Using Longitudinal Data for Evaluating Policy Changes and Other Interventions

-Information system in Tamilnadu Medical Services Corporation

MURALI .R, SATHYANARAYANAN.D, RAJ KUMAR.C, SENTHI L KUMAR.R & TI TUS.U

I NSTI TUTE OF COMMUNI TY MEDI CI NE,

MADRAS MEDI CAL COLLEGE, CHENNAI

INTRODUCTION

An efficient health care delivery system is an important requisite to achieve health for all.

Access to essential drugs is probably the most important element of health care delivery system.

The Government of Tamil Nadu, India

realizing this, developed and implemented various strategies

under the broad framework of Tamil Nadu

Medical Services Corporation to control and monitor drug procurement, storage and

distribution to the Public sector hospitals in the state.

Monitoring and evaluation

H.O.Server

Warehouse Information System

M.I.S.

Payroll & Personal

CT Scan System

Drug Management & Monitoring System

Financial Accounts

Automated Material Handling

Construction Management

Supplier Information

QC Monitoring System

Data collection at the facility level: Pass book of TNMSC

Stock registers

Sub-stock register

Daily token register

Doctor’s diagnosis register

PATIENT FLOW

Stock status at a central warehouse

STOCK STATUS BY MONTHAMOXYCILLIN

-20

0

20

40

60

80

100

Jan-9

7

Apr-

97

Jul-97

Oct-

97

Jan-9

8

Apr-

98

Jul-98

Oct-

98

Jan-9

9

Apr-

99

Jul-99

Oct-

99

Jan-0

0

Apr-

00

Jul-00

Oct-

00

MONTHS

ST

OC

K IN

MO

NT

HS

Desired months of stockMinimum - 10 Maximum - 21

Drugs Indented for 3 yearsin a PHC

0

10

20

30

40

50

60

70

1996-1997 1997-1998 1998-1999

No.

of D

rugs

Total no. of drugs indented No. of drugs indented from the PHC list

No.of drugs indented outside the PHC list No. of drugs not indented from the PHC list

Impact of Tamil Nadu Medical Services Corporation on Drug Prescribing in primary health care- an example1)To study the impact of the TNMSC in

primary care centres (PHCs) on a) availability of 15 core essential drugs; b) continuous availability of an adequate quantity of the core essential drugs; and c) rational use of drugs in PHCs;

2) to study the maintenance of quality of drugs by the TNMSC and

3) to study the control of drug expenditures by the TNMSC.

Study design

Longitudinal time series with control before and after various TNMSC interventions (20 PHCs Vs 20 Controls).

Time series study of government rural PHCs before and after various TNMSC interventions in 1994-8.

Feasible indicators % of key drugs available average number of days of stock-out. % cases receiving prescription; average number of drugs per prescription; % drugs prescribed by generic name; % drugs prescribed that belong to the PHC EDL

(51 drugs); % prescriptions containing an antibiotic; % prescriptions containing a vitamin % prescriptions containing an injection; average cost per prescription. % of prescriptions as per STG

10 years of data is to be preserved at every point of time

This gives sufficient longitudinal data to evaluate the policy change.

Limitations

Missing data ( the tokens of a year or a portion of the year may be missing)

Non-uniformity in writing the diagnosis

Injection tokens often not well preserved

Thank you