Simulation Modelling and Analysis of Primary Health Centre Operations

We present discrete-event simulation models of the operations of primary health centres (PHCs) in the Indian context. Our PHC simulation models incorporate four types of patients seeking medical care: outpatients, limited inpatient care, childbirth cases, and patients seeking antenatal care. A generic modelling approach involving development of reconfigurable simulations was adopted to simulate PHC operations. This involved developing an archetype PHC simulation, which was then modified to represent the three PHC configurations, differing in the number and type of services provided, encountered during PHC visits. A model representing the government-mandated case was also developed. Simulation outcomes for all three observed configurations indicate negligible average patient waiting times and low resource utilization values at observed estimates of patient demand. Simulation outcomes for the government mandated configuration model based on demand estimated from public health data and larger outpatient consultation times indicated significantly higher resource utilization. Simulation experiments to evaluate the effect of potential changes in operational patterns on reducing the utilization of stressed resources for the government mandated case were performed. Our analysis also motivated the development of simple analytical approximations of the average utilization of a server in a queueing system with characteristics similar to the PHC doctor/patient system.