1 hospital its organisation and functions

DOCTOR OF PHARMACY
IV YEAR
HOSPITAL PHARMACY
14T00402
Chapter 1
Hospital - its Organization and functions
Dr.V.CHANUKYA Pharm- D

Contents
• Hospital definition
• Evolution of health care services in India
• Role of different committees
• Classification of the Hospitals
• Functions of a hospital

Hospital -Definition
• Hospitals in India have been organized along British lines with strict
hierarchical structure. The term hospital implies an establishment for
temporary occupation by the sick and injured.
• The World Health Organization (WHO) defines modern hospitals
thus: “A hospital is an integral part of social and medical organization,
the function of which is to provide complete healthcare for the
population, both curative and preventive and whose out-patient
services reach out to the family and its home environment. The
hospital is also a center for training of health workers and for bio-
social research”1.

• The hospital is a unique institution of man. A WHO Expert Committee
in 1963 proposed the following working definition of a hospital.
“A hospital is a residential establishment which provides short-term and
long term medical care consisting of observational, diagnostic,
therapeutic and rehabilitative services for persons suffering or suspected
to be suffering from a disease or injury and for parturient. It may or may
not also provide services for ambulatory patients on an outpatient basis”2.
• Syed Amin Tabish, “The hospital can be defined as an institution
whose primary function is the provision of a variety of diagnostic and
therapeutic services of patients, both in the hospital and in the
outpatient clinics.

• It is umbrella organization under which many individual health care
professionals provide some or all of their services.
• More than 30 disciplines are represented in most hospitals, each
having its own processional structure, body of knowledge, code of
ethics, and technical procedures.
• A hospital is also a social institution, dealing daily with a broad
panorama of human hopes, fears, and concerns.
• Finally, a hospital is a business, responsible for the efficient, cost-
effective provision of wide range of services”3.

Evolution of health care services in India
• Pre Christian Era – civilization started in Indus Valley
– Environmental sanitation, houses with drainage
• 1400 B.C. – Ayurveda and Siddha system
– Developed a comprehensive concept of health
• Post vedic – teaching of buddhism and Jainism
• Rahula Sankirtyana – developed hospital system.
• Moghul empire – Arabic system of medicine (Unani)
• British Gov – British nationals, armed forces, civil servants.

Role of different committees
• 1943 – Bhore Committee (Health survey and development
committee)
– Chairman-Joseph Bhore
– Purpose-To study the existing health conditions and to make
recommendations for the future development
– Recommendations-
1. No individual shall fail to secure adequate medical care
because of inability to pay for it.
2. Special emphasis on preventive work.

3. Provision of medical relief and preventive healthcare to rural
population.
4. Health services should be placed as close to the people as
possible to ensure maximum profit to the community.
5. It is essential to secure the active cooperation of the people in
the development of health programme.
6. Three month training recommended for preventive and social
medicine workers.
7. long term programme, a primary health unit for a population
of 20,000, and a second unit for a population of 6 lakes are
earmarked.

• 1961 – Mudaliar Committee
– Chairman- Mudaliar
– Purpose- To survey the progress made in the field of health and
medical relief since submission of Bhore committee’s report and to
make recommendations for the future development.
• Consolidation of advances, efforts and achievements made in
First and Second Year Plans.
• Equipping district hospitals with specialized services.
• Need of regionalization of health services.
• Fixed upper limit for each PHC is 40,000.

• 1963– ChadahCommittee
– Chairman- Dr.Chadah, M.S.
– Purpose- To study the arrangements for the maintenance phase of
national malaria eradication programme.
1. The vigilance operation of the national Malaria eradication
programme should be under control of PHC.
2. Vigilance operations through monthly home visits should be
implemented through basic health workers.
3. The norm of basic health worker per 10,000 populations was
recommended.
4. The general health services at district level should undertake
the responsibility for the maintenance phase.

• 1965 – Mukerji committee
– Separate staff for the family planning programme
• 1967 – Jungalwala committee
– Integration of health services
– Elimination of private practice by Gov. doctor
• 1973 – Kartar singh committee
– Committee on multipurpose worker
– ANM replaced by female health worker
– Basic health worker replaced by male health worker
– Lady health worker designated as female health supervisor.

Classification of the Hospitals
Hospitals are classified in mainly two ways.
– According to the objective of the hospital or service offered to the
patient
– According to the ownership or control
– others
• According to the objective, or service offered, hospitals are
divided into:
– Teaching-cum- Research hospitals
– General Hospitals
– Special Hospitals4

• Here the hospitals are classified mainly focusing on the objectives.
Some hospitals are set up with the motto of imparting medical education,
training and research facilities whereas in some other hospitals, the prime
attention is on health care.
Teaching-cum-Research Hospitals:
• These hospitals are teaching based. They are found engaged in
advancing knowledge, promoting the research activities and training
the medicos. Here the healthcare is secondary. For example, All India
Institute of Medical Sciences, New Delhi, Post- Graduate Medical
Education and Research Institute, Chandigarh etc.,

General Hospitals:
• The main objective in the General Hospitals is to provide medical
care. The General Hospitals also offer teaching and research facilities
but these objectives are secondary, for example, different General
Hospitals, District and Sub-divisional hospitals.
• In general hospital, care is given to many kinds of conditions such as
medical, surgical, pediatrics and obstetrics.
• Nowadays in many general hospitals, there are sections for psychiatry
and communicable diseases.
Special Hospitals:
• The main objective of Special Hospital is to provide specialized
medical services. These hospitals concentrate on a particular organ of
the body or a particular disease.
• A special hospital limits its services to a particular condition or sex or
age such as tuberculosis, maternity and pediatric hospital,
respectively.

• According to ownership, hospitals are divided into:
– Government Hospitals
– Semi-Government Hospitals
– Voluntary Agencies Hospitals
– Private Hospitals
• The Government Hospitals are owned, managed and controlled by the
Government whereas Semi-Government Hospitals are found acting as
an autonomous body. The voluntary agencies hospitals are owned by
voluntary organizations whereas the private hospitals are owned by
private parties.3

According to Medical System, hospitals are divided into:
– Allopathic Hospitals
– Ayurvedic Hospitals
– Homeopathic Hospitals
– Unani Hospitals
– Others
• According to different systems of medicine, classification can be
made as Allopathic, Ayurvedic, Homeopathic, Unani and hospitals of
other systems of medicine.

Government or Public Hospital may be:
– Medical College Hospital
– District Hospital
– City or Town Hospital
– Primary Health Center
– Rural Hospital
– Employees of State Insurance Hospital
• These government hospitals may be a general hospital or a special
hospital according to the need of the community.

Non-Governmental or Private Hospital may be:
• Private Medical College Hospital
• Mission Hospital
• Private Hospital
• Industrial Workers Hospital
Based on length of stay:
• Short term / short stay hospitals (stay less than 30 days)
• Long term / Long stay hospitals (stay more than 30 days)

Basing on bed capacity (Size)
– Small hospital (Upto 100 beds)
– Medium hospital (More than 100 to less than 300 beds)
– Large hospital (More than 300 beds)
By teaching affiliation:
– Teaching hospital
– Non-teaching hospital
Basing on level of care:
– Primary Care
– Secondary Care
– Tertiary Care

Basing on level of care
• Every individual has required different care depending upon their
health problem like some require normal care and some require extra
special care.
• So on the basis of patient condition healthcare divides into various
types. Following types of healthcare are explained below:
Primary Healthcare:
• Primary health care mainly focuses on health equity producing social
policy beyond the traditional healthcare system.
• Its main aim is to provide local care to a patient because
professionals related to primary care are normal generalists, deals
with a broad range of psychological, physical and social problems
etc rather than specialists in any particular disease area.

• Primary care services rapidly increasing in both the developed and
developing countries depending upon the increasing number of
adults at greater risk of chronic non-communicable disease like
diabetes, asthma, back pain, hypertension, anxiety, depression etc.
• To achieve the ultimate goals of primary health care., WHO has
described four elements to achieve this goal.
Following are:
1. Stakeholder participation increased.
2. Integrate health into all sectors.
3. According to people need & expectation organizing healthy
services.
4. Pursuing collaborative models of policy dialogue.

Secondary Healthcare:
• This healthcare is provided by the medical specialists and other
health problems who do not have direct contact with a patient like
urologists, dermatologists, cardiologists etc.
• According to National health system policy, the patient required
primary care professionals referral to proceed further for secondary
care.
• Depends on countries to countries, the patient cannot directly take
secondary care because sometimes health system imposed a restriction
of referral on a patient in terms of payment.

• The systems come under this category is known as District Health
system and County Health system.
(a) District Health system :
– This system mainly focus on child health and maternity care. People population
of this system is about 25000 to 50000 and includes various healthcare centres
and district hospitals.
– Healthcare centers receive referrals from various primary health care and is
remain open for 24 hours every day.
– District hospitals include emergency services, neonatal care, comprehensive
emergency obstetric etc and is remain open for 24 hours every day.
(b) County Health system:
– Into this system, hospitals receive referrals from the District & community
health systems.
– County hospital provides gynecologic services, general medicine,
obstetrics, general surgery etc and is remain open for 24 hours every day.

Tertiary Healthcare:
• This type of healthcare is known as specialized consultative healthcare
usually for inpatients and on referral from primary and secondary
healthcare for advanced medical investigation and treatment.
• following examples of tertiary care services are plastic surgery, burn
treatment, cardiac surgery, cancer management, neurosurgery,
complex medical and surgical interventions etc.
• The main provider of tertiary care is national Health system consist
of Regional hospitals and National Hospital.
• Regional hospitals receive a reference from various county hospitals
and serves as training sites complementary to the National referral
hospital.
• It also provides additional care services and remains open for 24 hours
every day.

Definitions and Terms for Different Levels of Hospital 8
Disease Control Priorities Project:
terminology and definitions
Alternative terms commonly found in the
literature
Primary-level hospital: few specialties—
mainly internal medicine, obstetrics and
gynecology, pediatrics, and general surgery, or
just general practice; limited laboratory
services available for general but not
specialized pathological analysis
District hospital
Rural hospital
Community hospital
General hospital
Secondary-level hospital: highly differentiated
by function with 5 to 10 clinical specialties;
size ranges from 200 to 800 beds; often
referred to as a provincial hospital
Regional hospital
Provincial hospital(or equivalent administrative
area such as county)
General hospital
Tertiary-level hospital: highly specialized
staff and technical equipment— for example,
cardiology, intensive care unit, and specialized
imaging units; clinical services highly
differentiated by function; could have teaching
activities; size ranges from 300 to 1,500 beds
National hospital
Central hospital
Academic or teaching or university hospital

Functions of a hospital
• The following are the main functions of hospitals:
A. Investigation, Diagnosis and care of the sick and injured:
• In modern times, the chief functions of the hospital; conduct the
investigations, for diagnosis, and provide care to the sick and injured.
• According to the condition of the patient, they are examined or the
necessary investigations are done of the outpatient or inpatient.
• When the condition of the patient requires a detailed investigation or
due to many other reasons, the doctor may advise the patient to stay
as an inpatient.
• In undiagnosed conditions – the patient may be admitted for
observation only.5

B. Health Supervision and Prevention of Disease:
• The prevention aspect of medical work has been given so much
emphasis in all aspects of medical practice, that, hospitals and health
centers are involved in health supervision and preventive therapy.
• In the entire outpatient department provisions are available for the
routine health examination and supervision of antenatal and postnatal
mothers, health supervision and immunization of sick and healthy
children and other services to persons in normal conditions.
• Hospitals prevent the spread of diseases by isolating the patients with
communicable disease and help to raise the standard of health in the
community by health education.
• Hospital staff and other medical social workers render great services
in dealing with the social problems and recurrence of psychiatric
conditions and the adjustments of such persons in the community.

• Different types of home care are given to patients by community
health programme.6
• Modern hospitals extend their services to the community by arranging
camps and clinics such as eye camps, detection of cancer, diabetic
clinics, immunization camps, family welfare programme camps, etc.
by specialized doctors and other health supervisors for the health
supervision and prevention of diseases in the community.

C. Education of Medical workers:
• Doctors, nurses, dieticians, social workers, physical therapists,
technicians, hospital administrators and other medical and
paramedical people are taught within the hospital much of what they
must learn in order to practice their profession.
• The theoretical part of their learning is conducted in an affiliated
institution and they practice their knowledge in the actual situation of
the hospital.
• Without hospitals or equivalents, it would be impossible to give an
adequate preparation for almost any type of modern medical service,
because such experiences are not available anywhere in the
community other than a hospital or health clinic.

D. Medical Research:
• Hospitals offer medical workers opportunities for investigations in
the form of laboratory facilities, trained personnel, patients and
accumulated records, which are not available elsewhere.
• This research is thought to be an important factor in the successful
practice of medicine and the advancement of medical science.
• The modern trend is to establish a close association between the
small rural hospitals, research centers and between all hospitals and
other community health organizations in order that their personnel
may have provision for an adequate research and diagnostic and
therapeutic facilities.

• The large number of patients and workers in these research centers
and district hospitals help promote all kinds of medical research.7
• The statistical side of the research works in the hospital help to
evaluate the occurrence and prevalence of particular disease in locality
or society and the health status of a country.
E. Rehabilitation:
• The rehabilitation in the hospital is a facility to provide additional help
to recover from an injury for stabilized patients who still need
inpatient hospital care.
• They might require physical, occupational or speech therapy as their
injuries improve, and they might need social work assistance to
determine how to live life once they are discharged.

Aspects of the hospital services
• The different aspects of hospital services are shown in charts below

Aspects of the hospital services

• The above classification of product is based on different categories of
hospitals.
• The medical colleges and some of the medical institutes impart
medical education, training and research facilities.
• It is natural that concentration of product varies depending on the
nature of the hospitals.
• However, it is right to believe that the ultimate aim of all the providers
is to make available the best possible medical services and to prepare
best medicos to simplify the task.
• Here it is essential that providers should be aware of the nature,
behaviour, requirements and status of the users.
• This helps in planning and development of best medical services.1

1. Line Services
a. Emergency (casualty) Services:
• The casualty department provides round the clock service, immediate
diagnosis and treatment for illness of an urgent nature and injuries
from accidents.
• Cases of serious nature are admitted in emergency wards to provide
immediate medical care.
• Now-a-days, emergency service is acquiring increasing importance
due to modern problems arising out of urbanization and
mechanization.
• Such patients are either discharged after two or three days or
transferred to the inpatient wards.
• This procedure in emergency is given below.

Procedure in an Emergency Service

b. Out-Patient Services:
• Here, all patients suffering from diseases of minor, acute and chronic
nature are analyzed.
• These services are designed to provide services to at least 1% of the
population of the area.
• The functions of outpatient services are provision of diagnostic,
curative, preventive and rehabilitative services on an ambulatory
basis.1
• This process of out-patient department is explained in the following
diagram.

c. In-patient Services (wards): After the patient has been examined in
the outpatient department or in the casualty, he may be advise
admission into the wards. Each ward has generally a doctor’s duty
room, dressing room, central nursing staff station and other essential
items needed for patient care.
d. Intensive Care Unit: Some of the patients admitted into the
hospitals require acute, multi-disciplinary and intensive observation
and treatment, hence it is desirable to have an intensive care unit for
such patients.
e. Operation Theatres: Each operating room will have a preanesthesia
room, sterilization room and scrub room. There is a trend to provide
simple laboratory facilities within the operating area to serve the
purpose during emergency.

2. Supportive Services
a. Central Sterile Supply Services: The Central Sterile Supply
Department is to store, sterilize, maintain and issue those
instruments, materials and garments which are sterilized.
b. Diet Services: The catering department comprises the kitchen, bulk
food stores and dining rooms and supplies of food material
throughout the hospital. This department is required to provide
general diet or special diet for patients suffering from certain
diseases.
c. Pharmacy Services: The Pharmacy Services represent the functions
of procurement and distribution of medicines through medical stores
on the basis of Doctor’s prescription by the persons hitherto known
as Compounders, generally under the control of Medical Officers.

d. Laundry Services: There is a need for an efficient mechanical
laundry to ensure the availability of bacteria free linen. The aim of
this service is to make available to the patients clean and sterile linen.
e. Laboratory and X-ray services: For proper diagnosis of ailments of
patients, it is necessary to have a properly manned diagnostic
laboratory facility. Laboratory and X-ray services play a prominent
role in aiding the Doctor fulfill his.
f. Nursing Services:
– Nursing is a vital aspect of healthcare. It needs to be properly
organized. A nurse is in frequent contact with the patients. Hence,
her role in restoring the health and confidence of the patients is of
utmost importance.
– The nursing services are managed by a matron who is assisted by
a sister-in-charge of the ward and staff nurses. Nursing sisters
control the ward. The quality of nursing care and the management
of nursing staff reflect the image of the hospital.

3. Auxiliary Services
a. Registration and Record Keeping Services:
– Registration is a must for a hospital which enrolls new patients
with proper entry in outpatient department and keeps the track
record of the re-visits of patients.
– A medical record helps in regulating the admission of patients. It
helps in codifying the records according to internal disease index.
• Stores: The central store receives and issues bulk items. Stores are of
different types-Pharmacy Stores, Chemical Stores, Linen Stores etc.
Stock policy should be devised in such a way that vital and essential
items are always available. It should be managed by a competent
stores officer.

c. Transport Services: Transport services are required for the carriage
of supplies and patients such as trolleys, stretchers and wheel chairs.
d. Mortuary Services: Each hospital has a cold storage where dead
bodies are kept before they are claimed by their relatives. Some times
post-mortem is needed for medico legal reasons. Unclaimed bodies
will be disposed according to rules.
e. Engineering and Maintenance Services: Regular repairs and
maintenance of the hospital building, furniture and other equipment's
are essential for the efficient functioning of the hospital, especially in
a large hospital. Therefore, there is a need to have a separate
department of engineering and maintenance services to provide
immediate services and keep the hospital effective and efficient.
f. Hospital Security: The establishment of hospital security force is
essential to ensure the safety of the patients and the staff. This
department will have active liaison with the local police in the area so
that they can supplement each others effort.

Hospital Organizational Structure

The hospital organization
• Hospital word has been derived from the latin word ‘HOSPES’ as we
know, which means ‘a host or guest’ or ‘hotel’, hostel.
• Some also believe that the origin of the hospital from the word
‘HOSPITUM’ a rest house for travelers or night shelter showing
‘hospitality’ to the guests.
• Hospital. is a social organization and logical combination of the
activities of a number of persons with different level of knowledge
and skills for achieving a common goal of patient care through a
hierarchy of authority and responsibility.

Organization
• Organizing is a process of grouping the activities in workable units
and connected by authority, communication and control.
• Organization is the anatomy and Management is the physiology of the
process.
• Importance of Understanding Organizational Structure of Hospital
A. Facilitates the understanding of the hospital’s chain of command
B. Shows which individual or department is accountable for each
area of the hospital

• Complexity of Organizational Structure Depends on Size of
Healthcare Facility; large acute care hospitals have complicated
structures, whereas, the smaller institutions have a much simpler
organizational structure
• A hospital is a regulated organization with multiple departments. Like
any other organization, it is essential to define a structure of
operations at a hospital.
• The organizational model defines the framework, line of duty,
communication roles and resource allocation.
• It also reflects the ethics of the organization.

• There are two broad forms of organizational structures that are
explained below:
• Horizontal organizations: Horizontal or flat organizations have
lesser defined hierarchy and multiple bosses.
• Individuals have more power at hand and are required to perform
many different functions and are required to consult multiple
supervisors.
• Although, this allows for greater independence to staff members, it
necessitates greater time and resources to arrive at decisions.
• Horizontal structures are best rated workplaces and this delayering can
be done gradually over a period of time.

• Vertical organizations: A vertical organizational structure has a well-
defined top-down hierarchy. Each staff has set roles and
responsibilities and they report directly to the person above them.
Vertical organization are more rigid but more efficient as well.
Decision making is faster and accountability is greater.
• A hospital deals with lives in their hands every hour of the day. This
demand from them efficient and timely operations, quick decision-
making, greater accountability and allows minimum margin for error.
• For such organizations, vertical structure is most suited. A top-down
structure allows for efficient management and accountability and
establishes a chain of command within the organization.
• This narrows down the roles and responsibility of each individual and
allows the managerial team to maintain equilibrium.

Organizational Structure of the Hospital
The uppermost level of hospital management:
• The hospital director = Chief Executive Officer (CEO)
– Second level managers:
• Chief Operating Officer (COO)
• Chief Financial Officer (CFO)
• Director of Nursing
• Bigger hospital may have third level management to assist second
level and called as Hospital Assistant Director

• The next level of management:
– Department heads or directors (pharmacy, nursing, other clinical
and support services)
• They have responsibility for managing and directing all aspects of
particular service such as pharmacy services
• Also, hospital may be organized by “product lines” reporting to
concern director.

Hospital organization -example

The Organizational Structure of Hospitals
Board
• All hospitals include some form of governing body responsible for
making high-level decisions about the organization
• A hospital’s board of directors is often drawn from the healthcare
community and is made up of experts in their respective fields.
• Religiously affiliated hospitals often include clergy on their boards of
directors.
• Teaching hospitals often include university faculty from the medical
school with which they’re affiliated.

Common organizational categories might include:
1. Administration Services(often referred to simply as “administration”)
2. Informational Services
3. Therapeutic Services
4. Diagnostic Services
5. Support Services (sometimes referred to as “Environmental
Services”)

1. Administration services—business people who “run” the hospital
A. Hospital administrators
1. Manage and oversee the operation of departments
a. Oversee budgeting and finance
b. Establish hospital policies and procedures
c. Perform public relation duties
2. Generally include: hospital president, vice presidents, executive
assistants, department heads
2. Informational services—documents and process information
A. Admissions-often the public’s first contact with hospital personnel
– Checks patients into hospital
a. Responsibilities include: obtaining vital information (patient’s full name,
address, phone number, admitting doctor, admitting diagnosis, social
security number, date of birth, all insurance information)
b. Frequently, admissions will assign in-house patients their hospital room

B. Billing and collection departments - responsible for billing patients
for services rendered
C. Medical records - responsible for maintaining copies of all patient
records
D. Information systems - responsible for computers and hospital
network
E. Health education - responsible for staff and patient health-related
education
F. Human resources - responsible for recruiting/ hiring employees and
employee benefits

3. Therapeutic services – provides treatment to patients. It includes
the following departments:
1. Physical therapy (PT)
a. Provide treatment to improve large-muscle mobility and prevent or limit
permanent disability
b. Treatments may include: exercise, massage, hydrotherapy, ultrasound,
electrical stimulation, heat application
2. Occupational therapy (OT)
a. Goal of treatment is to help patient regain fine motor skills so that they
can function independently at home and work
b. Treatments might include: arts and crafts that help with hand-eye
coordination, games and recreation to help patients develop balance and
coordination, social activities to assist patient’s with emotional health

3. Speech/language pathology
a. Identify, evaluate, and treat patients with speech and language
disorders
b. Also help patients cope with problems created by speech
impairments
4. Respiratory therapy (RT)
a. Treat patient’s with heart and lung diseases
b. Treatment might include: oxygen, medications, breathing
exercises
5. Medical psychology
a. Concerned with mental well-being of patients
b. Treatments might include: talk therapy, behavior modification,
muscle relaxation, medications, group therapy, recreational
therapies (art, music, dance).

6. Social Services
a. aid patients by referring them to community resources for living
assistance (housing, medical, mental, financial)
b. social worker specialties include: child welfare, geriatrics, family,
correctional (jail)
7. Pharmacy
a. dispense medications per written orders of physician, dentists, etc.
b. provide information on drugs and correct ways to use them
c. ensure drug compatibility
8. Dietary - responsible for helping patients maintain nutritionally
sound diets

9. Sports Medicine
a. provide rehabilitative services to athletes
b. teaches proper nutrition
c. prescribe exercises to increase strength and flexibility or correct
weaknesses
d. apply tape or padding to protect body parts
e. administer first aid for sports injuries
10. Nursing (RN, LVN, LPN)
a. provide care for patients as directed by physicians
b. many nursing specialties include: nurse practitioner, labor and
delivery nurse, neonatal nurse, emergency room nurse, nurse
midwife, surgical nurse, nurse anesthetist
c. In some facilities, Nursing is a service in and of itself.

4. Diagnostic services – determines cause(s) of illness or injury
• A. Includes the following departments:
1. Medical laboratory (MT) - studies body tissues to determine
abnormalities.
2. Imaging
a. Image body parts to determine lesions and abnormalities
b. Includes the following: diagnostic radiology, MRI, CT, ultra sound
3. Emergency medicine - provides emergency diagnoses and
treatment

5. Support Services—provides support to entire hospital. It includes
the following departments:
1. Central Supply
• a. in charge of ordering, receiving, stocking and distributing all equipment
and supplies used by healthcare facility
• b. sterilize instruments or supplies
• c. clean and maintain hospital linen and patient gowns
2. Housekeeping and Maintenance
• a. maintain safe clean environment
• b. cleaners, electricians, carpenters, gardeners

3. Biomedical Technology
a. Design and build biomedical equipment (engineers)
b. Diagnose and repair defective equipment (biomedical technicians)
c. Provide preventative maintenance to all hospital equipment
(biomedical technicians)
d. Pilot use of medical equipment to other hospital employees
(biomedical technicians)

Organizational structure in India
• Health system has 3 main links
– Central, state and local or peripheral.
• India is a Union of 28 states and 7 territories.
• Health is the responsibility of state.
• Central responsibility
– Policy making
– Guiding
– Assisting
– Evaluating and Coordinating the work of state health ministries.

At the Centre
Official organ
• The union ministry of health and family welfare
Headed by Cabinet minister
Minister of state
Deputy health minister
The union
ministry of health
and family
welfare
The directorate
general of health
services.
The central
council of
health and
family welfare.

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1. The union health ministry of health and family welfare
Department of health
Secretary to the Gov. of India
(Executive head)
Joint secretary
Administrative staff
Directorate general of health services
Subordinate officer
Department of family welfare
• Was created in 1966
Secretary to the Gov. of India
Secretary
Additional secretary
Commissioner
One joint secretary

2. Directorate general of health services
- Principal advisor in both medical and public health matter.
DGHS
Additional Director General of health services
Team of deputies
Administrative staff
Directorates - three main units
General
administratio
n
Public health
Medical care
and hospital

3. The central council of health and family welfare
– Chairman – Union health minister
– Members – State health ministers
Function
• To consider and recommend board outlines of policy in regards to
matters of health
• To make proposals for legislation in fields of medical and public
health matters and to lay down.
• To make recommendations to the central government regarding the
health.
• To established any organization with appropriate functions for
promoting and maintain cooperation between central and state health
administrations.

At the state level
• The state health administration was started in the year 1919.
• The state list which become the responsibility of the state included
– Provision of medical care
– Preventive health services
– Pilgrim within the state
State - management sector
Directorate of
health and family
welfare services
State ministry of
health

2. State ministry of health and family welfare
A. Headed - Cabinet minister and deputy minister. (Political head)
B. Responsibility - formulating policies
i. Monitoring the implementation of these policies and programmes.
3. State health directorate and family welfare
A. Principle advisor in matters relating to medicine and public health
B. Assisted by joint director, regional joint director and assistant
directors.

At the district level
• Principal unit of administration in India
• District health organization
– identifies and provide the needs of expanding rural health and
family welfare program
• Within each district again, there are 6 types of administrative
areas
• No uniform model of district health organization

Rural Urban
Panchayats
Villages
Community
Development
Blocks
Corporations
Municipal
Boards
Town area
committees
Tahsil (Taluka)
District
Sub-division

Panchayati Raj –
• 3 tier structure of rural local self government
• Linking the village to the district
Panchayat Raj
Panchayat Panchayat Samiti Zilla Parishad
Gram Sabha Gram Panchayat

Health care delivery system in India
At the block level
• Objective - to provide primary health care to all the sections of
the society.
• 80% of the population is scattered in villages
• 20% of rural population have health care facilities
Centre Plain area Hilly / Tribal / Difficult area
Community health centre 1,20,000 80,000
Primary health centre 30,000 20,000
Sub-centre 5,000 3,000

Community health Centre’s
• Established and maintained by the State Government under
MNP/BMS programme.
• As per minimum norms, a CHC is required to be manned by four
Medical Specialists i.e. Surgeon, Physician, Gynecologist and
Pediatrician supported by 21 paramedical and other staff.
• It has 30 in-door beds with one OT, X-ray, Labour Room and
Laboratory facilities.
• It serves as a referral centre for 4 PHCs and also provides facilities for
obstetric care and specialist consultations.
• As on March, 2011, there are 4,809 CHCs functioning in the country.

Primary health Centre’s
• First contact point between village community and the Medical
Officer.
• To provide an integrated curative and preventive health care with
emphasis on preventive and promotive aspects of health care.
• Established and maintained by the State Governments under the MNP/
BMS Programme.
• Manned by a Medical Officer supported by 14 paramedical and other
staff.
• NRHM - two additional Staff Nurses at PHCs (contractual).
• It acts as a referral unit for 6 Sub Centre’s and has 4 - 6 beds for
patients.
• There were 23,887 PHCs functioning in the country as on March
2011.

Sub-Centre
• Most peripheral and first contact point between the primary health
care system and the community.
• Manned by at least one ANM / Female Health Worker and one Male
Health Worker.
• Under NRHM, one additional second ANM on contract basis.
• Provide services in relation to maternal and child health, family
welfare, nutrition, immunization and control of communicable
diseases.
• Provided with basic drugs for minor ailments.
• Ministry of Health & Family Welfare is providing 100% Central
assistance to all the Sub-Centre’s
• 148,124 Sub Centre’s functioning in the country as on March 2011.

Village
• Accredited Social Health Activist (ASHA) for 1000 population
• Chosen by and accountable to the panchayat
• Act as the interface between the community and the public health
system.
• Honorary volunteer, receiving performance-based compensation
• Facilitate preparation and implementation of the Village Health Plan
• The other persons are
– Indigenous dais and Anganwadi workers

Rural health infrastructure: Norms and level of
achievements (All India)
S.
No.
Indicator National Norms Present Avg
Coverage
1 Rural Population (2011) (Provisional)
covered by
General Tribal/Hilly/
Desert
Sub Centre 5000 3000 5624
Primary Health Centre (PHC) 30000 20000 34876
Community Health Centre (CHC) 120000 80000 173235
2 Number of Sub Centre’s per PHC 6 6
3 Number of PHCs per CHC 4 5
4 Rural Population (2011) (Provisional) covered by a:
HW (F) (at Sub Centre’s and PHCs) 5000 3000 4008
HW (M) (At Sub Centre’s) 5000 3000 15955
5 Ratio of HA (M) at PHCs to HW (M) at Sub
Centre’s
1:6 1:3
6 Ratio of HA (F) at PHCs to HW (F) at Sub
Centre’s and PHCs
1:6 1:13

Urban health care delivery system in India
• The government of india has identified “urban health” as one of the
thrust area in the tenth five year plan, national population policy 2000,
national health policy 2002 and second phase of RCH program
The central government health scheme (1954)
• Objective of providing comprehensive medical health care facilities to
the central government employees and their family members.
Urban family welfare centers
• Launched during the first five year plan.
• At present 1083 centers are functioning and providing outreach
services, primary health services, mch services and distribution of
contraceptives.

Urban health post
• Urban Revamping Scheme – introduced following the
recommendations of the Krishnan Committee in 1983.
• To provide services through setting up of health posts mainly in slum
area.
• 4 type of health post were set up depending on the allotted population.
– Type A – less than 5000 population
– Type B – between 5000 to 10000 population
– Type C – between 10000 to 25000 populations
– Type D – between 25000 to 50000 populations
• Only Type D health post has a Medical officer.
• Services provided by these posts are outreach of RCH services, first
and referral services and distribution of contraceptives.

Health care delivery services in Delhi
• Well established infrastructure for its people
• One of the highest bed capacity (2.14 beds/1000 persons).
• Public Health expenditure consistently remained above 6 per cent .
• Delhi’s per capita expenditure on health is Rs. 685.
• However, there is multiplicity of agencies operating their health care
outlets in different areas or for defined subset of populations in
different areas like Delhi Government, MCD, NDMC, CGHS, DGHS,
ESI and Army etc.
• Primary health care level – Delhi has wide network of 969
dispensaries.
• Secondary and tertiary health care level – there are 706 hospitals
including 505 registered nursing homes with 33711 beds. There are
118 hospitals in the government sector in Delhi.

Health care delivery system in Mumbai
• Mumbai has a vast supply of public and private health care services.
The services range from the super specialty, tertiary-level care
hospitals to the general practitioners.
• The Central Government has its own dispensaries, which are
available only for their employees.
• ESIS - health care services that include hospitals and dispensaries
which cater to employees in the organized sector.
• The various government organisations, such as ports, railways and
defence, have their own health care services for their employees.
• The Municipal Corporation of Greater Mumbai (MCGM) provides
major facilities in the public sector along with the State Government.

Health care delivery system in Mumbai cont…
• The Department is divided into zonal set-ups for administrative
purposes.
• There are five such zones, which cover 23 Wards
• The Deputy Municipal Commissioner handles each zone.
• Each Ward has a separate Ward Office and the Ward Medical Health
Officer (MHO) heads the Public Health Department in that Ward.
• Family welfare and maternal child health programmes are under the
supervision of Officer- Maternal Child Health & Family Welfare at
F/South Ward.
• Peripheral hospitals linked to four super specialty hospitals. Health
posts and dispensaries linked to peripheral hospitals in their respective
Wards

Private health sector
• India - dominance of Private sector.
• In a NSS survey in 2001-02, 13 lakhs practitioners were working in
private sector.
• Accounts 80% of the total facility in the country.
• 88% of the towns have a medical facility compared to 24% in rural
areas with 90% of the facilities manned by sole practitioners.
• The private sector has 75% of specialists and 85% of the technology
in their facilities.
• The private sector accounts for 49% beds and an occupancy ratio of
44% whereas the occupancy rate is 62% in the public sector.

AYUSH
• Old acceptance in the communities in India
• Form the first line of treatment in case of common ailments in most of
the places
• Ayurveda is the most ancient medical system with an impressive
record of safety and efficacy.
• Mainstreaming AYUSH to strengthen the Public Health System at all
levels.
• AYUSH facilities had been co-located with 208 District Hospitals
(36%), 910 Community Health Centres (23%) and 3883 Primary
Health Centres in the country .

References
1. World Health Organization, Technical report series No. 122, Geneva, quoted in
Mrs. A. Dalal’s research thesis on hospital administration in Bombay with respect
to Bombay’s Municipal Teaching Hospitals.
2. Theirry, “Laying the Foundation” in world Health, March 1969, p.13.
3. Syed Amin Tabish, Hospitals & Nursing Homes, First Edition, 2003, Jaypee
Borthers, Medical Publishers (P) Ltd., New Delhi.
4. S.L. Goel and R. Kumar, Hospital Administration and Management, Deep & Deep
Publications Pvt. Ltd, New Delhi, 2007, pp. 28-29
5. Pragna Pai, “Hospital Administration and Management”, Second Edition, 2007,
The National Book Deposit, Mumbai, pp.4-8.
6. CM. Francis, Mario C de Souza, “Hospital Administration” 3rd Edition, 2000,
Jaypee Brothers Medical

7. S.L. Goel and R. Kumar, Hospital Administration and Management, Deep & Deep
Publications Pvt. Ltd, New Delhi, 2007, pp. 28-29
8. GOI. Twelfth five year plan (2012-2017) social sector, Volume III. Planning
commission government of India.p1- 47
9. MOHFW. Rural health care system in India-the structure and current scenario.
Rural health statistics 2011.
10. GOI. MOHFW. National rural health mission. [online]. [cited 2012 Dec 27].
Available from: http://www.mohfw.nic.in/NRHM.htm
11. Indian Public Health Standards (IPHS) guideline for community health centers,
Revised 2012. DGHS, MOHFW, GOI. 1-94
12. GOI. Financing and delivery of health care services in India. MOHFW 2005; 1-320
13. Park K. Park's Textbook of Preventive and Social Medicine. 21st ed. Prem Nagar,
Jabalpur, (M.P.), India: M/s Banarsidas Bhanot; 2011

End of
Introduction
“Precipitate as weather, she appeared from somewhere, then
evaporated, leaving only memory.”
― Haruki Murakami

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1 hospital its organisation and functions