QUESTIONNAIRE FOR PATIENTS TO MEASURE SATISFACTION LEVEL Name of Patient Age: - Sex: - Address: - 1. For what disease you came here? 2. Did you receive the services you came for? Yes [ ] No [ ] 3. Are you satisfied with services you received? Extremely satisfied Very Satisfied Moderately satisfied Not sure 1 2 3 4 Moderately dissatisfied Very dissatisfied Extremely dissatisfied. 5 6 7 4. How many hours are you waiting for getting service? 5. Whether PHC near or far away from your home? Near [ ] Far away [ ] 6. What is the distance you travel for medical facility? k.m 7. Is PHC Within the village [ ] outside village [ ] 8. In case of severity of the disease, which is the nearest referral Health Facility? :. 1
9. How long does it take to travel? Distance in Km 10. Do you regular go to the Govt. PHC[ ] quacks [ ] Private Doctor [ ] Tantrik [ ] for disease? 11. When you visit, is the doctor available? Yes [ ] No [ ] If No, what do you do? 12. Reasons for not visiting Govt. Health Facility: Absence of Doctors and medical personnel [ ] Medicines not available [ ] Poor quality of service [ ] Poor infrastructural Facilities [ ] Attitude/Behavior of the doctors and medical personnel [ ] Distance to the Health Facility [ ] Congestion/Overcrowding in the Health Facilities [ ] 13. Whether you receive proper guidance for your disease? Yes [ ] No [ ] 14. Whether doctors available during OPD hours? Morning [ ] Evening [ ] 15. How often do you see regular doctor? Always [ ] Sometimes [ ] Rarely [ ] 16. Are you satisfied with the service provided by nurses? Extremely satisfied Very Satisfied Moderately satisfied Not sure 1 2 3 4 Moderately dissatisfied Very dissatisfied Extremely dissatisfied. 5 6 7 17. Rate the following questions as per the service received from PHC. Sr.No. Statements Poor fair Good Excellent 1. How do you rate the waiting time 2
2. 3. 4. 5. 6 7. 8. before consultation? How do you rate the convenience of PHC? How thoroughly does doctor ask about your symptoms? How well the doctor listens to what you had to say? How well the doctor explained your problems? How well does the nurse listen to what you say? How do you rate the quality of care they provide? How well do they explain your health problem? 18. Overall, Are you satisfied with existing medical facilities in your village? Extremely satisfied Very Satisfied Moderately satisfied Not sure 1 2 3 4 Moderately dissatisfied Very dissatisfied Extremely dissatisfied. 5 6 7 The questionnaire consists of several questions under which view points are listed out. Each viewpoint consists of seven point rating scale which includes: Strongly agree/very much important/excellent Agree/important/Good Slightly agree/slightly important Neutral Slightly disagree Disagree Strongly disagree 3
Sr.No. Statements S.A A Sl.A N Sl.D D S.D 1. The distance from my home to the PHC is acceptable. 2. Appropriate chairs are available in the waiting room. 3. The time spent in the waiting room for a routine visit is acceptable. 4. The operating hours of the PHC are not suitable 5. The physical separation of the PHC into male and female areas is done appropriately. 7. I see the same doctor at each visit in PHC. 8. I visit only this PHC for non-hospitalbased care. 9. The PHC does not provide all my family s vaccination needs. 10. The staffs at the PHC never mistreat the patients. 11. There are appropriate numbers of staff to perform all the tasks I require at each visit 12. The pharmacist explains how to take medication. 13. The PHC provides health education materials that allow me to understand diseases, their treatment, and prevention. 14. My doctor prescribes medications I can obtain at my local pharmacy. The clinic is not always clean and tidy. 15. 4
16. 17. 18. The medical facilities available at village are not appropriate. Safe drinking water facility available at PHC The facility provided to you by PHC is improper. Thank you, 5
Questionnaire for Doctors on Analytical study of Primary Health Center The questionnaire consists of several questions under which view points are listed out. Each viewpoint consists of seven point rating scale which includes: Strongly agree/very much important/excellent Agree/important/Good Slightly agree Neutral Slightly disagree Disagree Strongly disagree Village: Tehsil: District: Head of Primary Health Center: Name of the Doctor: Designation: Age: Experience: Qualification: You are in this PHC since Years/months 1
Infrastructure:- 1. PHC is provided a government building:- Yes No IF NO, state the location of PHC:- Rented Building Rent free/ Panchayat Voluntary Society Building Others (SPECIFY) 2. Current/existing position of PHC building is:- Kachha Semi-Pucca Pucca 3. Rate the Cleanliness:- Type Good Fair Poor Premises Wards OPD 4. Is power supply available? Regular Power supply Occasional Power Supply Power cut in summer only Regular Power cut No electricity Connection 5. Is standby facility of generator/inventor available in working condition? Yes No 6. Is telephone facility available in the PHC? Yes No 2
7. State the main source of water supply:- Piped Bore Well/ Tube Well Hand Pump Well Others (Specify) No Water Supply 8. Availability of quarters for Medical Officer in PHC:- Residential Quarter for PHC staff Available Whether Residing If Quarter is available and not residing state the reasons : Medical Officer Yes No Yes No A) Poor Condition Of PHC Quarters B) No Water Supply C) No Electricity Facility D) Spouse Staying in another place E) Location of PHC quarter is outside village F) Education of Children G) Security H) Any other (SPECIFY) 9. Labor Room and Operation Theatre:- Facility Labor Room Operation Theater Available Separately Yes No Yes No Currently in use Yes No Yes No If NO then give reasons A) Non-availability of Doctors and staff B) Lack of Equipments C) Poor Physical State D) No Power Supply E). Any other (SPECIFY) A) Non-availability of Doctors and staff B) Lack of Equipments C) Poor Physical State D) No Power Supply E) Any other (SPECIFY) 3
10. Physical Facilities:- Sr. Item Available Not Available No. a) Complaint box/suggestion box b) Standby facility of generator/inverter c) Telephone facility d) Personal Computer e) Trained computer operator f) Connectivity to NIC (national informatics center) terminal Administration: - 11. Staff Position:- Sr. No. Staff Required In position Shortfall a) Medical Officer b) Medical Officer (Ayush) c) Nurses d) Female Health worker e) Male Health worker f) Lab Technician g) Pharmacist h) Computer Operator i) Clerk j) Driver k) Grade D Employee l) B.I.E.C.O 4
12. Number of Sub centers catered by the PHC 13. Population covered by the PHC (Latest) Year 14. Distance (in KM) between CHC and PHC 15. Major diseases prevailing in the village/area:- 1., 2, 3. 16. The important causes for health problems in the village are:- Drinking water Problems: Sanitation problem: Drainage problem: Lack of cleanliness (hygiene): Climate/seasonal factors: Others (specify): 17. Functioning of PHC:- Sr. Statement No. a) Population covered by PHC as per the criteria of IPHS criteria. b) The PHC operationalized on 24*7 bases as planned staff commensurately. S.A A Sl.A N Sl.D D S.D c) The villagers are aware about the available medical facilities. d) PHC does not provide qualitative health facilities to the people. e) Generally the patients consult health facilities at primary stage of diseases. f) Present condition of PHC building is satisfactory. g) An appropriate ventilation facility is 5
available in each & every room of PHC. h) PHC has separate waiting area in OPD. i) Continuous power supply is available in PHC. (PHC has been provided continuous power supply.) j) Access to Internet facility is readily available at PHC. k) PHC manages Rogi Kalyan Samiti in a improper manner. l) On the recommendation of RKS immediate action is taken by government. (if RKS recommends anything government takes immediate action) m) Fully utilization of existing Health Care facilities in PHC. n) PHC utilizes and maintains the fund provided for referral appropriately. o) After the introduction of NRHM, there is an increase in the numbers of outdoor patients. p) NRHM worked at the PHCs level in proper manner. q) The objectives of NRHM are not achieved in PHC. 18. Infant/child Health Services Sr. Statement No. a) Every new born child is provided post natal care. b) Routine immunization activities are done appropriately in village. c) Qualitative Emergency care of sick children is not available at PHC. d) Adequate New born care services available at PHC. S.A A Sl.A N Sl.D D S.D 6
e) PHC has mechanism to monitor and report maternal and neonatal deaths timely to district and state authority. f) PHC provides Vitamin A doses to the children as per target. g) School health programme is run by PHC in improper manner. h) School health programme covers every child in village. i) The children with refractive errors are provided with glasses. j) After the launch of NRHM there is a significant decrease neonatal and infant death rate. k) There is an increase in immunization coverage after the launch of NRHM. l) Implementation of NRHM leads to improvement in nutrition status of children. m) Due to the launch of NRHM rate of low birth babies decreased. 19. Maternal Health Services Sr. Statement No. a) PHC provides antenatal care service as per target. b) Number of Delivery performed by PHC as per target. c) PHC does not provide appropriate post natal care services. d) Adequate delivery services are available at PHC round the clock. e) Emergency Obstetric care (Caesarian services & other medical intervention) is available at PHC. f) As and when required all pregnant women are assisted for referral services. S.A A Sl.A N Sl.D D S.D 7
g) Contraceptives are distributed in village in sync with target. h) MTP performed at PHC is not as per target. i) There is much awareness on family planning among the people in village. j) There is explicit campaign done by the Health Facility towards family planning. k) Regular incentives are provided to the Health Facility staff for achieving family planning targets. l) Facility of tubectomy, laparoscopic tubectomy and vasectomy available at PHC are ideal. m) PHC achieves annual target for male and female sterilizations. n) The target given to the PHC for family planning is achieved. o) There is an increase in number of institutional deliveries after the launch of NRHM p) There is significant increase in number of out patient and inpatient cases at PHC after the launch of NRHM q) Due to implementation of NRHM there is a decrease in MMR. 20. About National Health Programme Rate the various National Programme run at PHC:- National Program Excellent Good Average Poor Very poor Don t know Not available National Vector Borne Disease Control Programme {Filaria, Kala Azhar, Malaria, Dengue, Japanese Encephalitis} 8
National leprosy Eradication Programme Revised National T.B. Control Programme National Programme for Control Blindness National Iodine deficiency disorder control Programme National Cancer Control Programme (Tobacco Control Programme) Reproductive & Child Health Programme THANK YOU 9