Healthcare Agencies

By Abdulla Israr & Simran Rani

Healthcare Agencies

Introduction

  • Definition: Health Administration is the process of planning, organizing, directing, coordinating, and controlling health services for the promotion, protection, and restoration of health.
  • Scope: Encompasses preventive, promotive, curative, and rehabilitative services.
  • Objectives:
    • Ensure equitable access to health services.
    • Reduce morbidity and mortality.
    • Promote efficiency in resource allocation and utilization.
    • Strengthen health systems and infrastructure.
  • Functions:
    • Policy formulation and implementation.
    • Regulation and standard setting.
    • Coordination between different levels of healthcare.
    • Monitoring, evaluation, and reporting.
    • Training and capacity building of health professionals.
  • Importance:
    • Bridges the gap between health policy and delivery.
    • Improves accountability and efficiency.
    • Provides direction in national health programs.

Public Health System in India

The Indian health system is structured as a three-tier system with integration of preventive and curative services.

a) Central Level

  • Ministry of Health and Family Welfare (MoHFW) is the apex body.
  • Functions:
    • Formulation of health policies and legislation.
    • Planning and funding of national health programs.
    • Establishment of apex institutions (AIIMS, ICMR, NACO).
    • Regulation of medical and paramedical education.
    • International health relations (WHO, UNICEF, World Bank).
  • Central Health Agencies:
    • Directorate General of Health Services (DGHS) – technical advisory body.
    • Indian Council of Medical Research (ICMR) – research in biomedical sciences.
    • National Health Mission (NHM) – umbrella program for primary health care.
    • National Centre for Disease Control (NCDC) – surveillance and outbreak control.

b) State Level

  • State Health Department headed by Principal Secretary/Commissioner of Health.
  • Directorate of Health Services (DHS) – technical body at state level.
  • Responsibilities:
    • Implement national health programs in the state.
    • Manage secondary hospitals and medical colleges.
    • Supervise district health administration.
    • Allocate state health budget and manpower.

c) District Level

  • District Health Officer/Chief Medical Officer (CMO) leads district health administration.
  • Functions:
    • Coordination of primary and secondary healthcare.
    • Supervision of public health programs at block and PHC levels.
    • Maintenance of district hospitals and health centres.
    • Collection of health statistics and reporting to state.
  • Key Institutions:
    • District Hospital – secondary care, referral from PHCs/CHCs.
    • Community Health Centres (CHCs) – 30-bed hospitals, first referral units.
    • Primary Health Centres (PHCs) – for every ~30,000 population.
    • Sub-Centres (SCs) – for ~5,000 population, manned by ANMs.

d) Urban Level

  • Urban health is managed under:
    • Municipal Corporations / Urban Local Bodies (ULBs).
    • National Urban Health Mission (NUHM).
  • Services include:
    • Urban Primary Health Centres (UPHCs).
    • Maternity homes, dispensaries, polyclinics.
    • Specialized hospitals (TB, Infectious diseases).
  • Challenges: Overcrowding, slums, inadequate sanitation, shortage of staff.

Voluntary Health Agencies

  • Definition: Non-profit, non-governmental organizations working in health care with community participation and government collaboration.
  • Functions:
    • Supplement government efforts in health care delivery.
    • Create awareness, health education, and advocacy.
    • Provide services in remote or underserved areas.
    • Pilot innovative models for health care.
  • Examples in India:
    • Indian Red Cross Society (IRCS) – disaster relief, blood banks.
    • Family Planning Association of India (FPAI) – reproductive health.
    • Tuberculosis Association of India (TAI) – TB control.
    • Hind Kusht Nivaran Sangh – leprosy control.
    • Voluntary Health Association of India (VHAI) – health promotion, advocacy.
  • Advantages:
    • Flexibility and innovation.
    • Closer to community.
    • Mobilization of local resources.
  • Limitations:
    • Financial instability.
    • Limited coverage.
    • Duplication of efforts.

Role of NGOs in Health Care

  • NGOs play an essential role in community health development and public-private partnerships.
  • Roles:
    • Health education and behavior change communication.
    • Implementation of disease control programs (HIV/AIDS, TB, malaria).
    • Running hospitals, mobile clinics, and rural health centers.
    • Advocacy for marginalized populations.
    • Training community health workers.
  • Examples:
    • SEWA (Self-Employed Women’s Association) – women’s health and livelihood.
    • CARE India – maternal and child health, nutrition.
    • PHFI (Public Health Foundation of India) – capacity building and research.

Hospital Statistics and Indicators Measuring Impact of Health Care Administration

a) Importance of Hospital Statistics

  • Provide information for planning, monitoring, and evaluation.
  • Assist in decision-making for hospital administration.
  • Measure performance and utilization of services.
  • Ensure accountability and transparency.

b) Types of Hospital Statistics

  1. Patient Statistics
    • Admissions, discharges, transfers.
    • Outpatient attendance.
    • Emergency visits.
  2. Bed Statistics
    • Bed occupancy rate.
    • Average length of stay (ALOS).
    • Bed turnover rate.
  3. Service Statistics
    • Surgical operations.
    • Diagnostic tests.
    • Deliveries, immunizations.
  4. Manpower Statistics
    • Doctor-patient ratio.
    • Nurse-patient ratio.

c) Indicators for Measuring Impact

  1. Input Indicators
    • Health infrastructure (PHCs, CHCs, hospitals).
    • Manpower availability (doctors, nurses, ASHAs).
    • Health expenditure per capita.
  2. Process Indicators
    • Utilization rates of health services.
    • Coverage of immunization, antenatal care.
    • Referral rates.
  3. Output Indicators
    • Bed occupancy rate.
    • Outpatient attendance per doctor.
    • Surgical procedures performed.
  4. Outcome Indicators
    • Infant Mortality Rate (IMR).
    • Maternal Mortality Ratio (MMR).
    • Life expectancy.
    • Disease incidence and prevalence trends.
    • Control of epidemics.
  5. Efficiency Indicators
    • Cost per patient treated.
    • Average length of stay (ALOS).
    • Bed turnover interval.

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