SHSRCK
State Health Systems Resource Centre - Kerala
Department of Health & Family Welfare, Government of Kerala
0471 2323223

Ongoing Research Studies

Patient Experience Study in Public Health Facilities of Kerala

Quality of care has been given prime importance in health care sector lately. Various national and state level agencies are involved in setting benchmarks for quality in health care sector. To evaluate the quality by examining the treatment modalities and their effectiveness is a laborious task and hence patient experience surveys were devised to measure the feedback of patients about the care. Health care unlike other sectors have historically continued to include the feedback of its users. Patient experience studies are designed to capture experiences of patients visiting the facilities CAHPS scale for measuring patient experiences are highly acclaimed and validated tool.

SHSRCK has conducted a patient experience study to understand the experiences of patients visiting public health facilities of Kerala. The main objective of the study is to understand the experiences of patients visiting public hospitals and understand the issues thereof. The tool for the patient experience survey was adapted from CAHPS tool and was modified to Kerala context. The study is carried out in 30 government hospitals at secondary level (Taluk, District Hospital and General Hospital) in ten districts of the state.

Data Analysis of NCD Screening in Kerala

The state of Kerala is facing demographic and epidemiological transition with increased life expectancy along with drastic change in living standards. The change in disease profiles brought about by this transition, and its differential impact on different social classes, largely remain unstudied. This is the point of departure for our exploration into the prevalence of diabetes and related states across the State. Our study aims at finding out the prevalence of diabetes and hypertension from the NCD screening data in various outpatient facilities throughout Kerala where NPCDCS programme is implemented regularly.

The main objective of the study is to understand the prevalence of diabetes and hypertension in Kerala in people above thirty years. The study also aims at understanding the effects of gender, age and geographical variation on the prevalence. The study has used the secondary data collected from districts of Kerala where NPCDCS programme is implemented and screening data is collected.

Completed Research Studies

Evaluation of ASHA Component of NRHM in Kerala

The National Rural Health Mission launched in 2005 had the preeminent goal 'to improve the availability of and access to quality health care by people, especially for those residing in rural areas, the poor, women and children' aimed to do so through 'enabling community ownership and demand for services, strengthening public health systems for efficient service delivery, enhancing equity and accountability and promoting decentralization. One of the core strategies to achieve this goal was the introduction of a new cadre of lay women health volunteers called accredited social health activists (ASHA) who will 'act as the interface between the community and the public health system 'and paid a performance based compensation. They were expected to provide information regarding available health care services, on issues such as basic health and sanitation and impress the need timely utilization of health care utilization of the community and ensure community participation to improve the accountability of health care service delivery.

The evaluation broadly sought to seek whether the selection process was adequately done, whether the roles and responsibilities of the ASHAs understood by them and the health services department, to understand the bottlenecks in the day to day functioning and the major causes of concern, identify the on the ground realities of their nature of work, their challenges and suggestions for improvement.

The evaluation study was carried out across seven districts of the state using a mixed methodology employing qualitative and quantitative methods. The quantitative component of the evaluation was designed mainly as a cross sectional survey among ASHA workers, JPHNs and beneficiaries across six districts using a multistage sampling design. In addition key informant interviews with district level officials and focused group discussions with the JPHNs and ASHAs were done in all the selected districts.

State Specific Training Module /Training Material for ASHA Program

The training module primarily aims at enhancing the competencies of ASHA' s in terms of their roles and responsibilities, through equipping trainers /training coordinators to handle sessions/conduct the program more effectively. The task of developing the state-specific training modules was undertaken by Centre for Management Development (CMD) in collaboration with SHSRCK. The thrust of the modules is to develop skills among ASHA's to carry out their roles/tasks more effectively rather than just imparting knowledge on health related topics.

Modules were developed based on stakeholder discussions held with representatives of Department of health, NRHM, SHSRCK, observation of training sessions for ASHA and interaction with participants. Kerala. The training consists of two parts and part one is intended for trainers on how to use the module. This includes lesson plan, check list of materials required, learning objectives and the process of conducting the session. The second part contains a set of reading materials/handouts meant for participants which can as well be used by trainers.

Evaluation of NRHM Fund Utilization in Different Health Facilities in Kerala

National Rural Health mission started in 2005 aimed at strengthening public facilities and increasing access to comprehensive primary health care especially in the rural areas throughout the country. The public spending on health increased considerably after the advent of NRHM. The society route of funding was aimed at hassle free fund transfer to various programs. The changes in terms of infrastructure, human resource medicine supply, quality of care are notable after the NRHM implementation. But the utilization patterns of NRHM funds are limited to annual performance audits done by external audits.

The evaluation study of NRHM fund utilization assesses the extent of utilization, under or better utilization and under lying reasons for these utilization patterns of funds. The study looks at utilization patterns of health care institutions at district, block and panchayat level. It also aims at identifying various barriers of fund utilizations and tries to provide feasible steps to overcome these barriers. Mixed methodology comprising of both qualitative and quantitative techniques were used for the study. A multistage random sampling was devised to select health institutions of various levels from three geographic zones north, central and southern regions.

Costing Study in Public Hospitals of Kerala

The broad objective of the costing study is to arrive at average cost figures of specific cost centers in public hospital which can be used to build the package costs under a provider payment system. This would involve collection of baseline information on costs and utilization from the hospitals and generate information which can be used for better provider payment mechanism. The present study attempts to arrive at average cost of different departments in public hospitals using a combination of both step-down and bottom up cost computations. In the step down procedure, average cost of each components of cost is worked out for the cost centre defined in terms of the clinical and surgical departments of care in a hospital. The cost components are allocated into direct, indirect and overhead costs. The study sample includes two secondary level hospitals; Taluk Hospital Cherthala and General Hospital Ernakulum.

Documentation of Best Practices of State Health Systems

The State Health System Resource Center in collaboration with Population Research Center (PRC), is undertaking a series of case studies on "Documentation of Best Practices of State Health systems" to provide useful insights to the best innovations in health made by our state. The documentation of best practices is aimed at bringing out the salient features of the scheme which includes program performance, governance mechanisms, issues & challenges faced by the scheme. The three schemes which are taken up for documentation includes (a) CHIS Plus Scheme (b) Palliative Care Program of NRHM (3) Karunya Benevolent Fund

Baseline Study for the UHC Primary Care Pilot Project

The baseline survey on Universal Primary Care Pilot Project aims to capture the quality, coverage and reach of curative, preventive, promotive and rehabilitative aspects of the services offered through the public health system in the pilot area in the six selected health topics, namely antenatal care, hypertension, diabetes, mild depression, mild fever and immunization. The baseline study will also assess the health system preparedness, community acceptance, economic underpinnings, and empiricism in providing the services. The study uses mixed methodology using a combination of both quantitative and qualitative methods. For each of the pilot site, a nearby area/institute having almost the same characteristics would be chosen as the control area. The baseline study also includes facility observation checklist and also In-depth interviews with various stakeholders of the pilot project.