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Confidential As-Is Report on Government Doon Male Hospital, Dehradun

NHSRC and ICRA Management Consulting Services Limited Page 1

Government Doon Male Hospital

As-Is Analysis Report

Submitted to

National Health Systems Resource Centre

From

ICRA Management Consulting Services Ltd

June 2008



Contents Landscape of the Study .................................................................................................................... 5

Approach to the Study ...................................................................................................................... 6

Hospital Fact Sheet .......................................................................................................................... 7

Overview Uttarakhand State Health Services ................................................................................... 8

Health Facilities in Uttarakhand ........................................................................................................ 9

Background of the hospital ............................................................................................................. 12

Key Issues ...................................................................................................................................... 15

Hospital Layout ............................................................................................................................... 17

Patient Care Services at the hospital .............................................................................................. 19

Health Programmes ........................................................................................................................ 22

Patient Volume and profile .............................................................................................................. 23

Operating Statistics ......................................................................................................................... 24

Out-Patient (OP) Services ........................................................................................................... 27

In Patient (IP) Service ................................................................................................................. 27

Operation Theatre ....................................................................................................................... 29

Emergency.................................................................................................................................. 31

Intensive Care unit ...................................................................................................................... 31

Transfusion Medicine .................................................................................................................. 31

Laboratory Services .................................................................................................................... 31

Imaging Services ........................................................................................................................ 32

Engineering Service .................................................................................................................... 32

Medical Store Supply Services .................................................................................................... 32

Governance ................................................................................................................................ 32

Financial Analysis ........................................................................................................................... 35

Chikitsa Prabandhan Samiti at the hospital ................................................................................. 35

Gap Analysis .................................................................................................................................. 36

Gap Classification ....................................................................................................................... 36

1. Governance & Management Gaps-GM 001 to 014 ............................................................... 37

2. Out Patient Department-OP 001 to 003 ................................................................................ 54

3. In-Patient Department-IP 001 to 010 .................................................................................... 57

4. Emergency-EM 001 ............................................................................................................. 68

5. Operation Theatre-OT 001 to 003 ........................................................................................ 70



6. Dialysis Room-DY 001 to 002 .............................................................................................. 77

7. Laboratory- LB 001 to 004 .................................................................................................... 79

8. Transfusion Medicine ........................................................................................................... 83

9. Imaging-IM 001 .................................................................................................................... 85

10. Medical Store-MS 001 to 006 ........................................................................................... 86

11. Injection Room-IR 001 ...................................................................................................... 94

12. Kitchen-KI 001 to 003 ....................................................................................................... 95

13. Medical Records- MR 001 ................................................................................................ 98

14. Customer Satisfaction- CS 001 ....................................................................................... 100

15. Employee Satisfaction- ES 001 ...................................................................................... 102

The Next Steps ............................................................................................................................. 104

Annexures .................................................................................................................................... 106

Annexure 1: List of People Interviewed ..................................................................................... 106

Annexure 2: List of Documents Reviewed in the Hospital ......................................................... 108

Annexure 3: Areas and Sections Analysed for As-Is Survey ..................................................... 111

Annexure 4: Detailed Manpower Calculations ........................................................................... 112

Annexure 5: Chikitsa Prabandhan Samiti .................................................................................. 115

Annexure 6: Patient Satisfaction Survey Questionnaire and Attributes ...................................... 117

Annexure 7: Employee Satisfaction Survey Questionnaire and Attributes ................................. 119

Details of Dehradun District CHC‘s and PHC‘s ............................................................................. 121

1. CHC- Mussoorie ................................................................................................................. 129

2. CHC- Raipur ...................................................................................................................... 131

3. CHC- Doiwala .................................................................................................................... 133

4. CHC- Sahaspur .................................................................................................................. 135

5. CHC- Vikas Nagar .............................................................................................................. 137

6. CHC- Sahiya ...................................................................................................................... 139

7. CHC- Chakrata................................................................................................................... 141

8. PHC- Balawala ................................................................................................................... 143

9. PHC- Nehrugram ............................................................................................................... 145

10. PHC- Raiwala ................................................................................................................. 147

11. PHC- Chiddarwala .......................................................................................................... 149

12. PHC- Kunja .................................................................................................................... 151

13. PHC- Prem Nagar .......................................................................................................... 153

14. PHC- Thano.................................................................................................................... 155

15. PHC- Bhaniyawala.......................................................................................................... 157



16. PHC- Kalsi ...................................................................................................................... 159

17. PHC- Dudhali .................................................................................................................. 161

18. PHC- Rajawala ............................................................................................................... 163

19. PHC- Mehuwala ............................................................................................................. 165

20. PHC- Bhagwantpur ......................................................................................................... 167

21. PHC- Tyuni ..................................................................................................................... 169

22. PHC- Nayagaon Pelio ..................................................................................................... 171

23. PHC- Pachimwala .......................................................................................................... 173

24. PHC- Rudrapur ............................................................................................................... 175

25. Primary Health Centre, Herbertpur ................................................................................. 177

26. Primary Health Centre, Manthad..................................................................................... 177

27. Primary Health Centre, Kwanza ...................................................................................... 177

28. Primary Health Centre, Pigitlani ...................................................................................... 177



Landscape of the Study

In the current state of affairs in India, most of the public healthcare facilities have scope for

improvement in both the direct and indirect patient care areas, in terms of its resources and

processes involved in delivering healthcare service. In-order-to ensure comprehensiveness of care

delivered; there is a need to focus on:

Improving the quality of resources and processes involved in the care delivery system (both

direct and in-direct),

Laying down well documented systems to monitor, evaluate and train the system to sustain,

and continuously up-grade quality within the facility.

As a part of National Rural Health Mission (NRHM) the MoHFW has established National Health

Systems Resource Centre (NHSRC) to:

Principally coordinate and provide technical assistance to MOHFW Public Health Systems

across the Indian States,

Take initiatives for improving the health systems encompassing various facets of the health

system – capacity building, robust and responsive health information system, PPP,

community monitoring & empowerment, immunisation, quality assurance, among others.

The current mandate targets the capacity building of select health care facilities in 8 states,

Uttarakhand being one of them. The agenda includes:

Mapping the As-is Process

Identifying the resource and process gaps

Developing documents in line with the ISO requirements

Developing systems for continuous evaluation, monitoring, control and improvement to

ensure customer satisfaction

Undertaking requisite training to manage the change

Incorporate learning and best practices from the facilities that are best in the health sector

Achieving ISO certification as a milestone



Approach to the Study The current facility at Government Doon Hospital and its processes are evaluated against the IPHS

standards, and ISO 9001-2000 guidelines to analyse the as-is scenario.

The method of as-is mapping at the District Hospital includes the following:

Observation of the processes and the facility

Study of the documents available at the departments

Data collection from the hospital records, patients & staff (survey)

Participative brainstorming with department heads/in-charges of hospital areas

All the data collected by the above tools, has been collated and analysed to offer a comparative

format for efficient gap identification.



Hospital Fact Sheet

1 Name of the Institution : Government Doon Hospital (Male)

2 Date of establishment : 1854

3 Size of hospital (no. of inpatient

beds)

: 252 (sanctioned)

4 Scope of services : Large size general hospital

5 Name of owner entity : State Government of Uttarakhand

6 Status of owner entity : State Government

7 Chief Medical Superintendent : Dr. R K Pant

8 Registered office / address : Government Doon Hospital, Dehradun,

Uttarakhand



Overview Uttarakhand State Health Services Uttarakhand1 came into existence on the 9th of November 2000 and constituted the 27th state of

the Republic of India. The state was earlier a part of the State of Uttar Pradesh. About 63 percent of

the State‘s geographical area is covered by forests and is rich with numerous species of trees and

herbs. About 93 percent of the area is hilly, and the remaining 7 percent is covered by plains. From

the administrative point of view the state comprises of 13 districts, 49 tehsils, 95 blocks, and 16,414

villages. The state has 86 cities / towns of which only 5 are major cities with a population of more

than 100,000.

As per the 2001 census, the population of Uttaranchal is 8.5 million with a population density of 159

persons per square kilometers; sex ratio is 964 females per 1,000 males, and the sex ratio for the

juvenile population being (0-6 years) 906.The population size of districts varies from a minimum of

200,000 to a maximum of 1.4 million. Uttaranchal is predominantly rural with about 74 percent of the

population living in 16,414 rural settlements. Of the total villages, more than four-fifths are small

villages with population less than 500 persons. Another 10 percent have population sizes ranging

between 500 - 999 persons and the remaining 6 percent are villages with over 1,000 populations.

Small-sized, scattered villages without road connectivity pose a major challenge to health service

delivery. Hilly districts are at a disadvantage compared with districts in the plain areas.

The Government of Uttarakhand is committed to improve the health status and quality of life of its

people, by focusing on health issues with the objective of reducing disease burden, creating an

enabling environment, influencing direct and indirect health determinants such as nutrition, water,

sanitation and other factors like education and employment in the state. The Government intends to

reach the replacement level of fertility, population stability with due attention to disadvantaged

sections, inaccessible and remote areas.

1 Source: Department of Medical Health and Family Welfare, Uttarakhand



Health Facilities in Uttarakhand The health facilities available in the State are as below:

Primary Level Health Services Secondary Level Health Services

Main Centre 84 Community Health Centers 49

Sub Centre 1765 Combined Hospitals 15

State Allopathic Dispensaries 322 District Hospital (Male/Female) 17

Female Rural Hospitals 24 Base Hospitals 3

Additional Primary Health Centers 187 Regional Diagnostic Centers 3

Primary Health Centers 45 TB Clinics / Hospitals / Sanatoriums 19

Health Posts 9 Leprosy Hospitals 3

Urban Family Welfare Centers 2 Blood Banks (Private Sector) 5

Post Partum Centers 24 Blood Banks (Public Sector) 17

TB Clinics 19 Mobile Dispensaries 3

The tertiary care is offered through Medical College hospitals. Doon Hospital being the premier

hospital of the newly formed Uttarakhand State, few departments have been up-graded to provide

tertiary care by engaging super-specialties on contractual basis. This apart the State has following

healthcare facilities:

Ayurvedic / Unani Hospitals

Ayurvedic Dispensaries 516

District Ayurvedic Hospitals 2

Unani Hospitals 5

Homeopathic Hospitals 107

At a generic level, the medical facilities provided by the different types of health centres are aimed

at providing comprehensive healthcare facility through a regionalized healthcare delivery system in

Uttarakhand State. The functional mandate of each type of healthcare unit is:

Sub Centers



Sub-centres (SC) are mandated to offer preventive and promotive care through the various National

Health Programs (NHP): such as-Mother & Child Care (MCH) services; Janani Suraksha Yojna to

encourage safe institutional delivery; Universal Immunization Programme; Family Welfare Services;

Primary Medical Care; Birth & Death Registration, Micro Nutrient Program--Like Distribution of

Vitamin A, Iron & Folic Acid; DOTs provider for Tuberculosis; Collection of Health Data & Vital

Statistics

Primary Health Centers

Primary Health Centres (PHC) are mandated to offer preventive, promotive and curative care in

broad specialties through its outpatient (OP), and In-patient Services (IP); participate in Control of

Epidemic, Endemic & Communicable Disease Programme; implementation of all National

Programmes; Provision of Micro Nutrient: Like Vitamin A & Iron & Folic Acid; undertake Behavioral

Change Communication Program through- Public awareness Campaign for Safe Water Supply &

Basic Sanitation; Collection & Reporting of Vital Statistics; Reproductive and Child Health (RCH);

Referral Services and Emergency Services

Community Health Centers

Community Health Centres (CHC) is mandated to offer preventive, promotive and curative care in

broad specialties through its outpatient (OP), In-patient (IP), Surgical, and Investigative Services. It

is also mandated to participate in Control of Epidemic, Endemic & Communicable Disease

Programme; implementation of All National Programmes; Provision of Micro Nutrient: Like Vitamin

A & Iron & Folic Acid; undertake Behavioral Change Communication Program through- Public

awareness Campaign for Safe Water Supply & Basic Sanitation; Collection & Reporting of Vital

Statistics; Reproductive and Child Health (RCH); Referral Services and Emergency Services

First Referral Units

First Referral Unit (FRU) is mandated to offer preventive, promotive and curative care in broad

specialties through its outpatient (OP), In-patient (IP), Surgical, Investigative, and Neo-Natal Care

/Obstetric Care Services. It is also mandated to participate in Control of Epidemic, Endemic &

Communicable Disease Programme, and integrate National Programme in CHCs with all the

existing Programmes like Blindness Control, Iodine Deficiency, Integrated Diseases, Reproductive

and Child Health, along with Emergency, Medico Legal, and 24 hour Ambulance service.

District Hospital

District Health Centres (DHC) is mandated to offer preventive, promotive and curative care in broad

specialties and select sub-specialties depending upon the community requirement through its

outpatient (OP), In-patient (IP), Surgical, Emergency Services, Ambulance, Investigative, and Post



Mortem Services. They can be male or female depending upon the community that they want to

address, or may be combined.

In the 10th (2002-07) 5 year plan about 240 Sub-centers, 19 PHCs, 26 CHCs, 7 Blood banks, 5 TB

Clinics, 1 District Hospital and 3 Regional Diagnostic Centers were established. In the 11th 5 year

plan (2007-2012) the objective of Directorate of Medical Health & Family Welfare is to ensure

"Health for All".

It is this challenge to offer comprehensive preventive, promotive and curative care in the

broad specialties and select sub-specialties to the population, was kept in mind while

undertaking the As-is Analysis at Government Doon Hospital (GDH), Dehradun.



Background of the hospital The Doon Hospital began as a small dispensary in 1854, but soon, because of the increased

demand for in-patient care, a few hospital beds began to be added to it. In 1890, the first major

extension of wards was achieved, and in 1910 an operation room was established in the complex.

The decision to have an improved hospital in place came from the recommendations made by the

then Chairman of the District Board, Major Shamsher B. Singh. The task of preparing the blue print

for the new hospital complex fell upon Lt. Col. C H Barber, DSO and IMS who had come to

Dehradun as Civil Surgeon. Lt. Col. C H Barber made a rough plan on the basis of which he

estimated the cost of the new hospital at Rs. 3.50 lac. As the District Board was unable to undertake

such a heavy expenditure, it decided to sell the existing building and utilize the sale proceeds for

constructing the new hospital.

Official and private estimates were made and Rs. 1.00 lac was determined as a fair and proper

values for the then existing building. This was by no means sufficient and a request was made to its

Chairman for help. The Chairman, Municipal Board realized the urgent necessity of the hospital, but

owing to the Baldi Nadi Water Supply Scheme, for which the Municipal Board was committed, he

was unable to offer any financial help.

As the need was a genuine one and it was the public that suffered most for want of a well equipped

Hospital, it was thought advisable to approach the general public through an appropriate forum. Lt.

Col. Barber then met Mr. G. Flowers, ICS, and the then Superintendent of Doon, who very kindly

agreed to support the scheme.

A public meeting was called at the A.P. Mission School Hall on 27th March, 1926. Lt. Col. Barber

explained the scheme and Mr. Flowers appealed for funds for the Hospital and also very kindly

promised to recommend the scheme to the Government on the condition that at least Rs. 1.00 lac

was realized by public donations. The public, beyond all expectations, realizing the urgent need of

the Hospital, promised to subscribe Rs. 1,19,000/- and it was hoped that by the time the list closed,

the amount realized and placed to the credit of the New Hospital amounted to Rs. 1,10,000/-. Mr.

Flowers in his letter No. 548/14-2-1927 recommended to the Commissioner, Meerut Division to

approach the Government for a grant of Rs. 1.50 lac for the Hospital building, presently identified as

the Old Building was completed in 1932 in Art Deco Style

Swamy Vivekananda had got Akandananda who was a accompanying him treated in Doon Hospital

for three weeks when he fell ill with Bronchitis. Swamy Vivekananda described that the Doon

Hospital looks from a distance as a Bungalow of a residence of the English

Uttarakhand the 27th State of the Republic of India was formed on 9th Nov. 2000

Dehradun District has a population of 12 Lakhs and Dehradun City is functioning as the State

Capital. This City has a rich Heritage of Buildings and huge Campuses

Due to unplanned additions during the course of time the Doon Hospital acquired a crowded

unattractive appearance. Some of the buildings had become dilapidated. There was dissatisfying

conditions in the Hospital. Drug addicts and pimps used to invade in to the Hospital Campus



The erstwhile Health Development Project of the undivided Uttar Pradesh after the formation of

Uttaranchal, the Uttaranchal Health Systems Development Project was launched in the month of

July 2001. With this the World Bank Funding came to this State.

Being the Main Hospital of the newly formed State with its State Capital in Dehradun a decision was

taken to upgrade this Hospital and to make this the Premier Hospital of this State. Hon‘ble Chief

Minister laid the Foundation Stone on 11th May 2003.

For improving the functioning, performance, efficiency and quality of services in the Hospitals, Govt.

of Uttarakhand granted Autonomy to 33 Hospitals including Doon Hospital vide a G.O. in March

2003. This innovative orders were issued under the able guidance of Shri Alok Kumar Jain (IAS),

the then Secretary of Health to the Govt. Uttaranchal. Government kept the Strategic Control,

allowing the Operational and Managerial aspects to be handled at the facility level.

Under the guidance of Shri Alok Kumar Jain GO‘s were issued for.

Collection of Users Charges- Facility retaining 100% of the collection.

One Line Budget.

Outsourcing of

Hospital Cleanliness.

Laundry.

Food for Patients.

The Outsourcing has brought increased efficiency and Autonomy has given the stake holders to

take independent decisions about its finances and day to day administration and not being tied

down by bureaucratic and hierarchical constraints that are usually typical of Govt. organization

Dr. Rakesh Kumar a Post Graduate in Medicine from AIIMS and an IAS officer who also had a

tenure in Unicef used his rich experience as the Project Director of UAHSDP and was instrumental

in planning this up gradation

1. A New three Storey Building. • Ground floor 24 OPD Rooms with toilets and waiting halls.

• First & Second floors the wing on the right side 54 private rooms with attached bath

and toilet.

• First & Second floors the wing on the left side Two General Wards 44 additional beds

created.

2. A New Two Storey Administrative Block.

3. A New Building for Reception & Registration

4. A New Building for Kitchen

5. A New Building for Mortuary

6. The Old Building Renovated



• Two New Operation Theatres made.

• An ICU with 8 beds.

• An ICCU with 8 beds.

• An Air Conditioned Burn Ward with 14 beds.

• Emergency OPD with a Trauma Unit.

• All Old General Wards, Bathrooms and Circulation Areas Completely renovated

7. Landscaping--A new two storey building constructed as a Regional Dagnostic Centre.

The execution of the construction was the most difficult phase of the up gradation. The construction

and renovation was being under taken in a functioning hospital with the Out Patients and In Patients

continuing to be treated. There was a cap on the funds for construction activity from the World

Bank. It is during this phase that Shri S.K. Das IAS appeared in the scene as a Visionary in the form

of Principal Secretary of Health. The one universal statement made by the Politicians, Senior

Administrators, Professionals, National and International and the Public is that the transformation

which has happened in the Doon Govt. Hospital is unimaginable. If one person is to be given the

credit for the turn around it will be Shri S.K. Das

Some of the small buildings constructed earlier had to be removed for the smooth flow of patients

and patient carrying vehicles inside the hospital. Here the importance of political will in a

development played its big role. Hon'ble Shri B.C. Khanduri when requested though being then in

the opposition party magnanimously gave permission for two such buildings to be removed for

which he had laid the foundation and done the inauguration. His benevolence brought ambience to

the hospital.

The Inauguration of the New Building and the Renovated Old Building was done on 9th Sept. 2005

by the Hon‘ble Chief Minister who dedicated this to the public.

The Union Health Minister and the Union Health Secretary visited the hospital and commended the

progress that could be achieved in a Govt. hospital. The Central Govt detailed the Medical

Superintendents of RML Hospital, Safdurjung Hospital and Lady Hardinge College on 7th April 2006

to visit Doon Hospital to appreciate this progress. The Additional Secretary of Health from the

Centre accompanied them

With this up gradation of the hospital it has become possible to increase the bed strength to 312.In

certain department‘s treatment right up to tertiary care has become possible. There was a Quantum

jump in the quality & quantity of the service provided.

When the proposal was received from National Rural Health Mission (NRHM) Mrs. Manisha

Panwar, IAS, then secretary Medical &Health took the opportunity to propose Doon Hospital for

getting the ISO 9001:2000 Certification. With this systems could be placed to ISO requirements,

increasing the patient satisfaction and further improve Doon Hospital for which there is an urgent

need and scope.

.



Key Issues Given the above analysis, it emerges that while the hospital is challenged in terms of the patient

load that it receives, given the resource constraints that it has, it is able to mitigate the same and

retain the trust of the community owing to the group of its highly motivated clinical and support staff.

Some of the key issues that need to be addressed and incremental steps that need to be taken over

and above what is already being done at the micro and macro levels are highlighted below, the

detail of which are being described in the next section on Gap Analysis.

Key Strengths

Strong political will appreciable in governance

Pleasing hospital environment

High patient satisfaction levels

Approachable and proactive Senior Management of hospital

The ―will‖ to improvise service delivery

Well known, highly experienced and trusted group of doctors

Growing operational statistics

Key Weaknesses

Signage system needs improvement

There is no unique Identification number to track patients.

Increased patient attendance in the OPD, coupled with inadequate space in the waiting area

leads to long waiting time and crowding in doctor‘s chambers

Infrastructure and equipment not in line with service delivery in all specialties

Utilization not optimal for all equipment

Zoning in Operation Theatre is not adequate

No ICU to offer critical care

Low doctor to patient, nurse to patient and ward boy / ayah to patient ratios

No well documented system in place for key functions in the hospital, such as Hospital

Infection Control, inventory management, equipment maintenance, monitoring the service

quality of outsourced services, fire fighting

Clinical Audits and Medical Record Management system is not in place

Emergency not geared to handle disasters

Disaster Management System not in place

No centralized billing system



Key Opportunities

Initiatives towards public private partnership – proposed utilization of the MRI after office

hours of hospital by private players in the city to ensure optimal utilization of high cost

equipment

Role of the Chikitsa Prabandhan Samiti (CPS) in the generation of funds for the hospital

Newly formed State of Uttarakhand – thus more opportunity to improvise



Hospital Layout The hospital is a Y-shaped building that is zonally laid out to ensure optimality of function. The overall layout presented below the key areas in this block and their functional relation with others.

1 Reception and Enquiry and main entrance to hospital

2 Old Block—wards

3 Blood Bank

4 Eye Block

5 Administration Block and Main Store

6 Ambulance Parking

7 Mortuary

8 Dispensary

9 Radio diagnostics and Dialysis

10 Kitchen

11 Pathology

3

4

13

2

11

5

12 10

7

6

8

1

14 12

15

16

9



12 OPD and Ward Block (new)

13 New Block

14 Registration area

15 Operation Theatre

16 Emergency and Orthopaedic OPD



Patient Care Services at the hospital The hospital offers preventive, promotive, curative services through its secondary care facilities in

the clinical, support and utility areas as has been detailed below.

Clinical Services Clinical Sub-

Services

Support

Services

Utility

Services

In House General medicine Nephrology

Cardiology

Neurology

Laboratory Theatre Sterile

Supply unit

Medical records Medical Gases

Medical Stores

and Pharmacy

General surgery Neurosurgery

Urology

Plastic Surgery

Imaging

Transfusion

Medicine

Dermatology

Psychiatry

Pediatrics

Ophthalmology

ENT surgery

Orthopedic

Dentistry

Anesthesiology

Out sourced Dietary

Laundry

Housekeeping

Security



However, the hospital does not offer Radio-therapy services as defined in the IPHS standards for

300-500 bedded facility. This has been attributed to service relocation plan of the government to

unify the services of the three government facilities in city of Dehradun including GDH. With this

unification there is a plan to shift the super-specialties to the Coronation Hospital and retain the

General Specialties in GDH, thereby increasing the bed utilisation at GDH for broad specialties.

Additional land adjoining to the Doon Hospital has now been transferred from PWD. New Building

that is in the planning stage would be used to increase the bed strength, add new specialties, and

upgrade existing specialties.

The hospital currently supports its clinical team with the following investigative facilities:

Laboratory Services

Biochemistry Heamatology Clinical Pathology Microbiology

Blood sugar Haemoglobin Urine examination VDRL

Blood urea Differential Count Stool examination Malaria

S. Creatinine Total Leucocytes count Rheumatoid factor A.S.O Titer

S. Uric acid HBsAg

S. Bilirubin (total)

SGOT

SGPT

S. Total protein

S. Albumin

S. Globulin

Total cholesterol

HDL

LDL

VLDL

Triglycerides

S. alk phosphatase

S. Amylase



Imaging Cardiology

Digital X ray ECG

X Ray-300mA, 500mA, 100mA ECHO cardiography

Ultrasound TMT

OPG

CT scan

Mammography

Color Doppler

MRI



Health Programmes The Government Doon Hospital supports various National Health Programs such as:

National IDD Control Programme National Blindness Control Programme

National AIDS Control Programme National Family Welfare Programme

Birth Death Registration Programme Immunization Programme

Integrated Disease Surveillance Project Information Education Communication

National Cancer Control Program

In addition, the Latika Roy Memorial Foundation present

at the Government Doon Hospital provides education

and therapy for children with disabilities, supports their

families, and creates awareness and advocates for the

disabled in the community. At the Government Doon

Hospital, the Foundation looks after dissemination of

information related to disabilities, and provides guidance

to eligible persons on procedures to receive disability

certificate.

The SmileTrain project is also in operation at the

Government Doon Hospital. This initiative focuses on

offering free reconstructive surgical services to children with cleft lip and palate defects who are

unable to afford such care. At the Government Doon Hospital, a ―Muskaan‖ ward (ward 10) has

been designated for the SmileTrain project patients to ensure maximum and comfortable coverage

of most patients with similar defects.

The hospital also has designated beds to treat the destitute and unattended patients, who are

neglected by the community, who are nursed by a voluntary worker under the guidance of the

doctors.

http://gov.ua.nic.in/health/IDD.html

http://gov.ua.nic.in/health/bc.html

http://gov.ua.nic.in/health/NACP.html

http://gov.ua.nic.in/health/fw.html

http://gov.ua.nic.in/health/br.html

http://gov.ua.nic.in/health/immu.html

http://gov.ua.nic.in/health/idsp.html

http://gov.ua.nic.in/health/IEC.html



Patient Volume and profile Government Doon Hospital has catered to around 0.5 million outpatients, and 16,000 inpatients in

CY 2007. Being a government referral hospital for the community the hospital not only receives

referrals from the PHCs and CHCs in the district but also other parts of the State. The hospital,

owing to its ownership (government), the breadth its broad service profile, attracts a large volume of

patients predominately from the lower social economic strata, with lower educational background.



Operating Statistics

The hospital offers

comprehensive secondary level

in the various broad specialties

and tertiary level care in select

sub-specialties as detailed in

the earlier section. The

hospital‘s operations have been

continuously growing over the

years. The number of patients

benefitting from the out patient

services has been constantly

increasing over the last many

years. A compounded annual

growth rate (CAGR) of over

11% is observed from CY

2002 to 2007, which is trend

witnessed for most secondary

care settings. The absolute

number of patients yearly

attending the OPD services

since 2002 have grown from

2,79,692 to 4,78,277 as on CY

2007 as shown in the chart 1.

The number of patients

admitted in the Government

Doon Hospital has also been

constantly increasing since

2002. A CAGR of over 8% is

observed from 2002 to 2007.

The actual number of

patients yearly admitted in

the hospital since 2002 have

grown from 11,006 in CY

2002 to 16,549 in CY 2007

as shown in the chart 2.



On an average, Doon

hospital handles

1,594 patients per

day, admits 45

patients (including

day-care patients),

and discharges 42

patients per day. It

handles on an

average, 4-5 major

surgeries and 10-12

minor surgeries are

conducted at the

GDH‘s OT complex

every day. There has been a steady rise in the number of major and minor surgeries performed at

the Government Doon Hospital during the period 2002 to 2007. In the year 2007, 1949 major

surgeries and 2034 minor surgeries were conducted at the GDH‘s OT complex (chart 3).

Similarly there has been a rise in the eye

surgeries and the number of Dialysis done in the

hospital, as shown in charts 4 and 5.

The investigations carried out have also

correspondingly risen @ 12.3%, 14%, and 23%

for X-ray, USG and laboratory, and CT

respectively from CY 2006 to CY 2007, as

depicted in the charts 6 to 9.



On an average the hospital has a crude death rate

of 4.5-5%, which is twice the international

standard for a secondary care facility. This can be

attributed to the stretched resources (human

resources and infrastructural) at the facility.

Complicated cases that the other district hospitals

are not able to treat are transferred here. The

hospital also caters to the terminally ill patients

shifted from the nursing homes and other private

facilities.

The Average Length of Stay

(ALOS) is also more than the

industry norms of 4-4.5days

(depicted in the chart below) at 6.27

days. This has been attributed to

the delivery of tertiary care services

in the sub-specialties (such as

orthopaedics, plastic surgery,

nephrology, neurology, etc.), while

the burden of the secondary care

ailments still remains unaddressed.

Secondly, there is shortage of

operation theatres (OT) that forces

the patient to occupy a bed

unnecessarily, before he is

scheduled for a surgery.



Out-Patient (OP) Services

All OP clinics at the Government Doon Hospital are on the ground floor of the OPD Block. The OP

department operates in one shift from morning till afternoon, for six days in a week. Patients who

are advised investigations by consultants are required to submit samples at the laboratory (lab), or

get imaging tests done at the imaging centre during OPD hours. The lab as well as the imaging

centre is situated within the hospital premises. In general, the space available at the Government

Doon Hospital in the OP waiting area is insufficient for the daily attendance of patients. The

absence of an appointment scheduling system, absence of Class IV staff outside consultation

rooms and the lack of displays on health topics to hold the attention of waiting patients lead to

overcrowding in the consultation rooms and the corridors. Most of the specialists handle more than

150 patients every day. A patient visiting the OP for consultation currently has to wait somewhere

between 2.5-3.5 hours from the time of registration to the receipt of consultation. However, most

patients are ready to bear with the waiting time as they understand that clinicians are overcrowded

and trust the care offered in the hospital.

In Patient (IP) Service

In line with the State Government‘s policies,

Doon hospital is typically basic in terms of

internal furnishing but fully functional. The

general cleanliness within the wards at the

GDH is adequate.

The wards are open type with beds are placed

next to each other. It is likely that the relatively

high Average Length of Stay (ALOS) at the

Government Doon Hospital is in part linked to

the hospital‘s open ward designs, besides the

typically low hygiene levels of patients visiting

the hospital. Also, most wards remain

overcrowded with attendants. There is also no

data available on the hospital acquired

infection (HAI) rate in the GDH ward areas,

and neither does the GDH conduct

environment surveys to capture HAI rates in

other patient care areas. The distribution of

beds in the various wards of GDH is as below:



Ward No. Name of the Ward No. of Beds

1 Trauma Ward 14

2 Emergency Ward I & II 29

3 Female Orthopedic Ward 11

4 Male Orthopedic Ward 39

5 Children Ward 16

6 Paying Ward 6

7 Burn Ward 13

8 Male Surgical Ward 29

9 Intensive Coronary care unit (ICCU) 8

10 Muskaan Ward (cleft lip) 8

11 Female Surgical Ward 22

12 Female Medicine Ward 30

13 Private Ward (1st floor) 10

14 Male Medicine Ward 30

15 Private Ward (2nd Floor) 10

16 Eye Ward 20

17 VIP Ward 2

Total 297

It is evident from the above table that while there are 252 sanctioned beds, the hospital has beds

more than the scheduled sanction. GDH has separate wards for males and females as is required

for open wards and is culturally acceptable among the population that visits the hospital. There are

semi-private and private wards for the patients who can afford to pay, but even these are

subsidised. Unlike the OP, the wards at the GDH are spacious.



GDH as per its mandate has to admit all patients that require admission, which has contributed to

the addition of beds in the wards; however, waiting period for surgical inpatients depends on the

availability of operation theatre (OT) and beds in the wards.

Once a patient is adviced admission by the doctor, the patient is assigned a new IP number

different from the OP number at the emergency and admits the patient with the right ward based on

the illness and the availability of beds in that ward. Similar is the case when a patient comes to the

hospital directly to the emergency. Once assigned a bed, the patient reports to the nurse on duty in

the ward concerned and a patient Bed Head Ticket (BHT) is prepared in the ward for further

treatment.

Operation Theatre

GDH has a single OT complex with 5 operation rooms, of which only two are currently functioning,

leading to a waiting period of 6 months for an elective procedure. The OTs have not been designed

on the principles of zonalisation (clean and protective areas are not well segregated) and there are

no separate recovery and pre-anaesthetic areas, as depicted in the picture below. Moreover, the

OTs do not have a proper ventilation system (which lets untreated outside air inside the sterile

areas), and there is no system to ensure partial zonalisation in the OTs. Further, the OT tables are

old, the scrub area has regular taps, and can lead to hand contamination – sensor or foot taps

would be ideal. Also, the OT design is such that there is no separate corridor for disposals to be

taken out. However, even as GDH‘s OTs has structural and systemic shortcomings, the hospital‘s

post-surgical mortality rate is estimated by the specialists to be relatively low level at around 2%.



Location No.

Functional Area Location No.

Functional Area

1 Main OT 11 Corridor – want to use it

2 Scrub area 12 Supposed to be recovery room

3 Slipper‘s area 13 OT

4 Anesthesia room 14 Supposed to be pre-op room

5 Doctors room 15 Supposed to be duty room

6 Open area / entry 16 Supposed to be preparation room

7 Cupboards kept here 17 Not clear

8 Equipment kept here 18 Supposed to be doctors room

9 Dressing room 19 Supposed to be recovery room

10 Corridor – want to use 20

3 2

4

5

6

7

1

8

9

11

16

19

15

18 17

14

10

12

13



Emergency

The GDH operates a 24-hour Type-II emergency service and receives around 100 emergencies a

day. The GDH Emergency block is easily accessible from the hospital entrance, wherein the

patients are stabilised, treated and shifted to the relevant wards depending on the availability of

beds if long-term treatment is required. If a bed is not available, the patient is admitted in the

emergency ward itself. The Government Doon Hospital has five ambulances manned with five

drivers.

Intensive Care unit

While GDH operates a 294 bedded large general hospital, there is no infrastructural and human

resource support to operate an Intensive Care unit (ICU) to handle various kinds of medical

emergencies, excepting an ICCU that operates under the guidance of Cardiologist for handling

cardiac emergencies.

Transfusion Medicine

The GDH operates an in-house blood bank that collects annually around 4,618 units (CY 2007) of

blood and issues 4,584 units of whole blood. While, the blood bank has the license of an in-house

service, it operates as a regional Blood Transfusion Centre organising camps and supplying to the

entire region, including private facilities. In 2007, 13 blood donation camps were organized, and 312

units of blood were collected through the same.

The Government Doon Hospital‘s blood bank follows the protocols laid down by the National and

State Blood Transfusion Councils for the selection of donors, and for the collection, processing,

storage and issue of blood to ensure blood safety. Despite having a transfusion committee, GDH‘s

blood bank has not been able to enforce rational use of blood owing to the lack of component

separation unit and relatively reduced awareness among clinical staff on the same. The department

also undertakes CD4 testing for the HIV positive patients as a part of the VCTC programme.

Laboratory Services

The GDH has an in-house laboratory service that caters to OP as well as IP in the wards. The load

at the lab has almost tripled from 2002 to 2007, while the human resources employed in this period

has remained the same. In CY2002, 75,029 tests were performed, while the number rose to 2,

19,351 in CY 2007.

The lab operates from 8am to 2pm, and sample collection is done in the morning hours. Since there

is no centralized billing system at the GDH, owing to which test charges are collected by the

technicians within the lab before they move on to putting the tests, which is a misuse of the skilled

resources. While the lab does not have documented protocols to ensure internal quality control

systems, it participates with CMC, Vellore in the external QC program on a regular basis.



Imaging Services

The radio-diagnostic centre at the GDH processed 32,400 X-Rays (including digital X Rays), 13,025

Ultrasounds, and 5,265 CT scans in 2007. The corresponding figures in 2006 were 28,242 x-Rays,

11,195 Ultrasounds, and 4,012 C T Scans. Thus, there was a 15%, 16%, and 31% growth

respectively in the number of X-Rays processed, Ultrasounds done and C T Scans carried out. The

hospital has recently acquired a MRI machine and has plans to move ahead offering this service on

a public private partnership (PPP) mode to ensure optimal utilisation of the machine. The cardiac

testing facilities available at the Government Doon Hospital include ECG, ECHO and TMT.

Engineering Service

The GDH‘s engineering services are maintained by the Public Works Department (PWD) of the

State Government of Uttarakhand.

Currently, most equipment at GDH are utilised at 60%. However, the hospital has plans to operate

the same on a PPP mode to improve utilisation to 80% and generate revenues to fund the growing

needs of the hospital.

Medical Store Supply Services

Medical supplies value chain at GDH involves the pharmacy, the sub-store and the main store.

Supplies at GDH are procured from the rate contracts available with the State govt, ESIC, Central

govt or public sector undertakings. There is also provision to make stock available through local

purchases for urgent and not readily available items, on the rates fixed by the govts.

Governance

The organisation structure at is typical to that in a District hospital.

The Chief Medical Superintendent (CMS) serves as the medical and administrative head of GDH

and is supported by a Hospital Administrator on deputation. The nursing function is headed by a

Chief Matron, who is supported by Grade II matrons.

Resource planning at GDH is largely guided by the policies of the State government. For instance,

recruitment at various levels has to be in line with the number of sanctioned posts and other

guidelines. Similarly, material procurement is mostly through rate contracts of the govt. Thus, the

management‘s role in resource planning is mostly limited to sending requests to the next level of

authority and follow-up, managing purchases within its control, and managing the hospital‘s

operations with the resources available, which is not a small challenge.



At GDH, there is generally a shortage of manpower at all levels, which poses a considerable

operational challenge considering the hospital‘s increasing patient load. Besides, there is also the

task of ensuring that the available manpower performs its duties effectively (encompassing the

aspects of both willingness and competence). However, in managing these issues, the

management also has to adhere to Government policies that are not always flexible, besides coping

with problems relating to unionism, transfers, deputation, and special duties.

Despite these constraints the staff seems to be motivated to change things and is proud to be

associated with DOON hospital, which is visible in terms of their keenness to bring forth issues and

suggest solutions that are locally addressable.

Some important governance related features characterising GDH are.

Zonality of functions: As the heritage buildings housing the various departments,

maintaining zonality has been difficult. However, the hospital management has tried to maintain the

broad zonality of function. Zonality ensures that functionally related specialties are located close to

each other, thereby reducing unnecessary movement of patients within the critical areas of hospital

and to reduce fatigue of the service providers. For instance, all surgical blocks are located in the

same building; Trauma is close to the Emergency. However, to maintain zonality and proximity to



patient care areas, the management has decentralised many services like billing. This in turn has

resulted in duplication of assets, besides raising the manpower.

Internal communication: GDH mostly uses telephone to reach its staff, but there is scope

to improve maintenance (both preventive and breakdown) of its intercom system so that faster

communication is possible.

Information system: GDH regularly collects data (including statistics like census,

immunization done, OP and IP load) from various patients care areas for reporting to the State

Government.

Outsourced Services: While the Dietary Service management has been outsourced, GDH

is responsible for providing physical infrastructure and equipment to operate the in-house kitchen of

the hospital. However, linen and laundry services are completely outsourced to an external agency

outside the premises of the hospital.

Bio-medical waste management (BMW): GDH follows the BMW Management & Handling

Rules, 1998. It is authorised to segregate, collect and store waste, before it is picked up by the

outsourced agency for disposal of bio-hazardous waste. Municipality takes away the general

wastes. Glass vials are cleaned, sterilized and re-used locally to collect blood samples.



Financial Analysis The budget allocation for the Government Doon Hospital for the year 2007-08 was Rs. 4,33,79,054.

The budget is received as a single line budget and expenditure on different heads is done with due

approval of the CPS. An analysis of the allocation of budget and the expenses at the Government

Doon Hospital shows that the maximum amount is required for the head ―Local Purchase‖. For

example, in the financial year 2007-08, Local Purchase accounted for over 26%. This was followed

by the head ―Medicine‖, which accounted for over 23%, and ―Salary‖ which accounted for over 13%.

Thus, Local Purchase, Medicine and Salary together account for almost 64% of the budget

allocation and expenses at the Government Doon Hospital. Other major heads include ―Diet‖,

―Electricals‖, ―Surgical‖, and ―X Ray‖, ―Furniture‖ etc.

Chikitsa Prabandhan Samiti at the hospital

A CPS has been constituted at the hospital, as per laid down norms. In line with the norms of CPS,

a Governing Body and an Executive Body have been constituted. These bodies meet on a regular

basis to discuss the patient care issues in the hospital; however, the CPS is yet to function at its

optimality covering all its mandates, as detailed in its mandate in Annexure 5. The members of the

CPS at the GDH are as follows:

Governing Body Executive Body

Chairman: District Magistrate CMS

Member Secretary: CMS

Members: CMO Superintendent/Senior

Medical Officer

Representative of DG Health CMO nominee

Representative of Chairman, Municipal

Board

Senior Medical

Specialist

Representative of Local MLA Accounts Officer

Representative of Member of Parliament

Representative of Member of Rajya Sabha

Accounts Officer (Nominated by DM)

Social worker

Special invitee with permission of

chairman



Gap Analysis For the detailed analysis of the gaps within the hospital were classified and defined.

Gap Classification

High: Resources and processes that are Vital, without which patient care delivery is not possible,

are called as ‗High‘ Gap

Medium: Resources and processes that are Essential, without which patient care delivery is

possible for sometime, are called as ‗Medium‘ Gap

Low: Resources and processes that are Desirable, which does not affect the patient care delivery,

are called as ‗Low‘ Gap



1. Governance & Management Gaps-GM 001 to 014

Gap ID No GM 001

Observed in Governance & Management

Gap Statement:

There is overall shortage of human resources.

Rationale / Explanation:

While, the hospital operates at 314 beds, the human resources sanctioned do

not commensurate with those required for >300 beds.

Staff Cadre IPHS Current @ Doon Shortage % Shortage

doctors 77 55 22 40%

nurses 250 76 174 229%

lab technicians 13 6 7 117%

ward boys / ayahs 90 60 30 50%

Absence of a full time Hospital Administrator, Manager (Administration),

Manager (Finance) and Manager (HR) is a serous gap for the seamless

functioning of a large specialty hospital, such as this.

Gap Classification

Resources

Gap Classification

High

Gap Reference IPHS standards -300-500 beds, section 9, pages 39-41

Supporting Annexure Detailed in Annexure--4



Gap ID No GM 002


Gap Statement:

Hospital specific legal requirements are not adequately addressed.


No legal clearance for all X-rays, and the CT Scanner

The fire fighting systems are not adequate, rendering the system vulnerable to

fire accidents

No documented system to undertake fire fighting mock drills, which prepares

the system during such an exigency.

Gap Classification

Resources

Gap Classification

High

Gap Reference ISO 9001-2000 guidelines, section 6.3, 7.2.1

Supporting Annexure NA



Gap ID No GM 003


Gap Statement:

There is a lack of defined audit criteria by CPS for verification of meeting targets of

Samiti.


While the Governing and Executive Body of CPS meets regularly and discusses

various issues, it needs to improve upon its internal audit systems to offer itself

timelines to meet self defined targets/ source funds

Gap Classification

Processes

Gap Classification

High

Gap Reference IPHS standards for 300-500 bed facility, section 15, page no. 78

Supporting Annexure Annexure 5



Gap ID No GM 004


Gap Statement:

The citizen charter, fixed in the reception area is not legible or fixed at ergonomic

height and does not carry all the information required as per the IPHS requirement.


The charter is fixed near the ceiling height, in a font size that is not suitable

to attract attention of people

While the citizen‘s charter covers the rights and responsibility of the patients

but does not capture the following:

Service profile of the hospital.

List of specialists on roll and the OP room nos. where they offer consultation

and the schedule of visit in OP

Facilities available in emergency—both clinical and investigative

In-service details—namely, the no. of beds, their distribution in various

specialties, service offered, intensive care facilities being offered

Location of suggestion box/complaint boxes, system for closed loop

complaint management system

Hospital utilization indices—no. of patients treated, investigated, dialysed,

operated, referred

Wherever information is being displayed clearly, it is a challenge to ensure

that instructions are followed carefully at every step, given the low educational

background of the patients seeking care at GDH. One such example is the

signage fixed at the radio-diagnosis department on radiation hazard, which is

not at all followed by patients and their attendants despite verbal and written

reinforcements.

Gap Classification

Gap Classification



Processes Low

Gap Reference IPHS standards-300-500 bedded hospital, section 16, page no.78-83

Supporting Annexure Picture 1

Picture 1: Lack of privacy in x ray room



Gap ID No GM 005


Gap Statement:

Hospital does not have appropriate signage in all locations


Following areas wherein no signage implementation evident are:

No location and layout signage at the entrances of the hospital

No signage in the OPD registration area giving the details of the specialists

and their room numbers

Toilets, Fire evacuation plans, Fire exits, Fire extinguishers capacity and

usage identification, Private and general wards(Rooms above dispensary),

Lifts, Walk ways, Floor plans, Emergency Assembly Area, Parking bay,

electrical panel, Danger signs

Signage of ‗danger‘, with ‗do‘s and don‘t‘ on the electrical panel, along with

instruction of usage fire extinguisher could have been handy

Sign boards not displayed at ergonomic height

Sign boards not designed with uniform colour and font scheme plan.

Gap Classification

Resources

Gap Classification

Medium

Gap Reference ISO 9001-2000 Guidelines (Internal Communication)- 5.5.3




Picture 2: Citizen Charter not at an Easily Readable Height and Font



Gap ID No GM 006


Gap Statement:

Specialty services offered are not in line with IPHS requirement


Number of OT tables not adequate for the number of surgeries performed

leading to 2-3 weeks of waiting for a fracture reduction surgery. The patients

thus occupy the beds in the surgical wards without any definitive treatment

more than two weeks before a surgery is done. Thus the Bed Turnover Rate

(BTR) of the Hospital is low reducing the accessibility of care to larger number

of patients. BTR is the number of times a single bed is used for patient care

delivery. Higher the BTR better is the utilization of hospital bed.

No separate OT for ENT or Orthopedics leading to more than 6months of

waiting for elective cases

While there is intensive coronary unit, there is no adult or paediatric ICU-to

handle all kinds of patient requiring intensive care

Gap Classification

Resources

Gap Classification

High

Gap Reference IPHS standards 300-500 bedded facility, section 7, page 36




Gap ID No GM 007


Gap Statement:

There is a mis-match between the specialties offered, and the resources required to

deliver the same.


While the hospital offers Neurological services and has a Neurophysician

recruited for the same, there is no Electro-encephalogram (EEG) to undertake

the investigation required for the service offered. Having an EEG becomes

much more crucial as the hospital is designated as a Regional Diagnostic

Center.

The hospital has a Neurosurgeon but no Neurosurgical instruments to

undertake requisite surgeries, especially handling trauma and head injury.

While the hospital has Microtome and Tissue Processor, the hospital does not

undertake Fine Needle Aspiration Cytology (FNAC) to offer Histopathology and

Cytopathology Services.

The hospital is also not able to offer Microbiology services owing to lack of

infrastructural services to offer the same.

The hospital has all the equipment required to operate a Component Separator

unit, but does not have license to operationalise the same owing to non-

availability of a fulltime technician for the same.

The hospital does not offer endoscopic services in all the specialties, for

example Gastroenterology and orthopaedics

Gap Classification

Resources

Gap Classification

High

Gap Reference IPHS standards 300-500 bedded facility, section 9, page 42-62




Picture 3: Centrifuge for Component Separation at Blood Bank lying unused



Gap ID No GM 008


Gap Statement:

The equipment management system in the hospital is not robust enough to ensure

effective utilization of equipment procured.


While there is equipment that is lying unutilized for over a year, there are others that

are over-utilised. The following are some of the high cost equipment, which are not in

use for over 52 weeks

Equipment Quantity Date of Installation

Ventilator Servo 2 June 2004

Automatic Tissue processor 1 March 2003

Microtome with razor 1 March 2003

Ventilator Neo sbp 1 March 2003

300MA X-ray Machine 1 March 2004

Plasma Separator 1 March 2005

Ventilator SBP 1 August 2006

Ventilator Anset 1 September 2009

Arthroscope 1 --

Also there is no system to ensure regular calibration of equipment to ensure

reliability and repeatability of the reporting done by the various measuring devices

such as, BP apparatus, electrolyte analyser, cell counter, freezing cabinets in the

blood bank among others.

Gap Classification

Gap Classification



Resources High

Gap Reference IPHS standards 300-500 bedded facility, section 9, page 42-62


Gap ID No GM 009


Gap Statement:

Disaster Management Plan not addressed in a detailed manner.


No disaster management ward has been provided, and room for storing the

equipment and consumables

No well defined system for triage, i.e. categorizing the patients in the accident and

emergency department based on the criticality of their ailments so that patients are

offered care efficiently and effectively, during any disaster situation.

The Disaster Alert Code to activate hospital disaster plan is yet to be defined, such

as—

Key personnel to be notified;

Key departments to be activated for mobilization of resources; to plan for

logistics and supplies, making security arrangements

Definition of the roles of hospital controller, senior nursing officer, hospital

administrator, reception and admission of patients;

Criteria for patient categorization

Principles of management of casualties, of providing basic life support,

administering cardio-pulmonary resuscitation

Establishment of communication networks and disposal of dead

System to monitor and control deviation and take corrective action



Gap Classification

Resources

Gap Classification

High

Gap Reference National disaster management guidelines


Gap ID No GM 010


Gap Statement:

The terms of reference for outsourced activities are not sufficiently covering the

service quality criteria for outsourced agencies.


The terms of reference (TOR) that is documented, is not completely in line with

service quality requirements for housekeeping and laundry services.

Housekeeping Checklist not meeting service quality definitions such as—

cleaning of spills, usage of disinfectants, usage of brooms/mops and cleaning

of drains-TOR dated 20/8/04

Lack of checks mandating on-site inspection of the outsourced laundry-

19p/chi u0/14/2001/140/20142,dated 7/121/2001

Lack of system checks to ensure that soiled and un-soiled linen are taken by

laundry boy separately

Gap Classification

Processes

Gap Classification

Medium

Gap Reference ISO 9001-2000 guidelines- 7.4.3




Picture 4: No Defined Parameter to Monitor Cleanliness of Drains

Gap ID No GM 011


Gap Statement:

There is no system to monitor, measure and analyse select service quality

management processes


There is no evident system to audit the following on a regular basis:

o Hospital operations.

o Hospital Acquired Infection Rate

o Clinical processes-continuity of care, clinical pathway analysis, ethical

practice, rationale of practice (mortality audit, medical audit, prescription audit)

Gap Classification

Processes

Gap Classification

Medium



Gap Reference IPHS standards for 300-500 bedded facility, section 14, page 78; ISO

9001: 2000, section 4.1


Gap ID No GM 012

Observed in Emergency

OT

ICCU

Wards

Injection Room

Gap Statement:

Bio medical waste (BMW) segregation is not done properly / uniformly in all the

hospital areas.


As per matron‘s records, BMW segregation in the emergency ward is

improperly done.

Also, instances were found in which a ―red‖ bin was being used with a

―yellow‖ plastic bag, since a yellow bin was not available.

A ―blue‖ bag was found containing plastic material. A regular dustbin was

found containing plastic IV remains and banana peels.

BMW segregation is not adequate as per the guidelines-syringes in yellow bag

General wastes like cardboards are not collected from the pharmacy on a daily

basis

Gap Classification

Processes

Gap Classification

Medium

Gap Reference BMW Management and Handling Rules 1998




Picture 5: Improper BMW segregation in wards

Gap ID No GM 013

Observed in All areas of hospital

Gap Statement:

While there is a system to capture patient feedback, it is not clear as to how it is used

to enhance patient satisfaction


Neither survey frequency is defined or scaled nor questionnaire is validated to

receive a statistically significant response

Gap Classification

Processes

Gap Classification

Medium

Gap Reference ISO 9001-2000 guidelines, section 5.2, 7.2.1, 8.2.1




Gap ID No GM 014

Observed in Mortuary

Gap Statement:

There are no freezing cabinets to preserve dead bodies in the mortuary


While the hospital receives medico-legal cases and undertakes post-mortems on a

regular basis, there are no freezing cabinets to preserve the dead bodies in the

mortuary.

Gap Classification

Processes

Gap Classification

Medium

Gap Reference ISO 9001-2000 guidelines, section 5.2, 7.2.1, 8.2.1




2. Out Patient Department-OP 001 to 003

Gap ID No OP 001

Observed in Registration

Gap Statement:

The OP registration system generates confusing information as regards the number

of patients visiting the hospital.


Presence of two different registration numbers (one computer generated and

the other printed on the form) on the OP ticket makes it difficult to track the

actual number of patients‘ visit to the facility.

There is no system to collect the number of repeat patients that visits the

doctor directly.

Gap Classification

Processes

Gap Classification

Medium

Gap Reference ISO 9001-2000 guidelines, section 4.1




Picture 6: Two different registration numbers on registration form

ap ID No OP 002

Observed in Registration

Gap Statement:

The address / contact details of the patient are not entered in the registration form.


Due to a heavy load at the registration counters the details are not recorded, which

are essential to understand the demographic profile of people visiting the hospital

Gap Classification

Processes

Gap Classification

Low





Gap ID No OP 003

Observed in OPD

Gap Statement:

Overcrowding in the OP waiting area reduces effectiveness of care delivered in the

OP area.


Management of high number of patients turning up at OPD is not appropriate,

which results in crowding

The system for calling patients in the doctor‘s chamber one by one is not

evidenced. As a result of which the doctor is surrounded by patients from all

sides

Space in the waiting area and sitting arrangements in the OPD is not adequate,

to handle the quantum of patients visiting the facility

Gap Classification

Resources

Gap Classification

Medium

Gap Reference ISO 9001-2000 guidelines, section 4.1, 6.1, 6.3, and 6.4;

Supporting Annexure Picture 7 and 8

Picture 7: Improper crowd management in OPD Picture 8: No patient privacy in OPD



3. In-Patient Department-IP 001 to 010

Gap ID No IP 001

Observed in Ward – Female Medicine

Ward – Male Medicine

Gap Statement:

Nurse‘s time is wasted in copying the list of similar drugs every time in the Medicine

indent Book


In the ‗Ward Medicine Consumption Register‘ the nurse has to put in the page

numbers and list out the drugs used in the wards every time to keep an

account of consumption pattern of drugs.

Absence of printed register with drug list and numbered pages wastes the

nurse‘s time on clerical activities, which can be better utilised can have the

drug list, and page numbers printed on it to avoid consumption of nurse‘s time

to write them on a daily basis.

Gap Classification

Resources

Gap Classification

Low

Gap Reference ISO 9001-2000 Guidelines, section 4.1, 6.4

Supporting Annexure Picture 9 and 10



Picture 9: Unnecessary information captured in ward register-―F‖ in Female Ward Picture 10:

Manual page numbering on ward registers

Gap ID No IP 002

Observed in Wards

Gap Statement:

TPR and BP charts and input-output charts in wards are not being filled regularly by

the nursing staff


Absence of monitoring these details in select wards could be a constraint in the

management of patients, especially the post-surgical patients.

Gap Classification

Processes

Gap Classification

High

Gap Reference ISO 9001-2000 Guidelines, section 8.2.3




Gap ID No IP 003

Observed in Ward

Gap Statement:

Transfer of information between the nurses in between shifts, is verbal.


Patient information and patient status is verbally communicated by the nurses from

one shift to the other in select wards. This may be a constraint in patient care

management.

Gap Classification

Processes

Gap Classification

Medium

Gap Reference ISO 9001-2000 Guidelines, section 8.2.3




Gap ID No IP 004

Observed in Ward

Gap Statement:

Disposables (like used needles, IV bottles, etc.) are kept in cardboard boxes before

they are segregated (needles burnt, IV tubes cut, etc.) and are disposed off all at one

time after each shift in contravention to BMW Rules.


Medicines are carried in cardboard boxes by nurses for drug dispensing and

injection administration to the patient bedside. These open needles in the

cardboard boxes can be source of accidental needle stick injury of the staff

This increases the probability of nurses / ward boys getting needle stick injury

at the time of processing it prior to disposal.

Gap Classification

Processes

Gap Classification

High

Gap Reference BMW management rules




Picture 11: Improper management of disposables in wards

Gap ID No IP 005

Observed in Wards

Gap Statement:

There is no identified and accessible location to keep the emergency tray in wards,

which may be a constraint to access it during a medical emergency.


The site to keep the emergency tray was found to be different in different

wards of similar layout.

The emergency tray in one instance was not available readily, as it was kept

inside a cupboard which was behind the nurse‘s counter.

Gap Classification

Gap Classification



Processes High

Gap Reference IPHS standards 300-500 bed facility, national disaster management

guidelines


Picture 12: Emergency tray kept in cupboard behind nurse‘s counter

Gap ID No IP 006

Observed in Ward

Gap Statement:

There is no standard practice across wards available for units of medicines /

injections to be kept in the emergency tray.




Currently, some wards randomly keep four/three/two ampoules for each type

of injection in the emergency tray.

Also, there is no standard available across wards regarding the medicines /

injections that need to be placed in the emergency tray.

Gap Classification

Processes

Gap Classification

Medium

Gap Reference National Disaster Management Guidelines


Picture 13: Emergency tray not clearly defined



Gap ID No IP 007

Observed in ICCU

Gap Statement:

Trained people for operating the ventilator are not available.


Ventilators are available in the hospital, but there are no trained personnel to

operate the same.

Thus, in spite of the facility being available, the general public is unable to

benefit from the same.

Gap Classification

Resources

Gap Classification

High

Gap Reference IPHS standard 300-500 bedded facility




Gap ID No IP 008

Observed in Ward

Gap Statement:

There is no system to monitor the usage of personal linen on the hospital beds by

patients.


It was seen that patients put their own linen on the beds.

Gap Classification

Processes

Gap Classification

Medium



Picture 14: Patients put their own linen on beds in ward



Gap ID No IP 009

Observed in Wards

ICCU

Gap Statement:

Shortage of security personnel in the hospital makes it difficult to offer optimal

security services in all areas of the hospital.


Many a times, more than 2-3 attendants are present with a patient in wards.

Attendants are also seen sitting on patients beds in the ward as well as in the

ICCU.

Gap Classification

Processes

Gap Classification

High

Gap Reference Security contract; IPHS standards 300-500 bed facility-section 14

page 78; ISO 9001-2000 Guidelines, section 7.4.1


Picture

15:

Improp

er

attend

ant

manag

ement

in

wards



Gap ID No IP 010

Observed in Ward – Female Medicine

Gap Statement:

Male attendants are seen sleeping in the female ward.


This violates the privacy of other female patients in the ward.

Gap Classification

Resources

Gap Classification

Medium

Gap Reference IPHS standards 300-500 bed facility




4. Emergency-EM 001

Gap ID No EM 001

Observed in Emergency Room

Gap Statement:

Resources and processes in Emergency Ward not as per the IPHS Standards


No exclusive Emergency Medical Officer (EMO) for the emergency room. The

EMO has to handle emergencies across all the 14 wards 2pm to 8am next day

Separate Emergency Orthopedic OT, and Burn and Plastic OT does not exist,

as mandated in IPHS

Emergency area not adequate to cater to the patient load

The Emergency is not air conditioned.

Resuscitation procedures in emergency are not adequate

No ambu bag, ET tubes, laryngoscopes, ECG or defibrillator in the emergency

room.

There is no covered passage made while shifting patient to other wards.

Currently the patient is shifted from emergency ward to reach the other ward

under the open sky through the inter-departmental road within the hospital

campus.

Gap Classification

Processes

Gap Classification

High

Gap Reference IPHS standards 300-500 bed facility: Section 7 and 8, pages

36,38,39,79; National Disaster Management Guidelines




Picture 16: Patient Being Shifted from Emergency Ward to General Ward under Open Sky



5. Operation Theatre-OT 001 to 003

Gap ID No OT 001

Observed in Operation Theatre

Gap Statement:

Structure and layout of Operation Theatre (OT) not as per IPHS norms




The Operation Theatre complex (OT) is conveniently located away from the main

traffic, in the first floor close to surgical ward, intensive care unit (ICU), radiology,

pathology, blood bank and CSSD.

However, OT is not cordoned off adequately to be free from contamination and

possible cross infection, to offer maximum protection from solar radiation.

As per the principles of zoning the design of OT complex and the ventilation system should

be such that it can maintain the operative site free from any infection and prevent mixing of

air between dirty and sterile area to avoid any infection2. There are four well defined zones

of varying degree of cleanliness namely, Protective Zone, Clean Zone, Aseptic or Sterile

Zone and Disposal or Dirty Zone. The sterile zone is the area of highest sterility. Therefore it

demands positive pressure ventilation so that air from areas with relatively low sterility does

not enter the main operation room. Currently the doctors‘ Changing room directly opens

into the main OT as against the IPHS norm for 300-500 bedded facility, section 7, and

page 36. The OT is not adequately ventilated on the principles of zoning to ensure an

infection free environment in the operation site, and maintain adequate positive pressure in

the main OT with negative pressure in the clean and dirty area to avoid mixing of air.

Currently the OT has window a/c which is not suitable to maintain the various levels

of positive and negative pressures in the OT to mitigate infection. It should have a

ventilation system with filters to control and monitor the desired pressure gradient

desired. For the specialised cases that the hospital is supposed to undertake such

are arthoscopic surgery, neurosurgery, implant surgeries there is a need to have a

laminar ventilation flow that needs to be maintained as against the IPHS norm for

300-500 bedded facility, section 7, page 36.

Normally there are three types of traffic flow, namely, patients, staff and supplies. All these

should also be properly channelized on the principles of zoning to reduce antibiotic usage

within the hospital environment, which not happening currently because the design of

the OT complex does not facilitate zoning of traffic flow.

OT does not have Preparation Room, Pre-operative Room and Post Operative Resting

Room. It should have a single leaf door with self closing device and viewing window

to communicate with the operation theatre. Currently, one of the OT is accessible and

visible to all the trespassers as against the IPHS norm for 300-500 bedded facility,

section 7, and page 36.

The Scrub-up room where operating team washes and scrub-up their hands and

arms, put on their sterile gown, gloves and other covers before entering the operation

theatre, do not have sink with photo sensors or foot operated taps for water.

Currently the hospital has an elbow operated tap. Therefore the scrubbed hands of the

2 40% of infection in the hospital comes from cut opening a surgical site--WHO



surgeons may also be considered to be of relatively lower sterility than that is desired for the

kind of clean and large number of specialised cases being handled at Doon Hospital.

Owing to the said gaps the arthroscope that has been procured is lying unutilised.

There is no proper space for wearing gown and mask

While, a lot of space is available, but it is not utilized appropriately, lying vacant and

serve as place for dumping equipment, cylinders and instruments.

Gap Classification

Resources

Gap Classification

High

Gap Reference IPHS standards 300-500 bed facility, section 7, page 36


Picture 17: Improper Zoning in OT Complex, Door Opening Directly Into OT Area



Gap ID No OT 002

Observed in Operation Theatre

Gap Statement:

General OT procedures like, cleaning and hand washing, is not complied with, every

time by everyone.


There is no system laid down to ensure regular and systematic cleaning the OT

Normally OT cleaning is done in three stages—Intermediate cleaning, Daily cleaning and

Terminal cleaning3

a) Intermediate cleaning is done after each case wherein, disinfect is used to clean work

surface with ethyl or iso propyl alcohol after every case, and spills are cleaned if any

immediately, waste is collected and stored in the disposal area, floor is mopped with

disinfectant for the next case.

b) Daily cleaning is done at the end of each day’s surgery, wherein detergent plus a clear

soluble phenolic disinfectant is used for mopping the floor, furniture and ledges are

disinfected once in the day, walls and ceilings are also cleaned periodically when visibly

soiled.

c) Terminal cleaning is done at the end of a week to 15days, wherein the OT is fumigated

and kept closed for 24hrs or carbolised and kept closed for 12 hrs and microbiological

surveillance is done pre and post fumigation for identifying the bacterial flora in the

environment.

d) spills are cleaned if any immediately

Gap Classification

Resources

Gap Classification

High

3 Hospital Infection Control Manual, AIIMS, New Delhi



Gap Reference IPHS standards 300-500 bed facility, ISO 9001-2000 Guidelines,

section 4.1, and 7.1


Picture 19: Uncleaned Spill in the CSSD



Gap ID No OT 003

Observed in Central Sterile Supply Department (CSSD)

Gap Statement:

The CSSD is not designed on the principles of sterilisation.


OT being the major user of sterile supplies, the CSSD operates close to OT. However it is

not designed on the principles of sterilisation. Currently, the CSSD is located outside the OT

complex across the main corridor for general traffic, and the instruments after sterilisation

reach to the OT back from the same main corridor rendering the efforts of sterilisation futile.

The CSSD has one exit and entry, rendering the

path traversed by sterile and unsterile item same,

through the dirty utility corridor. The level of

cleanliness and the zoning in the CSSD should also

be like OT wherein there should be no mixing of

unsterile and sterile air within the facility. This means

the entry and exit should be separate as per the

functional requirements of CSSD, which is currently

not the case.

The CSSD does not have separate work station to pack and dry items.

The CSSD does not use quality control techniques to monitor the quality of sterilisation,

such as the air leak test, bacillus thermophilus biological indicator test. It only uses litmus

testing, which indicates completion of sterilisation cycle but does not indicate the sterile

status of a pack. The rapid use of sterile packs can be the only explanation that can be

offered for mitigating infection in the surgical cases in the current scenario.

Gap Classification

Gap Classification

Receiving

Washing &

Cleaning

Sorting &

Packing

SterilisationSterile Storage

& Distribution



Resources High

Gap Reference IPHS standards 300-500 bed facility, ISO 9001-2000 Guidelines,

section 6.3

Supporting

Annexure

Picture 18

Picture 18: Improper zoning in CSSD



6. Dialysis Room-DY 001 to 002

Gap ID No DY 001

Observed in Dialysis room

Gap Statement:

There is no separate designated location for keeping acid charging tanks in one of

the Dialysis Room.


Since there is no adequate space, the acid charging tanks were found to be kept in

the room near the patient, a potential safety hazard.

Gap Classification

Resources

Gap Classification

High

Gap Reference IPHS Standards for hospital-300-500 beds, ISO 9001-2000

Guidelines-6.3




Gap ID No DY 002

Observed in Dialysis room

OT

Gap Statement:

Instructions for removal of footwear are not available.


Clear instruction for removal of footwear and change in slipper, not available in

locations like the OT and dialysis room where it is mandatory

Gap Classification

Processes

Gap Classification

Medium

Gap Reference IPHS Standards for hospital-300-500 beds,




7. Laboratory- LB 001 to 004

Gap ID No LB 001

Observed in Lab

Gap Statement:

Skilled human resource in the lab used for administrative work


Lab technicians are involved in collecting the charges for the tests and maintain the

related accounts, which is improper utilization of the already stretched skilled

technical hands that are already in short supply.

Gap Classification

Resources

Gap Classification

High

Gap Reference IPHS Standards for hospital-300-500 beds, ISO 9001-2000 guidelines


Picture 19: Lab technician collecting test charges in pathology

lab



Gap ID No LB 002

Observed in Lab

Gap Statement:

BPL status verification is not centralized; it is undertaken separately in all the areas

where the patient visits in the hospital, leading to repetition of effort.


It is observed that BPL patients have to give a copy of their BPL status as a proof

separately in all cash counters-OP registration, labs, dialysis, and imaging, instead, a

single copy that can be maintained at the time of registration and duly stamped on

the patient OP ticket. This leads to duplication of efforts at all the patient care areas

whilst verifying the status of the patient and also causes inconvenience to the patient

Gap Classification

Processes

Gap Classification

Medium

Gap Reference IPHS Standards for hospital-300-500 beds, government order, ISO

9001-2000 guidelines




Gap ID No LB 003

Observed in Lab

Gap Statement:

Many a time‘s samples from the wards are sent to lab in syringes with needle, without

cap on it.


Chance for needle stick injury to the patient attendant/ ayah carrying the sample

Gap Classification

Resources

Gap Classification

High



Picture 20: Samples sent from ward to pathology lab in open bottles and cap-less syringes



Gap ID No LB 004

Observed in Pathology

Gap Statement:

Inadequate equipment in the laboratory to process tests


No auto-analyser for estimating Sodium, Calcium, Potassium levels,

No ELISA reader

No equipment for undertaking culture sensitivity

No equipment for estimating thyroid levels.

Gap Classification

Resources

Gap Classification

Medium





8. Transfusion Medicine

Gap ID No TM 001

Observed in Blood Bank

Gap Statement:

Patient to sample traceability not adequately defined


Rewriting the Donor serial numbers on the vials with pen, to make the number visible

–wastes time, especially given the limited human resources available. The use of a

marker pen instead of a regular pen would help resolve this issue.

Gap Classification

Resources

Gap Classification

Medium

Gap Reference IPHS standards 300-500 bed facility, ISO 9001-2000 guidelines




Gap ID No TM002

Observed in Blood Bank

Gap Statement:

Donor information management is not up to the mark.


The information captured in the donor form and that copied into the donor record

register is different – though the address of the donor is copied, the contact number

is not copied, and thus it could be difficult to contact a donor in the future.

Gap Classification

Processes

Gap Classification

Low

Gap Reference ICRA Grading norm, Documentation


Picture 21: Blood donor‘s contact number not captured in the blood donor record register



9. Imaging-IM 001

Gap ID No IM 001

Observed in Imaging

Gap Statement:

X-Ray room is crowded.


Men, women and children crowd inside the X-Ray room, which is a potential health

and safety hazard.

Also the X-Ray beam in the room is focused outside the window, which is a potential

safety hazard.

One unused x-ray machine-300mA occupies one room for last few years.

Gap Classification

Processes

Gap Classification

Medium

Gap Reference Atomic energy and Research Board (AERB) and Bhaba Atomic

Research Centre (BARC) norms-radiation hazard, ISO 9001-2000

guidelines, section 6.3, 7.2.1




10. Medical Store-MS 001 to 006

Gap ID No MS 001

Observed in Sub Store

Gap Statement:

Inventory management in the pharmacy, sub-store and main store do not have a well

defined system with respect to their procurement, storage and distribution.


Internal lead time and Re-order Level (ROL) not defined to ensure availability of items

at all times. Reorder Level (ROL) is quantity set apart as a safeguard against the variation

in demand & procurement period so that service delivery is not hampered. ROL helps us to

decide the time when fresh order needs to be placed. It is also known as Safety/Reserve

Stock, given by the formula-- (Average Consumption/day) x lead time. Thus Reorder Point

is the stock level at which fresh order has to be placed to avoid a situation of Stock Out.

Lead Time is the average time taken (no. of days) between placing of order & receipt of

material. The Lead Time has two parts namely the External LT and the Internal LT. The

External Lead Time (ELT) is time required for placement of order & receipt of goods. The

Internal lead time is the time required for the organisational formalities to be completed.

While ELT cannot be avoided, and can be only minimised by timely reminders, maintaining

good relationship with suppliers & penalising for delayed supplies; the ILT can be judiciously

managed with adequate planning.

While ROL tells us when to order, Economic Order Quantity (EOQ) tells us how much to

order in a given time. EOQ is the size of the order which helps us to minimise total carrying

cost & ordering cost of inventories.



Lack of a system to ensure availability of all drugs in one location, is a cause

for inconvenience to patients. Currently the patients are forced to visit both

the central store and dispensary for collecting all the drugs.

Again, the hospital supplies to the main store are also sometimes delayed, as

the hospital has no control over the ELT as these are not part of rate contracts

set with the State Govt., but with other govt. entities-such as ESIC/CGHS.

Therefore, the hospital is unable to levy any penalty on the manufacturer‘s

from whom they are procuring on rate contracts

Gap Classification

Resources

Gap Classification

Medium

Gap Reference ISO 9001-2000 Guidelines section 7.2.1


Gap ID No MS 002

Observed in Sub Store

Gap Statement:

There is no evidence of application of principles of Inventory management, such as

the ‗individual itemized‘ and ‗category wise‘ analysis of inventory to facilitate

management of inventory in the stores and while dispensing the same through the

pharmacy.


Inventory in the hospital is analysed in different stages, i.e. the overall analysis, ‗individual

itemized‘ and ‗category wise‘ analysis so as to facilitate management of inventory at

different levels of the organization for the overall smooth functioning of the stores. Some of

the way with which items are classified and the purpose they serve include:



Individual Itemised

Analysis

Basis of Classification Purpose

ABC-‗A‘ is the costliest

item procured by the

store. ‗B‘ group of items

have relatively lower cost

and the ‗C‘ group of items

are the least cost items

Based on the monetary

value of the item

Defines the level of

authorization required to

dispense a particular drug.

Antibiotics are costly items

and hence can be handled at

top management level

VED analysis—Vital,

Essential and Desirable

Based on the value of the

drug as regards its potential

to safe life and prevent

disability

Defines the availability of

items in the various patient

care areas based on the

criticality of its presence in

that area. For instance, while

atropine is not a costly drug is

it is very critical for life saving

hence its absence can be

catastrophic for care delivery.

HML Analysis-High,

Medium and Low moving

items

Based on the consumption

pattern of the drugs

Determines the way items

can be stocked so that they

are easily retrievable for

dispensing

The sub store does not store all items available in the main store

Currently all items required to be dispensed are not available in the sub-store

and pharmacy. For instance, Items like injections, gauze among others are not

available in the sub store / pharmacy and these needs to be collected by

patients / their attendants directly from the main store.

Thus, there is no single window system through which items can be collected

by patients / attendants, and they need to shuttle between the pharmacy, sub

and the main store for the same.

Gap Classification

Resources

Gap Classification

Medium

Gap Reference ISO 9001-2000 Guidelines, section 7.2.1, 7.3.4, 7.3.7




Gap ID No MS 003

Observed in Main Store

Gap Statement:

The ventilation in main store is not adequate, which may adversely impact the shelf

life of drugs.


Main store is stuffy, which may impact the shelf life of drugs

An adequate ventilation and storing facility is required in the main store to

maintain the shelf life of medicines depending upon the type of items being

stored

Gap Classification

Resources

Gap Classification

Medium

Gap Reference ISO 9001-2000 guidelines, section-7.5.5




Gap ID No MS 004

Observed in Main Store

Gap Statement:

Expiry register for drugs in the main store is not regularly updated.


An ―expiry register‖ is available, but expiry dates of drugs are generally mentioned in

the ―stock register‖ itself instead of the expiry register, as it is accessed more

regularly, which may pose difficulty in tracing the expired drugs in a single place.

Gap Classification

Processes

Gap Classification

Medium

Gap Reference ISO 9001-2000 guidelines, section 7.5.3 on traceability


Picture 22: Expiry date of medicines captured in two different places in main store



Gap ID No MS 005

Observed in Sub Store, Main Store, Wards

Gap Statement:

The shelves in which the medicines / IV fluids / injections etc. Are kept in the main

and the sub-store are not labeled.


Medicines / IV fluids / injections stored in the sub store and main store

cupboards / shelves are not labeled to facilitate easy retrieval.

The drugs are stocked on the basis of availability of space in the main and

sub-store, rather than being stocked in designated location as per a well

defined plan

Gap Classification

Processes

Gap Classification

Medium

Gap Reference ISO 9001-2000 Guidelines, section 6.4, 7.1, 7.5.3 and 7.5.5


Picture 23: No labeling of items in store



Gap ID No G006

Observed in Pharmacy

Gap Statement:

Dosage prescribed by doctors is not verified at any level – even by pharmacists.


Given the patient / attendant load at the two counters of the pharmacy,

pharmacists are currently able to play the role of medicine dispensers only.

Since they do not validate the dosage of medicines prescribed by doctors, the

dosage prescribed by doctors remains unverified.

Sometimes, dosage is not written completely by doctors and only final

quantity is indicated to pharmacy on separate small paper – this could lead to

confusion regarding the dosage.

Gap Classification

Processes

Gap Classification

Medium

Gap Reference ISO 9001:2000 guidelines, section 5.3




Picture 24: Dosage not written completely by doctors + only final quantity indicated to

pharmacy on separate small paper



11. Injection Room-IR 001

Gap ID No IR 001

Observed in Injection Room

Gap Statement:

Records in the injection room do not capture all the injections administered.


The exact number of injection given in the injection room is not recorded.

It was found that the record book in the injection room maintains record only

for those administered injections that are available in the injection room. The

select Injections bought by the patients from the open market are also

administered in the injection room if the patient so desires, but a record for the

same is not maintained.

In the event of any adverse reaction to the injections brought from outside, no

details (what drug was injected and in what dose was it injected) for such dugs

are available with the hospital to handle the case suitably.

Gap Classification

Processes

Gap Classification

Medium

Gap Reference ISO 9001-2000 guidelines, section 7.5.3 on traceability




12. Kitchen-KI 001 to 003

Gap ID No KI 001

Observed in Kitchen

Gap Statement:

Kitchen premises do not comply with hygiene and cleanliness requirement.


The overall hygiene of the kitchen was not found to be adequate.

Kitchen staff was cooking without aprons, caps

Food material was found to be lying around.

The wash area was found to be unclean.

Do not have regular health checks and hand swab cultures for the food

handlers

Gap Classification

Resources

Gap Classification

Medium

Gap Reference Service contract, ISO 9001-2000 Guidelines-6.3




Picture 25: Unclean kitchen cooking and washing area

Gap ID No KI 002

Observed in Kitchen

Gap Statement:

Movement of food outside the kitchen to the wards is inadequately handled


There is no food trolley to carry the foods for serving in the wards

Food was found to be moved from the kitchen manually – one person carrying

3 to 4 semi-covered plates, which is an unacceptable practice.

This situation is worsened in the monsoon season.

Gap Classification

Resources

Gap Classification

High



Gap Reference ISO 9001-2000 guidelines, 7.6, 8.2.3


Picture 26: Food Carried in Covered Trays under Open Sky

Gap ID No KI 003

Observed in Kitchen

Gap Statement:

There is no dietician in the hospital.


Dietary services not offered as per the diet advices of dietician

In the absence of dietician the diet advices are offered by the clinicians

Gap Classification

Resources

Gap Classification

Medium



Gap Reference IPHS standards 300-500 beds, section 7, page 37


13. Medical Records- MR 001

Gap ID No MR 001

Observed in Hospital

Gap Statement:

There is neither designated location for keeping the old medical records nor there is

an evident record keeping/maintenance process with retention timelines


No designated area for storing medical records

While records are maintained at the hospital in a adhoc fashion, there is no

documented process in evidence for the same

Also there is no trained staff to maintain medical records

Gap Classification

Processes

Gap Classification

Medium

Gap Reference IPHS standards for 300-500 bedded facility, section 14, page 78; ISO

9001: 2000, section 4.1




Picture 27: Improper medical record management - kept in cardboard boxes in the main store

Gap ID No MR 002

Observed in Ward

Gap Statement:

Date and time is not filled in by all doctors on the bed head ticket while writing

examination findings/ prescribing.


An absence of date and time in the case sheet may affect the subsequent

management of complications in any or to revise the plan of treatment.

Gap Classification

Processes

Gap Classification

High

Gap Reference IPHS standards 300-500 bed facility, Consumer Protection Act, ISO

9001-2000 guidelines section 7.5.3




14. Customer Satisfaction- CS 001

Gap ID No CS 001

Observed in Hospital in general

Gap Statement:

There is wide variance in the perception of the patients as regards the service

delivered in the hospital


As there is no structured mechanism for grievance redressal and offering suitable

feedback on the action taken, we undertook a patient satisfaction survey on a six-

point scale.

Being a well known hospital and located in the State capital it is no wonder that

patients from even very far off locations come to the GDH for treatment – over 40% of

patients were found to be coming from far off locations, districts other than Dehradun

and also from adjoining States. While, satisfaction levels varied from attribute to

attribute, most patients were found to be satisfied with most of the aspects related to

the hospital. Overall level, 23% patients felt that the overall patient care process was

excellent; 31% felt that it was satisfactory.

Gap Classification

Resources

Gap Classification

Medium


Supporting Annexure The questions and their individual responses

are detailed in Annexure 6.





15. Employee Satisfaction- ES 001

Gap ID No ES 001

Observed in Hospital in general

Gap Statement:

There is wide variance in the perception of the employees as regards their

satisfaction levels while serving in Doon Hospital.


As there is no structured mechanism for grievance redressal, receiving employee

complaints/suggestions and offering suitable feedback on the action taken, we

undertook an employee satisfaction survey on a six-point scale.

Employee satisfaction was evaluated on basis of the following attributes:

1. Remuneration

2. Work Environment

3. Division of Labor

4. Career Progress

5. Approachability of seniors management

6. Perception of service provided

While there are approx 40% employees who are satisfied with the current functioning

of the facility, there are equal proportion of people who have concerns and

objections, and there are 20% people who are absolutely indifferent to the existing

scenario.



This indicates that there is a need to make suitable efforts for mainstreaming the 40%

people who have concerns and suggestions through suitable complaint management

system.

The overall employee satisfaction including all parameters is depicted in the chart

below, the satisfaction levels varied from attribute to attribute.

Gap Classification

Resources

Gap Classification

Medium


Supporting Annexure The questions and their individual responses

are detailed in Annexure 7.



The Next Steps

1. Implementation of Gap filling

Herein, the gaps as identified will be taken up strategically and short term, long term goals

will be identified in liaison with the hospital

a. Develop documents including quality manual, procedures and work instructions to

institute processes, to maintain optimal functionality within the existing resources and

processes

b. Develop handy broad framework of Standard Treatment Protocol (STP) for ensuring

delivery of uniform and standardised services

c. Develop benchmarks, based on local needs and sensitivities and that would be

focused at improving the quality of services provided

d. Develop an effective HMIS to elucidate actionable feedback

e. Build capacity and prepare the system to meet ISO 9001:2000 guidelines with the

existing inputs.

This would include basic orientation and training to hospital managers or

resource group and/or internal auditors meant to help this process, and provide

capacity building training to the existing Staff at the Healthcare facilities.

This would also include active hand-holding and guidance as they test out and put

new processes into place.

f. Basic training to individual healthcare staff shall comprise the following training &

awareness program at minimum of:

Awareness on Good Management System Design, ISO 9001: 2000 requirements

Training on Documentation & Document Control

Training on Work Instruction, Quality Improvement & Performance Tools for

improved status

Corrective & Preventive Action Plan Management, e.g. as for Biomedical Waste

Management

g. Awareness training on clinical care system management

Clinical Audits and documentation

Ward management

Inventory management

Equipment planning and management

Accident and Emergency Management



Disaster management

Bio-Medical Waste Management

h. Orientation of CPS towards their roles in quality improvement of healthcare facilities

i. Develop system to facilitate effective implementation of documented processes in

liaison with all the stakeholders involved in direct improvement with the healthcare

facility, i.e., CPS, hospital managers and district health administration

j. Hand-hold the health care facility to sustain and achieve the prevailing ISO 9001:

2000 standards.

k. Applying for ISO Certification

2. Mapping the To-Be Process

Herein, the To-Be processes will be mapped and a system will be developed to ensure

continuous improvement and monitoring within the healthcare facility in-order-to meet the

IPHS standards,



Annexures

Annexure 1: List of People Interviewed

Sr. No. Name Designation

1 Dr. R K Pant Chief Medical Superintendent

2 Mr. Keshav Desiraju Principal Secretary Health

3 Dr. G C Bounthiyal Chief Medical Officer, Dehradun District

4 Dr. P L Joshi Director General, Medical Services

5 Col. Dr. J V Ramamurthi Manager

6 Mr. K L Gautam Assistant Superintendent

7 Dr. Pankaj Arora Neurosurgeon

8 Dr. S K Gupta Senior Orthopedic Surgeon

9 Dr. Alok Jain ENT Specialist

10 Dr. K B Joshi Cardiologist

11 Dr. B C Pathak Senior Eye Surgeon

12 Dr. K C Pant Senior Physician

13 Dr. S K Jha Emergency Medical Officer

14 Mr. Vishal Raj Dialysis Technician

15 Dr. S K Nautiyal Senior Pathologist

16 Dr. Sulekha Nautiyal Pathologist

17 Dr. N K Mishra Pathologist

18 Dr. T R Joshi Pathologist

19 Mr. S K Tyagi Physiotherapist

20 Mrs. P K Pillai Matron

21 Ms. Saroj Rawat Sister in Charge, Male medical ward

22 Ms. C K Thapa Sister in Charge, Female Surgical ward



23 Mr. Ram Vijay Singh Social Worker

24 Mr. U P Dangwal Injection Room

25 Mr. P S Negi Incharge, Medical Records

26 Mr. H S Phoniya Pharmacy

27 Mr. B S Payal Sub Store

28 Mr. P C Semwal Main Store

29 Ms. Babita Employed at Registration Counter

30 Ex Hawaldar Mahender Electrician

31 Mr. Thapa CSSD

32 Mr. D C Danosi Finance Head

33 Dr. Anil Arya Skin Specialist

34 Dr. J D S Rana Dentist

35 Dr. Alok Teotia Senior Physician

36 Dr. J S Bisht Neuropsychiatrist

In addition, sisters-in-charge and staff nurses were met in the wards.



Annexure 2: List of Documents Reviewed in the Hospital

BLOOD BANK

1 Donor Register 9 Donor Screening Register

2 Blood Issue Register 10 Donor Screening Form

3 Master Record Register 11 Cross Match Form

4 Stock Book of Blood 12 Blood Requisition Form

5 Cash Book 13 Cash Receipt Form

6 Blood Donation Camp Register 14 Bag Slip for different blood group

7 Positive Result Details 15 Volunteer Donor Register

8 BMW Management Register 16 Below Poverty Line Register

PATHALOGY

1 Requisition Form 6 Indoor Register

2 Reporting Form 7 BPL Register

3 Registration Register 8 Medico legal Register

4 User Charges Register 9 Patient Fee Register

5 DPD Register 10 Sterilizer Register

MEDICINE STORE

1 Main Stock Book

4 Cancer Program Medicine Stock

book

2 Surgical Stock Book 5 Local Purchase Register

3 Date of Expiry Register

6 BDL, VIP, Press and general

register

NURSING

1 Patient Report Book 12 Complaint Book

2 Admission Discharge Book 13 Diet Book

3 Medicine Indent Book 14 Dhobi Book



4 Medicine Expenditure Book 15 User Charges Book

5 Death Certificate Book 16 Contingency Indent Book

6 Call Book 17 BMW Report Book

7 Pathology Book 18 Fresh Order Book

8 Blood Transfusion Book 19 Linen Stock Book

9 BPL Indent Book 20 Bed Vacant Book

10 Dead Stock Book

21 TPR Chart/BP Record/Intake &

output

11 Local Purchase Indent Book

IMAGING

1 Daily X Ray Register 11 Daily CT Scan Register

2 Daily Digital X Ray Register 12 CT Log Book

3 Daily Ultrasound Register 13 CT Cash Book

4 Daily Mammography Register 14 Daily CT c Register

5 Daily Color Doppler Register 15 Daily CT Film Register

6 Dead Stock Register 16 Cash Register - X Ray

7 Consumable Register - X Ray 17 Cash Register - Ultrasound

8 Consumable Register - Ultrasound 18 Cash Register - Mammography

9

Consumable Register -

Mammography

19

Cash Register - Color Doppler

10 PNDT Register 20 Cash Register - Digital X Ray

EMERGENCY

1 Emergency Slip 6 Police Case Register

2 Emergency OPD Register 7 Gastric Lavage Sample Register

3 Medico Legal Register 8 Police Information Register

4 Inquiry Register 9 Magistrate information Register

5 Private Register



ICCU

1 Admission/Discharge Register 7 Contingency Register

2 Treatment Register 8 Blood Transfusion Register

3 Drug Expenditure Register 9 Complaint Book

4 Call Book 10 BPL Register

5 Lab Blood 11 Daily Charges Register

6 Dhobi Register 12 Report Book

PHARMACY

1 Sub Store Stock Book 7 MLC Register

2 Indent book 8 Stock Wash Register

3 Daily Consumption Register 9 Mortuary Register

4 Injection Register 10 Indoor Register

5 ARV Vaccination Register 11 Admission Register

6

All Records of OPD & Pharmacy

department of hospital



Annexure 3: Areas and Sections Analysed for As-Is Survey

I. Resources:

1. Infrastructure and Technology-

a) Clinical Services-OPD, IPD, ICU,

High Dependency Unit, Operation

theatres, Dialysis unit, Emergency &

Ambulance Services

b) Support Services-Radio Diagnostic

and lab services, Blood Bank, Medical

Record Division, Dietary & Pharmacy

Services

c) Utility Services-Linen & Laundry,

Central Sterile Supply Division, House

Keeping, Security services

2. Human resources

a) Medical

b) Nursing

c) Paramedical

d) Class IV

e) Administrative

3. Financial Management

4. Governance and Management:

a) Facility risk management

b) Patient safety management

c) Quality improvement

d) Information management

e) Legal obligation management

f) Billing practice management

g) Equipment management

h) Store purchase management

i) Chikitsa Prabandhan Samiti management

II. Processes

a) Patient flow processes-

accessibility, affordability, continuity,

admission, discharge, death, patient

satisfaction survey

b) Patient care management process

Clinical credentialing-ALOS, BOR,

Bed Turn Over Rate

Clinical audits-Medical Audit,

Tissue Audit

Clinical risk management-Hospital

Acquired Infection Rate, Cross

Infection Rate, Patient Safety

Criteria

Clinical outcome measurement-

success rate wherever possible

Clinical Care pathways

Ethical practice

c) Document management and

control

Medical records

Prescription records- to evaluate

the patient communications

provided

Committee minutes reports

Reports of measurement and

assessment activities

Reports to medical staff, hospital

committees, and the governing

body

a) Hospital Infection Control

management

b) Medication management

c) BMW management



Annexure 4: Detailed Manpower Calculations

Doctors IPHS Current Shortage

Chief Medical Superintendent 1 1 0

Medical Specialist 4 4

Surgery Specialists 3 3

O&G specialist 8 8

Psychiatrist 1 1

Dermatologist / Venereologist 2 2 0

Paediatrician 4 2 2

Anesthetist (Regular / trained) 8 1 7

ENT Surgeon 2 1 1

Ophthalmologist 2 3 -1

Orthopaedician 2 5 -3

Radiologist 5 2 3

Microbiologist 1 1

Pathologist and Blood Bank In-

charge

1 2 -1

Casualty Doctors / General Duty

Doctors

24 3 21

Dental Surgeon 1 1 0

Forensic Specialist 1 1

Public Health Manager1 1 1

AYUSH Physician 4 4

Environmental Officer 1 1

Waste Management Officer 1 1



Paramedical IPHS Current Shortage

Staff Nurse 225 74 151

Infection Control Nurse 2 2

Hospital worker (OP/ward +OT+ blood bank) 50 30 20

Sanitary Worker 30 30

Ophthalmic Assistant / Refractionist 2 2 0

Social Worker / Counsellor 2 2 0

Dermatology/STD/Leprosy Technician – Lab 1 1

AIDS/STD Counselor cum field Support 2 2

ECG Technician 1 0 1

ECHO Technician 1 1

Audiometrician 1 1

Laboratory Technician ( Lab + Blood Bank) 9 6 3

Laboratory Attendant (Hospital Worker) 3 2 1

Dietician 2 2

PFT Technician 1 1

Maternity assistant (ANM) 4 4

Radiographer 12 12

Dark Room Assistant 8 2 6

Pharmacist1 10 17 -7

Matron 9 1 8

Physiotherapist 2 1 1

Statistical Assistant 1 1

Medical Records Officer / Technician 2 2

Electrician 2 1 1

Plumber 2 1 1



Admin IPHS Current Shortage

Hospital Superintendent 1 1

Manager (Administration) 1 1

Manager (Finance) 1 1 0

Manager (HR) 1 1

Account Officer 1 1 0

Accountant 4 3 1

Assistant cum Computer 6 2 4

Driver 4 2 2

Peon 2 4 -2

Security Staff* 2 4 -2

OT Staff IPHS Current Shortage

Staff Nurse 11 11

OT Assistant 10 10

Sweeper 5 5

Blood Bank Staff IPHS Current Shortage

Blood Bank In-charge 1 1

Staff Nurse 3 3

MNA / FNA 1 1

Blood Bank Technician 1 1

Sweeper 1 1



Annexure 5: Chikitsa Prabandhan Samiti

The National Rural Health Mission has defined guidelines for the objectives, functions and

activities of the Rogi Kalyan Samiti, which the States call it by different names, for instance

in State of Uttarakhand it is called as Chikitsa Prabandhan Samiti (CPS). The objective and

mandate of CPS are as follows:

Objectives of the RKS

Ensure compliance to minimal standard for facility and hospital care and protocols of

treatment as issued by the Government

Ensure accountability of the public health providers to the community

Introduce transparency with regard to management of funds

Upgrade and modernize the health services provided by the hospital and any associated

outreach services

Supervise the implementation of National Health Programmes at the hospital and other

health institutions that may be placed under its administrative jurisdiction

Organize outreach services / health camps at facilities under the jurisdiction of the

hospital

Display a Citizens‘ Charter in the Health facility and ensure its compliance through

operationalisation of a Grievance Redressal Mechanism

Generate resources locally through donations, user fees and other means

Establish affiliations with private institutions to upgrade services

Undertake construction and expansion in the hospital building

Ensure optimal use of hospital land as per govt. guidelines

Improve participation of the Society in the running of the hospital

Ensure scientific disposal of hospital waste

Ensure proper training for doctors and staff

Ensure subsidized food, medicines and drinking water and cleanliness to the patients

and their attendants

Ensure proper use, timely maintenance and repair of hospital building equipment and



machinery

Functions and Activities of the RKS

The functions and activities below can help the RKS achieve its objectives as stated above:

Identifying the problems faced by the patients in CHC/PHC

Acquiring equipment, furniture, ambulance (through purchase, donation, rental or any

other means, including loans from banks) for the hospital

Expanding the hospital building, in consultation with and subject to any Guidelines that

may be laid down by the State Government

Making arrangements for the maintenance of hospital building (including residential

buildings), vehicles and equipment available with the hospital

Improving boarding / lodging arrangements for the patients and their attendants

Entering into partnership arrangement with the private sector (including individuals) for

the improvement of support services such as cleaning services, laundry services, diagnostic

facilities and ambulatory services etc.

Developing / leasing out vacant land in the premises of the hospital for commercial

purposes with a view to improve financial position of the Society

Encouraging community participation in the maintenance and upkeep of the hospital

Promoting measures for resource conservation through adoption of wards by institutions

or individuals

Adopting sustainable and environmental friendly measures for the day-to-day

management of the hospital, e.g. scientific hospital waste disposal system, solar lighting

systems, solar refrigeration systems, water harvesting and water recharging systems etc.



Annexure 6: Patient Satisfaction Survey Questionnaire and Attributes

Sr.

No.

Question

Attributes

Excell

ent

Very

good

Satisfa

ctory

Indiffer

ent

Unsatis

factory

no

choic

e

1 Was coming here a right

decision as far as receiving

patient care is concerned?

40% 17% 24% 10% 5% 5%

2 Were you satisfied with the

behaviour of staff at the

registration counter?

61% 14% 14% 7% 4% 0%


time taken at the registration

counter?

54% 6% 29% 4% 7% 0%


behaviour of doctors / staff

in emergency?

43% 14% 9% 9% 9% 17%


time taken for someone to

treat you in emergency?

55% 11% 14% 7% 7% 7%


waiting time for consultation

in OP?

12% 12% 12% 23% 19% 23%


public amenities that are

provided to patients in the

hospital?

48% 22% 19% 5% 0% 5%


overall convenience and

comfort offered during the

patient care process?

23% 31% 33% 5% 3% 5%


privacy offered while being

treated in the various

patient care areas?

7% 2% 32% 25% 11% 24%




quality of the food served at

the hospital

43% 14% 17% 9% 9% 9%


waiting time for OP

investigations in the lab?

0% 4% 10% 11% 50% 25%



Annexure 7: Employee Satisfaction Survey Questionnaire and Attributes

Employee satisfaction was evaluated on basis of the following attributes:

1. Remuneration

2. Work Environment

3. Division of Labor

4. Career Progress

5. Approachability of seniors management

6. Perception of service provided

A scale of 1 to 5 was used to indicate the level of satisfaction, where,

Rating Meaning

1 Completely unsatisfied

2 Unsatisfied

3 Indifferent

4 Satisfied

5 Fully satisfied

Completel

y

unsatisfie

d

Unsatisfie

d

Indifferen

t

Satisfied Fully

satisfied

Remuneration 30% 33% 26% 11% 0%

Work Environment 15% 33% 30% 7% 15%

Division of Labour 15% 19% 22% 37% 7%

Career Path 22% 44% 15% 15% 4%



Approachability of

seniors

0% 7% 7% 15% 70%

Perception of service

provided

4% 11% 33% 48% 4%

The satisfaction levels varied from attribute to attribute. For example, while most employees

were satisfied with the approachability of senior management, most were unsatisfied with the

remuneration and career progress. While 11% employees were satisfied with the

remuneration and none were fully satisfied, 33% were unsatisfied with the remuneration, and

an additional 30% were completely unsatisfied. As regards the work environment, 7%

employees were satisfied while 15% were fully satisfied; on the other hand, 33% were

unsatisfied while 15% were completely unsatisfied. 44% employees were either satisfied or

fully satisfied with the division of labor, while 34% were either unsatisfied or completely

unsatisfied. Similarly as regards the satisfaction with career path, it was seen that only 19%

employees showed a good satisfaction level (but only 4% were fully satisfied), while 66%

were either unsatisfied or fully unsatisfied. A very good response was received from

employees‘ w.r.t. the approachability of seniors. 85% employees showed a good satisfaction

level (70% were fully satisfied), and no employee was seen to be full unsatisfied. Also, 52%

employees were either satisfied or fully satisfied with the service they provided, and only

15% were either unsatisfied or completely unsatisfied.



Details of Dehradun District CHC‘s and PHC‘s

Picture 31: A Collage with Pictures of the PHCs and CHCs in Dehradun District

The launch of the National Rural Health Mission (NRHM) has given the public health

facilities to have a fresh look at their functioning. NRHM envisages bringing the CHC

services to the level of Indian Public Health Standards. Although there are already existing



standards as prescribed by the Bureau of Indian Standards for 30-bedded hospital, these

are at present not achievable as they are very resource-intensive. Under the NRHM, the

Accredited Social Health Activist (ASHA) has been envisaged in each village to promote the

health activities. With ASHA in place, the system not only requires to upgrade its services to

handle higher patient load, but also has emphasis to improve patient satisfaction. In order to

ensure quality of services, the Indian Public Health Standards (IPHS) has provided a

yardstick (detailed in the table below) to measure the services being provided in the PHCs

and CHCs projected based on the assumption that there will be average bed occupancy of

60%, which may be further increased if the occupancy increases with subsequent up

gradation.

Clinical Manpower 5 Total Manpower 15

Personnel at CHC Minimum

requirement

at CHC

Personnel at PHC Minimum

requirement

at PHC

General Surgeon 1 Medical Officer

Physician 1 Pharmacist

Obstetrician/Gynaecologist 1 Nurse 2 Contractual if

need be

Paediatrics 1 Health workers (F)

Eye surgeon 1 Health Educator 1

Support Personnel 21/22+2 Health Asst (Male & Female) 2

*Nurse-midwife 7+2 Clerks 2

Dresser (certified by Red

Cross/

St. Johns Ambulance)

Laboratory Technician 1

Pharmacist/compounder Driver 1

Optional/vehicl

es may be out-

sourced

Lab. Technician Class IV 4

Radiographer

**Ophthalmic Assistant 0-1



Ward boys/ nursing orderly 2

Sweepers 3

Chowkidar 5***

OPD attendant

Statistical Assistant/Data entry

operator

OT attendant

Registration clerk

*1 ANM and 1 PHN for family welfare will be appointed under the ASHA scheme

** Ophthalmic assistant may be placed wherever it does not exist through redeployment or

contract basis.

*** Flexibility may rest with the state for recruitment of personnel as per needs.

Dehradun district has 7 CHC‘s and 21 PHC‘s. This apart there are SAD‘s and Sub-centres

as described in the table below:

Type of Medical Institution Number

Community Health Centre (CHC) 7

Primary Health Centre (PHC) 21

State Allopathic Dispensary (SAD) 24

Sub Centre (SC)

Block Doiwal 28

Block Raipur 27

Block Sahaspur 28

Block Vikas Nagar 28



Block Kalsi 29

Block Chakrata 28

Additional PHC (A-PHC) 2

Project Hospital 2

The distribution of the medical institutions is located in either building owned by the

Government, Under-construction, or in rented buildings is as below:

Type of Medical

Institution

Located in Government

buildings

Under

Construction

Located in rented

buildings

CHC 5 4 0

PHC 15 5 3

SAD 8 12 5

The Primary Health Centres (PHC‘s) in Dehradun district are as below:

Primary Health Centres (PHC‘s)

1 Kalsi Bhagwantpur

2 Bhaniyawala Rajawala

3 Dudhali Kunja

4 Chiddarwala Herbertpur

5 Raiwala Rudrapur

6 Balawala Pachimwala

7 Thano Tyuni

8 Nehrugram Manthat

9 Mehuwala Kwansi

1 Prem Nagar Pigitlani

1 Nayagaon Pelio



The human resources expected to be employed at the different types of medical institutions

in Dehradun district is as below:

Type of Medical Institution Human Resources

SAD 1 medical officer

1 pharmacist

1 ward boy / ayah

1 sweeper / chowkidaar

PHC 1 medical officer

1 pharmacist

1 ward boy / ayah


1 ANM

A-PHC 2 medical officers

1 pharmacist

1 ward boy / ayah


1 ANM

CHC I medical superintendent

1 surgeon

1 physician

1 pediatrician

1 eye surgeon

1 dental surgeon

1 radio diagnostics

technician

1 anesthetist

1 gynecologist



The Manpower Status in Community Health Centres (CHC‘s) in Dehradun district as

received from the CMO‘s office is as follows:

Community Health Centres (CHC‘s)

1 Raipur 1 CMS 2 Doiwala 1 CMS

1 Gynaecologist 1 Chikitsa Adhikari Pratham

1 Chikitsa Adhikari 1 Pediatrician

1 Surgeon 1 Dental surgeon

1 Physician 1 Surgeon

1 Radiologist 1 Chikitsa adhikari dvitiya

1 Pharmacist 1 Pathologist

1 Female health worker 1 Female medical officer

3 Upcharika 4 Staff nurse

1 ANM 1 Chief pharmacist

1 Driver 1 Pharmacist

1 Sweeper 1 X Ray technician

5 Ward boy 1 Driver

1 Ayah 2 Optometrist

2 Safai karmachari 1 Senior officer

3 Sahiya 1 CMS 1 SPS

1 Deputy Medical

Superintendent

2 Vaccinator

1 Radiologist 1 Health supervisor

1 Orthopedic surgeon 1 SPS

1 Dental chikitsak 1 HI

1 Female medical officer 1 HI

1 Pharmacist 1 SPS

3 Staff nurse 8 HV



1 Female health worker 3 HS

1 ANM 1 HI

1 TB health worker 2 LHV

1 MPW 52 ANM

1 Driver 3 Ward boy

1 Orderly 1 Ayah

1 Ward boy 2 Chowkidaar

1 Sweeper 1 Cook

1 Dhobi

1 Male sweeper

1 Female sweeper

1 Orderly??

2 Dai

4 Mussoorie 1 Physician 5 Chakrata 1 Prabhari chikitsa adhikari

1 ENT surgeon 1 Chikitsa adhikari dvitiya

1 Dental surgeon 1 Pediatrician

1 Female medical officer 1 Dental surgeon

1 Male medical officer 1 Surgeon

1 Chief pharmacist 1 Pathologist

3 Upcharika 3 Staff nurse

1 X Ray technician 4 Swarthy paryavekshak

1 ANM 3 Swasthya paryavekshika

1 Administrative officer 18 Swasthya karya. (ma.)

1 Cook 1 Driver

1 Dhobi 1 Swa. Karya. (pu.)

2 Ward boy 1 X Ray technician



1 Ayah 1 Ward boy / ayah

3 Safai karmachari 4 Chowkidaar

1 Chowkidaar

6 Vikas

Nagar

1 Prabhari chikitsa

adhikari

7 Sahaspur 1 Prabhari chikitsa adhikari

1 Pediatrician 1 Chikitsa adhikari dvitiya

1 Surgeon 1 Streerog visheshagyn

1 Pathologist 1 Medical officer

1 Streerog visheshagyn 1 Dental surgeon

1 Female medical officer

(PPC)

1 Pharmacist

1 Dental surgeon 3 Staff nurse

1 Radiologist 1 Dental hygienist

2 Pharmacist 1 Ward boy

1 Pravar sahayak 3 Sweeper cum chowkidaar

1 Lab technician 1 Eye sahayak

1 X Ray technician 2 Swa. Parya. (male)

1 FPHA 6 Swa. Karya. (male)

1 Female health worker 3 Dai

1 ANM 3 Swa. Parya. (female)

3 Staff nurse 30 Swa. Karya. (female)

1 Ayah 3 Pharmacist

3 Sweeper 1 Ardali, HV

3 Ward boy

The details of our visit vetting the sanctioned posts and required resources in the

PHCs and CHCs are described below.



1. CHC- Mussoorie

Infrastructure The hospital operates in a state owned building. The hospital has separate O.T., Labor room, Emergency room, Store room and Injection room/Dressing room but Post Operative recovery room is not available. Separate Public utilities for male and female are also available. Electricity is mostly available for 24 hours and the hospital also has its own generator, but there is problem regarding the round the clock availability of water. The hospital also has proper signage and seating/waiting arrangements.

Processes The hospital has OPD services which are available from 9am to 3pm in winters and 8am to 2pm in summers. The hospital also has 30 bedded IPD. The hospital does regular clinical audits but never had any Disaster audit.

Services The hospital offers preventive, promotive, curative services through its OPD, IPD and 24 hours emergency facility. The hospital also has referral services available and refers the patients to Doon Hospital as and when the patient condition necessitates. The hospital provides vaccination, Anti-natal, delivery and new-born care services. The hospital also provides malaria treatment and TB treatment through its own DOTS center and has facilities for treatment of complicated cases of Malaria, Filaria and Dengue. The hospital also has facility to offer post exposure prophylaxis and/or treatment for the patients of dog bite, snake bite and scorpion bite. Family planning and plaster services are also available.

Facilities The hospital has its own lab in which Hemoglobin, Urine Albumin, Diabetes and Rapid Test for Syphilis are available. The hospital does not have Blood Storage Facility. The hospital also has its own ambulance facility for referral of patients.

Legal Compliance

The hospital complies to all legal requirements.

Support processes

The clinical services is supported by full time Nursing care in the hospital The hospital has its own housekeeping and laundry to ensure availability of a clean and hygienic environment for patient care.

Security The hospital has its own in-house security guard to ensure security of patients and infrastructure/facility of the hospital.

Equipment The hospital has a Baby warmer/Phototherapy unit and operation table along with accessories to offer surgical services including O.T. light, anesthesia apparatus and instruments for general surgery and MTP. The other vital equipment includes Ambu bag and Oxygen Cylinder.



Manpower: - Following are the details of the staff members of the hospital rendering

care at CHC Mussoorie.

Staff members

Physician 1

LMO 1

General medicine Doctor 1

Dental 1

Radiologist 1

Chief pharmacist 1

X-Ray technician 1

Nursing Staff 6 (3 regular, 2 Attached and 1 contractual)

ANM 1 (Common with St. Mary)

Ward Boy 2 (from St. Mary)

Cook 1

Dhobi 1

Safai karmachari 3

Chowkidar 1



2. CHC- Raipur

Infrastructure The hospital operates in a state owned building. The hospital has separate O.T., Labor room, Emergency room, Store room, Injection room/Dressing room and Post Operative recovery room. The hospital also has Instrument sterilization area. Separate Public utilities for male and female are also available. Water and Electricity are mostly available for 24 hours and the hospital also has its own generator. The hospital also has proper signage and seating/waiting arrangements.

Processes The hospital has OPD services which are available from 8am to 2pm. The hospital also has 10 bedded IPD. Internal Clinical audits are not done, but teams from CMO office comes for these audits. The hospital has never had any Disaster audit.

Services The hospital offers preventive, promotive, curative services through its OPD, IPD and 24 hours emergency facility. The hospital also has referral services available and refers the patients to Doon Hospital as and when the patient condition necessitates. The hospital provides vaccination, Anti-natal, delivery and new-born care services. The hospital also provides malaria treatment and TB treatment through its own DOTS center and has capability for treatment of complicated cases of Malaria, Filaria and Dengue but there has been no case of Malaria, Dengue and Filaria registered till date. The hospital also has facility to offer post exposure prophylaxis and/or treatment for the patients of snake bite and scorpion bite. The hospital has surgical services available for Hernia and Appendices. Cataract and family planning surgical treatment is available but not regularly, registration is done and then camps are organized for the same.

Facilities The hospital does not have any lab of its own; the lab is expected to be established in period of 2-3 months. The hospital does not have Blood Storage Facility. The hospital also does not have its own ambulance facility for referral of patients, but expects to get the same in 2-3 months.

Legal Compliance


Support processes

The clinical services are supported by full time Nursing care in the hospital The hospital has its own housekeeping staff to ensure availability of a clean and hygienic environment for patient care.

Security The hospital does not have any in-house security guard to ensure security of patients and infrastructure/facility of the hospital.

Equipment The hospital has operation table along with accessories to offer surgical services O.T. light, anesthesia apparatus and instruments for general surgery and MTP. The other vital equipment includes Ambu bag and



Oxygen Cylinder. The center does not have Baby warmer/Phototherapy unit.


care at CHC Raipur.

Staff members

Medical Officer in Charge 1

Physician 1

Dental surgeon 1

General Duty Medical

Officer

1

Nurse 3

Pharmacist 1

Ward Boy 2

Health

Assistant/Supervisor

1

(Male)

Clerk 1

Sweeper 2

Special Comment: Raipur CHC is located at a distance of about 5-6 Km‘s from

Dehradun Central. It has been recently converted from PHC to CHC and has a

newly constructed building/campus. Certain posts in the hospital still needs to be

filled, including that of a Pediatrician, Eye specialist, Radiologist among others.

The hospital does not have laboratory and is expected to be operational in a

period of about 2-3 months.



3. CHC- Doiwala

Infrastructure The hospital operates in a state owned building. The hospital has separate O.T., Labor room, Emergency room, Store room, Injection room/Dressing room and Post Operative recovery room. The hospital also has separate Operation Disposable area and Instrument Sterilization area. Water and Electricity are mostly available for 24 hours and the hospital also has its own generator. The hospital also has proper signage and seating/waiting arrangements. Separate Public utilities for male and female are also available.

Processes The hospital has OPD services which are available from 8am to 2pm. The hospital also has 30 bedded IPD. IPD load is 100 percent and almost all the beds are occupied. Internal Clinical audits are not done, but teams from CMO office comes for these audits. The hospital has never had any Disaster audit.

Services The hospital offers preventive, promotive, curative services through its OPD, IPD and 24 hours emergency facility. The hospital also has referral services available and refers the patients to Doon Hospital as and when the patient condition necessitates. The hospital provides vaccination, Anti-natal, delivery and new-born care services. The hospital also provides TB treatment (through its own DOTS center) and malaria treatment. Complicated cases of Malaria, Filaria and Dengue are referred to Doon Hospital. The hospital also has facility to offer post exposure prophylaxis and/or treatment for the patients of dog bite, snake bite and scorpion bite. Surgical services for Hernia, Appendices, Cataract and Family planning are available. Plaster services are also available. For head injury, only primary treatment/first aid is available and then the patient is referred to Doon Hospital.

Facilities The hospital does not have its own lab; lab technician is available only for TB. Center provides the testing facility for Hemoglobin, Urine Albumin and Diabetes. The hospital does not have Blood Storage Facility, but this will be available in short period of time as the hospital is awaiting the license approval. The hospital also has its own ambulance facility for referral of patients.

Legal Compliance


Support processes

The clinical services are supported by full time Nursing care in the hospital The hospital has its own housekeeping and laundry to ensure availability of a clean and hygienic environment for patient care.




Equipment The hospital has operation table along with accessories to offer surgical services including O.T. light, anesthesia apparatus and instruments for general surgery and MTP. The other vital equipment includes Ambu bag and Oxygen Cylinder. The center does not have Baby warmer/Phototherapy unit.


care at CHC Doiwala.

Staff members

General Surgeon 1

Physician 1

Gynaec 2

Pediatrician 1

Anesthetist 1

Nurse 6

Radiologist 1, (avail. 4 days/week)

Ortho Surgeon 1

Dental Surgeon 1

Female Health Worker 2

Male Health Worker 1

Male Health Supervisor 4

Female Health

Supervisor

1

Clerk 2

Lab Technician 2

Class IV Employees 8

Special Comment: - Doiwala CHC is located at a distance of about 20 Km‘s from

Dehradun Central. This CHC is the one with the best of the facilities, infrastructure

and staff available. For the CHC, only a few posts need to be filled-up. The hospital

has almost 100% occupancy rate and therefore it encounters shortage of staff.

Trauma center is also required at the Doiwala CHC as accident prone areas surrounds

it and it attends a considerable number of accidental cases.



4. CHC- Sahaspur

Infrastructure The hospital operates in a newly built state owned building. The hospital has separate O.T., Labor room, Emergency room and Store room but separate Injection room/Dressing room and Post Operative recovery room are not available. The hospital has separate Operation Disposable but Instrument Sterilization area is not there. Water is not available for 24 hours, but overhead tanks are there. Electricity is also not available round the clock because of normal power cuts. Generator is available at the old building and demand for the same for the new building has already been made to the higher authorities. The officials expect to receive it in some time. The hospital has proper seating/waiting arrangements but signage needs some improvement. Separate Public utilities for male and female are also available.

Processes The hospital has OPD services which are available from 8am to 2pm. The hospital also has 30 bedded IPD. IPD load is 100 percent and almost all the beds are occupied. Internal Clinical audits are done and teams from CMO office also visits for clinical audits. The hospital has never had any Disaster audit.

Services The hospital offers preventive, promotive, curative services through its OPD, IPD and 24 hours emergency facility. The hospital also has referral services available and refers the patients to Doon Hospital as and when the patient condition necessitates. The hospital provides vaccination, Anti-natal, delivery and new-born care services. The hospital also provides TB treatment (through its own DOTS center) and malaria treatment. Complicated cases of Malaria, Filaria and Dengue are referred to Doon Hospital. The hospital also has facility to offer post exposure prophylaxis and/or treatment for the patients of dog bite, snake bite and scorpion bite. Surgical services are available only for Family planning. The hospital is still not competent to provide surgical services for Hernia, Appendices, Head Injury, and Cataract. Plaster services are also not available.

Facilities The hospital has its own lab but the post of lab technician is vacant. The lab has testing facility for Hemoglobin, Urine Albumin and Diabetes. The hospital does not have Blood Storage Facility. The hospital has its own ambulance facility for referral of patients.

Legal Compliance


Support processes

The clinical services are supported by full time Nursing care in the hospital The hospital has its own housekeeping staff to ensure availability of a clean and hygienic environment for patient care. In-house laundry service is still not there and the same has been outsourced.




Equipment The hospital has operation table along with accessories to offer surgical services including O.T. light, anesthesia apparatus and instruments for general surgery and MTP. The other vital equipment includes Ambu bag and Oxygen Cylinder. The center has a Baby warmer unit but Phototherapy unit is not there.


care at CHC Sahaspur.

Staff members

Gynaec/Obstetrician 1

Nurse 5 (3 regular, 1 Attached

and 1 on Contract)

Radiologist 1

Doctors 2

Dental Surgeon 1

Pharmacist 1

Clerk 1

Ward Boy 1

Sweeper 3

Health Visitor 1



Eye Assistant (Primary level

eye doctor)

1

Assistant to dental surgeon 1

Driver 1

National Rural Health Program

Accountant (Block level)

1

Special Comment: - This CHC is located at a distance of about 23 Km‘s from

Dehradun Central. The CHC has a number of posts vacant, Physician, Pediatrician,

Anesthetist, Lab Technician, Ward boy‘s etc. to name a few. Proper hygiene is also

not maintained in the hospital. The hospital has a burial pit which is used as

disposable area for BMW but the same is flooded with water because of high water

level. It also lacks a number of other basic facilities as evident from the details above.



5. CHC- Vikas Nagar

Infrastructure The hospital operates in a state owned building. The hospital has separate O.T., Labor room, Store room and Post Operative recovery room but separate Injection Room and Dressing Room is not available. Separate Emergency Room is available, but it is there along with the dressing room. The trauma Center for the hospital is under construction. The hospital has separate Instrument Sterilization area but Operation Disposable Area is not available and Bio-Hazardous materials are currently being taken by the concerned authority/institution. Water and Electricity are not available round the clock but the hospital has overhand tanks and its own generator to take care of the same. Proper signage and seating/waiting arrangements are not there in the hospital. Separate Public utilities for male and female are not available.

Processes The hospital has OPD services which are available from 8am to 2pm. The hospital also has 30 bedded IPD. OPD load is approximately 120-150 patients per day and IPD load is approximately 100 percent and almost all the beds are occupied. Internal Clinical audits are not done, but teams from CMO office comes for these audits. The hospital has never had any Disaster audit.

Services The hospital offers preventive, promotive, curative services through its OPD, IPD and 24 hours emergency facility. The hospital also has referral services available and refers the patients to Doon Hospital as and when the patient condition necessitates. The hospital provides vaccination, Anti-natal, delivery and new-born care services. The hospital also provides TB treatment (through its own DOTS center) and malaria treatment. Complicated cases of Malaria are treated in the hospital but those for Filaria and Dengue are referred to Doon Hospital. The hospital also has facility to offer post exposure prophylaxis and/or treatment for the patients of dog bite, snake bite and scorpion bite. Surgical services for Hernia, Appendices and Family planning are available. For head injury, only primary treatment/first aid is available and then the patient is referred to Doon Hospital. Surgical services for Cataract and Plaster services are not available.

Facilities The hospital has its own lab and provides the testing facility for Hemoglobin, Urine Albumin, Diabetes and Rapid test for Syphilis. The hospital does not have Blood Storage Facility, but the management is making efforts to get the same. The hospital also has its own ambulance facility for referral of patients.

Legal Compliance

The hospital complies with all legal requirements.

Support processes

The clinical services are supported by full time Nursing care in the hospital



The hospital has its own housekeeping staff to ensure availability of a clean and hygienic environment for patient care. In-house laundry service is still not there and the same has been outsourced.


Equipment The hospital has Baby warmer/Phototherapy unit and operation table along with accessories to offer surgical services including O.T. light, anesthesia apparatus and instruments for general surgery and MTP. The other vital equipment includes Ambu bag and Oxygen Cylinder.


care at CHC Vikas Nagar.

Staff members

General Surgeon 1

Lady Doctor 1

Pediatrician 1

Anesthetist 1

Nurse 4 (2 regular and 2 on contract)

Pharmacist 2

Clerk 1

Lab Technician 1

Ward Boy 2

Sweeper 3 (M:2, F:1)

Ward Ayah 1 (on contract)

Chowkidar 1 (on contract)

Health Visitor/Supervisor 1

ANM 1

Lady Medical Officer 2

Leprosy Center 2

Special Comment: - The distance of this CHC about 42 Km‘s from Dehradun Central.

As with the other CHC‘s this CHC also has a number of important posts vacant. These

include Gynecologist/Obstetrician, Eye Surgeon, and Health Supervisor among the

others. Seating and waiting arrangement in the hospital is dismal. The OPD area is

always crowded with the patients and the patient find it troublesome to sit and wait

for their turn. The hospital is also not properly manned keeping in view the patient

load. The hospital also lacks other facilities and needs a lot of improvement.



6. CHC- Sahiya

Infrastructure The hospital operates in a newly built state owned building. The hospital has separate O.T., Labor room, Emergency room, Store room and Post Operative recovery room but separate Injection room/Dressing room is not available, the same is currently being taken care of in the emergency room only. The hospital has separate Operation Disposable and Instrument Sterilization area. Water is not available for 24 hours, but overhead tanks are there. Electricity is also not available round the clock because of normal power cuts but invertor is available to take care of the power cuts. The hospital has proper seating/waiting arrangements and proper signage. Separate Public utilities for male and female are under construction.

Processes The hospital has OPD services which are available from 8am to 2pm. The hospital also has 30 bedded IPD. Internal Clinical audits are not done but teams from CMO office visits the CHC for clinical audits. The hospital has never had any Disaster audit.

Services The hospital offers preventive, promotive, curative services through its OPD, IPD and 24 hours emergency facility. The hospital also has referral services available and refers the patients to Doon Hospital as and when the patient condition necessitates. The hospital provides vaccination, Anti-natal, delivery and new-born care services. The hospital also provides TB treatment (through its own DOTS center) and malaria treatment. Complicated cases of Malaria, Filaria and Dengue are referred to Doon Hospital. The hospital also has facility to offer post exposure prophylaxis and/or treatment for the patients of dog bite and scorpion bite. Surgical services are not available except for Family planning, which is available when camps are organized.

Facilities The hospital has its own lab but permanent lab technician is not there. There is testing facility for Hemoglobin, Urine Albumin and Diabetes. The hospital does not have Blood Storage Facility. The hospital has its own ambulance facility for referral of patients.

Legal Compliance


Support processes


Security The hospital does not have its own in-house security guard to ensure security of patients and infrastructure/facility of the hospital.



Equipment The hospital has operation table along with accessories to offer surgical services including O.T. light, anesthesia apparatus and instruments for general surgery and MTP. The other vital equipment includes Ambu bag and Oxygen Cylinder. The center has a Baby warmer/Phototherapy unit.


care at CHC Sahiya.

Staff members

Medical Officer 2 (including 1

Chief/Incharge)

Dentist 1

Ladies Medical Officer 1 (Contractual)

Pharmacist 1

Staff Nurse 3

Female Health Visitor 1

Driver 1

Sputum Micrologist (DOTS) 1 (Contractual)

ANM 1

Ward Boy 1

Sweeper 2 (1 Attached)

Non Medical Assistant 1 (Attached)

Ayurvedic Pharmacist 1

Special Comment: - The Sahiya CHC is located at a distance of about 69 Km‘s from

Dehradun Central. The CHC has a number of gaps if considered on the basis of CHC

norms. The hospital has a Radiology unit but the post of the Radiologist is vacant.

Basic treatments like that for snake bite and other treatments like for head injury are

not available currently. The hospital does not have any surgical staff on its rolls

because of which the residents of the region are deprived of even the basic surgical

services.



7. CHC- Chakrata

Infrastructure The hospital operates in a leased building, which was earlier an Army Hospital. The hospital has separate O.T., Labor room, Emergency room, Store room, Post Operative recovery room and Injection room/Dressing room. The hospital also has separate Operation Disposable and Instrument Sterilization area. Water is not available for 24 hours, but overhead tanks are there. Electricity is also not available round the clock because of normal power cuts but generator is available to take care of the power cuts. The hospital does not have proper seating/waiting arrangements and proper signage. Separate Public utilities for male and female are available.

Processes The hospital has OPD services which are available from 8am to 2pm. The hospital also has 10 bedded IPD. Internal Clinical audits are not done but teams from CMO office visits the CHC for clinical audits. The hospital has never had any Disaster audit.

Services The hospital offers preventive, promotive, curative services through its OPD, IPD and 24 hours emergency facility. The hospital also has referral services available and refers the patients to Doon Hospital as and when the patient condition necessitates. The hospital provides vaccination, Anti-natal, delivery and new-born care services. The hospital also provides treatment for TB and malaria. Complicated cases of Malaria, Filaria and Dengue are referred to Doon Hospital. The hospital also has facility to offer post exposure prophylaxis and/or treatment for the patients of dog bite and snake bite. Surgical services are not available except for Family planning.

Facilities Though the hospital does not have any lab, testing facility is available for Hemoglobin, Urine Albumin and Diabetes. Only DOTS lab is there and no general technician is there in the hospital. The hospital does not have Blood Storage Facility. The hospital has its own ambulance facility for referral of patients.

Legal Compliance


Support processes



Equipment The hospital has a Baby warmer/Phototherapy unit and operation table along with accessories to offer surgical services including O.T. light, anesthesia apparatus and instruments for general surgery and MTP. The other vital equipment includes Ambu bag and Oxygen Cylinder.




care at CHC Chakrata.

Staff members

Medical Officer 2 (including 1 Chief/In-

charge)

Chief Pharmacist 1

Homoeo Pharmacist 1

Health Supervisor 1

Health Visitor 1


Non Medical Supervisor

(Leprosy)

1

Staff Nurse 2

ANM 2

Radiographer (X-ray Technician) 1

Driver 1

Ward Ayah 1

Chowkidar 1

DOTS Supervisor 2 (contract)

Block Level Accountant 1

Lady Medical Officer 2

Special Comment: - Chakrata CHC is located at a distance of about 92 Km‘s from

Dehradun Central at an elevation of about 7000 feet (2118 meters). The CHC is

running on a leased building, which was earlier an Army Hospital. The building is not

proper and has very less space to accommodate a CHC. The CHC is only 10-bedded

CHC; this is because the impatient accommodation space/area has been reduced for

developing other infrastructure like O.T. etc. Proper hygiene is also not maintained in

the hospital. As clear from the above details, the hospital is not even providing even

the basic services, though it is manned properly. Geographical challenge apart, this is

primarily because of lack of space and administrative support.



8. PHC- Balawala

Infrastructure The hospital operates in a state owned building. The hospital does not have has separate O.T., Labor room, Emergency room, Post Operative recovery room and Injection room/Dressing room, but the all are planned in the new building. The hospital has separate store room and separate Operation Disposable and Instrument Sterilization area. Water and electricity are not available for 24 hours and generator is also not available. The hospital does have proper seating/waiting arrangements but signage is not proper. Separate Public utilities for male and female are not available but the same are planned in the new building.

Processes The hospital has OPD services which are available from 8am to 2pm. The hospital also has 2 bedded IPD. Internal Clinical audits are done but hospital never had any Disaster audit.

Services The hospital offers preventive, promotive, curative services through its OPD, IPD. 24 hrs emergency services are not available currently but the same is planned in the new building. The hospital also has referral services available and refers the patients to Doon Hospital or CHC Doiwala as and when the patient condition necessitates. The hospital provides vaccination. Anti-natal, delivery and new-born care services are presently not available. TB treatment is available through the in-house DOTS Center but for Malaria treatment slides are prepared and are then sent to CHC Doiwala. Complicated cases of Malaria, Filaria and Dengue are referred to Doon Hospital. The hospital does not have facility to offer post exposure prophylaxis and/or treatment for the patients of dog bite, scorpion bite and snake bite. Surgical services are not available.

Facilities The hospital does not have any lab and testing facility, only DOTS lab is there. The hospital does not have Blood Storage Facility and ambulance facility for referral of patients.

Legal Compliance


Support processes

The hospital has its own housekeeping staff to ensure availability of a clean and hygienic environment for patient care. In-house laundry service is still not there and the same is currently being done by the chowkidar.


Equipment The vital equipment at the hospital includes Ambu bag and Oxygen Cylinder. The hospital does not have a Baby warmer/Phototherapy unit.




care at PHC Balawala.

Staff members

Doctor (Contracted) 1

MOCH 1

ANM 2

Male Health supervisor 1

Female Health supervisor 1

Pharmacist 1

Male health worker 1

Female health worker 6

Ward Boy 1

Class IV 1



9. PHC- Nehrugram

Infrastructure The hospital operates in a state owned building. The hospital has separate O.T., Post Operative recovery room, store room and Injection room/Dressing room but does not have separate Labor room and Emergency room. The hospital has separate store room and separate Operation Disposable and Instrument Sterilization area. Water and electricity are normally available for 24 hours but generator is not available. The hospital does have proper seating/waiting arrangements but signage is not proper. Separate Public utilities for male and female are available.

Processes The hospital has OPD services which are available from 8am to 2pm. The hospital also has 2 bedded IPD. Internal Clinical audits are done once a year but hospital never had any Disaster audit.

Services The hospital offers preventive, promotive, curative services through its OPD and IPD. 24 hrs emergency services are not available currently. The hospital also has referral services available and refers the patients to Doon Hospital as and when the patient condition necessitates. The hospital provides vaccination, Anti-natal and new-born care services. For normal deliveries, people generally go to Doon hospital. TB treatment is available through the in-house DOTS Center but for Malaria treatment slides are prepared and are then sent to other hospital for examination. Complicated cases of Malaria, Filaria and Dengue are referred. The hospital has the facility to offer post exposure prophylaxis and/or treatment for the patients of snake bite, but the same is not available for the dog bite and scorpion bite. Surgical services are not available.

Facilities The hospital has its lab but lab technician is not there. Testing facility is available for hemoglobin, urine albumin and diabetes. The hospital does not have Blood Storage Facility and ambulance facility for referral of patients.

Legal Compliance


Support processes

The hospital has its own housekeeping staff to ensure availability of a clean and hygienic environment for patient care. In-house laundry service is still not there and the same is currently being done by the other PHC staff members.


Equipment The hospital has Ambu bag and Oxygen Cylinder but Baby warmer/Phototherapy unit is not available.




care at PHC Nehrugram.

Staff members

Doctor–General Medicine 1

Doctor–Ayurveda 1

ANM 3

Health supervisor 1

Ward boy 1

Pharmacist (contracted) 1


Female health worker 1

Sweeper 1



10. PHC- Raiwala

Infrastructure The hospital operates in a state owned building. The hospital has a separate store and Instrument Sterilization area but does not have separate O.T., Post Operative recovery room, Injection room/Dressing room, Labor room and Emergency room. Water and electricity are not available for 24 hours and generator is also not available. The hospital has proper seating/waiting arrangements but signage is not proper. Separate Public utilities for male and female are available.

Processes The hospital has OPD services which are available from 8am to 2pm. The hospital also has 4 bedded IPD. Internal Clinical audits are done once or twice a year but hospital never had any Disaster audit.

Services The hospital offers preventive, promotive, curative services through its OPD, IPD and 24 hrs emergency services. The hospital also has referral services available and refers the patients to SPS, Hrishikesh as and when the patient condition necessitates. The hospital provides vaccination. Anti-natal, delivery and new-born care services are not available. For Malaria treatment, slides are prepared and are then sent to other hospital for examination. TB treatment is not available. No complicated cases of Malaria, Filaria and Dengue have been observed. The hospital has the facility to offer post exposure prophylaxis and/or treatment for the patients of snake bite, but the same is not available for the dog bite and scorpion bite. Surgical services are not available.

Facilities The hospital does not have lab, ambulance and blood storage facility of its own.

Legal Compliance


Support processes

The hospital does not has any permanent housekeeping staff to ensure availability of a clean and hygienic environment for patient care and currently the same is being taken care by the other staff members. In-house laundry service is still not there and the same is currently being outsourced.


Equipment The hospital does not have necessary equipment including Ambu bag, Oxygen Cylinder and Baby warmer/Phototherapy unit.




care at PHC Raiwala.

Staff members

Doctor 1

ANM 3

Pharmacist 1


Ward boy 1

Health visitor (from

Doiwala)

1



11. PHC- Chiddarwala

Infrastructure The hospital operates in a state owned building. The hospital has a separate store, Injection room/Dressing room, and operation disposable area and Instrument Sterilization area but does not have separate O.T., Post Operative recovery room, Labor room and Emergency room. Water is not available 24 hrs but overhead water tanks are there. Electricity is also not available round the clock because of general power cuts and generator is also not available. The hospital has proper seating/waiting arrangements but signage is not proper. Separate Public utilities for male and female are available.

Processes The hospital has OPD services which are available from 8am to 2pm. The hospital also has 4 bedded IPD. Internal Clinical audits are done but hospital never had any Disaster audit.

Services The hospital offers preventive, promotive, curative services through its OPD and IPD. 24 hrs emergency services are not available. The hospital also has referral services available and refers the patients generally to GD, Hrishikesh and also to CHC Doiwala as and when the patient condition necessitates. The hospital provides vaccination. Anti-natal, delivery and new-born care services are not available. Delivery and new-born services are available in the sub-centers. TB treatment is available as the hospital is DOTS sub-center but Malaria treatment is not available. No complicated cases of Malaria, Filaria and Dengue have been observed. The hospital does not have the facility to offer post exposure prophylaxis and/or treatment for the patients of snake bite, dog bite and scorpion bite. Surgical services are not available.

Facilities The hospital does not have lab and ambulance of its own.

Legal Compliance


Support processes

The hospital does not has any permanent laundry and housekeeping staff to ensure availability of a clean and hygienic environment for patient care and currently the same is being taken care by the other staff members independently.

Security The hospital has its own security guard to ensure security of patients and infrastructure/facility of the hospital.

Equipment The hospital has a Baby warmer/Phototherapy unit but does not have other necessary equipment including Ambu bag, Oxygen Cylinder.




care at PHC Chiddarwala.

Staff members

MOCH 1

ANM 1

Pharmacist 1

Male health supervisor 1

Chowkidaar 1



12. PHC- Kunja

Infrastructure The hospital operates in a state owned building. The hospital has separate O.T., Labor room, Emergency room and store room. Water and Electricity are not available 24 hrs and generator is also not available. The hospital does not have proper signage and seating/waiting arrangements.

Processes The hospital has OPD services which are available from 8am to 2pm with a load of 30-35 patients per day. The hospital also has 4 bedded IPD.

Services The hospital offers preventive, promotive, curative services through its OPD and IPD. 24 hrs emergency services are not available. The hospital also has referral services available and refers the patients to other hospital as and when the patient condition necessitates. The hospital provides vaccination. Anti-natal, delivery and new-born care services are not available. TB treatment and Malaria treatment is not available. TB patients are referred to Herbertpur PHC for preparation of slides. The hospital has the facility to offer post exposure prophylaxis and/or treatment for the patients of snake bite, but the same is not available for dog bite and scorpion bite. Surgical services for family planning are available through camps, but surgical services are not available for cataract.

Facilities The hospital does not have its own lab and ambulance.

Legal Compliance


Support processes

The hospital has housekeeping staff to ensure availability of a clean and hygienic environment for patient care.

Security The hospital does not have its own security guard to ensure security of patients and infrastructure/facility of the hospital.

Equipment The hospital does not have necessary equipment including Baby warmer/Phototherapy, Ambu bag, Oxygen Cylinder etc.




care at PHC Kunja.

Staff members

Doctor 1

Pharmacist 1

Sweeper 1

Special Comment: - Kunja PHC is located at Kunja Grant village, located at a

distance of about 40 Km‘s from Dehradun Central. Though the hospital has

infrastructure but staffing gaps are a concern The hospital also lacks the basic

equipments which are required for a normal hospital.



13. PHC- Prem Nagar

Infrastructure The hospital operates in a state owned building. The hospital has a separate store room, but there are no separate O.T., Labor room and Emergency room. Water and Electricity are not available 24 hrs but hospital has tube well boring, overhead tanks and generator to take care of that. The hospital does not have proper signage and seating/waiting arrangements.

Processes The hospital has OPD services which are available from 8am to 2pm. There is an IPD but without any specification about the number of beds as there are no rooms available because the hospital is being run in the residential premises of two resident doctors. The new building has not yet been handed over for functional purposes.

Services The hospital offers preventive, promotive, curative services through its OPD and IPD and 24 hrs emergency services. The hospital also has referral services available and refers the patients to other hospital as and when the patient condition necessitates. The hospital provides vaccination and Anti-natal consultancy. Delivery services are not available and the same is referred to Doon Hospital because separate labor room is not there. The infrastructure is available in the new building. New born care services are also not available. TB treatment and Malaria treatment is available. For TB, slides are prepared and sent to the concerned CHC, if test is positive then medicine are received from the CHC and given to the patients. The hospital has the facility to offer post exposure prophylaxis and/or treatment for the patients of snake bite and scorpion bite, but the same is not available for dog bite. Surgical services for family planning are available, but surgical services are not available for cataract.

Facilities The hospital has the facility of Hemoglobin testing, but other tests are not available. Ambulance service is not available in the hospital.

Legal Compliance


Support processes

The clinical services is supported by Nursing care facility in the hospital. The hospital has housekeeping staff to ensure availability of a clean and hygienic environment for patient care.

Security The hospital also has its own security guard to ensure security of patients and infrastructure/facility of the hospital.

Equipment The hospital does not have necessary equipment including Ambu bag and Oxygen Cylinder.



Manpower: - Following are the details of the staff members of the hospital

rendering care at PHC Prem Nagar.

Staff members

Doctors 2

Lady Doctor 1

Ayurvedic Doctor 1

Pharmacist 3

Nurse 2

Health Supervisor, Male 1 (attached)

Health Supervisor,

Female

1

Multi Purpose Worker

(Male)

2

Lab technician 1 (Dots Technician)

Class IV Employees 3 ( 1 Chowkidar, 1 Sweeper

and 1 Ward Boy)

Special Comment: - This PHC is located at a distance of about 10 KM‘s from

Dehradun Central. The hospital does not have proper infrastructure and the new

building is under construction for the proposed Combined Hospital (30 Bedded).

On-duty doctor/in-charge considers that all the facilities will be available in the

new hospital.



14. PHC- Thano

Infrastructure The hospital operates in a state owned building. The hospital has a BHW center in the campus where all immunization, post-natal and anti-natal facilities are available. There is also a separate store room, but there is no separate O.T. and Emergency room. Water and Electricity are not available 24 hrs and generator is also not available. The hospital has proper signage and seating/waiting arrangements.

Processes The hospital has OPD services which are available from 8am to 2pm. The hospital also has a 4 bedded IPD where 1-2 beds are occupied at a time and patients usually stay for 2 to 4 hours, during emergency.

Services The hospital offers preventive, promotive, curative services through its OPD and IPD and 24 hrs emergency services. The hospital also has referral services available and refers the patients to Doiwala CHC or Doon hospital as and when the patient condition necessitates. The hospital provides vaccination, Anti-natal, Delivery services and New born care services. Malaria treatment is also available in the hospital but TB treatment is not available currently. Earlier TB treatment was there but the same was removed because of lack of patients, now it is referred to other hospitals. The hospital has the facility to offer post exposure prophylaxis and/or treatment for the patients of snake bite and scorpion bite, but the same is not available for dog bite. Surgical services for family planning are available through camps, but surgical services are not available for cataract.

Facilities The hospital does not have the facility for Lab testing and all tests are referred to Doiwala CHC. Ambulance service is not available in the hospital.

Legal Compliance


Support processes


Security The sweeper cum chowkidar takes care of the security of patients and infrastructure/facility of the hospital.

Equipment The necessary equipment with the hospital includes Ambu bag, Oxygen Cylinder, deep freezer, Ice-Lined Refrigerator etc.




care at PHC Thano.

Staff members

Doctor 1

Pharmacist 1

Ward Boy 1

Nurse 1

Sweeper Cum Chowkidar 1



Female Health

Supervisor

1

Male health Supervisor 1

Special Comment: - The hospital has a number of gaps. The main constraint is that it

lacks the staff requirements to be considered for the certification and also needs a lot

of improvement on the infrastructure side.



15. PHC- Bhaniyawala

Infrastructure The hospital operates in a state owned building. The hospital has separate O.T., Emergency room, Labor room and store room. Water and Electricity are not available 24 hrs. Water is available for 2-3 Hrs in the morning and 2-3 Hrs in the evening and there is 3-4 hrs of power cut every day and generator is also not available. The hospital has proper seating/waiting arrangements but proper signage is not there.

Processes The hospital has OPD services which are available from 8am to 2pm but doctors are not available and Pharmacist attends the patients. The hospital also has a 4 bedded IPD.

Services The hospital does not have proper OPD, IPD and emergency services because of lack of staff. The patients are generally referred to the CHC or Doon hospital by the pharmacist. The hospital does not have provision of vaccination, Anti-natal, Delivery services. New born care services are provided by the ANM. Malaria treatment and TB treatment is not available currently, though vaccination is available for Malaria. No surgical services are available in the hospital.

Facilities The hospital does not have any laboratory and there is no facility for Lab testing. All tests are referred to other hospitals. Ambulance service is also not available in the hospital.

Legal Compliance


Support processes


Security The hospital does not have its own security guard to ensure security of patients and infrastructure/facility of the hospital.





care at PHC Bhaniyawala.

Staff members

Doctor 1

Pharmacist 1

Ayurvedic Doctor 1

ANM 1

Ward Boy 1

Field MPW (multi-

purpose worker)

1

Sweeper 1

Special Comment: - Although the hospital has proper infrastructure/

building/rooms etc., it lacks administrative support/check. Staffing is the main

issue of this hospital for the last two years. One Doctor is there, but he is not

available all the time, as the doctor has additional responsibility of another

PHC. During our visit to the hospital, the doctor was temporarily posted at

Haridwar.



16. PHC- Kalsi

Infrastructure The hospital operates in a state owned building. The hospital has separate O.T., Emergency room, Labor room and store room. Water and Electricity are not available 24 hrs but hospital has generator and overhead tanks to take care of these two things. The hospital has good seating/waiting arrangements but proper signage in the premises.

Processes The hospital has OPD services which are available from 8am to 2pm. The hospital also has a 4 bedded IPD.

Services The hospital offers preventive, promotive, curative services through its OPD, IPD and 24 hrs emergency services. The hospital also has referral services available and refers the patients to Vikas Nagar CHC or Doon hospital as and when the patient condition necessitates. The hospital provides vaccination, Anti-natal, Delivery services and New born care services. Malaria and TB treatment is also available in the hospital. The hospital has the facility to offer post exposure prophylaxis and/or treatment for the patients of snake bite, dog bite and scorpion bite. Surgical services for family planning and cataract are available through camps, which are organized occasionally.

Facilities The hospital has its own laboratory where tests are available for Hemoglobin, Urine Albumin and Diabetes. The hospital also has its own Ambulance service.

Legal Compliance


Support processes


Security The clinical services is supported by Nursing care facility in the hospital. The hospital does not have its own security guard to ensure security of patients and infrastructure/facility of the hospital.




Manpower: - Following are the details of the staff members of the hospital

rendering care at PHC Kalsi.

Staff members

Doctor 3

Ophthalmologist 1

Nurse 1

Health Worker, Female 2

Health Assistant, Male 1

Clerk 1

Lab Technician 1

Pharmacist 1

Class IV Employees 4 (1 each ward boy,

sweeper, peon and

ward Aya)

Special Comment: - Kalsi PHC is located at a distance of about 49 km‘s from

Dehradun Central. The Kalsi PHC is one of the best managed PHC in the district. The

hospital has good infrastructure, staff, testing and good overall facilities. Proper

hygiene is also maintained in the hospital. The PHC campus also has one

Homoeopathic dispensary and one Female Hospital.



17. PHC- Dudhali

Infrastructure The hospital operates in a state owned building. The hospital has separate O.T. and a store room but separate Emergency room and Labor room are not available. Water and Electricity are not available 24 hrs and hospital also does not have a generator to take care of the power cuts. The hospital has proper seating/waiting arrangements and proper signage in the premises.


Services The hospital offers preventive, promotive, curative services through its OPD and IPD, but 24 hrs emergency services are not available. The hospital also has referral services available and generally refers the patients to Doon hospital as and when the patient condition necessitates. The hospital provides vaccination, Anti-natal and Delivery services. The hospital has a MCH (Mother Child Health Center) and ANM takes care of this, hospital does not have any Lady Doctor for this purpose. New born care services are currently not being provided because of unavailability of necessary equipment. Malaria and TB treatment is also available in the hospital. For TB, slides are prepared and sent to the concerned CHC, if test is positive then medicine are received from the CHC and given to the patients. The hospital does not have the facility to offer post exposure prophylaxis and/or treatment for the patients of snake bite, dog bite and scorpion bite. The hospital does not have any facility for surgical services including that for family planning and cataract.

Facilities The hospital does not have its own laboratory and no testing facilities are there. Ambulance is also not available in the hospital.

Legal Compliance


Support processes


Security The hospital does not have its own security guard but sweeper cum chowkidar ensures the security of patients and infrastructure/facility of the hospital.

Equipment The necessary equipment with the hospital includes deep freezer, Ice-Lined Refrigerator etc.




care at PHC Dudhali.

Staff members

Doctor 1

Pharmacist 1

ANM 2

Male Health Supervisor 1

Female Health Supervisor/ Ladies

Health Visitor

1

Ward Boy 1

Sweeper cum Chowkidar 1



18. PHC- Rajawala

Infrastructure The hospital operates in a state owned building. The hospital has separate O.T., and a store room but separate Emergency room is not available, currently the same is being clubbed with the dressing room. Labor room is also not there. Water and Electricity are not available 24 hrs and hospital also does not have a generator to take care of the power cuts. The hospital also does not have proper seating/waiting arrangements and proper signage in the premises.


Services The hospital offers preventive, promotive, curative services through its OPD and IPD, but 24 hrs emergency services are not available. The hospital also has referral services available and generally refers the patients to other hospitals as and when the patient condition necessitates. The hospital provides vaccination, Anti-natal and New-born care services. Delivery services are not available currently because Labor room is not there, it is under construction. Deliveries are currently being done at the homes by the ANM‘s. Malaria treatment is available, for this slides are prepared and sent to the concerned CHC, if test is positive then medicine are received from the CHC and the patient is treated. TB treatment is not available and the same is referred to other hospitals. The hospital has the facility to offer post exposure prophylaxis and/or treatment for the patients of snake bite but the same is not available for dog bite and scorpion bite. The hospital does not have any facility for family planning and cataract surgeries. Camps are organized when the need arises depending on the participants/patients. This is done with the help of CMO office.

Facilities The hospital does not have its own laboratory and no testing facilities are there. There is no lab and no post for Lab Technician in the hospital currently. Ambulance is also not available in the hospital.

Legal Compliance


Support processes


Security The hospital does not have its own security guard to ensure the security of patients and infrastructure/facility of the hospital.

Equipment The necessary equipment with the hospital includes Ambu bag, oxygen cylinder, deep freezer, Ice-Lined Refrigerator etc.




care at PHC Rajawala.

Staff members

Doctor 1, not permanent, he is on

contract for a term of year

Pharmacist 1

Ward Boy 1

Sweeper 1

ANM 1


Multipurpose worker 1



19. PHC- Mehuwala

Infrastructure The hospital operates in a state owned building. The hospital has separate O.T. and Labor room but separate Emergency room and Store room are not there. Water and Electricity are not available 24 hrs and hospital also does not have a generator to take care of the power cuts. The hospital also does not have proper seating/waiting arrangements and proper signage in the premises.

Processes The hospital has OPD services which are available from 8am to 2pm. OPD load is about 60 patients per day. The hospital also has a 4 bedded IPD with a load of approximately 13-14%.

Services The hospital offers preventive, promotive, curative services through its OPD, IPD and 24 hrs emergency services. The hospital also has referral services available and generally refers the patients to Doon hospital as and when the patient condition necessitates. The hospital provides vaccination, Anti-natal, Delivery and New-born care services. Malaria treatment is available, for this slides are prepared and sent to Doiwala CHC, if test is positive then medicine are received from the CHC and the patient is treated. TB treatment is not available and the same is referred to other hospitals. The hospital has the facility to offer post exposure prophylaxis and/or treatment for the patients of dog bite but the same is not available for snake bite and scorpion bite. The hospital does not have any facility for family planning and cataract surgeries. For family planning surgeries, camps are organized when the need arises depending on the participants/patients.


Legal Compliance


Support processes


Security The hospital does not have its own whole time security guard and sweeper cum chowkidar ensures the security of patients and infrastructure/facility of the hospital.

Equipment The necessary equipment with the hospital includes Ambu bag, oxygen cylinder, artery forceps, tooth forceps, sponge holding, chital forceps, deep freezer, Ice-Lined Refrigerator etc.




care at PHC Mehuwala.

Staff members

Doctor 1

Ayurvedic Doctor 1

Pharmacist 1

Ward Boy 1


ANM 1

Lady Health Visitor 1

Supervisor, male 1

Special Comment: - The hospital cannot be taken up for the ISO Certification. It has a

lot of gaps like staffing, infrastructure, facilities etc., which needs to be addressed

before considering it for certification.



20. PHC- Bhagwantpur

Infrastructure The hospital operates in a state owned building. The hospital has separate O.T. and Store room but separate Emergency room and Labor room are not there. Emergencies are currently being taken care of in the dressing room only. Water and Electricity are not available 24 hrs and hospital also does not have a generator to take care of the power cuts. The hospital also does not have proper seating/waiting arrangements and proper signage in the premises.

Processes The hospital has OPD services which are available from 8am to 2pm. OPD load is about 40 patients per day. The hospital also has a 4 bedded IPD where patient stays for 2-3 hours in case of emergency.

Services The hospital offers preventive, promotive, curative services through its OPD and IPD. 24 hrs emergency services are not available in the hospital. The hospital also has referral services available and generally refers the patients to Doon hospital as and when the patient condition necessitates. The hospital provides vaccination, Anti-natal and New-born care services. Delivery services are not available because of unavailability of Lady doctor. Malaria treatment is available, for this slides are prepared and sent to Doiwala CHC, if test is positive then medicine are received from the CHC and the patient is treated. TB treatment is not available and the same is referred to Doon hospital. The hospital does not have the facility to offer post exposure prophylaxis and/or treatment for the patients of dog bite, snake bite and scorpion bite. The hospital does not have any facility for family planning and cataract surgeries. Patients for these surgeries are referred to Doon Hospital.


Legal Compliance


Support processes


Security The hospital does not have a security guard to ensure the security of patients and infrastructure/facility of the hospital.

Equipment The necessary equipment with the hospital includes nebulizer, oxygen kit, deep freezer, Ice-Lined Refrigerator etc.




care at PHC Bhagwantpur.

Staff members

Doctor 2

Pharmacist 1

Ward Boy 1

Sweeper 1


Male Supervisor 1

Special Comment: - The distance of Bhagwantpur CHC is about 13 Km‘s from

Dehradun Central. The hospital needs a lot of improvement on most fronts.



21. PHC- Tyuni

Infrastructure The hospital operates in a state owned building. The hospital has separate O.T., Emergency room, Labor room and store room. Water and Electricity are not available 24 hrs, but hospital does have a generator to take care of the power cuts. The hospital does not have proper seating/waiting arrangements and proper signage in the premises.

Processes The hospital has OPD services which are available from 8am to 2pm. OPD load is about 70-100 patients per day. The hospital also has a 4 bedded IPD with patient load of 20-25 patients per month and patient stays for 2-3 hours in case of emergency.

Services The hospital offers preventive, promotive, curative services through its OPD, IPD and 24 hrs emergency services. The hospital also has referral services available and patients are referred to other hospitals as and when the patient condition necessitates. The hospital provides vaccination, Anti-natal, delivery and New-born care services. Treatment of TB is available but Malaria treatment is not available and the patients are referred to Doon hospital. The hospital has the facility to offer post exposure prophylaxis and/or treatment for the patients of snake bite but the same is not available for dog bite and scorpion bite. The hospital does not have any facility for cataract surgeries. For family planning surgeries, camps are organized when required.


Legal Compliance

The hospital does not comply with legal requirements as regards the X-ray Facility

Support processes


Security The hospital does not have a full time security guard and sweeper cum chowkidar ensures the security of patients and infrastructure/facility of the hospital.

Equipment The necessary equipment with the hospital includes X-Ray machine, Ambu bag, sterilizer, oxygen kit, deep freezer, Ice-Lined Refrigerator etc.




care at PHC Tyuni.

Staff members

Doctor 1

Pharmacist 2

Nurse 3

ANM 2

Health Supervisor 1

X-Ray Technician 1

Ward Boy 2

Sputum Micrologist 1

Ayurvedic Pharmacist 1


Special Comment: - Tyuni CHC is the remotest CHC of the all in the district, located at

a distance of about 200 Km‘s from Dehradun. Currently the hospital does not have

facilities/infrastructure to be considered for the certification. The new building for the

hospital is under construction and the same is expected to be completed in 2-3 years.



22. PHC- Nayagaon Pelio

Infrastructure The hospital operates in a state owned building. The hospital has separate O.T., Labor room and store room but separate store room is not available. Water and Electricity are not available 24 hrs and hospital also does not have a generator to take care of the power cuts. The hospital has proper seating/waiting arrangements and proper signage in the premises.

Processes The hospital has OPD services which are available from 8am to 2pm. OPD load is about 40-45 patients per day. The hospital also has a 4 bedded IPD where patients stay for about 2-3 hours in case of emergency.

Services The hospital offers preventive, promotive, curative services through its OPD and IPD. 24 hrs emergency services are not available in the hospital. The hospital also has referral services available and patients are referred to other hospitals as and when the patient condition necessitates. The hospital provides vaccination, Anti-natal, delivery and New-born care services. Treatment of Malaria is available but TB treatment is not available and the patients are referred to other hospitals for treatment of TB. The hospital has the facility to offer post exposure prophylaxis and/or treatment for the patients of snake bite but the same is not available for dog bite and scorpion bite. The hospital does not have any facility for cataract surgeries. For family planning surgeries, camps are organized when required.

Facilities The hospital has the testing facilities for Hemoglobin, Urine Albumin and Diabetes. Ambulance is also not available in the hospital.

Legal Compliance


Support processes



Equipment The necessary equipment with the hospital includes BP Apparatus, Ambu bag, oxygen kit, deep freezer, Ice-Lined Refrigerator etc.




care at PHC Nayagaon Pelio.

Staff members

Doctor (Lady/Medical

Officer)

1

Pharmacist 1

Lady Health Supervisor 1

ANM 1

Ward Boy 1

Lab Assistant 1

Special Comment: - Located at a distance of about 28 Km‘s from Dehradun

central, the Nayagaon Pelio CHC is managed quite properly. Staffing and

certain other infrastructure gaps are the primary concern of this hospital.



23. PHC- Pachimwala

Infrastructure The hospital operates in a state owned building. The hospital has separate O.T., Labor room, Emergency room and store room. Water and Electricity are not available 24 hrs and hospital also does not have a generator to take care of the power cuts. The hospital has proper seating/waiting arrangements and proper signage in the premises.

Processes The hospital has OPD services which are available from 8am to 2pm. OPD load is about 30-40 patients per day. The hospital also has a 4 bedded IPD.

Services The hospital offers preventive, promotive, curative services through its OPD, IPD and 24 hrs emergency services. The hospital also has referral services available and patients are referred to other hospitals as and when the patient condition necessitates. The hospital provides vaccination, Anti-natal and New-born care services. Delivery services are not available and ANM center is under construction and will take 5-6 months to be completed. Treatment of Malaria is available, slides are prepared and sent to Vikas Nagar CHC, if test is positive then medicine are received from the CHC and the patient is treated accordingly. TB treatment is not available and the patients are referred to Vikas Nagar CHC. The hospital has the facility to offer post exposure prophylaxis and/or treatment for the patients of snake bite but the same is not available for dog bite and scorpion bite. The hospital does not have any facility for cataract surgeries and family planning surgeries.

Facilities The hospital does not have any lab and no testing facilities are there. Lab is there but Lab technician is not there only Lab attendant is there. The hospital also does not have its own ambulance.

Legal Compliance


Support processes


Security The hospital does not have a full time security guard but sweeper cum chowkidar ensures the security of patients and infrastructure/facility of the hospital.

Equipment The necessary equipment with the hospital includes suction machine, auto clave, delivery table, baby tray, oxygen kit, deep freezer, Ice-Lined Refrigerator etc.




care at PHC Pachimwala.

Staff members

Doctor 1, on contract

Ayurvedic Doctor 1

Pharmacist 1

Female Health Visitor 1

ANM/Female Health

Worker

1

Lab Attendant 1

Health Supervisor (Male) 2, both

attached


.



24. PHC- Rudrapur

Infrastructure The hospital operates in a state owned building. The hospital does not have separate O.T., Labor room, Emergency room, only store room is there. Water and Electricity are not available 24 hrs and hospital also does not have a generator to take care of the power cuts. The hospital has proper seating/waiting arrangements and proper signage in the premises.


Services The hospital offers preventive, promotive, curative services through its OPD, IPD and 24 hrs emergency services. The hospital also has referral services available and patients are referred to other hospitals as and when the patient condition necessitates. The hospital provides vaccination, Anti-natal, Delivery and New-born care services. Treatment of Malaria is available, slides are prepared and sent to Vikas Nagar CHC, if test is positive then medicine are received from the CHC and the patient is treated accordingly. TB treatment is not available and the patients are referred to the concerned hospitals for this. The hospital has the facility to offer post exposure prophylaxis and/or treatment for the patients of snake bite but the same is not available for dog bite and scorpion bite. The hospital does not have any facility for cataract surgeries and family planning surgeries.

Facilities The hospital does not have any lab and no testing facilities are there. The hospital also does not have its own ambulance.

Legal Compliance


Support processes



Equipment The necessary equipment with the hospital includes Ambu bag, oxygen kit, deep freezer, Ice-Lined Refrigerator etc.




care at PHC Rudrapur.

Staff members

Doctor 1

Ayurvedic Doctor 1

Pharmacist 1

Ward Boy 1

ANM 1

Health Visitor (Female) 1

Sweeper 1



25. Primary Health Centre, Herbertpur

The PHC in Herbertpur is located at a distance of about 36 Km‘s from central Dehradun and

is currently operating in rented premises. 1 Doctor, 1 Pharmacist, 1 Lady Health Worker, 1

Ward Boy are staffed there. The new building for this PHC is still to be sanctioned and

constructed.

We visited the PHC in the initial stage of the first day of the visits but the officer-in-charge did

not entertain because there was no authorization letter available from the CMO office. Foul

weather conditions made it impossible to reach the Herbertpur PHC subsequently. The

details were taken from Mr. Bauntiyal, CMO, and Dehradun District and are mentioned in the

earlier section on the data received from CMO‘s office.

26. Primary Health Centre, Manthad

The Manthad PHC located at a distance of about 195 Km‘s from Dehradun is under

construction. The newly built retaining wall recently collapsed because of inferior quality of

material used. The payment to the contractor has been stopped.

The PHC is currently being run in rented premises and 1 Pharmacist and 1 Ward Boy cum

Sweeper cum Chowkidar are staffed there.

Bad road and foul weather conditions made it impossible to reach the Manthad PHC. To

reach the location also required about 6-7 km‘s of walking because of blockage of the main

connecting road. The details of this PHC were also taken from Mr. Bauntiyal, CMO, and

Dehradun District.

27. Primary Health Centre, Kwanza

The Kwanza PHC has just been sanctioned and land has been allotted for the same. The

construction work for this CHC has yet not started.

The details were collected from Dr. Bauntiyal, CMO, and Dehradun District.

28. Primary Health Centre, Pigitlani

The Pigitlani PHC has also been sanctioned but the other things like allotment of land,

construction etc. is pending.

The details were taken from Mr. Bauntiyal, CMO, and Dehradun District.



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