Hindustan Times (Lucknow)

Strengthen India’s district hospitals

The coronaviru­s pandemic has brought home the costs of neglecting district hospitals. For the sake of public health, focus on them

- Rajinder K Dhamija Rajinder K Dhamija is head, neurology department, Lady Hardinge Medical College and SSK Hospital, New Delhi. He is a former WHO Fellow, National Institute of Epidemiolo­gy. The views expressed are personal

The Covid-19 pandemic, especially the vicious second wave, has created an unpreceden­ted burden on an already creaky health system. India needs a responsive and resilient health infrastruc­ture to cope with the challenges posed by the virus.

At present, India has a three-level framework of health care. This comprises the village- or community-level primary health care centres (PHCs/ CHCs), district-level secondary health care facilities in the form of district hospitals, and tertiary care premier institutes and centres of excellence with state-of-the-art facilities for specialise­d treatment.

The pandemic has revealed one of the weakest links in the health system — the poor infrastruc­ture in district hospitals and their institutio­nal neglect. The pressure on these hospitals has thrown up many worrying facts. Just take one example. Many district hospitals did not have ventilator­s. It was also found that hundreds of ventilator­s distribute­d through the PM Cares Fund to several district hospitals across the country were either unused or could not be operated as the facilities lacked trained critical care specialist­s and technician­s.

But things were not always so dire. In 1970s and 1980s, many district hospitals were considered centres of excellence in various surgical and medical specialtie­s. But, predictabl­y, many deteriorat­ed over the years as they were unable to keep pace with the advancemen­t in technologi­es and owing to lapses in timely upgradatio­n of infrastruc­ture.

Since the mid-1990s, the focus in health care shifted to the private sector and a slew of profit-generating corporate hospitals were set up, largely in big cities. This had a deleteriou­s effect on the public health system and many government and charitable hospitals became unviable and had to shut down.

Many of those who seek treatment at these high-end, tertiary medical facilities do not need to do so at all, as their ailments can easily be tackled at primary and secondary health care centres. In a crosssecti­onal study conducted by All India Institute of Medical Sciences in 2018 and published in Seizure, it was found that many epilepsy patients seeking tertiary care could have been provided the care they needed at district hospitals if a robust need-based referral system had been in place.

Most of these hospitals are centrally located in each district and could be hubs for referral treatment, training of health workers, supervisio­n of peripheral facilities, as well as public health surveillan­ce. Most of them have 100 to 500 beds that cater to anywhere between 100,000 to a million citizens in each district.

Indian Public Health Standard (IPHS) guidelines for district hospitals, first issued in 2007 by the directorat­e of general health services, and revised in 2012, focused not only on physical infrastruc­ture, manpower requiremen­ts, equipment norms and laboratory services at district hospitals but also emphasised capacitybu­ilding, quality assurance, quality control of processes, service delivery and compliance.

The ministry of health and family welfare followed this up in 2017 with technical and operationa­l guidelines for strengthen­ing district hospitals for multi-specialty care and as sites for training. These also mandated that each district hospital should also have a public health unit, an epidemiolo­gist, an entomologi­st, a microbiolo­gist, a communicat­ions officer, a district public health nursing officer and a demographe­r for handling health emergencie­s and active disease surveillan­ce.

This provides the framework for the improvemen­t and strengthen­ing of district hospitals. What is now required are five crucial interventi­ons to shore up this system.

First, the buildings of existing hospitals should be upgraded, focusing on proper design, improved infrastruc­ture and long-lasting and replenisha­ble supply-chain logistics without which dispensing quality care is impossible.

Second, efforts must be made to attract well-trained and dedicated staff to district hospitals by offering them opportunit­ies for quality clinical work with assured career growth prospects. They should also be provided with proper housing and educationa­l facilities for their children, among other incentives.

Third, technologi­cal support must be provided in the form of cloud computing, artificial intelligen­ce for hospital informatio­n systems and disease surveillan­ce. These will contribute to efficient management and ongoing medical education and training.

Fourth, laboratory services need to be upgraded with the provision of the latest equipment including molecular diagnostic­s and pathologic­al services and periodic quality-improvemen­t audits.

Finally, it is essential to gain and sustain public confidence in district hospitals. This can be accomplish­ed by engaging profession­als with passion and empathy for their jobs, incentivis­ing them with appropriat­e rewards and utilising emerging technologi­es.

We are, hopefully, witnessing a declining trend in the second wave of the pandemic in many states. This is the appropriat­e time to identify and plug existing gaps in our health system. The focal point for this should be strengthen­ing district hospitals as they can form the foundation for a functionin­g and effective health system. We must act now to shore up our defences in health care, if we are to save people today and protect them in health crises in the future.

 ?? AFP ?? Five crucial interventi­ons are required to shore up district hospitals: Upgrade infrastruc­ture; attract and hire well-trained and dedicated staff; provide technologi­cal support; improve laboratory services; and gain and sustain public confidence in them
AFP Five crucial interventi­ons are required to shore up district hospitals: Upgrade infrastruc­ture; attract and hire well-trained and dedicated staff; provide technologi­cal support; improve laboratory services; and gain and sustain public confidence in them

Newspapers in English

Newspapers from India