Group-1 Dr. Dr. Dr. Dr. Dr. Dr. Dr. Dr.

Akhtar Farrukh Khalid Nazish Rehan Sumaida Tehseen Waseem

Introduction
If the health care system is to serve the community, there must be a good fit between community health needs and health system.

Objectives

To determine the extent to which the services are oriented towards needs. To determine what systems are in place to adequately manage and support the services.

Problem solving approach

Contents
Availability of specific Health Programs Health Facility Management Health Facility Physical Inventory Health Facility Activities Health Facility Morbidity Conditions

BHU Bhukkar Population Coverage 11,000 persons Availability of Services General curative services, Antenatal care, Delivery care, Postnatal care, EPI, Family planning Active Outreach for Midwifery, Health education, Family planning, Antenatal and Postnatal care and Curative care Not Available

Social Security Hospital 199,000 persons General curative services, Antenatal care, Delivery care, Postnatal care, EPI, Family planning Feeding program, Nutritional rehabilitation, Nutritional surveillance, Curative care, Surgical care, Obstetric and Gynaecological care Available Available

Inpatient Curative Services

Specific Preventive and Available Health Promotive Services Specific Organization

TBA Training, Program Transport system, drug

Adequacy Of Staff (<75% denotes absentism) BHU Bhukkar Proportion of staff physically present Training and Supervision Score BHU Bhukkar On job training and supportive 6/8 (Adequate) supervision Adequacy of treatment guideline 5/8 (Adequate) Social Security Hospital 7/8 (Adequate) 8/8 (Adequate) 25% Social Security Hospital Not available

Management and Organization BHU Bhukkar Adequacy of transport facilities. Drug Management 0/7 (InAdequate) Drug received from district office (InAdequate) 4/6 (Good job organization and planning) Social Security Hospital 7/10 (Adequate) Drug received from Central Medical Store (Adequate) 6/7 (Good job organization and planning)

Planning and Management Finance

Total Budget: Information Total Budget: not available. (incharge 101,072,900 was not aware of financial Salaries: 70,987,000 requirements. Drugs: 13,000,000 Repair: 430,000 (Hospital is self sufficient with respect to running cost. 12/20 (Record well 22/24 (Adequate record

Health Information

BHU Bhukkar Status of building

Social Security Hospital

2/7 (Largely InAdequate 19/23 (Adequate physical facilities) physical infrastructure) 21/25 (Very well equipped and maintained facility) 101/101 (Very well equipped and maintained facility) 23/23 (Adequate lab equipement) 31/31 (Adequate)

Status of furniture and 7/13 (InAdequate utensils availability) Status of equipment and instruments Lab Equipment Status of drugs and sundries in OPD 14/29 (InAdequate Availability) NA 10/23 (InAdequate)

Outpatient Load (visits per person to OPD per year) BHU Bhukkar Social Security Hospital 0.837 Visits (gross underutilization 0.44 Visits (gross underutilization of of services) services)

MCH Activities BHU Bhukkar No. of antinatal visits per pregnancy. No. of preschool children seen per population unit per month. 0.412 ( <1 means population is under served) Social Security Hospital 0.93 (population is under served)

26 ( <50 means under 10 (population is under utilization of services) served)

Outreach BHU BhukkarSocial Security Hospital Percentage of home deliveries carried out by BHU staff none none Data Unavailable

Health education talks given in Zero community %age of beds for pre-school children 12% %age of beds for maternity care Record keeping 12 recent pre-school children admissions Average duration of stay of preschool children 12 recent maternity admissions 19%

Good Management & Organization GE, ARI, Fever, IDDM, Anemia, GB Syndrome, malaria 3 days (Efficient use of facility) Pregnancy induced hypertension, anemia, UTI, Preterm labor, Miscarriages, Fibriod uterus, Elective C-Section

12 recent school-age children admissions Average duration of stay

Vomiting, ARI, GE, Thalassemia, Asthma, Hepatitis, Fits 3 days

12 recent adult admissionsDM, COPD, CLD, Acute hepatitis, HTN, CVA, CRF, PUO, Anxiety Average duration of stay Daily theatre utilization rate 4 days 3 operations per day

%age of operations carried 7% out on pre-school children C-Section rate 50%

Morbid conditions encountered in OPD, Services
BHU Bhukkar Pre-School Children School Age GESTRO, ARI, Dysentery, Fever (clinical malaria), Scabies Social Security Hospital GESTRO, ARI, Dysentery, Scabies

ARI, Diarrhea, Dysentery, Diarrhea, URTI, Malaria, Scabies, Malaria Enteric Fever, Acute hepatitis Arthritis, APD, Anxiety, ARI, Fever ARI, APD, Hypertension, Minor injuries Fever, Arthritis, Hypertension, Obstetric conditions Hypertension, IHD, TIA, CLD, Acute hepatitis

Women

Men

Sanitation Water supply Prevalence of infectious diseases Inadequate physical, human and financial resources Unavailability of evening and night services Unavailability of sanctioned items Underutilization of services Poor immunization coverage Inefficient management of resources

Focus on preventive rather than curative services Target the improvement of PHC facilities Ensure sufficient allocation as well as distribution of financial resources Inter sectoral collaboration Community participation Ensure job satisfaction of working staff (human resource management)

Thank You

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