Pun Jab Study Final

A Study to Review
The Health Care Delivery System

Provided by
PHSC
Punjab Health Systems Corporation
Punjab
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National Institute of Health and Family Welfare

Baba Gang Nath Marg, Munirka, New Delhi - 110067
A Study to Review
Provided by
Punjab Health Systems Corporation (PHSC), Punjab
Report
2008
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Baba Gang Nath Marg, Munirka, New Delhi – 110067
Email: director.nihfw@nic.in
Website: www.nihfw.org
Study to Review
The Health Care Delivery System provided by PHSC, Punjab
i
List of Abbreviations vi
Preface vii
Acknowledgement viii
Study Team viii
Executive Summary ix
CONTENTS
Introduction 1
Objectives of the Punjab Health Systems Corporation Project 1
Rationale 3
Study Objectives 4
Methodology 5
Study Findings 8
Structural and Operational Framework

of Punjab Health Systems Corporation (PHSC) 8
Facility Assessment 18
A. District Hospitals 18
B. Sub-divisional Hospitals (SDHs) 35
C. Community Health Centres (CHCs) 50
Views of the Beneficiaries on Quality of Services 64

1. In-patient Department 64
2. Out-patient Department 74
Evaluation of the Training Institutes 84
Community Voice 91
Views of the Stakeholders 100

• At District Level 100
Deputy Commissioners (D.C) 100
MLA/Elected Representative 102
Civil Surgeons 104
SMO in charge – District Hospitals 106
• At Sub-Division Level 109

MLA/Elected Representative 109
SMO – Sub Divisional Hospitals 110
• At CHC Level 113

Elected Representatives at CHC 113
Senior Medical Officers - CHC 114
Observations and Discussion 118

Facility Survey 118
Views of the Beneficiaries 121
Views of the Community (through FGDs’) 125
Views of the Stakeholders 125
Conclusion and Recommendations 127

List of Tables
1 District Hospitals
1.1 General Profile and Facility Survey 132
1.2 Facilities Available 136
1.3 Laboratory Facilities 140
1.4 Out-patient Department 141
1.5 Emergency Services 144
1.6 Intensive Care Unit 146
1.7 Clinical Laboratories 147
1.8 Blood Banking Facilities 148
1.9 Radiology and Imaging 149
1.10 Operation Theatre 150
1.11 In-patient Wards 151
1.12 Hospital Medical Stores 153
1.13 Medical Record Department 155
1.14 Hospital Waste Management 156
1.15 Support Services 157
1.16 User Charges 160
1.17 Performance Report 163
1.18 Staff Position 165
1.19 Specialist Position 167
2 Sub Divisional Hospitals

2.2 Availability of Equipment 171
2.5 Emergency Medical Services 178
2.6 Intensive Care Unit 180
2.9 Radiology and Imaging Services 183
2.10 Operation Theatres 185
2.11 In-patient Department 188
iii
2.14 Central Supply Department 194
2.15 Five Year Performance Report 196
2.16 Utilisation of User Charges 198
2.17 Medical Officers in Position 201
2.18 Staff Positions 203
3 Community Health Centres

3.2 Equipment available at CHCs 208
3.4 Referral Facilities 210
3.6 Emergency Medical Services 214
3.9 Special Investigations 218
3.10 Operation Theatres 219
3.11 In-patient Department 220
3.14 Hospital Waste Management 224
3.15 Central Supply Department, 225
3.16 Laundry Services 225
3.17 Dietary Services 226
3.18 Medical Officers in Position 227
3.19 Five Year Performance Report 229
3.20 Staff Positions 231
3.21 Utilisation of User Charges 233
4 Distribution of Patients in Wards 236

5 Admissions in Different Hospitals 238
6 User Charges for Services in Various Hospitals 239
7 Experience at Facility and Quality of Care 240
8 Patient Responses on Quality of Services 242
9 Patient Responses on Behaviour of Staff 244
10 Availability of Medicines (patients’ responses) 245
11 Money Spent (patients’ responses) 245
12 Rules and Regulations at Facilities (patients’ responses) 246
13 Satisfaction from the Services 246
14 Suggestions for Further Improvement 247
15 Distribution of Out-patients 248
16 User Charges for Services (patients’ responses) 250
17 Observations on Facility Profile (patients’ responses) 251
18 Quality of Services (patient responses) 252
19 Health Manpower (patient responses) 254
20 Waiting Time (patient responses) 255
21 Patients’ Experience (Rating) 256
22 Suggestions for Further Improvement (out patients) 257
23 Responses of Deputy Commissioners 260
24 Responses of MLA/Elected Representatives 261
25 Responses of Civil Surgeons 262
26 Responses of SMOs of District Hospitals 263
27 Responses of Elected Representatives at Sub-division Level 264
28 Responses of SMOs of SDH 265
29 Responses of Elected Representatives at CHC Areas 266
30 Responses of SMOs of CHC 268
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v
List of Abbreviations
ANC Ante Natal Care

ANM Auxiliary Nurse Midwife
ASHA Accredited Social Health Activist
BOR Bed Occupancy Rate
BTR Bed Turnover Rate
CHA Community Health Administration
CHC Community Health Centre
CSSD Central Sterile Supply Department
DC Deputy Commissioner
DD-cum-CS Deputy Director-cum-Civil Surgeon
DH District Hospital
DMC Deputy Medical Commissioner
ECG Electro Cardiogram
FGDs Focus Group Discussions
GDMO General Duty Medical Officer
ICU Intensive Care Unit
IPF In-Patient Facilities
LP Lumbar Puncture
MLA Member, Legislative Assembly
MO Medical Officer
NHP National Health Programmes
OPD Out-patient Department
OT Operation Theatre
PHC Primary Health Centre
PHSC Punjab Health Systems Corporation
PPS Population Proportionate to Size
RKS Rogi Kalyan Samiti
SDH Sub-divisional Hospital
SHC Subsidiary Health Centre
SMO Senior Medical Officer
SP Hospital Special Hospital
VED Vital, Essential, Desirable
Study to Review
vi The Health Care Delivery System provided by PHSC, Punjab
Preface
The Punjab Health Systems Corporation (PHSC) was created as a non-commercial statutory
corporation in 1996 vide Punjab Act no. 6 of 1996, with the purpose to establish, expand, improve
and administer curative and preventive services at secondary level health care institutions in the
state of Punjab. The corporation has taken over the District Hospitals, Sub-Divisional Hospitals
(SDHs) and Community Health Centres (CHCs) along with some rural and urban Medical Institutions.
Training Institutes viz. State Institute of Health and Family Welfare (SIHFW), Mohali, and State
Institute of Nursing and Paramedical Sciences (SINPS), Badal, Distt. Muktsar and Institute of
Mental Health, Amritsar have also been included under PHSC institutions.
The present study was conducted with the aim to review the extent to which the objective of
the Health Systems Development Project II focusing on improving the health care delivery at
the secondary level of health care has been achieved. It was an exploratory study for situational
analysis in order to identify the areas of sub-optimal utilisation and suggest the measures for
improvement. The study was conducted through the in-depth review of structural organisational
and operational framework of PHSC. The site visits to review at least 50% of the 20 District
Hospitals located in the different regions of the state and 26% of 37 SDHs and 10% of the
111 CHCs were made along with two special hospitals (Patiala & Bhatinda) and all the training
institutions.
Ten teams each comprising of faculty and research staff from National Institute of Health and
Family Welfare (NIHFW) visited each of the 10 selected sample districts of Punjab and collected
the data from respective district areas comprising of District Hospital, Sub divisional Hospital
and Community Health Centre.
It is hoped that the report of this study will be of considerable help to the State Government and
other stakeholders in improving health care delivery system at secondary level of health care.
Prof. Deoki Nandan

Director, NIHFW
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vii
Acknowledgement
The leadership and guidance provided by
Prof. J.S. Bajaj, Vice Chairman, Punjab State Planning Board, Government of Punjab,
support extended by Health and Family Welfare Department and
various stakeholders towards conduction of this study is greatly acknowledged.
Study Team
Team Leader Prof. Deoki Nandan, Director, NIHFW
Amritsar Dr. U. Datta, Reader and Acting Head, Deptt. of Education and Training
Mrs. Rita Dhingra, Research Officer
Mr. G.P. Devrani, Asstt. Research Officer
Dr. B.S. Diwan, PG (CHA) student and Dr. Yashika, PG (CHA) student
Bhatinda Prof. J.K. Das, Head, Deptt. of Epidemiology and MCHA
Mrs. Reeta Dhingra, Research Officer
Dr. Devinder Megha, PG (CHA) student and Dr. Vartika, PG (CHA) student
Firozpur Dr. Vivek Adhish, Reader, Department of CHA
Mrs. Vandana Bhattacharya, Research Officer
Mr. S.S. Mehra, Asstt. Research Officer
Dr. B.S. Diwan, PG (CHA) student and Dr. Jagriti, PG (CHA) student
Gurdaspur Dr. Sanjay Gupta, Reader, Department of CHA and Sub Dean
Dr. Rachna Agarwal, Asstt. Research Officer and Mr. S.P. Singh, Research Assistant
Dr. Nishant, PG (CHA) student and Dr. Ashu, PG student
Hoshiarpur Dr. V. Adhish, Reader, Department of CHA
Mrs. Vandana Bhattacharya, Research Officer
Dr. Sonia, PG (CHA) student and Dr. Vijaydeep, PG (CHA) student
Jallandhar Dr. Gyan Singh, Chief Medical Officer, Department of CHA
Mrs. Vaishali, Research Assistant
Dr. Vartika, PG (CHA) student and Dr. Devendra Megha, PG (CHA) student
Ludhiana Prof. M. Bhattacharya, Head, Department of CHA, and Dean
Mr. Parimal Pariya, Research Officer
Mr. Ramesh Gandotra, Asstt. Research Officer
Dr. Kumud, PG (CHA) student and Dr. Naveen, PG (CHA) student
Muktsar Dr. Sanjay Gupta, Reader, Department of CHA, and Sub Dean
Mr. Parimal Pariya, Research Officer
Dr. Rachna Agarwal, Asstt. Research Officer
Dr. Shailender, PG (CHA) student and Dr. Sudha Goel, PG (CHA) student
Sangrur Prof. J.K. Das, Head, Deptt. of Epidemiology and MCHA
Mrs. Reeta Dhingra, Research Officer
Dr. Rakesh, PG (CHA) student and Dr. Madhu, PG (CHA) student
Tarantaran Prof. J.K. Das, Head, Deptt. of Epidemiology and MCHA
Mr. J.P. Shivdasani, Research Officer
Mrs. Vinod, Asstt. Research Officer
Dr. Sunil, PG (CHA) student and Dr. Indu, PG (CHA) student
Editorial Team Prof. J.K. Das, Dr. Neera Dhar, Reader, Mr. Jai Shivdasani, RO, Dr. Poonam Khattar,
Reader, Department of Education and Training, Dr. Manish Jain, MD, and Ramesh
Chand, ARO
Executive Summary
The Punjab Health Systems Corporation (PHSC), has been enacted through “The Punjab Health
Systems Corporation Act, 1996 (Punjab Act No. 6 of 1996)”. The ‘Second State Health Systems
Development Project’ was started under PHSC in the year 1996, with financial assistance from
World Bank, with an objective to upgrade health services at secondary level. This project ended
in the year 2002, and since then the Government of Punjab is supervising it through PHSC. Today,
PHSC has 166 health institutions throughout the state of Punjab (86 in rural and 80 in urban
areas), including District Hospitals, Sub Divisional Hospitals and Community Health Centres.
Three Training Institutions viz. State Institute of Health and Family Welfare (SIHFW), Mohali,
State institute of Nursing and Paramedical Sciences (SINPS), Badal, and Institute of Mental
Health, Amritsar have also been included under PHSC.
The present study is an in-depth review of structural organisation and operational framework of the
PHSC, and an assessment of the achievements/success of the Health Systems Development Project
in improving health care delivery at secondary health care level. The assessment also meant to
bring to light the gaps in delivery of health care services and to provide practical recommendations
for further strengthening the system. For the present review, a Review Committee was constituted
and it conducted on site visits to 10 District Hospitals, 10 Sub Divisional Hospitals, 11 Community
Health Centres, 2 Speciality Hospitals and 3 Training Institutions, which were selected using
Population Proportionate Sampling Technique (PPS). Key quantitative information was collected
using Facility Survey Checklist, Interview Schedules (for health staff), Exit Interviews of clients,
and Interviews with other stakeholders. The information obtained was further triangulated with
qualitative observations by conducting Focus Group Discussions with the community. The study
was conducted between 15th January 2008 and 5th March 2008.
It was revealed following the study that health facilities under PHSC are well accessible and the
buildings and other infrastructure are appropriate. But the cleanliness of facility and surroundings,
as well as landscape requires more attention. Some health facilities were not having the required
equipment and among those which were having them, there were few where these equipment were
either not being used or was non-functional. Shortage of manpower was revealed as a generalised
observation in almost all the health facilities, particularly the specialists, laboratory technicians
and Class IV employees. This issue was of grave concern in Sub Divisional Hospitals (SDHs) and
Community Health Centres (CHCs). Another observation was that there is no separate cadre for
GDMOs (General Duty Medical Officers) and Specialists, which is leading to poor OPD (Out patient
department) services since the specialist doctors have to do emergency duties as well.
Availability of medicines, particularly of the essential medicines was lacking in almost all the
health facilities, and patients had to buy it from private medical shops, which was a matter of
dissatisfaction among majority of patients as well as community. Health facilities were also found
purchasing few essential drugs from the user charges and were not being supplied from State
Study to Review
ix
or district level. Besides this although laboratory facilities were available in all the institutions
visited, it was observed that they were not able to provide services most of the time due to lack
of reagents and equipment. Radiologists and lab technicians were also not available in majority
of these institutions. Emergency services were also found grossly compromised, particularly in
the sub divisional hospitals, mainly due to staff vacancy and security reasons. Overall the health
facilities visited were found deficient with regard to disaster preparedness, referral linkages, record
keeping, store management and in provision of basic facilities like toilets to the visiting clients.
It was observed that majority of clients approaching PHSC institutions were females belonging
to poor socio-economic strata of the community. It was revealed that well to do families prefer
to visit private doctors, because of better quality and prompt services there as compared to
Government facilities. Major reasons for this discontentment were more waiting time due to lack
of doctors and other staff, lack of medicines and other investigative facilities and poor behaviour
of some of the health staff. Overall experience of respondents at OPDs of the various health
institutions was not found to be very satisfactory. This observation was in particular for CHCs and
District Hospitals, which require prompt attention.
The community also opined and favoured the observations obtained at the OPD and in-
patient departments of the health facilities. Lack of medicines, specialised doctors particularly
gynaecologists, lack of diagnostic equipment, investigation facilities, appropriate emergency
services, and referrals including ambulance service were major issues raised by the community,
which needs to be addressed for improving the acceptability of these services.
In brief, it was revealed from the community, clients and other stakeholders, that the project has
succeeded in building the infrastructure. But its further maintenance, its capacity to address the
community needs and satisfaction and provision of quality health care services through public
health facilities still need to be addressed for better utilisation of the available resources.
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x The Health Care Delivery System provided by PHSC, Punjab
1.0 Introduction
Hospital services at secondary level play a vital and complimentary role to the tertiary and primary
health care systems and together form a comprehensive district based health care system.
It was observed that in the state of Punjab, District Hospitals, Sub-divisional Hospitals and
Community Health Centres were having critical gaps in buildings, equipment, manpower, and skills
and were unable to provide basic health care services. With an objective to improve efficiency
and quality of the health care provided at first referral level hospitals, the State Government took
an initiative to prepare a proposal for seeking aid from the World Bank.
On the request of the State Government, the World Bank team visited the State in March 1995
to review preparation and pre-appraisal of the proposal for the “Health Systems Development
Project-II”. On March 21st, 1996, the International Development Association (IDA) approved
credit of SDR 235.5 million (US$350 million equivalent) under the multi-states Health Systems
Development Project for implementation in the States of Karnataka, Punjab and West Bengal.
The Development Credit Agreement and the Project Agreements were signed on April 18, 1996 on
behalf of the Government of India and respective states. Thus, Punjab Health Systems Corporation
was incorporated through enactment of Legislative act “The Punjab Health Systems Corporation
Act, 1996 (Punjab Act No. 6 of 1996)”.
The Corporation was incorporated through measures by the Government of Punjab to bring more
administrative flexibility for implementation of the ‘Second State Health Systems Development
Project’ with World Bank assistance to upgrade Health Services at secondary level.
The Corporation took over 166 Institutions, which included District Hospitals, Sub-Divisional
Hospitals and Community Health Centres. 86 Medical Institutions are situated in rural areas and
80 are in urban areas. Two training institutes viz. State Institute of Health and Family Welfare,
Mohali and State institute of Nursing and Paramedical Sciences, Badal, Distt. Muktsar have also
been constructed and were included under PHSC institutions.
The World Bank sanctioned the Second State Health Systems Development Project of US$106.10
million to upgrade the envisaged areas means clinical, diagnostic and other services provided
by community/rural, sub-divisional/taluka/state general and District Hospitals in the State of
Punjab.
1.1 Objectives of the Punjab Health Systems Corporation

Project
a) To improve efficiency in the allocation and use of health resources in the Project States
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1
through policy and institutional development; and
b) To improve the performance of the health care system in the Project States through
improvements in the quality, effectiveness and coverage of health services at the first referral
level and selective coverage at the primary level, so as to improve the health status of the
people, especially the poor, by reducing mortality, morbidity and disability.
As per the suggestions, the Project for revamping the Secondary Level Health Care Services was
proposed to help in:
• Adding and renovating hospital building at the block, sub-divisional and district
headquarters;
• Supplementation of accommodation for essential staff;
• Provision of more ambulances and better machinery and equipment;
• Increase in body strength at some places;
• Additional hospital linen and accessories;
• Maintenance funds for building, vehicles, machinery and equipment;
• Cleanliness, repair and up-keep of all buildings.
The whole of the State was to be covered through 86 Government Health Centres in the rural
areas.
1.2 The Benefits to the General Public

a. Free consultation for all
b. Free diagnostic analysis, medicines and also treatment like operations, etc. for Yellow Card
holders, Punjab Government Employees, Pensioners, past and present Members of Legislative
Assembly, Hon’ble Judges, Freedom Fighters, under trial Prisoners, under emergencies and
natural calamities and under National Programmes.
c. Full availability of equipment and chemicals, etc. for diagnostic facilities.
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2 The Health Care Delivery System provided by PHSC, Punjab
2.0 Rationale
As mentioned above, the Health Systems Development Project started under PHSC in 1996 with
financial assistance from World Bank and concluded in the year 2002. Since then Government
of Punjab is supervising it through a duly constituted corporation i.e. Punjab Health Systems
Corporation (PHSC).
The present study was conducted with the aim of reviewing as to how far the objective of this
Project (HSDP II) has been achieved in improving health care delivery at the secondary level of
health care. Also to bring to light any lacunae or gaps observed in delivering the health care
services to the community. The study is an In-depth review of the Punjab Health System by the
Review Committee constituted for the purpose.
2.1 Constitution of Committee

i) Dr. J.S. Bajaj Chairman
V.C.Punjab Planning Board
ii) Dr. K.K. Talwar Member
Director, Post Graduate Institute of Medical
Education and Research (PGIMER), Chandigarh
iii) Dr. P.K. Dave Member
Former Director, All India Institute of
Medical Sciences (AIIMS), New Delhi
iv) Dr. Deoki Nandan Member
Director, National Institute of Health
and Family Welfare (NIHFW), New Delhi
v) Dr. Shakti Gupta Member
Medical Superintendent, AIIMS, New Delhi
vi) Dr. Sukhdev Singh Member
Director, Family Welfare, Punjab
vi) Dr. Roshan Sunkaria, IAS Member
Managing Director, PHSC Convener Member
viii) Shri Tejveer Singh, IAS Coordinator
Special Secretary to Government of Punjab Member
Department of Planning
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2.2 Terms of Reference
The Committee was to make on site visits and to review at least 50% of the 20 District Hospitals
located in different regions of the State, along with a similar inspection of 2 Special Hospitals
(Patiala and Bhatinda), as well as of 10% of 37 Sub Divisional Hospitals (SDHs) and 5% of the
111 Community Health Centres (CHCs).
2.3 Study Objectives

i) To conduct an in-depth review of structural organisational and operational framework of
Punjab Health System Corporation (PHSC) and to assess the efficiency and effectiveness of
management system so far established.
ii) To conduct site visits to a specified number of District Hospitals, special hospitals, sub
divisional hospitals and community health centres and assess the quality and efficiency of
the delivery of health care at each of the health institutions.
iii) To visit the three special Training and Teaching Institutions which are under the management
control of PHSC and conduct a short academic review of the physical facilities as well as of
the process of education.
iv) To propose requisite remedial measures aimed at optimising a cost-effective and efficient
management of PHSC as well as of hospitals and training institutions under its control and
management.
The field work, data collection, analysis, interpretation and report writing was done by National
Institute of Health and Family Welfare, New Delhi.
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3.0 Methodology
3.1 Type of Study

This was an exploratory study conducted in the state of Punjab with an objective to undertake
situational analysis, identify areas of sub optimal functioning and suggest remedial measures.
3.2 Duration of Study

15th January to 5th March 2008.
3.3 Sample Size

1. 50% of 20 District Hospitals (DHs) 10 DHs
2. 26% of 37 Sub Divisional Hospitals (SDHs) 10 SDHs
3. 10% of 111 Community Health Centres (CHCs) 11 CHCs
4. All the Special Hospitals (SHs) 02 SHs
5. All the Training Centres (TCs) 03 TCs
Total 36
3.4 Sampling Technique

Selection of the Districts was done by using the Population Proportionate to Size (PPS)
Technique. These Districts were selected proportionately from the 3 existing geographical regions
i.e. Majha, Doaba and Malwa.
Hence the region wise sample of the Districts drawn was as follows:
Majha
1. Amritsar
2. Gurdaspur
3. Taran Taran
Doaba
1. Hoshiarpur
2. Jalandhar
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Malwa
1. Bhatinda
2. Ferozpur
3. Muktsar
4. Sangrur
5. Ludhiana
3.5 Data Collection Tools and Techniques

1) Interview schedule for health functionaries/service providers
2) Exit interview schedule for patient satisfaction
3) Checklist for Facility Survey
4) Questionnaire for trainers
5) Interview schedule for other stakeholders including community
The health functionaries, other stakeholders, sample of beneficiaries (i.e. patients selected
randomly) and facility surveys of health institutions for study were as follows:
3.5.1 At district level

a) District Collector 1x10 = 10 in no.
b) Civil Surgeon 1x10 = 10 in no.
c) Local MLA/MP 1x10 = 10 in no.
d) SMO/MS at
District Hospitals 1x10 = 10 in no.
e) Indoor patients 10% of the total admitted in hospital or minimum of
10 patients
f) Outdoor patients (OPD) 5% of the OPD attendance or minimum of 20 patients
g) Facility Survey of 1x10 = 10 in no.
District Hospitals
3.5.2 At sub-divisional level

a) Local elected representatives
at sub-divisional level 1x10 = 10 in no.
b) SMOs/MS at
Sub-Divisional Hospitals 1x10 = 10 in no.
c) Indoor patients 10% of the total admitted in hospital or minimum of
6 patients
d) Outdoor patients (OPD) 5% of the OPD attendance or minimum
of 20 patients
e) Facility Survey of 1x10 = 10 in no.
Sub-Divisional Hospitals
f) FGD (Male Community Members) 1x10 = 10 in no.
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3.5.3 At CHC level
a) Local elected representatives
at CHCs 1x11 = 11 in no.
b) SMO/MS at CHC 1x11 = 11 in no.
c) Indoor patients 10% of the total admitted in hospital or minimum of
3 patients
d) Outdoor patients (OPD) 5% of the OPD attendance or minimum of 10 patients
e) Facility Survey of the CHCs 1x11 = 11 in no.
f) FGD (female community members) 1x11 = 11 in no.
Due care was taken to select the SDHs and CHCs from the same district from which District
Hospital was selected so as to study the referral linkages.
3.5.4 Special hospitals

a) SMO/MS at Special Hospitals 1x2 = 2 in no.
b) Indoor patients 10% of the total admitted in hospital or minimum of
10 patients
c) Outdoor patients (OPD) 5% of the OPD attendance or minimum of 20 patients
3.5.5 Training institutes

a) Facility Survey 1x3 = 3 in no.
b) Interview of the faculty
3.6 Data Collection Team

10 Teams, each comprising of 1 faculty member, 2 research staff and 2 students from NIHFW
visited their respective sample district and collected the above mentioned data from whole of the
district area. Training Institutes were also evaluated during these visits.
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4.0 Study Findings
Following are the study findings as per the terms of reference provided:
4.1 Structural and Operational Framework of Punjab Health

Systems Corporation (PHSC)
A review of structural, organisational and operational framework of Punjab Health Systems
Corporation (PHSC) was carried out. The detailed findings are as follows:
The World Bank team on the request of the State Government visited the State in March-95
to review preparation and pre-appraisal of the proposal for the “Health Systems Development
Project-II”. Thus, Punjab Health Systems Corporation had been incorporated through enactment
of Legislative act “The Punjab Health Systems Corporation Act, 1996 (Punjab Act No. 6 of 1996)’.
The Corporation has been incorporated through measures by the State Government of Punjab to
bring more administrative flexibility for implementation with assistance of World Bank to upgrade
Health Services at secondary level.
The PHSC was incorporated on October 20, 1995 to establish, expand, improve and administer
medical care at secondary level of health care services. The project activities were undertaken by
the PHSC and the State Government has ensured that PHSC should function as an autonomous
body. For its effective implementation, a Strategic Planning Cell is functioning under the overall
supervision of the MD, PHSC-cum-Secretary Health.
Under this project, PHSC had taken over 166 Institutions, which includes District Hospitals, Sub-
divisional Hospitals and Community Health Centres. 86 Medical Institutions are situated in rural
areas and 80 are in urban areas. Two training institutes viz. State Institute of Health and Family
Welfare, Mohali and State Institute of Nursing and Paramedical Sciences, Badal, Distt. Mukatsar
have also been constructed and were included under PHSC institutions.
The World Bank sanctioned the Second State Health Systems Development Project of US$106.10
million (approximately Rs. 422 crores) to upgrade the envisaged areas means clinical, diagnostic
and other services provided by community/rural, sub-divisional/taluka/state general and District
Hospitals in the State of Punjab.
Study to Review
Organogram of Department of Health & Family Welfare
Health & Family Welfare Minister
Parliamentary Secretary
Health & Family Welfare
Principal Secretary
Health & Family Welfare
Secretary Special Director Director Director Secretary Head of

Health cum Secretary Health Health Family (SI) Health cum Department
Managing cum Mission Services Welfare Commissioner Homeopathy
Director PHSC Director NRHM AYUSH
cum PD AIDS
C D E F G
PHSC Jt. Secretary

Health
A
Health-I, II &
PSACS
IV Branches
Under
Secretary
Health
PHSC Punjab Health Systems Corporation

Health B PSACS Punjab State Aids Control Society
- V, VI & VII SI Social Insurance (ESI)
Branches
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The major heads under which the funds were provided were Loan Rs. 252.00 crore, Grant
Rs. 127.00 crore and Share of the State Government. Rs.43.00 crore.
Break up of the budget was as follows:

Head Rs. in Crore
Civil works for renovation, new construction and extension 174.07
Major/Minor equipment, Surgical Packs and Furniture 66.09
Vehicles and Ambulances 8.49
Medicines, Medical Lab, Supplies 26.51
Information Systems and Computers 11.14
Training and Workshop 12.45
Salaries and Office Expenses 49.66
Price Contingencies 73.47
Total Rs. 421.88
4.2 The Corporation consists of:

(a) The Chairman who shall be the Secretary to the Government of Punjab in the Department of
Health and Family Welfare or a distinguished and eminent medical person.
(b) The Vice Chairman of the Punjab Health Systems Corporation is the Secretary Health and
Family Welfare and is the overall in charge of the department. He is the Chairman of the Punjab
AIDS Control Society, Chairman of SCOVA (RCH Society), TB society and Leprosy Society.
(c) Secretary Health-cum-Managing Director, who shall be an officer of the Indian Administrative
Service. He assists the Vice chairman of the PHSC in connection with the administrative
issues concerning to the PCMS doctors, which include Recruitment, Posting, Transfers,
Disciplinary Actions, Service Rules etc. In addition to this, he has also been designated
as Head of Department (HOD) of Government Mental Hospital, Amritsar. He is assisted by
Superintendents of Health – I and II Branches of the Department and is supported by the
Director, General Manager (F&A), Executive Engineers and other Programme Officers.
(d) A Board of Directors; and such other employees, as may be determined by the Board of
Directors.
4.3 Constitution of Board of Directors

The Board of Directors consisting of the following members namely: -
(a) The Secretary to the Government of Punjab in the Department of Finance,
(b) The Secretary to the Government of Punjab in the Department of Rural Development and
Panchayats,
(c) The Secretary to the Government of Punjab in the Department of Local Government,
(d) Representative of the Government of India in the Ministry of Health,
(e) The Director of Health Services, Punjab,
(f) Six eminent persons as given below nominated by the Government for a period of three
years, (provided that no nominee shall be a member of the Board of Directors for more than
Study to Review
Chairman A
Vice Chairman-cum-Principal Secretary, Health & Family Welfare
Managing Director
Director Director General Executive

cum Principal (Institute of Manager Engineer
S.I.H.F.W. Mental Health (F&A cum (Works)
Mohali Amritsar) Secy Board)
AM EE (C) EE (C) EE (C)

DMA AMFA Audit Mohali Patiala Jalandhar
AAO
Principal State
Institute (Badal)
Dy Dir. (Admn) Accountants AMFA Assistant Manager (Finance & Accounts)

AAO Assistant Accounts Officer
Dy Dir. (P&T)
Acct Accountant
Asst. Dir. (Admn) Admn Administration

BB Blood Bank
Asst. Dir. (Sur) DMA Deputy Manager Accounts
DMC Deputy Medical Commissioner
Asst. Dir. (HS)
EE (C) Executive Engineer (Civil)
Asst. Dir. (BB) F&A Finance and Accounts

HMIS Health Management Information Systems
Asst. Dir (Equip) HS Hospital Services
Med Supdt Medical Superintendent
P&T Procurement and Transport
Stat Anyst Statistical Analyst
Sur Surveillance
Study to Review
11
two terms or six years whichever is less):
(i) A representative of medical institution of excellence in the country,
(ii) Two distinguished experts in professions related to medicine and health,
(iii) An experienced professionals in Systems Management or Telecommunication,
(iv) The Director of the National Institute of Pharmaceutical Education and Research; and
(v) A representative of a reputed industrial house manufacturing pharmaceuticals.
4.4 The Managing Director

• The Managing Director is the Executive Officer of the Corporation and he shall implement the
decisions of the Board of Directors and shall exercise such other powers and perform such
other functions, as may be delegated to him from time by the Broad of Directors.
• The Managing Director exercise general control and supervision over the dispensaries and
hospitals in the effective performance of their functions under this Act or the regulations
made there under.
• Corporate Level Departments
1. Strategic Planning Cell (SPC)
2. Department of Administration
3. Department of Procurement
4. Engineering Wing
5. Department of Finance and Accounts
6. Computer Cell.
• District Level Management of the Corporation

7. Deputy Medical Commissioner
8. District Health Committee
9. Assistant Medical Commissioner
10. Other medical and Paramedical Staff
• Hospital Level Staff

11. Senior Medical Officer
12. Medical Officer
13. Other medical and Paramedical Staff
4.5 Functions of the Corporation

In order to ensure the focused approach for management of secondary level health care services,
additional programme officers in the field of Quality Assurance, HMIS, Waste Management,
Surveillance, Referral, Training, IEC, Hospital Services, Blood Bank have been positioned at
headquarters level. Separate offices were set-up for Deputy Medical Commissioners (DMC).
Apart from this, in order to enhance the data collection and analysis capabilities, the office of
DMCs have been strengthened by providing manpower in the field of accounts and HMIS which
support the hospitals in proper record keeping and monitoring.
Study to Review
The functions of the Corporation are as follows:
a) to formulate and implement the schemes for the comprehensive development of the
dispensaries and hospitals;
b) to construct and maintain dispensaries and hospitals including cleanliness;
c) to implement National Health Programmes as per the directions of the State. The State
Government and Central Government shall make funds available for this purpose;
d) to purchase, maintain and allocate quality equipment to various dispensaries and hospitals;
e) to procure, stock and distribute drugs, diet, linen and other consumable among the
dispensaries and hospitals;
f) to provide services of specialists and super-specialist in various hospitals
g) to enter into collaboration for super specialities with health institutions both within the
country and abroad to provide better medical care;
h) to receive donations, funds and the like from the general public and institutions from both
within and outside India;
i) to receive grants or contributions which may be made by the Government on such conditions
as it may impose;
j) to provide for construction of houses to the employees of the dispensaries and hospitals, and
the maintenance thereof by mobilising resources for financing institutions;
k) to plan, construct and maintain commercial complexes, paying wards and providing diagnostic
services and treatment on payment basis and to utilise the receipts for the improvement of
the dispensaries and hospitals;
l) to run public utility services and undertake any other activity of commercial nature for the
delivery of health care within or without the hospital premises directly or in collaboration
with private or voluntary agency on contract basis;
m) to engage specialised agencies or individuals in the relevant disciplines, directly or from
external sources for the efficient conduct of the functions; and
n) to provide immediate treatment in case of emergency and for unaccompanied patients.
4.6 Steps for the betterment of employees

1. Chance of foreign training for all doctors and para-medical staff;
2. Substantial training opportunities and fellowships etc. within the country;
3. No change in the terms and conditions of the services, establishment matters will remain
wherever they are.
4.6.1 At district headquarter level

There is one Deputy Director cum Civil Surgeon (DD cum CS) in each district and hence a total 20
DD cum CS in Punjab. DD cum CS supports the Directorate of Health Services through taking care of
implementation of various National and State Health Programmes, Implementation of Registration
of Births and Deaths Act and Prevention of Food Adulteration Act. The Deputy Medical Commissioner
(DMC) supports the DD cum CS in the provision of hospital services in the district. The District
Health Officer assists the DD cum CS in the implementation of the Disease Control Programmes. S/he
also supports the Directorate of Family Welfare (DFW) in enforcement of PNDT Act as District Appropriate
Study to Review
13
Authority and implementation of different schemes in the District under National Family Welfare Programme
through District Family Welfare Officer and District Immunisation Officer.
4.6.2 At block level

The Civil Surgeon is supported by Senior Medical Officers, I/c of PHCs and Medical Officers I/c of
Subsidiary Health Centre (SHC) in implementation of various National and State Health Programmes
at grassroot level.
4.6.3 At subsidiary health centre level

The Senior Medical Officers are supported by Medical Officer I/c SHC for Implementation of
different schemes in the SHC area under National Family Welfare Programme through Multipurpose
Health Worker (Male and Female). Medical Officers I/c are supported by Multipurpose Health
Worker (Male/Female) in implementation of (i) Universal Immunisation Programme (DPT, Polio,
BCG, Measles and TT for Pregnant mothers). (ii) Maternal & Child Health (Antenatal Check Up,
Institutional Delivery & Post Natal Check Up). (iii) Family Planning: Counseling/motivation.
District Headquarters
Deputy Director-cum-Civil Surgeon X
{1 Post at each district}
(Total = 18)
District
Assistant Civil District District Family Deputy Medical
Immunisation
Surgeon Health Officer Planning Officer Commissioner
Officer
Senior Medical
Officers of
PHC/SHCs SMO
(Hospitals)
1 Primary Health Centre for appropriately (100,000) population

Total in the State 118
SMO - 1 MO - 2 at each PHC
SHC
(Subsidiary Health Centre/Dispensary) LHV (Lady Health Visitor)
For 10,000 population each total in the State: 1200
M+F (Male & Female)
MPHW (Multipurpose Health Worker)
PHC (Primary Health Centres)
Sub-centre Total with State: 2858+ (5000 population)
LHV, Multi-Purpose Supervisor – For a Population of 30,000 SHC (Subsidiary Health Centre)
(MPHW – M+F) SMO (Senior Medical Officer)
Study to Review
(iv) Management of diarrhoea especially in infants. (v) Health Education: educating the
community about the various available services. (vi) Control of Acute Respiratory Infection
especially in infants. (vii) Identify the women requiring help for medical termination of
pregnancy and refer them to nearest approved institution (viii) Health Survey.
4.6.4 Deputy Medical Commissioner (DMC)

The DMC looks after the hospital services in District Hospitals, Sub Divisional Hospitals, and Block
level Community Health Centres, which are headed by Sr. Medical Officer or In-charge of the
hospital. In two special hospitals, i.e. MKH Patiala and Civil Hospital Jalandhar, there are Medical
Superintendents who directly report to headquarters. Apart from this, Principal, State Institute of
Nursing and Paramedical Sciences, Badal reports to MD-PHSC through Director cum Principal, State
Institute of Health & Family Welfare, Mohali and Director, Institute of Mental Health i.e. Government
Mental Hospital, Amritsar reports directly to the Managing Director. Recently the SINPS, Dadal has
been handed over to Baba Faridkot University.
4.7 Review of functioning of PHSC

To give more autonomy to the Hospitals, PHSC took the steps like (i) Higher financial powers to
hospital in-charge, DMCs and CSs were given; (ii) Full powers were given to hospital incharge for
commercial exploitation for support services for revenue raising, outsourcing of sanitation services,
maintenance services of equipment and hospital building and condemnation of unserviceable
articles; (iii) Clear-cut guidelines were given for the procedures to be adopted for retention and
utilisation of user charges; (iv) Direct recommendation for recruitment of critical manpower on
contractual terms. This is a very encouraging move. Higher accountability is possible only when
more autonomy is given to the institutions.
In more than 50 hospitals and 20 districts headquarters, capacity has been developed for computerised
record keeping, which covers records of HMIS, Accounts, OPD/IPD, Blood Banks, and Diagnostic
Services. For this purpose, the concerned staff has been trained and computer operators have been
provided. In-house capabilities have been developed for commercially negotiating with the private
partners for outsourcing. Slowly this capacity is being decentralised for effective implementation.
Though computer was provided for computerised record keeping in hospitals/health centres at all
levels, but in reality these computers were being used only for the registration purposes and these
were not being used for record keeping or generation of HMIS. Only at few of the places, the medical
records department was being managed by trained persons.
Computerised HMIS systems were in position and regular data of the hospital activity and efficiency
indicators were supposed to be collected and analysed. This was found to be one of the weakest
areas in all most all the hospitals/health centres that were evaluated.
There was hardly any well planned and organised Medical Record Department. Most of the centres
were not even fully computerised, as the computers were there in the registration areas only.
Even in some places untrained clerical staff manned it. The data so generated were not properly
analysed to get the right information (like BOR, Average Length of stay, BTR, Death Rates etc.)
required for effective management and to take right policy decisions. For an effective and efficient
Hospital Administrator these are very important tools.
Study to Review
15
Hence, efforts should be made to strengthen these aspects by planning and organising a good
Medical Record Department for hospitals at every level. Also these Medical Record Departments
should be Computerised and manned by properly trained and dedicated staff, which will take care
of all the required Management Information System used for Hospital Administration.
Overall percentage of the total Government expenditure on health sector increased from 3.54% in FY
94-95 to 4.27% in FY 03-04 (BE). In absolute term, the allocations have increased from Rs. 2057
million in FY 94-95 to Rs. 7117.20 million in FY 03-04 (BE) against the projected level of Rs. 2956
million. The per capita expenditure on Health at current price has increased from Rs.101 in FY 94-95
to Rs.292 in FY 03-04.
Policy as regard to implementation of user charges was placed right from the very beginning.
Reports showed the User Charges collections have increased sharply from Rs. 4 million in FY 96-
97 to Rs. 125.37 million in FY 03-04. This increase has been established by introducing better
collection method and increase in the services offered. Retained user charges are being utilised
on defined priorities of essential drugs (45%), patient’s facilities (25%), equipment maintenance
(15%) and building maintenance (15%). During the study it was observed that in almost all the
hospitals at all level about 40-50% of retained revenue from User Charges were used to procure
medicines and 20-30% amount on IFP purpose. But utilisation on building maintenance and
equipment maintenance were found to be less utilised than its actual allotment.
In the year 1996 & 1998, the State Government recruited 279 & 785 doctors. But since then no
new recruitments were made. As a result there were some shortages of doctors in the regular cadre
which is having its adverse effect on the overall functioning.
Efforts were made to ensure that core team of specialists to be made available in every hospital.
But in reality the availability of all the basic specialists in respective hospitals could not be
ensured. Some times it was observed that a Medical Officer of one speciality on transfer was
replaced by a Medical Officer of another speciality or a general duty medical officer, because in
Punjab, there is only one cadre for Medical Officers.
100% equipment as per the norms was supposed to be in position in all the newly commissioned
hospitals along with preventive maintenance of the vital equipment to be undertaken through
AMCs. But in reality it was found not to be always in place.
Availability of the drugs was to be monitored on monthly basis as a part of the hospital grading
exercise. The State Government has continued providing the supplies of the medicines in hospitals.
But in practice this was one of the major lacunas on the part of service providers. Most of the
places it was told that the hospitals were not getting any regular supply of Drugs from the State,
rather, they were told to arrange the same from funds generated through User Charges.
Support services i.e. ambulance maintenance services, sanitation services and general maintenance
services had been contracted out as a time gap arrangement. Waste disposal activities were also
contracted out. This initiative was a very good move and it was reported that there were some
visible improvements. But later on due to some policy decision the regular Class IV employees
Study to Review
working in the peripheral health centres were deployed and contractual staff was removed. As a
result, situation of general maintenance services in the hospitals were not one of the best. Main
reasons told were absenteeism and unionism.
Comprehensive referral system was to be established by introducing procedures at the primary

level, through Out Reach Camps held in the rural and far-flung areas and by providing incentives
for the referred cases at the higher level institutions.
Referral manual has been prepared containing guidelines that specify ‘what’ ‘when’ and ‘how’ of
referral. Colour coded referral cards have been introduced for sub centre level to district level for
referring the patients. Training to doctors and paramedics for implementation of referral system
was given. Incentive for referred patients (queue jump, exemption of OP/Admission Charges) have
been introduced, referral routes have been established and displayed in all the hospitals. Special
tie-up has been made at tertiary level facilities for creation of special window for the referred
patients. But in practice none of these measures could be observed in exact desired manner. This
is a very important aspect for an effective and holistic Health Care delivery system and hence all
efforts should be made to further strength it and effectively implement it.
A set of core indicators is being used to grade all the 154 hospitals. External lab quality assurance
programme has been introduced. This was found to be a very useful and an effective mechanism
for better and quality service output.
Overall, as per the objectives of the PHSC and its policy implementations it was found to be quite
cost effective with management efficient system. All the aspects are properly implemented. Many
of these aspects are already mentioned above.
For ensuring better availability of drugs and other consumables in hospitals/health centres at
every level the Model of Tamil Nadu Medical Corporation may be followed. As this model is
followed by many states with some modification as per their needs.
Referral System needs to made more effective and extreme care needs to be taken to make it two way
system and not one way, which was found to be followed in present situation. This was found to be
more of Transfer System of patient than of Referral System. In this process the patients will tend to
lose their confidence on the lower centres and as a result these centres will become under utilised.
The examples for successful two way Referral Systems which are being followed in India are CGHS,
ESIC, Railways, Army, etc. Further, for developing an effective and efficient system the National
Health Scheme (NHS) followed at United Kingdom (UK) may be studied for its implementation.
Efforts should be made to ensure the availability of all the services required for diagnostic and
therapeutic processes by applying the modern scientific management techniques.
There should be atleast two separate cadres for doctors. One for General Duty and other for the
Specialists as it is followed in Central Health Scheme (CHS), ESIC, Railways, Army, etc.
Study to Review
17
5.0 Facility Assessment
A survey was conducted to assess the existing facilities with respect to various indicators at each
health set up.
5.1 District Hospitals

Facility assessment was done in ten District Hospitals selected as sample, which were Amritsar,
Bhatinda, Ferozpur, Gurdaspur, Hoshiarpur, Jalandhar, Ludhiana, Muktsar, Sangrur and Taran Taran.
Along with these hospitals, two special hospitals were also studied viz. women and child hospital
in Patiala and Bhatinda. The general profile and facility assessment of District Hospitals is
given in the Table Section (Refer Table – 1).
5.1.1 Accessibility
All District Hospitals and special hospitals were easily accessible from the railway station and
bus stand and well connected with the road. Average distance from the railway station and bus
station ranged from one to four kilometres respectively.
5.1.2 Bed strength

Six District Hospitals were 50 to 100 bedded, three were 100 to 200 bedded and one District
Hospital of Jalandhar was found to be 300 bedded hospital. Special hospital at Patiala was 154
bedded and one at Bhatinda was 50 bedded hospital.
5.1.3 Water supply

Almost all district and special hospitals were having adequate water supply except Bhatinda and
Muktsar. Five District Hospitals and two special hospitals were having bore well water supply and
four hospitals were having municipal water supply. District hospital, Muktsar was having canal
water supply. Water storage capacity was available for one day at 2 District Hospitals and one
special hospital, three days at 6 District Hospitals along with Patiala special hospital and two
days at the remaining two District Hospitals.
5.1.4 Electricity supply

Electricity supply was found to be regular in most of the district and special hospitals.
Only three District Hospitals viz. Amritsar, Muktsar and Taran Taran, were having irregular
supplies. However, only one District Hospital was having double phase electric supply, while,
rest of the nine District Hospitals and two special hospitals were having three phase electric
supply. Back up generator system was available in all the ten District Hospitals and two
special hospitals.
Study to Review
5.1.5 Lifts and ramps
Lifts were available in only four District Hospitals out of ten District Hospitals and two special
hospitals included in the study. All hospitals were having ramps.
5.1.6 General impression on cleanliness and maintenance of gardens

Six district hospitals (60%) were having good cleanliness and four (40%) were average. Among
special hospitals, the cleanliness standard was good in Patiala and average in Bhatinda.
Five District Hospitals (50%) were found to be having good upkeep of garden and rest five were
having average landscaping. Among special hospitals, Patiala was found to have good while
Bhatinda hospital with average upkeep of garden/landscaping.
5.1.7 Status of Buildings

The status of the buildings in six District Hospitals was good, while it was average in the remaining
four District Hospital buildings. Both the special hospitals included in the study were having a
good building status.
5.1.8 Signs, roads and lighting

Signage system was poor in Sangrur and average in Ludhiana District Hospitals. Rest of the eight
District Hospitals were having good sign post system. Among special hospitals Patiala was having
good while Bhatinda was having average sign posting.
Roads and lighting of six District Hospitals were good, three were average and only one hospital
(Amritsar) was found to be poor. Both the special hospitals under study were having good roads
and lighting.
5.1.9 Public utility facilities

Among all the District Hospitals covered under the study, six had a chemist shop within the
premises; majority of District Hospitals (70%) had a canteen as well. Only two District Hospitals
did not have Sulabh Shochalaya (Toilet facility) out of 10 District Hospitals. Five District Hospitals
had STD/PCO booth within the premises.
Both the special hospitals had a chemist shop, canteen and Sulabh Shochalaya within the hospital
premises. Bhatinda Hospital did not have STD/PCO booth in the premises.
5.1.10 Ambulance service

Ambulance facility was available among all the district and special hospitals covered under the
study, with the District Hospital in Bhatinda having ten ambulances and rest of the district and
special hospitals having one to five ambulances each.
Study to Review
19
Majority of these ambulances were found to be partially equipped. Only three District Hospitals
had fully equipped ambulances. Out of the two special hospitals assessed, only one had a fully
equipped ambulance.
5.1.11 Operation Theatres (OT)

Majority of the District Hospitals were having at least one minor OT, except Jalandhar and Muktsar
hospitals, which were having four and three minor OTs’ respectively.
Regarding major OTs, two District Hospitals were having one major OT, three District Hospitals
were having three major OTs, three District Hospitals had two major OTs and two hospitals were
having four major OTs. Patiala special hospital had two major OTs while Bhatinda special hospital
had only one major OT.
5.1.12 Dental services

Only the special hospital at Bhatinda, where no Dental Department exists, was without dental
services out of the ten District Hospitals and two special hospitals covered under the study.
5.1.13 Maternity services

All the hospitals were having maternity services.
Fig 1: Normal deliveries conducted in District Hospitals (Punjab) in the last five years
4000
1st Yr
2nd Yr
3500
3rd Yr
3000 4th Yr
No. of normal deliveries
5th Yr
2500
2000
1500
1000
500
sa
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r o a i n h uk l n a
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Ho Ja Pa
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G Ta h
B
Districts
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Fig 2: Caesarians done in District Hospitals (Punjab) in the last five years
1600
1st Yr
1400
2nd Yr
1200
3rd Yr
4th Yr
No. of caesarians
1000 5th Yr
800
600
400
200
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Districts
5.1.14 Mortuary
Out of ten, seven of the District Hospitals (70%) were having a Mortuary whereas two of them
did not have post mortem facilities. Both the special hospitals were without Mortuary and post
mortem facilities.
5.1.15 Various hospital management committees

Only three District Hospitals were having a drug formulary and hospital antibiotic committee.
None of the two special hospitals had a Hospital antibiotic committee, although Patiala special
hospital was having a drug formulary committee. All the ten district and two special hospitals were
having a store purchase and store verification committee except special hospital at Patiala.
Four District Hospitals were not having a Hospital Infection Control Committee and medical
audit/death review committee. Both the special hospitals were without Hospital Infection Control
Committee, although Patiala hospital had a medical audit/death review committee.
5.1.16 Drugs and equipment management

Almost all District Hospitals and special hospitals were having dual drug supply. They get drugs
and equipment supply from the state and they can also purchase these supplies on their own,
utilising the user charge money.
Study to Review
21
Percentage of drug items which were requested and received were found to be 50 % in four
District Hospitals, 40% in one, 60% in one District Hospital and one special hospital, 90% in one
District Hospital, 100% in another and only 20% in Patiala special hospital.
Percentage of patients getting all the prescribed medicines was found to range between 40%
to 75% in most of the hospitals, except in Muktsar where it was only 25% and in Hoshiarpur
it ranged from 5% to 10% for OPD patients. However, indoor patients in Hoshiarpur District
Hospital were found to receive 100% of the prescribed medicines.
Only two District Hospitals were having their own drug formulary. Six District Hospitals and both
the special hospitals maintained buffer stock. All the hospitals were having annual maintenance
contracts for maintenance of costly equipment and all hospitals maintained a logbook and
history sheet for the equipment except two District Hospitals at Sangrur and Taran Taran. Current
functional status of all the existing equipment was found to be good at the time of assessment.
5.1.17 Major equipment

Only two District Hospitals at Amritsar and Bhatinda and special hospital at Patiala were not
found to have baby incubators. The same were not functional in two out of the remaining District
Hospitals having baby incubators.
All the District Hospitals were having functional Boyle’s apparatus with circle absorber. All the
hospitals were having a cardiac monitor though it was non functional in two of these District
Hospitals. One special hospital did not have dental chairs.
Dosimeter was present only in Taran Taran and one special hospital. ECG facility was available
at all the hospitals; however, the same was not functional in Ferozpur hospital. Emergency
resuscitation kit was available in all District Hospitals, except at Muktsar District Hospital. The
emergency resuscitation kit was not found functional in Ferozpur hospital.
Endoscope was available only in five District Hospitals, although it was non functional in Gurdaspur
District Hospital. Endoscope was not available in any of the special hospitals assessed.
All the ten District hospitals were having a functional ophthalmoscope. Out of two special
hospitals, it was available only at Bhatinda special hospital.
Four District Hospitals and one special hospital were having a perimeter. Only one District Hospital
at Muktsar was not having phototherapy unit. Only Sangrur District Hospital and one special
hospital were not having retinoscope. Shortwave diathermy was not present in three District
Hospitals and it was found to be non functional in two District Hospitals and one special hospital.
Sigmoidoscope was available at six District Hospitals out of ten.
X-ray facility was present in all the hospitals, but ultrasound facility was not present in Sangrur
and special hospital, Bhatinda. Slit lamp was available at all District Hospitals, but nowhere at
special hospitals.
Study to Review
5.1.18 Referral system
Referral facilities were available in almost all hospitals, though referral manual was not present in
half of the District Hospitals and both the special hospitals. Guidelines for referring patients were
not available in four District Hospitals and in both the special hospitals. Colour coded referral
cards were available only in six District Hospitals and one special hospital at Bhatinda. Feedback
mechanism existed only in three District Hospitals.
Transport facilities were provided by all the hospitals. Only one District Hospital and one special
hospital was not maintaining records and registers for the same. Incentives for following referral
route for patients were provided only in four District Hospitals and one special hospital; they are
mainly providing the vehicle for referral.
Five District Hospitals along with special hospital at Bhatinda had a tie-up with other hospitals
(both public and private) for diagnostic or referral purposes and most of them were with
Government hospitals or Medical colleges except District Hospital at Jalandhar which was having
tie-ups with private hospitals also.
Statistical Bulletin was available only in four District Hospitals.
5.1.19 Outreach services and residential area

Three District Hospitals and one special hospital at Bhatinda were having an outreach area and
the services provided were mainly related to maternal and child health.
All hospitals were having residential accommodation for the essential staff except at Amritsar
and Muktsar. Though residential accommodation was available but still staff members were
not getting it. 80% of staff was not getting accommodation in Bhatinda, 70% in Taran Taran,
50% in Hoshiarpur and Ludhiana, 40% in Sangrur and 15 % in Jalandhar. Among special
hospitals, 40% of the staff was not getting accommodation in Patiala and 90% in Bhatinda.
Ferozpur and Gurdaspur were having full accommodation and all staff members were getting
the accommodation.
All hospitals were having a security service. Among them three District Hospitals were having
contractual security service and rest were having in-house security service.
Three District Hospitals and one special hospital were having Dharamshala facility.
5.1.20 Out-patient department (OPD)

Reception and registration counter was computerised in nine District Hospitals and in one special
hospital at Patiala. It was found to be managed by a clerk in two District Hospitals, staff nurse
in one, pharmacist in six and by a computer operator in eight District Hospitals and one special
hospital. (See Fig 3)
Study to Review
23
Fig 3: No. of OPD Patients in District Hospital (Punjab) in last five years
300000
1st Yr
2nd Yr
250000
3rd Yr
4th Yr
No. of OPD patients
200000 5th Yr
150000
100000
50000
0
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Districts
There were separate registration counters for male, female and senior citizens in most of the
hospitals, except in three District Hospitals and one special hospital where only one District
Hospital and one special hospital were having a separate registration counter for the staff.
Registration registers were properly maintained and entries were made neatly in all hospitals
except District Hospital at Muktsar.
In all the hospitals, OPDs were having proper signage and directional signage in every section
except at District Hospital Muktsar. Waiting area and sitting arrangement were found to be
adequate in all the ten District Hospitals and two special hospitals.
Only one District Hospital at Ludhiana was not having proper drinking water facility and
District Hospital at Sangrur was not having separate toilet facility for male and female.
Ceiling fans were present in all the hospitals. All doctor’s rooms were having adequate space,
proper illumination and the examination tables covered by proper sheets, along with stools
for seating the patients. All of them were having examination equipment like BP apparatus,
torch, hammer etc.
Minor OT dressing room was present in all the hospitals except at Taran Taran District Hospital.
Injection room within the OPD was available in eight district and two special hospitals.
Five District Hospitals and both the special hospitals were having a dispensary/pharmacy with
separate counters for male/female/senior citizens/staff.
Study to Review
Laboratory and imaging services were easily accessible from the OPD in all the hospitals. Out
of all these hospitals only two District Hospitals were not having central collection centre for
laboratory services.
5.1.21 Emergency/casualty services

A separate medical officer was found available round the clock for emergency cases at eight
District Hospitals out of ten and at one special hospital out of two. Glow sign board display at
Emergency service department was observed in seven District Hospitals and one special hospital.
Board displaying names of doctors/specialists on call in emergency, was found available in nine
District Hospitals and one special hospital.
Emergency wards were attached along with emergency in all hospitals. However, two of these
District Hospitals and one special hospital was not having any triage area. Maximum number of
observation beds were in Bhatinda, i.e 19 beds, followed by Hoshiarpur with 10 beds. In rest of
the hospitals, observation beds ranged from three to eight.
Trolleys and wheel chairs were present in all hospitals except Muktsar. The number varied between
one to five.
Fig 4: No. of emergency patients in District Hospitals (Punjab) in the last five years
20000
18000 1st Yr
2nd Yr
16000 3rd Yr
4th Yr
14000
5th Yr
No.of patients
12000
10000
8000
6000
4000
2000
0
Batinda Ferozpur Gurdaspur Hoshiarpur Jalandhar Sangrur Taran taran Bhatinda(SH)
Districts
At least one examination room with all basic equipments was present in emergency departments
of seven District Hospitals and both the special hospitals assessed. Out of these, one District
Hospital and one special hospital had two examination rooms. All the registers including MLR
were available in all district and special hospitals assessed. Call book in the prescribed format
was not available at two District Hospitals.
Study to Review
25
Fig 5: Admissions through emergency in District Hospitals (Punjab) in the last five years
8000
No. of admissions through emergency
1st Yr
7000
2nd Yr
6000 3rd Yr
4th Yr
5000 5th Yr
4000
3000
2000
1000
)
da
r
r
ur
r
ar
ur
H
ha
pu
ru
n
ra
ts
sp
(S
tin
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ta
nd
z
ar
uk
dh
da
ro
da
ha
hi
Sa
n
la
M
Fe
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Lu
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os
B
Ja
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B
Districts
Waiting area for the attendants, with basic facilities like sitting arrangement, drinking water, toilets
etc. were present in emergency department of all hospitals except Taran Taran District Hospital.
Public telephone facility was found in only four District Hospitals and one special hospital.
Emergency department of all the hospitals had a retiring room for doctors with toilet facility. All
the hospitals were having minor OTs for emergency procedures.
Sufficient stock of essential and life saving drugs was observed in all the hospitals and all of them
were having oxygen cylinders with attachments too.
Separate laboratory services in emergency department was observed in six District Hospitals
and both the special hospitals assessed. All the hospitals were having imaging and ambulance
services in their emergency departments.
Treatment facilities for dog/snake bite and poisoning were available in emergency departments of
eight District Hospitals only. Similarly only seven District Hospitals were having plaster room in
their emergency departments. Almost all hospitals were having staff trained in basic life support
practices/system except in Gurdaspur and Muktsar District Hospitals.
5.1.22 Disaster management

Only two District Hospitals were having disaster manual and disaster alert code, recall and deployment
arrangements. Eight District Hospitals were maintaining a separate drug store for disaster situations.
Study to Review
5.1.23 Intensive care unit (ICU)
Five District Hospitals out of ten were having Intensive Care Unit, while none of the two special
hospitals assessed were having this facility. Numbers of beds available in the ICU of these
five hospitals were 10 in Jalandhar, 6 each in Bhatinda and Gurdaspur, 5 in Sangrur and 4 in
Ludhiana. All of these ICUs were air conditioned with generator support. Regarding separate
sanctioned staff in these ICUs, Gurdaspur was having two doctors and three nurses; Ludhiana
was having one doctor and two nurses and ICU at other hospitals were without any sanctioned
staff. None of these ICUs were having sanctioned technical staff.
5.1.24 Clinical laboratory

Pathology laboratories were present in all District Hospitals and special hospitals assessed
except Ferozpur District Hospital. Microbiology laboratories did not exist in Gurdaspur District
Hospital and the special hospital at Bhatinda. A qualified pathologist was available in nine
District Hospitals and both the special hospitals. A qualified biochemist was present in only
three District Hospitals and a qualified microbiologist was present only in one i.e. Jalandhar
District Hospital.
All hospitals were having facility for complete

urine examination, stool test, blood urea, blood
sugar, liver function test, blood grouping and
matching test, semen examination and VDRL
(Venereal disease research laboratory) test.
Special hospital at Bhatinda was not doing

complete blood haemo analysis, while all other
District Hospitals and special hospitals were doing
it. All hospitals were doing lipid profile and FNAC
(Finel Needle Aspiration Cytology Biopsy) except
Bhatinda special hospital and Ferozpur District
Hospital. Three District Hospitals were not doing
Pap smear.
Biopsies were done only by three District Hospitals

and culture and smear examination by only
five District Hospitals. Out of ten districts and
two special hospitals under study only District
Hospital Sangrur was not doing vaginal discharge
examination.
Bone marrow examination was done in only three District Hospitals out of ten District Hospitals
assessed.
All these laboratories were found following universal precaution procedures and were using
protective measures like gown, gloves, masks etc.
Study to Review
27
All hospitals were collecting specimens centrally except Gurdaspur District Hospital.
All the hospitals were having sufficient chemicals and reagents and were observing all bio safety
measures.
Laboratories of three District Hospitals were not having regular internal quality and external
quality control measures.
5.1.25 Blood banking services

Blood banking facility was not available at one District Hospital i.e. Amritsar and both the
special hospitals. Among the hospitals with blood bank facility, trained qualified medical
officers and other staff were present round the clock. All these blood banks were maintaining
proper cold chain and refrigerators and doing proper checking and cross matching of blood.
Australia antigen, HCV, VDRL, MP and HIV tests were done for every blood bottle of the donor
in all these blood banks and efforts were made to collect blood through organising camps. All
these blood banks have been renewing the blood banks and HIV licensing as per the rules.
5.1.26 Radiology and imaging services

Round the clock availability of X-ray services/sonography was present in all the District Hospitals
assessed during the study.
All hospitals were having a dark room with all facilities. Moreover, only two District Hospitals
and one special hospital were using a dosimeter. Seven District Hospitals and special hospital at
Patiala were conducting special investigations like IVP, contrast media etc.
Separate register for MLC records was not found to be maintained in three District Hospitals and
both the special hospitals. History book and log book of X-ray machines were maintained in all
except in Ludhiana District Hospital and Bhatinda special hospital.
5.1.27 Operation theater (OT)

All the hospitals were having major and minor OT. Out of ten, two District Hospitals were having
four major OTs each, four were having three major OTs, and one District Hospital and both the
special hospitals were having two major OTs each. Rest were having at least one major OT. District
hospital Jalandhar was having four minor OTs Muktsar hospital having three and rest of the
hospitals having one minor OT each.
Zoning concept was strictly followed in seven District Hospitals out of ten and one special
hospital out of two. All the hospitals were having emergency light- generator facility for the OT.
Regular disinfection and sterilisation were done in the OT of all hospitals assessed in this study.
Availability of fire-fighting equipments and knowledge to use them were found to be in all OTs
except two District Hospitals and one special hospital.
Study to Review
Fig 6: Surgeries performed in District Hospitals (Punjab) in the last five years
35000
1st Yr
2nd Yr
30000 3rd Yr
4th Yr
5th Yr
25000
No. of surgeries
20000
15000
10000
5000
0
r
)
da
r
r
a
ur
ar
r
r
H
H
sa
ha
pu
ru
pu
ra
ts
sp
(S
(S
tin
ia
ng
rit
ta
nd
z
ar
uk
dh
da
la
ro
da
ha
m
hi
Sa
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la
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M
Fe
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A
ur
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B
Ja
Pa
Ta
G
ha
H
B
Districts
5.1.28 In-patient wards

Almost all the hospitals were having satisfactory cleanliness of wards with adequate housekeeping
services except District Hospital Gurdaspur. Wards of hospitals in Hoshiarpur and Gurdaspur
were not having adequate and clean toilets and bathrooms.
Only at wards of District Hospital Taran Taran, proper bio medical waste management guidelines
for collection and segregation of bio medical waste were not followed, but they were having table
top syringe and needle destroyer as in other hospitals.
Wards in all hospitals were having adequate water supply and upkeep of sanitary blocks except
Hoshiarpur. Adequate linen on bed was found in all district and special hospitals except in
Gurdaspur and Sangrur hospitals. Three District Hospitals viz. Ferozpur, Ludhiana and Muktsar
were having doubling of beds or floor beds.
Eight District Hospitals and one special hospital were having satisfactory upkeep of cots,
mattresses, lockers, linen etc. in the wards. Only one District Hospital was using uniform for the
patients.
Regarding availability of necessary equipments in the wards it was observed that nine District
Hospitals and one special hospital had functional suction apparatus while in one District
Hospital, although it was available but was non-functional. All hospitals were having functional
oxygen cylinders with accessories while only six hospitals including one special hospital were
having functional venesection/LP/tracheotomy tray. All hospitals were found having functional
Study to Review
29
Fig 7: No. of In-patients in District Hospitals (Punjab) in the last five years
18000
16000
1st Yr
14000 2nd Yr
12000 3rd Yr
No. of In-patients
4th Yr
10000 5th Yr
8000
6000
4000
2000
0
r
)
r
da
ur
)
ur
na
ar
H
sa
H
ha
pu
ru
ra
ts
sp
zp
(S
(S
tin
ia
ng
rit
ta
nd
ar
uk
dh
da
la
ro
da
ha
m
hi
Sa
n
la
tia
M
Fe
tin
Lu
ra
A
ur
os
B
Ja
Pa
Ta
G
ha
H
B
Districts
emergency light, wheel chairs and stretcher trolleys.
Only two District Hospitals and one special hospital wards were not having stationery, forms and
various updated registers.
Two District Hospitals were not found following the concept of progressive patient care. All
hospitals were having adequate fans and lights. None of the hospitals assessed were providing
diet to the inpatients.
5.1.29 Hospital medical store

Medical store, suitably located with adequate space was found available in eight District Hospitals
and one special hospital. In six hospitals including both the special hospitals, staff members of
the medical stores were found to have knowledge on material management, system of FIFO, bin
cards, lead time, buffer stock etc. and CMO (Chief Medical Officer)/MO (Medical Officer) were
found regularly inspecting the medical store and verifying stock books in all hospitals except
Ludhiana and Sangrur. All hospitals were having restriction on entry of unauthorised personnel
in the medical store.
Vital and essential drugs were found available in the medical stores of all hospitals under study
except Sangrur and Ludhiana. Only five District Hospitals were found up-keeping the expiry date
register which was regularly inspected by the Medical officer.
Study to Review
Eight hospitals including both the special hospitals were found making efforts to redistribute
large stocks of slow moving drugs or near expiry drugs for its timely utilisation, while only four
District Hospitals were having proper arrangements to keep drugs as per ABC/VED category and
storage of rubber goods as per guidelines.
Medical stores of all the hospitals, except Taran Taran and Ludhiana, were not taking appropriate
steps to prevent pilferage of drugs. All hospitals, except Ludhiana and Amritsar, were found
having convenient arrangements of issuing drugs to various wards. Only four District Hospitals
were found regularly sending samples to chemical laboratory for checking the standard of drugs.
All hospitals except Ludhiana were circulating list of available drugs to all MOs, OPD and wards
as per generic name.
At five District Hospitals and both the special hospitals, the medical store was submitting certified
bills to office for release of payment within three days. Auction to clear the empty material from
store was done regularly in six hospitals only, including one special hospital.
Availability of fire-fighting equipments and knowledge to use them were found at medical stores
of only four hospitals including one special hospital.
Standing drug committees were found in only five District Hospitals, and only two District
Hospitals were having a regularly updated hospital drug formulary.
5.1.30 Medical record department

Seven District Hospitals and one special hospital were having a medical record room with enough
number of racks. Medical record room was found to be managed by a trained medical record officer
or technician in 50% of District Hospitals and both the special hospitals.
Case records were maintained as per WHO classification of disease (ICD-X schedule) in only
three District Hospitals and one special hospital. All hospitals were found regularly submitting
morbidity and mortality reports except in District Hospital of Taran Taran. None of these
hospitals were found maintaining the basic hospital utilisation indices like Bed Occupancy
Rate, Average Length of Stay, Bed Turnover Interval, Death Rate etc. on a regular basis and in
a proper scientific way.
All the records were found to be maintained for ten years in five District Hospitals and special
hospital at Patiala, five years in two District Hospitals and one special hospital, seven years in
Amritsar and fourteen and fifteen years in Muktsar and Bhatinda District Hospitals respectively.
Only three District Hospitals and one special hospital were having back up facility to safe guard
these records and only five hospitals including one special hospital were following effective
retrieval system.
Medical audit was done at regular intervals in seven hospitals including one special hospital and
Study to Review
31
regular death audit meetings were held and corrective action was taken in only three District
Hospitals and special hospital at Patiala.
5.1.31 Hospital waste management

Adequate number of bins and bags of the required colour codes were available and placed
strategically in all patient care areas in all the hospitals except Amritsar District Hospital.
Proper segregation and collection of waste was done with proper packaging and record keeping in
almost all hospitals except Amritsar District Hospital. Gurdaspur, Amritsar and Jalandhar hospitals
were also found lacking in proper storage facilities of waste.
All hospitals were found following proper transportation of the collected waste. Waste disposal
was outsourced in all hospitals assessed except at Sangrur District Hospital.
Six District Hospitals along with both the special hospitals were found following the disposal/
recycling methods appropriately for various categories of waste.
5.1.32 Central sterile supply department (CSSD)

Nine District Hospitals and one special hospital at Bhatinda were having CSSD under supervision
of trained staff/senior nursing officer. Special hospital at Patiala was not having any CSSD.
Eight District Hospitals and one special hospital were also having all the required equipments
and autoclaves. Physical and chemical quality control measures were followed in seven District
Hospitals and special hospital Bhatinda and biological quality control measures were followed in
six District Hospitals along with special hospital at Bhatinda.
5.1.33 Laundry services

Out of ten District Hospitals, nine were having in-house laundry services, while this service was
found to be outsourced at only one hospital. Both the special hospitals were having mechanised
in-house laundry service. At five District Hospitals laundry was of conventional (dhobi) type,
while it was mechanised at the remaining five.
Quality of wash and linen was good in seven District Hospitals and both the special hospitals. In
rest of the District Hospitals it was average.
5.1.34 Kitchen facility

Kitchen facility was not found available in any of the studied district and special hospitals.
5.1.35 Utilisation of patient care services

Analysis of the last 5 years’ data showed that in all the District Hospital the number of patients
Study to Review
utilising various medical care facilities including diagnostic and therapeutic, from in-patient
and out-door either marginally or steadily increased almost all the District Hospitals.
5.1.36 Utilisation of user charges

Year-wise expenditure of the User Charges made under the following major heads i.e. medicines,
improvement of In-patient Facilities (IPF), Building Maintenance and Equipments Maintenance.
The expenditure made under the head Medicines was 40% to 50% in most of the District Hospitals
except at Ludhiana where it went upto 80% and then came down to 50% over the next 4 years.
Fig 8: Percent of expenditure of the user charges on Medicine of different District Hospitals (Punjab)
90.00
80.00
70.00
60.00
Percent cost (Rs)
50.00
40.00
30.00
20.00
10.00
0.00
Bhatinda Ferozpur Gurdaspur Hoshiarpur Jalandhar Ludhiana Patiala (SH)
2003-04 2004-05 2005-06 2006-07 2007-08
Fig 9: Percent of expenditure of the user charges in IPF of different District Hospitals (Punjab)
35.00
30.00
25.00
Percent cost (Rs)
20.00
15.00
10.00
5.00
0.00
2003-04 2004-05 2005-06 2006-07 2007-08
Study to Review
33
Regarding expenditure on IPF head, it was found to be to be around 20% in most of the District
Hospitals.
In maintenance of buildings the expenditure was 5% to 10% over the years except for the Special
Hospital of Patiala in the first year, which was recorded around 63%.
Fig 10: Percent of expenditure of the user charges on buildings of different District Hospitals (Punjab)
70
60
50
Percent cost (Rs)
40
30
20
10
0 Bhatinda Ferozpur Gurdaspur Hoshiarpur Jalandhar Ludhiana Patiala (SH)
2003-04 2004-05 2005-06 2006-07 2007-08
Fig 11: Percent of expenditure of the user charges on equipments of different District Hospitals (Punjab)
18
16
14
Percent cost (Rs)
12
10
0
2003-04 2004-05 2005-06 2006-07 2007-08
Study to Review
In most of the District Hospitals, expenditure on medical equipments recorded less than 10% over
the years, except at Bhatinda, Ferozpur and Ludhiana where in some years it was more than 10%.
5.2 Sub-divisional Hospitals (SDHs)

Total ten Sub-Divisional Hospitals (SDH) were assessed and facility survey was done as per the pre-
structure32d checklist. These Sub-Divisional Hospitals were at Ajnala, Batala, Dasuya, Fazilaka,
Jagraon, Maler Kotla, Malout, Nakodar, Patti and Talwandi. The General Profile and facility
survey of Sub- Divisional hospitals is given in the Tables Section (Refer Table – 2.)
5.2.1 Accessibility
All Sub-Divisional Hospitals (SDHs) were easily accessible from the railway station and bus stand
and were well connected with the roads.
5.2.2 Water supply

All SDH were having adequate water supply. Seven SDH were having bore well supply, while
three of them i.e. Maler Kotla, Malout and Talwandi were having Municipal water supply. One day
storage capacity of water was found available at three SDH, while rest seven were having storage
capacity of three days.

Electricity supply was found to be regular in six SDHs, while it was irregular in rest of the
hospitals. Only one hospital (Fazilaka) was having double phase electric supply, while rest of the
nine hospitals were having three phase electric supply. All the hospitals were found having back
up generator system except Nakodar Sub-Divisional Hospital.
5.2.4 Availability of lift and ramps

Most of the Sub-Divisional Hospital were single storey buildings. Facility of lifts was available
only at Malout Sub-Divisional Hospital. Ramp was available at all hospitals except Batala, Fazilaka
and Jagraon.
5.2.5 General impression on cleanliness and maintenance of gardens

Eight hospitals were having good cleanliness whereas it was found average at two hospitals.
Upkeep of garden was found to range from àverage to good’ at most of the Sub-Divisional
Hospitals except Ajnala and Jagraon.
5.2.6 Signs, roads and lighting

Signage was found good in six Sub-Divisional Hospitals. Rest of the four hospitals were having
average sign postings. Roads and lighting of eight hospitals were found good and two average.
Study to Review
35
5.2.7 Status of buildings
Buildings of eight Sub-Divisional Hospitals were found to be in good condition while at two Sub-
Divisional Hospitals (Patti and Talwandi) it was average.

Out of all the Sub-Divisional Hospitals studied, three were having chemist shops, two
were having STD/PCO booths, and only one was having a grocery shop and a cycle stand
within the hospital premises. Fifty percent (five out of ten) of the Sub-Divisional Hospitals
studied were having a functional canteen. Five hospitals were also found to have Sulabh
Shochalaya.

Although facility of ambulance services was available at all the Sub-Divisional Hospitals but
only three of them, namely Batala, Fazilaka and Maler Kotla were fully equipped. Seven SDH
were having two ambulances while another two viz Dasuya and Talwandi were having three
ambulances. Ajnala hospital had only one ambulance and that too was found to be only
partially equipped.
5.2.10 Dental services

All the Sub-Divisional Hospitals were found providing dental services except one hospital at
Fazilaka.
5.2.11 Maternity services

Maternity services were provided at all the Sub-Divisional Hospitals assessed in the present study.
5.2.12 Mortuary services

Mortuary services with cold storage and other preservative facilities were found to be present at
seven out of ten Sub-Divisional Hospitals, whereas facilities of post mortem were available at
eight hospitals. Fazilaka was the only SDH where although the mortuary services were available,
facilities for post mortem were absent.

Only Nakodar and Patti SDH’s were having a drug formulary committee. Nakodar SDH was found
to be the only one with a hospital antibiotic committee. Hospital infection control committee
was present at Batala, Nakodar and Patti SDH. Store purchase committee was present at all SDH
except at Maler Kotla.
Similarly, store inspection committee was present at all SDHs except Maler Kotla and Fazilaka.
Five of the ten SDH assessed were found having a Medical Audit/Death Review Committee.
Study to Review
Out of the ten Sub-Divisional Hospitals assessed, five were having a drug formulary. Almost all
hospitals were found to have dual drug supply. They get drugs and equipment supply directly from
the state and they can also purchase on their own through user charges money. Buffer stock was
found to be maintained at all the SDHs, except Ajnala and Patti. Reorder levels were found to be
maintained only at Ajnala, Dasuya, Jagraon and Nakodar SDH.
All the SDHs except Ajnala and Patti were found having annual maintenance procedures for costly
equipment. Fazilaka, Maler Kotla and Patti SDH were not maintaining log book and history sheet
for the equipment. The present status of the existing equipments was found to be average at
seven SDHs and good at Batala, Dasuya and Malout SDH.
5.2.15 Major equipment

Six out of the ten Sub-Divisional Hospitals were having baby incubators but the incubator at
Fazilaka SDH was not found functional at the time of visit.
Boyle’s apparatus was available and functional at all the SDH except Fazilaka, where it was not
functional.
Cardiac monitor was available in all SDHs except Dasuya and Jagraon. The cardiac monitors at
Ajnala and Fazilaka SDH were found to be non-functional.
Dental chair was available at all SDHs but it was not functional at Ajnala and Fazilaka.
Dosimeter was available only at Maler Kotla and Malout SDH and out of these it was found
functional only at Malout SDH.
ECG machine was available and functional at all the SDHs except Fazilaka.
Emergency resuscitation kit was available and functional at all the SDHs.
Fibre-optic Endoscope was not available at any of the SDH assessed.
Malout was the only Sub-Divisional Hospital without an ophthalmoscope, while rest of the
SDH were having a functional ophthalmoscope. Perimeter was available only at Maler Kotla
and it was found to be functional. Five of the ten SDHs assessed were having a Retinoscope,
which was functional. Slit lamps, which were also in working condition, were present only
at five SDHs.
Short wave diathermy (Physiotherapy) unit was available and functional at Fazilaka and
Nakodar SDH.
Study to Review
37
Sigmoidoscopes were present only in two Sub-Divisional Hospitals but these were found to be
non-functional.
X-ray facility was available and functional in all Sub-Divisional Hospitals. Ultrasound was present
at all SDH except Talwandi. The ultrasound at Patti SDH was not functional.

Referral facilities were available in all SDH but referral manual was present only at six out of ten
SDH’s studied. Guidelines for what to refer and when to refer were present at five SDHs whereas
guidelines for how to refer were present at six places.
Colour coded referral cards were available at five and feedback mechanism existed at four Sub-
Divisional Hospitals. Transport facility was provided by all the SDHs. Maintenance of records and
registers was done at all except Talwandi SDH. Incentive for following the referral route in the form
of provision of ambulance was available only at Fazilaka SDH.
All the SDHs were found to refer their patients to government/District Hospitals/medical colleges
except Nakodar and Talwandi SDH. For diagnostic purposes, five SDHs were found to have a tie-up
with other hospitals (both public and private).
Statistical Bulletin was available only in four SDHs and out of them two were also having monthly
bulletin and two fortnightly bulletins.
5.2.17 Outreach services

Out-reach area services in the form of MCH camp, Eye camp, Blood donation camp and IEC were
found to be available only at Fazilaka, Jagraon, Maler Kotla and Talwandi SDH.
5.2.18 Residential area

Residential accommodation for the essential staff members was available at all SDHs except
Ajnala and Jagraon. However, only four of these were having in house security services. Non
availability of accommodation at four of these places was more than 50%.
None of the Sub-Divisional Hospitals were found to have the facility of Dharamshalas.
5.2.19 Out-patient department

Reception and registration counters were present in all the Sub-Divisional Hospitals (four were
having computerised registration and rest of them manual). These counters were managed by a
clerk in one SDH, by MSW in another one, by clerk/MSW in two others and a computer operator in
five SDHs. Staff manning these counters was knowledgeable about the OPD procedures.
There were separate registration counters for male, female and staff members at three SDHs. Four
SDHs were having a separate registration counter for senior citizens as well. Registration registers
were properly maintained and entries were made in all SDHs except at Malout.
Study to Review
Fig 12: No. of OPD Patients in Sub-Divisional Hospitals (Punjab) in the last five years
180000
160000 1st Yr
2nd Yr
140000 3rd Yr
No. of OPD Patients
120000 4th Yr
5th Yr
100000
80000
60000
40000
20000
0
a
a
a
tti
t
ka
ar
di
ou
al
uy
al
tk
ao
an
Pa
od
la
jn
at
ko
al
as
gr
zi
lw
ak
A
M
er
Fa
Ja
D
Ta
N
al
M
Sub-divisional Hospitals
In all SDHs, all sections of OPD were having proper signage and directional sign except at Ajnala
and Maler Kotla. Waiting area was found to be adequate in six out of ten SDHs and only five SDHs
were having proper sitting arrangement.
Drinking water facility, Ceiling fans, Toilet facility, doctor’s chamber with adequate space, examination
table with proper sheet, stool for patients to sit and examination equipments (like torch, BP apparatus
and hammer etc.) were available in almost all the Sub-Divisional Hospitals. However toilet facility was
not available at Nakodar. Examination table with proper sheet was not present at Jagraon SDH. All the
hospitals were having adequately illuminated OPDs. Injection room along with facilities to deal with
emergency situations was not available at Maler Kotla and Patti SDH. Similarly, Talwandi and Patti SDH
were not having Minor OT/Dressing room with all the basic equipments.
Only five Sub-Divisional Hospitals were having dispensaries/pharmacy with separate counters for
male/female/senior citizens/staff.
Laboratory and imaging services were easily accessible from the OPD in all the Sub-Divisional Hospitals.
All SDHs were having a central collection centre for laboratory services except Maler Kotla SDH.

All the Sub-Divisional Hospitals assessed were found having round the clock emergency services,
with almost all the basic facilities.
There was a separate medical officer available round the clock for emergency situations in seven
Sub-Divisional Hospitals out of ten. Glow sign board displaying emergency service department
Study to Review
39
Fig 13: Emergency Patients in Sub-Divisional Hospitals (Punjab) in the last five years
6000
1st Yr
2nd Yr
5000 3rd Yr
4th Yr
5th Yr
4000
No. of patients
3000
2000
1000
0
Ajnala Batala Dasuya Jagraon Malerkotka Malout Nakodar Patti Talwandi
was seen at five SDHs and board displaying doctors/specialists on call in emergency was seen at
eight SDHs.
Emergency wards were found attached to the emergency department in all SDHs except Ajnala,
with observation bed strengths ranging from 1 to 12. Four of these ten SDHs were not having any
triage area. Trolleys and wheel chairs (ranging from 1 to 4 in number) were present in all SDHs.
Examination rooms with all basic equipments and all the registers including MLR were available in
emergencies of all SDHs. Emergency department at all SDHs also had a retiring room for doctors
with toilet facility except at Malout hospital. Call book in the prescribed format was seen only at
four SDHs assessed.
Waiting area for the attendants of the patients with basic facilities like sitting arrangements,
drinking water, toilets etc were available in emergency departments of seven SDHs, but public
telephone facility was found at only two places.
Five SDHs had Major OT for emergency services whereas treatment room cum minor OT for various
emergency procedures was present in emergency departments of all SDHs.
All SDHs were having oxygen cylinders with attachments and sufficient stock of essential and life
saving drugs was available in almost all the SDHs except at Ajnala.
Laboratory, imaging, and ambulance services were available at emergency departments of all the
Sub-Divisional Hospitals. All the SDHs were having staff trained in basic life support except at
Malout and Talwandi.
Study to Review
Treatment facilities for dog/snake bite and poisoning were available at emergency departments
of eight SDHs (except Patti and Talwandi).

Only three SDHs (viz. Dasuya, Fazilaka and Nakodar) were having Disaster manual and all
these three were having disaster alert code, as well as recall and deployment arrangements.
Seven SDHs were maintaining a drug store for disaster situation. Plaster room was present at
six SDHs.
5.2.22 Intensive care unit (ICU)

ICU was available at only four SDHs viz. Ajnala, Batala, Patti and Talwandi, with the bed strength
ranging from 2 to 6 beds. None of these ICUs were found to be air-conditioned and were also not
having any back up generator support.
Staff sanctioned specifically for ICU was present only at Ajnala Sub-Divisional Hospital (Doctor-1,
Nurse-1, Technical staff-1 and class IV-1). Similarly record keeping of the patients was found to
be done only at Ajnala SDH.
Oxygen/suction apparatus/compressed air were available at Ajnala, Batala and Talwandi SDH.
Defibrillator and ventilator were not available at any of the SDH, whereas ECG machine was
available only at Batala SDH. Only Batala and Talwandi SDH were found to have all the life saving
vital drugs. Strict aseptic procedures were found to be followed only at the Batala SDH.

A pathology as well as microbiology laboratory was present in half of the Sub-Divisional Hospitals
assessed during the study. Qualified pathologists and microbiologists were found present at four
of these hospitals respectively. None of the hospitals were having a qualified biochemist.
All Sub-Divisional Hospitals were having facility for complete blood haemogram analysis except
Batala and Patti SDHs. Complete urine examination was available at all the Sub-Divisional
Hospitals.
Ajnala SDH was found not conducting stool tests whereas Blood Urea and Blood sugar tests were
not conducted by Patti SDH. All of the rest SDHs were providing these laboratory facilities.
Facility of liver function test was available at five SDHs, lipid profile at four, FNAC at one, culture
and smear examination at one, semen examination at eight, vaginal discharge examination at two,
bone marrow examination at one and other routine tests like HIV/pregnancy tests at six SDHs.
Blood grouping and matching test and VDRL tests were done at all the SDHs. Pap smear and
biopsy were not done at any of the SDH.
Study to Review
41
Six of ten SDHs were found following universal precaution procedures and were using some
protective measures like the use of gown, gloves, masks etc. All necessary laboratory chemicals
and reagents were available at all SDHs except at Ajnala Sub-Divisional Hospital.
Specimens were collected centrally in all the ten SDHs. All of them were observing the bio-
safety measures except Ajnala and Maler Kotla SDH. Regular internal and external quality control
measures were found being undertaken by twelve SDHs respectively.

Batala, Dasuya, Fazilaka, Maler kotla, Nakodar and Patti SDH were having the facility of a blood
bank. Trained or qualified medical officer as Blood Transfusion Officer was present at Batala, Dasuya,
Fazilaka and Nakodar SDH, while no such officer was available at Maler, Kotla and Patti SDH. Round
the clock availability of trained staff and services was a feature of all SDHs except Maler Kotla.
All SDHs having blood banks were found following all the procedures like - checking and cross
matching of blood by B.T.O; proper maintenance of cold chain and refrigerators; Australia
antigen, HCV, VDRL, MP and HIV tests for every blood unit of donor; renewal of blood bank/HIV
license as per rules; disposal of HIV positive blood bags and undertaking bio-safety measures and
availability of table top syringe and needle destroyer and, colour coded bags. Efforts were made
to collect blood through voluntary blood donation camps at five sub divisional hospitals out of
the six having a blood bank.
Feedback of transfusion and record maintenance of untoward incidences was found being done at
Batala, Dasuya, Maler kotla and Nakodar SDH.
5.2.25 Radiology services

Round the clock availability of X-ray services/sonography was present at six SDHs. However,
radiologists were available only at two out of these.
X-ray machines (500/300mA) were available at all the SDHs visited, but they were not found
working at Batala and Dasuya SDH. X-ray machines (200/100mA) were available at five SDH and
out of these only three were found functional; rest two were pending for condemnation. X-ray
machines (moblie/60mA) were available at six SDHs and all of them were in functional status.
All SDH were having a dark room with all the required facilities. Dosimeter was used only at Maler
Kotla and Malout SDH and they send these dosimeters regularly to BARC for evaluation. Special
investigations like IVP; contrast media etc. were available and conducted at four SDHs.
Separate register for MLC records was found to be maintained at all the SDHs; and all of them
except Patti SDH were found maintaining history sheet and log book of X-ray machines.
5.2.26 Operation theatre

Dasuya Sub-Divisional Hospital was having three major operation theatres whereas hospitals at
Fazilaka, Malout and Patti were having one major operation theatre each. Rest of the hospitals
Study to Review
were found to have two operation theatres. All the hospitals assessed were having at least one
minor operation theatre with the exception of Malout and Nakodar hospitals with two minor
operation theatres.
All SDHs were having major and minor OTs, except Jagraon SDH, which was not having a minor
OT. Zoning concept in OT was followed at six SDHs.
Fig 13: Normal Deliveries conducted in Sub-Divisional Hospitals (Punjab) in the last five years
900
1st Yr
800 2nd Yr
3rd Yr
700 4th Yr
No. of Normal Deliveries
5th Yr
600
500
400
300
200
100
0
a
ar
ka
di
a
tti
ou
al
uy
tk
al
ao
an
od
Pa
la
jn
at
ko
al
as
gr
zi
lw
ak
A
M
er
Fa
Ja
D
Ta
N
al
M
Fig 14: Caesarians done in Sub-Divisional Hospitals (Punjab) in the last five years
600 1st Yr
2nd Yr
3rd Yr
500
4th Yr
5th Yr
400
No. of caesarians
300
200
100
0
Ajnala Batala Dasuya Fazilaka Jagraon Malerkotka Nakodar Patti Talwandi
Study to Review
43
Boyle’s apparatus was available in OT of all the SDHs and the same was found under repair at two
of them. Boyle’s apparatus at Ajnala SDH was found pending for condemnation. All the SDH were
having hydraulic operation tables. Operation tables at three of these hospitals were found to be
under repair and at one for condemnation.
Shadowless lamps were available at all the hospitals. One lamp each at Fazilaka and Maler kotla
SDHs were under repair. Fumigation apparatus was available at six SDHs. One out of the two
available fumigation apparatus at Jagraon SDH was found to be under repair. Suction apparatus
was available at all the SDHs, but one of the two suction apparatus at Patti SDH was under
repair. All SDHs were having air conditioned OTs. Electrical cautery was available at all the SDHs.
However, it was not functional and under repair at Ajnala, Batala and Jagraon SDH.
Endoscope in the operation theatre was available at Fazilaka SDH only while laryngoscope was
available at Batala, Dasuya, Fazilaka, Maler Kotla and Nakodar SDH.
Facility of cardiac monitor was available at six SDHs and that of cardiac defibrillators at two
SDHs. Pulse oxymeters were found to be available at all the SDHs except at Batala and Jargaon.
All SDHs were found to maintain OT records, but maintenance of OT postponement records were
done only at two SDHs. Emergency light or back up generator facilities to the OTs were available
in all SDHs. Availability of fire-fighting equipments and knowledge to use them was found in
OTs of five SDHs. Regular disinfection and sterilisation procedures were done at OTs of all sub
divisional hospitals.

Almost all SDHs were having satisfactory cleanliness of wards, with adequate housekeeping
Fig 15: Patients admitted in Sub-divisional Hospitals (Punjab) in the last five years
10000 1st Yr
2nd Yr
9000
3rd Yr
8000 4th Yr
7000 5th Yr
No. of Patients
6000
5000
4000
3000
2000
1000
0
a
tti
a
t
a
ar
ka
di
ou
al
uy
al
tk
ao
Pa
an
od
la
jn
at
ko
al
as
gr
zi
lw
ak
A
M
er
Fa
Ja
D
Ta
N
al
M
Study to Review
services. All SDHs had adequate and clean toilets and bathrooms and; adequate and proper linen
for all the beds except at the Batala SDH.
At Batala and Talwandi SDH, the wards were not found to follow proper bio medical waste management
guidelines for collection and segregation of bio medical waste; Talwandi SDH, in addition, was not
having table top syringe and needle destroyer, whereas at Ajnala and Batala SDH, although the
table top syringe and needle destroyer were available, they were not properly utilised.
Wards in all SDH except Talwandi were having adequate water supply and upkeep of sanitary
blocks. None of the SDH had doubling of beds or floor beds.
All SDHs under study were having satisfactory upkeep of cots, mattresses, lockers, linen etc. in
the wards except at Batala and Malout. Uniform for the patients was found to be used only at
Jagraon SDH.
Regarding availability of necessary equipments in the wards, it was observed that all SDHs were
having functional suction apparatus except Malout, where it was not available. Oxygen cylinders
with accessories were available in functional condition at all SDHs. Functional venesection/LP/
tracheotomy tray were available at all SDHs, except Malout, Patti and Talwandi. Eight SDH were
having functional emergency light/wheel chairs/stretcher trolley.
All SDHs were found to have adequate stationery, forms and various updated registers, and they
were found maintaining various registers and records required in the ward.
Concept of progressive patient care was not followed at Ajnala and Jagraon SDH. All SDHs were having
adequate and working fans and lights. Only Malout SDH was providing diet to the inpatients.

Medical stores were found suitably located with adequate space and protection of drugs and
non-drug items from pilferage, temperature and humidity at Dasuya, Fazilaka, Jagraon and
Nakodar SDH. There was no restriction on entry of unauthorised personnel in the medical
store at Maler kotla and Patti SDH. At seven SDHs, staff members of the medical stores had
knowledge on material management, system of FIFO, bin cards, lead time, buffer stock etc.,
while at the remaining three hospitals the staff responsible was not having this knowledge.
CMO/MO were found regularly inspecting the medical stores and verifying stock books at all
SDHs except Maler Kotla.
Availability of vital and essential drugs was found at medical stores of all SDHs except Ajnala.
Up-keep of the expiry date register and its regular inspection by the medical officer was observed
at six out of the ten SDHs under study.
At seven SDHs, efforts were made to redistribute large stocks of slow moving drugs or near
expiry drugs for its timely utilisation, while only four SDHs were having proper arrangements
Study to Review
45
to keep drugs as per ABC/VED category and storage of rubber goods as per guidelines.
Medical stores of six SDHs were taking appropriate steps to prevent pilferage of drugs, while
all SDHs except Ajnala were having convenient arrangements of issuing drugs to various wards.
Six out of ten SDHs were regularly sending samples to a chemical laboratory for checking the
standard of drugs and to take necessary action thereon.
All SDHs except Maler Kotla were circulating list of available drugs to all MOs, OPDs and wards as
per their generic names.
Medical stores of all SDHs except Jagraon, were submitting certified bills to office for release of
payment with in three days. Auction to clear the empty material from store was found to be done
regularly at only five SDHs.
Availability of fire-fighting equipments and knowledge of staff to use them was found in medical
stores of five SDHs.
Standing drug committee and availability of regularly updated hospital drug formulary was found
at only five SDHs out of ten.

Only five SDHs were having medical record room with enough number of racks and cup boards.
Record keeping in medical record room was manual in all the SDH assessed, except Jagraon where
it was computerised. Trained staff comprising medical record officer or technician was present at
all SDHs, except Maler Kotla. However, in spite of this, the condition of the medical records was
not found satisfactory. None of these hospitals were found maintaining some of the basic hospital
utilisation indices like Bed Occupancy Rate, Average Length of Stay, Bed Turnover Interval, Death
Rate etc. on regular basis and in proper scientific way.
Case records were maintained as per WHO classification of disease (ICD-X schedule) at only three
SDHs. All SDHs except Patti were regularly submitting their morbidity and mortality reports.
Duration for which the record was maintained ranged from 5 to 10 years. Back up facility to
safe guard these records was present at Ajnala, Dasuya, Fazilaka and Malout SDH. Five SDHs were
having effective retrieval system. Six SDHs were found holding regular death and medical audit.

Adequate number of bins and bags of required colour codes were found available at all SDH
except Talwandi; and these were found placed strategically in all patient care areas at seven
out of these SDHs.
Study to Review
Proper segregation, collection of waste with proper packaging and record keeping, proper
transportation and storage of waste was seen in almost all SDHs except Talwandi, where proper
segregation and collection were lacking and Ajnala, where proper collection, packaging, labelling
and record keeping were lacking. All SDHs were having proper storage facility and transportation
for the biomedical waste.
Waste disposal was found to be outsourced at all SDHs except Maler Kotla and Malout. Disposal/
recycling methods for various waste categories were done at six SDHs. Autoclaves and shredders
were not available at Ajnala, Fazilaka and Malout SDH.
5.2.31 Central sterile supply department (CSSD)

All SDHs except Maler kotla and Malout were having CSSD under supervision of trained staff/senior
nursing officer, and these SDH were having all the required equipments and autoclaves.
Physical and chemical quality control measures were found to be followed at CSSD of seven;
whereas biological quality control measures were followed at six SDHs.

Among ten SDHs under study, five were having in house laundry service while the remaining five
were found to have outsourced laundry services. Laundry was of conventional (dhobi) type in five
SDHs and mechanised in rest of the SDH. Laundry staff was found to be adequate only at four
SDHs. Quality of linen as well as quality of wash was good at four SDHs only, while in rest SDHs
it was found average.

Kitchen facility was present only at Maler Kotla Sub-Divisional Hospital, with proper and safe
arrangement for storage of raw material.
5.2.34 Utilisation of patient care services

Analysis of the last 5 years’ data showed that at all SDHs the number of patients utilising
various medical care including diagnostic and treatment from in-patient and outdoor came
down in first 2-3 years. But after that, it steadily increased (though at a slower rate) during
the recent years.
However, the figures for the delivery services were not found very encouraging, during the
last 5 years and in almost all the districts, these figures fluctuated on either side. Therefore,
it is not only very difficult to conclude anything from this data, but it was found very much
disturbing, that in some places the numbers have actually come down. One of the reasons
may be irregular availability of the gynaecologist and its associated basic facilities in these
hospitals.
Study to Review
47
Year-wise expenditure of the user charges made under the following major heads i.e. medicines,
improvement in-patient’s facilities (IPF), maintenance of buildings and equipments. The
expenditure made under the head medicines was 40% to 45% in most of the Sub-Divisional
Hospitals except at Ajnala where maximum expenditure made on first 4 years (2002-06) whereas
very low during the year 2006-07.
Fig 16: Percent of expenditure of the user charges in medicine of different Sub-Divisional Hospitals (Punjab)
120
100
80
Percent cost (Rs)
60
40
20
0
Dasuya Fazilka Ajnala Batala Jagraon Malar Kotla Malout Patti Talwan-di Saboo
2003-04 2004-05 2005-06 2006-07 2007-08
Fig 17: Percent of expenditure of the user charges in IPF of different Sub-Divisional Hospitals (Punjab)
70
60
50
Percent cost (Rs)
40
30
20
10
0
Dasuya Fazilka Ajnala Batala Jagraon Malar Kotla Malout Patti Talwan-di Saboo
2003-04 2004-05 2005-06 2006-07 2007-08
Study to Review
Regarding IPF, most of the Sub-Divisional Hospitals utilised 20% to 25% of the user charges over
the years.
In maintenance of buildings, majority of the Sub-Divisional Hospitals used less than 15% of the
users charges except Fazilka, Batala and Jagraon.
In maintenance of equipment majority of the Sub-Divisional Hospitals spent less than 10% of the
user charges over the year, except the hospitals at Ajnala, Jagraon and Talwan-di Saboo where it
was more than 10% in some years.
Fig 18: Percent of expenditure of the User charges in building of different Sub-Divisional Hospitals (Punjab)
25
20
Percent cost (Rs)
15
10
0
Dasuya Fazilka Ajnala Batala Jagraon Malar Kotla Malout Patti Talwan-di
Saboo
2003-04 2004-05 2005-06 2006-07 2007-08
Fig 19: Percent of expenditure of the user charges in equipment of different sub-divisional hospitals (Punjab)
35
30
25
Percent cost(Rs)
20
15
10
0
Dasuya Fazilka Ajnala Batala Jagraon Malar Kotla Malout Patti Talwan-di
Saboo
2003-04 2004-05 2005-06 2006-07 2007-08
Study to Review
49
5.3 Community Health Centres (CHCs)
Facility survey was done at total of eleven CHCs as per the pre-structured checklist. These CHCs
were Badal, Fatehgarh, Ferozshah, Goniana, Kartarpur, Khemkra, Longowal, Machiwar, Mahilpur,
Majitha and Manawala. The general profile and facility survey of CHCs is given in the Tables
Section (Refer Table – 3).
5.3.1 Accessibility
All CHCs assessed were easily accessible from the railway station and bus stand and were well
connected with the roads.
5.3.2 Water supply

Almost all CHCs were having adequate water supply except CHC Manawala. Nine CHCs were having
bore well supply while two CHCs i.e. Badal and Goniana were with Municipal water supply. Water
storage capacity was found to be one day at 4 CHCs, three days at another 4 CHCs and for two
days at remaining three CHCs.

Electricity supply was found to be irregular in most of the CHCs and only three CHCs at Kartarpur,
Mahilpur and Majitha, were having regular supply to some extent. Only one CHC was with double
phase electric supply, while rest of the CHCs were having three phase electric supply. Back up
generator system was available at all the eleven CHCs.
5.3.4 General impression on cleanliness and up keep of gardens

Six CHCs maintained good cleanliness while five were found to be average.
Only two CHCs were having good upkeep of the garden and rest were having average landscaping.
Only one CHC was found to have poor upkeep of the garden.
5.3.5 Status of Buildings

Regarding status of the building, nine CHCs were in good condition and at two CHCs i.e. Khemkara
and Mahilpur, buildings were in average condition.
5.3.6 Sign, roads and lighting

Signage was found poor in Khemkara CHC whereas, it was good at six CHCs. Rest of the CHCs were
having average sign posting. Roads and the lighting system were good at seven CHCs, average at
three and found poor at one CHC.
Study to Review
Out of all the CHCs studied, none were having a chemist shop or a grocery shop within the premises
and only one CHC was having a canteen. Three out of 11 CHCs were having Sulabh Shochalaya.

Ambulance facility was available in all the CHCs studied. Out of these, six CHCs were having at least
one ambulance and rest were having two or more ambulances. These ambulances were found to be
partially equipped except at two CHCs, where ambulances were well equipped to some extent.
5.3.9 Intensive care unit

None of the CHCs were having intensive care unit; however all the CHCs were found to have round
the clock emergency services.
5.3.10 Other services (patient care)

Except two CHCs all were having dental services and all eleven CHCs were having delivery services.
5.3.11 Mortuary
None of the CHCs were having mortuary or post mortem facilities.

Out of eleven, only one CHC was having a drug formulary and hospital antibiotic committee, eight
CHCs were having a store purchase and store verification committee, while only three CHCs were
having hospital infection control committee and medical audit/death review committee.

Almost all CHCs were having dual drug supply. They receive drugs and equipment supply through
the state and also buy on their own utilising user charge money. Only three CHCs were found to
have their own drug formulary. Seven CHCs were maintaining buffer stock, while only four CHCs
followed reorder level.
Five CHCs were having annual maintenance contracts for costly equipment, while six CHCs
maintained log book and history sheet for the available equipment.
5.3.14 Major equipments

Only one CHC was not having Boyle’s apparatus with circle absorber and two CHCs were lacking
the facility of dental chairs.
Emergency resuscitation kit was present at all CHCs except Badal CHC.
Study to Review
51
Eight CHCs were having ophthalmoscope, but it was found to be non functional at one of these
CHCs.
Sigmoidoscope was only present in three CHCs. Other major and minor operation equipment was
not found present at CHC Manawala.
X-ray facility was available in all CHC except in one CHC i.e Manawala.

Referral facilities were available in all CHCs except Manawala; however, proper referral manual
and guidelines for referring patients were not present in most of the CHCs. Colour coded referral
cards were found to be present only at five CHCs and feedback mechanism existed only at CHC
Longowal.
Transport facilities were provided by almost all the CHCs except CHC Manawala, as referral facilities were
not present here. Only one CHC was not maintaining records and registers other than CHC Manawala.
Seven CHCs were found to have a tie-up with other hospitals (both public and private) for
diagnostic or referral purposes and most of them were with government hospitals or medical
colleges except CHC Kartarpur, which had a tie-up only with private hospitals.
Statistical bulletins were available only at four CHCs; and out of these three were also having
monthly bulletin and one CHC fortnightly bulletin.
Study to Review
5.3.16 Outreach services
Six CHCs were having an outreach area and services provided were mainly maternal and child health.
5.3.17 Residential area

Only one CHC was not having residential accommodation for the essential staff. Besides
this, six CHCs mentioned that they were having some sort of security services, which was mainly
in house.
None of the CHCs had the facility of dharamshala.
5.3.18 Out-patient department

Reception and registration counter was maintained by a clerk at one CHC, by a staff nurse at three
CHCs, by a pharmacist at six CHCs and remaining one CHC was found to be managed by either
staff nurse or pharmacist.
Separate registration counters for male, female and freedom fighters were available only at two
CHCs, while rest of them were having single registration counters. Only one CHC was having
separate registration counters for staff and senior citizens. Registers used for registration were
properly maintained and entries were found to be made at all CHCs.
At all CHCs, OPDs were having proper signage and directional sign in every section. Waiting area was
found to be adequate at ten CHCs, and proper sitting arrangements were available at 9 CHCs.
Fig 20: No. of OPD attendance at CHC hospitals (Punjab) in the last five years
80000
1st Yr
70000 2nd Yr
3rd Yr
Number of OPD Patients
60000
4th Yr
50000 5th Yr
40000
30000
20000
10000
0
r
a
ra
al
a
ah
rh
n
r
al
a
u
pu
n
al
ra
ad
gw
iw
ilp
ga
ia
it
h
aw
ka
r
js
oj
B
on
ta
h
te
ah
n
ro
ac
em
an
Lo
ar
Fa
M
Fe
M
K
M
h
K
Community Health Centres
Study to Review
53
Two CHCs were not having drinking water facility, and three were not having separate toilet
facility for male and female. Ceiling fans were present at all eleven CHCs. Doctor’s rooms were
having adequate space and proper illumination with examination table covered by proper sheet
at all eleven CHCs’. Only one CHC was not having a stool for seating the patient and examination
equipments like BP apparatus, torch, hammer etc.
Seven CHCs were having an injection room along with OPD facility, to deal with emergency
situation; minor OT/dressing room was present at six CHCs.
Only five CHCs were having dispensaries/pharmacy with separate counters for male/female/senior
citizens/staff.
Laboratory and imaging services were easily accessible from OPD at all the CHCs, with only seven
CHCs having a central collection centre for laboratory services.

A separate medical officer was found to be available round the clock in emergency departments
of eight CHCs. Glow sign board displaying ‘emergency service department’ was found only at four
CHCs, while board displaying ‘doctors/specialists on call in emergency’ was found at nine CHCs.
Emergency wards were attached along with emergency departments at eight CHCs, with bed strengths
ranging from 1 to 6 in number. However, two of these eight CHCs were not having triage area.
Observation beds were available at nine CHCs, with beds ranging from one to four in number.
Trolleys and wheel chairs were present at all CHCs, mostly ranging from 1 to 3 in number. Only
one CHC had five trolleys/wheel chairs.
Examination rooms with all basic equipments were available in emergency departments of six
CHCs and all the registers including MLR were available at nine CHCs. Call book in prescribed
format was not found at any of the eleven CHCs.
Waiting area for the attendants of the patients, with basic facilities like sitting arrangement,
drinking water, toilets etc. were available at emergency departments of eight CHCs, but public
telephone facility was found to be present only at one CHC.
Emergency departments of six CHCs were having a retiring room for doctors with toilet facility.
Seven CHCs were having minor OT in emergency department for various emergency procedures.
Sufficient stock of essential and life saving drugs were available at almost all the CHCs except CHC
Khemkar; two CHCs were not having oxygen cylinders with necessary attachments.
Separate laboratory service and imaging service in emergency department was available in seven
and eight CHCs respectively. All CHCs were having ambulance services.
Study to Review
Fig 21: No. of emergency patients at CHC Hospitals (Punjab) in the last five years
3000
1st Yr
2nd Yr
2500 3rd Yr
4th Yr
5th Yr
2000
No. of patients
1500
1000
500
0
Badal Fategarh Ferojshah Goniana Khemkaran Longowal Mahilpur Mojitha Manawala
Fig 22: Admission through emergency at CHC Hospitals (Punjab) in the last five years
900
1st Yr
800
No. of admissions in the Emergency
2nd Yr
3rd Yr
700 4th Yr
5th Yr
600
500
400
300
200
100
0
Fatehgarh Ferojshah Goniana Kartarpur Khemkaran Longowal Mahilpur Mojitha Machiwara
Study to Review
55
Treatment facilities for dog/snake bite and poisoning were available at emergency departments
of nine CHCs. Only seven CHCs were having staff trained in basic life support.

Only five CHCs were having a disaster manual, and four CHCs out of them were having disaster
alert code, recall and deployment arrangements as well. Five CHCs were found to maintain a drug
store for disaster situation.

All CHCs were having facility for complete blood haemogram analysis and complete urine
examination.
Two CHCs were not conducting stool test and special tests like blood urea; rest all CHCs’ were
providing these services.
Blood sugar test and blood grouping and matching tests were available in all CHCs except one.
Biochemistry laboratory was present at all CHCs with pathology lab only at three CHCs and
microbiology lab at four. However, none of the CHCs were having a qualified pathologist, biochemist
or microbiologist.
Only three CHCs were not found following universal precaution procedures; laboratories at six
CHCs were found having some protective measures like gown, gloves, masks etc. Five CHCs were
collecting specimens centrally. Three CHCs’ were not having all the necessary laboratory chemicals
and reagents.

None of the CHCs under the study were having blood bank facility.
5.3.23 Radiology services

Round the clock availability of X-ray services/sonography were found available at seven CHCs.
However, a radiologist was present only at CHC Ferojshah. All CHCs were having a dark room with
all the facilities, but none of the CHCs were using dosimeter or conducting special investigations
like IVP, contrast media etc.
Only CHC Longowal was not found maintaining separate register for MLC records. Five CHCs were
found maintaining history book and log book of X-ray machines.
Study to Review
5.3.24 Operation theatre (OT)
All the CHCs were having major OT except CHC Ferojshah, and out of these two CHCs were having
two major OTs. CHC Goniana, Mahilpur and Khemkaran were not having any minor OTs, while rest
of the eight CHCs were having one minor OT each.
Zoning concept in the OT was found to be followed only at three CHCs. All the CHCs were having
emergency light-generator facility for OT. All CHCs were maintaining OT records except CHC
Manawala. However, maintenance of OT postponement records was done only at three CHCs.
Regular disinfection and sterilisation were found being done in OTs of eight CHCs out of eleven
CHCs under this study. Availability of fire-fighting equipments and knowledge to use them were
found at OTs of only two CHCs.

All the CHCs, except CHC Badal, were having satisfactory cleanliness of wards with adequate housekeeping
services. At nine CHCs wards were found to have adequate and clean toilets and bathrooms.
Wards at only two CHCs were not following proper bio medical waste management guidelines
for collection and segregation of bio medical waste, and were not having table top syringe and
needle destroyer.
Fig 23: Nornal deliveries conducted at CHC Hospitals (Punjab) in the last five years
250
1st Yr
2nd Yr
200
3rd Yr
No. of Normal deliveries
4th Yr
5th Yr
150
100
50
0
h
a
h
na
al
n
ar
al
ar
ur
ur
ith
ha
ra
w
ad
hg
w
ilp
rp
ia
ka
ng
hi
js
oj
on
B
ta
te
ah
ro
ac
m
M
Lo
ar
Fa
M
he
Fe
M
K
Study to Review
57
Fig 24: Caesarians done at CHC Hospitals (Punjab) in the last five years
120
1st Yr
2nd Yr
100 3rd Yr
4th Yr
5th Yr
80
No. of caesarians
60
40
20
0
Fatehgarh Goniana Kartarpur Longowal Mahilpur Mojitha Machiwara
Wards in eight CHCs were having adequate water supply and upkeep of sanitary blocks with proper
and adequate linen on bed. None of the CHCs were found having doubling of beds or floor beds.
Nine CHCs were found having satisfactory upkeep of cots, mattresses, lockers, linen etc. in the
wards. Only one of the 11 CHCs was having uniforms for the patients.
Regarding availability of necessary equipments in the wards, it was found that six CHCs were
having functional suction
apparatus, while another CHC
which although was having
the suction apparatus, but it
was non functional. All CHCs
were having oxygen cylinders
with accessories; however,
at two CHCs, they were non-
functional. Only three CHCs
were having functional
venesection/LP/tracheotomy
tray. Nine CHCs were found
having functional emergency
light/wheel chairs/stretcher
trolley.
Study to Review
Fig 25: No. of patients admitted at CHC Hospitals (PUNJAB) in the last five years
3500
1st Yr
2nd Yr
3000 3rd Yr
4th Yr
5th Yr
2500
Number of Inpatients
2000
1500
1000
500
0
Badal Fatehgarh Ferojshah Goniana Kartarpur Khemkaran Longowal Mahilpur Mojitha Machiwara
Wards at only two CHCs were not having adequate stationery, forms and various updated registers;
however, all were found maintaining various registers and records required in the ward.
All CHCs were having adequate fans and light. None of the CHCs were providing diet to the
inpatients.

Medical stores suitably located with adequate space were found at eight CHCs. At seven CHCs, the
medical store staff had knowledge on material management, system of FIFO, bin cards, lead time,
buffer stock etc. CMO/MO were found to regularly inspect the medical store and verify stock books
at all CHCs except CHC Manawala. Eight CHCs were having restriction on entry of unauthorised
persons in medical store.
Availability of vital and essential drugs was found at medical stores of eight CHCs, while only five
CHCs were up-keeping the expiry date register, which was regularly inspected by a medical officer.
Only five CHCs were making efforts to redistribute large stocks of slow moving drugs or near expiry
drugs for its timely utilisation. Three CHCs were having proper arrangements to keep drugs as per
ABC/VED category and storage of rubber goods as per the guidelines.
Study to Review
59
Medical stores of three CHCs were not found to take appropriate steps to prevent pilferage of drugs.
All CHCs were having convenient arrangements of issuing drugs to various wards. Only CHC Kartarpur
was found to send samples regularly to chemical laboratory for checking standards of drugs.
Eight CHCs were circulating list of available drugs to all MOs, OPD and wards as per their generic
names.
Medical store at seven CHCs was submitting certified bills to office for release of payment within
three days. Auction to clear the empty material from store was done regularly at only five CHCs.
Availability of fire-fighting equipments and knowledge to use them were found to be in the
medical stores of only two CHCs.
Standing drug committee was found to exist only at three CHCs, and only these CHCs were having
regularly updated hospital drug formulary.

All eleven CHCs were having medical record room with sufficient numbers of racks. Record keeping
in medical record room was manual in all the CHCs assessed, but at only four CHCs, this was
managed by medical record officer or technician having some training in medical record keeping.
None of these hospitals were found to maintain some of the basic hospital utilisation indices like
bed occupancy rate, average length of stay, bed turnover interval, death rate etc. on the regular
basis and in proper scientific way.
Case records were maintained as per WHO classification of disease (ICD-X schedule) at only two
CHCs. However, all eleven CHCs were found regularly submitting morbidity and mortality report
except CHC Manawala.
Only two CHCs were having back-up facility to safe guard these records and only four CHCs were
found following some kind of retrieval system.

Adequate number of bins and bags of required colour codes were available and placed strategically
in all patient care areas in nine out of eleven CHCs included in the study.
Proper segregation and collection of waste was found to be done with proper packaging and
record keeping at almost all CHCs except Badal. CHC Fatehgarh and Badal were found lacking
in proper transportation of waste. Only four CHCs were having proper storage facility for the
biomedical waste.
Study to Review
5.3.29 Central sterile supply department
Only six CHCs were having CSSD under supervision of trained staff/senior nursing officer, nine
CHCs were having all required equipments and autoclaves. Quality control measures were found to
be followed at all six CHCs having CSSD.

Among eleven CHCs under study, six were having in-house laundry services, while remaining five
had outsourced it. At all CHCs, laundry was of conventional (dhobi) type. Quality of wash was
found good at four CHCs only, while in rest of the CHCs, it was found to be average. Quality of
linen was good at six CHCs and average in the remaining five CHCs.

Kitchen facility was not available at any of the CHCs assessed.
5.3.32 Utilisation of Patient care services

At all the CHC hospitals, analysis of last 5 year data, revealed that the number of patients
utilising various medical care services, including diagnostics and treatment, from in-patient and
outdoor had came down in first 2-3 years. But after that, it has steadily increased during the
recent years, though at a slower rate.
However, the figures for service delivery were not found very encouraging. For the last 5 years,
the figures had fluctuated on either side in almost all the districts. Therefore, not only it is very
difficult to conclude anything, but is very much disturbing, that in some places the numbers
have even come down. One of the reasons may be irregular availability of a gynaecologist and its
associated basic facilities in these hospitals.

Year-wise expenditure of the user charges made under the following major heads i.e. medicines,
improvement of the in-patient’s facilities (IPF), maintenance of buildings and equipments. The
expenditure made under the head medicines was 40% to 50% in most of the community health
centre (CHC) except the CHC at Badal, Fatehgarh Churian and Manawala.
Regarding IFP, most of the CHC spent 20% to 30% of the user charges over the years except at
Longowal. (See Fig 26 and 27)
The utilisation of User charges in maintenance of buildings at the CHCs under study were observed
to be varying very widely in the CHCs, over the years as shown in the graph.
10% to 15% of user charges were found to be used for equipment maintenance in all the CHCs over
the years except for Badal, Kartarpur and Mahilpur where it was even less then 5% except in few years.
(See Fig 28 and 29)
Study to Review
61
Fig 26: Percent of expenditure of the user charges in medicine of different CHCs of PHSC (Punjab)
70
60
50
Percent cost (Rs)
40
30
20
10
0
Badal Fatehgarh Ferojshah Goniana Kartarpur Khemkaran Longowal Mahilpur Majitha Machiwara Manawala
Churian
2003-04 2004 -05 2005-06 2006-07 2007-08
Fig 27: Percent of expenditure of the user charges in IPF of different CHCs of PHSC (Punjab)
70.00
60.00
50.00
Percent cost (Rs)
40.00
30.00
20.00
10.00
0.00
Churian
2003-04 2004 -05 2005-06 2006-07 2007-08
Study to Review
Fig 28: Percentage of expenditure of the user charges in buildings of different CHCs of PHSC (Punjab)
35
30
25
Percent cost (Rs)
20
15
10
0
Churian
2003-04 2004 -05 2005-06 2006-07 2007-08
Fig 29: Percentage of expenditure of the user charges in equipment of different CHCs of PHSC (Punjab)
30
25
20
Percent cost (Rs)
15
10
0
Churian
2003-04 2004 -05 2005-06 2006-07 2007-08
Study to Review
63
6.0 Views of the Beneficiaries on
Quality of Services
6.1 In-patient Department

A total of 224 respondents were interviewed from various health institutions like CHCs, Sub-divisional
hospitals, District hospitals and Special Hospitals of Punjab Health Systems Corporation.
6.1.1 Socio-economic profile of respondents

• Out of 224 respondents, the services of Punjab Health Systems Corporation were utilised
more by females (56.3%) as compared to males (43.8%). When observed separately at
the in-patient department of special hospitals, more female patients (90.9%) were found
admitted as compared to the males (9.1%). This may be because these hospitals were mainly
for women and children. Similarly at Sub-divisional hospitals, more female patients (55.9%)
were found admitted as compared to the male patients (44.1%).
• At District hospitals the service utilisation was found to be 55.2% by females as compared to
44.8% by males. But at CHCs, the service utilisation by males was found to be more (65.5%)
as compared to the females (34.5%). Utilisation of services by less than 15 years age group
was very little (1.3%).
• Half of the respondents (50%) were in the age group of 15-30 years, while 20.1% respondents
were in 31-45 years age group. Remaining respondents were above 46 years of age.
Fig 30: Age distribution of in-patients at various health care institutions in Punjab
80
68.2
70
Percentage of Patients
60 54.4
48.3
50
43.8
40
30 25 24.1
22.9 22.7
18.1
20
13.3 13.8 13.8
11.8
8.8
10 4.5 4.5
1.9
0 0 0
0
Dist. Hospital(105) Sub-Divisional(68) CHC(29) SP. Hospital(22)
Less than 15 15-30 31-45 46-60 Above 60
Study to Review
• Literacy level of respondents was low. 35.7% were illiterate and 24.6% were just educated
up to primary level. 26.3% respondents were educated upto senior secondary level and 2.2%
were graduate and post graduate.
• Economic status of the respondents was low, as monthly income of 40.2% respondents was
less than Rs.2000 per month; of 39.3% respondents was between Rs.2000-Rs.5000 per month
and only that of 1.3% respondents using PHSC health services was more than Rs. 15000 per
month. (Refer Table 4)
Fig 31: Income distribution of in-patients at various health care institutions in Punjab
60
55.2
50
Percentage of patients
44.8
39 39.7
38.2
40
31 31.8
30 27.3
22.7
20 16.2
13.6
11.4
10 5.9 6.9
3.8 3.4 3.4 4.5
1 0
0
Dist. Hospital (105) Sub-Divisional (68) CHC (29) SP. Hospital (22)
Less than 2000 2001-5000 5001-10000 10001-15000 Above 15000
6.1.2 Admission procedure

• 51.3% of the respondents were found to be admitted through emergency, while 48.2% of
the admissions were through regular OPD. This indicates that, nearly half of the respondents
came for utilisation of PHSC services only in the case of emergency. This might be because
they do not have access to other health facilities due to economic reasons and are left with
no other alternative except to seek emergency care in these facilities.
• When respondents were asked to rate their experience about the admission procedure at
these institutions, 77.7% respondents rated it as being poor while another 12.1% stated
that the procedure was average. When this poor rating was assessed specifically at different
health institutions, it was revealed that 86.2% respondents from CHCs; 80.9% from Sub-
divisional hospitals and 77.3% from Special Hospitals had rated the admission procedure
as poor. At District hospitals percentage rating was slightly less than the other health
institutions (73.3%). This is indicative of the fact that the majority of respondents were not
satisfied with the admission procedure. (Refer Table 5)
Study to Review
65
Fig 32: Opinion of in-patients about admission procedure at various health care
institutions in Punjab
100
90 86.20
80.90
77.30
80 73.30
70
60
50
40
30
20 18.20
10.50 11.40 11.80 10.30
10 4.40 3.40 4.50
0
Good Average Poor
6.1.3 User charges

• More than 3/4th of respondents (87.9%) were found to have paid charges for making slip/
card; 78.6% for admission and 86.2% for investigations as user charges.
• 69.2% respondents stated that adequacy of information imparted to them by the doctor
about their disease and treatment was perceived as adequate; however 24.6% respondents
Fig 33: Distribution of in-patients regarding user charges at various health care
120
96.6 96.6
100
87.6 84.8 90.9

83.8 85.3 86.4 86.4
79.3
80
64.7
60
40
18.2
20 10.3 10.3
8.6
0
Slip/card Admission charges Investigation charges Consultancy charges
Study to Review
said that the information given to them was incomplete. When the issue about the adequacy
of information was looked at from the perspective of health-institution, it was found to be
highest at CHCs (82.8%), followed by Special Hospitals (77.3%), District Hospital (65.7%)
and at last the Sub-Divisional Hospitals (66.2%).
• 54.5% respondents stated that they were informed about the rules and regulations of
health institutions, while 44.2% respondents stated that they did not receive any such
information. (Refer Table 6)
6.1.4 Experience of respondents at OPD/Emergency

• 17.9% of respondents rated their experience at the emergency/OPD as average for various
health care institutions. 1.8% respondents rated their experience as poor and 2.2%
respondents preferred not to express their experience regarding services at emergency/OPD.
• When an analysis was done in terms of health facility, it was found that 90.9% respondents
at Special Hospitals, 82.4% respondents at Sub-Divisional Hospitals, 75.2% respondents at
District Hospitals and 65.5% respondents at CHCs rated their experience as good. Thus, there
is a scope of improving the services at CHCs level. (Refer Table 7)
6.1.5 Cleanliness and comfort in the wards

• Out of all respondents, 66.5% rated general cleanliness of wards and beds as good while
44.2% respondents rated it as average. When percentage rating was done separately for
different facilities with respect to the in-patient department for general cleanliness,
it was found to be rated as good by 95.5% respondents in Special Hospitals, 79.3%
respondents in CHCs, 63.3% respondents in Sub-Divisional Hospitals and 64% in District
Hospitals.
Fig 34: Opinion of in-patients about general cleanliness of beds/wards at various

health care institutions in Punjab
120
100 95.5
79.3
80
61 60.3
60
40 36.2 35.3
20.7
20
2.9 4.4 4.5
0 0
0
Good Average Poor
Study to Review
67
• 66.5% respondents perceived the cleanliness of bed linen as good and 30.8% respondents
perceived it as average. Facility wise 100% of respondents at CHCs, 86.4% at Special Hospitals,
63.2% at Sub-Divisional Hospitals and 60% at the District Hospitals perceived cleanliness of
bed linen as good.
Fig 35: Opinion of in-patients about general cleanliness of ward bed-linen at various
120
100
100
86.4
80
63.2
60
60
40 33.3
27.9
20 13.6
6.7 8.8
0 0 0
0
Good Average Poor
• Among the respondents from different health institutions, 74.1% respondents perceived that
the degree of comfort in the ward was good while 30% perceived it as average. When different
facilities were compared, it was revealed that respondents perceived comfort better in the
wards of CHCs (86.7%) and Special Hospitals (86.4%); as compared to District Hospitals
(72.4%) and Sub-Divisional Hospitals (66.2%).
• Overall 79.5% respondents stated that good facilities e.g. lights and fans were available in
the wards whereas 18.8% respondents considered these facilities as average. Respondents
had perceived these facilities better at the wards of Special Hospitals (90.9%) and CHCs
(82.8%), as compared to SDH (77.9%) and District Hospitals (77.1%). (See Fig 25)
• Regarding toilet facilities, overall 47.3% respondents perceived that toilets were clean.
However, when assessed facility wise, 63.6% respondents from Special Hospitals, 55.2% from
CHCs, 47.1% from Sub-Divisional Hospitals and 41.9% from District Hospitals perceived that
toilets in the wards were clean. (Refer Table 8)(See Fig 26)
6.1.6 Behaviour of doctors, nurses and staff during stay in hospitals

• Overall 93.3% respondents stated that the behaviour of the doctors with the patients is
good, while 5.8% respondents considered it as average. Remaining 0.9% respondents did
not make any comment. When the percentage distribution was seen separately at different
Study to Review
Fig 36: Opinion of in-patients about availability of light & fans in wards at various health
care institutions in Punjab
100
90.9
90 82.8
Percentage of Patients 77.1 77.9
80
70
60
50
40
30 22.1
19 17.2
20
9.1
10 3.8
0 0 0
0
Good Average Poor
Fig 37: Opinion of in-patients about cleanliness of toilets in wards at various health
70
63.6
60 55.2
50 47.1
41.9
40 38.1 37.9
31.8
30 27.9
23.5
20 18.1
10 6.9 4.5
1.9 1.5 0 0
0
Good Average Poor Can't say
facilities, it was found that 95.5% respondents from Special Hospitals, 94.1% from Sub-
Divisional Hospitals, 92.4% from District Hospitals and 93.1% patients from CHCs considered
the behaviour of doctors as good. This indicates that the overall behaviour of doctors in the
health institutions has been good.
• Regarding the behaviour of nurses in the in-patient departments, 80.4% respondents
perceived it as good, 17.4% as average, 1.8% as poor and the remaining 0.4% did not
comment on their behaviour. Health facility-wise, 87.6% patients from District Hospitals,
Study to Review
69
Fig 38: Opinion of in-patients about behaviour of nurses at various health care
100
87.6
90 82.8 81.8
80
67.6
70
60
50
40
30.9
30
18.2
20
11.4
6.9 6.9
10 3.4
1 0 1.5 0 0 0
0
82.8% from CHCs, 81.8% from Special hospitals and 67% respondents from Sub-divisional
hospitals considered the behaviour of nurses as good.
• Overall, 74.1% respondents stated that the behaviour of staff members was good in the in-
patient department of various health institutions. 19.2% patients considered the behaviour as
average, 1.8% considered it poor, while remaining 4.9% respondents did not say anything.
Fig 39: Opinion of in-patients about behaviour of doctors at various health care
90
78.1 77.3
80
69.1 69
70
60
50
40
30
20.6 20.7
18.1 18.2
20
10.3
10 6.9
2.9 3.4 4.5
1 0 0
0
Study to Review
• When the respondents were asked about the attitude of nurses at the time of admission, it
was revealed that 77.7% respondents considered it good, 19.6% considered it average, 1.3%
considered it poor while remaining 1.3% did not comment on this. Facility-wise it was found
that 86.4% respondents from Special Hospitals, 80% respondents from District Hospitals,
75.9% from CHCs and 72.1% from Sub-Divisional Hospitals considered the behaviour of
nurses as good.
• Regarding behaviour of other staff members, health facility-wise assessment revealed that
78.1% respondents from District Hospitals, 77.3% from Special Hospitals, 69.1% from Sub-
Divisional Hospitals and 69% from CHCs stated that the behaviour of other staff members
was good.
• The findings revealed that 99.6 % respondents had not paid any money to staff members of
the health facility. It was found that none of the respondents from District Hospitals, CHCs
and Special Hospitals had to pay any money to staff members of the hospital. However,
at the Sub-Divisional Hospital, 1.5% respondents stated that they had paid to the staff
members of the hospital. (Refer Table 9)
6.1.7 Availability of diagnostic services

• Out of 224 respondents, 65.6% stated that the facilities e.g. laboratory and radiological
investigations were good, 24.1% respondents considered the facilities as average, 1.3%
considered them poor and remaining 12.1% respondents did not respond to it.
• When percentage of laboratory and radiological investigation facilities were seen at different
health institutions separately, it was revealed that 86.4% respondents of Special Hospitals
considered them as good. But in other health facilities such as District Hospitals (65.7%),
Sub-Divisional Hospitals (54.4%) and CHCs (51.7%) these percentages were lower than the
Special Hospitals. (Refer Table 10)
Fig 40: Opinion of in-patients about availability of Lab. facilities at various health
care Institutions in Punjab
100
90 86.4
80
72.4
70 65.7
63.6
60 54.4
51.4 52.9 51.7
50
36.8 37.9
40 34.3 31.8
30 25.7
22.1 20.6
20 13.8
12.4
8.8 10.3 10.3 9.1
7.6
10 1.9 3.4 4.5 4.5
2.9 1.5 0
1 0 0
0
Good Average Poor Can't say All available Some available None available Can't say
Study to Review
71
6.1.8 Availability of medicines in the In-patient department
• Only 13.4% respondents stated that all the medicines were available, 55.8% stated that
some medicines were available and 29% respondents stated that no medicine was available
in the ward of the concerned health facility.
• When the percentage was seen separately for the various health institutions, then the
comparative availability of medicines was found to be more at Special Hospitals (31.8%) as
compared to CHC (13.8%), District hospital (12.4%) and Sub-Divisional Hospitals (8.8%).
(Refer Table 10) (See Fig 41)
6.1.9 Money spent on medicines by the respondents

• Out of the total respondents interviewed, 91.1% respondents spent money on medicines
while remaining 8.9% respondents did not have to spend any money.
• In different health institutions, the percentage of respondents who spent money on medicines
was 100% at Sub-Divisional Hospitals, 93.3% at District Hospitals, 81.8% at Special Hospitals
and 69% at CHCs. (Refer Table 11)
6.1.10 Food supply to the patients

• Since, at most of the institutions, food was not supplied from the hospitals, therefore,
majority of respondents (80.4%) did not comment on this aspect of the questionnaire.
6.1.11 Quality of care

• 83.0% respondents rated their experience at the reception counter as good, 13.4% rated
it as average and 0.4% respondents rated it poor. 2.2% respondents did not comment.
Fig 41: Opinion of in-patients about availability of medicines at various health care
80
72.4
70
63.6
60
51.4 52.9
50
40 36.8
34.3
31.8
30
20 13.8
12.4
8.8 10.3
10 4.5
1.9 1.5 3.4
0
0
All available Some available None available Can't say
Study to Review
Facility-wise experience of respondents revealed that services were rated well by 90.9%
respondents at Special Hospitals, 86.8% at Sub-Divisional Hospitals, 82.9% at the District
Hospitals and 69% at the CHCs.
• Out of all, 79.0% respondents stated that the overall quality of treatment was good, 17.0%
considered it average, 1.8% stated that the quality of treatment was poor while remaining
2.2% respondents did not comment. When assessed for different facilities, quality of
treatment was found to be better at Special Hospitals (95.5%) and District Hospitals
(81%) as compared to Sub-Divisional Hospitals (73.5%) and CHCs (72.4%).
6.1.12 Security in the In-patient department

• Nearly half (46.4%) of the respondents from all the health institutions perceived that the security
at health facilities was good. This was perceived as average by 17.4%, poor by 17% respondents
and 2.2% respondents did not made any comment about their perception on security.
• About half of the respondents at District Hospitals (51.4%) and Special Hospitals (50%)
and less than half at CHCs (44.8%) and at Sub-Divisional Hospitals (38.2%) perceived the
security as good.
• The above findings suggest that more than half of the respondents did not feel adequately
secure in the in-patient department and there is scope to improve security in the health
institutions.
6.1.13 Overall satisfaction of the respondents

• Overall, 94.2% respondents of the in-patient department expressed satisfaction and only
5.8% were not satisfied with the services of the health institutions.
• When their satisfaction percentage was observed separately for the different health facilities,
Fig 42: Opinion of in-patients about satisfaction on over all services at various health
120
100 100
96.2
100
86.8
80
60
40
20 13.2
3.8
0 0
0
Yes No
Study to Review
73
it was revealed that 100% of the patients from in-patient department of CHCs and Special
Hospitals, 96.2% patients from District Hospitals and 86.8% from the Sub-Divisional Hospitals
were satisfied with the services provided. (Refer Table 13)
6.1.14 Suggestions given by the respondents

The major suggestions given by the respondents were as below:
• About 25.5% of the patients were of the view that the medicines should be provided free of
cost or atleast on subsidised rates.
• Quality of medicines should be improved; food should be provided, clean toilets, regular visits by
the higher authorities to check the facilities of the hospital etc.
• Only 4.2% of the patients were satisfied with the services being provided by the hospitals.
(Refer Table 14)
6.2 Outpatient Department

A total of 580 respondents were interviewed in the outpatient department of various health
institutions like CHCs, Sub-Divisional Hospitals, District Hospitals and Special Hospitals of Punjab
Health System Corporation. The following findings have emerged based on the interview of
respondents in the outpatient department.
6.2.1 Socio-economic profile of respondents

• Out of 580 respondents interviewed the services of PHSC were more utilised by females
(57.9%) as compared to males (42.1%). When analysed for health facilities it was found that
in the outpatient department of Special Hospitals more female respondents (87.2%) utilised
Fig 43: Age distributon of patients attending OPD at various health care institutions
in Punjab
60
55.3
50
38.7 37.7
40
34.1
30.3
30 26.7 25.5
25.4
20.7
19.0 19.3
20 15.8
14.1
12.8
10 6.7
5.3 4.4 4.3
1.8 2.1
Less than 15 15-30 31-45 46-60 Above 60
Study to Review
Fig 44: Educational status of patients attending OPD at various health care institutions in Punjab
60
49.1
Percentage of Patients 50
38.5
40
28.9 28.2 27.7

30
25.2 25.5
22.9
21.3
19.3
20 15.8 16.7 17
11.9 11.4
10.6
8.5
10 6.7
3.7 4.4
2.8 1.5 2.6
0
0
Illiterate Primary Secondary Senior Secondary Graduate Above Graduate
the services as compared to the male respondants (12.8%). Similarly in District Hospitals,
the service utilisation was 59.2% by females as compared to 40.8% by males. But at Sub-
Divisional Hospitals and CHCs, the utilisation of services by both males and females was
almost same.
• Majority of respondents were in the age group of 15-30 years (35.2%) and 31-45 years (29.5%).
• The literacy level of majority of the respondents was found to be low, as 34.8% were illiterate
and 22.4% were just educated up to primary level. (See Fig 44)
• Their economic status was also low, as 34.0% respondants’ income was less than Rs.2000 per
month and 37.9% respondents’ income was between Rs.2000-Rs.5000.
• This indicates that majority of respondents utilising PHSC were females having poor education
and low income. (Refer Table 15)
6.2.2 User charges

• Majority of the respondents (94.8%) were paying user charges for getting an OPD card and 70%
of the respondents were found to have paid for investigation charges. (Refer Table 16)
• The amount of user charge was found to be a token amount of Re.1, which could be the
reason for higher proportion of respondents paying for OPD card. (See Fig 45)
6.2.3 General cleanliness

• Out of total 580 respondents, 72.4% rated general cleanliness of OPD as good whereas
25.3% respondents rated it average. When the percentage rating was seen separately at
outpatient department of different facilities, the general cleanliness was rated good by
87.2% respondents in Special Hospitals, 73.9% respondents in District Hospitals, 71.1% in
Sub-Divisional Hospitals and 64% in CHCs. (See Fig 46)
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75
Fig 45: User charges at OPD in various health care institutions in Punjab
120
98.5
100 94.4 93 91.5
80 71.9 71.1
69 68.1
60
40
20 12.8
4.6 3.7 3.5
0
OPD card charges Investigation charges Consultancy charges
• Overall 77.8% respondents rated the waiting area of OPD as good and 20.3% respondents
rated it average. Facility-wise the waiting area of OPD was perceived as good by 93.6%
respondents in the Special hospitals, 82.7% in District Hospitals, 77% in Sub-Divisional
Hospitals and 59.6% in CHCs.
• Thus, overall rating of general cleanliness of the OPD along with basic facilities was found to be
better in the Special Hospitals in comparison to CHCs. (Refer Table 17)
Fig 46: Views of patients attending OPD about general cleanliness at various health
100
87.2
90
80 73.9
71.1
70 64
60
50
40 34.2
27.4
30 22.9
20 12.8
10 2.5 1.5 1.8

0.7 0 0 0 0
0
Good Average Poor Cannot say
Study to Review
6.2.4 Availability of basic facilities
• Overall 75.7% respondents stated that facilities such as light and fan were good where as
18.4% respondents considered these facilities as average. These facilities were perceived to
be better at the OPD of Special Hospitals (89.4%), Sub-Divisional Hospitals (83.7%) and
District Hospitals (79.2%), as compared to CHCs’ where 51.8% respondents were positive.
• The availability of STD/PCO booth was 43.1% in various health institutions. Health facility-
wise, 52.6% Sub-Divisional Hospitals 48.6% District Hospitals, 46.8% Special Hospitals and
16.7% CHCs were having the STD/PCO facility.
• Separate toilets for women were available in 86% of the health facilities. Facility wise separate
toilets for women were available at 97.9% Special Hospitals, 88% District Hospitals, 85.9%
Sub-Divisional Hospitals and 76.3% of CHCs. This is indicative of the fact that separate toilet
facilities need to be made available to the female respondents when more number of females
are utilising the OPD services at various institutions.
• Availability of drinking water was 89.1% in various health institutions. The same was 100%
at Special Hospitals, 97% at Sub-Divisional Hospitals, 88% at District Hospitals and 78.1%
at the CHCs. (See Fig 47)
• Overall availability of screened examination room was found to be 87.2%. However this was
100% at Special Hospitals, while the availability of screened examination room was 88.1% in
Sub-Divisional Hospitals, 86.3% in District Hospitals and 83.3% in CHCs. (Refer Table 17)
6.2.5 Adequacy of information about disease and treatment

• Overall 81.4% respondents stated that adequacy of information given to them about their
disease and treatment by the doctor was good, while 13.6% respondents stated that the
information given was average.
Fig 47: Views of patients attending OPD about drinking water facility at various
120
100
97
100
88
78.1
80
60
40
20 10.9
14
7.9
1.1 3
0 0 0
0
Yes No Cannot say
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77
Fig 48: Distribution of OPD patients informed about the diseases and treatment by the
treating doctor at various health care institutions in Punjab
100
85.9
90 85.1
78.5
80 71.9
70
60
50
40
30 22.8
20 12.6 10.6
10 1.1 2.1
5.2 3.7 1.8 3.5 4.3
0.9 0
0
• When the adequacy of information given to respondents about disease and treatment by
doctors was assessed facility-wise, it was found that adequacy of information was maximum
in District Hospitals (85.9%), followed by Special Hospitals (85.1%), Sub-Divisional Hospitals
(78.5%) and CHCs (71.9%) respectively. (Refer Table 18) (See Fig 48)
6.2.6 Availability of medicines

• Out of all the respondents, only 10.3% respondents stated that all medicines were available
in the OPD, whereas other respondents (62.8%) stated that not all medicines were available.
Rest of the respondents (26.4%) stated that none of the medicines were available in the
OPD. (Refer Table 18)
• When the issue was analysed health facility-wise, it was revealed that the availability of
all medicines in Sub-Divisional Hospitals and CHCs was 17% and 14% respectively. At other
health facilities such as Special Hospitals (8.5%) and District Hospitals (6%) the availability
of all medicines was less. (See Fig 49)
6.2.7 Availability of diagnostic facilities

• Most of the respondents stated that the facilities like laboratory and radiological investigations
were good (50.7%), whereas 22.1% respondents stated that they were average and 1.95%
stated them as poor. (Refer Table 18) (See Fig 50)
6.2.8 Behaviour of staff members

• Overall 56.9% respondents stated that behaviour of staff members was good in the OPD of
various institutions. Out of the remaining respondents, 32.4% respondents stated that the
Study to Review
Fig 49: Opinion of patients attending OPD about availability of medicines at various
80 74.5
72.8
68.1
70
60 54.2
50
39.1
40
30
20 17
14.1 14 13.2
8.5 7
10 6
0.7 0.7 0 0
0
All available Some available None available No response
Fig 50: Opinion of patients attending OPD about Lab. & radiological facilities at
various health care institutions in Punjab
70
63.8
60
53.9
51.9
50
40 36
32.5 31.9
28.9 28.1
30
23.2
21.5
20 17
10
3.5 4.3
1.4 2.2
0
0
overall behaviour of the staff was average, 8.8% respondents did not say anything about
their behaviour and 1.9% said that the behaviour was poor. (See Fig 51)
• When the percentage distribution was seen separately for different facilities, it was
found that 70.2% respondents of Special Hospitals, 60% respondents of Sub-Divisional
Study to Review
79
Fig 51: Opinion of patients attending OPD about behaviour of staff at various health
80
70.2
70
60
60 56
50
50
40.4
40 34.5
30.4
30
21.3
20
7.7 8.8
10 6.7 6.4
1.8 3 2.1
0.9
0
Hospitals, 56% respondents of District Hospitals and 50% respondents of CHCs stated
that the behaviour of staff members was good.
• Almost all the respondents (97.1%) said that they did not have to pay any money to the
staff members of the hospitals, while 2.9% respondents reported to have paid to staff
members of the hospitals. When this was looked for at different health institutions, it was
found that 3.2% respondents from District Hospitals, 3% from Sub-Divisional Hospitals,
2.6% from CHCs and 1% from Special Hospitals had paid to staff members at the respective
hospitals. (Refer Table 19)
2.9 Availability of doctors, nurses and staff in the OPD

• Overall availability of doctors as stated by the respondents at the health institutions was
94.8%. When respondents were asked about doctor’s behaviour towards them, 91.4% reported
the doctor’s behaviour being good.
• When availability of doctors was assessed for different facilities, then 97.9% respondents of
Special Hospitals, 95.1% of Sub-Divisional Hospitals, 95.1% of District Hospitals and 89.5%
respondents of CHCs stated that doctors were available.
• Overall availability of nurses was confirmed by 79% of the respondents and 64.5% said that
the behaviour of nurses was good towards the patients. Facility wise percentages of the
availability of nurses and their good behaviour towards patients were found to be 80.6% &
63% at District Hospitals, 78.1% & 68.4% at CHCs, 77% & 62.2% at Sub-Divisional Hospitals
and 76.6% & 70.2% at Special Hospitals respectively. (Refer Table 19) (See Fig 52)
Study to Review
Fig 52: Opinion of patients attending OPD about availabilty of doctors at various health
120
97.8 97.9
100 95.1
89.5
80
60
40
20
10.5
4.9
2.2 2.1
0
Available Not available
6.2.10 Waiting time

• When respondents were asked about the waiting time at various health facilities, a majority of
the respondents (88.7%) stated that they have to wait upto 15 minutes. Rest of the patients
stated that they waited longer i.e. 9% for 16-30 minutes and 2.3% for more than 30 minutes.
• At District Hospital, waiting time for 83.6% respondents was up to 15 minutes where as at rest
of the facilities more than 91% respondents reported to have got themselves registered in less
than 15 minutes (95.7% at Special Hospitals, 95.6% at CHCs and 91.1% at District Hospitals).
• Time spent in waiting for specialist consultation in the OPD was less than 15 minutes
for 63.4% respondents. 22.7% respondents stated that they had waited between 16–30
minutes for specialist consultation where as 13.9% waited for more than 30 minutes. When
it was seen for different institutions, 79.7% respondents at Sub-Divisional Hospitals, 72%
respondents at CHCs, 55.6% respondents at District Hospitals and 46.4% respondents at
Special Hospitals waited upto 15 minutes.
• Time spent for getting investigations done at the OPD was found to be less than 15 minutes
for 83.6% respondents. Between 9.9% respondents waited for 16–30 minutes for getting the
investigations done where as 6.5%% waited for more than 30 minutes. When it was seen for
different institutions, 91.1% respondents at Sub-Divisional Hospitals, 86.9% respondents at
CHCs, 80.5% respondents at District Hospitals and 78.4% respondents at Special Hospitals
waited for up to 15 minutes.
• Waiting time for getting the medicine in the OPD was up to 10 minutes for 80.8% respondents,
between 11-20 minutes for 15% respondents and more than 20 minutes for 4.2% respondents.
At different health institutions it was up to 10 minutes for 90.4% respondents at CHCs,
86.5% at Special Hospitals, 81% at Sub-Divisional Hospitals and 74% at District Hospitals.
(Refer Table 20)
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81
2.11 Experience of respondents at OPD
• Out of 580 respondents, 70% rated their experience at OPD as good and 27.4% rated it
as being average at the OPD of various health care settings. 1.4% respondents rated their
experience as poor and 1.2% respondents did not respond. (See Fig 53)
Fig 53: Views of patients attending OPD about waiting area at various health care
100
93.6
90 82.7
77
80
70
59.6
60
50
36.8
40
30
20.7
20 15.8
10
10 6.4
0.7 0.7 2.2 2.6 0.9
0 0
0
• For different health facilities, it was found that 85.1% respondents at Special Hospitals,
72.6% at Sub-Divisional Hospitals, 71.5% at District Hospitals and 57% at CHCs rated their
experience as good. (Refer Table 21) (See Fig 54)
Fig 54: Rating of patient’s experience attending OPD at various health care
80
71.5 72.6
70
70
60 57
50
39.5
40
27.4
30 26.4
23.7
20
10
1.1 1.1 0 0.7 0.9 0 1.4 1.2
0
Study to Review
6.2.12 Quality of treatment
• Overall 75.9% respondents rated the quality of treatment in the hospitals as good. Whereas
21% respondents rated quality of treatment as average, 1.4% stated it as poor and 1.7%
respondents did not respond.
• When percentage distribution was seen separately at different facilities, it was revealed that 93.6%
respondents of Special Hospitals, 78.5% respondents of District Hospitals, 77% respondents of
Sub-Divisional Hospitals and 60.5% respondents of CHCs rated their experience as good.
• Overall 77.9% respondents were satisfied with the services of various health institutions,
whereas 22.1% respondents were not satisfied with the services of health institutions.
Health facility-wise analysis reveals that 80% respondents of Sub-Divisional Hospitals,
79.8% respondents of CHCs, 78.5% respondents of District Hospitals and 63.8% respondents
of Special Hospitals were satisfied with the services.
• In the overall rating about the level of cooperation at the reception counter at various
institutions, 93.6% respondents rated it as good and 6.4% respondents rated it as average.
Health facility-wise, 80% respondents of CHCs, 79.2% respondents of District Hospitals, 77%
respondents of Sub-Divisional Hospitals and 70.2% respondents of CHCs, rated the level of
cooperation as good. (See Fig 55)
Fig 55: Opinion of patients attending OPD about quality of treatment received at
various health care institutions in Punjab
100 93.6
90
78.5 77
80
70
60.5
60
50
40 36
30
18.7 18.5
20
10 6.4
1.8 2.2 2.2 3.5
1.1 0 0 0
0
6.2.13 Suggestions for improvement of services

• Regarding all facilities, 28.3% respondents did not offer any suggestion. 50.5% respondents
suggested for free provision of all medicines to everyone, especially to the poor.
• Other suggestions from respondents were; provision of more doctors or specialists (6.4%),
cleanliness of OPD and toilets (4.9%) and proper care of respondents and emergency care
(3.6%). 2.3% respondents were fully satisfied with the services of the out-patient department.
(Refer Table 22)
Study to Review
83
7.0 Training Institutes
7.1 Introduction
Last two decades have witnessed major shift in the health system and concerns have been expressed
regarding health issues, critical to women, children and people in the rural and tribal areas. The
health sector being no exception, has very heavily relied upon and included in-built components
like systematic training. Training has been used as a planned strategy towards development of
human resource for the achievement of total health in the country. The training system helps in
continuing the review of current needs of state and national programmes and policies to match
with the training personnel at all levels in the health care system. In addition to strengthening the
functional performance of human resources, it also caters to aspects like cost containment, quality
of care and creation of new categories of health personnel.
However, several lacunae have been identified in the existing training programmes such as:
i. Training often does not bear directly on an employee’s official duties.
ii. Duplication of training programmes and the same participants receiving training frequently.
iii. Lack of written course evaluations with an objective to provide feedback after training while
one has resumed one’s job.
Realising these gaps in the existing health care delivery system it was felt that training institutes
would also be evaluated along with the other health service facilities in the state of Punjab
during conduction of the study.
Training institutes evaluated were:

1. State Institute of Health and Family Welfare, Mohali.
2. State Institute of Nursing and Paramedical Sciences, Badal (in the district of Muktsar).
3. Mental Hospital, Amritsar.
7.2 State Institute of Health and Family Welfare (SIHFW),

Mohali
The State Institute of Health and Family Welfare (Kharar) was established under a WB aided project
in 1992 after upgrading the Health and Family Welfare Training Centre, Kharar. Now, State Institute
of Health and Family Welfare, Phase-VI, Mohali, Punjab, has been established under IPP VII (Year
1997-1999), under World Bank aided project as an apex institute to cater to the training needs of
the northern states like Punjab, U.P, Chandigarh, J&K and Haryana. The Institute has been declared
as Collaborative Training Institute (CTI, Mohali) with NIHFW, New Delhi being the nodal agency.
The institute from Kharar has been shifted to a new campus at Mohali and is made operational with
effect from 1st April, 2004 as State Institute of Health and Family Welfare, Phase-VI, Mohali.
Study to Review
7.2.1 Objectives
• To develop trained health manpower resources for better delivery of health care services and
effective health management.
• To conduct policy relevant and field based research studies on areas relating to population
health and family welfare.
• To monitor, supervise and provide technical guidance to regional training centre/School/DTC
and NGOs.
• To render advisory and consultancy services to government, and other health related
organisations for developing programmes and policies on population and health.
• To provide training to other departments/organisations.
7.2.2 Functions
• To plan, conduct, evaluate and follow up of the training programmes for the health personnel
in the region.
• Develop the urban and rural field practice and demonstration areas for providing practical
experience to the trainees and utilise the area as field labs.
• To develop a training curriculum.
• Conduct simple studies and research, to improve training techniques and tools.
• Serve as a technical resource for the region
• Plan, conduct and evaluate special health and family welfare campaigns
• Provide consultative services on family planning and training to voluntary and allied agencies.
• Maintain a close liaison with central training institutions for technical help and guidance.
7.2.3 Major components

1. Training
• Professional development course
• Basic training for MPHW male
• In-service training for medical and para medicals
• TOT for key trainers (RCH) trainings
2. Research and evaluation studies in collaboration with medical health and related organisation.
3. Service cum training counseling clinics.
4. Monitoring and evaluation of the trainings under Health and Family Welfare departments
in the State.
5. Computer HMIS.
7.2.4 Trainers of the training institute

This survey was conducted in SIHFW, Mohali. Questions were asked from trainers, considering
them as an important stakeholders in this survey. A total of 7 respondents were interviewed. The
trainers were mainly medical officers and the nursing tutors, having an average experience of 15-
20 years of service. The job responsibilities given to them were teaching, planning for ongoing
trainings and different administrative responsibilities.
Study to Review
85
The activities mainly carried out by them were training, administrative, planning, session
teaching and sometimes data collection for different research projects.
After the inception of PHSC, there have been special training programmes sponsored to nominate
specialists like surgeons, physicians etc. to improve the quality of different training programmes.
One of the respondents was of the view that there is not much change; everything is as it is as
it was before. Another respondent indicated that there is an improvement in the quality of work,
but she could not specifically point out the type of quality being referred to. After the inception
of PHSC, more emphasis is given to Behaviour Change Communication and on counseling which
was not the case earlier.
All the respondents have done many training programmes over the years like on disaster
management, capacity building, RCH, counseling skills, integrated course for NRHM, adolescent
and reproductive health, first aid course, workshop on community participation etc. It indicates
that trainers are given relevant training, which is of importance to keep them updated with the
new emerging trends. They can apply this while conducting different training sessions.
Almost all the respondents were positive about the need of more training in the areas like
leadership, management.
Skills of Trainers: Faculty of training institute were asked basic information regarding organisation
of trainings.
• When asked about the concept of systems approach to training, all the seven respondents
could not speak about it. Though few responded that it should be based on needs assessment
followed by a systematic approach to training.
• The response on pre-requisites for preparation of training calendar, the respondents most
of them reported as training load, availability of resources (man, money and material) and
availability of venue.
• According to the respondents the training methods used for skill development are hands on
training, demonstrations, powerpoint presentations, group discussion and role-play.
The above analysis shows that the trainers have fairly good knowledge about the organisation of
training programmes.
Common complaints of trainees attending training programmes:
When asked about the nature of complaints by the trainees who attended the training programmes,
some of the common complaints were:
Shortage of faculty members, duration of the lectures being very long, quality of food is not very
good, and poor hostel facilities.
The quality of training programmes is usually assessed by the trainers from pre and post evaluation,
participant’s evaluation report and through informal communication with the participants.
Study to Review
The procedure for the preparation of training report includes compiling data and taking feedback
from the participants.
The impact evaluation is not done in the institute, however, according to one of respondent, reaction
feedback (immediate) from the participants is taken on completion of training programme..
Some programmes which are proposed to be started shortly are on NRHM, BCC, HISM, Leadership
and Disaster Management.
Changes required in the existing training structures: Opinion of the respondents was taken to
identify the changes required in the existing training structure for the staff in their district.
• Guidelines for organising training programmes should be more clear and freely available
• More class rooms are required
• Training calendar should be spread uniformly throughout the year
• There should be more training programmes for the nursing personnel
7.3 State Institute of Nursing and Paramedical Sciences,

Badal (in the district of Muktsar)
The State Institute of Nursing and Paramedical Sciences was established in the year 2001 at Badal
in the district of Muktsar. The main objective of this training institute was to have a good quality
training institute available in the rural area of Punjab which can teach and train the candidates
from the rural community. It was till recently under the Punjab Health Systems Corporation
and has now been transferred to Baba Faridkot University.
7.3.1 Major courses being offered

1. BSc. (Nursing)- a four year full time course with a capacity of 50 admissions (recently started)
2. General Nursing & Midwifery course- Three and a half years with a capacity of 50 admissions
3. Diploma in Radiography- a two year course with a capacity of 10 admissions
4. Diploma in Medical Laboratory Technology- a two year course with a capacity of 20 admissions.
7.3.2 Practical training of students

The practical training of a student is done in a number of hospitals on a rotational basis. The
hospitals are:
a. Civil hospital Badal- not very suitable as daily attendance is very low
b. Civil hospital Bhatinda- good daily attendance
c. Women and Children Hospital Bhatinda- around 70-80, attendance
d. Civil hospital Malout- daily attendance of around 50
e. Mata Kaushalya hospital Patiala- around 200 daily attendance
f. Institute of Mental Health, Amritsar
g. Rajindra Hospital and Medical college Patiala
Study to Review
87
h. Baba Faridkot (GGS Medical college) for Radiography
i. Sub Centre Singhewala under PHC Lumbi for Community Health Nursing
7.3.3 Fees structure

The fee structure is as follows:
For BSc Nursing the annual fees is Rs. 43,500/-
For GNM course the annual fees I Rs. 41,500/-
For DMRT and DMLT courses, the annual fees is Rs. 17,000/-
7.3.4 Salient features

1. The intake in the BSc (Nursing) and GNM courses is very good and generally the fifty seats
allocated are filled up with very few drop outs during the academic year.
2. The Diploma in Radiography has generally 50-60% occupancy. This year there are only two
students enrolled against 10 seats.
3. The Diploma in Medical Lab Technology does not attract enough number of students- in this
batch there is only one student against 20 seats.
4. There is shortage of faculty. 10 out of the required 18 nursing tutor posts are filled up.
Further there are only 2 MSc. qualified nurses (including the Principal) for training the BSc.
Nursing students.
5. As there is no hospital within the premises and for all practical purposes the civil hospital
Badal has very few patients, it is difficult for the students to go for training to Bhatinda and
other places. The students have to commute to and fro to Bhatinda as the hostel facilities
are not there. This suggests that there is a need of a hostel for the nursing students which
will help in cutting down on the commuting time and promote better learning.
6. The eligibility criteria for DMLT course needs to be re-looked at. Punjab technical University
is admitting Arts students too.
7. There is lot of dissatisfaction amongst the staff as regards the pay scales. Further as many
of the tutors are on contract, they are not able to deliver their best.
8. There is a need for atleast one staff bus for the employees and one more bus for the students
as the public transport system is not functioning well.
9. There is also requirement for a full time student counsellor and one health officer.
10. Upgradation of the library with more books, journal and computers with internet connectivity
is a must.
11. Modern AV aids are required- especially LCD projector
12. Funds for repair and maintenance of the hostel are needed as many repairs and renovations
are pending
13. The institute was more comfortable under the PHSC as regards funds and sanctions for different
tasks. It is facing more problems after being transferred to the Baba Faridkot University.
Study to Review
7.4 Mental Hospital, Amritsar
This hospital is catering to services of psychiatric patients from Punjab and other states. All the
available staff has the expertise in psychiatric and related areas. Training programme of nurses in care
of psychiatric patients is also being organised by the hospital. There is a capacity of 350 students
for the training programme with a fee structure of Rs. 1500 per student for 1 month training. This is
one of the sources of income for the hospital. By virtue of this training programme being organised
for the nursing categories, the institute may be considered as one of the potential training institutes.
However, before considering that, the following points may be taken into account.
• The faculty of the institute is tuned to the psychiatric care services and due to shortage of
them; it would be very difficult for them to carry out other training activities.
• The institute does not have any professional trainer or faculty who has been trained in Training
Technology. Furthermore, their experiences were not matched with the primary health care
service delivery.
• Hence, in the context of declaring a training institute for primary health care service delivery,
Institute will have to depend totally on external resource persons.
• In lieu of the above context, a major part of the training budget might be utilised in the
payment of honorarium to the guest faculty. In addition to this, training programmes would
likely be earning source for the institute and it will enhance the training budget more.
• The institute does not have established hostel with mess facilities. Dharamshala for the
attendants of in-patients is being used as hostel for the trainee, nurses and kitchen for the
patients was being used for the food for them on adhoc basis.
• As the ongoing in-service training was limited to the psychiatric ward only, institute has
not developed any Field Practice Demonstration Area (FPDA), which is essential for Primary
Health Care Skill training.
• On the other side, the Director of the institute, a retired Principal from Medical College, has
vast experience and good networking with the health system in Punjab. Furthermore, all the
teaching aids space for the training programme is available in the institute.
A summarised SWOT analysis is being projected below:
7.5 SWOT analysis of training institutes

Variable State Institute of State Institute of Nursing and Mental Hospital, Amritsar
Health and Family Paramedical Sciences, Badal
Welfare, Mohali (in the district of Muktsar)
Strength Well designed complex Well designed complex having • Sufficient infrastructure.
spread over 5 Acers of • A vast Teaching Block • Had experiences in the
land having • Two Hostel Blocks conduction of Nursing training
• Teaching Block • Administration Block • Availability of training and
• Hostel Block • Residential Block teaching aids
• Administration Block
• Residential Block
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89
Variable State Institute of State Institute of Nursing and Mental Hospital, Amritsar
Health and Family Paramedical Sciences, Badal
Welfare, Mohali (in the district of Muktsar)
Well equipped Well equipped • Availability of class rooms.

• Auditorium • Auditorium • Availability of transport
• Lecture Halls • Lecture Halls facilities for field visit.
• Seminar Room • Seminar Room • Availability of library
• Committee Room • Committee Room
• Computer Lab • Demonstration Room
• Demonstration Room Modestly Furnished
• Library
Hostel Rooms
Well Furnished
• 64 Hostel Rooms • Common Room
• Guest House • Mess (run as a cooperative mess
• Recreation Room with contractual staff)
• Common Room
Operational
• Mess
• Three Buses- one 52 seater, one
• Gym
32 seater, one an 18 seater,
Operational One Tata Sumo
• Two Buses
Generating income
through hostel
charges.
Weakness • Very limited faculty. • Staff shortage. 1. Only experience of Psychiatric
• Consultant posts are • Only experience in nursing training, no experience of other
vacant training training methodology.
• No full time director. 2. Very limited faculty and that
• Too much • Library has adequate space. It too psychiatric specialist.
dependence on does not have enough books. There 3. No proper hostel or mess
external funding are only 797 books and 13 nursing facilities.
training programmes journals available. Seven types of
health related journals are also
available.
There is no internet connectivity in
the library and no facilities for the
students to browse the internet.
Opportunities • Very good linkages • Good political support 1. On going mess facilities for
with Punjab Health patients, may be used for trainees.
System Corporation 2. Existing dharamshala may be
having the facilities in used as hostel.
the same premises. Director of the institute is a very
• Established linkages much known personality in the
with NIHFW and health field and having good
other central training network which may help in the
institute mobilisation of trainer.
Threats • Depends upon No apparent threat 1. Funds for the training may be
Punjab Health System used in the hospital services for
Corporation. the psychiatric patients.
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8.0 Community Voice
For listening to the community voice, focus group discussions (FGDs) were conducted to take care
of qualitative dimensions. Ten (10) FGDs among the females were undertaken in nearby villages
of community health centres and 10 FGDs among the males were conducted in nearby villages of
sub divisional hospitals. Let us read and understand their issues.
8.1 Observations among Male Groups

8.1.1 Accessibility to health care facility:
a) Health care facility availed by villagers
• Local people are interested in availing the government facilities. However due to various
reasons most of them are not utilising these facilities.
• People of low socio-economic group are utilising the government facilities due to their very
little paying capacities. These are the people who primarily try to avail the services. The
people belonging to lower–middle group and above, generally utilise private facilities as per
their paying capacities.
• Few Sub-divisional hospital’s /CHCs attract large number of patients, even from the far off
places, only because of the good administration and services offered by the hospital in-
charge.
b) Reasons for non-utilisation of Government health facilities

Varied reasons emerged following the discussions in different districts. Following are the few
common reasons from all the districts:
• If the distance of the health facility is more, then local people tend to utilise private facility
only.
“Anay janay may he to sara kharcha ho jana hai, Time waste hoga who alag.
Isliye hum to pas ke doctor ke pas he chaley jatey hain”.
• People are primarily unhappy with the fact that they have to spend the money for availing
health services.
“Private mein jayen ya serkari mein, kharcha to dono mein he karna hai,
Private vale doctor per to hum jor bhi dal sakte hain”.
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91
“Sui se le kar glucose, davaiyan, injection sab bahar se he khareedna padta hai”.
• In most of the emergency departments, 24 hour services are not available due to non-
availability of staff. Therefore people prefer to go to the private hospitals/nursing homes
only.
“aise jaedah hai jadon police case hove, emergency which to koi sahuliat nahin hai”.
• Availability of the doctor in the hospital/CHC is not sure.

“Asain doron jaidai doctor ravey na ravey, sanu to kuch pata nahin,”.
(Once we reach most of the time doctor is on leave or gone for some meeting or other commitment,
our whole day is gone and even the money).
• Majority mentioned that the government doctors prefer to see the patients in their private
settings, charging heavy consultation fees. Besides specific investigations, like ultrasound
etc. are required to be done from outside private centres.
c) Distance from home and connectivity from the road

• Majority pointed out that distance is an important factor, but if all the facilities are available
with good doctors, people would prefer to utilise those health facilities, e.g. Dasua Sub-
Divisional Hospital is known to be good so far as deliveries are concerned. People from far
off places utilise the services available there.
• There are places where the hospitals/health centres are near the villages or in the residential
area, but people still do not utilise the services and go to private hospitals/nursing homes
which are far away.
• Many of the groups commented - “as the same doctors give good treatment in private nursing
homes, so we go there only”.
d) Transport facilities and cost of travel

• Sub-divisional hospitals are generally situated near the main roads, which are well connected
with the local transport as well. Travel cost depends on the economic status of the family
and for the poor patients it is a cause of concern.
‘Panchayat aur local loki madad kar den dey , chanda ekthda ker key de den de”.
(Villagers help their native people by contributing money for the medical expenses etc.)
e) Services:
• The services in the hospital are on payment basis. One group said that they need to buy
everything needed during hospitalisation or otherwise. As outpatient also, majority of them
have to purchase the medicines from outside.
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“We can only save the visiting fees of the doctor otherwise
there is no difference in going to either Government or Pvt. Facilities.
8.1.2 Availability of the facilities in the hospital

a) Waiting time in OPD
• Majority commented that waiting time in OPD depends on the number of the patients. If the
doctor is available and fewer patients are there. It takes 20-25 minutes.
• Whereas if the number of the patients is more, than it may take even 2-3 hours. As far as
timings of the OPD are concerned, all of them feel it is convenient for them.
b) Availability of the doctors

• Different opinions emerged. Most of them agreed that availability of the staff is there, but
there is a scarcity of the staff.
• The participants also put forth that the availability of the doctors /staff etc. depends on the
administrator of that place.
“Bade doctor sakht jadon honge sab changa chalta hey”.
c) Availability of the medicines

• All emphasised on the non-availability of the medicines. Whatever the patient needs
while hospitalisation or in OPD, they are asked to buy. Very few people mentioned that for
economically weaker section some medicines are given from the hospital.
“sarkari aspatalan bich to asan garib loki e jaedah hai,

davaiyan kuch bhi nahi dende”
‘Why should we go to the Government hospitals, as only visiting the doctor is not going to help,
we need to buy the medicines also “Local private doctors give the medicines also within the
Fees”.
d) Availability of the laboratory and radiological services

• All were unhappy with the functioning of the laboratory and radiological services.
• It was pointed out that in case of emergency, there are great difficulties in availing any of
these facilities. They were of the opinion that at few of the places, machines/equipment are
either not in working condition or the technician is not available.
“If it is only the availability, ‘yes’, it is available but if we talk about the functioning aspect, it
is questionable”.
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93
“Whole day goes off only for one investigation to be done”. Again they were required to collect
the report from the lab and then visit the doctor.
8.1.3 Behaviour of health care providers towards patients

• Most expressed happiness with the doctors’ behaviour.
• Few reflected that doctor’s behaviour is more prompt and appropriate when they visit the
same doctors in their clinics.
• It emerged that the staff does not ask for any money for any reason.
• They are at times cooperative.
8.1.4 Outreach services offered by Government facility

• Most pointed out that though ANMs exists in the area, but they are not conducting group
meetings. Home visits were also very less.
• ANC is not a regular agenda. Women themselves go to the hospital to get registered.
• Few of the respondents said that ANM is active and take due care of the pregnant women.
• Visits of the ANM/ASHA are actually restricted to specific areas.
• These workers are more centred to areas near their residence. The far off villages are not
taken care off. As such there is no coverage for family planning services.
• No medicines have been distributed by the ANM since 4-5 years.
• Iron and folic acid tablets are also not available with them. Only hospitals provide these
medicines for 3-5 days to each pregnant women.
8.1.5 Coverage
• Remote areas are not being served. People are forced to utilise private services, sometimes
with the same government doctor of the hospital in their private clinics.
• Most emphasised that health facilities are not fully equipped. They need to go to the other
specialised hospitals/referrals to avail some of the facilities.
8.1.6 Satisfaction with the services provided by the Government

health facility
• Responses were varied among different groups. In the Sub-divisional hospital areas, which
are running fine due to good administration, people are somewhat satisfied with it. Whereas
those, where there is bad administration like no doctors on duty or shortage of doctors,
people are not at all happy with them.
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• They feel that government has invested so much in the infrastructure for the betterment of
the general public, but the ultimate purpose has not been achieved.
8.2 Observations among the Female Groups

8.2.1 Accessibility to health care facility
a) Health care facility availed by villagers
• Women primarily want to avail the government facilities. This is either due to their positive
experiences in the past or those of the friends/relatives.
• Most of the women said that for delivery they primarily feel safe in going to the government
hospital but due to various reasons most of them actually are not utilising these facilities.
Women from the villages need to travel long distances, as CHCs are not situated in the
villages but near the main roads.
• Various groups with single voice stated that delivery occurs most of time during odd hours or
in emergency, and for that, one could not depend on the present health system. They added
that doctors are not available and for the reasons not known to them, they refer the patient
to either private hospital or to the District Hospital.
“Wahan hota hi kon hay”.

‘asan to aes lai privaton e jainda hega”
• For this reason they go to either private or to the District Hospital. Few of the women also
added that the government doctors, who are practicing privately also provide good treatment
in their nursing homes, and so it is better to go to them.
• Parishad CHCs are more popular in some of the areas as compared to the PHSC’s CHCs.
b) Reasons for non-utilisation of Government health facilities

• Most of the rural women visit the CHCs for their reproductive health problems.
• Most of the places gynaecologists are not available.
• If the distance of the health facility is more, the local people utilise private facility only.
“For delivery we cannot take any chances” was the version of most of the respondents.
• People were found unhappy because they have to spend the money for availing health
services. They were of the opinion that at least delivery facility should be provided by the
Government free of cost.
“Madam suin se ley kar glucose, davaina, injection sab bahar se he khareedna padta hai”.
“Serkari aspatal witch to sab kokh hi milna chaida hay”
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95
• At night time nobody can think of going to the CHC for any emergency as hardly anybody
would be available there. People prefer to go the private hospitals /nursing homes only.
It was commented that in general, these government health service providers provide no
emergency facilities.
• Availability of the doctor in the hospital/CHC is not very sure.
• Laboratory testing, ultrasound etc. are required to be done from private centres. At many
places, women groups stated that these centres are also in someway or other related to the
government hospital doctors. Most commented that the government doctors prefer to see
the patient in their private settings charging consultation fees..
c) Distance from home and connectivity from the road

• Although distance is an important factor, but if good doctors are available at health facilities,
people will most likely utilise these health facilities.
• Most of the rural women visit Parishad CHC, as it provides the services. The nearby CHCs
under PHSCs with 6 doctors are not being visited.
• At places, where the CHC are nearby the villages or even in the residential area, people
still do not utilise the services and rather go to private hospitals/nursing homes which are
situated at distance. “The same doctors give good treatment in private nursing homes, so we
go there only’.
d) Transport facilities and cost of travel

• CHCs are found to be mainly situated near the main roads but away from many villages. These
roads are however, well connected with the local transport also. Still the paying capacity for
the cost of travel depends on the economic status of the family, which is a matter of concern
for the poor patients.
• Those who cannot afford to bear these costs prefer to call for TBAs for conducting the
delivery, irrespective of the fact whether she is trained or untrained.
e) Services
• It was stated that they have to purchase everything needed during hospitalisation or otherwise.
Even as outpatients, majority of the medicines have to be purchased from outside.
8.2.2 Availability of the facilities in the hospital

a) Waiting time at OPD
• Waiting time in OPD depends on the number of the patients. If doctor is available and few
patients are there it only takes 20-25 minutes. Whereas if the number of the patients is
more, than it may take even 5-6 hours. As far as timings of the OPD are concerned, all of
them felt it is convenient for them.
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• Few opined that if a gynaecologist is there, women will feel comfortable in going to them
and would not even mind the waiting time. Very few deliveries are being conducted at the
CHCs.
b) Availability of the doctors

• Different members were having different opinions on this issue. Though most of them agreed
that availability of the doctors is there but there are also some places where there is scarcity
of the staff. Few of the women added that if doctor is from the same area, there are chances
that they will be available.
c) Availability of the medicines

• Almost all mentioned about the non-availability of the medicines. Whatever the patient
needed whether as in-patients or as out-patients, they are being asked to buy almost
everything. Even for the delivery, everything is to be purchased. No medicines are being
provided from the hospitals. Very few people mentioned that for economically weaker
sections, some medicines are given from the hospital.
c) Availability of the laboratory and radiological investigation

• All were not very happy with the functioning of the laboratory and radiological investigations.
The respondents pointed out the fact that in emergency, it becomes a great problem in
availing any of these facilities. Few respondents opined that it is difficult for a pregnant
woman to collect the report from the lab and then visit the doctor.
• It was revealed that at few of the places, machines/equipments are either not in working
condition or else the technician is not available.
“If it is only the availability ‘Yes’, it is available but if we talk about the functioning aspect, it
is questionable”.
“Whole day goes off only for one test to be done”
8.2.3 Behaviour of health care providers towards patients

• In general, members experienced happiness with the general doctors. But few commented
that gynaecologists are available only sometimes.
• It was reflected that the doctors’ behaviour is more prompt and appropriate when they go
to visit the same doctors in their private clinics as compared to government facility.
• Behaviour of the nursing staff was reported to be good. It was also mentioned that the staff
did not ask for any money for any reason and that they are at times cooperative.
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97
8.2.4 Outreach services offered by Government facility
• Though ANM is available but home visits are very less.
• No health related discussion takes place ever.
“ab to sub jante hai kya achha hai kya kharab”
• All were happy about the pulse polio. However, ANC is not a regular agenda. Women generally
go by themselves to the hospital to get registered.
• Families were found to be well aware about the institutional deliveries. Few stated that ANM
is active and takes due care of the pregnant women.
• Visits of ANM/ASHA is generally restricted to specific area. It was stated that they are more
centred towards their residential area.
• Far off villages are not taken care of. Some women commented that as such there is hardly
any coverage for family planning services. They use contraceptives, based on whatever
information they get from various sources.
• No medicines are distributed by the ANM. Iron and folic acid tablets are also not available
with them. CHCs provide these medicines for 3-5 days to each pregnant women.
• Women who go to the private doctors get prescription for iron and folic acid tablets and they
purchase it. The people from poor background only visit the hospitals for delivery and that
also was when local dais tell them that about some problem during home delivery.
8.2.5 Coverage
• Remote areas are not being properly served. People are forced to utilise private services
sometimes with the same government doctor of the hospital in their private clinics.
The centres are like “ujada chaman, wahan kon jayga”.
• Health facilities are not fully equipped. They need to go to the other specialised hospitals/
referrals.
8.2.6 Satisfaction with the services provided by the Government health

facility
• Most were not satisfied with the government facilities.
• Very few of them commented that services are fine to an extent but almost all women were
of the opinion that the services need improvement.
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8.2.7 Suggestions for improvements
• There should be improvement in basic facilities in hospitals including cleanliness, recruitment
of the staff, specialised doctors, drinking water arrangement, toilets on all the floors and
wards, electricity (lighting arrangement), generator, water tank, timely repair of accessories
and machines etc.
• Medicines should be provided by the hospital. If not possible, at least the BPL families should
get the facility. For the other patients, subsidised medicines can also be a good option.
• In emergency delivery cases, at least hospital should provide everything.
• Provision for laboratory and ultrasound, especially in emergency, should be in perfect condition.
• On call doctors should be arranged for emergency departments.
• Fee for the investigations should be subsidised.
• Community oriented programmes e.g. Camps, health Melas, health education etc. should be
organised especially in far-flung areas.
• Local community participation should be enhanced for utilisation of health services. Mahila
Mandals should be strengthened.
• Emergency departments, ambulances should be arranged at very minimum rates. For transport
of delivery cases, there should be no charge.
• Doctor on emergency duty should be available for 24 hours.
• The private practice of the Government doctors should be stopped.
• Every village should have a trained dai and a lady doctor.
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9. Views of the Stakeholders
Interviews were conducted with senior administrators and other stakeholders to get their
views on the functioning of the health system. The findings of interviews as per facility are
given below:
9.1 At District Level

9.1.1 Deputy Commissioners (DC)
Out of the 10 districts visited in Punjab for evaluation of the health System, the Deputy
Commissioners (DC) of only 9 districts could be interviewed as the DC of Hoshiarpur district was
not available at the time the study team visited the district. All the DCs interviewed had less than
2 years of service as D.C.
The revelations from these interviews are as follows: (Refer Table 23)
9.1.1.1 Overall functioning

• Out of the total 9 DCs interviewed from the various districts visited, DCs of 50% districts
reported that the overall functioning of health facilities in their district is good, while 30%
reported average (mainly due to shortage of staff) and 20% reported poor and gave lack of
doctors as one reason for poor functioning.
• Regarding availability of staff, 60% DCs admitted shortage of staff, while 30% of the
DCs could not say anything definitely on this matter. DCs of district Muktsar, Sangrur and
Gurdaspur felt that the decrease in utilisation of health services by the community is mainly
due to the shortage of staff particularly the specialists viz., gynaecologist, orthopedician
and eye-specialist.
• Shortage of O.T staff at most places was reported by DC, Muktsar. He also reported that
cancer is a big problem in Muktsar and no focus has been given to that.
• It was emphasised mostly that the general cleanliness is not good and needs further
improvement. Maternity services in most of the District Hospitals also need improvement.
Long waiting time was also reported as a big problem in the delivery of services (Sangrur
District).
• Besides this, lack of staff, lack of supervision to ensure punctuality and to check absenteeism,
improper monitoring systems as well as negative interference (on non-health issues) were
reported as other constraints in the delivery of services.
9.1.1.2 Extent of fulfilment of community needs

• Regarding the extent of fulfilment of health needs of the community, 40% of the DCs stated
that it is being partially fulfilled (upto 50%) while 40% DCs stated that large extent of
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community needs are being fulfilled (upto 80%). Remaining 10% DCs did not have any
conclusive comment on this issue.
• Regarding the perceived barriers among facilities in utilising public health services, 30% felt
that availability and accessibility are a barrier mainly for CHCs. 20% felt that there are some
barriers in terms of utilisation and acceptability of services. Remaining 50% DCs felt that there
are no barriers for the availability, accessibility, utilisation and acceptability at services at
District hospitals, but for Sub-divisional hospitals and CHCs it requires further improvement.
9.1.1.3 Referral services

• According to 40% DCs non availability and not fully equipped ambulance are a problem, 30%
DCs opined that referral services are satisfactory in their districts and the remaining 20% DCs
had no idea about this.
9.1.1.4 Knowledge of RKS (Rogi Kalyan Samiti)

• More than 60% of DCs were found to have knowledge of RKS while rest were unaware. 10%
DCs told about BPL cards being given to poor patients for free treatment.
9.1.1.5 Fund flow

• Regarding the fund flow it was felt by 30% DCs that there is no problem with respect to the
fund flow, 20% stated that it is not through DC. Other 10% DCs stated that funds are not
adequate and another 10% felt that the funds are not being fully utilised. 20% did not have
any comment regarding the funds flow. It was suggested that funds should be given for the
purchase of C.T. Scan and MRI. Medical Insurance for poor and economically backward people
should be introduced at state level.
9.1.1.6 Manpower management

• About 40% DCs reported good levels of motivation amongst their staff, 20% reported low to
very low motivation level, over load of work and low salaries being the main reasons for low
motivation. 30% DCs did not give any comments. Frequent transfers were also opined as one
of the main reasons for low motivation level.
9.1.1.7 Constraints in delivery of services

• About 30% of the D.C felt that lack of staff is a major constraint in the delivery of health care
services. 10% felt that lack of supervision, absenteeism, lack of punctuality, lack of funds,
lack of super specialists, lack of facilities and high load of work are some other constraints
in the delivery of quality health care services.
9.1.1.8 Suggestions
The following suggestions were given by DCs:
• More infrastructure facilities and equipments should be provided.
• Salary of doctors should be increased otherwise they will go for private practice.
• More contractual employees should be placed – especially class IV and lab technician.
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• PPP model need to be introduced.
• Telemedicine should be promoted.
• Performance linked appraisal should be there.
• Number and quality of drugs need to be increased and improved.
• Paid wards should be started.
• Transport services should be improved.
• Health insurance should be done for poor patients.
• Cleanliness should be emphasised upon.
9.1.2 MLA/Elected Representative

A total of 10 districts were visited in Punjab for evaluation of the health system and elected
representatives of all these districts were interviewed. Elected representatives of 60% districts had
a length of service of more than 2 years and 30% had 1 – 1.5 yrs. of service. (Refer Table 24)

• About 50% reported that the overall functioning of health facilities in their district is good,
while 10% reported it as average and 20% reported as poor (mainly the CHCs). Remaining
20% did not give any comments.
• The overall services of hospitals were reported to be satisfactory by 40%, 20% reported as
average and 10% reported them bad mainly due to poor gynaecological facility. No comments
were received from 30% of the representatives.
• MLA of Jalandhar opined that for improving the functioning of the hospitals, the Sub-
Divisional Hospitals should be upgraded to 100 beds, since the load of patients is more in
these hospitals.
9.1.2.2 OPD services

• With regard to the availability of staff it was felt by 20% of MLAs that the adequate staff is
available in the District Hospitals, however, it was felt by 70% of them that there is shortage
of doctors in most of the hospitals.
• With regard to the availability of medicines in OPD, 60% stated that medicines are available
but are not sufficient as per the requirement, 40% felt that the medicines are not at all
available. They felt the need and suggested that the costly medicines, which the people
purchase from outside should be provided at subsidised rates by the District Hospital.
• With regard to the waiting time, 60% of the elected representatives felt that the waiting
time is not much (<30 minutes), while 30% of them felt that it could range anywhere from
1-3 hours.
• With regard to cleanliness, 70% felt that the District Hospitals are maintaining good and/or
satisfactory level of cleanliness while 20% felt that the cleanliness is not good.

• Regarding the extent of fulfilment of health needs of the community, 40% gave a satisfactory
response that the health needs are being fulfilled for >60% of the community. 50% of them
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reported low levels of community needs fulfilment (30 – 50%) and that mostly poor people
are the only ones using it.
9.1.2.4 Behaviour of staff

• 60% of the elected representatives felt that the overall behaviour of health staff is good/
satisfactory while the rest 20% felt that it is not satisfactory.
• It was stated that the behaviour of nurses and class IV in particular is rude towards the
patients. No conclusive comments were given by 20% of the elected representatives.

• Regarding the ambulance services, 40% reported that there are good services while the other
40% said that the ambulance services are either not available or wherever available are not
functioning well. 20% did not give any comments.
• When asked to rate the services in a government hospital as compared to Private/NGO/
Charitable hospital, it was stated that government doctors are better qualified than private,
but in odd hours and emergency and due to non-availability of the doctors, they have to go
to private facilities.
• Otherwise government services are better. One of the MLA stated that private facilities are
better but one needs to pay for that. They stressed on more number of ambulances to be
made available and further increase in IEC activity at government hospitals.
9.1.2.6 RKS and poor patients’ treatment

• About 40% of the elected representatives were having the knowledge of RKS while the other
30% had no knowledge and 30% did not give any comments.
• With regard to free treatment of poor patients, 20% stated that free treatment is being given
to poor while 30% said that no free treatment is being provided to the poor. 20% said that
treatment for poor is being provided from Red Cross fund or from NGOs. 30% did not give any
comments which might be due to lack of knowledge.
9.1.2.7 Perceived barriers

• When asked about the perceived barriers, the responses received were as follows: Regarding
availability, 20% felt that less availability of medicines and ambulance service is a barrier.
One serious issue which was reported from Civil Hospital Firozpur was that anti-rabies vaccine
is not available and with an increase in the number of street dogs, it is becoming difficult
to tackle the situation.
• With regard to the accessibility, 80% felt that there is no barrier, rather, health facilities
upto CHCs are easily accessible, whereas 20% felt that referral service is a barrier as this
requires money.
• Regarding utilisation, 20% of the elected representatives felt that it is not low, while 40%
felt that the scarcity of medicines is a barrier and 20% felt that utilisation is low mainly due
to lack of diagnostic equipments and laboratory facilities in CHCs.
• With regard to the acceptability, 20% felt that it is a barrier in CHCs only and 10% felt that
non-availability of equipments is a barrier.
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9.1.2.8 Suggestions
• Most elected representatives suggested that more equipment for diagnostic facility (i.e. C.T.
Scan, MRI) should be made available for poor patients.
• More number of ambulances should be made available.
• They advocated sanction of vehicle for SMO for field visits.
• Extra water facility should be provided.
• Security guards should be recruited at health facilities.
• They suggested increasing plantation in and around hospital complex.
• Night and emergency services should be improved and more doctors should be made available.
• The hospital should be upgraded from 50 to 100 beds to adequately meet the patient load.
• A Generator with greater capacity and power should be installed to improve functioning.
• Technicians for ultrasound must be recruited.
9.1.3 Civil Surgeons

Civil Surgeons of all 10 districts of Punjab included in the assessment for evaluation of the Health
System were interviewed. (Refer Table 25)

• CHCs:
Civil surgeons of 40% district stated that overall functioning of health facilities in their
district is good, while 40% reported poor service condition of CHCs and 20% reported
over utilisation of OPD.
Problem with indoor facilities was reported by 10%. Main problem reported by civil
surgeons was shortage of staff especially at CHCs.
Regarding bed occupancy, 60% Civil Surgeons stated bed occupancy in the range of 40-
60% in their CHCs, 20% reported between 10-20% and 20% were not able to provide any
exact figure.
• Sub-Divisional hospitals:
70% Civil Surgeons stated bed occupancy in their districts in the range of 70-100%
in Sub divisional hospitals, 20% Civil Surgeons stated bed occupancy as 50%, while
remaining 10% did not give any comments.
• District hospitals:
70% civil surgeons stated bed occupancy in the range of 70-100% in the District
Hospitals and 20% reported bed occupancy of 50%. No comments were given by 10%
civil surgeons.

• Regarding the extent of fulfilment of the health needs of the community, 50% civil surgeons
gave a satisfactory response, while 40% reported average level of fulfillment of community
and 10% reported that the needs are not being fulfilled at all.
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• Most of the civil surgeons opined that the health services are not being fully utilised by the
community because of the following main reasons:
Lack of specialists
Shortage of technical staff
Non-availability of medicines
• It was stated by most of the civil surgeons that the patients had to spend money on laboratory
and radiological investigations. Some civil surgeons also felt that lack of infrastructure for
building is also one of the constraints in utilisation of services by the community.
• It was also stated that due to the shortage/non-availability of staff, patients had to wait for
considerable time for receiving consultation from specialists/doctors, for getting medicines
and getting investigations done.
• Civil surgeons were of the view that patients of well off families are not availing their health
care facilities because of poor cleanliness, lack of privacy for admitted patients, inferior
quality of nursing care and low client satisfaction level.
• It was stated by civil surgeons that one of the constraints in delivery of health services
is due to non-staying doctors at the health facility, which again is due to lack of good
accommodation facility and irregular supply of electricity.
• Civil surgeon of Taran Taran district felt that there is a need to improve the obstetrics &
gynaecology services in these facilities.
9.1.3.3 Availability of medicines

• Only 20% civil surgeons stated that medicines are available in OPD while 80% of them
reported that the medicines are lacking.
• With regard to the waiting time, 50% civil surgeons felt that it is not much, while another
50% felt that the waiting time is long.
• About 40% civil surgeons stated that cleanliness is not good in their hospitals, while 50%
reported it to range from good to average and only 10% felt that it is of very good standard.

• 80% civil surgeons felt that the overall behaviour of health staff is in range of good to
satisfactory while the rest 20% felt that it needs improvement.
• Regarding referral services it was stated by 30% civil surgeons that there is no problem while
50% reported that there is shortage of ambulances and drivers at some places.
9.1.3.5 Funds flow

• It was stated by 40% of the Civil Surgeons that there is no problem regarding the fund flow.
30% of them reported that funds are not being provided and they are managing only through
the user charges.
• 10% civil surgeons stated that there is a slight delay in getting the funds and the remaining
10% said that funds are available only under NRHM (National Rural Health Mission).
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• About 30% of civil surgeons reported low levels of motivation amongst their staff, 40%
reported good motivation level and 20% reported average levels of motivation.
• For improving the motivational level among staff members, they laid importance on increasing
the salary of staff, constructing the residential quarters, giving desired place of posting of
job, incentives for good workers and reducing mismatch with specialist and GDMO regarding
place of posting.

• Regarding availability, 20% civil surgeons felt that lack of manpower in SDH and CHC is a
barrier while other 70% reported no barriers in availability of services.
• Regarding accessibility, 10% felt that it is a barrier especially for the CHC while the other
70% did not report any barriers.
• 30% civil surgeons felt that the utilisation of services at CHCs is low by the community, 10%
felt that short supply of medicines is a barrier in effective utilisation, while the rest 40% felt
that there are no barriers as such with regard to utilisation.
• Regarding acceptability, 30% civil surgeons felt that there are barriers with regard to CHC
while 50% reported no barriers. No conclusive comments were received from 20% civil
surgeons.
• According to most of the civil surgeons interviewed, the areas which require attention are
cleanliness of toilets, proper working condition of certain equipments, IEC activity among
community, filling up of vacant posts of Class IV, sweepers, ambulances for the hospital,
increase in allotment of funds and staff for O.T and pharmacists.
9.1.4 SMO (Senior Medical Officers) In-charge of District Hospitals

Senior Medical Officers In-charge of all District Hospitals from 10 districts visited were interviewed.
It was observed that out of the 10 District Hospital SMOs interviewed, 50% had their length of
service for less than 2 years while other 50% had more than 2 yrs. of service in their respective
District Hospitals. (Refer Table 26)

• Regarding the staff strength of OPD, 20% SMOs felt that the staff strength is adequate, while
60% felt that there is shortage of nursing staff, Paramedics, Class IV, and radiologists. 20%
felt shortage of specialists especially paediatricians in their OPDs. Staff of OPD is overworked
in opinion of some SMOs.
• SMOs of all districts stated that the OPD timings are adequate and the quality of treatment
provided from OPD is also quite good.
• Bed occupancy was estimated 100% in 30% of the hospitals, more than 70% in 40% of the
hospitals and less than 70% in 20% hospitals as stated by the SMOs.
• 60 % SMOs stated that poor patients are being provided with free medicines. 30% SMOs
stated that very few medicines are actually available (mainly the 5 basic medicines i.e.
Antibiotics, B-Complex, Paracetamol, Ibuprofen & Metronidazole).
Study to Review
9.1.4.2 Services provided
• In opinion of the SMOs, patients are spending money mainly on the transport, medicines and
lab investigations.
• No dietary service is available in any of the District hospitals but it was revealed that at
10% of the hospitals only one meal is being provided to them free of charge by Voluntary
organisations.
• While most SMOs were of the opinion that their services are up to 80% at par with the private
sector, some were of the opinion that private sector is giving better services. However, most
of the SMOs felt that they are giving best services and value for money particularly to the
poor patients.
9.1.4.3 National Health Programmes (NHP)

• About 80% of the SMOs were having information regarding various National Health
Programmes. However, 10% SMOs stated that this information is not available under PHSC.
9.1.4.4 Fund flow and RKS

• About 40% SMOs stated no problem in fund flow in their hospitals. But 30% SMOs (viz;
Tarantaran, Jalandhar and Hoshiarpur) stated that no funds are being provided and they are
managing from User Charges alone; 10% SMOs reported shortage of funds while another 10%
(i.e., Sangrur) stated that SMO has got no role in this regard.
• While 80% SMOs were found to be aware of the Rogi Kalyan Samiti, 20% were not sure about
its functioning, since they have been recently constituted. They reported that there are some
problems in constitution of the committee and conducting the regular meetings.
• It was revealed that money is mostly being used for infrastructure development, e.g.
building etc.
• At some places, free dentures, dental check-ups and Cataract Operation are being done for
poor patients.
• All the SMOs stated that efforts are being made to provide medicines to all, but due to non-
availability of medicines, some medicines are to be purchased through user charges (e.g.
vital and life saving drugs).
9.1.4.5 Extent of community needs fulfilment

• Regarding the extent of fulfilment of health needs of the community, 50% SMOs felt that
they are able to fulfil up to 100% needs; while 30% stated that they are mainly catering to
the needs of the poor.
• The community was found to be utilising OPD facility to its maximum.
9.1.4.6 In-patient services

• It was stated by SMOs that at some places (20%) there is shortage of nursing staff and junior
doctors, with nurse to bed ratio ranging from 1:20–1:40. 50% SMOs stated that nurse to bed
ratio is adequate, in the range 1:2 to 1:6.
• Doctor/Bed ratio also showed a lot of variation.
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• It was revealed that job of cleanliness is given on contract in more than 50% of health
facilities. It was also commented by SMOs that at many places drinking water is not being
treated and is supplied for usage as such.
9.1.4.7 Manpower management and other services

• 90% SMOs stated that they have a system of performance appraisal in their hospitals. The
problem of conflicts between the staff and patients was not found to be a big issue in most
of the hospitals.
• Regarding Emergency services, SMOs stated that they run for 24 hours a day with Specialists
and Surgeons available on call. One doctor is always present for night duty. Emergency
supply of drugs is ensured and Lab. Technician is also available on call during emergency.
9.1.4.8 Community participation and manpower management

• Regarding community participation, it was revealed that at some places food is being provided
by Voluntary Organisations and at others there are NGOs and charitable organisations that
are providing medicines and blankets other than food.
• At most places no barriers/challenges are being faced for effective community participation,
whereas at one place (Amritsar) some political interference was found leading to some
administrative problems, like transfer of staff etc.
• SMOs were found to adopt a variety of methods for monitoring and effective supervision e.g. ACRs,
Daily rounds, monthly meetings, surprise checks, checking of medicine registers, feed backs etc.
• Some SMOs also stated that they undertake efforts for reducing the stress levels of the staff
by counselling them, appreciating them, motivating, following appraisal system, by directly
talking and by obliging the person. To increase motivation level, doctors are also being sent
outside to receive trainings.
• Bio-medical waste management was found to be undertaken in most (90%) of the District
Hospitals; however 10% of them reported shortage of bags.
9.1.4.9 Perceived barriers to avail health facilities

• Regarding the perceived barriers for availability of health services, 20% SMOs felt that there
is lack of information and shortage of staff which is a barrier while the rest 60% did not felt
that any barrier existed.
• Regarding accessibility, 20% SMOs felt that shortage of medicines and lack of staff is a barrier.
• 60% the SMOs opined that there is no perceived barrier for ‘Utilisation’, while 20% felt that shortage
of facilities and lack of information is a barrier in effective utilisation of health services.
• Regarding acceptability of health facilities only 10% reported these as barriers.
Study to Review
9.2 At Sub-division Level
9.2.1 MLA/Elected Representative–Sub Divisional Hospital
Elected representatives of 9 out of 10 districts were interviewed at SDH level. Elected representative
of Amritsar district was not available for interview. Elected representatives of 70% districts had
more than 2 years of length of service while 20% had less than 2 yrs. of service. (Refer Table 27)

• About 30% of elected representatives reported that the overall functioning of health facilities
in their district is good, while 50% reported it as satisfactory and 10% as poor (mainly
at CHCs).
• The overall services of hospitals were reported to be in ranges from good to satisfactory by
70% of them, while 20% reported them as not very good.

• With regard to the availability of staff, 40% of elected representatives stated that the staff
was available at the Sub Divisional hospitals, whereas 50% felt that there is shortage of
doctors/specialists in the hospitals.
• Regarding availability of medicines in the OPD, only 20% stated that medicines are available,
while 60% stated that sufficient medicines are not available so as to meet the requirement.
10% stated that most of the time no medicines are available.
• They opined that, all the medicines which the people purchase from outside should be
provided from the hospital itself.
• Regarding the waiting time, 40% of the representatives stated that the waiting time is not
much, while 50% of them stated that it is long and it depends on the number of patients
and availability of doctors.
• Regarding cleanliness in OPD, 30% felt that the Sub Divisional Hospitals are maintaining good
level of cleanliness, while 30% stated that it is of average level. Rest 30% representatives
felt that the cleanliness is not good.
9.2.1.3 Extent of fulfilment of community needs:

• In response to this question, 50% of them gave a good response, with the health needs being
fulfilled for more than 75% of the community. 10% stated that only average level of need
fulfilment is being achieved. Remaining 20% reported low levels of community needs fulfilment
(20 – 40%) and mentioned that the services are being mostly utilised by poor people.

• Regarding behaviour of staff in Sub Divisional hospitals, 40% elected representatives felt
that the overall behaviour ranges from good to satisfactory. 40% felt that it varies and
reported the behaviour of staff as average while 10% reported that the behaviour is not
good. It was stated that the behaviour of Nurses and class IV in particular is not good.
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• Regarding the Ambulance services, 40% stated that the services are available and satisfactory,
while another 40% stated that the ambulance services are either not available or wherever
available, these are on payment basis.
9.2.1.6 RKS and treatment of poor patients

• About 40% of the elected representatives were having the knowledge of RKS, while another
50% were having no knowledge about it.
• Regarding free treatment of poor patients, 60% stated that these facilities are providing free
treatment to poor, while 20% stated that no free treatment is being given to the poor patients.

When asked about the perceived barriers the responses were as follows:
• Regarding the availability, 20% felt that less availability of medicines and equipments is a
barrier, while 70% perceived that availability as such is no barrier.
• With regard to the accessibility, all of them opined that there is no barrier.
• 70% of the elected representatives also felt that there is no perceived barrier for utilisation,
while 20% stated that it is a barrier due to non-availability of USG machine and other
diagnostic facilities.
• Regarding acceptability, 80% elected representatives stated that it is no barrier, while 10%
felt that the acceptability of health services by community is low.
9.2.1.8 Suggestions
• Most of the elected representatives suggested that more equipment for diagnostic facility
(i.e. C.T.Scan, MRI) should be made available for poor patients.
• They advocated sanction of vehicle for SMO for field visits.
• Extra water facility should be provided; and security guards must be recruited to ensure patient
security. They even suggested increasing plantation in and around hospital complex.
• Technician for Ultrasound must be recruited.
• Medicines should be available in good quantity
• There should be a Blood bank at these health facilities
• More staff, medicines, funds and ambulances should be made available.
9.2.2 SMO – Sub Divisional Hospitals

Senior Medical Officers of all Sub divisional hospitals included in the study were interviewed. It
was found that out of SMOs of 10 Sub divisional hospitals, 80% had their length of service less
than 2 yrs. and 10% had more than 2 yrs. of service in their respective Sub divisional hospitals.
(Refer Table 28)
Study to Review
• Regarding the OPD Services, 50% SMOs felt that the staff strength is adequate, while other
50% stated that it is poor due to shortage of Class IV employees and specialist doctors.
• Bed occupancy was stated as 85-100% in 50% of the hospitals, while the rest 40% SMOs’
reported 40-70% bed occupancy.
• Poor patients were being given free medicines in opinion of 60% of the SMOs, while in other
30% hospitals, only some of the medicines are available as free.
9.2.2.2 National Health Programmes (NHP)

• Most of the SMOs (70%) were having information regarding various National Health
Programmes, but at few facilities (30%) information regarding malaria and STD programmes
were not available.

• Regarding the extent of fulfilment of health needs of the community, 20% of the SMOs felt
that they are able to fulfil 100% of health related needs; while other 30% stated this level
of fulfilment upto 75% and rest 30% upto 50%.
• 10 % of the SMOs opined that health needs of the community are fulfilled to high level by
the OPD; however, this is comparatively lower for in patient departments.
9.2.2.4 In-patient department

• It was found that Nurse to bed ratio in most (80%) hospitals was in the range 1:3 to 1:5,
while at 10% of the hospital (Ludhiana) this ratio was 1:12.
• Doctor/Bed ratio was found to be of range 1:3 to 1:6 at 50% of the hospitals, while it is in
the range of 1:7 to 1:10 at 30% hospitals. For the rest 20% the ratio was not specified.
• Dietary services are not organised in the hospitals and this is mostly managed by patient’s
attendants.
• Level of cleanliness was opined to be good at 20% of the hospitals, average level at 30% and
poor at 10% of the hospitals.
• 20% of the SMOs reported shortage of staff and 10% reported that they had recruited the
staff on contract basis.
9.2.2.5 RKS and fund flow

• While 60% SMOs were aware of the Rogi Kalyan Samiti, its exact status and functioning
was not known to 10% of them and 20% reported that RKS is not functioning in their
hospitals.
• 60% SMOs reported no problem of fund flow in their respective hospitals, while 20% of them
(Tarantaran and Jalandhar) reported that no funds are being provided to them.
• SMO of Amritsar Sub-Divisional Hospital stated that they are managing only from the user
charges.
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111
9.2.2.6 Manpower management and other services
• Most of the SMOs (70%) stated that they have a system of performance appraisal in their
hospitals, which included benchmarking for doctors and ACRs. 10% stated they do not have
any appraisal system, while 10% said that they have their own personal perception.
• Almost all (90%) hospitals were having Emergency services running 24 hours a day with
specialists and surgeons available on call, in the opinion of SMOs. They stated that at least
one doctor is always present for night duty.
• Only major constraint brought out following interview with SMOs was that of the non-
availability of doctors.
• Bio-medical waste management was found being followed at most (80%) of the Sub divisional
hospitals, however, 20% SMOs reported shortage of disposal bags.
9.2.2.7 Perceived barriers to avail health services

Responses received regarding the perceived barriers are as follows:
• Regarding availability, 30% SMOs stated that there is lack of specialists and doctors, which
are barriers at their hospitals, 10% SMOs stated lack of medicines and staff as a barrier. Rest
40% SMOs stated that no barrier exist in terms of availability.
• Regarding accessibility, 70% SMOs felt that it is no barrier, while the other 30% did not
comment on this aspect.
• 10% of the SMOs felt that lack of infrastructure and behaviour of staff are being perceived
as barriers for the utilisation of services, while 70% stated that it is not a perceived barrier.
Rest 20% did not give any comment on this.
• With regard to the acceptability, it was felt by 70% SMOs that it is not a barrier and no
comments were received from the rest 30% of the respondents.
9.2.2.8 Suggestions
• Vacant staff positions should be filled up.
• Regular training for the staff should be provided.
• Repair and maintenance of staff quarters should be done.
• Manpower shortage, especially of gynaecologists, radiologists and Class IV employees should
be looked into.
• Fully equipped ambulance and CT scan service should be provided.
• Private wards should be created at these health facilities.
• There should be provision of seminar room in these facilities.
• SMOs should be given authority to cut down on non-performing staff.
• Security services should be provided on contract basis to ensure security.
• Costly equipments should have annual maintenance contracts.
• More and regular supply of medicines should be ensured.
• Awareness generation regarding available services should be done through the media.
Study to Review
9.3 At CHC Level
9.3.1 Elected Representatives
Elected representatives were interviewed for assessment of the functioning of CHCs in their
respective areas, in all districts included in the study.. Out of the total 10 districts visited, elected
representatives of 90% districts had more than 2 years of length of service while remaining 10%
had less than 2 years of service. (Refer Table 29)

• When asked about the functioning of CHCs in their districts, about 50% of them reported
that the overall functioning of CHCs in their area is good, while 20% stated that it is getting
better now and 20% reported that the functioning of CHCs is not good, mainly because the
doctors are not available as they were going for private practice.
• The overall services of CHCs were opined as good by 30% of them, 60% reported the services
as average and 10% reported them as ‘not good’.

• Regarding the availability of staff it was stated by 70% of the elected representatives that
the staff is available in the CHCs, however, 30% of them opined that there is shortage of
doctors in most places, especially of the gynaecologist.
• With regard to the availability of medicines in OPD, 50% felt that medicines are available,
however rest 50% stated that the medicines are either less or only partly available. They also
stated that, all the medicines should be provided at the CHC.
• Regarding the waiting time, 70% of the representatives felt that the waiting time is not
much (<30 minutes), while 30% of them felt that it is long.
• With regard to cleanliness, 80% stated that the CHCs are maintaining satisfactory/good level
of cleanliness; while 10% felt that the level of cleanliness is bad (Hoshiarpur) and 10% felt
that this needs improvement (Muktasar).

• In response to this question, 40% stated that the needs are being fulfilled to a large extent;
another 30% felt that only 50% of the health needs are being fulfilled and the rest 30% felt
that only 10% of the community health needs are being fulfilled and only medico legal cases
generally go to CHCs.

• Regarding behaviour of staff in CHCs, 70% elected representatives felt that the overall
behaviour is good and the rest 30% felt that it is not good.
• It was commented upon that the behaviour of nurses in particular is bad.
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113
• Regarding Ambulance services at CHCs, 30% stated that the services are available, while 60%
stated that the ambulance services are either not available or only partially available.
• It was stated by the elected representatives that in the emergency situation they utilise the
untied funds available with Panchayats to hire a vehicle.
9.3.1.6 RKS and poor patients’ treatment

• About 40% of the elected representatives were found to have knowledge of RKS, while the
other 50% were having no knowledge and 10% did not comment on this issue.
• Regarding free treatment of poor patients, only 20% said that they are being given free
treatment, while majority of them (60%) said that no free treatment is being offered to the
poor. 20% were not able to give any conclusive comments.

Regarding perceived barriers to avail health facilities the views of elected representatives were
as follows:
• Regarding the availability, 40% of them felt that less availability of medicines and absence
of doctors is a perceived barrier, 10% felt that far off location is a barrier, while the rest 50%
opined that there are no perceived barriers in terms of availability.
• Regarding accessibility, 10% felt that referral services are a barrier since these referral
facilities are located very far, while 90% stated that there no barriers.
• 40% felt that scarcity of medicines and less availability of doctors is a barrier in utilisation
of services available CHCs, while the other 60% reported no barrier.
• With regard to the Acceptability, it was felt by 40% that it is a barrier in CHCs due to
restricted or lack of quality facilities, no barriers were reported by the other 60%.
9.3.2 Senior Medical Officers – CHC

• A total of 11 Senior Medical Officers from 11 CHCs were interviewed in 10 districts visited in
Punjab for evaluation of the Health System. One SMO from each of the sampled district CHC
and 2 from Amritsar were interviewed. It was found that out of 11 SMOs interviewed, 80%
had their length of service as more than 2 yrs. while rest 30% had more than 2 yrs. of service
at their respective CHCs’. (Refer Table 30)

• Regarding the OPD Services, only 30% stated that the staff strength is adequate; while the
other 70% felt opined there is shortage of staff.
Study to Review
• Bed occupancy rate was found to be between 10-20% in 60% of the CHCs, 30-50% in 20%
of the CHC and 100% at only one CHC (Bhatinda).
• Poor patients were being given free medicines in the opinion of 90% of the SMOs interviewed;
while 10% stated that they are providing only few medicines and the remaining 10% SMOs
did not comment on this.
9.3.2.2 RKS and National Health Programmes

• About 80% SMOs were aware of the Rogi Kalyan Samiti. Though some initiatives had already
been taken in other areas, but it found not functioning/not formed in 30% of the CHCs due
to various administrative reasons.
• About 40% of the SMOs were having information regarding various National Health
Programmes, while 50% stated that not all information is available to them (i.e., Malaria,
T.B and STD). Rest 20% SMOs did not give any comments in this regard.

• 20% SMOs felt that they are able to fulfil upto 90-100% needs of the community; 20% stated
they are able to fulfil 70-80% of the health needs, 20% stated satisfactory level of needs
fulfilment, 20% reported that the CHCs are under-utilised and no definite comments were
obtained from remaining 20% of the SMOs.
9.3.2.4 In-patient department (IPD)

• With regard to the IPD Services it was found that Nurse to bed ratio in about 20% CHCs was
about 1:10, another 40% CHCs had this ratio between 1:3 –and 1:7, while CHC at Ferozpur
reported this ratio as 1:1.2.
• CHC Jalandhar reported shortage of staff. No conclusive comments were received from 30%
of the SMOs on issue of services in in-patient departments.
• Doctor/Bed ratio at 20% of the CHCs was between 1:2 and 1:4 and at the other 40% CHC sit
was in the range of 1:5 to 1:7.
• Doctor-bed ratio was 1:30 at Manawala CHC in Amritsar.
• Staff shortage was reported form Jalandhar; Sangrur CHC reported high i.e., 1:15 doctor/bed
ratio.
• Level of cleanliness was opined as good by 30% of the SMOs and as average by 70%. 10%
SMOs stated that level of cleanliness is not up to the mark.
9.3.2.5 Fund flow

• While 50% SMOs reported no problem of fund flow in their respective CHCs, 10% of them
reported that no funds are being provided to them. Rest 40% SMOs stated that this is being
handled by civil surgeons.
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115
• About 90% of the SMOs stated that they have a system of performance appraisal by means
of ACRs in their CHCs, which also includes laying down benchmarking indicators for doctors
and medical officers.
• 20% SMOs stated that they are doing appraisals through records and meetings as well as
through appreciation letters, other than ACRs.
9.3.2.7 Other services

• About 90% SMOs stated about availability of emergency services running 24 hours a day,
with specialists and surgeons being available on call. Only 10% said that there is shortage
of staff but still somehow they are providing services.
• Doctors were mostly available on call. 10% stated that they take help from mini PHCs.
• Bio-medical waste management was being followed in opinion of 90% of the SMOs, rest SMOs
did not provide any conclusive information regarding this aspect.

• Regarding the availability of services, 30% SMOs felt that there is lack of doctors and
shortage of staff, which is a barrier, while the rest 30% did not feel any barrier existed.
• With regard to the Accessibility, only 10% stated that difficulties are there as CHC is in a
border area while 60% reported no problem.
• Regarding utilisation of services at CHC, 60% of the SMOs felt that due to lack of funds, non-
availability of specialists, shortage of drugs, poor investigation facilities and poor quality of
services, there is low utilisation.
• With regard to the acceptability, it was felt by 20% SMOs that it is low due to less number
of doctors, while 40% did not perceive this as a barrier.
9.3.2.9 Suggestions
The following suggestions were made:
• Regular Investigation and X-ray facility should be made available even after 3 p.m., so that
patients do not suffer.
• Essential drugs should be adequately available.
• Bed linen should be provided in adequate quantity. Laundry unit should be made available
in CHC.
• Services should be made accountable to general public/community.
• Assured career plan should be developed for all cadres comparable to bench marks.
• Manpower must be provided in places where it is lacking. Vacant posts should be filled. The
available services can be improved a lot by providing a gynaecologist, paediatrician and
dentists in the CHCs’.
• Medicines should be supplied and ‘border area’ allowances also be given where the CHC is
located near the border.
Study to Review
• Doctors and staff should be provided good accommodation facility at par with their status.
• CHCs should be provided with uninterrupted supply of electricity.
• There should be AMC for all equipments.
• Computer operators should be provided.
• Junior Engineer should visit CHCs twice a month.
• Availability of Diesel for generator should be ensured at all times.
• User charges should be increased according to rising inflation, as patients are ready to pay
for quality services.
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117
10.0 Observations and Discussion
10.1 Facility Survey

Based on the analysis of quantitative and qualitative data, the following
observations are drawn forth:
10.1.1 Infrastructure
a) Almost all the hospitals under study were easily accessible from the Bus Stop and nearest
Railway Station and easily approachable by a motorable road.
b) The building and general infrastructure for all the health care facilities were found to be
reasonably well constructed. But as most of them are newly constructed, this infrastructure
needs proper maintenance so that its life can be prolonged.
c) Most of the hospitals were not found to be equipped with the required equipments. In some
hospitals, equipment was there but there was mismatch as some were found to be either not
in use and some were reported to be out of order.
d) The surrounding of these health care facilities was not found in good condition. Almost every
health facility required paying serious attention towards this aspect.
e) The cleanliness of the hospital premises was not up to the mark.
10.1.2 Human resources

a) Almost all the hospitals under study have vacant posts including post of Doctors and Support
Staff.
b) The doctors posted in these hospitals are from one single cadre. There is no separate cadre
for GDMO and Specialists. As a result, particularly in CHCs and Sub Divisional Hospitals, the
Specialists were also doing night duties/emergency duties and hence were not available for
regular OPDs.
c) Doctors including specialists in the hospitals under study were supposed to perform other
duties like, the VIP duties, attend court cases and remain involved in various public health
activities and health fairs. If regular GDMO would have been available, these duties could
well be undertaken by GDMOs.
d) There is an acute shortage of Radiologist, Anaesthetists, Paediatrician and Gynaecologist in
almost all the hospitals, particularly in Sub Divisional Hospitals and CHCs.
e) There is also an acute shortage of the support staff, particularly the Technical staff in Sub
Divisional Hospitals and CHCs.
f) Frequent transfers of the doctors has also been reflected as a cause of concern and problems
in these hospitals. For example, in case where a doctor of one speciality is transferred, he
is most likely to be replaced by doctor of another speciality. This disrupts the services of
hospital for that particular speciality and patients suffer on this account.
Study to Review
a) It was observed in all the hospitals and reported by almost everybody that medicines are not
available in adequate quantity.
b) The patients were found to purchase the medicines from outside.
c) Though there is a provision of supply from the State and District level, but in practice
most of these centres reported that they are asked to buy the medicines from the User
Charges fund.
d) It was also observed that purchasing medicines from User Charges fund have become a
routine practice in almost every hospital/health centre under study.
10.1.4 Laboratory and diagnostic services

a) Though the laboratories and diagnostic services were available in all the hospitals assessed,
but functioning of the labs was not reported to be up to the mark.
b) The patients are forced to get the tests done from outside laboratory services due to lack of
reagents and equipments..
c) Regarding the radiological services, X-ray Units were found to be non-functional due to
erratic electric supply and non-availability of films.
d) Moreover, Radiologists were also not available in all the hospitals.
10.1.5 Emergency and maternity services

a) Emergency and Maternity services found to be worst effected mainly in Sub Divisional
Hospitals and CHCs. Main reason for this was non-availability of the doctors for Emergency
and Maternity services.
b) Even Nursing staff was not feeling comfortable to do the duty in the night and odd hours
due to security reasons, as other staff and people are not available during night hours.
c) It was revealed that due to non-availability of the staff and other facilities, the patients
have to return back from the facility. As a result, the community is losing confidence in the
hospitals. This is one reason of low utilisation of health facilities and also for this trend to
down further.
10.1.6 Disaster preparedness

a) None of the hospitals, including District Hospitals were found to be properly prepared to deal
with any Disaster situation.
b) None of the hospitals including District Hospitals were having any well-prepared Disaster
Action Plan. Nor they are having any disaster drill or any disaster manual.
10.1.7 Referral linkages

a) Though on paper all these hospitals are having a well laid down referral system but in
practice this is not very meticulously followed.
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119
b) Mostly the patients are transferred from the lower health centre to the higher centre without
any feedback loop.
c) No guidelines are available at the facilities for “whom to refer”, “how to refer” “when to
refer” and “where to refer”.
10.1.8 Medical records

An analysis of all medical records revealed the following:
a) None of the hospitals were having a properly planned and organised Medical Record
Department.
b) All the data and statistics from Medical records were found to be maintained manually. None
of the Medical Record Departments were found to be computerised.
c) Most of the case-sheets kept in the Medical Record Departments were found to be incomplete
and mostly not maintained as per any definite standard indexing/procedure.
10.1.9 Stores management

a) The Medical Store management was not found to be very organised, and following the modern
techniques of store management.
b) In almost all the hospitals, only few medicines could be found in the medical stores of health
facilities.
c) The record maintenance of the stores was not found to be in proper order and they were not
maintaining any “Buffer Stock” or calculating the “Reorder Level”.
d) The scientific ‘Inventory Control Techniques’ were not practiced in any of the stores visited
and the staff was also not having much knowledge about these techniques.
10.1.10 Diet services

a) None of the hospitals were providing regular diet to their in-patients, except in one Sub-
divisional hospital (Meler Kotla).
b) It has been suggested that if the patients are provided diet from the hospitals, this would
be highly appreciated.
10.1.11 Basic facilities

a) The relatives of the patients, particularly those who are coming from distant places, were not
having any proper place to stay (Dharmshala) and were having no access to other facilities
like toilet, kitchen etc. As a result they were found loitering all over the places in and around
the hospital.
b) Similarly, the basic facilities like toilets, particularly separate toilets for ladies were not
available in every OPD.
c) These facilities must also have other services like STD booths, canteen and subsidised chemist
shop.
d) Residential accommodation available was not found to be fully utilised, mostly due to poor
maintenance of residential accommodation.
Study to Review
10.1.12 Rogi Kalyan Samiti
a) Though on papers Rogi Kalyan Samitis existed in all the hospitals, but due to their internal
administrative problems and non fulfilment of the required pre-requisites, these Samitis were
found to be non functional or yet to be made functional in almost all the hospitals.
b) Funds under these Samitis were found to be un-utilised in all these hospitals.
10.2 Views of the Beneficiaries

A total of 580 respondents were interviewed in the outpatient department and 224 respondents
from inpatient departments of various health institutions like CHCs, Sub-divisional hospitals,
District hospitals and two Special Hospitals of Punjab Health System Corporation to obtain their
opinion about the available health services.
10.2.1 Socio-economic dimension of the respondents

a) Majority of respondents utilising PHSC were females having poor education and low income
in age group of 15-30 years.
10.2.2 User charges

a) Majority of the respondents were paying user charges for getting OPD card and for getting
investigations done. More than 3/4th of respondents were paying the charges for making
slip/card required for admission.
10.2.3 Admission procedure

a) 77.7% of the respondents were not satisfied with the admission procedures and 86.2% of
respondents at CHC and 81% at sub divisional hospitals rated it poor.
b) Only half of the respondents were informed about rules and regulation of these health facilities
regarding admission procedures.
10.2.4 General cleanliness and comfort in wards

a) Overall ratings of general cleanliness of the OPD along with basic facilities were found to be
better in the Special Hospitals and the same was comparatively lower in the CHCs.
b) According to the findings, 66.5% rated general cleanliness of wards and beds as good whereas
44.2% respondents rated it average. 66.5% respondents had perceived the cleanliness of bed
linen as good, while 30.8% respondents perceived it average.
c) There is a need to improve the general cleanliness and cleanliness of linen in Sub-divisional
hospitals and District hospitals.
d) Out of various health institutions 74.1% respondents perceived that the level of comfort in
the wards was good but 30% perceived comfort as average, with better comfort in CHCs and
special hospitals.
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121
e) Only 47.3% respondents perceived that toilets were clean. This was further low in case of
District Hospitals and Sub divisional hospitals.
10.2.5 Availability of basic facilities

a) Facilities like fan and lights were found to be good according to 75.7% of respondents in
OPD and 79.5% for inpatients. These facilities were not up to the mark in OPD of CHCs,
although it was good in wards of CHC.
b) District hospitals need improvement for both outpatients and inpatients services. STD/PCO
booths were not present in 57% of health institutions and only 16.7% of CHCs were having
STD/PCO booths out of these health institutions.
c) 14% of health institutions were not having a separate toilet facility which was 23.7% in
case of CHCs. 11% of health institutions were lacking in drinking water facilities and again
CHCs were lacking more in context of this facility. Separate toilet facilities need to be made
available to the female respondents, particularly when more number of females are utilising
the services of the OPD of various institutions. 16.7% of CHCs were not having screens in the
examination room.
10.2.6 Adequacy of information about disease and treatment

a) Among OPD patients, 81.4% said that adequacy of information given to them about their
disease and treatment by doctor was good. 69.2% inpatients reported the adequacy of
information as good. In the case of OPD, information given was least in CHCs as compared
to other institutions, but on the contrary, CHCs were found better in case of inpatient
services.

a) Only 10.3% respondents stated that all medicines are available in the OPD and 26.4%
stated that none of the medicines are available in the OPD. When the percentage was seen
separately in the various health institutions than the availability of medicines was more in
Sub-divisional hospitals and least in District hospitals.
b) In case of Inpatient department, only 13.4% respondents stated that all the medicines are
available and 29% respondents stated that none of the medicine were available in the wards.
When the percentage was seen separately in the various health institutions then availability of
medicines was found to be more in Special hospitals and least in Sub-divisional hospitals.
c) Among the in-patients, 91.1% respondents were found to have spent money on medicines
and in case of different health institutions, the percentage of respondents who spent money
on medicines was as high as 100% at Sub-divisional hospitals and up to 69% at CHCs.
10.2.8 Availability of diagnostic facilities

a) Out of all respondents interviewed at OPD, 50.7% stated that the facilities like laboratory and
radiological investigations are good. In case of inpatients, 65.6% stated that the facilities
such as laboratory and radiological investigations are good.
Study to Review
10.2.9 Availability and behaviour of doctors, nurses and staff
a) Overall availability of doctors as stated by the respondents at the health institutions was 94.8%
and when respondents were asked about doctor’s behaviour towards them, 91.4% respondents
from OPD and 93.3% from in patient departments stated that doctor’s behaviour is good.
b) Availability and behaviour of staff was found to be similar in case of specialists. When
percentage availability of doctors and specialists were seen separately, then it was found
lower in case of CHCs and District Hospitals among all the institutions.
c) Availability and behaviour of nurses was not found to be as good as in case of doctors.
Availability of nurses was found to be 79% and good behaviour of nurses in OPD as 64.5%.
On the other hand 80.4% nurse’s behaviour was good in the in-patient department of various
health institutions with lowest in Sub-Divisional Hospitals (67%).
d) Overall 56.9% staff member’s behaviour was perceived as good by the respondents in the
OPD of various institutions, which was 74% in case of in-patient services.
e) Behaviour of staff was rated lowest in CHCs as compared to other health institutions. In case
of OPD 2.9% respondents had to pay to staff members of the hospitals other than user fees
for getting services.
10.2.10 Waiting time in OPD

a) Time spent in waiting for specialist consultation in the OPD was less than 15 minutes for
63.4% respondents and more than 30 minutes for other 13.9%. In case of investigations,
83.6% respondents were found to have waited for 15 minutes and 6.5%% for more than
30 minutes.
b) Waiting time for getting the medicine in the OPD was up to 10 minutes for 80.8%
respondents. Patients at District Hospitals and special hospitals were found to have
waited for more time period.
10.2.11 Security in the in-patient department

a) Only 46.4% respondents of all the health institutions perceived that the security at these
facilities is good, whereas 17% respondents perceived it poor.
b) It means that more than half of the respondents did not feel adequately secure in the in-
patient department. Security in the health institutions needs to be improved with more
focus on CHCs and sub divisional hospitals.
10.2.12 Quality of care

a) Overall 75.9% of OPD and 79% of in-patient respondents rated the quality of treatment
in the hospitals as good. CHCs and Sub-Divisional Hospitals were rated low in quality in
comparison to the other institutions.
b) Overall 77.9% respondents in OPD were satisfied with the services of various health
institutions. However, only 2.3% respondents were fully satisfied with the services of the
out-patient department. 22.1% respondents were not satisfied with the services available at
the health institutions. 94.2% respondents of the in-patient department were satisfied and
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123
only 5.8% were not satisfied with the services of the health institutions.
c) Overall rating about the cooperation at the reception counter of the various institutions was
found to be good, but CHCs need to have improvement in this regard.
d) 70% respondents rated their experience at OPD as good and this proportion is only 57% at
CHCs. This indicates that services at CHCs need overall improvement.
10.2.13 To sum up
a) Majority of respondents utilising PHSC were females having poor education and low income
levels.
b) Patients approach mainly PHSC for utilisation of emergency services. This may be because
at that time they do not have access to other health facilities and they have no other
alternative left due to economic reasons.
c) General cleanliness and cleanliness of linen in Sub-Divisional Hospitals and District Hospitals
need to be improved.
d) Overall behaviour of doctors, nurses and other staff members in the health institutions was
stated to be good by majority of the respondents. Only a minor proportion of them rated it
unsatisfactory.
e) Majority of the respondents stated that the medicines are not available, and that they have
to buy it from market, as advised by doctors.
f) More than half of the respondents did not feel adequately secure in the in-patient department.
Security in the health institutions needs to be improved.
g) Availability of basic facilities, in general, was not very satisfactory in all type of health
institutions and particularly in District Hospitals and CHCs. These include:
Availability of STD/PCO booth,
Better toilet facilities and mainly separate toilets for women in all types of health
institutions,
Availability of safe drinking water,
Availability of screen in the examination room.
h) Behaviour of staff members in the OPDs was not rated to be satisfactory by majority of the
respondents.
i) A good percentage of respondents stated that availability of doctors, nurses and staff in the
OPDs is good, except at CHCs. However, the finding on the similar issue in the community
was very different. Rather this was reported to be as one of the major issues underlying low
utilisation of health services provided by PHSC.
j) The facilities like laboratory and radiological investigations were not rated to be satisfactory
by majority of the respondents as most of the time these facilities are not available. Because
of this, patients are forced to go to private facilities to get the required investigations done.
k) Overall experience of respondents at OPDs of the various health institutions under study
was not found to be very satisfactory. This observation holds true in particular for CHCs and
District hospitals and needs further attention.
l) A good percentage of respondents felt that the quality of treatment in the hospitals needs to
be improved, mainly in the CHCs, as these are in the rural areas and mostly the community
was not having any other alternative option for health care.
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10.3 Views of the Community based on Focus Group
Discussions
The following observations are noted based on focus group discussion in the community:
a) General administration of the hospital needs rectification. This includes cleanliness,
recruitment of the staff, doctors with specialties, drinking water arrangement, toilets on all
the floors & wards, electricity (lightening arrangement), generator, water tank, timely repair
of accessories and machines etc.
b) All necessary medicines should be provided by the hospital. If not possible, at least the BPL
families should get this facility. For the other patients subsidised medicines can also be a
good option.
c) At least in the emergency situation hospital should provide every facility like diagnostic
services or medicines.
d) Provision for laboratory and ultrasound should also be in perfect situation.
e) Surgeons can be arranged for emergencies on call.
f) Fee for the diagnostic tests should also be subsidised.
g) There is a need to organise community campaigns such as camps, health melas, health
education etc. especially in far-flung areas.
h) Local community participation should be enhanced for utilisation of health services.
i) For strengthening emergency services, ambulances need to be arranged at very minimum rates.
j) Doctor on emergency duty should be available for 24 hours a day.
k) The private practice of the Government doctors should be stopped.
l) Every village should have a trained dai and a lady doctor.
m) It was desired that at least delivery facility for pregnant women should be provided by the
government free of cost.
n) If all the facilities with the good doctors were available people would prefer to utilise those
health facilities
o) It was observed in the discussion that the parishad CHCs were more popular in the areas as
compared to the PHSCs/CHCs.
10.4 Views of other Stakeholders

The view of the other stakeholders is as given below:
i) More infrastructure facilities and equipments need to be provided.
ii) Salaries of doctors are not very lucrative as a result they go for private practice.
iii) More contractual employees are required – especially class IV and lab technicians.
iv) Public Private Partnership model needs to be introduced.
v) Telemedicine should be promoted.
vi) Performance linked appraisal should be adopted.
vii) Number and quality of drugs need to be increased and improved for increasing acceptance
of the services.
viii) Paid wards should be started.
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125
ix) Transport services should be improved.
x) Health insurance should be made available for poor patients.
xi) Cleanliness should be emphasised.
xii) More equipment for diagnostic facility (i.e. CT Scan, MRI) should be made available for
poor patients.
xiii) More number of ambulances should be made available.
xiv) A separate vehicle should be made available for SMO for field visits.
xv) Extra water facility and clean, treated water should be provided.
xvi) Security guards must be recruited to improve security of in patients.
xvii) Plantation in and around hospital complex should be increased.
xviii) Night and emergency services should be improved and more doctors should be made
available.
xix) The 50 bedded hospitals need to be upgraded to 100 beds to meet the community needs.
xx) Generators with more power and capacity should be made available to improve functioning,
as frequent power failure is a perpetual problem in many areas.
xxi) Technician for Ultrasound must be recruited.
xxii) Vacant staff positions should be filled up.
xxiii) Regular training should be provided to the staff.
xxiv) Repair and maintenance of staff quarters should be done.
xxv) Manpower shortage especially that of radiologist, anaesthetist, paediatrician and
gynaecologist and obstetrician, along with class IV employees, should be seriously looked
into.
xxvi) Fully equipped ambulance and CT scan should be provided.
xxvii) There should be provision of a seminar room.
xxviii) Facility in charge should be given authority to cut down on non-performing staff.
xxix) Security services should be provided on contract.
xxx) Costly equipments should have AMC.
xxxi) Awareness of services should be done through media.
Study to Review
11.0 Conclusion and Recommen-
Based on above quantitative, qualitative and triangulation of data, the following

recommendations are proposed:
11.1 Human Resource

a) An assessment may be done for the State of Punjab to find out the staff position for all
categories of health workers including doctors.
b) An exercise to find out the strength of the sanctioned and vacant posts needs to be
undertaken.
c) Urgent efforts may be made to fill up the vacant positions.
d) Two separate cadres for the doctors i.e. one for GDMOs and one for specialists instead of
having only one single cadre of Medical Officers should be created.
e) Category wise GIS mapping of all types of human resources including Medical officers and
various Specialists for all the Health Institutions may be done for the entire state. By this
exercise, a clear picture will emerge regarding the exact availability against the requirement
of each category of health personnel.
f) It is suggested that PHSC may take policy decisions whereby all the doctors are paid a basic
minimum salary so as to motivate them to work at government health facilities.
g) This exercise will help in planning and recruitment of the required specialists and GDMOs.
h) Moreover based on the norms of IPHS, posts for GDMOs and other essential categories of
specialists may be created and filled up.
i) Availability of basic specialists in the respective health centres will surely build up the
confidence among the community and hence result in increased utilisation of services.
j) Separate administrative cadre may be developed for the administrative posts of district,
sub-division and CHCs so that a full time and well qualified/trained doctor can be assigned
to these jobs. A specialist may not be given this responsibility by virtue of his/her seniority
as this effects his clinical practice in the hospital.
k) As reported, the salaries of the doctors under PHSC were not at par with the private sector
and this could be one of the reasons for high attrition rate among the doctors.
l) Performance based incentives may be considered not only for retaining the existing specialists,
but also State may explore the possibility of involvement of private practitioners under public
private partnership as per market rate. This exercise can be done under human resource
innovation which is one of the components in NRHM. A similar performance assessment
system was already in practice i.e. ‘Bench Marking’. Also, by this method, it may be easier to
retain the specialist category of radiology, anaesthesia, paediatric, gynaecology etc.
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127
11.2 Availability of Drugs
a) At all the health care institutions, the beneficiaries reported to have expectations that the
medicines, particularly the vital ones, should be provided by the health centre. Moreover,
it becomes a moral obligation for the authorities to provide at least the vital and essential
medicines.
b) Hence, the availability of these medicines specially the vital and essential ones should be
necessary in all health facilities..
c) Therefore it is recommended that every health centre should prepare the list of medicines
(drug formulary) to be used at that centre and the same to be sent to their concerned
authorities for procurement/indent.
d) At the State level, these lists of drugs, coming from various types of health facilities through
their respective district headquarters to be compiled and a common list to be prepared.
e) By applying scientific Inventory Control Techniques of ABC and VED analysis, they should
find out the list of all the vital and essential drugs and the costlier one (which shall not be
more than 20% of the total procured drugs).
f) These medicines should be procured through state level and distributed to the districts for
onwards supply.
g) Alternatively the state may fix up the rate contract of each item after following the laid
down procurement procedures for drug items and supply this information with the required
authority letter to the respective districts so that they can directly procure these medicines
from the suppliers at the rate fixed by the state.
h) In this way, the state headquarters need not to worry about their budget and every district
health centre and below will be procuring these medicines by using funds of Rogi Kalyan
Samitis or user charges.
i) By this partial de-centralised procurement, the availability of the medicines will definitely
improve and quality of the medicines can also be ensured.
j) Every hospital/health centre should have proper antibiotic policy and standard treatment
guidelines.
k) There should be regular practice of prescription audit.
11.3 Community Education and Community Rights

Regarding Health Facilities
a) Every hospital/health centre should clearly display the citizen charter and the name,
designation and telephone numbers of the concerned officers to whom they can approach at
the time of any dispute or complaint.
b) The beneficiaries should also be informed about the routine procedures they are expected to
follow in that health centre and their rights.
11.4 Cleanliness
a) Special efforts should be taken to maintain the cleanliness of the hospital. CHCs should
focus more on this so that it is at par with basic required standards.
Study to Review
b) The general up keep of surroundings of the hospital should also be maintained properly.
For this reason, special efforts should be taken for regular repair, maintenance and
landscaping.
c) The toilets should be kept clean and the drainage system in particular to be flushed routinely
at regular intervals. Drainage system should be regularly cleaned and monitored.
d) For the support staff a training capsule having role and responsibilities\ including basics
of hygiene and sanitation, preventive and promotive health care, motivation, attitudinal
changes, services available in the health facility may be developed and continuing exercise
should be regularly undertaken.
e) For house keeping and sanitation, the services may be out sourced and may be given to the
professional organisation like sulabh etc.
f) A separate toilet for the females should be there in the OPDs of every hospital/health
centre.
11.5 Diagnostic Facilities

a) Efforts should be made to ensure that all the required reagents and equipments in the
laboratories are available.
b) For those special investigations, which are not carried out in the respective centres, the
authorities should tie up with the private laboratories at pre-negotiated fixed rates.
c) With these arrangements, the beneficiaries can be referred to these laboratories and they will
not end up paying a higher price.
d) Even for the poor patients, respective health centre may pay their charges from the funds
available from user charges/Rogi Kalyan Samitis.
11.6 Medical Record Department

a) For any good administration, the correct and timely information is very important. This
information can only be made available, if the respective data is generated in outpatient and
In-door facilities. Hence, to have proper information, every hospital needs to have a well
planned and organised medical record department. The information in medical records, helps
hospital administrator to monitor the utilisation pattern of their respective hospital and to
help them to take required necessary decision for improvement. The following observations
are made in this regard:
• All the case sheets and medical records pertaining to patient care is required to be maintained
following some standard indexing system so that in future, retrieval becomes easy.
• Every hospital should come out with the routine statistical bulletin, which should include
some of the important Hospital Utilisation Indices like bed occupancy rate, average
length of stay, bed turnover interval, gross and net death rate etc.
11.7 Emergency Services

a) Due to paucity of doctors and other support staff in various hospitals, the emergency
services are not functioning properly. This creates a problem for the community
Study to Review
129
(especially for the poor population) who are forced to go to the private sector for availing
emergency services.
b) This calls for taking into account, that the emergency services are taken very seriously and
action needs to be taken immediately.
c) To start with, doctors may be posted in these hospitals, particularly at sub divisional hospital
and CHC, exclusively to run emergency services.
11.8 Maternity Services

a) Emergency obstetric services: Non-availability of satisfactory obstetric services is another
major drawback in the system. The community is compelled to seek care from the private
sector due to the non availability of emergency obstetric services in the public sector.
b) Main reasons found out for this was non-availability of gynaecology and obstetrics specialists.
c) Hence efforts should be made to ensure that every hospital upto CHC level has atleast one
gynaecologist with all required facilities.
d) A model of public private partnership like the one followed in Gujarat (Chiranjeevi scheme)
may be looked into for strengthening the maternity services.
11.9 Other Aspects

a) Admission procedures need improvement with more focus on CHC and sub divisional hospitals.
Rules and regulations of health institutions should be properly informed to the patients.
b) Cleanliness of linen in Sub-Divisional Hospitals and District Hospitals needs to be
improved.
c) STD/PCO booth to be installed for convenience of the patients and relatives as per IPHS
standards and NRHM.
d) CHCs were lacking in many facilities and PHSC should look into this matter immediately to
provide quality service to rural people.
e) Inpatients should also be provided by adequate information regarding disease and treatment.
f) The inclination of community to use private services is due to ensured availability of the
services including holidays, at night, clean environment and at a time convenient to the
people in the community.
g) Hence to increase the utilisation of the facilities, evening OPDs may be started.
h) On the experimental basis, it may be made as pay clinics, with the choice of the patient to
select the doctor. A good share of the earning (say about 60-70%) from these pay clinics
may be paid to the doctors.
i) The amount paid to the doctors as honorarium may be in consonance to the number of
patients they are attending.
j) Proper and well maintained residential accommodation for doctors and other staff may be
provided at all levels of health centres.
k) Security in the health institutions needs to be improved with more focus on CHCs and sub
divisional hospitals.
Study to Review
l) Every Hospital should have a hospital infection control committee.
m) There should be a regular grand clinical rounds for all the health centres i.e. CHCs and above.
This should be attended by all the doctors.
Hence, to sum up, the utilisation of health care services will definitely improve if along with
the availability of doctors and required specialists, the medicines (at least the vital ones), basic
laboratory and radiological investigations are made available.
Further, the emergency services and the delivery services could be improved and made available
round the clock for the satisfaction of the community. This would result in increased utilisation
of the facilities provided by PHSC.
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131
Table 1.1. General Profile and Facility Survey of District Hospitals
132
Name of the District
Amritsar Bhatinda Ferozpur Gurdaspur Hoshiarpur Jalandhar Ludhiana Muktsar SH Patiala Sangrur Taran SH
Taran Bhatinda
Accessibility to Railway/ Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes
Bus Station
Distance from Rail Station 2 3 3 2 3 3 2 3 1 1 2 3
km
Study to Review
Distance from Bus Station 1 1 2 1 1 3 4 2 1 1 3 1
km
All Weather Roads Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Bed Strength 50 100 200 60 100 -300 -200 100 164- 100 50 60
Source of Water Supply Municipal Bore well Bore well Bore well Bore well Municipal Municipal Canal Bore well Municipal Bore well Bore well
supply supply supply water supply
Water Supply (Quantity) Adequate Inadequate Adequate Adequate Adequate Adequate Adequate Inadequate Adequate Adequate Adequate Adequate
Water Supply (storage 1 1 3 3 2 3 2 3 3 3 3 1
capacity available for no.
of days)

Electricity (supply) Irregular Regular Regular Regular Regular Regular Regular Irregular Regular Regular Irregular Regular
Electricity (phase) Phase- Phase- Phase- Phase- Phase-three Phase- Phase- Phase- Phase- Phase- Phase- Phase-
three three three three three three three three three double three
Electricity (Backup Available Available Available Available Available Available Available Available Available Available Available Available
Generator /UPS Available )
If more than one storey Yes Yes No No No Yes No No No Yes No No
building (Lift Available)
If more than one storey Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
building (Ramp Available )
General Impression- up Good Average Good Average Good Good Average Good Good Average Average Average
keep of garden
General Impression- Good Average Good Good Good Good Average Good Good Average Average Average
cleanliness
General Impression- sign Good Good Good Good Good Good Average Good Good poor Good Average
posting
General Impression- roads Poor Good Good Good Good Good Average Good Good Average Average Good
and lighting
(Contd...)
Taran Bhatinda
General Impression- State Good Average Good Good Good Good Average Good Good Average Average Good
of Building
Any Public Utility Service No Good No No No No No Good No No No Good
available in Hospital
Premises
Any public Utility Service Yes Yes No Yes No No Yes Yes Yes Yes No Yes
Available in Hospital
Premises-Chemist
Any Public Utility Yes Yes Yes Yes Yes Yes Yes No Yes Yes No Yes
Service available in
Hospital Premises-Sulabh
Sauchalaya
Any Public Utility Service No Yes Yes Yes Yes Yes Yes No Yes Yes No Yes
Premises-Canteen
Any Public Utility Service No No Yes Yes Yes Yes Yes No Yes No No No
Premises-STD/PCO booth
Ambulance Services Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Ambulance Services if Partially Fully Fully Partially Partially Partially Partially Partially Fully Partially Fully Partially
available Equipped Equipped Equipped Equipped Equipped Equipped Equipped Equipped Equipped Equipped Equipped Equipped
Total Number of Vehicles 1 10 5 3 4 4 3 2 1 3 2 1
(Nos.)
No. of Operation Theatres- 1 1 1 1 1 4 1 3 1 1 1 1
Minor (Nos.)
No. of Operation Theatres- 4 3 1 2 3 4 2 3 2 1 2 1
Major (Nos.)
ICU types Yes Yes No Yes No Yes Yes No No Yes No No
ICU no. of beds 8 6 NA 6 NA 10 4 NA NA 5 NA NA
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133
(Contd...)
134
Taran Bhatinda
Emergency Services Round the Round the Round the Round the Round the Round the Round the Round the Restricted Round the Round the Round the
Clock Clock Clock Clock Clock Clock Clock Clock Clock Clock Clock
Dental Services Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No
Delivery Services Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
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Facilities for Post-mortem No Yes Yes Yes Yes Yes Yes Yes No No Yes No
Mortuary services with No Yes Yes No Yes Yes Yes Yes No No Yes No
cold storage & other
preservative facilities
available.
Drug formulary committee No No No Yes No Yes No No Yes No Yes No
Hospital Antibiotic No No No Yes Yes No No No No No Yes No
committee
Hospital Infection Control Yes No No Yes Yes Yes No Yes No No Yes No
Committee.
Store Purchase Committee Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Store verification Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes

Committee
Medical Audit/ Death Yes No Yes No Yes Yes Yes No Yes Yes No No
Review Committee
System of Supply of Drug Push Push Pull Pull Push Pull Push Push Pull Push Push Pull
items through
% of Drug items asked for 50 60 50 90 100 40 50 20 50 60
is supplied
% of patients getting all 50 40 50 70 100-indoor 40 25 75 50 70
the medicines prescribed
5-10-OPD
Is the drug formulary No No No No Yes Yes No No No No No No
available
Is buffer stock maintained Yes Yes Yes No Yes Yes Yes No Yes No No Yes
(Contd...)
Taran Bhatinda
Annual maintenance Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
procedure for costly
Equipments
Log book/ History sheet Yes Yes Yes Yes Yes Yes Yes Yes Yes No No Yes
maintained for the
Equipments
Present status/situations Good Good Good Good Good Good Good Good Good Good Good Good
of the existing
Equipments:
Study to Review
135
Table 1.2 Facilities Available at District Hospitals
136
Bhatinda Ferozpur Gurdaspur Hoshiarpur Jalandhar Ludhiana Muktsar SH Patiala Sangrur Taran SH
Taran Bhatinda
Baby Incubators No No Yes Yes Yes Yes Yes Yes No Yes Yes Yes
Baby Incubators NA NA Non Functional Functional Functional Non Functional NA Functional Functional Functional
Functional Functional
Study to Review
Boyles Apparatus Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Boyles Apparatus Functional Functional Functional Functional Functional Functional Functional Functional Functional Functional Functional
Cardiac Monitor Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Cardiac Monitor Non Functional Functional Functional Functional Functional Functional Functional Functional Non Functional Functional
Functional
Dental Chair Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No
Dental Chair Non Functional Functional Functional Functional Functional Functional Functional Functional Functional N
Functional
Dosimeter No No No No No No No No No No Yes Yes
Dosimeter NA NA NA NA NA NA NA NA NA NA Functional Functional

ECG Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
ECG Functional Non Functional Functional Functional Functional Functional Functional Functional Functional Functional
Functional
Emergency Resuscitation Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes
Kit
Emergency Resuscitation Functional Non Functional Functional Functional Functional NA Functional Functional Functional Functional
Kit Functional
Endoscope No No Yes Yes Yes Yes Yes No No No No No
(fiber optic)
Endoscope(fiber optic) NA NA Functional Non Functional Functional Functional NA NA NA NA NA
Functional
Ophthalmo-scopes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No
Ophthalmo-scopes Functional Functional Functional Functional Functional Functional Functional Functional Functional Functional NA
(Contd...)
Taran Bhatinda
Perimeter No No No Yes Yes Yes Yes No Yes No No No
Perimeter NA NA NA Functional Functional Functional Functional Functional Functional NA NA NA
Photo Therapy Unit Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes
Photo Therapy Unit Functional Functional Functional Functional Functional Functional NA Functional Functional Functional Functional
Retinoscope Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes No
Retinoscope Functional Non Functional Functional Functional Functional Functional Functional NA Functional NA
Functional
Short Wave Diathermy No Yes Yes Yes Yes Yes Yes No Yes Yes No Yes
(Physio therapy)
Short Wave Diathermy NA Non Non Functional Functional Functional Functional NA Functional Functional NA Non
(Physio therapy) Functional Functional Functional
Sigmoidoscopes No Yes Yes Yes Yes Yes No No No Yes No
Sigmoidoscopes NA Functional Functional Functional Functional Functional NA NA NA Functional NA
Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes No
Slit lamp
Slit lamp Functional Functional Functional Functional Functional Functional Functional NA Functional Functional NA
Ultra sound Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes No
Ultra sound Functional Functional Functional Functional Functional Functional Functional Functional NA Functional NA
X ray Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
X ray Functional Functional Functional Functional Functional Functional Functional Functional Functional Functional Functional
Other Major and Minor Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Operation equipments
Other Major and Minor Functional Functional Functional Functional Functional Functional Functional Functional Functional Functional
Study to Review
Any Referral System in Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
place
137
(Contd...)
138
Taran Bhatinda
Referral manual available No No Yes Yes Yes Yes Yes No No No No No
Guidelines for- What to No No Yes Yes No Yes Yes Yes No Yes No No
refer
Guidelines-When to refer No No Yes Yes No Yes Yes Yes No Yes No No
Study to Review
Guidelines- How to refer No No Yes Yes Yes Yes Yes Yes No Yes No No
Colour coded referral cards No Yes Yes Yes No Yes Yes Yes No No No Yes
available
Feed-back Mechanism No No No No Yes Yes Yes No No No No No
existing:
Transport facility provided: Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Maintenance of records/ Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes No
registers
Incentive for following No No Yes No No Yes Yes No No No Yes Yes
referral route
If Yes, what NA NA Vehicle NA NA Vehicle No proper NA NA NA No proper No Answer

provided provided Answer Answer
Procedure followed for Higher No Medical Colour coded Vehicle Vehicle Higher With PGI Refer to Refer to Not Serve
referral: Centre College card-Medical provide to with colour Centre referral Chandigarh Patiala Medical
college Medical card card College
College
Tie-up with other hospital No Yes Yes No No Yes Yes No No No Yes Yes
(both public and pvt) for
diagnostic
Hospital has a tie-up None Other Medical Medical None Private Pvt. None None None 1 2
with: (Medical College/ Government College College Hospitals Hospitals
other government/ pvt. Hospitals & Other
institutions) Government
Hospitals
Does the Hospital have No Yes Yes No No No Yes No No No No Yes
any Outreach Area
(Contd...)
Taran Bhatinda
Statistical Bulletin: Available Not Not Not Available Not Not Not Available Not Not
Available Available Available Available Available Available Available Available
Availability of dharamshala No Yes No No No Yes No No No Yes No Yes
Availability of residential No Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes
accommodation for the
essential
if available, what % is not NA 80 0 0 50 15 50 NA 40 40 70 90
getting accommodation
(In % )
Security arrangement: Contra- In house In house In house In house Contractual Contractual NA In house In house In house In house
ctual
Study to Review
139
Table 1.3 Laboratory Tests
140
Amritsar Bhatinda Ferozpur Gurdaspur Hoshiarpur Jalandhar Ludhiana Muktsar SH Patiala Sangrur Taran Taran SH
Bhatinda
Complete Blood Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No
Haemogram
Analysis
Study to Review
Complete Urine Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Examination
stool test Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Blood urea Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Blood sugar Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Liver function test Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Lipid profile Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes No
PAP smear Yes Yes No No Yes Yes Yes Yes Yes Yes No Yes
FNAC Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes No
Blood Grouping Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes

and Matching test
Biopsy test No No No No Yes Yes No No No Yes No No
Culture and smear Yes No No No Yes Yes No Yes No No Yes No
examination
Semen Examination Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Vaginal discharge Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes
examination
Bone Marrow No No No Yes No Yes No Yes No No No No
Examination
VDRL test Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Other routine Yes Yes Yes Yes Yes No Yes Yes No No Yes
tests.
Table 1.4 Out Patient Department
Name of the District Total

Out Patient
Department Amritsar Bhatinda Ferozpur Gurdaspur Hoshiarpur Jalandhar Ludhiana Muktsar SH Patiala Sangrur Taran Taran SH
Bhatinda
Reception & Manual Computerised Computerised Computerised Computerised Computerised Manual Computerised Computerised Computerised Computerised Manual 3
Registration
Counter (manual/
computerised)
Managed by clerk No No No No No No No Yes No Yes No No 2

Managed by MSW No No No No No No No No No No No No 10
Managed by staff No No No No No No No No No Yes No No 1
nurse
Managed by No Yes Yes Yes Yes Yes No Yes Yes Yes Yes No 9
computer operator
Knowledgeable Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes 12
about the OPD
Separate registration Yes Yes Yes Yes No Yes No No Yes Yes Yes No 8
for male
Separate registration Yes Yes Yes Yes No Yes No No Yes Yes Yes No 8
for female
Separate registration Yes Yes Yes No Yes Yes Yes No Yes Yes No No 8
for senior citizens
Separate registration No No Yes No No No No No Yes No No No 2

for staff
Registration Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes 11
registers are
properly maintained
and
(Contd...)
Study to Review
141
142
Out Patient
Bhatinda
All sections of Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes 10
the OPD having
proper signage and
directional sign
Waiting area is Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes 12
adequate
Study to Review
Proper sitting Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes 12
arrangement
Drinking water Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes 11
facility
Ceiling Fans Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes 12
Toilet facility Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes 11
Doctor’s Chambers Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes 12
are having adequate
space
Examination table Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes 12
with proper sheet
Stool for the patient Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes 12

to sit
Examination Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes 12
equipments (like
BP apparatus Torch,
hammer, etc.)
Adequate Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes 12
illumination
Injection Room Yes Yes Yes Yes Yes Yes No Yes Yes Yes No Yes 10
along with facilities
and to deal with
Emergency situation
(Contd...)
Out Patient
Bhatinda
Minor OT / Dressing Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes 11
Room with all the
basic Equipments
Dispensaries / No Yes Yes Yes No No Yes No Yes Yes No Yes 8
Pharmacy with
separate counters
for male/female/
senior citizen
Laboratory & Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes 12
Imaging Services
easily accessible
Central Collection Yes No Yes Yes Yes Yes Yes Yes Yes No Yes Yes 10
Centre for
Laboratory Services
Study to Review
143
Table 1.5 Emergency Medical Services (Casualty)
144
Bhatinda
EMERGENCY MEDICAL Yes Yes Yes No Yes Yes Yes Yes Yes No Yes No
SERVICES (CASUALTY)
Separate Medical
Officer(s) available
Study to Review
round the clock
Board displaying on call Yes Yes Yes Yes Yes Yes Yes Yes No No Yes Yes
doctors/specialist and
other staff on duty
Glow sign board Yes Yes Yes Yes Yes Yes No Yes Yes No No No
indicating ‘Emergency
Services Department’
Emergency Ward Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
attached to Emergency
Department
Triage area Yes Yes Yes Yes Yes Yes No Yes No Yes No Yes

Observation Beds (fill 3 19 3 7 10 8 4 3 4 5 3 6
number, for No fill 00)
Trolleys (fill number, for 4 3 3 3 5 5 2 0 2 2 3 2
No fill 00)
Wheel chairs (fill 2 2 1 1 4 5 2 0 1 2 2 1
Examination rooms (fill 0 0 1 1 2 1 1 0 1 1 1 2
All the registers Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
including MLR available
for proper reg.
Retiring room with Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
toilets for the doctors
Call book in prescribed Yes Yes Yes Yes Yes Yes Yes Yes Yes No No Yes
format available
(Contd...)
Bhatinda
Waiting area for the Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes
attendants of the
patients with the basic
Facilities like sitting
arrangements, drinking
water, toilet etc.
Public telephone Yes No No Yes Yes Yes No No No No No Yes
available
Treatment room-cum- Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
minor OT
Major OT Yes Yes No No Yes Yes No No Yes Yes No Yes
Sufficient stock of Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
essential and life saving
drugs
Oxygen cylinders with Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
attachments
Laboratory services Yes No No Yes Yes Yes Yes No Yes No Yes Yes
Radiology Services Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Ambulance services Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Staff trained in BLS Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Treatment facilities Yes Yes Yes Yes Yes Yes No No No Yes Yes No
for Dog/ snake bite &
Poisoning
Availability of Disaster No No No No Yes Yes No No No No No No
manual
Disaster Alert Code, No No No No Yes Yes No No No No No No
recall & deployment
Maintenance of Yes Yes Yes No Yes Yes Yes Yes No Yes No No
dedicated Drug store for
Study to Review
disaster situation
Plaster Room Yes Yes Yes Yes No Yes No Yes No Yes No No
145
Table 1.6 Intensive Care Unit (ICU)
146
Taran Bhatinda
Intensive Care Unit (ICU) No Yes No Yes No Yes Yes No No Yes No No
Total number of beds NA 6 NA 6 NA 10 4 NA NA 5 NA NA
available:
Study to Review
Air-conditioned ICU with NA Yes NA Yes NA Yes Yes NA NA Yes NA NA
generator support
Staff sanctioned for the ICU- NA 0 NA 2 NA 0 1 NA NA 0 NA NA
no. of doctors
no. of nurses
no. of technical staff

Table 1.7 Clinical Laboratories

Taran Bhatinda
Type of laboratories- Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes
pathology
Type of laboratories- Yes Yes No No Yes Yes Yes Yes Yes Yes Yes No
microbiology
Qualified-Pathologist Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes
Qualified-Biochemist No No No No Yes Yes Yes No No No No No
Qualified-Micro biologist No No No No No Yes No No No No No No
Following the Universal Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Precaution Procedures
Using Protective Measures Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
i.e. gloves/gowns/masks
Specimen Collection done Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes
Centrally
Availability of all the Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Chemicals and Reagents
Observing all the Bio- Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
safety measures
Accuracy of the Reports Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes
Regular Internal Quality No Yes Yes Yes Yes Yes No Yes Yes Yes No Yes
Control Measures
Undertaken
Regular External Quality Yes Yes Yes Yes No Yes Yes No Yes Yes No Yes
Control Measures
Undertaken
Study to Review
147
Table 1.8 Blood Banking Facilities
148
Amritsar Name of the District
Bhatinda
BLOOD BANK (If No blood No Yes Yes Yes Yes Yes Yes Yes No Yes Yes No
bank fill “8” for section E)
Trained or Qualified NA Yes Yes Yes Yes Yes Yes Yes NA Yes Yes NA
Study to Review
Medical Officer Posted as
B.T.O.
Round the Clock NA Yes Yes Yes Yes Yes Yes Yes NA Yes Yes NA
Availability of Trained Staff
and Services
Checking & Cross Matching NA Yes Yes Yes Yes Yes Yes Yes NA Yes Yes NA
by B.T.O.
Proper Maintenance of Cold NA Yes Yes Yes Yes Yes Yes Yes NA Yes Yes NA
Chain and Refrigerators
Australia antigen, HCV, NA Yes Yes Yes Yes Yes Yes Yes NA Yes Yes NA
VDRL, M.P. and HIV tests
done for Every Blood
Bottle of donor.

Efforts made to Collect NA Yes Yes Yes Yes Yes Yes Yes NA Yes Yes NA
Blood through Voluntary
Organisation Camps
Renewal of Blood Bank/ NA Yes Yes Yes Yes Yes Yes Yes NA Yes Yes NA
HIV License as per Rules
Table 1.9 Radiology & Imaging

Amritsar Bhatinda Ferozpur Gurdas pur Hoshiarpur Jalandhar Ludhiana Muktsar SH Patiala Sangrur Taran SH
Taran Bhatinda
Availability of the Dark Room Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
with all Facilities
Use of Dosimeter and they No No No No No No No Yes No No Yes Yes
Regularly sent to BARC
Special Investigation like IVP, No No No Yes Yes Yes Yes Yes Yes Yes Yes No
Contrast Media etc.
Round the clock availability of Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes No
X-ray services/ Sonography
Separate Register for MLC Yes No Yes No Yes Yes Yes Yes No No Yes No
Records
Maintenance of History Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes No
Book and Log book of X-ray
Machines
Study to Review
149
Table 1.10 Operation Theatre
150
Taran Bhatinda
No. of Operations 4 3 1 2 3 4 3 3 2 1 1 2
Theatres- major
No. of Operations 1 1 1 1 1 4 1 3 1 1 1 1
Study to Review
Theatres- minor
Zoning concepts strictly No Yes Yes No Yes Yes Yes Yes No No Yes Yes
followed
Emergency light or Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
generator facilities
provided to O.T.
Availability of fire No No Yes No Yes Yes Yes Yes Yes Yes Yes No
fighting equipments and
knowledge to use them
Regular disinfections & Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
sterilisation procedures
done at O.T.

Table 1.11 In-patients Ward

Taran Bhatinda
Satisfactory cleanliness of Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes
the wards with adequate
house keeping
Colour codes of Yellow, Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes
Blue, Red, White bin &
Blue transparent PPF for
waste collection
Table top syringe & needle Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
destroyer
Proper Utilisation Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Adequate water supply and Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes
up keep of sanitary blocks.
Adequate & Clean Toilets Yes Yes Yes No No Yes Yes Yes Yes Yes Yes Yes
and Bathrooms
All the beds are having Yes Yes Yes No Yes Yes Yes Yes Yes No Yes Yes
proper & adequate linen
Floor beds/doubling of No No Yes No No No Yes Yes No No No No
beds in the wards
if Yes, Analyse the Reason NA NA Rare cases NA NA NA NA NA NA NA
of Gastro &
Pead.
Satisfactory up Keep of Yes Yes Yes No Yes Yes Yes Yes Yes No Yes No
cots, mattresses, bedside
lockers, linen
Use of Hospital Uniforms No No No No No No No Yes No No No No
by all Patients
Availability and Available Not Available Available Available Available Available Available Available Available Available Not
Functioning of Suction Available Available
Study to Review
apparatus (Electric & Foot
Operated)
(Contd...)
151
152
Taran Bhatinda
If available (Functional/ Functional NA Functional Functional Functional Functional Functional Functional Functional Functional Not NA
Not) Functional
Availability and functioning Available Available Available Available Available Available Available Available Available Available Available available
of oxygen cylinder with
accessories
Study to Review
If available (functional) Functional Functional Functional Functional Functional Functional Functional Functional Functional Functional Functional Functional
Availability and functioning Available Not Available Not Not Available Not Available Available Available Not Not
of venesection tray, LP, Available Available Available Available Available Available
tracheotomy tray.
If available (functional) Functional NA Functional NA NA Functional NA Functional Functional Functional NA NA
Availability and functioning Available Available Available Available Available Available Available Available Available Available Available Available
of emergency light, wheel
chair, trolley
If available (functional) Functional Functional Functional Functional Functional Functional Functional Functional Functional Functional Functional Functional
Stationeries, forms, upto Yes Yes Yes Yes Yes Yes Yes Yes No No No Yes
date various registers etc.

Concept of progressive Yes Yes Yes Yes Yes Yes No Yes Yes Yes No Yes
patient care
Adequacy and working of Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
fans and lights
Satisfactory availability of No No Own No Yes No No No No No No Yes
diet, arrangement
Quality of care No Yes Yes Yes Yes Yes Yes Yes Yes No Yes
Maintenance of various Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes
registers, records, etc.
Table 1.12 Hospital Medical Stores

Taran Bhatinda
Medical store suitably located Yes Yes Yes Yes Yes Yes No Yes Yes Yes No
with adequate space and
protection of drugs and non-
drugs items from pilferage,
temperature, humidity
Restriction on entry for Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
unauthorised personnel’s
Staff knowledgeable in materials Yes No Yes No Yes Yes No Yes No No Yes
management
Inspection of stores by the Civil Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes
Surgeon / M.O. I/c at regular
interval to verify stock books
Availability of Vital, essential Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes
drugs in sufficient Quantity
Upkeep of expiry date register Yes Yes Yes No Yes Yes No No No No No
and its regular inspection by
MO I/c
Efforts made to redistribute No Yes Yes No Yes Yes Yes Yes No Yes Yes
large stock of slow moving drugs
or near expiry for its utilisation.
Proper arrangements to keep the Yes No Yes No Yes Yes No No No No No
drugs as per ABC/VED category
and storage of rubber goods as
per guidelines
Appropriate steps taken to Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes
prevent pilferage of
A convenient arrangement of No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
issuing drugs to various
Study to Review
(Contd...)
153
154
Taran Bhatinda
Regular sending of samples to No No Yes No Yes Yes Yes No No No No
chemical laboratory to check it
as per specification and standard
& action taken thereon
Circulation of lists of available Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Study to Review
drugs to all the MOs, OPD&
wards as per generic names
Submission of certified bills to Yes Yes Yes No Yes Yes No Yes No No Yes
office for release of payments
within three days.
Auction to clear the empty No Yes No No Yes Yes Yes No Yes No Yes
material from store done
regularly.
Availability of Fire Fighting No No No No Yes Yes No Yes No Yes No
equipments and knowledge of
staff to operate it
Availability of regularly updated No Yes No No No Yes No No No No No

Hospital Drug Formulary
Existence of standing Drug Yes Yes No No Yes Yes No No No Yes No
Committee
Table 1.13 Medical Record Department

Amritsar Bhatinda Ferozpur Gurdas Hoshiar Jalandhar Ludhiana Muktsar SH Patiala Sangrur Taran SH
pur Taran Bhatinda
pur
Availability of Medical Record No Yes Yes Yes Yes Yes No Yes No Yes No Yes
Room with enough number of
racks
Medical record No No No No Yes No No No No No No No
Is it managed by a trained No Yes Yes No Yes No No Yes Yes No Yes Yes
medical record officer /
technician or
Case record is maintained as per No No No No Yes Yes Yes No No No Yes
WHO classification of diseases
(ICD-X)
Regular submission of the Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes
morbidity, mortality reports
For what duration all the records 7 15 10 10 5 5 10 14 10 10 10 5
being maintained (In years)
Is the backup facility available No No Yes No Yes No backup No Manual Yes Yes No No
to safeguard these records
What is the effective retrieval No new & As per Admission Computer No No Yes No No No
system followed by this hospital old crno., admission No.,
alpha No. & year bundle of
index wise 100
Regular death audit meetings Yes No Yes No Yes No No No Yes No No No
held & minutes of meeting
Medical audit done at regular Yes Yes Yes No Yes Yes No Yes Yes No No No
interval
Study to Review
155
Table 1.14 Hospital Waste Management
156
Taran Bhatinda
Are the adequate number of No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
bins and the bags of required
Are these placed strategically Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Study to Review
in all patient care areas
Segregation of different Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
categories of wastes done at
the
Collection of waste, No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
packaging, labelling, record
keeping done in scientific
Proper transportation of the Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
waste so collected
Storage facilities and duration No Yes Yes No Yes No Yes Yes Yes Yes Yes Yes
Disposal/ recycling methods No Yes No Yes Yes No Yes No Yes Yes Yes Yes
for various categories of

Whether waste disposal is Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes
outsourced
Table 1.15 SUPPORT SERVICES
Central Sterile Supply Department

Taran Bhatinda
Under the Supervision of Yes Yes Yes Yes Yes Yes Yes Yes NA Yes No Yes
a Trained Technical Staff/
Senior Nursing Officer
Having all the required Yes Yes Yes No Yes Yes Yes Yes NA Yes No Yes
equipments & Autoclaves
Quality control measures are Yes No Yes No Yes Yes Yes Yes NA Yes No Yes
strictly followed -physical
Quality control measures are Yes Yes Yes No Yes Yes Yes No NA Yes NA Yes
strictly followed- chemical
Quality control measures are Yes No Yes No Yes Yes Yes No NA Yes NA Yes
strictly followed- biological
Study to Review
157
Laundry Services
158
Bhatinda
Laundry Conventional Mechanised Conventional Mechanised Mechanised Mechanised Mechanised conventional Mechanised Conventional Conventional Mechanised
Services
(Mechanised/
conventional)
Study to Review
Laundry Adequate Adequate Adequate Adequate Adequate Adequate Not Not Adequate Not Adequate Adequate
Services-staff Adequate Adequate Adequate
(Adequate)
Quality of Good Average Good Good Good Good Average Good Good Average Good Good
wash
Quality of Good Good Good Average Good Good Average Good Good Average Good Good
linen

Dietary Services

Taran Bhatinda
Proper & safe arrangement No NA NA NA NA NA NA NA NA NA NA NA
for storage of raw materials
Measures for Pest & Rodent No NA NA NA NA NA NA NA NA NA NA NA
control
Sanitation and hygiene of No NA NA NA NA NA NA NA NA NA NA NA
the cooking area properly
maintained
Regular health check-up for No NA NA NA NA NA NA NA NA NA NA NA
food handlers
Availability of modern No NA NA NA NA NA NA NA NA NA NA NA
cooking equipments
Availability of properly No NA NA NA NA NA NA NA NA NA NA NA
maintained records &
registers
Diet service under the No NA NA NA NA NA NA NA NA NA NA NA
supervision of a qualified
Dietician
Study to Review
159
Table 1.16 User Charges in Different District Hospitals
160
Name of Years Total Income Total Detailed Expenditure
District (Collection) Expenditure
Hospital Medicine I.F.P. Buildings Equipment ERF A/c Salary to Rogi Kalyan
Contractual Samiti
Staff
2003-04 1900185
2004-05 2374199
Study to Review
2005-06 2741536
Amritsar
2006-07 3050132
2007-08 3301463
Total 13367515
2003-04 5138784 6517634 2944683 1611906 319306 319306 - - -
2004-05 5045995 4323803 2249330 984908 241353 241353 - 488959 -
2005-06 6313724 5711847 2386983 1310739 537007 471309 538604 467205 -
Batinda
2006-07 6162264 6209016 2193207 1485296 345977 1045958 636396 502182 -
2007-08 5290741 4718401 1653431 943988 469782 790272 512474 348454 -
Total 27951508 27480701 11427634 6336837 3353758 2868198 1687474 1806800 -

2003-04 2179219 2129219 874143 435635 291381 291381 - 236679 -
2004-05 2840423 2840423 1162196 645664 387398 387398 - 257767 -
2005-06 2908548 4673865 2908548 634350 380910 380910 - 369147 -
Ferozpur
2006-07 3074681 3074681 1186566 659203 395522 395522 - 437868 -
2007-08 3275538 3275538 1312560 729201 437521 437521 - 358735 -
Total 14278409 14278409 7444013 3104053 1892732 1892732 - 1660196 -
2003-04 3875328 2586302 1290006 754828 208792 175548 0000 157128 0000
2004-05 4889763 3229772 1480509 820269 440287 297101 0000 191606 0000
2005-06 5213162 3365249 1610770 659437 433148 145677 279392 236625 0000
Gurdaspur
2006-07 6519411 4482801 2061622 866236 666745 275882 364511 247805 0000
2007-08 NA 3882273 1712314 761250 365905 261018 446126 235660 100000
Total 20497664 17546397 8155221 3862220 2114877 1155226 1090029 1068824 100000
(Contd...)
Contractual Samiti
Staff
2003-04
2004-05
2005-06
Hoshiarpur
2006-07
2007-08 5826166 6027980 2404437 1399160 611882 527801 619475 465225 -
Total 5826166 6027980 2404437 1399160 611882 527801 619475 465225 -
2003-04
2004-05
2005-06 9419098 9630442 4747258 2315901 967000 335006 512714 752563 -
Jalandhar
2006-07 13499437 10724214 5622143 2127532 755944 460244 1194458 563893 -
2007-08 15416929 15858716 6393457 3189803 1056121 1355608 3234468 629259 -
Total 383355464 36213372 16762858 7633236 2779065 2150858 4941640 1945715 -
2003-04 3101683 3777674 2643851 521440 335221 129908 - 147254 -
2004-05 3803090 3607862 2948549 334737 58076 205813 - 60687 -
2005-06 4544871 4573092 3326884 524630 189417 167830 115586 248745 -
Ludhiana
2006-07 4811096 3183321 1976830 349661 237645 419185 599608 72068 -
2007-08 5024987 3864421 2007813 770511 796861 289236 33138 4580 -
Total 21285727 19006370 12903927 2700979 1617220 1211972 748332 533254 -
2003-04
2004-05
2005-06
2006-07
Muktsar
2007-08
Study to Review
Total
(Contd...)
161
162
Contractual Samiti
Staff
2003-04 6030396 4212300 804050 433198 2674019 52349 - 248684 -
2004-05 457581 1513687 796653 301086 42819 47958 - 325171 -
2005-06 5476548 2529041 1201486 489679 88679 85397 342852 320948 -
Patiala
Study to Review
2006-07 6887658 3027748 1499017 371009 137009 115355 477461 427897 -
(Sp.
Hospital) 2007-08
Total 18852183 11282776 4301206 1594972 2942526 301059 820313 1322700 -
2003-04 3188235 2011939 - - - - - - -
2004-05 4054724 2072265 - - - - - - -
2005-06 4687936 3129318 - - - - - - -
Sangrur
2006-07 4454628 3777499 - - - - - - -
2007-08 4745583 4782224 - - - - - - -
Total 21131106 15773245 - - - - - - -
Taran Taran 2003-08 Not Available Due to Formation of New District

2003-04 951796 982268 504591 - - - - - -
2004-05 1133336 561907 216541 230419 57573 57374 - - -
Sp. Hospital 2005-06 1431652 1062972 423376 338376 156962 43467 100791 - -
Bhatinda 2006-07 1541913 1160399 581205 199501 87269 162740 118959 10725 -
2007-08 1223898 967836 500471 139788 70660 119039 122744 15134 -
Total 6282595 4735382 2226184 1130925 445485 564435 342494 25859 -
Table 1.17 Performance Report of District Hospital
Performance (Annual) Name of the District

Taran Bhatinda
OPD attendance 1st Yr 68726 170936 112815 115247 189243 - - 96961 123171 143949 88942 47753
last 5 years
2nd Yr 104203 178083 100355 13404 215921 - - 95591 148476 151743 112667 54733
3rd Yr 109836 193687 88901 160954 235353 169891 176891 106841 162196 158268 120134 61725
4th Yr 125668 221187 95306 183196 242693 222669 182811 134335 188125 201481 126646 62565
5th Yr 139137 220217 104298 176432 231386 156827 156942 93713 162518 174259 121578 67955
1st Yr 2041 6293 6805 9184 10188 - - 3149 6093 10165 4491 2361
2nd Yr 3370 7053 6314 9467 12476 - - 3149 6093 10165 4491 2361
3rd Yr 4371 9045 6072 10713 13170 12538 10249 4069 8802 11492 4804 4518
4th Yr 5271 9808 6146 11564 13219 16054 10241 3881 10495 12323 4868 4906
5th Yr 7853 10657 6340 12004 12731 5106 8366 3956 11522 13051 4728 5958
No. of Surgeries 1st Yr 1330 3567 11103 3925 - - - 1708 3355 5751 2114 859
done
2nd Yr 2930 3665 10113 4177 9214 - - 3071 3977 9072 2490 2197
3rd Yr 9438 7109 8516 6596 12217 25081 13607 4403 4201 8590 3845 2554
4th Yr 9885 6089 8234 6325 11494 29301 13304 4201 8652 8223 5056 2033
th
5 Yr 10819 6965 9095 6272 10973 27245 13596 2944 10619 8642 5181 3442
st $
No. of 1 Yr - 4543 2596 4621 - - - - 0 5353 2147 345
Emergencies nd $
2 Yr - 4983 3167 4715 13022 - - - 0 6241 2579 941
rd $
3 Yr - 4689 2735 5396 13438 13385 - - 0 5802 2590 977
th $
4 Yr - 7370 3626 5570 15083 18073 - - 0 6422 2614 1176
th $
5 Yr - 6496 4735 5973 15490 2541 - - 0 7140 3059 1792
st $
No. of 1 Yr - 3580 1317 4687 - - - 1043 0 2817 2016 345
admissions nd $
2 Yr - 3328 1610 4822 6905 - - 1514 0 3419 2204 941
through
rd $
emergency 3 Yr - 3631 2171 4919 6708 4596 3275 1814 0 3288 2015 977
Study to Review
th $
4 Yr - 3461 1525 4925 6989 6647 4295 1902 0 3924 2017 1176
th $
5 Yr - 4229 1495 5594 6523 1891 3039 1912 0 5055 1922 1792
163
(Contd...)
Performance (Annual) Name of the District
164
Taran Bhatinda
No. of medico- 1st Yr 1350 - 1181 544 - - 9542 561 0$ 1016 - 0$
legal cases
2nd Yr 2737 1282 1010 654 612 - 9734 701 0$ 752 192 0$
3rd Yr 2363 962 1085 721 670 1998 10116 666 0$ 580 421 0$
4th Yr 2593 1575 1343 741 951 1570 12168 903 0$ 909 535 0$
Study to Review
5th Yr 2733 1167 1344 701 896 1605 14049 908 0$ 815 509 0$
No. of 1st Yr - 392 173 186 - - 1439 - 0$ 123 186 0$
post-mortum
2nd Yr - 460 233 203 294 - 1435 - 0$ 104 190 0$
done
3rd Yr - 524 180 223 258 644 1492 - 0$ 85 201 0$
4th Yr - 580 158 279 293 827 1731 - 0$ 110 91 0$
5th Yr - 610 184 270 375 790 1703 - 0$ 192 95 0$
No. of normal 1st Yr 158 0* 268 578 - - - 60 1966 1058 258 331
deliveries
2nd Yr 237 0* 310 595 577 - - 76 2452 1457 259 610
conducted
3rd Yr 272 0* 520 567 781 476 222 185 2802 1477 234 558

4th Yr 409 0* 296 577 742 737 298 265 3268 1177 152 811
5th Yr 457 0* 317 615 554 738 196 301 3671 1557 92 1014
No of Caesarean 1st Yr 114 0* 255 414 - - - 30 571 530 205 124
done
2nd Yr 221 0* 308 514 350 - - 21 852 714 162 305
3rd Yr 312 0* 269 483 460 314 164 49 1123 531 230 378
4th Yr 392 0* 291 463 387 379 147 40 1241 519 137 333
5th Yr 324 0* 367 653 376 362 196 31 1409 470 101 281
* All deliveries were conducted at Special hospital Bhatinda

$ There was no regular emergency department. There were special hospitals for women and child.
Table 1.18 Staff Position of District Hospital
Name of Post Position of Name of the District Hospital

Post
Taran Bhatinda
M.S. Sanctioned - - - - - 1 - - 1 - - -
Vacant - - - - - - - - - - - -
S.M.O. In-position - - - - - 1 - - 1 - - -
Sanctioned 2 1 1 1 2 4 - 1 2 2 - 1
Vacant 1 - - - - - - 1 - 1 - 1
Doctors In-position 1 1 1 1 2 4 - - 2 1 - -
Sanctioned 27 6 9 11 8 44 8 13 4 5 - -
G.D.M.O. Vacant 2 1 1 3 - 2 4 3 - 1 - -
Doctors In-position 25 5 8 8 8 42 4 10 4 4 - -
Specialist (Adhoc-1)
Sanctioned - 12 11 8 20 34 25 - 29 19 13 17
Vacant - - 4 - 2 - 5 - 2 4 - 1
Nursing Staff In-position - 15 7 8 18 34 26 - 27 15 13 16
Sanctioned 40 33 27 28 40 110 45 11 54 27 12 38
Vacant 4 7 3 - - 10 7 3 8 1 - 18
Adhoc - - - - 8 - - - - - - -
Technician In-position 36 26 24 28 40 100 38+11(*) 8 46 26 12 20
Sanctioned - 16 14 16 10 44 9 3 4 4 7 2
Vacant - 4 1 - - 4 - 2 - 1 - 1
Adhoc/con - - - - - - 3 con. - - - - -
Administrative In-position 35 12 13 16 10 40 9 1 4 3 7 1
Staff
Sanctioned - 9 9 7 13 20 10 2 1 10 2 9
Vacant - - 1 - - 2 2 - - - - 2
Study to Review
(Contd...)
165
Name of Post Position of Name of the District Hospital
166
Post
Taran Bhatinda
Class-IV In-position - 9 8 7 13 18 4+1 (*) 2 1 10 2 7
+5($)
Sanctioned - 71 66 67 80 110 74 32 101 71 26 28
Vacant - 2 2 19 - - - - 22 1 - 1
Others In-position - 69 64 48 80 110 36+38($) 32 79 70 26 29+6(*)
Study to Review
Sanctioned 2 9 6 6 - 85 8 7 38 - - 7
Vacant - 3 6 - - 18 2 2 11 - - 3
In-position 9 6 - 6 - 67 10+4(*). 5 27 - - 4
* Placed on Deputation
$ Gone on deputation to other districts/places

Table 1.19 Position of Specialist in District Hospital
Name of Degree Name of the District Hospital

Speciality
Amritsar Bhatinda Ferozpur Gurdaspur Hoshiarpur Jalandhar Ludhiana Muktsar SH Sangrur Taran SH
Patiala Taran Bhatinda
Medicine M.D. 2 1 1 2 5 2 1 1 1 2 1 1
Surgery M.S 2 1 2 1 3 5 3 1 1 2 1 1
M.D. 2 1 1 2 2 4 3 - 3 1 1 3
Gynaecologist &
Obstetrician
Paediatric MBBS - - - - - - - - - - - -
M.D. 2 1 - 1 2 3 3 - 2 2 1 2
Diploma - - - - - - - 1 - - - -
Opthamology M.D. - 1 - 1 2 - 3 1 1 1 1 1
ENT M.D. - - - 2 2 2 2 1 - 1 1 1
Ortho. M.S 1 2 1 1 1
Dermatology M.D. - 1 - - 2 2 2 1 1 1 1 1
Psychiatric M.D. - - - - 1 2 - - 1 - 1 -
M.D. - 1 - 1 2 5 3 1 - 1 1 2
Anaesthesia
Blood Bank Diploma - - - - - - - - 1 - - -
M.D. - - - - 1 1 1 1 - 1 - -
MBBS - 1 - - - - - - - - - -
Pathology M.D. - 1 - 1 1 2 1 1 1 1 - 1
Biochemistry M.D. - - - - 1 1 - - - - -
Micro-Biology M.D. - - - - - 1 - - - - - -
Radiology M.D. - 1 - - 2 2 1 - - - 1 -
B.D.S. - 1 - 1 3 2 1 - 1 1 1 1
Study to Review
Dental
MBBS - - - - - - - 1 - - - -
167
Table 2.1 General Profile & Facility Survey of Sub-Divisional Hospitals
168
General Profile of Hospitals Name of the Sub-Divisional Hospitals
Ajnala Batala Dasuya Fazilka Jagraon Maler Malout Nakodar Patti Talwandi
Kotla
Accessibility to Railway/Bus Station Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Water Supply Bore well Bore well Bore well Bore well Bore well Municipal Municipal Bore well Bore well Municipal
supply supply supply
Study to Review
Water Supply Adequate Adequate Adequate Adequate Adequate Adequate Adequate Adequate Adequate Adequate
Water Supply 1 day 1 day 1 day 3 days 3 days 3 days 3 days 3 days 3 days 3 days
Electricity Regular Irregular Regular Irregular Irregular Regular Regular Regular Regular Irregular
supply supply supply supply
Electricity-Phase Three Three Three Double Three Three Three Three Three Three
Electricity-Back up Available Available Available Available Available Available Available Not Available Available Available
(Generator/UPS)
Availability of lift Not Not Available Not Available Not Available Not Available Not Available Not Available Not Available Not
Available Available Available

Availability of ramp Available Not Available Available Not Available Not Available Available Available Not Available Available Available
• Up keep of garden Poor Average Good Good Poor Good NA Good Average Average
• Cleanliness Good Good Good Good Good Good Good Good Average Average
• Sign posting Average Good Good Good Good Average Good Good Average Average
• Roads and light Average Good Good Good Good Good Good Good Average Good
General Impression
• State of building Good Good Good Good Good Good Good Good Average Average
• Chemist No No No Yes Yes No No Yes No No
• Sulabh sauchalaya Yes Yes No Yes No Yes Yes No No No
• Canteen No Yes Yes Yes Yes No No No Yes No
• Grocery shops No Yes No No No No No No No No
• STD/PCO booth No Yes No Yes No No No No No No
Any public utility

hospital premises
service available in
• Other -cycle stand Yes No No No No No No No No No
(Contd...)
Kotla
Available Available Available Available Available Available Available Available Available Available
Ambulance Services Partially Fully Partially Fully Partially Fully Partially Partially Partially Partially
Equipped Equipped Equipped Equipped Equipped Equipped Equipped Equipped Equipped Equipped
Total number of vehicles 1 2 3 2 2 2 2 2 2 3
No. of Minor 1 1 1 1 1 1 2 2 1 1
operation
Major 2 2 3 1 2 2 1 2 1 2
theatres
ICU types General General No General No No No No General General
ICU no. of beds 2 5 NA NIL NA NA NA NA 4 6
Emergency Services Round the Round the Round the Round the Round the Round the Round the Round the Round the Round the
clock clock clock clock clock clock clock clock clock clock
Dental Services Yes Yes Yes No Yes Yes Yes Yes Yes Yes
Delivery Services Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Facilities for Post-mortem Yes Yes Yes No Yes Yes Yes Yes Yes No
Mortuary services with cold storage No Yes Yes Yes No Yes Yes Yes Yes No
& other preservative facilities
available.
Drug formulary committee No No No No No No No Yes Yes No
Hospital Antibiotic committee No No No No No No No Yes No No
Hospital Infection Control No Yes No No No No No Yes Yes No
Committee.
Store Purchase Committee Yes Yes Yes Yes Yes No Yes Yes Yes Yes
Store verification Committee Yes Yes Yes No Yes No Yes Yes Yes Yes
Medical Audit/ Death Review Yes No Yes No No No Yes Yes Yes No
Committee
Is the drug formulary available Yes No Yes No Yes No Yes Yes No No
Study to Review
(Contd...)
169
170
Kotla
System of supply of drug items Push Pull Push Pull Push Push Pull & Push Pull Push Push
through
Is buffer stock maintained No Yes Yes Yes Yes Yes Yes Yes No Yes
Reorder level maintained Yes No Yes No Yes No No Yes No No
Study to Review
Annual maintenance procedure for No Yes Yes Yes Yes Yes Yes Yes No Yes
costly Equipments
Log book/ History sheet maintained
Yes Yes Yes No Yes No Yes Yes No Yes
for the Equipments
Present status/situations of the
Average Good Good Average Average Average Good Average Average Average
existing Equipments:

Table 2.2 Availability of equipment
Name of the Sub-Divisional Hospitals

Ajnala Batala Dasuya Fazilka Jagraon Maler Kotla Malout Nakodar Patti Talwandi
Yes Yes Yes Yes No Yes No Yes No No
Baby Incubators
Functional Functional Functional Non Functional NA Functional NA Functional NA NA
Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Boyles Apparatus
Functional Functional Functional Non Functional Functional Functional Functional Functional Functional Functional
Yes Yes No Yes No Yes Yes Yes Yes Yes
Cardiac Monitor Non Functional Functional Non Functional NA Functional Functional Functional Functional Functional
Functional
Dental Chair Non Functional Functional Non Functional Functional Functional Functional Functional Functional Functional
Functional
No No No No No Yes Yes No No No
Dosimeter NA NA NA NA NA Non Functional NA NA NA
Functional
Yes Yes Yes No Yes Yes Yes Yes Yes Yes
ECG
Functional Functional Functional NA Functional Functional Functional Functional Functional Functional
Emergency Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Resuscitation Kit Functional Functional Functional Functional Functional Functional Functional Functional Functional Functional
No No No No No No No No No No
Endoscope (fiber optic)
NA NA NA NA NA NA NA NA NA NA
Yes Yes Yes Yes Yes Yes No Yes Yes Yes
Ophthalmoscopes
Functional Functional Functional Functional Functional Functional NA Functional Functional Functional
No No No No No Yes No No No No
Perimeter
NA NA NA NA NA Functional NA NA NA NA
Yes Yes Yes Yes No No No Yes No No
Photo Therapy Unit
Study to Review
Functional Functional Functional Functional NA NA NA Functional NA NA
(Contd...)
171
172
No Yes Yes Functional No Yes No No Yes No
Retinoscope
NA Functional Functional Functional NA Functional NA NA Functional NA
Short Wave Diathermy No No No Yes No No No Yes No No

(Physio therapy) NA NA NA Functional NA NA NA Functional NA NA
No Yes No No No No Yes No No No
Study to Review
Sigmoidoscopes
NA Non Functional NA NA NA NA Non Functional NA NA NA
No Yes No Yes No Yes No Yes Yes No
Slit lamp
NA Functional NA Functional NA Functional Non Functional Functional Functional NA
Yes Yes Yes Yes Yes Yes Yes Yes Yes No
Ultra sound Functional Functional Functional Functional Functional Functional Functional Functional Non NA
Functional
X ray
Functional Functional Functional Functional Functional Functional Functional Functional Functional Functional
Other Major and Minor Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Operation equipments Functional Functional Functional Functional Functional Functional Functional Functional Functional Functional

Table 2.3 Laboratory Facilities Available at Sub-Divisional Hospitals
Laboratory Tests Name of the Sub-Divisional Hospitals

Complete Blood Haemogram Yes No Yes Yes Yes Yes Yes Yes No Yes
Analysis
Complete Urine Examination Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Stool test No Yes Yes Yes Yes Yes Yes Yes Yes Yes
Blood urea Yes Yes Yes Yes Yes Yes Yes Yes No Yes
Blood sugar Yes Yes Yes Yes Yes Yes Yes Yes No Yes
Liver function test No Yes Yes No No Yes No Yes No Yes
Lipid profile No No Yes Yes No No No Yes No Yes
PAP smear No No No No No No No No No No
FNAC No No No Yes No No No No No No
Blood Grouping and Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Matching test
Biopsy test No No No No No No No No No No
Culture and smear No No No No No No No Yes No No
examination
Semen Examination Yes Yes Yes Yes Yes Yes Yes Yes No No
Vaginal discharge No No No No No Yes No Yes No No
examination
Bone Marrow Examination No Yes No No No No No No No No
VDRL test Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Other routine tests. Yes Yes No Yes Yes No Yes No No Yes
HIV/Pregnancy Test
(Contd...)
Study to Review
173
174
Any Referral System in place Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Referral manual available Yes Yes Yes Yes Yes No No Yes No No
Guidelines for- What to refer Yes Yes No Yes Yes No NA Yes NA No
Guidelines-When to refer Yes Yes No Yes Yes No NA Yes NA No
Guidelines- How to refer Yes Yes Yes Yes Yes No NA Yes NA No
Study to Review
Colour coded referral cards No Yes No Yes No No No Yes Yes Yes
available
Feed-back Mechanism No Yes No Yes No Yes No Yes No No
existing:
Transport facility provided: Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Maintenance of records/ Yes Yes Yes Yes Yes Yes Yes Yes Yes No
registers
Incentive for following No No No Yes No No No Yes No No
referral route
if Yes what NA NA NA Ambulance NA NA NA No Waiting NA NA
Provided For Patient

Procedure followed for Government. Government. Distt. Medical Government. Government. Distt. None Government. None
referral: Hospitals Hospitals Hospitals College Hospitals Hospitals Hospitals Hospitals
Tie-up with other hospital No No No Yes Yes No No Yes Yes Yes
(both public and private)
for diagnostic
None Medical None Medical Medical Other None None Medical Other
Hospital has a tie-up with: College College College Government. College Government.
Hospitals Hospitals
Does the Hospital have any No No No Yes Yes Yes No No No Yes
Outreach Area
NA NA NA Eye camp, MCH, Blood Coll. NA NA NA MCH
If Yes, what services are IEC Camp,
provided Eye camp
Eye camp
(Contd...)
Yes No No Yes No Yes No Yes No No
Statistical Bulletin
Monthly NA NA Fortnightly NA Fortnightly NA Monthly NA NA
Availability of Dharamshala No No No No No No No No No No
Availability of residential No Yes Yes Yes No Yes Yes Yes Yes Yes
essential staff
If available, What % is not NA 00 90% 25% NA 70% 25% `25% 50% 65%
Getting Accommodation
Security Arrangement: No NA In house In house No In house No No In house No
Study to Review
175
Table 2.4 Out Patient Department at Sub-Divisional Hospitals
176
Out Patient Department Name of the Sub-Divisional Hospitals
Reception & Registration Counter Manual Computerised Computerised Manual Manual Computerised Computerised Manual Manual Manual
Managed by clerk No No No Yes Yes Yes No No Yes No

Managed by MSW Yes No No Yes Yes No No No No No
Study to Review
Managed by staff nurse No No No No No No No No No No
Managed by computer operator No Yes Yes No No Yes Yes Yes No No
Knowledgeable about the OPD Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Separate registration for male Yes Yes No No No Yes No No No No
Separate registration for female Yes Yes No No No Yes No No No No
Separate registration for senior citizens Yes Yes Yes No No Yes No No No No
Separate registration for staff Yes Yes No No No Yes No No No No
registration registers are properly Yes Yes Yes Yes Yes Yes No Yes Yes Yes
maintained
All sections of the OPD having proper No Yes Yes Yes Yes No Yes Yes Yes Yes
signage and directional sign

Waiting area is adequate Yes No Yes Yes Yes Yes No No Yes No
Proper sitting arrangement Yes No Yes Yes Yes Yes No No No No
Drinking water facility Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Ceiling Fans Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Toilet facility Yes Yes Yes Yes Yes Yes Yes No Yes Yes
Doctor’s Chambers are having adequate Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
space
Examination table with proper sheet Yes Yes Yes Yes No Yes Yes Yes Yes Yes
Stool for the patient to sit Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Examination equipments (like BP Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
apparatus Torch, hammer, etc.)
(Contd...)
Out Patient Department Name of the Sub-Divisional Hospitals
Adequate Illumination Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Injection Room along with facilities Yes Yes Yes Yes Yes No Yes Yes No Yes
and to deal with Emergency situation
Minor OT/ Dressing Room with all the Yes Yes Yes Yes Yes Yes Yes Yes No No
basic Equipments
Dispensaries/ Pharmacy with separate No Yes Yes No No No Yes Yes No Yes
counters for male/female/senior citizen
Laboratory & Imaging Services easily Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
accessible
Central Collection Centre for Laboratory Yes Yes Yes Yes Yes No Yes Yes Yes Yes
Services
Study to Review
177
Table 2.5 Emergency Medical Services (Casualty) at Sub-Divisional Hospitals
178
Separate Medical Officer(s) available Yes No Yes Yes Yes Yes No Yes No Yes
round the clock
Board displaying on call doctors/ Yes Yes Yes Yes Yes No Yes Yes Yes No
specialist and other staff on duty
Study to Review
Glow sign board indicating No Yes Yes Yes Yes No No Yes No No
‘Emergency Services Department’
Emergency Ward attached to No Yes Yes Yes Yes Yes Yes Yes Yes Yes
Emergency Department
Triage area Yes No Yes Yes Yes No Yes Yes No No
Observation Beds (fill number, for No 02 04 12 04 03 04 07 05 01 06
fill 00)
Trolleys (fill number, for No fill 00) 4 2 2 4 1 2 4 2 1 1
Wheel chairs (fill number, for No fill 04 01 02 03 01 03 02 02 00 01
00)
Examination rooms (fill number, for 01 01 01 02 01 01 01 01 01 02

No fill 00)
All the Registers including MLR Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
available for Proper Reg.
Retiring room with toilets for the Yes Yes Yes Yes Yes Yes No Yes Yes Yes
doctors
Call book in prescribed format No Yes Yes No Yes No No Yes No No
available
Waiting area for the attendants of Yes No Yes Yes Yes Yes Yes Yes No No
the patients with the basic Facilities
like sitting arrangements, drinking
water, toilet etc.
Public telephone available No Yes No Yes No No No No No No
Treatment room-cum-minor OT Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
(Contd...)
Major OT Yes No No Yes No Yes Yes Yes No No
Sufficient stock of Essential and Life No Yes Yes Yes Yes Yes Yes Yes Yes Yes
Saving Drugs
Oxygen Cylinders with Attachments Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Laboratory Services Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Radiology Services Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Ambulance Services Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Staff Trained in BLS Yes Yes Yes Yes Yes Yes No Yes Yes No
Treatment Facilities for Dog/Snake Yes Yes Yes Yes Yes Yes Yes Yes No No
Bite & Poisoning
Availability of Disaster Manual No No Yes Yes No No No Yes No No
Disaster Alert Code, Recall & No No Yes Yes No No Yes Yes No No
Deployment
Maintenance of Dedicated Drug store No Yes Yes Yes Yes No Yes Yes No Yes
for Disaster Situation
Plaster Room Yes Yes Yes Yes No Yes No Yes No No
Study to Review
179
Table 2.6 Intensive Care Unit at Sub-Divisional Hospitals
180
Availability of ICU Yes Yes No No No No No No Yes Yes
Total number of beds available: 02 05 NA NA NA NA NA NA 04 06
Air-conditioned ICU with Generator No No NA NA NA NA NA NA No No
Support
Study to Review
Staff sanctioned for the ICU- no. of 01 00 NA NA NA NA NA NA 00 00
Doctors
Nurses
Staff Sanctioned for the ICU- no. of 01 00 NA NA NA NA NA NA 00 00
Technical Staff
Class IV
Record Keeping of the Patients Yes No NA NA NA NA NA NA No 00
Availability of oxygen/ suction Yes Yes NA NA NA NA NA NA No Yes
apparatus/ compressed air

Defibrillator No No NA NA NA NA NA NA No No
ECG machine No Yes NA NA NA NA NA NA No No
Ventilator No No NA NA NA NA NA NA No No
All the life saving Vital drugs No Yes NA NA NA NA NA NA No Yes
Strict aseptic procedures are followed No Yes NA NA NA NA NA NA No No
Table 2.7 Clinical Laboratories at Sub-Divisional Hospitals
Clinical Laboratories Name of the Sub-Divisional Hospitals

Type of Laboratories- Pathology Yes Yes No Yes No No No Yes No Yes
Type of Laboratories- Microbiology Yes No No No Yes Yes No Yes No Yes
Qualified- Pathologist No Yes No Yes No No No Yes No No
Qualified- Biochemist No No No No No No No No No No
Qualified- Micro Biologist No No No No No No No Yes No No
Following the Universal Precaution No Yes Yes Yes No Yes No Yes Yes No
Procedures
Using Protective Measures i.e. gloves/ Yes No Yes Yes No Yes No Yes Yes No
gowns/masks
Specimen Collection done Centrally Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Availability of all the Chemicals and No Yes Yes Yes Yes Yes Yes Yes Yes Yes
Reagents
Observing all the bio-safety measures No Yes Yes Yes Yes No Yes Yes Yes Yes
Accuracy of Reports Yes Yes Yes Yes Yes Yes Yes Yes No Yes
Regular Internal Quality Control No Yes Yes Yes No Yes No Yes No No
Measures Undertaken
Regular External Quality Control No Yes Yes No Yes Yes Yes Yes No Yes
Measures Undertaken
Study to Review
181
182
BLOOD BANK (If No blood bank fill “8” No Yes Yes Yes NA Yes NA Yes Yes
for section E)
Trained or qualified medical officer NA Yes Yes Yes NA No NA Yes No NA
posted as B.T.O.
Study to Review
Round the clock availability of trained NA Yes Yes Yes NA No NA Yes Yes NA
staff and services
Checking & cross matching by B.T.O. NA Yes Yes Yes NA Yes NA Yes Yes NA
Proper maintenance of cold chain and NA Yes Yes Yes NA Yes NA Yes Yes NA
refrigerators
Australia antigen, HCV, VDRL, M.P. and NA Yes Yes Yes NA Yes NA Yes Yes NA
HIV tests done for Every blood bottle of
donor.
Efforts made to collect blood through NA Yes Yes Yes NA No NA Yes Yes NA
Voluntary Organisation Camps
Renewal of blood bank/HIV License as NA Yes Yes Yes NA Yes NA Yes Yes NA
per Rules

Disposal of HIV Positive Blood Bags & NA Yes Yes Yes NA Yes NA Yes Yes NA
bio-safety measures undertaken
Availability of Table Top Syringe & NA Yes Yes Yes NA Yes NA Yes Yes NA
needle destroyer and Colour Coded Bags
Feedback of Transfusion, and Record NA Yes Yes No NA Yes NA Yes No NA
maintenance of untoward incidences
Table 2.9 Radiology and Imaging Services at Sub-Divisional Hospitals

Radiologist available No No No No Yes No No Yes No No
X-ray Machines Mobile C-arm- Total No. 0 0 1 1 1 0 0 1 1 0
Available
X-ray Machines Mobile C-arm Working 0 0 0 1 1 0 0 1 1 0
Condition
X-ray Machines Mobile C-arm Under 0 0 0 0 0 0 0 0 0 0
Repairs
X-ray Machines Mobile C-arm Pending for 0 0 0 0 0 0 0 0 0 0
Condemnation
X-ray Machines 500/300 mA Total No. 1 1 2 1 1 2 1 1 0 1
Available
X-ray Machines 500/300 mA Working 1 0 0 1 1 2 1 1 0 1
X-ray Machines 500/300 mA Under 0 0 0 0 0 0 0 0 0 0
Repairs
X-ray Machines 500/300 mA Pending 0 0 0 0 0 0 0 0 0 0
for Condemnation
X-ray Machines 200/100 mA Total No. 1 0 0 1 0 0 1 0 1 2
Available
X-ray Machines 200/100 mA Working 1 0 0 1 0 0 0 0 0 2
Condition
X-ray Machines 200/100 mA Under 0 0 0 0 0 0 0 0 0 0
Repairs
X-ray Machines 200 / 100 mA Pending 0 0 0 0 0 0 1 0 1 0
for Condemnation
X-ray Machines Mobile / 60 mA Total No. 1 1 0 1 1 1 1 0 0 0
Available
X-ray Machines Mobile / 60 mA Working 1 1 0 1 1 1 1 0 0 0
Condition
Study to Review
(Contd...)
183
184
X-ray Machines Mobile / 60 mA Under 0 0 0 0 0 0 0 0 0 0
Repairs
X-ray Machines Mobile / 60 mA Pending 0 0 0 0 0 0 0 0 0 0
for Condemnation
Availability of the dark room with all Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
facilities
Study to Review
Use of dosimeter and they regularly sent No No No No No Yes Yes No No No
to BARC
Special investigations like IVP, contrast No No Yes Yes Yes Yes No No No No
media etc.
Round the clock availability of X-ray No Yes No Yes Yes No Yes Yes No Yes
services/Sonography
Separate register for MLC records Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes

Table 2.10 Operation Theatres At Sub-Divisional Hospitals

No. of Operation Major 2 2 3 1 2 2 1 2 1 2
Theatres
Minor 1 1 1 1 0 1 1 2 1 1
Zoning concepts strictly followed No No Yes Yes Yes No Yes Yes No Yes
Total No. Available 1 2 3 2 1 1 1 2 1 1
Under Repair 0 0 0 1 0 0 1 0 0 0
Boyles
Apparatus
Pending for Condemnation 1 0 0 0 0 0 0 0 0 0
Under Repairs 0 2 0 0 0 1 2 0 0 0
Table
Hydraulic
Operation
Under Repairs 0 0 0 1 0 1 0 0 0 0
lamp
Shadow less
Under Repairs 0 NA 0 0 1 0 0 0 0 0
apparatus
Fumigation
Pending for Condemnation 0 NA 0 0 0 0 0 0 0 0
Under Repairs 0 0 0 0 0 0 0 0 1 0
Suction
Apparatus
Study to Review
Air
Under Repairs 0 0 0 0 0 0 0 0 0 0
conditioner
185
(Contd...)
186
Under Repairs 1 1 0 0 1 0 0 0 0 0
Electric
cautery
Study to Review
Under Repairs 0 0 0 0 0 0 0 0 0 0
Endoscope
Under Repairs 0 0 0 0 0 0 0 0 0 0
scope
Laparo-
Under Repairs 1 0 0 0 0 0 0 0 0 0
Cardiac
monitor

Under Repairs 0 0 0 0 0 0 0 0 0 0
Cardiac
defibrillators
Under Repairs 0 1 0 0 1 0 0 0 0 0
Pulse
oxymeter
Under Repairs 0 0 0 0 0 0 0 0 0 0
Portable
machine
mobile x ray
(Contd...)
Up-to-date maintenance of O.T. records Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
like O.T. registers, emergency O.T.,
Monthly abstract discipline wise,
major/minor etc
Maintenance of operation No Yes No Yes No No No No No No
postponement register
Emergency light or generator facilities Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
provided to O.T.
Availability of fire fighting equipments No No Yes Yes Yes Yes No No Yes No
and knowledge to use them
Regular disinfections & sterilisation Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
procedures done at O.T.
Study to Review
187
Table 2.11 In Patient Wards at Sub-Divisional Hospitals
188
Satisfactory cleanliness of the wards with Yes No Yes Yes Yes Yes Yes Yes Yes Yes
adequate house keeping
Colour codes of Yellow, Blue, Red, White Yes No Yes Yes Yes Yes Yes Yes Yes No
bin & Blue transparent PPF for waste
Study to Review
collection
Table top syringe & needle destroyer Yes Yes Yes Yes Yes Yes Yes Yes Yes No
Proper utilisation No No Yes Yes Yes Yes Yes Yes Yes Yes
Adequate water supply and up keep of Yes Yes Yes Yes Yes Yes Yes Yes Yes No
sanitary blocks.
Adequate & clean Toilets and Bathrooms Yes No Yes Yes Yes Yes Yes Yes Yes No
All the beds are having proper & adequate Yes No Yes Yes Yes Yes Yes Yes Yes Yes
linen
Floor beds/doubling of beds in the wards No No No No No No No No No No
if Yes, analyse the reason NA NA NA NA NA NA NA NA NA NA
Satisfactory up keep of cots, mattresses, Yes No Yes Yes Yes Yes No Yes Yes Yes

bedside lockers, linen
Use of hospital uniforms by all patients No No No No Yes No No No No No
Availability and functioning of suction Available Available Available Available Available Available Not Available Available Available
apparatus ( electric & foot operated) Available
If Available Functional Functional Functional Functional Functional Functional Not Functional Functional Functional
Functional
Availability and functioning of oygen Available Available Available Available Available Available Available Available Available Available
cylinder with accessories
If available Functional Functional Functional Functional Functional Functional Functional Functional Functional Functional
Availability and functioning of Available Available Available Available Available Available Not Available Not Not
venesection tray, LP, tracheostomy tray. Available Available Available
If available Functional Functional Functional Functional Functional Functional NA Functional NA NA
(Contd...)
Availability and functioning of emergency Available Not Available Available Available Available Available Available Not Available
light, wheel chair, trolley Available Available
If available Functional NA Functional Functional Functional Functional Functional Functional NA Functional
Stationeries, forms, upto date various Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
registers etc.
Concept of progressive patient care No Yes Yes Yes No Yes Yes Yes Yes Yes
Adequacy and working of fans and lights Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Satisfactory availability of diet, NA NA No No No No Yes No No No
Quality of care Yes Yes Yes Yes Yes No Yes Yes No Yes
Maintenance of various registers, records, Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
etc.
Study to Review
189
Table 2.12 Hospital Medical Stores at Sub-Divisional Hospitals
190
Medical store suitably located with No No Yes Yes Yes No No Yes No No
adequate space and protection of drugs
and non-drugs items from pilferage,
temperature, humidity
Study to Review
Restriction on entry for unauthorised Yes Yes Yes Yes Yes No Yes Yes No Yes
personnel’s
Staff knowledgeable in materials No No Yes Yes Yes Yes Yes Yes Yes No
management
Inspection of stores by the Civil Surgeon/ Yes Yes Yes Yes Yes No Yes Yes Yes Yes
M.O. I/c at regular interval to verify stock
books
Availability of Vital, essential drugs in No Yes Yes Yes Yes Yes Yes Yes Yes Yes
sufficient Quantity
Upkeep of expiry date register and its No Yes No Yes Yes No Yes Yes No Yes
regular inspection by MO I/c
Efforts made to redistribute large stock of No Yes Yes No Yes Yes Yes Yes Yes

slow moving drugs or near expiry for its
utilisation.
Proper arrangements to keep the drugs No No Yes Yes Yes No No Yes No No
as per ABC/VED category and storage of
rubber goods as per guidelines
Appropriate steps taken to prevent No Yes Yes No Yes No Yes Yes No Yes
pilferage of
A convenient arrangement of issuing No Yes Yes Yes Yes Yes Yes Yes Yes Yes
drugs to various
Regular sending of samples to chemical No Yes Yes Yes No Yes Yes Yes No No
laboratory to check it as per specification
and standard & action taken thereon
(Contd...)
Circulation of lists of available drugs to Yes Yes Yes Yes Yes No Yes Yes Yes Yes
all the MOs, OPD& wards as per generic
names
Submission of certified bills to office for Yes Yes Yes Yes No Yes Yes Yes Yes Yes
release of payments within three days.
Auction to clear the empty material from No No Yes Yes No Yes No Yes Yes No
store done regularly.
Availability of Fire Fighting equipments No No Yes No Yes Yes Yes No Yes No
and knowledge of staff to operate it
Availability of regularly updated Hospital No No Yes Yes Yes No Yes Yes No No
Drug Formulary
Existence of standing Drug Committee No Yes Yes No Yes No No Yes Yes No
Study to Review
191
Table 2.13 Medical Records Department at Sub-Divisional Hospitals
192
Availability of medical room Yes Yes Yes Yes Yes No No No No No
with enough no. of racks and
cup-board etc.
Medical record Manual Manual Manual Manual Computerised Manual Manual Manual Manual Manual
Study to Review
Is it managed by a trained Yes Yes Yes Yes Yes No Yes Yes Yes Yes
medical record officer/
technician or
Case record is maintained No Yes Yes Yes No No No No No No
as per WHO classification of
diseases (ICD-X)
Regular submission of the Yes Yes Yes Yes Yes Yes Yes Yes No Yes
morbidity, mortality reports
Duration for all the records 5 yrs. 9 yrs. 5 yrs. 10 yrs. Not Available 6 yrs. 10 yrs. 5 yrs. Not 8 yrs
being maintained (In years) Available
Is the backup facility available Yes No Yes Yes No No Yes No No No
to safeguard these records

Is the effective retrieval No No Computerised Yes No BLS In-patient No No Correspondence
system followed by this no.
hospital
Regular death audit meetings Yes No Yes Yes Yes No Yes Yes No No
held & minutes of meeting
Medical audit done at regular Yes No Yes Yes Yes Yes No Yes No No
interval
Are the adequate number of Yes Yes Yes Yes Yes Yes Yes Yes Yes No
bins and the bags of required
Are these placed strategically No No Yes Yes Yes Yes Yes Yes Yes No
(Contd...)
Segregation of different Yes Yes Yes Yes Yes Yes Yes Yes Yes No
categories of wastes done at
the
Collection of waste, packaging, No Yes Yes Yes Yes Yes Yes Yes Yes No
labelling, record keeping done
in scientific
Proper transportation of the Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
waste so collected
Storage facilities and duration Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Disposal/ recycling methods for No Yes Yes Yes No Yes No Yes No Yes
various categories of Waste
Availability of autoclaves, No Yes Yes No Yes Yes No Yes Yes Yes
shredders
Whether waste disposal is Yes Yes Yes Yes Yes No No Yes Yes Yes
outsourced
Study to Review
193
Table 2.14 Central Supply Department at Sub-Divisional Hospitals
194
Under the supervision of a trained Yes Yes Yes Yes Yes No No Yes Yes Yes
technical staff/ senior nursing
officer
Having all the required equipments Yes Yes Yes Yes Yes No No Yes Yes Yes
Study to Review
& Autoclaves
Quality control measures are strictly No Yes Yes Yes Yes Yes No Yes Yes No
followed -physical
Quality control measures are strictly No Yes Yes Yes Yes Yes No Yes Yes No
followed- chemical
Quality control measures are strictly No Yes Yes No Yes Yes No Yes Yes No
followed- biological
Laundry Services In house In house In house Out sourced In house Out sourced Out sourced In house Out sourced Out sourced
Laundry Services Conventional Mechanised Mechanised Conventional Mechanised Conventional Mechanised Mechanised Conventional Conventional
Laundry Services- staff Not Not Adequate Adequate Not Not adequate Not Not Adequate Adequate
adequate adequate adequate adequate adequate

Quality of wash Average Average Good Good Good Average Good Average Average Average
Quality of linen Average Average Good Good Good Average Good Average Average Average
Dietary Services (If no dietary NA NA NA NA NA Yes NA NA NA NA
services fill “8”) Adequate space for
kitchen
Proper & safe arrangement for NA NA NA NA NA Yes NA NA NA NA
storage of raw materials
Measures for Pest & Rodent control NA NA NA NA NA NA NA NA NA NA
Sanitation and hygiene of the NA NA NA NA NA No NA NA NA NA
cooking area properly maintained
(Contd...)
Regular health check-up for food NA NA NA NA NA No NA NA NA NA
handlers
Availability of modern cooking NA NA NA NA NA No NA NA NA NA
equipments
Availability of properly maintained NA NA NA NA NA No NA NA NA NA
records & registers
Diet service under the supervision of NA NA NA NA NA No NA NA NA NA
a qualified Dietician
Study to Review
195
Table 2.15 Five Years Performance Report of Sub-divisional Hospitals
196
Performance Name of the Sub-Division hospital
(Annual)
Ajnala Batala Dasuya Fazilka Jagraon Malar kotla Malout Nakodar Patti Talwandi
st
1 Yr 80500 87877 83843 - 74417 132144 93452 107846 132857 55896
nd
2 Yr 79500 123853 87245 - 83174 139954 89208 NA 129245 57762
OPD Attendance last rd
78300 118951 90957 71851 91738 145816 88343 NA 125296 43878
3 Yr
5 years
th
4 Yr 81000 94889 92177 76734 114972 156622 82641 107246 124884 55667
Study to Review
th
5 Yr 72000 110633 93716 83576 140825 165133 80273 153877 122326 57050
1st Yr 2810 5932 4297 - 3593 6062 1882 3697 4525 1554
2nd Yr 2729 6066 5123 - 4340 7370 2022 - 3871 1563
In-patient Admitted 3rd Yr 2915 6025 5610 3997 4680 8477 2480 - 3620 985
th
4 Yr 2670 5723 6265 4221 5012 8631 2808 5315 3001 1728
th
5 Yr 2750 6348 7653 4867 5240 9242 2882 4513 2771 1911
st
1 Yr 3419 2573 1890 - 3045 1925 931 4196 1939 853
nd
2 Yr 3335 4521 5212 - 5847 4647 649 - 3432 766
rd
No. of Surgeries done 3 Yr 3840 4803 8233 777 6208 6519 1087 - 5220 508

th
4 Yr 3853 4176 7442 2404 6002 10474 1567 5891 4832 1282
th
5 Yr 3524 4011 9416 2926 6179 8456 4141 5977 4115 1418
st
1 Yr 1470 4257 2581 - 2956 3991 1627 2083 1303 617
nd
2 Yr 1390 4189 2863 - 2305 4264 1997 - 1405 531
rd
No. of Emergencies 3 Yr 1220 3984 3072 - 3432 4610 2104 - 1248 392
th
4 Yr 1410 4086 3512 - 4111 4260 2039 2352 2267 745
th
5 Yr 1524 3777 4522 - 4144 4984 2351 2463 1479 943
st
1 Yr 1470 3384 1990 - 1271 2915 1013 1230 1303 405
nd
2 Yr 1390 2938 2280 - 1540 3582 1271 - 1410 479
No. of admissions rd
3 Yr 1220 2384 2452 2139 1690 3758 1395 - 1486 392
through emergency
th
4 Yr 1410 2607 2696 2380 1925 3549 1203 1618 1349 739
th
5 Yr 1524 2599 3545 2796 2046 3596 1484 1872 1525 795
(Contd...)
Performance Name of the Sub-Division hospital
(Annual)
Ajnala Batala Dasuya Fazilka Jagraon Malar kotla Malout Nakodar Patti Talwandi
1st Yr New 850 150 - 625 - 390 NA 502 NA
Hospitals
2nd Yr NA 870 154 - 883 609 444 NA 484 234
No. of Medico-legal
rd
cases 3 Yr NA 880 180 1120 740 635 445 NA 489 237
th
4 Yr NA 902 229 1445 934 790 321 NA 471 417
5th Yr NA 900 318 1711 838 - 417 262 467 363
1st Yr NA 118 150 - 125 126 76 85 137 0
2nd Yr NA 126 150 - 101 98 89 - 141 0
No. of post-mortem
3rd Yr NA 136 148 137 119 90 91 - 121 0
Done
4th Yr NA 178 149 151 129 118 110 210 151 0
5th Yr NA 159 160 129 169 103 223 108 0
1st Yr 91 244 427 - 17 586 - 11 104 9
2nd Yr 85 333 516 - 14 706 9 - 133 7
No. of normal
3rd Yr 77 313 574 198 27 798 10 - 239 25
deliveries conducted
4th Yr 82 270 677 90 44 848 39 140 374 93
5th Yr 45 214 724 138 141 88 192 365 117
1st Yr 120 261 152 - 62 56 27 52 0
2nd Yr 125 321 282 - 99 116 - 100 0
No. of Caesarian
3rd Yr 152 461 356 76 96 147 - 265 0
done
4th Yr 137 286 413 64 62 207 50 269 3
5th Yr 36 230 556 93 105 73 344 4
Study to Review
197
Table 2.16 Utilisation of user Charges in different Sub-divisional Hospitals
198
SDH Years Total Income Total Detailed Expenditure Rogi Kalyan
(Collection) Expenditure Samiti
Medicine I.F.P. Buildings Equipment ERF A/c Salary to
Contractual
Staff
2002-03 62785 61842 34450 159042 1500 9950 - -
2003 -04 68831 98998 86210 6593 6195 - - -
Study to Review
2004-05 128887 186126 112365 52071 17340 4350 - -
Ajnala
2005-06 64310 62204 14087 1610 5050 - -
2006-07 67140 31069 765 15450 1825 7676 - 5353
Total 4,42,345 2,95,994 1,04,143 28,470 27,026 - 5.353
2003-04 2856930 1455379 709554 412825 65783 - 213389
2004-05 2501043 1254498 749642 323472 44323 - 129108
2005-06 2564636 1359199 797979 47256 38168 201324 120710
Batala
2006-07 2591846 985821 751368 455726 225669 57869 115393
2007-08 2781007 1208331 635697 513302 307953 - 115724
Total 1,32,95,462 62,63,228 36,44,240 17,52,581 6,81,896 2,59,193 6,94,324

2003 Jan to Dec 1937123 1906015 949630 481342 117708 204455 _ 152880
2004 2569442 2118990 999299 517145 239991 136185 _ 226370
2005 2724788 2560358 1138910 624839 256041 210429 140035 184104
Dasuya
2006 3236033 3824239 1019279 1737364 246270 400142 219412 201772
2007 3555379 2944546 1007892 804628 361026 262757 524273 176177
Total 1,40,22,765 1,33,54,148 51,15,010 41,65,300 12,21,036 12,13,968 8,83,720 9,41,303
2003 NA NA NA NA NA NA _ _
2004 1498695 2109466 1331367 511424 168746 97929 _ _
2005 1526801 1643986 824751 368495 318647 132093 _ _
Fazilka
2006-07 1417432 1184084 592215 323291 220125 48453 _ _
2007-08 1713121 1405856 628269 423310 227657 126620 _ _
Total 61,56,049 63,43,392 33,76,602 16,26,520 9,35,175 4,05,095 - -
(Contd...)
Contractual
Staff
2003-04 767384 816526 189553 479142 127358 20473 - -
2004-05 1280104 1171531 539026 332573 131927 168005 - -
2005-06 1526969 1166907 464614 318339 125349 130561 112842 15202
Jagraon
2006-07 1586933 1089631 385255 354189 170995 179192 163221 11520
2007-08 1949779 1224822 503702 319985 192054 209081 178744 -
Total 71,11,169 54,69,417 20,82,150 18,04,228 7,47,683 7,07,312 4,54,807 26,722
2003-04 2401730 1845039 861281 496054 58658 92452 _ 336599
2004-05 2911828 2913691 1341339 700184 72985 233949 _ 565234
Malar 2005-06 3074958 2643327 1290855 650957 234480 214823 _ 252212

Kotla 2006-07 3843699 3096277 1544136 865383 89337 187615 _ 409806
2007-08 3431073 3232796 1894129 768283 97998 269202 _ 203184
Total 1,56,63,288 1,37,31,130 69,31,740 34,80,861 5,53,458 9,98,041 - 17,67,035
2002-03 883084 786189 259610 177339 74497 29124 0 245619
2003-04 1170491 906414 427686 124537 59033 32525 0 262633
2004-05 1218956 1045483 497789 84062 63443 68380 0 331809
Malout 2005-06 1485141 1543708 202159 519310 159343 146260 0 516636
2006-07 1643569 1194926 269199 296156 26556 64820 161124 377071
2007-08 1785796 1229213 314876 246211 59721 97408 174611 336386
Total 81,87,037 67,05,933 19,71,319 14,47,615 4,42,593 4,38,517 3,35,735 20,70,154
2002-03 984319 748091 - - - - - -
2003-04 1088831 1217550 - - - - - -
2004-05 1564222 1747670 - - - - - -
Nakodar 2005-06 1919253 1658387 - - - - - -
2006-07 1178820 993277 - - - - - -
Study to Review
2007-08
Total 67,35,445 63,64,975
199
(Contd...)
200
Contractual
Staff
2003 1447955 1664515 682856 440026 134411 240122 _ 167100
2004 1664189 1821980 813206 590521 128621 145632 _ 144000
2005 1941864 4010536 1020627 600732 221555 81758 _ 144000
Patti
2006 1895881 3840986 1111049 526386 53579 117934 _ 136157
Study to Review
2007 2132756 2234989 927108 396859 134275 640747 _ 136000
Total 90,82,645 1,35,73,006 45,54,846 25,54,524 6,72,441 12,26,193 - 7,27,257
2003-04 378461 370944 155980 137884 36199 40881 - -
2004-05 320439 299001 93472 84821 35112 35671 - 49925
Talwan De 2005-06 392751 402239 139355 100269 31148 27951 9455 94061
Saboo 2006-07 564122 524283 156613 122462 67410 73995 17257 86546 100000
2007-08 475974 465776 188931 115123 69741 51674 7632 32675 100000
Total 21,31,747 20,62,243 7,34,351 5,60,559 2,39,610 2,30,172 34,344 2,63,207 2,00,000

Table 2.17 Medical Officers in Position
Name of Post Post Ajnala Batala Dasuya Fazilka Jagraon Maler kotla Malaout Nakodar Pathi Talwandi Total
M.D. 1 2 2 1 2 1 2 2 3 - 16
Medicine Diploma - - - - - - - - - - -
MBBS - - - - - - - 1 - - 1
M.D. 1 1 2 1 2 1 1 1 2 1 13
Surgery Diploma - - - - - - - - - - -
MBBS - - - - - - - - - - -
M.D. 1 1 1 - 1 2 - 1 1 1 9
OBG Diploma - - - - - - - - - - -
MBBS - - - - - - - - - - -
M.D. 2 - 1 - 1 - - - - - 4
Paediatrics Diploma - 1 - 1 - - - - - - 2
MBBS - - - - - - - - - - -
M.D. 1 1 1 1 2 1 - 1 1 - 9
ENT Diploma - - - - - - - - - - -
MBBS - - - - - - - - - - -
M.D. 2 1 1 - 1 - - 1 1 - 7
Orthopaedics Diploma - 1 - 1 - - - - - - 2
MBBS - - - - - - - - - - -
M.D. 1 1 - 1 1 - 1 1 - - 6
Dermatologist Diploma - - - - - - - - - - -
MBBS - - - - - - - - - - -
M.D. - - - - - - 1 - - - 1
Psychiatry Diploma - - - - - - - - - - -
MBBS - - - - - - - - - - -
Study to Review
(Contd...)
201
Name of Post Post Ajnala Batala Dasuya Fazilka Jagraon Maler kotla Malaout Nakodar Pathi Talwandi Total
202
M.D. 1 1 1 2 - - - 1 1 - 7
Anaesthesia Diploma - - - - - - - - - - -
MBBS - - - - - - - - - - -
M.D. - 1 - - - 1 - 1 - - 3
Blood Bank Diploma - - - - - - - - - - -
MBBS - - - - - - - - - - -
Study to Review
M.D. - - - 1 - 1 - 1 - - 3
Pathology Diploma - - - - - - - - - - -
MBBS - - - - - - - - - - -
MD/MSc - - - - - - - - - -
Bio-chemistry Diploma - - - - - - - - - - -
MBBS - - - - - - - - - - -
MD/MSc - - - - - 1 - 1 - - 2
Microbiology Diploma - - - - - - - - - - -
MBBS - - - - - - - - - - -

M.D. - 1 1 - 1 - - - - - 3
Radiology Diploma - - - - - - - - - - -
MBBS - - - - - - 1 - - - 1
BDS 1 1 1 1 1 1 1 1 1 1 10
Dental
Diploma - - - - - - - - - - -
Table 2.18 Present Staff Position of Sub-Divisional Hospitals Under PHSC
Name of Post Post Ajnala Batala Dasuya Fazilka Jagraon Malar kotla Malout Nakodar Patti Talwandi
Sanction 1 1 1 1 - 1 1 1 1 1
Vacant - 1 - - - - - - - -
SMO
Ad hock - - - - - - - - - -
Total in position 1 1 (office) 1 1 - 1 1 1 1 -
Sanction 14 21 21 14 14 10 13 13 12 11
Medical Officer Vacant 1 3 2 3 1 - 6 - 1 7
(GDMO &
Specialists) Ad hock - - - - - - - - - -
Total in position 13 18 19 11 13 10 7 13 11 4
Sanction 12 14 25 24 16 24 11 12 13 10
Vacant - - - 7 - 2 3 3 - 2
Nursing Staff
Ad hock - 12(cont.) 7 - - - - - -
Total 10+2($) 14 12 17 16 22+2 (depu.)* 8 9 13 8
Sanction 4 3 9 2 5 4 2 3 3 -
Vacant - - 1 - - - - - - -
Technician
Ad hock - - 1 - - - - - - -
Total in position 2+2(*) 3 8 2 5 4 2 3 3 -
Sanction 2 5 3 1 2 7 1 2 3 5
Administrative Vacant - - - - - - - - - -
staff Ad hock - - - - - - - - - -
Total in position 2 5 3 1 2 7 1 2 3 5
Sanction 3 5 2 - - 3 - - 2 2
Vacant - - - - - - - - - -
Driver
Ad hock - 3 - - - - 2 - - -
Total in position 2+1(*) 2 2 - - 3 - - 2 2
Study to Review
203
Name of Post Post Ajnala Batala Dasuya Fazilka Jagraon Malar kotla Malout Nakodar Patti Talwandi
204
Sanction 23 32 30 30 28 47 7 26 19 21
Vacant 2 9 7 7 3 9 - 7 - 1
Class IV
Ad hock - - - - - - - - - -
Total in position 19+2(*) 23 23 23 25 38 7 19 19 20
Sanction 15 3 5 7 - - 4 2 25 -
Vacant - - - - - - 1 - - -
Study to Review
Others
Ad hock - 1 - - - - - - - -
Total in position 15 2 5 7 - - 3 2 25 -
• On deputation placed in the SDH
$ Gone deputation in other places/outside SDH

Table 3.1 General Profile & Facility Survey of CHCs Under PHSC
Description of facilities Name of the CHC

Badal Fatehgarh Ferozshah Goniana Kartarpur Khemkaran Longowal Machiwara Mahilpur Majitha Manawala
Accessibility to Railway/Bus
Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Station
Water Supply Municipal Bore well Bore well Municipal Bore well Bore well Bore well Bore well Bore well Bore well Bore well
Availability of water Adequate Adequate Adequate Adequate Adequate Adequate Adequate Adequate Adequate Adequate Inadequate
Storage capacity of Water
Three day One day Three day Three day Three day Two day Two day One day Two day One day One day
Supply
Electricity - Irregular Irregular Irregular Irregular Regular Irregular Irregular Irregular Regular Regular Irregular
Phase of Electricity Three Three Double Three Three Three Three Three Three Three Three
Backup Generator/ UPS Available Available Available Available Available Available Available Available Available Available Available
Not Not Not Not Not Not Not Not Not Not Not
Availability of lift
available available available available available working available available available available available
Not Not Not Not
Ramp facility Available Available Available Available Available Available Available
available available available available
General Impression -Up keep Not
Average Average Good Good Average Average Average Poor Average Average
of garden Applicable
Cleanliness Good Average Good Average Good Average Good Good Average Good Average
Sign posting Good Average Good Good Good Poor Average Good Average Good Average
Roads & lighting Good Average Good Good Good Average Good Good Good Poor Average
State of building Good Good Good Good Good Average Good Good Average Good Good
Any public utility service
available in hospital No No No No No No No No No No No
premises chemist
Sulabh Sochalaya No Yes No No No No Yes No No Yes No
Restaurants/ canteen No No Yes No No No No No No No No
Grocery shops No No No No No No No No No No No
Study to Review
(Contd...)
205
206
Ambulance Services Available Available Available Available Available Available Available Available Available Available Available
If Available Partially Partially Fully Partially Partially Partially Fully Partially Partially Partially Partially
equipped equipped equipped equipped equipped equipped equipped equipped equipped equipped equipped
Total No. of Vehicles 2 1 4 1 3 2 1 1 3 1 1
Study to Review
No. of Operation Theatres- 1 1 1 0 1 0 1 1 0 1 1
Minor
No. of Operation Theatres 2 1 0 2 1 1 1 1 2 1 1
-Major
Intensive Care Units No No No No No No No No No No No
No. of beds in ICU NA NA NA NA NA NA NA NA NA NA NA
Emergency Services Round the Round the Round the Round the Round the Round the Round the Round the Round the Round the Round the
clock clock clock clock clock clock clock clock clock clock clock
Dental Services Yes Yes No Yes Yes Yes No Yes Yes Yes Yes
Delivery Services Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Facilities for Post-mortem No No No No No No No No No No No

Mortuary services with cold No No No No No No No No No No No
storage & other preservative
facilities available
Various management No No No No Yes No No No No No No
committees, Drug formulary
committee
Hospital Antibiotic No No No No Yes No No No No No No
committee
Hospital Infection Control No No No Yes No Yes No No No Yes No
Committee
Store Purchase Committee Yes Yes No Yes Yes Yes No Yes Yes Yes No
Store verification Committee Yes Yes No Yes Yes Yes No Yes No Yes Yes
(Contd...)
Medical Audit/ Death Review Yes No No No No Yes No No No No Yes

Committee
System of Supply of Drug Pull Pull Pull Push Push Push Pull Push Pull Pull & Push
items through Push
Is the drug formulary available No No No No Yes No Yes No Yes No No
Is buffer stock maintained Yes Yes No Yes Yes No Yes Yes Yes No No
Is Reorder level maintained No No No Yes Yes No No Yes Yes No No
Annual maintenance procedure Yes No No Yes No No Yes Yes No Yes No
for costly Equipments
Log book/ History sheet No No No Yes Yes Yes Yes Yes No Yes No
maintained for the Equipments
Study to Review
207
208
Table 3.2 Equipment available at CHCs

Boyles apparatus with circle Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes
absorber
Functional Functional NA Functional Functional Functional Functional Functional Functional Functional Functional
Dental chair No Yes No Yes Yes Yes Yes Yes Yes Yes Yes
Study to Review
NA Functional NA Functional Non Non Functional Functional Functional Functional Functional
Functional Functional
Emergency Resuscitation Kit No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Not Functional Functional Functional Non- Functional Functional Functional Functional Functional Functional
applicable functional
Ophthalmoscopes No Yes Yes Yes No Yes Yes Yes No Yes Yes
Not Non - Functional Functional NA Functional Functional Functional NA Functional Functional
applicable Functional
Sigmoidoscopes No Yes No Yes No No No No No Yes No
NA Functional NA Functional Not NA NA NA NA Functional NA

applicable
X-Ray Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes
Functional Functional Functional Not Functional Functional Functional Functional Functional Functional Functional
applicable
Other Major and Minor Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No
Functional Functional Functional Functional Functional Functional Functional Functional Functional Functional NA
Table 3.3 Laboratory tests
Complete Urine Examination Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Stool Test No Yes Yes Yes Yes No Yes Yes Yes Yes Yes
Special Test Like:-blood urea Yes No Yes Yes Yes No Yes Yes Yes Yes Yes
Blood Sugar Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes
Blood Grouping and Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes
Matching test
Many other routine tests. Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Study to Review
209
210
Table 3.4 Referral Facilities
Any Referral System in Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No
place
Referral manual available NA Yes Yes Yes Yes No Yes Yes Yes Yes No
Study to Review
Guidelines given regarding: No Yes Yes No Yes NA Yes Yes Yes Yes No
What to refer
When to refer No Yes Yes No Yes NA Yes Yes Yes Yes No

How to refer No Yes Yes No Yes NA Yes Yes Yes Yes No
Colour coded referral cards No Yes No Yes Yes NA Yes No No Yes No
available
Feed-back Mechanism No No No No No No Yes No No No No
existing
Transport facility provided Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No
Maintenance of records/ Yes Yes Yes Yes Yes No Yes Yes Yes Yes No

registers
Incentive for following No No Yes No Yes Yes No Yes No Yes No
referral route
Procedure followed for No Yes Yes Don’t know Don’t know Yes Yes Yes Yes Yes No
referral *
Tie-up with other hospital No No No Yes Yes Yes Yes Yes Yes No Yes
(both public and private)
for diagnostic or referral
purposes
Hospital has a tie-up with NA NA NA Other Pvt. Medical Other Other Other Medical Other
Hospitals College & College
(Contd...)
If Available NA NA NA NA Monthly NA Monthly NA Fortnightly Monthly NA

Does the Hospital have any Yes No No Yes Yes Yes Yes Yes No No No
Outreach Area
If yes, what services are MCH NA NA MCH MCH Nat. Health Ed. MCH MCH NA NA NA
provided health MCH
prog.
Availability of Dharamshala No No No No No No No No No No No
Availability of residential Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes
essential staff with in the
campus
Security arrangement No In-house In-house No No In-house In-house No No In-house In-house
Study to Review
211
Table 3.5 Outpatient Department
212
MSW No No No No No No No No No No No
Staff Nurse No Yes Yes No No No No No Yes Yes No
Pharmacist No Yes No Yes Yes Yes Yes Yes No No Yes
Study to Review
Knowledgeable about the Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
OPD
(by observation)
Separate registration for Male No No No No No No Yes Yes No No No
Female No No No No No No Yes Yes No No No
Freedom fighters No No No No No No Yes Yes No No No
Senior citizens No No No No No No No Yes No No No
Staff No No No No No No Yes No No No No
The registration registers Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes
are properly maintained and
entries are made neatly

All sections of the OPD Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
having proper signage and
directional sign
Waiting area is adequate Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes
Proper sitting arrangement Yes No Yes Yes Yes No Yes Yes Yes Yes Yes
Drinking water facility No No Yes Yes Yes Yes Yes Yes Yes Yes Yes
Ceiling Fans Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Toilet facility(Separate for No Yes Yes Yes Yes No Yes No Yes Yes Yes
Male and Female)
Doctor’s Chambers are having Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
adequate space
(Contd...)
Description of Name of the CHC
facilities
Examination table with Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
proper sheet
Stool for the patient No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
to sit
Examination equipments No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
(like BP apparatus
Torch, hammer, etc.)
Adequate illumination Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Injection Room along No Yes Yes No Yes Yes No Yes Yes Yes No
with facilities and to
deal with Emergency
situation
Minor OT / Dressing Yes No Yes No No Yes Yes Yes No Yes No
Room with all the basic
Equipments
Dispensaries / Pharmacy Yes No No No No Yes No Yes Yes No Yes
with separate counters
for male/female/senior
citizen/staff
Laboratory & Imaging Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Services easily
accessible
Central Collection Centre No No Yes Yes Yes No No Yes Yes Yes Yes
for Laboratory Services
Study to Review
213
214
Table 3.6 Emergency (Casualty) Services at CHCs
Board displaying on call doctors/ Yes Yes Yes No Yes Yes No Yes Yes Yes Yes
specialist and other staff on duty
Study to Review
Glow sign board indicating No Yes Yes No Yes No No No Yes No No
‘Emergency Services Department’
Emergency Ward attached to Yes No Yes No Yes Yes No Yes Yes Yes Yes
Emergency Department
If Yes, the no. of beds 2 NA 2 NA 1 6 Not 1 2 Not 3

Triage area mentioned mentioned
Yes No Yes No Yes No No Yes Yes Yes No
Observation Beds Yes Yes Yes Yes Yes Yes No Yes Yes Yes No
If Yes, No. of beds
2 1 1 4 Not 6 NA 2 2 Not NA
mentioned mentioned

Trolleys and Wheel chairs Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
available If yes, exact No.
2 3 2 1 1 2 1 3 3 5 2
Examination rooms with all basic No No Yes No Yes Yes No Yes No Yes Yes
equipments
All the registers including MLR Yes Yes Yes No Yes Yes No Yes Yes Yes Yes
available for proper registration
Retiring room with toilets for the No No Yes No Yes No Yes Yes No Yes Yes
doctors
Call book in prescribed format No No No No No No No No Yes No No
available
(Contd...)
Waiting area for the Yes No Yes Yes Yes No Yes Yes Yes Yes No
attendants of patients with
the basic facilities like sitting
arrange-ments, drinking
water, toilet etc
Public telephone available Yes No No No No No No No No No No
Treatment room-cum-minor OT No Yes Yes No Yes No Yes Yes No Yes Yes
Major OT Yes No No No Yes No Yes Yes No Yes No
Sufficient stock of essential Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes
and life saving drugs
Oxygen cylinders with Yes No No Yes Yes Yes Yes Yes Yes Yes Yes
attachments
Laboratory services No No Yes No Yes No Yes Yes Yes Yes Yes
Radiology Services Yes No Yes No Yes No Yes Yes Yes Yes Yes
Ambulance services Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Staff trained in BLS No No Yes No Yes No Yes Yes Yes Yes Yes
Treatment facilities for Dog/ No Yes Yes Yes No Yes Yes Yes Yes Yes Yes
snake bite & Poisoning
Availability of Disaster No No Yes Yes Yes No No Yes Yes No No
Manual
Disaster Alert Code, recall & No No Yes Yes No No No Yes Yes No No
deployment
Maintenance of dedicated No No Yes Yes Yes No No Yes Yes No No
drug store for disaster
situation
Study to Review
215
216
Table 3.7 Clinical Laboratories at CHCs
Type of laboratories Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Biochemistry
Study to Review
Pathology No No No Yes Yes No No No No Yes No
Microbiology No No No Yes No No Yes Yes No Yes No
Qualified Pathologist No No No No No No No No No No No
available
Biochemist available No No No No No No No No No No No
Microbiologist available No No No No No No No No No No No
Following the universal No Yes Yes Yes Yes No Yes Yes Yes Yes No
precaution procedures
Using protective measures No No No Yes Yes No Yes Yes Yes Yes No
i.e. gloves/gowns/masks

Specimen collection done No No Yes Yes Yes No No Yes Yes Yes No
centrally
Availability of all the Yes Yes No No Yes Yes Yes Yes Yes Yes No
chemicals and reagents
Observing all the bio-safety No No Yes Yes Yes No No Yes Yes Yes No
measures
Regular Internal Quality No No Yes Yes Yes No No No Yes No No
control measures
undertaken
Regular External Quality No No Yes Yes Yes No No No No No No
control measures
undertaken
(Contd...)
Availability of Blood Bank No No No No No No No No No No No

Trained or qualified medical NA NA NA NA NA NA NA NA NA NA NA
officer posted as B.T.O.
Round the clock availability NA NA NA NA NA NA NA NA NA NA

of trained staff and services
Checking & cross matching NA NA NA NA NA NA NA NA NA NA NA
by B.T.O
Proper maintenance of cold NA NA NA NA NA NA NA NA NA NA NA
chain and refrigerators
Australia antigen, HCV, VDRL, NA NA NA NA NA NA NA NA NA NA NA
M.P. and HIV tests done for
Every blood bottle of donor.
Efforts made to collect NA NA NA NA NA NA NA NA NA NA NA
blood through Voluntary
Organisation Camps
Renewal of blood bank/HIV NA NA NA NA NA NA NA NA NA NA NA
License as per Rules
Disposal of HIV positive NA NA NA NA NA NA NA NA NA NA
blood bags & bio-safety
measures undertaken.
Availability of Table Top NA NA NA NA NA NA NA NA NA NA NA
Syringe & needle destroyer
and colour coded bags
Feed back of transfusion, NA NA NA NA NA NA NA NA NA NA NA
and record maintenance of
untoward incidences
Radiologist availability No No Yes No No No No No No No No
Availability of the dark room Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
with all facilities
Study to Review
Use of dosimeter and they No No No No No No No No No No Yes
regularly sent to BARC
217
218
Table 3.9 Special Investigations at CHCs
Special investigations like No No No No No No No No No No No
Study to Review
IVP, contrast media etc
Round the clock availability Yes Yes No Yes No No Yes Yes No Yes Yes
of X-ray services/
Sonography
Separate register for MLC Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes
records
Maintenance of history Yes No No Yes No Yes Yes Yes No No No
book and log book of X-ray
machines

Table 3.10 Operation Theatres at CHCs’
No. of major OT 1 1 0 2 1 1 1 1 2 1 1
No. of minor OT 1 1 1 0 1 0 1 1 0 1 1
Zoning Concept Strictly No No No Yes No No No Yes Yes No No
Followed
Maintenance of OT records Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No
Maintenance of OT No No No No No Yes No Yes Yes No No
postponement records
Emergency light-generator Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
facility for OT
Availability of fire fighting No No No No No No Yes No No No Yes
equipment & knowledge to
use them
Regular disinfection & Yes No Yes No Yes Yes Yes Yes Yes Yes No
sterilisation done at OT
Study to Review
219
Table 3.11 In patient wards at CHCs
220
Satisfactory cleanliness of wards No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
with adequate house keeping
Colour codes of yellow, No Yes Yes Yes Yes No Yes Yes Yes Yes Yes
blue,red,white bin & blue
Study to Review
transparent PPF for waste
collection, table top syringe &
needle destroyer& utilisation
Adequate water supply and upkeep No Yes Yes Yes Yes No Yes Yes Yes Yes No
of sanitary blocks
Adequate and clean toilets and No Yes Yes Yes Yes Yes Yes Yes Yes Yes No
bathrooms
Proper and adequate linen on beds No Yes No Yes Yes Yes No Yes Yes Yes Yes
Floor beds/doubling of beds No No No No No No No No No No No
involved
Satisfactory upkeep of cots, No Yes Yes Yes Yes Yes No Yes Yes Yes Yes

mattresses, lockers, linen etc.
Use of hospital uniforms by No No No No No No No Yes No No No
patients
Availability and functioning of Not Available Not Available Available Not Available Available Not Available Available
suction apparatus available available available available
Condition on availability Not Non NA Functional Functional NA Functional Functional NA Functional Functional
available Functional
Availability and functioning of Available Available Available Available Available Available Available Available Available Available Available
oxygen cylinders with accessories
Condition on availability Functional Functional Non Functional Functional Non Functional Functional Functional Functional Functional
functional functional
(Contd...)
Availability and functioning Not Not Not Available Available Not Not Available Not Not Not
of venesection/ LP/ available available available available available available available available
tracheostomy tray
Condition on availability NA NA NA Functional Functional NA NA Functional NA NA NA
Availability and functioning Available Available Not Available Available Not Available Available Available Available Available
of emergency light /wheel available available
chairs/stretcher trolley
Condition on availability Functional Functional NA Functional Functional NA Functional Functional Functional Functional Functional
Stationeries, forms and Yes Yes No Yes Yes Yes No Yes Yes Yes Yes
various updated registers etc.
Concept of progressive No Yes Yes Yes Yes No No No Yes No Yes
patient care
Adequacy and working of fans Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
and lights
Satisfactory availability of Not Not Not Not Not Not Not Not Not Not Not
diet available available available available available available available available available available available
Quality of care No Yes Yes Yes Yes No Yes Yes Yes No No
Maintenance of various Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
registers, records, etc.
Study to Review
221
Table 3.12 Hospital Medical Stores at CHCs
222
restriction on entery for Yes Yes Yes Yes Yes No No Yes No Yes Yes
unauthorised personnels
Staff knowledge on material No No Yes Yes Yes Yes Yes No Yes Yes No
management, system of FIFO,bin
Study to Review
cards, lead time, buffer stock
reorder level
Availability of vital,essential drugs Yes Yes No Yes Yes No Yes Yes Yes Yes No
in sufficient quantity
Upkeep of expiry date register and No No Yes No Yes Yes No Yes Yes No No
its regular inspection by MO i/c
Efforts made to redistribute large No No Yes Yes Yes No No Yes Yes No No
stocks of slow moving drugs or near
expiry for its utilisation
Proper arrangements to keep drugs No No No Yes Yes No No No Yes No No
as per ABC/VED category and
storage of rubber goods as per
guidelines

Appropriate steps taken to prevent No Yes Yes Yes Yes Yes No Yes Yes Yes No
pilferage or drugs
Convenient arrangement of issuing Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
drugs to various wards
Regular sending of samples to No No No No Yes No No No No No No
chemical laboratory for checking
standards of drugs
Circulation of list of available drugs Yes Yes No Yes Yes Yes No Yes Yes Yes No
to all MOs, OPD& wards as per
generic name
Submission of certified bills to No Yes Yes Yes Yes No No Yes Yes Yes No
office for release of payments with
in three days
Auction to clear the empty material Yes No No Yes Yes No No No Yes No Yes
from store done regularly
Availability of fire fighting Yes No No No No No Yes No No No No
equipment & knowledge to use them
Availability of regularly updated No No Yes No Yes No No No Yes No No
hospital drug formulary
Existence of standing drug Yes No No Yes Yes No No No No No No
committee
Table 3.13 Medical Record Department at CHCs’
Availability of medical record Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
room with enough no. of racks
etc.
Is the medical record Manual Manual Manual Manual Manual Manual Manual Manual Manual Manual Manual
computerised or manual
Is it managed by trained medical Yes No Yes No No No No Yes No Yes No
record officer/technician &
supervision provided by MOi/c
Case record is maintained as per No No No No No No No Yes Yes No No
WHO classification of diseases
(ICD-X)
Regular submission of morbidity, Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No
mortality reports
Is the backup facility kept to No No Yes No No No No No Yes No No
safe guard these records
Is the effective retrieval system Yes No No No No No Yes No Yes No Yes
followed
Regular death audit meeting Yes No No No Yes No No Yes No No No
held/minutes or meeting
recorded/ corrective action taken
Medical audit done at regular Yes Yes No Yes Yes Yes Yes No Yes No No
interval
Study to Review
223
224
Table 3.14 Hospital Waste Management at CHCs
Adequate no. of bins and No Yes Yes Yes Yes No Yes Yes Yes Yes Yes
bags of required colour codes
are available
Study to Review
Are these placed strategically No Yes Yes Yes Yes No Yes Yes Yes Yes Yes
Segregation of different No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
categories of waste done at
point of generation
Collection of waste, No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
packaging, labeling, record
keeping done in scientific
way
Proper transportation of No No Yes Yes Yes Yes Yes Yes Yes Yes Yes
waste collected
Storage facility and duration No Yes No Yes No Yes Yes No No No No

Disposal/ recycling methods No No No Yes No No Yes Yes Yes No No
for various categories of
waste
Availability of autoclave, No No No Yes Yes Yes Yes Yes No No Yes
shredders , incinerators
etc.
Table 3.15 Central Sterile Supply Department at CHCs
CSSD (under supervision No No Yes Yes No No Yes Yes No Yes Yes
of trained staff/ senior
nursing officer
Having all the required Yes No Yes Yes Yes Yes Yes Yes Yes Yes
equipments & autoclaves
Quality control measures No No Yes Yes Yes Yes No Yes Yes No Yes
are strictly followed
Table 3.16 Laundry Services at CHCs

Laundry services In-house In-house In-house In-house In-house Outsourced Outsourced Outsourced Outsourced Outsourced In-house
if in-house
Conventional Conventional Conventional Conventional Conven- Conven- Conven- Conven Conventional Conventional Conven tional
(dhobi) (dhobi) (dhobi) (dhobi) tional (dhobi) tional (dhobi) tional (dhobi) tional (dhobi) (dhobi) (dhobi) (dhobi)
Laundry staff Not Not Not Adequate Adequate NA NA NA NA NA Adequate

adequate adequate adequate
Quality of wash Average Average Average Good Good Average Average Good Average Good Average
Quality of linen Average Average Average Good Good Average Average Good Good Good Good
Study to Review
225
226
Table 3.17 Dietary Services
Description of Name of the CHC
facilities
Availability of Not available Not available Not available Not available Not Not Not Not Not available Not available Not
kitchen Facility available available available available available
Proper and safe NA NA NA NA NA NA NA NA NA NA NA
arrangement for
Study to Review
storage of raw
material
Measures for pest NA NA NA NA NA NA NA NA NA NA NA
and rodent control
Sanitation and NA NA NA NA NA NA NA NA NA NA NA
hygiene of the
cooking area
properly maintained
Regular health NA NA NA NA NA NA NA NA NA NA NA
checkup for food
handlers
Availability of NA NA NA NA NA NA NA NA NA NA NA

modern cooking
equipments
Availability of NA NA NA NA NA NA NA NA NA NA NA
properly maintained
records & registers
Diet service under NA NA NA NA NA NA NA NA NA NA NA
the supervision of a
qualified dietitian
Table 3.18 Medical Officers in Position
Name of Post Post Name of CHC

Badal Fategarh Feroz Goniana Kartarpur Khem Longo Machi- Mahil- Majitha Mana- Total
shah Karan wal Wara Pur wala
M.D. - 1 - 1 - 1 1 1 - 4 1 10
Medicine Diploma 1 - - - - - - - - - - 1
MBBS - - 1 - - - - 1 - - 2 4
M.S. 1 1 1 1 1 1 - 1 - - - 7
Surgery Diploma - - - - - - - - - - - -
MBBS - - - - - - - - - - - -
M.S. - - - - - 1 - - 1 - - 2
OBG Diploma - - - - - - - - - - - -
MBBS - - - - - - - - - - - -
M.D. - 1 1 - - - - - - - 1 3
Pediatrics Diploma - - - - - - - - - - - -
MBBS - - - - - - - - - - - -
M.S. - - - - 1 - - - 1 - - 2
ENT Diploma - - - - - - - - - - - -
MBBS - - - - - - - - - - - -
M.S. - - - - - - - - - - - -
Orthopedics Diploma 1 - - - - - - - - - - 1
MBBS - - - - - - - - - - - -
M.D. - - - - - - - - - - - -
Dermatologist Diploma - - - - - - - - - - - -
MBBS - - - - - - - - - - - -
M.D. - - - - - - - - - - - -
Psychiatry Diploma - - - - - - - - - - - -
Study to Review
MBBS - - - - - - - - - - - -
227
(Contd...)
Name of Post Post Name of CHC
228
Badal Fategarh Feroz Goniana Kartarpur Khem Longo Machi- Mahil- Majitha Mana- Total
shah Karan wal Wara Pur wala
M.D. 1 1 - - - - - 1 - - - 3
Anaesthesia Diploma - - - - - - - - - - - -
MBBS - - - - - - - - - - - -
M.D. - - - - - - - - - - - -
Study to Review
Blood Bank Diploma - - - - - - - - - - - -
MBBS - - - - - - - - - - - -
M.D. - - - - - - - - - - - -
Pathology Diploma - - - - - - - - - - - -
MBBS - - - - - - - - - - - -
MD/MSc - - - - - - - - - - - -
Bio-chemistry Diploma - - - - - - - - - - - -
MBBS - - - - - - - - - - - -
MD/MSc - - - - - - - - - - - -
Microbiology Diploma - - - - - - - - - - - -

MBBS - - - - - - - - - - - -
M.D. - - - - - - - - 1 - - 1
Radiology Diploma - - - - - - - - - - - -
MBBS 1 - - - - - - - - - - 1
BDS - 1 - - 1 1 - 1 - 1 1 6
Dental
MBBS 1 - - 1 - - - - - - - 2
Table 3.19 Five Years Performance Report of CHC Hospitals (Punjab)
Name of the CHC

Performance (Annual)
Badal Fategarh Feroz shah Goniana Kartarpur Khem Longo wal Machi- Mahil- Majitha Mana-
Karan Wara Pur wala
1st Yr 30492. 37673 8688 41371 59152 - 17797 28788 20361 44498 19683
2nd Yr 17531 39209 13792 44249 68949 - 13504 34748 26459 41406 21263
OPD attendance
3rd Yr 15594 47052 10804 35013 56222 21008 14038 35166 24531 51578 20980
last 5 year
4th Yr 18881 52710 9940 47352 59030 23310 17066 29461 33811 - 20387
5th Yr 27901 50034 11354 40925 62492 28756 13061 35158 37977 - 25980
st
1 Yr 649 1482 272 3116 1795 - 843 426 413 - -
nd
2 Yr 256 1476 523 2940 2017 - 629 719 631 - -
In-patient rd
3 Yr 281 1401 499 2089 1950 748 602 1415 621 1219 -
Admitted
th
4 Yr 608 1176 431 2592 1867 713 636 1266 328 1142 -
th
5 Yr 765 919 547 2966 1728 1229 465 1263 1072 1410 -
st
1 Yr 356 675 169 1576 241 - 386 573 255 - -
nd
2 Yr 1052 1084 425 1503 249 - 345 784 474 - -
No. of Surgeries
rd
done 3 Yr 1570 1242 703 706 271 807 140 791 518 814 -
th
4 Yr 2087 1293 605 1121 282 741 560 725 649 805 -
th
5 Yr 2272 1759 590 1524 292 1020 302 964 6 1314 -
st
1 Yr 120 280 139 791 - - 526 1478 13 - -
nd
2 Yr 61 348 293 735 - - 533 1756 131 - 768
No. of
3rd Yr 66 258 164 616 - 40 422 1791 167 - 956
emergencies
4th Yr 107 247 72 823 - 55 189 1933 106 - 1296
5th Yr 375 225 77 874 - 114 226 2675 387 - 1703
No. of 1st Yr - 233 51 744 547 - 257 344 13 - -
admission nd
2 Yr - 242 37 653 473 - 250 364 131 - -
through
rd
emergency 3 Yr - 141 45 469 493 31 264 263 167 509 -
Study to Review
4th Yr - 174 61 594 762 32 100 453 106 558 -
5th Yr - 261 71 627 697 106 104 466 365 500 -
229
(Contd...)
Name of the CHC
230
Performance (Annual)
Badal Fategarh Feroz shah Goniana Kartarpur Khem Longo wal Machi- Mahil- Majitha Mana-
Karan Wara Pur wala
1st Yr - 197 49 NA 203 - 133 281 0 378 208
nd
2 Yr - 169 43 283 225 - 122 315 0 415 257
No. of medico- rd
3 Yr - 145 49 248 237 - 104 300 0 385 264
legal cases
th
4 Yr - 91 72 354 305 - 68 400 0 365 239
th
Study to Review
5 Yr - 148 68 282 390 - 67 352 0 293 218
st
1 Yr - - NIL 0 - - 0 - 0 - -
2nd Yr - - 0 0 - - 0 - 0 - -
No. of
3rd Yr - - 0 0 - NA 0 - 0 - -
Postmortem
4th Yr - - 0 0 - NA 0 - 0 - -
5th Yr - - 0 0 - NA 0 - 0 - -
st
1 Yr 18 63 6 230 9 42 NA 1 - -
nd
2 Yr 23 56 13 102 23 43 NA - - -
No. of Normal
rd
deliveries 3 Yr 101 69 10 78 56 64 30 72 6 28 -
conducted th
4 Yr 84 13 9 78 82 86 38 151 - 32 -

th
5 Yr 8 4 7 76 71 139 43 54 - 40 -
st
1 Yr - 104 NIL 64 - - 4 NA - - -
nd
2 Yr - 73 Do 47 - - 0 NA 1 - -
No. of rd
3 Yr - 67 0 1 13 NIL 0 31 1 1 -
Caesarians done
th
4 Yr - 47 0 0 10 NIL 0 41 - 3 -
th
5 Yr - 9 0 0 7 NIL 0 5 - 7 -
Table 3.20 Staff Position at CHC
Name Post Badal Fategarh Feroz Goniana Kartarpur Khem Longo wal Machi- Mahil- Majitha Mana-
shah Karan Wara Pur wala
Sanction 11 1 5 5 6 1 - 6 1 1 6
Vacant 6 - 3 2 2 1 - 1 - - -
Doctors/ GDMO
Ad hock 1 - - - - - - - - - -
Total in Position 4 1 2 3 4 - - 5 1 1 6
Sanction 3 4 1 1 - 5 4 3 4 5 -
Vacant 2 1 - - - 1 3 1 - 1 (L.L) -
Doctors specialist
Ad hock - - - - - - - - - - -
Total in Position 1 3 1 1 - 4 1 2 4 4 -
Sanction 10 4 9 5 5 7 7 10 6 4 5
Vacant 5 - - 2 - 5 5 1 1 - -
Nursing Staff
Ad hock 3 - - - - - - - 4 - 1
Total in Position 2 4+3(*) 9 3 5 2 2 9 5+1(*) 3+7(*) 4
Sanction 1 3 3 3 2 4 3 4 1 2 5
Technician Vacant - - - 2 - 1 - 1 - - 1
(MLT) Ad hock 1 - 1 - - - - - - - -
Total in Position - 3 2 1 2 3 3 3 1 2 4
Sanction 1 - 3 2 - 1 - 5 1 - 6
Administrative Vacant - - - - - 1 - 1 - - -
staff Ad hock - - - - - - - - - - 1
Total in Position 1 - 3 2 - - - 4 1 missing - 5
Sanction 2 20 9 6 4 14 7 23 1 10 40
Vacant - - 1 - - 2 - 3 - - 7
Class IV
Ad hock - - - - - - - - - - -
Total in Position 2+7(*) 20 8 6 4 12 7 20 1 7+3(*) 33
Study to Review
(Contd...)
231
232
Name Post Badal Fategarh Feroz Goniana Kartarpur Khem Longo wal Machi- Mahil- Majitha Mana-
shah Karan Wara Pur wala
Sanction 2 3 - 3 - - 3 3 1 2 5
Vacant - - - - - - - 1 - - -
Safai Sewak
Ad hock - - - - - - - - - - -
Total in Position 2+3(*) 3 - 3 - - 3 2 1+2(*) 2+2(*) 5
Sanction 3 - 2 3 1 2 - - 1 - 3
Study to Review
Vacant - - - - - - - - - - -
Pharmacists
Ad hock - - - - - - - - - - -
Total in Position 3+4(*) - 2 3 1 2 - - 1 - 8+1(LL)
Sanction - 1 1 1 - 1 - - - - -
Vacant - - - - - - - - - - -
Ophthalmolo-Gists
Ad hock - - - - - - - - - - -
Total in Position - 1 1 1 - 1 - - - - -
Sanction - 1 1 1 - 1 - - 1 - -
Vacant - - - - - - - - - - -

Radiographer
Ad hock - - - - - 1 - - - - -
Total in Position - 1 1 1 - - - - 1 - -
Sanction - - 2 2 - 2 - - - - -
Vacant - - 1 1 - - - - - - -
BEE & Computer
Ad hock - - - - - - - - - - -
Total in Position - - 1 1 - 2 - - - - -
Sanction - - 3 3 - - - - - - -
Vacant - - - - - - - - - - -
MPW/ Trained Dai
Ad hock - - - - - - - - - - -
Total in Position - - 3 3 - - - - - - -
Sanction - - - - - 2 - - 1 - -
Others (Driver Vacant - - - - - 2 - - - - -

Cook) Ad hock - - - - - - - - - - -
Total in Position - - - - - - - - 1 - -
* Placed on Deputation in CHC
LL Staff on long leave
Table 3.21 Utilisation of User Charges in different CHC of PHSC (Punjab)
Name of CHC Years Total Income Total Detailed Expenditure Rogi Kalayan
(Collection) Expenditure
Medicine I.F.P. Buildings Equipment ERF A\c Salary to
contractual staff
2002-03 565264 644881 127036 59777 17832 47650 - 392586
2003-04 399211 470469 83575 51130 18378 16423 - 237963
2004 -05 348579 278619 80866 60687 15809 11391 - 109866
Badal 2005-06 310317 235849 72054 48060 15659 6261 - 93815
2006-07 368792 323920 65841 86891 47429 17888 14765 91106
2007-08 533207 690227 140727 182053 87348 110842 9123 160134
Total 25,25,370 25,80,965 5,70,099 4,88,598 2,02,455 2,10,455 23,888 10,85,470
2003-04 215000 355131 112023 112701 48806 72215 - 9386 -
2004-05 400000 434410 159859 138416 45184 86282 - 4633 -
Fateh Garh 2005-06 280425 331667 138780 90569 38388 50205 13725 0000 0000
Churian 2006-07 366520 323200 85931 92113 60074 75812 9270 0000 0000
2007-08 219240 389692 100870 140129 9395 39893 0000 0000 99405
Total 1481185 18,34,100 5,97,499 5,73,928 2,01,847 3,24,407 22,995 14,019 99,405
2004-05 70213 47001 11345 18558 8337 8761 - - -
2005-06 58344 42493 26645 13685 2080 83 - - -
Ferozshah 2006-07 51263 21298 6886 10000 3522 890 - - -
2007-08 36953 35426 4658 12976 5944 5904 - - -
Total 2,66,095 1,79,218 57,465 75,571 23,468 16,770 - - -
2003-04 250366 801568 429198 165769 98752 107849 - - -
2004-05 713391 543636 218989 162089 29174 87476 - 45908 -
2005-06 696636 744866 278851 137195 31166 115240 67929 114485 -
Goniana
2006-07 911286 674991 167246 190755 27689 62794 126507 - -
2007-08 562800 604410 197456 102112 21500 93508 145603 44231 100000
Study to Review
Total 3559998 3469471 1391740 757920 208281 466867 340039 204624 100000
(Contd...)
233
234
contractual staff
2003-04 431765 426968 217221 169371 31049 9327 - - -
2004-05 450315 359099 166057 153339 37876 1827 - - -
2005-06 478843 572262 322973 150704 32813 34387 - - -
Kartarpur
2006-07 492373 413679 211149 104888 54948 42694 - - -
Study to Review
2007-08 474959 469563 220268 58670 138152 52473 - - -
Total 23,28,255 22,41,571 11,37,668 6,36,972 2,94,838 1,40,708 - - -
2003-04 103447 89751 43998 30681 8732 6340 000 1072243 -
2004-05 130270 79366 29787 20491 14193 14855 000 1260697 -
2005-06 128097 98388 48182 22396 4745 20705 2360 844840 -
Khemkaran
2006-07 161712 159780 41508 51864 48769 14430 3309 1907024 -
2007-08 207068 241751 108074 94624 9228 24930 4895 -
Total 7,30,594 6,69,036 2,71,549 2,20,056 85,667 81,260 10,564 -
2003-04 124229 158285 36128 20271 12043 12043 - 78000 -
2004-05 79065 79434 33045 18359 11015 11015 - 6000 -

2005-06 66505 80028 36013 20007 12004 12004 - 0000 -
Longowal
2006-07 54895 65543 29494 16386 9831 9832 - 0000 -
2007-08 164564 130702 58816 32676 19605 19605 - 0000 -
Total 3,89,258 5,13,992 1,93,496 1,07,499 64,498 64,499 - 84.000 -
2003-04 281055 215745 106636 44143 57650 7316 - - -
2004-05 366152 285383 123477 97184 52766 11056 - - -
2005-06 51939 382006 210672 148645 9839 12850 - - -
Mahilpur
2006-07 322719 330901 138608 143693 29079 19521 - - -
2007-08 NA NA NA NA NA NA - - -
Total 13,21,865 12,14,035 5,80,293 4,33,665 1,49,334 50,743 - - -
(Contd...)
contractual staff
2003-04 135510 135119 45970 12824 11255 17070 - 48000 -
2004-05 182930 187379 58492 40568 15717 23037 - 49565 -
2005-06 184678 187891 84299 48859 11982 20660 3456 19135 -
Majitha
2006-07 288735 219896 74884 66133 39279 32305 7295 - -
2007-08 266770 266790 125567 57703 38585 40025 4910 - -
Total 10,58,623 9,97,075 3,89,212 2,26,087 1,16,318 1,33,097 15,661 1,16,700 -
2003-04 250717 148554 50853 62351 14306 21044 - -
2004-05 363384 325598 153708 107985 45625 18280 - -
2005-06 318580 233467 111935 91636 10554 9107 3825 6410 -
Machiwara
2006-07 293193 227145 98497 66777 18708 43163 2799 - -
2007-08 401442 404630 130392 149071 17841 107326 13935 - -
Total 16,27,316 13,39,394 5,45,385 4,77,820 1,07,034 1,98,920 20,559 6,410 -
2003-04 NA NA NA NA NA NA NA NA
2004-05 3,29,175 1,07,777 1,02,643 49,949 64,581 - 4,225 -
2005-06 4,36,904 1,79,740 1,27,786 14,801 1,08,297 - 6,280 -
Manawala
2006-07 3,20,209 1,22,149 1,08,489 34,452 49,541 - 5,578 -
2007-08 503043 5,32,964 2,20,740 1,37,261 92,839 66,975 - 15,149 100000
Total 16,19,252 6,30,406 4,76,179 1,92,041 2,89,394 - 31,232 1,00,000
Study to Review
235
Table 4. Distribution of Inpatients by Sex, Age Group, Education, Income & type of Health Facility Utilised
236
N=224
Socioeconomic dimension of inpatient District Hospital Sub-Divisional Hospital CHC Special Hospital TOTAL
Less than 15 2 0 0 1 3
1.9% 0% .0% 4.5% 1.3%
15-30 46 37 14 15 112
43.8% 54.4% 48.3% 68.2% 50.0%
Study to Review
31-45 19 17 4 5 45
Age group
18.1% 25.0% 13.8% 22.7% 20.1%
46-60 24 6 7 1 38
22.9% 8.8% 24.1% 4.5% 17.0%
Above 60 14 8 4 0 26
13.3% 11.8% 13.8% .0% 11.6%
Male 47 30 19 2 98
44.8% 44.1% 65.5% 9.1% 43.8%
Sex
Female 58 38 10 20 126
55.2% 55.9% 34.5% 90.9% 56.3%
Illiterate 45 19 12 4 80
42.9% 27.9% 41.4% 18.2% 35.7%

Primary 23 18 7 7 55
21.9% 26.5% 24.1% 31.8% 24.6%
Secondary 26 24 6 3 59
24.8% 35.3% 20.7% 13.6% 26.3%
Education
Senior secondary 9 3 4 4 20
8.6% 4.4% 13.8% 18.2% 8.9%
Graduate 2 1 0 2 5
1.9% 1.5% .0% 9.1% 2.2%
> Graduate 0 3 0 2 5
.0% 4.4% .0% 9.1% 2.2%
(Contd...)
Less than 2000 41 26 16 7 90
39.0% 38.2% 55.2% 31.8% 40.2%
2001-5000 47 27 9 5 88
44.8% 39.7% 31.0% 22.7% 39.3%
5001-10000 12 11 2 6 31
Income group
11.4% 16.2% 6.9% 27.3% 13.8%
10001-15000 4 4 1 3 12
3.8% 5.9% 3.4% 13.6% 5.4%
Above 15000 1 0 1 1 3
1.0% .0% 3.4% 4.5% 1.3%
Study to Review
237
Table 5. Admission In Different Categories of Hospitals
238
Emergency 55 38 16 6 115
52.4% 55.9% 55.2% 27.3% 51.3%
OPD 49 30 13 16 108
Admission through
46.7% 44.1% 44.8% 72.7% 48.2%
Can’t say 1 0 0 0 1
1.0% .0% .0% .0% .4%
Study to Review
Table 6. User Charges for Services in Various Hospitals in Punjab
Payment Type of Hospital Total

District Hospital SDH CHC Special Hospital
Yes 92 58 28 19 197
87.6% 85.3% 96.6% 86.4% 87.9%
No 13 9 1 3 26
Slip/card making
12.4% 13.2% 3.4% 13.6% 11.6%
No response 0 1 0 0 1
.0% 1.5% .0% .0% .4%
Yes 9 7 3 4 23
8.6% 10.3% 10.3% 18.2% 10.3%
No 96 60 21 18 195
Consultancy charges
91.4% 88.2% 72.4% 81.8% 87.1%
.0% 1.5% 17.2% .0% 2.7%
Yes 89 44 23 20 176
84.8% 64.7% 79.3% 90.9% 78.6%
Payment for No 16 23 6 2 47
admission charges 15.2% 33.8% 20.7% 9.1% 21.0%
.0% 1.5% .0% .0% .4%
Yes 88 58 28 19 193
83.8% 85.3% 96.6% 86.4% 86.2%
Payment for
No 16 8 0 3 27
investigation
15.2% 11.8% .0% 13.6% 12.1%
charges
1.0% 2.9% 3.4% .0% 1.8%
Yes 27 22 10 3 62
25.7% 32.4% 34.5% 13.6% 27.7%
Payment for any No 62 39 12 16 129
other 59.0% 57.4% 41.4% 72.7% 57.6%
Study to Review
15.2% 10.3% 24.1% 13.6% 14.7%
239
Table 7. Experience at OPD/emergency/reception/Admission, Quality of Treatment, Security & Admission Procedure of
240
Various Hospitals
Rating experience Type of Hospital Total

District Hospital Sub-Divisional Hospital CHC Special Hospital
Good 79 56 19 20 174
75.2% 82.4% 65.5% 90.9% 77.7%
Average 20 9 9 2 40
Study to Review
19.0% 13.2% 31.0% 9.1% 17.9%
Poor 1 3 0 0 4
OPD/Emergency
1.0% 4.4% .0% .0% 1.8%
Can’t say 4 0 1 0 5
3.8% .0% 3.4% .0% 2.2%
1.0% .0% .0% .0% .4%
Good 87 59 20 20 186
82.9% 86.8% 69.0% 90.9% 83.0%
Average 13 7 8 2 30
12.4% 10.3% 27.6% 9.1% 13.4%

Poor 0 1 0 0 1
Reception/admission
.0% 1.5% .0% .0% .4%
Can’t say 4 0 1 0 5
3.8% .0% 3.4% .0% 2.2%
1.0% 1.5% .0% .0% .9%
Good 85 50 21 21 177
81.0% 73.5% 72.4% 95.5% 79.0%
Average 16 14 7 1 38
Quality of treatment 15.2% 20.6% 24.1% 4.5% 17.0%
in hospital
Poor 1 3 0 0 4
1.0% 4.4% .0% .0% 1.8%
Can’t say 3 1 1 0 5
2.9% 1.5% 3.4% .0% 2.2%
(Contd...)
Rating experience Type of Hospital Total
Good 54 26 13 11 104
51.4% 38.2% 44.8% 50.0% 46.4%
Average 20 11 1 7 39
19.0% 16.2% 3.4% 31.8% 17.4%
Security of hospital
Poor 15 14 8 1 38
14.3% 20.6% 27.6% 4.5% 17.0%
Can’t say 16 17 7 3 43
15.2% 25.0% 24.1% 13.6% 19.2%
Good 11 3 1 1 16
10.5% 4.4% 3.4% 4.5% 7.1%
Rating of admission Average 12 8 3 4 27
procedure of hospital 11.4% 11.8% 10.3% 18.2% 12.1%
Poor 77 55 25 17 174
73.3% 80.9% 86.2% 77.3% 77.7%
Study to Review
241
Table 8. Patient’s Responses on Quality of Services in Terms of General Cleanliness, Basic Support Services in Ward in
242
Various Health Settings
Ward & bed- General characteristics Type of Hospital Total

District Hospital Sub-Divisional Hospital CHC Special Hospital N=224
Good 64 41 23 21 149
61.0% 60.3% 79.3% 95.5% 66.5%
Ward & bed- General Average 38 24 6 1 99
Study to Review
cleanliness 36.2% 35.3% 20.7% 4.5% 44.2%
Poor 3 3 0 0 3
2.9% 4.4% .0% .0% 1.3%
Good 63 43 29 19 149
60.0% 63.2% 100.0% 86.4% 66.5%
Average 35 19 0 3 69
Ward & bed- linen
33.3% 27.9% .0% 13.6% 30.8%
Poor 7 6 0 0 6
6.7% 8.8% .0% .0% 2.7%
Good 76 45 26 19 166
72.4% 66.2% 89.7% 86.4% 74.1%

Average 28 21 3 3 57
Ward & bed- comfort
26.7% 30.9% 10.3% 13.6% 25.4%
Poor 1 2 0 0 13
1.0% 2.9% .0% .0% 5.8%
Good 81 53 24 20 178
77.1% 77.9% 82.8% 90.9% 79.5%
Ward & bed- light Average 20 15 5 2 42
& fan 19.0% 22.1% 17.2% 9.1% 18.8%
Poor 4 0 0 0 3
3.8% .0% .0% .0% 1.3%
(Contd...)
Ward & bed- General characteristics Type of Hospital Total
District Hospital Sub-Divisional Hospital CHC Special Hospital N=224
Good 44 32 16 14 106
41.9% 47.1% 55.2% 63.6% 47.3%
Average 40 16 11 7 74
38.1% 23.5% 37.9% 31.8% 33.0%
Ward & bed- toilet
Poor 19 19 2 0 40
18.1% 27.9% 6.9% .0% 17.9%
Can’t say 2 1 0 1 4
1.9% 1.5% .0% 4.5% 1.8%
Good 17 8 7 4 36
16.2% 11.8% 24.1% 18.2% 16.1%
Average 3 3 0 1 7
Ward & bed- food 2.9% 4.4% .0% 4.5% 3.1%
Poor 0 1 0 0 1
.0% 1.5% .0% .0% .4%
Can’t say 85 56 22 17 180
81.0% 82.4% 75.9% 77.3% 80.4%
Study to Review
243
Table 9. Patients Observation about the Behaviour & Attitude of Nurses, Doctors, Staff during stay in Hospital
244
Type of Hospital Total
92 46 24 18 180
Good
87.6% 67.6% 82.8% 81.8% 80.4%
12 21 2 4 39
Behaviour of nurses Average
11.4% 30.9% 6.9% 18.2% 17.4%
during stay in
Study to Review
hospital 1 1 2 0 4
Poor
1.0% 1.5% 6.9% .0% 1.8%
0 0 1 0 1
Can’t say
.0% .0% 3.4% .0% .4%
97 64 27 21 209
Good
92.4% 94.1% 93.1% 95.5% 93.3%
Behaviour of doctors
7 3 2 1 13
during stay in Average
6.7% 4.4% 6.9% 4.5% 5.8%
hospital
1 1 0 0 2
Can’t say
1.0% 1.5% .0% .0% .9%
82 47 20 17 166
Good
78.1% 69.1% 69.0% 77.3% 74.1%

19 14 6 4 43
Behaviour of rest of Average
18.1% 20.6% 20.7% 18.2% 19.2%
staff during stay in
hospital 1 0 2 1 4
Poor
1.0% .0% 6.9% 4.5% 1.8%
3 7 1 0 11
Can’t say
2.9% 10.3% 3.4% .0% 4.9%
84 49 22 19 174
Good
80.0% 72.1% 75.9% 86.4% 77.7%
20 16 5 3 44
Average
Attitude of sisters at 19.0% 23.5% 17.2% 13.6% 19.6%
admission 0 1 2 0 3
Poor
.0% 1.5% 6.9% .0% 1.3%
1 2 0 0 3
Can’t say
1.0% 2.9% .0% .0% 1.3%
Table 10. Patient’s Responses on Quality of Services in Terms of Availability of Medicines in the Ward Laboratory &
Radiological Services

All available 13 6 4 7 30
12.4% 8.8% 13.8% 31.8% 13.4%
54 36 21 14 125
Availability of Some available
51.4% 52.9% 72.4% 63.6% 55.8%
medicines in the
ward None available 36 25 3 1 65
34.3% 36.8% 10.3% 4.5% 29.0%
Can’t say 2 1 1 0 4
1.9% 1.5% 3.4% .0% 1.8%
Good 69 37 15 19 140
65.7% 54.4% 51.7% 86.4% 62.5%
Facilities for Average 27 15 11 1 54

laboratory & 25.7% 22.1% 37.9% 4.5% 24.1%
radiological Poor 1 2 0 0 3
investigations 1.0% 2.9% .0% .0% 1.3%
Can’t say 8 14 3 2 27
7.6% 20.6% 10.3% 9.1% 12.1%
Table 11. Patient’s Response in Terms of any Money Spent on Medicine
Yes 98 68 20 18 204
Any money spend on 93.3% 100.0% 69.0% 81.8% 91.1%
medicine No 7 0 9 4 20
6.7% .0% 31.0% 18.2% 8.9%
Yes 0 1 0 0 1
Paid any money to .0% 1.5% .0% .0% .4%
Study to Review
staff member during
stay in hospital No 105 67 29 22 223
100.0% 98.5% 100.0% 100.0% 99.6%
245
Table 12. Patient’s Responses on Quality of Services in Terms of Adequacy of Information About Rules, Regulation, Disease
246
& Treatment In Health Settings

Yes 60 38 13 11 122
57.1% 55.9% 44.8% 50.0% 54.5%
Information about No 43 30 15 11 99
Study to Review
rules and regulation 41.0% 44.1% 51.7% 50.0% 44.2%
1.9% .0% 3.4% .0% 1.3%
Complete 69 45 24 17 155
65.7% 66.2% 82.8% 77.3% 69.2%
Information about Partial 33 16 3 3 55

disease & treatment 31.4% 23.5% 10.3% 13.6% 24.6%
by doctor Inadequate 1 7 1 2 11
1.0% 10.3% 3.4% 9.1% 4.9%
Can’t say 2 0 1 0 3
1.9% .0% 3.4% .0% 1.3%

Table 13. Satisfactions of the Patients with Services of Hospital at the Various Health Facilities
Yes 101 59 29 22 211

Satisfaction with 96.2% 86.8% 100.0% 100.0% 94.2%
services of hospital No 4 9 0 0 13
3.8% 13.2% .0% .0% 5.8%
Table 14. Suggestions for Further Improvement in the Services by the In-patients
S.No Suggestions for Improvement of the Services for In-patient Department N = 224 Percentage
1. Medicines should be available in the hospital/provide all medicines. 42 18.75
2. Medicines should be provided free of cost or subsidise rate. 15 6.7
3. Health facilities should be provided free of cost to BPL/poor families 14 6.25
4. Quality of medicine should be improved, those are supplied by the hospitals 3 1.34
5. Needs regular visits of higher authorities for day-to-day work of the hospitals/female doctors/specialist should treat gynae. problems & 10 4.46
doctors should be available in OPD clinic on fixed days.
6. Doctors should be available in hospitals at night shifts/needs proper care at night shifts in emergency. 3 1.34
7. Behaviour of staff nurses & class-IV employees should be improved towards patients. 3 1.34
8. Other facilities needs to be improved:
i) Provision of food for the patients on subsidise rate 12 5.36
ii) Needs cleanliness of toilets/separate toilets for male & female. 15 6.7
iii) Hospital cleanliness. 11 4.91
iv) Drinking water facilities should be available /improved. 5 2.23
v) All diagnostic facilities for treatment should be available in the hospitals on subsidise rate or free of cost. 4 1.79
vi) Proper Security arrangements for wards & Hospital. 4 1.79
vii) Private rooms should be available in hospitals for patients on payment basis/needs sitting arrangements & patient’s attendants. 4 1.79
9. Satisfied with the Health Services. 9 4.02
10 No response 112 50
Study to Review
247
Table 15. Distribution of Outpatient by Sex, Age Group, Education, Income and Type of Facility Utilised
248
N=580
116 65 57 6 244
Male
(40.8) (48.1) (50) (12.8) (42.1)
Sex
168 70 57 41 336
Female
(59.2) (51.9) (50) (87.2) (57.9)
Study to Review
15 6 2 12 35
Less than 15
(5.3) (4.4) (1.8) (25.5) (6.0)
110 46 22 26 204
15-30
(38.7) (34.1) (19.3) (55.3) (35.2)
86 36 43 6 171
Age 31-45
(30.3) (26.7) (37.7) (12.8) (29.5)
54 28 29 1 112
46-60
(19) (20.7) (25.4) (2.1) (19.3)
19 19 18 2 58
Above 60
(6.7) (14.1) (15.8) (4.3) (10.0)
82 52 56 12 202
Illiterate

(28.9) (38.5) (49.1) (25.5) (34.8)
65 34 18 13 130
Primary
(22.9) (25.2) (15.8) (27.7) (22.4)
80 26 19 8 133
Secondary
(28.2) (19.3) (16.7) (17.0) (22.9)
Education
30 16 13 10 69
Senior Secondary
(10.6) (11.9) (11.4) (21.3) (11.9)
19 5 5 4 33
Graduate
(6.7) (3.7) (4.4) (8.5) (5.7)
8 2 3 0 13
>Graduate
(2.8) (1.5) (2.6) (0.0) (2.2)
(Contd...)
Less than 2000 85 49 52 11 197
(29.9) (36.3) (45.6) (23.4) (34.0)
2001-5000 120 42 36 22 220
(42.3) (31.1) (31.6) (46.8) (37.9)
5001-10000 48 30 10 6 94
(16.9) (22.2) (8.8) (12.8) (16.2)
Income
10001-15000 14 5 5 2 26
(4.9) (3.7) (4.4) (4.3) (4.5)
Above 15000 16 6 2 5 29
(5.6) (4.4) (1.8) (10.6) (5.0)
Don’t Know 1 3 9 1 14
(0.4) (2.2) (7.9) (2.1 (2.4)
Study to Review
249
Table 16. User Charges for Services in Various Health Care Settings
250
Type of Hospital TOTAL
Yes 268 133 106 43 550
(94.4) (98.5) (93.0) (91.5) (94.8)
OPD card charges
16 2 8 4 30
No
(5.6) (1.5) (7.0) (8.5) (5.2)
Study to Review
13 5 4 6 28
Yes
(4.6) (3.7) (3.5) (12.8) (4.8)
269 130 109 41 549
Consultancy charges No
(94.7) (96.3) (95.6) (87.2) (94.7)
2 0 1 0 3
Can’t say
(0.7) (0.0) (0.9) (0.0) (0.5)
196 97 81 32 406
Yes
(69.0) (71.9) (71.1) (68.1) (70.0)
Investigation 82 33 29 15 159
No
charges (28.9) (24.4) (25.4) (31.9) (27.4)
6 5 4 0 15
Can’t say
(2.1) (3.7) (3.5) (0.0) (2.6)

71 27 34 21 153
Up to 100
46.4% 17.6% 22.2% 13.7% 100.0%
68 29 26 9 132
101 - 200
Money spent on 51.5% 22.0% 19.7% 6.8% 100.0%
medicine 58 22 11 7 98
201-500
59.2% 22.4% 11.2% 7.1% 100.0%
35 12 10 4 61
Above 500
57.4% 19.7% 16.4% 6.6% 100.0%
Table 17. Patients Observations about Cleanliness, Basic Support Services and Privacy During Examination in Various
Health Care Settings in Punjab

Good 210 (73.9) 96 (71.1) 73 (64.0) 41 (87.2) 420 (72.4)
Average 65 (22.9) 37 (27.4) 39 (34.2) 6 (12.8) 147 (25.3)
General cleanliness
Poor 7 (2.5) 0 (0.0) 2 (1.8) 0 (0.0) 9 (1.6)
Cannot say 2 (0.7) 2 (1.5) 0 (0.0) 0 (0.0) 4 (0.7)
Good 235 (82.7) 104 (77.0) 68 (59.6) 44 (93.6) 451 (77.8)
Average 45 (15.8) 28 (20.7) 42 (36.8) 3 (6.4) 118 (20.3)
Waiting area
Poor 2 (0.7) 0 (0.0) 3 (2.6) 0 (0.0) 5 (0.9)
Cannot say 2 (0.7) 3 (2.2) 1 (0.9) 0 (0.0) 6 (1.0)
Good 225 (79.2) 113 (83.7) 59 (51.8) 42 (89.4) 439 (75.7)
Average 52 (18.3) 18 (13.3) 32 (28.1) 5 (10.6) 107 (18.4)
Light and fan
Poor 3 (1.1) 1 (0.7) 22 (19.3) 0 (0.0) 26 (4.5)
Cannot say 4 (1.4) 3 (2.2) 1 (0.9) 0 (0.0) 8 (1.4)
Yes 138 (48.6) 71 (52.6) 19 (16.7) 22 (46.8) 250 (43.1)
STD/PCO Booth No 135 (47.5) 54 (40.0) 84 (73.7) 25 (53.2) 298 (51.4)
Can’t say 11 (3.9) 10 (7.4) 11 (9.6) 0 (0.0) 32 (5.5)
Yes 250 (88.0) 116 (85.9) 87 (76.3) 46 (97.9) 499 (86.0)
Separate toilet for
No 27 (9.5) 16 (11.9) 15 (13.2) 1 (2.1) 59 (10.2)
women
Cannot say 7 (2.5) 3 (2.2) 12 (10.5) 0 (0.0) 22 (3.8)
Yes 250 (88.0) 131 (97.0) 89 (78.1) 47 (100.0) 517 (89.1)
Drinking Water No 31 (10.90) 4 (3.0) 16 (14.0) 0 (0.0) 51 (8.8)
Cannot say 3 (1.1) 0 (0.0) 9 (7.9) 0 (0.0) 12 (2.1)
Yes 245 (86.3) 119 (88.1) 95 (83.3) 47 (100.0) 506 (87.2)
Confidentiality
(screened No 34 (12.0) 13 (9.6) 5 (4.4) 0 (0.0) 52 (9.0)
Study to Review
examination room)
Cannot say 5 (1.8) 3 (2.2) 14 (12.3) 0 (0.0) 22 (3.8)
251
Table 18. Quality of Services in Terms of Adequacy of Information, Availability of Medicine, Laboratory Services,
252
Behaviour of Staff

Good 244(85.9) 106 (78.5) 82(71.9) 40(85.1) 472 (81.4)
Adequacy of information
given to patient about Average 31(10.9) 17(12.6) 26(22.8) 5(10.6) 79 (13.6)
disease and treatment by Poor 3(1.1) 7(5.2) 2(1.8) 2 (4.3) 14(2.4)
Study to Review
doctor
Can not say 6(2.1) 5(3.7) 4(3.5) 0(0.0) 15(2.6)
All available 17(6.0) 23(17.0) 16(14.0) 4(8.5) 60(10.3)
Some available 154(54.2) 92(68.1) 83(72.8) 35(74.5) 364(62.8)
Availability of medicines
None available 111(39.1) 19(14.1) 15(13.2) 8(17.0) 153(26.4)
No response 2(0.7) 1(0.7) 0(0.0) 0(0.0) 3(0.5)
Good 153(53.9)) 70(51.9) 41(36.0) 30(63.8) 294(50.7)
Facilities for laboratory and Average 66(23.2) 23(17.0) 37(32.5) 2(4.3) 128(22.1)
radiological investigation Poor 4(1.4) 3(2.2) 4(3.5) 0(0.0) 11(1.9)
Can not say 61(21.5) 39(28.9) 32(28.1) 15(31.9) 147(25.3)

Good 159(56.0) 81(60.0) 57(50.0) 33(70.2) 330(56.9)
Behaviour of rest of the Average 98(34.5) 41(30.4) 46(40.4) 3(6.4) 188(32.4)

staff? Poor 5(1.8)) 4(3.0) 1(0.9) 1(2.1) 11(1.9)
Can not say 22(7.7) 9(6.7) 10(8.8) 10(21.3) 51(8.8)
Payment to any staff Yes 9(3.2) 4(3.0) 3(2.6) 1(2.1) 17(2.9)

member No 275(96.8) 131(97.0) 111(97.4) 46(97.9) 563(97.1)
Good 223(78.5) 104(77.0) 69(60.5) 44(93.6) 440(75.9)
Rating the quality of Average 53(18.7) 25(18.5) 41(36.0) 3(6.4) 122(21.0)

treatment in the hospital Poor 5(1.8) 3(2.2) 0(0.0) 0(0.0) 8(1.4)
Can not say 3(1.1) 3(2.2) 4(3.5) 0(0.0) 10(1.7)
(Contd...)
Good 159(56.0) 81(60.0) 57(50.0) 33(70.2) 330(56.9)
Behaviour of rest of the Average 98(34.5) 41(30.4) 46(40.4) 3(6.4) 188(32.4)

staff? Poor 5(1.8)) 4(3.0) 1(0.9) 1(2.1) 11(1.9)
Can not say 22(7.7) 9(6.7) 10(8.8) 10(21.3) 51(8.8)
Satisfaction with the Yes 223(78.5) 108(80.0) 91(79.8) 30(63.8) 452(77.9)

services of the hospital No 61(21.5) 27(20.0) 23(20.2) 17(36.2) 128(22.1)
Study to Review
253
Table 19. Patients’ Observations Regarding Health Man Power in Various Health Care Settings in Punjab
254
Type of Hospital
Good 225 (79.2) 104 (77.0) 80 (70.2) 44 (93.6)
Cooperation at the reception of Average 50 (17.6) 30 (22.2) 33 (28.9) 3 (6.4)

the counter Poor 5 (1.8) 1 (0.7) 1 (0.9) 0 (0.0)
Can not say 4 (1.4) 0 (0.0) 0 (0.0) 0 (0.0)
Study to Review
Available 270 (95.1) 132 (97.8) 102 (89.5) 46 (97.9)
Availability of doctors
Not available 14 (4.9) 3 (2.2) 12 (10.5) 1 (2.1)
Available 256 (90.1) 116 (85.9) 74 (64.9) 43 (91.5)
Availability of specialists
Not available 28 (9.9) 19 (14.1) 40 (35.1) 4 (8.5)
Available 229 (80.6) 104 (77.0) 89 (78.1) 36 (76.6)
Availability of nurses
Not available 55 (19.4) 31 (23.0) 25 (21.9) 11 (23.4)
Good 264 (93.0) 124 (91.9) 98 (86.0) 44 (93.6)
Average 16 (5.6) 9 (6.7) 13 (11.4) 3 (6.4)
Behaviour of doctors
Poor 1 (0.4) 0 (0.0) 0 (0.0) 0 (0.0)

Can not say 3 (1.1) 2 (1.5) 3 (2.6) 0 (0.0)
Good 245 (86.3) 106 (78.5) 66 (57.9) 41 (87.2)
Average 13 (4.6) 10 (7.4) 12 (10.5) 3 (6.4)
Behaviours of specialists
Poor 3 (1.1) 0 (0.0) 0 (0.0) 0 (0.0)
Can not say 23 (8.1) 19 (14.1) 36 (31.6) 3 (6.4)
Good 179 (63.0) 84 (62.2) 78 (68.4) 33 (70.2)
Average 41 (14.4) 21 (15.6) 16 (14.0) 4 (8.5)
Behaviour of nurses
Poor 3 (1.1) 2 (1.5) 1 (0.9) 0 (0.0)
Can not say 61 (21.5) 28 (20.7) 19 (16.7) 10 (21.3)
Table 20. Waiting Time for Registration, Consultation with Doctors and Specialist, Investigations and Receiving Medicines

Up to 15 minutes 235 123 109 45 512
83.6% 91.1% 95.6% 95.7% 88.7%
16 - 30 minutes 35 10 5 2 52
Registration time
12.5% 7.4% 4.4% 4.3% 9.0%
Above 30 minutes 11 2 13
3.9% 1.5% 2.3%
Total Count 281 135 114 47 577
Col % 100.0% 100.0% 100.0% 100.0% 100.0%
Up to 15 minutes 89 63 36 13 201
55.6% 79.7% 72.0% 46.4% 63.4%
Specialist consulting 16 - 30 minutes 38 13 13 8 72
time 23.8% 16.5% 26.0% 28.6% 22.7%
Above 30 minutes 33 3 1 7 44
20.6% 3.8% 2.0% 25.0% 13.9%
Count 160 79 50 28 317
Total
Col % 100.0% 100.0% 100.0% 100.0% 100.0%
Up to 30 minutes 173 72 73 29 347
80.5% 91.1% 86.9% 78.4% 83.6%
31 - 60 minutes 24 4 7 6 41
Investigation time
11.2% 5.1% 8.3% 16.2% 9.9%
Above 60 minutes 18 3 4 2 27
8.4% 3.8% 4.8% 5.4% 6.5%
Count 215 79 84 37 415
Total
Col % 100.0% 100.0% 100.0% 100.0% 100.0%
Up to 10 minutes 134 85 94 32 345
74.0% 81.0% 90.4% 86.5% 80.8%
Time getting 11 - 20 minutes 39 14 6 5 64
medicine 21.5% 13.3% 5.8% 13.5% 15.0%
Study to Review
Above 20 minutes 8 6 4 18
4.4% 5.7% 3.8% 4.2%
Count 181 105 104 37 427
Total
255
Col % 100.0% 100.0% 100.0% 100.0% 100.0%
Table 21. Patient’s Experience (Rating) at OPD of Various Health Care Settings
256
N=580
Good 203 (71.5) 98 (72.6) 65 (57.0) 40 (85.1) 406 (70.0)
Average 75 (26.4) 32 (23.7) 45 (39.5) 7 (14.9) 159 (27.4)
Poor 3 (1.1) 4 (3.0) 1 (0.9) 0 (0.0) 8 (1.4)
Study to Review
Can’t say 3 (1.1) 1 (0.7) 3 (2.6) 0 (0.0) 7 (1.2)

Table 22. Suggestions for Further Improvement in the Services

No suggestion 82 33 30 18 163
(29.0) (24.6) (26.8) (38.3) (28.3)
Provide all medicine at least to poor people 151 58 56 26 291
(53.4) (43.3) (50.0) 55.3% 50.5%
Proper supervision of higher officials 2 0 1 0 3
(0.7) .0% .9% .0% .5%
Proper care/ emergency care should be 7 7 6 1 21
provided (2.5) 5.2% 5.4% 2.1% 3.6%
Provide more doctors or specialists 10 14 13 0 37
(3.5) 10.4% 11.6% .0% 6.4%
Cleanliness 20 7 0 1 28
(7.1) 5.2% .0% 2.1% 4.9%
Provision of female doctors 0 2 0 0 2
(0.0) 1.5% .0% .0% .3%
Punctuality of staff should be maintained 0 2 1 0 3
(0.0) 1.5% .9% .0% .5%
Good behaviour of staff 1 2 0 1 4
(0.4) 1.5% .0% 2.1% .7%
Provide more staff 1 1 0 0 2
.4% .7% .0% .0% .3%
Provision for female privacy 2 0 0 0 2
.7% .0% .0% .0% .3%
Satisfied with present condition 4 8 1 0 13
1.4% 6.0% .9% .0% 2.3%
Should get costly medicines 1 0 3 0 4
.4% .0% 2.7% .0% .7%
Provision of food 2 0 1 0 3
(0.7) .0% .9% .0% .5%
Study to Review
257
Type of Health Institute = District Hospital
258
Registration time Doctors consulting Specialists consulting Investigations time Time in getting Money spent to buy
time time medicines medicine
Mean 12.19 30.48 22.24 29.91 9.52 449.77

Median 10.00 25.00 12.50 20.00 10.00 200.00
Mode 10 30 0 30 10 150
Study to Review
Std. Deviation 13.005 27.481 23.133 32.919 7.375 1378.487
Range 104 209 120 307 50 13000
Minimum 1 1 0 0 0 0
Maximum 105 210 120 307 50 13000
Type of Health Institute = Sub-Divisional Hospital
Statistics Registration time Doctors consulting Specialists consulting Investigations time Time in getting Money spent to buy

Mean 8.09 17.21 11.99 21.67 9.50 245.56
Median 5.00 10.00 10.00 15.00 10.00 200.00
Mode 5 5 10 30 10 200
Std. Deviation 7.581 19.875 15.931 27.208 8.266 226.589
Range 44 120 120 180 60 1260
Minimum 1 0 0 0 0 20
Maximum 45 120 120 180 60 1280

Type of Health Institute = CHC
Mean 6.68 18.37 11.40 19.71 7.47 216.67
Median 5.00 10.00 10.00 10.00 5.00 150.00
Mode 5 10 0 5 5 200
Std. Deviation 5.112 18.017 13.288 27.301 5.951 220.623
Range 29 119 60 150 30 999
Minimum 1 1 0 0 0 1
Maximum 30 120 60 150 30 1000
Type of Health Institute = Special Hospital
Mean 7.26 18.87 26.25 26.14 8.59 195.93
Median 5.00 12.50 20.00 20.00 10.00 100.00
Mode 5 5 15 30 10 100
Std. Deviation 4.623 17.642 18.540 19.405 4.524 186.691
Range 19 57 55 78 19 988
Minimum 1 3 5 2 1 12
Maximum 20 60 60 80 20 1000
Study to Review
259
Table 23. Responses of the Deputy Commissioners
260
Facility/ Name of the Amritsar Bathinda Ferozpur Gurdaspur Jalandhar Ludhiana Muktsar Sangrur Taran Ta
District
Length of service 5 months 8 months 1 yrs. 2 months < 2 yrs. < 2 yrs. 1 yrs. 1 yr. 5 months
Overall functioning of O.K Average Not well Good Can’t say Good OK Lack of doctors Good
CHC, SDH and DH
Availability of staff - Shortage of Shortage of Shortage of - - Shortage of Lack of doctors Shortage of
Study to Review
staff staff staff staff staff
Extent of fulfilment 50% Partially 70 - 80% Good Can’t say Large Not Good Large Extent 40%
of health needs of
community
Referral services No Idea Non-availability Ambulance not Not Good Can’t say Yes Not Good Satisfactory Satisfactory
is a problem fully equipped
Knowledge of RKS BPL Cards Yes Yes Yes - - Yes No Yes
Fund flow No problem Not through DC - Not full utilised Inadequate - - No problem Not through
D.C.
Poor patients exempt BPL Card Red Cross Yes Yes partially - BPL Cards Yes partially Red Cross Yes
from User Charges holders

Motivation Level - Very low Good Good - - Good Not low Low
Perceived Barriers
Availability Nil Nil Nil Nil Yes - Yes Nil ↓ CHC
Accessibility Nil Nil Nil Nil Yes - Yes Nil ↓ CHC
Utilisation Nil Nil Nil Nil Yes - No ↓ ↓ CHC
Acceptability Nil Nil Nil Nil Yes - No ↓ ↓ CHC
Table 24. Responses of the MLA/elected Representative at District Level
Amritsar Bathinda Ferozpur Gurdaspur Hoshiarpur Jalandhar Ludhiana Muktsar Sangrur Taran Ta
Length of service > 2 yrs. - >2 yrs. 1.5 yrs. 1 yr. 1.5 yrs. >2 yrs. > 2 yrs. > 2 yrs. > 2 yrs.
Overall functioning Good Average Satisfactory OK Average Good Good Well Poor in CHC Not very good
Availability of staff Yes Doctors post Shortage of Shortage Sometimes Scarcity Yes, But Less in no. No doctors Yes
vacant D&N shortage of
Doctors
Availability of Medicines No No Yes Less No Some Yes Not enough Not enough No Some
in OPD
Overall services of O.K. Average Satisfactory Average - Good Average Gynae-Bad Satisfactory Average
Hospital
Extent of fulfilment 80% 30% Good no. 60% Only poor < 50% To some 60% 60-70% 40%
of health needs of use it extent
Community
Waiting Time 2 - 5 mins. Not much 20-30 mins. 2-3 hrs. Not much 2-3 hrs. 30-60 mins. Not much Not much Not much
Cleanliness Good Not proper Good Good O.K. Good Good Not good Satisfactory Good
Behaviour of staff Good Not Good Good Fine Rude Nurses Good OK Very Good Good
satisfactory & Class IV
Referral services No problem - Satisfactory N.A. Not good Scarcity of Yes Not available Very Good No ambulance
Ambulance
Knowledge of RKS Yes No Yes Yes No Yes BPL Cards No No No
Yes.
Poor patients exempted Yes - Yes Yes No No No Red Cross From NGOs -
from treatment charges Funds
Perceived Barriers
Availability Nil Nil Nil Nil Nil Less Medicine Nil Ambulance Nil Nil
Service
Accessibility Nil Nil Nil Referral Requires Nil Nil Nil Nil Nil
money
Utilisation Nil Nil Nil Medicines Medicines not Scarcity of - Less facilities ↓ CHC ↓
available Medicine
Study to Review
Acceptability Nil Nil Nil Nil Nil Non - Nil ↓ CHC ↓
availability of
equipments
261
Table 25: Responses of the Civil Surgeons
262
Amritsar Bathinda Ferozpur Gurdaspur Hoshiarpur Jalandhar Ludhiana Muktsar Sangrur Taran Taran
Length of service <1 year 2 years 1.5 years - 1.5 years 1.5 years 2.5 months 2 months - 1.5 years
Overall functioning of OPD - O.K, Over utilised Well Well CHC-poor DH- Except CHC Well CHC OPD lacks Not fully CHC-Average, SDH-
CHC, SDH and DH Indoor- Good rest well manpower Utilised Good, DH-New,
Problem rest O.K. coming up
Bed Occupancy (%)
Study to Review
CHC 50 50 - 10 - 15% - 60 50 20 50 40
SDH 50 70 - 100% 50.8 70.8 90 90 80.9 90
D.H. 50 100 - 100% 50.8 70 87 100 80.9 90
Extent of fulfilment Full 60% 50 - 60% Satisfactory Large extent Not fulfilled 90% 70% 60 - 70% Large extent
of health needs of at Village
Community level
Medicine in OPD Yes No No No Yes No No No No No
Waiting Time Nil Less Long Less Long Long Less Long Long Less
Cleanliness Not proper Not good Good Very Good Good Not good Good O.K. Not clean Average
Behaviour of staff Overwork Good Good Doctors - Good Satisfactory Cordial Good Average Needs
leads to Good improvement

irritation Nurses-O.K
Referral services No driver, Satisfactory Not good No problem Good Ambulance - Less no. of Ambulance Satisfactory
only 1 shortage ambulance with
ambulance payment
Fund flow No problem Only user User charges No problem No funds No problem - Slight delay No problem Only under NRHM
charges
Manpower Management
Motivation level Low Good Satisfactory V.Good O.K. Low Good Good Low Low
Perceived Barriers
Availability Nil CHC ± Nil Nil - Nil Nil Lack of O.K. O.K.
Manpower in
SDH & CHC
Accessibility Nil Nil Nil Nil - Nil Nil Yes Nil ↓ CHC
Utilisation Nil ↓ CHC Nil Nil - Nil Medicine facility No O.K. ↓ CHC
Acceptability Nil ↓ CHC Nil Nil - Nil Nil No ↓ CHC ↓ CHC
Table 26. Responses of The SMOs Incharge of District Hospitals
Amritsar Bathinda Ferozpur Gurdaspur Hoshiarpur Jalandhar Ludhiana Muktsar Sangrur Taran Taran
Length of service < 2 yrs. > 2 yrs. < 2 yrs. 15 days > 2 yrs. 4 yrs. < 2 yrs. 3 yrs. 3 years 5 months
OPD Services- Staff Adequate Shortage of Less Adequate Sufficient Shortage No security Radiologist Shortage of
strength paramedics, Specialists Doctors. Less of nurses & guards Specialists – absent. EMO, staff
staff Nurses class IV Jr.doctors lacking Psychiatrist vacant
Bed Occupancy Rate (%) 80% 100% 98-100% 100% 75-76% 70% 75% 60-70% 74% 60-70%
Medicines to poor in OPD Yes BPL Yes Yes Yes Yes Some - Very few Mostly all Not all
Existence of RKS Yes Yes Yes No Yes Yes Yes Yes Yes Yes
(Recently) (Recently)
Information regarding NHP Available Available Yes Yes Yes Yes Yes Yes Not under PHSC Yes
Extent of fulfilment of By poor and Full 100% 100% - Full By poor More for OPD 80% Over used
health needs of Community middle class patients
mostly
IPD Services Nurse/Bed 1:2 Nurses Less 1:4.5 1:20 - - - 1:5 1:5 1:6
ratio (1:40)
Staff Strength Doctors/Bed 1:2 1:7 1:6 1:25 - - - - 1:5 1:5
ratio
Cleanliness Satisfactory Not good O.K. OK Outsourced - On contract On contract Difficult to maintain On contract
Emergency Service Yes Yes Yes Yes Yes Yes Yes On call Yes Yes
Available round the clock
Fund flow No problem Shortage No problem No problem No funds only No money No problem Sanctions No role of SMO No fund
User Charges given from CS/DMC
Performance appraisal Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
system
Perceived Barriers
Availability Nil No problem Nil Nil Shortage of Nil Lack of Not Good Lack of Staff Nil
staff information
Accessibility Nil No problem Nil Nil Shortage of Nil Lack of Not Good Nil Nil
Medicines information
Utilisation Nil No problem Nil Nil Shortage of Nil Lack of Nil Nil Nil
Study to Review
Facilities information
Acceptability Yes No problem Nil Nil - Nil Nil Nil Nil Nil
263
Biomedical Waste Yes Yes Yes Yes Yes Yes Yes On contract Yes No Bags
Management supplied
Table 27. Responses of The MLA/elected Representative at Sub Divisional Level
264
Facility Name of the District
Bhatinda Ferozpur Gurdaspur Hoshiarpur Jalandhar Ludhiana Muktsar Sangrur Taran Taran
(Talwaddi) (Fazilzka) (Batala) (Dasuya) (Navodar) (Jagrraon) (Malout) (Malarkotta) (Patti)
Length of service >2 yrs >2 yrs <2 yrs >2 yrs >2 yrs >2 yrs >2 yrs >2 yrs <2 yrs
Functioning of health Satisfactory Satisfactory OK Satisfactory Good Good OK Not much Good
services in the district improved
Study to Review
Availability of staff Doctors not available Shortage SN, Doctors Yes Yes Yes Specialist Doctors not Yes
not available available
Availability of Medicines in Mostly Not available Yes Less Very few Not all Not all. OK Less No antibiotics
OPD Only 7 availability
essential ones
Overall services of Hospital Not Very. Good Satisfactory OK OPD, Good Good OK Less Satisfactory
Emergency & developed
lab good
Extent of fulfilment of 30% - 40% - Good Full To quite an Good Average 20% 80%
health needs of Community extent
Waiting Time Variable, depending 15 -30 minutes 2-3 hrs Depends on no Not much 30min– 2hrs Not better Quite some Very less
upon the availability of patients time

of doctors
Cleanliness Satisfactory Good OK Bad Bad Good Average Not clean Good
Behaviour of staff Friendly Good OK Only doctors O. K. Good Not good Variable Very good
good, rest bad
Referral services Good Satisfactory NA Ambulance on - Available Good Ambulance on No transport
payment Payment
Knowledge of RKS Yes Yes No No No Yes Yes No No idea
Poor patients exempted Yes Yes Yes No - Yes Yes No Yes
from treatment charges
Perceived Barriers
Availability Nil Nil Nil Medicine & Nil Nil Yes Nil Nil
equipments
Accessibility Nil Nil Nil Nil Nil Nil Nil Nil Nil
Utilisation Low Nil Nil Nil USG machine Nil Nil Nil Nil
Acceptability Low Nil Nil Nil Nil Nil Nil Nil Nil
Table 28. Responses of the SMO Incharges of Sub-divisional Hospitals
Amritsar Bhatinda Ferozpur Gurdaspur Hoshiarpur Jalandhar Ludhiana Muktsar Sangrur Taran Taran
(Ajnala) (Talwaddi) (Fazilzka) (Batala) (Dasuya) (Navodar) (Jagrraon) (Malout) (Malarkotta) (Patti)
Length of service 6 months < 2 yrs. 3 months < 2 yrs. < 2 yrs. 7 months > 2 yrs. 1 yr. 3 years < 2 yrs.
OPD staff strength Good Poor Adequate less Shortage of Specialists Adequate Less Adequate Good
Class IV shortage
Bed Occupancy Rate (%) 40-65% 50-60% 90% 100% 70% 100% 90-100% 50-55% 70% 85-90%
Medicine to poor in OPD Yes Yes Yes Tedious Yes Mostly Some Some Some Yes
Procedure
Existence of RKS Yes Yes Yes Not Not Yes Yes Yes-not clear Money was Yes
functioning functioning received
Information regarding Yes (except Yes (except Yes Yes Yes Yes-all Yes Yes Yes except Yes
NHP Malaria) STD) for STD
Extent of fulfilment 75% 50% 100% 80% - 100% 50% OPD-High IPD- Average 75%
of health needs of Low
community
IPD Services (Nurse/Bed 1:3 1:4 1:4 1: 3.5 - Sufficient 1:12 1:5 1:5 O.K.
ratio) Nurses
Doctor/Bed ratio 1:3 1:10 1:10 1: 4 - - 1:5 1;7 1:6 O.K.
Cleanliness Good Staff absent O.K. Good Shortage of O.K. On contract Poor No problem O.K.
staff
Emergency services Yes Yes Yes On call Yes Yes Yes Yes Yes Yes
Fund flow Only User No problem Not much O.K. No problem No funds No problem No delay Only User- No fund
charges problem charges
Performance appraisal Yes-ACR Yes-ACR & No Bench marks Personal Yes-weekly Yes Doctors Bench ACR Yes-ACR
system Bench marks for doctors perception review mark, ACR
Perceived Barriers
Availability - Doctors not Nil Nil Doctors Nil - Specialist Lack of staff Nil
available Overburdened absent & medicine
Accessibility - Nil Nil Nil - Nil - Nil Nil Nil
Utilisation - Nil Nil Nil - Nil Infrastructure Nil Nil Nil
and staff
Study to Review
Behaviour
Acceptability - Nil Nil Nil - Nil - Nil Nil Nil
Bio-medical waste Yes Yes Yes Outsourced Yes (shortage Yes Yes Yes Yes – On Bags not
265
management of bags) contract available
Table 29. Responses of the Elected Representatives of CHC Areas
266
Name of the District (CHC)
(Manawala) (Goniana) (Firozshah) ((Fataihgarh (Mahilpur) (Kartarpur) (Machhiwara) (Badal) (Longwal) (Khem
Churian) Karan)
Length of service >5 yrs. >2 yrs. >2 yrs. >2 yrs. > 2 yrs. >2 yrs. >2 yrs. >2 yrs. > 2 yrs. < 2 yrs.
Overall functioning of Good V.Good Not good Doctors not Good Better now Better now Quiet Good
Study to Review
CHC, SDH and DH available satisfactory
(go for pvt.
practice)
Availability of Staff Yes Yes Yes No Bad Yes Yes O.K. No doctors Yes
gynaecologist
Availability of Medicine Partly Mostly Yes Yes V.Few Yes Not all Less Yes Not all
in OPD
Overall services of the Not good Good O.K. O.K. Average Good Average O.K. O.K. Satisfactory
Hospital
Extent of fulfilment 50% 50% 10% O.K. Only MLC Sufficient Large extent Large extent 10 - 20% 80%
of health needs of cases (<10%) extent
Community

Waiting Time 5 minutes 45 mins. - 1 Nil Not much Not much Long Long Not much Not much Not much
hrs. sometimes
Cleanliness Good V.Good Good O.K. Very Bad Good Good Needs Satisfactory Good
improvement
Referral services No Yes Lacking Yes No ambulance - Available but No ambulance Good No
not always
Knowledge of RKS - No No Yes No Yes Yes Yes No No
Behaviour of staff Good V.Good Good Good Not Good Bad Nurses Good Not Good Very .Good Very Good
behaviour
Poor patients exemption No No - No No No Yes Yes No -
from User charges
Perceived Barriers
(Contd...)
(Manawala) (Goniana) (Firozshah) ((Fataihgarh (Mahilpur) (Kartarpur) (Machhiwara) (Badal) (Longwal) (Khem
Churian) Karan)
Availability Nil Nil No medicine Nil Doctors not Less Medicine Nil More doctors Nil Very .Far
available
Accessibility Nil Nil Nil Nil Nil Nil Nil Yes Nil Nil
Utilisation Nil Nil Less doctors Nil Lack of Lack of Nil Nil ↓↓ Nil
medicines Medicine
Acceptability Nil Nil Restricted Nil Lack of Nil Quality of Nil ↓↓ Nil
Services Facility to be
improved
Study to Review
267
Table 30. Responses of the SMO Incharges of CHCS
268
Amritsar Amritsar Bhatinda Ferozpur Gurdaspur Hoshiarpur Jalandhar Ludhiana Muktsar Sangrur Taran Taran
(Mazitha) (Manawala) (Goniana) (Firozshah) ((Fataihgarh (Mahilpur) (Kartarpur) (Machhiwara) (Badal) (Longwal) (Khem
Churian) Karan)
Length of service < 2 yrs. 1 month > 2 yrs. 7 months 2.5 yrs. 6 months 6 months >2 years < 2 yrs. 6 months 16 months
OPD Staff strength Shortage Shortage of Shortage Adequate O.K. Less no. of Shortage Adequate. Specialists Except Shortage
Study to Review
doctors doctors & Only M.O post lacking medicine all
Class IV vacant available
Bed Occupancy Rate 5-10 Beds 10-15% 100% 10% 50% 5 – 10% - 25.04 15- 20% 10 – 15% 30-40%
(%) are occupied
Medicines to poor Yes Some Yes Yes Yes Yes Yes Yes - Yes Yes
in OPD (some to be
purchased)
Existence of RKS Yes Yes Yes Yes Not Not yet Yes Yes - Yes Yes
functioning formed
Information Yes Only T.B. & Yes Yes - No to all Yes Yes all except - Yes except Not all (i.e.
regarding NHP Malaria except T.B STD STD Malaria, STD)
Extent of fulfilment 90% 50% 70% Under - OPD 60-80% 100% Satisfactory - Very Less 70.80%

of health needs of utilised IPD=5-10%
Community
IPD Services (Nurse/ - 1:5 1;10 1:1.2 - 1:5 Staff 1:3 - 1:7 1:10
Bed ratio) shortage
Doctor/Bed ratio - 1:30 1:7 1:6 1:2 1:5 Staff 1:5 O.K. 1:15 1:4
shortage
Cleanliness O.K. Not upto Good Good O.K. O.K Good Shortage of O.K. Managed by O.K.
the mark staff own staff
Fund flow No problem Managed by No problem No problem - No problem No Budget No problem - N.A Through C.S
C.S. received
Performance Yes ACR Yes Records & Doctors- Yes – ACR Appreciation Annual C.R Doctors- Yes – ACR Yes (ACR)
appraisal system meetings Bench mark letter Bench mark
(Contd...)
Amritsar Amritsar Bhatinda Ferozpur Gurdaspur Hoshiarpur Jalandhar Ludhiana Muktsar Sangrur Taran Taran
(Mazitha) (Manawala) (Goniana) (Firozshah) ((Fataihgarh (Mahilpur) (Kartarpur) (Machhiwara) (Badal) (Longwal) (Khem
Churian) Karan)
Perceived Barriers
Availability Nil - Staff/ Doctor not - Nil Staff Nil - Staff not Less staff
Medicine not available shortage available
available
Accessibility Nil - No problems Nil - Nil Nil Nil - Nil Yes Border
area
Utilisation No - Nil Under - Nil Less due to Needs to be - Low Shortage of
Specialist utilised lack of funds increased Drugs
Acceptability Nil Non Nil Low - Nil Nil Nil - Less no. of -
availability doctors
of staff /
medicines
Bio-medical Waste Yes Yes Yes Yes - 2 coloured Yes Yes Contracted Yes – on Yes
Management bags used contract
Study to Review
269
A Study to Review
Provided by
PHSC
Punjab
vkjksX;e~ lq[klEink

Baba Gang Nath Marg, Munirka, New Delhi - 110067

Pun Jab Study Final

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A Study to Review

The Health Care Delivery System

National Institute of Health and Family Welfare

National Institute of Health and Family Welfare

Structural and Operational Framework

Views of the Beneficiaries on Quality of Services 64

Evaluation of the Training Institutes 84

Views of the Stakeholders 100

• At Sub-Division Level 109

• At CHC Level 113

Observations and Discussion 118

Conclusion and Recommendations 127

2 Sub Divisional Hospitals

3 Community Health Centres

4 Distribution of Patients in Wards 236

ANC Ante Natal Care

Prof. Deoki Nandan

1.1 Objectives of the Punjab Health Systems Corporation

1.2 The Beneﬁts to the General Public

2.1 Constitution of Committee

2.3 Study Objectives

3.1 Type of Study

3.2 Duration of Study

3.3 Sample Size

3.4 Sampling Technique

3.5 Data Collection Tools and Techniques

3.5.1 At district level

3.5.2 At sub-divisional level

3.5.4 Special hospitals

3.5.5 Training institutes

3.6 Data Collection Team

4.1 Structural and Operational Framework of Punjab Health

Health & Family Welfare Minister

Secretary Special Director Director Director Secretary Head of

PHSC Jt. Secretary

PHSC Punjab Health Systems Corporation

Break up of the budget was as follows:

4.2 The Corporation consists of:

4.3 Constitution of Board of Directors

Vice Chairman-cum-Principal Secretary, Health & Family Welfare

Director Director General Executive

AM EE (C) EE (C) EE (C)

Dy Dir. (Admn) Accountants AMFA Assistant Manager (Finance & Accounts)

Asst. Dir. (Admn) Admn Administration

Asst. Dir. (BB) F&A Finance and Accounts

4.4 The Managing Director

• District Level Management of the Corporation

• Hospital Level Staff

4.5 Functions of the Corporation

4.6 Steps for the betterment of employees

4.6.1 At district headquarter level

4.6.2 At block level

4.6.3 At subsidiary health centre level

1 Primary Health Centre for appropriately (100,000) population

4.6.4 Deputy Medical Commissioner (DMC)

4.7 Review of functioning of PHSC

Comprehensive referral system was to be established by introducing procedures at the primary

5.1 District Hospitals

5.1.2 Bed strength

5.1.3 Water supply

5.1.4 Electricity supply

5.1.6 General impression on cleanliness and maintenance of gardens

5.1.7 Status of Buildings