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The hospital in rural and urban districts. Report of a WHO Study Group on the Functions of Hospitals at the First Referral Level.
WORLD HEALTH ORGANIZATION TECHNICAL REPORT SERIES. 1992; (819):i-vii, 1-74.In 1992, the WHO Study Group on the Functions of Hospitals at the First Referral Level compiled a report on the functions of the hospital in rural and urban districts. It advocates that the 1st referral level hospital should be integrated into the district health care system, which is administered by a district health council. This approach strengthens primary health care and uses hospital resources to promote health. The most pressing need for this approach to work is changing people's attitudes and motivation. Various obstacles invariably slow this integration process such as resistance by central and local government officials and inadequate funding. The district hospital should help people to find health rather than just cure disease. Further it must accept the fact that it is not the center of the health system. This means a redistribution of both finance and effort. Governments need to improve the decentralization process to facilitate integration. The study group proposes a step by step methodology to integrate the health system. The 1st step is creating a district health council with representatives from the district health office, the hospital, other sectors of the health care system, and the community. The council determines the community diagnosis including population trends, patterns of morbidity and mortality, and disease and risk distribution by age and location. It also needs to review health services in the district. The council can divide these services into preventive, promotional, curative, rehabilitative, and organizational services. It also must reassess distribution of resources including people, buildings, equipment, and materials. The council must draft a plan and deliberate on implementing the plan. Once the council has taken these steps, it can then implement, monitor, and evaluate the plan and its results.
Hospitals and health for all. Report of a WHO Expert Committee on the Role of Hospitals at the First Referral Level.
WORLD HEALTH ORGANIZATION TECHNICAL REPORT SERIES. 1987; (744):1-82.The World Health Organization (WHO) Expert Committee on the Role of Hospitals at the First Referral Level met from December 9-17, 1985, to review the role of the hospital in the broader context of a health system. The Expert Committee recognized that different strategies could be used to define the role of hospitals in relation to primary health care and that, for example, it would be possible to begin by analyzing what hospitals currently are doing with respect to primary health care, describe the different approaches being used, and then formulate guidelines to be followed by hospitals that are seeking to strengthen their involvement in primary health care. A shortcoming of this strategy is that it is based on what hospitals are already doing in particular circumstances, rather than helping people to decide what is required in a wide range of different settings. Consequently, the Expert Committee undertook to provide an analysis of primary health care, particularly in relation to the principles of health for all, to specify the components of a district health system based on primary health care, and to use this information as a basis for describing the role of the hospital at the first referral level in support of primary health care. This report of the Expert Committee covers the following: hospitals versus primary health care -- a false antithesis (the need for hospital involvement, the evolution of health services, expanding the role of hospitals, delineation of primary health care, hospitals and primary health care, and the common goal of health for all); components of a health system based on primary health care (targeted programs, levels of service delivery, and the functional infrastructure of primary health care); role and functions of the hospital in the first referral level (patient referral, health program coordination, education and training, and management and administrative support); the district health system; and approaches to some persistent problems (problems of organization and function; problems of attitudes, orientation, and training; and problems of information, financing, and referral system). The report includes recommendations to WHO, to governments, to nongovernmental organizations, and to hospitals. The Expert Committee considered that the conceptual focal point for organizational and functional integration should be the district health system encompassing the hospital and all other local health services. Further, the Expert Commitee was convinced that organizational and functional interaction (focused on the district health system) is imperative if full and effective use is to be made of the resources of the hospitals at the first referral level and if the health needs of the population are to be met.
Lancet. 1998 Sep 12; 352(9131):889.Last week, the Delhi High Court, during its own suo moto motion against the Municipal Corporation of Delhi and the Central government, chastised the government of India and the government of the Delhi state for ignoring warnings concerning dengue. These warnings were given by the World Health Organization (WHO) and experts at the meeting in Pune in 1994. The Court also chastised the government's criminal negligence which caused hundreds of deaths from the disease in 1996. The Court was alerted by mass media reports of the government's failure to deal with the spreading epidemic in the second half of 1996. 10,252 patients were admitted to hospitals in Delhi; 423 patients died. Hospitals were ill equipped, and blood banks were disorganized. There were no dengue control initiatives until 1997, when they were instituted by court order. The 10 major Delhi hospitals are now required to be fully equipped for any dengue outbreak, and the Central and Delhi governments have been ordered to prepare dengue control programs at the national and state levels. Justices Bhandari and Kumar stated that the respondents must adhere to any further suggestions or warnings by WHO, and that a similar blunder must not be repeated.
Washington, D.C., World Bank, 1992. xxvii, 133 p. (World Bank Country Study)In the early 1990s, the World Bank sent a team of specialists in demography, medicine, hospital administration, health policy, personnel, medical technology, and finance to China to examine the present health status of the population and to protect its future status. Before making any projections, however, they had to learn what demographic and epidemiologic factors would basically determine future health status. The main factors driving China's health transition included aging of the population; increased risk of developing chronic disease caused by changes in life style, dietary, environmental, and occupational risk factors; and changing morbidity and mortality patterns (i.e., shift from infectious to disabling and chronic diseases). The team mapped out specific strategies, which can indeed be achieved, to avert a health care crisis. The strategies revolved around a sustained effort of primary prevention of chronic diseases, especially circulatory diseases, which caused considerable premature mortality. The team illustrated how different formulas of total health expenditures would affect epidemiologic outcomes. The team learned that health care costs would probably increase due to unavoidable demographic trends (especially demographic aging), epidemiologic forces, and utilization and unit cost changes. Suggested primary prevention strategies alone would not be enough to control health expenditures to a level where feasible equity can be maintained. China must also greatly improve efficiency of hospital services, personnel, and technologies. The evaluation team concluded that the government needs to reassess policies for financing primary and preventive health services, the basis and conditions of insurance, and the role of prices and incentives in directing use and provision of services.
POPULATION RESEARCH ABSTRACT. 1991 Dec; 2(2):3-11.An overview, objectives, implementation, and research and evaluation studies of 2 India Population Projects in Karnataka are presented. The India Population Project I (IPP-I) was conducted in Karnataka and Uttar Pradesh. India Population Project III (IPP-III) took place between 1984-92 in 6 districts of Karnataka: Belgaum, Bijapur, Dharwad, Bidar, Gulbarga, and Raichur, and 4 districts in Kerala. The 6 districts in Karnataka accounted for 36% (13.2 million) of the total national population. The project cost was Rs. 713.1 million which was shared by the World Bank, and the Indian national and regional government. Due to poor past performance, these projects were undertaken to improve health and family welfare status. Specific project objectives are outlined. IPP-I included an urban component, and optimal Government of India program, and an intensive rural initiative. The urban program aimed to improved pre- and postnatal services and facilities, and the family planning (FP) in Bangalore city. The rural program was primarily to provide auxiliary nurse-midwives and hospitals and clinics, and also supplemental feeding program for pregnant and nursing mothers and children up to 2 years. The government program provided FP staff and facilities. IPP-I had 3 units to oversee building construction, to recruit staff and provide supplies and equipment, and to establish a Population Center. IPP-III was concerned with service delivery; information, education, and communication efforts (IEC) and population education; research and evaluation; and project management. Both projects contributed significantly to improving the infrastructure. A brief account of the types and kinds of studies undertaken is given. Studies were grouped into longitudinal studies of fertility, mortality, and FP; management information and evaluation systems for health and family welfare programs; experimental strategies; and other studies. Research and evaluation studies in IPP-III encompassed studies in gaps in knowledge, skills, and practice of health and FP personnel; baseline and endline surveys; and operational evaluation of the management information and evaluation system; factors affecting primary health care in Gulbarga district; evaluation of radio health lessons and the impact of the Kalyana Matha Program; and studies of vaccination and child survival and maternal mortality. Training programs were also undertaken.
World Health Forum. 1981; 2(4):525-8.In recent years, the hospital has been recognized as an integral part of a comprehensive health system. Because of this, the hospital manager must deal with the broader issues of health services management, as well as with the immediate problems of the management of an individual hospital. The problems hindering the improvement of hospital management and its training programs include: 1) Lack of a solid data base concerning the health status of the population, and range of health resources available to serve the population. 2) Limited funds for the training of managers, despite many governments' assurances of their commitment to the importance of efficient management. 3) Appointments to top management positions of physicians who have little or no management training. The development of profiles or inventories of the existing health situation and health care services available at both district and village levels will help solve some of the current management problems. Increased management training should be expanded wherever possible. Increased communication between regional centers for training and research into management should be developed. There must be stronger governmental commitment at the national level to improve management of hospitals.