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Indian Journal of Community Medicine

A new initiative on primary and preventive health care-early results on expenditure patterns

Author(s): Vedam Shankar R

Vol. 32, No. 2 (2007-04 - 2007-06)

LETTER TO EDITOR

Year : 2007 | Volume : 32 | Issue : 2 | Page : 160

A new initiative on primary and preventive health care-early results on expenditure patterns

Vedam Shankar R
F2 Pace Garden Apartments, 30 Cathedral Garden Road, Nungambakam, Chennai - 600 017, India
Date of Submission 08-Jan-2007

Correspondence Address:
Vedam Shankar R
F2 Pace Garden Apartments, 30 Cathedral Garden Road, Nungambakam, Chennai - 600 017
India

Source of Support: None, Conflict of Interest: None
How to cite this article:
Vedam SR. A new initiative on primary and preventive health care-early results on expenditure patterns. Indian J Community Med 2007;32:160
How to cite this URL:
Vedam SR. A new initiative on primary and preventive health care-early results on expenditure patterns. Indian J Community Med [serial online] 2007 [cited 2007 Nov 30];32:160. Available from: http://www.ijcm.org.in/text.asp?2007/32/2/160/35672

Sunshine family clinic was established as an outpatient facility at Ayyanpettai village near Kancheepuram in Tamil Nadu about eight months ago, with the objective of providing primary health care facilities in a rural area that would be comparable to the best available in any of the industrialized countries. The clinic houses primary care physicians, an obstetrician, a paediatrician, a surgeon, a dentist, and qualified nurses. It also has a modern computerized laboratory with bio-analyzers and a haematology counter. This is complemented by a fully-equipped procedure room and observation beds. The in-house pharmacy is manned by dispensing pharmacists.

The patient, once registered, is issued a case sheet in which his or her entire treatment history is recorded. The diagnoses made by the doctors are classified as per ICD 9 to enable study of the prevailing disease patterns. Medicines are dispensed using dispensing labels and prescriptions are provided on request. Separate records are maintained for antenatal patients. The clinic is an accredited DOTS and microscopy centre and also offers immunization services.

This clinic, in collaboration with the Kamala Vedam Educational and Charitable Trust, has commenced a public health initiative. This program, christened as Operation Sunshine, provides supportive health-care services to the neighbouring villages. The program is headed by a senior public health nurse who is assisted by a village health nurse. A centre has been established for training village health workers; they receive training in both theoretical and practical aspects at the clinic and at the government health centres nearby.

In early December 2006, ten village health care centres were opened that were housed at the panchayath buildings in the respective villages. Here, under the supervision of trained nurses, health workers provide basic health care for minor ailments, impart health education, advise on health promotion, conduct health screening and disease surveillance, and carry out house visits and patient follow-up. In addition, they also assist in immunization and aid in the various health activities of the health department of the state. There is a complete record of all the activities carried out.The information that is collected is shared with the concerned government department. All of this data is being compiled as part of a three-year study.

Early data on 5000 patients has been clubbed under different heads: as expenditures on consultation, for laboratory services, and at the pharmacy.

Average patient expenditure on consultation was Rs. 40.35, that included procedures and specialist charges. Physician at his dicretion provided injection, which is administered by the physician at his discretion. It is found that a majority of the patients avail of this facility. Normally, each patient is charged about Rs. 20.00 per consultation with the general physician and about Rs. 50.00 for a specialist consultation. Specialist consultation charges accounted for less than 5% of the total amount collected under this head. The peak patient load was in the mornings and the evenings, with most of the specialist consultations being in the afternoon and early evening hours. The expenditure towards the laboratory services was about Rs. 13.80 per patient. Most patients seem to be averse to laboratory investigations and diabetics who regularly monitor their blood sugar make up the bulk of this contribution. The other major contributors were those who checked their serum cholesterol levels. The expenditure incurred for purchase of drugs was about Rs. 45.12 per patient. It was observed that almost 40% of the patients preferred not to buy drugs but, instead, avail of the free injection that was offered. This was more so in the case of adults than in the case of children. The operating cost involved in running this clinic at the current level works out to about Rs. 281.71 per patient seen and if the total establishment costs, with a repayment in three years is taken into account, the cost per patient works out to Rs. 615.60.

Massive turnout of 900 patients on each day during free camps in the clinic signify that people valued the free care.

The clinic covers a population of about 30 000, which is also being serviced by a government PHC. A disappointing finding is that next to the government PHC, it is the quacks who operate in the village who attract the maximum number of patients. The clinic and its ancillary services are being promoted as an example of a private-public partnership in a rural area and seeks to encompass all the aspects of primary and preventive health care.

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