What India’s first assessment of district hospitals found

NITI Aayog, the Government of India think-tank, released the country’s first performance assessment of government district hospitals September 30, 2021.

The assessment, Report on Best Practices in the Performance of District Hospitals framework, evaluated 707 district hospitals on 10 key performance indicators (KPI). It was based on data from 2017-18.

For this performance assessment, district hospitals were categorised into small (up to 200 beds), mid-sized (201-300 beds) and large hospitals (more than 300 beds). Of the total hospitals, 62 per cent were small. 

Here are some key findings of the assessment:

• On an average, a district hospital had 24 beds for 100,000 people. For the assessment, it was set that a hospital should have 22 beds for those many people. The World Health Organization recommends five hospital beds for every 1,000 people. According to the assessment, Puducherry had the highest average beds in the country while Bihar had the lowest average of six beds per 100,000 citizens.
• Only 27 per cent of the total 707 districts assessed met the doctor-to-bed ratio of 29 doctors per 100 beds in a hospital.
• 88 hospitals out of 707 had the required ratio of staff nurses.
• Only 399 hospitals were found to have a ratio of paramedical staff in position as IPHS norms laid down. IPHS norms based on corresponding bed category. Madhya Pradesh had the highest proportion (14.8 per cent) such hospitals, followed by Delhi (12.5 per cent) and UP (11.4 per cent).
• On an average, every district hospital in India had 11 support services, compared to the required 14. Only 89 hospitals had all support services. Tamil Nadu had the highest proportion (20.2 per cent) of hospitals with all support services, followed by Rajasthan (11.2 per cent), UP (10.1 per cent), Karnataka (10.1 per cent), and West Bengal (9 per cent).
• Only 21 hospitals fulfilled the criteria of having all diagnostic testing services available. Karnataka had the highest proportion (28.6 per cent) of hospitals with all support services, followed by Telangana (19 per cent), Andhra Pradesh (14 per cent) and Gujarat (9.5 per cent).
• 182 hospitals out of the 707 had bed occupancy of 90 per cent or more. Occupancy of 80-85 per cent is considered ideal. Uttar Pradesh (14.8 per cent) had the highest proportion of hospitals with bed occupancy rate greater than or equal to 90 per cent, followed by Madhya Pradesh (10.9 per cent), Maharashtra (8.2 per cent), Odisha (8.2 per cent), West Bengal (7.1 per cent) and Andhra Pradesh (5.5 per cent).
• At an average a doctor in a district hospital attends to 27 OPD patients.