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System for standardising medical institutions within the health services department, Kerala
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Subject Area="Infrastructure and Equipment." Objective="Development of norms to ensure a standardisation of facilities and manpower at all levels of the health service."
Details for Reform Option "System for standardising medical institutions within the health services department, Kerala"

Background: Kerala is noted for its achievements in the fields of health and education. It is the only State in India having at least one health care delivery institution in each of its Panchayath. Moreover almost all Panchayaths have Primary Health Centres. This undertaking makes Kerala Health Services the second largest department under the government, responsible for about 45,000 employees working in about 1,272 institutions. If the grass root level institutions (viz. the 5,094 sub centres) are also considered, the number of institutions increases to about 6,366. In addition, there are presently about 41 different categories of institutions with more than 295 categories of employees. However because there were no standardised norms, there was no uniformity of service provision, bed strength or staff in these institutions resulting in an uneven quality of health delivery. In December 2001, it was decided that to ensure a minimum service delivery to all sections of the population, all institutions needed to be standardised to comply with the needs of the public. Action: 1. A committee was constituted by the Director of Health Services in May 2002 to prepare a report on the standard pattern of the Government Medical Institutions under Kerala Health Services Department in terms of infrastructure, equipment and service delivery. 2. A facility survey was conducted using data from the Statistical Wing of the Directorate of Health Services. 3. The collected data was analysed. 4. Key informant interviews were conducted with various stakeholders including the DHS, additional directors, district medical officers, PHC medical officers, service organisations. 5. Data was analysed and final report developed and posted on the Government of Kerala website. Results: In July 2005, the committee published a report detailing minimum standards for service delivery; infrastructure; manpower requirements; equipment requirements and laboratory services. It also concluded that the hierarchy of institutions should be changed. It recommended that there should be: (i) One Sub-Centre for every 5,000 population in plane areas and for 2,500-3,000 in hilly or difficult areas. (ii) One Primary Health Centre (PHC) in every Gram Panchayath (iii) One Community Health Centre (CHC) in every Community Development (CD) Block in the first phase and then one CHC for every one lakh population in the second phase. (iv) Each taluk, or block, should have a Taluk Hospital. (v) Each district should have a designated District Hospital. The report also includes details of recommended service provision at each facility, bed strength and levels of manpower. It recommends standard building requirements and structural design for any new facilities. For full details see the report in Documents and Illustrations below. The report is now used as the basic framework for developing new health care institutions and upgrading existing institutions. In addition, 10% of institutions in the Health Department have now been selected for standardisation under the Modernization of Government Programme.

Cost For the preparation of report and its dissemination – INR 2 lakhs.
Place Kerala.
Time Frame Twelve months to prepare the report.

Uniformity of healthcare provision: Provides a standard pattern for all Medical Institutions within the health services department.


Cost: Implementing the recommendations will need a substantial budget. Time: Implementing the recommendations will take time and require consistent political will.


Political will. Qualified professionals to carry out the report.

Who needs to be consulted

Director of Health Services. Additional Director of Health Services (Planning).



Funding for the report came from the European Commission-Project Management Committee (EC-PMC) budget. Funds to carry out standardisation of facilities are now expected to come from a variety of sources including the state budget; Central assistance; health projects; local self government; hospital development committees/societies (ie user charges).

Chances of Replication

Any State could commission such a report. The challenge will be implementation of its recommendations which, as mentioned above, will take time and money.


Initially it had been hoped that the committee would also develop standardized management and referral protocols. However this was abandoned due to time and budget constraints and because it was decided they could only be accomplished after the physical standardization was completed.


Submitted By

Dr K Sandeep, Technical Secretary, Sector Reform Cell, Directorate of Health Services, Thiruvananthapuram, Kerala. September 2005.

Status Active
Reference Files
List of Institutions (31-12-04).xls List of Medical institutions in Health Services Department.
List of Sub-centers in Kerala.xls Report on the Standardization of Medical Institutions in Kerala.
Reference Links
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