সেবার মানের দৃশ্যমান উন্নয়ন সাধনের স্বীকৃতিস্বরুপ বিভিন্ন সরকারী হাসপাতাল ও স্বাস্থ্য ব্যবস্থাপকের অফিস পেলো স্বাস্থ্যমন্ত্রী জাতীয় পুরস্কার ২০১৮

Background

The Management Information System (MIS) unit of the Directorate General of Health Services (DGHS) has launched a performance management initiative for improvement of health services in the public health sector. The Government of Bangladesh has taken the initiative to measure performance, to rank and to reward the different tiers of health facilities since 2014. The World Health Organization (WHO) has been providing technical assistance in the conceptualization and development of the initiative which are aligned with the health systems building blocks and the results chain analytical frameworks. An online system for measurement and scoring is now accessible to all through a real time dashboard. Different partners such as UNICEF, icddr,b and Health Information System Program (HiSP) Bangladesh have been supporting the initiative along with WHO.

The initiative is being supported by WHO Country Office in Bangladesh under the biennium 2018-2019 under the Health System Strengthening program, which follows the principles of 6 health systems building blocks of WHO, viz., (i) health services; (ii) supplies of medicines, equipment, and technologies; (iii) health workforce; (iv) health financing; (v) health information system; and (vi) leadership and governance.

The incentive to the participating hospitals was the Health Minister National Award to be accorded to the best performing hospitals and health managers. Certain areas, which commonly do not require external interventions, have been chosen for making visible change. These areas include cleanliness, staff punctuality, placement of appropriate display boards and patient guidance signs, good behavior with patients, improving laboratory services, waste management, reducing weighting time at the outpatient department, improvement of overall hospital service, updating data in the online reporting systems, holding monthly staff meeting and follow-up of the decisions made in the past meetings, etc. The Health Minister National Award was first introduced in 2014 under WHO biennium 2013-2014. This report is on this ranking of the government hospitals for 2017.

Procedure of hospital ranking for 2017

A total of 68 public health facilities were nominated both physical assessment and patient satisfaction survey out of 511 public health facilities in the country which was carried out to see the actual situation and validation of data.

Out of 68, 44 Upazila health complex (UHC), 17 district hospital (DH), three medical college hospital (MCH) one specialty post-graduate institute & hospital (SpH) have been short listed on the basis 60% score out of 100 (aggregated scores of on-line and onsite). No district hospital was short listed due to attain minimum 60% score of (combined score of online and onsite). 34 assessors (Government officials from different departments, such as, MIS; Medical Education; and Hospital & Clinics; Community based health services; officers from respective divisional health offices and development partners and WHO) during the month of November and December 2017.

In physical verification visits, assessors checked and verified 243 indicators for UHC, 260 indicators for DH, 265 indicators for medical college hospital (MCH), and 244 indicators for specialty post-graduate institute & hospital (SpH). Separate patient satisfaction survey on outdoor and indoor patients was also done. The physical verifications were “joint assessments” between the external evaluators and local authorities and supervisors; the evaluation sheets have been countersigned by the local and supervising authorities on both the completed checklists and survey questionnaires.

HSS core committee

A meeting was held on 05-Feb-2018 at the MIS resource center, DGHS. Director, MIS Dr Ashish Kumar Saha was the chair of the meeting. The preliminary results of Health Minister’s National Award 2017 result was presented to the meeting including the description of shortlisting and compilation of the final score according the category of awards. The members of the committee reviewed the total process of scoring mechanism and the list of health facilities in each category. The members recommended the result as acceptable and finally endorsed it.

A. Result 2017 (National Award)

Table 1. Category of award: Upazila Health Complex (Top 5)

Facility name	District	Division	Total Score	Facility score (100)	PAT (150)	PST (50)	Rank
Chowgacha Upazila Health Complex	Jessor	Khulna	240.51	69.45	146.30	24.76	1
Keshabpur Upazila Health Complex	Jessor	Khulna	240.38	68.46	146.91	25.00	2
Wazirpur Upazila Health Complex	Barisal	Barisal	232.90	66.68	140.74	25.48	3
Iswardi Upazila Health Complex	Pabna	Rajshahi	229.18	65.08	139.81	24.29	4
Kumarkhali Upazila Health Complex	Kustia	Khulna	227.57	65.96	138.27	23.33	5

Table 2. Category of award: District Hospital (Top 5)

Facility name	District	Division	Total Score	Facility score (100)	PAT (150)	PST (50)	Rank
Narsingdi 100 bed district hospital	Narsingdi	Dhaka	236.39	63.94	147.69	24.76	1
Narsingdi district hospital	Narsingdi	Dhaka	235.51	66.41	144.81	24.29	2
250 beded general hospital	Jessore	Khulna	230.11	67.99	137.60	24.52	3
Pabna 250 bed general hospital	Pabna	Rajshahi	228.04	63.61	139.90	24.52	4
Kurigram district hospital	Kurigram	Rangpur	226.18	62.75	139.62	23.81	5

Table 3. Category of award: Medical College Hospital (Top 3)

Facility name	Division	District	Total Score	Facility score (100)	PAT (150)	PST (50)	Rank
Shaheed Suhrawardy Medical College Hospital	Dhaka	Dhaka	220.97	60.00	138.11	22.86	1
M Abdur Rahim Medical College Hospital	Rangpur	Dinajpur	211.53	61.99	126.51	23.04	2
Dhaka Medical College Hospital	Dhaka	Dhaka	208.35	66.11	121.70	20.54	3

Table 4. Category of award: Specialty post graduate Institute hospital

Facility name	Division	District	Total Score	Facility score (100)	PAT (150)	PST (50)	Rank
National Institute of Neuroscience & Hospital	Dhaka	Dhaka	198.14	63.29	113.42	21.43	1

Table 5. Category of award: Community Health Services (Top 5)

Facility name	District	Division	Total Score	Rank
Amtali Upazila	Barguna	Barisal	91.68%	1
Bamna Upazila	Barguna	Barisal	91.45%	2
Monpura Upazila	Bhola	Barisal	90.57%	3
Wazirpur Upazila	Barisal	Barisal	89.46%	4
Ramgarh Upazila	Khagrachari	Chittagong	88.86%	5

B. Result 2017 (Divisional Award)

Table 6. Category of award: Upazila Health Complex

Facility name	District	Division	Total Score	Facility score (100)	PAT (150)	PST (50)	Rank
Lalmohan Upazila Health Complex	Bhola	Barisal	218.48	63.19	131.48	23.81	Champion
Banaripara Upazila Health Complex	Barisal	Barisal	209.36	61.14	123.46	24.76	Runner Up
Saharasti Upazila Health Complex	Chandpur	Chittagong	219.36	64.59	130.25	24.52	Champion
Patiya Upazila Health Complex	Chittagong	Chittagong	200.28	67.30	109.88	23.10	Runner Up
Sibpur Upazila Health Complex	Norsingdi	Dhaka	205.52	64.51	123.15	17.86	Champion
Dhamrai Upazila Health Complex	Dhaka	Dhaka	200.66	67.43	108.95	24.29	Runner Up
Kotchadpur Upazila Health Complex	Jhenaidah	Khulna	223.19	64.98	134.88	23.33	Champion
Shailkupa Upazila Health Complex	Jhenaidah	Khulna	221.54	64.02	133.95	23.57	Runner Up
Nandail Upazila Health Complex	Mymensingh	Mymensingh	213.69	67.26	125.00	21.43	Champion
Kazipur Upazila Health Complex	Sirajganj	Rajshahi	207.57	60.67	128.09	18.81	Champion

Table 7. Category of award: District Hospital (Divisional Champion)

Facility name	District	Division	Total Score	Facility score (100)	PAT (150)	PST (50)	Rank
Pirojpur District Hospital	Pirozpur	Barisal	225.82	69.72	130.38	25.71	Champion
Moulvibazar 250 bed district hospital	Moulavibazar	Sylhet	224.17	62.85	138.46	22.86	Champion
Lakshmipur District Hospital	Laxmipur	Chittagong	222.26	64.80	132.69	24.76	Champion
Jhenaidah District Hospital	Jhenaidah	Khulna	220.87	67.10	130.67	23.10	Champion
Panchagarh District Hospital	Panchagarh	Rangpur	206.04	66.36	120.87	18.81	Champion
Tangail District Hospital	Tangail	Dhaka	202.78	63.89	123.17	15.71	Champion

Table 8. Category of award: Community Health Services (Divisional Champion)

Facility name	District	Division	Total Score
Tarail Upazila	Kishoreganj	Dhaka	87.36%
Shyamnagar Upazila	Satkhira	Khulna	87.17%
Durgapur Upazila	Netrokona	Mymensingh	87.16%
Debiganj Upazila	Panchagharh	Rangpur	85.71%
Patharghata Upazila	Barguna	Barisal	85.03%
Biswambarpur Upazila	Sunamganj	Sylhet	84.95%
Kazipur Upazila	Sirajganj	Rajshahi	84.72%
Raipur Upazila	Lakshmipur	Chittagong	80.08%

Table 9. Category of award: Civil Surgeon Office (Top 5)

Office	District	Division	Total Score	Rank
Civil surgeon office	Jessore	Khulna	85.65	1
Civil surgeon office	Chuadanga	Khulna	84.48	2
Civil surgeon office	Panchagarh	Rangpur	82.21	3
Civil surgeon office	Jhenaidah	Khulna	81.64	4
Civil surgeon office	Narsingdi	Dhaka	79.51	5

Table 10. Category of award: Divisional Health Office (Champion and Runner up)

Office	Division	Total Score	Rank
Divisional health office	Khulna	73.51	1
Divisional health office	Rajshahi	68.17	2

Performance measurement

Health system is a set of interconnected parts that must function synergistically broadly to secure more equitable and sustained improvement across health services and better health outcome. The initiative, through the cycle of assessment and measurement and finally rewarding, was an attempt to effectively managing and strengthening interactions of six health system building blocks (WHO’s health system framework); and ultimately promote improved health, responsiveness, social and financial risk protect and improved efficiency. The tools for physical verification used to measure how much the facility is ready to deliver required services safely with quality and with minimum waste of resources; what are the drivers of good performance and where is the weakness to develop health workforce and other key resources; mobilize and allocate finances, and ensure leadership and governance. The conducted patient exit survey has documented the extent of the health facility service meeting the expectation of the population.

The full mark for evaluation was 300. This was divided into four components -

Table 11.

Tools of measurement	Scores	Percentage
Online	80	26.70
Onsite monitoring	20	06.70
Physical assessment tool (PAT)	150	50.00
Patient satisfaction tool (PST)	50	16.60
Total	300	100.00

Ranking and awards for 2017

Three categories of awards proposed: a) national and divisional award for top ranking or best health facility b) national awards and divisional awards for top ranking community health services c) national awards for top ranking civils surgeon and divisional office.

The facility awards have been calculated upon aggregation of the scores across all four tools. For community health service one year data from community clinics and field were collected from DHIS2 and average score was calculated. Civil surgeon office data has been be estimated from the average scores of online, onsite and community health service of duration of 12 month for the facilities under his jurisdiction. Similar estimation has been done for divisional office.

A total of 50 awards and certificates have been proposed according to the top scores in national and divisional category. The awards for community health services have been proposed for national and divisional category. The best civil surgeon office and divisional office and top tertiary hospital and specialized post graduate institute have been proposed for national award.

Table 11. National awards

Health facility	Number of awards
Top three medical college hospital (MCH)	03
Top one specialty post-graduate institute & hospital (SpH)	01
Top five district hospital (DH)	05
Top five upazila health complex (UHC)	05
Community health service (CHS)	05
Divisional health office (DHO)	02
Civil surgeon office (CSO)	05

Table 12. Divisional awards

Health facility	Number of awards
Top eight district hospital (DH)- one from each division	08
Top 16 upazila health complexes (UHC)- two per division	16

Based on the final score, the ranking of all the physically verified hospitals in each category has been made. The ranking for year 2017 has been made as follows:

Name of short-listed facilities

Division	District	Code	Type	Name of facility
Barisal	Barisal	10001966	UHC	Banaripara Upazila Health Complex
Barisal	Barisal	10001997	UHC	Wazirpur Upazila Health Complex
Barisal	Bhola	10002002	DH	Bhola District Hospital
Barisal	Bhola	10002006	UHC	Charfession Upazila Health Complex
Barisal	Bhola	10002015	UHC	Lalmohan Upazila Health Complex
Barisal	Pirojpur	10002067	DH	Pirojpur District Hospital
Chittagong	Chandpur	10000727	UHC	Saharasthi Upazila Health Complex
Chittagong	Chittagong	10000740	UHC	Boalkhali Upazila Health Complex
Chittagong	Chittagong	10000756	MCH	Chittagong Medical College Hospital
Chittagong	Chittagong	10000802	UHC	Patiya Upazila Health Complex
Chittagong	Comilla	10000875	UHC	Daudkandi Upazila Health Complex
Chittagong	Comilla	10000914	UHC	Titas Upazila Health Complex
Chittagong	Lakshmipur	10001001	DH	Lakshmipur District Hospital
Dhaka	Dhaka	10000033	MCH	Dhaka Medical College Hospital
Dhaka	Dhaka	10000064	UHC	Dhamrai Upazila Health Complex
Dhaka	Dhaka	10000069	UHC	Dohar Upazila Health Complex
Dhaka	Dhaka	10017210	SpH	National Institute of Neuro Sciences & Hospital
Dhaka	Dhaka	10000080	UHC	Nawabganj Upazila Health Complex
Dhaka	Gazipur	10000144	UHC	Kaliganj Upazila Health Complex
Dhaka	Kishorgonj	10000243	DH	Kishorganj 250 Bed District Sadar Hospital
Dhaka	Munshiganj	10000328	DH	Munshiganj District Hospital
Dhaka	Narsingdi	10000453	DH	Narsingdi 100 Bed Zilla Hospital
Dhaka	Narsingdi	10000452	DH	Narsingdi District Hospital
Dhaka	Narsingdi	10000461	UHC	Shibpur Upazila Health Complex
Dhaka	Rajbari	10000505	UHC	Baliakandi Upazila Health Complex
Dhaka	Rajbari	10000508	UHC	Goalanda Upazila Health Complex
Dhaka	Rajbari	10000518	UHC	Pangsha Upazila Health Complex
Dhaka	Rajbari	10000536	DH	Rajbari District Hospital
Dhaka	Tangail	10000647	DH	Tangail 250 Bed District Hospital
Khulna	Bagerhat	10001701	UHC	Fakirhat Upazila Health Complex
Khulna	Chuadanga	10001719	UHC	Alamdanga Upazila Health Complex
Khulna	Chuadanga	10001723	DH	Chuadanga District Hospital
Khulna	Jessore	10001737	UHC	Abhoynagar Upazila Health Complex
Khulna	Jessore	10001741	UHC	Bagherpara Upazila Health Complex
Khulna	Jessore	10001744	UHC	Chowgacha Upazila Health Complex
Khulna	Jessore	10013096	DH	Jessore 250 bed General Hospital
Khulna	Jessore	10001759	UHC	Jhikargacha Upazila Health Complex
Khulna	Jessore	10001760	UHC	Keshabpur Upazila Health Complex
Khulna	Jessore	10001763	UHC	Monirampur Upazila Health Complex
Khulna	Jhenaidah	10001771	UHC	Harinakunda Upazila Health Complex
Khulna	Jhenaidah	10001776	DH	Jhenaidah District Hospital
Khulna	Jhenaidah	10002213	UHC	Kaliganj Upazila Health Complex
Khulna	Jhenaidah	10001780	UHC	Kotchandpur Upazila Health Complex
Khulna	Jhenaidah	10001785	UHC	Moheshpur Upazila Health Complex
Khulna	Jhenaidah	10001790	UHC	Shailkupa Upazila Health Complex
Khulna	Khulna	10001824	UHC	Paikgacha Upazila Health Complex
Khulna	Kushtia	10001848	UHC	Kumarkhali Upazila Health Complex
Khulna	Satkhira	10001928	UHC	Shyamnagar Upazila Health Complex
Mymensingh	Mymensingh	10000404	UHC	Nandail Upazila Health Complex
Rajshahi	Bogra	10001111	MCH	Shaheed Ziaur Rahman Medical College Hospital
Rajshahi	Joypurhat	10001289	UHC	Akkelpur Upazila Health Complex
Rajshahi	Joypurhat	10001303	UHC	Khetlal Upazila Health Complex
Rajshahi	Naogaon	10001394	DH	Naogaon District Hospital
Rajshahi	Naogaon	10001402	UHC	Patnitala Upazila Health Complex
Rajshahi	Pabna	10001482	UHC	Iswardi Upazila Health Complex
Rajshahi	Pabna	10001484	DH	Pabna 250 bed General Hospital
Rajshahi	Sirajganj	10001624	UHC	Belkuchi Upazila Health Complex
Rajshahi	Sirajganj	10001633	UHC	Kazipur Upazila Health Complex
Rangpur	Dinajpur	10001193	UHC	Birganj Upazila Health Complex
Rangpur	Dinajpur	10001224	UHC	Ghoraghat Upazila Health Complex
Rangpur	Dinajpur	10002288	MCH	M Abdur Rahim Medical College Hospital
Rangpur	Kurigram	10001317	DH	Kurigram District Hospital
Rangpur	Panchagarh	10001506	UHC	Debiganj Upazila Health Complex
Rangpur	Panchagarh	10001514	DH	Panchagarh District Hospital
Sylhet	Maulvibazar	10002096	UHC	Barlekha Upazila Health Complex
Sylhet	Maulvibazar	10002116	DH	Moulvibazar 250 bed District Sadar Hospital
Sylhet	Sylhet	10002195	MCH	Sylhet MAG Osmani Medical College Hospital

*Individual facility score is above 200 (total score 300) for all except SpH. CHS, CSO and DHO have been calculated by taking one year average scores of online data + community health services report to UHC (ANC-1, exclusive breast feeding , BCG coverage , fully vaccinated child , % of CC reporting )

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