The document is a research paper that analyzes the status of public healthcare management across Indian states using a multi-criteria decision making (MCDM) approach. It ranks the states based on 30 indicators related to healthcare outcomes and resources. The paper uses the Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) MCDM method, which identifies ideal and negative-ideal solutions to rank the states based on their distance from these solutions while accounting for the relative weight of each indicator. The paper concludes that states in South India rank higher in terms of public healthcare management compared to other parts of the country.
A Study of Healthcare Quality Measures across Countries to Define an Approach...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Project Synopsis -A STUDY ON AWARENESS OF HEALTH INSURANCE PRODUCTS AND
CLAIM SETTLEMENT PROCESS WITH REFERENCE TO THE
UNITED INDIA INSURANCE COMPANY LIMITED
A Study of Healthcare Quality Measures across Countries to Define an Approach...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Project Synopsis -A STUDY ON AWARENESS OF HEALTH INSURANCE PRODUCTS AND
CLAIM SETTLEMENT PROCESS WITH REFERENCE TO THE
UNITED INDIA INSURANCE COMPANY LIMITED
Factors Affecting Retention of Human Resources for Health in TRANS-NZOIA Coun...paperpublications3
Abstract: Retention possesses an essential spot and position inside the entire administration process. This component is utilized productively for swaying staff to make positive commitment for accomplishing organizational goals. Retention is vital, as individual temperament needs some kind of prompting, consolation or motivation to give higher execution. Over the past 5yrs, the rate of nursing staff leaving their jobs has been 40% annually and this has continued to be a problem affecting the delivery of health services. Motivation of employee's therefore, offers numerous edges to the Organization and also to the staff. Hence this study sought to establish the factors affecting retention of health workers in the health sector and especially nurses in the health department of Transnzoia County Government. The study was guided by the following objectives; - to determine the factors that affect nurse retention in the Health sector of Transnzoia County Government, to find out the effects of job satisfaction on nurse retention in the Health sector of Transnzoia County Government and to establish the effect of retention programs in the health sector of Transnzoia County Government. The design used for this study is the descriptive method. The targeted sample for this study comprised of senior management nurses as well as junior management nurses at the hospitals, health centers and dispensaries within Transnzoia County. The total population of nurses currently stands at three hundred and twenty. A sample size of one seventy five members was selected by using random sampling method. Both primary and secondary sources of data were used during the study. The procedures for collection of data for this study were basically questionnaires and interviews. Data collected using the questionnaires was edited for clarity and then frequency tables drawn to show the final results using Pearson product-Moment Coefficient correlation and Statistical Package for Social Science (SPSS) software. The SPSS was used to analyze the information gathered which was used in development of charts and graphs. It is therefore important to understand personal premises and key retention factors anchored on contemporary nursing management practices with identifiable indicators.
Analysis of Employee Retention Strategies on Organizational Performance of Ho...inventionjournals
Globally, the retention of skilled medical staff in health care sector has been a serious concern to management due to higher turnover of medics. The desired critical measures for retention strategies of medics need to be done to sustain competition among health care providers. The purpose of this study was to analyse of employee retention strategies on organizational performance of hospitals in Mombasa County. The study was guided by the following objectives; to analyse the relationship between recruitment strategies and organizational performance, to examine the extent to which supervision strategies affects organization performance,. The study employed descriptive correlational research design. Target populations of 102 respondents, the study had a sample size of 102 respondents all drawn from senior staff in the County’s ministry of health department. Sampling procedure will be census. Semi-structured Questionnaire will be used, Likert five point scale questionnaire will be used, factoring Strongly Agree to Strongly Disagree. Cronbach’s alpha coefficient was used to measure the reliability of the questionnaire. Data was analysed using descriptive statistics and regression analysis was used to measure the relationship between variables. Data was presented in cumulative frequency tables. The finding the study were The relationship between recruitment strategies and organization performance of public hospitals in Mombasa County was found to be positive and significant in that its R was 0.485 and had a p-value less than 0.05 (ε= 0.006). The regression results revealed that supervision strategies effect on performance was statistically significant (overall p-value = 0.036).The study concluded that all the employee retention strategies need to be improved because they have been found to have a positive and significant effect on organizational performance. The study recommended that the management of public hospitals in Mombasa County should improve on employee retention strategies because they have been found by this study to have a positive effect on the organizational performance
This is a report about Indian Health care industry and How different sectors like Hospitals, Pharmacy and Diagnostics industry are growing. What are the new government policies that are implemented for Health care sector in India.
Health sector is considered as one of the most important sectors in any economy because the
wellness of a country depends on the wellness of its citizens. This can be only achieved when there is an efficient
and effective health system in the country. Despite many government interventions to ensure that services are
not interrupted in public hospitals in Kenya, there are still many challenges as pertains to efficient stock
management leading to frequent stock outs
For the last 10 years or more, the industry has been crying out loud for a major reform of the way medical education and supply side constraints of talent in India has been governed. The major constraints in
the implementation of government’s health programmes and schemes have been in the realm of physical infrastructure, manpower and other support facilities for an effective healthcare delivery system.
Factors Affecting Retention of Human Resources for Health in TRANS-NZOIA Coun...paperpublications3
Abstract: Retention possesses an essential spot and position inside the entire administration process. This component is utilized productively for swaying staff to make positive commitment for accomplishing organizational goals. Retention is vital, as individual temperament needs some kind of prompting, consolation or motivation to give higher execution. Over the past 5yrs, the rate of nursing staff leaving their jobs has been 40% annually and this has continued to be a problem affecting the delivery of health services. Motivation of employee's therefore, offers numerous edges to the Organization and also to the staff. Hence this study sought to establish the factors affecting retention of health workers in the health sector and especially nurses in the health department of Transnzoia County Government. The study was guided by the following objectives; - to determine the factors that affect nurse retention in the Health sector of Transnzoia County Government, to find out the effects of job satisfaction on nurse retention in the Health sector of Transnzoia County Government and to establish the effect of retention programs in the health sector of Transnzoia County Government. The design used for this study is the descriptive method. The targeted sample for this study comprised of senior management nurses as well as junior management nurses at the hospitals, health centers and dispensaries within Transnzoia County. The total population of nurses currently stands at three hundred and twenty. A sample size of one seventy five members was selected by using random sampling method. Both primary and secondary sources of data were used during the study. The procedures for collection of data for this study were basically questionnaires and interviews. Data collected using the questionnaires was edited for clarity and then frequency tables drawn to show the final results using Pearson product-Moment Coefficient correlation and Statistical Package for Social Science (SPSS) software. The SPSS was used to analyze the information gathered which was used in development of charts and graphs. It is therefore important to understand personal premises and key retention factors anchored on contemporary nursing management practices with identifiable indicators.
Analysis of Employee Retention Strategies on Organizational Performance of Ho...inventionjournals
Globally, the retention of skilled medical staff in health care sector has been a serious concern to management due to higher turnover of medics. The desired critical measures for retention strategies of medics need to be done to sustain competition among health care providers. The purpose of this study was to analyse of employee retention strategies on organizational performance of hospitals in Mombasa County. The study was guided by the following objectives; to analyse the relationship between recruitment strategies and organizational performance, to examine the extent to which supervision strategies affects organization performance,. The study employed descriptive correlational research design. Target populations of 102 respondents, the study had a sample size of 102 respondents all drawn from senior staff in the County’s ministry of health department. Sampling procedure will be census. Semi-structured Questionnaire will be used, Likert five point scale questionnaire will be used, factoring Strongly Agree to Strongly Disagree. Cronbach’s alpha coefficient was used to measure the reliability of the questionnaire. Data was analysed using descriptive statistics and regression analysis was used to measure the relationship between variables. Data was presented in cumulative frequency tables. The finding the study were The relationship between recruitment strategies and organization performance of public hospitals in Mombasa County was found to be positive and significant in that its R was 0.485 and had a p-value less than 0.05 (ε= 0.006). The regression results revealed that supervision strategies effect on performance was statistically significant (overall p-value = 0.036).The study concluded that all the employee retention strategies need to be improved because they have been found to have a positive and significant effect on organizational performance. The study recommended that the management of public hospitals in Mombasa County should improve on employee retention strategies because they have been found by this study to have a positive effect on the organizational performance
This is a report about Indian Health care industry and How different sectors like Hospitals, Pharmacy and Diagnostics industry are growing. What are the new government policies that are implemented for Health care sector in India.
Health sector is considered as one of the most important sectors in any economy because the
wellness of a country depends on the wellness of its citizens. This can be only achieved when there is an efficient
and effective health system in the country. Despite many government interventions to ensure that services are
not interrupted in public hospitals in Kenya, there are still many challenges as pertains to efficient stock
management leading to frequent stock outs
For the last 10 years or more, the industry has been crying out loud for a major reform of the way medical education and supply side constraints of talent in India has been governed. The major constraints in
the implementation of government’s health programmes and schemes have been in the realm of physical infrastructure, manpower and other support facilities for an effective healthcare delivery system.
A STUDY ON PATIENT’S PREFERENCES AND SERVICE QUALITY OF THE HOSPITALS WITH SP...IAEME Publication
Patient satisfaction regarding health care is a multidimensional concept that now becomes a very crucial health care outcome. An analysis of this satisfaction with the health care received revealed the following aspects for patient satisfaction and overall performance of an organization encompassing the total quality, trust, reputation, continuity, competence, information, organization, facilities, attention to psychosocial problems, humaneness and outcome of care. All of these factors have high influence on service quality of health care organizations and at the same time. Patients have been given the choice and opportunity to choose between the different hospitals in country regions, and sometimes amongst different hospitals in neighbouring countries. This kind of choice is promoting competition. While many current health care improvement efforts are taken by the government of India such as provision of health infrastructure, equipment, introduction of the health insurance scheme and the adjustments of the salaries of health workers, they seem to have overshadowed the need for constant monitoring to examine the quality of service being provided. Hence empirical research on service quality in health care in is the need of the hour that signals an alarm to the health industry.
Health System in India: Opportunities and Challenges for EnhancementsIOSRJBM
One of the basic vitalities of good living is quick access to essential services like health care. But many times it could mean a condition of life and death for an individual who is unable to get the access to these services. Thus an important part of social sector development is incomplete without adequate health care facilities. The quality of human health is the foundation upon which the realization of life goals and objectives of a persona, the community or nation as whole depends. It is both an end and means of development strategy. The relationship between health and development is mutually reinforcing- while health contributes to economic development, economic development, in turn, tends to improve the health status of the population in a country. India as a nation has been growing economically at a rapid pace particularly after the advent of New Economic Policy of 1991. However, this rapid economic development has not been accompanied by social development particularly health sector development. Health sector has been accorded very low priority in terms of allocation of resources. Public expenditure on health is less than 1 per cent of GDP in India. This research paper focuses on the current status of the Indian healthcare industry, the challenges faced plus the comparison of few selected Indian states based on health indicators. Furthermore comparison of India with some developed and developing countries is also employed in order get the clear picture of the health sector. In order to boost the development line, some opportunities in the health care industry are also discussed and necessary policy implications. Regarding in this connection India lags behind in regard of health improvement as compared to U.S.A, Canada, China, and Brazil, but contrary to other developing countries like Pakistan, Bangladesh the scenario is better with life expectancy, Mortality ratios, health care spending speak volumes about the healthcare status. When analyzed through the prism eye, within India there are large disparities amongst states in achieving health outcomes as well. Before liberalization the improvement was at a snail’s pace, but after liberalization the whole picture changed because the key initiatives to improve the current healthcare standard a two prong strategy focusing on the infrastructure needs and the technology solution were implemented, which resulted in the healthy scenario of the healthcare industry. Healthcare sector, a leading weapon as the contributor to GDP (approx.8%) is thus the matter to be deeply looked into, so that golden harvest is reaped.
13 – impact of social media on health in punjab,South India(Current), Riya(PW...ashimasahni3
A sound health and effective mental care are essential part of nation state system. In-fact
Economy and Social goal of any nation depends on the health of the people. Health is
measured by different variables like access to quality health care, genetic inheritance and the
factors comprised with the quality of water, air, environment conditions etc. However recent
researches in related filed indicates correlation between mass media and health. Mass
media plays very important role in diffusing health messages and generating awareness
about health information which guides in attitude and behavior change of the audience to
ascertain a good health. Thus, Mass media guides health officials to reach the general
people, that is very important for health communication. Hence, mass media, radio,
television, and online media are the useful ways to make up mind of the the target people to
imbibe a new life-style and to alarm them with needful information because this is the only
way which is used to pursued the public about a particular disease or epidemic. The current
study intends to find out the level of awareness of health issues among the people and to
find out the most effective mode of health communication. The present research leads to the
findings that people of Punjab are aware of health issues but not fully aware about the health
schemes initiated by government of India. The mainstream media like radio and television
are doing very good job on national level to make people aware about government related
schemes but local channels are least interested to do a job for health awareness. It has also
come into light that private media is not very serious for spreading health related information
An Empirical Study on Patient Delight and the Impact of Human and Non-Human F...IOSR Journals
Health, one of the Fundamental Human Rights has been accepted in the Indian Constitution. Today the healthcare industry has emerged as one of the most challenging sectors as well as one of the largest service sector industries in India. Patient perceived service quality become the prominent aspect to choose between hospitals. The purpose of this paper is to evaluate patient perceived service quality in Indian hospitals. Further the impact of the dimensions on patient satisfaction and patient delight is examined. A questionnaire was administered to the in-patients and multiple regression analysis has been used to examine the impact of the dimensions on patient satisfaction and patient delight. Findings emphasize eight distinct dimensions of patient perceived service quality and the impact on patient satisfaction and patient delight. A positive and significant relationship with patient satisfaction and patient delight has been found, except two dimensions. The results of this study are limited, as they are based on Indian hospitals. The contribution of this research paper, incorporate patient delight in health care sector. In addition, this paper highlights the importance of emotional attachment for patient satisfaction and patient delight in health care.
Innovative social enterprise, rural health, India Infrastructure Report 2014Poonam Madan
It is a moot issue just how much time and resources can get used up by social entrepreneurs in seeking public partnerships to scale their work, while it would be in the interest of the nation for governments to examine, identify and work with them.
Allied Health Professionals, Essential but Neglectedijtsrd
In today’s changing health scenario, management and quality health care has been the crude demand of society, where the pandemic of Covid 19 during 2019 21 has been a major lesson for individuals about the current devastating health scenario. The health management system in India has been described based on the responsibility of general practitioners, nurses, and allied healthcare professionals. However, the balance of educational support and other efforts has been not considered effectively rather the era of nepotism and disregard in the healthcare sector have been increasing irrespective of consideration for respective needs. ”œHealth is for all, and everyone plays their own part in maintaining so”, these quotes may be found to be more lucrative than their actual practical existence in the surrounding especially for the case of different spectra of healthcare workers. Hence, it is an urgent call for considering the responsibilities of each individual role in healthcare rather than limiting to the old books that need to be torn apart. This paper thus highlights the role, need, scarcity, actuality, reality, and ahead steps for the management of the health system. Dr. Sinchan Das | Priyankesh Mishra | Swastika Subba "Allied Health Professionals, Essential but Neglected" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-7 | Issue-3 , June 2023, URL: https://www.ijtsrd.com.com/papers/ijtsrd57561.pdf Paper URL: https://www.ijtsrd.com.com/medicine/other/57561/allied-health-professionals-essential-but-neglected/dr-sinchan-das
An Analysis of Impact of Human Capital Investment on Demographic Characterist...inventionjournals
The demographic features of the 2011census of India have revealed that India is the second largest country next to China in terms of working age population (25 - 50 years) in the world. It has been known that the country’s economic growth is based on both natural and human resources available in the country. Still, there are more avenues for effective and efficient use of labour-productivity in this age group. It is well conceived by the theory that the human resources are the biggest contributor of economic growth which is augmented by a process of human capital formation. Of late, health and education have been viewed as the two dimensions of human capital which are treated as an indicator of social welfare. The variations in health status of different age groups in market and non-market labour productivities are still prevalent in many developing countries. The low health status persons contribute less to human capital formation than of others (Behrman and Deolalikar, 1988). According to them, “Health is a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity”. Therefore, it cannot be purchased by the consumers in the market as we do for other goods and services in the market. On the other hand, it can be produced by spending time upon health improving activities, as well as, purchasing medical inputs (Grossman M., 1972). Behrman has pointed out that there is an inverse relationship between low health status and human capital formation. Therefore, the economists have focused their attention to study the determinants and impact of health status on economic growth. The present study attempts to analyse the human capital investment and its impact of socio- economic status on human resources (HR) in Chennai district, Tamil Nadu. To aid our research effort, an extensive literature has also been reviewed in an attempt to answer various queries raised. On the basis of the statement of problems, the research questionnaires have been canvassed among the respondents to obtain the information. This study is based on databases obtained both from primary and secondary sources. The information through primary sources has been collected with the help of interview schedule. The secondary data on Human Capital Investment and the Impact of Socio- Economic Status on Human Resources have been collected from various sources in Chennai City. In the health sector, this study focuses its attention to reporting illness, amount spent, days lost. Some of the opted econometric techniques have been used to examine the objectives of the study. Our empirical strategy has applied the following tools of analysis. The statistical tools like OLS, PROBIT and LOGIT techniques are used to analyze the indicator ‘selfreported illnesses. And, ‘Health expenditure’ and ‘number of days lost’ are estimated by OLS and TOBIT techniques, besides by applying correlation, regression analysis.
STATUS OF HEALTH TECHNOLOGY ASSESSMENT IN INDIA (2010)Ruby Med Plus
Research is well-established on a national level, especially essential national Health research (ENHR), with the Indian Council of Medical Research identifying the priority areas. However, the main users of these research findings are academics and researchers. In India, for commissioned research, there is a direct channel of communication between Health care researchers and policymakers. For non-commissioned research the channels of dissemination to policymakers are less clear and more varied, as dissemination of noncommissioned research is limited to academic channels (e.g. papers in peer-reviewed journals or presentations at conferences). The direct dissemination of noncommissioned research at central government level is available to a range of policymakers by distribution of a research report or inviting key policymakers and other stakeholders to a dissemination workshop often less intensively. Another Major constraint, policymakers may not fully understand how to use research to support policy formation as policymakers may not have the ability to evaluate the quality of a research study, difference between qualitative and quantitative research or to interpret research findings, thus experience difficulties in incorporating research findings into policy development for health care programs, which may lead to the failure to translate research into policy or to extraneous conclusions drawn from research results.
“Sarvé bhavantu sukhinaḥ, sarvé santu nirāmayāḥ, Sarvé bhadrāṇi pashyantu, mā kashchid_duḥkha-bhāg-bhavét”. The meaning of this Sanskrit Sloka is “All should/must be happy, be healthy, see good; may no one have sorrow. Mahatma Gandhi also says, “It is health which is real wealth, and not pieces of gold and silver”. Without robust health nobody can do anything. WHO emphasized on “Health for all” in this 21st Century in Geneva Conference in 1998. Government of India also committed to the goal of ‘Health for All’. WHO defined “health” as "State of complete physical, mental, and social well being, and not merely the absence of disease or infirmity". There are strong linkages between population, health and development. India’s health challenges are not only huge in magnitude due to its large population but they are complex due to its diversity and the chronic poverty and inequality. There are extreme inter-state variations, caused by not only the cultural diversity but because -the states are at different stages of demographic transition, epidemiological transition and socio economic development. Along with the old problems like persistence of communicable diseases and high maternal mortality in some parts, there is an urgent need to address the emerging issues like the threat of non-communicable diseases, HIV (AIDS) and health problems of the growing aged population. Accelerating demographic transition is not only necessary for the population stabilization but it is closely related to health goals. Despite substantial improvements in some health indicators in the past decade, India contributes disproportionately to the global burden of disease, with health indicators that compare unfavorably with other middle-income countries and India's regional neighbours. Large health disparities between states, between rural and urban populations, and across social classes persist. A large proportion of the population is impoverished because of high out-of-pocket health-care expenditures and suffers the adverse consequences of poor quality of health care. The obligation of the Government of India is to ensure the highest possible health status to its population and access to quality health care has been recognized by a number of its key policy documents. This paper attempts to study the over view of health care in India.
Key words: Health Care, National Health Policy, Access, Affordability, Equity, Urban Vs Rural-------------
Similar to An analytical study on investors’ awareness and perception towards the hedge funds in gujarat (20)
Tech transfer making it as a risk free approach in pharmaceutical and biotech iniaemedu
Tech transfer is a common methodology for transferring new products or an existing
commercial product to R&D or to another manufacturing site. Transferring product knowledge to the
manufacturing floor is crucial and it is an ongoing approach in the pharmaceutical and biotech
industry. Without adopting this process, no company can manufacture its niche products, let alone
market them. Technology transfer is a complicated, process because it is highly cross functional. Due
to its cross functional dependence, these projects face numerous risks and failure. If anidea cannot be
successfully brought out in the form of a product, there is no customer benefit, or satisfaction.
Moreover, high emphasis is in sustaining manufacturing with highest quality each and every time. It
is vital that tech transfer projects need to be executed flawlessly. To accomplish this goal, risk
management is crucial and project team needs to use the risk management approach seamlessly.
2. International Journal of Advanced Research in Management (IJARM), ISSN 0976 – 6324 (Print),
ISSN 0976 – 6332 (Online), Volume 3, Issue 2, July-December (2012)
KEY WORDS
Healthcare, MCDM (Multi Criteria Decision Making), TOPSIS (Technique for Order
Preference by Similarity to Ideal Solution), Shannon’s Weight
INTRODUCTION
Health care refers to the treatment and prevention of illness which is delivered by
professionals in medicine, dentistry, nursing, pharmacy and allied health. The health care
industry incorporates several sectors that are dedicated to providing services and products
with the objective of improving the health of individuals. This industry consists of
players from public sector (Government) as well as private sector. The delivery of
modern health care depends on an expanding group of trained professionals coming
together as an interdisciplinary team in both the sectors. The rate of growth of the health
care industry in India is moving ahead neck to neck with the software industry of the
country and the health care industry in India is reckoned to be the engine of the economy
in the years to come. Indian population mostly resides in the rural areas (~70%) and it the
public healthcare system that primarily offers healthcare need solutions in those areas.
India in case of health care facilities still lakes the adequate supply, especially in the rural
areas. In fact there is huge gap between demand and supply at all the levels of society.
Still there are many urban areas where one can hardly find any multi specialty hospital.
Researches indicate that there are many constraints in healthcare system in India of which
the absence of health insurance for the unorganized sector and the adverse resource
allocation for the rural sector stand out significantly in case of public healthcare system.
Various state governments and the centre have adopted comprehensive agenda of health
sector reforms and health care management systems to improve the services and also
narrow the demand supply gap. The present study aims to evaluate the healthcare
management status in Indian states.
REVIEW OF LITERATURE
Amlan Majumder (2005) in his work on “Economics of Health Care: A Study of
Health Services in Cooch Behar and Jalpaiguri Districts” draws attention to the
economic side of the health care services. The study applies econometric tools to
investigate facts empirically in the rural and urban areas of Cooch Behar and Jalpaiguri
districts of North Bengal. Demographic factors like age, and family size has been found
to be important determinants of utilisation of care from modern source. Negative
relationship between education and utilisation of a care has been found out. Demand for
public health facilities is also very high among rural mass. So, privatization or plan of
leasing out the primary health care system to private operators is not justified. Utilisation
of health facilities by rural people is associated with low reported quality of care. In his
another work on “Demand for Healthcare in India”, Amlan Majumder (2006)
highlights the need for different types of health care which is changing very rapidly
among Indian population in the phase of transition. The present study tries to investigate
in Indian context whether the demand for public health facilities has decreased among all
12
3. International Journal of Advanced Research in Management (IJARM), ISSN 0976 – 6324 (Print),
ISSN 0976 – 6332 (Online), Volume 3, Issue 2, July-December (2012)
sections of population for the easy availability of private sources of care or whether
public health care is perceived inferior to the private ones. The research highlights that
public health care, in Indian context, is an inferior commodity. Moreover, acceptability of
it is concentrated among some religious or some ethnic minorities who generally occupy
lower stratum in the local hierarchy. Among the factors in the supply side, availability of
drugs played positively towards utilisation of public health facilities.
J.K. Satia and Ramesh Bhat (1999) in their paper “Progress and challenges of health
sector: A balance sheet” highlights that considerable progress has been made in
improving the health status of the population over the last half-century in India. Despite
this impressive progress, many challenges remain. The life expectancy is still 4 years
below world average. So is under five mortality (12 per 1000 per year) higher than global
average. New disease patterns and non-communicable diseases are also emerging as
major challenges. The paper makes an attempt to explain the tardy progress in the health
sector. The programme management by public sector, allocation of public resources to
health sector, centre-state roles and financing of programmes, private sector role,
contribution and role of NGOs, public-private partnerships in health have been analysed.
The paper suggests that key challenge in the next century is the leadership challenge and
reforms in the health sector require several measures. Firstly, it requires policy and
programme emphasis that ensures access to quality primary health care for all. Secondly,
there is a need for inclusive political dialogue and decision making which will involve
community groups representing voices of the poor, local private sector and the
government in operationalizing the new vision of health sector. Thirdly, the social capital
in the sector needs to be built up which will promote trust, cooperation and other norms
that enable health markets to function effectively.
Dileep Mavalankar (1998) in his paper on “Need and Challenges of Management
Education in Primary Health Care System in India” points out that Primary Health
Care (PHC) system in India is very large and consumes large amount of resources. The
paper argues that given the lack of training of doctors in management it is imperative that
the doctors who are put in charge of the PHC system receive reasonable skills and
training in management so that the resources spent on the PHC system can be utilized
well. It is also observed that most management training is very divorced from the day-to-
day realities of the working of the PHC system and the kind of challenges they face. The
paper also argues that there is a need for developing a separate health management cadre
in India who will be trained in public health and health management to take up leadership
role in PHC system in future. Finally the paper argues that substantial efforts will be
needed in preparing doctors for the management posts in the PHC system.
Research studies conducted on Indian healthcare system and its management reveals that
most of the works have been conducted on specific healthcare issues and problems, many
of them restricting to select geographical areas. Though public healthcare and its
13
4. International Journal of Advanced Research in Management (IJARM), ISSN 0976 – 6324 (Print),
ISSN 0976 – 6332 (Online), Volume 3, Issue 2, July-December (2012)
management in Indian States have drawn attention but relative progress made by them
has not been found in the substantial number of literatures that were reviewed. The same
has thus been identified as the gap in the present research study.
OBJECTIVE
To rank and compare the relative position of Indian States basis their healthcare
management status using TOPSIS, a Multi Criteria Decision Making approach.
METHODOLOGY
Evaluating the relative position of Indian states basis their healthcare management status
involves finding out the state ranks against a set of chosen parameters. State ranks can be
evaluated using additive rule that involves ranking each state against individual
parameters considered and then adding them to arrive at the total rank score. The lower
the value of the total rank score, higher is the overall ranking for that state. This method
has a major limitation in considering equal weightage of all parameters since in reality all
parameters cannot have equal importance. This limitation is overcome by incorporating
relative weight of the parameters in the overall rank determination when studied amidst
in a multi criteria decision making environment (MCDM). Within the MCDM approach,
data of input parameters are first classified as positive or negative. A parameter is
considered as positive if increase in its value enhances or improves the healthcare status,
otherwise negative. The absolute values of the parameters are then subjected to statistical
normalization to annul the effect of disparate units followed by weight determination
using Shannon’s method before finally applying the MCDM approach for rank
determination. Within this study, 30 input parameters (indicator variables) have been
chosen in the present study which according to the researcher is the most important ones
that influence the healthcare management status. The 30 indicator variables chosen are
shown in Exhibit 1.
Sl # INDICATOR VARIABLES Sl # INDICATOR VARIABLES
1 Fertility Rate 16 Primary Health Centres (per 1 lac population)
2 Vaccination Coverage (%) 17 Hospital Beds (per 1 lac population)
3 HIV awareness (males%) 18 Rev. Exp. On Health (In Mn per 1 lac pop.)
4 HIV awareness (females%) 19 Cap. Exp. On Health (In Mn per 1 lac pop.)
5 Low BMI Males (%) 20 Health Exp. As a % of Tot. Exp.
6 Low BMI Females (%) 21 Rev. Exp. On Family Welfare (In Mn per 1 lac pop.)
7 Life Expectancy at Birth 22 Exp. On Medical Services (In Mn per 1 lac pop.)
8 Birth Rate (per 1000 population) 23 Exp. On Public Health (In Mn per 1 lac pop.)
9 Infant Mortality Rate (per 1000 live births) 24 Rev. Exp. On Med. Edu, Training & Research (In Mn per 1 lac pop.)
10 Institutional Births 25 Severe Anemia amongst pregnant women (%)
11 Birth Attended by trained Practiciners 26 Severe Anemia amongst adolescent girls (%)
12 Doctors (per 1 lac population) 27 % of Children as under nourished by weight (0-71 mths)
13 Nurses (per 1 lac population) 28 % of Children having iron deficiency - anemic (0-71 mths)
14 Hospitals (per 1 lac population) 29 Female per 1000 Male
15 Dispenseries (per 1 lac population) 30 Maternal Mortality Ratio
Exhibit 1. List of Indicator Variables
14
5. International Journal of Advanced Research in Management (IJARM), ISSN 0976 – 6324 (Print),
ISSN 0976 – 6332 (Online), Volume 3, Issue 2, July-December (2012)
THE MCDM APPROACH
In a MCDM environment, there are a number of alternatives to be assessed on the basis
of their preference order. Many MCDM techniques available among which the technique
for order preference by similarity to ideal solution (TOPSIS) proposed by Yoon (1980),
Hwang and Yoon (1981) is a very effective one. The basic principle in this method is that
the best alternative should have the shortest distance from the ideal alternative.
The MCDM environment: Suppose there are all together K alternatives to be assessed
and the best alternative is to be selected. Let the alternatives be denoted by S1, ………SK.
there are also N criteria identified to assess the alternatives, which are denoted by C1,
….CN. The k-th alternative’s value on the n-th criteria is obtained as xkn, and the same is
written as: Sk = (xk1, ……., xkN), 1,……,K, and Cn = (x1n, ……, xkn), n = 1, ……,N.
The ideal solution: It is feasible to compare each alternative with an “ideal alternative”
to solve the assessment or decision making problem. TOPSIS adopts an intuitive
approach to the construction of the best and worst alternative and calls them the ideal and
the negative-ideal alternatives or solutions. The ideal alternative S+, is formed by taking
all the best values attained on each criterion by some alternatives, and can be denoted by:
S+ = (x+1, ….., x+N) = [min {xk1}, …., min {xkM}, max {xkm + 1},……., max {xkN}].
and the negative-ideal alternative S-, comprises of all the worst criterion values attained
by some alternatives, and is denoted by
S- = (x-1, ….., x-N) = [max {xk1}, …., max {xkM}, min {xkm + 1},……., min {xkN}].
The TOPSIS Procedure: With the above notation and explanation, the TOPSIS
procedure for assessing the ranking can be described as follows:
1. Firstly we normalize the n-th criterion vector Cn into TCn:
TCn = C n / || C n ||= ( x1n / || C n ||,....., xkn / || C n ||) ≡ (t1n ,......,t kn ), n = 1,...., N ,
K
where ||Cn|| = ∑ (x
k =1
kn ) 2 is the Euclidean length or norm of Cn, so the new criterion
vectors have the same unit length and are thus unit free and directly comparable. Under
the new criterion values, the k-th alternative, Sk, and the ideal and negative ideal
solutions S+ and S- , are transformed to TSk, TS+ and TS-, respectively:
TSk = (tk1,…..,tkN) = (xk1/||C1,…., xkN/||C1||), k=1,….,K,
TS+= (t+1,….., t+N) = (x+1/||C1||,…..,x+N /||CN||,
TS- = (t -1,….., t - N) = (x -1/||C1||,…..,x – N /||CN||,
2. Next the distances of Sk and x+ as the weighted Euclidean distance of TSk from
TS+ are defined:
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6. International Journal of Advanced Research in Management (IJARM), ISSN 0976 – 6324 (Print),
ISSN 0976 – 6332 (Online), Volume 3, Issue 2, July-December (2012)
N N
d ( S k , S + ) =|| w • (TS k − TS + ) ||= ∑[Wn (t kn − t +1 ]2 =
n =1
∑[W ( x
n =1
n kn − x+ n / || C n || 2
N
= ∑ [W n ( x kn − min {x jn }) || C n ||] 2 +
j
∑
n = M +1
[Wn ( x kn − max{x jn }) / || C n ||] 2
j
k = 1,…..,K,
where “ • ” is vector product operator and w is an N-dimensional weight vector whose
elements represent the relative importance of the N criteria. Similarly, the distance of Sk
from S- is defined as the weighted Euclidean distance of TSk from TS- and the same is
N N
represented as: d ( S k , S − ) =|| w • (TS k − TS − ) ||= ∑ [W (t
n =1
n kn − t −n ] 2
∑ [W
n =1
n ( x kn − x − n / || C n ||) 2
M N
= ∑[Wn ( xkn − max{x jn }) || Cn ||] 2 +
n =1
j
∑
n = M +1
[Wn ( x kn − min{x jn } / || C n ||] 2 k = 1,……,K,
j
3. Finally the K alternatives are ranked according to the preference order by their
relative closeness to the ideal alternative S+ which for the k-th alternative is
defined as: r(Sk, S+) = d(Sk, S+)/[d(Sk, S+) + d(Sk, S-)], k = 1,…..,K
The assessment criterion of TOPSIS is that the smaller the value of r(Sk, S+) which
ranges between 0 and 1, the more preferred is the alternative Sk.
Choice of weights: A reasonably good approach to obtain internal importance weights is
to use the entropy concept. It is a criterion for the amount of information (or uncertainty)
represented by a discrete probability distribution, p1, …..pk and this measure of
k
information was given by Shannon and Weaver (1947) as E ( p1 ,...., p k ) = −φk ∑ pk1n( pk )
k =1
where φ k=1/1n(K) is a positive constant which guarantees that 0 ≤ E(p1,……,pk) ≤ 1. it
is noted that the larger the E(p1,……,pk) value, the smaller the variations among the pk’s
and that 0 entropy means maximum information and 1 minimum information. For the n-
th criterion vector Cn in an MCDM environment, let Xn = x1n + …+ xKn be the total value
of the criterion. If we view the normalized values pkn = xkn / Xn for k = 1, ….,K as the
“probability distribution” of Cn on the K alternatives, the entropy of Cn may be defined
K K
as: E(Cn) = - ø k ∑ p k 1n( p k ) = φk ∑ ( xkn / X n )1b( xkn / X n ), n = 1,......N , and define the
k =1 k =1
N
weights as wn = (1 − E (C n )) / ∑ (1 − E (C j )), n = 1,...., N .
j =1
FINDINGS & ANALYSIS
The values of 30 indicator variables have been initially plotted for each state as shown
below. To annul the effect of the varying units of indicator variables, Statistical
Normalization was done followed by weight determination using Shannon’s Method. The
distance from Normalized Ideal and Negative Ideal is calculated before finally
calculating the rank of Indian states.
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8. International Journal of Advanced Research in Management (IJARM), ISSN 0976 – 6324 (Print),
ISSN 0976 – 6332 (Online), Volume 3, Issue 2, July-December (2012)
Rev. Exp. Exp. On Exp. On Rev. Exp. Severe Severe % of % of Children
On Family Medical Public On Med. Anemia Anemia Children as having iron Female Maternal
Welfare (In Services (In Health (In Edu, amongst amongst under deficiency - per 1000 Mortality
Mn per 1 lac Mn per 1 Mn per 1 Training & pregnant adolescent nourished anemic (0-71 Male Ratio
pop.) lac pop.) lac pop.) Research women girls (%) by weight (0- mths)
C21 C22 C23 (In Mn per
C24 (%)
C25 C26 71 C27
mths) C28 C29 C30
Positive Positive Positive Positive Negative Negative Negative Negative Positive Negative
ANDHRA PRADESH 3.22 7.94 1.74 0.69 2.1 23.6 42.3 38.7 978 154
ARUNACHAL PRADESH 1.56 28.07 5.07 0.84 7.8 40.3 32.2 42.9 901 480
ASSAM 2.24 5.15 1.08 0.58 0.4 0.2 12.6 23.6 932 312
BIHAR 0.85 1.93 0.54 0.53 2.2 27.6 54.6 46.6 921 371
CHATTISH GARH 0.45 3.94 0.51 2.13 5.1 48.3 47.4 55.5 990 379
DELHI 11.30 18.23 8.23 6.72 1.3 28.7 35.3 48 821 101
GOA 2.13 36.71 3.23 4.29 0 10.8 30 24.9 960 62
GUJRAT 2.20 7.05 1.92 0.83 5.1 39 46 51.7 921 160
HARYANA 1.34 8.25 1.97 2.32 3.3 40.2 35.6 54.1 861 186
HIMACHAL PRADESH 4.68 28.93 4.22 7.31 4 31 36.4 47.7 970 196
JAMMU & K 1.51 17.96 3.68 2.04 2.6 10.1 20.3 27.9 900 196
JHARKHAND 2.39 6.66 0.72 0.09 1.3 24.2 52.2 40.9 941 371
KARNATAKA 2.24 8.83 0.66 1.61 0.9 14.8 44.8 34 964 213
KERALA 2.76 13.30 1.51 2.24 0 2.2 35.8 10.2 1,058 95
MADHYA PRADESH 1.51 8.27 1.97 0.73 3.4 33.2 55.4 50.2 920 335
MAHARASTRA 1.58 5.42 4.28 1.12 1.8 29.4 47.7 50.2 922 130
MANIPUR 2.80 10.44 4.49 1.38 1.2 9.4 34.9 34.9 978 401
MEGHALAYA 2.50 14.07 2.60 0.56 1.5 0.7 15.2 24.1 975 404
MIZORAM 4.54 20.26 4.18 1.15 1.1 21 21.4 30.5 938 398
NAGALAND 4.27 27.96 1.78 0.13 4 21.4 9.7 39.4 909 396
ORISSA 1.81 6.29 1.42 0.71 3.8 27.2 42.8 40.9 972 303
PUNJAB 1.62 15.67 1.54 2.11 2.9 33.9 40 50.2 874 192
RAJASTAN 2.12 9.14 1.04 0.98 3.3 21.9 58.1 39.7 922 388
SIKKIM 7.78 60.30 4.16 0.14 0.8 19.3 30.2 42.7 875 212
TAMIL NADU 2.62 11.10 2.42 1.29 1.9 17.7 38.3 30.6 986 111
TRIPURA 5.01 11.08 1.71 0.47 1 8.5 29.7 17.8 950 407
UTTAR PRADESH 3.32 0.35 0.89 0.39 3.4 28.8 55.3 47.1 898 440
UTTARANCHAL 26.40 1.32 1.04 1.06 3.2 28.6 52.6 36.6 964 517
WEST BENGAL 2.03 9.43 1.51 0.89 3.7 18 44.9 30.7 934 141
Exhibit 4. Indicator Variables
The relative weights of all the chosen indicator variables has been calculated using
Shannon’s Weight determination method and the same is shown in Exhibit 5. No. of
Hospitals, No. of Dispensaries, Capital Expenditure on Health, Revenue Expenditure on
Medical Training, Revenue Expenditure on Family Welfare, Expenditure on Medical
Services, No. of Primary Health Centres, Low BMI of male & females, Anemia amongst
pregnant women have been found to be the 10 most important indicator variables
affecting the healthcare management status of public sector in Indian states.
Shannon's Shannon's
Sl # INDICATOR VARIABLES Sl # INDICATOR VARIABLES
Weight (%) Weight (%)
1 Fertility Rate 0.41 16 Primary Health Centres (per 1 lac population) 4.52
2 Vaccination Coverage (%) 0.76 17 Hospital Beds (per 1 lac population) 3.45
3 HIV awareness (males%) 0.17 18 Rev. Exp. On Health (In Mn per 1 lac pop.) 2.92
4 HIV awareness (females%) 0.59 19 Cap. Exp. On Health (In Mn per 1 lac pop.) 9.10
5 Low BMI Males (%) 4.50 20 Health Exp. As a % of Tot. Exp. 0.42
6 Low BMI Females (%) 3.94 21 Rev. Exp. On Family Welfare (In Mn per 1 lac pop.) 5.56
7 Life Expectancy at Birth 0.02 22 Exp. On Medical Services (In Mn per 1 lac pop.) 4.30
8 Birth Rate (per 1000 population) 1.92 23 Exp. On Public Health (In Mn per 1 lac pop.) 3.00
9 Infant Mortality Rate (per 1000 live births) 2.67 24 Rev. Exp. On Med. Edu, Training & Research (In Mn per 1 lac pop.) 5.82
10 Institutional Births 2.45 25 Severe Anemia amongst pregnant women (%) 3.26
11 Birth Attended by trained Practiciners 2.31 26 Severe Anemia amongst adolescent girls (%) 2.30
12 Doctors (per 1 lac population) 2.47 27 % of Children as under nourished by weight (0-71 mths) 0.87
13 Nurses (per 1 lac population) 2.31 28 % of Children having iron deficiency - anemic (0-71 mths) 0.63
14 Hospitals (per 1 lac population) 13.60 29 Female per 1000 Male 0.02
15 Dispenseries (per 1 lac population) 14.12 30 Maternal Mortality Ratio 1.55
Exhibit 5. Shannon’s Weight of Indicator variables
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9. International Journal of Advanced Research in Management (IJARM), ISSN 0976 – 6324 (Print),
ISSN 0976 – 6332 (Online), Volume 3, Issue 2, July-December (2012)
Rank Table
Relative Closeness TOPSIS
STATES Value RANK
KERALA 0.30098236 1
SIKKIM 0.43986403 2
GUJRAT 0.48134232 3
DELHI 0.48945707 4
ARUNACHAL PRADESH 0.49493230 5
ANDHRA PRADESH 0.52015254 6
TAMIL NADU 0.52299724 7
MAHARASTRA 0.52525553 8
PUNJAB 0.52561855 9
GOA 0.53127624 10
HIMACHAL PRADESH 0.54751923 11
MIZORAM 0.56189787 12
KARNATAKA 0.57160608 13
WEST BENGAL 0.60203498 14
JAMMU & K 0.63580135 15
NAGALAND 0.63741721 16
MANIPUR 0.64319223 17
HARYANA 0.64680915 18
MEGHALAYA 0.66260120 19
MADHYA PRADESH 0.67244550 20
ORISSA 0.68935158 21
TRIPURA 0.69413424 22
ASSAM 0.69870290 23
CHATTISH GARH 0.69935484 24
JHARKHAND 0.73008429 25
UTTARANCHAL 0.73437144 26
BIHAR 0.73981427 27
RAJASTAN 0.74733990 28
UTTAR PRADESH 0.78774375 29
Exhibit 6. Rank of Indian States
CONCLUSION
The ensuing research study reveals that Kerala is the state with the best public healthcare
management status in India followed by Sikkim and Gujarat respectively. This indicates
that in these states, the overall healthcare status is being managed better compared to
other states. Looking at the top 10 developed states in India on public healthcare
management status, it is to be noted that 3 states are from South India, 3 from West India,
2 from East India and 2 from North India. Again looking at the bottom 10 states, it is
noted that 5 are from East India and North East, 2 from Central India, 2 from North India
and 1 from West India. Looking at the Top 10 and Bottom 10 states, the researcher
opines that public healthcare management status is positive and has progressed in states
where the impact of globalization has been high and public sector tends to compete with
the private sector, especially in South & West India.
LIMITATIONS & DIRECTIONS FOR FUTURE RESEARCH
The present work includes 30 indicator variables which could be a limitation in the sense
that there is a scope to increase the same. This research work is based on secondary data
and incorporation of primary data could have led to a more real time analysis. The
research can be extended to other areas on social development like assessing the public
education status and crime status in Indian States.
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10. International Journal of Advanced Research in Management (IJARM), ISSN 0976 – 6324 (Print),
ISSN 0976 – 6332 (Online), Volume 3, Issue 2, July-December (2012)
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