nalanda, Samastipur and Madhepura Districts of Bihar
state.
Methodology: JSY enumerates 83.78 lakh beneficiaries, and the
expenditure under this head is now over Rs. 1241 crores. Both the
number of beneficiaries and expenditure on this scheme continues to
increase steeply and there is little clarity on where this will plateau. The
central guidelines for the JSY to the states set out clear directions on the
administrative and financial mechanism for the scheme. However JSY
has been interpreted and implemented in a variety of ways across the
states, not necessarily in contradiction to the guidelines, but based on
individual state contexts, field reality, and the perceptions of
administrators and service providers. Outcomes in the states also vary
substantially.
JBSY (Janani Baal Suraksha Yojana) Evaluation
Keywords: Janani Baal Suraksha Yojana, JSY, NRHM, Safe Delivery,
Health Facilities
Findings: Nalanda is a second best performing while Samastipur and
Madhepura are poor performing districts. Selection of the three districts
is based on the number of institutional deliveries in the district. The
districts will be ranked based on the number of institutional deliveries
against expected deliveries using HMIS* data. The second best
performing and lowest performing districts will be selected. In addition
the district with second highest percentage of SC/ST population will be
selected to understand issues of social exclusion. The reason for
selecting the second best and lowest is to exclude the outliers.
Ab-20
Non IPHS PHCs in Gondia District, Maharashtra
Neha Maheshwari
Background: The flow of patients has been increased over time.
Hence, it became extremely important for the management executives
to find out the service delivery and service utilization pattern in the
district so that they can upgrade rest of the PHCs through IPHS in the
second round.
Objective: A case control study was carried out with the objective of
seeing the effects of IPHS standards in the PHCs of Gondia district in
Maharashtra which were upgraded through IPHS in 2006-07 in the first
round. The cases were the PHCs upgraded through IPHS and controls
were the PHCs yet to be upgraded through IPHS. The specific
objectives of the study were to understand the present service
utilization pattern and the change in service utilization at PHC level.
Methodology: Data was collected for service coverage and service
utilization pattern in terms of OPD case load, Indoor case load, delivery
service and investigations performed. Observations were done for the
availability of inputs like provision of doctors and health workers at
PHCs, infrastructure development, provision of potable water and
electricity in the PHC. Also survey of health facilities under study was
done with the checklist of standard guidelines provided by IPHS. Exit
interviews were taken from the women who delivered in the PHC and
the OPD patients. Questions incorporated in the schedule were mainly
directed toward the inputs provided to improve quality of services.
To Assess the Service Delivery of IPHS Upgraded and
Keywords: Services Delivery, Services Utilization, PHCs, IPHS
48
Findings: The findings of the study show an improvement in the
utilization of the services being provided. The indicators in both the
study groups show progress. But IPHS PHCs are running ahead. The
main reason may be ascribed to the provision of additional qualified
man power to the upgraded PHCs. It can be inferred from the data
available and interrogation with the staff and beneficiaries that the
increment in service utilization may be ascribed to provisions of extra
facilities to the IPHS PHCs. The IPHS PHCs under study are well
equipped with the basic facilities suggested by the guidelines. Man-
power remains the most important issue in both the types of PHCs. Staff
nurses and ANMs are unavailable in far flunked areas.
Ab-21
Diwas in Vallabhipur Block of Bhavnagar District
Nidhi Jain
Background: Mamta diwas is exclusively designed concept to
improve the health of mother and child. But the proper implementation
is a must to achieve the desired goals. Mamta sessions have been going
from years and as the time passes monitoring and supervision of
sessions are not taking place. No supervison is there to check whether
the services being provided are in a proper way or whether all the
services that are meant to be provided are given to the beneficiaries or
not. Lack of supervision is hampering the effectiveness of these
sessions.
Objective: To find out exactly how supervision will improve the
services an intervention was done in Bhavnagar district. A block,
Vallabhipur was chosen to see the effect of increased supervision of
mamta diwas. All the sessions were supervised and on the spot training
was also given wherever required. Maximum coverage was ensured, as
well as all the essential equipments, drugs, stationary was also
provided. The supervisors were given supervisory checklist and
interview with the beneficiaries and service providers.
Findings: As per the supervisory checklist required set up for mamta
diwas was present at the centers but effective execution is needed at all
levels. All the service providers felt that the project had helped a lot in
Effect of Supervision on Service Delivery at Mamta
Keywords: Mamta Diwas, Service Delivery, Supervision
their working, since the workers knew that someone was coming to
monitor them they remain present at the sessions otherwise whole
burden was on FHW’s shoulders. The availability of staff especially
MPHW (only 2 were present out of 9) & ASHA (only 5 were present) in
the district was a major problem.
The district report from past 6 months showed that there are some
improvements in the services, for e.g., the number of cases identified
and referred for ANC had increased during the months when the project
was running. The same improvement was been tracked in child status
also. Moreover financial assistance to anagnwadi workers had also
started.
Recommendations: The supervision activity had played a supportive
role in implementing and designing mamta sessions effectively and
efficiently. But the focus should be given to those elements which plays
underlying role for e.g. the staff, sources of motivation as well as the
financial support.
Ab-22
Blocks of Mewat
Nidhi Vats
Background: Women form the backbone of any society and deserve an
equal status in the society as that enjoyed by men. But women are
excluded from social, economic and political spheres of society.
Objective: The study was conducted to understand the social status of
women in the community of Mewat in Haryana. Mewat is
predominantly a rural district in Haryana. The health indicators in
Mewat especially for women are particularly dismal. The area lags
behind the rest of Haryana on almost every yardstick of development
indices.
Methodology: The study is qualitative and focus group discussions
were conducted with various stakeholders mainly women to obtain
information and understand the needs of the community about current
practices, communication media and beliefs regarding role of women
in the society. Focus group discussions were conducted in villages of
Nuh and Tauru Blocks in Mewat district.
Gender Bias and Status of Women in Nuh and Tauru
Keywords: Gender Bias, Women Health, Women Status
49
Findings: The findings reveal that in Mewat, by and large in the
societies of both the religious groups, girls are less wanted in the family
compared to boys. Education of girls is not preferred by the Meos and
girls get married at an early age. Women have been found to have no say
in the decision making process of the families. Men take all the major
decisions of the family as well as all the decisions regarding number,
timing and sex of children. As women have no autonomy to take
decisions for themselves, it is crucial to involve key stakeholders, men,
mother-in-laws and community influencers such as Maulvis in the
project. Also, education is one of the means to empower the women
with knowledge, skills and self-confidence necessary to participate
fully in the development process. Hence, emphasis on female literacy is
essential.
Recommendations: Door-to-door interaction with both women and
members of the family is the suggested communication media for
achieving the overall objective of the project.
Ab-23
Jeevan Raksha Kosh
Poonam Yadav
Background: Millennium development goal represents the
international consensus on improving conditions that affect the poor. To
achieve the MDG, government health policies need to focus on poor
population of India. With low literacy levels, poor health information
and often persistence of traditional beliefs and superstitions, the poor
are ill equipped to make rational choices in health related matters. To
make health facility available to BPL families, ‘free health care model’
is adopted by Rajasthan government called as ‘Chief Minister BPL
Jeevan Raksha Kosh’(CM BPL JRK). The scheme was envisaged
during the year 1999-2000 by the then Rajasthan Government headed
by Ashok Gehlot, CM Rajasthan. It came into implementation from
September 2009. CM BPL JRK was launched in all the districts at one
go. Under this scheme free treatment facility, both indoor and outdoor is
provided to BPL family’s patient in all government Health Institute in
the State.
Objectives: This study is an attempt to identify the factors that affects
Factors Affecting Utilization of Chief Minister BPL
Keywords: BPL, Jeevan Raksha Kosh, Millennium Development Goal
utilization of this scheme.
Methodology: Study population is the BPL population of district Jhunjhunu. Secondary data was from the data available from online reporting. Primary data was taken from questionnaire filled by a sample of 90 patients coming to the district hospital.
Findings: During the study, it was revealed that the BPL population’s awareness about various features of the scheme is limited in JJN. Wages loss is a major factor that affects the care seeking behavior of BPL population. The poor report (slightly) greater illness (high OPD) but are much less likely to use go for treatment(low IPD); they are more likely to self treat and much more likely to do nothing.
Ab-24Health Services (AFHS) Centre at PHC Sadhi, Block Padra, Gujarat
Puneet Gupta
Background: Adolescents account for almost one third of India's
population. They are prone to suffer from reproductive and sexual
health, nutritional, mental and behavioral problems. Health services
which cater exclusively to the needs of adolescents are scanty and
concentrated in urban areas. Adolescent Friendly Health Services
(AFHS) which provide a broad range of preventive, promotive and
curative services under one roof can help to ensure improved
availability, accessibility and utilization of health services. AFHS is
being initiated by governmental, private and non-governmental
organizations. Lessons to improve the quality of AFHS could be further
learnt from evaluation of pilot projects and success stories of similar
initiatives in other places.
Objective: Adolescent Friendly Health Services (AFHS) introduced in
Vadodara district, Gujarat state as a pilot project at PHC Sadhi, Block
Padra. Services started w.e.f. 9th March 2009 and a separate compound
was designated as the centre for providing AFHS. Block Padra a highly
industrial area showing high no. of migratory population. PHC Sadhi
was made a 24x7 PHC. The PHC has a good linkage with school staff.
The services being rendered at the Adolescent Friendly Health Services
Centre at PHC Sadhi were being assessed as the study objective.
Analyzing the Functioning of Adolescent Friendly
Keywords: Adolescent, Friendly Health Services, AFHS, Health Services
50
Methodology: The population of the adolescents covered was 4071.
Questionnaire was developed to assess the client’s perspective
(adolescents) as well as the service provider (staff at the centre trained
to provide services).The data was secondary in nature and was collected
from registers maintained at the AFHS centre Visits were undertaken to
the AFHS centre established within the premises of the PHC at Sadhi
(Block Padra). Adolescents visiting the centre were interviewed as also
the medical officer at PHC. The other staff providing the services at the
centre was also interviewed to have an overview of service-provider’s
perspective, the client (adolescents) perspective.
Findings : The services provided at the AFHS centre at PHC Sadhi
were grossly underutilized. As compared to boys the number of girls
reporting to the centre was considerably lower mainly due of cultural
barriers and lack of a regular female counselor. A wide communication
gap existed between parents and their adolescent children and also
between school teachers and the school going adolescents. Hence, the
adolescents sought information mostly from peers and media. The
adolescents visiting the centre were satisfied with the quality of
services being provided. Though mostly preventive services were used,
but a few of them sought curative services for sexually transmitted
infections from the Medical Officer at PHC or the visiting
Gynecologist. The preventive services on the other hand, mainly
included counselling for general issues and contraception.
Recommendations: The situation analysis suggests that there is an
urgent need to address the problems related to adolescence by
providing services specifically catering to this age group. A relevant
response would be to equip them with appropriate knowledge, skills,
attitude, and support for self advancement. Sensitization of parents,
school teachers and civic society is an important step to set the stage for
the healthy growth and development of adolescents.
Ab-25
Dahod
Ram Krishna Kumar
Background: National Rural Health Mission was launched to provide
accessible, accountable, affordable, effective and reliable primary
Assessment of Functioning of ASHA in District
Keywords: ASHA, NRHM, Primary Health Care, Health Services
health care to all. The Mission proposed architectural amendments in
the health infrastructure while introducing a new community based
cadre designated as Accredited Social Health Activist (ASHA). ASHA
was proposed to work as a change agent and will act as a link between
community and the health service provider. The proposed role of ASHA
was to provide primary medical care, advice the villagers on sanitation,
hygiene, and antenatal & post natal care, escorting expectant mothers to
hospital for safe delivery etc.
Objective: ASHAs are working in the villages since last five year no
systematic study has been conducted to evaluate the performance of
ASHA in the district Dahod. Therefore the main objective of the study
was to assess the gap in functioning of the ASHAs and then suggest
steps for improvement.
Methodology: To assess the objectives, a cross sectional study with 40
ASHAs, who served at least for one year, was conducted in two block of
Dahod district. Interviews were also conducted with ANMs and AWWs
to assess the coordination level of ASHAs with them. An interview
schedule was used to conduct the survey.
Findings: Results from the study show that ASHAs were selected
based on their qualification and experience through personal
interviews. Being a tribal district, majority of the ASHAs in the block
were young and more educated against proposed criteria. Half of the
ASHAs were serving village with population more than 1000. Majority
of the ASHAs received training on two initial modules only. The level
of knowledge about the role and responsibility was poor among
ASHAs.
Primarily ASHAs focused on incentive related activities like
institutional delivery, Immunization, and ANC/PNC services. They
were reported to be satisfied with their job. However, they were
unsatisfied with the irregular distribution of monthly honorarium.
Approximately half of the ASHAs did not possess the Drug Kit.
Ab-26Rajasthan
Richa Chaturvedy
Background: HIV Estimates for Rajasthan are erratic it has been
HSS Data Analysis of HIV/AIDS in Sentinel Group of
Keywords: HIV/AIDS, HSS Data Analysis, STI, HIV Sentinel Surveillance
51
described as a highly vulnerable, high priority state. Given the current level of knowledge regarding sexually transmitted infections (STI) and sexual behavior, particularly among vulnerable sub-populations, there are strong indications that Rajasthan is indeed a highly vulnerable state.
Objective: The objective of this report is to study the HIV /AIDS prevalence rate among sentinel groups in the State of Rajasthan and develop the strategy to strengthen the HIV/AIDS programme in the state.
Methodology: HIV Sentinel Surveillance (HSS) system involves carrying out cross-sectional studies, to collect the data for ANC, FSW, STD sentinel groups. This study is based on the secondary data which was collected during the district Epidemiological profiling of HIV/AIDS scenario in Rajasthan at SIHFW from RSACS, NACO and District officials at various districts which were appointed for DEP Project.
Findings: The main outcome of this study is, HIV is more prevalent in 20-29 yrs age group and in rural area. HIV prevalence in ANC sentinel group in less than 20 years age group is 0.2%, in 20-29 year age group 1.6%, in 30-44 age groups 0.3% and 0.1% of the Urban and 0.3 % of the Rural Population is HIV Positive. FSWs are more prone to HIV positivity in the age group of 20-29yrs, 1.88% of the Urban Population and 4.73 % of the Rural Population are HIV Positive. In STD clinics- Age group, 2.6% of males and 3.1 of females are positive.
Recommendations: Suggested to organize awareness camps, volunteers and target intervention groups for working for the upliftment of FSWs. The ANC attendees should be benefitted through counseling and future treatment with ART. The STD patients need to be informed about their vulnerability to Contract HIV/AIDS, treatment and timely advice are most important.
Ab-27Services: ART Center vs. ART Center
Rit Shukla
Objective: The Study was conducted to study the perception of clients
towards the HIV care services provided at ART Centre vs. Link ART
Centre as well as to understand the level of adherence of PLHA to ART.
Clients Perspective on Assessment of HIV Care
Keywords: HIV/AIDS, ART Center, HIV Care Services, Clients Perspective
The study also suggested some amendments in the strategies to manage
the existing problem of non adherence to ART.
Methodology: Exit interviews were conducted to assess the clients’
satisfaction level at the Link ART Centre and ART Centre which in turn
reflects the quality of services provided by the Centre. Situational
analysis of Link ART Centers was undertaken by a comprehensive
assessment of space allocated to LAC, human resources, materials and
other facilities available in the selected Centers. Facility tool was
prepared for this purpose. Relevant information on utilization of
services in selected LACs was obtained through the available records
and registers maintained by them.
Findings: ART Center has improved access to rural population. The
occupational distribution of clients employed in the 12 months
preceding the survey shows that majority clients were agriculture/
unskilled worker. Nearly one fourth of the clients were students,
housewives or unemployed. The awareness regarding the services
available in the center was found to be high among the clients of ART
Centre. The study reveals that 65 percent of the clients reported
improvement in the quality of life to a great extent after using services at
LACs. Method used for counseling is one of the most critical steps of
high quality counseling.
Recommendation: Improved accessibility of Anti retro viral treatment
through LAC has definitely increase the regularity of PLHA for HIV
treatment which is most significant component of drug adherence.
There is need for taking a decision on provided ART services (through
ART centers or LAC) in each district of the country to attain optimal
level of adherence. Facilities for CD4 count at LACs will further
facilitate PLHA including new registrants. Better linkage and feedback
from nodal ART center and DAPCU wherever set up is also
recommended.
Ab-28 Assessment of EmOC Services in Kachchh District,
Gujarat
Sabyasachi Mohapatra
Background: The EmOC strategy was adopted in India in 1992 under
the Child Survival and Safe Motherhood (CSSM) project (funded by
the World Bank and UNICEF).
Keywords: EmOC, Child Survival, Safe Motherhood, RCH
52
Objective: This program specifically focused on development of
comprehensive EmOC centers throughout India. The focus continued
in the subsequent program (1997–2004, also funded by the World
Bank) with the new name of Reproductive and Child Health (RCH).
However, there was little progress in establishing comprehensive
EmOC centers in rural area.
Methodology: A facility survey of 80 health facility providing
maternity services in Kachchh was done on the conceptual framework
of 5 process indicators EmOC as mentioned by “Guidelines for
Monitoring the Availability and use of obstetric services UNICEF
WHO UNFPA August 1997” data was collected for the time period of
1st April 2009 to 31st march 2010.
Findings; In total there were 49 government and private facilities
which provided EmOC services .17 government and 13 private
institutions that were non EmOC service providers. Number of EmOC
facilities per 500000 population comes around 13.61. The distributions
of these facilities are not adequate. Caesarean section services and
blood transfusion services are located in urban area of Bhuj and Anjar.
Proportion of births in EmOC facilities (basic and comprehensive) was
44%. Proportion of women estimated to have obstetric complication
treated and delivered in EmOC facilities is 49%. The percentage of
Caesarean section of total births was 3%. This clearly indicated that
access to critical surgical services was not adequate.
Ab-29
Suraksha Yojana in General Hospital, Sirohi
Sakshi Jain
Objective: Present study for assessing the implementation status of
Janani Suraksha Yojana was conducted at General Hospital, Sirohi to
study the current status of the scheme, awareness of the beneficiary,
involvement of ASHA and other providers in the implementation of
JSY in the hospital.
Methodology: Both Primary and secondary data from beneficiaries,
providers and hospital records respectively was collected. This
includes Interview Schedules for beneficiaries and ASHA’s, focused
group discussions with ASHA’s and Hospital records. Results of this
A Study on the Implementation Status of Janani
Keywords: Janani Suraksha Yojana, ASHA, NRHM, ANC
study are based on interviews, informal discussions and Focused group
discussion with 105 beneficiaries, 2 Doctors and 15 ASHA’s.
Findings: Number of deliveries in General hospital, Sirohi has shown a
rise of more than three times after the implementation of the scheme.
Same is the case with ANC coverage and TT that are showing a decline
due to the non compulsion of ANC card for getting JSY benefits. Both
beneficiaries and providers have a very poor knowledge about JSY but
as far as utilization of services is concerned about 87 percent have
undergone ANC checkup and about 92 percent have received TT
immunization. No beneficiary stayed in hospital for less than a day as
per NRHM guideline all has received their JSY benefits through
cheques. However, services received by beneficiaries particulary
through ASHA are very poor. Out of the 78 beneficiaries who aware
about ASHA 30.7 percent replied that they received any kind of
counseling like for breast feeding or nutritional practices, While 74
percent of the woman replied that they were neither accompanied by
ASHA nor transportation was arranged by ASHA. The focused group
discussion and interview from doctors state the need for some
innovative measures that need to be taken for better results and success
of the scheme.
Recommendations: Time to time training of ASHA’s is necessary.
Provision of blue sarees instead of Blue coats for ASHA’s to remove
cultural barriers among community can be initiated., Extensive
campaigning for JSY using a celebrity , Compulsion of presenting ANC
card and accompany of ASHA for getting JSY benefits and provision of
weighing machines for regular monitoring of pregnant mothers and
some other recommendations.
Ab-30 EPI Coverage Survey in Rural Areas of Sabarkantha
District in Gujarat
Shikha Bansal
Background: According to data revealed in DLHS-3, the percentage of
fully immunized children in Sabarkantha district stands at 46.8%. In the
purview of the same, a series of interventions were planned and
implemented throughout the district with special focus on tribal and
underserved population. Thus, a study was needed which aimed to
provide current estimation of immunization coverage among the
Keywords: EPI Coverage Survey, DLHS-3, Immunization Coverage
Keywords: Infants Deaths, Maternal Deaths, Verbal Autopsy, MRS
Background: The verbal autopsy guidelines were developed in the
1960s when the Model Registration Survey of cause of death (MRS)
scheme first came into existence. The MRS later came to be known as
the SCD-Rural scheme. The verbal autopsy was introduced by India in
1965, which was the first verbal autopsy based cause of death reporting
system in the world. The concept of verbal autopsy as a source of cause
of death information has been used in many developing areas which
have poorly developed facilities for medical certification of cause of
death. The Government of Gujarat has begun registration of infant
deaths and verbal autopsies since 2005 – 2006. Infant death audit is
done by Medical Officer (MBBS).
Objective: To conduct a verbal autopsy audit for Infant Deaths and
Maternal Deaths in Gandhinagar District.
Methodology: The audit was initiated by collecting data from
secondary sources. Desk Review of reported verbal autopsy of infant
deaths and maternal deaths in year April 2009-March 2010 was done of
Manasa Block of Gandhinagar district. Out of 97 infant deaths, 86
verbal autopsies were done and 7 verbal autopsies were done for
maternal death. So the total sample size taken was 93(86 infant deaths +
7 maternal deaths).
Findings: The study revealed that out of the total 86 infant deaths,
maximum occurred in the first month of life. 25.58% infant deaths
occurred in Low Birth Weight babies (<2 kg).The major cause of infant
deaths was Respiratory diseases. It was observed that although
institutional delivery percentage was high (90%), many infant deaths
were seen.41.86% of deaths were cases of premature delivery.
Out of total of 7 maternal deaths, 4 occurred in the age group of 15-19
years.ANC examination of the pregnant women was found to be 100%
but still maternal deaths were observed. It was highly conspicuous from
the study that all maternal deaths happened because of first level delay,
i.e. delay due to decision making.
Recommendation: All maternal and infant verbal autopsies should be
reviewed in every monthly meeting at district level and the block health
officer should supervise regularly how VA forms would be filled by
P.H.C medical officer and FHW. Strengthening of implemented
programs like IMNCI, Mamata Divas needs to be done. Home visits for
53
children of age group 12-23 months in the rural areas of Sabarkantha
district to validate the success of field level interventions as well as the
progress made as Gujarat celebrates its golden jubilee year.
Objective: The Expanded Programme on Immunization Coverage
Survey in Sabarkantha district has as its primary objective to provide
up-to-date information for assessing the situation of immunization in
rural areas of Sabarkantha.
Methodology: the study included choosing 30 clusters out of the list of
all the villages of Sabarkantha district by PPS (Probability Proportional
to Size).
Findings: It was found that 50.5% of children of 12-23 months were
fully immunized in the district. 79% of children aged 12-23 months
have received BCG vaccine. 71 % of the children received all the three
doses of Oral Polio Vaccine (OPV) and only 54.3% received complete
three doses of DPT vaccine. Also it was found out that 69% of the
children aged 12-23 months were immunized by measles (MMR)
vaccine and 65.7% received at least one dose of Vitamin A. No dropout
for OPV was noticed although drop outs in DPT vaccinations were
12.3% and a total drop out 12.6 % was noticed from BCG to Measles.
When compared with the district data of 2008-09, it was found that the
data was over-reported.
Recommendations: Regular and meticulous monitoring and
supportive supervision is required at the grass root level. Planned IEC
activities are also required. For example Banners in local language
should be displayed at prominent sites, other field specific activities
like Bhawai shows, nukkad nataks, role plays, flash cards, and inter-
personal communication activities etc. Moreover, NGOs should be
encouraged to accelerate activities on motivating people to bring their
children for immunization. Apart from these, the Health Management
Information System should be improved so that reported coverage
gives true picture of the district scenario. Lastly, Sanctioned but vacant
positions of the grass root level health workers should be filled so that
shortage of manpower doesn’t pose as a cause for inefficient working
and outcomes.
Ab-31
Maternal Deaths
Shraddha S. Rajput
Review of Verbal Autopsy Reports of Infants and
54
Units (PSUs – Villages/Urban Frame Size) were selected with
probability proportional to size (PPS) using the 1991 Census data. All
the villages were stratified according to population size, and female
literacy was used for implicit arrangement within each strata. The
number of PSUs in rural and urban areas was decided on the basis of
percent of urban population in the district, with minimum of 12 urban
PSUs. The target sample size in each district was set at 1,000 complete
residential households from 40 selected PSUs. A total of 10308 women
drawn from Jammu and Kashmir as a whole out of which 5067
belonged to Jammu region and 5241 belonged to Kashmir and Ladakh,
Kargil region. A bivariate analysis was done to depict the level of any
antenatal care and safe delivery practice with different socio-economic,
demographic and the health variables of women. In addition, a logistic
regression has been performed to identify the factors governing the
utilisation parameters.
Findings: It was evident from the analysis that among the socio-
economic and demographic characteristics, the factors place of
residence, religion, caste, years of schooling of man and wife,
household standard of living index, age, age at consummation of
marriage, marital duration and number of stillbirths emerged out as
some of the factors significantly associated with utilization of maternal
health services. It was seen that utilization by Muslims in the state is
less and so is the utilization in rural areas. Women aged 35-44 were seen
to have least utilization of services. Women who had been married for
less than five years were found to have the highest utilization of
maternal health care services while those married for 15 years or more
were found to have the least. Also, women from middle SLI strata have
the highest utilization. Those women who had problems during
pregnancy and during delivery were seen to have higher utilization of
maternal health services than those who did not.
Recommendation: Initiation of awareness programmes addressing the
general populations is the need of the hour.
Ab-33
City
Sumana Arora
Background: Geriatric population is increasing rapidly both
Geriatric Health Insurance: A Study in Bangalore
Keywords: Health Insurance, Geriatric Health, Elderly
pregnant women and infant children should be made by FHW, AWW,
ASHA to create awareness about various kind of health programme for
maternal and child heath which requires vigorous training sessions of
these people to make them more efficient and competent in their job. It
is recommended to find out the important managerial and
administrative inputs to improve current mortality and morbidity
scenario.
Ab-32
Jammu and Kashmir-a Regional Analysis
Suhail Ismail Shiekh
Background: In the current global scenario maternal health has come
to be seen as an area of great opportunity for bringing about
improvement by individuals and organizations working in the field of
public health in developing countries. India has vowed to achieve a
Maternal Mortality Ratio (MMR) of 100 maternal deaths per 100000
live births by 2015 from the current level of 254. However, this requires
an in depth understanding of the causative factors affecting maternal
health. The Government has taken various steps one of which in the
Reproductive and Child Health (RCH) Survey amongst others to
enhance the service delivery of health care like ‘National Rural Health
Mission’ which seeks to provide effective healthcare to rural population
throughout the country with special focus on 18 states, one of which is
the mountainous state of Jammu and Kashmir. The need for the study
comes from the fact that in the realm of socio-economic, cultural and
demographic influence, factors like religion, caste, education, standard
of living, age, age at marriage, place of residence in terms of rural-
urban, have significant importance on the reproductive health care
utilization of women particularly on ANC and safe delivery.
Objective: The study aims at examining the various factors; socio-
economic, demographic and health related, governing the utilization of
two major maternal health services namely antenatal care and safe
delivery for two regions of Jammu and Kashmir (J&K) i.e. Jammu
region and Kashmir and Ladakh, Kargil region.
Methodology: A systematic, multi-stage stratified sampling was done
from data from RCH Round II. In each district, 40 Primary Sampling
Determinants of Maternal Healthcare Utilization in
Keywords: Maternal Health, Healthcare Utilization, NRHM, Safe
Delivery
Management Information System (HMIS) in Sadar, Dharhara and Jamalpur Blocks of Munger
Tukaram Khandade
Objectives: This study was conducted to know the training needs of the health workers before actual start of the training program for them.
Methodology: The study area is 3 blocks of Munger district namely: Sadar, Jamalpur and Dharhara. Data was collected in two weeks in January 2010 through semi structured schedules for ANMs and LHVs with some open ended questions. The study gave results on KAP in HMIS for which training is needed. The convenience sampling was taken to match the lack of time. Analysis of quantitative and qualitative data after coding was done on SPSS.
Findings: The analysis showed training needs in the following areas: Knowledge: The one-fourth of ANMs was graduated. Around 70% (N=30) of ANMs have less than five years of experience but all LHVs have more than 10 years of working experience in the health department Most of the ANMs and LHVs have taken secondary level of education besides having the basic training of nursing. Almost 38.5% of ANMs were not aware about their job responsibilities. Majority of ANMs (92.3%) and all LHVs have knowledge regarding supportive supervision. Not a single health worker has received training on HMIS. Lack of supply of registers at HSC is major problem in maintenance of records. Almost 31% ANMs faced problem in data collection. Attitude: Around 23% of ANMs didn’t know the importance of data. Not a single LHV was satisfied with on job support. Every health worker feel need of Training on HMIS. Practice: About 33.3% LHVs didn’t utilize their data. Around 10 % of ANMs don’t have any idea how to calculate the stock of vaccines. Estimation of pregnant women, OCP users, condom users was done through information from register or AWWs/ ASHAs. Health workers were not aware of advance data usage for their level eg. To know her coverage area.
Recommendation: From the finding we can easily conclude that ANMs and LHVs need training in the areas like Knowing and understanding job responsibilities; Registers to be maintained at the HSC; Knowing supportive supervision; Training on HMIS; Understanding importance of data; Training on HMIS; Utilization of data; Calculation of stock – TT; Calculation of expected target – pregnant women; Calculation of coverage – Immunization.
Keywords: Health Management Information Systems, Knowledge Attitude and Practice, KAP, HMIS, Training Need Assessment
55
internationally and nationally. By the year 2040, the world geriatric population is projected to be 1.3 billion (14%) of the total population as against 506 million (7%) in mid 2008. Thus, in just over thirty years, the proportion of the elderly will double. Similarly, the number of elderly in India is also estimated to increase from 77 million in 2001 to 222 million by 2040; a three- fold increase in just over thirty years. As the morbidity levels in the elderly are high, they need good medical services. Unfortunately, the public health systems are neither adequate nor well equipped to cater to their needs. People have to spend over 70 percent of money on healthcare out of their pocket. The life expectancy being 69.2 years and most people retiring at 58 to 60 years, on an average, a person lives for 10 years post retirement. After retirement, there is a drastic reduction in the income levels. Further, the healthcare costs are also rising. It is in this context that geriatric health insurance assumes great importance.
Objective: This study was carried out in Bangalore city to study the awareness of Geriatric Health Insurance among the people of the city.
Methodology: It was a cross-sectional study. Primary data was collected using a structured questionnaire. The city was divided into four zones and data was collected from each of these zones. A sample size of 102 was attained.
Findings: It was found that LIC was the most popular health insurance company and that the hospital network available was the most important criteria while deciding on the health insurance product. Further, the awareness about health insurance among the geriatric population is low. Furthermore, this population is largely dependent upon their children for decision making/ procedural formalities. Hence, customer awareness generation should be a part of the marketing strategy of a health insurance company; the marketing strategy should be directed both towards the target group as well as their adult children and companies providing insurance without an upper age limit should market this differentiator.
The study has succeeded to a large extent in finding answers to the questions which have been brought out in the main report. This study can be a useful resource for a health insurance company entering into the geriatric market.
Ab-34Functionaries of Government of Bihar in Knowledge Attitude and Practice (KAP) in Health
Training Need Assessment (TNA) of Health
PharmaceuticalManagement
57
Ab-1 Renal Cell Carcinoma: Therapeutic Segment
Outlook and Pipeline Analysis in Evalueserve,
Gurgaon
Ginni Kumar
Renal cell carcinoma accounts for approximately 3% of adult
malignancies and 90-95% of neoplasms arising from the kidney. It is
characterized by a lack of early warning signs, diverse clinical
manifestations, resistance to radiation and chemotherapy, and
infrequent but reproducible responses to immunotherapy agents such
as interferon alpha and interleukin (IL)-2. Renal cell carcinoma is the
eighth or ninth leading cause of cancer death in the United States. The 5-
year survival rates initially reported by Robson in 1969 were 66% for
stage I renal carcinoma, 64% for stage II, 42% for stage III, and only
11% for stage IV. The age-adjusted incidence of renal cell carcinoma
has been rising by 3% per year. Renal cell carcinoma has 5 histologic
subtypes, as follows: clear cell (75%), chromophilic (15%),
chromophobic (5%), oncocytoma (3%), and collecting duct (2%).
Renal Cell Carcinoma drug market will more than double over the next
10 years, rising from US$ 625 million in 2007 to nearly US$ 1.6 billion
in 2017. The RCC market has recently attracted significant investments
in research and development from big pharma, specialty pharma, and
biotechnology companies. Historically, the market for RCC treatments
has comprised a comparatively small section of the oncology market.
More than 50% of patients with renal cell carcinoma are cured in early
stages, but outcome for stage IV disease is poor. The probability of cure
is related directly to the stage or degree of tumor dissemination, so the
approach is curative for early stage disease. Selected patients with
metastatic disease respond to immunotherapy, but many patients can be
offered only palliative therapy for advanced disease. The treatment
options for renal cell cancer are surgery, radiation therapy,
chemotherapy, hormonal therapy, immunotherapy, or combinations of
these. Options for chemotherapy and endocrine-based approaches are
limited, and no hormonal or chemotherapeutic regimen is accepted as a
standard of care. Older immunotherapy regimens have now been
replaced as the standard of care by the newer targeted therapies
launched in recent years, namely Pfizer' s Sutent (sunitinib),
Bayer/Onyx' Nexavar (sorafenib), Roche' s Avastin (bevacizumab) and
Keywords: Renal Cell Carcinoma, Therapeutic Segment, Pipeline
Analysis, Renal Cell Carcinoma Drug
Pfizer' s Torisel (temsirolimus). The RCC market has evolved into a
rapidly growing segment since the launch of newer targeted therapies.
Sutent is considered as the standard first line therapy for previously
untreated RCC patients followed by Nexavar prescribed as the second
line therapy to Sutent refractory patients. The most recently approved
drug, GSK’s Votrient is anticipated to compete with sorafenib and
everolimus as second line use.
Significant opportunities still exist for products to expand within this
marketplace. A large percentage of patients are not currently treated
with drug therapies and are not cured by surgery alone; patients with
localised and locally-advanced disease represent a significant patient
population that may be suitable for adjuvant therapy with targeted
therapies. Established agents such as Sutent, Nexavar and Avastin are
being investigated in the adjuvant setting, along with new therapies
including Wilex' Rencarex (girentuximab), currently in Phase III trials.
In addition, many patients do not respond to current therapies, and more
effective product introductions and greater use of combination
therapies will address this clinical need for patients with metastatic
RCC. Also, two molecules in the late stage pipeline provide a multitude
of possibilities for potential future regimens.
Ab-2
the Globe
Kuldeep Dabas
Background: Biopharmaceuticals account for between 10% and 15%
of the world pharmaceutical market, with sales in the USA alone
reaching around $30 billion in recent time. Biopharmaceutical drugs
have outperformed the pharmaceutical market as a whole largely due to
two factors: they address areas of clinical need that are unmanageable
with conventional therapeutics (including many cancers and genetic
diseases) and they are able to command a premium price.
Objective: The study enlighten on the increasing importance of
biologics in pharmaceutical market. The every possible aspect like
definitions, manufacturing, regulation and marketing strategies of the
biopharmaceutical was analyzed.
Market Assessment of Biopharmaceuticals Round
Keywords: Biopharmaceuticals, Market Assessment, Pharmaceutical
Market, Biopharmaceuticall Drugs
Findings: Market by protein : Biopharmaceuticals : The sales of
Calcitonins and Glucagon will increase by 51% in 2011 reaching
market to $ 60,037 million from $ 22,098 million in 2006 with 47.8%
followed by Erythropoietin. Biosimilars : The sale of Erythropoietin by
2011 will increase by 38.6% reaching the market to $ 1,247 million and
market penetration will increase by 5%. Biopharmaceuticals market by
application. The market is now worth about $67 billion, or 10% of the
total Pharma sales, and we expect it to rise to $ 118 billion or 12% of
Pharma sales in 2011. Monoclonal antibodies currently make up 27%
of the biopharmaceuticals market but this figure will rise to 36% in
2011 because sales are increasing more rapidly. Oncology is the
dominant application accounting for one-third of overall sales. Indeed
in value terms, protein drugs now account for about two-third of the
worldwide. According to the forecasts based on an extrapolation of the
sales of existing products together with estimated sales for agents
currently in clinical trials but likely to be launched during the forecast
period Amgen and Roche have the biggest overall shares, with 40% of
the total market between them. North America (mainly the US) has
almost 40% of the market and Europe has 30%. The fastest growth rates
are outside the two regions, a trend that is consistent with the
pharmaceutical market in general. Europe will be in the lead with nearly
45% of the market and distribution of sales will be somewhat different
because owing to patent constraints and prescribing practices
respectively, we expect no EPO or G-CSF sales of biogenerics in Japan.
There were no sales data for 2006. But in 2011, Europe will be in the
lead with nearly 45% of the market and the distribution of sales will be
somewhat different because owing to patent constraints and prescribing
practices respectively we expect no EPO or G-CSF sales in the US and
depressed sales of biogenerics in Japan. EPO represents the largest
market opportunity for biosimilars and GCSF is also sizeable
opportunity.
Recommendation: Industry should focus more on R&D activities
about emerging diseases. Better cooperation between research
institutes and pharmaceutical companies so as to coordinate their
activities about development of new molecule. Improvement in
technology advancement for the production of biopharmaceuticals
should be cost effective. Government should facilitate establishment of
more institutes both in the academic as well as research so as to
58
encourage development of interest in the field of biopharmaceuticals
research. Government should offer incentives so as to encourage more
participation of industry in the field of biopharmaceuticals.
Government should encourage FDI in the field of biopharmaceuticals
so as to promote transfer of technology.
Ab-3
Business Opportunities
Pritika Garg
Background: The Japanese pharmaceutical market is the second largest
individual market and with sales of $66 billion constitutes
approximately 8.2% of the world market. Despite its prolonged
economic troubles in recent years, Japan still holds its second position
in world market being after US only. It also remains one of the less
penetrable markets. MHLW is strongly promoting generic drugs
through incentives on prescribing and selling generic drugs. This makes
a space for small generic companies to enter in Japan. Although despite
of full support of Japanese government one need to have local
partnership to get the know how of the market. The main therapeutic
areas where one can enter are anti-cancer, lifestyle diseases and also
diseases related to central nervous system.
Objective: To assess the Japanese generic pharmaceutical market and
search for opportunities available for an India generic firm Radiance
pharmaceutical.
Methodology: The study is done on secondary data. The data gathered
was taken from trusted government sites and several market reports.
Market forecast done by market research firms were also taken in
consideration.
Findings: The Japanese pharmaceutical market is the second largest in
the world after the USA accounting for 8.2% of the total world market.
Increasing demand of pharmaceutical market is due to the rapidly
increasing population of Japan. Japan market size increased by 123% in
1993-2003. The market is dominated by domestic producers who
manufacture drugs primarily for the home market.
Recommendations: Therapeutic areas in which companies can entre
Assessment of Japanese Pharmaceutical Market to Search
Keywords: Japanese Pharmaceutical Market, Pharmaceutical
Marketing, Business Opportunities
59
could be anti- cancer and other life style disease because Japanese
epidemiology is changing. Even if a generic drug market does not grow,
and the company has unique challenges of this market.
Ab-4
Assessment
Pushpendra Dixit
Background: Vitamin-A supplementation is a low cost sustainable
approach to control the Vitamin A deficiency. Children between 1–5
years age , who are less likely to have regular contact with health
facilities and health services, are the neediest group for this
supplementation.
Objective: A process and knowledge assessment study of Vitamin A
supplementation was carried out in all the blocks of Surendranagar
District.
Methodology: 14 PHCs were selected from the slot of 31 by using
simple random sampling (2 from each block). Interviews of ANM,
AWW and mothers/caretaker were conducted. 2 SCs were selected
from each PHC by using convenience sampling method. Under each SC
one extra village was surveyed for interviewing the AWW and
mother/caretaker of children age group 1-5 years. Total 38 ANM, 53
AWW and 358 mother /caretaker were interviewed for the study.
Findings: The major findings of the study include knowledge of ANM
and AWW, preparedness for the bi-annual round and most importantly
the level of awareness among the mothers/caretaker about the program.
The most common place of Vitamin A supplementation was AWC
(40%), followed by SC (32%). IEC material was only available at 73%
sessions of mamta divas. Marking in mamta card and making notes in
register was found to be low. Only 44% ANMs were found marking in
mamta card which is not a good sign for the supplementation program.
The reason for not making entries was unavailability of the mamta card.
It was also seen that often the mothers/caretaker do not bring the card
with them. The knowledge of ANM and AWW regarding Vitamin A
supplementation was found out to be low, especially in AWW. Another
major finding revealed was very low supervision level. Only 65% ANM
Vitamin A Bi-annual Round Process and Knowledge
Keywords: Vitamin-A, Vitamin A Supplementation, Knowledge
Assessment
and 55% AWW got the instructions from their respective supervisors.
The knowledge of mother/caretaker was very low. Out of the total who
received the services, only 37% mother/caretaker knew about it. Only
74% children (out of the total visited 358) received the Vitamin A
supplementation. In the study ASHA was found to be the major source
of information for the mother/caretaker about the program.
Ab-5
Linezolid on the behalf of Kee Pharma Ltd.
Rahul Gupta
This study is regarding the feasibility approach for Linezolid tablet
Launch. Linezolid is a synthetic antibiotic used in resistant gram
positive infection.
Objcetive: The aim of study was “To assess the market and propose the
product Launching strategy of Linezolid tablet” and specific objectives
followed were To study the prescription habits of Linezolid tablet in
market. To identify the competitors for Linezolid Antibiotic. To study
the strength and weakness of Linezolid tablet To recommend the
Product Launch Strategy.
Methodology: The background of the drug market was analyzed first
as Pharmaceutical marketing is quite different than marketing of any
other goods. Within pharmaceutical products, marketing of prescribed
products is a way different from that of over the- counter (OTC) drugs
and actual behaviour of prescribed drug market may vary based upon
various parameters. To achieve the objectives a primary research and
secondary research both were done and 60 doctors and 60 chemists
were surveyed on the basis of convenient sampling and structured
questionnaire was used as a research instrument.
Findings: Orthopedician, surgeon and Physicians were the major
prescribers for Linezolid tablet and the major competitors were Linox
(Unichem), Linid (Zydus) and Linospan (Cipla) Successful launching
of Linezolid tablet requires a more aggressive promotion amongst the
Physician, Orthopedician and surgeon and Linezolid tablet should be
available at all major retail pharmacy stores especially those which are
in premises of a hospital and nursing homes and near the Physician,
Market Assessment and Product Launching Strategy of
Keywords: Linezolied, Pharmaceutical Marketing, Product Launching
Strategy
60
Orthopedician and Surgeon. Linezolid tablet should be made more cost
effective.
Ab-6
and Faridabad Through Retail Chemist Audit
Ramneek Atreya
Background: Diabetes drug market and insulin market has shown
remarkable growth in recent years. This growth is mostly driven by
increasing prevalence of diabetes globally and easily availability of
insulin in other countries due to its access at an affordable price. The
diabetes prevalence is increasing due to changing food habits in the
western world leading to obesity. Top 8 diabetes drug made a sale of
more than US$ 5 Billion from the period of October 2007 to October
2008.
Objective: The study is based on the assessment of insulin market in
Delhi NCR and Jaipur and broadly covers the analysis of insulin market
dynamics, share of various brands in the market and most prescribing
physicians. The study was done by using descriptive research method
with simple random sampling by the help of primary data collected
from retailer through Questionnaire.
Findings:. Human Mixtard* was ranked 1 in terms of sales and
availability. Hum insulin (30- 70)/Humalog as the second best (20%)
selling brand. Wosulin and Insugen were taken as market follower.
Market penetration of Human Mixtard was 100% followed by Hum
insulin.
Recommendation: Company can increase sales force size and can also
do Flank Attack (attacking on Market leaders weak points).
Ab-7 Analysis of Pharmacy Function and Work Load
Reenu Bajapi
Background: Hospital pharmacies can usually be found within the
premises of the hospital. Hospital pharmacies usually stock a larger
Assessment of Insulin Market in Jaipur, Gurgaon
Keywords: Insulin Market, Retail Chemist Audit, Diabetes Drug
Market
Keywords: Hospital Pharmacy, Pharmacy Store, Quality Assurance
range of medications, including more specialized medications, than
would be feasible in the community setting. Most of the hospitals have
one store and from which all IPD and OPD patients purchase
medicines. Availability of one store and large number of indents
coming everyday (in comparison to bed admission ration), causes high
returns of pharmacy items and long internal lead time between
pharmacy stores to IPD. This is a complex process that requires
adequate training of personnel, quality assurance of products, and
adequate facilities to avoid conflicts between staff and patient
dissatisfaction.
Objective: To analysis the causes of pharmacy overloads and unduly
stretched internal lead time between central pharmacies store to IPD.
Methodology: A Group comparison case control study of the patients
admitted in 6th, 7th and 9th wards from 15 to 29 April was conducted.
Data was collected through interviews and observation. It was a
Retrospective study. From the studies it was found that an average of
288 indents come in a single day for 180 bedded hospitals and it takes
81 min to process that indent
Findings: The numbers of indents are too high because there was no
stock monitoring in wards level by nursing staff before giving indents to
pharmacy. This causes a high number of returns in a day. From the
studies it was also found that a clear cut demarcation for pharmacist is
not available which leads to a high lead time in indent processing. There
was a lack of communication between pharmacy store and the nursing
staff.
Recommendation: The situation analysis suggests that there is an
urgent need of controlling the process. Through systematic approach of
working the work load of pharmacy can be reduced. Scientific reorder
level estimation helps the hospital in reducing the internal lead time
process. There is a need of strict process monitoring of medicines
through bar coding and by group of quality managers.
Ab-8
European Countries
Siyaram Sharma
Market Assessment of Rheumatoid Arthritis in 5-
Keywords: Rheumatoid Arthritis, Market Assessment, European
Countries
Objective: This Study is the market assessment of rheumatoid arthritis
in European countries in which thorough market search is done for
therapeutic area Rheumatoid Arthritis (RA) in 5- European countries
(France, Germany, Italy, Spain and UK). This assessment gives idea
about current market scenario product wise and company wise as well
and the assessment of pipeline products helps to estimate future
estimates of anti RA market.
Methodology: Secondary desk research is used for this study and data
are taken from reliable sources like- IMS, CENTER WACH etc. On the
basis of three major fields i.e Epidemiological facts of Rheumatoid
Arthritis in 5- EU Countries in which major epidemiological facts
related with RA are touched upon to get idea about the spectrum of the
disease, Treatment rate and mortality status due to RA in respective
country to understand the potentiality of the market. The second field is
prescribed drugs of RA in 5-EU Countries in which the name of the
prescribed drugs for Rheumatoid Arthritis along with their companies
in 5- EU Countries are assessed this information gives idea about major
drugs present in these countries for RA treatment. The Third Field is
Competitive Analysis which includes three sub fields i. Major
companies in the market and their products for RA Treatment ii. Sales
Value Status of anti RA Products in 5- EU Countries iii. Pipeline drugs
for RA Treatment
Findings: UK has highest prevalence of Rheumatoid Arthritis among
5 European countries followed by Germany Treatment rate of
Rheumatoid Arthritis is high in all 5-European Countries it is above
75% in all countries. Though UK and Germany have highest prevalence
of Rheumatoid Arthritis but RA related mortality is lowest in these two
countries. Abbott, Pfizer and Merck & co. are common major players in
all 5- European Countries with their products Humira (Adalimumab),
Enbrel (Etanerecept) and Ramicade (Infliximab) respectively. Roche
is the leading company in pipeline products with 3 pipeline products for
RA treatment.
Recommendations: The patents of the most selling drugs in European
markets like Humira, Ramicade, Enbrel are going to expire in next 2-3
years so there is a great scope for biogeneric drugs. Ramicade
(Infliximab) is strong competitor of Enbrel and Humira in France, Ital
and Spain but far behind in UK and Germany so Merck & Co. can
implement similar marketing strategy in UK and Germany as they are
using in France, Italy and Spain. Companies like Sanofi-Aventis,
61
Bristol Myers squib should increase their marketing efforts for their
respective drugs (Arava and Orencia) which are strong market follower
drugs.
Ab-9
Competitor Overview in Evalueserve, Gurgaon
Sonal Ghura
Background: Most pharmaceutical companies are interested in getting
their hands on a stable therapeutic region. PAH (pulmonary arterial
hypertension) is a relatively new indication which has been served so
far by niche players such as Actelion and Gilead Life sciences. Big
companies like Eli Lilly, Pfizer have recently entered the market.
Global Data has estimated the global pulmonary Arterial Hypertension
(PAH) market was worth of $2653 Mn in 2009. According to Global
Data, the PAH market is expected to grow at CAGR of 5% over next six
year and it will reach to $ 3569 Mn by 2015. So the report will analyze
the competitors’ marketed drugs and drugs that are in the pipeline for
clinical development, thereby giving a picture of the market leader and
its movements till 2016.
Objectives: To conduct a pipeline analysis of the pulmonary arterial
hypertension (PAH) market. To analyze the present market of PAH
based on prevailing market leaders. To assess the movement of
competitors and its positions in the market till 2016. To forecast ParaIV
filing activities for various companies after market leader Tracleer
(Bosentan) hits the patent cliff. To investigate geography for the launch
of PAH drugs. At last but not the least, to compile all the essential pieces
of information and present the finding and recommendations.
Methodology: The study is done on secondary data basis. The list of
the molecules in the pipeline has been derived from companies’ press
releases, annual reports and other freely available databases. Through
SWOT analysis, BCG matrices and PEST analysis of the competitors
and the market leaders had been carried out for analysis of the data and
then reporting is done.
Findings: The market leader in this PAH market is Trocleer and its total
market share is about 50%. Eli lily’s Revatio and United therapeutics’s
Pulmonary Arterial Hypertension: Futuristic
Keywords: Pharmaceutical Companies, Pulmonary Arterial
Hypertension, PHA Market
62
Remodulin had a market share of 15% each. Trocleer slowly and
gradually will enter the Dog phase as the molecule’s patent expire
during 2015-16 in EU & US market. Venatvis is the only inhaled
formulation available for PAH. However the drug is not popular
because of high cost and no additional improvement in efficacy. The
entry of big pharmaceutical companies such as Eli Lily, Pfizer will
drive the growth of the PAH market. The annual reports of these
companies have stated that as for PDE-5 inhibitors, PAH is not as key
area of focus.
Recommendations: EU is the choice for the first launch of PAH drugs
as the population of the country is genetically isolated as has a lesser
approval lead times as compared to the US. Para IV filing for launched
drugs should have been started for brands like Trocleer. Companies
like Eli lily, Pfizer and GSK are all rounder in this field and therefore do
not need to adopt niche marketing strategy to launch a product in the
market.
Ab-10 Market Survey of Treatment Options for Osteoarthritis
and Awareness about Sodium Hyaluronate 1 % Solution
in Medical Profession
Sumati Kumar Jain
Background: Importance of Hyaluronic acid in body is felt when pain
is observed in joints. Hyaluronic acid is a natural component of
cartilage and joint fluid. It lubricates and absorbs shock in the joint. Just
imagine what will happen when the hyaluronic acid fluid from body
gets finished due to ageing. Well Xyata lifescinces ltd has a solution to
it, Hyness the product for osteoarthritis patients. The (FDA) recently
approved this therapy where sodium hyluronate injections are given to
patients with osteoarthritis of the knee if they do not get relief from
exercise, physical therapy, or simple analgesics. Researchers are also
testing whether hyaluronic acid can slow down the progression of
osteoarthritis.
Objective: The main objective of this market survey was to find out the
awareness and perception level of prescriber about Sodium
Hyaluronate.
Keywords: Sodium Hyaluronate 1% Solution, Market Survey,
Osteoarthritis
Methodology: Primary research was done doing market survey in
Jaipur District with a sample size 50 prescriber of sod. Hyaluronate.
Findings: Injecting this substance into the knee joint provides long-
term pain relief for some people with osteoarthritis. Hyaluronic acid is a
natural component of cartilage and joint fluid. It lubricates and absorbs
shock in the joint. The Food and Drug Administration (FDA) recently
approved this therapy for patients with osteoarthritis of the knee if they
do not get relief from exercise, physical therapy, or simple analgesics.
Researchers are testing whether hyaluronic acid can slow down the
progression of osteoarthritis.
Ab-11
North African (MENA) Region
Vibha Chadha
Objectives: To raise awareness regarding the burden of disease related
to viral hepatitis and the need for urgent action to prevent hepatitis C
virus transmission in the Eastern Mediterranean Region.
Methodology: This study was based on secondary research and the
data was collected from internet.
Findings: The global burden of disease due to cirrhosis of the liver and
hepatocellular carcinoma (HCC) is high (approximately 2% of all
deaths) and is expected to increase over the next two decades. Studies
indicate that more than 75% of cirrhosis and hepatocellular carcinoma
in the region is attributable to hepatitis C virus (HCV) infection with
higher prevalence in Egypt. Many of these infections are acquired in the
health care settings particularly in countries with rapidly evolving
health systems and increasing demand for health services. There are
two medications used to treat Hepatitis C i.e. Ribavirin and Interferon
with Roche and Schering Plough as market leaders. As the current
treatment guidelines are not economically favorable (US $12000-US
$22000), lengthy (24-48 week) and well tolerated, a comprehensive
strategy is urgently needed to prevent transmission of these blood-
borne pathogens. Roche recently collaborated with ministry of health to
create awareness for disease whereas GSK and Schering Plough are
promoting their product through national level campaign in Egypt.
They have agreed for price reductions and are negotiating with
Market Overview of Hepatitis C in Middle East and
Keywords: Hepatitis C, Market Overview, Global Burden Disease
Egyptian government to provide 2 yr supply of Ribavarin.They have
provided funds for training and post exposure follow up and treatment
for nurses and physicians who are exposed to Hepatitis C.
Recommendations: Hepatitis C specific mortality in Egypt, Iraq and
morocco regions are quite high therefore the main focus should be on
these regions. Hepatitis C treatment should be provided through
government in countries like Egypt, Libiya and Saudi Arabia as the
health care is almost free for citizens. Increased improvement in safety,
efficacy and tolerability of Hepatitis C treatment is needed with second
line therapies for increasing population. Newer drug need to be potent
and should have a high genetic barrier to prevent development of
resistance. New dosage forms (injectables) should be there to have
patient compliance. Treatment must be affordable so that it is accessible
to all individuals who require it.
63
INSTITUTE OF HEALTH MANAGEMENT RESEARCH1, Prabhu Dayal Marg, Sanganer Airport, Jaipur 302011 India
Ph.: +91-141-3924700. Fax : 91-141-3924738. Web: www.iihmr.org
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