Compiled by

Lata Suresh

PREFACE
IIHMR being the premier institute of hospital and health management in the country has the prime responsibility to shape the direction and dimensions of research and development in the field of health and hospital management. From the year of its inception; it is committed to generating quality research in these fields. The Institute offers a two-year full-time Postgraduate Programme with specialization in Hospital Management and Health Management. It is a flag ship educational programme aiming at developing trained professional managers with requisite skills in planning and operating management techniques; diagnosing and solving management problems; and acquiring consultancy skills, with a view to preparing them to manage hospitals and pharmaceutical and healthcare institutions in developing countries both in the public and the private sectors, and to meet the rising demand for quality care. For practical training the Institute has collaborative arrangements with multi-specialty hospitals and several pharmaceutical companies, NGOs and healthcare organizations. As the programme has set high standards of management education in the health sector, it has attained the status of a premier programme in the country. Our students go for training and placement to as many as one hundred hospitals and pharmaceutical and healthcare organizations. Hence, Institute decided to publish abstracts of the entire dissertations carried out by the students. This volume summarizes the work done by the students of PGDHM batch 2008-2010. We acknowledge the help and support provided by the PGDHM and PGDPM students batch 2009-2011 and the library staff for their immense help provided during the final stage of this publication. We also acknowledge the help and support by Mr. Mukesh Gahlot, computer department for his assistance.

Lata Suresh

CONTENTS
HOSPITAL MANAGEMENT S.No Title
1. Infection Control in Intensive Care Unit & Facility Based New Born Care Unit Efficient Work Flow Management in Radiology Department Comparative Study on Incidence of VAP in ICU at a Hospital in Patna Strategy Evolvement for Improving Turnaround Time for Bed having Synergized Effect on Delivering Quality Health Care to Patients in a 200 Bedded Hospital Study on Factors Associated with Satisfaction and Motivation of the Class III & IV Employees in Government District Hospital Quality Assessment of Radiology Department Statistical Approach to Inventory Optimization with Focus on Medical Consumable Items A Comprehensive Study of Gap Analysis of Facility Management & Safety (FMS) at Specialty Hospital, as per Joint Commission International (JCI) Accreditation Standards Quality Assurance in Biomedical Waste Management Study of Process Compliance for Rationalization of Usage of Restricted Antimicrobials in a Tertiary Care Hospital in India A Study on Patient Satisfaction at Multi Super Specialized Hospital and Heart Institute, New Delhi Compliance Percentage Assessment and Comparison (Pre and Post) to NABH Standards for Capacity Building Rapid Assessment of a Model Initiative to Ensure Quality Family Planning Services in Uttarakhand

Students Name
Amritesh Mullick

Advisor
Goutam Sadhu

Pg No.
2

2. 3.

Anil Gupta Anuj Dandotia

L.P. Singh

2 3

4.

Anurag Gupta

Vinod Kumar

5.

Aparna Jha

S.C. Gupta

6. 7.

Archana Agarwal Arti Sharma

S.D. Gupta Abhishek Dadhich

4 5

8.

Bhushan Sarmandal

Anoop Khanna

9. 10.

Deep Makkar Deepti Choudhari

Dipti Govil S.K. Puri

5 6

11.

Divya

P.R. Sodani

12.

Eesha Arora

P.R. Sodani

13.

Esha Kalra

Vivek Lal

S.No Title
14. Formulation and Implementation of Performance Management System at a Tertiary Care Hospital Nosocomial Infection Management Influence of Post Surgical LOS, Surgeon, Insurance and Bed Class on Patients Hospital Expenses for MRM, Amputation and Oesophagectomy Surgeries done in a quarter. Measuring Operational Efficiency of 210 Beded Multi Super Specialty Construction and Implementation of Information System for TPA Department Time Utilization of Operation Theatre Internal Assessment of as per NABH Standards Benchmarking of Inventory and Stores Department of an Eye Hospital Application of Lean Principles to Improve Operational Efficiency in Health Check-up Department Inventory Classification of Medicines at Multi Speciality Hospital Gurgaon PDCA Approach to Accreditation

Students Name
Gargi Agarwal

Advisor
Jyoti Dua

Pg No.
8

15. 16.

Garima Singh Meel Ginny Kaushal

Nutan P.Jain C.K. Aiyer

8 9

17.

Heena Kausar

Santosh Kumar

18.

Indu Dhangar

R.S. Goyal

10

19. 20. 21.

Jitendra Kumar Hayaran Jyoti Ahuja Kanwalpreet Grewal

Neetu Purohit Barun Kanjilal Neetu Purohit

10 11 11

22.

Karan P. Mansukhani

Santosh Kumar

12

23.

Komal Jeet

C.K. Aiyer

13

24. 25. 26.

Kunal Jawahar Thakkar

Suresh Joshi P.R. Sodani Barun Kanjilal

13 13 14

Improving the Operational Efficiency by Assessing Quality Indicators Meetu Garg Business Process Re-engineering of Admission, Discharge and Transfer in a Tertiary Care Hospital Gap Analysis as per NABH Norms of a General Hospital in Gujarat Patient Satisfaction with Quality of Care: A Comparative Study of Indoor Patients in Different Wards Assessment of Adherence to Protocol in Medical Record Documentation in accordance with NABH Guidelines Megha Ahuja

27. 28.

Namrata Nancy Gupta

Vivek Lal R.S. Goyal

14 15

29.

Natasha Ahmad

Suresh Joshi

15

S.No Title
30. Implementation of Performance Appraisal System in Tertiary Care Hospital Study on Community Perception About a District Hospital in Relation to IPHS Norms Need and Location Identification of Dialysis Units in Delhi Under PPP Framework Study on Patient Care Quality Standards at a General Hospital, Gujarat Study on Roles and Perspective of Nurses in CCC in India Bridging the Gaps in the HIC Chapter of NABH Enhancing the Preparedness for NABH Accreditation Assessment of Laboratory Services Against N.A.B.L. Standards Gap Analysis for Phase II Expansion in a Tertiary Care Hospital at Rajkot Knowledge Attitude Practice (KAP) among the Staff Regarding Biomedical Waste Management A Study on the Bio-Medical Waste Management Benchmarking Medical Records Department in Accordance with NABH Standards Gap Analysis of District Hospital in Conformance to NABH Standards Medical Record Auditing at Delhi Study of Time Utilization of Operation Theatre at a General Hospital Assessment of Bio-Medical Waste Management Practices Performance Management in Operating Rooms at a Health Institute Benchmarketing of Medical Records at Eye Hospital at New Delhi

Students Name
Neha Agarwal

Advisor
S.C. Gupta

Pg No.
16

31.

Neha Awasthi

Goutam Sadhu

16

32.

Neha Garg

Jyoti Dua

17

33.

Nehashree

Dipti Govil

17

34. 35.

Nisha Kadyan Payal Ahuja

S.K. Puri J.P.Singh

18 18

36. 37.

Pooja Aggarwal Prabhat Govindan

Suresh Joshi Vivek Lal

19 19

38.

Priyanka Maan

Jyoti Dua

20

39. 40.

Priyanka Sharma Priyanka Singh

Dipti Govil L.P.Singh

20 21

41.

Priyanka Vashishta

Jyoti Dua

21

42. 43. 44. 45. 46.

Rashmi Chaudhary Richa Daftray Roshni Dilbagi Ruchika Goyal Rupinder Sahota

Vinod Kumar L.P. Singh Neetu Purohit Neetu Purohit Santosh Kumar

22 22 23 24 24

S.No Title
47. Study of the Opinion of inpatients to Measure Patient Satisfaction in an Emergency Hospital

Students Name
Samarth Tripathi

Advisor
Goutam Sadhu

Pg No.
25

48.

Study on the Utilization of Radio Diagnostic Equipments, Ultrasound Sangeeta Ravindran & Operation Theatre Challenges & Opportunities of Medical Tourism in Hospitals Quality Assessment for Training Needs Assessment Sanjhi Singh Saumya Misra

Anoop Khanna

25

49. 50. 51.

Barun Kanjilal Alok K. Mathur J.P. Singh

26 26 26

Flyover Feeds you more Momentum Expected Vs Perceived Hospital Shadad Mirza Services Nosocomial Infections in Intensive Care Unit Bed Utilization in a General Hospital at Gujarat Study of Employee Satisfaction at a General Hospital, Gujarat Study on Disaster Management Plan Sheetal Yadav Shikha Jain Shreyasi Sen Gupta Shruti Khanna

52. 53. 54. 55. 56.

S.D. Gupta Alok Mathur Dipti Govil S.K. Puri Goutam Sadhu

27 27 28 29 29

Study the Operations, Medical / Clinical Record Keeping and Prepare Shweta Sandhu Functional Specifications for Clinical System for Oncology Quality Improvement through Patient Satisfaction Survey A Study on Control Measures of Hospital Acquired Infection in Intensive Care Unit Assessment of a Hospital as per FFHI Guidelines Internal Quality Assurance in Clinical Documentation Human Resource for Health in a District Hospital at Rajasthan Study of Housekeeping Services ICU per Bed Day Costing in a Charitable Hospital, Delhi Cost Analysis of Medical Imaging Modalities Scope of IT in OPD and IPD Areas: First Step Towards a Paperless Hospital Suhas Parnami Suhasini

57. 58.

Vinod Kumar S D Gupta

29 30

59. 60. 61. 62. 63. 64. 65.

Sunita Choudhary Thirumalai N Trupti Khandelwal Vatsala Vijay Shankar Patel Vikas Goya Vikash Tyagi

Goutam Sadhu L.P. Singh Nutan P.Jain J.P. Singh Vive Lal Barun Kanjilal J.P. Singh

30 31 31 32 33 33 33

S.No Title
66. External Emergency Response Plan in a Multispeciality Hospital at Jaipur Study of Improving Effectiveness and Efficiency of the Linen and Laundry Department Comparative Analysis of two Multi-Superspeciality Hospitals for assessing the performance of Dialysis Unit Monitoring and Strengthening of OPD and IPD Services in District Hospital, Sikar

Students Name
Vikram Singh Chouhan

Advisor
P.R. Sodani

Pg No.
34

67.

Vrajesh Shah

Alok Mathur

34

68.

Vritti Lumba

Alok K. Mathur

34

69.

Yatendra Kumar Sharma

Abhishek Dadhich

35

HEALTH MANAGEMENT S.No Title

1. 2. Yashoda Assessment at District Hospital Quality of Ante-natal, Intra-natal and Post-natal Services in two Districts of Orissa

Students Name
Aastha Srivastava Aishwarya Rathore

Advisor
Suresh Joshi S.K. Puri

Pg No.
37 37

3.

To Study the Relationship of JSY with Institutional Delivery/Maternal Akash Kumar Lal Complications and Its Utilization by the Beneficiaries Human Resource in Health (HRH) in India To Ascertain the Role of LBWs in Neonatal Mortality and Development of Strategy for Preventing Deaths Due to LBWs in the Tirbal District of Narmada Customer Expectation Survey Regarding Health Insurance in Pune Analysis of Low Institutional Delivery Rate in a District Block in Gujarat Evaluation of Training Programme Conducted by State ASHA Resource Centre Training Need Assessment (TNA) on Health Management Information System (HMIS) of Sub Centre Level Health Workers (ANMs and LHVs) of Government of Bihar Immunization Coverage in Mahadalit a District of Bihar: A Feedback to Programme Manager Comparison of Organ Transplant Scenario in 5EU and India W.R.T Health Care Reforms and Immunosuppressant Therapy Training Need Assessment (TNA) on Health Management Information System (HMIS) of Block and District Level Health Personnel (DEO/BHE/ BHM, M&E Officer/SA and DPM) of Government of Bihar Factors Governing Contraceptive use in the Northeastern States of India Amandeep Singh Ambrish Kumar Chandan

Nutan P.Jain

38

4. 5.

Arindam Das J.P. Singh

38 39

6. 7.

Amit Ray Anamika

S.D. Gupta Barun Kanjilal

39 40

8.

Anil Rajesh Dungdung

S.K. Puri

40

9.

Anisha Saxena

Santosh Kumar

41

10.

Arunabh Ray

S.C. Gupta

41

11.

Deepa Raina

Hemant Anand

42

12.

Jaspreet Mahal

Santosh Kumar

43

13.

Jaya Swarup Mohanty

Arindam Das

43

S.No Title
14. 15. Study on Implementation of Referral System in District Rajsamand Assessment of the Knowledge and Attitude of Participants, Pre and Post Capacity Building Training for Village Health and Sanitation Committee in Chittorgarh District of Rajasthan Performance Assessment of IMNCI in District Valsad Evaluation of Functioning of Rogi Kalyan Samiti and Utilization of RKS Grant Received byPHC in the District Navsari, Gujarat (Financial Year 2009-10) for Improving the Standard of PHC An Assessment of Mamta Diwas Programme in Urban Slums of a Municipal Corporation at Gujarat JBSY (Janani Baal Suraksha Yojana) Evaluation Study in Bihar To Assess the Service Delivery of IPHS Upgraded and Non IPHS PHCs in Gondia District, Maharashtra Effect of Supervision on Service Delivery at Mamta Diwas in Vallabhipur Block of Bhavnagar District Gender Bias and Status of Women in Nuh and Tauru Blocks of Mewat Factors Affecting Utilization of Chief Minister BPL Jeevan Raksha Kosh Analyzing the Functioning of Adolescent Friendly Health Services (AFHS) Centre at PHC block, Gujarat Assessment of Functioning of ASHA in District Dahod HSS Data Analysis of HIV/AIDS in Sentinel Group of Rajasthan Clients Perspective on Assessment of HIV Care Services: ART Center vs. ART Center Assessment of EmOC Services in Kachchh District, Gujarat A Study on the Implementation Status of Janani Suraksha Yojana in General Hospital, Sirohi

Students Name
Jyoti Meena Kiran Madhukar Narkhede

Advisor
Neetu Purohit R.S. Goyal

Pg No.
44 44

16. 17.

Mansi Shekhar Minu Manuhar Sinha

S.D. Gupta P.R. Sodani

45 45

18.

Mohit Sharma

Santosh Kumar

46

19. 20.

Neha Dumka Neha Maheshwari

S.D. Gupta Suresh Joshi

47 47

21.

Nidhi Jain

Vivek Lal

48

22.

Nidhi Vats

S.C. Gupta

48

23.

Poonam Yadav

S.D. Gupta

49

24.

Puneet Gupta

P.R. Sodani

49

25. 26. 27.

Ram Krishna Kumar Richa Chaturvedy Rit Shukla

Dipti Govil Santosh Kumar Dipti Govil

50 50 51

28. 29.

Sabyasachi Mohapatra Sakshi Jain

L.P. Singh J.P. Singh

51 52

S.No Title
30. EPI Coverage Survey in Rural Areas of Sabarkantha District in Gujarat Review of Verbal Autopsy Reports of Infants and Maternal Deaths Determinants of Maternal Healthcare Utilization in Jammu and Kashmir-a Regional Analysis Geriatric Health Insurance: A Study in Bangalore City Training Need Assessment (TNA) of Health Functionaries of Government of Bihar in Knowledge Attitude and Practice (KAP) in Health Management Information System (HMIS) in three Blocks of Munger

Students Name
Shikha Bansal

Advisor
Alok K. Mathur

Pg No.
52

31. 32.

Shraddha S. Rajpur Suhail Ismail Shiekh

Jyoti Dua Arindam Das

53 54

33. 34.

Sumana Arora Tukaram Khandade

Barun Kanjilal Santosh Kumar

54 55

PHARMACEUTICAL MANAGEMENT S.No Title

1. Renal Cell Carcinoma: Therapeutic Segment Outlook and Pipeline Analysis in Evalueserve, Gurgaon Market Assessment of Biopharmaceuticals Round the Globe Assessment of Japanese Pharmaceutical Market to Search Business Opportunities Vitamin A Bi-annual Round Process and Knowledge Assessment Market Assessment and Product Launching Strategy of Linezolid Assessment of Insulin Market in Jaipur, Gurgaon and Faridabad Through Retail Chemist Audit Analysis of Pharmacy Function and Work Load Market Assessment of Rheumatoid Arthritis in 5-European Countries Pulmonary Arterial Hypertension: Futuristic Competitor Overview Gurgaon

Students Name
Ginni Kumar

Advisor
C.K. Aiyer

Pg No.
57

2. 3.

Kuldeep Dabas Pritika Garg

Hemant Anand Hemant Anand

57 58

4. 5. 6.

Pushpendra Dixit Rahul Gupta Ramneek Atreya

Suresh Joshi Hemant Anand Hemant Anand

59 59 60

7. 8. 9.

Reenu Bajapi Siyaram Sharma Sonal Ghura

Anoop Khanna Hemant Anand C.K. Aiyer

60 60 61

10.

Market Survey of Treatment Options for Osteoarthritis and Awareness Sumati Kumar Jain About Sodium Hyaluronate 1 % Solution in Medical Profession Market Overview of Hepatitis C in Middle East and North African (MENA) Region Vibha Chadha

C.K.Aiyer

62

11.

Hemant Anand

62

Hospital Management

Ab-1 Infection Control in Intensive Care Unit & Facility Based New Born Care Unit
Amritesh Malik

satisfactory. Fifty three percent have undergone periodic health checkup and immunization relevant to their work. Recommendations: Proper facilities and adequate resources may be provided to support the infection control programme. It includes hand washing facilities in all patient care areas and accessible to health care providers and compliance with proper hand washing is monitored regularly.

Keywords: Infection Control, Intensive Care Unit, New Born Care Unit
Objective : The main objective was to study the physical facilities available for infection control in the intensive care unit and to study the existing infection control procedures used in the intensive care unit. Methodology : The study is carried out in the intensive care unit, particularly medical intensive care unit and facility born new care unit(FBNC) at a hospital at Bharatpur. The required data is collected from nurses, doctors, hospital nursing assistance, staff of central sterile supply department who is responsible for supplying sterile items to medical intensive care unit & FBNC unit , house keeping staff who work in medical intensive care & FBNC unit, through questionnaires, personal observation and studying relevant record or infection control maintained in medical intensive care unit. The tools adopted for study is descriptive method and the required data is obtained from 26 respondents, consisting of nurses, doctors, hospital nursing assistance, staff of central sterile supply department (supplying sterile items to medical intensive care unit), house keeping staff who work in medical intensive care unit through questionnaires, personal observation and studying relevant record for infection control maintained in medical intensive care unit. Findings : It was found that hundred percent responded said that surface of MICU, table and trolleys are been wet cleaned daily. Further analysis revealed that, seventy six percent responded that walls are wet cleaned monthly. higher than th (29 percent) of the respondent reported that the monitoring sterilizing efficiency of autoclave was done daily whereas little more than1/2 of the respondent (53 percent) responded reported that sterilizing efficiency of autoclave was monitored weekly, and rest 1/5 responded said that that it is done monthly. Major discrimination was seen in frequency of monitoring. majority of the respondent reported that there were adequate hand washing facilities available in the hospital, where as 6 percent reported that the facilities were not adequate. The study revealed that surfaces in MICU & FBNC are wet cleaned daily walls are wet cleaned monthly. The study revealed that according to fifty nine(59%) percent respondents (nurses and doctors, N=17), the level of safety measures is

Ab-2 Efficient Work Flow Management in Radiology Department

Anil Gupta Keywords: Radiology Department, Work Flow Department, Hospital Management, Hospital Profile Background: Radiology diagnostic procedure has several steps from billing and appointment to procedure and report collection in which patient had to wait for his turn for procedure and then for collection of report, increased waiting time and TAT for reporting adds to patient dissatisfaction and inefficiency of radiology department. Objective: To minimize the waiting time for test and minimum turnaround time (TAT) for report generation for the efficient workflow management in radiology department. Methodology: The study was done in two steps, (1) the current situation was analyzed for 2 weeks for busy days and busy hours. (2), the current appointment system was revised and the situation after was analyzed for 6 weeks for waiting time and report TAT. Findings: After revising the current appointment system the waiting time reduced from 10min to 6 min and reporting TAT reduced from 33 to 5 min. The percentage reporting in 15 minutes increased from 64% in 1st week to 97% in 6th week, which shows the increased efficiency of the radiology department. Recommendation: Timely revision of appointment system according to the work load of the department. The quality of the billing process can make or break a radiology practice. Extra manpower on billing counters in busy hours of busy days and have roaster accordingly. Extending the existing HIS system and using electronic requisition and appointment system

Ab-3 Comparative Study on Incidence of VAP in ICU at a Hospital in Patna

Anuj Dandotia

Ab-4 Strategy Evolvement for Improving Turnaround Time for Bed having Synergized Effect on Delivering Quality Health Care to Patients in a 200 Bedded Hospital
Anurag Gupta

Keywords: IUC, Incidence of VAP, Nosocomial Infection; Intensive Care Unit

Background: The study was done focusing on ICU services in developing VAP and also comparative study was done on incidence of VAP and suggested measures to reduce it. The study consists of two parts- understanding the working of the hospital, the infection control policies persisting in the hospital, working manual of infection control committee, review of literature and past studies done on Nosocomial infection. (2) collection, analyzing and summarizing of data collected from the ICU and thus calculating incidence of VAP. Objective: To study the incidence of nosocomial infection, to study the incidence of VAP of patients on ventilator, to compare the incidence of infection rate at the hospital of study with the hospitals of similar capacity. Previous studies and literature available were also taken as reference. Rationale: This was an emergency hospital and most of the patients which are being referred to the hospital of study are from its sister concern hospital. It is a multispecialty kidney Hospital where most of the patients are being admitted is of chronic kidney disease and at end stage renal disease with already immuno-compromised status. Many of them are on the immuno-compresive drugs so these patients are more susceptible to acquire infection after being admitted in the hospital thus it is quite necessary to develop and implement the infection control policy in this hospital to check out the morbidity as well as mortality. Methodology: The study was based on data collected of all the patients being admitted in ICU of the hospital and their follow up during entire period of stay in the hospital. A descriptive study of exploratory nature was conducted within a stipulated time frame of two weeks was done in consciences with the higher authorities Findings: The incidence of ventilator associated pneumonia (VAP) was found to be 28% which when compared with the other studies was found to be significantly higher as the study was done in MICU and incidence of VAP in MICU is considered to be 9-10%.Out of 141 patients being admitted in the ICU for various ailments most of them were of chronic kidney disease among them 46 required assisted ventilation and 13 of them developed VAP.

Keywords: Quality of Health Care, 200 Bedded Hospital, Synergized Effect, Intensive Care unit
Background: The study initially focused on one ward of a 200 bedded hospital at Mohali. It has a multispecialty ward for patients of all categories except CTVS patients, with 34 beds. Patients are received from various entry points like direct admissions from OPD, triage and ED, GICU. Room turnaround time is a vital measure of performance for a number of service industries. For hospitals, reducing the room turnaround time leads to increased revenues as well as increased patient satisfaction. If a room is ready sooner, a waiting patient is required to spend less time in the emergency department or less time in stepping down from ICU, HDU. Objective: To increase patient satisfaction through timely discharge .Analysis of room clearance process and finding areas of delays. Methodology: The operational efficiency study is retrospective prospective analytical study .The study is based on primary data. Findings: The average room clearance turnaround time was 4 min 20 seconds in excess than the desirable 25 min standards. The discharges at 11 A.M were about 79% and planned discharges about 95%.Housekeeping taking more than required time in room clearance. Patient dissatisfaction was due to delay in discharge. Admission of patients delayed as room clearance not on time Recommendations: Consultant should inform about discharge one day prior and discharge summary should be made accordingly. Patients attendants must also be informed a day prior. Bills should be prepared in time. Proper guidance and training should be provided to the housekeeping and general staff.

Ab-5 Study on Factors Associated with Satisfaction and Motivation of the Class III & IV Employees in Government District Hospital, Kota

Aparna Jha Keywords: IUC, Incidence of VAP, Nosocomial Infection; Intensive Care Unit Background: The importance of human factor is very well realized by the corporate and other private organizations. On the other hand, the government organizations are still struggling with the problems of workers union, strikes, lockouts, unaccountability of the workers who consider their future secure after joining the government organization even if they do not perform. Human resources are considered important hence, this study was carried out to understand the problem faced by the employees, which dissatisfy them and degraded their efficiency. Objectives: To explore and compare the perceptions of the class III & IV employees working in the Government tertiary care hospital at Rajasthan with regard to the availability of motivators at their workplace and to suggest some interventions to improve the work environment in the hospital. Methodology: The methodology used to conduct this study was both quantitative and qualitative technique through personal interview, questionnaire consisting both open and close ended questions. The analysis was done using MS-excel and the findings were shown with the help of pie and bar charts. Findings: Findings revealed that all class III employees know about their job responsibilities. No formal orientation or induction programme was done when they join the organization. Majority responded that they have some valuable suggestions to improve the functioning of the hospital. The class IV employees neither get any kind of appreciation from the senior officers nor get any promotion in job which leads to lower satisfaction and motivation level in the employees. More than half of the nurse face problem in getting the adequate amount of supply of materials for efficient discharge of their duties. 25% staff was not working according to their post. A majority of employees doesnt wear their uniforms on duty. Recommendations: Job chart to be prepared for every worker including the daily wage employees. Manpower planning should be done for the proper allocation of the staff. Uniform policies should be formulated and strictly followed to ensure discipline. Discipline and punctuality should be improved and strictly observed. Good work should be appreciated not only in words but also in terms of remunerations or reward. Basic facilities like canteen, pure drinking

water, rest rooms should be provided to the staff. Feedbacks can be taken from the staff for nay scope of improvements in the functioning of the hospital.

Ab-6 Quality Assessment of Radiology Department

Archana Agarwal Keywords: Quality Assessment, Radiology Department, TQM Background: A focus on operational excellence in everything we do translate the focus on the quality of the service provided. Trying to improve something when the organization do not have a standard to measure against and improve a process without measuring the current status is like playing a game without knowing the score. Measurement and improvement of the processes are absolutely essential if operational excellence is required in the organization. Objective: The study was done to measure performance of radiology department across three perspectives viz. Customer/patient, internal business processes and learning and growth at a tertiary care private sector hospital in Mumbai. Methodology: Both qualitative and quantitative methods were used. Interview, Questionnaire and Checklists prepared to collect data. 55 patients were interviewed. The sampling for each investigation was done on random basis. 20 employee of radiology department were taken as per their designation. Findings: The overall satisfaction of both employees and patients was found to be 61%. Majority of Customer/Patient showed their dissatisfaction in relation to waiting time, Infrastructure- Perception, Access. Employees were mainly dissatisfied with the present performance appraisal system. As a result there was no motivation to improve their efficiency. TAT was higher than desired for X RAY. Wastage of films were found to be more in X RAY and Ultrasound Recommendation: Provision of LAN connectivity and other interunits in radiology department is found to be essential. Majority of Customer/Patient showed their dissatisfaction in relation to waiting time, Infrastructure- Perception, Access. Employees were mainly dissatisfied with the present performance appraisal system. As a result there was no motivation to improve their efficiencyProper scheduling of investigation especially in-patients is recommended. It is also essential to motivate staff by arranging training programmes etc.

Ab-7 Statistical Approach to Inventory Optimization with Focus on Medical Consumable Items
Arti Sharma Keywords: Inventory Control; Medical Consumable Items; Inventory Management Background: Cores of rupee are being spent every year for the purchase of around thousands of varieties of medical consumable items. As there is no formal inventory system in existence, it happens that high value slow moving items are stocked in larger quantity whereas fast moving less value items are stocked out. Objective: This project study is aimed to introducing an improved system of inventory control of medical consumable items used in Healthcare Industry (Hospital). To analyze the efficiency of Inventory Management as well as to classify the various components based on its value and movements. Methodology: The research design used in this project is analytical in nature. The data are collected from the annual reports maintained by the company and from the TP-Pospro Plus Software. ABC Analysis, FSN Analysis, HML Analysis were used as study tools. Findings: On the basis of unit cost involved, the various items were classified into ABC categories. Category A needs the most rigorous control, C requires minimum attention and B deserves less attention than a but more than C. According to data analyzed by FSN analysis techniques there are no non-moving items found and the company maintains low percentage in moving items, which is not a good result. It was also found that there was no selective control techniques like economic ordering quantity, reorder level etc. are available to monitor individually very often & to avoid stock outs. This is very laborious and cumbersome. Also this consumes valuable time of higher officials. Recommendations: Under ABC analysis, the management must have more control on A than B&C, because A class constitutes more (70%) of higher values. There should be tight control exercised on stock levels, to avoid deterioration. The company must not go to the Non-moving items as far as possible, because there will be unnecessary blocking of working capital. This would hinder the other activities of the organization. The company is required to maintain safety stock for its components in order to avoid stock-out conditions & help in continuous production flow. Items should be placed into the store based on their

consumption so that there would be no obsolescence and deterioration & that would also help in taking decisions on disposal of none and slow moving items.

Ab-8 A Comprehensive Study of Gap Analysis of Facility Management & Safety (FMS) as per Joint Commission International (JCI) Accreditation Standards
Bhushan Sarmandal Keywords: Gap Analysis, Facility Management, JCI, Accreditation Standards Objective: This study was designed to analyze the available facility of tertiary care hospital at, Ahemdabad to meet out JCI standards. Methodology: In this study available facility and safety practices of hospital compared against facility management and safety standards of JCI accreditation and scoring is being done as per guidelines to know about status. It is essential that hospital should analyze its facilities, before going for JCI accreditation. As the hospital was a NABH & NABL accredited, tertiary care referral hospital, and it is recognized as centre of excellence for providing medical care, education and research facilities of high order in the field of medical sciences Findings: An aggregate score of at least 7 for each chapter is required for achieving accreditation but this FMS chapter score obtained is 6.23. An aggregate score of 8.5 is required for each standard but actually it is below for all 11 FMS standard in this study. Recommendations: Therefore there is need to finalize the time limits to fulfil the non compliances and partial compliances especially utility system, biomedical equipment and fire safety related standards and then organisation should apply for JCI accreditation.

Ab-9 Quality Assurance in Biomedical Waste Management

Deep Makkar Keywords: Quality Assurance, Biomedical Waste, Waste Management Despite of statutory provision of biomedical waste management practice, Indian hospitals have still not achieved the desired standard

even after twelve years of enforcement of law Biomedical Waste (Management and Handling) Rules, 1998. Objective: The study was carried out in order to assess the management of bio medical waste in Primus Super Speciality Hospital and to carry out a Force Field analysis for the quality assurance in bio medical waste management. Methodology: The primary data was collected through observations and interviews of the staff in various departments. The path of the bio medical waste transport was also studied from the user site till the end. Target group was housekeeping staff. Findings: The awareness regarding bio medical waste management was found to be low and the identification of the cause was done which came out to be the lack of training among the staff. Force field analysis clearly depicted the positive and negative forces which led to the improper management of the bio medical waste. The positive force was that the housekeeping staff was not only practicing but also was having good knowledge of biomedical waste management. The negative force was lack of supervision and training towards housekeeping staff by their supervisor, which led to poor quality in practicing. Recommendation: After analysis of by the various forces, action plan/recommendations were given which needs to be implemented in order to manage the bio medical waste in the appropriate manner and to fulfill the statutory requirements as well. One of the major recommendations is the provision of training to staff regarding bio medical waste management and then evaluation of the training needs to be done to assess the future training needs. There should be regular rotation of the duty places so that everyone could well acquaint with all aspects of his/her job.

Objective: This study was done to monitor judicious use of restricted anti microbial agents in a health care organization and develop ways to improve policy practice compliance. Methodology: Retrospective and concurrent audit of restricted antibiotics usage and rationalization forms. Review of RAB usage survey/audit forms. Interaction, interviews and questionnaire with medical and paramedical professionals was conducted. Literature review and comparisons with international standards was also done. Findings: 255 RAm prescribed to 144 patients during March 2010. Of the 255 prescriptions documentation of justification for RAm usage is done for only 55 prescriptions which constitute only 21.5 %. No documentation of justification for addition of Ram prescriptions was found. Recommendation: Improvement in compliance policy needs revision & amendments and implementation of restrictive and educative methods with feedback should be made compulsory. Inclusion of RAm usage compliance as performance & quality Indicator should also be there.

Ab-11 A Study on Patient Satisfaction at Multi Super Specialized Hospital and Heart Institute, New Delhi
Divya Keywords: Patient Satisfaction, Multi Super Specialized Hospital, Quality of Health Care Background: A brief study of patient satisfaction was done at a 150 bedded multi super specialized health care centre which is accredited with ISO 9001: 2000 & 14001: 2004 certification for quality healthcare services and management. Methodology: A patient satisfaction questionnaire and a checklist for in-depth interviews with service providers were used as a study tools. In total of 100 inpatients were included in three departments of the hospital with highest patient inflow; medicine, gynecology and surgery. The aggregate scores of the questionnaire regarding patient satisfaction were calculated using MS Excel and SPSS version 12. Findings: It was found that only 32% of patients were satisfied from the reception services and only 18% from the billing department. The service providers agree that billing and reception were the major areas in the hospital that need improvements. While the score for

Ab-10 Study of Process Compliance for Rationalization of Usage of Restricted Antimicrobials in a Tertiary Care Hospital in India
Deepti Choudhari Keywords: Rationalizaition; Restricted Antimicrobials; Tertiary Care Hospital; Rationalizaition of Usage Background: Antibiotics are life saving drugs. Irresponsible and erratic use of these life-saving instruments has resulted in the development of drug resistance in many organisms .

interpersonal manner (86.3%) and communication (85.4%) were found well. The score for financial aspects was found low at only 61.6%. The study also gives some insight into the services available and suggestions for further improvement in the medical care services.

percentage compliance ranges in between 94% to 100%, few sensitive findings are noted during internal assessment e.g. narcotics storage. Recommendations: The corrective actions towards the list of Non compliances as well as unanswered questions to be taken by taking the non compliances and unanswered questions as training topics in the forthcoming training module & monitoring & evaluation of the training program.

Ab-12 Compliance Percentage Assessment and Comparison (Pre and Post) to NABH Standards for Capacity Building
Eesha Arora Keywords: NABH Standards, Capacity Building, NABH Accreditation Background: The study was done at tertiary care hospital in Mumbai with the aim to study the compliance percentage assessment & comparison (Pre & Post) to NABH Standards for capacity building. National Accreditation Board for Hospitals & Healthcare Providers (NABH) is a constituent board of Quality Council of India, set up to establish and operate accreditation programe for healthcare organizations. Research is beginning to show that good quality also offers practical benefits to family planning clients and programs. It was found that P.D Hinduja National Hospital & MRC, Mumbai got its NABH Accreditation in the year 2009 with an aim to assure the best outcome, build seamless service, create value & satisfy with personalized care. Objectives: The objectives were to assess the current compliance to NABH standards, compare the current observations with the previous study & to identify the training topics for capacity building of the staff. Methodology: The departments / areas were assessed based on the customized checklist prepared for each department. Based on the total number of checkpoints the compliance of the departments / areas is denoted in percentage. Findings: In general, the hospital staffs were well aware of the responsibilities and additional policies/practices included pertaining to their core work. However, some points do exist on which the staff needs to develop its knowledge and make them well versed with them. These points mainly include-the knowledge about the mission, vision and quality system (quality organization) being followed in the hospital, safety from the hazardous materials/chemicals being used, spill management procedures, cardiac emergency protocols and some of the HR policies. The analysis of the data shows that although the current

Ab-13 Rapid Assessment of a Model Initiative to Ensure Quality Family Planning Services in Uttarakhand
Esha Kalra Keywords: Family Planning Services, Uttarakhand, Quality of Care, Rapid Assessment Background: Quality of Care, more commonly called as QOC, is an integral part of the family planning services. A Project Model Initiative to Ensure Quality Family Planning Services in Uttarakhand has been initiated by Population Foundation of India (PFI-New Delhi) in collaboration with one of the hospital in Dehradun with a focus on increasing access and reach of Quality family planning services in the project area of Dehradun and Rishikesh. It aims to provide QOC through the existing health infrastructure viz. training centers and the government health facilities with which the partners have collaborated. Objective: The study was planned by the partner organizations to capture the quality indicators set by the project as the outcome objectives. Methodology: The study was done by assessing four health camps being organised under the project through observation of the facility and the client-provider interaction process with the help of a checklist. The client satisfaction was assessed through exit-interviews. To capture the QOC view from the sterilization facilities and to have a feedback from the providers, data was collected for these also. A qualitative analysis of the data from various collection methods have been used in this study. Findings: The study shows that the facilities are capable and ready to provide quality care. Few re-arrangements are needed at one of the camps like the judicious utilization of the free space in the facility to convert it into a separate reception and a waiting area. A separate area

for counseling in the camps will also lead to quality care. The introduction of a separate counselor under the project is seen as a blessing to the project. All the providers are found to have the required skills from the observational checklist. But few important components of are not properly taken care of. These are also indicated by the client exit interviews. The Urban Health Centre is seen as having the potential for being developed as a centre of excellence for maternal, child health and family planning services. Recommendations: The study suggests that bio waste-management and handling rules, a client feedback system, and regular up gradation of the knowledge and skills of the providers including updates on contraceptive advances can be added in the program to achieve high levels of QOC. It has tried to find out the gaps and the required solutions to fill those gaps. The mid-project corrections based on the study and the regular assessments in future will help in ensuring that quality family planning services are given in Uttarakhand. It will fulfill the hope that more people of the state will have Planned Parenthood. As a future scope of the study, the present study will be a part of the literature on Rapid Assessment of Quality in Family Planning services in India.

hospital administration and resident-hospital administration. Considering the sensitivity and the importance of the topic, the problem analysis was conducted in a very in-depth manner. Problem analysis was conducted in three phases Analysis of the PMS process in the hospital, workshop cum FGDs and survey. Findings: The study highlights many concerns which the employees have regarding the current PMS process. Current key result areas are not well defined for a particular position which leads to overlap. Lack of communication between superiors and subordinates was found. Record of critical events pertaining to officers were not made, which leads to improper review of performance. Recommendation: Proposed to shift to position-based KRAs this would help in setting of clear expectations in each superior-subordinate pair. Proposed a workshop methodology for goal setting. Proposed to create a mechanism to record critical incident pertaining to officers. People development activities are proposed to increase employee performance motivation and engagement levels. Also many changes are required to be incorporated in the existing PMS process to customize it to the specific organizational needs of the hospital.

Ab-14 Formulation and Implementation of Performance Management System in Tertiary Care Hospital
Gargi Agarwal Keywords: Performance Management, Performance Management System, Hospital Administration Background: The urgent need for the study arose in because of proposal from the senior management to implement the performance management system (PMS) in the hospital. The PMS process would be adapted and customized to the organizational needs of the hospital which would help in stabilizing the process once formulated. Objectives: To confirm the deeming application price, to develop a business planning framework at the hospital taken for study, expectation of management of all the employees. Methodology: It was a qualitative study formulated with the help of discussions with all the stakeholders of the PMS process that would be implemented in the hospital. The stakeholders include General Manager, representatives from doctors, human resources, Head-

Ab-15 Nosocomial Infection Management

Garima Singh Meel Keywords: Nosocomial Infection, Infection Management, Intensive Care Unit Background: The study was done to know the facilities available to control infection at Medical ICU. Objective: The main objectives was to study the physical facilities available for Infection control in intensive care unit (medical ICU) and also the existing infection control procedures used in the MICU. The study also identified the gaps for infection control and suggested measures to fill those gaps. Methodology: The research approach adopted for the study was a descriptive method. It includes collection of information regarding infection control procedures and its measures and also existing physical facilities available for infection control through questionnaires, studying relevant record maintained in MICU.

Findings: The physical facilities available for infection control in MICU are satisfactory but the infection control measures practiced in MICU is poor and needs improvements and up-gradation. When compared to the ISIS standards, the facilities available for infection control in MICU are satisfactory and meets . Result show that current physical facilities available for infection control are satisfactory but the existing infection control measures practiced in MICU are poor. Recommendation: Strict adherence to standard infection control procedures need to be given under consideration and existing infection control measures in MICU needs improvement and up-gradation.

Methodology: A total of 42 cases were taken in the study. 17 Unilateral Modified Radical Mastectomy (MRM) cases, 18 Amputation (single toe) cases and 7 Total Oesophagectomy cases operated between 1st November09 to 31 January10. Clinical information was retrospectively obtained from the OT database and medical records of the patients Findings: In addition to variation by patient co-morbidities and procedure, findings show that the patients hospital expenses vary with PSLOS, Bed Class, Surgeon and Insurance.

Ab-16 Influence of Post Surgical LOS, Surgeon, Insurance and Bed Class on Patients Hospital
Expenses for MRM, Amputation and Oesophagectomy Surgeries done in a quarter. Ginny Kaushal Keywords: Post Surgical LOS, Oespohagectomy Surgery, Hospital Expenses Background: The study discusses the pattern of influence of the factors on the patient bills and correlation using the Pearsons correlation coefficient. Controlling hospital costs is central to lowering overall health care costs. Fortunately, there are interventions that show promise in decreasing hospital costs without harming quality. Studies also show a significant amount of influence of Health Insurance on patients hospital expenditure. It is important to know the factors which are affecting the cost of healthcare and if possible then reduce the cost of healthcare by controlling the factors which affecting the patients hospital expenses. Patients hospital expenses i.e. the patient bills were studied in detail for three different types of surgeries namely MRM, Amputation and Oesophagectomy and a variation of more than 1SD from the mean was observed. The patient records were further studied to find details related to presence of co-morbid condition, increase post surgical length of stay (PSLOS), Surgeon, Insurance and Bed Class. Objective: To investigate the influence of Post Surgical LOS, Surgeon, Insurance and Bed Classon Patients Hospital Expenses for MRM, Amputation and Oesophagectomy Surgeries done in a quarter.

Ab-17 Measuring Operational Efficiency of 210 Beded Multi Super Specialty Hospital
Heena Kausar Keywords: 210 Bedded Hospital, Multi Super Specialty Hospital, Operational Efficiency Background: Health care is becoming transparent and customer focused. Patients and their relatives have the right to know the standard of care and its cost. It is therefore becoming more and more mandatory for the institution to monitor quality indicators/parameters and compare their performance level with the national standard or international bench marks. By monitoring operational efficiency and further providing feedback based on indicator data can be effective in changing health care professional practice. Objective: The objective of this report is to measure the operational efficiency of the hospital, as per set standards and to find out the gaps in input/process/outcome for enhancing the overall quality of system. Methodology: This operational efficiency study is retrospective prospective analytical study. The study is based on primary data. Findings: The main outcome of this study is that although hospital is following all the quality indicators still there is potential of improvement. For example in initial nursing assessment (within 30 minutes) of inpatients comparative trend is higher from Feb. to March i.e. 84% compliance to 92%. Initial assessment by consultant within 24 hrs there is initially only 62.7% cases received assessment within 24 hrs which increased to 85.7% later on. In needle stick injury indicated only one nurse suffered needle stick injury in the whole study period. Nurse

patient ratio is 1:4 which is sufficient for providing quality nursing care but in ICU it is not as per the standards which should be 1:1. The cases of redoes which was 1.96% in the month of January falls to 1.58% in Feb, which is an appreciable outcome but on the contrary the same has risen up in march to 1.66%, though still less than Jan redoes. Records without nursing care is also declining from Jan i.e. 25% to march i.e. 14.1%. Recommendations: Suggested to have regular meeting with staff, proper distribution of work between all the staff, negligence part should to be looked upon by continuous monitoring, only personnel with required qualification should be appointed, continuous training and proper communication for staff should be there. Clarity of authority & responsibility at all the level should be there to minimize gaps.

the organization. The hospital is already having a hospital information system (HIS) package that starts by the word 'i-care.' the HIS caters to the front office operations like appointment ,IP and OP billing, registration, pharmacy, examination, etc. However, back office operations like procurement, accounts payable, accounts receivables, TPA receivables and outstanding payments etc. could not be carried out through the HIS and documents related to these processes exist in independent files and folders on a shared documentation basis in the back office systems. The lack of automation for these processes and the 'disconnect' with HIS lead to delays in monthly stock reconciliation, financial status information, profitability analysis and cost center accounting. Recommendation: The need of the hour is streamlining of all the hospital activities related to the interaction with TPA vis preauthorization, query reply, approval status, claim settlement, TPA receivables and outstanding reconciliation. In this study , work is done mainly on time saving activities for getting the approval, enlightening the patients about their roles and responsibilities related to Cashless hospitalization and introduction of information system in order to improve the process of tracking financial data , its storage , retrieval and reconciliation..

Ab-18 Construction and Implementation of Information System for TPA Department

Indu Dhangar Keywords: TPA Department, Information System, Hospital Information System Objective: This project is envisaged to enhance the productivity and improvement in the operational efficiency of the functions routinely performed in TPA department and reducing the time lag for getting information to take key decisions. Methodology: Implementation of HIS was done in six phases and the method of data collection was observational and discussion with end users. Total expenditure on health in India is nearly 6% of the entire GDP. Indian health insurance industry stands at INR 5,125 crores with only a small section of the total population (around 2%) covered so far. CAGR of this sector is around 35% (FY 2002 08). This shows that the health insurance industry is one of the largest and fastest growing of all human activities. This huge growth has led to the development of a number of third party administrators to manage the client base. Currently there is 36 TPAs working for different insurance companies. Findings: CFS is in the panel of 31 TPAs and thus it can serve most of the insured patients. As the number of TPAs and PSUs that are in the panel of CFS is large, keeping a track of all the cases, payments and outstanding bills is very important to maintain the financial integrity of

Ab-19 Time Utilization of Operation Department

Jitendra Kumar Hayaran Keywords: Operation Department, Time Utilization, OT, NABH Standards Background: The study was conceived to assess the overall utilization of the OT and also the type of surgeries for which it is being utilized at Sola Hospital. The operation theatre complex of a hospital represents an area of considerable expenditure in a hospital budget and requires maximal utilization to ensure optimum cost-benefit. There is paucity of data in India on the use of available operating time and the reasons for less than optimal utilization have not been studied. In order to improve the utilization of operating room it is essential to know how much time is spent on each of the activities. Since Sola hospital has acquired pre accreditation certification from NABH, it has relatively become a centre of high activity.

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Objectives: The objective of the study deals with to assess the overall utilization of operation theaters in terms of hours to assess the extent to which different departments are utilizing the allocated hours and to identify the proportion of (unplanned or planned) of surgeries. Methodology: This study is a descriptive in nature. Data was collected from various sources. Findings: It was found that highest number of unplanned surgeries occurred in the department of orthopedics (48.57%) followed by general surgery (28.57%). In three months 689 hours were utilized for O.T. surgeries (Planned + Unplanned) & 511 hours were left unutilized. Orthopedic was identified as a department where highest no. of hours wasted for O.T. utilization was observed (216 hours un utilized in comparison to only 144 hours utilized in 3 months); followed by general surgery 189 hours unutilized in comparison to only 27 hours utilized in 3 months. Orthopedic was identified as a department where highest no. of hours wasted for O.T. utilization was observed (216 hours unutilized in comparison to only 144 hours utilized in 3 months); followed by general surgery 189 hours un utilized in comparison to only 27 hours utilized in 3 months. In General Hospital, utilization of theater shows that scope of operative services is wide but utilization in various specialty shows that the distribution is not appropriate. While for some specialties, the O.T. utilization is satisfactory, for others, it is far below the expected level.

and NABH guidelines; and suggests the ways to fulfill the gaps Findings: An internal assessment report is necessarily a document, which evolves as per circumstantial requirement of the organization and to know scope of activities required to meet standards to achieve NABH Accreditation status. It is necessary to review this report on regular basis. This assessment is important as it guides the organization to check the progress and success of the initiatives taken to fulfill these gaps. The hospital can further plan its proceedings within the time frame based on the analysis. Recommendations: Government of Gujarat is very keen on getting the NABH accreditation for district hospitals and medical colleges, so it becomes necessary for the hospital to review its status on regular basis. The hospital can focus on the areas where the gaps are more in importance or in number and move ahead for the achieving the accreditation status.

Ab-21 Benchmarking of Inventory and Stores Department at an Eye Hospital

Kanwalpreet Grewal Keywords: Inventory Department, Store Department, Inventory Control, Benchmarking Background: In hospitals, the supply chain is a key strategic activity to generate profits by optimum utilization of resources, efficient inventory control and cost containment models. Objective: The objective of the study was to assess whether the existing practices at the central store of the eye hospital at New Delhi, meets the standards and to find the scope of improvement. Discussion with the staff and the higher authorities led to a conclusion of need of standardizing processes at the centre. Methodology: The study design evaluates the primary and secondary data collected from the centre. The central store department was observed, had interview and informal talks with the department staff. Findings: The hospital had processes in place but was not standardized. There was a frequent problem of stock out and emergency requisition orders from the entire peripheral centre, this lead to imbalance in the stock in hand in the central store. This also led to frequent order

Ab-20 Internal Assessment of Hospital as per NABH Standards

Jyoti Ahuja Keywords: Operation Department, Time Utilization, OT, NABH Standards Objective: The study was done to identify the gaps present in the hospital to achieve NABH through the reference book of standards given by NABH. An analysis tool have been developed which carries the relevance of standard to the departments present in the hospital. Later on grading was done according to NABH guidelines. The gaps were communicated in the recommendations. This assessment focuses on finding the gaps present in manpower available, equipments, structural designs and statutory requirements as per the IPHS Standards

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placements. A set of safety stock for the hospital was calculated, by analyzing the secondary data of a quarter year of the purchase order master list maintained by the department. A sheet with the quantity of safety stock for every item stored in the central store was prepared. The safety stock is prepared both months wise as well as weekly. Recommendation: To counter the problem of standardization and stock outs, a policy as well as standard operating procedures for the hospital was prepared. The results of the calculation of safety stock were observed to be less in quantity; the reason was analyzed to be very less lead time. This was because vendors shared a good relation with the organization and gave timely delivery of the order. The standard operating procedures as well as the policy is turned into the stores manual, and serves as the guidelines for the staff as well and management for strategic decisions. The safety stock lead to the fall in stock out level, and there was a proper stock for emergency requisitions. It also saved the cost of logistics for small quantity of material

time is under/over producing by comparing take time with mean cycle time. Methodology: This is an analytical study and the area of study selected were -basic, comprehensive regular, comprehensive plus, special regular, special ultra and premium. The Data collection tool used was simple format consisting of in time and out time for each step of the health checkups used to collect data for time analysis. The sample size for the study was 100. (50 males and 50 females). Selection was based on the percentage of health checkups frequencies for the period January 2009-December 2009. The sampling method is stratified random sampling SIPOC, SWOT analysis, time analysis, vital defect analysis, report delivery analysis and take time analysis was used to analyze the data. Findings: The special ultra and basic packages found to have the maximum waiting time of 47 mins and the mean cycle time for basic and comprehensive regular packages are similar at 85 and 86 mins respectively (From Figure 4). However, their turn around time is 240 and 540 mins respectively. The only additions to basic are a surgeon/gynaecologist consultation and a second physician consultation 2 with reports. Special ultra, basic, premium female have the maximum Waiting time beyond stated end time at 47, 36 and 31 minutes respectively. Premium male and comprehensive plus packages also have a waiting time beyond stated end time, but to a lesser extent at 20 and 2 minutes respectively. Comprehensive regular and comprehensive plus have the least percentage of cycle time to turn around time ratio. This means these customers are idle for a larger proportion of time, 83% and 73% respectively, with respect to the other packages, which average 64%. The major defects in each of the packages are the consultation with doctors like the physician consultation (pre and post checkup), surgeon, gynecologist, ophthalmologist, ears-nose throat consultations. The non compliance of medical report turn around time is lowest for mammography and sonography at 40 and 74.42 percent. The mean cycle time is greater than takt time by 14,9.77,8.5,8.5,6.46 and 3.08 minutes for Ultrasound 14, Ophthalmology consultation, Ears Nose Throat consultation, pulmonary function test, Chest X-ray and ECG respectively. Recommendations: There are a number of changes that can be made, using the same resources available to reduce customer turn around time and thus accommodate more health checkups. Implementing these changes, will result in a decreased customer turn around time, and

Ab-22 Application of Lean Principles to Improve Operational Efficiency in Health Check-up Department
Karan P. Mansukhani Keywords: Health Check-Up Department, Operational Efficiency, Lean Principles, SWOT Analysis Background: A health checkup is a multi step process involving various tests/ investigations/ consultations, and is dependant on various departments for its completion. Lean principles are a set of tools which assist in diagnosing and rectifying bottlenecks. Thus, if implemented will increase operational efficiency of the department. This study was done to improve operational efficiency in the Health Checkup department, P.D. Hinduja Hospital and Medical Research Centre, Mumbai. Objectives: To map the health checkup customer, staff and information flow. To conduct SWOT analysis of the health check up department. To compare health checkup cycle time, Interval time, waiting time and turn around time for each package. To isolate the critical defects/delays of each health checkup package. To identify the medical reports those have a low compliance of complete and accurate reports for health checkup executive. To identify activities where mean activity cycle

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enable department to accommodate a larger number of health checkups. The recommendations that are an output of this study categorized in the following categories i) Reduce turn around time, ii) System, iii) Infrastructure, iv) Poka yoke/ mistake proofing.

Ab-24 PDCA Approach to Accreditation

Keywords: Health Care Delivery, NABH Standards, PDCA Kunal Jawahar Thakkar Background: In every organization, there is an opportunity to improve the quality and performance of the healthcare delivery. The problem frequently faced by organizations today is to know which quality approaches complemented by and integrated with existent quality improvement systems would have the greatest impact on the outcomes delivered by their healthcare providing systems. Objectives: This study done at super specialty hospital provides organizations with an opportunity to strategize accreditation processes with a time tested approach. The hospital was going towards achieving NABH accreditation, as a first step towards it, with the question that does the hospital fully compliant to NABH standards? and with the objective of bringing a basic quality approach towards accreditation, this study on PDCA approach to accreditation was done. Methodology & Findings: With scoring the hospital in comparison with standards as 0/5/10 and checking them as in which step of PDCA are the objective elements; it was found that the current status of operations at the hospital is about 70 percent compliant to NABH standards and out of 479 applicable objective elements, only 293 have completed their PDCA cycle of improvement. Percentage compliance and requisites for compliance to standards were found out for all the objective elements. Chapter HIC hospital infection control among the patient centric standards and chapter CQI continuous quality control among the organization centric standards were with the lowest scores. Recommendation: The study revealed areas that need special focus and all the requisites to achieve NABH accreditation. It was emphasized and proved that accreditation is not mere buzzword but an extraordinary tool for health care institutions to improve their services. Application of PDCA approach to Accreditation is the right way for hospitals to trudge the path of quality healthcare provisioning.

Ab-23 Inventory Classification of Medicines at Multi Speciality Hospital, Gurgaon

Komal Jeet Keywords: Inventory Classification, Inventory Control of Medicines, ABC Analysis, VED Analysis Background and The study were carried at a multi speciality hospital situated in Gurgaon. The Hospital pharmacy was five months old. The purchase department purchases the medicines as per the requirement. So, there is need to streamline the procurement by proper inventory control and to reduce the shortage and delay in supply. For purchase of drugs it is very essential to know the consumption of drugs on the basis of value and volume as well as criticality. This will help in bulk discounts as well help in getting supplies on time. Objectives: The main objective of the study was to categorize all the drugs available in pharmacy on value and volume basis as well criticality. This was done efficiently by doing inventory analysis of the pharmacy. Methodology: The organization wants the categorization of drugs on value and criticality bases, ABC-VED matrix was found appropriate method for the inventory control. Findings: The five month consumption of all the drugs was calculated after multiplying unit cost by consumption and resulting figures were arranged in descending order. The drugs then classified in to A B C categories according to total cost consumed 70 %, 20 %, and 10 %. For VED analysis, the entire drugs list was distributed to a panel of five medical personnel comprising physician, surgeon, anaesthetist, paediatrician and Head of Nursing Department. Recommendation: They were asked to classify the drugs into vital, essential and desirable. The drugs were categorised if more than 50 % members of panel concurred.The data was coupled into an ABC and VED matrix resulting in drug categorisation of Category I, II, and III.

Ab-25 Improving the operational efficiency by assessing quality indicators Meetu Garg Keywords: Quality Improvement, Employee Rights, Operational Efficiency

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Objective: The main objective of this study was to identify area of improvement and develop recommendation in coordination with organization for strengthening and improving the quality of system. Methodology: Both primary and secondary data was collected for the study. For this purpose patient records audited, exit interviews of staff(HR) was done, employee (HR)and inpatient feedback forms were filled up. Findings: The number of patients receiving initial assessment was 20% in January which was risen upto 48% in March. In January the number of patients receiving intitial assessment by doctors in one hour was 12% which was risen upto 36% in March. Initial assessment by the dietician hiked to 40% in march regular status of the patient to be discharged was also informed to the dietician. Hike in the percentage of operations in month of March which was 34 out of 145 in total compared to 15 out of 104 in jan and 15 out of 123 in feb. Recommendation: It is recommended that proper inventory levels to be maintained as per requirement. Regular awareness programmes should be started for information related to employee rights and responsibility.

hospitals and 40% of hospital beds in the country are in the private sector. The healthcare industry faces a lot of challenges in todays world, competition everywhere has ot left the hospitals untouched. The hospitals strive for excellence and deliver their best to be at the top. Thats where a BPR comes into the picture. Bpr revamps he process and gives the process a new face which if not the best is the ideal in the induatry with best practices an maximum patient friendly. When hospitals put in the money the return on investments is a natural phenomena and thats wht the hospitals are expecting, a bpr should give the hospital processes a boostup and help it come to a place where the patients are benefitted the maximum and the working takes minimum time with maximum efficiency.

Ab-27 Gap Analysis of General Hospital as per NABH Norms in a General Hospital, Gujarat
Namrata Keywords: Gap Analysis, NABH Norms, NABH Accreditation, General Hospital Objective: The gap analysis of the General Hospital as per NABH norms was done to assess the existing status of the hospital and prepare it for NABH accreditation. As Government of Gujarat is very keen on getting the NABH accreditation for district hospitals and medical colleges, so it becomes necessary for the hospital to review its status on regular basis. The hospital can focus on the areas where the gaps are more in importance or in number and move ahead for the achieving the accreditation status. Methodology: The gap analysis was done with the help of NABH Self Assessment Toolkit which comprised of 10 chapters, 100 standards and 514 objective elements. For getting the required data the various activities in the hospital were observed, policy manuals and records were referred and patients and hospital staff were interviewed. According to the toolkit the documentation and implementation of each objective element was checked and scores were given according to NABH guidelines. Findings: The study shows the findings of the existing status of the hospital according to each chapter and average scores for all the

Ab-26 Business Process Re-engineering of Admission, Discharge and Transfer in a Tertiary Care Hospital
Megha Ahuja Keywords: Healthcare Infrastructure, Re-engineering of Admission, Discharge Indias healthcare infrastructure has not kept pace with the economys growth. The physical infrastructure is woefully inadequate to meet todays healthcare demands, much less tomorrows. While India has several centres of excellence in healthcare delivery, these facilities are limited in their ability to drive healthcare standards because of the poor condition of the infrastructure in the vast majority of the country. The total healthcare financing by the public sector is dwarfed by private sector spending. In 2003, fee-charging private companies accounted for 82% of Indias $30.5 billion expenditure on healthcare. This is an extremely high proportion by international standards. Private firms are now thought to provide about 60% of all outpatient care in India and as much as 40% of all in-patient care. It is estimated that nearly 70% of all

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standards and chapters. These were checked against the evaluation criteria for accreditation. The study focuses on the gaps according to the evaluation criteria for accreditation and suggests ways to fulfill the gaps. The analysis shows that there are some gaps in the hospital as per NABH norms. Mainly the gaps were in the chapters of management of medication, quality management and information management system. The hospital fulfills the required criteria partially and requires great efforts and focus on the weak points so as to cover the gaps and to be prepared for getting NABH accreditation.

respectively in accessibility and safety and high quality coordinated care .Orthopedic ward scored highest (77% of the patient fully satisfied )in building relationship whereas in area of cleanliness, security and nutrition all four ward showed high dissatisfaction .Patient dissatisfaction was mostly due to .1)security service.2) accuracy of diagnostic and imaging facility of the hospital .3) unhygienic condition in the ward.4) summer temperature of the wards were rising high specially surgical and orthopedics ward.5)drinking water facility.6) privacy during stay and treatment in female wards patients. Recommendation: Portable X ray machine in orthopedics ward.24hrs pharmacy for IPD .Medication and treatment should be fully explained to patients. In maternity ward privacy should be maintain for the female. Appropriate airing should be done in wards. Frequent Mopping & periodic washing of hospital Wards specially Surgical & Maternity Ward. Periodic Medical Examination of cook's & Food handlers & Surveillances. A grievance letter box/register should be made available for the patients.

Ab-28 Patient Satisfaction with Quality of Care: A Comparative Study of Indoor Patients in Different Wards
Nancy Gupta Keywords: Patient Satisfaction, Quality of Care, Indore Patients Background: Many hospitals use lengthy surveys collected when the patients discharge to better understand the quality of their own care. The response rates for these surveys are generally good compared with many other types of surveys. Understanding the implications of the survey data can lead to new strategies that increase demand for services in part by reducing inappropriate instances when patients leave the system. The aim of the study is to compare the satisfaction level of patients admitted in surgical ward, medical ward, orthopedics ward and gynec ward at tertiary care general hospital of Gujarat: Objective: The study is to provide a systematic and visible way to lead and operate an organization working to improve performance by patient feedback. Secondly was to measure the satisfaction level of the patient getting treatment from the hospital and to work effectively on the quality improvement procedure. Methodology: The methodology which is used in study is cross sectional and observational. Close ended questionnaire is used as a tool for data collection and findings are elucidated with the help of graphical representation. Findings: Satisfaction level of the patients was highest in maternity ward and least in surgical ward. Most of the patients were satisfied with the Accessibility of the services and waiting time for registration. Maternity ward scored highest that is 65% and 69% full satisfaction

Ab-29 Assessment of Adherence to Protocol in Medical Record Documentation in accordance with NABH Guidelines
Natasha Ahmad Keywords: Medical Record, NABH Guidelines, Audit Manual Objective: The main objective of this study was to study medical record department of the hospital, to audit manual according to the NABH standards and to highlight major observations to recommend implementable solutions. Methodology: To enumerate various types of forms in use in ward areas, OPD, different clinical department and laboratories a survey was done using Checklist keeping in mind the various quality standards, checklist was prepared and filled by the data gathered, Interviewing the doctors and nursing staff and the direct observation of the functioning of various departments. 130 records were audited for the purpose of assessing medical records for proper documentation. Medical Records of 15 specialties were taken for the purpose of audit. Out of the 347 in patients records 130 were picked up (38%). Data analyzed using Microsoft excel.

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Findings: It was found that many medical records were not sufficiently well documented to provide adequate evidence of continuity of care. It was found that in the 4 various parameters assigned Admission request form, Doctors initial evaluation form, condition of the discharge time mentioned and birth certificate matter comes into the poor segment, whereas Elements in medical records and patients daily progress comes into the excellent parameter. Recommendation: The study needs further exploration as to identify the gaps in process flow department wise. For the same reasons the forms should be redesigned and redundant columns should be done away with. MR contents for discharged patients should be arranged prior to filing. And qualitative analysis of MR contents should be done a regular basis to monitor completeness of information. It is recommended that entries be recorded as closely as possible to the time of the encounter, when the detail is most fresh in the physicians mind. This will allow physicians to deep records that are detailed, accurate and comprehensive.

excellent ratings in terms of the facilitator and the training given showing that the trainers had excellent communication skills, they explained the subject very well, answered questions to the trainees satisfaction, provided summary of the major points. The trainees have given the training sessions a higher priority revealing the fact that they are enthusiastic to learn and update their knowledge. Overall a positive feedback has been received for the training sessions conducted for the nursing staff. Recommendations: More practice sessions have to be organized for the HIS (Hospital Information system) Trainees. The training environment needs to be improved making it comfortable for the trainees to concentrate and learn. Time duration of the session has to be increased and the pace at which the trainer delivers should be decreased. Demonstration and orientation through videos and pictures can be included for making the trainings more interesting to learn.

Ab-31 Study on Community Perception about a District Hospital in Relation to IPHS Norms Ab-30 Implementation of Performance Appraisal System in a Tertiary Care Hospital
Neha Agarwal Keywords: Performance Appraisal, Gap Analysis, NABH Standards, Appraisal System Objective: the main objective was to include the Gap analysis of the HR department in a tertiary care hospital in accordance with the NABH Sstandards, performance appraisal of the nursing staff and feedback analysis of the trainings done with adequate statistical evidence. Methodology: This descriptive study was carried out using NABH check list to do the Gap Analysis of the HR department and a feedback questionnaire was used to do the feedback analysis Findings: Only two training sessions out of the nine which were conducted got good towards excellence ratings in the course content and the training environment while the other training sessions were rated average on same parameter. This implies that the course content was not stimulating enough to develop the interest of the trainees; also the temperature of the room was high making it difficult for the trainees to concentrate. About 90% of the training sessions have got good and Neha Awasthi Keywords: Community Perception, District Health, IPHS Norms, NRHM Background: A concern for patient satisfaction has been taken up by many health care authorities worldwide with the aim of responding to the clients needs when addressing the issue of quality improvements in public health care services. Standards are developed with intentions of assuring quality services. Therefore, National Rural Health Mission has provided the opportunity to set IPHS for various health institutions. Objective: This study (dissertation) was designed to examine how the consumers of services of secondary health care at District hospital, at Jodhpur viewed their health-seeking experience, and this was correlated with organizational aspects as well as the community perceptions of the same. This study sought to understand community perception; assess clients satisfaction and the facility survey against IPHS norms. Methedology: This is a descriptive study, conducted during 19 February, 2010 to 5 May, 2010. Methods of data collection employed were schedules and collection through observation and by conducting interviews. Study was conducted undertaken at the hospital and

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includes an area covered by four anganwadi centres. Findings: In this area 80 percent of women who rely upon public health sector for the child birth do not come to the hospital, 48 percent of women do not know about the location of this hospital. Most women who attended the hospital for came because trusted an employee who was a relative and not because of the services of the hospital. Half of the clients rated the hospital good,( 3 in scale of 1 to 5, where 1 is poor and 5 is excellent), 59 percent clients said that they visit this hospital for mall ailments and two third (67 Percent) accepted that they would not like to get admit in the hospital. Overall Hospital only complies with 17 percent of the IPHS norms. This data analysis depicts the discrepancy between expectation of services from hospital and actual delivery of services. Recommendation: To improve the facility as per community perception and IPHS norms it was recommended that a government organization cannot develop at facility level itself. There several areas where State and district level interventions are required.

both secondary and primary data. After finding a significant demand the methodology for the referral and satellite centers was formulated by visiting different Delhi government hospitals and getting information of services provided there. Private centers dialysis prices and volumes were found and thereby provision to charge nominal fee was designed so that maximum people can afford the services. This project helped to understand patient behavior by primaries with various doctors. Findings: It was found that here are only 500 machines in Delhi with only 24 in government setup. If machines in centrally funded hospitals and centres operated by quasi-government organisations also include then also it accounts for only 60-70 machines. This means only the high income category can afford treatment in private centres while a large section of the middle and low income population does not have the access to avail dialysis services. Thus there is a gap of around 600 machines facilities should be provided at least for sec A, B and C population strata for which around 750 900 machines are required. Thereby in the 1st phase government should look at the provision of around 250 more machines. 25 government hospitals were visited and were segmented based on presence of critical care and dialysis facility. Based on this segmentation 13 19 hospitals were identified where machines can be placed and also 3 clusters were formed to address the issue of transportation which is significant for a dialysis patient as he has to come 3 times a week for dialysis sessions. 3 4 hospitals were identified in each cluster out of which one or two can be developed as referral centres and in the rest of centres relatively fewer machines can be placed. Recommendation: It is recommended that there is need for setting up more machines in Delhi and the government should look at the provision of 250 to 300 additional dialysis beds to augment existing supply of services.

Ab-32 Need and Location Identification of Dialysis Units in Delhi Under PPP Framework Neha Garg Keywords: Dialysis Unit, PPP Framework, Dialysis Patients Background: Delhi is the healthcare hub for a geographically large and populated catchment area comprising of J&K, Punjab, Haryana, UP, Bihar, MP and Rajasthan. Given the states current population it is estimated that 3,000 patients are diagnosed with ESRD every year. Also the expenditure of a dialysis patient in private facilities is significantly high i.e Rs.20000 per month and there is inadequate facility in government centres. Thereby this issue need to be addressed and PPP framework has been found the most suitable option for the same. Objective: The aim of the study was to assess the need and location identification for setting up of dialysis units in Delhi under PPP framework. The study was both quantitative and qualitative for finding the number and location of dialysis units. The data was collected through primary interactions with doctors, suppliers and government hospitals. Methodology: Primary data collection was done through detailed questionnaire. Hence the demand supply study was done by collecting

Ab-33 Study on Patient Care Quality Standards at General Hospital, Rajkot

Nehashree Keywords: Patient Care, Quality Standards, General Hospital, TQM, NABH Standards Background: The state of Gujarat has been regarded as one of the best

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performing state in India on various economic and health parameters. However, Gujarat health care system faced lack of adequate standards in public health services. With the effort to improve the quality of healthcare delivery, the GoG adopted Total Quality Management (TQM) system in 2007 to strengthen medical institutions as per NABH and NABL standards in three phases. General Hospital in District Rajkot was covered under the third phase of NABH implementation. Objective: The present study is aimed to assess the health care service delivery the hospital against patient centric standards of NABH. The study assessed the current level of performance as per standards, identified the gaps and proposed recommendations. Few of the recommendations were implemented in the hospital under quality improvement programs. Methodology: The study was conducted in General Hospital, Rajkot. All the staffs from the clinical departments, wards were questioned about the standards. The staff from support services like laboratory and radiology and utility services like house-keeping were also involved. The assessment of the hospital was conducted by using the selfassessment toolkit provided on NABH website. The toolkit was modified according to the study requirement. To fill the toolkit, the data was collected through primary as well as secondary sources. Findings: The study showed that the hospital scored well on standards related to management of medication and was poorly compliant to standards for hospital infection control. Out of the total applicable objective elements hospital compliance was 43.9 percent, partial compliance was 20.8 percent and non-compliance was 35.3 percent. Overall the hospital was found to be 56.4 percent compliant to NABH patient centric standards. As per the results, quality improvement programs were initiated like signage system, training regarding basic life support, biomedical waste management, proposing hospital committees, hand washing practices, vaccination to employees etc. Recommendation: Any journey starts with a single step and Quality Improvement Programs (QIPs) for these vital areas was the first step taken towards the journey of quality improvement in patient care services and achieving NABH accreditation.

Background: Community Care Centers (CCC) are the focal points to provide short term institutional care to PLHA and Nurses play a central role in delivering the care to PLHIV at CCC. Since the inception of CCC is rather new and India, being the first of its kind to provide this niche level of service in the service providers domain, it is essential to understand the provision of care and support from the service providers perspective. Objective: The present study is an attempt to understand the Nurses roles and perspectives, their responsibilities, their job satisfaction and problems they face while working at CCC. Methodology: In the CCC assessment, a sampling frame of all the CCCs was prepared and out of 270 functional CCCs, 199 CCCs which have been functioning for at least one year as on November 30, 2008 were included in the study. From each selected CCCs, the nurse with maximum working experience was included in the study sample. A total of 199 Nurses working in CCC across the India were interviewed using semi-structured questionnaire. The data was analyzed using SPSS 16. Findings: The results highlighted that the nurses were aware of their roles and responsibilities and were also performing the same. To effectively meet the needs of those living with the infection, nurses have assumed multiple responsibilities in HIV care and treatment in the resource restricted environment of CCC. They mentioned lack of adequate infrastructure, lack of human resources and lack of proper training as the main problems because of which they were not able to give their best. Study recommends that the weak areas like Shortage of manpower, staff training and infrastructure require attention not only to achieve the targets quantitatively but also to improve the services qualitatively.

Ab-35 Bridging the Gaps in the HIC Chapter of NABH E n h a n c i n g t h e P re p a re d n e s s f o r N A B H Accreditation

Payal Ahuja Keywords: NABH Accreditation, OPD Waiting Time, HIC Chapter

Ab-34 Study on Roles and Perspective of Nurses in CCC in India

Nisha Kadyan Keywords: Role of Nurses, Community Care Centers

Objective: The study was to monitor the OPD Waiting Time so as to know the patient flow in the hospital and to monitor the time from the Registration to the consultation. Also this project was a major help in data collection of monitoring for the NABH as this organization has

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already applied for NABH Pre Assessment. This project help in monitoring the patient flow in the hospital as well as bringing out the flaws in the process. Methodology: The project was done in all the 11 OPDs. Total 20 patients were monitored and time lapse between the times of registration till the time of consultation was seen and the causes of deviations were observed in various OPDs. OPD waiting time analysis is a comparative qualitative and observational study. The checklist were filled in person targeting the high risk areas of the hospital and the inpatient areas in which all the metrics of hand washing, needle stick injury, biomedical waste management, linen management, surgical site infection were covered. Findings: Result of the above analysis suggested that only 50 % standards of HIC of NABH were fully complied. Rest 50% of the work is needed to be done in the other areas of the hospital. It was seen that the compliance rate for the HIC chapter was relatively low than other chapters of the NABH. Recommendations : Recommendations were suggested and report was submitted to the Chapter Head for the improvement. Major learning was understanding of the standards their scoring and implementation in an organization.

The main aim of carrying out this research is to check the compliance of laboratory services with NABL standards, so that a comprehensive quality management system can be established. Methodology: An observational and descriptive study was carried out for a period of three months to explore the topic with the help of both primary and secondary data. Findings: The study revealed many interesting facts like the shortage of manpower, poor conditions of the equipments, need for calibration, AMC/CMC, lack of inter departmental and intradepartmental coordination, faulty government policies regarding procurement and maintenance of equipments, poor infrastructure and need of SOP formulation. Recommendations: Based on findings and address the objectives of the study recommendations were made. It can be summarized that this report proved to be a helpful tool in analyzing the gaps in the laboratory service delivery. The results of the report will be useful in establishing a well implemented and monitored quality management system that generates services with elements of both patient safety and employee safety. This will help in making the laboratory services error free and on time.

Ab-36 Assessment of Laboratory Services, at General Hospital, Palanpur against N.A.B.L. Standards
Pooja Aggarwal Keywords: Laboratory Services, General Hospital, Facility Management, NABH Standards Background: A laboratory is a facility that supports patient care by providing diagnostic & management information to the care giver. Its ultimate goal is to provide accurate & timely results for diagnosis, treatment & monitoring of ailing patients. Because of the increased dependence of clinical services on the diagnostic procedures, a large number of laboratories have started going for national and international accreditations. Objective: This report presents a research on the assessment of the laboratory services, at general hospital, Palanpur, against the national accreditation board for calibration and testing laboratories standards.

Ab-37 Gap Analysis for Phase II Expansion in tertiary care hospital at Rajkot
Prabhat Govindan Keywords: Gap Analysis, Tertiary Care Hospital, Hospital Planning; Equipment Planning Background: Proper planning is a key ingredient in starting a new project as well as ramping up services and facility from one phase to another. This study was conducted to analyze the gap in terms of two key essential ingredients are manpower, and medical equipments. Objective: The general objective of this study was to assess the gap that exists and need to be fulfilled in terms of manpower and equipments, in order to ramp up form stage 1 to stage 2 of the hospital services. Specific objectives include equipment planning, manpower planning and setting up timelines for completion of the ramp up. Methodology: This was analyzed through a gap analysis done by mapping the existing equipments available and establishing the actual

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requirement as per the standard ratios used by the equipment planners. Findings: It was seen that there is a major requirement in the form of syringe pumps, around sixty is required and patient monitors, twenty, ten ventilators and five each of defibrillators, pulse oxymeters and ECG machines. These are the basic equipments which are required to operationalize and admit patients in ward and ICU. In case of equipments, it was also found that additional equipments in the form of Patient monitors, ventilators, pulse oxymeters, defibrillators, syringe pumps, ECG machine need to be accounted for. In case of manpower it was seen that an additional number of specialists, doctors and nurses will be required to be recruited in order to push off the Phase II plans. Along with it the timelines for acquiring the additional task force and equipments were worked and displayed in the form of Gantt Charts, with task numbered in the order of priority. Recommendations: It was seen that the recruitment process, can be completed in about four to six weeks, and the equipment purchase process will take about 8 weeks, hence once can start rolling the beds in two months or eight weeks time.

understand the KAP of the staff involved in direct patient care facility regarding the biomedical waste management practices.110 questionnaire were distributed out of which 89 were received back. Findings: The study has shown a definite apathy of intellectuals towards the operational aspects of the system. The medical professionals have tubular vision on patient care services and pay very little heed to support services in the overall context of comprehensive patient welfare. Doctors are high on attitude and understanding of the system with sound knowledge but need to improve on their practice habits. OT staff and technicians also have understanding of the subject but more attitudes to be developed in these functionaries. Practice habits of nurses have large scope to improve. Sanitary staff is a matter of concern as they have very low understanding of the subject and resulting in poor practice habits. Recommendations: In the field of medical practice statutory public health guidelines for BMWM and close monitoring of its compliance alone cannot achieve the ultimate goal, if it is not accompanied with social science approach of mass education, motivation, training and changes of mind set in all strata of medical practice. Thus a comprehensive training module for all the functionaries is formulated to get good results and improve the situation.

Ab-38 Knowledge Attitude Practice (KAP) Among the Staff Regarding Biomedical Waste Management at Government Hospital, Jaipur
Priyanka Maan Keywords: Knowledge Attitude Practice, KAP, Biomedical Waste, Waste Management Background: Despite the statutory provision of biomedical waste management, practice in Indian Hospitals has not achieved the desired standard even after so many years of enforcement of the law. In view of this, the present study on Knowledge, Attitude and Practice (KAP) on the subject was carried out in. Govt. Hospital, Jaipur The hospital under scrutiny for KAP is a 100 bedded hospital with all general specialties. The hospital has a work force of 30 doctors, 80 nursing, support and paramedical staff. Objective: The objective of this study is to assess the knowledge, attitude and practice among the staff members by classifying them into categories of doctors, nurses, OT staff, technicians and sanitary workers. Methodology: The study is based on a questionnaire designed to

Ab-39 A Study on the Bio-Medical Waste Management

Priyanka Sharma Keywords: Biomedical Waste, Waste Management, BMW Handling Rules Background: The Bio-medical Waste (Management & Handling) Rules, 1998 were notified under the Environment Protection Act, 1986 by the Ministry of Environment and Forest, Govt. of India on 20th July 1998. The rule regulates the disposal of biomedical wastes and lays down the procedures for collection, treatment and disposal and standards to be complied with. Objective: The main objective of the study was to understand the process followed in managing the bio-medical waste against the BMW Management and Handling Rules (1998) of Government of India in tertiary care hospital. Apart from studying the Bio- Medical Waste Management Process, the project also tried to assess the level of awareness about the BMWM, among the hospital staff and bottle necks

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while managing BMW. Methodology: The study was of a descriptive type and was based on the observations made in the hospital, checklist provided by NRHM, and bio-medical records in the hospital. Awareness among the staff was assessed using a questionnaire. The checklist and the observations were filled during the visits to the departments in the hospital. Findings: The required resources for the BMWM were present in the Hospital. However, it was observed that the protective gears were not properly used by the staff. The process of segregating the waste was not appropriate in many deopartments in spite of the awareness among the staff on Bio-medical Waste Management, as they were trained. The waste collection bags were not closed properly due to unavailability of means. Recommendations: Based on the results it was recommended that it should be made mandatory for the staff to wear the protective gears while handling waste. The supplies for the waste collection bags should be changed with new specifications so that they can be closed properly before being disposed off. The Ward In- charge should check periodically to ensure that proper segregation takes place. Staff should be encouraged to put into practice their knowledge about BMWM.

to be ZERO in scoring. Therefore new policies & procedures were formulated and implemented and then reassessed. Data was collected by one to one discussion with the staff from the MRD, nursing, and few consultants & previous record and observation primarily and NABH manual of other hospital, literature on internet secondarily Findings: The retrieval of a file in MRD was found to be 22 minutes and this by following the new policy decreased upto 11%. The completeness of the medical records is very important because as also it reflects the standard for IMS in continuity of care as per the guideline of NABH, but this was found to be in very poor shape i.e. only 18% files were found to be completed by the nursing staff. Similarly even the doctors (mainly the consultants under which the patients was admitted) showed a very poor data as only 28% files were found to be complete (i.e. 72% incomplete in terms of doctors sign & stamp, daily notes and updates in the treatment). This data after following the new policy went upto 78% in the nursing staff and only 68% by the doctors for the completion of the records. The medical records must reach the department after 1 day of the discharge but only 16% of the files reached around 84% reached the department in around 48 hours. This data increased from 16 % to 78% after the new policy. Recommendations: As for the scope of study in future, it can be used as a literature on benchmarking of medical records & thus be received as in similar research studies. The major limitation that existed was majorly of the shortage of the qualified & skilled staff as the entire MRD of a 200 bedded hospital was handled by only 2 people out of which one was not at all qualified.

Ab-40 Benchmarking Medical Records Department in Accordance with NABH Standards

Priyanka Singh Keywords: Medical Records Department, NABH Standards Background: The medical record section of a hospital serves as a basis for planning patient care, documenting communication between the health care provider and any other health professional contributing to the patient's care, assisting in protecting the legal interest of the patient and the health care providers responsible for the patient's care, and documenting the care and services provided to the patient Objective: This study analysis the current situation and quality of medical records before the pre-assessment of the organization. The purpose of the study was to find whether the organization was ready for the upcoming accreditation and if not then assess the gap and fill them. Methodology: The standards of the IMS were assessed in a self assessment toolkit whereby most of the objective elements were found

Ab-41 Gap Analysis of District Hospital in Conformance to NABH Standards

Priyanka Vashishta Keywords: Gap Analysis, District Hospital, NABH Standards Background: A gap analysis report is necessarily a document, which evolves as per circumstantial requirements of the client organization and to know scope of activities required to meet standards to achieve project goal i.e. National Accreditation Board of Hospital and health care (NABH) accreditation status. The board is structured to cater to much desired needs of the consumers and to set benchmarks for progress of health. Objectives: The objectives of the present study were to study the

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different procedures at District Hospital for assurance and conformance with the standards as laid by NABH and to identify the gap between the NABH laid down practices and prevalent practices at hospital. Methodology: Sources of data were both primary data (personal interviews, observations.) and secondary data.(literatures, reports, registers and records.) Findings: The findings of the study shows that out of the total 514 objective elements,307 ( 60%) are in non compliance,149 (29%) are in partial compliance and 58 (11%) are on compliance to N.A.B.H standards. Gap analysis is the initial and one of the most critical exercises of the entire process. It helps us to revisit existing system with an eye to finding facts not faults. Recommendations: The analysis that has been conducted has divulged various quality related issues in clinical and non clinical departments. It will take a long time to close the existing non compliances. To close these non compliances the hospital has to bear a huge financial implication in terms of infrastructure, manpower equipments & other resources.

Records, identifying needs, problems and suggesting implementable solutions, 5. To highlight major observations, 6. To recommend implementable solutions. Methodology: Stratified random selection of MRs to assess their contents and the no. of records depends upon the no. of records available the medical record department, selection of a respondent (doctors & MR persons) and department visit to understand their record flow process, records of patient admitted, records of patient getting operated in hospital and consulting doctors was selected as tool. Survey, Interview direct observation method was done to collect data. Documents (MR files and forms, policies, procedures), HIS Hospital and MR department persons & doctors were the data sources. Findings: The study found that medical record department follows the one-unit numbering and filing system (i.e. the patient has one MR for outpatient visits, admission, and emergency). Filing systems are standardized. There is cabinets and shelving system of record keeping. Percentage of compliance of one unit numbering system ranges from 95% to 100% in the hospital.

Ab-42 Medical Record Auditing at Delhi

Rashmi Chaudhary Keywords: Medical Record, Record Auditing, Electronic Medical Record System Background: Medical record serves as a means of doctors self assessment.Medical records provide pertinent patient care information to authorized organizations.The records are important to the public health authorities as they contain reliable information regarding morbidity and mortality patterns,Medical Records provide patient care information to third party payers.Medical Records protects the patient, physician, as well as the health care institution and its employees in the event of litigation. Objective: 1.To study medical record department of the Hospital and suggesting best practices 2.To understand process flow of medical records in different departments 3. To audit manual medical records, 4. To study electronic medical record system in the hospital and Manual

Ab-43 Study of Time Utilization of Operation Theatre at General Hospital, Junagadh

Richa Daftray Keywords: Time Utilization, Operation Theatre, General Hospital Background: The operation time utilization varies in different healthcare settings. Optimum utilization of the OT time has always been a priority area for hospital administrators. Operation room utilization analysis is essential to assess the existing workload as well as to optimize facility functioning and patient scheduling for surgical operations. It also aids in allocating reserve time for emergency operations, asepsis measures and procedures, and provides decision making information for augmentation or downsizing of the facility. The study of Time utilization of operation theatre was carried out in all the operation theatres which carried out major surgeries at general hospital at Junagadh. Objective: The project includes study conducted on 3 parameters time spent on actual surgery, time spent on supportive services and time waiting while operating room was being made ready for surgery.

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Methodology: Simple random sampling method used taking a sample size of 35 % of total major surgeries. (130 out of 347 cases were taken which includes 40 general surgeries, 40 orthopedic surgeries, 40 G&O surgeries, 10 ENT surgeries). The format was based on specific questions, asked to Anesthetists, staff nurse and housekeeping staff of OT regarding times at which various activities and events was taking place in operating room was recorded. Data sources include primary, secondary data, observation and interview method. Findings: Workload at operation theatres in Junagadh is high and no proper scheduling of the operative cases has been noted and there were no activity wise checklist found and filled during surgery so, it is essential to know how much time is spent on which activity. The total bed Strength of hospital is 510. The surgical beds utilizing Main OT is 120. No. of Operation Theatres is 5, the total no. of major operations performed/year is 5000(apprx.). Out of the utilized time, time spent on actual surgery was found to be 88 min., time spent on supportive services was found to be 16 min. and time spent on making room ready was found to be 4 min. Orthopedic department and O & G department dealt with the highest work load out of the total inpatient department and surgery cases, so these two operation theatres requires more attention in the sense of new implementations. Recommendations: Utilization of theatre can be increased by anaesthetizing the patient in anesthesia room instead of operating room and by lying of sterile trolleys in lay-up room instead of operating room, by avoiding delayed starts, avoiding cancellation of cases, proper scheduling of surgeries.

Objective: The attempt of the study was made to determine the awareness about biomedical waste management policy, practices and to assess attitude towards it. Methodology: The sample size of the present study is 80. The technique of sampling is purposive sampling. The methodologies used in the study are mainly tools of questionnaire, interview and non participatory observation of the practices of the staffs. Questionnaire was prepared for the three groups of people i.e. Doctors, paramedical (including nurses, technicians etc) and housekeeping staffs. The data was coded on MS Excel and the same was analyzed. Findings: The findings showed that 82% of the wastes generated were non infectious and 18% were hazardous. Handling of those 18% was so much difficult that is causes major Hazard. The study finding revealed that on an average 124.8kg of the total waste was generated everyday and 32.9 kg of biomedical waste was generated. Most of the doctors were aware about the BMW management and they thought that it is peoples responsibility. This is the group effort and not a single person can brought about any change. Regarding BMW handling rules, most of the paramedical heard for the first time. Half of them considered sharps as the dangerous waste product. Three fourth of them had knowledge that HIV was the most common disease spread by improper disposal of hazardous waste. Paramedical did not seem to be enthusiastic about having new training session for them. Housekeeping staff that were in direct involvement of BMW handling were not punctual. They were irregular to their work and their ignorance was reflected in their practice. Most of them wanted that there should be separate management unit for BMW, but they did not want to get involve themselves. They had less knowledge about harmful impacts of BMW as only 13.33% of people said it causes HIV/AIDS. Around 82% of them said that they themselves are at highest risk of getting infection. Their knowledge was very poor regarding BMW 66% of them had no idea about color coding. They did not use protective measures. They always complained that government had not provided anything to them, but whatever government had provided to them, they were not utilizing. They did not want to put extra effort in any additional work. The study analyses the various aspects of the BMW management and accordingly recommendations were made to bring required changes in the district hospitals BMW management and other aspects associated with peoples KAP.

Ab-44 Assessment of Bio-Medical Waste Management Practices

Roshni Dilbagi Keywords: Biomedical Waste, Waste Management, District Hospital, Health Care Facilities Background: The need of the study came because of the fact that the biomedical waste management practices is started in the health care facilities of district hospital but although formal training has been given but there awareness level was very low. This has led to conduct a knowledge, attitude and practice study and assessment study among the staffs of district hospital.

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Recommendations: Study shows that there is an urgent need of audit system with this respect. Doctors agreed that there should be management team for waste management.

utilized hours and lowers the contributing margin. So to streamline the processes and to improve the efficiency in the operating room a balanced scorecard approach was introduced as a performance management tool.

Ab-45 Performance Management in Operating Rooms

Ruchika Goyal Keywords: Performance Management, Operating Room, Surgical Services Background: As healthcare organizations look for ways to gain new efficiencies and reduce costs, they are examining surgical services with a critical eye. In many cases, the operating room (OR) was not included in enterprise wide reengineering efforts, thereby limiting the positive impact of those efforts. Healthcare organizations are recognizing that every point along the patient care continuum is interrelated. To truly maximize reengineering efforts, they need to integrate the entire process and information flow within the OR and across the enterprise. Objective: The study was carried out, to assess the efficiency in the operating rooms. The purpose was to identify service-focused opportunities for efficiency improvement, and to guide continuous improvement activities within operating rooms and anesthesia services. Methodology: A descriptive study was carried out and both primary and secondary data was collected. An analysis of capacity utilization was done by calculating the percentage utilization of the operating rooms, percentage of first case start delays and the number of cases cancelled and rescheduled. The scheduling process was studied and reasons for delays in the surgeries were stated. Findings: During the past seven months i.e. from July 09 to March 10 total 3577 surgeries were carried out. Avg. utilization of OR during the elective hours is approximately 60%. On an average 45% were FCS delays, 5.7% surgeries cancelled and approx. 21% were rescheduled. OR six and seven were underutilized as compared to the others due to inappropriate case mix. The ORs were not differentiated specialty wise leading to discrepancies in case mix and poor predicted time of case length. Forecasting shows that the utilization of ORs would increase from the current utilization of 60% to 70%. Recommendations: A large amount of cost is incurred to run the operating rooms, under runs leads to opportunity cost during the un-

Ab-46 Benchmarketing of Medical Records at Eye Hospital at New Delhi

Rupinder Sahota Keywords: Benchmarking, Medical Records, MRD Policy Objective: Detailed study was done to see how strong the information system (Medical Records Department) at Eye hospital was done. Relevant facts were taken from journals and internet as a part of literature review and secondly, old patient records, direct interaction with hospital staff was done to gather primary data. Methodology: This retrospective study is based on, both secondary and primary data. Relevant analysis was done to formulate strategies in order to provide solution to the given objective. Random sampling was done for retrospective part and whole population was studied for prospective part. Fro content analysis 757 files were scanned out of which 400 were taken form the past data and 357 files were taken for prospective study. The strategies were divided according to the key findings. Contribution was met with success, and thus further recommendations were done. Findings: MRD and general store should be in separate place. Lack of signage found. Space of store room is cramped. Security is not adequate. MRD policy is not implemented. The quality of consent forms is very found to be very poor and the print is also not clear. Coding system is not present. Records are not received every day. For cataract occupies the least % of discrepancies were found. Procedures like cyclocryotherapy, pupilloplasty, probing and syringing have 100% discrepancy. Only 8 elements out of the 36 were seen in IMS 1 and IMS 5. Somewhat compliance is noted in IMS 7 (42.8%) which pertains to the procedure laid down for medical audit. It was also found that documented procedure is not present. Arrangement and configuration of records is not standardized. A lack of awareness and training is there amongst all the staff members specially doctors. Recommendation: Formulating a medical records department policy

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is recommended on priority. Some Architectural suggestions were also be implemented. Documents mentioned in the policy should be maintained. Filled consent forms of OPD procedures should be taken care off by the MRD.

Ab-48 Study on the Utilization of Radio Diagnostic Equipments, Ultrasound & Operation Theatre
Sangeeta Ravindran Keywords: Utilization of Radio Diagnostic Equipment, Ultrasound, Operation Theatre

Ab-47 Study of the Opinion of inpatients to Measure Patient Satisfaction in an Emergency Hospital
Samarth Tripathi Keywords: Patient Satisfaction, Emergency Hospital, Inpatients Objective: To study the level of patient satisfaction in wards and the different factors affecting patient satisfaction. To suggest measures for improvement of services leading to better patient satisfaction and to evaluate the services being provided to inpatients. Methodology: The data collected on feedback project was a prospective study. Primary data was collected through interviews and discussions and direct communication with the patients the secondary data was collected through literature available in pamphlets, journals, booklets, through various records of the hospital, websites and currently available national and international literature on the subject. Semi-structured open-ended questionnaire for the purpose of the study were developed. Findings: 74.5% respondent ranked the consultants fees in the hospital as moderate and the 4.5 % of respondent have ranked it low. 33.6% respondent ranked the food service of the hospital as excellent and 32.7 % of the respondent has ranked it as good. 32.4 5 have claimed it as excellent.26.4% respondent ranked the hospital support staff service of the hospital as excellent and 50% ranked it as good. 89.7 % claimed support staff service as excellent. Recommendations: There should be some training on communication skills for nurses as how to deal with patients. (English and Hindi). The nurse who gives the charge to another on duty should clearly brief her about everything related to patients condition, what all medication needs to be given and so on. When a nurse joins, a feeling of responsiveness should be incorporated in their mind so that they feel accountable for the work assigned to them.

Background: Medical equipment plays a very significant role in the healthcare delivery system. In the present healthcare scenario, increasing operational efficiency and reducing costs, whilst improving service provided to the patient, are a constant challenge. Biomedical equipment accounts for nearly 50 percent of the hospital project cost. Therefore, it is essential to ensure maximum utilization of the equipment with minimum downtime. With the adaptation of proper maintenance techniques and management systems one can utilize resources optimally and reduce the breakdown and related maintenance. Utilization index or use coefficient is one of the important parameters to monitor the functional status of the equipment. Objective: This study deals with the utilization rates of CT scan, Xray and Ultrasound machines in the Imaging department, Ultrasound machine in the Gynecology OPD, and the utilization of the Pediatric & Gynecology OT in a tertiary pediatric and neonatal referral center in Andhra Pradesh and to suggest ways to increase the efficiency of these equipments by better utilization. Objectives of the study was to record the time taken for a scan/surgery , calculate the utilization coefficient and see the trend of utilization. Methodology: The study was an analytical one with valid quantitative data as a background proof and time frame of three months. Findings: The study revealed an optimum utilization for the ultrasound machine used for pregnancy related scans in the gynecology OPD, ultrasound scan machine in the radiology department and the pediatric OT. The CT scan machine, X-ray machine and the Gynecology OT, were found to be less utilized, the CT machine being grossly underutilized. The Gynecology OT again is being underutilized owing to the fact that the hospital is essentially a pediatric entity and the gynecology department was started much later. The percentage utilization of CT for the month of January, February & March was seen to be 6%. This shows gross underutilization of the equipment. The percentage utilization of Ultrasound in Gynecology department was much higher than pediatric department. It was found that surgeons

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were exceeding the booked duration for a surgery by more than half an hour in many cases. Recommendations: The management was recommended to increase marketing for the CT and X-ray services. Scans should be started on Sundays to achieve optimum utilization of the equipment. The department has well trained and experienced technicians working in 3 shifts. Thus there is round the clock availability of staff. Regular preventive maintenance of the equipment will assure lesser downtime and ensure better functioning. Monthly report is generated to monitor surgeries which were exceeding booked duration. Elective surgeries can be planned on Sunday.

countries can be established. Medical Tourism Regulatory Body /Ethics Committees should be formed.

Ab-50 Quality Assessment for Training Needs Assessment

Saumya Misra Keywords: Quality Assessment, Training Needs Assessment, Quality of Services Background: Measuring quality leads directly to the identification of areas for improvement or enhancementthe first step in improving quality. Successful improvement ultimately contributes to attaining quality care, the goal of quality assurance. Quality assessment of the facilities enables to track the practices, acceptability of the protocols delivered during training as well as an important tool for training needs assessment for capacity building in form of refresher training or further trainings in new franchisees, as the network is gradually undergoing expansion. Therefore the quality parameters need to be studied to trace the needs. Objective: To find out the issues regarding quality in the charitable trust hospitals that need to be focused more during the capacity building exercises so that the main aim of the project was fulfilled i.e. to provide quality care at affordable prices. Methodology: For this hospitals in 12 districts of Uttar Pradesh were analysed which lead to inference that segments of quality parameter. Findings: Study reveals the need of additional session on neonatal resuscitation and refresher training to be conducted along with the infection prevention session during the training and quality assurance visits that could help in improving the quality of services being delivered at the charitable trust hospitals.

Ab-49 Challenges & Opportunities of Medical Tourism in Hospitals of Delhi & NCR
Sanjhi Singh Keywords: Medical Tourism, JCI Accreditation, Healthcare Industry Objective: To compare the performance of three hospitals in the region in selected operations on the basis of Cost, Value added services, Popular operations, promotional activities, approachability & to analyze trends Indian medical and healthcare Industry. To study the opportunities & challenges of medical tourism in Delhi and NCR. Findings: Majority of the tourist consider India (Delhi) as a destination for heart surgery followed by nephro surgeries (kidney related problems) then orthopedic, Neuro and only a fraction of them come for kidney transplants. The study also indicates that if proper investment is made then India will be at the top level in the healthcare industry. The graph shows in what ratios the investment should be done like on medical equipment could account for 20-30% of investment in beds. Recommendations: Aggressive marketing & awareness programs are required. Hospitals should have JCI accreditation to enhance international business. Web sites, list, details, telephone & E mail ids of hospitals & executives dealing with medical tourism Establishment of Indian Medical Tourism Corporation: - International BranchesLiaison cell with all Indian & Foreign Missions, Regular Chartered Medical Tourism should be announced, India International MT Media is also essential. Corporate Hospitals Medical Tourism Consortium with front offices in UK, USA, Canada, Middle East, South East Asian

Ab-51 Flyover feeds you more Momentum Expected Vs Perceived Hospital Services
Shadad Mirza Keywords: Hospital Services, Healthcare Market, Patient Satisfaction Background: With the healthcare market turning from a sellers market into a buyers market, healthcare providers are turning more and more towards marketing of their services. This requires a marketing

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information system, which provides information that is accurate, timely and need-based. Market research can provide such information to hospital administrators. A relevant tool for hospital administrators today is a patient expectation survey, which reveals what patients actually desire from hospitals. Objective: A study was carried out to know the healthcare market and patient satisfaction in a tertiary and secondary care hospital. Methodology: Survey, interview and observation methods were used to collect data. Findings: Under this study as one of the quality/medical care attributes 100 % patients in both hospitals expect physicians to listen to their problems and answer their queries, as against 73% & 63% in tertiary and secondary hospital who were listened to respectively and 60% and 52% patients who were answered to respectively in the tertiary and secondary hospital . The implications here was: Potential dissatisfaction causing factor and sensitize doctors about above in both hospitals Recommendations: Here again in both hospitals, expectations were not met and this needs attention. There is need to sensitize doctors about patient expectations, which if heeded to, can improve the situation without any additional input in terms of resources.

their cost attributable to the patients. Methodology: All the patients who were directly admitted to the ICU and stayed for more than 2 days in ICU were included. The patients who had bacteremia at the time of the admission and who stayed less than 2 days in ICU were excluded. Findings: In a sample size of 129, 36 patients got infection during ICU stay and remaining 93 did not get infection. The study revealed the crude rate of ICU acquired infection was 27.9% comprising maximum number (41.1%) suffered with ventilator-associated pneumonia. The most prevalent pathogen for pneumonia and BSI was found to be Acinetobacter. It was multi drug resistant organism for which costly antibiotics [colostin] were required. Most prevalent organism for UTI was candida. 55.5% of infected patients expired, where as only 17.2 % of non-infected patients expired. The extra length of stay due to infection was 8.11 days, which in turn amounts to, estimated 200,000 INR per patient. Recommendations: There is a positive association on mortality rate with infection hence it is estimated that if the infection rate is reduced then the mortality rate will also get reduced. This will bring name and fame to the hospital. If infection rate drops down patient turn over will increase, which can lead to more revenue generation as compared to existing situation, As per the literature, first three days of the hospital stay of any patient are the most revenue-generating period.

Ab-52 Nosocomial Infections in Intensive Care Unit

Sheetal Yadav Keywords: Nosocomial Infection, Intensive Care Unit, IUC, Hospital Acquired Infection Background: Due to high dependency of ICU patients and their critical conditions there are increased chances of getting hospital acquired infections among these patients. Infections acquired in health care settings are among the major causes of death and increased morbidity among hospitalized patients. They are a significant burden both for the patient and for hospital. Objective: A prospective descriptive study in the ICU multispecialty hospital at Gurgaon for a period of two & a half months has been designed to elicit information on the rate of nosocomial infections and

Ab-53 Bed Utilization in General Hospital at Gujarat

Shikha Jain Keywords: Bed Utilization, General Hospital, Health Care Expenditure Background: A hospital is an economic institution with a significant social role in the community. It is not possible to discuss problems in medical and health care intelligently without reference to hospitals what they are, what they do, and how they do it. Economics of the hospital sector has often received wide attention because it has been the major consumer of the health care expenditure accounting for about 4060% of gross health care expenditure. Therefore it is essential to ensure that services provide an excellent experience for customers i.e. the patients. Objective: The study on the bed utilization was conducted in the

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district hospital at Gujarat. The general objectives of this study is to identify the various procedures at the Outpatient, Inpatient and Para clinical services as well as to investigate the possible operational problems those are leading to low bed utilization. Methodology: The primary data was collected help of qualitative as well as quantitative research techniques. In total 60 patients (40 out patients and 20 in patients), 5 doctors and 5 nurses from various specialties were interviewed. The secondary data comprised of last one year monthly report of indicators of general hospital . Findings: The study brought out the fact that overall bed occupancy rate was low (about 30-40%) which is low compared to ideal bed occupancy rate of 70-80%. Various reasons like patients lack of knowledge about hospital functioning, lack of proper signage, lack of confidentiality, respect and dignity of the patient, lesser OPD timings etc lead to dissatisfaction among patients. Recommendations: The low bed occupancy rate in the district hospital can be improved by capacity building, planning for hospital budget, and revision of OPD timings, improving internal communication and strengthening of security services at the hospital campus. Thus a well organized and professionally run hospital not only can help in avoiding confusion, frustration and dissatisfaction by fearful patients but can also manage the flow of inpatients to the hospitals, thus improving bed utilization.

Hospital, Gujarat, to know the causes of their satisfaction as well as dissatisfaction, To provide recommendations for the improvement of the services. Methodology: The primary data was collected with the help of qualitative as well as quantitative research techniques. In total 50 employees were interviewed. The sample comprised doctors, pharmacists, technicians, receptionists, data operators, security guards, administrative staffs. Findings: Results from the survey indicate that approximately 74 per cent of the employees were satisfied with the organization. There were several issues regarding the employee satisfaction survey. The employees have many grievances as well as their problems regarding some of the issues in the hospital. The issues should be handled very carefully. In this survey it was found that 74% of employees were satisfied. Majority of the employees i.e. 68% of the employees are on contract basis. The majority of the age group is of age between 21yrs 25yrs, which is of 42%. 66% believe that the organization treats them like a person, not like a number, 42% believes that the organization gives them enough recognition for good work, Majority agrees that quality work and safety are the top priority of the organization, 60% agreed that employees are treated fairly regardless of race, gender, age, religion, or sexual orientation, 68% agrees that employees are comfortable with their colleagues. When the employees were asked about their relationship between the employees with their immediate supervisors, majority agreed that their supervisor treats fairly, with respect and acknowledges their work, and guide fairly for the improvement in work and they also have trust in what the supervisors suggests. Recommendations: The work should be equally divided among the employees; the employees should get the salary at right time as it is one of the motivations for them to work. Employees need more training, proper incentive should be given to the employees, work atmosphere should be more improved, printers should be attached at every OPDs in order to upload data on HMIS, work load should not be there. The work should be equally divided among the employees; the employees should get the salary at right time as it is one of the motivations for them to work.

Ab-54 Study of Employee Satisfaction at General Hospital, Gujarat

Shreyasi Sen Gupta Keywords: Employee Satisfaction, General Hospital, Motivations Background: The strength and the success of an organization depend on the capacity of its employees. Employee satisfaction survey is one of the important surveys which need to be done in any organization at periodical basis. It helps the top level managers to understand their employees and manage accordingly. Therefore the present study aimed to conduct an employee satisfaction survey in the General Hospital Gujarat. Objectives: The basic objective of employee satisfaction survey were: To understand the perspective of the employees about the General

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Ab-55 Study on Disaster Management Plan

Shruti Khanna Keywords: Disaster Management, Disaster Management Plan, Gap Analysis, NDMA Guidelines Objective: The main aim of the project was to make disaster preparation of GGH effective by identifying all the grey areas and removing all the loopholes, whatever there may be. Methodology: An intensive research of the NDMA guidelines was done and then the gap analysis was conducted to quantify how much were lagging behind the industry standards and what should be done to cover the gap. Findings: The study revealed many interesting facts like the shortage of manpower, poor conditions and improper utilization of funds , lack of inter departmental and intradepartmental coordination, faulty Govt. policies regarding condemnation of equipments, retrofitting of buildings in accordance with NDMA guidelines, very poor infrastructure, SOP formulations, pertaining to external and internal disaster, Up gradation of disaster plan of the Hospital, no fire evacuating system, lack of statutory requirements, Poor awareness and preparedness in relation to disasters, disaster management committee was never formed etc. Recommendations: The study proved to be a helpful tool in analyzing the gaps in the existing disaster plan, in the formation of disaster management committee, in up gradation of the old plan. The results of the report are being used in recommending a revised plan to the State authorities.

development of functional specifications for the clinical process documentation with clinical backup. As a part of zero stage of implementation cycle which consists of process change identification workshop, detailed implementation planning and functional specification document preparation. Methodology: For process flow analysis a 150 bedded, state of art leading oncology centre at Hyderabad was chosen. Operational process flow, with step by step data capturing at every stage with documentation was studied. Operational process flow, with step by step data capturing at every stage with documentation was studied. Both qualitative and quantitative method was used for the study. Findings: Various stake holders at Cancer Hospital were interviewed. Following, an elaborate document of their existing process flow was made which was further sent to parent hospital for approval and authentication. After analyzing the scope of the product and various work rounds available voids in data capturing were identified. A functional specification document was prepared for the technical team consisting of what information has to be captured, which field shall capture it, who shall capture it, which all other areas it will be displayed in, masters for the same were created after extensively. Data captured were tabulated and a sample copy of the same was created and added on to the existing report. Completing the stage zero of the project the details were sent to the parent hospital for their approval post which it shall be sent to the technical team for development. Another important part that was deeply looked into was capturing and presentation of this data according to existing standards in the healthcare.

Ab-56 Study the Operations, Medical / Clinical Record Keeping and Prepare Functional Specifications for Clinical System for Oncology
Shweta Sandhu Keywords: Record Keeping, Medical Record, Clinical System, Oncology Objective: The main objective f the project was to understand the operational process of a functioning oncology centre followed by

Ab-57 Quality Improvement through Patient Satisfaction Survey

Suhas Parnami Keywords: Quality Improvement, Patient Satisfaction, Hospital Administration Background: The patient is the ultimate consumer to the hospital. It is one of the yardsticks to measure the success of service that it produces. The effectiveness of the hospital relates to provision of good patient care as intended. The patient satisfaction is real testimony to the efficiency of hospital administration.

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Objectives: To study the satisfaction level of patients and understand their expectations. To evaluate feedback and provide a remedial suggestion. Methodology: In order to understand the standing of the hospital from the views of the customers, a closed ended questionnaire was designed. 100 patients were selected for the study. Questionnaire and interviews methods were used. Findings: This study helped to find the hidden problems and issues which need to be dealt with immediate effect. After analyzing the completed questionnaire of 100 patients/attendants, it was revealed that the billing services at the time of discharge was the least satisfactory in the hospital and was the root of all the dissatisfaction among the patients. Reasons behind this dissatisfaction were: Billing done manually, less manpower, no pre planned discharge intimation from the floor. To which I proposed that have billing done on HIS, and pre planned discharge intimation from the floor a day prior of discharge. Next in dissatisfaction list was Radiology services. Major reasons found out after studying the questionnaire in detail was: Delay in procedures. 50% of the patients were found satisfied with the registration process and 11% was dissatisfied. 88% patients were found to be satisfied with the doctors ability and 55 were dissatisfied due to the non availability of the doctor when required. 54% were satisfied with the Nursing and Lab services and 8% were dissatisfied. 96% were fully satisfied with the housekeeping services. 56% were satisfied with the food quality and services.14% comprising of international patients were dissatisfied with the menu of the food. Recommendation: It is recommended to have a proper appointment system to achieve maximum patient satisfaction.

patient during the course of treatment. Objectives: The main objectives is to study the physical facilities available for infection control in intensive care unit and also the existing infection control procedures used in the intensive care unit . Methodology: The research approach adopted in the study was descriptive method. It includes collection of information regarding infection control procedures and its measures and also existing physical facilities available for infection control through questionnaires, studying relevant record maintained in ICU. The required data is collected from nurses, doctors, hospital nursing assistance, staff of central sterile supply department who are responsible for supplying sterile items to medical intensive care unit and the, housekeeping staff who work in medical intensive care unit. Findings: Result show that current physical facilities available for infection control are satisfactory and meet the ISI standard, but the existing infection control measures practiced in ICU are poor. No standard operating manual is maintained in ICU. Culture studies of swabs from ICU floor / equipment are done. Bacteriological testing of water is done but bacteriological testing of air is not done. No antibiotic policy is available No protocol is followed for wearing gloves Recommendation: Strict adherence to standard infection control procedures need to be taken under consideration and existing infection control measures in ICU needs improvement and up-gradation.

Ab-59 Assessment of a Hospital as Per FFHI Guidelines

Sunita Choudhary Keywords: FFHI Guidelines, Family Friendly Hospital Initiative, Health Facilities, Quality of Services Background: Family Friendly Hospital Initiative (FFHI), a kind of certification of health facilities wherein certain quality of services needs to be ensured. The essential components for declaring a facility as FFHI are (a) evidence based protocol; (b) quality of services; (c) availability of essential drugs; (d) and availability of referral transport. A Hospital at Rajkot has already got the certification for Baby friendly hospital initiative some years ago. Assessment of the hospital was done for Family friendly hospital certification initiative.

Ab-58 A Study on Control Measures of Hospital Acquired Infection in Intensive Care Unit
Suhasini Keywords: Hospital Acquired Infection, Intensive Care Unit, Infection Control, ICU Background: Hospital acquired infection creates a major problem to the patient admitted to the hospital as well as to health care personnel, affecting the reputation of hospital and making unnecessary cost to

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Objective : To review the existing system of the hospital. To have a best possible H.R. measure study on employee satisfaction. To have patient perspective study on patient satisfaction. To identify the lacunas in hospital to become a family friendly hospital. To recommend the areas of improvement for strengthening and improving the quality as per FFHI check list, this helps to reduce the lacunaes and variation. Methodology: The project was descriptive in nature. Primary data was collected by Observation Structured Interview method. Secondary data was collected from hospital medical records. The primary data collected was transferred to a standard format of Quality FrameworkSystem approach and then analysis done through Ishikawa fishbone diagram (Root cause analysis). Findings: Results shows that 90 percent patients were satisfied with the cleanliness of hospital campus. Results of table 8 shows that almost 80 percent patients were found to be highly satisfied to the cleanliness of bed sheet. Analysis pertaining to cleanliness of ward reveals that 96 percent patients were found satisfied from the cleanliness of the hospital. Result reflects that 28 percent patients were not aware about their treatment. Around 92 percent patients were found to be highly satisfied with the behaviour of doctors. It was found that, 84 percent patients were satisfied with food quality and time. The major gap was related to the service environment like Non availability of display of doctors availability and timings, Littering by the patients in the hospital, Non availability of electronic display of token, Junks inside the hospital. The second major gap was related to client provider interaction like No feedback system from the patient, Non-availability complaint box for the patients. The third gap was related to access to the patient. Non availability of service guarantees character, non availability of signage and directions. The forth gap was related to professional standards and technical competence like Non availability of check sheet for surgical patients.

documentation in clinical areas. To suggest remedial and corrective/preventive actions to sustain the quality of documentation in clinical areas and to examine the effect of implementation the preventive/corrective actions. The sole aim of the study is to identify the areas to sustain or improve the documentation process and to recommend the methods to achieve them. Methodology: First phase, all departments in the hospital was observed for the documentations process. Informal interview and group discussion was carried out with people involved in the documentation. Area of common mistakes and difficulties faced by the department in clinical documentation was observed in detail. In second phase, a check list is prepared based on non conformance/Partial conformance of measurable elements which were identified during the NABH external assessment. Final phase, medical records of the patient who are treated in the hospital are audited with the help of check list and the data was analyzed. Major contributing factors are identified using pare to principle and recommendations for the same was formulated. Findings: It was found that 94.6% of the medical officers are not mentioning the time of assessment and reassessment. 91.9% Charge nurse is not mentioning the date, time and signature in each valid medication notes. General consent forms on admission were not duly signed by 89.3%.patient. This was because patient comes to inpatient department (wards) through the emergency department, so during filling the admission patients relatives were signing the general consent form. Recommendation: To enhance the effectiveness and sustainability of internal quality assurance efforts, internal hospital quality assurance program should encompass all the aspect of the facility (not just one type of service) and aim from the outset to construct a self sustaining QA system that does not depends on external support.

Ab-60 I n t e r n a l Q u a l i t y A s s u r a n c e i n C l i n i c a l Documentation
Thirumalai N Keywords: Quality Assurance, Clinical Documentation, Quality of Documentation Objectives: The study was taken to examine and measure the quality of

Ab-61 Human Resource for Health in a District Hospital at Rajasthan

Trupti Khandelwal Keywords: Human Resources, District Hospital, NRHM Background: Shortage of human resource in health sector is a major problem in India and more in rural areas. Similarly in Rajasthan, it is

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scarcer in terms of doctors. Nearly one nursing staff is available for 1000 population but even single doctor is not available for per thousand populations. Objective: A study on HRH was conducted in District Hospital, Rajasthan. The study objective were: (i) to review the efforts made by the GoR to attract and retain the health functionaries in health facilities, (ii) to find out reasons for success/ failure of the efforts made in the district, and (iii) to suggest about what more could be done in the present context human resources for health encompasshealth and hospital mangers, medical officers, nursing staff and support staff to study the current status at the District Hospital in Rajasthan Methodology: Purposive sampling was done to understand the human resource planning and other relevant issues. A total of 22 officials at the district and state were conducted using a checklist. In addition, secondary data was collected and analyzed. Findings: The results revealed acute shortage of health functionaries, especially Medical i.e. 44% following Government of Rajasthan rules. It will be more if IPHS is followed. However, under NRHM, Government of Rajasthan has initiated efforts for attracting and retaining the medical officers. Moreover, the medical officers were overburdened due to high rate of vacant positions, including voluntary retirement scheme. Recommendation: The study recommended a dedicated human resource cell at the state level, decentralization and evidence-based planning.

examine the efficiency of housekeeping staff or quality of their working. Methodology: A sample of 11 in-house housekeeping staff (providers) was interviewed using a structured questionnaire to evaluate their awareness about cleaning methods, frequency of cleaning, BMW, their responsibilities in mass casualty etc and to determine the training given to them and if they are getting housekeeping material timely so that quality of service is not affected. A sample of 48 IPD patients/ attendants and 50 OPD patients/ attendants were also interviewed using a questionnaire to evaluate users satisfaction regarding the level of cleanliness and housekeeping services. Findings: It was found that 55% knows the correct method of sweeping a patients room while only 27% knows the correct method of mopping. Only 9%answered all the 5 questions related to BMW correctly while 91% replied that they have got training on BMW (it was 6 months before). 91% replied that they got training on BMWonly during their work in organization, no other training was given. 67% answered that they didnt get equipments/ supplies on time. A time-motion study was done to determine the activity schedule of housekeeping staff at different timings. It was found that besides cleaning, they were also performing nursing activities and others (activities of ward boy etc) A check list was prepared to further assess the training needs of housekeeping staff to increase their efficiency; the check list was filled in by ward in charges (supervisors of housekeeping staff of their respective ward). Maximum score (i.e. for the area in which training is required immediately) was given to Induction training and training on waste disposal. Another check list was prepared to examine the existing practices of housekeeping services by checking the system of recordkeeping, training schedule, cleaning activities (performed or not), and to determine if the existing system of supply of housekeeping material was working efficiently by checking the availability of equipments/ supplies required in cleaning procedures. Recommendation: It proposes proper organization and planning of Housekeeping department with sufficient storage and work space, a system to ensure availability of housekeeping material on time, an annual training plan and its proper implementation, preparing housekeeping records and monitoring of records and a monitoring system to measure the efficacy of housekeeping services .

Ab-62 Study of Housekeeping Services

Vatsala Sharma Keywords: Housekeeping Services, Quality Assurance, Hospital Care Background: Housekeeping services in a hospital is entrusted with maintaining a hygienic and clean hospital environment conducive to patient care. The housekeeping related activities have a direct effect on the health, comfort and morale of the patient, staff and visitors and are an important public relations variable. It is an essential ingredient in the provision of quality assurance of hospital care. Objective: This study was carried out in order to assess the existing practices of housekeeping in the District Hospital at Karauli and to

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Ab-63 ICU per Bed Day Costing in a Charitable Hospital at Delhi

Vijay Shankar Patel Keywords: ICU, Per Bed Costing, Cost Benefit Objectives: The major objectives were to know the costing of per bed day in ICT and to know cost and benefit from ICU. Methodology: Depreciation method is used to calculate the cost of instrument and there are some direct cost like doctor cost, nursing cost, housekeeping and linen cost. Step down method is used to calculate the cost of administration. Data observed and collected includes:-per bed day doctor charge, nursing charge, administrative charge, electricity, water and other charges. Findings: Some indirect costs are electricity and water cost. The ICU per bed day costing is Rs.2300.68. Per bed day cost charged from patient is Rs 3500. Bed occupancy for month of March is 97%. Revenue generation per bed par Day = Rs 3395. Total discounts in the month of March for ICU patients- 132000 rupees. Discount per bed day in the month of March is = Rs.488.88. Revenue generation per bed day in the month of March is= Rs 2906.12. Benefit per bad day = Rs 2906.12Rs.2300.68 =Rs 605.44. Benefit for ICU per bed day for the month of March is =26.31%

forming cost sheet . Methodology: The scope of the study was limited to 4 investigations, of which 1 is contrast based. The methodology utilized includes review of literature, internet search, understanding market trend, enumeration of services, cost heads and various resources required, meeting various healthcare professionals including vendors supplying equipments and consumables, etc. The data collection was both through primary and secondary basis. Findings: The study found that the imaging services provide a pool of revenues if proper patient inflow is maintained; otherwise it may also be a means for losses to the organization as in CT scan and X-Ray procedures, while it is profit making in USG & Mammography units as per the study and manpower, depreciation but without interest cost contributions.

Ab-65 Scope of IT in OPD and IPD Areas: First Step towards a Paperless Hospital
Vikash Tyagi Keywords: OPD, IPD, Information Technology, Quality of Services, Electronic Medical Records Objective: The purpose of the study was to see the adoption of IT in OPD and IPD can help in streamlining the various processes and improve the quality of the services. The study analyzes the role of information technology in this regard through improved quality, efficiency and ability to conduct research with the use of electronic medical records. Methodology: A random sample of the users of the computer system was taken and informal interviews were conducted with them. They were asked about the problems associated with the present system specially related to their area of operations. Findings: The areas of concern are duplication of entries, Lack of interoperability between various modules and large and bulky paper based records. The role of proper training and the integration between various modules has been emphasized.

Ab-64 Cost Analysis of Medical Imaging Modalities

Vikas Goyal Keywords: Cost Analysis, Medical Imaging Services, Cost of Services, Micro Costing Objective: The study t provides an analysis of departmental costs involved in providing Imaging services and ascertain the costs of some commonly done tests or procedures in the Imaging Department. Bottom-up or Micro costing is applied in which all the inputs consumed in undergoing the procedure are identified, measured and quantified, finally converting into value terms to produce a cost estimate. Absorption costing, a technique that assigns all costs, i.e., both fixed cost and variable cost to product cost of service rendered is applied in

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Recommendation: Hospitals may be more likely to adopt EMR if they can reassure patients that their confidentiality is legally protected. Among the barriers to implementation are a dearth of integrated delivery systems, reluctant providers, and prohibitive costs.

Background: The hospital is supposed to provide well-laundered linen for all requirements of the hospital in adequate quantities, at the right place, at the right time and this is possible only if the means to attain these objectives are controlled by the hospital itself. Linen and Laundry department was comparatively weak area at Childrens Hospital. Objective: The main objective was to streamline the process flow and to improve the effectiveness and efficiency of the department and to understand the structure and service flow of the linen and laundry department, to develop policy for linen department, to identify and analyze the flaws in the structure and service flow of linen and laundry department for improving its functioning, Methodology: Observation, interview and linen satisfaction survey was carried out by identifying five quality indicators i.e. Clour, texture, timely availability, smell and adequate quantity of the linen services. Findings: It was found that 28% were highly satisfied and 17% were not satisfied, rest was satisfied with the colour of the linen. 23% were highly satisfied, 60% were satisfied with and the 17% were not satisfied with the smell of the linen. 25% was highly satisfied, 60% satisfied and 15% were not satisfied with the texture of the linen. In the case of timely availability of the linen 30% were highly satisfied, 57% were satisfied and 13% were not satisfied. 32% was highly satisfied, 48% was satisfied and 20% was not satisfied with the adequate availability of the linen. Recommendation: Major were to change the design of the linen, to dispose the linen whose life is completed, for the laundry department to change the detergent quality and lastly for the housekeeping department to follow the policy suggested by the surveyor for the department for improving quality of services of this department.

Ab-66 E x t e r n a l E m e r g e n c y R e s p o n s e P l a n i n Multispecialty Hospital at Jaipur

Vikram Singh Chouhan Keywords: Gap Analysis, NABH Standards, External Emergency Response Plan Objective: The main objective was to study the o gap analysis and preparing an external emergency response plan as per the requirement of NABH. Methodology: The study was descriptive and qualitative in nature. The study was based on the standards of NABH. Comparing the existing plan and requirements of NABH and doing gap analysis as well as developing plan that fills the gap according to the NABH norms. Findings: The findings of the study are described as gap analyses which are as follows: The allocation of bed in case of mass casualty was not appropriate, No Triage Area, No proper communication within the hospital, No process flow for different departments which will play an important role in emergency situation (Pharmacy, Laboratory, Blood Bank, Medical Record, Material management and no description of responsibilities of individuals in case of external disaster. Recommendations: It is very necessary to have a policy for the communication within the organization during external emergency to avoid confusion and the staff and the department head get the right information and start working according to their job description.

Ab-68 Comparative Analysis of two Multi-Superspeciality Hospitals for assessing the performance of Dialysis Unit
Vritti Lumba

Ab-67 Study of Improving Effectiveness and Efficiency of the Linen and Laundry Department
Vrajesh Shah Keywords: Lean Department, Laundry Department, Hospital Support Services

Keywords: Dialysis Unit, Dialysis Unit Records, Quality Care Control Background: Chronic kidney disease is increasing worldwide, but due to lack of awareness the incidence is increasing in the developing countries. In India, there is no existing data available and the patients

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undergoing renal replacement therapy form only tip of the iceberg. In India the setups providing dialysis are not doing a great job either. Objective: To find out the gaps between the standard guidelines and the processes followed. The objective of the study was to do a gap analysis of the parameters that reflect the efficacy of the dialysis unit with standard guidelines and to compare it with its older peers and then give recommendations so as to improve the quality of life of dialysis patients. In this endeavour studied. Methodology: Secondary data available in hospital records in the form of patient files, dialysis unit documentation registers and records on hospital information system the patients who had been examined on outpatient basis when they were in chronic kidney disease stage-IV was studied. The data was analyzed using Microsoft excel. Findings: It was found that the hospital is a new setup, its dialysis unit was being underutilized, no. of dialysis being thrice weekly in 68% patients; AVFistulas created prior to first hemodialysis in 52% patients; improper documentation of time of vaccination for hepatitis and pneumococcus; target hemoglobin of 11-12 achieved in 32%; serum albumin of 52% patients meeting the standards. No seroconversions and line infection rates of 14% more than the standards. When compared to second hospital it was found that there was better utilization of the dialysis unit but the staff patient ratio was not meeting the standards; almost all patients had hemodialysis done twice/week and AVFistulas were created prior to first dialysis in none of the patients. Hemoglobin level was in the standard range in 20% patients while urea reduction ratio was not evaluated, though serum albumin was meeting standard in 48% but the lowest value was 2.2mg/dl. Seroconversion rates for hepatitis B, C and HIV were 16%, 16%, and 4% respectively. There were no records available for the time of immunization of patients and no records were there for line infections. On comparing the two, the dialysis unit is doing better than its old competitor, yet lot needs to be done in order to achieve the standards and reach to a state where it can give real quality of life to its patients. Recommendations: VIP rooms may be utilized by other patients when there is no booking of VIP rooms. Night shifts to be started to incr5ease the utilization of dialysis unit. Results should be monitored as part of comprehensive quality care control programme. Proper documentation needs to be done in order to ensure quality.

Ab-69 Monitoring and Strengthening of OPD and IPD Services in District Hospital, Sikar
Yatendra Kumar Sharma Keywords: District Health System, Health Care Services, OPD Services, IPD Services Background: District hospital is an integral part of the District Health System (DHS). District Hospitals function as a secondary level of healthcare which provides curative, preventive and primitive health care services to the people in the district. It is also the fundamental platform for implementing various health policies and delivery of health care and management of health services for defined geographical areas. Objective: A study was conducted in District hospital at Sikar, with the objective to know a broader perspective of the issues related to the OPD and IPD services, and the behavioral aspect and attitudes of Hospital staff, as well as patients and to strengthen the OPD and IPD services of the hospital. Methodology: Structured questionnaire was prepared and primary data was collected on random basis by interviewing the patients. Analysis was done using Ms-Excel. Findings: From the aggregate of scores of 14 questions of satisfaction questionnaire, it was found that 13.3% patients considered the services at as excellent, 21% considered it as good, 30.1% say that it was average and 12% of patients were poorly satisfied with the services. Item- wise satisfaction score showed highest score for patient satisfaction of excellent category regarding pharmacy (21%), followed by 11% about registration and 11% regarding ambience of the hospital. Item wise dissatisfaction score showed highest score for poor satisfaction i.e. 30% regarding nursing staff behavior, followed by overall experience (25%) and poor cleanliness of toilets and bathrooms (16%). 7% of patients preferred to suggest this hospital for friends and relations and for future consultations. Recommendations: The hospital administrators should be aware of the needs and expectations of the public as per the feedback of the public relations department and accordingly take policy decisions. These measures play a significant role in patients satisfaction. A good communication between the patient and provider of health care is vital factor for patient satisfaction. There should not develop any communication bridge between the doctor and the patient.

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Health Management

Ab-1

Yashoda Assessment at District Hospital Bharatpur

Aastha Srivastava Keywords: Health Care Delivery System, Yashoda Assessment, Health System Objectives: The study was based on the intervention benefiting the health system by improving the health care delivery system for mother and newborn and also to check the efficiency and the effectiveness of the work performed by Yashoda. Methodology: The descriptive cross sectional study area was Bhartpur district hospital. Target population are the mothers staying in the institution after delivery. Sampling done is as per convenience. Tool based on job assessment questionnaire and self administered questionnaire for Yashoda. Checklist was also prepared to observe the process under study. Frequency table and graph generated by manual calculation using Microsoft Excel for analysis. Findings: The finding reflects that initially Yashoda faced various problems and they were not accepted by the staff and were not given the recognition in the institution. Major Finding shows that most of the Yashoda staff are not counseling for the new borne care, family planning, proper nutrition and breast feeding. It was also observed that cleaning the baby inside the labor room and motivating the mother for follow up visits was also not done. It was also observed that 75% of Yashoda are informing doctors about newborn who require more care and attention. Very few are helping in making monitoring charts, in registration and helping mother in choosing family planning tool. The patient satisfaction increased with the efficiency of the staff. Good coordination with floor staff and the nursing staff was also observed and has increased quality service and care. Their presence in the hospital has made increase in no. of weighing of babies, early initiation of breast feeding, increase in immunization status of the district, increase in no of stay hour i.e. more than 24-48 hours in the hospital. Recommendations: Refresher training course should be conducted regularly. Clarity in the job profile is essential. Nursing staff and the floor staff must coordinate with them.

Keywords: Post-natal Services, Intra-natal Services, Ante-natal Services, NRHM, MGDs, Quality of Services Objective: This study was carried out under the aegis of staff of PHFI for the project Developing an Investment Case for Scaling up Equitable Progress towards MDGs 4 and 5 in Asia Pacific Region. According to State of World Children Report 2009 by UNICE lack of proper antenatal care is responsible for the manifestation of these three lethal causes. It says hemorrhage after delivery is the major cause of high maternal mortality in Orissa followed by eclampsia, sepsis and anemia. Sixty-eight per cent pregnant women in Orissa are anemic. 54 per cent births are not assisted by any health worker while the institutional deliveries constitute only 39 per cent. Rationale: To achieve MDG 4 & MDG 5, NRHM & RCH II was launched. Since their inception & efforts quantitative figures have gone up but the quality figures are not reviewed at any level. Objective: To study the quality of Antenatal, Intra-natal and Post-natal services in Kendrapara and Rayagada districts of Orissa. To see the trends of Ante-natal, Intra-natal and Post-natal care from DLHS-2 to DLHS-3. To identify gaps between quantitative figures and quality of Ante-natal, Intra-natal and Post-natal care provided in Rayagada and Kendrapara. Methodology: Analysis of raw data from DLHS-2(2002-2004) & DLHS-3(2007-2008) was done using Stata 10 statistical package & Microsoft Excel for analysis The study analyzed the analysis of secondary data from DLHS-3. The Study Areas were Rayagada and Kendrapara district of Orissa Findings: Coverage indicators for the districts Kendrapara & Rayagada have improved from DLHS-2 to DLHS -3. This can be attributed to the implementation of NRHM, RCH II. The increase is more for Kendrapara than Rayagada, this can be due to difficult terrain. Quality indicators are lagging behind the coverage indicators for both the districts Recommendations: Implementation of NRHM, RCH II has brought about a drastic improvement in the coverage indicators for Ante-natal, Intra-natal & Post-natal care but the quality indicators have not been

Ab-2

Quality of Ante-natal, Intra-natal and Post-natal Services in Kendrapara and Rayagada Districts of Orissa

Aishwarya Rathore

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reviewed at any level. There is a stark gap in the quality & quantity of ANC, Intra-natal & PNC. Kendrapara is much ahead of Rayagada, this can be due to the large chunk of tribal population & naxalite infestation in the latter.

Ab-3

To Study the Relationship of JSY with Institutional Delivery/Maternal Complications and Its Utilization by the Beneficiaries

Recommendations: The study recommended that JSY incentive need to cover all aspects of antenatal, postnatal care and the quality of care rather than on institutional delivery only for example 25% for ANC, 50% during delivery, 25% for PNC. Attention need to be paid to increase the facilities (infrastructure and human resources) at health facilities. Adolescent girls need to be sensitized about benefits of different health schemes. This effort will directly help in parents awareness and acceptance of institutional deliveries in one way or the other and they themselves will contribute in JSY in near future.

Akash Kumar Lal Keywords: NRHM, JSY, Institutional Delivery, Maternal Care, Post Delivery Care Objective: Under NRHM JSY integrates cash assistance with delivery and post delivery care for women, to have healthy outcomes of pregnancy and childbirth. A study was undertaken in the AMRELI district of Gujarat to (i) review the JSY under NRHM in the district; (ii) conduct trend analysis of institutional deliveries under the JSY scheme in the district; (iii) study the utilization of the JSY incentive by the beneficiaries; and recommend for better utilization of JSY, and/or sustain the progress even without cash incentives. Methodology: The study was conducted in the five blocks of the district AMRELI during February-April 2010. The methods of data collection included interview with 50 JSY beneficiaries; and 10 medical officers, and 16 female health workers. In addition, district health records for the last three years were also analyzed. Findings: The study shows that around 44% beneficiaries spent the cash (Rs. 700/-) received under JSY for supplementary nutrition which is one of the prime purpose of the incentive. The record review shows that the percentage of institutional delivery among JSY beneficiary has been around 25% during 2006 to 2010 in the district. There was no difference in reducing maternal complications. The JSY scheme has proven to be more benefitting for the urban population rather than the rural population. The MOs and the FHWs believed that the incentive is very beneficial for the beneficiary who belong to very low socioeconomic status but is not very much required by others who are economically sound.

Ab-4

Human Resource in Health (HRH) in India

Amandeep Singh Keywords: NRHM, Human Resource in Health, Janani Surksha Scheme Objective: Under NRHM JSY integrates cash assistance with delivery and post delivery care for women, to have healthy outcomes of pregnancy and childbirth. A study was undertaken in the AMRELI district of Gujarat to (i) review the JSY under NRHM in the district; (ii) conduct trend analysis of institutional deliveries under the JSY scheme in the district; (iii) study the utilization of the JSY incentive by the beneficiaries; and recommend for better utilization of JSY, and/or sustain the progress even without cash incentives. Methodology: The study was conducted in the five blocks of the district AMRELI during February-April 2010. The methods of data collection included interview with 50 JSY beneficiaries; and 10 medical officers, and 16 female health workers. In addition, district health records for the last three years were also analyzed. Findings: The study shows that around 44% beneficiaries spent the cash (Rs. 700/-) received under JSY for supplementary nutrition which is one of the prime purpose of the incentive. The record review shows that the percentage of institutional delivery among JSY beneficiary has been around 25% during 2006 to 2010 in the district. There was no difference in reducing maternal complications. The JSY scheme has proven to be more benefitting for the urban population rather than the

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rural population. The MOs and the FHWs believed that the incentive is very beneficial for the beneficiary who belong to very low socioeconomic status but is not very much required by others who are economically sound. Recommendations: The study recommended that JSY incentive need to cover all aspects of antenatal, postnatal care and the quality of care rather than on institutional delivery only for example 25% for ANC, 50% during delivery, 25% for PNC. Attention need to be paid to increase the facilities (infrastructure and human resources) at health facilities. Adolescent girls need to be sensitized about benefits of different health schemes. This effort will directly help in parents awareness and acceptance of institutional deliveries in one way or the other and they themselves will contribute in JSY in near future.

estimation of low birth rates are used for this study, along with data from a supplementary qualitative discussion conducted with the medical officers on LBWs for the years 2008-09 & 2009-10 to bring the estimates up to date. Literature search strategy included reviewing relevant databases, conducting manual searches, contacting experts active in the field and various online resources on the subject. The total sample size for this study is 560 infant deaths (0-1 yr.) over the year 2008-09 & 2009-10.The sample frame was 260 LBW babies over the same year. Findings: The figures clearly suggest that LBWs cases are higher among the forest villages. This is one of the prime reasons for high neonatal mortality in the district. This can also be taken as a poverty, knowledge and health vicious cycle. The estimated 260 LBWs in this small district that occurred in 2008 -2010 represent a substantial problem for already overtaxed health department. A challenge for future analyses is finding ways to distinguish and quantify very early, early and late LBWs births. Recommendations: Ensuring early registration of pregnant women, strengthening Mamta divas, promotion of proper eating habits for pregnant women, promotion of institutional deliveries, Installation of sonography machine, Kangaroo Mother Care are some recommendations that can be started as early as possible.

Ab-5

To Ascertain the Role of LBWs in Neonatal Mortality and Development of Strategy for Preventing Deaths Due to LBWs in the Tirbal District of Narmada

Ambrish Kumar Chandan Keywords: Low Birth Weight, Neonatal Mortality, LBWs, Neonatal Deaths Background: Low birth weight has been defined by the World Health Organization (WHO) as weight at birth of less than 2,500 grams (5.5 pounds). The goal of reducing low birth weight incidence by at least one third between 2000 and 2010 is one of the major goals in A World Fit for Children, the Declaration and Plan of Action adopted by the United Nations General Assembly Special Session on Children in 2002. Objective: The purpose of this study is to devise and promote a strategy that prevents the neonatal deaths due to LBW in the tribal district of Narmada and similar settings. This study presents an analysis of low birth weights in the tribal area is an effort to understand the severity of this public health problem, gain insight into existing assessment strategies and map the regional distribution of LBWs. Methodology: The statistics of live birth and linked infant death records aggregated over the years 2008-09 and 2009- 10 by health dept. of Narmada district is used for this study . The study has been done by using Secondary data. Data extracted for that review and relevant to the

Ab-6

Customer Expectation Survey Regarding Health Insurance in Pune

Amit Ray Keywords: Health Insurance, Customer Expectation Survey, Consumer Behavior Objective: The study was focused on the consumer behavior towards different types of Health Insurance Policies and also on consumers awareness, preference and consumption patterns. It also focused on the determinants of image of a Health Insurance in the city of Pune . Methodology: A study was conducted Health Insurance Industry determining the factors influencing image of a Health Insurances through consumers opinion. Sample Selection: Non-probability sampling technique, a convenience sampling method was used. Sample consists of all those people who are above 18 year age in the city of Pune. Sample Size was 100 for this study.

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Personal interviews and a semi structured questionnaire were used for data collection. Findings: 68% of the Respondents were not aware about health insurance and 71% of the same were not aware about the benefits of health insurance. 62% of those who had had a health policy had availed benefit from their health policy, out of which 69% had faced Problems during pre-auth/claims settlement. A sizeable 68% of the respondents were not satisfied with the service of their current health insurer. 46% thought that they did not need a health policy at their age, 23% had other important financial Priorities and 11% thought that health insurance is a bad investment as it does not yield good returns. 27% of the Study sample strongly believes that there should be ease in pre-auth and claims/reimbursement process. 18% ranked it as second most important decisive parameter. Medical benefits (25%) sample ranked it as No.1 and 22% ranked it No.2. Health risks / ailments covered was the important decision variable as 21% of the respondents ranked it as no.1. 17% of the respondents ranked transparency as the No.1 decisive parameter and 15% ranked as No.2. Recommendations: Considering that 71% of the people were not aware about the benefits of Health Insurance proper awareness initiatives should be taken from the Health Insurance Companies. Clients should be assisted during pre-authorizations and claims settlement by the representatives of the Health Insurance Company. Good coverage in terms of Medical Benefits should be inbuilt in the policy without any loading premiums. Transparency regarding the terms and conditions, exclusions, waiting periods at the point of sales is also an important decision parameter for buying a policy. Critical health risks can be covered in General Health Policies with a specific waiting period.As 46% of the respondents are Private/Govt. Employees, Group Policies for corporate tie ups should be also be introduced.

of Panchmahal district in Gujarat. In Panchmahal the institutional delivery rate is 85.05%. Institutional delivery rate of Ghoghamba Block in which the study is carried out is 57.87% , quite below the district performance. Objectives: 1. To identify and analyze the reasons for low institutional deliveries in the most low performing block, Ghoghamba of the district Panchmahal, in Gujarat. To find out the major demand side barriers responsible for low institutional delivery rate in Ghoghamba block of Panchmahal district. Findings: The study shows that there are many prevalent myths existing in the villages due to which females deliver at home, at the same time the literacy rate of the females as well as males is very low which adds to this problem. Also more than 50% of people were living BPL and their family income are less than 10,000 per month so they cant afford the services. It is found that decision of delivery regarding the place is taken by in laws. There is a very strong association of trained and untrained dais in the villages in the block. These dais convince the beneficiaries for home deliveries so that by assisting them at home during delivery, they can earn some amount. Recommendations: Rigorous IEC activities are needed to be done to overcome these barriers responsible for substantially low institutional delivery rate in Ghoghamba.

Ab-8

Evaluation of Training Programme Conducted by State ASHA Resource Centre

Anil Rajesh Dungdung Keywords: ASHA Training Programme, Evaluation of Training, NRHM Objective: The study was done to assess and evaluate the ASHA training programme. Methodology: The investigator has made an effort to evaluate the training programme by making field visits to 3 districts, observation of cascade model of training and questionnaire method based on certain criteria such as level of attendance etc. Findings: Its main responsibility has been successful implementation of the ASHA training programme so as to make the ASHA, the

Ab-7

Analysis of Low Institutional Delivery Rate in Ghoghamba Block of Panchmahal District in Gujarat

Anamika Keywords: Institutional Delivery, Institutional Delivery Rate, Low Institutional Delivery Background: This study aims to find out the major demand side barriers responsible for low institutional delivery in Ghoghamba Block

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backbone of health care system in Assam. For this, it has recruited community mobilizers, which has been actively involved in providing training to the ASHA facilitators, who in turn, train the ASHAs in their respective villages. The ASHA training programme has been following the TOT model of training for ASHAs in the state of Assam. So far it has conducted 4 TOT, to provide trainers in the respective districts. The total no. of trainers as of March 31, 2010 were 111.These trainers in turn have been conducting trainings in their districts in the stipulated time given by the NRHM Assam. Finally this study opens up avenue for further research, on ASHA training programme so as to assess, its long term impact on the healthcare system of the state of Assam. Limitations: This study does have certain limitation which has also been mentioned.

Ab-9

Training Need Assessment (TNA) on Health Management Information System (HMIS) of Sub Centre Level Health Workers (ANMs and LHVs) of Government of Bihar

Anisha Saxena Keywords: Health Management Information System, HMIS, Training Need Assessment, Health Workers, ANMs, LHVs, Sub Centre Level Objective: This study was undertaken in order to upgrade the skills of the health staff at different levels as well as to know the status of HMIS in the state, with perception on HMIS from officials at district and block level and also the training needs of the health personnel. Methodology: The study was conducted in 9 zonal headquarter districts of Bihar including; Patna, Saran, Muzaffarpur, Purnia, Saharsa, Gaya, Munger, Bhagalpur and Darbhanga. The time frame of the study includes data collection simultaneously in all the districts by nine zonal coordinators of IIHMR, Patna office. A semi-structured schedule was prepared for interviewing health workers at Sub center level, which also included some qualitative aspects of the study. Findings: The study was conducted in 9 zonal headquarter districts of Bihar including; Patna, Saran, Muzaffarpur, Purnia, Saharsa, Gaya, Munger, Bhagalpur and Darbhanga. The study has shown that about 33% of ANMs (age group more than 45 years) are the permanent staff

who find it difficult to collect data and prepare reports. The contractual ANMs are young but they do not have any kind of training on data collection and reporting. During the informal interaction, it was felt that there was displeasure among the senior ANMs as they had been on the same post since the time of recruitment. There has not been any kind of promotion at their level and this has decreased their motivational level regarding work. It was found that post of LHV in most of the blocks is vacant and thus there is absence of handholding of ANMs at the field level, which can again cause problems in obtaining support from higher authority. The major problem felt by the ANMs is lack of understanding of the formats since there are so many formats present at their level. Knowledge about their activities 90.2 % had a positive answer but when asked to list out their activities then out of all their job responsibilities maximum percentage of 70 % were for maternal health and immunization respectively. About 90 % of the ANMs just collect data for the sake of completion of monthly reports which they have to submit monthly. About 31% of ANMs had problems in maintaining the registers and the major problem is found to be lack of understanding. The results show that only 29% of the health workers have ever received training on HMIS in past and 71 % has no idea about HMIS which is a major point of concern. Recommendations: Through discussion it was brought to light that the HMIS system of Bihar is in a developmental phase, which needs training of personnel in order to develop a strong base for quality data generation. Some aspects which require immediate attention include duplicate system of reporting in many districts leading to nonuniformity of reports generated. The need for a support system, especially at field level in order to improve the data quality parameters is highly recommended.

Ab-10 Immunization Coverage in Mahadalit of Jamui District Bihar: A Feedback to Programme Manager Arunabh Ray Keywords: Immunization, Mahadalit Community, Health Indicators Background: This study discusses the use of trends in immunization coverage data in Mahadalit Community in Jamui District in Bihar. The study argues that these should be used as a proxy for monitoring overall

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health indicators in most vulnerable group of the society. This also discusses the need for special attention regarding the immunization in the Mahadalit community. Objective: In order to monitor progress in achieving this objective, immunization coverage, if measured annually, can serve as an indicator of a health system's capacity to deliver essential services to the most vulnerable members of a population(in this study children of Mahadalit community. Finding: This is the most socially and economically backward community and the health indicators, literacy, living places are in very poor shape. Partial Immunization is around 50 percent in this community. Illiteracy is around 92 percent and only 7 percent populations are using toilet facility. Recommendation: By protecting infants from VPDs, immunization significantly lowers morbidity and mortality rates in children. The security provided to families can lead to lower birth rates. This study concludes with recommendations that urge for special emphasis and planning to increase immunization coverage and overall development of Mahadalit Community.

Methodology: The secondary data for 5EU countries and India was collected for comparison from various sources. The findings were compared on various parameters like donor policy, organ allocation criteria, reimbursement, waiting list and role of transplant coordinators. Findings: Spain is the most evolved market due to its policies and effective implementation of the same with the donor population of 33.8 per million populations. Specific agencies in 5EU countries look after the transplant related affairs where as in India there is no such organization that is completely functional and maintains the organ related transplant data. In India opt-in system of donor policy is followed whereas in 5EU countries they follow the opt-out policy. This supports the deceased donation of organs and brain deaths. There are hurdles in sharing organs between government and private hospitals in India. Where as in 5EU countries there is a channeled sharing of organs between different regions All the 5EU countries have reimbursement schemes for the transplant procedure and also for the lifelong immunosuppressant usage by the government which is lacking in India. In India transplant coordinators roles are not defined, whereas in 5EU the transplant coordinators have a well defined role of procurement and allocation of organs in hospital. In Indian immunosuppressant market it is 1.6 billion rupees i.e. 35.83 m USD which when compared to the 5EU market it is less than the half of sales of monoclonal antibodies class of drug only. Recomendations: The shortage of organs can be reduced by promoting deceased organ donation with presumed consent awareness programmes to the public. If only 5% of all the deceased patients go on for donating their organs then there would be statistically no requirement from the living donors. The government can also make a policy to donate organs of brain dead patients. National insurance policy can be introduced so that the patients can afford the procedure and lifelong immunosuppressant therapy. An organization or society should be given the task of keeping the country related transplant data records. The transplant coordinators to provide the counseling to the living donors as well as relatives of brain dead donor must be appointed in various hospitals.

Ab-11 Comparison of Organ Transplant Scenario in 5EU and India w.r.t Health Care Reforms and Immunosuppressant Therapy
Deepa Raina Keywords: Organ Transplant Scenario, Health Care Reforms, Immunosuppressant Therapy. Background: The paper discusses the organ transplantation that takes place in India. As per the data available total of road accidents in India is roughly 90,000 per annum. Approximately 4000 transplants take place in a year. These organs are taken from living donors and not cadaver donors. Objectives: To compare the existing system of organ transplant in India with that of 5EU ( UK, Spain, Italy Germany, France) countries. To analyse the existing gap between India and 5EU countries.To recommend the suggestions for future improvements.

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Ab-12 Training Need Assessment (TNA) on Health Management Information System (HMIS) of Block and District Level Health Personnel (DEO/BHE/ BHM, M&E Officer/SA and DPM) of Government of Bihar
Jaspreet Mahal Keywords: Health Management Information System, HMIS, Training Need Assessment, Health Personnel The project of Strengthening of HMIS in Bihar is undertaken in order to upgrade the skills of the health staff at different levels. Under this project, the study was undertaken in order to know the status of HMIS in the state, with perception of HMIS from officials at district and block level and the training needs of the health personnel. Methodology:. The study is exploratory in nature with both aspects of Qualitative and Quantitative research methodology. The study was conducted in 9 zonal headquarter districts of Bihar including; Patna, Saran, Muzaffarpur, Purnia, Saharsa, Gaya, Munger, Bhagalpur and Darbhanga. Data collection was done simultaneously from January 1926, 2010. Multi stage sampling was done as per convenience of the researcher. Various sets of semi-structured schedules were prepared for interviewing district and block level officials Findings: Block level findings were - 71% of the respondents reported the following of new reporting system (web portal system). The district HMIS feedback mechanism mainly includes weekly meets (49%) with no discussions on problems regarding reporting format. There is a duplication of reporting in many districts and lack of standardization of the state reporting formats and recording registers. Other weak areas of HMIS cited by respondents include lack of understanding of the formats by the ANMs (38%), Data entry operators unaware of the basic concepts of health data, problems in internet connectivity (22%), incomplete and late reporting by field level workers, untrained new staff (80%), data used majorly for report preparation only (73%) and low number of data quality checks (53%) due to high workload of block level data officials. The need for HMIS training is felt by 91% of respondents and mostly on all components of HMIS. The weak areas of district level HMIS as perceived by district personnel were similar to those of block level. The content analysis of the NRHM monthly reporting formats of PHC level and District level data from MoHFWHMIS portal highlighted the common mistakes in filled in formats at

the PHC level, especially in immunization and Iron Folic Acid tablet distribution data. Recommendations: Through discussion it was brought to light that the HMIS system of Bihar is in a developmental phase, which needs training of personnel in order to develop a strong base for quality data generation. There is need of training for block level workers especially for improvement of data quality and importance of use of data as information in decision making and planning. We also require handholding of the field level staff for better data generation, regularize the logistic supply and improved internet connectivity at block level and strengthening of the monitoring system regarding HMIS on field.

Ab-13 Factors Governing Contraceptive use in the Northeastern States of India

Jaya Swarup Mohanty Keywords: Contraceptive Use, Northeastern States, RCH Objective: The study was conducted to have an understanding of the various factors that are responsible for contraceptive use, as there was variation in the TFR in eight different states (Arunachal Pradesh, Assam, Manipur, Meghalaya, Mizoram, Nagaland, Sikkim and Tripura). Methodology: Data of RCH round 2 was analyzed in this study. First a bivariate analysis was done followed by a binomial logistic regression. The use of contraceptives was taken as the dependent variable and the predictors were religion, caste, place of residence, standard of living index, years of schooling of respondents and their husbands, sons ever born, children ever born, age at consummation of marriage, marital duration and awareness for temporary methods of contraception. In the first bivariate analysis the background variables were analyzed against the awareness about the female sterilization, male sterilization and other modern methods of contraception. In the second bivariate analysis the awareness variables were clubbed together with the background variables and were analyzed against current use of contraceptives. In the logistic regression current use of contraceptive was used as the dependent variable (contraceptive use =1 contraceptive non use =2) , to identify the predictor variables related to socioeconomic, demographic factors governing its use among the people of the eight different states under study. Two models were used to

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demonstrate the effect of awareness regarding temporary methods of contraception. The first model used only those background variables which showed significant association with current use of contraceptives. In the second model awareness was clubbed together with background variables to observe effects on the current use of contraceptives. Findings: The major result that could be interpreted was the significant effect of primary education of both respondents and husbands on the use of contraceptives. The other factors that were significantly affecting the use of contraceptives were religion, caste, place of residence, standard of living index, sons ever born, children ever born, age at consummation of marriage, marital duration and awareness of temporary methods of contraception. It was found out that not all these factors were significantly affecting the contraceptive use in all the states. The result of the study confirms that to significantly increase the contraceptive use in the North east part of India, the prevailing policies and acts of the Government of India are enough if implemented in the right spirit and with firm conviction.

reasons behind non compliance of the referral system and to suggests way to improve the referral system. Methodology: The research approach adopted for the study was a descriptive method. It includes informal interviews with doctors, patient counselor, ward incharges & DPC and study of referral records. Findings: In the month of January, February and March cases referred to district hospital form 0.025 %, 0.037% and 0.081% respectively and cases referred from district hospital form 0.50%, 0.46% and 0.37% respectively of total OPD. Average percentage of referred cases from different CHCs of district Rajsamand to tertiary care hospital in January, February and March is 0.47% , 0.42%, 0.31% respectively of the total OPD. Recommendation: The findings points towards two things: One is the referral cases are very less and secondly the referral system is not being followed. An effective referral system has to be designed by focusing on three important areas: the structure of referral system, management coordination and quality improvement.

Ab-14 Study on Implementation of Referral System in District Rajsamand

Jyoti Meena Keywords: Referral System, Health Facilities, Quality Improvement Background: With the up gradation of health facilities provision of additional inputs, and enhancement of skills of service providers it is expected that the health facilities would comply with the requirements of the clients. The utilization of these institutions depends upon the flow of the patients from the outreach areas. Referral at appropriate institutions will reduce the gap between illness and seeking treatment and out-of-pocket expenditure. The institutions below district level would be able to screen the patients, limiting the load on district hospitals. However, the above investments could really bring forth the desired results if only they are backstopped by an effective referral system. Usually between 5 and 10% of patients seen in the PHC/CHC will be referred to a higher level for either diagnostic or more specialized care. Objectives: The main objectives of the study were to study the existing structure of the referral system in the district Rajsamand. To study the

Ab-15 Assessment of the Knowledge and Attitude of Participants, Pre and Post Capacity Building Training for Village Health and Sanitation Committee in Chittorgarh District of Rajasthan
Kiran Madhukar Narkhede Keywords: Capacity Building, Village Health, Management Structure, Knowledge and Attitude Background: The Village Health & Sanitation Committee (VHSC) is a simple and effective management structure at the lowest level, comprising representatives from the village. Its key function is to prepare the village health plan, implement it and manage the fund which is earmarked as per the need of the community. Objective: A small scale Knowledge and Attitude survey was conducted during (Pre and Post) trainings of participants for Block TOT of Village Health and Sanitation Committee capacity building training for in Chittorgarh district of Rajasthan. The purpose of the study was to assess the level of Knowledge and Attitude of the participants, before

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and after the VHSC training sessions and develop recommendations for future implementation of VHSC trainings in other states in India. Methodology: The study was carried out for 11 blocks of Chittorgarh districts of Rajasthan. Survey conducted of all trainees pre and post training. Convenience sampling was used. Closed ended self administered questionnaire was prepared for the survey. Sample achieved was 34. Findings: It was found that, the knowledge and attitude improvement was significant in each area of trainings. Knowledge and attitude has been improved in every aspects of the training. So it is quite obvious that pre-training the answers were distracted towards many options but post-training responses were accumulated to the correct response Medicine at PHC is out of stock should be informed to block CMO as a advocacy protocol. 79% pre and 85% respondents post training were for block CMO. Recommendation: The survey reveals, Training is the effective tool for the better functioning of VHSC. The knowledge and Attitude can be improved by effective training sessions. Study can help and provide data support to develop modus operandi for future implementation of the VHSC trainings in other states in India. Information from this survey shall be helpful for the other states to focus on the problem areas and re route resources to conduct the VHSC trainings.

Objectives: The goal of this study is to assess IMNCI implementation in Valsad district of Gujarat to strategize for accelerating effective implementation. Methodology: For this data from IMNCI format filled on district level quarterly and compiled yearly have been used for this study .we are going to assess the implementation of IMNCI on the basis of mortality pattern , morbidity pattern, and case management skills of the heath staff. Findings: The number of infant death reported has increased in both the age groups 0-2 months and 2 months-5 years after the implementation of IMNCI in Valsad district especially in the two tribal blocks of Valsad District i.e. Kaprada and Dharampur,due to prompt reporting from the health staff. Number of children, identified as sick, followed-up, referred to a health facility shows increase. Percentage of reported LBW babies has increased since 2008 to 2009 due to proper weighing done by health worker. Morbidity due to diseases has been reduced from 2008 to 2009.

Ab-17 Evaluation of Functioning of Rogi Kalyan Samiti and Utilization of RKS Grant Received byPHC in the District Navsari, Gujarat (Financial Year 2009-10) for Improving the Standard of PHC Minu Manuhar Sinha Keywords: Rogi Kalyan Samity, RKS Grant, PHC, Decentralized Funding Objective: The objective was to study the functioning of RKS in the districts Navsari, Gujarat and to understand the process of decentralized funding and the provision of providing untied funds at the peripheral level (Primary Health Centre) from the central level. The study also focused on the structure and functioning of RKS in health facilities, the utilization of funds by RKS and to assess the facilitating and inhibiting factors affecting the functioning of RKS. To study the improvements made at the facilities and services provided for the purpose of improving standards. The study also identified all possible strength, weakness, opportunity and threat that is involved in proper utilization of the provided funds. Methodology: The study was a cross-sectional descriptive study done

Ab-16 Performance Assessment of IMNCI in District Valsad

Mansi Shekhar Keywords: Integrated Management, Neonatal and Childhood Illness, IMNCI, Performance Assessment Background: During the mid-1990s, the World Health Organization (WHO), in collaboration with UNICEF and many other agencies, institutions and individuals, responded to this challenge by developing a strategy known as the Integrated Management of Childhood Illness (IMCI). This strategy has been expanded in India to include all neonates and renamed as Integrated Management of Neonatal and Childhood Illness (IMNCI). To start this scheme in India, it has been decided to start its implementation in BDCS focused districts .district initially with support from UNICEF. So in Gujarat state it has been started in Valsad.

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in the PHCs of district Navsari of Gujarat. 50 % PHCs were identified from the district. Simple random sampling technique was adopted as sampling design and Non Probability sampling was done on convenience basis for the selection of Client in the hospitals. Predesigned and pretested interview schedule was used for data collection from the study subjects. The study subjects were RKS members ( Medical Officer of the PHC and Kerawani Nirikshak ) and clients (20% OPD and 10% IPD patients). Quantitative data were entered and analyzed using Microsoft Excel. Findings: It was observed that the RKS existed according to guidelines at all the PHCs. A shortfall of members was however, noted. The flow of the central grant of Rs. 1, 00, 000 was found to be smooth. The received funds were mainly utilized for development of physical facilities and infrastructure of the PHCs, provision of basic facilities for the patients, purchase of medicines, development of basic laboratory facilities and transportation. The expenditure however is below the mark in absence of predefined protocols. The facilitating factors for the smooth functioning of RKS include involvement of health personnel in the top management, uninhibited flow of grants annually and peoples involvement in decision -making. The inhibiting factors for the same are multifaceted: ranging from non -availability of proper expenditure guidelines to involvement of unmotivated members burdened with additional responsibilities, as also low knowledge and awareness levels among the community. Most of the community members and clients were not aware regarding existence and objectives of RKS in the health facilities, but they reported some improvements in the quality of the health services within 2-3 years. However, most of the community members were not satisfied with the provision of good quality of medicine, availability of specialist care, high referral rates and higher investigation. Recommendations: Proper guidelines for expenditure of funds should be framed, and audit mechanism defined. The barriers to the effective functioning of RKS may be identified at the earliest and effective measures to eliminate those may be initiated. Additional incentives for additional work should be provided to the RKS members. Increase community participation and have more informed clients. Sundry Fund is to be maintained at PHCs for emergency. As there is no feedback mechanism hence, it is recommended for the development of a proper mechanism related to the decisions taken during the meetings of the RKS members for the effective implementation.

Ab-18 An Assessment of Mamta Diwas Programme in Urban Slums of Junagadh Municipal Corporation, Gujarat
Mohit Sharma Keywords: Mamta Diwas, Urban Slum, NRHM, Maternal and Childhood Health Background: For providing effective coverage for maternal and childhood health and nutrition Mamta Divas was launched by the Department of Health and Family Welfare and Department of Women and Child Development, Government of Gujarat. Mamta Divas programme was launched under NRHM, R.C.H-II that is considered as platform for inter-sectoral convergence. Objective: The present study was conducted in the urban slums pockets of Junagadh city, under Junagadh Municipal Corporation, describing the effectiveness in the implementation and utilization of the services given during Mamta Divas. This study was done to assess the implementation of Mamta Divas on the targeted mothers and children and to study various factors related to knowledge and awareness of the programme in the urban slum pockets of Junagadh city. Methodology; This qualitative research study was done in urban slums for looking into various issues and components related to Mamta Divas. Under this study, the service delivery, the knowledge and attitude of the community with the factors responsible for the utilization of the services of Mamta Divas was studied. A total of 60 Mamta Diwas sessions were visited for the survey and 150 mothers those who are either in their antenatal period or having a living child under 0-3 months were interviewed in the survey these respondents were selected using the Multi stage sampling based on 30 clusters methodology. In step 1, 30 clusters were selected and in next step 5 sample units were selected from each cluster. The level of utilization of the services provided at the Mamta Divas, the determinant factors against the knowledge and utilization of services were also identifies. Research tool is interviews with target population, questionnaires for the service providers and beneficiaries and checklists for the assessment. Findings: Study emphasis on effective and efficient implementation in order to overcome loopholes of procedure .This Study reveals major issues related to the implementation of Mamta Divas Programme in urban slums, that prevents better out-reach to beneficiary. It was

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evident from the findings of the study that there was lack of monitoring and supervision activities by the higher cadre, which brings irregularity in the working & reporting of field staff. A large chunk of the population are aware of the Mamta sessions, but still no visits are done because of the reasons like familys apprehensiveness and lack of belief in the health services. Recommendations: Regular and focused IEC activities are required so as to elevate community belief in the need for antenatal and post natal care. This study may prove useful in chalking out targeted interventions for the Mamta Diwas.

Findings: Nalanda is a second best performing while Samastipur and Madhepura are poor performing districts. Selection of the three districts is based on the number of institutional deliveries in the district. The districts will be ranked based on the number of institutional deliveries against expected deliveries using HMIS* data. The second best performing and lowest performing districts will be selected. In addition the district with second highest percentage of SC/ST population will be selected to understand issues of social exclusion. The reason for selecting the second best and lowest is to exclude the outliers.

Ab-19 JBSY (Janani Baal Suraksha Yojana) Evaluation Study in Bihar

Neha Dumka Keywords: Janani Baal Suraksha Yojana, JSY, NRHM, Safe Delivery, Health Facilities Background: The Janani Suraksha Yojana (JSY) is a centrally sponsored intervention under the National Rural Health Mission, with the objective of reducing maternal and neo-natal mortality. The JSYs main strategy is the promotion of institutional delivery by empowering and enabling women to access safe delivery in health facilities. The mechanism is the provision of a cash entitlement to the family and an incentive to the ASHA. Objective: An Evaluation study of Janani Baal Suraksha Yojana was conducted in Nalanda, Samastipur and Madhepura Districts of Bihar state. Methodology: JSY enumerates 83.78 lakh beneficiaries, and the expenditure under this head is now over Rs. 1241 crores. Both the number of beneficiaries and expenditure on this scheme continues to increase steeply and there is little clarity on where this will plateau. The central guidelines for the JSY to the states set out clear directions on the administrative and financial mechanism for the scheme. However JSY has been interpreted and implemented in a variety of ways across the states, not necessarily in contradiction to the guidelines, but based on individual state contexts, field reality, and the perceptions of administrators and service providers. Outcomes in the states also vary substantially.

Ab-20 To Assess the Service Delivery of IPHS Upgraded and Non IPHS PHCs in Gondia District, Maharashtra
Neha Maheshwari Keywords: Services Delivery, Services Utilization, PHCs, IPHS Background: The flow of patients has been increased over time. Hence, it became extremely important for the management executives to find out the service delivery and service utilization pattern in the district so that they can upgrade rest of the PHCs through IPHS in the second round. Objective: A case control study was carried out with the objective of seeing the effects of IPHS standards in the PHCs of Gondia district in Maharashtra which were upgraded through IPHS in 2006-07 in the first round. The cases were the PHCs upgraded through IPHS and controls were the PHCs yet to be upgraded through IPHS. The specific objectives of the study were to understand the present service utilization pattern and the change in service utilization at PHC level. Methodology: Data was collected for service coverage and service utilization pattern in terms of OPD case load, Indoor case load, delivery service and investigations performed. Observations were done for the availability of inputs like provision of doctors and health workers at PHCs, infrastructure development, provision of potable water and electricity in the PHC. Also survey of health facilities under study was done with the checklist of standard guidelines provided by IPHS. Exit interviews were taken from the women who delivered in the PHC and the OPD patients. Questions incorporated in the schedule were mainly directed toward the inputs provided to improve quality of services.

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Findings: The findings of the study show an improvement in the utilization of the services being provided. The indicators in both the study groups show progress. But IPHS PHCs are running ahead. The main reason may be ascribed to the provision of additional qualified man power to the upgraded PHCs. It can be inferred from the data available and interrogation with the staff and beneficiaries that the increment in service utilization may be ascribed to provisions of extra facilities to the IPHS PHCs. The IPHS PHCs under study are well equipped with the basic facilities suggested by the guidelines. Manpower remains the most important issue in both the types of PHCs. Staff nurses and ANMs are unavailable in far flunked areas.

their working, since the workers knew that someone was coming to monitor them they remain present at the sessions otherwise whole burden was on FHWs shoulders. The availability of staff especially MPHW (only 2 were present out of 9) & ASHA (only 5 were present) in the district was a major problem. The district report from past 6 months showed that there are some improvements in the services, for e.g., the number of cases identified and referred for ANC had increased during the months when the project was running. The same improvement was been tracked in child status also. Moreover financial assistance to anagnwadi workers had also started. Recommendations: The supervision activity had played a supportive role in implementing and designing mamta sessions effectively and efficiently. But the focus should be given to those elements which plays underlying role for e.g. the staff, sources of motivation as well as the financial support.

Ab-21 Effect of Supervision on Service Delivery at Mamta Diwas in Vallabhipur Block of Bhavnagar District
Nidhi Jain Keywords: Mamta Diwas, Service Delivery, Supervision Background: Mamta diwas is exclusively designed concept to improve the health of mother and child. But the proper implementation is a must to achieve the desired goals. Mamta sessions have been going from years and as the time passes monitoring and supervision of sessions are not taking place. No supervison is there to check whether the services being provided are in a proper way or whether all the services that are meant to be provided are given to the beneficiaries or not. Lack of supervision is hampering the effectiveness of these sessions. Objective: To find out exactly how supervision will improve the services an intervention was done in Bhavnagar district. A block, Vallabhipur was chosen to see the effect of increased supervision of mamta diwas. All the sessions were supervised and on the spot training was also given wherever required. Maximum coverage was ensured, as well as all the essential equipments, drugs, stationary was also provided. The supervisors were given supervisory checklist and interview with the beneficiaries and service providers. Findings: As per the supervisory checklist required set up for mamta diwas was present at the centers but effective execution is needed at all levels. All the service providers felt that the project had helped a lot in

Ab-22 Gender Bias and Status of Women in Nuh and Tauru Blocks of Mewat
Nidhi Vats Keywords: Gender Bias, Women Health, Women Status Background: Women form the backbone of any society and deserve an equal status in the society as that enjoyed by men. But women are excluded from social, economic and political spheres of society. Objective: The study was conducted to understand the social status of women in the community of Mewat in Haryana. Mewat is predominantly a rural district in Haryana. The health indicators in Mewat especially for women are particularly dismal. The area lags behind the rest of Haryana on almost every yardstick of development indices. Methodology: The study is qualitative and focus group discussions were conducted with various stakeholders mainly women to obtain information and understand the needs of the community about current practices, communication media and beliefs regarding role of women in the society. Focus group discussions were conducted in villages of Nuh and Tauru Blocks in Mewat district.

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Findings: The findings reveal that in Mewat, by and large in the societies of both the religious groups, girls are less wanted in the family compared to boys. Education of girls is not preferred by the Meos and girls get married at an early age. Women have been found to have no say in the decision making process of the families. Men take all the major decisions of the family as well as all the decisions regarding number, timing and sex of children. As women have no autonomy to take decisions for themselves, it is crucial to involve key stakeholders, men, mother-in-laws and community influencers such as Maulvis in the project. Also, education is one of the means to empower the women with knowledge, skills and self-confidence necessary to participate fully in the development process. Hence, emphasis on female literacy is essential. Recommendations: Door-to-door interaction with both women and members of the family is the suggested communication media for achieving the overall objective of the project.

utilization of this scheme. Methodology: Study population is the BPL population of district Jhunjhunu. Secondary data was from the data available from online reporting. Primary data was taken from questionnaire filled by a sample of 90 patients coming to the district hospital. Findings: During the study, it was revealed that the BPL populations awareness about various features of the scheme is limited in JJN. Wages loss is a major factor that affects the care seeking behavior of BPL population. The poor report (slightly) greater illness (high OPD) but are much less likely to use go for treatment(low IPD); they are more likely to self treat and much more likely to do nothing.

Ab-24 Analyzing the Functioning of Adolescent Friendly Health Services (AFHS) Centre at PHC Sadhi, Block Padra, Gujarat
Puneet Gupta

Ab-23 Factors Affecting Utilization of Chief Minister BPL Jeevan Raksha Kosh
Poonam Yadav Keywords: BPL, Jeevan Raksha Kosh, Millennium Development Goal Background: Millennium development goal represents the international consensus on improving conditions that affect the poor. To achieve the MDG, government health policies need to focus on poor population of India. With low literacy levels, poor health information and often persistence of traditional beliefs and superstitions, the poor are ill equipped to make rational choices in health related matters. To make health facility available to BPL families, free health care model is adopted by Rajasthan government called as Chief Minister BPL Jeevan Raksha Kosh(CM BPL JRK). The scheme was envisaged during the year 1999-2000 by the then Rajasthan Government headed by Ashok Gehlot, CM Rajasthan. It came into implementation from September 2009. CM BPL JRK was launched in all the districts at one go. Under this scheme free treatment facility, both indoor and outdoor is provided to BPL familys patient in all government Health Institute in the State. Objectives: This study is an attempt to identify the factors that affects

Keywords: Adolescent, Friendly Health Services, AFHS, Health Services Background: Adolescents account for almost one third of India's population. They are prone to suffer from reproductive and sexual health, nutritional, mental and behavioral problems. Health services which cater exclusively to the needs of adolescents are scanty and concentrated in urban areas. Adolescent Friendly Health Services (AFHS) which provide a broad range of preventive, promotive and curative services under one roof can help to ensure improved availability, accessibility and utilization of health services. AFHS is being initiated by governmental, private and non-governmental organizations. Lessons to improve the quality of AFHS could be further learnt from evaluation of pilot projects and success stories of similar initiatives in other places. Objective: Adolescent Friendly Health Services (AFHS) introduced in Vadodara district, Gujarat state as a pilot project at PHC Sadhi, Block Padra. Services started w.e.f. 9th March 2009 and a separate compound was designated as the centre for providing AFHS. Block Padra a highly industrial area showing high no. of migratory population. PHC Sadhi was made a 24x7 PHC. The PHC has a good linkage with school staff. The services being rendered at the Adolescent Friendly Health Services Centre at PHC Sadhi were being assessed as the study objective.

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Methodology: The population of the adolescents covered was 4071. Questionnaire was developed to assess the clients perspective (adolescents) as well as the service provider (staff at the centre trained to provide services).The data was secondary in nature and was collected from registers maintained at the AFHS centre Visits were undertaken to the AFHS centre established within the premises of the PHC at Sadhi (Block Padra). Adolescents visiting the centre were interviewed as also the medical officer at PHC. The other staff providing the services at the centre was also interviewed to have an overview of service-providers perspective, the client (adolescents) perspective. Findings : The services provided at the AFHS centre at PHC Sadhi were grossly underutilized. As compared to boys the number of girls reporting to the centre was considerably lower mainly due of cultural barriers and lack of a regular female counselor. A wide communication gap existed between parents and their adolescent children and also between school teachers and the school going adolescents. Hence, the adolescents sought information mostly from peers and media. The adolescents visiting the centre were satisfied with the quality of services being provided. Though mostly preventive services were used, but a few of them sought curative services for sexually transmitted infections from the Medical Officer at PHC or the visiting Gynecologist. The preventive services on the other hand, mainly included counselling for general issues and contraception. Recommendations: The situation analysis suggests that there is an urgent need to address the problems related to adolescence by providing services specifically catering to this age group. A relevant response would be to equip them with appropriate knowledge, skills, attitude, and support for self advancement. Sensitization of parents, school teachers and civic society is an important step to set the stage for the healthy growth and development of adolescents.

health care to all. The Mission proposed architectural amendments in the health infrastructure while introducing a new community based cadre designated as Accredited Social Health Activist (ASHA). ASHA was proposed to work as a change agent and will act as a link between community and the health service provider. The proposed role of ASHA was to provide primary medical care, advice the villagers on sanitation, hygiene, and antenatal & post natal care, escorting expectant mothers to hospital for safe delivery etc. Objective: ASHAs are working in the villages since last five year no systematic study has been conducted to evaluate the performance of ASHA in the district Dahod. Therefore the main objective of the study was to assess the gap in functioning of the ASHAs and then suggest steps for improvement. Methodology: To assess the objectives, a cross sectional study with 40 ASHAs, who served at least for one year, was conducted in two block of Dahod district. Interviews were also conducted with ANMs and AWWs to assess the coordination level of ASHAs with them. An interview schedule was used to conduct the survey. Findings: Results from the study show that ASHAs were selected based on their qualification and experience through personal interviews. Being a tribal district, majority of the ASHAs in the block were young and more educated against proposed criteria. Half of the ASHAs were serving village with population more than 1000. Majority of the ASHAs received training on two initial modules only. The level of knowledge about the role and responsibility was poor among ASHAs. Primarily ASHAs focused on incentive related activities like institutional delivery, Immunization, and ANC/PNC services. They were reported to be satisfied with their job. However, they were unsatisfied with the irregular distribution of monthly honorarium. Approximately half of the ASHAs did not possess the Drug Kit.

Ab-25 Assessment of Functioning of ASHA in District Dahod

Ram Krishna Kumar Keywords: ASHA, NRHM, Primary Health Care, Health Services Background: National Rural Health Mission was launched to provide accessible, accountable, affordable, effective and reliable primary

Ab-26 HSS Data Analysis of HIV/AIDS in Sentinel Group of Rajasthan

Richa Chaturvedy Keywords: HIV/AIDS, HSS Data Analysis, STI, HIV Sentinel Surveillance Background: HIV Estimates for Rajasthan are erratic it has been

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described as a highly vulnerable, high priority state. Given the current level of knowledge regarding sexually transmitted infections (STI) and sexual behavior, particularly among vulnerable sub-populations, there are strong indications that Rajasthan is indeed a highly vulnerable state. Objective: The objective of this report is to study the HIV /AIDS prevalence rate among sentinel groups in the State of Rajasthan and develop the strategy to strengthen the HIV/AIDS programme in the state. Methodology: HIV Sentinel Surveillance (HSS) system involves carrying out cross-sectional studies, to collect the data for ANC, FSW, STD sentinel groups. This study is based on the secondary data which was collected during the district Epidemiological profiling of HIV/AIDS scenario in Rajasthan at SIHFW from RSACS, NACO and District officials at various districts which were appointed for DEP Project. Findings: The main outcome of this study is, HIV is more prevalent in 20-29 yrs age group and in rural area. HIV prevalence in ANC sentinel group in less than 20 years age group is 0.2%, in 20-29 year age group 1.6%, in 30-44 age groups 0.3% and 0.1% of the Urban and 0.3 % of the Rural Population is HIV Positive. FSWs are more prone to HIV positivity in the age group of 20-29yrs, 1.88% of the Urban Population and 4.73 % of the Rural Population are HIV Positive. In STD clinicsAge group, 2.6% of males and 3.1 of females are positive. Recommendations: Suggested to organize awareness camps, volunteers and target intervention groups for working for the upliftment of FSWs. The ANC attendees should be benefitted through counseling and future treatment with ART. The STD patients need to be informed about their vulnerability to Contract HIV/AIDS, treatment and timely advice are most important.

The study also suggested some amendments in the strategies to manage the existing problem of non adherence to ART. Methodology: Exit interviews were conducted to assess the clients satisfaction level at the Link ART Centre and ART Centre which in turn reflects the quality of services provided by the Centre. Situational analysis of Link ART Centers was undertaken by a comprehensive assessment of space allocated to LAC, human resources, materials and other facilities available in the selected Centers. Facility tool was prepared for this purpose. Relevant information on utilization of services in selected LACs was obtained through the available records and registers maintained by them. Findings: ART Center has improved access to rural population. The occupational distribution of clients employed in the 12 months preceding the survey shows that majority clients were agriculture/ unskilled worker. Nearly one fourth of the clients were students, housewives or unemployed. The awareness regarding the services available in the center was found to be high among the clients of ART Centre. The study reveals that 65 percent of the clients reported improvement in the quality of life to a great extent after using services at LACs. Method used for counseling is one of the most critical steps of high quality counseling. Recommendation: Improved accessibility of Anti retro viral treatment through LAC has definitely increase the regularity of PLHA for HIV treatment which is most significant component of drug adherence. There is need for taking a decision on provided ART services (through ART centers or LAC) in each district of the country to attain optimal level of adherence. Facilities for CD4 count at LACs will further facilitate PLHA including new registrants. Better linkage and feedback from nodal ART center and DAPCU wherever set up is also recommended.

Ab-27 Clients Perspective on Assessment of HIV Care Services: ART Center vs. ART Center
Rit Shukla Keywords: HIV/AIDS, ART Center, HIV Care Services, Clients Perspective Objective: The Study was conducted to study the perception of clients towards the HIV care services provided at ART Centre vs. Link ART Centre as well as to understand the level of adherence of PLHA to ART.

Ab-28 Assessment of EmOC Services in Kachchh District, Gujarat Sabyasachi Mohapatra Keywords: EmOC, Child Survival, Safe Motherhood, RCH Background: The EmOC strategy was adopted in India in 1992 under the Child Survival and Safe Motherhood (CSSM) project (funded by the World Bank and UNICEF).

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Objective: This program specifically focused on development of comprehensive EmOC centers throughout India. The focus continued in the subsequent program (19972004, also funded by the World Bank) with the new name of Reproductive and Child Health (RCH). However, there was little progress in establishing comprehensive EmOC centers in rural area. Methodology: A facility survey of 80 health facility providing maternity services in Kachchh was done on the conceptual framework of 5 process indicators EmOC as mentioned by Guidelines for Monitoring the Availability and use of obstetric services UNICEF WHO UNFPA August 1997 data was collected for the time period of 1st April 2009 to 31st march 2010. Findings; In total there were 49 government and private facilities which provided EmOC services .17 government and 13 private institutions that were non EmOC service providers. Number of EmOC facilities per 500000 population comes around 13.61. The distributions of these facilities are not adequate. Caesarean section services and blood transfusion services are located in urban area of Bhuj and Anjar. Proportion of births in EmOC facilities (basic and comprehensive) was 44%. Proportion of women estimated to have obstetric complication treated and delivered in EmOC facilities is 49%. The percentage of Caesarean section of total births was 3%. This clearly indicated that access to critical surgical services was not adequate.

study are based on interviews, informal discussions and Focused group discussion with 105 beneficiaries, 2 Doctors and 15 ASHAs. Findings: Number of deliveries in General hospital, Sirohi has shown a rise of more than three times after the implementation of the scheme. Same is the case with ANC coverage and TT that are showing a decline due to the non compulsion of ANC card for getting JSY benefits. Both beneficiaries and providers have a very poor knowledge about JSY but as far as utilization of services is concerned about 87 percent have undergone ANC checkup and about 92 percent have received TT immunization. No beneficiary stayed in hospital for less than a day as per NRHM guideline all has received their JSY benefits through cheques. However, services received by beneficiaries particulary through ASHA are very poor. Out of the 78 beneficiaries who aware about ASHA 30.7 percent replied that they received any kind of counseling like for breast feeding or nutritional practices, While 74 percent of the woman replied that they were neither accompanied by ASHA nor transportation was arranged by ASHA. The focused group discussion and interview from doctors state the need for some innovative measures that need to be taken for better results and success of the scheme. Recommendations: Time to time training of ASHAs is necessary. Provision of blue sarees instead of Blue coats for ASHAs to remove cultural barriers among community can be initiated., Extensive campaigning for JSY using a celebrity , Compulsion of presenting ANC card and accompany of ASHA for getting JSY benefits and provision of weighing machines for regular monitoring of pregnant mothers and some other recommendations.

Ab-29 A Study on the Implementation Status of Janani Suraksha Yojana in General Hospital, Sirohi
Sakshi Jain Keywords: Janani Suraksha Yojana, ASHA, NRHM, ANC Objective: Present study for assessing the implementation status of Janani Suraksha Yojana was conducted at General Hospital, Sirohi to study the current status of the scheme, awareness of the beneficiary, involvement of ASHA and other providers in the implementation of JSY in the hospital. Methodology: Both Primary and secondary data from beneficiaries, providers and hospital records respectively was collected. This includes Interview Schedules for beneficiaries and ASHAs, focused group discussions with ASHAs and Hospital records. Results of this

Ab-30 EPI Coverage Survey in Rural Areas of Sabarkantha District in Gujarat Shikha Bansal Keywords: EPI Coverage Survey, DLHS-3, Immunization Coverage Background: According to data revealed in DLHS-3, the percentage of fully immunized children in Sabarkantha district stands at 46.8%. In the purview of the same, a series of interventions were planned and implemented throughout the district with special focus on tribal and underserved population. Thus, a study was needed which aimed to provide current estimation of immunization coverage among the

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children of age group 12-23 months in the rural areas of Sabarkantha district to validate the success of field level interventions as well as the progress made as Gujarat celebrates its golden jubilee year. Objective: The Expanded Programme on Immunization Coverage Survey in Sabarkantha district has as its primary objective to provide up-to-date information for assessing the situation of immunization in rural areas of Sabarkantha. Methodology: the study included choosing 30 clusters out of the list of all the villages of Sabarkantha district by PPS (Probability Proportional to Size). Findings: It was found that 50.5% of children of 12-23 months were fully immunized in the district. 79% of children aged 12-23 months have received BCG vaccine. 71 % of the children received all the three doses of Oral Polio Vaccine (OPV) and only 54.3% received complete three doses of DPT vaccine. Also it was found out that 69% of the children aged 12-23 months were immunized by measles (MMR) vaccine and 65.7% received at least one dose of Vitamin A. No dropout for OPV was noticed although drop outs in DPT vaccinations were 12.3% and a total drop out 12.6 % was noticed from BCG to Measles. When compared with the district data of 2008-09, it was found that the data was over-reported. Recommendations: Regular and meticulous monitoring and supportive supervision is required at the grass root level. Planned IEC activities are also required. For example Banners in local language should be displayed at prominent sites, other field specific activities like Bhawai shows, nukkad nataks, role plays, flash cards, and interpersonal communication activities etc. Moreover, NGOs should be encouraged to accelerate activities on motivating people to bring their children for immunization. Apart from these, the Health Management Information System should be improved so that reported coverage gives true picture of the district scenario. Lastly, Sanctioned but vacant positions of the grass root level health workers should be filled so that shortage of manpower doesnt pose as a cause for inefficient working and outcomes.

Keywords: Infants Deaths, Maternal Deaths, Verbal Autopsy, MRS Background: The verbal autopsy guidelines were developed in the 1960s when the Model Registration Survey of cause of death (MRS) scheme first came into existence. The MRS later came to be known as the SCD-Rural scheme. The verbal autopsy was introduced by India in 1965, which was the first verbal autopsy based cause of death reporting system in the world. The concept of verbal autopsy as a source of cause of death information has been used in many developing areas which have poorly developed facilities for medical certification of cause of death. The Government of Gujarat has begun registration of infant deaths and verbal autopsies since 2005 2006. Infant death audit is done by Medical Officer (MBBS). Objective: To conduct a verbal autopsy audit for Infant Deaths and Maternal Deaths in Gandhinagar District. Methodology: The audit was initiated by collecting data from secondary sources. Desk Review of reported verbal autopsy of infant deaths and maternal deaths in year April 2009-March 2010 was done of Manasa Block of Gandhinagar district. Out of 97 infant deaths, 86 verbal autopsies were done and 7 verbal autopsies were done for maternal death. So the total sample size taken was 93(86 infant deaths + 7 maternal deaths). Findings: The study revealed that out of the total 86 infant deaths, maximum occurred in the first month of life. 25.58% infant deaths occurred in Low Birth Weight babies (<2 kg).The major cause of infant deaths was Respiratory diseases. It was observed that although institutional delivery percentage was high (90%), many infant deaths were seen.41.86% of deaths were cases of premature delivery. Out of total of 7 maternal deaths, 4 occurred in the age group of 15-19 years.ANC examination of the pregnant women was found to be 100% but still maternal deaths were observed. It was highly conspicuous from the study that all maternal deaths happened because of first level delay, i.e. delay due to decision making. Recommendation: All maternal and infant verbal autopsies should be reviewed in every monthly meeting at district level and the block health officer should supervise regularly how VA forms would be filled by P.H.C medical officer and FHW. Strengthening of implemented programs like IMNCI, Mamata Divas needs to be done. Home visits for

Ab-31 Review of Verbal Autopsy Reports of Infants and Maternal Deaths

Shraddha S. Rajput

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pregnant women and infant children should be made by FHW, AWW, ASHA to create awareness about various kind of health programme for maternal and child heath which requires vigorous training sessions of these people to make them more efficient and competent in their job. It is recommended to find out the important managerial and administrative inputs to improve current mortality and morbidity scenario.

Ab-32 Determinants of Maternal Healthcare Utilization in Jammu and Kashmir-a Regional Analysis Suhail Ismail Shiekh Keywords: Maternal Health, Healthcare Utilization, NRHM, Safe Delivery Background: In the current global scenario maternal health has come to be seen as an area of great opportunity for bringing about improvement by individuals and organizations working in the field of public health in developing countries. India has vowed to achieve a Maternal Mortality Ratio (MMR) of 100 maternal deaths per 100000 live births by 2015 from the current level of 254. However, this requires an in depth understanding of the causative factors affecting maternal health. The Government has taken various steps one of which in the Reproductive and Child Health (RCH) Survey amongst others to enhance the service delivery of health care like National Rural Health Mission which seeks to provide effective healthcare to rural population throughout the country with special focus on 18 states, one of which is the mountainous state of Jammu and Kashmir. The need for the study comes from the fact that in the realm of socio-economic, cultural and demographic influence, factors like religion, caste, education, standard of living, age, age at marriage, place of residence in terms of ruralurban, have significant importance on the reproductive health care utilization of women particularly on ANC and safe delivery. Objective: The study aims at examining the various factors; socioeconomic, demographic and health related, governing the utilization of two major maternal health services namely antenatal care and safe delivery for two regions of Jammu and Kashmir (J&K) i.e. Jammu region and Kashmir and Ladakh, Kargil region. Methodology: A systematic, multi-stage stratified sampling was done from data from RCH Round II. In each district, 40 Primary Sampling

Units (PSUs Villages/Urban Frame Size) were selected with probability proportional to size (PPS) using the 1991 Census data. All the villages were stratified according to population size, and female literacy was used for implicit arrangement within each strata. The number of PSUs in rural and urban areas was decided on the basis of percent of urban population in the district, with minimum of 12 urban PSUs. The target sample size in each district was set at 1,000 complete residential households from 40 selected PSUs. A total of 10308 women drawn from Jammu and Kashmir as a whole out of which 5067 belonged to Jammu region and 5241 belonged to Kashmir and Ladakh, Kargil region. A bivariate analysis was done to depict the level of any antenatal care and safe delivery practice with different socio-economic, demographic and the health variables of women. In addition, a logistic regression has been performed to identify the factors governing the utilisation parameters. Findings: It was evident from the analysis that among the socioeconomic and demographic characteristics, the factors place of residence, religion, caste, years of schooling of man and wife, household standard of living index, age, age at consummation of marriage, marital duration and number of stillbirths emerged out as some of the factors significantly associated with utilization of maternal health services. It was seen that utilization by Muslims in the state is less and so is the utilization in rural areas. Women aged 35-44 were seen to have least utilization of services. Women who had been married for less than five years were found to have the highest utilization of maternal health care services while those married for 15 years or more were found to have the least. Also, women from middle SLI strata have the highest utilization. Those women who had problems during pregnancy and during delivery were seen to have higher utilization of maternal health services than those who did not. Recommendation: Initiation of awareness programmes addressing the general populations is the need of the hour.

Ab-33 Geriatric Health Insurance: A Study in Bangalore City

Sumana Arora Keywords: Health Insurance, Geriatric Health, Elderly Background: Geriatric population is increasing rapidly both

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internationally and nationally. By the year 2040, the world geriatric population is projected to be 1.3 billion (14%) of the total population as against 506 million (7%) in mid 2008. Thus, in just over thirty years, the proportion of the elderly will double. Similarly, the number of elderly in India is also estimated to increase from 77 million in 2001 to 222 million by 2040; a three- fold increase in just over thirty years. As the morbidity levels in the elderly are high, they need good medical services. Unfortunately, the public health systems are neither adequate nor well equipped to cater to their needs. People have to spend over 70 percent of money on healthcare out of their pocket. The life expectancy being 69.2 years and most people retiring at 58 to 60 years, on an average, a person lives for 10 years post retirement. After retirement, there is a drastic reduction in the income levels. Further, the healthcare costs are also rising. It is in this context that geriatric health insurance assumes great importance. Objective: This study was carried out in Bangalore city to study the awareness of Geriatric Health Insurance among the people of the city. Methodology: It was a cross-sectional study. Primary data was collected using a structured questionnaire. The city was divided into four zones and data was collected from each of these zones. A sample size of 102 was attained. Findings: It was found that LIC was the most popular health insurance company and that the hospital network available was the most important criteria while deciding on the health insurance product. Further, the awareness about health insurance among the geriatric population is low. Furthermore, this population is largely dependent upon their children for decision making/ procedural formalities. Hence, customer awareness generation should be a part of the marketing strategy of a health insurance company; the marketing strategy should be directed both towards the target group as well as their adult children and companies providing insurance without an upper age limit should market this differentiator. The study has succeeded to a large extent in finding answers to the questions which have been brought out in the main report. This study can be a useful resource for a health insurance company entering into the geriatric market.

Management Information System (HMIS) in Sadar, Dharhara and Jamalpur Blocks of Munger
Tukaram Khandade Keywords: Health Management Information Systems, Knowledge Attitude and Practice, KAP, HMIS, Training Need Assessment Objectives: This study was conducted to know the training needs of the health workers before actual start of the training program for them. Methodology: The study area is 3 blocks of Munger district namely: Sadar, Jamalpur and Dharhara. Data was collected in two weeks in January 2010 through semi structured schedules for ANMs and LHVs with some open ended questions. The study gave results on KAP in HMIS for which training is needed. The convenience sampling was taken to match the lack of time. Analysis of quantitative and qualitative data after coding was done on SPSS. Findings: The analysis showed training needs in the following areas: Knowledge: The one-fourth of ANMs was graduated. Around 70% (N=30) of ANMs have less than five years of experience but all LHVs have more than 10 years of working experience in the health department Most of the ANMs and LHVs have taken secondary level of education besides having the basic training of nursing. Almost 38.5% of ANMs were not aware about their job responsibilities. Majority of ANMs (92.3%) and all LHVs have knowledge regarding supportive supervision. Not a single health worker has received training on HMIS. Lack of supply of registers at HSC is major problem in maintenance of records. Almost 31% ANMs faced problem in data collection. Attitude: Around 23% of ANMs didnt know the importance of data. Not a single LHV was satisfied with on job support. Every health worker feel need of Training on HMIS. Practice: About 33.3% LHVs didnt utilize their data. Around 10 % of ANMs dont have any idea how to calculate the stock of vaccines. Estimation of pregnant women, OCP users, condom users was done through information from register or AWWs/ ASHAs. Health workers were not aware of advance data usage for their level eg. To know her coverage area. Recommendation: From the finding we can easily conclude that ANMs and LHVs need training in the areas like Knowing and understanding job responsibilities; Registers to be maintained at the HSC; Knowing supportive supervision; Training on HMIS; Understanding importance of data; Training on HMIS; Utilization of data; Calculation of stock TT; Calculation of expected target pregnant women; Calculation of coverage Immunization.

Ab-34 Training Need Assessment (TNA) of Health Functionaries of Government of Bihar in Knowledge Attitude and Practice (KAP) in Health

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Pharmaceutical Management

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Renal Cell Carcinoma: Therapeutic Segment Outlook and Pipeline Analysis in Evalueserve, Gurgaon

Ginni Kumar Keywords: Renal Cell Carcinoma, Therapeutic Segment, Pipeline Analysis, Renal Cell Carcinoma Drug Renal cell carcinoma accounts for approximately 3% of adult malignancies and 90-95% of neoplasms arising from the kidney. It is characterized by a lack of early warning signs, diverse clinical manifestations, resistance to radiation and chemotherapy, and infrequent but reproducible responses to immunotherapy agents such as interferon alpha and interleukin (IL)-2. Renal cell carcinoma is the eighth or ninth leading cause of cancer death in the United States. The 5year survival rates initially reported by Robson in 1969 were 66% for stage I renal carcinoma, 64% for stage II, 42% for stage III, and only 11% for stage IV. The age-adjusted incidence of renal cell carcinoma has been rising by 3% per year. Renal cell carcinoma has 5 histologic subtypes, as follows: clear cell (75%), chromophilic (15%), chromophobic (5%), oncocytoma (3%), and collecting duct (2%). Renal Cell Carcinoma drug market will more than double over the next 10 years, rising from US$ 625 million in 2007 to nearly US$ 1.6 billion in 2017. The RCC market has recently attracted significant investments in research and development from big pharma, specialty pharma, and biotechnology companies. Historically, the market for RCC treatments has comprised a comparatively small section of the oncology market. More than 50% of patients with renal cell carcinoma are cured in early stages, but outcome for stage IV disease is poor. The probability of cure is related directly to the stage or degree of tumor dissemination, so the approach is curative for early stage disease. Selected patients with metastatic disease respond to immunotherapy, but many patients can be offered only palliative therapy for advanced disease. The treatment options for renal cell cancer are surgery, radiation therapy, chemotherapy, hormonal therapy, immunotherapy, or combinations of these. Options for chemotherapy and endocrine-based approaches are limited, and no hormonal or chemotherapeutic regimen is accepted as a standard of care. Older immunotherapy regimens have now been replaced as the standard of care by the newer targeted therapies launched in recent years, namely Pfizer' s Sutent (sunitinib), Bayer/Onyx' Nexavar (sorafenib), Roche' s Avastin (bevacizumab) and

Pfizer' s Torisel (temsirolimus). The RCC market has evolved into a rapidly growing segment since the launch of newer targeted therapies. Sutent is considered as the standard first line therapy for previously untreated RCC patients followed by Nexavar prescribed as the second line therapy to Sutent refractory patients. The most recently approved drug, GSKs Votrient is anticipated to compete with sorafenib and everolimus as second line use. Significant opportunities still exist for products to expand within this marketplace. A large percentage of patients are not currently treated with drug therapies and are not cured by surgery alone; patients with localised and locally-advanced disease represent a significant patient population that may be suitable for adjuvant therapy with targeted therapies. Established agents such as Sutent, Nexavar and Avastin are being investigated in the adjuvant setting, along with new therapies including Wilex' Rencarex (girentuximab), currently in Phase III trials. In addition, many patients do not respond to current therapies, and more effective product introductions and greater use of combination therapies will address this clinical need for patients with metastatic RCC. Also, two molecules in the late stage pipeline provide a multitude of possibilities for potential future regimens.

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Market Assessment of Biopharmaceuticals Round the Globe

Kuldeep Dabas Keywords: Biopharmaceuticals, Market Assessment, Pharmaceutical Market, Biopharmaceuticall Drugs Background: Biopharmaceuticals account for between 10% and 15% of the world pharmaceutical market, with sales in the USA alone reaching around $30 billion in recent time. Biopharmaceutical drugs have outperformed the pharmaceutical market as a whole largely due to two factors: they address areas of clinical need that are unmanageable with conventional therapeutics (including many cancers and genetic diseases) and they are able to command a premium price. Objective: The study enlighten on the increasing importance of biologics in pharmaceutical market. The every possible aspect like definitions, manufacturing, regulation and marketing strategies of the biopharmaceutical was analyzed.

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Findings: Market by protein : Biopharmaceuticals : The sales of Calcitonins and Glucagon will increase by 51% in 2011 reaching market to $ 60,037 million from $ 22,098 million in 2006 with 47.8% followed by Erythropoietin. Biosimilars : The sale of Erythropoietin by 2011 will increase by 38.6% reaching the market to $ 1,247 million and market penetration will increase by 5%. Biopharmaceuticals market by application. The market is now worth about $67 billion, or 10% of the total Pharma sales, and we expect it to rise to $ 118 billion or 12% of Pharma sales in 2011. Monoclonal antibodies currently make up 27% of the biopharmaceuticals market but this figure will rise to 36% in 2011 because sales are increasing more rapidly. Oncology is the dominant application accounting for one-third of overall sales. Indeed in value terms, protein drugs now account for about two-third of the worldwide. According to the forecasts based on an extrapolation of the sales of existing products together with estimated sales for agents currently in clinical trials but likely to be launched during the forecast period Amgen and Roche have the biggest overall shares, with 40% of the total market between them. North America (mainly the US) has almost 40% of the market and Europe has 30%. The fastest growth rates are outside the two regions, a trend that is consistent with the pharmaceutical market in general. Europe will be in the lead with nearly 45% of the market and distribution of sales will be somewhat different because owing to patent constraints and prescribing practices respectively, we expect no EPO or G-CSF sales of biogenerics in Japan. There were no sales data for 2006. But in 2011, Europe will be in the lead with nearly 45% of the market and the distribution of sales will be somewhat different because owing to patent constraints and prescribing practices respectively we expect no EPO or G-CSF sales in the US and depressed sales of biogenerics in Japan. EPO represents the largest market opportunity for biosimilars and GCSF is also sizeable opportunity. Recommendation: Industry should focus more on R&D activities about emerging diseases. Better cooperation between research institutes and pharmaceutical companies so as to coordinate their activities about development of new molecule. Improvement in technology advancement for the production of biopharmaceuticals should be cost effective. Government should facilitate establishment of more institutes both in the academic as well as research so as to

encourage development of interest in the field of biopharmaceuticals research. Government should offer incentives so as to encourage more participation of industry in the field of biopharmaceuticals. Government should encourage FDI in the field of biopharmaceuticals so as to promote transfer of technology.

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Assessment of Japanese Pharmaceutical Market to Search Business Opportunities

Pritika Garg Keywords: Japanese Pharmaceutical Market, Pharmaceutical Marketing, Business Opportunities Background: The Japanese pharmaceutical market is the second largest individual market and with sales of $66 billion constitutes approximately 8.2% of the world market. Despite its prolonged economic troubles in recent years, Japan still holds its second position in world market being after US only. It also remains one of the less penetrable markets. MHLW is strongly promoting generic drugs through incentives on prescribing and selling generic drugs. This makes a space for small generic companies to enter in Japan. Although despite of full support of Japanese government one need to have local partnership to get the know how of the market. The main therapeutic areas where one can enter are anti-cancer, lifestyle diseases and also diseases related to central nervous system. Objective: To assess the Japanese generic pharmaceutical market and search for opportunities available for an India generic firm Radiance pharmaceutical. Methodology: The study is done on secondary data. The data gathered was taken from trusted government sites and several market reports. Market forecast done by market research firms were also taken in consideration. Findings: The Japanese pharmaceutical market is the second largest in the world after the USA accounting for 8.2% of the total world market. Increasing demand of pharmaceutical market is due to the rapidly increasing population of Japan. Japan market size increased by 123% in 1993-2003. The market is dominated by domestic producers who manufacture drugs primarily for the home market. Recommendations: Therapeutic areas in which companies can entre

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could be anti- cancer and other life style disease because Japanese epidemiology is changing. Even if a generic drug market does not grow, and the company has unique challenges of this market.

Ab-4

Vitamin A Bi-annual Round Process and Knowledge Assessment

and 55% AWW got the instructions from their respective supervisors. The knowledge of mother/caretaker was very low. Out of the total who received the services, only 37% mother/caretaker knew about it. Only 74% children (out of the total visited 358) received the Vitamin A supplementation. In the study ASHA was found to be the major source of information for the mother/caretaker about the program.

Pushpendra Dixit Keywords: Vitamin-A, Vitamin A Supplementation, Knowledge Assessment Background: Vitamin-A supplementation is a low cost sustainable approach to control the Vitamin A deficiency. Children between 15 years age , who are less likely to have regular contact with health facilities and health services, are the neediest group for this supplementation. Objective: A process and knowledge assessment study of Vitamin A supplementation was carried out in all the blocks of Surendranagar District. Methodology: 14 PHCs were selected from the slot of 31 by using simple random sampling (2 from each block). Interviews of ANM, AWW and mothers/caretaker were conducted. 2 SCs were selected from each PHC by using convenience sampling method. Under each SC one extra village was surveyed for interviewing the AWW and mother/caretaker of children age group 1-5 years. Total 38 ANM, 53 AWW and 358 mother /caretaker were interviewed for the study. Findings: The major findings of the study include knowledge of ANM and AWW, preparedness for the bi-annual round and most importantly the level of awareness among the mothers/caretaker about the program. The most common place of Vitamin A supplementation was AWC (40%), followed by SC (32%). IEC material was only available at 73% sessions of mamta divas. Marking in mamta card and making notes in register was found to be low. Only 44% ANMs were found marking in mamta card which is not a good sign for the supplementation program. The reason for not making entries was unavailability of the mamta card. It was also seen that often the mothers/caretaker do not bring the card with them. The knowledge of ANM and AWW regarding Vitamin A supplementation was found out to be low, especially in AWW. Another major finding revealed was very low supervision level. Only 65% ANM

Ab-5

Market Assessment and Product Launching Strategy of Linezolid on the behalf of Kee Pharma Ltd.

Rahul Gupta Keywords: Linezolied, Pharmaceutical Marketing, Product Launching Strategy This study is regarding the feasibility approach for Linezolid tablet Launch. Linezolid is a synthetic antibiotic used in resistant gram positive infection. Objcetive: The aim of study was To assess the market and propose the product Launching strategy of Linezolid tablet and specific objectives followed were To study the prescription habits of Linezolid tablet in market. To identify the competitors for Linezolid Antibiotic. To study the strength and weakness of Linezolid tablet To recommend the Product Launch Strategy. Methodology: The background of the drug market was analyzed first as Pharmaceutical marketing is quite different than marketing of any other goods. Within pharmaceutical products, marketing of prescribed products is a way different from that of over the- counter (OTC) drugs and actual behaviour of prescribed drug market may vary based upon various parameters. To achieve the objectives a primary research and secondary research both were done and 60 doctors and 60 chemists were surveyed on the basis of convenient sampling and structured questionnaire was used as a research instrument. Findings: Orthopedician, surgeon and Physicians were the major prescribers for Linezolid tablet and the major competitors were Linox (Unichem), Linid (Zydus) and Linospan (Cipla) Successful launching of Linezolid tablet requires a more aggressive promotion amongst the Physician, Orthopedician and surgeon and Linezolid tablet should be available at all major retail pharmacy stores especially those which are in premises of a hospital and nursing homes and near the Physician,

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Orthopedician and Surgeon. Linezolid tablet should be made more cost effective.

Ab-6

Assessment of Insulin Market in Jaipur, Gurgaon and Faridabad Through Retail Chemist Audit

Ramneek Atreya Keywords: Insulin Market, Retail Chemist Audit, Diabetes Drug Market Background: Diabetes drug market and insulin market has shown remarkable growth in recent years. This growth is mostly driven by increasing prevalence of diabetes globally and easily availability of insulin in other countries due to its access at an affordable price. The diabetes prevalence is increasing due to changing food habits in the western world leading to obesity. Top 8 diabetes drug made a sale of more than US$ 5 Billion from the period of October 2007 to October 2008. Objective: The study is based on the assessment of insulin market in Delhi NCR and Jaipur and broadly covers the analysis of insulin market dynamics, share of various brands in the market and most prescribing physicians. The study was done by using descriptive research method with simple random sampling by the help of primary data collected from retailer through Questionnaire. Findings:. Human Mixtard* was ranked 1 in terms of sales and availability. Hum insulin (30- 70)/Humalog as the second best (20%) selling brand. Wosulin and Insugen were taken as market follower. Market penetration of Human Mixtard was 100% followed by Hum insulin. Recommendation: Company can increase sales force size and can also do Flank Attack (attacking on Market leaders weak points).

range of medications, including more specialized medications, than would be feasible in the community setting. Most of the hospitals have one store and from which all IPD and OPD patients purchase medicines. Availability of one store and large number of indents coming everyday (in comparison to bed admission ration), causes high returns of pharmacy items and long internal lead time between pharmacy stores to IPD. This is a complex process that requires adequate training of personnel, quality assurance of products, and adequate facilities to avoid conflicts between staff and patient dissatisfaction. Objective: To analysis the causes of pharmacy overloads and unduly stretched internal lead time between central pharmacies store to IPD. Methodology: A Group comparison case control study of the patients admitted in 6th, 7th and 9th wards from 15 to 29 April was conducted. Data was collected through interviews and observation. It was a Retrospective study. From the studies it was found that an average of 288 indents come in a single day for 180 bedded hospitals and it takes 81 min to process that indent Findings: The numbers of indents are too high because there was no stock monitoring in wards level by nursing staff before giving indents to pharmacy. This causes a high number of returns in a day. From the studies it was also found that a clear cut demarcation for pharmacist is not available which leads to a high lead time in indent processing. There was a lack of communication between pharmacy store and the nursing staff. Recommendation: The situation analysis suggests that there is an urgent need of controlling the process. Through systematic approach of working the work load of pharmacy can be reduced. Scientific reorder level estimation helps the hospital in reducing the internal lead time process. There is a need of strict process monitoring of medicines through bar coding and by group of quality managers.

Ab-7

Analysis of Pharmacy Function and Work Load

Ab-8

Reenu Bajapi Keywords: Hospital Pharmacy, Pharmacy Store, Quality Assurance Background: Hospital pharmacies can usually be found within the premises of the hospital. Hospital pharmacies usually stock a larger

Market Assessment of Rheumatoid Arthritis in 5European Countries

Siyaram Sharma Keywords: Rheumatoid Arthritis, Market Assessment, European Countries

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Objective: This Study is the market assessment of rheumatoid arthritis in European countries in which thorough market search is done for therapeutic area Rheumatoid Arthritis (RA) in 5- European countries (France, Germany, Italy, Spain and UK). This assessment gives idea about current market scenario product wise and company wise as well and the assessment of pipeline products helps to estimate future estimates of anti RA market. Methodology: Secondary desk research is used for this study and data are taken from reliable sources like- IMS, CENTER WACH etc. On the basis of three major fields i.e Epidemiological facts of Rheumatoid Arthritis in 5- EU Countries in which major epidemiological facts related with RA are touched upon to get idea about the spectrum of the disease, Treatment rate and mortality status due to RA in respective country to understand the potentiality of the market. The second field is prescribed drugs of RA in 5-EU Countries in which the name of the prescribed drugs for Rheumatoid Arthritis along with their companies in 5- EU Countries are assessed this information gives idea about major drugs present in these countries for RA treatment. The Third Field is Competitive Analysis which includes three sub fields i. Major companies in the market and their products for RA Treatment ii. Sales Value Status of anti RA Products in 5- EU Countries iii. Pipeline drugs for RA Treatment Findings: UK has highest prevalence of Rheumatoid Arthritis among 5 European countries followed by Germany Treatment rate of Rheumatoid Arthritis is high in all 5-European Countries it is above 75% in all countries. Though UK and Germany have highest prevalence of Rheumatoid Arthritis but RA related mortality is lowest in these two countries. Abbott, Pfizer and Merck & co. are common major players in all 5- European Countries with their products Humira (Adalimumab), Enbrel (Etanerecept) and Ramicade (Infliximab) respectively. Roche is the leading company in pipeline products with 3 pipeline products for RA treatment. Recommendations: The patents of the most selling drugs in European markets like Humira, Ramicade, Enbrel are going to expire in next 2-3 years so there is a great scope for biogeneric drugs. Ramicade (Infliximab) is strong competitor of Enbrel and Humira in France, Ital and Spain but far behind in UK and Germany so Merck & Co. can implement similar marketing strategy in UK and Germany as they are using in France, Italy and Spain. Companies like Sanofi-Aventis,

Bristol Myers squib should increase their marketing efforts for their respective drugs (Arava and Orencia) which are strong market follower drugs.

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Pulmonary Arterial Hypertension: Futuristic Competitor Overview in Evalueserve, Gurgaon

Sonal Ghura Keywords: Pharmaceutical Companies, Pulmonary Arterial Hypertension, PHA Market Background: Most pharmaceutical companies are interested in getting their hands on a stable therapeutic region. PAH (pulmonary arterial hypertension) is a relatively new indication which has been served so far by niche players such as Actelion and Gilead Life sciences. Big companies like Eli Lilly, Pfizer have recently entered the market. Global Data has estimated the global pulmonary Arterial Hypertension (PAH) market was worth of $2653 Mn in 2009. According to Global Data, the PAH market is expected to grow at CAGR of 5% over next six year and it will reach to $ 3569 Mn by 2015. So the report will analyze the competitors marketed drugs and drugs that are in the pipeline for clinical development, thereby giving a picture of the market leader and its movements till 2016. Objectives: To conduct a pipeline analysis of the pulmonary arterial hypertension (PAH) market. To analyze the present market of PAH based on prevailing market leaders. To assess the movement of competitors and its positions in the market till 2016. To forecast ParaIV filing activities for various companies after market leader Tracleer (Bosentan) hits the patent cliff. To investigate geography for the launch of PAH drugs. At last but not the least, to compile all the essential pieces of information and present the finding and recommendations. Methodology: The study is done on secondary data basis. The list of the molecules in the pipeline has been derived from companies press releases, annual reports and other freely available databases. Through SWOT analysis, BCG matrices and PEST analysis of the competitors and the market leaders had been carried out for analysis of the data and then reporting is done. Findings: The market leader in this PAH market is Trocleer and its total market share is about 50%. Eli lilys Revatio and United therapeuticss

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Remodulin had a market share of 15% each. Trocleer slowly and gradually will enter the Dog phase as the molecules patent expire during 2015-16 in EU & US market. Venatvis is the only inhaled formulation available for PAH. However the drug is not popular because of high cost and no additional improvement in efficacy. The entry of big pharmaceutical companies such as Eli Lily, Pfizer will drive the growth of the PAH market. The annual reports of these companies have stated that as for PDE-5 inhibitors, PAH is not as key area of focus. Recommendations: EU is the choice for the first launch of PAH drugs as the population of the country is genetically isolated as has a lesser approval lead times as compared to the US. Para IV filing for launched drugs should have been started for brands like Trocleer. Companies like Eli lily, Pfizer and GSK are all rounder in this field and therefore do not need to adopt niche marketing strategy to launch a product in the market.

Methodology: Primary research was done doing market survey in Jaipur District with a sample size 50 prescriber of sod. Hyaluronate. Findings: Injecting this substance into the knee joint provides longterm pain relief for some people with osteoarthritis. Hyaluronic acid is a natural component of cartilage and joint fluid. It lubricates and absorbs shock in the joint. The Food and Drug Administration (FDA) recently approved this therapy for patients with osteoarthritis of the knee if they do not get relief from exercise, physical therapy, or simple analgesics. Researchers are testing whether hyaluronic acid can slow down the progression of osteoarthritis.

Ab-11 Market Overview of Hepatitis C in Middle East and North African (MENA) Region
Vibha Chadha Keywords: Hepatitis C, Market Overview, Global Burden Disease

Ab-10 Market Survey of Treatment Options for Osteoarthritis and Awareness about Sodium Hyaluronate 1 % Solution in Medical Profession Sumati Kumar Jain Keywords: Sodium Hyaluronate 1% Solution, Market Survey, Osteoarthritis Background: Importance of Hyaluronic acid in body is felt when pain is observed in joints. Hyaluronic acid is a natural component of cartilage and joint fluid. It lubricates and absorbs shock in the joint. Just imagine what will happen when the hyaluronic acid fluid from body gets finished due to ageing. Well Xyata lifescinces ltd has a solution to it, Hyness the product for osteoarthritis patients. The (FDA) recently approved this therapy where sodium hyluronate injections are given to patients with osteoarthritis of the knee if they do not get relief from exercise, physical therapy, or simple analgesics. Researchers are also testing whether hyaluronic acid can slow down the progression of osteoarthritis. Objective: The main objective of this market survey was to find out the awareness and perception level of prescriber about Sodium Hyaluronate.

Objectives: To raise awareness regarding the burden of disease related to viral hepatitis and the need for urgent action to prevent hepatitis C virus transmission in the Eastern Mediterranean Region. Methodology: This study was based on secondary research and the data was collected from internet. Findings: The global burden of disease due to cirrhosis of the liver and hepatocellular carcinoma (HCC) is high (approximately 2% of all deaths) and is expected to increase over the next two decades. Studies indicate that more than 75% of cirrhosis and hepatocellular carcinoma in the region is attributable to hepatitis C virus (HCV) infection with higher prevalence in Egypt. Many of these infections are acquired in the health care settings particularly in countries with rapidly evolving health systems and increasing demand for health services. There are two medications used to treat Hepatitis C i.e. Ribavirin and Interferon with Roche and Schering Plough as market leaders. As the current treatment guidelines are not economically favorable (US $12000-US $22000), lengthy (24-48 week) and well tolerated, a comprehensive strategy is urgently needed to prevent transmission of these bloodborne pathogens. Roche recently collaborated with ministry of health to create awareness for disease whereas GSK and Schering Plough are promoting their product through national level campaign in Egypt. They have agreed for price reductions and are negotiating with

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Egyptian government to provide 2 yr supply of Ribavarin.They have provided funds for training and post exposure follow up and treatment for nurses and physicians who are exposed to Hepatitis C. Recommendations: Hepatitis C specific mortality in Egypt, Iraq and morocco regions are quite high therefore the main focus should be on these regions. Hepatitis C treatment should be provided through government in countries like Egypt, Libiya and Saudi Arabia as the health care is almost free for citizens. Increased improvement in safety, efficacy and tolerability of Hepatitis C treatment is needed with second line therapies for increasing population. Newer drug need to be potent and should have a high genetic barrier to prevent development of resistance. New dosage forms (injectables) should be there to have patient compliance. Treatment must be affordable so that it is accessible to all individuals who require it.

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