Indmedica Home | About Indmedica | Medical Jobs | Advertise On Indmedica
Search Indmedica Web
Indmedica - India's premier medical portal

Journal of the Academy of Hospital Administration

Availability and Utilization of Major Equipment at District Hospital Gurgaon, Haryana

Author(s): O.P. Lathwal*, Alok Banerjee**

Vol. 13, No. 2 (2001-07 - 2001-12)

Key Messages:

  • In the district Hospital, Gurgaon, shortfall in availability of equipment was 25.9%.
  • Actual utilization of equipment was only 39%. Non utilization was due to non-functionality(36%), not in use (25%) and kept as reserve.
  • There is improper and poor system of maintenance and repair of equipment as also in appropriate procurement of equipment.

Abstract

This prospective study was carried out at the district hospital Gurgaon in Haryana, in nine different departments and ten service areas, in order to find out the availability and their utilization of various major equipment in the respective areas. The study was primarily based on a pre-determined check list of the required standard equipment in a district hospital. It revealed that there was a shortfall of 25.9% of equipment from the standard requirements in 100 to 200 bedded district hospital. However, amongst the available various departments service areas in the district hospital, Gurgaon, the actual shortfall were only 14.2% of the required equipment. The actual utilization of the available equipment was found to be only 39.3%, the rest were either non functional (35.5%) or not in use (25.2%) and kept as reserve. Majority of the non functional/ break down equipment were just lying for condemnation (28.2%), only 7.3% kept for repair, out of the available total equipment of 369. The reason for less availability, non functioning and under utilization of equipment was found to be improper and poor system of maintenance and repair, and tendency to keep some of them in reserve for their future use, in case of breakdown of the existing ones.

Keywords : Medical Equipment, District Hospital, Utilization

Introduction

The equipment is an important and all pervasive factor in the present day hospital and has become a necessity in almost all its activities whether diagnostic, therapeutic and supportive in nature. Further, due to rapid technological progress, particularly during the last few decades, the equipment has become not only more and more complex but also require regular specialized maintenance and repair, which is very expensive. The term 'equipment' in the context of a hospital, generally means any instrument, apparatus, tool, appliance, machine or any other related article, used for various preventive, diagnostic, therapeutic, supportive and control procedures for day to day patient care activities.

The availability and utilization of various health care equipment at all levels in the health system for effective and efficient service delivery, was amply emphasized in the Alma-Ata declaration at the International Conference on Primary Health Care in 1978, which was later included into the strategy paper of Health for All by 2000AD. The Planning Commission of India in their 8th plan document has also emphasized the role of essential equipment in the delivery of health and family welfare services. In the present days health care delivery system, district hospitals are playing a vital role to link the tertiary care institutions with the primary level care at the primary health centers, and are also providing secondary or intermediary health care to the community. Therefore, the availability and utilization of equipment in providing specialized diagnostic and therapeutic services at the district hospitals and its serious financial implications can not thus be under estimated. This paper has tried to bring about availability and ther utilization of various major equipments in different functional areas for health care delivery at the district hospital, Gurgaon.

Methodology

The study was based on the check list of equipment to required for different departments/service facilities of the district hospital, Gurgaon. Since no specific norms exist in our country on the required essential equipment in a district hospital, and whatever available, had become old on account of the rapid technological advances, so, for the purpose of the study, a check list of equipment was prepared for each department/service facility of the district hospital, Gurgaon, on the basis of the recommendations of various technical committees of Government of India (namely Ayyar committee in 19631, Jain Committee in 19682, and Bajaj committee in 1980)3, study of Anand and Agarwal from NIHFW in 19924, and the recommendations of the Bureau of Indian Standard (BIS) in 19885, 1989 6, Rao Committee, Ministry of Health & Family Wealth 7. Government of India and WHO for some departments. The study was based on

  1. interview of the hospital administrator, specialists and the officer in charge dealing with various equipment at different department/service facilities as also the concerned technicians who handle the equipment, using semistructured questionnaires;
  2. study of various records and documents pertaining to the same, and
  3. actual observations of the various service delivery sites/departments.

Observation and Discussion

The district hospital, Gurgaon had bed strength of about 158 (actual sanction was 120). It had various facilities like casualty, out patient, laboratory services, central sterilization services, kitchen, delivery room and operation theatre, and most of the speciality departments like medicine, surgery, paedriatics, obstretics & gynaecology, ophthalmology, ENT, dentistry, anesthesiology, physiotherapy and radiology. Departments/facilities like orthopedics, nursery, intensive care unit (ICU), laundry and workshop, were not present in the district hospital, Gurgaon. Basing on different functions including types of services to be provided, number of beds, patients's load etc., the total number of major standard equipment to be required in the district hospital, Gurgaon, was calculated to be 498 as per norms for 100 to 200 beded hospital and the necessary check list was thus prepared for the present study. However, in the present study amongst 19 different functioning departments and service areas, 430 equipment were calculated to have been required, which following assessment were found to be only 369 available for use (Table 1). Therefore, there was an overall shortfall of 25.9% of major equipments against the standard list of equipment, that would have been available in the district hospital of this type. The main reasons contributing towards this shortage were - (i) non existence of certain departments/facilities like orthopaedic, neonatal nursery, intensive care unit (ICU), laundry and hospital workshop, (ii) limited activities in certain important areas like blood bank (which was attached with pathology department), physiotherapy, central sterilization, kitchen, mortuary etc., and (iii) several items were lying for condemnation. It was also observed that out of total 369 available major equipment, 104 (28.2%) of them were totally nonfunctional and lying for condemnation (Table 3). These condemnable items of 104 when added to the already existing shortage of 129 equipment led to increase in the non availability for use of 233 equipment (46.8%) of the total number required for proper functioning of the district hospital. Varying number of condemnable equipment were found in majority of the department of which was maximum at OT (31), then other areas like laboratory (19), medical ward (9), casualty (11), labour room (6), radiology department (5), post partum center (4), surgical ward (4), ECG department (3) etc. Majority of the available 369 equipment in 19 different departments / service areas, were of indigenous make (82%), rest 18% were imported items. The source of supply was mostly found to be from the Haryana State Government (83.2%). The rest of the items were through donation (9.6%) from Red Cross, UNICEF etc. and supply from Government of India (7.2%) under various National Health and FW programme.

An indepth assessment of the available 369 major standard equipment in various department/functional area, revealed that 64.5% of them were in working order, but only 39.6% of them were in actual use (fully functional 37.4% and partially functional 1.9%). The other 93 equipment (25.2%) were not in use, although they were in working condition (Table 1). The reasons found for non utilization, were -non availability of trained personnel (8.9%), kept as reserve (12.9%), non installation, non availability os supportive equipment necessary to operate etc. (Table 2). Mehta in 1974 (8) studied various hospitals in northern India and observed that only 30% to 40% of their hospital equipment were functioning and in working order, while those in other developing countries as reported by Issakov in 1989 (9) was varying between 20% to 50%. Gupta in 1990 (10) had studied three departments of All-India Institute of Medical Sciences and found that only 14% were non functional as compared to 35.5% in the present study, Kumar in 1989 (11) reported that the major hospitals had often surplus equipment, whereas in peripheral facilities there were shortage of most commonly used equipments.

Table 1: Status of equipment in district hospital, Gurgaon

Serial No. Name of Deptts/Service areas Quantity Required Quantityactually available Functional Status of the Equipment
Fully Functioning Partially Functioning Not Functioning Not
in Use
1 Anesthesiology 17 13 0 1 7 5
2. Casualty 34 31 14 0 12 5
3 Central Services 4 3 0 0 2 1
4 C.S.S.D. 10 5 2 0 3 0
5 Dentistry 20 10 4 1 3 2
6 E.C.G. 4 8 1 0 3 4
7 E.N.T. 13 10 2 0 0 8
8 Ophthanlmology 15 10 6 0 1 1
9 Kitchen 21 4 0 0 1 1
10 Laboratory andBlood Bank 60 52 14 0 21 17
11 Labour Room 21 40 16 0 13 11
12 Medical andPaedriatics Ward 30 22 6 1 10 6
13 Mortuary 9 2 2 0 0 0
14 Operation Theatre 50 76 20 0 33 22
15 O.P.D. 16 12 11 0 1 0
16 Physiotherapy 31 9 0 0 3 6
17 Post Partum Centre 40 24 16 0 5 3
18 Surgical Ward 15 13 6 0 6 1
19 Radiology 20 25 18 0 7 0
  Total No. 430* 369 138 07 131 93
  Percentage   85.8% 37.4% 1.9% 35.5% 25.2%

Note:* Excluding non-existing departments/facilities like Nursery (20), ICU (18), Orthopaedic (8), Laundry (17), and Workshop (5) - all of which constitute a total No. of 68 equipment. Thus, Total of 498 Equipment should have been there in a 100-200 beded District Hospital.

Table 2: Reasons for non-functioning of available equipment

Serial No. Name of Deptts/Service areas No. of available Equipment Total No. of Equipment Non-functioning/ Not in use Reason for Non-functioning/Not in use
Breakdown Completely Non-availability of trained personnel Kept as Reserve/ Surplus item Others Usedveryrarely
1 Anesthesiology 13 12 7 5 0 0
2. Casualty 31 17 12 0 1 4
3 Central Services 3 3 2 0 0 1
4 C.S.S.D. 5 3 3 0 0 0
5 Dentistry 10 5 3 0 1 1
6 E.C.G. 8 7 3 0 4 0
7 E.N.T. 10 8 0 7 1 0
8 Ophthanlmology 10 2 1 0 1 0
9 Kitchen 4 2 1 0 1 0
10 Laboratory andBlood Bank 52 38 21 0 10 7
11 Labour Room 40 24 13 2 3 6
12 Medical andPaedriatics Ward 22 16 10 0 0 6
13 Mortuary 2 0 0 0 0 0
14 Operation Theatre 76 55 33 0 4 18
15 O.P.D. 12 1 1 0 0 0
16 Physiotherapy 9 9 3 6 0 0
17 Post Partum Centre 24 8 5 0 3 0
18 Surgical Ward 13 7 6 0 0 1
19 Radiology 25 7 7 0 0 0
Total No. 369 224 131 20 29 44
Percentage 60.7% 58.5% 8.9% 12.9% 19.7%

Table 3: Status of breakdown equipment

Serial No. Name of Deptts/Service areas No. of available Equipment Total No. of Breakdown Equipment No. Service areas available Breakdown
Condemable  Repairable
1 Anesthesiology 13 7  7 0
2. Casualty 31 12  11 1
3 Central Services 3 2 0 2
4 C.S.S.D. 5 3 1 2
5 Dentistry 10 3 3 0
6 E.C.G. 8 3 3 0
7 E.N.T. 10 0 0 0
8 Ophthanlmology 10 1 0 1
9 Kitchen 4 1 0 1
10 Laboratory andBlood Bank 52 21 19 2
11 Labour Room 40 13 6 7
12 Medical andPaedriatics Ward 22 10 9 1
13 Mortuary 2 0 0 0
14 Operation Theatre 76 33 31 2
15 O.P.D. 12 1 1 0
16 Physiotherapy 9 3 0 3
17 Post Partum Centre 24 5 4 1
18 Surgical Ward 13 6 4 2
19 Radiology 25 7 5 2
  Total No. 369 131 104 27
  Percentage   35.5% 28.2% 7.3%

The reason for less availability, non-functioning and under utilization of the equipment at the district hospital, Gurgaon was mainly due to administrative problem arising out of the low priority given to this important aspect by the hospital administrator, tendency to keep some of the equipment in reserve for their future use in case of breakdown, and no proper and convenient system of repair and maintenance. To overcome this administrative problems, Jain Committee in 1968 had recommended that the hospital authority should periodically review the status of the existing equipments and take necessary corrective steps for any shortfalls. However this recommendation has not been implemented at the district hospital, Gurgaon.

[Note: This study was conducted for the thesis work of M.D. (Community Health Administration) at the National Institute of Health & Family Welfare, New Delhi during the year 1992-93.]

References

  1. Ayyar Committee (1963): Report of hospital equipment standardization committee. Directorate General of Health Services, Government of India, New Delhi.
  2. Jain Committee (1968): Report of the study group on hospitals. Ministry of Health and Family Planning and Urban Development, Government of India, New Delhi.
  3. Bajaj Committee (1980): Report of hospital equipment standardization committee. Directorate General of Health Services, Government of India.
  4. Anand, T.R. and Agarwal, A.K. (1992): Guidelines on norms for equipment of hospitals of different sizes. National Institute of Health and Family Welfare, New Delhi.
  5. Bureau of Indian Standards (1988); Indian standards on basic requirements for hospital planning : Part I upto 30 beded hospital. B.I.S., Manak Bhawan, New Delhi.
  6. Bureau of Indian Standards (1989): Indian Standards for surgical instruments and medical equipment. B.I.S., Manak Bhawan, New Delhi.
  7. Rao Committee (1968): Report of the hospital review committee (Delhi Hospitals). Ministry of Health and Family Planning and Urban Development, Government of India, New Delhi.
  8. Mehta, J.C. (1974): Hospital Engineering - delayed concept. National Institute of Health Administration and Education Bulletin, Volume VII, No.3.
  9. Issakov, A (1989): Health care equipment - WHO global effort. Hospital Management International, International Hospital Federation, London.
  10. Kumar, V.P. (1989): The right equipment....in working order. World Health Forum, Volume 10, No.1.

* Principal, State Health and Family Welfare Training Centre, Rohtak, Haryana

** Consultant Surgeon and Quality Assurance Specialist, New Delhi.

Access free medical resources from Wiley-Blackwell now!

About Indmedica - Conditions of Usage - Advertise On Indmedica - Contact Us

Copyright © 2005 Indmedica