We present discrete-event simulation models of the operations of primary health centers (PHCs) in the Indian context. Our PHC simulation models incorporate four types of patients seeking medical care: outpatients, inpatients, childbirth cases, and patients seeking antenatal care. A generic modeling approach was adopted to develop simulation models of PHC operations. This involved developing an archetype PHC simulation, which was then adapted to represent two other PHC configurations, differing in numbers of resources and types of services provided, encountered during PHC visits. A model representing a benchmark configuration conforming to government-mandated operational guidelines, with demand estimated from disease burden data and service times closer to international estimates (higher than observed), was also developed. Simulation outcomes for the three observed configurations indicate negligible patient waiting times and low resource utilization values at observed patient demand estimates. However, simulation outcomes for the benchmark configuration 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 benchmark 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. Our study represents the first step in an ongoing effort to establish the computational infrastructure required to analyze public health operations in India and can provide researchers in other settings with hierarchical health systems, a template for the development of simulation models of their primary healthcare facilities.

我们提出了印度背景下初级卫生中心 (PHC) 运营的离散事件模拟模型。我们的 PHC 模拟模型包含四种类型的寻求医疗护理的患者：门诊患者、住院患者、分娩病例和寻求产前护理的患者。采用通用建模方法来开发 PHC 操作的仿真模型。这涉及开发原型 PHC 模拟，然后对其进行调整以代表在 PHC 访问期间遇到的其他两种 PHC 配置，这些配置在资源数量和提供的服务类型方面有所不同。还开发了一个代表符合政府规定的操作指南的基准配置的模型，根据疾病负担数据估计的需求和服务时间更接近国际估计（高于观察值）。三种观察到的配置的模拟结果表明，在观察到的患者需求估计值时，患者等待时间可以忽略不计，资源利用率值较低。然而，基准配置的模拟结果表明资源利用率显着提高。进行了模拟实验，以评估操作模式的潜在变化对降低基准案例的压力资源利用率的影响。我们的分析还推动了对具有类似于 PHC 医生/患者系统特征的排队系统中服务器平均利用率的简单分析近似的开发。