These hospitals should play an important referral link between the Community Health Centres, Primary Health Centres and sub-centres. They have an important role to play as First Referral Units in providing emergency obstetrics care and neonatal care and help in bringing down the Maternal Mortality and Infant Mortality. It also saves the travel time for the cases needing emergency care and reduces the workload of the district hospital. In some of the states, each district is subdivided in to two or three sub divisions.
A subdivision hospital caters to about 5-6 lakhs people. In bigger districts the sub-district hospitals fills the gap between the block level hospitals and the district hospitals. There are about 1200 such hospitals in the country with a varying strength of number of beds ranging from 50 to 100 beds or more. The Government of India is strongly committed to strengthen the health sector for improving the availability, accessibility of affordable quality health services to the people.
In order to improve the quality and accountability of health services a set of standards need to be there for all health service institutions including sub-district hospitals. Standards are a means of describing the level of quality that health care organizations are expected to meet or aspire to. The key aim of standard is to underpin the delivery of quality services which are fair and responsive to client’s needs, which should be provided equitably and which deliver improvements in health and well being of the population.
Standards are the main driver for continuous improvements in quality. The performance of Sub-district hospitals can be assessed against a set of standards. There has been effort to set standards for 30 and 100 bedded hospitals by the Bureau of Indian Standards (BIS).
However, these standards are considered very resource intensive and lack the process to ensure community involvement, accountability and citizens charter issues that are important for public hospitals.
Under the National Rural Health Mission (NRHM), the concept of Indian Public Health Standards (IPHS) for the Health Centres/ Hospitals functioning in the country. IPHS for CHC, PHC and Sub-centres have been finalized available on the ministry’s website www. mohfw. nic. in. The current effort is to prepare Indian Public Health Standards for the Sub-district Hospitals. Reference has been made to the BIS Standard for 100 bedded hospitals; Rationalisation of Service Norms for Secondary Care Hospitals prepared by Govt. f Tamil Nadu; District Health Facilities, Guidelines for Development and Operations, WHO, 1998 and Indian Public Health Standards (IPHS) for Community Health Centres. 3 Setting standards is a dynamic process. This document contains the standards to bring the Sub-district Hospitals to a minimum acceptable functional grade with scope for further improvement in it. These standards are flexible as per the requirements and resources available to the concerned State/UT Government. The timeframe for implementation and achievement of these Standards could be extended for five years and to be done in phases.
Most of the existing hospitals below district level (51-100 Bed category) are located in older buildings in urbanized areas / towns as compared to most Primary Health Centres / Sub-centres. The expansions already done have resulted in construction touching the boundaries walls with no scope of further expansions. As far as possible, States should not dislocate the said hospitals to a new location (in case of dislocating to a new location, the original client group will not be able to have same access to the desired health facilities) . Objectives of Indian Public Health Standards (IPHS) for Sub-District Hospitals: The overall objective of IPHS is to provide health care that is quality oriented and sensitive to the needs of the people of the district. The specific objectives of IPHS for Sub District Hospitals are: i. ii. iii. To provide comprehensive secondary health care (specialist and referral services) to the community through the Sub District Hospital. To achieve and maintain an acceptable standard of quality of care.