Lok Sabha Question No. 175 (UNSTARRED), answered on 2017-12-15
Subject: Performance of District Hospitals
Ministry: HEALTH AND FAMILY WELFARE
Asked by: AJAY (TENI) MISRA, G. HARI

## GOVERNMENT OF INDIA MINISTRY OF HEALTH AND FAMILY WELFARE DEPARTMENT OF HEALTH AND FAMILY WELFARE

## LOK SABHA UNSTARRED QUESTION NO. 175 TO BE ANSWERED ON   15 TH DECEMBER, 2017

## PERFORMANCE OF DISTR ICT HOSPITALS

## 175. SHRI AJAY MISRA TENI: SHRI G. HARI:

Will the Minister of HEALTH AND FAMILY WELFARE be pleased to state:

- (a) whether the Government has any proposal to launch index to assess performance of district hospitals in the country and if so, the details thereof;
- (b) the details of parameters to b efor the performance/rating of district hospitals;
- (c) whether despite large funds being allocated to district hospitals there is no comprehensive system to assess their performance and if so, the details thereof;
- (d) whether the Government has identified facilities which need focus by the State Government; and
- (e) if so, the details thereof?

## ANSWER THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE (SHRI ASHWINI KUMAR CHOUBEY)

- (a) & (b): Yes. An index has been developed by NIT I Aayog in consultation with various stakeholders  including  Ministry  of  Health  &  Family  Welfare  (MoHFW),  and  representative from  States.    NITI  Aayog  has  devised  a  methodology  to  rank  district  hospitals  acros country. The District Hospitals would be c ategorized on the basis of bed count. District Hospital of North Eastern States would be ranked separately amongst themselves. Each District Hos would be provided a score on the basis of 16 indicators covering infrastructure, quality resources and services rendered.

Parameters for ranking of District Hospitals are annexed.

- (c): Under  National  Health  Mission  (NHM),  a  comprehensive  system  to  assess  the performance of various public health facilities, including district hospitals, implemented under the National Quality Assurance Programme (NQAP).

h

NQAP has defined 30 key pe rformance indicators grouped as productivity, efficiency, clinical care & safety and service quality, for assessment of performance of District H The hospitals report these indicators through the institutional mechanism set up under National Quality Assurance Standards guidelines is available at URL: ' http://nhsrcindia.org/sites/ default/files/ Operational%20Guidelines%20on%20Quality %20Assurance.pdf' which includes the list of indicators.

(d)& (e): Public  Health  and  Hospitals  being  a  State  subject,  the  primary  responsibi regarding  provision  of  healthcare  services  lies  under  the  jurisdiction  of  the  S Governments, including strengthening of health facilities. Central Government does no t identify particular health facilities that need focus by State Government centrally. However, unde technical and financial support is provided to States/UTs for strengthening their overa systems based on the proposals received from them in their NHM- Programme Implementation Plans  (PIPs),  within  their  overall  resource  envelope.  This  support  inter  alia  include towards strengthening of health facilities identified by them, if any.

## Parameters for ranking of District Hospita ls :

The ranking would involve the following 16 indicators covering infrastructure, quality, human resources and services rendered , which are categorized majorly as:

- i. Structure
- ii. Process
- iii. Outcome/ output

These indicators are categorized into two major types:

- i. Indicators that are largely under the control of the State (Category A)
- ii. Indicators that are largely under the control of the District hospital (Categ

The  indicators  were  identified  and  finalized  after  due  consultation  with  stake involving MoHFW, NITI Aayog, States/ UTs and Development Partners.

beds per

services

| Domain                     |   Weightage (%) | Category   | Indicators                                                                                                                      |
|----------------------------|-----------------|------------|---------------------------------------------------------------------------------------------------------------------------------|
| Structure (15%)            |               3 | A          | 1. Number of functional hospital 100,000 population                                                                             |
| Structure (15%)            |               3 | A          | 2. a -Ratio of doctors in position to IPHS b- Ratio of staff nurses in position norm c- Ratio of paramedical staff in IPHS norm |
| Structure (15%)            |               3 | B          | 3. Proportion of support services                                                                                               |
| Structure (15%)            |               3 | A          | 4. Proportion of core healthcare available                                                                                      |
| Structure (15%)            |               3 | A          | 5. Proportion of diagnostic services available                                                                                  |
| Process (10%)              |               5 | B          | 6. Kayakalp score                                                                                                               |
| Process (10%)              |               5 | B          | 7. Quality score                                                                                                                |
| Outputs and Outcomes (75%) |               8 | B          | 8. Number of laboratory tests per                                                                                               |
| Outputs and Outcomes (75%) |               8 | B          | 9. Stock out rate of essential drugs                                                                                            |
| Outputs and Outcomes (75%) |               8 | B          | 10. OPD per doctor                                                                                                              |
| Outputs and Outcomes (75%) |               9 | B          | 11. Bed occupancy rate                                                                                                          |
| Outputs and Outcomes (75%) |               8 | B          | 12. Surgical Productivity Index                                                                                                 |
| Outputs and Outcomes (75%) |               8 | B          | 13. C - section rate                                                                                                            |
| Outputs and Outcomes (75%) |               8 | B          | 14. Blood bank replacement rate                                                                                                 |
| Outputs and Outcomes (75%) |               9 | B          | 15. Post - surgical infection rate                                                                                              |
| Outputs and Outcomes (75%) |               9 | B          | 16. Patient satisfaction score                                                                                                  |

Each indicator has been assigned a specific weightage which would be considered while scaling indicator. A composite index based on the scaled value of the indicators w generated to provide the final score to the district hospital.