Report from 64 PHCs across Bangalore

Number of PHCs visited:

59 (Data gathered from 64 PHCs)

Total number of schools under the visited PHCs:

• Government, Corporation & Government-aided: 722
• Private: 409+ (we did not get data from some PHCs)

PHCs on our priority list

We shortlisted 23 PHCs as most needy so that we focus on empowering these PHCs on priority. The need was decided based on the following criteria:

• Absence of manpower, especially doctor, at the PHC
• Distance from city centre which makes it difficult for patients to avail specialist referral services which are directed to hospitals like Victoria, Vani Vilas and Jayadeva
• Number of schools to be covered
• Total population served by the PHC
• Number of staff available
• Our personal observations while visiting and interacting with the PHC staff

The PHCs shortlisted as needy are mostly from the outer regions of Bangalore which have a resource crunch due to their distance from city centre which prevents medical manpower from reaching these PHCs. These PHCs also have a greater burden of needy populations utilising their services as compared to PHCs in the city centre, and hence the need. The list includes:

1. Anjanappa Garden
2. Avalahalli
3. Gangondahalli
4. Nayandahalli
5. Bangarappanagara
6. Mallathahalli
7. Kengeri Upanagara
8. Chandrappa circle
9. Kengeri
10. Konanakunte
11. Uttarahalli
12. J.C. Nagar
13. Bagalagunte
14. RT Nagar
15. Shankarnagar
16. Singasandra
17. Begur
18. Roopena Agrahara
19. Arekere
20. Kodichikanahalli
21. K.R.Puram
22. Kadugodi
23. Kodihalli

The complete list of 64 PHCs which we will attempt to cover can be seen at the end of this report.

The overall challenges faced by PHCs

CHALLENGES	PHCs in outer Bangalore	PHCs within Bangalore city
Medicines	Shortage of medicines has been mentioned by majority of PHCs. Only 50% of the needs are currently being met.
Specialists	Needed in many PHCs, but not available in any. Requests were for gynaecologist, dermatologist, orthopedician
Medical Colleges	Colleges do not reach out to these PHCs due to distance	Not much problem with getting medical colleges to assist in school screenings
Unpaid salaries (4 to 6 months)	Leads to corruption	Staff go on frequent strikes
Corruption	Rampant corruption witnessed by our team while they were there	Not very vocal
Absence of doctor	Absence becomes a problem as average patient visits when doctor is present is around 50-55 per day, and in the absence of doctor, it dips to around 10-15	Usually compensated by a doctor from a nearby PHC who visits once a week
	9 PHCs informed us that they had no appointed doctor and were managing with the help of a doctor from a nearby PHC visiting once a week or a temporary doctor. These PHCs are in Gangondahalli, Nayandahalli, Mallathahalli, Bangarappanagara, Arekere, Kodichikanahalli, Roopena Agrahara, Begur and Yarabnagar.
Field workers	Insufficient staff to reach out to community, especially for tracking cases having tuberculosis and giving necessary awareness on prevention
Population catered to	Between 20000 to 50000 on an average	Between 50000 t0 300000
Utilization of services	Good	Average to Poor

Why PHCs are not able to effectively implement Suvarna Arogya Chaitanya Yojane

CHALLENGES	PHCs in outer Bangalore	PHCs within Bangalore city
Interest in the program	Interested, but not enough resources	PHCs were neutral about the program as they felt that it is just one of the programs that they are involved in and felt that greater attention needs to be given to women’s health and other community health initiatives
Doctor for the screening	Difficulty in getting manpower. Medical colleges which assist other PHCs in the city have difficulty helping these PHCs due to the distance	Even if doctor is present in the PHC, attending to OPD cases & other initiatives take up their time and they are unable to focus on school screenings. In addition, retired doctors appointed in PHCs are unable to handle the work load
Private schools	Children in private schools are also from low income families and cannot be ignored. Hence larger number of schools to be covered if we consider need	Private schools do not have much need. They either do not cooperate to help completion of screening or put pressure on PHCs, making it difficult for them to focus on the more needy government & aided schools
Medicines	Basic medicines like iron are also not available. Supply of medicines happens only once a year. The Urban Family welfare centres are usually attached with maternity centre and do not get any specific medicine supply, and need to procure medicines for the school program from the Maternity centre
Help from other NGOs or groups	None. Other NGOs mainly help during immunization programs
Diagnostic tests / lab facility	Very few or none	Basic lab tests are outsourced or a mobile lab comes once a week
Referrals	Referral hospitals are at a distance of more than 15 kms and hence referred cases may not be availing the services	No special attention to completion or follow up of referral cases as it requires field work to visit parents and ensure that they follow up with children
Specialist treatments	No options for covering eye and dental screening at school	Refractionists are attached to some PHCs, but most needed help with eye and dental

Requests made by PHCs

• Help to address the problem of doctors’ shortage, not necessarily because there is no appointed doctor for the PHC, but because the doctor present is unable to handle the patient load and school screenings
• Help reach out to private schools as well, especially in the outer areas where children from private schools are also from low income families
• The doctors in the PHCs within the cities  asked help to cover private schools since they are greater in numbers
• Many of the PHCs requested for specialists like gynaecologists, skin and orthopaedic to volunteer at the PHC (if we obtain permission from the DHO)
• Repeated requests were made to cover eye and dental screenings in schools
• Requests to help with medicines were made in majority of the PHCs, especially supplements. Some even requested for chronic medication for management of diabetes, cholesterol, etc. for adults
• Requests for connecting volunteers to the PHC staff to help in non-school programs to reach out to communities was made across several PHCs such as Uttarahalli, Yarabnagar, Chennamanakere, Kodichikanahalli, Roopena Agrahara, Singasandra, etc
• They were happy to know we can help out with programs like the Pulse Polio etc. and are receptive to help for other such activities.

Our observations

• PHCs in the city don’t have a great need and can probably manage fine without our help. However, we will continue to cover the 50 schools where we undertook the project last year by partnering with the PHCs which cater to those schools
• Ownership of covering schools lies with one of the staff, not with doctor
• They have not tracked referrals or followed up on treatments in any of the PHCs
• In some of the PHCs, the doctor admitted that they rush through the school screening and complete the entire process in about 1.5 hours in one school (In comparison, the DFS doctors we connect, spend 2-4 hours each week for a period of 4-6 weeks to thoroughly screen each child)
• The PHCs under BBMP are better staffed with more link workers
• Some PHCs were adopted by other NGOs such as Red Cross, Karuna Trust, Sumangali Sevashrama. In cases like Red Cross, the infrastructure was good and the PHC seemed to be functioning well. In cases like Karuna Trust, they sought our help for manpower
• Not many patients visit the PHCs in the cities, while PHCs in the outer areas are well utilized
• One of the PHCs was not a typical PHC, and was under the World Bank project (Indian Population Project) to improve some centres (total 55) of which this was one. It is a sub centre of Begur PHC, so no Jr. Health assistants, but have nurses who are part of maternity home. Ambulance is defunct, no driver. The Doctor was present, but was unhappy with the IPP and complained of improper payment.
• PHCs at Kadugodi and Kodihalli need a lot of help not just with school but with many other activities
• Overall, it can be said that the staff were cooperative with our team in sharing information and welcomed the idea of our assistance for the school program

Next steps

With the above understanding of the situation and need at the PHCs, our team will now work on mapping doctors and hospitals to nearby PHCs. We plan to try and involve the PHC staff to visit nearby clinics and doctors so that it will help in establishing good rapport between the private practitioners and the PHC right from the start.

List of all the PHCs we visited

S.No	Area	Cluster
1	Anjanappa garden	Mysore road
2	mysore circle	Mysore road
3	Goripalya	Mysore road
4	Avalahalli	Bangalore south
5	Gangondahalli	Mysore road
6	Nayandahalli	Mysore road
7	Bangarappanagar	Mysore road
8	Mallathahalli	Kengeri outer ring rd
9	Kengeri Upanagar	Kengeri outer ring rd
10	Chandrappa circle	Kengeri outer ring rd
11	Ullal Upanagar	Kengeri outer ring rd
12	kengeri	Mysore road/outer ring rd
13	Konanakunte	Bangalore south
14	Azadh nagar	mysore road
15	Bhapujinagar	mysore road
16	Modalapalya	Bangalore north
17	Beggar colony	kengeri outer ring rd
18	modalapalya(byraveswara nagar)	kengeri outer ring rd
19	Sunkada katte(Herohalli)	kengeri outer ringrd
20	uttarahalli	Kengeri
21	Yarabnagar	Bangalore south
22	Kumaraswamy layout	Bangalore south
23	NS palya	Bangalore south
24	Chennamanakere	Bangalore south
25	vidyapeeta	Bangalore south
26	Gavipuram gutahalli	Bangalore south
27	vv puram	Bangalore south
28	JP Nagar sarakki	Bangalore south
29	JC Nagar	Bangalore north
30	Bagalngunte	Bangalore north
31	RT Nagar	Bangalore north
32	Peenya/ Magadi Road	Bangalore north
33	Hebbal	Bangalore north
34	Sanjayanagar PHC	Bangalore north
35	RT Nagar	Bangalore north
36	Vasanthnagar	Bangalore north
37	Yashwantpur	Bangalore north
38	Shankarnagar	Bangalore north
39	Mahalakshmi Layout	Bangalore north
40	Kamalanagar	Bangalore north
41	Govindarajnagar	Bangalore north
42	AD Halli	Bangalore west
43	Hosahalli	Bangalore north
44	Begur	Electronic City
45	Singasandra	Electronic City
46	Gottigere	Electronic City
47	Bommanahalli	Electronic City
48	Roopena Agrahara	Electronic City
49	Arakere	Bangalore south
50	Kodichikkanahalli	bangalore south
51	K.R.Puram	Bangalore East
52	Avalahalli	Bangalore East
53	Kadugodi	Bangalore East
54	Varthur	Bangalore East
55	Gunjur	Bangalore East
56	Siddapura	Bangalore East
57	Vibhutipuram	Bangalore East
58	Yemlur	Bangalore East
59	Doddanekundi	Bangalore East
60	Doddakanahalli	Bangalore East
61	Konena Agrahara	Bangalore East
62	Jeevanbhima nagar	Bangalore East
63	C.V.Raman nagar	Bangalore East
64	Kodihalli	Bangalore East