Protocol for Case Study Of

Protocol for case study of

Community Health Centre

Or Rural Hospital (RH)

Note:

· The organizational structure of a Community Health Centre (CHC) is slightly different from that of a Rural Hospital (RH). There may also be inter-state variations in the structure of a CHC / RH. In some states they may be known as Additional PHCs. Therefore, some of the questions in this checklist may not be applicable to any given CHC/RH. Wherever such is the case, please write ‘NOT APPLICABLE’ against the concerned question(s).

· Kindly put a tick mark(Ö) against the option applicable in the question given. In cases where more than one answer is applicable, please tick mark against the options applicable. If required, you may write out any other answers that may not have been enlisted in the options given.

· Kindly make a report of all that you observe at the CHC/ RH (behaviour of staff, locked wards, etc.) and send it along with this filled up checklist

Questions to be asked from Medical Officer-in-charge of CHC or any other doctor present

Give the Informed Consent to MO and get it signed from him/her

1. General Information about CHC

· Name of the Community Health Centre (CHC)/ RH: ______

· Taluka/Block in which CHC/ RH is located: ______

· Is this Taluka in a Tribal / hilly area or general? Tribal/hilly General

· Total number of Primary Health Centres (PHCs) under the CHC / RH:

2. Infrastructure

· Where is this hospital located?

Ä Within Village Locality

Ä Far from village locality

Ä If far from locality specify in km______

· Is a designated government building available for the RH/CH? Yes No

· If there is no designated government building, then where does the hospital function?

Ä Rented premises

Ä Other government building

Ä PHC

Ä Any other specify______

· Does the hospital building have following facilities?

Sr. no. / Structure / Yes / No
1 / Wards of total 30 beds
2 / Major Operation Theatre
3 / Minor Operation Theatre
4 / Labour Room with delivery table
5 / Laboratory Room
6 / X-ray Room
7 / Pharmacy
8 / Staff Quarters
9 / Disinfecting Room

· Water: Is water available on tap in the RH/CHC? Yes No

· Electricity: Is there electricity supply to the CHC/RH? Yes No

· If there is irregular electricity supply, then, is a generator available as a backup measure?

Yes No Sometimes

· What is the state of the building of the RH/CHC?

Ä Satisfactory construction

Ä Leaking

Ä Dilapidated

Ä Water logged sections

· What is the present observed state of the premises?

Ä Quite clean

Ä Somewhat dirty

Ä Very dirty

· Are the following facilities available in the CHC/ RH for patients and their relatives?

Ä Waiting room Yes No

Ä Toilets (that are in working condition) Yes No

Ä Drinking water Yes No

· How many wards are there? 1 2 3

· How many beds are there in one ward? 10 15 more than 15

· If labour room is present, are deliveries carried out in the labour room?

Ä Yes

Ä No

Ä Sometimes

· If labour room is present, but deliveries are not being conducted there, then what are the reasons for the same?

Ä Non-availability of doctors / staff

Ä Seepage in the labour room

Ä No power supply in the labour room

Ä Any other reason (specify) ______

· If operation theatre is present, are surgeries carried out in the operation theatre?

Yes No Sometimes

· If operation theatre is present, but surgeries are not being conducted there, then what are the reasons for the same?

Ä Non-availability of doctors / anaesthetist / staff

Ä Lack of equipment / poor physical state of the operation theatre

Ä No power supply in the operation theatre

Ä Any other reason (specify) ______

· Is post- Mortem conducted in CHC/ RH? Yes No

· Is an ambulance available for the RH/CHC? Yes No

· Is the ambulance in working condition? Yes No

· Is the ambulance service provided even if the patient cannot pay for it? Yes No

· As of today, what is the status of the following equipments at the RH/CHC?

Sr. no / Equipments / Present / Not present / If present, then
Working / Not working
1 / X-ray machine
2 / Laboratory microscope,
3 / Examination table
4 / Ice Lined Refrigerator
5 / Oxygen cylinder

3. Availability of Staff at CHC/RH

Does the RH/Cottage have the following staff?

Sr. no / Designation / Minimum norm / Filled Post / Vacant post
1 / Medical Superintendent / 1
2 / Specialist Medical Officers / 3
3 / General medical officers / 3
4 / Sister in Charge / 1
5 / Staff Nurses / 7
6 / X – Ray Technician / 1
7 / Laboratory Technician / 1
8 / Pharmacist / 2
9 / Driver / 1

· Who are the specialists currently posted at the RH/CHC?

Ä Paediatrician Yes No

Ä Gynaecologist Yes No

Ä Surgeon Yes No

Ä Anaesthetist Yes No

Ä Specialist physician Yes No

Ä Any other specialists in position (specify) ______

· Is there any additional post Sanctioned in RH/CHC?

Ä Dental Surgeon Yes No

Ä Ophthalmologic Assistant Yes No

Ä Any other post (specify)______

· Is there a female medical doctor at the RH/CHC? Yes No

· How many of the posted doctors stay at the headquarters?

All Some of them None

4. Timings of CHC/RH, charges, transport facilities, etc

· Is the RH/CHC open for outpatient services for the stipulated OPD time?

Ä Yes, on all days excepting designated holidays

Ä No, it always closes before time

Ä Only on some days itfunctions for the stipulated time

· In cases where a patient needs to be admitted for inpatient care, is s/he admitted?

Ä Yes, patients who can be managed at CHC are always admitted

Ä Some deserving patients are not admitted but are referred to other facilities

Ä Patientsusually refused admission

Charges at CHC/RH if any

· If a patient is admitted for inpatient care, then does she have to pay for certain types of goods/ services? Yes No

· If the patient has to pay for some goods and/ or services, what are those?

Ä Purchase of drugs

Ä Purchase of cotton, syringe, bandage etc

Ä Bribes to doctor, nurse, sweeper, etc

Ä Any other (specify)______

· Does the RH/CHC provide treatment to emergency patients (victims of accident, burns, medical emergencies etc) at any time of the day/ night?

Ä Emergency patients are given treatment. Where necessary, they are referred to a higher level Govt. hospital

Ä Emergency patients are often not treated, referred to a public health care facility

Ä Emergency patients are often not treated, referred to a private medical facility

Is there any public-private partnership arrangement (PPP) with the private medical facility for such referrals? If yes, then give details? Does the patient have to make payments at the facility?

· Are the following types of patients given emergency treatment at the RH/CH at any time of the day/ night?

Ä Snake bite victims Yes No Sometimes

Ä Dog bite victims Yes No Sometimes

· If referred to a higher-level health care facility, how is the patient taken there?

Ä Free transport by hospital ambulance

Ä By hospital ambulance, but fuel and other charges have to be made by the patient

Ä Private/ personal conveyance

Is there any PPP arrangement for ambulance facility? If yes, then give details of how it is executed? Do patients have to pay for it?

5. Reproductive and Child health services

· Are regular antenatal clinics conducted by the CHC/RH? Yes No

· Are normal deliveries carried out in the CHC/ RH? Yes No

· Who carries out the normal deliveries in the CHC/ RH?

Ä Male doctor

Ä Female doctor

Ä Staff nurse

Ä Other

· If normal deliveries are not conducted at the CHC, then where are the cases sent?

Ä Cases are referred to a higher level govt. hospital

Ä Casesare referred to a private health care facility

· Are deliveries by Caesarean Section conducted in the CHC/ RH? Yes No Sometimes

If they are not conducted, then where are patients sent? If there is a PPP then give details.

· Are hysterectomies conducted at CHC/ RH? Yes No Sometimes

· What are the expenses for hysterectomy?

· Is medical termination of pregnancy (Abortion) carried out at the RH/CHC?

Yes, always No, never Sometimes

· Is there any precondition imposed for doing MTP (like compulsory Copper T insertion or sterilization after MTP etc.)? Yes, always No, never Sometimes

· Is husband’s signature obligatory for carrying out MTP?

Yes, always No, never Sometimes

· Does the RH/CHC provide services for Reproductive Tract Infections (RTIs)?

Yes, always No, never Sometimes

· Are family planning services provided by the RH/CH?

Ä Condom distribution Yes No

Ä Distribution of Oral contraceptive pills Yes No

Ä IUD insertion Yes No

Ä Female sterilization Yes No

Ä Male sterilization Yes No

Ä Injectable contraceptives (Depoprovera) Yes No

· Are the facilities required for providing these contraceptives available at RH/CHC? Like trained health workers for insertion and removal of IUD, following aseptic conditions for insertion of IUD etc.

· Are newborn babies requiring neonatal care managed at the CHC?

Usually Sometimes Never

· Are infants / children needing critical care for pneumonia treated at the CHC?

Usually Sometimes Never

· Are infants / children needing critical care for diarrhoea with dehydration treated at the RH/CHC?

Usually Sometimes Never

· What are the days on which immunization services are offered?

Ä Select days of the week

Ä Only in camps

Ä Both on certain days of the week and also in camps

Ä Irregularly

6. Other services at the RH/CHC

· Are surgeries carried out at the RH / CHC?