Compiled by

Lata Suresh

PREFACE

IIHMR being the premier institute of hospital and health management in the country has the prime responsibility to shape the direction

and dimensions of research and development in the field of health and hospital management. From the year of its inception; it is

committed to generating quality research in these fields.

The Institute offers a two-year full-time Postgraduate Programme with specialization in Hospital Management and Health

Management. It is a flag ship educational programme aiming at developing trained professional managers with requisite skills in

planning and operating management techniques; diagnosing and solving management problems; and acquiring consultancy skills,

with a view to preparing them to manage hospitals and pharmaceutical and healthcare institutions in developing countries both in the

public and the private sectors, and to meet the rising demand for quality care. For practical training the Institute has collaborative

arrangements with multi-specialty hospitals and several pharmaceutical companies, NGOs and healthcare organizations. As the

programme has set high standards of management education in the health sector, it has attained the status of a premier programme in the

country. Our students go for training and placement to as many as one hundred hospitals and pharmaceutical and healthcare

organizations. Hence, Institute decided to publish abstracts of the entire dissertations carried out by the students. This volume

summarizes the work done by the students of PGDHM batch 2008-2010.

We acknowledge the help and support provided by the PGDHM and PGDPM students batch 2009-2011 and the library staff for their

immense help provided during the final stage of this publication. We also acknowledge the help and support by Mr. Mukesh Gahlot,

computer department for his assistance.

Lata Suresh

1. Infection Control in Intensive Care Unit & Facility Based New

Born Care Unit

2. Efficient Work Flow Management in Radiology Department Anil Gupta L.P. Singh 2

3. Comparative Study on Incidence of VAP in ICU at a Hospital Anuj Dandotia 3

in Patna

4. Strategy Evolvement for Improving Turnaround Time for Bed Anurag Gupta Vinod Kumar 3

having Synergized Effect on Delivering Quality Health Care to

Patients in a 200 Bedded Hospital

5. Study on Factors Associated with Satisfaction and Motivation of Aparna Jha S.C. Gupta 3

the Class III & IV Employees in Government District Hospital

6. Quality Assessment of Radiology Department Archana Agarwal S.D. Gupta 4

7. Statistical Approach to Inventory Optimization with Focus on Arti Sharma Abhishek Dadhich 5

Medical Consumable Items

8. A Comprehensive Study of Gap Analysis of Facility Management Bhushan Sarmandal Anoop Khanna 5

& Safety (FMS) at Specialty Hospital, as per Joint Commission

International (JCI) Accreditation Standards

9. Quality Assurance in Biomedical Waste Management Deep Makkar Dipti Govil 5

10. Study of Process Compliance for Rationalization of Usage of Deepti Choudhari S.K. Puri 6

Restricted Antimicrobials in a Tertiary Care Hospital in India

11. A Study on Patient Satisfaction at Multi Super Specialized Hospital Divya P.R. Sodani 6

and Heart Institute, New Delhi

12. Compliance Percentage Assessment and Comparison (Pre and Post) Eesha Arora P.R. Sodani 7

to NABH Standards for Capacity Building

13. Rapid Assessment of a Model Initiative to Ensure Quality Family Esha Kalra Vivek Lal 7

Planning Services in Uttarakhand

Amritesh Mullick Goutam Sadhu 2

CONTENTS

HOSPITAL MANAGEMENT

S.No Title Students’ Name Advisor Pg No.

14. Formulation and Implementation of Performance Management

System at a Tertiary Care Hospital

15. Nosocomial Infection Management Garima Singh Meel Nutan P.Jain 8

16. Influence of ‘Post Surgical LOS’, ‘Surgeon’, ‘Insurance’ and Ginny Kaushal C.K. Aiyer 9

‘Bed Class’ on ‘Patient’s Hospital Expenses’ for MRM,

Amputation and Oesophagectomy Surgeries done in a quarter.

17. Measuring Operational Efficiency of 210 Beded Multi Super Heena Kausar Santosh Kumar 9

Specialty

18. Construction and Implementation of Information System for Indu Dhangar R.S. Goyal 10

TPA Department

19. Time Utilization of Operation Theatre Jitendra Kumar Hayaran Neetu Purohit 10

20. Internal Assessment of as per NABH Standards Jyoti Ahuja Barun Kanjilal 11

21. Benchmarking of Inventory and Stores Department of an Eye Kanwalpreet Grewal Neetu Purohit 11

Hospital

22. Application of Lean Principles to Improve Operational Efficiency Karan P. Mansukhani Santosh Kumar 12

in Health Check-up Department

23. Inventory Classification of Medicines at Multi Speciality Hospital Komal Jeet C.K. Aiyer 13

Gurgaon

24. PDCA Approach to Accreditation Kunal Jawahar Thakkar Suresh Joshi 13

25. Improving the Operational Efficiency by Assessing Quality Indicators Meetu Garg P.R. Sodani 13

26. Business Process Re-engineering of Admission, Discharge and Megha Ahuja Barun Kanjilal 14

Transfer in a Tertiary Care Hospital

27. Gap Analysis as per NABH Norms of a General Hospital in Gujarat Namrata Vivek Lal 14

28. Patient Satisfaction with Quality of Care: A Comparative Study of Nancy Gupta R.S. Goyal 15

Indoor Patients in Different Wards

29. Assessment of Adherence to Protocol in Medical Record Natasha Ahmad Suresh Joshi 15

Documentation in accordance with NABH Guidelines

Gargi Agarwal Jyoti Dua 8

S.No Title Students’ Name Advisor Pg No.

30. Implementation of Performance Appraisal System in Tertiary

Care Hospital

31. Study on Community Perception About a District Hospital in Neha Awasthi Goutam Sadhu 16

Relation to IPHS Norms

32. Need and Location Identification of Dialysis Units in Delhi Under Neha Garg Jyoti Dua 17

PPP Framework

33. Study on Patient Care Quality Standards at a General Hospital, Nehashree Dipti Govil 17

Gujarat

34. Study on Roles and Perspective of Nurses in CCC in India Nisha Kadyan S.K. Puri 18

35. Bridging the Gaps in the HIC Chapter of NABH Enhancing the Payal Ahuja J.P.Singh 18

Preparedness for NABH Accreditation

36. Assessment of Laboratory Services Against N.A.B.L. Standards Pooja Aggarwal Suresh Joshi 19

37. Gap Analysis for Phase II Expansion in a Tertiary Care Hospital Prabhat Govindan Vivek Lal 19

at Rajkot

38. Knowledge Attitude Practice (KAP) among the Staff Regarding Priyanka Maan Jyoti Dua 20

Biomedical Waste Management

39. A Study on the Bio-Medical Waste Management Priyanka Sharma Dipti Govil 20

40. Benchmarking Medical Records Department in Accordance with Priyanka Singh L.P.Singh 21

NABH Standards

41. Gap Analysis of District Hospital in Conformance to NABH Priyanka Vashishta Jyoti Dua 21

Standards

42. Medical Record Auditing at Delhi Rashmi Chaudhary Vinod Kumar 22

43. Study of Time Utilization of Operation Theatre at a General Hospital Richa Daftray L.P. Singh 22

44. Assessment of Bio-Medical Waste Management Practices Roshni Dilbagi Neetu Purohit 23

45. Performance Management in Operating Rooms at a Health Institute Ruchika Goyal Neetu Purohit 24

46. Benchmarketing of Medical Records at Eye Hospital at New Delhi Rupinder Sahota Santosh Kumar 24

Neha Agarwal S.C. Gupta 16

S.No Title Students’ Name Advisor Pg No.

47. Study of the Opinion of inpatients to Measure Patient Satisfaction in

an Emergency Hospital

48. Study on the Utilization of Radio Diagnostic Equipments, Ultrasound Sangeeta Ravindran Anoop Khanna 25

& Operation Theatre

49. Challenges & Opportunities of Medical Tourism in Hospitals Sanjhi Singh Barun Kanjilal 26

50. Quality Assessment for Training Needs Assessment Saumya Misra Alok K. Mathur 26

51. Flyover Feeds you more Momentum Expected Vs Perceived Hospital Shadad Mirza J.P. Singh 26

Services

52. Nosocomial Infections in Intensive Care Unit Sheetal Yadav S.D. Gupta 27

53. Bed Utilization in a General Hospital at Gujarat Shikha Jain Alok Mathur 27

54. Study of Employee Satisfaction at a General Hospital, Gujarat Shreyasi Sen Gupta Dipti Govil 28

55. Study on Disaster Management Plan Shruti Khanna S.K. Puri 29

56. Study the Operations, Medical / Clinical Record Keeping and Prepare Shweta Sandhu Goutam Sadhu 29

Functional Specifications for Clinical System for Oncology

57. Quality Improvement through Patient Satisfaction Survey Suhas Parnami Vinod Kumar 29

58. A Study on Control Measures of Hospital Acquired Infection in Suhasini S D Gupta 30

Intensive Care Unit

59. Assessment of a Hospital as per FFHI Guidelines Sunita Choudhary Goutam Sadhu 30

60. Internal Quality Assurance in Clinical Documentation Thirumalai N L.P. Singh 31

61. Human Resource for Health in a District Hospital at Rajasthan Trupti Khandelwal Nutan P.Jain 31

62. Study of Housekeeping Services Vatsala J.P. Singh 32

63. ICU per Bed Day Costing in a Charitable Hospital, Delhi Vijay Shankar Patel Vive Lal 33

64. Cost Analysis of Medical Imaging Modalities Vikas Goya Barun Kanjilal 33

65. Scope of IT in OPD and IPD Areas: First Step Towards a Paperless Vikash Tyagi J.P. Singh 33

Hospital

Samarth Tripathi Goutam Sadhu 25

S.No Title Students’ Name Advisor Pg No.

66. External Emergency Response Plan in a Multispeciality Hospital at

Jaipur

67. Study of Improving Effectiveness and Efficiency of the Linen and Vrajesh Shah Alok Mathur 34

Laundry Department

68. Comparative Analysis of two Multi-Superspeciality Hospitals for Vritti Lumba Alok K. Mathur 34

assessing the performance of Dialysis Unit

69. Monitoring and Strengthening of OPD and IPD Services in District Yatendra Kumar Sharma Abhishek Dadhich 35

Hospital, Sikar

Vikram Singh Chouhan P.R. Sodani 34

S.No Title Students’ Name Advisor Pg No.

1. Yashoda Assessment at District Hospital Aastha Srivastava Suresh Joshi 37

2. Quality of Ante-natal, Intra-natal and Post-natal Services in two Aishwarya Rathore S.K. Puri 37

Districts of Orissa

3. To Study the Relationship of JSY with Institutional Delivery/Maternal Akash Kumar Lal Nutan P.Jain 38

Complications and Its Utilization by the Beneficiaries

4. Human Resource in Health (HRH) in India Amandeep Singh Arindam Das 38

5. To Ascertain the Role of LBWs in Neonatal Mortality and Ambrish Kumar Chandan J.P. Singh 39

Development of Strategy for Preventing Deaths Due to LBWs in the

Tirbal District of Narmada

6. Customer Expectation Survey Regarding Health Insurance in Pune Amit Ray S.D. Gupta 39

7. Analysis of Low Institutional Delivery Rate in a District Block in Anamika Barun Kanjilal 40

Gujarat

8. Evaluation of Training Programme Conducted by State ASHA Anil Rajesh Dungdung S.K. Puri 40

Resource Centre

9. Training Need Assessment (TNA) on Health Management Anisha Saxena Santosh Kumar 41

Information System (HMIS) of Sub Centre Level Health Workers

(ANMs and LHVs) of Government of Bihar

10. Immunization Coverage in Mahadalit a District of Bihar: A Feedback Arunabh Ray S.C. Gupta 41

to Programme Manager

11. Comparison of Organ Transplant Scenario in 5EU and India W.R.T Deepa Raina Hemant Anand 42

Health Care Reforms and Immunosuppressant Therapy

12. Training Need Assessment (TNA) on Health Management Jaspreet Mahal Santosh Kumar 43

Information System (HMIS) of Block and District Level Health

Personnel (DEO/BHE/ BHM, M&E Officer/SA and DPM) of

Government of Bihar

13. Factors Governing Contraceptive use in the Northeastern States of Jaya Swarup Mohanty Arindam Das 43

India

S.No Title Students’ Name Advisor Pg No.

HEALTH MANAGEMENT

14. Study on Implementation of Referral System in District Rajsamand Jyoti Meena Neetu Purohit 44

15. Assessment of the Knowledge and Attitude of Participants, Pre and Kiran Madhukar Narkhede R.S. Goyal 44

Post Capacity Building Training for Village Health and Sanitation

Committee in Chittorgarh District of Rajasthan

16. Performance Assessment of IMNCI in District Valsad Mansi Shekhar S.D. Gupta 45

17. Evaluation of Functioning of Rogi Kalyan Samiti and Utilization Minu Manuhar Sinha P.R. Sodani 45

of RKS Grant Received byPHC in the District Navsari, Gujarat

(Financial Year 2009-10) for Improving the Standard of PHC

18. An Assessment of Mamta Diwas Programme in Urban Slums of a Mohit Sharma Santosh Kumar 46

Municipal Corporation at Gujarat

19. JBSY (Janani Baal Suraksha Yojana) Evaluation Study in Bihar Neha Dumka S.D. Gupta 47

20. To Assess the Service Delivery of IPHS Upgraded and Non IPHS Neha Maheshwari Suresh Joshi 47

PHCs in Gondia District, Maharashtra

21. Effect of Supervision on Service Delivery at Mamta Diwas in Nidhi Jain Vivek Lal 48

Vallabhipur Block of Bhavnagar District

22. Gender Bias and Status of Women in Nuh and Tauru Blocks of Nidhi Vats S.C. Gupta 48

Mewat

23. Factors Affecting Utilization of Chief Minister BPL Jeevan Raksha Poonam Yadav S.D. Gupta 49

Kosh

24. Analyzing the Functioning of Adolescent Friendly Health Services Puneet Gupta P.R. Sodani 49

(AFHS) Centre at PHC block, Gujarat

25. Assessment of Functioning of ASHA in District Dahod Ram Krishna Kumar Dipti Govil 50

26. HSS Data Analysis of HIV/AIDS in Sentinel Group of Rajasthan Richa Chaturvedy Santosh Kumar 50

27. Clients Perspective on Assessment of HIV Care Services: ART Rit Shukla Dipti Govil 51

Center vs. ART Center

28. Assessment of EmOC Services in Kachchh District, Gujarat Sabyasachi Mohapatra L.P. Singh 51

29. A Study on the Implementation Status of Janani Suraksha Yojana Sakshi Jain J.P. Singh 52

in General Hospital, Sirohi

S.No Title Students’ Name Advisor Pg No.

30. EPI Coverage Survey in Rural Areas of Sabarkantha District in

Gujarat

31. Review of Verbal Autopsy Reports of Infants and Maternal Deaths Shraddha S. Rajpur Jyoti Dua 53

32. Determinants of Maternal Healthcare Utilization in Jammu and Suhail Ismail Shiekh Arindam Das 54

Kashmir-a Regional Analysis

33. Geriatric Health Insurance: A Study in Bangalore City Sumana Arora Barun Kanjilal 54

34. Training Need Assessment (TNA) of Health Functionaries of Tukaram Khandade Santosh Kumar 55

Government of Bihar in Knowledge Attitude and Practice (KAP) in

Health Management Information System (HMIS) in three Blocks of

Munger

Shikha Bansal Alok K. Mathur 52

S.No Title Students’ Name Advisor Pg No.

1. Renal Cell Carcinoma: Therapeutic Segment Outlook and Pipeline

Analysis in Evalueserve, Gurgaon

2. Market Assessment of Biopharmaceuticals Round the Globe Kuldeep Dabas Hemant Anand 57

3. Assessment of Japanese Pharmaceutical Market to Search Business Pritika Garg Hemant Anand 58

Opportunities

4. Vitamin A Bi-annual Round Process and Knowledge Assessment Pushpendra Dixit Suresh Joshi 59

5. Market Assessment and Product Launching Strategy of Linezolid Rahul Gupta Hemant Anand 59

6. Assessment of Insulin Market in Jaipur, Gurgaon and Faridabad Ramneek Atreya Hemant Anand 60

Through Retail Chemist Audit

7. Analysis of Pharmacy Function and Work Load Reenu Bajapi Anoop Khanna 60

8. Market Assessment of Rheumatoid Arthritis in 5-European Countries Siyaram Sharma Hemant Anand 60

9. Pulmonary Arterial Hypertension: Futuristic Competitor Overview Sonal Ghura C.K. Aiyer 61

Gurgaon

10. Market Survey of Treatment Options for Osteoarthritis and Awareness Sumati Kumar Jain C.K.Aiyer 62

About Sodium Hyaluronate 1 % Solution in Medical Profession

11. Market Overview of Hepatitis C in Middle East and North African Vibha Chadha Hemant Anand 62

(MENA) Region

Ginni Kumar C.K. Aiyer 57

S.No Title Students’ Name Advisor Pg No.

PHARMACEUTICAL MANAGEMENT

HospitalManagement

2

Ab-1 Infection Control in Intensive Care Unit & Facility

Based New Born Care Unit

Amritesh Malik

Keywords: Infection Control, Intensive Care Unit, New Born

Care Unit

Objective : The main objective was to study the physical facilities

available for infection control in the intensive care unit and to study the

existing infection control procedures used in the intensive care unit.

Methodology : The study is carried out in the intensive care unit,

particularly medical intensive care unit and facility born new care

unit(FBNC) at a hospital at Bharatpur. The required data is collected

from nurses, doctors, hospital nursing assistance, staff of central sterile

supply department who is responsible for supplying sterile items to

medical intensive care unit & FBNC unit , house keeping staff who

work in medical intensive care & FBNC unit, through questionnaires,

personal observation and studying relevant record or infection control

maintained in medical intensive care unit. The tools adopted for study is

descriptive method and the required data is obtained from 26

respondents, consisting of nurses, doctors, hospital nursing assistance,

staff of central sterile supply department (supplying sterile items to

medical intensive care unit), house keeping staff who work in medical

intensive care unit through questionnaires, personal observation and

studying relevant record for infection control maintained in medical

intensive care unit.

Findings : It was found that hundred percent responded said that

surface of MICU, table and trolleys are been wet cleaned daily. Further

analysis revealed that, seventy six percent responded that walls are wet

cleaned monthly. higher than ¼ th (29 percent) of the respondent

reported that the monitoring sterilizing efficiency of autoclave was

done daily whereas little more than1/2 of the respondent (53 percent)

responded reported that sterilizing efficiency of autoclave was

monitored weekly, and rest 1/5 responded said that that it is done

monthly. Major discrimination was seen in frequency of monitoring.

majority of the respondent reported that there were adequate hand

washing facilities available in the hospital, where as 6 percent reported

that the facilities were not adequate. The study revealed that surfaces in

MICU & FBNC are wet cleaned daily walls are wet cleaned monthly.

The study revealed that according to fifty nine(59%) percent

respondents (nurses and doctors, N=17), the level of safety measures is

satisfactory. Fifty three percent have undergone periodic health check-

up and immunization relevant to their work.

Recommendations: Proper facilities and adequate resources may be

provided to support the infection control programme. It includes hand

washing facilities in all patient care areas and accessible to health care

providers and compliance with proper hand washing is monitored

regularly.

Ab-2 Efficient Work Flow Management in Radiology

Department

Anil Gupta

Keywords: Radiology Department, Work Flow Department, Hospital

Management, Hospital Profile

Background: Radiology diagnostic procedure has several steps from

billing and appointment to procedure and report collection in which

patient had to wait for his turn for procedure and then for collection of

report, increased waiting time and TAT for reporting adds to patient

dissatisfaction and inefficiency of radiology department.

Objective: To minimize the waiting time for test and minimum

turnaround time (TAT) for report generation for the efficient workflow

management in radiology department.

Methodology: The study was done in two steps, (1) the current

situation was analyzed for 2 weeks for busy days and busy hours. (2),

the current appointment system was revised and the situation after was

analyzed for 6 weeks for waiting time and report TAT.

Findings: After revising the current appointment system the waiting

time reduced from 10min to 6 min and reporting TAT reduced from 33

to 5 min. The percentage reporting in 15 minutes increased from 64% in

1st week to 97% in 6th week, which shows the increased efficiency of

the radiology department.

Recommendation: Timely revision of appointment system according

to the work load of the department. The quality of the billing process

can make or break a radiology practice. Extra manpower on billing

counters in busy hours of busy days and have roaster accordingly.

Extending the existing HIS system and using electronic requisition and

appointment system

3

Ab-3 Comparative Study on Incidence of VAP in ICU at a

Hospital in Patna

Anuj Dandotia

Keywords: IUC, Incidence of VAP, Nosocomial Infection;

Intensive Care Unit

Background: The study was done focusing on ICU services in developing VAP and also comparative study was done on incidence of VAP and suggested measures to reduce it. The study consists of two parts- understanding the working of the hospital, the infection control policies persisting in the hospital, working manual of infection control committee, review of literature and past studies done on Nosocomial infection. (2) collection, analyzing and summarizing of data collected from the ICU and thus calculating incidence of VAP.

Objective: To study the incidence of nosocomial infection, to study the incidence of VAP of patients on ventilator, to compare the incidence of infection rate at the hospital of study with the hospitals of similar capacity. Previous studies and literature available were also taken as reference.

Rationale: This was an emergency hospital and most of the patients which are being referred to the hospital of study are from its’ sister concern hospital. It is a multispecialty kidney Hospital where most of the patients are being admitted is of chronic kidney disease and at end stage renal disease with already immuno-compromised status. Many of them are on the immuno-compresive drugs so these patients are more susceptible to acquire infection after being admitted in the hospital thus it is quite necessary to develop and implement the infection control policy in this hospital to check out the morbidity as well as mortality.

Methodology: The study was based on data collected of all the patients being admitted in ICU of the hospital and their follow up during entire period of stay in the hospital. A descriptive study of exploratory nature was conducted within a stipulated time frame of two weeks was done in consciences with the higher authorities

Findings: The incidence of ventilator associated pneumonia (VAP) was found to be 28% which when compared with the other studies was found to be significantly higher as the study was done in MICU and incidence of VAP in MICU is considered to be 9-10%.Out of 141 patients being admitted in the ICU for various ailments most of them were of chronic kidney disease among them 46 required assisted ventilation and 13 of them developed VAP.

Ab-4Time for Bed having Synergized Effect on Delivering Quality Health Care to Patients in a 200 Bedded Hospital

Anurag Gupta

Keywords: Quality of Health Care, 200 Bedded Hospital, Synergized Effect, Intensive Care unit

Background: The study initially focused on one ward of a 200 bedded

hospital at Mohali. It has a multispecialty ward for patients of all

categories except CTVS patients, with 34 beds. Patients are received

from various entry points like direct admissions from OPD, triage and

ED, GICU. Room turnaround time is a vital measure of performance for

a number of service industries. For hospitals, reducing the room

turnaround time leads to increased revenues as well as increased patient

satisfaction. If a room is ready sooner, a waiting patient is required to

spend less time in the emergency department or less time in stepping

down from ICU, HDU.

Objective: To increase patient satisfaction through timely discharge

.Analysis of room clearance process and finding areas of delays.

Methodology: The operational efficiency study is retrospective –

prospective analytical study .The study is based on primary data.

Findings: The average room clearance turnaround time was 4 min 20

seconds in excess than the desirable 25 min standards. The discharges at

11 A.M were about 79% and planned discharges about

95%.Housekeeping taking more than required time in room clearance.

Patient dissatisfaction was due to delay in discharge. Admission of

patients delayed as room clearance not on time

Recommendations: Consultant should inform about discharge one

day prior and discharge summary should be made accordingly. Patient’s

attendants must also be informed a day prior. Bills should be prepared in

time. Proper guidance and training should be provided to the

housekeeping and general staff.

Ab-5 Study on Factors Associated with Satisfaction and

Motivation of the Class III & IV Employees in

Government District Hospital, Kota

Strategy Evolvement for Improving Turnaround

Aparna Jha

Background: The importance of human factor is very well realized by

the corporate and other private organizations. On the other hand, the

government organizations are still struggling with the problems of

workers union, strikes, lockouts, unaccountability of the workers who

consider their future secure after joining the government organization

even if they do not perform. Human resources are considered important

hence, this study was carried out to understand the problem faced by

the employees, which dissatisfy them and degraded their efficiency.

Objectives: To explore and compare the perceptions of the class III &

IV employees working in the Government tertiary care hospital at

Rajasthan with regard to the availability of motivators at their work-

place and to suggest some interventions to improve the work

environment in the hospital.

Methodology: The methodology used to conduct this study was both

quantitative and qualitative technique through personal interview,

questionnaire consisting both open and close ended questions. The

analysis was done using MS-excel and the findings were shown with

the help of pie and bar charts.

Findings: Findings revealed that all class III employees know about

their job responsibilities. No formal orientation or induction

programme was done when they join the organization. Majority

responded that they have some valuable suggestions to improve the

functioning of the hospital. The class IV employees neither get any kind

of appreciation from the senior officers nor get any promotion in job

which leads to lower satisfaction and motivation level in the employees.

More than half of the nurse face problem in getting the adequate amount

of supply of materials for efficient discharge of their duties. 25% staff

was not working according to their post. A majority of employees

doesn’t wear their uniforms on duty.

Recommendations: Job chart to be prepared for every worker including the daily wage employees. Manpower planning should be done for the proper allocation of the staff. Uniform policies should be formulated and strictly followed to ensure discipline. Discipline and punctuality should be improved and strictly observed. Good work should be appreciated not only in words but also in terms of remunerations or reward. Basic facilities like canteen, pure drinking

Keywords: IUC, Incidence of VAP, Nosocomial Infection; Intensive

Care Unit

4

water, rest rooms should be provided to the staff. Feedbacks can be taken from the staff for nay scope of improvements in the functioning of the hospital.

Ab-6

Archana Agarwal

Background: A focus on operational excellence in everything we do translate the focus on the quality of the service provided. Trying to improve something when the organization do not have a standard to measure against and improve a process without measuring the current status is like playing a game without knowing the score. Measurement and improvement of the processes are absolutely essential if operational excellence is required in the organization.

Objective: The study was done to measure performance of radiology department across three perspectives viz. Customer/patient, internal business processes and learning and growth at a tertiary care private sector hospital in Mumbai.

Methodology: Both qualitative and quantitative methods were used. Interview, Questionnaire and Checklists prepared to collect data. 55 patients were interviewed. The sampling for each investigation was done on random basis. 20 employee of radiology department were taken as per their designation.

Findings: The overall satisfaction of both employees and patients was found to be 61%. Majority of Customer/Patient showed their dissatisfaction in relation to waiting time, Infrastructure- Perception, Access. Employees were mainly dissatisfied with the present performance appraisal system. As a result there was no motivation to improve their efficiency. TAT was higher than desired for X RAY. Wastage of films were found to be more in X RAY and Ultrasound

Recommendation: Provision of LAN connectivity and other inter-units in radiology department is found to be essential. Majority of Customer/Patient showed their dissatisfaction in relation to waiting time, Infrastructure- Perception, Access. Employees were mainly dissatisfied with the present performance appraisal system. As a result there was no motivation to improve their efficiencyProper scheduling of investigation especially in-patients is recommended. It is also essential to motivate staff by arranging training programmes etc.

Quality Assessment of Radiology Department

Keywords: Quality Assessment, Radiology Department, TQM

5

Ab-7

Focus on Medical Consumable Items

Arti Sharma

Background: Cores of rupee are being spent every year for the

purchase of around thousands of varieties of medical consumable

items. As there is no formal inventory system in existence, it happens

that high value slow moving items are stocked in larger quantity

whereas fast moving less value items are stocked out.

Objective: This project study is aimed to introducing an improved

system of inventory control of medical consumable items used in

Healthcare Industry (Hospital). To analyze the efficiency of Inventory

Management as well as to classify the various components based on its

value and movements.

Methodology: The research design used in this project is analytical in

nature. The data are collected from the annual reports maintained by

the company and from the TP-Pospro Plus Software. ABC Analysis,

FSN Analysis, HML Analysis were used as study tools.

Findings: On the basis of unit cost involved, the various items were

classified into ABC categories. Category A needs the most rigorous

control, C requires minimum attention and B deserves less attention

than a but more than C. According to data analyzed by FSN analysis

techniques there are no non-moving items found and the company

maintains low percentage in moving items, which is not a good result. It

was also found that there was no selective control techniques like

economic ordering quantity, reorder level etc. are available to monitor

individually very often & to avoid stock outs. This is very laborious and

cumbersome. Also this consumes valuable time of higher officials.

Recommendations: Under ABC analysis, the management must have

more control on A than B&C, because A class constitutes more (70%) of

higher values. There should be tight control exercised on stock levels, to

avoid deterioration. The company must not go to the Non-moving items

as far as possible, because there will be unnecessary blocking of

working capital. This would hinder the other activities of the

organization. The company is required to maintain safety stock for its

components in order to avoid stock-out conditions & help in continuous

production flow. Items should be placed into the store based on their

Statistical Approach to Inventory Optimization with

Keywords: Inventory Control; Medical Consumable Items; Inventory

Management

consumption so that there would be no obsolescence and deterioration &

that would also help in taking decisions on disposal of none and slow

moving items.

Ab-8

Management & Safety (FMS) as per Joint

Commission International (JCI) Accreditation

Standards

Bhushan Sarmandal

Objective: This study was designed to analyze the available facility of

tertiary care hospital at, Ahemdabad to meet out JCI standards.

Methodology: In this study available facility and safety practices of

hospital compared against facility management and safety standards of

JCI accreditation and scoring is being done as per guidelines to know

about status. It is essential that hospital should analyze its facilities,

before going for JCI accreditation. As the hospital was a NABH &

NABL accredited, tertiary care referral hospital, and it is recognized as

centre of excellence for providing medical care, education and research

facilities of high order in the field of medical sciences

Findings: An aggregate score of at least “7” for each chapter is required

for achieving accreditation but this FMS chapter score obtained is 6.23.

An aggregate score of 8.5 is required for each standard but actually it is

below for all 11 FMS standard in this study.

Recommendations: Therefore there is need to finalize the time limits to

fulfil the non compliances and partial compliances especially utility

system, biomedical equipment and fire safety related standards and then

organisation should apply for JCI accreditation.

Ab-9 Quality Assurance in Biomedical Waste Management

Deep Makkar

Despite of statutory provision of biomedical waste management

practice, Indian hospitals have still not achieved the desired standard

A Comprehensive Study of Gap Analysis of Facility

Keywords: Gap Analysis, Facility Management, JCI, Accreditation

Standards

Keywords: Quality Assurance, Biomedical Waste, Waste Management

6

even after twelve years of enforcement of law ‘Biomedical Waste

(Management and Handling) Rules, 1998’.

Objective: The study was carried out in order to assess the

management of bio medical waste in Primus Super Speciality Hospital

and to carry out a Force Field analysis for the quality assurance in bio

medical waste management.

Methodology: The primary data was collected through observations

and interviews of the staff in various departments. The path of the bio

medical waste transport was also studied from the user site till the end.

Target group was housekeeping staff.

Findings: The awareness regarding bio medical waste management was found to be low and the identification of the cause was done which came out to be the lack of training among the staff. Force field analysis clearly depicted the positive and negative forces which led to the improper management of the bio medical waste. The positive force was that the housekeeping staff was not only practicing but also was having good knowledge of biomedical waste management. The negative force was lack of supervision and training towards housekeeping staff by their supervisor, which led to poor quality in practicing.

Recommendation: After analysis of by the various forces, action plan/recommendations were given which needs to be implemented in order to manage the bio medical waste in the appropriate manner and to fulfill the statutory requirements as well. One of the major recommendations is the provision of training to staff regarding bio medical waste management and then evaluation of the training needs to be done to assess the future training needs. There should be regular rotation of the duty places so that everyone could well acquaint with all aspects of his/her job.

Ab-10Usage of Restricted Antimicrobials in a Tertiary Care Hospital in India

Deepti Choudhari

Background: Antibiotics are life saving drugs. Irresponsible and erratic use of these life-saving instruments has resulted in the development of drug resistance in many organisms .

Study of Process Compliance for Rationalization of

Keywords: Rationalizaition; Restricted Antimicrobials; Tertiary Care Hospital; Rationalizaition of Usage

Objective: This study was done to monitor judicious use of restricted anti microbial agents in a health care organization and develop ways to improve policy practice compliance.

Methodology: Retrospective and concurrent audit of restricted antibiotics usage and rationalization forms. Review of RAB usage survey/audit forms. Interaction, interviews and questionnaire with medical and paramedical professionals was conducted. Literature review and comparisons with international standards was also done.

Findings: 255 RAm prescribed to 144 patients during March 2010. Of the 255 prescriptions documentation of justification for RAm usage is done for only 55 prescriptions which constitute only 21.5 %. No documentation of justification for addition of Ram prescriptions was found.

Recommendation: Improvement in compliance policy needs revision & amendments and implementation of restrictive and educative methods with feedback should be made compulsory. Inclusion of RAm usage compliance as performance & quality Indicator should also be there.

Ab-11Specialized Hospital and Heart Institute, New Delhi

Divya

Background: A brief study of patient satisfaction was done at a 150 bedded multi super specialized health care centre which is accredited with ISO 9001: 2000 & 14001: 2004 certification for quality healthcare services and management.

Methodology: A patient satisfaction questionnaire and a checklist for in-depth interviews with service providers were used as a study tools. In total of 100 inpatients were included in three departments of the hospital with highest patient inflow; medicine, gynecology and surgery. The aggregate scores of the questionnaire regarding patient satisfaction were calculated using MS Excel and SPSS version 12.

Findings: It was found that only 32% of patients were satisfied from the reception services and only 18% from the billing department. The service providers agree that billing and reception were the major areas in the hospital that need improvements. While the score for

A Study on Patient Satisfaction at Multi Super

Keywords: Patient Satisfaction, Multi Super Specialized Hospital, Quality of Health Care

7

interpersonal manner (86.3%) and communication (85.4%) were found well. The score for financial aspects was found low at only 61.6%. The study also gives some insight into the services available and suggestions for further improvement in the medical care services.

Ab-12

(Pre and Post) to NABH Standards for Capacity Building

Eesha Arora

Background: The study was done at tertiary care hospital in Mumbai

with the aim to study the compliance percentage assessment &

comparison (Pre & Post) to NABH Standards for capacity building.

National Accreditation Board for Hospitals & Healthcare Providers

(NABH) is a constituent board of Quality Council of India, set up to

establish and operate accreditation programe for healthcare

organizations. Research is beginning to show that good quality also

offers practical benefits to family planning clients and programs. It was

found that P.D Hinduja National Hospital & MRC, Mumbai got its

NABH Accreditation in the year 2009 with an aim to assure the best

outcome, build seamless service, create value & satisfy with

personalized care.

Objectives: The objectives were to assess the current compliance to

NABH standards, compare the current observations with the previous

study & to identify the training topics for capacity building of the staff.

Methodology: The departments / areas were assessed based on the

customized checklist prepared for each department. Based on the total

number of checkpoints the compliance of the departments / areas is

denoted in percentage.

Findings: In general, the hospital staffs were well aware of the

responsibilities and additional policies/practices included pertaining to

their core work. However, some points do exist on which the staff needs

to develop its knowledge and make them well versed with them. These

points mainly include-the knowledge about the mission, vision and

quality system (quality organization) being followed in the hospital,

safety from the hazardous materials/chemicals being used, spill

management procedures, cardiac emergency protocols and some of the

HR policies. The analysis of the data shows that although the current

Compliance Percentage Assessment and Comparison

Keywords: NABH Standards, Capacity Building, NABH

Accreditation

percentage compliance ranges in between 94% to 100%, few sensitive

findings are noted during internal assessment e.g. narcotics storage.

Recommendations: The corrective actions towards the list of “Non

compliances” as well as “unanswered questions” to be taken by taking

the “non compliances” and “unanswered questions” as training topics

in the forthcoming training module & monitoring & evaluation of the

training program.

Ab-13

Quality Family Planning Services in Uttarakhand

Esha Kalra

Background: Quality of Care, more commonly called as QOC, is an

integral part of the family planning services. A Project ‘Model Initiative

to Ensure Quality Family Planning Services in Uttarakhand’ has been

initiated by Population Foundation of India (PFI-New Delhi) in

collaboration with one of the hospital in Dehradun with a focus on

increasing access and reach of Quality family planning services in the

project area of Dehradun and Rishikesh. It aims to provide QOC

through the existing health infrastructure viz. training centers and the

government health facilities with which the partners have collaborated.

Objective: The study was planned by the partner organizations to

capture the quality indicators set by the project as the outcome

objectives.

Methodology: The study was done by assessing four health camps

being organised under the project through observation of the facility

and the client-provider interaction process with the help of a checklist.

The client satisfaction was assessed through exit-interviews. To capture

the QOC view from the sterilization facilities and to have a feedback

from the providers, data was collected for these also. A qualitative

analysis of the data from various collection methods have been used in

this study.

Findings: The study shows that the facilities are capable and ready to

provide quality care. Few re-arrangements are needed at one of the

camps like the judicious utilization of the free space in the facility to

convert it into a separate reception and a waiting area. A separate area

Rapid Assessment of a Model Initiative to Ensure

Keywords: Family Planning Services, Uttarakhand, Quality of Care,

Rapid Assessment

8

for counseling in the camps will also lead to quality care. The

introduction of a separate counselor under the project is seen as a

blessing to the project. All the providers are found to have the required

skills from the observational checklist. But few important components

of are not properly taken care of. These are also indicated by the client

exit interviews. The Urban Health Centre is seen as having the potential

for being developed as a centre of excellence for maternal, child health

and family planning services.

Recommendations: The study suggests that bio waste-management

and handling rules, a client feedback system, and regular up gradation

of the knowledge and skills of the providers including updates on

contraceptive advances can be added in the program to achieve high

levels of QOC. It has tried to find out the gaps and the required solutions

to fill those gaps. The mid-project corrections based on the study and

the regular assessments in future will help in ensuring that quality

family planning services are given in Uttarakhand. It will fulfill the

hope that more people of the state will have Planned Parenthood. As a

future scope of the study, the present study will be a part of the literature

on Rapid Assessment of Quality in Family Planning services in India.

Ab-14

Management System in Tertiary Care Hospital

Gargi Agarwal

Background: The urgent need for the study arose in because of proposal

from the senior management to implement the performance

management system (PMS) in the hospital. The PMS process would be

adapted and customized to the organizational needs of the hospital

which would help in stabilizing the process once formulated.

Objectives: To confirm the deeming application price, to develop a

business planning framework at the hospital taken for study,

expectation of management of all the employees.

Methodology: It was a qualitative study formulated with the help of

discussions with all the stakeholders of the PMS process that would be

implemented in the hospital. The stakeholders include General

Manager, representatives from doctors, human resources, Head-

Formulation and Implementation of Performance

Keywords: Performance Management, Performance Management

System, Hospital Administration

hospital administration and resident-hospital administration.

Considering the sensitivity and the importance of the topic, the problem

analysis was conducted in a very in-depth manner. Problem analysis

was conducted in three phases – Analysis of the PMS process in the

hospital, workshop cum FGDs and survey.

Findings: The study highlights many concerns which the employees

have regarding the current PMS process. Current key result areas are

not well defined for a particular position which leads to overlap. Lack of

communication between superiors and subordinates was found. Record

of critical events pertaining to officers were not made, which leads to

improper review of performance.

Recommendation: Proposed to shift to position-based KRA’s this

would help in setting of clear expectations in each superior-subordinate

pair. Proposed a workshop methodology for goal setting. Proposed to

create a mechanism to record critical incident pertaining to officers.

People development activities are proposed to increase employee

performance motivation and engagement levels. Also many changes

are required to be incorporated in the existing PMS process to

customize it to the specific organizational needs of the hospital.

Ab-15

Garima Singh Meel

Background: The study was done to know the facilities available to

control infection at Medical ICU.

Objective: The main objectives was to study the physical facilities

available for Infection control in intensive care unit (medical –ICU) and

also the existing infection control procedures used in the MICU. The

study also identified the gaps for infection control and suggested

measures to fill those gaps.

Methodology: The research approach adopted for the study was a

descriptive method. It includes collection of information regarding

infection control procedures and its measures and also existing physical

facilities available for infection control through questionnaires,

studying relevant record maintained in MICU.

Nosocomial Infection Management

Keywords: Nosocomial Infection, Infection Management, Intensive

Care Unit

9

Findings: The physical facilities available for infection control in

MICU are satisfactory but the infection control measures practiced in

MICU is poor and needs improvements and up-gradation. When

compared to the ISIS standards, the facilities available for infection

control in MICU are satisfactory and meets . Result show that current

physical facilities available for infection control are satisfactory but the

existing infection control measures practiced in MICU are poor.

Recommendation: Strict adherence to standard infection control

procedures need to be given under consideration and existing infection

control measures in MICU needs improvement and up-gradation.

Ab-16

‘Insurance’ and ‘Bed Class’ on ‘Patient’s Hospital

Expenses’ for MRM, Amputation and Oesophagectomy

Surgeries done in a quarter.

Ginny Kaushal

Background: The study discusses the pattern of influence of the factors

on the patient bills and correlation using the Pearson’s correlation

coefficient. Controlling hospital costs is central to lowering overall

health care costs. Fortunately, there are interventions that show promise

in decreasing hospital costs without harming quality. Studies also show

a significant amount of influence of Health Insurance on patient’s

hospital expenditure. It is important to know the factors which are

affecting the cost of healthcare and if possible then reduce the cost of

healthcare by controlling the factors which affecting the patient’s

hospital expenses. Patient’s hospital expenses i.e. the patient bills were

studied in detail for three different types of surgeries namely MRM,

Amputation and Oesophagectomy and a variation of more than ±1SD

from the mean was observed. The patient records were further studied

to find details related to presence of co-morbid condition, increase post

surgical length of stay (PSLOS), Surgeon, Insurance and Bed Class.

Objective: To investigate the influence of “Post Surgical LOS”,

“Surgeon”, “Insurance” and “Bed Class”on “Patient’s Hospital

Expenses” for MRM, Amputation and Oesophagectomy Surgeries

done in a quarter.

Influence of ‘Post Surgical LOS’, ‘Surgeon’,

Keywords: Post Surgical LOS, Oespohagectomy Surgery, Hospital

Expenses

Methodology: A total of 42 cases were taken in the study. 17 Unilateral

Modified Radical Mastectomy (MRM) cases, 18 Amputation (single

toe) cases and 7 Total Oesophagectomy cases operated between 1st

November’09 to 31 January’10. Clinical information was

retrospectively obtained from the OT database and medical records of

the patients

Findings: In addition to variation by patient co-morbidities and

procedure, findings show that the patient’s hospital expenses vary with

PSLOS, Bed Class, Surgeon and Insurance.

Ab-17

Multi Super Specialty Hospital

Heena Kausar

Background: Health care is becoming transparent and customer

focused. Patients and their relatives have the right to know the standard

of care and its cost. It is therefore becoming more and more mandatory

for the institution to monitor quality indicators/parameters and

compare their performance level with the national standard or

international bench marks. By monitoring operational efficiency and

further providing feedback based on indicator data can be effective in

changing health care professional practice.

Objective: The objective of this report is to measure the operational

efficiency of the hospital, as per set standards and to find out the gaps in

input/process/outcome for enhancing the overall quality of system.

Methodology: This operational efficiency study is retrospective -

prospective analytical study. The study is based on primary data.

Findings: The main outcome of this study is that although hospital is

following all the quality indicators still there is potential of

improvement. For example in initial nursing assessment (within 30

minutes) of inpatients comparative trend is higher from Feb. to March

i.e. 84% compliance to 92%. Initial assessment by consultant within 24

hrs there is initially only 62.7% cases received assessment within 24 hrs

which increased to 85.7% later on. In needle stick injury indicated only

one nurse suffered needle stick injury in the whole study period. Nurse

Measuring Operational Efficiency of 210 Beded

Keywords: 210 Bedded Hospital, Multi Super Specialty Hospital,

Operational Efficiency

10

patient ratio is 1:4 which is sufficient for providing quality nursing care

but in ICU it is not as per the standards which should be 1:1. The cases

of redoes which was 1.96% in the month of January falls to 1.58% in

Feb, which is an appreciable outcome but on the contrary the same has

risen up in march to 1.66%, though still less than Jan redoes. Records

without nursing care is also declining from Jan i.e. 25% to march i.e.

14.1%.

Recommendations: Suggested to have regular meeting with staff,

proper distribution of work between all the staff, negligence part should

to be looked upon by continuous monitoring, only personnel with

required qualification should be appointed, continuous training and

proper communication for staff should be there. Clarity of authority &

responsibility at all the level should be there to minimize gaps.

Ab-18

System for TPA Department

Indu Dhangar

Objective: This project is envisaged to enhance the productivity and

improvement in the operational efficiency of the functions routinely

performed in TPA department and reducing the time lag for getting

information to take key decisions.

Methodology: Implementation of HIS was done in six phases and the

method of data collection was observational and discussion with end

users. Total expenditure on health in India is nearly 6% of the entire

GDP. Indian health insurance industry stands at INR 5,125 crores with

only a small section of the total population (around 2%) covered so far.

CAGR of this sector is around 35% (FY 2002 – 08). This shows that the

health insurance industry is one of the largest and fastest growing of all

human activities. This huge growth has led to the development of a

number of third party administrators to manage the client base.

Currently there is 36 TPA’s working for different insurance companies.

Findings: CFS is in the panel of 31 TPA’s and thus it can serve most of

the insured patients. As the number of TPAs and PSUs that are in the

panel of CFS is large, keeping a track of all the cases, payments and

outstanding bills is very important to maintain the financial integrity of

Construction and Implementation of Information

Keywords: TPA Department, Information System, Hospital

Information System

the organization. The hospital is already having a hospital information

system (HIS) package that starts by the word 'i-care.' the HIS caters to

the front office operations like appointment ,IP and OP billing,

registration, pharmacy, examination, etc. However, back office

operations like procurement, accounts payable, accounts receivables,

TPA receivables and outstanding payments etc. could not be carried out

through the HIS and documents related to these processes exist in

independent files and folders on a shared documentation basis in the

back office systems. The lack of automation for these processes and the

'disconnect' with HIS lead to delays in monthly stock reconciliation,

financial status information, profitability analysis and cost center

accounting.

Recommendation: The need of the hour is streamlining of all the

hospital activities related to the interaction with TPA vis pre-

authorization, query reply, approval status, claim settlement, TPA

receivables and outstanding reconciliation. In this study , work is done

mainly on time saving activities for getting the approval, enlightening

the patients about their roles and responsibilities related to Cashless

hospitalization and introduction of information system in order to

improve the process of tracking financial data , its storage , retrieval and

reconciliation..

Ab-19

Jitendra Kumar Hayaran

Background: The study was conceived to assess the overall utilization

of the OT and also the type of surgeries for which it is being utilized at

Sola Hospital. The operation theatre complex of a hospital represents

an area of considerable expenditure in a hospital budget and requires

maximal utilization to ensure optimum cost-benefit. There is paucity of

data in India on the use of available operating time and the reasons for

less than optimal utilization have not been studied. In order to improve

the utilization of operating room it is essential to know how much time

is spent on each of the activities. Since Sola hospital has acquired pre

accreditation certification from NABH, it has relatively become a

centre of high activity.

Time Utilization of Operation Department

Keywords: Operation Department, Time Utilization, OT, NABH

Standards

11

Objectives: The objective of the study deals with to assess the overall

utilization of operation theaters in terms of hours to assess the extent to

which different departments are utilizing the allocated hours and to

identify the proportion of (unplanned or planned) of surgeries.

Methodology: This study is a descriptive in nature. Data was collected

from various sources.

Findings: It was found that highest number of unplanned surgeries

occurred in the department of orthopedics (48.57%) followed by

general surgery (28.57%). In three months 689 hours were utilized for

O.T. surgeries (Planned + Unplanned) & 511 hours were left unutilized.

Orthopedic was identified as a department where highest “no. of hours

wasted” for O.T. utilization was observed (216 hours un utilized in

comparison to only 144 hours utilized in 3 months); followed by

general surgery 189 hours unutilized in comparison to only 27 hours

utilized in 3 months. Orthopedic was identified as a department where

highest “no. of hours wasted” for O.T. utilization was observed (216

hours unutilized in comparison to only 144 hours utilized in 3 months);

followed by general surgery 189 hours un utilized in comparison to only

27 hours utilized in 3 months. In General Hospital, utilization of theater

shows that scope of operative services is wide but utilization in various

specialty shows that the distribution is not appropriate. While for some

specialties, the O.T. utilization is satisfactory, for others, it is far below

the expected level.

Ab-20

Standards

Jyoti Ahuja

Objective: The study was done to identify the gaps present in the

hospital to achieve NABH through the reference book of standards

given by NABH. An analysis tool have been developed which carries

the relevance of standard to the departments present in the hospital.

Later on grading was done according to NABH guidelines. The gaps

were communicated in the recommendations. This assessment focuses

on finding the gaps present in manpower available, equipments,

structural designs and statutory requirements as per the IPHS Standards

Internal Assessment of Hospital as per NABH

Keywords: Operation Department, Time Utilization, OT, NABH

Standards

and NABH guidelines; and suggests the ways to fulfill the gaps

Findings: An internal assessment report is necessarily a document,

which evolves as per circumstantial requirement of the organization

and to know scope of activities required to meet standards to achieve

NABH Accreditation status. It is necessary to review this report on

regular basis. This assessment is important as it guides the organization

to check the progress and success of the initiatives taken to fulfill these

gaps. The hospital can further plan its proceedings within the time

frame based on the analysis.

Recommendations: Government of Gujarat is very keen on getting the

NABH accreditation for district hospitals and medical colleges, so it

becomes necessary for the hospital to review its status on regular basis.

The hospital can focus on the areas where the gaps are more in

importance or in number and move ahead for the achieving the

accreditation status.

Ab-21

at an Eye Hospital

Kanwalpreet Grewal

Background: In hospitals, the supply chain is a key strategic activity to

generate profits by optimum utilization of resources, efficient

inventory control and cost containment models.

Objective: The objective of the study was to assess whether the

existing practices at the central store of the eye hospital at New Delhi,

meets the standards and to find the scope of improvement. Discussion

with the staff and the higher authorities led to a conclusion of need of

standardizing processes at the centre.

Methodology: The study design evaluates the primary and secondary

data collected from the centre. The central store department was

observed, had interview and informal talks with the department staff.

Findings: The hospital had processes in place but was not standardized.

There was a frequent problem of stock out and emergency requisition

orders from the entire peripheral centre, this lead to imbalance in the

stock in hand in the central store. This also led to frequent order

Benchmarking of Inventory and Stores Department

Keywords: Inventory Department, Store Department, Inventory

Control, Benchmarking

time is under/over producing by comparing ‘take time’ with mean cycle

time.

Methodology: This is an analytical study and the area of study selected

were -basic, comprehensive regular, comprehensive plus, special

regular, special ultra and premium. The Data collection tool used was

simple format consisting of in time and out time for each step of the

health checkups used to collect data for time analysis. The sample size

for the study was 100. (50 males and 50 females). Selection was based

on the percentage of health checkups frequencies for the period January

2009-December 2009. The sampling method is stratified random

sampling SIPOC, SWOT analysis, time analysis, vital defect analysis,

report delivery analysis and take time analysis was used to analyze the

data.

Findings: The special ultra and basic packages found to have the

maximum waiting time of 47 mins and the mean cycle time for basic

and comprehensive regular packages are similar at 85 and 86 mins

respectively (From Figure 4). However, their turn around time is 240

and 540 mins respectively. The only additions to basic are a

surgeon/gynaecologist consultation and a second physician

consultation 2 with reports. Special ultra, basic, premium female have

the maximum Waiting time beyond stated end time at 47, 36 and 31

minutes respectively. Premium male and comprehensive plus packages

also have a waiting time beyond stated end time, but to a lesser extent at

20 and 2 minutes respectively. Comprehensive regular and

comprehensive plus have the least percentage of cycle time to turn

around time ratio. This means these customers are idle for a larger

proportion of time, 83% and 73% respectively, with respect to the other

packages, which average 64%. The major defects in each of the

packages are the consultation with doctors like the physician

consultation (pre and post checkup), surgeon, gynecologist,

ophthalmologist, ears-nose throat consultations. The non compliance

of medical report turn around time is lowest for mammography and

sonography at 40 and 74.42 percent. The mean cycle time is greater than

takt time by 14,9.77,8.5,8.5,6.46 and 3.08 minutes for Ultrasound 14,

Ophthalmology consultation, Ears Nose Throat consultation,

pulmonary function test, Chest X-ray and ECG respectively.

Recommendations: There are a number of changes that can be made,

using the same resources available to reduce customer turn around time

and thus accommodate more health checkups. Implementing these

changes, will result in a decreased customer turn around time, and

12

placements. A set of safety stock for the hospital was calculated, by

analyzing the secondary data of a quarter year of the purchase order

master list maintained by the department. A sheet with the quantity of

safety stock for every item stored in the central store was prepared. The

safety stock is prepared both months wise as well as weekly.

Recommendation: To counter the problem of standardization and

stock outs, a policy as well as standard operating procedures for the

hospital was prepared. The results of the calculation of safety stock

were observed to be less in quantity; the reason was analyzed to be very

less lead time. This was because vendors shared a good relation with the

organization and gave timely delivery of the order. The standard

operating procedures as well as the policy is turned into the stores

manual, and serves as the guidelines for the staff as well and

management for strategic decisions. The safety stock lead to the fall in

stock out level, and there was a proper stock for emergency requisitions.

It also saved the cost of logistics for small quantity of material

Ab-22

Operational Efficiency in Health Check-up

Department

Karan P. Mansukhani

Background: A health checkup is a multi step process involving

various tests/ investigations/ consultations, and is dependant on various

departments for its completion. Lean principles are a set of tools which

assist in diagnosing and rectifying bottlenecks. Thus, if implemented

will increase operational efficiency of the department. This study was

done to improve operational efficiency in the Health Checkup

department, P.D. Hinduja Hospital and Medical Research Centre,

Mumbai.

Objectives: To map the health checkup customer, staff and information

flow. To conduct SWOT analysis of the health check up department. To

compare health checkup cycle time, Interval time, waiting time and turn

around time for each package. To isolate the critical defects/delays of

each health checkup package. To identify the medical reports those

have a low compliance of ‘complete and accurate’ reports for health

checkup executive. To identify activities where mean activity cycle

Application of Lean Principles to Improve

Keywords: Health Check-Up Department, Operational Efficiency,

Lean Principles, SWOT Analysis

13

enable department to accommodate a larger number of health checkups.

The recommendations that are an output of this study categorized in the

following categories i) Reduce turn around time, ii) System, iii)

Infrastructure, iv) Poka yoke/ mistake proofing.

Ab-23

Speciality Hospital, Gurgaon

Komal Jeet

Background and The study were carried at a multi speciality hospital

situated in Gurgaon. The Hospital pharmacy was five months old. The

purchase department purchases the medicines as per the requirement.

So, there is need to streamline the procurement by proper inventory

control and to reduce the shortage and delay in supply. For purchase of

drugs it is very essential to know the consumption of drugs on the basis

of value and volume as well as criticality. This will help in bulk

discounts as well help in getting supplies on time.

Objectives: The main objective of the study was to categorize all the

drugs available in pharmacy on value and volume basis as well

criticality. This was done efficiently by doing inventory analysis of the

pharmacy.

Methodology: The organization wants the categorization of drugs on

value and criticality bases, ABC-VED matrix was found appropriate

method for the inventory control.

Findings: The five month consumption of all the drugs was calculated

after multiplying unit cost by consumption and resulting figures were

arranged in descending order. The drugs then classified in to A B C

categories according to total cost consumed 70 %, 20 %, and 10 %. For

VED analysis, the entire drugs list was distributed to a panel of five

medical personnel comprising physician, surgeon, anaesthetist,

paediatrician and Head of Nursing Department.

Recommendation: They were asked to classify the drugs into vital,

essential and desirable. The drugs were categorised if more than 50 %

members of panel concurred.The data was coupled into an ABC and

VED matrix resulting in drug categorisation of Category I, II, and III.

Inventory Classification of Medicines at Multi

Keywords: Inventory Classification, Inventory Control of Medicines,

ABC Analysis, VED Analysis

Ab-24

Kunal Jawahar Thakkar

Background: In every organization, there is an opportunity to improve the quality and performance of the healthcare delivery. The problem frequently faced by organizations today is to know which quality approaches – complemented by and integrated with existent quality improvement systems – would have the greatest impact on the outcomes delivered by their healthcare providing systems.

Objectives: This study done at super specialty hospital provides organizations with an opportunity to strategize accreditation processes with a time tested approach. The hospital was going towards achieving NABH accreditation, as a first step towards it, with the question that “does the hospital fully compliant to NABH standards?” and with the objective of bringing a basic quality approach towards accreditation, this study on PDCA approach to accreditation was done.

Methodology & Findings: With scoring the hospital in comparison with standards as 0/5/10 and checking them as in which step of PDCA are the objective elements; it was found that the current status of operations at the hospital is about 70 percent compliant to NABH standards and out of 479 applicable objective elements, only 293 have completed their PDCA cycle of improvement. Percentage compliance and requisites for compliance to standards were found out for all the objective elements. Chapter HIC – hospital infection control among the patient centric standards and chapter CQI – continuous quality control among the organization centric standards were with the lowest scores.

Recommendation: The study revealed areas that need special focus and all the requisites to achieve NABH accreditation. It was emphasized and proved that accreditation is not mere buzzword but an extraordinary tool for health care institutions to improve their services. Application of PDCA approach to Accreditation is the right way for hospitals to trudge the path of quality healthcare provisioning.

Ab-25 Improving the operational efficiency by assessing quality indicators

Meetu Garg

PDCA Approach to Accreditation

Keywords: Health Care Delivery, NABH Standards, PDCA

Keywords: Quality Improvement, Employee Rights, Operational Efficiency

14

Objective: The main objective of this study was to identify area of

improvement and develop recommendation in coordination with

organization for strengthening and improving the quality of system.

Methodology: Both primary and secondary data was collected for the

study. For this purpose patient records audited, exit interviews of

staff(HR) was done, employee (HR)and inpatient feedback forms

were filled up.

Findings: The number of patients receiving initial assessment was 20%

in January which was risen upto 48% in March. In January the number

of patients receiving intitial assessment by doctors in one hour was 12%

which was risen upto 36% in March. Initial assessment by the dietician

hiked to 40% in march –regular status of the patient to be discharged

was also informed to the dietician. Hike in the percentage of operations

in month of March which was 34 out of 145 in total compared to 15 out

of 104 in jan and 15 out of 123 in feb.

Recommendation: It is recommended that proper inventory levels to

be maintained as per requirement. Regular awareness programmes

should be started for information related to employee rights and

responsibility.

Ab-26

Discharge and Transfer in a Tertiary Care Hospital

Megha Ahuja

India’s healthcare infrastructure has not kept pace with the economy’s

growth. The physical infrastructure is woefully inadequate to meet

today’s healthcare demands, much less tomorrows. While India has

several centres of excellence in healthcare delivery, these facilities are

limited in their ability to drive healthcare standards because of the poor

condition of the infrastructure in the vast majority of the country.

The total healthcare financing by the public sector is dwarfed by private

sector spending. In 2003, fee-charging private companies accounted for

82% of India’s $30.5 billion expenditure on healthcare. This is an

extremely high proportion by international standards. Private firms are

now thought to provide about 60% of all outpatient care in India and as

much as 40% of all in-patient care. It is estimated that nearly 70% of all

Business Process Re-engineering of Admission,

Keywords: Healthcare Infrastructure, Re-engineering of Admission,

Discharge

hospitals and 40% of hospital beds in the country are in the private

sector.

The healthcare industry faces a lot of challenges in todays world,

competition everywhere has ot left the hospitals untouched. The

hospitals strive for excellence and deliver their best to be at the top.

That’s where a BPR comes into the picture. Bpr revamps he process and

gives the process a new face which if not the best is the ideal in the

induatry with best practices an maximum patient friendly.

When hospitals put in the money the return on investments is a natural

phenomena and that’s wht the hospitals are expecting, a bpr should give

the hospital processes a boostup and help it come to a place where the

patients are benefitted the maximum and the working takes minimum

time with maximum efficiency.

Ab-27

Norms in a General Hospital, Gujarat

Namrata

Objective: The gap analysis of the General Hospital as per NABH

norms was done to assess the existing status of the hospital and prepare

it for NABH accreditation. As Government of Gujarat is very keen on

getting the NABH accreditation for district hospitals and medical

colleges, so it becomes necessary for the hospital to review its status on

regular basis. The hospital can focus on the areas where the gaps are

more in importance or in number and move ahead for the achieving the

accreditation status.

Methodology: The gap analysis was done with the help of NABH Self

Assessment Toolkit which comprised of 10 chapters, 100 standards and

514 objective elements. For getting the required data the various

activities in the hospital were observed, policy manuals and records

were referred and patients and hospital staff were interviewed.

According to the toolkit the documentation and implementation of each

objective element was checked and scores were given according to

NABH guidelines.

Findings: The study shows the findings of the existing status of the

hospital according to each chapter and average scores for all the

Gap Analysis of General Hospital as per NABH

Keywords: Gap Analysis, NABH Norms, NABH Accreditation,

General Hospital

15

standards and chapters. These were checked against the evaluation

criteria for accreditation. The study focuses on the gaps according to the

evaluation criteria for accreditation and suggests ways to fulfill the

gaps. The analysis shows that there are some gaps in the hospital as per

NABH norms. Mainly the gaps were in the chapters of management of

medication, quality management and information management system.

The hospital fulfills the required criteria partially and requires great

efforts and focus on the weak points so as to cover the gaps and to be

prepared for getting NABH accreditation.

Ab-28

A Comparative Study of Indoor Patients in Different

Wards

Nancy Gupta

Background: Many hospitals use lengthy surveys collected when the

patients discharge to better understand the quality of their own care. The

response rates for these surveys are generally good compared with

many other types of surveys. Understanding the implications of the

survey data can lead to new strategies that increase demand for services

in part by reducing inappropriate instances when patients leave the

system. The aim of the study is to compare the satisfaction level of

patients admitted in surgical ward, medical ward, orthopedics ward and

gynec ward at tertiary care general hospital of Gujarat:

Objective: The study is to provide a systematic and visible way to lead

and operate an organization working to improve performance by

patient feedback. Secondly was to measure the satisfaction level of the

patient getting treatment from the hospital and to work effectively on

the quality improvement procedure.

Methodology: The methodology which is used in study is cross

sectional and observational. Close ended questionnaire is used as a tool

for data collection and findings are elucidated with the help of graphical

representation.

Findings: Satisfaction level of the patients was highest in maternity

ward and least in surgical ward. Most of the patients were satisfied with

the Accessibility of the services and waiting time for registration.

Maternity ward scored highest that is 65% and 69% full satisfaction

Patient Satisfaction with Quality of Care:

Keywords: Patient Satisfaction, Quality of Care, Indore Patients

respectively in accessibility and safety and high quality coordinated

care .Orthopedic ward scored highest (77% of the patient fully satisfied

)in building relationship whereas in area of cleanliness, security and

nutrition all four ward showed high dissatisfaction .Patient

dissatisfaction was mostly due to .1)security service.2) accuracy of

diagnostic and imaging facility of the hospital .3) unhygienic condition

in the ward.4) summer temperature of the wards were rising high

specially surgical and orthopedics ward.5)drinking water facility.6)

privacy during stay and treatment in female wards patients.

Recommendation: Portable X ray machine in orthopedics ward.24hrs

pharmacy for IPD .Medication and treatment should be fully explained

to patients. In maternity ward privacy should be maintain for the

female. Appropriate airing should be done in wards. Frequent Mopping

& periodic washing of hospital Wards specially Surgical & Maternity

Ward. Periodic Medical Examination of cook's & Food handlers &

Surveillances. A grievance letter box/register should be made available

for the patients.

Ab-29

Record Documentation in accordance with NABH

Guidelines

Natasha Ahmad

Objective: The main objective of this study was to study medical

record department of the hospital, to audit manual according to the

NABH standards and to highlight major observations to recommend

implementable solutions.

Methodology: To enumerate various types of forms in use in ward

areas, OPD, different clinical department and laboratories a survey was

done using Checklist – keeping in mind the various quality standards,

checklist was prepared and filled by the data gathered, Interviewing the

doctors and nursing staff and the direct observation of the functioning

of various departments. 130 records were audited for the purpose of

assessing medical records for proper documentation. Medical Records

of 15 specialties were taken for the purpose of audit. Out of the 347 in

patients records 130 were picked up (38%). Data analyzed using

Microsoft excel.

Assessment of Adherence to Protocol in Medical

Keywords: Medical Record, NABH Guidelines, Audit Manual

16

Findings: It was found that many medical records were not sufficiently

well documented to provide adequate evidence of continuity of care. It

was found that in the 4 various parameters assigned Admission request

form, Doctors initial evaluation form, condition of the discharge time

mentioned and birth certificate matter comes into the poor segment,

whereas Elements in medical records and patients’ daily progress

comes into the excellent parameter.

Recommendation: The study needs further exploration as to identify

the gaps in process flow department wise. For the same reasons the

forms should be redesigned and redundant columns should be done

away with. MR contents for discharged patients should be arranged

prior to filing. And qualitative analysis of MR contents should be done

a regular basis to monitor completeness of information. It is

recommended that entries be recorded as closely as possible to the time

of the encounter, when the detail is most fresh in the physician’s mind.

This will allow physicians to deep records that are detailed, accurate

and comprehensive.

Ab-30

in a Tertiary Care Hospital

Neha Agarwal

Objective: the main objective was to include the Gap analysis of the

HR department in a tertiary care hospital in accordance with the NABH

Sstandards, performance appraisal of the nursing staff and feedback

analysis of the trainings done with adequate statistical evidence.

Methodology: This descriptive study was carried out using NABH

check list to do the Gap Analysis of the HR department and a feedback

questionnaire was used to do the feedback analysis

Findings: Only two training sessions out of the nine which were

conducted got good towards excellence ratings in the course content

and the training environment while the other training sessions were

rated average on same parameter. This implies that the course content

was not stimulating enough to develop the interest of the trainees; also

the temperature of the room was high making it difficult for the trainees

to concentrate. About 90% of the training sessions have got good and

Implementation of Performance Appraisal System

Keywords: Performance Appraisal, Gap Analysis, NABH Standards,

Appraisal System

excellent ratings in terms of the facilitator and the training given

showing that the trainers had excellent communication skills, they

explained the subject very well, answered questions to the trainees’

satisfaction, provided summary of the major points. The trainees have

given the training sessions a higher priority revealing the fact that they

are enthusiastic to learn and update their knowledge. Overall a positive

feedback has been received for the training sessions conducted for the

nursing staff.

Recommendations: More practice sessions have to be organized for

the HIS (Hospital Information system) Trainees. The training

environment needs to be improved making it comfortable for the

trainees to concentrate and learn. Time duration of the session has to be

increased and the pace at which the trainer delivers should be

decreased. Demonstration and orientation through videos and pictures

can be included for making the trainings more interesting to learn.

Ab-31 Study on Community Perception about a District

Hospital in Relation to IPHS Norms

Neha Awasthi

Background: A concern for patient satisfaction has been taken up by

many health care authorities worldwide with the aim of responding to

the client’s needs when addressing the issue of quality improvements in

public health care services. Standards are developed with intentions of

assuring quality services. Therefore, National Rural Health Mission has

provided the opportunity to set IPHS for various health institutions.

Objective: This study (dissertation) was designed to examine how the

consumers of services of secondary health care at District hospital, at

Jodhpur viewed their health-seeking experience, and this was

correlated with organizational aspects as well as the community

perceptions of the same. This study sought to understand community

perception; assess clients’ satisfaction and the facility survey against

IPHS norms.

Methedology: This is a descriptive study, conducted during 19

February, 2010 to 5 May, 2010. Methods of data collection employed

were schedules and collection through observation and by conducting

interviews. Study was conducted undertaken at the hospital and

Keywords: Community Perception, District Health, IPHS Norms,

NRHM

17

includes an area covered by four anganwadi centres.

Findings: In this area 80 percent of women who rely upon public health

sector for the child birth do not come to the hospital, 48 percent of

women do not know about the location of this hospital. Most women

who attended the hospital for came because trusted an employee who

was a relative and not because of the services of the hospital. Half of the

clients rated the hospital good,( 3 in scale of 1 to 5, where 1 is poor and 5

is excellent), 59 percent clients said that they visit this hospital for mall

ailments and two third (67 Percent) accepted that they would not like to

get admit in the hospital. Overall Hospital only complies with 17

percent of the IPHS norms. This data analysis depicts the discrepancy

between expectation of services from hospital and actual delivery of

services.

Recommendation: To improve the facility as per community

perception and IPHS norms it was recommended that a government

organization cannot develop at facility level itself. There several areas

where State and district level interventions are required.

Ab-32 Need and Location Identification of Dialysis Units in

Delhi Under PPP Framework

Neha Garg

Background: Delhi is the healthcare hub for a geographically large and

populated catchment area comprising of J&K, Punjab, Haryana, UP,

Bihar, MP and Rajasthan. Given the state’s current population it is

estimated that 3,000 patients are diagnosed with ESRD every year. Also

the expenditure of a dialysis patient in private facilities is significantly

high i.e Rs.20000 per month and there is inadequate facility in

government centres. Thereby this issue need to be addressed and PPP

framework has been found the most suitable option for the same.

Objective: The aim of the study was to assess the need and location

identification for setting up of dialysis units in Delhi under PPP

framework. The study was both quantitative and qualitative for finding

the number and location of dialysis units. The data was collected

through primary interactions with doctors, suppliers and government

hospitals.

Methodology: Primary data collection was done through detailed

questionnaire. Hence the demand supply study was done by collecting

Keywords: Dialysis Unit, PPP Framework, Dialysis Patients

both secondary and primary data. After finding a significant demand the

methodology for the referral and satellite centers was formulated by

visiting different Delhi government hospitals and getting information

of services provided there. Private center’s dialysis prices and volumes

were found and thereby provision to charge nominal fee was designed

so that maximum people can afford the services. This project helped to

understand patient behavior by primaries with various doctors.

Findings: It was found that here are only 500 machines in Delhi with

only 24 in government setup. If machines in centrally funded hospitals

and centres operated by quasi-government organisations also include

then also it accounts for only 60-70 machines. This means only the high

income category can afford treatment in private centres while a large

section of the middle and low income population does not have the

access to avail dialysis services. Thus there is a gap of around 600

machines facilities should be provided at least for sec A, B and C

population strata for which around 750 – 900 machines are required.

Thereby in the 1st phase government should look at the provision of

around 250 more machines. 25 government hospitals were visited and

were segmented based on presence of critical care and dialysis facility.

Based on this segmentation 13 – 19 hospitals were identified where

machines can be placed and also 3 clusters were formed to address the

issue of transportation which is significant for a dialysis patient as he

has to come 3 times a week for dialysis sessions. 3 – 4 hospitals were

identified in each cluster out of which one or two can be developed as

referral centres and in the rest of centres relatively fewer machines can

be placed.

Recommendation: It is recommended that there is need for setting up

more machines in Delhi and the government should look at the

provision of 250 to 300 additional dialysis beds to augment existing

supply of services.

Ab-33

Hospital, Rajkot

Nehashree

Background: The state of Gujarat has been regarded as one of the best

Study on Patient Care Quality Standards at General

Keywords: Patient Care, Quality Standards, General Hospital, TQM,

NABH Standards

18

performing state in India on various economic and health parameters. However, Gujarat health care system faced lack of adequate standards in public health services. With the effort to improve the quality of healthcare delivery, the GoG adopted Total Quality Management (TQM) system in 2007 to strengthen medical institutions as per NABH and NABL standards in three phases. General Hospital in District Rajkot was covered under the third phase of NABH implementation.

Objective: The present study is aimed to assess the health care service delivery the hospital against patient centric standards of NABH. The study assessed the current level of performance as per standards, identified the gaps and proposed recommendations. Few of the recommendations were implemented in the hospital under quality improvement programs.

Methodology: The study was conducted in General Hospital, Rajkot. All the staffs from the clinical departments, wards were questioned about the standards. The staff from support services like laboratory and radiology and utility services like house-keeping were also involved. The assessment of the hospital was conducted by using the self-assessment toolkit provided on NABH website. The toolkit was modified according to the study requirement. To fill the toolkit, the data was collected through primary as well as secondary sources.

Findings: The study showed that the hospital scored well on standards related to management of medication and was poorly compliant to standards for hospital infection control. Out of the total applicable objective elements hospital compliance was 43.9 percent, partial compliance was 20.8 percent and non-compliance was 35.3 percent. Overall the hospital was found to be 56.4 percent compliant to NABH patient centric standards. As per the results, quality improvement programs were initiated like signage system, training regarding basic life support, biomedical waste management, proposing hospital committees, hand washing practices, vaccination to employees etc.

Recommendation: Any journey starts with a single step and Quality Improvement Programs (QIPs) for these vital areas was the first step taken towards the journey of quality improvement in patient care services and achieving NABH accreditation.

Ab-34India

Nisha Kadyan

Study on Roles and Perspective of Nurses in CCC in

Keywords: Role of Nurses, Community Care Centers

Background: Community Care Centers (CCC) are the focal points to

provide short term institutional care to PLHA and Nurses play a central

role in delivering the care to PLHIV at CCC. Since the inception of

CCC is rather new and India, being the first of its kind to provide this

niche level of service in the service providers’ domain, it is essential to

understand the provision of care and support from the service

providers’ perspective.

Objective: The present study is an attempt to understand the Nurses

roles and perspectives, their responsibilities, their job satisfaction and

problems they face while working at CCC.

Methodology: In the CCC assessment, a sampling frame of all the

CCCs was prepared and out of 270 functional CCCs, 199 CCCs which

have been functioning for at least one year as on November 30, 2008

were included in the study. From each selected CCCs, the nurse with

maximum working experience was included in the study sample. A total

of 199 Nurses working in CCC across the India were interviewed using

semi-structured questionnaire. The data was analyzed using SPSS 16.

Findings: The results highlighted that the nurses were aware of their

roles and responsibilities and were also performing the same. To

effectively meet the needs of those living with the infection, nurses

have assumed multiple responsibilities in HIV care and treatment in the

resource restricted environment of CCC. They mentioned lack of

adequate infrastructure, lack of human resources and lack of proper

training as the main problems because of which they were not able to

give their best. Study recommends that the weak areas like Shortage of

manpower, staff training and infrastructure require attention not only to

achieve the targets quantitatively but also to improve the services

qualitatively.

Ab-35

Enhancing the Preparedness for NABH

Accreditation

Payal Ahuja

Objective: The study was to monitor the “OPD Waiting Time” so as to

know the patient flow in the hospital and to monitor the time from the

Registration to the consultation. Also this project was a major help in

data collection of monitoring for the NABH as this organization has

Bridging the Gaps in the HIC Chapter of NABH

Keywords: NABH Accreditation, OPD Waiting Time, HIC Chapter

19

already applied for NABH Pre Assessment. This project help in

monitoring the patient flow in the hospital as well as bringing out the

flaws in the process.

Methodology: The project was done in all the 11 OPDs. Total 20

patients were monitored and time lapse between the “times of

registration” till the “time of consultation” was seen and the causes of

deviations were observed in various OPDs. OPD waiting time analysis

is a comparative qualitative and observational study. The checklist were

filled in person targeting the high risk areas of the hospital and the

inpatient areas in which all the metrics of hand washing, needle stick

injury, biomedical waste management, linen management, surgical site

infection were covered.

Findings: Result of the above analysis suggested that only 50 %

standards of HIC of NABH were fully complied. Rest 50% of the work

is needed to be done in the other areas of the hospital. It was seen that

the compliance rate for the HIC chapter was relatively low than other

chapters of the NABH.

Recommendations : Recommendations were suggested and report

was submitted to the Chapter Head for the improvement. Major

learning was understanding of the standards their scoring and

implementation in an organization.

Ab-36

Hospital, Palanpur against N.A.B.L. Standards

Pooja Aggarwal

Background: A laboratory is a facility that supports patient care by

providing diagnostic & management information to the care giver. Its

ultimate goal is to provide accurate & timely results for diagnosis,

treatment & monitoring of ailing patients. Because of the increased

dependence of clinical services on the diagnostic procedures, a large

number of laboratories have started going for national and international

accreditations.

Objective: This report presents a research on the assessment of the

laboratory services, at general hospital, Palanpur, against the national

accreditation board for calibration and testing laboratories standards.

Assessment of Laboratory Services, at General

Keywords: Laboratory Services, General Hospital, Facility

Management, NABH Standards

The main aim of carrying out this research is to check the compliance of

laboratory services with NABL standards, so that a comprehensive

quality management system can be established.

Methodology: An observational and descriptive study was carried out

for a period of three months to explore the topic with the help of both

primary and secondary data.

Findings: The study revealed many interesting facts like the shortage

of manpower, poor conditions of the equipments, need for calibration,

AMC/CMC, lack of inter departmental and intradepartmental

coordination, faulty government policies regarding procurement and

maintenance of equipments, poor infrastructure and need of SOP

formulation.

Recommendations: Based on findings and address the objectives of

the study recommendations were made. It can be summarized that this

report proved to be a helpful tool in analyzing the gaps in the laboratory

service delivery. The results of the report will be useful in establishing a

well implemented and monitored quality management system that

generates services with elements of both patient safety and employee

safety. This will help in making the laboratory services error free and on

time.

Ab-37

hospital at Rajkot

Prabhat Govindan

Background: Proper planning is a key ingredient in starting a new

project as well as ramping up services and facility from one phase to

another. This study was conducted to analyze the gap in terms of two

key essential ingredients are manpower, and medical equipments.

Objective: The general objective of this study was to assess the gap that

exists and need to be fulfilled in terms of manpower and equipments, in

order to ramp up form stage 1 to stage 2 of the hospital services. Specific

objectives include equipment planning, manpower planning and setting

up timelines for completion of the ramp up.

Methodology: This was analyzed through a gap analysis done by mapping the existing equipments available and establishing the actual

Gap Analysis for Phase II Expansion in tertiary care

Keywords: Gap Analysis, Tertiary Care Hospital, Hospital Planning;

Equipment Planning

20

requirement as per the standard ratios used by the equipment planners.

Findings: It was seen that there is a major requirement in the form of syringe pumps, around sixty is required and patient monitors, twenty, ten ventilators and five each of defibrillators, pulse oxymeters and ECG machines. These are the basic equipments which are required to operationalize and admit patients in ward and ICU. In case of equipments, it was also found that additional equipments in the form of Patient monitors, ventilators, pulse oxymeters, defibrillators, syringe pumps, ECG machine need to be accounted for. In case of manpower it was seen that an additional number of specialists, doctors and nurses will be required to be recruited in order to push off the Phase II plans. Along with it the timelines for acquiring the additional task force and equipments were worked and displayed in the form of Gantt Charts, with task numbered in the order of priority.

Recommendations: It was seen that the recruitment process, can be completed in about four to six weeks, and the equipment purchase process will take about 8 weeks, hence once can start rolling the beds in two months or eight weeks time.

Ab-38Staff Regarding Biomedical Waste Management at Government Hospital, Jaipur

Priyanka Maan

Background: Despite the statutory provision of biomedical waste management, practice in Indian Hospitals has not achieved the desired standard even after so many years of enforcement of the law. In view of this, the present study on Knowledge, Attitude and Practice (KAP) on the subject was carried out in. Govt. Hospital, Jaipur The hospital under scrutiny for KAP is a 100 bedded hospital with all general specialties. The hospital has a work force of 30 doctors, 80 nursing, support and paramedical staff.

Objective: The objective of this study is to assess the knowledge, attitude and practice among the staff members by classifying them into categories of doctors, nurses, OT staff, technicians and sanitary workers.

Methodology: The study is based on a questionnaire designed to

Knowledge Attitude Practice (KAP) Among the

Keywords: Knowledge Attitude Practice, KAP, Biomedical Waste, Waste Management

understand the KAP of the staff involved in direct patient care facility

regarding the biomedical waste management practices.110

questionnaire were distributed out of which 89 were received back.

Findings: The study has shown a definite apathy of intellectuals

towards the operational aspects of the system. The medical

professionals have tubular vision on patient care services and pay very

little heed to support services in the overall context of comprehensive

patient welfare. Doctors are high on attitude and understanding of the

system with sound knowledge but need to improve on their practice

habits. OT staff and technicians also have understanding of the subject

but more attitudes to be developed in these functionaries. Practice

habits of nurses have large scope to improve. Sanitary staff is a matter of

concern as they have very low understanding of the subject and

resulting in poor practice habits.

Recommendations: In the field of medical practice statutory public

health guidelines for BMWM and close monitoring of its compliance

alone cannot achieve the ultimate goal, if it is not accompanied with

social science approach of mass education, motivation, training and

changes of mind set in all strata of medical practice. Thus a

comprehensive training module for all the functionaries is formulated

to get good results and improve the situation.

Ab-39

Priyanka Sharma

Background: The Bio-medical Waste (Management & Handling)

Rules, 1998 were notified under the Environment Protection Act, 1986

by the Ministry of Environment and Forest, Govt. of India on 20th July

1998. The rule regulates the disposal of biomedical wastes and lays

down the procedures for collection, treatment and disposal and

standards to be complied with.

Objective: The main objective of the study was to understand the

process followed in managing the bio-medical waste against the BMW

Management and Handling Rules (1998) of Government of India in

tertiary care hospital. Apart from studying the Bio- Medical Waste

Management Process, the project also tried to assess the level of

awareness about the BMWM, among the hospital staff and bottle necks

A Study on the Bio-Medical Waste Management

Keywords: Biomedical Waste, Waste Management, BMW Handling

Rules

21

while managing BMW.

Methodology: The study was of a descriptive type and was based on

the observations made in the hospital, checklist provided by NRHM,

and bio-medical records in the hospital. Awareness among the staff was

assessed using a questionnaire. The checklist and the observations were

filled during the visits to the departments in the hospital.

Findings: The required resources for the BMWM were present in the

Hospital. However, it was observed that the protective gears were not

properly used by the staff. The process of segregating the waste was not

appropriate in many deopartments in spite of the awareness among the

staff on Bio-medical Waste Management, as they were trained. The

waste collection bags were not closed properly due to unavailability of

means.

Recommendations: Based on the results it was recommended that it

should be made mandatory for the staff to wear the protective gears

while handling waste. The supplies for the waste collection bags should

be changed with new specifications so that they can be closed properly

before being disposed off. The Ward In- charge should check

periodically to ensure that proper segregation takes place. Staff should

be encouraged to put into practice their knowledge about BMWM.

Ab-40

Accordance with NABH Standards

Priyanka Singh

Background: The medical record section of a hospital serves as a basis

for planning patient care, documenting communication between the

health care provider and any other health professional contributing to

the patient's care, assisting in protecting the legal interest of the patient

and the health care providers responsible for the patient's care, and

documenting the care and services provided to the patient

Objective: This study analysis the current situation and quality of

medical records before the pre-assessment of the organization. The

purpose of the study was to find whether the organization was ready for

the upcoming accreditation and if not then assess the gap and fill them.

Methodology: The standards of the IMS were assessed in a self

assessment toolkit whereby most of the objective elements were found

Benchmarking Medical Records Department in

Keywords: Medical Records Department, NABH Standards

to be ZERO in scoring. Therefore new policies & procedures were

formulated and implemented and then reassessed. Data was collected

by one to one discussion with the staff from the MRD, nursing, and few

consultants & previous record and observation primarily and NABH

manual of other hospital, literature on internet secondarily

Findings: The retrieval of a file in MRD was found to be 22 minutes

and this by following the new policy decreased upto 11%. The

completeness of the medical records is very important because as also it

reflects the standard for IMS in continuity of care as per the guideline of

NABH, but this was found to be in very poor shape i.e. only 18% files

were found to be completed by the nursing staff. Similarly even the

doctors (mainly the consultants under which the patients was admitted)

showed a very poor data as only 28% files were found to be complete

(i.e. 72% incomplete in terms of doctors sign & stamp, daily notes and

updates in the treatment). This data after following the new policy went

upto 78% in the nursing staff and only 68% by the doctors for the

completion of the records. The medical records must reach the

department after 1 day of the discharge but only 16% of the files

reached around 84% reached the department in around 48 hours. This

data increased from 16 % to 78% after the new policy.

Recommendations: As for the scope of study in future, it can be used

as a literature on benchmarking of medical records & thus be received

as in similar research studies. The major limitation that existed was

majorly of the shortage of the qualified & skilled staff as the entire

MRD of a 200 bedded hospital was handled by only 2 people out of

which one was not at all qualified.

Ab-41

NABH Standards

Priyanka Vashishta

Background: A gap analysis report is necessarily a document, which

evolves as per circumstantial requirements of the client organization

and to know scope of activities required to meet standards to achieve

project goal i.e. National Accreditation Board of Hospital and health

care (NABH) accreditation status. The board is structured to cater to

much desired needs of the consumers and to set benchmarks for

progress of health.

Objectives: The objectives of the present study were to study the

Gap Analysis of District Hospital in Conformance to

Keywords: Gap Analysis, District Hospital, NABH Standards

22

different procedures at District Hospital for assurance and conformance

with the standards as laid by NABH and to identify the gap between the

NABH laid down practices and prevalent practices at hospital.

Methodology: Sources of data were both primary data (personal

interviews, observations.) and secondary data.(literatures, reports,

registers and records.)

Findings: The findings of the study shows that out of the total 514

objective elements,307 ( 60%) are in non compliance,149 (29%) are in

partial compliance and 58 (11%) are on compliance to N.A.B.H

standards. Gap analysis is the initial and one of the most critical

exercises of the entire process. It helps us to revisit existing system with

an eye to finding facts not faults.

Recommendations: The analysis that has been conducted has

divulged various quality related issues in clinical and non clinical

departments. It will take a long time to close the existing non

compliances. To close these non compliances the hospital has to bear a

huge financial implication in terms of infrastructure, manpower

equipments & other resources.

Ab-42

Rashmi Chaudhary

Background: Medical record serves as a means of doctor’s self

assessment.Medical records provide pertinent patient care information

to authorized organizations.The records are important to the public

health authorities as they contain reliable information regarding

morbidity and mortality patterns,Medical Records provide patient care

information to third party payers.Medical Records protects the patient,

physician, as well as the health care institution and its employees in the

event of litigation.

Objective: 1.To study medical record department of the Hospital and

suggesting best practices 2.To understand process flow of medical

records in different departments 3. To audit manual medical records, 4.

To study electronic medical record system in the hospital and Manual

Medical Record Auditing at Delhi

Keywords: Medical Record, Record Auditing, Electronic Medical

Record System

Records, identifying needs, problems and suggesting implementable

solutions, 5. To highlight major observations, 6. To recommend

implementable solutions.

Methodology: Stratified random selection of MRs to assess their

contents and the no. of records depends upon the no. of records

available the medical record department, selection of a respondent

(doctors & MR persons) and department visit to understand their record

flow process, records of patient admitted, records of patient getting

operated in hospital and consulting doctors was selected as tool.

Survey, Interview direct observation method was done to collect data.

Documents (MR files and forms, policies, procedures), HIS Hospital

and MR department persons & doctors were the data sources.

Findings: The study found that medical record department follows the

one-unit numbering and filing system (i.e. the patient has one MR for

outpatient visits, admission, and emergency). Filing systems are

standardized. There is cabinets and shelving system of record keeping.

Percentage of compliance of one unit numbering system ranges from

95% to 100% in the hospital.

Ab-43

General Hospital, Junagadh

Richa Daftray

Background: The operation time utilization varies in different

healthcare settings. Optimum utilization of the OT time has always

been a priority area for hospital administrators. Operation room

utilization analysis is essential to assess the existing workload as well as

to optimize facility functioning and patient scheduling for surgical

operations. It also aids in allocating reserve time for emergency

operations, asepsis measures and procedures, and provides decision

making information for augmentation or downsizing of the facility. The

study of Time utilization of operation theatre was carried out in all the

operation theatres which carried out major surgeries at general hospital

at Junagadh.

Objective: The project includes study conducted on 3 parameters time

spent on actual surgery, time spent on supportive services and time

waiting while operating room was being made ready for surgery.

Study of Time Utilization of Operation Theatre at

Keywords: Time Utilization, Operation Theatre, General Hospital

Objective: The attempt of the study was made to determine the

awareness about biomedical waste management policy, practices and to

assess attitude towards it.

Methodology: The sample size of the present study is 80. The

technique of sampling is purposive sampling. The methodologies used

in the study are mainly tools of questionnaire, interview and non

participatory observation of the practices of the staffs. Questionnaire

was prepared for the three groups of people i.e. Doctors, paramedical

(including nurses, technicians etc) and housekeeping staffs. The data

was coded on MS Excel and the same was analyzed.

Findings: The findings showed that 82% of the wastes generated were

non infectious and 18% were hazardous. Handling of those 18% was so

much difficult that is causes major Hazard. The study finding revealed

that on an average 124.8kg of the total waste was generated everyday

and 32.9 kg of biomedical waste was generated. Most of the doctors

were aware about the BMW management and they thought that it is

people’s responsibility. This is the group effort and not a single person

can brought about any change. Regarding BMW handling rules, most

of the paramedical heard for the first time. Half of them considered

sharps as the dangerous waste product. Three fourth of them had

knowledge that HIV was the most common disease spread by improper

disposal of hazardous waste. Paramedical did not seem to be

enthusiastic about having new training session for them. Housekeeping

staff that were in direct involvement of BMW handling were not

punctual. They were irregular to their work and their ignorance was

reflected in their practice. Most of them wanted that there should be

separate management unit for BMW, but they did not want to get

involve themselves. They had less knowledge about harmful impacts of

BMW as only 13.33% of people said it causes HIV/AIDS. Around 82%

of them said that they themselves are at highest risk of getting infection.

Their knowledge was very poor regarding BMW 66% of them had no

idea about color coding. They did not use protective measures. They

always complained that government had not provided anything to

them, but whatever government had provided to them, they were not

utilizing. They did not want to put extra effort in any additional work.

The study analyses the various aspects of the BMW management and

accordingly recommendations were made to bring required changes in

the district hospital’s BMW management and other aspects associated

with peoples KAP.

23

Methodology: Simple random sampling method used taking a sample

size of 35 % of total major surgeries. (130 out of 347 cases were taken

which includes 40 general surgeries, 40 orthopedic surgeries, 40 G&O

surgeries, 10 ENT surgeries). The format was based on specific

questions, asked to Anesthetists, staff nurse and housekeeping staff of

OT regarding times at which various activities and events was taking

place in operating room was recorded. Data sources include primary,

secondary data, observation and interview method.

Findings: Workload at operation theatres in Junagadh is high and no

proper scheduling of the operative cases has been noted and there were

no activity wise checklist found and filled during surgery so, it is

essential to know how much time is spent on which activity. The total

bed Strength of hospital is 510. The surgical beds utilizing Main OT is

120. No. of Operation Theatres is 5, the total no. of major operations

performed/year is 5000(apprx.). Out of the utilized time, time spent on

actual surgery was found to be 88 min., time spent on supportive

services was found to be 16 min. and time spent on making room ready

was found to be 4 min. Orthopedic department and O & G department

dealt with the highest work load out of the total inpatient department

and surgery cases, so these two operation theatres requires more

attention in the sense of new implementations.

Recommendations: Utilization of theatre can be increased by

anaesthetizing the patient in anesthesia room instead of operating room

and by lying of sterile trolleys in lay-up room instead of operating room,

by avoiding delayed starts, avoiding cancellation of cases, proper

scheduling of surgeries.

Ab-44

Practices

Roshni Dilbagi

Background: The need of the study came because of the fact that the

biomedical waste management practices is started in the health care

facilities of district hospital but although formal training has been given

but there awareness level was very low. This has led to conduct a

knowledge, attitude and practice study and assessment study among the

staffs of district hospital.

Assessment of Bio-Medical Waste Management

Keywords: Biomedical Waste, Waste Management, District Hospital,

Health Care Facilities

24

Recommendations: Study shows that there is an urgent need of audit

system with this respect. Doctors agreed that there should be

management team for waste management.

Ab-45

Ruchika Goyal

Background: As healthcare organizations look for ways to gain new

efficiencies and reduce costs, they are examining surgical services with

a critical eye. In many cases, the operating room (OR) was not included

in enterprise wide reengineering efforts, thereby limiting the positive

impact of those efforts. Healthcare organizations are recognizing that

every point along the patient care continuum is interrelated. To truly

maximize reengineering efforts, they need to integrate the entire

process and information flow within the OR and across the enterprise.

Objective: The study was carried out, to assess the efficiency in the

operating rooms. The purpose was to identify service-focused

opportunities for efficiency improvement, and to guide continuous

improvement activities within operating rooms and anesthesia services.

Methodology: A descriptive study was carried out and both primary

and secondary data was collected. An analysis of capacity utilization

was done by calculating the percentage utilization of the operating

rooms, percentage of first case start delays and the number of cases

cancelled and rescheduled. The scheduling process was studied and

reasons for delays in the surgeries were stated.

Findings: During the past seven months i.e. from July ‘09 to March ‘10

total 3577 surgeries were carried out. Avg. utilization of OR during the

elective hours is approximately 60%. On an average 45% were FCS

delays, 5.7% surgeries cancelled and approx. 21% were rescheduled.

OR six and seven were underutilized as compared to the others due to

inappropriate case mix. The OR’s were not differentiated specialty wise

leading to discrepancies in case mix and poor predicted time of case

length. Forecasting shows that the utilization of OR’s would increase

from the current utilization of 60% to 70%.

Recommendations: A large amount of cost is incurred to run the

operating rooms, under runs leads to opportunity cost during the un-

Performance Management in Operating Rooms

Keywords: Performance Management, Operating Room, Surgical

Services

utilized hours and lowers the contributing margin. So to streamline the

processes and to improve the efficiency in the operating room a

balanced scorecard approach was introduced as a performance

management tool.

Ab-46

at New Delhi

Rupinder Sahota

Objective: Detailed study was done to see how strong the information

system (Medical Records Department) at Eye hospital was done.

Relevant facts were taken from journals and internet as a part of

literature review and secondly, old patient records, direct interaction

with hospital staff was done to gather primary data.

Methodology: This retrospective study is based on, both secondary

and primary data. Relevant analysis was done to formulate strategies in

order to provide solution to the given objective. Random sampling was

done for retrospective part and whole population was studied for

prospective part. Fro content analysis 757 files were scanned out of

which 400 were taken form the past data and 357 files were taken for

prospective study. The strategies were divided according to the key

findings. Contribution was met with success, and thus further

recommendations were done.

Findings: MRD and general store should be in separate place. Lack of

signage found. Space of store room is cramped. Security is not

adequate. MRD policy is not implemented. The quality of consent

forms is very found to be very poor and the print is also not clear.

Coding system is not present. Records are not received every day. For

cataract occupies the least % of discrepancies were found. Procedures

like cyclocryotherapy, pupilloplasty, probing and syringing have 100%

discrepancy. Only 8 elements out of the 36 were seen in IMS 1 and IMS

5. Somewhat compliance is noted in IMS 7 (42.8%) which pertains to

the procedure laid down for medical audit. It was also found that

documented procedure is not present. Arrangement and configuration

of records is not standardized. A lack of awareness and training is there

amongst all the staff members specially doctors.

Recommendation: Formulating a medical records department policy

Benchmarketing of Medical Records at Eye Hospital

Keywords: Benchmarking, Medical Records, MRD Policy

25

is recommended on priority. Some Architectural suggestions were also

be implemented. Documents mentioned in the policy should be

maintained. Filled consent forms of OPD procedures should be taken

care off by the MRD.

Ab-47

Patient Satisfaction in an Emergency Hospital

Samarth Tripathi

Objective: To study the level of patient satisfaction in wards and the

different factors affecting patient satisfaction. To suggest measures for

improvement of services leading to better patient satisfaction and to

evaluate the services being provided to inpatients.

Methodology: The data collected on feedback project was a

prospective study. Primary data was collected through interviews and

discussions and direct communication with the patients the secondary

data was collected through literature available in pamphlets, journals,

booklets, through various records of the hospital, websites and

currently available national and international literature on the subject.

Semi-structured open-ended questionnaire for the purpose of the study

were developed.

Findings: 74.5% respondent ranked the consultants fees in the hospital

as moderate and the 4.5 % of respondent have ranked it low. 33.6%

respondent ranked the food service of the hospital as excellent and 32.7

% of the respondent has ranked it as good. 32.4 5 have claimed it as

excellent.26.4% respondent ranked the hospital support staff service of

the hospital as excellent and 50% ranked it as good. 89.7 % claimed

support staff service as excellent.

Recommendations: There should be some training on communication

skills for nurses as how to deal with patients. (English and Hindi). The

nurse who gives the charge to another on duty should clearly brief her

about everything related to patient’s condition, what all medication

needs to be given and so on. When a nurse joins, a feeling of

responsiveness should be incorporated in their mind so that they feel

accountable for the work assigned to them.

Study of the Opinion of inpatients to Measure

Keywords: Patient Satisfaction, Emergency Hospital, Inpatients

Ab-48

Equipments, Ultrasound & Operation Theatre

Sangeeta Ravindran

Background: Medical equipment plays a very significant role in the

healthcare delivery system. In the present healthcare scenario,

increasing operational efficiency and reducing costs, whilst

improving service provided to the patient, are a constant

challenge. Biomedical equipment accounts for nearly 50 percent of the

hospital project cost. Therefore, it is essential to ensure maximum

utilization of the equipment with minimum downtime. With the

adaptation of proper maintenance techniques and management systems

one can utilize resources optimally and reduce the breakdown and

related maintenance. Utilization index or use coefficient is one of the

important parameters to monitor the functional status of the equipment.

Objective: This study deals with the utilization rates of CT scan, X-

ray and Ultrasound machines in the Imaging department, Ultrasound

machine in the Gynecology OPD, and the utilization of the Pediatric &

Gynecology OT in a tertiary pediatric and neonatal referral center in

Andhra Pradesh and to suggest ways to increase the efficiency of these

equipments by better utilization. Objectives of the study was to record

the time taken for a scan/surgery , calculate the utilization

coefficient and see the trend of utilization.

Methodology: The study was an analytical one with valid quantitative

data as a background proof and time frame of three months.

Findings: The study revealed an optimum utilization for the ultrasound

machine used for pregnancy related scans in the gynecology OPD,

ultrasound scan machine in the radiology department and the pediatric

OT. The CT scan machine, X-ray machine and the Gynecology OT,

were found to be less utilized, the CT machine being grossly

underutilized. The Gynecology OT again is being underutilized owing

to the fact that the hospital is essentially a pediatric entity and the

gynecology department was started much later. The percentage

utilization of CT for the month of January, February & March was seen

to be 6%. This shows gross underutilization of the equipment. The

percentage utilization of Ultrasound in Gynecology department was

much higher than pediatric department. It was found that surgeons

Study on the Utilization of Radio Diagnostic

Keywords: Utilization of Radio Diagnostic Equipment, Ultrasound,

Operation Theatre

26

were exceeding the booked duration for a surgery by more than half an

hour in many cases.

Recommendations: The management was recommended to

increase marketing for the CT and X-ray services. Scans should be

started on Sundays to achieve optimum utilization of the equipment.

The department has well trained and experienced technicians working

in 3 shifts. Thus there is round the clock availability of staff. Regular

preventive maintenance of the equipment will assure lesser downtime

and ensure better functioning. Monthly report is generated to monitor

surgeries which were exceeding booked duration. Elective surgeries

can be planned on Sunday.

Ab-49

Hospitals of Delhi & NCR

Sanjhi Singh

Objective: To compare the performance of three hospitals in the

region in selected operations on the basis of Cost, Value added

services, Popular operations, promotional activities, approachability &

to analyze trends Indian medical and healthcare Industry. To study the

opportunities & challenges of medical tourism in Delhi and NCR.

Findings: Majority of the tourist consider India (Delhi) as a destination

for heart surgery followed by nephro surgeries (kidney related

problems) then orthopedic, Neuro and only a fraction of them come for

kidney transplants. The study also indicates that if proper investment is

made then India will be at the top level in the healthcare industry. The

graph shows in what ratios the investment should be done like on

medical equipment could account for 20-30% of investment in beds.

Recommendations: Aggressive marketing & awareness programs are

required. Hospitals should have JCI accreditation to enhance

international business. Web sites, list, details, telephone & E mail ids of

hospitals & executives dealing with medical tourism Establishment of

“Indian Medical Tourism Corporation”: - International Branches-

Liaison cell with all Indian & Foreign Missions, Regular Chartered

Medical Tourism should be announced, India International MT Media

is also essential. Corporate Hospitals Medical Tourism Consortium

with front offices in UK, USA, Canada, Middle East, South East Asian

Challenges & Opportunities of Medical Tourism in

Keywords: Medical Tourism, JCI Accreditation, Healthcare Industry

countries can be established. Medical Tourism Regulatory Body /Ethics

Committees should be formed.

Ab-50

Saumya Misra

Background: Measuring quality leads directly to the identification of

areas for improvement or enhancement—the first step in improving

quality. Successful improvement ultimately contributes to attaining

quality care, the goal of quality assurance. Quality assessment of the

facilities enables to track the practices, acceptability of the protocols

delivered during training as well as an important tool for training needs

assessment for capacity building in form of refresher training or further

trainings in new franchisees, as the network is gradually undergoing

expansion. Therefore the quality parameters need to be studied to trace

the needs.

Objective: To find out the issues regarding quality in the charitable

trust hospitals that need to be focused more during the capacity building

exercises so that the main aim of the project was fulfilled i.e. to provide

quality care at affordable prices.

Methodology: For this hospitals in 12 districts of Uttar Pradesh were

analysed which lead to inference that segments of quality parameter.

Findings: Study reveals the need of additional session on neonatal

resuscitation and refresher training to be conducted along with the

infection prevention session during the training and quality assurance

visits that could help in improving the quality of services being

delivered at the charitable trust hospitals.

Ab-51 Flyover feeds you more Momentum Expected Vs

Perceived Hospital Services

Shadad Mirza

Background: With the healthcare market turning from a seller’s

market into a buyer’s market, healthcare providers are turning more and

more towards marketing of their services. This requires a marketing

Quality Assessment for Training Needs Assessment

Keywords: Quality Assessment, Training Needs Assessment, Quality

of Services

Keywords: Hospital Services, Healthcare Market, Patient Satisfaction

27

information system, which provides information that is accurate,

timely and need-based. Market research can provide such information

to hospital administrators. A relevant tool for hospital administrators

today is a patient expectation survey, which reveals what patients

actually desire from hospitals.

Objective: A study was carried out to know the healthcare market and

patient satisfaction in a tertiary and secondary care hospital.

Methodology: Survey, interview and observation methods were used to

collect data.

Findings: Under this study as one of the quality/medical care attributes

100 % patients in both hospitals expect physicians to listen to their

problems and answer their queries, as against 73% & 63% in tertiary

and secondary hospital who were listened to respectively and 60% and

52% patients who were answered to respectively in the tertiary and

secondary hospital . The implications here was: Potential

dissatisfaction causing factor and sensitize doctors about above in both

hospitals

Recommendations: Here again in both hospitals, expectations were

not met and this needs attention. There is need to sensitize doctors about

patient expectations, which if heeded to, can improve the situation

without any additional input in terms of resources.

Ab-52

Sheetal Yadav

Background: Due to high dependency of ICU patients and their critical

conditions there are increased chances of getting hospital acquired

infections among these patients. Infections acquired in health care

settings are among the major causes of death and increased morbidity

among hospitalized patients. They are a significant burden both for the

patient and for hospital.

Objective: A prospective descriptive study in the ICU multispecialty

hospital at Gurgaon for a period of two & a half months has been

designed to elicit information on the rate of nosocomial infections and

Nosocomial Infections in Intensive Care Unit

Keywords: Nosocomial Infection, Intensive Care Unit, IUC, Hospital

Acquired Infection

their cost attributable to the patients.

Methodology: All the patients who were directly admitted to the ICU

and stayed for more than 2 days in ICU were included. The patients who

had bacteremia at the time of the admission and who stayed less than 2

days in ICU were excluded.

Findings: In a sample size of 129, 36 patients got infection during ICU

stay and remaining 93 did not get infection. The study revealed the

crude rate of ICU acquired infection was 27.9% comprising maximum

number (41.1%) suffered with ventilator-associated pneumonia. The

most prevalent pathogen for pneumonia and BSI was found to be

Acinetobacter. It was multi drug resistant organism for which costly

antibiotics [colostin] were required. Most prevalent organism for UTI

was candida. 55.5% of infected patients expired, where as only 17.2 %

of non-infected patients expired. The extra length of stay due to

infection was 8.11 days, which in turn amounts to, estimated 200,000

INR per patient.

Recommendations: There is a positive association on mortality rate

with infection hence it is estimated that if the infection rate is reduced

then the mortality rate will also get reduced. This will bring name and

fame to the hospital. If infection rate drops down patient turn over will

increase, which can lead to more revenue generation as compared to

existing situation, As per the literature, first three days of the hospital

stay of any patient are the most revenue-generating period.

Ab-53

Shikha Jain

Background: A hospital is an economic institution with a significant

social role in the community. It is not possible to discuss problems in

medical and health care intelligently without reference to hospitals

what they are, what they do, and how they do it. Economics of the

hospital sector has often received wide attention because it has been the

major consumer of the health care expenditure accounting for about 40-

60% of gross health care expenditure. Therefore it is essential to ensure

that services provide an excellent experience for customers i.e. the

patients.

Objective: The study on the bed utilization was conducted in the

Bed Utilization in General Hospital at Gujarat

Keywords: Bed Utilization, General Hospital, Health Care Expenditure

Hospital, Gujarat, to know the causes of their satisfaction as well as

dissatisfaction, To provide recommendations for the improvement of

the services.

Methodology: The primary data was collected with the help of

qualitative as well as quantitative research techniques. In total 50

employees were interviewed. The sample comprised doctors,

pharmacists, technicians, receptionists, data operators, security guards,

administrative staffs.

Findings: Results from the survey indicate that approximately 74 per

cent of the employees were satisfied with the organization. There were

several issues regarding the employee satisfaction survey. The

employees have many grievances as well as their problems regarding

some of the issues in the hospital. The issues should be handled very

carefully. In this survey it was found that 74% of employees were

satisfied. Majority of the employees i.e. 68% of the employees are on

contract basis. The majority of the age group is of age between 21yrs -

25yrs, which is of 42%. 66% believe that the organization treats them

like a person, not like a number, 42% believes that the

organization gives them enough recognition for good work, Majority

agrees that quality work and safety are the top priority of the

organization, 60% agreed that employees are treated fairly

regardless of race, gender, age, religion, or sexual orientation, 68%

agrees that employees are comfortable with their colleagues. When the

employees were asked about their relationship between the employees

with their immediate supervisors, majority agreed that their supervisor

treats fairly, with respect and acknowledges their work, and guide fairly

for the improvement in work and they also have trust in what the

supervisors suggests.

Recommendations: The work should be equally divided among the

employees; the employees should get the salary at right time as it is one

of the motivations for them to work. Employees need more training,

proper incentive should be given to the employees, work atmosphere

should be more improved, printers should be attached at every OPDs in

order to upload data on HMIS, work load should not be there. The work

should be equally divided among the employees; the employees should

get the salary at right time as it is one of the motivations for them to

work.

28

district hospital at Gujarat. The general objectives of this study is to

identify the various procedures at the Outpatient, Inpatient and Para

clinical services as well as to investigate the possible operational

problems those are leading to low bed utilization.

Methodology: The primary data was collected help of qualitative as

well as quantitative research techniques. In total 60 patients (40 out

patients and 20 in patients), 5 doctors and 5 nurses from various

specialties were interviewed. The secondary data comprised of last one

year monthly report of indicators of general hospital .

Findings: The study brought out the fact that overall bed occupancy

rate was low (about 30-40%) which is low compared to ideal bed

occupancy rate of 70-80%. Various reasons like patient’s lack of

knowledge about hospital functioning, lack of proper signage, lack of

confidentiality, respect and dignity of the patient, lesser OPD timings

etc lead to dissatisfaction among patients.

Recommendations: The low bed occupancy rate in the district hospital

can be improved by capacity building, planning for hospital budget, and

revision of OPD timings, improving internal communication and

strengthening of security services at the hospital campus. Thus a well

organized and professionally run hospital not only can help in avoiding

confusion, frustration and dissatisfaction by fearful patients but can

also manage the flow of inpatients to the hospitals, thus improving bed

utilization.

Ab-54

Gujarat

Shreyasi Sen Gupta

Background: The strength and the success of an organization depend

on the capacity of its employees. Employee satisfaction survey is one of

the important surveys which need to be done in any organization at

periodical basis. It helps the top level managers to understand their

employees and manage accordingly. Therefore the present study aimed

to conduct an employee satisfaction survey in the General Hospital

Gujarat.

Objectives: The basic objective of employee satisfaction survey were:

To understand the perspective of the employees about the General

Study of Employee Satisfaction at General Hospital,

Keywords: Employee Satisfaction, General Hospital, Motivations

29

Ab-55

Shruti Khanna

Objective: The main aim of the project was to make disaster

preparation of GGH effective by identifying all the grey areas and

removing all the loopholes, whatever there may be.

Methodology: An intensive research of the NDMA guidelines was

done and then the gap analysis was conducted to quantify how much

we’re lagging behind the industry standards and what should be done to

cover the gap.

Findings: The study revealed many interesting facts like the shortage

of manpower, poor conditions and improper utilization of funds , lack

of inter departmental and intradepartmental coordination, faulty Govt.

policies regarding condemnation of equipments, retrofitting of

buildings in accordance with NDMA guidelines, very poor

infrastructure, SOP formulations, pertaining to external and internal

disaster, Up gradation of disaster plan of the Hospital, no fire

evacuating system, lack of statutory requirements, Poor awareness and

preparedness in relation to disasters, disaster management committee

was never formed etc.

Recommendations: The study proved to be a helpful tool in analyzing

the gaps in the existing disaster plan, in the formation of disaster

management committee, in up gradation of the old plan. The results of

the report are being used in recommending a revised plan to the State

authorities.

Ab-56 Study the Operations, Medical / Clinical Record

Keeping and Prepare Functional Specifications for

Clinical System for Oncology

Shweta Sandhu

Objective: The main objective f the project was to understand the

operational process of a functioning oncology centre followed by

Study on Disaster Management Plan

Keywords: Disaster Management, Disaster Management Plan, Gap

Analysis, NDMA Guidelines

Keywords: Record Keeping, Medical Record, Clinical System,

Oncology

development of functional specifications for the clinical process

documentation with clinical backup. As a part of zero stage of

implementation cycle which consists of process change identification

workshop, detailed implementation planning and functional

specification document preparation.

Methodology: For process flow analysis a 150 bedded, state of art

leading oncology centre at Hyderabad was chosen. Operational process

flow, with step by step data capturing at every stage with documentation

was studied. Operational process flow, with step by step data capturing

at every stage with documentation was studied. Both qualitative and

quantitative method was used for the study.

Findings: Various stake holders at Cancer Hospital were interviewed.

Following, an elaborate document of their existing process flow was

made which was further sent to parent hospital for approval and

authentication. After analyzing the scope of the product and various

work rounds available voids in data capturing were identified. A

functional specification document was prepared for the technical team

consisting of what information has to be captured, which field shall

capture it, who shall capture it, which all other areas it will be displayed

in, master’s for the same were created after extensively. Data captured

were tabulated and a sample copy of the same was created and added on

to the existing report. Completing the stage zero of the project the

details were sent to the parent hospital for their approval post which it

shall be sent to the technical team for development. Another important

part that was deeply looked into was capturing and presentation of this

data according to existing standards in the healthcare.

Ab-57

Survey

Suhas Parnami

Background: The patient is the ultimate consumer to the hospital. It is

one of the yardsticks to measure the success of service that it produces.

The effectiveness of the hospital relates to provision of good patient

care as intended. The patient satisfaction is real testimony to the

efficiency of hospital administration.

Quality Improvement through Patient Satisfaction

Keywords: Quality Improvement, Patient Satisfaction, Hospital

Administration

30

Objectives: To study the satisfaction level of patients and understand

their expectations. To evaluate feedback and provide a remedial

suggestion.

Methodology: In order to understand the standing of the hospital from

the views of the customers, a closed ended questionnaire was designed.

100 patients were selected for the study. Questionnaire and interviews

methods were used.

Findings: This study helped to find the hidden problems and issues

which need to be dealt with immediate effect. After analyzing the

completed questionnaire of 100 patients/attendants, it was revealed that

the billing services at the time of discharge was the least satisfactory in

the hospital and was the root of all the dissatisfaction among the

patients. Reasons behind this dissatisfaction were: Billing done

manually, less manpower, no pre planned discharge intimation from the

floor. To which I proposed that have billing done on HIS, and pre

planned discharge intimation from the floor a day prior of discharge.

Next in dissatisfaction list was Radiology services. Major reasons

found out after studying the questionnaire in detail was: Delay in

procedures. 50% of the patients were found satisfied with the

registration process and 11% was dissatisfied. 88% patients were found

to be satisfied with the doctor’s ability and 55 were dissatisfied due to

the non availability of the doctor when required. 54% were satisfied

with the Nursing and Lab services and 8% were dissatisfied. 96% were

fully satisfied with the housekeeping services. 56% were satisfied with

the food quality and services.14% comprising of international patients

were dissatisfied with the menu of the food.

Recommendation: It is recommended to have a proper appointment

system to achieve maximum patient satisfaction.

Ab-58

Infection in Intensive Care Unit

Suhasini

Background: Hospital acquired infection creates a major problem to

the patient admitted to the hospital as well as to health care personnel,

affecting the reputation of hospital and making unnecessary cost to

A Study on Control Measures of Hospital Acquired

Keywords: Hospital Acquired Infection, Intensive Care Unit, Infection

Control, ICU

patient during the course of treatment.

Objectives: The main objectives is to study the physical facilities

available for infection control in intensive care unit and also the

existing infection control procedures used in the intensive care unit .

Methodology: The research approach adopted in the study was

descriptive method. It includes collection of information regarding

infection control procedures and its measures and also existing physical

facilities available for infection control through questionnaires,

studying relevant record maintained in ICU. The required data is

collected from nurses, doctors, hospital nursing assistance, staff of

central sterile supply department who are responsible for supplying

sterile items to medical intensive care unit and the, housekeeping staff

who work in medical intensive care unit.

Findings: Result show that current physical facilities available for

infection control are satisfactory and meet the ISI standard, but the

existing infection control measures practiced in ICU are poor. No

standard operating manual is maintained in ICU. Culture studies of

swabs from ICU floor / equipment are done. Bacteriological testing of

water is done but bacteriological testing of air is not done. No antibiotic

policy is available No protocol is followed for wearing gloves

Recommendation: Strict adherence to standard infection control

procedures need to be taken under consideration and existing infection

control measures in ICU needs improvement and up-gradation.

Ab-59

Sunita Choudhary

Background: Family Friendly Hospital Initiative (FFHI), a kind of

certification of health facilities wherein certain quality of services

needs to be ensured. The essential components for declaring a facility as

FFHI are (a) evidence based protocol; (b) quality of services; (c)

availability of essential drugs; (d) and availability of referral transport.

A Hospital at Rajkot has already got the certification for Baby friendly

hospital initiative some years ago. Assessment of the hospital was done

for “Family friendly hospital certification initiative”.

Assessment of a Hospital as Per FFHI Guidelines

Keywords: FFHI Guidelines, Family Friendly Hospital Initiative,

Health Facilities, Quality of Services

31

Objective : To review the existing system of the hospital. To have a best

possible H.R. measure study on employee satisfaction. To have patient

perspective study on patient satisfaction. To identify the lacunas in

hospital to become a family friendly hospital. To recommend the areas

of improvement for strengthening and improving the quality as per

FFHI check list, this helps to reduce the lacunae’s and variation.

Methodology: The project was descriptive in nature. Primary data was

collected by Observation Structured Interview method. Secondary

data was collected from hospital medical records. The primary data

collected was transferred to a standard format of “Quality Framework-

System approach” and then analysis done through Ishikawa fishbone

diagram (Root cause analysis).

Findings: Results shows that 90 percent patients were satisfied with the

cleanliness of hospital campus. Results of table 8 shows that almost 80

percent patients were found to be highly satisfied to the cleanliness of

bed sheet. Analysis pertaining to cleanliness of ward reveals that 96

percent patients were found satisfied from the cleanliness of the

hospital. Result reflects that 28 percent patients were not aware about

their treatment. Around 92 percent patients were found to be highly

satisfied with the behaviour of doctors. It was found that, 84 percent

patients were satisfied with food quality and time. The major gap was

related to the service environment like Non availability of display of

doctors’ availability and timings, Littering by the patients in the

hospital, Non availability of electronic display of token, Junks inside

the hospital. The second major gap was related to client provider

interaction like No feedback system from the patient, Non-availability

complaint box for the patients. The third gap was related to access to the

patient. Non availability of service guarantees character, non

availability of signage and directions. The forth gap was related to

professional standards and technical competence like Non availability

of check sheet for surgical patients.

Ab-60

Documentation

Thirumalai N

Objectives: The study was taken to examine and measure the quality of

Interna l Qual i ty Assurance in Cl in ica l

Keywords: Quality Assurance, Clinical Documentation, Quality of

Documentation

documentation in clinical areas. To suggest remedial and

corrective/preventive actions to sustain the quality of documentation in

clinical areas and to examine the effect of implementation the

preventive/corrective actions. The sole aim of the study is to identify

the areas to sustain or improve the documentation process and to

recommend the methods to achieve them.

Methodology: First phase, all departments in the hospital was

observed for the documentations process. Informal interview and group

discussion was carried out with people involved in the documentation.

Area of common mistakes and difficulties faced by the department in

clinical documentation was observed in detail. In second phase, a

check list is prepared based on non conformance/Partial conformance

of measurable elements which were identified during the NABH

external assessment. Final phase, medical records of the patient who

are treated in the hospital are audited with the help of check list and the

data was analyzed. Major contributing factors are identified using pare

to principle and recommendations for the same was formulated.

Findings: It was found that 94.6% of the medical officers are not

mentioning the time of assessment and reassessment. 91.9% Charge

nurse is not mentioning the date, time and signature in each valid

medication notes. General consent forms on admission were not duly

signed by 89.3%.patient. This was because patient comes to inpatient

department (wards) through the emergency department, so during

filling the admission patients relatives were signing the general consent

form.

Recommendation: To enhance the effectiveness and sustainability of

internal quality assurance efforts, internal hospital quality assurance

program should encompass all the aspect of the facility (not just one

type of service) and aim from the outset to construct a self sustaining

QA system that does not depends on external support.

Ab-61

Rajasthan

Trupti Khandelwal

Background: Shortage of human resource in health sector is a major

problem in India and more in rural areas. Similarly in Rajasthan, it is

Human Resource for Health in a District Hospital at

Keywords: Human Resources, District Hospital, NRHM

examine the efficiency of housekeeping staff or quality of their

working.

Methodology: A sample of 11 in-house housekeeping staff (providers)

was interviewed using a structured questionnaire to evaluate their

awareness about cleaning methods, frequency of cleaning, BMW, their

responsibilities in mass casualty etc and to determine the training given

to them and if they are getting housekeeping material timely so that

quality of service is not affected. A sample of 48 IPD patients/

attendants and 50 OPD patients/ attendants were also interviewed using

a questionnaire to evaluate user’s satisfaction regarding the level of

cleanliness and housekeeping services.

Findings: It was found that 55% knows the correct method of sweeping

a patient’s room while only 27% knows the correct method of mopping.

Only 9%answered all the 5 questions related to BMW correctly while

91% replied that they have got training on BMW (it was 6 months

before). 91% replied that they got training on BMWonly during their

work in organization, no other training was given. 67% answered that

they didn’t get equipments/ supplies on time. A time-motion study was

done to determine the activity schedule of housekeeping staff at

different timings. It was found that besides cleaning, they were also

performing nursing activities and others (activities of ward boy etc) A

check list was prepared to further assess the training needs of

housekeeping staff to increase their efficiency; the check list was filled

in by ward in charges (supervisors of housekeeping staff of their

respective ward). Maximum score (i.e. for the area in which training is

required immediately) was given to Induction training and training on

waste disposal. Another check list was prepared to examine the existing

practices of housekeeping services by checking the system of record-

keeping, training schedule, cleaning activities (performed or not), and

to determine if the existing system of supply of housekeeping material

was working efficiently by checking the availability of equipments/

supplies required in cleaning procedures.

Recommendation: It proposes proper organization and planning of

Housekeeping department with sufficient storage and work space, a

system to ensure availability of housekeeping material on time, an

annual training plan and its proper implementation, preparing

housekeeping records and monitoring of records and a monitoring

system to measure the efficacy of housekeeping services .

32

scarcer in terms of doctors. Nearly one nursing staff is available for

1000 population but even single doctor is not available for per thousand

populations.

Objective: A study on HRH was conducted in District Hospital,

Rajasthan. The study objective were: (i) to review the efforts made by

the GoR to attract and retain the health functionaries in health facilities,

(ii) to find out reasons for success/ failure of the efforts made in the

district, and (iii) to suggest about what more could be done in the

present context human resources for health encompass–health and

hospital mangers, medical officers, nursing staff and support staff to

study the current status at the District Hospital in Rajasthan

Methodology: Purposive sampling was done to understand the human

resource planning and other relevant issues. A total of 22 officials at the

district and state were conducted using a checklist. In addition,

secondary data was collected and analyzed.

Findings: The results revealed acute shortage of health functionaries,

especially Medical i.e. 44% following Government of Rajasthan rules.

It will be more if IPHS is followed. However, under NRHM,

Government of Rajasthan has initiated efforts for attracting and

retaining the medical officers. Moreover, the medical officers were

overburdened due to high rate of vacant positions, including voluntary

retirement scheme.

Recommendation: The study recommended a dedicated human

resource cell at the state level, decentralization and evidence-based

planning.

Ab-62

Vatsala Sharma

Background: Housekeeping services in a hospital is entrusted with

maintaining a hygienic and clean hospital environment conducive to

patient care. The housekeeping related activities have a direct effect on

the health, comfort and morale of the patient, staff and visitors and are

an important public relations variable. It is an essential ingredient in the

provision of quality assurance of hospital care.

Objective: This study was carried out in order to assess the existing

practices of housekeeping in the District Hospital at Karauli and to

Study of Housekeeping Services

Keywords: Housekeeping Services, Quality Assurance, Hospital Care

33

forming cost sheet .

Methodology: The scope of the study was limited to 4 investigations,

of which 1 is contrast based. The methodology utilized includes review

of literature, internet search, understanding market trend, enumeration

of services, cost heads and various resources required, meeting various

healthcare professionals including vendors supplying equipments and

consumables, etc. The data collection was both through primary and

secondary basis.

Findings: The study found that the imaging services provide a pool of

revenues if proper patient inflow is maintained; otherwise it may also

be a means for losses to the organization as in CT scan and X-Ray

procedures, while it is profit making in USG & Mammography units as

per the study and manpower, depreciation but without interest cost

contributions.

Ab-65

towards a Paperless Hospital

Vikash Tyagi

Objective: The purpose of the study was to see the adoption of IT in

OPD and IPD can help in streamlining the various processes and

improve the quality of the services. The study analyzes the role of

information technology in this regard through improved quality,

efficiency and ability to conduct research with the use of electronic

medical records.

Methodology: A random sample of the users of the computer system

was taken and informal interviews were conducted with them. They

were asked about the problems associated with the present system

specially related to their area of operations.

Findings: The areas of concern are duplication of entries, Lack of

interoperability between various modules and large and bulky paper

based records. The role of proper training and the integration between

various modules has been emphasized.

Scope of IT in OPD and IPD Areas: First Step

Keywords: OPD, IPD, Information Technology, Quality of Services,

Electronic Medical Records

Ab-63

Delhi

Vijay Shankar Patel

Objectives: The major objectives were to know the costing of per bed

day in ICT and to know cost and benefit from ICU.

Methodology: Depreciation method is used to calculate the cost of

instrument and there are some direct cost like doctor cost, nursing cost,

housekeeping and linen cost. Step down method is used to calculate the

cost of administration. Data observed and collected includes:-per bed

day doctor charge, nursing charge, administrative charge, electricity,

water and other charges.

Findings: Some indirect costs are electricity and water cost. The ICU

per bed day costing is Rs.2300.68. Per bed day cost charged from

patient is Rs 3500. Bed occupancy for month of March is 97%. Revenue

generation per bed par Day = Rs 3395. Total discounts in the month of

March for ICU patients- 132000 rupees. Discount per bed day in the

month of March is = Rs.488.88. Revenue generation per bed day in the

month of March is= Rs 2906.12. Benefit per bad day = Rs 2906.12-

Rs.2300.68 =Rs 605.44. Benefit for ICU per bed day for the month of

March is =26.31%

Ab-64 Cost Analysis of Medical Imaging Modalities

Vikas Goyal

Objective: The study t provides an analysis of departmental costs

involved in providing Imaging services and ascertain the costs of some

commonly done tests or procedures in the Imaging Department.

Bottom-up or Micro costing is applied in which all the inputs consumed

in undergoing the procedure are identified, measured and quantified,

finally converting into value terms to produce a cost estimate.

Absorption costing, a technique that assigns all costs, i.e., both fixed

cost and variable cost to product cost of service rendered is applied in

ICU per Bed Day Costing in a Charitable Hospital at

Keywords: ICU, Per Bed Costing, Cost Benefit

Keywords: Cost Analysis, Medical Imaging Services, Cost of Services,

Micro Costing

34

Recommendation: Hospitals may be more likely to adopt EMR if they

can reassure patients that their confidentiality is legally protected.

Among the barriers to implementation are a dearth of integrated

delivery systems, reluctant providers, and prohibitive costs.

Ab-66

Multispecialty Hospital at Jaipur

Vikram Singh Chouhan

Objective: The main objective was to study the o gap analysis and

preparing an external emergency response plan as per the requirement

of NABH.

Methodology: The study was descriptive and qualitative in nature. The

study was based on the standards of NABH. Comparing the existing

plan and requirements of NABH and doing gap analysis as well as

developing plan that fills the gap according to the NABH norms.

Findings: The findings of the study are described as gap analyses

which are as follows: The allocation of bed in case of mass casualty was

not appropriate, No Triage Area, No proper communication within the

hospital, No process flow for different departments which will play an

important role in emergency situation (Pharmacy, Laboratory, Blood

Bank, Medical Record, Material management and no description of

responsibilities of individuals in case of external disaster.

Recommendations: It is very necessary to have a policy for the

communication within the organization during external emergency to

avoid confusion and the staff and the department head get the right

information and start working according to their job description.

Ab-67 Study of Improving Effectiveness and Efficiency of

the Linen and Laundry Department

Vrajesh Shah

E x t e r n a l E m e r g e n c y R e s p o n s e P l a n i n

Keywords: Gap Analysis, NABH Standards, External Emergency

Response Plan

Keywords: Lean Department, Laundry Department, Hospital Support Services

Background: The hospital is supposed to provide well-laundered linen for all requirements of the hospital in adequate quantities, at the right place, at the right time and this is possible only if the means to attain these objectives are controlled by the hospital itself. Linen and Laundry department was comparatively weak area at Children’s Hospital.

Objective: The main objective was to streamline the process flow and to improve the effectiveness and efficiency of the department and to understand the structure and service flow of the linen and laundry department, to develop policy for linen department, to identify and analyze the flaws in the structure and service flow of linen and laundry department for improving its functioning,

Methodology: Observation, interview and linen satisfaction survey was carried out by identifying five quality indicators i.e. Clour, texture, timely availability, smell and adequate quantity of the linen services.

Findings: It was found that 28% were highly satisfied and 17% were not satisfied, rest was satisfied with the colour of the linen. 23% were highly satisfied, 60% were satisfied with and the 17% were not satisfied with the smell of the linen. 25% was highly satisfied, 60% satisfied and 15% were not satisfied with the texture of the linen. In the case of timely availability of the linen 30% were highly satisfied, 57% were satisfied and 13% were not satisfied. 32% was highly satisfied, 48% was satisfied and 20% was not satisfied with the adequate availability of the linen.

Recommendation: Major were to change the design of the linen, to dispose the linen whose life is completed, for the laundry department to change the detergent quality and lastly for the housekeeping department to follow the policy suggested by the surveyor for the department for improving quality of services of this department.

Ab-68Hospitals for assessing the performance of Dialysis Unit

Vritti Lumba

Background: Chronic kidney disease is increasing worldwide, but due

to lack of awareness the incidence is increasing in the developing

countries. In India, there is no existing data available and the patients

Comparative Analysis of two Multi-Superspeciality

Keywords: Dialysis Unit, Dialysis Unit Records, Quality Care Control

undergoing renal replacement therapy form only tip of the iceberg. In

India the setups providing dialysis are not doing a great job either.

Objective: To find out the gaps between the standard guidelines and the

processes followed. The objective of the study was to do a gap analysis

of the parameters that reflect the efficacy of the dialysis unit with

standard guidelines and to compare it with its older peers and then give

recommendations so as to improve the quality of life of dialysis

patients. In this endeavour studied.

Methodology: Secondary data available in hospital records in the form

of patient files, dialysis unit documentation registers and records on

hospital information system the patients who had been examined on

outpatient basis when they were in chronic kidney disease stage-IV was

studied. The data was analyzed using Microsoft excel.

Findings: It was found that the hospital is a new setup, its dialysis unit

was being underutilized, no. of dialysis being thrice weekly in 68%

patients; AVFistulas created prior to first hemodialysis in 52% patients;

improper documentation of time of vaccination for hepatitis and

pneumococcus; target hemoglobin of 11-12 achieved in 32%; serum

albumin of 52% patients meeting the standards. No seroconversions

and line infection rates of 14% more than the standards. When

compared to second hospital it was found that there was better

utilization of the dialysis unit but the staff patient ratio was not meeting

the standards; almost all patients had hemodialysis done twice/week

and AVFistulas were created prior to first dialysis in none of the

patients. Hemoglobin level was in the standard range in 20% patients

while urea reduction ratio was not evaluated, though serum albumin

was meeting standard in 48% but the lowest value was 2.2mg/dl.

Seroconversion rates for hepatitis B, C and HIV were 16%, 16%, and

4% respectively. There were no records available for the time of

immunization of patients and no records were there for line infections.

On comparing the two, the dialysis unit is doing better than its old

competitor, yet lot needs to be done in order to achieve the standards

and reach to a state where it can give real quality of life to its patients.

Recommendations: VIP rooms may be utilized by other patients when

there is no booking of VIP rooms. Night shifts to be started to incr5ease

the utilization of dialysis unit. Results should be monitored as part of

comprehensive quality care control programme. Proper documentation

needs to be done in order to ensure quality.

35

Ab-69

Services in District Hospital, Sikar

Yatendra Kumar Sharma

Background: District hospital is an integral part of the District Health

System (DHS). District Hospitals function as a secondary level of

healthcare which provides curative, preventive and primitive health

care services to the people in the district. It is also the fundamental

platform for implementing various health policies and delivery of

health care and management of health services for defined geographical

areas.

Objective: A study was conducted in District hospital at Sikar, with the

objective to know a broader perspective of the issues related to the OPD

and IPD services, and the behavioral aspect and attitudes of Hospital

staff, as well as patients and to strengthen the OPD and IPD services of

the hospital.

Methodology: Structured questionnaire was prepared and primary

data was collected on random basis by interviewing the patients.

Analysis was done using Ms-Excel.

Findings: From the aggregate of scores of 14 questions of satisfaction

questionnaire, it was found that 13.3% patients considered the services

at as excellent, 21% considered it as good, 30.1% say that it was average

and 12% of patients were poorly satisfied with the services. Item- wise

satisfaction score showed highest score for patient satisfaction of

excellent category regarding pharmacy (21%), followed by 11% about

registration and 11% regarding ambience of the hospital. Item wise

dissatisfaction score showed highest score for poor satisfaction i.e. 30%

regarding nursing staff behavior, followed by overall experience (25%)

and poor cleanliness of toilets and bathrooms (16%). 7% of patients

preferred to suggest this hospital for friends and relations and for future

consultations.

Recommendations: The hospital administrators should be aware of

the needs and expectations of the public as per the feedback of the

public relations department and accordingly take policy decisions.

These measures play a significant role in patient’s satisfaction. A good

communication between the patient and provider of health care is vital

factor for patient satisfaction. There should not develop any

communication bridge between the doctor and the patient.

Monitoring and Strengthening of OPD and IPD

Keywords: District Health System, Health Care Services, OPD

Services, IPD Services

HealthManagement

Keywords: Post-natal Services, Intra-natal Services, Ante-natal

Services, NRHM, MGDs, Quality of Services

Objective: This study was carried out under the aegis of staff of PHFI

for the project “Developing an Investment Case for Scaling up

Equitable Progress towards MDGs 4 and 5 in Asia Pacific Region.

According to State of World Children Report 2009 by UNICE lack of

proper antenatal care is responsible for the manifestation of these three

lethal causes. It says hemorrhage after delivery is the major cause of

high maternal mortality in Orissa followed by eclampsia, sepsis and

anemia. Sixty-eight per cent pregnant women in Orissa are anemic. 54

per cent births are not assisted by any health worker while the

institutional deliveries constitute only 39 per cent.

Rationale: To achieve MDG 4 & MDG 5, NRHM & RCH II was

launched. Since their inception & efforts quantitative figures have gone

up but the quality figures are not reviewed at any level.

Objective: To study the quality of Antenatal, Intra-natal and Post-natal

services in Kendrapara and Rayagada districts of Orissa. To see the

trends of Ante-natal, Intra-natal and Post-natal care from DLHS-2 to

DLHS-3. To identify gaps between quantitative figures and quality of

Ante-natal, Intra-natal and Post-natal care provided in Rayagada and

Kendrapara.

Methodology: Analysis of raw data from DLHS-2(2002-2004) &

DLHS-3(2007-2008) was done using Stata 10 statistical package &

Microsoft Excel for analysis The study analyzed the analysis of

secondary data from DLHS-3. The Study Areas were Rayagada and

Kendrapara district of Orissa

Findings: Coverage indicators for the districts Kendrapara &

Rayagada have improved from DLHS-2 to DLHS -3. This can be

attributed to the implementation of NRHM, RCH II. The increase is

more for Kendrapara than Rayagada, this can be due to difficult terrain.

Quality indicators are lagging behind the coverage indicators for both

the districts

Recommendations: Implementation of NRHM, RCH II has brought

about a drastic improvement in the coverage indicators for Ante-natal,

Intra-natal & Post-natal care but the quality indicators have not been

37

Ab-1 Yashoda Assessment at District Hospital Bharatpur

Aastha Srivastava

Objectives: The study was based on the intervention benefiting the

health system by improving the health care delivery system for mother

and newborn and also to check the efficiency and the effectiveness of

the work performed by Yashoda.

Methodology: The descriptive cross sectional study area was

Bhartpur district hospital. Target population are the mothers staying in

the institution after delivery. Sampling done is as per convenience. Tool

based on job assessment questionnaire and self administered

questionnaire for Yashoda. Checklist was also prepared to observe the

process under study. Frequency table and graph generated by manual

calculation using Microsoft Excel for analysis.

Findings: The finding reflects that initially Yashoda faced various

problems and they were not accepted by the staff and were not given the

recognition in the institution. Major Finding shows that most of the

Yashoda staff are not counseling for the new borne care, family

planning, proper nutrition and breast feeding. It was also observed that

cleaning the baby inside the labor room and motivating the mother for

follow up visits was also not done. It was also observed that 75% of

Yashoda are informing doctors about newborn who require more care

and attention. Very few are helping in making monitoring charts, in

registration and helping mother in choosing family planning tool. The

patient satisfaction increased with the efficiency of the staff. Good

coordination with floor staff and the nursing staff was also observed and

has increased quality service and care. Their presence in the hospital

has made increase in no. of weighing of babies, early initiation of breast

feeding, increase in immunization status of the district, increase in no of

stay hour i.e. more than 24-48 hours in the hospital.

Recommendations: Refresher training course should be conducted

regularly. Clarity in the job profile is essential. Nursing staff and the

floor staff must coordinate with them.

Ab-2 Quality of Ante-natal, Intra-natal and Post-natal Services

in Kendrapara and Rayagada Districts of Orissa

Aishwarya Rathore

Keywords: Health Care Delivery System, Yashoda Assessment, Health

System

38

reviewed at any level. There is a stark gap in the quality & quantity of

ANC, Intra-natal & PNC. Kendrapara is much ahead of Rayagada, this

can be due to the large chunk of tribal population & naxalite infestation

in the latter.

Ab-3

Delivery/Maternal Complications and Its Utilization

by the Beneficiaries

Akash Kumar Lal

Objective: Under NRHM JSY integrates cash assistance with delivery

and post delivery care for women, to have healthy outcomes of

pregnancy and childbirth. A study was undertaken in the AMRELI

district of Gujarat to (i) review the JSY under NRHM in the district;

(ii) conduct trend analysis of institutional deliveries under the JSY

scheme in the district; (iii) study the utilization of the JSY incentive by

the beneficiaries; and recommend for better utilization of JSY, and/or

sustain the progress even without cash incentives.

Methodology: The study was conducted in the five blocks of the

district AMRELI during February-April 2010. The methods of data

collection included interview with 50 JSY beneficiaries; and 10

medical officers, and 16 female health workers. In addition, district

health records for the last three years were also analyzed.

Findings: The study shows that around 44% beneficiaries spent the

cash (Rs. 700/-) received under JSY for supplementary nutrition which

is one of the prime purpose of the incentive. The record review shows

that the percentage of institutional delivery among JSY beneficiary has

been around 25% during 2006 to 2010 in the district. There was no

difference in reducing maternal complications. The JSY scheme has

proven to be more benefitting for the urban population rather than the

rural population. The MOs and the FHWs believed that the incentive is

very beneficial for the beneficiary who belong to very low

socioeconomic status but is not very much required by others who are

economically sound.

To Study the Relationship of JSY with Institutional

Keywords: NRHM, JSY, Institutional Delivery, Maternal Care, Post

Delivery Care

Recommendations: The study recommended that JSY incentive need

to cover all aspects of antenatal, postnatal care and the quality of care

rather than on institutional delivery only for example 25% for ANC,

50% during delivery, 25% for PNC. Attention need to be paid to

increase the facilities (infrastructure and human resources) at health

facilities. Adolescent girls need to be sensitized about benefits of

different health schemes. This effort will directly help in parent’s

awareness and acceptance of institutional deliveries in one way or the

other and they themselves will contribute in JSY in near future.

Ab-4

Amandeep Singh

Objective: Under NRHM JSY integrates cash assistance with delivery

and post delivery care for women, to have healthy outcomes of

pregnancy and childbirth. A study was undertaken in the AMRELI

district of Gujarat to (i) review the JSY under NRHM in the district;

(ii) conduct trend analysis of institutional deliveries under the JSY

scheme in the district; (iii) study the utilization of the JSY incentive by

the beneficiaries; and recommend for better utilization of JSY, and/or

sustain the progress even without cash incentives.

Methodology: The study was conducted in the five blocks of the

district AMRELI during February-April 2010. The methods of data

collection included interview with 50 JSY beneficiaries; and 10

medical officers, and 16 female health workers. In addition, district

health records for the last three years were also analyzed.

Findings: The study shows that around 44% beneficiaries spent the

cash (Rs. 700/-) received under JSY for supplementary nutrition which

is one of the prime purpose of the incentive. The record review shows

that the percentage of institutional delivery among JSY beneficiary has

been around 25% during 2006 to 2010 in the district. There was no

difference in reducing maternal complications. The JSY scheme has

proven to be more benefitting for the urban population rather than the

Human Resource in Health (HRH) in India

Keywords: NRHM, Human Resource in Health, Janani Surksha

Scheme

39

rural population. The MOs and the FHWs believed that the incentive is

very beneficial for the beneficiary who belong to very low

socioeconomic status but is not very much required by others who are

economically sound.

Recommendations: The study recommended that JSY incentive need

to cover all aspects of antenatal, postnatal care and the quality of care

rather than on institutional delivery only for example 25% for ANC,

50% during delivery, 25% for PNC. Attention need to be paid to

increase the facilities (infrastructure and human resources) at health

facilities. Adolescent girls need to be sensitized about benefits of

different health schemes. This effort will directly help in parent’s

awareness and acceptance of institutional deliveries in one way or the

other and they themselves will contribute in JSY in near future.

Ab-5 To Ascertain the Role of LBWs in Neonatal Mortality and

Development of Strategy for Preventing Deaths Due to

LBWs in the Tirbal District of Narmada

Ambrish Kumar Chandan

Background: Low birth weight has been defined by the World Health

Organization (WHO) as weight at birth of less than 2,500 grams (5.5

pounds). The goal of reducing low birth weight incidence by at least one

third between 2000 and 2010 is one of the major goals in ‘A World Fit

for Children’, the Declaration and Plan of Action adopted by the United

Nations General Assembly Special Session on Children in 2002.

Objective: The purpose of this study is to devise and promote a strategy

that prevents the neonatal deaths due to LBW in the tribal district of

Narmada and similar settings. This study presents an analysis of low

birth weights in the tribal area is an effort to understand the severity of

this public health problem, gain insight into existing assessment

strategies and map the regional distribution of LBWs.

Methodology: The statistics of live birth and linked infant death

records aggregated over the years 2008-09 and 2009- 10 by health dept.

of Narmada district is used for this study . The study has been done by

using Secondary data. Data extracted for that review and relevant to the

Keywords: Low Birth Weight, Neonatal Mortality, LBWs, Neonatal

Deaths

estimation of low birth rates are used for this study, along with data from

a supplementary qualitative discussion conducted with the medical

officers on LBWs for the years 2008-09 & 2009-10 to bring the

estimates up to date. Literature search strategy included reviewing

relevant databases, conducting manual searches, contacting experts

active in the field and various online resources on the subject. The total

sample size for this study is 560 infant deaths (0-1 yr.) over the year

2008-09 & 2009-10.The sample frame was 260 LBW babies over the

same year.

Findings: The figures clearly suggest that LBWs cases are higher

among the forest villages. This is one of the prime reasons for high

neonatal mortality in the district. This can also be taken as a poverty,

knowledge and health vicious cycle. The estimated 260 LBWs in this

small district that occurred in 2008 -2010 represent a substantial

problem for already overtaxed health department. A challenge for

future analyses is finding ways to distinguish and quantify very early,

early and late LBWs births.

Recommendations: Ensuring early registration of pregnant women,

strengthening Mamta divas, promotion of proper eating habits for

pregnant women, promotion of institutional deliveries, Installation of

sonography machine, Kangaroo Mother Care are some

recommendations that can be started as early as possible.

Ab-6

Insurance in Pune

Amit Ray

Objective: The study was focused on the consumer behavior towards

different types of Health Insurance Policies and also on consumer‘s

awareness, preference and consumption patterns. It also focused on the

determinants of image of a Health Insurance in the city of Pune .

Methodology: A study was conducted Health Insurance Industry

determining the factors influencing image of a Health Insurances

through consumer‘s opinion. Sample Selection: Non-probability

sampling technique, a convenience sampling method was used. Sample

consists of all those people who are above 18 year age in the city of

Pune. Sample Size was 100 for this study.

Customer Expectation Survey Regarding Health

Keywords: Health Insurance, Customer Expectation Survey, Consumer

Behavior

40

Personal interviews and a semi structured questionnaire were used for

data collection.

Findings: • 68% of the Respondents were not aware about health

insurance and 71% of the same were not aware about the benefits of

health insurance. 62% of those who had had a health policy had availed

benefit from their health policy, out of which 69% had faced Problems

during pre-auth/claims settlement. A sizeable 68% of the respondents

were not satisfied with the service of their current health insurer. 46%

thought that they did not need a health policy at their age, 23% had other

important financial Priorities and 11% thought that health insurance is a

bad investment as it does not yield good returns. 27% of the Study

sample strongly believes that there should be ease in pre-auth and

claims/reimbursement process. 18% ranked it as second most

important decisive parameter. Medical benefits (25%) sample ranked it

as No.1 and 22% ranked it No.2. Health risks / ailments covered was the

important decision variable as 21% of the respondents ranked it as no.1.

17% of the respondents’ ranked transparency as the No.1 decisive

parameter and 15% ranked as No.2.

Recommendations: Considering that 71% of the people were not

aware about the benefits of Health Insurance proper awareness

initiatives should be taken from the Health Insurance Companies.

Clients should be assisted during pre-authorizations and claims

settlement by the representatives of the Health Insurance Company.

Good coverage in terms of Medical Benefits should be inbuilt in the

policy without any loading premiums. Transparency regarding the

terms and conditions, exclusions, waiting periods at the point of sales is

also an important decision parameter for buying a policy. Critical health

risks can be covered in General Health Policies with a specific waiting

period.As 46% of the respondents are Private/Govt. Employees, Group

Policies for corporate tie ups should be also be introduced.

Ab-7 Analysis of Low Institutional Delivery Rate in

Ghoghamba Block of Panchmahal District in Gujarat

Anamika

Background: This study aims to find out the major demand side

barriers responsible for low institutional delivery in Ghoghamba Block

Keywords: Institutional Delivery, Institutional Delivery Rate, Low

Institutional Delivery

of Panchmahal district in Gujarat. In Panchmahal the institutional

delivery rate is 85.05%. Institutional delivery rate of Ghoghamba Block

in which the study is carried out is 57.87% , quite below the district

performance.

Objectives: 1. To identify and analyze the reasons for low institutional

deliveries in the most low performing block, Ghoghamba of the district

Panchmahal, in Gujarat. To find out the major demand side barriers

responsible for low institutional delivery rate in Ghoghamba block of

Panchmahal district.

Findings: The study shows that there are many prevalent myths

existing in the villages due to which females deliver at home, at the

same time the literacy rate of the females as well as males is very low

which adds to this problem. Also more than 50% of people were living

BPL and their family income are less than 10,000 per month so they

can’t afford the services. It is found that decision of delivery regarding

the place is taken by in laws. There is a very strong association of

trained and untrained dais in the villages in the block. These dais

convince the beneficiaries for home deliveries so that by assisting them

at home during delivery, they can earn some amount.

Recommendations: Rigorous IEC activities are needed to be done to

overcome these barriers responsible for substantially low institutional

delivery rate in Ghoghamba.

Ab-8

State ASHA Resource Centre

Anil Rajesh Dungdung

Objective: The study was done to assess and evaluate the ASHA

training programme.

Methodology: The investigator has made an effort to evaluate the

training programme by making field visits to 3 districts, observation of

cascade model of training and questionnaire method based on certain

criteria such as level of attendance etc.

Findings: Its main responsibility has been successful implementation

of the ASHA training programme so as to make the ASHA, the

Evaluation of Training Programme Conducted by

Keywords: ASHA Training Programme, Evaluation of Training,

NRHM

41

backbone of health care system in Assam. For this, it has recruited

community mobilizers, which has been actively involved in providing

training to the ASHA facilitators, who in turn, train the ASHAs in their

respective villages. The ASHA training programme has been following

the TOT model of training for ASHAs in the state of Assam. So far it has

conducted 4 TOT, to provide trainers in the respective districts. The

total no. of trainers as of March 31, 2010 were 111.These trainers in turn

have been conducting trainings in their districts in the stipulated time

given by the NRHM Assam. Finally this study opens up avenue for

further research, on ASHA training programme so as to assess, its long

term impact on the healthcare system of the state of Assam.

Limitations: This study does have certain limitation which has also

been mentioned.

Ab-9

Management Information System (HMIS) of Sub

Centre Level Health Workers (ANMs and LHVs) of

Government of Bihar

Anisha Saxena

Objective: This study was undertaken in order to upgrade the skills of

the health staff at different levels as well as to know the status of HMIS

in the state, with perception on HMIS from officials at district and block

level and also the training needs of the health personnel.

Methodology: The study was conducted in 9 zonal headquarter

districts of Bihar including; Patna, Saran, Muzaffarpur, Purnia,

Saharsa, Gaya, Munger, Bhagalpur and Darbhanga. The time frame of

the study includes data collection simultaneously in all the districts by

nine zonal coordinators of IIHMR, Patna office. A semi-structured

schedule was prepared for interviewing health workers at Sub center

level, which also included some qualitative aspects of the study.

Findings: The study was conducted in 9 zonal headquarter districts of

Bihar including; Patna, Saran, Muzaffarpur, Purnia, Saharsa, Gaya,

Munger, Bhagalpur and Darbhanga. The study has shown that about

33% of ANMs (age group more than 45 years) are the permanent staff

Training Need Assessment (TNA) on Health

Keywords: Health Management Information System, HMIS, Training

Need Assessment, Health Workers, ANMs, LHVs, Sub Centre Level

who find it difficult to collect data and prepare reports. The contractual

ANMs are young but they do not have any kind of training on data

collection and reporting. During the informal interaction, it was felt that

there was displeasure among the senior ANMs as they had been on the

same post since the time of recruitment. There has not been any kind of

promotion at their level and this has decreased their motivational level

regarding work. It was found that post of LHV in most of the blocks is

vacant and thus there is absence of handholding of ANMs at the field

level, which can again cause problems in obtaining support from higher

authority. The major problem felt by the ANMs is lack of understanding

of the formats since there are so many formats present at their level.

Knowledge about their activities 90.2 % had a positive answer but when

asked to list out their activities then out of all their job responsibilities

maximum percentage of 70 % were for maternal health and

immunization respectively. About 90 % of the ANMs just collect data

for the sake of completion of monthly reports which they have to submit

monthly. About 31% of ANMs had problems in maintaining the

registers and the major problem is found to be lack of understanding.

The results show that only 29% of the health workers have ever

received training on HMIS in past and 71 % has no idea about HMIS

which is a major point of concern.

Recommendations: Through discussion it was brought to light that the

HMIS system of Bihar is in a developmental phase, which needs

training of personnel in order to develop a strong base for quality data

generation. Some aspects which require immediate attention include

duplicate system of reporting in many districts leading to non-

uniformity of reports generated. The need for a support system,

especially at field level in order to improve the data quality parameters

is highly recommended.

Ab-10 Immunization Coverage in Mahadalit of Jamui District

Bihar: A Feedback to Programme Manager

Arunabh Ray

Background: This study discusses the use of trends in immunization

coverage data in Mahadalit Community in Jamui District in Bihar. The

study argues that these should be used as a proxy for monitoring overall

Keywords: Immunization, Mahadalit Community, Health Indicators

Methodology: The secondary data for 5EU countries and India was

collected for comparison from various sources. The findings were

compared on various parameters like donor policy, organ allocation

criteria, reimbursement, waiting list and role of transplant coordinators.

Findings: Spain is the most evolved market due to its policies and

effective implementation of the same with the donor population of 33.8

per million populations. Specific agencies in 5EU countries look after

the transplant related affairs where as in India there is no such

organization that is completely functional and maintains the organ

related transplant data. In India opt-in system of donor policy is

followed whereas in 5EU countries they follow the opt-out policy. This

supports the deceased donation of organs and brain deaths. There are

hurdles in sharing organs between government and private hospitals in

India. Where as in 5EU countries there is a channeled sharing of organs

between different regions All the 5EU countries have reimbursement

schemes for the transplant procedure and also for the lifelong

immunosuppressant usage by the government which is lacking in India.

In India transplant coordinators roles are not defined, whereas in 5EU

the transplant coordinators have a well defined role of procurement and

allocation of organs in hospital. In Indian immunosuppressant market it

is 1.6 billion rupees i.e. 35.83 m USD which when compared to the 5EU

market it is less than the half of sales of monoclonal antibodies class of

drug only.

Recomendations: The shortage of organs can be reduced by promoting

deceased organ donation with presumed consent awareness

programmes to the public. If only 5% of all the deceased patients go on

for donating their organs then there would be statistically no

requirement from the living donors. The government can also make a

policy to donate organs of brain dead patients. National insurance

policy can be introduced so that the patients can afford the procedure

and lifelong immunosuppressant therapy. An organization or society

should be given the task of keeping the country related transplant data

records. The transplant coordinators to provide the counseling to the

living donors as well as relatives of brain dead donor must be appointed

in various hospitals.

42

health indicators in most vulnerable group of the society. This also

discusses the need for special attention regarding the immunization in

the Mahadalit community.

Objective: In order to monitor progress in achieving this objective,

immunization coverage, if measured annually, can serve as an indicator

of a health system's capacity to deliver essential services to the most

vulnerable members of a population(in this study children of Mahadalit

community.

Finding: This is the most socially and economically backward

community and the health indicators, literacy, living places are in very

poor shape. Partial Immunization is around 50 percent in this

community. Illiteracy is around 92 percent and only 7 percent

populations are using toilet facility.

Recommendation: By protecting infants from VPDs, immunization

significantly lowers morbidity and mortality rates in children. The

security provided to families can lead to lower birth rates. This study

concludes with recommendations that urge for special emphasis and

planning to increase immunization coverage and overall development

of Mahadalit Community.

Ab-11

and India w.r.t Health Care Reforms and

Immunosuppressant Therapy

Deepa Raina

Background: The paper discusses the organ transplantation that takes

place in India. As per the data available total of road accidents in India is

roughly 90,000 per annum. Approximately 4000 transplants take place

in a year. These organs are taken from living donors and not cadaver

donors.

Objectives: To compare the existing system of organ transplant in India

with that of 5EU ( UK, Spain, Italy Germany, France) countries. To

analyse the existing gap between India and 5EU countries.To

recommend the suggestions for future improvements.

Comparison of Organ Transplant Scenario in 5EU

Keywords: Organ Transplant Scenario, Health Care Reforms,

Immunosuppressant Therapy.

43

Ab-12

Management Information System (HMIS) of Block and

District Level Health Personnel (DEO/BHE/ BHM, M&E

Officer/SA and DPM) of Government of Bihar

Jaspreet Mahal

The project of “Strengthening of HMIS in Bihar” is undertaken in order

to upgrade the skills of the health staff at different levels. Under this

project, the study was undertaken in order to know the status of HMIS

in the state, with perception of HMIS from officials at district and block

level and the training needs of the health personnel.

Methodology:. The study is exploratory in nature with both aspects of

Qualitative and Quantitative research methodology. The study was

conducted in 9 zonal headquarter districts of Bihar including; Patna,

Saran, Muzaffarpur, Purnia, Saharsa, Gaya, Munger, Bhagalpur and

Darbhanga. Data collection was done simultaneously from January 19-

26, 2010. Multi stage sampling was done as per convenience of the

researcher. Various sets of semi-structured schedules were prepared for

interviewing district and block level officials

Findings: Block level findings were - 71% of the respondents reported

the following of new reporting system (web portal system). The district

HMIS feedback mechanism mainly includes weekly meets (49%) with

no discussions on problems regarding reporting format. There is a

duplication of reporting in many districts and lack of standardization of

the state reporting formats and recording registers. Other weak areas of

HMIS cited by respondents include lack of understanding of the

formats by the ANMs (38%), Data entry operators unaware of the basic

concepts of health data, problems in internet connectivity (22%),

incomplete and late reporting by field level workers, untrained new

staff (80%), data used majorly for report preparation only (73%) and

low number of data quality checks (53%) due to high workload of block

level data officials. The need for HMIS training is felt by 91% of

respondents and mostly on all components of HMIS. The weak areas of

district level HMIS as perceived by district personnel were similar to

those of block level. The content analysis of the NRHM monthly

reporting formats of PHC level and District level data from MoHFW-

HMIS portal highlighted the common mistakes in filled in formats at

Training Need Assessment (TNA) on Health

Keywords: Health Management Information System, HMIS, Training

Need Assessment, Health Personnel

the PHC level, especially in immunization and Iron Folic Acid tablet

distribution data.

Recommendations: Through discussion it was brought to light that the

HMIS system of Bihar is in a developmental phase, which needs

training of personnel in order to develop a strong base for quality data

generation. There is need of training for block level workers especially

for improvement of data quality and importance of use of data as

information in decision making and planning. We also require

handholding of the field level staff for better data generation, regularize

the logistic supply and improved internet connectivity at block level

and strengthening of the monitoring system regarding HMIS on field.

Ab-13

Northeastern States of India

Jaya Swarup Mohanty

Objective: The study was conducted to have an understanding of the

various factors that are responsible for contraceptive use, as there was

variation in the TFR in eight different states (Arunachal Pradesh,

Assam, Manipur, Meghalaya, Mizoram, Nagaland, Sikkim and

Tripura).

Methodology: Data of RCH round 2 was analyzed in this study. First a

bivariate analysis was done followed by a binomial logistic regression.

The use of contraceptives was taken as the dependent variable and the

predictors were religion, caste, place of residence, standard of living

index, years of schooling of respondents and their husbands, sons ever

born, children ever born, age at consummation of marriage, marital

duration and awareness for temporary methods of contraception. In the

first bivariate analysis the background variables were analyzed against

the awareness about the female sterilization, male sterilization and

other modern methods of contraception. In the second bivariate

analysis the awareness variables were clubbed together with the

background variables and were analyzed against current use of

contraceptives. In the logistic regression current use of contraceptive

was used as the dependent variable (contraceptive use =1 contraceptive

non use =2) , to identify the predictor variables related to socio-

economic, demographic factors governing its use among the people of

the eight different states under study. Two models were used to

Factors Governing Contraceptive use in the

Keywords: Contraceptive Use, Northeastern States, RCH

44

demonstrate the effect of awareness regarding temporary methods of

contraception. The first model used only those background variables

which showed significant association with current use of

contraceptives. In the second model awareness was clubbed together

with background variables to observe effects on the current use of

contraceptives.

Findings: The major result that could be interpreted was the significant

effect of primary education of both respondents and husbands on the

use of contraceptives. The other factors that were significantly affecting

the use of contraceptives were religion, caste, place of residence,

standard of living index, sons ever born, children ever born, age at

consummation of marriage, marital duration and awareness of

temporary methods of contraception. It was found out that not all these

factors were significantly affecting the contraceptive use in all the

states. The result of the study confirms that to significantly increase the

contraceptive use in the North east part of India, the prevailing policies

and acts of the Government of India are enough if implemented in the

right spirit and with firm conviction.

Ab-14 S

District Rajsamand

Jyoti Meena

Background: With the up gradation of health facilities provision of

additional inputs, and enhancement of skills of service providers it is

expected that the health facilities would comply with the requirements

of the clients. The utilization of these institutions depends upon the flow

of the patients from the outreach areas. Referral at appropriate

institutions will reduce the gap between illness and seeking treatment

and out-of-pocket expenditure. The institutions below district level

would be able to screen the patients, limiting the load on district

hospitals. However, the above investments could really bring forth the

desired results if only they are backstopped by an effective referral

system. Usually between 5 and 10% of patients seen in the PHC/CHC

will be referred to a higher level for either diagnostic or more

specialized care.

Objectives: The main objectives of the study were to study the existing

structure of the referral system in the district Rajsamand. To study the

tudy on Implementation of Referral System in

Keywords: Referral System, Health Facilities, Quality Improvement

reasons behind non compliance of the referral system and to suggests

way to improve the referral system.

Methodology: The research approach adopted for the study was a

descriptive method. It includes informal interviews with doctors,

patient counselor, ward incharges & DPC and study of referral records.

Findings: In the month of January, February and March cases referred

to district hospital form

0.025 %, 0.037% and 0.081% respectively and cases referred from

district hospital form

0.50%, 0.46% and 0.37% respectively of total OPD. Average

percentage of referred cases from different CHCs of district Rajsamand

to tertiary care hospital in January, February and March is 0.47% ,

0.42%, 0.31% respectively of the total OPD.

Recommendation: The findings points towards two things: One is the

referral cases are very less and secondly the referral system is not being

followed. An effective referral system has to be designed by focusing

on three important areas: the structure of referral system, management

coordination and quality improvement.

Ab-15

Participants, Pre and Post Capacity Building

Training for Village Health and Sanitation

Committee in Chittorgarh District of Rajasthan

Kiran Madhukar Narkhede

Background: The Village Health & Sanitation Committee (VHSC) is a

simple and effective management structure at the lowest level,

comprising representatives from the village. Its key function is to

prepare the village health plan, implement it and manage the fund

which is earmarked as per the need of the community.

Objective: A small scale Knowledge and Attitude survey was

conducted during (Pre and Post) trainings of participants for Block TOT

of Village Health and Sanitation Committee capacity building training

for in Chittorgarh district of Rajasthan. The purpose of the study was to

assess the level of Knowledge and Attitude of the participants, before

Assessment of the Knowledge and Attitude of

Keywords: Capacity Building, Village Health, Management Structure,

Knowledge and Attitude

45

and after the VHSC training sessions and develop recommendations for

future implementation of VHSC trainings in other states in India.

Methodology: The study was carried out for 11 blocks of Chittorgarh

districts of Rajasthan. Survey conducted of all trainees’ pre and post

training. Convenience sampling was used. Closed ended self

administered questionnaire was prepared for the survey. Sample

achieved was 34.

Findings: It was found that, the knowledge and attitude improvement

was significant in each area of trainings. Knowledge and attitude has

been improved in every aspects of the training. So it is quite obvious

that pre-training the answers were distracted towards many options but

post-training responses were accumulated to the correct response

Medicine at PHC is out of stock should be informed to block CMO as a

advocacy protocol. 79% pre and 85% respondents post training were

for block CMO.

Recommendation: The survey reveals, Training is the effective tool

for the better functioning of VHSC. The knowledge and Attitude can be

improved by effective training sessions. Study can help and provide

data support to develop modus operandi for future implementation of

the VHSC trainings in other states in India. Information from this

survey shall be helpful for the other states to focus on the problem areas

and re route resources to conduct the VHSC trainings.

Ab-16

Valsad

Mansi Shekhar

Background: During the mid-1990s, the World Health Organization

(WHO), in collaboration with UNICEF and many other agencies,

institutions and individuals, responded to this challenge by developing

a strategy known as the Integrated Management of Childhood Illness

(IMCI). This strategy has been expanded in India to include all neonates

and renamed as ‘Integrated Management of Neonatal and Childhood

Illness (IMNCI)’. To start this scheme in India, it has been decided to

start its implementation in BDCS focused districts .district initially

with support from UNICEF. So in Gujarat state it has been started in

Valsad.

Performance Assessment of IMNCI in District

Keywords: Integrated Management, Neonatal and Childhood Illness,

IMNCI, Performance Assessment

Objectives: The goal of this study is to assess IMNCI implementation

in Valsad district of Gujarat to strategize for accelerating effective

implementation.

Methodology: For this data from IMNCI format filled on district level

quarterly and compiled yearly have been used for this study .we are

going to assess the implementation of IMNCI on the basis of mortality

pattern , morbidity pattern, and case management skills of the heath

staff.

Findings: The number of infant death reported has increased in both

the age groups 0-2 months and 2 months-5 years after the

implementation of IMNCI in Valsad district especially in the two tribal

blocks of Valsad District i.e. Kaprada and Dharampur,due to prompt

reporting from the health staff. Number of children, identified as sick,

followed-up, referred to a health facility shows increase. Percentage of

reported LBW babies has increased since 2008 to 2009 due to proper

weighing done by health worker. Morbidity due to diseases has been

reduced from 2008 to 2009.

Ab-17 Evaluation of Functioning of Rogi Kalyan Samiti and

Utilization of RKS Grant Received byPHC in the District

Navsari, Gujarat (Financial Year 2009-10) for Improving

the Standard of PHC

Minu Manuhar Sinha

Objective: The objective was to study the functioning of RKS in the

districts Navsari, Gujarat and to understand the process of

decentralized funding and the provision of providing untied funds at the

peripheral level (Primary Health Centre) from the central level. The

study also focused on the structure and functioning of RKS in health

facilities, the utilization of funds by RKS and to assess the facilitating

and inhibiting factors affecting the functioning of RKS. To study the

improvements made at the facilities and services provided for the

purpose of improving standards. The study also identified all possible

strength, weakness, opportunity and threat that is involved in proper

utilization of the provided funds.

Methodology: The study was a cross-sectional descriptive study done

Keywords: Rogi Kalyan Samity, RKS Grant, PHC, Decentralized

Funding

in the PHCs of district Navsari of Gujarat. 50 % PHCs were identified

from the district. Simple random sampling technique was adopted as

sampling design and Non Probability sampling was done on

convenience basis for the selection of Client in the hospitals.

Predesigned and pretested interview schedule was used for data

collection from the study subjects. The study subjects were RKS

members ( Medical Officer of the PHC and Kerawani Nirikshak ) and

clients (20% OPD and 10% IPD patients). Quantitative data were

entered and analyzed using Microsoft Excel.

Findings: It was observed that the RKS existed according to guidelines

at all the PHCs. A shortfall of members was however, noted. The flow of

the central grant of Rs. 1, 00, 000 was found to be smooth. The received

funds were mainly utilized for development of physical facilities and

infrastructure of the PHCs, provision of basic facilities for the patients,

purchase of medicines, development of basic laboratory facilities and

transportation. The expenditure however is below the mark in absence

of predefined protocols. The facilitating factors for the smooth

functioning of RKS include involvement of health personnel in the top

management, uninhibited flow of grants annually and people’s

involvement in decision -making. The inhibiting factors for the same

are multifaceted: ranging from non -availability of proper expenditure

guidelines to involvement of unmotivated members burdened with

additional responsibilities, as also low knowledge and awareness levels

among the community. Most of the community members and clients

were not aware regarding existence and objectives of RKS in the health

facilities, but they reported some improvements in the quality of the

health services within 2-3 years. However, most of the community

members were not satisfied with the provision of good quality of

medicine, availability of specialist care, high referral rates and higher

investigation.

Recommendations: Proper guidelines for expenditure of funds should

be framed, and audit mechanism defined. The barriers to the effective

functioning of RKS may be identified at the earliest and effective

measures to eliminate those may be initiated. Additional incentives for

additional work should be provided to the RKS members. Increase

community participation and have more informed clients. Sundry Fund

is to be maintained at PHCs for emergency. As there is no feedback

mechanism hence, it is recommended for the development of a proper

mechanism related to the decisions taken during the meetings of the

RKS members for the effective implementation.

46

Ab-18

Urban Slums of Junagadh Municipal Corporation,

Gujarat

Mohit Sharma

Background: For providing effective coverage for maternal and

childhood health and nutrition Mamta Divas was launched by the

Department of Health and Family Welfare and Department of Women

and Child Development, Government of Gujarat. Mamta Divas

programme was launched under NRHM, R.C.H-II that is considered as

platform for inter-sectoral convergence.

Objective: The present study was conducted in the urban slums

pockets of Junagadh city, under Junagadh Municipal Corporation,

describing the effectiveness in the implementation and utilization of the

services given during Mamta Divas. This study was done to assess the

implementation of “Mamta Divas” on the targeted mothers and

children and to study various factors related to knowledge and

awareness of the programme in the urban slum pockets of Junagadh

city.

Methodology; This qualitative research study was done in urban slums

for looking into various issues and components related to Mamta Divas.

Under this study, the service delivery, the knowledge and attitude of the

community with the factors responsible for the utilization of the

services of Mamta Divas was studied. A total of 60 Mamta Diwas

sessions were visited for the survey and 150 mothers those who are

either in their antenatal period or having a living child under 0-3 months

were interviewed in the survey these respondents were selected using

the Multi stage sampling based on 30 clusters methodology. In step 1,

30 clusters were selected and in next step 5 sample units were selected

from each cluster. The level of utilization of the services provided at the

Mamta Divas, the determinant factors against the knowledge and

utilization of services were also identifies. Research tool is interviews

with target population, questionnaires for the service providers and

beneficiaries and checklists for the assessment.

Findings: Study emphasis on effective and efficient implementation in

order to overcome loopholes of procedure .This Study reveals major

issues related to the implementation of Mamta Divas Programme in

urban slums, that prevents better out-reach to beneficiary. It was

An Assessment of Mamta Diwas Programme in

Keywords: Mamta Diwas, Urban Slum, NRHM, Maternal and

Childhood Health

47

evident from the findings of the study that there was lack of monitoring

and supervision activities by the higher cadre, which brings irregularity

in the working & reporting of field staff. A large chunk of the population

are aware of the Mamta sessions, but still no visits are done because of

the reasons like family’s’ apprehensiveness and lack of belief in the

health services.

Recommendations: Regular and focused IEC activities are required so

as to elevate community belief in the need for antenatal and post natal

care. This study may prove useful in chalking out targeted interventions

for the Mamta Diwas.

Ab-19

Study in Bihar

Neha Dumka

Background: The Janani Suraksha Yojana (JSY) is a centrally

sponsored intervention under the National Rural Health Mission, with

the objective of reducing maternal and neo-natal mortality. The

JSY’s main strategy is the promotion of institutional delivery by

empowering and enabling women to access safe delivery in health

facilities. The mechanism is the provision of a cash entitlement to the

family and an incentive to the ASHA.

Objective: An Evaluation study of Janani Baal Suraksha Yojana was

conducted in Nalanda, Samastipur and Madhepura Districts of Bihar

state.

Methodology: JSY enumerates 83.78 lakh beneficiaries, and the

expenditure under this head is now over Rs. 1241 crores. Both the

number of beneficiaries and expenditure on this scheme continues to

increase steeply and there is little clarity on where this will plateau. The

central guidelines for the JSY to the states set out clear directions on the

administrative and financial mechanism for the scheme. However JSY

has been interpreted and implemented in a variety of ways across the

states, not necessarily in contradiction to the guidelines, but based on

individual state contexts, field reality, and the perceptions of

administrators and service providers. Outcomes in the states also vary

substantially.

JBSY (Janani Baal Suraksha Yojana) Evaluation

Keywords: Janani Baal Suraksha Yojana, JSY, NRHM, Safe Delivery,

Health Facilities

Findings: Nalanda is a second best performing while Samastipur and

Madhepura are poor performing districts. Selection of the three districts

is based on the number of institutional deliveries in the district. The

districts will be ranked based on the number of institutional deliveries

against expected deliveries using HMIS* data. The second best

performing and lowest performing districts will be selected. In addition

the district with second highest percentage of SC/ST population will be

selected to understand issues of social exclusion. The reason for

selecting the second best and lowest is to exclude the outliers.

Ab-20

Non IPHS PHCs in Gondia District, Maharashtra

Neha Maheshwari

Background: The flow of patients has been increased over time.

Hence, it became extremely important for the management executives

to find out the service delivery and service utilization pattern in the

district so that they can upgrade rest of the PHCs through IPHS in the

second round.

Objective: A case control study was carried out with the objective of

seeing the effects of IPHS standards in the PHCs of Gondia district in

Maharashtra which were upgraded through IPHS in 2006-07 in the first

round. The cases were the PHCs upgraded through IPHS and controls

were the PHCs yet to be upgraded through IPHS. The specific

objectives of the study were to understand the present service

utilization pattern and the change in service utilization at PHC level.

Methodology: Data was collected for service coverage and service

utilization pattern in terms of OPD case load, Indoor case load, delivery

service and investigations performed. Observations were done for the

availability of inputs like provision of doctors and health workers at

PHCs, infrastructure development, provision of potable water and

electricity in the PHC. Also survey of health facilities under study was

done with the checklist of standard guidelines provided by IPHS. Exit

interviews were taken from the women who delivered in the PHC and

the OPD patients. Questions incorporated in the schedule were mainly

directed toward the inputs provided to improve quality of services.

To Assess the Service Delivery of IPHS Upgraded and

Keywords: Services Delivery, Services Utilization, PHCs, IPHS

48

Findings: The findings of the study show an improvement in the

utilization of the services being provided. The indicators in both the

study groups show progress. But IPHS PHCs are running ahead. The

main reason may be ascribed to the provision of additional qualified

man power to the upgraded PHCs. It can be inferred from the data

available and interrogation with the staff and beneficiaries that the

increment in service utilization may be ascribed to provisions of extra

facilities to the IPHS PHCs. The IPHS PHCs under study are well

equipped with the basic facilities suggested by the guidelines. Man-

power remains the most important issue in both the types of PHCs. Staff

nurses and ANMs are unavailable in far flunked areas.

Ab-21

Diwas in Vallabhipur Block of Bhavnagar District

Nidhi Jain

Background: Mamta diwas is exclusively designed concept to

improve the health of mother and child. But the proper implementation

is a must to achieve the desired goals. Mamta sessions have been going

from years and as the time passes monitoring and supervision of

sessions are not taking place. No supervison is there to check whether

the services being provided are in a proper way or whether all the

services that are meant to be provided are given to the beneficiaries or

not. Lack of supervision is hampering the effectiveness of these

sessions.

Objective: To find out exactly how supervision will improve the

services an intervention was done in Bhavnagar district. A block,

Vallabhipur was chosen to see the effect of increased supervision of

mamta diwas. All the sessions were supervised and on the spot training

was also given wherever required. Maximum coverage was ensured, as

well as all the essential equipments, drugs, stationary was also

provided. The supervisors were given supervisory checklist and

interview with the beneficiaries and service providers.

Findings: As per the supervisory checklist required set up for mamta

diwas was present at the centers but effective execution is needed at all

levels. All the service providers felt that the project had helped a lot in

Effect of Supervision on Service Delivery at Mamta

Keywords: Mamta Diwas, Service Delivery, Supervision

their working, since the workers knew that someone was coming to

monitor them they remain present at the sessions otherwise whole

burden was on FHW’s shoulders. The availability of staff especially

MPHW (only 2 were present out of 9) & ASHA (only 5 were present) in

the district was a major problem.

The district report from past 6 months showed that there are some

improvements in the services, for e.g., the number of cases identified

and referred for ANC had increased during the months when the project

was running. The same improvement was been tracked in child status

also. Moreover financial assistance to anagnwadi workers had also

started.

Recommendations: The supervision activity had played a supportive

role in implementing and designing mamta sessions effectively and

efficiently. But the focus should be given to those elements which plays

underlying role for e.g. the staff, sources of motivation as well as the

financial support.

Ab-22

Blocks of Mewat

Nidhi Vats

Background: Women form the backbone of any society and deserve an

equal status in the society as that enjoyed by men. But women are

excluded from social, economic and political spheres of society.

Objective: The study was conducted to understand the social status of

women in the community of Mewat in Haryana. Mewat is

predominantly a rural district in Haryana. The health indicators in

Mewat especially for women are particularly dismal. The area lags

behind the rest of Haryana on almost every yardstick of development

indices.

Methodology: The study is qualitative and focus group discussions

were conducted with various stakeholders mainly women to obtain

information and understand the needs of the community about current

practices, communication media and beliefs regarding role of women

in the society. Focus group discussions were conducted in villages of

Nuh and Tauru Blocks in Mewat district.

Gender Bias and Status of Women in Nuh and Tauru

Keywords: Gender Bias, Women Health, Women Status

49

Findings: The findings reveal that in Mewat, by and large in the

societies of both the religious groups, girls are less wanted in the family

compared to boys. Education of girls is not preferred by the Meos and

girls get married at an early age. Women have been found to have no say

in the decision making process of the families. Men take all the major

decisions of the family as well as all the decisions regarding number,

timing and sex of children. As women have no autonomy to take

decisions for themselves, it is crucial to involve key stakeholders, men,

mother-in-laws and community influencers such as Maulvis in the

project. Also, education is one of the means to empower the women

with knowledge, skills and self-confidence necessary to participate

fully in the development process. Hence, emphasis on female literacy is

essential.

Recommendations: Door-to-door interaction with both women and

members of the family is the suggested communication media for

achieving the overall objective of the project.

Ab-23

Jeevan Raksha Kosh

Poonam Yadav

Background: Millennium development goal represents the

international consensus on improving conditions that affect the poor. To

achieve the MDG, government health policies need to focus on poor

population of India. With low literacy levels, poor health information

and often persistence of traditional beliefs and superstitions, the poor

are ill equipped to make rational choices in health related matters. To

make health facility available to BPL families, ‘free health care model’

is adopted by Rajasthan government called as ‘Chief Minister BPL

Jeevan Raksha Kosh’(CM BPL JRK). The scheme was envisaged

during the year 1999-2000 by the then Rajasthan Government headed

by Ashok Gehlot, CM Rajasthan. It came into implementation from

September 2009. CM BPL JRK was launched in all the districts at one

go. Under this scheme free treatment facility, both indoor and outdoor is

provided to BPL family’s patient in all government Health Institute in

the State.

Objectives: This study is an attempt to identify the factors that affects

Factors Affecting Utilization of Chief Minister BPL

Keywords: BPL, Jeevan Raksha Kosh, Millennium Development Goal

utilization of this scheme.

Methodology: Study population is the BPL population of district Jhunjhunu. Secondary data was from the data available from online reporting. Primary data was taken from questionnaire filled by a sample of 90 patients coming to the district hospital.

Findings: During the study, it was revealed that the BPL population’s awareness about various features of the scheme is limited in JJN. Wages loss is a major factor that affects the care seeking behavior of BPL population. The poor report (slightly) greater illness (high OPD) but are much less likely to use go for treatment(low IPD); they are more likely to self treat and much more likely to do nothing.

Ab-24Health Services (AFHS) Centre at PHC Sadhi, Block Padra, Gujarat

Puneet Gupta

Background: Adolescents account for almost one third of India's

population. They are prone to suffer from reproductive and sexual

health, nutritional, mental and behavioral problems. Health services

which cater exclusively to the needs of adolescents are scanty and

concentrated in urban areas. Adolescent Friendly Health Services

(AFHS) which provide a broad range of preventive, promotive and

curative services under one roof can help to ensure improved

availability, accessibility and utilization of health services. AFHS is

being initiated by governmental, private and non-governmental

organizations. Lessons to improve the quality of AFHS could be further

learnt from evaluation of pilot projects and success stories of similar

initiatives in other places.

Objective: Adolescent Friendly Health Services (AFHS) introduced in

Vadodara district, Gujarat state as a pilot project at PHC Sadhi, Block

Padra. Services started w.e.f. 9th March 2009 and a separate compound

was designated as the centre for providing AFHS. Block Padra a highly

industrial area showing high no. of migratory population. PHC Sadhi

was made a 24x7 PHC. The PHC has a good linkage with school staff.

The services being rendered at the Adolescent Friendly Health Services

Centre at PHC Sadhi were being assessed as the study objective.

Analyzing the Functioning of Adolescent Friendly

Keywords: Adolescent, Friendly Health Services, AFHS, Health Services

50

Methodology: The population of the adolescents covered was 4071.

Questionnaire was developed to assess the client’s perspective

(adolescents) as well as the service provider (staff at the centre trained

to provide services).The data was secondary in nature and was collected

from registers maintained at the AFHS centre Visits were undertaken to

the AFHS centre established within the premises of the PHC at Sadhi

(Block Padra). Adolescents visiting the centre were interviewed as also

the medical officer at PHC. The other staff providing the services at the

centre was also interviewed to have an overview of service-provider’s

perspective, the client (adolescents) perspective.

Findings : The services provided at the AFHS centre at PHC Sadhi

were grossly underutilized. As compared to boys the number of girls

reporting to the centre was considerably lower mainly due of cultural

barriers and lack of a regular female counselor. A wide communication

gap existed between parents and their adolescent children and also

between school teachers and the school going adolescents. Hence, the

adolescents sought information mostly from peers and media. The

adolescents visiting the centre were satisfied with the quality of

services being provided. Though mostly preventive services were used,

but a few of them sought curative services for sexually transmitted

infections from the Medical Officer at PHC or the visiting

Gynecologist. The preventive services on the other hand, mainly

included counselling for general issues and contraception.

Recommendations: The situation analysis suggests that there is an

urgent need to address the problems related to adolescence by

providing services specifically catering to this age group. A relevant

response would be to equip them with appropriate knowledge, skills,

attitude, and support for self advancement. Sensitization of parents,

school teachers and civic society is an important step to set the stage for

the healthy growth and development of adolescents.

Ab-25

Dahod

Ram Krishna Kumar

Background: National Rural Health Mission was launched to provide

accessible, accountable, affordable, effective and reliable primary

Assessment of Functioning of ASHA in District

Keywords: ASHA, NRHM, Primary Health Care, Health Services

health care to all. The Mission proposed architectural amendments in

the health infrastructure while introducing a new community based

cadre designated as Accredited Social Health Activist (ASHA). ASHA

was proposed to work as a change agent and will act as a link between

community and the health service provider. The proposed role of ASHA

was to provide primary medical care, advice the villagers on sanitation,

hygiene, and antenatal & post natal care, escorting expectant mothers to

hospital for safe delivery etc.

Objective: ASHAs are working in the villages since last five year no

systematic study has been conducted to evaluate the performance of

ASHA in the district Dahod. Therefore the main objective of the study

was to assess the gap in functioning of the ASHAs and then suggest

steps for improvement.

Methodology: To assess the objectives, a cross sectional study with 40

ASHAs, who served at least for one year, was conducted in two block of

Dahod district. Interviews were also conducted with ANMs and AWWs

to assess the coordination level of ASHAs with them. An interview

schedule was used to conduct the survey.

Findings: Results from the study show that ASHAs were selected

based on their qualification and experience through personal

interviews. Being a tribal district, majority of the ASHAs in the block

were young and more educated against proposed criteria. Half of the

ASHAs were serving village with population more than 1000. Majority

of the ASHAs received training on two initial modules only. The level

of knowledge about the role and responsibility was poor among

ASHAs.

Primarily ASHAs focused on incentive related activities like

institutional delivery, Immunization, and ANC/PNC services. They

were reported to be satisfied with their job. However, they were

unsatisfied with the irregular distribution of monthly honorarium.

Approximately half of the ASHAs did not possess the Drug Kit.

Ab-26Rajasthan

Richa Chaturvedy

Background: HIV Estimates for Rajasthan are erratic it has been

HSS Data Analysis of HIV/AIDS in Sentinel Group of

Keywords: HIV/AIDS, HSS Data Analysis, STI, HIV Sentinel Surveillance

51

described as a highly vulnerable, high priority state. Given the current level of knowledge regarding sexually transmitted infections (STI) and sexual behavior, particularly among vulnerable sub-populations, there are strong indications that Rajasthan is indeed a highly vulnerable state.

Objective: The objective of this report is to study the HIV /AIDS prevalence rate among sentinel groups in the State of Rajasthan and develop the strategy to strengthen the HIV/AIDS programme in the state.

Methodology: HIV Sentinel Surveillance (HSS) system involves carrying out cross-sectional studies, to collect the data for ANC, FSW, STD sentinel groups. This study is based on the secondary data which was collected during the district Epidemiological profiling of HIV/AIDS scenario in Rajasthan at SIHFW from RSACS, NACO and District officials at various districts which were appointed for DEP Project.

Findings: The main outcome of this study is, HIV is more prevalent in 20-29 yrs age group and in rural area. HIV prevalence in ANC sentinel group in less than 20 years age group is 0.2%, in 20-29 year age group 1.6%, in 30-44 age groups 0.3% and 0.1% of the Urban and 0.3 % of the Rural Population is HIV Positive. FSWs are more prone to HIV positivity in the age group of 20-29yrs, 1.88% of the Urban Population and 4.73 % of the Rural Population are HIV Positive. In STD clinics- Age group, 2.6% of males and 3.1 of females are positive.

Recommendations: Suggested to organize awareness camps, volunteers and target intervention groups for working for the upliftment of FSWs. The ANC attendees should be benefitted through counseling and future treatment with ART. The STD patients need to be informed about their vulnerability to Contract HIV/AIDS, treatment and timely advice are most important.

Ab-27Services: ART Center vs. ART Center

Rit Shukla

Objective: The Study was conducted to study the perception of clients

towards the HIV care services provided at ART Centre vs. Link ART

Centre as well as to understand the level of adherence of PLHA to ART.

Clients Perspective on Assessment of HIV Care

Keywords: HIV/AIDS, ART Center, HIV Care Services, Clients Perspective

The study also suggested some amendments in the strategies to manage

the existing problem of non adherence to ART.

Methodology: Exit interviews were conducted to assess the clients’

satisfaction level at the Link ART Centre and ART Centre which in turn

reflects the quality of services provided by the Centre. Situational

analysis of Link ART Centers was undertaken by a comprehensive

assessment of space allocated to LAC, human resources, materials and

other facilities available in the selected Centers. Facility tool was

prepared for this purpose. Relevant information on utilization of

services in selected LACs was obtained through the available records

and registers maintained by them.

Findings: ART Center has improved access to rural population. The

occupational distribution of clients employed in the 12 months

preceding the survey shows that majority clients were agriculture/

unskilled worker. Nearly one fourth of the clients were students,

housewives or unemployed. The awareness regarding the services

available in the center was found to be high among the clients of ART

Centre. The study reveals that 65 percent of the clients reported

improvement in the quality of life to a great extent after using services at

LACs. Method used for counseling is one of the most critical steps of

high quality counseling.

Recommendation: Improved accessibility of Anti retro viral treatment

through LAC has definitely increase the regularity of PLHA for HIV

treatment which is most significant component of drug adherence.

There is need for taking a decision on provided ART services (through

ART centers or LAC) in each district of the country to attain optimal

level of adherence. Facilities for CD4 count at LACs will further

facilitate PLHA including new registrants. Better linkage and feedback

from nodal ART center and DAPCU wherever set up is also

recommended.

Ab-28 Assessment of EmOC Services in Kachchh District,

Gujarat

Sabyasachi Mohapatra

Background: The EmOC strategy was adopted in India in 1992 under

the Child Survival and Safe Motherhood (CSSM) project (funded by

the World Bank and UNICEF).

Keywords: EmOC, Child Survival, Safe Motherhood, RCH

52

Objective: This program specifically focused on development of

comprehensive EmOC centers throughout India. The focus continued

in the subsequent program (1997–2004, also funded by the World

Bank) with the new name of Reproductive and Child Health (RCH).

However, there was little progress in establishing comprehensive

EmOC centers in rural area.

Methodology: A facility survey of 80 health facility providing

maternity services in Kachchh was done on the conceptual framework

of 5 process indicators EmOC as mentioned by “Guidelines for

Monitoring the Availability and use of obstetric services UNICEF

WHO UNFPA August 1997” data was collected for the time period of

1st April 2009 to 31st march 2010.

Findings; In total there were 49 government and private facilities

which provided EmOC services .17 government and 13 private

institutions that were non EmOC service providers. Number of EmOC

facilities per 500000 population comes around 13.61. The distributions

of these facilities are not adequate. Caesarean section services and

blood transfusion services are located in urban area of Bhuj and Anjar.

Proportion of births in EmOC facilities (basic and comprehensive) was

44%. Proportion of women estimated to have obstetric complication

treated and delivered in EmOC facilities is 49%. The percentage of

Caesarean section of total births was 3%. This clearly indicated that

access to critical surgical services was not adequate.

Ab-29

Suraksha Yojana in General Hospital, Sirohi

Sakshi Jain

Objective: Present study for assessing the implementation status of

Janani Suraksha Yojana was conducted at General Hospital, Sirohi to

study the current status of the scheme, awareness of the beneficiary,

involvement of ASHA and other providers in the implementation of

JSY in the hospital.

Methodology: Both Primary and secondary data from beneficiaries,

providers and hospital records respectively was collected. This

includes Interview Schedules for beneficiaries and ASHA’s, focused

group discussions with ASHA’s and Hospital records. Results of this

A Study on the Implementation Status of Janani

Keywords: Janani Suraksha Yojana, ASHA, NRHM, ANC

study are based on interviews, informal discussions and Focused group

discussion with 105 beneficiaries, 2 Doctors and 15 ASHA’s.

Findings: Number of deliveries in General hospital, Sirohi has shown a

rise of more than three times after the implementation of the scheme.

Same is the case with ANC coverage and TT that are showing a decline

due to the non compulsion of ANC card for getting JSY benefits. Both

beneficiaries and providers have a very poor knowledge about JSY but

as far as utilization of services is concerned about 87 percent have

undergone ANC checkup and about 92 percent have received TT

immunization. No beneficiary stayed in hospital for less than a day as

per NRHM guideline all has received their JSY benefits through

cheques. However, services received by beneficiaries particulary

through ASHA are very poor. Out of the 78 beneficiaries who aware

about ASHA 30.7 percent replied that they received any kind of

counseling like for breast feeding or nutritional practices, While 74

percent of the woman replied that they were neither accompanied by

ASHA nor transportation was arranged by ASHA. The focused group

discussion and interview from doctors state the need for some

innovative measures that need to be taken for better results and success

of the scheme.

Recommendations: Time to time training of ASHA’s is necessary.

Provision of blue sarees instead of Blue coats for ASHA’s to remove

cultural barriers among community can be initiated., Extensive

campaigning for JSY using a celebrity , Compulsion of presenting ANC

card and accompany of ASHA for getting JSY benefits and provision of

weighing machines for regular monitoring of pregnant mothers and

some other recommendations.

Ab-30 EPI Coverage Survey in Rural Areas of Sabarkantha

District in Gujarat

Shikha Bansal

Background: According to data revealed in DLHS-3, the percentage of

fully immunized children in Sabarkantha district stands at 46.8%. In the

purview of the same, a series of interventions were planned and

implemented throughout the district with special focus on tribal and

underserved population. Thus, a study was needed which aimed to

provide current estimation of immunization coverage among the

Keywords: EPI Coverage Survey, DLHS-3, Immunization Coverage

Keywords: Infants Deaths, Maternal Deaths, Verbal Autopsy, MRS

Background: The verbal autopsy guidelines were developed in the

1960s when the Model Registration Survey of cause of death (MRS)

scheme first came into existence. The MRS later came to be known as

the SCD-Rural scheme. The verbal autopsy was introduced by India in

1965, which was the first verbal autopsy based cause of death reporting

system in the world. The concept of verbal autopsy as a source of cause

of death information has been used in many developing areas which

have poorly developed facilities for medical certification of cause of

death. The Government of Gujarat has begun registration of infant

deaths and verbal autopsies since 2005 – 2006. Infant death audit is

done by Medical Officer (MBBS).

Objective: To conduct a verbal autopsy audit for Infant Deaths and

Maternal Deaths in Gandhinagar District.

Methodology: The audit was initiated by collecting data from

secondary sources. Desk Review of reported verbal autopsy of infant

deaths and maternal deaths in year April 2009-March 2010 was done of

Manasa Block of Gandhinagar district. Out of 97 infant deaths, 86

verbal autopsies were done and 7 verbal autopsies were done for

maternal death. So the total sample size taken was 93(86 infant deaths +

7 maternal deaths).

Findings: The study revealed that out of the total 86 infant deaths,

maximum occurred in the first month of life. 25.58% infant deaths

occurred in Low Birth Weight babies (<2 kg).The major cause of infant

deaths was Respiratory diseases. It was observed that although

institutional delivery percentage was high (90%), many infant deaths

were seen.41.86% of deaths were cases of premature delivery.

Out of total of 7 maternal deaths, 4 occurred in the age group of 15-19

years.ANC examination of the pregnant women was found to be 100%

but still maternal deaths were observed. It was highly conspicuous from

the study that all maternal deaths happened because of first level delay,

i.e. delay due to decision making.

Recommendation: All maternal and infant verbal autopsies should be

reviewed in every monthly meeting at district level and the block health

officer should supervise regularly how VA forms would be filled by

P.H.C medical officer and FHW. Strengthening of implemented

programs like IMNCI, Mamata Divas needs to be done. Home visits for

53

children of age group 12-23 months in the rural areas of Sabarkantha

district to validate the success of field level interventions as well as the

progress made as Gujarat celebrates its golden jubilee year.

Objective: The Expanded Programme on Immunization Coverage

Survey in Sabarkantha district has as its primary objective to provide

up-to-date information for assessing the situation of immunization in

rural areas of Sabarkantha.

Methodology: the study included choosing 30 clusters out of the list of

all the villages of Sabarkantha district by PPS (Probability Proportional

to Size).

Findings: It was found that 50.5% of children of 12-23 months were

fully immunized in the district. 79% of children aged 12-23 months

have received BCG vaccine. 71 % of the children received all the three

doses of Oral Polio Vaccine (OPV) and only 54.3% received complete

three doses of DPT vaccine. Also it was found out that 69% of the

children aged 12-23 months were immunized by measles (MMR)

vaccine and 65.7% received at least one dose of Vitamin A. No dropout

for OPV was noticed although drop outs in DPT vaccinations were

12.3% and a total drop out 12.6 % was noticed from BCG to Measles.

When compared with the district data of 2008-09, it was found that the

data was over-reported.

Recommendations: Regular and meticulous monitoring and

supportive supervision is required at the grass root level. Planned IEC

activities are also required. For example Banners in local language

should be displayed at prominent sites, other field specific activities

like Bhawai shows, nukkad nataks, role plays, flash cards, and inter-

personal communication activities etc. Moreover, NGOs should be

encouraged to accelerate activities on motivating people to bring their

children for immunization. Apart from these, the Health Management

Information System should be improved so that reported coverage

gives true picture of the district scenario. Lastly, Sanctioned but vacant

positions of the grass root level health workers should be filled so that

shortage of manpower doesn’t pose as a cause for inefficient working

and outcomes.

Ab-31

Maternal Deaths

Shraddha S. Rajput

Review of Verbal Autopsy Reports of Infants and

54

Units (PSUs – Villages/Urban Frame Size) were selected with

probability proportional to size (PPS) using the 1991 Census data. All

the villages were stratified according to population size, and female

literacy was used for implicit arrangement within each strata. The

number of PSUs in rural and urban areas was decided on the basis of

percent of urban population in the district, with minimum of 12 urban

PSUs. The target sample size in each district was set at 1,000 complete

residential households from 40 selected PSUs. A total of 10308 women

drawn from Jammu and Kashmir as a whole out of which 5067

belonged to Jammu region and 5241 belonged to Kashmir and Ladakh,

Kargil region. A bivariate analysis was done to depict the level of any

antenatal care and safe delivery practice with different socio-economic,

demographic and the health variables of women. In addition, a logistic

regression has been performed to identify the factors governing the

utilisation parameters.

Findings: It was evident from the analysis that among the socio-

economic and demographic characteristics, the factors place of

residence, religion, caste, years of schooling of man and wife,

household standard of living index, age, age at consummation of

marriage, marital duration and number of stillbirths emerged out as

some of the factors significantly associated with utilization of maternal

health services. It was seen that utilization by Muslims in the state is

less and so is the utilization in rural areas. Women aged 35-44 were seen

to have least utilization of services. Women who had been married for

less than five years were found to have the highest utilization of

maternal health care services while those married for 15 years or more

were found to have the least. Also, women from middle SLI strata have

the highest utilization. Those women who had problems during

pregnancy and during delivery were seen to have higher utilization of

maternal health services than those who did not.

Recommendation: Initiation of awareness programmes addressing the

general populations is the need of the hour.

Ab-33

City

Sumana Arora

Background: Geriatric population is increasing rapidly both

Geriatric Health Insurance: A Study in Bangalore

Keywords: Health Insurance, Geriatric Health, Elderly

pregnant women and infant children should be made by FHW, AWW,

ASHA to create awareness about various kind of health programme for

maternal and child heath which requires vigorous training sessions of

these people to make them more efficient and competent in their job. It

is recommended to find out the important managerial and

administrative inputs to improve current mortality and morbidity

scenario.

Ab-32

Jammu and Kashmir-a Regional Analysis

Suhail Ismail Shiekh

Background: In the current global scenario maternal health has come

to be seen as an area of great opportunity for bringing about

improvement by individuals and organizations working in the field of

public health in developing countries. India has vowed to achieve a

Maternal Mortality Ratio (MMR) of 100 maternal deaths per 100000

live births by 2015 from the current level of 254. However, this requires

an in depth understanding of the causative factors affecting maternal

health. The Government has taken various steps one of which in the

Reproductive and Child Health (RCH) Survey amongst others to

enhance the service delivery of health care like ‘National Rural Health

Mission’ which seeks to provide effective healthcare to rural population

throughout the country with special focus on 18 states, one of which is

the mountainous state of Jammu and Kashmir. The need for the study

comes from the fact that in the realm of socio-economic, cultural and

demographic influence, factors like religion, caste, education, standard

of living, age, age at marriage, place of residence in terms of rural-

urban, have significant importance on the reproductive health care

utilization of women particularly on ANC and safe delivery.

Objective: The study aims at examining the various factors; socio-

economic, demographic and health related, governing the utilization of

two major maternal health services namely antenatal care and safe

delivery for two regions of Jammu and Kashmir (J&K) i.e. Jammu

region and Kashmir and Ladakh, Kargil region.

Methodology: A systematic, multi-stage stratified sampling was done

from data from RCH Round II. In each district, 40 Primary Sampling

Determinants of Maternal Healthcare Utilization in

Keywords: Maternal Health, Healthcare Utilization, NRHM, Safe

Delivery

Management Information System (HMIS) in Sadar, Dharhara and Jamalpur Blocks of Munger

Tukaram Khandade

Objectives: This study was conducted to know the training needs of the health workers before actual start of the training program for them.

Methodology: The study area is 3 blocks of Munger district namely: Sadar, Jamalpur and Dharhara. Data was collected in two weeks in January 2010 through semi structured schedules for ANMs and LHVs with some open ended questions. The study gave results on KAP in HMIS for which training is needed. The convenience sampling was taken to match the lack of time. Analysis of quantitative and qualitative data after coding was done on SPSS.

Findings: The analysis showed training needs in the following areas: Knowledge: The one-fourth of ANMs was graduated. Around 70% (N=30) of ANMs have less than five years of experience but all LHVs have more than 10 years of working experience in the health department Most of the ANMs and LHVs have taken secondary level of education besides having the basic training of nursing. Almost 38.5% of ANMs were not aware about their job responsibilities. Majority of ANMs (92.3%) and all LHVs have knowledge regarding supportive supervision. Not a single health worker has received training on HMIS. Lack of supply of registers at HSC is major problem in maintenance of records. Almost 31% ANMs faced problem in data collection. Attitude: Around 23% of ANMs didn’t know the importance of data. Not a single LHV was satisfied with on job support. Every health worker feel need of Training on HMIS. Practice: About 33.3% LHVs didn’t utilize their data. Around 10 % of ANMs don’t have any idea how to calculate the stock of vaccines. Estimation of pregnant women, OCP users, condom users was done through information from register or AWWs/ ASHAs. Health workers were not aware of advance data usage for their level eg. To know her coverage area.

Recommendation: From the finding we can easily conclude that ANMs and LHVs need training in the areas like Knowing and understanding job responsibilities; Registers to be maintained at the HSC; Knowing supportive supervision; Training on HMIS; Understanding importance of data; Training on HMIS; Utilization of data; Calculation of stock – TT; Calculation of expected target – pregnant women; Calculation of coverage – Immunization.

Keywords: Health Management Information Systems, Knowledge Attitude and Practice, KAP, HMIS, Training Need Assessment

55

internationally and nationally. By the year 2040, the world geriatric population is projected to be 1.3 billion (14%) of the total population as against 506 million (7%) in mid 2008. Thus, in just over thirty years, the proportion of the elderly will double. Similarly, the number of elderly in India is also estimated to increase from 77 million in 2001 to 222 million by 2040; a three- fold increase in just over thirty years. As the morbidity levels in the elderly are high, they need good medical services. Unfortunately, the public health systems are neither adequate nor well equipped to cater to their needs. People have to spend over 70 percent of money on healthcare out of their pocket. The life expectancy being 69.2 years and most people retiring at 58 to 60 years, on an average, a person lives for 10 years post retirement. After retirement, there is a drastic reduction in the income levels. Further, the healthcare costs are also rising. It is in this context that geriatric health insurance assumes great importance.

Objective: This study was carried out in Bangalore city to study the awareness of Geriatric Health Insurance among the people of the city.

Methodology: It was a cross-sectional study. Primary data was collected using a structured questionnaire. The city was divided into four zones and data was collected from each of these zones. A sample size of 102 was attained.

Findings: It was found that LIC was the most popular health insurance company and that the hospital network available was the most important criteria while deciding on the health insurance product. Further, the awareness about health insurance among the geriatric population is low. Furthermore, this population is largely dependent upon their children for decision making/ procedural formalities. Hence, customer awareness generation should be a part of the marketing strategy of a health insurance company; the marketing strategy should be directed both towards the target group as well as their adult children and companies providing insurance without an upper age limit should market this differentiator.

The study has succeeded to a large extent in finding answers to the questions which have been brought out in the main report. This study can be a useful resource for a health insurance company entering into the geriatric market.

Ab-34Functionaries of Government of Bihar in Knowledge Attitude and Practice (KAP) in Health

Training Need Assessment (TNA) of Health

PharmaceuticalManagement

57

Ab-1 Renal Cell Carcinoma: Therapeutic Segment

Outlook and Pipeline Analysis in Evalueserve,

Gurgaon

Ginni Kumar

Renal cell carcinoma accounts for approximately 3% of adult

malignancies and 90-95% of neoplasms arising from the kidney. It is

characterized by a lack of early warning signs, diverse clinical

manifestations, resistance to radiation and chemotherapy, and

infrequent but reproducible responses to immunotherapy agents such

as interferon alpha and interleukin (IL)-2. Renal cell carcinoma is the

eighth or ninth leading cause of cancer death in the United States. The 5-

year survival rates initially reported by Robson in 1969 were 66% for

stage I renal carcinoma, 64% for stage II, 42% for stage III, and only

11% for stage IV. The age-adjusted incidence of renal cell carcinoma

has been rising by 3% per year. Renal cell carcinoma has 5 histologic

subtypes, as follows: clear cell (75%), chromophilic (15%),

chromophobic (5%), oncocytoma (3%), and collecting duct (2%).

Renal Cell Carcinoma drug market will more than double over the next

10 years, rising from US$ 625 million in 2007 to nearly US$ 1.6 billion

in 2017. The RCC market has recently attracted significant investments

in research and development from big pharma, specialty pharma, and

biotechnology companies. Historically, the market for RCC treatments

has comprised a comparatively small section of the oncology market.

More than 50% of patients with renal cell carcinoma are cured in early

stages, but outcome for stage IV disease is poor. The probability of cure

is related directly to the stage or degree of tumor dissemination, so the

approach is curative for early stage disease. Selected patients with

metastatic disease respond to immunotherapy, but many patients can be

offered only palliative therapy for advanced disease. The treatment

options for renal cell cancer are surgery, radiation therapy,

chemotherapy, hormonal therapy, immunotherapy, or combinations of

these. Options for chemotherapy and endocrine-based approaches are

limited, and no hormonal or chemotherapeutic regimen is accepted as a

standard of care. Older immunotherapy regimens have now been

replaced as the standard of care by the newer targeted therapies

launched in recent years, namely Pfizer' s Sutent (sunitinib),

Bayer/Onyx' Nexavar (sorafenib), Roche' s Avastin (bevacizumab) and

Keywords: Renal Cell Carcinoma, Therapeutic Segment, Pipeline

Analysis, Renal Cell Carcinoma Drug

Pfizer' s Torisel (temsirolimus). The RCC market has evolved into a

rapidly growing segment since the launch of newer targeted therapies.

Sutent is considered as the standard first line therapy for previously

untreated RCC patients followed by Nexavar prescribed as the second

line therapy to Sutent refractory patients. The most recently approved

drug, GSK’s Votrient is anticipated to compete with sorafenib and

everolimus as second line use.

Significant opportunities still exist for products to expand within this

marketplace. A large percentage of patients are not currently treated

with drug therapies and are not cured by surgery alone; patients with

localised and locally-advanced disease represent a significant patient

population that may be suitable for adjuvant therapy with targeted

therapies. Established agents such as Sutent, Nexavar and Avastin are

being investigated in the adjuvant setting, along with new therapies

including Wilex' Rencarex (girentuximab), currently in Phase III trials.

In addition, many patients do not respond to current therapies, and more

effective product introductions and greater use of combination

therapies will address this clinical need for patients with metastatic

RCC. Also, two molecules in the late stage pipeline provide a multitude

of possibilities for potential future regimens.

Ab-2

the Globe

Kuldeep Dabas

Background: Biopharmaceuticals account for between 10% and 15%

of the world pharmaceutical market, with sales in the USA alone

reaching around $30 billion in recent time. Biopharmaceutical drugs

have outperformed the pharmaceutical market as a whole largely due to

two factors: they address areas of clinical need that are unmanageable

with conventional therapeutics (including many cancers and genetic

diseases) and they are able to command a premium price.

Objective: The study enlighten on the increasing importance of

biologics in pharmaceutical market. The every possible aspect like

definitions, manufacturing, regulation and marketing strategies of the

biopharmaceutical was analyzed.

Market Assessment of Biopharmaceuticals Round

Keywords: Biopharmaceuticals, Market Assessment, Pharmaceutical

Market, Biopharmaceuticall Drugs

Findings: Market by protein : Biopharmaceuticals : The sales of

Calcitonins and Glucagon will increase by 51% in 2011 reaching

market to $ 60,037 million from $ 22,098 million in 2006 with 47.8%

followed by Erythropoietin. Biosimilars : The sale of Erythropoietin by

2011 will increase by 38.6% reaching the market to $ 1,247 million and

market penetration will increase by 5%. Biopharmaceuticals market by

application. The market is now worth about $67 billion, or 10% of the

total Pharma sales, and we expect it to rise to $ 118 billion or 12% of

Pharma sales in 2011. Monoclonal antibodies currently make up 27%

of the biopharmaceuticals market but this figure will rise to 36% in

2011 because sales are increasing more rapidly. Oncology is the

dominant application accounting for one-third of overall sales. Indeed

in value terms, protein drugs now account for about two-third of the

worldwide. According to the forecasts based on an extrapolation of the

sales of existing products together with estimated sales for agents

currently in clinical trials but likely to be launched during the forecast

period Amgen and Roche have the biggest overall shares, with 40% of

the total market between them. North America (mainly the US) has

almost 40% of the market and Europe has 30%. The fastest growth rates

are outside the two regions, a trend that is consistent with the

pharmaceutical market in general. Europe will be in the lead with nearly

45% of the market and distribution of sales will be somewhat different

because owing to patent constraints and prescribing practices

respectively, we expect no EPO or G-CSF sales of biogenerics in Japan.

There were no sales data for 2006. But in 2011, Europe will be in the

lead with nearly 45% of the market and the distribution of sales will be

somewhat different because owing to patent constraints and prescribing

practices respectively we expect no EPO or G-CSF sales in the US and

depressed sales of biogenerics in Japan. EPO represents the largest

market opportunity for biosimilars and GCSF is also sizeable

opportunity.

Recommendation: Industry should focus more on R&D activities

about emerging diseases. Better cooperation between research

institutes and pharmaceutical companies so as to coordinate their

activities about development of new molecule. Improvement in

technology advancement for the production of biopharmaceuticals

should be cost effective. Government should facilitate establishment of

more institutes both in the academic as well as research so as to

58

encourage development of interest in the field of biopharmaceuticals

research. Government should offer incentives so as to encourage more

participation of industry in the field of biopharmaceuticals.

Government should encourage FDI in the field of biopharmaceuticals

so as to promote transfer of technology.

Ab-3

Business Opportunities

Pritika Garg

Background: The Japanese pharmaceutical market is the second largest

individual market and with sales of $66 billion constitutes

approximately 8.2% of the world market. Despite its prolonged

economic troubles in recent years, Japan still holds its second position

in world market being after US only. It also remains one of the less

penetrable markets. MHLW is strongly promoting generic drugs

through incentives on prescribing and selling generic drugs. This makes

a space for small generic companies to enter in Japan. Although despite

of full support of Japanese government one need to have local

partnership to get the know how of the market. The main therapeutic

areas where one can enter are anti-cancer, lifestyle diseases and also

diseases related to central nervous system.

Objective: To assess the Japanese generic pharmaceutical market and

search for opportunities available for an India generic firm Radiance

pharmaceutical.

Methodology: The study is done on secondary data. The data gathered

was taken from trusted government sites and several market reports.

Market forecast done by market research firms were also taken in

consideration.

Findings: The Japanese pharmaceutical market is the second largest in

the world after the USA accounting for 8.2% of the total world market.

Increasing demand of pharmaceutical market is due to the rapidly

increasing population of Japan. Japan market size increased by 123% in

1993-2003. The market is dominated by domestic producers who

manufacture drugs primarily for the home market.

Recommendations: Therapeutic areas in which companies can entre

Assessment of Japanese Pharmaceutical Market to Search

Keywords: Japanese Pharmaceutical Market, Pharmaceutical

Marketing, Business Opportunities

59

could be anti- cancer and other life style disease because Japanese

epidemiology is changing. Even if a generic drug market does not grow,

and the company has unique challenges of this market.

Ab-4

Assessment

Pushpendra Dixit

Background: Vitamin-A supplementation is a low cost sustainable

approach to control the Vitamin A deficiency. Children between 1–5

years age , who are less likely to have regular contact with health

facilities and health services, are the neediest group for this

supplementation.

Objective: A process and knowledge assessment study of Vitamin A

supplementation was carried out in all the blocks of Surendranagar

District.

Methodology: 14 PHCs were selected from the slot of 31 by using

simple random sampling (2 from each block). Interviews of ANM,

AWW and mothers/caretaker were conducted. 2 SCs were selected

from each PHC by using convenience sampling method. Under each SC

one extra village was surveyed for interviewing the AWW and

mother/caretaker of children age group 1-5 years. Total 38 ANM, 53

AWW and 358 mother /caretaker were interviewed for the study.

Findings: The major findings of the study include knowledge of ANM

and AWW, preparedness for the bi-annual round and most importantly

the level of awareness among the mothers/caretaker about the program.

The most common place of Vitamin A supplementation was AWC

(40%), followed by SC (32%). IEC material was only available at 73%

sessions of mamta divas. Marking in mamta card and making notes in

register was found to be low. Only 44% ANMs were found marking in

mamta card which is not a good sign for the supplementation program.

The reason for not making entries was unavailability of the mamta card.

It was also seen that often the mothers/caretaker do not bring the card

with them. The knowledge of ANM and AWW regarding Vitamin A

supplementation was found out to be low, especially in AWW. Another

major finding revealed was very low supervision level. Only 65% ANM

Vitamin A Bi-annual Round Process and Knowledge

Keywords: Vitamin-A, Vitamin A Supplementation, Knowledge

Assessment

and 55% AWW got the instructions from their respective supervisors.

The knowledge of mother/caretaker was very low. Out of the total who

received the services, only 37% mother/caretaker knew about it. Only

74% children (out of the total visited 358) received the Vitamin A

supplementation. In the study ASHA was found to be the major source

of information for the mother/caretaker about the program.

Ab-5

Linezolid on the behalf of Kee Pharma Ltd.

Rahul Gupta

This study is regarding the feasibility approach for Linezolid tablet

Launch. Linezolid is a synthetic antibiotic used in resistant gram

positive infection.

Objcetive: The aim of study was “To assess the market and propose the

product Launching strategy of Linezolid tablet” and specific objectives

followed were To study the prescription habits of Linezolid tablet in

market. To identify the competitors for Linezolid Antibiotic. To study

the strength and weakness of Linezolid tablet To recommend the

Product Launch Strategy.

Methodology: The background of the drug market was analyzed first

as Pharmaceutical marketing is quite different than marketing of any

other goods. Within pharmaceutical products, marketing of prescribed

products is a way different from that of over the- counter (OTC) drugs

and actual behaviour of prescribed drug market may vary based upon

various parameters. To achieve the objectives a primary research and

secondary research both were done and 60 doctors and 60 chemists

were surveyed on the basis of convenient sampling and structured

questionnaire was used as a research instrument.

Findings: Orthopedician, surgeon and Physicians were the major

prescribers for Linezolid tablet and the major competitors were Linox

(Unichem), Linid (Zydus) and Linospan (Cipla) Successful launching

of Linezolid tablet requires a more aggressive promotion amongst the

Physician, Orthopedician and surgeon and Linezolid tablet should be

available at all major retail pharmacy stores especially those which are

in premises of a hospital and nursing homes and near the Physician,

Market Assessment and Product Launching Strategy of

Keywords: Linezolied, Pharmaceutical Marketing, Product Launching

Strategy

60

Orthopedician and Surgeon. Linezolid tablet should be made more cost

effective.

Ab-6

and Faridabad Through Retail Chemist Audit

Ramneek Atreya

Background: Diabetes drug market and insulin market has shown

remarkable growth in recent years. This growth is mostly driven by

increasing prevalence of diabetes globally and easily availability of

insulin in other countries due to its access at an affordable price. The

diabetes prevalence is increasing due to changing food habits in the

western world leading to obesity. Top 8 diabetes drug made a sale of

more than US$ 5 Billion from the period of October 2007 to October

2008.

Objective: The study is based on the assessment of insulin market in

Delhi NCR and Jaipur and broadly covers the analysis of insulin market

dynamics, share of various brands in the market and most prescribing

physicians. The study was done by using descriptive research method

with simple random sampling by the help of primary data collected

from retailer through Questionnaire.

Findings:. Human Mixtard* was ranked 1 in terms of sales and

availability. Hum insulin (30- 70)/Humalog as the second best (20%)

selling brand. Wosulin and Insugen were taken as market follower.

Market penetration of Human Mixtard was 100% followed by Hum

insulin.

Recommendation: Company can increase sales force size and can also

do Flank Attack (attacking on Market leaders weak points).

Ab-7 Analysis of Pharmacy Function and Work Load

Reenu Bajapi

Background: Hospital pharmacies can usually be found within the

premises of the hospital. Hospital pharmacies usually stock a larger

Assessment of Insulin Market in Jaipur, Gurgaon

Keywords: Insulin Market, Retail Chemist Audit, Diabetes Drug

Market

Keywords: Hospital Pharmacy, Pharmacy Store, Quality Assurance

range of medications, including more specialized medications, than

would be feasible in the community setting. Most of the hospitals have

one store and from which all IPD and OPD patients purchase

medicines. Availability of one store and large number of indents

coming everyday (in comparison to bed admission ration), causes high

returns of pharmacy items and long internal lead time between

pharmacy stores to IPD. This is a complex process that requires

adequate training of personnel, quality assurance of products, and

adequate facilities to avoid conflicts between staff and patient

dissatisfaction.

Objective: To analysis the causes of pharmacy overloads and unduly

stretched internal lead time between central pharmacies store to IPD.

Methodology: A Group comparison case control study of the patients

admitted in 6th, 7th and 9th wards from 15 to 29 April was conducted.

Data was collected through interviews and observation. It was a

Retrospective study. From the studies it was found that an average of

288 indents come in a single day for 180 bedded hospitals and it takes

81 min to process that indent

Findings: The numbers of indents are too high because there was no

stock monitoring in wards level by nursing staff before giving indents to

pharmacy. This causes a high number of returns in a day. From the

studies it was also found that a clear cut demarcation for pharmacist is

not available which leads to a high lead time in indent processing. There

was a lack of communication between pharmacy store and the nursing

staff.

Recommendation: The situation analysis suggests that there is an

urgent need of controlling the process. Through systematic approach of

working the work load of pharmacy can be reduced. Scientific reorder

level estimation helps the hospital in reducing the internal lead time

process. There is a need of strict process monitoring of medicines

through bar coding and by group of quality managers.

Ab-8

European Countries

Siyaram Sharma

Market Assessment of Rheumatoid Arthritis in 5-

Keywords: Rheumatoid Arthritis, Market Assessment, European

Countries

Objective: This Study is the market assessment of rheumatoid arthritis

in European countries in which thorough market search is done for

therapeutic area Rheumatoid Arthritis (RA) in 5- European countries

(France, Germany, Italy, Spain and UK). This assessment gives idea

about current market scenario product wise and company wise as well

and the assessment of pipeline products helps to estimate future

estimates of anti RA market.

Methodology: Secondary desk research is used for this study and data

are taken from reliable sources like- IMS, CENTER WACH etc. On the

basis of three major fields i.e Epidemiological facts of Rheumatoid

Arthritis in 5- EU Countries in which major epidemiological facts

related with RA are touched upon to get idea about the spectrum of the

disease, Treatment rate and mortality status due to RA in respective

country to understand the potentiality of the market. The second field is

prescribed drugs of RA in 5-EU Countries in which the name of the

prescribed drugs for Rheumatoid Arthritis along with their companies

in 5- EU Countries are assessed this information gives idea about major

drugs present in these countries for RA treatment. The Third Field is

Competitive Analysis which includes three sub fields i. Major

companies in the market and their products for RA Treatment ii. Sales

Value Status of anti RA Products in 5- EU Countries iii. Pipeline drugs

for RA Treatment

Findings: UK has highest prevalence of Rheumatoid Arthritis among

5 European countries followed by Germany Treatment rate of

Rheumatoid Arthritis is high in all 5-European Countries it is above

75% in all countries. Though UK and Germany have highest prevalence

of Rheumatoid Arthritis but RA related mortality is lowest in these two

countries. Abbott, Pfizer and Merck & co. are common major players in

all 5- European Countries with their products Humira (Adalimumab),

Enbrel (Etanerecept) and Ramicade (Infliximab) respectively. Roche

is the leading company in pipeline products with 3 pipeline products for

RA treatment.

Recommendations: The patents of the most selling drugs in European

markets like Humira, Ramicade, Enbrel are going to expire in next 2-3

years so there is a great scope for biogeneric drugs. Ramicade

(Infliximab) is strong competitor of Enbrel and Humira in France, Ital

and Spain but far behind in UK and Germany so Merck & Co. can

implement similar marketing strategy in UK and Germany as they are

using in France, Italy and Spain. Companies like Sanofi-Aventis,

61

Bristol Myers squib should increase their marketing efforts for their

respective drugs (Arava and Orencia) which are strong market follower

drugs.

Ab-9

Competitor Overview in Evalueserve, Gurgaon

Sonal Ghura

Background: Most pharmaceutical companies are interested in getting

their hands on a stable therapeutic region. PAH (pulmonary arterial

hypertension) is a relatively new indication which has been served so

far by niche players such as Actelion and Gilead Life sciences. Big

companies like Eli Lilly, Pfizer have recently entered the market.

Global Data has estimated the global pulmonary Arterial Hypertension

(PAH) market was worth of $2653 Mn in 2009. According to Global

Data, the PAH market is expected to grow at CAGR of 5% over next six

year and it will reach to $ 3569 Mn by 2015. So the report will analyze

the competitors’ marketed drugs and drugs that are in the pipeline for

clinical development, thereby giving a picture of the market leader and

its movements till 2016.

Objectives: To conduct a pipeline analysis of the pulmonary arterial

hypertension (PAH) market. To analyze the present market of PAH

based on prevailing market leaders. To assess the movement of

competitors and its positions in the market till 2016. To forecast ParaIV

filing activities for various companies after market leader Tracleer

(Bosentan) hits the patent cliff. To investigate geography for the launch

of PAH drugs. At last but not the least, to compile all the essential pieces

of information and present the finding and recommendations.

Methodology: The study is done on secondary data basis. The list of

the molecules in the pipeline has been derived from companies’ press

releases, annual reports and other freely available databases. Through

SWOT analysis, BCG matrices and PEST analysis of the competitors

and the market leaders had been carried out for analysis of the data and

then reporting is done.

Findings: The market leader in this PAH market is Trocleer and its total

market share is about 50%. Eli lily’s Revatio and United therapeutics’s

Pulmonary Arterial Hypertension: Futuristic

Keywords: Pharmaceutical Companies, Pulmonary Arterial

Hypertension, PHA Market

62

Remodulin had a market share of 15% each. Trocleer slowly and

gradually will enter the Dog phase as the molecule’s patent expire

during 2015-16 in EU & US market. Venatvis is the only inhaled

formulation available for PAH. However the drug is not popular

because of high cost and no additional improvement in efficacy. The

entry of big pharmaceutical companies such as Eli Lily, Pfizer will

drive the growth of the PAH market. The annual reports of these

companies have stated that as for PDE-5 inhibitors, PAH is not as key

area of focus.

Recommendations: EU is the choice for the first launch of PAH drugs

as the population of the country is genetically isolated as has a lesser

approval lead times as compared to the US. Para IV filing for launched

drugs should have been started for brands like Trocleer. Companies

like Eli lily, Pfizer and GSK are all rounder in this field and therefore do

not need to adopt niche marketing strategy to launch a product in the

market.

Ab-10 Market Survey of Treatment Options for Osteoarthritis

and Awareness about Sodium Hyaluronate 1 % Solution

in Medical Profession

Sumati Kumar Jain

Background: Importance of Hyaluronic acid in body is felt when pain

is observed in joints. Hyaluronic acid is a natural component of

cartilage and joint fluid. It lubricates and absorbs shock in the joint. Just

imagine what will happen when the hyaluronic acid fluid from body

gets finished due to ageing. Well Xyata lifescinces ltd has a solution to

it, Hyness the product for osteoarthritis patients. The (FDA) recently

approved this therapy where sodium hyluronate injections are given to

patients with osteoarthritis of the knee if they do not get relief from

exercise, physical therapy, or simple analgesics. Researchers are also

testing whether hyaluronic acid can slow down the progression of

osteoarthritis.

Objective: The main objective of this market survey was to find out the

awareness and perception level of prescriber about Sodium

Hyaluronate.

Keywords: Sodium Hyaluronate 1% Solution, Market Survey,

Osteoarthritis

Methodology: Primary research was done doing market survey in

Jaipur District with a sample size 50 prescriber of sod. Hyaluronate.

Findings: Injecting this substance into the knee joint provides long-

term pain relief for some people with osteoarthritis. Hyaluronic acid is a

natural component of cartilage and joint fluid. It lubricates and absorbs

shock in the joint. The Food and Drug Administration (FDA) recently

approved this therapy for patients with osteoarthritis of the knee if they

do not get relief from exercise, physical therapy, or simple analgesics.

Researchers are testing whether hyaluronic acid can slow down the

progression of osteoarthritis.

Ab-11

North African (MENA) Region

Vibha Chadha

Objectives: To raise awareness regarding the burden of disease related

to viral hepatitis and the need for urgent action to prevent hepatitis C

virus transmission in the Eastern Mediterranean Region.

Methodology: This study was based on secondary research and the

data was collected from internet.

Findings: The global burden of disease due to cirrhosis of the liver and

hepatocellular carcinoma (HCC) is high (approximately 2% of all

deaths) and is expected to increase over the next two decades. Studies

indicate that more than 75% of cirrhosis and hepatocellular carcinoma

in the region is attributable to hepatitis C virus (HCV) infection with

higher prevalence in Egypt. Many of these infections are acquired in the

health care settings particularly in countries with rapidly evolving

health systems and increasing demand for health services. There are

two medications used to treat Hepatitis C i.e. Ribavirin and Interferon

with Roche and Schering Plough as market leaders. As the current

treatment guidelines are not economically favorable (US $12000-US

$22000), lengthy (24-48 week) and well tolerated, a comprehensive

strategy is urgently needed to prevent transmission of these blood-

borne pathogens. Roche recently collaborated with ministry of health to

create awareness for disease whereas GSK and Schering Plough are

promoting their product through national level campaign in Egypt.

They have agreed for price reductions and are negotiating with

Market Overview of Hepatitis C in Middle East and

Keywords: Hepatitis C, Market Overview, Global Burden Disease

Egyptian government to provide 2 yr supply of Ribavarin.They have

provided funds for training and post exposure follow up and treatment

for nurses and physicians who are exposed to Hepatitis C.

Recommendations: Hepatitis C specific mortality in Egypt, Iraq and

morocco regions are quite high therefore the main focus should be on

these regions. Hepatitis C treatment should be provided through

government in countries like Egypt, Libiya and Saudi Arabia as the

health care is almost free for citizens. Increased improvement in safety,

efficacy and tolerability of Hepatitis C treatment is needed with second

line therapies for increasing population. Newer drug need to be potent

and should have a high genetic barrier to prevent development of

resistance. New dosage forms (injectables) should be there to have

patient compliance. Treatment must be affordable so that it is accessible

to all individuals who require it.

63

INSTITUTE OF HEALTH MANAGEMENT RESEARCH1, Prabhu Dayal Marg, Sanganer Airport, Jaipur 302011 India

Ph.: +91-141-3924700. Fax : 91-141-3924738. Web: www.iihmr.org

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