IIT Madras research shows improved healthcare in TN
POLICY ANALYSIS The team of researchers at IIT Madras analysed the public healthcare delivery system across three districts to discover that the Tamil Nadu government’s initiative had steered significant improvement
A recent study carried out by the Indian Institute of Technology Madras has shown that the pilot run of the Universal Health Care (UHC) project introduced by the government of Tamil Nadu has helped improve access to primary care at a sub-centre level.
The study took place in three blocks of the state, namely, Shoolagiri block, Viralimalai block and Veppur block over a period of 8-10 months.
The research focused on the primary clinical care availability through sub-centres which are the first point of contact in the health delivery system. “Sub-centres in some regions were neglected and sometimes opened just one day a week and the UHC was introduced to improve the delivery system,” said VR Muraleedharan, Department of Humanities and Social Sciences, IIT Madras. His team has been gathering data for the UHC scheme for nearly three years and a follow-up report is expected to be launched later this year.
The first stage was a baseline survey that analysed the healthseeking behaviour of citizens followed by a facility gap analysis at primary health centres and sub-centres. About 1000 households across 25 villages in each block were covered with about three months of data gathering, for both base line and endline surveys. A qualitative analysis on the overall performance of all 67 sub-centres was carried out, as part of the evaluation of used to qualitatively analyse the quality of outpatient care.
The data gathering team also acted as facilitators in helping Village Health Nurses (VHNs, equivalent of ANMs) learn how
The sTuDy exAMineD The priMAry CLiniCAL CAre AVAiLABiLiTy Through suBCenTres ThAT Are The FirsT poinT oF ConTACT
to use the UHC-app, which provides patient related information..The app helped capture details such as diagnostic history and pharmaceutical consumption. This data was then read in association with the National Population Register (NPR) and other local databases.
The government’s model aimed to improve the first point of contact in the health delivery system and ensure that residents access the sub-health centre instead of going to higher level public facilities, or private hospitals/clinics. “Transportation accounted for a large portion of out of pocket expenditure (OOPE), for those seeking outpatient care from a block level or distrit level government facilities”, said Muraleedharan. In the Shoolagiri block, for instance, OOPE was Rs 5.98 for sub-health centre compared to Rs 55.87 for a primary health centre and Rs 607.80 for a private clinic. According to Muraleedharan, for every patient diverted from a primary health centre to a sub-health centre, the government not only saves Rs 200 but also saves a doctor time and diagnostic resources.
The UHC also aims to improve the manpower at the health centres as the government often struggled to fill the vacancies. Many of these centres were not in a good condition, even if they were open, they did not have up-to-the mark sanitation facilities or the necessary physical infrastructure.
The study also shows that the patients trusted the local health services with nearly 35% patients every month being repeat patients. The study suggest that if delivery of clinical primary care is guaranteed on a daily basis, patients’ trust on public delivery system is bound to improve leading to increase in the use of services.
Among the challenges faced by researchers, multilingualism in some of the districts in the border areas was a hurdle as several households had members who also spoke Telugu and Kannada “Often women of the households were employed under the MGNREGA scheme and therefore were unavailable during the morning and the researchers had to return for questioning in the evening,” said R Gopinath, member of the team conducting interviews.
At a micro level, often patient data was incomplete and the team spent quite some time in collecting data and updating records to be in sync with the NPR.