STATUS OF CHRISTIAN MEDlCAL WORK PRESENT AND FUTURE
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STATUS OF CHRISTIAN
MEDlCAL WORK PRESENT
AND FUTURE
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STATUS OF CHRISTIAN MEDICAL WORK
PRESENT AND FUTURE
•"•"V health cr
(A Study of member institutions of
the Christian Medical Association of India)
Dr. J. RICHARD
and
Dr. P. S. S. SUNDAR RAO
Department of Biostatistics
Christian Medical College
Vellore-632002
September 1986
f V------
Table_of.contents
Page
Salient Findings and Recommendations
1
Report
1.
Objectives of the study
8
2.
Institutions included in the study
9
3.
Ownership / Management
13
4.
Services
20
5.
Training Programmes
28
6.
Patient Load
35
7.
Finance
40
8.
Staff
43
9.
Contact with community
48
10.
Targets or Goals set for the institutions
50
11 .
Religious activities
52
11.1 Role of clergy in management process
53
12.
Future plans
57
13.
Needs
63 ..
14.
Vision or ideas about Christian
work in the 21st Century
15.
Summary
Medical
64
67
LIST.. OF TABLES
TABLE. NO.
TABLE 1
TABLE 2
TABLE 3
TABLE 4
TABLE 5
TABLE 6
TABLE 7
TABLE 8
TABLE 9
TITLE
PAGE,!'
RECEIPT OF FILLED QUESTIONNAIRES AS OF 1-4-1986
10
TYPE OF INSTITUTION
12
BOTTLENECK OR PROBLEM IN MANAGEMENT PROCESS
AND TYPE OF INSTITUTION
14
COMMUNITY HEALTH SERVICE AND TYPE OF INSTITUTION
21
PROBLEMS IN COMMUNITY HEALTH PROGRAMME
24
COURSES OFFERED BY THE INSTITUTION
29
TYPE OF COURSES WHICH ARE RUN BY INSTITUTIONS THEMSELVES
32
TREND OF OUT PATIENT ATTENDANCE DURING THE
YEARS
34
LAST
FIVE
TREND OF INPATIENTS OVER LAST FIVE YEARS
34
TABLE 10
MAIN SOURCES OF INCOME FOR CAPITAL BUDGET
38
TABLE 11
MAIN SOURCES OF INCOME FOR MAINTENANCE
(RECURRING) BUDGET
39
FREQUENCY OF PREPARATION OF AUDITED STATEMENT
OB’ ACCOUNTS
42
YEAR FOR WHICH THE LAST STATEMENT OF ACCOUNTS
WAS PREPARED
42
CATEGORY OF STAFF IN WHICH TURNOVER PROBLEM
EXPERIENCED
44
TABLE 15
RETURN OF SPONSORED PERSONS FOR WORK
45
TABLE 16
DETAILS OF TARGETS OR GOALS OF 170 INSTITUTIONS
WHICH HAVE TARGETS
49
ROLE OF CLERGY IN THE MANAGEMENT PROCESS
51
RESPONSE FOR THE QUESTION "WHAT ARF THE PI ANS
AND PRIORITIES FOR NEXT FIVE YEARS?"
54
TABLE 18a DETAILS OF PLANS ^1
“ F;;; RITIES CLASSIFIED AS "DEVELOP
ANP._PRI°
A PARTICULAR DEPARTMENT"
----- ' AND "BUILDING PROGRAMME"
55
TABLE 12
TABLE 13
TABLE 14
TABLE 17
TABLE 18
TABLE 19
MATERIAL NEEDS OF THE INSTITUTION
....
59
—
V
* w
9
ACKNOWLEDGEMENT
We thank all the respondents for patiently answering
our
lengthy questionnaire and the staff of the Department of
Biostatistics for their help in analysing the data and for
preparation of report.
We are grateful to Dr.Daleep S.Mukarji
for giving us the opportunity of doing this study.
I
►
_St_atus_of_Christian_Medical_Work_z_Fresent_and_Future
(A Study of Member Institutions of CMAI)
SALIENT_FINDINGS^AND_RECOMMENDATIONS
I
policy
the priorities of the CMAI, mentioned in the
This is a felt need of mostj
is leadership development.
of
One
statement
of
the institutions.
!
hospital
untrained
superintendents
i
Training programmes should be organised for
administrators,
directors
and
medical
on management of hospitals and health programmes.
head of any hospital, as the
Before an young graduate is posted as
limited during
exposure to management and administration is very
good training programme
the training leading to MBBS degree,
both theoretical and practical
should be organised which includes
Special emphasis should be given on the
aspects of management.
role of committees, its composition, the method of making best use
the
committees,
different
types
of
of
the
advantages
and
disadvantages
of
persons
constituting
the
committee.
For
and
method
when a politician is a member of a committee the
governmental and politcal support to the institution
of getting
Similarly when clergy is
through that member should be taught.
of deriving benefits from the
included in the committee the way
example,
church
and its members through the clergy should be taught.
The
of give and take in the committee, and using it to the
best
tact
advantage of the institution should also be emphasised.
4-
▼ ww
-z-
The
problems
management
are
management.
experienced
the
respondents
regarding
the
level
in
specifically the major problem pointed out
by
mostly
More
by
those
arising at
many
is
the difficulty to convince the higher
body
or
committee
institutions.
mainly
the
needs
and
level
management
of
priorities
their
According to the respondents this difficulty occurs
because
governing
about
higher
most
body
of the members of the
management
are not from health or medical profession.
are
mostly clergy or lay persons who have very little
in
hospital
administration.
orientation
body
or
They
experience
These persons should also be
given
towards the role of hospital and health centres,
the
role
of committees in the management of health institutions,
the
part
played
by
each
member in promoting
health
this
institution
and
also
the special nature
of
heal tli
institution
hospitals,
and
the
administration
problems arising
their staff and patients.
through
in
of
dealing
with
A refresher course for
the
management body could be a solution for this, followed by visiting
all
administrative
personnel from the CMAI.
This course can
be
conducted at the time when CMAI conference takes place.
It
have
i
found that among general hospitals,
small
hospitals
more problems in the management process than big
hospitals.
Probably
I
is
the big hospitals had undergone this propblem stage
and
then
stabilised.
which
aie the pattern of most of the CMAI affiliatd institutions,
need
guidance
small
hospitals
This means small hospitals with upto 100
for
management.
should
Those who are posted
be given proper training
in
for
beds,
these
management
—
-3-
process before they take charge of these hospitals.
for
this
.The CHAI can,
purpose, prepare guidelines for management
process
°f,7
small hospitals and keep some model institutions which are good in
II
management
an (5
replieating
centres
patient
load
but
and
use
these
small
enough
to
institutions
serve
for
as
giving
practical
training
to the future heads of small hospitals.
The
guidelines
should
also
and
information
regarding
give
tackling
a model staff
trade
union
service
rules
activities.
Some
aspects of the human resources development, staff training, making
use
of students and other trainees for the best advantage of
hospi tai
should
also be included in the guidelines
or
the
training
programme.
One of the major problems spelt out by the respondents is
lack
of
may
not
know
the various agencies which are giving funds for medical
and
finance.
care,
heal tli
This may mean two things, first they
and secondly they may not know how to approach
the
agencies
and how to make a case for their own institution to
get
adequate
funds.
must
also
proposal.
The refresher course or the orientation
course
include training on how to write a successful
'Project
The CHAI journal can publish, the addresses of various
funding agencies and their interests.
I
Many
institutions
say
that they
lack
experienced
staff .
CMAI
can
smaller
ones
so that the senior members of the bigger
can,
a
regular basis, visit the smaller hospitals
on
help by grouping some
bigger
hospitals
senior
with
hospitals
and
give
w
-4-
training to the staff of
I
their problems
with them about
I
They can also discuss
of management.
it is
funds internally,
is
generating
One area of concern
enough funds for
good number have
a
find 'tha't quite
• heartening to
The
and other internal sources.
fees
maintenance through patient
that these
introduce paying beds so
to
hospitals may be encouraged
income to the institution.
beds generate some
The
views
experience
of
large
non-medical
do not favour
institutions
a
having
proportion
administrator
with
about
by the respondents
expressed
are quite interesting.
administrators
A
smaller hospitals.
of
non-medical
not had any
Those who have
their
administrators in
such administrator.
respondents
who
them would like to have
At the same time,
had
non-medical
such person in
their
This
favourable views about them.
institutions and also they have
should be given training
-medical persons
reveals that not only non
medical personnel
but also the senior
administration
on hospital
-medical hospital
orientation about the role of non
should be given
The major
of having them.
advantages
administrator and the
administrator is releasing senior
of having non-medical
advantage
wit!
will not be tied up
They
for medical work.
medical personnel
tha
It is a common sight to see
administrative work.
too much of
ar
, good senior medical personnel
small medical institutions
in
not abl
administrative matters and thus are
tied up with manifold
medical work.
to make themselves available for
5
is
of non-med i c'-« 1 ad m i n i strator s
Similar to the experience
the
Most of
relating to sponst irship•
matters
on
response
the
sponsoring for various
enough experience in
who
had
institutions
would return
that the sponsored persons
the
views
express
courses,
indicated that the sponsored candidates
They
also
back and work.
of these who
time a good proportion
At
the
same
would be useful.
that
staff have mentioned
in sponsoring their
experience
had no
return back
sponsored candidates do not
sponsoring is not good and
the value of
Such institutions should be educated on
work
.
and
future
in thei r
to fill
staff
selected
proper
sponsori ng
I
vacancies.
i
wi th
Insti tutions
programmes
and
carry
of
referral
hospitaIs
encouraged
based
on
community.
emphasi s
on
communi ty
hea1th
to manage
said that, they did not have proper manpower
the
general
In
health programmes .
ou I. community
appropriate
both preventive primary health care and
approach
statement
low
should be emphasized as stated in the
the CMAI.
of
to
have
This means every institution
a component that involves
participation
by the community and
A good training for
should
community
working
policy
be
health
with
management of such programmes
the
is
Di ploma course in Community
out by RUHSA under the name,
the diploma
Candidates who have undergone
Health and Management.
staff ,
Management can motivate the
and
Health
Commun
ity
in
revitaiise
work among the people and start or
support,
generate
Once this i s
on proper foundation.
community
health
program
the
carri ed
-6-
could
finance
speed f _ic
programs
be
can
approached
for funding either general community health program or
financing
special
project which would involve specific areas
community
health.
The hospital will function as referral
♦.
m
I
who
agencies
done,
centre
can
The CHAI
capacity it may be for the community.
whatever
of
help
in publicising the course and offer scholarship for persons
from
small
leading
institutions
to take up this course.
training
The
diploma in community health and management will go
to
a
long way to solve this problem.
The
problem
of
problems
getting adequate committed staff
and
This
of turnover of staff are mentioned very frequently.
is the problem faced by all institutions, both small and big.
■■
the
So,
constant
sponsoring of local candidates who have shown promise of
returning
back
account the future needs of the institution.
into
done
and working in the hospital must be
taking
The problem of
institutions situated in very remote areas are that ;the staff are
not
good
getting either proper quarters to stay and / or have no
facilities
children
Education
of
a concern
of
The CHAI may select atleast one good school
in
education of their children.
the
for
staff, a welfare programme, should be
of
the
institution.
each
region and enter into agreement with the school
for
admission
areas.
It
may
of
children of staff who are
also
be necessary for
facilities
for such students.
especial1y
of
experienced
CMAI
authorities
in
remote
obtain
hostel
working
to
This would reduce staff
staff because of
lack
of
turnover,
education
facility for their children.
TW*
-7-
In
all
institutions
we find that more than
90%
the
of
community served are the people belonging to the local area, viz. ,
Hindus
in
Hindu dominated area and Muslims in
area .
So,
these
institutions serve all
religious
community
group
with
policy statement expressed by CMAI.
the
Muslim
without any distinction which is
dominated
and
groups
in
accordance
This character
of
these institutions serving all people should be encouraged.
Another
!
free
or
encouraging aspect is that all institutions extend
concessional treatrment to a large number
agencies
Proper
including
the government may be
of
patients.
approached
to
reimburse the money spent on free or concessional treatment.
Some
of
such
the
institutions which have been successful in
getting
funds can share their experiences with other institutions.
Al though
care
I
most
facilities,
of the training programmes fortify
new
many
various
institutions
status
of the community.
the
economic
and
!
upliftment
of
train programmes
are
medical
mentioned
which will indirectly increase
the
by
health
Such training courses aim at increasing
social level of the community in
the poor and the vulneravle group
in
general
and
particular.
CMAI
can evaluate these new programmes to find out the usefulness
and
if
other
they are found useful these courses can be
institutions.
advocated
This would go a longway towards providing
better life for the poor and weaker sections of our country.
September 1986.
to
a
Status.$?f_Christian_Mgdical_Work_r„ Present..and_Futuxe
(A STUDY OF MEMBER INSTITUTIONS OF CHAI)
lJ._Qbject.ives_of_the„gtudj!:
In
response
to
request
the
of
the
Christi an
Medical
all
member
Association
of
India(CMAI) a study was conducted of
institutjons
of
the
CMAI to find out the
work done by them.
Med ica1
status
the ownership / management and leadership
of the institutions
b.
services offered by the institution and
t. i 1 e i r t r a i n i n g p r o g r a mm e s
c.
broad areas of source of finance
d.
staffing pattern and their needs
e.
contact with the community served
f.
i-e 1 igi.ous activities
g.
targets, goals and future plans
-
I
*.
Christian
The specific objectives of the
are to find out
a.
of
- 8-
study
9
2_._,_ Ins 11 tut ions.J n eluded i.n_the_s t udy
directory
A
institutions
used
312
of
containing
the
addresses
of
the Christian Medical Association of
al 1
member
I ndia
was
All the
covered by the study.
to identify the institutions
situated in 22 States and Union |(
current member institutions
Territory of India were sent a questionnaire.
Four
questionnaires,
(three in Andhra Pradesh and one
in
a note stating that no senior
Nadu) were returned back with
After excluding
fill out the details.
staff was available to
total number of eligible institutions
those four hospitals, the
the largest
Of these,
308 .
from wh 1 ch we expected answers was
was in Tamil Nadu.
number 43 (14.0%) was in Kerala and 40 (13.0'6)
These
institutions.
have 140 (44.5%)
The f ou r southern States
the
of
with Maharashtra cover 56.5%
along
States
foui'
Tami 1
institutions.
received (up
total number of filled out questionnaires
eligible
is 77.9% of the total
to 1-4-86) was 240, which
West Bengal, Himachal Pradesh, Del hi,
institutions (Table 1) .
questionnaires.
Kashmir and Mizoram returned 100% of the
Jammu
number of institutions.
However these states have very small
institutions has not returned any.
Nagaland which has only two
The
institutions, the percentage of
Among the states with many
T Wl
i
/
TABLE 1
No. of
Eligible
Institutions
Wo.of filled
Questionnai res
received
% of filled
Questionnaires
received
Andhra Pradesh
A s sam
38
35
92.1
14
7
3.
Bi bar
50.0
16
4.
13
Delhi
91.3
2
5.
2
Oujarat
100.0
0
6.
7.
6
Haryana
75.0
3
Himachal Pradesh
66.7
6
2
6
Oammu & Kashmir
100.0
1
Karnataka
1
19
100.0
17
Kerala
89.5
43
Madhya Pradesh
74.0
28
32
21
Maharast ra
75.0
34
13.
25
Manipur
74.4
2
14.
Meghalaya
Mi zoram
50.0
3
1
2
66.7
2
2
100.0
S.No.
1.
2.
8.
9.
|
10-
! 11.
12.
15.
1
RECEIPT OF FILLED QUESTIONNAIRES AS
OF 1-/1-1986
16.
STATE
Wag al and
Ori s sa
2
0
0
8
5
Punjab
62.5
5
19-
3
Rajasthan
60.0
3
J 20.
2
Tamil Nadu
66.7
40
21.
35
Uttar Pradesh
87.5
26
22.
13
Uest Bengal
69.2
5
5
130.0
308
240
77.9
I 17’
18.
Tot al
11-
response
was ,
87.5%,
Madhya
Andhra Pradesh 92%, Karnataka 89.5%, T am 11
Pradesh
75%, Kerala 74% and
Uttar
Nadu
Pradesh
69%.
women’s Home/project,
who have not responded included some
and small health centres.
institutions for leprosy, dispensaries
Those
The
types of institutions vary widely,
ranging from
small
specialised hospital
dispensary (with only outpatient facility) to
General hospitals with various
such as chest hospital (Table 2).
so majority of the institutions are
bed strength are 195 (81.2%);
Development projects in the rural or urban
of this category.
beds (one is
These include 3 centres with no
areas a re 9.
welfare centre with 65 beds and a
situated in an urban area), a
(Seva Mandir with no medical work).
non-medleal welfare centre
Twenty
treating leprosy.
Altogether there are 30 Institutions
community health work, one is doing
of them .are also doing leprosy
remaining 9 institutions are
ophthalmic and leprosy work and the
which do not have any community health
'Leprosy hospital and Home’
hospitals for
Among the six specialised hospitals, two are
work.
of opthalmic hospital, Tuberculosis hospital,
women and one each
I
I
Chest hospital and Psychiatric hospital.
(24.2%) have 21 to 50
a quarter of the institutions
A little
another quarter (26.6%) have 51 to 100 beds.
Nearly
beds
and
have 101 to 200 beds .
one fifth of the institutions (22.9%)
So
than 200 beds are o n ]. y 26 or 10.8% .
Big hospitals with more
195 general
Among the
the. institutions a re small.
mostly
(54.1%) have up to
a little, over half the institutions
hospitals,
over
2 a
1
- 12 -
type of
T^PLE .2
INSTITUTION
No • °F
Typa
|
institutions
c/
No •
i
i
General Hospit al
j
DeveloPmsn^
Proj acts
(Rural/Urban)
patients
Institutions for leprosy
institutions
Other speci ali s0^
I
Total
I
195
01.2
9
3.8
29
12.1
7
2.9
240
100.0
r
13
beds and 27.9% of the
25% of all their beds as private
institutions do not. have any private bed at a'1.
3^^Qwnership2Management
These 240 institutions are owned and/or managed by Churches
01’
diocese or
or
Ashram.
Mission Trust, or a Board, Association or Fellowship
In
■
registered
by
owned
are
by
large number of these institutions are run
A
o r ga n i s a t i o n s .
they
words
other
20.4?<) ,
of So uth In di a (49,
Church
Indi a
(24,
(7.1%)
instituti ons and Methodist Church of
The Leprosy Mission (and
10.0%).
North
and the Church of
the
17
runs
Trust)
(5.8%)
India runs 14
Inst-1 tut. i ons .
Of
respondents.
three
those
systern
t, i e r
management
i ndieating
Answers
sy s t< - in is provided by
23 5
55.0%
have
16.1% have two tier system,
2 5.7 % h a v e m o r e
and
tier
3
than
system.
Similar situation is reported for the decision making process.
r
It
I
i
is
not
are
good to find that 140 institutions (62.8%)
Only
the management process (Table 3).
any bottleneck in
the management
have some problems or bottlenecks in
(37.2%)
having
83
(This
process.
Among
genera1
hospitals
(wi th
management
than
is not given
information
hospitals
less
big
there
tli an
50
hospitals.
is
an
beds )
by
17
institutions).
indication
h 11 v e
more
As the number of
smal 1
that
problems
of
in
the
beds
institutions with problems i n
h o s p i t a 1 i n c r e a s e s the percentage of
- 14
CNAI
Table_ 3.
Bottleneck or Problem in Management Process and tyoe of Instituticn
Any
Tyne of Institutions
Bottle neck or Problems in
Mananement Process
Yes
No
Not Neco rd cd
Total
No.
30
28
8
66
%
45.5
42.4
12.1
100.0
No.
21
29
3
53
%
39.6
54.7
5.7
100.0
\'o.
18
23
2
43
%
41.9
53.5
4.7
100.0
5
19
0
24
%
20.8
79.2
0
100.0
No •
74
99
13
186
39.8
53.2
7.0
100.0
No.
0
8
1
9
%
0
88.9
11.1
100 .0
No.
3
6
0
9
%
33.3
66.7
0
100.0
No.
3
16.7
14
1
5.5
18
100.0
a. Pene ra1 ! 1 o s n i t a 1
1
51
101
50 beds
100 beds
200 beds
Above 200
beds
Total for a
b.
c.
I
Ho suit al and
Rural Health
Centre
Oevelooment orcject
and Welfare centre
Total for b & c
No.
77.8
c o n t d.. .
- 15 T^RLE 3
d. Leprosy with
Community Health
e. Leo rosy Hosnitai
and Home
Total
for d & e
f. Specialised
Ho soit al
Tot al
No •
Ye?
No
5
15
Not
Recorded
1
21
71.4
4.8
100.0
No •
0
R
1
9
%
0
88.9
11.1
100.0
No •
5
23
2
30
16.7
76.7
6.7
100.0
No.
1
4
1
6
%
16.7
66.6
16.7
100.0
No.
83
140
17
240
?
34.6
7.1
100.0
58.3
62.8)*
Percentage taken including 17 cases which
have not given this information
i
Total
23.A
( %■ 37.2
*
(contd.)
16
management
process
institutions
which
for
percentage
I; h e
way
t.c/wa r j1 s
1 ess
tii an
these
of
charge
havt? to
be trained to take
CM AI
the
of
which are the pattern of m ?:-. I.
bed s
!)0
The persons
manage uion t.
affi1 fated 1 n s t i 11; I, i ons n ee11 gu i d ance f o r
in
pcavi ng
Therefore sii’ 11 l.er liospitcils with
function in*?..
unoo 11;
the
So, 'h j ring
expansi on the management problem.’- .settle down
of
of
h i gh
have not given this informati?n is a 1 so
hospitci.l s and low for big hospitals')
sma 11.
process
ove r
(More
decreases -
sma 11
of
ca re
should be given
hospita 1s and also members of management committee
ori entation i 11 the management of these insti tu 1, ions.
big hospitals a r e free of problems. Nearly one
Not. all
of
tlie ge n e ra 1 11o s p i t a 1 s w i r. 11 more than 200 beds have problems in
their
management
which
do
Kura 1
Health
small
1n
abou t
There are two groups of
They are small
institutions
hosp i. tals
wi th
Although
Centre and 'Leprosy Hospitals and Home’.
which
are
and
a 1 so
institutions classified as ’leprosy
one four tri of the
with
to
help
commun i t.y
tackle
process.
not have this problem.
classified
'
fifth
number,
as
thi rd
devolopmen I
heal tli ’
each
one
have
institution
of
the
institulions
P r o j e c t a n d w e 1 f i' e
problems.
of
this
en tr
The solution may be
category
separately
af ter
ascertaining their specifi c problems.
A total of 95 problems or bottlenecks in management process
The probl eun frequently
given by t hose 83 r espo nd ents.
is
mentioned by most of the respondents are related to the management
1
17
by
mentioned
the
needs
and
body or committee about the
ma i nly
This difficulty occurs
They are
and they have little experience on
clergy
admin1stration
understand
hospitai
Next is the delay at higher level in
decision
The current management process does not allow
decisions
Specifically
management.
making.
field.
they do not.
be taken by the local chief such as medica .1 superintendent
even
level
essential aspects like
for
or
They have to wait for the decision from higher
manager.
business
for
getting
funds
smooth
funet1oning
are
convince
know little about heal th or medical care delivery.
management
■
to
govern1ng
mo s11y
and
probl ern
ma jor
of the members of the management body or
mo s t
because
to
management.
of their institutions.
priorities
body
of these is the difficulty
many
I evel
higher
The
in management.
higher le v e 1
the
at
process
The reasons for
staff,
of
This interferes
medicine and so on.
of institution.
appo in t.merit
the
in
delay
this
the decision making process at the higher level is very long,
postponement of many items at the
indeci si on
and
infrequent
meet!ng
away
far
living
h i gher
of the board, because the board
and
scattered over a
large
area
level,
members
are
and
hence
■
convene
a meeting at a short notice,
the difficulty
to
unde rs tandi n g
and co-ordination and lastly lack of
lack
of
understanding
of the local needs by the management committee.
The
politics
bottle-necks
spilling
or
problems at local level
are,
Church
over hospital administration, interference
■irTinm in..’i r ~ ‘ ’
of
i
■ ■
-
i r-%
■
-
18
of hospital, personality
thorlties
Church au
l
i'
r
i
in t,he ru nt*
clashes
of
local level, no
no demarcation
at. the
different menihers
administrative members at
the
among
different
ahd responsibilities of
Superintendent who
duties
the
Medical
these
Apart f rom
spend more
level
.
local
activities has to
p r o f e s s i o na 1
involved in
to
be
1B.UWUO°»- t'« existence
likes
work.
In some
a dm i n i s t r a t i v tof labour union
time in
and staff, interference
management
and
between
of dedication
of gap
of
spirit
ini st. rati on, lack
are
hospital
long time
in the
a
f c.' r
solved
no t been
which. have
untrained business
problems
institutions
In a few
this.
prob1ems
c o n t r i b u t i n g for
contribute to
al
so
facilities
physical
lack
of
tiiat financial
man a go r,
said
li
a
ve
respondents
Eight
management..
i
in
the bottl1- necks.
contrainta are
the
in
available
ri
)*•
.•
staff
senior
whet.ho ■’
the
asked
most of
We
In
there
.
were
so how many
if
a
n
d
In fact, in
Institution
avai l.able.
staff
ure
experienced senior
i institutions
senior members w i tl'i
)
Institutions ( 30.
third of
In another 15.4%
ab out- oin'
avai
1
able
•
of experience are
25 years
to 25 years
than
more
members having 21
senior
institutions there are
are
titutions
of the
the
ins
members who
The. senior
institutions.
experience.
12
of
in
less) experience
years (or
hospital 1
5
only
trained
having
a
i
s
there
whether
question
affirmatively
the
For
an swered
63
(23.3%)
j nstitution
ov erwheIm i n g
administrator in the
an
Therefore there is
(72.5%)174 negatively
They a/'e
administrator.
and
l.ra i ned hospital
a
wi
thout
maJorlty
hospital s .
mostly small
- 19
beds
tlie
have
higher
of
than
adminIstrators
trained
In fact, general
hospitais
10
in
50 beds have trained administrators only
than
1 ess
with
percentage
with lower number of beds.
hospitals
of
general Ho.*3pi'La 1 s , t.hose wi 1.11 11 i g 11or number.
Among
institutions (15.2%), whereas 37.5% of genera 1 hospi t.a 1 s with more
of
category
of
strongthening
t r a i. n e d a :■ .1 m i n i s t r a t o r .
any
have
no t
The
classified as Development. Project and Welfare Centre
institutions
do
trained administrators.
have?;
beds
200
than
1mlni s tration th rough trained hospi tai administrators i
hospi ta1
de sir a bl .
odminisI va to r
non ’ med i ’a 1
faven rable
and 32.6% have
di • f i n i te
of the hospitals with trained
63.4%
vi ews.
47% have
respondon to
al 1
Among
■
non medi cal
hospito 1
a bou t
v I ows
unfavourable
administrator
have
in
adm.i u i sd.rator
f avou rab .1 < ■
v i ows
about
co in pa r isc/n
to 39.
% of the hospitals without a trained
hospi tai
a
hospital
1 9.3%
admin i strator.
the
the
institutions
wi th
without
1nstitutions
a
hospital.
When
administrator.
respondents
were asked to write whether more hospitals should
encouraged
to
(58.5%)
have
a non-medical hospital
said yes and 76 (35.0%) said no.
did
not
answer
administrator,
be
127
Only 7 respondents said
that it depended on the size of the hospital.
institutions
of
unfavourable views in comparison to 37-. 3%
have
administrator
of
this question).
(A total of 23
who
Those
have
trained hospital administrators said that more hospitals should be
’encouraged
to
have
t r a i n e d h o s p i t a 1 a d m i n i s I, r a t o r.
To
put
.11
20
precisely,
77%
of
the
hospitals
with
a
trained
hospital
51.3% of hospitals without ci trained
hospital.
is found that in institutions where a brained
hospital
administrator
and
a dm inis tr a t o r.
It
administrator
is
available
process
management
is
the
1ess .
proportion
30.5% of
with
the
problems
i nstituti oris
.1 n
with
trained
hospi ta1
process
compared to 39.9?i of the institutions without any trained
administrator
has problems
in
the
managemen t
hospital a d m i r i i s t r a t o r .
l^_Seryices
The
c.'i tchmen t
area
(i n
institutions
vary
from
2000
institutions
speci fied
f ou r
and some of them might have taken into
States
longest
di s tance
institutions.
terms of
populat ion)
to
over
'all
the area of one district;
from
which
the
patients
of
these
India’.
Many
some have
said
account
come
to
In general, many institutions do not have
the
their
defined
catchment are a.
Most of the institutions provide general medleal services.
Table
the
4 gives community health services classified according to
type
question
of
communi ty
? number
Of the 224 instituti i a i s
on community health services,
j majority
I
of institution.
has
of
heal th
servi ces.
commun ity
beds,
invoIve
answered
the
203 (90.6%) liave some kind
Among the
he a1th services.
less frequently
genera1
Hospi ta1s
in
hospita1s
a
wi tli
.1 ower
community
hea1 th
TABLE
Commanity Health Service? and Type
of Institution
’Tyoe of
Community Health Services
Institution
Yrs
No
No.
53
10
3
66
%
00.3
15.2
4.5
100.0
No.
45
5
3
53
/°
04.9
9.4
5.7
100.0
No.
41
2
43
%
95.3
4.7
100.0
No.
22
2
24
%
91.7
8.3
100.0
Not
Recorded
Total
q. General Hosoltal
1
51
101
50 beds
100
beds
200 beds
Ibove 200
beds
Total for a
b. Hospital and Rural
Health Centre
No. .
161
17
0
186
%
86.6
9.1
4.3
100.0
No.
9
%
c . Development oroject
and Uelfare Centre
100.0
100.0
9
No.
c7
Total for b & c
9
9
100.0
No.
100.0
18
cf
18
100.0
100.0
cont d..
I
0
COMMUNITY HEALTH CELl
47/1.(First Floor) J.. Marks Hoad
BANGALORE- 560001
iimii iirrii n«g
i i ifipp
inn
iai
inn ninMl -
’'Hill
TA RLE J. (enntd)
No
Yes
d. Leprosy and
Community Health
e. Leorosy Hospital
and Home
Total for d & e
f. SoeciEilfc®6^
Ho spit al
Tot al
I
Total
No •
20
1
21
%
95.2
4.8
100.0
No«
1
3
5
9
%
11>1
33.3
55.6
100.0
No •
21
3
6
30
%
70.0
10.0
20.0
100.0
No.
3
2
50.0
33.3
6
100.0
%
1
16.7
No •
203
21
16
240
84.6
(r'O,6r<)
9.8
*
(9.4^)
6.7
100.0
%
* Percent a cie excludino Pot
I
Not Recorded
Recorded Cases
23
ranges from 80.3
involved in community health services
ho spit, a Is
to
of tlie.se
The. perc-f
services thaii those with more beds.
tea1th service was
The population covered by community 1
and from 10,000 to
than 10,000 in 36.4% of the institutions
91.. 7% •
1 ess
25,000 in 13.B% of the institutions.
health
one
they
never had
any
Majori ty
time to e v a 11J a t f- ‘.
s a i d that it needed more
problems regarding finance, lack of funds to carry out
programmes.
Next to that is lack of staff; they
Another
staff
there
wo rk
nor
find time to be away from the
base
hospi tai.
commitment of
ma 1 u problem was the m o t i v a t i o n o f s t a f f o r
One of the responses was that
for community health work.
for the staff such as quarters,
was lack of infrastructure
the children (when they are posted in
facilities
education
for
the
Besides finance and staff,
rura 1
areas).
is
the
commun ity
interes ted
nor
co--opera t i ve and also not participating in
very
need
the base hospital neither 11 a v e g o o d train i. n g f o r
the staff
village
smal 1
problem
Some
programmes.
barriers
itself.
rcsponses
The
community
highlighued
socia1
is
next
neither
their
taboos,
the community which act as
a nd cultural b/.‘liefs of
Eight
programme.
for the modern community hea 1 tli
supers tition
I
and
that
i..: o m rn unity 11 e a 11 h w o r k ,
staff or regular full time staff for
field
I
problems
said
commoni ty
J
32
summarised and listed in
of them are
and
5.
were
Institution
I
t3b,l.e
programmes
institutions
commoni ty
of the problems in carrying out
nature
The
criAi
TAULE
5
Problems in Community Health Programme
Problems
No. of problems/lnstitutions
. F inanc e
No .
%
Funds
53
22.4
42
17.7
11
4.6
2
o.e
4
1.7
1
0.4
4
1.7
1
0.4
5
2.1
6
2.5
No transport facilities/No vehicle
25
10.5
No building at periphery
2
0.8
5
2.1
1
0.4
9
3.8
b. Staff
Uualified/full time staff for village work
Motivation of staff/committment of staff
No infrastructure for staff
e.g.O^ education of children
(2) No accommodation for Nurses
c. Planning
d Organisation
No expert to lead d plan
Lack of day
to
day planning
No organization
(lore patients at base hospital
d. Physical Environment
Poor road
Hostile terrain
e. Supplies
No vaccines from Government for
immunization programme
I
Lack of educational aids
f. Community
J.
Illiteracy
■
I
Expects
everything free
8
3.4
Poverty d/unemployment
12
5.1
Expects a hospital
1
0.4
22
9.3
Not interested/not co-operative/
not participating
contd. •
I-W
■him iiiiiri"
»
T-^LE 5
(contd.)
continued
^Social taboos/superstition/
cultural beliefs
Exploitation by the
No.
16
6.8
3
1.3
1
0.4
1
0.4
2
0.8
237
100.0
well-to-do
Resistance (of~ local indigeneous
practi tioners
People do not understand
.
Others
Total problems
Needs more time to evoj.uate
Institutions with
no problems
Institution not given the information
1
32
40
26
respondents said that the community expects everything to be given
In
free.
give”.
Poverty,
and illiteracy of the villagers are also
consi dered
"It
fac t
unemployment
is
always
take
no t
as
problems in carrying out community health programme.
of
the
they could not understand the
i1 literacy
Because
importance
Special type of education which does not involve written
heal th.
is
script
necessary
to
teach them
health
matters.
Physical
poor road and hostile terrain and
lack
environment
such
transport
facilities
were also mentioned as problems by a
of respondents.
Non-receipt of supplies such as
numbe.r
from
of
as
large
vaccines
Government for immunisation programme was mentioned
the
of
by
five respondents.
Only a very few respondents mentioned that lack
of
no expertise to lead them to
planning,
or
community health programme as the problem.
expertise
on
organisation
proper
organised
All these show lack of
and management
of
community
health
programmes.
The question on rehabilitation services was answered by 222
and
institutions
services.
Some
only
70
(31.5%)
i.nsti tu ti ons
institutions have specifically
offer
these
men tioned
their
nature of the rehabilitation programme (such as Tailoring, cottage
industries)
which
rehabilitation programmes are offered.
programmes
I
and some institutions have mentioned the diseases for
frequent
offered,
and
cottage
industries,
Among the
and
specif ic
agri culture
among the diseases, reha b i1i t ati on f or
leprosy
are
is
27
must
mention
Special
frequent.
the most
the
of
made
be
rehabilitation programme for alcoholics and drug addicts conducted
by two institutions.
In
all institutions all religious groups are served.
11 s
of
the
religious
these
composition
Except
institutions.
in
2
where 90% of the community groups are mus]ims and in
institutions
3 institutions where 90% of the community around them are
another
Hindus.
all other places the majority served are
in
Christians,
All
the
around
residing
population
on
depends
distribution
these institutions serve people of all communities
including
all
(97.7%)
caste
scheduled
and
scheduled
Almost
tribes.
All
have offered free treatment to deserving cases.
institutions
hospitals of 'leprosy with Community Health’ and institutions with
Rural
Health
treatment.
concessional
or
have provision for free
Services
Among general hospitals 95.8% of the institutions with
less
than 200 beds in comparison to 89.8% of hospitals with
more
than 50 beds have provision for free or concessional treatment.
14
Only
other
institutions
private practitioners operated.
There are 19 institutions (8.2%)
only these member hospitals.
in
whose area one more private practitioner operates.
the
institutions’
operating.
It
institutions’
area
is
In 9.9% of
2 to 4 private practitioners
rea1ly
(43.6%)
revealing
many
no
served
So these areas are
by
area,
where
are situated in areas
to
(4 or more
find
than
that
15)
are
also
in
101
private
28
• practitioners
have
93
practitioners.In
shares
practitioner
private
many
other
private
institutions no private practitioner
shares
In
facilities.
the
37
(17.2%)
the facilities.
In 11
The number
which are situated in places where no other
Hospitals
exist
served
Government
are
In areas where 146 hospitals
areas
This shows that in a majority of the
by the member institutions Government hospitals or medical
institutions run by other organisations
seems
of
Hospital is already functioning within
a Government
miles distance.
1-3
(5.1%)
1nstitutions
practitioners share the facilities.
is 14 (5.7%).
private
one
institutions
hospitals
functioning,
the
There a re ins tances where
the member hospitals are shared by
of
facilities
been working.
to
percentage
be
trend among general
a
are also existing.
That
hospitals.
There
is,
the
of medical institutions run by other organisations
in
that area is low in areas where general hospitals with 50 beds are
functioning and high for those with more than 200 beds.
hJL_Traini.ng_Programmes
Courses
formal
specialised
nonformal
(Table
offered
courses
6) .
by
the institutions
range
highly
from
post graduate courses in medical sciences
such
as
adult literacy
and
sew i ng
to
course.
Some of the institutions, although do not run
basic
M.B.B.S. course, by virtue of their specialisation, are recognised
for
course
training
of medical post graduate candidates
or part of the course).
(either
full
Medical officers and also medical
vi
TAPLE 6
Courses offerred by the institution
No. of
institutions
Type of course
r
A* Hedical
M.B.B.S.
2
P.G. Courses
9
Housemanship
7
Medical Officer Training
Medical Students Training
M.Sc. (Non olinical)
1
1
71
57
Post Cert.
2
B.Sc.
1
N. Sc.
G.G.A.A. Nursing
1
Aneast he si a Nursing
3
Step ladder Nursing
1
Opthalmic Nursing
1
Practical Training in Nursing
2
Advanced Midwifery
2
C. A.N.n.
21
1
8. Nursing
General Nursing
B.Sc.
Secti on
T ot al
1
42
and Dai Training etc^
28
A.N.H.
Dais Training
1
Nursing Aids
6
Nursing Assistants Course
3
Uard Aid
1
Course
First Aid Training
2
Hospital Auxilary
1
cont d-r
- 30 TWLE 6
(contd.)
No< of
Institutions
Type of course
D.
Physiotherapy
Dggree Course in Occupation
Therapy (B.D.T.)
Physiotherapy Technician
Physiotherapy Polio Technician
Physiotherapy Technician (Leprosy)
E.
Paramedical
1
1
2
1
3
51
Couree.s
All Paramedical
Non medical
Courses
Supervisor
Paramedical Leprosy Worker
Theater Technicians Course
Splint Technician
Leather Technician
Radio diagnosis
Diploma in Pharmacy
Diploma in Health Statistics/
Dietetics/Ho spit al Administration
Nedical Record Technician
Bachelor of Medical
Record Science
Laboratory Technician
F.
8
(Occupation Thepgpy)
Degree Course in Phy slotherapy(B•P.T.)
1
2
4
1
1
1
9
2
1
2
1
26
34
Health and Management
Community Health & Management
Community Health Guides
Community Eye Health Field Workers
Basic Health Worker
Village Health Worker
Uhdlistic Health
M.P.H.W,
Health Staff
Health Worker
Village Level
Section
T ot al
Worker
1
3
1
2
9
1
8
2
4
3
contd
T -■
6 vContZ
No. of
In st it ut ion s
Tyoe of course
G.
Section
Total
14
Others
Business Management
1
Office Management
1
Vocational Training
1
Animator
1
Creach running
1
Adult Literacy
1
Sewing Course
3
Carpentary
1
Handicraft s
Training the Trainees
1
Transactional Analysi s
1
Advanced Transactional Analysis
1
1
TOTAL
241
w
FT
T T
- 32 TABLE :
INSTITUTIONS THENSELVES
TYPE OF COURSES UH I CH ARE RUN B Y
TYPE OF COURSE
Nursing/Nursing
NO.OF INSTITUTIONS
aid
Practical Training in Nursing
2
Opthalmic Nursing
1
Advanced Midwifery
1
Nurses aid Training
Nursing assistant courses
5
3
Paramedi ca1 Courses
Laboratory Technician
1
3
Theatre Technician
1
Phy siotheraphy Technician
Health and Management
Community Health & Management
1
Community Health Guide
1
Community Eye Health Field Worker
1
Basic Health Worker
Village Health Worker
1
8
Village Level Worker
2
Health Staff
1
Others
Advanced Transactional Analysis
1
Transactional Analysis
1
Training the trainee
1
Creach running
1
1
Carn ent ary
Sauing Course
1
TOTAL
38
<>
33
students from other colleges come to such special institutions for
short-term
training.
Of all the courses run by the institutions,
nursing
courses
(run
by
71 i n s11 tut ions) .
among
al 1 courses.
f 1rst
(57
.i nsti tut ions
General nursing is the most
frequent
Among nursing courses General nursing
institutions
institu tions
(27
are conducted by a large number of
offer
this) next is
ANM
training
offer this), next is laboratory technician’s
institutions off ex* this).
stands
(28
course
Thirty four courses are related to
common 1ty
heal t h, rangi ng f rom community ha1th and management to
training
of village level worker.
development
aspects
Courses on social and economic
of the poor people, such as adult
1iteracy,
handicraft training are given by only a few institutions.
9.1% of
these
cou rses
of
the
State
Government,
of
the
with
an
by
the
courses
with
are affiliated with an organisation/organ
24.5% of the courses with CHAI, 23.7%
Nu rsing
Council and 4.1% of the
organ!sation
at
institutions
themselves is 15.8%.
the
All India Level.
all
The courses
T h e s e course s a r e
of short duration and of informal type
Of
courses
run
i nnovative,
(Tabl.e 7 ) .
the training courses, 39% are of one to two
years
duration and another 30.7% are of less than 12 months duration.
43.6%
10
In
of the courses the number of students admitted per year
is
or less and in another 28.6% of the training courses 11, to
20
student s a re a dm it ted.
if
I
- 34 TABLE 8
Trend of out patnuance
during the last fi
Number of Hospitals
No.
%
Trend of out patients
over last five years
Increasing
82
37.6
Decreasi ng
29
13.3
107
49.1
218
100.0
22
9.2
240
100.0
Fluctuation
(No definite t rend)
T ot al
Not Recorded
Total
•t
(
I'
-'t
TABLE 9
Trend of inpatients over last flvo year9
Trend of inpatients
over last five years
Increasing
Decreasing
Fluctuating
(No definite trend)
Total
Not Recorded
1
Tot al
Number of Institutions
No •
74
36.6
25
12.4
103
51.0
202
100.0
38
1 6.5
240
100.0
35
6z__Patient_Load
They
The
institutions vary in turnout of patients considerably.
range
from less than a thousand to more than one
pat tents
per year.
patients
between
(2.7?^)
the
lakh
out
About one third of the institutions have
ou t
10,000 and 25,000 per year.
Six
more than one lakh out patients a yea r.
get
institutions
the
institutions
In 40.4%
of
were
not
sex distribution of outpatients
available.
Among the institutions from which such statistics are
available,
59.4%
than
of the institutions have more
male patients.
female
patients
The trend of outpatient attendance (Table 8)
that 37.6% of the institutions have increasing trend of
indicates
outpatient attendance, 13.3% of the institutions show a decreasing
in
a large proportion (49.1%) there is
no
definite
trend,
and
trend.
An oscillating trend may also indicate oscillating income
through outpatients.
Similar to out patients, the number of female inpatients is
higher than the male inpatients in 58.1% of the institutions.
(Sex
of
the
distribution
of
inpatients
are not available in
39.6%
Just like outpatients in half of the institutions
institutions) .
(51%), there is no definite trend of inpatients over the last five
years.
It
is
encouraging
to
note
that,
in
institutions there is an increasing trend (Table 9).
36.6%
of
the
36
Among
out
thousand
the
general hospitals 4
patients du.ting
1984 .
institutions had less
Among the hospitals
than
with
10,000 out patients in a
50
beds,
40.9%
have
1000
to
less than
patients.
out
have 10,000 to 25,000
34.8%
Another
year.
anticipated, bad large number of
as
larger
beds,
Hospitals w i th
of hospitals with more than 200
We find that 29.2%
out patients.
and another 25% have more
beds have 25,000 to 50,000 out patients
More over larger proportion
patients in 1984.
1,00,000
out
than
out patients
show an increasing trend of
hospitals
bigger
of
the hospitals with less than 50 beds.
.during the last 5 years than
of institutions which do
The number of institutions and percentage
are distributed nearly equally among
not show steady trend,
The number of inpatients
hospitals with 1 e s s than 200 beds.
showed that there was no (.rend over the
during the last five years
of a 1 1 si se
Nearly a large percentage
size of hospitals.
This is not
in the trend.
hospitals showed irregular fluctuations
these hospitals, because it is very
for
situation
healthy
a
proper trend is visualised.
difficult to plan for future if no
Among
the
States
with
more than
10
institutions,
the
(18.4% for inpatients and
proportion of the institutions
inpatient and
out patients) with decreasing trend of
28.9% for
the Andhra Pradesh.
out patient attendance is in
highest
more
the institutions have
The bed occupancy shows that 38.1% of
and 34% have 51% to 7 5% occupancy.
than 7 5% of occupancy
37
that most of the institutions do not have full occupan
inferred
of
From this it
a few (11.6%) have occupancy less than 25%.
On 1 y
Usually a bed occupancy of around 85% is taken .
their beds.
did
n<
supply
occupancy rates, probably because they either do not
kn<
how
calculate
to
statistics).
total of 84 (35.0%)
(A
occupancy.
full
bed
occupancy
or
do
institutions
not
keep
average length of stay of inpatients
The
need*
the
le£
is
than 5 days in 21.7% of the institutions and 6-10 days in 50.9% c
the
It is encouraging to find that 72.6%
institutions.
tl
of
institutions have average length of stay less than 10 days.
Blood
examinations
were done in 185 (77.1%) institutions
Facility for stool examination exists in 181 (75.7%) institutions
A
of
total
183 (76.2%) institutions have facilities
sputum
take
(68.7%)
165
examination.
examination.
X-Ray.
urir
to
c
151 (62.9%) institutions have facilities
t
institutions have
facilities
Only 82 institutions have facilities to
take
ECC
Faci1i ties
for
doing surgery exist in 184 (76.6%)
Diagnostic
aids
such as facilities for blood examination,
urir
examination
and
so on do not exist in greater
proportion
amor
This
mear
the
smal
smaller
hospitals
s t ren g the ni n g
of
compared
to
bigger
di agnostic
aids
is
institutions
hospitals.
necessary
ho s p i t a 1 1 eve .1.
I;
E
f or
I mi
at
38
TABLE 10
for Capital Exoenditocc
Main Sources of Income
Main Source
Number Of Institutions
%
No •
2
0.9
26.6
1.
Self supporting
2.
Feas, House rent etc
(Hospital generated
income)
59
Faes,donations & grants
from government
13 *
5.9
Church/ Mission (Indian)
23
10.4
5.
Indian Mission with
International connection®
L_
22
9.9
31
14.0
6.
Gifts and donations
56
25.2
1
0.4
15
6.7
3.
4.
Foreign gifts/donation
7.
8.
Investment by one
member (private)
9.
No definite source
Tbbal
222
(92.5%)
18,X
Not Recorded
(7.5%)
240
Tot al
1
* Includes loan from bank —
100
CHAI
TA-LE 11
Main Sources of Income for Mai nt on3nce (Recurrinq) Rudoet
No. of Institutions
Source of Income
1 .
No.
z*1
115
55.3
b.Patients Fee and Local
contribution/Local Income
20
'1.6
c.Patients Fees and Occasional
Foreign donation
15
7.2
11
5.3
25
12.0
5
2.4
17
8.2
208
100.0
a.Pat lents Fees
Abroad
2.
From
3.
ChurcV Sy nod/Ashram/Head Quarters
4.
Oonations
5.
Lenrosy Mission
and Gifts
Tot al
Specific Purpose Grant/Fee
CHAI
CRM
OXFAM
8
9
Government
1
7
RF’J
1
TEAR Fund
1
40
_ Finance
The
in
main source of income for capital expenditure is given
Table
10.
Two
self-supporting .
generate
and
they
institutions
Mission,
23
available
(26.6%)
Foreign
56
(25.2%)
Indian Missions with international net work such as
institutions.
for
are
All other
donations are the main source for another
Leprosy
income
next category of 59
that
get some financial help from other sources.
institutions.
the
The
declared
their income from fees, house rent and so on.
institutions
gifts
institutions have
for
institutions
SDA
are the main
source
for
22
(9.9%)
Indian Church/Mission or Diocese is the source
of
(10.4%)
source
is
of
the
15
institutions.
institutions.
depend
on
gifts,
Thus
No
the
donations,
def inite
majori ty
grants
etc .
either
internally or from abroad for their capital expenditure.
The
main
source of income for regular maintenance of
institution
(recurring expenditure) was given by 208
(Table
It is gratifying to note that more than half of
11).
institutions
through
(55.3%)
meet
patient fee alone.
all
their
maintenance
the
respondents
the
expenditure
In addition to these institutions
20
respondents
have
expenditure
through patient fees and local contribution or local
income.
and
said
that
they
meet
all
their
maintenance
Moreover 15 institutions completely rely on patient fees
occasional
institutions
foreign
donation.
In other words 72.1%
of
have patient fee as the main source of income.
’ —’Tl
.
■
the
The
¥
f
41
second
main source of income is the parent Church or Synod or the
parent
Society.
said that they get the main income for maintenance
i nstitutions
India and Leprosy
Mi ss i on
Leprosy
from
17
This category of institution is 25 (12.0%).
Mission
Tnternational.
Very few institutions get their income for maintenance from abroad
i nsti tutions,
(11
projects
runn i ng
Genera 1
with grant earmarked for them.
the main sources for 5 institutions.
are
are
Some of them
5.3%).
specif ic
funds and
gifts
Apa r t from th is ,
these
institutions get earmarked grant or fee (for service) from various
agencies
i nternational
tubectomy
cases,
and
organisations
as
such
CM AI
CBM for eye services, Government for
for
tubectomy
beds and so on.
The
contributed
information
on
the
proportion
of
tota 1
by patients is given by 173 institutions.
income
16
(9.2%)
institutions reported that there was no contribution at all by the
90
patients.
institutions
(52.0%)
reported
that
they
had
received more than 76% as contribution by the patients.
Moreover,
in
people
the
majority
of the cases contribution by
nothing or negligible.
either
local
In fact 59.6% of the
is
institutions
reported that they had no contribution by local people and another
22.3%
have reported that the contribution by the local people
negligible .
churches
Similar
and
congregations.
Altogether
7 3.3%
contributi on
or
from the churches and congregation.
No
institutions recorded
contribution
situation exists regarding contribution
either
no
of
is
by
the
negligible
substanti a.1
income was got through other services in most of the institutions.
■i lOTiWiiMiiriiiiiiitfiiiiii
II I IIIIIIIIIIIIIIR I
wr
I
TABLE
12
CM Al
Frequency of preparation of audited statement
of accounts
Audited stat emen t
of accouhts
Number of Hospitals
No.
%
Twice a year
2
0.9
On ce a yea r
219
97.3
4
1.8
225
100.0
5
2.2
2 30
100.0
Not onco a year
Total
Not Recorded
Total
TABLE 13
Year for which the last statement of accounts
was prepared
Year
Number of Hospitals
NO.
%
1985
43
19.7
198 4
167
76.6
1983
4
1.8
198 2
2
0.9
1981
1
0.5
before 1980
1
0.5
218
100.0
22
9o2
2 40
100.0
Total
Not
Recorded
Total
in
43
Audited
statement
of
accounts
are
prepared
by
230
institutions
and
only two institutions do not prepare this.
(10
members
not
given any information
219
have
institutions
regarding
this.)
have replied that the audited statement of
accounts
have been prepared every year, and two institutions have said that
the
statements
institutions
1985.
1984
are
prepared
twice
a
year
(Table
12).
43
prepared the last statement of accounts for the year
167 members have prepared the last statement for the
(Table 13).
year
It is interesting to note that only 125 (57.9%)
institutions
make
interesting
to find that 106 (47.3%) have received help from
Government .
Mostly they received help for family planning work or
provision
for depreciation.
It
is
equally
the
for an earmarked project.
8. Staff
The
strength
considerably.
5.
5
in
have 6 to 25 staff nurses.
workers.
workers
and
institutions
they
had
pa rained i ca 1 wo rker s .
47.2% of
37.1%
have
In a majority of the institutions
than 70% staff are Christians.
that
vary
turnover
the
118 institutions have up
another
6
to
25
(69.4%)
The distribution of category
of staff turnover is given in table 14.
said
these
Most of the institutions (61.0%) have doctors up to
paramedical
paramedical
more
doctors
26.6% of the institutions have up to 5 nurses.
institutions
to
of
30.7% of the institutions
problem of
doctors,
nurses
and
Apart from this the sing] ' category in which
- 44 -
CHAI
TABLE 14
Category of staff in uhich turn over
problem experienced
Category
Number of Hospitals
No .%
16
33
8.5
17.5
2.6
Administrator
5
2
Doctor, Nurse &
Paramedical
58
3C.7
Teaching staff
4
All
Others
12
2o1
6.3
14
7O4
No problem
45
23.8
T89
IOOoO
Not Recorded
51
21.3
Total
240
100.0
Doctor
Nurse
paramedical
To tai
1 1
lii"
45
CNAI
TABLE 15
eturn of Sponsored persons for uork
Do you sponsor anybody
(for course) with the
aim of adding to the
st af f
Yes
No
Tot al
Do the sponsored person s/st af f return
promptly and work
Yes
No
No .
131
17
%
79.9
No.
4
Host of
them/usually
Not desi
rable
Tot al
2
164
10.4
14
8.5
1.2
90.1
12
0
2
18
0
11.1
9.9
%
22.2
66.7
No •
135
29
14
4
192
74.2
15.9
7.7
1.1
100.0
Wff IL
! J
II
.... Ol
46
12
frequently is nurses (17.5%).
experienced
problem i s
turnover
of
they have turnover problem
se.id
that
(6.3%) have
institutions
23.8% of the
note that
It
is
good
to
staff.
category of
all
(Information on th i s
problem.
turnover
no
iiisti lutions repert
The member
instituti e.ns. )
189
by
only
p rov i. ded
is
aspec.t
difficulty in
they experien co any
asked
whether
were
institutions
the
asked to specify
staff
and
they
were
trained
getting ful ly
the
1 4.3% of
t.liat
reported
is
It
staff•
the
category of
staf f•
of
in getting all category
difficulty
institutions ha ve
doctors,
difficulty in getting
that
they
have
29.5%' said
Another
categories,
Apart from these two
and paramedical workers.
nurses
Only two hospitals
difficult to get was nurses.
a group which is
trained
fully
to get
able
not
they were
that
reported
provided by 224 institutions).
is
information
administrator. (Th i. s
It
adequate1y
reported
is
trained
th a t
64.2%
senior staff.
of
the
Most of the
institutions
have
institutions
have
of the staf f
need for further training
that there is a
recorded
category.
course for various
update
ref resher course or
through
(or
staff
recorded that all
institutions
the
of
Nearly half
need refresher courses.
workers
)
nurses and p a r a m edleal
doctors,
needs refresher
highest category which
the
single
Apart from this
course is the doctor.
Most
of
the institutions
sponsored persons
of adding to the staf f■
courses with the aim
for
training
Hospitals which
47
staff (or some
sponsored
aim
the
class i fled
1.0
persons
Tliis
with
them
absorbing
of
on the
experience
their
the institution for work.
tabl e
clearly
w i th
other persons) for various courses
si lows
that
return
a re
cross
of
sponsored
This is given in table
15.
who
have
those
j t is ti tut ions
of
have said that. a large proportion
s p o n s o r ed p e r s on s for studies
In fact 88.4% have said that they have
work
.
and
return
them
includes the answer yes, most of
for
work
(this
promptly
returned
wh i ch have • not
the institute ons
Among
usually)
.
and
them,
told that they do not return promptly
s p o n s o t’ e d any b o d y 66.7% have
latter
that there is a feeling in the
This
suggests
and work.
somebody they may not come back
institutions that if they ponsor
experience of the institutions
far
as
the
I
d
fact
as
and Join.
return
J 0.4% have said that they do not
soi
’
ed
persons
,
wh i eh s |? on
promptly and work.
86
institutions
(40.6%)
have said that they
have
staff
they do not have any
programme and 126 have said that
are
Written staff service rules
programme.
development
staf f
In 31 institutions
of the institutions.
available in 197 (86.4/o)
the
In most of
rules are avallable.
service
written
no
of the staff was lower than the
the
salary
(78
.4%)
institutions
to
institutions (12.8%) it is equal
Tn
some
salary
.
Government
The, i nstitutions in which
categories.
salary
for
some
Government
is negligible
higher than Governin' nt salar>
salary
of
staff
is
the?
development
(2.2%)•
48
local committee
a
there i s
(33.6%)
institutions
79
In
In 156
institutions.
served by those
the commonity
that
r o p r e s e n 11 n g
72.6% have sa i d
such
committee.
is no
there
institutions
have
Moreover those who
not advantageous.
committee is
such a
it is advantageous
say that
committees
in having 1 ocal
xperience
than those
proportion (87.3%)
in
a
higher
committee
(30.6%)•
to have such a
representing community
local committee
do not have a
and 2.8% of
who
local committee
without
institutions
In fact, 58.3% of
is not
it
local committee said that
institutions with a
in
committee
the
to have such a
hindrance)
it is a
(or
that
ad v a n tageou s
having local committee said
8.5% o f those
j nstitution.
the
institution to have
to
the
dvantageous and hindrance
is both a
it
such committee.
The
spelt
cut
role
of
local committee
by those who have a
r e p r e s e nt i n g
community
was
Many are
common
local committee.
institutions.
Most of the
roles
for those
some are specific
•General help and Guidance or
the title
class i f ied under
respondents might
can be
( Many
director
’
•
or
to the management
Hospiotal
Advice
the
was
committee
local
the
that
have thought
are members)■
leaders
which
local
in
administrative committee
as community
the committee as far
is the role of
in
to this
Next
role of helping
(21.9%)
the
16 times
is concerned.
heal th
and
- 49 t .•> n l E
‘lotAilE.
16
Targets or goal? of 170 Institutinng uhic h..j2ay,e targets
No. of Institutions
Target or goal
No.
% nut of 170
30
17.6
24
14.1
Up gradinq/expansion
21
12.4
To develop full fledged Community
Health Programme/Cent re
20
11.8
To show Love of Oesus Christ and
to obey His commands
18
10,6
Fami ly Planning and Community Health
15
8.8
Tn improve care in specialised
dpp-i rt ment
15
8.8
Train!ng/ CJu cat i o n
Vi
8.2
Leprosy Cent ro 1/1 mat men t etc.
14
8.2
Self supporting
13
7.6
To meet the needs of poor tribals
and backward people
6
3.5
To develop lou cost health care
3
1.8
Staff
1
Improvement of hnalth care
Providing
improved medical
Indi anization of
Hosoital
care
Establish Cordial relations between
staff <!• m a n an em e n t
Total t arg et s/go a 1s
1
195
)
)
1.2
50
and
implementation
of community heal t h
programmes
is
is
question
this
which
real aim for
(Thl s is the
mentioned.
maintaining public r e 1 a t i on s
role
of
8 times (11.0%) the
asked)•
gaining community
the people and
of
<o ~ o p e r a 11 on
to ke<'• p UP
back from the
or
Only once, getting feed
participation is mentioned.
related to the
other
roles
are
The
mentioned.
co mm tin i ty i s
planning
institution and its
,
The
n 11 mb e i'
functioning.
e-pt
of
for the_in§.tituti.?’h
institutions which have
replled
f o I’
the
(21.3%) have
Out of this 46
is 216.
and
goals
targets
quest ion on
do not have
f ixed or they
target
they do not have any
targets,
thcit
said
institutions which have
The 170 (78.7%)
written targets.
Among them 30
(Table 16).
targets or goal
.nentioued 195 items as
the
the quality of
have target to improve
institutions
(17.6%)
the quality of
target to improve
Next to this is the
including
health care.
of patient care
all aspects
care, which includes
expansion.
med i cal
institution and
their
Upgrading
concern.
equipment
love and
building,
facilities such as
ph y s i c a 1
either by adding
xtending the
faciliti®5 or e
diagnostic
increasing
(12.4%)
so on or by
and
or goal of 21
the
target
lation is
health
for a larger popu
care
comprehensive community
a
To develop
institutions.
aspects
health centre with all
community
prov ide
(11.8%)
programme or to
20
of
is the target
participation
including communi ty
ma
I 4’-'LL 1 (
8 o I f- of
Clrrgy in the Management Process*
•' o . of In s 11.1 u t i o n s
^ole
No.
out of 141*
Chairman/President of Managing Committee/
Governing Hoard etc.
21
14.9
Vice Chairman of ^anaqinn Committee,
Coverninq Hoard etc.
4
2.8
67
47.5
4
2.8
Administrative Officer
14
9.9
Role of advisor, guide and
giving suggestions
12
8.5
Very minimal involvement in
man aq em ent
5
3.5
Hanane^ent
1
0.7
Part i ci pat es in Management as a
staff member
1
0.7
To help reduce difference between
the Church and the hosoital
1
0.7
26
18.4
Member of ^anaqino Ooard/Administrative
Committee/Executive Committee/
Medical Hoard etc.
Representative at
Nanari er/ ri enera 1
Oiocese level
Superintendent/
co-ordinator
Chaplaincy services only - No
management involvement
Total
* 156
156
roles were mentioned hy 141 institutions.
O(U.S"2M|?
30
Ij 3.0
COMMUNiTY HEALTH CELU
47/1.(First FlooriSt. MarksHoad
BANGAtOaE • 560 001
I
institutions.
18
(10.6%)
institutions have recorded
that
the
Christ and to obey His
love
of
Jesus
target or goal is to show
of
have written targets either
(8.8%)
institutions
15
command.
planning
the Government for family
of
fixed
by
the i r own or that
15
The target or goal fixed by
health
services.
and community
specialised
patient care in
to
improve
is
(7.7%)
institutions
for each speciality
institutions fixed targets
These
departments.
care,
intensive
gyneacology,
obstetrics,
like
departments
(both
Emphasis on training
so on.
and
surgery
tuberculosis,
new persons in paramedical
and
also
training
training the staff
The institutions
institutions.
by
14
mentioned
is
services)
Some
got clearly defined targets.
patients
have
serving leprosy
to develop low cost health o«re, to meet
other
targets
are
of the
backward people, to Indianise
tribal
people
and
the needs of poor
staf f
establish cardial relations between
and
to
hospital staff
and management.
ll_.__Religious_Activities
72.5%
of
the
institutions have a chapel.
Mostly
the
and special religious programmes,
used
for
daily
prayer
chapel is
those activities.
123
patients participate in
Staff, students and
institutions
Chaplain and 44 (19.1%)
have a
institutions
(52.6%)
chaplain.
have nei111er a chapel nor a
53
Religi ous
programmes
have
re]igious
•activities such as prayer and Gpee.ial
been conducted in all the
insti tutions
whether
these institutions have a Chapel or not.
institutions
125
services
rendered
answered
by them.
the
question
on
Of those answered, 52.5%
ecumenical
have
s a i (J
and 30.4% have said that they
that they render ecumenical services
do not do any type of ecumenical service.
_ gqle.„of_clergz_in„management_prqcess
Of
by
a11 the
(85.4%)
205
40 institutions, the role of clergy was
j nstitutions
and nothing
was
recorded
given
by
35
institut ions.
Of
the
the 205 respondents who specified the role
f clergy in
management process of their institutions, 64 (31.3%) recorded
The
that clergy do not have any role at all in their institutions.
institutions, gave 156 answers wh i ch a re given in
remaining 141
the
/I total of 25 (17.7%) have written that cl orgy is
table 17.
President of the Managing Committee
Cha irman or President or Vice
Board of their institutions 67 (47.5%) have said
Governing
02'
or Administrative
that the clergy are members of Managing Board
Board of their
Committee o r Executive Committee or Medical
In four instances they
This is the largest group.
institution.
the diocese level has representation in
have sa id that clergy at
A total of 14 (9.9%) have
the management committee and boards.
Superintendent or
clergy were Manager, General
recorded that
CrlAI
TAALE - 18
for next Five yA’lLS.—
Plan /
1.
Number nf
No.
Priorities
Strenqthen Community health
(i) Community health project
56
(ii) Out reach programme
16
(ill) Improve health centres
26
rec.ponses
?•
98
22.1
2.
Ogvelop a particular department *
52*
11.7
3.
Imorcve Patient
11 •
2 5.0
18
4.1
37
9.3
32
7 •7
54
I7.2
42
9.5
444
10 0.0
4.
Services
(i)
Imorove the duality of
(ii)
Extend more facilities to patients
Service
Control
15
Leprosy
(iv)
Maternal
and child health
12
(v)
Surgical
services
11
Increase Specialities Services
(ii) Intensive care Hnit
(iii) Oiannostic Equipment
11 •
5
2
Finance
(i )
(ii)
6.
27
(iii)
(i) Introduce specialities
5.
46
'A 11
ininq
self sufficienby
OpeJucinq Foreinn Subsidy
Training Programme
(i) Start training Programme
(ii) Training the Paramedicals
7.
8ui Irling
A.
0t hers
(i)
(ii)
(iii)
(iv)
35
2
27
5
Programme *
Sati sf y the needs of staff
To Puild a Healing Community
Family Planning
Increasing staff
(v) Rehabilitation
Total
details are in table 18.a.
19
11
8
1
Tr-JLELtAsOrf ,115 Of y wjaiJttttUiMJilasat.
••’T e
11 DevGlaj?. a. 2 A'
Develco
o
Farticular ^enartmont
Un.
of responses
6
P e ad i at r i c s
f^ed icing
2
5 um pry
1
4.
?enti rt ry
2
5.
Obstetrics
-•
E%'T
2
7.
Opthalmolony
n
Q #
P sy chi at ry
1
9.
Pat hoiony
1
10.
1
11 .
^i crobi ology
r«i a e r n i t y ’J a r d
12.
Neuro-Surgery Uard
1
13 .
Physiotherapy Services
2
14.
Rehahilit at ion Centre
2
15.
Oenhrolopv
1
16.
Hicro-surqpry Unit
1
1715.
Nevi Cobalt Unit
1
Super Speciality departments
1
19.
Unora kno the Institution
1
20.
Ante-Nat al Clinic
1
21 .
X-ray Unit
4
22.
Alood
23.
Cursinq School
4
24.
Community 'ir,alth Programme
1
25.
Leo rosy Hospital
1
26.
Institute of Health Services
1
27.
Oevelopino Sub centres
1
1 .
2.
Oynecology
1
1
•7
Bank
Total
52
co n t d . . .
1
TABLE-18 .a.
I
(c©ntd)
^uiJjlLOa.
12
1 .
7
Staff "carters
Neu ’InmH. al OonnleX
6
0.0. but Idina
Olock/Labour 'J 3 rd
r'1it ar nit y
thp buildinn r
[■'odernizinq
buiIdina proaranme
Ext encive
n of clinics in vilUnes
Cnnst runt io
Pediatrics building
4
A.
5.
6.
o
n
10 .
11 .
1?.
13.
14.
15.
16.
17.
15.
19.
5
22.
3
2
2
1
Administration building
null tl inn
Co-nmunity 'lealth
1
Emercipncy block
1
Community hall
1
X-ray plant
Inpatient building
1
Cant een
1
I solation Uard
Pptholmic Unit
1
Nursing School
2
Private rooms/ward
Sep3rale lonrocy Complex
1
Pperation Theatre
1
1
1
1
20 .
21 .
3
3
Cnmuo'jnd Jail
Total
54
57
The role of adviser
Administrative Officer of their institutions.
or
Although
guide has been played by clergy in 12 institutions.
have much authority in 3 institutions they have been
they
do not
used
as
staff
member
management co-ordinator, participant in management as
a
In
5
and
also
as
a
management
co-ordinator.
In 26
the clergy play a minimal role in management.
institubions
institutions clergy involve themselves only i n chaplaincy services
but
in management.
not
j ns ta nce
that
in
one
as member of Managing Board, in 2 instances as member of
Committee,
Administrative
Management
said
useful involvement by the clergy was noticed
and
active
Additionally the respondents
Committee
supportive role’).
(and
instance
as
Chairman
of
in four instances
in
* Advisory
and
in
one
It is also mentioned that the clergy played an
2
unfriendly
or incompetent role as members of Managing Boai'd in
instances,
as representative of diocese at one instance and as an
Administrative Officei' at another instance.
rest
A pa r t Irom these, the
to
the
details
of plans and priorities for next 5 years
are
ia Table 18.
Altogether a total of 444 were mentioned
by
of
the
roles mentioned above
are not. specific as
d i rection (positive or negative) of the role of clergy.
12. F u t u r e _P 1 a n s
The
given
213 institutions.
services
wh i ch
The main aspect of it is improvement of patient
is mentioned by 111 (25.0%) of the
institutions.
58
Nex t
comes
health (98).
s 1- r e n g t h e n i n g community
Development' of a
of the institution is the priority of 52
institutions
department
foreign
self sufficiency and reducing
attaining
Aga i n
(11. 7'^) •
for
37 institutions and priority
f
o
r
priority
subs idy i s the
respondents (7.2%).
(.raining programme is given by 32
187 respondents gave
Commun ity
information on Comini tment on
recorded that they do not have any
49
(26.7%)
Out of them
Hea 1 th.
said that
Another 45 (24.1%) have
on
Community
Health.
comm itment
programme
full community health
to
a
committed
they have been
(The comprehensive
programme
small
curative
includes a
which
maternity and
covers immunisation,
programme
commun 5ty health
d e v e 1 o pm e n t
visit, Health education and a
Home
chi 1 d health,
have
(27.3%) recorded that they
institutions
51
programme).
are
but their programmes
health
programme,
committed to community
They have either
the
previous
group.
as
programmes
n o t full
for villagers
or mobile clinic programmes
programme
immunization
18
villages and so on.
to
the
nurses
or weekly visit by
programmes.
very 1imited
minimal
or
a
institutions have only
have
have recorded that they
institutions
A part f rom this 7
related to leprosy control .
community programme
It
is
he a rteni n»i
self-supporting.
another
to
108
instituti ous seif-support!ng.
find that 57
a re
(26.2%)
(49.5%) have plans to
a 1r^ady
make
thei r
institutions
Unfortunately 13 (6%)
*
"HlBUBliBm II
ISA
- 59
TAB Lil 19
Descript!on of need
Finance
Medicine/drug
Build!ng
Buildings
Staff Quarters
Hostel for Nurses/staff
Guest house for visiters
Modern Operation Theatre
Accomodation for patient atten en
I;
Compound VIa 11
Labour room
Operating room
h
Chapel
Auditorium
W a rd
0 .T a rd
Indoor kitchen
Unit
Intensive care unit
Dialysing Unit
w
- ' ‘
I.
Dental Unit
ENT Unit
Cobalt Unit
Lab services
ECG services
X-Ray services
' 1
I ■»
, '/'tit
Needed
No.
%
48
9.2
10
t.9
116
22.4
14
64
4
1
7
1
6
1
1
1
1
11
1
1
2
Canteen
11
Number
12
4
1
2
1
1
1
1
1
2.3
table
19 (contd.)
Equipment & Instruments.
Plastic surgery equipment
i
Surgical instruments
-
'5?
Modern equipments
Lab equipments
Culture & Sensitivity test facilities
Radiotheraphy equipment
1
12
21
13
1
1
3
t
I
Beds
Cradles
1
Endoscopic instruments
Diathermy set
rt
4?z;
Wax bath apparatus
Cardiology equipment
Dressing material/Linen
Delivery Table
t
X-Ray equipment
Physiotheraphy equipment
Operation instruments for tubectomy
Diagnostic equipment
Heavy grinding machine
Surgical Table
Orthopedic operating Table
■ I
pedestal Shoe Finishing machine
$L-
Suction apparatus
Bayles apparatus for Anaesthesia
ntthopaedic operating instruments
I
I
I
1
6
1
30
2
2
1
1
2
6
11
ECG
4
1
3
Lapros cope
I
1
1
Radient heat
J
1
1
4
6
2
5
Microscope
Endoscones
□astroscope
Bronchoscooes
Calorimetre
3
2
1
2
1
Radium
Infant Incubator
8
1
Neuromytone
a
Autoclave
2
Delivery kits
-rr-sr
No.
%
i70
32.8
'I
I
TABLE 19 (contd.)
No.
' 9 Monitors
■
Fl
1 'I
'
Cardiac monitor
3
Faetal monitor
Ultrasound monitor
2
6
1.1
6
1.1
151
29.1
1
■
Staff facilities
School for staff children
iv.;
7.‘
2
Staff sponsorship
1
Education materials
1
AlIowa nce/PF/Gratuvity
2
t.| Others
• M
■
?. ■ ®
d1' w
!.■ V'
If
*
I
i
'4'
Generator
16
Bef rigerator
2
V ehic le
17
Ambulance
19
A.Video player
3
Proj ector
2
Calculator
Still
1
Water cooler
1
Water/Water tank
70 mm X-Ray films (not roll type)
13
T ra nsf ormer
2
Motor cycle
Bicycle
1
Auto-T ra iler
1
Oxygen cylinders
1
4
1
Oxygen supply
Recreation facilities
T!
-< ■
School
’
(l
1
1
Furniture
Replacement of furntiture
i
0/
/J
for Leprosy children
1
1
f
i
I
J
1
1
Bore well for agriculture
1
Planting more trees
1
bJ I
■
-A.
'wn'arr
■r
62
v
TABLE 19 (contd.)
Toe a ti on for Hospital
1
Pumps, Fitte rand pipes etc for the water
supply scheme
Better road
7
4
Medical surgical stores’ supplies
Internal Communication system
Stationery
Books and Periodicals for li brary
Laundry soap/section
Fence
1
2
1
3
3
1
2
T ypewriter
Computer for accounts
Mixing mill for Microcellular :rubber
Repair of building
Repair of Vehicle
Furnishing of Lab, Ward, 0T
Loan for Private Housing
T echnicians
Renovation of chest clinic
Recurring grant
Trained and dedicated Christian staff
Linen,blankets, bed sheet etc
TOTAL
1
I
1
I
1
1
15
4
1
L
1
1
I;
1
1
Of
1
7
519
li/.
I?
i-
100.0
lb• ‘
b
I;
K
|t
I
I'I
i
I
I
r
I
fI-v1'
fe:'
- Media
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