PROF.

DEOKI NANDAN
Doctor Honoris Causa-Odessa State Medical University, MD, FAMS,
FIAPSM, FIPHA, FISCD
Director
(director@nihfw.org, www.nihfw.org)
&
NIHFW FAMILY MEMBERS
 Regional inequalities.
 Per capita Public Health spending varies largely from
Rs.630 (in Himachal Pradesh) to Rs. 93 (in Bihar) in
2004-2005. (GOI, 2009).
 Over 47% of hospitalized persons in rural areas & 31%
in urban areas borrow heavily or sell assets to cover the
expenses (NSSO-60th Round).
 Due to high hospital expenses over 25% of hospitalised
Indians fall below poverty line.
 Only 10% Indians have some form of health insurance,
mostly inadequate.
 Increase in life expectancy

 Reduction of Fertility

 Eradication of Smallpox/ Guinea Worm

 Initial Success in Leprosy/ TB/ Malaria

 Ageing

 Morbidity & Mortality burden

 Water/ Vector borne diseases

 New Emerging Diseases

 Life Style Diseases

 Understanding the nature of problems.
 Rural/ Urban Differentials
 Responsibility for Health
 Responsiveness of health system
 HMIS and Early Warning System (?IDSP)
 Public, private, corporate and voluntary sector
 Convergence/ Inter-sectoral action for health
 Role of AYUSH
 Health Manpower Development
 Increase in cigarette smoking
 Less physical exercise - increase in diseases as coronary heart
disease, stroke, diabetes and arthritis.
 Mental illnesses have been a continuing concern.
 Life expectancy has increased - issues of long-term care, dementia,
arthritis and multiple diseases
 Rise in the side-effects for drugs
 Poverty - inequalities in levels of health between the various social
groupings
 Reduction in MMR, IMR and TFR
 Major public health concerns

• Outbreaks of disease caused by infective or toxic agents

• Problems arising from social and environmental issues
• Behavioral concerns
• Health service issues
• Life Style Diseases
 Public health practitioners must develop their skills in handling
outbreaks of disease
 Training in epidemiology is crucial to this
 It is important for the effective monitoring of health needs and
outcome that data collected about patients are linked to
individuals, and not merely based on events
 Appropriate epidemiological and other studies are necessary to
determine the factors responsible for ill-health
Ability to communicate with the media, pressure
groups and the public on the concept of health
has enormous implications for any future
public health structure
 There remains at present, confusion between the role of public
health in the management of clinical services and its primary
role in the management of public health services.

 Public health can influence the priorities and distribution of

health service resources to improve the health of the
population for which it is responsible.
 Public health has made massive inroads into diseases within a relatively
short period.
 Public health is now at a cross-roads where it can either accept the status
quo or confront realistic change and challenge and seek to regain its former
independent voice.
 The specialty has a duty to inform the public responsibly on public health
matters.
 We perceive public health as the central medical specialty of the future.

Let us move on to concerns of quality…….

 ---Affects all stake holders
1. Enables us to provide services that improve health

 Prevention services keep people healthy

 Good planning means you get the drugs etc. when you need it.
 Decreases the chance of harm in the services
 Hospital based infection rates – adds average of 4-5 days to hospital
stay
 Redoing procedures, patient complaints, potential lawsuits in CPA
add to the cost
 Contributes to economics of the country
 Healthy people make happy families and communities
 Overuse- unnecessary surgeries, tests, medications and
procedures Eg. prescription antibiotics, MRIs, X Rays.
 Underuse – Failure to provide routine preventive screening &
services eg immunization resulting in illness.
 Misuse (mainly medical errors) – prescription drug misuse,
hospital acquired infections, surgical errors etc.
 Medical errors are best documented indicators of poor quality
… National Policy &
…
Infrastructure

National &
regional
Performance Monitoring &
macro management

Institutional
Operations & Governance

Individual
Health Services Provision:
Professional accountability and patient satisfaction
Principles Quality Strategies

Values Empowering
consumers
Policies Professional
development
Framework
Legislation Institutional
development
Existing Management
mechanisms development
Clinical practice
development
16
1. User/customer focus
2. Leadership and Vision
3. Decision-making based on evidence
4. Team based decision making/multi-disciplinary teams
5. System and process approach
6. Stakeholder/community involvement
7. Capacity building/training of staff
Medical waste is
not disposed of
in a functional pit,
needles and other
medical waste are
scattered in the
vicinity of the
healthcare facility.
Managing Medical Waste
Standard:
Medical waste is
disposed of in a
functional pit (e.g. not
accessible to children
and animals) within the
compound
 Established in year 1854, honoured for being one of
the first three Medical Schools of the country.

 This Medical College was affiliated to Agra

University (now Dr. B.R. Ambedkar University) in
year 1939 and started awarding MBBS degree.

 Renamed as Sarojini Naidu Medical College &

Hospital during year 1947.
 Institute provides primary, secondary and tertiary level
specialized health care facilities not only to people from
Agra but also to those approaching from surrounding
Districts and States.

 Institute had earned National and International repute

for excellent standards of Teaching, Training, Research
and Patient Care.
 Facilities available at the institute:
• Outdoor Patient Department

• Indoor Wards (total of 976 beds in various departments)

• Teaching & training of undergraduate and postgraduate

medical students
• Teaching & training of Nursing students and provision

of courses in Lab. Technology, Diploma in Pharmacy etc.

• Research in various disciplines (MD/MS & Ph.D.)
 With the ever increasing number of Private Health Facilities and
dominance of private qualified and unqualified practitioners,
patient input was decreased during past few years.
 Considerable vacancies in college & hospital staff and irregularity
and inconsistency in working led to deterioration of the image of
the institute in the past.
 Lack of budget -especially medicines
 Lack of ownership and involvement among those involved in
management and administration also contributed to decline in the
quality of services.
Pictures from the past

COLLEGE BUILDING

SURGERY BUILDING
 Strengths:
• Prestigious Institution
• Highly qualified and skilled doctors
• Tertiary level institution with glorious history
• Large numbers of renowned alumni at
national & international organisations
• Undergraduate & postgraduate students
 Weaknesses:

• Lack of teaching and other staff resulting in compromise

of teaching/training at the institution.

• Lack of ownership, motivation and communication

• Inadequate attention towards hygiene and sanitation

• Lack of work culture at each level- ‘Chalta hai’ Culture

 Opportunities:
• Development of Medical diagnostic & curative
modalities.
• Global change and attention towards health
requirement of the community.
• Investment from Public / Private Sector

• Social & Political will

• Support from community and other organizations

working for health.
 Threats:
• Influence of Private Health Sector -
malpractices

• Political interference

• Adhocism in decision making at the

governmental level
 Up gradation and renovation of existing infrastructure.
 Establishment of new functional and sustainable
infrastructure- modern diagnostic and treatment facilities.
 Improving the work culture and motivation levels
 Ensuring multi sectoral involvement with multi dimensional
approach- seeking support from the private sector, politicians
and media.
 Computerization of college & hospital related data and
information.
 Strengthening of undergraduate

and postgraduate teaching and training .

 Due consideration to hygiene and sanitation

in college hospital premises and wards.

 Ultimately- improving quality of care

 Garner political support
- Get Emergency Block completed and inaugurated (by
Chief Minister)
- invite politicians for visits and organising functions
(get their commitment)
- ’oblige’ them!
- frequent interactions with key media personnel
 Mobilise support from Directorate and
bureaucracy

-frequent interactions
-submit plan(s)-
-organise visits
-more budget
 Human Resource Management:
- talk to all associations-faculty, staff(different
levels), students
- establishing a Grievance cell
- negotiate commitment of faculty
- open door policy
- appreciation letters, awards/ punishment
 MBWA

 Suggestion box (actually opened weekly!)

 support from private sector

 Updating all official records and developing a

system for office management.
2. Organization of meetings / discussions for listening and
solving grievances with faculty members, Class III and Class
IV employees, Pharmacists, Nursing staff, Employee Unions
and undergraduate/ postgraduate students for reaching at
mutual consensus for betterment; and seeking their support.

3. Ensuring regular monitoring at out patient and indoor

departments for provision of timely and quality health care
services – fixing responsibility.

4. Ensuring regular and strict attendance of students in

lectures, practical, demonstrations and training sessions.
6. For ensuring proper computerization of college &
hospital, 7 day training was organized for clerical staff on
Computer Literacy and Applications (total 6 batches were
trained).
7. Secretarial Training of Class III employees was organized
by Department of Personal Training at District Level.
8. For prevention of nuisance and interruption of anti-social
& criminal activities, Barriers and Parking facilities were
developed at different points within the campus.
9. Support of Police and District Administration was sought
for better functioning..
10. Installation of ‘Suggestion Box’ where suggestions or
grievances can be put ‘with name’ or ‘without name’, for
prompt action.
11. norms for file disposal
12. negotiated with suppliers- no cuts!
13. Use of multi skilled personnel
 more budget- for renovation, equipment,
maintenance- MCI requirement
 regularisation of adhoc employees
 promotion of faculty
 dues of faculty,residents,staff,pensioners
 Infrastructure and Equipment:

• Inauguration of New Emergency Department

• Inauguration of Dr. Nawal Kishore Ward in Deptt. of
Obstetrics & Gynaecology
• Inauguration of new X ray Unit
• Inauguration of "Endoscopy Lab" in Deptt of Medicine
• Inauguration of Ultrasonograpy Unit in Deptt of Obstetrics
& Gynaecology.
• Inauguration of Dr. P. Awasthi Seminar Room at Deptt of
Ophthalmology.
New Emergency Deptt
 Infrastructure and Equipment:
• Inauguration of Cancer Clinic at Deptt of Obstetrics &
Gynaecology.
• Establishment of Neonatal Intensive Care Unit at Deptt.
of Pediatrics.
• Establishment of Thalessemia Unit.
• Up gradation of Burn Unit.
• Inauguration of Lecture Theatre at Out Patient
Department.
• Inauguration of Indoor Ward (no. 10) at Deptt. of
Orthopedics.
 Support from Private Sector:
• Donation of Air Conditioners to Deptt of Medicine by
Bharat Vikas Parishad.
• Donation of Laparoscope & other instruments to Deptt of
Surgery by Shri Chaturvedi Manav Seva Sansthan,
Mathura.
• Donation of Ultrasonography machine to Deptt. Of
Obstetrics and Gynaecology by Bansal Charitable Trust.
• Donation of Marble benches for OPD by Nav Surbhi
Mahila Samiti.
• Donation of Red stone benches for Deptt of Obstetrics &
Gynaecology by Lions Club
 Support from Private Sector:
• Donation of Ventilators for establishment of NICU at Deptt
of Pediatrics by Swarup Group of Industries, Mumbai.
• Provision of Free Diet at Rain Basera near Deptt of
Obstetrics & Gynaecology by Shri Nath ji Nishulk Rain
Basera, Agra.
• Establishment of Community Toilets near Deptt. of
Obstetrics & Gynaecology by firm ‘Kwality Petha’, Agra
• Community Hall and Community Kitchen – ‘Sanjha Chulha’
near Deptt of Medicine by Pt. Keshav Dixit.
 Support from Private Sector:

• Initiative of Lions Club for bearing the expenditure for

printing of new OPD slips.

• Donation of Rs. 5 lacs by firm ‘Doctor Soap’ of Agra for

purchase of necessary equipment.

• Donation of 100 blankets and establishment of 4 pyau's by

Ganesh Seva Sansthan, Agra.

 Computerization of College & Hospital:
• Launching of website of the institution by name
www.snmcagra.net

• Inauguration of Internet Cyber Cafe at Central Library.

• Regular computerization of outdoor and indoor

patient data.

• Computerization of all information related to

employees and students.
• Computerization of Duty Rosters of Nursing staff and
other support staff.
Today
Today-endoscopy lab
Today-labour room
DEEPAWLI DEEP MELA
CENTRAL LIBRARY DECORATED ON DIWALI
 Achievements and involvement of Students:
• Students gave valuable inputs and successfully organized
150th Year Celebrations, including Clinical Week, Cultural
& Sport Activities.
• Students from the Institute also visited Tsunami affected
areas of South India and Andaman and provided Medical
Aid to the affected.
• Regular CMEs, seminars etc

• Post graduate students were sent/deputed to other

Hospitals and Institutes for receiving training in modern
modalities.
 367730

314341 292090

186168 195606

152934

2001 2002 2003 2004 2005 2006

 15455

13194

10357 9912

8051

2001 2002 2003 2004 2005

Saanjha Chulha-medicine
Sanjha chulha-Gynae
 Support from Professional Bodies/Social
Bodies:
• Initiativeof Lions Club for bearing the
expenditure for printing of new OPD slips.

• Built post Mortem House.

• Artificial Limbs workshop for Orthopedics from

the trust
 Got good media coverage, frequent
interactions with key media personnel

 Had a good relationship with the press- kept

them informed –so less negative publicity!

 OPD duty roaster of Doctors in a daily

leading newspaper
 Support and confidence from all employees and students of
the institute.
 Trust from the Community
 Support from Private and other Sectors
 Political will and Administrative & Judicial support
 High degree of motivation among the staff members.
 Collective wisdom for collective action through
participatory approach.