  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.
