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/reso
urces
Manpower
Materials
Money
Machines
Methods
Minutes
information

Processing

Planning
Organizing
Staffing
Directing
Controlling
Coordination

Output

No. of lives saved

No. of deaths prevented
No. of investigations done
No. of operations performed
No. of patients treated.

Feedback

Outcome
Decrease in morbidity
rates
Decrease in mortality
rates
Decrease in disability rate
Decrease in absenteeism
due to sickness
Improved health status of
community

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
Entrepreneur role
Disturbance handler role
Resource allocator role
Negotiator role

Informational roles
Recipient role
Disseminator role
Spokesperson 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 patients physical needs.
Patient's emotional needs.
Patients clinical needs.
Patients' satisfaction.
Patients' education.
Patients 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 Centresstaffed 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.
2.
3.

The ministry of health and family welfare.

The directorate of general health services
The central council of health and family welfare.

1.The ministry 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.

3. The central council of health and family

welfare

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

Control of communicable diseases

3. Medical education, training and research
2.
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.