Evaluating Policy Changes in Tamilnadu Medical Services Corporation Using Longitudinal Data

2. Using Longitudinal Data for Evaluating Policy Changes and Other Interventions -Information system in Tamilnadu Medical Services Corporation

4. 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.

5. 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.

6. Monitoring and evaluation

7. H.O.Server CT Scan System Drug Management & Monitoring System Warehouse Information System Computerization QC Monitoring System M.I.S. TNMSC Financial Accounts Payroll & Personal Integrated System Construction Management Automated Material Handling Supplier Information

8. Data collection at the facility level: • Pass book of TNMSC • Stock registers • Sub-stock register • Daily token register • Doctor’s diagnosis register

9. PATIENT FLOW

10. Stock status at a central warehouse

11. Drugs Indented for 3 yearsin a PHC

13. Impact of Tamil Nadu Medical Services Corporation on Drug Prescribing in primary health care- an example 1)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.

14. 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.

15. % 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 Feasible indicators

16. 10 years of data is to be preserved at every point of time • This gives sufficient longitudinal data to evaluate the policy change.

17. 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

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