Hospital Management In Nepal

There is no internationally accepted clear definition for hospital. There are several types of hospitals based on the facilities, equipments and services, i.e. district hospitals, provincial hospitals, speciality hospitals and referral hospitals, teaching University hospitals and other types of health care facilities. There is no international standard defining what should be the minimum services that each hospital should provide during a health crisis. Each country has to develop a national policy and technical guidelines to deal with a health crisis. Before defining the essential services, the ministry of health has to define the essential health services that the health sector will provide to the community to the community in order to identify what more specific services will be delivered by hospitals (WHO, 2009).

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Management is defined as the organization and coordination of the activities of an enterprise in accordance with certain policies and in achievement of defined objectives. Management is included as a factor of production along with machines, materials and money. Renowned guru of management Peter Drucker (19909-2005) has said that the basic task of management is two fold: marketing and innovation. Practice of modern management owes its origin to the 16th century enquiry into low efficiency and failures of certain enterprises, conducted by the English statesman Sir. Thomas Moore (1478-1535). As a discipline, management consists of the interlocking services of formulating corporate policy6 and organizing, planning, controlling and directing an organization’s resources to achieve the policies’ objectives (Walden University, 2011).Hospital managenmnet.net suggests that Hospital Management provides a direct link between healthcare facilities and those supplying the services they need ( Hospital management.net 2011) .
WHO in 2009 suggests understanding by hospital management as the effective and combined management of, the following factors:-
(a) Acute care for emergency patients;
(b) Out Patient Department (OPD) activities;
(c) Investigation (laboratory; X-ray; other diagnostic elements);
(d) Referral for primary health care (PHC); specialized consultations or services;
(e) Contribution to public health programmes;
(f) Part of health information system (surveillance system, including a EWS
Component);
(g) Public information and education; and
(h) Preparedness for health crisis management.
Nepal is a landlocked country which is mostly covered by hills and mountains and it has a population of 25.8 million as estimated in 2006. It is in the south Asian continent, north to India and south to China. Its area is 147,181 sq. km (WHO, 2007). It has been facing several challenges to establish a functional health management system (Thapa, 2010).
This essay deals with the challenges which Nepali health system is facing at present and suggests the possible ways for its improvement.
Statement of the problem
Nepal’s health system is in transition. Nepal is an underdeveloped country where the health indicators are very poor. The health service facility is not adequate to Nepali people. So the hospitals are (Dixit, 2005). Nepal’s hospital bed per ten thousand populations is 4.26 (2001/02), physician per ten thousand populations is 2 and Nurses per ten thousand population is also 2 as per the data of 2004 Similarly, Total Expenditure on Health (THE) as % of Gross Domestic Product (GDP) 5.3% and Public Expenditure on Health (PHE) as % of Total Expenditure on Health (THE) is 28 while Private Expenditure on Health (PvtHE) as % of Total Expenditure on Health (THE) 72(WHO, 2007). If it is compared with the other developing countries in the same region i.e. south east Asian region, the level of the problem may be perceived. Maldives, a small tiny country with population 298 thousand has Total Expenditure on Health (THE) as % of Gross Domestic Product (GDP) 6.2. Maldives’ Public Expenditure on Health (PHE) as % of Total Expenditure on Health (THE) is 89 as compared with 28 of Nepal. Private Expenditure on Health (PvtHE) as % of Total Expenditure on Health (THE) in Maldives is 11. It shows that the state has better involvement in Maldives than in Nepal. More over, the population per hospital bed is 381, which are 26.2 hospital beds per 10000 populations. Similarly, number of populations per physician 959 and nurses per 10000 populations are 33 (WHO, 2007). It clearly shows the scenario of health development of Nepal.
As part of health, curative health services have a major role in providing quality health service to the people. Until the health care provider organizations are strong, the curative health service can not be delivered to the beneficiaries properly (Edelman and Mandle 2006). Hospitals are the key component of health care delivery system and they needs to be reformed to ensure a quality health care system (McKay and Healy, 2000).Unfortunately the hospitals in Nepal have very poor in quality management and they are not able to deliver quality health services to the people (Dixit, 2005).
To address the needs and requirement of the hospital, the government of Nepal ( GON), Ministry of Health and Population ( MOHP) has published ”The guideline on the establishment, Operation policy and standard and infrastructure for Private and Public Health Hospitals” in 2004 ( MOHP,2004). But it is still lacking in the formulation of the standard for the hospitals run by the government (Dixit, 2005). However, the policy published by the MOHP tries to clarify on the basic parameters of the infrastructures required for the hospitals which may be applied for the general hospitals as well. But the document does not speak about the application in the government run hospitals (MOHP, 2004). That is why; there is a lack of clear cut guideline for the management of hospital.
Nepal’s health sector is facing a challenge regarding the management (Dixit, 2005). As part of whole system of health in the country, management of the hospitals is also a challenge.
Summary of the problem
Nepal has set a target to achieve the millennium Development goals by 2015. It has to meet the target in all health indicators. Goal no 3 and 4 are c loosely related with health and as part of curative health, hospital and hospital management have crucial role in health promotion. In Nepalese context, hospital management skill and concept of hospital management is still beyond the priority of the government and the government still does not have any policy guidelines over the hospital management sector (Dixit, 2005).
People skill is a key asset for the development of key management styles. Dealing the people is a professional skill in itself. Being able to see from the perspective of others is essential, and caring for their welfare is also of prime importance. There are many high-profile examples of how to develop a successful management style. Managers like Bill Gates and Warren Buffett have famously developed their own distinctive management style from which others can learn. However, the fact that the two examples are very different management styles shows that there is no single route to success (Bono and Heller’s, 2009). But unfortunately, there are no clear guidelines or policy found in the government documents. The recent document on the guideline on the requirement of a hospital, government does not speak about the hospital management, its skill development and transfer for the improvement of a hospital (MOHP, 2004).
Lack of professional skill in the person responsible to manage the hospitals has created a problem in hospital management. The government run or supervised hospitals still do not have positions for the hospitals. MOHP in its policy document has not mentioned anything about the hospital managers (MOHP, 2004). However, the private hospitals have started hiring them which is still out of the government policy (Thapa, 2010).
Nepal is a underdeveloped country where the literacy rate is only 62.7% for male and 34.9% for female as per the report of census 2001 (CBS, 2001). It means still 64.1% women are out of literacy coverage. Nepal has poor health facilities all over the country except in capital Kathmandu and other urban areas. Most of the doctors are not willing to go to the rural areas hospitals and they are often running without (qualified) doctors (Dixit, 2005).
In conclusion, the poor socio-economic conditions, hard geographical conditions and lack of awareness of the people and traditional beliefs and superstitions, lack of will in the political parties and their leaders are the main burning issues for the improvement of health sector in Nepal (Chaulagain, 2004). These all are problems associated with the hospitals and ultimately with their management.
The factors associated to hospital management are still not uncovered in Nepal (Thapa, 2010).
Purpose of the study
As mentioned above, it has been obvious that Nepal is facing the problems to strengthen the management of the health sector. The documents are not found to have been lacking regarding the strategies and policies on the health management. So, the essay aims to identify the hindering factors affecting the hospital management in Nepal. It will study the existing policies and strategies of the government of Nepal on hospital management, international principles, theories and practices on hospital management and identify the factors which are affecting the betterment for hospital management sector of Nepal.
So, the purpose of the study is to identify the current issues that hinder the hospital management in the case of Nepal and suggest the concerning authorities about improving the management system, formulating the policies and implementing them. It will analyse the strength and limitations of the hospital management system in Nepal and help all the concerned to mitigate and minimize them.
Main research question
The study can not answer all questions that come on surface while studying about the issue. So, to narrow down the study area and sharpen the focus, the study has defined the main study questions as follows:-

What are the hindering factors that effect the hospital management in Nepal?

Subsidiary Questions
To supplement the main research question, these questions are defined as subsidiary questions as follows:-

What are the existing strong aspects of the hospital management in Nepal?
What are the limiting factors in hospital management in Nepal?
How is the existing hospital management system in Nepal?
What is the appropriate modality or best practices of hospital management that are applied in the world by other countries and
What are the factors that are hindering the in the betterment in the hospital management in Nepal?

Hypothesis
Lindsen and Jong (2005) have defined hypothesis as an alternative explanation of residual switch trial costs or, more precisely, of the empirical finding that the repetition trial (RT) distribution for switch trials with a long preparation intervals can be modelled as a mixture of the RT distributions for repetition trials and for switch trials with a short preparation interval (Lindsen and Jong, 2010). In here, the hypothesis tries to establish an alternative factor that might be supposed to be the commonest hindering factor for the management of hospitals in Nepal. The hypothesis taken here is the lack of professionalization of hospital managers or the person who are involved in the management of either government run or private or community run hospitals in Nepal. It will be verified by the study afterwards in here.
Significance of Study
As mentioned above there are no special policies and practices established for hospital management in Nepal. The hospitals are managed by the medical doctors or surgeons so far (MOHP, 2004). The doctors are not entitled to diagnose the patients, treat them, run medical and surgical and public health cams campaigns in the hospitals or in the periphery of the hospitals. The Medical council is liable to assign the job responsibilities of the doctors in the case of Nepal. But it has not mentioned about the management part of the hospital and its regulation, Nepal Medical Council Act, 1964 (amended in 2001).It does not speak who is responsible for that (Nepal Medical Council, NMC, 2001). There is no one professionally responsible for the hospital management in the present context. In the country where the government policy about the medical sector does not speak about the role of hospital management, it becomes obvious that the hospital management sector is not running smoothly. No presence of the monitoring body to supervise and evaluate the hospital management is found in the present documents whether published by the government or private organizations. So, the studies’ significance is in establishing the fact what is the main barrier and other minor barriers in the hospital management of Nepal. That is why this study is has an important significance.