MEDICAL

Item

Title: MEDICAL
extracted text: RF_MP_7_SUDHA

DFFINITIOrS:
1. Hospital beds. A hospital bed is one regularly
maintained and staffed for the accommodation and full-time care
of a succession of in-patients, and is situated in wards or areas
of the hospital in which continuous medical care for in-patients
is provided. The total number of such beds constitutes the
normally available bed complement of the hospital. This bed
complement excludes the cots for normal, healthy, newborn
babies in maternity wards but includes incubators and bassinets
for premature babies.

2. Admissions. Admissions refer to the number per year
of acceptances by a hospital of a patient who is to receive
medical care while in residence therein and who is expected to
remain for one or more nights. Normal, healthy, newborn babies
should not be counted as in-patient admissions, but babies
requiring special care should be included among the admissions.
3. Discharges and deaths. The annual number of discharges
includes the number of patients who have left the hospital (cured,
improved, etc.), the number who have transferred to another health
or social institution, and the number who have died.

4. Bed-days or patient-days. "Bed-day” orMpatient-day”
is the unit of measure denoting the service rendered to one
in-patient in the hospital census between one day and the
succeeding one. Sometimes the day of admission and the day
of discharge are counted as one day. In other cases, a full day
is counted only when admission is before mid-day or discharge is
after mid-day. Thus, the data given should be the annual total
of the daily census of occupied in-patient beds throughout the
reporting year. Patient-days should not include data for healthy,
newborn infants.

In this section, the bed complement will be designated
MB”; the annual number of admissions will be nA”, which can be
replaced by the sum of discharges and deaths (D + d); and the
annual number of hospitalized patient days will be WHH. The
daily average of beds occupied (N) will be H/365.
. .2

2

Indices relating to the hospital
Average length of stay (L). This index indicates the
average period in hospital (in days) per patient admitted#
Ideally, this figure should be calculated as follows: cumulative
number of bed-days of all discharged patients (including those
dying in hospital) during one year divided by the number of
discharged and dead patients. This calculation takes into
account the bed-days ©f patients in the year (or years) previous
to the one under consideration, but disregards the bed-days of
patients who were still in hospital at the end of the year.
It may be said, therefore, that the result of this method of
calculation represents the true average length of stay per
patient; and it is recommended that this method be used, at least
in long-stay hospitals.
However, various countries or various institutions
obtain the figure for the average length of stay in hospital in
different ways. The following are some of the formulas currently
in use:

(a) total number of bed-days in the year divided by the
number of admissions in the same year: L =H/A
(b) total number of bed-days in the year divided by the number of discharges and deaths in the same year: L =H/(D ♦ d)
(c) total number of bed-days i n the year divided by half
the sum of admissions and discharges (including deaths) in the
same year:
1

H

=2 x-

L=H x-

|(A + D +d)

A t D t d

llwill be noted that these three methods result in a
figure representing the average length of stay per patient per year,
which is not the same as the average period of stay per patient
admitted. In hospitals in which the patient’s stay is usually
short, the two figures are practically identical, and either may
be used; in hospitals in which patients stay for relatively long
periods, or in cases in which changes in the bed complement have
occurred during the year, the average length of stay is more
correctly calculated by the first method described above.
• .3

3

A new method of assessing the length of stay in hospital
derives from the distribution of patients by number of days speqt
from the day of admission. This can be done by counting, on a
survey day taken at random, the number of days all the patients
have spent since their admission. It is possible to obtain a
graphic curve that expresses the number of patients in relation
to the number of days spent between the admission day and the survey
day. This curve shows a maximum that corresponds to a value that
can be called ’’average time after admission”. This value is
practically identical to the average length of stay. It happens
that the curve shows two maxima because the patients are composed of
two groups, the acutely ill, with a short length of stay, and the
long-term patients.
The great advantage of this method is that it is possible to
select during a ward round with the clinician a homogenious grou | of
patients and to disregard those who suffer from chronic disorder and
those who are kept in hospital for social reasons, It is also pbssible to study separately one category of patient-those suffering
from pleurisy, for irstance-and to determine their average length
of stay. To obtain a higher standard of accuracy the survey can
be made at intervals.

Eed-occupancy rate (0). This figure expresses the average
percentage occupancy of hospital beds. It is calculated by dividing
the daily average number of beds occupied (obtained from the daily
census of occupied beds) by the bed complement (nominal number
of beds in the establishment) and multiplying by 100:
0

N

K

H
x 100 =

x 100.

365*3

The bed-occupancy rate reflects the ratio\ between beds used
and beds provided. Opinions differ regarding the wisdom of using
this mode of presentation, and some would prefer to use as a
denominator the actual number of beds used (including any additional
bes) rather than the bed complement. On the other hand, it would
appear preferable to use the bed complement as a denominator since
a bed-occupancy rate of 100 or over would call the attention of
4

4

administrators to a disproportion between the number of beds
provided and the number used. Furthermore, it sometimes happens
that the need for additional beds is only seasonal in nature, ir
which case a month-by-month analysis would enable administrators to
plan ahead for meeting this contingency. A persistently high
occupancy rate all through the year would, on the other hand, call

attention to a possible shortage of beds.
Occupancy rate should not be thought of solely as a measure
of administrative efficiency. Although it is reasonable to
expect that services shus such as ’’cold” orthopaedic surgery,
in which admissions can be controlled, should achieve high
occupancy rates, such as 90%, there are other services, such as
accident care and children’s services, in which a fairly low
occupancy rate is necessary, perhaps 75%, to ensure that emergency
admission is always possible. Thus, the establishment of occupancy
rate is an instument of medical and social policy.
Turnover interval (T). The turnover interval expresses the
average period, in days, that a bed remains empty, in other words, the
average time elapsing between the discharge of one patient and the
admission of the next. This figure is obtained by subtracting tlje
actual number of hospitalization days from the potential number
of hospitalization days in a year and dividing the result by the
number of discharges (and deaths) in the same year:

T = B x 365
D * d

H

The turnover intetval is zero when the bed-occupancy rate is
100 and becomes negative when the bed-occupancy rate is over 100.
In order to be meaningful, the turnover interval should be
calculated separately for the various types of hospital and,
especially, for the various wards of the hospital. A very short br
negative turnover interval points to a shortage of beds, whereas
a long interval may indicate an excess of beds or a defective
admission mechanism.

5

5
Indices relating to the population at risk
The object of calculating indices relative to the population
at risk is to know to what extent the population utilizes the
hospital services; therefore, it is necessary to know the number df
people that this population comprises. This number can easily be
found when two conditions are fulfilled: (a) the geographic area served
by the hospital or group of hospitals is clearly defined and a regular
census is made, as in the case of nations, or regions, or isolated
areas; and (b) the hospital or goup of hospitals is within reach
of this population and the means of communication are faiily conven
ient and fast.

If these two conditions are not fulfilled, it is necessary
to make a detailed satistical survey. If there is more than one
hospital in the area, the analysis will show the distribution of
patients among them. If part of a population cannot easily reach the
hospital, the survey will give the gradient of the attraction of
each hospital; The method for determining the population at risk ^s
applied by the planning authorities; it will be discussed in the
following chapter. The population at risk is designated ,,PH
Admission rate. The admission rate, which is also knwn
as the hospital frequentation rate or hospital attendance rate and which
is designated
is usually expressed at the number of hospital
admissions per 1000 of the population per year. Other units of
population may be used, however: rate per person, rate per 100 pers ons
etc.

In calculating admission rates, all admission, including
readmissions for the same pathological condition, are counted.
In the* case of mental hospitals and other establishments in which
the patients stay for a long time but may be allowed to leave the
hospital for short or long period ’’on parole” or ”on leave”, an
admission should be counted only if the patient has previously been
discharged, not simply let out ”on parole”.
Admission rates are calculated both on the basis of total
admissions to all hospitals, regardless of type, ownership, etc.
{gross admission rates), and separately for the various types
of hospital or hospital servee (specific admission rates):

6

t
6

Fh =

A

x 1000.

P
Hospitalization rate per person. This index expresses th4
volume of hospitalization in terms of number of hospitalization
days per person per year. It is caluculated by dividing the total
number of hospitalization days in a year by the mean population
in that year:

Hc

P

Bed\ occupancy ratio. The bed-occupancy ratio is the
average daily number of persons hospitalized per unit of population
(usually per 1000 population). It is obtained by dividing the
average daily number of beds occupied (average daily census) by

the mean population in the same year and multiplying by 1000.
Alternatively, this ratio^ could be obtained by the product of
the bed/popplation index
seG below) and the bed-occupancy
rate, divided by 100.
Ec=

N

x ±000 = Ib/p x

0

p
Bed/population index. The bed/population index (lb/p) is
probably the commonest and most controversial figure- used for the
assessment of hospital utilization. It expresses the availability
of hospital beds in terms of the number of beds per 1000 of the
population. bometimes this figure is expressed as the number of
persons per bed.

The bed/ population index is obtained by dividing the bed
complement by the mean population and multiplying by 1000.

zb/p _

B

y 4ooo.’

P
Used aline, this figure cannot be considered as an index
of hospital utilization, but simply as an indicator of the
availability of beds, regardless of how they are utilized. On the
other hand, as will be seen below, the availability of beds is
perhaps the most important single factor in the determination
of the hospital utilization in a country.'

A.

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Asport i'io 24)

Quantitative ^valuation - Indices

Indicfffi for In Patient

11 PS)

&
Indicaa For out natiant servicBRC IOPS)
I IPS
a) Bed occupancy Rate

b) Bed turn over Rate
c) Turn over Interval

d) Average length of stay
o) Average daily census(of IP)

XOPS

a) Daily average OPD attendance

b) Average 0»P attendance per patient
c) Daily average OPD attendance per bed
I.ndices! for aunlitative .Perfogmance
1» Ftortality Hatee
a) Grose

b) Net

ss Tqtai Nfi*. pf
during a narti^ulnr neripd
x 100
No of discharges & Deaths
K

Tptal _Dq* of deathft occuring after

hnurs or

aft or adpiasion during any uiven period
X 100
No* of discharges & Deaths
2« Ant op e y %te

•

Grose—Ratio

• Net-Ratio

Cost

All act on si
All Deaths

AH ^MgftppniRR
All Deaths - Medico

cases

IndiceeS Certain minimum cost indices should be developed Fot the

budgetting and control

at the Institutional level*

The Indices

recommended are mainly the total expenditure classified under different
heads such as •

Diets
Hedicinea

Instruments

equipment
X-rays

Lab etc* to give tho estimates of overall expenditure per

impatient and outpatient served*

dhatweer needed* the unit cost of

services provided may also be worked out e*g« cost per x-ray exam9
cost per lab test etc*
f

/

4

%
: 2

*

Had leal Hecords Section (Htmt ba

under Statistical Division)

Staff based on bed-strength

Number of beds
500

750

1000

1, Red Hecord officer

1

1

1

2« Asst Medical Record officer
3« Sr Medical Record Technician

1

1

2

2

4

5

1

4* 3r Med Record Technician

4

6

7

10

5® Mod Record Attendants

2

2

3

4

1® Asst Med Record Officer
2* Sr Med Record Technician

2

2

5

5

2
6

2
6

3» Med Record Attendants

5

5

5

5

6

Central Admitting-cum-Enquiry
and OPD Service

for qualifications and details see original report itself

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REGIONAL PROGRAMME TO ERADICATE DISEASE X.

BRIEF:

The government has decided to implement an urgent programme

to eradicate disease X in your region. This is to be done by sere ening

the population for the disease, vaccinating the uninfected and
initiating treatment for the infected.

All .resources are assumed

to be available and the only activities

you need to consider are listed in the table together with the time
•veach one will take to perform,and additional notes. (Evidently this
list is simplified for the purpose of the excercise and would be
more detailed in practice. You are not required to elaborate it or

to suggest changes.)
You are asked to organize the programme so as to complete it in

the shortest possible time (given the duration of each activity)
Your report should:

(a) Indicate the starting and finishing time of each activity
(e.g. Start in week % Finish in week 11).

(b) Advise on the minimum feasible duration of the programme
(e.g. 35 weeks).

(c) Indicate any activities where delay in completion would increase
the minimum duration.

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t,.. .. vk.kE T.) ERADICATE DIOEAEE X .

ACTIVITY

DURATION
IN WEEKS

NOTES

(7)

Engage field director

6

This is done by the Chief Medical Officer

'2

Approve equipment 4supplies

2

This is done by the Chief Medical Officer

A

Recruit field workers

4

This is done by the Field director

2

The field workers are medical orderlies
requiring only short training in screening
techniques

© Train field workers
Select population
centres on which
activities will by
based

j

10

Acquire vehicles

7L

©

(ZO

This is done by the field director who w-J.ll
decide on which centres of population he wishes
to base his teams, after touring the region.

1

This is done fry the Field director. Ex army
vehicles have been promised by the Ministry
of Defence but the e-^act type will not bj known
until the negotiations are complete.

■z

7

The vehicles will require modification ar.d if
they are of a suitable type will be equipped
as mobile dispensaries.

Screen the population

7

This will be done by the field workers wc irking
from the centres of population selected, The
techniques are well established and require no
sophisticated equipment. The Department c-f Health
already has transport for these workers.

Transport the vacci
nation and treatment
teams to the selected
population centres

2

Vaccinate the
uninfected and start
treatment of the
infected.

4

Publicity campaign

9

Adapt and equip
vehicles

This activity cannot feegin until the vehicles
acquired have been modified and equipped.
The teams are permanent Health Department staff
in addition to the field workers screening.
This activity will be undertaken by the
vaccination and treatment teams and cannct begin
until the screening teams have finished.
This activity is important to ensure maximum
public cooperation but it cannot begin until
equipment supplies are approved and vehicles
have been acquired.

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Health care institutions are complex and dynamic,

continually interacting with diverse political, economic,
social and technological forces in their environments.

It is

difficult to assess the effectiveness of health care institutions and re-define the emerging role without a deeper understanding and analysis of socio-economic changes during the
last 44 years.

An objective analysis and realistic assessment

of changes ani.development, in health care scenario of this

:'X

country since 1947 shall reveal significant result in reducing

general, infant and maternal mortality, increase in expectancy

of life at birth, control of some infectious and vector borne
diseases, eradication of smallpox, etc.

Amongst innumerable

failures the major are population aontrol, control of common
communicable waterborne and airborne diseases which has long

been eradicated in developed countries.

There is no improve

ment in nutritional status of the population, the prevailing

rate of malnutrition amongst the women and children is alarming
The failure is glaring in basic health infrastructure like

water supply, sanitation, housing which directly influences
the Equality of life'.
uncontrolled.

Debilitating diseases remained

Health problems related to industrialization,

rapid and unplanned urbanization like accidents, disease related
social maladjustment like STD, AID, drug addiction, mental

problem are on the rise.

Environmental polution, degradation

of natural resources, occupational hazards are going to add

many more complexity to problem ridden health situation of this
country.

A significant effort has been made to improve the

accessability to health care by increasing the number of PHC*s

and subcentres.

But the ’service quality’ remained far below

the expected level and absence of organised referral system,

inadequate number of ill administered taluka and district
hospital has plagued the health situation of the country.

... 2/-

V

In terms of reduction in death rate and increase in expectancy

of life at birth the improvement is significant, but in terms
of improvement in the ’quality of life’ the growth is negative.

The

Our focus is on the health status of Karnataka.

total area of Karnataka is 1,91,791 sq. kms. divided in four

revenue districts, 20 districts, 49 sub division, 175 taluka
250 towns and cities and 27048 villages#. . . Nearly 42 percent of

the villages are inhabited by less than 500 people.

According

to 1981 census population was 371.36 lakhs (projected 1992 462 lakhs), percentage of urban population 28.89, sex ratio

963, percentage literate 38.46, female literacy as low as

27.71, schedule caste and schedule tribe constitute about
20 percent of the total population; density of population
is 194.

In 1988, birth rate has been calculated at 28.7, death

rate 6.8, infant mortality 74, expectation of life at birth
56.3 and. dependency ratio 858.

Projected, population by

2000 A.D. is 529 lakhs and increase of 75 lakhs on the current
population

The latest available data (March 1990) revealed 288

hospitals with 34477 beds, 208 dispensaries with 121 beds,

625 Primary Health Unit with 730 beds and 1142 Primary Health

Centres (PHC) with 7069 beds.

In addition there are 160

Community Health Centres, (CHC, upgraded PHC) and 7793 sub
centres.

Medical institution population ratio 1:19658 and

bed population ratio urban.1:380 and rural 1:3689 total

1:1049.

... 3/-

: 3 :
i

•

*

There are 19 medical colleges (4 government,15 private) 9

13 dental colleges (1 government, 12 private), 4 College of
Nursing (1 government, 3 private)*

As far as Indian System of Medicine and Homoeopath^ is

concerned in 1990 there were 23 hospitals with 750 beds and
407 dispensaries.

There are 9 Ayurvedic colleges (government 3;

private 6), 9 Homoeopathic Colleges (government 1, private 8)
-1 Unani College (government) and 1 Nature Cure College (government).

(government) ... (1)

Analysis of incidence and mortality from principal

diseases of 1988 and 1989 reveal acute diarrhoeal diseases other
than Cholera, Tetanus, Acute Respiratory Infection and Pneumonia;,
Tuberculosis are major cause of ailment and death in the state.

Number of cases and death from gastro-enteritis and cholera is
on the high side.

Active Tuberculosis cases brought under

treatment as on 1990 was 8,72,568.

The prevelance rate of

leprosy was estimated at 2.39 per 1000 in 1990.

Accessibility of basic health services in the statfe is

indicated by the following :
TABLE - 1

1 . Delivery conducted at home by
untrained village dai or other
untrained professional (l986)

Urban

Rural

Combined

6.6%

17.6%

14.8%

35.6%
31.6%
19.6%
. .
.2. Delivery conducted at home if
by
(46.4%
of
the
total
deliveries
in
the
state)
relatives (''

3. Death occured and was attended
by unqualified practitioner

4.2%

9.8%

8.6%

50.2%
4. No professional doctor/Hakim/Vaidya 41.9%
-J
52.6%
attended (58.8% of total death were not attended by
professionally trained physicians)

V-

: 4 s
Percentage of Infant death to total death in the state
24,53 compared to national average of 28.23.

Thirty five

percent of the population live below poverty line (1983-3-4).
Percapita (Public Sector) expenditure on health (1985-86) is

Rs.34.24 on Health Rs.8.86 in Family welfare, which is below all
India level (Rs.46.23 and Rs.7.89).
There is a need for those concerned with decision making

for the health and welfare of the people of a country to
redirect their priorities to examining more fundamental issues
These issues are the basic mechanisms necessary for whatever
)

programme may be formulated or eventually evolve through
voluntary initiative.

The inadequacies of our present programm

are familiar to most.

To review them again may help only to

illustrate the need for a systematic, co-ordinated approach to

their solutions.
As we review the myraid committee reports, proposals

and programmes that have been abandoned or replaced by the
planning authority in the centre since 1948 are excellent
examples - it is clear that, lack of overall strategy and
objective, piecemeal approaches are doomed to failure.

It is

doubtful that this country will make constructive progress in
overall health affairs until it can view the problem as a whole

It must be ‘understood that :

1. Health care extends beyond the delivery of health
services.

It cannot exclude consideration "of such socro economic

factors as education, housing, sanitation, income, nutrition,
inequitable distribution of health facilities, environment,

lifestyleand the training of appropriate manpower;

(2)

... 5/-

■■

:

5

:

2. The weakness of our present disjointed, fragmented
and multilevel practice of delivering health care - whether it

be narrower concept of sickness care or the broader concept of

health and social care (’human care’) - must be acknowledged
by all parties if they even to be considered;

3. Change is inevitable and desirable, but change in any
It must be

part of the system affects every other part.

gradual, consistent and compatible with defined objectives
4. The system - which includes many levels and division

of Government sector, civic authorities, voluntary sector,

private sector, private practitioners, third party payers and
consumers - must therefore be dealt with as a total entity

5. ’A Comprehensive health and social programme1 may not

be monolithic, but can be administered by government, the

private sector or any combination of the both;
6. A huge social service sector like health of a nation

cannot be overly dependent on foreign technology, knowhow,
import of bulk drug, etc. for a long time.

The country has to

develop its own model, technology, system suited to its own
requirement in rebtion to quantity, quality and cost.
7• Integrated approach to health and medical care by

trying to utilize the maximum benefit from various sytems of
medicine is a must - people are to be educated about strengths

and weaknesses of each system so that they can feel free to

choose;
8. It must take into account problems of organization,

administration and leadership at all levels ••• (3)

... 6/-

9. A comprehensive developmental programme can only
■>

succeed if leaders from all sectors work as partners, rather
than adversaries,

. (4)

The above requirements are enormous and highly complex.

Components are numerous, complicated and competing.
sametime they are very much interdependent.

At the

If we do not

consider them as a part of overall system, if the organizationa■_
base is not flexible, we cannot expect our solutions to bring
lasting results.
The country is going through a period in which there is

strong sentiment in favour of decentralization and local self

determination and against control by central and state govern-

ment.

It seems natural, therefore, to ask why health and social

care should be more structured and co-ordinated.

The present

:system’ cost too much to providers and consumers as.the
services are fragmented and uneven in quantity, quality and

distribution.

In a situation like this the consumer is unable

to Judge his moneys worth.

of the people of a

Above all. the health and welfare

nation are too important to be left to a

haphazard diversity of practice.

COST OF MEDICAL CARE
Health and social needs of the people are basic to the
nation’s welfare.

Central, state and local bodies have the

responsibility to meet the needs upto their capacity.

So do

providers from the voluntary and the private sector and so do
the recipients themselves.

Cost- containment in human welfare

is very difficult (over' trationing) and we may disagree with.

the priority upon public and private expenditure. yet we must

7/-

: 7 :

still recognise that our 'human care* needs can be almost

infinite 9 and from the resources from which they can be met

remain finite.
faced.

This is an inescapable reality that must be

The cost of health care - particularly of sickness

care - is steadily increasing. ... (5)

Reliable financial data on national health expenditure
is not available, several groups have attempted to estimate
national health expenditure.

There is wide divergence of data

but one significant finding is voluntary and private sector
expenditure on health varies 50 to 80 percent of total expendi
ture.

These studies also suggest that India's overall spending

as a percent of Gross Domestic Product (GDP) may vary from 3

to 8 percent of GDP, although the public sector expenditure is
estimated around 2 percent excluding expenditure on family

welfare, water and sanitation ... (6)

It must be understood that significant cost containment
cannot be achieved through the efforts of voluntary providers
it can only be achieved through prudent and knowledgeable

buying by consumers.

It is unrealistic to expect effective

overall control of costs as a result of governmental initiative

alone.

The delivery of health care is a 'Big Business', one

of the largest industries in the country.

No business of its

size would imagine that it could operate efficiently and

economically, with a reasonable assurance to good quality,
without careful cooridnation of all its component parts ... (7)
FRAGEiviENTATIQN, DUPLICATION AND LEADERSHIP

Instead of cooridnation , however, fragmentation of
responsibility and duplication of services are common at all

levels of health and social care - in central, state and local

... 8/-

: 8 :

bodies, voluntary and private sector.

Clearly the result is

increased costs.
In India health is a state subject, state and municipal

local bodies are important financiers and providers of public

sector health care.

Government financing of health includes :

expenditure by state government and local bodies 9 centrally

sponsored schemes,purely central schemes^

Government expendi-

ture on health is subdivided into six heads 9 minimum need

programme (rural health), control of communicable diseases,
hospital and dispensaries , medical education .and training,
Indian Council of Medical Research, Indian System of Medicine
and Homoeopathy, ESI and other programmes.

Some of the health

related programmes are provided through other ministries like
Ministries of Human Resource Development, Social Welfare,

Rural Development, etc.

In addition direct financing of health

is made through Ministry of Defence, Ministry of Railway and a
number of other public sector organizations.

Drugs and Parma

ceuticals is under the control of Ministry of Petroleum,

In a

situation like this problem of co-ordination, problem of

leadership (who takes initiative) could be easily visualised.

Administration with competent and respected health
professionals are the crying need,

The government could not

find ways tc recruit and retain the necessary career profess
ionals who could broaden the concern to human services.

It

is difficult to expect competence, continuity and consistency

in programme in a bureaucratic and a highly politicized
atmosphere in which these ’short tenure’ bureaucrats operate.

The current sentiment that strongly favours more local
control . at grassroot level and peoples participation gives greater responsibility to the state.

The leadership

9/■.ra

: 9 :

has to be flexible, adaptive and innovative.

In fact there

are continuous allegation and counter allegation between centre
and state officials about non availability of fund, non cohfor-

mance to guidelines and inadequate result.

If any one tries to

make an objective evaluation from state’s past record, a very -

legitimate question that is likely to arise whether their
organization and competence are such that they will be able to

carry out whatever responsibilities they are expected to asaire#
A greater degree of fragmentation besets the private

sector - voluntary hospitals, private teaching hospital,, private

profit seeking hospitals, industrial hospitals, nursing homes,
diagnostic centres. third party payers, private practitioners*.

and the entire gamut of resources concerned with care of people
They are mushrooming in urban and semiurban areas, they are

pppearing to becoming more and more self centred and concerned

with individual ’survival’ or preservation of the market
segment.

Regional and state co-operation remained as lip

service.

The existing institutional and professional associa-

tion do not have required expertise or organizational strength
to deal authoritatively and competently with other organization^

and with government.
In a pluralistic society like ours, states, local bodies

and institutions differ greatly in resources and demands made
upon them, in expertise and in local conditions.

these problems need pluralistic approach,

Solutions to

They cannot be

achieved solely by government initiative or solely by the
individual effort of voluntary and private institutions.

But

this very need for varied approaches makes it imperative that

... 10/-

: 10 :

all levels of government , voluntary and the private sector

work together to co-ordinate their efforts on every
front. ... (8)

COST CONTAINMENT

Cost of medical care (sickness care) is rising out of all
proportion and there is increasing public criticism,
part of the expense is for acute care.

The major

”A satisfactory mechanism

’has not been found to deal with the remarkable influence of the

physician, not only upon the responsibilities of the hospital
and services it provides, but also'on the utilization of those

services and on the patients’ admission , discharge and length
of stay. Actions of the physician can affect the hospital’s
financial health and its very existence.

Yet in most institutions

the physicians assume no personal responsibility for costs related c
to the patients or to the hospitals”. ... (9), The market
place has little influence upon the physicians services for
hospital costs.

In private practice the physician charges

’usual. customary and reasonable’ (UCR) fees, as well as broad

latitude is given to the frequency of visits, utilization of

technological procedures and the ordering of special tests these rights are fiercely defended by the physicians and their
association. ... (10)

The lines are generally fuzzy between

quality of care, custom-., protection from malpractice and simple

economics and income - all concern to the practicing
physician.

(11)

Planning, quality and utilization control and cutting

down ’frills’ are the general cools that could be tried by the

voluntary and private sector.

Regulation on consumption of

... 11/-

: 11 :

health resources is an impossibility in a democratic society.

The alternative advocated revolve around the expectation that
the purchasing bodies or individual patients will respond to

market forces and will purchase prudently". ... (12). "People
do not buy health care as they do clothes and groceries.

They

do not want to go to doctor or to hospitals any more than they

want to go funderal hofiies.

They usually ask for health care

because they need it or because they think they need it",., (13)

The cost of care is inflated in both ways : if they do not report
early and wait for the disease to aggravate or they report too
frequently with a tendency to overconsume health resources.

"It is a rare personwho can assess the quality and quantity of
care that he/sfya needs at one point of time and whatever he/she

receives can be equated with its cost"... (14)

The health sector of a given society should endeavour to

make the services available to common people at a reasonable
and affordable cost.

As we are moving towards free enterprise

economy. - the big question is who determines a reasonable and

affordable cost and how ?
A realistic thrust of cost containment should be on
health education making people health conscious, assume

’self responsibility for maintaining health’.

QUALITY ASSURANCE

Hospital authorities in government, voluntary and
private sector are evading a formal system of quality

assurance for a long time, whereas in advanced countries the
present trend is toward 'Total Quality Management’(TQM).
’Doing Something somehow’ may be an acceptable standard during

... 12/-

: 12 :

dire emergencies in the battle front.

Providing medical

services without any regular formal system of review
wi thout
9
developing any performance index (PI) year after year cannot be

considered as a professional service,

The governing board or

management committee may not be aware that the institution

(management) and the treatingJ physicians are directly responsi—
hie to the patients for any lapse in service.

The 'Consumer

Forums * are getting more and more teeth and if we fail to

maintain standard quality of services, they will drag us to
the court.

More than that , patients will be misinformed and
they will become more conscious about their rights and underplay

their responsibilities.

The danger is, physicians will try

to avoid the slightest element of risk, health services shall
become more 'cost intensive and litigation prone'.

SICKNESS CARE AND HEALTH CARE
Many health care providers, payers and governmental
agencies do not clearly understand that it is impossible to

separate health and social services in considering the total
welfare of the individual as a member of the family and a part

of the community.

Too many programmes and institutions are

geared to sickness instead to health,

The present emphasis is

on crisis-oriented treatment of acute episodic illness.

If it

is to be truly effective , it must be viewed as only one part

of a continuum.

This should include ambulatory, institutional

(acute and long term) and home health care... (15).

It must

also be recognised that the allied social components mentioned

at the beginning of this discussion are of major importance
in the development of a strategy or a programme for human care,
For example, it is impossible to separate health from social

... 13/-

: 13 :

services in the care of children, the ae>ed, the mentally ill

or physically handicapped, the endemic patients of tuberculosis

and leprosy. the indigent.

A combined approach is not only

more humane, but more economical as well.

For many elderly

individuals, mental illness and endemic diseases, social

support in their own home is sufficient and home health care

can be provided at about 50 percent less cost than institutional
care.

It is quite evident that neither a governmental agency
nor the private voluntary sector alone can plan for such comprb-

hensive care, let alone provide it.

Effective result can be

achieved only through the coordinated efforts of the agencies,

governmental and voluntary and private, that must participate

in its provision along with those receiving them... (16)

HOW CAN VJE APPROACH VARIOUS FUNDAlffiNTAL ISSUES
The health managers and planners are at a cross road- -

the population of the country is going to touch a billion by

2000 A.D., the country needs a gigantic health system,
resources are scanty and health problems are innumerable,
interwoven in the complex socio-economic fabric of the country e

The need is for ” A COi'IPilEHENSIVE APPROACH TO HEALTH AND
WELFARE”.

It is easier to point out deficiencies of our

practice of health care than to propose practicable measures

to improve it.
plan.

It is not my purpose to advocate any specific

No one person can have the range of expertise required

to find solutions to all the problems.

However, I firmly

believe that a concerted and systematic effort by those with

experience in each of the major components of health care
should find it possible to reach agreement on a comprehensive

... 14/-

;? 14 s

programme that will work reasonably well.

I shall confine

myself to suggesting certain broad avenues which, if followed
by all parties concerned, might lead to an organizational 9

administrative and leadership capacity to develop and imple

ment a programme of health and human services for the people
of this country.

ROLE OF THE STATE
*

—w———i- ■it■ —i ir- .-wustra

Regardless of political philosophies 9 the states mus
always play a major role in any programme concerned with the

health and welfare of their people.

Questions are raised about

competence and capacity to meet those responsibilitieso

their

organization, administration and leadership require far more
attention and commitment than what has been demonstrated so

far.

The senior officials of various ministries involved

directly or indirectly to various health issues 9 should be
encouraged to mount a joint major study of the inherent
problems.

its purpose would be to establish sound principles

guidelines and organizational patterns to help the states to

carry out their responsibilities - whatever is required to

assure effective methods for the delivery of health and social
care to people.

The experience of states could be thoroughly

reviewed and deliberated before starting the process of

reorganization. ... (17)
Each state should carefully explore, together with the

private voluntary sector, the creation of an independent state
!Institute/Academy of nealth’.

This would enable the s'cate

to tap more effectively the many available resources of
education research, health care provision and payment, and to
develop a working partnership with governmental agencies,

: 15 :

business and labour interest and informed consumers.

Purpose of the Institute : Planning, quality control

•Integration of facilities and programmes, modifications of
systems of providing and changing for health services with the

components of the delivery system.'

It must be concerned with

cost containment.
Objective of the Institute : Partnership and co-operation

with proper organization and administration of the state in the
broad field of human services and specific involvement of
government.

Authority of the Institute : The competence and the
representation of the body should enable each state to decide:
what authority it should be given beyond that of providing

research and consultation. ... (18)
The delegates-of Indian Hospital Association - Karnataka
are genuinely interested in establishing a formal partnership
with state government for development of health and welfare

of the people.
We must J.aud the Government of Karnataka’s decisions to

establish^ a ’Health University’ in the state.

ROLE OF THE CENTRAL GOVERNMENT
Again regardless of political trends, the Central

government bear a comparable responsibility to develop more
effective working organization and leadership.

Serious

consideration has to be given for creating an innovative
atmosphere for testing and field trial of new concepts, ideas,

... 16/-

: 1.6 :

techniques with sponsorship and support of both central and

state government and active participation of private voluntary

sector.

There are many ’experienced health professionals who

have been active in health administration - both in governmental
and private sector areas - who would be invaluable in such an

effort.

It is very essential that any activity or organization

of this sort must not be politicized.

Its objective should be

to help the central government develop its organization and
leadership so as to produce realistic and constructive programme

and to administer that programme knowledgably and flexibly so
as to allow for changes.

Its approach should be strictly

professional and its sole purpose the improved care of people -

’not to heating headlines and propaganda for the next election*.
!7.

r'

,

■

Associated with this approach should be a renewed effort
to establish a stable core of competent professionals in both
central and state governments, who are respected and supported
for their contribution to human welfare. ... (19)

ROLE OF THE VOLUNTARY AND PRIVATE SECTOR
In the voluntary and private sector the groups and
a ■

.tin the care of people, training and
.“^^y^Meveiopment of manpower, and. continuing research are divergent

in their objectives and goals.

Their primary task would be

to develop a mechanism by which many independent organizations

with special interest can work together constructively and

advise their partners in government objectively.
Health Care ^vbdel : We require to develop an indepen
dent and unique ’health care model’ and gradually replace

’foreign technology and drug dependent sickness model’*

... 17/-

Our

: 17 :

model should embrace an integrated system of medicine

Ayurveda, Allopathy and iiomoeopathy - and much more emphasis
should be placed on development and popularization of herbal
drugs and home cure*

2. Financing of Health : Economy and improved services
may result from providing health care through 'Health

Cooperative', 'Comprehensive Prepayment Scheme', '^roup
Not much study or experimentation has been done
on its feasibility in the country. They have the advantage of

Practice',

The most

involving physicians in fiscal responsibilities.

important aspect for consideration is it helps generation of
income from more positive contribution towards improvement off
health rather than from ’increased sickness’. ... (20), (21)

3. Health Services Planning.
(a) Currently the system concentrates on crisis care

of acute sickness in hospitals and nursing homes..

Ambulato ■ V

treatment in outpatient clinic needs much bigger emphasis

lighted OPD is the need of the day.

Equal emphasis should be

given to develop integrated home health care services.

(b) Regional Planning : Overlapping and duplication

of services has to be stopped at all cost, regionalization
of health services is a must.

The state health planners should

play the pioneering role of coordinating various health service
units.

Free flowing referral system of both converging and

diverging type could be developed through active co-operation
of larger and smaller institutions.

... 18/-

: 18 :

(c) Primary Physician : The need for conscious, dedica
ted primary. (personal and family) physician in the country is

much greater than specialists and superspecialist.

The teach-

ing programmes and institutions are rqquired to pay more atten

tion to training of ’well rounded’ primary physicians.

Such

new physician shall be trained to recognize the patients’ need
and if the physician is unable or unwilling to follow up his

patients conditions adequately, he should be the first one to
encourage home health care agencies

other health services or

specialist to share or take over the responsibility.

Continuous

medical education is a must for the primary physician, without

which they may be gradually reduced to ’professional quacks’..(22)

Cost Containment: The emphasis of cost containment
should be on : ’Health Education’, ’Early Reporting’,

Inexpensive Diagnosis’ and ’Home Care’.

1 Quicker

The top most priority

should be on rousing ’health consciousness’ and acceptance of
i

’self responsibility ’ for maintaining health.
5* Quality Assurance : We have avoided a formal system of
review of'quality of services for a long time resulting in
’non-professional attitude of doing something somehow by the

health professionals in general1.

The management of health

care institutions demonstrate a ’typical fire fighting attitude’

The greatest mistake is ignoring the 1educatiohal content

from a review programme

Services provided in this manner

can never be termed as ’professionally and technologically

sound’.

... 19/-

: 19 :

6. Professionalization of Management : The country needs

a large number of well trained, experienced and dedicated
'health leaders'.

Growing complexity of hospital and health

management makes it imperative.

Our success in meeting the

comprehensive health and welfare need of the teeming millions
largely depends on the professionalization of management®

7. Holistic Approach to Health Care : If we try to trace

the changes and development in health care in both developed

and developing countries in terms of rising cost, larger

commitment of resources and outcome during the last four
decades,

'sickness or illness ? oriented health system has no

future and has to be discarded.

must.

'Wellness' orientation is a

Should we commit the same mistake and wait till we

reach a point of no return ?

Should we change our direction

and recast a: new model and move towards holistic health ?

The system suggested does not require super agency or

massive cooperate effort,

-^-t can involve voluntary and private

sector institutions preferably in the shape of ’ccnsortia xr
orinformal agreement of cooperation and many types of partner

relationships.

The fundamental objective would be concern

for individual patient - putting him in right place and right

time with.-

the least delay (red tape) and the least expenditure

and with maximum of continuing professional supervision... (23)

These suggestions are made only as modest challenges

to stimulate thinking about realistic approaches to a

comprehensive well co-ordinated system of health care for the

people of this country.

I am confident that a workable system

.•. 20/-

: 20 :

can be achieved if experienced professional from government,
voluntary and private sector attack the problem with open
mind, a spirit of co-operation and a determination to succeed.

A quotation from the speech of Jack Masur is appropriate

”those of us who work in hospitals must join with education,

social work , employment placement, vocational guidance and any

number of related services to provide patients with the help
they need to restore them to their maximum functioning „..
physicians in hospitals must realize that their job is not

gnded when the fever is down, or the sutures out of ’clinical
cure’ has been achieved... we shall have to concentrate on the

ends as well as the means in the management of patients”... (2u)

s 21 :

REFERENCES

1. Status Report, 1989-90 Department of Health and family
Welfare, Government of Karnataka (Bureau of Health Intelligence
Management Information and Evaluation Division, Directorate
of health and Family Welfare Services, Bangalore.

2t4 Albert W Snoke, "What Is Legislation or Planning - If we
Can’t Make It Work ? The Need for a Comprehensive Approach
to Health and Welfare” American Journal of Public Health No
9:1028-1033, 1982
5

Ibid.

6. Peter Berman, Health Economics, Health Financing and the Health
Needs of Poor V^omen and Children in India (Ford Foundation
New Delhi,9 1991) pp. 21-24
7. AlbertaiW Snoke (op.cit*)

8. Ibid.
9. M Fildstein, "The Medical Economy” Scientific Anerican 1973 >
229: -151-154.

10. B.B. Rao. f,The UCR Boondoggle - A death knell for private
practice”, New England Journal of Medicine, 1931 305: 89- 94
11. Albert W Snoke (op.cit)
12. A Enthoven , "Consumer-choice Health Plan” (Michael Davis
Lecture, University of Chicago, 1978)
13. Albert W Snoke (op.cit.)
14. Ibid

15. E..Feingold, "The Crisis of Health Care”, Rakham Report,
University of Michigan, Ann Arbour 1978 4: (2)

16. Albert W Snoke (op.cit.)
17. Albert W Snoke (op.cit.)

... 22/-

: 22 :

18. Albert W &ioke (op.cit.)

19. Albert W Snoke (op.cit.)
20. P.M.Elwoad, Jr. s,The Health Maintenance Strategy ” Mddical
Care 1971 9: 291-298

21. J.B.Christiansen and W Me Clure ^Competition in the delivery
of Medical Care”, New England Journal of Medicine 1955,
30:567-572.
22. Albert W Snoke (op.cit.)

2J. Albert W Snoke (op.cit.)
24. J.Masur "Some Challenges in Hospital Administration :
Discharged - Cured”, Journal of Medical Education, 1955;
30-567-572.

■■

1

■i

APPENDIX I

VITAL STATISTICS

1.

Karnataka

India

30.1
24.9
28.7

32.8
26.0
31.3

Birth Rate (l988)(Provisional)
. Rural
Urban
Combined

I

2.

3.

4.

5.

Death Rate (1988)(Provisional)
Rural
Urban
Combined

9.5
6.9
8.8

11.8
7. 5
10. 9

Infant Mortality Rate (1988)
(Provisional)
Rural
Urban
Combined

83
46
74

102
67
94

Expectation of Life at Birth
(1976 - 80)
RURAL
Male
Female
Persons

54.0
53.9 •
53.9

51.0
50.3
50.6

URBAN
Male
Female
Persons

62.9
64.9
64.0

59.6
60.8
60.1

COMBINED
Male
Female
Persons

56.2
56.6
56.3

52.5
52.1

Dependency Ratio'. (1981) (No. of
persons in the age group of 0.14
and 60 and above per 1000 persons
in age group 15-59)

858

854

52.3

: 2 :

IMPORTANT HEALTH INDICES
(FOR PROJECTED POPULATION OF 1990)

(GOVERNMENT HEALTH AiW MEDICAL INSTITUTIONS ONLY)
I

II

III

INSTITUTION POPULATION RATIO
i.
Rural
ii.
Urban
iii. Total

1:19527
1:39789
1:22895

BED POPULATION RATIO
i.
Rural
ii.
Urban
iii. Total

1:3948
1: 551
1:1496

DOCTOR POPULATION RATIO

Excluding Teaching Staff
Including Teaching staff

IV

AUXILARY NURSE MIDWIFE/MIDWIFE POPULATION
For Total Population
For Rural Population

V

NURSE BED RATIO

1:10062
1: 8196

RATIO
1:4869
1:3462

1:7

ALL HEALTH AND MEDICAL INSTITUTIONS IN THE STATE
I

II

INSTITUTION POPULATION RATIO
i.
Rural
ii.
Urban
iii. Total

BED POPULATION RATIO
i.
Rural
ii.
Urban
iii. Total

1:18796
1:22158
1:19658

1:3689
1:380
1:1O49

: 3 :

INCIDENCE AND MORTALITY FROM PRINCIPAL
DISEASES FOR THE YEAR 1988 AND 1989

SI.
No.

1988

Name of the Disease

1

2

1989 (provisional)

Cases

Deaths

3

4

Cases

Deaths

5

6

—

1.
2.
3.
4.

Acute Diarrhoeal
Diseases other than
Cholera
Diptheria
Poliomyelitis
Tetanus :
i) ^eonatal
ii) Others

5.
6.

Whooping Cough
Measles

7.

i)

2,72,938
1,141

Acute Respiratory
Infection '
ii) Pneumonia

356

1mri—r w‘ rrj-UJrwnri

1,325

15
30

2,65,723
1,165
326

179
8
6

348
5,630

62
358

111
2,789

29
147

8,190
5,750

13
33

3,477
8,706

20

2,72,565
7,697

120
101

2,07,173
2,748

248
80

8.

Enteric Fever

21,174

39

8,078

19

9.

Viral Hepatitis

6,944

93

2,602

71

10.

Japanese Excephalitis

44

18

7

3

11.

Meningcoccal Meningitis

175

29

385

9

12.

Rabies

3,626

47

2,179

27

13.

Syphillis

9,192

1

5,973

14.

Gonoccal Infection

10,265

15.

T.B.

2,98,595

16.

All other Diseases
TOTAL
*»»TreiTnill —

IM .1

7,620

2

1,330

70,049

943

94,50,199 13,499

68,43,310

6,694

1,03,75,798 16,144

74,32,421

8,485

: 4 :

MORTALITY INDICATORS - 1-986 '

Indicators

1.
2.

Crude Death Rate
Infant MortalityRate
Neo-natal
Mortality Rate
Post-natal
Mortality Rate
Pre-natal
Mortality Rate
Still Birth Rate

3.
4.

5.
6.

INDIA

KARNATAKA

SI.
No.

Rufiil Urban Combined

Rural

Urban Cbmbi

9.4

6.8

8.7

12.2

7.6

11.1

82.0

47.2

73.2

104.6

62.0

9'5.4

60.8

35.5

54.5

65.6

36.2

59.8

21.2

11.7

18.8

39.1

25.8

36.6

57.3
12.2

35t1
9.6

51.7
11.5

51.8
10.5

32.7
9.0

43.1
10.2

PERCENTAGE OF INFANT DEATHS TO TOTAL DEATHS - 1986

India/State

Rural

Urban

Total

India
Karnataka

29.40
26.16

22.00
18.58

28.23
24.53

PERCENTAGE OF POPULATION BELOW POVERL ’
• . 5
PERCENTAGE OF POPULATION BELOW POVERTY LINE BY RURAL/

URBAN AREAS 1983-84 (PROVISIONAL) IN SOUTHERN STATES & INDIA
SI.
No.

India/State

Rural

Urban

Combined

1.

Andhra Pradesh

38.7

29.5

36.4

2..

Karnataka

37.5

29.2

35.0

3.

Kerala

26.1

30.1

26.8

4.

Tamil Nadu

44.1

30.9

39.6

5.

All India

40.4

28.1

37.4

S 5 :

PER CAPITA.. (PUBLIC SECTOR.) EXPENDITURE

ON HEALTH (MEDICAL AND PUBLIC HEALTH AND F^ILY
WELF.iRE OB1 SOUTHERN STATES DURING THE YEARS 1983-84 TO

1985-86

1985-86
(Rs.)
F.W.
Health

State/UT

1983-84
(Rs.)
Health
F.W.

Andhra Pradesh

31.32

5.691

33.28

6.56

39.08

7.86

Karnataka

24.98

4.80

31.58

5.62

34.24

8.86

Kerala

49.65

4.41

47.15

7.14

45.36

9.12

Tamil Nadu

50.76

4.63

40.84

5.39

47.57

5.23

Pondicherry

104.99

5.35

127.03

5.11

153.47

6.21

All India

37.20

5.41

41.24

5.88

46.23

7.19

'1984-85
(Rs.)
F.W.
Health

: 6 :

TEN MAJOR DISEASES IDENTIFIED BY Tl-ffi SURVEY TEaM

OF COMMUNITY HEALTH DEPi\RTF!ENT OF ST. JOHN1 S

MEDICAL COLLEGE, B/lNGALORE

St.John’s Medical
^ollege Hospital
(Source:Ho spital
Records)

Vol.Organization
(Source : Ques
tionnaire survey)

Government
(Source : OiSt.
Health Office)

1. Chronic Obstructive
pulmonary disease

Pyrexia of unknown
origin

Gastroenteritis

2. Hypertension

Gastroenteriti s

P U 0

3. Diabetes

Upper Respiratory
Infection

Rheumatic
Arthritis

4. Ishchaemic Heart
Diseases

Anaemia

Achte Respira
tory Infection

5• Gastroenteritis

Leucorrhoea

Injuries

6fc Urinary Tract
Infection

Peptic Ulcer

Allergies

Tuberculosis

Injuries

Pyoderma

8. Bronchial Asthma

Pyoderma

Anaemia

9. Typhoid

Bronchial Asthma

Leucorrhoea

10. Septicemia

Scabies

Dysentries

7. Pulmonary

Mf-3-.
Information on

Master of Health Administration
and
Master of Hospital Administration
Degree Programmes 2001-2003
t

J

Text composed on DTP Systems, Publications Unit, Tata Institute of Social
Sciences, Deonar, Mumbai-400 088 and printed at Julee Commercial
Printer, Anusuya Niwas, Borla, Govandi, Mumbai 400 088.

TATA INSTITUTE OF SOCIAL SCIENCES
(A Deemed University)

£

POSITIONS AND INCUMBENTS
Director

Prof. R.R. Singh

Head, Department of Health Services Studies
Prof. C.A.K. Yesudian
Administration
Dr. S.K. Bandyopadhyay
Mr. H.G. Bhise
Ms. Janaki Ramdas
Mr. Dilip K. Shetty
Mr. V.L. Ghotage

Registrar
Asst. Registrar (Academic)
Asst. Registrar
Asst. Registrar (Personnel)
Asst. Registrar (Accounts)

Academic Section
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Mr. V.G. Gimonkar
Mr. V.K. Shinde
Ms. S.D. Bhalerao

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Senior Assistant
Assistant
Upper Division Clerk

Library
Dr. M.M. Koganuramath
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Librarian
Assistant Librarian

Hostel/Dining Hall
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Warden, Men’s Hostels
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Chairperson, Dining Hall
Section Officer (Hostels)
Section Officer (Dining Hall)

Students
Prof. S. Bharat

Students’ Union and
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Ms. Hemangi Naik

Student Counsellor

Hon. Medical Officer

Dr. (Mrs.) R.V. Ambekar

About the Institute
The Tata Institute of Social Sciences (TISS) was founded
by the Trustees of the Sir Dorabji Tata Trust in 1936. Then
called the Sir Dorabji Tata Graduate School of Social
Work, it was given its present name in 1944. The TISS
is a pioneering institute of Social Work and a centre of
excellence in social science research in South Asia. It is
a registered society under the Indian Societies
Registration Act (XXI of 1860). In 1964, the Institute

became a Deemed University under Section 3 of the
University Grants Commission Act, 1956.
About the Department of Health Services Studies
The Department of Health Services S Indies was
established in 1989 with the objective of undertaking
training, research, field action and consultancy< in the field
of health services. The Department organise^ a one year
evening programme, a Diploma in Hospital Administration
and 5 to 10 short-term training programmes in health care
management and hospital management. It also
undertakes research projects sponsored by pational and
international organisations. The department i$ recognised
as centre of excellence in health training by Ministry of
^^ealth and Family Welfare, Government of India.
About the MHA Programmes

The Master of Health Administration and Master of
Hospital Administration, referred here to as MHA, fulfill
specific needs of developing a cadre of professional
managers in the health sector. The syllabus and course
content take into consideration the existing background of
available personnel and the future needs of the health
sector. These comprehensive post-graduate Drogrammes
will provide a professional qualification for thojse who wish
to take up health/hospital administration as a career. They
will also be of immediate benefit to tho^e currently
engaged in health/hospital administration at senior and
middle levels.

Format of the Programmes

i

The MHA is a two year post-graduate degree consisting
of four semesters. Each semester is further divided into
four modules. The duration of each module is one
^fconth, covering a few courses or an internship. The
Student will accumulate credits in each rriodule. This
means that the student has to write exam nations, do
assignments, make presentations and undergo
internship training in each module, all of which will be
evaluated for credits. The programmes are also organised
in a step-ladder fashion in which the student will be
awarded a Certificate for completing all the requirements
for the first semester, a Diploma for completing all the
requirements for the second semester, and finally, the
Degree for completing all four semesters.
The step-ladder programme has been devsed to help
working administrators acquire credits at a pace
convenient to their work and domestic commitments. This

1

means that, if a student can spend only a few months in
an academic year for this programme, he/she can
accumulate credits for the period of his/her work and can
complete the programme at a slower pace not necessarily
in two years.

Eligibility
1. The applicant must have a First Bachelor’s Degree or its
equivalent (under 10+2+3 or 10+2+4 or 10+2+2+1 year
bridge course pattern of study or any other pattern
fulfilling the mandatory requirement of 15 years of formal
education to become eligible for admission to any Master
Degree programme) from a recognised university in any
faculty with a minimum average of 50% of marks (40^^
for SC/ST).
W
2. Age under 45 years. The age limit may be relaxed only in
special circumstances.
3. Preference will be given to persons holding administrative
positions in the health sector.
4. Medical graduates should have completed internship
before the date of commencement of the academic
session. Otherwise, their candidature will be
automatically cancelled

LOCATION AND ACCESS

The Mumbai campus of the Institute is located in the
North-East Section of Greater Mumbai on V.N. Purav
Marg, earlier known as Sion-Trombay Road. It is
situated opposite Deonar Bus Depot. The nearest local
railway station is Govandi. State transport buses from
Kolhapur, Solapur, Goa, Pune and other cities, pass by
the Institute and the nearest ST bus stop is at Maitri
Park.

BEST Bus Routes

The BEST buses stop near TISS is known as Deonar Bus
Depot stop.
J^Dations

Bus Routes

From Dadar Station

90, 93, 503, 504, 506, 521
(all Ltd.) and 59
8 Ltd. (upto Diamond Garden,
Chembur)
352, 358, 505 (all Ltd.) and 371
362 and 501 Ltd.

From Chhatrapati
Shivaji Terminus
From Bandra Station
From Kurla Station
COMMUNICATION

Postal Address
Post Box 8313, Deonar, Mumbai - 400 088

Eligibility once determined on the basis of the
information given by the candidate in the coding sheet
shall be final for the purpose of test/interview/
selection.

Telephone/Fax Services
Telephone Nos.:
91-22-556 3289-96, Extn. 261
Fax:
91-22-556 2912
The telephone board functions from 9.00 a.m. to 8.00 p.m.
from Monday to Friday.

Method for Calculation of Average Percentage of
Marks

e-mail
acadsec@tiss.edu

Marks of only the first Bachelor’s degree pursued idU
the applicant will be taken for determining her/his
eligibility. Marks of all the subjects taken at the
Bachelor’s Degree examination, including major/main,
minor/subsidiary, languages and college marks
(internal assessment) are to be taken into account
while calculating the overall average percentage of
marks to be shown by all the candidates applying for
the M.H.A. programmes of the Institute (page 2 of the
application form for admission and the coding sheet).
Examples for the same are given below. The
candidates, whose marks are in the grade points must
attach a photocopy of the conversion table along
with their application to check the percentage of

2

v flfebsite
Wp://www. tiss.edu
Telegram
FERNSTALK, Chembur, Mumbai 400 071.

15

(iv) Fees once paid will not be refunded under any
circumstances.

marks. In the absence of such a conversion table, the
application will be treated as i neo mpleteand rejected.

(v) Hostel Accommodation: Selected candidates requiring
hostel facilities should check allotment status from the
Wardens. The Institute reserves the right to decide
admission to its hostels and can refuse admission
without assigning any reason.

Examples for calculation of average percentage of marks.
1. In case of candidates who have passed a Bachelor’s
degree under 10+2+3 pattern of study.
I Year

(vi) Medical examination: The candidate should undergo a
medical examination on June 22 or June 25 after
paying the fee of Rs. 50/- for the purpose. All foreign
candidates and the Indian nationals returning from
abroad, should give an undertaking to undergo an
HIV/AIDS test, as per the Government of India
regulations.
fl

Course No.
Max. Marks
Passing Marks
Marks Obtained
II Year

^Course No.
^Mx. Marks
passing Marks

(vii) Migration Certificate: Certificate issued by College/
University authorities should be handed over to the
office of the Assistant Registrar (Academic), within a
month after admission.

Marks Obtained

III Year

Course No.
Max. Marks
Passing Marks
Marks Obtained

Subsidiary Courses
including languages

Main Courses

I
100
35
60

I
100
35
50

II
100
35
45

III
100
35
50

65

IV
100
35
54

Subsidiary Courses
including languages

Main Courses
III
100
35
70

ii
100
35

Grand
Total

IV

V
100
35
40

100
35
60

V!
100
35
50

V

VI

IX

100

100

100

35
75

35
65

35
45

X
100
35
55

VII

VIII

100
35
55

100
35
55

600

600

Average Percentage of Marks =
a
a
600

XI
100
35
60

324

Grand
Total

600
330

Grand
Total

Subsidiary Courses
including languages

Main Courses

600

XII
1100
35
60

600
360

1014
1800 =:56-33

APPLICATION FOR ADMISSION

The prescribed application form may be obtained from the
Assistant Registrar (Academic), Tata Instituts of Social
Sciences, Deonar, Mumbai-400 088, specifying the title of
the programme for which admission is (sought by
enclosing: (i) a Bank Draft of Rs. 250/- (nonjrefundable)
drawn in favour of TATA INSTITUTE OF SOCIAL
SCIENCES, preferably payable at the State Bank of India,
^heonar, Mumbai and (ii) a self-addressed envelope (20
^mis x 25 ems) affixed with postal stamps worth Rs. 32/for one form with brochure and Rs. 44/- for two forms with
two brochures.
i

SUBMISSION OF APPLICATION

The application form must be complete in all respects with
all annexures.
The Registration fee of Rs. 250/- (non-refundable) payable
in cash at the Institute cash counter or by Bank Draft
should accompany the application.
The last date for receiving the application forms at the
Institute is March 30, 2001 upto 2.00 p.m.
14

3

The last date for receiving application sent by POST from
remote areas/regions (Assam, Meghalaya, Arunachal
Pradesh, Mizoram, Manipur, Nagaland, Tripura, Sikkim,
Jammu & Kashmir, Lahaul and Spiti district and Pangi
sub-division of Chamba district of Himachal Pradesh,
Andaman and Nicobar Islands or Lakshadweep) or
abroad, the last date is 06-04-2001.
Candidates who are claiming the benefit of extended time
should clearly indicate in their forwarding letter along with
the application form, the name of particular area or region
(e.g. Assam, Meghalaya, J&K, etc.) from where they have
posted their application. In case they fail to do so, the
benefit of extended time will not be allowed to them.

In case of applications received BY HAND OR THROLK^^
COURIER OR COURIER SERVICES OF ANY TYPE,
benefit of extended time will NOT be available, regardless
of the place of residence of the applicant.

Candidates should clearly note that the Institute will in no
case be responsible for non-receipt of their application or
any delay in receipt thereof on any account whatsoever.
They should therefore ensure that their applications reach
the Institute on or before the prescribed last date.
Candidates can also deliver their applications personally
to the Academic Section, TISS, against proper receipt.
The Institute will not be responsible for the applications
delivered to any other functionary of the Institute.
Candidates should write their name and address on the
reverse of the Bank Draft at the top, at the time of
submitting the completed form.
The candidates should write in bold capital letters
the envelope “Application for Admission to the

Application will be treated as incomplete if the photocopies
of relevant mark/grade cards and other testimonials are
not submitted with the application form. Incomplete
application forms will be rejected. Candidates will be
called for the tests only on the basis of information
provided by them in the coding sheet attached with the
application form. Therefore, in case it is found that the
information furnished by a candidate is incorrect or
misleading or ineligibility being detected before or after
the tests / interview / selection / admission, his / her
candidature will be cancelled without giving reasons
thereof.
4

Objection Certificate from the employer, if employed, and
(x) a conversion table of grade points into percentage
equivalents, in the case of grade card holders. Admission
will be subject to the fulfilment of the eligibility
requirements as confirmed through verification of
original certificates and mark-sheets.
Original documents for verification will not be accepted by
Post or courier service. They have to be presented by the
candidate or his/her nominee in person.

Important: If any of the above documents in original are
not produced for verification, or the copies of the
document attached to the application form do not tally with
the original documents, provisional selection will be
immediately cancelled.
Announcement of Selection

The list of candidates selected will be displayed on the
Institute’s notice board on Wednesday, June 20, 2001.
The selected candidates will be informed by post or
telegram. All the selected candidates will be
expected to make their own arrangement to check
the result of their admission to the Institute, since
there is no guarantee about the delivery of telegram/
letter.
The M.H.A. programmes
Wednesday, June 27, 2001.

will

commence

on

After Selection Formalities
(i) Acceptance letter should be obtained, signed and
returned to the Academic Section on or before Friday,

June 25, 2001, if admission is accepted.
(ii) The full fees and deposits of the first semester should
be paid to the Cashier of the Institute on or before June
25, 2001, if required by T.M.O. or a Bank Draft drawn
in favour of Tata Institute of Social Sciences.
Otherwise, the admission will be treated automatically
cancelled. No further extension would be given and
selected candidates in the waiting list will be offered the
seat. Cash timings: 10.30 a.m. to 1.00 p.m. and 1.30
p.m. to 2.00 p.m. from Mondays to Fridays and from
10.30 a.m. to 1.00 p.m. on Saturdays.

(iii) Those, who have accepted admission by paying the full

fees and deposits, are expected to join the programme
on June 27, 2001, Admission of those who fail to join
by July 4, 2001 will remain automatically cancelled.
13

education in a different subject, e.g. B.Sc. after B.A.
or B.Com. after B.A. or M.A. in one subject after M. A.
in other subject will not be eligible for the G.O.I. Post
Matric Scholarship.
(d) SC/ST candidates who, after having completed their
educational career in one professional line, continue
professional studies in a different line, e.g., LL.B,
after B.A./B.Ed. will not be eligible for the G.O.I. Post
Matric Scholarship.

SELECTION PROCEDURE AND ADMISSION

Assessment for Selection
Those satisfying the eligibility requirement will be
assessed for selection through the following:

Academic Background

The academic background is assessed by the overall
percentage of marks secured in the first bachelor’s
degree.

V. After selection
(a) Reimbursement of Travelling Allowance (TA): Travel
expenses from their place of residence to Mumbai
for joining the programme will be met by the Institute
on production of tickets or giving ticket nos.
fl
(b) SC/ST candidates in employment whose pay is
protected during the period of study and SC/ST
candidates who have already availed of the
Government of India Scholarship, during a
professional course of a University, will not be
eligible for G.O.I. Post Matric Scholarship.
(c) Those SC/ST candidates who are eligible for the
Post Matric Scholarship will be exempted from
payment of tuition fees and other fees including all
deposits. They are also exempted from payment of
Dining Hall and Hostel charges during their study at
the Institute. However, selected candidates (other
than Maharashtra) are required to bring two Post
Matric Scholarship forms (fresh) while coming to the
Institute for joining the programme. They should also
obtain the parents’/guardian’s signature on the form,
wherever required.

Essay Test
The topics for the essay test are based on
contemporary issues. Candidates are judgbd in terms
"f their ability to understand the problem, to think
clearly, to express in simple language and to present
ideas systematically. This test will be conducted in
English, which is the medium of instruction at the
Institute.

Group Discussion
Every candidate participates in. a group discussion
comprising about 10 candidates. An assessment of the
candidate is made on the basis of expression of ideas,
relationship to the group and contribution to the
discussion.

Interview
To be eligible for the interview, a candidate should secure
at least 40% of the marks in the Essay Tesi and Group
Discussion put together. The candidate is alko expected
to know something about the field of specialisation for
which he/she has applied.

Verification of Original Documents:

The following documents must be produced for verification
in original by the selected candidates at the time of
admission.

Reservation of Seats for Scheduled Caste/Tribe
Candidates
c

15% and 7.5% of seats are reserved for SC/ST candidates
respectively, under each programme.

(i) Secondary School Certificate Marks-sheet (X/XI); (ii)
Higher Secondary Certificate Marks-sheet (XII); (iii) First
Year/I & II Semester Bachelor’s Degree Marks-sheet; (iv)
- Second Year/lll & IV Semester Bachelor’s Degree
Marks-sheet; (v) Third Year/V & VI Semester Bachelor’s
Degree Marks-sheet; (vi) Fourth Year/VII & VIII Semester
Bachelor’s Degree Marks-sheet; (vii) Caste/Tribe
Certificate (only for SC/ST); (viii) Income Certificate of the
preceding financial year (only for SC/ST), (ix) No

They have to obtain the student visa which should
indicate (i) the name of the Institute, and (ii) the period of
study at the Institute. Only, such candidates will be
permitted to appear for entrance tests at this Institute,
subject to their fulfilling the eligibility requirements as

12

5

Foreign Nationals

Foreign nationals have a maximum of 5% of the seats.

applicable to the general candidates. They will be admitted
only if found suitable. If they have stayed in the hostel,
they will vacate it by the evening on the day of
announcement of their selection results.

annum during the financial year 1999-2000. They should
attach a photocopy of the income certificate of their
parent/guardian issued by the employer or by a Village
Revenue Officer.

Self-supporting foreign nationals should also give data,
under item 18 on page 6 on the Application Form. Their
admission is subject to the regulations of the Government
of India. The candidates other than SAARC countries
should deposit US $2,850/- with the Institute immediately
on admission, to cover the first year’s fees plus board and
lodging charges and related expenses. Candidates from
SAARC countries will be required to pay all fees as per
the Indian students. The Institute does not offer financial
assistance to foreign nationals. They should give an
undertaking to undergo an HIV/AIDS tests as per tb^fe
Government of India regulations.

II. Reimbursement of Travelling Allowance (TA) etc.: Those
SC/ST candidates who will be called for the tests to be
held in June 2001 at the institute, must produce two
photocopies of the income certificate for the financial year
2000-2001, before appearing for the tests. If the
candidates appearing for the tests for the first time are
unemployed, and their parent’s/guardian’s income is
Rs. 60,965/- or below, per annum for the financial year
2000-2001 they will be provided free hostel
accommodation, meals, and to and fro travel expenses
(second class railway or State Transport Bus fare). The
reimbursement of the travel expenses will be subject
to their submission of the tickets or ticket numbers. It
will be the responsibility of the SC/ST candidates
to fill in the TA form before they sit for the test and
collect the money as soon as the test will be over.
Non-receipt of TA will not be accepted as reason
for overstay in the hostel.

Deputed Candidates

The officers deputed by the Central/State Governments/
autonomous organisation, for studying the MHA Degree
Programme will have to undergo the written test and group
discussion and, if found eligible, the interview, along with
other candidates. A government officer, having quarter in the
Mumbai Metropolitan Region, will not be eligible for hostel
accommodation, unless the person has surrendered such
accommodation and produces a certificate to that effect.

III. SC/ST candidates who are eligible for such facilities
should report at the Institute only after receiving the call
letter for test. Any applicant not receiving call letter by May
15, 2001 should presume that he/she has not been called
for tests. Those staying in the hostel will be required to
vacate rooms immediately after the interview or the
names of the candidates selected for interview will be
announced, as the case may be.

HOSTELS
Separate hostels are available for men and women.
Candidates requiring hostel accommodation should
include, along with the application form for admission,
a hostel application form, duly completed and signed
by the parent/guardian. While allotting accommodation
in the hostels, preference will be given to students froi
outside Mumbai, who have no relatives in the cit’W
Please note that candidates cannot claim hostel
accommodation, merely because they have
submitted the hostel form.

(a) SC/ST candidates who have already availed of free

DISTRIBUTION OF CREDIT HOURS

The total credit hours for this programme will be 88,
divided equally between the First Year and Second Year,
as detailed below.
First Year
Credit Hours
Courses
32
Internship
12

Total
6

44

c-

facilities but were not selected and who wish to try
again, should deposit on arrival, at the rate of Rs. 50/per day, as lodging charges if they desire to stay in
the hostel. Their boarding and lodging expenses at
the Institute and travelling expenses will be
reimbursed only if they are selected.
(b) SC/ST candidates who have received financial
assistance to enroll for any Master’s degree
programme of the Institute in one field will not be
eligible for similar free facilities if they apply for
Master’s degree programme in another field.
(c) SC/ST candidates who after passing one stage of
education are studying in the same stage of

11

Selection for Interview

Credit Hours

Second Year (Health)

The names of the candidates eligible for interview on the
basis of performance in the tests and group discussion
will be announced on the same day at about 8.00 p.m.
The interview will be held on the next working day.
Candidates not eligible for interview should immediately
vacate the hostel, if availed of it, to make room for other
candidates.
As the candidates are selected strictly on merit, no request
will be entertained for information regarding the marks
obtained by them in the entrance tests.

Courses
Internship
Research Project

Total

26
12
6
44

Second Yea< (Hospital)
Courses
Internship
Research Project OR Additional Internship
Total

26

12
6
44

Facilities During Selection

CURRICULA (Courses listed below are subject to change
without notice)

Hostel

Pasic Courses: Each course is for a duration of 2 hours

In comparison to the number of outstation applications
received, the hostel facilities are very much inadequate.
Therefore, hostel accommodation may be provided only
to those candidates who do not have relatives or friends
in the Mumbai Metropolitan area. Those needing
accommodation should write to the Section Officer
(Hostels) or the Warden, Men’s/Women’s Hostel. Since
only a few rooms are available, allotment will be on first
come first serve basis. During the period of selection, the
charges for lodging will be Rs. 50/- a day which should
be paid to the hostel staff immediately on arrival.
Candidates who are not selected for interview must vacate
the rooms immediately after the selection list is put up on
the notice board. Persons accompanying the
candidates will not be provided accommodation.

Dining Hall

The Dining Hall is managed by the Dining Hall Committee,
consisting of student representatives, with a Facu|^h
member serving as Chairperson. Vegetarian ai^r

non-vegetarian food is available.
Tea/Lunch Coupons
Coupons can be bought from the cash counter and the
Section Offlc'er (Hostels), if applicants wish to have

Tea/lunch in‘the Dining Hall of the* Institute

Special Facilities for Scheduled Caste/Tribe Candidates

I. Registration Fees: SC/ST candidates need not pay the
registration fee if they are unemployed and their
parent’s/guardian’s income is Rs. 60,965/- or below per

10

and carries 2 credit hours. BC1 to BC15 are compulsory
for all the students.
FIRST SEMESTER
Basic Courses:
Social Sciences in Health
BC-1
Health and Development
BC-2
Health Policy and Administration
BC-3
Principles of Health Services Management
BC-4
Research Methodology
BC-5
Qualitative Research Methods
BC-6
Organisational Behaviour
BC-7
Human Resource Management
BC-8
Labour Legislation
BC-9
BC-10 Operations Research
Health Systems Research
BC-11
BC-13 Financial Accounting
BC-14 Basic Epidemiology and Bio-statistics
BC-16 Comparative Health Systems

pecialisation Courses (Health)
Community Organisation in Community Health
HE-1
Management of National Health Programmes
HE-2
Specialisation Courses (Hospital)
Organisation and Administration of Supportive
HO-1
Services
Organisation and Administration of Clinical
HO-2
Services
SECOND YEAR

Basic Courses:
BC-12 Economics of Health Services
BC-15 Strategic Management in Healthcare Settings
7

Specialisation Courses (Health)
HE-3
Financing of Health Services
HE-4
Advanced Epidemiology
HE-5
Health Planning
HE-6
Management Information Systems .
HE-7
Materials Management
HE-8
Public Health Legislation
HE-9
Health Education
HE-10 Health Status of Women
HE-11
Urban Health
HE-12 Health Policy Formulation and Implementation
HE-13 Non-governmental and International Agencies in
Health Sector

Specialisation Courses (Hospital)
HO-3
Organisation and Administration of Super
speciality Services and Facility Services
HO-4
Management Accounting
HO-5
Materials Management
HO-6
Marketing Management
HO-7
Financial Management
HO-8
Legal Framework for Hospitals
HO-9
Hospital Planning
HO-10 Information Resource Management
HO-11 Systems Development in Hospitals
HO-12 Quality Management
HO-13 Seminar on Management Issues in Hospitals

II

III

First-Year

26,430

25,430

25,030

12,810

Second-Year

25,330

24,330

23,930

11,930

I - Single Seater Room;

II - Double Seater Room;

III - Multi Seater Room.

Fees and Deposits payable for First Semester:

In addition, the hostelites will be required to pay the hostel
charges, as per the hostel allotment.

Tuition Fees

9,000

Other Fees

820

Participation in Crisis Events: In keeping with the
tradition of the Institute, the students may be called upon
to participate in relief work and extension activities of the
Institute, in or outside Mumbai, from time to time.
Examples of some of the natural, social and human crisis
situations that the students have participated in, are
floods, earthquakes (Marathwada earthquake of 1993),
environmental disaster, riots (Mumbai riots of 1993) and
extension activities such as literacy campaigns. All
students will be expected to participate in these activities
which emerge from the character of the Institute as a
university conducting professional courses, with teaching,
research and extension functions and social
g^ponsibilities towards the community. The Institute will
"cide the extent of incorporation into the curriculum and

Hostel
Single Seater

2,40'

Double Seater

1,400

the nature of credit to be awarded.

Multi Seater

1,000

OTHER IMPORTANT INFORMATION

Electricity Charges

1,000

Dining Hall (for vegetarian food)
(for non-veg. food extra charges)

7,200

D.

Internship Expenses

2,000

E.

Project Expenses (Second Year)

2,000

F.

Block Internship Expenses

G.

Refundable Deposits

500

4,000

8

Non-Resi.

Rs. 6,940 (day scholars)
Rs. 11,640 (hostel students)

Rs.

B.

First Year

The following fees and deposits are to be paid to the Cashier,
^Bd the official receipt to be obtained by the candidate:

ESTIMATED EXPENDITURE FOR ONE ACADEMIC
YEAR

A.

Total Estimated Expenditure
(Excluding Research Expenses)

The tests will be held from June 13 to 19, 2001 except
on Saturday and Sunday. The actual date of the tests of
a candidate will be informed through the call letter which
will be sent under REGISTERED POST. Any applicant not
receiving such a letter should presume that he/she has
not been called for the test.

Request for change in the dates for tests/interview will not
be entertained.

9

30.
i.

I

Management of Health
Information and Records

Introduction :

b.

In what form is this information required and by whom, at what levels?

c.

When is the information required?

d. How quickly should this information be available? What will be cost or
consequences, if this information
was not available speedily and in the right
from?

manpower required to process information to maintain the records

approaches to gathering the required information.
Information and Records :

a.

b.

I

I
I

Activity
Correspondence
Staff problems
Patient problems
Administrative problems

Paper work
Staff files
Patient referral letters
Letters to and from supervisors

Patient arrival
Examination & diagnosis
Treatment
Inpatient admission
Discharge
Special Diseases
Maternal care
Child care

Registration
Clinical record
Lab. Registration
Ward Register
Discharge letter/form
TB/Leprosy Register

Ante-natal card
Child health card

I

168

I

I

c.

Administration of Funds and Equipment
Ordering
Requisition forms
Storing
Stock ledgers
Issuing
Issue Vouchers
Inventories
Funds
Cash books
Receipts
Petty Cash Vouchers
Staff Meetings
Minutes of meetings
Environmental Survey
Report Forms
General Activity
Monthly Report form
Health Education
Posters/Leallets
Family Information
Family file

ir
u

ai

af
of
et
nc

efl
W
sk
sk

Medical Records, planning, organizing and its management are based on
the needs of a hospital.

Main considerations are :

a. Medical Records should always be available when required and in the
form they are required. Good system of numbering and tracing to enable speedy
retrieval are required.
J

pa

pei

b. Adequate liaison should exist between the different groups of staff
using medical records to enable due consideration to be given to such matters
as the design and content, methods of storage, availability, use and movement
of records.

lep
lim
dis
infc
epi.

c. Medical records proceedings should cause patients minimum of
waiting, inconvenience and embarrassment.

d. Medical records work will generally be organized on the basis of the
hospital rather than the groups.

on

e. A group policy for the organization of medical records work should
exist. There should be a medical records committee consisting of centre and
state level officers responsible for managing health institutions. This committee
should develop information and records system common for public and private
hospitals, as well as nursing hours as per the provisions of the International
Classification of Diseases. 1979.

con
par
of 1
wor

f. The Medical Records Department should generally be adjacent to or
linked with the Outpatient Department, where one exists, since normally a
considerable part of its work is associated without patient arrangements.

m. Present Status of Health Information System :
a. Keeping in view the provisions of International Classification of
Diseases, which became effective on 1st Januaiy 1979. there is gross inadequacy
of health information needed for planning and management of health services.

I

need
level

169

r

■.....

Pi b’ ^etd.f°r T Change fr°m the outmoded practice of maintaining the data
in files which involves a cumbersome process for its retrieval to the increasing
use of mechanized data storage and processing equipments.
Qi’ t HosPital stadstics tabulated in statement A to F. Very few hospitals
and States cofiect and report the data-major reason is lack of an agency for
nr rhr°PHnre malate"ance of medical records and processing and dissemination
Ptr
.°ne / Para medical personnel like nurses, pharmacists,
not mafntained11103110" °f CaUSe ofdeath and uniform classification ofdiseases.

on

pitp <■' A central ™mPilatlon scheme for hospital inpatient data has been
effect ive ly developed and provided encouraging results in the States of Punjab.
West Bengal, etc. The scheme can be implemented by employing one or two
sta istical assistan ts or medical record technicians or creation of institutional
statistics units at State headquarters.
e.

Data on health manpower is inadequate.

he
dy

f. I-ack if information on facilities
f
of undergraduate medical training,
post-graduate medical education and different categories of para-medicalpersonnel training .

aff
:rs
nt

g. National diseases control programmes for malaria, filaria, tuberculosis
eprosy. cholera, sexually transmitted diseases, trachome and EPI diseases
limited surveys have been conducted to determine the extent of some of those
irJpldemloloKicaJ services are hardly developed to provide any significant
information on the trends of the different communicable diseases and the
epidemiological factors responsible for their spread and control.

of

h. COI has stated "monthly Surveillance Report" based on data collected
on cases and deaths of about 20 communicable diseases.

Id
id
ie

te
al
)r
a

i. Primary Health Care : 5400 PHCs. 40.000 Sub-centres, village level
community health workers being selected and provided training for community
participation. Monitoring and Evaluation of these activities involves collection
of health information generated from rural communities through basic health
worKers.
i.

Occurrence of communicable diseasesInstitutional and non-institutional.
ii. Immunization and other preventive activities.
iii. Maternal and child care and other family welfare services.
iv. Vital events.
v. Availability ofhealth and medical services in terms of personnel, patient
attendance, laboratory services, etc.
vi. Health education activities.
vii. Many other such information.

)f
y
5.

Suitable reporting forms using standardized vocabularies and definitions
levef at periodic^ tnJnSrnitting information from one level to the next higher

170

1

I

J. In order to meet the requirements of planners and administrators, data
from oHicial health statistics need to be supplemented by information that are
not routinely coUected. Such data could be obtained through special
investigations-surveys and studies.

k. Currently, input data recorded informs or registers and stored in files
without sufficient classification of indexing which possess problems in retrieval.
Scientific filing system for data storage with proper classification and indexing
required.

Suggestions for Improvement ofInformation and Recordsfor
Effective Health Services Management.

IV.

a. Medical Record Departments in all hospitals for carrying our
maintenance of records coding, compilation and dissemination of the hospital
statistics, is essential. Hospitals without medical record departments be provided
with one or two statistical assistant.

b. Pending the establishment of medical record departments in hospitals,
as an interim measure, a central compilation scheme for morbidity and
mortality among hospital inpatients be introduced on the pattern already in
vogue in the States of Punjab and West Bengal.
c. Need for special surveys : To fill up gaps in information that routinely
collected official statistics fail to provide, following subjects should be surveyed
on priority basis :
J

1.

General health status and nutritional status of the community .

ii.

Extent and causes of mortality particularly among infants and mothers.

ili. Utilization of health services by the community.

iv. Total medical care facilities under different systems of medicine.
V.

Health manpower studies including para-health personnel, state-wise
and employment status :

vi. Attrition rate, unemployment rate, rural-urban distribution, etc., of
health manpower.
vii. Assessment of the extent and magnitude of the problem of brain drain
for health professionals.
viii. Sample surveys on participation rates among highly trained
professionals.

ix. Assessment of provision of protected water supply and/sewage disposal
in different geographic areas * and

x.

Expenditure on health and cost-effectiveness studies ofdifferent medical
and health care services.
171

r

d. There is a need for establishment of a national Centre of Health
Statistics with a multi-disciplinary team of health and information specialists
for collecting and providing all types of health information needed by health
administrators.
These are some of the areas for development of information system in India
for effective health planning and delivery of services.

References
1. Department of health and Social security: Guide to Good Practices in
Hospital Administration, National Health Services, London, 1972.

2. Directorate General Health Services: Report of the National Seminar
Health
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on

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J

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