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ADMINISTRATION
Dr. Jayesh Patidar
www.drjayeshpatidar.blogspot.com
The definitions given by various authors can be explained as follows:
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effectiveness and efficiency.
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Input process output
Input/resourc
Processing Output Outcome
es
Feedback
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1. Productivity: it is an output input ratio within a time
period with due consideration for quality
Productivity = Output/Input
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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.
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Role of hospital administrators
General roles
Interpersonal roles
• Figure head
• Leader role
• Liaison role
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• Disturbance handler role • Disseminator role
• Resource allocator role • Spokesperson role
• Negotiator role
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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.
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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.
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Patient‟s communication needs.
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2. Role towards hospital organization
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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
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3. Role towards community
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Health System in India
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Introduction
The political economy context
Coverage patterns
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The Political Economy
Context
A democratic federal system which is subdivided into 28 States, 7 union
territories and 593 districts
80% health care expenditure born by patients and their families as out-of -pocket
payment (fee for service and drugs)
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Different Phases of Indian Health
System Development
Pre-independence phase
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Main Systems of Medicine
Western allopathic
Ayurveda
Unani
Siddha
Homeopathy
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Government Health System
Three levels of responsibilities-
- First-
- Second-
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- Third-
- both the centre and the states have a joint responsibility for programmes listed
under the concurrent list.
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Administrative Structure
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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.
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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.
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Health Financing Mechanisms..
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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
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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)
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Contradictions
India has the largest numbers of medical colleges in the
world
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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
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Health, far from being accepted as a basic right of the people, is now being
shaped into a saleable commodity
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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
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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.
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Health Inequities
A girl is 1.5 times more likely to die before reaching her
fifth birthday
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NATIONAL HEALTH POLICY
• The Ministry of Health and Family Welfare, Govt. of
India, evolved a National Health Policy in 1983 and
2002.
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objectives
• A greater awareness of health problems and means to solve them.
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• Greater co-ordination of different systems of medicine.
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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.
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• Headed by a cabinet minister, a minister of state and a
deputy health minister.
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Functions
I. International health relations
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IX. Population control and family planning
X. Labour welfare.
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2. The directorate of general health services
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Functions
I. International health relations – all major ports and international
airports are directly controlled.
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IX. Health intelligence – collection, analysis, evaluation of all
information on health statistics.
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Functions
I. To recommend broad outlines of policy concerning health –
preventive and remedial care.
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II – At the state level
State health administration comprises of
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1. State ministry of health
Headed by a minister of health and family welfare and
a deputy minister of health and family welfare
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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.
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two types – regional & functional
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The regional directors inspect all the branches of
public health irrespective of their specialty.
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Health planning in India
The guidelines for National health planning were
provided by a number of committees.
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1. Bhore Committee 1946
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Five year plans
Planning commission gave considerable importance to
health programmes in the five year plans
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Healthcare of the community
Levels of healthcare
Primary care level
Secondary care level
Tertiary care level
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Health for all by the year 2000
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