H E A LT H SE RVI CE P ROVI SI O N IN MA DHYA PRA DES H
Assessing Facility Capacity, Costs of Care, and Patient Perspectives
INSTITUTE FOR HEALTH METRICS AND EVALUATION UNIVERSITY OF WASHINGTON
PUBLIC HEALTH FOUNDATION OF INDIA
A B C E
CCESS, OTTLENECKS, OSTS, AND QUITY
UNITED NATIONS CHILDREN’S FUND
HE ALTH SERVICE PROVISION IN M AD HYA P R AD E SH
Assessing Facility Capacity, Costs of Care, and Patient Perspectives
A B C E
CCESS, OTTLENECKS, OSTS, AND QUITY
Table of Contents 5 Acronyms
6
Terms and definitions
11
Introduction
18
Main findings Health facility profiles
8
13
Executive summary
ABCE project design
Facility capacity and characteristics Patient perspectives Efficiency and costs
50 Conclusions and policy implications 56 Annex
INSTITUTE FOR HEALTH METRICS AND EVALUATION UNIVERSITY OF WASHINGTON
PUBLIC HEALTH FOUNDATION OF INDIA
UNITED NATIONS CHILDREN’S FUND
About Public Health Foundation of India The Public Health Foundation of India (PHFI) is a public-private initiative to build institutional capacity in India for
strengthening training, research, and policy development for public health in India. PHFI adopts a broad, integrative
approach to public health, tailoring its endeavors to Indian conditions and bearing relevance to countries facing similar
challenges and concerns. PHFI engages with various dimensions of public health that encompass promotive, preventive,
Collaborations This project has immensely benefitted from the key inputs and support from the Madhya Pradesh (MP) state
government. Approvals and valuable support for this project were received from the Madhya Pradesh state government
and district officials, which are gratefully acknowledged.
and therapeutic services, many of which are often lost sight of in policy planning as well as in popular understanding.
About IHME
About this report
The Institute for Health Metrics and Evaluation (IHME) is an independent global health research center at the University
Assessing Facility Capacity, Costs of Care, and Patient Perspectives: Madhya Pradesh provides a comprehensive as-
of Washington that provides rigorous and comparable measurement of the world’s most important health problems and
sessment of health facility performance in Madhya Pradesh, including facility capacity for service delivery, efficiency of
the evidence they need to make informed decisions about how to allocate resources to best improve population health.
through the ABCE project in Madhya Pradesh, which aims to collate and generate the evidence base for improving the
evaluates the strategies used to address them. IHME makes this information freely available so that policymakers have
service delivery, and patient perspectives on the service they received. Findings presented in this report were produced
cost-effectiveness and equity of health systems. The ABCE project in Madhya Pradesh is funded by UNICEF through a grant from AusAID. The ABCE project in India is funded through the Disease Control Priorities Network (DCPN), which is a
multi-year grant from the Bill & Melinda Gates Foundation to comprehensively estimate the costs and cost-effectiveness of a range of health interventions and delivery platforms.
About UNICEF The United Nations Children’s Fund (UNICEF) works in 190 countries and territories to protect the rights of every
child. UNICEF has spent 70 years working to improve the lives of children and their families. Defending children’s rights
throughout their lives requires a global presence, aiming to produce results and understand their effects. UNICEF in India is fully committed to working with the Government of India to ensure that each child born in this country gets the best start in life, thrives, and develops to his or her full potential.
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Acknowledgments
Acronyms
We especially thank all of the health facilities and their staff in Madhya Pradesh, who generously gave of their time
ABCE
Madhya Pradesh, especially the Principal Secretary, Health Commissioner, Mission Director and Deputy Director Child
ANM
and facilitated the sharing of facility data that made this study possible. Our special thanks to the Government of
Health, Rajashree Bajaj. We are also most appreciative of patients of the facilities who participated in this work, as they too
were giving of their time and were willing to share their experiences with the field research team.
At PHFI, we wish to thank Rakhi Dandona and Lalit Dandona, who served as the principal investigators for the ABCE
project in India. We also wish to thank G. Anil Kumar for guidance with data collection, management, and analysis. The
quantity and quality of the data collected for the ABCE project in India is a direct reflection of the dedication of the field
team. We thank the India field coordination team, which included Md. Akbar, G. Mushtaq Ahmed, and S.P. Ramgopal. We also recognize and thank Venkata Srinivas, Amit Kumar, Simi Chacko, and Ranjana Kesarwani for data management and
ANC
AusAID CH
CHC
DCPN
we thank those at IHME who supported publication management, editorial support, writing, and design: Joan Williams,
Adrienne Chew, and Michaela Loeffler.
At Bhopal field office of UNICEF, we wish to thank health specialists Gagan Gupta and Vandana Bhatia, who played
a critical role in coordinating with state and district government through the entire duration of the project. We are also
thankful to support from Syed Hubbe Ali and Rahul Bhadoria who supported coordination with district teams.
This report was drafted by Marielle Gagnier, Lauren Hashiguchi, and Nikhila Kalra of IHME and Rakhi Dandona
Community health centre
Disease Control Priorities Network
Directly observed therapy, short-course
MP
to the project: Michael Hanlon, Santosh Kumar, Herbie Duber, Kelsey Bannon, Aubrey Levine, and Nancy Fullman. Finally,
Civil hospital
DOTS
DH
We also recognize and thank data analysts and Post-Bachelor Fellows at IHME: Roy Burstein, Alan Chen, Emily Dansereau, vey updates, data transfer, and ongoing verification at IHME during fieldwork. We are grateful to others who contributed
Auxiliary nurse midwife
Australian Agency for International Development
Data envelopment analysis
IHME
Katya Shackelford, Alexander Woldeab, Alexandra Wollum, and Nick Zyznieuski for managing survey programming, sur-
Antenatal care
DEA
coordination with field teams.
At IHME, we wish to thank Christopher Murray and Emmanuela Gakidou, who served as the principal investigators.
Access, Bottlenecks, Costs, and Equity
IPHS
District hospital
Institute for Health Metrics and Evaluation Indian Public Health Standards Madhya Pradesh
NCD
Non-communicable diseases
PHFI
Public Health Foundation of India
SHC
Sub health centre
PHC SFA STI
UNICEF
WHO
Primary health centre
Stochastic frontier analysis
Sexually transmitted infection
United Nations Children’s Fund
World Health Organization
and G. Anil Kumar of PHFI.
Funding for this research comes from the Bill & Melinda Gates Foundation under the Disease Control Priorities
Network (DCPN), and from UNICEF, provided by AusAID.
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A B C E I N M A D H YA P R A D E S H
TERMS AND DEFINITIONS
Terms and definitions
Definitions presented for key technical terms used in the report. Constraint
a factor that facilitates or hinders the provision of or access to health services. Constraints exist as both “supply-side,” or
the capacity of a health facility to provide services, and “demand-side,” or patient-based factors that affect health-seeking behaviors (e.g., distance to the nearest health facility, perceived quality of care received from providers).
Table 1 defines the types of health facilities in Madhya Pradesh; this report will refer to facilities according to these definitions.
Table 1 Health facility types in Madhya Pradesh1 Health facility types in Madhya Pradesh
Data Envelopment Analysis (DEA)
an econometric analytic approach used to estimate the efficiency levels of health facilities.
District hospital (DH)
This type of facility is the secondary referral level for a given district. Its objective is to provide comprehensive
Efficiency
a measure that reflects the degree to which health facilities are maximizing the use of the resources available in producing services.
secondary health care services to the district’s population. DHs are sized according to the size of the district population, so the number of beds varies from 75 to 500. Civil hospital (CH)
Facility sampling frame
the list of health facilities from which the ABCE sample was drawn. This list was based on a 2012–2013 facility inventory published by the Madhya Pradesh state government.
These facilities are sub-district/sub-divisional hospitals below the district and above the block level hospitals (CHC). As First Referral Units, they provide emergency obstetrics care and neonatal care. These facilities serve populations of 500,000 to 600,000 people and have a bed count varying between 31 and 100.
Inpatient visit
a visit in which a patient has been admitted to a facility. An inpatient visit generally involves at least one night spent at the
facility, but the metric of a visit does not reflect the duration of stay.
Community health centre (CHC)
These facilities constitute the secondary level of health care and were designed to provide referral as well as
specialist health care to the rural population. They act as the block-level health administrative unit and as the gatekeeper for referrals to higher-level facilities. Bed strength ranges up to 30 beds.
Inputs
tangible items that are needed to provide health services, including facility infrastructure and utilities, medical supplies and equipment, and personnel.
Primary health centre (PHC)
These facilities provide rural health services. PHCs serve as referral units for primary health care from Sub-Centres
and refers cases to CHCs and higher-order public hospitals. Depending on the needs of the region, PHCs may
Outpatient visit
a visit at which a patient receives care at a facility without being admitted. Outputs
volumes of services provided, patients seen, and procedures conducted, including outpatient and inpatient care, laboratory and diagnostic tests, and medications.
be upgraded to provide 24-hour emergency hospital care for a number of conditions. A typical PHC covers a population of 20,000 to 30,000 people and hosts about six beds. Sub health centre (SHC)
Along with PHCs, these facilities provide rural health care. SHCs typically provide outpatient care, which includes immunizations, and refer inpatient care and deliveries to higher-level facilities.
Platform
a channel or mechanism by which health services are delivered. Stochastic Frontier Analysis (SFA)
1 Directorate General of Health Services, Ministry of Health & Family Welfare, and Government of India. Indian Public Health Standards (IPHS) Guidelines. New Delhi, India: Government of India, 2012.
an econometric analytic approach used to estimate the efficiency levels of health facilities.
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EXECUTIVE SUMMARY
Executive summary
facilities reported providing a given service but lacked
Lower-level facilities tended to employ more para- and
full capacity to properly deliver it, for instance lacking
non-medical staff than nurses or doctors.
functional equipment or medications. For example,
• Staff numbers were concentrated at district hospi-
while nearly all hospitals reported providing routine
tals. Civil hospitals had the second highest number
delivery care, only 29% of district hospitals and 7% of
of personnel, but this was a quarter of that at district
civil hospitals were fully equipped to do so. Discor-
hospitals. Health centres averaged between 2 and 28
dances like these have substantial programmatic and
W
ith the aim of establishing universal health
and comparison of facility-level outputs, efficiency, capac-
coverage, India’s national and state gov-
ity and patient experiences. It is with this information that
ernments have invested significantly in
we strive to provide the most relevant and actionable in-
expanding and strengthening the public
formation for health system programming and resource
health care sector. This has included a particular com-
allocation in Madhya Pradesh.
mitment to extending its reach to rural populations and reducing disparities in access to care for marginalized
Facility capacity for service provision
sary for the country to critically consider the full range of
While most facilities report providing key health services, significant gaps in capacity were identified between reported and functional capacity for care.
groups. However, in order to realize this goal, it is neces-
factors that contribute to or hinder progress towards it.
Since its inception in 2011, the Access, Bottlenecks,
Costs and Equity (ABCE) project has sought to compre-
• Health facilities generally reported a high availability
hensively identify what and how components of health
service provision- access to services, bottlenecks in de-
of a subset of key services. Services such as antenatal
health system performance in several countries. Through
vices were widely available across facilities.
care, routine deliveries, general medicine, and lab ser-
livery, costs of care, and equity in care received- affect the ABCE project, multiple sources of data, including
• Few facilities reported available services for non-com-
facility surveys and patient exit interviews, are linked
municable diseases (NCDs). Just over half of district
together to provide a nuanced picture of how facili-
hospitals reported providing cardiology (53%), but
ty-based factors (supply-side) and patient perspectives (demand-side) influence optimal service delivery.
and the Institute for Health Metrics and Evaluation (IHME),
the country’s drivers of health care access and costs of
at all health facility levels, but laboratory equipment
and blood pressure apparatus were widely available
care. Derived from a state representative sample of 203
such as glucometers and blood chemistry analyzers
were less readily available at lower facility levels. For example, over a quarter of community health centres
governments, international agencies, and development
and nearly half of primary health centres did not have
partners alike with actionable information that can help
glucometers. This shows limited capacity for testing in
identify areas of success and targets for improving health
the health system, with particular implications for diag-
service provision.
nosing and treating NCDs.
The main topical areas covered in this report move
from an assessment of facility-reported capacity for care,
• Gaps also emerged with regard to imaging equipment
to quantifying the services actually provided by facilities
across health facilities. 40% of civil hospitals had a
and the efficiency with which they operate; tracking facil-
functional ultrasound, and CT scans were available in
ity expenditures and the costs associated with different
just 29% of district hospitals.
types of service provision; and comparing patient per-
• A service capacity gap emerged for the majority of
spectives of the care they received across different types
health facilities across several types of services. Many
of facility. Further, we provide an in-depth examination
8
Facility production of health services
Physical infrastructure of health facilities has improved, but gaps in transport and communication remain.
The number of outpatient visits produced by facilities has remained stable over time, while inpatient visits have increased slightly.
• Functional electricity was available at all hospitals
• Between 2008 and 2012, the average number of out-
and community health centres, and the large major-
patient visits remained stable. Civil hospitals had
ity (94%) of primary health centres. 43% of sub health
nearly triple the outpatient visits of community health
centres had electricity, showing substantial improve-
centres, while primary health centres had ten times the
ment on figures from past government surveys.
visits of sub health centres.
• Access to piped water was generally high at hospi-
• Inpatient visits increased for all facility types between
tals (100%), though much lower at primary and sub
2008 and 2012.
health centres (33% and 9% respectively). Similarly,
• The number of immunization doses administered
while there was universal availability of flush toilets
between 2008 and 2012 remained stable for all
at hospitals, they were available at 69% of sub health
centres. These figures reflect investments into improv-
facility types.
some discrepancies remain between high and low-
Facilities showed capacity for larger patient volumes given observed resources.
level facilities.
tioned to inform the evidence-base for understanding
facilities, the findings presented in this report provide
a full range of services.
health system.
• Basic medical equipment such as scales, stethoscopes,
relative shortages in human resources for health.
ing facilities have all the supplies they need to provide
ing physical infrastructure at health facilities, though
the ABCE project in Madhya Pradesh is uniquely posi-
provision and population size, this also demonstrates
Pradesh, highlighting continued challenges in ensur-
few provided psychiatry (6%) or chemotherapy (6%), and availability decreased at lower levels of the
Led by the Public Health Foundation of India (PHFI)
staff. While some of this variation is a result of service
policy implications for the health system in Madhya
• In generating estimates of facility-based efficiency, or
• 28% of primary health centres had access to a com-
the alignment of facility resources with the number of
puter, and only 9% had access to a phone. Access
patients seen or services produced, we found a wide
to emergency vehicles was relatively high at district
range of efficiency levels within and across facility
hospitals (94%), civil hospitals (73%) and community
types. The average efficiency score of district hospitals
health centres (59%), but much lower at primary health
ranged from 73% to 88%, with a platform average of
centres (4%). Given that these types of facilities often
78%. Civil hospitals were between 57% and 72% effi-
play key referral functions, these findings have serious
cient. Community health centres were between 39%
implications for coordinating the care and transporta-
and 79% efficient. The range of efficiency scores for
tion of patients.
primary health centres was from 22% to 49%.
Nurses were the most common medical staff at district hospitals, while at other facility types para-medical staff outnumbered both doctors and nurses.
• If they operated at optimal efficiency, district hospitals
nurses than doctors, and district hospitals in particular
• These efficiency scores indicate that there is consid-
could provide 42,684 additional outpatient visits with
the same inputs (including physical capital and personnel), while primary health centres could produce
10,576 additional outpatient visits.
• In general, hospitals reported that they staffed more
employed high proportions of non-medical personnel.
9
erable room for health facilities to expand service
els of satisfaction than those treated by doctors. The
production given their resources existing resources.
opposite tended to be true of community and primary
Future work on pin-pointing specific factors that
health centres. Satisfaction with both doctors and
heighten or hinder facility efficiency, and how effi-
Introduction
nurses was highest at district hospitals, and lower at
ciency is related to the quality of service provision,
civil hospitals and health centres.
should be considered.
• Similar proportions of patients (52%-57%) were satisfied with the cleanliness at the facility they visited at all facility types-- except sub health centres, which
Costs of care
received particularly low ratings (13% satisfied with cleanliness). Similar trends were observed for privacy.
Trends in average facility spending between 2008 and 2012 varied between facility types, though all platforms recorded higher spending in 2012 than 2008.
• The vast majority of patients received all drugs that they were prescribed during their visits. Proportions
of patients receiving all prescribed drugs ranged from
98-100% across all platforms.
• Spending on personnel accounted for the majority
T
he performance of a country’s health sys-
questions facing policymakers and health stakeholders in
tem ultimately shapes the health outcomes
each country or state for public sector health care service
experienced by its population, influencing
delivery:
the ease or difficulty with which individuals
• What health services are provided, and where
can seek care and facilities can address their needs. At a
are they available?
time when international aid is plateauing1 and the gov-
• What are the bottlenecks in provision of
ernment of India has prioritized expanding many health
these services?
programs,2,3 identifying health system efficiencies and
• How much does it cost to produce health services?
promoting the delivery of cost-effective interventions has
of annual spending across facility types. Community
health centres spent a slightly lower proportion of their
With its multidimensional assessment of health ser-
total expenditures on personnel than other platforms,
vice provision, findings from the ABCE project in Madhya
while the proportion of expenditure on medical sup-
Pradesh provide an in-depth examination of health facility
plies was highest at primary health centres.
become increasingly important.
• How efficient is provision of these health services?
Assessing health system performance is crucial to opti-
Findings from each country’s ABCE work will pro-
mal policymaking and resource allocation; however, due
capacity, costs of care, and how patients view their inter-
to the multidimensionality of health system functions,4
vide actionable data to inform their own policymaking
provision landscape was markedly heterogeneous, and
Rigorously measuring what factors are contributing to or
analyses will likely yield more global insights into health
the need for continuous and timely assessment of health
bottlenecks in service delivery, costs of care, and equity in
countries have been purposively selected for the overar-
successful implementation and quickly responding to
information for improving service delivery and popula-
system structures, composition of providers (public and
actions with the health system. Madhya Pradesh’s health
processes and needs. Further, ongoing cross-country
comprehensive and detailed assessment seldom occurs.
Patient perspectives
will likely continue to evolve over time. This highlights
hindering health system performance – access to services,
service delivery and costs of health care. These eight
Travel and wait times were generally shorter for patients visiting lower-level facilities than higher-level ones.
service delivery, which is critical for identifying areas of
service provision throughout a country – provides crucial
ching ABCE project as they capture the diversity of health
service disparities or faltering performance. Expanded
analyses would also allow for an even clearer picture of
• Most patients had travel times of less than 30 min-
tion health outcomes.
private), and disease burden profiles. The ABCE project
and capacity for health service provision, aiming to de-
utes to a facility for care, and travel times were shorter
the trends and drivers of facility capacity, efficiencies,
project was launched globally in 2011 to address these
higher-level ones; 42% of patients who went to district
data, capturing information from health facilities, recipi-
pronged, multi-partner ABCE project has taken place in
sub-health centres traveled for that long.
yield the evidence base to make informed decisions for
Kenya, Lebanon, Uganda, and Zambia). In India, the ABCE
uitable provision of cost-effective interventions throughout
and Telangana, Gujarat, Madhya Pradesh, Odisha, and
for patients seeking care at lower-level facilities than
and costs of care. With regularly collected and analyzed
hospitals traveled more than 30 minutes, while none at
ents of care, policymakers, and program managers can
achieving optimal health system performance and the eq-
• The large majority of patients waited less than 30 minutes to receive care at all platforms, and nearly all
Madhya Pradesh.
patients seeking care at community health centres
(94%) and primary health centres (97%) received care
contributes to the global evidence base on the costs of
The Access, Bottlenecks, Costs, and Equity (ABCE)
gaps in information. In addition to India, the multi-
velop data-driven and flexible policy tools that can be
seven other countries (Bangladesh, Colombia, Ghana,
velopment partners, and international agencies.
project was undertaken in six states – Andhra Pradesh
Institute for Health Metrics and Evaluation (IHME) com-
Tamil Nadu.
received vital support and inputs from the state Ministry
adapted to the particular demands of governments, deThe Public Health Foundation of India (PHFI) and the
pose the core team for the ABCE project in India, and they
of Health and Family Welfare for data collection, analysis,
The ABCE project, with the goal of rigorously assessing
and interpretation. The core team harnessed information
the drivers of health service delivery across a range of set-
within 30 minutes. At district hospitals, 21% of patients
from distinct but linkable sources of data, drawing from
tings and health systems, strives to answer these critical
waited more than 30 minutes to receive care.
a state-representative sample of health facilities to create a large and fine-grained database of facility attributes, expenditure, and capacity, patient characteristics, and
1 Institute for Health Metrics and Evaluation (IHME). Financing Global Health 2015: Development assistance steady on the path to new Global Goals. Seattle, WA: IHME, 2016. 2 Planning Commission Government of India. Eleventh Five Year Plan (2007-12). New Delhi, India: Government of India, 2007. 3 Planning Commission Government of India. Twelfth Five Year Plan (2012-17). New Delhi, India: Government of India, 2012. 4 Murray CJL, Frenk J. A Framework for Assessing the Performance of Health Systems. Bulletin of the World Health Organization. 2000; 78 (6): 717-731.
Patients gave higher ratings of health care providers than facility characteristics, particularly cleanliness
• At hospitals, patients receiving care from nurses or
auxiliary nurse midwives reported relatively higher lev-
10
outcomes. By capturing the interactions between facility characteristics and patient perceptions of care, we have
been able to piece together what factors drive or hinder
optimal and equitable service provision in rigorous, da-
ta-driven ways.
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A B C E I N M A D H YA P R A D E S H
We focus on the facility because health facilities are the
consider the factors that affect patient perceptions of and
the health system or receive care. Understanding the ca-
range of factors that influence health service delivery, we
experiences with state’s health system. By considering a
main points through which most individuals interact with
ABCE project design
have constructed a nuanced understanding of what helps
pacities and efficiencies within and across different types
and hinders the receipt of health services through facili-
of public sector health facilities unveils the differences in
health system performance at the level most critical to
ties in the state of Madhya Pradesh.
immensely valuable to governments and development
haustive; rather, they align with identified priorities for
The results discussed in this report are far from ex-
patients – the facility level. We believe this information is
health service provision and aim to answer questions
partners, particularly for decisions on budget alloca-
tions. By having data on what factors are related to high
about the costs of health care delivery in the respective
icymakers and development partners can then support
tion of health facility capacity across different platforms,
state in India. This report provides an in-depth examina-
facility performance and improved health outcomes, pol-
specifically covering topics on human resource capacity,
evidence-driven proposals and fund the replication of
facility-based infrastructure and equipment, health ser-
these strategies at facilities throughout India.
vice availability, patient volume, facility-based efficiencies,
The ABCE project in India has sought to generate the
costs associated with service provision, and demand-side
evidence base for improving the cost-effectiveness and
factors of health service delivery as captured by patient
equity of health service provision. In this report, we ex-
exit interviews.
amine facility capacity across platforms, as well as the
Table 2 defines the cornerstone concepts of the ABCE
efficiencies and costs associated with service provision for
project: Access, Bottlenecks, Costs, and Equity.
each type of facility. Based on patient exit interviews, we
F
ABCE Facility Survey
or the ABCE project in India, we conducted
primary data collection through a two-
Through the ABCE Facility Survey, direct data collec-
pronged approach:
tion was conducted from a state-representative sample of
health service platforms and captured information on the
1. A comprehensive facility survey administered to a
following indicators for the five fiscal years (running from
representative sample of health facilities in select
April to March of the following year) prior to the survey:
states in India (the ABCE Facility Survey).
• Inputs: the availability of tangible items that are
2. Interviews with patients as they exited the
needed to provide health services, including in-
sampled facilities.
frastructure and utilities, medical supplies and equipment, pharmaceuticals, personnel, and
Here, we provide an overview of the ABCE sur-
non-medical services.
vey design and primary data collection mechanisms.
All ABCE survey instruments are available online at
• Finances: expenses incurred, including spending on
http://www.healthdata.org/dcpn/india.
infrastructure and administration, medical supplies
and equipment, pharmaceuticals including vaccines,
and personnel. Facility funding from different sources
Table 2 Access, Bottlenecks, Costs, and Equity
(e.g., central and state governments) and revenue
from service provision were also captured.
Access, Bottlenecks, Costs, and Equity
• Outputs: volume of services and procedures pro-
Access
duced, including outpatient and inpatient care,
Health services cannot benefit populations if they cannot be accessed; thus, measuring which elements are
emergency care, and laboratory and diagnostic tests.
driving improved access to – or hindering contact with – health facilities is critical. Travel time to facilities, user
• Supply-side constraints and bottlenecks: factors
fees, and cultural preferences are examples of factors that can affect access to health systems.
that affected the ease or difficulty with which patients received services they sought, including bed
Bottlenecks
availability, pharmaceutical availability and stockouts,
Mere access to health facilities and the services they provide is not sufficient for the delivery of care to popula-
cold-chain capacity, personnel availability, and
tions. People who seek health services may experience supply-side limitations, such as medicine stockouts, that
service availability.
prevent the receipt of proper care upon arriving at a facility.
Table 3 provides more information on the specific
indicators included in the ABCE Facility Survey.
Costs
Health services cost can translate into very different financial burdens for consumers and providers of such care. Thus, the ABCE project measures these costs at several levels, quantifying what facilities spend to provide services. Equity
Various factors influence how populations interact with a health system. The nature of these interactions either facilitates or obstructs access to health services. In addition to knowing the cost of scaling up a given set of
services, it is necessary to understand costs of scale-up for specific populations and across population-related factors (e.g., distance to health facilities). The ABCE project aims to pinpoint which factors affect the access to and use of health services and to quantify how these factors manifest.
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A B C E I N M A D H YA P R A D E S H
Table 3 Modules included in the ABCE Facility Survey in India SURVEY MODULE Module 1: Facility finances and inputs
SURVEY CATEGORY
KEY INDICATORS AND VARIABLES
Inputs
Input funding sources, managing authority and maintenance information Availability and functionality of medical and non-medical equipment
Finances
Salary/wages, benefits, and allowances Total expenses for infrastructure and utilities; medical supplies and equipment; pharmaceuticals; administration and training; non-medical services, personnel (salaries and wages, benefits, allowances) Performance and performance-based financing questions
Revenue
User fees; total revenue and source
Personnel characteristics
Total personnel by cadre Funding sources of personnel Health services provided and their staffing; administrative and support services and their staffing
Module 2: Facility management and direct observation
Facility management and infrastructure characteristics
Characteristics of patient rooms; electricity, water, and sanitation Facility meeting characteristics Guideline observation
Direct observation
Latitude, longitude, and elevation of facility. Facility hours, characteristics, and location; waiting and examination room characteristics
Facility capacity
Lab-based tests available
Medical consumables and equipment
Lab-based medical consumables and supplies available
Module 4: Pharmaceuticals
Facility capacity
Drug availability and stockout information
Module 5: General medical consumables, equipment, and capacity
Medical consumables and equipment
Availability and functionality of medical furniture, equipment, and supplies
Module 6: Facility outputs
Facility capacity
Fund and vehicle availability for referral and emergency referral
General service provision
Inpatient care and visits; outpatient care and visits; emergency visits; home or outreach visits
Module 3: Lab-based consumables, equipment, and capacity
A B C E P R OJ E CT D E S I G N
Sample design
Figure 1 Sampled districts in Madhya Pradesh
A total of 17 districts in Madhya Pradesh were selected
for the ABCE survey (Figure 1). The districts were selected
using three strata to maximize heterogeneity: proportion of full immunization in children aged 12–23 months as an
indicator of preventive health services; proportion of safe delivery (institutional delivery or home delivery assisted
by skilled person) as an indicator of acute health services;
and proportion of urban population as an indicator of
overall development. The districts were grouped as high
and low for urbanization based on median value, and into
three equal groups as high, medium, and low for the safe delivery and full immunization indicators. Sixteen districts
were selected randomly from each of the various combinations of indicators, and in addition the capital district
was selected purposively.
Within each sampled district, we then sampled pub-
lic sector health facilities at all levels of services based
on the structure of the state health system (Figure 2).
Figure 2 Sampling strategy for health facilities in a district in the ABCE survey in India
Inventory of procedures for sterilization, sharp items, and infectious waste Inventory of personnel
Laboratory and diagnostic tests Module 7: Vaccines
Facility procedures for vaccine supply, delivery and disposal
Source from vaccine obtained Personnel administering vaccine Procedures to review adverse events Disposal of vaccines
Vaccine availability, storage, and output
Stock availability and stockouts of vaccines and syringes Types and functionality of storage equipment for vaccines Temperature chart history; vaccine inventory and vaccine outputs; vaccine outreach and home visits Vaccine sessions planned and held
14
Selected facilities are in blue; unselected facilities from the sampling frame are in grey. DH: District hospital; CH: Civil hospital; CHC: Community health centre; PHC: Primary health centre; SHC: Sub health centre
15
A B C E I N M A D H YA P R A D E S H
A B C E P R OJ E CT D E S I G N
Data collection for the ABCE survey in MP
Table 4 Types of questions included in the Patient Exit Interview Survey in India SURVEY CATEGORY
Data collection took place from January to June 2014.
TYPES OF KEY QUESTIONS AND RESPONSE OPTIONS
Direct observation of patient
Sex of patient (and of patient’s attendant if surveyed)
Direct interview with patient
Demographic questions (e.g., age, level of education attained, caste)
Prior to survey implementation, PHFI and the data-collec-
tion agency hosted a two-week training workshop for 50 interviewers, where they received extensive training on
Scaled-response satisfaction scores (e.g., satisfaction with medical doctor)
the electronic data collection software (DatStat and Sur-
Open-ended questions for circumstances and reasons for facility visit, as well as visit characteristics (e.g., travel time to facility) Reporting costs associated with facility visit (user fees, medications, transportation, tests, other), with an answer of “yes” prompting follow-up questions pertaining to amount
veybe), the survey instruments, the MP health system’s organization, and interviewing techniques. Following this
workshop, a one-week pilot of all survey instruments took place at health facilities. Ongoing training occurred on an
as-needed basis throughout the course of data collection. All collected data went through a thorough verification
process between PHFI and IHME and the ABCE field team.
Following data collection, the data were methodically
Table 5 Facility sample, by platform, for the ABCE project in Madhya Pradesh
In each sampled district, one district hospital (DH); one civil hospital (CH, from a total of two or three) for each
sampled DH; two community health centres (CHC, from
a total of two to five) for each sampled CH; two primary
FACILITY TYPE
health centres (PHC, from a total of two to four) for each
FINAL SAMPLE
sampled CHC; and one sub centre (SHC, from a total of
District hospital
17
lected for the study. Some of the sampled districts did
Civil hospital
15
one; all available CHs in sampled districts were sampled.
Community health centre
34
Primary health centre
69
interviewed at each facility, based on the expected out-
Sub health centre
68
were interviewed at district hospitals, 16 at CH, 12 at CHC,
Total health facilities
203
one to four) for each sampled PHC were randomly se-
not have a civil hospital and some districts had more than
Patient exit interview survey
A fixed number patients or attendants of patients were
patient density for the platform. A target of 24 patients
cleaned and re-verified, and securely stored in databases
hosted at PHFI and IHME.
A total of 203 health facilities participated in the ABCE
project. Ten facilities were replaced (one CHC, four PHCs,
and five SHCs) due to data being unavailable for the
years considered; the reporting chain of the sampled
facility being incorrect; or the facility being functional for less duration.
10 at PHC and five at SHC. Patient selection was based
on a convenience sample. The main purpose of the Pa-
tient Exit Interview Survey was to collect information on patient perceptions of the health services they received
and other aspects of their facility visit (e.g., travel time
to facility, costs incurred during the facility visit, and satisfaction with the health care provider). Table 4 provides more information on the specific indicators included in
the exit survey. This information fed into quantifying the
“demand-side” constraints to receiving care (as opposed
to the facility-based, “supply-side” constraints and bottlenecks measured by the ABCE Facility Survey).
16
17
M A I N F I N D I N G S : H E A LT H FA C I L I T Y P R O F I L E S
Main findings Health facility profiles T
Table 6 Availability of services in health facilities, by platform DISTRICT HOSPITAL (DH)
CIVIL HOSPITAL (CH)
Total OBGYN services
100%
100%
100%
93%
100%
COMMUNITY HEALTH CENTRE (CHC)
he delivery of facility-based health ser-
Facility capacity and characteristics
Routine births
100%
Emergency obstetrics
100%
93%
100%
resources, ranging from personnel to phys-
Service availability
Antenatal care
100%
100%
100%
Surgical services
100%
80%
76%
Cardiology
53%
0%
3%
Psychiatric
6%
7%
0%
100%
60%
59%
vices requires a complex combination of
ical infrastructure, that vary in their relative
Across and within district hospitals, civil hospitals and
importance and cost to facilities. Determining what fac-
community health centres in MP (Table 6), several nota-
tors support the provision of services at lower costs and
ble findings emerged for facility-based health service
higher levels of efficiency at health facilities is critical in-
provision. While fundamental services such as antenatal
formation for policymakers to expand health system
care, routine deliveries, general medicine, and pharmacy
coverage and functions within constrained budgets.
were nearly universally available, only a few district hos-
Using the ABCE MP facility sample (Table 5), we
pitals reported available services for non-communicable
analyzed five key drivers of health service provision
diseases, such as psychiatry and chemotherapy; only half
at facilities:
reported cardiology. District hospitals reported a wide
• Facility-based resources (e.g., human resources,
range of services such as blood banks, surgical services,
infrastructure and equipment, and pharmaceuticals),
and emergency obstetrics. Civil hospitals generally of-
which are often referred to as facility inputs.
fered fewer services than district hospitals but reported
high coverages of services like OBGYN services, ante-
• Patient volumes and services provided at facilities
natal care, and immunizations. Less than one-quarter of
(e.g., outpatient visits, inpatient bed-days), which are
community health centres reported providing STI/HIV
also known as facility outputs.
treatment and less than a third pediatric medicine.
• Patient-reported experiences, capturing
“demand-side” factors of health service delivery.
Human resources for health
A facility’s staff size and composition directly affect
• Facility alignment of resources and service production,
the types of services it provides. In general, a greater
which reflects efficiency.
availability of health workers is related to higher service
• Facility expenditures and production costs for
utilization and better health outcomes.1 India has a severe
service delivery.
shortage of qualified health workers, and the workforce
is concentrated in urban areas.2 The public health system
These components build upon each other to create a
comprehensive understanding of health facilities in Mad-
has a shortage of both medical and paramedical per-
areas for improvement.
centres without adequate staff is substantially higher if
sonnel. The number of primary and community health
hya Pradesh, highlighting areas of high performance and
high health-worker absenteeism is taken into consider-
ation.3 The Indian Government is aware of the additional requirements and shortages in the availability of health
workers for the future. The National Rural Health Mission,
Accident, trauma, and emergency Ophthalmology
100%
73%
74%
Pediatric
100%
73%
29%
94%
47%
6%
100%
27%
9%
Dentistry
94%
67%
6%
DOTS treatment
94%
93%
82%
STI/HIV
88%
80%
24%
Immunization
100%
100%
88%
Internal/general med
100%
100%
94%
Mortuary
100%
47%
59%
Burns
100%
53%
29%
Orthopedic
100%
40%
3%
Pharmacy
100%
100%
100%
Chemotherapy
6%
0%
NA
Dermatology
53%
13%
NA
Alternative medicine
53%
47%
32%
Diagnostic medical
94%
87%
65%
Laboratory services
100%
100%
100%
53%
67%
59%
General anesthesiology Blood bank
Outreach services
Figure 3 Composition of facility personnel, by platform MP District Hospital
Civil Hospital
Community Health Centre
Primary Health Centre
Sub Health Centre
Doctors
Nurses
Para-medical staff
Non-medical staff
200
250
structure, with substantial increases in personnel at every
tier of the public health system.4
Based on the ABCE sample, we found substantial
heterogeneity across facility types in MP by considering
the total number of staff in the context of bed strength (i.e., number of beds in the facility) and patient load
(Figure 3). Overall, the most common medical staff at
district hospitals were nurses, while at lower levels, para-
medical staff outnumbered doctors and nurses. This is
a reflection of the differential service offerings between higher- and lower-level facilities. Additionally, higher-level
facilities tended to have a greater number of health personnel overall; while a degree of this variation is due to
differences in service provision and population size, some of this indicates relative shortages in human resources
for health.
The volume of human resources across platforms was
on the expected lines, with the greatest number of doc-
tors, nurses, paramedical staff, and non-medical staff
HIGHEST AVAILABILITY
concentrated at the district hospitals, and the least at
the sub-health centres. Civil hospitals reported the sec-
Note: All values represent the percentage of facilities, by platform, that reported offering a given service at least one day during a typical week.
ond highest number of personnel; however, the total
personnel at these facilities was one-quarter of what was
1 Rao KD, Bhatnagar A, Berman P. So many, yet few: Human resources for health in India. Human Resources for Health. 2012; 10(19). 2 Rao M, Rao KD, Kumar AK, Chatterjee M, Sundararaman T. Human resources for health in India. The Lancet. 2011; 377(9765): 587-98. 3 Hammer J, Aiyar Y, Samji S. Understanding government failure in public health services. Economic and Political Weekly. 2007; 42: 4049–58.
18
150 100 Number of Staff
for instance, recommends a vastly strengthened infra-
NA: Not applicable to this platform according to standards. LOWEST AVAILABILITY
50
0
reported by district hospitals. Community health centres 4 National Rural Health Mission. Ministry of Health and Family Welfare, Government of India. Mission Document (2005-2012). New Delhi, India: Government of India, 2005.
19
A B C E I N M A D H YA P R A D E S H
Figure 4 Nurse to doctor ratio, by platform
M A I N F I N D I N G S : H E A LT H FA C I L I T Y P R O F I L E S
Figure 5 Ratio of nurses and doctors to paramedical and non-medical staff, by platform
Table 7 Availability of physical capital, by platform DISTRICT HOSPITAL (DH)
CIVIL HOSPITAL (CH)
Functional electricity
100%
100%
100%
94%
43%
Piped water
100%
100%
76%
33%
9%
Flush toilet
100%
100%
85%
91%
69%
94%
100%
94%
91%
71%
100%
80%
79%
6%
NA
94%
73%
59%
4%
NA
0%
40%
56%
9%
NA
100%
87%
94%
28%
NA
Hand disinfectant Any 4-wheeled vehicle Emergency 4-wheeled vehicle Landline phone 0
2
4
6
8
10
0
4
2
6
District Hospital
Civil Hospital
District Hospital
Civil Hospital
Community Health Centre
Primary Health Centre
Community Health Centre
Primary Health Centre
Vertical bars represent the platform average ratio.
8
10
Vertical bars represent the platform average ratio.
Computer
COMMUNITY HEALTH CENTRE (CHC)
PRIMARY HEALTH CENTRE (PHC)
SUB HEALTH CENTRE (SHC)
NA: Not applicable to this platform according to standards. LOWEST AVAILABILITY
HIGHEST AVAILABILITY
Note: Values represent the percentage of facilities, by platform, that had a given type of physical capital
Nurses and doctors to paramedical and non-medical staff
maintained a smaller body of health workers, an average
total of 28, with most workers reported to be paramedical staff. Primary health centres reported, on average, seven
The ratio of number of nurses and/or doctors to num-
staff. Finally, sub-health centres reported the lowest num-
health workers in total, most of which were paramedical
care, and community outreach.
is presented in Figure 5. A ratio greater than 1 indicates
volumes than others, and thus “achieving” staffing tar-
tial components of physical capital: power supply, water
non-medical personnel; for instance, a ratio of 2 indicates
patient loads. While an overstaffed facility has a different
with the latter composed of laboratory, imaging, and
a poor alignment of facility resources and patient needs.
physical capital, excluding medical equipment, available
that there are two nurses and/or doctors staffed for every one paramedical/non-medical staff. Alternatively, a ratio
Nurses to doctor ratio
The ratio of number of nurses to number of doctors
that nurses outnumber doctors; for instance, a ratio of 2
doctors outnumber nurses; for instance, a ratio of 0.5 indicates there is one nurse staffed for every two doctors.
In general, district hospitals reported a high ratio, indi-
cating that they staff more nurses than doctors. However,
the ratio reported by various district hospitals ranged
ty’s capacity (inputs) in the context of its patient volume
more nurses than doctors, and half had more doctors
Power supply
All hospitals and community health centres reported
and services (outputs). We further explore these find-
access to a functional electrical supply. Among smaller
ings in the “Efficiency and costs” section. As part of the
facilities, 6% of primary health centres and 57% of sub
Community health centres were quite homogenous, re-
services. In this report, we primarily focus on the delivery
ported solely relying on a generator for power.
ratios that ranged from 0.1 to 0.5. Primary health centres
includes doctors, nurses, and other paramedical staff. It
the availability of electricity at the lowest platform level
doctors and nurses, with all but two facilities reporting a
vice provision, especially at lower levels of care, but the
centres had a regular electric supply. 5 However, inade-
medical and non-medical staff, with an average of 0.4.
staffing with the production of different types of health
health centres lacked functional electricity. No facilities re-
porting an average ratio of 0.3, with facilities reporting
of health services by skilled medical personnel, which
These results demonstrate some improvement in
In isolation, facility staffing numbers are less meaning-
health centres, with ratios ranging from 0.1 to 6. Finally, all
across platforms.
areas to improve costs, it is important to assess a facili-
ABCE project in India, we compare levels of facility-based
ratio less than 0.7.
than nurses. There was heterogeneity among community
other medical equipment. Table 7 illustrates the range of
had the next highest ratio of nurses and doctors to para-
employ more paramedical and non-medical staff than
from 0.7 to 9.9. About half of civil hospitals reported
and sanitation, transportation, and medical equipment,
set of challenges than an understaffed one, each reflects
Most district hospitals reported ratios greater than
tal reported ratios less than or equal to 1. Civil hospitals
doctor. Alternatively, a ratio lower than 1 indicates that
(physical capital). In this report, we focus on four essen-
gets could leave them with an excess of personnel given
To better understand bottlenecks in service delivery and
1, ranging from 0.5 to 1.7. All levels below district hospi-
indicates that there are two nurses staffed for every one
Further, some facilities may have much smaller patient
lower than 1 indicates that paramedical and/or non-medical personnel outnumber nurses and/or doctors.
is presented in Figure 4. A ratio greater than 1 indicates
Health service provision depends on the availability of
adequate facility infrastructure, equipment, and supplies
that nurses and doctors outnumber paramedical and
personnel who perform immunizations, simple outpatient
administration, failing to achieve the doctor staffing target may be less important than having too few nurses.
ber of paramedical and/or non-medical staff in 2012
ber of staff, with only two paramedical and non-medical
Infrastructure and equipment
cility mostly offers services that do not require a doctor’s
is possible that non-medical staff also contribute to ser-
compared to 2007–2008, when only 7% of sub health
ABCE project in India is not currently positioned to ana-
quate access to consistent electric power has substantial
lyze these scenarios.
ful without considering a facility’s overall patient volume
primary health centres reported fewer or the same num-
5 International Institute for Population Sciences (IIPS). District Level Household and Facility Survey (DLHS-3), 2007-08: India, Madhya Pradesh. Mumbai, India: IIPS, 2010.
and production of specific services. For instance, if a fa-
ber of nurses staffed as doctors.
20
21
A B C E I N M A D H YA P R A D E S H
care facilities.6 Table 8 illustrates the distribution of SARA
implications for health service provision, particularly
scores across platforms. In general, hospitals had greater
for the effective storage of medications, vaccines, and
M A I N F I N D I N G S : H E A LT H FA C I L I T Y P R O F I L E S
Table 8 Availability of functional equipment, by platform
availability of medical equipment, and notable deficits in
blood samples.
DISTRICT HOSPITAL
essential equipment availability were found in the lower
Water and sanitation
There was a high availability of improved sanitation.
functional piped water. All hospitals, 85% of community
Wheelchair
100%
93%
100%
88%
NA
Adult scale
100%
100%
100%
96%
94%
Child scale
100%
100%
100%
96%
91%
Blood pressure apparatus
100%
100%
100%
100%
94%
Stethoscope
100%
100%
100%
99%
85%
a microscope to use them with. Additional testing capac-
Light source
100%
93%
82%
65%
38%
across lower platforms. For instance, 100% of district
Glucometer
100%
80%
74%
52%
NA
Test strips for glucometer
100%
80%
82%
58%
NA
Hematologic counter
100%
73%
47%
22%
NA
Blood chemistry analyzer
100%
67%
56%
10%
NA
Incubator
94%
80%
56%
13%
NA
Centrifuge
100%
100%
91%
36%
NA
Microscope
100%
100%
97%
52%
NA
Slides
100%
100%
100%
100%
99%
diabetes, for which this equipment is necessary. District
Slide covers
100%
100%
94%
87%
93%
with the notable exception of CT scans, which were avail-
X-ray
100%
80%
74%
NA
NA
ECG
100%
53%
29%
NA
NA
Ultrasound
88%
40%
3%
NA
NA
CT scan
29%
NA
NA
NA
NA
prevalent among all facilities, except at primary health
of sub health centres. Hand disinfectant was broadly
centres, where all had slides but almost half did not have
available as a supplementary sanitation method at most platform levels, though again was less available in sub
ity was relatively high at district hospitals but declined
health centres. Access to piped water declined at lower
levels of the health system as all hospitals but only 76%
hospitals and only 67% of civil hospitals and community
of community health centres, 33% of primary health
health centres had a blood chemistry analyzer. All district
centres, and 9% of sub health centres had piped water.
hospitals and 80% of civil hospitals had both a functional
Among all facilities, 30% reported a severe shortage of
glucometer and test strips for the glucometer. However,
water at some point during the year. These findings show
in both community health centres and primary health
a mixture of both notable gains and ongoing needs for
centres, more facilities had glucometer test strips than
facility-based water sources and sanitation practices
had a glucometer itself. This indicates limited capacity for
among primary care facilities.
addressing non-communicable diseases (NCDs) such as
Transportation and computers
hospitals had good availability of imaging equipment,
Facility-based transportation and modes of communi-
cation varied across platforms. In general, the availability
able in only 29% of facilities. Civil hospitals show patchier
of a vehicle, irrespective of its emergency capabilities,
availability of imaging equipment, as nearly half had no
substantially decreased down the levels of health plat-
ECG and 60% had no ultrasound. Community health cen-
forms. Only 4% of primary health centres had emergency
tres had poor availability of essential imaging equipment.
transportation and 6% had any four-wheeled vehicles at
Overall, these findings demonstrate gradual improve-
all, which means transferring patients under emergency
ments in equipping health facilities with basic medical
circumstances from these facilities could be fraught with
delays and possible complications. This transportation
exacerbated by the relatively low availability of landline
Lab equipment
Imaging equipment
NA: Not applicable to this platform according to standards.
equipment in MP, as well as the continued challenge of
LOWEST AVAILABILITY
to provide a full range of services. Measuring the avail-
Note: Availability of a particular piece of equipment was determined based on facility ownership on the day of visit. Data on the number of items present in a facility were not collected. All values represent the percentage of facilities, by platform, that had a given piece of equipment.
ensuring that these facilities carry the supplies they need
gap and the coordination of transport might be further
HIGHEST AVAILABILITY
ability of individual pieces of equipment sheds light on
phones at lower-level facilities. The availability of a func-
specific deficits, but assessing a health facility’s full stock
tional computer in facilities exceeded that of phones
of necessary or recommended equipment provides a
across all platforms but sub centres.
more precise understanding of a facility’s service capacity.
Equipment
For three main types of facility equipment – medical,
lab, and imaging – clear differences emerge across levels
of health service provision, with Table 8 summarizing the
availability of functional equipment by platform.
We used WHO’s Service Availability and Readiness As-
sessment (SARA) survey as our guideline for what types of
6 World Health Organization (WHO). Service Availability and Readiness Assessment (SARA) Survey: Core Questionnaire. Geneva, Switzerland: WHO, 2013.
equipment should be available in hospitals and primary
22
SUB-HEALTH CENTRE
of important patient clinical data, and the large majority
scopes and corresponding components were largely
sewer infrastructure, though this was found in only 69%
PRIMARY HEALTH CENTRE
Medical equipment
of facilities across all platforms did carry these. Micro-
health centres, and 91% of primary health centres had
COMMUNITY HEALTH CENTRE
levels of care. Lacking basic equipment such as scales
and blood pressure cuffs can severely limit the collection
Generally, more facilities had sewer infrastructure than
CIVIL HOSPITAL
23
A B C E I N M A D H YA P R A D E S H
Focus on service provision
M A I N F I N D I N G S : H E A LT H FA C I L I T Y P R O F I L E S
Antenatal care services
For the production of any given health service, a
In MP, according to the National Family Health Sur-
health facility requires a complex combination of the ba-
vey-4, 36% of women had at least four antenatal care
sic infrastructure, equipment, and pharmaceuticals, with
(ANC) visits during their last pregnancy. This is a low level
Table 10 Availability of blood tests and functional equipment to perform routine delivery care, by platform
7
personnel who are adequately trained to administer nec-
of coverage; moreover, it neither reflects what services
Testing availability
DISTRICT HOSPITAL
CIVIL HOSPITAL
COMMUNITY HEALTH CENTRE
PRIMARY HEALTH CENTRE
Hemoglobin
100%
100%
94%
83%
portion of facilities stocked the range of tests and medical
Glucometer and test strips
100%
80%
68%
48%
Cross-match blood
100%
40%
NA
NA
subset of specific services – antenatal care, delivery, gen-
to note that this list was not exhaustive but represented a
Medical equipment
of service provision, we only included facilities that re-
of ANC.
Blood pressure apparatus
100%
100%
100%
100%
IV catheters
100%
100%
100%
86%
Gowns
100%
100%
100%
74%
88%
93%
100%
70%
100%
100%
100%
86%
94%
80%
56%
42%
100%
87%
59%
42%
88%
40%
NA
NA
Infant scale
100%
87%
88%
67%
Scissors or blade to cut umbilical cord
100%
93%
100%
86%
Needle holder
100%
100%
97%
93%
Speculum
94%
93%
97%
75%
Delivery forceps
88%
93%
79%
57%
Dilation and curettage kit
88%
67%
71%
51%
Neonatal bag valve mask
100%
93%
94%
64%
Vacuum extractor
76%
47%
53%
43%
Incubator
65%
60%
68%
29%
100%
93%
100%
87%
29%
7%
15%
1%
essary clinical assessments, tests, and medications. Thus,
were actually provided nor the quality of care received.
it is important to consider this intersection of facility re-
Through the ABCE Facility Survey, we estimated what pro-
this report, we further examined facility capacity for a
equipment to conduct a routine ANC visit. It is important
sources to best understand facility capacity for care. In
eral surgery, and laboratory testing. For these analyses
number of relevant supplies necessary for the provision
ported providing the specific service, excluding facilities
The availability of tests and functional equipment for
that were potentially supposed to provide a given service
ANC is presented in Table 9. While all hospitals and com-
but did not report providing it in the ABCE Facility Sur-
vey. Thus, our findings reflect more of a service capacity
7 International Institute for Population Sciences (IIPS). National Family Health Survey (NFHS-4), 2015-2016: Madhya Pradesh Factsheet. Mumbai, India: IIPS, 2016.
“ceiling” across platforms, as we are not reporting on the
facilities that likely should provide a given service but have indicated otherwise on the ABCE Facility Survey.
Measuring tape Masks Sterilization equipment Adult bag valve mask Ultrasound Delivery equipment
Table 9 Availability of tests and functional equipment to perform routine antenatal care, by platform DISTRICT HOSPITAL
CIVIL HOSPITAL
COMMUNITY HEALTH CENTRE
PRIMARY HEALTH CENTRE
SUB HEALTH CENTRE
Testing availability Urinalysis
100%
100%
91%
77%
79%
Hemoglobin
100%
100%
94%
83%
91%
Glucometer and test strips
100%
80%
68%
48%
18%
Blood typing
100%
93%
79%
16%
NA
Blood pressure apparatus
100%
100%
100%
100%
94%
Adult scale
100%
100%
100%
96%
94%
Ultrasound
88%
40%
NA
NA
NA
Functional equipment
Service summary Facilities reporting delivery services Facilities fully equipped for delivery services based on the above tests and equipment availability
NA: Not applicable to this platform according to standards. LOWEST AVAILABILITY
Service summary Facilities reporting ANC services
100%
100%
100%
94%
93%
Facilities fully equipped for ANC provision based on above tests and equipment availability
88%
33%
65%
10%
12%
HIGHEST AVAILABILITY
Note: Availability of a given delivery item was determined by its availability at a facility on the day of visit. All values represent the percentage of facilities, by platform, that had the given delivery item. The service summary section compares the total percentage of facilities reporting that they provided routine delivery services with the total percentage of facilities that carried all of the recommended pharmaceuticals and functional equipment to provide routine delivery services.
NA: Not applicable to this platform according to standards. LOWEST AVAILABILITY
HIGHEST AVAILABILITY
Note: Availability of a given ANC item was determined by its availability at a facility on the day of visit. All values represent the percentage of facilities, by platform, that had the given ANC item. The service summary section compares the total percentage of facilities reporting that they provided ANC services with the total percentage of facilities that carried all of the functional equipment to provide ANC services.
24
25
A B C E I N M A D H YA P R A D E S H
M A I N F I N D I N G S : H E A LT H FA C I L I T Y P R O F I L E S
Table 11 Availability of blood tests and functional equipment to perform general surgery, by platform DISTRICT HOSPITAL (DH)
CIVIL HOSPITAL (CH)
COMMUNITY HEALTH CENTRE (CHC)
PRIMARY HEALTH CENTRE (PHC)
Hemoglobin
100%
100%
94%
83%
Cross-match blood
100%
40%
NA
NA
Testing availability
Medical equipment
Eighty-one percent of deliveries in MP are in a health
care. District hospitals were, on the whole, well equipped
facility, and 70% are in public facilities.8 Availability of
essary tests and equipment. However, only one-third of
ity delivery care; these results are presented in Table 10.
for ANC services, with 88% of facilities having all the nec-
essential equipment is necessary for providing high-qual-
civil hospitals were equipped: for example, 60% had no
Availability was generally highest in district hospitals,
available ultrasound. Urinalysis and hemoglobin testing
declining at lower levels. While most civil hospitals, com-
were actually available in more sub health centres than
munity health centres, and primary health centres offered
primary care centres, but facilities across all health centre
Blood pressure apparatus
100%
100%
100%
100%
IV catheters
100%
100%
100%
86%
94%
80%
59%
42%
Gowns
100%
100%
100%
74%
Masks
100%
100%
100%
86%
Adult bag valve mask
100%
87%
59%
42%
Surgical scissors/blade
100%
93%
100%
86%
Thermometer
100%
87%
65%
51%
General anesthesia equipment
100%
73%
29%
1%
88%
93%
91%
58%
Suction apparatus
100%
87%
65%
36%
Retractor
100%
87%
65%
39%
Sterilization equipment
Delivery care services
munity health centers in this survey reported providing
ANC services, many were not adequately supplied for
routine delivery services, none had all essential tests and
platforms lacked many essential tests.
equipment available. Only 29% of district hospitals were
fully equipped. An ultrasound machine was absent from
60% of civil hospitals.
8 International Institute for Population Sciences (IIPS). National Family Health Survey (NFHS-4), 2015-2016: Madhya Pradesh Factsheet. Mumbai, India: IIPS, 2016.
Surgical equipment
Scalpel
Nasogastric tube
94%
80%
62%
36%
Blood storage unit/refrigerator
100%
40%
15%
NA
Intubation equipment
100%
67%
41%
17%
Service summary Facilities reporting general surgery services Facilities fully equipped for general surgery services based on the above tests and equipment availability
100%
80%
76%
55%
82%
25%
12%
0%
NA: Not applicable to this platform according to standards. LOWEST AVAILABILITY
HIGHEST AVAILABILITY
Note: Availability of a given surgery item was determined by its availability at a facility on the day of visit. All values represent the percentage of facilities, by platform, that had the given surgery item. The service summary section compares the total percentage of facilities reporting that they provided general surgery services with the total percentage of facilities that carried all of the recommended functional equipment to provide general surgery services.
Table 12 Availability of laboratory tests, by platform DISTRICT HOSPITAL (DH)
CIVIL HOSPITAL (CH)
COMMUNITY HEALTH CENTRE (CHC) 79%
PRIMARY HEALTH CENTRE (PHC)
Blood typing
100%
93%
16%
Cross-match blood
100%
40%
NA
NA
Complete blood count
100%
80%
59%
12%
Hemoglobin
100%
100%
94%
83%
HIV
100%
87%
79%
17%
Liver function
100%
67%
65%
NA
Malaria
100%
100%
94%
83%
Renal function
94%
53%
41%
4%
Serum electrolytes
82%
7%
12%
NA
Spinal fluid test
82%
13%
9%
NA
Syphilis
100%
80%
76%
NA
Tuberculosis skin
100%
100%
85%
29%
Urinalysis
100%
100%
91%
77%
NA: Not applicable to this platform according to standards. LOWEST AVAILABILITY
HIGHEST AVAILABILITY
Note: Availability of a given test was determined by its availability at a facility on the day of visit. All values represent the percentage of facilities, by platform, that had the given test.
26
27
A B C E I N M A D H YA P R A D E S H
M A I N F I N D I N G S : H E A LT H FA C I L I T Y P R O F I L E S
Figure 6 Number of outpatient visits, by platform Each line represents outpatient visits for an individual facility, with the bold line depicting the average for the platform. Scales are different for each platform.
200000
CH
150000 Visits 100000
2010
2009
2008
OP visits by facility
2012
OP visits average
tals. Most civil hospitals also notably lacked cross-match
there were gaps in test availability. Availability was gen-
and surgical equipment, in community health centres and
facility levels. Serum electrolyte tests, useful as part of a
equipped to carry out surgery. It is also crucial to consider
ease and high blood pressure, had very low availability in
nity health centres offer the range of laboratory services, erally high in district hospitals, and decreased at lower
primary health centres. No primary health centre was fully
metabolic panel and to measure symptoms of heart dis-
the human resources available to perform surgical proce-
civil hospitals (7%) and community health centres (12%).
2012
10000 Visits
2011 OP visits average
20000
5000
OP visits by facility
OP visits average
0
0
SHC
2008
3000
CH
15000
80000
DH
Visits 40000
2010
2009
2008
2012
2011
ability of surgical equipment was also relatively high,
60000
5000 0
2010
OP visits by facility
The availability of laboratory tests is presented in Table
12. While all district hospitals, civil hospitals, and commu-
Each line represents inpatient visits for an individual facility, with the bold line depicting the average for the platform. Scales are different for each platform.
Visits 10000 15000
Visits 40000 60000 20000 0
2009
2010
IP visits by facility
2011
2012
2008
IP visits average
2009
800
8000
Visits 600 400 200 0
2012
Visits 4000 6000
2011 OP visits average
2000
2010
OP visits by facility
2008
2009
2010
IP visits by facility
28
2012
1000
10000
2000 Visits 1000 0
2009
2011 IP visits average
PHC
CHC
2008
2010
IP visits by facility
0
2009
Laboratory testing
Figure 7 Number of inpatient visits (excluding deliveries), by platform
20000
80000
2011
PHC
25000
CHC
2008
pacity at health facilities should collect this information.
blood tests. There were large gaps, particularly in medical
OP visits average
OP visits by facility
availability was substantially lower in civil hospitals and
with the exception of blood storage units in civil hospi-
2012
2011
not be captured, but future work on assessing surgical ca-
tation of human resources in the records, such data could
community health centres, while no primary health cen-
0
2010
percent of district hospitals had all of the essential items;
eral surgery services are presented in Table 11. Eighty-two
was mostly available in both types of hospitals, and avail-
0
2009
Availability of essential tests and equipment for gen-
to affect patient outcomes. Given the nature of documen-
tres were fully equipped. Essential medical equipment
50000
200000
Visits
400000
600000
DH
2008
dures, as assembling an adequate surgical team is likely
General surgery services
2011
2008
2012
2009
2010
IP visits by facility
IP visits average
29
2011 IP visits average
2012
A B C E I N M A D H YA P R A D E S H
M A I N F I N D I N G S : H E A LT H FA C I L I T Y P R O F I L E S
Figure 8 Number of deliveries, by platform
Figure 9 Number of immunization doses administered, by platform
Note: Each line represents delivery visits for an individual facility, with the bold line depicting the average for the platform. Scales are different for each platform.
Note: Each line represents immunization doses for an individual facility, with the bold line depicting the average for the platform. Scales are different for each platform.
Deliveries 4000 2000
Deliveries by facility
2011
2012
Deliveries average
2009
2010
Deliveries by facility
2011
2012
2009
40000
2012
2011
2010
Immunization doses by facility
Immunization doses by facility
2011
2012
Immunization doses average
CHC
PHC
Doses administered 5000 10000
Doses administered 2000 4000 6000
1500
2009
2010
Deliveries by facility
2011
2012
2008
2009
2010
Deliveries by facility
Deliveries average
2011
2012
Deliveries average
0
2008
0
0
0
500
Deliveries 1000
Deliveries 1000 2000
2010
2009
2008
Immunization doses average
Deliveries average
PHC
2000
CHC
3000
2008
8000
2010
15000
2009
0
0
2008
0
2008
CH
Doses administered 10000 20000 30000
6000
12000 Deliveries 8000 10000 6000 4000
DH
Doses administered 20000 40000 60000 80000 100000
CH
8000
DH
2008
2009
The number of outpatient visits by year, by platform,
Spinal fluid tests were also rare among facilities below
district hospitals. Most facilities were equipped to test for
is presented in Figure 6. In general, the average num-
centres, which had a low availability of TB (29%) and HIV
years, with slight declines for civil hospitals, community
ber of outpatient visits remained stable over five fiscal
malaria, HIV, and TB, with the exception of primary health
health centres, and primary health centres. Patient vol-
(17%) tests.
ume was highest in district (average of 176,970–188,262
Facility outputs
Immunization doses by facility
Immunization doses average
4000
SHC
Doses administered 1000 2000 3000
Outpatient visits
2010
2009
2008
2012
2011
2010
Immunization doses by facility
number reported by community health centres (average
ber of services delivered, which are known as outputs, is
of 20,383–24,342 visits per year). Primary health centres
critical to understanding how facility resources align with
0
visits per year). Civil hospitals reported an average of
60,084–71,016 visits per year, which was near triple the
Measuring a facility’s patient volume and the num-
2008
2009
2010
Immunization doses by facility
reported more than 10 times more outpatient visits (aver-
patient demand for care. Figure 6 illustrates the trends
age of 4,295–5,196 visits per year) than sub-health centres
in average outpatient volume across platforms and
(average of 402–443 visits per year).
over time.
30
31
2011
2012
Immunization doses average
2011
2012
Immunization doses average
A B C E I N M A D H YA P R A D E S H
Inpatient visits
M A I N F I N D I N G S : H E A LT H FA C I L I T Y P R O F I L E S
Deliveries
Inpatient visits generally entail more service demands
The reported number of deliveries, by platform and
than outpatient visits, including ongoing occupancy of
over time, is presented in Figure 8. District hospitals re-
inpatient visits (other than deliveries) by year are pre-
in each year of observation, which his triple that of civil
facility resources such as beds. The reported number of
Figure 10 Patient travel times to facilities, by platform
Figure 11 Patient wait times at facilities, by platform
ported an average between 6,136 and 6,688 deliveries
sented in Figure 7. Over time, the average number of
hospitals (an average of 2,178–2,344 deliveries per year).
inpatient visits have increased for all platforms. District
While many hospitals experienced an increase in the
hospitals provided care for an average of 22,708–28,782
number of deliveries over time, several hospitals reported
inpatient visits per year, with one facility reporting con-
decreasing numbers over the five years of observation.
sistently more than 60,000 inpatient visits per year. Civil
Community health centres reported an annual average
hospitals provided care for an average of 6,176–6,656
number of deliveries between 1,117 and 1,279. Few deliv-
visits per year, while community health centres provided
eries were reported in primary health centres (an average
one-third as many visits (an average between 2,502 and
of 214–245 deliveries per year). The ratio of deliveries to
2,618 inpatient visits per year). Primary health centres re-
inpatient visits is higher among the lower platforms.
ported substantially fewer inpatient visits (on average
DH
DH
CH
CH
CHC
CHC
PHC
PHC
SHC
SHC
0
20
40
60 Percent (%)
< 30 min.
85–106 visits per year). It is important to note that the
80
100
0
20
40
< 30 min.
> 30 min.
80
60 Percent (%)
100
> 30 min.
ABCE Facility Survey did not capture information on the
length of inpatient stays, which is a key indicator to moni-
DH: District hospital; CH: Civil hospital; CHC: Community health centre; PHC: Primary health centre; SHC: Sub health centre
tor and include in future work.
Table 13 Characteristics of patients interviewed after receiving care at facilities
DH: District hospital; CH: Civil hospital; CHC: Community health centre; PHC: Primary health centre; SHC: Sub health centre
Immunization
the health care provider), but each can have the same impact on whether patients seek care at particular facilities
The number of immunization doses administered over
DH
CH
CHC
PHC
SHC
TOTAL
Total patient sample
695
338
493
492
74
2092
Percent female
41%
51%
51%
54%
75%
48%
Patient’s age group (years) <16
23%
22%
23%
20%
25%
22%
16–29
35%
38%
31%
27%
25%
32%
30–39
15%
15%
16%
16%
0%
15%
40–49
11%
10%
10%
13%
38%
11%
>50
17%
15%
20%
24%
13%
19%
Scheduled caste/scheduled tribe
29%
29%
35%
33%
0%
31%
Other backwards caste
45%
46%
48%
45%
100%
46%
None
24%
22%
36%
38%
63%
30%
Classes 1 to 5
17%
22%
28%
24%
38%
22%
Classes 6 to 9
25%
25%
17%
22%
0%
22%
Class 10 or higher
33%
31%
19%
16%
0%
25%
Education attainment
Note: Educational attainment refers to the patient’s level of education or the attendant’s educational attainment if the interviewed patient was younger than 18 years old.
time, by platform, is presented in Figure 9. Generally, the
or have contact with the health system at all.
ble over the five years. District hospitals reported many
tient experiences, interviews were conducted with 2,092
ages between 37,091 and 42,922) than civil hospitals
The majority of patients were male (52%), though at all fa-
nity health centres (annual averages between 3,652 and
female. One-third of patients identified as part of a sched-
immunization delivery; primary health centres reported
another backwards caste. Most patients had some educa-
In order to measure demand-side constraints and pa-
average number of doses administered remained sta-
patients or their attendants at public facilities (Table 13).
more immunization doses administered (annual aver-
cility levels except district hospitals, most patients were
(annual averages between 13,171 and 13,693) and commu-
uled caste/scheduled tribe, and nearly half identified as
4,736). Facilities at the PHC and SHC level are central to an average of 708–1,033 doses per year while sub health
tion (70%), though primary health centres tended to see
1,366 doses per year.
were under the age of 30.
patients with less education. Over half (54%) of patients
centres reported slightly more, with an average of 1,228–
Patient perspectives
Travel and wait times
The amount of time patients spend traveling to facili-
A facility’s availability of and capacity to deliver ser-
vices is only half of the health care provision equation; the
ties and then waiting for services can substantially affect
services. Many factors can affect patients’ decisions to
times of less than 30 minutes to a facility for care (Figure
other half depends upon patients seeking those health
their care-seeking behaviors. Most patients had travel
seek care, ranging from associated visit costs to how pa-
10). Travel time was shorter for patients seeking care at
constraints can be more quantifiable (e.g., distance from
tients who went to district hospitals traveled more than 30
lower-level facilities than higher-level ones; 42% of pa-
tients view the care they receive. These “demand-side”
minutes, while none at sub-health centres traveled for as
facility) or intangible (e.g., perceived respectfulness of
32
33
A B C E I N M A D H YA P R A D E S H
Figure 12 Patient scores of facilities, by platform
M A I N F I N D I N G S : H E A LT H FA C I L I T Y P R O F I L E S
long. This finding is not unexpected, as these are the closest health facilities for many patients, particularly those
in rural areas. It also reflects the fact that many patients
Figure 13 Availability of prescribed drugs at facility, by platform
of quality of health services in India.9
Ratings of patient satisfaction, based on a scale from
one to 10, with 10 being the highest score, are presented
travel longer distances to receive the kind of specialized
DH
CH
care offered at hospitals.
DH
satisfaction. The large majority of patients waited less
CH
and nearly all patients seeking care at community health
CHC
care within 30 minutes. At district hospitals, 21% of pa-
PHC
Wait time is also an important determinant of patient
CHC
in Figure 12. Overall, patients were satisfied with the care
they received and, in general, ratings were higher for higher-level platforms. 12.5% of patients receiving care at
a sub health centre gave a rating below six, while no pa-
than 30 minutes to receive care at all platforms (Figure 11),
PHC
centres (94%) and primary health centres (97%) received
SHC
0
40
20
80
60 Percent (%) <6 8-9
tients waited more than 30 minutes to receive care.
100
Patient satisfaction ratings
6-7 10
We report primarily on factors associated with patient
satisfaction with provider care and perceived quality of
and hospital infrastructure, as these have been previously
identified to be of significance in the patientâ&#x20AC;&#x2122;s perception
Note: Facility ratings were reported along a scale of 0 to 10, with 0 as the worst facility possible and 10 as the best facility possible.
nity health centres had the highest proportion of patients
give a 10-rating (2.9%), it also had the highest proportion of patients who rated lower than six (18.1%).
SHC
Patients were also asked more detailed questions
0
20
40
60 Percent (%)
Got none/some of the drugs
80
about satisfaction with providers and facility character-
100
istics (Table 14). Less than two-thirds of patients were
Got all perscribed drugs
satisfied with facility cleanliness or privacy of facilities.
DISTRICT HOSPITAL
CIVIL HOSPITAL
COMMUNITY HEALTH CENTRE
PRIMARY HEALTH CENTRE
SUB HEALTH CENTRE
Staff interactions Medical provider respectfulness
83%
82%
74%
69%
100%
Clarity of provider explanations
79%
77%
75%
68%
75%
Time to ask questions
72%
75%
72%
67%
75%
Medical provider respectfulness
78%
64%
70%
71%
NA
Clarity of provider explanations
79%
64%
76%
73%
NA
Time to ask questions
74%
67%
74%
77%
NA
Cleanliness
57%
52%
55%
57%
13%
Privacy
66%
55%
65%
58%
25%
Facility characteristics
LOWEST PROPORTION
HIGHEST PROPORTION
NA: Results not applicable.
DH: District hospital; CH: Civil hospital; CHC: Community health centre; PHC: Primary health centre; SHC: Sub health centre
9 Rao KD, Peters DH, Bandeen-Roche K. Towards patient-centered health services in Indiaâ&#x20AC;&#x201D;a scale to measure patient perceptions of quality. International Journal for Quality in Health Care. 2006; 18(6):414-421.
Figure 14 Determinants of satisfaction with doctors
Table 14 Proportion of patients satisfied with facility visit indicators, by platform
Nurse/ANM
a rating, only 1.9% rated their facility a 10. While commu-
services by patients with regard to medicine availability
DH: District hospital; CH: Civil hospital; CHC: Community health centre; PHC: Primary health centre; SHC: Sub health centre
Doctor
tients gave a rating of 10. Among all patients who gave
Female Male >=40 years 16-39 years Other caste Backwards caste Schooling No schooling Not prescribed all drugs Prescribed all drugs Wait time <30 min Wait time >=30 min DH SHC CHC CH
0
1
Odds Ratio
3
Dotted vertical line represents an odds ratio of one. Black points represent the reference groups, which all carry an odds ratio of one. Compared to the referent category, significant odds ratios and 95% confidence intervals are represented with blue points and horizontal lines, respectively. Odds ratios that are not significant are represented by green points, and their 95% confidence intervals with a green horizontal line. Any confidence intervals with an upper bound above 3 were truncated for ease of interpretation. DH: District hospital; CH: Civil hospital; CHC: Community health centre; PHC: Primary health centre
34
2
35
A B C E I N M A D H YA P R A D E S H
M A I N F I N D I N G S : H E A LT H FA C I L I T Y P R O F I L E S
Table 15 Input-output model specifications
These ratings were lowest at sub health centres, where
only 13% were satisfied with cleanliness and 25% were
satisfied with privacy. Three parameters were assessed
CATEGORY
to document satisfaction with health providers – being
Inputs
treated respectfully by the provider, clarity of explanation provided by the provider, and that provider gave
versed in community health centres and primary health
enough time to ask questions about a health problem or
Model 1
Outputs
est ratings of good and very good responses combined
Expenditure on personnel
Inputs
was created separately for doctors and nurses – if a pa-
tient reported good/very good for all three parameters, civil hospitals, patients receiving care from nurses and
Model 2
Inpatients visits (excluding deliveries)
Number of beds
Number of doctors
of satisfaction with respectfulness, clarity, and time than
those receiving care from doctors. This trend was re-
were prescribed drugs and attempted to obtain those
from two approaches – the restricted versions of Data
(Figure 13). This ranged from 98% of patients at primary
Function (rSDF). 10 Based on this analysis, an efficiency
Reasons for patient satisfaction of medical care are
use of its resources. Relating the outputs to inputs, the
drugs during the visit, 1,927 received all prescribed drugs
Envelopment Analysis (rDEA) and Stochastic Distance
health centres to 100% of patients at sub-health centres.
score was estimated for each facility, capturing a facility’s
complex, so a multivariable logistic regression was con-
rDEA and rSDF approaches compute efficiency scores
facility characteristics that could determine patient satis-
ing that a facility achieved the highest level of production
(Figure 15). For each characteristic, the odds ratio (OR) is
This approach assesses the relationship between in-
ranging from 0% to 100%, with a score of 100% indicat-
ducted to measure the association of select patient and
Number of non-medical staff Outputs
technical efficiency in health facilities, combining results
be part of the right to health. Among 1,968 patients who
Outpatient visits
Number of paramedical staff
auxiliary nurse midwives (ANMs) reported higher levels
An ensemble model approach was used to quantify
Access to to affordable drugs has been interpreted to
Number of nurses
it was categorized as satisfied. At district hospitals and
Analytical approach
health centres than district hospitals.
Expenditure on pharmaceuticals
Immunization visits
rameters of satisfaction, a composite satisfaction variable
L3), due to the types of services provided.
lower for patients seeking care at community and primary
Deliveries
as satisfied, and rest as not satisfied. Using the three pa-
Community health centres are stratified by levels (L2 and
Satisfaction with both nurse and doctor interactions were
VARIABLES
All other expenditure
treatment – using a five-point Likert scale, with the high-
community health centres and primary health centres.
centres, where patients were more satisfied with doctors.
Outpatient visits
relative to all facilities in that platform.
faction with medical doctors (Figure 14) and nurses/ANMs
Inpatients visits (excluding deliveries)
puts and outputs to estimate an efficiency score for each
presented. An odds ratio greater than 1.0 indicates that
Deliveries
Immunization visits
there are greater odds of being satisfied with care as
facility. Recognizing that each type of input requires a
1.0 indicates that there are lower odds of being satisfied
an inpatient visit uses more resources and more com-
Longer wait time to receive attention was associated
visit), we applied weight restrictions to rescale each fa-
95% confidence interval [CI]: 0.31–0.64). Compared to
of additional weight restrictions is widely used in order
different amount of facility resources (e.g., on average,
compared to the reference group. An odds ratio below
plex types of equipment and services than an outpatient
with care than the reference group.
Figure 15 Determinants of satisfaction with nurses/ANMs
with lower patient satisfaction with doctors (OR: 0.44,
cility’s mixture of inputs and outputs. The incorporation
patients of another caste, there was slightly higher satis-
to improve the discrimination of the models. Weight re-
>=40 years 16-39 years
1.28, 95% CI: 1.02–1.61). Patients younger than 40 years
about the importance of individual inputs and outputs, or
Other caste Backwards caste
(OR: 1.35, 95% CI: 1.04–1.73). There was no difference in
ble efficiency scores were averaged over five years and
Female Male
strictions are most commonly based upon the judgment
faction with doctors for patients of backwards caste (OR:
Schooling No schooling
were more satisfied with doctors than were older patients
reflect cost or price considerations. The resulting ensem-
satisfaction by platform.
between the two input models.
teristics, no factors significantly increased the odds of a
into outpatient visits, inpatient visits, delivery and immu-
For these models, service provision was categorized
Considering all selected patient and facility charac-
Not prescribed all drugs Prescribed all drugs
nization. Two input-output specifications were used, with
patient being satisfied with their care.
Wait time <30 min Wait time >=30 min
the inputs being different in the two models. The inputs
Efficiency and costs
and outputs are listed in Table 15. The detailed data uti-
The costs of health service provision and the efficiency
CH SHC PHC CHC CH
lized for this analysis is documented in the annex. The
with which care is delivered by health facilities go hand-
average and range of inputs and outputs for the variables
in-hand. An efficient health facility uses resources well,
is presented in Table 16.
producing a high volume of patient visits and services
without straining its resources. Conversely, an ineffi-
1
0
Odds Ratio
2
3
Dotted vertical line represents an odds ratio of one. Black points represent the reference groups, which all carry an odds ratio of one. Compared to the referent category, significant odds ratios and 95% confidence intervals are represented with blue points and horizontal lines, respectively. Odds ratios that are not significant are represented by green points, and their 95% confidence intervals with a green horizontal line. Any confidence intervals with an upper bound above 3 were truncated for ease of interpretation.
cient health facility is one where the use of resources is
not maximized, leaving usable beds empty or medical
10 Di Giorgio L, Flaxman AD, Moses MW, Fullman N, Hanlon M, Conner RO, et al. Efficiency of Health Care Production in Low-Resource Settings: A Monte-Carlo Simulation to Compare the Performance of Data Envelopment Analysis, Stochastic Distance Functions, and an Ensemble Model. PLOS ONE. 2016; 11(2): e0150570.
staff seeing very few patients per day. We present techni-
cal efficiency analysis for district hospitals, civil hospitals,
DH: District hospital; CH: Civil hospital; CHC: Community health centre; PHC: Primary health centre; SHC: Sub health centre
36
37
A B C E I N M A D H YA P R A D E S H
M A I N F I N D I N G S : H E A LT H FA C I L I T Y P R O F I L E S
Table 16 Average and range of inputs and outputs, by platform. INR denotes Indian Rupees.
Personnel expenditure (INR)
Pharmaceutical expenditure (INR)
Inputs
Other expenditure (INR)
Number of beds Number of doctors Number of nurses Number of paramedical staff Number of non-medical staff
Outputs
Outpatient visits
Inpatient visits (excluding deliveries) Deliveries
Immunization doses
Table 17 Average annual cost in INR, by district and platform, last fiscal year. INR denotes Indian Rupees.
DISTRICT HOSPITAL
CIVIL HOSPITAL
COMMUNITY HEALTH CENTRE (LEVEL 2)
COMMUNITY HEALTH CENTRE (LEVEL 3)
PRIMARY HEALTH CENTRE
DISTRICT
DISTRICT HOSPITAL
CIVIL HOSPITAL
COMMUNITY HEALTH CENTRE (LEVEL 2)
46,129,692
117,34,724
4,052,619
6,917,399
1,179,654
District 1
61,159,191
14,831,786
7,005,634
(552,288 – 175,446,304)
(2,661,636 – 41,681,476)
(1,095,426 – 11,030,358)
(1,625,424 – 14,426,618)
(230,016 – 3,356,424)
District 2
69,952,031
3,052,272
1,461,811
386,318
442,081
450,984
District 3
(1,215,640 – 4,614,253)
(645,746 – 3,828,819)
(70,515 – 1,282,738)
(78,201 – 1,009,550)
(54,743 – 1,749,360)
District 4
102,884,044
19,057,838
6,810,956
3,083,264
549,9079
605,892
District 5
85,012,043
(6,485,010 – 37,058,224)
(47,195 – 21,218,072)
(195,042 – 6,800,380)
(641,753 – 11,995,070)
(23,548 – 5,156,782)
District 6
13,831,620
294 (120 – 533)
66 (0 – 125)
25 (4 – 41)
35 (10 – 48)
6 (0 – 15)
25 (9 – 51)
7 (1 – 22)
2 (0 – 9)
4 (1 – 7)
1 (0 – 3)
64 (2 – 155)
8 (1 – 29)
3 (0 – 9)
3 (0 – 7)
0 (0 – 2)
52 (18 – 115)
24 (8 – 57)
11 (4 – 24)
16 (4 – 28)
5 (1 – 18)
44 (9 – 128)
16 (3 – 31)
8 (1 – 23)
11 (2 – 27)
2 (0 - 11)
170,902
62,603
19,270
33,855
6,318
(1,184 – 568,442)
(14,587 – 183,573)
(584 – 52,235)
(9,177 – 87,898)
(138 – 25,294)
26718
6,076
1,746
3,925
173
(66,50 – 78,720)
(0 – 11,924)
(80 – 4,341)
6,460
2,242
991
(3,392 – 12,689)
(0 – 6,813)
(83 – 2,670)
(297 – 2,882)
(0 – 1,311)
(793 – 10,331) 1,594
(0 – 1,075) 265
39,572
12,814
3,808
62,54
998
(5,944 – 92,849)
(1,497 – 37,871)
(335 – 10,066)
(0 – 12,734)
(0 – 2,712)
Costs of care
sented in Table 17. In terms of annual total expenditures,
District 7
10,624,417
18,054,811
3,096,714
6,378,878
2,366,454 2,958,584
1,875,066
19,032,197
2,052,144
13,260,717
1,332,077
26,144,943
District 9
69,735,120
13,145,077
District 10
106,374,009
1,843,673
District 11
96,412,260
District 12
79,646,985
District 13
67,113,598
District 14
30,910,343
12,225,018
District 15
70,999,502
11,114,390
District 16
56,773,327
8,237,254
District 17
37,089,941
5,939,195
3,206,382 7,235,921
23,133,987
25,463,896
3,450,501 11,221,508
1,648,587
5,915,959
1,865,989
11,711,570
3,599,145
8,086,259
1,218,292
3,501,974 2,173,071
15,349,913
4,038,913
puts – in this case, staff – a simple ratio of outpatient visits
visits per staff, civil hospitals providing 125, commu-
It is important to note that data availability on the in-
20), and immunization doses (Figure 21) per staff are pre-
centres (L3) providing 128, and primary health centres
platforms, with more non-availability for PHCs. Facilities
outpatient visits per staff, though the ratio ranged greatly.
(Figure 18), inpatient visits (Figure 19), deliveries (Figure
with five years of missing data for any input or output vari-
The average ratio for civil hospitals was 1,334 visits per
facility types. Community health centres spent a slightly
were smoothed where necessary based on the trends
munity health centres (L3) was 1,007, and for primary
than other platforms, while the proportion of expenditure
To further illustrate the production of outputs per in-
tient visits, with district hospitals providing 157 inpatient
able were dropped from analysis. In addition, the data seen in inputs or outputs for that facility.
38
2,436,466
75,703,007
higher spending in 2012 than 2008. Spending on person-
lower proportion of their total expenditures on personnel
12,509,894
District 8
puts and output indicators varied across the facilities and
nel accounted for the majority of annual spending across
9,606,974
7,735,776
18,899,505
trends in average facility spending varied by platform between 2008 and 2012 (Figure 16). All platforms recorded
1,130,722
7,580,404 13,608,939
PRIMARY HEALTH CENTRE
on medical supplies was highest at primary health centres (Figure 17).
Total expenditure, by district and platform, is pre-
41,250,883
COMMUNITY HEALTH CENTRE (LEVEL 3)
nity health centres (L2) providing 80, community health
sented. District hospitals produced an average of 1,099
providing 24. The range of inpatient visits per staff was
low for primary health centres, where inpatient visits are
rare. Overall, as expected, outpatient visits accounted for
staff, for community health centres (L2) was 862, for com-
the overwhelmingly large majority of the patients seen
health centres was 844. This gradient was similar for inpa-
Fewer deliveries were performed per staff than other
per staff per day across the platforms.
services, with an average of 43 deliveries per staff in
39
A B C E I N M A D H YA P R A D E S H
M A I N F I N D I N G S : H E A LT H FA C I L I T Y P R O F I L E S
Figure 16 Average total and type of expenditure, by platform, 2008–2012
Figure 17 Average percentage of expenditure type, by platform, in 2012
1,000
250 Expenditure in 100,000 Rupees 100 150 200
is variation in facility efficiency both between and within
District Hospital
districts, however, the primary health centres were significantly inefficient in all the districts.
Area Hospital
If all facilities were perfectly efficient, many more pa-
Community Health Centre L2
tient services could be provided with the same inputs (Figure 23). On average, district hospitals could provide
Community Health Centre L3
42,684 additional outpatient visits with the same inputs,
Primary Health Centre
50
200
while primary health centres could see an average of
20
0
0
2009
2012
2011
2010
mary health centres, from 21.5% to 49%.
Efficiency by district is presented in Table 18. There
0 2008
efficient. The range of efficiency scores was wide for pri-
CIVIL HOSPITALS
Expenditure in 100,000 Rupees 400 600 800
DISTRICT HOSPITALS
slightly more homogenous, ranging from 69.3% to 78.9%
2008
Personnel
2009
2010
2012
2011
Other
80
10,576 additional outpatient visits. Community health cen-
100
tres (L2) could administer an average of 3,319 additional
Personnel
Personnel
Pharmaceuticals and consumables
40 60 Percent of Total Expenditure
immunization doses with the same inputs if all facilities
Pharmaceuticals and consumables
Pharmaceuticals and consumables
Other
Other
were efficient.
Given observed levels of facility-based resources
COMMUNITY HEALTH CENTRES, LEVEL 3
L2: Level 2; L3: Level 3
had the capacity to handle much larger patient volumes
than they reported. Figure 23 displays this gap in potential efficiency performance across platforms, depicting the possible gains in total service provision that could be
district hospitals, 44 per staff in civil hospitals, 47 per staff
Expenditure in 100,000 Rupees 50 100
Expenditure in 100,000 Rupees 40 60 80
150
100
COMMUNITY HEALTH CENTRES, LEVEL 2
(beds and personnel), it would appear that many facilities
achieved if every facility in the ABCE sample operated at
in community health centres (L2), 47 per staff in commu-
optimal efficiency.
nity health centres (L3), and 38 per staff in primary health
We found that all types of facilities could expand their
centres. For immunization doses, 234 doses were admin-
outputs substantially given their observed resources.
istered per staff in district hospitals, 274 per staff in civil
Based on our analyses, the highest level of care, district
20
hospitals, 183 per staff in community health centres (L2),
hospitals, had the greatest potential for increasing service
0
0
189 per staff in community health centres (L3), and 156 per 2009
2012
2011
2010
2008
Personnel
2009
2010
2012
2011
Personnel
Pharmaceuticals and consumables
Other
Pharmaceuticals and consumables
Other
provision without expanding current resources. Over-
staff in primary health centres.
all, based on our estimation of efficiency, a large portion of health facilities could increase the volume of patients
Efficiency results
seen and services provided with the resources available
Using the five fiscal years of data to estimate the effi-
to them.
ciency scores for all facilities, two main findings emerged.
At the same time, many reports and policy documents
First, efficiency scores were relatively higher for district
PRIMARY HEALTH CENTRES
emphasize that pronounced deficiencies in human re-
hospitals and community health centres (level 3), with the
sources for health exist across India in the public sector
Expenditure in 100,000 Rupees 10 15 20
25
primary health centres having the lowest efficiency across
all the platforms. Second, the range between the facilities
health system, such that “significant [human resources for
platforms suggesting that a substantial performance gap
services.11 Our results suggest otherwise, as most facilities
with highest and lowest efficiency scores was large within
health] will be required to meet the demand” for health
may exist between the average facility and facilities with
in the ABCE sample had the potential to bolster service
of facility efficiency scores across platforms for MP.
nel and physical capital.
ranged from 72.5% to 87.6%, with a platform average of
facility capacity and how health facilities have used their
production given their reported staffing of skilled person-
5
the highest efficiency scores. Figure 22 depicts this range
These findings provide a data-driven understanding of
The five-year average efficiency of district hospitals
0
2008
2008
2009
2010
2012
2011
Personnel Pharmaceuticals and consumables
Other
78.2%. Civil hospitals were between 57.2% and 72.2% efficient. Community health centres (L2) were between 39.1%
11 Rao M, Rao KD, Kumar AK, Chatterjee M, Sundararaman T. Human resources for health in India. The Lancet. 2011; 377(9765): 587-98.
and 68.4% efficient. Community health centres (L3) were
40
41
A B C E I N M A D H YA P R A D E S H
M A I N F I N D I N G S : H E A LT H FA C I L I T Y P R O F I L E S
Figure 18 Outpatient load per staff by platform
Figure 19 Inpatient load per staff by platform DH
CH 400
300
6000
CH
300
200
Visits 200
Visits
2012
2011
2008
2009
2011
2012
2012
2011
2010
2012
2011
2010
2008
CHC2
2010
2011
OP visits per staff by facility OP visits per staff average
2012
2011
250 200
2008
2009
2012
2011
2010
2008
2009
IP visits per staff by facility IP visits per staff average
2010
2011
IP visits per staff by facility IP visits per staff average
PHC
50
1000
Visits 100
Visits 2000
150
3000
200
PHC
0
0
2008
2009
2010
2011
2012
OP visits per staff by facility OP visits per staff average
DH: District hospital; CH: Civil hospital; CHC2: Community health centre level 2; CHC3: Community health centre level 3; PHC: Primary health centre Note: each line represents an individual facility, with the bolded line depicting the average for the platform. Scales are different for each platform type.
42
2012
Visits 100 150
Visits 100 150
2009
2010
CHC3
0
2008
OP visits per staff by facility OP visits per staff average
2009
IP visits per staff by facility IP visits per staff average
50
800 600
2009
2009
200
1400 Visits 1000 1200
2000 Visits 1000 1500 500 0
2008
2008
IP visits per staff by facility IP visits per staff average
CHC3
1600
CHC2
2500
2010
OP visits per staff by facility OP visits per staff average
50
2010
OP visits per staff by facility OP visits per staff average
0
2009
250
2008
0
0
0
0
1000
100
100
2000
Visits
Visits 2000 3000
4000
4000
5000
DH
2008
2009
2010
2011
2012
IP visits per staff by facility IP visits per staff average
DH: District hospital; CH: Civil hospital; CHC2: Community health centre level 2; CHC3: Community health centre level 3; PHC: Primary health centre Note: each line represents an individual facility, with the bolded line depicting the average for the platform. Scales are different for each platform type.
43
2012
A B C E I N M A D H YA P R A D E S H
M A I N F I N D I N G S : H E A LT H FA C I L I T Y P R O F I L E S
Figure 20 Deliveries per staff by platform
Figure 21 Immunizations per staff per day by platform CH
Doses administered 400 600 800
1000
600
2012
2011
2010
2008
2009
Deliveries per staff by facility Deliveries per staff average
CHC2
2012
2008
2009
2012
2011
2010
2008
CHC3
2011
2010
2009
Immunization doses per staff by facility Immunization doses per staff average
2012
Immunization doses per staff by facility Immunization doses per staff average
CHC2
CHC3
2008
2009
2010
2012
2011
2008
2009
Deliveries per staff by facility Deliveries per staff average
2010
2011
Deliveries per staff by facility Deliveries per staff average
2012
0
2008
2009
2010
2012
2011
2008
Immunization doses per staff by facility Immunization doses per staff average
2009
2010
2011
Immunization doses per staff by facility Immunization doses per staff average
PHC
0
0
Deliveries 100 200
Doses administered 500 1000
1500
PHC
300
Doses administered 200 400
Doses administered 200 400 0
0
0
50
Deliveries 50
Deliveries 100
100
150
2011
2010
Deliveries per staff by facility Deliveries per staff average
600
2009
600
2008
0
0
0
0
200
50
50
DH
Doses administered 200 400
150
CH
Deliveries 100
Deliveries 100
150
DH
2008
2009
2010
2011
2012
Deliveries per staff by facility Deliveries per staff average
DH: District hospital; CH: Civil hospital; CHC2: Community health centre level 2; CHC3: Community health centre level 3; PHC: Primary health centre Note: each line represents an individual facility, with the bolded line depicting the average for the platform. Scales are different for each platform type.
44
2008
2009
2010
2011
2012
Immunization doses per staff by facility Immunization doses per staff average
DH: District hospital; CH: Civil hospital; CHC2: Community health centre level 2; CHC3: Community health centre level 3; PHC: Primary health centre Note: each line represents an individual facility, with the bolded line depicting the average for the platform. Scales are different for each platform type.
45
2012
A B C E I N M A D H YA P R A D E S H
M A I N F I N D I N G S : H E A LT H FA C I L I T Y P R O F I L E S
Figure 22 Range of efficiency scores across platforms 100
Table 18 District-wise efficiency scores (%), by platform
60
80
DISTRICT/ PLATFORM
DISTRICT HOSPITAL
1
District 1
66.9
68.3
District 2
72.5
40
District 4
20 0
Civil Hospital
Community Health Centre L2
Community Health Centre L3
Primary Health Centre
District hospital
Civil hospital
Mean: 78.2
Mean: 64.6
Median: 77.0
Median: 63.6
IQR: 72.5-87.6
IQR: 57.2-72.2
2
3
58.6 86
District 5
91.3
District 6
70.9
District 7
District Hospital
CIVIL HOSPITAL
1
District 3
COMMUNITY HEALTH CENTRE LEVEL 2
1
2
42.5
33.5
71.8
District 8
63.5
50.4
District 9
72.7
58.9
District 10
80.1
District 11
75.8
District 12
74.5
District 13
77.8
District 14
87.9
71.5
90.6
57.2
57.5
50.6
77.6
72.2
2
82.5
42.1 8.1
38.6
40.3
85.1
50.1
51.8
68.4
51.1
20.5
3
4
19.5
19.2
43.3 69.3
50.5
27.4
78
31.1
6.2
77.2
51.1
29.9
43.2
11.5
80.7
22.5 78.9
27.8
49
67.9
64.2
58.9
48.8
34
38.1
25.8
57.5
54.9
40 83.5
Community health centre L2
Community health centre L3
Primary health centre
District 15
89
Mean: 53.6
Mean: 74.3
Mean: 34.8
District 16
77
70
Median: 51.8
Median: 77.2
Median: 30.5
IQR: 39.1-68.4
IQR: 69.3-78.9
IQR: 21.5-49.0
District 17
87.6
64.5
L2: Level 2; L3: Level 3 Note: One data point per five-year facility average.
1
66.7
78.2 73.5
1
PRIMARY HEALTH CENTRE
39.1
46 45.4
COMMUNITY HEALTH CENTRE LEVEL 3
71.3 71.9 58.7
53 25.8
21.9
20.9
13.4
24.4
White cells were either dropped from analysis due to data availability, or there were no more facilities to sample from that platform. There were no civil hospitals in Districts 2, 4, 6, 12, 14, 15, 16, and 17.
Note: Each circle represents the five-year facility average efficiency score; IQR refers to intra-quartile range.
resources in MP; at the same time, they are not without
limitations. Efficiency scores quantify the relationship be-
tween what a facility has and what it produces, but these
measures do not fully explain where inefficiencies orig-
inate, why a given facility scores higher than another, or
what levels of efficiency are truly ideal. It is conceivable that always operating at full capacity could actually have
negative effects on service provision, such as longer wait
times, high rates of staff burnout and turnover, and compromised quality of care. These factors, as well as less
tangible characteristics such as facility management, are
all important drivers of health service provision, and fu-
ture work should also assess these factors alongside measures of efficiency.
46
47
A B C E I N M A D H YA P R A D E S H
Figure 23 Observed and estimated additional visits that could be produced given observed facility resources
OUTPATIENT VISITS
INPATIENT VISITS
Outpatient visits
Inpatient visits
District Hospital
District Hospital
Area Hospital
Area Hospital
Community Health Centre L2
Community Health Centre L2
Community Health Centre L3
Community Health Centre L3
Primary Health Centre
Primary Health Centre
0
50,000 Observed
150000 100000 Outpatient visits
200000
0
Estimate additional visits
Observed
DELIVERIES
District Hospital
Area Hospital
Area Hospital
Community Health Centre L2
Community Health Centre L2
Community Health Centre L3
Community Health Centre L3
Primary Health Centre
Primary Health Centre
Observed
4,000 Deliveries
Estimate additional visits
Immunization Doses
District Hospital
2,000
40,000
IMMUNIZATION DOSES
Deliveries
0
30,000 20,000 Inpatient visits
10,000
6,000
8,000
0
Estimate additional deliveries
20,000
60,000 40,000 Immunization doses
Observed
80,000
Estimate additional doses
L2: Level 2; L3: Level 3
48
49
C O N C L U S I O N S A N D P O L I C Y I M P L I C AT I O N S
Conclusions and policy implications
of essential equipment for NCD services, including glu-
Infrastructure and equipment
cometer/test strips and blood chemistry analyzer. While
Adequate operational infrastructure is essential for the
functional ultrasound machines were present in 88% of
functioning of a facility, which in turn affects the efficiency
district hospitals, they were notably lacking in civil hos-
of service provision. In Madhya Pradesh, all hospitals and
pitals (40%) where they are still considered essential.
community health centres and almost all primary health
Furthermore, though functional CT scans are considered
centres had access to functioning electricity, and no fa-
essential, they were available only in 29% of the district
T
o achieve its mission to “expand the reach of
indicated that they provided routine delivery care, only
health care and establishing universal health
29% of district hospitals and no lower-level facilities had
coverage,” India has strived over the past 10 1
years to expand and strengthen the public
sector of health care, with a focus on reaching rural areas.
The country recognizes disparities and has sought to en-
the full stock of medical supplies and equipment to opti-
through improved public health and primary health
These gaps were also evident for ANC and general sur-
cost-effective interventions.45
gical services, and in all facility types, though they were
According to recent studies, India has a severe short-
pitals were well equipped with medical and laboratory
qualified health workers, and the workforce is concen-
and electricity likely reflects India’s commitment 10,11 to
qualified health personnel at all levels of the health sys-
Standards. However, less than half of sub health centres
staffing patterns between facilities. Hospitals employ
This suggests that there should be a sustained focus on
Our findings show that these goals are ambitious but at-
equipment, though with limited capacity for imaging ser-
trated in urban areas.6 In the context of a shortage of
levels of the system, particularly with regard to laboratory
tem, but especially rural areas,7,8,9 results reveal disparate
and making sure that all facilities are fully equipped to
a large number of staff. At the lower, community levels,
policy consideration.
the majority of care to patients (based on reported staff-
health disorders, diabetes, and cancer) and injuries are
hierarchy of care. However, nurses do not have much
tainable, if the country focuses on rigorously measuring
vices. The availability of equipment declined through the
and within levels of care, and if it can align the different
equipment and imaging equipment. Closing these gaps
health system performance.
optimally provide essential services warrants further
Facility capacity for service provision
Optimal health service delivery, one of the key build-
ing blocks of the health system, is linked to facility 2
capacity to provide individuals with the services they
staff and supplies needed to offer both essential and special health services, a health system has the necessary
foundation to deliver quality, equitable health services.
The availability of a subset of services including immu-
nization, DOTS treatment, OBGYN services, laboratory services, and general medicine was generally high across
ing said, the majority of facilities across these platforms
reported having flush toilets. That so many facilities reported access to essential resources like water, sanitation,
upgrade all facilities so they meet Indian Public Health
had functional electricity and only 9% had piped water.
making sure that these resources reach the lowest levels
paramedical staff including nurses and ANMs provide
of the health system.
Communication is also an important facet of health ser-
ing). These staffing patterns are not unexpected in the
vice delivery. Limited facilities reported access to a
the leading causes of death and disability in India, and are
authority or say within the health system, and the re-
mobile phones are widely available and in use by the
of disease during the next 25 years.3,4,5 Much of the care
been made to the government to urgently address the
low: only 4% of primary health centres had an emergency
sector and can be very expensive.45 These study findings
national policy for human resources to achieve univer-
To address this, Madhya Pradesh now has a reasonable
all levels of care, including cardiology, psychiatry, and
that despite the shortfall in human resources, the study
available for use in emergencies.12,13
issues of human resources through a comprehensive
also document notably lacking NCD-related services at
sal health care in India.48 However, it should be noted
cardiology services, and only 6% report providing psychi-
landline phone; however, it is important to point out that
sources to train them are still inadequate. A call has
for chronic diseases and injuries is provided in the private
chemotherapy. Only 53% of the district hospitals provide
facility types in Madhya Pradesh, reflecting the expansion
at hospitals but more variable at health centres. This be-
Chronic diseases (e.g., cardiovascular diseases, mental
projected to increase in their contribution to the burden
need and want. With the appropriate balance of skilled
laboratory samples. Access to piped water was universal
care systems that are essential for the implementation of
more pronounced at lower levels. In general, district hos-
dimensions of health service provision to support optimal
lows for reliable storage of medications, vaccines, and
mally provide these services as relevant to that platform.
act policies and implement programs to expand access
health facility performance and costs of services across
This means a higher quality of service provision, as it al-
ate action to scale up interventions for chronic diseases
age of human resources for health: it has a shortage of
to essential and special services for marginalized groups.
cilities reported being solely dependent on a generator.
hospitals. These findings support the need for immedi-
staff. Access to emergency vehicles was also generally
vehicle available and 94% had no vehicle available at all. network of 108 and 102 ambulances which are readily
findings suggest suboptimal efficiency in production
of services with the given level of human resources.
atric care. Such gaps in the health system will exacerbate
of these services throughout the state. However, differ-
disparities by not dealing appropriately with NCDs while
ences remain between high- and lower-level platforms.
continuing to strive to eliminate major infectious diseases
For example, while STI/HIV services were available in
like tuberculosis, HIV, and malaria, or to reduce neonatal
most district hospitals, they were available in only 24% of
and infant mortality. Furthermore, there also is a paucity
community health centers. Moreover, substantial gaps
10 Planning Commission Government of India. Eleventh Five Year Plan (2007-12). New Delhi, India: Government of India, 2007. 11 Planning Commission Government of India. Twelfth Five Year Plan (2012-17). New Delhi, India: Government of India, 2012. 12 India Infoline News Service. GVK EMRI 108 Neonatal Ambulances in Madhya Pradesh. IIFL [cited 2017 Nov 1]. Available from: https://www.indiainfoline. com/article/news-corporate/gvk-emri-108-neonatal-ambulances-in-madhya-pradesh-113103107152_1.html 13 Afridi S. Soon, dial 102 to get ambulance service in MP, medical advice 24x7. Hindustan Times. 2015 Feb 03 [cited 2017 Nov 1]. Available from: http://www. hindustantimes.com/bhopal/soon-dial-102-to-get-ambulance-service-in-mp-medical-advice-24x7/story-uCLEt4khR9og7mm7tdGrVJ.html
were identified between facilities reporting availability of these services and having the full capacity to actually
3 GBD 2015 Mortality and Causes of Death Collaborators. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015. The Lancet. 2016; 388:1459–1544. 4 Patel V, Chatterji S, Chisholm D, Ebrahim S, Gopalakrishna, G, Mathers C et al. Chronic diseases and injuries in India. The Lancet. 2011; 377: 413-28. 5 GBD 2015 DALYs and HALE Collaborators. Global, regional, and national disability-adjusted life-years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE), 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. The Lancet. 2016 Oct 7; 388:1603–1658.
deliver them. While almost all facilities, across platforms,
1 Planning Commission Government of India. Twelfth Five Year Plan (2012-17). New Delhi, India: Government of India, 2012. 2 World Health Organization (WHO). Everybody’s Business: Strengthening health systems to improve health outcomes: WHO’s Framework for Action. Geneva, Switzerland: WHO, 2007.
50
6 Rao M, Rao KD, Kumar AK, Chatterjee M, Sundararaman T. Human resources for health in India. The Lancet. 2011; 377(9765): 587-98. 7 Planning Commission Government of India. Twelfth Five Year Plan (2012-17). New Delhi, India: Government of India, 2012. 8 Hazarika I. Health Workforce in India: Assessment of Availability, Production and Distribution. WHO South East Asia Journal of Public Health. 2013; 2(2): 106-112. 9 Rao M, Rao KD, Kumar AK, Chatterjee M, Sundararaman T. Human resources for health in India. The Lancet. 2011; 377(9765): 587-98.
51
A B C E I N M A D H YA P R A D E S H
Facility production of health services
quantifying facility-based levels of efficiency provides a
Overall, the number of outpatient visits by year and
Outpatient visits were considerably lower at the lower
ral hierarchical system to provide a continuum of health
potentially expand service provision without necessarily
impact the chain of care at another level.19 Although var-
increasing personnel or bed capacity in parallel.
health facilities. The volume of inpatient visits and deliver-
ies increased slightly over the five years of observation for
Costs of care
most platforms. The highest volumes of visits were held
Average facility expenditure per year differed sub-
by district hospitals, followed by civil hospitals. Facility ex-
stantially across platforms. We were unable to estimate
penditure is dominated by personnel costs – accounting
for, on average, at least half of total costs.
the costs of care by type of services (such as outpatients,
facility-based resources and the facility’s total patient
disease/condition (such as TB, diabetes, etc.), as such
Efficiency scores reflect the relationship between
inpatients, deliveries, immunization, etc.) or by type of
volume each year. Average efficiency scores by platform
data are not readily available at the facilities. Estimating
ranged from 34.8% to 78.2%, indicating patient volume
such costs of care and identifying differences in patient
resources and expenditure. Within each platform, there
areas to improve cost-effectiveness and expand less
costs across the type of platforms is critical for isolating
could substantially increase with the observed levels of
is great variation in the efficiency of health facilities be-
costly services, especially for hard-to-reach populations.
estimated that facilities could substantially increase the
sights into each state’s health financing landscape, a
Nevertheless, these results on expenditures offer in-
tween and within districts. With this information, we
number of patients seen and services provided each,
key component to health system performance, in terms
resources. As India seeks to strengthen public sector care
costs do not reflect the quality of care received or the
based on their observed levels of medical personnel and
of cost to facilities and service production. While these
to reduce the heavy burden of out-of-pocket expendi-
specific services provided for each visit, they can enable
tures,14,15 stakeholders may seek to increase efficiency by
a compelling comparison of overall health care expenses
pacity (beds), and expenditure.
capture information on the quality of services provided,
providing more services while maintaining personnel, ca-
across states within India. Future studies should aim to
Further use of these results requires considering ef-
as it is a critical indicator of the likely impact of care on patient outcomes.
ficiency in the context of several other factors, including
quality of care provided, demand for care, and expediency with which patients are seen.
Patient perspectives
The policy implications of these efficiency results are
Patient satisfaction is an important indicator of pa-
both numerous and diverse, and they should be viewed
with a few caveats. A given facility’s efficiency score cap-
tient perception of the quality of services provided by
and facility-based resources, but it does not reflect the
tients is important for purposes of monitoring, increasing
provision of services; demand for the care received, and
adapting patient-centric services, and for utilization of
advantaged. These are all critical components of health
examined patient perspectives at public facilities; a ma-
tures the relationship between observed patient volume
the health care sector.17,18 Evaluation of services by pa-
expediency with which patients are seen; the optimal
accountability, recognizing good performance, and
equity in provision of services to serve those who are dis-
services and compliance with treatment. This report
16
jor strength of this study is that patient satisfaction was
service delivery, and they should be thoroughly consid-
assessed across the various levels of public sector
ered alongside measures of efficiency. On the other hand,
health care.
14 Planning Commission Government of India. Eleventh Five Year Plan (2007-12). New Delhi, India: Government of India, 2007. 15 Kumar AKS, Chen LC, Choudhury M, Ganju S, Mahajan V, Sinha A et al. Financing health care for all: challenges and opportunities. The Lancet. 2011; 377: 668-79. 16 UNICEF. Narrowing the gaps: The power of investing in the poorest children. New York, NY: UNICEF, 2017.
17 Mpinga EK, Chastonay P. Satisfaction of patients: a right to health indicator? Health Policy. 2011; 100(2-3):144-150. 18 Baltussen RM, Yé Y, Haddad S, Sauerborn RS. Perceived quality of care of primary health care services in Burkina Faso. Health Policy Plan. 2002; 17: 42-48.
52
developing strategies to improve performance and utili-
The public health system in India is designed as a refer-
data-driven, rather than strictly anecdotal, understand-
ing of how much Madhya Pradesh health facilities could
platform was stable over the five years of observation.
C O N C L U S I O N S A N D P O L I C Y I M P L I C AT I O N S
zation of the public health system.23
care, and as a consequence of this, failure at one level can
Health information system
This study was dependent on data availability at the
ious government initiatives have led to improved basic
facilities for the various inputs and outputs. Because of
service delivery at primary care health facilities over the
last few years, still a large number of patients directly visit
the vast extent of data that were collected for five finan-
facilities,
regarding the common bottlenecks within the health in-
cial years across the facilities, there were several lessons
higher-level facilities, leading to overcrowding of those 20
which impacts quality of care as it stretches
formation system, both at the facility level and at the state
facility resources in terms of both infrastructure and staff. In addition, the persistent shortage of medical staff in
level. In general, there is less availability of staff to capture
these facilities.
agement, and use (interpretation or planning) at all levels.
generally satisfied with the care they received, and rat-
that could guide planning or improvement of service pro-
data and also weak staff capacity for data capture, man-
public facilities only aggravates the crowded condition at 21
No system of regular review of data at the facility level
The findings of this study indicate that patients were
ings and satisfaction were highest at the highest levels of
vision was observed.
ness or privacy at the facility they visited. Holding other
condition other than those for deliveries, as data are not
It is not possible to assess the outputs by disease/
care. However, many were not satisfied with the cleanli-
captured or collated by disease groups at the facilities. At
factors constant, patients with wait times longer than 30
the higher-level facilities, collation of patients seen at the
minutes were less satisfied with care from doctors. Most patients experienced short travel and wait times. Most
facilities was not readily available, and it was not possible
with patients at lower-level facilities reporting the shortest
partments. Furthermore, documentation of patients as a
to assess the level of duplication of patients across de-
patients traveled for less than 30 minutes to receive care,
new patient or a follow-up patient was neither standard-
travel times. District hospitals had the highest proportion
of patients who had to wait more than 30 minutes to re-
ized nor practiced across most health facilities. Therefore,
than 30 minutes were at primary health centres. Finally,
visits and not in terms of number of patients.
able to acquire prescribed drugs. Though these levels are
cilities for expenditure, patient-related outputs, and staff
data interpretation is possible only in terms of number of
ceive care; the lowest proportion of patients waiting more
Data were either incomplete or inaccurate at some fa-
fewer than 3% of patients at all levels reported being un-
numbers. In a significant number of facilities, in case of
encouraging, ensuring that all patients may obtain pre-
scribed medications at the time of their visit should be a
staff turnover the previous staff did not hand over all the
With the developmental priorities for the government
added to non-availability of data. Expenditure documen-
documentation of previous years to the new staff, which
priority, as it facilitates adherence and continuity of care.
of India clearly highlighting the need to increase user
tation had the most bottlenecks, with these data available
countability,22 understanding how patients perceive the
to document the expenditures at a given facility without
ing various dimensions of care, such as time to receive
facility (block level), district health society, and from the
across various sources for a given facility. It is not possible
participation in health care service delivery for better ac-
procuring relevant data from the facility, a higher level of
quality of the existing public health services encompass-
state. The most limited capacity was to capture the expen-
medical attention, staff behavior, etc., could contribute to
diture on drugs, medical consumables, and supplies.
19 National Health Mission, Ministry of Health and Family Welfare, Government of India. Framework for Implementation National Health Mission (2012-2017). New Delhi, India: Government of India, 2012. 20 Bajpai V. The Challenges Confronting Public Hospitals in India, Their Origins, and Possible Solutions. Advances in Public Health 2014; 2014: 27. 21 Rao M, Rao KD, Kumar AK, Chatterjee M, Sundararaman T. Human resources for health in India. The Lancet. 2011; 377(9765): 587-98. 22 Planning Commission, Government of India. Faster, sustainable and more inclusive growth: An approach to the Twelfth Five Year Plan. New Delhi, India: Government of India, 2012.
23 World Health Organization (WHO). Global Health Observatory Data Repository. Geneva, Switzerland: WHO, 2016.
53
A B C E I N M A D H YA P R A D E S H
Summary
The ABCE project was designed to provide policymak-
ers and funders with new insights into health systems and
to drive improvements. We hope these findings will not only prove useful to policymaking in the state, but will
also inform broader efforts to mitigate factors that impede the equitable access or delivery of health services in
India. It is with this type of information that the individual
building blocks of health system performance, and their
critical interaction with each other, can be strengthened.
More efforts like the ABCE project in India are needed to continue many of the position trends highlighted in this
report and overcome the identified gaps. Analyses that
take into account a broader set of the stateâ&#x20AC;&#x2122;s facilities, including private facilities, may offer an even clearer pic-
ture of levels and trends in capacity, efficiency, and cost.
Continued monitoring of the strength and efficiency of
service provision is critical for optimal health system per-
formance and the equitable provision of cost-effective interventions throughout the states and in India.
54
55
Annex: Facility-specific data utilized for the efficiency analysis
FACILITY INFORMATION
INPUTS (BEDS & STAFF)
OUTPUTS
EXPENDITURE Medical supplies + pharmaceuticals
Administration and training
Non-medical
Year
Beds
Doctors
Nurses
Paramed
Nonmed
Outpatient
Inpatient
Vaccinations
Births
Personnel
Infrastructure + utilities
1
2008
300
28
36
39
31
50,743
21,702
32,824
5,932
24,253,898
6,054,749
2,932,278
198,368
11,917,856
District Hospital (DH)
1
2009
300
27
38
41
30
49,189
21,410
29,635
6,281
29,655,112
6,097,349
3,115,383
315,737
14,941,225
1
District Hospital (DH)
1
2010
300
29
83
45
31
45,211
21,916
32,050
6,121
45,208,904
6,328,414
3,293,773
364,640
13,441,178
1
District Hospital (DH)
1
2011
300
28
79
43
36
42,215
24,301
33,720
6,659
39,825,124
6,764,854
3,461,753
342,264
13,217,772
1
District Hospital (DH)
1
2012
300
35
103
46
48
44,255
26,991
31,017
6,524
49,974,248
6,984,087
3,606,762
824,558
12,675,668
1
Civil Hospital (CH)
1
2008
48
6
8
16
13
56,312
5,978
7,650
944
6,941,810
39,594
1,030,251
12,437
1,920,666
1
Civil Hospital (CH)
1
2009
48
6
10
16
13
56,267
4,398
7,225
893
8,623,636
111,995
1,084,348
21,518
1,895,080
1
Civil Hospital (CH)
1
2010
48
6
10
16
13
57,167
5,231
6,871
904
9,478,314
111,995
1,144,603
15,289
1,839,284
1
Civil Hospital (CH)
1
2011
48
6
10
16
13
60,766
6,340
8,037
962
15,426,240
112,228
1,179,665
7,623
2,008,389
1
Civil Hospital (CH)
1
2012
48
6
10
16
13
53,268
5,921
7,559
1,034
17,499,384
135,336
1,318,429
13,770
2,187,048
1
Community Health Centre (CHC)
1
2008
30
2
5
8
6
18,721
2,495
1,225
447
2,745,532
2,008,177
135,362
0
2,353,941
1
Community Health Centre (CHC)
1
2009
30
2
5
8
6
17,437
2,699
975
499
3,385,968
1,999,943
143,153
0
2,868,133
1
Community Health Centre (CHC)
1
2010
30
2
5
8
6
16,480
2,936
568
539
4,696,247
2,062,533
149,193
0
3,475,273
1
Community Health Centre (CHC)
1
2011
30
2
5
8
6
15,244
3,531
1,704
572
5,492,181
2,025,456
156,087
0
4,008,644
1
Community Health Centre (CHC)
1
2012
30
2
5
8
6
13,051
3,174
1,648
616
6,559,942
2,085,286
168,572
0
4,715,094
1
Primary Health Centre (PHC)
1
2008
10
1
0
3
0
6,084
0
380
193
757,812
74,332
64,189
1,046
0
1
Primary Health Centre (PHC)
1
2009
10
1
0
3
0
6,605
0
150
76
974,349
76,509
67,081
1,121
0
1
Primary Health Centre (PHC)
1
2010
10
1
0
3
0
8,141
0
134
69
1,699,500
87,540
69,771
1,145
0
1
Primary Health Centre (PHC)
1
2011
10
2
0
3
0
8,467
0
147
50
1,778,684
87,341
72,545
1,134
0
1
Primary Health Centre (PHC)
1
2012
10
2
0
3
0
6,791
0
126
43
1,862,868
105,334
75,802
1,410
0
1
Primary Health Centre (PHC)
2
2008
0
0
0
3
0
9,649
569
356
515
296,410
65,546
92,985
0
0
1
Primary Health Centre (PHC)
2
2009
0
0
0
3
0
9,035
508
336
422
400,654
65,038
72,968
0
0
1
Primary Health Centre (PHC)
2
2010
0
0
0
3
0
9,099
542
360
482
609,932
64,454
79,292
0
0
1
Primary Health Centre (PHC)
2
2011
0
0
0
3
0
7,351
624
242
507
677,339
66,218
82,469
0
0
1
Primary Health Centre (PHC)
2
2012
0
0
0
3
0
8,691
579
179
472
719,939
63,878
90,587
0
0
1
Community Health Centre (CHC)
2
2008
30
1
4
9
3
24,062
858
335
494
1,923,104
167,779
124,431
8,360
707,825
1
Community Health Centre (CHC)
2
2009
30
1
4
9
3
25,463
789
486
257
2,294,132
177,019
154,440
17,491
371,733
1
Community Health Centre (CHC)
2
2010
30
1
4
9
3
23,672
716
436
274
2,950,150
151,413
171,747
19,229
401,780
District
Platform
1
District Hospital (DH)
1
Facility
56
57
FACILITY INFORMATION
INPUTS (BEDS & STAFF)
OUTPUTS
EXPENDITURE Medical supplies + pharmaceuticals
Administration and training
Non-medical
Beds
Doctors
Nurses
Paramed
Nonmed
Outpatient
Inpatient
Vaccinations
Births
Personnel
Infrastructure + utilities
2011
30
2
4
10
4
18,296
493
473
208
3,450,862
167,189
211,269
25,920
308,724
2
2012
30
2
4
10
4
19,445
745
490
282
4,156,251
182,944
238,991
27,750
411,090
Primary Health Centre (PHC)
1
2008
4
0
0
2
1
3,638
0
376
183
521,864
75,174
61,645
7,040
256,200
1
Primary Health Centre (PHC)
1
2009
4
0
0
2
1
3,602
0
161
188
608,448
71,871
64,890
1,565
263,200
1
Primary Health Centre (PHC)
1
2010
4
0
0
3
1
3,345
0
129
215
783,032
64,356
68,305
2,928
301,000
1
Primary Health Centre (PHC)
1
2011
4
0
0
3
1
2,711
0
342
210
927,444
75,399
71,524
19,656
294,000
1
Primary Health Centre (PHC)
1
2012
4
0
0
3
1
2,510
0
373
172
878,030
58,142
74,894
16,700
240,800
1
Primary Health Centre (PHC)
2
2008
6
0
0
2
0
1,299
0
100
156
243,152
79,413
61,645
14,330
218,400
1
Primary Health Centre (PHC)
2
2009
6
0
0
2
0
1,149
0
296
159
311,564
77,451
64,890
3,711
222,600
1
Primary Health Centre (PHC)
2
2010
6
0
0
2
0
1,208
0
190
172
341,261
77,757
68,305
7,087
240,800
1
Primary Health Centre (PHC)
2
2011
6
0
0
2
0
1,241
0
171
165
403,703
74,161
71,524
13,696
231,000
1
Primary Health Centre (PHC)
2
2012
6
0
0
2
0
1,171
0
517
205
468,941
80,658
74,894
13,845
287,000
2
District Hospital (DH)
1
2008
234
12
83
51
22
95,321
24,400
25,294
4,940
34,549,876
2,196,043
3,277,710
3,200,059
10,004,231
2
District Hospital (DH)
1
2009
234
12
83
51
22
96,967
24,510
33,593
4,703
41,508,536
2,218,185
3,485,981
4,001,385
8,736,595
2
District Hospital (DH)
1
2010
234
12
82
54
22
99,621
25,058
34,864
5,066
48,717,496
2,170,277
3,626,843
4,597,065
9,017,653
2
District Hospital (DH)
1
2011
234
12
82
54
22
120,824
36,895
29,289
4,938
65,853,204
2,186,861
3,886,500
4,805,245
8,182,269
2
District Hospital (DH)
1
2012
234
16
85
55
22
129,540
37,847
24,358
4,222
61,881,312
2,100,065
4,097,174
8,174,404
7,285,187
2
Community Health Centre (CHC)
1
2008
33
1
3
18
9
16,786
922
4,986
792
3,105,344
620,415
635,387
36,050
2,974,750
2
Community Health Centre (CHC)
1
2009
33
1
3
20
13
18,722
983
5,229
898
4,642,489
683,695
673,882
55,200
3,143,200
2
Community Health Centre (CHC)
1
2010
33
2
3
21
14
14,356
1,187
7,200
931
5,220,132
690,970
720,840
56,500
2,956,500
2
Community Health Centre (CHC)
1
2011
33
2
3
18
12
11,486
1,177
8,024
1,007
5,733,097
699,055
755,579
60,150
2,968,400
2
Community Health Centre (CHC)
1
2012
33
2
3
18
13
11,551
1,073
8,380
679
7,157,571
696,415
794,780
65,570
2,888,900
2
Primary Health Centre (PHC)
1
2008
6
1
1
5
2
1,727
128
0
121
811,819
68,549
932,624
5,550
157,500
2
Primary Health Centre (PHC)
1
2009
6
1
1
5
2
1,795
104
0
96
979,441
119,509
981,710
5,490
166,250
2
Primary Health Centre (PHC)
1
2010
6
1
0
5
2
1,360
98
0
96
1,009,005
140,103
1,033,379
7,540
314,800
2
Primary Health Centre (PHC)
1
2011
6
0
0
5
2
1,122
0
76
126
1,036,642
150,483
1,082,350
9,950
187,950
2
Primary Health Centre (PHC)
1
2012
6
0
0
5
2
867
88
144
87
1,036,143
144,322
1,133,607
10,340
200,200
2
Primary Health Centre (PHC)
2
2008
6
0
0
3
1
3,417
179
1,442
0
336,147
32,893
932,624
5,220
242
2
Primary Health Centre (PHC)
2
2009
6
0
0
3
1
3,086
123
2,382
0
439,566
39,175
981,710
6,155
51,597
2
Primary Health Centre (PHC)
2
2010
6
0
0
3
1
4,778
103
439
0
481,573
46,091
1,033,379
7,142
38,255
2
Primary Health Centre (PHC)
2
2011
6
1
0
3
1
6,208
236
681
0
644,206
41,256
1,082,072
8,310
80,550
2
Primary Health Centre (PHC)
2
2012
6
0
0
3
1
7,007
305
1,366
42
947,088
36,399
1,133,060
8,750
372,150
2
Community Health Centre (CHC)
2
2008
40
4
6
11
5
36,775
2,743
685
1,626
7,610,743
737,297
634,068
77,976
1,756,615
2
Community Health Centre (CHC)
2
2009
40
3
6
11
5
34,091
3,128
1,321
1,448
7,944,345
687,013
670,008
91,065
1,988,301
2
Community Health Centre (CHC)
2
2010
40
2
6
11
5
32,444
2,961
1,356
1,387
8,209,637
677,800
703,938
102,648
2,312,469
2
Community Health Centre (CHC)
2
2011
40
4
7
11
6
32,488
2,741
1,211
1,524
8,664,398
761,927
736,305
252,899
2,364,950
2
Community Health Centre (CHC)
2
2012
40
4
7
16
6
30,558
3,149
1,260
1,526
9,868,854
717,708
770,543
309,691
3,898,273
2
Primary Health Centre (PHC)
1
2008
1
1
0
4
1
8,166
0
723
163
2,207,280
56,326
932,624
0
0
2
Primary Health Centre (PHC)
1
2009
1
1
0
4
1
8,998
0
517
146
2,450,880
69,991
981,710
0
0
District
Platform
Facility
1
Community Health Centre (CHC)
2
1
Community Health Centre (CHC)
1
Year
58
59
FACILITY INFORMATION
INPUTS (BEDS & STAFF)
OUTPUTS
EXPENDITURE Medical supplies + pharmaceuticals
Administration and training
Non-medical
Beds
Doctors
Nurses
Paramed
Nonmed
Outpatient
Inpatient
Vaccinations
Births
Personnel
Infrastructure + utilities
2010
1
1
0
4
1
5,786
0
284
111
2,326,880
50,238
1,033,379
0
0
1
2011
1
1
0
4
1
3,727
0
406
82
1,862,400
58,853
1,082,072
0
0
Primary Health Centre (PHC)
1
2012
1
0
0
3
0
2,658
0
768
41
503,750
50,823
1,133,060
0
0
2
Primary Health Centre (PHC)
2
2008
4
1
1
2
2
6,815
0
0
283
917,160
54,952
932,624
14,797
462,738
2
Primary Health Centre (PHC)
2
2009
4
1
1
3
3
5,670
0
914
302
1,294,780
72,891
985,952
13,122
505,883
2
Primary Health Centre (PHC)
2
2010
4
1
1
3
3
6,040
0
928
260
1,036,177
67,946
1,037,877
16,450
460,462
2
Primary Health Centre (PHC)
2
2011
4
1
2
2
2
7,083
0
1,264
221
873,684
61,479
1,087,832
15,700
303,465
District
Platform
Facility
2
Primary Health Centre (PHC)
1
2
Primary Health Centre (PHC)
2
Year
2
Primary Health Centre (PHC)
2
2012
4
1
1
2
2
5,189
0
1,311
216
899,267
56,661
1,139,539
15,890
312,077
3
District Hospital (DH)
1
2008
353
55
94
63
119
437,341
25,239
48,060
4,744
94,044,656
7,261,903
3,338,240
654,321
7,854,749
3
District Hospital (DH)
1
2009
353
55
96
66
124
361,180
26,794
47,810
5,440
85,957,208
5,908,564
3,503,947
876,543
9,633,703
3
District Hospital (DH)
1
2010
353
60
118
73
128
444,895
27,916
45,610
5,945
130,035,776
21,444,895
3,645,065
1,098,765
11,461,865
3
District Hospital (DH)
1
2011
353
60
118
73
128
519,883
30,277
46,820
6,028
154,174,624
21,465,523
3,831,274
1,243,675
13,260,367
3
District Hospital (DH)
1
2012
353
60
118
73
128
319,008
31,567
74,640
5,745
196,335,904
26,886,037
4,117,123
1,693,079
13,855,848
3
Civil Hospital (CH)
1
2008
125
19
28
46
27
102,951
4,216
19,644
1,058
25,492,524
2,652,016
645,746
281,468
1,651,750
3
Civil Hospital (CH)
1
2009
125
16
29
45
27
102,690
4,314
20,420
963
27,084,292
3,515,118
692,295
77,570
2,053,537
3
Civil Hospital (CH)
1
2010
125
17
28
45
27
103,448
5,138
20,421
1,181
36,315,664
3,080,483
710,389
253,726
2,341,187
3
Civil Hospital (CH)
1
2011
125
22
28
45
27
119,869
5,773
24,464
1,607
39,452,164
5,177,467
758,752
377,953
2,907,916
3
Civil Hospital (CH)
1
2012
125
21
29
47
27
136,586
7,283
22,648
2,134
41,681,476
3,861,157
785,091
381,117
4,023,555
3
Community Health Centre (CHC)
1
2008
44
7
4
19
21
78,590
2,274
8,251
2,494
7,457,974
698,916
89,065
897,758
5,523,864
3
Community Health Centre (CHC)
1
2009
44
6
4
18
23
75,460
2,306
6,045
2,756
8,042,640
1,103,782
97,736
1,782,543
1,767,132
3
Community Health Centre (CHC)
1
2010
44
6
4
18
27
87,898
1,423
11,326
2,813
10,304,139
750,943
114,707
1,113,678
5,622,328
3
Community Health Centre (CHC)
1
2011
44
7
4
18
27
82,169
2,283
12,504
2,858
12,356,244
1,324,101
122,028
539,139
8,035,132
3
Community Health Centre (CHC)
1
2012
44
7
6
18
25
78,540
4,524
11,248
1,985
14,426,618
1,162,881
127,375
806,594
6,006,736
3
Primary Health Centre (PHC)
1
2008
5
1
0
5
2
8,335
0
1,530
187
1,351,452
61,516
61,979
1,618
300,900
3
Primary Health Centre (PHC)
1
2009
5
1
0
6
2
7,915
0
1,794
133
855,376
82,352
65,241
5,754
233,050
3
Primary Health Centre (PHC)
1
2010
5
2
1
7
3
8,070
0
1,078
87
1,750,958
64,401
68,675
1,000
169,600
3
Primary Health Centre (PHC)
1
2011
5
2
1
6
2
6,705
0
899
49
1,692,597
91,026
71,911
3,000
88,500
3
Primary Health Centre (PHC)
1
2012
5
2
1
6
2
5,836
0
937
43
2,116,999
168,927
75,300
2,000
77,400
3
Primary Health Centre (PHC)
2
2008
5
1
0
2
0
7,972
569
91
557
496,864
361,453
61,979
0
974,750
3
Primary Health Centre (PHC)
2
2009
5
1
0
3
0
6,049
660
992
630
611,411
361,453
65,241
0
1,102,500
3
Primary Health Centre (PHC)
2
2010
5
1
0
3
0
5,153
750
1,783
701
1,034,985
361,453
68,675
0
1,226,750
3
Primary Health Centre (PHC)
2
2011
5
1
1
3
0
7,284
540
2,274
523
1,099,456
361,453
80,520
0
915,250
3
Primary Health Centre (PHC)
2
2012
5
2
1
7
1
4,225
600
2,416
570
1,026,370
337,453
85,581
0
997,500
3
Community Health Centre (CHC)
2
2008
30
6
6
24
19
52,235
785
2,015
247
5,168,284
205,856
70,515
42,220
1,260,000
3
Community Health Centre (CHC)
2
2009
30
7
7
19
17
42,045
1,631
1,826
455
5,597,134
223,605
76,023
55,290
2,226,649
3
Community Health Centre (CHC)
2
2010
30
7
9
19
23
35,914
1,237
2,677
615
9,703,573
220,425
79,169
75,657
2,147,601
3
Community Health Centre (CHC)
2
2011
30
9
7
18
15
33,938
1,127
2,355
562
10,200,592
334,377
82,658
54,481
1,941,837
3
Community Health Centre (CHC)
2
2012
30
9
7
18
16
37,901
1,254
2,750
596
11,030,358
274,939
86,751
54,211
1,909,880
3
Primary Health Centre (PHC)
1
2008
4
2
0
12
2
17,280
0
2,288
54
2,082,385
82,180
72,941
3,659
94,500
60
61
FACILITY INFORMATION
INPUTS (BEDS & STAFF)
OUTPUTS
EXPENDITURE Medical supplies + pharmaceuticals
Administration and training
Non-medical
Beds
Doctors
Nurses
Paramed
Nonmed
Outpatient
Inpatient
Vaccinations
Births
Personnel
Infrastructure + utilities
2009
4
2
0
12
4
17,640
0
2,506
96
2,430,053
135,961
78,698
4,000
168,000
1
2010
4
2
0
13
4
15,080
0
2,487
78
2,933,806
138,068
80,707
3,755
136,500
Primary Health Centre (PHC)
1
2011
4
1
0
8
3
14,970
0
2,482
95
2,597,566
189,825
83,702
4,489
168,710
3
Primary Health Centre (PHC)
1
2012
4
2
0
11
5
11,637
0
2,712
213
3,318,640
199,736
88,040
11,037
376,611
3
Primary Health Centre (PHC)
2
2008
2
2
0
6
0
5,704
0
562
74
1,925,840
146,190
61,979
0
39,250
3
Primary Health Centre (PHC)
2
2009
2
2
0
6
0
4,666
0
1,974
14
1,807,661
168,562
65,241
11,600
28,650
3
Primary Health Centre (PHC)
2
2010
2
2
0
7
2
4,239
0
4,188
56
2,340,980
184,938
68,675
500
145,000
3
Primary Health Centre (PHC)
2
2011
2
5
0
8
2
4,630
0
7,998
88
3,580,867
187,544
71,911
0
163,250
3
Primary Health Centre (PHC)
2
2012
2
5
0
6
2
6,420
0
761
56
3,559,032
135,011
75,300
0
113,050
4
District Hospital (DH)
1
2008
260
21
15
52
27
499,749
20,979
24,674
5,220
14,062,020
4,227,706
2,143,703
145,551
13,591,447
4
District Hospital (DH)
1
2009
260
21
15
52
27
542,802
22,275
33,144
6,007
18,970,456
4,287,570
2,204,098
126,014
12,971,014
4
District Hospital (DH)
1
2010
260
21
14
52
27
562,515
21,626
34,463
5,868
26,736,076
4,412,787
2,200,406
121,188
15,569,558
4
District Hospital (DH)
1
2011
260
21
37
32
23
563,968
23,898
29,161
6,475
166,336,912
4,897,788
2,311,086
212,279
16,980,748
4
District Hospital (DH)
1
2012
260
27
38
49
24
568,442
25,489
23,933
6,171
175,446,304
5,366,960
2,654,404
813,334
17,630,812
4
Community Health Centre (CHC)
1
2008
36
2
3
8
9
20,174
1,094
2,044
644
3,514,904
479,185
409,134
13,000
1,587,840
4
Community Health Centre (CHC)
1
2009
36
2
3
8
9
20,685
861
3,630
604
3,466,020
555,185
425,811
22,000
1,670,040
4
Community Health Centre (CHC)
1
2010
36
2
2
8
10
25,474
1,436
4,689
655
4,536,613
478,690
443,214
150,505
2,235,900
4
Community Health Centre (CHC)
1
2011
36
4
1
9
12
22,937
1,938
5,391
763
5,515,122
448,760
468,415
157,500
1,864,900
4
Community Health Centre (CHC)
1
2012
36
4
1
9
12
26,010
1,768
5,053
755
6,419,776
483,739
501,252
109,525
3,305,360
4
Primary Health Centre (PHC)
1
2008
4
0
0
3
0
3,258
0
321
453
265,980
62,050
604,510
1,500
824,120
4
Primary Health Centre (PHC)
1
2009
4
0
0
3
0
4,789
0
726
439
306,126
62,050
636,326
2,300
895,560
4
Primary Health Centre (PHC)
1
2010
4
0
0
3
0
5,584
0
1,059
420
411,443
62,050
669,817
2,800
865,200
4
Primary Health Centre (PHC)
1
2011
4
0
0
3
0
6,836
0
1,185
441
455,304
62,050
701,379
3,550
908,460
4
Primary Health Centre (PHC)
1
2012
4
1
0
3
5
7,972
609
1,140
436
1,114,309
62,050
734,428
4,000
2,114,910
4
Primary Health Centre (PHC)
2
2008
5
0
0
1
1
1,183
4
0
0
168,000
69,425
665,955
3,952
2,225
4
Primary Health Centre (PHC)
2
2009
5
1
0
1
1
3,154
1
0
0
246,000
73,462
671,964
522
54,804
4
Primary Health Centre (PHC)
2
2010
5
0
0
1
1
3,704
0
0
0
288,000
85,295
758,574
9,200
20,724
4
Primary Health Centre (PHC)
2
2011
5
1
0
1
1
3,418
0
318
110
486,000
79,095
708,337
7,450
311,832
4
Primary Health Centre (PHC)
2
2012
5
1
0
1
0
2,467
0
558
194
420,000
87,110
742,170
9,100
716,880
4
Community Health Centre (CHC)
2
2008
15
1
3
9
4
6,992
0
2,853
616
4,218,686
61,968
382,237
3,400
897,127
4
Community Health Centre (CHC)
2
2009
15
1
3
9
5
4,557
0
3,011
604
5,301,398
68,276
409,546
3,579
1,340,254
4
Community Health Centre (CHC)
2
2010
15
1
3
9
8
11,170
0
4,350
777
5,368,254
68,555
434,642
5,682
1,238,835
4
Community Health Centre (CHC)
2
2011
15
1
3
10
8
12,450
0
6,225
888
5,852,470
66,271
492,477
11,700
1,493,540
4
Community Health Centre (CHC)
2
2012
15
2
3
11
8
12,421
0
5,087
858
6,729,875
70,487
489,890
7,650
1,524,852
4
Primary Health Centre (PHC)
1
2008
5
0
1
2
0
1,778
0
119
38
526,361
146,906
604,510
0
53,200
4
Primary Health Centre (PHC)
1
2009
5
0
1
2
0
2,762
0
524
79
616,863
147,730
636,326
0
110,600
4
Primary Health Centre (PHC)
1
2010
5
0
1
2
0
2,930
0
820
105
702,543
150,546
669,817
10,970
152,100
4
Primary Health Centre (PHC)
1
2011
5
1
1
2
0
1,876
0
547
108
764,589
152,646
701,379
11,500
156,100
4
Primary Health Centre (PHC)
1
2012
5
1
1
2
0
1,738
0
879
107
855,400
297,446
734,428
0
149,800
District
Platform
Facility
3
Primary Health Centre (PHC)
1
3
Primary Health Centre (PHC)
3
Year
62
63
FACILITY INFORMATION
INPUTS (BEDS & STAFF)
OUTPUTS
EXPENDITURE Medical supplies + pharmaceuticals
Administration and training
Non-medical
Beds
Doctors
Nurses
Paramed
Nonmed
Outpatient
Inpatient
Vaccinations
Births
Personnel
Infrastructure + utilities
2008
6
0
0
3
1
3,062
0
1,805
150
446,883
179,932
615,164
0
210,000
2
2009
6
0
0
3
1
3,382
0
1,847
161
563,296
180,050
647,969
0
225,400
Primary Health Centre (PHC)
2
2010
6
0
0
3
1
4,606
0
1,834
187
655,603
176,762
680,881
0
261,800
4
Primary Health Centre (PHC)
2
2011
6
0
0
3
1
3,915
0
1,842
197
765,184
180,935
712,127
0
275,800
4
Primary Health Centre (PHC)
2
2012
6
0
0
3
1
2,978
0
1,904
299
914,266
181,549
745,877
0
418,600
5
District Hospital (DH)
1
2008
400
24
136
72
32
258,222
70,599
40,069
7,897
38,071,924
4,341,339
1,982,108
253,644
11,300,000
5
District Hospital (DH)
1
2009
400
24
136
72
32
269,643
69,968
39,561
8,521
46,290,108
4,401,267
2,083,636
397,682
11,635,833
5
District Hospital (DH)
1
2010
400
20
136
72
32
261,245
68,687
41,048
8,933
58,193,848
4,389,524
2,173,362
307,739
14,351,808
5
District Hospital (DH)
1
2011
400
20
136
72
32
251,783
73,732
39,764
8,807
65,267,164
4,571,438
2,266,886
353,416
16,378,291
5
District Hospital (DH)
1
2012
400
24
139
72
32
249,613
78,720
40,457
9,299
113,480,664
4,445,398
2,378,843
1,076,027
14,668,267
5
Civil Hospital (CH)
1
2008
40
2
4
15
13
47,539
6,534
1,497
1,120
3,798,470
401,241
858,666
302,100
2,820,000
5
Civil Hospital (CH)
1
2009
40
3
5
17
15
51,354
6,860
2,309
1,274
5,117,071
406,016
903,723
342,864
3,374,000
5
Civil Hospital (CH)
1
2010
40
3
4
17
14
33,768
6,500
2,772
1,337
7,354,400
411,352
955,543
471,465
3,971,936
5
Civil Hospital (CH)
1
2011
40
3
4
17
13
38,872
5,699
3,037
1,413
7,296,503
414,830
997,401
490,238
3,785,287
5
Civil Hospital (CH)
1
2012
40
4
7
16
14
35,026
6,688
2,999
1,295
8,550,586
427,712
1,045,221
519,050
3,227,297
5
Community Health Centre (CHC)
1
2008
10
1
1
4
2
11,311
1,127
0
313
1,625,424
80,899
78,201
854
560,000
5
Community Health Centre (CHC)
1
2009
10
1
2
4
2
11,463
1,033
0
297
1,875,888
81,722
81,458
2,300
599,050
5
Community Health Centre (CHC)
1
2010
10
1
2
4
2
10,525
1,179
0
451
2,025,600
75,745
84,724
1,122
742,662
5
Community Health Centre (CHC)
1
2011
10
1
2
4
2
10,307
1,140
248
408
2,260,800
73,062
88,916
4,597
827,637
5
Community Health Centre (CHC)
1
2012
10
1
2
4
2
9,177
1,074
352
379
2,582,592
73,384
108,087
4,216
853,980
5
Primary Health Centre (PHC)
1
2008
3
2
0
4
1
8,950
158
0
70
853,012
52,168
59,468
3,516
11,292
5
Primary Health Centre (PHC)
1
2009
3
2
0
4
1
6,273
149
0
47
1,108,835
53,583
62,598
1,491
7,191
5
Primary Health Centre (PHC)
1
2010
3
1
0
4
1
2,860
152
0
43
1,249,573
69,784
65,893
1,809
5,822
5
Primary Health Centre (PHC)
1
2011
3
1
0
4
1
3,285
147
0
29
1,677,547
52,781
68,998
1,250
7,255
5
Primary Health Centre (PHC)
1
2012
3
1
0
4
1
2,996
157
0
42
1,790,156
69,868
72,249
5,033
1,900
5
Primary Health Centre (PHC)
2
2008
5
2
1
5
3
8,623
127
1,497
48
1,445,479
200,586
116,218
4,847
100,057
5
Primary Health Centre (PHC)
2
2009
5
2
1
4
3
9,671
118
1,981
49
1,651,109
200,865
110,529
2,790
80,170
5
Primary Health Centre (PHC)
2
2010
5
2
1
4
3
10,008
56
1,696
27
1,714,448
209,621
116,300
1,817
65,558
5
Primary Health Centre (PHC)
2
2011
5
2
0
4
2
13,359
38
1,105
27
2,291,017
206,229
117,942
1,480
65,821
5
Primary Health Centre (PHC)
2
2012
5
2
0
4
2
13,741
62
1,411
43
2,270,842
218,587
125,919
8,103
71,251
5
Community Health Centre (CHC)
2
2008
30
1
4
11
12
32,154
4,341
1,239
1,491
4,126,963
139,004
71,071
12,280
2,217,600
5
Community Health Centre (CHC)
2
2009
30
1
4
11
14
28,518
3,239
1,545
1,542
4,418,408
137,842
74,812
12,443
2,175,600
5
Community Health Centre (CHC)
2
2010
30
1
6
14
19
28,106
2,876
1,727
1,691
5,062,489
136,335
104,071
13,739
2,261,000
5
Community Health Centre (CHC)
2
2011
30
1
6
15
19
23,164
3,178
2,456
1,584
5,996,965
137,926
131,798
12,057
2,241,400
5
Community Health Centre (CHC)
2
2012
30
1
6
15
21
23,881
3,258
2,161
1,461
6,748,224
136,325
163,078
12,050
2,135,400
5
Primary Health Centre (PHC)
1
2008
6
0
0
4
4
2,686
0
1,602
392
316,564
116,899
68,976
6,890
687,300
5
Primary Health Centre (PHC)
1
2009
6
0
0
4
4
2,372
0
1,641
461
317,408
121,629
73,980
11,110
722,039
5
Primary Health Centre (PHC)
1
2010
6
1
1
5
5
3,221
0
2,136
434
455,841
122,629
79,183
13,567
740,380
5
Primary Health Centre (PHC)
1
2011
6
1
1
4
5
2,547
0
2,001
436
497,805
117,629
83,447
13,390
745,867
District
Platform
Facility
4
Primary Health Centre (PHC)
2
4
Primary Health Centre (PHC)
4
Year
64
65
FACILITY INFORMATION
INPUTS (BEDS & STAFF)
OUTPUTS
EXPENDITURE Medical supplies + pharmaceuticals
Administration and training
Non-medical
Beds
Doctors
Nurses
Paramed
Nonmed
Outpatient
Inpatient
Vaccinations
Births
Personnel
Infrastructure + utilities
2012
6
1
1
3
4
2,884
0
2,627
491
589,087
120,529
88,204
15,240
946,591
2
2008
0
0
0
2
0
639
0
472
21
250,191
53,256
59,468
600
29,400
Primary Health Centre (PHC)
2
2009
0
0
0
2
0
468
0
970
16
292,714
52,516
62,598
7,230
22,400
5
Primary Health Centre (PHC)
2
2010
0
0
0
2
1
510
0
862
12
342,340
52,674
65,893
3,496
16,800
5
Primary Health Centre (PHC)
2
2011
0
0
0
2
1
311
0
443
0
429,688
53,144
68,998
7,352
7,000
5
Primary Health Centre (PHC)
2
2012
0
0
0
2
1
676
0
585
0
489,304
56,223
72,249
2,829
4,200
5
Sub Health Centre (SHC)
1
2008
0
0
0
1
0
493
0
638
0
130,080
5,002
2,099
450
0
5
Sub Health Centre (SHC)
1
2009
0
0
0
1
0
480
0
820
0
176,382
5,375
3,227
722
0
5
Sub Health Centre (SHC)
1
2010
0
0
0
1
0
484
0
815
0
216,324
5,324
2,919
744
0
5
Sub Health Centre (SHC)
1
2011
0
0
0
1
0
402
0
620
0
256,206
5,170
2,303
1,072
0
5
Sub Health Centre (SHC)
1
2012
0
0
0
1
0
482
0
513
0
301,560
5,739
2,067
2,400
0
5
Civil Hospital (CH)
2
2008
30
2
7
8
3
26,353
810
3,309
405
2,986,930
132,064
866,290
65,554
1,099,900
5
Civil Hospital (CH)
2
2009
30
2
7
8
3
20,266
734
3,136
424
3,619,000
114,157
914,100
60,233
813,010
5
Civil Hospital (CH)
2
2010
30
2
7
8
3
16,699
563
3,103
369
3,951,860
120,082
959,798
91,164
509,000
5
Civil Hospital (CH)
2
2011
30
1
7
8
3
17,376
601
4,155
408
4,066,736
125,427
1,004,739
10,859
1,007,998
5
Civil Hospital (CH)
2
2012
30
3
7
8
3
19,961
834
4,055
391
7,226,814
151,674
1,053,002
0
961,440
5
Civil Hospital (CH)
3
2008
78
8
3
18
20
62,745
4,686
9,197
1,368
8,863,851
1,062,496
954,521
630,242
5,875,085
5
Civil Hospital (CH)
3
2009
78
6
3
14
23
63,038
5,455
11,106
1,463
10,335,697
1,094,671
1,034,046
656,440
5,470,544
5
Civil Hospital (CH)
3
2010
78
5
3
10
15
49,845
5,676
11,535
1,498
10,046,087
929,673
1,250,767
577,520
6,025,261
5
Civil Hospital (CH)
3
2011
78
10
5
18
18
51,191
5,103
12,051
1,734
16,034,739
3,230,170
1,353,725
1,026,444
5,874,890
5
Civil Hospital (CH)
3
2012
78
9
5
18
21
50,878
5,371
12,037
1,721
18,121,182
1,785,701
1,704,861
2,647,978
7,392,695
6
District Hospital (DH)
1
2008
313
22
128
55
45
92,719
6,650
37,179
4,080
552,288
2,459,464
3,611,707
151,682
4,523,100
6
District Hospital (DH)
1
2009
313
26
118
62
70
95,663
8,204
39,853
4,102
797,509
2,618,209
3,787,948
276,335
5,939,600
6
District Hospital (DH)
1
2010
313
28
145
76
58
111,647
10,480
41,408
3,506
570,517
2,833,697
3,977,458
355,504
5,450,000
6
District Hospital (DH)
1
2011
313
30
150
88
58
114,403
7,893
40,033
3,392
1,802,650
3,486,295
4,136,124
217,145
4,271,000
6
District Hospital (DH)
1
2012
313
38
155
107
60
115,791
8,908
40,260
3,522
3,323,217
4,417,317
4,335,554
14,228
5,249,550
6
Community Health Centre (CHC)
1
2008
34
7
3
19
11
38,613
10,331
10,832
1,946
6,508,339
266,742
730,832
23,500
5,030,422
6
Community Health Centre (CHC)
1
2009
34
7
4
19
11
38,645
9,013
11,714
2,148
7,809,214
291,742
787,074
150,950
9,508,329
6
Community Health Centre (CHC)
1
2010
34
7
3
21
13
37,208
5,218
12,734
2,493
8,312,104
316,742
817,943
63,609
11,614,719
6
Community Health Centre (CHC)
1
2011
34
7
4
22
13
36,584
5,598
10,692
2,724
11,423,492
321,742
853,424
296,273
8,142,328
6
Community Health Centre (CHC)
1
2012
34
7
5
22
15
37,192
4,740
11,256
2,661
12,348,508
312,242
896,753
335,592
7,998,370
6
Primary Health Centre (PHC)
1
2008
5
0
0
5
1
1,429
0
214
75
454,269
17,960
1,053,444
1,200
160,000
6
Primary Health Centre (PHC)
1
2009
5
0
0
4
1
2,049
0
215
36
432,928
19,960
1,108,888
4,000
160,000
6
Primary Health Centre (PHC)
1
2010
5
0
0
4
1
1,823
0
203
11
484,174
17,960
1,167,251
1,500
140,000
6
Primary Health Centre (PHC)
1
2011
5
0
0
4
1
1,313
0
288
0
566,851
25,460
1,222,252
5,000
0
6
Primary Health Centre (PHC)
1
2012
5
0
0
4
1
2,979
0
342
0
625,081
26,460
1,279,845
6,000
0
6
Primary Health Centre (PHC)
2
2008
4
0
0
4
1
570
0
617
38
465,736
197,382
1,053,444
4,500
53,200
6
Primary Health Centre (PHC)
2
2009
4
0
0
4
1
604
0
553
18
541,528
205,982
1,108,888
3,000
25,200
6
Primary Health Centre (PHC)
2
2010
4
0
0
4
1
443
0
1,038
21
731,238
204,382
1,167,251
2,000
29,400
District
Platform
Facility
5
Primary Health Centre (PHC)
1
5
Primary Health Centre (PHC)
5
Year
66
67
FACILITY INFORMATION
INPUTS (BEDS & STAFF)
OUTPUTS
EXPENDITURE Medical supplies + pharmaceuticals
Administration and training
Non-medical
Beds
Doctors
Nurses
Paramed
Nonmed
Outpatient
Inpatient
Vaccinations
Births
Personnel
Infrastructure + utilities
2011
4
0
0
4
1
395
0
846
8
935,404
185,432
1,222,252
3,419
12,000
2
2012
4
0
0
4
1
138
0
945
11
988,013
185,328
1,279,845
3,790
16,000
Community Health Centre (CHC)
2
2008
40
4
4
15
6
26,846
3,710
2,294
1,392
4,670,440
176,529
710,968
1,786
1,948,800
6
Community Health Centre (CHC)
2
2009
40
4
4
15
5
36,420
4,524
2,367
1,275
4,557,912
166,744
748,585
2,499
1,785,000
6
Community Health Centre (CHC)
2
2010
40
4
3
17
5
23,967
5,382
2,403
1,357
4,644,399
269,521
786,588
5,128
1,899,800
6
Community Health Centre (CHC)
2
2011
40
4
3
17
10
36,677
4,541
3,228
1,154
5,170,767
194,728
824,502
8,705
1,615,600
6
Community Health Centre (CHC)
2
2012
40
4
3
17
10
17,163
4,069
3,027
1,058
5,225,387
237,997
865,830
10,392
1,481,200
6
Primary Health Centre (PHC)
1
2008
0
1
1
3
0
1,077
0
1,233
0
669,632
96,770
1,058,460
84
11
6
Primary Health Centre (PHC)
1
2009
0
1
1
5
0
707
0
1,141
0
786,832
147,421
1,113,787
2,386
24
6
Primary Health Centre (PHC)
1
2010
0
1
1
3
0
455
0
1,107
0
572,187
122,421
1,171,562
3,795
1,659
6
Primary Health Centre (PHC)
1
2011
0
0
0
5
0
345
0
1,093
0
580,233
93,536
1,226,326
4,849
1,411
6
Primary Health Centre (PHC)
1
2012
0
0
0
6
0
365
0
1,388
0
469,902
65,866
1,285,514
8,600
4,000
6
Primary Health Centre (PHC)
2
2008
2
1
0
3
0
4,330
358
1,265
0
642,858
92,722
1,064,068
0
0
6
Primary Health Centre (PHC)
2
2009
2
1
0
3
0
5,298
376
1,207
0
651,334
104,159
1,120,567
0
0
6
Primary Health Centre (PHC)
2
2010
2
1
0
3
0
4,464
284
1,216
0
705,350
116,797
1,178,129
0
0
6
Primary Health Centre (PHC)
2
2011
2
1
0
4
0
3,105
237
1,201
0
711,508
143,353
1,233,106
0
0
6
Primary Health Centre (PHC)
2
2012
2
1
0
3
0
1,932
213
1,218
0
724,720
116,867
1,291,291
0
0
7
District Hospital (DH)
1
2008
192
30
50
70
55
107,467
8,602
37,335
5,923
8,015,074
2,229,123
2,296,735
427,302
10,415,865
7
District Hospital (DH)
1
2009
192
33
55
77
60
112,771
11,485
53,437
6,675
8,848,434
2,308,618
2,395,618
651,712
10,667,355
7
District Hospital (DH)
1
2010
192
33
60
83
65
112,473
12,081
46,109
6,694
9,934,584
2,414,535
2,508,924
144,563
9,725,241
7
District Hospital (DH)
1
2011
192
36
65
90
74
126,289
2,276
46,483
6,159
10,810,460
3,515,223
2,575,878
549,481
8,849,001
7
District Hospital (DH)
1
2012
192
38
70
94
78
125,392
8,267
48,620
6,200
12,258,769
3,042,072
2,742,766
651,931
10,446,848
7
Civil Hospital (CH)
1
2008
60
12
9
27
22
73,428
9,012
29,174
5,404
19,710,226
2,281,251
1,074,464
39,424
10,419,140
7
Civil Hospital (CH)
1
2009
60
12
9
27
22
64,151
10,000
19,962
6,404
24,291,468
2,239,125
1,104,671
181,625
9,274,138
7
Civil Hospital (CH)
1
2010
60
6
4
38
22
55,264
10,389
21,427
6,813
27,659,980
2,243,417
1,148,847
327,002
8,894,997
7
Civil Hospital (CH)
1
2011
60
6
6
40
31
47,153
6,441
17,040
3,909
30,795,460
2,248,093
1,188,113
449,441
9,602,263
7
Civil Hospital (CH)
1
2012
60
7
5
40
31
43,997
8,704
17,092
5,342
36,360,704
2,233,455
1,236,643
782,061
8,450,998
7
Community Health Centre (CHC)
1
2008
40
6
2
24
7
48,991
3,880
4,017
2,400
5,400,735
608,988
215,256
90,254
4,518,740
7
Community Health Centre (CHC)
1
2009
40
5
1
24
9
50,369
4,530
5,159
2,671
7,004,925
598,024
230,481
184,485
4,347,225
7
Community Health Centre (CHC)
1
2010
40
6
1
24
7
39,177
4,356
5,103
2,117
8,329,920
617,673
239,826
275,716
4,781,114
7
Community Health Centre (CHC)
1
2011
40
7
2
28
6
32,222
4,329
5,436
2,410
9,165,913
580,636
247,827
81,447
3,515,450
7
Community Health Centre (CHC)
1
2012
40
7
1
23
12
30,928
4,252
5,559
2,241
10,117,459
672,606
265,336
369,465
3,844,085
7
Primary Health Centre (PHC)
1
2008
6
1
0
18
6
17,016
757
1,750
618
315,618
61,562
181,055
4,625
430,859
7
Primary Health Centre (PHC)
1
2009
6
2
0
18
5
13,827
1,075
1,784
457
435,923
87,261
191,331
8,323
851,241
7
Primary Health Centre (PHC)
1
2010
6
3
0
18
5
11,669
644
1,876
380
545,378
95,509
189,682
5,730
719,000
7
Primary Health Centre (PHC)
1
2011
6
3
0
17
7
12,391
747
1,939
406
589,468
88,806
196,131
19,386
1,025,939
7
Primary Health Centre (PHC)
1
2012
6
3
1
14
5
10,805
544
2,229
314
637,834
90,793
209,258
17,500
858,753
7
Primary Health Centre (PHC)
2
2008
0
1
0
4
1
2,448
0
1,016
0
493,652
38,957
56,706
20,460
20,800
7
Primary Health Centre (PHC)
2
2009
0
2
0
4
1
2,473
0
775
0
538,469
16,967
59,690
745
8,750
District
Platform
Facility
6
Primary Health Centre (PHC)
2
6
Primary Health Centre (PHC)
6
Year
68
69
FACILITY INFORMATION
INPUTS (BEDS & STAFF)
OUTPUTS
EXPENDITURE Medical supplies + pharmaceuticals
Administration and training
Non-medical
Beds
Doctors
Nurses
Paramed
Nonmed
Outpatient
Inpatient
Vaccinations
Births
Personnel
Infrastructure + utilities
2010
0
1
0
4
1
1,935
0
1,007
0
618,893
139,260
62,832
0
0
2
2011
0
2
0
4
1
1,510
0
614
0
795,673
10,687
65,793
0
0
Primary Health Centre (PHC)
2
2012
0
2
0
4
1
1,527
0
1,471
0
978,385
31,847
68,893
0
0
7
Community Health Centre (CHC)
2
2008
30
2
2
11
8
18,914
1,326
2,685
1,108
2,208,672
603,304
188,729
8,388
2,028,143
7
Community Health Centre (CHC)
2
2009
30
3
3
12
9
19,713
1,320
3,530
1,123
2,975,162
634,387
214,705
22,564
2,063,993
7
Community Health Centre (CHC)
2
2010
30
2
2
13
10
9,105
1,574
4,061
1,280
2,777,408
606,802
225,553
7,590
2,114,893
7
Community Health Centre (CHC)
2
2011
30
3
2
11
10
8,932
1,525
3,097
1,243
3,940,312
586,415
231,283
20,955
2,023,693
7
Community Health Centre (CHC)
2
2012
30
3
3
10
12
9,602
1,596
3,863
1,268
5,182,934
596,339
245,097
17,262
2,369,805
7
Primary Health Centre (PHC)
1
2008
11
1
0
12
2
16,124
83
1,943
1,121
1,488,672
73,487
69,332
0
1,148,000
7
Primary Health Centre (PHC)
1
2009
11
1
0
12
2
21,323
1
1,499
1,123
2,235,173
54,067
66,458
10,000
0
7
Primary Health Centre (PHC)
1
2010
11
3
0
13
2
13,090
2
1,454
1,173
2,817,576
53,954
77,142
0
1,758,750
7
Primary Health Centre (PHC)
1
2011
11
2
0
17
3
6,396
0
1,513
755
3,162,741
140,483
74,359
0
1,127,000
7
Primary Health Centre (PHC)
1
2012
11
1
0
15
4
12,976
0
1,602
569
2,997,580
55,916
84,133
0
0
7
Sub Health Centre (SHC)
1
2012
0
0
0
2
0
462
0
1,491
0
510,312
16,217
6,113
0
0
7
Primary Health Centre (PHC)
2
2008
3
1
0
7
1
3,555
0
1,169
51
658,719
22,635
61,582
2,436
0
7
Primary Health Centre (PHC)
2
2009
3
1
0
7
1
5,251
0
1,147
54
759,543
26,812
64,915
2,975
0
7
Primary Health Centre (PHC)
2
2010
3
2
0
7
1
4,701
0
1,359
57
1,118,809
20,568
68,747
8,835
0
7
Primary Health Centre (PHC)
2
2011
3
2
0
7
1
4,483
0
1,430
45
1,082,234
28,708
71,404
3,450
0
7
Primary Health Centre (PHC)
2
2012
3
2
0
7
1
4,146
0
1,094
63
1,351,979
30,983
68,893
9,578
0
7
Civil Hospital (CH)
2
2008
0
3
1
14
4
29,311
0
6,552
0
2,661,636
36,755
982,045
10,440
0
7
Civil Hospital (CH)
2
2009
0
3
2
15
3
21,374
0
14,285
0
2,790,372
47,885
1,055,316
9,588
0
7
Civil Hospital (CH)
2
2010
0
3
2
15
3
21,158
0
10,036
0
3,842,292
61,833
1,118,539
11,720
0
7
Civil Hospital (CH)
2
2011
0
3
2
15
3
16,152
0
8,875
0
4,587,444
71,568
1,161,451
13,305
0
7
Civil Hospital (CH)
2
2012
0
3
3
20
3
14,587
0
12,973
0
5,183,208
63,350
1,242,433
12,756
0
7
Civil Hospital (CH)
3
2008
48
4
2
11
14
183,573
5,145
33,455
2,117
3,901,338
441,244
929,672
207,452
3,350,260
7
Civil Hospital (CH)
3
2009
48
4
3
10
15
164,997
5,446
29,854
2,378
4,700,338
717,983
978,602
377,946
3,362,874
7
Civil Hospital (CH)
3
2010
48
5
4
10
18
178,300
5,638
31,160
2,090
5,536,017
428,206
1,159,883
153,055
3,359,169
7
Civil Hospital (CH)
3
2011
48
6
5
14
18
173,784
5,916
37,871
2,535
6,267,601
2,116,252
1,274,967
381,336
3,309,138
7
Civil Hospital (CH)
3
2012
48
8
7
14
21
132,787
6,163
34,568
2,684
6,974,920
251,093
1,354,422
269,458
2,488,401
8
District Hospital (DH)
1
2008
216
22
28
38
27
2,658
15,782
26,677
5,775
50,163,692
4,720,511
2,297,856
194,701
13,081,460
8
District Hospital (DH)
1
2009
216
19
47
38
27
2,453
18,012
23,046
4,912
56,048,140
6,961,379
2,351,264
95,834
8,308,529
8
District Hospital (DH)
1
2010
216
28
62
38
28
1,184
17,428
23,440
5,729
59,058,440
7,654,423
2,511,709
151,733
7,318,258
8
District Hospital (DH)
1
2011
216
29
65
38
28
4,729
19,202
17,428
4,758
59,843,568
3,671,931
2,612,966
1,674,424
8,211,688
8
District Hospital (DH)
1
2012
216
19
68
38
29
3,317
18,745
21,780
4,781
63,323,484
7,223,111
2,802,407
129,854
8,103,675
8
Civil Hospital (CH)
1
2008
54
5
13
36
25
42,191
5,934
4,644
2,044
9,116,184
784,549
1,262,882
602,276
10,904,147
8
Civil Hospital (CH)
1
2009
54
5
13
35
25
35,925
6,054
3,819
1,456
10,217,785
843,659
1,330,696
608,354
9,618,400
8
Civil Hospital (CH)
1
2010
54
5
13
35
25
34,123
6,192
4,893
1,813
11,080,644
917,987
1,388,719
1,376,935
10,366,854
8
Civil Hospital (CH)
1
2011
54
5
13
35
25
27,630
6,343
4,281
1,788
17,401,440
898,024
1,457,260
1,015,572
8,999,833
8
Civil Hospital (CH)
1
2012
54
6
13
35
26
24,206
5,519
4,494
1,304
17,524,984
1,093,692
1,510,405
1,319,360
9,084,076
District
Platform
Facility
7
Primary Health Centre (PHC)
2
7
Primary Health Centre (PHC)
7
Year
70
71
FACILITY INFORMATION
INPUTS (BEDS & STAFF)
OUTPUTS
EXPENDITURE Medical supplies + pharmaceuticals
Administration and training
Non-medical
Beds
Doctors
Nurses
Paramed
Nonmed
Outpatient
Inpatient
Vaccinations
Births
Personnel
Infrastructure + utilities
2008
20
1
1
5
8
11,541
2,030
0
1,248
1,300,234
126,947
56,176
47,436
1,875,100
1
2009
20
1
1
4
8
9,908
1,819
0
794
1,472,247
158,788
59,133
87,986
2,476,890
Community Health Centre (CHC)
1
2010
20
0
1
6
8
8,797
1,529
0
960
1,822,362
194,179
62,245
79,962
2,577,241
8
Community Health Centre (CHC)
1
2011
20
1
1
6
8
9,985
1,419
0
892
2,304,949
192,335
65,178
85,196
2,944,554
8
Community Health Centre (CHC)
1
2012
20
1
1
5
7
8,322
1,662
0
558
2,728,342
169,455
68,250
96,200
1,731,950
8
Primary Health Centre (PHC)
1
2008
10
1
0
4
0
1,380
40
190
174
575,832
168,937
175,698
0
0
8
Primary Health Centre (PHC)
1
2009
10
1
0
4
0
1,508
41
181
109
700,470
180,170
185,301
0
0
8
Primary Health Centre (PHC)
1
2010
10
1
0
4
0
2,454
49
117
117
750,258
181,189
194,094
0
0
8
Primary Health Centre (PHC)
1
2011
10
1
0
4
0
1,833
25
122
113
803,190
193,918
203,370
0
0
8
Primary Health Centre (PHC)
1
2012
10
1
0
4
0
985
27
121
66
1,127,250
251,579
212,700
0
0
8
Primary Health Centre (PHC)
2
2008
6
0
1
4
2
8,186
646
0
616
780,200
172,558
172,948
0
862,400
8
Primary Health Centre (PHC)
2
2009
6
0
1
4
2
6,425
548
0
529
993,654
171,391
182,050
0
925,000
8
Primary Health Centre (PHC)
2
2010
6
1
1
4
2
6,370
621
0
588
1,195,684
165,095
191,632
0
1,070,000
8
Primary Health Centre (PHC)
2
2011
6
1
1
4
2
6,624
610
1,416
597
1,500,978
191,393
207,634
0
873,000
8
Primary Health Centre (PHC)
2
2012
6
1
1
3
2
5,704
562
1,245
556
1,762,698
194,695
216,761
0
703,000
8
Community Health Centre (CHC)
2
2008
30
1
3
10
1
10,111
2,930
2,573
1,534
3,412,854
140,981
74,499
6,002
2,717,600
8
Community Health Centre (CHC)
2
2009
30
1
3
10
1
8,365
3,132
3,624
1,285
2,748,744
118,328
81,978
7,781
2,270,950
8
Community Health Centre (CHC)
2
2010
30
1
3
10
1
10,049
2,430
3,671
1,190
4,347,912
132,952
85,290
12,060
2,097,000
8
Community Health Centre (CHC)
2
2011
30
1
3
10
1
9,983
2,123
3,665
1,075
5,734,870
110,168
84,998
10,380
1,893,550
8
Community Health Centre (CHC)
2
2012
30
1
3
10
1
8,890
2,330
2,890
727
8,141,144
218,117
91,101
8,529
1,352,820
8
Primary Health Centre (PHC)
1
2008
2
1
0
5
0
3,604
0
162
186
406,086
33,530
172,948
712
372,000
8
Primary Health Centre (PHC)
1
2009
2
1
0
5
0
3,121
0
405
157
415,650
36,820
182,050
3,160
314,000
8
Primary Health Centre (PHC)
1
2010
2
1
0
5
0
2,896
0
245
152
406,086
37,650
191,632
2,400
304,000
8
Primary Health Centre (PHC)
1
2011
2
1
0
5
0
3,234
0
324
118
797,526
36,200
200,662
3,672
236,000
8
Primary Health Centre (PHC)
1
2012
2
1
0
5
0
2,268
0
379
84
1,009,637
38,950
210,117
4,200
168,000
8
Primary Health Centre (PHC)
2
2008
4
1
0
7
0
3,600
0
357
331
613,140
96,960
172,948
558
400,000
8
Primary Health Centre (PHC)
2
2009
4
1
0
7
0
3,759
1
712
403
566,670
104,916
182,050
5,582
564,200
8
Primary Health Centre (PHC)
2
2010
4
1
0
7
0
4,533
0
393
452
564,378
102,557
191,632
5,400
632,800
8
Primary Health Centre (PHC)
2
2011
4
1
0
7
0
2,624
0
402
357
1,495,108
102,171
200,662
4,497
406,000
8
Primary Health Centre (PHC)
2
2012
4
1
0
7
0
2,750
0
458
400
1,212,512
100,557
210,117
6,222
450,000
9
District Hospital (DH)
1
2008
500
27
29
47
69
207,590
11,593
52,081
5,588
29,316,296
5,969,856
3,532,093
26,636
5,075,103
9
District Hospital (DH)
1
2009
500
27
35
50
64
257,945
13,255
49,638
6,514
37,909,692
8,016,846
3,739,402
370,084
7,222,082
9
District Hospital (DH)
1
2010
500
24
33
51
63
193,693
12,841
53,542
7,048
47,548,816
9,580,789
3,833,062
85,679
15,664,693
9
District Hospital (DH)
1
2011
500
28
41
53
58
206,421
13,862
49,012
6,653
56,228,640
7,175,568
4,084,892
201,220
14,654,945
9
District Hospital (DH)
1
2012
500
26
116
46
57
198,802
13,842
49,208
6,724
59,865,576
7,018,324
4,443,835
498,813
16,612,658
9
Civil Hospital (CH)
1
2008
49
3
3
15
14
43,448
3,258
7,695
1,092
3,209,016
282,790
2,237,951
229,848
1,590,148
9
Civil Hospital (CH)
1
2009
49
2
5
15
14
44,706
2,879
7,263
882
4,010,470
277,636
2,406,899
482,986
2,281,262
9
Civil Hospital (CH)
1
2010
49
3
6
16
14
48,860
4,037
7,332
1,065
4,329,675
336,416
2,485,580
279,845
2,064,450
9
Civil Hospital (CH)
1
2011
49
3
6
19
15
44,503
2,995
7,646
1,122
5,795,136
259,720
2,671,735
604,773
2,129,234
District
Platform
Facility
8
Community Health Centre (CHC)
1
8
Community Health Centre (CHC)
8
Year
72
73
FACILITY INFORMATION
INPUTS (BEDS & STAFF)
OUTPUTS
EXPENDITURE Medical supplies + pharmaceuticals
Administration and training
Non-medical
Beds
Doctors
Nurses
Paramed
Nonmed
Outpatient
Inpatient
Vaccinations
Births
Personnel
Infrastructure + utilities
2012
49
4
6
19
15
39,988
3,119
7,171
1,020
7,286,821
457,009
2,768,604
528,907
3,832,947
1
2008
9
1
0
5
1
814
90
1,261
199
1,338,468
207,131
84,086
1,286
506,700
Community Health Centre (CHC)
1
2009
9
1
2
4
1
584
95
1,135
185
1,151,904
59,809
93,670
7,314
386,550
9
Community Health Centre (CHC)
1
2010
9
1
2
5
1
847
90
1,112
200
1,165,878
57,831
97,910
2,219
228,750
9
Community Health Centre (CHC)
1
2011
9
1
2
6
1
731
104
2,025
126
1,687,464
62,911
106,078
6,173
125,958
9
Community Health Centre (CHC)
1
2012
9
1
1
5
1
1,391
113
1,574
83
1,891,856
62,131
108,954
5,876
247,300
9
Primary Health Centre (PHC)
1
2008
6
1
0
4
1
3,421
0
210
59
1,030,577
24,730
44,654
1,009
90,800
9
Primary Health Centre (PHC)
1
2009
6
1
0
5
1
4,170
0
413
63
1,430,942
24,684
47,004
5,519
187,800
9
Primary Health Centre (PHC)
1
2010
6
1
0
4
1
2,653
0
653
173
1,117,392
25,610
49,478
1,206
364,066
9
Primary Health Centre (PHC)
1
2011
6
2
0
6
1
2,357
0
522
323
1,326,305
34,554
51,809
1,315
541,250
9
Primary Health Centre (PHC)
1
2012
6
2
0
5
1
3,031
0
812
383
1,666,317
26,904
54,250
3,457
650,900
9
Primary Health Centre (PHC)
2
2008
8
2
2
12
8
5,049
0
1,606
364
1,585,608
56,426
54,743
14,440
509,600
9
Primary Health Centre (PHC)
2
2009
8
2
1
9
9
5,915
0
1,700
522
1,882,672
78,745
58,466
12,125
730,800
9
Primary Health Centre (PHC)
2
2010
8
2
1
11
11
4,785
0
1,593
447
3,206,760
49,949
60,930
13,128
625,800
9
Primary Health Centre (PHC)
2
2011
8
1
0
11
10
4,012
0
1,084
598
3,067,344
48,656
60,000
10,364
837,200
9
Primary Health Centre (PHC)
2
2012
8
3
2
13
10
6,441
0
1,192
586
3,356,424
47,057
62,009
5,661
817,600
9
Community Health Centre (CHC)
2
2008
41
1
4
10
3
34,204
1,600
7,465
900
1,273,093
230,286
120,131
20,274
610,120
9
Community Health Centre (CHC)
2
2009
41
2
3
9
5
42,612
2,000
8,520
1,000
1,137,990
238,373
131,449
24,902
1,781,050
9
Community Health Centre (CHC)
2
2010
41
2
1
11
5
32,517
2,800
8,164
1,011
1,931,496
291,637
133,747
91,765
3,255,840
9
Community Health Centre (CHC)
2
2011
41
2
1
7
7
33,704
2,164
9,148
1,100
1,948,580
407,244
143,792
92,304
3,003,224
9
Community Health Centre (CHC)
2
2012
41
2
1
9
5
31,354
2,337
9,256
1,200
1,850,022
403,448
148,165
77,288
3,023,391
9
Primary Health Centre (PHC)
1
2008
5
0
0
3
1
1,844
0
388
0
240,643
54,209
44,654
1,122
14,603
9
Primary Health Centre (PHC)
1
2009
5
0
0
3
1
2,415
0
587
92
270,728
36,532
47,004
965
161,000
9
Primary Health Centre (PHC)
1
2010
5
0
0
4
1
3,854
0
385
96
507,868
31,520
49,478
904
168,000
9
Primary Health Centre (PHC)
1
2011
5
0
0
5
1
1,343
0
196
125
617,432
45,501
51,809
1,279
218,750
9
Primary Health Centre (PHC)
1
2012
5
0
0
5
1
953
0
348
63
660,119
54,888
54,250
3,275
110,250
9
Primary Health Centre (PHC)
2
2008
0
0
0
1
1
1,827
0
654
0
239,340
61,424
44,654
0
0
9
Primary Health Centre (PHC)
2
2009
0
0
0
1
1
2,166
0
1,348
0
265,200
62,241
47,004
0
0
9
Primary Health Centre (PHC)
2
2010
0
0
0
1
1
2,275
0
1,069
0
303,828
57,881
49,478
0
0
9
Primary Health Centre (PHC)
2
2011
0
0
0
1
1
2,630
0
879
0
333,000
69,914
51,809
0
0
9
Primary Health Centre (PHC)
2
2012
0
0
0
1
1
2,496
0
457
0
392,760
56,739
54,250
0
0
9
Civil Hospital (CH)
2
2008
75
6
1
22
9
29,496
7,143
9,604
2,070
3,529,843
2,528,591
2,007,143
40,874
4,531,416
9
Civil Hospital (CH)
2
2009
75
5
5
22
6
23,068
6,600
9,765
2,200
5,077,324
2,492,797
2,120,967
34,607
5,593,657
9
Civil Hospital (CH)
2
2010
75
4
3
22
11
18,507
4,153
9,954
2,273
5,377,856
3,550,179
2,229,611
100,300
7,184,119
9
Civil Hospital (CH)
2
2011
75
4
3
17
11
16,615
5,012
9,990
2,265
5,865,509
2,637,029
2,331,085
120,176
4,219,131
9
Civil Hospital (CH)
2
2012
75
4
4
15
13
16,997
6,012
10,109
2,382
5,724,216
3,152,940
2,442,595
84,749
5,634,200
10
District Hospital (DH)
1
2008
533
41
72
98
128
146,187
22,872
67,441
8,268
48,934,144
9,735,559
3,337,092
889,978
7,033,208
10
District Hospital (DH)
1
2009
533
39
72
97
127
177,659
35,363
85,429
6,666
68,749,640
8,976,723
3,600,761
2,538,275
14,435,517
10
District Hospital (DH)
1
2010
533
40
81
112
124
190,455
42,592
92,849
7,877
75,409,296
10,157,377
3,760,060
592,239
12,683,987
District
Platform
Facility
9
Civil Hospital (CH)
1
9
Community Health Centre (CHC)
9
Year
74
75
FACILITY INFORMATION
District
Platform
10
District Hospital (DH)
10
District Hospital (DH)
10
INPUTS (BEDS & STAFF)
Facility
Year
Beds
Doctors
Nurses
1
2011
533
47
1
2012
533
51
Civil Hospital (CH)
1
2008
70
10
Civil Hospital (CH)
1
2009
10
Civil Hospital (CH)
1
10
Civil Hospital (CH)
10
OUTPUTS
Paramed
Nonmed
Outpatient
Inpatient
74
115
76
114
128
177,239
126
179,483
8
6
15
24
70
9
8
17
2010
70
10
9
1
2011
70
11
Civil Hospital (CH)
1
2012
70
10
Community Health Centre (CHC)
1
2008
10 10
Community Health Centre (CHC)
1
Community Health Centre (CHC)
1
10
Community Health Centre (CHC)
10
EXPENDITURE Infrastructure + utilities
Medical supplies + pharmaceuticals
Administration and training
Vaccinations
Births
Personnel
42,642
80,505
8,864
94,873,104
12,687,415
3,896,548
813,420
13,742,201
43,577
84,188
8,586
96,106,216
20,393,120
4,066,678
638,841
13,818,646
113,475
12,688
23,963
2,554
11,422,547
194,737
2,641,545
21,440
4,701,980
24
130,475
12,426
23,892
1,997
16,848,920
230,169
2,771,196
45,867
3,546,840
18
27
118,620
11,311
22,904
2,552
18,786,886
284,499
2,905,085
27,245
4,428,692
11
18
26
97,158
10,381
18,642
2,433
23,631,272
453,926
3,041,248
24,120
3,303,096
11
9
18
28
91,482
10,856
16,444
2,454
24,256,290
397,424
3,187,327
32,266
3,730,764
48
3
4
9
17
35,169
7,902
4,588
1,706
3,038,669
941,052
145,467
429,165
3,403,781
2009
48
4
3
11
18
32,824
7,217
4,039
1,556
4,508,097
1,098,383
155,179
910,876
3,795,428
2010
48
5
3
12
21
27,850
9,161
5,968
1,748
4,919,516
1,068,115
167,379
811,820
4,131,248
1
2011
48
4
3
16
15
27,910
7,762
5,315
1,797
5,235,833
1,243,385
165,823
841,028
4,675,045
Community Health Centre (CHC)
1
2012
48
4
3
15
16
24,980
6,966
6,159
1,526
6,888,355
1,276,444
174,025
1,355,903
4,727,526
10
Primary Health Centre (PHC)
1
2008
6
1
0
8
2
4,196
0
276
276
912,844
83,609
68,793
3,525
624,650
10
Primary Health Centre (PHC)
1
2009
6
2
0
9
2
4,183
0
334
334
799,628
80,372
72,414
3,452
694,550
10
Primary Health Centre (PHC)
1
2010
6
1
0
5
2
2,270
0
383
383
945,830
376,960
76,225
2,481
702,580
10
Primary Health Centre (PHC)
1
2011
6
1
0
3
2
2,597
0
316
316
1,155,459
91,060
79,817
8,375
688,000
10
Primary Health Centre (PHC)
1
2012
6
2
0
3
2
1,856
661
361
361
1,543,273
92,605
83,578
3,650
1,123,391
10
Primary Health Centre (PHC)
2
2008
4
1
0
4
1
5,331
0
0
132
795,196
35,763
68,793
4,182
117,959
10
Primary Health Centre (PHC)
2
2009
4
1
0
4
1
5,261
0
0
109
981,448
36,042
72,414
3,275
131,927
10
Primary Health Centre (PHC)
2
2010
4
1
0
4
1
2,985
0
0
120
934,323
116,657
76,225
2,724
181,808
10
Primary Health Centre (PHC)
2
2011
4
1
0
4
1
1,980
0
0
108
1,372,888
81,646
79,817
3,589
189,934
10
Primary Health Centre (PHC)
2
2012
4
1
0
4
1
1,119
0
0
94
1,678,726
70,429
83,578
1,878
187,646
10
Community Health Centre (CHC)
2
2008
20
2
2
8
6
30,116
2,124
9,420
1,339
2,568,597
1,207,606
172,346
110,912
1,348,337
10
Community Health Centre (CHC)
2
2009
20
3
2
11
8
38,809
2,653
7,788
1,304
3,021,677
960,693
177,940
357,460
1,619,548
10
Community Health Centre (CHC)
2
2010
20
3
2
11
8
27,862
2,529
7,807
1,729
4,038,943
1,067,276
184,882
419,758
2,296,413
10
Community Health Centre (CHC)
2
2011
20
3
2
10
10
28,325
2,645
7,866
1,816
4,234,320
933,241
196,155
481,069
2,113,682
10
Community Health Centre (CHC)
2
2012
20
4
2
11
12
20,049
2,885
8,413
1,794
4,244,448
911,968
209,580
1,017,919
2,284,837
10
Primary Health Centre (PHC)
1
2008
4
1
0
4
3
5,340
0
0
0
949,824
56,602
68,793
885
3,309
10
Primary Health Centre (PHC)
1
2009
4
1
0
4
3
6,674
0
0
0
968,554
57,002
72,414
2,151
853
10
Primary Health Centre (PHC)
1
2010
4
1
0
4
3
5,722
0
0
0
928,572
55,741
76,786
1,118
7,003
10
Primary Health Centre (PHC)
1
2011
4
1
0
3
3
4,953
0
21
7
1,456,644
55,735
92,625
2,950
5,614
10
Primary Health Centre (PHC)
1
2012
4
2
0
3
3
4,509
0
24
8
2,178,486
61,568
95,328
8,254
18,300
10
Primary Health Centre (PHC)
2
2008
8
1
1
5
1
11,047
391
2,116
210
919,308
134,364
92,142
248
0
10
Primary Health Centre (PHC)
2
2009
8
1
1
6
1
8,825
423
2,216
324
1,027,332
143,056
116,276
102
0
10
Primary Health Centre (PHC)
2
2010
8
1
1
7
1
6,380
607
2,402
459
1,223,196
139,422
110,720
2,893
0
10
Primary Health Centre (PHC)
2
2011
8
1
1
7
1
5,759
588
2,197
480
1,712,028
133,177
145,737
4,265
0
10
Primary Health Centre (PHC)
2
2012
8
1
1
7
1
5,380
534
2,067
384
1,933,702
151,922
127,243
3,500
0
11
District Hospital (DH)
1
2008
400
29
53
66
48
311,813
37,063
35,806
8,449
48,129,984
7,929,968
3,867,758
68,465
17,205,116
11
District Hospital (DH)
1
2009
400
30
56
66
57
256,839
32,834
41,711
7,518
45,680,228
8,514,108
4,245,279
190,388
16,520,449
76
77
Non-medical
FACILITY INFORMATION
INPUTS (BEDS & STAFF)
OUTPUTS
EXPENDITURE Medical supplies + pharmaceuticals
Administration and training
Non-medical
Year
Beds
Doctors
Nurses
Paramed
Nonmed
Outpatient
Inpatient
Vaccinations
Births
Personnel
Infrastructure + utilities
1
2010
400
34
65
67
58
307,365
32,718
38,688
8,751
55,136,476
8,628,946
4,172,007
544,483
19,536,996
District Hospital (DH)
1
2011
400
38
59
66
58
234,872
32,399
63,128
8,932
72,622,944
12,882,848
4,409,953
187,224
20,011,832
11
District Hospital (DH)
1
2012
400
40
55
69
57
253,441
36,184
39,282
8,482
89,903,376
12,099,260
4,614,253
837,276
24,121,688
11
Civil Hospital (CH)
1
2008
114
5
4
28
15
42,000
11,656
22,975
5,206
5,174,278
527,189
3,172,634
364,041
3,400,045
11
Civil Hospital (CH)
1
2009
114
5
6
28
15
44,901
11,551
21,440
5,197
5,960,866
746,525
3,341,428
747,889
9,776,114
11
Civil Hospital (CH)
1
2010
114
5
6
30
18
41,218
11,412
21,657
5,280
6,878,952
850,250
3,507,859
669,182
9,700,718
11
Civil Hospital (CH)
1
2011
114
5
6
31
18
40,598
11,924
21,159
5,240
9,633,706
694,491
3,660,348
926,423
9,412,110
11
Civil Hospital (CH)
1
2012
114
7
6
33
20
53,817
11,757
21,121
4,440
11,477,996
1,070,561
3,828,819
1,091,610
19,055,900
11
Community Health Centre (CHC)
1
2008
12
2
0
7
4
22,346
910
3,646
679
2,154,806
115,727
151,421
2,102
679,700
11
Community Health Centre (CHC)
1
2009
12
2
0
8
4
24,075
963
4,505
619
3,145,525
117,663
160,259
5,451
1,751,900
11
Community Health Centre (CHC)
1
2010
12
2
2
8
5
26,740
1,011
4,607
730
3,802,580
118,570
165,579
10,038
1,600,650
11
Community Health Centre (CHC)
1
2011
12
2
2
8
5
24,198
941
3,998
688
4,555,350
135,699
172,552
16,126
1,624,000
11
Community Health Centre (CHC)
1
2012
12
2
2
8
5
21,193
850
4,091
592
5,335,598
177,336
180,923
13,248
1,722,858
11
Primary Health Centre (PHC)
1
2008
3
0
1
5
1
3,722
18
1,615
5
834,666
11,537
87,797
5,480
0
11
Primary Health Centre (PHC)
1
2009
3
0
1
5
1
3,665
15
1,467
5
1,233,025
14,700
92,418
2,771
0
11
Primary Health Centre (PHC)
1
2010
3
0
1
5
1
2,897
21
2,335
10
1,399,956
20,617
97,282
4,233
0
11
Primary Health Centre (PHC)
1
2011
3
0
1
5
1
2,181
15
3,994
8
1,547,919
18,832
101,866
2,430
0
11
Primary Health Centre (PHC)
1
2012
3
0
1
5
1
2,250
14
3,838
9
1,790,731
21,226
106,666
2,218
0
11
Primary Health Centre (PHC)
2
2008
3
2
0
4
2
13,148
58
352
49
899,067
29,548
92,712
436
0
11
Primary Health Centre (PHC)
2
2009
3
2
0
4
2
14,290
207
438
202
1,214,166
28,883
100,759
1,062
0
11
Primary Health Centre (PHC)
2
2010
3
2
0
4
2
12,024
227
425
211
1,401,177
19,225
104,352
4,524
0
11
Primary Health Centre (PHC)
2
2011
3
2
0
4
2
11,482
184
430
176
1,513,753
28,753
107,796
4,239
0
11
Primary Health Centre (PHC)
2
2012
3
2
0
4
2
11,392
137
454
134
1,734,506
12,863
113,106
10,685
0
11
Community Health Centre (CHC)
2
2008
30
1
2
12
2
19,212
2,500
2,400
1,801
1,095,426
212,626
95,039
52,500
3,071,200
11
Community Health Centre (CHC)
2
2009
30
1
2
13
2
16,514
2,363
3,102
1,480
1,159,410
221,717
105,936
45,085
3,644,558
11
Community Health Centre (CHC)
2
2010
30
2
2
13
2
12,146
2,252
2,788
1,712
1,213,510
187,369
110,943
94,250
4,406,600
11
Community Health Centre (CHC)
2
2011
30
2
3
15
3
11,811
2,065
3,829
1,631
1,429,550
282,297
117,143
72,556
5,370,665
11
Community Health Centre (CHC)
2
2012
30
2
3
15
4
12,234
1,846
2,795
1,238
1,633,780
310,855
120,049
121,067
6,069,800
11
Primary Health Centre (PHC)
1
2008
0
1
0
6
0
3,739
0
579
0
687,900
5,715
87,797
1,297
10,460
11
Primary Health Centre (PHC)
1
2009
0
0
0
3
0
2,812
0
773
0
693,891
5,332
92,418
1,187
13,500
11
Primary Health Centre (PHC)
1
2010
0
0
0
5
0
2,930
0
548
0
744,330
5,115
97,282
1,183
915
11
Primary Health Centre (PHC)
1
2011
0
0
0
4
0
4,237
0
1,192
0
856,540
5,530
101,866
1,329
584
11
Primary Health Centre (PHC)
1
2012
0
0
0
4
0
4,368
0
1,458
0
958,290
10,981
106,666
1,467
936
11
Primary Health Centre (PHC)
2
2008
6
1
0
4
4
12,427
0
1,716
201
1,264,260
15,086
100,894
16,162
327,000
11
Primary Health Centre (PHC)
2
2009
6
1
0
5
4
11,435
0
2,332
352
1,372,750
12,597
109,062
20,861
889,542
11
Primary Health Centre (PHC)
2
2010
6
1
0
5
4
9,595
0
2,350
404
1,443,040
12,088
115,338
14,530
629,267
11
Primary Health Centre (PHC)
2
2011
6
1
0
5
4
8,988
0
2,681
468
1,467,310
9,565
121,057
12,469
890,406
11
Primary Health Centre (PHC)
2
2012
6
1
0
5
4
6,745
0
2,414
326
1,754,718
16,982
124,042
14,340
484,911
12
District Hospital (DH)
1
2008
280
13
100
40
87
151,166
34,317
34,165
5,780
14,449,883
4,774,566
2,609,236
523,835
12,006,160
District
Platform
11
District Hospital (DH)
11
Facility
78
79
FACILITY INFORMATION
INPUTS (BEDS & STAFF)
OUTPUTS
EXPENDITURE Medical supplies + pharmaceuticals
Administration and training
Non-medical
Year
Beds
Doctors
Nurses
Paramed
Nonmed
Outpatient
Inpatient
Vaccinations
Births
Personnel
Infrastructure + utilities
1
2009
280
13
133
41
85
197,062
35,812
33,598
5,925
45,144,892
5,971,747
2,752,077
222,972
14,195,796
District Hospital (DH)
1
2010
280
13
133
39
81
215,949
37,053
33,884
5,864
55,622,568
11,845,810
2,886,251
546,968
15,131,916
12
District Hospital (DH)
1
2011
280
12
139
39
78
202,885
34,660
35,548
5,082
71,927,456
9,172,288
3,027,748
410,320
13,672,164
12
District Hospital (DH)
1
2012
280
14
139
41
76
200,917
35,535
35,802
4,687
82,744,944
10,578,204
3,200,002
613,300
14,203,824
12
Community Health Centre (CHC)
1
2008
10
3
3
8
5
11,748
163
2,526
605
4,425,952
1,314,063
1,045,123
238,072
2,628,017
12
Community Health Centre (CHC)
1
2009
10
3
3
8
5
10,646
135
3,538
580
4,231,912
1,322,303
1,097,267
472,747
2,334,114
12
Community Health Centre (CHC)
1
2010
10
3
3
8
5
10,792
107
4,157
718
5,289,573
1,335,767
1,148,346
630,573
3,374,539
12
Community Health Centre (CHC)
1
2011
10
3
3
8
9
13,601
83
4,362
670
5,710,234
1,331,826
1,211,520
669,181
2,705,550
12
Community Health Centre (CHC)
1
2012
10
3
3
8
10
13,729
80
4,131
677
5,538,335
1,341,157
1,266,744
942,469
3,106,530
12
Primary Health Centre (PHC)
1
2008
15
0
0
6
2
4,052
0
1,320
448
1,819,390
63,437
1,378,160
740
627,200
12
Primary Health Centre (PHC)
1
2009
15
0
0
6
2
4,386
0
867
298
1,161,859
55,740
1,450,694
885
417,200
12
Primary Health Centre (PHC)
1
2010
15
0
0
6
2
4,882
0
1,191
399
1,339,166
56,651
1,527,047
999
558,600
12
Primary Health Centre (PHC)
1
2011
15
0
0
6
2
4,830
0
1,557
525
1,633,487
54,866
1,599,002
2,520
735,000
12
Primary Health Centre (PHC)
1
2012
15
1
0
7
2
5,820
0
1,824
618
2,096,712
58,235
1,749,360
6,738
865,200
12
Primary Health Centre (PHC)
2
2008
0
0
0
3
0
895
0
309
0
290,856
7,604
1,380,168
10,000
58
12
Primary Health Centre (PHC)
2
2009
0
0
0
3
0
1,165
0
299
0
377,629
8,730
1,452,955
10,000
1,151
12
Primary Health Centre (PHC)
2
2010
0
0
0
3
0
917
0
205
0
457,629
8,244
1,529,506
2,350
2,645
12
Primary Health Centre (PHC)
2
2011
0
0
0
4
0
1,185
0
282
0
773,101
12,029
1,601,451
7,087
2,365
12
Primary Health Centre (PHC)
2
2012
0
0
0
4
0
1,045
0
276
0
781,697
7,058
1,677,078
2,844
2,750
12
Community Health Centre (CHC)
2
2008
40
2
7
18
15
17,446
2,297
1,534
864
5,686,725
727,663
1,051,455
22,343
2,255,509
12
Community Health Centre (CHC)
2
2009
40
1
7
18
14
21,899
3,370
1,551
852
6,913,318
772,852
1,109,335
22,640
2,650,999
12
Community Health Centre (CHC)
2
2010
40
2
8
18
14
25,864
3,857
1,437
878
7,719,337
734,697
1,160,136
48,235
3,577,642
12
Community Health Centre (CHC)
2
2011
40
2
6
17
13
27,305
3,484
1,729
855
7,979,729
791,071
1,219,908
50,745
3,441,114
12
Community Health Centre (CHC)
2
2012
40
2
6
20
14
24,440
3,374
1,962
653
8,844,972
938,237
1,282,738
60,076
3,342,305
12
Primary Health Centre (PHC)
1
2008
10
1
0
8
2
25,294
0
1,358
515
712,664
128,651
1,405,196
9,442
721,000
12
Primary Health Centre (PHC)
1
2009
10
1
0
6
2
24,943
498
1,480
499
832,200
125,283
1,479,546
9,195
697,200
12
Primary Health Centre (PHC)
1
2010
10
1
0
6
2
20,450
0
1,338
421
901,936
135,406
1,554,456
15,718
639,400
12
Primary Health Centre (PHC)
1
2011
10
2
1
5
2
14,101
0
1,472
455
1,174,842
133,518
1,627,207
22,948
701,788
12
Primary Health Centre (PHC)
1
2012
10
2
1
7
2
13,912
0
1,332
376
1,215,737
137,215
1,704,071
25,637
622,306
12
Primary Health Centre (PHC)
2
2008
6
1
1
2
1
3,127
0
250
108
242,932
100,520
1,378,160
12,190
2,400
12
Primary Health Centre (PHC)
2
2009
6
1
0
2
1
3,222
0
330
108
283,504
100,299
1,450,694
12,200
2,480
12
Primary Health Centre (PHC)
2
2010
6
1
0
1
1
4,689
0
458
91
302,556
102,084
1,527,047
13,900
2,800
12
Primary Health Centre (PHC)
2
2011
6
1
0
1
1
7,487
0
346
118
437,204
113,179
1,599,002
14,500
2,900
12
Primary Health Centre (PHC)
2
2012
6
1
0
1
2
4,729
0
506
78
314,000
114,609
1,674,348
21,000
3,000
13
District Hospital (DH)
1
2008
189
9
13
34
34
163,147
17,263
37,835
5,170
22,949,892
6,481,075
3,202,959
594,408
10,692,719
13
District Hospital (DH)
1
2009
189
10
15
45
38
158,281
19,107
33,476
4,905
33,206,166
8,189,854
3,120,384
267,670
11,191,738
13
District Hospital (DH)
1
2010
189
12
15
47
38
142,212
20,643
41,932
5,111
43,374,192
7,937,005
3,269,870
319,307
11,116,293
13
District Hospital (DH)
1
2011
189
18
31
49
38
166,203
20,731
37,557
5,106
54,133,548
6,747,195
3,759,602
1,768,481
10,206,985
13
District Hospital (DH)
1
2012
189
27
78
42
38
173,935
22,634
31,904
4,939
71,976,928
6,093,907
3,666,736
784,879
10,516,200
District
Platform
12
District Hospital (DH)
12
Facility
80
81
FACILITY INFORMATION
INPUTS (BEDS & STAFF)
OUTPUTS
EXPENDITURE Medical supplies + pharmaceuticals
Administration and training
Non-medical
Beds
Doctors
Nurses
Paramed
Nonmed
Outpatient
Inpatient
Vaccinations
Births
Personnel
Infrastructure + utilities
2008
92
6
1
12
6
77,314
9,723
7,130
3,009
6,602,379
2,333,159
1,037,232
38,118
8,897,395
1
2009
92
6
1
12
6
75,817
10,819
7,922
3,449
5,895,653
2,543,776
1,125,337
309,901
9,572,030
Civil Hospital (CH)
1
2010
92
7
1
12
8
88,738
9,991
9,123
3,357
8,743,692
2,791,837
1,188,747
823,775
8,398,549
13
Civil Hospital (CH)
1
2011
92
8
1
12
8
73,740
9,880
12,576
3,508
8,951,213
2,984,307
1,213,902
955,418
8,039,368
13
Civil Hospital (CH)
1
2012
92
8
1
13
9
74,136
10,276
12,195
3,329
9,970,860
3,289,916
1,279,920
1,718,009
8,695,297
13
Community Health Centre (CHC)
1
2008
29
4
1
17
4
24,036
4,180
3,581
1,642
4,213,336
1,695,122
382,645
103,969
2,717,400
13
Community Health Centre (CHC)
1
2009
29
4
1
19
4
18,086
4,184
3,278
1,398
5,141,794
1,683,443
403,770
74,007
2,517,300
13
Community Health Centre (CHC)
1
2010
29
4
1
19
4
16,838
4,277
3,183
1,521
5,931,439
1,782,140
422,427
59,391
2,532,015
13
Community Health Centre (CHC)
1
2011
29
4
1
18
4
15,073
4,263
2,906
1,485
6,489,988
1,738,555
441,345
20,913
2,291,941
13
Community Health Centre (CHC)
1
2012
29
4
1
19
4
16,934
4,890
2,690
1,321
7,482,869
1,780,607
463,681
13,777
1,706,196
13
Primary Health Centre (PHC)
1
2008
5
1
0
3
0
3,340
0
149
287
759,492
20,342
177,547
925
574,000
13
Primary Health Centre (PHC)
1
2009
5
1
0
3
0
4,140
0
122
188
832,878
20,302
186,892
540
376,000
13
Primary Health Centre (PHC)
1
2010
5
1
0
3
0
3,234
0
203
136
1,044,798
24,425
196,728
830
272,000
13
Primary Health Centre (PHC)
1
2011
5
1
0
3
0
5,626
0
146
133
1,225,722
34,182
205,998
1,440
266,000
13
Primary Health Centre (PHC)
1
2012
5
1
0
3
0
7,480
0
448
153
1,425,282
35,427
215,705
1,450
319,250
13
Primary Health Centre (PHC)
2
2008
7
0
0
2
0
698
0
291
114
165,606
140,096
177,547
1,045
194,993
13
Primary Health Centre (PHC)
2
2009
7
0
0
2
0
1,201
0
1,006
45
221,952
139,252
186,892
11,316
90,757
13
Primary Health Centre (PHC)
2
2010
7
0
0
2
0
2,292
0
1,458
33
267,516
139,377
196,728
12,849
56,076
13
Primary Health Centre (PHC)
2
2011
7
0
1
2
0
5,119
0
708
11
473,774
140,447
205,998
11,369
20,200
13
Primary Health Centre (PHC)
2
2012
7
0
1
2
0
5,487
0
530
24
711,238
140,712
215,705
10,378
53,850
13
Community Health Centre (CHC)
2
2008
30
0
0
9
4
14,155
1,782
1,372
1,129
1,349,508
271,467
369,544
19,324
3,992,000
13
Community Health Centre (CHC)
2
2009
30
1
0
9
5
12,145
1,588
1,452
843
2,754,647
322,670
390,250
31,406
3,986,000
13
Community Health Centre (CHC)
2
2010
30
1
0
10
5
13,385
1,842
1,409
1,092
3,834,461
253,782
409,612
18,000
4,540,222
13
Community Health Centre (CHC)
2
2011
30
1
2
12
6
13,001
2,814
1,554
1,159
4,015,424
315,244
428,517
33,500
4,294,800
13
Community Health Centre (CHC)
2
2012
30
1
2
17
6
14,600
1,920
1,800
1,079
4,754,768
313,053
449,817
20,966
3,262,311
13
Primary Health Centre (PHC)
1
2008
6
1
0
4
1
6,449
96
1,707
0
271,464
113,078
184,897
3,091
253
13
Primary Health Centre (PHC)
1
2009
6
1
0
5
2
6,451
98
1,837
0
559,502
120,892
194,584
2,000
3,453
13
Primary Health Centre (PHC)
1
2010
6
1
0
6
2
5,826
120
2,293
0
845,684
135,085
206,558
2,604
8,107
13
Primary Health Centre (PHC)
1
2011
6
1
0
5
2
7,692
132
2,029
16
968,168
184,931
213,973
2,808
28,000
13
Primary Health Centre (PHC)
1
2012
6
1
0
9
2
7,645
140
2,058
38
1,546,807
192,431
224,002
7,379
71,710
13
Primary Health Centre (PHC)
2
2008
2
2
0
3
1
3,609
0
181
105
355,220
40,109
177,547
0
210,000
13
Primary Health Centre (PHC)
2
2009
2
2
0
3
1
2,703
0
156
54
488,707
40,125
186,892
0
108,000
13
Primary Health Centre (PHC)
2
2010
2
2
0
3
1
2,376
0
172
34
584,232
39,013
196,728
0
68,000
13
Primary Health Centre (PHC)
2
2011
2
1
0
3
1
3,051
0
259
35
685,214
45,977
205,998
0
70,000
13
Primary Health Centre (PHC)
2
2012
2
1
0
4
1
2,313
0
445
16
774,345
44,197
215,705
0
32,000
13
Civil Hospital (CH)
2
2008
105
12
16
53
22
135,107
9,866
14,336
4,283
12,133,239
567,421
1,067,894
59,923
7,481,654
13
Civil Hospital (CH)
2
2009
105
11
15
45
20
132,004
10,201
15,162
4,117
14,359,438
647,808
1,126,600
75,699
6,034,492
13
Civil Hospital (CH)
2
2010
105
13
14
51
21
122,797
9,887
15,414
4,621
18,735,250
1,700,676
1,178,737
136,470
9,137,672
13
Civil Hospital (CH)
2
2011
105
14
15
56
20
121,993
10,229
15,568
4,730
23,976,700
654,630
1,340,114
150,448
7,871,969
District
Platform
Facility
13
Civil Hospital (CH)
1
13
Civil Hospital (CH)
13
Year
82
83
FACILITY INFORMATION
INPUTS (BEDS & STAFF)
OUTPUTS
EXPENDITURE Medical supplies + pharmaceuticals
Administration and training
Non-medical
Beds
Doctors
Nurses
Paramed
Nonmed
Outpatient
Inpatient
Vaccinations
Births
Personnel
Infrastructure + utilities
2012
105
15
14
57
20
113,543
11,335
14,984
4,844
26,761,120
608,060
1,389,048
111,640
9,932,464
1
2008
140
16
3
19
11
120,638
14,951
22,614
3,491
11,099,313
551,825
1,215,640
32,401
5,900,784
District Hospital (DH)
1
2009
140
23
2
18
11
119,140
15,245
21,929
3,720
15,388,755
1,099,116
1,279,621
27,420
6,599,952
14
District Hospital (DH)
1
2010
140
24
10
30
13
95,341
16,854
24,649
4,015
19,171,304
2,075,216
1,346,969
17,274
6,689,732
14
District Hospital (DH)
1
2011
140
27
20
34
16
119,833
23,963
21,980
4,106
27,319,056
2,640,938
1,410,439
38,637
6,814,788
14
District Hospital (DH)
1
2012
140
34
24
34
16
137,373
28,860
24,093
4,098
32,102,756
2,982,810
1,753,756
18,614
6,974,600
14
Community Health Centre (CHC)
1
2008
39
1
0
18
5
28,493
4,799
10,408
2,492
3,723,392
1,965,900
865,162
131,205
899,118
14
Community Health Centre (CHC)
1
2009
39
1
0
18
5
19,176
5,206
11,765
2,665
4,237,280
1,967,740
936,313
86,211
5,074,799
14
Community Health Centre (CHC)
1
2010
39
3
0
18
5
16,239
5,621
11,562
2,882
4,711,638
1,977,469
958,507
109,603
5,501,797
14
Community Health Centre (CHC)
1
2011
39
4
3
19
5
21,482
5,516
10,973
2,488
5,515,091
1,978,746
954,558
189,505
5,035,347
14
Community Health Centre (CHC)
1
2012
39
4
3
20
6
22,781
4,799
10,556
2,100
6,648,165
2,025,286
1,009,550
286,542
4,336,167
14
Primary Health Centre (PHC)
1
2008
5
0
0
2
1
5,267
0
198
319
321,669
331,351
651,919
0
446,600
14
Primary Health Centre (PHC)
1
2009
5
0
0
2
1
5,927
0
225
320
363,897
312,604
686,231
0
448,000
14
Primary Health Centre (PHC)
1
2010
5
1
0
2
1
6,263
0
223
707
582,997
310,477
722,348
0
989,800
14
Primary Health Centre (PHC)
1
2011
5
1
0
2
1
6,256
0
374
678
681,799
309,777
756,386
0
949,200
14
Primary Health Centre (PHC)
1
2012
5
1
0
2
1
4,710
0
120
445
713,908
284,007
792,027
0
623,000
14
Primary Health Centre (PHC)
2
2008
6
2
0
5
2
4,454
330
222
176
699,851
72,285
651,919
4,234
257,250
14
Primary Health Centre (PHC)
2
2009
6
2
0
5
2
5,207
373
633
186
786,887
104,092
686,231
2,235
336,788
14
Primary Health Centre (PHC)
2
2010
6
2
0
5
2
4,095
399
399
120
880,078
98,784
722,348
1,734
241,500
14
Primary Health Centre (PHC)
2
2011
6
2
0
5
2
4,291
360
522
154
986,039
79,610
756,386
2,072
254,798
14
Primary Health Centre (PHC)
2
2012
6
2
0
5
2
4,154
457
495
145
1,015,437
74,947
792,027
3,000
208,546
14
Community Health Centre (CHC)
2
2008
8
3
0
9
0
19,151
3,154
784
1,144
5,110,735
2,169,808
439,097
95,340
3,477,411
14
Community Health Centre (CHC)
2
2009
8
4
0
9
0
18,981
3,283
1,573
1,153
5,353,544
2,267,880
462,207
171,763
3,556,818
14
Community Health Centre (CHC)
2
2010
8
5
0
9
1
15,079
3,765
3,549
1,324
5,466,028
2,209,021
486,534
109,118
4,082,547
14
Community Health Centre (CHC)
2
2011
8
6
1
10
3
14,064
4,191
5,121
1,450
5,337,656
2,264,731
509,460
228,638
4,829,513
14
Community Health Centre (CHC)
2
2012
8
4
1
11
4
12,514
3,987
2,752
1,293
5,641,049
2,060,534
533,466
139,668
3,466,103
14
Primary Health Centre (PHC)
1
2008
5
0
0
2
1
715
7
3,274
0
136,485
1,318,974
651,919
1,446
0
14
Primary Health Centre (PHC)
1
2009
5
0
0
2
1
1,114
6
2,865
0
139,111
1,322,115
686,231
2,105
0
14
Primary Health Centre (PHC)
1
2010
5
1
0
2
1
1,073
12
1,721
0
340,121
1,340,991
722,348
6,738
0
14
Primary Health Centre (PHC)
1
2011
5
1
0
2
1
1,189
7
1,338
0
500,171
1,366,657
756,386
1,277
0
14
Primary Health Centre (PHC)
1
2012
5
1
0
1
1
952
16
957
0
554,030
1,371,744
792,027
100
0
14
Primary Health Centre (PHC)
2
2008
10
2
0
5
0
9,260
0
131
1,264
676,887
41,779
651,919
3,386
1,773,641
14
Primary Health Centre (PHC)
2
2009
10
2
0
4
0
9,327
0
136
1,169
511,050
37,911
686,231
7,166
1,641,223
14
Primary Health Centre (PHC)
2
2010
10
2
0
4
0
5,122
0
84
1,167
813,219
55,878
722,348
3,078
1,635,743
14
Primary Health Centre (PHC)
2
2011
10
2
1
3
0
6,184
0
388
1,045
1,175,995
55,206
756,386
5,400
1,463,000
14
Primary Health Centre (PHC)
2
2012
10
1
1
4
0
3,595
0
365
1,032
708,000
40,001
792,027
1,050
1,446,960
15
District Hospital (DH)
1
2008
232
32
43
23
24
142,737
21,341
62,868
7,947
26,087,828
4,411,303
3,436,070
396,602
12,792,210
15
District Hospital (DH)
1
2009
232
30
43
28
24
146,527
27,371
73,935
8,124
35,608,664
4,818,609
3,649,131
345,808
13,987,722
15
District Hospital (DH)
1
2010
232
30
46
30
28
151,090
26,726
70,443
8,642
45,701,196
4,534,469
3,890,706
405,077
17,762,224
District
Platform
Facility
13
Civil Hospital (CH)
2
14
District Hospital (DH)
14
Year
84
85
FACILITY INFORMATION
INPUTS (BEDS & STAFF)
OUTPUTS
EXPENDITURE Medical supplies + pharmaceuticals
Administration and training
Non-medical
Beds
Doctors
Nurses
Paramed
Nonmed
Outpatient
Inpatient
Vaccinations
Births
Personnel
Infrastructure + utilities
2011
232
32
64
33
30
150,875
26,470
83,528
8,120
54,231,968
6,205,629
3,943,856
1,061,971
19,411,220
1
2012
232
34
81
36
32
153,229
30,063
81,939
8,045
62,737,984
6,929,148
4,113,229
367,089
18,167,794
Community Health Centre (CHC)
1
2008
30
3
1
8
4
17,296
3,285
6,555
0
3,760,752
753,133
395,189
112,060
177,510
15
Community Health Centre (CHC)
1
2009
30
4
1
8
4
14,341
3,201
8,641
0
5,007,012
1,191,251
425,665
108,428
4,718,263
15
Community Health Centre (CHC)
1
2010
30
4
0
10
6
11,568
3,563
11,770
0
4,191,306
3,467,676
421,849
169,084
4,842,778
15
Community Health Centre (CHC)
1
2011
30
4
2
10
7
15,597
3,227
7,175
0
5,313,888
2,302,396
512,352
290,097
5,404,990
15
Community Health Centre (CHC)
1
2012
30
4
2
10
7
15,091
3,167
9,687
0
5,989,350
1,700,681
533,448
317,500
3,465,290
15
Primary Health Centre (PHC)
1
2008
6
1
0
7
1
8,065
0
494
1,090
1,187,784
62,636
594,548
3,595
1,810,219
15
Primary Health Centre (PHC)
1
2009
6
2
0
3
0
9,144
0
594
1,159
662,946
59,127
626,712
10,580
1,723,212
15
Primary Health Centre (PHC)
1
2010
6
2
0
5
0
10,765
0
818
1,311
1,287,042
90,489
660,692
30,625
1,990,763
15
Primary Health Centre (PHC)
1
2011
6
2
0
4
0
8,878
0
906
1,195
1,419,972
64,556
692,845
9,039
1,673,000
15
Primary Health Centre (PHC)
1
2012
6
1
0
3
0
8,989
0
2,118
1,121
456,000
84,102
732,238
7,750
1,569,400
15
Primary Health Centre (PHC)
2
2008
5
1
1
3
1
2,830
9
0
145
525,441
70,971
592,461
843
62,970
15
Primary Health Centre (PHC)
2
2009
5
1
1
3
1
3,883
12
0
168
623,771
73,918
623,643
457
358,161
15
Primary Health Centre (PHC)
2
2010
5
1
1
4
1
4,409
8
0
212
726,085
76,110
656,466
456
41,559
15
Primary Health Centre (PHC)
2
2011
5
2
1
4
1
3,472
20
0
197
898,372
75,553
687,399
972
448,676
15
Primary Health Centre (PHC)
2
2012
5
2
1
4
2
3,041
10
0
246
846,536
77,647
719,790
400
512,444
15
Primary Health Centre (PHC)
3
2008
6
0
0
2
1
1,574
0
610
60
365,886
140,637
592,461
0
0
15
Primary Health Centre (PHC)
3
2009
6
0
0
2
1
1,800
0
2,958
74
121,560
158,204
623,643
0
0
15
Primary Health Centre (PHC)
3
2010
6
0
0
2
1
1,983
0
3,068
125
198,540
143,204
656,466
0
0
15
Primary Health Centre (PHC)
3
2011
6
1
0
3
1
2,464
0
2,291
104
222,600
143,004
687,399
0
0
15
Primary Health Centre (PHC)
3
2012
6
1
0
3
1
2,478
0
1,884
51
608,880
130,043
719,790
0
0
15
Community Health Centre (CHC)
2
2008
13
1
0
9
1
11,529
1,299
6,613
1,231
5,311,878
598,719
380,719
56,538
282,617
15
Community Health Centre (CHC)
2
2009
13
1
0
9
1
8,181
1,547
7,283
1,535
5,274,587
535,688
400,757
65,240
2,505,631
15
Community Health Centre (CHC)
2
2010
13
1
0
9
1
8,751
2,030
8,320
2,001
5,077,140
542,431
437,190
65,052
2,077,780
15
Community Health Centre (CHC)
2
2011
13
1
1
8
1
8,438
1,849
8,097
1,824
6,818,544
532,466
453,976
222,424
2,229,400
15
Community Health Centre (CHC)
2
2012
13
2
0
9
1
11,591
1,507
7,595
1,437
8,826,900
559,195
480,392
115,302
2,463,600
15
Primary Health Centre (PHC)
1
2008
5
1
0
5
0
4,922
0
0
1,077
300,600
60,293
592,461
2,117
89,623
15
Primary Health Centre (PHC)
1
2009
5
1
0
5
0
5,164
0
0
859
301,200
61,993
623,643
6,005
1,920,186
15
Primary Health Centre (PHC)
1
2010
5
2
0
5
0
3,595
1
0
1,745
503,100
69,402
656,466
3,000
2,130,306
15
Primary Health Centre (PHC)
1
2011
5
1
0
5
0
4,301
0
0
1,188
664,080
56,993
687,399
5,000
1,606,750
15
Primary Health Centre (PHC)
1
2012
5
1
0
5
0
4,769
0
0
747
369,240
58,279
719,790
9,876
1,212,995
15
Primary Health Centre (PHC)
2
2008
2
1
0
0
0
2,341
0
33
112
162,240
56,531
592,461
922
88,679
15
Primary Health Centre (PHC)
2
2009
2
1
0
0
0
3,159
0
27
220
253,200
59,727
623,643
2,766
337,600
15
Primary Health Centre (PHC)
2
2010
2
1
0
0
0
2,346
0
33
170
319,740
56,080
656,466
3,065
305,950
15
Primary Health Centre (PHC)
2
2011
2
1
0
0
0
2,617
0
59
224
364,590
60,295
687,399
5,600
387,400
15
Primary Health Centre (PHC)
2
2012
2
1
0
0
0
4,316
0
71
215
402,216
59,084
719,790
6,600
391,600
16
District Hospital (DH)
1
2008
298
17
22
40
30
139,116
23,660
39,058
5,098
16,101,454
11,554,685
2,500,503
737,904
9,077,091
16
District Hospital (DH)
1
2009
298
17
22
42
34
136,081
24,803
38,650
5,273
20,735,896
11,633,173
2,632,108
930,207
10,691,460
District
Platform
Facility
15
District Hospital (DH)
1
15
District Hospital (DH)
15
Year
86
87
FACILITY INFORMATION
INPUTS (BEDS & STAFF)
OUTPUTS
EXPENDITURE Medical supplies + pharmaceuticals
Administration and training
Non-medical
Year
Beds
Doctors
Nurses
Paramed
Nonmed
Outpatient
Inpatient
Vaccinations
Births
Personnel
Infrastructure + utilities
1
2010
298
17
17
62
51
141,910
29,873
59,197
5,835
40,955,600
13,035,558
2,770,640
255,639
12,107,143
District Hospital (DH)
1
2011
298
18
18
65
51
141,578
30,052
41,766
6,157
31,002,732
12,693,543
2,901,194
213,271
12,090,894
16
District Hospital (DH)
1
2012
298
28
35
77
56
143,163
32,357
42,587
5,943
37,142,704
14,287,884
3,037,900
486,303
14,291,151
16
Community Health Centre (CHC)
1
2008
4
1
1
9
1
9,288
1,841
3,267
1,579
1,372,224
566,513
516,794
2,920
2,915,382
16
Community Health Centre (CHC)
1
2009
4
1
1
9
2
9,010
2,365
3,438
1,812
1,811,490
556,186
549,941
4,472
4,405,912
16
Community Health Centre (CHC)
1
2010
4
1
1
9
2
8,033
2,230
3,185
1,678
2,336,172
447,864
533,109
5,765
3,970,500
16
Community Health Centre (CHC)
1
2011
4
1
1
9
2
6,537
2,063
3,386
1,481
2,601,246
499,355
571,959
4,988
4,071,739
16
Community Health Centre (CHC)
1
2012
4
1
1
9
2
6,532
1,853
3,580
1,398
3,106,494
466,991
615,901
5,902
2,947,892
16
Primary Health Centre (PHC)
1
2008
5
0
0
4
1
6,036
2
281
2
481,776
57,848
549,385
0
309,727
16
Primary Health Centre (PHC)
1
2009
5
0
0
4
1
3,243
1
407
3
580,872
51,822
578,300
640
569,400
16
Primary Health Centre (PHC)
1
2010
5
0
0
4
1
5,091
0
225
0
814,662
49,674
608,737
820
300,900
16
Primary Health Centre (PHC)
1
2011
5
0
0
4
1
3,469
0
745
0
841,916
57,025
637,421
0
0
16
Primary Health Centre (PHC)
1
2012
5
0
0
4
1
3,466
0
1,295
0
1,006,626
60,074
667,456
0
0
16
Primary Health Centre (PHC)
2
2008
10
1
0
1
1
2,184
0
1,601
134
464,754
115,000
559,250
0
110,000
16
Primary Health Centre (PHC)
2
2009
10
1
0
2
1
1,384
0
1,625
167
732,740
115,000
590,089
0
419,200
16
Primary Health Centre (PHC)
2
2010
10
1
0
2
1
2,592
0
1,710
201
1,037,850
115,000
620,210
0
283,100
16
Primary Health Centre (PHC)
2
2011
10
1
0
2
1
2,990
0
1,728
184
1,187,250
115,000
649,569
0
381,350
16
Primary Health Centre (PHC)
2
2012
10
1
0
2
1
3,226
0
1,788
149
1,371,528
115,000
680,827
0
132,400
16
Community Health Centre (CHC)
2
2008
30
2
2
12
8
18,787
2,911
7,624
1,911
3,108,264
296,314
504,374
2,492
4,108,604
16
Community Health Centre (CHC)
2
2009
30
2
2
12
8
16,265
2,950
9,322
2,106
3,802,940
323,220
560,659
17,465
4,863,572
16
Community Health Centre (CHC)
2
2010
30
2
2
12
8
16,221
2,985
10,066
2,670
4,070,239
293,394
593,654
7,175
4,554,761
16
Community Health Centre (CHC)
2
2011
30
2
2
12
8
17,253
2,801
8,925
2,647
4,731,228
295,699
603,094
10,749
3,400,062
16
Community Health Centre (CHC)
2
2012
30
4
2
13
8
18,774
2,940
7,307
2,416
6,597,624
322,078
637,856
9,580
3,769,736
16
Primary Health Centre (PHC)
1
2008
4
1
0
6
1
4,378
682
0
571
1,305,912
67,235
550,018
2,800
1,111,330
16
Primary Health Centre (PHC)
1
2009
4
1
0
6
1
4,968
827
0
644
1,577,952
81,325
579,310
0
1,115,212
16
Primary Health Centre (PHC)
1
2010
4
1
0
6
1
2,820
730
0
575
1,688,820
78,655
609,818
1,400
1,147,531
16
Primary Health Centre (PHC)
1
2011
4
1
0
6
1
1,834
622
1,010
507
1,962,960
122,245
645,235
290
1,051,300
16
Primary Health Centre (PHC)
1
2012
4
1
0
6
1
1,741
672
905
454
2,263,554
188,437
683,423
0
1,071,237
16
Primary Health Centre (PHC)
2
2008
0
0
0
2
0
240
0
1,503
0
230,016
44,189
557,159
0
0
16
Primary Health Centre (PHC)
2
2009
0
0
0
2
0
270
0
2,058
0
280,950
44,476
589,333
0
0
16
Primary Health Centre (PHC)
2
2010
0
0
0
2
0
250
0
2,203
0
300,654
49,217
619,976
0
0
16
Primary Health Centre (PHC)
2
2011
0
0
0
2
0
280
0
2,359
0
349,380
54,194
648,585
0
0
16
Primary Health Centre (PHC)
2
2012
0
0
0
2
0
320
0
2,478
0
399,678
47,774
679,365
0
0
17
District Hospital (DH)
1
2008
120
21
22
39
14
81,874
9,022
6,570
10,002
12,218,213
5,337,330
1,505,182
253,496
5,603,534
17
District Hospital (DH)
1
2009
120
22
24
36
11
75,404
11,537
5,944
11,333
15,704,328
6,132,435
1,584,403
406,639
5,944,193
17
District Hospital (DH)
1
2010
120
21
22
31
14
73,978
13,092
15,502
12,689
19,142,194
6,977,219
1,667,792
152,642
7,367,452
17
District Hospital (DH)
1
2011
120
19
21
27
13
56,447
14,215
13,535
10,640
25,365,916
9,370,110
1,746,379
1,162,201
7,175,760
17
District Hospital (DH)
1
2012
120
19
20
24
9
73,308
9,704
14,853
10,581
30,197,468
12,228,067
1,828,670
707,345
5,670,737
17
Community Health Centre (CHC)
1
2008
23
1
1
6
3
22,910
2,175
3,020
1,017
1,392,025
166,154
386,203
7,446
2,247,157
District
Platform
16
District Hospital (DH)
16
Facility
88
89
FACILITY INFORMATION
INPUTS (BEDS & STAFF)
OUTPUTS
EXPENDITURE Medical supplies + pharmaceuticals
Administration and training
Non-medical
Beds
Doctors
Nurses
Paramed
Nonmed
Outpatient
Inpatient
Vaccinations
Births
Personnel
Infrastructure + utilities
2009
23
2
3
7
3
19,783
3,089
3,046
1,013
2,551,164
175,904
407,885
15,798
2,505,013
1
2010
23
1
2
7
3
25,307
3,154
3,681
1,116
3,130,637
167,682
429,025
20,841
2,954,268
Community Health Centre (CHC)
1
2011
23
3
4
8
3
26,446
2,445
3,784
942
3,335,615
211,994
451,197
64,546
2,390,885
17
Community Health Centre (CHC)
1
2012
23
2
1
7
5
18,600
2,119
4,436
666
3,418,699
204,773
473,913
35,731
2,551,418
17
Primary Health Centre (PHC)
1
2008
6
1
0
6
5
4,071
640
0
267
1,044,678
127,813
420,125
2,083
3,884,701
17
Primary Health Centre (PHC)
1
2009
6
1
0
6
5
5,168
760
0
395
1,323,918
133,567
442,237
13,440
3,500,000
17
Primary Health Centre (PHC)
1
2010
6
1
0
6
5
4,178
780
0
493
1,482,394
130,495
465,513
23,887
5,002,400
17
Primary Health Centre (PHC)
1
2011
6
1
0
6
5
4,245
855
0
474
1,806,562
136,503
487,448
42,165
4,349,017
17
Primary Health Centre (PHC)
1
2012
6
1
0
6
5
3,498
932
0
473
2,193,692
134,556
510,417
22,785
2,909,335
17
Primary Health Centre (PHC)
2
2008
1
0
0
4
0
381
5
613
0
184,800
154,084
420,125
4,340
12,411
17
Primary Health Centre (PHC)
2
2009
1
0
0
5
0
436
7
1,978
0
202,800
109,615
442,237
3,406
11,700
17
Primary Health Centre (PHC)
2
2010
1
0
0
4
0
404
7
914
0
212,400
97,540
465,513
5,987
12,724
17
Primary Health Centre (PHC)
2
2011
1
0
0
5
0
692
8
541
0
256,800
112,975
487,448
6,558
13,070
17
Primary Health Centre (PHC)
2
2012
1
0
0
4
1
827
3
1,900
0
304,800
137,120
510,417
12,725
25,210
17
Community Health Centre (CHC)
2
2008
30
4
0
20
11
38,143
1,218
2,064
1,165
7,030,410
1,683,402
411,100
388,581
3,231,755
17
Community Health Centre (CHC)
2
2009
30
4
2
20
13
38,930
793
3,519
751
6,671,977
1,713,909
431,627
430,668
3,517,669
17
Community Health Centre (CHC)
2
2010
30
4
3
20
14
36,566
1,306
4,028
947
7,644,289
1,737,250
456,089
461,026
3,498,439
17
Community Health Centre (CHC)
2
2011
30
4
5
20
16
35,693
1,423
4,115
958
11,577,535
1,764,540
478,815
509,940
3,723,550
17
Community Health Centre (CHC)
2
2012
30
5
6
23
20
31,614
1,143
4,232
861
12,993,898
1,796,650
503,637
544,170
3,548,637
17
Primary Health Centre (PHC)
1
2008
3
1
0
4
1
1,984
0
876
106
745,720
19,826
423,210
2,066
572,695
17
Primary Health Centre (PHC)
1
2009
3
1
0
4
1
2,013
0
836
100
671,152
20,498
445,725
6,266
651,978
17
Primary Health Centre (PHC)
1
2010
3
1
0
4
1
1,183
0
1,415
130
772,870
20,639
471,053
6,926
662,020
17
Primary Health Centre (PHC)
1
2011
3
1
0
5
2
1,133
0
1,356
125
966,072
23,821
492,746
3,245
731,550
17
Primary Health Centre (PHC)
1
2012
3
1
0
4
1
1,157
0
1,320
134
690,184
21,289
530,310
4,157
843,379
17
Primary Health Centre (PHC)
2
2008
5
1
0
1
1
912
10
329
23
231,680
157,882
420,125
16,000
14,470
17
Primary Health Centre (PHC)
2
2009
5
1
0
1
1
880
18
411
27
365,752
130,847
442,237
17,001
14,141
17
Primary Health Centre (PHC)
2
2010
5
1
0
2
1
800
19
985
39
443,002
143,169
465,513
18,500
15,200
17
Primary Health Centre (PHC)
2
2011
5
1
0
3
1
895
20
1,511
42
503,020
142,369
487,448
18,012
17,100
17
Primary Health Centre (PHC)
2
2012
5
1
0
4
1
1,123
8
1,502
45
349,413
136,209
510,417
19,200
18,900
District
Platform
Facility
17
Community Health Centre (CHC)
1
17
Community Health Centre (CHC)
17
Year
90
91
92
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