|Ahead of print publication
Assessment of Kayakalp Yojna in public health-care facilities in Himachal Pradesh
Sunite A Ganju1, Alka Gupta2, Shriya Ganju3, Neha Gautam4
1 Associate Professor, Department of Microbiology, SLBSGMC, Mandi, Himachal Pradesh, India
2 Quality Assurance consultant, NHM, Kullu, Himachal Pradesh, India
3 Gynaecologist, Regional Hospital Kullu, Kullu, Himachal Pradesh, India
4 Department of Microbiology, DYSPGMC, Nahan, Himachal Pradesh, India
|Date of Submission||03-Jul-2020|
|Date of Decision||04-Sep-2020|
|Date of Acceptance||25-Sep-2025|
Department of Microbiology, DR YSPGMC, Nahan, Himachal Pradesh
Source of Support: None, Conflict of Interest: None
Background: Maintenance of a clean environment in a hospital is challenging and at the same time crucial for patient safety. The importance of the hospital environment in patient care has received worldwide attention, especially in infection prevention and control. The Ministry of Health and Family welfare launched “Kayakalp Yojna,” an initiative to promote cleanliness and enhance the quality of public health facilities. Objective: This study was undertaken to assess the impact of the implementation of the Kayakalp initiative in public health-care facilities of Himachal Pradesh. Material and Methods: This analytical study was conducted to assess the impact of Kayakalp Yojna in six thematic areas; hospital/facility upkeep, sanitation and hygiene, waste management, infection control (IC), supportive services, and hygiene promotion in government hospitals using the Kayakalp assessment tool in the state of Himachal Pradesh in 2017–2018. Results: Post implementation of Kayakalp Yojna, there was an average improvement of 20% in the total scores of the hospitals from internal assessment to external assessment. Four of the 12 district hospitals, three of the 89 community health centers, and 26 of the 475 public health centers scored more than 70% in the external assessment. Conclusion: The Kayakalp assessment results give an insight to the problem areas and present a possibility to improve the public health facilities.
Keywords: Internal assessment, Kayakalp Yojna, peer assessment, record review, thematic areas
|How to cite this URL:|
Ganju SA, Gupta A, Ganju S, Gautam N. Assessment of Kayakalp Yojna in public health-care facilities in Himachal Pradesh. Med J DY Patil Vidyapeeth [Epub ahead of print] [cited 2021 Dec 6]. Available from: https://www.mjdrdypv.org/preprintarticle.asp?id=321292
| Introduction|| |
The World Health Organization has defined quality of care as “the extent to which health care services provided to individuals and patient populations improved desired health outcomes.” Cleanliness in health-care facilities is a crucial aspect of quality of care that contributes to both the satisfaction of the patient and the health-care personnel. Maintenance of the hygiene and cleanliness of health facilities is not only related to esthetics and patient fulfillment but it also reduces the incidence of hospital-acquired infections (HAI). Keeping a hospital clean requires an active participation of all the personnel of hospitals along with the patients and their visitors. Sanitation and hygiene practices of a health-care institute play a decisive role in the selection of health-care facilities by individuals. The Ministry of Health and Family Welfare, Government of India, launched a national initiative “Kayakalp Yojna” on May 15, 2015 to promote cleanliness and enhance the quality of public health facilities. The purpose of this initiative is to appreciate, recognize the effort to create a healthy environment, and to inculcate a sustainable culture of cleanliness in the health-care facilities. The health facilities that show exemplary performance on six thematic areas are awarded at the national level. These areas are hospital upkeep, sanitation and hygiene, waste management, infection control (IC), hospital support services, and hygiene promotion. The final score is based on the standardized Kayakalp facility assessment tool. The score varies in district hospitals (DH), community health centers (CHC), and primary health centers (PHC) being 500 for DHs and CHCs, 300 for PHCs with beds, and 200 for PHCs without beds. The weightage for each thematic area in DH is 100 excepting for hospital support services and hygiene promotion, which are given 50 marks each. Each thematic area has several criteria to be checked. The assessment method and the means of verification for each criterion are described in the assessment tool.
This study was undertaken to assess the impact of the implementation of the Kayakalp initiative in public health-care facilities of Himachal Pradesh.
| Material and Methods|| |
This is an observational-cross sectional study conducted across health-care facilities of Himachal Pradesh using the Kayakalp assessment tool during the year 2017–2018. Twelve DH, 89 CHCs, and 475 PHCs were assessed. The process of assessment in “Kayakalp yojna” comprised four major steps; internal assessment, peer assessment, nomination of facilities for the state level awards committee, and external assessment. The staff and the quality consultants of the district were given an initial training in the “Kayakalp Yojna” and the quality aspects. The internal assessment was carried by the internal staff of each facility to identify gaps at the beginning of the financial year. The process is ongoing every quarter and helps to identify and address the gaps for improvement. The second assessment is the peer assessment for facilities scoring an average of 70% in internal assessment. The state level program officers of the neighboring districts within the state do this. A score of 70% or above in peer assessment is a prerequisite for nomination to state level awards. This process is followed by the external assessment to validate the scores of the peer assessment and for formal recognition and award at the national level. The external assessment is carried out by a three member expert team, which includes a consultant not from the government. The facilities were ranked on the basis of percentage scores obtained during the course of the assessment process. The means of verification for assessment were direct observation, staff interview, patient interview, and record review. The scores given were two for full compliance, one for partially compliance, and zero for noncompliance. The assessment and documentation were conducted using a standard checklist provided under Kayakalp yojna. The results presented here represent the ranking in the external assessment.
| Results|| |
Of the 12 DHs of the state, four DHs (three urban and one rural) qualified for external assessment scoring around 70% as shown in [Table 1]. However, between the peer assessment and external assessment, there was an observable change ranging up to 20%. DH Kullu scored a total of 91% among the winning DHs. These winning DHs scored maximum in the criteria of support services and least in hospital facility upkeep. Among 89 CHCs, CHC Bir, (Kangra) in the rural area, scored a maximum of 89.6% in the state registering a positive change of 19%. Among the winning CHCs, CHC pooh scored higher in IC and support services than CHC Bir, which had an overall maximum score. The scores in the six thematic areas of winning CHCs are shown in [Table 2]. A total of 26 PHCs scored more than 70% in the peer assessment, and the improvement recorded from peer assessment to external assessment was upto 25%. PHC Panjawar scored the highest (95.3%). [Table 3] depicts the scores obtained in the six thematic areas in the top five PHCs. PHC Annadale was the only urban PHC (out of six urban PHCs in the state) to score 83.33%.
|Table 1: District hospitals scoring more than 70% in external assessment|
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| Discussion|| |
The major concern for the public today, when information is readily available, is regarding health-care services and providers. Public health facilities are generally perceived to be unpleasant and unhygienic with poorly maintained buildings, overflowing drains, presence of dogs/cats/rodents inside the hospital, and patient care areas and often dirty or nonfunctional toilets. Thus, all government hospitals need to improve hygiene and cleanliness, biomedical waste management (BMWM), and support services in order to provide quality services to their patients. Keeping this perception in view, the Kayakalp initiative was launched to enhance the quality of public health facilities. This initiative has played a vital role in gaining trust and confidence of the community in public health facilities. Kayakalp has given a sense of ownership among stakeholders, which has translated into commitment for Swachhta. In our state, four district/regional hospitals scored more than 70% and won a commendation award. In a study conducted at Chhattisgarh, the average percentage improvement in the score of district was reported to be 18.27%. After the implementation of Kayakalp Yojna, there was an average improvement of 20% in the total scores of our health-care facilities from internal assessment to external assessment.
The Kayakalp Yojna gives an insight to the problem areas in each health facility, thereby giving a scope for improvement. In our study, the gap analysis has shown that the DHs of the state have scored less in the hospital upkeep and sanitation and hygiene criteria, 73.75% and 82.25%, respectively. This enabled to work on improving the hospital upkeep and ensuring health facilities to carry out the functions in safe and secure environment. Several areas of concern like correcting the landscaping, innovative ideas for fencing, and herbal plantation will go a long way to do refinement of hospital upkeep. It not only has a positive effect on patient's feeling of well-being and also increases access to social support for patients, families, and staff. Another area of improvement was pest control. Pest and animals pose a number of health threats by spreading microbial infection and communicable diseases. Therefore, animal- and pest-free environment is of utmost importance in health-care facilities. Sanitation and hygiene is another area, which needs improvement at DH level. Environmental cleaning and disinfection is necessary to eliminate or reduce the organisms in the environment to prevent the occurrence of HAIs. Therefore, maintaining cleanliness of high-, moderate-, and low-risk areas of the health-care setting is of significant importance.
Only 3.37% of the CHCs and 5.47% of the PHCs in the state have scored more than 70% in this Kayakalp assessment. These peripheral units have scored maximum in sanitation criteria (90% for CHCs and 81.83% for PHCs) and least in the BMWM criteria (79% for CHCs and 71.02% for PHCs). Biomedical waste generated in hospitals as a result of various procedures carried out during the treatment process of a patient needs efficient handling. Improper handling of biomedical waste may have serious health hazards and adverse impact on the environment. A study conducted on biomedical waste management using the Kayakalp tool in southern India demonstrated that only 57% of BMWM guidelines are followed. There is an urgent need to provide training to increase the knowledge, awareness, and practices among the health-care workers. It is imperative to manage biomedical waste generated in appropriate manner and all bedded health-care settings should maintain daily and display a monthly record of the biomedical waste generated in the setup. The CHCs of our state attained 80% in support services thematic area. Support services are important to keep the hospital clean, keep the patient beds ready, provide nourishing delicious food, and keep the linen clean and equipment in working condition. This will improve patient throughput, diagnostics, and outcomes.
IC is another area, which has a huge impact on patient outcomes. In our state, the health facilities scored around 80% in IC criteria and have scope for betterment. Good IC practices help in decreasing the rate of HAIs, which create additional sufferings and cost for the patients. HAIs increase hospital stay, cause disability, increase resistance to antimicrobials, and cause preventable deaths. Effective IC practices which include hand hygiene, use of PPEs, processes of decontamination, sterilization, and high-level disinfection, following proper isolation and barrier nursing techniques, monitoring HAIs, and taking corrective and preventive measures should be performed regularly in health facilities to maintain quality of care. In the study conducted in DHs in Chhattisgarh, the authors state that compliance to the Kayakalp initiative enabled the hospitals to improve their status of cleanliness and hygiene with an average improvement of 23.5% in hygiene promotion and 19.88% score in the area of IC. This reflects that education, training, and work culture can highly improve the outcome indicators of health-care services rendered by the facilities. The cleaning and disinfecting a hospital is a repetitive task and thus cleaning personnel should be trained sufficiently and highlighted the importance of their work.
| Conclusion|| |
The results of external audit of our state are encouraging and also give us an opportunity to strengthen our capacities to provide better quality health care. Kayakalp assessment is an innovative basic tool that provides awareness of the problem areas to be improved besides an integrated development of the public health facilities.
We acknowledge the officers/officials of the Kayakalp program for involving us in the assessment of the program and tabulation of final results of our state and permitting us to publish the data vide letter dated March 17, 2020.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]