NITI Aayog, in collaboration with the Ministry of Health and Family Welfare and WHO India, has recently published an evaluation report on the performance of district hospitals in the country. The report, titled ‘Best Practices in the Performance of District Hospitals’, was compiled using data from the Health Management Information System (HMIS) for the year 2017-18. This data underwent on-ground validation by the National Accreditation Board for Hospitals and Healthcare Providers, a component board of the Quality Council of India.
Categorisation of Hospitals for Assessment
For this assessment, the district hospitals were segregated into small, mid-sized, and large facilities based on their capacity. Small hospitals have up to 200 beds, mid-sized ones hold 201-300 beds, and large hospitals comprise more than 300 beds. Of all the hospitals, 62% were categorized as small.
Evaluation Based on Key Performance Indicators
The report evaluated 707 district hospitals using ten Key Performance Indicators (KPIs) based on data collected in the fiscal year 2017-18. These indicators include:
– The number of operational hospital beds per 1,00,000 population
– The ratio of doctors, nursing staff, and paramedical staff in position to Indian Public Health Standards (IPHS) norm
– The percentage of essential healthcare services available
– Availability of support services and diagnostic services
– Bed occupancy rate and surgical productivity index
– Ratio of outpatient department (OPD) per doctor
– Blood bank replacement rate
Significant Findings of the Report
After analysing these KPIs, the report discovered that on average, a district hospital had 24 beds for every 1,00,000 people, which is higher than the IPHS 2012 guidelines recommendation of 22 beds. However, only 27% of the total hospitals met the norm of having 29 doctors for every 100 beds in a hospital. Regarding support services, each district hospital in India had an average of 11, compared to the required 14.
Suggestions for Improvement
The report proposes solutions for enhancing the efficiency and quality of services provided by these district hospitals. These recommendations include:
– Providing adequate resources for digitization
– Establishing links with medical colleges using a hub and spoke distribution model
– Ensuring 24×7 availability of support services, testing facilities, and well-planned staff shifts for optimal resource utilisation
– Promoting tele-medicine services and encouraging institutional over home deliveries through leveraging the Auxiliary Nurse Midwife (ANM)–ASHA–Anganwadi Worker (AAA) network
Public Healthcare in India: Constitutional Provisions
Public health and sanitation along with hospitals and dispensaries are state subjects in India. Although the central government also invests in health services via centrally sponsored schemes like National Health Mission (NHM), Ayushman Bharat, and others, the primary responsibility of their management and services delivery is vested upon state governments.
Digitisation of Healthcare
The National Digital Health Mission (NDHM) is working towards creating a complete digital health ecosystem. This platform is set to incorporate four key features, including health ID, personal health records, Digi Doctor, and a health facility registry. The Aarogya Setu App, another digital initiative, primarily focuses on bluetooth based contact tracing, hotspot mapping, and dissemination of relevant COVID-19 information.
National Health Policy 2017
This policy strives to provide universal access to good quality health care services without imposing any financial hardship. By 2025, it proposes to increase public health expenditure to 2.5% of the GDP. It also advocates for a three-dimensional integration of AYUSH systems, including cross referrals, co-location, and integrative practices across various medical systems.
