Evolution of Health Services Management

Evolution of Health Services Management

• Mesopotamia — Health Services as an ordered form first materialized in the olden part of South-West Asia. The first recorded prescription was made in this section of ancient Babylon.
• Greek Hospitals — Today Hippocrates is known as the father of modern medicine, who first used auscultation method to detect diseases and also performed different surgeries. Greeks realized the importance of coherent methods of treatment and started to study natural causes of disease.
• Indian Hospitals — during King Ashoka’s period India developed a splendid health care system. Their obstetrics specialty was superb in succession to save mother and child. There was one physician for every ten villages.
• Roman Hospitals — Organized by Romans surprisingly could not develop good health care system for general mass. Although they developed infirmaries for the sick slaves and proper hospitalization process was only for the military personnel.
• Arabian Hospitals — The development of efficient hospitals was an outstanding contribution by the Arabs, especially during the 7th century. During the time of Prophet (S), a real system of hospitals was developed. Some of the best known hospitals and Medical schools were in Baghdad, Damascus and in Cairo.
• Hospitals during the Renaissance — The Renaissance period lasted from the 14th to 16th century. Real health services management started its journey from this period.

Key medical achievements in development of people’s health

• The 17th Century — Invention of Microscope
• The 18th Century — Discovery of Vaccines
• The 19th Century — The four incredible discoveries

1. Bacteria as the cause of disease
2. Anaesthesia
3. Steam sterilization
4. The legacy of Florence Nightingale

History of Health Services Management in the Sub Continent

Having realized the need to develop the health care services, the British Indian authority made a committee in 1943, which was designated as ‘Health Survey and Development Committee’ headed by Sir Joseph Bhore. This was also known as ‘Bhore Committee’. This committee included doctors, civil surgeons, public health experts, engineers, lawyers and administrators. They reviewed the countries overall health services under-

1. Public Health
2. Medical Relief
3. Professional Education
4. Medical Research and
5. International Health.

The first ‘All Pakistan Health Conference’, which was held in 1947, adopted the ‘Bhore Committee’ Report and its recommendations as the basis of planning and development of Health Services Administration.
Bangladesh health care sector started its intrinsic expedition with insignificant health facilities in terms of human resources and hospitals/health centres at the dawn of independence (1971).
For a long time, shortage of doctors and hospitals has been the key words in our health service. The country now has over 33,000 registered doctors — whereas the number of physicians in 1972 was 731 at the 120 hospitals.
By 1986, Bangladesh had about 16.000 physicians and eventually managed expansion of health care facilities through a cross-country network.
There were around 9,000 beds in 1971 most if not all in the government domain. At present the number of hospital beds has risen to more than 50,000 in government and about 52,000 in private hospitals & clinics. Reduction of fertility rate and childhood mortality remains a couple of success stories, however especially in the villages- much remains to be done.
The existing health care system fails in many ways due to lack of proper accountability and client confidence in it. Bangladesh is certainly not poor in human resources, however it remains poor in professional health services management.

Keystones in the history and development of hospitals

• Considered to be beginning of modern health care services management.
• Thoughts and plans of Florence Nightingale is one of the greatest contributions to the evolution of modern hospitals. She introduced professional nursing services. Eventually this provided empathetic medical treatment and emphasized a hygienic environment. It was a giant step in the history of improved health services management. During the Crimean war Nightingale properly organized support services in an English hospital. They were — (a) Laundry services, (b) Kitchens and (c) Central supply department and it is amazing that in 10 days she reduced the death rate from 38% to only 2%. Being a modernizer she realized the importance of infection control and nursing care. Her capacity in administration was also notable in the expansion of the processes required for successful health services management.
• In due course, advances in Human service management skills became a part of the increasing development of modern health care delivery system.
• At present, the “technological” era of the computer age has also played a major part in reshaping the face of modern medical practice and care delivery.
• In the last two decades rapid and major advances have been made in the field of improved investigation techniques and processes including Imaging with CT and MRI scanning capacities, Nuclear medicine to non-invasive treatment - all contributing to heightened and quickened understanding of disease and its measurement.
• Laboratory facilities likewise have rapidly developed with multi field scanners etc and last but certainly not least the introduction of the “Robot to replace the Human” in robotic and minimally invasive surgery.
• The human is still needed however to be better skilled in the use of the technologies now and increasingly becoming available.
• The ability to transfer electronic data including images across continents has revolutionized the capacity of local environments to benefit from the world expertise in diagnosis and treatment protocols.
• Educational development of nursing and paramedical staff role definition and support to 'THE DOCTOR' has also been a qualitative leap for mankind in the 21st Century.
• It is no longer a rarity for university graduated Paramedical and nursing personnel taking their place in the team approach to care.
• Likewise the development of hospital management programs and syllabi has brought a major new welcome dimension to the effective and efficient management of health care services and in particular hospitals.