Figure 1
This map of government health facilities was created through Google Maps in 2016. The facilities in red are the tertiary facilities. Patients access the tertiary facilities after referral from the CHC in purple. The distances from the CHC to the tertiary facilities range from 19.31 km to 30.35 km.
Figure 2
Hierarchy of government healthcare facilities in rural India.
Table 1
Requirements of each level of government healthcare and the surveyed facilities serving Nanakpur. * Secondary level of care represents World Health Organization district level hospital. ** AYUSH Physician: Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy physician.
| LEVEL OF CARE | HEALTH FACILITY | POPULATION SERVED | MANDATORY WORKFORCE | BEDS | NANAKPUR HEALTH FACILITY |
|---|---|---|---|---|---|
| Subcenter | 5,000 | 1 male healthcare worker | N/A | ||
| 1 female healthcare worker | |||||
| Primary | Primary Health Center | 30,000 | 1 General Medicine | 6 | PHC Nankpur |
| Secondary* | Community Health Center | 120,000 | 1 General Surgeon | 30 | PHC Pinjore |
| 1 General Medicine | CHC Kalka | ||||
| 1 Obstetrician | |||||
| 1 Pediatrician | |||||
| 1 Anesthesiologist | |||||
| Tertiary | Sub-district hospital | 500,000 | 1 General Surgeon | 31–100 | |
| 1 General Medicine | |||||
| 1 Obstetrician | |||||
| 1 Pediatrician | |||||
| 1 Anesthesiologist | |||||
| 1 Ophthalmologist | |||||
| 1 Orthopedic Surgeon | |||||
| 1 ENT Surgeon | |||||
| 1 Radiologist | |||||
| 1 Dental Surgeon | |||||
| 7 General Duty Doctors | |||||
| 1 Public Health Manager | |||||
| 1 AYUSH Physician** | |||||
| 1 Hospital Superintendent | |||||
| Tertiary | District Hospital | 32,000–3,000,000 | 2–4 General Surgeon | 101–500 | Sector 6 General Hospital, Panchkula |
| 2–5 General Medicine | |||||
| 2–6 Obstetricians | |||||
| 2–5 Pediatricians | Sector 16 General Hospital, Chandigarh | ||||
| 2–4 Anesthesiologists | |||||
| 1–2 Ophthalmologist | |||||
| 1–2 Orthopedic Surgeon | Sector 32 General Hospital, Chandigarh | ||||
| 1–2 ENT Surgeon | |||||
| 1–2 Radiologist | |||||
| 1–3 Dental Surgeon | Post Graduate Institute of Medical Education and Research, Chandigarh | ||||
| 1–4 Pathologist | |||||
| 11–23 Medical Officers | |||||
| 0–1 Dermatologist | |||||
| 1 Psychiatrist | |||||
| 0–1 Microbiologist | |||||
| 0–1 Forensic Specialist | |||||
| 1 AYUSH Physician** |
Table 2
Individual and index median PIPES and INTACT scores divided by health facility size. * The p-values were determined with the Wilcoxon rank-sum test.
| PIPES | PHC/CHC (N = 3) | TERTIARY (N = 4) | P-VALUE* | INTACT | PHC/CHC (N = 3) | TERTIARY (N = 4) | P-VALUE* |
|---|---|---|---|---|---|---|---|
| PIPES Index | 4.7 (IQR 3.9, 6.2) | 13.8 (IQR 9.5, 18.2) | 0.03 | INTACT Index (IQR) | 3.8 (IQR 3.5, 6.3) | 9.5 (IQR 8.3, 9.9) | 0.03 |
| Personnel | 0 (IQR 0, 1.0) | 37.5 (IQR 12.5, 71.5) | 0.03 | Personnel (IQR) | 0 (IQR 0, 1.0) | 2.0 (IQR 2.0, 2.0) | 0.03 |
| Infrastructure | 6.0 (IQR 4.0, 10.0) | 25.5 (IQR 16.5, 33) | 0.03 | Infrastructure (IQR) | 2.0 (IQR 2.0, 4.0) | 7 (IQR 7.0, 7.0) | 0.02 |
| Procedures | 5.0 (IQR 5.0, 13.0) | 37.0 (IQR 30.0, 38.5) | 0.03 | Procedures (IQR) | 4.0 (IQR 3.0, 7.0) | 14.5 (IQR 11.5, 15.5) | 0.03 |
| Equipment | 14.0 (IQR 13.0, 18.0) | 21.5 (IQR 17.0, 22.0) | 0.21 | Equipment (IQR) | 6.0 (IQR 5.0, 9.0) | 10.5 (IQR 8.5, 11) | 0.07 |
| Supplies | 19.0 (IQR 18.0, 22.0) | 23.5 (IQR 22.0, 24.5) | 0.08 | Supplies (IQR) | 4.0 (IQR 3.0, 4.0) | 4.0 (IQR 4.0, 4.0) | 0.25 |
Table 3
Comparison of median infrastructure values of the PHCs/CHC vs. tertiary health centers. * The p-values were determined with the Wilcoxon rank-sum test.
| INFRASTRUCTURE ITEM | PHC/CHCS (N = 3) | TERTIARY HEALTH CENTERS (N = 4) | P-VALUE* |
|---|---|---|---|
| Running/Portable Water | 1.0 (IQR 1.0, 1.0) | 1.0 (IQR 1.0, 1.0) | 0.99 |
| Electricity | 1.0 (IQR 1.0, 1.0) | 1.0 (IQR 1.0, 1.0) | 0.99 |
| Back-up Generator | 1.0 (IQR 0, 1.0) | 1.0 (IQR 0.5, 1.0) | 0.82 |
| Incinerator | 0 (IQR 0, 0) | 0.5 (IQR 0, 1.0) | 0.18 |
| Medical Records | 1.0 (IQR 1.0, 1.0) | 1.0 (IQR 1.0, 1.0) | 0.99 |
| Emergency Room | 1.0 (IQR 0, 1.0) | 1.0 (IQR 1.0, 1.0) | 0.25 |
| Postoperative Care Area | 0 (IQR 0, 1.0) | 1.0 (IQR 1.0, 1.0) | 0.07 |
| Intensive Care Unit | 0 (IQR 0, 0) | 1.0 (IQR 1.0, 1.0) | 0.01 |
| Blood Bank | 0 (IQR 0, 1.0) | 1.0 (IQR 1.0, 1.0) | 0.07 |
| Lab to Test Blood and Urine | 1.0 (IQR 1.0, 1.0) | 1.0 (IQR 1.0, 1.0) | 0.99 |
| Functioning X-Ray Machine | 0 (IQR 0, 1.0) | 1.0 (IQR 1.0, 1.0) | 0.07 |
| Functioning Ultrasound Machine | 0 (IQR 0, 0) | 1.0 (IQR 1.0, 1.0) | 0.01 |
| Functioning CT Scanner | 0 (IQR 0, 0) | 1.0 (IQR 1.0, 1.0) | 0.01 |
| Number of ORs | 0 (IQR 0, 1.0) | 13.0 (IQR 4.5, 20.5) | 0.03 |
Table 4
The total number of major and minor surgical procedures at each facility.
| Health Facility | Time period | Total Number of Vaginal Deliveries | Total Number of Surgical Procedures |
|---|---|---|---|
| Nanakpur PHC | May 2015 | 20 | 0 |
| Pinjore PHC | June 2015 | 12 | 0 |
| Kalka CHC | May 2015 | 99 | 39 |
| Sector 6 General Hospital | 2013 | N/A | 7402 |
| Sector 32 General Hospital | 2014 | N/A | 43902 |
| Postgraduate Institute of Medical Education and Research | 2013 | N/A | 182177 |