जन स्वास्थ्य अभियान हरयाणा

जन स्वास्थ्य अभियान हरयाणा

स्वास्थ्य एक अहम मुद्दा रहा है और अब और भी अहम स्थान लेता जा रहा है | समाज और व्यक्ति के स्वास्थ्य के लिए जरूरी कारकों मसलन साफ वातावरण , पौष्टिक भोजन , साफ़ पानी , हवादार आवास और रोजगार की तरफ ध्यान बहुत ही कम दिया जा रहा है |  इसके चलते जहाँ गैर संक्रामक मसलन हृदय रोग , डायबटीज, जैसी बीमारियों की बढ़त हुई है वहीँ संक्रामक बीमारियों की वापसी भी तेज हुई है |  हरयाणा आर्थिक क्षेत्र में विकसित होते हुए हुए और स्वास्थ्य के क्षेत्र में कुछ मानकों में सुधार के बावजूद कुल मिलाकर सरकारी सुविधाओं के क्षेत्र में काफी पिछड़ता जा रहा है |  द पायनीयर अख़बार में 15 दिसम्बर 2017 को स्वास्थ्य सुविधाओं के बारे दिए आंकड़े चौकाने वाले हैं |

1 .71 .1 % ( 6 -59 )  महीनों के बीच के बच्चे खून की कमी के शिकार हैं| 

2 . (15 -49 ) साल के बीच की महिलाएं और लड़कियां खून की कमी की शिकार हैं |

3 . (15 -19 ) साल की किशोर लड़कियों में 62 . 7 % में खून की कमी है

|  इसी उम्र के 29 . 7 % लड़कों में खून की कमी पाई गई |

4 . ( 15 -19 ) साल की 36 . 6 % किशोरियां कुपोषण की शिकार हैं | इसी उम्र के 30.6 % लड़कों में कुपोषण है |

       इसी प्रकार हरियाणा स्वास्थ्य रक्षा सुविधाओं में 1966 से 2005 तक तो कुछ विस्तार हुआ मगर उसके बाद विकास बहुत धीमा है |  सार्वजनिक स्वास्थ्य सेवाओं का ढांचा चरमराता सा नजर आ रहा है |  जबकि कारपोरेट सैक्टर में स्वास्थ्य सेवाओं का निजीकरण  तेजी से हो रहा  है | सरकार की नीतियों और आर्थिक मदद के चलते ही प्राइवेट सैक्टर फला फूला है|  इसके प्रोहत्साहन के बीमा योजना और एम्पेनलमेंट खास तरीके नजर आते हैं |  साथ ही पीपीपी मोड भी उभरता जा रहा है |   प्राइवेट मैडीकल कालेजों की बढ़त हो रही है |  सरकारी में एम बी बी एस की 600 सीटें हैं और प्राइवेट में 800 सीटें हैं | 60 --70 लाख खर्च हो जाता है |  फिर पोस्ट ग्रेजुएशन के लिए 2 करोड़ से ज्यादा खर्च हो जाते हैं |

    हरियाणा की जनसंख्या (2011 )  2. 54 करोड़ के लगभग है | ग्रामीण जनसंख्या 16,509 ,359  है |  5 हजार पर एक उप स्वास्थ्य केंद्र , 30. 000 पर एक प्राथमिक स्वास्थ्य केंद्र और एक लाख पर एक सामुदायिक स्वास्थ्य केंद्र ग्रामीण क्षेत्र का प्रारूप माना गया है |

जो अब स्वास्थ्य सुविधाओं का ढांचा है :

1 . उप स्वास्थ्य केंद्र ------------  2630

2. प्राथमिक स्वास्थ्य केंद्र--------486

3. सामुदायिक स्वास्थ्य केंद्र -----119

( 2015 --2016 के आंकड़ों पर आधारित )

जो स्वास्थ्य सेवाओं का ढांचा होना चाहिए ::::

 1.उप स्वास्थ्य केंद्र ------------   3301 

2. प्राथमिक स्वास्थ्य केंद्र-------- 550 

3. सामुदायिक स्वास्थ्य केंद्र ----- 165

यदि 2018 की अनुमानित जनसंख्या पर सोचा जाये तो और भी ज्यादा ढांचा चाहिए | सरकारी ढांचे में सामुदायिक स्वास्थ्य केंद्र पर 1 सर्जन , 1 शिशु रोग विशेषज्ञ , 1 स्त्री रोग विशेषज्ञ और  1  फिजिसियन होना चाहिए | ये चारों स्पेस्लिस्ट शायद ही किसी सामुदायिक केंद्र में हों |बाकि डाक्टरों , नर्सों , रेडिओग्राफरों ,  ए एन एम और बाकि के पैरामैडीकल  स्टाफ की भी काफी कमी है |  दवाओं की कमी , लैब टेस्टों की कमी , एक्विमेंट्स की कमी आम बात हो गयी लगती है | इस प्रकार यदि प्राथमिक और सैकण्डरी स्तर की  स्वास्थ्य सेवाओं  के ढांचे का यह हाल है तो टर्सरी स्तर के पी जीआई एम  एस रोहतक और दूसरे मैडीकल  की हालत समझी जा सकती है |  

 इस उपलक्ष्य में निम्नलिखित प्रस्ताव रखे जाते हैं जो कि मौजूदा स्वास्थ्य परीस्थिति, जो कि पूर्णरुप से खारीज करने लायक है, को पलट सकें तथा स्वास्थ्य को बढ़ावा देने वाली परिस्थितियां तथा स्वास्थ्य सेवाएं लागू करते हुए सबके लिए स्वास्थ्य का सपना साकार कर सकें।

1        स्वास्थ्य के सामाजिक निर्णायकों पर ध्यान हो:: इसके  स्वास्थ्य सुरक्षा को बढ़ावा देना , लोक वितरण प्रणाली को सार्वभौमिक बनाना होगा जिसके तहत स्थानीय खाद्य पदार्थों को बढ़ावा दिया जाए। राष्ट्रीय शिशु स्वास्थ्य एवं पोषण नीति बनाई जाए जिसके अंतर्गत आई सी डी एस का सार्वभौमिकीकरण हो व तीन साल तक के बच्चों को पूर्ण रुप से शामिल करने हेतू सेवाओं तथा कार्यदल में विस्तार हो। समस्त गावों व मोहल्लों में शुद्ध एवं सुरक्षित पेयजल की सार्वभौमिक उपलब्धता हो तथा हर गांव व मोहल्ले में स्वच्छ शोचालयों तक सार्वभौमिक पहुंच हो।

2- स्वास्थ्य सम्बन्धित लैंगिक पहलूओं को सम्बोधित किया जाए -इसके अंर्तगत समस्त महिलाओं तथा समलैंगिक नागरिकों को समेकित , आसानी से उपलब्ध उच्चगुणवतापूर्ण स्वास्थ्य सेवाओं तक पहुंच व इसकी उपलब्धता की गाारण्टी दी जाए जो कि केवल मातृत्व सवास्थ्य सेवाओं तक ही सीमित न हो। उन समस्त कानून ,नीतियों तथा आाचरणों को समाप्त किया जाए जो कि महिलाओं के प्रजनन, यौनिक तथा जनतांन्त्रिक अधिकारों का हनन करता है। जो भी विभिन्न प्रजनन प्रोद्योगिकियां जो कि महिलाओं के लिए हानिकारक हो सकती हैं उन्हें नियंत्रित किया जाए । लिंग आाधारित उत्पीड़न को एक लोक स्वास्थ्य समस्या माना जाए तथा इसके तहत शारीरिक एवम मानसिक रुप से पीड़ितों को तमाम आवश्यक स्वास्थ्य जांच, दस्तावेजिकरण, रेफरल का अधिकार दिया जाए तथा समन्वित नैतिक चिकित्सीय कानूनी प्रक्रियाओं के लिए भी उन्हें अधिकृत बनाया जाए । स्वास्थ्य सेवाओं को किषोर किषोरियों के लिए मित्ऱतापूर्ण बनाया जाए तथा इस तबके को भी समेकित, उच्चगुणवता पूर्ण , आासनी से पहुंचने लायक स्वास्थ्य सेवाएं सुनिष्चित हो जो कि उनके विषेश प्रजनन तथा यौनिक स्वास्थ्य आवश्यकताओं को पूरा करती हों।

3- समस्त जाति आधारित भेदभाव तुरंत समाप्त किया जाए- जाति आधारित भेदभावों को, जो कि बुरे स्वास्थ्य का एक महत्वपूर्ण सामाजिक कारक है , पूर्णरुप से समाप्त करने हेतू त्वरित एवं प्रभावी कदम उठाये जाएं। मानव द्वारा मैला ढोने वाले समस्त मैनुअल कार्य पूर्ण रुप से प्रतिबन्धित हों। स्वास्थ्य सेवा के क्षेत्र में इस भेदभाव से पीड़ित तबकों को प्राथमिकता दी जाए । इसके लिए स्वास्थ्य सेवाओं का पुर्नगठन किया जाए।

4- स्वास्थ्य सेवाओं के अधिकार को संवैधानिक बनाया जाए- देश में स्वास्थ्य के अधिकार का कानून लागू किया जाए जो कि समेकित, उच्चगुणवतापूर्ण, आसानी से उपलब्ध सेवाओं को सुनिष्चित करता हो तथा प्राथमिक, द्वितीय एवं तृतीय स्तरीय सेवायें आवष्यकतानुसार सबको उपलब्ध करता हो। सेवा प्रदाता को सेवाओं को उपलब्ध नहीं कराने या मना करने पर ;चाहे गुणवता,पहुंच या खर्च से जुड़े हुए कारणों से भी हो, उसे कानूनी अपराध घोषित किया जाए।

5- स्वास्थ्य के उपर सार्वजनिक व्यय को बढ़ाया जाए-सकल घरेलू उत्पाद के कम से कम 3-6 प्रतिशत को स्वास्थ्य के लिए सुरक्षित किया जाए जो कि 2014 की स्थििति में प्रति व्यक्ति 3000 रुपये बनता है।

इस व्यय में कम से कम एक तिहाई केन्द्रिीय सरकार से राज्यों को उपलब्ध हो। हरियाणा सरकार का प्रति व्यक्ति खर्च 1786 है। एक मध्य सीमा के तहत स्वास्थ्य के उपर किये जाने वाले समस्त सार्वजनिक व्यय को सकल घरेलू उत्पाद के 5% तक बढ़ाया जाए।

6- स्वास्थ्य सेवाओं की उपलब्धता एवं गुणवता सुनिश्चित की जाए-समस्त स्वास्थ्य सुविधाओं में सेवाओं की गुणवता सुनिश्चित की जाए जिसके तहत स्वास्थ्य सेवाओं को प्रभावी , सुरक्षित , गैर शोषणीय बनाये तथा लोगों को सम्मानपूर्वक सेवायें उपलब्ध हों। मरीजों के अधिकारों का आदर हो एवं मरीजों की आराम तथा संतुष्टि पर ध्यान दिया जाता हो। गुणवता का मानक केवल भौतिक या चिकित्सकीय संरचना पर आधारित न हो जो कि प्रायः बड़े कार्पोरेट अस्पतालों या मैडीकल टूरिज्म को बढ़ावा देते हैं तथा कम खर्च में सही एवं प्रभावी सेवाओं के प्रदाय को बढ़ावा नहीं देता है। समस्त लोक सवास्थ्य संस्थान अपने स्तर पर गारन्टी की गई सभी स्वास्थ्य सेवाओं को प्रदान करने हेतू बाध्य हों । समस्त लोक स्वास्थ्य सुविधाओं को किसी भी प्रकार के उपभोग्ता शुल्क से मुक्त किया जाए तथा सेवाएं शासन द्वारा संचालित सुविधाओं के माध्यम से उपलब्ध कराया जाए न कि निजी सार्वजनिक सहयोग व्यवस्था से।

7- स्वास्थ्य सेवाओं का सक्रीय एवं निष्क्रिय निजीकरण बंद हो- सक्रीय निजीकरण के तरीके ; जैसे सार्वजनिक संसाधन या पूंजी को निजी संस्थानों को वाणिज्यिक हस्तानन्तरण करना , पूर्ण रुप से बंद करने हेतू आवश्यक कदम उठाया जाए। निष्क्रिय रुप से हो रहे निजीकरण को रोकने के लिए लोक सुविधाओं में निवेश बढ़ाया जाए। सार्वजनिक स्वास्थ्य संस्थानों से प्रदत सेवाएं केवल प्रजनन स्वास्थ्य,टीकाकरण एवं अन्य चुनिन्दा बीमारियों के नियन्त्रण पर सीमित न होकर समेकित स्वास्थ्य सेवाओं पर आधारित हो।

8- स्वास्थ्य कार्यदल का बेहतर प्रशिक्षण होः स्वास्थ्य सेवाओं में कार्यरत सभी कर्मचारियों की बेहतरीन शिक्षा एवं प्रशिक्षण के लिए सार्वजनिक निवेश को बढ़ाया जाए। सरकार द्वारा चलायी जा रही सभी शिक्षण संस्थान द्वारा उन जरुरत मंद इलाकों से चिकित्सकों, नर्सों तथा स्वास्थ्य कर्मचारियों को आवश्यक संख्या में चयनित कर शिक्षा व प्रशिक्षण दिया जा रहा है यह सुनिश्चित किया जाए। प्रशिक्षण नीति में बदलाव लाया जाए जिससे कि स्वास्थ्य कार्यदल द्वारा स्थानीय आवश्यकताओं को पूरा करने हेतू समस्त जरुरी दक्षताएं दी जा सकें। चिकित्सा तथा संबन्धित क्षेत्र के उच्च शिक्षा व्यवस्था के वाणिज्यिकरण बंद हों तथा निजी शिक्षण संस्थाओं के व्यवस्थित नियन्त्रण हेतू प्रभावी एवं पारदर्शी तन्त्र लागू किया जाए।भारतीय चिकित्सा परिषद,भारतीय नर्सिंग परिषद जैसी संस्थाओं विनियामक संस्थाओं को गहन समीक्षा के पश्चात पुनर्गठित किया जाए जिससे कि वर्तमान भ्रष्ट एवं अनैतिक व्यवस्था को समाप्त किया जा सके।

9- बेहतर शासित पर्याप्त लोक स्वास्थ्य कार्यदल होः लोक स्वास्थ्य प्रणाली में समस्त सेवाओं के लिए आवश्यक सभी पद एवं स्थान प्रर्याप्त रुप से सृजित किया जाए एवं इन पदों को समय समय पर भरा जाये। संविदा में नियुक्त कर्मचारियों को नियमित किया जाए तथा आशाओं , बहुउद्येशीय कार्यकर्ताओं तथा अन्य लोक स्वास्थ्य तऩ्त्र के कर्मचारियों का प्रयाप्त रुप से क्षमतानिर्माण किया जाए एवं उन्हें अपने कार्य के लिए सही मानदेय किया जाए व उपयुक्त काय्र करने का माहौल प्रदान किया जाए। कर्मचारियों के स्वास्थ्य एवं सुरक्षा पर ध्यान दिया जाएतािा इस हेतू महिला कर्मचारियों के लिए विशेष व्यवस्था बनाई जाए। उपलब्ध शोध से यह पता चलता है कि ग्रामीण क्षेत्र में डाक्टरों की कमी पेषेवर समस्याओं से ज्यादा प्रशासनिक कमजोरी तथा राजनैतिक पराजय के चलते है, जिसके सुधारने के लिए कार्य किया जाए । हर स्तर के लिए ऐसे लोक स्वास्थ्य कैडर का गठन हो जिसमें प्रयाप्त संख्या में चिकित्सक, नर्सें तथा स्वास्थ्य कर्मियों का दल सम्मिलित हो जिसका जिसको प्राथमिक स्वास्थ्य सेवा के क्षेत्र में, लोक स्वास्थ्य के सम्बन्ध में एवं एक दल के रुप में बेहतर कार्य करने में प्रशिक्षण प्राप्त हो।

10- सभी आवष्यक दवाओं का एवं जांच सुविधाओं की मुफत एवं गुणवतापूर्ण उपलब्धता सुनिष्चित होः जिस प्रकार तामिलनाडू, केरल एवं राजस्थान राज्य में किया गया है वैसा स्वायत , पारदर्शी एवं आवश्यकता आाधारित दवा एवं अन्य सामग्रियों के खरीदी एवं वितरण प्रणाली गठित एवं लागू हो। लंबित बीमारियो के सभी मरीजों के लिए सभी आवष्यक दवाओं का पूरी अवधि के लिए उपलब्धता सुनिश्चित हो एवं दवा वितरण केन्द्रों को मरीजों के आसान पहुंच के मद्येनजर गठित किया जाये। समस्त स्वास्थ्य सुविधाओं में जेनेरिक दवाओं का प्रिस्क्रिप्सन एवं उपयोग को अनिवार्य करार दिया जाये।

11 - सामुदायिक सहभागिता, सहभागी योजना निर्माण एवं समुदाय आधारित निगरानी को बढ़ावा दिया जायेः स्वास्थ्य सेवायें जनता के प्रति जवाबदेह हों। इसके लिए समुदाय आधारित निगरानी एवं योजना निर्माण प्रक्रिया को समस्त लोक स्वास्थ्य कार्यक्रमों एवं सेवाओं का अनिवार्य हिस्सा बनाया जायेजिससे कि सेवा प्रदान में उतरदायित्व एवं पारदर्शिता बढे। शिकायत निवारण की प्रक्रियाओं को सुचारु रुप से चलाने के लिए संस्थागत व्यवस्थायें बनाई जायें जिसके लिए पर्याप्त धन राशि के साथ साथ आवश्यक प्रबंधन स्वायतता भी प्राप्त हो।

12- लोक स्वास्थ्य प्रणाली को भ्र्ष्टाचार मुक्त किया जायेः नियुक्ति, पदोन्नति, स्थानान्तरण, खरीदी तथा अधोरचना विकास के लिए पारदर्शी नीतियां बनाई जायें तथा लागू की जाएं जिस प्रकार तामिलनाडू राज्य ने खरीदी के लिए तािा कर्नाटक राज्य ने स्थानान्तरण के लिए नीतियां बनाइ्र हैं। शिकायत निवारण की प्रक्रियाओं को सुचारु रुप से चलाने के लिए संस्थागत व्यवस्थायें बनाई जायें जिसके लिए प्रयाप्त धनराशि के साथ साथ आवश्यक स्वायत्तता प्राप्त भी हो।

13- निजी अस्पतालों द्वारा किये जाने वाले शोषण को समाप्त किया जायेः राष्ट्रीय क्लिनिकल एस्टेब्लिष्मैंट एक्ट के अंर्तगत मरीजों के अधिकार हर संस्थाओं में सुरक्षित हों । विभिन्न सेवाओं के दाम नियंत्रित हों। प्रिस्क्रिप्षन, जांच तथा रेफरल के पीछे चलने वाली घूसखोरी को बंद किया जाए, एवं इसके लिए शासन द्वारा पर्यवेक्षित लेकिन स्वतंत्र शिकायत निवारण व्यवस्था लागू की जाये। मानक निर्माण का प्रकार ऐसा हो जिसमें कारपोरेट हित का बढ़ावा न हो सके। इन तमाम व्यवस्थाओं पर यह भी विशेष ध्यान हो कि नैतिक एवं गैर वाणिज्यिक सेवा प्रदान करने वाले निजी प्रदाताओं को संम्पूर्ण परि रक्षा मिल रहा है।

14- समस्त सार्वजनिक बीमा योजनाओं को समय सीमा के अंतर्गत लोक सेवा व्यवस्था में विलीन किया जायेः आर एस बी वाई जैसे तथा अन्य राज्य संचालित बीमाएं कर-आधारित सार्वजनिक वितीय व्यव्स्था से पोषित लोक स्वास्थ्य सेवा व्यवस्था में समय सीमा के अंर्तगत विलीन हो । इन बीमा योजनाओं के अंर्तगत प्राप्त सभी सेवायें लोक स्वास्थ्य प्रणाली में भी सम्मिलित हों एवं इसके लिए पर्याप्त संसाधन उपलब्ध हों। संगठित एवं असंगठित क्षेत्र के मजदूरों को लोक स्वास्थ्य प्रणाली में पूर्ण रुप से शामिल किया जाये जिससे कि उनके लिए समेकित स्वास्थ्य सेवा उपलब्ध हो।

हरयाणा मुख्यमंत्री मुफ्त इलाज ‘योजना’, जननी सुरक्षा योजना आदि सभी स्वास्थ्य योजनाओं को ठीक प्रकार से लागू किया जाए। इसके लिए जिला स्तर पर सामाजिक संस्थाओं व जन संगठनों के कार्यकर्ताओं की एक माॅनिटरिंग कमेटी बनाई जाए जिसकी सिफारिशों पर सम्बंधित विभाग उचित कार्यवाही तुरन्त करे। हरयाणा से गुजरने वाले हाइवे पर एक्सीडैंट होने पर 48 घण्टे तक सभी को मुफ्त स्वास्थ्य सेवाएं देने की योजना उचित ढंग से लागू की जाए।

15- स्वास्थ्य नीतियों के विकास में तथा प्राथमिकतायें तय करने में बहुपक्षीय अंर्तराष्ट्रीय वितीय संस्थाओं का तकनीकी सहयोग पूर्ण रुप से समाप्त होः विश्व बैंक , यू.एस.एड., गेट्स फाउन्डेशन , कंसलटेंसी संस्थाएं जैसे डियोलाइट,मैकेन्सी आदि का राष्ट्रीय स्वास्थ्य प्राथमिकतांए एवं वितीय या सेवा प्रदाय रणनीतियों के निर्धारण में भूमिका को पूर्ण रुप से समाप्त किया जाये। शोध व ज्ञान संसाधन का विकास एवं वितरण के लिए एक विषेश अंतर्राष्ट्रीय सहयोग प्रणाली गठित किया जाये , खासकर अन्य विकासशील देशों के साथ। डब्लू.एच. ओ. ,यूनिसेफ तथा अन्य संयुक्त राष्ट्रीय संस्थाओं के उपर तकनीकी निर्भरता एवं उनकी वितिय सहायता की आवश्यकता से मुक्त किया जाने हेतू शासकीय स्तर पर दबाव बनें। इस प्रकार की संस्थाओं

की ओर से आने वाले परामर्श तथा विशेषज्ञता को भी समीक्षात्मक दृष्टि से देखा जाये क्योंकि यह संस्थाएं भी कारपोरेट एवं निजी संस्थानों के हित से प्रभावित हैं ।

16 - राष्ट्रीय एवं राज्य स्तर पर स्वास्थ्य पर शोध एवं विकास के लिए क्षमता निर्माण होः लोक स्वास्थ्य बजट का कम से कम 5% स्वास्थ्य पर शोध के लिए आवंटित हो जिसमें स्वास्थ्य तन्त्रों पर शोध भी शामिल हो। सवास्थ्य के क्षेत्र में तथा स्वास्थ्य तन्त्रों पर शोध हेतू नवीन संस्थागत ढांचे शासन द्वारा गठित हो तथा मौजूदा संस्थाओं को पर्याप्त शासकीय वितिय सहायता दिया जाये।

17- आवश्यक एवं सुरक्षित दवाईयों तथा उपकरणों की सही उपलब्धता सुनिष्चित होः सभी दवाईयों का मूल्य आधारित दाम नियन्त्रण हो , दवा एवं उपकरण सुरक्षा के लिए आवश्यक प्रावधान हो। जेनेरिक दवाईयों के वितरण के लिए पर्याप्त संविधायें प्रणाली हों व चिकित्सकों द्वारा जेनेरिक दवाईयों के प्रिस्क्रिप्षन हेतू अनिवार्यता हो। इंडियन पेटैंट एक्ट के अंर्तगत लोक स्वास्थ्य सुरक्षा के लिए की गई व्यवस्थाओं का दवाईयों की उपलब्धता बढ़ाने के लिए उपयोग हो तथा ज्यादातर दवाईयों एवं उपकरणों के देषी निर्माण को बढावा मिले।

18- जैव चिकिस्तकीय शोध तथा क्लिनिकल ट्रायलों की सशक्त विनियामक व्यवस्था होः क्लिनिकल ट्रायलों के नैतिक संचालन हेतू स्पष्ट रुप रेखा तैयार एवं लागू हो जिससे समस्त हितग्राहियों के सशक्त विनमय के लिए व्यवस्थायें बंधित हो चाहे वे वितीय प्रदाता हो , शोध संस्थाएं हों या नैतिक समितियां हों। सी.डी.एस.सी.ओ. तथा आई.सी. एम. आर. द्वारा समस्त क्लिनिकल ट्रायलों का तथा ट्रायल स्थानों की सशक्त निगरानी की जाये तथा ट्रायल संसाधनों के आंवटन के दौरान वहां पर आवश्यक सभी आपातकालीन स्थिति के निपटारे हेतू व्यवस्थायें सुनिश्चित हों । क्लिनिकल ट्रायलों में भाग लेने वाले प्रतिभागियों को प्र्याप्त क्षतिपूर्ण राशि उपलब्ध कराने हेतू एवं उनको हो सकने वाले समस्त बुरे प्रभाव निपटारे के लिए पर्याप्त व्यवस्था के साथ निर्देश विकसित और लागू हों। क्लिनिकल ट्रायल प्रतिभागियों के लिए उनके अधिकार पत्र विकसित किया जाय जिसकी कानूनी रुप में भी वैधता हो।

19- सभी मानसिक रुप से पीड़ित मरीजों को स्वास्थ्य सेवाएं एवं रक्षा सुनिश्चित की जायेंः जिला स्तरीय मानसिक स्वास्थ्य कार्यक्रम को राष्ट्रीय स्वास्थ्य मिशन के अंर्तगत शामिल किया जाये। राष्ट्रीय मानसिक स्वास्थ्य नीति पर अमल हो तथा मानसिक स्वास्थ्य कानून पास किया जाये।

20- कीटनाशक दवाओं के अन्धाधुन्ध इस्तेमाल के चलते हरियाणा के हर क्षेत्र, मानवीय, पशु व खेती में इसके दुष्परिणाम सामने आ रहे हैं। दुर्भाग्यपूर्ण बात यह है कि मानवीय स्तर पर इन कीटनाशकों की मात्रा पता लगाने के टैस्टों की सुविधा इस प्रदेश के इकलौते पीजीआईएमएस में भी नहीं है। कई तरह की बीमारियां इसके चलते बढ़ रही हैं या पैदा हो रही हैं। यह सुविधा तत्काल मुहैया करवाई जाए।

21- सामुदायिक स्वास्थ्य केन्द्रों पर - एक सर्जन, एक फिजिसियन, एक शिशु रोग विशेषज्ञ व एक महिला रोग विशेषज्ञ के प्रावधान के मानक केन्द्रीय स्वास्थ्य विभाग द्वारा तय किये गए हैं। इसके साथ यदि मरीज बेहोशी का विशेषज्ञ नहीं है तो सर्जन और गायनकाॅलोजिस्ट तो अपंग हो जाते हैं। इसलिए इन पांचों विशेषज्ञों की नियुक्तियां प्रत्येक सामुदायिक स्वास्थ्य केन्द्रों मे की जाए।

22. प्रदेश के जिलों में गुड़गांव, रोहतक, हिसार, भिवानी,फरीदाबाद और सोनीपत में विशेष आर्थिक पैकेज के तहत 1500 करोड़ रुपये की परियोजनांए शुरू की गइ्र हैं जिसके तहत स्वास्थ्य सेवाओं के आधारभूत ढांचे को विकसित करने के लिए इन जिलों के अस्पतालों को अपगे्रड करके सुपर स्पेशिलिटी अस्पताल बनाये जा रहे हैं। बहुत ही हाईटेक उपकरण पिछले सालों में खरीदे गए जो बहुत कम जगह और कमतर स्तर पर इस्तेमाल किये जा रहे हैं। यहां पर उपयुक्त स्टाफ की कमी को पूरा करते हुए इसके लिए सम्बंधित विशेषज्ञों, डाॅक्टरों, नर्सों व पैरामैडिकल स्टाफ को उपयुक्त ट्रेनिंग देने की भी आवश्यकता है। निशुल्क सर्जीकल पैकेज योजना के तहत 2009 से बी. पी. एल परिवारों को दी जा रही निशुल्क सर्जरी की सेवा को लागू करने में आ रही सभी दिक्कतों को दूर करने के लिए ठोस कदम उठाये जायें। गरीबी रेखा से नीचे जीवन यापन करने वाले व अधिसूचित झोंपड़ पट्टियों एवं बस्तियों के निवासियों के सभी आपरेशन मुफत करने की योजना को सही ढंग से लागू किया जाए । इंदिरा बाल स्वास्थ्य योजना 26 जनवरी 2010 से लागू की गई। जिसके तहत अठारह वर्ष तक की आयु के बचचों के स्वास्थ्य कार्ड बना कर सरकारी अस्पतालों में उनके स्वास्थ्य की निशुल्क जांच व ईलाज किया जाता है। बहुत से लोगों को इन सब योजनाओं से वाकिफ ही नहीं लगते ओर इनके क्रियान्वयन की दिक्कतों को भी दुरुस्त करने के कदम पहले सुझाये गये माध्यमों के द्वारा उठाये जायें। प्रदेश में 2005 तक एम. बी.बी.एस.की कुल सीटें 350 थी जो वर्ष 2013 में 850 हो गई। मगर इन विद्यार्थियों की गुणवता पूर्ण मैडीकल शिक्षा के लिए जरुरी फैकल्टी की काफी कमी है हरेक मैडीकल कालेज में और इन्फ्रास्ट्रक्चर की बहुत कमी है जिसे पूरा करना बड़ी चुनौती है। राष्ट्रीय खाद्य सुरक्षा अधिनियम 2013 के तहत दाल रोटी योजना को सही सही लागू किया जाए।

23- कुपोषण ;नैशनल फैमिली हैल्थ सर्वे- 4  के अनुसार, हरियाणा में बढ़ा है। दूर करने के लिए कारगर कदम उठाये जायें। इसी प्रकार गर्भवती महिलाओं में नैशनल फैमिली हैल्थ सर्वे 4 के अनुसार नैषनल फैमिली हैल्थ सर्वे 3 के मुकाबले 10 प्रतिशत खून की कमी बढ़ी है। इसके साथ-साथ लड़कियों में किये गये सरकारी सर्वे में भी खून की कमी का प्रतिशत काफी पाया गया है। उचित कदम उठाये जाने की जरूरत है।

24-पी एन डी टी एक्ट के तहत उचित कार्यवाही की जाएं।

25- मुख्यमंत्री मुफ्त इलाज योजना सुचारू रूप से लागू की जाये |

26- जननी सुरक्षा योजना को भी ठीक ढंग से लागू करवाने  के लिए जन समुदाय को संगठित किया जाये |

27- प्रधानमंत्री जन औषधि योजना में 699 दवाओं की लिस्ट दी गयी है | सभी दवाएं जान औषधी केंद्र पर उपलब्ध नहीं हो रही |  उपलब्ध करवाया जाये |

और इस सुविधा का ब्लॉक स्तर तक विस्तार किया जाये |

28- जन संख्या के हिसाब से जन स्वास्थ्य रक्षा सेवाओं के पब्लिक ढांचे को मजबूत किया जाये |  |

29 अपने अपने मोहल्ले , गली, शहर गांव के स्तर पर जन स्वास्थ्य सेवाओं की जनता के सहयोग से उपलब्धता करवाने के लिए संघर्ष की जरूरत होंगी|

स्वास्थ्य का मुद्दा सामाजिक और आर्थिक तो है ही साथ ही यह राजनैतिक मुद्दा भी है |  इसलिए जन स्वास्थ्य सेवाओं को कारपोरेट सैक्टर के  हाथों में दिए जाने का विरोध भी जन स्वास्थ्य अभियान का हिस्सा है |

जन स्वास्थय अभियान हरियाणा जनता से, जनता के वंचित तबकों से  और इसके जन संगठनों से अपील करता है कि मजबूत संगठन बना कर  स्वास्थय हमारा हक़ है "के मुद्दे पर संघर्ष में हिस्सेदारी करें |

डॉ रणबीर सिंह दहिया

सदस्य

कोर ग्रुप , जन स्वास्थ्य अभियान

हरियाणा

SOT

Abstract

An operation theater complex is the "heart" of any major surgical hospital. An operating theatre, operating room, surgery suite or a surgery centre is a room within a hospital within which surgical and other operations are carried out. Operating theatres were so-called in the United Kingdom because they traditionally consisted of semi-cir­cular amphitheatres to allow students to observe the medi­cal procedures. OT complexes are designed and built to carry out investigative, diagnostic, therapeutic and palliative proce­dures of varying degrees of invasiveness. Many such set ups are customized to the requirements based on size of hospital, patient turnover and may be specialty specific. The aim is to provide the maximum benefit for maximum number of patients arriving to the operation theatre. Both the present as well as future needs should be kept in mind while planning. Proper application of programming methods to the design of a surgical suite requires a thorough understanding of the design criteria that are important to proper sizing and arrangements of the ORs. Many innovations have been reported to the literature for patient safety and low vacuum, high flow, low resistance systems with many protective devices have become available. The establishment and working of the operation the­atre (O.T.) needs specialised planning and execution and is not a simple civil engineering work. A "civil-mechanical-elec­trical-electronic- bio medical" combo effort driven and co­ordinated by the needs, preferences and safety of the medical/ surgical team forms the basis for starting and maintain­ing an operation theatre. Anaesthesiologists, by virtue of their knowledge of the intricacies of physiology, physics and bio­medical aspects of medicine and constant proximity to the operation theatre should preferably be involved from the early stages of planning of operating theatres. Hospitals want to reduce costs and improve their financial assets, on the one hand, while they want to maximize the level of patient satisfaction, on the other hand. One unit that is of particular interest is the operating theater. Since this facility is the hospital's largest cost and revenue center, it has a major impact on the performance of the hospital as a whole. Managing the operating theater, however, is hard due to the conflicting priorities and the preferences of its stakeholders, but also due to the scarcity of costly resources. Moreover, health managers have to anticipate the increasing demand for surgical services caused by the aging population. These factors clearly stress the need for efficiency and necessitate the development of adequate planning and scheduling procedures. A patient—centered approach to facility planning starts with the single— patient room. which makes it possible to reduce disruptive noise, improve communication between caregiver and patient, involve family and significantly reduce infections. Hospital operating rooms are among the most infection-sensitive environments in health care facilities. Surgical procedures increase patient vulnerability to pathogens transmitted from surgical personnel, surgical equipment, the air and a patient’s own skin flora. Despite advancements in surgical techniques and infection-prevention methods, two out of every 100 surgeries in the U.S. result in surgical site infections (SSIs), according to the Centers for Disease Control and Prevention (CDC). Impacts on quality of care include morbidity, extended hospital stays and, in extreme cases, mortality. Laminar airflow is prevalent in both settings, but the difference in designs can be radical. In ISO Class 1 to Class 4 clean-room environments, nearly every square inch of ceiling space is dedicated to providing laminar airflow to minimize turbulence and produce predictable movement of particles away from the sterile field. Conversely, hospital operating room laminar flow systems typically consist of multiple laminar flow diffusers arranged in a variety of arrays to optimize airflow. In many cases, the arrangement of these diffusers—with large gaps for light troffers and other components—would be unacceptable by ISO Class 1 to Class 4 clean-room standards, and ultimately create, versus minimize, turbulence in the space. Given the quality of care and economic consequences of SSIs, consideration should be given to rethinking the requirements for the operating room to include some measure of contamination control and aerobiological quality standards. The technology and design practices have already been successfully implemented by critical-process manufacturers facing similar consequences in a different context. Challenges exist in the operating room setting—booms, lights and other components are obstacles that affect performance—but facing them head-on to advance the typical operating room beyond current design standards can be a worthy venture toward improving the quality of patient care and the financial bottom line of any health care facility. Hospitals are creating a new breed of surgery spaces called hybrid operating rooms. Hybrid ORs combine the surgical capacity of traditional operating rooms with the imaging capabilities of a catheterization lab, two spaces that have traditionally been distinct. Placing state-of-the-art imaging and X-ray equipment in an operating room allows for less invasive, safer procedures with faster recovery times for patients. The imaging equipment helps surgeons pinpoint the area of incision and provides instantaneous feedback during procedures. For example, endovascular neurosurgical cases, such as aneurysm operations, can now be performed more safely and efficiently in a hybrid OR. As surgeons conduct these high-risk, complex cases, high-tech diagnostic imaging increases positive outcomes, enabling neurosurgeons to transition seamlessly from a closed to open procedure, without losing critical time to transport a patient to another location for imaging. If designed with clinical flow in mind, the hybrid operating room suite can be a force for the future of interventional platforms. By combining imaging and surgical capabilities, hospitals are redefining the interventional suite, with great advantages in patient care and cost efficiency. With emergence of hybrid operating rooms comes both cultural and design implications that go far beyond the operating room itself and extend to the entire surgical suite and the hospital as a whole. Planning and design The first step in planning a hybrid OR is to seek input from each of the surgical specialists who will utilize the room. Design teams should include representatives from surgical and perioperative departments, administration, facilities, and IT. The team should also tour hybrid ORs at other hospitals to experience these new types of spaces. During the design phase, it’s critical to use the latest 3-D drawing tools to create a clear vision of the hybrid room’s elements. Once a design has been approved, a full-scale mock-up of the space should be built. This will give the team the opportunity to identify and solve any design challenges in the room before it’s constructed. Early vendor selection and coordination are also important steps, especially since the addition of imaging equipment adds spatial complications to the operating room. In particular, ceilings require careful consideration and advance planning, as both surgical and imaging equipment tend to be ceiling-mounted. With advance planning, designers have the opportunity to encourage vendors to work together to fit specific design parameters by facilitating conversations between them. Increasingly, vendors have joined forces to offer more synergistic solutions. For example, in the Geisinger Wyoming Valley Medical Center’s hybrid OR, two vendors teamed up to integrate their systems into one solution. One vendor’s boom mount was added to another vendor’s monitors required for the cath system, reducing the amount of ceiling-mounted equipment. Vendors are also working to offer systems that integrate IT with equipment. For example, it is now possible for staff to navigate a variety of different equipment systems, including surgical, video, and patient monitoring, from one centralized control panel. Layout and equipment Hybrid ORs can include a variety of imaging equipment, including either single or bi-plane, and increasingly, CT scanners (CTORs) and MRI scanners (MRORs). MRORs can range in size from 1,200 square feet to 2,600 square feet, while CTORs run from 800 square feet to 1,100 square feet. Both rooms must allow space for the control room, supply space, scrub area, locker sequence, and the generator rack room, which runs the equipment. Different zones of OT complex The location and flow of the patients, the staff and the materials form the three broad groups to be considered during all stages of design. Four zones can be described in an O T complex, based on varying degrees of cleanliness, in which the bacteriological count progressively diminishes from the outer to the inner zones (operating area) and is maintained by a differential decreasing positive pressure ventilation gradi­ent from the inner zone to the outer zone. (1) Protective zone: It includes Change rooms for all medical and paramedical staff with conveniences Transfer bay for patient, material & equipment Rooms for administrative staff Stores & records Pre & post-operative rooms I.C.U. and P.A.C.U. Sterile stores (2) Clean zone : Connects protective zone to aseptic zone and has other areas also like Stores & cleaner room Equipment store room Maintenance workshop Kitchenette (pantry) Firefighting device room Emergency exits Service room for staff Close circuit TV control area (3) Aseptic zone - Includes operation rooms (sterile) (4) Disposal zone - Disposal areas from each OR and corridor lead to disposal zone Sub areas (1) Pre-operative check in area (reception)- This is important with respect to maintaining privacy, for changing from street clothes to gown and to provide lockers and lavatories for staff. (2) Holding area- This area is planned for IV line in­sertion, preparation, catheter / gastric tube insertion, connection of monitors, and shall have O 2 and suction lines. Facility for CPR should be available in this area. (3) Induction room - (anaesthetic room). It should have all facilities as in OT, but there is controversy as to its need. One for each OT is required, ideally each is a duplicate of the other in each floor. The anaesthetic room will provide a more tranquil atmosphere to the patient than the OT. It should provide space for anaesthetic trolleys and equipment and should be located with direct access to circulation corridors and ready access to the operating room. It will also allow cleaning, testing and storing of anaes­thesia equipment. It should contain work benches, sink(s). It should have sufficient power outlets and medical gas panels for testing of equipment. (4) Post anaesthetic care units (PACU) - preferably adjacent to recovery room. These should contain a medication station, hand washing station, nurse sta­tion, storage space for stretchers, supplies and moni­tors / equipment and gas, suction outlets and ventila­tor. Additionally 80 sq ft (7.43 sq m) for each patient bed, clearance of 5 ft (1.5 m) between beds and 4 ft (1.22m) between patient bed sides and adjacent walls should be planned. (5) Staff room - Men and women change dress from street cloth to OT attire; lockers and lavatory are essential; rest room TV, etc. are desirable. (6) Sanitary facility for staff- One wash basin and one western closet (WC) should be provided for 8-10 persons. Showers and their number is a matter of local decision. Inclusion of toilet facilities in changing rooms is not acceptable; they should be located in an adjacent space . (7) The anaesthesia gas / cylinder manifold room / storage area- A definite area to be designated. It should be in a cool, clean room that is constructed of fire resistant materials. Conductive flooring must be present but is not required if non inflammable gases are stored. Adequate ventilation to allow leaking gases to escape, safety labels and separate places for empty and full cylinders to be allocated . (8) Offices - for staff nurse and anaesthesia staff­- The office should allow access to both unrestricted and semi-restricted areas as frequent communication with public is needed. (9) Rest rooms- Pleasant and quiet rest for staff should be arranged either as one large room for all grades of staff or as separate rooms; both have merits. Comfortable chairs, one writing table, a book case etc., may be arranged. (10) Laboratory - Small lab. with refrigerator for pa­thologist to be arranged. (11) Seminar room- Since staff cannot leave an OT complex easily, it is better to have a seminar room within the OT complex. Intra-departmental discussions, teaching and training sessions for staff may be conducted here. (12) Store room- This is designed to store large but less frequently used equipment in the OT. There should be storage space for special equipment after cleaning. (13) Theatre sterile supply unit (TSSU)- Within this area, following are desirable - Temperature between 18 0 -22 0 C, humidity of 40%­-50% is the aim. Air conditioned with 10-12 air exchanges per hour Storage of sterile drapes, sponges, gloves, gowns and other items ready to use. Option to store in from one side and remove from other side. Proper inventory to prevent running out of stock. (14) Scrub room- This is planned to be built within the restricted area. Elbow operated or infrared sensor operated taps / water source is ideal. It is essential to have non slippery flooring in this area. Types of OT complexes There are three main categories of operating the­atres: The single theatre suite with OT, scrub-up and gowning, anaesthesia room, trolley preparation, utility and exit bay plus staff change and limited ancillary accommodation. The twin theatre suite with facilities similar to 1, but with duplicated ancillary accommodation immediate to each OT, sometimes sharing a small post anaes­thesia recovery area. OT complexes of three or more OTs. with ancillary accommodation including post anaesthesia recovery, reception, porter's desk, sterile store and staff change. Principles to be taken into consideration while planning an O.T. (physical / architecture): Location: Low rise buildings limited to two or three storeys high are preferred because of maximum advantage of natural light and ventilation as appropriate can be derived . The OT should be separate from general 'traffic' and air movement of rest of the hospital, OT, surgical wards, intensive care units (ICU), accident and emergency department (A & E), Radiological department (X-Ray) should be closely related and access is also required to Sterilizing and disinfecting unit (SDU) and laboratory facilities. The location of the operation complex in a multi-storey building is planned on the first floor, connecting to surgical and other wards on the same floor. Adequate electric lift is planned for vertical movement from casualty on the ground floor and ENT, Orthopaedics, Ophthalmology & other wards on the floors above. Zone wise distribution of the area, so as to avoid criss­cross movements of men & machines Adequate & appropriate space allotted as per utility of the area Provision for emergency exit Provision for ventilation & temperature control, keeping in mind the need for laminar flow, HEPA filter air conditioner etc. Operation rooms: The number & size can be as per the requirement but recommended size is 6.5 m x 6.5m x 3.5 m. Glass windows can be planned on one side only. Doors: Main door to the OT complex has to be of adequate width (1.2 to 1.5 m). The doors of each OT should be spring loaded flap type, but sliding doors are preferred as no air currents are generated. All fittings in OT should be flush type and made of steel. The surface / flooring must be slip resistant, strong & impervious with minimum joints (eg. mosaic with cop­per plates for antistatic effect ) or jointless conductive tiles/ terrazzo, linoleum etc., The recommended minimum conductivity is 1m ohm and maximum 10m Ohms. Presently the need for antistatic flooring has dimin­ished as flammable anaesthetic agents are no longer in use. Walls- Laminated polyester or smooth paint provides seamless wall; tiles can break and epoxy paint can chip out. Collusion corners to be covered with steel or alu­minium plates, colour of paint should allow reflection of light and yet soothing to eyes. Light colour (light blue or green ) washable paint will be ideal. A semi-matt wall sur­face reflects less light than a highly gloss finish and is less tiring to the eyes of OT team. Operation Table: One operation table per OT Electric point: Adequate electric points on the wall (at < 1.5 m height from the floor) (discussed later) X-Ray illuminators: There should be X-ray film illu­minators preferably recessed into the wall. Scrub area: to be planned for at-least for 2-3 persons in each OT. There has to be a preparation room in clean zone Corridors not less than 2.85 m width for easy movement of men, stretcher & machines Separate corridors for uses other than going into OT. Rooms for different persons working in OT & for different purpose (it should be as per zone & size ) Gas and suction (control, supply & emergency stock) for all OTs & areas where patients are retained. Oxygen, gas and suction pipe to be connected with central facility and standby local facility should also be available. Provision for adequate & continuous water supply: Besides normal supply of available water at the rate of 400 litres per bed per day, a separate reserve emergency over head tank should be provided for operation theatre. Elbow taps have to be 10 cm. above wash basins. Proper drainage system. Pre-operative area with reception with separate designated area for paediatric patients is desirable. Adequate illumination with shadow less lamps of 70,000-120,000 Lumens intensity, for assessing patient colour and tissue visibility. The safety in working place is essential, and fire extinguishers have to be planned in appropriate zone. Provision for expansion of the OT complex should be borne in mind during planning stages itself. Recommendations on the number of OTs required. It is observed that out of all surgical beds, of the hospital, 50% of patients are expected to undergo surgery. Thus for 100 beds, with average length of stay of 10 days for each patient, 10 operations per day can be performed. In general, multiuse OTs, instead of multiple OTs of­fer advantages of efficient man power utilization, economi­cal maintenance and better training of supporting staff. In a 300 bedded hospital (with 150 surgical beds), one OT complex with 3 OTs for General Surgery, Gynaecology, Orthopaedics/ENT, one for Endoscopy and one for Septic. OT will be required with 8 hours a day working duration. Ventilation Ventilation should be on the principle that the direction of air flow is from the operation theatre towards the main entrance. There should be no interchange air movement between one OT and another. Efficient ventilation will control temperature and humidity in OT, dilute the con­tamination by micro-organisms and anaesthetic agents. There are two types of air conditioning systems : re­-circulating and non re-circulating. Non re-circulating systems heat / cool the air as de­sired and convey it into the operating room with ideally 20 air exchange per hour. Air is then exhausted to outside. Anaesthetic agents in the OT air are also automatically removed. These are thus ideal but are expensive. The circulating system takes some or all of the air, adjusts the temperature and circulates air back to the room. The broad recommendations include: 20-30 air exchanges / hour for re-circulated air Only upto 80% re-circulation of air to prevent build up of anaesthetic and other gases Ultraclean laminar air flow - the filtered air delivery must be 90% efficient in removing particles more than 0.5m m. Positive air pressure system in OT: It should en­sure a positive pressure of 5 cm of water from ceiling of OT downwards and outwards, to push out air from OT. Relative humidity of 40-60% to be maintained Temperature between 20 0 -24 0 C. Temperature should not be adjusted for the comfort of OT personnel but for the requirement of patient, especially in pediatric, geriatric, burns, neonatal cases etc. Pendant services Two ceiling pendants for pipeline services should be designed; one for surgical team and one for anaesthetist . Anaesthetic pendant should be retractable and have lim­ited lateral movement and provide a shelf for monitoring equipment. It should have oxygen, nitrous oxide, four bar pressure medical compressed air, medical vacuum, scav­enging terminal outlets and atleast four electric sockets. Piped gases in the OT Automatic / semi-automatic fail safe manifold room to be designed. Two outlets for Oxygen and suction and one for N 2 O are a minimum in each OT. Pipeline supply system should be able to cut off from mainline if the problem occurs anywhere along the delivery hosing / tubing. Scavenging The method of scavenging should be decided during planning stage of OT .US and International standards are available for scavenging but it is ideal to plan the type of system (active / passive) and number and location of scav­enging outlets beforehand. Electrical All electrical equipment in the OT need Proper grounding In the past, isolated power systems were preferred when explosive agents were being used. They have the advantage of a transformer using grounded electricity and there is no risk to the patient or machines if a machine gets faulty. The grounded systems as used at homes offer pro­tection from macro shock but devices may lose power without warning. Life support systems, if in use could be disturbed. Criteria ideal with respect to electricity in OT complex: Use of circuit breakers / interrupters is desirable if there is an overload or ground fault. Power line of 220 Volts Suspended ceiling outlets should have locking plugs to avoid accidental disconnection. Insulation around ceiling electrical power sources should withstand frequent bendings and flexings. They should not develop cracks and should not damage wires. Wires inside rigid or retractable ceil­ing service column can help to some extent Wall outlets to be installed 1.5 m above ground. Use of explosion proof plugs. Multiple outlets from different electrical line sources should be available. Electrical load calculation should be based on, equip­ments likely to be used and appropriate current car­rying capacity cords to be used. Emergency power: OT electrical networks need to be connected to the emergency generators with au­tomatic two way changeover facility. Lighting Some natural daylight is preferred by staff . Where possible, high level windows which give a visual appre­ciation of the 'outside world' can be considered in the OT. General lighting: Colour corrected fluorescent lamps (recessed or surface ceiling mounted) to produce even illumination of at least 500 Lux at working height, with minimal glare are preferred . Means of dim­ming may be needed during endoscopies. To mini­mize eye fatigue, the ratio of intensity of general room lighting to that at the surgical site should not exceed 1:5, preferably 1:3. This contrast should be maintained in corridors and scrub areas, as well as in the room itself, so that the surgeon becomes accustomed to the light before entering the sterile field. Colour and hue of the lights also should be consistent. About 2000 Lux light is needed to asses the patients colour. White and glistening / shiny body tissues need less light than dark and dull tissues Operating area: Overhead light should be shadow less and give 25000-125000 Lux of light (50000 to100000 Lux at the centre and at least 15000 Lux at the pe­riphery). About 10-12 inch of focus of light gives adequate illumination both at depth as well as surface of body. Lights should be freely movable both in horizontal and vertical ranges. Pendant systems are preferred. OT light should produce blue white colour of daylight at spectral energy range of 50000K (35000-67000­ kelvin acceptable) Halogen lights produce less heat and hence pre­ferred. OT light should not produce more than 25000 mw/cm 2 of radiant energy. Elimination of heat by dich­roic reflectors (cold mirrors) with heat absorbing re­flectors or filters should be available along with the luminaire. An auxiliary light for a second surgical site is often beneficial UPS of adequate capacity to be installed after con­sidering OT light, anaesthesia machine, monitors, cautery etc until the backup generator takes over In endoscopic OTs, a reduced lighting is sometimes recommended. A grazing light over the floor can be helpful. Anaesthesia equipment and monitoring needs. At least one anaesthesiologist should be in the team involved in planning an OT. It is imperative that certain mandatory considerations with respect to the anaesthetic equipment and monitors be planned during the planning and design stage itself. Personal, practice and cost preferences may influence the plans. Communications Telephones, intercom and code warning signals are desirable inside the OT. One phone per OT and one exclu­sively for use of anaesthesia personnel is desirable. Inter­com to connect to control desk, pathology and other OTs as well as use of paging receivers (bleeps) is also ideal. A code signal, when activated, signals an emergency state such as cardiac arrest or need for immediate assistance.

MEDICAL TOURISM BENEFITS

Unbeatable Success Story of Medical Tourism Industry in India

• 18 Sep 2017
• admin

A huge number of patients visit India every year to seek high-quality medical and surgical treatment services. Medical tourism in India is popular for a variety of procedures, especially the ones related to the cosmetic, orthopedic, cardiac, neurology, and organ transplant surgery. The medical tourism industry in India is currently growing at an immense rate. According to a medical tourism report for the year 2015, more than 2,000,000 p

Top 5 Tourism Benefits Every Patient Should Consider

• 12 Dec 2016
• admin

The tourism benefits are huge for Westerners in many developing countries. Many people receive treatment each year for a much lower cost than they could pay in their own home countries, and with international travel being pretty much hassle-free, it’s a great deal. More and more JCI accredited international hospitals and centers are popping up all over the world, making it much easier to find quality healthcare a

MEDICAL TOURISM BENEFITS

Top 15 Hospitals In India Best Known For Tourism

Top 15 Hospitals In India Best Known For Tourism

India’s Booming Medical Tourism:

As healthcare prices rise in developed countries, more and more people from all around the world are looking for alternatives to affordable healthcare. This search for cheaper healthcare is driving people to the developing countries in order to seek affordable treatment. Currently, India is one of the leaders in this medical tourism boom. Medical tourism in India is currently about a $3 billion industry annually, and it is said that the entire medical tourism industry in India could reach $7-8 billion by 2020.

There are many factors besides increasingly expensive healthcare that is driving the entire medical travel industry in India. Constantly improving infrastructure in developing countries is helping them handle the medical tourism industry boom. Most tourists are from African, Asian, and Middle Eastern countries, but tourists are coming from more and more parts of the world to receive first-class treatment at a more affordable cost.

Below is a discussion of the top 15 medical tourist hospitals in India. The facilities listed below accept a large majority of the international tourists that flock to India each year as medical tourists. These facilities are considered as “cutting edge” and sophisticated as many medical centers and hospitals in Western countries are today, yet healthcare here is provided at a much more affordable cost. People can save between 30-70% on what they would pay in Western countries where costs for healthcare has ballooned to new heights in recent years, and its believed that it will continue to rise in the future.

Top 15 Medical Tourist Hospitals:

1) FORTIS LA FEMME, GREATER KAILASH – NEW DELHI

Fortis La Femme offers a wide variety of services in India’s capital of New Delhi. New Delhi is a town of about 302,000 people supporting some of the leading hospitals in India, servicing international visitors, as well as India’s own population of over 1.25 billion people, which alone is around 1/6 of the world’s entire population.

Fortis La Femme Hospital provides a wide variety of medical procedures from bariatric procedures to neurosurgical procedures, and virtually anything in between. A large, international hospital like Fortis La Femme meets most of the needs that foreigners traveling here would have in regards to medical care. It’s modern, state-of-the-art facility complete with options to keep other guests comfortable such as gift shops, cafeterias, and places to stay while their loved one undergoes treatment make it a prime tourist attraction within the capital city of New Delhi.

The hospital also has international travel agencies to help aid international travelers coming to the hospital for treatment. Everything from currency exchanges to finding airfares hotels or transportation to and from the airport are services offered to the international guest. Help providing meals and other needs upon arrival are available as well.

The international visitor’s page on the website provides extra information to assure you that you will have an excellent travel and hospitality experience from the moment you arrive. It also assures that there are accommodations for people traveling with the patient, and reassures that nothing but hospitality and premiere customer service await you and your family upon arrival.

Specialties: Fetal Medicine, Internal Medicine, Pediatrics, Anesthesia, Endocrinology, Plastic/Cosmetic Surgery, Mental Health, Gynecology, Clinical Nutrition & Bariatric Surgeries.

2) FORTIS ESCORTS HEART INSTITUTE (FEHI) – NEW DELHI

Also located in the capital city of New Delhi, FEHI specializes in cardiovascular care as the name suggests. FEHI offers major operations like heart transplants and open-heart surgeries as well. FEHI is a complete cardiology care center for all procedures and surgeries, and attracts many international patients and locals seeking treatment each year. FEHI is consistently ranked as one of the top heart centers in all of India at which anyone (including internationals patients.

Specialties: Cardiology, Cardiac Surgery, Pediatric/Fetal Cardiology, Heart Transplants, Bone/Joint Health, Liver/Digestive Issues & Urology.

3) ROCKLAND HOSPITAL – NEW DELHI

Yet another prime healthcare facility located in India’s capital of New Delhi, Rockland Hospital is one of the premiere private medical facilities in India. Rockland provides many specialties and procedures including anything from Cosmetic Surgeries to ENT/cochlear implant procedures. The hospital currently has 3 locations open for business, and those are in Manesar, Qutab, and Dwarka. A 4th location is under construction at Noida and is set to open in the near future. Each location has its own specialties, and among all the 3 locations most specialties are covered.

Specialties: Oncology, Cardiac Science, Neuroscience, Gastroenterology, Renal Sciences, Bariatric Surgery, Internal Medicine, Dental Procedures, Dietetics/Physiotherapy, ENT/Cochlear Implants & Plastic Surgery.

4) BLK SUPER SPECIALTY HOSPITAL – NEW DELHI

Also located in India’s capital city of New Delhi, BLK Super Specialty Hospital is a 650-bed facility providing a wide variety of services to people of all ages. BLK Super Specialty Hospital boasts one of the largest critical care programs in the region providing 125 beds to ICU care. BLK Super Specialty Hospital offers all services patients need right on site including a blood bank, CT scans, MRI labs, testing laboratory surgery facilities, MRIs, and X-Rays just to name a few services offered. Complete patient services are offered 24/7.

Specialties: Cancer Treatments, Neurosciences, Digestive/Liver Diseases, Kidney Transplants, Plastic/Cosmetic Surgeries, Pediatrics, Psychiatry & Rheumatology

5) PRIMUS SUPER SPECIALTY HOSPITAL – NEW DELHI

Primus Super Specialty Hospital is committed serving those who need care from across India, but from across the world. There is a strong desire within the Primus Super Specialty Hospital to uplift series of social issues affecting the world as a whole. Specialties in orthopedics, brain procedures, spinal surgeries, gastroenterology, cochlear implants, nephrology, and many other high staked procedures are offered.

Primus Super Specialty Hospital also boasts a notoriously low infection and illness rates among patients in their care. Complex procedures such as organ transplants and brain surgeries are common, and they specialize in dialysis as well. Primus Super Specialty Hospital also offers premiere 24-hour emergency ambulance and pharmacy services on site as well. Primus Super Specialty Hospitals welcomes all international patients need various treatments as well.

Specialties: Orthopedics, Spinal Procedures, Neurology/Neurosurgery, ENT/Cochlear Implants, Urology, Kidney Transplants, Cardiology, Reconstructive Surgeries, GI/Bariatric Surgeries, Dermatology & Oncology.

Get A Personalized Treatment Plan & Quote For YouCLICK HERE

6) COLUMBIA ASIA REFERRAL HOSPITAL – YESHWANTHPUR

Columbia Asia Referral Hospitals offer locations in several Indian cities including Bangalore, Kolkata, Maharashtra, Gujarat, Gurgaon, Uttar, Pradesh, and Punjab. The Yeshwanthpur location specifically opened in 2008, and is a comprehensive facility that is consistently considered one of the best hospitals in India.

Columbia Asia Referral Hospital offers services to meet the major needs of most patients including man life-saving treatments. The hospital follows internationally-set benchmarks and standards for care excellence. Columbia Asia Referral Hospital is a preferred destination for patients from across India, and also around the world. Columbia Asia Referral Hospital also offers complete rehabilitation therapy including physiotherapy, occupational, speech, swallowing, voice, and neuropsychological therapies. In addition, 24 hours trauma and sepsis care alonf with cardiac and emergency care are provided.

Specialties: Anesthesiology, Bariatric Surgery, Cardiology, Critical Care Medicine, Dermatology, ENT, Gastroenterology, Neonatal Care, Nephrology, Neurology, Nutrition/Dietetics, Obstetrics/Gynecology, Opthomology, Joint Replacements, Pediatrics, Psychiatry, Oncology & Urology.

7) APOLLO HOSPITALS – BANGALORE

Apollo Hospitals (Bangalore) offers a wide variety of various cutting-edge specialty services in various fields to meet many medical needs. Apollo Hospital, Bangalore welcomes international patients from all over the globe. This hospital also has international representatives to help people arrange medical vacations. This provides international patients with cheaper care than they can receive in their home countries.

Apollo Hospitals provide a full spectrum of healthcare services, including some unique procedures such as procedures done by the Renaissance Robotical Surgical Systems and the Vinci Robotical Surgical Systems that perform minimally invasive procedures with this new breakthrough technology. Apollo Hospitals also offer a full spectrum of care in cancer care as well as for transplant procedures and critical care.

Specialties: ENT, Oncology, Neonatology, Advanced Pediatrics, Fertility Clinics, Gynecology, Bariatric Surgeries, Urology, Renal care, Mental Health, Gastroenterology, Hematology, Rheumatology, Cosmetology, Dermatology, Nuclear Medicine, Transplants & Peripheral Nerve Damage.

8) FORTIS HOSPITAL – CUNNINGHAM ROAD – BANGALORE

Fortis Hospital of Cunningham Road – Bangalore currently ranks #2 in the TopMastersInHealthCare.com search for the best hospitals in India, as well as around the world. Fortis Hospital treats about 10,000 patients annually at over 50 of its medical facilities in India. Fortis Hospital offers specialties in a variety of areas at their various facilities to offer premiere care to many patients as possible.

Fortis Hospital also provides assistance to international patients to help organize their travel to India for their medical treatments. This ensures that travelers have a positive experience while receiving medical care abroad, and are treated with great hospitality upon their arrival. Fortis Hospital also offers some healthcare programs to help cover costs for people who need life-saving procedures that may not have insurance or the financial means to pay for the total cost of healthcare abroad. They also help resolve any tie-ups with insurances people may have that they need to clear before receiving treatment.

Specialties: Anesthesiology, Cardiology, Nutrition/Dietetics, Dental Surgeries, Dermatology, Diabetes/Metabolic Disorders, ENT, Endocrinology, Gastrointerology, Internal Medicine, Nephrology, Neurology, Neurosurgeries, Oncology, Opthalmology, Organ Transplants, Sports Medicine & Urology.

9) NARAYANA INSTITUTE OF CARDIAC SCIENCES (NICS) – BANGALORE

The Narayana Institute Of Cardiac Sciences (NICS) provides care at over 15 locations throughout India, including a location in Bangalore. NICS specializes in a wide variety of different specialties, and will meet the needs of many international patients as well as the needs of many people from all across India. Key procedures that international patients come to NICS to receive include stem cell therapies with more than 600 procedures successfully performed to date. Other procedures include organ transplants and joint replacements.

NICS offers specialists at each specialized location who are experts in various areas of medicine. Among all the locations the right professionals and services that you are seeking as a medical tourist are likely available at one or more of the NICS locations across India. There are professionals standing by ready to help you plan your visit, choose the proper procedures for your needs, and decide which location is best for you to visit to meet your personal needs.

Specialties: Critical Care, Cardiac Surgeries, Cardiology, Clinical Nutrition/Dietetics, Dental Sciences, Dermatology, Cosmetology, ENT, Endocrinology, Gastroenterology, Genetics, Geriatrics, Internal Medicines, Nephrology, Orthopedics, Pediatrics, Pathology, Plastic Surgery, Reproductive Medicine, Spinal Procedures, Transplants & Urology.

10) GLOBAL HOSPITALS – CHENNAI

Global Hospitals have over 22 hospitals throughout Asia combining for over 4,000 available beds in total. The Global Hospitals group contains over 13 different disciplines throughout their hospitals, and is considered as one of the best hospitals in Asia. It is often compared to being on par with many top hospitals in the Western World.

Global Hospital, Chennai specifically specializes in things like bariatric surgery, cardiology, dermatology, heart transplants, endocrinology, sports medicine, breast oncology, vascular surgeries, dentistry, ENT, gynecology, hematology, and interventional radiation. Chennai offers personalized healthcare plans for each international patient to help plan the trip they need to be able to afford quality healthcare.

Specialties: Anesthesiology, Bariatric Surgery, Cardiology, Critical Care, Dermatology, Endocrinology, Heart Transplants, HPB/Liver Procedures, Breast Oncology, Dentistry, Gynecology, ENT & Hepatology.

Get A Personalized Treatment Plan & Quote For YouCLICK HERE

11) SRI RAMACHANDRA MEDICAL CENTRE (SRMC) – CHENNAI

Sri Ramachandra Medical Centre (SRMC) is considered as a “temple for a cure” where 800 beds and 200 ICU beds provide a top-quality healthcare experience for patients from across India, as well as around the world. SRMC is one of the most recommended hospitals in all of Southern India, offering procedures in everything from Gastroenterology to Neurology or Organ Transplants to name a few. This multi-specialty hospital also provides special locations for women and children hospitals as well. All locations provide in-patient and out-patient services to meet a wide variety of medical needs.

SRMC also provides both private and shared rooms to help meet people’s needs and preferences, as well as the needs of those on different budgets. SRMC states that it is their goal to help provide care to patients on all various budgets. All needed services are offered under one roof including anything from neurosurgeries or transplants as well as other life-saving procedures. All locations welcome international patients to provide quality healthcare by committed professionals at an affordable cost to the patient.

Specialties: Cardiac Medicine, Endocrinology, Gastroenterology, Pediatrics, Rheumatology, Organ Transplants, Nephrology, Neurology, Psychiatry, Reproductive Medicine, Sports Medicine, ENT, Cosmetology, Urology, Gastroenterology & Gynecology.

12) APOLLO GLENEAGLES HOSPITALS – CHENNAI

Apollo Gleneagles Hospitals are situated in more than 15 locations all over India, including a premiere location in Chennai. Apollo Gleneagles Hospitals includes locations specializing in both children’s and women’s health as well. International patients are welcome to receive treatment at any Apollo Gleneagles Hospital across India, including the location at Chennai.

Medical experts await to help provide quality care to international patients including heart procedures, orthopedics, spine procedures, neurosurgeries, gastroenterology procedures, cancer treatments, organ transplants, robotically-performed surgeries, bariatric procedures, colorectal procedures, and preventative medicine.

Specialties: Cardiology, Nephrology, Pediatrics, Orthopedics, Spinal Procedures, Cosmetology, Oncology, Colorectal Surgeries, Gastroenterology, Transplants, Bariatric Surgeries & Pediatrics.

13) AKSHAYA APOLLO HOSPITAL – AHMEDABAD

Akshaya Apollo Hospital (Ahmedabad) is the heart at the heart of the Gujarat campus, which is a world class facility with 276 beds with the capacity to expand upto 400 beds in the future. The Ahmedabad location provides over 35 clinical specialties under one roof, including 85 ICU beds as well. Ahmedabad location has performed over 150 successful solid organ transplants to date, and is the only CDC certified center for Immigrant Health Checks in Gujarat.

Ahmedabad location provides full services to international medical tourists including money/currency exchanges, internet access, language interpreters, transportations from airports to the facilities, banking/ATM access, and sightseeing tours for those accompanying patients on their visits.

Specialties: Anesthesiology, Bariatric Surgeries, Cardiology, ENT, Gastroenterology, Dermatology, Neurosurgery, Nephrology, Pediatrics, Renal Transplants, Organ Transplants & Urology.

14) FORTIS HOSPITALS – MOHALI

Mohali is the prime location offered through Fortis Healthcare Limited, along with around 15 other locations across India with over 10,000 beds available, and 314 diagnostic centers available as well. The massive part of the Fortis Healthcare Limited Institute (FMRI) being situated in Mohali, this beautiful city ranks #2 worldwide by TopMatstersInHealthcare.com for specialties in virtually every single area of healthcare.

Most international patients come to Fortis Hospitals at Mohali to seek treatments including cardiac surgeries, as their results are one of the best success rates in the world. Westerners also come seeking for bypass surgeries and transplants.

Specialties: Anesthesiology, Bariatric Surgeries, Cardiology, Dental Procedures, Dermatology, Metabolic Disorders Treatments, ENT, Organ Transplants, Joint Replacements, Endocrinology, Gastroenterology, Neonatology, Neonatology, Cosmetic Surgery, Psychiatry & Urology.

15) FORTIS HOSPITALS – AMRITSAR

Amritsar is another location brought to you by Fortis Healthcare Limited provides over 50 locations across India with over 10,000 beds available, and 314 diagnostic centers available as well. Fortis Healthcare, Amritsar is a 154-bed facility that specializes in cardiac sciences. Opened in 2003 the Amritsar location offers 20 specialties of medical care in various healthcare disciplines as well 56 ICU beds all under one roof.

Amritsar also provides international patients the opportunity to inquire about facilities and find a doctor for treatment online before even traveling for a procedure. Most international patients come to Amritsar seeking cardiac treatments, which is their specialty.

Specialties: Anesthesiology, Bariatric Surgeries, Cardiology, Dental Procedures, Dermatology, Metabolic Disorders Treatments, ENT, Organ Transplants, Joint Replacements, Endocrinology, Gastroenterology, Neonatology, Neonatology, Cosmetic Surgery, Psychiatry & Urology

IN A NUTSHELL:

With all of the excellent hospitals and medical centers in India, it’s clear to see why people choose India as a premiere location to travel to receive medical treatment outside of their home countries. With healthcare being more affordable as well, India is now touted to have a great medical tourism industry, which also provides lucrative incomes for many Indian workers, as well as a great money-saver for those foreigners seeking various treatments that they can simply not afford in their home country. This is how the medical tourism industry is taking off in India, and will continue to soar into the future!