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Eastern Mirror Desk
Dimapur, Oct. 3 (EMN): Nagaland has an average of 26.39% bed occupancy in district hospitals as opposed to the Indian Public Health Standards (IPHS) recommended bed occupancy rate of at least 80%, a report by Niti Aayog has revealed.
At the time of assessment during the period 2018–19, a total of 731 district hospital across 37 states/union territories (UTs) were part of the on-ground data collection and validation exercise.
Of these, 24 hospitals could not be assessed due to security issues and difficult terrain. In effect, 707 (97%) district hospitals were assessed for data validation by the National Accreditation Board for Hospitals and Healthcare Providers (NABH), a constituent board of Quality Council of India (QCI).
The report -- best practices in the performance of district hospitals -- was developed by Niti Aayog, the Ministry of Health and Family Welfare (MoH and FW), and World Health Organisation (WHO) for a comprehensive assessment of district hospitals with a set of key performance indicator (KPIs) finalised in consultation with States and UTs and other key stakeholders.
Out of 707 district hospitals assessed, a total of 182 hospitals had bed occupancy rate of 90% or higher. Uttar Pradesh (14.8%) had the highest proportion of hospitals with bed occupancy rate greater than or equal to 90%, followed by Madhya Pradesh (10.9%), Maharashtra (8.2%), Odisha (8.2%), West Bengal (7.1%), and Andhra Pradesh (5.5%).
Only three district hospitals in Nagaland were part of the assessment – Ongpangkong District Hospital, Mokokchung (Dr. Imkongliba Memorial District Hospital); Dimapur District Hospital, Dimapur, and Wokha District Hospital, Wokha.
For meaningful analysis and comparison, district hospitals were categorised according to their bed strength, thereby enabling comparison of similar-sized hospitals. Therefore, for the purpose of the assessment, district hospitals having up to 200 beds were referred to as small hospitals; those with more than 300 beds were called large hospitals; and those with 201 to 300 beds were referred to as mid-sized hospitals
Puducherry had the highest average beds in the country, with a district hospital in the UT having an average of 222 beds per 1 lakh population, while Bihar had the lowest average of 6 beds per 1 lakh population.
Meanwhile, Nagaland failed to meet the IPHS norms for doctor to bed ratio with only one district hospital meeting the norms for positioned doctors and zero hospital for positioned staff nurses.
Overall, 189 of 707 district hospitals were found to meet the doctor to bed ratio as per IPHS norms.
Only 88 hospitals, however, were found to have the ratio of staff nurses as per the IPHS norms based on corresponding bed category. A total of 399 hospitals were found to have ratio of paramedical staff in position as per the IPHS norms.
Uttar Pradesh had the highest proportion (12.7%) of doctors in position at district hospitals meeting IPHS norms, followed by Karnataka (9.5%), Delhi (8.5%), Haryana (8.5%), and Jammu and Kashmir (5.8%).
The report recommended states and union territories to conduct a periodic review of the vacancies in all district hospitals in order to ensure timely recruitment of doctors, nurses, and paramedical staff, thereby contributing to better health outcomes. It said that states may utilise flexibilities under NHM to engage HR and assume availability of full contingent of HR as per IPHS norms. Meanwhile, it said that nurses and paramedical staff should be well trained, and have periodic refresher training sessions.
Bi-annual trainings for nurses and paramedical staff may be conducted at the nearest medical college, it added.
The report also revealed that on an average, every district hospital in India has 11 support services. However, only 21 hospitals belonging to states/UTs fulfilled the criteria of having all diagnostic testing services available.
Karnataka had the highest proportion (28.6%) of hospitals with all support services, followed by Telangana (19%), Andhra Pradesh (14%), and Gujarat (9.5%).
Some of the top performing district hospitals in the country that had all the identified support services were Tandur, Vikarabad, Telangana; (Small hospital) Aizawl Civil Hospital, Aizawl West, Mizoram (Mid-sized hospital) and Shimoga District Hospital, Shimoga, Karnataka (Large hospital).
It informed that the Aizawl Civil Hospital in Mizoram made use of the Rogi Kalyan Samities (RKS) fund for procuring of required consumables and equipment (e.g., fully automatic analyser) to provide efficient support services. The hospital took lead in engaging a qualified firm for the annual or comprehensive maintenance contract (AMC/CMC) of the hospital equipment. Regular skill training of the staff has played a pivotal role in increasing efficiency of the hospital, it read.
About 60–70 per cent of medical treatments are based on laboratory diagnostic tests, thus making it one of the most indispensable segments in the health care industry. Diagnostics may not completely aid in curing the disease but can go a long way in this direction.
The report suggested states/UTs to increase resources to improve quality at district hospitals. It said that adequate resources may be provided to district hospitals towards digitisation.
This can be done by enabling provision of good data network, organising frequent training sessions, and encouraging large-scale use of various platforms of Government of India like Mera Aspataal. National and regional level trainings, workshops etc. may be organised to acknowledge as well as disseminate hospitals’ best practices, it read.
It suggested maintaining uniformity and continuity in data entry. Necessary regular posts should be created by the State/UT to maintain continuity and uniformity in data management work at the hospital, it said.
Moreover, it suggested that the accountability of the officer’s in-charge of the facility for quality of data reporting should be increased and their role clearly defined.