Rationalisation of Service Norms for Secondary Care Hospitals
Introduction
The Government of Tamil Nadu is strongly committed to strengthen the health sector for improving the health status of the population. A number of steps have been taken during the last 2 decades to that effect. One such step is strengthening of the referral services and provision of speciality services at District and Sub district hospitals. Senior specialists like Surgeons, Physicians, Obstetrician and Gynecologists, Pediatricians, Orthopedic Surgeons, Ophthalmologists, Anaesthetists and ENT Surgeons in the grade of Civil Surgeons were posted in all the District Head Quarters Hospitals in the eighties and they were allotted specific number of beds in their specialities. Major hospitals had more specialists like Dermatologists, Psychiatrists etc. Again in the early nineties, specialists in the grade of Assistant surgeons were posted in the major sub district hospitals. After introduction of First Referral Unit Scheme Obstetrician and Gynecologists, Pediatricians and Anaesthetists were posted in identified 136 sub district hospitals which are functioning as First Referral Units.
However the staff strength, bed strength, equipment supply and service availability are not uniform among all the district hospitals and among all the sub district hospitals. Hence, the Government of Tamil Nadu decided to develop service norms to various categories of hospitals as also the staff norms, equipment norms, building norms as well as distribution of beds to each speciality.
Development of Norms for Clinical Services
The State Government had developed norms in clinical services in consultation with the specialists in the subjects from different levels of institutions and clinical specialists from the teaching institutions. These norms were also compared with the service norms of other States where HSDPs are implemented. While revising / developing these norms, standards were given to the working groups from different sources to be supplemented by their own clinical experience and to have it matched by service provisions at various levels. The service norms thus developed were revised further and elaborated to produce norms for facilities of different sizes (bed number) with different specialist departments. For revising the norms, the state government organized a workshop to finalise various norms in consultation with district health authorities, including Joint Directors of Health Services (JDHS), Deputy Directors (DD) (Medical), Deputy Director of Health Services (DDHS), Specialists, Medical Officers, Nursing and Other Personnel and as well as the state level officers like Director of Medical and Rural Health Services (DM&RHS), Director of Medical Education (DME) and Director of Public Health and Preventive Medicine(DPH&PM).
Grading of Hospitals
- The hospitals are now graded into six grades (viz.)
- Dist Hospital Gr I Norms 500 beds (Range: above 350 beds)
- Dist Hospital Gr II Norms 300 beds (Range: 350 beds and below)
- Sub Dist Hospital Gr I Norms 200 beds (Range: between 150 to 250)
- Sub Dist Hospital Gr II Norms 100 beds (Range: 75 to 150 beds)
- Sub Dist Hospital Gr III Norms 50 beds (Range: 40 to 75 beds)
- Sub Dist Hospital Gr IV Norms 30 beds (Range: less than 40 beds)
- The Block PHCs which are provided with 30 beds will also have all the facilities of Grade-IV sub district hospital.
- The PHCs where only 6 beds are available will adhere to the service norms of PHCs.
- Speciality wise distribution of beds
- The workshop has also finalized speciality wise distribution of beds for each speciality in the hospitals. An emphasis has been given to Maternity and Family Welfare department in the allocation of beds depending upon the present level of utilization under these services.
Presently, at the district hospitals only the Senior Civil Surgeons are posted speciality wise. The other doctors are not identified specialitywise. Similarly in sub district hospitals, all posts are general posts only, resulting in maldistribution of specialists. Hence, the workshop has recommended identification of each and every post of doctor in district hospitals and sub district hospitals specialitywise. This rationalization of doctors posts will go a long way in providing speciality services in district and sub district hospitals continuously without any postings mismatch of specialists. The number of posts of nursing personnel is also rationalized so that adequate nursing personnel are available at all the departments to provide quality-nursing service and ward management. Similar exercise is done as to the para medical workers and sanitary workers. Posts of technicians are also rationalized as per the equipment norms and work load.
Diagnostic and Investigation Facilities
Norms concerning equipments for diagnostic services have been recommended for various types of hospitals. Sufficient laboratory investigation services are recommended for each grade of hospital obviating the need for the patient to be referred to higher institution for the sake of minimum lab tests.
Equipment Norms
Equipment norms are worked out keeping in mind the service norms recommended for various grades of the hospitals. The equipments required are worked out under the following headings:
- Imaging equipments
- X Ray Room Accessories
- Cardiac Equipments
- Labour ward & Neo Natal Equipments
- Ear Nose Throat Equipments
- Eye Equipments
- Dental Equipments
- Operation Theatre Equipment
- Laboratory Equipments
- Surgical Equipment Sets
- PhysioTherapy Equipments
- Endoscopy Equipments
- Anaesthesia Equipments
- Furniture & Hospital Accessories
- PM equipments
- Linen
- Teaching Equipments
- Administration
- Refrigeration & AC
- Hospital Plants
- Hospital Fittings & Necessities
- Transport