Download - suresh dessertation

ADissertation on

ldquoGovernment Public Health Administration in PHC- Primary Health Center Role rdquo

To be submitted to the department of Public AdministrationKSKVKachchh University Bhuj (Kachchh) in the partfullment of therequirement for the degree of Master of Public Administration (MPA)

GuideMrs Jagrutiben PandyaAssistant ProfessorDepartment of Public AdministrationKSKV Kachchh University Bhuj

Research bySuresh R Makwana(MPA SEM IV)Year 2012-2013

Acknowledgement

At the outset I wish to thank Almighty GOD for his guidance and blessings in everysteps of my life It is an immense pleasure for me on the occasion to convey my gratitude andregards to all the personalities to whom I owe a lot

My family has played an important role in the completion of the Dissertation Throughoutthe years my parents and Brother encouraged me to do my very best in everything I haveundertaken I am eternally grateful for all the support they have given me

I wish offer my sincere gratitude and deep appreciation to my research guide Mrs Jagrutiben Pandya who anabled me in designing the whole research work for the study It was because ofhis timely advice and expert guidance and suggestion I was able to complete my researchI would also like to thank our Faculty member Dr Tushar Hati and Mrs Jagrutiben Pandya for their kindsupport

I am thankful to all medical staff members respondents who spared their valuable timefor filling up the questionnaires and provided authentic information about health servicesFinally I must say that getting involved in this dissertation has been a matter of immensepleasure amp satisfaction for me

Suresh R Makwana

ABBREVIATIONSANM Auxiliary Nurse MidwifeAPI Annual Parasite IncidenceARSH Adolescent Reproductive and Sexual HealthASHA Accredited Social health ActivistAWW Aanganwadi WorkerAYUSH Ayurvedic Yoga Unani Siddha amp HomeopathicBHO Block Health OfficeOfficerBPL Below Poverty LineCBR Crude Birth RateCDHO Chief District Health OfficerCDR Crude Death RateCHC Community Health CentreCHCU Comprehensive Health Care UnitCMR Child Mortality RateDH District HospitalDHAP District Health Action PlanDMO District Malaria OfficerDRCHO District Reproductive and Child Health OfficerFHW Female Health WorkerFRU First Referral UnitHQ HeadquarterHampFW Health and Family WelfareIMR Infant Mortality RateJSY Janani Suraksha YojanaMDT Multi Drug TherapyMMR Maternal Mortality RatioMPW Multi-purpose WorkerMTP Medical Termination of PregnancyNGO Non Government OrganizationNRHM National Rural Health MissionOPD Outdoor Patient DeskPHC Primary Health CentrePNC Post Natal Check upRCH Reproductive amp Child HealthSHC Sub Health CentreSWOT Strength Weakness Opportunity amp ThreatsTFR Total Fertility Rate

Statement by StudentI Mr Suresh R Makwan am bonafide students of Sem-IV (MPA) I haveprepared dissertation on ldquoEffectiveness and utility value of Primary Health Centerrdquo as partialfulfillment of the requirement for the degree of MPA I here by declare that this is my own andoriginal work I have not submitted such work to this or any other university for any other degree

or diplomaPlace Bhuj Name Date Suresh R Makwana

Statement by GuideThis is to certify that Mr Suresh Raymalbhai Makwana is bonafide student of SemIV (MPA) This dissertation on ldquoEffectiveness and utility value of Primary Health Centerrdquo is hisoriginal work He has not submitted such work to this or any other degree or diploma

Date Mrs Jagrutiben Pandya

CONTENTSNo Indicator Page No01 IntroductionPersonnel health structureHealth scenario in GujaratHealth scenario in Kachchh12-2502 Research MethodologyResearch ProblemObjectivesUniverseSignificantLimitationReview of literature26-3403 Profile of Study RegionKachchh Dist profile35-4404 Data Analysis InterpretationReview of Government Health SchemePrimary Data AnalysisSecondary Data Analysis45-10505 Finding Observation Suggestion Conclusion 106-112

06 AppendixBibliographyQuestionnaire113-120List of TablesNo Name of Table1 SEX OF RESPONDENTS2 PROFESSION OF RESPONDENTS3 EDUCATION OF RESPONDENTS4 CASTE CATEGORY5 Classification of Respondents in respect of BPL6 When you go to PHC for treatment Doctor or Midwife present at there7 Is delivery facility available in PHC 8 Are PHC medical staffs trained in primary health staff9 Is an emergency Ambulance facility available in PHC10 Are you satisfied with the treatment given by the doctor and midwife11 If yes what kind of treatment was given by the doctor and midwife12 How is Electricity facility in PHC 13 How is water and sanitation system in PHC 14 Indoor treatment available in PHC15 Is there 24x7 service available in Primary Health Center 16 Respondents opinion for available of treatment off the time period17 Do you get free treatment from PHC 18 Regularity of vaccination facility at PHC19 Respondents regarding beneficiaries of CHIRANJEEVI Scheme20 Respondents reflections regarding the benefit of ldquoJanani Suraksha Yojanardquo21 If yes How many rupees did you get from above scheme 22 Is medicine facility available at PHC 23 Reasons for visiting PHC24 Respondents reflections regarding regular visit of ASHA worker25 Reflections regarding PHCrsquos approach for preventive care26 Type of preventive program offered by PHC27 Respondents reflections regarding environment preservation of PHC28 How is preservation of environment in PHC 29 Do you get information on awareness of female health30 If yes who gives the guidance

CHAPTER 01INTRODUCTIONCHAPTER 01INTRODUCTIONAfter independent in 1947 India decided to expand and improve health services of the

country as one of a comprehensive package programmes to raise the standard of living of thepeople Indian constitution does not list health as a fundamental right The recommendatorydirective principles of state policy enjoin the state to raise nutrition level and improve publichealth (Article-47) but many court rulings have interpreted the fundamental right protection ofright of life and liberty (Article-21) So we can say that perticurly right to health is includedIndia has achieved relatively a good health during the last 60 years Before independent therewas very poor system and situation of health in IndiaIn India health care system- Allopathic Ayurveda Homeopathy Unani and various typesof ownership patterns- Public (Central and State government Municipal and panchayat localgovernment) Private (for profit and non profit)11 Central Government health policy goal to be achieved by 2000-20151 Eradicated Polio and yaws-20052 Eliminate leprosy-20053 Eliminate Kala Azar-20104 Eliminate Lymphatic Filariasis-20155 Achieve Zero level growth of HIVAIDS- 20076 Reduce Morality by 50 on account of malaria and other water Bo diseases- 20107 Reduce Prevalence of Blindness to 05 - 20108 Reduce IMR to 301000 and MMR 100lakh- 20109 Increase utilization of public health facility from current Level of lt20 to gt75 -201010 Establish an integrated system surveillance National Health Accounts a statistics- 200511 Increase health expenditure12 Government as a of GDP from existing 09 to 20 -201013 Increase share of Central grants Constitute at least 25 of total head spending -201014 Increase state Sector Health spending for 2005 55 of the budget Further increase to 8- 201012 PUBLIC HOSPITALPublic hospitals are owned and operated by federal state or city governments Many havea continuing tradition of caring for the poor They are usually located in the inner cities and areoften in precarious financial situations because many of their patients are unable to pay forservices These hospitals depend heavily on Medicaid payments supplied by local state andfederal agencies or on grants from local governments Medicaid is a program run by both thestate and federal government for the provision of health care insurance to persons younger thansixty-five years of age who cannot afford to pay for private health insurance The federalgovernment matches the states contribution to provide a certain minimal level of availablecoverage and the states may offer additional services at their own expense There are manytypes of government public hospitals ndash District hospital (district level) Municipality hospital(urban level) Community Health Center Primary Health Center (Taluka level) In India centralgovernment is not direct involve in above but indirectly involve but financial support andmonitoring on the state government health department For example in rural hospital (PHCCHC) most of schemes are come under NRHM (Nation Rural Health Mission)NRHM is held bycentral government health department and state government implementation of NRHMrsquosschemes

13 What is the Primary Health Center(PHC) Primary Health Center (PHC) is the cornerstone of rural health care The 6th five yearplan (1983-1988) proposed reorganization of PHCs on of one PHC for every 30000 ruralpopulations in the plains and one PHC for every 20000 population in hilly treble and backwardareas for more effective coverage Each PHC has five or six sub-centers staffed by healthworkers for outreach services such as immunization basic curative care services and maternaland child health services PHCs generally consist of one or more doctors a pharmacist a staffnurse and other paramedical support staff14 Personnel Structure of Government Health department

15 Evaluation and History of Primary Health CenterState has the responsibility for the health of its citizen Health is the fundamental rights ofthe every citizen The department of health and family welfare Gujarat is striving hard for theattainment of health of its people through network of the Government health care system Healthcare is more then medical care The Department of health amp welfare Gujarat state has madeintegrated health services available to the people of Gujarat through its Primary health carenetwork of the state The current focus is on providing healthcare in rural areas because of thelarge gap in services facilities in these areasOn 2nd October 1962 a two tier rural health care system came into existence throughoutIndia and in the state as well to fulfill these objectives Under this system one six beddedPrimary Health Center and four sub Center attached to it were established in each communitydevelopment BlockFollowing the World Health summit at Alma Ata and declaration of the goal of ldquoHealthfor All (HFA) - 2000 Ad the concept framed Being a signatory to HFA- 2000 the three tiersystem was rolled out in India under the rural services with the Fifth plan in 1978 This systemwith based on the concept of primary health care defined as ldquonecessary health care madeuniversally accessible to individuals and acceptable to them through their full participation andat a cost the community and country can affordrdquoUnder the Guidance of the commissioner (Health) the Additional and monitors ruralhealth care services with the help of Rational Deputy Director and other programmed officerCDHOs with the heap of other health officers and staff look after all health activities in theirrespective districts16 Health Scenario and infrastructure in GujaratGujarat State located in the western part of India has an area of 160022 sqkmRepresenting about 6 of the local area The state has a population of 603 million (2011) 499 of the total population of the country About 37 of the state population resides in urbanareas compared India is average of 28 about 24 Gujaratrsquos population is estimated of BPLWhile 7 and 15 are classified as SC and ST respectively The vital rates amp various healthindicators of Gujarat it shows that the state has a CBR(Child Birth Rate) of 249 CDR( ChildDeath Rate) of 78 MMR(Maternal Morality Ration) of 339 IMR(Infant Morality Ratio) of 60the rates The health scenario of Gujarat shows that it has an ANC (Ante Natal Check-up)coverage of 864 Institution delivery of 463 and unmet need for FP of 850 The datefrom RNTCP shows that it has a sputum detection rate of 80 the prevalence for leprosy is510000 The disability rate is 34 The incident rate of HIV is 04 and the prevalence rate is414No Indicators Gujarat India01 CBR(Child Birth Rate)249 254

02 CDR (2009(Child Death Rate)78 8403 MMR (1992-93)( Maternal Morality Rate )339 45804 Life expectancy at birth (1996-2001)MaleFemale615362776236633905 Neonatal Morality Rate (1998) 44 4506 IMR (2001)(Infant Morality Rate)60 6607 Postnatal Morality Rate (1998) 21 2708 Child Morality Rate 851 94909 GFR (1998) 987 106510 TFR (1998)(Total Fertility Rate)30 3211 Full Vaccination amp CompleteImmunization (2007-2008)549 -Sources RHS Bulletin March-2008 MO Health amp FW department govt of India

17 HEALTH INFTRASTRUCTURE IN GUJARATParticular Required In PositionPrimary Health Center 1172 1072Sub-Center 7263 7274Community Health Center 293 273Multipurpose worker(Female) ANM at Sub-Center amp PHCs8347 7060Health worker (Male) MPW(M) at Sub-Center 7274 4456Health Assistance (Female) at PHC 1073 806Health Assistance (male) at PHC 1073 1019Doctor At PHC 1073 10Sources RHS Bulletin March-2008 MO Health amp FW department govt of India18 Health Scenario in KachchhKachchh is district of Gujarat state in western India Kachchh district 1st in the state entirestate with its maximum square km area and its population occupies 16th rank in the state Thusthe vast area of the district is a challenge for effective management of health services in thedistrict but government health department and local government department tried and faced to

these problemsThe vital rates and various indicators of kachchh its shows that first trimester ANCregister (Early ANC registration)78 institution delivery 89 delivery under govt facilities48 deliveries under CHIRANJIVI SCHEME 18 The health scenario in kachchh shows thatpolio3 vaccination 58 Fully Immunized 82 PHCs having 100 adequate supply of

medicines and other medical supplies in kachchhHealth infrastructure in Kachchh district there are 1 district hospital 13 CHCs 40 PHCs279 Sub-Centers 35 dispensaries and 5 mobile centersNo Name of Indicator Level ()01 Woman ANC registration to all pregnant (Up to Oct-2010) 780002 Institutional delivery (Up to Oct-2010) 890003 Delivery under government facilities (Up to Oct-2010) 480004 Delivery under CHIRANJIVI scheme (Up to Oct-2010) 180005 BCG Vaccination (Up to Oct-2010) 610006 DTP3 Vaccination (Up to Oct-2010) 580007 Polio3 Vaccination (Up to Oct-2010) 580008 Total Sterilization (2009-2010) 884810 Maternal Mortality Rate (2009-2010) 23000Sources Kachchh Dist Health Action plan-2008-rsquo09 2011-rsquo12

19 Health Infrastructure in KachchhThe district health infrastructure consisting of Primary Health 13 Community HealthCenter 11 Comprehensive health care units 5 Mobile units and 35 Dispensaries Detailregarding facilities and staffing position are shown in table format given belowNo Facility Available01 District Hospital 0102 Community Health Center 1303 Primary Health Center 4004 Sub-Center 27905 Dispensary 3506 Mobile Dispensary 0507 Comprehensive Health Care Unit 13Sources Kachchh Dist health action plan 2011-lsquo12

110 Staff Position at District LevelNo Post Sanctioned Filled up01 Chief Dist Health officer 1 102 Additional Dist Health Officer 1 103 Dist RCH officer 1 104 Epidemic medical officer 1 105 Dist malaria officer 1 106 Administrative officer 3 107 DIECO 1 108 DPHN 1 1

09 ECSS 1 010 PMA 1 111 DSI 3 012 SHA 1 0Sources Kachchh Dist health action plan 2011-rsquo12

BibliographyKachchh District Health Plan2008-lsquo09Kachchh District Health Plan2011-lsquo12Dissrtation-2008-lsquo09 Mira N Vadi ZNPatel Trust-Bhujwwwgujhealthgovinhome

CHAPTER 2RESEARCH METHODOLOGYCHAPTER 2RESEARCH METHODOLOGY21 What is ResearchGenerally research can be defined as the search for knowledge or as any systematicinvestigation The Primary purpose for basic research is discovering interpreting and thedevelopment of method and system for the advancement of human knowledge on wide variety ofany matter of the universe22 Title of the Study


23 Research ProblemHealth is importance for all human being Health is not only meaning Physical fitness butoverfull health is achieved through a combination of Physical Mental and Social well being Ifany person not be healthier heshe can not do any work in anywhere or any time Heath is firststep of human life and health care service is basic right of humanNow days in the world WHO is focusing on human health services WHO guide whencreate any health problem in all over world In India fundamental rights are not directly protectbut indirectly protection In health care practice there are two types of hospitals- (1) Privatehospital and (2) Government hospital In the government hospitals state and local govt aremonitoring and handling and central government is financial supporting to the govt hospital

Consisting the utmost significance it needs to be examine as whether the government ispure to prone health awareness at rural level Is there adequate infrastructure in health Are thepeople in general satisfied the service24 ObjectivesThe specific objectives of the study as are under

1048766 To know effective and utility value of Primary Health Center in rural areas1048766 To comparison with the beneficiate experience to providing facility by the medical staff inPrimary Health Center1048766 To comparison about the health services between health centers who is first center near fromtaluka block office and second who is far distance from the taluka block health office1048766 To describe all patient of health care service by the doctor at a not profit health care inGujarat govt on the following demographic characteristics 1048766 AGE1048766 GENDER1048766 MERITAL STATUS1048766 PATIENT TYPE25 Sample and Sampling MethodSample consist 100 persons Simple random sampling was used

26 Reference PeriodThe duration of data collection was approximately 22 days and whole research was taken47 days27 Tools for Data CollectionQuestionnaireThe feedback from was prepared from collection of various recourses and complied withthe suitable requirement and was available in English and Gujarati language to help the localpopulation28 UniverseSix PHCs of Rapar Taluka1048766 Suvai PHC1048766 Bela PHC1048766 Fatehgadh PHC1048766 Bhimasar PHC1048766 Adesar PHC1048766 Gagodar PHC

29 Significant of the studyThe absence of satisfaction in onersquos has been the important cause of ineffectiveness ofPHC So satisfaction is an important issue to study in order to see that person who is patientsatisfaction is important for every Primary Health Center (PHC)Significant of my topic is know that at which level rural public get satisfaction from thestaff service providing by the PHC that

1048766 The respondent is the person and not a static hehas feeling emotion blases1048766 The respondent is not dependent upon us We are depend on them1048766 To know that most of rural people are poor So they wants to financial supporting in healthby the government scheme

210 Limitation1048766 Respondents were busy therefore less time was given1048766 The number of persons found to get information was only 1001048766 Time Constraint1048766 Due to some fear some medical staff didnrsquot give proper answer and avoid the providingthe information211 Review Of LiteratureThe study aims at to give a back ground for the present study So it become necessary toknow that what relevant studies have been make in particular field and their outcomesThe director general of WHO Gro Harlen Brundland rightly observes that the healthsystems are designed managed financed affects people live livelihoods1048766 World Health report- 2000World Health report-2000 state that health system are valuable and important but theycould accomplish much more with the available understanding of how to improve health Thefailing which limit performance do not result primarily from lack of knowledge but from not

fully applying what is already known that is from systematic rather than technical failure Thistrue even of most medical errors because ldquothe problem is not bad people the problem is that thesystems need to be sufferrdquo How to measure current performance and how to achieve thepotential improvement in it are subject to this report Research to expand knowledge is crucial inthe long run as progress over the last two countries in the short run Much could be accomplishedby the wider and better application of existing knowledge This can improve health more quicklythan continued and more equality distributed socio-economic progress The minister of health ofcountries of the south-east Asia region adopted the declaration on health development in thesouth East Asia region in the 21st century at their 15th meeting in Bangkok Thailand in august1997 This regional Health declaration services as the basis for future health declaration and theglobal health policy It is statement of commitment on health development and a pledge ofensure health It is also resolved strengthen national capacity and regional solidarity to furtherthis aimThis World Health report-2000 Health system Improving performance by WHOrightly state thatldquoFrom safe delivery of the health baby to care with dignity of the frail-elderly Health systemshave a vital and continuing responsibility to people throughout the life span They are crucial tothe healthy development of individual families and societies every whererdquo1048766 Respondents views of quality of careRecently quality of medical care assessment focused mainly on the technical aspects ofcare Client satisfaction has only just been incorporated into quality of care assessment(Barnett 1995) with international development organizations such as the World Bank andthe WHO often being in the fore-front of efforts to make medical service more client oriented(De Geydent 1995)Definition of good quality in medical care is difficult bur any attempt of doing so shouldincorporate respondents views (Cleary and Edgman-Levitan 1997) There is evidence tosuggest that using patient views in planning health services result in better provision and

more client satisfaction (Barry etal 1997 Macfarlane etal1997) such respondent viewsshould however nor be a one-off measure repeated evaluations of respondents experienceand preferences should be an integral aspects of care

Bibliographywwwgujhealthgovinchiranjivi 20 yojanapdfCY-2008Kachchh District Health Action Plan 2008-rsquo09Kachchh District Health Action Plan 2011-rsquo12Komal Tandel Dissertation-2009 NSPatel College-Anand

CHAPTER 3PROFILE OF STUDY REGIONCHAPTER 3Profile of Study RegionKACHCHH DISTRICT MAP

PROFELE OF KACHCHH DISTRICTKachchh is a district of Gujarat state in western India Covering an area of 45652 km it is thelargest district in the state of Gujarat and the second largest in India Kachchh which literallymeans surrounded by water this district is surrounded by gulf of kachchh and Arabian Sea insouth and west North and eastern parts are surrounded by Great and Small rann (desert) ofKachchh When there were not many dams built on rivers rann of kachchh remains to be wetlandfor large part of the year Still the region remains to be wet for significant part of year Many alsobelieves that district derives its name from its shape of its map which when viewed upside down(south upward) resembles a tortoise The word for tortoise is Kachchh or Kachbo in theKachchhi and Gujarati languages It is known as The Mystery Land because of its people andreligion(s) little is known about this entire area The district had a population of 1750000 ofwhich 30 were urban as of 2001AREA amp POPULATIONIt occupy the area of 45652 sq km having the population of 17 50000 It is composed of 10talukas with 951 villages District rank ldquo1st ldquoin the entire state with its maximum sq km areawhile looking to its population quantum it occupies 16th rank in the State Thus the vast andscattered area of the District is a challenge for the effective management of Health Services inthe DistrictGeographical Area 45652 sqkmNo of talukas 10Cities 8Villages 951Of which Populated villages 886Municipalities 6Village panchayat 615INFILTRATION OF POPULATIONInfiltration of the population takes place maximum at Kandla Port Gandhidham Mundra AdaniPort Naliya block and Pandhro Lignite Mines Being a major port and industry laborers from allthe state come to Port Area Some of them harbor infection of communicable diseasesIt isrecorded that a massive earthquake hit Kachchh on June 16 1819 Thispartially changed thecourse of a section of the river Indus and caused a surface epression that became an inland sea

LANGUAGE AND PEOPLEThe languages spoken predominantly in Kachchh are Kachchhi and Gujarati Kachchh islanguage that draws heavily from its neighbouring language groups Sindhi Punjabiand Gujarati however it is usually considered a dialect of Gujarati Mostly people of theKachchh speak Kachchhi as well as Kachchhi who have moved to more commercial areas suchas Ahmedabad Baroda and Rajkot The Kachchhi language has not historically been a writtenlanguage though in modern times it is occasionally written in the Gujarati script Kachchhi andGujarati are not mutually intelligible though Sindhi and Kachchhi are to some extent Kachchhhas a strong tradition of crafts and is famous for its embroidery Some of the finest ariembroidery was stiched for royalty here whilst women in every village were busy preparingbeautiful clothes and decorations for dowries[citation needed]Unfortunately many of these fine skills have now been lost though some are beingRejuvenated through handicrafts initiatives Another important art of Kachchh is Bandhaniwhich was primarily originated in the region Women wear sari of Bandhani art in festivals like

Marriages Navaratri and Diwali Hand printing is used to make the Bedspreads pillow coversand other such furnishing products for household The dominant religion of Kachchh is a form ofHinduismADMINISTRATIVE DIVISIONSThe district has an area of 45612 sq km amp it covers 23 of the total of state area Theadministrative headquarter of the district is Bhuj The district has 10 Talukas 8 citiestowns 6nagarpalikas 951 villages and 614 gram panchayats (Census 2001)Kachchh is divided into 5 distinct regions as under(i) The Great Rann or uninhabited waste land in the north(ii) The Grass lands of Banni(iii) Main land consisting of planes hills and dry river beds(iv) The coast line along the Arabian Sea in the south and(v) Creeks and mangroves in the west More loosely the southern portin of

The Rann is considered an inside with sea water inundating the land forMost of the year The main land is generally plane but has some hillranges and isolated hillsDEMOGRAPHIC INDICATORSThe district has an area of 45612 sq km amp it covers 23 of the total of statearea The administrative headquarter of the district is Bhuj The district has 10 Talukas8 citiestowns 6 nagarpalikas 951 villages and 614 gram panchayats (Census 2001)District has total population of 17 50000 out of which 30 of people live in urbanareas Taluka wise details of villages amp citiestowns are as underNo Taluka No of villages No of citiestownsNo TalukaNo ofvillagesNo of citiestowns1 BHUJ 159 12 ANJAR 68 13 GANDHIDHAM 7 24 BHACHAU 71 15 RAPAR 97 16 MANDAVI 91 17 MUNDRA 60 18 NAKHATRANA 132 09 ABDASA 166 010 LAKHPAR 100 0TOTAL 951 08

LITERACYThe literacy rate of the district is 7104 with 5193 for males and 4907 forfemalesSEX RATIOThe sex ratio of the district is 942 which being higher than the states figures andis favorable for the district

Sex wise populationMale 815152Female 768073SC ST POPULATIONOut of total 10 talukas of the district nearly four talukas are under developed andhence due to unavailability of proper employment because of illiteracy of thecommunity population of Schedule Caste amp Schedule Tribe is nearly 30 of the totalpopulation Out of this 30 community pertaining to SC is 1742 while 1215 is STThis is directly affected due to large migration of laborers for employment from otherStates alsoPopulation according to SCCTSC Population 185932ST population 130138

AGE DISTRIBUTIONAge group wise distribution males amp females out of total population of Kachchh is(Source Statistical Branch District Panchayat Kachchh)It has been indicated that there is almost same population among males and females in all agegroups More than half of total population comprising of young age group which is very potentialfor the district Dependency ratio is not much high but out of total working population more than25 are from minority groupPopulation according to AgeAge 0 to 19 years 448660Age 20 to 59 years 361035Age 60 years amp above 97030WORK PARTICIPATIONAround 26 of the population is working class out of which 4042 are males and 1074 arefemales Male participation is more in both rural and urban areas while in rural areasparticipation of females is more compared to urban female participation In most of rural areascommunity engaged with farming labour work and home based low investment work ofproduction of coal and sell it into local marketEmployment Occupation wise distribution ofpopulationAgriculturists 112502Agricultural laborers 142821Cottage Industries 30211Other Workers 311232Small amp Marginal farmers 54816

ECONOMIC AND INDUSRTIAL PROFILE1048766 Kachchh has re-emerged from the ruins of one of the most disastrous earthquakes in thehistory that took place in January 2001 and today has become a major industrial hub1048766 Over 60 of total salt production is contributed by the district1048766 With large reserves of limestone bauxite lignite and bentonite Kachchh district is one of thepreferred destinations for most of the mineral based industries1048766 It boasts of being the worldrsquos largest manufacturer of Submerged Arc Welded (SAW) pipes

1048766 A good number of medium large scale industries are supported by a sizeable number ofsmall scale industries1048766 Due to presence of two important ports Kandla and Mundra Kachchh district accounts for avery high cargo movement1048766 Kachchh is also known for handicrafts Out of total 136 industrial cooperative societies 71belong to handicrafts1048766 The district accounts for the highest production of date palms in Gujarat which was 93597MT in 2006-20071048766 Palaces temples fairs and festivals of Kachchh attracts a large number of tourists in thedistrict1048766 The district has the highest production of Lignite and China clay in Gujarat The totalproduction of lignite in 2005-06 was 6412663 MT

Industrial and Business Units the District Engaged InhellipINDUSTRIAL UNITS IN THEDISTRICT ENGAGED INNoAgriculture amp Allied activities 25Foods and beverages 91Wood amp Coal 112Chemical Production 60Mineral amp metals 84Machines amp Machine parts 7RadioTV amp Communication equipment 4Motor vehicle 7Motor vehicle sales amp services 26Others 75Total units registered 491Small Industrial units 299Joint Stock Cos 54BUSINESS UNITS IN THE DISTRIC NoMines amp Minerals 189Production amp Ancillary Services 6063Construction 782Wholesaler amp Retail Trade 14866Transport 3036Communication 542Hotels amp Restaurants 1648Others 14014TOTAL 41140

BibliographyDistrict Health Action Plan 2009-2010District Health Action plan 2011-2012Kachchh-District-Profile-pdf Industries Commissionerate Government of Gujarat

CHAPTER 4DATA ANALYSISReview of Government Health SchemeIn India many peoples are living in villages and they are most of medium class and poorclass So they are not able to expand for get better health facilities So government providesfinancial support for get better health services In Health sector there are many governmenthealth schemes under the NRHM like Janni Surksha Yojana Chiranjivi Yojana Bal SakhaYojana Rastriya Swasthya Bima Yojana (RSBY) etc The entire government schemersquos goal isimprovement and increase of human health in rural areas Some mainly Health schemes whichare very useful in rural areas as under1048766 CHIRANJIVI YOJANAGovernment of Gujarat announced a ldquoChiranjeevi Yojanardquo in April 2005 The objectiveof this scheme is to encourage private medical practitioners to provide maternity health servicesin remote areas which record the highest infant and maternal mortality and thereby improve theinstitutional delivery rate in Gujarat The scheme was finally launched as a one year pilot projectin December 2005 in five districts viz Banaskantha Dahod Kachchh Panchmahal andSabarkantha District Health Society signed a MOU with of them in each five district Theprivate empanelled providers are reimbursed on capitation payment basis according to whichthey are reimbursed at a fixed rate for deliveries carried out by them The payments are made fora batch of 100 deliveries This is expected to take care of case-mix differences (ie normal orcomplicated deliveries) and help the providers to keep the costs below the reimbursed amountsThe scheme proposes to use a voucher system to target the people living below poverty line(BPL) Under this scheme Rs1795- per delivery include all normal and complicated deliveries(including necessary facilities investigation and medication)The package also include Rs200-for transportation to the pregnant mother and Rs50- for TBA or the person escorting thepregnant

Selection criteria for private obgyns for enrolment in to the PPP scheme1 Doctor must be having post-graduate qualification in Obgyn2 Must have hisher own hospital - preferably minimum of 15 beds3 Must have labor room and operating room4 Must be able to access blood in emergency situation5 Must be able to arrange for anesthetists and do emergency surgery6 Facility should be preferably accredited for sterilization procedures for FP by thegovernment7 Norm would be to select 2-3 private obgyns per sub-district All the available andwilling obgyns were contacted1048766 Rapar talukarsquos data of Janni Suraksha Yojana as followsBhuj Taluka block health office

1048766 JANANI SURAKSHA YOJANAJanani Suraksha Yojana (JSY) under the overall umbrella of National rural HealthMission (NRHM) is being proposed by way of modifying the existing National MaternityBenefit Scheme (NMBS) While NMBS is linked to provision of better diet for pregnant womenfrom BPL families This Yojana launched on 12th April 2005 by the Honrsquoble Prime Minister isbeing implemented in all states and UTs with special focus on low

Performing states JSY integrates the each assistance with antenatal care during the pregnancyperiod institutional care during delivery and immediate post-partum period in a health centre byestablishing a system of coordinated care by field level health worker The JSY is a 100centrally sponsored scheme The scheme provides a mechanism for individual tracking andfollows up of each woman of the marginalized sections (Scheduled Castes Scheduled Tribesand BPL) during the entire pregnancy and post delivery period Cash assistance of Rs 500- fornutrition support and Rs 200- for transport support is provided to each pregnant womanRole of Asha or other link health worker associated with JSY would bebull Identify pregnant woman as a beneficiary of the scheme and report or facilitateregistration for ANCbull Assist the pregnant woman to obtain necessary certifications wherever necessarybull Provide and or help the women in receiving at least three ANC checkups including TTinjections IFA tabletsbull Identify a functional Government health centre or an accredited private health institutionfor referral and deliverybull Counsel for institutional deliverybull Escort the beneficiary women to the pre-determined health centre and stay with her tillthe woman is dischargedbull Arrange to immunize the newborn till the age of 14 weeksbull Inform about the birth or death of the child or mother to the ANMMObull Post natal visit within 7 days of delivery to track motherrsquos health after delivery andfacilitate in obtaining care wherever necessarybull Counsel for initiation of breastfeeding to the newborn within one-hour of delivery and itscontinuance till 3-6 Months and promote family planning

1048766 The Data of Janani Suraksha Yojana as followsRapar Taluka BlockYear Achievement2005-06 2172006-lsquo07 10472007-lsquo08 11492008-lsquo09 17622009-lsquo10 2556Up to- jan2011 1683No Name ofPHC2009-lsquo10

Up tojan20111 Suvai 501 3472 Bela 771 3903 Fatehgadh 362 3124 Adesar 301 1695 Gagodar

42 PRIMARY DATA ANALYSISI have collected primary data from questionnaire These questionnaires are filled up bylocal people and medical staffs in at PHCI have this data as followsI have analysis these data in tabular form and chart has also used

PRIMARY COLLECTION DATA ANALYSIS

CHAPTER 01INTRODUCTIONCHAPTER 01INTRODUCTIONAfter independent in 1947 India decided to expand and improve health services of thecountry as one of a comprehensive package programmes to raise the standard of living of thepeople Indian constitution does not list health as a fundamental right The recommendatorydirective principles of state policy enjoin the state to raise nutrition level and improve publichealth (Article-47) but many court rulings have interpreted the fundamental right protection ofright of life and liberty (Article-21) So we can say that perticurly right to health is includedIndia has achieved relatively a good health during the last 60 years Before independent therewas very poor system and situation of health in IndiaIn India health care system- Allopathic Ayurveda Homeopathy Unani and various typesof ownership patterns- Public (Central and State government Municipal and panchayat localgovernment) Private (for profit and non profit)11 Central Government health policy goal to be achieved by 2000-20151 Eradicated Polio and yaws-20052 Eliminate leprosy-20053 Eliminate Kala Azar-20104 Eliminate Lymphatic Filariasis-2015

5 Achieve Zero level growth of HIVAIDS- 20076 Reduce Morality by 50 on account of malaria and other water Bo diseases- 20107 Reduce Prevalence of Blindness to 05 - 20108 Reduce IMR to 301000 and MMR 100lakh- 2010

9 Increase utilization of public health facility from current Level of lt20 to gt75 -201010 Establish an integrated system surveillance National Health Accounts a statistics- 200511 Increase health expenditure12 Government as a of GDP from existing 09 to 20 -201013 Increase share of Central grants Constitute at least 25 of total head spending -201014 Increase state Sector Health spending for 2005 55 of the budget Further increase to 8- 201012 PUBLIC HOSPITALPublic hospitals are owned and operated by federal state or city governments Many havea continuing tradition of caring for the poor They are usually located in the inner cities and areoften in precarious financial situations because many of their patients are unable to pay forservices These hospitals depend heavily on Medicaid payments supplied by local state andfederal agencies or on grants from local governments Medicaid is a program run by both the

state and federal government for the provision of health care insurance to persons younger thansixty-five years of age who cannot afford to pay for private health insurance The federalgovernment matches the states contribution to provide a certain minimal level of availablecoverage and the states may offer additional services at their own expense There are manytypes of government public hospitals ndash District hospital (district level) Municipality hospital(urban level) Community Health Center Primary Health Center (Taluka level) In India centralgovernment is not direct involve in above but indirectly involve but financial support andmonitoring on the state government health department For example in rural hospital (PHCCHC) most of schemes are come under NRHM (Nation Rural Health Mission)NRHM is held bycentral government health department and state government implementation of NRHMrsquosschemes

13 What is the Primary Health Center(PHC) Primary Health Center (PHC) is the cornerstone of rural health care The 6th five yearplan (1983-1988) proposed reorganization of PHCs on of one PHC for every 30000 ruralpopulations in the plains and one PHC for every 20000 population in hilly treble and backwardareas for more effective coverage Each PHC has five or six sub-centers staffed by healthworkers for outreach services such as immunization basic curative care services and maternaland child health services PHCs generally consist of one or more doctors a pharmacist a staffnurse and other paramedical support staff

14 Personnel Structure of Government Health department

15 Evaluation and History of Primary Health CenterState has the responsibility for the health of its citizen Health is the fundamental rights ofthe every citizen The department of health and family welfare Gujarat is striving hard for theattainment of health of its people through network of the Government health care system Healthcare is more then medical care The Department of health amp welfare Gujarat state has madeintegrated health services available to the people of Gujarat through its Primary health carenetwork of the state The current focus is on providing healthcare in rural areas because of the

large gap in services facilities in these areasOn 2nd October 1962 a two tier rural health care system came into existence throughoutIndia and in the state as well to fulfill these objectives Under this system one six beddedPrimary Health Center and four sub Center attached to it were established in each communitydevelopment BlockFollowing the World Health summit at Alma Ata and declaration of the goal of ldquoHealthfor All (HFA) - 2000 Ad the concept framed Being a signatory to HFA- 2000 the three tiersystem was rolled out in India under the rural services with the Fifth plan in 1978 This systemwith based on the concept of primary health care defined as ldquonecessary health care madeuniversally accessible to individuals and acceptable to them through their full participation andat a cost the community and country can affordrdquoUnder the Guidance of the commissioner (Health) the Additional and monitors ruralhealth care services with the help of Rational Deputy Director and other programmed officerCDHOs with the heap of other health officers and staff look after all health activities in theirrespective districts

16 Health Scenario and infrastructure in GujaratGujarat State located in the western part of India has an area of 160022 sqkmRepresenting about 6 of the local area The state has a population of 603 million (2011) 499 of the total population of the country About 37 of the state population resides in urbanareas compared India is average of 28 about 24 Gujaratrsquos population is estimated of BPLWhile 7 and 15 are classified as SC and ST respectively The vital rates amp various healthindicators of Gujarat it shows that the state has a CBR(Child Birth Rate) of 249 CDR( ChildDeath Rate) of 78 MMR(Maternal Morality Ration) of 339 IMR(Infant Morality Ratio) of 60the rates The health scenario of Gujarat shows that it has an ANC (Ante Natal Check-up)coverage of 864 Institution delivery of 463 and unmet need for FP of 850 The datefrom RNTCP shows that it has a sputum detection rate of 80 the prevalence for leprosy is510000 The disability rate is 34 The incident rate of HIV is 04 and the prevalence rate is414

No Indicators Gujarat India01 CBR(Child Birth Rate)249 25402 CDR (2009(Child Death Rate)78 8403 MMR (1992-93)( Maternal Morality Rate )339 45804 Life expectancy at birth (1996-2001)MaleFemale615362776236

633905 Neonatal Morality Rate (1998) 44 4506 IMR (2001)(Infant Morality Rate)60 6607 Postnatal Morality Rate (1998) 21 2708 Child Morality Rate 851 94909 GFR (1998) 987 106510 TFR (1998)(Total Fertility Rate)30 3211 Full Vaccination amp CompleteImmunization (2007-2008)549 -Sources RHS Bulletin March-2008 MO Health amp FW department govt of India

17 HEALTH INFTRASTRUCTURE IN GUJARATParticular Required In PositionPrimary Health Center 1172 1072Sub-Center 7263 7274Community Health Center 293 273Multipurpose worker(Female) ANM at Sub-Center amp PHCs8347 7060Health worker (Male) MPW(M) at Sub-Center 7274 4456Health Assistance (Female) at PHC 1073 806Health Assistance (male) at PHC 1073 1019Doctor At PHC 1073 10Sources RHS Bulletin March-2008 MO Health amp FW department govt of India18 Health Scenario in KachchhKachchh is district of Gujarat state in western India Kachchh district 1st in the state entirestate with its maximum square km area and its population occupies 16th rank in the state Thusthe vast area of the district is a challenge for effective management of health services in thedistrict but government health department and local government department tried and faced tothese problemsThe vital rates and various indicators of kachchh its shows that first trimester ANCregister (Early ANC registration)78 institution delivery 89 delivery under govt facilities48 deliveries under CHIRANJIVI SCHEME 18 The health scenario in kachchh shows thatpolio3 vaccination 58 Fully Immunized 82 PHCs having 100 adequate supply of

medicines and other medical supplies in kachchhHealth infrastructure in Kachchh district there are 1 district hospital 13 CHCs 40 PHCs279 Sub-Centers 35 dispensaries and 5 mobile centersNo Name of Indicator Level ()01 Woman ANC registration to all pregnant (Up to Oct-2010) 7800

02 Institutional delivery (Up to Oct-2010) 890003 Delivery under government facilities (Up to Oct-2010) 480004 Delivery under CHIRANJIVI scheme (Up to Oct-2010) 180005 BCG Vaccination (Up to Oct-2010) 610006 DTP3 Vaccination (Up to Oct-2010) 580007 Polio3 Vaccination (Up to Oct-2010) 580008 Total Sterilization (2009-2010) 884810 Maternal Mortality Rate (2009-2010) 23000Sources Kachchh Dist Health Action plan-2008-rsquo09 2011-rsquo12


110 Staff Position at District LevelNo Post Sanctioned Filled up01 Chief Dist Health officer 1 102 Additional Dist Health Officer 1 103 Dist RCH officer 1 104 Epidemic medical officer 1 105 Dist malaria officer 1 106 Administrative officer 3 107 DIECO 1 108 DPHN 1 109 ECSS 1 010 PMA 1 111 DSI 3 012 SHA 1 0Sources Kachchh Dist health action plan 2011-rsquo12


CHAPTER 2RESEARCH METHODOLOGYCHAPTER 2RESEARCH METHODOLOGY21 What is ResearchGenerally research can be defined as the search for knowledge or as any systematicinvestigation The Primary purpose for basic research is discovering interpreting and thedevelopment of method and system for the advancement of human knowledge on wide variety ofany matter of the universe22 Title of the StudyldquoAn Analytical study on the effectiveness and utility value of Primary Health Center(PHC)rdquo23 Research ProblemHealth is importance for all human being Health is not only meaning Physical fitness butoverfull health is achieved through a combination of Physical Mental and Social well being Ifany person not be healthier heshe can not do any work in anywhere or any time Heath is firststep of human life and health care service is basic right of humanNow days in the world WHO is focusing on human health services WHO guide whencreate any health problem in all over world In India fundamental rights are not directly protectbut indirectly protection In health care practice there are two types of hospitals- (1) Privatehospital and (2) Government hospital In the government hospitals state and local govt aremonitoring and handling and central government is financial supporting to the govt hospital

Consisting the utmost significance it needs to be examine as whether the government ispure to prone health awareness at rural level Is there adequate infrastructure in health Are thepeople in general satisfied the service24 ObjectivesThe specific objectives of the study as are under1048766 To know effective and utility value of Primary Health Center in rural areas1048766 To comparison with the beneficiate experience to providing facility by the medical staff inPrimary Health Center1048766 To comparison about the health services between health centers who is first center near fromtaluka block office and second who is far distance from the taluka block health office1048766 To describe all patient of health care service by the doctor at a not profit health care inGujarat govt on the following demographic characteristics 1048766 AGE1048766 GENDER1048766 MERITAL STATUS1048766 PATIENT TYPE

25 Sample and Sampling MethodSample consist 100 persons Simple random sampling was used

26 Reference PeriodThe duration of data collection was approximately 22 days and whole research was taken47 days27 Tools for Data CollectionQuestionnaireThe feedback from was prepared from collection of various recourses and complied withthe suitable requirement and was available in English and Gujarati language to help the localpopulation28 UniverseSix PHCs of Rapar taluka1048766 Suvai PHC1048766 Bela PHC1048766 Fatehgadh PHC1048766 Bhimasar PHC1048766 Adesar PHC1048766 Gagodar PHC



210 Limitation1048766 Respondents were busy therefore less time was given1048766 The number of persons found to get information was only 1001048766 Time Constraint1048766 Due to some fear some medical staff didnrsquot give proper answer and avoid the providingthe information211 Review Of LiteratureThe study aims at to give a back ground for the present study So it become necessary toknow that what relevant studies have been make in particular field and their outcomesThe director general of WHO Gro Harlen Brundland rightly observes that the healthsystems are designed managed financed affects people live livelihoods

1048766 World Health report- 2000World Health report-2000 state that health system are valuable and important but theycould accomplish much more with the available understanding of how to improve health Thefailing which limit performance do not result primarily from lack of knowledge but from not




CHAPTER 3

PROFILE OF STUDY REGIONCHAPTER 3Profile of Study RegionKACHCHH DISTRICT MAP

PROFELE OF KACHCHH DISTRICTKachchh is a district of Gujarat state in western India Covering an area of 45652 km2 it is thelargest district in the state of Gujarat and the second largest in India Kachchh which literallymeans surrounded by water this district is surrounded by gulf of kachchh and Arabian Sea insouth and west North and eastern parts are surrounded by Great and Small rann (desert) ofKachchh When there were not many dams built on rivers rann of kachchh remains to be wetlandfor large part of the year Still the region remains to be wet for significant part of year Many alsobelieves that district derives its name from its shape of its map which when viewed upside down(south upward) resembles a tortoise The word for tortoise is Kachchh or Kachbo in theKachchhi and Gujarati languages It is known as The Mystery Land because of its people andreligion(s) little is known about this entire area The district had a population of 1750000 ofwhich 30 were urban as of 2001AREA amp POPULATIONIt occupy the area of 45652 sq km having the population of 17 50000 It is composed of 10talukas with 951 villages District rank ldquo1st ldquoin the entire state with its maximum sq km areawhile looking to its population quantum it occupies 16th rank in the State Thus the vast andscattered area of the District is a challenge for the effective management of Health Services inthe DistrictGeographical Area 45652 sqkmNo of talukas 10Cities 8Villages 951Of which Populated villages 886Municipalities 6Village panchayat 615INFILTRATION OF POPULATIONInfiltration of the population takes place maximum at Kandla Port Gandhidham Mundra AdaniPort Naliya block and Pandhro Lignite Mines Being a major port and industry laborers from allthe state come to Port Area Some of them harbor infection of communicable diseasesIt isrecorded that a massive earthquake hit Kachchh on June 16 1819 Thispartially changed thecourse of a section of the river Indus and caused a surface epression that became an inland sea

LANGUAGE AND PEOPLEThe languages spoken predominantly in Kachchh are Kachchhi and Gujarati Kachchh islanguage that draws heavily from its neighbouring language groups Sindhi Punjabiand Gujarati however it is usually considered a dialect of Gujarati Mostly people of theKachchh speak Kachchhi as well as Kachchhi who have moved to more commercial areas such

as Ahmedabad Baroda and Rajkot The Kachchhi language has not historically been a writtenlanguage though in modern times it is occasionally written in the Gujarati script Kachchhi andGujarati are not mutually intelligible though Sindhi and Kachchhi are to some extent Kachchhhas a strong tradition of crafts and is famous for its embroidery Some of the finest ariembroidery was stiched for royalty here whilst women in every village were busy preparingbeautiful clothes and decorations for dowries[citation needed]Unfortunately many of these fine skills have now been lost though some are beingRejuvenated through handicrafts initiatives Another important art of Kachchh is Bandhaniwhich was primarily originated in the region Women wear sari of Bandhani art in festivals likeMarriages Navaratri and Diwali Hand printing is used to make the Bedspreads pillow coversand other such furnishing products for household The dominant religion of Kachchh is a form ofHinduismADMINISTRATIVE DIVISIONSThe district has an area of 45612 sq km amp it covers 23 of the total of state area Theadministrative headquarter of the district is Bhuj The district has 10 Talukas 8 citiestowns 6nagarpalikas 951 villages and 614 gram panchayats (Census 2001)Kachchh is divided into 5 distinct regions as under(i) The Great Rann or uninhabited waste land in the north(ii) The Grass lands of Banni(iii) Main land consisting of planes hills and dry river beds(iv) The coast line along the Arabian Sea in the south and(v) Creeks and mangroves in the west More loosely the southern portin of

The Rann is considered an inside with sea water inundating the land forMost of the year The main land is generally plane but has some hillranges and isolated hillsDEMOGRAPHIC INDICATORSThe district has an area of 45612 sq km amp it covers 23 of the total of statearea The administrative headquarter of the district is Bhuj The district has 10 Talukas8 citiestowns 6 nagarpalikas 951 villages and 614 gram panchayats (Census 2001)District has total population of 17 50000 out of which 30 of people live in urbanareas Taluka wise details of villages amp citiestowns are as underNo Taluka No of villages No of citiestownsNo TalukaNo ofvillagesNo of citiestowns1 BHUJ 159 12 ANJAR 68 13 GANDHIDHAM 7 24 BHACHAU 71 15 RAPAR 97 16 MANDAVI 91 17 MUNDRA 60 18 NAKHATRANA 132 09 ABDASA 166 0

10 LAKHPAR 100 0TOTAL 951 08

LITERACYThe literacy rate of the district is 7104 with 5193 for males and 4907 forfemalesSEX RATIOThe sex ratio of the district is 942 which being higher than the states figures andis favorable for the districtSex wise populationMale 815152Female 768073SC ST POPULATIONOut of total 10 talukas of the district nearly four talukas are under developed andhence due to unavailability of proper employment because of illiteracy of thecommunity population of Schedule Caste amp Schedule Tribe is nearly 30 of the totalpopulation Out of this 30 community pertaining to SC is 1742 while 1215 is STThis is directly affected due to large migration of laborers for employment from otherStates alsoPopulation according to SCCTSC Population 185932ST population 130138

AGE DISTRIBUTIONAge group wise distribution males amp females out of total population of Kachchh is(Source Statistical Branch District Panchayat Kachchh)It has been indicated that there is almost same population among males and females in all agegroups More than half of total population comprising of young age group which is very potentialfor the district Dependency ratio is not much high but out of total working population more than25 are from minority groupPopulation according to AgeAge 0 to 19 years 448660Age 20 to 59 years 361035Age 60 years amp above 97030WORK PARTICIPATIONAround 26 of the population is working class out of which 4042 are males and 1074 arefemales Male participation is more in both rural and urban areas while in rural areasparticipation of females is more compared to urban female participation In most of rural areascommunity engaged with farming labour work and home based low investment work ofproduction of coal and sell it into local marketEmployment Occupation wise distribution ofpopulationAgriculturists 112502Agricultural laborers 142821Cottage Industries 30211

Other Workers 311232Small amp Marginal farmers 54816

ECONOMIC AND INDUSRTIAL PROFILE1048766 Kachchh has re-emerged from the ruins of one of the most disastrous earthquakes in thehistory that took place in January 2001 and today has become a major industrial hub1048766 Over 60 of total salt production is contributed by the district1048766 With large reserves of limestone bauxite lignite and bentonite Kachchh district is one of thepreferred destinations for most of the mineral based industries1048766 It boasts of being the worldrsquos largest manufacturer of Submerged Arc Welded (SAW) pipes1048766 A good number of medium large scale industries are supported by a sizeable number ofsmall scale industries1048766 Due to presence of two important ports Kandla and Mundra Kachchh district accounts for avery high cargo movement1048766 Kachchh is also known for handicrafts Out of total 136 industrial cooperative societies 71belong to handicrafts1048766 The district accounts for the highest production of date palms in Gujarat which was 93597MT in 2006-20071048766 Palaces temples fairs and festivals of Kachchh attracts a large number of tourists in thedistrict1048766 The district has the highest production of Lignite and China clay in Gujarat The totalproduction of lignite in 2005-06 was 6412663 MT

Industrial and Business Units the District Engaged InhellipINDUSTRIAL UNITS IN THEDISTRICT ENGAGED INNoAgriculture amp Allied activities 25Foods and beverages 91Wood amp Coal 112Chemical Production 60Mineral amp metals 84Machines amp Machine parts 7RadioTV amp Communication equipment 4Motor vehicle 7Motor vehicle sales amp services 26Others 75Total units registered 491Small Industrial units 299Joint Stock Cos 54BUSINESS UNITS IN THE DISTRIC NoMines amp Minerals 189Production amp Ancillary Services 6063Construction 782Wholesaler amp Retail Trade 14866

Transport 3036Communication 542Hotels amp Restaurants 1648Others 14014TOTAL 41140



Selection criteria for private obgyns for enrolment in to the PPP scheme1 Doctor must be having post-graduate qualification in Obgyn2 Must have hisher own hospital - preferably minimum of 15 beds

3 Must have labor room and operating room4 Must be able to access blood in emergency situation5 Must be able to arrange for anesthetists and do emergency surgery6 Facility should be preferably accredited for sterilization procedures for FP by thegovernment7 Norm would be to select 2-3 private obgyns per sub-district All the available andwilling obgyns were contacted1048766 Bhuj talukarsquos data of Chiranjivi Yojana as followsBhuj Taluka block health officeYEAR NORMAL LSCS COMPLOCATED TOTAL MALE FEMALE2007-20082007 125 1138 3270 1713 15822008-091398 106 1160 2664 1447 12402009-101372 99 302 2273 1165 11221048766 JANANI SURAKSHA YOJANAJanani Suraksha Yojana (JSY) under the overall umbrella of National rural HealthMission (NRHM) is being proposed by way of modifying the existing National MaternityBenefit Scheme (NMBS) While NMBS is linked to provision of better diet for pregnant womenfrom BPL families This Yojana launched on 12th April 2005 by the Honrsquoble Prime Minister isbeing implemented in all states and UTs with special focus on low

Performing states JSY integrates the each assistance with antenatal care during the pregnancyperiod institutional care during delivery and immediate post-partum period in a health centre byestablishing a system of coordinated care by field level health worker The JSY is a 100centrally sponsored scheme The scheme provides a mechanism for individual tracking andfollows up of each woman of the marginalized sections (Scheduled Castes Scheduled Tribesand BPL) during the entire pregnancy and post delivery period Cash assistance of Rs 500- fornutrition support and Rs 200- for transport support is provided to each pregnant womanRole of Asha or other link health worker associated with JSY would bebull Identify pregnant woman as a beneficiary of the scheme and report or facilitateregistration for ANCbull Assist the pregnant woman to obtain necessary certifications wherever necessarybull Provide and or help the women in receiving at least three ANC checkups including TTinjections IFA tabletsbull Identify a functional Government health centre or an accredited private health institutionfor referral and deliverybull Counsel for institutional deliverybull Escort the beneficiary women to the pre-determined health centre and stay with her tillthe woman is dischargedbull Arrange to immunize the newborn till the age of 14 weeks

bull Inform about the birth or death of the child or mother to the ANMMObull Post natal visit within 7 days of delivery to track motherrsquos health after delivery andfacilitate in obtaining care wherever necessarybull Counsel for initiation of breastfeeding to the newborn within one-hour of delivery and itscontinuance till 3-6 Months and promote family planning

1048766 The Data of Janani Suraksha Yojana as followsRapar Taluka BlockYear Achievement2005-06 2172006-lsquo07 10472007-lsquo08 11492008-lsquo09 17622009-lsquo10 2556Up to- jan2011 1683No Name ofPHC2009-lsquo10Up tojan20111 Kodki 501 3472 Gorevali 771 3903 Dhori 362 3124 Dhaneti 301 169


PRIMARY COLLECTION DATA ANALYSISTABLE 1SEX OF RESPONDENTSNO RESPONDENTS PERCENTAGE1 MALE 29 292 FEMALE 71 71TOTAL 100 10029710102030405060

7080MALE FEMALEAs percentage in table form total 100 respondents- 71 are female and 29 are malerespondents

TABLE 2PROFESSION OF RESPONDENTSNO RESPONDENTS PERCENTAGE1 HOUSE WIFE 49 49 2 LABOUR 39 39 3 BUSINESS 7 7 4 EMPLOYEE 3 3 5 OTHER 2 2 TOTAL 100 100 493973 20102030405060708090100HOUSE WIFE LABOUR BUSINESS EMPLOYEE OTHER`The table indicated that 49 are found House Wives and 39 are found Laborers and7 are found to have business 3 found Employees and 2 are Others

TABLE 3EDUCATION OF RESPONDENTSNO RESPONDENTS PERCENTAGE1 PRIMARY EDUCATION 32 32 2 SECONDARY EDUCATION 10 10 3 HIGHER EDUCATION 0 0 4 UNEDUCATED 58 58 TOTAL 100 100 321005801020

30405060708090100PRIMARYEDUCATIONSECONDARYEDUCATIONHIGHEREDUCATIONUNEDUCATED

As presented into above table 32 Respondents of the total got Primary education 10of respondents got secondary education and 58 uneducated According to the table none of therespondents had higher education

TABLE 4CASTE CATEGORYNO RESPONDENTS PERCENTAGE1 SC 44 44 2 ST 19 19 3 OBC 28 28 4 OTHER 09 09 TOTAL 100 100 44192890102030405060708090100SC ST OBC OTHER

It is found above table that from total 100 respondents 44 were from SC category 19were of ST category while 28 were from OBC and a were from general category

TABLE 5Classification of Respondents in respect of BPL NO RESPONDENTS PERCENTAGE1 YES 53 53 2 NO 47 47 TOTAL 100 100 53470

102030405060708090100YES NOAs revealed in the table from 100 total respondents 53 were of BPL category while47 were from other category

PRIMARY HEALTH CENTER ENVIROMENTTABLE 6When you go to PHC for treatment Doctor or Midwife present at thereNO RESPONDENTS PERCENTAGE1 YES 86 86 2 NO 14 14 TOTAL 100 100 86140102030405060708090YES NOAccording to above table 86 reported that when they go to PHC for treatment doctoror midwife present at there and 14 reported that when they go to PHC for treatment doctor ormidwife was not present at PHC

TABLE 7Is delivery facility available in PHC NO RESPONDENTS PERCENTAGE1 YES 90 90 2 NO 9 09 3 NO OPINION 1 01 TOTAL 100 100 909 1010203040

5060708090YES NO NO OPINIONThe table indicated that 90 respondent found delivery facility available in PHC and 9found delivery facility not available in PHC and 1 did not give any opinion about deliveryfacility available

TABLE 8Are PHC medical staffs trained in primary health staffNO RESPONDENTS PERCENTAGE1 YES 91 91 2 NO 09 09 TOTAL 100 100 919020406080100YES NOAccording to above table 91 believed that medical staff is trained in PHC and 09believed that medical staff not trained in PHC

TABLE 9Is an emergency Ambulance facility available in PHCNO RESPONDENTS PERCENTAGE1 YES 26 26 2 NO 72 72 3 NO OPINION 02 02 TOTAL 100 100 2672201020304050607080YES NO NO OPINION According to above table 26 believed that an Emergency ambulance facility availablein PHC and 72 believed that an Emergency ambulance facility is not available in PHC butgive arrangement of 108 emergency ambulance by PHC and 02 did not give any opinion

TABLE 10Are you satisfied with the treatment given by the doctor and midwifeNO RESPONDENTS PERCENTAGE1 YES 84 84 2 NO 16 16 TOTAL 100 100 84160102030405060708090YES NOAccording to above table10 84 respondents satisfied with the treatment given by thedoctor and midwife and 16 respondents were found not satisfied with the treatment given bythe doctor and midwife

TABLE 11If yes what kind of treatment was given by the doctor and midwifeNO RESPONDENTS PERCENTAGE1 Good Treatment 48 48 2 More instruction about health 21 21 3 Other reason 15 154 Not Treatment given by Doctor or midwife 16 16 TOTAL 100 100 482115 1605101520253035404550Good Treatment More Instructionabout HealthOther Reason Not TreatmentGiven By Doctoror Midw ife

The table-11 indicated that 48 respondents found always gave good treatment by doctorand midwife and 21 respondents found always give more instruction about health by doctorand midwife and 16 respondents found not treatment given by PHCrsquos doctor and midwife

TABLE 12How is Electricity facility in PHC NO RESPONDENTS PERCENTAGE1 Very Good 44 44 2 Good 34 34 3 Normal 21 21 4 Weak 01 01 TOTAL 100 100 4434211051015202530354045Very Good Good Normal Weak

According to above table-12 that 44 respondents believed very good Electricity facilityin PHC and 34 respondents believed that good Electricity facility in PHC and 21 respondents believed that normal Electricity facility in PHCSo We can say that now GoodElectricity facility at PHC

TABLE 13How is water and sanitation system in PHC NO RESPONDENTS PERCENTAGE1 Very Good 38 38 2 Good 53 53 3 Normal 07 07 4 Weak 01 01 No Opinion 01 01 TOTAL 100 100 385371 10102030405060Very Good Good Normal Weak No OpinionAccording to above table-13 that 38 respondents believed very good Water andSanitation facility in PHC and 34 respondents believed that good Water and sanitation facility

in PHC and 21 respondents believed that normal Water and sanitation facility in PHC and01 respondents believed that weak sanitation and sanitation facility in PHC and 01 respondents did not give hisher opinion So we can say according above table that there is goodfacility of water and sanitation in PHC but not very good

TABLE 14Indoor treatment available in PHC919020406080100YES NOThe table-15 indicated that 91 respondents found bed facility available in PHC and09 respondents found bed facility not available in PHCNO RESPONDENTS PERCENTAGE1 YES 91 91 2 NO 09 09 TOTAL 100 100

TABLE 15Is there 24x7 service available in Primary Health Center NO RESPONDENTS PERCENTAGE1 YES 43 43 2 NO 57 57 TOTAL 100 100 43570102030405060YES NOAccording to above table-15 43 respondents believed 247 services available in PHCand 57 respondents believed 247 services not available in PHC Gorevali and dhaneti PHCsare cover under 247 facility and Kodki and Dhori PHCs are not cover under 247 facility Sowe can say according above table that people have not known about 247 facility So need toadvertise for 247 facilities

TABLE 16Respondents opinion for available of treatment off the time periodNO RESPONDENTS PERCENTAGE1 YES 63 63 2 NO 37 37

TOTAL 100 100 6337010203040506070YES NOThe table-16 indicated that 63 respondents found always when heshe go PHC afterschedule times to this receive treatment and 37 respondents found when heshe go PHC afterschedule times Doctor not give treatment So we can say that useful 247 facility to the people

TABLE 17Do you get free treatment from PHC NO RESPONDENTS PERCENTAGE1 YES 96 96 2 NO 03 03 3 NO OPINION 01 01 TOTAL 100 100 963 10102030405060708090100YES NO NO OPINIONThe table-17 indicated that 96 respondents found always got free treatment from PHCand 03 respondents found did not get free treatment from PHC So we can say according toabove table that PHC given free treatment to the all people

TABLE 18Regularity of vaccination facility at PHC NO RESPONDENTS PERCENTAGE1 YES 89 89 2 NO 10 10 3 NO OPINION 01 01 TOTAL 100 100 8910 10

102030405060708090YES NO NO OPINIONThe table-18 indicated that 89 respondents found always regular vaccination in PHCand 10 respondents found that not regular held vaccination in PHC and 01 respondents notgiven hisher opinion We can say according to above table that not very good situation aboutvaccination matter

TABLE 19Respondents regarding beneficiaries of CHIRANJEEVI Scheme NO RESPONDENTS PERCENTAGE1 YES 29 29 2 NO 71 71 TOTAL 100 100 297101020304050607080YES NOThe table-19 indicated that 29 respondents take the maternity beneficiarythrough CHIRANJEEVI and 71 respondent did not take the maternity scheme ofCHIRANJEEVI So we can say that People have not known about the CHIRANJEEVI schemeSo Government should take the necessary action to advertise the government health scheme inrural areas

TABLE 20Respondents reflections regarding the benefit of ldquoJanani Suraksha Yojanardquo NO RESPONDENTS PERCENTAGE1 YES 53 53 2 NO 47 47 TOTAL 100 100 53474446485052

54YES NOThe table-20 indicated that 53 respondents had taken the benefit of JANNISURAKSHA YOJANA scheme and 47 respondents did not take benefit of the scheme ofJANNI SURAKSHA YOJANA So we can say that there has been good progress in this scheme

TABLE 21If yes How many rupees did you get from above scheme NO RESPONDENTS PERCENTAGE1 RS500 53 53 2 BETWEEN RS500 TO RS700 00 00 3 RS700 00 00 4 LESS FROM RS500 00 00 5 NOT RECEIVED 47 47 6 TOTAL 100 100530 0 0470102030405060Rs500- BetweenRs500- ToRs700-Rs700- Less FromRs500-NotReceived`The table-21 indicated that 53 respondents received Rs500 and 47 respondents didnot get any rupees because of they did not take ever scheme

TABLE 22Is medicine facility available at PHC NO RESPONDENTS PERCENTAGE1 YES 98 98 2 NO 02 02 TOTAL 100 100 982020406080100YES NO

According to above table-22 98 respondents believed that medicine facility isavailable in PHC and 02 respondents believed that medicine facility not available in PHCsowe can say that people get good medical facility in PHC

TABLE 23Reasons for visiting PHC NO RESPONDENTS PERCENTAGE1 CHEEP TREATMENT 55 55 2 FIXED DOCTOR 03 03 3 GOOD TREATMENT 18 18 4 OTHER REASON 22 22 5 NO OPINION 02 02 553182220102030405060CHEEP DESIDEDDOCTORGOODTREATMENTOTHERREASONNO OPINIONAccording to above table-23 55 respondents believed that it is cheep and 03respondents believed that have decided doctor and 18 respondent believed that PHC give goodtreatment and 22 respondent believed that they are other reason and 02 respondents did notgive any opinion

TABLE 24Respondents reflections regarding regular visit of ASHA worker NO RESPONDENTS PERCENTAGE1 YES 68 68 2 NO 32 32 TOTAL 100 100 683201020304050

6070YES NOThe table-24 indicated that 68 respondents found always asha worker come for giveninformation on vaccination and other scheme and 32 found that asha worker not come forgiven information on vaccination and other schemeso we can say that Asha worker is great workfor vaccination and any government scheme

TABLE 25Reflections regarding PHCrsquos approach for preventive care NO RESPONDENTS PERCENTAGE1 YES 71 71 2 NO 29 29 TOTAL 100 100 712901020304050607080YES NOAccording to above table-25 those 71 respondents believed that PHC is participant inpreventive programmed and 29 respondents believed that PHC has not participated inpreventive programmed

TABLE 26Type of preventive program offered by PHC 46250 02905101520253035404550WORKSHOP DOOR TODOORTELEVISION OTHERREASON

NO OPINIONAccording to above table-26 those 46 respondents believed that PHC does participatein preventive programmed by workshop and 25 respondents believed that PHC does participatein preventive programmed by door to door and 29 respondents believed that PHC has notparticipated in preventive programmed So we can say to according table that PHC has notparticipant in preventive programmed by television yetNO RESPONDENTS PERCENTAGE1 WORKSHOP 46 46 2 DOOR TO DOOR 25 25 3 TELEVISION 00 00 4 OTHER REASON 00 00 5 NO OPINION 29 29 TOTAL 100 100

TABLE 27Respondents reflections regarding environment preservation of PHC 102454110102030405060Very Good Good Normal Weak

According above table-27 those 10 respondents believed that there is very goodcleanness environment in PHC and village and 24 respondents believed that there is goodcleanness environment in PHC and 54 respondents believed that there is normal cleannessenvironment in PHC and 11 respondents believed there is weak cleanness environment in PHCNO RESPONDENTS PERCENTAGE1 Very Good 10 10 2 Good 24 24 3 Normal 54 54 4 Weak 11 11 TOTAL 100 100

TABLE 28How is preservation of environment in PHC 1426402005101520

25303540Very Good Good Normal Weak

According to above table-28 those 14 respondents believed that there is verygood preservation of environment in PHC and 26 respondents believed that there is goodpreservation of environment in PHC and 40 respondents believed that there is normalpreservation environment in PHC and 20 respondents believed that there is weak reservationenvironment in PHCNO RESPONDENTS PERCENTAGE1 Very Good 14 14 2 Good 26 26 3 Normal 40 40 4 Weak 20 20 TOTAL 100 100

TABLE 29Do you get information on awareness of female healthNO RESPONDENTS PERCENTAGE1 YES 81 81 2 NO 19 19 TOTAL 100 100 81190102030405060708090YES NOThe table-29 indicated that 81 respondents found always get information on awarenessof female health and 19 respondents found has not got information on awareness of femalehealth We can females have not field shy on awareness of female health

TABLE 30If yes who gives the guidance37 354 60180510152025

303540ASHA MIDWIFE NGO DAI OTHER NOTOPINIONThe table-30 indicated that 33 respondents found that they got guidance by Ashaworker and 20 respondents found that they got guidance by midwife and 04 respondentsfound that they got guidance by NGO and 06 respondents found that they got guidance by DAIand 19 respondents have not got any guidance on awareness of female healthNO RESPONDENTS PERCENTAGE1 ASHA 37 372 MIDWIFE 35 353 NGO 04 04 4 DAI 06 06 5 OTHER 00 00 6 NOT OPONION 18 18 TOTAL 100 100

TABLE 31Is there NGO presence for the activity of health awarenessNO RESPONDENTS PERCENTAGE1 YES 13 13 2 NO 87 87 TOTAL 100 100 13870102030405060708090YES NOAccording to above table-31 those 13 believed that there is NGO is presence for theactivity of health awareness at their and 87 believed that there is no any health awarenessactivity by NGO

INFORMATION PROVIDED BY THE PRIMARY HEALTH CENTERSTAFF TABLE 32Professional employees are working hereNO RESPONDENTS PERCENTAGE1 YES 04 100 2 NO 00 00 TOTAL 04 100

10000102030405060708090100YES NOAccording to above table-32 those 100 professional employees are working at PHCWe can say according to above table that professional employees working in government healthdepartment at rural level

TABLE 33Is there fill up the post of medical officer in PHCNO RESPONDENTS PERCENTAGE1 YES 04 100 2 NO 00 00 TOTAL 04 100 10000102030405060708090100YES NOMEDICAL OFFICERAccording to above table-33 that 100 post has field up to the medical officer so wecan say that medical office post has filed up in PHC

TABLE 34Is there fill up the post of Ayus doctor in PHC NO RESPONDENTS PERCENTAGE1 YES 03 75 2 NO 01 25 TOTAL 04 100 75 250204060

80YES NOAYUS DOCTORAccording to above table-34 that 75 post has field up to the Ayus doctor 25 post hasfield up to the Ayus doctor So we can say that good position to the post of Ayus doctor in PHClevel

TABLE 35Is there fill up the post of Lab technician in PHC NO RESPONDENTS PERCENTAGE1 YES 02 50 2 NO 02 50 TOTAL 04 100 50 5001020304050YES NOLAB TECHNICIANAccording to above table-35 that in 50 post has field up and 50 post has vacant Sowe can say according to above table that government should necessary action for fill up the postof Lab technician because of this lab department is important for PHC

TABLE 36Is there fill up the post of Ward boy in PHCNO RESPONDENTS PERCENTAGE1 YES 03 75 2 NO 01 25 TOTAL 04 100 7525020406080YES NOWARD BOYAccording to above table-36 that 75 post has field up to the Ward boy 25 post hasvacant So we can say that good position to the post of Ward boy in PHC level

TABLE 37Is there fill up the post of Nurse in PHCNO RESPONDENTS PERCENTAGE1 YES 03 75 2 NO 01 25 TOTAL 04 100

7525020406080YES NONURSEAccording to above table-37 that 75 post has field up to the Nurse 25 post hasvacant So we can say that good position to the post of Nurse in the PHC level But Nurse post isimportant base of Health sector so government should take the necessary action for fill up thispost

TABLE 38Is there fill up the post of MPW and Junior Pharmacist in PHCNO RESPONDENTS PERCENTAGE1 YES 04 100 2 NO 00 00 TOTAL 04 100 1000020406080100YES NOMPW AND JUNIOR PHARMACISTAccording to above table-38 that 100 post has field up to the Nurse So wecan say that very good position to the post of MPW and Junior pharmacist in the PHC level

TABLE 39Which types of treatment available in PHCNO RESPONDENTS PERCENTAGEYES NO TOTAL YES NO TOTAL1 COTTON BANDAGE 04 00 04 100 00 100 2 LABORATORY 03 01 04 75 25 100 3 SICKNESS 04 00 04 100 00 100 4 OTHER FACILITY 04 00 04 100 00 100 100 75 100 1000102030405060708090

100COTTONBANDAGELABORATORY SICKNESS OTHER FACILITY

According to above table-39 that 100 PHCs have facility of cottonbandage sickness and other facilities But 25 PHCs has not laboratory facility So we can saythat very good position in Cotton bandage sickness and other facilities

TABLE 40Is there good facility in PHC regarding the treatment for new born babyNO RESPONDENTS PERCENTAGE1 YES 02 50 2 NO 02 50 TOTAL 04 100 505005101520253035404550YES NOThe table-40 indicated that 50 PHCs have good facility in PHC where thetreatment is available of new born baby and 50 PHCs have not good facility in PHC where thetreatment is available of new born baby

TABLE 41How is awareness seen in mothers for new born babyrsquos healthNO RESPONDENTS PERCENTAGE1 YES 03 75 2 NO 01 25 TOTAL 04 100 75 2501020304050607080YES NOThe table-41 indicated that 75 respondents believed that awareness seen inmothers for new born babyrsquos health and 25 respondents believed that there is no awarenessseen in mother for new born babyrsquos health

TABLE 42How is awareness in people for vaccinationNO RESPONDENTS PERCENTAGE1 VERY GOOD 02 50 2 GOOD 01 25 3 NORMAL 00 00 4 WEAK 01 25 TOTAL 04 100 50250250102030405060708090100VERY GOOD GOOD NORMAL POOR

The table-42 indicated that 50 respondents field that very good awareness in the people forvaccination and 25 respondents field that good awareness in the people for vaccination and 25 respondents field that weak awareness in the people for vaccination

TABLE 43How is peoplersquos enthusiasms for health awareness program organized byPHCNO RESPONDENTS PERCENTAGE1 VERY GOOD 02 50 2 GOOD 01 25 3 NORMAL 01 25 4 WEAK 00 00 TOTAL 04 100 5025 2500102030405060708090100

VERY GOOD GOOD NORMAL OTHER FACILITY

The table-43 indicated that 50 respondents field that very goodenthusiasms for health awareness programmed organized by PHC and 25 respondents fieldthat good enthusiasms for health awareness programmed organized by PHC and 25 respondents field that normal enthusiasms for health awareness programmed organized by PHC

TABLE 44Are women feeling shy for treatment when doctor is maleNO RESPONDENTS PERCENTAGE1 YES 01 25 2 NO 03 75 TOTAL 04 100 257501020304050607080YES NOThe table-44 indicated that 25 respondents believed that the women feelshy for treatment when doctor is male and 75 respondents believed that the women are not shyfor treatment when doctor is male

TABLE 45Are you satisfied with the infrastructure of PHCNO RESPONDENTS PERCENTAGE1 WHOLE 02 50 2 NORMAL 02 50 3 POOR 00 00 TOTAL 04 10050 5000102030405060708090100WHOLE NORMAL POORThe table-45 indicated that 50 respondents found whole satisfied with theinfrastructure of PHC and 50 respondents found normal satisfied with the infrastructure ofPHC So we can say that government health employees field on good infrastructure of the PHC

TABLE 46Have you felt any administrative improvement in PHCNO RESPONDENTS PERCENTAGE1 YES 04 100 2 NO 00 00 TOTAL 04 100 10000102030405060708090100YES NOAccording to above table-46 those 100 respondents have field onadministrative improvement in PHC So we can say that government has change the healthconcept and improved the administrative work and structure

SECONDARY DATA ANALYSISI have collected secondary data from the district health department Bhuj taluka blockhealth office and Primary Health CenterI have analysis these data in tabular form and chart has also used

Analysis on PHC vise DeliverySuvai PHCYear TotalDeliveryInstitutionalDelivery Home DeliveryNumber of delivery Per() Number of delivery Per ()2008-lsquo09 1265 1160 9170 105 8302009-lsquo10 1184 1067 9012 117 988Up to-Jan2011 1087 1000 9200 87 8000200400600800100012001400

Total Delivery Insti Delivery Home Delivery2008‐092009‐10Up to Jan‐2011According to above table in year 2008-rsquo09 institutional delivery is 9170 and homedeliveries 830 and in year 2009-rsquo10 institutional delivery is 9012 and home delivery ratio988 and in year up to-Jan2011 institutional delivery ratio is 92 and home delivery ratio is800 So we can say according to above table that home delivery ratio has downed andinstitutional delivery ratio is same position in last three years

Bela PHCYear TotalDeliveryInstitutionalDelivery Home DeliveryNumber of delivery Per() Number of delivery Per ()2008-lsquo09 1397 683 4890 714 51102009-lsquo10 1542 834 5409 708 4591Up to-Jan2011 1287 875 6799 412 320102004006008001000120014001600Total Delivery Insti Delivery Home Delivery2008‐092009‐10Up to Jan‐2011According to above table in year 2008-rsquo09 institutional delivery ratio is 4890 andhome delivery ratio is 5110 and in year 2009-rsquo10 institutional delivery is 5409 and homedelivery ratio 4591 and in year up to-Jan2011 institutional delivery ratio is 6799 andhome delivery ratio is 3201 So We can say according to above table that home delivery ratiohas downed and institutional delivery ration has increased in last three year

Fatehgadh PHCYear TotalDeliveryInstitutionalDelivery Home DeliveryNumber of delivery Per() Number of delivery Per ()2008-lsquo09 651 512 7865 139 2135

2009-lsquo10 685 591 8628 94 1372Up to-Jan2011 639 572 8951 67 10670100200300400500600700Total Delivery Insti Delivery Home Delivery2008‐092009‐10Up to Jan‐2011According to above table in year 2008-rsquo09 institutional delivery ratio is 7865 andhome delivery ratio is 2135 and in year 2009-rsquo10 institutional delivery is 8628 and homedelivery ratio 1372 and in year up to-Jan2011 institutional delivery ratio is 8951 andhome delivery ratio is 1067 So We can say according to above table that home delivery ratiohas down and institutional delivery ration has increased in last three year

Bhimasar PHCYear TotalDeliveryInstitutionalDeliveryHome DeliveryNumber of delivery Per () Number of delivery Per ()2008-lsquo09 905 783 8652 122 13482009-lsquo10 846 764 9031 82 969Up to-Jan2011 830 778 9373 52 62701002003004005006007008009001000Total Delivery Insti Delivery Home Delivery2008‐092009‐10Up to Jan‐2011

Analysis of Total PHCrsquos DeliveryName ofPHCInstitutional Home2008-lsquo092009-lsquo10upto-Jan2011Total Per()2008-lsquo092009-lsquo10upto-Jan2011TotalPer()Kodki 1160 1067 1000 3227 9126 105 117 87 309 874Gorevali 683 834 875 2392 5660 714 708 412 1834 4340Dhori 512 591 572 1675 8481 139 94 67 300 1519Dhaneti 783 764 778 2325 9008 122 82 52 256 992TOTAL 3138 3256 3225 9619 8221 1080 1001 618 2081 1779According to above table in Kodki PHC total institutional delivery 9126 and Homedelivery 874 in Gorevali PHC total institutional delivery 5660 and home delivery 4340in Dhori PHC total institutional delivery ratio 8481 and home delivery ratio 1519 and inDhaneti PHC total institutional delivery ratio is 9008 and home delivery ratio is 1779 andin total PHC institutional ratio is 8221 and Home delivery ratio is 1779 So we can say thatthe Institutional delivery ratio is up in Gorevali PHC than other PHCs and down in Kodki PHCthan other PHC

Analysis on PHC vise ImmunizationSuvai PHCYear Target ActualBCG DTP3 Polio3 Measles FullyImmunized() () () () ()2008-

lsquo09 1266 1229 9808 1239 9787 1239 9787 1075 8491 1061 83812009-lsquo10 1299 1175 9045 1125 8661 1125 8661 1071 8245 1035 7968Up to-Jan20111469 1068 7270 1055 7182 1055 7182 1025 6977 1025 6977According to above table in year 2008-09 immunization target was 1266 andachievement was 9808 in BCG immunize achieved 9787 in DTP3 immunize achieved9787 in Polio3 immunize achieved 8491 in measles immunize and achieved 8380 infully immunize In year 2009-rsquo10 immunized target was 1299 and achieved 9045 in BCGimmunize achieved 8661 in DTP3 immunize achieved 8661 in Polio3 immunizeachieved 8245 in measles immunize achieved 7968 in fully immunize In year 2010-rsquo11immunized target was 1469 and achieved 7282 in BCG immunize achieved 7182 inDTP3 immunize achieved 7182 in Polio3 immunize achieved 6977 in measles immunizeand achieved 6977 in fully immunize So we can say target have increased but have notachieved whole target

Bela PHCYear Target ActualBCG DTP3 Polio3 Measles FullyImmunized() () () () ()2008-lsquo09 1033 1166 11288 1084 10494 1080 10455 990 9584 954 92352009-lsquo10 1060 1166 11000 1094 10321 1094 10321 1164 10981 1161 10953Up to-Jan20111625 1295 7969 1240 7631 1240 7631 1191 7329 1191 7329According to above Gorevalirsquos table in year 2008-09 immunization target was 1033 andachieved 11288 in BCG immunize achieved 9787 in DTP3 immunize achieved 9787 in Polio3 immunize 8491 achieved in measles immunize and achieved 8380 in fullyimmunize In year 2009-rsquo10 immunized target was 1299 and achieved 9045 in BCGimmunize achieved 8661 in DTP3 immunize achieved 8661 in Polio3 immunizeachieved 8245 in measles immunize and achieved 7968 in fully immunize In year 2010-rsquo11 immunization target was 1469 and achieved 7282 in BCG immunize achieved 7182 in DTP3 immunize achieved 7182 in Polio3 immunize achieved 6977 in measlesimmunize and achieved 6977 in fully immunize So we can say target has increased but havenot achieved whole target

Suvai PHCYear Target ActualBCG DTP3 Polio3 Measles FullyImmunized

() () () () ()2008-lsquo09 673 654 9718 710 10550 710 1055 618 9183 618 91832009-lsquo10 690 684 9913 692 10029 692 10029 666 9652 666 9652Up to-Jan2011837 631 7539 650 7766 650 7766 608 7264 608 7264According to above Dhorirsquos table in year 2008-09total immunization target was 673 andachieved 9718 in BCG immunize achieved 10550 in DTP3 immunize achieved 10550 in Polio3 immunize 9183 achieved in measles immunize and achieved 9183 in fullyimmunize In year 2009-rsquo10 immunized target was 690 and achieved 9913 in BCGimmunize achieved 10029 in DTP3 immunize achieved 10029 in Polio3 immunizeachieved 9652 in measles immunize and achieved 9652 in fully immunize In year 2010-rsquo11 immunization target was 837 and achieved 7539 in BCG immunize achieved 7766 inDTP3 immunize achieved 7766 in Polio3 immunize achieved 7264 in measles immunizeand achieved 7264 in fully immunize So we can say target has increased but have notachieved whole target in last three years

Bela PHCYear Target ActualBCG DTP3 Polio3 Measles FullyImmunized() () () () ()2008-lsquo09 771 876 11362 874 11336 874 11336 788 1022 769 99742009-lsquo10 791 852 10771 867 10961 867 10961 813 10278 811 10253Up to-Jan2011977 786 8045 739 7564 739 7564 684 7000 684 7000According to above Dhanetirsquos table in year 2008-09total immunization target was 771and achieved 11362 in BCG immunize achieved 11336 in DTP3 immunize achieved11336 in Polio3 immunize 10220 achieved in measles immunize and achieved 9974 in fully immunize In year 2009-rsquo10 immunized target was 791 and achieved 10771 in BCGimmunize achieved 10961 in DTP3 immunize achieved 10961 in Polio3 immunizeachieved 10278 in measles immunize and achieved 10253 in fully immunize In year2010-rsquo11 immunization target was 977 and achieved 8045 in BCG immunize achieved7564 in DTP3 immunize achieved 7564 in Polio3 immunize achieved 7000 inmeasles immunize and achieved 7000 in fully immunize So we can say there was goodworked in year 2009-rsquo10

Analysis on respondents views of different QuestionIs an Emergency Ambulance facility available in PHC

bull 108 Emergency Ambulance handling by direct state government and when create anyhealth problem PHC call to Emergency department and give arrangement of ambulanceWhich types of guidance given by the NGObull Give guidance about government health schemesbull Fill up form of health scheme for beneficiarybull Programmed for healthbull Give guidance about vaccination maternity health child health etcIn which way PHC do disposal of wastage For example medicine bottle cotton bandageglucose-blood bottle etcbull Sarpitbull deapbaril

CHAPTER 05FINDING OBSERVATION ANDSUGGESTIONCHAPTER 05FINDING1048766 Out of 100 respondents 91 satisfied trained medical staff and only 09 are notsatisfied with trained medical staff

1048766 Out of 100 respondents 84 satisfied with treatment of PHC and only 16 are notsatisfied

1048766 Out of 100 respondents 74 satisfied with electricity facility in PHC and 21 lesssatisfied and only 01 are not satisfied

1048766 Out of 100 respondents 63 satisfied with give treatment after schedule time and 37 are not satisfied

1048766 Out of 100 respondents 96 satisfied with give free treatment by PHC and only 04 are not satisfied

1048766 Out of 100 respondents 89 satisfied with services of vaccination and only 10 are notsatisfied

1048766 Out of 100 respondents 29 satisfied with scheme of Chiranjivi and 71 are notsatisfied

1048766 Out of 100 respondents 53 satisfied with scheme of Janani Suraksha Yojana and 47 are not satisfied

1048766 Out of 100 respondents 68 satisfied with work of Asha worker and 32 are notsatisfied

1048766 Out of 100 respondents 81 satisfied with get information about female health and only19 no satisfied

1048766 Out of 100 respondents 71 satisfied with preventive programmed who held by PHCand only 29 are not satisfied

1048766 Out of 04 respondents (medical staff) 75 satisfied with awareness in mother for newborn babyrsquos health and 25 are not satisfied

1048766 Out of 04 respondents (medical staff) 75 satisfied with awareness of vaccination inpeople and 25 are not satisfied

1048766 Out of 04 respondents (medical staff) 50 satisfied with the infrastructure of PHC and50 are not satisfied

1048766 Out of 04 respondents (medical staff) 100 satisfied with administrative improvementin health sector

OBSERVATIONIn my observation of utility value of PHC I observed that in four PHC eachperson get importance and care Here I found complete absence of any kind ofdiscrimination means treatment of patient is not based on caste socio-economic level etchellipSome staff member however who come in contact patient them with foundnot treating them with care or not try to provide them comfort as much as they can It isfound that despite govtrsquos efforts utility value is not found increasesSome other thing which I observed1048766 Not improvement in respect of number of beneficiaries of health schemes1048766 The village people are not fully satisfied with facility of 2471048766 Women feel shy for treatment when doctor is male in border arearsquos PHC1048766 Relatively fair treatment is provided1048766 Some PHC havenrsquot emergency Ambulance 108 emergency department held emergencyAmbulance services1048766 Good electricity and sanitation facility in PHC1048766 Good environment atmosphere in kodki Dhaneti PHC1048766 If beneficiary takes health schemes they are paid by bank cheque1048766 In most of village guidance given by Asha worker in maternity health situation1048766 Good behaviors of doctor and midwife with patient1048766 Give free medicine in all four PHC1048766 Most of women are doing home delivery by the Dai in Gorevali PHC1048766 There is good cleanness in primary health center1048766 Wide geographical area1048766 There is good transport facility in Gorevali PHC1048766 Very poor Illiteracy is found in villages near by 4 PHCs1048766 At all PHCs visited staff is found over burdenedSUGGETION1048766 Most of people are unknown about the health schemes So government need to have morepropaganda for effective healthrsquos schemes so that people can know about own hisherright1048766 In practice people should be assured of 247 availability of treatment at PHC1048766 People are inclined to know more about the benefits of immunization Govt shouldpromote batter extension services in this respect

1048766 Most of people are unknown about in which types of medical services given by PHC Sogovernment should more active in medical services and give the information to publicabout the PHC services by medical staff or Asha or NGO1048766 Considering the wide distance of the villages in kachchh district and Bhuj taluka inparticular Govt should try to strength the extension services at 2001 and enhance thephysical coverage

CONCLUSIONSI feel happy for research on effectiveness and utility value of PHC I knewafter research that in government health sector there are many issues and challenges I also cometo know about health service and schemes which are providing health services to the rural healthpeople Primary Health Center is blessing for the village poor people In private hospital it iscostly treatment So rural people are not able for expand enough money in health services Sogovernment providing free treatment to the rural public though PHC Now days Primary HealthCenter faced many health issue however health center much tried for improvement and increasein health servicesI also knew after research that in border area many people are illiterate sothey canrsquot be known about own health right Some time rural public do not support in matter ofimmunization village cleanness and green environment Government efforts to mobilizeawareness needs to be substantially responded by the proper for which NGO intervention wouldbe more meaningfulBriefly I feel happy for prepared research of health services and thank youvery much too all persons who helped me to prepared this dissertation

APPENDIXBibliographywwwgujhealthgovinchiranjivi yojanapdfCY-2008wwwplanningcommissionnicinwwwmohfwnicindepthhtmwwwwikipediaorgwikiPrimary_Health_CentreMira NVadi Dissertation on Woman Health (2008-rsquo09) ZN Pate trust-BhujGeeta J Dholakia Dissertation on women getting facility after their pregnancy (2007-08)Saurastra UniversityNRHM-2008 Gujarat state reportAnnual Administrative report-2009-10 Commissionerate of Health Medical Services andMedical Education (HS)Gujarat State GandhinagarDr Dileep V Mavalankar Report of Comparison of medicine budgets in PHCs and expenditureon medicines for government employees (Jan1999) IIM AhmedabadFarouk Muhammad Jega Dissertation on Contracting Out to Improve Maternal HealthEvaluating the Quality of Care under the Chiranjeevi Yojana in Gujarat India (2007) Universityof LiverpoolHimanshu Shekhar Rout and Prashant Kumar Panda book of Health Economics in India(2007) New Century Publication New DelhiDistrict Health Action Plan 2008-09 District Health Society District Panchayat Bhuj-KachchhDistrict Health Action Plan 2011-12 District Health Society District Panchayat Bhuj-Kachchh

Bhuj taluka health progressive report-2008 to up to Jan2011 Bhuj taluka block Healthoffice-Bhuj-KachchData of health schemes from Kachchh District Pachayat-BhujPHC progressive report 2009 to up toJan2011 PHC DhanetiGorevali Tabhuj-kachchh

QUESTIONNAIRE(A)BASIC INFORMATION

Suresh R Makwana

ABBREVIATIONSANM Auxiliary Nurse MidwifeAPI Annual Parasite IncidenceARSH Adolescent Reproductive and Sexual HealthASHA Accredited Social health ActivistAWW Aanganwadi WorkerAYUSH Ayurvedic Yoga Unani Siddha amp HomeopathicBHO Block Health OfficeOfficerBPL Below Poverty LineCBR Crude Birth RateCDHO Chief District Health OfficerCDR Crude Death RateCHC Community Health CentreCHCU Comprehensive Health Care UnitCMR Child Mortality RateDH District HospitalDHAP District Health Action PlanDMO District Malaria OfficerDRCHO District Reproductive and Child Health OfficerFHW Female Health WorkerFRU First Referral UnitHQ HeadquarterHampFW Health and Family WelfareIMR Infant Mortality RateJSY Janani Suraksha YojanaMDT Multi Drug TherapyMMR Maternal Mortality RatioMPW Multi-purpose WorkerMTP Medical Termination of PregnancyNGO Non Government OrganizationNRHM National Rural Health MissionOPD Outdoor Patient DeskPHC Primary Health CentrePNC Post Natal Check upRCH Reproductive amp Child HealthSHC Sub Health CentreSWOT Strength Weakness Opportunity amp ThreatsTFR Total Fertility Rate

Statement by StudentI Mr Suresh R Makwan am bonafide students of Sem-IV (MPA) I haveprepared dissertation on ldquoEffectiveness and utility value of Primary Health Centerrdquo as partialfulfillment of the requirement for the degree of MPA I here by declare that this is my own andoriginal work I have not submitted such work to this or any other university for any other degree














































































CHAPTER 3
















































































































































































































CHAPTER 3



































































































































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