Indian Public Health Standards (101 to 500 bedded) (Revised 2012) (Government of India) (Ministry of Health and Family Welfare) has prescribed Guidelines for District Hospitals.
District Hospital is a hospital at the secondary referral level responsible for a district of a defined geographical area containing a defined population. Its objective is to provide comprehensive secondary health care services to the people in the district at an acceptable level of quality and being responsive and sensive to the needs of the people and referring centres. Every district is expected to have a district hospital. As the population of a district is variable, the bed strength also varies from 75 to 500 beds depending on the size, terrain and population of the district.
Overall objective of setting up and management of District Hospitals is prescribed under the IPHS guidelines. As per 2012 Revised IPHS Guidelines the objectives for District Hospitals are:
- To provide comprehensive secondary health care (specialist and referral services) to the community through the District Hospital.
- To achieve and maintain an acceptable standard of quality of care.
- To make the services more responsive and sensitive to the needs of the people of the district and the hospitals/centres from where the cases are referred to the district hospitals.
Grading of District Hospitals
The size of a district hospital is a function of the hospital bed requirement, which in turn is a function of the size of the population it serves. In India the population size of a district varies from 35,000 to 30,00,000 (Census 2001). Based on the assumptions of the annual rate of admission as 1 per 50 populations and average length of stay in a hospital as 5 days, the number of beds required for a district having a population of 10 lakhs will be around 300 beds. However, as the population of the district varies a lot, it would be prudent to prescribe norms by grading the size of the hospitals as per the number of beds.
Functions of District Hospitals
A district hospital has the following functions:
- It provides effective, affordable health care services (curative including specialist services, preventive and promotive) for a defined population, with their full participation and in co-operation with agencies in the district that have similar concern. It covers both urban population (district head quarter town) and the rural population in the district.
- Function as a secondary level referral centre for the public health institutions below the district level such as Sub-divisional Hospitals, Community Health Centres, Primary Health Centres and Sub-centres. To provide wide ranging technical and administrative support and education and training for primary health care.
Essential (Minimum Assured Services) and Desirable Services
District Hospital is expected to provide Essential (Minimum Assured Services) and Desirable (which should be aspired to be achieved. The services include OPD, indoor and Emergency Services.
Essential (Minimum Assured Services)
Otorhinolaryngology (ENT); Orthopaedics; Radiology including Imaging; Psychiatry Geriatric Services (10 bedded ward); Health promotion and Counseling Services; Dental care District Public Health Unit; DOT centre; AYUSH; Integrated Counseling and Testing Centre; STI Clinic; ART Centre; Blood Bank; Disability Certification Services (As may be notified by the State Government); Services under Other National Health Programmes
Diagnostic and other Para clinical services regarding:
Laboratory services including Pathology and Microbiology; Designated Microscopy centre X-Ray; Sonography ECG Endoscopy Blood Bank and Transfusion Services; Physiotherapy; and Dental Technology (Dental Hygiene); Drugs and Pharmacy.
Ancillary and support services: Following ancillary services shall be ensured:
Medico-legal/post mortem (Standard procedures for medico-legal cases, management of dead body and post mortem services (if needed) to be followed) ; Ambulance services; Dietary services; Laundry services; Security services; Waste management including Biomedical Waste; Ware housing/central store; Maintenance and repair Electric Supply (power generation and stabilization); Water supply (plumbing); Heating, ventilation and air-conditioning; Transport; Communication; Medical Social Work; Nursing Services; CSSD - Sterilization and Disinfection; Horticulture (Landscaping); Refrigeration; Hospital Infection Control; Referral Services
Post Partum Unit (if the load of deliveries is more than 75 per month) with following services in an integrated manner:
Post Natal Services;
All Family Planning services i.e Counseling, Tubectomy (Both Laparoscopic and Minilap), NSV, IUCD, OCPs, Condoms, ECPs, Follow up services; Safe Abortion Services; Immunization
Super Specialties (To be provided depending upon the availability of manpower and budget allocation in the Department.)
Cardiology; Cardio-thoracic and Vascular Surgery; Gastro-enterology; Surgical Gastro‑enterolog; Plastic Surgery; Electrophysiology; Nephrology; Urology; Neurology; Neurosurgery; Oncology; Endocrinology/Metabolism; Medical oncology; Surgical oncology; Radiation oncology; Nuclear medicine Specialist
Diagnostic and other Para clinical services regarding: Blood Bank with all allied facilities; CT Scan; MRI; EEG; NCV; EMG; VEP (visual evoked potential); Muscle Biopsy; Angiography; Echocardiography; Occupational therapy
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