problems in health care delivery.shimla.18.5.2010

8/7/2019 PROBLEMS IN HEALTH CARE DELIVERY.SHIMLA.18.5.2010

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PROF. DEOKI NANDAN

Doctor Honoris Causa-Odessa State Medical University, MD, FAMS,FIAPSM, FIPHA, FISCDDirector

([email protected], www.nihfw.org)&

NIHFW FAMILY MEMBERS



Regional inequalities. Per capita Public Health spending varies largely from

Rs.630 (in Himachal Pradesh) to Rs. 93 (in Bihar) in

2004-2005. (GOI, 2009).

Over 47% of hospitalized persons in rural areas & 31%

in urban areas borrow heavily or sell assets to cover the

expenses (NSSO-60th Round).

Due to high hospital expenses over 25% of hospitalisedIndians fall below poverty line.

Only 10% Indians have some form of health insurance,

mostly inadequate.



Increase in life expectancy

Reduction of Fertility

Eradication of Smallpox/ Guinea Worm

Initial Success in Leprosy/ TB/ Malaria



Ageing

Morbidity & Mortality burden

Water/ Vector borne diseases

New Emerging Diseases

Life Style Diseases



Understanding the nature of problems.

Rural/ Urban Differentials

Responsibility for Health

Responsiveness of health system

HMIS and Early Warning System (?IDSP)

Public, private, corporate and voluntary sector Convergence/ Inter-sectoral action for health

Role of AYUSH

Health Manpower Development



� Increase in cigarette smoking

� Less physical exercise - increase in diseases as coronary

heart disease, stroke, diabetes and arthritis.

� Mental illnesses have been a continuing concern.

� Life expectancy has increased - issues of long-term care,

dementia, arthritis and multiple diseases

� Rise in the side-effects for drugs

� Poverty - inequalities in levels of health between the various

social groupings



�Reduction in MMR, IMR and TFR

�Major public health concerns

� Outbreaks of disease caused by infective or toxicagents

� Problems arising from social and environmentalissues

� Behavioral concerns

� Health service issues

� Life Style Diseases



� Public health practitioners must develop their skills inhandling outbreaks of disease

� Training in epidemiology is crucial to this

� It is important for the effective monitoring of healthneeds and outcome that data collected about patientsare linked to individuals, and not merely based on

events

� Appropriate epidemiological and other studies arenecessary to determine the factors responsible for ill-health



Ability to communicate with the media,

pressure groups and the public on theconcept of health has enormous

implications for any future public health

structure



� There remains at present, confusion between the role of

public health in the management of clinical services

and its primary role in the management of public

health services.

� Public health can influence the priorities and

distribution of health service resources to improve the

health of the population for which it is responsible.



� Public health has made massive inroads into diseases within a

relatively short period.

� Public health is now at a cross-roads where it can either accept the

status quo or confront realistic change and challenge and seek to

regain its former independent voice.

� The specialty has a duty to inform the public responsibly on public

health matters.

� We perceive public health as the central medical specialty of the

future.

Let us move on to concerns of quality««.



�

---Affects all stake holders



1. Enables us to provide services that improve health

� Prevention services keep people healthy

� Good planning means you get the drugs etc. when you need

it.

� Decreases the chance of harm in the services

� Hospital based infection rates ² adds average of 4-5 days to

hospital stay

� Redoing procedures, patient complaints, potential lawsuits in

CPA add to the cost

� Contributes to economics of the country

� Healthy people make happy families and communities



� Overuse- unnecessary surgeries, tests, medicationsand procedures Eg. prescription antibiotics, MRIs, XRays.

� Underuse ² Failure to provide routine preventivescreening & services eg immunization resulting inillness.

� Misuse (mainly medical errors) ² prescription drug

misuse, hospital acquired infections, surgical errors etc.

� Medical errors are best documented indicators of poor quality



«

«

Policy &Infrastructure

Performance Monitoring &macro management

Operations & Governance

Health Services Provision:Professional accountability and patient satisfaction

National

National &regional

Institutional

Individual



Principles Quality Strategies

Values Empoweringconsumers

Policies

Framework

Professional

development

Legislation Institutionaldevelopment

Existingmechanisms Managementdevelopment

Clinical practicedevelopment

16



1. User/customer focus

2. Leadership and Vision

3. Decision-making based on evidence

4. Team based decision making/multi-

disciplinary teams

5. System and process approach

6. Stakeholder/community involvement

7. Capacity building/training of staff



Medical waste is

not disposed of

in a functional pit,

needles and other

medical waste are

scattered in the

vicinity of the

healthcare facility.



Managing Medical Waste

Standard:

Medical waste is

disposed of in afunctional pit (e.g. not

accessible to children

and animals) within the

compound



� Established in year 1854, honoured for being one of

the first three Medical Schools of the country.

� This Medical College was affiliated to Agra

University (now Dr. B.R. Ambedkar University) in

year 1939 and started awarding MBBS degree.

� Renamed as Sarojini Naidu Medical College &

Hospital during year 1947.



� Institute provides primary, secondary and tertiary level

specialized health care facilities not only to people from

Agra but also to those approaching from surrounding

Districts and States.

� Institute had earned National and International repute

for excellent standards of Teaching, Training, Research

and Patient Care.



� Facilities available at the institute:

� Outdoor Patient Department

� Indoor Wards (total of 976 beds in various departments)

� Teaching & training of undergraduate and postgraduate

medical students

� Teaching & training of Nursing students and provision of

courses in Lab. Technology, Diploma in Pharmacy etc.

� Research in various disciplines (MD/MS & Ph.D.)



� With the ever increasing number of Private Health Facilities and

dominance of private qualified and unqualified practitioners,

patient input was decreased during past few years.

� Considerable vacancies in college & hospital staff and irregularity

and inconsistency in working led to deterioration of the image of

the institute in the past.

� Lack of budget -especially medicines

� Lack of ownership and involvement among those involved in

management and administration also contributed to decline in the

quality of services.



Pictures from the past

SURGERY BUILDINGSURGERY BUILDING

COLLEGE BUILDINGCOLLEGE BUILDING



�Strengths:

�Prestigious Institution

�Highly qualified and skilled doctors�Tertiary level institution with glorious history

�Large numbers of renowned alumni at

national & international organisations

�Undergraduate & postgraduate students



�Weaknesses:

� Lack of teaching and other staff resulting in compromise

of teaching/training at the institution.

� Lack of ownership, motivation and communication

� Inadequate attention towards hygiene and sanitation

� Lack of work culture at each level- ¶Chalta hai· Culture



�Opportunities:

� Development of Medical diagnostic & curative

modalities.

� Global change and attention towards health

requirement of the community.

� Investment from Public / Private Sector

� Social & Political will

� Support from community and other organizations

working for health.



�Threats:

�Influence of Private Health Sector -

malpractices

�Political interference

�Adhocism in decision making at the

governmental level



� Up gradation and renovation of existing infrastructure.

� Establishment of new functional and sustainable

infrastructure- modern diagnostic and treatment facilities.� Improving the work culture and motivation levels

� Ensuring multi sectoral involvement with multi

dimensional approach- seeking support from the privatesector, politicians and media.

� Computerization of college & hospital related data and

information.



�Strengthening of undergraduate

and postgraduate teaching and training .

�Due consideration to hygiene and sanitation

in college hospital premises and wards.

�Ultimately- improving quality of care



�Garner political support

- Get Emergency Block completed and inaugurated

(by Chief Minister)

- invite politicians for visits and organising

functions (get their commitment)

- ·oblige· them!

- frequent interactions with key media personnel



�Mobilise support from Directorate and

bureaucracy

-frequent interactions

-submit plan(s)-

-organise visits

-more budget



�Human Resource Management:

- talk to all associations-faculty,

staff(different levels), students

- establishing a Grievance cell

- negotiate commitment of faculty

- open door policy

- appreciation letters, awards/ punishment



�MBWA

�Suggestion box (actually opened weekly!)

� support from private sector

�Updating all official records and developing a

system for office management.



2. Organization of meetings / discussions for listening andsolving grievances with faculty members, Class III and

Class IV employees, Pharmacists, Nursing staff, Employee

Unions and undergraduate/ postgraduate students for

reaching at mutual consensus for betterment; and seeking their support.

3. Ensuring regular monitoring at out patient and indoor

departments for provision of timely and quality health care

services ² fixing responsibility.

4. Ensuring regular and strict attendance of students in

lectures, practical, demonstrations and training sessions.



6. For ensuring proper computerization of college &

hospital, 7 day training was organized for clerical staff on

Computer Literacy and Applications (total 6 batches weretrained).

7. Secretarial Training of Class III employees was organized

by Department of Personal Training at District Level.

8. For prevention of nuisance and interruption of anti-social

& criminal activities, Barriers and Parking facilities were

developed at different points within the campus.



9. Support of Police and District Administration was sought

for better functioning..

10. Installation of ¶Suggestion Box· where suggestions orgrievances can be put ¶with name· or ¶without name·, for

prompt action.

11. norms for file disposal

12. negotiated with suppliers- no cuts!

13. Use of multi skilled personnel



�more budget- for renovation, equipment,

maintenance- MCI requirement

�regularisation of adhoc employees

�promotion of faculty

�dues of faculty,residents,staff,pensioners



� Infrastructure and Equipment:

� Inauguration of New Emergency Department

� Inauguration of Dr. Nawal Kishore Ward in Deptt. ofObstetrics & Gynaecology

� Inauguration of new X ray Unit

� Inauguration of "Endoscopy Lab" in Deptt of Medicine

� Inauguration of Ultrasonograpy Unit in Deptt of Obstetrics& Gynaecology.

� Inauguration of Dr. P. Awasthi Seminar Room at Deptt ofOphthalmology.



New Emergency Deptt



� Infrastructure and Equipment:

� Inauguration of Cancer Clinic at Deptt of Obstetrics &Gynaecology.

� Establishment of Neonatal Intensive Care Unit at Deptt.of Pediatrics.

� Establishment of Thalessemia Unit.

� Up gradation of Burn Unit.

� Inauguration of Lecture Theatre at Out PatientDepartment.

� Inauguration of Indoor Ward (no. 10) at Deptt. ofOrthopedics.



� Support from Private Sector:

� Donation of Air Conditioners to Deptt of Medicine byBharat Vikas Parishad.

� Donation of Laparoscope & other instruments to Deptt ofSurgery by Shri Chaturvedi Manav Seva Sansthan,Mathura.

� Donation of Ultrasonography machine to Deptt. OfObstetrics and Gynaecology by Bansal Charitable Trust.

� Donation of Marble benches for OPD by Nav SurbhiMahila Samiti.

� Donation of Red stone benches for Deptt of Obstetrics &Gynaecology by Lions Club




� Donation of Ventilators for establishment of NICU at Depttof Pediatrics by Swarup Group of Industries, Mumbai.

� Provision of Free Diet at Rain Basera near Deptt ofObstetrics & Gynaecology by Shri Nath ji Nishulk RainBasera, Agra.

� Establishment of Community Toilets near Deptt. of

Obstetrics & Gynaecology by firm ¶Kwality Petha·, Agra

� Community Hall and Community Kitchen ² ¶Sanjha Chulha·

near Deptt of Medicine by Pt. Keshav Dixit.




� Initiative of Lions Club for bearing the expenditure for

printing of new OPD slips.

� Donation of Rs. 5 lacs by firm ¶Doctor Soap· of Agra for

purchase of necessary equipment.

� Donation of 100 blankets and establishment of 4 pyau's

by Ganesh Seva Sansthan, Agra.



� Computerization of College & Hospital:

� Launching of website of the institution by namewww.snmcagra.net

� Inauguration of Internet Cyber Cafe at CentralLibrary.

� Regular computerization of outdoor and indoorpatient data.

� Computerization of all information related toemployees and students.

� Computerization of Duty Rosters of Nursing staff

and other support staff.



Today



Today-endoscopy lab



Today-labour room



DEEPAWLI DEEP MELADEEPAWLI DEEP MELA



CENTRAL LIBRARY DECORATED ON DIWALICENTRAL LIBRARY DECORATED ON DIWALI



� Achievements and involvement of Students:

� Students gave valuable inputs and successfully organized150th Year Celebrations, including Clinical Week, Cultural& Sport Activities.

� Students from the Institute also visited Tsunami affectedareas of South India and Andaman and provided MedicalAid to the affected.

� Regular CMEs, seminars etc� Post graduate students were sent/deputed to other

Hospitals and Institutes for receiving training in modernmodalities.



152934

186168195606

314341 292090

367730

2001 2002 2003 2004 2005 2006



8051

103579912

13194

15455

2001 2002 2003 2004 2005



Saanjha Chulha-medicine



Sanjha chulha-Gynae



�Support from Professional Bodies/SocialBodies:

� Initiative of Lions Club for bearing theexpenditure for printing of new OPD slips.

� Built post Mortem House.

� Artificial Limbs workshop for Orthopedics fromthe trust



�Got good media coverage, frequent

interactions with key media personnel

�Had a good relationship with the press-

kept them informed ²so less negative

publicity!

�OPD duty roaster of Doctors in a daily

leading newspaper



� Support and confidence from all employees and students of

the institute.

� Trust from the Community

� Support from Private and other Sectors

� Political will and Administrative & Judicial support

� High degree of motivation among the staff members.

� Collective wisdom for collective action through

participatory approach.

problems in health care delivery.shimla.18.5.2010

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