CHC's

PEO Evaluation Studies
Functioning of Community
Health Centres (CHCs)
i Preface
ii Executive Summary
1 Introduction
2 The Evaluation Study- Objectives and Methodology
3 Coverage and Location of CHCs
4 Infrastructure in CHC – Availability and Adequacy
5 Utilisation of Medical Services
6 Family Welfare and National Health Programmes - Role of CHCs..
7 The Utility of CHCs- Beneficiaries’ Views
iii Appendix Tables
iv Project TeamPreface
The Community Health  Centre (CHC), the third tier of the network of rural health care
institutions, was required to act primarily as a referral centre (for the neighbouring PHCs, usually 4 in
number) for the patients requiring specialised health care services. The objective of having a referral
centre for the primary health care institutions was two-fold; to make modern health care services
accessible to the rural people and to ease the overcrowding in the district hospitals.The CHCs were
accordingly designed to be equipped with : four specialists in the areas of medicine, surgery,
paediatrics and gynaecology; 30 beds for indoor patients; operation theatre, labour room,  X-ray
machine, pathological laboratory, standby generator , etc., along with the complementary medical and
para medical staff.
At the instance of Planning Commission, the Programme Evaluation Organisation undertook
the study to evaluate the functioning of the Community Health Centres (CHCs) and their effectiveness
in bringing specialised health care services within the reach of rural people.
Both secondary and primary data were required to be analysed to test the various
hypotheses relating to the above mentioned objectives of the study. While the information available in
published sources was obtained and used wherever necessary, the major part of the data, required
for the study, was generated through a sample survey of 62 PHCs and 31 CHCs spread over the 16
sample districts of eight states selected for the study.
The findings of the Study are as follows:
(a)  Given the other relevant factors, the services of a CHC are likely to be used less intensively, if:
 (i)  its geographical coverage is very large;
 (ii)  it has inadequate medical staff, particularly the specialists; and
(iii)  the mean distance of the PHCs from the CHC is longer.
(b) Some CHCs have been approved without sanctioning all the posts of specialists. Only 30 per cent
of the required posts of the specialists were found to be in position. More than 70 per cent of
the sample CHCs are running either with one specialist or without any specialist.
(c) There is a mis-match between medical specialists vis-a-vis equipments/facilities/ staff, leading to
sub-optimal utilisation of resources. The over- all productivity of the public health services can
substantially be improved if this mis-match as well as thin spread of resources is avoided.
(d) Only two out of 31 CHCs were found to have been used as referral centres to some extent. As
many as 11 CHCs have not attended any referral case, while the remaining 18 have been
used sub-optimally with an average of 206 cases per year. The constraints to utilisation of the
services of CHCs relate to inadequacies of infrastructure, medical and paramedical staff, and
more importantly, the mis-match of various inputs.
(e) Notwithstanding the existing limitations in the services delivery system, a large majority of the
households expressed their strong preference for public health care system as against the private
facilities.
The findings tend to suggest that CHCs have not made any significant contributions towards
realisation of the intended objectives even after about two decades of their establishment. The study has been able to identify a set of key factors that has contributed to the poor performance of CHCs. It
is hoped that the findings of the study will be useful to the planning/ implementing agencies in
introducing the necessary corrective steps for improving the services delivery system.
The study received constant support and encouragement from the Deputy Chairman,
Secretary and Chairman (EAC) of Planning Commission. Dr. (Mrs.) Manjula Chakraborty, the then
Deputy Adviser (PEO) initiated the study, but it was designed and conducted under the direction of
Shri Amar Singh, Deputy Adviser (PEO). The efforts  put in by the officers of PEO (Hqrs.) and
Regional/Project Evaluation Offices under the guidance of Shri V.K. Bhatia, Joint Adviser (PEO) in
completing the study deserve special mention.
The help and cooperation extended by the officers of Union Ministry of Health and Family
Welfare as also the Health and Family Welfare Division of Planning Commission at different stages of
study is gratefully acknowledged.
(S.P. Pal)
Adviser (Evaluation)
New Delhi.
Dated : September, 1999