Designing an intervention to improve the effectiveness of Primary Healthcare Centres in southwest India
A senior health official in an Indian State government has approached you for advice. The State has a rapidly growing population and a high demand for primary healthcare, but a tight budget which means that every effort has to be made to improve the effectiveness of the existing provision. There will only be limited resources to cope with the growing demand for primary healthcare services. The existing provision is good when benchmarked against WHO standards and exceptionally good when compared with countries at a similar stage of development and with most other states within India.
There are about 500 primary healthcare centres spread across the State, many in isolated rural areas. Their role is to offer medical care, mother and child welfare, family planning, improvements in environmental sanitation, control of communicable disease, health education, and school health. In addition they are required to collect statistics and provide a referral service. Each Centre is managed by a chief medical officer and has an establishment of approximately 60 staff. There is typically a main facility that has accommodation for clinics, operating theatres for minor surgery, three wards for short stay patients and a pharmacy. In addition various outreach services maybe located at satellite sites in the community served by a Centre.
Up until now attempts to improve the effectiveness of primary healthcare provision have been limited to sending chief medical officers and other doctors who have been identified as candidates for promotion on a lengthy training programme at the State’s Institute for Management in Government. The senior health official who has approached you for advice believes that there has been relatively little transfer of learning back into the primary healthcare centres and that the heavy investment in training has had little effect on performance.
- Design an intervention that will improve the capability of the staff working in the health centres to improve the effectiveness of the services they provide.
- Identify issues that might affect the success of your proposed intervention and explain how you would address these issues.