Hub and Spoke Model of delivery of Diagnostic services

Problem Statement

Non availability of Lab Technicians and infrastructure is a major issue in providing diagnostic services at Primary Health Centres.

Programme Description

Diagnostic services are expanded by following the hub and spoke model, creating 7 hubs (Central Diagnostic Unit) at 5 CHCs and 2 PHCs (where lab technicians were available) covering 27 PHC-HWCs (spokes). Samples are collected from the spokes during OPD hours, transported to the nearest hub by transporter (staff or field worker) and the reports are brought back to the spoke facilities in evening. Before setting up hubs, detailed gap assessment was done to know the availability of diagnostic equipment, logistics and supplies; capacity of lab technicians and other requirement. The District Health and Wellness Committee known as District Arogyam Committee ensured logistics availability. Capacity building of lab technicians was done by attaching them to diagnostic lab of District Hospital for a week to enhance their skills. Certain challenges faced include overburdening of LTs at hubs, and delays in sample and report transfer as it is dependent on transportation system. Adopting Khandwa model, state has scaled up hub and spoke model to all HWCs of 51 districts where lab technicians are not available.

Programme Outcomes

Number of diagnostics made available at PHCs have increased from 19 to 48 tests. Hub and spoke model helped to minimize the movement of the patient and improved the timeliness of reporting.

Scalability

The model has potential of scalability when implemented with commensurate planning to maintain quality of transportation and hub strengthening.

Implementation Partner

National Health Mission, Madhya Pradesh; USAID-MCSP/Jhpiego

Financing Mechanism

In the initial phase, District Arogyam Commtiee (DAC) coordinated with Rogi Kalyan Samiti (RKS) to provide INR 90 per day for transporting sample and bring report back to the spoke. State has made provision of Rs. 300/ per day for the transporter for the time being by utilising free pathological services funds under laboratory strengthening activity, to ensure sustainability.

Source : We Care Coffee Table Book - Good, Replicable and Innovative Practices 2019