EFFECTIVE UTILIZATION OF HUMAN RESOURCE MANAGEMENT A Comparative Study of Public & Private Hospitals in Sindh With Special Reference to Four Leading Hospitals in Karachi and Hyderabad (1990 — 2000) A Dissertation submitted by Farah Lalani for the degree of Doctor of Philosophy in Public Administration University of Karachi Pakistan (2007)EFFECTIVE UTILIZATION OF HUMAN RESOURCE MANAGEMENT A Comparative Study of Public & Private Hospitals in Sindh With Special Reference to Four Leading Hospitals in Karachi and Hyderabad (1990 — 2000) A Dissertation submitted to Board of Advance Studies & Research University of Karachi by Farah Lalani in the Supervision of Prof. Dr. Muhammad Abuzar Wajidi Department of Public Administration University of Karachi for the degree of Doctor of Philosophy in Public Administration University of Karachi, Pakistan (2007)Certificate This is to certify that this dissertation on the topic ‘Effective Utilization of Human Resource Management : A Comparative Study of Public & Private Hospital of Sindh with special reference to Four Leading Hospitals in Karachi and Hyderabad’ is an outcome of personal efforts of Mrs. Farah Lalani d/o Badruddin Lalani. She has submitted the dissertation in Panel det Zari fulfillment of the requirement of Ph.D. in social sciences./It is her original research and it has not been submitted for any other degree.| dedicate this dissertation to my kind and affectionate father Badruddin LalaniAcknowledgements I wish to express profound gratitude and deep appreciation to my Research Supervisor, Dr. M. Abuzar Wajidi, Professor & Chairman, Department of Public Administration and former Dean, Faculty of Social Sciences and Business Administration, University of Karachi for his consistent, gracious and untiring guidance for completion of this dissertation. I am highly indebted to him for his enduring review, expert advice as well as necessary corrections in this research work. His affectionate support has been of great significance in this research effort. I would also thank my colleagues Dr. Siraj Jamal Siddiqui, Prof. Yousuf Pardesi, Dr. Zareen Abbasi, Dr. M. Bukhsh Burdi and Mr. Masih-uz-Zaman for their kind and friendly cooperation in the process of collection of necessary data and related material. Besides, those who deserve my gratitude include Ms. Safia Awan, Ms. Yasmeen Parpio and Mr. Liaquat Khoja (Research Cell) and Mr. Murad Ali Veerji (HR Director) of Aga Khan University Hospital Karachi, Dr. Hamid Khan (M.S.), Dr. Veeroomal (A.M.S.) and Mr. Rizvi (Statistical Officer) of Civil Hospital Karachi, Dr, Akbar Lakhani of Bhittai Hospital, Hyderabad and Mr. Aftab (HR Department) of Rajputana Hospital, Hyderabad. I must also mention here very kind cooperation of Dr. Wagar Kazmi, Director, Research Centre, Dow Medical University. I appreciate cooperation of management of the University of Karachi main library, Aga Khan University Research library, Defence library, libraries of SBP, IBA, CBM, Sindh University and Sindhiology, AIOU (Karachi - Mr. Pervez S. Khoja). My special thanks are also due to those whose mention I happen to forget here. I find it really hard to express my gratitude to my husband Muhammad Ali Karimani who has accompanied me in my frequent travels during the past few years. He has always been a source of inspiration, and without his help, it was not possible for me to complete this research work. My very special thanks go to my daughter Aleeza and son Alishan who have, most courageously and without complaint, passed numerous hours without me cn account of absence from home in pursuit of the research work, Last, but not the least, how can I forget my parents and in-laws without whose support I would have not been able to accomplish this research work.TABLE OF CONTENTS S.#. | Chapter | Title Page # 4 List of Abbreviations IV-VIL 2 Abstract VUN-IX 3/0 INTRODUCTION 4-51 4 04 ‘Study Perspective 04 5 02 Value of Study 17 6 03 Elucidation of the Problem 25 7 0.4 Aims of the Study 27 8 05 Hypothesis 28 9 06 Area of Study 29 10 07 Overview of HRM ~ 40 11 08 ‘Organization of Study 48 12 /A LITERATURE ANALYSIS 50-78 13 14 Detailed Perspective 50 14 42 impact Of Health Education 55 15 13 HR Employment in Developing Countries 56 46 1.4 Readiness for Disasters 59 47 15 The Horizon Human Resource Management 61 18 16 impact ‘of Utilization Management on Healthcare Quality & #3 19 17 Sustainability & Quality of Healthcare 66 20 18 Impact of NHS Reforms on HR Function 68 21 49 Role of System Health Area Resource Planning (SHARP) 69 22 4.40 Focused Psychiatric Review 7” 23 4 Utilization Management & Curtailment Of Costs 72 24 412 Healthcare Supplies’ Demand in Pakistan 764 S#. | Chapter | Title Page # 25 12 Research Technique 79-88 26 24 Rationale of Study 19 27 22 The Covert Advantages of General Open Questions 80 28 23 Challenging Character of General Open Questions 82 29 24 Responses to General Open Questions 83 30 25 importance of Design in Qualitative Data Generation ad 31 26 ‘Target Population 86 2 27 Sampling Design 87 3 13 Working of HR Management 89-129 34 34 Planning for Human Resonrce 89 35 32 eg Enoroyess Potential through Training & 7 36 3.3 Hospital Management in Communication Perspective 106 37 34 Inspiration of Employees 122 | 38 a4 Skillful Application of Human Resource | 439.495 Management in Hospitals 39 4A Human Resource Planning 133 40 4.2 HR Information System in Hospitals. 139 aL 43 Condition of HR Management at Hospitals in Pakistan He 42 44 Human Resource Planning in Hospitals 148 43 45 Planning for Healthcare Provision 151 44 46 Training & Development in Hospitals 158 4s 47 Health, Safety, Compensation & Benefits for the Employees in 10 Public & Private Hospitals 46 48 Provision of Services and other Miscellaneous Benefits for | Employees 47 49 Employees’ Healthcare 174 48 4.10 Escatating Collaboration between Public and Private Sectors 7 49 an Work Environment, Safety, Welfare and Employees’ Health 178 Facilities in HospitatsS.#. | Chapter | Title Page # 50-15 Human Resource Management In The Context! 196-234 _ Of Hospital Environment In Pakistan 31 6A Policy Formulation, Planning and Management 196 52 5.2 investment for HR Development 198 53 5.3 Magnitude of Training & Development Programs in Pakistan 206 34 54 Enhancing Capability of Hospital Employees 206 55 55 Workers” Skill Development : A True Source Of National |" Wealth 56 |6 RESULTS. 235-287 57 64 Data Analysis and Interpretation 235, 38 62 Data Management 235 59 63 Descriptive Statistics 235 60 64 ‘Questionnaire — Section t 236 61 65 ‘Questionnaire — Section 2 248 a 66 ‘Questionnaire — Section 3 258 3 67 sate cameaaon » Public & “Private Hospitals [~ os ca sae eomparon 3" Public & Private Hospitals | 65 CONCLUSION 288-297 66 A Functions of AKUH, HR Department 290 67 B Statistical Results and Findings 291 68 c Labour Affairs 295 69 D Measures Proposed 297 10 i References 298-310 7” F | Bibliography 311318 nm i Appendices 319-321 InLIST OF ABBREVIATIONS AIDS: Acquired Immune Deficiency Syndrome AKHS: Aga Khan Health Services AKDNA: Aga Khan Development Network AKF: Aga Khan Foundation AKU: Aga Khan University ARI: Acute Respiratory Infections BDN: Basic Development Needs BHU: Basic Health Units BPR: Business Process Reengineering CCU: Coronary Care Unit cG: Coast Guard CHC: Community Health Centers IMD: Centre for International Migration and Development CME: Continuing Medical Education COME: Community-Oriented Medical Education CPSP: College of Physicians and Surgeons, Pakistan DHG: District Health Government DOTS: Directly Observed Treatment Short Course EIQ: Emotional Intelligence Quotient EPI: Expanded Program on ImmunizationFH2: FPR: GDI: GDP: GEM: GNP: HIv: HMO: HHRP: HRM: HRH: HRD: HRP: HRIS; IBA: ICU: IEF: IT: ITN: IOM: JCAHO: Organizations LAICO: Second Family Health Project Focused Psychiatric Review Gender - Related Development Index Gross Domestic Product Gender Empowerment Measurement Gross National Product Human Immune Deficiency Virus Health Medical Officer Health Human Resource Planning Human Resource Management Human Resources for Health Human Resource Development Human Resource Planning Human Resource Information System Institute of Business Administration Intensive Care Unit International Eye Foundation Information Technology Insecticide Treated Nets Institute of Medicine Joint Commission on Accreditation of Healthcare Lions Aravind Institute of Community OphthalmologyLHW; MoST: MoH: NWFP: NCD: NITM: NGO: NHS: OD: OSHA: OSHA: PIS: PMDC: PNS: PMRC: PIM: PPO: PHC: RIHS: RHC: R&D: Swo: SPSS: Lady Health Workers. Ministry of Science and Technology Ministry of Health North Western Frontier Province Non-Communicable Diseases National Institute of Traditional Medicine Non — Government Organization National Health Services Organizational Development Occupational Safety and Heaith Act Occupational Safety and Health Administration Personnel Information System Pakistan Medical and Dental Council Pakistan Nursing Council Pakistan Medical Research Centre Pakistan Institute of Management Preferred Provider Organizations Primary Health Centers Royal Institute of Health Sciences. Rural Health Centers Research and Development Social Welfare Department Software Program for Social Sciences viSHARP: TVA: TCHA: TB: TQM: USA: UK: UR: UM: VRS: WHO: System for Health Area Resource Planning Tennessee Valley Authority The Children's Hospital of Alabama Tuberculosis Total Quality Management United States of America United Kingdom Utilization Review Utilization Management Voluntary Retirement Scheme World Health Organization vilABSTRACT The Human Resource Management (HRM) policies and practices of two state- owned and two private hospitals of Karachi and Hyderabad have been analytically studied to determine the range of utilization of HRM and the level of attainment of organizational objectives. The object is to determine as to how modern HRM policies and practices can help in qualitative as well as qualitative improvement of the range, standard, performance and reach of services and product of private and public hospitals of Pakistan, which would lead to improvement and development of the healthcare sector as a whole, A two tier research methodology has been used. The first tier comprises collection of factual data from print media and from interviewing and questioning, through questionnaires, randomly selected upper, middle and tower management and technical personnel. The second tier comprises collection of information from books and journals of management. The data thus collected was statistically analyzed in the following steps: classification, tabulation and diagrammatic and graphical presentation. Central tendency has been measured and followed because averages do not reflect the exact state of affairs. Chi-test and F-test as well as SPSS by means of computer have been used to draw conclusions. vuwe wigte LvE etal lp eu Bil Madu tLeeyey WUitunbllle giP (Ae Ball dif Cult tralfitenL be SLL GIL JPL Kt Susbublatecstile Ap wil fos BIHE Se uti K Tod CEP dtnele J ebects YH Pe Odie Ue Mibenile th Ltaledideye tule Eee aire USA REL EL Guin fr Sere UM Ste Kern Meta beth oe phen ES Koe ipa wL Lx fur Wrshe ey re LOS SLE MNP EL Ee LE Ei Swill av wiLieodhigyl BYE F random AE ge iltlel oe Epes Me Minivan UR PPVE PEW he WL Patella oe werner Syrldr SGlaI SI sug Shige ene WuliablelbalS ce VWI sIL tL Ailes Ss al FeTest, ChiTeste ou Sade DSIRE bebe utie Sbeur ~olfulimle SPSSINTRODUCTION 0.1 STUDY PERSPECTIVE An attempt has been made in this research study to search the concept of effective utilization of Human Resource Management with reference to some main public and private hospitals of Karachi and Hyderabad. The intention in this work is to bring to light the real working of HRM in the said hospitals of the southern province of Pakistan where establishment of HRM in real sense is still awaited, The relatively recent perception of human resource management is reflective of modern attitude to what is termed as administration, and it stresses the participation of human beings in an organization, whatever be its nature and function. Advances in sciences have brought drastic changes in human society since the industrial revolution, having great impact, besides industry, on agriculture, business and services. The services include also the healthcare section. So far, human resources have been described and treated as tools in the expanded business and industrial machines. It used to be the production and profit being assigned on priority before the employer, while far less thought was. given to human rights and demands. Resultantly, there was a considerable increase in production, but only at the cost of emergence of social, economic, political and human problems. It was later realized seriously, that human factor had a unique value despite office computerization and availability of factoriesrobots. In all ventures, be those small, local, national or international, man acquires the key place. The old ‘administration’, consequently brought into existence the HRM which in strategic and tactical meanings became autonomous. Several relevant publications are sufficient evidence to this effect (Bartlett and Ghoshal 1998, Fatehi 1996, Deresky 1994, Hodgett and Luthans 1991). The publications concern organizational and international aspects of HRM. It concludes that to make a venture successful, satisfaction of personnel must be ensured. Human Resource Management is outcome of about a century and a quarter long experience of old administrative techniques. Factors like advancement in science and technology, social welfare movement, the two World Wars, legislative measures in the USA and Europe, collectively asserted that development of business and industry depended on the trained and nurtured human resources. We further extend our study in the light of the concept given by some prominent writers on Human Resource Management. George T1997: The HRM is “a series of integrated decisions that form the employment relationship, their quality contributes to the ability of the organization and the employees to achieve their objective.” De Cenzo Robbins, 1996: In a more specific vein, the HRM is an approach consisting of four functions, viz. staffing, training, development motivation and maintenance.Torrington and Hall (1991): The HRM is “a series of activities which first enables working people and their employing organizations to agree about the objectives and nature of their working relationship and, secondly, ensures that the agreement is fulfilled.” Davis (1990). “Better people for better results” is how he has rather succinctly put it, the word “better” being used here in its widest sense. Edwin B and Flippo (1984): The HRM is the planning, organization, directing and controlling the procurement, development, compensation, integration, maintenance of human resources to the end that objectives organizational, individual and social are achieved. The function of HRM is to bring forth leadership and expertise in recruitment, training, motivation, management and development of employees for the sake of bringing out their optimum capabilities (Nadler & Wiggs, 1986). Social conditions, according to Lansbury (1984) are rapidly changing and showing new problems and this is a real challenge for the management. Shari (1994) observes that “the only thing that will uphold the competitive advantage tomorrow is the caliber of the people in its organization today”. These days, in business organizations, human resource is assigned great value as it designs and moulds destiny of business. For this reason, HRM is considered imperative for developing humancapital and managing the workforce, thereby winning optimum targets and objectives of an organization. Management of human resource encircles all activities that an enterprise undertakes to ascertain effective consumption of employees for achieving objectives at individual, team and organization levels. Whether local, national or international, public or private markets, human resource management is a key concern (Milkovich 1988), HR management keeps itself updated with the novel technology, new competitors, business re-structuring and fegal & societal aspects for an effective competition (Schuler 1998), It concerns managing HR from professional point of view, and profitable deployment of HR management is ascertained when employees are efficiently and effectively stimulated (Baig 1997). The purpose of HRM is also to ensure that employees obtain psychological and material rewards from their work through their ability (Graham 1998). ‘Human resource management is used to achieve organizational and individual goals by effectively utilizing peopie’ (VSP Rao, 2001). The strategic role of human resource management emphasizes the value of people as resources and that they should be considered as investment in an organization’ (Mathis H and Jackson 1999). HRM is linked vertically with strategic planning, and horizontally with other human resource functions e.g. recruitment and selection, development andtraining, benefits and labor relations and also evaluation of human resource planning, to be able to cope with the fast varying environmental circumstances. Presumably, for an effective utilization of HR, training and development is not ‘only vital but also an essential part of its HR planning since training meets immediate requirements while development takes care of long-term targets and of the changing conditions. Both training and development are a continuous process. Besides, a sound HRM anticipates and plans turnover including retirements. Keeping inventories of employees’ skills is very important. Training and recruitment should be mission-oriented. Developing strategic plans must not overlook social and cultural changes, regulations, technological advancements and upcoming HR needs. An organization's capital can be valued in terms of its investments, its ownership, revenues, assets and performances. Collective efforts of committed people make the organization productive for mutual benefits. Public and private hospitals recruit people for alike objectives. However, as the private organizations generally get the better employees than the public sector does, things happen to be different. Hospitals' HR i.e. doctors, nurses, midwives, pharmacists, dentists, para-medi personnel, supervisors, managers and technicians etc., directly or indirectly, provide healthcare. The employees perform professional duties, primarily to improve people’s health (WHO 2006). Another WHO report (2000) values HR as "the most important of the health system's inputs”.Training of health workers consumes substantial time and investment. Years of investment are lost in case a health worker quits one hospital to join elsewhere. Making up scarcity of hospital personnel is not that simple. For any hospital, it requires a lot of investment to train and sustain an individual. Individual workers functioning together contribute different skills, performing various functions --- all forming into healthcare. Number of healthcare workers and their skill contribution is determined by various factors like regulatory environment, resource availability, customs and culture. These workers are backbone of any healthcare system. For offering appropriate services to citizens, planners and policy-makers ought to be well informed so as to ascertain a regular supply of healthcare workers because improved productive efficiency of the latter can significantly reduce the required number of health workers. There are, however, countries where such performance and productivity is on a very low side. According to Bryant M (1995), only about 25% of the health workers were used for production of health services, while as reported by Filmer D (2002), in India, health workers were found regularly absent from their assigned positions. Several organizational and management factors determine the commitment of the heaith staff who are motivated by a sense of responsibility and fiscal benefits. They are associated in an environment of team work and mutual reliance. Lack of dedication is experienced in staff members towards their professional assignments. Due to some procedural deficiencies, staff motivation gets affectedand they do not observe the required duty hours, and patient-provider dialogue becomes deficient. This trend introduces acceptance of informal payments to cope with undesirable working conditions (Ensor T 2004, Van Lerberghe W 2002, McPake B, 2000). Miller Franco L (2004) reports that staff performance goes unchecked in several countries where assessment practice and quality standards are not satisfactory. Moreover, care is no taken to ensure transparency in procedures and performance audits. Such state of affairs demands effective management systems of health workers to attain productivity. Improved work environment can certainly uplift health workers’ output. As for rural areas of Pakistan, Zaidi A (1986) observes that motivation to work is linked with availability of suitable health facilities. It has been reported (Bloor K 2003, WHO 2002) that even countries such as Germany, England and Australia have a fractional approach to planning the health-sector workforce and that various categories of health professions are overlooked. No doubt social, political and legal pressures on organizations have unwanted effects on HRM practices and these pressures also have impact on the safety and health of their employees. In response to these pressures, the organizations design programs for accident prevention and for ensuring physical and mental health of their employees e.g. employee assistance programs. HRM is also influenced by global economy which has stimulated many firms enter foreign markets for linkage to business markets. So, a number of globally-orientedmanagers need to be fostered who would possess knowledge of foreign cultures and languages and of foreign markets. Healthcare has become world’s largest industrial commodity. In the past, philanthropists have helped out hospital budgets through generous donations. In present times, hospitals are earning institutions that always look towards maximizing the use of resources so as to support people in need. Healthcare industry has acquired quite an escalation on account of its increasing demand and entrepreneuriai tendency. Therefore, hospital management has become a specialized job as it involves important aspects like marketing, promotion, retention of staff'and quality enhancement. Now a hospital administrator is not necessarily a medical professional. An effective management and human resource together can turn a health organization into a real success (Zarar R. Zubair, Director Training, PIM 1992). In the new millennium, the role of HRM is further changing. An HR manager should be able to cope with the changing competitive trends and business environment. His role has transformed into that of an active business partner with the management. The new trend can ensure success continuity and escalating the organization for a future highly competitive world. An HR management is successful when, besides administrative skills, it can influence people’s minds and counsel line management, Such changes are part and parcel of the HR strategy, its organizational policy and its profile. Privatization, economic liberalization, curtailment of trade barriers and loosening of state control in developing counties are signs of business environment.Advancements in information technotogy and communications have brought about a worldwide upheaval letting geographic location become no disadvantage in accessing capital or technology. National economies, according to Parvez Rahim (1998), in the form of globalization, create challenges as well as opportunities. Human resource strategies laced with high impact corporate initiatives are of great value for a company. In the present century, such strategies are assigning immense worth to human resource that raises company's human capital that , in turn, creates competitive advantages for the enterprise. Human resources are ever changing. According to John Wiley & sons (1996) it is highly challenging to revolutionize the HR organization. Primary factor is the strategy composed of both corporate and human resource components. Role of the health sector in HRM interventions is particularly sophisticated and outcomes can be directly attributed to these interventions. Some of the characteristics, that make the health sector unique in terms of effective HRM application in an organization, have been highlighted by Buchan (2004) as follows: (a) The healthcare workforce, usually large, comprises diversified occupations (doctors, nurses, dentists etc.). Strong professional associations, tending to influence the organization of the work environment, and the method used for management of the staff, represent these occupations. In presence of occupational barriers and status distinctions, it is hard to create a culture of shared learning and(b) {c) {d) (e) teamwork in an organization. Sound relations and constant communication between various cadres of health workers result in better output in a developed country’s hospitals (Scott, Mannion et al 2003). Since healthcare sector is a major recipient of public and/or private funding, in most countries, health delivery is a politicized process with significant government control. As a usual trend, physicians and nurses are more loyal to their professions and their patients than to their organization and employer. Due to the fact that HRM is a system-based approach to uplift organizational output, the said divided loyalties affect the impact of HRM interventions. Standard and entry requirements, that sometimes the profession determines, control access to pre-service education and on-job training. This also affects the kind and quality of HRM changes introducible to employees who feel that their work remains under pressure of rules and procedures. HRM, particularly in the public health sector, is treated in divided way especially in developing states, for example, most of the health ministries in sub Saharan Africa have limited or no authority in key personnei areas such as recruitment and promotion, setting salary levels, determining and enacting disciplinary procedures and establishing sound career avenues. The weak and unstable key HRMfunctions exist within the government structure. For instance, in Kenya, the Public Service Commission works closely with the Directorate of Personnel Management in the office of the President to define jobs for all positions and describe qualifications and salaries. The ministry of finance controls and determines the overall budget. With the increasing competition and globalization of management, HR factor in the attainment of organizational objectives has also developed over the years. In factories and hospitals now-a-days, workforce is perceived most important. The academicians and the professional managers are conscious to relate management review as the process of managing the people. Much attention is assigned to such work environment that motivates and retains people and gets the optimum output. As it appears, this approach is fine, though perfection in the HRM is a complicated and tricky job. Sometimes, employees find it difficult to adopt new ideas. This situation puts most organizations in deep trouble. In fact, HR management plays an important role in the fast changing management scenario (R.C. Goyal 2002). As the fast expanding field of hospital service, scientific advancements in surgery and medicine and the growing competition and globalization of its trained ad qualified personnel make the science and art of hospital administration a more complex job, the value of human resource in accomplishment of hospital objectives is realized in a fuller sense. Hospital has acquired.a vital place in the social life of people because it providesessential services dealing with safety of Jife. Apart from care of the injured and the sick, a hospital has several medicinal and administrative responsibilities. To deal with these responsibilities successfully, the hospital must be scientifically and professionally administered for effective and efficient performance of its functions. This requires each hospital employee to be thoroughly trained and sufficiently prepared for treatment of the injured and the sick. He should be duly and suitably rewarded for this. Today, there is greater demand of efficient hospitals’ administration and their HR development than ever before. This is so, because trade unions, educational problems and financial professionals are constantly confronted with the administrators. Also, the HR managers are asking for their valuable time and judicious consideration. Well-trained, competent administrators and HR managers are in great demand. The same is true for other hospital personnel as well. There is scarcity of dedicated and cammitted personnel in hospitals although training of doctors, nurses, dietician, medical-social workers, medical record technicians, _ physiotherapists, pharmacists, radiographers, laboratory technicians and lady health visitors is an achievement and remarkable progress. Different strategies are adopted by different hospitals. As R C Goyal describes, in order to turn their work places into ideal ones, these hospitals may motivate, retain and get the best out of their personnel. Selection and recruitment of right persons is one of the most important obligations of the HR department of a hospital. For a sympathetic attitude andattention of healthcare staff toward patients and visitors, hospitals rely on their employees and their commitments. So, much responsibility rests with the individuals recruiting and selecting personnel for the hospitals. In-charge of HR department must accurately communicate the hospital policy and aims to the job candidates. An institution's greatest resource is its employees although building, machines, money and physical facilities are also necessary they are always secondary. For a HR department, recruitment, selection and induction are complex and continuing functions. Every organization should, therefore, evolve attractive staffing policies as it is the quality of its human resources on which depends its success. A Human Resource Manager should not ever be in a hurry to hire personnel. On one hand they may be expensive in terms of salaries, and on the other they may be a risk for the patients. Recently, the operations of an ultramodern operation theatre of a renowned hospital came to a standstill as the Human Resource Manger and the management of that hospital relied on the under-paid and under- skilled workforce to run it. The investment in a scientific and professional employment program always pays good dividends in the long run. The cost of recruitment, selection and induction can be minimized, turnover can be appreciably reduced and the hospital can depend upon competent employees. In some cases hospital authorities spend considerable amount of time and effort to choose the rignt location, architecture, equipment, etc., but they fail to viewemployment as a strategic function, which leads to substantial harm because they happen to overlook that recruitment is a strategic function, which generates an impact across all departments, makes or mars patient satisfaction and has a significant impact on the services that the hospital renders. So, one should avoid making hasty recruitments so that unsuitable or mediocre candidates may be kept away from the hospital. Such employees require more attention of the management in overcoming certain problems like their lack of competency, indiscipline, reduced service, mal reputation and other problems to the hospital authorities. Some hospitals not only recruit right persons but also look after them properly so that the latter may give their best services to the patients and to the hospital. Old favorites such as profit, production sales cost controls are taking the back seat and the focus these days is on soft areas — service values and quality of personnel (R. C, Goyal: 2002). Human resource management functions have, of course, always been carried out in every organization in one way or the other, but these functions may not have been performed efficiently or economically. Importance of hospital human resource management must be recognized, the workload of the general administrator may be reduced and better service rendered to the patients through the establishment of a separate human resource department. There are certain symptoms that are indicative of the need for establishing an HR department, for example, poor selection of employees, irrational pay scales, high staff turnover, increase in absenteeism, employee grievances, differences in total hours of works required for similar tasks in different departments, fack of adequaterecords employee, and absence of human resource policies. An alert administrator does not find it difficult to recognize these symptoms. When the administrator of a hospital decides to have human resource departments, he also has to decide whether to recruit a full-time or part-time human resource manager. As a common practice, a hospital with 200 or more employees can use the services of a full-time human resource manager while a hospital employing lesser employees may also use the services of a full-time HR manager. However, in such a case the HR manager should be assigned some additional responsibilities like purchase, public relations, transport management, fegal work. In hospitals with more than 300 employees, the HR manager ce should be assisted. In fact, with increase in the size of the hospital, there will be specialization within the HR department. The exact strength of the staff of the human resource department depends upon the function assigned, the degree to which the hospital administration wishes those functions to be implemented and availability of funds for implementation of these functions, One formula used as a guide to determine the required size of the staff is that at each interval of 200 employees, the staff of the HR department should be increased by another member. Establishing the HR department according to this formula makes it possible for it to assume all the major functions considered to be a part of HRM. An HR manager in a hospital basically deals with staff, and guides, counsels and serves the line officers who include physicians, surgeons, radiologists, pathologists, anesthetists, matrons etc. have direct responsibility foraccomplishing the major objectives of the hospitals with the help of staff officers who comprise the finance officers accounts officer, human resource manager etc. The human resource managers job is to assist the physician in the recruitment and selection of his subordinate doctors. He is thus a staff officer. The HR manager and his department assist and generally act in an advisory capacity with regard to other departments. The line officers are often unhappy about this because most of them feel that a person who does not belong to their department should not interfere in their departmental affairs. Therefore, the HR manager has to’ develop a patient attitude to avoid conflicts and to win the confidence of the line officers. He or she should play the role of a social worker (i.e. the role of an enabler) instead of indulging in spoon-feeding while dealing with the officers. ‘Hospital’ is a simple and familiar word but it is not always understood in its entirety and complexity. It cares for patients of all ages and backgrounds, some appreciative and some disgruntled, some happy and others sad. It houses various people inter-acting with each other such as cooks and doctors, cleaners and nurses, technician and therapists, ambulance drivers and administrators of different kinds, plumbers and clerks. It experiences hope and despair, sympathy and indifference, love and hate, It is a place always open to all sort of people. It has complex equipment and supplies of a wide variety. It imposes policies and tules, has budgets and debts, experiments and learns and plans for the future William, 1990).According to Armstrong (1987) functions of the Human resource management are critically important and cardinal for the efficient and effective operation of a hospital as an organization. Despite this fact, the recurring variations taking place in the healthcare industry, which affects health services, have also substantially influenced the HRM function. They should, therefore, be regarded not as variable costs but as valued assets in which to invest, thus adding to their inherent value. 0.2 VALUE OF STUDY Efforts to achieve objectives for developing human resources for health continued, in the areas of policy formulation and improvement of management in anticipation of the challenges to health, at the start of new millennium. A consultation held in February 1999 on human resources for health in the 21st century reviewed the situation of global and regional human resources for health and discussed important trends and issues coming up in the new cantury. Fer development of health in the Eastern Mediterranean Region, the consultation suggested policies, strategic directions and recommendations for human resources. Five months later, in July 1999, the results and recommendations of this consultation were presented at the Regional Conference on Health-for-All Policy and Health Sector Reform in the 21st Century. One of the recommendations of the consultation was the establishment of an expert pane! on HR for health and a proposal has been completed in this regard.The importance and dynamic nature of policy formulation as well as the importance of preparation and revision of national plans for human resources for health within the context of national health programs are not recognized by the countries of the region, in order to contribute to the goal of health for all, Accordingly, Bahrain, Egypt, islamic Republic of Iran, Oman, Pakistan and Saudi Arabia have prepared or revised their master plans for human resources for health. In the Syrian Arab Republic a team has been assigned to develop human resources policy and strategy and to determine needs at the Ministry of Health in the next 20 years. Consultants visited Lebanon and Sudan to assist national authorities in preparing the national policy and plans for HR for health. Partnership, a major aspect of policy formulation, between the main stakeholders remained a focus of attention. Two documents have been prepared for this partnership including establishing partnership with the Ministry of Health and with the community, as well as guidelines for conducting a national workshop on partnership. Based on feedback from the countries of the region, the two documents will be field-tested and the final version revised. All the countries of the region were distributed the report of the Symposium on Improving Continuing Education for Health Personnel in the Eastern Mediterranean Region, containing recommendations and guidelines for the development of nationa! programs of continuing education for health personnel. Meanwhile consultants to the Islamic Republic of Iran, Libyan Arab Jamahiriya, Morocco, Oman, Saudi Arabia and Sudan undertook situation analysis,preparation of plans for continuing education and evaluation of continuing medical education and national training activities. Morocco has already undertaken development of a program of HRM at regional level, which focuses at ‘the training of regional managers for appropriate skills and tools. With special attention on HR management, the Ministry of Health of Morocco is working towards decentralization of the health system in several fields. All bodies involved have validated the national continuing education strategy for health professionals. The establishment of a coordination committee is planned for the purpose. From Yemen, three fellows visited Bahrain and the Islamic Republic of Iran to share their experience in continuing education, As many as 123 fellowships were awarded in HR for health to build up national capacity in the Region. (Regional Annual Report, 1999). The Regional Office reviewed the continuing education for health personnel in Iran. The parliament approved the policy document and a national and provincial structure for continuing education has been established. Continuing education for health personnel programs has been well implemented and it assesses the quality and impact of continuing education for health personnel in promotion of healthcare, In collaboration with the Regional Office, the National Center for Continuing Education for Health Personnel in the Ministry of Health and Medical Education and Isfahan University of Medical Sciences and Health Services, hasestablished an exemplary teaching/learning facility for continuing education (Regional Annual Report, 1999). Jordan is in the process of establishing an Academy of Health Sciences. The Islamic Republic of Iran and Jordan publish monthly journals and newsletters for continuing education for health personnel. Through direct financial cooperation in collaboration with WHO, Egypt has conducted numerous continuing education courses besides national training activities in all health and human resources in the subjects of health. As per Region Annual Report 1999, the Regional Office continued to support postgraduate courses in Sudan and the Republic of Yemen as well as courses in Jordan and the Syrian Arab Republic. Some sixty people, in collaboration with the Suez Canal University, Ain Shams University and the High Institute of Public Health, Alexandria, participated in the training course in management and development while the number of participant students participating in the masters degree program in public health was 24. A hospital, besides the treatment of human ailments and the promotion of general health of the community, has to take care of the welfare of its personnel because every individual, whether he be a skilled surgeon or an unskilled sweeper, engaged in the singular service of promoting the mission of the hospital, is a vital link in its overall chain. The lower staff should never be bracketed as ‘labour’ in trade union terms. Rather, they should be considered essential hospital functionaries. 20Employees should not be viewed as a commodity. Intervention by the state and the overall idea of a welfare state must make the alert manager recognize the value of human relations and his actions must result in social justice, Workers today are more progressive in their outlook and better organized through trade unions. These factors highlight the need to motivate them in the right direction and to develop happier management-employee relations. The human resource manager must be familiar with the relevant findings of the behavioral sciences. Apart from being conversant with the labour laws of the land, he should also be aware of the contributions made towards it by psychology, business management and sociology. In advanced countries like the USA, Canada, the UK, Germany and Japan, governing boards and administrators of industries as well as of hospitals became long ago conscious of the importance of HRM. However, in developing countries, for example, India, the governing boards and administrators in industries alone have realized its importance. It is now time for these bodies of government and voluntary hospitals to adopt HR management as a part of hospital administration for the following reasons: 1. The growing complexity of the various problems in dealing with employee relations demands a specially trained individual who can give these problems continued attention so that desirable working relationships may be established among all employees of the hospital. 2. The expanding size of hospitals has made impossible the continuance of the employee-employer relationship in which both of them worked side by side, 2knew each other as individuals and understood mutual problems. In small hospitals such relationship is still possible. In large hospital, it is the supervisors who function as links between administration and employees. But in most cases, these supervisors are only interested in getting the work done. So they themselves need training in the human relationship involved in their own work situation. . Previously, The United States of America, Australia, Canada and Germany have literally ‘snatched away’ trained personnel and scientists from the Third World. India is facing the problem of brain drain. For several years, the Arab countries too have started attracting them by offering attractive salaries, which no home employer can afford to pay. Proper HR management can result in enhanced job satisfaction, making it more attractive to stay and work in home country. . Inadequacy of trained personnel is one of the problems confronting health- care institutions. This deficiency and the dangers it poses to the expanding healthcare needs, have been repeatedly stressed by the healthcare leaders. This serious problem has deteriorated the hospital services in India. Like the rising production costs in industry, the increasing costs of hospital care have a similar implication for hospitals. Unit costs of operation must be re-examined to ensure optimum performance by each employee. The worker must be provided proper guidance, training and necessary tools for satisfactory work. His working conditions must be congenial. All this ispossible through skillful selection, training planning work loads, motivation and supervision. 6. Appropriate selection, training and control play vital roles in bringing about economy and efficiency in the execution of a hospital. These aspects require special skills, time and effort which is usually hard to expect from a person charged with the general administration work of the hospital. 7. During the last twenty five years, numerous labour legislations, imposing legal restrictions on employment in hospitals, have been passed. Therefore it is obvious that a human resource manager well versed in the labour laws can be of immense service. 8. it is generally believed that hospital employees are not usually unionized because they are working. In most of the cases, with missionaries and religious bodies, they too become dedicated and do not charter their demands like the industries employees do through their union leaders. However, this is not entirely true as most of the hospitals today have unions to fight against low salary scales and allowances, few fringe benefits and poor working conditions, prevailing in hospitals in comparison with those in industries. The above stated factors acquire even more significance when it is realized that hospital personnel are not dealing with machines and tools, but with human beings with whom these employees are brought in contact with, belong to four groups: management, medical staff, patients and visitors. Their dealings with 23each of these four exhibits involve a wide range of interpersonal relationships. For a safe and sound functioning of a hospital, these relationships must be positive, As a matter of fact, the human factor is significant in the industrial field also, but it assumes top priority in the working of a hospital employee. Now, a hospital employee is surrounded by human beings from all four sides, while an industrial employee is surrounded by human beings from two sides and by machines and products from the remaining two sides. Thus, the importance of employee's contact with human beings in a hospital is greater than in other occupational areas because a considerable number of the individuals with whom the hospital employees have to deal are under more than average stress. A patient's reaction to his physical and menta! condition may not be the same as that of a healthy person. Visitors may be worried because of the condition of the patient in whom they are interested. Members of the medical staff may be working under stress due to the serious condition of their patients. These are conditions little known to professional in industrial organizations. In addition to adequate training in the professional skills necessary to perform their daily tasks, hospital employees must also be trained in the art of getting along with the sick and the worried people. It is evident, as R C Goyal (2002) concludes that in comparison to the average industial HRM, the human resource management in hospitais involves more complexities. 240.3. ELUCIDATION OF THE PROBLEM In the present times, the fast pace socio-economic, scientific and technological progress has influenced every sector of human activity and everywhere there is an increasing want of new approach and adoption of new methods to bring closer the achievement of objectives. As for health sector, which is under increasing pressure due to prominent growth in population and for other reasons, it is all the more obvious. Hospitals as healthcare centers need reform and development not only with regard to facilities, but also in the ways and techniques of providing services to the clients. To great extent, it is the attitudes, skills-levels and qualities of the health care personnel on which factors the reform and development depend. The concept of human resource management is a tool to develop human capital and to manage people at work properly and systematically so that human resource at work could be utilize at maximum level for the achievement of the optimum organizational goals and targets. Like as in many other developing countries, in Pakistan, health care sector has not been managed properly and has consequently failed to provide the necessary services of the desired standard. This is largely due to the lack of proper management of resources which include the personnel i.e. human resources. Purpose of undertaking this study is to determine in a comparative way the human resource management levels of both public and private hospital in 25Pakistan, so as to provide foundations for HRM development in the health care sector in the country. In number of other developing countries including Kenya with similar complicated HR scenarios, two fundamental problems affect the determination and direct application of HRM improvements to the health system: * Atleast as far as HR policies and practices are concerned, the health system is nota single cohesive organization with its own integrity. * HRM is an autonomous entity and a system that works best when the “target” is known. When implementers are faced with a fragmented public health system that has no authority over basic HR function and fairly limited HR “decision space” it is often unclear where and how to anchor HRM as a tactical organizational feat. Johnson (2002) observes that addressing these practical challenges especially in the context of health ministries in a developing country, setting and improving our comprehension of how civil service system works or fails to work, are crucial to the way human resources in the public health sector should be understood and managed. During the past decades, international development bodies have emphasized the need for developing country governments to reform and strengthen heaith system through a combination of sector specific and wider civil service reforms. The reforms particularly focusing on decentralization, have largely overlooked or 26failed to address the complexities and challenges associated with HRM. This state of affairs has endangered the successful accomplishment of the reform measures. The reform spotlight now needs to be focused on this huge gap that is holding back progress (Kolehmainen- Aitken, 2003). The public-sector reforms will have to consider granting autonomy to key social sector ministries such as health, especially in terms of empowering them to assume direct responsibility and authority to plan, develop and manage their workforce. This is a fact that drugs and medical technology cannot lead to quality healthcare without motivated and well managed health workers (Institute of Medicine, 2005). The ongoing and future structural reform and financing initiatives must assign top priority to the human resources planning management and _ productivity. Ummiouro (2006) describes that just as it is considered a standard requirement to conduct an environment - impact assessment before any major capital infrastructure project, initiatives in the health sector must carry out an HR audit to at least establish an inventory of HRM system strength including the availability requirements and preparedness of health workers to absorb the new investments. 0.4 AIMS OF THE STUDY » To create awareness among workers about future skills, and to attain a comprehensive understanding of their problems. > To analyze effective utilization of Human Resource Management in hospitals. 27> To explore effectiveness, efficiency and productiveness of public and private hospitals. > To enable policy-makers in both public and private sectors improve the scientific understanding of individual and group interactions and organizational structure related to employment and productivity. » To re-structure planning policy, salary set up, training and development, communication channels, compensation, and motivational techniques. > To explore the drawbacks and weaknesses of HRM methods in public and private hospitals. 0.5 HYPOTHESIS 1. Between effective utilization of HRM and productivity of hospital employees. and success of the health care organization, there exists an association. 2. In comparison with public health care sector, there is greater job satisfaction among employees of private healthcare sector because of effective HRM in the latter. 3. There is a link between hospital staff's (doctors and nurses’) job satisfaction and quality care provided to patients through client-provider relationship, guided by sound policy of HR management.0.6 AREA OF STUDY General area of this study is Pakistan with the cities of Karachi and Hyderabad in the province of Sindh being specific areas. KARACHI The present capital of the province of Sindh, Karachi, a megalopolis with over 12 million inhabitants, is the largest city and the principal seaport of Pakistan. This industrial centre is the hub of all banking and commercial activities. History of Karachi dates back to the 4" century B.C, Alexander the Great, on his way back, stayed her for 27 days and called this place a bridge between the east and the west. Arab historians too mention Karachi- through not by this name ~ because on their way to conquests inland, their armies passed through it. However its subsequent history remains obscure till the 19" century. In 1839 the British conquered Karachi and, upon their annexation of Sindh in 1843 declared it the capital of the new territory. At that time it was called Kolachi after the tribe of fishermen living here. The fishing village continued to grow and expand, and by the beginning of the 20" century had a population exceeding 100,000 inhabitants. On independence of Pakistan in 1947, Karachi, as it was now known, became the capital of the newly founded country of Pakistan and then began to grow fast. This growth did not slow down even after the national capital was shifted to Islamabad. Rather it kept accelerating, and today it has formed into a vast 29sprawling city. Its population keeps increasing because of the steady influx of job and fortune-seekers from allover the country. Karachi has certainly the best health-care services in the country with four medical universities and some of the largest hospitals in the country. HYDERABAD After Karachi, the city of Hyderabad is the next important and the second fargest city in the province of Sindh. It was the provincial capital at one time, but today it the district as well as the divisional headquarters. This city was founded in 1768 during the period of Kalhoras. It became the capital of Sindh under the Talpur dynasty in 1789. The British annexed Sindh in 1843 and Hyderabad became a garrison town. The city of Hyderabad today is a bustling metropolis with a population estimated at 1.5 million some five years ago. It is home to considerable industry and has a number of hospitals as well as medical colleges, Hospitals located in the study area a) Karachi (i) | The Aga Khan University Hospital (AKUH) The AKUH is a private teaching hospital established by the Aga Khan Foundation, a private philanthropic foundation under benevolent patronage of H. H. Prince Karim Aga Khan the spiritual head of the Ismaili community.& Vision The Aga Khan University is an autonomous, international institution of distinction, primarily serving the developing world and Muslim societies in innovative and enduring ways. Mission Through the discovery and dissemination of knowledge and application via service, the Aga Khan University is committed to the development of human capacities. AKU seeks to prepare individuals for constructive and exemplary leadership roles, and shaping public and private policies, through strength in research and excellence in education, all dedicated to providing the society with significant offerings. AKUH’s Measures to advance its Mission: Facilitate service to uplift its academic and research aims; Promotes and fosters management capacity with the help of its education and research programs, Responds to identified needs in the countries and regions which it serves; Prioritizes teaching and research updating information on_ intellectual innovation and change; Offers programs of international quality and standards; Assesses its impact and effectiveness; 31“+ Through positive measures, promotes access and equity, in order to make the University inclusive of all socio-economic groups, addressing the particular needs and circumstances of the disadvantaged; supporting the welfare and advancement of women, “+ Adds value by promoting partnership and networking across the Aga Khan Development Network (AKDN), and with other national and international institutions. “’ Engages in knowiedge networking and emerging technologies; Values and Ethics Being an international institution, the Aga Khan University operates on the core principles of quality, relevance, impact and access in pursuit ef achieving its Mission Drawing inspiration from the Islamic morals and ethics, humanistic ideals and the philosophy of the Aga Khan Development Network (AKDN), the University is committed to building an environment that promotes intellectual liberty, distinction in scholarship, pluralism, consideration, and humanity's collective responsibility to bring about an environment physically, socially and culturally sustainable, With most modern first rate diagnostic and curative facilities, the 495- bed hospital encompasses almost all branches of medical science. It has 8 main operation theaters besides 6 subsidiary operation theaters. The diagnostic laboratories serve not only the out- and in-patients, but 32through more than 40 citywide collection centres, provide diagnostic and testing services to a large population. AMENITIES The AKUH has 495 beds including 4 VIP, 111 private and 115 semi- private air conditioned rooms, 227 general ward beds and 38 special care beds are available in its ICU, CCU and NICU. It has 8 main operating theaters. In addition to these, there are 3 operating theaters in surgical day care, 2 in community health center and 1 each in obs/gyn and emergency room, Day- care surgeries are also performed at the hospital, Latest and novel pharmacy, radiology (including nuclear medicine) laboratory, cardiopulmonary, neurophysiology and physiological measurement services are available here. For the accessibility and convenience of public, the AKUH laboratory operates more than 40 phlebotomy or specimen collection centers in Karachi and all major cities of Pakistan. The AKU hospital is a private academic medical center committed to providing the best diagnosis of disease and team management of patient care supported by the highest doctor:patient and nurse : patient ratios in the city. The hospital is sufficiently equipped to handle medical (including cardiac), surgical, obstetric & gynaecology, pediatric and psychiatry patients. Highest standards of cleanliness, décor and ambiance unmatched in the city are maintained at the hospital. More than three thousand and five hundred employees serve at the hospital. 33ROLE OF HUMAN RESOURCE AT AKU HOSPITAL Human Resource Department at the AKUH ensures the following aspects: > well-planned and quality hiring of personnel > job description of its employees and proper structure/staffing of departments > Individual development centered on improving professional skills & performance keeping in view future needs > Proper utilization of human resource by motivation to improve the efficiency of organization. HRM is series of integrated decisions that form the employment relationship. Their quality directly contributes to the ability of the organization and employees towards attaining their objectives. The HR department aids the organization work within resources with ultimate creativity and it redesigns work process and jobs to focus. In HR management sound policies of recruitment, training condition of services, discipline and retirement are adopted in order to find greater versatility from work force. Apart from the above, the HRM works on better job satisfaction that reflects in lower absenteeism and higher turnover is achieved. As another important obligation the HRM helps maintain high moral and better human relation to win employee commitment. 34(ii) The Civil Hospital, Karachi The Civil Hospital of Karachi is a public sector (state-run) teaching hospital associated with the Dow University of Health sciences (formerly the Dow Medical College), Antedating Dow Medical College, the Civil Hospital was founded in 1885. At that time it had 250 beds for a population of 0.2 million. Presently it has 1750 beds that make it one of the largest hospitals of the country, catering to more than 900,000 and 250,000 in-patient and out- patients, respectively, and treating 250,000 emergencies yearly. Every year more than 20,000 surgeries including 300 free cardiac surgeries are performed. Among the diagnostic 5,400 X- rays, 12,000 sonogram and 2,700 CT scans are done every year. Itis appreciable that despite its dilapidated looks and confusing jumble of odd building structure, this hospital has been providing fair healthcare to the city’s poor and needy besides facilitating training to the host medical and para- medical staff. b) Hyderabad {i) Wali Bhai Rajputana Hospital The Wali Rajputana Hospital owes its establishment to the philanthropy of the Wali Bhai Rajputana Federation, a representative body of immigrants from the Rajasthan (formerly Rajputana) province of India, and above all to the vision and indefatigable energy of Al- Haj Seth Wali Muhammad Akbarjee, a businessman of Rajput origin. The hospital was established forty years ago (in 1967) after 371 35acres of land on Jamshoro Road on the outstrips of Hyderabad were purchased for the purpose. Commencement of the construction took place in November the November 1967, The main hospital building is spread over an area of 208,792 square feet. AIMS & OBJECTIVES > To provide, promote and develop education, recreational, medical and social welfare facilities for the people belonging to former state of Rajputana having permanently settled down in Pakistan and general public. > To establish, acquire, organize and to provide nursing homes, hospitals, dispensaries, medical services and educational institutions such as schools, colleges, hostels, boarding houses, poor houses, technical institution and also trading centers, industrial homes, recreational club, sports grounds, sporting clubs and all sorts of games for the people of Rajputana as stated above (Brochure of Wali Bhai Rajputana Hospital) > To foster and to bring about unity among the peoples belonging to former state of Rajputana and general public. >» To protect, promote and propagate social and moral values among the peoples belonging to former state of Rajputana and genera! public. 36SERVICES & AMENITIES OFFERED BY RAJPUTANA HOSPITAL 41. OUT-DOOR PATIENT DEPARTMENT With a capacity of treating 500 patients at a time, the hospital maintains a dispensary, a vaccination center and consultation chambers. Annuatly, more than 50,000 patients seek treatment and medical advice from the qualified and renowned specialists in various fields of medical science. OPD is run on welfare basis with minimal charges. 2. OPERATION THEATRES This hospital has 5 well-equipped operation theatres of international standard for general and orthopedic surgery, a separate operation theater for ophthalmologic operations with centralized oxygen supply unit. Well-trained staff and technicians are employed here of necessary support. 3. RADIOLOGY & ULTRA-SONOLOGY DEPARTMENT This department is faced with modern ultra-sound, x- ray and C-T scanning equipment. 4. UROLOGY AND NEPHROLOGY A separate nephrology and urology ward called Barkat Bhai Kidney Centre is established in this hospital with the name of Barkat Bhai Kidney Centre, in which there is a where separate Operation Theater for urological and nephrology operations, laparoscopic surgery and kidney transplantation. A dialysis center is also an integral part of this ward with 4 modern dialysis machines.5. PATHOLOGY LABORATORY Pathology lab has formally qualified staff and is equipped with latest machines and apparatuses including Microlab 100, Microlab 300, Electrolyte Analyzer (manual and digital), CP Analyzer, Microscopes, Blood Refrigerator, Hot Box and oven, Distilled Water Machine, Urilux machine, Incubator, Centrifuge, Spectronic 21, Photometer 4010 etc, More than 70 pathological tests of urine, blood, liver, stool, sera, as well as bacteriological, biochemical and surgical pathological test are conducted in these labs. 6. EXTRA - CORPOREAL SHOCK WAVE LITHOTRIPTOR It has been installed for removing kidney and thousand of patients have benefited from it. 7. WARDS. This hospital has the following wards: (a) FEMALE GENERAL WARD: It has 8 rooms with attached bathroom and 52 beds. Neonatal unit of 12 beds is annexed with female general ward. A separate operation theater is also established for gynea and obstetrics. (b) MALE GENERAL WARD It has 12 rooms with attached bathroom and 52 beds; pediatric unit of 12 beds is attached to the male general wards. (c) SINGLE PRIVATE ROOM WARD: It has 52 rooms with attached baths and balconies. 38(a) DOUBLE PRIVATE ROOM WARDS: It has 24 large rooms, each having attached bathroom, and a separate room for attendants and a balcony. (e) EAST WARD It comprises 34 small rooms with attached bathroom, Neurology ward is also housed in this ward. (f) CORONARY CARE UNIT (CCU) With centralized monitoring system it has 40 single rooms and 6 cabins and duty doctors’ room. 8, DENTAL CLINIC This unit is a recent addition to the hospital. It operates under the supervision of qualified and experienced dental surgeons. It may be mentioned that this hospital is providing high quality services in the following fields: > vVvvywywyyv v General surgery E.N.T., Physiotherapy, Neonatology Gynae & obstetrics Cardiology Orthopaedics Psychiatry Neurology Medicine Dentistry 39> Dermatology >. Ophthalmology (ii) Bhitai Hospital Bhitai Hospital is also a public sector one that started functioning in 1981 with 50 beds of which 40 were for gynecology and obstetrics and the rest of 10 for emergency cases. Later, it was expanded in 1989 with addition of 58 beds. A second expansion added another 50 beds for cardiac and 25 beds for general medical patients. Today it is a full-fledged 158-bed hospital providing health care facilities in all preventive and curative specialties. However, like most other public sector hospitals, this hospital suffers shortage of funds and amenities and is badly needs renovation of the building. REQUIREMENT OF BUILDING IMPROVEMENTS. The following buildings are urgentiy needed in this hospital: 1. Casualty block is to be renovated and expanded 2. Main operation theatre is to be renovated. 3. Anew block for dental patients to be constructed. DILAPIDATED SEWARAGE SYSTEM The sewerage system of the old building is already damaged and is only partly operational. Moreover, after the construction of the new block, the old sewerage system has proved inadequate. Improvement of the sewerage system is vitally essential, FLOORING OF OPD All out-patient departments need new (marble and tile) flooring. 40UPLIFTING OF THE FRONT ELEVATION OF THE HOSPITAL The front of the hospital needs a face-lift. ROOF OF THE OLD BUILDING Roof of the old building is damaged at many places with plaster chips off and on falling down all over the place. Repair work is required here on urgent basis. REPLACEMENT OF DAMAGED ITEMS Netting on the doors and windows are torn and need replacement. COLORING OF BUILDINGS Outside as well as the inside of the old and new hospital buildings including windows and doors need to be suitably colored afresh: BOUNDARY WALL OF THE HOSPITAL WITH BAR BIDDING The hospital boundary wall is low and damaged at places and requires urgent repairs. The wall should also be raised to at least 5 feet height. NEW WATER CONNECTION FOR THE HOSPITAL Presently only a single water connection is available which does not suffice water needs of the hospitals. Therefore, more water supply arrangements are required. NEW WATER SUCTION PUMPS Water pumps currently in use are old and not functioning properly. These need replacement. ELECTRICAL FITTINGS AND REPAIRS. Electrical fittings at the hospital are quite old and badly need up-to-date replacement. 41