Best Practices in the Performance of District Hospital Report

Relevance

• GS 2: Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

Context

• Recently, NITI Aayog has released a report titled, ‘Best Practices in the Performance of District Hospital’ where it has accessed the performance the district hospitals across the country.
• This report is the first-ever performance assessment of district hospitals undertaken across the country.
• A few months ago, NITI Aayog released a report on Not-for-Profit Hospital Model Study.

Key findings

• Average number of functional beds in a district hospital per 1 lakh population
  • On an average, a district hospital in India has 24 beds per 1 lakh population.
  • The number of functional beds in a district hospital ranges from 1 to 409 beds per 1 lakh population.
  • Puducherry had the highest average beds in the country with a district hospital in the UT having an average of 222 beds per 1 lakh population, while Bihar had the lowest average of 6 beds per 1 lakh population.
• Ratio of doctors
  • Doctors prescribed by IPHS (Indian Public Health Standards).

• Overall, 189 of 707 district hospitals were found to meet the doctor to bed ratio as per IPHS norms.
• Uttar Pradesh had the highest proportion (12.7%) of doctors in position at district hospitals meeting IPHS norms, followed by Karnataka. However, looking at the percentage of hospitals in each State/UT that meet the IPHS norm, only Chandigarh, Dadra and Nagar Haveli, and Goa had all district hospitals fulfilling IPHS norms for positioned doctors.

• Availability of core health services
  • A total 101 out of 707 hospitals fulfilled the criteria of having all 14 functional specialties belonging to States/UTs
  • . Tamil Nadu had the highest proportion (16.8%; 17/101) of hospitals with all functional specialties, followed by Karnataka (13.9%; 14/101)
• Availability of diagnostic testing services
  • Only 21 hospitals belonging to States/UTs fulfilled the criteria of having all diagnostic testing services available.
  • Karnataka had the highest proportion (28.6%) of hospitals with all support services, followed by Telangana (19%).
• Bed Occupancy ratio
  • Bed occupancy rate = (Total number of inpatient bed days added for a year × 100) / (Total Functional Beds × 365)
  • The bed occupancy rate in many hospitals (n=123) were found to exceed 100% occupancy rate because the government hospitals cannot deny admission to patients.
  • Of 707 hospitals, a total of 182 hospitals had bed occupancy rate of 90% or higher.
  • Uttar Pradesh (14.8%) had the highest proportion of hospitals with bed occupancy rate greater than or equal to 90%, followed by Madhya Pradesh (10.9%),

Shoonya Campaign

Suggestions

• To the Ministry of Health and Family Welfare
  • Strengthen HMIS system
  • Increase regular trainings on digitisation
• For the states/UTs
  • Increase resources to improve quality at district hospital
  • Maintain uniformity and continuity in data entry
  • Strengthen the health system
  • Increase accountability
• For district hospitals
  • Improve maintenance of records
  • Encourage maximum participation
  • Increase both in-person and digital trainings

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