Assessment of functioning of public health facilities in a North Indian state

Tarundeep Singh, Ankita Kankaria, Nidhi Bhatnagar, Gopal Singh Jat, Sukhwinder Kaur, Rajesh Kumar


Background: This study was conducted to assess the current status of functioning of health facilities in Punjab.

Methods: A checklist based on six building blocks of health system proposed by WHO and the IPHS was developed, validated and pretested. District hospital (DH), one sub district hospital (SDH) and two Community Health Centres or Block Primary Health Centres (CHCs/BPHCs) were randomly selected from each of 22 districts of Punjab and evaluated against checklist. Total score was thus assigned to each facility. Additionally, workload of healthcare workforce, presence of health functionaries as against total posted strength and feedback from administrators of these facilities were also recorded.

Results: Health services are concentrated at the DH and SDH. Functional equipment like ECG, oxygen, mask, ambubag etc. are deficient at all levels of health facilities. Nearly 50% of expected medicines were in stock at the DH and SDH and 66% at CHC/BPHC level. Patient to doctor ratio is highest at SDH in outpatient department and CHC/BPHC in emergency section. Number of lab tests per lab technician are highest at CHC/BPHC level. Administrators express the need for reducing staff shortage, more intensive training in the financial and administrative processes and simplification of procedures for management of equipment.

Conclusions: Strengthening CHC/BPHC level institutions may improve utilization of public health system and reduce referrals. Lifesaving drugs and equipment need to be available and operational at all levels of facilities. Content of training to administrators needs to be tailored to the felt needs.


Functional assessment, Building block of health system, Healthcare workload

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The WHO Health Systems Framework. Available at Accessed 13 December 2014.

Ministry of Health and Family Welfare. National Rural Health Mission (2005-2012): Mission Document. New Delhi; 2005: 184-192.

Travis P, Bennett S, Haines A, Pang T, Bhutta Z, Hyder AA, et al. Overcoming health-systems constraints to achieve the Millennium Development Goals. The Lancet. 2004;364(9437):900-6.

Malhotra S, Zodpey SP, Vidyasagaran AL, Sharma K, Raj SS, Neogi SB, et al. Assessment of Essential Newborn Care Services in Secondary-level Facilities from Two Districts of India. J Health Popul Nutr, 2014;32(1):130-41.

Sodani PR, Sharma K. Assessing Indian Public Health Standards for 24x7 primary health centres: A Case Study with Special Reference to Essential Newborn Care Services. Ind J Public Health, 2011;55(4):260-6.

National Rural Health Mission. Third common review mission report. New Delhi, India: National Rural Health Mission, Ministry of Health and Family Welfare, Government of India; 2009: 151.

National Rural Health Mission. Fourth common review mission report 2010. New Delhi, India: National Rural Health Mission, Ministry of Health and Family Welfare, Government of India; 2011. 130.

Sharma CP, Mittal M, Uppadhaya S, Sharma S, Kumar A, Sharma S. A study to assess healthcare facilities at community health centres in Udaipur district and their conformance to Indian Public Health Standards 2007. J Res Med Den Sci 2014;2(1):45-50.

Report on Medical Certification of Cause of Death 2012. Office of the Registrar General of India. Ministry of Home affairs. New Delhi, India: Vital Statistics Division; 2015. Available at mccd_Report1/MCCD_2012.pdf. Accessed 10 April 2019.

Groenewegen PP, Hutten JBF. Workload and job satisfaction among general practitioners: a review of the literature. Soc Sci Med. 1991;32(10):1111–9.

Camasso MJ, Camasso AE. Practitioner productivity and the product content of medical care in publicly supported health centers. Soc Sci Med. 1994;38(5):733–48.

Andersson SO, Mattsson B. Length of consultations in general practice in Sweden: views of doctors and patients. Fam Pract. 1989;6(2):130–4.

Ghosh N, Chakrabarti I, Chakraborty M. Imbalances in health force in a primary health center (PHC) of Darjeeling District, West Bengal, India. IOSR J of Den and Med Sci. 2013;8(6):18-22.

Rural Health Statistics 2013-2014. Ministry of Health and Family Welfare. Statistics division. Government of India. New Delhi: 2014.

Sample Registration System Bulletin. Registrar General. New Delhi, India: Vital statistics division, 2014;49(1).

National Sample Survey Organisation (NSSO). Key indicators of social consumption in India, Health. Government of India. New Delhi. 2015.

Alam M, Tyagi RP. A study of out of pocket household expenditure on drugs and medical services. An exploratory analysis of UP, Rajasthan and Delhi. Population Research Center. Delhi, India: Institute of Economic Growth; 2009.

Prinja S, Bahuguna P, Pinto AD, Sharma A, Bharaj G, Kumar V, et al. The cost of universal health care in India: a model-based estimate. PLoS One 2012;7(1): e30362.

Ray SK, Basu SS, Basu AK. An assessment of rural health care delivery system in some areas of West Bengal-An overview. Indian J Public Health, 2011;55(2):70-80.

Kumar R, Kumar D, Jagnoor J, Aggarwal AK, Lakshmi PV. Epidemiological transition in a rural community of northern India: 18-year mortality surveillance using verbal autopsy. J Epidemiol Community Health. 2012;66(10):890-3.