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Which doctors for primary health care?An assessment of task shifting among primary care clinicians -Krishna D .Rao

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Which Doctor for Primary Health Care? Two studies from Chhattisgarh, India  Public Health Foundation of India National Health Systems Resource Center State Health Systems Resource Center, Chhattisgarh Sponsors: AHSPR WHO, NHSRC, SHRC Chhattisgarh December 10, 2010
Where are the health workers?
State Experiments ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Chhattisgarh State
PHC Clinical Providers in Chhattisgarh
Study 1 -  Objectives and Design ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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Which doctors for primary health care?An assessment of task shifting among primary care clinicians -Krishna D .Rao

  • 1. Which Doctor for Primary Health Care? Two studies from Chhattisgarh, India Public Health Foundation of India National Health Systems Resource Center State Health Systems Resource Center, Chhattisgarh Sponsors: AHSPR WHO, NHSRC, SHRC Chhattisgarh December 10, 2010
  • 2. Where are the health workers?
  • 3.
  • 5. PHC Clinical Providers in Chhattisgarh
  • 6.
  • 7.
  • 8. Study 1 - Results : Clinician Competence Score by Case
  • 9. Study 1 - Results: Community Perceptions Note: Figures are %(N) or Mean (SD); *significantly different from Medical Officer at alpha = 0.05. Standard errors adjusted for clustering of observations.   Medical Officer AYUSH Medical Officer RMA Paramedical Patient satisfaction (%) 84% (266 ) 80% (296) 85% (272) 73% (243)* Community perception of local PHC (standardized scores): Able to treat common illness 0.11 0.22 0.01 -0.35* (-1.015) (-0.852) (-0.903) (-1.122) Able to treat serious illness 0.4 -0.02* -0.11* -0.28* (-1.105) (-1.002) (-0.879) (-0.878) N (households) 512 492 539 502
  • 10. Study 1 - Results: Health Care Providers Visited for Treatment
  • 11.
  • 12.
  • 13.
  • 16. Study 1 - Sample District PHCs Regular Medical Officer Contract Medical Officer AYUSH Medical Officer RMA Paramed Oth Total PHCs 706 210 123 169 63 53 88 Sampling frame 456 205   135 63 53   PHC (target) 146 (160) 35 (40)   37 (40) 35 (40) 39 (40)   Patients (target) 1600 (1,082) 400 (269)   400 (296) 400 (273) 400 (244)   Hhold (target) 2400 (2,124) 600 (525)   600 (503) 600 (571) 600 (525)  
  • 18.
  • 19. Study 1 - Results : Percentage of Correct Responses and Overall Competence Note: Figures are % (number of relevant items) or mean (SD); * Significantly different from Medical Officer at alpha=0.05. Medical Officer AYUSH Medical Officer RMA Paramedical History 44% (2170) 32%*(2294) 43% (2418) 25%*(2170) Examinations 42% (1365) 29%*(1443) 40% (1521) 21%*(1365) Investigation 81% (105) 75% (111) 80% (117) 61%*(105) Diagnosis 86% (210) 66%* (222) 86% (234) 54%*(210) Prescriptions (effective) 61% (140) 51% (148) 61% (156) 33%*(140) Home care 37% (1155) 31%* (1221) 37% (1287) 26%*(1155) Competence score (range 0 to 100) 56.5 (8.42) 43.7 (8.36) 55.8 (9.10) 33.8 (9.43) Competence score (std & adjusted) 0.51 (0.47) -0.46* (0.20) 0.44 (0.22) -1.24* (0.19) Number of providers 35 37 39 35