Peer review among district health officers in Maharashtra, India
Srinivasan, V.
International Journal of Gynaecology and Obstetrics the Official Organ of the International Federation of Gynaecology and Obstetrics 30(1): 33-36
1989
ISSN/ISBN: 0020-7292 PMID: 2572469 DOI: 10.1016/0020-7292(89)90211-7Document Number: 364886
A conventional information system has been used by management to stimulate excellent primary health care (PHC) worker performance through a combination of peer review, motivation by ranking and reward, and taking corrective action in Maharashtra, India. Maharashtra has a large public health system which serves a population of around 62 million. The existing management information system (MIS) was sharpened. Reports were reviewed monthly. The reports were of 6 programs--family planning, maternal and child health, leprosy control, tuberculosis control, malaria control, and blindness control--for all areas, comparing performance to targets, and integrating program components into 1 single measure by weights. Criteria guided the choice of 39 indicators from existing reports. Targets were fixed for all indicators. Weights were assigned to each indicator to arrive at some appreciation of a program's performance trends. Information analysis focussed on poor performance. This resulted in a battery of questions, a "public health audit." It was characterized by the search for causes of unsatisfactory functioning in different areas and in various programs. The health workers involved have been able to develop more desirable approaches to each of the program components through discussion and analyses. The monthly peer review leads to improved skills and professionalism. The format leads to proposals of corrective action. This had led to a large number of administrative and policy measures that have increased the output of the health care delivery system. District ranking has been extended to lower levels, to the medical officers in charge of PHC workers and the multipurpose workers/ auxiliary nurse midwives of subcenters within the PHC. The MIS was very productive. The improvement in performance indices is given. The system helped junior medical officers, the district health officers, district medical officers and top management to attain desired results. Its most important aspect has been peer review and discussion and its training function.