RF_MP_7_SUDHA.pdf
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                        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.
 
 p^oX*
 
 4
 
 <
 
 NIHA£(Toch
 
 np ?-x
 
 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
 
 np
 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
 
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 requiring only short training in screening
 techniques
 
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 centres on which
 activities will by
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 to base his teams, after touring the region.
 
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 vehicles have been promised by the Ministry
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 until the negotiations are complete.
 
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 they are of a suitable type will be equipped
 as mobile dispensaries.
 
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 7
 
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 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.
 
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 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
 Ms. Geetha V.
 Mr. V.G. Gimonkar
 Mr. V.K. Shinde
 Ms. S.D. Bhalerao
 
 Section Officer
 Senior Assistant
 Assistant
 Upper Division Clerk
 
 Library
 Dr. M.M. Koganuramath
 Ms. S. Subramanian
 
 Librarian
 Assistant Librarian
 
 Hostel/Dining Hall
 Dr. H. Beck
 Dr. V. Gowri
 Dr. G.G.Wankhede
 Ms. S. Deodhar
 Mr. M. Momin
 
 Warden, Men’s Hostels
 Warden, Women’s Hostels
 Chairperson, Dining Hall
 Section Officer (Hostels)
 Section Officer (Dining Hall)
 
 Students
 Prof. S. Bharat
 
 Students’ Union and
 Sports Advisor
 
 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
 Information System, Government of India, New Delhi, 1979.
 on
 
 172
 
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