Project

On

Study, Analysis and Development of Strategies for setting up Primary

HealthCare Centres in Villages.

Submitted by

Neha Jain (38)

Ashwini Sharma (13)
Srushti Sawant (37)
Vicky Lapasia (41)
Prajwal Goyal (43)

Guided by
Mr. Subhash Shinde

SIES COLLEGE OF MANAGEMENT STUDIES, NERUL, NAVI

MUMBAI

1
 Abstract
Background:
In this Project the major concern of health care scenario in rural village has been addressed and
solution of setting up a Primary Health Care centre through which development can take place.
Project Objective and Scope:
The project objective was to study the present condition of the underprivileged people living
in rural village and to work on the development of strategy for setting up Primary Health Care
centre in the village. The scope include reviewing the plan by taking into consideration any
current plans/scheme in the target rural area.
Project Profile:
Keeping in mind, the aim of our study topic, we started our research with a literature
review of various State, National and International papers which helped us understand and
define our objective to study the ground realities of the health care problems faced by the
underprivileged people in rural villages and to come up with an effective strategy of setting
up a Primary Health care centre which would take care of the community as a whole. The target
study area for our research was Pankhanda Village which is situated in
Maharashtra. We did a survey of the village to understand the health care problems faced
by people in the village. We also studied the guidelines of setting up of Primary Health care
centres in rural villages, which helped us in the development of a Primary Health Care model,
a well defined structure which could be implemented in any rural part of the world.

Learning Experience:

This project helped us to understand and learn the problems that the underprivileged people
face in the rural areas with respect to health care conditions.
This project helped us to use our knowledge and research to come up with an effective solution
to tackle the rural health care problems.
We also learnt that in the ongoing Covid19 situation one should always find new ways to keep
learning and adapting themselves to changing circumstances.

Recommendations:
As far as this project is concerned there can be improvements in collecting more information
by the visiting the village physically as we were unable to visit the village due to Covid -19
pandemic.
Short term plan:
• To be implemented within 5-10 years.
• Each primary health centre in the rural area to cater to a population of 40,000.

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Secondary health centre to serve as a supervisory, coordinating and referral institution for each
PHC 2 medical officers, 4 public health nurses, 4 trained dais and 15 class IV employees.

Perception:

Before: We as a team had a perception that we should be able to contribute to the society in
such a way that it will help the people of the village to understand and bring more knowledge
about the Primary Health Care Center.

After: After working with SSF we got a sense of satisfaction that in spite of much difficulty
we were able to contribute for the better development of the people of the village in such a way
that they will understand the importance and need of primary health care center and can
implement models like these in future for the betterment of the people.

Lastly would like to conclude with a quote which was learned during the course of this
internship:

“The future belongs to the common man with uncommon determination.”

- Dr. Baba Amte

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 ACKNOWLEDGEMENT

This research work would not have been possible without the help and support by many people
and we are indebted to all of them.
We would express our hearty gratitude to our Head of CSR Department, Mentor & Professor
DR. DURGA SUREKHA for providing her exemplary guidance, monitoring and constant
encouragement throughout the course of this project. She has been a great help throughout
making of this project.

We would also like extend our gratitude towards S.I.E.S COLLEGE OF MANAGEMENT
STUDIES for allowing us to undertake this project and DR. BIGYAN VERMA, Director,
SIESCOMS for providing us this internship opportunity.

And finally, we would like to express our deepest appreciation to SHRI SHASHWAT
FOUNDATION for their valuable inputs and constant motivation guidance, support and
giving us the excellent opportunity to do this wonderful Research project. We appreciate their
efforts and the amount of time they put inspite of their busy schedule to ensure that we learn
the fundamentals of the CSR project.

Once again, we thank to all those who have encouraged and helped us in preparing this project
and who extended us much understanding, patience, and support.

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 Table of Content

SR. NO. PARTICULARS PAGE NO.

1 Chapter 1:Introduction 6-7

• Context/Background 6
• Aim of the Study 6
• Objective of the Study 6
• Expected Outcomes 7
• Outline of the Report 7

2 Chapter 2: Literature Review 8-15

3 Chapter 3: Methodology 16-19

20-35
4 Chapter 4: Case Study
21
• Survey of the village
21
• Study of the Health Situation of the Villagers
22
• Interviewing with the NGO
22
• Data Collection
24
• Data Interpretation 26
• Development of the Primary Health Care Model 34
• Evaluation of the Primary Health Care Model 35
• Implementation of the Primary Health Care Model
35-36
5 Chapter 5: Conclusion
• Conclusion 35
• Recommendations 35
• References 36

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 CHAPTER 1-INTRODUCTION

1.1 Context/Background
In India, where more than 70 percent population reside in the rural areas. Rural Health Care
has become one of the biggest challenges facing the Health Ministry of India today.
Considering the picture of the serious facts of the condition of medical facilities being
deplorable, mortality rates due to diseases being on a high, there is a need to adopt new
practices & systems to ensure that quality & timely health care reaches the deprived corner of
the Indian villages.

In Maharashtra, the lack of adequate health care centres have become an important concern for
the increasingly growing population in the rural villages. There is a need to have adequate
Primary health Care infrastructure in rural villages as it provides the first level contact between
the population and health care providers. It addresses the broader determinants of health and
focuses on the comprehensive aspects of physical, mental and social health and wellbeing.
The current status of Primary Health Care in India is very grim. The current primary healthcare
structure is very rigid and unsuccessful in addressing the needs effectively. The unavailability
of resources such as manpower, inadequate infrastructure facilities, are some of the major
factors leading to the poor performance of the primary healthcare system. These problems need
to be addressed in order to provide better services and delivery of primary health care system.

1.2 Aim of the study

The aim of our research is to develop an effective strategy to set up primary healthcare centres
in rural areas by studying information regarding location, population, income, health literacy
and existing government plans/schemes in related area and analysing critical issues, advantages
and limitations of setting up PHC in the concerned areas.

1.3 Objectives of the study

• To study the PHC system of Underprivileged people in villages.
• To review the present conditions of the underprivileged people living in Pankhanda
village, Maharashtra.
• To develop strategies for setting up PHC centres in villages.

1.4 Scope of the Project

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The scope of our report is to design how to develop a Primary Healthcare Centre (PHC) in
Pankhanda Village, Maharashtra.To scope also includes reviewing the plan by taking into
consideration any current plan/scheme in the target rural area.Consulting the officials and
locals for any changes in the plan and making necessary changes.

1.5 Expected Outcomes

To have a better understanding about the Health Care scenario of underprivileged people in
rural areas and to have effective strategy for the development of PHC in rural areas.

1.6 Outline of report

CHAPTER 1: INTRODUCTION
This is the first chapter of the report which gives a basic idea about the Rural Health Care
scenario in India and why there is a need to set up Primary Health Care Centre in rural villages.

CHAPTER 2: LITERATURE REVIEW

This chapter shows a systematic review of identifying the tools and methods used to assess the
adequacy of Primary Health Care Centres. There are 15 research papers consisting of 6 Local,
6 National, and 7 International papers.

CHAPTER 3: METHODOLOGY
This chapter shows how the research is conducted. It explains the method of conducting the
study, method of data collection for completion of the project.

CHAPTER 4: CASE STUDY

This chapter is related to analysis of primary & secondary data. The primary data is collected
in the form of questionnaire. Data collected is further examined to determine problems. It
also explains the main aspect of the project with respect to the strategy for setting up Primary
Health Care centre in rural villages.

CHAPTER 5: CONCLUSION
This is the final chapter of the report where in the conclusion to the work is given. It also
discusses the various key recommendations in the light of results obtained.

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 CHAPTER 2- LITERATURE REVIEW
This study comprises a systematic review and met synthesis of qualitative literature on state,
national and international databases to identify the main tools used to assess Primary Health
Care (PHC). It explores the issues faced by practitioners in this new health system
environment.

STATE
1. AUTHOR- Harshal Tukaram Pandve and Tukaram K. Pandve(Department of Community
Medicine, Smt. KashibaiNavale Medical College, Narhe, Pune, 1 Health Advice Call Center,
Aundh, Pune, Maharashtra, India)
YEAR-Sept 2013
TOPIC- “Evolution and challenges of Primary healthcare system in India”
The research paper depicts about essential care that the community and the country can afford
to maintain at every stage of their development in the spirit of self-reliance and
self-determination. Deriving quality care to a large population inculcating various types of
diseases such as communicable/Non-communicable diseases, maternal, perinatal, and
nutritional deficiencies, mental health, continue to rise substantially. India’s progress towards
achieving progress in healthcare has advanced taking the future challenges in a rigorous manner
achieving effective results.

2.AUTHORS- Rahi Jain and Bakul Rao -PHD Students, Centre for Technology Alternatives
for Rural Areas, Indian Institute of Technology Bombay (IITB), Powai, Mumbai, India
YEAR - June 2019
TOPIC- Role of laboratory services in primary health centre (PHC) outpatient department
performance: an Indian case study of Osamnabad district, Maharashtra
The research paper presented the study on improving the performances of the Primary Health
Care Centres in rural areas by focusing on its laboratory services. To analyse the role of PHC
laboratory services on the overall PHC performance, a Cross-sectional study was conducted
based on 42 PHCs of Osmanabad District, Maharashtra. The study concluded that skill-up
gradation of existing Laboratory technicians could help in improving the laboratory services
thus maximizing the PHC performance and could be a cost-effective approach to maximize the
returns from the existing medical workforce in PHCs.

3.AUTHOR-Sudha Ramani's School of Health Systems Studies, Tata Institute of Social

Sciences, Mumbai, Maharashtra, India
YEAR -Sept 2019

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TOPIC-Community perspectives on primary health centers in rural Maharashtra
The research paper is the qualitative study, based on data from 14 Focus Group Discussions in
a rural area in Maharashtra in the area of 8 PHCs.For analysis, principles of maximum variation
sampling like age, education, marital status, and caste was collected from the FGD participants.
It was found that the lack of availability of drugs/services at PHCs, there was no trust in doctor-
patient interactions and general. People had faith that private doctors’ treatments would lead to
an early recovery. PHC was little distance away, people expressed willingness to travel- if good
drugs and services were provided at the centre.

4.AUTHORS- Uday W. Narlawar (Professor and Head) and Ujjwal Sourav (Assistant
Professor) Department of community medicine, GMC Nagpur, Maharashtra

YEAR - August 2019

TOPIC - Assessment of Infrastructure facilities in Primary Health Centres of Nagpur District,
Maharashtra
The research paper presented the study on assessing the infrastructure facilities available at the
Primary health centres in Nagpur district, Maharashtra by method of descriptive cross-sectional
study Data was collected by interviewing service providers through a structured standard
questionnaire and was analysed using statistical software. The study concluded that none of the
PHCs completely adhered to the Indian Public Health Standards for infrastructure facilities.

5. AUTHORS - Shreekant Iyengar, Ravindra H. Dholakia,Institute Of Law, NirmaUniversity

YEAR-12 July 2016

TOPIC- Access of the Rural Poor to Pimary Healthcare in India

For this study, survey of households was conducted in six states – Madhya Pradesh (MP) and
Uttar Pradesh (UP) in 2005, Rajasthan in 2006, Andhra Pradesh (AP) and Karnataka in 2007,
and Tamil Nadu in 2008. It examines the coverage of basic primary healthcare services among
the BPL population in rural areas of these states. It resulted that the coverage of PHC, such as
antenatal care, institutional deliveries, and immunization was very low among the BPL
population. The focus of the programme for improving coverage of PHC services should be on
the BPL population.
6.AUTHORS- Dnyaneshwar Shivaji Suryawanshi - Associate Professor, VW's college
Dhule, Maharashtra
YEAR - January 2015
TOPIC - Micro Level Planning for Health Service Centres of Nandurbar district of
Maharashtra

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The research paper presented the study on adequacy and in adequacy of Primary Health Care
centres and to study the relationship between the distribution of population and availability of
health facilities. Primary Data was collected from field survey through questionnaire related to
health problems of the people. The secondary data related to PHC was collected from District
Health office. The study concluded that Primary health centres are not equally distributed and
not sufficient in the area where the study was conducted.

NATIONAL

1.AUTHOR- Rajpurohit AC, Srivastava AK, Srivastava VK Assistant Professor(Department

of Community Medicine, Hind Institute of Medical Sciences, Barabanki, Uttar Pradesh, India
(National)
DATE-Dec 2013
TOPIC- Utilization of primary health centre services amongst rural population of northern
India - some socio-demographic correlates
The Primary Health Centre’s (PHCs) play the central role in delivering health care to
nationwide. The PHCs, are supposed to deliver preventive, promotive and curative health care
to the community. There were total 1134 households in the 6 villages, a total of 585 subjects
could be covered and interviewed about their knowledge about PHC. Majority (76.2%) of the
subjects was aware about the PHC in their area and utilization of its services was found to be
36.3%. The awareness about the PHC services and its services of is high, however, the
utilization of its services is quite low among the community.

2.AUTHORS - Anitha C.V (Research Scholar) and Dr.Navitha Thimmaiah9 (Assistant

Professor), Department of Studies in Economics and Co-operation, University of Mysore,
Manasagangotri, Mysore, Karnataka
YEAR - Sept 2013
TOPIC -Accessibility of Primary Health Care Services: A Case study of Kadakola Primary
Health Centre in Mysore district
The research paper depicted to study the extent of utilization pattern of Primary Health Care
centre services in rural areas and tried to identify the factors such as Gender, Education, Income
and Distance that influence the accessibility of Primary Health Care centre(PHC). Hence a
survey of villagers was undertaken in Kadakola PHC in Mysore district. It was found that in
the study area 82% people were utilising PHC services and the distance from the homes of the
people to the PHC was found as major determinant to the access of health care services.

3.AUTHOR-D. Varatharajan and D. Wilson Arul Anandan, Tamil Nadu

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YEAR -Jan 2009

TOPIC- Re-Activating Primary Health Centres through industrial partnership in Tamil Nadu
is it sustainable model of partnership

The purpose of the paper is to study the overall intent of public-private partnership is to utilise
the strengths of the public and private sectors. In India, private sector participated in public
health care system in several ways like clinical, nonclinical, philanthropic, non-philanthropic,
financial,non-financial,preventive,curative, and rehabilitative.The policy of industrial
partnership to re-activate PHCs in TamilNadu, although implemented through ‘gentle
coercion’, seems to have brought in significant intangible and limited tangible benefits to the
PHCs.

4. AUTHOR -Peter Berman, ManjiriBhawalkar, Rajesh Jha, Harvard T.H. Chan School of
Public Health Boston, MA, USA

YEAR -June 2017

Topic -Tracking Financial Resources for Primary Health Care in Uttar Pradesh, India

Developing strategies to meet those goals, enabling mid-course correction, and measuring
health system performance rely on availability of sound data.The paradox that despite limited
budgets the utilization of the scarce resourcesis low, particularly of NHM funds. If the
utilization of these funds could be improved, in one of the study years it would make an
additional Rs 2407 crores available for spending, which is approximately 20 percent of the
TGHE.In 2014-15 utilization of Treasury funds against budget (excluding NHM) was 70
percent and for NHM, utilization against available funds was 61 percent.

5.AUTHORS- Virendra Kumar and Anindya Jayanta Mishra, Department of Humanities and
Social Sciences, Indian Institute of Technology, Roorkee, Uttarakhand, India

YEAR - July - Sept 2015

TOPIC -Quality of health care in primary health care system: A reflection from
Indian state (Uttar Pradesh)

Quality in primary health care services is a key component in reducing allcause mortality and
disability cases. The purpose of the study is to summarize the quality of primary health care in
Uttar Pradesh (UP) and to identify important barriers that hamper quality service achievement.
The results indicate that the quality of PHC services is abysmally poor in primary health care
setting of UP. There are numerous barriers that impede quality services achievement and
service utilization.

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6. AUTHOR -NeelmaniJaysawal (Department of Social Work, Visva-Bharati, PO-
Sriniketan, Dist.-Birbhum, West Bengal), India

YEAR - Feb, 2015

TOPIC: Rural Health System in India: A Review

Nearly 75 percent of health infrastructure and other health resources are concentrated in urban
areas. One of key achievements in the area of rural health is National Rural Health Mission
(NRHM). The RSBY offers a micro-insurance product for households designated as “below
the poverty line (BPL)” and aims to cover up to 60 million households throughout the country
over the next five years.

INTERNATIONAL

1. AUTHOR- Oluwasogo A. Olalubi (Department of Public Health, School of Basic Medical

Sciences, Kwara State University Nigeria )
YEAR -Jan 2020
TOPIC- Community-Based Strategies to Improve Primary Health Care (PHC) Services in
Developing Countries. Case Study of Nigeria
The purpose of the paper is to improve relatively the health status of the nation ensuring
provision of healthcare services to people in the rural area which is indicated by reduced
mortality and morbidity and improved survival rates in such communities. There is also the
need for policies restructure, leadership and running of these PHC institutions. The country
needs to set up strategies and reforms in the system. Furthermore, policies should be formulated
to combat these identified factors in the quest to strengthen the PHC system and the health
status of the populace.

2. AUTHORS - Andres V. Villarroel, J. Seoane, F. del Pozo - Senior Members, IEEE in

Transactions on Information Technology in Biomedicine, America
YEAR - March 2005
TOPIC- Analysis of Information and Communication Needs in Rural Primary Health Care in
Peru and Nicaragua
The research paper presented the study of information and the communication needs in rural
primary health care systems of these countries. Results showed the PHC Systems were
inefficient due to lack of electricity access in most rural villages, scare or no public
telecommunication infrastructure, rural health establishments had a limited purchasing power

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and many other factors. The research paper presented some proposals to improve technology
requirements and howto deal with the use of telemedicine in rural areas of these countries.

3.AUTHOR- Ntuli A. Kapologwe (BMC Health Services Research), Tanzania

YEAR -Oct 2018

TOPIC-Development and upgrading of public primary healthcare facilities with essential

surgical services infrastructure: a strategy towards achieving universal health coverage in
Tanzania

The paper is investigated to study the cross-sectional analysis of data collected from public
PHC facilities from all over the country from 2005 to 2019.Health facilities in Tanzania needed
some sort of renovation or reconstruction in order to offer the quality health services to its
catchment populations. There were renovations or construction with ability to offer safe
surgical services through the use of a force account approach, whereby they implemented
rehabilitative or developmental work by utilizing its domestic resources rather than following
the conventional contracting processes.

4. AUTHORS -Shizheng Du, Yuling Cao, Tong Zhou, Agus Setiawan, MyatThandar,
ViryaKoy, Mohd. Said Bin Nurumal, Hong Anh, WipadaKunaviktikul& Yan Hu

YEAR - 27 August 2019

TOPIC: The knowledge, ability, and skills of primary health care providers in SEANERN
countries: a multi-national cross-sectional study.

They would develop a train-the-trainer model to deliver the high-quality training program.
Implement newly emerging training modalities such as participatory training, interactive case-
based learning, high-fidelity simulation training, and web-based learning. Tailor the training
priorities to different levels of PHC personnel, e.g., entry level training to novices, enhanced
training to backbone staff, and management training for administrators. PHC members who
scored lower in this survey deserve special attention and targeted training programs can be
designed and provided for them.

5.AUTHORS
• Peter Makaula- Research for Health Environment and Development, Mangochi,
Malawi.
• Paul Bloch - Centre for Health Research and Development, University of
Copenhagen, Denmark.Steno Health Promotion Center, Steno Diabetes Center,
Denmark.

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 • Hastings T Banda and Grace Bongololo Mbera - Research for Equity and Community
Health Trust Malawi
• Charles Mangani and Adamson S Muula - Department of Community Health, College
of Medicine, University of Malawi, Chichiri, Blantyre 3, Malawi.
• Alexandra de Sousa - Special Programme for Research and Training in Tropical
Diseases, World Health Organisation, Geneva Switzerland.
• Edwin Nkhonoand SamuelJemu- Ministry of Health, Capital City Lilongwe 3,
Malawi.

YEAR - September 2012

TOPIC-Primary health care in rural Malawi (East Africa)- a qualitative assessment

exploringthe relevance of the community-directed interventions approach

The study of 2010 in Malawi showed that there is a functional PHC system in place though its
implementation faced challenges of accessibility of services and shortage of resources. Health
service providers and consumers shared perceptions on the importance of intensifying
community participation to strengthen PHC. The study indicates that intensified community
participation based on the CDI approach can be considered as a realistic means to increase
accessibility of certain vital interventions at community level.

6.AUTHOR - Md. Kamrul Hasan a Centre for Development Studies, The University of
Auckland, Auckland, New Zealand.

YEAR - March 2012

TOPIC-Quality of Primary Health Care Services In Rural Bangladesh: Patients’ Perspectives

The aim of the research paper is to provide quality health services to all its citizens.Data for
the research came from 10 ex-patients who sought primary health services in a health centre in
a sub-district in Bangladesh. This paper demonstrates that lack of adequate health
professionals, misuse of resources, provider absenteeism, provider-centric consultations result
in patient dissatisfaction and ineffectiveness of services.The data analyses suggest that the
structure of the UHC organisation and the processes of health service delivery influence the
outcome of the health services.

7.AUTHOR-Soma Hewa,School of Policy Studies, Queen's University, Kingston, Ontario,

Canada

DATE-October 2011
TOPIC-Sri Lanka's approach to Primary Health Care: a success story in South Asia
This paper argues that Sri Lanka's primary health care program succeeded in reducing mortality
and promoting health in the early twentieth century as it tackled the most serious health

14
problems across the country with the help of local communities.Sri Lanka has achieved
outstanding health indicators, like low mortality rate (5 per 1000) and high life expectancy (75
years), which are the results of historical commitment to health as a social goal, welfare
orientation to development, community participation in the decision-making process pertaining
to health, and the universal coverage of health services.

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 CHAPTER 3-METHODOLOGY
Methodology represents the steps involved in conducting the research. It represents the details
about the methods which are not only focused on characterizing and defining them, but also
explaining the procedures used for selection, methods of data collection and data analysis.
The methodology carried out in our research project is presented in the flowchart below:

Survey of the Village

Study of the Health Situation of the Villagers

Interviewing with the NGO

Data Collection

Data Interpretation

Development of PHC Model

Evaluation of PHC Model

Implementation of PHC Model

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1. Survey of the Village
This included collecting the information about village. The information was collected through
Google Earth, Google Maps as it was not possible to physically visit the area due the situation
of Covid-19. This helped us understand about the area, location, roads, etc. about the village.

2.Study the health condition of the villagers

The target group of our project were the people of the village and to understand their present
health conditions was an important objective for us. Hence, we tried to gather as much data as
possible through the survey.

3. Interview with the NGO

An interview with the NGO was conducted with reference to the questionnaire to understand
the prevailing situation of the village. This gave us a great insight as to what they are dealing
with and helped us to scale our research accordingly.

4. Data Collection
Data collection is an important part of research as important decisions are made based on the
analysis of the data collected from a research and one critical component of data collection is
ensuring the quality of the data collected. Specifically, it is important that the data should be
both high-quality and relevant.

The data was collected with the help of a Questionnaire to study about the village. Data was
collected to understand the existing situation of the Health Care scenario and problems faced
by the people living in the village.
Hence we designed a questionnaire which is shown on the next page.

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 QUESTIONAIRE
Q1. No. of Households in the village

Q2. Total Population? Bifurcation of Men/Women/Children.

Q3. Average income of households.

a. Less than Rs. 4000,
b. Rs. 4001 - Rs. 8000,
c. Rs. 8001 - Rs. 12000,
d. More than Rs. 12000

Q4. Educational Qualification (Overall view)

Q5. Are the people aware about what is Primary Health Care Centre?
a. Yes
b. No
Q6. Are there any government health care programmes and schemes in the
village?
a. Yes (If Yes, which ones)
b. No
Q7. What kind of pre-existing ailments /diseases are the people suffering
from?
Q8. What type of houses do people live in?

Q9. Do the people have toilet/sanitation facility at their homes?

a. Yes
b. No

Q10. Electricity availability in the village

Q11. Sources of drinking water
Q12. How far is the nearest clinic/hospital from the village? How are the
facilities available there?
a. Good
b. Fair
c. Poor
Q13. How do people deal with their medical treatments?
Q14. Is there a chemist store in the village?
a. Yes
b. No

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5. Data Interpretation
The purpose of data analysis is to extract useful information from data collected and take the
decisions based upon the interpretation.

For this research, our group collected the data in the form of questionnaire which was used
while surveying the rural population in village. This helped us to interpret the data in a
meaningful manner. Thus, we proceeded with qualitative and quantitative interpretation of
data.
QUANTITATIVE ANALYSIS: In quantitative analysis, we used questions related to facts
and figures number of households, income of people, health facilities and number of people
affected with any pre-existing ailment. These quantitative facts and figures helped us to support
our research and study.

QUALITATIVE ANALYSIS:The qualitative analysis included non-numerical facts in the

questionnaire such as medical awareness in the village, proper supply of medication and
availability of essential utilities affecting the health of the people like source of drinking water.

6.Development of PHC Model

Model development is considered as an effective research method. It helps to describe, predict,
test or understand complex systems or events. Hence in this scenario, a Primary Health centre
model was developed to provide basic health care facilities for people living in the village.

7. Evaluation of PHC Model

An evaluation of model was done to understand its Strength, Opportunities and Limitations.
This would help us to understand the model in an effective way.

8. Implementation of PHC Model

The implementation of the model is done to help the people of the village to improve their
health care issues and to see how well the chosen model can be best implemented in the future.

Conclusion
We feel the methods mentioned above were the best methods possible in the existing scenario
of the Covid19 pandemic. The above study helped us understand the existing situation
prevailing in the village and to come up with an effective solution to tackle it.

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 CHAPTER 4- CASE STUDY
In this chapter, the study of the village was carried out which lead to the development of
Primary Healthcare Center model which would benefit the underprivileged people in the rural
area and provide them with basic healthcare facilities.
Healthcare Issues around the World
According to a report from WHO the poor are treated with less respect, given less choice of
service providers and offered lower quality amenities.Atleast half of the world’s people still
lack full coverage of essential health services.A fit-for-purpose workforce is essential to deliver
primary health care, yet the world has an estimated shortfall of 18 million health workers.Of
the 30 countries for which data are available, only 8 spend at least US$ 40 per person on
primary health care per year.
Study Area of a village in Maharashtra, India

Source: Google Earth

Study of Pankhanda Village, Maharashtra

Source: Google Earth

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4.1 Survey of the village

Village Name Pankhanda

District Thane

State Maharashtra

Region Konkan

Local Language Marathi

Assembly Constituency Thane Assembly Constituency

We tried to gather as much as possible details possible about the village but could not physically
visit the remotely areas due to the inaccessibility as a result of the lockdown due to COVID19.
The information we collected about the village gave us a great insight as to what they are
dealing with and also helped us to project and scale our research accordingly.

Source: https://www.google.com/search?q=phc+village+images&tbmhttps://ehealth.eletsonline.com/2018/05/well-equipped-
primary-healthcare-centres-needed/

4.2 Study of the Health Situation of the Villagers

The purpose of our project were the people of the village and understanding their present
conditions were the primary objective.

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Source:https://www.google.com/search?q=primary+health+care+center+images&tbmhttps://www.slideshare.net/pradipawat
e7/primary-health-care-in-india

4.3 Interviewing with the NGO

An interview with the target group was conducted with reference to the questionnaires to know
about the health conditions of the people, the patients affected with the diseases.

4.4 Data Collection

As mentioned, due to the prevailing pandemic situation, we could not collect data by directly
confronting with the villagers residing in the study area. So,while interviewing with the NGO
who used to keep relevant data of the residers and working in this regard, we collected data
from following sources.

Sources of data:
Primary Source-Questionnaire
Secondary Source- Google Maps, Google Earth

We have designed a questionnaire which is shown in detail on the next page.

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 QUESTIONAIRE ANSWERS
Q1. No. of Households in the village Households - 150

Population - 750,
Grandparents - 300,
Parents - 300 and
Q2. Total Population? Bifurcation of Men/Women/Children. Children - 150
Q3. Average income of households.
a. Less than Rs. 4000,
b. Rs. 4001 - Rs. 8000,
c. Rs. 8001 - Rs. 12000,
d. More than Rs. 12000 Rs. 4001 - Rs. 8000
1 Girl is Graduate,
8th Pass Everyone and
Parents Illiterate
Q4. Educational Qualification (Overall view)
Q5. Are the people aware about what is Primary Health Care
Centre?
a. Yes
b. No Yes
Q6. Are there any government health care programmes and
schemes in the village?
a. Yes (If Yes, which ones)
b. No No
Diarrhoeal diseases, Fever,
Q7. What kind of pre-existing ailments /diseases are the people Cough, Cold, Eye problems &
suffering from? Snake bites.
Pakka Houses-15% and
Q8. What type of houses do people live in? Kachha Houses - 85%
Q9. Do the people have toilet/sanitation facility at their homes?
a. Yes 30 % People have sanitation
b. No facility
Q10. Electricity availability in the village 12 - 16 Hours
Public tube well, Pond, River
Q11. Sources of drinking water and Open Well
Q12. How far is the nearest clinic/hospital from the village?
How are the facilities available there?
a. Good
b. Fair 3 kms and facilities are Fair
c. Poor
Govt. Hospitals/
Localdispensaries/ Private
Q13. How do people deal with their medical treatments? charges -Rs. 50 - Rs. 60
Q14. Is there a chemist store in the village?
a. Yes
b. No No

23
4.5 Data Interpretation

From the above data we interpreted that-

• The villagers residing there are aware about the existing healthcare facility(private
clinic/ local dispensary) existing within the 3 km radius of the village. Though most
of them are below poverty line, so they couldn’t avail expensive private medical
facilities outside the village.
• Since most of them have Kachha houses, they also lack sanitation facilities. Thus due
to unawareness of the consequences of open field sanitation and due to financial
problems, most of the households are lacking separate clean toilets and sanitation
facility. Thus they are unable to live hygienic lifestyle which led to many diseases like
Diarrhoea.
• There is no separate chemist in the village so the sole dependency of availing
medicines is most probably the existing dispensaries. This may be the problem for the
whole population of the village as every patient may not be able to get the right
medicine at the right time or not at the earliest.
• Since as often, the patients are suffering from of cold, fever and Diarrhoea, dispensary
may avail medicines for these diseases. But it may lack medicines for any other
emergent or specific type of disease like Tuberculosis etc. due to lack of chemist
facility.
• However, given only the existence of most occurring diseases of fever, cold and
Diarrhoea, availing medicine from dispensary may prove to be cheaper than getting it
from any chemist outside the village for the financial unstable ones.

About Primary Health Care:

Primary health care is a whole-of-society approach to health and well-being centred on the
needs and preferences of individuals, families and communities. It addresses the broader
determinants of health and focuses on the comprehensive and interrelated aspects of physical,
mental and social health and wellbeing.

It provides whole-person care for health needs throughout the lifespan, not just for a set of
specific diseases. Primary health care ensures people receive comprehensive care - ranging
from promotion and prevention to treatment, rehabilitation and palliative care - as close as
feasible to people’s everyday environment.

Primary health care has been proven to be a highly effective and efficient way to address the
main causes and risks of poor health and well-being today, as well as handling the emerging
challenges that threaten health and well-being tomorrow.
Healthcare is the right of every individual but lack of quality infrastructure, dearth of qualified
medical functionaries, and non- access to basic medicines and medical facilities thwarts its
reach to 60% of population in India. A majority of 700 million people lives in rural areas where
the condition of medical facilities is deplorable.
The two images below show the poor conditions of the Primary Health Care Centres in
rural areas.The villages don’t have proper facility for healthcare and medicines, lack of
adequate infrastructure, lack of adequate training and expertise and various other factors.

24
Source:https://donatekart.com/phc/medical-support/Source:Shitalkuchi-Block-Primary-Health-Centre-Cooch-Behar

Also, many and studies have pointed out that availability PHC Centres are low in rural areas
as it is influenced by numerous factors. Unless these factors are identified and the
measurestaken, the goal of “Universal Health Care and Health for All” may not be achieved.
Based on studying the conditions of the village, we have developed a Primary Health
Care Centre model and which can be implemented in any part of Rural India. The same
is explained in detail on the next page.

25
4.6 Development of the Primary Health Care Model
The result drawn from the above research showed the past and the present healthcare
situation and the facilities available to the people of Pankhanda village and also their health
care requirements which helped us to build a suitable model plan for the village.

Primary Health Care Model Plan

26
 Primary Health Care Model Area Specifications are listed as follows:

Sr.
Function Area Sq. Metres Sq. Feet
No.
1 Treatment Room 3.8 m X 4.43 m 16.834 181.2
2 Store Room 2.4 m X 3.0 m 7.2 77.5
3 Dispensing Room 2.4 m X 3.0 m 7.2 77.5
Consultation Room(Capacity -
4 3 Beds) 3.5 m X 4.6 m 16.1 173.299
5 Male Toilet 1.8 m X 1.3 m 2.34 25.188
6 Female Toilet 1.8 m X 1.3 m 2.34 25.188
7 Passage Space 3.2 m 2.4 m 7.68 82.667
8 Passage ahead of Bathroom 1.6 m X 2.7 m 4.32 46.5
9 Waiting Area 4.8 m X 3.0 m 14.4 155

Total Carpet Area 78.414 844.042

Floor Plan
1. Entrance Lobby/ Waiting Area:
• In the waiting area there will be 10 chairs for the patients to sit and wait till their
number comes.
• There will be one staff member who will be taking a note of the patient and keep their
records safely in the desk/ table which will be kept in the waiting area.

2. Consultation Room:
• In the consultation room there will be one chair for the doctor and two chairs for the
patient and one bed for the patient to lie down while the doctor will treat them.
• There will be two tubelights and one big fan so that there is enough light in the room
to treat the patient and also proper ventilation.

3. Dispensing Room:
• In the dispensing room there will be one chemist who will give the medicines to the
patient as recommended by the doctor.
• There is window on the other side, through which the villagers can take basic
medicines from the dispensary directly.

4. Store Room:
• All the medicines and other basic things like extra bedsheet, pillow, etc required in the
PHC will be kept in the store room.
• There will be a fire exit from the store room which will also be used to load the
medicines directly from the fire exit door in the store room.
• There will be medicines kept in the refrigerator in the store room.

27
5. Treatment Room:
• In the treatment room there are three beds kept for the patient who need urgent
treatment and need saline so they can have rest in this room.
• This room can also be used for basic eye operations.

6. Sanitization Facility:
• There are different toilets built for male and female.
• The toilets will have exhaust fans and also wash basin to maintain hygiene.

This Primary Healthcare Centre will be a good quality outpatient healthcare facility that intends
to serve as a first point contact to the people living in the village and will provide basic health
care facilities which includes prevention and treatment of common diseases and injuries, basic
emergency services, referrals to/coordination with other levels of care (such as hospitals and
specialist care), healthy child development etc.

Working on a shoe string budget the Primary health care centre will exploit local construction
skills and utilize low cost effective and quality materials available in vicinity.

The structural design utilizes the strength characteristics of individual materials. A load-
bearing wall which will be an active structural element of facility, which will hold the weight
of the elements above it, by conducting its weight to a foundation structure below it.

The walls are produced by a bricklayer, using bricks and mortar. Typically, rows of bricks
called courses are laid on top of one another to build up a structure such as a brick wall as
shown in the image below.

Source: Pinterest

Roof Plan : Using of Mangalore tiles for Roof Construction

Mangalore Tiles are the oldest and the most popular tiles favourite since ages because of their
nostalgic & evocative use in heritage buildings and the peculiar pattern.

28
They are made from a type of red clay (referred to as ‘laterite clay’) which is typically
considered very hard as compared to other kinds of building clay. The roof is built with wooden
frames and laid out with Mangalore tiles on the roofas shown in the image below.

Source:http://newseq.blogspot.com/2011/10/affordable-housing-with-mangalore-tiles.htm

Benefits:
Economical:Mangalore tiles are relatively cheap to produce which means their purchase price
is also low when compared to other roofing materials. Also, Mangalore tiles offer your
money’s worth: they are as durable as can last a century and more which means you do not
have to replace them anytime soon.

Eco Friendly: Due to the material they are made of, they have very little or no negative effect
on the environment and pose no threat to the normal flow of ecological activities within the
environment.

Energy Insulation: Since they are made of clay, Mangalore tiles help to regulate the flow of
electrical energy within a building.

29
Equipments and Medicines required:

No. of No. of
Equipment PP Drugs/facilities Pp %
Dressing drum 30 Calcium chloride injection 16 53
Dressing trays 28 Antihistaminic injection 10 33
Urinary catheter 21 Sodium bicarbonate injection 20 67
Dressing table 2 Hydrocortisone injection 29 97
Side lamp with 27 Naloxone hydrochloride 2 6.7
stand injection
Forceps 30 Dextrose 30 100
Scissors 30 Normal saline 30 100
Suture materials 30 Ringer lactate 28 93
Needle holder 29 Activated charcoal powder 1 3.3
Suction apparatus 25 Metergotamine 22 73
Mouth gag 13 Metoclopramide (PlasiP) 20 67
Blades 29 Adrenaline injection 30 100
IV stand 30 Ventolin 29 97
Splints 23 Anti-scorpion 30 100
Nasogastric tubes 9 Anti-snake 28 93
Cannulas 16 Anti-tetanic serum 27 90
Cervical collars 4 Tetanus toxold 30 100
Oxygen cylinder 30 Rabies vaccine 17 57
with standard
fitting
Oxygen mask 29 Diazepam 14 47
Airways 19 Furosemide (Lasie) 28 93
equipment
Manual 28 Hyoscine 29 97
resuscitator (Ambu
bag)
Nebulizer 27

30
Facilities and drugs mention by Government of India for PHC for 1000 people:

Essentials
Normal Delivery Kit. Baby weighing scale.
Equipment for assisted vacuum delivery. Height measuring Scale.
Table lamp with 200 watt bulb for
Equipment for Manual Vacuum Aspiration. New born baby.
Equipment for New Born Care and Neonatal
Resuscitation. Phototherapy unit (Desirable).
Self-inflating bag and mask-neonatal
Refrigerator. size.
ILR (Small) and DF (Small) with Voltage
Stabilizer. Feeding tubes for baby.
Cold Boxes (Small & Large): Small- one, Large –
two. Torch without batteries – 2.
Vaccine Carriers with 4 Icepacks: Two per Battery dry cells 1.5 volt (large size) –
SC(maximum 2 per polio booth) + 1 for PHC. 4.
Spare ice pack box: 8, 25 & 60 ice pack boxes per
vaccine carrier, Small cold box & Large cold box Bowl for antiseptic solution for
respectively. soaking cotton swabs.
Waste disposal twin bucket, hypochlorite Tray containing chlorine solution for
solution/ bleach: As per need. keepingsoiled instruments.
Kits for testing residual chlorine in
Freeze Tag: 2 per ILR bimonthly. drinking water.
Thermometres Alcohol (stem): Need Based H2S Strip test bottles.
Ice box.
Adult weighing scale.

List of suggested equipment and Furniture including Reagents and diagnostic Kits
• Head Light.
• Ear specula.
• Stethoscope - 2.
• Minilap kits - 5.

Desirable
• Room Heater/Cooler for immunization clinic with electrical fittings as per need.
• Ear Syringe.
• Noise Maker.
• Nebuliser - 1

31
Requirements for a fully equipped and operational labour room Essential :
A fully equipped and operational labour Glassware and other equipment
room

1. A labour table 1. Colorimetre

2. Suction machine 2. Test tubes
3. Facility for Oxygen administration 3. Pipettes
4. Sterilization equipment 4. Glass rods
5. 24-hour running water Glass slides
6. Electricity supply with back-up facility
(generator with POL) 6. Cover slips
7. Attached toilet facilities 7. Light Microscope
8. Differential blood cell counter (Desirable)
9. Glucometer (Desirable)

List of Furniture at PHC

The list is indicative and not exhaustive. The Furniture/fittings &Medical and Surgical items
are to be provided as per need and availability of space &services provided by the PHC.

Essential Items
Examination table - 4 Basin 2
Writing tables with table sheets - 6 Basin stand 2
Plastic chairs (for in-patients’ attendants) - 6 Buckets 4
Armless chairs - 16 Mugs 4
Full size steel almirah - 7 LPG stove 1
Table for Immunization/FP/Counseling - 1 LPG cylinder 2
Bench for waiting area - 2 Sauce pan with lid 2
Wheel chair - 2 Water receptacle 3
Stretcher on trolley 2 Rubber/plastic shutting 2 metres
Wooden screen 1 Drum with tap for storing water 2
Foot step 5 Mattress for beds 12
Coat rack 2 Foam Mattress for OT table 2
Bed side table 6 Foam Mattress for labour table 2
Bed stead iron (for in-patients) 6 Bed sheets 30
Baby cot 2 Pillows with covers 30
Stool 10 Blankets 18
Medicine chest 1 Baby blankets 4
Lamp 3 Towels 18
Side Wooden racks 4 Curtains with rods 20 metres
Fans 6 Dustbin 5
Tube light 8 Coloured Puncture proof bags
Generator (5 KVA with POL for immunization

32
Desirable
• Black Board/Overhead Projector 1
• Public Address System

Human Resources
The Primary Health Care Centre will consist of following human resources.
• 1 Doctor
• 1 Pharmacist
• 1 Caretaker
• 1 Receptionist
• Nurse Staff - 1 Male and 1 Female

The overall objective was to create a basic effective Primary Health Care facility that would
cater to the health requirements of the underprivileged people living in the village.

4.7 Evaluation of the Primary Health Care Model

Basis the development of the PHC model, the evaluation of the model was done to identify its
Strength, Limitations and Opportunities. This would be taken further into consideration while
implementing the model.
STRENGTHS:

• It will be Low cost Health Care facility as low cost effective and quality materials will
be used to construct the model.
• The centre will provide better sanitation facilities.
• Higher Accessibility and Feasibility - The centre will serve as a first point contact to
the villagers and will provide basic health care facilities which includes prevention
and treatment of common diseases and injuries, basic emergency services, referrals
to/coordination with other levels of care (such as hospitals and specialist care),
healthy child development etc.
• The model when implemented in the future will lead to increase in the employment
opportunities for the villagers which will improve the standard of living of the people
in the village.
• As research showed that there is no Chemist facility in the village, the model will
provide a Dispensing Room as well.
• The model can be implemented in any Rural part of India.

33
LIMITATIONS:

• Treatment room in the PHC can only accommodate up to 3 people.

• Shortage of Electricity is a problem in the village as it would affect the functioning of
the Primary Health Care Centre.
OPPORTUNITIES:

• Expansion of the model will be possible.

4.8 Implementation of the Primary Health Care Model

This model can be implemented in any rural part of the world. This is a simple yet an effective
model which will helps the patient in the rural areas to undergo their basic health care
treatments instead of travelling far distances to the Hospital.
The centre aims to provide basic health care facilities and treatments in order to improve the
condition of Rural Health Care scenario.
The model can be implemented with the help of Government Corporate Partnership for
financial resources and adequate infrastructure facilities.
The goal of any health care system is to provide universal access to appropriate, efficient, effective
and quality health services, in order to improve and promote people’s health.

Figure: Actors involved in the implementation of the primary health care strategy
Source: https://onlinelibrary.wiley.com/doi/full/10.1002/hpm.2228

34
 CHAPTER 5-CONCLUSION

The healthcare system in India has been one of the important issues for development. But it
has been one of the neglected sectors in the economy. The existing state of public health in the
country is so dissatisfactory that any attempt to improve the present condition must necessarily
involve administrative measures.
Health indicators are poor in the areas where primary health care services are
delivered.Therefore, improvement in the quality of primary health care services are needed to
improve the current health status. The awareness about the PHC services and its services of is
high, however, the utilization of its services is quite low among the community.
Therefore, improvement in the quality of primary health care services are needed to improve
the current health status. To reduce the disease burden and health inequalities the government
policies has to enhance their focus on preventive and promotive health care services.It is
imperative for us to revitalize the existing rural health system from both structural and
functional points of view.

RESULTS

As interpreted above, the studied village area is lacking some of the significant medical and
hygienic awareness and facilities. The village people need to be actively made aware about
practicing sanitation in toilets. Those households are lacking the toilets, shall be lended a hand
from the government authorities accountable for the development of that area, to build toilets
for those who are really unable to make it on their own.

Since dispensary may be the sole provider of medicines, but the villagers shall not depend on
it for any uncertain diseases whose medication need not to be happen with the dispensary.
Atleast one or two chemist shop should be operated in the village with the help of the
accountable government authorities so that everyone can avail the medicines from the chemist
as well. Also, the price shall be the matter of concern for the poor ones. They shall be provided
medicines at reasonable and affordable price or may be given with some discounts.
Primary healthcare centres itself says that its responsibility is to primarily taking care of the
health of society wherever there is a need. So, developing a PHC in this area will lend a great
hand towards the medical conditions of the village. Apart from this not, development shall be
followed by the major awareness among the villagers of not practicing any unhygienic lifestyle
and shall be taught about various diseases and how to avail the medical facilities at the earliest

35
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