Transcript EXTERNAL REVIEW- WAYAMBA PROVINCE Dr .Nihal Abeysinghe Chief Epidemiologist

EXTERNAL REVIEW- WAYAMBA
PROVINCE
Dr .Nihal Abeysinghe
Chief Epidemiologist
Ministry of Health
Distribution of curative services
Type of hospital
Kurunegala
Puttalam
Teaching
1
General
0
1
Base
2
2
District
16
3
Rural
16
5
Peripheral
12
4
Central dispensary
and maternity home
1
5
Central dispensary
50
20
Total
98
40
SERVICE UTILIZATION-Out patient Care
Average daily OPD
atendance in wayamba
province
50
0
517.5
556.8
993.6
BH MAR
BH PUT
GHCHI
1& 2 quarters 2005
BHNIK
PUT
BHKU
KUR
THK
District
303.7
100
456.2
150
1000
900
800
700
600
500
400
300
200
100
0
551.5
200
pateints/day
250
236.4
300
322.4
OPD attendance/day
350
Average daily OPD attendance
in secondary and tertiary
hospitals
Highest average attendance – tertiary &
secondary care institutions
Tertiary Care Institution
1& 2 quarters 2005
46 .9
36 .1
40.9
40.9
CD/MH
76 .5
70.5
RH
108.7 11 8.9
150
PU
200
KUR
PUT
100
0
MH
50
DH
• In Puttalam district ,
proportionately more
subsequent visits to
primary care institutions
than in secondary care
institutions
250
OPD attendance/day
• Lower the level of
hierarchical institution,
daily average OPD
attendance decreases
19 8.3
243.7
SERVICE UTILIZATION-Out patient Care
SERVICE UTILIZATION-In patient Care
2500
305
237.4
BHPUT
Source 1& 2 quarters-2005
BHKUL
PUT
0
333
500
BHCHIL
1000
KUR
• Comparatively high value
at RH Gonigoda ( 90.7)
with other Primary Care
Institutions
873
1500
1283
2000
THKU
• Low daily average bed
occupancy- lower level
institutions
Average daily bed occupancy
in district and higher level
institutions
2008
• Highest bed occupancytertiary and secondary
care institutions
SERVICE UTILIZATION-In patient Care
BHMAR
BHKUL
THK
0
PUT
10
73
93.6
RH
Nawagatt
20
Rhkoshena
30
73
68.8
BHPUT
40
100
90
80
70
60
50
40
30
20
10
0
DH
ALAWWA
65
50
GHCHIL
60
56.4
68.8
70
KU
Bed Occupancy Rate
80
BOR
90
73.3
100
Primary Care institutions with high
BOR
88.7
98.8
Bed occupancy rate in higher level
institutions and districts
SERVICE UTILIZATION-In patient Care
• Average duration of stay – higher in secondary and
tertiary care institutions
TH Kurunegala
BH Kuliyapitiya
GH Chilaw
BH Puttalam
BH Marawila
3.7days
3.3days
2.7days
2.6days
3.0days
• Primary Care institutions with high average duration
of stay
Kurunegala district- RH. Mahamukalanyaya( 3.8)
RH. Delwita( 3.0)
Puttalam district
DH Mundal( 2.9),
RH Nawagattgama (2.6)
SERVICE UTILIZATION-clinic services
• Average clinic attendance in Puttalam district63.4
• Institutions with high average clinic
attendance
PU Mundal
114.4
DH Anamaduwa
91.2
BH Marawila
67.5
GH Chilaw
53.4
• Ratio of first visit to subsequent 1: 2
• Irrespective of the hierarchical type of
institutions, utilisation of medical clinics – very
high
(Average clinic attendance exceeds 100).
SERVICE UTILIZATION-clinic services
• Utilisation of diabetic clinics- high.
• Specialised clinics such as Surgical,
Orthopaedic, Ophthalmology, ENT clinics highly utilised ( average attendance exceeds 50)
• Universally available dental and Anti Natal
clinics - highly utilised at GH Chillaw ( Dental55.3, ANC-73.8)
• Clinics at PU Mundal- exclusively subsequent
users( 95%)
Human resources (per 10000 population)
Category
Kurunegala
Puttalam
Specialists
0.21
0.21
Medical officers
1.18
2.80
Dental surgeons
0.30
0.32
RMO/AMO
Nurses
MLT
0.90
4.20
0.21
0.58
4.50
0.34
Pharmacists
0.16
0.33
Dispensers
0.01
0.02
Radiographers
0.03
0.05
Costing of anti rabies activities in Puttalam
district
2003
Recipients of
ARV
No of consumed
vials
Total cost for
ARV
2004
Difference
%
increase
/decrease
6956
4082
-2874
-41.3
13961
7826
-6135
-43.9
5672773.13 2592675.54 -3080097.59
-54.3
Recipients of
ARS
2195
1705
-490
-22.3
No of consumed
vials
3218
2482
-733
-22.7
Total cost for
ARS
2695042.85 3948590.45 1253547.63
46.5
Trend of increase in transport cost of an
ambulance per KM in Puttalam district
300
cost on SL Rs
250
200
150
100
50
0
1994
1996
1998
2000
year
2002
2004
Average cost per a birth at hierarchial institutions in Puttalam district
350000
Cost in rupees
300000
250000
200000
150000
100000
50000
0
GH
BH
DH
PU
Type of hospital
2003
2004
RH
MH
Costing of diets in Puttalam district
• The highest total diet expenditure - BH Marawila –
2,969,057SLR
• In secondary care institutions , expenditure for patients was
higher than that for the staff
• Institutions with higher expenditure of diet for staff than
patients
DH Anamaduwa(56%),
PU Lunuwila(57%),
PU Madampe(64%)
RH Thabbowa (53%)
RH Anawilanduwa(60%)
CD& MH Mampuri(52%)
CD& MH Alutwewa(95%)
CD& MH Kottantivu(65%)
CD& MH Mahakubukkadawela(95%)
• proportion of the diet cost for staff out of total cost is given in
parenthesis
Costing of diets in Kurunegala district
• The highest total diet expenditure - BH
Kuliyapitiya – 3,468,855.33SLR
• In secondary care institutions , expenditure for
patients was higher than that for the staff
• In all primary care hospitals, except for
Dambadeniya and Rideegama, expenditure of
diet of staff was higher than that for patients
Conclusion
• Lower the level of hierarchical institutions, the average
daily OPD attendance tends to decrease in both districts.
• Out patient services at secondary care institutions had
been exclusively used by users for first visits.
• Secondary visits were proportionately higher in primary
care hospitals than in the secondary and tertiary care
institutions.
• Higher daily average occupancy , average duration of
stay and Bed occupancy rates in tertiary and secondary
care institutions reflects the under utilization of smaller
institutions and over crowding of specialized institutions
in the province .
• In Primary Care institutions , a hospital bed on average
has changed more occupants than in secondary and
tertiary care institutions
• higher clinic utilization at some Primary Health Care institutions
and registered proportionately high subsequent visits at these
places may be due to easy access
• Higher utilisation of clinics for non communicable diseases
irrespective of the type of institution.
• Higher utilisation of specialised clinic services ( ex.
Orthopaedic, ENT).
• Though, family planning and Ante natal clinics are universally
available, high utilisation of these clinics at secondary care
institutions reflect the by passing tendency by clients.
• Resources
• The available cadre is less than the approved cadre for many
categories
• Similar rates of distribution of health personnel within the
province except for some categories .
Costing of services ( Puttalam
district)
• Two thirds of MOHs in Puttalam district have
been able to curtail the average transport cost
per MOH vehicle in 2004 while increasing the
mileage in comparison to the previous year
• Lower the level of the hierarchical institutions,
cost per a delivery increases