Hospital administration

The definitions given by various authors can be explained as follows:

As a hospital administrator, he has to carry out

management functions of planning, organizing, staffing,
directing, controlling and coordinating
Management applies to all kinds of organization,
whether government or non-government, small or big
hospitals, profit making hospitals or charitable hospitals.
It applies to administrator at all organizational level,
whether lower level or top level.
The aim of all administrators is the same that is to
maximize the output.
It is concerned with productivity that implies
effectiveness and efficiency.
 Input process output
Input/resourc
Processing Output Outcome
es

Manpower Decrease in morbidity

Materials Planning No. of lives saved rates
Money Organizing No. of deaths prevented Decrease in mortality
Machines Staffing No. of investigations done rates
Methods Directing No. of operations performed Decrease in disability rate
Minutes Controlling No. of patients treated. Decrease in absenteeism
information Coordination due to sickness
Improved health status of
community

Feedback
1. Productivity: it is an output input ratio within a time
period with due consideration for quality

Productivity = Output/Input

Productivity can be given by

Increasing output and maintaining same input.

Increasing output and decreasing input.

By decreasing input but maintaining same output.

2. Effectiveness: when a manager is able to achieve his
objectives, he is called an effective manager/
administrator. The focus is on the output. The end
result is to be evaluated.

2. Efficiency: when a manager is able to achieve the

objectives, with the least (optimum) amount of
resources, he is called an efficient manager.
 Role of hospital administrators
General roles

The hospital administrator like any other manager performs

various roles; the managerial roles as described by Mitzberg can
be grouped as follows, which are equally relevant for hospital
administrator also

Interpersonal roles
• Figure head
• Leader role
• Liaison role

Decision role Informational roles

• Entrepreneur role • Recipient role
• Disturbance handler role • Disseminator role
• Resource allocator role • Spokesperson role
• Negotiator role
Specific roles
By virtue of serving a healthcare organization the
hospital administrator performs some specific roles
which are described below.
The hospital administrator ensures that hospital runs
effectively and efficiently.
The role of hospital administrator varies, depending
upon the nature and complexity of hospital.
Various roles can be grouped as role towards patients,
towards hospital organization, towards community.
1. Role towards patients
The hospital administrator has a great responsibility to
understand and appreciate the emotional aspects of the patient
care, his responsibility is to understand the specific needs of
certain groups of patients, i.e. patients on wheelchairs,
stretchers, geriatric group of patients, pediatric patients,
neonates, serious cases, foreign nationals etc. some of the
aspects of patients are given below:
Creation of friendly environment.
Understanding patient’s physical needs.
Patient's emotional needs.
Patient’s clinical needs.
Patients' satisfaction.
Patients' education.
Patient’s communication needs.
2. Role towards hospital organization

To handle the hospital resources for maximizing the

output is one of the fundamental roles of the
administrator.

The role of administrator is more of coordination in

nature instead of controlling, he is coordinating
officer.
a. Strategic planning
b. Environmental influence on the hospital
c. Operational management
d. Management of hospital staff
e. Materials management
f. Financial management
g. Hospital information
h. Communication
i. Public relation
j. Risk management
k. Law, ethics and code of conduct
l. Marketing of health services
m. Quality management
3. Role towards community

a. Integrating with primary health care

b. Integrating hospital with other healthcare

organizations.

c. Community participation in planning of services and

also for utilization of hospital services.

d. Outreach program: outreach program like health

camps, camp surgery, immunization camps, etc.
Health System in India
 Introduction
The political economy context

The organisational structure and delivery mechanism

Health financing mechanisms

Coverage patterns

Current status of health and health care

 The Political Economy
Context
A democratic federal system which is subdivided into 28 States, 7 union
territories and 593 districts

In most of the states three local levels of government (Panchayat-raj)

Per capita income US $440

435 million Indians are estimated to live on less than US $ 1 a day

36% of the total number of the worlds’ poor are in India

Tax based health finance system with health insurance

80% health care expenditure born by patients and their families as out-of -pocket
payment (fee for service and drugs)

Expenditure on health care is second major cause of indebtedness among rural

poor
 Characteristics of Indian
Health System
Complex mixed health system
- Publicly financed government health
system
- Fee-levying private health sector
 Different Phases of Indian Health
System Development
Pre-independence phase

Development centred phase

Comprehensive Primary Health Care phase

Neoliberal economic and health sector reform phase

Health systems phase

 Main Systems of Medicine

Western allopathic

Ayurveda

Unani

Siddha

Homeopathy
 Government Health System
Three levels of responsibilities-

- First-

- health is primarily a state responsibility

- Second-

- the central government is responsible for developing and monitoring national

standards and regulations

- sponsoring various schemes for implementation by state governments

- providing health services in union territories

- Third-

- both the centre and the states have a joint responsibility for programmes listed
under the concurrent list.
 Administrative Structure

1. Central Ministries of Health and Family

Welfare –
- Responsible for all health related programmes
- Regulatory role for private sector
2. State Ministries of Health and Family Welfare
3. District Health Teams headed by Chief Medical and Health
Officer
 Service Delivery Structure
Sub Health Centres- staffed by a trained female
health worker and/or a male health worker for a
population of 5000 in the plains and a population of
3000 in hilly and tribal areas.

Primary Health Centres-

staffed by a medical officer and other paramedical staff
for a population of 30,000 in the plains and a
population of 20,000 in hilly, tribal and backward
areas. A PHC centre supervises six to eight sub centres.
 Service Delivery Structure
Community health centres- with 30-50 beds and basic
specialities covering a population of 80,000 to 120,000.
The CHC acts as a referral centre for four to six PHCs.

District/General hospitals- at district level with multi

speciality facilities (City dispensaries)

Medical colleges, All India institute of Medical

Sciences and quasi government institutes
Health Financing Mechanisms..

Revenue generation by tax

Out of pocket payments or direct
payments
Private insurance
Social insurance
External Aid supported schemes
 Spending on Health
Annually over 150,000 crores or US$34 billion, which
is 6% of GDP (Government spending on health Is only
0.9% of GDP)
Out of this only 15 % is publicly financed 4% from
social insurance, 1% by private insurance remaining
80% is out of pocket spending ( 85% of which goes in
private sector)
Only 15% of the population is in organised sector and
has some sort of social security the rest is left to the
mercy of the market
 The Aspects of Neoliberal Economic
Reforms Affecting Public Health
Increasing unregulated privatisation of the health care sector with
little accountability to patients
Cutting down government Health care expenditure
Systematic deregulation of drug prices resulting in skyrocketing
prices of drugs and rising cost of health services
Selective intervention approach instead comprehensive primary
health care
Measure diseases in terms of cost effectiveness
Techno centric approach( emphasis on content instead processes)
 Contradictions
India has the largest numbers of medical colleges in the
world

It produces the largest numbers of doctors among

developing countries

It gets “medical Tourists” from developed countries

This country is fourth largest producer of drugs by

volume in the world
But... the current situation….
Only 43.5% children are fully immunised.
79.1% of children from 6 months to 5 years of age are anaemic.
56.1% ever married women aged 15-49 are anemic.
Infant Mortality Rate is 58/1000 live births for the country with a low of 12 for
Kerala and a high of 79 for Madhya Pradesh.
Maternal Mortality Rate is 301 for the country with a low of 110 for Kerala
and a high of 517 for UP and Uttaranchal in the 2001-03 period.
Two thirds of the population lack access to essential drugs.
80% health care expenditure born by patients and their families as out-of -
pocket payment (fee for service and drugs)
Health inequalities across states, between urban and rural areas, and across the
economic and gender divides have become worse
Health, far from being accepted as a basic right of the people, is now being
shaped into a saleable commodity
 Contd….
poor are being excluded from health services
Increased indebtedness among poor (Expenditure
on health care is second major cause of
Indebtedness among rural poor)
Difference across the economic class spectrum and
by gender in the untreated illness has significantly
increased
Cutbacks by poor on food and other consumptions
resulting increased illnesses and increasing
malnutrition
 Health Inequities
The infant mortality Rate in the poorest 20% of the
population is 2.5 times higher than that in the richest
20% of the population
A child in the ‘Low standard of living’ economic group
is almost four times more likely to die in childhood
than a child in a better of high standard living group
A person from the poorest quintile of the population,
despite more health problems, is six times less likely to
access hospitlisation than a person from richest
quintile.
 Health Inequities
A girl is 1.5 times more likely to die before reaching
her fifth birthday

The ratio of doctors to population in rural areas is

almost six times lower than that for urban areas.

Per person, government spending on public health is

seven times lower in rural areas compared to
government spending urban areas
NATIONAL HEALTH POLICY
• The Ministry of Health and Family Welfare, Govt. of
India, evolved a National Health Policy in 1983 and
2002.

• The policy lays stress on preventive, promotive, public

health and rehabilitation aspects of healthcare.

• The policy stresses the need of establishing

comprehensive primary health care services to reach
the population in the remote area of the country.
 objectives
• A greater awareness of health problems and means to solve them.

• Supply of safe drinking water and basic sanitation.

• Reduction of existing imbalance in health services by concentrating

on the rural health infrastructure.

• Establishment of dynamic health management information system

to support health planning

• Provision of legislative support to health protection and promotion.

• Research into alternative methods of healthcare delivery and low

cost health technologies.

• Greater co-ordination of different systems of medicine.

 Roles and responsibilities of Government
in the health sector, health system in India

I. At the centre
1. The ministry of health and family welfare.
2. The directorate of general health services
3. The central council of health and family welfare.
• Headed by a cabinet minister, a minister of state and a
deputy health minister.

• Union health ministry has 2 departments.

• Department of health
• Department of family welfare.
 Functions
I. International health relations

II. Administration of central institutes like AIIMS, National

Institute for control of communicable diseases Delhi, etc.

III. Promotion of Research

IV. Development of Medical, Dental, Nursing professionals.

V. Establishment and maintenance of drug standards.

VI. Prevention of communicable diseases

VII. Control of drugs and poisons.

VIII. Collection of vital statistics.

IX. Population control and family planning

X. Labour welfare.
2. The directorate of general health services

• Principal adviser to the union Govt. in both medical

and public health matters.

• Directorate comprises of 3 main units.

• Medical care and hospitals
• Public health
• General administration
 Functions
I. International health relations – all major ports and international
airports are directly controlled.

II. Control of drug standards

III. Maintaining medical store departments

IV. Post graduate training

V. Incharge for medical education

VI. Medical research – ICMR, etc.

VII. Central Govt. health schemes

VIII. National health programmes – AIDS, etc.

IX. Health intelligence – collection, analysis, evaluation of all

information on health statistics.

X. National medial library – to help in the advancement of medical,

health and related sciences.
• To promote coordinated and concerted action between
the centre and the states in the implementation of all
the programmes pertaining to the health of the nation.
 Functions
I. To recommend broad outlines of policy concerning health –
preventive and remedial care.

II. To make proposals for legislation in the fields of activity relating

to medical and public health.

III. To make recommendations to central government regarding

distribution of available grants for health purposes to the states.

IV. To establish any organization having function for promoting and

maintaining co-operation between the central and state health
administration.
 II – At the state level
State health administration comprises of

State ministry of health

State health directorate
 1. State ministry of health
Headed by a minister of health and family welfare and
a deputy minister of health and family welfare

Health secretariat is the official organization of the

state ministry of health and is headed by a secretary.

The secretary is a senior officer of the Indian

Administrative service.
 2. State health directorate
Director of medical and health services is the chief
technical adviser to the state government on all matters
relating to medicine and public health.

Responsible for the organization and direction of all

health activities.

The director of medical and health services is assisted

by a suitable number of deputy and assistant directors.

The deputy and assistant directors of health may be of

two types – regional & functional
The regional directors inspect all the branches of
public health irrespective of their specialty.

The functional directors are usually specialists in a

particular branch of public health such as mother and
child health, family planning, nutrition, TB, leprosy,
health education, etc.
 Health planning in India
The guidelines for National health planning were
provided by a number of committees.

These committees were appointed by the government

of India from time to time to review the existing health
situation and recommend measures for further action.

The following are some of the committees, which are

important landmarks in the history of public health in
India.
1. Bhore Committee 1946

2. Mudaliar Committee 1962

3. Chadah Committee 1963

4. Mukerji Committee 1965

5. Mukerji Committee 1966

6. Jungawalla committee 1967

7. Kartar singh committee 1973

8. Shrivastav committee 1975

9. Rural health scheme 1977

10. Health for all by 2000 AD – report of the working

group 1981
Planning commission – health sector planning
Planning commission gave considerable importance to
health programmes in the Five year plans.

For purposes of planning the health sector has been

divided into the following subsectors
1. Water supply and sanitation
2. Control of communicable diseases
3. Medical education, training and research
4. Medical care including hospitals, dispensaries and
primary health centres.
5. Public health services.
6. Family planning
7. Indigenous systems of medicine.
All the above received due consideration in the five year plan.
 Five year plans
Planning commission gave considerable importance to
health programmes in the five year plans

The objectives of the health programmes during the

five year plans have been
1. Control and eradication of major communicable
diseases.
2. Population control
3. Development of health man power resources.
4. Strengthening basic health services through the
establishment of primary health centres.
Healthcare of the community
Levels of healthcare
Primary care level
Secondary care level
Tertiary care level
 Health for all by the year 2000
Fundamental principal of HFA/2000 strategy is equity,
i.e. an equal health status for people and countries,
ensured by an equitable distribution of health
resources.

National strategy for HFA/2000 (for India)

• Government of India was committed, to taking steps to

provide HFA to its citizen by 2000

• The national health policy 1983 committed the

government and people of India to the achievement of
HFA.

• It has laid down specific goals in respect of various

health indicators.
The important goals to be achieved by 2000 were,

• Reduction of infant mortality from the level of 125

(1978) to below 60.

• To raise the expectation of life from the level of 52

years to 64

• To reduce the crude death rate from the level of 14 per

1000 population to 9 per 1000

• To reduce the crude birth rate from the level of 33 per

1000 population to 21

• To provide water to the entire rural population.