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THE ANALYSIS OF THE RURAL OUTREACH PROGRAMME OF A TERTIARY CARE

HOSPITAL IN GHAZIABAD AND THE MORBIDITY PROFILE OF OUT - PATIENTS
ATTENDING THE PROGRAMME

Article  in  Journal of Evolution of Medical and Dental Sciences · July 2015

DOI: 10.14260/jemds/2015/1382

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DOI: 10.14260/jemds/2015/1382

ORIGINAL ARTICLE
THE ANALYSIS OF THE RURAL OUTREACH PROGRAMME OF A TERTIARY
CARE HOSPITAL IN GHAZIABAD AND THE MORBIDITY PROFILE OF OUT-
PATIENTS ATTENDING THE PROGRAMME
Ravi Kant Sehgal1, Rinku Garg2, Sharmila Anand3, P. S. Dhot4

HOW TO CITE THIS ARTICLE:

Ravi Kant Sehgal, Rinku Garg, Sharmila Anand, P. S. Dhot. “The Analysis of the Rural Outreach Programme of a
Tertiary Care Hospital in Ghaziabad and the Morbidity Profile of Out-Patients attending the Programme”.
Journal of Evolution of Medical and Dental Sciences 2015; Vol. 4, Issue 55, July 09; Page: 9561-9567,
DOI: 10.14260/jemds/2015/1382

ABSTRACT: BACKGROUND: Considering that the rural areas in India are generally deprived of
adequate medical facilities, a Rural Outreach Programme was launched by Santosh Hospital in order
to provide free out-patient services to the rural population of some villages in Ghaziabad as part of its
social obligation to the society. The aim of this study is to analyse the morbidity profile of the
patients attending these outreach clinics. MATERIAL AND METHODS: A weekly OPD was run in nine
villages with each village being visited once a week on a fixed day every week by a team of resident
doctors. A record based descriptive study was carried out to find out the morbidity profile of patients
based on the information about their age, sex, residence, new or old case and diagnosis as recorded in
the out-patient register. RESULTS: Maximum patients were in the 26 to 50 years age group and there
were more females than males attending the clinics. Maximum cases were of Eye diseases followed
by Respiratory diseases, GIT diseases, Bone and Joint diseases and CVS diseases in that order.
CONCLUSION: The data provided in this study which describes the morbidity profile of patients
attending the Rural Outreach Programme of Santosh Hospital can help in planning health services as
per the actual needs of the community as well as help in training of health staff.
KEYWORDS: Rural Outreach Programme, Village Pradhans, Morbidity Profile, Health Problems.

INTRODUCTION: It is a well-known fact that most of the medical facilities in our country are located
in the urban areas and the rural population has to travel long distance even for minor sickness. With
the motto of ‘Reaching the Unreached’, Santosh Hospital has been carrying out Rural Outreach
Services in the outskirts of Ghaziabad since beginning of Aug 2014. The data recorded about the
patients attending these outreach OPDs was compiled and analyzed to find out the morbidity profile
of these villages. Attendance rates of Out-Patient Department are used for assessing ill-health of the
community.1 Such studies help in making a ‘Community Diagnosis’ on important health problems
and their socio-demographic characteristics which in turn help in organizing health care for the
community.2
OBJECTIVES:
 To reach out to the community by providing free specialist services to the people near their
homes.
 To increase the clinical exposure of PGs and interns.
 Increase the outpatient and inpatient load in Santosh Hospital in the long run.
 To study the morbidity profile of the rural population in the area covered.

METHODOLOGY: Nine villages in District Ghaziabad at a distance of 12 to 18 KM where least

Government medical facilities were available were selected, in consultation with the Ghaziabad
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ORIGINAL ARTICLE
Development Authority, for running the programme. The programme was started on 04 Aug 2014 in
five villages. Each village was visited on a fixed day every week from Monday to Friday. The timings
of the camp were 10 AM to 1 PM. The publicity about the camp was carried out by local munadiwalah
and by announcement made in religious establishments. The visiting team consisted of resident
doctors in Medicine, Pediatrics, Ophthalmology, ENT and Dentistry. After eight weeks, four more
villages were taken up and weekly visits were continued in these villages. A total of 3111 patients
were seen during these visits. The total population covered was 45020. A common register was
maintained for all out-patients and information like age, sex, residence, new/old case and principal
diagnosis was recorded. In this record based descriptive study, the data concerning morbidity
pattern of patients attending as out-patients in these clinics has been analyzed.
Ethical approval was taken from the research committee of the Institution before starting the study.

STATISTICAL ANALYSIS: Statistical analysis was done by using Pearson’s Chi-square (x2) statistical
test and percent ratios wherever applicable. The level of significance was set at 5% (p<0.05).

Inclusion and exclusion criteria: The analysis of Morbidity Profile was done on the basis of new
patients only, if the same patient came for consultation more than one time for a particular illness
then he/she was considered once only.

ANALYSIS OF RURAL HEALTH PROGRAMME OF SANTOSH HOSPITAL:

Activities/Services Provided:
 OPD services were run at a convenient place in the village. Free specialist consultation was
provided to the villagers.
 Health check-up was carried out free of charge for those asking for it.
 School Health examination of children studying in the Government schools located in the
village was carried out without charging any money. On the days when School Health
Examination was carried out, the other patients were also seen at the school location only.
 Health education about personal hygiene, hand-washing, prevention and control of
communicable diseases especially insect-borne and food and water borne diseases was carried
out by the PG and Interns from Dept of Community Medicine.
 Those patients who required further investigation and treatment were referred to Santosh
Hospital.
 These patients were provided free transportation in vehicle of Santosh Hospital.
 The patients were received on arrival in the hospital and guided by the hospital staff and after
getting all investigation/ treatment etc, they were dropped back in the same vehicle.
 They were provided 15% concession for all investigations and indoor treatment facilities.

Constraints/ Difficulties:
 Working conditions were poor at many places. There was no electricity in the villages in
daytime and the weather was hot and sultry.
 Most of the patients were unwilling to spend money on purchase of medicines and demanded
free medicines. The attendance in the camp declined drastically after the first visit due to this
factor alone.

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ORIGINAL ARTICLE
 For proper conduct of the camps, cooperation of the village Pradhans is a must which was
lacking at many places.
 For prior publicity about the camp, one had to depend on the village Pradhan but invariably the
same was not carried out properly.
 Attendance was poor in the camps sometimes because of the festival (Dussehra/Diwali) season
and harvesting season keeping people busy.

Value/Benefits to the Hospital:

 Increased awareness about Santosh Hospital and facilities available here.
 Lot of patients have been brought from the camp site for treatment and investigation in our
transport.
 Lot of patients are coming directly from these villages to the hospital after the programme has
started.
 Community based studies can be carried out in these villages by the PG students.
 Higher standing of Santosh brand in society in view of the social work.

Lessons Learnt:
 The number of patients reporting for the medical camp declined drastically during the second
and subsequent visits in all the villages. The reason for that was that the patients were not
satisfied with consultation and advice only, without medicines being given to them free of
charge. Thus there is a need to revise the strategy for running the camps in order to get more
patients to avail the facility. The camps can be run in collaboration with Government agencies
who can provide the medicines while we provide the specialist manpower.
 The second difficulty being faced was lack of proper publicity. Involvement of Government
dept can resolve this issue as well as they have their Anganwadi Workers/ASHA and other
social workers in these areas who can take care of the publicity aspect.

RECOMMENDATIONS:
 Extended timings till 2.30pm/3.00pm-in the morning hours the villagers go to work in the
fields and are not available to avail the facilities unless acutely ill.
 Reduce frequency of visits – once in three/four weeks- after initially running the camp for few
weeks, the frequency of visits should be reduced to once in 3 to 4 weeks.
 Include other specialists e.g., orthopaedics/surgery and dermatology.
 There is a need to sensitize the hospital staff especially the HODs, reception, billing staff etc
regarding the 15 percent concession that is to be given to these patients as many patients
reported about difficulty in obtaining the concession.
 Involvement of government agencies–Public Private Partnership. Santosh Hospital has got
trained manpower in the form of PGs of various specialities as well as nursing and paramedical
staff to run outreach programmes but we lack in infrastructure at the rural level and cannot
provide free medicines to the patients. These requirements can be met by having a partnership
with government health agencies where our manpower and resources can be utilised to
provide medical cover to the rural/urban slum population.
 Involvement/role in implementation of national health programmes eg. immunization, dots etc.

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ORIGINAL ARTICLE
 Involvement of government/voluntary organisations/drug dealers- One of the main reasons for
the poor response to the outreach programme amongst the villagers was the non-availability of
free medicines which all of them demanded.
 Provide lab facilities eg. random blood sugar testing etc.
 Mobile van with dental chair which can provide treatment of minor dental ailments should be
made available to increase satisfaction level of village population.
 Publicity in the village before the visit. If involvement of government agencies is there, then the
Anganwadi Workers can carry out this activity.
 Publicity through print media should be undertaken about outreach activities by Santosh
Hospital.
 Interaction with village Pradhans. A meeting can be held with the village Pradhans over a cup
of tea where they can interact with the hospital staff and can be taken around the hospital and
told about the facilities being provided in the hospital.
 Community based research activities in the villages adopted – by the Faculty and PG students.

MORBIDITY PROFILE OF PATIENTS ATTENDING THE PROGRAMME:

RESULTS AND DISCUSSION: The total population of the villages covered under the programme was
45020 which included 23002 males and 22018 females. Table 1 shows the distribution of patients
according to their age and sex. Maximum attendance was observed in 26-50 years age group
(41.56%) followed by those in over 50 age group (38.77%) and minimum attendance was observed
in less than 12 years age group (7.52%). These findings were similar to those observed by Dutta and
Kale3 who too reported maximum attendance in the age group of 25-44 years. However our findings
differ from the study done by Singh4 which reported maximum attendance in under-fives and in the
age group of 15-24 years. One reason for the lower attendance of 0-12 years in the present study
could be because the outreach camps were conducted from 10 AM to 1 PM when most of the children
were away to their schools.
Gender-wise analysis reveals that there were more females (54.20%) attending the clinics
than males (45.80%). Similar findings were observed in other studies done by Rao et al5 and
Sangeeta Kansal et al.6 Maximum difference was observed in the age group of 26 to 50 years in which
there were 25. 84% females and 15. 72% males. This could be so because during the time of the
camp, most of the men were away to their places of work.
Distribution of reported cases of different types of diseases according to sex is given in
Table 2. It was found that out of total reported cases in the clinics, maximum cases were of Eye
diseases (15.59%) followed by Respiratory diseases (10.06%), GIT diseases (6.20%), Bone and Joint
diseases (5.86%) and CVS diseases (5.20%) in that order. Similar pattern of reported cases was also
found by Singh IJ4, Sangeeta Kansal et al,6 Dutta et al,7 Seal SC et al8 and Arti Gupta et al.9 The present
study differs from other studies in having highest reported cases of Eye diseases. This could be
explained by the fact that there were larger number of elderly people reporting to the clinics as
compared to other age groups during the camp timings because the children and younger adults had
gone to schools and places of work respectively and the elderly people have a high incidence of eye
diseases especially presbyopia and cataract.

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ORIGINAL ARTICLE
The case rate per 1000 population for different types of diseases was found to be higher for
females than male population with the exception of cases of Injuries and accidents which were more
amongst males. Similar findings were reported by Singh4 and Sangeeta et al.6

CONCLUSION: The Rural Outreach Programme was started in Santosh Hospital as a Community
Benefit Programme with the aim of increasing clinical exposure to the medical/dental students
besides increasing the social standing of Santosh brand amongst the local population. The
programme was partially successful in meeting its social as well as professional objective. However,
it is felt that the experience gained in running this programme should not be allowed to go waste and
the programme should be continued in a slightly modified pattern in collaboration with State
Government Health authorities so that the two problems of providing free medicines as well as
adequate publicity prior to the camp are taken care off. The analysis of the data pertaining to patients
attending the clinics revealed that maximum patients were in the 26 to 50 years age group and there
were more females than males attending the clinics. Maximum cases were of Eye diseases followed
by Respiratory diseases, GIT diseases, Bone and Joint diseases and CVS diseases in that order. The
data about the morbidity profile of the patients attending the Rural Outreach Programme can help
the public health planners in planning health services as per the actual needs of the community as
well as help in training of health staff.

ACKNOWLEDGEMENT: We are thankful to the subjects as well as all the doctors who participated in
the Rural Outreach Programme for their contribution in the completion of the study.

REFERENCES:
1. Park K. Textbook of Preventive and Social Medicine, M/S Banarasidas Bhanot, 1167 Prem
Nagar, Jabalpur. 20th Edition, 2009, p 25.
2. Public Health and Preventive Medicine for Indian Armed Forces. Department of Community
Medicine, AFMC Pune, 8th Edition, 2008, p 2.
3. Dutta SP and Kale PV. “An Observational Research Study in Primary Medical Care in
Pondicherry”, Indian Journal of Preventive and Social Medicine, 1, No 2, 1969.
4. Singh IJ. “A Study of Morbidity Pattern in a Rural Community”, Health and Population, 2(3):
193-206, 1979.
5. Rao NSN, Marwah SM, Tiwari IC. “Disabilities, Morbidity and Mortality in a Community
Development Block”, Indian Journal of Medical Sciences, 513-520, 1973.
6. Sangeeta Kansal, Alok Kumar, IJ Singh, SC Mohapatra.”A Study of Morbidity Profile in Rural
Community of Eastern Uttar Pradesh”, Indian Journal of Preventive and Social Medicine, Vol 39,
No. 3 and 4, 2008.
7. Dutta Jayant Kumar and Banerjee RR. “Morbidity Pattern of Out- Patients’ Attendance”, Indian
Journal of Paediatrics, Vol 37, 267, 1974.
8. Seal SC.”General Health Survey of Talcher Community Development Block”Orissa, Director
General of Health Service, New Delhi, 1958.
9. Arti Gupta, Vinoth Chellaiyan, Ayush Lohiya, Rizwan SA, Ravi P Upadhyay, Palanivel C.
”Morbidity Profile of Out- Patients Attending a Primary Health Centre in Rural Puducherry,
South India”, National Journal of Community Medicine, Vol 5, No 4, Oct- Dec 2014, 424-427.

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ORIGINAL ARTICLE
Annexure 1:

Age (in years) Male Female Both

No. of Patients % No. of Patients % No. of Patients %
0-12 123 3. 95 111 3. 57 234 7. 52
13-25 207 6. 65 171 5. 50 378 12. 15
26-50 489 15. 72 804 25. 84 1293 41. 56
>51 606 19. 48 600 19. 29 1206 38. 77
Total 1425 45. 8 1686 54. 2 3111 100
Table 1:Distribution of patients according to Age and Sex
Annexure 2:
Morbidity Male(n=23002) Female(n=22018) Both(n=45020)
Case Case Case
Rate Rate Rate
No % No % No %
per per per
1000 1000 1000
Respiratory 13. 14.
218 15. 30 9. 48 235 10. 67 453 10. 06
Diseases 94 56
GIT Diseases 129 9. 05 5. 61 150 8. 90 6. 81 279 8. 97 6. 20
CVS
107 7. 51 4. 65 127 7. 53 5. 77 234 7. 52 5. 20
Diseases
CNS
18 1. 26 0. 78 20 1. 19 0. 91 38 1. 22 0. 84
Diseases
23. 22.
Eye Diseases 312 21. 89 13. 56 390 17. 71 702 15. 59
13 57
Ear Diseases 40 2. 81 1. 74 41 2. 43 1. 86 81 2. 60 1. 80
Skin Disease 79 5. 54 3. 43 95 5. 63 4. 31 174 5. 59 3. 86
Bone & Joint
112 7. 86 4. 87 152 9. 02 6. 90 264 8. 49 5. 86
Diseases
Dental
54 3. 79 2. 35 67 3. 97 3. 04 121 3. 89 2. 69
Diseases
Anaemia &
Nutritional 69 4. 84 3. 00 126 7. 47 5. 72 195 6. 27 4. 33
Deficiency
Endocrine
30 2. 11 1. 30 36 2. 14 1. 63 66 2. 12 1. 47
Disorders
Injuries &
99 6. 95 4. 30 78 4. 63 3. 54 177 5. 69 3. 93
Accidents
10. 11.
Others* 166 11. 65 7. 22 183 8. 31 349 7. 75
86 22
Total 1433# 61. 95 1700# 76. 57 3133 69. 10
Table 2: Distribution of Reported Cases of Different Diseases according to Sex
X2 = 19. 51 df= 12 p> 0. 05.
*Others mainly included diseases like general weakness, myalgia, menstrual disorders and
vaginal discharge etc.
#Some of the patients had more than one disability due to which the total is more than the

actual no. of patients.

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ORIGINAL ARTICLE
AUTHORS:
1. Ravi Kant Sehgal
4. Professor, Department of Pathology,
2. Rinku Garg
Santosh Medical College, Ghaziabad.
3. Sharmila Anand
4. P. S. Dhot
NAME ADDRESS EMAIL ID OF THE
PARTICULARS OF CONTRIBUTORS: CORRESPONDING AUTHOR:
1. Associate Professor, Department of Dr. Ravi Kant Sehgal,
Community Medicine, Santosh Medical 1420/Sector 29,
College, Ghaziabad. Park View Apartments,
2. Associate Professor, Department of Noida, Utter Pradesh.
Physiology, Santosh Medical College, E-mail: [email protected]
Ghaziabad.
3. Assistant Professor, Department of Date of Submission: 17/06/2015.
Pharmacology, Santosh Medical College, Date of Peer Review: 18/06/2015.
Ghaziabad. Date of Acceptance: 01/07/2015.
Date of Publishing: 07/07/2015.
FINANCIAL OR OTHER
COMPETING INTERESTS: None

J of Evolution of Med and Dent Sci/ eISSN- 2278-4802, pISSN- 2278-4748/ Vol. 4/ Issue 55/ July 09, 2015 Page 9567

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