Introduction
At present one Primary health centre covers
about 30,000 or more population. With Primary functions of preventive,
promotive and curative health service delivery to the community through its
subcentres. The most peripheral institutional facility is the subcentre, which
is run by one male and female multipurpose worker. In most places there is one
subcentre for about 5000 population. (1)
Each subcentre is visited by medical officer
from Primary Health centre on fixed week days for fixed hours for providing clinical
services and supervision of National programs.
Primary Health Centre Sankhali is situated in
the Bicholim Taluka of North Goa, which covers approximately 40,000 populations.
There are seven sub-centres under PHC Sankhali, Karapur, Amona, Harwalem, Surla,
Velgem, Pali and Sankhali-Virdi. Each subcentre serves approximately 5000- 6000
population. There are specific week days allotted to each subcentre to be
visited by PHC doctor to provide clinical services and to supervise
implementation of various health programs e.g. Amona Subcentre will be visited by
doctor on every Thursday except on public holidays.
Aim:
To Study the utilization of the clinical
services at Subcentre.
Methodology:
In this study only clinical service provided
by doctor at 2 of the 7 sub centres has
been evaluated, other services has not taken into consideration. Data regarding
age, sex and provisional diagnosis of individuals treated at subcentre, Karapur
and Harwalem was collected from November 2012 and Jan 2013. Data was entered in
Excel sheet and analysed with SPSS software.
Result:
Harwalem subcentre is visited on every
Tuesday and Karapur on every Friday except on Public Holidays. Total of 13
visits were available for each subcentre from November 2012 to January 2013. Of
this 9 (69%) visits were made to Harwalem Subcentre, two visit missed due to
Public holidays and two because of some official work. At Karapur all 13 visits
were made.
There were total 447 visits by patients at
both the centres, of which majority were females 337(75.4%). Of the total
females, most i.e. 219 (64.99%) were from Karapur centre. Also male OPD
attendance at Karapur subcentre was 73 (66.36%) compare to Harwalem centre
33.64%. On an Average 17 and 22 patients visit Harwalem and Karapur Sub-centre every
week days respectively. Children below 10 years visiting from both the
subcentre were 14.1% and 55.7% of patients were from age group of 31- 60 years.
Only 19.5% of patients were above 60 years of age.
Of the total visits, 139(31.1%) were for ARI
and 114(25.5%) for Hypertension, Bodyache and Backache were 10.7 %( 48), 4.7%
(21) were COPD patients. Most of the bodyache and backache i.e. 40 patients
were female, 34.53% of ARI cases were among children less than 10 years old.It has been also observe that there is no
card system at Subcentre and patient clinical details are maintain in OPD
register.
Discussion:
Both the subcentre are 3-4km from primary
health centre, still OPD attendance at subcentre is an average 17-22 patients.
It has also been found that maximum 40 patient had visited the Karapur
subcentre. Most of the patients who are visiting subcentre are residing in and
around subcentre within 500m-1km radius. Each subcentre covers approximately
5000 population, but clinical services utilisation from subcentre is by
villagers staying near subcentre. This may be because:
1. Doctor
visits once a week, only clinical and limited investigation facility available.
2. Most
patients visiting subcentre are women probably because men go to work.
3. Old patients
who cannot afford to go to the Primary Health Centre come to the subcentre.
In our study 19.5% of patients were above 60
years utilising subcentre OPD services, whereas in survey conducted by ICMR
among the population aged 60 years and above 11.3% were utilising Subcentre
health services(2).
Important
finding of this study is that the Subcentre facility is mostly underutilised
and utilisers are mostly women and elderly who are residing in immediate
vicinity of the subcentre.
Recommendation:
Since the OPD services are under utilise,
this can be further improved by applying the following:
1. OPD card
system can be introduced with provision of monthly medication to Hypertension,
DM and COPD patients.
2. Provision of
monthly blood collection facility at subcentre- Those patient requiring monthly
or routine monitoring of blood profile like FBSL, lipid profile, renal function
test and others can be provided to patients by collecting blood at subcentre on
monthly basis and sending for analysis at Govt. Lab at PHC.
3. Improve IEC
activities to increase utilisation of services at Sub centre especially by
patients with chronic illness like diabetes and hypertension, this would also
decrease patient load at PHC.
4. Location of
subcentre should be at strategic point, so that maximum patients can avail
services.
Acknowledgement: I gratefully acknowledge help provided
by Subcentre ANM staff Ms. Bharati Betkikar, Mrs. Diksha Parsekar, Ms. Poonam
Palkar and Mrs. Pratima Gaonkar.
Bibliography
1. Kishore, J. National Health Programs. 6th. ed : Century Publication,
2006.
2. Indian
Council of Medical Research. http://icmr.nic.in/final/hcra_1.html [Cited:
february 14, 2013.].
Dr.Swapnil Salelkar MBBS DPH PDCR
Medical Officer-Sankhali-Goa PHC
nil3483@gmail.com
Dr.Saroj Salelkar MBBS DPH PDCR
Insurance Medical Officer- ESI Dispensary
Bicholim-Goa
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| Table 1. Patient visit at Subcentre |
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| Table 2. Patient visit to subcentre by Age and sex |
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| Patient visit to subcentre by Age and Gender |
