health system analysis by Group 2

HEALTH SYSTEM ANALYSIS : 

HEALTH SYSTEM ANALYSIS GROUP NO 2 Dr Aasia Zamurrad Mr Ali Akbar Abro Dr Ghulam Hussain Dr Ghulam Yasin Dr Khola Manzoor Miss Kaneez Fatima Dr Mehtab Akhtar Dr Mohammad Farooq Umar Dr Raana Dr Wakeel Hussain Dr Waseem Bashir Dr Zaeema Arif

Historical Prospective of Jullian: 

Historical Prospective of Jullian Jullian is at the boundary of KPK & Punjab. Buddha University is just at 10 minutes walk from center of the village. University origination traces back to 230 to 272 BC.

OBJECTIVES: 

OBJECTIVES To gather the information regarding various aspects of the social, cultural, economic & ecological environment at Jullian, Uc Tofkian, Tehsil & District Haripur To analyze health system according to A.A.Kielmann micro level model of health. To analyze the various levels of community participation. To understand the pattern of health needs & the organization of health care services in SHC (Jullian, Haripur).

PowerPoint Presentation: 

Service Outcome * Social, cultural, environmental, political, economic ecosystem Service Distribution Service Output Health Problems Service Inputs ® A.A.Kielmann Management and Organization Support Systems Community Participation

BACKGROUND INFORMATION: 

BACKGROUND INFORMATION Environmental About 6 kilometers from Khanpur city and 3 kilometers from Tofkian. Weather: Moderate Houses: Brick and cemented Water Source- : Centralized water supply 2 to 3 hours supply daily (individual wells as well) Solid Waste Disposal---Open Road Network ---Available Public Transport—Suzuki's, Taxis, Qinchis , & buses

BACKGROUND INFORMATION: 

BACKGROUND INFORMATION Personal Transport--- cars, Motor cycles Latrine— Available inside House. Waste Water Disposal---open channels draining into canal. Littering, animal waste spread in streets/ fileds Kitchen ----Separate Source of Fuel for Cooking---Gas supply available

BACKGROUND INFORMATION cont:: 

BACKGROUND INFORMATION cont: Agriculture: Wheat, Corn, Malta (orange orchards), litchi, locart. Industry: Marble factory & small scaled cigarette factory. Markets: Small markets with few mixed shops Four mosques & one Imam bargah Livestock: Cows, Buffalos, Goats, Sheep, Donkeys Electricity, Cable, mobile towers, landline telephone were also present.

BACKGROUND INFORMATION cont:: 

BACKGROUND INFORMATION cont: Population Size & distribution Population: 5500 (approximate) Reach: Around 5 villages ranging up-to 3-4 KM Prevalent type of community: Mixed Religion: Islam (mainly Sunni) Post Office National Bank Branch. Police Station was not there but it came under the jurisdiction of Thana Kanpur.

BACKGROUND INFORMATION cont:: 

BACKGROUND INFORMATION cont: Economic Work/ Jobs: Government employees, Agriculture, labours in small scaled marble industry, Profession---Laborer, Employed Unemployment was a problem in the area. Per Person Income(on average) ----Rs. 8000/- to 10,000/- Financial status: mediocre, rich mixed but overall looked well & happy a few are poor, children were well nourished & well dressed. Property---House and Animals and Land

BACKGROUND INFORMATION cont:: 

BACKGROUND INFORMATION cont: Cultural / Social Language: Hindko, (Urdu). Mostly women /Housewives were educated (Middle/Matriculate) Marriage age of girls is16 to 18 + Women cant access the health services because of Non availability of the Female staff in the Health centre even though it was in their immediate vicinity. Mostly Joint Family System/ Independent family system Religious Facility:4 Mosques and 1 ImamBargah. No recreational facility available.

Educational Facilities: 

Educational Facilities Total No. of Schools : 06 2 Boys School 1 primary school 1 Middle school. 2 Girls school 1Primary 1 High. 2 Private Schools, primary (Co-Education) 2 Madrassas

Political: 

Political UC Tofkian Wall Chalking for a separate Province Hazara Casts/ Bradri System: Raja and Mughal were Pre-dominant.

: 

CHILDREN ARI Diarrhoea Scabies Malaria Worms Eye Infections ADULTS Goiter Hepatitis T.B. Malaria Hypertension Skin problems Anemia HEALTH PROBLEMS

HEALTH PRIORITIES*: 

HEALTH PRIORITIES * *Data of Feb, 2011.

SERVICE INPUTS : 

SERVICE INPUTS HUMAN RESOURCE Medical technician sanctioned posts –01……Posted- 01 Dai sanctioned post-01………Posted-01 Sanitary Patrol sanctioned post-01……. Posted-01 Watchman sanctioned post-01……..Posted-01 Except watchman all other staff was present, stated by in charge that watchman attached some where else. S taff is residing within the vicinity of Village Jullian. FINANCIAL RESOURCES Administered by higher authorities…EDO office Haripur. PHYSICAL INFRASTRUCTURE Situated with in the reach of population, Boundary Wall present but cracked, Display Board, solid waste Disposal was dumped in pit & then burned.

MATERIAL: 

MATERIAL INFRASTRUCTURE AND FACILITIES Land & three rooms Building…..Donated by Community Established as one room on 1965, extended in 1985 to three rooms and washrooms, Boundary wall built in 2009 by Government No of rooms 03 in SHC Condition of the building is satisfactory Under supervision of Ministry of Health Supplies from EDO office

PowerPoint Presentation: 

No. Facility Available / No. Working Y/N 1. In charge room 1 Yes 2. Dai room 1 Yes 3. Store room 1 Yes 4. Sterilizer\Autoclave 1 Not Functional (not used) 5. B.P Apparatus\ stethoscope 1 Yes 6. Toilet 2 Yes

PRIVATE SERVICE INPUT : 

PRIVATE SERVICE INPUT No of IHCPs : 3 Hakeem : 0 Dai : 2 Pharmacies : 1

SERVICE DISTRIBUTION: 

SERVICE DISTRIBUTION AVAILABILITY Function Timings from 8.30 to 2.00 pm on Friday till 12.00 at noon Service offered by SHC General curative services Common diseases drugs available eg : antibiotics, antihistamines, cough syrups, antifungal, eye drops, iron supplements & multivitamins. Emergency life saving drugs eg : Hydrocortisone ( antihelminths , antipyretics, antimalarials , antihypertensives , hypoglycemics , ATT, contraceptives were not available)

SERVICE DISTRIBUTION cont:: 

SERVICE DISTRIBUTION cont: Service NOT offered by SHC Delivery care program at M.C.H. Mid wifery EPI In-patient care Outreach program Health education Family planning Antenatal, natal & post natal The available facilities require up gradation as there is no Mo, no WMO no LHV, no nurse or dispenser.

ACCESSIBILITY: 

ACCESSIBILITY Geographic /Physical Accessibility catchments area is within 4-5 KMs Transport facility, road, terrain are compatible to reach. However the facility was inaccessible for few days during last fluids. Financial Accessibility Services are offered at nominal cost (2 rupees user fee) Social accessibility services are socially, religiously, and culturally acceptable.

AFFORDABILITY: 

AFFORDABILITY Lower class are the major beneficiaries as they cant afford to go to private hospitals.

SERVICE OUTPUT: 

SERVICE OUTPUT Total OPD patient : 4 pt / day ( 333 patients in last three months) Total No. of pregnant women: 4-5/month Total No. of births : Nil Total No. of still birth :Nil Total No. of abortion :Nil No. of ante-natal visits: 4/month Total No. of deliveries by trained birth attendant: Nil

Service outputs cont: : 

Service outputs cont: No. infants seen: 3/one month ( 9 in last three months) No. of ORS distributed: 4 in last month for 2pt No. of immunization sessions: usually carried out by vaccinator of BHU Tofkian. Record keeping was satisfactory and information is being shared with EDOH Haripur regularly. No data about immunization available.

facility utilization rate: 9.08% facility utilization rate (female): 10% pregnant women Antenatal visit @least 1 visit: 22.4% M.M.R. No Record I.M.R. No Record <5 mortality No Record Area covered by LHWs: 100% : 

facility utilization rate: 9.08% facility utilization rate (female): 10% pregnant women Antenatal visit @least 1 visit: 22 .4% M.M.R. No Record I.M.R. No Record <5 mortality No Record Area covered by LHWs: 100% Service outcome

SUPPORT SYSTEM: 

SUPPORT SYSTEM Management & Organization Training & supervision TBA training Drug supply system Referral (PIMS)

Management & Organization: 

Management & Organization EDOH is overall in charge of the facility. Available staff (Medical technician) is responsible to EDOH. Financial management is being carried out by EDOH office. Medical technician is keeping time schedules & shares information to higher authorities. Written guidelines/Health manual not available.

SUPPORT SYSTEMS: 

SUPPORT SYSTEMS Repair and maintenance There was occasional repairing of Furniture and Building but it did require more of it . On Job training EDOH office arranged two days training on breast feeding and attended by MT. CHIP training was attended by MT few months back. HMIS training attended by MT in 2010. Transport System ambulance No Transport Facility (Patients are going through private or public transport, 100 rupees cost to reach at RHC khanpur, 300 rupees cost to reach at THQ Taxilla ) Drug and contraceptive Supply System Supply on demand from EDO office (09-02-2011 last supply of drugs) Monitoring and Supervision System No one visited since last one year, EDOH last visit in year January 2010 which should not be the case.

INFORMATION & RECORD KEEPING: 

INFORMATION & RECORD KEEPING Record of O.P.D was well maintained but HMIS monthly reports were not available. ( although they claimed that they report it)

COMMUNITY PARTICIPATION: 

COMMUNITY PARTICIPATION A. Community Organization No health Committee but Masjid committee exists. B. Need Verbalization Health needs are not verbalized C. Community contribution Land provision, hospital building D. Service Utilization Available Health facilities for Curative services are utilized only by non affording.

Acknowledgement: 

Acknowledgement Dr. Shehzad SHC Team Group members

PowerPoint Presentation: 

Dr Waseem Bashir, Dr Mohammad Farooq Umar, Dr Ghulam Hussain, Dr Khola Manzoor, Dr Zaeema Arif, Dr Raana, Miss Kaneez Fatima, Dr Aasia Zamurrad, Dr Mehtab Akhtar.

PowerPoint Presentation: 

Mr Ali Akbar Abro, Dr Ghulam Yasin, Dr Wakeel Hussain

Thank you : 

Thank you