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Title: Status Of X-Ray Services In Public Hospitals In Maharashtra, India
Authors: Deshmukh, Vibhavari Sandeep
Keywords: School of Health System Studies
Harshad P. Thakur
Healthcare - Human Right
X-Ray Servies - Public Hospitals In Maharashtra - India
Issue Date: 2018
Abstract: Background: Although the Universal Declaration of Human Rights has declared healthcare as a human right, universal access to health care is still beyond reach in many countries including India. WHO has identified six building blocks in healthcare provision financing, human resources, information, service delivery, governance, and medical technology. Many studies are available one first five components. However, studies on medical technology are limited in number. One of the critical categories of medical technology is imaging services. Medical radiography and USG are two basic imaging equipment which cover 90% of imaging needs. Non-availability of these services results in a delay in treatment and increased cost due to transportation. Medical radiography (x-ray) is used as a basic medical investigation for a large number of patients presenting for routine primary and emergency care. These patients suffer from pulmonary or orthopedics conditions for which medical radiography are critical for diagnosis and treatment. Methodology: The broad objective of this study is to explore the status of x-ray services in public hospitals in Maharashtra, India. However, specific objectives of the study are to understand availability, functionality, and utilization of x-ay services. The researcher also attempts to study the role of guidelines, policies, and strategies for the provision of x-ray services as well as factors influencing the availability of x-ray services. The research uses mix method approach with Convergent Parallel study design. Primary and secondary data were collected concurrently or simultaneously during the study. Primary data were collected through Key Informant Interview (KII) and Non-Participatory Observation. Secondary data were collected through review of documents and policies, and secondary databases like DLHS-4, Equipment Mapping Data, AERB data, and Utilization data. Findings: The study shows that 30 percent Community Health Centres (CHCs) do not have x- ray equipment and in another 10 percent CHCs, available x-ray equipment are nonfunctional in Maharashtra. Furthermore, there is a huge shortfall of x-ray technicians. Around two third CHCs do not have x-ray technicians. Around half of the x-ray equipment were more than ten years old and exhausted their lifespan which may need to replace shortly. It is likely that to minimize the gap in required and present health infrastructure, CHCs were established without a corresponding upgrade in necessary health services like an x-ray. The study revealed non- compliance with radiation safety regulations. Around one-third private registered equipment and half of the public registered equipment are from Mumbai circle. Distribution of x-ray equipment is uneven with lower availability and functionality in economically backward regions of Marathwada and Vidarbha. It resulted in underutilization of x-ray services. Around 29 percent x-ray equipment at DH, are non-functional, compared with 13 percent nonfunctional equipment in SDH and 16 percent non-functional equipment in CHC. There are two possibilities for the higher number of non-functional equipment at DH – first, the presence of more than one equipment has resulted in lesser attention to maintenance services and second, the old nonfunctional x-ray may not have condemned. WHO suggests one x-ray equipment per 50000 population. In Maharashtra, state-run hospitals have 0.4, and private providers have three x-ray equipment per one lakh population. It indicates that public hospitals are grossly underdeveloped and cannot achieve availability norms in isolation and are dependent on other public health hospitals, medical colleges, and private providers. The study measured utilization of x-ray investigations per 1000 OPD registration and per 1000 IPD admissions. Compared with CHCs, x-ray utilization per 1000 OPD is almost double in Sub District Hospitals (SDH) and five to six times more in District Hospitals. Overall utilization growth was negative in nearly all health circles and type of hospitals. X-ray investigations per 1000 population were five which are too low. PAHO has reported 30 x-rays per 1000 people in developing countries. The study also highlighted managerial gap by identifying a mismatch in the availability of x-ray technician and x-ray equipment, inadequate financial provisions, delayed installation due to non- prepared sites, noncompliance to the regulatory body (Atomic Energy Regulatory Board), etc. The study brings out that few factors like 24X 7 services, availability of x-ray technicians, availability of OT, and serious cases referred from CHC have a bearing on the availability and functionality of x-ray unit. Conclusion and recommendations: The study highlights the need to develop processes to assess diagnostic needs and agreed priorities. X-ray services investments should be based on realistic forward planning which includes replacement needs. There should be balance between budget approved and targets set. User fee raised through x-ray services should be utilized to develop x-ray facility. Directorate of Health Services (DHS) should consider introducing a specific x-ray management standard to provide assurances of proper strategic and operational guidelines. There should be a system to measure and monitor clinical governance and accountability for x-ray services by using performance indicators. Adequate in service training must to be organized to modify behavior of health care professionals towards equipment maintenance, safety and utilization. The study brings out that poor availability, unequal distribution and poor performance of x-ray services exacerbates the already severe constraints for providing adequate health care, especially in rural areas. The study highlights the need for reconsidering the guidelines for health services with a strategic map for consolidation of existing facilities.
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01_Title Page.pdf132.33 kBAdobe PDFView/Open
02_Certificate.pdf233.42 kBAdobe PDFView/Open
03_Declaration.pdf233.01 kBAdobe PDFView/Open
04_Acknowledgement.pdf238.04 kBAdobe PDFView/Open
05_Contents.pdf247.53 kBAdobe PDFView/Open
06_List Of Tables And Figures.pdf236.53 kBAdobe PDFView/Open
07_Abbreviations.pdf122.41 kBAdobe PDFView/Open
08_Abstract.pdf240.84 kBAdobe PDFView/Open
09_Chapter 1.pdf267.77 kBAdobe PDFView/Open
10_Chapter 2.pdf655.35 kBAdobe PDFView/Open
11_Chapter 3.pdf403.11 kBAdobe PDFView/Open
12_Chapter 4.pdf352.6 kBAdobe PDFView/Open
13_Chapter 5.pdf583.19 kBAdobe PDFView/Open
14_Chapter 6.pdf491.92 kBAdobe PDFView/Open
15_Chapter 7.pdf585.1 kBAdobe PDFView/Open
16_References.pdf372.91 kBAdobe PDFView/Open
17_Appendix.pdf872.5 kBAdobe PDFView/Open

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