Make a Difference: UTILIZATION OF SUBCENTER OPD SERVICES UNDER SANKHALI PRIMARY HEALTH CENTER

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