Objectives:

This study aims to provide quality evidence for improving the equity and cost-effectiveness of

health service provision. The specific objectives are:

A. To assess the performance of public health care delivery system in terms of technical efficiency and its determinants in four districts of Bihar,

B. To document the profile of human resource in the public health care delivery system.

C. To assess the level of satisfaction among the users of public health care system, and understand its determinants.

D. To provide policy recommendations to improve performance of public health care delivery system and need for regulation and strategic purchasing of health care services from other sources, as relevant.

 

Methodology:

Four out of 38 districts in Bihar were sampled for this study. The districts were selected using two health systems strata: proportion of full immunization among children aged 12-23 months and proportion of safe delivery. Based on these indicators, the districts were grouped into four quartile categories. One district was selected randomly from each category until a reasonable geographic distribution was attained. Detailed cost, inputs and outputs data over the last two fiscal years are currently being collected from a representative sample of 84 public sector health facilities across four districts of the state. The facilities are included based on these four platforms of health care delivery in decreasing order of size: district hospitals (4), sub-district hospitals (4), referral hospitals (4), community health centres/primary health centres (18),

additional primary health centres (18) and health sub-centres (18).

The study includes facility survey, patient exit survey and human resource profiling for which the study staff will collect data directly at the facilities. Four main types of indicators of interest will be captured in the facility level data collection: Infrastructure, Pharmaceuticals, Finances, and Outputs indicators. The qualitative assessment of constraints for coverage, quality and equity for health services would include constraints related to staff availability, performance and training; drug availability and supply; availability of laboratory for diagnostics; cost of referrals; access, and access and availability of support. A fixed number of patients or attendants of patients <15 years of age will be interviewed at each facility, based on the expected patient load for the respective level of health care delivery system. This survey is designed to capture perceptions and satisfaction with the health facility and service provision. All medical and non-medical personnel present in the health facility on the days of data collection will be sampled for human resource profile assessment. This interview will document the socio-demographic details, educational background, years in service, promotion, motivation level and satisfaction with the current position in the health system.

Data collection is expected to be completed by February 2019 and results are expected to be available by April 2019.

 

Data Analysis

This study will collect information from public health facilities to quantify the costs of health service delivery in Bihar. The ultimate goal is to assess the facilitators and barriers towards achieving greater efficiency. Analysis of qualitative data will enable contextualising the quantitative findings. Expected outcomes from the analyses include advanced analyses to understand the bottlenecks in the health system as well as practical recommendations to improve the health system in order to achieve better population health.

 

Dissemination plan

Dissemination plan is designed to meet the information needs of policy makers and a variety of stakeholders in Bihar. This will include reports/publication in peer-reviewed journals and scientific presentations.

 

For details, please contact:

Principal Investigator

Dr. Vikash R Keshri

Health Policy & System Specialist

CHP, ADRI

Email: vikash.chp@adriindia.org

&

Dr. Rakhi Dandona

Professor

Public Health Foundation of India

Gurugram, India